ST MARY'S HOSPITAL - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hopsital_Cdm_Chg , Self_Pay_Chg , Minimum_Negotiated_Chg , Maximum_Negotiated_Chg , 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 , 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 , UNITY HOSPICE , WEA INSURANCE CORPORATION , WEA INSURANCE CORPORATION                         1 , WEA INSURANCE CORPORATION                         2 , WEA TRUST PPP/TRUST PREFERRED , WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION 
ST MARY'S HOSPITAL,N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$30,258.85 ","$3,210.12 ","$64,130.00 ","$3,210.12 ","$60,517.70 ","$60,517.70 ","$64,130.00 ","$60,517.70 ","$51,440.05 ","$42,362.39 ","$34,953.77 ","$57,491.82 ","$43,572.74 ","$44,177.92 ","$60,517.70 ","$51,440.05 ","$64,130.00 ","$60,517.70 ","$51,440.05 ","$44,177.92 ","$3,210.12 ","$64,130.00 ","$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 ","$43,572.74 ","$42,150.58 ","$63,475.87 ","$43,572.74 ","$3,581.81 ","$60,517.70 ","$60,517.70 ","$62,847.40 ","$60,517.70 ","$7,500.00 ","$43,572.74 ","$37,520.97 ","$43,572.74 ","$43,572.74 ","$60,517.70 "
ST MARY'S HOSPITAL,N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$7,652.85 ","$1,000.00 ","$16,872.15 ","$3,210.12 ","$15,305.70 ","$15,305.70 ","$16,705.10 ","$15,305.70 ","$13,009.85 ","$10,713.99 ","$7,834.25 ","$14,540.42 ","$11,020.10 ","$11,173.16 ","$15,305.70 ","$13,009.85 ","$16,705.10 ","$15,305.70 ","$13,009.85 ","$11,173.16 ","$3,210.12 ","$16,705.10 ","$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 ","$11,020.10 ","$10,660.42 ","$16,872.15 ","$11,020.10 ","$3,581.81 ","$15,305.70 ","$15,305.70 ","$16,705.10 ","$15,305.70 ","$1,000.00 ","$11,020.10 ","$9,489.53 ","$11,020.10 ","$11,020.10 ","$15,305.70 "
ST MARY'S HOSPITAL,N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$5,727.58 ","$1,000.00 ","$12,793.23 ","$3,210.12 ","$11,455.16 ","$11,455.16 ","$12,666.56 ","$11,455.16 ","$9,736.89 ","$8,018.61 ","$8,042.06 ","$10,882.40 ","$8,247.72 ","$8,362.27 ","$11,455.16 ","$9,736.89 ","$12,666.56 ","$11,455.16 ","$9,736.89 ","$8,362.27 ","$3,210.12 ","$12,666.56 ","$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 ","$8,247.72 ","$7,978.52 ","$12,793.23 ","$8,247.72 ","$3,581.81 ","$11,455.16 ","$11,455.16 ","$12,666.56 ","$11,455.16 ","$1,000.00 ","$8,247.72 ","$7,102.20 ","$8,247.72 ","$8,247.72 ","$11,455.16 "
ST MARY'S HOSPITAL,N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$11,847.29 ","$1,500.00 ","$25,504.91 ","$3,210.12 ","$23,694.57 ","$23,694.57 ","$25,504.91 ","$23,694.57 ","$20,140.38 ","$16,586.20 ","$13,696.31 ","$22,509.84 ","$17,060.09 ","$17,297.04 ","$23,694.57 ","$20,140.38 ","$25,504.91 ","$23,694.57 ","$20,140.38 ","$17,297.04 ","$3,210.12 ","$25,504.91 ","$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 ","$17,060.09 ","$16,503.27 ","$25,244.76 ","$17,060.09 ","$3,581.81 ","$23,694.57 ","$23,694.57 ","$24,994.81 ","$23,694.57 ","$1,500.00 ","$17,060.09 ","$14,690.63 ","$17,060.09 ","$17,060.09 ","$23,694.57 "
ST MARY'S HOSPITAL,N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$3,414.31 ","$1,000.00 ","$7,891.76 ","$3,210.12 ","$6,828.61 ","$6,828.61 ","$7,813.62 ","$6,828.61 ","$5,804.32 ","$4,780.03 ","$4,242.62 ","$6,487.18 ","$4,916.60 ","$4,984.89 ","$6,828.61 ","$5,804.32 ","$7,813.62 ","$6,828.61 ","$5,804.32 ","$4,984.89 ","$3,210.12 ","$7,813.62 ","$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 ","$4,916.60 ","$4,756.13 ","$7,891.76 ","$4,916.60 ","$3,581.81 ","$6,828.61 ","$6,828.61 ","$7,813.62 ","$6,828.61 ","$1,000.00 ","$4,916.60 ","$4,233.74 ","$4,916.60 ","$4,916.60 ","$6,828.61 "
ST MARY'S HOSPITAL,12100001,N/A,HC DAILY SERVICE,121,1 ,"$1,532.00 ",$766.00 ,$766.00 ,"$1,532.00 ", Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ","$1,302.20 ","$1,072.40 ", Inpatient Medicaid ,"$1,455.40 ","$1,103.04 ","$1,118.36 ","$15,741.00 ","$1,302.20 ", Inpatient Medicare ,"$15,741.00 ","$1,302.20 ","$1,118.36 ", Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ","$1,302.20 ", Inpatient Medicare +100% ,"$1,409.44 ","$1,072.40 ","$10,190.82 ","$10,957.76 ",$932.99 ,"$10,190.82 ","$1,058.61 ","$1,103.04 ","$1,067.04 ", Inpatient Medicaid ,"$1,103.04 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,"$1,103.04 ",$949.84 ,"$1,103.04 ","$1,103.04 ","$16,452.63 "
ST MARY'S HOSPITAL,16900000,N/A,HC DAILY SERVICE PROLONGED STAY,169,1 ,$466.00 ,$233.00 ,$233.00 ,$466.00 , Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ",$396.10 ,$326.20 , Inpatient Medicaid ,$442.70 ,$335.52 ,$340.18 ,"$15,741.00 ",$396.10 , Inpatient Medicare ,"$15,741.00 ",$396.10 ,$340.18 , Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ",$396.10 , Inpatient Medicare +100% ,$428.72 ,$326.20 ,"$10,190.82 ","$10,957.76 ",$283.79 ,"$10,190.82 ",$322.01 ,$335.52 ,$324.57 , Inpatient Medicaid ,$335.52 , Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,$335.52 ,$288.92 ,$335.52 ,$335.52 ,"$16,452.63 "
ST MARY'S HOSPITAL,17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,"$1,190.00 ",$595.00 ,$595.00 ,"$1,190.00 ", Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ","$1,011.50 ",$833.00 , Inpatient Medicaid ,"$1,130.50 ",$856.80 ,$868.70 ,"$15,741.00 ","$1,011.50 ", Inpatient Medicare ,"$15,741.00 ","$1,011.50 ",$868.70 , Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ","$1,011.50 ", Inpatient Medicare +100% ,"$1,094.80 ",$833.00 ,"$10,190.82 ","$10,957.76 ",$724.71 ,"$10,190.82 ",$822.29 ,$856.80 ,$828.84 , Inpatient Medicaid ,$856.80 , Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,$856.80 ,$737.80 ,$856.80 ,$856.80 ,"$16,452.63 "
ST MARY'S HOSPITAL,17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$1,553.00 ",$776.50 ,$776.50 ,"$1,553.00 ", Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ","$1,320.05 ","$1,087.10 ", Inpatient Medicaid ,"$1,475.35 ","$1,118.16 ","$1,133.69 ","$15,741.00 ","$1,320.05 ", Inpatient Medicare ,"$15,741.00 ","$1,320.05 ","$1,133.69 ", Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ","$1,320.05 ", Inpatient Medicare +100% ,"$1,428.76 ","$1,087.10 ","$10,190.82 ","$10,957.76 ",$945.78 ,"$10,190.82 ","$1,073.12 ","$1,118.16 ","$1,081.66 ", Inpatient Medicaid ,"$1,118.16 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,"$1,118.16 ",$962.86 ,"$1,118.16 ","$1,118.16 ","$16,452.63 "
ST MARY'S HOSPITAL,17300002,N/A,HC DAILY INFANT SERVICE LEV 3,173,1 ,"$1,760.00 ",$880.00 ,$880.00 ,"$1,760.00 ", Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ","$1,496.00 ","$1,232.00 ", Inpatient Medicaid ,"$1,672.00 ","$1,267.20 ","$1,284.80 ","$15,741.00 ","$1,496.00 ", Inpatient Medicare ,"$15,741.00 ","$1,496.00 ","$1,284.80 ", Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ","$1,496.00 ", Inpatient Medicare +100% ,"$1,619.20 ","$1,232.00 ","$10,190.82 ","$10,957.76 ","$1,071.84 ","$10,190.82 ","$1,216.16 ","$1,267.20 ","$1,225.84 ", Inpatient Medicaid ,"$1,267.20 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,"$1,267.20 ","$1,091.20 ","$1,267.20 ","$1,267.20 ","$16,452.63 "
ST MARY'S HOSPITAL,20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$4,244.00 ","$2,122.00 ","$2,122.00 ","$4,244.00 ", Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ","$3,607.40 ","$2,970.80 ", Inpatient Medicaid ,"$4,031.80 ","$3,055.68 ","$3,098.12 ","$15,741.00 ","$3,607.40 ", Inpatient Medicare ,"$15,741.00 ","$3,607.40 ","$3,098.12 ", Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ","$3,607.40 ", Inpatient Medicare +100% ,"$3,904.48 ","$2,970.80 ","$10,190.82 ","$10,957.76 ","$2,584.60 ","$10,190.82 ","$2,932.60 ","$3,055.68 ","$2,955.95 ", Inpatient Medicaid ,"$3,055.68 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,"$3,055.68 ","$2,631.28 ","$3,055.68 ","$3,055.68 ","$16,452.63 "
ST MARY'S HOSPITAL,20600002,N/A,HC DAILY SERVICE IMCU,206,1 ,"$3,105.00 ","$1,552.50 ","$1,552.50 ","$3,105.00 ", Inpatient Medicaid ,"$18,207.00 ","$18,207.00 ", Inpatient Medicare ,"$15,711.03 ","$2,639.25 ","$2,173.50 ", Inpatient Medicaid ,"$2,949.75 ","$2,235.60 ","$2,266.65 ","$15,741.00 ","$2,639.25 ", Inpatient Medicare ,"$15,741.00 ","$2,639.25 ","$2,266.65 ", Inpatient Medicaid , Inpatient Medicare ,"$11,879.79 ","$2,639.25 ", Inpatient Medicare +100% ,"$2,856.60 ","$2,173.50 ","$10,190.82 ","$10,957.76 ","$1,890.95 ","$10,190.82 ","$2,145.56 ","$2,235.60 ","$2,162.63 ", Inpatient Medicaid ,"$2,235.60 ", Inpatient Medicaid +6% ,"$14,518.00 ","$14,518.00 ", Inpatient Medicare ,"$14,518.00 ",$500.00 ,"$2,235.60 ","$1,925.10 ","$2,235.60 ","$2,235.60 ","$16,452.63 "
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 , N/A ,$71.50 ,$93.50 ,$80.30 , N/A , N/A ,$46.20 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 , N/A ,$79.20 , N/A ,$66.00 ,$66.00 , N/A ,$66.00 , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,23300002,N/A,HC SURCHARGE IMCU/HR,233,1 ,$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 ,$46.80 ,$47.45 ,$42.25 ,$55.25 , N/A ,$42.25 ,$55.25 ,$47.45 , N/A , N/A ,$27.30 ,$55.25 , N/A ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$36.93 ,$44.92 ,$46.80 ,$45.27 , N/A ,$46.80 , N/A ,$39.00 ,$39.00 , N/A ,$39.00 , N/A ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$448.00 ,$224.00 ,$95.17 ,$448.00 ,$95.17 ,$289.81 ,$289.81 ,$198.95 ,$268.80 ,$380.80 ,$313.60 ,$95.17 ,$425.60 ,$322.56 ,$327.04 ,$291.20 ,$380.80 ,$198.95 ,$291.20 ,$380.80 ,$327.04 ,$95.17 ,$198.95 ,$188.16 ,$380.80 ,$447.64 ,$412.16 ,$313.60 ,$227.23 ,$272.70 ,$272.83 ,$254.51 ,$309.57 ,$322.56 ,$312.03 ,$200.94 ,$322.56 ,$100.88 ,$224.00 ,$224.00 ,$198.95 ,$224.00 ,$198.95 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$179.00 ,$89.50 ,$38.92 ,$179.00 ,$161.07 ,$115.80 ,$115.80 ,$38.92 ,$107.40 ,$152.15 ,$125.30 ,$161.07 ,$170.05 ,$128.88 ,$130.67 ,$116.35 ,$152.15 ,$38.92 ,$116.35 ,$152.15 ,$130.67 ,$161.07 ,$38.92 ,$75.18 ,$152.15 ,$87.57 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$101.69 ,$123.69 ,$128.88 ,$124.67 ,$39.31 ,$128.88 ,$170.73 ,$89.50 ,$89.50 ,$38.92 ,$89.50 ,$38.92 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$538.00 ,$269.00 ,$95.17 ,$538.00 ,$95.17 ,$348.03 ,$348.03 ,$198.95 ,$322.80 ,$457.30 ,$376.60 ,$95.17 ,$511.10 ,$387.36 ,$392.74 ,$349.70 ,$457.30 ,$198.95 ,$349.70 ,$457.30 ,$392.74 ,$95.17 ,$198.95 ,$225.96 ,$457.30 ,$447.64 ,$494.96 ,$376.60 ,$272.87 ,$327.48 ,$327.64 ,$305.64 ,$371.76 ,$387.36 ,$374.72 ,$200.94 ,$387.36 ,$100.88 ,$269.00 ,$269.00 ,$198.95 ,$269.00 ,$198.95 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$322.80 
ST MARY'S HOSPITAL,26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$179.00 ,$89.50 ,$38.92 ,$179.00 ,$161.07 ,$115.80 ,$115.80 ,$38.92 ,$107.40 ,$152.15 ,$125.30 ,$161.07 ,$170.05 ,$128.88 ,$130.67 ,$116.35 ,$152.15 ,$38.92 ,$116.35 ,$152.15 ,$130.67 ,$161.07 ,$38.92 ,$75.18 ,$152.15 ,$87.57 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$101.69 ,$123.69 ,$128.88 ,$124.67 ,$39.31 ,$128.88 ,$170.73 ,$89.50 ,$89.50 ,$38.92 ,$89.50 ,$38.92 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$168.00 ,$84.00 ,$60.30 ,$168.00 ,$95.17 ,$108.68 ,$108.68 ,$60.30 ,$100.80 ,$142.80 ,$117.60 ,$95.17 ,$159.60 ,$120.96 ,$122.64 ,$109.20 ,$142.80 ,$60.30 ,$109.20 ,$142.80 ,$122.64 ,$95.17 ,$60.30 ,$70.56 ,$142.80 ,$135.67 ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 ,$60.90 ,$120.96 ,$100.88 ,$84.00 ,$84.00 ,$60.30 ,$84.00 ,$60.30 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$167.70 ,$219.30 , N/A ,$167.70 ,$219.30 ,$188.34 ,$95.17 , N/A ,$108.36 ,$219.30 , N/A ,$237.36 ,$180.60 ,$130.86 ,$157.04 ,$157.12 ,$146.57 ,$178.28 ,$185.76 ,$179.70 , N/A ,$185.76 ,$100.88 ,$129.00 ,$129.00 , N/A ,$129.00 , N/A ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$501.84 ,$508.81 ,$453.05 ,$592.45 , N/A ,$453.05 ,$592.45 ,$508.81 ,$309.60 , N/A ,$292.74 ,$592.45 , N/A ,$641.24 ,$487.90 ,$353.52 ,$424.26 ,$424.47 ,$395.97 ,$481.63 ,$501.84 ,$485.46 , N/A ,$501.84 ,$328.18 ,$348.50 ,$348.50 , N/A ,$348.50 , N/A ,$501.84 ,$432.14 ,$501.84 ,$501.84 ,$418.20 
ST MARY'S HOSPITAL,26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$903.00 ,$451.50 ,$379.26 ,$965.21 ,$450.00 ,$584.15 ,$584.15 ,$428.98 ,$541.80 ,$767.55 ,$632.10 ,$450.00 ,$857.85 ,$650.16 ,$659.19 ,$586.95 ,$767.55 ,$428.98 ,$586.95 ,$767.55 ,$659.19 ,$450.00 ,$428.98 ,$379.26 ,$767.55 ,$965.21 ,$830.76 ,$632.10 ,$903.00 ,$903.00 ,$549.93 ,$903.00 ,$623.97 ,$650.16 ,$628.94 ,$433.27 ,$650.16 ,$477.00 ,$451.50 ,$451.50 ,$428.98 ,$451.50 ,$428.98 ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$541.80 
ST MARY'S HOSPITAL,26000016,M0245,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB AND ETESEVIMAB ADMINISTRATION",260,1 ,$754.00 ,$377.00 ,$316.68 ,$965.21 ,$450.00 ,$487.76 ,$487.76 ,$428.98 ,$452.40 ,$640.90 ,$527.80 ,$450.00 ,$716.30 ,$542.88 ,$550.42 ,$490.10 ,$640.90 ,$428.98 ,$490.10 ,$640.90 ,$550.42 ,$450.00 ,$428.98 ,$316.68 ,$640.90 ,$965.21 ,$693.68 ,$527.80 ,$754.00 ,$754.00 ,$459.19 ,$754.00 ,$521.01 ,$542.88 ,$525.16 ,$433.27 ,$542.88 ,$477.00 ,$377.00 ,$377.00 ,$428.98 ,$377.00 ,$428.98 ,$542.88 ,$467.48 ,$542.88 ,$542.88 ,$452.40 
ST MARY'S HOSPITAL,26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,125.00 ",$562.50 ,$428.98 ,"$1,125.00 ",$450.00 ,$727.76 ,$727.76 ,$428.98 ,$675.00 ,$956.25 ,$787.50 ,$450.00 ,"$1,068.75 ",$810.00 ,$821.25 ,$731.25 ,$956.25 ,$428.98 ,$731.25 ,$956.25 ,$821.25 ,$450.00 ,$428.98 ,$472.50 ,$956.25 ,$965.21 ,"$1,035.00 ",$787.50 ,"$1,125.00 ","$1,125.00 ",$685.13 ,"$1,125.00 ",$777.38 ,$810.00 ,$783.56 ,$433.27 ,$810.00 ,$477.00 ,$562.50 ,$562.50 ,$428.98 ,$562.50 ,$428.98 ,$810.00 ,$697.50 ,$810.00 ,$810.00 ,$675.00 
ST MARY'S HOSPITAL,27100061,N/A,HC HELI OX PER HOUR,271,1 ,$34.00 ,$17.00 ,$14.28 ,$34.00 , N/A ,$21.99 ,$21.99 , N/A ,$20.40 ,$28.90 ,$23.80 , N/A ,$32.30 ,$24.48 ,$24.82 ,$22.10 ,$28.90 , N/A ,$22.10 ,$28.90 ,$24.82 , N/A , N/A ,$14.28 ,$28.90 , N/A ,$31.28 ,$23.80 ,$17.24 ,$20.70 ,$20.71 ,$19.32 ,$23.49 ,$24.48 ,$23.68 , N/A ,$24.48 , N/A ,$20.40 ,$20.40 , N/A ,$20.40 , N/A ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$20.40 
ST MARY'S HOSPITAL,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 ","$1,458.00 ","$1,478.25 ","$1,316.25 ","$1,721.25 ", N/A ,"$1,316.25 ","$1,721.25 ","$1,478.25 ", 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 ","$1,150.40 ","$1,399.28 ","$1,458.00 ","$1,410.41 ", N/A ,"$1,458.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,458.00 ","$1,255.50 ","$1,458.00 ","$1,458.00 ","$1,215.00 "
ST MARY'S HOSPITAL,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 ,$416.88 ,$422.67 ,$376.35 ,$492.15 , N/A ,$376.35 ,$492.15 ,$422.67 , N/A , N/A ,$243.18 ,$492.15 , N/A ,$532.68 ,$405.30 ,$293.67 ,$352.44 ,$352.61 ,$328.93 ,$400.09 ,$416.88 ,$403.27 , N/A ,$416.88 , N/A ,$347.40 ,$347.40 , N/A ,$347.40 , N/A ,$416.88 ,$358.98 ,$416.88 ,$416.88 ,$347.40 
ST MARY'S HOSPITAL,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 ,$416.88 ,$422.67 ,$376.35 ,$492.15 , N/A ,$376.35 ,$492.15 ,$422.67 , N/A , N/A ,$243.18 ,$492.15 , N/A ,$532.68 ,$405.30 ,$293.67 ,$352.44 ,$352.61 ,$328.93 ,$400.09 ,$416.88 ,$403.27 , N/A ,$416.88 , N/A ,$347.40 ,$347.40 , N/A ,$347.40 , N/A ,$416.88 ,$358.98 ,$416.88 ,$416.88 ,$347.40 
ST MARY'S HOSPITAL,27100099,N/A,HC NITRIC OXIDE HR NICU,271,1 ,$559.00 ,$279.50 ,$234.78 ,$559.00 , N/A ,$361.62 ,$361.62 , N/A ,$335.40 ,$475.15 ,$391.30 , N/A ,$531.05 ,$402.48 ,$408.07 ,$363.35 ,$475.15 , N/A ,$363.35 ,$475.15 ,$408.07 , N/A , N/A ,$234.78 ,$475.15 , N/A ,$514.28 ,$391.30 ,$283.52 ,$340.26 ,$340.43 ,$317.57 ,$386.27 ,$402.48 ,$389.34 , N/A ,$402.48 , N/A ,$335.40 ,$335.40 , N/A ,$335.40 , N/A ,$402.48 ,$346.58 ,$402.48 ,$402.48 ,$335.40 
ST MARY'S HOSPITAL,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 ,$16.56 ,$16.79 ,$14.95 ,$19.55 , N/A ,$14.95 ,$19.55 ,$16.79 , N/A , N/A ,$9.66 ,$19.55 , N/A ,$21.16 ,$16.10 ,$11.67 ,$14.00 ,$14.01 ,$13.07 ,$15.89 ,$16.56 ,$16.02 , N/A ,$16.56 , N/A ,$13.80 ,$13.80 , N/A ,$13.80 , N/A ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$13.80 
ST MARY'S HOSPITAL,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 ,$125.28 ,$127.02 ,$113.10 ,$147.90 , N/A ,$113.10 ,$147.90 ,$127.02 , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$98.85 ,$120.23 ,$125.28 ,$121.19 , N/A ,$125.28 , N/A ,$104.40 ,$104.40 , N/A ,$104.40 , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$104.40 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 , N/A ,$85.00 ,$76.32 , N/A ,$85.00 ,$73.00 , N/A ,$76.32 ,$42.00 ,$85.00 ,$171.72 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$77.08 ,$72.00 , N/A , N/A , N/A ,$76.32 , N/A ,$76.32 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$35.75 ,$46.75 , N/A ,$35.75 ,$46.75 ,$40.15 , N/A , N/A ,$23.10 ,$46.75 ,$33.00 ,$50.60 ,$38.50 ,$27.90 ,$33.48 ,$33.50 ,$31.25 ,$38.01 ,$39.60 ,$38.31 , N/A ,$39.60 , N/A ,$33.00 ,$33.00 , N/A ,$33.00 , N/A ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ","$1,299.60 ","$1,317.65 ","$1,173.25 ","$1,534.25 ", N/A ,"$1,173.25 ","$1,534.25 ","$1,317.65 ", 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 ","$1,025.42 ","$1,247.26 ","$1,299.60 ","$1,257.18 ", N/A ,"$1,299.60 ", N/A ,"$1,083.00 ","$1,083.00 ", N/A ,"$1,083.00 ", N/A ,"$1,299.60 ","$1,119.10 ","$1,299.60 ","$1,299.60 ","$1,083.00 "
ST MARY'S HOSPITAL,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 ","$1,657.44 ","$1,680.46 ","$1,496.30 ","$1,956.70 ", N/A ,"$1,496.30 ","$1,956.70 ","$1,680.46 ", 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 ","$1,307.77 ","$1,590.68 ","$1,657.44 ","$1,603.34 ", N/A ,"$1,657.44 ", N/A ,"$1,381.20 ","$1,381.20 ", N/A ,"$1,381.20 ", N/A ,"$1,657.44 ","$1,427.24 ","$1,657.44 ","$1,657.44 ","$1,381.20 "
ST MARY'S HOSPITAL,27200029,C1726,HC DILATOR BALLOON,272,1 ,"$1,038.00 ",$519.00 ,$435.96 ,"$1,038.00 ", N/A ,$671.48 ,$671.48 , N/A ,$622.80 ,$882.30 ,$726.60 , N/A ,$986.10 ,$747.36 ,$757.74 ,$674.70 ,$882.30 , N/A ,$674.70 ,$882.30 ,$757.74 , N/A , N/A ,$435.96 ,$882.30 , N/A ,$954.96 ,$726.60 ,$526.47 ,$631.83 ,$632.14 ,$589.69 ,$717.26 ,$747.36 ,$722.97 , N/A ,$747.36 , N/A ,$622.80 ,$622.80 , N/A ,$622.80 , N/A ,$747.36 ,$643.56 ,$747.36 ,$747.36 ,$622.80 
ST MARY'S HOSPITAL,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 ,$386.64 ,$392.01 ,$349.05 ,$456.45 , N/A ,$349.05 ,$456.45 ,$392.01 , N/A , N/A ,$225.54 ,$456.45 , N/A ,$494.04 ,$375.90 ,$272.37 ,$326.87 ,$327.03 ,$305.07 ,$371.07 ,$386.64 ,$374.02 , N/A ,$386.64 , N/A ,$322.20 ,$322.20 , N/A ,$322.20 , N/A ,$386.64 ,$332.94 ,$386.64 ,$386.64 ,$322.20 
ST MARY'S HOSPITAL,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 ,$748.80 ,$759.20 ,$676.00 ,$884.00 , N/A ,$676.00 ,$884.00 ,$759.20 , N/A , N/A ,$436.80 ,$884.00 , N/A ,$956.80 ,$728.00 ,$527.49 ,$633.05 ,$633.36 ,$590.82 ,$718.64 ,$748.80 ,$724.36 , N/A ,$748.80 , N/A ,$624.00 ,$624.00 , N/A ,$624.00 , N/A ,$748.80 ,$644.80 ,$748.80 ,$748.80 ,$624.00 
ST MARY'S HOSPITAL,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 ,$238.32 ,$241.63 ,$215.15 ,$281.35 , N/A ,$215.15 ,$281.35 ,$241.63 , N/A , N/A ,$139.02 ,$281.35 , N/A ,$304.52 ,$231.70 ,$167.88 ,$201.48 ,$201.58 ,$188.04 ,$228.72 ,$238.32 ,$230.54 , N/A ,$238.32 , N/A ,$198.60 ,$198.60 , N/A ,$198.60 , N/A ,$238.32 ,$205.22 ,$238.32 ,$238.32 ,$198.60 
ST MARY'S HOSPITAL,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 ","$2,139.12 ","$2,168.83 ","$1,931.15 ","$2,525.35 ", N/A ,"$1,931.15 ","$2,525.35 ","$2,168.83 ", 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 ","$1,687.83 ","$2,052.96 ","$2,139.12 ","$2,069.30 ", N/A ,"$2,139.12 ", N/A ,"$1,782.60 ","$1,782.60 ", N/A ,"$1,782.60 ", N/A ,"$2,139.12 ","$1,842.02 ","$2,139.12 ","$2,139.12 ","$1,782.60 "
ST MARY'S HOSPITAL,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 ,$555.12 ,$562.83 ,$501.15 ,$655.35 , N/A ,$501.15 ,$655.35 ,$562.83 , N/A , N/A ,$323.82 ,$655.35 , N/A ,$709.32 ,$539.70 ,$391.05 ,$469.31 ,$469.54 ,$438.01 ,$532.76 ,$555.12 ,$537.00 , N/A ,$555.12 , N/A ,$462.60 ,$462.60 , N/A ,$462.60 , N/A ,$555.12 ,$478.02 ,$555.12 ,$555.12 ,$462.60 
ST MARY'S HOSPITAL,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 ","$2,456.64 ","$2,490.76 ","$2,217.80 ","$2,900.20 ", N/A ,"$2,217.80 ","$2,900.20 ","$2,490.76 ", 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 ","$1,938.36 ","$2,357.69 ","$2,456.64 ","$2,376.46 ", N/A ,"$2,456.64 ", N/A ,"$2,047.20 ","$2,047.20 ", N/A ,"$2,047.20 ", N/A ,"$2,456.64 ","$2,115.44 ","$2,456.64 ","$2,456.64 ","$2,047.20 "
ST MARY'S HOSPITAL,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 ","$7,932.96 ","$8,043.14 ","$5,509.00 ","$9,365.30 ", N/A ,"$5,509.00 ","$9,365.30 ","$8,043.14 ", 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 ","$6,259.33 ","$7,613.44 ","$7,932.96 ","$7,674.04 ", N/A ,"$7,932.96 ", N/A ,"$5,509.00 ","$5,509.00 ", N/A ,"$5,509.00 ", N/A ,"$7,932.96 ","$6,831.16 ","$7,932.96 ","$7,932.96 ","$6,610.80 "
ST MARY'S HOSPITAL,27200078,C1765,HC INTERCEED ADHESION BARRIER,278,1 ,$527.00 ,$263.50 ,$221.34 ,$527.00 , N/A , N/A , N/A , N/A ,$316.20 ,$447.95 ,$368.90 , N/A ,$500.65 ,$379.44 ,$384.71 , N/A ,$447.95 , N/A , N/A ,$447.95 ,$384.71 , N/A , N/A ,$221.34 ,$447.95 , N/A ,$484.84 ,$368.90 ,$267.29 ,$320.78 ,$320.94 ,$299.39 ,$364.16 ,$379.44 ,$367.06 , N/A ,$379.44 , N/A , N/A , N/A , N/A , N/A , N/A ,$379.44 ,$326.74 ,$379.44 ,$379.44 ,$316.20 
ST MARY'S HOSPITAL,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 ",$766.08 ,$776.72 ,$691.60 ,$904.40 , N/A ,$691.60 ,$904.40 ,$776.72 , N/A , N/A ,$446.88 ,$904.40 , N/A ,$978.88 ,$744.80 ,$539.66 ,$647.66 ,$647.98 ,$604.46 ,$735.22 ,$766.08 ,$741.08 , N/A ,$766.08 , N/A ,$638.40 ,$638.40 , N/A ,$638.40 , N/A ,$766.08 ,$659.68 ,$766.08 ,$766.08 ,$638.40 
ST MARY'S HOSPITAL,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 ,$383.04 ,$388.36 ,$345.80 ,$452.20 , N/A ,$345.80 ,$452.20 ,$388.36 , N/A , N/A ,$223.44 ,$452.20 , N/A ,$489.44 ,$372.40 ,$269.83 ,$323.83 ,$323.99 ,$302.23 ,$367.61 ,$383.04 ,$370.54 , N/A ,$383.04 , N/A ,$319.20 ,$319.20 , N/A ,$319.20 , N/A ,$383.04 ,$329.84 ,$383.04 ,$383.04 ,$319.20 
ST MARY'S HOSPITAL,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 ","$3,327.84 ","$3,374.06 ","$2,311.00 ","$3,928.70 ", N/A ,"$2,311.00 ","$3,928.70 ","$3,374.06 ", 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 ","$2,625.76 ","$3,193.80 ","$3,327.84 ","$3,219.22 ", N/A ,"$3,327.84 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,327.84 ","$2,865.64 ","$3,327.84 ","$3,327.84 ","$2,773.20 "
ST MARY'S HOSPITAL,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 ","$2,280.24 ","$2,311.91 ","$2,058.55 ","$2,691.95 ", N/A ,"$2,058.55 ","$2,691.95 ","$2,311.91 ", 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 ","$1,799.17 ","$2,188.40 ","$2,280.24 ","$2,205.82 ", N/A ,"$2,280.24 ", N/A ,"$1,900.20 ","$1,900.20 ", N/A ,"$1,900.20 ", N/A ,"$2,280.24 ","$1,963.54 ","$2,280.24 ","$2,280.24 ","$1,900.20 "
ST MARY'S HOSPITAL,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 ","$3,842.64 ","$3,896.01 ","$3,469.05 ","$4,536.45 ", N/A ,"$3,469.05 ","$4,536.45 ","$3,896.01 ", 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 ","$3,031.95 ","$3,687.87 ","$3,842.64 ","$3,717.22 ", N/A ,"$3,842.64 ", N/A ,"$3,202.20 ","$3,202.20 ", N/A ,"$3,202.20 ", N/A ,"$3,842.64 ","$3,308.94 ","$3,842.64 ","$3,842.64 ","$3,202.20 "
ST MARY'S HOSPITAL,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 ,$100.80 ,$102.20 ,$91.00 ,$119.00 , N/A ,$91.00 ,$119.00 ,$102.20 , N/A , N/A ,$58.80 ,$119.00 , N/A ,$128.80 ,$98.00 ,$71.01 ,$85.22 ,$85.26 ,$79.53 ,$96.74 ,$100.80 ,$97.51 , N/A ,$100.80 , N/A ,$84.00 ,$84.00 , N/A ,$84.00 , N/A ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$84.00 
ST MARY'S HOSPITAL,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 ","$5,752.80 ","$5,832.70 ","$5,193.50 ","$6,791.50 ", N/A ,"$5,193.50 ","$6,791.50 ","$5,832.70 ", 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 ","$4,539.12 ","$5,521.09 ","$5,752.80 ","$5,565.04 ", N/A ,"$5,752.80 ", N/A ,"$4,794.00 ","$4,794.00 ", N/A ,"$4,794.00 ", N/A ,"$5,752.80 ","$4,953.80 ","$5,752.80 ","$5,752.80 ","$4,794.00 "
ST MARY'S HOSPITAL,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 ","$2,928.96 ","$2,969.64 ","$2,644.20 ","$3,457.80 ", N/A ,"$2,644.20 ","$3,457.80 ","$2,969.64 ", 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 ","$2,311.03 ","$2,810.99 ","$2,928.96 ","$2,833.36 ", N/A ,"$2,928.96 ", N/A ,"$2,440.80 ","$2,440.80 ", N/A ,"$2,440.80 ", N/A ,"$2,928.96 ","$2,522.16 ","$2,928.96 ","$2,928.96 ","$2,440.80 "
ST MARY'S HOSPITAL,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 ","$1,657.44 ","$1,680.46 ","$1,496.30 ","$1,956.70 ", N/A ,"$1,496.30 ","$1,956.70 ","$1,680.46 ", 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 ","$1,307.77 ","$1,590.68 ","$1,657.44 ","$1,603.34 ", N/A ,"$1,657.44 ", N/A ,"$1,381.20 ","$1,381.20 ", N/A ,"$1,381.20 ", N/A ,"$1,657.44 ","$1,427.24 ","$1,657.44 ","$1,657.44 ","$1,381.20 "
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$24.70 ,$32.30 , N/A ,$24.70 ,$32.30 ,$27.74 , N/A , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$21.59 ,$26.26 ,$27.36 ,$26.47 , N/A ,$27.36 , N/A ,$22.80 ,$22.80 , N/A ,$22.80 , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,27200748,N/A,HC CATH ARGYLE TROCAR,272,1 ,$120.00 ,$60.00 ,$50.40 ,$120.00 , N/A ,$77.63 ,$77.63 , N/A ,$72.00 ,$102.00 ,$84.00 , N/A ,$114.00 ,$86.40 ,$87.60 ,$78.00 ,$102.00 , N/A ,$78.00 ,$102.00 ,$87.60 , N/A , N/A ,$50.40 ,$102.00 , N/A ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$68.17 ,$82.92 ,$86.40 ,$83.58 , N/A ,$86.40 , N/A ,$72.00 ,$72.00 , N/A ,$72.00 , N/A ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ",$982.80 ,$996.45 ,$887.25 ,"$1,160.25 ", N/A ,$887.25 ,"$1,160.25 ",$996.45 , N/A , N/A ,$573.30 ,"$1,160.25 ", N/A ,"$1,255.80 ",$955.50 ,$692.33 ,$830.88 ,$831.29 ,$775.46 ,$943.22 ,$982.80 ,$950.72 , N/A ,$982.80 , N/A ,$819.00 ,$819.00 , N/A ,$819.00 , N/A ,$982.80 ,$846.30 ,$982.80 ,$982.80 ,$819.00 
ST MARY'S HOSPITAL,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 ,$87.84 ,$89.06 ,$79.30 ,$103.70 , N/A ,$79.30 ,$103.70 ,$89.06 , N/A , N/A ,$51.24 ,$103.70 , N/A ,$112.24 ,$85.40 ,$61.88 ,$74.26 ,$74.30 ,$69.31 ,$84.30 ,$87.84 ,$84.97 , N/A ,$87.84 , N/A ,$73.20 ,$73.20 , N/A ,$73.20 , N/A ,$87.84 ,$75.64 ,$87.84 ,$87.84 ,$73.20 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$85.00 ,$73.00 , N/A , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 , N/A ,$72.00 , N/A ,$60.00 ,$60.00 , N/A ,$60.00 , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$126.72 ,$128.48 ,$114.40 ,$149.60 , N/A ,$114.40 ,$149.60 ,$128.48 , N/A , N/A ,$73.92 ,$149.60 , N/A ,$161.92 ,$123.20 ,$89.27 ,$107.13 ,$107.18 ,$99.99 ,$121.62 ,$126.72 ,$122.58 , N/A ,$126.72 , N/A ,$105.60 ,$105.60 , N/A ,$105.60 , N/A ,$126.72 ,$109.12 ,$126.72 ,$126.72 ,$105.60 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$189.15 ,$247.35 , N/A ,$189.15 ,$247.35 ,$212.43 , N/A , N/A ,$122.22 ,$247.35 , N/A ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 , N/A ,$209.52 , N/A ,$174.60 ,$174.60 , N/A ,$174.60 , N/A ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$653.76 ,$662.84 ,$590.20 ,$771.80 , N/A ,$590.20 ,$771.80 ,$662.84 , N/A , N/A ,$381.36 ,$771.80 , N/A ,$835.36 ,$635.60 ,$460.54 ,$552.70 ,$552.97 ,$515.83 ,$627.43 ,$653.76 ,$632.42 , N/A ,$653.76 , N/A ,$544.80 ,$544.80 , N/A ,$544.80 , N/A ,$653.76 ,$562.96 ,$653.76 ,$653.76 ,$544.80 
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$75.40 ,$98.60 , N/A ,$75.40 ,$98.60 ,$84.68 , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$65.90 ,$80.16 ,$83.52 ,$80.79 , N/A ,$83.52 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 , N/A ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$41.76 ,$42.34 ,$37.70 ,$49.30 , N/A ,$37.70 ,$49.30 ,$42.34 , N/A , N/A ,$24.36 ,$49.30 , N/A ,$53.36 ,$40.60 ,$29.42 ,$35.30 ,$35.32 ,$32.95 ,$40.08 ,$41.76 ,$40.40 , N/A ,$41.76 , N/A ,$34.80 ,$34.80 , N/A ,$34.80 , N/A ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$34.80 
ST MARY'S HOSPITAL,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 ,$540.00 ,$547.50 ,$487.50 ,$637.50 , N/A ,$487.50 ,$637.50 ,$547.50 , N/A , N/A ,$315.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,$380.40 ,$456.53 ,$456.75 ,$426.08 ,$518.25 ,$540.00 ,$522.38 , N/A ,$540.00 , N/A ,$450.00 ,$450.00 , N/A ,$450.00 , N/A ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,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 ","$1,791.36 ","$1,816.24 ","$1,617.20 ","$2,114.80 ", N/A ,"$1,617.20 ","$2,114.80 ","$1,816.24 ", 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 ","$1,413.43 ","$1,719.21 ","$1,791.36 ","$1,732.89 ", N/A ,"$1,791.36 ", N/A ,"$1,492.80 ","$1,492.80 ", N/A ,"$1,492.80 ", N/A ,"$1,791.36 ","$1,542.56 ","$1,791.36 ","$1,791.36 ","$1,492.80 "
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$189.15 ,$247.35 , N/A ,$189.15 ,$247.35 ,$212.43 , N/A , N/A ,$122.22 ,$247.35 , N/A ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 , N/A ,$209.52 , N/A ,$174.60 ,$174.60 , N/A ,$174.60 , N/A ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$62.64 ,$63.51 ,$56.55 ,$73.95 , N/A ,$56.55 ,$73.95 ,$63.51 , N/A , N/A ,$36.54 ,$73.95 , N/A ,$80.04 ,$60.90 ,$44.13 ,$52.96 ,$52.98 ,$49.42 ,$60.12 ,$62.64 ,$60.60 , N/A ,$62.64 , N/A ,$52.20 ,$52.20 , N/A ,$52.20 , N/A ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$52.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$33.80 ,$44.20 , N/A ,$33.80 ,$44.20 ,$37.96 , N/A , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$29.54 ,$35.93 ,$37.44 ,$36.22 , N/A ,$37.44 , N/A ,$31.20 ,$31.20 , N/A ,$31.20 , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$76.32 ,$77.38 ,$68.90 ,$90.10 , N/A ,$68.90 ,$90.10 ,$77.38 , N/A , N/A ,$44.52 ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$60.22 ,$73.25 ,$76.32 ,$73.83 , N/A ,$76.32 , N/A ,$63.60 ,$63.60 , N/A ,$63.60 , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$63.60 
ST MARY'S HOSPITAL,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 ,$43.92 ,$44.53 ,$39.65 ,$51.85 , N/A ,$39.65 ,$51.85 ,$44.53 , N/A , N/A ,$25.62 ,$51.85 , N/A ,$56.12 ,$42.70 ,$30.94 ,$37.13 ,$37.15 ,$34.65 ,$42.15 ,$43.92 ,$42.49 , N/A ,$43.92 , N/A ,$36.60 ,$36.60 , N/A ,$36.60 , N/A ,$43.92 ,$37.82 ,$43.92 ,$43.92 ,$36.60 
ST MARY'S HOSPITAL,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 ","$3,255.84 ","$3,301.06 ","$2,939.30 ","$3,843.70 ", N/A ,"$2,939.30 ","$3,843.70 ","$3,301.06 ", 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 ","$2,568.95 ","$3,124.70 ","$3,255.84 ","$3,149.57 ", N/A ,"$3,255.84 ", N/A ,"$2,713.20 ","$2,713.20 ", N/A ,"$2,713.20 ", N/A ,"$3,255.84 ","$2,803.64 ","$3,255.84 ","$3,255.84 ","$2,713.20 "
ST MARY'S HOSPITAL,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 ,$438.48 ,$444.57 ,$395.85 ,$517.65 , N/A ,$395.85 ,$517.65 ,$444.57 , N/A , N/A ,$255.78 ,$517.65 , N/A ,$560.28 ,$426.30 ,$308.88 ,$370.70 ,$370.88 ,$345.97 ,$420.82 ,$438.48 ,$424.17 , N/A ,$438.48 , N/A ,$365.40 ,$365.40 , N/A ,$365.40 , N/A ,$438.48 ,$377.58 ,$438.48 ,$438.48 ,$365.40 
ST MARY'S HOSPITAL,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 ,$125.28 ,$127.02 ,$113.10 ,$147.90 , N/A ,$113.10 ,$147.90 ,$127.02 , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$98.85 ,$120.23 ,$125.28 ,$121.19 , N/A ,$125.28 , N/A ,$104.40 ,$104.40 , N/A ,$104.40 , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$104.40 
ST MARY'S HOSPITAL,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 ,$211.68 ,$214.62 ,$191.10 ,$249.90 , N/A ,$191.10 ,$249.90 ,$214.62 , N/A , N/A ,$123.48 ,$249.90 , N/A ,$270.48 ,$205.80 ,$149.12 ,$178.96 ,$179.05 ,$167.02 ,$203.15 ,$211.68 ,$204.77 , N/A ,$211.68 , N/A ,$176.40 ,$176.40 , N/A ,$176.40 , N/A ,$211.68 ,$182.28 ,$211.68 ,$211.68 ,$176.40 
ST MARY'S HOSPITAL,27202051,N/A,HC SHEATH KIT,272,1 ,"$1,340.00 ",$670.00 ,$562.80 ,"$1,340.00 ", N/A ,$866.85 ,$866.85 , N/A ,$804.00 ,"$1,139.00 ",$938.00 , N/A ,"$1,273.00 ",$964.80 ,$978.20 ,$871.00 ,"$1,139.00 ", N/A ,$871.00 ,"$1,139.00 ",$978.20 , N/A , N/A ,$562.80 ,"$1,139.00 ", N/A ,"$1,232.80 ",$938.00 ,$679.65 ,$815.66 ,$816.06 ,$761.25 ,$925.94 ,$964.80 ,$933.31 , N/A ,$964.80 , N/A ,$804.00 ,$804.00 , N/A ,$804.00 , N/A ,$964.80 ,$830.80 ,$964.80 ,$964.80 ,$804.00 
ST MARY'S HOSPITAL,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 ,$238.32 ,$241.63 ,$215.15 ,$281.35 , N/A ,$215.15 ,$281.35 ,$241.63 , N/A , N/A ,$139.02 ,$281.35 , N/A ,$304.52 ,$231.70 ,$167.88 ,$201.48 ,$201.58 ,$188.04 ,$228.72 ,$238.32 ,$230.54 , N/A ,$238.32 , N/A ,$198.60 ,$198.60 , N/A ,$198.60 , N/A ,$238.32 ,$205.22 ,$238.32 ,$238.32 ,$198.60 
ST MARY'S HOSPITAL,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 ,$38.88 ,$39.42 ,$35.10 ,$45.90 , N/A ,$35.10 ,$45.90 ,$39.42 , N/A , N/A ,$22.68 ,$45.90 , N/A ,$49.68 ,$37.80 ,$27.39 ,$32.87 ,$32.89 ,$30.68 ,$37.31 ,$38.88 ,$37.61 , N/A ,$38.88 , N/A ,$32.40 ,$32.40 , N/A ,$32.40 , N/A ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$32.40 
ST MARY'S HOSPITAL,27202641,N/A,HC SYRINGE/GAUGE ASSEMBLY/HANDLE,272,1 ,$198.00 ,$99.00 ,$83.16 ,$198.00 , N/A ,$128.09 ,$128.09 , N/A ,$118.80 ,$168.30 ,$138.60 , N/A ,$188.10 ,$142.56 ,$144.54 ,$128.70 ,$168.30 , N/A ,$128.70 ,$168.30 ,$144.54 , N/A , N/A ,$83.16 ,$168.30 , N/A ,$182.16 ,$138.60 ,$100.43 ,$120.52 ,$120.58 ,$112.48 ,$136.82 ,$142.56 ,$137.91 , N/A ,$142.56 , N/A ,$118.80 ,$118.80 , N/A ,$118.80 , N/A ,$142.56 ,$122.76 ,$142.56 ,$142.56 ,$118.80 
ST MARY'S HOSPITAL,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 ,$218.16 ,$221.19 ,$196.95 ,$257.55 , N/A ,$196.95 ,$257.55 ,$221.19 , N/A , N/A ,$127.26 ,$257.55 , N/A ,$278.76 ,$212.10 ,$153.68 ,$184.44 ,$184.53 ,$172.13 ,$209.37 ,$218.16 ,$211.04 , N/A ,$218.16 , N/A ,$181.80 ,$181.80 , N/A ,$181.80 , N/A ,$218.16 ,$187.86 ,$218.16 ,$218.16 ,$181.80 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$23.40 ,$30.60 , N/A ,$23.40 ,$30.60 ,$26.28 , N/A , N/A ,$15.12 ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$20.45 ,$24.88 ,$25.92 ,$25.07 , N/A ,$25.92 , N/A ,$21.60 ,$21.60 , N/A ,$21.60 , N/A ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,27203106,N/A,HC BIOPSY FORCEPS DISP,272,1 ,$169.00 ,$84.50 ,$70.98 ,$169.00 , N/A ,$109.33 ,$109.33 , N/A ,$101.40 ,$143.65 ,$118.30 , N/A ,$160.55 ,$121.68 ,$123.37 ,$109.85 ,$143.65 , N/A ,$109.85 ,$143.65 ,$123.37 , N/A , N/A ,$70.98 ,$143.65 , N/A ,$155.48 ,$118.30 ,$85.72 ,$102.87 ,$102.92 ,$96.01 ,$116.78 ,$121.68 ,$117.71 , N/A ,$121.68 , N/A ,$101.40 ,$101.40 , N/A ,$101.40 , N/A ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$101.40 
ST MARY'S HOSPITAL,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 ","$5,658.48 ","$5,737.07 ","$5,108.35 ","$6,680.15 ", N/A ,"$5,108.35 ","$6,680.15 ","$5,737.07 ", 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 ","$4,464.70 ","$5,430.57 ","$5,658.48 ","$5,473.79 ", N/A ,"$5,658.48 ", N/A ,"$4,715.40 ","$4,715.40 ", N/A ,"$4,715.40 ", N/A ,"$5,658.48 ","$4,872.58 ","$5,658.48 ","$5,658.48 ","$4,715.40 "
ST MARY'S HOSPITAL,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 ","$1,830.96 ","$1,856.39 ","$1,652.95 ","$2,161.55 ", N/A ,"$1,652.95 ","$2,161.55 ","$1,856.39 ", 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 ","$1,444.68 ","$1,757.21 ","$1,830.96 ","$1,771.20 ", N/A ,"$1,830.96 ", N/A ,"$1,525.80 ","$1,525.80 ", N/A ,"$1,525.80 ", N/A ,"$1,830.96 ","$1,576.66 ","$1,830.96 ","$1,830.96 ","$1,525.80 "
ST MARY'S HOSPITAL,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 ","$1,997.28 ","$2,025.02 ","$1,803.10 ","$2,357.90 ", N/A ,"$1,803.10 ","$2,357.90 ","$2,025.02 ", 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 ","$1,575.91 ","$1,916.83 ","$1,997.28 ","$1,932.09 ", N/A ,"$1,997.28 ", N/A ,"$1,664.40 ","$1,664.40 ", N/A ,"$1,664.40 ", N/A ,"$1,997.28 ","$1,719.88 ","$1,997.28 ","$1,997.28 ","$1,664.40 "
ST MARY'S HOSPITAL,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 ","$1,584.72 ","$1,606.73 ","$1,430.65 ","$1,870.85 ", N/A ,"$1,430.65 ","$1,870.85 ","$1,606.73 ", 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 ","$1,250.39 ","$1,520.89 ","$1,584.72 ","$1,533.00 ", N/A ,"$1,584.72 ", N/A ,"$1,320.60 ","$1,320.60 ", N/A ,"$1,320.60 ", N/A ,"$1,584.72 ","$1,364.62 ","$1,584.72 ","$1,584.72 ","$1,320.60 "
ST MARY'S HOSPITAL,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 ","$2,995.92 ","$3,037.53 ","$2,704.65 ","$3,536.85 ", N/A ,"$2,704.65 ","$3,536.85 ","$3,037.53 ", 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 ","$2,363.86 ","$2,875.25 ","$2,995.92 ","$2,898.14 ", N/A ,"$2,995.92 ", N/A ,"$2,496.60 ","$2,496.60 ", N/A ,"$2,496.60 ", N/A ,"$2,995.92 ","$2,579.82 ","$2,995.92 ","$2,995.92 ","$2,496.60 "
ST MARY'S HOSPITAL,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 ",$961.20 ,$974.55 ,$867.75 ,"$1,134.75 ", N/A ,$867.75 ,"$1,134.75 ",$974.55 , N/A , N/A ,$560.70 ,"$1,134.75 ", N/A ,"$1,228.20 ",$934.50 ,$677.11 ,$812.61 ,$813.02 ,$758.41 ,$922.49 ,$961.20 ,$929.83 , N/A ,$961.20 , N/A ,$801.00 ,$801.00 , N/A ,$801.00 , N/A ,$961.20 ,$827.70 ,$961.20 ,$961.20 ,$801.00 
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$75.40 ,$98.60 , N/A ,$75.40 ,$98.60 ,$84.68 , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$65.90 ,$80.16 ,$83.52 ,$80.79 , N/A ,$83.52 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 , N/A ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$167.04 ,$169.36 ,$150.80 ,$197.20 , N/A ,$150.80 ,$197.20 ,$169.36 , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$131.80 ,$160.31 ,$167.04 ,$161.59 , N/A ,$167.04 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 , N/A ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$139.20 
ST MARY'S HOSPITAL,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 ,$292.32 ,$296.38 ,$263.90 ,$345.10 , N/A ,$263.90 ,$345.10 ,$296.38 , N/A , N/A ,$170.52 ,$345.10 , N/A ,$373.52 ,$284.20 ,$205.92 ,$247.13 ,$247.25 ,$230.65 ,$280.55 ,$292.32 ,$282.78 , N/A ,$292.32 , N/A ,$243.60 ,$243.60 , N/A ,$243.60 , N/A ,$292.32 ,$251.72 ,$292.32 ,$292.32 ,$243.60 
ST MARY'S HOSPITAL,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 ","$2,551.68 ","$2,587.12 ","$2,303.60 ","$3,012.40 ", N/A ,"$2,303.60 ","$3,012.40 ","$2,587.12 ", 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 ","$2,013.35 ","$2,448.90 ","$2,551.68 ","$2,468.40 ", N/A ,"$2,551.68 ", N/A ,"$2,126.40 ","$2,126.40 ", N/A ,"$2,126.40 ", N/A ,"$2,551.68 ","$2,197.28 ","$2,551.68 ","$2,551.68 ","$2,126.40 "
ST MARY'S HOSPITAL,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 ","$1,830.96 ","$1,856.39 ","$1,652.95 ","$2,161.55 ", N/A ,"$1,652.95 ","$2,161.55 ","$1,856.39 ", 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 ","$1,444.68 ","$1,757.21 ","$1,830.96 ","$1,771.20 ", N/A ,"$1,830.96 ", N/A ,"$1,525.80 ","$1,525.80 ", N/A ,"$1,525.80 ", N/A ,"$1,830.96 ","$1,576.66 ","$1,830.96 ","$1,830.96 ","$1,525.80 "
ST MARY'S HOSPITAL,27203298,N/A,HC HEMOSTATIC PARTICLES,272,1 ,"$3,094.00 ","$1,547.00 ","$1,299.48 ","$3,094.00 ", N/A ,"$2,001.51 ","$2,001.51 ", N/A ,"$1,856.40 ","$2,629.90 ","$2,165.80 ", N/A ,"$2,939.30 ","$2,227.68 ","$2,258.62 ","$2,011.10 ","$2,629.90 ", N/A ,"$2,011.10 ","$2,629.90 ","$2,258.62 ", N/A , N/A ,"$1,299.48 ","$2,629.90 ", N/A ,"$2,846.48 ","$2,165.80 ","$1,569.28 ","$1,883.32 ","$1,884.25 ","$1,757.70 ","$2,137.95 ","$2,227.68 ","$2,154.97 ", N/A ,"$2,227.68 ", N/A ,"$1,856.40 ","$1,856.40 ", N/A ,"$1,856.40 ", N/A ,"$2,227.68 ","$1,918.28 ","$2,227.68 ","$2,227.68 ","$1,856.40 "
ST MARY'S HOSPITAL,27203306,N/A,HC ARCTIC SUN TEMP MANAGEMENT SYSTEM,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 ,$167.04 ,$169.36 ,$150.80 ,$197.20 , N/A ,$150.80 ,$197.20 ,$169.36 , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$131.80 ,$160.31 ,$167.04 ,$161.59 , N/A ,$167.04 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 , N/A ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$139.20 
ST MARY'S HOSPITAL,27203307,N/A,HC ARCTIC SUN PADS,272,1 ,"$1,894.00 ",$947.00 ,$795.48 ,"$1,894.00 ", N/A ,"$1,225.23 ","$1,225.23 ", N/A ,"$1,136.40 ","$1,609.90 ","$1,325.80 ", N/A ,"$1,799.30 ","$1,363.68 ","$1,382.62 ","$1,231.10 ","$1,609.90 ", N/A ,"$1,231.10 ","$1,609.90 ","$1,382.62 ", N/A , N/A ,$795.48 ,"$1,609.90 ", N/A ,"$1,742.48 ","$1,325.80 ",$960.64 ,"$1,152.88 ","$1,153.45 ","$1,075.98 ","$1,308.75 ","$1,363.68 ","$1,319.17 ", N/A ,"$1,363.68 ", N/A ,"$1,136.40 ","$1,136.40 ", N/A ,"$1,136.40 ", N/A ,"$1,363.68 ","$1,174.28 ","$1,363.68 ","$1,363.68 ","$1,136.40 "
ST MARY'S HOSPITAL,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 ,$499.68 ,$506.62 ,$451.10 ,$589.90 , N/A ,$451.10 ,$589.90 ,$506.62 , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$394.26 ,$479.55 ,$499.68 ,$483.37 , N/A ,$499.68 , N/A ,$416.40 ,$416.40 , N/A ,$416.40 , N/A ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$416.40 
ST MARY'S HOSPITAL,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 ,$748.80 ,$759.20 ,$676.00 ,$884.00 , N/A ,$676.00 ,$884.00 ,$759.20 , N/A , N/A ,$436.80 ,$884.00 , N/A ,$956.80 ,$728.00 ,$527.49 ,$633.05 ,$633.36 ,$590.82 ,$718.64 ,$748.80 ,$724.36 , N/A ,$748.80 , N/A ,$624.00 ,$624.00 , N/A ,$624.00 , N/A ,$748.80 ,$644.80 ,$748.80 ,$748.80 ,$624.00 
ST MARY'S HOSPITAL,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 ","$1,497.60 ","$1,518.40 ","$1,352.00 ","$1,768.00 ", N/A ,"$1,352.00 ","$1,768.00 ","$1,518.40 ", 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 ","$1,181.65 ","$1,437.28 ","$1,497.60 ","$1,448.72 ", N/A ,"$1,497.60 ", N/A ,"$1,248.00 ","$1,248.00 ", N/A ,"$1,248.00 ", N/A ,"$1,497.60 ","$1,289.60 ","$1,497.60 ","$1,497.60 ","$1,248.00 "
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$75.40 ,$98.60 , N/A ,$75.40 ,$98.60 ,$84.68 , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$65.90 ,$80.16 ,$83.52 ,$80.79 , N/A ,$83.52 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 , N/A ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$225.36 ,$228.49 ,$203.45 ,$266.05 , N/A ,$203.45 ,$266.05 ,$228.49 , N/A , N/A ,$131.46 ,$266.05 , N/A ,$287.96 ,$219.10 ,$158.75 ,$190.52 ,$190.62 ,$177.82 ,$216.28 ,$225.36 ,$218.00 , N/A ,$225.36 , N/A ,$187.80 ,$187.80 , N/A ,$187.80 , N/A ,$225.36 ,$194.06 ,$225.36 ,$225.36 ,$187.80 
ST MARY'S HOSPITAL,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 ",$766.08 ,$776.72 ,$691.60 ,$904.40 , N/A ,$691.60 ,$904.40 ,$776.72 , N/A , N/A ,$446.88 ,$904.40 , N/A ,$978.88 ,$744.80 ,$539.66 ,$647.66 ,$647.98 ,$604.46 ,$735.22 ,$766.08 ,$741.08 , N/A ,$766.08 , N/A ,$638.40 ,$638.40 , N/A ,$638.40 , N/A ,$766.08 ,$659.68 ,$766.08 ,$766.08 ,$638.40 
ST MARY'S HOSPITAL,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 ,$42.48 ,$43.07 ,$38.35 ,$50.15 , N/A ,$38.35 ,$50.15 ,$43.07 , N/A , N/A ,$24.78 ,$50.15 , N/A ,$54.28 ,$41.30 ,$29.92 ,$35.91 ,$35.93 ,$33.52 ,$40.77 ,$42.48 ,$41.09 , N/A ,$42.48 , N/A ,$35.40 ,$35.40 , N/A ,$35.40 , N/A ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$35.40 
ST MARY'S HOSPITAL,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 ,$167.04 ,$169.36 ,$150.80 ,$197.20 , N/A ,$150.80 ,$197.20 ,$169.36 , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$131.80 ,$160.31 ,$167.04 ,$161.59 , N/A ,$167.04 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 , N/A ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$139.20 
ST MARY'S HOSPITAL,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 ,$334.08 ,$338.72 ,$301.60 ,$394.40 , N/A ,$301.60 ,$394.40 ,$338.72 , N/A , N/A ,$194.88 ,$394.40 , N/A ,$426.88 ,$324.80 ,$235.34 ,$282.44 ,$282.58 ,$263.60 ,$320.62 ,$334.08 ,$323.18 , N/A ,$334.08 , N/A ,$278.40 ,$278.40 , N/A ,$278.40 , N/A ,$334.08 ,$287.68 ,$334.08 ,$334.08 ,$278.40 
ST MARY'S HOSPITAL,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 ",$790.56 ,$801.54 ,$713.70 ,$933.30 , N/A ,$713.70 ,$933.30 ,$801.54 , N/A , N/A ,$461.16 ,$933.30 , N/A ,"$1,010.16 ",$768.60 ,$556.91 ,$668.35 ,$668.68 ,$623.77 ,$758.72 ,$790.56 ,$764.76 , N/A ,$790.56 , N/A ,$658.80 ,$658.80 , N/A ,$658.80 , N/A ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$658.80 
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$75.40 ,$98.60 , N/A ,$75.40 ,$98.60 ,$84.68 , N/A , N/A ,$48.72 ,$98.60 , N/A ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$65.90 ,$80.16 ,$83.52 ,$80.79 , N/A ,$83.52 , N/A ,$69.60 ,$69.60 , N/A ,$69.60 , N/A ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$167.04 ,$169.36 ,$150.80 ,$197.20 , N/A ,$150.80 ,$197.20 ,$169.36 , N/A , N/A ,$97.44 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$131.80 ,$160.31 ,$167.04 ,$161.59 , N/A ,$167.04 , N/A ,$139.20 ,$139.20 , N/A ,$139.20 , N/A ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$139.20 
ST MARY'S HOSPITAL,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 ,$499.68 ,$506.62 ,$451.10 ,$589.90 , N/A ,$451.10 ,$589.90 ,$506.62 , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$394.26 ,$479.55 ,$499.68 ,$483.37 , N/A ,$499.68 , N/A ,$416.40 ,$416.40 , N/A ,$416.40 , N/A ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$416.40 
ST MARY'S HOSPITAL,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 ",$998.64 ,"$1,012.51 ",$901.55 ,"$1,178.95 ", N/A ,$901.55 ,"$1,178.95 ","$1,012.51 ", N/A , N/A ,$582.54 ,"$1,178.95 ", N/A ,"$1,276.04 ",$970.90 ,$703.49 ,$844.27 ,$844.68 ,$787.95 ,$958.42 ,$998.64 ,$966.05 , N/A ,$998.64 , N/A ,$832.20 ,$832.20 , N/A ,$832.20 , N/A ,$998.64 ,$859.94 ,$998.64 ,$998.64 ,$832.20 
ST MARY'S HOSPITAL,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 ","$2,488.32 ","$2,522.88 ","$2,246.40 ","$2,937.60 ", N/A ,"$2,246.40 ","$2,937.60 ","$2,522.88 ", 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 ","$1,963.35 ","$2,388.10 ","$2,488.32 ","$2,407.10 ", N/A ,"$2,488.32 ", N/A ,"$2,073.60 ","$2,073.60 ", N/A ,"$2,073.60 ", N/A ,"$2,488.32 ","$2,142.72 ","$2,488.32 ","$2,488.32 ","$2,073.60 "
ST MARY'S HOSPITAL,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 ","$2,329.20 ","$2,361.55 ","$2,102.75 ","$2,749.75 ", N/A ,"$2,102.75 ","$2,749.75 ","$2,361.55 ", 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 ","$1,837.80 ","$2,235.39 ","$2,329.20 ","$2,253.18 ", N/A ,"$2,329.20 ", N/A ,"$1,941.00 ","$1,941.00 ", N/A ,"$1,941.00 ", N/A ,"$2,329.20 ","$2,005.70 ","$2,329.20 ","$2,329.20 ","$1,941.00 "
ST MARY'S HOSPITAL,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 ,$74.88 ,$75.92 ,$67.60 ,$88.40 , N/A ,$67.60 ,$88.40 ,$75.92 , N/A , N/A ,$43.68 ,$88.40 , N/A ,$95.68 ,$72.80 ,$52.75 ,$63.30 ,$63.34 ,$59.08 ,$71.86 ,$74.88 ,$72.44 , N/A ,$74.88 , N/A ,$62.40 ,$62.40 , N/A ,$62.40 , N/A ,$74.88 ,$64.48 ,$74.88 ,$74.88 ,$62.40 
ST MARY'S HOSPITAL,27204120,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T20,272,1 ,"$27,000.00 ","$13,500.00 ","$11,340.00 ","$27,000.00 ", N/A ,"$17,466.30 ","$17,466.30 ", N/A ,"$16,200.00 ","$22,950.00 ","$18,900.00 ", N/A ,"$25,650.00 ","$19,440.00 ","$19,710.00 ","$17,550.00 ","$22,950.00 ", N/A ,"$17,550.00 ","$22,950.00 ","$19,710.00 ", N/A , N/A ,"$11,340.00 ","$22,950.00 ", N/A ,"$24,840.00 ","$18,900.00 ","$13,694.40 ","$16,434.90 ","$16,443.00 ","$15,338.70 ","$18,657.00 ","$19,440.00 ","$18,805.50 ", N/A ,"$19,440.00 ", N/A ,"$16,200.00 ","$16,200.00 ", N/A ,"$16,200.00 ", N/A ,"$19,440.00 ","$16,740.00 ","$19,440.00 ","$19,440.00 ","$16,200.00 "
ST MARY'S HOSPITAL,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 ","$5,062.32 ","$5,132.63 ","$4,570.15 ","$5,976.35 ", N/A ,"$4,570.15 ","$5,976.35 ","$5,132.63 ", 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 ","$3,994.31 ","$4,858.42 ","$5,062.32 ","$4,897.09 ", N/A ,"$5,062.32 ", N/A ,"$4,218.60 ","$4,218.60 ", N/A ,"$4,218.60 ", N/A ,"$5,062.32 ","$4,359.22 ","$5,062.32 ","$5,062.32 ","$4,218.60 "
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$25.35 ,$33.15 , N/A ,$25.35 ,$33.15 ,$28.47 , N/A , N/A ,$16.38 ,$33.15 , N/A ,$35.88 ,$27.30 ,$19.78 ,$23.74 ,$23.75 ,$22.16 ,$26.95 ,$28.08 ,$27.16 , N/A ,$28.08 , N/A ,$23.40 ,$23.40 , N/A ,$23.40 , N/A ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,27205502,C1894,HC DIAGNOSTIC SHEATH TIER 5,272,1 ,"$1,989.00 ",$994.50 ,$835.38 ,"$1,989.00 ", N/A ,"$1,286.68 ","$1,286.68 ", N/A ,"$1,193.40 ","$1,690.65 ","$1,392.30 ", N/A ,"$1,889.55 ","$1,432.08 ","$1,451.97 ","$1,292.85 ","$1,690.65 ", N/A ,"$1,292.85 ","$1,690.65 ","$1,451.97 ", N/A , N/A ,$835.38 ,"$1,690.65 ", N/A ,"$1,829.88 ","$1,392.30 ","$1,008.82 ","$1,210.70 ","$1,211.30 ","$1,129.95 ","$1,374.40 ","$1,432.08 ","$1,385.34 ", N/A ,"$1,432.08 ", N/A ,"$1,193.40 ","$1,193.40 ", N/A ,"$1,193.40 ", N/A ,"$1,432.08 ","$1,233.18 ","$1,432.08 ","$1,432.08 ","$1,193.40 "
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 , N/A ,$58.65 ,$36.12 , N/A ,$58.65 ,$50.37 , N/A ,$36.12 ,$28.98 ,$58.65 ,$81.27 ,$63.48 ,$48.30 ,$35.00 ,$42.00 ,$42.02 ,$39.20 ,$47.68 ,$49.68 ,$48.06 ,$36.48 ,$49.68 , N/A , N/A , N/A ,$36.12 , N/A ,$36.12 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,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 ,$142.56 ,$144.54 , N/A ,$168.30 ,$90.12 , N/A ,$168.30 ,$144.54 , N/A ,$90.12 ,$83.16 ,$168.30 ,$202.77 ,$182.16 ,$138.60 ,$100.43 ,$120.52 ,$120.58 ,$112.48 ,$136.82 ,$142.56 ,$137.91 ,$91.02 ,$142.56 , N/A , N/A , N/A ,$90.12 , N/A ,$90.12 ,$142.56 ,$122.76 ,$142.56 ,$142.56 ,$118.80 
ST MARY'S HOSPITAL,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 ,$91.44 ,$92.71 , N/A ,$107.95 ,$115.74 , N/A ,$107.95 ,$92.71 , N/A ,$115.74 ,$53.34 ,$107.95 ,$260.42 ,$116.84 ,$88.90 ,$64.41 ,$77.30 ,$77.34 ,$72.15 ,$87.76 ,$91.44 ,$88.46 ,$116.90 ,$91.44 , N/A , N/A , N/A ,$115.74 , N/A ,$115.74 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$76.20 
ST MARY'S HOSPITAL,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 ,$91.44 ,$92.71 , N/A ,$107.95 ,$115.74 , N/A ,$107.95 ,$92.71 , N/A ,$115.74 ,$53.34 ,$107.95 ,$260.42 ,$116.84 ,$88.90 ,$64.41 ,$77.30 ,$77.34 ,$72.15 ,$87.76 ,$91.44 ,$88.46 ,$116.90 ,$91.44 , N/A , N/A , N/A ,$115.74 , N/A ,$115.74 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$76.20 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 , N/A ,$247.35 ,$177.74 , N/A ,$247.35 ,$212.43 , N/A ,$177.74 ,$122.22 ,$247.35 ,$399.91 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 ,$179.52 ,$209.52 , N/A , N/A , N/A ,$177.74 , N/A ,$177.74 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$125.28 ,$127.02 , N/A ,$147.90 ,$143.83 , N/A ,$147.90 ,$127.02 , N/A ,$143.83 ,$73.08 ,$147.90 ,$323.62 ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$98.85 ,$120.23 ,$125.28 ,$121.19 ,$145.27 ,$125.28 , N/A , N/A , N/A ,$143.83 , N/A ,$143.83 ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$104.40 
ST MARY'S HOSPITAL,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 ,$138.96 ,$140.89 , N/A ,$164.05 ,$96.28 , N/A ,$164.05 ,$140.89 , N/A ,$96.28 ,$81.06 ,$164.05 ,$216.63 ,$177.56 ,$135.10 ,$97.89 ,$117.48 ,$117.54 ,$109.64 ,$133.36 ,$138.96 ,$134.42 ,$97.24 ,$138.96 , N/A , N/A , N/A ,$96.28 , N/A ,$96.28 ,$138.96 ,$119.66 ,$138.96 ,$138.96 ,$115.80 
ST MARY'S HOSPITAL,27400034,L3030,HC ORTHOTIC DEVICE,274,1 ,$162.00 ,$81.00 ,$68.04 ,$217.80 , N/A , N/A , N/A ,$96.80 ,$97.20 ,$137.70 ,$113.40 , N/A ,$153.90 ,$116.64 ,$118.26 , N/A ,$137.70 ,$96.80 , N/A ,$137.70 ,$118.26 , N/A ,$96.80 ,$68.04 ,$137.70 ,$217.80 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$92.03 ,$111.94 ,$116.64 ,$112.83 ,$97.77 ,$116.64 , N/A , N/A , N/A ,$96.80 , N/A ,$96.80 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 , N/A ,$133.45 ,$86.75 , N/A ,$133.45 ,$114.61 , N/A ,$86.75 ,$65.94 ,$133.45 ,$195.19 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$89.19 ,$108.49 ,$113.04 ,$109.35 ,$87.62 ,$113.04 , N/A , N/A , N/A ,$86.75 , N/A ,$86.75 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$84.24 ,$85.41 , N/A ,$99.45 ,$165.04 , N/A ,$99.45 ,$85.41 , N/A ,$165.04 ,$49.14 ,$99.45 ,$371.34 ,$107.64 ,$81.90 ,$59.34 ,$71.22 ,$71.25 ,$66.47 ,$80.85 ,$84.24 ,$81.49 ,$166.69 ,$84.24 , N/A , N/A , N/A ,$165.04 , N/A ,$165.04 ,$84.24 ,$72.54 ,$84.24 ,$84.24 ,$70.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 , N/A ,$133.45 ,$118.73 , N/A ,$133.45 ,$114.61 , N/A ,$118.73 ,$65.94 ,$133.45 ,$267.14 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$89.19 ,$108.49 ,$113.04 ,$109.35 ,$119.92 ,$113.04 , N/A , N/A , N/A ,$118.73 , N/A ,$118.73 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$541.44 ,$548.96 , N/A ,$639.20 ,$725.22 , N/A ,$639.20 ,$548.96 , N/A ,$725.22 ,$315.84 ,$639.20 ,"$1,631.75 ",$691.84 ,$526.40 ,$381.41 ,$457.74 ,$457.97 ,$427.21 ,$519.63 ,$541.44 ,$523.77 ,$732.47 ,$541.44 , N/A , N/A , N/A ,$725.22 , N/A ,$725.22 ,$541.44 ,$466.24 ,$541.44 ,$541.44 ,$451.20 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 , N/A ,$195.50 ,$238.06 , N/A ,$195.50 ,$167.90 , N/A ,$238.06 ,$96.60 ,$195.50 ,$535.64 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$240.44 ,$165.60 , N/A , N/A , N/A ,$238.06 , N/A ,$238.06 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ,$111.60 ,$113.15 , N/A ,$131.75 ,$87.32 , N/A ,$131.75 ,$113.15 , N/A ,$87.32 ,$65.10 ,$131.75 ,$196.47 ,$142.60 ,$108.50 ,$78.62 ,$94.35 ,$94.40 ,$88.06 ,$107.11 ,$111.60 ,$107.96 ,$88.19 ,$111.60 , N/A , N/A , N/A ,$87.32 , N/A ,$87.32 ,$111.60 ,$96.10 ,$111.60 ,$111.60 ,$93.00 
ST MARY'S HOSPITAL,27400046,L3908,HC ROYLAN D-RING WRIST BRC,274,1 ,$84.00 ,$42.00 ,$35.28 ,$164.52 , N/A , N/A , N/A ,$73.12 ,$50.40 ,$71.40 ,$58.80 , N/A ,$79.80 ,$60.48 ,$61.32 , N/A ,$71.40 ,$73.12 , N/A ,$71.40 ,$61.32 , N/A ,$73.12 ,$35.28 ,$71.40 ,$164.52 ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$47.72 ,$58.04 ,$60.48 ,$58.51 ,$73.85 ,$60.48 , N/A , N/A , N/A ,$73.12 , N/A ,$73.12 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$365.04 ,$370.11 , N/A ,$430.95 ,$309.42 , N/A ,$430.95 ,$370.11 , N/A ,$309.42 ,$212.94 ,$430.95 ,$696.20 ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$288.03 ,$350.34 ,$365.04 ,$353.13 ,$312.51 ,$365.04 , N/A , N/A , N/A ,$309.42 , N/A ,$309.42 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$304.20 
ST MARY'S HOSPITAL,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 ,$205.20 ,$208.05 , N/A ,$242.25 ,$265.02 , N/A ,$242.25 ,$208.05 , N/A ,$265.02 ,$119.70 ,$242.25 ,$596.30 ,$262.20 ,$199.50 ,$144.55 ,$173.48 ,$173.57 ,$161.91 ,$196.94 ,$205.20 ,$198.50 ,$267.67 ,$205.20 , N/A , N/A , N/A ,$265.02 , N/A ,$265.02 ,$205.20 ,$176.70 ,$205.20 ,$205.20 ,$171.00 
ST MARY'S HOSPITAL,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 ,$278.64 ,$282.51 , N/A ,$328.95 ,$324.14 , N/A ,$328.95 ,$282.51 , N/A ,$324.14 ,$162.54 ,$328.95 ,$729.32 ,$356.04 ,$270.90 ,$196.29 ,$235.57 ,$235.68 ,$219.85 ,$267.42 ,$278.64 ,$269.55 ,$327.38 ,$278.64 , N/A , N/A , N/A ,$324.14 , N/A ,$324.14 ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$232.20 
ST MARY'S HOSPITAL,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 ,$149.76 ,$151.84 , N/A ,$176.80 ,$201.75 , N/A ,$176.80 ,$151.84 , N/A ,$201.75 ,$87.36 ,$176.80 ,$453.94 ,$191.36 ,$145.60 ,$105.50 ,$126.61 ,$126.67 ,$118.16 ,$143.73 ,$149.76 ,$144.87 ,$203.77 ,$149.76 , N/A , N/A , N/A ,$201.75 , N/A ,$201.75 ,$149.76 ,$128.96 ,$149.76 ,$149.76 ,$124.80 
ST MARY'S HOSPITAL,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 ,$142.56 ,$144.54 , N/A ,$168.30 ,$121.26 , N/A ,$168.30 ,$144.54 , N/A ,$121.26 ,$83.16 ,$168.30 ,$272.84 ,$182.16 ,$138.60 ,$100.43 ,$120.52 ,$120.58 ,$112.48 ,$136.82 ,$142.56 ,$137.91 ,$122.47 ,$142.56 , N/A , N/A , N/A ,$121.26 , N/A ,$121.26 ,$142.56 ,$122.76 ,$142.56 ,$142.56 ,$118.80 
ST MARY'S HOSPITAL,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 ,$375.84 ,$381.06 , N/A ,$443.70 ,$322.92 , N/A ,$443.70 ,$381.06 , N/A ,$322.92 ,$219.24 ,$443.70 ,$726.57 ,$480.24 ,$365.40 ,$264.76 ,$317.74 ,$317.90 ,$296.55 ,$360.70 ,$375.84 ,$363.57 ,$326.15 ,$375.84 , N/A , N/A , N/A ,$322.92 , N/A ,$322.92 ,$375.84 ,$323.64 ,$375.84 ,$375.84 ,$313.20 
ST MARY'S HOSPITAL,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 ,$233.28 ,$236.52 , N/A ,$275.40 ,$198.62 , N/A ,$275.40 ,$236.52 , N/A ,$198.62 ,$136.08 ,$275.40 ,$446.90 ,$298.08 ,$226.80 ,$164.33 ,$197.22 ,$197.32 ,$184.06 ,$223.88 ,$233.28 ,$225.67 ,$200.61 ,$233.28 , N/A , N/A , N/A ,$198.62 , N/A ,$198.62 ,$233.28 ,$200.88 ,$233.28 ,$233.28 ,$194.40 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 , N/A ,$137.70 ,$97.59 , N/A ,$137.70 ,$118.26 , N/A ,$97.59 ,$68.04 ,$137.70 ,$219.58 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$92.03 ,$111.94 ,$116.64 ,$112.83 ,$98.57 ,$116.64 , N/A , N/A , N/A ,$97.59 , N/A ,$97.59 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$200.16 ,$202.94 , N/A ,$236.30 ,$157.17 , N/A ,$236.30 ,$202.94 , N/A ,$157.17 ,$116.76 ,$236.30 ,$353.63 ,$255.76 ,$194.60 ,$141.00 ,$169.22 ,$169.30 ,$157.93 ,$192.10 ,$200.16 ,$193.63 ,$158.74 ,$200.16 , N/A , N/A , N/A ,$157.17 , N/A ,$157.17 ,$200.16 ,$172.36 ,$200.16 ,$200.16 ,$166.80 
ST MARY'S HOSPITAL,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 ,$167.04 ,$169.36 , N/A ,$197.20 ,$216.09 , N/A ,$197.20 ,$169.36 , N/A ,$216.09 ,$97.44 ,$197.20 ,$486.20 ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$131.80 ,$160.31 ,$167.04 ,$161.59 ,$218.25 ,$167.04 , N/A , N/A , N/A ,$216.09 , N/A ,$216.09 ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$139.20 
ST MARY'S HOSPITAL,27400091,L0625,HC LUMBAR CORSET,274,1 ,$73.00 ,$36.50 ,$30.66 ,$105.37 , N/A , N/A , N/A ,$46.83 ,$43.80 ,$62.05 ,$51.10 , N/A ,$69.35 ,$52.56 ,$53.29 , N/A ,$62.05 ,$46.83 , N/A ,$62.05 ,$53.29 , N/A ,$46.83 ,$30.66 ,$62.05 ,$105.37 ,$67.16 ,$51.10 ,$37.03 ,$44.44 ,$44.46 ,$41.47 ,$50.44 ,$52.56 ,$50.84 ,$47.30 ,$52.56 , N/A , N/A , N/A ,$46.83 , N/A ,$46.83 ,$52.56 ,$45.26 ,$52.56 ,$52.56 ,$43.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 , N/A ,$56.95 ,$40.29 , N/A ,$56.95 ,$48.91 , N/A ,$40.29 ,$28.14 ,$56.95 ,$90.65 ,$61.64 ,$46.90 ,$33.98 ,$40.78 ,$40.80 ,$38.06 ,$46.30 ,$48.24 ,$46.67 ,$40.69 ,$48.24 , N/A , N/A , N/A ,$40.29 , N/A ,$40.29 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$342.72 ,$347.48 , N/A ,$404.60 ,$317.01 , N/A ,$404.60 ,$347.48 , N/A ,$317.01 ,$199.92 ,$404.60 ,$713.27 ,$437.92 ,$333.20 ,$241.43 ,$289.74 ,$289.88 ,$270.42 ,$328.92 ,$342.72 ,$331.53 ,$320.18 ,$342.72 , N/A , N/A , N/A ,$317.01 , N/A ,$317.01 ,$342.72 ,$295.12 ,$342.72 ,$342.72 ,$285.60 
ST MARY'S HOSPITAL,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 ,$476.64 ,$483.26 , N/A ,$562.70 ,$406.02 , N/A ,$562.70 ,$483.26 , N/A ,$406.02 ,$278.04 ,$562.70 ,$913.55 ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$376.08 ,$457.44 ,$476.64 ,$461.08 ,$410.08 ,$476.64 , N/A , N/A , N/A ,$406.02 , N/A ,$406.02 ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$397.20 
ST MARY'S HOSPITAL,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 ,$671.04 ,$680.36 , N/A ,$792.20 ,$575.66 , N/A ,$792.20 ,$680.36 , N/A ,$575.66 ,$391.44 ,$792.20 ,"$1,295.24 ",$857.44 ,$652.40 ,$472.71 ,$567.31 ,$567.59 ,$529.47 ,$644.01 ,$671.04 ,$649.14 ,$581.42 ,$671.04 , N/A , N/A , N/A ,$575.66 , N/A ,$575.66 ,$671.04 ,$577.84 ,$671.04 ,$671.04 ,$559.20 
ST MARY'S HOSPITAL,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 ,$603.36 ,$611.74 , N/A ,$712.30 ,$516.50 , N/A ,$712.30 ,$611.74 , N/A ,$516.50 ,$351.96 ,$712.30 ,"$1,162.13 ",$770.96 ,$586.60 ,$425.03 ,$510.09 ,$510.34 ,$476.07 ,$579.06 ,$603.36 ,$583.67 ,$521.67 ,$603.36 , N/A , N/A , N/A ,$516.50 , N/A ,$516.50 ,$603.36 ,$519.56 ,$603.36 ,$603.36 ,$502.80 
ST MARY'S HOSPITAL,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 ,$342.72 ,$347.48 , N/A ,$404.60 ,$287.26 , N/A ,$404.60 ,$347.48 , N/A ,$287.26 ,$199.92 ,$404.60 ,$646.34 ,$437.92 ,$333.20 ,$241.43 ,$289.74 ,$289.88 ,$270.42 ,$328.92 ,$342.72 ,$331.53 ,$290.13 ,$342.72 , N/A , N/A , N/A ,$287.26 , N/A ,$287.26 ,$342.72 ,$295.12 ,$342.72 ,$342.72 ,$285.60 
ST MARY'S HOSPITAL,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 ,$290.88 ,$294.92 , N/A ,$343.40 ,$244.70 , N/A ,$343.40 ,$294.92 , N/A ,$244.70 ,$169.68 ,$343.40 ,$550.57 ,$371.68 ,$282.80 ,$204.91 ,$245.91 ,$246.04 ,$229.51 ,$279.16 ,$290.88 ,$281.39 ,$247.15 ,$290.88 , N/A , N/A , N/A ,$244.70 , N/A ,$244.70 ,$290.88 ,$250.48 ,$290.88 ,$290.88 ,$242.40 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 , N/A ,$195.50 ,$238.06 , N/A ,$195.50 ,$167.90 , N/A ,$238.06 ,$96.60 ,$195.50 ,$535.64 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$240.44 ,$165.60 , N/A , N/A , N/A ,$238.06 , N/A ,$238.06 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ,$493.20 ,$500.05 , N/A ,$582.25 , N/A , N/A ,$582.25 ,$500.05 , N/A , N/A ,$287.70 ,$582.25 , N/A ,$630.20 ,$479.50 ,$347.43 ,$416.96 ,$417.17 ,$389.15 ,$473.34 ,$493.20 ,$477.10 , N/A ,$493.20 , N/A , N/A , N/A , N/A , N/A , N/A ,$493.20 ,$424.70 ,$493.20 ,$493.20 ,$411.00 
ST MARY'S HOSPITAL,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 ","$2,528.64 ","$2,563.76 ","$1,756.00 ","$2,985.20 ", N/A ,"$1,756.00 ","$2,985.20 ","$2,563.76 ", 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 ","$1,995.17 ","$2,426.79 ","$2,528.64 ","$2,446.11 ", N/A ,"$2,528.64 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,528.64 ","$2,177.44 ","$2,528.64 ","$2,528.64 ","$2,107.20 "
ST MARY'S HOSPITAL,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 ","$4,342.32 ","$4,402.63 ","$3,015.50 ","$5,126.35 ", N/A ,"$3,015.50 ","$5,126.35 ","$4,402.63 ", 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 ","$3,426.21 ","$4,167.42 ","$4,342.32 ","$4,200.59 ", N/A ,"$4,342.32 ", N/A ,"$3,015.50 ","$3,015.50 ", N/A ,"$3,015.50 ", N/A ,"$4,342.32 ","$3,739.22 ","$4,342.32 ","$4,342.32 ","$3,618.60 "
ST MARY'S HOSPITAL,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 ","$5,839.92 ","$5,921.03 ","$4,055.50 ","$6,894.35 ", N/A ,"$4,055.50 ","$6,894.35 ","$5,921.03 ", 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 ","$4,607.86 ","$5,604.70 ","$5,839.92 ","$5,649.31 ", N/A ,"$5,839.92 ", N/A ,"$4,055.50 ","$4,055.50 ", N/A ,"$4,055.50 ", N/A ,"$5,839.92 ","$5,028.82 ","$5,839.92 ","$5,839.92 ","$4,866.60 "
ST MARY'S HOSPITAL,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 ","$10,182.24 ","$10,323.66 ","$7,071.00 ","$12,020.70 ", N/A ,"$7,071.00 ","$12,020.70 ","$10,323.66 ", 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 ","$8,034.07 ","$9,772.12 ","$10,182.24 ","$9,849.90 ", N/A ,"$10,182.24 ", N/A ,"$7,071.00 ","$7,071.00 ", N/A ,"$7,071.00 ", N/A ,"$10,182.24 ","$8,768.04 ","$10,182.24 ","$10,182.24 ","$8,485.20 "
ST MARY'S HOSPITAL,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 ","$17,971.20 ","$18,220.80 ","$12,480.00 ","$21,216.00 ", N/A ,"$12,480.00 ","$21,216.00 ","$18,220.80 ", 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 ","$14,179.78 ","$17,247.36 ","$17,971.20 ","$17,384.64 ", N/A ,"$17,971.20 ", N/A ,"$12,480.00 ","$12,480.00 ", N/A ,"$12,480.00 ", N/A ,"$17,971.20 ","$15,475.20 ","$17,971.20 ","$17,971.20 ","$14,976.00 "
ST MARY'S HOSPITAL,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 ","$20,221.20 ","$20,502.05 ","$14,042.50 ","$23,872.25 ", N/A ,"$14,042.50 ","$23,872.25 ","$20,502.05 ", 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 ","$15,955.09 ","$19,406.74 ","$20,221.20 ","$19,561.20 ", N/A ,"$20,221.20 ", N/A ,"$14,042.50 ","$14,042.50 ", N/A ,"$14,042.50 ", N/A ,"$20,221.20 ","$17,412.70 ","$20,221.20 ","$20,221.20 ","$16,851.00 "
ST MARY'S HOSPITAL,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 ","$28,917.36 ","$29,318.99 ","$20,081.50 ","$34,138.55 ", N/A ,"$20,081.50 ","$34,138.55 ","$29,318.99 ", 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 ","$22,816.60 ","$27,752.63 ","$28,917.36 ","$27,973.53 ", N/A ,"$28,917.36 ", N/A ,"$20,081.50 ","$20,081.50 ", N/A ,"$20,081.50 ", N/A ,"$28,917.36 ","$24,901.06 ","$28,917.36 ","$28,917.36 ","$24,097.80 "
ST MARY'S HOSPITAL,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 ","$5,538.96 ","$5,615.89 ","$3,846.50 ","$6,539.05 ", N/A ,"$3,846.50 ","$6,539.05 ","$5,615.89 ", 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 ","$4,370.39 ","$5,315.86 ","$5,538.96 ","$5,358.17 ", N/A ,"$5,538.96 ", N/A ,"$3,846.50 ","$3,846.50 ", N/A ,"$3,846.50 ", N/A ,"$5,538.96 ","$4,769.66 ","$5,538.96 ","$5,538.96 ","$4,615.80 "
ST MARY'S HOSPITAL,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 ","$5,538.96 ","$5,615.89 ","$3,846.50 ","$6,539.05 ", N/A ,"$3,846.50 ","$6,539.05 ","$5,615.89 ", 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 ","$4,370.39 ","$5,315.86 ","$5,538.96 ","$5,358.17 ", N/A ,"$5,538.96 ", N/A ,"$3,846.50 ","$3,846.50 ", N/A ,"$3,846.50 ", N/A ,"$5,538.96 ","$4,769.66 ","$5,538.96 ","$5,538.96 ","$4,615.80 "
ST MARY'S HOSPITAL,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 ","$19,468.08 ","$19,738.47 ","$13,519.50 ","$22,983.15 ", N/A ,"$13,519.50 ","$22,983.15 ","$19,738.47 ", 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 ","$15,360.86 ","$18,683.95 ","$19,468.08 ","$18,832.66 ", N/A ,"$19,468.08 ", N/A ,"$13,519.50 ","$13,519.50 ", N/A ,"$13,519.50 ", N/A ,"$19,468.08 ","$16,764.18 ","$19,468.08 ","$19,468.08 ","$16,223.40 "
ST MARY'S HOSPITAL,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 ","$1,497.60 ","$1,518.40 ", N/A ,"$1,768.00 ", N/A , N/A ,"$1,768.00 ","$1,518.40 ", 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 ","$1,181.65 ","$1,437.28 ","$1,497.60 ","$1,448.72 ", N/A ,"$1,497.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,497.60 ","$1,289.60 ","$1,497.60 ","$1,497.60 ","$1,248.00 "
ST MARY'S HOSPITAL,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 ","$5,990.40 ","$6,073.60 ","$4,160.00 ","$7,072.00 ", N/A ,"$4,160.00 ","$7,072.00 ","$6,073.60 ", 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 ","$4,726.59 ","$5,749.12 ","$5,990.40 ","$5,794.88 ", N/A ,"$5,990.40 ", N/A ,"$4,160.00 ","$4,160.00 ", N/A ,"$4,160.00 ", N/A ,"$5,990.40 ","$5,158.40 ","$5,990.40 ","$5,990.40 ","$4,992.00 "
ST MARY'S HOSPITAL,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 ","$5,990.40 ","$6,073.60 ","$4,160.00 ","$7,072.00 ", N/A ,"$4,160.00 ","$7,072.00 ","$6,073.60 ", 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 ","$4,726.59 ","$5,749.12 ","$5,990.40 ","$5,794.88 ", N/A ,"$5,990.40 ", N/A ,"$4,160.00 ","$4,160.00 ", N/A ,"$4,160.00 ", N/A ,"$5,990.40 ","$5,158.40 ","$5,990.40 ","$5,990.40 ","$4,992.00 "
ST MARY'S HOSPITAL,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 ","$23,034.24 ","$23,354.16 ","$15,996.00 ","$27,193.20 ", N/A ,"$15,996.00 ","$27,193.20 ","$23,354.16 ", 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 ","$18,174.66 ","$22,106.47 ","$23,034.24 ","$22,282.43 ", N/A ,"$23,034.24 ", N/A ,"$15,996.00 ","$15,996.00 ", N/A ,"$15,996.00 ", N/A ,"$23,034.24 ","$19,835.04 ","$23,034.24 ","$23,034.24 ","$19,195.20 "
ST MARY'S HOSPITAL,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 ","$21,608.64 ","$21,908.76 ","$15,006.00 ","$25,510.20 ", N/A ,"$15,006.00 ","$25,510.20 ","$21,908.76 ", 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 ","$17,049.82 ","$20,738.29 ","$21,608.64 ","$20,903.36 ", N/A ,"$21,608.64 ", N/A ,"$15,006.00 ","$15,006.00 ", N/A ,"$15,006.00 ", N/A ,"$21,608.64 ","$18,607.44 ","$21,608.64 ","$21,608.64 ","$18,007.20 "
ST MARY'S HOSPITAL,27500202,C1786,HC PACEMAKER SINGLE MICRA C1786,275,1 ,"$19,314.00 ","$9,657.00 ","$8,111.88 ","$19,314.00 ", N/A ,"$9,610.65 ","$9,610.65 ", N/A ,"$11,588.40 ","$16,416.90 ","$13,519.80 ", N/A ,"$18,348.30 ","$13,906.08 ","$14,099.22 ","$9,657.00 ","$16,416.90 ", N/A ,"$9,657.00 ","$16,416.90 ","$14,099.22 ", N/A , N/A ,"$8,111.88 ","$16,416.90 ", N/A ,"$17,768.88 ","$13,519.80 ","$9,796.06 ","$11,756.43 ","$11,762.23 ","$10,972.28 ","$13,345.97 ","$13,906.08 ","$13,452.20 ", N/A ,"$13,906.08 ", N/A ,"$9,657.00 ","$9,657.00 ", N/A ,"$9,657.00 ", N/A ,"$13,906.08 ","$11,974.68 ","$13,906.08 ","$13,906.08 ","$11,588.40 "
ST MARY'S HOSPITAL,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 ","$4,714.56 ","$4,780.04 ","$3,274.00 ","$5,565.80 ", N/A ,"$3,274.00 ","$5,565.80 ","$4,780.04 ", 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 ","$3,719.92 ","$4,524.67 ","$4,714.56 ","$4,560.68 ", N/A ,"$4,714.56 ", N/A ,"$3,274.00 ","$3,274.00 ", N/A ,"$3,274.00 ", N/A ,"$4,714.56 ","$4,059.76 ","$4,714.56 ","$4,714.56 ","$3,928.80 "
ST MARY'S HOSPITAL,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 ","$5,024.88 ","$5,094.67 ","$3,489.50 ","$5,932.15 ", N/A ,"$3,489.50 ","$5,932.15 ","$5,094.67 ", 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 ","$3,964.77 ","$4,822.49 ","$5,024.88 ","$4,860.87 ", N/A ,"$5,024.88 ", N/A ,"$3,489.50 ","$3,489.50 ", N/A ,"$3,489.50 ", N/A ,"$5,024.88 ","$4,326.98 ","$5,024.88 ","$5,024.88 ","$4,187.40 "
ST MARY'S HOSPITAL,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 ,$666.00 ,$675.25 , N/A ,$786.25 , N/A , N/A ,$786.25 ,$675.25 , N/A , N/A ,$388.50 ,$786.25 , N/A ,$851.00 ,$647.50 ,$469.16 ,$563.05 ,$563.33 ,$525.49 ,$639.18 ,$666.00 ,$644.26 , N/A ,$666.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$666.00 ,$573.50 ,$666.00 ,$666.00 ,$555.00 
ST MARY'S HOSPITAL,27800159,C1752,HC DUAL LUMEN CATH-STRAIGHT,278,1 ,$757.00 ,$378.50 ,$317.94 ,$757.00 , N/A , N/A , N/A , N/A ,$454.20 ,$643.45 ,$529.90 , N/A ,$719.15 ,$545.04 ,$552.61 , N/A ,$643.45 , N/A , N/A ,$643.45 ,$552.61 , N/A , N/A ,$317.94 ,$643.45 , N/A ,$696.44 ,$529.90 ,$383.95 ,$460.79 ,$461.01 ,$430.05 ,$523.09 ,$545.04 ,$527.25 , N/A ,$545.04 , N/A , N/A , N/A , N/A , N/A , N/A ,$545.04 ,$469.34 ,$545.04 ,$545.04 ,$454.20 
ST MARY'S HOSPITAL,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 ,$666.00 ,$675.25 , N/A ,$786.25 , N/A , N/A ,$786.25 ,$675.25 , N/A , N/A ,$388.50 ,$786.25 , N/A ,$851.00 ,$647.50 ,$469.16 ,$563.05 ,$563.33 ,$525.49 ,$639.18 ,$666.00 ,$644.26 , N/A ,$666.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$666.00 ,$573.50 ,$666.00 ,$666.00 ,$555.00 
ST MARY'S HOSPITAL,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 ","$1,324.08 ","$1,342.47 ", N/A ,"$1,563.15 ", N/A , N/A ,"$1,563.15 ","$1,342.47 ", 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 ","$1,044.74 ","$1,270.75 ","$1,324.08 ","$1,280.86 ", N/A ,"$1,324.08 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,324.08 ","$1,140.18 ","$1,324.08 ","$1,324.08 ","$1,103.40 "
ST MARY'S HOSPITAL,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 ,$370.80 ,$375.95 , N/A ,$437.75 , N/A , N/A ,$437.75 ,$375.95 , N/A , N/A ,$216.30 ,$437.75 , N/A ,$473.80 ,$360.50 ,$261.21 ,$313.48 ,$313.64 ,$292.57 ,$355.87 ,$370.80 ,$358.70 , N/A ,$370.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$309.00 
ST MARY'S HOSPITAL,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 ","$1,128.24 ","$1,143.91 ", N/A ,"$1,331.95 ", N/A , N/A ,"$1,331.95 ","$1,143.91 ", N/A , N/A ,$658.14 ,"$1,331.95 ", N/A ,"$1,441.64 ","$1,096.90 ",$794.78 ,$953.83 ,$954.30 ,$890.21 ,"$1,082.80 ","$1,128.24 ","$1,091.42 ", N/A ,"$1,128.24 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,128.24 ",$971.54 ,"$1,128.24 ","$1,128.24 ",$940.20 
ST MARY'S HOSPITAL,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 ,$666.00 ,$675.25 , N/A ,$786.25 , N/A , N/A ,$786.25 ,$675.25 , N/A , N/A ,$388.50 ,$786.25 , N/A ,$851.00 ,$647.50 ,$469.16 ,$563.05 ,$563.33 ,$525.49 ,$639.18 ,$666.00 ,$644.26 , N/A ,$666.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$666.00 ,$573.50 ,$666.00 ,$666.00 ,$555.00 
ST MARY'S HOSPITAL,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 ","$9,136.08 ","$9,262.97 ","$6,344.50 ","$10,785.65 ", N/A ,"$6,344.50 ","$10,785.65 ","$9,262.97 ", 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 ","$7,208.62 ","$8,768.10 ","$9,136.08 ","$8,837.89 ", N/A ,"$9,136.08 ", N/A ,"$6,344.50 ","$6,344.50 ", N/A ,"$6,344.50 ", N/A ,"$9,136.08 ","$7,867.18 ","$9,136.08 ","$9,136.08 ","$7,613.40 "
ST MARY'S HOSPITAL,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 ","$7,031.52 ","$7,129.18 ","$4,883.00 ","$8,301.10 ", N/A ,"$4,883.00 ","$8,301.10 ","$7,129.18 ", 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 ","$5,548.06 ","$6,748.31 ","$7,031.52 ","$6,802.02 ", N/A ,"$7,031.52 ", N/A ,"$4,883.00 ","$4,883.00 ", N/A ,"$4,883.00 ", N/A ,"$7,031.52 ","$6,054.92 ","$7,031.52 ","$7,031.52 ","$5,859.60 "
ST MARY'S HOSPITAL,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 ","$4,159.44 ","$4,217.21 ","$2,888.50 ","$4,910.45 ", N/A ,"$2,888.50 ","$4,910.45 ","$4,217.21 ", 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 ","$3,281.91 ","$3,991.91 ","$4,159.44 ","$4,023.68 ", N/A ,"$4,159.44 ", N/A ,"$2,888.50 ","$2,888.50 ", N/A ,"$2,888.50 ", N/A ,"$4,159.44 ","$3,581.74 ","$4,159.44 ","$4,159.44 ","$3,466.20 "
ST MARY'S HOSPITAL,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 ","$3,327.84 ","$3,374.06 ","$2,311.00 ","$3,928.70 ", N/A ,"$2,311.00 ","$3,928.70 ","$3,374.06 ", 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 ","$2,625.76 ","$3,193.80 ","$3,327.84 ","$3,219.22 ", N/A ,"$3,327.84 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,327.84 ","$2,865.64 ","$3,327.84 ","$3,327.84 ","$2,773.20 "
ST MARY'S HOSPITAL,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 ,$233.28 ,$236.52 , N/A ,$275.40 , N/A , N/A ,$275.40 ,$236.52 , N/A , N/A ,$136.08 ,$275.40 , N/A ,$298.08 ,$226.80 ,$164.33 ,$197.22 ,$197.32 ,$184.06 ,$223.88 ,$233.28 ,$225.67 , N/A ,$233.28 , N/A , N/A , N/A , N/A , N/A , N/A ,$233.28 ,$200.88 ,$233.28 ,$233.28 ,$194.40 
ST MARY'S HOSPITAL,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 ","$1,248.48 ","$1,265.82 ", N/A ,"$1,473.90 ", N/A , N/A ,"$1,473.90 ","$1,265.82 ", 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 ",$985.09 ,"$1,198.19 ","$1,248.48 ","$1,207.73 ", N/A ,"$1,248.48 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,248.48 ","$1,075.08 ","$1,248.48 ","$1,248.48 ","$1,040.40 "
ST MARY'S HOSPITAL,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 ","$3,440.16 ","$3,487.94 ","$2,389.00 ","$4,061.30 ", N/A ,"$2,389.00 ","$4,061.30 ","$3,487.94 ", 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 ","$2,714.38 ","$3,301.60 ","$3,440.16 ","$3,327.88 ", N/A ,"$3,440.16 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,440.16 ","$2,962.36 ","$3,440.16 ","$3,440.16 ","$2,866.80 "
ST MARY'S HOSPITAL,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 ,$278.64 ,$282.51 , N/A ,$328.95 , N/A , N/A ,$328.95 ,$282.51 , N/A , N/A ,$162.54 ,$328.95 , N/A ,$356.04 ,$270.90 ,$196.29 ,$235.57 ,$235.68 ,$219.85 ,$267.42 ,$278.64 ,$269.55 , N/A ,$278.64 , N/A , N/A , N/A , N/A , N/A , N/A ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$232.20 
ST MARY'S HOSPITAL,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 ","$4,859.28 ","$4,926.77 ","$3,374.50 ","$5,736.65 ", N/A ,"$3,374.50 ","$5,736.65 ","$4,926.77 ", 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 ","$3,834.11 ","$4,663.56 ","$4,859.28 ","$4,700.68 ", N/A ,"$4,859.28 ", N/A ,"$3,374.50 ","$3,374.50 ", N/A ,"$3,374.50 ", N/A ,"$4,859.28 ","$4,184.38 ","$4,859.28 ","$4,859.28 ","$4,049.40 "
ST MARY'S HOSPITAL,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 ","$2,100.24 ","$2,129.41 ","$1,458.50 ","$2,479.45 ", N/A ,"$1,458.50 ","$2,479.45 ","$2,129.41 ", 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 ","$1,657.15 ","$2,015.65 ","$2,100.24 ","$2,031.69 ", N/A ,"$2,100.24 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,100.24 ","$1,808.54 ","$2,100.24 ","$2,100.24 ","$1,750.20 "
ST MARY'S HOSPITAL,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 ,$499.68 ,$506.62 , N/A ,$589.90 , N/A , N/A ,$589.90 ,$506.62 , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$394.26 ,$479.55 ,$499.68 ,$483.37 , N/A ,$499.68 , N/A , N/A , N/A , N/A , N/A , N/A ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$416.40 
ST MARY'S HOSPITAL,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 ","$5,492.16 ","$5,568.44 ","$3,814.00 ","$6,483.80 ", N/A ,"$3,814.00 ","$6,483.80 ","$5,568.44 ", 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 ","$4,333.47 ","$5,270.95 ","$5,492.16 ","$5,312.90 ", N/A ,"$5,492.16 ", N/A ,"$3,814.00 ","$3,814.00 ", N/A ,"$3,814.00 ", N/A ,"$5,492.16 ","$4,729.36 ","$5,492.16 ","$5,492.16 ","$4,576.80 "
ST MARY'S HOSPITAL,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 ","$7,488.00 ","$7,592.00 ","$5,200.00 ","$8,840.00 ", N/A ,"$5,200.00 ","$8,840.00 ","$7,592.00 ", 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 ","$5,908.24 ","$7,186.40 ","$7,488.00 ","$7,243.60 ", N/A ,"$7,488.00 ", N/A ,"$5,200.00 ","$5,200.00 ", N/A ,"$5,200.00 ", N/A ,"$7,488.00 ","$6,448.00 ","$7,488.00 ","$7,488.00 ","$6,240.00 "
ST MARY'S HOSPITAL,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 ","$1,252.08 ","$1,269.47 ", N/A ,"$1,478.15 ", N/A , N/A ,"$1,478.15 ","$1,269.47 ", 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 ",$987.93 ,"$1,201.65 ","$1,252.08 ","$1,211.21 ", N/A ,"$1,252.08 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,252.08 ","$1,078.18 ","$1,252.08 ","$1,252.08 ","$1,043.40 "
ST MARY'S HOSPITAL,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 ","$2,496.24 ","$2,530.91 ","$1,733.50 ","$2,946.95 ", N/A ,"$1,733.50 ","$2,946.95 ","$2,530.91 ", 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 ","$1,969.60 ","$2,395.70 ","$2,496.24 ","$2,414.77 ", N/A ,"$2,496.24 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,496.24 ","$2,149.54 ","$2,496.24 ","$2,496.24 ","$2,080.20 "
ST MARY'S HOSPITAL,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 ","$3,040.56 ","$3,082.79 ","$2,111.50 ","$3,589.55 ", N/A ,"$2,111.50 ","$3,589.55 ","$3,082.79 ", 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 ","$2,399.09 ","$2,918.09 ","$3,040.56 ","$2,941.32 ", N/A ,"$3,040.56 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,040.56 ","$2,618.26 ","$3,040.56 ","$3,040.56 ","$2,533.80 "
ST MARY'S HOSPITAL,27801796,C1889,HC COIL EMBOLIZATION T3,278,1 ,"$25,306.00 ","$12,653.00 ","$10,628.52 ","$25,306.00 ", N/A ,"$12,592.27 ","$12,592.27 ", N/A ,"$15,183.60 ","$21,510.10 ","$17,714.20 ", N/A ,"$24,040.70 ","$18,220.32 ","$18,473.38 ","$12,653.00 ","$21,510.10 ", N/A ,"$12,653.00 ","$21,510.10 ","$18,473.38 ", N/A , N/A ,"$10,628.52 ","$21,510.10 ", N/A ,"$23,281.52 ","$17,714.20 ","$12,835.20 ","$15,403.76 ","$15,411.35 ","$14,376.34 ","$17,486.45 ","$18,220.32 ","$17,625.63 ", N/A ,"$18,220.32 ", N/A ,"$12,653.00 ","$12,653.00 ", N/A ,"$12,653.00 ", N/A ,"$18,220.32 ","$15,689.72 ","$18,220.32 ","$18,220.32 ","$15,183.60 "
ST MARY'S HOSPITAL,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 ","$2,702.16 ","$2,739.69 ","$1,876.50 ","$3,190.05 ", N/A ,"$1,876.50 ","$3,190.05 ","$2,739.69 ", 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 ","$2,132.08 ","$2,593.32 ","$2,702.16 ","$2,613.96 ", N/A ,"$2,702.16 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,702.16 ","$2,326.86 ","$2,702.16 ","$2,702.16 ","$2,251.80 "
ST MARY'S HOSPITAL,29200003,N/A,HC CRUTCHES PER PAIR,271,1 ,$83.00 ,$41.50 ,$34.86 ,$83.00 , N/A ,$53.69 ,$53.69 , N/A ,$49.80 ,$70.55 ,$58.10 , N/A ,$78.85 ,$59.76 ,$60.59 ,$53.95 ,$70.55 , N/A ,$53.95 ,$70.55 ,$60.59 , N/A , N/A ,$34.86 ,$70.55 , N/A ,$76.36 ,$58.10 ,$42.10 ,$50.52 ,$50.55 ,$47.15 ,$57.35 ,$59.76 ,$57.81 , N/A ,$59.76 , N/A ,$49.80 ,$49.80 , N/A ,$49.80 , N/A ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$49.80 
ST MARY'S HOSPITAL,29200005,N/A,HC METAL CRUTCHES COMPLETE,271,1 ,$83.00 ,$41.50 ,$34.86 ,$83.00 , N/A ,$53.69 ,$53.69 , N/A ,$49.80 ,$70.55 ,$58.10 , N/A ,$78.85 ,$59.76 ,$60.59 ,$53.95 ,$70.55 , N/A ,$53.95 ,$70.55 ,$60.59 , N/A , N/A ,$34.86 ,$70.55 , N/A ,$76.36 ,$58.10 ,$42.10 ,$50.52 ,$50.55 ,$47.15 ,$57.35 ,$59.76 ,$57.81 , N/A ,$59.76 , N/A ,$49.80 ,$49.80 , N/A ,$49.80 , N/A ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$49.80 
ST MARY'S HOSPITAL,30000001,N/A,HC BLOOD GLUCOSE TEST,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 ,$12.96 ,$13.14 , N/A ,$15.30 , N/A , N/A ,$15.30 ,$13.14 , N/A , N/A ,$7.56 ,$15.30 , N/A ,$16.56 ,$12.60 ,$9.13 ,$10.96 ,$10.96 ,$10.23 ,$12.44 ,$12.96 ,$12.54 , N/A ,$12.96 , N/A ,$9.00 ,$9.00 , N/A ,$9.00 , N/A ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$10.80 
ST MARY'S HOSPITAL,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 ,$12.96 ,$13.14 , N/A ,$15.30 , N/A , N/A ,$15.30 ,$13.14 , N/A , N/A ,$7.56 ,$15.30 , N/A ,$16.56 ,$12.60 ,$9.13 ,$10.96 ,$10.96 ,$10.23 ,$12.44 ,$12.96 ,$12.54 , N/A ,$12.96 , N/A ,$9.00 ,$9.00 , N/A ,$9.00 , N/A ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$10.80 
ST MARY'S HOSPITAL,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 ,$33.48 ,$33.95 ,$5.10 ,$39.53 ,$3.00 ,$5.10 ,$39.53 ,$33.95 ,$0.73 ,$3.00 ,$3.40 ,$39.53 ,$6.75 ,$42.78 ,$32.55 ,$10.69 ,$11.49 ,$28.32 ,$10.69 ,$32.13 ,$33.48 ,$32.39 ,$3.03 ,$33.48 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$3.00 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$27.90 
ST MARY'S HOSPITAL,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 ,$21.60 ,$21.90 ,$5.03 ,$25.50 , N/A ,$5.03 ,$25.50 ,$21.90 ,$0.73 , N/A ,$12.60 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$17.04 ,$20.73 ,$21.60 ,$20.90 , N/A ,$21.60 ,$0.77 ,$3.47 ,$3.47 , N/A ,$3.47 , N/A ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$18.00 
ST MARY'S HOSPITAL,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 ,$33.48 ,$33.95 ,$5.10 ,$39.53 ,$3.00 ,$5.10 ,$39.53 ,$33.95 ,$0.73 ,$3.00 ,$3.40 ,$39.53 ,$6.75 ,$42.78 ,$32.55 ,$10.69 ,$11.49 ,$28.32 ,$10.69 ,$32.13 ,$33.48 ,$32.39 ,$3.03 ,$33.48 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$3.00 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$27.90 
ST MARY'S HOSPITAL,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 ,$33.48 ,$33.95 ,$5.10 ,$39.53 ,$3.00 ,$5.10 ,$39.53 ,$33.95 ,$0.73 ,$3.00 ,$3.40 ,$39.53 ,$6.75 ,$42.78 ,$32.55 ,$10.69 ,$11.49 ,$28.32 ,$10.69 ,$32.13 ,$33.48 ,$32.39 ,$3.03 ,$33.48 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$3.00 ,$33.48 ,$28.83 ,$33.48 ,$33.48 ,$27.90 
ST MARY'S HOSPITAL,30000014,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$119.00 ,$59.50 ,$18.43 ,$246.74 ,$18.43 ,$76.98 ,$76.98 ,$109.66 ,$71.40 ,$101.15 ,$83.30 ,$18.43 ,$113.05 ,$85.68 ,$86.87 ,$43.40 ,$101.15 ,$109.66 ,$43.40 ,$101.15 ,$86.87 ,$18.43 ,$109.66 ,$49.98 ,$101.15 ,$246.74 ,$109.48 ,$83.30 ,$119.00 ,$119.00 ,$72.47 ,$119.00 ,$82.23 ,$85.68 ,$82.88 ,$110.76 ,$85.68 ,$19.54 , N/A , N/A ,$109.66 , N/A ,$109.66 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$71.40 
ST MARY'S HOSPITAL,30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$65.00 ,$32.50 ,$18.43 ,$246.74 ,$18.43 ,$42.05 ,$42.05 ,$109.66 ,$39.00 ,$55.25 ,$45.50 ,$18.43 ,$61.75 ,$46.80 ,$47.45 ,$25.06 ,$55.25 ,$109.66 ,$25.06 ,$55.25 ,$47.45 ,$18.43 ,$109.66 ,$27.30 ,$55.25 ,$246.74 ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$36.93 ,$44.92 ,$46.80 ,$45.27 ,$110.76 ,$46.80 ,$19.54 , N/A , N/A ,$109.66 , N/A ,$109.66 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$129.00 ,$64.50 ,$18.43 ,$246.74 ,$18.43 ,$83.45 ,$83.45 ,$109.66 ,$77.40 ,$109.65 ,$90.30 ,$18.43 ,$122.55 ,$92.88 ,$94.17 ,$48.38 ,$109.65 ,$109.66 ,$48.38 ,$109.65 ,$94.17 ,$18.43 ,$109.66 ,$54.18 ,$109.65 ,$246.74 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$92.88 ,$89.85 ,$110.76 ,$92.88 ,$19.54 , N/A , N/A ,$109.66 , N/A ,$109.66 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$46.80 ,$47.45 ,$9.52 ,$55.25 ,$5.60 ,$9.52 ,$55.25 ,$47.45 ,$5.79 ,$5.60 ,$6.34 ,$55.25 ,$12.60 ,$59.80 ,$45.50 ,$26.76 ,$28.78 ,$39.59 ,$26.76 ,$44.92 ,$46.80 ,$45.27 ,$5.66 ,$46.80 ,$6.14 ,$6.72 ,$6.72 ,$5.60 ,$6.72 ,$5.60 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$9.52 ,$84.15 ,$5.60 ,$9.52 ,$84.15 ,$72.27 ,$5.79 ,$5.60 ,$6.34 ,$84.15 ,$12.60 ,$91.08 ,$69.30 ,$26.76 ,$28.78 ,$60.29 ,$26.76 ,$68.41 ,$71.28 ,$68.95 ,$5.66 ,$71.28 ,$6.14 ,$6.72 ,$6.72 ,$5.60 ,$6.72 ,$5.60 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$7.26 ,$34.85 ,$4.27 ,$7.26 ,$34.85 ,$29.93 ,$4.41 ,$4.27 ,$4.83 ,$34.85 ,$9.61 ,$37.72 ,$28.70 ,$20.74 ,$22.30 ,$24.97 ,$20.74 ,$28.33 ,$29.52 ,$28.56 ,$4.31 ,$29.52 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$12.46 ,$45.05 ,$7.33 ,$12.46 ,$45.05 ,$38.69 ,$7.57 ,$7.33 ,$8.30 ,$45.05 ,$16.49 ,$48.76 ,$37.10 ,$34.78 ,$37.40 ,$32.28 ,$34.78 ,$36.62 ,$38.16 ,$36.91 ,$7.40 ,$38.16 ,$8.02 ,$8.80 ,$8.80 ,$7.33 ,$8.80 ,$7.33 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$10.00 ,$33.15 ,$5.88 ,$10.00 ,$33.15 ,$28.47 ,$6.08 ,$5.88 ,$6.66 ,$33.15 ,$13.23 ,$35.88 ,$27.30 ,$20.99 ,$22.57 ,$23.75 ,$20.99 ,$26.95 ,$28.08 ,$27.16 ,$5.94 ,$28.08 ,$6.44 ,$7.06 ,$7.06 ,$5.88 ,$7.06 ,$5.88 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$9.84 ,$34.85 ,$5.79 ,$9.84 ,$34.85 ,$29.93 ,$5.98 ,$5.79 ,$6.55 ,$34.85 ,$13.03 ,$37.72 ,$28.70 ,$23.09 ,$24.83 ,$24.97 ,$23.09 ,$28.33 ,$29.52 ,$28.56 ,$5.85 ,$29.52 ,$6.34 ,$6.95 ,$6.95 ,$5.79 ,$6.95 ,$5.79 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,30000108,89220,HC SPUTUM COLLECTION,300,1 ,$97.00 ,$48.50 ,$8.63 ,$326.35 ,$8.63 ,$54.76 ,$46.94 ,$145.05 ,$58.20 ,$82.45 ,$67.90 ,$8.63 ,$92.15 ,$69.84 ,$70.81 ,$29.72 ,$82.45 ,$145.05 ,$29.72 ,$82.45 ,$70.81 ,$8.63 ,$145.05 ,$40.74 ,$82.45 ,$326.35 ,$89.24 ,$67.90 ,$97.00 ,$97.00 ,$59.07 ,$97.00 ,$67.03 ,$69.84 ,$67.56 ,$146.50 ,$69.84 ,$9.15 ,$97.00 ,$97.00 ,$145.05 ,$97.00 ,$145.05 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,30000109,89230,HC SWEAT COLLECTION,300,1 ,$194.00 ,$97.00 ,$3.50 ,$194.00 ,$9.06 ,$8.89 ,$7.62 ,$48.33 ,$116.40 ,$164.90 ,$135.80 ,$9.06 ,$184.30 ,$139.68 ,$141.62 ,$3.50 ,$164.90 ,$48.33 ,$3.50 ,$164.90 ,$141.62 ,$9.06 ,$48.33 ,$81.48 ,$164.90 ,$108.73 ,$178.48 ,$135.80 ,$140.48 ,$151.04 ,$118.15 ,$140.48 ,$134.05 ,$139.68 ,$135.12 ,$48.81 ,$139.68 ,$9.60 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$116.40 
ST MARY'S HOSPITAL,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 ,$205.92 ,$208.78 ,$14.64 ,$243.10 ,$8.61 ,$14.64 ,$243.10 ,$208.78 ,$8.90 ,$8.61 ,$9.74 ,$243.10 ,$19.37 ,$263.12 ,$200.20 ,$41.84 ,$44.98 ,$174.17 ,$41.84 ,$197.63 ,$205.92 ,$199.20 ,$8.70 ,$205.92 ,$9.43 ,$10.33 ,$10.33 ,$8.61 ,$10.33 ,$8.61 ,$205.92 ,$177.32 ,$205.92 ,$205.92 ,$171.60 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$20.93 ,$51.00 ,$12.31 ,$20.93 ,$51.00 ,$43.80 ,$12.72 ,$12.31 ,$13.93 ,$51.00 ,$27.70 ,$55.20 ,$42.00 ,$58.59 ,$60.00 ,$36.54 ,$58.59 ,$41.46 ,$43.20 ,$41.79 ,$12.43 ,$43.20 ,$13.48 ,$14.77 ,$14.77 ,$12.31 ,$14.77 ,$12.31 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 ,$18.14 ,$58.65 ,$10.67 ,$18.14 ,$58.65 ,$50.37 ,$3.02 ,$10.67 ,$12.08 ,$58.65 ,$24.01 ,$63.48 ,$48.30 ,$51.89 ,$55.79 ,$42.02 ,$51.89 ,$47.68 ,$49.68 ,$48.06 ,$10.78 ,$49.68 ,$3.20 ,$12.80 ,$12.80 ,$10.67 ,$12.80 ,$10.67 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,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 ,$18.72 ,$18.98 ,$10.44 ,$22.10 , N/A ,$10.44 ,$22.10 ,$18.98 ,$3.92 , N/A ,$10.92 ,$22.10 , N/A ,$23.92 ,$18.20 ,$13.19 ,$15.83 ,$15.83 ,$14.77 ,$17.97 ,$18.72 ,$18.11 , N/A ,$18.72 ,$4.16 ,$7.37 ,$7.37 , N/A ,$7.37 , N/A ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$15.60 
ST MARY'S HOSPITAL,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 ,$16.56 ,$16.79 , N/A ,$19.55 , N/A , N/A ,$19.55 ,$16.79 , N/A , N/A ,$9.66 ,$19.55 , N/A ,$21.16 ,$16.10 ,$11.67 ,$14.00 ,$14.01 ,$13.07 ,$15.89 ,$16.56 ,$16.02 , N/A ,$16.56 , N/A , N/A , N/A , N/A , N/A , N/A ,$16.56 ,$14.26 ,$16.56 ,$16.56 ,$13.80 
ST MARY'S HOSPITAL,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 ,$15.84 ,$16.06 , N/A ,$18.70 , N/A , N/A ,$18.70 ,$16.06 , N/A , N/A ,$9.24 ,$18.70 , N/A ,$20.24 ,$15.40 ,$11.16 ,$13.39 ,$13.40 ,$12.50 ,$15.20 ,$15.84 ,$15.32 , N/A ,$15.84 , N/A , N/A , N/A , N/A , N/A , N/A ,$15.84 ,$13.64 ,$15.84 ,$15.84 ,$13.20 
ST MARY'S HOSPITAL,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 ,$216.00 ,$219.00 ,$29.14 ,$255.00 ,$17.14 ,$29.14 ,$255.00 ,$219.00 ,$17.71 ,$17.14 ,$19.40 ,$255.00 ,$38.57 ,$276.00 ,$210.00 ,$61.08 ,$65.67 ,$182.70 ,$61.08 ,$207.30 ,$216.00 ,$208.95 ,$17.31 ,$216.00 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$17.14 ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$180.00 
ST MARY'S HOSPITAL,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 ,$216.00 ,$219.00 ,$29.14 ,$255.00 ,$17.14 ,$29.14 ,$255.00 ,$219.00 ,$17.71 ,$17.14 ,$19.40 ,$255.00 ,$38.57 ,$276.00 ,$210.00 ,$61.08 ,$65.67 ,$182.70 ,$61.08 ,$207.30 ,$216.00 ,$208.95 ,$17.31 ,$216.00 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$17.14 ,$216.00 ,$186.00 ,$216.00 ,$216.00 ,$180.00 
ST MARY'S HOSPITAL,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 ,$237.60 ,$240.90 ,$29.14 ,$280.50 ,$17.14 ,$29.14 ,$280.50 ,$240.90 ,$17.71 ,$17.14 ,$19.40 ,$280.50 ,$38.57 ,$303.60 ,$231.00 ,$61.08 ,$65.67 ,$200.97 ,$61.08 ,$228.03 ,$237.60 ,$229.85 ,$17.31 ,$237.60 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$17.14 ,$237.60 ,$204.60 ,$237.60 ,$237.60 ,$198.00 
ST MARY'S HOSPITAL,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 ,$131.76 ,$133.59 ,$29.14 ,$155.55 ,$17.14 ,$29.14 ,$155.55 ,$133.59 ,$17.71 ,$17.14 ,$19.40 ,$155.55 ,$38.57 ,$168.36 ,$128.10 ,$61.08 ,$65.67 ,$111.45 ,$61.08 ,$126.45 ,$131.76 ,$127.46 ,$17.31 ,$131.76 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$17.14 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$33.27 ,$76.50 ,$19.57 ,$33.27 ,$76.50 ,$65.70 ,$2.27 ,$19.57 ,$22.15 ,$76.50 ,$44.03 ,$82.80 ,$63.00 ,$66.64 ,$71.65 ,$54.81 ,$66.64 ,$62.19 ,$64.80 ,$62.69 ,$19.77 ,$64.80 ,$2.41 ,$23.48 ,$23.48 ,$19.57 ,$23.48 ,$19.57 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$92.88 ,$94.17 ,$129.00 ,$109.65 , N/A ,$129.00 ,$109.65 ,$94.17 ,$26.29 , N/A ,$54.18 ,$109.65 , N/A ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$73.28 ,$89.14 ,$92.88 ,$89.85 , N/A ,$92.88 ,$27.87 , N/A , N/A , N/A , N/A , N/A ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$13.77 ,$87.55 ,$8.10 ,$13.77 ,$87.55 ,$75.19 ,$8.37 ,$8.10 ,$9.17 ,$87.55 ,$18.23 ,$94.76 ,$72.10 ,$34.00 ,$36.55 ,$62.73 ,$34.00 ,$71.17 ,$74.16 ,$71.74 ,$8.18 ,$74.16 ,$8.87 ,$9.72 ,$9.72 ,$8.10 ,$9.72 ,$8.10 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$170.00 ,$146.00 ,$63.95 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$144.00 ,$139.30 ,$115.57 ,$144.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$170.00 ,$146.00 ,$63.95 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$144.00 ,$139.30 ,$115.57 ,$144.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$29.14 ,$170.00 ,$17.14 ,$29.14 ,$170.00 ,$146.00 ,$17.71 ,$17.14 ,$19.40 ,$170.00 ,$38.57 ,$184.00 ,$140.00 ,$61.08 ,$65.67 ,$121.80 ,$61.08 ,$138.20 ,$144.00 ,$139.30 ,$17.31 ,$144.00 ,$18.77 ,$20.57 ,$20.57 ,$17.14 ,$20.57 ,$17.14 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$170.00 ,$146.00 ,$63.95 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$144.00 ,$139.30 ,$115.57 ,$144.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$186.48 ,$189.07 ,$20.49 ,$220.15 ,$12.05 ,$20.49 ,$220.15 ,$189.07 ,$12.45 ,$12.05 ,$13.64 ,$220.15 ,$27.11 ,$238.28 ,$181.30 ,$58.59 ,$62.99 ,$157.73 ,$58.59 ,$178.97 ,$186.48 ,$180.39 ,$12.17 ,$186.48 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$186.48 ,$160.58 ,$186.48 ,$186.48 ,$155.40 
ST MARY'S HOSPITAL,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 ,$278.64 ,$282.51 ,$26.35 ,$328.95 ,$15.50 ,$26.35 ,$328.95 ,$282.51 ,$16.02 ,$15.50 ,$17.54 ,$328.95 ,$34.88 ,$356.04 ,$270.90 ,$75.34 ,$81.00 ,$235.68 ,$75.34 ,$267.42 ,$278.64 ,$269.55 ,$15.66 ,$278.64 ,$16.98 ,$18.60 ,$18.60 ,$15.50 ,$18.60 ,$15.50 ,$278.64 ,$239.94 ,$278.64 ,$278.64 ,$232.20 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,30000463,76120,HC CINERADIOGRAPHY 76120,320,1 ,$403.00 ,$201.50 ,$17.98 ,$403.00 ,$17.98 ,$363.74 ,$323.32 ,$105.88 ,$241.80 ,$342.55 ,$282.10 ,$17.98 ,$382.85 ,$290.16 ,$294.19 ,$194.01 ,$342.55 ,$105.88 ,$194.01 ,$342.55 ,$294.19 ,$17.98 ,$105.88 ,$169.26 ,$342.55 ,$238.23 ,$370.76 ,$282.10 ,$403.00 ,$403.00 ,$245.43 ,$403.00 ,$278.47 ,$290.16 ,$280.69 ,$106.94 ,$290.16 ,$19.06 ,$403.00 ,$403.00 ,$105.88 ,$403.00 ,$105.88 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,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 ,$372.96 ,$378.14 ,$326.94 ,$440.30 ,$192.32 ,$326.94 ,$440.30 ,$378.14 ,$164.96 ,$192.32 ,$217.67 ,$440.30 ,$432.72 ,$476.56 ,$362.60 ,$518.00 ,$518.00 ,$315.46 ,$518.00 ,$357.94 ,$372.96 ,$360.79 ,$194.24 ,$372.96 ,$174.86 ,$230.78 ,$230.78 ,$192.32 ,$230.78 ,$192.32 ,$372.96 ,$321.16 ,$372.96 ,$372.96 ,$310.80 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$105.64 ,$102.00 ,$62.14 ,$105.64 ,$102.00 ,$87.60 ,$63.40 ,$62.14 ,$70.33 ,$102.00 ,$139.82 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$86.40 ,$83.58 ,$62.76 ,$86.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$105.64 ,$102.00 ,$62.14 ,$105.64 ,$102.00 ,$87.60 ,$63.40 ,$62.14 ,$70.33 ,$102.00 ,$139.82 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$86.40 ,$83.58 ,$62.76 ,$86.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$6.48 ,$6.57 ,$9.00 ,$7.65 ,$8.46 ,$9.00 ,$7.65 ,$6.57 ,$8.74 ,$8.46 ,$9.00 ,$7.65 ,$19.04 ,$8.28 ,$6.30 ,$9.00 ,$9.00 ,$5.48 ,$9.00 ,$6.22 ,$6.48 ,$6.27 ,$8.54 ,$6.48 ,$9.26 ,$9.00 ,$9.00 ,$8.46 ,$9.00 ,$8.46 ,$6.48 ,$5.58 ,$6.48 ,$6.48 ,$5.40 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$14.38 ,$82.45 ,$8.46 ,$14.38 ,$82.45 ,$70.81 ,$8.74 ,$8.46 ,$9.58 ,$82.45 ,$19.04 ,$89.24 ,$67.90 ,$41.13 ,$44.22 ,$59.07 ,$41.13 ,$67.03 ,$69.84 ,$67.56 ,$8.54 ,$69.84 ,$9.26 ,$10.15 ,$10.15 ,$8.46 ,$10.15 ,$8.46 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$11.92 ,$46.75 ,$7.01 ,$11.92 ,$46.75 ,$40.15 ,$7.24 ,$7.01 ,$7.93 ,$46.75 ,$15.77 ,$50.60 ,$38.50 ,$34.11 ,$36.67 ,$33.50 ,$34.11 ,$38.01 ,$39.60 ,$38.31 ,$7.08 ,$39.60 ,$7.67 ,$8.41 ,$8.41 ,$7.01 ,$8.41 ,$7.01 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$17.95 ,$113.90 ,$10.56 ,$17.95 ,$113.90 ,$97.82 ,$10.91 ,$10.56 ,$11.95 ,$113.90 ,$23.76 ,$123.28 ,$93.80 ,$51.35 ,$55.21 ,$81.61 ,$51.35 ,$92.59 ,$96.48 ,$93.33 ,$10.67 ,$96.48 ,$11.56 ,$12.67 ,$12.67 ,$10.56 ,$12.67 ,$10.56 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$10.80 ,$10.95 ,$15.00 ,$12.75 ,$10.56 ,$15.00 ,$12.75 ,$10.95 ,$10.91 ,$10.56 ,$11.95 ,$12.75 ,$23.76 ,$13.80 ,$10.50 ,$15.00 ,$15.00 ,$9.14 ,$15.00 ,$10.37 ,$10.80 ,$10.45 ,$10.67 ,$10.80 ,$11.56 ,$12.67 ,$12.67 ,$10.56 ,$12.67 ,$10.56 ,$10.80 ,$9.30 ,$10.80 ,$10.80 ,$9.00 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$81.28 ,$247.35 ,$47.81 ,$81.28 ,$247.35 ,$212.43 ,$18.84 ,$47.81 ,$54.11 ,$247.35 ,$107.57 ,$267.72 ,$203.70 ,$228.83 ,$246.03 ,$177.22 ,$228.83 ,$201.08 ,$209.52 ,$202.68 ,$48.29 ,$209.52 ,$19.97 ,$57.37 ,$57.37 ,$47.81 ,$57.37 ,$47.81 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.76 ,$85.85 ,$13.39 ,$22.76 ,$85.85 ,$73.73 ,$13.84 ,$13.39 ,$15.15 ,$85.85 ,$30.13 ,$92.92 ,$70.70 ,$65.11 ,$70.00 ,$61.51 ,$65.11 ,$69.79 ,$72.72 ,$70.35 ,$13.52 ,$72.72 ,$14.67 ,$16.07 ,$16.07 ,$13.39 ,$16.07 ,$13.39 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$14.76 ,$95.20 ,$8.68 ,$14.76 ,$95.20 ,$81.76 ,$8.97 ,$8.68 ,$9.82 ,$95.20 ,$19.53 ,$103.04 ,$78.40 ,$42.23 ,$45.40 ,$68.21 ,$42.23 ,$77.39 ,$80.64 ,$78.01 ,$8.77 ,$80.64 ,$9.51 ,$10.42 ,$10.42 ,$8.68 ,$10.42 ,$8.68 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$80.97 ,$304.30 ,$47.63 ,$80.97 ,$304.30 ,$261.34 ,$49.22 ,$47.63 ,$53.91 ,$304.30 ,$107.17 ,$329.36 ,$250.60 ,$231.61 ,$249.02 ,$218.02 ,$231.61 ,$247.38 ,$257.76 ,$249.35 ,$48.11 ,$257.76 ,$52.17 ,$57.16 ,$57.16 ,$47.63 ,$57.16 ,$47.63 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$13.89 ,$66.30 ,$8.17 ,$13.89 ,$66.30 ,$56.94 ,$8.44 ,$8.17 ,$9.25 ,$66.30 ,$18.38 ,$71.76 ,$54.60 ,$39.70 ,$42.68 ,$47.50 ,$39.70 ,$53.90 ,$56.16 ,$54.33 ,$8.25 ,$56.16 ,$8.95 ,$9.80 ,$9.80 ,$8.17 ,$9.80 ,$8.17 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$85.68 ,$86.87 ,$25.64 ,$101.15 ,$15.08 ,$25.64 ,$101.15 ,$86.87 ,$15.58 ,$15.08 ,$17.07 ,$101.15 ,$33.93 ,$109.48 ,$83.30 ,$73.27 ,$78.78 ,$72.47 ,$73.27 ,$82.23 ,$85.68 ,$82.88 ,$15.23 ,$85.68 ,$16.51 ,$18.10 ,$18.10 ,$15.08 ,$18.10 ,$15.08 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$71.40 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$38.56 ,$76.50 , N/A ,$38.56 ,$76.50 ,$65.70 ,$3.81 , N/A ,$37.80 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 , N/A ,$64.80 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$76.32 ,$77.38 ,$38.56 ,$90.10 , N/A ,$38.56 ,$90.10 ,$77.38 ,$3.81 , N/A ,$44.52 ,$90.10 , N/A ,$97.52 ,$74.20 ,$53.76 ,$64.52 ,$64.55 ,$60.22 ,$73.25 ,$76.32 ,$73.83 , N/A ,$76.32 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$63.60 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$38.00 ,$32.30 , N/A ,$38.00 ,$32.30 ,$27.74 ,$3.81 , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$21.59 ,$26.26 ,$27.36 ,$26.47 , N/A ,$27.36 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$38.00 ,$32.30 , N/A ,$38.00 ,$32.30 ,$27.74 ,$3.81 , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$21.59 ,$26.26 ,$27.36 ,$26.47 , N/A ,$27.36 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$24.77 ,$91.80 ,$14.57 ,$24.77 ,$91.80 ,$78.84 ,$15.06 ,$14.57 ,$16.49 ,$91.80 ,$32.78 ,$99.36 ,$75.60 ,$70.81 ,$76.13 ,$65.77 ,$70.81 ,$74.63 ,$77.76 ,$75.22 ,$14.72 ,$77.76 ,$15.96 ,$17.48 ,$17.48 ,$14.57 ,$17.48 ,$14.57 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$89.28 ,$90.52 ,$22.53 ,$105.40 ,$13.25 ,$22.53 ,$105.40 ,$90.52 ,$13.69 ,$13.25 ,$15.00 ,$105.40 ,$29.81 ,$114.08 ,$86.80 ,$64.47 ,$69.31 ,$75.52 ,$64.47 ,$85.68 ,$89.28 ,$86.37 ,$13.38 ,$89.28 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$89.28 ,$76.88 ,$89.28 ,$89.28 ,$74.40 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$30.69 ,$76.50 ,$18.05 ,$30.69 ,$76.50 ,$65.70 ,$18.65 ,$18.05 ,$20.43 ,$76.50 ,$40.61 ,$82.80 ,$63.00 ,$87.78 ,$90.00 ,$54.81 ,$87.78 ,$62.19 ,$64.80 ,$62.69 ,$18.23 ,$64.80 ,$19.77 ,$21.66 ,$21.66 ,$18.05 ,$21.66 ,$18.05 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$30.24 ,$30.66 ,$38.56 ,$35.70 , N/A ,$38.56 ,$35.70 ,$30.66 ,$3.81 , N/A ,$17.64 ,$35.70 , N/A ,$38.64 ,$29.40 ,$21.30 ,$25.57 ,$25.58 ,$23.86 ,$29.02 ,$30.24 ,$29.25 , N/A ,$30.24 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$30.24 ,$26.04 ,$30.24 ,$30.24 ,$25.20 
ST MARY'S HOSPITAL,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 ,$102.24 ,$103.66 ,$22.58 ,$120.70 ,$13.28 ,$22.58 ,$120.70 ,$103.66 ,$13.72 ,$13.28 ,$15.03 ,$120.70 ,$29.88 ,$130.64 ,$99.40 ,$64.58 ,$69.43 ,$86.48 ,$64.58 ,$98.12 ,$102.24 ,$98.90 ,$13.41 ,$102.24 ,$14.54 ,$15.94 ,$15.94 ,$13.28 ,$15.94 ,$13.28 ,$102.24 ,$88.04 ,$102.24 ,$102.24 ,$85.20 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$23.02 ,$82.45 ,$13.54 ,$23.02 ,$82.45 ,$70.81 ,$13.99 ,$13.54 ,$15.32 ,$82.45 ,$30.47 ,$89.24 ,$67.90 ,$65.89 ,$70.85 ,$59.07 ,$65.89 ,$67.03 ,$69.84 ,$67.56 ,$13.68 ,$69.84 ,$14.83 ,$16.25 ,$16.25 ,$13.54 ,$16.25 ,$13.54 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 ,$38.56 ,$52.70 , N/A ,$38.56 ,$52.70 ,$45.26 ,$3.81 , N/A ,$26.04 ,$52.70 , N/A ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$35.22 ,$42.84 ,$44.64 ,$43.18 , N/A ,$44.64 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$85.68 ,$86.87 ,$27.78 ,$101.15 ,$16.34 ,$27.78 ,$101.15 ,$86.87 ,$16.88 ,$16.34 ,$18.49 ,$101.15 ,$36.77 ,$109.48 ,$83.30 ,$79.47 ,$85.44 ,$72.47 ,$79.47 ,$82.23 ,$85.68 ,$82.88 ,$16.50 ,$85.68 ,$17.89 ,$19.61 ,$19.61 ,$16.34 ,$19.61 ,$16.34 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$71.40 
ST MARY'S HOSPITAL,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 ,$124.56 ,$126.29 ,$27.85 ,$147.05 ,$16.38 ,$27.85 ,$147.05 ,$126.29 ,$16.93 ,$16.38 ,$18.54 ,$147.05 ,$36.86 ,$159.16 ,$121.10 ,$79.69 ,$85.67 ,$105.36 ,$79.69 ,$119.54 ,$124.56 ,$120.49 ,$16.54 ,$124.56 ,$17.95 ,$19.66 ,$19.66 ,$16.38 ,$19.66 ,$16.38 ,$124.56 ,$107.26 ,$124.56 ,$124.56 ,$103.80 
ST MARY'S HOSPITAL,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 ,$46.80 ,$47.45 ,$38.56 ,$55.25 , N/A ,$38.56 ,$55.25 ,$47.45 ,$3.81 , N/A ,$27.30 ,$55.25 , N/A ,$59.80 ,$45.50 ,$32.97 ,$39.57 ,$39.59 ,$36.93 ,$44.92 ,$46.80 ,$45.27 , N/A ,$46.80 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,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 ,$139.68 ,$141.62 ,$24.97 ,$164.90 ,$14.69 ,$24.97 ,$164.90 ,$141.62 ,$15.18 ,$14.69 ,$16.63 ,$164.90 ,$33.05 ,$178.48 ,$135.80 ,$71.42 ,$76.79 ,$118.15 ,$71.42 ,$134.05 ,$139.68 ,$135.12 ,$14.84 ,$139.68 ,$16.09 ,$17.63 ,$17.63 ,$14.69 ,$17.63 ,$14.69 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$116.40 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$11.24 ,$41.65 ,$6.61 ,$11.24 ,$41.65 ,$35.77 ,$6.83 ,$6.61 ,$7.48 ,$41.65 ,$14.87 ,$45.08 ,$34.30 ,$32.15 ,$34.56 ,$29.84 ,$32.15 ,$33.86 ,$35.28 ,$34.13 ,$6.68 ,$35.28 ,$7.24 ,$7.93 ,$7.93 ,$6.61 ,$7.93 ,$6.61 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$38.56 ,$72.25 , N/A ,$38.56 ,$72.25 ,$62.05 ,$3.81 , N/A ,$35.70 ,$72.25 , N/A ,$78.20 ,$59.50 ,$43.11 ,$51.74 ,$51.77 ,$48.29 ,$58.74 ,$61.20 ,$59.20 , N/A ,$61.20 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$26.01 ,$82.45 ,$15.30 ,$26.01 ,$82.45 ,$70.81 ,$15.81 ,$15.30 ,$17.32 ,$82.45 ,$34.43 ,$89.24 ,$67.90 ,$55.67 ,$59.85 ,$59.07 ,$55.67 ,$67.03 ,$69.84 ,$67.56 ,$15.45 ,$69.84 ,$16.76 ,$18.36 ,$18.36 ,$15.30 ,$18.36 ,$15.30 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$22.53 ,$82.45 ,$13.25 ,$22.53 ,$82.45 ,$70.81 ,$13.69 ,$13.25 ,$15.00 ,$82.45 ,$29.81 ,$89.24 ,$67.90 ,$64.47 ,$69.31 ,$59.07 ,$64.47 ,$67.03 ,$69.84 ,$67.56 ,$13.38 ,$69.84 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$54.72 ,$55.48 ,$23.39 ,$64.60 ,$13.76 ,$23.39 ,$64.60 ,$55.48 ,$14.22 ,$13.76 ,$15.57 ,$64.60 ,$30.96 ,$69.92 ,$53.20 ,$57.06 ,$61.34 ,$46.28 ,$57.06 ,$52.52 ,$54.72 ,$52.93 ,$13.90 ,$54.72 ,$15.07 ,$16.51 ,$16.51 ,$13.76 ,$16.51 ,$13.76 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$45.60 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$28.20 ,$82.45 ,$16.59 ,$28.20 ,$82.45 ,$70.81 ,$17.14 ,$16.59 ,$18.78 ,$82.45 ,$37.33 ,$89.24 ,$67.90 ,$80.68 ,$86.75 ,$59.07 ,$80.68 ,$67.03 ,$69.84 ,$67.56 ,$16.76 ,$69.84 ,$18.17 ,$19.91 ,$19.91 ,$16.59 ,$19.91 ,$16.59 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$82.80 ,$83.95 ,$28.48 ,$97.75 ,$16.75 ,$28.48 ,$97.75 ,$83.95 ,$17.31 ,$16.75 ,$18.96 ,$97.75 ,$37.69 ,$105.80 ,$80.50 ,$81.43 ,$87.55 ,$70.04 ,$81.43 ,$79.47 ,$82.80 ,$80.10 ,$16.92 ,$82.80 ,$18.35 ,$20.10 ,$20.10 ,$16.75 ,$20.10 ,$16.75 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$69.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$24.82 ,$93.50 ,$14.60 ,$24.82 ,$93.50 ,$80.30 ,$15.09 ,$14.60 ,$16.52 ,$93.50 ,$32.85 ,$101.20 ,$77.00 ,$70.99 ,$76.33 ,$66.99 ,$70.99 ,$76.01 ,$79.20 ,$76.62 ,$14.75 ,$79.20 ,$16.00 ,$17.52 ,$17.52 ,$14.60 ,$17.52 ,$14.60 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 ,$23.34 ,$73.10 ,$13.73 ,$23.34 ,$73.10 ,$62.78 ,$14.19 ,$13.73 ,$15.54 ,$73.10 ,$30.89 ,$79.12 ,$60.20 ,$66.75 ,$71.77 ,$52.37 ,$66.75 ,$59.43 ,$61.92 ,$59.90 ,$13.87 ,$61.92 ,$15.04 ,$16.48 ,$16.48 ,$13.73 ,$16.48 ,$13.73 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$129.60 ,$131.40 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$153.00 ,$131.40 ,$63.95 ,$114.43 ,$129.51 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$129.60 ,$125.37 ,$115.57 ,$129.60 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$108.00 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$23.34 ,$82.45 ,$13.73 ,$23.34 ,$82.45 ,$70.81 ,$14.19 ,$13.73 ,$15.54 ,$82.45 ,$30.89 ,$89.24 ,$67.90 ,$66.75 ,$71.77 ,$59.07 ,$66.75 ,$67.03 ,$69.84 ,$67.56 ,$13.87 ,$69.84 ,$15.04 ,$16.48 ,$16.48 ,$13.73 ,$16.48 ,$13.73 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 ,$24.04 ,$73.10 ,$14.14 ,$24.04 ,$73.10 ,$62.78 ,$14.61 ,$14.14 ,$16.00 ,$73.10 ,$31.82 ,$79.12 ,$60.20 ,$68.78 ,$73.95 ,$52.37 ,$68.78 ,$59.43 ,$61.92 ,$59.90 ,$14.28 ,$61.92 ,$15.49 ,$16.97 ,$16.97 ,$14.14 ,$16.97 ,$14.14 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$27.42 ,$82.45 ,$16.13 ,$27.42 ,$82.45 ,$70.81 ,$16.67 ,$16.13 ,$18.26 ,$82.45 ,$36.29 ,$89.24 ,$67.90 ,$78.37 ,$84.26 ,$59.07 ,$78.37 ,$67.03 ,$69.84 ,$67.56 ,$16.29 ,$69.84 ,$17.67 ,$19.36 ,$19.36 ,$16.13 ,$19.36 ,$16.13 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$69.84 ,$70.81 ,$20.26 ,$82.45 ,$11.92 ,$20.26 ,$82.45 ,$70.81 ,$12.32 ,$11.92 ,$13.49 ,$82.45 ,$26.82 ,$89.24 ,$67.90 ,$57.98 ,$62.34 ,$59.07 ,$57.98 ,$67.03 ,$69.84 ,$67.56 ,$12.04 ,$69.84 ,$13.06 ,$14.30 ,$14.30 ,$11.92 ,$14.30 ,$11.92 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$85.68 ,$86.87 ,$23.02 ,$101.15 ,$13.54 ,$23.02 ,$101.15 ,$86.87 ,$13.99 ,$13.54 ,$15.32 ,$101.15 ,$30.47 ,$109.48 ,$83.30 ,$65.89 ,$70.85 ,$72.47 ,$65.89 ,$82.23 ,$85.68 ,$82.88 ,$13.68 ,$85.68 ,$14.83 ,$16.25 ,$16.25 ,$13.54 ,$16.25 ,$13.54 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$71.40 
ST MARY'S HOSPITAL,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 ,$112.32 ,$113.88 ,$31.69 ,$132.60 ,$18.64 ,$31.69 ,$132.60 ,$113.88 ,$19.26 ,$18.64 ,$21.10 ,$132.60 ,$41.94 ,$143.52 ,$109.20 ,$66.57 ,$71.57 ,$95.00 ,$66.57 ,$107.80 ,$112.32 ,$108.65 ,$18.83 ,$112.32 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$112.32 ,$96.72 ,$112.32 ,$112.32 ,$93.60 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$31.69 ,$137.70 ,$18.64 ,$31.69 ,$137.70 ,$118.26 ,$19.26 ,$18.64 ,$21.10 ,$137.70 ,$41.94 ,$149.04 ,$113.40 ,$66.57 ,$71.57 ,$98.66 ,$66.57 ,$111.94 ,$116.64 ,$112.83 ,$18.83 ,$116.64 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$31.69 ,$104.55 ,$18.64 ,$31.69 ,$104.55 ,$89.79 ,$19.26 ,$18.64 ,$21.10 ,$104.55 ,$41.94 ,$113.16 ,$86.10 ,$66.57 ,$71.57 ,$74.91 ,$66.57 ,$84.99 ,$88.56 ,$85.67 ,$18.83 ,$88.56 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$46.09 ,$42.50 ,$27.11 ,$46.09 ,$42.50 ,$36.50 ,$21.69 ,$27.11 ,$30.68 ,$42.50 ,$61.00 ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$28.41 ,$34.55 ,$36.00 ,$34.83 ,$27.38 ,$36.00 ,$22.99 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$27.11 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$36.84 ,$93.50 ,$21.67 ,$36.84 ,$93.50 ,$80.30 ,$14.48 ,$21.67 ,$24.53 ,$93.50 ,$48.76 ,$101.20 ,$77.00 ,$64.47 ,$69.31 ,$66.99 ,$64.47 ,$76.01 ,$79.20 ,$76.62 ,$21.89 ,$79.20 ,$15.35 ,$26.00 ,$26.00 ,$21.67 ,$26.00 ,$21.67 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$22.53 ,$76.50 ,$13.25 ,$22.53 ,$76.50 ,$65.70 ,$13.69 ,$13.25 ,$15.00 ,$76.50 ,$29.81 ,$82.80 ,$63.00 ,$64.47 ,$69.31 ,$54.81 ,$64.47 ,$62.19 ,$64.80 ,$62.69 ,$13.38 ,$64.80 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$85.00 ,$73.00 ,$13.69 ,$13.25 ,$15.00 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$64.47 ,$69.31 ,$60.90 ,$64.47 ,$69.10 ,$72.00 ,$69.65 ,$13.38 ,$72.00 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$22.53 ,$93.50 ,$13.25 ,$22.53 ,$93.50 ,$80.30 ,$13.69 ,$13.25 ,$15.00 ,$93.50 ,$29.81 ,$101.20 ,$77.00 ,$64.47 ,$69.31 ,$66.99 ,$64.47 ,$76.01 ,$79.20 ,$76.62 ,$13.38 ,$79.20 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$85.00 ,$73.00 ,$13.69 ,$13.25 ,$15.00 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$64.47 ,$69.31 ,$60.90 ,$64.47 ,$69.10 ,$72.00 ,$69.65 ,$13.38 ,$72.00 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$46.09 ,$102.00 ,$27.11 ,$46.09 ,$102.00 ,$87.60 ,$19.70 ,$27.11 ,$30.68 ,$102.00 ,$61.00 ,$110.40 ,$84.00 ,$87.78 ,$94.37 ,$73.08 ,$87.78 ,$82.92 ,$86.40 ,$83.58 ,$27.38 ,$86.40 ,$20.88 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$27.11 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$31.69 ,$137.70 ,$18.64 ,$31.69 ,$137.70 ,$118.26 ,$19.26 ,$18.64 ,$21.10 ,$137.70 ,$41.94 ,$149.04 ,$113.40 ,$66.57 ,$71.57 ,$98.66 ,$66.57 ,$111.94 ,$116.64 ,$112.83 ,$18.83 ,$116.64 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$65.52 ,$66.43 ,$31.69 ,$77.35 ,$18.64 ,$31.69 ,$77.35 ,$66.43 ,$19.26 ,$18.64 ,$21.10 ,$77.35 ,$41.94 ,$83.72 ,$63.70 ,$66.57 ,$71.57 ,$55.42 ,$66.57 ,$62.88 ,$65.52 ,$63.38 ,$18.83 ,$65.52 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$65.52 ,$56.42 ,$65.52 ,$65.52 ,$54.60 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$31.69 ,$137.70 ,$18.64 ,$31.69 ,$137.70 ,$118.26 ,$19.26 ,$18.64 ,$21.10 ,$137.70 ,$41.94 ,$149.04 ,$113.40 ,$66.57 ,$71.57 ,$98.66 ,$66.57 ,$111.94 ,$116.64 ,$112.83 ,$18.83 ,$116.64 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 , N/A ,$561.85 , N/A , N/A ,$561.85 ,$482.53 ,$0.87 , N/A ,$277.62 ,$561.85 ,$396.60 ,$608.12 ,$462.70 ,$335.26 ,$402.35 ,$402.55 ,$375.51 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$0.92 ,$330.50 ,$330.50 , N/A ,$330.50 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$194.53 ,$170.00 ,$114.43 ,$194.53 ,$170.00 ,$146.00 ,$63.95 ,$114.43 ,$129.51 ,$170.00 ,$257.47 ,$184.00 ,$140.00 ,$200.00 ,$200.00 ,$121.80 ,$200.00 ,$138.20 ,$144.00 ,$139.30 ,$115.57 ,$144.00 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$7.68 ,$40.80 ,$4.52 ,$7.68 ,$40.80 ,$35.04 ,$4.67 ,$4.52 ,$5.12 ,$40.80 ,$10.17 ,$44.16 ,$33.60 ,$21.95 ,$23.60 ,$29.23 ,$21.95 ,$33.17 ,$34.56 ,$33.43 ,$4.57 ,$34.56 ,$4.95 ,$5.42 ,$5.42 ,$4.52 ,$5.42 ,$4.52 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$13.89 ,$46.75 ,$8.17 ,$13.89 ,$46.75 ,$40.15 ,$8.44 ,$8.17 ,$9.25 ,$46.75 ,$18.38 ,$50.60 ,$38.50 ,$39.74 ,$42.72 ,$33.50 ,$39.74 ,$38.01 ,$39.60 ,$38.31 ,$8.25 ,$39.60 ,$8.95 ,$9.80 ,$9.80 ,$8.17 ,$9.80 ,$8.17 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ,$347.04 ,$351.86 ,$28.68 ,$409.70 ,$16.87 ,$28.68 ,$409.70 ,$351.86 ,$17.43 ,$16.87 ,$19.09 ,$409.70 ,$37.96 ,$443.44 ,$337.40 ,$70.06 ,$75.33 ,$293.54 ,$70.06 ,$333.06 ,$347.04 ,$335.71 ,$17.04 ,$347.04 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$17.00 ,$14.45 ,$16.87 ,$17.00 ,$14.45 ,$12.41 ,$17.00 ,$16.87 ,$17.00 ,$14.45 ,$37.96 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$12.24 ,$11.84 ,$17.04 ,$12.24 ,$18.02 ,$17.00 ,$17.00 ,$16.87 ,$17.00 ,$16.87 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$17.00 ,$14.45 ,$16.87 ,$17.00 ,$14.45 ,$12.41 ,$17.00 ,$16.87 ,$17.00 ,$14.45 ,$37.96 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$12.24 ,$11.84 ,$17.04 ,$12.24 ,$18.02 ,$17.00 ,$17.00 ,$16.87 ,$17.00 ,$16.87 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$311.76 ,$316.09 ,$28.68 ,$368.05 ,$16.87 ,$28.68 ,$368.05 ,$316.09 ,$17.43 ,$16.87 ,$19.09 ,$368.05 ,$37.96 ,$398.36 ,$303.10 ,$70.06 ,$75.33 ,$263.70 ,$70.06 ,$299.20 ,$311.76 ,$301.58 ,$17.04 ,$311.76 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$311.76 ,$268.46 ,$311.76 ,$311.76 ,$259.80 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$65.65 ,$247.35 ,$38.62 ,$65.65 ,$247.35 ,$212.43 ,$39.91 ,$38.62 ,$43.71 ,$247.35 ,$86.90 ,$267.72 ,$203.70 ,$187.81 ,$201.93 ,$177.22 ,$187.81 ,$201.08 ,$209.52 ,$202.68 ,$39.01 ,$209.52 ,$42.30 ,$46.34 ,$46.34 ,$38.62 ,$46.34 ,$38.62 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$8.42 ,$32.30 ,$4.95 ,$8.42 ,$32.30 ,$27.74 ,$5.11 ,$4.95 ,$5.60 ,$32.30 ,$11.14 ,$34.96 ,$26.60 ,$24.06 ,$25.86 ,$23.14 ,$24.06 ,$26.26 ,$27.36 ,$26.47 ,$5.00 ,$27.36 ,$5.42 ,$5.94 ,$5.94 ,$4.95 ,$5.94 ,$4.95 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$8.42 ,$32.30 ,$4.95 ,$8.42 ,$32.30 ,$27.74 ,$5.11 ,$4.95 ,$5.60 ,$32.30 ,$11.14 ,$34.96 ,$26.60 ,$24.06 ,$25.86 ,$23.14 ,$24.06 ,$26.26 ,$27.36 ,$26.47 ,$5.00 ,$27.36 ,$5.42 ,$5.94 ,$5.94 ,$4.95 ,$5.94 ,$4.95 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.23 ,$56.95 ,$7.78 ,$13.23 ,$56.95 ,$48.91 ,$7.27 ,$7.78 ,$8.81 ,$56.95 ,$17.51 ,$61.64 ,$46.90 ,$25.16 ,$27.05 ,$40.80 ,$25.16 ,$46.30 ,$48.24 ,$46.67 ,$7.86 ,$48.24 ,$7.71 ,$9.34 ,$9.34 ,$7.78 ,$9.34 ,$7.78 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.23 ,$56.95 ,$7.78 ,$13.23 ,$56.95 ,$48.91 ,$7.27 ,$7.78 ,$8.81 ,$56.95 ,$17.51 ,$61.64 ,$46.90 ,$25.16 ,$27.05 ,$40.80 ,$25.16 ,$46.30 ,$48.24 ,$46.67 ,$7.86 ,$48.24 ,$7.71 ,$9.34 ,$9.34 ,$7.78 ,$9.34 ,$7.78 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$38.88 ,$39.42 ,$9.83 ,$45.90 ,$5.78 ,$9.83 ,$45.90 ,$39.42 ,$5.97 ,$5.78 ,$6.54 ,$45.90 ,$13.01 ,$49.68 ,$37.80 ,$28.12 ,$30.23 ,$32.89 ,$28.12 ,$37.31 ,$38.88 ,$37.61 ,$5.84 ,$38.88 ,$6.33 ,$6.94 ,$6.94 ,$5.78 ,$6.94 ,$5.78 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$32.40 
ST MARY'S HOSPITAL,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 ,$129.60 ,$131.40 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$153.00 ,$131.40 ,$63.95 ,$114.43 ,$129.51 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$129.60 ,$125.37 ,$115.57 ,$129.60 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$108.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$16.51 ,$56.95 ,$9.71 ,$16.51 ,$56.95 ,$48.91 ,$10.03 ,$9.71 ,$10.99 ,$56.95 ,$21.85 ,$61.64 ,$46.90 ,$47.18 ,$50.73 ,$40.80 ,$47.18 ,$46.30 ,$48.24 ,$46.67 ,$9.81 ,$48.24 ,$10.63 ,$11.65 ,$11.65 ,$9.71 ,$11.65 ,$9.71 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$226.08 ,$229.22 ,$69.28 ,$266.90 ,$40.75 ,$69.28 ,$266.90 ,$229.22 ,$42.11 ,$40.75 ,$46.12 ,$266.90 ,$91.69 ,$288.88 ,$219.80 ,$198.15 ,$213.04 ,$191.23 ,$198.15 ,$216.97 ,$226.08 ,$218.70 ,$41.16 ,$226.08 ,$44.64 ,$48.90 ,$48.90 ,$40.75 ,$48.90 ,$40.75 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$188.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.85 ,$85.85 ,$13.44 ,$22.85 ,$85.85 ,$73.73 ,$13.89 ,$13.44 ,$15.21 ,$85.85 ,$30.24 ,$92.92 ,$70.70 ,$65.32 ,$70.23 ,$61.51 ,$65.32 ,$69.79 ,$72.72 ,$70.35 ,$13.57 ,$72.72 ,$14.72 ,$16.13 ,$16.13 ,$13.44 ,$16.13 ,$13.44 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.85 ,$85.85 ,$13.44 ,$22.85 ,$85.85 ,$73.73 ,$13.89 ,$13.44 ,$15.21 ,$85.85 ,$30.24 ,$92.92 ,$70.70 ,$65.32 ,$70.23 ,$61.51 ,$65.32 ,$69.79 ,$72.72 ,$70.35 ,$13.57 ,$72.72 ,$14.72 ,$16.13 ,$16.13 ,$13.44 ,$16.13 ,$13.44 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$106.56 ,$108.04 ,$24.58 ,$125.80 ,$14.46 ,$24.58 ,$125.80 ,$108.04 ,$14.94 ,$14.46 ,$16.37 ,$125.80 ,$32.54 ,$136.16 ,$103.60 ,$70.31 ,$75.60 ,$90.13 ,$70.31 ,$102.27 ,$106.56 ,$103.08 ,$14.60 ,$106.56 ,$15.84 ,$17.35 ,$17.35 ,$14.46 ,$17.35 ,$14.46 ,$106.56 ,$91.76 ,$106.56 ,$106.56 ,$88.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.51 ,$104.55 ,$16.77 ,$28.51 ,$104.55 ,$89.79 ,$17.33 ,$16.77 ,$18.98 ,$104.55 ,$37.73 ,$113.16 ,$86.10 ,$81.58 ,$87.71 ,$74.91 ,$81.58 ,$84.99 ,$88.56 ,$85.67 ,$16.94 ,$88.56 ,$18.37 ,$20.12 ,$20.12 ,$16.77 ,$20.12 ,$16.77 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.51 ,$104.55 ,$16.77 ,$28.51 ,$104.55 ,$89.79 ,$17.33 ,$16.77 ,$18.98 ,$104.55 ,$37.73 ,$113.16 ,$86.10 ,$81.58 ,$87.71 ,$74.91 ,$81.58 ,$84.99 ,$88.56 ,$85.67 ,$16.94 ,$88.56 ,$18.37 ,$20.12 ,$20.12 ,$16.77 ,$20.12 ,$16.77 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.51 ,$104.55 ,$16.77 ,$28.51 ,$104.55 ,$89.79 ,$17.33 ,$16.77 ,$18.98 ,$104.55 ,$37.73 ,$113.16 ,$86.10 ,$81.58 ,$87.71 ,$74.91 ,$81.58 ,$84.99 ,$88.56 ,$85.67 ,$16.94 ,$88.56 ,$18.37 ,$20.12 ,$20.12 ,$16.77 ,$20.12 ,$16.77 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$43.32 ,$133.45 ,$25.48 ,$43.32 ,$133.45 ,$114.61 ,$26.33 ,$25.48 ,$28.84 ,$133.45 ,$57.33 ,$144.44 ,$109.90 ,$123.88 ,$133.19 ,$95.61 ,$123.88 ,$108.49 ,$113.04 ,$109.35 ,$25.73 ,$113.04 ,$27.91 ,$30.58 ,$30.58 ,$25.48 ,$30.58 ,$25.48 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$122.40 ,$124.10 ,$39.07 ,$144.50 ,$22.98 ,$39.07 ,$144.50 ,$124.10 ,$21.01 ,$22.98 ,$26.01 ,$144.50 ,$51.71 ,$156.40 ,$119.00 ,$82.00 ,$88.17 ,$103.53 ,$82.00 ,$117.47 ,$122.40 ,$118.41 ,$23.21 ,$122.40 ,$22.27 ,$27.58 ,$27.58 ,$22.98 ,$27.58 ,$22.98 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$102.00 
ST MARY'S HOSPITAL,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 ,$122.40 ,$124.10 ,$39.07 ,$144.50 ,$22.98 ,$39.07 ,$144.50 ,$124.10 ,$21.01 ,$22.98 ,$26.01 ,$144.50 ,$51.71 ,$156.40 ,$119.00 ,$82.00 ,$88.17 ,$103.53 ,$82.00 ,$117.47 ,$122.40 ,$118.41 ,$23.21 ,$122.40 ,$22.27 ,$27.58 ,$27.58 ,$22.98 ,$27.58 ,$22.98 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$102.00 
ST MARY'S HOSPITAL,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 ",$806.40 ,$817.60 ,$28.68 ,$952.00 ,$16.87 ,$28.68 ,$952.00 ,$817.60 ,$17.43 ,$16.87 ,$19.09 ,$952.00 ,$37.96 ,"$1,030.40 ",$784.00 ,$70.06 ,$75.33 ,$682.08 ,$70.06 ,$773.92 ,$806.40 ,$780.08 ,$17.04 ,$806.40 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$347.04 ,$351.86 ,$28.68 ,$409.70 ,$16.87 ,$28.68 ,$409.70 ,$351.86 ,$17.43 ,$16.87 ,$19.09 ,$409.70 ,$37.96 ,$443.44 ,$337.40 ,$70.06 ,$75.33 ,$293.54 ,$70.06 ,$333.06 ,$347.04 ,$335.71 ,$17.04 ,$347.04 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,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 ,$505.44 ,$512.46 ,$28.68 ,$596.70 ,$16.87 ,$28.68 ,$596.70 ,$512.46 ,$17.43 ,$16.87 ,$19.09 ,$596.70 ,$37.96 ,$645.84 ,$491.40 ,$70.06 ,$75.33 ,$427.52 ,$70.06 ,$485.08 ,$505.44 ,$488.94 ,$17.04 ,$505.44 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$505.44 ,$435.24 ,$505.44 ,$505.44 ,$421.20 
ST MARY'S HOSPITAL,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 ,$537.84 ,$545.31 ,$28.68 ,$634.95 ,$16.87 ,$28.68 ,$634.95 ,$545.31 ,$17.43 ,$16.87 ,$19.09 ,$634.95 ,$37.96 ,$687.24 ,$522.90 ,$70.06 ,$75.33 ,$454.92 ,$70.06 ,$516.18 ,$537.84 ,$520.29 ,$17.04 ,$537.84 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$537.84 ,$463.14 ,$537.84 ,$537.84 ,$448.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.77 ,$95.20 ,$14.57 ,$24.77 ,$95.20 ,$81.76 ,$15.06 ,$14.57 ,$16.49 ,$95.20 ,$32.78 ,$103.04 ,$78.40 ,$70.85 ,$76.17 ,$68.21 ,$70.85 ,$77.39 ,$80.64 ,$78.01 ,$14.72 ,$80.64 ,$15.96 ,$17.48 ,$17.48 ,$14.57 ,$17.48 ,$14.57 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$33.12 ,$33.58 ,$38.56 ,$39.10 , N/A ,$38.56 ,$39.10 ,$33.58 ,$3.81 , N/A ,$19.32 ,$39.10 , N/A ,$42.32 ,$32.20 ,$23.33 ,$28.00 ,$28.01 ,$26.13 ,$31.79 ,$33.12 ,$32.04 , N/A ,$33.12 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$27.60 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$11.02 ,$56.95 ,$6.48 ,$11.02 ,$56.95 ,$48.91 ,$6.70 ,$6.48 ,$7.33 ,$56.95 ,$14.58 ,$61.64 ,$46.90 ,$31.50 ,$33.87 ,$40.80 ,$31.50 ,$46.30 ,$48.24 ,$46.67 ,$6.54 ,$48.24 ,$7.10 ,$7.78 ,$7.78 ,$6.48 ,$7.78 ,$6.48 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$49.78 ,$190.40 ,$29.28 ,$49.78 ,$190.40 ,$163.52 ,$30.26 ,$29.28 ,$33.14 ,$190.40 ,$65.88 ,$206.08 ,$156.80 ,$142.34 ,$153.03 ,$136.42 ,$142.34 ,$154.78 ,$161.28 ,$156.02 ,$29.57 ,$161.28 ,$32.08 ,$35.14 ,$35.14 ,$29.28 ,$35.14 ,$29.28 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.82 ,$95.20 ,$14.60 ,$24.82 ,$95.20 ,$81.76 ,$15.09 ,$14.60 ,$16.52 ,$95.20 ,$32.85 ,$103.04 ,$78.40 ,$70.99 ,$76.33 ,$68.21 ,$70.99 ,$77.39 ,$80.64 ,$78.01 ,$14.75 ,$80.64 ,$16.00 ,$17.52 ,$17.52 ,$14.60 ,$17.52 ,$14.60 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.82 ,$95.20 ,$14.60 ,$24.82 ,$95.20 ,$81.76 ,$15.09 ,$14.60 ,$16.52 ,$95.20 ,$32.85 ,$103.04 ,$78.40 ,$70.99 ,$76.33 ,$68.21 ,$70.99 ,$77.39 ,$80.64 ,$78.01 ,$14.75 ,$80.64 ,$16.00 ,$17.52 ,$17.52 ,$14.60 ,$17.52 ,$14.60 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$35.85 ,$85.85 ,$21.09 ,$35.85 ,$85.85 ,$73.73 ,$21.79 ,$21.09 ,$23.87 ,$85.85 ,$47.45 ,$92.92 ,$70.70 ,$75.34 ,$81.00 ,$61.51 ,$75.34 ,$69.79 ,$72.72 ,$70.35 ,$21.30 ,$72.72 ,$23.10 ,$25.31 ,$25.31 ,$21.09 ,$25.31 ,$21.09 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$32.25 ,$45.05 ,$18.97 ,$32.25 ,$45.05 ,$38.69 ,$19.60 ,$18.97 ,$21.47 ,$45.05 ,$42.68 ,$48.76 ,$37.10 ,$53.00 ,$53.00 ,$32.28 ,$53.00 ,$36.62 ,$38.16 ,$36.91 ,$19.16 ,$38.16 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$18.97 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$32.25 ,$76.50 ,$18.97 ,$32.25 ,$76.50 ,$65.70 ,$19.60 ,$18.97 ,$21.47 ,$76.50 ,$42.68 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$64.80 ,$62.69 ,$19.16 ,$64.80 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$18.97 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$32.25 ,$76.50 ,$18.97 ,$32.25 ,$76.50 ,$65.70 ,$19.60 ,$18.97 ,$21.47 ,$76.50 ,$42.68 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$64.80 ,$62.69 ,$19.16 ,$64.80 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$18.97 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$32.25 ,$76.50 ,$18.97 ,$32.25 ,$76.50 ,$65.70 ,$19.60 ,$18.97 ,$21.47 ,$76.50 ,$42.68 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$64.80 ,$62.69 ,$19.16 ,$64.80 ,$20.78 ,$22.76 ,$22.76 ,$18.97 ,$22.76 ,$18.97 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.81 ,$66.30 ,$9.89 ,$16.81 ,$66.30 ,$56.94 ,$10.22 ,$9.89 ,$11.19 ,$66.30 ,$22.25 ,$71.76 ,$54.60 ,$48.04 ,$51.65 ,$47.50 ,$48.04 ,$53.90 ,$56.16 ,$54.33 ,$9.99 ,$56.16 ,$10.83 ,$11.87 ,$11.87 ,$9.89 ,$11.87 ,$9.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$38.00 ,$32.30 , N/A ,$38.00 ,$32.30 ,$27.74 ,$3.81 , N/A ,$15.96 ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$21.59 ,$26.26 ,$27.36 ,$26.47 , N/A ,$27.36 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$100.08 ,$101.47 ,$139.00 ,$118.15 ,$114.43 ,$139.00 ,$118.15 ,$101.47 ,$63.95 ,$114.43 ,$129.51 ,$118.15 ,$257.47 ,$127.88 ,$97.30 ,$139.00 ,$139.00 ,$84.65 ,$139.00 ,$96.05 ,$100.08 ,$96.81 ,$115.57 ,$100.08 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$83.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.51 ,$104.55 ,$16.18 ,$27.51 ,$104.55 ,$89.79 ,$16.72 ,$16.18 ,$18.31 ,$104.55 ,$36.41 ,$113.16 ,$86.10 ,$78.65 ,$84.56 ,$74.91 ,$78.65 ,$84.99 ,$88.56 ,$85.67 ,$16.34 ,$88.56 ,$17.72 ,$19.42 ,$19.42 ,$16.18 ,$19.42 ,$16.18 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$8.53 ,$32.30 ,$5.02 ,$8.53 ,$32.30 ,$27.74 ,$4.24 ,$5.02 ,$5.68 ,$32.30 ,$11.30 ,$34.96 ,$26.60 ,$24.38 ,$26.21 ,$23.14 ,$24.38 ,$26.26 ,$27.36 ,$26.47 ,$5.07 ,$27.36 ,$4.49 ,$6.02 ,$6.02 ,$5.02 ,$6.02 ,$5.02 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$8.53 ,$32.30 ,$5.02 ,$8.53 ,$32.30 ,$27.74 ,$4.70 ,$5.02 ,$5.68 ,$32.30 ,$11.30 ,$34.96 ,$26.60 ,$24.38 ,$26.21 ,$23.14 ,$24.38 ,$26.26 ,$27.36 ,$26.47 ,$5.07 ,$27.36 ,$4.98 ,$6.02 ,$6.02 ,$5.02 ,$6.02 ,$5.02 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$18.72 ,$18.98 ,$7.45 ,$22.10 ,$4.38 ,$7.45 ,$22.10 ,$18.98 ,$3.66 ,$4.38 ,$4.96 ,$22.10 ,$9.86 ,$23.92 ,$18.20 ,$15.82 ,$17.01 ,$15.83 ,$15.82 ,$17.97 ,$18.72 ,$18.11 ,$4.42 ,$18.72 ,$3.88 ,$5.26 ,$5.26 ,$4.38 ,$5.26 ,$4.38 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$15.60 
ST MARY'S HOSPITAL,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 ,$18.72 ,$18.98 ,$9.04 ,$22.10 ,$5.32 ,$9.04 ,$22.10 ,$18.98 ,$4.26 ,$5.32 ,$6.02 ,$22.10 ,$11.97 ,$23.92 ,$18.20 ,$15.82 ,$17.01 ,$15.83 ,$15.82 ,$17.97 ,$18.72 ,$18.11 ,$5.37 ,$18.72 ,$4.52 ,$6.38 ,$6.38 ,$5.32 ,$6.38 ,$5.32 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$15.60 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$7.19 ,$21.25 ,$4.23 ,$7.19 ,$21.25 ,$18.25 ,$4.26 ,$4.23 ,$4.79 ,$21.25 ,$9.52 ,$23.00 ,$17.50 ,$15.82 ,$17.01 ,$15.23 ,$15.82 ,$17.28 ,$18.00 ,$17.41 ,$4.27 ,$18.00 ,$4.52 ,$5.08 ,$5.08 ,$4.23 ,$5.08 ,$4.23 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.06 ,$104.55 ,$15.92 ,$27.06 ,$104.55 ,$89.79 ,$16.45 ,$15.92 ,$18.02 ,$104.55 ,$35.82 ,$113.16 ,$86.10 ,$77.33 ,$83.15 ,$74.91 ,$77.33 ,$84.99 ,$88.56 ,$85.67 ,$16.08 ,$88.56 ,$17.44 ,$19.10 ,$19.10 ,$15.92 ,$19.10 ,$15.92 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$40.19 ,$76.50 ,$23.64 ,$40.19 ,$76.50 ,$65.70 ,$24.43 ,$23.64 ,$26.76 ,$76.50 ,$53.19 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$64.80 ,$62.69 ,$23.88 ,$64.80 ,$25.90 ,$28.37 ,$28.37 ,$23.64 ,$28.37 ,$23.64 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$40.19 ,$76.50 ,$23.64 ,$40.19 ,$76.50 ,$65.70 ,$24.43 ,$23.64 ,$26.76 ,$76.50 ,$53.19 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$64.80 ,$62.69 ,$23.88 ,$64.80 ,$25.90 ,$28.37 ,$28.37 ,$23.64 ,$28.37 ,$23.64 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$40.19 ,$76.50 ,$23.64 ,$40.19 ,$76.50 ,$65.70 ,$24.43 ,$23.64 ,$26.76 ,$76.50 ,$53.19 ,$82.80 ,$63.00 ,$90.00 ,$90.00 ,$54.81 ,$90.00 ,$62.19 ,$64.80 ,$62.69 ,$23.88 ,$64.80 ,$25.90 ,$28.37 ,$28.37 ,$23.64 ,$28.37 ,$23.64 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$50.32 ,$190.40 ,$29.60 ,$50.32 ,$190.40 ,$163.52 ,$30.59 ,$29.60 ,$33.50 ,$190.40 ,$66.60 ,$206.08 ,$156.80 ,$143.98 ,$154.80 ,$136.42 ,$143.98 ,$154.78 ,$161.28 ,$156.02 ,$29.90 ,$161.28 ,$32.43 ,$35.52 ,$35.52 ,$29.60 ,$35.52 ,$29.60 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$45.54 ,$133.45 ,$26.79 ,$45.54 ,$133.45 ,$114.61 ,$27.68 ,$26.79 ,$30.32 ,$133.45 ,$60.28 ,$144.44 ,$109.90 ,$130.22 ,$140.01 ,$95.61 ,$130.22 ,$108.49 ,$113.04 ,$109.35 ,$27.06 ,$113.04 ,$29.34 ,$32.15 ,$32.15 ,$26.79 ,$32.15 ,$26.79 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$8.77 ,$32.30 ,$5.16 ,$8.77 ,$32.30 ,$27.74 ,$5.33 ,$5.16 ,$5.84 ,$32.30 ,$11.61 ,$34.96 ,$26.60 ,$25.09 ,$26.97 ,$23.14 ,$25.09 ,$26.26 ,$27.36 ,$26.47 ,$5.21 ,$27.36 ,$5.65 ,$6.19 ,$6.19 ,$5.16 ,$6.19 ,$5.16 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.26 ,$85.85 ,$13.68 ,$23.26 ,$85.85 ,$73.73 ,$14.14 ,$13.68 ,$15.48 ,$85.85 ,$30.78 ,$92.92 ,$70.70 ,$66.46 ,$71.46 ,$61.51 ,$66.46 ,$69.79 ,$72.72 ,$70.35 ,$13.82 ,$72.72 ,$14.99 ,$16.42 ,$16.42 ,$13.68 ,$16.42 ,$13.68 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$33.12 ,$33.58 ,$10.25 ,$39.10 ,$6.03 ,$10.25 ,$39.10 ,$33.58 ,$6.23 ,$6.03 ,$6.82 ,$39.10 ,$13.57 ,$42.32 ,$32.20 ,$29.33 ,$31.53 ,$28.01 ,$29.33 ,$31.79 ,$33.12 ,$32.04 ,$6.09 ,$33.12 ,$6.60 ,$7.24 ,$7.24 ,$6.03 ,$7.24 ,$6.03 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$27.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.88 ,$85.85 ,$12.87 ,$21.88 ,$85.85 ,$73.73 ,$13.30 ,$12.87 ,$14.57 ,$85.85 ,$28.96 ,$92.92 ,$70.70 ,$62.58 ,$67.28 ,$61.51 ,$62.58 ,$69.79 ,$72.72 ,$70.35 ,$13.00 ,$72.72 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$84.96 ,$86.14 ,$21.93 ,$100.30 ,$12.90 ,$21.93 ,$100.30 ,$86.14 ,$13.33 ,$12.90 ,$14.60 ,$100.30 ,$29.03 ,$108.56 ,$82.60 ,$62.69 ,$67.40 ,$71.86 ,$62.69 ,$81.54 ,$84.96 ,$82.19 ,$13.03 ,$84.96 ,$14.13 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$12.90 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$70.80 
ST MARY'S HOSPITAL,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 ,$372.24 ,$377.41 ,$30.70 ,$439.45 ,$18.06 ,$30.70 ,$439.45 ,$377.41 ,$10.38 ,$18.06 ,$20.44 ,$439.45 ,$40.64 ,$475.64 ,$361.90 ,$87.78 ,$94.37 ,$314.85 ,$87.78 ,$357.25 ,$372.24 ,$360.09 ,$18.24 ,$372.24 ,$11.00 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$18.06 ,$372.24 ,$320.54 ,$372.24 ,$372.24 ,$310.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$8.30 ,$85.85 ,$4.88 ,$8.30 ,$85.85 ,$73.73 ,$5.04 ,$4.88 ,$5.52 ,$85.85 ,$10.98 ,$92.92 ,$70.70 ,$23.77 ,$25.56 ,$61.51 ,$23.77 ,$69.79 ,$72.72 ,$70.35 ,$4.93 ,$72.72 ,$5.34 ,$5.86 ,$5.86 ,$4.88 ,$5.86 ,$4.88 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$30.96 ,$31.39 ,$8.30 ,$36.55 ,$4.88 ,$8.30 ,$36.55 ,$31.39 ,$5.04 ,$4.88 ,$5.52 ,$36.55 ,$10.98 ,$39.56 ,$30.10 ,$23.77 ,$25.56 ,$26.19 ,$23.77 ,$29.71 ,$30.96 ,$29.95 ,$4.93 ,$30.96 ,$5.34 ,$5.86 ,$5.86 ,$4.88 ,$5.86 ,$4.88 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$20.94 ,$142.80 ,$12.32 ,$20.94 ,$142.80 ,$122.64 ,$12.73 ,$12.32 ,$13.94 ,$142.80 ,$27.72 ,$154.56 ,$117.60 ,$59.91 ,$64.41 ,$102.31 ,$59.91 ,$116.09 ,$120.96 ,$117.01 ,$12.44 ,$120.96 ,$13.49 ,$14.78 ,$14.78 ,$12.32 ,$14.78 ,$12.32 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$20.94 ,$142.80 ,$12.32 ,$20.94 ,$142.80 ,$122.64 ,$12.73 ,$12.32 ,$13.94 ,$142.80 ,$27.72 ,$154.56 ,$117.60 ,$59.91 ,$64.41 ,$102.31 ,$59.91 ,$116.09 ,$120.96 ,$117.01 ,$12.44 ,$120.96 ,$13.49 ,$14.78 ,$14.78 ,$12.32 ,$14.78 ,$12.32 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.23 ,$124.10 ,$18.96 ,$32.23 ,$124.10 ,$106.58 ,$19.59 ,$18.96 ,$21.46 ,$124.10 ,$42.66 ,$134.32 ,$102.20 ,$92.23 ,$99.16 ,$88.91 ,$92.23 ,$100.89 ,$105.12 ,$101.69 ,$19.15 ,$105.12 ,$20.77 ,$22.75 ,$22.75 ,$18.96 ,$22.75 ,$18.96 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$32.23 ,$199.75 ,$18.96 ,$32.23 ,$199.75 ,$171.55 ,$19.59 ,$18.96 ,$21.46 ,$199.75 ,$42.66 ,$216.20 ,$164.50 ,$92.23 ,$99.16 ,$143.12 ,$92.23 ,$162.39 ,$169.20 ,$163.68 ,$19.15 ,$169.20 ,$20.77 ,$22.75 ,$22.75 ,$18.96 ,$22.75 ,$18.96 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$404.64 ,$410.26 ,$28.68 ,$477.70 ,$16.87 ,$28.68 ,$477.70 ,$410.26 ,$17.43 ,$16.87 ,$19.09 ,$477.70 ,$37.96 ,$517.04 ,$393.40 ,$70.06 ,$75.33 ,$342.26 ,$70.06 ,$388.34 ,$404.64 ,$391.43 ,$17.04 ,$404.64 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$404.64 ,$348.44 ,$404.64 ,$404.64 ,$337.20 
ST MARY'S HOSPITAL,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 ,$373.68 ,$378.87 ,$28.68 ,$441.15 ,$16.87 ,$28.68 ,$441.15 ,$378.87 ,$17.43 ,$16.87 ,$19.09 ,$441.15 ,$37.96 ,$477.48 ,$363.30 ,$70.06 ,$75.33 ,$316.07 ,$70.06 ,$358.63 ,$373.68 ,$361.48 ,$17.04 ,$373.68 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$373.68 ,$321.78 ,$373.68 ,$373.68 ,$311.40 
ST MARY'S HOSPITAL,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 ,$306.72 ,$310.98 ,$28.68 ,$362.10 ,$16.87 ,$28.68 ,$362.10 ,$310.98 ,$17.43 ,$16.87 ,$19.09 ,$362.10 ,$37.96 ,$391.92 ,$298.20 ,$70.06 ,$75.33 ,$259.43 ,$70.06 ,$294.37 ,$306.72 ,$296.71 ,$17.04 ,$306.72 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$255.60 
ST MARY'S HOSPITAL,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 ,$41.04 ,$41.61 ,$15.67 ,$48.45 ,$9.22 ,$15.67 ,$48.45 ,$41.61 ,$9.53 ,$9.22 ,$10.44 ,$48.45 ,$20.75 ,$52.44 ,$39.90 ,$44.83 ,$48.20 ,$34.71 ,$44.83 ,$39.39 ,$41.04 ,$39.70 ,$9.31 ,$41.04 ,$10.10 ,$11.06 ,$11.06 ,$9.22 ,$11.06 ,$9.22 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$34.20 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$42.93 ,$161.50 ,$25.25 ,$42.93 ,$161.50 ,$138.70 ,$26.09 ,$25.25 ,$28.58 ,$161.50 ,$56.81 ,$174.80 ,$133.00 ,$122.77 ,$132.00 ,$115.71 ,$122.77 ,$131.29 ,$136.80 ,$132.34 ,$25.50 ,$136.80 ,$27.66 ,$30.30 ,$30.30 ,$25.25 ,$30.30 ,$25.25 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$42.93 ,$161.50 ,$25.25 ,$42.93 ,$161.50 ,$138.70 ,$26.09 ,$25.25 ,$28.58 ,$161.50 ,$56.81 ,$174.80 ,$133.00 ,$122.77 ,$132.00 ,$115.71 ,$122.77 ,$131.29 ,$136.80 ,$132.34 ,$25.50 ,$136.80 ,$27.66 ,$30.30 ,$30.30 ,$25.25 ,$30.30 ,$25.25 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$42.93 ,$71.40 ,$25.25 ,$42.93 ,$71.40 ,$61.32 ,$26.09 ,$25.25 ,$28.58 ,$71.40 ,$56.81 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$60.48 ,$58.51 ,$25.50 ,$60.48 ,$27.66 ,$30.30 ,$30.30 ,$25.25 ,$30.30 ,$25.25 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$18.26 ,$66.30 ,$10.74 ,$18.26 ,$66.30 ,$56.94 ,$11.10 ,$10.74 ,$12.16 ,$66.30 ,$24.17 ,$71.76 ,$54.60 ,$52.21 ,$56.13 ,$47.50 ,$52.21 ,$53.90 ,$56.16 ,$54.33 ,$10.85 ,$56.16 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$10.74 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.00 ,$95.20 ,$14.12 ,$24.00 ,$95.20 ,$81.76 ,$14.59 ,$14.12 ,$15.98 ,$95.20 ,$31.77 ,$103.04 ,$78.40 ,$68.67 ,$73.83 ,$68.21 ,$68.67 ,$77.39 ,$80.64 ,$78.01 ,$14.26 ,$80.64 ,$15.47 ,$16.94 ,$16.94 ,$14.12 ,$16.94 ,$14.12 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$7.82 ,$56.95 ,$4.60 ,$7.82 ,$56.95 ,$48.91 ,$4.75 ,$4.60 ,$5.21 ,$56.95 ,$10.35 ,$61.64 ,$46.90 ,$22.35 ,$24.02 ,$40.80 ,$22.35 ,$46.30 ,$48.24 ,$46.67 ,$4.65 ,$48.24 ,$5.04 ,$5.52 ,$5.52 ,$4.60 ,$5.52 ,$4.60 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$9.78 ,$40.80 ,$5.75 ,$9.78 ,$40.80 ,$35.04 ,$5.94 ,$5.75 ,$6.51 ,$40.80 ,$12.94 ,$44.16 ,$33.60 ,$24.45 ,$26.28 ,$29.23 ,$24.45 ,$33.17 ,$34.56 ,$33.43 ,$5.81 ,$34.56 ,$6.30 ,$6.90 ,$6.90 ,$5.75 ,$6.90 ,$5.75 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$54.72 ,$55.48 ,$8.50 ,$64.60 ,$5.00 ,$8.50 ,$64.60 ,$55.48 ,$5.17 ,$5.00 ,$5.66 ,$64.60 ,$11.25 ,$69.92 ,$53.20 ,$23.77 ,$25.56 ,$46.28 ,$23.77 ,$52.52 ,$54.72 ,$52.93 ,$5.05 ,$54.72 ,$5.48 ,$6.00 ,$6.00 ,$5.00 ,$6.00 ,$5.00 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$45.60 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$7.40 ,$47.60 ,$4.35 ,$7.40 ,$47.60 ,$40.88 ,$4.49 ,$4.35 ,$4.92 ,$47.60 ,$9.79 ,$51.52 ,$39.20 ,$21.13 ,$22.72 ,$34.10 ,$21.13 ,$38.70 ,$40.32 ,$39.00 ,$4.39 ,$40.32 ,$4.76 ,$5.22 ,$5.22 ,$4.35 ,$5.22 ,$4.35 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$40.95 ,$133.45 ,$24.09 ,$40.95 ,$133.45 ,$114.61 ,$24.89 ,$24.09 ,$27.27 ,$133.45 ,$54.20 ,$144.44 ,$109.90 ,$87.78 ,$94.37 ,$95.61 ,$87.78 ,$108.49 ,$113.04 ,$109.35 ,$24.33 ,$113.04 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$131.76 ,$133.59 ,$31.69 ,$155.55 ,$18.64 ,$31.69 ,$155.55 ,$133.59 ,$19.26 ,$18.64 ,$21.10 ,$155.55 ,$41.94 ,$168.36 ,$128.10 ,$66.57 ,$71.57 ,$111.45 ,$66.57 ,$126.45 ,$131.76 ,$127.46 ,$18.83 ,$131.76 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,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 ,$192.96 ,$195.64 ,$34.48 ,$227.80 ,$20.28 ,$34.48 ,$227.80 ,$195.64 ,$10.23 ,$20.28 ,$22.95 ,$227.80 ,$45.63 ,$246.56 ,$187.60 ,$35.35 ,$38.01 ,$163.21 ,$35.35 ,$185.19 ,$192.96 ,$186.66 ,$20.48 ,$192.96 ,$10.84 ,$24.34 ,$24.34 ,$20.28 ,$24.34 ,$20.28 ,$192.96 ,$166.16 ,$192.96 ,$192.96 ,$160.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$34.48 ,$104.55 ,$20.28 ,$34.48 ,$104.55 ,$89.79 ,$10.23 ,$20.28 ,$22.95 ,$104.55 ,$45.63 ,$113.16 ,$86.10 ,$35.35 ,$38.01 ,$74.91 ,$35.35 ,$84.99 ,$88.56 ,$85.67 ,$20.48 ,$88.56 ,$10.84 ,$24.34 ,$24.34 ,$20.28 ,$24.34 ,$20.28 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$47.26 ,$171.70 ,$27.80 ,$47.26 ,$171.70 ,$147.46 ,$28.73 ,$27.80 ,$31.46 ,$171.70 ,$62.55 ,$185.84 ,$141.40 ,$135.17 ,$145.33 ,$123.02 ,$135.17 ,$139.58 ,$145.44 ,$140.69 ,$28.08 ,$145.44 ,$30.45 ,$33.36 ,$33.36 ,$27.80 ,$33.36 ,$27.80 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$36.00 ,$30.60 , N/A ,$36.00 ,$30.60 ,$26.28 ,$10.05 , N/A ,$15.12 ,$30.60 , N/A ,$33.12 ,$25.20 ,$18.26 ,$21.91 ,$21.92 ,$20.45 ,$24.88 ,$25.92 ,$25.07 , N/A ,$25.92 ,$10.65 , N/A , N/A , N/A , N/A , N/A ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$110.16 ,$111.69 ,$21.10 ,$130.05 ,$12.41 ,$21.10 ,$130.05 ,$111.69 ,$12.82 ,$12.41 ,$14.05 ,$130.05 ,$27.92 ,$140.76 ,$107.10 ,$49.93 ,$53.68 ,$93.18 ,$49.93 ,$105.72 ,$110.16 ,$106.56 ,$12.53 ,$110.16 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$12.41 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 ,$21.10 ,$58.65 ,$12.41 ,$21.10 ,$58.65 ,$50.37 ,$12.82 ,$12.41 ,$14.05 ,$58.65 ,$27.92 ,$63.48 ,$48.30 ,$49.93 ,$53.68 ,$42.02 ,$49.93 ,$47.68 ,$49.68 ,$48.06 ,$12.53 ,$49.68 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$12.41 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$21.10 ,$76.50 ,$12.41 ,$21.10 ,$76.50 ,$65.70 ,$12.82 ,$12.41 ,$14.05 ,$76.50 ,$27.92 ,$82.80 ,$63.00 ,$49.93 ,$53.68 ,$54.81 ,$49.93 ,$62.19 ,$64.80 ,$62.69 ,$12.53 ,$64.80 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$12.41 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$21.10 ,$102.00 ,$12.41 ,$21.10 ,$102.00 ,$87.60 ,$12.82 ,$12.41 ,$14.05 ,$102.00 ,$27.92 ,$110.40 ,$84.00 ,$49.93 ,$53.68 ,$73.08 ,$49.93 ,$82.92 ,$86.40 ,$83.58 ,$12.53 ,$86.40 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$12.41 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$21.10 ,$56.95 ,$12.41 ,$21.10 ,$56.95 ,$48.91 ,$12.82 ,$12.41 ,$14.05 ,$56.95 ,$27.92 ,$61.64 ,$46.90 ,$49.93 ,$53.68 ,$40.80 ,$49.93 ,$46.30 ,$48.24 ,$46.67 ,$12.53 ,$48.24 ,$13.59 ,$14.89 ,$14.89 ,$12.41 ,$14.89 ,$12.41 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.41 ,$104.55 ,$16.71 ,$28.41 ,$104.55 ,$89.79 ,$17.27 ,$16.71 ,$18.91 ,$104.55 ,$37.60 ,$113.16 ,$86.10 ,$81.25 ,$87.36 ,$74.91 ,$81.25 ,$84.99 ,$88.56 ,$85.67 ,$16.88 ,$88.56 ,$18.31 ,$20.05 ,$20.05 ,$16.71 ,$20.05 ,$16.71 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.71 ,$104.55 ,$16.30 ,$27.71 ,$104.55 ,$89.79 ,$16.84 ,$16.30 ,$18.45 ,$104.55 ,$36.68 ,$113.16 ,$86.10 ,$79.26 ,$85.21 ,$74.91 ,$79.26 ,$84.99 ,$88.56 ,$85.67 ,$16.46 ,$88.56 ,$17.85 ,$19.56 ,$19.56 ,$16.30 ,$19.56 ,$16.30 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$92.16 ,$93.44 ,$128.00 ,$108.80 ,$114.43 ,$128.00 ,$108.80 ,$93.44 ,$63.95 ,$114.43 ,$128.00 ,$108.80 ,$257.47 ,$117.76 ,$89.60 ,$128.00 ,$128.00 ,$77.95 ,$128.00 ,$88.45 ,$92.16 ,$89.15 ,$115.57 ,$92.16 ,$67.79 ,$128.00 ,$128.00 ,$114.43 ,$128.00 ,$114.43 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$76.80 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$100.00 ,$85.00 ,$100.00 ,$100.00 ,$85.00 ,$73.00 ,$63.95 ,$100.00 ,$100.00 ,$85.00 ,$225.00 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$101.00 ,$72.00 ,$67.79 ,$100.00 ,$100.00 ,$100.00 ,$100.00 ,$100.00 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$539.28 ,$546.77 ,$40.95 ,$636.65 ,$24.09 ,$40.95 ,$636.65 ,$546.77 ,$24.89 ,$24.09 ,$27.27 ,$636.65 ,$54.20 ,$689.08 ,$524.30 ,$87.78 ,$94.37 ,$456.14 ,$87.78 ,$517.56 ,$539.28 ,$521.68 ,$24.33 ,$539.28 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$539.28 ,$464.38 ,$539.28 ,$539.28 ,$449.40 
ST MARY'S HOSPITAL,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 ,$461.52 ,$467.93 ,$40.95 ,$544.85 ,$24.09 ,$40.95 ,$544.85 ,$467.93 ,$24.89 ,$24.09 ,$27.27 ,$544.85 ,$54.20 ,$589.72 ,$448.70 ,$87.78 ,$94.37 ,$390.37 ,$87.78 ,$442.93 ,$461.52 ,$446.46 ,$24.33 ,$461.52 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$461.52 ,$397.42 ,$461.52 ,$461.52 ,$384.60 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$11.07 ,$44.20 ,$6.51 ,$11.07 ,$44.20 ,$37.96 ,$6.73 ,$6.51 ,$7.37 ,$44.20 ,$14.65 ,$47.84 ,$36.40 ,$31.65 ,$34.02 ,$31.67 ,$31.65 ,$35.93 ,$37.44 ,$36.22 ,$6.58 ,$37.44 ,$7.13 ,$7.81 ,$7.81 ,$6.51 ,$7.81 ,$6.51 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$66.24 ,$67.16 ,$22.76 ,$78.20 ,$13.39 ,$22.76 ,$78.20 ,$67.16 ,$13.84 ,$13.39 ,$15.15 ,$78.20 ,$30.13 ,$84.64 ,$64.40 ,$65.15 ,$70.04 ,$56.03 ,$65.15 ,$63.57 ,$66.24 ,$64.08 ,$13.52 ,$66.24 ,$14.67 ,$16.07 ,$16.07 ,$13.39 ,$16.07 ,$13.39 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$55.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$19.64 ,$56.95 ,$11.55 ,$19.64 ,$56.95 ,$48.91 ,$8.66 ,$11.55 ,$13.07 ,$56.95 ,$25.99 ,$61.64 ,$46.90 ,$29.94 ,$32.19 ,$40.80 ,$29.94 ,$46.30 ,$48.24 ,$46.67 ,$11.67 ,$48.24 ,$9.18 ,$13.86 ,$13.86 ,$11.55 ,$13.86 ,$11.55 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$8.70 ,$33.15 ,$5.12 ,$8.70 ,$33.15 ,$28.47 ,$5.29 ,$5.12 ,$5.79 ,$33.15 ,$11.52 ,$35.88 ,$27.30 ,$24.91 ,$26.78 ,$23.75 ,$24.91 ,$26.95 ,$28.08 ,$27.16 ,$5.17 ,$28.08 ,$5.61 ,$6.14 ,$6.14 ,$5.12 ,$6.14 ,$5.12 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$33.15 ,$28.47 ,$5.35 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$25.16 ,$27.05 ,$23.75 ,$25.16 ,$26.95 ,$28.08 ,$27.16 ,$5.23 ,$28.08 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$33.15 ,$28.47 ,$5.35 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$25.16 ,$27.05 ,$23.75 ,$25.16 ,$26.95 ,$28.08 ,$27.16 ,$5.23 ,$28.08 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$33.15 ,$28.47 ,$5.35 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$25.16 ,$27.05 ,$23.75 ,$25.16 ,$26.95 ,$28.08 ,$27.16 ,$5.23 ,$28.08 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$16.08 ,$76.50 ,$9.46 ,$16.08 ,$76.50 ,$65.70 ,$9.78 ,$9.46 ,$10.71 ,$76.50 ,$21.29 ,$82.80 ,$63.00 ,$45.94 ,$49.39 ,$54.81 ,$45.94 ,$62.19 ,$64.80 ,$62.69 ,$9.55 ,$64.80 ,$10.37 ,$11.35 ,$11.35 ,$9.46 ,$11.35 ,$9.46 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$24.04 ,$44.20 ,$14.14 ,$24.04 ,$44.20 ,$37.96 ,$9.02 ,$14.14 ,$16.00 ,$44.20 ,$31.82 ,$47.84 ,$36.40 ,$31.18 ,$33.53 ,$31.67 ,$31.18 ,$35.93 ,$37.44 ,$36.22 ,$14.28 ,$37.44 ,$9.56 ,$16.97 ,$16.97 ,$14.14 ,$16.97 ,$14.14 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$11.00 ,$142.80 ,$6.47 ,$11.00 ,$142.80 ,$122.64 ,$6.69 ,$6.47 ,$7.32 ,$142.80 ,$14.56 ,$154.56 ,$117.60 ,$31.47 ,$33.83 ,$102.31 ,$31.47 ,$116.09 ,$120.96 ,$117.01 ,$6.53 ,$120.96 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.64 ,$95.20 ,$15.08 ,$25.64 ,$95.20 ,$81.76 ,$15.58 ,$15.08 ,$17.07 ,$95.20 ,$33.93 ,$103.04 ,$78.40 ,$73.27 ,$78.78 ,$68.21 ,$73.27 ,$77.39 ,$80.64 ,$78.01 ,$15.23 ,$80.64 ,$16.51 ,$18.10 ,$18.10 ,$15.08 ,$18.10 ,$15.08 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$42.96 ,$161.50 ,$25.27 ,$42.96 ,$161.50 ,$138.70 ,$26.11 ,$25.27 ,$28.60 ,$161.50 ,$56.86 ,$174.80 ,$133.00 ,$122.88 ,$132.11 ,$115.71 ,$122.88 ,$131.29 ,$136.80 ,$132.34 ,$25.52 ,$136.80 ,$27.68 ,$30.32 ,$30.32 ,$25.27 ,$30.32 ,$25.27 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$37.79 ,$142.80 ,$22.23 ,$37.79 ,$142.80 ,$122.64 ,$22.97 ,$22.23 ,$25.16 ,$142.80 ,$50.02 ,$154.56 ,$117.60 ,$108.09 ,$116.21 ,$102.31 ,$108.09 ,$116.09 ,$120.96 ,$117.01 ,$22.45 ,$120.96 ,$24.35 ,$26.68 ,$26.68 ,$22.23 ,$26.68 ,$22.23 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$65.45 ,$247.35 ,$38.50 ,$65.45 ,$247.35 ,$212.43 ,$39.78 ,$38.50 ,$43.57 ,$247.35 ,$86.63 ,$267.72 ,$203.70 ,$187.21 ,$201.27 ,$177.22 ,$187.21 ,$201.08 ,$209.52 ,$202.68 ,$38.89 ,$209.52 ,$42.17 ,$46.20 ,$46.20 ,$38.50 ,$46.20 ,$38.50 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$37.69 ,$219.30 ,$22.17 ,$37.69 ,$219.30 ,$188.34 ,$22.91 ,$22.17 ,$25.09 ,$219.30 ,$49.88 ,$237.36 ,$180.60 ,$87.78 ,$94.37 ,$157.12 ,$87.78 ,$178.28 ,$185.76 ,$179.70 ,$22.39 ,$185.76 ,$24.28 ,$26.60 ,$26.60 ,$22.17 ,$26.60 ,$22.17 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$104.55 ,$190.40 ,$61.50 ,$104.55 ,$190.40 ,$163.52 ,$48.31 ,$61.50 ,$69.61 ,$190.40 ,$138.38 ,$206.08 ,$156.80 ,$167.04 ,$179.59 ,$136.42 ,$167.04 ,$154.78 ,$161.28 ,$156.02 ,$62.12 ,$161.28 ,$51.21 ,$73.80 ,$73.80 ,$61.50 ,$73.80 ,$61.50 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.94 ,$85.85 ,$18.79 ,$31.94 ,$85.85 ,$73.73 ,$19.42 ,$18.79 ,$21.27 ,$85.85 ,$42.28 ,$92.92 ,$70.70 ,$91.41 ,$98.28 ,$61.51 ,$91.41 ,$69.79 ,$72.72 ,$70.35 ,$18.98 ,$72.72 ,$20.59 ,$22.55 ,$22.55 ,$18.79 ,$22.55 ,$18.79 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$47.50 ,$181.05 ,$27.94 ,$47.50 ,$181.05 ,$155.49 ,$28.87 ,$27.94 ,$31.62 ,$181.05 ,$62.87 ,$195.96 ,$149.10 ,$135.85 ,$146.06 ,$129.72 ,$135.85 ,$147.18 ,$153.36 ,$148.35 ,$28.22 ,$153.36 ,$30.60 ,$33.53 ,$33.53 ,$27.94 ,$33.53 ,$27.94 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$47.50 ,$181.05 ,$27.94 ,$47.50 ,$181.05 ,$155.49 ,$28.87 ,$27.94 ,$31.62 ,$181.05 ,$62.87 ,$195.96 ,$149.10 ,$135.85 ,$146.06 ,$129.72 ,$135.85 ,$147.18 ,$153.36 ,$148.35 ,$28.22 ,$153.36 ,$30.60 ,$33.53 ,$33.53 ,$27.94 ,$33.53 ,$27.94 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$36.89 ,$142.80 ,$21.70 ,$36.89 ,$142.80 ,$122.64 ,$22.42 ,$21.70 ,$24.56 ,$142.80 ,$48.83 ,$154.56 ,$117.60 ,$105.49 ,$113.42 ,$102.31 ,$105.49 ,$116.09 ,$120.96 ,$117.01 ,$21.92 ,$120.96 ,$23.77 ,$26.04 ,$26.04 ,$21.70 ,$26.04 ,$21.70 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$134.64 ,$136.51 ,$36.89 ,$158.95 ,$21.70 ,$36.89 ,$158.95 ,$136.51 ,$22.42 ,$21.70 ,$24.56 ,$158.95 ,$48.83 ,$172.04 ,$130.90 ,$105.49 ,$113.42 ,$113.88 ,$105.49 ,$129.22 ,$134.64 ,$130.25 ,$21.92 ,$134.64 ,$23.77 ,$26.04 ,$26.04 ,$21.70 ,$26.04 ,$21.70 ,$134.64 ,$115.94 ,$134.64 ,$134.64 ,$112.20 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$41.11 ,$171.70 ,$24.18 ,$41.11 ,$171.70 ,$147.46 ,$24.99 ,$24.18 ,$27.37 ,$171.70 ,$54.41 ,$185.84 ,$141.40 ,$117.57 ,$126.40 ,$123.02 ,$117.57 ,$139.58 ,$145.44 ,$140.69 ,$24.42 ,$145.44 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$24.18 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$81.36 ,$82.49 ,$41.11 ,$96.05 ,$24.18 ,$41.11 ,$96.05 ,$82.49 ,$24.99 ,$24.18 ,$27.37 ,$96.05 ,$54.41 ,$103.96 ,$79.10 ,$113.00 ,$113.00 ,$68.82 ,$113.00 ,$78.08 ,$81.36 ,$78.70 ,$24.42 ,$81.36 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$24.18 ,$81.36 ,$70.06 ,$81.36 ,$81.36 ,$67.80 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$41.11 ,$199.75 ,$24.18 ,$41.11 ,$199.75 ,$171.55 ,$24.99 ,$24.18 ,$27.37 ,$199.75 ,$54.41 ,$216.20 ,$164.50 ,$117.57 ,$126.40 ,$143.12 ,$117.57 ,$162.39 ,$169.20 ,$163.68 ,$24.42 ,$169.20 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$24.18 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$102.24 ,$103.66 ,$41.11 ,$120.70 ,$24.18 ,$41.11 ,$120.70 ,$103.66 ,$24.99 ,$24.18 ,$27.37 ,$120.70 ,$54.41 ,$130.64 ,$99.40 ,$117.57 ,$126.40 ,$86.48 ,$117.57 ,$98.12 ,$102.24 ,$98.90 ,$24.42 ,$102.24 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$24.18 ,$102.24 ,$88.04 ,$102.24 ,$102.24 ,$85.20 
ST MARY'S HOSPITAL,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 ,$131.76 ,$133.59 ,$42.42 ,$155.55 ,$24.95 ,$42.42 ,$155.55 ,$133.59 ,$25.78 ,$24.95 ,$28.24 ,$155.55 ,$56.14 ,$168.36 ,$128.10 ,$121.35 ,$130.47 ,$111.45 ,$121.35 ,$126.45 ,$131.76 ,$127.46 ,$25.20 ,$131.76 ,$27.33 ,$29.94 ,$29.94 ,$24.95 ,$29.94 ,$24.95 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,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 ,$288.00 ,$292.00 ,$25.33 ,$340.00 ,$14.90 ,$25.33 ,$340.00 ,$292.00 ,$7.95 ,$14.90 ,$16.86 ,$340.00 ,$33.53 ,$368.00 ,$280.00 ,$27.48 ,$29.54 ,$243.60 ,$27.48 ,$276.40 ,$288.00 ,$278.60 ,$15.05 ,$288.00 ,$8.43 ,$17.88 ,$17.88 ,$14.90 ,$17.88 ,$14.90 ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$240.00 
ST MARY'S HOSPITAL,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 ,$201.60 ,$204.40 ,$28.56 ,$238.00 ,$16.80 ,$28.56 ,$238.00 ,$204.40 ,$17.36 ,$16.80 ,$19.01 ,$238.00 ,$37.80 ,$257.60 ,$196.00 ,$81.72 ,$87.86 ,$170.52 ,$81.72 ,$193.48 ,$201.60 ,$195.02 ,$16.97 ,$201.60 ,$18.40 ,$20.16 ,$20.16 ,$16.80 ,$20.16 ,$16.80 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$31.91 ,$133.45 ,$18.77 ,$31.91 ,$133.45 ,$114.61 ,$18.72 ,$18.77 ,$21.24 ,$133.45 ,$42.23 ,$144.44 ,$109.90 ,$64.72 ,$69.58 ,$95.61 ,$64.72 ,$108.49 ,$113.04 ,$109.35 ,$18.96 ,$113.04 ,$19.84 ,$22.52 ,$22.52 ,$18.77 ,$22.52 ,$18.77 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$201.60 ,$204.40 ,$33.58 ,$238.00 ,$19.75 ,$33.58 ,$238.00 ,$204.40 ,$20.41 ,$19.75 ,$22.35 ,$238.00 ,$44.44 ,$257.60 ,$196.00 ,$87.78 ,$94.37 ,$170.52 ,$87.78 ,$193.48 ,$201.60 ,$195.02 ,$19.95 ,$201.60 ,$21.63 ,$23.70 ,$23.70 ,$19.75 ,$23.70 ,$19.75 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.17 ,$85.85 ,$13.63 ,$23.17 ,$85.85 ,$73.73 ,$14.08 ,$13.63 ,$15.43 ,$85.85 ,$30.67 ,$92.92 ,$70.70 ,$66.25 ,$71.23 ,$61.51 ,$66.25 ,$69.79 ,$72.72 ,$70.35 ,$13.77 ,$72.72 ,$14.92 ,$16.36 ,$16.36 ,$13.63 ,$16.36 ,$13.63 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$354.96 ,$359.89 ,$109.50 ,$419.05 ,$64.41 ,$109.50 ,$419.05 ,$359.89 ,$66.55 ,$64.41 ,$72.90 ,$419.05 ,$144.92 ,$453.56 ,$345.10 ,$313.19 ,$336.72 ,$300.24 ,$313.19 ,$340.66 ,$354.96 ,$343.37 ,$65.05 ,$354.96 ,$70.54 ,$77.29 ,$77.29 ,$64.41 ,$77.29 ,$64.41 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.99 ,$95.20 ,$14.70 ,$24.99 ,$95.20 ,$81.76 ,$15.19 ,$14.70 ,$16.64 ,$95.20 ,$33.08 ,$103.04 ,$78.40 ,$71.49 ,$76.86 ,$68.21 ,$71.49 ,$77.39 ,$80.64 ,$78.01 ,$14.85 ,$80.64 ,$16.10 ,$17.64 ,$17.64 ,$14.70 ,$17.64 ,$14.70 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$30.01 ,$76.50 ,$17.65 ,$30.01 ,$76.50 ,$65.70 ,$16.37 ,$17.65 ,$19.98 ,$76.50 ,$39.71 ,$82.80 ,$63.00 ,$56.59 ,$60.85 ,$54.81 ,$56.59 ,$62.19 ,$64.80 ,$62.69 ,$17.83 ,$64.80 ,$17.35 ,$21.18 ,$21.18 ,$17.65 ,$21.18 ,$17.65 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$56.95 ,$48.91 ,$9.61 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$45.19 ,$48.58 ,$40.80 ,$45.19 ,$46.30 ,$48.24 ,$46.67 ,$9.39 ,$48.24 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$15.81 ,$30.60 ,$9.30 ,$15.81 ,$30.60 ,$26.28 ,$9.61 ,$9.30 ,$10.53 ,$30.60 ,$20.93 ,$33.12 ,$25.20 ,$36.00 ,$36.00 ,$21.92 ,$36.00 ,$24.88 ,$25.92 ,$25.07 ,$9.39 ,$25.92 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$56.95 ,$48.91 ,$9.61 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$45.19 ,$48.58 ,$40.80 ,$45.19 ,$46.30 ,$48.24 ,$46.67 ,$9.39 ,$48.24 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$56.95 ,$48.91 ,$9.61 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$45.19 ,$48.58 ,$40.80 ,$45.19 ,$46.30 ,$48.24 ,$46.67 ,$9.39 ,$48.24 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.81 ,$56.95 ,$9.30 ,$15.81 ,$56.95 ,$48.91 ,$9.61 ,$9.30 ,$10.53 ,$56.95 ,$20.93 ,$61.64 ,$46.90 ,$45.19 ,$48.58 ,$40.80 ,$45.19 ,$46.30 ,$48.24 ,$46.67 ,$9.39 ,$48.24 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$51.12 ,$51.83 ,$15.81 ,$60.35 ,$9.30 ,$15.81 ,$60.35 ,$51.83 ,$9.61 ,$9.30 ,$10.53 ,$60.35 ,$20.93 ,$65.32 ,$49.70 ,$45.19 ,$48.58 ,$43.24 ,$45.19 ,$49.06 ,$51.12 ,$49.45 ,$9.39 ,$51.12 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$42.60 
ST MARY'S HOSPITAL,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 ,$51.12 ,$51.83 ,$15.81 ,$60.35 ,$9.30 ,$15.81 ,$60.35 ,$51.83 ,$9.61 ,$9.30 ,$10.53 ,$60.35 ,$20.93 ,$65.32 ,$49.70 ,$45.19 ,$48.58 ,$43.24 ,$45.19 ,$49.06 ,$51.12 ,$49.45 ,$9.39 ,$51.12 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$42.60 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.98 ,$104.55 ,$16.46 ,$27.98 ,$104.55 ,$89.79 ,$17.01 ,$16.46 ,$18.63 ,$104.55 ,$37.04 ,$113.16 ,$86.10 ,$80.08 ,$86.10 ,$74.91 ,$80.08 ,$84.99 ,$88.56 ,$85.67 ,$16.62 ,$88.56 ,$18.03 ,$19.75 ,$19.75 ,$16.46 ,$19.75 ,$16.46 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$13.63 ,$34.85 ,$8.02 ,$13.63 ,$34.85 ,$29.93 ,$5.90 ,$8.02 ,$9.08 ,$34.85 ,$18.05 ,$37.72 ,$28.70 ,$20.38 ,$21.92 ,$24.97 ,$20.38 ,$28.33 ,$29.52 ,$28.56 ,$8.10 ,$29.52 ,$6.25 ,$9.62 ,$9.62 ,$8.02 ,$9.62 ,$8.02 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$13.63 ,$34.85 ,$8.02 ,$13.63 ,$34.85 ,$29.93 ,$5.90 ,$8.02 ,$9.08 ,$34.85 ,$18.05 ,$37.72 ,$28.70 ,$20.38 ,$21.92 ,$24.97 ,$20.38 ,$28.33 ,$29.52 ,$28.56 ,$8.10 ,$29.52 ,$6.25 ,$9.62 ,$9.62 ,$8.02 ,$9.62 ,$8.02 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$18.70 ,$71.40 ,$11.00 ,$18.70 ,$71.40 ,$61.32 ,$11.37 ,$11.00 ,$12.45 ,$71.40 ,$24.75 ,$77.28 ,$58.80 ,$41.13 ,$44.22 ,$51.16 ,$41.13 ,$58.04 ,$60.48 ,$58.51 ,$11.11 ,$60.48 ,$12.05 ,$13.20 ,$13.20 ,$11.00 ,$13.20 ,$11.00 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$44.32 ,$124.10 ,$26.07 ,$44.32 ,$124.10 ,$106.58 ,$26.94 ,$26.07 ,$29.51 ,$124.10 ,$58.66 ,$134.32 ,$102.20 ,$94.08 ,$101.15 ,$88.91 ,$94.08 ,$100.89 ,$105.12 ,$101.69 ,$26.33 ,$105.12 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$26.07 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$133.91 ,$181.05 ,$78.77 ,$133.91 ,$181.05 ,$155.49 ,$39.91 ,$78.77 ,$89.15 ,$181.05 ,$177.23 ,$195.96 ,$149.10 ,$137.95 ,$148.32 ,$129.72 ,$137.95 ,$147.18 ,$153.36 ,$148.35 ,$79.56 ,$153.36 ,$42.30 ,$94.52 ,$94.52 ,$78.77 ,$94.52 ,$78.77 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$108.72 ,$110.23 ,$16.61 ,$128.35 ,$9.77 ,$16.61 ,$128.35 ,$110.23 ,$10.10 ,$9.77 ,$11.06 ,$128.35 ,$21.98 ,$138.92 ,$105.70 ,$42.44 ,$45.63 ,$91.96 ,$42.44 ,$104.34 ,$108.72 ,$105.17 ,$9.87 ,$108.72 ,$10.71 ,$11.72 ,$11.72 ,$9.77 ,$11.72 ,$9.77 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$90.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.97 ,$85.85 ,$17.63 ,$29.97 ,$85.85 ,$73.73 ,$18.22 ,$17.63 ,$19.95 ,$85.85 ,$39.67 ,$92.92 ,$70.70 ,$85.75 ,$92.19 ,$61.51 ,$85.75 ,$69.79 ,$72.72 ,$70.35 ,$17.81 ,$72.72 ,$19.31 ,$21.16 ,$21.16 ,$17.63 ,$21.16 ,$17.63 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 ,$24.29 ,$52.70 ,$14.29 ,$24.29 ,$52.70 ,$45.26 ,$13.88 ,$14.29 ,$16.17 ,$52.70 ,$32.15 ,$57.04 ,$43.40 ,$47.97 ,$51.57 ,$37.76 ,$47.97 ,$42.84 ,$44.64 ,$43.18 ,$14.43 ,$44.64 ,$14.71 ,$17.15 ,$17.15 ,$14.29 ,$17.15 ,$14.29 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$38.88 ,$39.42 ,$6.68 ,$45.90 ,$3.93 ,$6.68 ,$45.90 ,$39.42 ,$4.06 ,$3.93 ,$4.45 ,$45.90 ,$8.84 ,$49.68 ,$37.80 ,$19.10 ,$20.54 ,$32.89 ,$19.10 ,$37.31 ,$38.88 ,$37.61 ,$3.97 ,$38.88 ,$4.30 ,$4.72 ,$4.72 ,$3.93 ,$4.72 ,$3.93 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$32.40 
ST MARY'S HOSPITAL,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 ,$21.60 ,$21.90 ,$6.68 ,$25.50 ,$3.93 ,$6.68 ,$25.50 ,$21.90 ,$4.06 ,$3.93 ,$4.45 ,$25.50 ,$8.84 ,$27.60 ,$21.00 ,$19.10 ,$20.54 ,$18.27 ,$19.10 ,$20.73 ,$21.60 ,$20.90 ,$3.97 ,$21.60 ,$4.30 ,$4.72 ,$4.72 ,$3.93 ,$4.72 ,$3.93 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$18.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$8.08 ,$76.50 ,$4.75 ,$8.08 ,$76.50 ,$65.70 ,$4.91 ,$4.75 ,$5.38 ,$76.50 ,$10.69 ,$82.80 ,$63.00 ,$23.09 ,$24.83 ,$54.81 ,$23.09 ,$62.19 ,$64.80 ,$62.69 ,$4.80 ,$64.80 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$4.75 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$21.88 ,$95.20 ,$12.87 ,$21.88 ,$95.20 ,$81.76 ,$13.30 ,$12.87 ,$14.57 ,$95.20 ,$28.96 ,$103.04 ,$78.40 ,$62.58 ,$67.28 ,$68.21 ,$62.58 ,$77.39 ,$80.64 ,$78.01 ,$13.00 ,$80.64 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$22.32 ,$22.63 ,$6.66 ,$26.35 ,$3.92 ,$6.66 ,$26.35 ,$22.63 ,$4.05 ,$3.92 ,$4.44 ,$26.35 ,$8.82 ,$28.52 ,$21.70 ,$19.07 ,$20.50 ,$18.88 ,$19.07 ,$21.42 ,$22.32 ,$21.59 ,$3.96 ,$22.32 ,$4.29 ,$4.70 ,$4.70 ,$3.92 ,$4.70 ,$3.92 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$18.60 
ST MARY'S HOSPITAL,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 ,$310.32 ,$314.63 ,$16.49 ,$366.35 ,$9.70 ,$16.49 ,$366.35 ,$314.63 ,$10.02 ,$9.70 ,$10.98 ,$366.35 ,$21.83 ,$396.52 ,$301.70 ,$47.11 ,$50.65 ,$262.48 ,$47.11 ,$297.82 ,$310.32 ,$300.19 ,$9.80 ,$310.32 ,$10.62 ,$11.64 ,$11.64 ,$9.70 ,$11.64 ,$9.70 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.49 ,$66.30 ,$9.70 ,$16.49 ,$66.30 ,$56.94 ,$10.02 ,$9.70 ,$10.98 ,$66.30 ,$21.83 ,$71.76 ,$54.60 ,$47.11 ,$50.65 ,$47.50 ,$47.11 ,$53.90 ,$56.16 ,$54.33 ,$9.80 ,$56.16 ,$10.62 ,$11.64 ,$11.64 ,$9.70 ,$11.64 ,$9.70 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$13.68 ,$13.87 ,$5.58 ,$16.15 ,$3.28 ,$5.58 ,$16.15 ,$13.87 ,$3.30 ,$3.28 ,$3.71 ,$16.15 ,$7.38 ,$17.48 ,$13.30 ,$11.40 ,$12.26 ,$11.57 ,$11.40 ,$13.13 ,$13.68 ,$13.23 ,$3.31 ,$13.68 ,$3.50 ,$3.94 ,$3.94 ,$3.28 ,$3.94 ,$3.28 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$11.40 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$12.24 ,$46.75 ,$7.20 ,$12.24 ,$46.75 ,$40.15 ,$7.44 ,$7.20 ,$8.15 ,$46.75 ,$16.20 ,$50.60 ,$38.50 ,$35.00 ,$37.63 ,$33.50 ,$35.00 ,$38.01 ,$39.60 ,$38.31 ,$7.27 ,$39.60 ,$7.89 ,$8.64 ,$8.64 ,$7.20 ,$8.64 ,$7.20 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$26.27 ,$221.00 ,$15.45 ,$26.27 ,$221.00 ,$189.80 ,$15.96 ,$15.45 ,$17.49 ,$221.00 ,$34.76 ,$239.20 ,$182.00 ,$69.32 ,$74.52 ,$158.34 ,$69.32 ,$179.66 ,$187.20 ,$181.09 ,$15.60 ,$187.20 ,$16.92 ,$18.54 ,$18.54 ,$15.45 ,$18.54 ,$15.45 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$28.49 ,$76.50 ,$16.76 ,$28.49 ,$76.50 ,$65.70 ,$16.62 ,$16.76 ,$18.97 ,$76.50 ,$37.71 ,$82.80 ,$63.00 ,$57.45 ,$61.77 ,$54.81 ,$57.45 ,$62.19 ,$64.80 ,$62.69 ,$16.93 ,$64.80 ,$17.62 ,$20.11 ,$20.11 ,$16.76 ,$20.11 ,$16.76 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$31.59 ,$124.10 ,$18.58 ,$31.59 ,$124.10 ,$106.58 ,$19.20 ,$18.58 ,$21.03 ,$124.10 ,$41.81 ,$134.32 ,$102.20 ,$90.34 ,$97.13 ,$88.91 ,$90.34 ,$100.89 ,$105.12 ,$101.69 ,$18.77 ,$105.12 ,$20.35 ,$22.30 ,$22.30 ,$18.58 ,$22.30 ,$18.58 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$31.48 ,$124.10 ,$18.52 ,$31.48 ,$124.10 ,$106.58 ,$19.14 ,$18.52 ,$20.96 ,$124.10 ,$41.67 ,$134.32 ,$102.20 ,$90.02 ,$96.79 ,$88.91 ,$90.02 ,$100.89 ,$105.12 ,$101.69 ,$18.71 ,$105.12 ,$20.29 ,$22.22 ,$22.22 ,$18.52 ,$22.22 ,$18.52 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$28.34 ,$85.85 ,$16.67 ,$28.34 ,$85.85 ,$73.73 ,$17.23 ,$16.67 ,$18.87 ,$85.85 ,$37.51 ,$92.92 ,$70.70 ,$81.11 ,$87.21 ,$61.51 ,$81.11 ,$69.79 ,$72.72 ,$70.35 ,$16.84 ,$72.72 ,$18.26 ,$20.00 ,$20.00 ,$16.67 ,$20.00 ,$16.67 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.39 ,$85.85 ,$12.58 ,$21.39 ,$85.85 ,$73.73 ,$13.00 ,$12.58 ,$14.24 ,$85.85 ,$28.31 ,$92.92 ,$70.70 ,$61.15 ,$65.75 ,$61.51 ,$61.15 ,$69.79 ,$72.72 ,$70.35 ,$12.71 ,$72.72 ,$13.78 ,$15.10 ,$15.10 ,$12.58 ,$15.10 ,$12.58 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$37.33 ,$104.55 ,$21.96 ,$37.33 ,$104.55 ,$89.79 ,$22.69 ,$21.96 ,$24.85 ,$104.55 ,$49.41 ,$113.16 ,$86.10 ,$106.77 ,$114.79 ,$74.91 ,$106.77 ,$84.99 ,$88.56 ,$85.67 ,$22.18 ,$88.56 ,$24.05 ,$26.35 ,$26.35 ,$21.96 ,$26.35 ,$21.96 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$37.33 ,$104.55 ,$21.96 ,$37.33 ,$104.55 ,$89.79 ,$22.69 ,$21.96 ,$24.85 ,$104.55 ,$49.41 ,$113.16 ,$86.10 ,$106.77 ,$114.79 ,$74.91 ,$106.77 ,$84.99 ,$88.56 ,$85.67 ,$22.18 ,$88.56 ,$24.05 ,$26.35 ,$26.35 ,$21.96 ,$26.35 ,$21.96 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$92.16 ,$93.44 ,$21.88 ,$108.80 ,$12.87 ,$21.88 ,$108.80 ,$93.44 ,$6.41 ,$12.87 ,$14.57 ,$108.80 ,$28.96 ,$117.76 ,$89.60 ,$22.17 ,$23.83 ,$77.95 ,$22.17 ,$88.45 ,$92.16 ,$89.15 ,$13.00 ,$92.16 ,$6.79 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$76.80 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$21.88 ,$84.15 ,$12.87 ,$21.88 ,$84.15 ,$72.27 ,$6.41 ,$12.87 ,$14.57 ,$84.15 ,$28.96 ,$91.08 ,$69.30 ,$22.17 ,$23.83 ,$60.29 ,$22.17 ,$68.41 ,$71.28 ,$68.95 ,$13.00 ,$71.28 ,$6.79 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$94.32 ,$95.63 ,$21.88 ,$111.35 ,$12.87 ,$21.88 ,$111.35 ,$95.63 ,$6.41 ,$12.87 ,$14.57 ,$111.35 ,$28.96 ,$120.52 ,$91.70 ,$22.17 ,$23.83 ,$79.78 ,$22.17 ,$90.52 ,$94.32 ,$91.24 ,$13.00 ,$94.32 ,$6.79 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$94.32 ,$81.22 ,$94.32 ,$94.32 ,$78.60 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$30.70 ,$161.50 ,$18.06 ,$30.70 ,$161.50 ,$138.70 ,$18.66 ,$18.06 ,$20.44 ,$161.50 ,$40.64 ,$174.80 ,$133.00 ,$87.78 ,$94.37 ,$115.71 ,$87.78 ,$131.29 ,$136.80 ,$132.34 ,$18.24 ,$136.80 ,$19.78 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$18.06 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$30.70 ,$161.50 ,$18.06 ,$30.70 ,$161.50 ,$138.70 ,$18.66 ,$18.06 ,$20.44 ,$161.50 ,$40.64 ,$174.80 ,$133.00 ,$87.78 ,$94.37 ,$115.71 ,$87.78 ,$131.29 ,$136.80 ,$132.34 ,$18.24 ,$136.80 ,$19.78 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$18.06 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$30.70 ,$161.50 ,$18.06 ,$30.70 ,$161.50 ,$138.70 ,$18.66 ,$18.06 ,$20.44 ,$161.50 ,$40.64 ,$174.80 ,$133.00 ,$87.78 ,$94.37 ,$115.71 ,$87.78 ,$131.29 ,$136.80 ,$132.34 ,$18.24 ,$136.80 ,$19.78 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$18.06 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.51 ,$66.30 ,$9.71 ,$16.51 ,$66.30 ,$56.94 ,$10.03 ,$9.71 ,$10.99 ,$66.30 ,$21.85 ,$71.76 ,$54.60 ,$47.18 ,$50.73 ,$47.50 ,$47.18 ,$53.90 ,$56.16 ,$54.33 ,$9.81 ,$56.16 ,$10.63 ,$11.65 ,$11.65 ,$9.71 ,$11.65 ,$9.71 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.94 ,$56.95 ,$8.20 ,$13.94 ,$56.95 ,$48.91 ,$4.12 ,$8.20 ,$9.28 ,$56.95 ,$18.45 ,$61.64 ,$46.90 ,$14.26 ,$15.33 ,$40.80 ,$14.26 ,$46.30 ,$48.24 ,$46.67 ,$8.28 ,$48.24 ,$4.37 ,$9.84 ,$9.84 ,$8.20 ,$9.84 ,$8.20 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$12.43 ,$21.25 ,$7.31 ,$12.43 ,$21.25 ,$18.25 ,$4.90 ,$7.31 ,$8.27 ,$21.25 ,$16.45 ,$23.00 ,$17.50 ,$16.93 ,$18.20 ,$15.23 ,$16.93 ,$17.28 ,$18.00 ,$17.41 ,$7.38 ,$18.00 ,$5.19 ,$8.77 ,$8.77 ,$7.31 ,$8.77 ,$7.31 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$12.43 ,$21.25 ,$7.31 ,$12.43 ,$21.25 ,$18.25 ,$4.90 ,$7.31 ,$8.27 ,$21.25 ,$16.45 ,$23.00 ,$17.50 ,$16.93 ,$18.20 ,$15.23 ,$16.93 ,$17.28 ,$18.00 ,$17.41 ,$7.38 ,$18.00 ,$5.19 ,$8.77 ,$8.77 ,$7.31 ,$8.77 ,$7.31 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$12.43 ,$85.85 ,$7.31 ,$12.43 ,$85.85 ,$73.73 ,$4.90 ,$7.31 ,$8.27 ,$85.85 ,$16.45 ,$92.92 ,$70.70 ,$16.93 ,$18.20 ,$61.51 ,$16.93 ,$69.79 ,$72.72 ,$70.35 ,$7.38 ,$72.72 ,$5.19 ,$8.77 ,$8.77 ,$7.31 ,$8.77 ,$7.31 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$87.12 ,$88.33 ,$16.10 ,$102.85 ,$9.47 ,$16.10 ,$102.85 ,$88.33 ,$9.79 ,$9.47 ,$10.72 ,$102.85 ,$21.31 ,$111.32 ,$84.70 ,$41.13 ,$44.22 ,$73.69 ,$41.13 ,$83.61 ,$87.12 ,$84.28 ,$9.56 ,$87.12 ,$10.38 ,$11.36 ,$11.36 ,$9.47 ,$11.36 ,$9.47 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$72.60 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$8.08 ,$47.60 ,$4.75 ,$8.08 ,$47.60 ,$40.88 ,$4.91 ,$4.75 ,$5.38 ,$47.60 ,$10.69 ,$51.52 ,$39.20 ,$23.09 ,$24.83 ,$34.10 ,$23.09 ,$38.70 ,$40.32 ,$39.00 ,$4.80 ,$40.32 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$4.75 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$50.20 ,$181.05 ,$29.53 ,$50.20 ,$181.05 ,$155.49 ,$30.51 ,$29.53 ,$33.42 ,$181.05 ,$66.44 ,$195.96 ,$149.10 ,$143.59 ,$154.38 ,$129.72 ,$143.59 ,$147.18 ,$153.36 ,$148.35 ,$29.83 ,$153.36 ,$32.34 ,$35.44 ,$35.44 ,$29.53 ,$35.44 ,$29.53 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.46 ,$113.90 ,$17.92 ,$30.46 ,$113.90 ,$97.82 ,$18.52 ,$17.92 ,$20.28 ,$113.90 ,$40.32 ,$123.28 ,$93.80 ,$82.00 ,$88.17 ,$81.61 ,$82.00 ,$92.59 ,$96.48 ,$93.33 ,$18.10 ,$96.48 ,$19.63 ,$21.50 ,$21.50 ,$17.92 ,$21.50 ,$17.92 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$38.10 ,$95.20 ,$22.41 ,$38.10 ,$95.20 ,$81.76 ,$19.62 ,$22.41 ,$25.36 ,$95.20 ,$50.42 ,$103.04 ,$78.40 ,$67.85 ,$72.95 ,$68.21 ,$67.85 ,$77.39 ,$80.64 ,$78.01 ,$22.63 ,$80.64 ,$20.80 ,$26.89 ,$26.89 ,$22.41 ,$26.89 ,$22.41 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$38.10 ,$95.20 ,$22.41 ,$38.10 ,$95.20 ,$81.76 ,$19.62 ,$22.41 ,$25.36 ,$95.20 ,$50.42 ,$103.04 ,$78.40 ,$67.85 ,$72.95 ,$68.21 ,$67.85 ,$77.39 ,$80.64 ,$78.01 ,$22.63 ,$80.64 ,$20.80 ,$26.89 ,$26.89 ,$22.41 ,$26.89 ,$22.41 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$90.00 ,$91.25 ,$30.43 ,$106.25 ,$17.90 ,$30.43 ,$106.25 ,$91.25 ,$18.50 ,$17.90 ,$20.26 ,$106.25 ,$40.28 ,$115.00 ,$87.50 ,$85.17 ,$91.58 ,$76.13 ,$85.17 ,$86.38 ,$90.00 ,$87.06 ,$18.08 ,$90.00 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$75.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.93 ,$85.85 ,$12.90 ,$21.93 ,$85.85 ,$73.73 ,$13.33 ,$12.90 ,$14.60 ,$85.85 ,$29.03 ,$92.92 ,$70.70 ,$62.69 ,$67.40 ,$61.51 ,$62.69 ,$69.79 ,$72.72 ,$70.35 ,$13.03 ,$72.72 ,$14.13 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$12.90 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$33.84 ,$34.31 ,$21.93 ,$39.95 ,$12.90 ,$21.93 ,$39.95 ,$34.31 ,$13.33 ,$12.90 ,$14.60 ,$39.95 ,$29.03 ,$43.24 ,$32.90 ,$47.00 ,$47.00 ,$28.62 ,$47.00 ,$32.48 ,$33.84 ,$32.74 ,$13.03 ,$33.84 ,$14.13 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$12.90 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$28.20 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$46.19 ,$181.05 ,$27.17 ,$46.19 ,$181.05 ,$155.49 ,$28.07 ,$27.17 ,$30.75 ,$181.05 ,$61.13 ,$195.96 ,$149.10 ,$132.11 ,$142.04 ,$129.72 ,$132.11 ,$147.18 ,$153.36 ,$148.35 ,$27.44 ,$153.36 ,$29.75 ,$32.60 ,$32.60 ,$27.17 ,$32.60 ,$27.17 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$129.60 ,$131.40 ,$41.31 ,$153.00 ,$24.30 ,$41.31 ,$153.00 ,$131.40 ,$25.11 ,$24.30 ,$27.50 ,$153.00 ,$54.68 ,$165.60 ,$126.00 ,$118.21 ,$127.09 ,$109.62 ,$118.21 ,$124.38 ,$129.60 ,$125.37 ,$24.54 ,$129.60 ,$26.62 ,$29.16 ,$29.16 ,$24.30 ,$29.16 ,$24.30 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$108.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$19.60 ,$76.50 ,$11.53 ,$19.60 ,$76.50 ,$65.70 ,$11.91 ,$11.53 ,$13.05 ,$76.50 ,$25.94 ,$82.80 ,$63.00 ,$56.09 ,$60.31 ,$54.81 ,$56.09 ,$62.19 ,$64.80 ,$62.69 ,$11.65 ,$64.80 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$79.92 ,$81.03 ,$19.60 ,$94.35 ,$11.53 ,$19.60 ,$94.35 ,$81.03 ,$11.91 ,$11.53 ,$13.05 ,$94.35 ,$25.94 ,$102.12 ,$77.70 ,$56.09 ,$60.31 ,$67.60 ,$56.09 ,$76.70 ,$79.92 ,$77.31 ,$11.65 ,$79.92 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$66.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$19.60 ,$85.85 ,$11.53 ,$19.60 ,$85.85 ,$73.73 ,$11.91 ,$11.53 ,$13.05 ,$85.85 ,$25.94 ,$92.92 ,$70.70 ,$56.09 ,$60.31 ,$61.51 ,$56.09 ,$69.79 ,$72.72 ,$70.35 ,$11.65 ,$72.72 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$19.60 ,$68.00 ,$11.53 ,$19.60 ,$68.00 ,$58.40 ,$11.91 ,$11.53 ,$13.05 ,$68.00 ,$25.94 ,$73.60 ,$56.00 ,$56.09 ,$60.31 ,$48.72 ,$56.09 ,$55.28 ,$57.60 ,$55.72 ,$11.65 ,$57.60 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,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 ,$59.76 ,$60.59 ,$19.60 ,$70.55 ,$11.53 ,$19.60 ,$70.55 ,$60.59 ,$11.91 ,$11.53 ,$13.05 ,$70.55 ,$25.94 ,$76.36 ,$58.10 ,$56.09 ,$60.31 ,$50.55 ,$56.09 ,$57.35 ,$59.76 ,$57.81 ,$11.65 ,$59.76 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$49.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$19.60 ,$76.50 ,$11.53 ,$19.60 ,$76.50 ,$65.70 ,$11.91 ,$11.53 ,$13.05 ,$76.50 ,$25.94 ,$82.80 ,$63.00 ,$56.09 ,$60.31 ,$54.81 ,$56.09 ,$62.19 ,$64.80 ,$62.69 ,$11.65 ,$64.80 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$19.60 ,$85.85 ,$11.53 ,$19.60 ,$85.85 ,$73.73 ,$11.91 ,$11.53 ,$13.05 ,$85.85 ,$25.94 ,$92.92 ,$70.70 ,$56.09 ,$60.31 ,$61.51 ,$56.09 ,$69.79 ,$72.72 ,$70.35 ,$11.65 ,$72.72 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$347.76 ,$352.59 ,$31.28 ,$410.55 ,$18.40 ,$31.28 ,$410.55 ,$352.59 ,$19.00 ,$18.40 ,$20.83 ,$410.55 ,$41.40 ,$444.36 ,$338.10 ,$65.68 ,$70.62 ,$294.15 ,$65.68 ,$333.75 ,$347.76 ,$336.41 ,$18.58 ,$347.76 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$347.76 ,$299.46 ,$347.76 ,$347.76 ,$289.80 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$31.28 ,$87.55 ,$18.40 ,$31.28 ,$87.55 ,$75.19 ,$19.00 ,$18.40 ,$20.83 ,$87.55 ,$41.40 ,$94.76 ,$72.10 ,$65.68 ,$70.62 ,$62.73 ,$65.68 ,$71.17 ,$74.16 ,$71.74 ,$18.58 ,$74.16 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$40.07 ,$219.30 ,$23.57 ,$40.07 ,$219.30 ,$188.34 ,$19.88 ,$23.57 ,$26.68 ,$219.30 ,$53.03 ,$237.36 ,$180.60 ,$68.75 ,$73.91 ,$157.12 ,$68.75 ,$178.28 ,$185.76 ,$179.70 ,$23.81 ,$185.76 ,$21.07 ,$28.28 ,$28.28 ,$23.57 ,$28.28 ,$23.57 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$121.68 ,$123.37 ,$31.28 ,$143.65 ,$18.40 ,$31.28 ,$143.65 ,$123.37 ,$19.00 ,$18.40 ,$20.83 ,$143.65 ,$41.40 ,$155.48 ,$118.30 ,$65.68 ,$70.62 ,$102.92 ,$65.68 ,$116.78 ,$121.68 ,$117.71 ,$18.58 ,$121.68 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$101.40 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$31.28 ,$476.00 ,$18.40 ,$31.28 ,$476.00 ,$408.80 ,$19.00 ,$18.40 ,$20.83 ,$476.00 ,$41.40 ,$515.20 ,$392.00 ,$65.68 ,$70.62 ,$341.04 ,$65.68 ,$386.96 ,$403.20 ,$390.04 ,$18.58 ,$403.20 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$172.80 ,$175.20 ,$31.28 ,$204.00 ,$18.40 ,$31.28 ,$204.00 ,$175.20 ,$19.00 ,$18.40 ,$20.83 ,$204.00 ,$41.40 ,$220.80 ,$168.00 ,$65.68 ,$70.62 ,$146.16 ,$65.68 ,$165.84 ,$172.80 ,$167.16 ,$18.58 ,$172.80 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$172.80 ,$148.80 ,$172.80 ,$172.80 ,$144.00 
ST MARY'S HOSPITAL,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 ,$129.60 ,$131.40 ,$65.57 ,$153.00 ,$38.57 ,$65.57 ,$153.00 ,$131.40 ,$15.44 ,$38.57 ,$43.65 ,$153.00 ,$86.78 ,$165.60 ,$126.00 ,$68.78 ,$73.95 ,$109.62 ,$68.78 ,$124.38 ,$129.60 ,$125.37 ,$38.96 ,$129.60 ,$16.37 ,$46.28 ,$46.28 ,$38.57 ,$46.28 ,$38.57 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$108.00 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$29.36 ,$285.60 ,$17.27 ,$29.36 ,$285.60 ,$245.28 ,$17.85 ,$17.27 ,$19.55 ,$285.60 ,$38.86 ,$309.12 ,$235.20 ,$62.94 ,$67.67 ,$204.62 ,$62.94 ,$232.18 ,$241.92 ,$234.02 ,$17.44 ,$241.92 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$29.36 ,$119.85 ,$17.27 ,$29.36 ,$119.85 ,$102.93 ,$17.85 ,$17.27 ,$19.55 ,$119.85 ,$38.86 ,$129.72 ,$98.70 ,$62.94 ,$67.67 ,$85.87 ,$62.94 ,$97.43 ,$101.52 ,$98.21 ,$17.44 ,$101.52 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$84.15 ,$72.27 ,$17.85 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.94 ,$67.67 ,$60.29 ,$62.94 ,$68.41 ,$71.28 ,$68.95 ,$17.44 ,$71.28 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$29.36 ,$136.00 ,$17.27 ,$29.36 ,$136.00 ,$116.80 ,$17.85 ,$17.27 ,$19.55 ,$136.00 ,$38.86 ,$147.20 ,$112.00 ,$62.94 ,$67.67 ,$97.44 ,$62.94 ,$110.56 ,$115.20 ,$111.44 ,$17.44 ,$115.20 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$84.15 ,$72.27 ,$17.85 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.94 ,$67.67 ,$60.29 ,$62.94 ,$68.41 ,$71.28 ,$68.95 ,$17.44 ,$71.28 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$84.15 ,$72.27 ,$17.85 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.94 ,$67.67 ,$60.29 ,$62.94 ,$68.41 ,$71.28 ,$68.95 ,$17.44 ,$71.28 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$84.15 ,$72.27 ,$17.85 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.94 ,$67.67 ,$60.29 ,$62.94 ,$68.41 ,$71.28 ,$68.95 ,$17.44 ,$71.28 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$24.00 ,$190.40 ,$14.12 ,$24.00 ,$190.40 ,$163.52 ,$14.59 ,$14.12 ,$15.98 ,$190.40 ,$31.77 ,$206.08 ,$156.80 ,$68.67 ,$73.83 ,$136.42 ,$68.67 ,$154.78 ,$161.28 ,$156.02 ,$14.26 ,$161.28 ,$15.47 ,$16.94 ,$16.94 ,$14.12 ,$16.94 ,$14.12 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$19.43 ,$66.30 ,$11.43 ,$19.43 ,$66.30 ,$56.94 ,$11.81 ,$11.43 ,$12.94 ,$66.30 ,$25.72 ,$71.76 ,$54.60 ,$55.56 ,$59.73 ,$47.50 ,$55.56 ,$53.90 ,$56.16 ,$54.33 ,$11.54 ,$56.16 ,$12.52 ,$13.72 ,$13.72 ,$11.43 ,$13.72 ,$11.43 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$11.00 ,$41.65 ,$6.47 ,$11.00 ,$41.65 ,$35.77 ,$6.69 ,$6.47 ,$7.32 ,$41.65 ,$14.56 ,$45.08 ,$34.30 ,$31.47 ,$33.83 ,$29.84 ,$31.47 ,$33.86 ,$35.28 ,$34.13 ,$6.53 ,$35.28 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$14.86 ,$56.95 ,$8.74 ,$14.86 ,$56.95 ,$48.91 ,$9.03 ,$8.74 ,$9.89 ,$56.95 ,$19.67 ,$61.64 ,$46.90 ,$42.52 ,$45.71 ,$40.80 ,$42.52 ,$46.30 ,$48.24 ,$46.67 ,$8.83 ,$48.24 ,$9.57 ,$10.49 ,$10.49 ,$8.74 ,$10.49 ,$8.74 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$66.24 ,$67.16 ,$21.76 ,$78.20 ,$12.80 ,$21.76 ,$78.20 ,$67.16 ,$13.23 ,$12.80 ,$14.49 ,$78.20 ,$28.80 ,$84.64 ,$64.40 ,$62.26 ,$66.94 ,$56.03 ,$62.26 ,$63.57 ,$66.24 ,$64.08 ,$12.93 ,$66.24 ,$14.02 ,$15.36 ,$15.36 ,$12.80 ,$15.36 ,$12.80 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$55.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$19.67 ,$76.50 ,$11.57 ,$19.67 ,$76.50 ,$65.70 ,$11.96 ,$11.57 ,$13.09 ,$76.50 ,$26.03 ,$82.80 ,$63.00 ,$51.92 ,$55.83 ,$54.81 ,$51.92 ,$62.19 ,$64.80 ,$62.69 ,$11.69 ,$64.80 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$11.57 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$10.27 ,$41.65 ,$6.04 ,$10.27 ,$41.65 ,$35.77 ,$6.24 ,$6.04 ,$6.84 ,$41.65 ,$13.59 ,$45.08 ,$34.30 ,$29.33 ,$31.53 ,$29.84 ,$29.33 ,$33.86 ,$35.28 ,$34.13 ,$6.10 ,$35.28 ,$6.61 ,$7.25 ,$7.25 ,$6.04 ,$7.25 ,$6.04 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.74 ,$66.30 ,$12.79 ,$21.74 ,$66.30 ,$56.94 ,$13.22 ,$12.79 ,$14.48 ,$66.30 ,$28.78 ,$71.76 ,$54.60 ,$62.22 ,$66.90 ,$47.50 ,$62.22 ,$53.90 ,$56.16 ,$54.33 ,$12.92 ,$56.16 ,$14.01 ,$15.35 ,$15.35 ,$12.79 ,$15.35 ,$12.79 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$76.50 ,$65.70 ,$12.51 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.87 ,$63.30 ,$54.81 ,$58.87 ,$62.19 ,$64.80 ,$62.69 ,$12.23 ,$64.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$76.50 ,$65.70 ,$12.51 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.87 ,$63.30 ,$54.81 ,$58.87 ,$62.19 ,$64.80 ,$62.69 ,$12.23 ,$64.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$76.50 ,$65.70 ,$12.51 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.87 ,$63.30 ,$54.81 ,$58.87 ,$62.19 ,$64.80 ,$62.69 ,$12.23 ,$64.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$76.50 ,$65.70 ,$12.51 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.87 ,$63.30 ,$54.81 ,$58.87 ,$62.19 ,$64.80 ,$62.69 ,$12.23 ,$64.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$76.50 ,$65.70 ,$12.51 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.87 ,$63.30 ,$54.81 ,$58.87 ,$62.19 ,$64.80 ,$62.69 ,$12.23 ,$64.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.59 ,$76.50 ,$12.11 ,$20.59 ,$76.50 ,$65.70 ,$12.51 ,$12.11 ,$13.71 ,$76.50 ,$27.25 ,$82.80 ,$63.00 ,$58.87 ,$63.30 ,$54.81 ,$58.87 ,$62.19 ,$64.80 ,$62.69 ,$12.23 ,$64.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$389.52 ,$394.93 ,$32.15 ,$459.85 ,$18.91 ,$32.15 ,$459.85 ,$394.93 ,$13.65 ,$18.91 ,$21.40 ,$459.85 ,$42.55 ,$497.72 ,$378.70 ,$91.98 ,$98.89 ,$329.47 ,$91.98 ,$373.83 ,$389.52 ,$376.81 ,$19.10 ,$389.52 ,$14.47 ,$22.69 ,$22.69 ,$18.91 ,$22.69 ,$18.91 ,$389.52 ,$335.42 ,$389.52 ,$389.52 ,$324.60 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$11.71 ,$66.30 ,$6.89 ,$11.71 ,$66.30 ,$56.94 ,$7.12 ,$6.89 ,$7.80 ,$66.30 ,$15.50 ,$71.76 ,$54.60 ,$33.50 ,$36.02 ,$47.50 ,$33.50 ,$53.90 ,$56.16 ,$54.33 ,$6.96 ,$56.16 ,$7.55 ,$8.27 ,$8.27 ,$6.89 ,$8.27 ,$6.89 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$24.34 ,$66.30 ,$14.32 ,$24.34 ,$66.30 ,$56.94 ,$14.80 ,$14.32 ,$16.21 ,$66.30 ,$32.22 ,$71.76 ,$54.60 ,$62.94 ,$67.67 ,$47.50 ,$62.94 ,$53.90 ,$56.16 ,$54.33 ,$14.46 ,$56.16 ,$15.69 ,$17.18 ,$17.18 ,$14.32 ,$17.18 ,$14.32 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$132.48 ,$134.32 ,$57.56 ,$156.40 ,$33.86 ,$57.56 ,$156.40 ,$134.32 ,$32.56 ,$33.86 ,$38.32 ,$156.40 ,$76.19 ,$169.28 ,$128.80 ,$120.67 ,$129.74 ,$112.06 ,$120.67 ,$127.14 ,$132.48 ,$128.16 ,$34.20 ,$132.48 ,$34.51 ,$40.63 ,$40.63 ,$33.86 ,$40.63 ,$33.86 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$110.40 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$58.12 ,$209.10 ,$34.19 ,$58.12 ,$209.10 ,$179.58 ,$35.33 ,$34.19 ,$38.70 ,$209.10 ,$76.93 ,$226.32 ,$172.20 ,$153.39 ,$164.91 ,$149.81 ,$153.39 ,$169.99 ,$177.12 ,$171.34 ,$34.53 ,$177.12 ,$37.45 ,$41.03 ,$41.03 ,$34.19 ,$41.03 ,$34.19 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,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 ,$92.88 ,$94.17 ,$58.12 ,$109.65 ,$34.19 ,$58.12 ,$109.65 ,$94.17 ,$35.33 ,$34.19 ,$38.70 ,$109.65 ,$76.93 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$92.88 ,$89.85 ,$34.53 ,$92.88 ,$37.45 ,$41.03 ,$41.03 ,$34.19 ,$41.03 ,$34.19 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.92 ,$56.95 ,$8.19 ,$13.92 ,$56.95 ,$48.91 ,$8.46 ,$8.19 ,$9.27 ,$56.95 ,$18.43 ,$61.64 ,$46.90 ,$39.81 ,$42.80 ,$40.80 ,$39.81 ,$46.30 ,$48.24 ,$46.67 ,$8.27 ,$48.24 ,$8.97 ,$9.83 ,$9.83 ,$8.19 ,$9.83 ,$8.19 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$17.85 ,$66.30 ,$10.50 ,$17.85 ,$66.30 ,$56.94 ,$10.85 ,$10.50 ,$11.88 ,$66.30 ,$23.63 ,$71.76 ,$54.60 ,$46.40 ,$49.89 ,$47.50 ,$46.40 ,$53.90 ,$56.16 ,$54.33 ,$10.61 ,$56.16 ,$11.50 ,$12.60 ,$12.60 ,$10.50 ,$12.60 ,$10.50 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$11.39 ,$44.20 ,$6.70 ,$11.39 ,$44.20 ,$37.96 ,$6.92 ,$6.70 ,$7.58 ,$44.20 ,$15.08 ,$47.84 ,$36.40 ,$32.57 ,$35.02 ,$31.67 ,$32.57 ,$35.93 ,$37.44 ,$36.22 ,$6.77 ,$37.44 ,$7.34 ,$8.04 ,$8.04 ,$6.70 ,$8.04 ,$6.70 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$45.31 ,$133.45 ,$26.65 ,$45.31 ,$133.45 ,$114.61 ,$27.54 ,$26.65 ,$30.16 ,$133.45 ,$59.96 ,$144.44 ,$109.90 ,$119.57 ,$128.55 ,$95.61 ,$119.57 ,$108.49 ,$113.04 ,$109.35 ,$26.92 ,$113.04 ,$29.19 ,$31.98 ,$31.98 ,$26.65 ,$31.98 ,$26.65 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$45.31 ,$133.45 ,$26.65 ,$45.31 ,$133.45 ,$114.61 ,$27.54 ,$26.65 ,$30.16 ,$133.45 ,$59.96 ,$144.44 ,$109.90 ,$119.57 ,$128.55 ,$95.61 ,$119.57 ,$108.49 ,$113.04 ,$109.35 ,$26.92 ,$113.04 ,$29.19 ,$31.98 ,$31.98 ,$26.65 ,$31.98 ,$26.65 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$226.08 ,$229.22 ,$40.95 ,$266.90 ,$24.09 ,$40.95 ,$266.90 ,$229.22 ,$24.89 ,$24.09 ,$27.27 ,$266.90 ,$54.20 ,$288.88 ,$219.80 ,$87.78 ,$94.37 ,$191.23 ,$87.78 ,$216.97 ,$226.08 ,$218.70 ,$24.33 ,$226.08 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$188.40 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$40.99 ,$171.70 ,$24.11 ,$40.99 ,$171.70 ,$147.46 ,$24.91 ,$24.11 ,$27.29 ,$171.70 ,$54.25 ,$185.84 ,$141.40 ,$87.78 ,$94.37 ,$123.02 ,$87.78 ,$139.58 ,$145.44 ,$140.69 ,$24.35 ,$145.44 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$24.11 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$129.60 ,$131.40 ,$180.00 ,$153.00 ,$114.43 ,$180.00 ,$153.00 ,$131.40 ,$63.95 ,$114.43 ,$129.51 ,$153.00 ,$257.47 ,$165.60 ,$126.00 ,$180.00 ,$180.00 ,$109.62 ,$180.00 ,$124.38 ,$129.60 ,$125.37 ,$115.57 ,$129.60 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$108.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$22.53 ,$85.00 ,$13.25 ,$22.53 ,$85.00 ,$73.00 ,$13.69 ,$13.25 ,$15.00 ,$85.00 ,$29.81 ,$92.00 ,$70.00 ,$64.47 ,$69.31 ,$60.90 ,$64.47 ,$69.10 ,$72.00 ,$69.65 ,$13.38 ,$72.00 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$136.00 ,$116.80 ,$63.95 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$115.20 ,$111.44 ,$115.57 ,$115.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$85.85 ,$73.73 ,$16.80 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$79.05 ,$84.98 ,$61.51 ,$79.05 ,$69.79 ,$72.72 ,$70.35 ,$16.42 ,$72.72 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$16.26 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$85.85 ,$73.73 ,$16.80 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$79.05 ,$84.98 ,$61.51 ,$79.05 ,$69.79 ,$72.72 ,$70.35 ,$16.42 ,$72.72 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$16.26 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$85.85 ,$73.73 ,$16.80 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$79.05 ,$84.98 ,$61.51 ,$79.05 ,$69.79 ,$72.72 ,$70.35 ,$16.42 ,$72.72 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$16.26 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$27.64 ,$85.85 ,$16.26 ,$27.64 ,$85.85 ,$73.73 ,$16.80 ,$16.26 ,$18.40 ,$85.85 ,$36.59 ,$92.92 ,$70.70 ,$79.05 ,$84.98 ,$61.51 ,$79.05 ,$69.79 ,$72.72 ,$70.35 ,$16.42 ,$72.72 ,$17.81 ,$19.51 ,$19.51 ,$16.26 ,$19.51 ,$16.26 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$28.80 ,$113.90 ,$16.94 ,$28.80 ,$113.90 ,$97.82 ,$17.50 ,$16.94 ,$19.17 ,$113.90 ,$38.12 ,$123.28 ,$93.80 ,$82.36 ,$88.55 ,$81.61 ,$82.36 ,$92.59 ,$96.48 ,$93.33 ,$17.11 ,$96.48 ,$18.55 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$16.94 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$28.80 ,$113.90 ,$16.94 ,$28.80 ,$113.90 ,$97.82 ,$17.50 ,$16.94 ,$19.17 ,$113.90 ,$38.12 ,$123.28 ,$93.80 ,$82.36 ,$88.55 ,$81.61 ,$82.36 ,$92.59 ,$96.48 ,$93.33 ,$17.11 ,$96.48 ,$18.55 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$16.94 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$28.80 ,$113.90 ,$16.94 ,$28.80 ,$113.90 ,$97.82 ,$17.50 ,$16.94 ,$19.17 ,$113.90 ,$38.12 ,$123.28 ,$93.80 ,$82.36 ,$88.55 ,$81.61 ,$82.36 ,$92.59 ,$96.48 ,$93.33 ,$17.11 ,$96.48 ,$18.55 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$16.94 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$38.56 ,$178.50 , N/A ,$38.56 ,$178.50 ,$153.30 ,$1.53 , N/A ,$88.20 ,$178.50 , N/A ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 , N/A ,$151.20 ,$1.62 , N/A , N/A , N/A , N/A , N/A ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$29.24 ,$95.20 ,$17.20 ,$29.24 ,$95.20 ,$81.76 ,$17.77 ,$17.20 ,$19.47 ,$95.20 ,$38.70 ,$103.04 ,$78.40 ,$83.64 ,$89.93 ,$68.21 ,$83.64 ,$77.39 ,$80.64 ,$78.01 ,$17.37 ,$80.64 ,$18.84 ,$20.64 ,$20.64 ,$17.20 ,$20.64 ,$17.20 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$21.96 ,$95.20 ,$12.92 ,$21.96 ,$95.20 ,$81.76 ,$13.35 ,$12.92 ,$14.62 ,$95.20 ,$29.07 ,$103.04 ,$78.40 ,$62.79 ,$67.51 ,$68.21 ,$62.79 ,$77.39 ,$80.64 ,$78.01 ,$13.05 ,$80.64 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$12.92 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$21.96 ,$95.20 ,$12.92 ,$21.96 ,$95.20 ,$81.76 ,$13.35 ,$12.92 ,$14.62 ,$95.20 ,$29.07 ,$103.04 ,$78.40 ,$62.79 ,$67.51 ,$68.21 ,$62.79 ,$77.39 ,$80.64 ,$78.01 ,$13.05 ,$80.64 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$12.92 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$21.96 ,$95.20 ,$12.92 ,$21.96 ,$95.20 ,$81.76 ,$13.35 ,$12.92 ,$14.62 ,$95.20 ,$29.07 ,$103.04 ,$78.40 ,$62.79 ,$67.51 ,$68.21 ,$62.79 ,$77.39 ,$80.64 ,$78.01 ,$13.05 ,$80.64 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$12.92 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$66.74 ,$219.30 ,$39.26 ,$66.74 ,$219.30 ,$188.34 ,$40.57 ,$39.26 ,$44.43 ,$219.30 ,$88.34 ,$237.36 ,$180.60 ,$165.04 ,$177.44 ,$157.12 ,$165.04 ,$178.28 ,$185.76 ,$179.70 ,$39.65 ,$185.76 ,$43.00 ,$47.11 ,$47.11 ,$39.26 ,$47.11 ,$39.26 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.12 ,$85.85 ,$13.60 ,$23.12 ,$85.85 ,$73.73 ,$14.05 ,$13.60 ,$15.39 ,$85.85 ,$30.60 ,$92.92 ,$70.70 ,$66.07 ,$71.04 ,$61.51 ,$66.07 ,$69.79 ,$72.72 ,$70.35 ,$13.74 ,$72.72 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$13.60 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.12 ,$85.85 ,$13.60 ,$23.12 ,$85.85 ,$73.73 ,$14.05 ,$13.60 ,$15.39 ,$85.85 ,$30.60 ,$92.92 ,$70.70 ,$66.07 ,$71.04 ,$61.51 ,$66.07 ,$69.79 ,$72.72 ,$70.35 ,$13.74 ,$72.72 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$13.60 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.40 ,$76.50 ,$12.00 ,$20.40 ,$76.50 ,$65.70 ,$12.40 ,$12.00 ,$13.58 ,$76.50 ,$27.00 ,$82.80 ,$63.00 ,$58.38 ,$62.76 ,$54.81 ,$58.38 ,$62.19 ,$64.80 ,$62.69 ,$12.12 ,$64.80 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$12.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$91.44 ,$92.71 ,$23.12 ,$107.95 ,$13.60 ,$23.12 ,$107.95 ,$92.71 ,$14.05 ,$13.60 ,$15.39 ,$107.95 ,$30.60 ,$116.84 ,$88.90 ,$66.07 ,$71.04 ,$77.34 ,$66.07 ,$87.76 ,$91.44 ,$88.46 ,$13.74 ,$91.44 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$13.60 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$76.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$23.12 ,$76.50 ,$13.60 ,$23.12 ,$76.50 ,$65.70 ,$14.05 ,$13.60 ,$15.39 ,$76.50 ,$30.60 ,$82.80 ,$63.00 ,$66.07 ,$71.04 ,$54.81 ,$66.07 ,$62.19 ,$64.80 ,$62.69 ,$13.74 ,$64.80 ,$14.89 ,$16.32 ,$16.32 ,$13.60 ,$16.32 ,$13.60 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$45.36 ,$45.99 ,$63.00 ,$53.55 ,$63.00 ,$63.00 ,$53.55 ,$45.99 ,$63.00 ,$63.00 ,$63.00 ,$53.55 ,$141.75 ,$57.96 ,$44.10 ,$63.00 ,$63.00 ,$38.37 ,$63.00 ,$43.53 ,$45.36 ,$43.88 ,$63.63 ,$45.36 ,$66.78 ,$63.00 ,$63.00 ,$63.00 ,$63.00 ,$63.00 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$37.80 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$120.00 ,$102.00 ,$114.43 ,$120.00 ,$102.00 ,$87.60 ,$63.95 ,$114.43 ,$120.00 ,$102.00 ,$257.47 ,$110.40 ,$84.00 ,$120.00 ,$120.00 ,$73.08 ,$120.00 ,$82.92 ,$86.40 ,$83.58 ,$115.57 ,$86.40 ,$67.79 ,$120.00 ,$120.00 ,$114.43 ,$120.00 ,$114.43 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$13.77 ,$304.30 ,$8.10 ,$13.77 ,$304.30 ,$261.34 ,$8.37 ,$8.10 ,$9.17 ,$304.30 ,$18.23 ,$329.36 ,$250.60 ,$34.00 ,$36.55 ,$218.02 ,$34.00 ,$247.38 ,$257.76 ,$249.35 ,$8.18 ,$257.76 ,$8.87 ,$9.72 ,$9.72 ,$8.10 ,$9.72 ,$8.10 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$91.44 ,$92.71 ,$28.68 ,$107.95 ,$16.87 ,$28.68 ,$107.95 ,$92.71 ,$17.43 ,$16.87 ,$19.09 ,$107.95 ,$37.96 ,$116.84 ,$88.90 ,$70.06 ,$75.33 ,$77.34 ,$70.06 ,$87.76 ,$91.44 ,$88.46 ,$17.04 ,$91.44 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$76.20 
ST MARY'S HOSPITAL,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 ,$131.76 ,$133.59 ,$30.70 ,$155.55 ,$18.06 ,$30.70 ,$155.55 ,$133.59 ,$10.38 ,$18.06 ,$20.44 ,$155.55 ,$40.64 ,$168.36 ,$128.10 ,$87.78 ,$94.37 ,$111.45 ,$87.78 ,$126.45 ,$131.76 ,$127.46 ,$18.24 ,$131.76 ,$11.00 ,$21.67 ,$21.67 ,$18.06 ,$21.67 ,$18.06 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,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 ,$370.08 ,$375.22 ,$28.68 ,$436.90 ,$16.87 ,$28.68 ,$436.90 ,$375.22 ,$17.43 ,$16.87 ,$19.09 ,$436.90 ,$37.96 ,$472.88 ,$359.80 ,$70.06 ,$75.33 ,$313.03 ,$70.06 ,$355.17 ,$370.08 ,$358.00 ,$17.04 ,$370.08 ,$18.48 ,$20.24 ,$20.24 ,$16.87 ,$20.24 ,$16.87 ,$370.08 ,$318.68 ,$370.08 ,$370.08 ,$308.40 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$24.62 ,$87.55 ,$14.48 ,$24.62 ,$87.55 ,$75.19 ,$14.96 ,$14.48 ,$16.39 ,$87.55 ,$32.58 ,$94.76 ,$72.10 ,$52.78 ,$56.75 ,$62.73 ,$52.78 ,$71.17 ,$74.16 ,$71.74 ,$14.62 ,$74.16 ,$15.86 ,$17.38 ,$17.38 ,$14.48 ,$17.38 ,$14.48 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$19.67 ,$113.90 ,$11.57 ,$19.67 ,$113.90 ,$97.82 ,$11.96 ,$11.57 ,$13.09 ,$113.90 ,$26.03 ,$123.28 ,$93.80 ,$51.92 ,$55.83 ,$81.61 ,$51.92 ,$92.59 ,$96.48 ,$93.33 ,$11.69 ,$96.48 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$11.57 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$19.67 ,$113.90 ,$11.57 ,$19.67 ,$113.90 ,$97.82 ,$11.96 ,$11.57 ,$13.09 ,$113.90 ,$26.03 ,$123.28 ,$93.80 ,$51.92 ,$55.83 ,$81.61 ,$51.92 ,$92.59 ,$96.48 ,$93.33 ,$11.69 ,$96.48 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$11.57 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$51.84 ,$52.56 ,$23.02 ,$61.20 ,$13.54 ,$23.02 ,$61.20 ,$52.56 ,$13.99 ,$13.54 ,$15.32 ,$61.20 ,$30.47 ,$66.24 ,$50.40 ,$65.72 ,$70.65 ,$43.85 ,$65.72 ,$49.75 ,$51.84 ,$50.15 ,$13.68 ,$51.84 ,$14.83 ,$16.25 ,$16.25 ,$13.54 ,$16.25 ,$13.54 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$43.20 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$40.95 ,$247.35 ,$24.09 ,$40.95 ,$247.35 ,$212.43 ,$24.89 ,$24.09 ,$27.27 ,$247.35 ,$54.20 ,$267.72 ,$203.70 ,$87.78 ,$94.37 ,$177.22 ,$87.78 ,$201.08 ,$209.52 ,$202.68 ,$24.33 ,$209.52 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$18.96 ,$124.10 ,$11.15 ,$18.96 ,$124.10 ,$106.58 ,$11.52 ,$11.15 ,$12.62 ,$124.10 ,$25.09 ,$134.32 ,$102.20 ,$54.21 ,$58.28 ,$88.91 ,$54.21 ,$100.89 ,$105.12 ,$101.69 ,$11.26 ,$105.12 ,$12.21 ,$13.38 ,$13.38 ,$11.15 ,$13.38 ,$11.15 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$46.56 ,$124.10 ,$27.39 ,$46.56 ,$124.10 ,$106.58 ,$28.28 ,$27.39 ,$31.00 ,$124.10 ,$61.63 ,$134.32 ,$102.20 ,$97.76 ,$105.10 ,$88.91 ,$97.76 ,$100.89 ,$105.12 ,$101.69 ,$27.66 ,$105.12 ,$29.98 ,$32.87 ,$32.87 ,$27.39 ,$32.87 ,$27.39 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$40.12 ,$561.85 ,$23.60 ,$40.12 ,$561.85 ,$482.53 ,$23.14 ,$23.60 ,$26.71 ,$561.85 ,$53.10 ,$608.12 ,$462.70 ,$80.01 ,$86.02 ,$402.55 ,$80.01 ,$456.75 ,$475.92 ,$460.39 ,$23.84 ,$475.92 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$23.60 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ",$822.24 ,$833.66 ,$40.12 ,$970.70 ,$23.60 ,$40.12 ,$970.70 ,$833.66 ,$23.14 ,$23.60 ,$26.71 ,$970.70 ,$53.10 ,"$1,050.64 ",$799.40 ,$80.01 ,$86.02 ,$695.48 ,$80.01 ,$789.12 ,$822.24 ,$795.40 ,$23.84 ,$822.24 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$23.60 ,$822.24 ,$708.04 ,$822.24 ,$822.24 ,$685.20 
ST MARY'S HOSPITAL,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 ",$853.20 ,$865.05 ,$40.12 ,"$1,007.25 ",$23.60 ,$40.12 ,"$1,007.25 ",$865.05 ,$23.14 ,$23.60 ,$26.71 ,"$1,007.25 ",$53.10 ,"$1,090.20 ",$829.50 ,$80.01 ,$86.02 ,$721.67 ,$80.01 ,$818.84 ,$853.20 ,$825.35 ,$23.84 ,$853.20 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$23.60 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,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 ,$690.48 ,$700.07 ,$40.12 ,$815.15 ,$23.60 ,$40.12 ,$815.15 ,$700.07 ,$23.14 ,$23.60 ,$26.71 ,$815.15 ,$53.10 ,$882.28 ,$671.30 ,$80.01 ,$86.02 ,$584.03 ,$80.01 ,$662.67 ,$690.48 ,$667.94 ,$23.84 ,$690.48 ,$24.53 ,$28.32 ,$28.32 ,$23.60 ,$28.32 ,$23.60 ,$690.48 ,$594.58 ,$690.48 ,$690.48 ,$575.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$36.06 ,$104.55 ,$21.21 ,$36.06 ,$104.55 ,$89.79 ,$21.92 ,$21.21 ,$24.01 ,$104.55 ,$47.72 ,$113.16 ,$86.10 ,$80.01 ,$86.02 ,$74.91 ,$80.01 ,$84.99 ,$88.56 ,$85.67 ,$21.42 ,$88.56 ,$23.24 ,$25.45 ,$25.45 ,$21.21 ,$25.45 ,$21.21 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$26.64 ,$27.01 ,$27.08 ,$31.45 , N/A ,$27.08 ,$31.45 ,$27.01 ,$1.53 , N/A ,$15.54 ,$31.45 , N/A ,$34.04 ,$25.90 ,$18.77 ,$22.52 ,$22.53 ,$21.02 ,$25.57 ,$26.64 ,$25.77 , N/A ,$26.64 ,$1.62 , N/A , N/A , N/A , N/A , N/A ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$22.20 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$11.24 ,$42.50 ,$6.61 ,$11.24 ,$42.50 ,$36.50 ,$6.83 ,$6.61 ,$7.48 ,$42.50 ,$14.87 ,$46.00 ,$35.00 ,$32.15 ,$34.56 ,$30.45 ,$32.15 ,$34.55 ,$36.00 ,$34.83 ,$6.68 ,$36.00 ,$7.24 ,$7.93 ,$7.93 ,$6.61 ,$7.93 ,$6.61 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$11.59 ,$45.05 ,$6.82 ,$11.59 ,$45.05 ,$38.69 ,$7.05 ,$6.82 ,$7.72 ,$45.05 ,$15.35 ,$48.76 ,$37.10 ,$33.14 ,$35.63 ,$32.28 ,$33.14 ,$36.62 ,$38.16 ,$36.91 ,$6.89 ,$38.16 ,$7.47 ,$8.18 ,$8.18 ,$6.82 ,$8.18 ,$6.82 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$24.57 ,$51.00 ,$14.45 ,$24.57 ,$51.00 ,$43.80 ,$14.93 ,$14.45 ,$16.35 ,$51.00 ,$32.51 ,$55.20 ,$42.00 ,$60.00 ,$60.00 ,$36.54 ,$60.00 ,$41.46 ,$43.20 ,$41.79 ,$14.59 ,$43.20 ,$15.83 ,$17.34 ,$17.34 ,$14.45 ,$17.34 ,$14.45 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$90.00 ,$91.25 ,$24.57 ,$106.25 ,$14.45 ,$24.57 ,$106.25 ,$91.25 ,$14.93 ,$14.45 ,$16.35 ,$106.25 ,$32.51 ,$115.00 ,$87.50 ,$62.58 ,$67.28 ,$76.13 ,$62.58 ,$86.38 ,$90.00 ,$87.06 ,$14.59 ,$90.00 ,$15.83 ,$17.34 ,$17.34 ,$14.45 ,$17.34 ,$14.45 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$75.00 
ST MARY'S HOSPITAL,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 ,$226.08 ,$229.22 ,$70.18 ,$266.90 ,$41.28 ,$70.18 ,$266.90 ,$229.22 ,$42.65 ,$41.28 ,$46.72 ,$266.90 ,$92.88 ,$288.88 ,$219.80 ,$200.68 ,$215.76 ,$191.23 ,$200.68 ,$216.97 ,$226.08 ,$218.70 ,$41.69 ,$226.08 ,$45.21 ,$49.54 ,$49.54 ,$41.28 ,$49.54 ,$41.28 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$188.40 
ST MARY'S HOSPITAL,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 ,$19.44 ,$19.71 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$22.95 ,$19.71 ,$3.70 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.39 ,$18.70 ,$16.44 ,$17.39 ,$18.66 ,$19.44 ,$18.81 ,$3.62 ,$19.44 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$3.58 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$16.20 
ST MARY'S HOSPITAL,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 ,$19.44 ,$19.71 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$22.95 ,$19.71 ,$3.70 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.39 ,$18.70 ,$16.44 ,$17.39 ,$18.66 ,$19.44 ,$18.81 ,$3.62 ,$19.44 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$3.58 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$16.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$66.49 ,$95.20 , N/A ,$66.49 ,$95.20 ,$81.76 ,$20.67 , N/A ,$47.04 ,$95.20 , N/A ,$103.04 ,$78.40 ,$71.45 ,$76.82 ,$68.21 ,$71.45 ,$77.39 ,$80.64 ,$78.01 , N/A ,$80.64 ,$21.91 ,$51.97 ,$51.97 , N/A ,$51.97 , N/A ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$9.35 ,$181.05 ,$5.50 ,$9.35 ,$181.05 ,$155.49 ,$5.68 ,$5.50 ,$6.22 ,$181.05 ,$12.38 ,$195.96 ,$149.10 ,$26.73 ,$28.74 ,$129.72 ,$26.73 ,$147.18 ,$153.36 ,$148.35 ,$5.56 ,$153.36 ,$6.02 ,$6.60 ,$6.60 ,$5.50 ,$6.60 ,$5.50 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$74.88 ,$75.92 ,$12.99 ,$88.40 ,$7.64 ,$12.99 ,$88.40 ,$75.92 ,$7.89 ,$7.64 ,$8.65 ,$88.40 ,$17.19 ,$95.68 ,$72.80 ,$35.92 ,$38.62 ,$63.34 ,$35.92 ,$71.86 ,$74.88 ,$72.44 ,$7.72 ,$74.88 ,$8.36 ,$9.17 ,$9.17 ,$7.64 ,$9.17 ,$7.64 ,$74.88 ,$64.48 ,$74.88 ,$74.88 ,$62.40 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$16.42 ,$95.20 ,$9.66 ,$16.42 ,$95.20 ,$81.76 ,$9.98 ,$9.66 ,$10.93 ,$95.20 ,$21.74 ,$103.04 ,$78.40 ,$46.97 ,$50.50 ,$68.21 ,$46.97 ,$77.39 ,$80.64 ,$78.01 ,$9.76 ,$80.64 ,$10.58 ,$11.59 ,$11.59 ,$9.66 ,$11.59 ,$9.66 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$20.16 ,$20.44 ,$8.81 ,$23.80 ,$5.18 ,$8.81 ,$23.80 ,$20.44 ,$5.35 ,$5.18 ,$5.86 ,$23.80 ,$11.66 ,$25.76 ,$19.60 ,$25.16 ,$27.05 ,$17.05 ,$25.16 ,$19.35 ,$20.16 ,$19.50 ,$5.23 ,$20.16 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$20.16 ,$17.36 ,$20.16 ,$20.16 ,$16.80 
ST MARY'S HOSPITAL,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 ,$28.80 ,$29.20 ,$8.81 ,$34.00 ,$5.18 ,$8.81 ,$34.00 ,$29.20 ,$5.35 ,$5.18 ,$5.86 ,$34.00 ,$11.66 ,$36.80 ,$28.00 ,$25.16 ,$27.05 ,$24.36 ,$25.16 ,$27.64 ,$28.80 ,$27.86 ,$5.23 ,$28.80 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.13 ,$95.20 ,$14.78 ,$25.13 ,$95.20 ,$81.76 ,$15.27 ,$14.78 ,$16.73 ,$95.20 ,$33.26 ,$103.04 ,$78.40 ,$71.88 ,$77.28 ,$68.21 ,$71.88 ,$77.39 ,$80.64 ,$78.01 ,$14.93 ,$80.64 ,$16.19 ,$17.74 ,$17.74 ,$14.78 ,$17.74 ,$14.78 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$313.92 ,$318.28 ,$28.08 ,$370.60 ,$16.52 ,$28.08 ,$370.60 ,$318.28 ,$17.07 ,$16.52 ,$18.70 ,$370.60 ,$37.17 ,$401.12 ,$305.20 ,$80.33 ,$86.36 ,$265.52 ,$80.33 ,$301.28 ,$313.92 ,$303.67 ,$16.69 ,$313.92 ,$18.09 ,$19.82 ,$19.82 ,$16.52 ,$19.82 ,$16.52 ,$313.92 ,$270.32 ,$313.92 ,$313.92 ,$261.60 
ST MARY'S HOSPITAL,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 ,$310.32 ,$314.63 ,$18.24 ,$366.35 ,$10.73 ,$18.24 ,$366.35 ,$314.63 ,$11.09 ,$10.73 ,$12.14 ,$366.35 ,$24.14 ,$396.52 ,$301.70 ,$50.21 ,$53.99 ,$262.48 ,$50.21 ,$297.82 ,$310.32 ,$300.19 ,$10.84 ,$310.32 ,$11.76 ,$12.88 ,$12.88 ,$10.73 ,$12.88 ,$10.73 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$8.06 ,$30.60 ,$4.74 ,$8.06 ,$30.60 ,$26.28 ,$4.90 ,$4.74 ,$5.36 ,$30.60 ,$10.67 ,$33.12 ,$25.20 ,$23.02 ,$24.75 ,$21.92 ,$23.02 ,$24.88 ,$25.92 ,$25.07 ,$4.79 ,$25.92 ,$5.19 ,$5.69 ,$5.69 ,$4.74 ,$5.69 ,$4.74 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$9.83 ,$33.15 ,$5.78 ,$9.83 ,$33.15 ,$28.47 ,$5.97 ,$5.78 ,$6.54 ,$33.15 ,$13.01 ,$35.88 ,$27.30 ,$25.16 ,$27.05 ,$23.75 ,$25.16 ,$26.95 ,$28.08 ,$27.16 ,$5.84 ,$28.08 ,$6.33 ,$6.94 ,$6.94 ,$5.78 ,$6.94 ,$5.78 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 ,$14.35 ,$52.70 ,$8.44 ,$14.35 ,$52.70 ,$45.26 ,$8.72 ,$8.44 ,$9.55 ,$52.70 ,$18.99 ,$57.04 ,$43.40 ,$41.02 ,$44.10 ,$37.76 ,$41.02 ,$42.84 ,$44.64 ,$43.18 ,$8.52 ,$44.64 ,$9.24 ,$10.13 ,$10.13 ,$8.44 ,$10.13 ,$8.44 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$14.35 ,$56.95 ,$8.44 ,$14.35 ,$56.95 ,$48.91 ,$8.72 ,$8.44 ,$9.55 ,$56.95 ,$18.99 ,$61.64 ,$46.90 ,$41.02 ,$44.10 ,$40.80 ,$41.02 ,$46.30 ,$48.24 ,$46.67 ,$8.52 ,$48.24 ,$9.24 ,$10.13 ,$10.13 ,$8.44 ,$10.13 ,$8.44 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$354.96 ,$359.89 ,$166.79 ,$419.05 ,$98.11 ,$166.79 ,$419.05 ,$359.89 ,$90.57 ,$98.11 ,$111.04 ,$419.05 ,$220.75 ,$453.56 ,$345.10 ,$313.19 ,$336.72 ,$300.24 ,$313.19 ,$340.66 ,$354.96 ,$343.37 ,$99.09 ,$354.96 ,$96.00 ,$117.73 ,$117.73 ,$98.11 ,$117.73 ,$98.11 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$25.01 ,$113.90 ,$14.71 ,$25.01 ,$113.90 ,$97.82 ,$15.20 ,$14.71 ,$16.65 ,$113.90 ,$33.10 ,$123.28 ,$93.80 ,$71.53 ,$76.90 ,$81.61 ,$71.53 ,$92.59 ,$96.48 ,$93.33 ,$14.86 ,$96.48 ,$16.11 ,$17.65 ,$17.65 ,$14.71 ,$17.65 ,$14.71 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$25.01 ,$142.80 ,$14.71 ,$25.01 ,$142.80 ,$122.64 ,$15.20 ,$14.71 ,$16.65 ,$142.80 ,$33.10 ,$154.56 ,$117.60 ,$71.53 ,$76.90 ,$102.31 ,$71.53 ,$116.09 ,$120.96 ,$117.01 ,$14.86 ,$120.96 ,$16.11 ,$17.65 ,$17.65 ,$14.71 ,$17.65 ,$14.71 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$8.09 ,$29.75 ,$4.76 ,$8.09 ,$29.75 ,$25.55 ,$4.92 ,$4.76 ,$5.39 ,$29.75 ,$10.71 ,$32.20 ,$24.50 ,$22.35 ,$24.02 ,$21.32 ,$22.35 ,$24.19 ,$25.20 ,$24.38 ,$4.81 ,$25.20 ,$5.22 ,$5.71 ,$5.71 ,$4.76 ,$5.71 ,$4.76 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$8.09 ,$29.75 ,$4.76 ,$8.09 ,$29.75 ,$25.55 ,$4.92 ,$4.76 ,$5.39 ,$29.75 ,$10.71 ,$32.20 ,$24.50 ,$22.35 ,$24.02 ,$21.32 ,$22.35 ,$24.19 ,$25.20 ,$24.38 ,$4.81 ,$25.20 ,$5.22 ,$5.71 ,$5.71 ,$4.76 ,$5.71 ,$4.76 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$8.09 ,$29.75 ,$4.76 ,$8.09 ,$29.75 ,$25.55 ,$4.92 ,$4.76 ,$5.39 ,$29.75 ,$10.71 ,$32.20 ,$24.50 ,$22.35 ,$24.02 ,$21.32 ,$22.35 ,$24.19 ,$25.20 ,$24.38 ,$4.81 ,$25.20 ,$5.22 ,$5.71 ,$5.71 ,$4.76 ,$5.71 ,$4.76 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$23.04 ,$23.36 ,$8.04 ,$27.20 ,$4.73 ,$8.04 ,$27.20 ,$23.36 ,$4.89 ,$4.73 ,$5.35 ,$27.20 ,$10.64 ,$29.44 ,$22.40 ,$20.92 ,$22.49 ,$19.49 ,$20.92 ,$22.11 ,$23.04 ,$22.29 ,$4.78 ,$23.04 ,$5.18 ,$5.68 ,$5.68 ,$4.73 ,$5.68 ,$4.73 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$19.20 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$24.80 ,$42.50 ,$14.59 ,$24.80 ,$42.50 ,$36.50 ,$7.85 ,$14.59 ,$16.51 ,$42.50 ,$32.83 ,$46.00 ,$35.00 ,$27.16 ,$29.20 ,$30.45 ,$27.16 ,$34.55 ,$36.00 ,$34.83 ,$14.74 ,$36.00 ,$8.32 ,$17.51 ,$17.51 ,$14.59 ,$17.51 ,$14.59 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$35.46 ,$124.10 ,$20.86 ,$35.46 ,$124.10 ,$106.58 ,$21.55 ,$20.86 ,$23.61 ,$124.10 ,$46.94 ,$134.32 ,$102.20 ,$90.45 ,$97.25 ,$88.91 ,$90.45 ,$100.89 ,$105.12 ,$101.69 ,$21.07 ,$105.12 ,$22.84 ,$25.03 ,$25.03 ,$20.86 ,$25.03 ,$20.86 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.95 ,$124.10 ,$19.38 ,$32.95 ,$124.10 ,$106.58 ,$20.03 ,$19.38 ,$21.93 ,$124.10 ,$43.61 ,$134.32 ,$102.20 ,$94.23 ,$101.31 ,$88.91 ,$94.23 ,$100.89 ,$105.12 ,$101.69 ,$19.57 ,$105.12 ,$21.23 ,$23.26 ,$23.26 ,$19.38 ,$23.26 ,$19.38 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$31.26 ,$124.10 ,$18.39 ,$31.26 ,$124.10 ,$106.58 ,$19.00 ,$18.39 ,$20.81 ,$124.10 ,$41.38 ,$134.32 ,$102.20 ,$89.42 ,$96.13 ,$88.91 ,$89.42 ,$100.89 ,$105.12 ,$101.69 ,$18.57 ,$105.12 ,$20.14 ,$22.07 ,$22.07 ,$18.39 ,$22.07 ,$18.39 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$31.26 ,$124.10 ,$18.39 ,$31.26 ,$124.10 ,$106.58 ,$19.00 ,$18.39 ,$20.81 ,$124.10 ,$41.38 ,$134.32 ,$102.20 ,$89.42 ,$96.13 ,$88.91 ,$89.42 ,$100.89 ,$105.12 ,$101.69 ,$18.57 ,$105.12 ,$20.14 ,$22.07 ,$22.07 ,$18.39 ,$22.07 ,$18.39 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$20.88 ,$21.17 ,$6.24 ,$24.65 ,$3.67 ,$6.24 ,$24.65 ,$21.17 ,$3.79 ,$3.67 ,$4.15 ,$24.65 ,$8.26 ,$26.68 ,$20.30 ,$17.82 ,$19.16 ,$17.66 ,$17.82 ,$20.04 ,$20.88 ,$20.20 ,$3.71 ,$20.88 ,$4.02 ,$4.40 ,$4.40 ,$3.67 ,$4.40 ,$3.67 ,$20.88 ,$17.98 ,$20.88 ,$20.88 ,$17.40 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$6.24 ,$29.75 ,$3.67 ,$6.24 ,$29.75 ,$25.55 ,$3.79 ,$3.67 ,$4.15 ,$29.75 ,$8.26 ,$32.20 ,$24.50 ,$17.82 ,$19.16 ,$21.32 ,$17.82 ,$24.19 ,$25.20 ,$24.38 ,$3.71 ,$25.20 ,$4.02 ,$4.40 ,$4.40 ,$3.67 ,$4.40 ,$3.67 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$20.16 ,$20.44 ,$6.24 ,$23.80 ,$3.67 ,$6.24 ,$23.80 ,$20.44 ,$3.79 ,$3.67 ,$4.15 ,$23.80 ,$8.26 ,$25.76 ,$19.60 ,$17.82 ,$19.16 ,$17.05 ,$17.82 ,$19.35 ,$20.16 ,$19.50 ,$3.71 ,$20.16 ,$4.02 ,$4.40 ,$4.40 ,$3.67 ,$4.40 ,$3.67 ,$20.16 ,$17.36 ,$20.16 ,$20.16 ,$16.80 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$6.80 ,$45.05 ,$4.00 ,$6.80 ,$45.05 ,$38.69 ,$4.13 ,$4.00 ,$4.53 ,$45.05 ,$9.00 ,$48.76 ,$37.10 ,$17.82 ,$19.16 ,$32.28 ,$17.82 ,$36.62 ,$38.16 ,$36.91 ,$4.04 ,$38.16 ,$4.38 ,$4.80 ,$4.80 ,$4.00 ,$4.80 ,$4.00 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$6.80 ,$45.05 ,$4.00 ,$6.80 ,$45.05 ,$38.69 ,$4.13 ,$4.00 ,$4.53 ,$45.05 ,$9.00 ,$48.76 ,$37.10 ,$17.82 ,$19.16 ,$32.28 ,$17.82 ,$36.62 ,$38.16 ,$36.91 ,$4.04 ,$38.16 ,$4.38 ,$4.80 ,$4.80 ,$4.00 ,$4.80 ,$4.00 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$18.26 ,$66.30 ,$10.74 ,$18.26 ,$66.30 ,$56.94 ,$11.10 ,$10.74 ,$12.16 ,$66.30 ,$24.17 ,$71.76 ,$54.60 ,$52.21 ,$56.13 ,$47.50 ,$52.21 ,$53.90 ,$56.16 ,$54.33 ,$10.85 ,$56.16 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$10.74 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.31 ,$113.90 ,$17.83 ,$30.31 ,$113.90 ,$97.82 ,$18.42 ,$17.83 ,$20.18 ,$113.90 ,$40.12 ,$123.28 ,$93.80 ,$86.71 ,$93.22 ,$81.61 ,$86.71 ,$92.59 ,$96.48 ,$93.33 ,$18.01 ,$96.48 ,$19.53 ,$21.40 ,$21.40 ,$17.83 ,$21.40 ,$17.83 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.31 ,$113.90 ,$17.83 ,$30.31 ,$113.90 ,$97.82 ,$18.42 ,$17.83 ,$20.18 ,$113.90 ,$40.12 ,$123.28 ,$93.80 ,$86.71 ,$93.22 ,$81.61 ,$86.71 ,$92.59 ,$96.48 ,$93.33 ,$18.01 ,$96.48 ,$19.53 ,$21.40 ,$21.40 ,$17.83 ,$21.40 ,$17.83 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$114.48 ,$116.07 ,$28.95 ,$135.15 ,$17.03 ,$28.95 ,$135.15 ,$116.07 ,$17.60 ,$17.03 ,$19.27 ,$135.15 ,$38.32 ,$146.28 ,$111.30 ,$82.82 ,$89.05 ,$96.83 ,$82.82 ,$109.87 ,$114.48 ,$110.74 ,$17.20 ,$114.48 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$17.03 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$95.40 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$24.40 ,$76.50 ,$14.35 ,$24.40 ,$76.50 ,$65.70 ,$14.83 ,$14.35 ,$16.24 ,$76.50 ,$32.29 ,$82.80 ,$63.00 ,$69.74 ,$74.98 ,$54.81 ,$69.74 ,$62.19 ,$64.80 ,$62.69 ,$14.49 ,$64.80 ,$15.72 ,$17.22 ,$17.22 ,$14.35 ,$17.22 ,$14.35 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$45.37 ,$247.35 ,$26.69 ,$45.37 ,$247.35 ,$212.43 ,$25.05 ,$26.69 ,$30.21 ,$247.35 ,$60.05 ,$267.72 ,$203.70 ,$86.60 ,$93.11 ,$177.22 ,$86.60 ,$201.08 ,$209.52 ,$202.68 ,$26.96 ,$209.52 ,$26.55 ,$32.03 ,$32.03 ,$26.69 ,$32.03 ,$26.69 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$47.77 ,$181.05 ,$28.10 ,$47.77 ,$181.05 ,$155.49 ,$29.04 ,$28.10 ,$31.80 ,$181.05 ,$63.23 ,$195.96 ,$149.10 ,$136.60 ,$146.87 ,$129.72 ,$136.60 ,$147.18 ,$153.36 ,$148.35 ,$28.38 ,$153.36 ,$30.78 ,$33.72 ,$33.72 ,$28.10 ,$33.72 ,$28.10 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.62 ,$95.20 ,$14.48 ,$24.62 ,$95.20 ,$81.76 ,$14.96 ,$14.48 ,$16.39 ,$95.20 ,$32.58 ,$103.04 ,$78.40 ,$52.78 ,$56.75 ,$68.21 ,$52.78 ,$77.39 ,$80.64 ,$78.01 ,$14.62 ,$80.64 ,$15.86 ,$17.38 ,$17.38 ,$14.48 ,$17.38 ,$14.48 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$163.44 ,$165.71 ,$16.05 ,$192.95 ,$9.44 ,$16.05 ,$192.95 ,$165.71 ,$9.75 ,$9.44 ,$10.68 ,$192.95 ,$21.24 ,$208.84 ,$158.90 ,$45.90 ,$49.35 ,$138.24 ,$45.90 ,$156.86 ,$163.44 ,$158.11 ,$9.53 ,$163.44 ,$10.34 ,$11.33 ,$11.33 ,$9.44 ,$11.33 ,$9.44 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$136.20 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$62.17 ,$247.35 ,$36.57 ,$62.17 ,$247.35 ,$212.43 ,$37.79 ,$36.57 ,$41.39 ,$247.35 ,$82.28 ,$267.72 ,$203.70 ,$177.80 ,$191.16 ,$177.22 ,$177.80 ,$201.08 ,$209.52 ,$202.68 ,$36.94 ,$209.52 ,$40.06 ,$43.88 ,$43.88 ,$36.57 ,$43.88 ,$36.57 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$37.38 ,$142.80 ,$21.99 ,$37.38 ,$142.80 ,$122.64 ,$22.72 ,$21.99 ,$24.89 ,$142.80 ,$49.48 ,$154.56 ,$117.60 ,$106.95 ,$114.99 ,$102.31 ,$106.95 ,$116.09 ,$120.96 ,$117.01 ,$22.21 ,$120.96 ,$24.08 ,$26.39 ,$26.39 ,$21.99 ,$26.39 ,$21.99 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$205.92 ,$208.78 ,$43.40 ,$243.10 ,$25.53 ,$43.40 ,$243.10 ,$208.78 ,$26.38 ,$25.53 ,$28.89 ,$243.10 ,$57.44 ,$263.12 ,$200.20 ,$124.13 ,$133.45 ,$174.17 ,$124.13 ,$197.63 ,$205.92 ,$199.20 ,$25.79 ,$205.92 ,$27.96 ,$30.64 ,$30.64 ,$25.53 ,$30.64 ,$25.53 ,$205.92 ,$177.32 ,$205.92 ,$205.92 ,$171.60 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$43.40 ,$161.50 ,$25.53 ,$43.40 ,$161.50 ,$138.70 ,$26.38 ,$25.53 ,$28.89 ,$161.50 ,$57.44 ,$174.80 ,$133.00 ,$124.13 ,$133.45 ,$115.71 ,$124.13 ,$131.29 ,$136.80 ,$132.34 ,$25.79 ,$136.80 ,$27.96 ,$30.64 ,$30.64 ,$25.53 ,$30.64 ,$25.53 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$52.67 ,$161.50 ,$30.98 ,$52.67 ,$161.50 ,$138.70 ,$32.01 ,$30.98 ,$35.06 ,$161.50 ,$69.71 ,$174.80 ,$133.00 ,$150.61 ,$161.92 ,$115.71 ,$150.61 ,$131.29 ,$136.80 ,$132.34 ,$31.29 ,$136.80 ,$33.93 ,$37.18 ,$37.18 ,$30.98 ,$37.18 ,$30.98 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$164.16 ,$166.44 ,$52.67 ,$193.80 ,$30.98 ,$52.67 ,$193.80 ,$166.44 ,$32.01 ,$30.98 ,$35.06 ,$193.80 ,$69.71 ,$209.76 ,$159.60 ,$150.61 ,$161.92 ,$138.85 ,$150.61 ,$157.55 ,$164.16 ,$158.80 ,$31.29 ,$164.16 ,$33.93 ,$37.18 ,$37.18 ,$30.98 ,$37.18 ,$30.98 ,$164.16 ,$141.36 ,$164.16 ,$164.16 ,$136.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$36.94 ,$142.80 ,$21.73 ,$36.94 ,$142.80 ,$122.64 ,$22.45 ,$21.73 ,$24.59 ,$142.80 ,$48.89 ,$154.56 ,$117.60 ,$105.67 ,$113.61 ,$102.31 ,$105.67 ,$116.09 ,$120.96 ,$117.01 ,$21.95 ,$120.96 ,$23.80 ,$26.08 ,$26.08 ,$21.73 ,$26.08 ,$21.73 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$17.28 ,$17.52 ,$8.18 ,$20.40 ,$4.81 ,$8.18 ,$20.40 ,$17.52 ,$4.97 ,$4.81 ,$5.44 ,$20.40 ,$10.82 ,$22.08 ,$16.80 ,$23.38 ,$24.00 ,$14.62 ,$23.38 ,$16.58 ,$17.28 ,$16.72 ,$4.86 ,$17.28 ,$5.27 ,$5.77 ,$5.77 ,$4.81 ,$5.77 ,$4.81 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$14.40 
ST MARY'S HOSPITAL,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 ,$10.80 ,$10.95 ,$8.18 ,$12.75 ,$4.81 ,$8.18 ,$12.75 ,$10.95 ,$4.97 ,$4.81 ,$5.44 ,$12.75 ,$10.82 ,$13.80 ,$10.50 ,$15.00 ,$15.00 ,$9.14 ,$15.00 ,$10.37 ,$10.80 ,$10.45 ,$4.86 ,$10.80 ,$5.27 ,$5.77 ,$5.77 ,$4.81 ,$5.77 ,$4.81 ,$10.80 ,$9.30 ,$10.80 ,$10.80 ,$9.00 
ST MARY'S HOSPITAL,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 ,$17.28 ,$17.52 ,$8.18 ,$20.40 ,$4.81 ,$8.18 ,$20.40 ,$17.52 ,$4.97 ,$4.81 ,$5.44 ,$20.40 ,$10.82 ,$22.08 ,$16.80 ,$23.38 ,$24.00 ,$14.62 ,$23.38 ,$16.58 ,$17.28 ,$16.72 ,$4.86 ,$17.28 ,$5.27 ,$5.77 ,$5.77 ,$4.81 ,$5.77 ,$4.81 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$14.40 
ST MARY'S HOSPITAL,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 ,$26.64 ,$27.01 ,$8.60 ,$31.45 ,$5.06 ,$8.60 ,$31.45 ,$27.01 ,$5.23 ,$5.06 ,$5.73 ,$31.45 ,$11.39 ,$34.04 ,$25.90 ,$23.66 ,$25.44 ,$22.53 ,$23.66 ,$25.57 ,$26.64 ,$25.77 ,$5.11 ,$26.64 ,$5.54 ,$6.07 ,$6.07 ,$5.06 ,$6.07 ,$5.06 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$22.20 
ST MARY'S HOSPITAL,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 ,$26.64 ,$27.01 ,$8.26 ,$31.45 ,$4.86 ,$8.26 ,$31.45 ,$27.01 ,$5.02 ,$4.86 ,$5.50 ,$31.45 ,$10.94 ,$34.04 ,$25.90 ,$23.66 ,$25.44 ,$22.53 ,$23.66 ,$25.57 ,$26.64 ,$25.77 ,$4.91 ,$26.64 ,$5.32 ,$5.83 ,$5.83 ,$4.86 ,$5.83 ,$4.86 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$22.20 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$36.14 ,$142.80 ,$21.26 ,$36.14 ,$142.80 ,$122.64 ,$21.97 ,$21.26 ,$24.06 ,$142.80 ,$47.84 ,$154.56 ,$117.60 ,$103.35 ,$111.12 ,$102.31 ,$103.35 ,$116.09 ,$120.96 ,$117.01 ,$21.47 ,$120.96 ,$23.29 ,$25.51 ,$25.51 ,$21.26 ,$25.51 ,$21.26 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$13.77 ,$181.05 ,$8.10 ,$13.77 ,$181.05 ,$155.49 ,$8.37 ,$8.10 ,$9.17 ,$181.05 ,$18.23 ,$195.96 ,$149.10 ,$34.00 ,$36.55 ,$129.72 ,$34.00 ,$147.18 ,$153.36 ,$148.35 ,$8.18 ,$153.36 ,$8.87 ,$9.72 ,$9.72 ,$8.10 ,$9.72 ,$8.10 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$9.35 ,$56.95 ,$5.50 ,$9.35 ,$56.95 ,$48.91 ,$5.68 ,$5.50 ,$6.22 ,$56.95 ,$12.38 ,$61.64 ,$46.90 ,$26.73 ,$28.74 ,$40.80 ,$26.73 ,$46.30 ,$48.24 ,$46.67 ,$5.56 ,$48.24 ,$6.02 ,$6.60 ,$6.60 ,$5.50 ,$6.60 ,$5.50 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 ,$9.35 ,$58.65 ,$5.50 ,$9.35 ,$58.65 ,$50.37 ,$5.68 ,$5.50 ,$6.22 ,$58.65 ,$12.38 ,$63.48 ,$48.30 ,$26.73 ,$28.74 ,$42.02 ,$26.73 ,$47.68 ,$49.68 ,$48.06 ,$5.56 ,$49.68 ,$6.02 ,$6.60 ,$6.60 ,$5.50 ,$6.60 ,$5.50 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,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 ,$11.52 ,$11.68 ,$5.58 ,$13.60 ,$3.28 ,$5.58 ,$13.60 ,$11.68 ,$3.39 ,$3.28 ,$3.71 ,$13.60 ,$7.38 ,$14.72 ,$11.20 ,$12.22 ,$13.14 ,$9.74 ,$12.22 ,$11.06 ,$11.52 ,$11.14 ,$3.31 ,$11.52 ,$3.59 ,$3.94 ,$3.94 ,$3.28 ,$3.94 ,$3.28 ,$11.52 ,$9.92 ,$11.52 ,$11.52 ,$9.60 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$9.33 ,$30.60 ,$5.49 ,$9.33 ,$30.60 ,$26.28 ,$5.67 ,$5.49 ,$6.21 ,$30.60 ,$12.35 ,$33.12 ,$25.20 ,$23.09 ,$24.83 ,$21.92 ,$23.09 ,$24.88 ,$25.92 ,$25.07 ,$5.54 ,$25.92 ,$6.01 ,$6.59 ,$6.59 ,$5.49 ,$6.59 ,$5.49 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$43.30 ,$161.50 ,$25.47 ,$43.30 ,$161.50 ,$138.70 ,$26.32 ,$25.47 ,$28.83 ,$161.50 ,$57.31 ,$174.80 ,$133.00 ,$123.81 ,$133.11 ,$115.71 ,$123.81 ,$131.29 ,$136.80 ,$132.34 ,$25.72 ,$136.80 ,$27.90 ,$30.56 ,$30.56 ,$25.47 ,$30.56 ,$25.47 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$43.88 ,$161.50 ,$25.81 ,$43.88 ,$161.50 ,$138.70 ,$26.67 ,$25.81 ,$29.21 ,$161.50 ,$58.07 ,$174.80 ,$133.00 ,$122.56 ,$131.77 ,$115.71 ,$122.56 ,$131.29 ,$136.80 ,$132.34 ,$26.07 ,$136.80 ,$28.27 ,$30.97 ,$30.97 ,$25.81 ,$30.97 ,$25.81 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$43.30 ,$161.50 ,$25.47 ,$43.30 ,$161.50 ,$138.70 ,$26.32 ,$25.47 ,$28.83 ,$161.50 ,$57.31 ,$174.80 ,$133.00 ,$123.81 ,$133.11 ,$115.71 ,$123.81 ,$131.29 ,$136.80 ,$132.34 ,$25.72 ,$136.80 ,$27.90 ,$30.56 ,$30.56 ,$25.47 ,$30.56 ,$25.47 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$36.09 ,$113.90 ,$21.23 ,$36.09 ,$113.90 ,$97.82 ,$21.94 ,$21.23 ,$24.03 ,$113.90 ,$47.77 ,$123.28 ,$93.80 ,$103.21 ,$110.96 ,$81.61 ,$103.21 ,$92.59 ,$96.48 ,$93.33 ,$21.44 ,$96.48 ,$23.26 ,$25.48 ,$25.48 ,$21.23 ,$25.48 ,$21.23 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$159.12 ,$161.33 ,$36.09 ,$187.85 ,$21.23 ,$36.09 ,$187.85 ,$161.33 ,$21.94 ,$21.23 ,$24.03 ,$187.85 ,$47.77 ,$203.32 ,$154.70 ,$103.21 ,$110.96 ,$134.59 ,$103.21 ,$152.71 ,$159.12 ,$153.93 ,$21.44 ,$159.12 ,$23.26 ,$25.48 ,$25.48 ,$21.23 ,$25.48 ,$21.23 ,$159.12 ,$137.02 ,$159.12 ,$159.12 ,$132.60 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.30 ,$104.55 ,$16.06 ,$27.30 ,$104.55 ,$89.79 ,$16.59 ,$16.06 ,$18.18 ,$104.55 ,$36.14 ,$113.16 ,$86.10 ,$78.08 ,$83.95 ,$74.91 ,$78.08 ,$84.99 ,$88.56 ,$85.67 ,$16.22 ,$88.56 ,$17.59 ,$19.27 ,$19.27 ,$16.06 ,$19.27 ,$16.06 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$27.30 ,$304.30 ,$16.06 ,$27.30 ,$304.30 ,$261.34 ,$16.59 ,$16.06 ,$18.18 ,$304.30 ,$36.14 ,$329.36 ,$250.60 ,$78.08 ,$83.95 ,$218.02 ,$78.08 ,$247.38 ,$257.76 ,$249.35 ,$16.22 ,$257.76 ,$17.59 ,$19.27 ,$19.27 ,$16.06 ,$19.27 ,$16.06 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$11.68 ,$33.15 ,$6.87 ,$11.68 ,$33.15 ,$28.47 ,$7.10 ,$6.87 ,$7.78 ,$33.15 ,$15.46 ,$35.88 ,$27.30 ,$33.39 ,$35.90 ,$23.75 ,$33.39 ,$26.95 ,$28.08 ,$27.16 ,$6.94 ,$28.08 ,$7.53 ,$8.24 ,$8.24 ,$6.87 ,$8.24 ,$6.87 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.33 ,$56.95 ,$9.02 ,$15.33 ,$56.95 ,$48.91 ,$9.32 ,$9.02 ,$10.21 ,$56.95 ,$20.30 ,$61.64 ,$46.90 ,$43.83 ,$47.13 ,$40.80 ,$43.83 ,$46.30 ,$48.24 ,$46.67 ,$9.11 ,$48.24 ,$9.88 ,$10.82 ,$10.82 ,$9.02 ,$10.82 ,$9.02 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$15.33 ,$104.55 ,$9.02 ,$15.33 ,$104.55 ,$89.79 ,$9.32 ,$9.02 ,$10.21 ,$104.55 ,$20.30 ,$113.16 ,$86.10 ,$43.83 ,$47.13 ,$74.91 ,$43.83 ,$84.99 ,$88.56 ,$85.67 ,$9.11 ,$88.56 ,$9.88 ,$10.82 ,$10.82 ,$9.02 ,$10.82 ,$9.02 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$58.32 ,$59.13 ,$25.13 ,$68.85 ,$14.78 ,$25.13 ,$68.85 ,$59.13 ,$15.27 ,$14.78 ,$16.73 ,$68.85 ,$33.26 ,$74.52 ,$56.70 ,$71.88 ,$77.28 ,$49.33 ,$71.88 ,$55.97 ,$58.32 ,$56.42 ,$14.93 ,$58.32 ,$16.19 ,$17.74 ,$17.74 ,$14.78 ,$17.74 ,$14.78 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$48.60 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.56 ,$104.55 ,$16.80 ,$28.56 ,$104.55 ,$89.79 ,$17.36 ,$16.80 ,$19.01 ,$104.55 ,$37.80 ,$113.16 ,$86.10 ,$81.72 ,$87.86 ,$74.91 ,$81.72 ,$84.99 ,$88.56 ,$85.67 ,$16.97 ,$88.56 ,$18.40 ,$20.16 ,$20.16 ,$16.80 ,$20.16 ,$16.80 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$86.46 ,$247.35 ,$50.86 ,$86.46 ,$247.35 ,$212.43 ,$32.70 ,$50.86 ,$57.56 ,$247.35 ,$114.44 ,$267.72 ,$203.70 ,$113.08 ,$121.58 ,$177.22 ,$113.08 ,$201.08 ,$209.52 ,$202.68 ,$51.37 ,$209.52 ,$34.66 ,$61.03 ,$61.03 ,$50.86 ,$61.03 ,$50.86 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.11 ,$95.20 ,$14.18 ,$24.11 ,$95.20 ,$81.76 ,$14.65 ,$14.18 ,$16.05 ,$95.20 ,$31.91 ,$103.04 ,$78.40 ,$68.92 ,$74.10 ,$68.21 ,$68.92 ,$77.39 ,$80.64 ,$78.01 ,$14.32 ,$80.64 ,$15.53 ,$17.02 ,$17.02 ,$14.18 ,$17.02 ,$14.18 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$8.81 ,$33.15 ,$5.18 ,$8.81 ,$33.15 ,$28.47 ,$5.35 ,$5.18 ,$5.86 ,$33.15 ,$11.66 ,$35.88 ,$27.30 ,$25.16 ,$27.05 ,$23.75 ,$25.16 ,$26.95 ,$28.08 ,$27.16 ,$5.23 ,$28.08 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$28.80 ,$29.20 ,$9.01 ,$34.00 ,$5.30 ,$9.01 ,$34.00 ,$29.20 ,$5.48 ,$5.30 ,$6.00 ,$34.00 ,$11.93 ,$36.80 ,$28.00 ,$25.73 ,$27.66 ,$24.36 ,$25.73 ,$27.64 ,$28.80 ,$27.86 ,$5.35 ,$28.80 ,$5.81 ,$6.36 ,$6.36 ,$5.30 ,$6.36 ,$5.30 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,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 ,$38.88 ,$39.42 ,$21.69 ,$45.90 ,$12.76 ,$21.69 ,$45.90 ,$39.42 ,$13.18 ,$12.76 ,$14.44 ,$45.90 ,$28.71 ,$49.68 ,$37.80 ,$54.00 ,$54.00 ,$32.89 ,$54.00 ,$37.31 ,$38.88 ,$37.61 ,$12.89 ,$38.88 ,$13.97 ,$15.31 ,$15.31 ,$12.76 ,$15.31 ,$12.76 ,$38.88 ,$33.48 ,$38.88 ,$38.88 ,$32.40 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$21.69 ,$95.20 ,$12.76 ,$21.69 ,$95.20 ,$81.76 ,$13.18 ,$12.76 ,$14.44 ,$95.20 ,$28.71 ,$103.04 ,$78.40 ,$62.08 ,$66.75 ,$68.21 ,$62.08 ,$77.39 ,$80.64 ,$78.01 ,$12.89 ,$80.64 ,$13.97 ,$15.31 ,$15.31 ,$12.76 ,$15.31 ,$12.76 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$31.68 ,$32.12 ,$9.76 ,$37.40 ,$5.74 ,$9.76 ,$37.40 ,$32.12 ,$5.93 ,$5.74 ,$6.50 ,$37.40 ,$12.92 ,$40.48 ,$30.80 ,$27.94 ,$30.04 ,$26.80 ,$27.94 ,$30.40 ,$31.68 ,$30.65 ,$5.80 ,$31.68 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$5.74 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$26.40 
ST MARY'S HOSPITAL,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 ,$31.68 ,$32.12 ,$9.76 ,$37.40 ,$5.74 ,$9.76 ,$37.40 ,$32.12 ,$5.93 ,$5.74 ,$6.50 ,$37.40 ,$12.92 ,$40.48 ,$30.80 ,$27.94 ,$30.04 ,$26.80 ,$27.94 ,$30.40 ,$31.68 ,$30.65 ,$5.80 ,$31.68 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$5.74 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$26.40 
ST MARY'S HOSPITAL,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 ,$31.68 ,$32.12 ,$9.76 ,$37.40 ,$5.74 ,$9.76 ,$37.40 ,$32.12 ,$5.93 ,$5.74 ,$6.50 ,$37.40 ,$12.92 ,$40.48 ,$30.80 ,$27.94 ,$30.04 ,$26.80 ,$27.94 ,$30.40 ,$31.68 ,$30.65 ,$5.80 ,$31.68 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$5.74 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$26.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$11.00 ,$56.95 ,$6.47 ,$11.00 ,$56.95 ,$48.91 ,$6.69 ,$6.47 ,$7.32 ,$56.95 ,$14.56 ,$61.64 ,$46.90 ,$31.47 ,$33.83 ,$40.80 ,$31.47 ,$46.30 ,$48.24 ,$46.67 ,$6.53 ,$48.24 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.11 ,$95.20 ,$14.18 ,$24.11 ,$95.20 ,$81.76 ,$14.65 ,$14.18 ,$16.05 ,$95.20 ,$31.91 ,$103.04 ,$78.40 ,$68.92 ,$74.10 ,$68.21 ,$68.92 ,$77.39 ,$80.64 ,$78.01 ,$14.32 ,$80.64 ,$15.53 ,$17.02 ,$17.02 ,$14.18 ,$17.02 ,$14.18 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$28.80 ,$76.50 ,$16.94 ,$28.80 ,$76.50 ,$65.70 ,$16.62 ,$16.94 ,$19.17 ,$76.50 ,$38.12 ,$82.80 ,$63.00 ,$57.45 ,$61.77 ,$54.81 ,$57.45 ,$62.19 ,$64.80 ,$62.69 ,$17.11 ,$64.80 ,$17.62 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$16.94 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$128.16 ,$129.94 ,$28.80 ,$151.30 ,$16.94 ,$28.80 ,$151.30 ,$129.94 ,$16.62 ,$16.94 ,$19.17 ,$151.30 ,$38.12 ,$163.76 ,$124.60 ,$57.45 ,$61.77 ,$108.40 ,$57.45 ,$123.00 ,$128.16 ,$123.98 ,$17.11 ,$128.16 ,$17.62 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$16.94 ,$128.16 ,$110.36 ,$128.16 ,$128.16 ,$106.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$26.79 ,$56.95 ,$15.76 ,$26.79 ,$56.95 ,$48.91 ,$10.82 ,$15.76 ,$17.84 ,$56.95 ,$35.46 ,$61.64 ,$46.90 ,$37.42 ,$40.23 ,$40.80 ,$37.42 ,$46.30 ,$48.24 ,$46.67 ,$15.92 ,$48.24 ,$11.47 ,$18.91 ,$18.91 ,$15.76 ,$18.91 ,$15.76 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.20 ,$85.85 ,$12.47 ,$21.20 ,$85.85 ,$73.73 ,$12.89 ,$12.47 ,$14.11 ,$85.85 ,$28.06 ,$92.92 ,$70.70 ,$47.83 ,$51.42 ,$61.51 ,$47.83 ,$69.79 ,$72.72 ,$70.35 ,$12.59 ,$72.72 ,$13.66 ,$14.96 ,$14.96 ,$12.47 ,$14.96 ,$12.47 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$66.96 ,$67.89 ,$12.41 ,$79.05 ,$7.30 ,$12.41 ,$79.05 ,$67.89 ,$7.54 ,$7.30 ,$8.26 ,$79.05 ,$16.43 ,$85.56 ,$65.10 ,$35.50 ,$38.16 ,$56.64 ,$35.50 ,$64.26 ,$66.96 ,$64.77 ,$7.37 ,$66.96 ,$7.99 ,$8.76 ,$8.76 ,$7.30 ,$8.76 ,$7.30 ,$66.96 ,$57.66 ,$66.96 ,$66.96 ,$55.80 
ST MARY'S HOSPITAL,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 ,$21.60 ,$21.90 ,$6.72 ,$25.50 ,$3.95 ,$6.72 ,$25.50 ,$21.90 ,$4.08 ,$3.95 ,$4.47 ,$25.50 ,$8.89 ,$27.60 ,$21.00 ,$19.21 ,$20.65 ,$18.27 ,$19.21 ,$20.73 ,$21.60 ,$20.90 ,$3.99 ,$21.60 ,$4.32 ,$4.74 ,$4.74 ,$3.95 ,$4.74 ,$3.95 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$18.00 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$6.72 ,$32.30 ,$3.95 ,$6.72 ,$32.30 ,$27.74 ,$4.08 ,$3.95 ,$4.47 ,$32.30 ,$8.89 ,$34.96 ,$26.60 ,$19.21 ,$20.65 ,$23.14 ,$19.21 ,$26.26 ,$27.36 ,$26.47 ,$3.99 ,$27.36 ,$4.32 ,$4.74 ,$4.74 ,$3.95 ,$4.74 ,$3.95 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$6.72 ,$32.30 ,$3.95 ,$6.72 ,$32.30 ,$27.74 ,$4.08 ,$3.95 ,$4.47 ,$32.30 ,$8.89 ,$34.96 ,$26.60 ,$19.21 ,$20.65 ,$23.14 ,$19.21 ,$26.26 ,$27.36 ,$26.47 ,$3.99 ,$27.36 ,$4.32 ,$4.74 ,$4.74 ,$3.95 ,$4.74 ,$3.95 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$9.45 ,$56.95 ,$5.56 ,$9.45 ,$56.95 ,$48.91 ,$5.75 ,$5.56 ,$6.29 ,$56.95 ,$12.51 ,$61.64 ,$46.90 ,$23.09 ,$24.83 ,$40.80 ,$23.09 ,$46.30 ,$48.24 ,$46.67 ,$5.62 ,$48.24 ,$6.10 ,$6.67 ,$6.67 ,$5.56 ,$6.67 ,$5.56 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$7.68 ,$32.30 ,$4.52 ,$7.68 ,$32.30 ,$27.74 ,$4.67 ,$4.52 ,$5.12 ,$32.30 ,$10.17 ,$34.96 ,$26.60 ,$21.95 ,$23.60 ,$23.14 ,$21.95 ,$26.26 ,$27.36 ,$26.47 ,$4.57 ,$27.36 ,$4.95 ,$5.42 ,$5.42 ,$4.52 ,$5.42 ,$4.52 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$8.64 ,$30.60 ,$5.08 ,$8.64 ,$30.60 ,$26.28 ,$5.25 ,$5.08 ,$5.75 ,$30.60 ,$11.43 ,$33.12 ,$25.20 ,$23.09 ,$24.83 ,$21.92 ,$23.09 ,$24.88 ,$25.92 ,$25.07 ,$5.13 ,$25.92 ,$5.57 ,$6.10 ,$6.10 ,$5.08 ,$6.10 ,$5.08 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$7.60 ,$21.25 ,$4.47 ,$7.60 ,$21.25 ,$18.25 ,$4.58 ,$4.47 ,$5.06 ,$21.25 ,$10.06 ,$23.00 ,$17.50 ,$15.79 ,$16.97 ,$15.23 ,$15.79 ,$17.28 ,$18.00 ,$17.41 ,$4.51 ,$18.00 ,$4.85 ,$5.36 ,$5.36 ,$4.47 ,$5.36 ,$4.47 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$26.35 ,$95.20 ,$15.50 ,$26.35 ,$95.20 ,$81.76 ,$16.02 ,$15.50 ,$17.54 ,$95.20 ,$34.88 ,$103.04 ,$78.40 ,$75.34 ,$81.00 ,$68.21 ,$75.34 ,$77.39 ,$80.64 ,$78.01 ,$15.66 ,$80.64 ,$16.98 ,$18.60 ,$18.60 ,$15.50 ,$18.60 ,$15.50 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$60.06 ,$161.50 ,$35.33 ,$60.06 ,$161.50 ,$138.70 ,$17.93 ,$35.33 ,$39.99 ,$161.50 ,$79.49 ,$174.80 ,$133.00 ,$61.97 ,$66.63 ,$115.71 ,$61.97 ,$131.29 ,$136.80 ,$132.34 ,$35.68 ,$136.80 ,$19.01 ,$42.40 ,$42.40 ,$35.33 ,$42.40 ,$35.33 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$57.70 ,$219.30 ,$33.94 ,$57.70 ,$219.30 ,$188.34 ,$35.07 ,$33.94 ,$38.41 ,$219.30 ,$76.37 ,$237.36 ,$180.60 ,$165.04 ,$177.44 ,$157.12 ,$165.04 ,$178.28 ,$185.76 ,$179.70 ,$34.28 ,$185.76 ,$37.17 ,$40.73 ,$40.73 ,$33.94 ,$40.73 ,$33.94 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$19.74 ,$76.50 ,$11.61 ,$19.74 ,$76.50 ,$65.70 ,$12.00 ,$11.61 ,$13.14 ,$76.50 ,$26.12 ,$82.80 ,$63.00 ,$56.41 ,$60.65 ,$54.81 ,$56.41 ,$62.19 ,$64.80 ,$62.69 ,$11.73 ,$64.80 ,$12.72 ,$13.93 ,$13.93 ,$11.61 ,$13.93 ,$11.61 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$282.24 ,$286.16 ,$23.32 ,$333.20 ,$13.72 ,$23.32 ,$333.20 ,$286.16 ,$14.18 ,$13.72 ,$15.53 ,$333.20 ,$30.87 ,$360.64 ,$274.40 ,$66.68 ,$71.69 ,$238.73 ,$66.68 ,$270.87 ,$282.24 ,$273.03 ,$13.86 ,$282.24 ,$15.03 ,$16.46 ,$16.46 ,$13.72 ,$16.46 ,$13.72 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,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 ,$180.00 ,$182.50 ,$38.56 ,$212.50 , N/A ,$38.56 ,$212.50 ,$182.50 ,$3.81 , N/A ,$105.00 ,$212.50 , N/A ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$142.03 ,$172.75 ,$180.00 ,$174.13 , N/A ,$180.00 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$150.00 
ST MARY'S HOSPITAL,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 ,$177.84 ,$180.31 ,$194.53 ,$209.95 ,$114.43 ,$194.53 ,$209.95 ,$180.31 ,$63.95 ,$114.43 ,$129.51 ,$209.95 ,$257.47 ,$227.24 ,$172.90 ,$247.00 ,$247.00 ,$150.42 ,$247.00 ,$170.68 ,$177.84 ,$172.04 ,$115.57 ,$177.84 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$177.84 ,$153.14 ,$177.84 ,$177.84 ,$148.20 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$30.31 ,$46.75 ,$17.83 ,$30.31 ,$46.75 ,$40.15 ,$18.42 ,$17.83 ,$20.18 ,$46.75 ,$40.12 ,$50.60 ,$38.50 ,$55.00 ,$55.00 ,$33.50 ,$55.00 ,$38.01 ,$39.60 ,$38.31 ,$18.01 ,$39.60 ,$19.53 ,$21.40 ,$21.40 ,$17.83 ,$21.40 ,$17.83 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$19.36 ,$66.30 ,$11.39 ,$19.36 ,$66.30 ,$56.94 ,$11.77 ,$11.39 ,$12.89 ,$66.30 ,$25.63 ,$71.76 ,$54.60 ,$50.39 ,$54.18 ,$47.50 ,$50.39 ,$53.90 ,$56.16 ,$54.33 ,$11.50 ,$56.16 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$11.39 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$122.40 ,$124.10 ,$19.36 ,$144.50 ,$11.39 ,$19.36 ,$144.50 ,$124.10 ,$11.77 ,$11.39 ,$12.89 ,$144.50 ,$25.63 ,$156.40 ,$119.00 ,$50.39 ,$54.18 ,$103.53 ,$50.39 ,$117.47 ,$122.40 ,$118.41 ,$11.50 ,$122.40 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$11.39 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$102.00 
ST MARY'S HOSPITAL,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 ,$24.48 ,$24.82 ,$19.36 ,$28.90 ,$11.39 ,$19.36 ,$28.90 ,$24.82 ,$11.77 ,$11.39 ,$12.89 ,$28.90 ,$25.63 ,$31.28 ,$23.80 ,$34.00 ,$34.00 ,$20.71 ,$34.00 ,$23.49 ,$24.48 ,$23.68 ,$11.50 ,$24.48 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$11.39 ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$20.40 
ST MARY'S HOSPITAL,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 ,$62.64 ,$63.51 ,$7.40 ,$73.95 ,$4.35 ,$7.40 ,$73.95 ,$63.51 ,$4.49 ,$4.35 ,$4.92 ,$73.95 ,$9.79 ,$80.04 ,$60.90 ,$21.13 ,$22.72 ,$52.98 ,$21.13 ,$60.12 ,$62.64 ,$60.60 ,$4.39 ,$62.64 ,$4.76 ,$5.22 ,$5.22 ,$4.35 ,$5.22 ,$4.35 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$52.20 
ST MARY'S HOSPITAL,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 ,$92.88 ,$94.17 ,$40.95 ,$109.65 ,$24.09 ,$40.95 ,$109.65 ,$94.17 ,$24.89 ,$24.09 ,$27.27 ,$109.65 ,$54.20 ,$118.68 ,$90.30 ,$87.78 ,$94.37 ,$78.56 ,$87.78 ,$89.14 ,$92.88 ,$89.85 ,$24.33 ,$92.88 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$104.55 ,$190.40 ,$61.50 ,$104.55 ,$190.40 ,$163.52 ,$48.31 ,$61.50 ,$69.61 ,$190.40 ,$138.38 ,$206.08 ,$156.80 ,$167.04 ,$179.59 ,$136.42 ,$167.04 ,$154.78 ,$161.28 ,$156.02 ,$62.12 ,$161.28 ,$51.21 ,$73.80 ,$73.80 ,$61.50 ,$73.80 ,$61.50 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$9.76 ,$85.00 ,$5.74 ,$9.76 ,$85.00 ,$73.00 ,$5.93 ,$5.74 ,$6.50 ,$85.00 ,$12.92 ,$92.00 ,$70.00 ,$27.94 ,$30.04 ,$60.90 ,$27.94 ,$69.10 ,$72.00 ,$69.65 ,$5.80 ,$72.00 ,$6.29 ,$6.89 ,$6.89 ,$5.74 ,$6.89 ,$5.74 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$35.38 ,$85.85 ,$20.81 ,$35.38 ,$85.85 ,$73.73 ,$7.34 ,$20.81 ,$23.55 ,$85.85 ,$46.82 ,$92.92 ,$70.70 ,$25.37 ,$27.28 ,$61.51 ,$25.37 ,$69.79 ,$72.72 ,$70.35 ,$21.02 ,$72.72 ,$7.78 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.59 ,$95.20 ,$15.05 ,$25.59 ,$95.20 ,$81.76 ,$15.55 ,$15.05 ,$17.03 ,$95.20 ,$33.86 ,$103.04 ,$78.40 ,$73.20 ,$78.70 ,$68.21 ,$73.20 ,$77.39 ,$80.64 ,$78.01 ,$15.20 ,$80.64 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$14.40 ,$14.60 ,$20.00 ,$17.00 ,$15.05 ,$20.00 ,$17.00 ,$14.60 ,$15.55 ,$15.05 ,$17.03 ,$17.00 ,$33.86 ,$18.40 ,$14.00 ,$20.00 ,$20.00 ,$12.18 ,$20.00 ,$13.82 ,$14.40 ,$13.93 ,$15.20 ,$14.40 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$14.40 ,$12.40 ,$14.40 ,$14.40 ,$12.00 
ST MARY'S HOSPITAL,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 ,$28.80 ,$29.20 ,$25.59 ,$34.00 ,$15.05 ,$25.59 ,$34.00 ,$29.20 ,$15.55 ,$15.05 ,$17.03 ,$34.00 ,$33.86 ,$36.80 ,$28.00 ,$40.00 ,$40.00 ,$24.36 ,$40.00 ,$27.64 ,$28.80 ,$27.86 ,$15.20 ,$28.80 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$12.78 ,$56.95 ,$7.52 ,$12.78 ,$56.95 ,$48.91 ,$7.77 ,$7.52 ,$8.51 ,$56.95 ,$16.92 ,$61.64 ,$46.90 ,$36.56 ,$39.31 ,$40.80 ,$36.56 ,$46.30 ,$48.24 ,$46.67 ,$7.60 ,$48.24 ,$8.24 ,$9.02 ,$9.02 ,$7.52 ,$9.02 ,$7.52 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$13.68 ,$13.87 , N/A ,$16.15 , N/A , N/A ,$16.15 ,$13.87 ,$3.81 , N/A ,$7.98 ,$16.15 ,$11.40 ,$17.48 ,$13.30 ,$9.64 ,$11.57 ,$11.57 ,$10.79 ,$13.13 ,$13.68 ,$13.23 , N/A ,$13.68 ,$4.04 ,$9.50 ,$9.50 , N/A ,$9.50 , N/A ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$11.40 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$8.53 ,$32.30 ,$5.02 ,$8.53 ,$32.30 ,$27.74 ,$3.63 ,$5.02 ,$5.68 ,$32.30 ,$11.30 ,$34.96 ,$26.60 ,$24.38 ,$26.21 ,$23.14 ,$24.38 ,$26.26 ,$27.36 ,$26.47 ,$5.07 ,$27.36 ,$3.85 ,$6.02 ,$6.02 ,$5.02 ,$6.02 ,$5.02 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.83 ,$124.10 ,$19.31 ,$32.83 ,$124.10 ,$106.58 ,$19.95 ,$19.31 ,$21.86 ,$124.10 ,$43.45 ,$134.32 ,$102.20 ,$89.42 ,$96.13 ,$88.91 ,$89.42 ,$100.89 ,$105.12 ,$101.69 ,$19.50 ,$105.12 ,$21.15 ,$23.17 ,$23.17 ,$19.31 ,$23.17 ,$19.31 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$108.72 ,$110.23 ,$34.44 ,$128.35 ,$20.26 ,$34.44 ,$128.35 ,$110.23 ,$20.93 ,$20.26 ,$22.93 ,$128.35 ,$45.59 ,$138.92 ,$105.70 ,$98.50 ,$105.91 ,$91.96 ,$98.50 ,$104.34 ,$108.72 ,$105.17 ,$20.46 ,$108.72 ,$22.19 ,$24.31 ,$24.31 ,$20.26 ,$24.31 ,$20.26 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$90.60 
ST MARY'S HOSPITAL,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 ,$324.00 ,$328.50 ,$49.66 ,$382.50 ,$29.21 ,$49.66 ,$382.50 ,$328.50 ,$25.31 ,$29.21 ,$33.06 ,$382.50 ,$65.72 ,$414.00 ,$315.00 ,$87.49 ,$94.07 ,$274.05 ,$87.49 ,$310.95 ,$324.00 ,$313.43 ,$29.50 ,$324.00 ,$26.83 ,$35.05 ,$35.05 ,$29.21 ,$35.05 ,$29.21 ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$270.00 
ST MARY'S HOSPITAL,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 ,$118.08 ,$119.72 ,$32.84 ,$139.40 ,$19.32 ,$32.84 ,$139.40 ,$119.72 ,$6.82 ,$19.32 ,$21.87 ,$139.40 ,$43.47 ,$150.88 ,$114.80 ,$91.98 ,$98.89 ,$99.88 ,$91.98 ,$113.32 ,$118.08 ,$114.23 ,$19.51 ,$118.08 ,$7.23 ,$23.18 ,$23.18 ,$19.32 ,$23.18 ,$19.32 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$98.40 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$34.26 ,$85.00 ,$20.15 ,$34.26 ,$85.00 ,$73.00 ,$20.18 ,$20.15 ,$22.81 ,$85.00 ,$45.34 ,$92.00 ,$70.00 ,$89.91 ,$96.67 ,$60.90 ,$89.91 ,$69.10 ,$72.00 ,$69.65 ,$20.35 ,$72.00 ,$21.39 ,$24.18 ,$24.18 ,$20.15 ,$24.18 ,$20.15 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$132.48 ,$134.32 ,$57.56 ,$156.40 ,$33.86 ,$57.56 ,$156.40 ,$134.32 ,$32.56 ,$33.86 ,$38.32 ,$156.40 ,$76.19 ,$169.28 ,$128.80 ,$120.67 ,$129.74 ,$112.06 ,$120.67 ,$127.14 ,$132.48 ,$128.16 ,$34.20 ,$132.48 ,$34.51 ,$40.63 ,$40.63 ,$33.86 ,$40.63 ,$33.86 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$110.40 
ST MARY'S HOSPITAL,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 ,$135.36 ,$137.24 ,$43.88 ,$159.80 ,$25.81 ,$43.88 ,$159.80 ,$137.24 ,$26.67 ,$25.81 ,$29.21 ,$159.80 ,$58.07 ,$172.96 ,$131.60 ,$122.56 ,$131.77 ,$114.49 ,$122.56 ,$129.91 ,$135.36 ,$130.94 ,$26.07 ,$135.36 ,$28.27 ,$30.97 ,$30.97 ,$25.81 ,$30.97 ,$25.81 ,$135.36 ,$116.56 ,$135.36 ,$135.36 ,$112.80 
ST MARY'S HOSPITAL,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 ,$290.16 ,$294.19 ,$127.26 ,$342.55 ,$74.86 ,$127.26 ,$342.55 ,$294.19 ,$77.35 ,$74.86 ,$84.73 ,$342.55 ,$168.44 ,$370.76 ,$282.10 ,$363.40 ,$390.71 ,$245.43 ,$363.40 ,$278.47 ,$290.16 ,$280.69 ,$75.61 ,$290.16 ,$81.99 ,$89.83 ,$89.83 ,$74.86 ,$89.83 ,$74.86 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,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 ,$19.44 ,$19.71 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$22.95 ,$19.71 ,$3.70 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.39 ,$18.70 ,$16.44 ,$17.39 ,$18.66 ,$19.44 ,$18.81 ,$3.62 ,$19.44 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$3.58 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$16.20 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$28.80 ,$152.15 ,$16.94 ,$28.80 ,$152.15 ,$130.67 ,$16.62 ,$16.94 ,$19.17 ,$152.15 ,$38.12 ,$164.68 ,$125.30 ,$57.45 ,$61.77 ,$109.01 ,$57.45 ,$123.69 ,$128.88 ,$124.67 ,$17.11 ,$128.88 ,$17.62 ,$20.33 ,$20.33 ,$16.94 ,$20.33 ,$16.94 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$13.60 ,$46.75 ,$8.00 ,$13.60 ,$46.75 ,$40.15 ,$8.27 ,$8.00 ,$9.05 ,$46.75 ,$18.00 ,$50.60 ,$38.50 ,$28.97 ,$31.15 ,$33.50 ,$28.97 ,$38.01 ,$39.60 ,$38.31 ,$8.08 ,$39.60 ,$8.77 ,$9.60 ,$9.60 ,$8.00 ,$9.60 ,$8.00 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$50.32 ,$190.40 ,$29.60 ,$50.32 ,$190.40 ,$163.52 ,$30.59 ,$29.60 ,$33.50 ,$190.40 ,$66.60 ,$206.08 ,$156.80 ,$143.98 ,$154.80 ,$136.42 ,$143.98 ,$154.78 ,$161.28 ,$156.02 ,$29.90 ,$161.28 ,$32.43 ,$35.52 ,$35.52 ,$29.60 ,$35.52 ,$29.60 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$8.57 ,$14.45 ,$5.04 ,$8.57 ,$14.45 ,$12.41 ,$4.45 ,$5.04 ,$5.70 ,$14.45 ,$11.34 ,$15.64 ,$11.90 ,$15.40 ,$16.55 ,$10.35 ,$15.40 ,$11.75 ,$12.24 ,$11.84 ,$5.09 ,$12.24 ,$4.72 ,$6.05 ,$6.05 ,$5.04 ,$6.05 ,$5.04 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$46.27 ,$171.70 ,$27.22 ,$46.27 ,$171.70 ,$147.46 ,$28.13 ,$27.22 ,$30.81 ,$171.70 ,$61.25 ,$185.84 ,$141.40 ,$130.22 ,$140.01 ,$123.02 ,$130.22 ,$139.58 ,$145.44 ,$140.69 ,$27.49 ,$145.44 ,$29.82 ,$32.66 ,$32.66 ,$27.22 ,$32.66 ,$27.22 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$90.00 ,$91.25 ,$30.69 ,$106.25 ,$18.05 ,$30.69 ,$106.25 ,$91.25 ,$3.28 ,$18.05 ,$20.43 ,$106.25 ,$40.61 ,$115.00 ,$87.50 ,$77.33 ,$83.15 ,$76.13 ,$77.33 ,$86.38 ,$90.00 ,$87.06 ,$18.23 ,$90.00 ,$3.48 ,$21.66 ,$21.66 ,$18.05 ,$21.66 ,$18.05 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$75.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.77 ,$95.20 ,$14.57 ,$24.77 ,$95.20 ,$81.76 ,$15.06 ,$14.57 ,$16.49 ,$95.20 ,$32.78 ,$103.04 ,$78.40 ,$70.85 ,$76.17 ,$68.21 ,$70.85 ,$77.39 ,$80.64 ,$78.01 ,$14.72 ,$80.64 ,$15.96 ,$17.48 ,$17.48 ,$14.57 ,$17.48 ,$14.57 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$33.12 ,$33.58 ,$10.25 ,$39.10 ,$6.03 ,$10.25 ,$39.10 ,$33.58 ,$6.23 ,$6.03 ,$6.82 ,$39.10 ,$13.57 ,$42.32 ,$32.20 ,$29.33 ,$31.53 ,$28.01 ,$29.33 ,$31.79 ,$33.12 ,$32.04 ,$6.09 ,$33.12 ,$6.60 ,$7.24 ,$7.24 ,$6.03 ,$7.24 ,$6.03 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$27.60 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$47.26 ,$171.70 ,$27.80 ,$47.26 ,$171.70 ,$147.46 ,$28.73 ,$27.80 ,$31.46 ,$171.70 ,$62.55 ,$185.84 ,$141.40 ,$135.17 ,$145.33 ,$123.02 ,$135.17 ,$139.58 ,$145.44 ,$140.69 ,$28.08 ,$145.44 ,$30.45 ,$33.36 ,$33.36 ,$27.80 ,$33.36 ,$27.80 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$11.39 ,$44.20 ,$6.70 ,$11.39 ,$44.20 ,$37.96 ,$6.92 ,$6.70 ,$7.58 ,$44.20 ,$15.08 ,$47.84 ,$36.40 ,$32.57 ,$35.02 ,$31.67 ,$32.57 ,$35.93 ,$37.44 ,$36.22 ,$6.77 ,$37.44 ,$7.34 ,$8.04 ,$8.04 ,$6.70 ,$8.04 ,$6.70 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$24.57 ,$84.15 ,$14.45 ,$24.57 ,$84.15 ,$72.27 ,$14.93 ,$14.45 ,$16.35 ,$84.15 ,$32.51 ,$91.08 ,$69.30 ,$62.58 ,$67.28 ,$60.29 ,$62.58 ,$68.41 ,$71.28 ,$68.95 ,$14.59 ,$71.28 ,$15.83 ,$17.34 ,$17.34 ,$14.45 ,$17.34 ,$14.45 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$19.44 ,$19.71 ,$6.09 ,$22.95 ,$3.58 ,$6.09 ,$22.95 ,$19.71 ,$3.70 ,$3.58 ,$4.05 ,$22.95 ,$8.06 ,$24.84 ,$18.90 ,$17.39 ,$18.70 ,$16.44 ,$17.39 ,$18.66 ,$19.44 ,$18.81 ,$3.62 ,$19.44 ,$3.92 ,$4.30 ,$4.30 ,$3.58 ,$4.30 ,$3.58 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$16.20 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$9.83 ,$33.15 ,$5.78 ,$9.83 ,$33.15 ,$28.47 ,$5.97 ,$5.78 ,$6.54 ,$33.15 ,$13.01 ,$35.88 ,$27.30 ,$25.16 ,$27.05 ,$23.75 ,$25.16 ,$26.95 ,$28.08 ,$27.16 ,$5.84 ,$28.08 ,$6.33 ,$6.94 ,$6.94 ,$5.78 ,$6.94 ,$5.78 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$23.04 ,$23.36 ,$8.04 ,$27.20 ,$4.73 ,$8.04 ,$27.20 ,$23.36 ,$4.89 ,$4.73 ,$5.35 ,$27.20 ,$10.64 ,$29.44 ,$22.40 ,$20.92 ,$22.49 ,$19.49 ,$20.92 ,$22.11 ,$23.04 ,$22.29 ,$4.78 ,$23.04 ,$5.18 ,$5.68 ,$5.68 ,$4.73 ,$5.68 ,$4.73 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$19.20 
ST MARY'S HOSPITAL,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 ,$26.64 ,$27.01 ,$8.60 ,$31.45 ,$5.06 ,$8.60 ,$31.45 ,$27.01 ,$5.23 ,$5.06 ,$5.73 ,$31.45 ,$11.39 ,$34.04 ,$25.90 ,$23.66 ,$25.44 ,$22.53 ,$23.66 ,$25.57 ,$26.64 ,$25.77 ,$5.11 ,$26.64 ,$5.54 ,$6.07 ,$6.07 ,$5.06 ,$6.07 ,$5.06 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$22.20 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$8.64 ,$30.60 ,$5.08 ,$8.64 ,$30.60 ,$26.28 ,$5.25 ,$5.08 ,$5.75 ,$30.60 ,$11.43 ,$33.12 ,$25.20 ,$23.09 ,$24.83 ,$21.92 ,$23.09 ,$24.88 ,$25.92 ,$25.07 ,$5.13 ,$25.92 ,$5.57 ,$6.10 ,$6.10 ,$5.08 ,$6.10 ,$5.08 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$33.37 ,$133.45 ,$19.63 ,$33.37 ,$133.45 ,$114.61 ,$20.28 ,$19.63 ,$22.22 ,$133.45 ,$44.17 ,$144.44 ,$109.90 ,$95.44 ,$102.61 ,$95.61 ,$95.44 ,$108.49 ,$113.04 ,$109.35 ,$19.83 ,$113.04 ,$21.50 ,$23.56 ,$23.56 ,$19.63 ,$23.56 ,$19.63 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$19.60 ,$181.05 ,$11.53 ,$19.60 ,$181.05 ,$155.49 ,$11.91 ,$11.53 ,$13.05 ,$181.05 ,$25.94 ,$195.96 ,$149.10 ,$56.09 ,$60.31 ,$129.72 ,$56.09 ,$147.18 ,$153.36 ,$148.35 ,$11.65 ,$153.36 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$123.84 ,$125.56 ,$38.56 ,$146.20 , N/A ,$38.56 ,$146.20 ,$125.56 ,$10.05 , N/A ,$72.24 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$97.71 ,$118.85 ,$123.84 ,$119.80 , N/A ,$123.84 ,$10.65 , N/A , N/A , N/A , N/A , N/A ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$103.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$38.56 ,$76.50 , N/A ,$38.56 ,$76.50 ,$65.70 ,$3.81 , N/A ,$37.80 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 , N/A ,$64.80 ,$4.04 , N/A , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$37.33 ,$104.55 ,$21.96 ,$37.33 ,$104.55 ,$89.79 ,$22.69 ,$21.96 ,$24.85 ,$104.55 ,$49.41 ,$113.16 ,$86.10 ,$106.77 ,$114.79 ,$74.91 ,$106.77 ,$84.99 ,$88.56 ,$85.67 ,$22.18 ,$88.56 ,$24.05 ,$26.35 ,$26.35 ,$21.96 ,$26.35 ,$21.96 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$8.67 ,$29.75 ,$5.10 ,$8.67 ,$29.75 ,$25.55 ,$5.27 ,$5.10 ,$5.77 ,$29.75 ,$11.48 ,$32.20 ,$24.50 ,$24.73 ,$26.59 ,$21.32 ,$24.73 ,$24.19 ,$25.20 ,$24.38 ,$5.15 ,$25.20 ,$5.59 ,$6.12 ,$6.12 ,$5.10 ,$6.12 ,$5.10 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$30.69 ,$76.50 ,$18.05 ,$30.69 ,$76.50 ,$65.70 ,$18.65 ,$18.05 ,$20.43 ,$76.50 ,$40.61 ,$82.80 ,$63.00 ,$87.78 ,$90.00 ,$54.81 ,$87.78 ,$62.19 ,$64.80 ,$62.69 ,$18.23 ,$64.80 ,$19.77 ,$21.66 ,$21.66 ,$18.05 ,$21.66 ,$18.05 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$25.00 ,$21.25 , N/A ,$25.00 ,$21.25 ,$18.25 ,$10.05 , N/A ,$10.50 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$14.20 ,$17.28 ,$18.00 ,$17.41 , N/A ,$18.00 ,$10.65 , N/A , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$136.00 ,$116.80 ,$63.95 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$115.20 ,$111.44 ,$115.57 ,$115.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$136.00 ,$116.80 ,$63.95 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$115.20 ,$111.44 ,$115.57 ,$115.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$42.48 ,$43.07 ,$19.60 ,$50.15 ,$11.53 ,$19.60 ,$50.15 ,$43.07 ,$11.91 ,$11.53 ,$13.05 ,$50.15 ,$25.94 ,$54.28 ,$41.30 ,$56.09 ,$59.00 ,$35.93 ,$56.09 ,$40.77 ,$42.48 ,$41.09 ,$11.65 ,$42.48 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$35.40 
ST MARY'S HOSPITAL,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 ,$51.12 ,$51.83 ,$15.81 ,$60.35 ,$9.30 ,$15.81 ,$60.35 ,$51.83 ,$9.61 ,$9.30 ,$10.53 ,$60.35 ,$20.93 ,$65.32 ,$49.70 ,$45.19 ,$48.58 ,$43.24 ,$45.19 ,$49.06 ,$51.12 ,$49.45 ,$9.39 ,$51.12 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$42.60 
ST MARY'S HOSPITAL,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 ,$22.32 ,$22.63 ,$8.81 ,$26.35 ,$5.18 ,$8.81 ,$26.35 ,$22.63 ,$5.35 ,$5.18 ,$5.86 ,$26.35 ,$11.66 ,$28.52 ,$21.70 ,$25.16 ,$27.05 ,$18.88 ,$25.16 ,$21.42 ,$22.32 ,$21.59 ,$5.23 ,$22.32 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$18.60 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$28.95 ,$51.00 ,$17.03 ,$28.95 ,$51.00 ,$43.80 ,$17.60 ,$17.03 ,$19.27 ,$51.00 ,$38.32 ,$55.20 ,$42.00 ,$60.00 ,$60.00 ,$36.54 ,$60.00 ,$41.46 ,$43.20 ,$41.79 ,$17.20 ,$43.20 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$17.03 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$136.00 ,$116.80 ,$63.95 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$115.20 ,$111.44 ,$115.57 ,$115.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$143.28 ,$145.27 ,$46.19 ,$169.15 ,$27.17 ,$46.19 ,$169.15 ,$145.27 ,$28.07 ,$27.17 ,$30.75 ,$169.15 ,$61.13 ,$183.08 ,$139.30 ,$132.11 ,$142.04 ,$121.19 ,$132.11 ,$137.51 ,$143.28 ,$138.60 ,$27.44 ,$143.28 ,$29.75 ,$32.60 ,$32.60 ,$27.17 ,$32.60 ,$27.17 ,$143.28 ,$123.38 ,$143.28 ,$143.28 ,$119.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$24.00 ,$104.55 ,$14.12 ,$24.00 ,$104.55 ,$89.79 ,$14.59 ,$14.12 ,$15.98 ,$104.55 ,$31.77 ,$113.16 ,$86.10 ,$68.67 ,$73.83 ,$74.91 ,$68.67 ,$84.99 ,$88.56 ,$85.67 ,$14.26 ,$88.56 ,$15.47 ,$16.94 ,$16.94 ,$14.12 ,$16.94 ,$14.12 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.41 ,$104.55 ,$16.71 ,$28.41 ,$104.55 ,$89.79 ,$17.27 ,$16.71 ,$18.91 ,$104.55 ,$37.60 ,$113.16 ,$86.10 ,$81.25 ,$87.36 ,$74.91 ,$81.25 ,$84.99 ,$88.56 ,$85.67 ,$16.88 ,$88.56 ,$18.31 ,$20.05 ,$20.05 ,$16.71 ,$20.05 ,$16.71 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$108.72 ,$110.23 ,$31.69 ,$128.35 ,$18.64 ,$31.69 ,$128.35 ,$110.23 ,$19.26 ,$18.64 ,$21.10 ,$128.35 ,$41.94 ,$138.92 ,$105.70 ,$66.57 ,$71.57 ,$91.96 ,$66.57 ,$104.34 ,$108.72 ,$105.17 ,$18.83 ,$108.72 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$90.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$40.99 ,$76.50 ,$24.11 ,$40.99 ,$76.50 ,$65.70 ,$24.91 ,$24.11 ,$27.29 ,$76.50 ,$54.25 ,$82.80 ,$63.00 ,$87.78 ,$90.00 ,$54.81 ,$87.78 ,$62.19 ,$64.80 ,$62.69 ,$24.35 ,$64.80 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$24.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$40.99 ,$76.50 ,$24.11 ,$40.99 ,$76.50 ,$65.70 ,$24.91 ,$24.11 ,$27.29 ,$76.50 ,$54.25 ,$82.80 ,$63.00 ,$87.78 ,$90.00 ,$54.81 ,$87.78 ,$62.19 ,$64.80 ,$62.69 ,$24.35 ,$64.80 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$24.11 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.71 ,$104.55 ,$16.30 ,$27.71 ,$104.55 ,$89.79 ,$16.84 ,$16.30 ,$18.45 ,$104.55 ,$36.68 ,$113.16 ,$86.10 ,$79.26 ,$85.21 ,$74.91 ,$79.26 ,$84.99 ,$88.56 ,$85.67 ,$16.46 ,$88.56 ,$17.85 ,$19.56 ,$19.56 ,$16.30 ,$19.56 ,$16.30 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$31.76 ,$104.55 ,$18.68 ,$31.76 ,$104.55 ,$89.79 ,$14.65 ,$18.68 ,$21.14 ,$104.55 ,$42.03 ,$113.16 ,$86.10 ,$50.68 ,$54.49 ,$74.91 ,$50.68 ,$84.99 ,$88.56 ,$85.67 ,$18.87 ,$88.56 ,$15.53 ,$22.42 ,$22.42 ,$18.68 ,$22.42 ,$18.68 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.33 ,$56.95 ,$9.02 ,$15.33 ,$56.95 ,$48.91 ,$9.32 ,$9.02 ,$10.21 ,$56.95 ,$20.30 ,$61.64 ,$46.90 ,$43.83 ,$47.13 ,$40.80 ,$43.83 ,$46.30 ,$48.24 ,$46.67 ,$9.11 ,$48.24 ,$9.88 ,$10.82 ,$10.82 ,$9.02 ,$10.82 ,$9.02 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$28.56 ,$104.55 ,$16.80 ,$28.56 ,$104.55 ,$89.79 ,$17.36 ,$16.80 ,$19.01 ,$104.55 ,$37.80 ,$113.16 ,$86.10 ,$81.72 ,$87.86 ,$74.91 ,$81.72 ,$84.99 ,$88.56 ,$85.67 ,$16.97 ,$88.56 ,$18.40 ,$20.16 ,$20.16 ,$16.80 ,$20.16 ,$16.80 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.76 ,$85.85 ,$18.68 ,$31.76 ,$85.85 ,$73.73 ,$14.65 ,$18.68 ,$21.14 ,$85.85 ,$42.03 ,$92.92 ,$70.70 ,$50.68 ,$54.49 ,$61.51 ,$50.68 ,$69.79 ,$72.72 ,$70.35 ,$18.87 ,$72.72 ,$15.53 ,$22.42 ,$22.42 ,$18.68 ,$22.42 ,$18.68 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$115.92 ,$117.53 ,$31.76 ,$136.85 ,$18.68 ,$31.76 ,$136.85 ,$117.53 ,$14.65 ,$18.68 ,$21.14 ,$136.85 ,$42.03 ,$148.12 ,$112.70 ,$50.68 ,$54.49 ,$98.05 ,$50.68 ,$111.25 ,$115.92 ,$112.14 ,$18.87 ,$115.92 ,$15.53 ,$22.42 ,$22.42 ,$18.68 ,$22.42 ,$18.68 ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$96.60 
ST MARY'S HOSPITAL,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 ,$45.36 ,$45.99 ,$13.63 ,$53.55 ,$8.02 ,$13.63 ,$53.55 ,$45.99 ,$5.90 ,$8.02 ,$9.08 ,$53.55 ,$18.05 ,$57.96 ,$44.10 ,$20.38 ,$21.92 ,$38.37 ,$20.38 ,$43.53 ,$45.36 ,$43.88 ,$8.10 ,$45.36 ,$6.25 ,$9.62 ,$9.62 ,$8.02 ,$9.62 ,$8.02 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$37.80 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$29.36 ,$133.45 ,$17.27 ,$29.36 ,$133.45 ,$114.61 ,$17.85 ,$17.27 ,$19.55 ,$133.45 ,$38.86 ,$144.44 ,$109.90 ,$62.94 ,$67.67 ,$95.61 ,$62.94 ,$108.49 ,$113.04 ,$109.35 ,$17.44 ,$113.04 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$32.83 ,$104.55 ,$19.31 ,$32.83 ,$104.55 ,$89.79 ,$19.95 ,$19.31 ,$21.86 ,$104.55 ,$43.45 ,$113.16 ,$86.10 ,$89.42 ,$96.13 ,$74.91 ,$89.42 ,$84.99 ,$88.56 ,$85.67 ,$19.50 ,$88.56 ,$21.15 ,$23.17 ,$23.17 ,$19.31 ,$23.17 ,$19.31 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$136.00 ,$116.80 ,$63.95 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$115.20 ,$111.44 ,$115.57 ,$115.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$23.34 ,$161.50 ,$13.73 ,$23.34 ,$161.50 ,$138.70 ,$14.19 ,$13.73 ,$15.54 ,$161.50 ,$30.89 ,$174.80 ,$133.00 ,$66.75 ,$71.77 ,$115.71 ,$66.75 ,$131.29 ,$136.80 ,$132.34 ,$13.87 ,$136.80 ,$15.04 ,$16.48 ,$16.48 ,$13.73 ,$16.48 ,$13.73 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$155.52 ,$157.68 ,$31.69 ,$183.60 ,$18.64 ,$31.69 ,$183.60 ,$157.68 ,$19.26 ,$18.64 ,$21.10 ,$183.60 ,$41.94 ,$198.72 ,$151.20 ,$66.57 ,$71.57 ,$131.54 ,$66.57 ,$149.26 ,$155.52 ,$150.44 ,$18.83 ,$155.52 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$129.60 
ST MARY'S HOSPITAL,30101049,82565,HC CREATININE W/GFR POC,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 ,$28.08 ,$28.47 ,$8.70 ,$33.15 ,$5.12 ,$8.70 ,$33.15 ,$28.47 ,$5.29 ,$5.12 ,$5.79 ,$33.15 ,$11.52 ,$35.88 ,$27.30 ,$24.91 ,$26.78 ,$23.75 ,$24.91 ,$26.95 ,$28.08 ,$27.16 ,$5.17 ,$28.08 ,$5.61 ,$6.14 ,$6.14 ,$5.12 ,$6.14 ,$5.12 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$31.48 ,$104.55 ,$18.52 ,$31.48 ,$104.55 ,$89.79 ,$19.00 ,$18.52 ,$20.96 ,$104.55 ,$41.67 ,$113.16 ,$86.10 ,$66.07 ,$71.04 ,$74.91 ,$66.07 ,$84.99 ,$88.56 ,$85.67 ,$18.71 ,$88.56 ,$20.14 ,$22.22 ,$22.22 ,$18.52 ,$22.22 ,$18.52 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$249.84 ,$253.31 ,$40.99 ,$294.95 ,$24.11 ,$40.99 ,$294.95 ,$253.31 ,$24.91 ,$24.11 ,$27.29 ,$294.95 ,$54.25 ,$319.24 ,$242.90 ,$87.78 ,$94.37 ,$211.32 ,$87.78 ,$239.78 ,$249.84 ,$241.69 ,$24.35 ,$249.84 ,$26.40 ,$28.93 ,$28.93 ,$24.11 ,$28.93 ,$24.11 ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$208.20 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$49.78 ,$152.15 ,$29.28 ,$49.78 ,$152.15 ,$130.67 ,$30.26 ,$29.28 ,$33.14 ,$152.15 ,$65.88 ,$164.68 ,$125.30 ,$127.16 ,$136.71 ,$109.01 ,$127.16 ,$123.69 ,$128.88 ,$124.67 ,$29.57 ,$128.88 ,$32.08 ,$35.14 ,$35.14 ,$29.28 ,$35.14 ,$29.28 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$46.09 ,$93.50 ,$27.11 ,$46.09 ,$93.50 ,$80.30 ,$21.69 ,$27.11 ,$30.68 ,$93.50 ,$61.00 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$27.38 ,$79.20 ,$22.99 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$27.11 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$29.36 ,$85.85 ,$17.27 ,$29.36 ,$85.85 ,$73.73 ,$17.85 ,$17.27 ,$19.55 ,$85.85 ,$38.86 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$17.44 ,$72.72 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$31.28 ,$85.85 ,$18.40 ,$31.28 ,$85.85 ,$73.73 ,$19.00 ,$18.40 ,$20.83 ,$85.85 ,$41.40 ,$92.92 ,$70.70 ,$65.68 ,$70.62 ,$61.51 ,$65.68 ,$69.79 ,$72.72 ,$70.35 ,$18.58 ,$72.72 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$76.32 ,$77.38 ,$35.14 ,$90.10 ,$20.67 ,$35.14 ,$90.10 ,$77.38 ,$21.36 ,$20.67 ,$23.39 ,$90.10 ,$46.51 ,$97.52 ,$74.20 ,$100.53 ,$106.00 ,$64.55 ,$100.53 ,$73.25 ,$76.32 ,$73.83 ,$20.88 ,$76.32 ,$22.64 ,$24.80 ,$24.80 ,$20.67 ,$24.80 ,$20.67 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$63.60 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$42.42 ,$85.00 ,$24.95 ,$42.42 ,$85.00 ,$73.00 ,$25.78 ,$24.95 ,$28.24 ,$85.00 ,$56.14 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$25.20 ,$72.00 ,$27.33 ,$29.94 ,$29.94 ,$24.95 ,$29.94 ,$24.95 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$203.04 ,$205.86 ,$194.53 ,$239.70 ,$114.43 ,$194.53 ,$239.70 ,$205.86 ,$63.95 ,$114.43 ,$129.51 ,$239.70 ,$257.47 ,$259.44 ,$197.40 ,$282.00 ,$282.00 ,$171.74 ,$282.00 ,$194.86 ,$203.04 ,$196.41 ,$115.57 ,$203.04 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$203.04 ,$174.84 ,$203.04 ,$203.04 ,$169.20 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$114.43 ,$160.00 ,$136.00 ,$116.80 ,$63.95 ,$114.43 ,$129.51 ,$136.00 ,$257.47 ,$147.20 ,$112.00 ,$160.00 ,$160.00 ,$97.44 ,$160.00 ,$110.56 ,$115.20 ,$111.44 ,$115.57 ,$115.20 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$19.36 ,$68.00 ,$11.39 ,$19.36 ,$68.00 ,$58.40 ,$11.77 ,$11.39 ,$12.89 ,$68.00 ,$25.63 ,$73.60 ,$56.00 ,$50.39 ,$54.18 ,$48.72 ,$50.39 ,$55.28 ,$57.60 ,$55.72 ,$11.50 ,$57.60 ,$12.48 ,$13.67 ,$13.67 ,$11.39 ,$13.67 ,$11.39 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$27.30 ,$276.25 ,$16.06 ,$27.30 ,$276.25 ,$237.25 ,$16.59 ,$16.06 ,$18.18 ,$276.25 ,$36.14 ,$299.00 ,$227.50 ,$78.08 ,$83.95 ,$197.93 ,$78.08 ,$224.58 ,$234.00 ,$226.36 ,$16.22 ,$234.00 ,$17.59 ,$19.27 ,$19.27 ,$16.06 ,$19.27 ,$16.06 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$118.80 ,$120.45 ,$31.69 ,$140.25 ,$18.64 ,$31.69 ,$140.25 ,$120.45 ,$19.26 ,$18.64 ,$21.10 ,$140.25 ,$41.94 ,$151.80 ,$115.50 ,$66.57 ,$71.57 ,$100.49 ,$66.57 ,$114.02 ,$118.80 ,$114.92 ,$18.83 ,$118.80 ,$20.42 ,$22.37 ,$22.37 ,$18.64 ,$22.37 ,$18.64 ,$118.80 ,$102.30 ,$118.80 ,$118.80 ,$99.00 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.98 ,$124.10 ,$19.40 ,$32.98 ,$124.10 ,$106.58 ,$20.05 ,$19.40 ,$21.96 ,$124.10 ,$43.65 ,$134.32 ,$102.20 ,$94.30 ,$101.38 ,$88.91 ,$94.30 ,$100.89 ,$105.12 ,$101.69 ,$19.59 ,$105.12 ,$21.25 ,$23.28 ,$23.28 ,$19.40 ,$23.28 ,$19.40 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$62.17 ,$190.40 ,$36.57 ,$62.17 ,$190.40 ,$163.52 ,$37.79 ,$36.57 ,$41.39 ,$190.40 ,$82.28 ,$206.08 ,$156.80 ,$177.80 ,$191.16 ,$136.42 ,$177.80 ,$154.78 ,$161.28 ,$156.02 ,$36.94 ,$161.28 ,$40.06 ,$43.88 ,$43.88 ,$36.57 ,$43.88 ,$36.57 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$197.28 ,$200.02 ,$114.51 ,$232.90 ,$67.36 ,$114.51 ,$232.90 ,$200.02 ,$69.60 ,$67.36 ,$76.24 ,$232.90 ,$151.56 ,$252.08 ,$191.80 ,$274.00 ,$274.00 ,$166.87 ,$274.00 ,$189.33 ,$197.28 ,$190.84 ,$68.03 ,$197.28 ,$73.78 ,$80.83 ,$80.83 ,$67.36 ,$80.83 ,$67.36 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$164.40 
ST MARY'S HOSPITAL,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 ,$194.40 ,$197.10 ,$266.20 ,$229.50 ,$156.59 ,$266.20 ,$229.50 ,$197.10 ,$98.39 ,$156.59 ,$177.23 ,$229.50 ,$352.33 ,$248.40 ,$189.00 ,$270.00 ,$270.00 ,$164.43 ,$270.00 ,$186.57 ,$194.40 ,$188.06 ,$158.16 ,$194.40 ,$104.29 ,$187.91 ,$187.91 ,$156.59 ,$187.91 ,$156.59 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$162.00 
ST MARY'S HOSPITAL,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 ,$252.00 ,$255.50 ,$337.86 ,$297.50 ,$198.74 ,$337.86 ,$297.50 ,$255.50 ,$132.80 ,$198.74 ,$224.93 ,$297.50 ,$447.17 ,$322.00 ,$245.00 ,$350.00 ,$350.00 ,$213.15 ,$350.00 ,$241.85 ,$252.00 ,$243.78 ,$200.73 ,$252.00 ,$140.77 ,$238.49 ,$238.49 ,$198.74 ,$238.49 ,$198.74 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,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 ,$370.80 ,$375.95 ,$419.76 ,$437.75 ,$246.92 ,$419.76 ,$437.75 ,$375.95 ,$172.18 ,$246.92 ,$279.46 ,$437.75 ,$555.57 ,$473.80 ,$360.50 ,$515.00 ,$515.00 ,$313.64 ,$515.00 ,$355.87 ,$370.80 ,$358.70 ,$249.39 ,$370.80 ,$182.51 ,$296.30 ,$296.30 ,$246.92 ,$296.30 ,$246.92 ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$309.00 
ST MARY'S HOSPITAL,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 ,$92.88 ,$94.17 , N/A ,$109.65 , N/A , N/A ,$109.65 ,$94.17 ,$3.81 , N/A ,$54.18 ,$109.65 ,$77.40 ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$73.28 ,$89.14 ,$92.88 ,$89.85 , N/A ,$92.88 ,$4.04 ,$64.50 ,$64.50 , N/A ,$64.50 , N/A ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$111.60 ,$113.15 ,$29.36 ,$131.75 ,$17.27 ,$29.36 ,$131.75 ,$113.15 ,$17.85 ,$17.27 ,$19.55 ,$131.75 ,$38.86 ,$142.60 ,$108.50 ,$62.94 ,$67.67 ,$94.40 ,$62.94 ,$107.11 ,$111.60 ,$107.96 ,$17.44 ,$111.60 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$111.60 ,$96.10 ,$111.60 ,$111.60 ,$93.00 
ST MARY'S HOSPITAL,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 ,$100.80 ,$102.20 ,$46.09 ,$119.00 ,$27.11 ,$46.09 ,$119.00 ,$102.20 ,$21.69 ,$27.11 ,$30.68 ,$119.00 ,$61.00 ,$128.80 ,$98.00 ,$96.61 ,$103.87 ,$85.26 ,$96.61 ,$96.74 ,$100.80 ,$97.51 ,$27.38 ,$100.80 ,$22.99 ,$32.53 ,$32.53 ,$27.11 ,$32.53 ,$27.11 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$84.00 
ST MARY'S HOSPITAL,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 ,$720.00 ,$730.00 ,$419.76 ,$850.00 ,$246.92 ,$419.76 ,$850.00 ,$730.00 ,$172.18 ,$246.92 ,$279.46 ,$850.00 ,$555.57 ,$920.00 ,$700.00 ,$767.04 ,$824.68 ,$609.00 ,$767.04 ,$691.00 ,$720.00 ,$696.50 ,$249.39 ,$720.00 ,$182.51 ,$296.30 ,$296.30 ,$246.92 ,$296.30 ,$246.92 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$105.64 ,$314.50 ,$62.14 ,$105.64 ,$314.50 ,$270.10 ,$63.40 ,$62.14 ,$70.33 ,$314.50 ,$139.82 ,$340.40 ,$259.00 ,$230.40 ,$247.71 ,$225.33 ,$230.40 ,$255.67 ,$266.40 ,$257.71 ,$62.76 ,$266.40 ,$67.20 ,$74.57 ,$74.57 ,$62.14 ,$74.57 ,$62.14 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$99.00 ,$84.15 ,$99.00 ,$99.00 ,$84.15 ,$72.27 ,$63.95 ,$99.00 ,$99.00 ,$84.15 ,$222.75 ,$91.08 ,$69.30 ,$99.00 ,$99.00 ,$60.29 ,$99.00 ,$68.41 ,$71.28 ,$68.95 ,$99.99 ,$71.28 ,$67.79 ,$99.00 ,$99.00 ,$99.00 ,$99.00 ,$99.00 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$29.36 ,$84.15 ,$17.27 ,$29.36 ,$84.15 ,$72.27 ,$17.85 ,$17.27 ,$19.55 ,$84.15 ,$38.86 ,$91.08 ,$69.30 ,$62.94 ,$67.67 ,$60.29 ,$62.94 ,$68.41 ,$71.28 ,$68.95 ,$17.44 ,$71.28 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$141.84 ,$143.81 ,$28.95 ,$167.45 ,$17.03 ,$28.95 ,$167.45 ,$143.81 ,$17.60 ,$17.03 ,$19.27 ,$167.45 ,$38.32 ,$181.24 ,$137.90 ,$82.82 ,$89.05 ,$119.97 ,$82.82 ,$136.13 ,$141.84 ,$137.21 ,$17.20 ,$141.84 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$17.03 ,$141.84 ,$122.14 ,$141.84 ,$141.84 ,$118.20 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$37.69 ,$219.30 ,$22.17 ,$37.69 ,$219.30 ,$188.34 ,$22.91 ,$22.17 ,$25.09 ,$219.30 ,$49.88 ,$237.36 ,$180.60 ,$87.78 ,$94.37 ,$157.12 ,$87.78 ,$178.28 ,$185.76 ,$179.70 ,$22.39 ,$185.76 ,$24.28 ,$26.60 ,$26.60 ,$22.17 ,$26.60 ,$22.17 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$10.27 ,$71.40 ,$6.04 ,$10.27 ,$71.40 ,$61.32 ,$6.24 ,$6.04 ,$6.84 ,$71.40 ,$13.59 ,$77.28 ,$58.80 ,$29.33 ,$31.53 ,$51.16 ,$29.33 ,$58.04 ,$60.48 ,$58.51 ,$6.10 ,$60.48 ,$6.61 ,$7.25 ,$7.25 ,$6.04 ,$7.25 ,$6.04 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$11.71 ,$152.15 ,$6.89 ,$11.71 ,$152.15 ,$130.67 ,$7.12 ,$6.89 ,$7.80 ,$152.15 ,$15.50 ,$164.68 ,$125.30 ,$33.50 ,$36.02 ,$109.01 ,$33.50 ,$123.69 ,$128.88 ,$124.67 ,$6.96 ,$128.88 ,$7.55 ,$8.27 ,$8.27 ,$6.89 ,$8.27 ,$6.89 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$49.78 ,$152.15 ,$29.28 ,$49.78 ,$152.15 ,$130.67 ,$30.26 ,$29.28 ,$33.14 ,$152.15 ,$65.88 ,$164.68 ,$125.30 ,$127.16 ,$136.71 ,$109.01 ,$127.16 ,$123.69 ,$128.88 ,$124.67 ,$29.57 ,$128.88 ,$32.08 ,$35.14 ,$35.14 ,$29.28 ,$35.14 ,$29.28 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$108.00 ,$109.50 ,$34.41 ,$127.50 ,$20.24 ,$34.41 ,$127.50 ,$109.50 ,$20.91 ,$20.24 ,$22.91 ,$127.50 ,$45.54 ,$138.00 ,$105.00 ,$98.40 ,$105.79 ,$91.35 ,$98.40 ,$103.65 ,$108.00 ,$104.48 ,$20.44 ,$108.00 ,$22.16 ,$24.29 ,$24.29 ,$20.24 ,$24.29 ,$20.24 ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$90.00 
ST MARY'S HOSPITAL,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 ,$98.64 ,$100.01 ,$29.00 ,$116.45 ,$17.06 ,$29.00 ,$116.45 ,$100.01 ,$16.32 ,$17.06 ,$19.31 ,$116.45 ,$38.39 ,$126.04 ,$95.90 ,$56.41 ,$60.65 ,$83.43 ,$56.41 ,$94.67 ,$98.64 ,$95.42 ,$17.23 ,$98.64 ,$17.30 ,$20.47 ,$20.47 ,$17.06 ,$20.47 ,$17.06 ,$98.64 ,$84.94 ,$98.64 ,$98.64 ,$82.20 
ST MARY'S HOSPITAL,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 ,$599.76 ,$608.09 ,$29.36 ,$708.05 ,$17.27 ,$29.36 ,$708.05 ,$608.09 ,$17.85 ,$17.27 ,$19.55 ,$708.05 ,$38.86 ,$766.36 ,$583.10 ,$62.94 ,$67.67 ,$507.30 ,$62.94 ,$575.60 ,$599.76 ,$580.18 ,$17.44 ,$599.76 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$599.76 ,$516.46 ,$599.76 ,$599.76 ,$499.80 
ST MARY'S HOSPITAL,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 ,$151.92 ,$154.03 ,$31.28 ,$179.35 ,$18.40 ,$31.28 ,$179.35 ,$154.03 ,$19.00 ,$18.40 ,$20.83 ,$179.35 ,$41.40 ,$194.12 ,$147.70 ,$65.68 ,$70.62 ,$128.50 ,$65.68 ,$145.80 ,$151.92 ,$146.96 ,$18.58 ,$151.92 ,$20.14 ,$22.08 ,$22.08 ,$18.40 ,$22.08 ,$18.40 ,$151.92 ,$130.82 ,$151.92 ,$151.92 ,$126.60 
ST MARY'S HOSPITAL,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 ,$121.68 ,$123.37 ,$29.36 ,$143.65 ,$17.27 ,$29.36 ,$143.65 ,$123.37 ,$17.85 ,$17.27 ,$19.55 ,$143.65 ,$38.86 ,$155.48 ,$118.30 ,$62.94 ,$67.67 ,$102.92 ,$62.94 ,$116.78 ,$121.68 ,$117.71 ,$17.44 ,$121.68 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$101.40 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$40.95 ,$170.00 ,$24.09 ,$40.95 ,$170.00 ,$146.00 ,$24.89 ,$24.09 ,$27.27 ,$170.00 ,$54.20 ,$184.00 ,$140.00 ,$87.78 ,$94.37 ,$121.80 ,$87.78 ,$138.20 ,$144.00 ,$139.30 ,$24.33 ,$144.00 ,$26.38 ,$28.91 ,$28.91 ,$24.09 ,$28.91 ,$24.09 ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$157.68 ,$159.87 ,$194.53 ,$186.15 ,$114.43 ,$194.53 ,$186.15 ,$159.87 ,$63.95 ,$114.43 ,$129.51 ,$186.15 ,$257.47 ,$201.48 ,$153.30 ,$219.00 ,$219.00 ,$133.37 ,$219.00 ,$151.33 ,$157.68 ,$152.53 ,$115.57 ,$157.68 ,$67.79 ,$137.32 ,$137.32 ,$114.43 ,$137.32 ,$114.43 ,$157.68 ,$135.78 ,$157.68 ,$157.68 ,$131.40 
ST MARY'S HOSPITAL,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 ,$121.68 ,$123.37 ,$29.36 ,$143.65 ,$17.27 ,$29.36 ,$143.65 ,$123.37 ,$17.85 ,$17.27 ,$19.55 ,$143.65 ,$38.86 ,$155.48 ,$118.30 ,$62.94 ,$67.67 ,$102.92 ,$62.94 ,$116.78 ,$121.68 ,$117.71 ,$17.44 ,$121.68 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$101.40 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$15.81 ,$33.15 ,$9.30 ,$15.81 ,$33.15 ,$28.47 ,$9.61 ,$9.30 ,$10.53 ,$33.15 ,$20.93 ,$35.88 ,$27.30 ,$39.00 ,$39.00 ,$23.75 ,$39.00 ,$26.95 ,$28.08 ,$27.16 ,$9.39 ,$28.08 ,$10.19 ,$11.16 ,$11.16 ,$9.30 ,$11.16 ,$9.30 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$78.00 ,$66.30 ,$78.00 ,$78.00 ,$66.30 ,$56.94 ,$63.95 ,$78.00 ,$78.00 ,$66.30 ,$175.50 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$56.16 ,$54.33 ,$78.78 ,$56.16 ,$67.79 ,$78.00 ,$78.00 ,$78.00 ,$78.00 ,$78.00 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$194.40 ,$197.10 ,$12.24 ,$229.50 ,$7.20 ,$12.24 ,$229.50 ,$197.10 ,$7.44 ,$7.20 ,$8.15 ,$229.50 ,$16.20 ,$248.40 ,$189.00 ,$32.11 ,$34.52 ,$164.43 ,$32.11 ,$186.57 ,$194.40 ,$188.06 ,$7.27 ,$194.40 ,$7.89 ,$8.64 ,$8.64 ,$7.20 ,$8.64 ,$7.20 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$162.00 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$52.00 ,$44.20 ,$52.00 ,$52.00 ,$44.20 ,$37.96 ,$52.00 ,$52.00 ,$52.00 ,$44.20 ,$117.00 ,$47.84 ,$36.40 ,$52.00 ,$52.00 ,$31.67 ,$52.00 ,$35.93 ,$37.44 ,$36.22 ,$52.52 ,$37.44 ,$55.12 ,$52.00 ,$52.00 ,$52.00 ,$52.00 ,$52.00 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$38.56 ,$44.20 , N/A ,$38.56 ,$44.20 ,$37.96 ,$10.05 , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$29.54 ,$35.93 ,$37.44 ,$36.22 , N/A ,$37.44 ,$10.65 , N/A , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$38.56 ,$44.20 , N/A ,$38.56 ,$44.20 ,$37.96 ,$1.53 , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$29.54 ,$35.93 ,$37.44 ,$36.22 , N/A ,$37.44 ,$1.62 , N/A , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$38.56 ,$44.20 , N/A ,$38.56 ,$44.20 ,$37.96 ,$1.53 , N/A ,$21.84 ,$44.20 , N/A ,$47.84 ,$36.40 ,$26.37 ,$31.65 ,$31.67 ,$29.54 ,$35.93 ,$37.44 ,$36.22 , N/A ,$37.44 ,$1.62 , N/A , N/A , N/A , N/A , N/A ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$28.90 ,$29.30 ,$21.96 ,$34.12 ,$12.92 ,$21.96 ,$34.12 ,$29.30 ,$13.35 ,$12.92 ,$14.62 ,$34.12 ,$29.07 ,$36.93 ,$28.10 ,$40.14 ,$40.14 ,$24.45 ,$40.14 ,$27.74 ,$28.90 ,$27.96 ,$13.05 ,$28.90 ,$14.15 ,$15.50 ,$15.50 ,$12.92 ,$15.50 ,$12.92 ,$28.90 ,$24.89 ,$28.90 ,$28.90 ,$24.08 
ST MARY'S HOSPITAL,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 ,$121.68 ,$123.37 ,$29.36 ,$143.65 ,$17.27 ,$29.36 ,$143.65 ,$123.37 ,$17.85 ,$17.27 ,$19.55 ,$143.65 ,$38.86 ,$155.48 ,$118.30 ,$62.94 ,$67.67 ,$102.92 ,$62.94 ,$116.78 ,$121.68 ,$117.71 ,$17.44 ,$121.68 ,$18.92 ,$20.72 ,$20.72 ,$17.27 ,$20.72 ,$17.27 ,$121.68 ,$104.78 ,$121.68 ,$121.68 ,$101.40 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$8.87 ,$21.25 ,$5.22 ,$8.87 ,$21.25 ,$18.25 ,$4.57 ,$5.22 ,$5.91 ,$21.25 ,$11.75 ,$23.00 ,$17.50 ,$15.79 ,$16.97 ,$15.23 ,$15.79 ,$17.28 ,$18.00 ,$17.41 ,$5.27 ,$18.00 ,$4.84 ,$6.26 ,$6.26 ,$5.22 ,$6.26 ,$5.22 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$25.59 ,$104.55 ,$15.05 ,$25.59 ,$104.55 ,$89.79 ,$15.55 ,$15.05 ,$17.03 ,$104.55 ,$33.86 ,$113.16 ,$86.10 ,$73.20 ,$78.70 ,$74.91 ,$73.20 ,$84.99 ,$88.56 ,$85.67 ,$15.20 ,$88.56 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$25.59 ,$66.30 ,$15.05 ,$25.59 ,$66.30 ,$56.94 ,$15.55 ,$15.05 ,$17.03 ,$66.30 ,$33.86 ,$71.76 ,$54.60 ,$73.20 ,$78.00 ,$47.50 ,$73.20 ,$53.90 ,$56.16 ,$54.33 ,$15.20 ,$56.16 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$25.59 ,$85.85 ,$15.05 ,$25.59 ,$85.85 ,$73.73 ,$15.55 ,$15.05 ,$17.03 ,$85.85 ,$33.86 ,$92.92 ,$70.70 ,$73.20 ,$78.70 ,$61.51 ,$73.20 ,$69.79 ,$72.72 ,$70.35 ,$15.20 ,$72.72 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$25.59 ,$85.85 ,$15.05 ,$25.59 ,$85.85 ,$73.73 ,$15.55 ,$15.05 ,$17.03 ,$85.85 ,$33.86 ,$92.92 ,$70.70 ,$73.20 ,$78.70 ,$61.51 ,$73.20 ,$69.79 ,$72.72 ,$70.35 ,$15.20 ,$72.72 ,$16.48 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$31.23 ,$171.70 ,$18.37 ,$31.23 ,$171.70 ,$147.46 ,$18.98 ,$18.37 ,$20.79 ,$171.70 ,$41.33 ,$185.84 ,$141.40 ,$89.31 ,$96.02 ,$123.02 ,$89.31 ,$139.58 ,$145.44 ,$140.69 ,$18.55 ,$145.44 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$18.37 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$31.23 ,$181.05 ,$18.37 ,$31.23 ,$181.05 ,$155.49 ,$18.98 ,$18.37 ,$20.79 ,$181.05 ,$41.33 ,$195.96 ,$149.10 ,$89.31 ,$96.02 ,$129.72 ,$89.31 ,$147.18 ,$153.36 ,$148.35 ,$18.55 ,$153.36 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$18.37 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$314.64 ,$319.01 ,$31.23 ,$371.45 ,$18.37 ,$31.23 ,$371.45 ,$319.01 ,$18.98 ,$18.37 ,$20.79 ,$371.45 ,$41.33 ,$402.04 ,$305.90 ,$89.31 ,$96.02 ,$266.13 ,$89.31 ,$301.97 ,$314.64 ,$304.37 ,$18.55 ,$314.64 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$18.37 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$262.20 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$31.23 ,$171.70 ,$18.37 ,$31.23 ,$171.70 ,$147.46 ,$18.98 ,$18.37 ,$20.79 ,$171.70 ,$41.33 ,$185.84 ,$141.40 ,$89.31 ,$96.02 ,$123.02 ,$89.31 ,$139.58 ,$145.44 ,$140.69 ,$18.55 ,$145.44 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$18.37 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$41.76 ,$42.34 ,$31.23 ,$49.30 ,$18.37 ,$31.23 ,$49.30 ,$42.34 ,$18.98 ,$18.37 ,$20.79 ,$49.30 ,$41.33 ,$53.36 ,$40.60 ,$58.00 ,$58.00 ,$35.32 ,$58.00 ,$40.08 ,$41.76 ,$40.40 ,$18.55 ,$41.76 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$18.37 ,$41.76 ,$35.96 ,$41.76 ,$41.76 ,$34.80 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$31.23 ,$171.70 ,$18.37 ,$31.23 ,$171.70 ,$147.46 ,$18.98 ,$18.37 ,$20.79 ,$171.70 ,$41.33 ,$185.84 ,$141.40 ,$89.31 ,$96.02 ,$123.02 ,$89.31 ,$139.58 ,$145.44 ,$140.69 ,$18.55 ,$145.44 ,$20.12 ,$22.04 ,$22.04 ,$18.37 ,$22.04 ,$18.37 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.18 ,$85.85 ,$12.46 ,$21.18 ,$85.85 ,$73.73 ,$12.87 ,$12.46 ,$14.10 ,$85.85 ,$28.04 ,$92.92 ,$70.70 ,$60.58 ,$65.14 ,$61.51 ,$60.58 ,$69.79 ,$72.72 ,$70.35 ,$12.58 ,$72.72 ,$13.64 ,$14.95 ,$14.95 ,$12.46 ,$14.95 ,$12.46 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$20.55 ,$66.30 ,$12.09 ,$20.55 ,$66.30 ,$56.94 ,$12.49 ,$12.09 ,$13.68 ,$66.30 ,$27.20 ,$71.76 ,$54.60 ,$50.68 ,$54.49 ,$47.50 ,$50.68 ,$53.90 ,$56.16 ,$54.33 ,$12.21 ,$56.16 ,$13.24 ,$14.51 ,$14.51 ,$12.09 ,$14.51 ,$12.09 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$18.97 ,$76.50 ,$11.16 ,$18.97 ,$76.50 ,$65.70 ,$11.53 ,$11.16 ,$12.63 ,$76.50 ,$25.11 ,$82.80 ,$63.00 ,$54.28 ,$58.36 ,$54.81 ,$54.28 ,$62.19 ,$64.80 ,$62.69 ,$11.27 ,$64.80 ,$12.22 ,$13.39 ,$13.39 ,$11.16 ,$13.39 ,$11.16 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$12.41 ,$104.55 ,$7.30 ,$12.41 ,$104.55 ,$89.79 ,$7.54 ,$7.30 ,$8.26 ,$104.55 ,$16.43 ,$113.16 ,$86.10 ,$35.50 ,$38.16 ,$74.91 ,$35.50 ,$84.99 ,$88.56 ,$85.67 ,$7.37 ,$88.56 ,$7.99 ,$8.76 ,$8.76 ,$7.30 ,$8.76 ,$7.30 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$75.60 ,$76.65 ,$9.81 ,$89.25 ,$5.77 ,$9.81 ,$89.25 ,$76.65 ,$5.96 ,$5.77 ,$6.53 ,$89.25 ,$12.98 ,$96.60 ,$73.50 ,$28.05 ,$30.15 ,$63.95 ,$28.05 ,$72.56 ,$75.60 ,$73.13 ,$5.83 ,$75.60 ,$6.32 ,$6.92 ,$6.92 ,$5.77 ,$6.92 ,$5.77 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$63.00 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$8.81 ,$38.25 ,$5.18 ,$8.81 ,$38.25 ,$32.85 ,$5.35 ,$5.18 ,$5.86 ,$38.25 ,$11.66 ,$41.40 ,$31.50 ,$25.16 ,$27.05 ,$27.41 ,$25.16 ,$31.10 ,$32.40 ,$31.34 ,$5.23 ,$32.40 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$22.02 ,$142.80 ,$12.95 ,$22.02 ,$142.80 ,$122.64 ,$13.38 ,$12.95 ,$14.66 ,$142.80 ,$29.14 ,$154.56 ,$117.60 ,$62.94 ,$67.67 ,$102.31 ,$62.94 ,$116.09 ,$120.96 ,$117.01 ,$13.08 ,$120.96 ,$14.18 ,$15.54 ,$15.54 ,$12.95 ,$15.54 ,$12.95 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$43.27 ,$66.30 ,$25.45 ,$43.27 ,$66.30 ,$56.94 ,$8.17 ,$25.45 ,$28.80 ,$66.30 ,$57.26 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$25.70 ,$56.16 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$25.45 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$43.27 ,$56.95 ,$25.45 ,$43.27 ,$56.95 ,$48.91 ,$8.17 ,$25.45 ,$28.80 ,$56.95 ,$57.26 ,$61.64 ,$46.90 ,$28.26 ,$30.38 ,$40.80 ,$28.26 ,$46.30 ,$48.24 ,$46.67 ,$25.70 ,$48.24 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$25.45 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$54.72 ,$55.48 ,$43.27 ,$64.60 ,$25.45 ,$43.27 ,$64.60 ,$55.48 ,$8.17 ,$25.45 ,$28.80 ,$64.60 ,$57.26 ,$69.92 ,$53.20 ,$28.26 ,$30.38 ,$46.28 ,$28.26 ,$52.52 ,$54.72 ,$52.93 ,$25.70 ,$54.72 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$25.45 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$45.60 
ST MARY'S HOSPITAL,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 ,$54.72 ,$55.48 ,$43.27 ,$64.60 ,$25.45 ,$43.27 ,$64.60 ,$55.48 ,$8.17 ,$25.45 ,$28.80 ,$64.60 ,$57.26 ,$69.92 ,$53.20 ,$28.26 ,$30.38 ,$46.28 ,$28.26 ,$52.52 ,$54.72 ,$52.93 ,$25.70 ,$54.72 ,$8.66 ,$30.54 ,$30.54 ,$25.45 ,$30.54 ,$25.45 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$45.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.40 ,$76.50 ,$12.00 ,$20.40 ,$76.50 ,$65.70 ,$12.40 ,$12.00 ,$13.58 ,$76.50 ,$27.00 ,$82.80 ,$63.00 ,$58.38 ,$62.76 ,$54.81 ,$58.38 ,$62.19 ,$64.80 ,$62.69 ,$12.12 ,$64.80 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$12.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.40 ,$76.50 ,$12.00 ,$20.40 ,$76.50 ,$65.70 ,$12.40 ,$12.00 ,$13.58 ,$76.50 ,$27.00 ,$82.80 ,$63.00 ,$58.38 ,$62.76 ,$54.81 ,$58.38 ,$62.19 ,$64.80 ,$62.69 ,$12.12 ,$64.80 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$12.00 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$20.40 ,$152.15 ,$12.00 ,$20.40 ,$152.15 ,$130.67 ,$12.40 ,$12.00 ,$13.58 ,$152.15 ,$27.00 ,$164.68 ,$125.30 ,$58.38 ,$62.76 ,$109.01 ,$58.38 ,$123.69 ,$128.88 ,$124.67 ,$12.12 ,$128.88 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$12.00 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 ,$20.40 ,$73.10 ,$12.00 ,$20.40 ,$73.10 ,$62.78 ,$12.40 ,$12.00 ,$13.58 ,$73.10 ,$27.00 ,$79.12 ,$60.20 ,$58.38 ,$62.76 ,$52.37 ,$58.38 ,$59.43 ,$61.92 ,$59.90 ,$12.12 ,$61.92 ,$13.14 ,$14.40 ,$14.40 ,$12.00 ,$14.40 ,$12.00 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$34.54 ,$124.10 ,$20.32 ,$34.54 ,$124.10 ,$106.58 ,$21.00 ,$20.32 ,$23.00 ,$124.10 ,$45.72 ,$134.32 ,$102.20 ,$91.98 ,$98.89 ,$88.91 ,$91.98 ,$100.89 ,$105.12 ,$101.69 ,$20.52 ,$105.12 ,$22.26 ,$24.38 ,$24.38 ,$20.32 ,$24.38 ,$20.32 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.02 ,$85.85 ,$12.95 ,$22.02 ,$85.85 ,$73.73 ,$13.38 ,$12.95 ,$14.66 ,$85.85 ,$29.14 ,$92.92 ,$70.70 ,$62.94 ,$67.67 ,$61.51 ,$62.94 ,$69.79 ,$72.72 ,$70.35 ,$13.08 ,$72.72 ,$14.18 ,$15.54 ,$15.54 ,$12.95 ,$15.54 ,$12.95 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$22.53 ,$66.30 ,$13.25 ,$22.53 ,$66.30 ,$56.94 ,$13.69 ,$13.25 ,$15.00 ,$66.30 ,$29.81 ,$71.76 ,$54.60 ,$61.08 ,$65.67 ,$47.50 ,$61.08 ,$53.90 ,$56.16 ,$54.33 ,$13.38 ,$56.16 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.36 ,$85.85 ,$13.74 ,$23.36 ,$85.85 ,$73.73 ,$14.20 ,$13.74 ,$15.55 ,$85.85 ,$30.92 ,$92.92 ,$70.70 ,$66.79 ,$71.80 ,$61.51 ,$66.79 ,$69.79 ,$72.72 ,$70.35 ,$13.88 ,$72.72 ,$15.05 ,$16.49 ,$16.49 ,$13.74 ,$16.49 ,$13.74 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$113.90 ,$97.82 ,$18.53 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$87.17 ,$93.72 ,$81.61 ,$87.17 ,$92.59 ,$96.48 ,$93.33 ,$18.11 ,$96.48 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$17.93 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$113.90 ,$97.82 ,$18.53 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$87.17 ,$93.72 ,$81.61 ,$87.17 ,$92.59 ,$96.48 ,$93.33 ,$18.11 ,$96.48 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$17.93 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$113.90 ,$97.82 ,$18.53 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$87.17 ,$93.72 ,$81.61 ,$87.17 ,$92.59 ,$96.48 ,$93.33 ,$18.11 ,$96.48 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$17.93 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.48 ,$113.90 ,$17.93 ,$30.48 ,$113.90 ,$97.82 ,$18.53 ,$17.93 ,$20.29 ,$113.90 ,$40.34 ,$123.28 ,$93.80 ,$87.17 ,$93.72 ,$81.61 ,$87.17 ,$92.59 ,$96.48 ,$93.33 ,$18.11 ,$96.48 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$17.93 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$20.49 ,$47.60 ,$12.05 ,$20.49 ,$47.60 ,$40.88 ,$12.45 ,$12.05 ,$13.64 ,$47.60 ,$27.11 ,$51.52 ,$39.20 ,$56.00 ,$56.00 ,$34.10 ,$56.00 ,$38.70 ,$40.32 ,$39.00 ,$12.17 ,$40.32 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$20.49 ,$34.85 ,$12.05 ,$20.49 ,$34.85 ,$29.93 ,$12.45 ,$12.05 ,$13.64 ,$34.85 ,$27.11 ,$37.72 ,$28.70 ,$41.00 ,$41.00 ,$24.97 ,$41.00 ,$28.33 ,$29.52 ,$28.56 ,$12.17 ,$29.52 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$20.49 ,$110.50 ,$12.05 ,$20.49 ,$110.50 ,$94.90 ,$12.45 ,$12.05 ,$13.64 ,$110.50 ,$27.11 ,$119.60 ,$91.00 ,$58.59 ,$62.99 ,$79.17 ,$58.59 ,$89.83 ,$93.60 ,$90.55 ,$12.17 ,$93.60 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$120.24 ,$121.91 ,$20.49 ,$141.95 ,$12.05 ,$20.49 ,$141.95 ,$121.91 ,$12.45 ,$12.05 ,$13.64 ,$141.95 ,$27.11 ,$153.64 ,$116.90 ,$58.59 ,$62.99 ,$101.70 ,$58.59 ,$115.40 ,$120.24 ,$116.32 ,$12.17 ,$120.24 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$120.24 ,$103.54 ,$120.24 ,$120.24 ,$100.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$20.49 ,$95.20 ,$12.05 ,$20.49 ,$95.20 ,$81.76 ,$12.45 ,$12.05 ,$13.64 ,$95.20 ,$27.11 ,$103.04 ,$78.40 ,$58.59 ,$62.99 ,$68.21 ,$58.59 ,$77.39 ,$80.64 ,$78.01 ,$12.17 ,$80.64 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$20.49 ,$133.45 ,$12.05 ,$20.49 ,$133.45 ,$114.61 ,$12.45 ,$12.05 ,$13.64 ,$133.45 ,$27.11 ,$144.44 ,$109.90 ,$58.59 ,$62.99 ,$95.61 ,$58.59 ,$108.49 ,$113.04 ,$109.35 ,$12.17 ,$113.04 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$20.49 ,$133.45 ,$12.05 ,$20.49 ,$133.45 ,$114.61 ,$12.45 ,$12.05 ,$13.64 ,$133.45 ,$27.11 ,$144.44 ,$109.90 ,$58.59 ,$62.99 ,$95.61 ,$58.59 ,$108.49 ,$113.04 ,$109.35 ,$12.17 ,$113.04 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.36 ,$85.85 ,$13.74 ,$23.36 ,$85.85 ,$73.73 ,$14.20 ,$13.74 ,$15.55 ,$85.85 ,$30.92 ,$92.92 ,$70.70 ,$66.79 ,$71.80 ,$61.51 ,$66.79 ,$69.79 ,$72.72 ,$70.35 ,$13.88 ,$72.72 ,$15.05 ,$16.49 ,$16.49 ,$13.74 ,$16.49 ,$13.74 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.49 ,$76.50 ,$12.05 ,$20.49 ,$76.50 ,$65.70 ,$12.45 ,$12.05 ,$13.64 ,$76.50 ,$27.11 ,$82.80 ,$63.00 ,$58.59 ,$62.99 ,$54.81 ,$58.59 ,$62.19 ,$64.80 ,$62.69 ,$12.17 ,$64.80 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.49 ,$76.50 ,$12.05 ,$20.49 ,$76.50 ,$65.70 ,$12.45 ,$12.05 ,$13.64 ,$76.50 ,$27.11 ,$82.80 ,$63.00 ,$58.59 ,$62.99 ,$54.81 ,$58.59 ,$62.19 ,$64.80 ,$62.69 ,$12.17 ,$64.80 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$46.80 ,$47.45 ,$20.49 ,$55.25 ,$12.05 ,$20.49 ,$55.25 ,$47.45 ,$12.45 ,$12.05 ,$13.64 ,$55.25 ,$27.11 ,$59.80 ,$45.50 ,$58.59 ,$62.99 ,$39.59 ,$58.59 ,$44.92 ,$46.80 ,$45.27 ,$12.17 ,$46.80 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,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 ,$66.24 ,$67.16 ,$20.49 ,$78.20 ,$12.05 ,$20.49 ,$78.20 ,$67.16 ,$12.45 ,$12.05 ,$13.64 ,$78.20 ,$27.11 ,$84.64 ,$64.40 ,$58.59 ,$62.99 ,$56.03 ,$58.59 ,$63.57 ,$66.24 ,$64.08 ,$12.17 ,$66.24 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$55.20 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$20.49 ,$285.60 ,$12.05 ,$20.49 ,$285.60 ,$245.28 ,$12.45 ,$12.05 ,$13.64 ,$285.60 ,$27.11 ,$309.12 ,$235.20 ,$58.59 ,$62.99 ,$204.62 ,$58.59 ,$232.18 ,$241.92 ,$234.02 ,$12.17 ,$241.92 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$20.49 ,$51.00 ,$12.05 ,$20.49 ,$51.00 ,$43.80 ,$12.45 ,$12.05 ,$13.64 ,$51.00 ,$27.11 ,$55.20 ,$42.00 ,$58.59 ,$60.00 ,$36.54 ,$58.59 ,$41.46 ,$43.20 ,$41.79 ,$12.17 ,$43.20 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$20.49 ,$87.55 ,$12.05 ,$20.49 ,$87.55 ,$75.19 ,$12.45 ,$12.05 ,$13.64 ,$87.55 ,$27.11 ,$94.76 ,$72.10 ,$58.59 ,$62.99 ,$62.73 ,$58.59 ,$71.17 ,$74.16 ,$71.74 ,$12.17 ,$74.16 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$82.08 ,$83.22 ,$41.11 ,$96.90 ,$24.18 ,$41.11 ,$96.90 ,$83.22 ,$24.99 ,$24.18 ,$27.37 ,$96.90 ,$54.41 ,$104.88 ,$79.80 ,$114.00 ,$114.00 ,$69.43 ,$114.00 ,$78.77 ,$82.08 ,$79.40 ,$24.42 ,$82.08 ,$26.49 ,$29.02 ,$29.02 ,$24.18 ,$29.02 ,$24.18 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$68.40 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$133.45 ,$114.61 ,$21.50 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$101.18 ,$108.78 ,$95.61 ,$101.18 ,$108.49 ,$113.04 ,$109.35 ,$21.02 ,$113.04 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$94.32 ,$95.63 ,$35.38 ,$111.35 ,$20.81 ,$35.38 ,$111.35 ,$95.63 ,$21.50 ,$20.81 ,$23.55 ,$111.35 ,$46.82 ,$120.52 ,$91.70 ,$101.18 ,$108.78 ,$79.78 ,$101.18 ,$90.52 ,$94.32 ,$91.24 ,$21.02 ,$94.32 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$94.32 ,$81.22 ,$94.32 ,$94.32 ,$78.60 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$133.45 ,$114.61 ,$21.50 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$101.18 ,$108.78 ,$95.61 ,$101.18 ,$108.49 ,$113.04 ,$109.35 ,$21.02 ,$113.04 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$133.45 ,$114.61 ,$21.50 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$101.18 ,$108.78 ,$95.61 ,$101.18 ,$108.49 ,$113.04 ,$109.35 ,$21.02 ,$113.04 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$35.38 ,$133.45 ,$20.81 ,$35.38 ,$133.45 ,$114.61 ,$21.50 ,$20.81 ,$23.55 ,$133.45 ,$46.82 ,$144.44 ,$109.90 ,$101.18 ,$108.78 ,$95.61 ,$101.18 ,$108.49 ,$113.04 ,$109.35 ,$21.02 ,$113.04 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$8.81 ,$66.30 ,$5.18 ,$8.81 ,$66.30 ,$56.94 ,$5.35 ,$5.18 ,$5.86 ,$66.30 ,$11.66 ,$71.76 ,$54.60 ,$25.16 ,$27.05 ,$47.50 ,$25.16 ,$53.90 ,$56.16 ,$54.33 ,$5.23 ,$56.16 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$35.38 ,$142.80 ,$20.81 ,$35.38 ,$142.80 ,$122.64 ,$21.50 ,$20.81 ,$23.55 ,$142.80 ,$46.82 ,$154.56 ,$117.60 ,$101.18 ,$108.78 ,$102.31 ,$101.18 ,$116.09 ,$120.96 ,$117.01 ,$21.02 ,$120.96 ,$22.79 ,$24.97 ,$24.97 ,$20.81 ,$24.97 ,$20.81 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.48 ,$95.20 ,$14.99 ,$25.48 ,$95.20 ,$81.76 ,$15.49 ,$14.99 ,$16.97 ,$95.20 ,$33.73 ,$103.04 ,$78.40 ,$72.88 ,$78.36 ,$68.21 ,$72.88 ,$77.39 ,$80.64 ,$78.01 ,$15.14 ,$80.64 ,$16.42 ,$17.99 ,$17.99 ,$14.99 ,$17.99 ,$14.99 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.75 ,$113.90 ,$18.09 ,$30.75 ,$113.90 ,$97.82 ,$18.21 ,$18.09 ,$20.47 ,$113.90 ,$40.70 ,$123.28 ,$93.80 ,$62.94 ,$67.67 ,$81.61 ,$62.94 ,$92.59 ,$96.48 ,$93.33 ,$18.27 ,$96.48 ,$19.30 ,$21.71 ,$21.71 ,$18.09 ,$21.71 ,$18.09 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$20.37 ,$40.80 ,$11.98 ,$20.37 ,$40.80 ,$35.04 ,$12.38 ,$11.98 ,$13.56 ,$40.80 ,$26.96 ,$44.16 ,$33.60 ,$48.00 ,$48.00 ,$29.23 ,$48.00 ,$33.17 ,$34.56 ,$33.43 ,$12.10 ,$34.56 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$20.37 ,$40.80 ,$11.98 ,$20.37 ,$40.80 ,$35.04 ,$12.38 ,$11.98 ,$13.56 ,$40.80 ,$26.96 ,$44.16 ,$33.60 ,$48.00 ,$48.00 ,$29.23 ,$48.00 ,$33.17 ,$34.56 ,$33.43 ,$12.10 ,$34.56 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$37.98 ,$142.80 ,$22.34 ,$37.98 ,$142.80 ,$122.64 ,$23.08 ,$22.34 ,$25.28 ,$142.80 ,$50.27 ,$154.56 ,$117.60 ,$108.62 ,$116.79 ,$102.31 ,$108.62 ,$116.09 ,$120.96 ,$117.01 ,$22.56 ,$120.96 ,$24.46 ,$26.81 ,$26.81 ,$22.34 ,$26.81 ,$22.34 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$37.98 ,$199.75 ,$22.34 ,$37.98 ,$199.75 ,$171.55 ,$23.08 ,$22.34 ,$25.28 ,$199.75 ,$50.27 ,$216.20 ,$164.50 ,$108.62 ,$116.79 ,$143.12 ,$108.62 ,$162.39 ,$169.20 ,$163.68 ,$22.56 ,$169.20 ,$24.46 ,$26.81 ,$26.81 ,$22.34 ,$26.81 ,$22.34 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$49.90 ,$190.40 ,$29.35 ,$49.90 ,$190.40 ,$163.52 ,$30.33 ,$29.35 ,$33.22 ,$190.40 ,$66.04 ,$206.08 ,$156.80 ,$142.69 ,$153.42 ,$136.42 ,$142.69 ,$154.78 ,$161.28 ,$156.02 ,$29.64 ,$161.28 ,$32.15 ,$35.22 ,$35.22 ,$29.35 ,$35.22 ,$29.35 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$49.90 ,$190.40 ,$29.35 ,$49.90 ,$190.40 ,$163.52 ,$30.33 ,$29.35 ,$33.22 ,$190.40 ,$66.04 ,$206.08 ,$156.80 ,$142.69 ,$153.42 ,$136.42 ,$142.69 ,$154.78 ,$161.28 ,$156.02 ,$29.64 ,$161.28 ,$32.15 ,$35.22 ,$35.22 ,$29.35 ,$35.22 ,$29.35 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$26.50 ,$104.55 ,$15.59 ,$26.50 ,$104.55 ,$89.79 ,$16.11 ,$15.59 ,$17.64 ,$104.55 ,$35.08 ,$113.16 ,$86.10 ,$75.77 ,$81.46 ,$74.91 ,$75.77 ,$84.99 ,$88.56 ,$85.67 ,$15.75 ,$88.56 ,$17.08 ,$18.71 ,$18.71 ,$15.59 ,$18.71 ,$15.59 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$126.72 ,$128.48 ,$26.50 ,$149.60 ,$15.59 ,$26.50 ,$149.60 ,$128.48 ,$16.11 ,$15.59 ,$17.64 ,$149.60 ,$35.08 ,$161.92 ,$123.20 ,$75.77 ,$81.46 ,$107.18 ,$75.77 ,$121.62 ,$126.72 ,$122.58 ,$15.75 ,$126.72 ,$17.08 ,$18.71 ,$18.71 ,$15.59 ,$18.71 ,$15.59 ,$126.72 ,$109.12 ,$126.72 ,$126.72 ,$105.60 
ST MARY'S HOSPITAL,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 ,$183.60 ,$186.15 ,$36.40 ,$216.75 ,$21.41 ,$36.40 ,$216.75 ,$186.15 ,$22.12 ,$21.41 ,$24.23 ,$216.75 ,$48.17 ,$234.60 ,$178.50 ,$104.10 ,$111.92 ,$155.30 ,$104.10 ,$176.21 ,$183.60 ,$177.61 ,$21.62 ,$183.60 ,$23.45 ,$25.69 ,$25.69 ,$21.41 ,$25.69 ,$21.41 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$36.40 ,$199.75 ,$21.41 ,$36.40 ,$199.75 ,$171.55 ,$22.12 ,$21.41 ,$24.23 ,$199.75 ,$48.17 ,$216.20 ,$164.50 ,$104.10 ,$111.92 ,$143.12 ,$104.10 ,$162.39 ,$169.20 ,$163.68 ,$21.62 ,$169.20 ,$23.45 ,$25.69 ,$25.69 ,$21.41 ,$25.69 ,$21.41 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.64 ,$95.20 ,$15.08 ,$25.64 ,$95.20 ,$81.76 ,$14.28 ,$15.08 ,$17.07 ,$95.20 ,$33.93 ,$103.04 ,$78.40 ,$49.36 ,$53.07 ,$68.21 ,$49.36 ,$77.39 ,$80.64 ,$78.01 ,$15.23 ,$80.64 ,$15.14 ,$18.10 ,$18.10 ,$15.08 ,$18.10 ,$15.08 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$40.07 ,$85.85 ,$23.57 ,$40.07 ,$85.85 ,$73.73 ,$19.88 ,$23.57 ,$26.68 ,$85.85 ,$53.03 ,$92.92 ,$70.70 ,$68.75 ,$73.91 ,$61.51 ,$68.75 ,$69.79 ,$72.72 ,$70.35 ,$23.81 ,$72.72 ,$21.07 ,$28.28 ,$28.28 ,$23.57 ,$28.28 ,$23.57 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$181.44 ,$183.96 ,$64.14 ,$214.20 ,$37.73 ,$64.14 ,$214.20 ,$183.96 ,$38.99 ,$37.73 ,$42.70 ,$214.20 ,$84.89 ,$231.84 ,$176.40 ,$183.39 ,$197.17 ,$153.47 ,$183.39 ,$174.13 ,$181.44 ,$175.52 ,$38.11 ,$181.44 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$37.73 ,$181.44 ,$156.24 ,$181.44 ,$181.44 ,$151.20 
ST MARY'S HOSPITAL,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 ,$181.44 ,$183.96 ,$64.14 ,$214.20 ,$37.73 ,$64.14 ,$214.20 ,$183.96 ,$38.99 ,$37.73 ,$42.70 ,$214.20 ,$84.89 ,$231.84 ,$176.40 ,$183.39 ,$197.17 ,$153.47 ,$183.39 ,$174.13 ,$181.44 ,$175.52 ,$38.11 ,$181.44 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$37.73 ,$181.44 ,$156.24 ,$181.44 ,$181.44 ,$151.20 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$64.14 ,$247.35 ,$37.73 ,$64.14 ,$247.35 ,$212.43 ,$38.99 ,$37.73 ,$42.70 ,$247.35 ,$84.89 ,$267.72 ,$203.70 ,$183.39 ,$197.17 ,$177.22 ,$183.39 ,$201.08 ,$209.52 ,$202.68 ,$38.11 ,$209.52 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$37.73 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$64.14 ,$247.35 ,$37.73 ,$64.14 ,$247.35 ,$212.43 ,$38.99 ,$37.73 ,$42.70 ,$247.35 ,$84.89 ,$267.72 ,$203.70 ,$183.39 ,$197.17 ,$177.22 ,$183.39 ,$201.08 ,$209.52 ,$202.68 ,$38.11 ,$209.52 ,$41.33 ,$45.28 ,$45.28 ,$37.73 ,$45.28 ,$37.73 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$79.87 ,$304.30 ,$46.98 ,$79.87 ,$304.30 ,$261.34 ,$48.54 ,$46.98 ,$53.17 ,$304.30 ,$105.71 ,$329.36 ,$250.60 ,$228.44 ,$245.61 ,$218.02 ,$228.44 ,$247.38 ,$257.76 ,$249.35 ,$47.45 ,$257.76 ,$51.45 ,$56.38 ,$56.38 ,$46.98 ,$56.38 ,$46.98 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$79.87 ,$304.30 ,$46.98 ,$79.87 ,$304.30 ,$261.34 ,$48.54 ,$46.98 ,$53.17 ,$304.30 ,$105.71 ,$329.36 ,$250.60 ,$228.44 ,$245.61 ,$218.02 ,$228.44 ,$247.38 ,$257.76 ,$249.35 ,$47.45 ,$257.76 ,$51.45 ,$56.38 ,$56.38 ,$46.98 ,$56.38 ,$46.98 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$79.87 ,$304.30 ,$46.98 ,$79.87 ,$304.30 ,$261.34 ,$48.54 ,$46.98 ,$53.17 ,$304.30 ,$105.71 ,$329.36 ,$250.60 ,$228.44 ,$245.61 ,$218.02 ,$228.44 ,$247.38 ,$257.76 ,$249.35 ,$47.45 ,$257.76 ,$51.45 ,$56.38 ,$56.38 ,$46.98 ,$56.38 ,$46.98 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$141.12 ,$143.08 ,$45.53 ,$166.60 ,$26.78 ,$45.53 ,$166.60 ,$143.08 ,$27.67 ,$26.78 ,$30.31 ,$166.60 ,$60.26 ,$180.32 ,$137.20 ,$130.19 ,$139.97 ,$119.36 ,$130.19 ,$135.44 ,$141.12 ,$136.51 ,$27.05 ,$141.12 ,$29.33 ,$32.14 ,$32.14 ,$26.78 ,$32.14 ,$26.78 ,$141.12 ,$121.52 ,$141.12 ,$141.12 ,$117.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.74 ,$95.20 ,$14.55 ,$24.74 ,$95.20 ,$81.76 ,$15.03 ,$14.55 ,$16.47 ,$95.20 ,$32.74 ,$103.04 ,$78.40 ,$70.74 ,$76.06 ,$68.21 ,$70.74 ,$77.39 ,$80.64 ,$78.01 ,$14.70 ,$80.64 ,$15.93 ,$17.46 ,$17.46 ,$14.55 ,$17.46 ,$14.55 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.74 ,$95.20 ,$14.55 ,$24.74 ,$95.20 ,$81.76 ,$15.03 ,$14.55 ,$16.47 ,$95.20 ,$32.74 ,$103.04 ,$78.40 ,$70.74 ,$76.06 ,$68.21 ,$70.74 ,$77.39 ,$80.64 ,$78.01 ,$14.70 ,$80.64 ,$15.93 ,$17.46 ,$17.46 ,$14.55 ,$17.46 ,$14.55 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.74 ,$95.20 ,$14.55 ,$24.74 ,$95.20 ,$81.76 ,$15.03 ,$14.55 ,$16.47 ,$95.20 ,$32.74 ,$103.04 ,$78.40 ,$70.74 ,$76.06 ,$68.21 ,$70.74 ,$77.39 ,$80.64 ,$78.01 ,$14.70 ,$80.64 ,$15.93 ,$17.46 ,$17.46 ,$14.55 ,$17.46 ,$14.55 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$19.62 ,$87.55 ,$11.54 ,$19.62 ,$87.55 ,$75.19 ,$11.92 ,$11.54 ,$13.06 ,$87.55 ,$25.97 ,$94.76 ,$72.10 ,$49.54 ,$53.26 ,$62.73 ,$49.54 ,$71.17 ,$74.16 ,$71.74 ,$11.66 ,$74.16 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$11.54 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$41.04 ,$41.61 ,$19.62 ,$48.45 ,$11.54 ,$19.62 ,$48.45 ,$41.61 ,$11.92 ,$11.54 ,$13.06 ,$48.45 ,$25.97 ,$52.44 ,$39.90 ,$49.54 ,$53.26 ,$34.71 ,$49.54 ,$39.39 ,$41.04 ,$39.70 ,$11.66 ,$41.04 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$11.54 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$34.20 
ST MARY'S HOSPITAL,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 ,$65.52 ,$66.43 ,$19.62 ,$77.35 ,$11.54 ,$19.62 ,$77.35 ,$66.43 ,$11.92 ,$11.54 ,$13.06 ,$77.35 ,$25.97 ,$83.72 ,$63.70 ,$49.54 ,$53.26 ,$55.42 ,$49.54 ,$62.88 ,$65.52 ,$63.38 ,$11.66 ,$65.52 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$11.54 ,$65.52 ,$56.42 ,$65.52 ,$65.52 ,$54.60 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$19.62 ,$136.00 ,$11.54 ,$19.62 ,$136.00 ,$116.80 ,$11.92 ,$11.54 ,$13.06 ,$136.00 ,$25.97 ,$147.20 ,$112.00 ,$49.54 ,$53.26 ,$97.44 ,$49.54 ,$110.56 ,$115.20 ,$111.44 ,$11.66 ,$115.20 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$11.54 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$18.09 ,$68.00 ,$10.64 ,$18.09 ,$68.00 ,$58.40 ,$9.85 ,$10.64 ,$12.04 ,$68.00 ,$23.94 ,$73.60 ,$56.00 ,$34.03 ,$36.59 ,$48.72 ,$34.03 ,$55.28 ,$57.60 ,$55.72 ,$10.75 ,$57.60 ,$10.44 ,$12.77 ,$12.77 ,$10.64 ,$12.77 ,$10.64 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,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 ,$33.84 ,$34.31 ,$10.44 ,$39.95 ,$6.14 ,$10.44 ,$39.95 ,$34.31 ,$6.34 ,$6.14 ,$6.95 ,$39.95 ,$13.82 ,$43.24 ,$32.90 ,$27.58 ,$29.66 ,$28.62 ,$27.58 ,$32.48 ,$33.84 ,$32.74 ,$6.20 ,$33.84 ,$6.72 ,$7.37 ,$7.37 ,$6.14 ,$7.37 ,$6.14 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$28.20 
ST MARY'S HOSPITAL,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 ,$31.68 ,$32.12 ,$9.64 ,$37.40 ,$5.67 ,$9.64 ,$37.40 ,$32.12 ,$5.86 ,$5.67 ,$6.42 ,$37.40 ,$12.76 ,$40.48 ,$30.80 ,$27.58 ,$29.66 ,$26.80 ,$27.58 ,$30.40 ,$31.68 ,$30.65 ,$5.73 ,$31.68 ,$6.21 ,$6.80 ,$6.80 ,$5.67 ,$6.80 ,$5.67 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$26.40 
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$105.37 ,$399.50 ,$61.98 ,$105.37 ,$399.50 ,$343.10 ,$64.04 ,$61.98 ,$70.15 ,$399.50 ,$139.46 ,$432.40 ,$329.00 ,$301.35 ,$324.00 ,$286.23 ,$301.35 ,$324.77 ,$338.40 ,$327.36 ,$62.60 ,$338.40 ,$67.88 ,$74.38 ,$74.38 ,$61.98 ,$74.38 ,$61.98 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$67.00 ,$33.50 ,$3.28 ,$67.00 ,$3.28 ,$28.20 ,$24.17 ,$24.03 ,$40.20 ,$56.95 ,$46.90 ,$3.28 ,$63.65 ,$48.24 ,$48.91 ,$16.80 ,$56.95 ,$24.03 ,$16.80 ,$56.95 ,$48.91 ,$3.28 ,$24.03 ,$28.14 ,$56.95 ,$54.06 ,$61.64 ,$46.90 ,$48.08 ,$51.69 ,$40.80 ,$48.08 ,$46.30 ,$48.24 ,$46.67 ,$24.27 ,$48.24 ,$3.48 ,$27.59 ,$27.59 ,$24.03 ,$27.59 ,$24.03 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$23.04 ,$23.36 ,$7.26 ,$27.20 ,$4.27 ,$7.26 ,$27.20 ,$23.36 ,$4.41 ,$4.27 ,$4.83 ,$27.20 ,$9.61 ,$29.44 ,$22.40 ,$20.74 ,$22.30 ,$19.49 ,$20.74 ,$22.11 ,$23.04 ,$22.29 ,$4.31 ,$23.04 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$19.20 
ST MARY'S HOSPITAL,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 ,$46.80 ,$47.45 ,$7.26 ,$55.25 ,$4.27 ,$7.26 ,$55.25 ,$47.45 ,$4.41 ,$4.27 ,$4.83 ,$55.25 ,$9.61 ,$59.80 ,$45.50 ,$20.74 ,$22.30 ,$39.59 ,$20.74 ,$44.92 ,$46.80 ,$45.27 ,$4.31 ,$46.80 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$17.31 ,$87.55 ,$10.18 ,$17.31 ,$87.55 ,$75.19 ,$8.17 ,$10.18 ,$11.52 ,$87.55 ,$22.91 ,$94.76 ,$72.10 ,$28.26 ,$30.38 ,$62.73 ,$28.26 ,$71.17 ,$74.16 ,$71.74 ,$10.28 ,$74.16 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$42.48 ,$43.07 ,$21.88 ,$50.15 ,$12.87 ,$21.88 ,$50.15 ,$43.07 ,$8.17 ,$12.87 ,$14.57 ,$50.15 ,$28.96 ,$54.28 ,$41.30 ,$28.26 ,$30.38 ,$35.93 ,$28.26 ,$40.77 ,$42.48 ,$41.09 ,$13.00 ,$42.48 ,$8.66 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$35.40 
ST MARY'S HOSPITAL,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 ,$48.96 ,$49.64 ,$25.59 ,$57.80 ,$15.05 ,$25.59 ,$57.80 ,$49.64 ,$8.17 ,$15.05 ,$17.03 ,$57.80 ,$33.86 ,$62.56 ,$47.60 ,$28.26 ,$30.38 ,$41.41 ,$28.26 ,$46.99 ,$48.96 ,$47.36 ,$15.20 ,$48.96 ,$8.66 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$40.80 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$25.59 ,$47.60 ,$15.05 ,$25.59 ,$47.60 ,$40.88 ,$8.17 ,$15.05 ,$17.03 ,$47.60 ,$33.86 ,$51.52 ,$39.20 ,$28.26 ,$30.38 ,$34.10 ,$28.26 ,$38.70 ,$40.32 ,$39.00 ,$15.20 ,$40.32 ,$8.66 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$8.64 ,$8.76 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$10.20 ,$8.76 ,$8.17 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$8.64 ,$8.36 ,$12.12 ,$8.64 ,$8.66 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$7.20 
ST MARY'S HOSPITAL,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 ,$21.60 ,$21.90 ,$25.59 ,$25.50 ,$15.05 ,$25.59 ,$25.50 ,$21.90 ,$8.17 ,$15.05 ,$17.03 ,$25.50 ,$33.86 ,$27.60 ,$21.00 ,$28.26 ,$30.00 ,$18.27 ,$28.26 ,$20.73 ,$21.60 ,$20.90 ,$15.20 ,$21.60 ,$8.66 ,$18.06 ,$18.06 ,$15.05 ,$18.06 ,$15.05 ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$18.00 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$21.90 ,$29.75 ,$12.88 ,$21.90 ,$29.75 ,$25.55 ,$8.17 ,$12.88 ,$14.58 ,$29.75 ,$28.98 ,$32.20 ,$24.50 ,$28.26 ,$30.38 ,$21.32 ,$28.26 ,$24.19 ,$25.20 ,$24.38 ,$13.01 ,$25.20 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$41.04 ,$41.61 ,$17.31 ,$48.45 ,$10.18 ,$17.31 ,$48.45 ,$41.61 ,$8.17 ,$10.18 ,$11.52 ,$48.45 ,$22.91 ,$52.44 ,$39.90 ,$28.26 ,$30.38 ,$34.71 ,$28.26 ,$39.39 ,$41.04 ,$39.70 ,$10.28 ,$41.04 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$34.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.93 ,$66.30 ,$12.90 ,$21.93 ,$66.30 ,$56.94 ,$8.17 ,$12.90 ,$14.60 ,$66.30 ,$29.03 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.03 ,$56.16 ,$8.66 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$12.90 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.93 ,$66.30 ,$12.90 ,$21.93 ,$66.30 ,$56.94 ,$8.17 ,$12.90 ,$14.60 ,$66.30 ,$29.03 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.03 ,$56.16 ,$8.66 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$12.90 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$8.64 ,$8.76 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$10.20 ,$8.76 ,$8.17 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$8.64 ,$8.36 ,$12.12 ,$8.64 ,$8.66 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$7.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.93 ,$66.30 ,$12.90 ,$21.93 ,$66.30 ,$56.94 ,$8.17 ,$12.90 ,$14.60 ,$66.30 ,$29.03 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.03 ,$56.16 ,$8.66 ,$15.48 ,$15.48 ,$12.90 ,$15.48 ,$12.90 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$26.33 ,$104.55 ,$15.49 ,$26.33 ,$104.55 ,$89.79 ,$16.01 ,$15.49 ,$17.53 ,$104.55 ,$34.85 ,$113.16 ,$86.10 ,$75.30 ,$80.96 ,$74.91 ,$75.30 ,$84.99 ,$88.56 ,$85.67 ,$15.64 ,$88.56 ,$16.97 ,$18.59 ,$18.59 ,$15.49 ,$18.59 ,$15.49 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$26.33 ,$104.55 ,$15.49 ,$26.33 ,$104.55 ,$89.79 ,$16.01 ,$15.49 ,$17.53 ,$104.55 ,$34.85 ,$113.16 ,$86.10 ,$75.30 ,$80.96 ,$74.91 ,$75.30 ,$84.99 ,$88.56 ,$85.67 ,$15.64 ,$88.56 ,$16.97 ,$18.59 ,$18.59 ,$15.49 ,$18.59 ,$15.49 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$28.95 ,$113.90 ,$17.03 ,$28.95 ,$113.90 ,$97.82 ,$17.60 ,$17.03 ,$19.27 ,$113.90 ,$38.32 ,$123.28 ,$93.80 ,$82.82 ,$89.05 ,$81.61 ,$82.82 ,$92.59 ,$96.48 ,$93.33 ,$17.20 ,$96.48 ,$18.66 ,$20.44 ,$20.44 ,$17.03 ,$20.44 ,$17.03 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.18 ,$56.95 ,$8.93 ,$15.18 ,$56.95 ,$48.91 ,$8.17 ,$8.93 ,$10.11 ,$56.95 ,$20.09 ,$61.64 ,$46.90 ,$28.26 ,$30.38 ,$40.80 ,$28.26 ,$46.30 ,$48.24 ,$46.67 ,$9.02 ,$48.24 ,$8.66 ,$10.72 ,$10.72 ,$8.93 ,$10.72 ,$8.93 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$15.18 ,$51.00 ,$8.93 ,$15.18 ,$51.00 ,$43.80 ,$8.17 ,$8.93 ,$10.11 ,$51.00 ,$20.09 ,$55.20 ,$42.00 ,$28.26 ,$30.38 ,$36.54 ,$28.26 ,$41.46 ,$43.20 ,$41.79 ,$9.02 ,$43.20 ,$8.66 ,$10.72 ,$10.72 ,$8.93 ,$10.72 ,$8.93 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 ,$20.42 ,$52.70 ,$12.01 ,$20.42 ,$52.70 ,$45.26 ,$8.17 ,$12.01 ,$13.59 ,$52.70 ,$27.02 ,$57.04 ,$43.40 ,$28.26 ,$30.38 ,$37.76 ,$28.26 ,$42.84 ,$44.64 ,$43.18 ,$12.13 ,$44.64 ,$8.66 ,$14.41 ,$14.41 ,$12.01 ,$14.41 ,$12.01 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$20.09 ,$51.00 ,$11.82 ,$20.09 ,$51.00 ,$43.80 ,$8.17 ,$11.82 ,$13.38 ,$51.00 ,$26.60 ,$55.20 ,$42.00 ,$28.26 ,$30.38 ,$36.54 ,$28.26 ,$41.46 ,$43.20 ,$41.79 ,$11.94 ,$43.20 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$11.82 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$20.09 ,$40.80 ,$11.82 ,$20.09 ,$40.80 ,$35.04 ,$8.17 ,$11.82 ,$13.38 ,$40.80 ,$26.60 ,$44.16 ,$33.60 ,$28.26 ,$30.38 ,$29.23 ,$28.26 ,$33.17 ,$34.56 ,$33.43 ,$11.94 ,$34.56 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$11.82 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$20.09 ,$124.10 ,$11.82 ,$20.09 ,$124.10 ,$106.58 ,$8.17 ,$11.82 ,$13.38 ,$124.10 ,$26.60 ,$134.32 ,$102.20 ,$28.26 ,$30.38 ,$88.91 ,$28.26 ,$100.89 ,$105.12 ,$101.69 ,$11.94 ,$105.12 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$11.82 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$17.00 ,$14.45 ,$11.82 ,$17.00 ,$14.45 ,$12.41 ,$8.17 ,$11.82 ,$13.38 ,$14.45 ,$26.60 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$12.24 ,$11.84 ,$11.94 ,$12.24 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$11.82 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$20.09 ,$47.60 ,$11.82 ,$20.09 ,$47.60 ,$40.88 ,$8.17 ,$11.82 ,$13.38 ,$47.60 ,$26.60 ,$51.52 ,$39.20 ,$28.26 ,$30.38 ,$34.10 ,$28.26 ,$38.70 ,$40.32 ,$39.00 ,$11.94 ,$40.32 ,$8.66 ,$14.18 ,$14.18 ,$11.82 ,$14.18 ,$11.82 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$43.20 ,$43.80 ,$21.56 ,$51.00 ,$12.68 ,$21.56 ,$51.00 ,$43.80 ,$8.17 ,$12.68 ,$14.35 ,$51.00 ,$28.53 ,$55.20 ,$42.00 ,$28.26 ,$30.38 ,$36.54 ,$28.26 ,$41.46 ,$43.20 ,$41.79 ,$12.81 ,$43.20 ,$8.66 ,$15.22 ,$15.22 ,$12.68 ,$15.22 ,$12.68 ,$43.20 ,$37.20 ,$43.20 ,$43.20 ,$36.00 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$17.00 ,$14.45 ,$12.68 ,$17.00 ,$14.45 ,$12.41 ,$8.17 ,$12.68 ,$14.35 ,$14.45 ,$28.53 ,$15.64 ,$11.90 ,$17.00 ,$17.00 ,$10.35 ,$17.00 ,$11.75 ,$12.24 ,$11.84 ,$12.81 ,$12.24 ,$8.66 ,$15.22 ,$15.22 ,$12.68 ,$15.22 ,$12.68 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$39.60 ,$40.15 ,$21.56 ,$46.75 ,$12.68 ,$21.56 ,$46.75 ,$40.15 ,$8.17 ,$12.68 ,$14.35 ,$46.75 ,$28.53 ,$50.60 ,$38.50 ,$28.26 ,$30.38 ,$33.50 ,$28.26 ,$38.01 ,$39.60 ,$38.31 ,$12.81 ,$39.60 ,$8.66 ,$15.22 ,$15.22 ,$12.68 ,$15.22 ,$12.68 ,$39.60 ,$34.10 ,$39.60 ,$39.60 ,$33.00 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$19.50 ,$47.60 ,$11.47 ,$19.50 ,$47.60 ,$40.88 ,$8.17 ,$11.47 ,$12.98 ,$47.60 ,$25.81 ,$51.52 ,$39.20 ,$28.26 ,$30.38 ,$34.10 ,$28.26 ,$38.70 ,$40.32 ,$39.00 ,$11.58 ,$40.32 ,$8.66 ,$13.76 ,$13.76 ,$11.47 ,$13.76 ,$11.47 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$19.50 ,$66.30 ,$11.47 ,$19.50 ,$66.30 ,$56.94 ,$8.17 ,$11.47 ,$12.98 ,$66.30 ,$25.81 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$11.58 ,$56.16 ,$8.66 ,$13.76 ,$13.76 ,$11.47 ,$13.76 ,$11.47 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$51.84 ,$52.56 ,$20.60 ,$61.20 ,$12.12 ,$20.60 ,$61.20 ,$52.56 ,$8.17 ,$12.12 ,$13.72 ,$61.20 ,$27.27 ,$66.24 ,$50.40 ,$28.26 ,$30.38 ,$43.85 ,$28.26 ,$49.75 ,$51.84 ,$50.15 ,$12.24 ,$51.84 ,$8.66 ,$14.54 ,$14.54 ,$12.12 ,$14.54 ,$12.12 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$43.20 
ST MARY'S HOSPITAL,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 ,$51.84 ,$52.56 ,$20.60 ,$61.20 ,$12.12 ,$20.60 ,$61.20 ,$52.56 ,$8.17 ,$12.12 ,$13.72 ,$61.20 ,$27.27 ,$66.24 ,$50.40 ,$28.26 ,$30.38 ,$43.85 ,$28.26 ,$49.75 ,$51.84 ,$50.15 ,$12.24 ,$51.84 ,$8.66 ,$14.54 ,$14.54 ,$12.12 ,$14.54 ,$12.12 ,$51.84 ,$44.64 ,$51.84 ,$51.84 ,$43.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$28.65 ,$85.85 ,$16.85 ,$28.65 ,$85.85 ,$73.73 ,$8.17 ,$16.85 ,$19.07 ,$85.85 ,$37.91 ,$92.92 ,$70.70 ,$28.26 ,$30.38 ,$61.51 ,$28.26 ,$69.79 ,$72.72 ,$70.35 ,$17.02 ,$72.72 ,$8.66 ,$20.22 ,$20.22 ,$16.85 ,$20.22 ,$16.85 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$22.42 ,$47.60 ,$13.19 ,$22.42 ,$47.60 ,$40.88 ,$8.17 ,$13.19 ,$14.93 ,$47.60 ,$29.68 ,$51.52 ,$39.20 ,$28.26 ,$30.38 ,$34.10 ,$28.26 ,$38.70 ,$40.32 ,$39.00 ,$13.32 ,$40.32 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$48.96 ,$49.64 ,$22.42 ,$57.80 ,$13.19 ,$22.42 ,$57.80 ,$49.64 ,$8.17 ,$13.19 ,$14.93 ,$57.80 ,$29.68 ,$62.56 ,$47.60 ,$28.26 ,$30.38 ,$41.41 ,$28.26 ,$46.99 ,$48.96 ,$47.36 ,$13.32 ,$48.96 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$40.80 
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 ,$22.42 ,$58.65 ,$13.19 ,$22.42 ,$58.65 ,$50.37 ,$8.17 ,$13.19 ,$14.93 ,$58.65 ,$29.68 ,$63.48 ,$48.30 ,$28.26 ,$30.38 ,$42.02 ,$28.26 ,$47.68 ,$49.68 ,$48.06 ,$13.32 ,$49.68 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,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 ,$48.96 ,$49.64 ,$22.42 ,$57.80 ,$13.19 ,$22.42 ,$57.80 ,$49.64 ,$8.17 ,$13.19 ,$14.93 ,$57.80 ,$29.68 ,$62.56 ,$47.60 ,$28.26 ,$30.38 ,$41.41 ,$28.26 ,$46.99 ,$48.96 ,$47.36 ,$13.32 ,$48.96 ,$8.66 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$40.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$22.15 ,$56.95 ,$13.03 ,$22.15 ,$56.95 ,$48.91 ,$8.17 ,$13.03 ,$14.75 ,$56.95 ,$29.32 ,$61.64 ,$46.90 ,$28.26 ,$30.38 ,$40.80 ,$28.26 ,$46.30 ,$48.24 ,$46.67 ,$13.16 ,$48.24 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$13.03 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$22.15 ,$124.10 ,$13.03 ,$22.15 ,$124.10 ,$106.58 ,$8.17 ,$13.03 ,$14.75 ,$124.10 ,$29.32 ,$134.32 ,$102.20 ,$28.26 ,$30.38 ,$88.91 ,$28.26 ,$100.89 ,$105.12 ,$101.69 ,$13.16 ,$105.12 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$13.03 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$33.84 ,$34.31 ,$22.15 ,$39.95 ,$13.03 ,$22.15 ,$39.95 ,$34.31 ,$8.17 ,$13.03 ,$14.75 ,$39.95 ,$29.32 ,$43.24 ,$32.90 ,$28.26 ,$30.38 ,$28.62 ,$28.26 ,$32.48 ,$33.84 ,$32.74 ,$13.16 ,$33.84 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$13.03 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$28.20 
ST MARY'S HOSPITAL,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 ,$33.84 ,$34.31 ,$22.15 ,$39.95 ,$13.03 ,$22.15 ,$39.95 ,$34.31 ,$8.17 ,$13.03 ,$14.75 ,$39.95 ,$29.32 ,$43.24 ,$32.90 ,$28.26 ,$30.38 ,$28.62 ,$28.26 ,$32.48 ,$33.84 ,$32.74 ,$13.16 ,$33.84 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$13.03 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$28.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.30 ,$85.85 ,$13.12 ,$22.30 ,$85.85 ,$73.73 ,$13.56 ,$13.12 ,$14.85 ,$85.85 ,$29.52 ,$92.92 ,$70.70 ,$63.79 ,$68.59 ,$61.51 ,$63.79 ,$69.79 ,$72.72 ,$70.35 ,$13.25 ,$72.72 ,$14.37 ,$15.74 ,$15.74 ,$13.12 ,$15.74 ,$13.12 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.99 ,$95.20 ,$15.29 ,$25.99 ,$95.20 ,$81.76 ,$15.80 ,$15.29 ,$17.31 ,$95.20 ,$34.40 ,$103.04 ,$78.40 ,$74.38 ,$79.97 ,$68.21 ,$74.38 ,$77.39 ,$80.64 ,$78.01 ,$15.44 ,$80.64 ,$16.75 ,$18.35 ,$18.35 ,$15.29 ,$18.35 ,$15.29 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$30.84 ,$113.90 ,$18.14 ,$30.84 ,$113.90 ,$97.82 ,$18.74 ,$18.14 ,$20.53 ,$113.90 ,$40.82 ,$123.28 ,$93.80 ,$88.20 ,$94.83 ,$81.61 ,$88.20 ,$92.59 ,$96.48 ,$93.33 ,$18.32 ,$96.48 ,$19.86 ,$21.77 ,$21.77 ,$18.14 ,$21.77 ,$18.14 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$28.08 ,$28.47 ,$17.31 ,$33.15 ,$10.18 ,$17.31 ,$33.15 ,$28.47 ,$8.17 ,$10.18 ,$11.52 ,$33.15 ,$22.91 ,$35.88 ,$27.30 ,$28.26 ,$30.38 ,$23.75 ,$28.26 ,$26.95 ,$28.08 ,$27.16 ,$10.28 ,$28.08 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$28.08 ,$24.18 ,$28.08 ,$28.08 ,$23.40 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$17.31 ,$42.50 ,$10.18 ,$17.31 ,$42.50 ,$36.50 ,$8.17 ,$10.18 ,$11.52 ,$42.50 ,$22.91 ,$46.00 ,$35.00 ,$28.26 ,$30.38 ,$30.45 ,$28.26 ,$34.55 ,$36.00 ,$34.83 ,$10.28 ,$36.00 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$24.07 ,$56.95 ,$14.16 ,$24.07 ,$56.95 ,$48.91 ,$14.63 ,$14.16 ,$16.03 ,$56.95 ,$31.86 ,$61.64 ,$46.90 ,$50.57 ,$54.37 ,$40.80 ,$50.57 ,$46.30 ,$48.24 ,$46.67 ,$14.30 ,$48.24 ,$15.51 ,$16.99 ,$16.99 ,$14.16 ,$16.99 ,$14.16 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$20.83 ,$44.20 ,$12.25 ,$20.83 ,$44.20 ,$37.96 ,$7.15 ,$12.25 ,$13.86 ,$44.20 ,$27.56 ,$47.84 ,$36.40 ,$24.73 ,$26.59 ,$31.67 ,$24.73 ,$35.93 ,$37.44 ,$36.22 ,$12.37 ,$37.44 ,$7.58 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$12.25 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$28.65 ,$76.50 ,$16.85 ,$28.65 ,$76.50 ,$65.70 ,$8.17 ,$16.85 ,$19.07 ,$76.50 ,$37.91 ,$82.80 ,$63.00 ,$28.26 ,$30.38 ,$54.81 ,$28.26 ,$62.19 ,$64.80 ,$62.69 ,$17.02 ,$64.80 ,$8.66 ,$20.22 ,$20.22 ,$16.85 ,$20.22 ,$16.85 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$26.93 ,$133.45 ,$15.84 ,$26.93 ,$133.45 ,$114.61 ,$16.37 ,$15.84 ,$17.93 ,$133.45 ,$35.64 ,$144.44 ,$109.90 ,$77.01 ,$82.80 ,$95.61 ,$77.01 ,$108.49 ,$113.04 ,$109.35 ,$16.00 ,$113.04 ,$17.35 ,$19.01 ,$19.01 ,$15.84 ,$19.01 ,$15.84 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$254.16 ,$257.69 ,$32.90 ,$300.05 ,$19.35 ,$32.90 ,$300.05 ,$257.69 ,$19.99 ,$19.35 ,$21.90 ,$300.05 ,$43.54 ,$324.76 ,$247.10 ,$94.08 ,$101.15 ,$214.98 ,$94.08 ,$243.92 ,$254.16 ,$245.86 ,$19.54 ,$254.16 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$254.16 ,$218.86 ,$254.16 ,$254.16 ,$211.80 
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 ,$32.90 ,$58.65 ,$19.35 ,$32.90 ,$58.65 ,$50.37 ,$19.99 ,$19.35 ,$21.90 ,$58.65 ,$43.54 ,$63.48 ,$48.30 ,$69.00 ,$69.00 ,$42.02 ,$69.00 ,$47.68 ,$49.68 ,$48.06 ,$19.54 ,$49.68 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,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 ,$92.16 ,$93.44 ,$32.90 ,$108.80 ,$19.35 ,$32.90 ,$108.80 ,$93.44 ,$19.99 ,$19.35 ,$21.90 ,$108.80 ,$43.54 ,$117.76 ,$89.60 ,$94.08 ,$101.15 ,$77.95 ,$94.08 ,$88.45 ,$92.16 ,$89.15 ,$19.54 ,$92.16 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$76.80 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$32.90 ,$119.85 ,$19.35 ,$32.90 ,$119.85 ,$102.93 ,$19.99 ,$19.35 ,$21.90 ,$119.85 ,$43.54 ,$129.72 ,$98.70 ,$94.08 ,$101.15 ,$85.87 ,$94.08 ,$97.43 ,$101.52 ,$98.21 ,$19.54 ,$101.52 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$32.90 ,$119.85 ,$19.35 ,$32.90 ,$119.85 ,$102.93 ,$19.99 ,$19.35 ,$21.90 ,$119.85 ,$43.54 ,$129.72 ,$98.70 ,$94.08 ,$101.15 ,$85.87 ,$94.08 ,$97.43 ,$101.52 ,$98.21 ,$19.54 ,$101.52 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$95.04 ,$96.36 ,$29.17 ,$112.20 ,$17.16 ,$29.17 ,$112.20 ,$96.36 ,$17.73 ,$17.16 ,$19.42 ,$112.20 ,$38.61 ,$121.44 ,$92.40 ,$83.43 ,$89.70 ,$80.39 ,$83.43 ,$91.21 ,$95.04 ,$91.94 ,$17.33 ,$95.04 ,$18.79 ,$20.59 ,$20.59 ,$17.16 ,$20.59 ,$17.16 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$79.20 
ST MARY'S HOSPITAL,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 ,$79.92 ,$81.03 ,$24.46 ,$94.35 ,$14.39 ,$24.46 ,$94.35 ,$81.03 ,$14.87 ,$14.39 ,$16.29 ,$94.35 ,$32.38 ,$102.12 ,$77.70 ,$69.99 ,$75.25 ,$67.60 ,$69.99 ,$76.70 ,$79.92 ,$77.31 ,$14.53 ,$79.92 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$66.60 
ST MARY'S HOSPITAL,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 ,$79.92 ,$81.03 ,$24.46 ,$94.35 ,$14.39 ,$24.46 ,$94.35 ,$81.03 ,$14.87 ,$14.39 ,$16.29 ,$94.35 ,$32.38 ,$102.12 ,$77.70 ,$69.99 ,$75.25 ,$67.60 ,$69.99 ,$76.70 ,$79.92 ,$77.31 ,$14.53 ,$79.92 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$66.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$85.85 ,$73.73 ,$13.63 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$64.15 ,$68.97 ,$61.51 ,$64.15 ,$69.79 ,$72.72 ,$70.35 ,$13.32 ,$72.72 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$69.12 ,$70.08 ,$22.42 ,$81.60 ,$13.19 ,$22.42 ,$81.60 ,$70.08 ,$13.63 ,$13.19 ,$14.93 ,$81.60 ,$29.68 ,$88.32 ,$67.20 ,$64.15 ,$68.97 ,$58.46 ,$64.15 ,$66.34 ,$69.12 ,$66.86 ,$13.32 ,$69.12 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$69.12 ,$59.52 ,$69.12 ,$69.12 ,$57.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$124.10 ,$106.58 ,$19.99 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$94.08 ,$101.15 ,$88.91 ,$94.08 ,$100.89 ,$105.12 ,$101.69 ,$19.54 ,$105.12 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$124.10 ,$106.58 ,$19.99 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$94.08 ,$101.15 ,$88.91 ,$94.08 ,$100.89 ,$105.12 ,$101.69 ,$19.54 ,$105.12 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$23.44 ,$66.30 ,$13.79 ,$23.44 ,$66.30 ,$56.94 ,$14.25 ,$13.79 ,$15.61 ,$66.30 ,$31.03 ,$71.76 ,$54.60 ,$54.56 ,$58.66 ,$47.50 ,$54.56 ,$53.90 ,$56.16 ,$54.33 ,$13.93 ,$56.16 ,$15.11 ,$16.55 ,$16.55 ,$13.79 ,$16.55 ,$13.79 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$23.44 ,$66.30 ,$13.79 ,$23.44 ,$66.30 ,$56.94 ,$14.25 ,$13.79 ,$15.61 ,$66.30 ,$31.03 ,$71.76 ,$54.60 ,$54.56 ,$58.66 ,$47.50 ,$54.56 ,$53.90 ,$56.16 ,$54.33 ,$13.93 ,$56.16 ,$15.11 ,$16.55 ,$16.55 ,$13.79 ,$16.55 ,$13.79 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$23.44 ,$142.80 ,$13.79 ,$23.44 ,$142.80 ,$122.64 ,$14.25 ,$13.79 ,$15.61 ,$142.80 ,$31.03 ,$154.56 ,$117.60 ,$54.56 ,$58.66 ,$102.31 ,$54.56 ,$116.09 ,$120.96 ,$117.01 ,$13.93 ,$120.96 ,$15.11 ,$16.55 ,$16.55 ,$13.79 ,$16.55 ,$13.79 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$8.64 ,$8.76 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$10.20 ,$8.76 ,$12.00 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$8.64 ,$8.36 ,$12.12 ,$8.64 ,$12.72 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$7.20 
ST MARY'S HOSPITAL,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 ,$8.64 ,$8.76 ,$12.00 ,$10.20 ,$12.00 ,$12.00 ,$10.20 ,$8.76 ,$12.00 ,$12.00 ,$12.00 ,$10.20 ,$27.00 ,$11.04 ,$8.40 ,$12.00 ,$12.00 ,$7.31 ,$12.00 ,$8.29 ,$8.64 ,$8.36 ,$12.12 ,$8.64 ,$12.72 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$12.00 ,$8.64 ,$7.44 ,$8.64 ,$8.64 ,$7.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$23.31 ,$85.85 ,$13.71 ,$23.31 ,$85.85 ,$73.73 ,$14.17 ,$13.71 ,$15.52 ,$85.85 ,$30.85 ,$92.92 ,$70.70 ,$66.64 ,$71.65 ,$61.51 ,$66.64 ,$69.79 ,$72.72 ,$70.35 ,$13.85 ,$72.72 ,$15.02 ,$16.45 ,$16.45 ,$13.71 ,$16.45 ,$13.71 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$20.49 ,$76.50 ,$12.05 ,$20.49 ,$76.50 ,$65.70 ,$12.45 ,$12.05 ,$13.64 ,$76.50 ,$27.11 ,$82.80 ,$63.00 ,$58.59 ,$62.99 ,$54.81 ,$58.59 ,$62.19 ,$64.80 ,$62.69 ,$12.17 ,$64.80 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$20.49 ,$91.80 ,$12.05 ,$20.49 ,$91.80 ,$78.84 ,$12.45 ,$12.05 ,$13.64 ,$91.80 ,$27.11 ,$99.36 ,$75.60 ,$58.59 ,$62.99 ,$65.77 ,$58.59 ,$74.63 ,$77.76 ,$75.22 ,$12.17 ,$77.76 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$18.26 ,$66.30 ,$10.74 ,$18.26 ,$66.30 ,$56.94 ,$11.10 ,$10.74 ,$12.16 ,$66.30 ,$24.17 ,$71.76 ,$54.60 ,$52.21 ,$56.13 ,$47.50 ,$52.21 ,$53.90 ,$56.16 ,$54.33 ,$10.85 ,$56.16 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$10.74 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$42.48 ,$43.07 ,$18.26 ,$50.15 ,$10.74 ,$18.26 ,$50.15 ,$43.07 ,$11.10 ,$10.74 ,$12.16 ,$50.15 ,$24.17 ,$54.28 ,$41.30 ,$52.21 ,$56.13 ,$35.93 ,$52.21 ,$40.77 ,$42.48 ,$41.09 ,$10.85 ,$42.48 ,$11.77 ,$12.89 ,$12.89 ,$10.74 ,$12.89 ,$10.74 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$35.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$19.67 ,$56.95 ,$11.57 ,$19.67 ,$56.95 ,$48.91 ,$11.96 ,$11.57 ,$13.09 ,$56.95 ,$26.03 ,$61.64 ,$46.90 ,$56.24 ,$60.46 ,$40.80 ,$56.24 ,$46.30 ,$48.24 ,$46.67 ,$11.69 ,$48.24 ,$12.68 ,$13.88 ,$13.88 ,$11.57 ,$13.88 ,$11.57 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.06 ,$66.30 ,$12.39 ,$21.06 ,$66.30 ,$56.94 ,$12.80 ,$12.39 ,$14.02 ,$66.30 ,$27.88 ,$71.76 ,$54.60 ,$60.23 ,$64.75 ,$47.50 ,$60.23 ,$53.90 ,$56.16 ,$54.33 ,$12.51 ,$56.16 ,$13.57 ,$14.87 ,$14.87 ,$12.39 ,$14.87 ,$12.39 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$19.14 ,$133.45 ,$11.26 ,$19.14 ,$133.45 ,$114.61 ,$11.63 ,$11.26 ,$12.74 ,$133.45 ,$25.34 ,$144.44 ,$109.90 ,$54.74 ,$58.85 ,$95.61 ,$54.74 ,$108.49 ,$113.04 ,$109.35 ,$11.37 ,$113.04 ,$12.33 ,$13.51 ,$13.51 ,$11.26 ,$13.51 ,$11.26 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$26.01 ,$85.85 ,$15.30 ,$26.01 ,$85.85 ,$73.73 ,$15.81 ,$15.30 ,$17.32 ,$85.85 ,$34.43 ,$92.92 ,$70.70 ,$74.41 ,$80.00 ,$61.51 ,$74.41 ,$69.79 ,$72.72 ,$70.35 ,$15.45 ,$72.72 ,$16.76 ,$18.36 ,$18.36 ,$15.30 ,$18.36 ,$15.30 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$26.01 ,$85.85 ,$15.30 ,$26.01 ,$85.85 ,$73.73 ,$15.81 ,$15.30 ,$17.32 ,$85.85 ,$34.43 ,$92.92 ,$70.70 ,$74.41 ,$80.00 ,$61.51 ,$74.41 ,$69.79 ,$72.72 ,$70.35 ,$15.45 ,$72.72 ,$16.76 ,$18.36 ,$18.36 ,$15.30 ,$18.36 ,$15.30 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$27.54 ,$84.15 ,$16.20 ,$27.54 ,$84.15 ,$72.27 ,$8.17 ,$16.20 ,$18.34 ,$84.15 ,$36.45 ,$91.08 ,$69.30 ,$28.26 ,$30.38 ,$60.29 ,$28.26 ,$68.41 ,$71.28 ,$68.95 ,$16.36 ,$71.28 ,$8.66 ,$19.44 ,$19.44 ,$16.20 ,$19.44 ,$16.20 ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$22.19 ,$104.55 ,$13.05 ,$22.19 ,$104.55 ,$89.79 ,$13.48 ,$13.05 ,$14.77 ,$104.55 ,$29.36 ,$113.16 ,$86.10 ,$63.44 ,$68.20 ,$74.91 ,$63.44 ,$84.99 ,$88.56 ,$85.67 ,$13.18 ,$88.56 ,$14.29 ,$15.66 ,$15.66 ,$13.05 ,$15.66 ,$13.05 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$22.19 ,$38.25 ,$13.05 ,$22.19 ,$38.25 ,$32.85 ,$13.48 ,$13.05 ,$14.77 ,$38.25 ,$29.36 ,$41.40 ,$31.50 ,$45.00 ,$45.00 ,$27.41 ,$45.00 ,$31.10 ,$32.40 ,$31.34 ,$13.18 ,$32.40 ,$14.29 ,$15.66 ,$15.66 ,$13.05 ,$15.66 ,$13.05 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$22.51 ,$66.30 ,$13.24 ,$22.51 ,$66.30 ,$56.94 ,$13.68 ,$13.24 ,$14.99 ,$66.30 ,$29.79 ,$71.76 ,$54.60 ,$64.40 ,$69.24 ,$47.50 ,$64.40 ,$53.90 ,$56.16 ,$54.33 ,$13.37 ,$56.16 ,$14.50 ,$15.89 ,$15.89 ,$13.24 ,$15.89 ,$13.24 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$27.18 ,$34.85 ,$15.99 ,$27.18 ,$34.85 ,$29.93 ,$8.17 ,$15.99 ,$18.10 ,$34.85 ,$35.98 ,$37.72 ,$28.70 ,$28.26 ,$30.38 ,$24.97 ,$28.26 ,$28.33 ,$29.52 ,$28.56 ,$16.15 ,$29.52 ,$8.66 ,$19.19 ,$19.19 ,$15.99 ,$19.19 ,$15.99 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$25.55 ,$76.50 ,$15.03 ,$25.55 ,$76.50 ,$65.70 ,$15.53 ,$15.03 ,$17.01 ,$76.50 ,$33.82 ,$82.80 ,$63.00 ,$73.09 ,$78.59 ,$54.81 ,$73.09 ,$62.19 ,$64.80 ,$62.69 ,$15.18 ,$64.80 ,$16.46 ,$18.04 ,$18.04 ,$15.03 ,$18.04 ,$15.03 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$21.06 ,$40.80 ,$12.39 ,$21.06 ,$40.80 ,$35.04 ,$8.17 ,$12.39 ,$14.02 ,$40.80 ,$27.88 ,$44.16 ,$33.60 ,$28.26 ,$30.38 ,$29.23 ,$28.26 ,$33.17 ,$34.56 ,$33.43 ,$12.51 ,$34.56 ,$8.66 ,$14.87 ,$14.87 ,$12.39 ,$14.87 ,$12.39 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$95.20 ,$81.76 ,$14.87 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.99 ,$75.25 ,$68.21 ,$69.99 ,$77.39 ,$80.64 ,$78.01 ,$14.53 ,$80.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$95.20 ,$81.76 ,$14.87 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.99 ,$75.25 ,$68.21 ,$69.99 ,$77.39 ,$80.64 ,$78.01 ,$14.53 ,$80.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$24.46 ,$98.60 ,$14.39 ,$24.46 ,$98.60 ,$84.68 ,$14.87 ,$14.39 ,$16.29 ,$98.60 ,$32.38 ,$106.72 ,$81.20 ,$69.99 ,$75.25 ,$70.64 ,$69.99 ,$80.16 ,$83.52 ,$80.79 ,$14.53 ,$83.52 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.90 ,$85.85 ,$12.88 ,$21.90 ,$85.85 ,$73.73 ,$13.31 ,$12.88 ,$14.58 ,$85.85 ,$28.98 ,$92.92 ,$70.70 ,$62.65 ,$67.36 ,$61.51 ,$62.65 ,$69.79 ,$72.72 ,$70.35 ,$13.01 ,$72.72 ,$14.11 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$21.90 ,$85.85 ,$12.88 ,$21.90 ,$85.85 ,$73.73 ,$13.31 ,$12.88 ,$14.58 ,$85.85 ,$28.98 ,$92.92 ,$70.70 ,$62.65 ,$67.36 ,$61.51 ,$62.65 ,$69.79 ,$72.72 ,$70.35 ,$13.01 ,$72.72 ,$14.11 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$102.24 ,$103.66 ,$21.90 ,$120.70 ,$12.88 ,$21.90 ,$120.70 ,$103.66 ,$13.31 ,$12.88 ,$14.58 ,$120.70 ,$28.98 ,$130.64 ,$99.40 ,$62.65 ,$67.36 ,$86.48 ,$62.65 ,$98.12 ,$102.24 ,$98.90 ,$13.01 ,$102.24 ,$14.11 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$102.24 ,$88.04 ,$102.24 ,$102.24 ,$85.20 
ST MARY'S HOSPITAL,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 ,$54.00 ,$54.75 ,$22.42 ,$63.75 ,$13.19 ,$22.42 ,$63.75 ,$54.75 ,$11.50 ,$13.19 ,$14.93 ,$63.75 ,$29.68 ,$69.00 ,$52.50 ,$39.77 ,$42.76 ,$45.68 ,$39.77 ,$51.83 ,$54.00 ,$52.24 ,$13.32 ,$54.00 ,$12.19 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$25.16 ,$95.20 ,$14.80 ,$25.16 ,$95.20 ,$81.76 ,$15.29 ,$14.80 ,$16.75 ,$95.20 ,$33.30 ,$103.04 ,$78.40 ,$71.95 ,$77.36 ,$68.21 ,$71.95 ,$77.39 ,$80.64 ,$78.01 ,$14.95 ,$80.64 ,$16.21 ,$17.76 ,$17.76 ,$14.80 ,$17.76 ,$14.80 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$95.20 ,$81.76 ,$14.87 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.99 ,$75.25 ,$68.21 ,$69.99 ,$77.39 ,$80.64 ,$78.01 ,$14.53 ,$80.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$24.50 ,$85.85 ,$14.41 ,$24.50 ,$85.85 ,$73.73 ,$14.89 ,$14.41 ,$16.31 ,$85.85 ,$32.42 ,$92.92 ,$70.70 ,$62.12 ,$66.78 ,$61.51 ,$62.12 ,$69.79 ,$72.72 ,$70.35 ,$14.55 ,$72.72 ,$15.78 ,$17.29 ,$17.29 ,$14.41 ,$17.29 ,$14.41 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$30.96 ,$31.39 ,$22.51 ,$36.55 ,$13.24 ,$22.51 ,$36.55 ,$31.39 ,$11.13 ,$13.24 ,$14.99 ,$36.55 ,$29.79 ,$39.56 ,$30.10 ,$38.49 ,$41.38 ,$26.19 ,$38.49 ,$29.71 ,$30.96 ,$29.95 ,$13.37 ,$30.96 ,$11.80 ,$15.89 ,$15.89 ,$13.24 ,$15.89 ,$13.24 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$66.30 ,$56.94 ,$8.17 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.01 ,$56.16 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$21.90 ,$47.60 ,$12.88 ,$21.90 ,$47.60 ,$40.88 ,$8.17 ,$12.88 ,$14.58 ,$47.60 ,$28.98 ,$51.52 ,$39.20 ,$28.26 ,$30.38 ,$34.10 ,$28.26 ,$38.70 ,$40.32 ,$39.00 ,$13.01 ,$40.32 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$21.90 ,$38.25 ,$12.88 ,$21.90 ,$38.25 ,$32.85 ,$8.17 ,$12.88 ,$14.58 ,$38.25 ,$28.98 ,$41.40 ,$31.50 ,$28.26 ,$30.38 ,$27.41 ,$28.26 ,$31.10 ,$32.40 ,$31.34 ,$13.01 ,$32.40 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$21.90 ,$42.50 ,$12.88 ,$21.90 ,$42.50 ,$36.50 ,$8.17 ,$12.88 ,$14.58 ,$42.50 ,$28.98 ,$46.00 ,$35.00 ,$28.26 ,$30.38 ,$30.45 ,$28.26 ,$34.55 ,$36.00 ,$34.83 ,$13.01 ,$36.00 ,$8.66 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$28.65 ,$66.30 ,$16.85 ,$28.65 ,$66.30 ,$56.94 ,$8.17 ,$16.85 ,$19.07 ,$66.30 ,$37.91 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$17.02 ,$56.16 ,$8.66 ,$20.22 ,$20.22 ,$16.85 ,$20.22 ,$16.85 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$24.46 ,$76.50 ,$14.39 ,$24.46 ,$76.50 ,$65.70 ,$14.87 ,$14.39 ,$16.29 ,$76.50 ,$32.38 ,$82.80 ,$63.00 ,$69.99 ,$75.25 ,$54.81 ,$69.99 ,$62.19 ,$64.80 ,$62.69 ,$14.53 ,$64.80 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$66.30 ,$56.94 ,$3.28 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.01 ,$56.16 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$66.30 ,$56.94 ,$3.28 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.01 ,$56.16 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$21.90 ,$66.30 ,$12.88 ,$21.90 ,$66.30 ,$56.94 ,$3.28 ,$12.88 ,$14.58 ,$66.30 ,$28.98 ,$71.76 ,$54.60 ,$28.26 ,$30.38 ,$47.50 ,$28.26 ,$53.90 ,$56.16 ,$54.33 ,$13.01 ,$56.16 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$21.90 ,$110.50 ,$12.88 ,$21.90 ,$110.50 ,$94.90 ,$3.28 ,$12.88 ,$14.58 ,$110.50 ,$28.98 ,$119.60 ,$91.00 ,$28.26 ,$30.38 ,$79.17 ,$28.26 ,$89.83 ,$93.60 ,$90.55 ,$13.01 ,$93.60 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$63.36 ,$64.24 ,$21.90 ,$74.80 ,$12.88 ,$21.90 ,$74.80 ,$64.24 ,$3.28 ,$12.88 ,$14.58 ,$74.80 ,$28.98 ,$80.96 ,$61.60 ,$28.26 ,$30.38 ,$53.59 ,$28.26 ,$60.81 ,$63.36 ,$61.29 ,$13.01 ,$63.36 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$52.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$95.20 ,$81.76 ,$14.87 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.99 ,$75.25 ,$68.21 ,$69.99 ,$77.39 ,$80.64 ,$78.01 ,$14.53 ,$80.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.05 ,$104.55 ,$15.91 ,$27.05 ,$104.55 ,$89.79 ,$16.44 ,$15.91 ,$18.01 ,$104.55 ,$35.80 ,$113.16 ,$86.10 ,$77.33 ,$83.15 ,$74.91 ,$77.33 ,$84.99 ,$88.56 ,$85.67 ,$16.07 ,$88.56 ,$17.43 ,$19.09 ,$19.09 ,$15.91 ,$19.09 ,$15.91 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$27.05 ,$104.55 ,$15.91 ,$27.05 ,$104.55 ,$89.79 ,$16.44 ,$15.91 ,$18.01 ,$104.55 ,$35.80 ,$113.16 ,$86.10 ,$77.33 ,$83.15 ,$74.91 ,$77.33 ,$84.99 ,$88.56 ,$85.67 ,$16.07 ,$88.56 ,$17.43 ,$19.09 ,$19.09 ,$15.91 ,$19.09 ,$15.91 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.26 ,$95.20 ,$14.27 ,$24.26 ,$95.20 ,$81.76 ,$14.75 ,$14.27 ,$16.15 ,$95.20 ,$32.11 ,$103.04 ,$78.40 ,$69.39 ,$74.60 ,$68.21 ,$69.39 ,$77.39 ,$80.64 ,$78.01 ,$14.41 ,$80.64 ,$15.64 ,$17.12 ,$17.12 ,$14.27 ,$17.12 ,$14.27 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$118.08 ,$119.72 ,$26.33 ,$139.40 ,$15.49 ,$26.33 ,$139.40 ,$119.72 ,$16.01 ,$15.49 ,$17.53 ,$139.40 ,$34.85 ,$150.88 ,$114.80 ,$75.30 ,$80.96 ,$99.88 ,$75.30 ,$113.32 ,$118.08 ,$114.23 ,$15.64 ,$118.08 ,$16.97 ,$18.59 ,$18.59 ,$15.49 ,$18.59 ,$15.49 ,$118.08 ,$101.68 ,$118.08 ,$118.08 ,$98.40 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 ,$86.00 ,$73.10 ,$78.65 ,$86.00 ,$73.10 ,$62.78 ,$55.65 ,$78.65 ,$86.00 ,$73.10 ,$176.96 ,$79.12 ,$60.20 ,$86.00 ,$86.00 ,$52.37 ,$86.00 ,$59.43 ,$61.92 ,$59.90 ,$79.44 ,$61.92 ,$58.99 ,$86.00 ,$86.00 ,$78.65 ,$86.00 ,$78.65 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$291.60 ,$295.65 ,$133.71 ,$344.25 ,$78.65 ,$133.71 ,$344.25 ,$295.65 ,$55.65 ,$78.65 ,$89.02 ,$344.25 ,$176.96 ,$372.60 ,$283.50 ,$192.41 ,$206.87 ,$246.65 ,$192.41 ,$279.86 ,$291.60 ,$282.08 ,$79.44 ,$291.60 ,$58.99 ,$94.38 ,$94.38 ,$78.65 ,$94.38 ,$78.65 ,$291.60 ,$251.10 ,$291.60 ,$291.60 ,$243.00 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 ,$50.46 ,$52.70 ,$29.68 ,$50.46 ,$52.70 ,$45.26 ,$30.67 ,$29.68 ,$33.59 ,$52.70 ,$66.78 ,$57.04 ,$43.40 ,$62.00 ,$62.00 ,$37.76 ,$62.00 ,$42.84 ,$44.64 ,$43.18 ,$29.98 ,$44.64 ,$32.51 ,$35.62 ,$35.62 ,$29.68 ,$35.62 ,$29.68 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$189.36 ,$191.99 ,$50.46 ,$223.55 ,$29.68 ,$50.46 ,$223.55 ,$191.99 ,$30.67 ,$29.68 ,$33.59 ,$223.55 ,$66.78 ,$241.96 ,$184.10 ,$144.30 ,$155.14 ,$160.17 ,$144.30 ,$181.73 ,$189.36 ,$183.18 ,$29.98 ,$189.36 ,$32.51 ,$35.62 ,$35.62 ,$29.68 ,$35.62 ,$29.68 ,$189.36 ,$163.06 ,$189.36 ,$189.36 ,$157.80 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 ,$50.46 ,$73.10 ,$29.68 ,$50.46 ,$73.10 ,$62.78 ,$30.67 ,$29.68 ,$33.59 ,$73.10 ,$66.78 ,$79.12 ,$60.20 ,$86.00 ,$86.00 ,$52.37 ,$86.00 ,$59.43 ,$61.92 ,$59.90 ,$29.98 ,$61.92 ,$32.51 ,$35.62 ,$35.62 ,$29.68 ,$35.62 ,$29.68 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$43.88 ,$199.75 ,$25.81 ,$43.88 ,$199.75 ,$171.55 ,$26.67 ,$25.81 ,$29.21 ,$199.75 ,$58.07 ,$216.20 ,$164.50 ,$125.48 ,$134.91 ,$143.12 ,$125.48 ,$162.39 ,$169.20 ,$163.68 ,$26.07 ,$169.20 ,$28.27 ,$30.97 ,$30.97 ,$25.81 ,$30.97 ,$25.81 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$424.80 ,$430.70 ,$98.60 ,$501.50 ,$58.00 ,$98.60 ,$501.50 ,$430.70 ,$59.93 ,$58.00 ,$65.64 ,$501.50 ,$130.50 ,$542.80 ,$413.00 ,$281.97 ,$303.16 ,$359.31 ,$281.97 ,$407.69 ,$424.80 ,$410.94 ,$58.58 ,$424.80 ,$63.53 ,$69.60 ,$69.60 ,$58.00 ,$69.60 ,$58.00 ,$424.80 ,$365.80 ,$424.80 ,$424.80 ,$354.00 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 , N/A ,$52.70 , N/A , N/A ,$52.70 ,$45.26 ,$3.28 , N/A ,$26.04 ,$52.70 ,$37.20 ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$35.22 ,$42.84 ,$44.64 ,$43.18 , N/A ,$44.64 ,$3.48 ,$31.00 ,$31.00 , N/A ,$31.00 , N/A ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 , N/A ,$73.10 , N/A , N/A ,$73.10 ,$62.78 ,$3.28 , N/A ,$36.12 ,$73.10 ,$51.60 ,$79.12 ,$60.20 ,$43.62 ,$52.35 ,$52.37 ,$48.86 ,$59.43 ,$61.92 ,$59.90 , N/A ,$61.92 ,$3.48 ,$43.00 ,$43.00 , N/A ,$43.00 , N/A ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$115.92 ,$117.53 , N/A ,$136.85 , N/A , N/A ,$136.85 ,$117.53 ,$3.28 , N/A ,$67.62 ,$136.85 ,$96.60 ,$148.12 ,$112.70 ,$81.66 ,$98.00 ,$98.05 ,$91.46 ,$111.25 ,$115.92 ,$112.14 , N/A ,$115.92 ,$3.48 ,$80.50 ,$80.50 , N/A ,$80.50 , N/A ,$115.92 ,$99.82 ,$115.92 ,$115.92 ,$96.60 
ST MARY'S HOSPITAL,30200327,86850,HC AB SCREEN,302,1 ,$90.00 ,$45.00 ,$5.38 ,$108.73 ,$5.38 ,$34.20 ,$29.31 ,$48.33 ,$54.00 ,$76.50 ,$63.00 ,$5.38 ,$85.50 ,$64.80 ,$65.70 ,$16.61 ,$76.50 ,$48.33 ,$16.61 ,$76.50 ,$65.70 ,$5.38 ,$48.33 ,$11.06 ,$76.50 ,$108.73 ,$82.80 ,$63.00 ,$46.61 ,$50.12 ,$54.81 ,$46.61 ,$62.19 ,$64.80 ,$62.69 ,$48.81 ,$64.80 ,$5.70 ,$11.72 ,$11.72 ,$48.33 ,$11.72 ,$48.33 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,30200329,86860,HC ELUTION,302,1 ,$146.00 ,$73.00 ,$8.23 ,$326.35 ,$8.23 ,$109.85 ,$94.16 ,$145.05 ,$87.60 ,$124.10 ,$102.20 ,$8.23 ,$138.70 ,$105.12 ,$106.58 ,$52.53 ,$124.10 ,$145.05 ,$52.53 ,$124.10 ,$106.58 ,$8.23 ,$145.05 ,$61.32 ,$124.10 ,$326.35 ,$134.32 ,$102.20 ,$146.00 ,$146.00 ,$88.91 ,$146.00 ,$100.89 ,$105.12 ,$101.69 ,$146.50 ,$105.12 ,$8.72 ,$146.00 ,$146.00 ,$145.05 ,$146.00 ,$145.05 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,30200331,86870,HC RBC AB ID PANEL,302,1 ,$269.00 ,$134.50 ,$8.23 ,$637.30 ,$8.23 ,$150.89 ,$129.34 ,$283.24 ,$161.40 ,$228.65 ,$188.30 ,$8.23 ,$255.55 ,$193.68 ,$196.37 ,$71.52 ,$228.65 ,$283.24 ,$71.52 ,$228.65 ,$196.37 ,$8.23 ,$283.24 ,$112.98 ,$228.65 ,$637.30 ,$247.48 ,$188.30 ,$121.38 ,$130.50 ,$163.82 ,$121.38 ,$185.88 ,$193.68 ,$187.36 ,$286.07 ,$193.68 ,$8.72 ,$269.00 ,$269.00 ,$283.24 ,$269.00 ,$283.24 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,30200334,86880,HC COOMBS DIRECT,302,1 ,$56.00 ,$28.00 ,$5.57 ,$121.80 ,$5.57 ,$20.97 ,$17.97 ,$54.13 ,$33.60 ,$47.60 ,$39.20 ,$5.57 ,$53.20 ,$40.32 ,$40.88 ,$9.16 ,$47.60 ,$54.13 ,$9.16 ,$47.60 ,$40.88 ,$5.57 ,$54.13 ,$6.10 ,$47.60 ,$121.80 ,$51.52 ,$39.20 ,$20.88 ,$22.45 ,$34.10 ,$20.88 ,$38.70 ,$40.32 ,$39.00 ,$54.67 ,$40.32 ,$5.90 ,$6.47 ,$6.47 ,$54.13 ,$6.47 ,$54.13 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,30200336,86880,HC ANTIHUMAN GLOBULIN TEST,302,1 ,$53.00 ,$26.50 ,$5.57 ,$121.80 ,$5.57 ,$20.97 ,$17.97 ,$54.13 ,$31.80 ,$45.05 ,$37.10 ,$5.57 ,$50.35 ,$38.16 ,$38.69 ,$9.16 ,$45.05 ,$54.13 ,$9.16 ,$45.05 ,$38.69 ,$5.57 ,$54.13 ,$6.10 ,$45.05 ,$121.80 ,$48.76 ,$37.10 ,$20.88 ,$22.45 ,$32.28 ,$20.88 ,$36.62 ,$38.16 ,$36.91 ,$54.67 ,$38.16 ,$5.90 ,$6.47 ,$6.47 ,$54.13 ,$6.47 ,$54.13 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,30200338,86885,HC INDIRECT COOMBS,302,1 ,$80.00 ,$40.00 ,$5.91 ,$326.35 ,$5.91 ,$22.26 ,$19.08 ,$145.05 ,$48.00 ,$68.00 ,$56.00 ,$5.91 ,$76.00 ,$57.60 ,$58.40 ,$9.72 ,$68.00 ,$145.05 ,$9.72 ,$68.00 ,$58.40 ,$5.91 ,$145.05 ,$6.47 ,$68.00 ,$326.35 ,$73.60 ,$56.00 ,$27.83 ,$29.92 ,$48.72 ,$27.83 ,$55.28 ,$57.60 ,$55.72 ,$146.50 ,$57.60 ,$6.26 ,$6.86 ,$6.86 ,$145.05 ,$6.86 ,$145.05 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,30200339,86885,HC INDIRECT COOMBS (ABID),302,1 ,$11.00 ,$5.50 ,$5.50 ,$326.35 ,$5.91 ,$11.00 ,$11.00 ,$145.05 ,$6.60 ,$9.35 ,$7.70 ,$5.91 ,$10.45 ,$7.92 ,$8.03 ,$9.72 ,$9.35 ,$145.05 ,$9.72 ,$9.35 ,$8.03 ,$5.91 ,$145.05 ,$6.47 ,$9.35 ,$326.35 ,$10.12 ,$7.70 ,$11.00 ,$11.00 ,$6.70 ,$11.00 ,$7.60 ,$7.92 ,$7.66 ,$146.50 ,$7.92 ,$6.26 ,$6.86 ,$6.86 ,$145.05 ,$6.86 ,$145.05 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$6.60 
ST MARY'S HOSPITAL,30200340,86886,HC INDIRECT TITER,302,1 ,$67.00 ,$33.50 ,$5.35 ,$326.35 ,$5.35 ,$20.13 ,$17.25 ,$145.05 ,$40.20 ,$56.95 ,$46.90 ,$5.35 ,$63.65 ,$48.24 ,$48.91 ,$8.81 ,$56.95 ,$145.05 ,$8.81 ,$56.95 ,$48.91 ,$5.35 ,$145.05 ,$5.86 ,$56.95 ,$326.35 ,$61.64 ,$46.90 ,$25.16 ,$27.05 ,$40.80 ,$25.16 ,$46.30 ,$48.24 ,$46.67 ,$146.50 ,$48.24 ,$5.67 ,$6.22 ,$6.22 ,$145.05 ,$6.22 ,$145.05 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,30200342,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$381.00 ,$190.50 ,$8.35 ,$381.00 ,$8.35 ,$346.45 ,$296.95 ,$145.05 ,$228.60 ,$323.85 ,$266.70 ,$8.35 ,$361.95 ,$274.32 ,$278.13 ,$164.83 ,$323.85 ,$145.05 ,$164.83 ,$323.85 ,$278.13 ,$8.35 ,$145.05 ,$160.02 ,$323.85 ,$326.35 ,$350.52 ,$266.70 ,$232.47 ,$249.94 ,$232.03 ,$232.47 ,$263.27 ,$274.32 ,$265.37 ,$146.50 ,$274.32 ,$8.85 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$228.60 
ST MARY'S HOSPITAL,30200343,86891,HC BLOOD SALVAGE AUTOLOOUS INTRA,302,1 ,$504.00 ,$252.00 ,$8.35 ,"$1,433.98 ",$8.35 ,$490.09 ,$420.08 ,$637.32 ,$302.40 ,$428.40 ,$352.80 ,$8.35 ,$478.80 ,$362.88 ,$367.92 ,$232.46 ,$428.40 ,$637.32 ,$232.46 ,$428.40 ,$367.92 ,$8.35 ,$637.32 ,$211.68 ,$428.40 ,"$1,433.98 ",$463.68 ,$352.80 ,$232.47 ,$249.94 ,$306.94 ,$232.47 ,$348.26 ,$362.88 ,$351.04 ,$643.69 ,$362.88 ,$8.85 ,$504.00 ,$504.00 ,$637.32 ,$504.00 ,$637.32 ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$302.40 
ST MARY'S HOSPITAL,30200344,86900,HC BLOOD TYPING ABO,302,1 ,$40.00 ,$20.00 ,$3.09 ,$246.74 ,$3.09 ,$11.62 ,$9.96 ,$109.66 ,$24.00 ,$34.00 ,$28.00 ,$3.09 ,$38.00 ,$28.80 ,$29.20 ,$5.08 ,$34.00 ,$109.66 ,$5.08 ,$34.00 ,$29.20 ,$3.09 ,$109.66 ,$3.38 ,$34.00 ,$246.74 ,$36.80 ,$28.00 ,$13.33 ,$14.33 ,$24.36 ,$13.33 ,$27.64 ,$28.80 ,$27.86 ,$110.76 ,$28.80 ,$3.28 ,$3.59 ,$3.59 ,$109.66 ,$3.59 ,$109.66 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,30200346,86901,HC BLOOD TYPING RH,302,1 ,$44.00 ,$22.00 ,$3.09 ,$74.07 ,$3.09 ,$11.62 ,$9.96 ,$32.92 ,$26.40 ,$37.40 ,$30.80 ,$3.09 ,$41.80 ,$31.68 ,$32.12 ,$5.08 ,$37.40 ,$32.92 ,$5.08 ,$37.40 ,$32.12 ,$3.09 ,$32.92 ,$3.38 ,$37.40 ,$74.07 ,$40.48 ,$30.80 ,$13.33 ,$14.33 ,$26.80 ,$13.33 ,$30.40 ,$31.68 ,$30.65 ,$33.25 ,$31.68 ,$3.28 ,$3.59 ,$3.59 ,$32.92 ,$3.59 ,$32.92 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$26.40 
ST MARY'S HOSPITAL,30200347,86901,HC BLOOD TYPING RH (CLINIC),302,1 ,$24.00 ,$12.00 ,$3.09 ,$74.07 ,$3.09 ,$11.62 ,$9.96 ,$32.92 ,$14.40 ,$20.40 ,$16.80 ,$3.09 ,$22.80 ,$17.28 ,$17.52 ,$5.08 ,$20.40 ,$32.92 ,$5.08 ,$20.40 ,$17.52 ,$3.09 ,$32.92 ,$3.38 ,$20.40 ,$74.07 ,$22.08 ,$16.80 ,$13.33 ,$14.33 ,$14.62 ,$13.33 ,$16.58 ,$17.28 ,$16.72 ,$33.25 ,$17.28 ,$3.28 ,$3.59 ,$3.59 ,$32.92 ,$3.59 ,$32.92 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$14.40 
ST MARY'S HOSPITAL,30200349,86902,HC RBC AG SCR RGT SERUM,302,1 ,$78.00 ,$39.00 ,$5.37 ,$637.30 ,$5.37 ,$22.23 ,$19.05 ,$283.24 ,$46.80 ,$66.30 ,$54.60 ,$5.37 ,$74.10 ,$56.16 ,$56.94 ,$10.80 ,$66.30 ,$283.24 ,$10.80 ,$66.30 ,$56.94 ,$5.37 ,$283.24 ,$7.19 ,$66.30 ,$637.30 ,$71.76 ,$54.60 ,$18.60 ,$20.00 ,$47.50 ,$18.60 ,$53.90 ,$56.16 ,$54.33 ,$286.07 ,$56.16 ,$5.69 ,$7.62 ,$7.62 ,$283.24 ,$7.62 ,$283.24 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,30200351,86902,HC RBC AG SCR RGT SERUM TYPE UNIT,302,1 ,$67.00 ,$33.50 ,$5.37 ,$637.30 ,$5.37 ,$22.23 ,$19.05 ,$283.24 ,$40.20 ,$56.95 ,$46.90 ,$5.37 ,$63.65 ,$48.24 ,$48.91 ,$10.80 ,$56.95 ,$283.24 ,$10.80 ,$56.95 ,$48.91 ,$5.37 ,$283.24 ,$7.19 ,$56.95 ,$637.30 ,$61.64 ,$46.90 ,$18.60 ,$20.00 ,$40.80 ,$18.60 ,$46.30 ,$48.24 ,$46.67 ,$286.07 ,$48.24 ,$5.69 ,$7.62 ,$7.62 ,$283.24 ,$7.62 ,$283.24 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,30200352,86904,HC RBC AG SCR PAT SERUM,302,1 ,$86.00 ,$43.00 ,$13.37 ,$86.00 ,$13.37 ,$57.19 ,$49.02 ,$32.92 ,$51.60 ,$73.10 ,$60.20 ,$13.37 ,$81.70 ,$61.92 ,$62.78 ,$27.78 ,$73.10 ,$32.92 ,$27.78 ,$73.10 ,$62.78 ,$13.37 ,$32.92 ,$18.49 ,$73.10 ,$74.07 ,$79.12 ,$60.20 ,$46.22 ,$49.70 ,$52.37 ,$46.22 ,$59.43 ,$61.92 ,$59.90 ,$33.25 ,$61.92 ,$14.17 ,$19.61 ,$19.61 ,$32.92 ,$19.61 ,$32.92 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,30200354,86905,HC ANTIGEN ID ONLY,302,1 ,$67.00 ,$33.50 ,$3.96 ,$637.30 ,$3.96 ,$14.88 ,$12.75 ,$283.24 ,$40.20 ,$56.95 ,$46.90 ,$3.96 ,$63.65 ,$48.24 ,$48.91 ,$6.51 ,$56.95 ,$283.24 ,$6.51 ,$56.95 ,$48.91 ,$3.96 ,$283.24 ,$4.33 ,$56.95 ,$637.30 ,$61.64 ,$46.90 ,$18.60 ,$20.00 ,$40.80 ,$18.60 ,$46.30 ,$48.24 ,$46.67 ,$286.07 ,$48.24 ,$4.20 ,$4.60 ,$4.60 ,$283.24 ,$4.60 ,$283.24 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,30200356,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$157.00 ,$78.50 ,$7.15 ,$326.35 ,$7.15 ,$121.92 ,$104.50 ,$145.05 ,$94.20 ,$133.45 ,$109.90 ,$7.15 ,$149.15 ,$113.04 ,$114.61 ,$58.11 ,$133.45 ,$145.05 ,$58.11 ,$133.45 ,$114.61 ,$7.15 ,$145.05 ,$65.94 ,$133.45 ,$326.35 ,$144.44 ,$109.90 ,$121.38 ,$130.50 ,$95.61 ,$121.38 ,$108.49 ,$113.04 ,$109.35 ,$146.50 ,$113.04 ,$7.58 ,$157.00 ,$157.00 ,$145.05 ,$157.00 ,$145.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,30200358,86921,HC CROSSMATCH INCUBATION,302,1 ,$123.00 ,$61.50 ,$8.23 ,$326.35 ,$8.23 ,$109.85 ,$94.16 ,$145.05 ,$73.80 ,$104.55 ,$86.10 ,$8.23 ,$116.85 ,$88.56 ,$89.79 ,$52.53 ,$104.55 ,$145.05 ,$52.53 ,$104.55 ,$89.79 ,$8.23 ,$145.05 ,$51.66 ,$104.55 ,$326.35 ,$113.16 ,$86.10 ,$46.61 ,$50.12 ,$74.91 ,$46.61 ,$84.99 ,$88.56 ,$85.67 ,$146.50 ,$88.56 ,$8.72 ,$123.00 ,$123.00 ,$145.05 ,$123.00 ,$145.05 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,30200360,86922,HC CROSSMATCH AHG,302,1 ,$157.00 ,$78.50 ,$8.23 ,$326.35 ,$8.23 ,$130.37 ,$111.75 ,$145.05 ,$94.20 ,$133.45 ,$109.90 ,$8.23 ,$149.15 ,$113.04 ,$114.61 ,$62.02 ,$133.45 ,$145.05 ,$62.02 ,$133.45 ,$114.61 ,$8.23 ,$145.05 ,$65.94 ,$133.45 ,$326.35 ,$144.44 ,$109.90 ,$121.38 ,$130.50 ,$95.61 ,$121.38 ,$108.49 ,$113.04 ,$109.35 ,$146.50 ,$113.04 ,$8.72 ,$157.00 ,$157.00 ,$145.05 ,$157.00 ,$145.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,30200362,86923,HC CROSSMATCH ELECTRONIC,302,1 ,$157.00 ,$78.50 ,$8.23 ,$326.35 ,$8.23 ,$97.78 ,$83.81 ,$145.05 ,$94.20 ,$133.45 ,$109.90 ,$8.23 ,$149.15 ,$113.04 ,$114.61 ,$46.38 ,$133.45 ,$145.05 ,$46.38 ,$133.45 ,$114.61 ,$8.23 ,$145.05 ,$65.94 ,$133.45 ,$326.35 ,$144.44 ,$109.90 ,$121.38 ,$130.50 ,$95.61 ,$121.38 ,$108.49 ,$113.04 ,$109.35 ,$146.50 ,$113.04 ,$8.72 ,$157.00 ,$157.00 ,$145.05 ,$157.00 ,$145.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,30200363,86927,HC FFP THAWING EACH UNIT,302,1 ,$168.00 ,$84.00 ,$8.35 ,$326.35 ,$8.35 ,$68.81 ,$58.98 ,$145.05 ,$100.80 ,$142.80 ,$117.60 ,$8.35 ,$159.60 ,$120.96 ,$122.64 ,$32.96 ,$142.80 ,$145.05 ,$32.96 ,$142.80 ,$122.64 ,$8.35 ,$145.05 ,$70.56 ,$142.80 ,$326.35 ,$154.56 ,$117.60 ,$168.00 ,$168.00 ,$102.31 ,$168.00 ,$116.09 ,$120.96 ,$117.01 ,$146.50 ,$120.96 ,$8.85 ,$168.00 ,$168.00 ,$145.05 ,$168.00 ,$145.05 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,30200365,86945,HC BLOOD PRODUCT IRRADIATION,302,1 ,$115.00 ,$57.50 ,$8.35 ,$115.00 ,$8.35 ,$102.61 ,$87.95 ,$32.92 ,$69.00 ,$97.75 ,$80.50 ,$8.35 ,$109.25 ,$82.80 ,$83.95 ,$48.62 ,$97.75 ,$32.92 ,$48.62 ,$97.75 ,$83.95 ,$8.35 ,$32.92 ,$48.30 ,$97.75 ,$74.07 ,$105.80 ,$80.50 ,$46.61 ,$50.12 ,$70.04 ,$46.61 ,$79.47 ,$82.80 ,$80.10 ,$33.25 ,$82.80 ,$8.85 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$69.00 
ST MARY'S HOSPITAL,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 ,$145.05 ,"$1,035.00 ","$1,466.25 ","$1,207.50 ",$8.35 ,"$1,638.75 ","$1,242.00 ","$1,259.25 ",$126.28 ,"$1,466.25 ",$145.05 ,$126.28 ,"$1,466.25 ","$1,259.25 ",$8.35 ,$145.05 ,$724.50 ,"$1,466.25 ",$326.35 ,"$1,587.00 ","$1,207.50 ",$46.61 ,$50.12 ,"$1,050.53 ",$46.61 ,"$1,191.98 ","$1,242.00 ","$1,201.46 ",$146.50 ,"$1,242.00 ",$8.85 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,"$1,242.00 ","$1,069.50 ","$1,242.00 ","$1,242.00 ","$1,035.00 "
ST MARY'S HOSPITAL,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 ,$145.05 ,"$1,018.80 ","$1,443.30 ","$1,188.60 ",$8.35 ,"$1,613.10 ","$1,222.56 ","$1,239.54 ",$126.28 ,"$1,443.30 ",$145.05 ,$126.28 ,"$1,443.30 ","$1,239.54 ",$8.35 ,$145.05 ,$713.16 ,"$1,443.30 ",$326.35 ,"$1,562.16 ","$1,188.60 ",$46.61 ,$50.12 ,"$1,034.08 ",$46.61 ,"$1,173.32 ","$1,222.56 ","$1,182.66 ",$146.50 ,"$1,222.56 ",$8.85 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,"$1,222.56 ","$1,052.76 ","$1,222.56 ","$1,222.56 ","$1,018.80 "
ST MARY'S HOSPITAL,30200368,86965,HC BLOOD PRODUCT POOL,302,1 ,$127.00 ,$63.50 ,$8.35 ,$326.35 ,$8.35 ,$114.68 ,$98.29 ,$145.05 ,$76.20 ,$107.95 ,$88.90 ,$8.35 ,$120.65 ,$91.44 ,$92.71 ,$54.20 ,$107.95 ,$145.05 ,$54.20 ,$107.95 ,$92.71 ,$8.35 ,$145.05 ,$53.34 ,$107.95 ,$326.35 ,$116.84 ,$88.90 ,$127.00 ,$127.00 ,$77.34 ,$127.00 ,$87.76 ,$91.44 ,$88.46 ,$146.50 ,$91.44 ,$8.85 ,$127.00 ,$127.00 ,$145.05 ,$127.00 ,$145.05 ,$91.44 ,$78.74 ,$91.44 ,$91.44 ,$76.20 
ST MARY'S HOSPITAL,30200369,86970,HC RBC PRETREAT CHEM,302,1 ,$115.00 ,$57.50 ,$8.35 ,$115.00 ,$8.35 ,$102.61 ,$87.95 ,$32.92 ,$69.00 ,$97.75 ,$80.50 ,$8.35 ,$109.25 ,$82.80 ,$83.95 ,$48.62 ,$97.75 ,$32.92 ,$48.62 ,$97.75 ,$83.95 ,$8.35 ,$32.92 ,$48.30 ,$97.75 ,$74.07 ,$105.80 ,$80.50 ,$115.00 ,$115.00 ,$70.04 ,$115.00 ,$79.47 ,$82.80 ,$80.10 ,$33.25 ,$82.80 ,$8.85 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$69.00 
ST MARY'S HOSPITAL,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 ,$82.80 ,$83.95 ,$19.62 ,$97.75 ,$11.54 ,$19.62 ,$97.75 ,$83.95 ,$11.92 ,$11.54 ,$13.06 ,$97.75 ,$25.97 ,$105.80 ,$80.50 ,$49.54 ,$53.26 ,$70.04 ,$49.54 ,$79.47 ,$82.80 ,$80.10 ,$11.66 ,$82.80 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$11.54 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$69.00 
ST MARY'S HOSPITAL,30200375,86880,HC C3 DIRECT COOMBS,302,1 ,$52.00 ,$26.00 ,$5.57 ,$121.80 ,$5.57 ,$20.97 ,$17.97 ,$54.13 ,$31.20 ,$44.20 ,$36.40 ,$5.57 ,$49.40 ,$37.44 ,$37.96 ,$9.16 ,$44.20 ,$54.13 ,$9.16 ,$44.20 ,$37.96 ,$5.57 ,$54.13 ,$6.10 ,$44.20 ,$121.80 ,$47.84 ,$36.40 ,$20.88 ,$22.45 ,$31.67 ,$20.88 ,$35.93 ,$37.44 ,$36.22 ,$54.67 ,$37.44 ,$5.90 ,$6.47 ,$6.47 ,$54.13 ,$6.47 ,$54.13 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$653.04 ,$662.11 ,$550.38 ,$770.95 ,$323.75 ,$550.38 ,$770.95 ,$662.11 ,$139.23 ,$323.75 ,$366.42 ,$770.95 ,$728.44 ,$834.44 ,$634.90 ,$616.86 ,$663.21 ,$552.36 ,$616.86 ,$626.74 ,$653.04 ,$631.73 ,$326.99 ,$653.04 ,$147.58 ,$388.50 ,$388.50 ,$323.75 ,$388.50 ,$323.75 ,$653.04 ,$562.34 ,$653.04 ,$653.04 ,$544.20 
ST MARY'S HOSPITAL,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 ,$30.96 ,$31.39 ,$22.15 ,$36.55 ,$13.03 ,$22.15 ,$36.55 ,$31.39 ,$8.17 ,$13.03 ,$14.75 ,$36.55 ,$29.32 ,$39.56 ,$30.10 ,$28.26 ,$30.38 ,$26.19 ,$28.26 ,$29.71 ,$30.96 ,$29.95 ,$13.16 ,$30.96 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$13.03 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$30.48 ,$104.55 ,$17.93 ,$30.48 ,$104.55 ,$89.79 ,$18.53 ,$17.93 ,$20.29 ,$104.55 ,$40.34 ,$113.16 ,$86.10 ,$87.17 ,$93.72 ,$74.91 ,$87.17 ,$84.99 ,$88.56 ,$85.67 ,$18.11 ,$88.56 ,$19.64 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$17.93 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$32.90 ,$95.20 ,$19.35 ,$32.90 ,$95.20 ,$81.76 ,$19.99 ,$19.35 ,$21.90 ,$95.20 ,$43.54 ,$103.04 ,$78.40 ,$94.08 ,$101.15 ,$68.21 ,$94.08 ,$77.39 ,$80.64 ,$78.01 ,$19.54 ,$80.64 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$32.90 ,$95.20 ,$19.35 ,$32.90 ,$95.20 ,$81.76 ,$19.99 ,$19.35 ,$21.90 ,$95.20 ,$43.54 ,$103.04 ,$78.40 ,$94.08 ,$101.15 ,$68.21 ,$94.08 ,$77.39 ,$80.64 ,$78.01 ,$19.54 ,$80.64 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$98.64 ,$100.01 ,$19.50 ,$116.45 ,$11.47 ,$19.50 ,$116.45 ,$100.01 ,$8.17 ,$11.47 ,$12.98 ,$116.45 ,$25.81 ,$126.04 ,$95.90 ,$28.26 ,$30.38 ,$83.43 ,$28.26 ,$94.67 ,$98.64 ,$95.42 ,$11.58 ,$98.64 ,$8.66 ,$13.76 ,$13.76 ,$11.47 ,$13.76 ,$11.47 ,$98.64 ,$84.94 ,$98.64 ,$98.64 ,$82.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$20.55 ,$66.30 ,$12.09 ,$20.55 ,$66.30 ,$56.94 ,$12.49 ,$12.09 ,$13.68 ,$66.30 ,$27.20 ,$71.76 ,$54.60 ,$50.68 ,$54.49 ,$47.50 ,$50.68 ,$53.90 ,$56.16 ,$54.33 ,$12.21 ,$56.16 ,$13.24 ,$14.51 ,$14.51 ,$12.09 ,$14.51 ,$12.09 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,30200476,86985,HC SPLITTING BLOOD PRODUCT EA,302,1 ,$84.00 ,$42.00 ,$8.35 ,$326.35 ,$8.35 ,$84.00 ,$76.57 ,$145.05 ,$50.40 ,$71.40 ,$58.80 ,$8.35 ,$79.80 ,$60.48 ,$61.32 ,$42.47 ,$71.40 ,$145.05 ,$42.47 ,$71.40 ,$61.32 ,$8.35 ,$145.05 ,$35.28 ,$71.40 ,$326.35 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$60.48 ,$58.51 ,$146.50 ,$60.48 ,$8.85 ,$84.00 ,$84.00 ,$145.05 ,$84.00 ,$145.05 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$85.85 ,$73.73 ,$13.63 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$64.15 ,$68.97 ,$61.51 ,$64.15 ,$69.79 ,$72.72 ,$70.35 ,$13.32 ,$72.72 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$124.10 ,$106.58 ,$19.99 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$94.08 ,$101.15 ,$88.91 ,$94.08 ,$100.89 ,$105.12 ,$101.69 ,$19.54 ,$105.12 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$124.10 ,$106.58 ,$19.99 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$94.08 ,$101.15 ,$88.91 ,$94.08 ,$100.89 ,$105.12 ,$101.69 ,$19.54 ,$105.12 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$85.85 ,$73.73 ,$13.63 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$64.15 ,$68.97 ,$61.51 ,$64.15 ,$69.79 ,$72.72 ,$70.35 ,$13.32 ,$72.72 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$76.32 ,$77.38 ,$24.46 ,$90.10 ,$14.39 ,$24.46 ,$90.10 ,$77.38 ,$14.87 ,$14.39 ,$16.29 ,$90.10 ,$32.38 ,$97.52 ,$74.20 ,$69.99 ,$75.25 ,$64.55 ,$69.99 ,$73.25 ,$76.32 ,$73.83 ,$14.53 ,$76.32 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$76.32 ,$65.72 ,$76.32 ,$76.32 ,$63.60 
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$24.46 ,$98.60 ,$14.39 ,$24.46 ,$98.60 ,$84.68 ,$14.87 ,$14.39 ,$16.29 ,$98.60 ,$32.38 ,$106.72 ,$81.20 ,$69.99 ,$75.25 ,$70.64 ,$69.99 ,$80.16 ,$83.52 ,$80.79 ,$14.53 ,$83.52 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$24.46 ,$93.50 ,$14.39 ,$24.46 ,$93.50 ,$80.30 ,$14.87 ,$14.39 ,$16.29 ,$93.50 ,$32.38 ,$101.20 ,$77.00 ,$69.99 ,$75.25 ,$66.99 ,$69.99 ,$76.01 ,$79.20 ,$76.62 ,$14.53 ,$79.20 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$28.14 ,$76.50 ,$16.55 ,$28.14 ,$76.50 ,$65.70 ,$16.86 ,$16.55 ,$18.73 ,$76.50 ,$37.24 ,$82.80 ,$63.00 ,$58.30 ,$62.68 ,$54.81 ,$58.30 ,$62.19 ,$64.80 ,$62.69 ,$16.72 ,$64.80 ,$17.87 ,$19.86 ,$19.86 ,$16.55 ,$19.86 ,$16.55 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$82.80 ,$83.95 ,$20.59 ,$97.75 ,$12.11 ,$20.59 ,$97.75 ,$83.95 ,$12.51 ,$12.11 ,$13.71 ,$97.75 ,$27.25 ,$105.80 ,$80.50 ,$58.87 ,$63.30 ,$70.04 ,$58.87 ,$79.47 ,$82.80 ,$80.10 ,$12.23 ,$82.80 ,$13.26 ,$14.53 ,$14.53 ,$12.11 ,$14.53 ,$12.11 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$69.00 
ST MARY'S HOSPITAL,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 ,$61.92 ,$62.78 ,$20.49 ,$73.10 ,$12.05 ,$20.49 ,$73.10 ,$62.78 ,$12.45 ,$12.05 ,$13.64 ,$73.10 ,$27.11 ,$79.12 ,$60.20 ,$58.59 ,$62.99 ,$52.37 ,$58.59 ,$59.43 ,$61.92 ,$59.90 ,$12.17 ,$61.92 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$15.11 ,$76.50 ,$8.89 ,$15.11 ,$76.50 ,$65.70 ,$9.19 ,$8.89 ,$10.06 ,$76.50 ,$20.00 ,$82.80 ,$63.00 ,$43.19 ,$46.44 ,$54.81 ,$43.19 ,$62.19 ,$64.80 ,$62.69 ,$8.98 ,$64.80 ,$9.74 ,$10.67 ,$10.67 ,$8.89 ,$10.67 ,$8.89 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$22.98 ,$76.50 ,$13.52 ,$22.98 ,$76.50 ,$65.70 ,$13.97 ,$13.52 ,$15.30 ,$76.50 ,$30.42 ,$82.80 ,$63.00 ,$65.72 ,$70.65 ,$54.81 ,$65.72 ,$62.19 ,$64.80 ,$62.69 ,$13.66 ,$64.80 ,$14.81 ,$16.22 ,$16.22 ,$13.52 ,$16.22 ,$13.52 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$170.00 ,$399.50 ,$100.00 ,$170.00 ,$399.50 ,$343.10 ,$90.12 ,$100.00 ,$113.18 ,$399.50 ,$225.00 ,$432.40 ,$329.00 ,$364.29 ,$391.67 ,$286.23 ,$364.29 ,$324.77 ,$338.40 ,$327.36 ,$101.00 ,$338.40 ,$95.53 ,$120.00 ,$120.00 ,$100.00 ,$120.00 ,$100.00 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$28.75 ,$133.45 ,$16.91 ,$28.75 ,$133.45 ,$114.61 ,$17.47 ,$16.91 ,$19.14 ,$133.45 ,$38.05 ,$144.44 ,$109.90 ,$82.22 ,$88.40 ,$95.61 ,$82.22 ,$108.49 ,$113.04 ,$109.35 ,$17.08 ,$113.04 ,$18.52 ,$20.29 ,$20.29 ,$16.91 ,$20.29 ,$16.91 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$31.68 ,$32.12 ,$28.75 ,$37.40 ,$16.91 ,$28.75 ,$37.40 ,$32.12 ,$17.47 ,$16.91 ,$19.14 ,$37.40 ,$38.05 ,$40.48 ,$30.80 ,$44.00 ,$44.00 ,$26.80 ,$44.00 ,$30.40 ,$31.68 ,$30.65 ,$17.08 ,$31.68 ,$18.52 ,$20.29 ,$20.29 ,$16.91 ,$20.29 ,$16.91 ,$31.68 ,$27.28 ,$31.68 ,$31.68 ,$26.40 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$22.15 ,$124.10 ,$13.03 ,$22.15 ,$124.10 ,$106.58 ,$8.17 ,$13.03 ,$14.75 ,$124.10 ,$29.32 ,$134.32 ,$102.20 ,$28.26 ,$30.38 ,$88.91 ,$28.26 ,$100.89 ,$105.12 ,$101.69 ,$13.16 ,$105.12 ,$8.66 ,$15.64 ,$15.64 ,$13.03 ,$15.64 ,$13.03 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$27.05 ,$42.50 ,$15.91 ,$27.05 ,$42.50 ,$36.50 ,$16.44 ,$15.91 ,$18.01 ,$42.50 ,$35.80 ,$46.00 ,$35.00 ,$50.00 ,$50.00 ,$30.45 ,$50.00 ,$34.55 ,$36.00 ,$34.83 ,$16.07 ,$36.00 ,$17.43 ,$19.09 ,$19.09 ,$15.91 ,$19.09 ,$15.91 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$21.90 ,$95.20 ,$12.88 ,$21.90 ,$95.20 ,$81.76 ,$3.28 ,$12.88 ,$14.58 ,$95.20 ,$28.98 ,$103.04 ,$78.40 ,$28.26 ,$30.38 ,$68.21 ,$28.26 ,$77.39 ,$80.64 ,$78.01 ,$13.01 ,$80.64 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$68.40 ,$69.35 ,$21.06 ,$80.75 ,$12.39 ,$21.06 ,$80.75 ,$69.35 ,$8.17 ,$12.39 ,$14.02 ,$80.75 ,$27.88 ,$87.40 ,$66.50 ,$28.26 ,$30.38 ,$57.86 ,$28.26 ,$65.65 ,$68.40 ,$66.17 ,$12.51 ,$68.40 ,$8.66 ,$14.87 ,$14.87 ,$12.39 ,$14.87 ,$12.39 ,$68.40 ,$58.90 ,$68.40 ,$68.40 ,$57.00 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$20.01 ,$142.80 ,$11.77 ,$20.01 ,$142.80 ,$122.64 ,$12.16 ,$11.77 ,$13.32 ,$142.80 ,$26.48 ,$154.56 ,$117.60 ,$57.27 ,$61.57 ,$102.31 ,$57.27 ,$116.09 ,$120.96 ,$117.01 ,$11.89 ,$120.96 ,$12.89 ,$14.12 ,$14.12 ,$11.77 ,$14.12 ,$11.77 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$24.46 ,$95.20 ,$14.39 ,$24.46 ,$95.20 ,$81.76 ,$14.87 ,$14.39 ,$16.29 ,$95.20 ,$32.38 ,$103.04 ,$78.40 ,$69.99 ,$75.25 ,$68.21 ,$69.99 ,$77.39 ,$80.64 ,$78.01 ,$14.53 ,$80.64 ,$15.76 ,$17.27 ,$17.27 ,$14.39 ,$17.27 ,$14.39 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$20.83 ,$44.20 ,$12.25 ,$20.83 ,$44.20 ,$37.96 ,$7.15 ,$12.25 ,$13.86 ,$44.20 ,$27.56 ,$47.84 ,$36.40 ,$24.73 ,$26.59 ,$31.67 ,$24.73 ,$35.93 ,$37.44 ,$36.22 ,$12.37 ,$37.44 ,$7.58 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$12.25 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$22.19 ,$56.95 ,$13.05 ,$22.19 ,$56.95 ,$48.91 ,$13.48 ,$13.05 ,$14.77 ,$56.95 ,$29.36 ,$61.64 ,$46.90 ,$63.44 ,$67.00 ,$40.80 ,$63.44 ,$46.30 ,$48.24 ,$46.67 ,$13.18 ,$48.24 ,$14.29 ,$15.66 ,$15.66 ,$13.05 ,$15.66 ,$13.05 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$387.36 ,$392.74 ,$119.34 ,$457.30 ,$70.20 ,$119.34 ,$457.30 ,$392.74 ,$50.62 ,$70.20 ,$79.45 ,$457.30 ,$157.95 ,$494.96 ,$376.60 ,$341.27 ,$366.91 ,$327.64 ,$341.27 ,$371.76 ,$387.36 ,$374.72 ,$70.90 ,$387.36 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$70.20 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$322.80 
ST MARY'S HOSPITAL,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 ,$586.80 ,$594.95 ,$550.38 ,$692.75 ,$323.75 ,$550.38 ,$692.75 ,$594.95 ,$139.23 ,$323.75 ,$366.42 ,$692.75 ,$728.44 ,$749.80 ,$570.50 ,$616.86 ,$663.21 ,$496.34 ,$616.86 ,$563.17 ,$586.80 ,$567.65 ,$326.99 ,$586.80 ,$147.58 ,$388.50 ,$388.50 ,$323.75 ,$388.50 ,$323.75 ,$586.80 ,$505.30 ,$586.80 ,$586.80 ,$489.00 
ST MARY'S HOSPITAL,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 ,$45.36 ,$45.99 ,$17.31 ,$53.55 ,$10.18 ,$17.31 ,$53.55 ,$45.99 ,$8.17 ,$10.18 ,$11.52 ,$53.55 ,$22.91 ,$57.96 ,$44.10 ,$28.26 ,$30.38 ,$38.37 ,$28.26 ,$43.53 ,$45.36 ,$43.88 ,$10.28 ,$45.36 ,$8.66 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$37.80 
ST MARY'S HOSPITAL,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 ,$55.44 ,$56.21 ,$18.09 ,$65.45 ,$10.64 ,$18.09 ,$65.45 ,$56.21 ,$9.85 ,$10.64 ,$12.04 ,$65.45 ,$23.94 ,$70.84 ,$53.90 ,$34.03 ,$36.59 ,$46.89 ,$34.03 ,$53.21 ,$55.44 ,$53.63 ,$10.75 ,$55.44 ,$10.44 ,$12.77 ,$12.77 ,$10.64 ,$12.77 ,$10.64 ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$46.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$25.86 ,$76.50 ,$15.21 ,$25.86 ,$76.50 ,$65.70 ,$8.17 ,$15.21 ,$17.21 ,$76.50 ,$34.22 ,$82.80 ,$63.00 ,$28.26 ,$30.38 ,$54.81 ,$28.26 ,$62.19 ,$64.80 ,$62.69 ,$15.36 ,$64.80 ,$8.66 ,$18.25 ,$18.25 ,$15.21 ,$18.25 ,$15.21 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$48.96 ,$49.64 ,$21.90 ,$57.80 ,$12.88 ,$21.90 ,$57.80 ,$49.64 ,$3.28 ,$12.88 ,$14.58 ,$57.80 ,$28.98 ,$62.56 ,$47.60 ,$28.26 ,$30.38 ,$41.41 ,$28.26 ,$46.99 ,$48.96 ,$47.36 ,$13.01 ,$48.96 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$40.80 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$21.90 ,$102.00 ,$12.88 ,$21.90 ,$102.00 ,$87.60 ,$3.28 ,$12.88 ,$14.58 ,$102.00 ,$28.98 ,$110.40 ,$84.00 ,$28.26 ,$30.38 ,$73.08 ,$28.26 ,$82.92 ,$86.40 ,$83.58 ,$13.01 ,$86.40 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$48.96 ,$49.64 ,$21.90 ,$57.80 ,$12.88 ,$21.90 ,$57.80 ,$49.64 ,$3.28 ,$12.88 ,$14.58 ,$57.80 ,$28.98 ,$62.56 ,$47.60 ,$28.26 ,$30.38 ,$41.41 ,$28.26 ,$46.99 ,$48.96 ,$47.36 ,$13.01 ,$48.96 ,$3.48 ,$15.46 ,$15.46 ,$12.88 ,$15.46 ,$12.88 ,$48.96 ,$42.16 ,$48.96 ,$48.96 ,$40.80 
ST MARY'S HOSPITAL,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 ,$105.84 ,$107.31 ,$20.83 ,$124.95 ,$12.25 ,$20.83 ,$124.95 ,$107.31 ,$7.15 ,$12.25 ,$13.86 ,$124.95 ,$27.56 ,$135.24 ,$102.90 ,$24.73 ,$26.59 ,$89.52 ,$24.73 ,$101.58 ,$105.84 ,$102.39 ,$12.37 ,$105.84 ,$7.58 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$12.25 ,$105.84 ,$91.14 ,$105.84 ,$105.84 ,$88.20 
ST MARY'S HOSPITAL,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 ","$1,290.24 ","$1,308.16 ",$28.71 ,"$1,523.20 ",$16.89 ,$28.71 ,"$1,523.20 ","$1,308.16 ",$15.79 ,$16.89 ,$19.12 ,"$1,523.20 ",$38.00 ,"$1,648.64 ","$1,254.40 ",$69.99 ,$75.25 ,"$1,091.33 ",$69.99 ,"$1,238.27 ","$1,290.24 ","$1,248.13 ",$17.06 ,"$1,290.24 ",$16.74 ,$20.27 ,$20.27 ,$16.89 ,$20.27 ,$16.89 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,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 ,$505.44 ,$512.46 ,$28.71 ,$596.70 ,$16.89 ,$28.71 ,$596.70 ,$512.46 ,$15.79 ,$16.89 ,$19.12 ,$596.70 ,$38.00 ,$645.84 ,$491.40 ,$69.99 ,$75.25 ,$427.52 ,$69.99 ,$485.08 ,$505.44 ,$488.94 ,$17.06 ,$505.44 ,$16.74 ,$20.27 ,$20.27 ,$16.89 ,$20.27 ,$16.89 ,$505.44 ,$435.24 ,$505.44 ,$505.44 ,$421.20 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$78.80 ,$91.80 ,$46.35 ,$78.80 ,$91.80 ,$78.84 ,$9.51 ,$46.35 ,$52.46 ,$91.80 ,$104.29 ,$99.36 ,$75.60 ,$69.28 ,$74.49 ,$65.77 ,$69.28 ,$74.63 ,$77.76 ,$75.22 ,$46.81 ,$77.76 ,$10.08 ,$55.62 ,$55.62 ,$46.35 ,$55.62 ,$46.35 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.42 ,$85.85 ,$13.19 ,$22.42 ,$85.85 ,$73.73 ,$13.63 ,$13.19 ,$14.93 ,$85.85 ,$29.68 ,$92.92 ,$70.70 ,$64.15 ,$68.97 ,$61.51 ,$64.15 ,$69.79 ,$72.72 ,$70.35 ,$13.32 ,$72.72 ,$14.45 ,$15.83 ,$15.83 ,$13.19 ,$15.83 ,$13.19 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$32.90 ,$124.10 ,$19.35 ,$32.90 ,$124.10 ,$106.58 ,$19.99 ,$19.35 ,$21.90 ,$124.10 ,$43.54 ,$134.32 ,$102.20 ,$94.08 ,$101.15 ,$88.91 ,$94.08 ,$100.89 ,$105.12 ,$101.69 ,$19.54 ,$105.12 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$26.64 ,$27.01 ,$30.48 ,$31.45 ,$17.93 ,$30.48 ,$31.45 ,$27.01 ,$17.71 ,$17.93 ,$20.29 ,$31.45 ,$40.34 ,$34.04 ,$25.90 ,$37.00 ,$37.00 ,$22.53 ,$37.00 ,$25.57 ,$26.64 ,$25.77 ,$18.11 ,$26.64 ,$18.77 ,$21.52 ,$21.52 ,$17.93 ,$21.52 ,$17.93 ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$22.20 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$170.00 ,$247.35 ,$100.00 ,$170.00 ,$247.35 ,$212.43 ,$90.12 ,$100.00 ,$113.18 ,$247.35 ,$225.00 ,$267.72 ,$203.70 ,$291.00 ,$291.00 ,$177.22 ,$291.00 ,$201.08 ,$209.52 ,$202.68 ,$101.00 ,$209.52 ,$95.53 ,$120.00 ,$120.00 ,$100.00 ,$120.00 ,$100.00 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$25.48 ,$76.50 ,$14.99 ,$25.48 ,$76.50 ,$65.70 ,$15.49 ,$14.99 ,$16.97 ,$76.50 ,$33.73 ,$82.80 ,$63.00 ,$72.88 ,$78.36 ,$54.81 ,$72.88 ,$62.19 ,$64.80 ,$62.69 ,$15.14 ,$64.80 ,$16.42 ,$17.99 ,$17.99 ,$14.99 ,$17.99 ,$14.99 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$30.96 ,$31.39 ,$22.51 ,$36.55 ,$13.24 ,$22.51 ,$36.55 ,$31.39 ,$11.13 ,$13.24 ,$14.99 ,$36.55 ,$29.79 ,$39.56 ,$30.10 ,$38.49 ,$41.38 ,$26.19 ,$38.49 ,$29.71 ,$30.96 ,$29.95 ,$13.37 ,$30.96 ,$11.80 ,$15.89 ,$15.89 ,$13.24 ,$15.89 ,$13.24 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,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 ,$100.80 ,$102.20 ,$20.49 ,$119.00 ,$12.05 ,$20.49 ,$119.00 ,$102.20 ,$12.45 ,$12.05 ,$13.64 ,$119.00 ,$27.11 ,$128.80 ,$98.00 ,$58.59 ,$62.99 ,$85.26 ,$58.59 ,$96.74 ,$100.80 ,$97.51 ,$12.17 ,$100.80 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$84.00 
ST MARY'S HOSPITAL,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 ,$387.36 ,$392.74 ,$119.34 ,$457.30 ,$70.20 ,$119.34 ,$457.30 ,$392.74 ,$50.62 ,$70.20 ,$79.45 ,$457.30 ,$157.95 ,$494.96 ,$376.60 ,$341.27 ,$366.91 ,$327.64 ,$341.27 ,$371.76 ,$387.36 ,$374.72 ,$70.90 ,$387.36 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$70.20 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$322.80 
ST MARY'S HOSPITAL,30201171,86255,HC FLUORESCENT ANTIBODY SCREEN,302,1 ,$900.00 ,$450.00 ,$12.05 ,$900.00 ,$12.45 ,$46.87 ,$40.17 ,$12.05 ,$540.00 ,$765.00 ,$630.00 ,$12.45 ,$855.00 ,$648.00 ,$657.00 ,$20.49 ,$765.00 ,$12.05 ,$20.49 ,$765.00 ,$657.00 ,$12.45 ,$12.05 ,$13.64 ,$765.00 ,$27.11 ,$828.00 ,$630.00 ,$58.59 ,$62.99 ,$548.10 ,$58.59 ,$621.90 ,$648.00 ,$626.85 ,$12.17 ,$648.00 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$648.00 ,$558.00 ,$648.00 ,$648.00 ,$540.00 
ST MARY'S HOSPITAL,30201172,86256,HC FLUORESCENT ANTIBODY TITER,302,1 ,"$1,179.28 ",$589.64 ,$12.05 ,"$1,179.28 ",$12.45 ,$46.87 ,$40.17 ,$12.05 ,$707.57 ,"$1,002.39 ",$825.50 ,$12.45 ,"$1,120.32 ",$849.08 ,$860.87 ,$20.49 ,"$1,002.39 ",$12.05 ,$20.49 ,"$1,002.39 ",$860.87 ,$12.45 ,$12.05 ,$13.64 ,"$1,002.39 ",$27.11 ,"$1,084.94 ",$825.50 ,$58.59 ,$62.99 ,$718.18 ,$58.59 ,$814.88 ,$849.08 ,$821.37 ,$12.17 ,$849.08 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$849.08 ,$731.15 ,$849.08 ,$849.08 ,$707.57 
ST MARY'S HOSPITAL,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 ,$12.96 ,$13.14 ,$18.00 ,$15.30 ,$12.05 ,$18.00 ,$15.30 ,$13.14 ,$12.45 ,$12.05 ,$13.64 ,$15.30 ,$27.11 ,$16.56 ,$12.60 ,$18.00 ,$18.00 ,$10.96 ,$18.00 ,$12.44 ,$12.96 ,$12.54 ,$12.17 ,$12.96 ,$13.20 ,$14.46 ,$14.46 ,$12.05 ,$14.46 ,$12.05 ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$10.80 
ST MARY'S HOSPITAL,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 ,$7.27 ,$7.37 ,$8.87 ,$8.59 ,$5.22 ,$8.87 ,$8.59 ,$7.37 ,$4.57 ,$5.22 ,$5.91 ,$8.59 ,$11.75 ,$9.29 ,$7.07 ,$10.10 ,$10.10 ,$6.15 ,$10.10 ,$6.98 ,$7.27 ,$7.03 ,$5.27 ,$7.27 ,$4.84 ,$6.26 ,$6.26 ,$5.22 ,$6.26 ,$5.22 ,$7.27 ,$6.26 ,$7.27 ,$7.27 ,$6.06 
ST MARY'S HOSPITAL,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 ,$7.20 ,$7.30 ,$10.00 ,$8.50 ,$8.06 ,$10.00 ,$8.50 ,$7.30 ,$8.17 ,$8.06 ,$9.12 ,$8.50 ,$18.14 ,$9.20 ,$7.00 ,$10.00 ,$10.00 ,$6.09 ,$10.00 ,$6.91 ,$7.20 ,$6.97 ,$8.14 ,$7.20 ,$8.66 ,$9.67 ,$9.67 ,$8.06 ,$9.67 ,$8.06 ,$7.20 ,$6.20 ,$7.20 ,$7.20 ,$6.00 
ST MARY'S HOSPITAL,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 ,$14.40 ,$14.60 ,$19.62 ,$17.00 ,$11.54 ,$19.62 ,$17.00 ,$14.60 ,$11.92 ,$11.54 ,$13.06 ,$17.00 ,$25.97 ,$18.40 ,$14.00 ,$20.00 ,$20.00 ,$12.18 ,$20.00 ,$13.82 ,$14.40 ,$13.93 ,$11.66 ,$14.40 ,$12.64 ,$13.85 ,$13.85 ,$11.54 ,$13.85 ,$11.54 ,$14.40 ,$12.40 ,$14.40 ,$14.40 ,$12.00 
ST MARY'S HOSPITAL,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 ,$102.96 ,$104.39 ,$17.31 ,$121.55 ,$10.18 ,$17.31 ,$121.55 ,$104.39 ,$10.52 ,$10.18 ,$11.52 ,$121.55 ,$22.91 ,$131.56 ,$100.10 ,$49.54 ,$53.26 ,$87.09 ,$49.54 ,$98.81 ,$102.96 ,$99.60 ,$10.28 ,$102.96 ,$11.15 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$102.96 ,$88.66 ,$102.96 ,$102.96 ,$85.80 
ST MARY'S HOSPITAL,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 ,$92.88 ,$94.17 ,$8.19 ,$109.65 ,$4.82 ,$8.19 ,$109.65 ,$94.17 ,$4.77 ,$4.82 ,$5.46 ,$109.65 ,$10.85 ,$118.68 ,$90.30 ,$16.50 ,$17.74 ,$78.56 ,$16.50 ,$89.14 ,$92.88 ,$89.85 ,$4.87 ,$92.88 ,$5.06 ,$5.78 ,$5.78 ,$4.82 ,$5.78 ,$4.82 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$30.96 ,$31.39 ,$11.00 ,$36.55 ,$6.47 ,$11.00 ,$36.55 ,$31.39 ,$6.69 ,$6.47 ,$7.32 ,$36.55 ,$14.56 ,$39.56 ,$30.10 ,$31.47 ,$33.83 ,$26.19 ,$31.47 ,$29.71 ,$30.96 ,$29.95 ,$6.53 ,$30.96 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,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 ,$25.20 ,$25.55 ,$6.46 ,$29.75 ,$3.80 ,$6.46 ,$29.75 ,$25.55 ,$3.93 ,$3.80 ,$4.30 ,$29.75 ,$8.55 ,$32.20 ,$24.50 ,$16.71 ,$17.97 ,$21.32 ,$16.71 ,$24.19 ,$25.20 ,$24.38 ,$3.84 ,$25.20 ,$4.17 ,$4.56 ,$4.56 ,$3.80 ,$4.56 ,$3.80 ,$25.20 ,$21.70 ,$25.20 ,$25.20 ,$21.00 
ST MARY'S HOSPITAL,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 ,$12.96 ,$13.14 ,$4.03 ,$15.30 ,$2.37 ,$4.03 ,$15.30 ,$13.14 ,$2.45 ,$2.37 ,$2.68 ,$15.30 ,$5.33 ,$16.56 ,$12.60 ,$11.51 ,$12.38 ,$10.96 ,$11.51 ,$12.44 ,$12.96 ,$12.54 ,$2.39 ,$12.96 ,$2.60 ,$2.84 ,$2.84 ,$2.37 ,$2.84 ,$2.37 ,$12.96 ,$11.16 ,$12.96 ,$12.96 ,$10.80 
ST MARY'S HOSPITAL,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 ,$13.68 ,$13.87 ,$4.03 ,$16.15 ,$2.37 ,$4.03 ,$16.15 ,$13.87 ,$2.45 ,$2.37 ,$2.68 ,$16.15 ,$5.33 ,$17.48 ,$13.30 ,$11.51 ,$12.38 ,$11.57 ,$11.51 ,$13.13 ,$13.68 ,$13.23 ,$2.39 ,$13.68 ,$2.60 ,$2.84 ,$2.84 ,$2.37 ,$2.84 ,$2.37 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$11.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.21 ,$56.95 ,$7.77 ,$13.21 ,$56.95 ,$48.91 ,$8.03 ,$7.77 ,$8.79 ,$56.95 ,$17.48 ,$61.64 ,$46.90 ,$37.81 ,$40.65 ,$40.80 ,$37.81 ,$46.30 ,$48.24 ,$46.67 ,$7.85 ,$48.24 ,$8.51 ,$9.32 ,$9.32 ,$7.77 ,$9.32 ,$7.77 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$11.00 ,$41.65 ,$6.47 ,$11.00 ,$41.65 ,$35.77 ,$6.69 ,$6.47 ,$7.32 ,$41.65 ,$14.56 ,$45.08 ,$34.30 ,$31.47 ,$33.83 ,$29.84 ,$31.47 ,$33.86 ,$35.28 ,$34.13 ,$6.53 ,$35.28 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$11.00 ,$41.65 ,$6.47 ,$11.00 ,$41.65 ,$35.77 ,$6.69 ,$6.47 ,$7.32 ,$41.65 ,$14.56 ,$45.08 ,$34.30 ,$31.47 ,$33.83 ,$29.84 ,$31.47 ,$33.86 ,$35.28 ,$34.13 ,$6.53 ,$35.28 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$7.33 ,$124.10 ,$4.31 ,$7.33 ,$124.10 ,$106.58 ,$4.45 ,$4.31 ,$4.88 ,$124.10 ,$9.70 ,$134.32 ,$102.20 ,$20.92 ,$22.49 ,$88.91 ,$20.92 ,$100.89 ,$105.12 ,$101.69 ,$4.35 ,$105.12 ,$4.72 ,$5.17 ,$5.17 ,$4.31 ,$5.17 ,$4.31 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$24.48 ,$24.82 ,$6.78 ,$28.90 ,$3.99 ,$6.78 ,$28.90 ,$24.82 ,$4.12 ,$3.99 ,$4.52 ,$28.90 ,$8.98 ,$31.28 ,$23.80 ,$19.42 ,$20.88 ,$20.71 ,$19.42 ,$23.49 ,$24.48 ,$23.68 ,$4.03 ,$24.48 ,$4.37 ,$4.79 ,$4.79 ,$3.99 ,$4.79 ,$3.99 ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$20.40 
ST MARY'S HOSPITAL,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 ,$13.68 ,$13.87 ,$4.32 ,$16.15 ,$2.54 ,$4.32 ,$16.15 ,$13.87 ,$2.62 ,$2.54 ,$2.87 ,$16.15 ,$5.72 ,$17.48 ,$13.30 ,$12.33 ,$13.26 ,$11.57 ,$12.33 ,$13.13 ,$13.68 ,$13.23 ,$2.57 ,$13.68 ,$2.78 ,$3.05 ,$3.05 ,$2.54 ,$3.05 ,$2.54 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$11.40 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$7.62 ,$32.30 ,$4.48 ,$7.62 ,$32.30 ,$27.74 ,$4.63 ,$4.48 ,$5.07 ,$32.30 ,$10.08 ,$34.96 ,$26.60 ,$21.77 ,$23.41 ,$23.14 ,$21.77 ,$26.26 ,$27.36 ,$26.47 ,$4.52 ,$27.36 ,$4.91 ,$5.38 ,$5.38 ,$4.48 ,$5.38 ,$4.48 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,30500116,85097,HC BONE MARROW SMEAR INTERP,305,1 ,$457.00 ,$228.50 ,$12.46 ,"$1,433.98 ",$12.46 ,$172.66 ,$148.00 ,$637.32 ,$274.20 ,$388.45 ,$319.90 ,$12.46 ,$434.15 ,$329.04 ,$333.61 ,$112.69 ,$388.45 ,$637.32 ,$112.69 ,$388.45 ,$333.61 ,$12.46 ,$637.32 ,$191.94 ,$388.45 ,"$1,433.98 ",$420.44 ,$319.90 ,$140.48 ,$151.04 ,$278.31 ,$140.48 ,$315.79 ,$329.04 ,$318.30 ,$643.69 ,$329.04 ,$13.21 ,$457.00 ,$457.00 ,$637.32 ,$457.00 ,$637.32 ,$329.04 ,$283.34 ,$329.04 ,$329.04 ,$274.20 
ST MARY'S HOSPITAL,30500117,85097,HC BONE MARROW SMEAR INTERP (MAYO),305,1 ,$457.00 ,$228.50 ,$12.46 ,"$1,433.98 ",$12.46 ,$172.66 ,$148.00 ,$637.32 ,$274.20 ,$388.45 ,$319.90 ,$12.46 ,$434.15 ,$329.04 ,$333.61 ,$112.69 ,$388.45 ,$637.32 ,$112.69 ,$388.45 ,$333.61 ,$12.46 ,$637.32 ,$191.94 ,$388.45 ,"$1,433.98 ",$420.44 ,$319.90 ,$140.48 ,$151.04 ,$278.31 ,$140.48 ,$315.79 ,$329.04 ,$318.30 ,$643.69 ,$329.04 ,$13.21 ,$457.00 ,$457.00 ,$637.32 ,$457.00 ,$637.32 ,$329.04 ,$283.34 ,$329.04 ,$329.04 ,$274.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$34.63 ,$66.30 ,$20.37 ,$34.63 ,$66.30 ,$56.94 ,$6.40 ,$20.37 ,$23.05 ,$66.30 ,$45.83 ,$71.76 ,$54.60 ,$22.13 ,$23.79 ,$47.50 ,$22.13 ,$53.90 ,$56.16 ,$54.33 ,$20.57 ,$56.16 ,$6.78 ,$24.44 ,$24.44 ,$20.37 ,$24.44 ,$20.37 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$4.03 ,$137.70 ,$2.37 ,$4.03 ,$137.70 ,$118.26 ,$2.45 ,$2.37 ,$2.68 ,$137.70 ,$5.33 ,$149.04 ,$113.40 ,$11.51 ,$12.38 ,$98.66 ,$11.51 ,$111.94 ,$116.64 ,$112.83 ,$2.39 ,$116.64 ,$2.60 ,$2.84 ,$2.84 ,$2.37 ,$2.84 ,$2.37 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$22.07 ,$85.85 ,$12.98 ,$22.07 ,$85.85 ,$73.73 ,$8.17 ,$12.98 ,$14.69 ,$85.85 ,$29.21 ,$92.92 ,$70.70 ,$28.26 ,$30.38 ,$61.51 ,$28.26 ,$69.79 ,$72.72 ,$70.35 ,$13.11 ,$72.72 ,$8.66 ,$15.58 ,$15.58 ,$12.98 ,$15.58 ,$12.98 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$30.01 ,$142.80 ,$17.65 ,$30.01 ,$142.80 ,$122.64 ,$18.24 ,$17.65 ,$19.98 ,$142.80 ,$39.71 ,$154.56 ,$117.60 ,$85.78 ,$92.23 ,$102.31 ,$85.78 ,$116.09 ,$120.96 ,$117.01 ,$17.83 ,$120.96 ,$19.33 ,$21.18 ,$21.18 ,$17.65 ,$21.18 ,$17.65 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$30.43 ,$142.80 ,$17.90 ,$30.43 ,$142.80 ,$122.64 ,$18.50 ,$17.90 ,$20.26 ,$142.80 ,$40.28 ,$154.56 ,$117.60 ,$87.06 ,$93.61 ,$102.31 ,$87.06 ,$116.09 ,$120.96 ,$117.01 ,$18.08 ,$120.96 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$30.43 ,$85.85 ,$17.90 ,$30.43 ,$85.85 ,$73.73 ,$9.84 ,$17.90 ,$20.26 ,$85.85 ,$40.28 ,$92.92 ,$70.70 ,$34.00 ,$36.55 ,$61.51 ,$34.00 ,$69.79 ,$72.72 ,$70.35 ,$18.08 ,$72.72 ,$10.43 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$131.76 ,$133.59 ,$30.43 ,$155.55 ,$17.90 ,$30.43 ,$155.55 ,$133.59 ,$9.84 ,$17.90 ,$20.26 ,$155.55 ,$40.28 ,$168.36 ,$128.10 ,$34.00 ,$36.55 ,$111.45 ,$34.00 ,$126.45 ,$131.76 ,$127.46 ,$18.08 ,$131.76 ,$10.43 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,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 ,$133.92 ,$135.78 ,$39.00 ,$158.10 ,$22.94 ,$39.00 ,$158.10 ,$135.78 ,$23.70 ,$22.94 ,$25.96 ,$158.10 ,$51.62 ,$171.12 ,$130.20 ,$111.55 ,$119.93 ,$113.27 ,$111.55 ,$128.53 ,$133.92 ,$129.55 ,$23.17 ,$133.92 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$133.92 ,$115.32 ,$133.92 ,$133.92 ,$111.60 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$39.00 ,$152.15 ,$22.94 ,$39.00 ,$152.15 ,$130.67 ,$23.70 ,$22.94 ,$25.96 ,$152.15 ,$51.62 ,$164.68 ,$125.30 ,$111.55 ,$119.93 ,$109.01 ,$111.55 ,$123.69 ,$128.88 ,$124.67 ,$23.17 ,$128.88 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$39.00 ,$133.45 ,$22.94 ,$39.00 ,$133.45 ,$114.61 ,$23.70 ,$22.94 ,$25.96 ,$133.45 ,$51.62 ,$144.44 ,$109.90 ,$111.55 ,$119.93 ,$95.61 ,$111.55 ,$108.49 ,$113.04 ,$109.35 ,$23.17 ,$113.04 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$139.68 ,$141.62 ,$39.00 ,$164.90 ,$22.94 ,$39.00 ,$164.90 ,$141.62 ,$23.70 ,$22.94 ,$25.96 ,$164.90 ,$51.62 ,$178.48 ,$135.80 ,$111.55 ,$119.93 ,$118.15 ,$111.55 ,$134.05 ,$139.68 ,$135.12 ,$23.17 ,$139.68 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$116.40 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$39.00 ,$181.05 ,$22.94 ,$39.00 ,$181.05 ,$155.49 ,$23.70 ,$22.94 ,$25.96 ,$181.05 ,$51.62 ,$195.96 ,$149.10 ,$111.55 ,$119.93 ,$129.72 ,$111.55 ,$147.18 ,$153.36 ,$148.35 ,$23.17 ,$153.36 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$32.37 ,$190.40 ,$19.04 ,$32.37 ,$190.40 ,$163.52 ,$19.67 ,$19.04 ,$21.55 ,$190.40 ,$42.84 ,$206.08 ,$156.80 ,$92.55 ,$99.51 ,$136.42 ,$92.55 ,$154.78 ,$161.28 ,$156.02 ,$19.23 ,$161.28 ,$20.85 ,$22.85 ,$22.85 ,$19.04 ,$22.85 ,$19.04 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$159.84 ,$162.06 ,$32.37 ,$188.70 ,$19.04 ,$32.37 ,$188.70 ,$162.06 ,$19.67 ,$19.04 ,$21.55 ,$188.70 ,$42.84 ,$204.24 ,$155.40 ,$92.55 ,$99.51 ,$135.20 ,$92.55 ,$153.40 ,$159.84 ,$154.62 ,$19.23 ,$159.84 ,$20.85 ,$22.85 ,$22.85 ,$19.04 ,$22.85 ,$19.04 ,$159.84 ,$137.64 ,$159.84 ,$159.84 ,$133.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$30.43 ,$133.45 ,$17.90 ,$30.43 ,$133.45 ,$114.61 ,$18.50 ,$17.90 ,$20.26 ,$133.45 ,$40.28 ,$144.44 ,$109.90 ,$87.06 ,$93.61 ,$95.61 ,$87.06 ,$108.49 ,$113.04 ,$109.35 ,$18.08 ,$113.04 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$30.43 ,$142.80 ,$17.90 ,$30.43 ,$142.80 ,$122.64 ,$18.50 ,$17.90 ,$20.26 ,$142.80 ,$40.28 ,$154.56 ,$117.60 ,$87.06 ,$93.61 ,$102.31 ,$87.06 ,$116.09 ,$120.96 ,$117.01 ,$18.08 ,$120.96 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$32.90 ,$104.55 ,$19.35 ,$32.90 ,$104.55 ,$89.79 ,$19.99 ,$19.35 ,$21.90 ,$104.55 ,$43.54 ,$113.16 ,$86.10 ,$94.08 ,$101.15 ,$74.91 ,$94.08 ,$84.99 ,$88.56 ,$85.67 ,$19.54 ,$88.56 ,$21.19 ,$23.22 ,$23.22 ,$19.35 ,$23.22 ,$19.35 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$15.49 ,$47.60 ,$9.11 ,$15.49 ,$47.60 ,$40.88 ,$9.41 ,$9.11 ,$10.31 ,$47.60 ,$20.50 ,$51.52 ,$39.20 ,$43.26 ,$46.52 ,$34.10 ,$43.26 ,$38.70 ,$40.32 ,$39.00 ,$9.20 ,$40.32 ,$9.97 ,$10.93 ,$10.93 ,$9.11 ,$10.93 ,$9.11 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$20.15 ,$124.10 ,$11.85 ,$20.15 ,$124.10 ,$106.58 ,$12.24 ,$11.85 ,$13.41 ,$124.10 ,$26.66 ,$134.32 ,$102.20 ,$57.63 ,$61.96 ,$88.91 ,$57.63 ,$100.89 ,$105.12 ,$101.69 ,$11.97 ,$105.12 ,$12.97 ,$14.22 ,$14.22 ,$11.85 ,$14.22 ,$11.85 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$18.38 ,$85.85 ,$10.81 ,$18.38 ,$85.85 ,$73.73 ,$11.17 ,$10.81 ,$12.23 ,$85.85 ,$24.32 ,$92.92 ,$70.70 ,$52.57 ,$56.52 ,$61.51 ,$52.57 ,$69.79 ,$72.72 ,$70.35 ,$10.92 ,$72.72 ,$11.84 ,$12.97 ,$12.97 ,$10.81 ,$12.97 ,$10.81 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$20.42 ,$124.10 ,$12.01 ,$20.42 ,$124.10 ,$106.58 ,$12.41 ,$12.01 ,$13.59 ,$124.10 ,$27.02 ,$134.32 ,$102.20 ,$58.45 ,$62.84 ,$88.91 ,$58.45 ,$100.89 ,$105.12 ,$101.69 ,$12.13 ,$105.12 ,$13.15 ,$14.41 ,$14.41 ,$12.01 ,$14.41 ,$12.01 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$23.53 ,$104.55 ,$13.84 ,$23.53 ,$104.55 ,$89.79 ,$14.30 ,$13.84 ,$15.66 ,$104.55 ,$31.14 ,$113.16 ,$86.10 ,$67.25 ,$72.30 ,$74.91 ,$67.25 ,$84.99 ,$88.56 ,$85.67 ,$13.98 ,$88.56 ,$15.16 ,$16.61 ,$16.61 ,$13.84 ,$16.61 ,$13.84 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$62.64 ,$63.51 ,$23.53 ,$73.95 ,$13.84 ,$23.53 ,$73.95 ,$63.51 ,$14.30 ,$13.84 ,$15.66 ,$73.95 ,$31.14 ,$80.04 ,$60.90 ,$67.25 ,$72.30 ,$52.98 ,$67.25 ,$60.12 ,$62.64 ,$60.60 ,$13.98 ,$62.64 ,$15.16 ,$16.61 ,$16.61 ,$13.84 ,$16.61 ,$13.84 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$52.20 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$19.74 ,$124.10 ,$11.61 ,$19.74 ,$124.10 ,$106.58 ,$12.00 ,$11.61 ,$13.14 ,$124.10 ,$26.12 ,$134.32 ,$102.20 ,$56.41 ,$60.65 ,$88.91 ,$56.41 ,$100.89 ,$105.12 ,$101.69 ,$11.73 ,$105.12 ,$12.72 ,$13.93 ,$13.93 ,$11.61 ,$13.93 ,$11.61 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$26.04 ,$113.90 ,$15.32 ,$26.04 ,$113.90 ,$97.82 ,$15.83 ,$15.32 ,$17.34 ,$113.90 ,$34.47 ,$123.28 ,$93.80 ,$69.46 ,$74.68 ,$81.61 ,$69.46 ,$92.59 ,$96.48 ,$93.33 ,$15.47 ,$96.48 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$15.32 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$26.04 ,$124.10 ,$15.32 ,$26.04 ,$124.10 ,$106.58 ,$15.83 ,$15.32 ,$17.34 ,$124.10 ,$34.47 ,$134.32 ,$102.20 ,$69.46 ,$74.68 ,$88.91 ,$69.46 ,$100.89 ,$105.12 ,$101.69 ,$15.47 ,$105.12 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$15.32 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$123.12 ,$124.83 ,$26.04 ,$145.35 ,$15.32 ,$26.04 ,$145.35 ,$124.83 ,$15.83 ,$15.32 ,$17.34 ,$145.35 ,$34.47 ,$157.32 ,$119.70 ,$69.46 ,$74.68 ,$104.14 ,$69.46 ,$118.16 ,$123.12 ,$119.10 ,$15.47 ,$123.12 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$15.32 ,$123.12 ,$106.02 ,$123.12 ,$123.12 ,$102.60 
ST MARY'S HOSPITAL,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 ,$128.16 ,$129.94 ,$26.04 ,$151.30 ,$15.32 ,$26.04 ,$151.30 ,$129.94 ,$15.83 ,$15.32 ,$17.34 ,$151.30 ,$34.47 ,$163.76 ,$124.60 ,$69.46 ,$74.68 ,$108.40 ,$69.46 ,$123.00 ,$128.16 ,$123.98 ,$15.47 ,$128.16 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$15.32 ,$128.16 ,$110.36 ,$128.16 ,$128.16 ,$106.80 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$26.04 ,$113.90 ,$15.32 ,$26.04 ,$113.90 ,$97.82 ,$15.83 ,$15.32 ,$17.34 ,$113.90 ,$34.47 ,$123.28 ,$93.80 ,$69.46 ,$74.68 ,$81.61 ,$69.46 ,$92.59 ,$96.48 ,$93.33 ,$15.47 ,$96.48 ,$16.78 ,$18.38 ,$18.38 ,$15.32 ,$18.38 ,$15.32 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$21.88 ,$190.40 ,$12.87 ,$21.88 ,$190.40 ,$163.52 ,$13.30 ,$12.87 ,$14.57 ,$190.40 ,$28.96 ,$206.08 ,$156.80 ,$62.58 ,$67.28 ,$136.42 ,$62.58 ,$154.78 ,$161.28 ,$156.02 ,$13.00 ,$161.28 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$164.16 ,$166.44 ,$21.88 ,$193.80 ,$12.87 ,$21.88 ,$193.80 ,$166.44 ,$13.30 ,$12.87 ,$14.57 ,$193.80 ,$28.96 ,$209.76 ,$159.60 ,$62.58 ,$67.28 ,$138.85 ,$62.58 ,$157.55 ,$164.16 ,$158.80 ,$13.00 ,$164.16 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$164.16 ,$141.36 ,$164.16 ,$164.16 ,$136.80 
ST MARY'S HOSPITAL,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 ,$189.36 ,$191.99 ,$21.88 ,$223.55 ,$12.87 ,$21.88 ,$223.55 ,$191.99 ,$13.30 ,$12.87 ,$14.57 ,$223.55 ,$28.96 ,$241.96 ,$184.10 ,$62.58 ,$67.28 ,$160.17 ,$62.58 ,$181.73 ,$189.36 ,$183.18 ,$13.00 ,$189.36 ,$14.10 ,$15.44 ,$15.44 ,$12.87 ,$15.44 ,$12.87 ,$189.36 ,$163.06 ,$189.36 ,$189.36 ,$157.80 
ST MARY'S HOSPITAL,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 ,$75.60 ,$76.65 ,$7.28 ,$89.25 ,$4.28 ,$7.28 ,$89.25 ,$76.65 ,$4.42 ,$4.28 ,$4.84 ,$89.25 ,$9.63 ,$96.60 ,$73.50 ,$20.71 ,$22.26 ,$63.95 ,$20.71 ,$72.56 ,$75.60 ,$73.13 ,$4.32 ,$75.60 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$4.28 ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$63.00 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$7.28 ,$66.30 ,$4.28 ,$7.28 ,$66.30 ,$56.94 ,$4.42 ,$4.28 ,$4.84 ,$66.30 ,$9.63 ,$71.76 ,$54.60 ,$20.71 ,$22.26 ,$47.50 ,$20.71 ,$53.90 ,$56.16 ,$54.33 ,$4.32 ,$56.16 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$4.28 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$7.28 ,$56.95 ,$4.28 ,$7.28 ,$56.95 ,$48.91 ,$4.42 ,$4.28 ,$4.84 ,$56.95 ,$9.63 ,$61.64 ,$46.90 ,$20.71 ,$22.26 ,$40.80 ,$20.71 ,$46.30 ,$48.24 ,$46.67 ,$4.32 ,$48.24 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$4.28 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$19.44 ,$19.71 ,$7.28 ,$22.95 ,$4.28 ,$7.28 ,$22.95 ,$19.71 ,$4.42 ,$4.28 ,$4.84 ,$22.95 ,$9.63 ,$24.84 ,$18.90 ,$20.71 ,$22.26 ,$16.44 ,$20.71 ,$18.66 ,$19.44 ,$18.81 ,$4.32 ,$19.44 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$4.28 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$16.20 
ST MARY'S HOSPITAL,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 ,$15.84 ,$16.06 ,$7.28 ,$18.70 ,$4.28 ,$7.28 ,$18.70 ,$16.06 ,$4.42 ,$4.28 ,$4.84 ,$18.70 ,$9.63 ,$20.24 ,$15.40 ,$20.71 ,$22.00 ,$13.40 ,$20.71 ,$15.20 ,$15.84 ,$15.32 ,$4.32 ,$15.84 ,$4.69 ,$5.14 ,$5.14 ,$4.28 ,$5.14 ,$4.28 ,$15.84 ,$13.64 ,$15.84 ,$15.84 ,$13.20 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$11.71 ,$45.05 ,$6.89 ,$11.71 ,$45.05 ,$38.69 ,$7.12 ,$6.89 ,$7.80 ,$45.05 ,$15.50 ,$48.76 ,$37.10 ,$33.50 ,$36.02 ,$32.28 ,$33.50 ,$36.62 ,$38.16 ,$36.91 ,$6.96 ,$38.16 ,$7.55 ,$8.27 ,$8.27 ,$6.89 ,$8.27 ,$6.89 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$17.31 ,$66.30 ,$10.18 ,$17.31 ,$66.30 ,$56.94 ,$10.52 ,$10.18 ,$11.52 ,$66.30 ,$22.91 ,$71.76 ,$54.60 ,$39.42 ,$42.38 ,$47.50 ,$39.42 ,$53.90 ,$56.16 ,$54.33 ,$10.28 ,$56.16 ,$11.15 ,$12.22 ,$12.22 ,$10.18 ,$12.22 ,$10.18 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.52 ,$66.30 ,$9.72 ,$16.52 ,$66.30 ,$56.94 ,$10.04 ,$9.72 ,$11.00 ,$66.30 ,$21.87 ,$71.76 ,$54.60 ,$41.27 ,$44.37 ,$47.50 ,$41.27 ,$53.90 ,$56.16 ,$54.33 ,$9.82 ,$56.16 ,$10.64 ,$11.66 ,$11.66 ,$9.72 ,$11.66 ,$9.72 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$16.52 ,$56.95 ,$9.72 ,$16.52 ,$56.95 ,$48.91 ,$10.04 ,$9.72 ,$11.00 ,$56.95 ,$21.87 ,$61.64 ,$46.90 ,$41.27 ,$44.37 ,$40.80 ,$41.27 ,$46.30 ,$48.24 ,$46.67 ,$9.82 ,$48.24 ,$10.64 ,$11.66 ,$11.66 ,$9.72 ,$11.66 ,$9.72 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$24.58 ,$56.95 ,$14.46 ,$24.58 ,$56.95 ,$48.91 ,$11.94 ,$14.46 ,$16.37 ,$56.95 ,$32.54 ,$61.64 ,$46.90 ,$41.27 ,$44.37 ,$40.80 ,$41.27 ,$46.30 ,$48.24 ,$46.67 ,$14.60 ,$48.24 ,$12.66 ,$17.35 ,$17.35 ,$14.46 ,$17.35 ,$14.46 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$13.11 ,$171.70 ,$7.71 ,$13.11 ,$171.70 ,$147.46 ,$7.97 ,$7.71 ,$8.73 ,$171.70 ,$17.35 ,$185.84 ,$141.40 ,$37.49 ,$40.31 ,$123.02 ,$37.49 ,$139.58 ,$145.44 ,$140.69 ,$7.79 ,$145.44 ,$8.45 ,$9.25 ,$9.25 ,$7.71 ,$9.25 ,$7.71 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$180.00 ,$182.50 ,$29.22 ,$212.50 ,$17.19 ,$29.22 ,$212.50 ,$182.50 ,$17.76 ,$17.19 ,$19.46 ,$212.50 ,$38.68 ,$230.00 ,$175.00 ,$83.61 ,$89.89 ,$152.25 ,$83.61 ,$172.75 ,$180.00 ,$174.13 ,$17.36 ,$180.00 ,$18.83 ,$20.63 ,$20.63 ,$17.19 ,$20.63 ,$17.19 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$150.00 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$11.10 ,$199.75 ,$6.53 ,$11.10 ,$199.75 ,$171.55 ,$6.75 ,$6.53 ,$7.39 ,$199.75 ,$14.69 ,$216.20 ,$164.50 ,$31.79 ,$34.18 ,$143.12 ,$31.79 ,$162.39 ,$169.20 ,$163.68 ,$6.60 ,$169.20 ,$7.16 ,$7.84 ,$7.84 ,$6.53 ,$7.84 ,$6.53 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$13.14 ,$142.80 ,$7.73 ,$13.14 ,$142.80 ,$122.64 ,$7.99 ,$7.73 ,$8.75 ,$142.80 ,$17.39 ,$154.56 ,$117.60 ,$37.63 ,$40.46 ,$102.31 ,$37.63 ,$116.09 ,$120.96 ,$117.01 ,$7.81 ,$120.96 ,$8.47 ,$9.28 ,$9.28 ,$7.73 ,$9.28 ,$7.73 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.91 ,$56.95 ,$9.36 ,$15.91 ,$56.95 ,$48.91 ,$9.33 ,$9.36 ,$10.59 ,$56.95 ,$21.06 ,$61.64 ,$46.90 ,$32.25 ,$34.68 ,$40.80 ,$32.25 ,$46.30 ,$48.24 ,$46.67 ,$9.45 ,$48.24 ,$9.89 ,$11.23 ,$11.23 ,$9.36 ,$11.23 ,$9.36 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$22.25 ,$161.50 ,$13.09 ,$22.25 ,$161.50 ,$138.70 ,$13.53 ,$13.09 ,$14.82 ,$161.50 ,$29.45 ,$174.80 ,$133.00 ,$54.31 ,$58.39 ,$115.71 ,$54.31 ,$131.29 ,$136.80 ,$132.34 ,$13.22 ,$136.80 ,$14.34 ,$15.71 ,$15.71 ,$13.09 ,$15.71 ,$13.09 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$22.25 ,$161.50 ,$13.09 ,$22.25 ,$161.50 ,$138.70 ,$13.53 ,$13.09 ,$14.82 ,$161.50 ,$29.45 ,$174.80 ,$133.00 ,$54.31 ,$58.39 ,$115.71 ,$54.31 ,$131.29 ,$136.80 ,$132.34 ,$13.22 ,$136.80 ,$14.34 ,$15.71 ,$15.71 ,$13.09 ,$15.71 ,$13.09 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$42.48 ,$43.07 ,$22.25 ,$50.15 ,$13.09 ,$22.25 ,$50.15 ,$43.07 ,$13.53 ,$13.09 ,$14.82 ,$50.15 ,$29.45 ,$54.28 ,$41.30 ,$54.31 ,$58.39 ,$35.93 ,$54.31 ,$40.77 ,$42.48 ,$41.09 ,$13.22 ,$42.48 ,$14.34 ,$15.71 ,$15.71 ,$13.09 ,$15.71 ,$13.09 ,$42.48 ,$36.58 ,$42.48 ,$42.48 ,$35.40 
ST MARY'S HOSPITAL,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 ,$100.80 ,$102.20 ,$14.62 ,$119.00 ,$8.60 ,$14.62 ,$119.00 ,$102.20 ,$8.89 ,$8.60 ,$9.73 ,$119.00 ,$19.35 ,$128.80 ,$98.00 ,$41.84 ,$44.98 ,$85.26 ,$41.84 ,$96.74 ,$100.80 ,$97.51 ,$8.69 ,$100.80 ,$9.42 ,$10.32 ,$10.32 ,$8.60 ,$10.32 ,$8.60 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$84.00 
ST MARY'S HOSPITAL,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 ,$186.48 ,$189.07 ,$22.71 ,$220.15 ,$13.36 ,$22.71 ,$220.15 ,$189.07 ,$13.80 ,$13.36 ,$15.12 ,$220.15 ,$30.06 ,$238.28 ,$181.30 ,$64.97 ,$69.85 ,$157.73 ,$64.97 ,$178.97 ,$186.48 ,$180.39 ,$13.49 ,$186.48 ,$14.63 ,$16.03 ,$16.03 ,$13.36 ,$16.03 ,$13.36 ,$186.48 ,$160.58 ,$186.48 ,$186.48 ,$155.40 
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$42.35 ,$181.05 ,$24.91 ,$42.35 ,$181.05 ,$155.49 ,$25.74 ,$24.91 ,$28.19 ,$181.05 ,$56.05 ,$195.96 ,$149.10 ,$104.45 ,$112.30 ,$129.72 ,$104.45 ,$147.18 ,$153.36 ,$148.35 ,$25.16 ,$153.36 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$42.35 ,$66.30 ,$24.91 ,$42.35 ,$66.30 ,$56.94 ,$25.74 ,$24.91 ,$28.19 ,$66.30 ,$56.05 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$56.16 ,$54.33 ,$25.16 ,$56.16 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$42.35 ,$87.55 ,$24.91 ,$42.35 ,$87.55 ,$75.19 ,$25.74 ,$24.91 ,$28.19 ,$87.55 ,$56.05 ,$94.76 ,$72.10 ,$103.00 ,$103.00 ,$62.73 ,$103.00 ,$71.17 ,$74.16 ,$71.74 ,$25.16 ,$74.16 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$7.29 ,$30.60 ,$4.29 ,$7.29 ,$30.60 ,$26.28 ,$4.43 ,$4.29 ,$4.86 ,$30.60 ,$9.65 ,$33.12 ,$25.20 ,$19.14 ,$20.58 ,$21.92 ,$19.14 ,$24.88 ,$25.92 ,$25.07 ,$4.33 ,$25.92 ,$4.70 ,$5.15 ,$5.15 ,$4.29 ,$5.15 ,$4.29 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$6.70 ,$40.80 ,$3.94 ,$6.70 ,$40.80 ,$35.04 ,$4.07 ,$3.94 ,$4.46 ,$40.80 ,$8.87 ,$44.16 ,$33.60 ,$19.17 ,$20.61 ,$29.23 ,$19.17 ,$33.17 ,$34.56 ,$33.43 ,$3.98 ,$34.56 ,$4.31 ,$4.73 ,$4.73 ,$3.94 ,$4.73 ,$3.94 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.29 ,$66.30 ,$9.58 ,$16.29 ,$66.30 ,$56.94 ,$9.90 ,$9.58 ,$10.84 ,$66.30 ,$21.56 ,$71.76 ,$54.60 ,$46.54 ,$50.04 ,$47.50 ,$46.54 ,$53.90 ,$56.16 ,$54.33 ,$9.68 ,$56.16 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$9.58 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.29 ,$66.30 ,$9.58 ,$16.29 ,$66.30 ,$56.94 ,$9.90 ,$9.58 ,$10.84 ,$66.30 ,$21.56 ,$71.76 ,$54.60 ,$46.54 ,$50.04 ,$47.50 ,$46.54 ,$53.90 ,$56.16 ,$54.33 ,$9.68 ,$56.16 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$9.58 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.29 ,$66.30 ,$9.58 ,$16.29 ,$66.30 ,$56.94 ,$9.90 ,$9.58 ,$10.84 ,$66.30 ,$21.56 ,$71.76 ,$54.60 ,$46.54 ,$50.04 ,$47.50 ,$46.54 ,$53.90 ,$56.16 ,$54.33 ,$9.68 ,$56.16 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$9.58 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$98.64 ,$100.01 ,$16.29 ,$116.45 ,$9.58 ,$16.29 ,$116.45 ,$100.01 ,$9.90 ,$9.58 ,$10.84 ,$116.45 ,$21.56 ,$126.04 ,$95.90 ,$46.54 ,$50.04 ,$83.43 ,$46.54 ,$94.67 ,$98.64 ,$95.42 ,$9.68 ,$98.64 ,$10.49 ,$11.50 ,$11.50 ,$9.58 ,$11.50 ,$9.58 ,$98.64 ,$84.94 ,$98.64 ,$98.64 ,$82.20 
ST MARY'S HOSPITAL,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 ,$33.12 ,$33.58 ,$7.26 ,$39.10 ,$4.27 ,$7.26 ,$39.10 ,$33.58 ,$4.01 ,$4.27 ,$4.83 ,$39.10 ,$9.61 ,$42.32 ,$32.20 ,$17.25 ,$18.54 ,$28.01 ,$17.25 ,$31.79 ,$33.12 ,$32.04 ,$4.31 ,$33.12 ,$4.25 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$27.60 
ST MARY'S HOSPITAL,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 ,$28.80 ,$29.20 ,$4.59 ,$34.00 ,$2.70 ,$4.59 ,$34.00 ,$29.20 ,$2.79 ,$2.70 ,$3.06 ,$34.00 ,$6.08 ,$36.80 ,$28.00 ,$13.15 ,$14.14 ,$24.36 ,$13.15 ,$27.64 ,$28.80 ,$27.86 ,$2.73 ,$28.80 ,$2.96 ,$3.24 ,$3.24 ,$2.70 ,$3.24 ,$2.70 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$9.37 ,$56.95 ,$5.51 ,$9.37 ,$56.95 ,$48.91 ,$5.69 ,$5.51 ,$6.24 ,$56.95 ,$12.40 ,$61.64 ,$46.90 ,$26.84 ,$28.85 ,$40.80 ,$26.84 ,$46.30 ,$48.24 ,$46.67 ,$5.57 ,$48.24 ,$6.03 ,$6.61 ,$6.61 ,$5.51 ,$6.61 ,$5.51 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$9.81 ,$85.85 ,$5.77 ,$9.81 ,$85.85 ,$73.73 ,$1.16 ,$5.77 ,$6.53 ,$85.85 ,$12.98 ,$92.92 ,$70.70 ,$28.05 ,$30.15 ,$61.51 ,$28.05 ,$69.79 ,$72.72 ,$70.35 ,$5.83 ,$72.72 ,$1.23 ,$6.92 ,$6.92 ,$5.77 ,$6.92 ,$5.77 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$16.37 ,$47.60 ,$9.63 ,$16.37 ,$47.60 ,$40.88 ,$8.17 ,$9.63 ,$10.90 ,$47.60 ,$21.67 ,$51.52 ,$39.20 ,$28.26 ,$30.38 ,$34.10 ,$28.26 ,$38.70 ,$40.32 ,$39.00 ,$9.73 ,$40.32 ,$8.66 ,$11.56 ,$11.56 ,$9.63 ,$11.56 ,$9.63 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$37.44 ,$37.96 ,$10.22 ,$44.20 ,$6.01 ,$10.22 ,$44.20 ,$37.96 ,$6.21 ,$6.01 ,$6.80 ,$44.20 ,$13.52 ,$47.84 ,$36.40 ,$29.19 ,$31.38 ,$31.67 ,$29.19 ,$35.93 ,$37.44 ,$36.22 ,$6.07 ,$37.44 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$6.01 ,$37.44 ,$32.24 ,$37.44 ,$37.44 ,$31.20 
ST MARY'S HOSPITAL,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 ,$62.64 ,$63.51 ,$10.22 ,$73.95 ,$6.01 ,$10.22 ,$73.95 ,$63.51 ,$6.21 ,$6.01 ,$6.80 ,$73.95 ,$13.52 ,$80.04 ,$60.90 ,$29.19 ,$31.38 ,$52.98 ,$29.19 ,$60.12 ,$62.64 ,$60.60 ,$6.07 ,$62.64 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$6.01 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$52.20 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$10.22 ,$47.60 ,$6.01 ,$10.22 ,$47.60 ,$40.88 ,$6.21 ,$6.01 ,$6.80 ,$47.60 ,$13.52 ,$51.52 ,$39.20 ,$29.19 ,$31.38 ,$34.10 ,$29.19 ,$38.70 ,$40.32 ,$39.00 ,$6.07 ,$40.32 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$6.01 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$74.16 ,$75.19 ,$10.22 ,$87.55 ,$6.01 ,$10.22 ,$87.55 ,$75.19 ,$6.21 ,$6.01 ,$6.80 ,$87.55 ,$13.52 ,$94.76 ,$72.10 ,$29.19 ,$31.38 ,$62.73 ,$29.19 ,$71.17 ,$74.16 ,$71.74 ,$6.07 ,$74.16 ,$6.58 ,$7.21 ,$7.21 ,$6.01 ,$7.21 ,$6.01 ,$74.16 ,$63.86 ,$74.16 ,$74.16 ,$61.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$11.00 ,$66.30 ,$6.47 ,$11.00 ,$66.30 ,$56.94 ,$6.69 ,$6.47 ,$7.32 ,$66.30 ,$14.56 ,$71.76 ,$54.60 ,$31.47 ,$33.83 ,$47.50 ,$31.47 ,$53.90 ,$56.16 ,$54.33 ,$6.53 ,$56.16 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$18.72 ,$18.98 ,$11.00 ,$22.10 ,$6.47 ,$11.00 ,$22.10 ,$18.98 ,$6.69 ,$6.47 ,$7.32 ,$22.10 ,$14.56 ,$23.92 ,$18.20 ,$26.00 ,$26.00 ,$15.83 ,$26.00 ,$17.97 ,$18.72 ,$18.11 ,$6.53 ,$18.72 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$15.60 
ST MARY'S HOSPITAL,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 ,$46.80 ,$47.45 ,$11.00 ,$55.25 ,$6.47 ,$11.00 ,$55.25 ,$47.45 ,$6.69 ,$6.47 ,$7.32 ,$55.25 ,$14.56 ,$59.80 ,$45.50 ,$31.47 ,$33.83 ,$39.59 ,$31.47 ,$44.92 ,$46.80 ,$45.27 ,$6.53 ,$46.80 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$46.80 ,$40.30 ,$46.80 ,$46.80 ,$39.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$11.00 ,$133.45 ,$6.47 ,$11.00 ,$133.45 ,$114.61 ,$6.69 ,$6.47 ,$7.32 ,$133.45 ,$14.56 ,$144.44 ,$109.90 ,$31.47 ,$33.83 ,$95.61 ,$31.47 ,$108.49 ,$113.04 ,$109.35 ,$6.53 ,$113.04 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$19.84 ,$76.50 ,$11.67 ,$19.84 ,$76.50 ,$65.70 ,$12.06 ,$11.67 ,$13.21 ,$76.50 ,$26.26 ,$82.80 ,$63.00 ,$56.74 ,$61.00 ,$54.81 ,$56.74 ,$62.19 ,$64.80 ,$62.69 ,$11.79 ,$64.80 ,$12.78 ,$14.00 ,$14.00 ,$11.67 ,$14.00 ,$11.67 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$42.35 ,$85.85 ,$24.91 ,$42.35 ,$85.85 ,$73.73 ,$25.74 ,$24.91 ,$28.19 ,$85.85 ,$56.05 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$72.72 ,$70.35 ,$25.16 ,$72.72 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$42.35 ,$85.85 ,$24.91 ,$42.35 ,$85.85 ,$73.73 ,$25.74 ,$24.91 ,$28.19 ,$85.85 ,$56.05 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$72.72 ,$70.35 ,$25.16 ,$72.72 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$42.35 ,$85.85 ,$24.91 ,$42.35 ,$85.85 ,$73.73 ,$25.74 ,$24.91 ,$28.19 ,$85.85 ,$56.05 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$72.72 ,$70.35 ,$25.16 ,$72.72 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$42.35 ,$124.10 ,$24.91 ,$42.35 ,$124.10 ,$106.58 ,$25.74 ,$24.91 ,$28.19 ,$124.10 ,$56.05 ,$134.32 ,$102.20 ,$104.45 ,$112.30 ,$88.91 ,$104.45 ,$100.89 ,$105.12 ,$101.69 ,$25.16 ,$105.12 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$42.35 ,$124.10 ,$24.91 ,$42.35 ,$124.10 ,$106.58 ,$25.74 ,$24.91 ,$28.19 ,$124.10 ,$56.05 ,$134.32 ,$102.20 ,$104.45 ,$112.30 ,$88.91 ,$104.45 ,$100.89 ,$105.12 ,$101.69 ,$25.16 ,$105.12 ,$27.28 ,$29.89 ,$29.89 ,$24.91 ,$29.89 ,$24.91 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$39.00 ,$92.65 ,$22.94 ,$39.00 ,$92.65 ,$79.57 ,$23.70 ,$22.94 ,$25.96 ,$92.65 ,$51.62 ,$100.28 ,$76.30 ,$109.00 ,$109.00 ,$66.38 ,$109.00 ,$75.32 ,$78.48 ,$75.92 ,$23.17 ,$78.48 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$207.36 ,$210.24 ,$39.00 ,$244.80 ,$22.94 ,$39.00 ,$244.80 ,$210.24 ,$23.70 ,$22.94 ,$25.96 ,$244.80 ,$51.62 ,$264.96 ,$201.60 ,$111.55 ,$119.93 ,$175.39 ,$111.55 ,$199.01 ,$207.36 ,$200.59 ,$23.17 ,$207.36 ,$25.12 ,$27.53 ,$27.53 ,$22.94 ,$27.53 ,$22.94 ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$172.80 
ST MARY'S HOSPITAL,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 ,$159.12 ,$161.33 ,$30.43 ,$187.85 ,$17.90 ,$30.43 ,$187.85 ,$161.33 ,$9.84 ,$17.90 ,$20.26 ,$187.85 ,$40.28 ,$203.32 ,$154.70 ,$34.00 ,$36.55 ,$134.59 ,$34.00 ,$152.71 ,$159.12 ,$153.93 ,$18.08 ,$159.12 ,$10.43 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$159.12 ,$137.02 ,$159.12 ,$159.12 ,$132.60 
ST MARY'S HOSPITAL,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 ,$207.36 ,$210.24 ,$52.46 ,$244.80 ,$30.86 ,$52.46 ,$244.80 ,$210.24 ,$31.89 ,$30.86 ,$34.93 ,$244.80 ,$69.44 ,$264.96 ,$201.60 ,$111.55 ,$119.93 ,$175.39 ,$111.55 ,$199.01 ,$207.36 ,$200.59 ,$31.17 ,$207.36 ,$33.80 ,$37.03 ,$37.03 ,$30.86 ,$37.03 ,$30.86 ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$172.80 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$60.76 ,$171.70 ,$35.74 ,$60.76 ,$171.70 ,$147.46 ,$18.97 ,$35.74 ,$40.45 ,$171.70 ,$80.42 ,$185.84 ,$141.40 ,$130.19 ,$139.97 ,$123.02 ,$130.19 ,$139.58 ,$145.44 ,$140.69 ,$36.10 ,$145.44 ,$20.11 ,$42.89 ,$42.89 ,$35.74 ,$42.89 ,$35.74 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$30.43 ,$161.50 ,$17.90 ,$30.43 ,$161.50 ,$138.70 ,$18.50 ,$17.90 ,$20.26 ,$161.50 ,$40.28 ,$174.80 ,$133.00 ,$87.06 ,$93.61 ,$115.71 ,$87.06 ,$131.29 ,$136.80 ,$132.34 ,$18.08 ,$136.80 ,$19.61 ,$21.48 ,$21.48 ,$17.90 ,$21.48 ,$17.90 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$4.32 ,$32.30 ,$2.54 ,$4.32 ,$32.30 ,$27.74 ,$2.62 ,$2.54 ,$2.87 ,$32.30 ,$5.72 ,$34.96 ,$26.60 ,$12.33 ,$13.26 ,$23.14 ,$12.33 ,$26.26 ,$27.36 ,$26.47 ,$2.57 ,$27.36 ,$2.78 ,$3.05 ,$3.05 ,$2.54 ,$3.05 ,$2.54 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$33.84 ,$34.31 ,$9.37 ,$39.95 ,$5.51 ,$9.37 ,$39.95 ,$34.31 ,$5.69 ,$5.51 ,$6.24 ,$39.95 ,$12.40 ,$43.24 ,$32.90 ,$26.84 ,$28.85 ,$28.62 ,$26.84 ,$32.48 ,$33.84 ,$32.74 ,$5.57 ,$33.84 ,$6.03 ,$6.61 ,$6.61 ,$5.51 ,$6.61 ,$5.51 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$28.20 
ST MARY'S HOSPITAL,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 ,$63.36 ,$64.24 ,$31.88 ,$74.80 ,$18.75 ,$31.88 ,$74.80 ,$64.24 ,$19.37 ,$18.75 ,$21.22 ,$74.80 ,$42.19 ,$80.96 ,$61.60 ,$88.00 ,$88.00 ,$53.59 ,$88.00 ,$60.81 ,$63.36 ,$61.29 ,$18.94 ,$63.36 ,$20.53 ,$22.50 ,$22.50 ,$18.75 ,$22.50 ,$18.75 ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$52.80 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$6.70 ,$102.00 ,$3.94 ,$6.70 ,$102.00 ,$87.60 ,$4.07 ,$3.94 ,$4.46 ,$102.00 ,$8.87 ,$110.40 ,$84.00 ,$19.17 ,$20.61 ,$73.08 ,$19.17 ,$82.92 ,$86.40 ,$83.58 ,$3.98 ,$86.40 ,$4.31 ,$4.73 ,$4.73 ,$3.94 ,$4.73 ,$3.94 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,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 ,$180.00 ,$182.50 ,$52.46 ,$212.50 ,$30.86 ,$52.46 ,$212.50 ,$182.50 ,$31.89 ,$30.86 ,$34.93 ,$212.50 ,$69.44 ,$230.00 ,$175.00 ,$111.55 ,$119.93 ,$152.25 ,$111.55 ,$172.75 ,$180.00 ,$174.13 ,$31.17 ,$180.00 ,$33.80 ,$37.03 ,$37.03 ,$30.86 ,$37.03 ,$30.86 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$150.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$34.09 ,$133.45 ,$20.05 ,$34.09 ,$133.45 ,$114.61 ,$20.72 ,$20.05 ,$22.69 ,$133.45 ,$45.11 ,$144.44 ,$109.90 ,$97.51 ,$104.83 ,$95.61 ,$97.51 ,$108.49 ,$113.04 ,$109.35 ,$20.25 ,$113.04 ,$21.96 ,$24.06 ,$24.06 ,$20.05 ,$24.06 ,$20.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$34.09 ,$133.45 ,$20.05 ,$34.09 ,$133.45 ,$114.61 ,$20.72 ,$20.05 ,$22.69 ,$133.45 ,$45.11 ,$144.44 ,$109.90 ,$97.51 ,$104.83 ,$95.61 ,$97.51 ,$108.49 ,$113.04 ,$109.35 ,$20.25 ,$113.04 ,$21.96 ,$24.06 ,$24.06 ,$20.05 ,$24.06 ,$20.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$34.09 ,$133.45 ,$20.05 ,$34.09 ,$133.45 ,$114.61 ,$20.72 ,$20.05 ,$22.69 ,$133.45 ,$45.11 ,$144.44 ,$109.90 ,$97.51 ,$104.83 ,$95.61 ,$97.51 ,$108.49 ,$113.04 ,$109.35 ,$20.25 ,$113.04 ,$21.96 ,$24.06 ,$24.06 ,$20.05 ,$24.06 ,$20.05 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$59.65 ,$247.35 ,$35.09 ,$59.65 ,$247.35 ,$212.43 ,$36.26 ,$35.09 ,$39.71 ,$247.35 ,$78.95 ,$267.72 ,$203.70 ,$170.60 ,$183.42 ,$177.22 ,$170.60 ,$201.08 ,$209.52 ,$202.68 ,$35.44 ,$209.52 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$28.80 ,$29.20 ,$11.36 ,$34.00 ,$6.68 ,$11.36 ,$34.00 ,$29.20 ,$5.25 ,$6.68 ,$7.56 ,$34.00 ,$15.03 ,$36.80 ,$28.00 ,$18.14 ,$19.50 ,$24.36 ,$18.14 ,$27.64 ,$28.80 ,$27.86 ,$6.75 ,$28.80 ,$5.57 ,$8.02 ,$8.02 ,$6.68 ,$8.02 ,$6.68 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$17.54 ,$95.20 ,$10.32 ,$17.54 ,$95.20 ,$81.76 ,$10.66 ,$10.32 ,$11.68 ,$95.20 ,$23.22 ,$103.04 ,$78.40 ,$50.21 ,$53.99 ,$68.21 ,$50.21 ,$77.39 ,$80.64 ,$78.01 ,$10.42 ,$80.64 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$10.32 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$16.05 ,$66.30 ,$9.44 ,$16.05 ,$66.30 ,$56.94 ,$9.75 ,$9.44 ,$10.68 ,$66.30 ,$21.24 ,$71.76 ,$54.60 ,$45.90 ,$49.35 ,$47.50 ,$45.90 ,$53.90 ,$56.16 ,$54.33 ,$9.53 ,$56.16 ,$10.34 ,$11.33 ,$11.33 ,$9.44 ,$11.33 ,$9.44 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$16.05 ,$56.95 ,$9.44 ,$16.05 ,$56.95 ,$48.91 ,$3.40 ,$9.44 ,$10.68 ,$56.95 ,$21.24 ,$61.64 ,$46.90 ,$45.90 ,$49.35 ,$40.80 ,$45.90 ,$46.30 ,$48.24 ,$46.67 ,$9.53 ,$48.24 ,$3.60 ,$11.33 ,$11.33 ,$9.44 ,$11.33 ,$9.44 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$25.92 ,$26.28 ,$14.65 ,$30.60 ,$8.62 ,$14.65 ,$30.60 ,$26.28 ,$8.91 ,$8.62 ,$9.76 ,$30.60 ,$19.40 ,$33.12 ,$25.20 ,$36.00 ,$36.00 ,$21.92 ,$36.00 ,$24.88 ,$25.92 ,$25.07 ,$8.71 ,$25.92 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$25.92 ,$22.32 ,$25.92 ,$25.92 ,$21.60 
ST MARY'S HOSPITAL,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 ,$47.52 ,$48.18 ,$14.65 ,$56.10 ,$8.62 ,$14.65 ,$56.10 ,$48.18 ,$8.91 ,$8.62 ,$9.76 ,$56.10 ,$19.40 ,$60.72 ,$46.20 ,$41.87 ,$45.02 ,$40.19 ,$41.87 ,$45.61 ,$47.52 ,$45.97 ,$8.71 ,$47.52 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$47.52 ,$40.92 ,$47.52 ,$47.52 ,$39.60 
ST MARY'S HOSPITAL,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 ,$82.08 ,$83.22 ,$14.65 ,$96.90 ,$8.62 ,$14.65 ,$96.90 ,$83.22 ,$8.91 ,$8.62 ,$9.76 ,$96.90 ,$19.40 ,$104.88 ,$79.80 ,$41.87 ,$45.02 ,$69.43 ,$41.87 ,$78.77 ,$82.08 ,$79.40 ,$8.71 ,$82.08 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$68.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$11.27 ,$91.80 ,$6.63 ,$11.27 ,$91.80 ,$78.84 ,$6.85 ,$6.63 ,$7.50 ,$91.80 ,$14.92 ,$99.36 ,$75.60 ,$32.25 ,$34.68 ,$65.77 ,$32.25 ,$74.63 ,$77.76 ,$75.22 ,$6.70 ,$77.76 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$14.65 ,$85.85 ,$8.62 ,$14.65 ,$85.85 ,$73.73 ,$8.91 ,$8.62 ,$9.76 ,$85.85 ,$19.40 ,$92.92 ,$70.70 ,$41.87 ,$45.02 ,$61.51 ,$41.87 ,$69.79 ,$72.72 ,$70.35 ,$8.71 ,$72.72 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$9.36 ,$9.49 ,$13.00 ,$11.05 ,$8.62 ,$13.00 ,$11.05 ,$9.49 ,$8.91 ,$8.62 ,$9.76 ,$11.05 ,$19.40 ,$11.96 ,$9.10 ,$13.00 ,$13.00 ,$7.92 ,$13.00 ,$8.98 ,$9.36 ,$9.05 ,$8.71 ,$9.36 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$9.36 ,$8.06 ,$9.36 ,$9.36 ,$7.80 
ST MARY'S HOSPITAL,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 ,$123.12 ,$124.83 ,$14.65 ,$145.35 ,$8.62 ,$14.65 ,$145.35 ,$124.83 ,$8.91 ,$8.62 ,$9.76 ,$145.35 ,$19.40 ,$157.32 ,$119.70 ,$41.87 ,$45.02 ,$104.14 ,$41.87 ,$118.16 ,$123.12 ,$119.10 ,$8.71 ,$123.12 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$123.12 ,$106.02 ,$123.12 ,$123.12 ,$102.60 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$14.65 ,$228.65 ,$8.62 ,$14.65 ,$228.65 ,$196.37 ,$8.91 ,$8.62 ,$9.76 ,$228.65 ,$19.40 ,$247.48 ,$188.30 ,$41.87 ,$45.02 ,$163.82 ,$41.87 ,$185.88 ,$193.68 ,$187.36 ,$8.71 ,$193.68 ,$9.44 ,$10.34 ,$10.34 ,$8.62 ,$10.34 ,$8.62 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$16.10 ,$85.85 ,$9.47 ,$16.10 ,$85.85 ,$73.73 ,$9.79 ,$9.47 ,$10.72 ,$85.85 ,$21.31 ,$92.92 ,$70.70 ,$46.01 ,$49.47 ,$61.51 ,$46.01 ,$69.79 ,$72.72 ,$70.35 ,$9.56 ,$72.72 ,$10.38 ,$11.36 ,$11.36 ,$9.47 ,$11.36 ,$9.47 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.74 ,$56.95 ,$8.08 ,$13.74 ,$56.95 ,$48.91 ,$8.35 ,$8.08 ,$9.14 ,$56.95 ,$18.18 ,$61.64 ,$46.90 ,$39.31 ,$42.26 ,$40.80 ,$39.31 ,$46.30 ,$48.24 ,$46.67 ,$8.16 ,$48.24 ,$8.85 ,$9.70 ,$9.70 ,$8.08 ,$9.70 ,$8.08 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.74 ,$56.95 ,$8.08 ,$13.74 ,$56.95 ,$48.91 ,$8.35 ,$8.08 ,$9.14 ,$56.95 ,$18.18 ,$61.64 ,$46.90 ,$39.31 ,$42.26 ,$40.80 ,$39.31 ,$46.30 ,$48.24 ,$46.67 ,$8.16 ,$48.24 ,$8.85 ,$9.70 ,$9.70 ,$8.08 ,$9.70 ,$8.08 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.74 ,$56.95 ,$8.08 ,$13.74 ,$56.95 ,$48.91 ,$8.35 ,$8.08 ,$9.14 ,$56.95 ,$18.18 ,$61.64 ,$46.90 ,$39.31 ,$42.26 ,$40.80 ,$39.31 ,$46.30 ,$48.24 ,$46.67 ,$8.16 ,$48.24 ,$8.85 ,$9.70 ,$9.70 ,$8.08 ,$9.70 ,$8.08 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$11.27 ,$47.60 ,$6.63 ,$11.27 ,$47.60 ,$40.88 ,$6.85 ,$6.63 ,$7.50 ,$47.60 ,$14.92 ,$51.52 ,$39.20 ,$32.25 ,$34.68 ,$34.10 ,$32.25 ,$38.70 ,$40.32 ,$39.00 ,$6.70 ,$40.32 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$53.28 ,$54.02 ,$11.27 ,$62.90 ,$6.63 ,$11.27 ,$62.90 ,$54.02 ,$6.85 ,$6.63 ,$7.50 ,$62.90 ,$14.92 ,$68.08 ,$51.80 ,$32.25 ,$34.68 ,$45.07 ,$32.25 ,$51.13 ,$53.28 ,$51.54 ,$6.70 ,$53.28 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$44.40 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$42.50 ,$36.50 ,$6.85 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$32.25 ,$34.68 ,$30.45 ,$32.25 ,$34.55 ,$36.00 ,$34.83 ,$6.70 ,$36.00 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$42.50 ,$36.50 ,$6.85 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$32.25 ,$34.68 ,$30.45 ,$32.25 ,$34.55 ,$36.00 ,$34.83 ,$6.70 ,$36.00 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$58.32 ,$59.13 ,$11.27 ,$68.85 ,$6.63 ,$11.27 ,$68.85 ,$59.13 ,$6.85 ,$6.63 ,$7.50 ,$68.85 ,$14.92 ,$74.52 ,$56.70 ,$32.25 ,$34.68 ,$49.33 ,$32.25 ,$55.97 ,$58.32 ,$56.42 ,$6.70 ,$58.32 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$48.60 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$42.50 ,$36.50 ,$6.85 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$32.25 ,$34.68 ,$30.45 ,$32.25 ,$34.55 ,$36.00 ,$34.83 ,$6.70 ,$36.00 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$83.52 ,$84.68 ,$11.27 ,$98.60 ,$6.63 ,$11.27 ,$98.60 ,$84.68 ,$6.85 ,$6.63 ,$7.50 ,$98.60 ,$14.92 ,$106.72 ,$81.20 ,$32.25 ,$34.68 ,$70.64 ,$32.25 ,$80.16 ,$83.52 ,$80.79 ,$6.70 ,$83.52 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$11.27 ,$47.60 ,$6.63 ,$11.27 ,$47.60 ,$40.88 ,$6.85 ,$6.63 ,$7.50 ,$47.60 ,$14.92 ,$51.52 ,$39.20 ,$32.25 ,$34.68 ,$34.10 ,$32.25 ,$38.70 ,$40.32 ,$39.00 ,$6.70 ,$40.32 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$11.27 ,$42.50 ,$6.63 ,$11.27 ,$42.50 ,$36.50 ,$6.85 ,$6.63 ,$7.50 ,$42.50 ,$14.92 ,$46.00 ,$35.00 ,$32.25 ,$34.68 ,$30.45 ,$32.25 ,$34.55 ,$36.00 ,$34.83 ,$6.70 ,$36.00 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$46.08 ,$46.72 ,$11.27 ,$54.40 ,$6.63 ,$11.27 ,$54.40 ,$46.72 ,$6.85 ,$6.63 ,$7.50 ,$54.40 ,$14.92 ,$58.88 ,$44.80 ,$32.25 ,$34.68 ,$38.98 ,$32.25 ,$44.22 ,$46.08 ,$44.58 ,$6.70 ,$46.08 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$46.08 ,$39.68 ,$46.08 ,$46.08 ,$38.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.72 ,$56.95 ,$8.07 ,$13.72 ,$56.95 ,$48.91 ,$8.34 ,$8.07 ,$9.13 ,$56.95 ,$18.16 ,$61.64 ,$46.90 ,$39.24 ,$42.19 ,$40.80 ,$39.24 ,$46.30 ,$48.24 ,$46.67 ,$8.15 ,$48.24 ,$8.84 ,$9.68 ,$9.68 ,$8.07 ,$9.68 ,$8.07 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$13.75 ,$56.95 ,$8.09 ,$13.75 ,$56.95 ,$48.91 ,$8.36 ,$8.09 ,$9.16 ,$56.95 ,$18.20 ,$61.64 ,$46.90 ,$39.38 ,$42.34 ,$40.80 ,$39.38 ,$46.30 ,$48.24 ,$46.67 ,$8.17 ,$48.24 ,$8.86 ,$9.71 ,$9.71 ,$8.09 ,$9.71 ,$8.09 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$13.11 ,$113.90 ,$7.71 ,$13.11 ,$113.90 ,$97.82 ,$7.97 ,$7.71 ,$8.73 ,$113.90 ,$17.35 ,$123.28 ,$93.80 ,$37.49 ,$40.31 ,$81.61 ,$37.49 ,$92.59 ,$96.48 ,$93.33 ,$7.79 ,$96.48 ,$8.45 ,$9.25 ,$9.25 ,$7.71 ,$9.25 ,$7.71 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$45.36 ,$45.99 ,$13.11 ,$53.55 ,$7.71 ,$13.11 ,$53.55 ,$45.99 ,$7.97 ,$7.71 ,$8.73 ,$53.55 ,$17.35 ,$57.96 ,$44.10 ,$37.49 ,$40.31 ,$38.37 ,$37.49 ,$43.53 ,$45.36 ,$43.88 ,$7.79 ,$45.36 ,$8.45 ,$9.25 ,$9.25 ,$7.71 ,$9.25 ,$7.71 ,$45.36 ,$39.06 ,$45.36 ,$45.36 ,$37.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$14.30 ,$66.30 ,$8.41 ,$14.30 ,$66.30 ,$56.94 ,$8.69 ,$8.41 ,$9.52 ,$66.30 ,$18.92 ,$71.76 ,$54.60 ,$40.84 ,$43.91 ,$47.50 ,$40.84 ,$53.90 ,$56.16 ,$54.33 ,$8.49 ,$56.16 ,$9.21 ,$10.09 ,$10.09 ,$8.41 ,$10.09 ,$8.41 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$14.30 ,$56.95 ,$8.41 ,$14.30 ,$56.95 ,$48.91 ,$8.69 ,$8.41 ,$9.52 ,$56.95 ,$18.92 ,$61.64 ,$46.90 ,$40.84 ,$43.91 ,$40.80 ,$40.84 ,$46.30 ,$48.24 ,$46.67 ,$8.49 ,$48.24 ,$9.21 ,$10.09 ,$10.09 ,$8.41 ,$10.09 ,$8.41 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$34.78 ,$142.80 ,$20.46 ,$34.78 ,$142.80 ,$122.64 ,$12.68 ,$20.46 ,$23.16 ,$142.80 ,$46.04 ,$154.56 ,$117.60 ,$43.83 ,$47.13 ,$102.31 ,$43.83 ,$116.09 ,$120.96 ,$117.01 ,$20.66 ,$120.96 ,$13.44 ,$24.55 ,$24.55 ,$20.46 ,$24.55 ,$20.46 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$69.12 ,$70.08 ,$17.54 ,$81.60 ,$10.32 ,$17.54 ,$81.60 ,$70.08 ,$10.66 ,$10.32 ,$11.68 ,$81.60 ,$23.22 ,$88.32 ,$67.20 ,$50.21 ,$53.99 ,$58.46 ,$50.21 ,$66.34 ,$69.12 ,$66.86 ,$10.42 ,$69.12 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$10.32 ,$69.12 ,$59.52 ,$69.12 ,$69.12 ,$57.60 
ST MARY'S HOSPITAL,30600143,87106,HC CULTURE FUNGUS ID,306,1 ,$53.00 ,$26.50 ,$10.32 ,$53.00 ,$10.66 ,$40.15 ,$34.41 ,$10.32 ,$31.80 ,$45.05 ,$37.10 ,$10.66 ,$50.35 ,$38.16 ,$38.69 ,$17.54 ,$45.05 ,$10.32 ,$17.54 ,$45.05 ,$38.69 ,$10.66 ,$10.32 ,$11.68 ,$45.05 ,$23.22 ,$48.76 ,$37.10 ,$50.21 ,$53.00 ,$32.28 ,$50.21 ,$36.62 ,$38.16 ,$36.91 ,$10.42 ,$38.16 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$10.32 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$95.76 ,$97.09 ,$17.54 ,$113.05 ,$10.32 ,$17.54 ,$113.05 ,$97.09 ,$10.66 ,$10.32 ,$11.68 ,$113.05 ,$23.22 ,$122.36 ,$93.10 ,$50.21 ,$53.99 ,$81.00 ,$50.21 ,$91.90 ,$95.76 ,$92.63 ,$10.42 ,$95.76 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$10.32 ,$95.76 ,$82.46 ,$95.76 ,$95.76 ,$79.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$17.54 ,$66.30 ,$10.32 ,$17.54 ,$66.30 ,$56.94 ,$10.66 ,$10.32 ,$11.68 ,$66.30 ,$23.22 ,$71.76 ,$54.60 ,$50.21 ,$53.99 ,$47.50 ,$50.21 ,$53.90 ,$56.16 ,$54.33 ,$10.42 ,$56.16 ,$11.30 ,$12.38 ,$12.38 ,$10.32 ,$12.38 ,$10.32 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$26.16 ,$76.50 ,$15.39 ,$26.16 ,$76.50 ,$65.70 ,$14.01 ,$15.39 ,$17.42 ,$76.50 ,$34.63 ,$82.80 ,$63.00 ,$48.43 ,$52.07 ,$54.81 ,$48.43 ,$62.19 ,$64.80 ,$62.69 ,$15.54 ,$64.80 ,$14.85 ,$18.47 ,$18.47 ,$15.39 ,$18.47 ,$15.39 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$107.28 ,$108.77 ,$33.32 ,$126.65 ,$19.60 ,$33.32 ,$126.65 ,$108.77 ,$20.25 ,$19.60 ,$22.18 ,$126.65 ,$44.10 ,$137.08 ,$104.30 ,$95.26 ,$102.42 ,$90.74 ,$95.26 ,$102.96 ,$107.28 ,$103.78 ,$19.80 ,$107.28 ,$21.47 ,$23.52 ,$23.52 ,$19.60 ,$23.52 ,$19.60 ,$107.28 ,$92.38 ,$107.28 ,$107.28 ,$89.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$18.36 ,$66.30 ,$10.80 ,$18.36 ,$66.30 ,$56.94 ,$11.16 ,$10.80 ,$12.22 ,$66.30 ,$24.30 ,$71.76 ,$54.60 ,$52.53 ,$56.48 ,$47.50 ,$52.53 ,$53.90 ,$56.16 ,$54.33 ,$10.91 ,$56.16 ,$11.83 ,$12.96 ,$12.96 ,$10.80 ,$12.96 ,$10.80 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$18.36 ,$137.70 ,$10.80 ,$18.36 ,$137.70 ,$118.26 ,$11.16 ,$10.80 ,$12.22 ,$137.70 ,$24.30 ,$149.04 ,$113.40 ,$52.53 ,$56.48 ,$98.66 ,$52.53 ,$111.94 ,$116.64 ,$112.83 ,$10.91 ,$116.64 ,$11.83 ,$12.96 ,$12.96 ,$10.80 ,$12.96 ,$10.80 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$18.36 ,$72.25 ,$10.80 ,$18.36 ,$72.25 ,$62.05 ,$11.16 ,$10.80 ,$12.22 ,$72.25 ,$24.30 ,$78.20 ,$59.50 ,$52.53 ,$56.48 ,$51.77 ,$52.53 ,$58.74 ,$61.20 ,$59.20 ,$10.91 ,$61.20 ,$11.83 ,$12.96 ,$12.96 ,$10.80 ,$12.96 ,$10.80 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$24.84 ,$133.45 ,$14.61 ,$24.84 ,$133.45 ,$114.61 ,$15.10 ,$14.61 ,$16.54 ,$133.45 ,$32.87 ,$144.44 ,$109.90 ,$53.21 ,$57.21 ,$95.61 ,$53.21 ,$108.49 ,$113.04 ,$109.35 ,$14.76 ,$113.04 ,$16.01 ,$17.53 ,$17.53 ,$14.61 ,$17.53 ,$14.61 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$13.68 ,$13.87 ,$9.47 ,$16.15 ,$5.57 ,$9.47 ,$16.15 ,$13.87 ,$5.76 ,$5.57 ,$6.30 ,$16.15 ,$12.53 ,$17.48 ,$13.30 ,$19.00 ,$19.00 ,$11.57 ,$19.00 ,$13.13 ,$13.68 ,$13.23 ,$5.63 ,$13.68 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$13.68 ,$11.78 ,$13.68 ,$13.68 ,$11.40 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$9.47 ,$32.30 ,$5.57 ,$9.47 ,$32.30 ,$27.74 ,$5.76 ,$5.57 ,$6.30 ,$32.30 ,$12.53 ,$34.96 ,$26.60 ,$22.17 ,$23.83 ,$23.14 ,$22.17 ,$26.26 ,$27.36 ,$26.47 ,$5.63 ,$27.36 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 ,$9.47 ,$32.30 ,$5.57 ,$9.47 ,$32.30 ,$27.74 ,$5.76 ,$5.57 ,$6.30 ,$32.30 ,$12.53 ,$34.96 ,$26.60 ,$22.17 ,$23.83 ,$23.14 ,$22.17 ,$26.26 ,$27.36 ,$26.47 ,$5.63 ,$27.36 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$9.47 ,$47.60 ,$5.57 ,$9.47 ,$47.60 ,$40.88 ,$5.76 ,$5.57 ,$6.30 ,$47.60 ,$12.53 ,$51.52 ,$39.20 ,$22.17 ,$23.83 ,$34.10 ,$22.17 ,$38.70 ,$40.32 ,$39.00 ,$5.63 ,$40.32 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$15.12 ,$15.33 ,$9.47 ,$17.85 ,$5.57 ,$9.47 ,$17.85 ,$15.33 ,$5.76 ,$5.57 ,$6.30 ,$17.85 ,$12.53 ,$19.32 ,$14.70 ,$21.00 ,$21.00 ,$12.79 ,$21.00 ,$14.51 ,$15.12 ,$14.63 ,$5.63 ,$15.12 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$12.60 
ST MARY'S HOSPITAL,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 ,$15.12 ,$15.33 ,$9.47 ,$17.85 ,$5.57 ,$9.47 ,$17.85 ,$15.33 ,$5.76 ,$5.57 ,$6.30 ,$17.85 ,$12.53 ,$19.32 ,$14.70 ,$21.00 ,$21.00 ,$12.79 ,$21.00 ,$14.51 ,$15.12 ,$14.63 ,$5.63 ,$15.12 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$12.60 
ST MARY'S HOSPITAL,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 ,$79.92 ,$81.03 ,$21.28 ,$94.35 ,$12.52 ,$21.28 ,$94.35 ,$81.03 ,$12.94 ,$12.52 ,$14.17 ,$94.35 ,$28.17 ,$102.12 ,$77.70 ,$60.91 ,$65.48 ,$67.60 ,$60.91 ,$76.70 ,$79.92 ,$77.31 ,$12.65 ,$79.92 ,$13.72 ,$15.02 ,$15.02 ,$12.52 ,$15.02 ,$12.52 ,$79.92 ,$68.82 ,$79.92 ,$79.92 ,$66.60 
ST MARY'S HOSPITAL,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 ,$95.76 ,$97.09 ,$8.81 ,$113.05 ,$5.18 ,$8.81 ,$113.05 ,$97.09 ,$5.35 ,$5.18 ,$5.86 ,$113.05 ,$11.66 ,$122.36 ,$93.10 ,$25.16 ,$27.05 ,$81.00 ,$25.16 ,$91.90 ,$95.76 ,$92.63 ,$5.23 ,$95.76 ,$5.67 ,$6.22 ,$6.22 ,$5.18 ,$6.22 ,$5.18 ,$95.76 ,$82.46 ,$95.76 ,$95.76 ,$79.80 
ST MARY'S HOSPITAL,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 ,$179.28 ,$181.77 ,$59.65 ,$211.65 ,$35.09 ,$59.65 ,$211.65 ,$181.77 ,$36.26 ,$35.09 ,$39.71 ,$211.65 ,$78.95 ,$229.08 ,$174.30 ,$170.60 ,$183.42 ,$151.64 ,$170.60 ,$172.06 ,$179.28 ,$173.43 ,$35.44 ,$179.28 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$179.28 ,$154.38 ,$179.28 ,$179.28 ,$149.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$7.26 ,$66.30 ,$4.27 ,$7.26 ,$66.30 ,$56.94 ,$4.41 ,$4.27 ,$4.83 ,$66.30 ,$9.61 ,$71.76 ,$54.60 ,$20.74 ,$22.30 ,$47.50 ,$20.74 ,$53.90 ,$56.16 ,$54.33 ,$4.31 ,$56.16 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$7.33 ,$66.30 ,$4.31 ,$7.33 ,$66.30 ,$56.94 ,$4.45 ,$4.31 ,$4.88 ,$66.30 ,$9.70 ,$71.76 ,$54.60 ,$20.74 ,$22.30 ,$47.50 ,$20.74 ,$53.90 ,$56.16 ,$54.33 ,$4.35 ,$56.16 ,$4.72 ,$5.17 ,$5.17 ,$4.31 ,$5.17 ,$4.31 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$19.44 ,$19.71 ,$7.26 ,$22.95 ,$4.27 ,$7.26 ,$22.95 ,$19.71 ,$4.41 ,$4.27 ,$4.83 ,$22.95 ,$9.61 ,$24.84 ,$18.90 ,$20.74 ,$22.30 ,$16.44 ,$20.74 ,$18.66 ,$19.44 ,$18.81 ,$4.31 ,$19.44 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$19.44 ,$16.74 ,$19.44 ,$19.44 ,$16.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$15.13 ,$56.95 ,$8.90 ,$15.13 ,$56.95 ,$48.91 ,$9.20 ,$8.90 ,$10.07 ,$56.95 ,$20.03 ,$61.64 ,$46.90 ,$43.26 ,$46.52 ,$40.80 ,$43.26 ,$46.30 ,$48.24 ,$46.67 ,$8.99 ,$48.24 ,$9.75 ,$10.68 ,$10.68 ,$8.90 ,$10.68 ,$8.90 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$8.08 ,$66.30 ,$4.75 ,$8.08 ,$66.30 ,$56.94 ,$4.91 ,$4.75 ,$5.38 ,$66.30 ,$10.69 ,$71.76 ,$54.60 ,$23.09 ,$24.83 ,$47.50 ,$23.09 ,$53.90 ,$56.16 ,$54.33 ,$4.80 ,$56.16 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$4.75 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$110.16 ,$111.69 ,$8.08 ,$130.05 ,$4.75 ,$8.08 ,$130.05 ,$111.69 ,$4.91 ,$4.75 ,$5.38 ,$130.05 ,$10.69 ,$140.76 ,$107.10 ,$23.09 ,$24.83 ,$93.18 ,$23.09 ,$105.72 ,$110.16 ,$106.56 ,$4.80 ,$110.16 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$4.75 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$12.72 ,$47.60 ,$7.48 ,$12.72 ,$47.60 ,$40.88 ,$7.73 ,$7.48 ,$8.47 ,$47.60 ,$16.83 ,$51.52 ,$39.20 ,$33.54 ,$36.06 ,$34.10 ,$33.54 ,$38.70 ,$40.32 ,$39.00 ,$7.55 ,$40.32 ,$8.19 ,$8.98 ,$8.98 ,$7.48 ,$8.98 ,$7.48 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$54.72 ,$55.48 ,$12.72 ,$64.60 ,$7.48 ,$12.72 ,$64.60 ,$55.48 ,$7.73 ,$7.48 ,$8.47 ,$64.60 ,$16.83 ,$69.92 ,$53.20 ,$33.54 ,$36.06 ,$46.28 ,$33.54 ,$52.52 ,$54.72 ,$52.93 ,$7.55 ,$54.72 ,$8.19 ,$8.98 ,$8.98 ,$7.48 ,$8.98 ,$7.48 ,$54.72 ,$47.12 ,$54.72 ,$54.72 ,$45.60 
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$8.08 ,$47.60 ,$4.75 ,$8.08 ,$47.60 ,$40.88 ,$4.91 ,$4.75 ,$5.38 ,$47.60 ,$10.69 ,$51.52 ,$39.20 ,$23.09 ,$24.83 ,$34.10 ,$23.09 ,$38.70 ,$40.32 ,$39.00 ,$4.80 ,$40.32 ,$5.20 ,$5.70 ,$5.70 ,$4.75 ,$5.70 ,$4.75 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$14.71 ,$56.95 ,$8.65 ,$14.71 ,$56.95 ,$48.91 ,$8.94 ,$8.65 ,$9.79 ,$56.95 ,$19.46 ,$61.64 ,$46.90 ,$42.05 ,$45.21 ,$40.80 ,$42.05 ,$46.30 ,$48.24 ,$46.67 ,$8.74 ,$48.24 ,$9.48 ,$10.38 ,$10.38 ,$8.65 ,$10.38 ,$8.65 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$14.71 ,$95.20 ,$8.65 ,$14.71 ,$95.20 ,$81.76 ,$8.94 ,$8.65 ,$9.79 ,$95.20 ,$19.46 ,$103.04 ,$78.40 ,$42.05 ,$45.21 ,$68.21 ,$42.05 ,$77.39 ,$80.64 ,$78.01 ,$8.74 ,$80.64 ,$9.48 ,$10.38 ,$10.38 ,$8.65 ,$10.38 ,$8.65 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$7.26 ,$38.25 ,$4.27 ,$7.26 ,$38.25 ,$32.85 ,$4.41 ,$4.27 ,$4.83 ,$38.25 ,$9.61 ,$41.40 ,$31.50 ,$20.74 ,$22.30 ,$27.41 ,$20.74 ,$31.10 ,$32.40 ,$31.34 ,$4.31 ,$32.40 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,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 ,$53.28 ,$54.02 ,$7.26 ,$62.90 ,$4.27 ,$7.26 ,$62.90 ,$54.02 ,$4.41 ,$4.27 ,$4.83 ,$62.90 ,$9.61 ,$68.08 ,$51.80 ,$20.74 ,$22.30 ,$45.07 ,$20.74 ,$51.13 ,$53.28 ,$51.54 ,$4.31 ,$53.28 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$44.40 
ST MARY'S HOSPITAL,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 ,$33.12 ,$33.58 ,$9.16 ,$39.10 ,$5.39 ,$9.16 ,$39.10 ,$33.58 ,$5.57 ,$5.39 ,$6.10 ,$39.10 ,$12.13 ,$42.32 ,$32.20 ,$26.16 ,$28.12 ,$28.01 ,$26.16 ,$31.79 ,$33.12 ,$32.04 ,$5.44 ,$33.12 ,$5.90 ,$6.47 ,$6.47 ,$5.39 ,$6.47 ,$5.39 ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$27.60 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$9.16 ,$113.90 ,$5.39 ,$9.16 ,$113.90 ,$97.82 ,$5.57 ,$5.39 ,$6.10 ,$113.90 ,$12.13 ,$123.28 ,$93.80 ,$26.16 ,$28.12 ,$81.61 ,$26.16 ,$92.59 ,$96.48 ,$93.33 ,$5.44 ,$96.48 ,$5.90 ,$6.47 ,$6.47 ,$5.39 ,$6.47 ,$5.39 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$9.16 ,$68.00 ,$5.39 ,$9.16 ,$68.00 ,$58.40 ,$5.57 ,$5.39 ,$6.10 ,$68.00 ,$12.13 ,$73.60 ,$56.00 ,$26.16 ,$28.12 ,$48.72 ,$26.16 ,$55.28 ,$57.60 ,$55.72 ,$5.44 ,$57.60 ,$5.90 ,$6.47 ,$6.47 ,$5.39 ,$6.47 ,$5.39 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$10.18 ,$124.10 ,$5.99 ,$10.18 ,$124.10 ,$106.58 ,$6.19 ,$5.99 ,$6.78 ,$124.10 ,$13.48 ,$134.32 ,$102.20 ,$29.15 ,$31.34 ,$88.91 ,$29.15 ,$100.89 ,$105.12 ,$101.69 ,$6.05 ,$105.12 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$5.99 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$53.28 ,$54.02 ,$10.18 ,$62.90 ,$5.99 ,$10.18 ,$62.90 ,$54.02 ,$6.19 ,$5.99 ,$6.78 ,$62.90 ,$13.48 ,$68.08 ,$51.80 ,$29.15 ,$31.34 ,$45.07 ,$29.15 ,$51.13 ,$53.28 ,$51.54 ,$6.05 ,$53.28 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$5.99 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$44.40 
ST MARY'S HOSPITAL,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 ,$58.32 ,$59.13 ,$10.18 ,$68.85 ,$5.99 ,$10.18 ,$68.85 ,$59.13 ,$6.19 ,$5.99 ,$6.78 ,$68.85 ,$13.48 ,$74.52 ,$56.70 ,$29.15 ,$31.34 ,$49.33 ,$29.15 ,$55.97 ,$58.32 ,$56.42 ,$6.05 ,$58.32 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$5.99 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$48.60 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$30.57 ,$76.50 ,$17.98 ,$30.57 ,$76.50 ,$65.70 ,$18.58 ,$17.98 ,$20.35 ,$76.50 ,$40.46 ,$82.80 ,$63.00 ,$87.38 ,$90.00 ,$54.81 ,$87.38 ,$62.19 ,$64.80 ,$62.69 ,$18.16 ,$64.80 ,$19.69 ,$21.58 ,$21.58 ,$17.98 ,$21.58 ,$17.98 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$23.04 ,$23.36 ,$9.89 ,$27.20 ,$5.82 ,$9.89 ,$27.20 ,$23.36 ,$6.00 ,$5.82 ,$6.59 ,$27.20 ,$13.10 ,$29.44 ,$22.40 ,$20.74 ,$22.30 ,$19.49 ,$20.74 ,$22.11 ,$23.04 ,$22.29 ,$5.88 ,$23.04 ,$6.36 ,$6.98 ,$6.98 ,$5.82 ,$6.98 ,$5.82 ,$23.04 ,$19.84 ,$23.04 ,$23.04 ,$19.20 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$9.89 ,$38.25 ,$5.82 ,$9.89 ,$38.25 ,$32.85 ,$6.00 ,$5.82 ,$6.59 ,$38.25 ,$13.10 ,$41.40 ,$31.50 ,$20.74 ,$22.30 ,$27.41 ,$20.74 ,$31.10 ,$32.40 ,$31.34 ,$5.88 ,$32.40 ,$6.36 ,$6.98 ,$6.98 ,$5.82 ,$6.98 ,$5.82 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$7.26 ,$45.05 ,$4.27 ,$7.26 ,$45.05 ,$38.69 ,$4.41 ,$4.27 ,$4.83 ,$45.05 ,$9.61 ,$48.76 ,$37.10 ,$20.74 ,$22.30 ,$32.28 ,$20.74 ,$36.62 ,$38.16 ,$36.91 ,$4.31 ,$38.16 ,$4.67 ,$5.12 ,$5.12 ,$4.27 ,$5.12 ,$4.27 ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$94.32 ,$95.63 ,$33.56 ,$111.35 ,$19.74 ,$33.56 ,$111.35 ,$95.63 ,$20.40 ,$19.74 ,$22.34 ,$111.35 ,$44.42 ,$120.52 ,$91.70 ,$96.01 ,$103.22 ,$79.78 ,$96.01 ,$90.52 ,$94.32 ,$91.24 ,$19.94 ,$94.32 ,$21.62 ,$23.69 ,$23.69 ,$19.74 ,$23.69 ,$19.74 ,$94.32 ,$81.22 ,$94.32 ,$94.32 ,$78.60 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$44.32 ,$171.70 ,$26.07 ,$44.32 ,$171.70 ,$147.46 ,$26.94 ,$26.07 ,$29.51 ,$171.70 ,$58.66 ,$185.84 ,$141.40 ,$126.73 ,$136.25 ,$123.02 ,$126.73 ,$139.58 ,$145.44 ,$140.69 ,$26.33 ,$145.44 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$26.07 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$44.32 ,$171.70 ,$26.07 ,$44.32 ,$171.70 ,$147.46 ,$26.94 ,$26.07 ,$29.51 ,$171.70 ,$58.66 ,$185.84 ,$141.40 ,$126.73 ,$136.25 ,$123.02 ,$126.73 ,$139.58 ,$145.44 ,$140.69 ,$26.33 ,$145.44 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$26.07 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$82.08 ,$83.22 ,$44.32 ,$96.90 ,$26.07 ,$44.32 ,$96.90 ,$83.22 ,$26.94 ,$26.07 ,$29.51 ,$96.90 ,$58.66 ,$104.88 ,$79.80 ,$114.00 ,$114.00 ,$69.43 ,$114.00 ,$78.77 ,$82.08 ,$79.40 ,$26.33 ,$82.08 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$26.07 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$68.40 
ST MARY'S HOSPITAL,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 ,$90.00 ,$91.25 ,$44.32 ,$106.25 ,$26.07 ,$44.32 ,$106.25 ,$91.25 ,$26.94 ,$26.07 ,$29.51 ,$106.25 ,$58.66 ,$115.00 ,$87.50 ,$125.00 ,$125.00 ,$76.13 ,$125.00 ,$86.38 ,$90.00 ,$87.06 ,$26.33 ,$90.00 ,$28.56 ,$31.28 ,$31.28 ,$26.07 ,$31.28 ,$26.07 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$75.00 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$124.10 ,$106.58 ,$7.06 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$95.08 ,$102.23 ,$88.91 ,$95.08 ,$100.89 ,$105.12 ,$101.69 ,$19.76 ,$105.12 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$66.24 ,$67.16 ,$33.25 ,$78.20 ,$19.56 ,$33.25 ,$78.20 ,$67.16 ,$7.06 ,$19.56 ,$22.14 ,$78.20 ,$44.01 ,$84.64 ,$64.40 ,$92.00 ,$92.00 ,$56.03 ,$92.00 ,$63.57 ,$66.24 ,$64.08 ,$19.76 ,$66.24 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$55.20 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$124.10 ,$106.58 ,$7.06 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$95.08 ,$102.23 ,$88.91 ,$95.08 ,$100.89 ,$105.12 ,$101.69 ,$19.76 ,$105.12 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$124.10 ,$106.58 ,$7.06 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$95.08 ,$102.23 ,$88.91 ,$95.08 ,$100.89 ,$105.12 ,$101.69 ,$19.76 ,$105.12 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$124.10 ,$106.58 ,$7.06 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$95.08 ,$102.23 ,$88.91 ,$95.08 ,$100.89 ,$105.12 ,$101.69 ,$19.76 ,$105.12 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$124.10 ,$106.58 ,$7.06 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$95.08 ,$102.23 ,$88.91 ,$95.08 ,$100.89 ,$105.12 ,$101.69 ,$19.76 ,$105.12 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$24.53 ,$72.25 ,$14.43 ,$24.53 ,$72.25 ,$62.05 ,$14.91 ,$14.43 ,$16.33 ,$72.25 ,$32.47 ,$78.20 ,$59.50 ,$58.30 ,$62.68 ,$51.77 ,$58.30 ,$58.74 ,$61.20 ,$59.20 ,$14.57 ,$61.20 ,$15.80 ,$17.32 ,$17.32 ,$14.43 ,$17.32 ,$14.43 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$20.37 ,$92.65 ,$11.98 ,$20.37 ,$92.65 ,$79.57 ,$12.38 ,$11.98 ,$13.56 ,$92.65 ,$26.96 ,$100.28 ,$76.30 ,$58.30 ,$62.68 ,$66.38 ,$58.30 ,$75.32 ,$78.48 ,$75.92 ,$12.10 ,$78.48 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$20.37 ,$72.25 ,$11.98 ,$20.37 ,$72.25 ,$62.05 ,$12.38 ,$11.98 ,$13.56 ,$72.25 ,$26.96 ,$78.20 ,$59.50 ,$58.30 ,$62.68 ,$51.77 ,$58.30 ,$58.74 ,$61.20 ,$59.20 ,$12.10 ,$61.20 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$20.37 ,$72.25 ,$11.98 ,$20.37 ,$72.25 ,$62.05 ,$12.38 ,$11.98 ,$13.56 ,$72.25 ,$26.96 ,$78.20 ,$59.50 ,$58.30 ,$62.68 ,$51.77 ,$58.30 ,$58.74 ,$61.20 ,$59.20 ,$12.10 ,$61.20 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$20.83 ,$92.65 ,$12.25 ,$20.83 ,$92.65 ,$79.57 ,$12.66 ,$12.25 ,$13.86 ,$92.65 ,$27.56 ,$100.28 ,$76.30 ,$58.30 ,$62.68 ,$66.38 ,$58.30 ,$75.32 ,$78.48 ,$75.92 ,$12.37 ,$78.48 ,$13.42 ,$14.70 ,$14.70 ,$12.25 ,$14.70 ,$12.25 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$27.32 ,$92.65 ,$16.07 ,$27.32 ,$92.65 ,$79.57 ,$16.61 ,$16.07 ,$18.19 ,$92.65 ,$36.16 ,$100.28 ,$76.30 ,$58.30 ,$62.68 ,$66.38 ,$58.30 ,$75.32 ,$78.48 ,$75.92 ,$16.23 ,$78.48 ,$17.61 ,$19.28 ,$19.28 ,$16.07 ,$19.28 ,$16.07 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$26.52 ,$56.95 ,$15.60 ,$26.52 ,$56.95 ,$48.91 ,$16.12 ,$15.60 ,$17.66 ,$56.95 ,$35.10 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$15.76 ,$48.24 ,$17.09 ,$18.72 ,$18.72 ,$15.60 ,$18.72 ,$15.60 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$27.93 ,$72.25 ,$16.43 ,$27.93 ,$72.25 ,$62.05 ,$16.86 ,$16.43 ,$18.60 ,$72.25 ,$36.97 ,$78.20 ,$59.50 ,$58.30 ,$62.68 ,$51.77 ,$58.30 ,$58.74 ,$61.20 ,$59.20 ,$16.59 ,$61.20 ,$17.87 ,$19.72 ,$19.72 ,$16.43 ,$19.72 ,$16.43 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$22.81 ,$95.20 ,$13.42 ,$22.81 ,$95.20 ,$81.76 ,$13.87 ,$13.42 ,$15.19 ,$95.20 ,$30.20 ,$103.04 ,$78.40 ,$58.30 ,$62.68 ,$68.21 ,$58.30 ,$77.39 ,$80.64 ,$78.01 ,$13.55 ,$80.64 ,$14.70 ,$16.10 ,$16.10 ,$13.42 ,$16.10 ,$13.42 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$20.37 ,$95.20 ,$11.98 ,$20.37 ,$95.20 ,$81.76 ,$12.38 ,$11.98 ,$13.56 ,$95.20 ,$26.96 ,$103.04 ,$78.40 ,$58.30 ,$62.68 ,$68.21 ,$58.30 ,$77.39 ,$80.64 ,$78.01 ,$12.10 ,$80.64 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$22.81 ,$92.65 ,$13.42 ,$22.81 ,$92.65 ,$79.57 ,$13.87 ,$13.42 ,$15.19 ,$92.65 ,$30.20 ,$100.28 ,$76.30 ,$58.30 ,$62.68 ,$66.38 ,$58.30 ,$75.32 ,$78.48 ,$75.92 ,$13.55 ,$78.48 ,$14.70 ,$16.10 ,$16.10 ,$13.42 ,$16.10 ,$13.42 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$61.20 ,$62.05 ,$20.37 ,$72.25 ,$11.98 ,$20.37 ,$72.25 ,$62.05 ,$8.66 ,$11.98 ,$13.56 ,$72.25 ,$26.96 ,$78.20 ,$59.50 ,$58.30 ,$62.68 ,$51.77 ,$58.30 ,$58.74 ,$61.20 ,$59.20 ,$12.10 ,$61.20 ,$9.18 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$61.20 ,$52.70 ,$61.20 ,$61.20 ,$51.00 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$20.37 ,$113.90 ,$11.98 ,$20.37 ,$113.90 ,$97.82 ,$12.38 ,$11.98 ,$13.56 ,$113.90 ,$26.96 ,$123.28 ,$93.80 ,$58.30 ,$62.68 ,$81.61 ,$58.30 ,$92.59 ,$96.48 ,$93.33 ,$12.10 ,$96.48 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$20.37 ,$92.65 ,$11.98 ,$20.37 ,$92.65 ,$79.57 ,$12.38 ,$11.98 ,$13.56 ,$92.65 ,$26.96 ,$100.28 ,$76.30 ,$58.30 ,$62.68 ,$66.38 ,$58.30 ,$75.32 ,$78.48 ,$75.92 ,$12.10 ,$78.48 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$78.48 ,$79.57 ,$22.81 ,$92.65 ,$13.42 ,$22.81 ,$92.65 ,$79.57 ,$13.87 ,$13.42 ,$15.19 ,$92.65 ,$30.20 ,$100.28 ,$76.30 ,$58.30 ,$62.68 ,$66.38 ,$58.30 ,$75.32 ,$78.48 ,$75.92 ,$13.55 ,$78.48 ,$14.70 ,$16.10 ,$16.10 ,$13.42 ,$16.10 ,$13.42 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,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 ,$34.56 ,$35.04 ,$23.49 ,$40.80 ,$13.82 ,$23.49 ,$40.80 ,$35.04 ,$14.28 ,$13.82 ,$15.64 ,$40.80 ,$31.10 ,$44.16 ,$33.60 ,$48.00 ,$48.00 ,$29.23 ,$48.00 ,$33.17 ,$34.56 ,$33.43 ,$13.96 ,$34.56 ,$15.14 ,$16.58 ,$16.58 ,$13.82 ,$16.58 ,$13.82 ,$34.56 ,$29.76 ,$34.56 ,$34.56 ,$28.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$56.95 ,$48.91 ,$12.38 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$12.10 ,$48.24 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$24.45 ,$113.90 ,$14.38 ,$24.45 ,$113.90 ,$97.82 ,$14.86 ,$14.38 ,$16.28 ,$113.90 ,$32.36 ,$123.28 ,$93.80 ,$69.92 ,$75.18 ,$81.61 ,$69.92 ,$92.59 ,$96.48 ,$93.33 ,$14.52 ,$96.48 ,$15.75 ,$17.26 ,$17.26 ,$14.38 ,$17.26 ,$14.38 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$17.56 ,$66.30 ,$10.33 ,$17.56 ,$66.30 ,$56.94 ,$10.67 ,$10.33 ,$11.69 ,$66.30 ,$23.24 ,$71.76 ,$54.60 ,$50.25 ,$54.03 ,$47.50 ,$50.25 ,$53.90 ,$56.16 ,$54.33 ,$10.43 ,$56.16 ,$11.31 ,$12.40 ,$12.40 ,$10.33 ,$12.40 ,$10.33 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$17.56 ,$66.30 ,$10.33 ,$17.56 ,$66.30 ,$56.94 ,$10.67 ,$10.33 ,$11.69 ,$66.30 ,$23.24 ,$71.76 ,$54.60 ,$50.25 ,$54.03 ,$47.50 ,$50.25 ,$53.90 ,$56.16 ,$54.33 ,$10.43 ,$56.16 ,$11.31 ,$12.40 ,$12.40 ,$10.33 ,$12.40 ,$10.33 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$19.60 ,$56.95 ,$11.53 ,$19.60 ,$56.95 ,$48.91 ,$11.91 ,$11.53 ,$13.05 ,$56.95 ,$25.94 ,$61.64 ,$46.90 ,$56.06 ,$60.27 ,$40.80 ,$56.06 ,$46.30 ,$48.24 ,$46.67 ,$11.65 ,$48.24 ,$12.62 ,$13.84 ,$13.84 ,$11.53 ,$13.84 ,$11.53 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$22.53 ,$133.45 ,$13.25 ,$22.53 ,$133.45 ,$114.61 ,$13.69 ,$13.25 ,$15.00 ,$133.45 ,$29.81 ,$144.44 ,$109.90 ,$58.30 ,$62.68 ,$95.61 ,$58.30 ,$108.49 ,$113.04 ,$109.35 ,$13.38 ,$113.04 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$22.53 ,$124.10 ,$13.25 ,$22.53 ,$124.10 ,$106.58 ,$13.69 ,$13.25 ,$15.00 ,$124.10 ,$29.81 ,$134.32 ,$102.20 ,$58.30 ,$62.68 ,$88.91 ,$58.30 ,$100.89 ,$105.12 ,$101.69 ,$13.38 ,$105.12 ,$14.51 ,$15.90 ,$15.90 ,$13.25 ,$15.90 ,$13.25 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$40.90 ,$119.85 ,$24.06 ,$40.90 ,$119.85 ,$102.93 ,$24.81 ,$24.06 ,$27.23 ,$119.85 ,$54.14 ,$129.72 ,$98.70 ,$85.75 ,$92.19 ,$85.87 ,$85.75 ,$97.43 ,$101.52 ,$98.21 ,$24.30 ,$101.52 ,$26.30 ,$28.87 ,$28.87 ,$24.06 ,$28.87 ,$24.06 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$58.32 ,$59.13 ,$24.02 ,$68.85 ,$14.13 ,$24.02 ,$68.85 ,$59.13 ,$8.66 ,$14.13 ,$15.99 ,$68.85 ,$31.79 ,$74.52 ,$56.70 ,$58.30 ,$62.68 ,$49.33 ,$58.30 ,$55.97 ,$58.32 ,$56.42 ,$14.27 ,$58.32 ,$9.18 ,$16.96 ,$16.96 ,$14.13 ,$16.96 ,$14.13 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$48.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$23.65 ,$95.20 ,$13.91 ,$23.65 ,$95.20 ,$81.76 ,$14.37 ,$13.91 ,$15.74 ,$95.20 ,$31.30 ,$103.04 ,$78.40 ,$58.30 ,$62.68 ,$68.21 ,$58.30 ,$77.39 ,$80.64 ,$78.01 ,$14.05 ,$80.64 ,$15.23 ,$16.69 ,$16.69 ,$13.91 ,$16.69 ,$13.91 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$56.95 ,$48.91 ,$12.38 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$12.10 ,$48.24 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$28.58 ,$76.50 ,$16.81 ,$28.58 ,$76.50 ,$65.70 ,$16.86 ,$16.81 ,$19.03 ,$76.50 ,$37.82 ,$82.80 ,$63.00 ,$58.30 ,$62.68 ,$54.81 ,$58.30 ,$62.19 ,$64.80 ,$62.69 ,$16.98 ,$64.80 ,$17.87 ,$20.17 ,$20.17 ,$16.81 ,$20.17 ,$16.81 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$92.16 ,$93.44 ,$20.37 ,$108.80 ,$11.98 ,$20.37 ,$108.80 ,$93.44 ,$12.38 ,$11.98 ,$13.56 ,$108.80 ,$26.96 ,$117.76 ,$89.60 ,$58.30 ,$62.68 ,$77.95 ,$58.30 ,$88.45 ,$92.16 ,$89.15 ,$12.10 ,$92.16 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$92.16 ,$79.36 ,$92.16 ,$92.16 ,$76.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$56.95 ,$48.91 ,$12.38 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$12.10 ,$48.24 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$56.95 ,$48.91 ,$12.38 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$12.10 ,$48.24 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$56.95 ,$48.91 ,$12.38 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$12.10 ,$48.24 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$20.37 ,$56.95 ,$11.98 ,$20.37 ,$56.95 ,$48.91 ,$12.38 ,$11.98 ,$13.56 ,$56.95 ,$26.96 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$12.10 ,$48.24 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$20.37 ,$66.30 ,$11.98 ,$20.37 ,$66.30 ,$56.94 ,$12.38 ,$11.98 ,$13.56 ,$66.30 ,$26.96 ,$71.76 ,$54.60 ,$58.30 ,$62.68 ,$47.50 ,$58.30 ,$53.90 ,$56.16 ,$54.33 ,$12.10 ,$56.16 ,$13.12 ,$14.38 ,$14.38 ,$11.98 ,$14.38 ,$11.98 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$254.88 ,$258.42 ,$59.65 ,$300.90 ,$35.09 ,$59.65 ,$300.90 ,$258.42 ,$36.26 ,$35.09 ,$39.71 ,$300.90 ,$78.95 ,$325.68 ,$247.80 ,$170.60 ,$183.42 ,$215.59 ,$170.60 ,$244.61 ,$254.88 ,$246.56 ,$35.44 ,$254.88 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$254.88 ,$219.48 ,$254.88 ,$254.88 ,$212.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$63.36 ,$228.65 ,$37.27 ,$63.36 ,$228.65 ,$196.37 ,$38.51 ,$37.27 ,$42.18 ,$228.65 ,$83.86 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$37.64 ,$193.68 ,$40.82 ,$44.72 ,$44.72 ,$37.27 ,$44.72 ,$37.27 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$185.76 ,$188.34 ,$72.83 ,$219.30 ,$42.84 ,$72.83 ,$219.30 ,$188.34 ,$44.27 ,$42.84 ,$48.49 ,$219.30 ,$96.39 ,$237.36 ,$180.60 ,$208.27 ,$223.92 ,$157.12 ,$208.27 ,$178.28 ,$185.76 ,$179.70 ,$43.27 ,$185.76 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$141.12 ,$143.08 ,$72.83 ,$166.60 ,$42.84 ,$72.83 ,$166.60 ,$143.08 ,$44.27 ,$42.84 ,$48.49 ,$166.60 ,$96.39 ,$180.32 ,$137.20 ,$196.00 ,$196.00 ,$119.36 ,$196.00 ,$135.44 ,$141.12 ,$136.51 ,$43.27 ,$141.12 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$141.12 ,$121.52 ,$141.12 ,$141.12 ,$117.60 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$72.83 ,$314.50 ,$42.84 ,$72.83 ,$314.50 ,$270.10 ,$44.27 ,$42.84 ,$48.49 ,$314.50 ,$96.39 ,$340.40 ,$259.00 ,$208.27 ,$223.92 ,$225.33 ,$208.27 ,$255.67 ,$266.40 ,$257.71 ,$43.27 ,$266.40 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$276.25 ,$237.25 ,$44.27 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$208.27 ,$223.92 ,$197.93 ,$208.27 ,$224.58 ,$234.00 ,$226.36 ,$43.27 ,$234.00 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$72.83 ,$209.10 ,$42.84 ,$72.83 ,$209.10 ,$179.58 ,$44.27 ,$42.84 ,$48.49 ,$209.10 ,$96.39 ,$226.32 ,$172.20 ,$208.27 ,$223.92 ,$149.81 ,$208.27 ,$169.99 ,$177.12 ,$171.34 ,$43.27 ,$177.12 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$59.65 ,$152.15 ,$35.09 ,$59.65 ,$152.15 ,$130.67 ,$36.26 ,$35.09 ,$39.71 ,$152.15 ,$78.95 ,$164.68 ,$125.30 ,$170.60 ,$179.00 ,$109.01 ,$170.60 ,$123.69 ,$128.88 ,$124.67 ,$35.44 ,$128.88 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$59.65 ,$276.25 ,$35.09 ,$59.65 ,$276.25 ,$237.25 ,$36.26 ,$35.09 ,$39.71 ,$276.25 ,$78.95 ,$299.00 ,$227.50 ,$170.60 ,$183.42 ,$197.93 ,$170.60 ,$224.58 ,$234.00 ,$226.36 ,$35.44 ,$234.00 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$144.67 ,$276.25 ,$85.10 ,$144.67 ,$276.25 ,$237.25 ,$87.93 ,$85.10 ,$96.32 ,$276.25 ,$191.48 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$234.00 ,$226.36 ,$85.95 ,$234.00 ,$93.21 ,$102.12 ,$102.12 ,$85.10 ,$102.12 ,$85.10 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$144.67 ,$276.25 ,$85.10 ,$144.67 ,$276.25 ,$237.25 ,$87.93 ,$85.10 ,$96.32 ,$276.25 ,$191.48 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$234.00 ,$226.36 ,$85.95 ,$234.00 ,$93.21 ,$102.12 ,$102.12 ,$85.10 ,$102.12 ,$85.10 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$70.86 ,$190.40 ,$41.68 ,$70.86 ,$190.40 ,$163.52 ,$43.07 ,$41.68 ,$47.17 ,$190.40 ,$93.78 ,$206.08 ,$156.80 ,$170.60 ,$183.42 ,$136.42 ,$170.60 ,$154.78 ,$161.28 ,$156.02 ,$42.10 ,$161.28 ,$45.65 ,$50.02 ,$50.02 ,$41.68 ,$50.02 ,$41.68 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$59.65 ,$119.85 ,$35.09 ,$59.65 ,$119.85 ,$102.93 ,$36.26 ,$35.09 ,$39.71 ,$119.85 ,$78.95 ,$129.72 ,$98.70 ,$141.00 ,$141.00 ,$85.87 ,$141.00 ,$97.43 ,$101.52 ,$98.21 ,$35.44 ,$101.52 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$95.04 ,$96.36 ,$59.65 ,$112.20 ,$35.09 ,$59.65 ,$112.20 ,$96.36 ,$36.26 ,$35.09 ,$39.71 ,$112.20 ,$78.95 ,$121.44 ,$92.40 ,$132.00 ,$132.00 ,$80.39 ,$132.00 ,$91.21 ,$95.04 ,$91.94 ,$35.44 ,$95.04 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$79.20 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$59.65 ,$119.85 ,$35.09 ,$59.65 ,$119.85 ,$102.93 ,$36.26 ,$35.09 ,$39.71 ,$119.85 ,$78.95 ,$129.72 ,$98.70 ,$141.00 ,$141.00 ,$85.87 ,$141.00 ,$97.43 ,$101.52 ,$98.21 ,$35.44 ,$101.52 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$59.65 ,$104.55 ,$35.09 ,$59.65 ,$104.55 ,$89.79 ,$36.26 ,$35.09 ,$39.71 ,$104.55 ,$78.95 ,$113.16 ,$86.10 ,$123.00 ,$123.00 ,$74.91 ,$123.00 ,$84.99 ,$88.56 ,$85.67 ,$35.44 ,$88.56 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$44.64 ,$45.26 ,$59.65 ,$52.70 ,$35.09 ,$59.65 ,$52.70 ,$45.26 ,$36.26 ,$35.09 ,$39.71 ,$52.70 ,$78.95 ,$57.04 ,$43.40 ,$62.00 ,$62.00 ,$37.76 ,$62.00 ,$42.84 ,$44.64 ,$43.18 ,$35.44 ,$44.64 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$174.96 ,$177.39 ,$59.65 ,$206.55 ,$35.09 ,$59.65 ,$206.55 ,$177.39 ,$36.26 ,$35.09 ,$39.71 ,$206.55 ,$78.95 ,$223.56 ,$170.10 ,$170.60 ,$183.42 ,$147.99 ,$170.60 ,$167.91 ,$174.96 ,$169.25 ,$35.44 ,$174.96 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$174.96 ,$150.66 ,$174.96 ,$174.96 ,$145.80 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$276.25 ,$237.25 ,$44.27 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$208.27 ,$223.92 ,$197.93 ,$208.27 ,$224.58 ,$234.00 ,$226.36 ,$43.27 ,$234.00 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$95.04 ,$96.36 ,$21.64 ,$112.20 ,$12.73 ,$21.64 ,$112.20 ,$96.36 ,$13.15 ,$12.73 ,$14.41 ,$112.20 ,$28.64 ,$121.44 ,$92.40 ,$58.30 ,$62.68 ,$80.39 ,$58.30 ,$91.21 ,$95.04 ,$91.94 ,$12.86 ,$95.04 ,$13.94 ,$15.28 ,$15.28 ,$12.73 ,$15.28 ,$12.73 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$79.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$22.27 ,$95.20 ,$13.10 ,$22.27 ,$95.20 ,$81.76 ,$13.54 ,$13.10 ,$14.83 ,$95.20 ,$29.48 ,$103.04 ,$78.40 ,$58.30 ,$62.68 ,$68.21 ,$58.30 ,$77.39 ,$80.64 ,$78.01 ,$13.23 ,$80.64 ,$14.35 ,$15.72 ,$15.72 ,$13.10 ,$15.72 ,$13.10 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$28.10 ,$76.50 ,$16.53 ,$28.10 ,$76.50 ,$65.70 ,$16.86 ,$16.53 ,$18.71 ,$76.50 ,$37.19 ,$82.80 ,$63.00 ,$58.30 ,$62.68 ,$54.81 ,$58.30 ,$62.19 ,$64.80 ,$62.69 ,$16.70 ,$64.80 ,$17.87 ,$19.84 ,$19.84 ,$16.53 ,$19.84 ,$16.53 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$27.32 ,$56.95 ,$16.07 ,$27.32 ,$56.95 ,$48.91 ,$16.61 ,$16.07 ,$18.19 ,$56.95 ,$36.16 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$16.23 ,$48.24 ,$17.61 ,$19.28 ,$19.28 ,$16.07 ,$19.28 ,$16.07 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ","$1,128.96 ","$1,144.64 ",$437.67 ,"$1,332.80 ",$257.45 ,$437.67 ,"$1,332.80 ","$1,144.64 ",$266.02 ,$257.45 ,$291.38 ,"$1,332.80 ",$579.26 ,"$1,442.56 ","$1,097.60 ","$1,251.68 ","$1,345.73 ",$954.91 ,"$1,251.68 ","$1,083.49 ","$1,128.96 ","$1,092.11 ",$260.02 ,"$1,128.96 ",$281.98 ,$308.94 ,$308.94 ,$257.45 ,$308.94 ,$257.45 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ,$387.36 ,$392.74 ,$119.34 ,$457.30 ,$70.20 ,$119.34 ,$457.30 ,$392.74 ,$50.62 ,$70.20 ,$79.45 ,$457.30 ,$157.95 ,$494.96 ,$376.60 ,$341.27 ,$366.91 ,$327.64 ,$341.27 ,$371.76 ,$387.36 ,$374.72 ,$70.90 ,$387.36 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$70.20 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$322.80 
ST MARY'S HOSPITAL,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 ,$483.84 ,$490.56 ,$196.11 ,$571.20 ,$115.36 ,$196.11 ,$571.20 ,$490.56 ,$119.20 ,$115.36 ,$130.56 ,$571.20 ,$259.56 ,$618.24 ,$470.40 ,$560.87 ,$603.02 ,$409.25 ,$560.87 ,$464.35 ,$483.84 ,$468.05 ,$116.51 ,$483.84 ,$126.35 ,$138.43 ,$138.43 ,$115.36 ,$138.43 ,$115.36 ,$483.84 ,$416.64 ,$483.84 ,$483.84 ,$403.20 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$59.65 ,$209.10 ,$35.09 ,$59.65 ,$209.10 ,$179.58 ,$36.26 ,$35.09 ,$39.71 ,$209.10 ,$78.95 ,$226.32 ,$172.20 ,$170.60 ,$183.42 ,$149.81 ,$170.60 ,$169.99 ,$177.12 ,$171.34 ,$35.44 ,$177.12 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$59.65 ,$209.10 ,$35.09 ,$59.65 ,$209.10 ,$179.58 ,$36.26 ,$35.09 ,$39.71 ,$209.10 ,$78.95 ,$226.32 ,$172.20 ,$170.60 ,$183.42 ,$149.81 ,$170.60 ,$169.99 ,$177.12 ,$171.34 ,$35.44 ,$177.12 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$27.32 ,$56.95 ,$16.07 ,$27.32 ,$56.95 ,$48.91 ,$16.61 ,$16.07 ,$18.19 ,$56.95 ,$36.16 ,$61.64 ,$46.90 ,$58.30 ,$62.68 ,$40.80 ,$58.30 ,$46.30 ,$48.24 ,$46.67 ,$16.23 ,$48.24 ,$17.61 ,$19.28 ,$19.28 ,$16.07 ,$19.28 ,$16.07 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$28.14 ,$85.85 ,$16.55 ,$28.14 ,$85.85 ,$73.73 ,$16.86 ,$16.55 ,$18.73 ,$85.85 ,$37.24 ,$92.92 ,$70.70 ,$58.30 ,$62.68 ,$61.51 ,$58.30 ,$69.79 ,$72.72 ,$70.35 ,$16.72 ,$72.72 ,$17.87 ,$19.86 ,$19.86 ,$16.55 ,$19.86 ,$16.55 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$59.65 ,$133.45 ,$35.09 ,$59.65 ,$133.45 ,$114.61 ,$36.26 ,$35.09 ,$39.71 ,$133.45 ,$78.95 ,$144.44 ,$109.90 ,$157.00 ,$157.00 ,$95.61 ,$157.00 ,$108.49 ,$113.04 ,$109.35 ,$35.44 ,$113.04 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$68.94 ,$133.45 ,$40.55 ,$68.94 ,$133.45 ,$114.61 ,$38.30 ,$40.55 ,$45.89 ,$133.45 ,$91.24 ,$144.44 ,$109.90 ,$157.00 ,$157.00 ,$95.61 ,$157.00 ,$108.49 ,$113.04 ,$109.35 ,$40.96 ,$113.04 ,$40.60 ,$48.66 ,$48.66 ,$40.55 ,$48.66 ,$40.55 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$645.12 ,$654.08 ,$708.53 ,$761.60 ,$416.78 ,$708.53 ,$761.60 ,$654.08 ,$430.66 ,$416.78 ,$471.71 ,$761.60 ,$937.76 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$645.12 ,$624.06 ,$420.95 ,$645.12 ,$456.50 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$416.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$59.65 ,$190.40 ,$35.09 ,$59.65 ,$190.40 ,$163.52 ,$36.26 ,$35.09 ,$39.71 ,$190.40 ,$78.95 ,$206.08 ,$156.80 ,$170.60 ,$183.42 ,$136.42 ,$170.60 ,$154.78 ,$161.28 ,$156.02 ,$35.44 ,$161.28 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 ,$59.65 ,$190.40 ,$35.09 ,$59.65 ,$190.40 ,$163.52 ,$36.26 ,$35.09 ,$39.71 ,$190.40 ,$78.95 ,$206.08 ,$156.80 ,$170.60 ,$183.42 ,$136.42 ,$170.60 ,$154.78 ,$161.28 ,$156.02 ,$35.44 ,$161.28 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$148.32 ,$150.38 ,$59.65 ,$175.10 ,$35.09 ,$59.65 ,$175.10 ,$150.38 ,$36.26 ,$35.09 ,$39.71 ,$175.10 ,$78.95 ,$189.52 ,$144.20 ,$170.60 ,$183.42 ,$125.45 ,$170.60 ,$142.35 ,$148.32 ,$143.48 ,$35.44 ,$148.32 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$148.32 ,$127.72 ,$148.32 ,$148.32 ,$123.60 
ST MARY'S HOSPITAL,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 ,$148.32 ,$150.38 ,$59.65 ,$175.10 ,$35.09 ,$59.65 ,$175.10 ,$150.38 ,$36.26 ,$35.09 ,$39.71 ,$175.10 ,$78.95 ,$189.52 ,$144.20 ,$170.60 ,$183.42 ,$125.45 ,$170.60 ,$142.35 ,$148.32 ,$143.48 ,$35.44 ,$148.32 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$148.32 ,$127.72 ,$148.32 ,$148.32 ,$123.60 
ST MARY'S HOSPITAL,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 ,$114.48 ,$116.07 ,$59.65 ,$135.15 ,$35.09 ,$59.65 ,$135.15 ,$116.07 ,$36.26 ,$35.09 ,$39.71 ,$135.15 ,$78.95 ,$146.28 ,$111.30 ,$159.00 ,$159.00 ,$96.83 ,$159.00 ,$109.87 ,$114.48 ,$110.74 ,$35.44 ,$114.48 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$95.40 
ST MARY'S HOSPITAL,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 ,$114.48 ,$116.07 ,$59.65 ,$135.15 ,$35.09 ,$59.65 ,$135.15 ,$116.07 ,$36.26 ,$35.09 ,$39.71 ,$135.15 ,$78.95 ,$146.28 ,$111.30 ,$159.00 ,$159.00 ,$96.83 ,$159.00 ,$109.87 ,$114.48 ,$110.74 ,$35.44 ,$114.48 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$95.40 
ST MARY'S HOSPITAL,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 ,$114.48 ,$116.07 ,$59.65 ,$135.15 ,$35.09 ,$59.65 ,$135.15 ,$116.07 ,$36.26 ,$35.09 ,$39.71 ,$135.15 ,$78.95 ,$146.28 ,$111.30 ,$159.00 ,$159.00 ,$96.83 ,$159.00 ,$109.87 ,$114.48 ,$110.74 ,$35.44 ,$114.48 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$114.48 ,$98.58 ,$114.48 ,$114.48 ,$95.40 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$59.65 ,$66.30 ,$35.09 ,$59.65 ,$66.30 ,$56.94 ,$36.26 ,$35.09 ,$39.71 ,$66.30 ,$78.95 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$56.16 ,$54.33 ,$35.44 ,$56.16 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$59.65 ,$66.30 ,$35.09 ,$59.65 ,$66.30 ,$56.94 ,$36.26 ,$35.09 ,$39.71 ,$66.30 ,$78.95 ,$71.76 ,$54.60 ,$78.00 ,$78.00 ,$47.50 ,$78.00 ,$53.90 ,$56.16 ,$54.33 ,$35.44 ,$56.16 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$10.18 ,$56.95 ,$5.99 ,$10.18 ,$56.95 ,$48.91 ,$6.19 ,$5.99 ,$6.78 ,$56.95 ,$13.48 ,$61.64 ,$46.90 ,$29.15 ,$31.34 ,$40.80 ,$29.15 ,$46.30 ,$48.24 ,$46.67 ,$6.05 ,$48.24 ,$6.56 ,$7.19 ,$7.19 ,$5.99 ,$7.19 ,$5.99 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$40.94 ,$95.20 ,$24.08 ,$40.94 ,$95.20 ,$81.76 ,$24.88 ,$24.08 ,$27.25 ,$95.20 ,$54.18 ,$103.04 ,$78.40 ,$112.00 ,$112.00 ,$68.21 ,$112.00 ,$77.39 ,$80.64 ,$78.01 ,$24.32 ,$80.64 ,$26.37 ,$28.90 ,$28.90 ,$24.08 ,$28.90 ,$24.08 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ,$178.56 ,$181.04 ,$59.65 ,$210.80 ,$35.09 ,$59.65 ,$210.80 ,$181.04 ,$36.26 ,$35.09 ,$39.71 ,$210.80 ,$78.95 ,$228.16 ,$173.60 ,$170.60 ,$183.42 ,$151.03 ,$170.60 ,$171.37 ,$178.56 ,$172.73 ,$35.44 ,$178.56 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$148.80 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$276.25 ,$237.25 ,$44.27 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$208.27 ,$223.92 ,$197.93 ,$208.27 ,$224.58 ,$234.00 ,$226.36 ,$43.27 ,$234.00 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$678.24 ,$687.66 ,$708.53 ,$800.70 ,$416.78 ,$708.53 ,$800.70 ,$687.66 ,$430.66 ,$416.78 ,$471.71 ,$800.70 ,$937.76 ,$866.64 ,$659.40 ,$942.00 ,$942.00 ,$573.68 ,$942.00 ,$650.92 ,$678.24 ,$656.10 ,$420.95 ,$678.24 ,$456.50 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$416.78 ,$678.24 ,$584.04 ,$678.24 ,$678.24 ,$565.20 
ST MARY'S HOSPITAL,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 ,$645.12 ,$654.08 ,$708.53 ,$761.60 ,$416.78 ,$708.53 ,$761.60 ,$654.08 ,$430.66 ,$416.78 ,$471.71 ,$761.60 ,$937.76 ,$824.32 ,$627.20 ,$896.00 ,$896.00 ,$545.66 ,$896.00 ,$619.14 ,$645.12 ,$624.06 ,$420.95 ,$645.12 ,$456.50 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$416.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$72.83 ,$171.70 ,$42.84 ,$72.83 ,$171.70 ,$147.46 ,$44.27 ,$42.84 ,$48.49 ,$171.70 ,$96.39 ,$185.84 ,$141.40 ,$202.00 ,$202.00 ,$123.02 ,$202.00 ,$139.58 ,$145.44 ,$140.69 ,$43.27 ,$145.44 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$234.00 ,$237.25 ,$72.83 ,$276.25 ,$42.84 ,$72.83 ,$276.25 ,$237.25 ,$44.27 ,$42.84 ,$48.49 ,$276.25 ,$96.39 ,$299.00 ,$227.50 ,$208.27 ,$223.92 ,$197.93 ,$208.27 ,$224.58 ,$234.00 ,$226.36 ,$43.27 ,$234.00 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$314.64 ,$319.01 ,$218.09 ,$371.45 ,$128.29 ,$218.09 ,$371.45 ,$319.01 ,$132.56 ,$128.29 ,$145.20 ,$371.45 ,$288.65 ,$402.04 ,$305.90 ,$437.00 ,$437.00 ,$266.13 ,$437.00 ,$301.97 ,$314.64 ,$304.37 ,$129.57 ,$314.64 ,$140.51 ,$153.95 ,$153.95 ,$128.29 ,$153.95 ,$128.29 ,$314.64 ,$270.94 ,$314.64 ,$314.64 ,$262.20 
ST MARY'S HOSPITAL,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 ","$1,370.88 ","$1,389.92 ",$708.53 ,"$1,618.40 ",$416.78 ,$708.53 ,"$1,618.40 ","$1,389.92 ",$333.42 ,$416.78 ,$471.71 ,"$1,618.40 ",$937.76 ,"$1,751.68 ","$1,332.80 ","$1,650.36 ","$1,774.38 ","$1,159.54 ","$1,650.36 ","$1,315.66 ","$1,370.88 ","$1,326.14 ",$420.95 ,"$1,370.88 ",$353.43 ,$500.14 ,$500.14 ,$416.78 ,$500.14 ,$416.78 ,"$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,142.40 "
ST MARY'S HOSPITAL,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 ,$235.44 ,$238.71 ,$59.65 ,$277.95 ,$35.09 ,$59.65 ,$277.95 ,$238.71 ,$36.26 ,$35.09 ,$39.71 ,$277.95 ,$78.95 ,$300.84 ,$228.90 ,$170.60 ,$183.42 ,$199.14 ,$170.60 ,$225.96 ,$235.44 ,$227.76 ,$35.44 ,$235.44 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$235.44 ,$202.74 ,$235.44 ,$235.44 ,$196.20 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$59.65 ,$476.00 ,$35.09 ,$59.65 ,$476.00 ,$408.80 ,$36.26 ,$35.09 ,$39.71 ,$476.00 ,$78.95 ,$515.20 ,$392.00 ,$170.60 ,$183.42 ,$341.04 ,$170.60 ,$386.96 ,$403.20 ,$390.04 ,$35.44 ,$403.20 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$29.52 ,$29.93 ,$20.42 ,$34.85 ,$12.01 ,$20.42 ,$34.85 ,$29.93 ,$8.17 ,$12.01 ,$13.59 ,$34.85 ,$27.02 ,$37.72 ,$28.70 ,$28.26 ,$30.38 ,$24.97 ,$28.26 ,$28.33 ,$29.52 ,$28.56 ,$12.13 ,$29.52 ,$8.66 ,$14.41 ,$14.41 ,$12.01 ,$14.41 ,$12.01 ,$29.52 ,$25.42 ,$29.52 ,$29.52 ,$24.60 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$28.07 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$125.05 ,$134.45 ,$163.82 ,$125.05 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$29.75 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$90.00 ,$91.25 ,$33.25 ,$106.25 ,$19.56 ,$33.25 ,$106.25 ,$91.25 ,$7.06 ,$19.56 ,$22.14 ,$106.25 ,$44.01 ,$115.00 ,$87.50 ,$95.08 ,$102.23 ,$76.13 ,$95.08 ,$86.38 ,$90.00 ,$87.06 ,$19.76 ,$90.00 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$75.00 
ST MARY'S HOSPITAL,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 ,$555.12 ,$562.83 ,$72.83 ,$655.35 ,$42.84 ,$72.83 ,$655.35 ,$562.83 ,$44.27 ,$42.84 ,$48.49 ,$655.35 ,$96.39 ,$709.32 ,$539.70 ,$208.27 ,$223.92 ,$469.54 ,$208.27 ,$532.76 ,$555.12 ,$537.00 ,$43.27 ,$555.12 ,$46.93 ,$51.41 ,$51.41 ,$42.84 ,$51.41 ,$42.84 ,$555.12 ,$478.02 ,$555.12 ,$555.12 ,$462.60 
ST MARY'S HOSPITAL,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 ,$378.72 ,$383.98 ,$447.08 ,$447.10 ,$262.99 ,$447.08 ,$447.10 ,$383.98 ,$232.94 ,$262.99 ,$297.65 ,$447.10 ,$591.73 ,$483.92 ,$368.20 ,$526.00 ,$526.00 ,$320.33 ,$526.00 ,$363.47 ,$378.72 ,$366.36 ,$265.62 ,$378.72 ,$246.92 ,$315.59 ,$315.59 ,$262.99 ,$315.59 ,$262.99 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$315.60 
ST MARY'S HOSPITAL,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 ,$435.60 ,$441.65 ,$447.08 ,$514.25 ,$262.99 ,$447.08 ,$514.25 ,$441.65 ,$232.94 ,$262.99 ,$297.65 ,$514.25 ,$591.73 ,$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$435.60 ,$421.38 ,$265.62 ,$435.60 ,$246.92 ,$315.59 ,$315.59 ,$262.99 ,$315.59 ,$262.99 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$363.00 
ST MARY'S HOSPITAL,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 ,$105.12 ,$106.58 ,$33.25 ,$124.10 ,$19.56 ,$33.25 ,$124.10 ,$106.58 ,$7.06 ,$19.56 ,$22.14 ,$124.10 ,$44.01 ,$134.32 ,$102.20 ,$95.08 ,$102.23 ,$88.91 ,$95.08 ,$100.89 ,$105.12 ,$101.69 ,$19.76 ,$105.12 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,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 ,$51.12 ,$51.83 ,$9.47 ,$60.35 ,$5.57 ,$9.47 ,$60.35 ,$51.83 ,$5.76 ,$5.57 ,$6.30 ,$60.35 ,$12.53 ,$65.32 ,$49.70 ,$22.17 ,$23.83 ,$43.24 ,$22.17 ,$49.06 ,$51.12 ,$49.45 ,$5.63 ,$51.12 ,$6.11 ,$6.68 ,$6.68 ,$5.57 ,$6.68 ,$5.57 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$42.60 
ST MARY'S HOSPITAL,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 ,$257.76 ,$261.34 ,$59.65 ,$304.30 ,$35.09 ,$59.65 ,$304.30 ,$261.34 ,$36.26 ,$35.09 ,$39.71 ,$304.30 ,$78.95 ,$329.36 ,$250.60 ,$170.60 ,$183.42 ,$218.02 ,$170.60 ,$247.38 ,$257.76 ,$249.35 ,$35.44 ,$257.76 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$59.65 ,$56.95 ,$35.09 ,$59.65 ,$56.95 ,$48.91 ,$36.26 ,$35.09 ,$39.71 ,$56.95 ,$78.95 ,$61.64 ,$46.90 ,$67.00 ,$67.00 ,$40.80 ,$67.00 ,$46.30 ,$48.24 ,$46.67 ,$35.44 ,$48.24 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$143.28 ,$145.27 ,$59.65 ,$169.15 ,$35.09 ,$59.65 ,$169.15 ,$145.27 ,$36.26 ,$35.09 ,$39.71 ,$169.15 ,$78.95 ,$183.08 ,$139.30 ,$170.60 ,$183.42 ,$121.19 ,$170.60 ,$137.51 ,$143.28 ,$138.60 ,$35.44 ,$143.28 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$143.28 ,$123.38 ,$143.28 ,$143.28 ,$119.40 
ST MARY'S HOSPITAL,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 ,$279.36 ,$283.24 ,$119.34 ,$329.80 ,$70.20 ,$119.34 ,$329.80 ,$283.24 ,$50.62 ,$70.20 ,$79.45 ,$329.80 ,$157.95 ,$356.96 ,$271.60 ,$341.27 ,$366.91 ,$236.29 ,$341.27 ,$268.11 ,$279.36 ,$270.24 ,$70.90 ,$279.36 ,$53.66 ,$84.24 ,$84.24 ,$70.20 ,$84.24 ,$70.20 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$232.80 
ST MARY'S HOSPITAL,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 ,$290.16 ,$294.19 ,$14.71 ,$342.55 ,$8.65 ,$14.71 ,$342.55 ,$294.19 ,$8.94 ,$8.65 ,$9.79 ,$342.55 ,$19.46 ,$370.76 ,$282.10 ,$42.05 ,$45.21 ,$245.43 ,$42.05 ,$278.47 ,$290.16 ,$280.69 ,$8.74 ,$290.16 ,$9.48 ,$10.38 ,$10.38 ,$8.65 ,$10.38 ,$8.65 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$59.65 ,$228.65 ,$35.09 ,$59.65 ,$228.65 ,$196.37 ,$36.26 ,$35.09 ,$39.71 ,$228.65 ,$78.95 ,$247.48 ,$188.30 ,$170.60 ,$183.42 ,$163.82 ,$170.60 ,$185.88 ,$193.68 ,$187.36 ,$35.44 ,$193.68 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$11.27 ,$113.90 ,$6.63 ,$11.27 ,$113.90 ,$97.82 ,$6.85 ,$6.63 ,$7.50 ,$113.90 ,$14.92 ,$123.28 ,$93.80 ,$32.25 ,$34.68 ,$81.61 ,$32.25 ,$92.59 ,$96.48 ,$93.33 ,$6.70 ,$96.48 ,$7.26 ,$7.96 ,$7.96 ,$6.63 ,$7.96 ,$6.63 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$87.12 ,$88.33 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$102.85 ,$88.33 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$87.12 ,$84.28 ,$51.82 ,$87.12 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$51.31 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$72.60 
ST MARY'S HOSPITAL,30640281,87591,HC N GONOR RNA TMA-REF,306,1 ,$24.26 ,$12.13 ,$12.13 ,$54.59 ,$24.26 ,$24.26 ,$24.26 ,$24.26 ,$14.56 ,$20.62 ,$16.98 ,$24.26 ,$23.05 ,$17.47 ,$17.71 ,$24.26 ,$20.62 ,$24.26 ,$24.26 ,$20.62 ,$17.71 ,$24.26 ,$24.26 ,$24.26 ,$20.62 ,$54.59 ,$22.32 ,$16.98 ,$24.26 ,$24.26 ,$14.77 ,$24.26 ,$16.76 ,$17.47 ,$16.90 ,$24.50 ,$17.47 ,$25.72 ,$24.26 ,$24.26 ,$24.26 ,$24.26 ,$24.26 ,$17.47 ,$15.04 ,$17.47 ,$17.47 ,$14.56 
ST MARY'S HOSPITAL,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 ,$87.12 ,$88.33 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$102.85 ,$88.33 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$87.12 ,$84.28 ,$51.82 ,$87.12 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$51.31 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$72.60 
ST MARY'S HOSPITAL,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 ,$87.12 ,$88.33 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$102.85 ,$88.33 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$87.12 ,$84.28 ,$51.82 ,$87.12 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$51.31 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$72.60 
ST MARY'S HOSPITAL,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 ,$62.64 ,$63.51 ,$71.62 ,$73.95 ,$42.13 ,$71.62 ,$73.95 ,$63.51 ,$42.13 ,$42.13 ,$47.68 ,$73.95 ,$94.79 ,$80.04 ,$60.90 ,$87.00 ,$87.00 ,$52.98 ,$87.00 ,$60.12 ,$62.64 ,$60.60 ,$42.55 ,$62.64 ,$44.66 ,$50.56 ,$50.56 ,$42.13 ,$50.56 ,$42.13 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$52.20 
ST MARY'S HOSPITAL,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 ,$62.64 ,$63.51 ,$71.62 ,$73.95 ,$42.13 ,$71.62 ,$73.95 ,$63.51 ,$42.13 ,$42.13 ,$47.68 ,$73.95 ,$94.79 ,$80.04 ,$60.90 ,$87.00 ,$87.00 ,$52.98 ,$87.00 ,$60.12 ,$62.64 ,$60.60 ,$42.55 ,$62.64 ,$44.66 ,$50.56 ,$50.56 ,$42.13 ,$50.56 ,$42.13 ,$62.64 ,$53.94 ,$62.64 ,$62.64 ,$52.20 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$76.89 ,$71.40 ,$35.33 ,$76.89 ,$71.40 ,$61.32 ,$35.33 ,$35.33 ,$39.99 ,$71.40 ,$79.49 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$60.48 ,$58.51 ,$35.68 ,$60.48 ,$37.45 ,$54.44 ,$54.44 ,$35.33 ,$54.44 ,$35.33 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$87.12 ,$88.33 ,$87.23 ,$102.85 ,$51.31 ,$87.23 ,$102.85 ,$88.33 ,$51.31 ,$51.31 ,$58.07 ,$102.85 ,$115.45 ,$111.32 ,$84.70 ,$121.00 ,$121.00 ,$73.69 ,$121.00 ,$83.61 ,$87.12 ,$84.28 ,$51.82 ,$87.12 ,$54.39 ,$61.57 ,$61.57 ,$51.31 ,$61.57 ,$51.31 ,$87.12 ,$75.02 ,$87.12 ,$87.12 ,$72.60 
ST MARY'S HOSPITAL,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 ,$122.40 ,$124.10 ,$59.65 ,$144.50 ,$35.09 ,$59.65 ,$144.50 ,$124.10 ,$36.26 ,$35.09 ,$39.71 ,$144.50 ,$78.95 ,$156.40 ,$119.00 ,$170.00 ,$170.00 ,$103.53 ,$170.00 ,$117.47 ,$122.40 ,$118.41 ,$35.44 ,$122.40 ,$38.44 ,$42.11 ,$42.11 ,$35.09 ,$42.11 ,$35.09 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$102.00 
ST MARY'S HOSPITAL,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 ,$30.96 ,$31.39 ,$5.39 ,$36.55 ,$3.17 ,$5.39 ,$36.55 ,$31.39 ,$3.28 ,$3.17 ,$3.59 ,$36.55 ,$7.13 ,$39.56 ,$30.10 ,$15.40 ,$16.55 ,$26.19 ,$15.40 ,$29.71 ,$30.96 ,$29.95 ,$3.20 ,$30.96 ,$3.48 ,$3.80 ,$3.80 ,$3.17 ,$3.80 ,$3.17 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,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 ,$18.72 ,$18.98 ,$3.83 ,$22.10 ,$2.25 ,$3.83 ,$22.10 ,$18.98 ,$2.32 ,$2.25 ,$2.55 ,$22.10 ,$5.06 ,$23.92 ,$18.20 ,$10.91 ,$11.72 ,$15.83 ,$10.91 ,$17.97 ,$18.72 ,$18.11 ,$2.27 ,$18.72 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$18.72 ,$16.12 ,$18.72 ,$18.72 ,$15.60 
ST MARY'S HOSPITAL,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 ,$22.32 ,$22.63 ,$3.83 ,$26.35 ,$2.25 ,$3.83 ,$26.35 ,$22.63 ,$2.32 ,$2.25 ,$2.55 ,$26.35 ,$5.06 ,$28.52 ,$21.70 ,$10.91 ,$11.72 ,$18.88 ,$10.91 ,$21.42 ,$22.32 ,$21.59 ,$2.27 ,$22.32 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$18.60 
ST MARY'S HOSPITAL,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 ,$15.12 ,$15.33 ,$3.83 ,$17.85 ,$2.25 ,$3.83 ,$17.85 ,$15.33 ,$2.32 ,$2.25 ,$2.55 ,$17.85 ,$5.06 ,$19.32 ,$14.70 ,$10.91 ,$11.72 ,$12.79 ,$10.91 ,$14.51 ,$15.12 ,$14.63 ,$2.27 ,$15.12 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$15.12 ,$13.02 ,$15.12 ,$15.12 ,$12.60 
ST MARY'S HOSPITAL,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 ,$28.80 ,$29.20 ,$3.83 ,$34.00 ,$2.25 ,$3.83 ,$34.00 ,$29.20 ,$2.32 ,$2.25 ,$2.55 ,$34.00 ,$5.06 ,$36.80 ,$28.00 ,$10.91 ,$11.72 ,$24.36 ,$10.91 ,$27.64 ,$28.80 ,$27.86 ,$2.27 ,$28.80 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$28.80 ,$24.80 ,$28.80 ,$28.80 ,$24.00 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$3.83 ,$14.45 ,$2.25 ,$3.83 ,$14.45 ,$12.41 ,$2.32 ,$2.25 ,$2.55 ,$14.45 ,$5.06 ,$15.64 ,$11.90 ,$10.91 ,$11.72 ,$10.35 ,$10.91 ,$11.75 ,$12.24 ,$11.84 ,$2.27 ,$12.24 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$3.83 ,$21.25 ,$2.25 ,$3.83 ,$21.25 ,$18.25 ,$2.32 ,$2.25 ,$2.55 ,$21.25 ,$5.06 ,$23.00 ,$17.50 ,$10.91 ,$11.72 ,$15.23 ,$10.91 ,$17.28 ,$18.00 ,$17.41 ,$2.27 ,$18.00 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$3.83 ,$21.25 ,$2.25 ,$3.83 ,$21.25 ,$18.25 ,$2.32 ,$2.25 ,$2.55 ,$21.25 ,$5.06 ,$23.00 ,$17.50 ,$10.91 ,$11.72 ,$15.23 ,$10.91 ,$17.28 ,$18.00 ,$17.41 ,$2.27 ,$18.00 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$3.83 ,$21.25 ,$2.25 ,$3.83 ,$21.25 ,$18.25 ,$2.32 ,$2.25 ,$2.55 ,$21.25 ,$5.06 ,$23.00 ,$17.50 ,$10.91 ,$11.72 ,$15.23 ,$10.91 ,$17.28 ,$18.00 ,$17.41 ,$2.27 ,$18.00 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 ,$3.83 ,$14.45 ,$2.25 ,$3.83 ,$14.45 ,$12.41 ,$2.32 ,$2.25 ,$2.55 ,$14.45 ,$5.06 ,$15.64 ,$11.90 ,$10.91 ,$11.72 ,$10.35 ,$10.91 ,$11.75 ,$12.24 ,$11.84 ,$2.27 ,$12.24 ,$2.46 ,$2.70 ,$2.70 ,$2.25 ,$2.70 ,$2.25 ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$51.12 ,$51.83 ,$3.69 ,$60.35 ,$2.17 ,$3.69 ,$60.35 ,$51.83 ,$2.24 ,$2.17 ,$2.46 ,$60.35 ,$4.88 ,$65.32 ,$49.70 ,$10.55 ,$11.34 ,$43.24 ,$10.55 ,$49.06 ,$51.12 ,$49.45 ,$2.19 ,$51.12 ,$2.37 ,$2.60 ,$2.60 ,$2.17 ,$2.60 ,$2.17 ,$51.12 ,$44.02 ,$51.12 ,$51.12 ,$42.60 
ST MARY'S HOSPITAL,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 ,$52.56 ,$53.29 ,$3.69 ,$62.05 ,$2.17 ,$3.69 ,$62.05 ,$53.29 ,$2.24 ,$2.17 ,$2.46 ,$62.05 ,$4.88 ,$67.16 ,$51.10 ,$10.55 ,$11.34 ,$44.46 ,$10.55 ,$50.44 ,$52.56 ,$50.84 ,$2.19 ,$52.56 ,$2.37 ,$2.60 ,$2.60 ,$2.17 ,$2.60 ,$2.17 ,$52.56 ,$45.26 ,$52.56 ,$52.56 ,$43.80 
ST MARY'S HOSPITAL,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 ,$17.28 ,$17.52 ,$5.19 ,$20.40 ,$3.05 ,$5.19 ,$20.40 ,$17.52 ,$3.15 ,$3.05 ,$3.45 ,$20.40 ,$6.86 ,$22.08 ,$16.80 ,$14.79 ,$15.90 ,$14.62 ,$14.79 ,$16.58 ,$17.28 ,$16.72 ,$3.08 ,$17.28 ,$3.34 ,$3.66 ,$3.66 ,$3.05 ,$3.66 ,$3.05 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$14.40 
ST MARY'S HOSPITAL,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 ,$48.24 ,$48.91 ,$14.64 ,$56.95 ,$8.61 ,$14.64 ,$56.95 ,$48.91 ,$8.90 ,$8.61 ,$9.74 ,$56.95 ,$19.37 ,$61.64 ,$46.90 ,$30.76 ,$33.07 ,$40.80 ,$30.76 ,$46.30 ,$48.24 ,$46.67 ,$8.70 ,$48.24 ,$9.43 ,$10.33 ,$10.33 ,$8.61 ,$10.33 ,$8.61 ,$48.24 ,$41.54 ,$48.24 ,$48.24 ,$40.20 
ST MARY'S HOSPITAL,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 ,$18.00 ,$18.25 ,$6.19 ,$21.25 ,$3.64 ,$6.19 ,$21.25 ,$18.25 ,$3.76 ,$3.64 ,$4.12 ,$21.25 ,$8.19 ,$23.00 ,$17.50 ,$14.58 ,$15.67 ,$15.23 ,$14.58 ,$17.28 ,$18.00 ,$17.41 ,$3.68 ,$18.00 ,$3.99 ,$4.37 ,$4.37 ,$3.64 ,$4.37 ,$3.64 ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,30700135,81015,HC URINALYSIS MICRO ONLY PREVEA 72HR,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 ,$17.28 ,$17.52 ,$5.19 ,$20.40 ,$3.05 ,$5.19 ,$20.40 ,$17.52 ,$3.15 ,$3.05 ,$3.45 ,$20.40 ,$6.86 ,$22.08 ,$16.80 ,$14.79 ,$15.90 ,$14.62 ,$14.79 ,$16.58 ,$17.28 ,$16.72 ,$3.08 ,$17.28 ,$3.34 ,$3.66 ,$3.66 ,$3.05 ,$3.66 ,$3.05 ,$17.28 ,$14.88 ,$17.28 ,$17.28 ,$14.40 
ST MARY'S HOSPITAL,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 ,$7.92 ,$8.03 , N/A ,$9.35 , N/A , N/A ,$9.35 ,$8.03 , N/A , N/A ,$4.62 ,$9.35 , N/A ,$10.12 ,$7.70 ,$5.58 ,$6.70 ,$6.70 ,$6.25 ,$7.60 ,$7.92 ,$7.66 , N/A ,$7.92 , N/A ,$5.50 ,$5.50 , N/A ,$5.50 , N/A ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$6.60 
ST MARY'S HOSPITAL,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 ,$59.76 ,$60.59 ,$16.73 ,$70.55 ,$9.84 ,$16.73 ,$70.55 ,$60.59 ,$10.17 ,$9.84 ,$11.14 ,$70.55 ,$22.14 ,$76.36 ,$58.10 ,$43.37 ,$46.63 ,$50.55 ,$43.37 ,$57.35 ,$59.76 ,$57.81 ,$9.94 ,$59.76 ,$10.78 ,$11.81 ,$11.81 ,$9.84 ,$11.81 ,$9.84 ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$49.80 
ST MARY'S HOSPITAL,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 ,$100.08 ,$101.47 ,$33.25 ,$118.15 ,$19.56 ,$33.25 ,$118.15 ,$101.47 ,$7.06 ,$19.56 ,$22.14 ,$118.15 ,$44.01 ,$127.88 ,$97.30 ,$95.08 ,$102.23 ,$84.65 ,$95.08 ,$96.05 ,$100.08 ,$96.81 ,$19.76 ,$100.08 ,$7.48 ,$23.47 ,$23.47 ,$19.56 ,$23.47 ,$19.56 ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$83.40 
ST MARY'S HOSPITAL,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 ,$12.24 ,$12.41 , N/A ,$14.45 , N/A , N/A ,$14.45 ,$12.41 , N/A , N/A ,$7.14 ,$14.45 , N/A ,$15.64 ,$11.90 ,$8.62 ,$10.35 ,$10.35 ,$9.66 ,$11.75 ,$12.24 ,$11.84 , N/A ,$12.24 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$12.24 ,$10.54 ,$12.24 ,$12.24 ,$10.20 
ST MARY'S HOSPITAL,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 ,$26.64 ,$27.01 , N/A ,$31.45 , N/A , N/A ,$31.45 ,$27.01 , N/A , N/A ,$15.54 ,$31.45 , N/A ,$34.04 ,$25.90 ,$18.77 ,$22.52 ,$22.53 ,$21.02 ,$25.57 ,$26.64 ,$25.77 , N/A ,$26.64 , N/A ,$18.50 ,$18.50 , N/A ,$18.50 , N/A ,$26.64 ,$22.94 ,$26.64 ,$26.64 ,$22.20 
ST MARY'S HOSPITAL,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 ,$161.28 ,$163.52 , N/A ,$190.40 , N/A , N/A ,$190.40 ,$163.52 , N/A , N/A ,$94.08 ,$190.40 , N/A ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$127.25 ,$154.78 ,$161.28 ,$156.02 , N/A ,$161.28 , N/A ,$112.00 ,$112.00 , N/A ,$112.00 , N/A ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,31000006,88312,HC AUTOPSY SPECIAL STAIN LEVEL I,310,1 ,$28.00 ,$14.00 ,$6.95 ,$108.73 ,$6.95 ,$28.00 ,$28.00 ,$48.33 ,$16.80 ,$23.80 ,$19.60 ,$6.95 ,$26.60 ,$20.16 ,$20.44 ,$28.00 ,$23.80 ,$48.33 ,$28.00 ,$23.80 ,$20.44 ,$6.95 ,$48.33 ,$11.76 ,$23.80 ,$108.73 ,$25.76 ,$19.60 ,$28.00 ,$28.00 ,$17.05 ,$28.00 ,$19.35 ,$20.16 ,$19.50 ,$48.81 ,$20.16 ,$7.37 ,$28.00 ,$28.00 ,$48.33 ,$28.00 ,$48.33 ,$20.16 ,$17.36 ,$20.16 ,$20.16 ,$16.80 
ST MARY'S HOSPITAL,31000007,88312,HC AUTOPSY SPECIAL STAIN LEVEL II,310,1 ,$34.00 ,$17.00 ,$6.95 ,$108.73 ,$6.95 ,$34.00 ,$34.00 ,$48.33 ,$20.40 ,$28.90 ,$23.80 ,$6.95 ,$32.30 ,$24.48 ,$24.82 ,$34.00 ,$28.90 ,$48.33 ,$34.00 ,$28.90 ,$24.82 ,$6.95 ,$48.33 ,$14.28 ,$28.90 ,$108.73 ,$31.28 ,$23.80 ,$34.00 ,$34.00 ,$20.71 ,$34.00 ,$23.49 ,$24.48 ,$23.68 ,$48.81 ,$24.48 ,$7.37 ,$34.00 ,$34.00 ,$48.33 ,$34.00 ,$48.33 ,$24.48 ,$21.08 ,$24.48 ,$24.48 ,$20.40 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$49.00 ,$41.65 , N/A ,$49.00 ,$41.65 ,$35.77 ,$12.70 , N/A ,$20.58 ,$41.65 , N/A ,$45.08 ,$34.30 ,$24.85 ,$29.83 ,$29.84 ,$27.84 ,$33.86 ,$35.28 ,$34.13 , N/A ,$35.28 ,$13.46 ,$49.00 ,$49.00 , N/A ,$49.00 , N/A ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,31000009,88360,HC AUTOPSY IMMUNOPEROXIDASE QN,310,1 ,$56.00 ,$28.00 ,$12.70 ,$326.35 ,$12.70 ,$56.00 ,$56.00 ,$145.05 ,$33.60 ,$47.60 ,$39.20 ,$12.70 ,$53.20 ,$40.32 ,$40.88 ,$56.00 ,$47.60 ,$145.05 ,$56.00 ,$47.60 ,$40.88 ,$12.70 ,$145.05 ,$23.52 ,$47.60 ,$326.35 ,$51.52 ,$39.20 ,$56.00 ,$56.00 ,$34.10 ,$56.00 ,$38.70 ,$40.32 ,$39.00 ,$146.50 ,$40.32 ,$13.46 ,$56.00 ,$56.00 ,$145.05 ,$56.00 ,$145.05 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$612.72 ,$621.23 ,$278.73 ,$723.35 ,$163.96 ,$278.73 ,$723.35 ,$621.23 ,$169.42 ,$163.96 ,$185.57 ,$723.35 ,$368.91 ,$782.92 ,$595.70 ,$797.19 ,$851.00 ,$518.26 ,$797.19 ,$588.04 ,$612.72 ,$592.72 ,$165.60 ,$612.72 ,$179.59 ,$196.75 ,$196.75 ,$163.96 ,$196.75 ,$163.96 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$510.60 
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$278.73 ,$399.50 ,$163.96 ,$278.73 ,$399.50 ,$343.10 ,$169.42 ,$163.96 ,$185.57 ,$399.50 ,$368.91 ,$432.40 ,$329.00 ,$470.00 ,$470.00 ,$286.23 ,$470.00 ,$324.77 ,$338.40 ,$327.36 ,$165.60 ,$338.40 ,$179.59 ,$196.75 ,$196.75 ,$163.96 ,$196.75 ,$163.96 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,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 ,$741.60 ,$751.90 ,$246.23 ,$875.50 ,$144.84 ,$246.23 ,$875.50 ,$751.90 ,$149.66 ,$144.84 ,$163.93 ,$875.50 ,$325.89 ,$947.60 ,$721.00 ,$704.17 ,$757.09 ,$627.27 ,$704.17 ,$711.73 ,$741.60 ,$717.40 ,$146.29 ,$741.60 ,$158.64 ,$173.81 ,$173.81 ,$144.84 ,$173.81 ,$144.84 ,$741.60 ,$638.60 ,$741.60 ,$741.60 ,$618.00 
ST MARY'S HOSPITAL,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 ","$1,290.24 ","$1,308.16 ",$766.55 ,"$1,523.20 ",$450.91 ,$766.55 ,"$1,523.20 ","$1,308.16 ",$126.90 ,$450.91 ,$510.34 ,"$1,523.20 ","$1,014.55 ","$1,648.64 ","$1,254.40 ","$1,609.38 ","$1,730.31 ","$1,091.33 ","$1,609.38 ","$1,238.27 ","$1,290.24 ","$1,248.13 ",$455.42 ,"$1,290.24 ",$134.51 ,$541.09 ,$541.09 ,$450.91 ,$541.09 ,$450.91 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,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 ","$1,628.64 ","$1,651.26 ","$1,530.00 ","$1,922.70 ",$900.00 ,"$1,530.00 ","$1,922.70 ","$1,651.26 ",$516.91 ,$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 ","$1,628.64 ","$1,575.48 ",$909.00 ,"$1,628.64 ",$547.92 ,"$1,080.00 ","$1,080.00 ",$900.00 ,"$1,080.00 ",$900.00 ,"$1,628.64 ","$1,402.44 ","$1,628.64 ","$1,628.64 ","$1,357.20 "
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$111.67 ,$228.65 ,$65.69 ,$111.67 ,$228.65 ,$196.37 ,$53.70 ,$65.69 ,$74.35 ,$228.65 ,$147.80 ,$247.48 ,$188.30 ,$239.24 ,$257.22 ,$163.82 ,$239.24 ,$185.88 ,$193.68 ,$187.36 ,$66.35 ,$193.68 ,$56.92 ,$78.83 ,$78.83 ,$65.69 ,$78.83 ,$65.69 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$124.73 ,$228.65 ,$73.37 ,$124.73 ,$228.65 ,$196.37 ,$66.70 ,$73.37 ,$83.04 ,$228.65 ,$165.08 ,$247.48 ,$188.30 ,$269.00 ,$269.00 ,$163.82 ,$269.00 ,$185.88 ,$193.68 ,$187.36 ,$74.10 ,$193.68 ,$70.70 ,$88.04 ,$88.04 ,$73.37 ,$88.04 ,$73.37 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$96.97 ,$228.65 , N/A ,$96.97 ,$228.65 ,$196.37 ,$54.46 , N/A ,$64.56 ,$228.65 ,$161.40 ,$247.48 ,$188.30 ,$203.28 ,$218.55 ,$163.82 ,$203.28 ,$185.88 ,$193.68 ,$187.36 , N/A ,$193.68 ,$57.73 ,$68.45 ,$68.45 , N/A ,$68.45 , N/A ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$347.04 ,$351.86 ,$111.11 ,$409.70 ,$65.36 ,$111.11 ,$409.70 ,$351.86 ,$67.54 ,$65.36 ,$73.97 ,$409.70 ,$147.06 ,$443.44 ,$337.40 ,$317.78 ,$341.66 ,$293.54 ,$317.78 ,$333.06 ,$347.04 ,$335.71 ,$66.01 ,$347.04 ,$71.59 ,$78.43 ,$78.43 ,$65.36 ,$78.43 ,$65.36 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,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 ","$1,305.36 ","$1,323.49 ",$336.58 ,"$1,541.05 ",$197.99 ,$336.58 ,"$1,541.05 ","$1,323.49 ",$204.58 ,$197.99 ,$224.09 ,"$1,541.05 ",$445.48 ,"$1,667.96 ","$1,269.10 ",$962.62 ,"$1,034.95 ","$1,104.12 ",$962.62 ,"$1,252.78 ","$1,305.36 ","$1,262.75 ",$199.97 ,"$1,305.36 ",$216.85 ,$237.59 ,$237.59 ,$197.99 ,$237.59 ,$197.99 ,"$1,305.36 ","$1,124.06 ","$1,305.36 ","$1,305.36 ","$1,087.80 "
ST MARY'S HOSPITAL,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 ","$1,305.36 ","$1,323.49 ",$293.64 ,"$1,541.05 ",$172.73 ,$293.64 ,"$1,541.05 ","$1,323.49 ",$162.98 ,$172.73 ,$195.50 ,"$1,541.05 ",$388.64 ,"$1,667.96 ","$1,269.10 ",$726.02 ,$780.57 ,"$1,104.12 ",$726.02 ,"$1,252.78 ","$1,305.36 ","$1,262.75 ",$174.46 ,"$1,305.36 ",$172.76 ,$207.28 ,$207.28 ,$172.73 ,$207.28 ,$172.73 ,"$1,305.36 ","$1,124.06 ","$1,305.36 ","$1,305.36 ","$1,087.80 "
ST MARY'S HOSPITAL,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 ",$758.16 ,$768.69 ,$328.53 ,$895.05 ,$193.25 ,$328.53 ,$895.05 ,$768.69 ,$157.98 ,$193.25 ,$218.72 ,$895.05 ,$434.81 ,$968.76 ,$737.10 ,$703.78 ,$756.66 ,$641.28 ,$703.78 ,$727.62 ,$758.16 ,$733.41 ,$195.18 ,$758.16 ,$167.46 ,$231.90 ,$231.90 ,$193.25 ,$231.90 ,$193.25 ,$758.16 ,$652.86 ,$758.16 ,$758.16 ,$631.80 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$111.08 ,$285.60 ,$65.34 ,$111.08 ,$285.60 ,$245.28 ,$13.61 ,$65.34 ,$73.95 ,$285.60 ,$147.02 ,$309.12 ,$235.20 ,$212.22 ,$228.17 ,$204.62 ,$212.22 ,$232.18 ,$241.92 ,$234.02 ,$65.99 ,$241.92 ,$14.43 ,$78.41 ,$78.41 ,$65.34 ,$78.41 ,$65.34 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ",$879.12 ,$891.33 ,$592.55 ,"$1,037.85 ",$348.56 ,$592.55 ,"$1,037.85 ",$891.33 ,$316.03 ,$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 ,$879.12 ,$850.43 ,$352.05 ,$879.12 ,$334.99 ,$418.27 ,$418.27 ,$348.56 ,$418.27 ,$348.56 ,$879.12 ,$757.02 ,$879.12 ,$879.12 ,$732.60 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$111.08 ,$285.60 ,$65.34 ,$111.08 ,$285.60 ,$245.28 ,$13.61 ,$65.34 ,$73.95 ,$285.60 ,$147.02 ,$309.12 ,$235.20 ,$212.22 ,$228.17 ,$204.62 ,$212.22 ,$232.18 ,$241.92 ,$234.02 ,$65.99 ,$241.92 ,$14.43 ,$78.41 ,$78.41 ,$65.34 ,$78.41 ,$65.34 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$421.20 ,$427.05 ,$585.00 ,$497.25 ,$348.56 ,$585.00 ,$497.25 ,$427.05 ,$316.03 ,$348.56 ,$394.50 ,$497.25 ,$784.26 ,$538.20 ,$409.50 ,$585.00 ,$585.00 ,$356.27 ,$585.00 ,$404.24 ,$421.20 ,$407.45 ,$352.05 ,$421.20 ,$334.99 ,$418.27 ,$418.27 ,$348.56 ,$418.27 ,$348.56 ,$421.20 ,$362.70 ,$421.20 ,$421.20 ,$351.00 
ST MARY'S HOSPITAL,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 ,$701.28 ,$711.02 ,$352.43 ,$827.90 ,$207.31 ,$352.43 ,$827.90 ,$711.02 ,$214.21 ,$207.31 ,$234.63 ,$827.90 ,$466.45 ,$896.08 ,$681.80 ,$974.00 ,$974.00 ,$593.17 ,$974.00 ,$673.03 ,$701.28 ,$678.39 ,$209.38 ,$701.28 ,$227.06 ,$248.77 ,$248.77 ,$207.31 ,$248.77 ,$207.31 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$584.40 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$86.82 ,$314.50 ,$51.07 ,$86.82 ,$314.50 ,$270.10 ,$52.77 ,$51.07 ,$57.80 ,$314.50 ,$114.91 ,$340.40 ,$259.00 ,$182.00 ,$195.68 ,$225.33 ,$182.00 ,$255.67 ,$266.40 ,$257.71 ,$51.58 ,$266.40 ,$55.94 ,$61.28 ,$61.28 ,$51.07 ,$61.28 ,$51.07 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ",$764.64 ,$775.26 ,$74.21 ,$902.70 ,$43.65 ,$74.21 ,$902.70 ,$775.26 ,$13.61 ,$43.65 ,$49.40 ,$902.70 ,$98.21 ,$977.04 ,$743.40 ,$212.22 ,$228.17 ,$646.76 ,$212.22 ,$733.84 ,$764.64 ,$739.68 ,$44.09 ,$764.64 ,$14.43 ,$52.38 ,$52.38 ,$43.65 ,$52.38 ,$43.65 ,$764.64 ,$658.44 ,$764.64 ,$764.64 ,$637.20 
ST MARY'S HOSPITAL,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 ,$512.64 ,$519.76 ,$185.52 ,$605.20 ,$109.13 ,$185.52 ,$605.20 ,$519.76 ,$112.76 ,$109.13 ,$123.51 ,$605.20 ,$245.54 ,$655.04 ,$498.40 ,$530.58 ,$570.45 ,$433.61 ,$530.58 ,$491.99 ,$512.64 ,$495.91 ,$110.22 ,$512.64 ,$119.53 ,$130.96 ,$130.96 ,$109.13 ,$130.96 ,$109.13 ,$512.64 ,$441.44 ,$512.64 ,$512.64 ,$427.20 
ST MARY'S HOSPITAL,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 ,$302.40 ,$306.60 ,$108.73 ,$357.00 ,$63.96 ,$108.73 ,$357.00 ,$306.60 ,$51.17 ,$63.96 ,$72.39 ,$357.00 ,$143.91 ,$386.40 ,$294.00 ,$227.94 ,$245.07 ,$255.78 ,$227.94 ,$290.22 ,$302.40 ,$292.53 ,$64.60 ,$302.40 ,$54.24 ,$76.75 ,$76.75 ,$63.96 ,$76.75 ,$63.96 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,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 ,$322.56 ,$327.04 ,$232.90 ,$380.80 , N/A ,$232.90 ,$380.80 ,$327.04 ,$109.60 , N/A ,$155.06 ,$380.80 ,$268.80 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$322.56 ,$312.03 , N/A ,$322.56 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 , N/A ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,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 ,$423.36 ,$429.24 ,$255.56 ,$499.80 , N/A ,$255.56 ,$499.80 ,$429.24 ,$120.26 , N/A ,$170.14 ,$499.80 ,$352.80 ,$540.96 ,$411.60 ,$535.75 ,$576.00 ,$358.09 ,$535.75 ,$406.31 ,$423.36 ,$409.54 , N/A ,$423.36 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 , N/A ,$423.36 ,$364.56 ,$423.36 ,$423.36 ,$352.80 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$155.82 ,$476.00 ,$91.66 ,$155.82 ,$476.00 ,$408.80 ,$94.71 ,$91.66 ,$103.74 ,$476.00 ,$206.24 ,$515.20 ,$392.00 ,$445.69 ,$479.18 ,$341.04 ,$445.69 ,$386.96 ,$403.20 ,$390.04 ,$92.58 ,$403.20 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$91.66 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$299.52 ,$303.68 ,$124.73 ,$353.60 ,$73.37 ,$124.73 ,$353.60 ,$303.68 ,$66.70 ,$73.37 ,$83.04 ,$353.60 ,$165.08 ,$382.72 ,$291.20 ,$297.11 ,$319.44 ,$253.34 ,$297.11 ,$287.46 ,$299.52 ,$289.74 ,$74.10 ,$299.52 ,$70.70 ,$88.04 ,$88.04 ,$73.37 ,$88.04 ,$73.37 ,$299.52 ,$257.92 ,$299.52 ,$299.52 ,$249.60 
ST MARY'S HOSPITAL,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 ,$588.96 ,$597.14 ,$818.00 ,$695.30 ,$556.60 ,$818.00 ,$695.30 ,$597.14 ,$210.00 ,$556.60 ,$629.96 ,$695.30 ,"$1,252.35 ",$752.56 ,$572.60 ,$818.00 ,$818.00 ,$498.16 ,$818.00 ,$565.24 ,$588.96 ,$569.74 ,$562.17 ,$588.96 ,$222.60 ,$667.92 ,$667.92 ,$556.60 ,$667.92 ,$556.60 ,$588.96 ,$507.16 ,$588.96 ,$588.96 ,$490.80 
ST MARY'S HOSPITAL,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 ,$540.00 ,$547.50 ,$74.21 ,$637.50 ,$43.65 ,$74.21 ,$637.50 ,$547.50 ,$13.61 ,$43.65 ,$49.40 ,$637.50 ,$98.21 ,$690.00 ,$525.00 ,$212.22 ,$228.17 ,$456.75 ,$212.22 ,$518.25 ,$540.00 ,$522.38 ,$44.09 ,$540.00 ,$14.43 ,$52.38 ,$52.38 ,$43.65 ,$52.38 ,$43.65 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,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 ",$945.36 ,$958.49 ,$342.55 ,"$1,116.05 ",$201.50 ,$342.55 ,"$1,116.05 ",$958.49 ,$208.21 ,$201.50 ,$228.06 ,"$1,116.05 ",$453.38 ,"$1,207.96 ",$919.10 ,$979.69 ,"$1,053.31 ",$799.62 ,$979.69 ,$907.28 ,$945.36 ,$914.50 ,$203.52 ,$945.36 ,$220.70 ,$241.80 ,$241.80 ,$201.50 ,$241.80 ,$201.50 ,$945.36 ,$814.06 ,$945.36 ,$945.36 ,$787.80 
ST MARY'S HOSPITAL,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 ,$354.96 ,$359.89 ,$336.58 ,$419.05 ,$197.99 ,$336.58 ,$419.05 ,$359.89 ,$204.58 ,$197.99 ,$224.09 ,$419.05 ,$445.48 ,$453.56 ,$345.10 ,$493.00 ,$493.00 ,$300.24 ,$493.00 ,$340.66 ,$354.96 ,$343.37 ,$199.97 ,$354.96 ,$216.85 ,$237.59 ,$237.59 ,$197.99 ,$237.59 ,$197.99 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$354.96 ,$359.89 ,$293.64 ,$419.05 ,$172.73 ,$293.64 ,$419.05 ,$359.89 ,$162.98 ,$172.73 ,$195.50 ,$419.05 ,$388.64 ,$453.56 ,$345.10 ,$493.00 ,$493.00 ,$300.24 ,$493.00 ,$340.66 ,$354.96 ,$343.37 ,$174.46 ,$354.96 ,$172.76 ,$207.28 ,$207.28 ,$172.73 ,$207.28 ,$172.73 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$268.56 ,$272.29 ,$124.73 ,$317.05 ,$73.37 ,$124.73 ,$317.05 ,$272.29 ,$66.70 ,$73.37 ,$83.04 ,$317.05 ,$165.08 ,$343.16 ,$261.10 ,$297.11 ,$319.44 ,$227.16 ,$297.11 ,$257.74 ,$268.56 ,$259.79 ,$74.10 ,$268.56 ,$70.70 ,$88.04 ,$88.04 ,$73.37 ,$88.04 ,$73.37 ,$268.56 ,$231.26 ,$268.56 ,$268.56 ,$223.80 
ST MARY'S HOSPITAL,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 ,$66.24 ,$67.16 ,$92.00 ,$78.20 ,$65.36 ,$92.00 ,$78.20 ,$67.16 ,$67.54 ,$65.36 ,$73.97 ,$78.20 ,$147.06 ,$84.64 ,$64.40 ,$92.00 ,$92.00 ,$56.03 ,$92.00 ,$63.57 ,$66.24 ,$64.08 ,$66.01 ,$66.24 ,$71.59 ,$78.43 ,$78.43 ,$65.36 ,$78.43 ,$65.36 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$55.20 
ST MARY'S HOSPITAL,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 ",$871.20 ,$883.30 ,$155.82 ,"$1,028.50 ",$91.66 ,$155.82 ,"$1,028.50 ",$883.30 ,$94.71 ,$91.66 ,$103.74 ,"$1,028.50 ",$206.24 ,"$1,113.20 ",$847.00 ,$445.69 ,$479.18 ,$736.89 ,$445.69 ,$836.11 ,$871.20 ,$842.77 ,$92.58 ,$871.20 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$91.66 ,$871.20 ,$750.20 ,$871.20 ,$871.20 ,$726.00 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$246.23 ,$285.60 ,$144.84 ,$246.23 ,$285.60 ,$245.28 ,$149.66 ,$144.84 ,$163.93 ,$285.60 ,$325.89 ,$309.12 ,$235.20 ,$336.00 ,$336.00 ,$204.62 ,$336.00 ,$232.18 ,$241.92 ,$234.02 ,$146.29 ,$241.92 ,$158.64 ,$173.81 ,$173.81 ,$144.84 ,$173.81 ,$144.84 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$80.64 ,$81.76 ,$11.00 ,$95.20 ,$6.47 ,$11.00 ,$95.20 ,$81.76 ,$6.69 ,$6.47 ,$7.32 ,$95.20 ,$14.56 ,$103.04 ,$78.40 ,$31.47 ,$33.83 ,$68.21 ,$31.47 ,$77.39 ,$80.64 ,$78.01 ,$6.53 ,$80.64 ,$7.09 ,$7.76 ,$7.76 ,$6.47 ,$7.76 ,$6.47 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,31000102,80500,HC CLINAL PATH CONSULT LTD,310,1 ,$153.00 ,$76.50 ,$36.26 ,$153.00 , N/A ,$68.07 ,$58.34 , N/A ,$91.80 ,$130.05 ,$107.10 , N/A ,$145.35 ,$110.16 ,$111.69 ,$36.26 ,$130.05 , N/A ,$36.26 ,$130.05 ,$111.69 , N/A , N/A ,$64.26 ,$130.05 , N/A ,$140.76 ,$107.10 ,$77.60 ,$93.13 ,$93.18 ,$86.92 ,$105.72 ,$110.16 ,$106.56 , N/A ,$110.16 , N/A ,$76.50 ,$76.50 , N/A ,$76.50 , N/A ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,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 ",$967.68 ,$981.12 ,$433.59 ,"$1,142.40 ",$255.05 ,$433.59 ,"$1,142.40 ",$981.12 ,$37.31 ,$255.05 ,$288.67 ,"$1,142.40 ",$573.86 ,"$1,236.48 ",$940.80 ,$927.51 ,$997.21 ,$818.50 ,$927.51 ,$928.70 ,$967.68 ,$936.10 ,$257.60 ,$967.68 ,$39.55 ,$306.06 ,$306.06 ,$255.05 ,$306.06 ,$255.05 ,$967.68 ,$833.28 ,$967.68 ,$967.68 ,$806.40 
ST MARY'S HOSPITAL,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 ,$330.48 ,$335.07 ,$232.90 ,$390.15 , N/A ,$232.90 ,$390.15 ,$335.07 ,$109.60 , N/A ,$155.06 ,$390.15 ,$275.40 ,$422.28 ,$321.30 ,$459.00 ,$459.00 ,$279.53 ,$459.00 ,$317.17 ,$330.48 ,$319.69 , N/A ,$330.48 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 , N/A ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$470.00 ,$399.50 ,$300.00 ,$470.00 ,$399.50 ,$343.10 ,$195.07 ,$300.00 ,$339.54 ,$399.50 ,$675.00 ,$432.40 ,$329.00 ,$470.00 ,$470.00 ,$286.23 ,$470.00 ,$324.77 ,$338.40 ,$327.36 ,$303.00 ,$338.40 ,$206.77 ,$360.00 ,$360.00 ,$300.00 ,$360.00 ,$300.00 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$411.23 ,$399.50 ,$241.90 ,$411.23 ,$399.50 ,$343.10 ,$195.07 ,$241.90 ,$273.78 ,$399.50 ,$544.28 ,$432.40 ,$329.00 ,$470.00 ,$470.00 ,$286.23 ,$470.00 ,$324.77 ,$338.40 ,$327.36 ,$244.32 ,$338.40 ,$206.77 ,$290.28 ,$290.28 ,$241.90 ,$290.28 ,$241.90 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$206.77 ,$399.50 ,$121.63 ,$206.77 ,$399.50 ,$343.10 ,$98.08 ,$121.63 ,$137.66 ,$399.50 ,$273.67 ,$432.40 ,$329.00 ,$436.92 ,$469.75 ,$286.23 ,$436.92 ,$324.77 ,$338.40 ,$327.36 ,$122.85 ,$338.40 ,$103.96 ,$145.96 ,$145.96 ,$121.63 ,$145.96 ,$121.63 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,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 ,$435.60 ,$441.65 ,$605.00 ,$514.25 ,$450.91 ,$605.00 ,$514.25 ,$441.65 ,$126.90 ,$450.91 ,$510.34 ,$514.25 ,"$1,014.55 ",$556.60 ,$423.50 ,$605.00 ,$605.00 ,$368.45 ,$605.00 ,$418.06 ,$435.60 ,$421.38 ,$455.42 ,$435.60 ,$134.51 ,$541.09 ,$541.09 ,$450.91 ,$541.09 ,$450.91 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$363.00 
ST MARY'S HOSPITAL,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 ,$201.60 ,$204.40 ,$280.00 ,$238.00 ,$165.51 ,$280.00 ,$238.00 ,$204.40 ,$132.74 ,$165.51 ,$187.32 ,$238.00 ,$372.40 ,$257.60 ,$196.00 ,$280.00 ,$280.00 ,$170.52 ,$280.00 ,$193.48 ,$201.60 ,$195.02 ,$167.17 ,$201.60 ,$140.70 ,$198.61 ,$198.61 ,$165.51 ,$198.61 ,$165.51 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$141.10 ,$199.75 ,$83.00 ,$141.10 ,$199.75 ,$171.55 ,$85.76 ,$83.00 ,$93.94 ,$199.75 ,$186.75 ,$216.20 ,$164.50 ,$235.00 ,$235.00 ,$143.12 ,$235.00 ,$162.39 ,$169.20 ,$163.68 ,$83.83 ,$169.20 ,$90.91 ,$99.60 ,$99.60 ,$83.00 ,$99.60 ,$83.00 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,31000115,81257,HC HBA1/HBA2 GENE ANALYSIS COM DELETE OR VARIANTS,310,1 ,$627.00 ,$313.50 ,$105.67 ,$627.00 ,$105.67 ,$357.91 ,$306.78 , N/A ,$376.20 ,$532.95 ,$438.90 ,$105.67 ,$595.65 ,$451.44 ,$457.71 ,$173.84 ,$532.95 , N/A ,$173.84 ,$532.95 ,$457.71 ,$105.67 , N/A ,$115.74 ,$532.95 ,$376.20 ,$576.84 ,$438.90 ,$364.43 ,$391.82 ,$381.84 ,$364.43 ,$433.26 ,$451.44 ,$436.71 , N/A ,$451.44 ,$112.01 ,$122.71 ,$122.71 , N/A ,$122.71 , N/A ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$376.20 
ST MARY'S HOSPITAL,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 ,$428.40 ,$434.35 ,$336.58 ,$505.75 ,$197.99 ,$336.58 ,$505.75 ,$434.35 ,$204.58 ,$197.99 ,$224.09 ,$505.75 ,$445.48 ,$547.40 ,$416.50 ,$595.00 ,$595.00 ,$362.36 ,$595.00 ,$411.15 ,$428.40 ,$414.42 ,$199.97 ,$428.40 ,$216.85 ,$237.59 ,$237.59 ,$197.99 ,$237.59 ,$197.99 ,$428.40 ,$368.90 ,$428.40 ,$428.40 ,$357.00 
ST MARY'S HOSPITAL,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 ,$556.56 ,$564.29 ,$500.68 ,$657.05 ,$294.52 ,$500.68 ,$657.05 ,$564.29 ,$304.33 ,$294.52 ,$333.34 ,$657.05 ,$662.67 ,$711.16 ,$541.10 ,$773.00 ,$773.00 ,$470.76 ,$773.00 ,$534.14 ,$556.56 ,$538.39 ,$297.47 ,$556.56 ,$322.59 ,$353.42 ,$353.42 ,$294.52 ,$353.42 ,$294.52 ,$556.56 ,$479.26 ,$556.56 ,$556.56 ,$463.80 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$560.00 ,$476.00 ,$329.51 ,$560.00 ,$476.00 ,$408.80 ,$195.07 ,$329.51 ,$372.94 ,$476.00 ,$741.40 ,$515.20 ,$392.00 ,$560.00 ,$560.00 ,$341.04 ,$560.00 ,$386.96 ,$403.20 ,$390.04 ,$332.81 ,$403.20 ,$206.77 ,$395.41 ,$395.41 ,$329.51 ,$395.41 ,$329.51 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$411.12 ,$416.83 ,$352.43 ,$485.35 ,$207.31 ,$352.43 ,$485.35 ,$416.83 ,$214.21 ,$207.31 ,$234.63 ,$485.35 ,$466.45 ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$411.12 ,$397.70 ,$209.38 ,$411.12 ,$227.06 ,$248.77 ,$248.77 ,$207.31 ,$248.77 ,$207.31 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$342.60 
ST MARY'S HOSPITAL,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 ,$504.00 ,$511.00 ,$397.80 ,$595.00 ,$234.00 ,$397.80 ,$595.00 ,$511.00 ,$37.31 ,$234.00 ,$264.84 ,$595.00 ,$526.50 ,$644.00 ,$490.00 ,$700.00 ,$700.00 ,$426.30 ,$700.00 ,$483.70 ,$504.00 ,$487.55 ,$236.34 ,$504.00 ,$39.55 ,$280.80 ,$280.80 ,$234.00 ,$280.80 ,$234.00 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$232.90 ,$476.00 , N/A ,$232.90 ,$476.00 ,$408.80 ,$109.60 , N/A ,$155.06 ,$476.00 ,$336.00 ,$515.20 ,$392.00 ,$488.24 ,$524.93 ,$341.04 ,$488.24 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$232.90 ,$476.00 , N/A ,$232.90 ,$476.00 ,$408.80 ,$109.60 , N/A ,$155.06 ,$476.00 ,$336.00 ,$515.20 ,$392.00 ,$488.24 ,$524.93 ,$341.04 ,$488.24 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$116.18 ,$164.40 ,$164.40 , N/A ,$164.40 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$255.56 ,$476.00 , N/A ,$255.56 ,$476.00 ,$408.80 ,$120.26 , N/A ,$170.14 ,$476.00 ,$336.00 ,$515.20 ,$392.00 ,$535.75 ,$560.00 ,$341.04 ,$535.75 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$625.68 ,$634.37 ,$298.18 ,$738.65 ,$175.40 ,$298.18 ,$738.65 ,$634.37 ,$143.40 ,$175.40 ,$198.52 ,$738.65 ,$394.65 ,$799.48 ,$608.30 ,$638.81 ,$686.81 ,$529.22 ,$638.81 ,$600.48 ,$625.68 ,$605.26 ,$177.15 ,$625.68 ,$152.00 ,$210.48 ,$210.48 ,$175.40 ,$210.48 ,$175.40 ,$625.68 ,$538.78 ,$625.68 ,$625.68 ,$521.40 
ST MARY'S HOSPITAL,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 ","$1,532.16 ","$1,553.44 ","$1,972.00 ","$1,808.80 ","$1,160.00 ","$1,972.00 ","$1,808.80 ","$1,553.44 ",$608.00 ,"$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 ","$1,532.16 ","$1,482.15 ","$1,171.60 ","$1,532.16 ",$644.48 ,"$1,392.00 ","$1,392.00 ","$1,160.00 ","$1,392.00 ","$1,160.00 ","$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,276.80 "
ST MARY'S HOSPITAL,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 ",$967.68 ,$981.12 ,$551.79 ,"$1,142.40 ",$324.58 ,$551.79 ,"$1,142.40 ",$981.12 ,$264.01 ,$324.58 ,$367.36 ,"$1,142.40 ",$730.31 ,"$1,236.48 ",$940.80 ,"$1,176.09 ","$1,264.47 ",$818.50 ,"$1,176.09 ",$928.70 ,$967.68 ,$936.10 ,$327.83 ,$967.68 ,$279.85 ,$389.50 ,$389.50 ,$324.58 ,$389.50 ,$324.58 ,$967.68 ,$833.28 ,$967.68 ,$967.68 ,$806.40 
ST MARY'S HOSPITAL,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 ,$387.36 ,$392.74 ,$298.18 ,$457.30 ,$175.40 ,$298.18 ,$457.30 ,$392.74 ,$143.40 ,$175.40 ,$198.52 ,$457.30 ,$394.65 ,$494.96 ,$376.60 ,$538.00 ,$538.00 ,$327.64 ,$538.00 ,$371.76 ,$387.36 ,$374.72 ,$177.15 ,$387.36 ,$152.00 ,$210.48 ,$210.48 ,$175.40 ,$210.48 ,$175.40 ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$322.80 
ST MARY'S HOSPITAL,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 ","$1,612.80 ","$1,635.20 ","$1,016.45 ","$1,904.00 ",$597.91 ,"$1,016.45 ","$1,904.00 ","$1,635.20 ",$478.33 ,$597.91 ,$676.71 ,"$1,904.00 ","$1,345.30 ","$2,060.80 ","$1,568.00 ","$2,130.83 ","$2,240.00 ","$1,364.16 ","$2,130.83 ","$1,547.84 ","$1,612.80 ","$1,560.16 ",$603.89 ,"$1,612.80 ",$507.03 ,$717.49 ,$717.49 ,$597.91 ,$717.49 ,$597.91 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,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 ","$1,935.36 ","$1,962.24 ","$1,972.00 ","$2,284.80 ","$1,160.00 ","$1,972.00 ","$2,284.80 ","$1,962.24 ",$608.00 ,"$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 ","$1,935.36 ","$1,872.19 ","$1,171.60 ","$1,935.36 ",$644.48 ,"$1,392.00 ","$1,392.00 ","$1,160.00 ","$1,392.00 ","$1,160.00 ","$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$1,612.80 "
ST MARY'S HOSPITAL,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 ,$423.36 ,$429.24 ,$206.77 ,$499.80 ,$121.63 ,$206.77 ,$499.80 ,$429.24 ,$98.08 ,$121.63 ,$137.66 ,$499.80 ,$273.67 ,$540.96 ,$411.60 ,$436.92 ,$469.75 ,$358.09 ,$436.92 ,$406.31 ,$423.36 ,$409.54 ,$122.85 ,$423.36 ,$103.96 ,$145.96 ,$145.96 ,$121.63 ,$145.96 ,$121.63 ,$423.36 ,$364.56 ,$423.36 ,$423.36 ,$352.80 
ST MARY'S HOSPITAL,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 ,$322.56 ,$327.04 ,$314.84 ,$380.80 , N/A ,$314.84 ,$380.80 ,$327.04 ,$148.16 , N/A ,$209.61 ,$380.80 ,$268.80 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$322.56 ,$312.03 , N/A ,$322.56 ,$157.05 ,$222.24 ,$222.24 , N/A ,$222.24 , N/A ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,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 ,$302.40 ,$306.60 ,$255.56 ,$357.00 , N/A ,$255.56 ,$357.00 ,$306.60 ,$120.26 , N/A ,$170.14 ,$357.00 ,$252.00 ,$386.40 ,$294.00 ,$420.00 ,$420.00 ,$255.78 ,$420.00 ,$290.22 ,$302.40 ,$292.53 , N/A ,$302.40 ,$127.48 ,$180.40 ,$180.40 , N/A ,$180.40 , N/A ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 , N/A ,$285.60 , N/A , N/A ,$285.60 ,$245.28 ,$13.61 , N/A ,$141.12 ,$285.60 ,$201.60 ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$190.88 ,$232.18 ,$241.92 ,$234.02 , N/A ,$241.92 ,$14.43 ,$168.00 ,$168.00 , N/A ,$168.00 , N/A ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$290.16 ,$294.19 ,$155.82 ,$342.55 ,$91.66 ,$155.82 ,$342.55 ,$294.19 ,$94.71 ,$91.66 ,$103.74 ,$342.55 ,$206.24 ,$370.76 ,$282.10 ,$403.00 ,$403.00 ,$245.43 ,$403.00 ,$278.47 ,$290.16 ,$280.69 ,$92.58 ,$290.16 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$91.66 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,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 ,$318.24 ,$322.66 ,$232.90 ,$375.70 ,$137.00 ,$232.90 ,$375.70 ,$322.66 ,$109.60 ,$137.00 ,$155.06 ,$375.70 ,$308.25 ,$406.64 ,$309.40 ,$442.00 ,$442.00 ,$269.18 ,$442.00 ,$305.42 ,$318.24 ,$307.85 ,$138.37 ,$318.24 ,$116.18 ,$164.40 ,$164.40 ,$137.00 ,$164.40 ,$137.00 ,$318.24 ,$274.04 ,$318.24 ,$318.24 ,$265.20 
ST MARY'S HOSPITAL,31000252,81309,HC MOLECULAR MUTATION ANALYSIS PIK3CA,310,1 ,$414.00 ,$207.00 ,$207.00 ,$618.37 ,$219.86 ,$414.00 ,$414.00 ,$274.83 ,$248.40 ,$351.90 ,$289.80 ,$219.86 ,$393.30 ,$298.08 ,$302.22 ,$414.00 ,$351.90 ,$274.83 ,$414.00 ,$351.90 ,$302.22 ,$219.86 ,$274.83 ,$311.05 ,$351.90 ,$618.37 ,$380.88 ,$289.80 ,$414.00 ,$414.00 ,$252.13 ,$414.00 ,$286.07 ,$298.08 ,$288.35 ,$277.58 ,$298.08 ,$233.05 ,$329.80 ,$329.80 ,$274.83 ,$329.80 ,$274.83 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$248.40 
ST MARY'S HOSPITAL,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 ","$2,419.20 ","$2,452.80 ","$1,016.45 ","$2,856.00 ",$597.91 ,"$1,016.45 ","$2,856.00 ","$2,452.80 ",$478.33 ,$597.91 ,$676.71 ,"$2,856.00 ","$1,345.30 ","$3,091.20 ","$2,352.00 ","$2,130.83 ","$2,290.95 ","$2,046.24 ","$2,130.83 ","$2,321.76 ","$2,419.20 ","$2,340.24 ",$603.89 ,"$2,419.20 ",$507.03 ,$717.49 ,$717.49 ,$597.91 ,$717.49 ,$597.91 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,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 ,$307.44 ,$311.71 ,$155.82 ,$362.95 ,$91.66 ,$155.82 ,$362.95 ,$311.71 ,$94.71 ,$91.66 ,$103.74 ,$362.95 ,$206.24 ,$392.84 ,$298.90 ,$427.00 ,$427.00 ,$260.04 ,$427.00 ,$295.06 ,$307.44 ,$297.41 ,$92.58 ,$307.44 ,$100.39 ,$109.99 ,$109.99 ,$91.66 ,$109.99 ,$91.66 ,$307.44 ,$264.74 ,$307.44 ,$307.44 ,$256.20 
ST MARY'S HOSPITAL,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 ,$552.96 ,$560.64 ,$298.18 ,$652.80 ,$175.40 ,$298.18 ,$652.80 ,$560.64 ,$140.32 ,$175.40 ,$198.52 ,$652.80 ,$394.65 ,$706.56 ,$537.60 ,$685.60 ,$737.12 ,$467.71 ,$685.60 ,$530.69 ,$552.96 ,$534.91 ,$177.15 ,$552.96 ,$148.74 ,$210.48 ,$210.48 ,$175.40 ,$210.48 ,$175.40 ,$552.96 ,$476.16 ,$552.96 ,$552.96 ,$460.80 
ST MARY'S HOSPITAL,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 ,$548.64 ,$556.26 ,$502.84 ,$647.70 ,$295.79 ,$502.84 ,$647.70 ,$556.26 ,$175.10 ,$295.79 ,$334.78 ,$647.70 ,$665.53 ,$701.04 ,$533.40 ,$762.00 ,$762.00 ,$464.06 ,$762.00 ,$526.54 ,$548.64 ,$530.73 ,$298.75 ,$548.64 ,$185.61 ,$354.95 ,$354.95 ,$295.79 ,$354.95 ,$295.79 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,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 ,$322.56 ,$327.04 ,$448.00 ,$380.80 , N/A ,$448.00 ,$380.80 ,$327.04 ,$219.86 , N/A ,$311.05 ,$380.80 ,$268.80 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$322.56 ,$312.03 , N/A ,$322.56 ,$233.05 ,$329.80 ,$329.80 , N/A ,$329.80 , N/A ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$168.00 ,$84.00 ,$3.02 ,$168.00 ,$3.02 ,$139.26 ,$119.36 ,$32.92 ,$100.80 ,$142.80 ,$117.60 ,$3.02 ,$159.60 ,$120.96 ,$122.64 ,$110.33 ,$142.80 ,$32.92 ,$110.33 ,$142.80 ,$122.64 ,$3.02 ,$32.92 ,$70.56 ,$142.80 ,$74.07 ,$154.56 ,$117.60 ,$76.30 ,$82.03 ,$102.31 ,$76.30 ,$116.09 ,$120.96 ,$117.01 ,$33.25 ,$120.96 ,$3.20 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$235.00 ,$117.50 ,$3.02 ,$235.00 ,$3.02 ,$127.19 ,$109.02 ,$32.92 ,$141.00 ,$199.75 ,$164.50 ,$3.02 ,$223.25 ,$169.20 ,$171.55 ,$105.49 ,$199.75 ,$32.92 ,$105.49 ,$199.75 ,$171.55 ,$3.02 ,$32.92 ,$98.70 ,$199.75 ,$74.07 ,$216.20 ,$164.50 ,$76.30 ,$82.03 ,$143.12 ,$76.30 ,$162.39 ,$169.20 ,$163.68 ,$33.25 ,$169.20 ,$3.20 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,31100103,88108,HC CYTOPATH CONCENTRATION (BF),311,1 ,$217.00 ,$108.50 ,$3.02 ,$217.00 ,$3.02 ,$127.19 ,$109.02 ,$32.92 ,$130.20 ,$184.45 ,$151.90 ,$3.02 ,$206.15 ,$156.24 ,$158.41 ,$105.49 ,$184.45 ,$32.92 ,$105.49 ,$184.45 ,$158.41 ,$3.02 ,$32.92 ,$91.14 ,$184.45 ,$74.07 ,$199.64 ,$151.90 ,$76.30 ,$82.03 ,$132.15 ,$76.30 ,$149.95 ,$156.24 ,$151.14 ,$33.25 ,$156.24 ,$3.20 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$156.24 ,$134.54 ,$156.24 ,$156.24 ,$130.20 
ST MARY'S HOSPITAL,31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$190.00 ,$95.00 ,$9.06 ,$190.00 ,$9.06 ,$130.81 ,$112.12 ,$48.33 ,$114.00 ,$161.50 ,$133.00 ,$9.06 ,$180.50 ,$136.80 ,$138.70 ,$109.23 ,$161.50 ,$48.33 ,$109.23 ,$161.50 ,$138.70 ,$9.06 ,$48.33 ,$79.80 ,$161.50 ,$108.73 ,$174.80 ,$133.00 ,$140.48 ,$151.04 ,$115.71 ,$140.48 ,$131.29 ,$136.80 ,$132.34 ,$48.81 ,$136.80 ,$9.60 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,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 ,$113.04 ,$114.61 ,$34.44 ,$133.45 ,$20.26 ,$34.44 ,$133.45 ,$114.61 ,$20.93 ,$20.26 ,$22.93 ,$133.45 ,$45.59 ,$144.44 ,$109.90 ,$98.50 ,$105.91 ,$95.61 ,$98.50 ,$108.49 ,$113.04 ,$109.35 ,$20.46 ,$113.04 ,$22.19 ,$24.31 ,$24.31 ,$20.26 ,$24.31 ,$20.26 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$58.32 ,$59.13 ,$27.06 ,$68.85 ,$15.92 ,$27.06 ,$68.85 ,$59.13 ,$14.86 ,$15.92 ,$18.02 ,$68.85 ,$35.82 ,$74.52 ,$56.70 ,$51.39 ,$55.25 ,$49.33 ,$51.39 ,$55.97 ,$58.32 ,$56.42 ,$16.08 ,$58.32 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$15.92 ,$58.32 ,$50.22 ,$58.32 ,$58.32 ,$48.60 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$24.91 ,$38.25 ,$14.65 ,$24.91 ,$38.25 ,$32.85 ,$8.42 ,$14.65 ,$16.58 ,$38.25 ,$32.96 ,$41.40 ,$31.50 ,$29.15 ,$31.34 ,$27.41 ,$29.15 ,$31.10 ,$32.40 ,$31.34 ,$14.80 ,$32.40 ,$8.93 ,$17.58 ,$17.58 ,$14.65 ,$17.58 ,$14.65 ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$190.00 ,$95.00 ,$3.02 ,$190.00 ,$3.02 ,$151.33 ,$129.71 ,$24.03 ,$114.00 ,$161.50 ,$133.00 ,$3.02 ,$180.50 ,$136.80 ,$138.70 ,$117.32 ,$161.50 ,$24.03 ,$117.32 ,$161.50 ,$138.70 ,$3.02 ,$24.03 ,$79.80 ,$161.50 ,$54.06 ,$174.80 ,$133.00 ,$76.30 ,$82.03 ,$115.71 ,$76.30 ,$131.29 ,$136.80 ,$132.34 ,$24.27 ,$136.80 ,$3.20 ,$27.59 ,$27.59 ,$24.03 ,$27.59 ,$24.03 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,31100111,88160,HC CYTOPATH SMEAR NON GYN (TZANK),311,1 ,$190.00 ,$95.00 ,$3.02 ,$190.00 ,$3.02 ,$151.33 ,$129.71 ,$24.03 ,$114.00 ,$161.50 ,$133.00 ,$3.02 ,$180.50 ,$136.80 ,$138.70 ,$117.32 ,$161.50 ,$24.03 ,$117.32 ,$161.50 ,$138.70 ,$3.02 ,$24.03 ,$79.80 ,$161.50 ,$54.06 ,$174.80 ,$133.00 ,$76.30 ,$82.03 ,$115.71 ,$76.30 ,$131.29 ,$136.80 ,$132.34 ,$24.27 ,$136.80 ,$3.20 ,$27.59 ,$27.59 ,$24.03 ,$27.59 ,$24.03 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,31100112,88162,HC CYTOPATH SMEAR OVER 5 SLIDES,311,1 ,$280.00 ,$140.00 ,$12.46 ,$280.00 ,$12.46 ,$190.39 ,$163.20 ,$48.33 ,$168.00 ,$238.00 ,$196.00 ,$12.46 ,$266.00 ,$201.60 ,$204.40 ,$186.00 ,$238.00 ,$48.33 ,$186.00 ,$238.00 ,$204.40 ,$12.46 ,$48.33 ,$117.60 ,$238.00 ,$108.73 ,$257.60 ,$196.00 ,$76.30 ,$82.03 ,$170.52 ,$76.30 ,$193.48 ,$201.60 ,$195.02 ,$48.81 ,$201.60 ,$13.21 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,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 ,$49.68 ,$50.37 ,$27.06 ,$58.65 ,$15.92 ,$27.06 ,$58.65 ,$50.37 ,$14.86 ,$15.92 ,$18.02 ,$58.65 ,$35.82 ,$63.48 ,$48.30 ,$51.39 ,$55.25 ,$42.02 ,$51.39 ,$47.68 ,$49.68 ,$48.06 ,$16.08 ,$49.68 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$15.92 ,$49.68 ,$42.78 ,$49.68 ,$49.68 ,$41.40 
ST MARY'S HOSPITAL,31100114,88172,HC FINE NEEDLE EVAL,311,1 ,$141.00 ,$70.50 ,$12.46 ,$326.35 ,$12.46 ,$65.62 ,$56.25 ,$145.05 ,$84.60 ,$119.85 ,$98.70 ,$12.46 ,$133.95 ,$101.52 ,$102.93 ,$89.71 ,$119.85 ,$145.05 ,$89.71 ,$119.85 ,$102.93 ,$12.46 ,$145.05 ,$59.22 ,$119.85 ,$326.35 ,$129.72 ,$98.70 ,$76.30 ,$82.03 ,$85.87 ,$76.30 ,$97.43 ,$101.52 ,$98.21 ,$146.50 ,$101.52 ,$13.21 ,$141.00 ,$141.00 ,$145.05 ,$141.00 ,$145.05 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$403.00 ,$201.50 ,$11.57 ,$403.00 ,$11.57 ,$272.48 ,$233.55 ,$48.33 ,$241.80 ,$342.55 ,$282.10 ,$11.57 ,$382.85 ,$290.16 ,$294.19 ,$257.18 ,$342.55 ,$48.33 ,$257.18 ,$342.55 ,$294.19 ,$11.57 ,$48.33 ,$169.26 ,$342.55 ,$108.73 ,$370.76 ,$282.10 ,$140.48 ,$151.04 ,$245.43 ,$140.48 ,$278.47 ,$290.16 ,$280.69 ,$48.81 ,$290.16 ,$12.26 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$47.60 ,$85.85 , N/A ,$47.60 ,$85.85 ,$73.73 ,$12.46 , N/A ,$42.42 ,$85.85 , N/A ,$92.92 ,$70.70 ,$42.34 ,$45.52 ,$61.51 ,$42.34 ,$69.79 ,$72.72 ,$70.35 , N/A ,$72.72 ,$13.21 ,$8.66 ,$8.66 , N/A ,$8.66 , N/A ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$48.33 ,$90.60 ,$128.35 ,$105.70 ,$12.46 ,$143.45 ,$108.72 ,$110.23 ,$151.00 ,$128.35 ,$48.33 ,$151.00 ,$128.35 ,$110.23 ,$12.46 ,$48.33 ,$63.42 ,$128.35 ,$108.73 ,$138.92 ,$105.70 ,$140.48 ,$151.00 ,$91.96 ,$140.48 ,$104.34 ,$108.72 ,$105.17 ,$48.81 ,$108.72 ,$13.21 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$90.60 
ST MARY'S HOSPITAL,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 ,$48.33 ,$369.60 ,$523.60 ,$431.20 ,$12.46 ,$585.20 ,$443.52 ,$449.68 ,$239.58 ,$523.60 ,$48.33 ,$239.58 ,$523.60 ,$449.68 ,$12.46 ,$48.33 ,$258.72 ,$523.60 ,$108.73 ,$566.72 ,$431.20 ,$140.48 ,$151.04 ,$375.14 ,$140.48 ,$425.66 ,$443.52 ,$429.04 ,$48.81 ,$443.52 ,$13.21 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$369.60 
ST MARY'S HOSPITAL,31100119,88184,HC FLOW CYTO 1ST MARKER (CD4),311,1 ,$31.00 ,$15.50 ,$9.06 ,$637.30 ,$9.06 ,$31.00 ,$31.00 ,$283.24 ,$18.60 ,$26.35 ,$21.70 ,$9.06 ,$29.45 ,$22.32 ,$22.63 ,$31.00 ,$26.35 ,$283.24 ,$31.00 ,$26.35 ,$22.63 ,$9.06 ,$283.24 ,$13.02 ,$26.35 ,$637.30 ,$28.52 ,$21.70 ,$31.00 ,$31.00 ,$18.88 ,$31.00 ,$21.42 ,$22.32 ,$21.59 ,$286.07 ,$22.32 ,$9.60 ,$31.00 ,$31.00 ,$283.24 ,$31.00 ,$283.24 ,$22.32 ,$19.22 ,$22.32 ,$22.32 ,$18.60 
ST MARY'S HOSPITAL,31100120,88184,HC FLOW CYTO 1ST MARKER (PCLI),311,1 ,$77.00 ,$38.50 ,$9.06 ,$637.30 ,$9.06 ,$77.00 ,$77.00 ,$283.24 ,$46.20 ,$65.45 ,$53.90 ,$9.06 ,$73.15 ,$55.44 ,$56.21 ,$77.00 ,$65.45 ,$283.24 ,$77.00 ,$65.45 ,$56.21 ,$9.06 ,$283.24 ,$32.34 ,$65.45 ,$637.30 ,$70.84 ,$53.90 ,$77.00 ,$77.00 ,$46.89 ,$77.00 ,$53.21 ,$55.44 ,$53.63 ,$286.07 ,$55.44 ,$9.60 ,$77.00 ,$77.00 ,$283.24 ,$77.00 ,$283.24 ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$46.20 
ST MARY'S HOSPITAL,31100121,88184,HC FLOW CYTO 1ST MARKER,311,1 ,$470.00 ,$235.00 ,$9.06 ,$637.30 ,$9.06 ,$225.40 ,$193.20 ,$283.24 ,$282.00 ,$399.50 ,$329.00 ,$9.06 ,$446.50 ,$338.40 ,$343.10 ,$110.08 ,$399.50 ,$283.24 ,$110.08 ,$399.50 ,$343.10 ,$9.06 ,$283.24 ,$197.40 ,$399.50 ,$637.30 ,$432.40 ,$329.00 ,$140.48 ,$151.04 ,$286.23 ,$140.48 ,$324.77 ,$338.40 ,$327.36 ,$286.07 ,$338.40 ,$9.60 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,31100122,88184,HC FLOW CYTO 1ST MARKER (MM),311,1 ,$152.00 ,$76.00 ,$9.06 ,$637.30 ,$9.06 ,$152.00 ,$152.00 ,$283.24 ,$91.20 ,$129.20 ,$106.40 ,$9.06 ,$144.40 ,$109.44 ,$110.96 ,$110.08 ,$129.20 ,$283.24 ,$110.08 ,$129.20 ,$110.96 ,$9.06 ,$283.24 ,$63.84 ,$129.20 ,$637.30 ,$139.84 ,$106.40 ,$140.48 ,$151.04 ,$92.57 ,$140.48 ,$105.03 ,$109.44 ,$105.87 ,$286.07 ,$109.44 ,$9.60 ,$152.00 ,$152.00 ,$283.24 ,$152.00 ,$283.24 ,$109.44 ,$94.24 ,$109.44 ,$109.44 ,$91.20 
ST MARY'S HOSPITAL,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 ,$55.44 ,$56.21 ,$35.46 ,$65.45 , N/A ,$35.46 ,$65.45 ,$56.21 ,$12.46 , N/A ,$32.34 ,$65.45 , N/A ,$70.84 ,$53.90 ,$65.43 ,$70.35 ,$46.89 ,$65.43 ,$53.21 ,$55.44 ,$53.63 , N/A ,$55.44 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 , N/A ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$46.20 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$35.46 ,$66.30 , N/A ,$35.46 ,$66.30 ,$56.94 ,$12.46 , N/A ,$32.76 ,$66.30 , N/A ,$71.76 ,$54.60 ,$65.43 ,$70.35 ,$47.50 ,$65.43 ,$53.90 ,$56.16 ,$54.33 , N/A ,$56.16 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$35.46 ,$247.35 , N/A ,$35.46 ,$247.35 ,$212.43 ,$12.46 , N/A ,$122.22 ,$247.35 , N/A ,$267.72 ,$203.70 ,$65.43 ,$70.35 ,$177.22 ,$65.43 ,$201.08 ,$209.52 ,$202.68 , N/A ,$209.52 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 , N/A ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$55.44 ,$56.21 ,$35.46 ,$65.45 , N/A ,$35.46 ,$65.45 ,$56.21 ,$12.46 , N/A ,$32.34 ,$65.45 , N/A ,$70.84 ,$53.90 ,$65.43 ,$70.35 ,$46.89 ,$65.43 ,$53.21 ,$55.44 ,$53.63 , N/A ,$55.44 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 , N/A ,$55.44 ,$47.74 ,$55.44 ,$55.44 ,$46.20 
ST MARY'S HOSPITAL,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 ,$403.92 ,$409.53 ,$198.03 ,$476.85 ,$116.49 ,$198.03 ,$476.85 ,$409.53 ,$70.04 ,$116.49 ,$131.84 ,$476.85 ,$262.10 ,$516.12 ,$392.70 ,$242.16 ,$260.36 ,$341.65 ,$242.16 ,$387.65 ,$403.92 ,$390.74 ,$117.65 ,$403.92 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$116.49 ,$403.92 ,$347.82 ,$403.92 ,$403.92 ,$336.60 
ST MARY'S HOSPITAL,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 ,$113.76 ,$115.34 ,$158.00 ,$134.30 ,$116.49 ,$158.00 ,$134.30 ,$115.34 ,$70.04 ,$116.49 ,$131.84 ,$134.30 ,$262.10 ,$145.36 ,$110.60 ,$158.00 ,$158.00 ,$96.22 ,$158.00 ,$109.18 ,$113.76 ,$110.05 ,$117.65 ,$113.76 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$116.49 ,$113.76 ,$97.96 ,$113.76 ,$113.76 ,$94.80 
ST MARY'S HOSPITAL,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 ,$215.28 ,$218.27 ,$198.03 ,$254.15 ,$116.49 ,$198.03 ,$254.15 ,$218.27 ,$70.04 ,$116.49 ,$131.84 ,$254.15 ,$262.10 ,$275.08 ,$209.30 ,$242.16 ,$260.36 ,$182.09 ,$242.16 ,$206.61 ,$215.28 ,$208.25 ,$117.65 ,$215.28 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$116.49 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$179.40 
ST MARY'S HOSPITAL,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 ,$84.96 ,$86.14 ,$118.00 ,$100.30 ,$116.49 ,$118.00 ,$100.30 ,$86.14 ,$70.04 ,$116.49 ,$118.00 ,$100.30 ,$262.10 ,$108.56 ,$82.60 ,$118.00 ,$118.00 ,$71.86 ,$118.00 ,$81.54 ,$84.96 ,$82.19 ,$117.65 ,$84.96 ,$74.24 ,$118.00 ,$118.00 ,$116.49 ,$118.00 ,$116.49 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$70.80 
ST MARY'S HOSPITAL,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 ,$402.48 ,$408.07 ,$198.03 ,$475.15 ,$116.49 ,$198.03 ,$475.15 ,$408.07 ,$70.04 ,$116.49 ,$131.84 ,$475.15 ,$262.10 ,$514.28 ,$391.30 ,$242.16 ,$260.36 ,$340.43 ,$242.16 ,$386.27 ,$402.48 ,$389.34 ,$117.65 ,$402.48 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$116.49 ,$402.48 ,$346.58 ,$402.48 ,$402.48 ,$335.40 
ST MARY'S HOSPITAL,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 ,$326.16 ,$330.69 ,$198.03 ,$385.05 ,$116.49 ,$198.03 ,$385.05 ,$330.69 ,$70.04 ,$116.49 ,$131.84 ,$385.05 ,$262.10 ,$416.76 ,$317.10 ,$242.16 ,$260.36 ,$275.88 ,$242.16 ,$313.02 ,$326.16 ,$315.51 ,$117.65 ,$326.16 ,$74.24 ,$139.79 ,$139.79 ,$116.49 ,$139.79 ,$116.49 ,$326.16 ,$280.86 ,$326.16 ,$326.16 ,$271.80 
ST MARY'S HOSPITAL,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 ,$287.28 ,$291.27 ,$239.24 ,$339.15 ,$140.73 ,$239.24 ,$339.15 ,$291.27 ,$70.04 ,$140.73 ,$159.28 ,$339.15 ,$316.64 ,$367.08 ,$279.30 ,$242.16 ,$260.36 ,$242.99 ,$242.16 ,$275.71 ,$287.28 ,$277.90 ,$142.14 ,$287.28 ,$74.24 ,$168.88 ,$168.88 ,$140.73 ,$168.88 ,$140.73 ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$239.40 
ST MARY'S HOSPITAL,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 ,$658.08 ,$667.22 ,$239.24 ,$776.90 ,$140.73 ,$239.24 ,$776.90 ,$667.22 ,$70.04 ,$140.73 ,$159.28 ,$776.90 ,$316.64 ,$840.88 ,$639.80 ,$242.16 ,$260.36 ,$556.63 ,$242.16 ,$631.57 ,$658.08 ,$636.60 ,$142.14 ,$658.08 ,$74.24 ,$168.88 ,$168.88 ,$140.73 ,$168.88 ,$140.73 ,$658.08 ,$566.68 ,$658.08 ,$658.08 ,$548.40 
ST MARY'S HOSPITAL,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 ,$433.44 ,$439.46 ,$255.51 ,$511.70 ,$150.30 ,$255.51 ,$511.70 ,$439.46 ,$70.04 ,$150.30 ,$170.11 ,$511.70 ,$338.18 ,$553.84 ,$421.40 ,$242.16 ,$260.36 ,$366.62 ,$242.16 ,$415.98 ,$433.44 ,$419.29 ,$151.80 ,$433.44 ,$74.24 ,$180.36 ,$180.36 ,$150.30 ,$180.36 ,$150.30 ,$433.44 ,$373.24 ,$433.44 ,$433.44 ,$361.20 
ST MARY'S HOSPITAL,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 ,$316.08 ,$320.47 ,$244.38 ,$373.15 ,$143.75 ,$244.38 ,$373.15 ,$320.47 ,$70.04 ,$143.75 ,$162.70 ,$373.15 ,$323.44 ,$403.88 ,$307.30 ,$242.16 ,$260.36 ,$267.35 ,$242.16 ,$303.35 ,$316.08 ,$305.76 ,$145.19 ,$316.08 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$143.75 ,$316.08 ,$272.18 ,$316.08 ,$316.08 ,$263.40 
ST MARY'S HOSPITAL,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 ,$368.64 ,$373.76 ,$244.38 ,$435.20 ,$143.75 ,$244.38 ,$435.20 ,$373.76 ,$70.04 ,$143.75 ,$162.70 ,$435.20 ,$323.44 ,$471.04 ,$358.40 ,$242.16 ,$260.36 ,$311.81 ,$242.16 ,$353.79 ,$368.64 ,$356.61 ,$145.19 ,$368.64 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$143.75 ,$368.64 ,$317.44 ,$368.64 ,$368.64 ,$307.20 
ST MARY'S HOSPITAL,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 ,$264.24 ,$267.91 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$311.95 ,$267.91 ,$70.04 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$242.16 ,$260.36 ,$223.50 ,$242.16 ,$253.60 ,$264.24 ,$255.62 ,$145.19 ,$264.24 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$143.75 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$220.20 
ST MARY'S HOSPITAL,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 ,$264.24 ,$267.91 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$311.95 ,$267.91 ,$70.04 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$242.16 ,$260.36 ,$223.50 ,$242.16 ,$253.60 ,$264.24 ,$255.62 ,$145.19 ,$264.24 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$143.75 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$220.20 
ST MARY'S HOSPITAL,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 ,$264.24 ,$267.91 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$311.95 ,$267.91 ,$70.04 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$242.16 ,$260.36 ,$223.50 ,$242.16 ,$253.60 ,$264.24 ,$255.62 ,$145.19 ,$264.24 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$143.75 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$220.20 
ST MARY'S HOSPITAL,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 ,$264.24 ,$267.91 ,$244.38 ,$311.95 ,$143.75 ,$244.38 ,$311.95 ,$267.91 ,$70.04 ,$143.75 ,$162.70 ,$311.95 ,$323.44 ,$337.64 ,$256.90 ,$242.16 ,$260.36 ,$223.50 ,$242.16 ,$253.60 ,$264.24 ,$255.62 ,$145.19 ,$264.24 ,$74.24 ,$172.50 ,$172.50 ,$143.75 ,$172.50 ,$143.75 ,$264.24 ,$227.54 ,$264.24 ,$264.24 ,$220.20 
ST MARY'S HOSPITAL,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 ,$357.12 ,$362.08 ,$250.78 ,$421.60 ,$147.52 ,$250.78 ,$421.60 ,$362.08 ,$70.04 ,$147.52 ,$166.96 ,$421.60 ,$331.92 ,$456.32 ,$347.20 ,$242.16 ,$260.36 ,$302.06 ,$242.16 ,$342.74 ,$357.12 ,$345.46 ,$149.00 ,$357.12 ,$74.24 ,$177.02 ,$177.02 ,$147.52 ,$177.02 ,$147.52 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$297.60 
ST MARY'S HOSPITAL,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 ,$466.56 ,$473.04 ,$250.78 ,$550.80 ,$147.52 ,$250.78 ,$550.80 ,$473.04 ,$70.04 ,$147.52 ,$166.96 ,$550.80 ,$331.92 ,$596.16 ,$453.60 ,$242.16 ,$260.36 ,$394.63 ,$242.16 ,$447.77 ,$466.56 ,$451.33 ,$149.00 ,$466.56 ,$74.24 ,$177.02 ,$177.02 ,$147.52 ,$177.02 ,$147.52 ,$466.56 ,$401.76 ,$466.56 ,$466.56 ,$388.80 
ST MARY'S HOSPITAL,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 ,$35.28 ,$35.77 ,$22.22 ,$41.65 ,$13.07 ,$22.22 ,$41.65 ,$35.77 ,$9.83 ,$13.07 ,$14.79 ,$41.65 ,$29.41 ,$45.08 ,$34.30 ,$33.96 ,$36.52 ,$29.84 ,$33.96 ,$33.86 ,$35.28 ,$34.13 ,$13.20 ,$35.28 ,$10.42 ,$15.68 ,$15.68 ,$13.07 ,$15.68 ,$13.07 ,$35.28 ,$30.38 ,$35.28 ,$35.28 ,$29.40 
ST MARY'S HOSPITAL,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 ,$202.32 ,$205.13 ,$281.00 ,$238.85 ,$173.17 ,$281.00 ,$238.85 ,$205.13 ,$178.94 ,$173.17 ,$195.99 ,$238.85 ,$389.63 ,$258.52 ,$196.70 ,$281.00 ,$281.00 ,$171.13 ,$281.00 ,$194.17 ,$202.32 ,$195.72 ,$174.90 ,$202.32 ,$189.68 ,$207.80 ,$207.80 ,$173.17 ,$207.80 ,$173.17 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$168.60 
ST MARY'S HOSPITAL,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 ,$504.72 ,$511.73 ,$213.33 ,$595.85 ,$125.49 ,$213.33 ,$595.85 ,$511.73 ,$129.67 ,$125.49 ,$142.03 ,$595.85 ,$282.35 ,$644.92 ,$490.70 ,$605.99 ,$651.53 ,$426.91 ,$605.99 ,$484.39 ,$504.72 ,$488.25 ,$126.74 ,$504.72 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$504.72 ,$434.62 ,$504.72 ,$504.72 ,$420.60 
ST MARY'S HOSPITAL,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 ,$112.32 ,$113.88 ,$156.00 ,$132.60 ,$125.49 ,$156.00 ,$132.60 ,$113.88 ,$129.67 ,$125.49 ,$142.03 ,$132.60 ,$282.35 ,$143.52 ,$109.20 ,$156.00 ,$156.00 ,$95.00 ,$156.00 ,$107.80 ,$112.32 ,$108.65 ,$126.74 ,$112.32 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$112.32 ,$96.72 ,$112.32 ,$112.32 ,$93.60 
ST MARY'S HOSPITAL,31100155,88299,HC CYTOGENIC STUDY (LYMPH),311,1 ,$464.00 ,$232.00 ,$13.61 ,$464.00 ,$13.61 ,$300.16 ,$300.16 ,$48.33 ,$278.40 ,$394.40 ,$324.80 ,$13.61 ,$440.80 ,$334.08 ,$338.72 , N/A ,$394.40 ,$48.33 , N/A ,$394.40 ,$338.72 ,$13.61 ,$48.33 ,$194.88 ,$394.40 ,$108.73 ,$426.88 ,$324.80 ,$76.30 ,$82.03 ,$282.58 ,$76.30 ,$320.62 ,$334.08 ,$323.18 ,$48.81 ,$334.08 ,$14.43 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$334.08 ,$287.68 ,$334.08 ,$334.08 ,$278.40 
ST MARY'S HOSPITAL,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 ,$213.84 ,$216.81 ,$213.33 ,$252.45 ,$125.49 ,$213.33 ,$252.45 ,$216.81 ,$129.67 ,$125.49 ,$142.03 ,$252.45 ,$282.35 ,$273.24 ,$207.90 ,$297.00 ,$297.00 ,$180.87 ,$297.00 ,$205.23 ,$213.84 ,$206.86 ,$126.74 ,$213.84 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$213.84 ,$184.14 ,$213.84 ,$213.84 ,$178.20 
ST MARY'S HOSPITAL,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 ,$547.20 ,$554.80 ,$213.33 ,$646.00 ,$125.49 ,$213.33 ,$646.00 ,$554.80 ,$129.67 ,$125.49 ,$142.03 ,$646.00 ,$282.35 ,$699.20 ,$532.00 ,$605.99 ,$651.53 ,$462.84 ,$605.99 ,$525.16 ,$547.20 ,$529.34 ,$126.74 ,$547.20 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,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 ,$358.56 ,$363.54 ,$213.33 ,$423.30 ,$125.49 ,$213.33 ,$423.30 ,$363.54 ,$129.67 ,$125.49 ,$142.03 ,$423.30 ,$282.35 ,$458.16 ,$348.60 ,$498.00 ,$498.00 ,$303.28 ,$498.00 ,$344.12 ,$358.56 ,$346.86 ,$126.74 ,$358.56 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$358.56 ,$308.76 ,$358.56 ,$358.56 ,$298.80 
ST MARY'S HOSPITAL,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 ,$349.92 ,$354.78 ,$213.33 ,$413.10 ,$125.49 ,$213.33 ,$413.10 ,$354.78 ,$129.67 ,$125.49 ,$142.03 ,$413.10 ,$282.35 ,$447.12 ,$340.20 ,$486.00 ,$486.00 ,$295.97 ,$486.00 ,$335.83 ,$349.92 ,$338.50 ,$126.74 ,$349.92 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$349.92 ,$301.32 ,$349.92 ,$349.92 ,$291.60 
ST MARY'S HOSPITAL,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 ,$365.04 ,$370.11 ,$213.33 ,$430.95 ,$125.49 ,$213.33 ,$430.95 ,$370.11 ,$129.67 ,$125.49 ,$142.03 ,$430.95 ,$282.35 ,$466.44 ,$354.90 ,$507.00 ,$507.00 ,$308.76 ,$507.00 ,$350.34 ,$365.04 ,$353.13 ,$126.74 ,$365.04 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$304.20 
ST MARY'S HOSPITAL,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 ,$522.72 ,$529.98 ,$213.33 ,$617.10 ,$125.49 ,$213.33 ,$617.10 ,$529.98 ,$129.67 ,$125.49 ,$142.03 ,$617.10 ,$282.35 ,$667.92 ,$508.20 ,$605.99 ,$651.53 ,$442.13 ,$605.99 ,$501.67 ,$522.72 ,$505.66 ,$126.74 ,$522.72 ,$137.45 ,$150.59 ,$150.59 ,$125.49 ,$150.59 ,$125.49 ,$522.72 ,$450.12 ,$522.72 ,$522.72 ,$435.60 
ST MARY'S HOSPITAL,31100164,88299,HC CYTOGENIC STUDY (STLBRT1),311,1 ,$455.00 ,$227.50 ,$13.61 ,$455.00 ,$13.61 ,$294.34 ,$294.34 ,$48.33 ,$273.00 ,$386.75 ,$318.50 ,$13.61 ,$432.25 ,$327.60 ,$332.15 , N/A ,$386.75 ,$48.33 , N/A ,$386.75 ,$332.15 ,$13.61 ,$48.33 ,$191.10 ,$386.75 ,$108.73 ,$418.60 ,$318.50 ,$76.30 ,$82.03 ,$277.10 ,$76.30 ,$314.41 ,$327.60 ,$316.91 ,$48.81 ,$327.60 ,$14.43 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$327.60 ,$282.10 ,$327.60 ,$327.60 ,$273.00 
ST MARY'S HOSPITAL,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 ,$660.24 ,$669.41 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$779.45 ,$669.41 ,$149.43 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$605.99 ,$651.53 ,$558.45 ,$605.99 ,$633.65 ,$660.24 ,$638.69 ,$146.06 ,$660.24 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$144.61 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$550.20 
ST MARY'S HOSPITAL,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 ,$660.24 ,$669.41 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$779.45 ,$669.41 ,$149.43 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$605.99 ,$651.53 ,$558.45 ,$605.99 ,$633.65 ,$660.24 ,$638.69 ,$146.06 ,$660.24 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$144.61 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$550.20 
ST MARY'S HOSPITAL,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 ,$660.24 ,$669.41 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$779.45 ,$669.41 ,$149.43 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$605.99 ,$651.53 ,$558.45 ,$605.99 ,$633.65 ,$660.24 ,$638.69 ,$146.06 ,$660.24 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$144.61 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$550.20 
ST MARY'S HOSPITAL,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 ,$660.24 ,$669.41 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$779.45 ,$669.41 ,$149.43 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$605.99 ,$651.53 ,$558.45 ,$605.99 ,$633.65 ,$660.24 ,$638.69 ,$146.06 ,$660.24 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$144.61 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$550.20 
ST MARY'S HOSPITAL,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 ,$660.24 ,$669.41 ,$245.84 ,$779.45 ,$144.61 ,$245.84 ,$779.45 ,$669.41 ,$149.43 ,$144.61 ,$163.67 ,$779.45 ,$325.37 ,$843.64 ,$641.90 ,$605.99 ,$651.53 ,$558.45 ,$605.99 ,$633.65 ,$660.24 ,$638.69 ,$146.06 ,$660.24 ,$158.40 ,$173.53 ,$173.53 ,$144.61 ,$173.53 ,$144.61 ,$660.24 ,$568.54 ,$660.24 ,$660.24 ,$550.20 
ST MARY'S HOSPITAL,31100170,88299,HC CYTOGENIC STUDY (SOLID),311,1 ,$594.00 ,$297.00 ,$13.61 ,$594.00 ,$13.61 ,$384.26 ,$384.26 ,$48.33 ,$356.40 ,$504.90 ,$415.80 ,$13.61 ,$564.30 ,$427.68 ,$433.62 , N/A ,$504.90 ,$48.33 , N/A ,$504.90 ,$433.62 ,$13.61 ,$48.33 ,$249.48 ,$504.90 ,$108.73 ,$546.48 ,$415.80 ,$76.30 ,$82.03 ,$361.75 ,$76.30 ,$410.45 ,$427.68 ,$413.72 ,$48.81 ,$427.68 ,$14.43 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$356.40 
ST MARY'S HOSPITAL,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 ,$178.56 ,$181.04 ,$36.41 ,$210.80 ,$21.42 ,$36.41 ,$210.80 ,$181.04 ,$20.36 ,$21.42 ,$24.24 ,$210.80 ,$48.20 ,$228.16 ,$173.60 ,$70.39 ,$75.67 ,$151.03 ,$70.39 ,$171.37 ,$178.56 ,$172.73 ,$21.63 ,$178.56 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$148.80 
ST MARY'S HOSPITAL,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 ,$311.04 ,$315.36 ,$36.41 ,$367.20 ,$21.42 ,$36.41 ,$367.20 ,$315.36 ,$20.36 ,$21.42 ,$24.24 ,$367.20 ,$48.20 ,$397.44 ,$302.40 ,$70.39 ,$75.67 ,$263.09 ,$70.39 ,$298.51 ,$311.04 ,$300.89 ,$21.63 ,$311.04 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$311.04 ,$267.84 ,$311.04 ,$311.04 ,$259.20 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$217.44 ,$220.46 ,$36.41 ,$256.70 ,$21.42 ,$36.41 ,$256.70 ,$220.46 ,$20.36 ,$21.42 ,$24.24 ,$256.70 ,$48.20 ,$277.84 ,$211.40 ,$70.39 ,$75.67 ,$183.92 ,$70.39 ,$208.68 ,$217.44 ,$210.34 ,$21.63 ,$217.44 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$181.20 
ST MARY'S HOSPITAL,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 ,$136.08 ,$137.97 ,$36.41 ,$160.65 ,$21.42 ,$36.41 ,$160.65 ,$137.97 ,$20.36 ,$21.42 ,$24.24 ,$160.65 ,$48.20 ,$173.88 ,$132.30 ,$70.39 ,$75.67 ,$115.10 ,$70.39 ,$130.60 ,$136.08 ,$131.64 ,$21.63 ,$136.08 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$113.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$136.08 ,$137.97 ,$36.41 ,$160.65 ,$21.42 ,$36.41 ,$160.65 ,$137.97 ,$20.36 ,$21.42 ,$24.24 ,$160.65 ,$48.20 ,$173.88 ,$132.30 ,$70.39 ,$75.67 ,$115.10 ,$70.39 ,$130.60 ,$136.08 ,$131.64 ,$21.63 ,$136.08 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$113.40 
ST MARY'S HOSPITAL,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 ,$155.52 ,$157.68 ,$36.41 ,$183.60 ,$21.42 ,$36.41 ,$183.60 ,$157.68 ,$20.36 ,$21.42 ,$24.24 ,$183.60 ,$48.20 ,$198.72 ,$151.20 ,$70.39 ,$75.67 ,$131.54 ,$70.39 ,$149.26 ,$155.52 ,$150.44 ,$21.63 ,$155.52 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$129.60 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$36.41 ,$91.80 ,$21.42 ,$36.41 ,$91.80 ,$78.84 ,$20.36 ,$21.42 ,$24.24 ,$91.80 ,$48.20 ,$99.36 ,$75.60 ,$70.39 ,$75.67 ,$65.77 ,$70.39 ,$74.63 ,$77.76 ,$75.22 ,$21.63 ,$77.76 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$357.12 ,$362.08 ,$59.18 ,$421.60 ,$34.81 ,$59.18 ,$421.60 ,$362.08 ,$35.97 ,$34.81 ,$39.40 ,$421.60 ,$78.32 ,$456.32 ,$347.20 ,$156.24 ,$167.98 ,$302.06 ,$156.24 ,$342.74 ,$357.12 ,$345.46 ,$35.16 ,$357.12 ,$38.13 ,$41.77 ,$41.77 ,$34.81 ,$41.77 ,$34.81 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$297.60 
ST MARY'S HOSPITAL,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 ,$136.08 ,$137.97 ,$59.18 ,$160.65 ,$34.81 ,$59.18 ,$160.65 ,$137.97 ,$35.97 ,$34.81 ,$39.40 ,$160.65 ,$78.32 ,$173.88 ,$132.30 ,$156.24 ,$167.98 ,$115.10 ,$156.24 ,$130.60 ,$136.08 ,$131.64 ,$35.16 ,$136.08 ,$38.13 ,$41.77 ,$41.77 ,$34.81 ,$41.77 ,$34.81 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$113.40 
ST MARY'S HOSPITAL,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 ,$155.52 ,$157.68 ,$72.05 ,$183.60 ,$42.38 ,$72.05 ,$183.60 ,$157.68 ,$43.79 ,$42.38 ,$47.97 ,$183.60 ,$95.36 ,$198.72 ,$151.20 ,$169.24 ,$181.96 ,$131.54 ,$169.24 ,$149.26 ,$155.52 ,$150.44 ,$42.80 ,$155.52 ,$46.42 ,$50.86 ,$50.86 ,$42.38 ,$50.86 ,$42.38 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$129.60 
ST MARY'S HOSPITAL,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 ,$155.52 ,$157.68 ,$72.05 ,$183.60 ,$42.38 ,$72.05 ,$183.60 ,$157.68 ,$43.79 ,$42.38 ,$47.97 ,$183.60 ,$95.36 ,$198.72 ,$151.20 ,$169.24 ,$181.96 ,$131.54 ,$169.24 ,$149.26 ,$155.52 ,$150.44 ,$42.80 ,$155.52 ,$46.42 ,$50.86 ,$50.86 ,$42.38 ,$50.86 ,$42.38 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$129.60 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$87.02 ,$247.35 ,$51.19 ,$87.02 ,$247.35 ,$212.43 ,$52.89 ,$51.19 ,$57.94 ,$247.35 ,$115.18 ,$267.72 ,$203.70 ,$195.26 ,$209.93 ,$177.22 ,$195.26 ,$201.08 ,$209.52 ,$202.68 ,$51.70 ,$209.52 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$427.68 ,$433.62 ,$87.02 ,$504.90 ,$51.19 ,$87.02 ,$504.90 ,$433.62 ,$52.89 ,$51.19 ,$57.94 ,$504.90 ,$115.18 ,$546.48 ,$415.80 ,$195.26 ,$209.93 ,$361.75 ,$195.26 ,$410.45 ,$427.68 ,$413.72 ,$51.70 ,$427.68 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$356.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$91.80 ,$78.84 ,$52.89 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$77.76 ,$75.22 ,$51.70 ,$77.76 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$87.02 ,$119.85 ,$51.19 ,$87.02 ,$119.85 ,$102.93 ,$52.89 ,$51.19 ,$57.94 ,$119.85 ,$115.18 ,$129.72 ,$98.70 ,$141.00 ,$141.00 ,$85.87 ,$141.00 ,$97.43 ,$101.52 ,$98.21 ,$51.70 ,$101.52 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$163.44 ,$165.71 ,$87.02 ,$192.95 ,$51.19 ,$87.02 ,$192.95 ,$165.71 ,$52.89 ,$51.19 ,$57.94 ,$192.95 ,$115.18 ,$208.84 ,$158.90 ,$195.26 ,$209.93 ,$138.24 ,$195.26 ,$156.86 ,$163.44 ,$158.11 ,$51.70 ,$163.44 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$136.20 
ST MARY'S HOSPITAL,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 ,$163.44 ,$165.71 ,$87.02 ,$192.95 ,$51.19 ,$87.02 ,$192.95 ,$165.71 ,$52.89 ,$51.19 ,$57.94 ,$192.95 ,$115.18 ,$208.84 ,$158.90 ,$195.26 ,$209.93 ,$138.24 ,$195.26 ,$156.86 ,$163.44 ,$158.11 ,$51.70 ,$163.44 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$136.20 
ST MARY'S HOSPITAL,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 ,$233.28 ,$236.52 ,$87.02 ,$275.40 ,$51.19 ,$87.02 ,$275.40 ,$236.52 ,$52.89 ,$51.19 ,$57.94 ,$275.40 ,$115.18 ,$298.08 ,$226.80 ,$195.26 ,$209.93 ,$197.32 ,$195.26 ,$223.88 ,$233.28 ,$225.67 ,$51.70 ,$233.28 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$233.28 ,$200.88 ,$233.28 ,$233.28 ,$194.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$91.80 ,$78.84 ,$52.89 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$77.76 ,$75.22 ,$51.70 ,$77.76 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$136.08 ,$137.97 ,$87.02 ,$160.65 ,$51.19 ,$87.02 ,$160.65 ,$137.97 ,$52.89 ,$51.19 ,$57.94 ,$160.65 ,$115.18 ,$173.88 ,$132.30 ,$189.00 ,$189.00 ,$115.10 ,$189.00 ,$130.60 ,$136.08 ,$131.64 ,$51.70 ,$136.08 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$113.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$91.80 ,$78.84 ,$52.89 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$77.76 ,$75.22 ,$51.70 ,$77.76 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$155.52 ,$157.68 ,$87.02 ,$183.60 ,$51.19 ,$87.02 ,$183.60 ,$157.68 ,$52.89 ,$51.19 ,$57.94 ,$183.60 ,$115.18 ,$198.72 ,$151.20 ,$195.26 ,$209.93 ,$131.54 ,$195.26 ,$149.26 ,$155.52 ,$150.44 ,$51.70 ,$155.52 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$155.52 ,$133.92 ,$155.52 ,$155.52 ,$129.60 
ST MARY'S HOSPITAL,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 ,$175.68 ,$178.12 ,$87.02 ,$207.40 ,$51.19 ,$87.02 ,$207.40 ,$178.12 ,$52.89 ,$51.19 ,$57.94 ,$207.40 ,$115.18 ,$224.48 ,$170.80 ,$195.26 ,$209.93 ,$148.60 ,$195.26 ,$168.60 ,$175.68 ,$169.95 ,$51.70 ,$175.68 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$175.68 ,$151.28 ,$175.68 ,$175.68 ,$146.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$91.80 ,$78.84 ,$52.89 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$77.76 ,$75.22 ,$51.70 ,$77.76 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$87.02 ,$91.80 ,$51.19 ,$87.02 ,$91.80 ,$78.84 ,$52.89 ,$51.19 ,$57.94 ,$91.80 ,$115.18 ,$99.36 ,$75.60 ,$108.00 ,$108.00 ,$65.77 ,$108.00 ,$74.63 ,$77.76 ,$75.22 ,$51.70 ,$77.76 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$136.08 ,$137.97 ,$87.02 ,$160.65 ,$51.19 ,$87.02 ,$160.65 ,$137.97 ,$52.89 ,$51.19 ,$57.94 ,$160.65 ,$115.18 ,$173.88 ,$132.30 ,$189.00 ,$189.00 ,$115.10 ,$189.00 ,$130.60 ,$136.08 ,$131.64 ,$51.70 ,$136.08 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$136.08 ,$117.18 ,$136.08 ,$136.08 ,$113.40 
ST MARY'S HOSPITAL,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 ,$139.68 ,$141.62 ,$87.02 ,$164.90 ,$51.19 ,$87.02 ,$164.90 ,$141.62 ,$52.89 ,$51.19 ,$57.94 ,$164.90 ,$115.18 ,$178.48 ,$135.80 ,$194.00 ,$194.00 ,$118.15 ,$194.00 ,$134.05 ,$139.68 ,$135.12 ,$51.70 ,$139.68 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$139.68 ,$120.28 ,$139.68 ,$139.68 ,$116.40 
ST MARY'S HOSPITAL,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 ,$194.40 ,$197.10 ,$56.90 ,$229.50 ,$33.47 ,$56.90 ,$229.50 ,$197.10 ,$34.58 ,$33.47 ,$37.88 ,$229.50 ,$75.31 ,$248.40 ,$189.00 ,$122.02 ,$131.19 ,$164.43 ,$122.02 ,$186.57 ,$194.40 ,$188.06 ,$33.80 ,$194.40 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$33.47 ,$194.40 ,$167.40 ,$194.40 ,$194.40 ,$162.00 
ST MARY'S HOSPITAL,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 ,$224.64 ,$227.76 ,$56.90 ,$265.20 ,$33.47 ,$56.90 ,$265.20 ,$227.76 ,$34.58 ,$33.47 ,$37.88 ,$265.20 ,$75.31 ,$287.04 ,$218.40 ,$122.02 ,$131.19 ,$190.01 ,$122.02 ,$215.59 ,$224.64 ,$217.31 ,$33.80 ,$224.64 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$33.47 ,$224.64 ,$193.44 ,$224.64 ,$224.64 ,$187.20 
ST MARY'S HOSPITAL,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 ,$133.20 ,$135.05 ,$56.90 ,$157.25 ,$33.47 ,$56.90 ,$157.25 ,$135.05 ,$34.58 ,$33.47 ,$37.88 ,$157.25 ,$75.31 ,$170.20 ,$129.50 ,$122.02 ,$131.19 ,$112.67 ,$122.02 ,$127.84 ,$133.20 ,$128.85 ,$33.80 ,$133.20 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$33.47 ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$111.00 
ST MARY'S HOSPITAL,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 ,$215.28 ,$218.27 ,$58.53 ,$254.15 ,$34.43 ,$58.53 ,$254.15 ,$218.27 ,$35.58 ,$34.43 ,$38.97 ,$254.15 ,$77.47 ,$275.08 ,$209.30 ,$167.43 ,$180.01 ,$182.09 ,$167.43 ,$206.61 ,$215.28 ,$208.25 ,$34.77 ,$215.28 ,$37.71 ,$41.32 ,$41.32 ,$34.43 ,$41.32 ,$34.43 ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$179.40 
ST MARY'S HOSPITAL,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 ,$84.96 ,$86.14 ,$58.53 ,$100.30 ,$34.43 ,$58.53 ,$100.30 ,$86.14 ,$35.58 ,$34.43 ,$38.97 ,$100.30 ,$77.47 ,$108.56 ,$82.60 ,$118.00 ,$118.00 ,$71.86 ,$118.00 ,$81.54 ,$84.96 ,$82.19 ,$34.77 ,$84.96 ,$37.71 ,$41.32 ,$41.32 ,$34.43 ,$41.32 ,$34.43 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$70.80 
ST MARY'S HOSPITAL,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 ,$47.52 ,$48.18 ,$27.06 ,$56.10 ,$15.92 ,$27.06 ,$56.10 ,$48.18 ,$14.86 ,$15.92 ,$18.02 ,$56.10 ,$35.82 ,$60.72 ,$46.20 ,$51.39 ,$55.25 ,$40.19 ,$51.39 ,$45.61 ,$47.52 ,$45.97 ,$16.08 ,$47.52 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$15.92 ,$47.52 ,$40.92 ,$47.52 ,$47.52 ,$39.60 
ST MARY'S HOSPITAL,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 ,$41.04 ,$41.61 ,$27.06 ,$48.45 ,$15.92 ,$27.06 ,$48.45 ,$41.61 ,$14.86 ,$15.92 ,$18.02 ,$48.45 ,$35.82 ,$52.44 ,$39.90 ,$51.39 ,$55.25 ,$34.71 ,$51.39 ,$39.39 ,$41.04 ,$39.70 ,$16.08 ,$41.04 ,$15.75 ,$18.14 ,$18.14 ,$15.92 ,$18.14 ,$15.92 ,$41.04 ,$35.34 ,$41.04 ,$41.04 ,$34.20 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$72.05 ,$110.50 ,$42.38 ,$72.05 ,$110.50 ,$94.90 ,$43.79 ,$42.38 ,$47.97 ,$110.50 ,$95.36 ,$119.60 ,$91.00 ,$130.00 ,$130.00 ,$79.17 ,$130.00 ,$89.83 ,$93.60 ,$90.55 ,$42.80 ,$93.60 ,$46.42 ,$50.86 ,$50.86 ,$42.38 ,$50.86 ,$42.38 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$95.04 ,$96.36 ,$36.41 ,$112.20 ,$21.42 ,$36.41 ,$112.20 ,$96.36 ,$20.36 ,$21.42 ,$24.24 ,$112.20 ,$48.20 ,$121.44 ,$92.40 ,$70.39 ,$75.67 ,$80.39 ,$70.39 ,$91.21 ,$95.04 ,$91.94 ,$21.63 ,$95.04 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$95.04 ,$81.84 ,$95.04 ,$95.04 ,$79.20 
ST MARY'S HOSPITAL,31100222,88299,HC CYTOGENIC STUDY,311,1 ,$532.00 ,$266.00 ,$13.61 ,$532.00 ,$13.61 ,$344.15 ,$344.15 ,$48.33 ,$319.20 ,$452.20 ,$372.40 ,$13.61 ,$505.40 ,$383.04 ,$388.36 , N/A ,$452.20 ,$48.33 , N/A ,$452.20 ,$388.36 ,$13.61 ,$48.33 ,$223.44 ,$452.20 ,$108.73 ,$489.44 ,$372.40 ,$76.30 ,$82.03 ,$323.99 ,$76.30 ,$367.61 ,$383.04 ,$370.54 ,$48.81 ,$383.04 ,$14.43 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$383.04 ,$329.84 ,$383.04 ,$383.04 ,$319.20 
ST MARY'S HOSPITAL,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 ,$168.48 ,$170.82 ,$56.90 ,$198.90 ,$33.47 ,$56.90 ,$198.90 ,$170.82 ,$34.58 ,$33.47 ,$37.88 ,$198.90 ,$75.31 ,$215.28 ,$163.80 ,$122.02 ,$131.19 ,$142.51 ,$122.02 ,$161.69 ,$168.48 ,$162.98 ,$33.80 ,$168.48 ,$36.65 ,$40.16 ,$40.16 ,$33.47 ,$40.16 ,$33.47 ,$168.48 ,$145.08 ,$168.48 ,$168.48 ,$140.40 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$36.41 ,$137.70 ,$21.42 ,$36.41 ,$137.70 ,$118.26 ,$20.36 ,$21.42 ,$24.24 ,$137.70 ,$48.20 ,$149.04 ,$113.40 ,$70.39 ,$75.67 ,$98.66 ,$70.39 ,$111.94 ,$116.64 ,$112.83 ,$21.63 ,$116.64 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$174.24 ,$176.66 ,$87.02 ,$205.70 ,$51.19 ,$87.02 ,$205.70 ,$176.66 ,$52.89 ,$51.19 ,$57.94 ,$205.70 ,$115.18 ,$222.64 ,$169.40 ,$195.26 ,$209.93 ,$147.38 ,$195.26 ,$167.22 ,$174.24 ,$168.55 ,$51.70 ,$174.24 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$145.20 
ST MARY'S HOSPITAL,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 ,$174.24 ,$176.66 ,$87.02 ,$205.70 ,$51.19 ,$87.02 ,$205.70 ,$176.66 ,$52.89 ,$51.19 ,$57.94 ,$205.70 ,$115.18 ,$222.64 ,$169.40 ,$195.26 ,$209.93 ,$147.38 ,$195.26 ,$167.22 ,$174.24 ,$168.55 ,$51.70 ,$174.24 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$145.20 
ST MARY'S HOSPITAL,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 ,$174.24 ,$176.66 ,$87.02 ,$205.70 ,$51.19 ,$87.02 ,$205.70 ,$176.66 ,$52.89 ,$51.19 ,$57.94 ,$205.70 ,$115.18 ,$222.64 ,$169.40 ,$195.26 ,$209.93 ,$147.38 ,$195.26 ,$167.22 ,$174.24 ,$168.55 ,$51.70 ,$174.24 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$174.24 ,$150.04 ,$174.24 ,$174.24 ,$145.20 
ST MARY'S HOSPITAL,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 ,$182.16 ,$184.69 ,$87.02 ,$215.05 ,$51.19 ,$87.02 ,$215.05 ,$184.69 ,$52.89 ,$51.19 ,$57.94 ,$215.05 ,$115.18 ,$232.76 ,$177.10 ,$195.26 ,$209.93 ,$154.08 ,$195.26 ,$174.82 ,$182.16 ,$176.21 ,$51.70 ,$182.16 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$182.16 ,$156.86 ,$182.16 ,$182.16 ,$151.80 
ST MARY'S HOSPITAL,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 ,$202.32 ,$205.13 ,$87.02 ,$238.85 ,$51.19 ,$87.02 ,$238.85 ,$205.13 ,$52.89 ,$51.19 ,$57.94 ,$238.85 ,$115.18 ,$258.52 ,$196.70 ,$195.26 ,$209.93 ,$171.13 ,$195.26 ,$194.17 ,$202.32 ,$195.72 ,$51.70 ,$202.32 ,$56.06 ,$61.43 ,$61.43 ,$51.19 ,$61.43 ,$51.19 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$168.60 
ST MARY'S HOSPITAL,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 ,$614.16 ,$622.69 ,$36.41 ,$725.05 ,$21.42 ,$36.41 ,$725.05 ,$622.69 ,$20.36 ,$21.42 ,$24.24 ,$725.05 ,$48.20 ,$784.76 ,$597.10 ,$70.39 ,$75.67 ,$519.48 ,$70.39 ,$589.42 ,$614.16 ,$594.11 ,$21.63 ,$614.16 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$614.16 ,$528.86 ,$614.16 ,$614.16 ,$511.80 
ST MARY'S HOSPITAL,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 ,$543.60 ,$551.15 ,$36.41 ,$641.75 ,$21.42 ,$36.41 ,$641.75 ,$551.15 ,$20.36 ,$21.42 ,$24.24 ,$641.75 ,$48.20 ,$694.60 ,$528.50 ,$70.39 ,$75.67 ,$459.80 ,$70.39 ,$521.71 ,$543.60 ,$525.86 ,$21.63 ,$543.60 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$543.60 ,$468.10 ,$543.60 ,$543.60 ,$453.00 
ST MARY'S HOSPITAL,31100309,88121,HC CYTOPATH URINE 3-5 MOL PROBES EA SPEC COMP ASSIST,311,1 ,$589.00 ,$294.50 ,$12.46 ,$637.30 ,$12.46 ,$589.00 ,$589.00 ,$283.24 ,$353.40 ,$500.65 ,$412.30 ,$12.46 ,$559.55 ,$424.08 ,$429.97 ,$589.00 ,$500.65 ,$283.24 ,$589.00 ,$500.65 ,$429.97 ,$12.46 ,$283.24 ,$247.38 ,$500.65 ,$637.30 ,$541.88 ,$412.30 ,$589.00 ,$589.00 ,$358.70 ,$589.00 ,$407.00 ,$424.08 ,$410.24 ,$286.07 ,$424.08 ,$13.21 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$424.08 ,$365.18 ,$424.08 ,$424.08 ,$353.40 
ST MARY'S HOSPITAL,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 ,$319.68 ,$324.12 ,$36.41 ,$377.40 ,$21.42 ,$36.41 ,$377.40 ,$324.12 ,$20.36 ,$21.42 ,$24.24 ,$377.40 ,$48.20 ,$408.48 ,$310.80 ,$70.39 ,$75.67 ,$270.40 ,$70.39 ,$306.80 ,$319.68 ,$309.25 ,$21.63 ,$319.68 ,$21.58 ,$25.70 ,$25.70 ,$21.42 ,$25.70 ,$21.42 ,$319.68 ,$275.28 ,$319.68 ,$319.68 ,$266.40 
ST MARY'S HOSPITAL,31100316,88184,HC PCPDS PRE ANAL CELL SORT BM 1 MARKER,311,1 ,$88.00 ,$44.00 ,$9.06 ,$637.30 ,$9.06 ,$88.00 ,$88.00 ,$283.24 ,$52.80 ,$74.80 ,$61.60 ,$9.06 ,$83.60 ,$63.36 ,$64.24 ,$88.00 ,$74.80 ,$283.24 ,$88.00 ,$74.80 ,$64.24 ,$9.06 ,$283.24 ,$36.96 ,$74.80 ,$637.30 ,$80.96 ,$61.60 ,$88.00 ,$88.00 ,$53.59 ,$88.00 ,$60.81 ,$63.36 ,$61.29 ,$286.07 ,$63.36 ,$9.60 ,$88.00 ,$88.00 ,$283.24 ,$88.00 ,$283.24 ,$63.36 ,$54.56 ,$63.36 ,$63.36 ,$52.80 
ST MARY'S HOSPITAL,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 ,$20.88 ,$21.17 ,$29.00 ,$24.65 , N/A ,$29.00 ,$24.65 ,$21.17 ,$12.46 , N/A ,$12.18 ,$24.65 , N/A ,$26.68 ,$20.30 ,$29.00 ,$29.00 ,$17.66 ,$29.00 ,$20.04 ,$20.88 ,$20.20 , N/A ,$20.88 ,$13.21 ,$26.86 ,$26.86 , N/A ,$26.86 , N/A ,$20.88 ,$17.98 ,$20.88 ,$20.88 ,$17.40 
ST MARY'S HOSPITAL,31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$109.00 ,$54.50 ,$6.95 ,$109.00 ,$6.95 ,$37.86 ,$32.45 ,$24.03 ,$65.40 ,$92.65 ,$76.30 ,$6.95 ,$103.55 ,$78.48 ,$79.57 ,$24.45 ,$92.65 ,$24.03 ,$24.45 ,$92.65 ,$79.57 ,$6.95 ,$24.03 ,$45.78 ,$92.65 ,$54.06 ,$100.28 ,$76.30 ,$76.30 ,$82.03 ,$66.38 ,$76.30 ,$75.32 ,$78.48 ,$75.92 ,$24.27 ,$78.48 ,$7.37 ,$27.59 ,$27.59 ,$24.03 ,$27.59 ,$24.03 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$224.00 ,$112.00 ,$6.95 ,$224.00 ,$6.95 ,$80.11 ,$68.66 ,$24.03 ,$134.40 ,$190.40 ,$156.80 ,$6.95 ,$212.80 ,$161.28 ,$163.52 ,$51.22 ,$190.40 ,$24.03 ,$51.22 ,$190.40 ,$163.52 ,$6.95 ,$24.03 ,$94.08 ,$190.40 ,$54.06 ,$206.08 ,$156.80 ,$76.30 ,$82.03 ,$136.42 ,$76.30 ,$154.78 ,$161.28 ,$156.02 ,$24.27 ,$161.28 ,$7.37 ,$27.59 ,$27.59 ,$24.03 ,$27.59 ,$24.03 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$280.00 ,$140.00 ,$6.95 ,$280.00 ,$6.95 ,$97.01 ,$83.15 ,$48.33 ,$168.00 ,$238.00 ,$196.00 ,$6.95 ,$266.00 ,$201.60 ,$204.40 ,$67.61 ,$238.00 ,$48.33 ,$67.61 ,$238.00 ,$204.40 ,$6.95 ,$48.33 ,$117.60 ,$238.00 ,$108.73 ,$257.60 ,$196.00 ,$140.48 ,$151.04 ,$170.52 ,$140.48 ,$193.48 ,$201.60 ,$195.02 ,$48.81 ,$201.60 ,$7.37 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,31200105,88305,HC CELLIENT CELL BLOCK,312,1 ,$114.00 ,$57.00 ,$12.70 ,$114.00 ,$12.70 ,$101.84 ,$87.29 ,$48.33 ,$68.40 ,$96.90 ,$79.80 ,$12.70 ,$108.30 ,$82.08 ,$83.22 ,$114.00 ,$96.90 ,$48.33 ,$114.00 ,$96.90 ,$83.22 ,$12.70 ,$48.33 ,$47.88 ,$96.90 ,$108.73 ,$104.88 ,$79.80 ,$114.00 ,$114.00 ,$69.43 ,$114.00 ,$78.77 ,$82.08 ,$79.40 ,$48.81 ,$82.08 ,$13.46 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$68.40 
ST MARY'S HOSPITAL,31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$336.00 ,$168.00 ,$12.70 ,$336.00 ,$12.70 ,$101.84 ,$87.29 ,$48.33 ,$201.60 ,$285.60 ,$235.20 ,$12.70 ,$319.20 ,$241.92 ,$245.28 ,$117.06 ,$285.60 ,$48.33 ,$117.06 ,$285.60 ,$245.28 ,$12.70 ,$48.33 ,$141.12 ,$285.60 ,$108.73 ,$309.12 ,$235.20 ,$140.48 ,$151.04 ,$204.62 ,$140.48 ,$232.18 ,$241.92 ,$234.02 ,$48.81 ,$241.92 ,$13.46 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$48.33 ,$171.60 ,$243.10 ,$200.20 ,$12.70 ,$271.70 ,$205.92 ,$208.78 ,$117.06 ,$243.10 ,$48.33 ,$117.06 ,$243.10 ,$208.78 ,$12.70 ,$48.33 ,$120.12 ,$243.10 ,$108.73 ,$263.12 ,$200.20 ,$140.48 ,$151.04 ,$174.17 ,$140.48 ,$197.63 ,$205.92 ,$199.20 ,$48.81 ,$205.92 ,$13.46 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$205.92 ,$177.32 ,$205.92 ,$205.92 ,$171.60 
ST MARY'S HOSPITAL,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 ,$283.24 ,$658.80 ,$933.30 ,$768.60 ,$12.70 ,"$1,043.10 ",$790.56 ,$801.54 ,$467.89 ,$933.30 ,$283.24 ,$467.89 ,$933.30 ,$801.54 ,$12.70 ,$283.24 ,$461.16 ,$933.30 ,$637.30 ,"$1,010.16 ",$768.60 ,$236.35 ,$254.11 ,$668.68 ,$236.35 ,$758.72 ,$790.56 ,$764.76 ,$286.07 ,$790.56 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$658.80 
ST MARY'S HOSPITAL,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 ,$283.24 ,$658.80 ,$933.30 ,$768.60 ,$12.70 ,"$1,043.10 ",$790.56 ,$801.54 ,$467.89 ,$933.30 ,$283.24 ,$467.89 ,$933.30 ,$801.54 ,$12.70 ,$283.24 ,$461.16 ,$933.30 ,$637.30 ,"$1,010.16 ",$768.60 ,$236.35 ,$254.11 ,$668.68 ,$236.35 ,$758.72 ,$790.56 ,$764.76 ,$286.07 ,$790.56 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$658.80 
ST MARY'S HOSPITAL,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 ,$637.32 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$12.70 ,"$1,489.60 ","$1,128.96 ","$1,144.64 ",$713.27 ,"$1,332.80 ",$637.32 ,$713.27 ,"$1,332.80 ","$1,144.64 ",$12.70 ,$637.32 ,$658.56 ,"$1,332.80 ","$1,433.98 ","$1,442.56 ","$1,097.60 ",$690.91 ,$742.83 ,$954.91 ,$690.91 ,"$1,083.49 ","$1,128.96 ","$1,092.11 ",$643.69 ,"$1,128.96 ",$13.46 ,$753.84 ,$753.84 ,$637.32 ,$753.84 ,$637.32 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ,$637.32 ,$940.80 ,"$1,332.80 ","$1,097.60 ",$12.70 ,"$1,489.60 ","$1,128.96 ","$1,144.64 ",$713.27 ,"$1,332.80 ",$637.32 ,$713.27 ,"$1,332.80 ","$1,144.64 ",$12.70 ,$637.32 ,$658.56 ,"$1,332.80 ","$1,433.98 ","$1,442.56 ","$1,097.60 ",$690.91 ,$742.83 ,$954.91 ,$690.91 ,"$1,083.49 ","$1,128.96 ","$1,092.11 ",$643.69 ,"$1,128.96 ",$13.46 ,$753.84 ,$753.84 ,$637.32 ,$753.84 ,$637.32 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ,$56.16 ,$56.94 ,$33.86 ,$66.30 , N/A ,$33.86 ,$66.30 ,$56.94 ,$12.70 , N/A ,$32.76 ,$66.30 , N/A ,$71.76 ,$54.60 ,$39.77 ,$42.76 ,$47.50 ,$39.77 ,$53.90 ,$56.16 ,$54.33 , N/A ,$56.16 ,$13.46 ,$10.82 ,$10.82 , N/A ,$10.82 , N/A ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,31200119,88312,HC SPECIAL STAIN I (STEINER),312,1 ,$157.00 ,$78.50 ,$6.95 ,$157.00 ,$6.95 ,$157.00 ,$157.00 ,$48.33 ,$94.20 ,$133.45 ,$109.90 ,$6.95 ,$149.15 ,$113.04 ,$114.61 ,$157.00 ,$133.45 ,$48.33 ,$157.00 ,$133.45 ,$114.61 ,$6.95 ,$48.33 ,$65.94 ,$133.45 ,$108.73 ,$144.44 ,$109.90 ,$76.30 ,$82.03 ,$95.61 ,$76.30 ,$108.49 ,$113.04 ,$109.35 ,$48.81 ,$113.04 ,$7.37 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,31200120,88312,HC SPECIAL STAIN I (WARTHIN-STARRY),312,1 ,$141.00 ,$70.50 ,$6.95 ,$141.00 ,$6.95 ,$141.00 ,$141.00 ,$48.33 ,$84.60 ,$119.85 ,$98.70 ,$6.95 ,$133.95 ,$101.52 ,$102.93 ,$141.00 ,$119.85 ,$48.33 ,$141.00 ,$119.85 ,$102.93 ,$6.95 ,$48.33 ,$59.22 ,$119.85 ,$108.73 ,$129.72 ,$98.70 ,$76.30 ,$82.03 ,$85.87 ,$76.30 ,$97.43 ,$101.52 ,$98.21 ,$48.81 ,$101.52 ,$7.37 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,31200122,88312,HC SPECIAL STAIN I (AFB),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$48.33 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$115.20 ,$116.80 ,$160.00 ,$136.00 ,$48.33 ,$160.00 ,$136.00 ,$116.80 ,$6.95 ,$48.33 ,$67.20 ,$136.00 ,$108.73 ,$147.20 ,$112.00 ,$76.30 ,$82.03 ,$97.44 ,$76.30 ,$110.56 ,$115.20 ,$111.44 ,$48.81 ,$115.20 ,$7.37 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,31200123,88312,HC SPECIAL STAIN I,312,1 ,$358.00 ,$179.00 ,$6.95 ,$358.00 ,$6.95 ,$247.90 ,$212.49 ,$48.33 ,$214.80 ,$304.30 ,$250.60 ,$6.95 ,$340.10 ,$257.76 ,$261.34 ,$184.52 ,$304.30 ,$48.33 ,$184.52 ,$304.30 ,$261.34 ,$6.95 ,$48.33 ,$150.36 ,$304.30 ,$108.73 ,$329.36 ,$250.60 ,$76.30 ,$82.03 ,$218.02 ,$76.30 ,$247.38 ,$257.76 ,$249.35 ,$48.81 ,$257.76 ,$7.37 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,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 ,$48.33 ,$214.80 ,$304.30 ,$250.60 ,$6.95 ,$340.10 ,$257.76 ,$261.34 ,$184.52 ,$304.30 ,$48.33 ,$184.52 ,$304.30 ,$261.34 ,$6.95 ,$48.33 ,$150.36 ,$304.30 ,$108.73 ,$329.36 ,$250.60 ,$76.30 ,$82.03 ,$218.02 ,$76.30 ,$247.38 ,$257.76 ,$249.35 ,$48.81 ,$257.76 ,$7.37 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,31200125,88313,HC SPECIAL STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200126,88313,HC SPECIAL STAIN II (OIL RED),312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200127,88313,HC SPECIAL STAIN II (SUDAN BLACK),312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200128,88313,HC SPECIAL STAIN II (MISC),312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200129,88313,HC SPECIAL STAIN II (MAST CELL),312,1 ,$143.00 ,$71.50 ,$6.95 ,$143.00 ,$6.95 ,$143.00 ,$143.00 ,$32.92 ,$85.80 ,$121.55 ,$100.10 ,$6.95 ,$135.85 ,$102.96 ,$104.39 ,$131.95 ,$121.55 ,$32.92 ,$131.95 ,$121.55 ,$104.39 ,$6.95 ,$32.92 ,$60.06 ,$121.55 ,$74.07 ,$131.56 ,$100.10 ,$76.30 ,$82.03 ,$87.09 ,$76.30 ,$98.81 ,$102.96 ,$99.60 ,$33.25 ,$102.96 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$102.96 ,$88.66 ,$102.96 ,$102.96 ,$85.80 
ST MARY'S HOSPITAL,31200130,88313,HC SPECIAL STAIN II (CONGO RED),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$32.92 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$115.20 ,$116.80 ,$131.95 ,$136.00 ,$32.92 ,$131.95 ,$136.00 ,$116.80 ,$6.95 ,$32.92 ,$67.20 ,$136.00 ,$74.07 ,$147.20 ,$112.00 ,$76.30 ,$82.03 ,$97.44 ,$76.30 ,$110.56 ,$115.20 ,$111.44 ,$33.25 ,$115.20 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,31200131,88313,HC SPECIAL STAIN II (FE),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$32.92 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$115.20 ,$116.80 ,$131.95 ,$136.00 ,$32.92 ,$131.95 ,$136.00 ,$116.80 ,$6.95 ,$32.92 ,$67.20 ,$136.00 ,$74.07 ,$147.20 ,$112.00 ,$76.30 ,$82.03 ,$97.44 ,$76.30 ,$110.56 ,$115.20 ,$111.44 ,$33.25 ,$115.20 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,31200132,88313,HC SPECIAL STAIN II (PAS),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$32.92 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$115.20 ,$116.80 ,$131.95 ,$136.00 ,$32.92 ,$131.95 ,$136.00 ,$116.80 ,$6.95 ,$32.92 ,$67.20 ,$136.00 ,$74.07 ,$147.20 ,$112.00 ,$76.30 ,$82.03 ,$97.44 ,$76.30 ,$110.56 ,$115.20 ,$111.44 ,$33.25 ,$115.20 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$32.92 ,$164.40 ,$232.90 ,$191.80 ,$6.95 ,$260.30 ,$197.28 ,$200.02 ,$131.95 ,$232.90 ,$32.92 ,$131.95 ,$232.90 ,$200.02 ,$6.95 ,$32.92 ,$115.08 ,$232.90 ,$74.07 ,$252.08 ,$191.80 ,$76.30 ,$82.03 ,$166.87 ,$76.30 ,$189.33 ,$197.28 ,$190.84 ,$33.25 ,$197.28 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$164.40 
ST MARY'S HOSPITAL,31200134,88313,HC SPECIAL STAIN II (ELASTIC),312,1 ,$251.00 ,$125.50 ,$6.95 ,$251.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$150.60 ,$213.35 ,$175.70 ,$6.95 ,$238.45 ,$180.72 ,$183.23 ,$131.95 ,$213.35 ,$32.92 ,$131.95 ,$213.35 ,$183.23 ,$6.95 ,$32.92 ,$105.42 ,$213.35 ,$74.07 ,$230.92 ,$175.70 ,$76.30 ,$82.03 ,$152.86 ,$76.30 ,$173.44 ,$180.72 ,$174.82 ,$33.25 ,$180.72 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$180.72 ,$155.62 ,$180.72 ,$180.72 ,$150.60 
ST MARY'S HOSPITAL,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 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,31200136,88313,HC SPECIAL STAIN II (MUCICARMINE),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,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 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,31200138,88313,HC SPECIAL STAIN II (ARGENTAFFIN),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,31200139,88313,HC SPECIAL STAIN II (BIELSCHOWSKY SILVER),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,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 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,31200142,88313,HC SPECIAL STAIN II (RHODAMINE),312,1 ,$255.00 ,$127.50 ,$6.95 ,$255.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$153.00 ,$216.75 ,$178.50 ,$6.95 ,$242.25 ,$183.60 ,$186.15 ,$131.95 ,$216.75 ,$32.92 ,$131.95 ,$216.75 ,$186.15 ,$6.95 ,$32.92 ,$107.10 ,$216.75 ,$74.07 ,$234.60 ,$178.50 ,$76.30 ,$82.03 ,$155.30 ,$76.30 ,$176.21 ,$183.60 ,$177.61 ,$33.25 ,$183.60 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$183.60 ,$158.10 ,$183.60 ,$183.60 ,$153.00 
ST MARY'S HOSPITAL,31200143,88313,HC SPECIAL STAIN II (TRICHROME),312,1 ,$160.00 ,$80.00 ,$6.95 ,$160.00 ,$6.95 ,$160.00 ,$160.00 ,$32.92 ,$96.00 ,$136.00 ,$112.00 ,$6.95 ,$152.00 ,$115.20 ,$116.80 ,$131.95 ,$136.00 ,$32.92 ,$131.95 ,$136.00 ,$116.80 ,$6.95 ,$32.92 ,$67.20 ,$136.00 ,$74.07 ,$147.20 ,$112.00 ,$76.30 ,$82.03 ,$97.44 ,$76.30 ,$110.56 ,$115.20 ,$111.44 ,$33.25 ,$115.20 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,31200144,88313,HC SPECIAL STAIN II (RETICULUM),312,1 ,$251.00 ,$125.50 ,$6.95 ,$251.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$150.60 ,$213.35 ,$175.70 ,$6.95 ,$238.45 ,$180.72 ,$183.23 ,$131.95 ,$213.35 ,$32.92 ,$131.95 ,$213.35 ,$183.23 ,$6.95 ,$32.92 ,$105.42 ,$213.35 ,$74.07 ,$230.92 ,$175.70 ,$76.30 ,$82.03 ,$152.86 ,$76.30 ,$173.44 ,$180.72 ,$174.82 ,$33.25 ,$180.72 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$180.72 ,$155.62 ,$180.72 ,$180.72 ,$150.60 
ST MARY'S HOSPITAL,31200145,88313,HC SPECIAL STAIN II (ALCIAN BLUE),312,1 ,$274.00 ,$137.00 ,$6.95 ,$274.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$164.40 ,$232.90 ,$191.80 ,$6.95 ,$260.30 ,$197.28 ,$200.02 ,$131.95 ,$232.90 ,$32.92 ,$131.95 ,$232.90 ,$200.02 ,$6.95 ,$32.92 ,$115.08 ,$232.90 ,$74.07 ,$252.08 ,$191.80 ,$76.30 ,$82.03 ,$166.87 ,$76.30 ,$189.33 ,$197.28 ,$190.84 ,$33.25 ,$197.28 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$164.40 
ST MARY'S HOSPITAL,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 ,$32.92 ,$164.40 ,$232.90 ,$191.80 ,$6.95 ,$260.30 ,$197.28 ,$200.02 ,$131.95 ,$232.90 ,$32.92 ,$131.95 ,$232.90 ,$200.02 ,$6.95 ,$32.92 ,$115.08 ,$232.90 ,$74.07 ,$252.08 ,$191.80 ,$76.30 ,$82.03 ,$166.87 ,$76.30 ,$189.33 ,$197.28 ,$190.84 ,$33.25 ,$197.28 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$164.40 
ST MARY'S HOSPITAL,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 ,$32.92 ,$554.40 ,$785.40 ,$646.80 ,$6.95 ,$877.80 ,$665.28 ,$674.52 ,$131.95 ,$785.40 ,$32.92 ,$131.95 ,$785.40 ,$674.52 ,$6.95 ,$32.92 ,$388.08 ,$785.40 ,$74.07 ,$850.08 ,$646.80 ,$76.30 ,$82.03 ,$562.72 ,$76.30 ,$638.48 ,$665.28 ,$643.57 ,$33.25 ,$665.28 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$665.28 ,$572.88 ,$665.28 ,$665.28 ,$554.40 
ST MARY'S HOSPITAL,31200150,88313,HC SPECIAL STAIN II (WARTHIN STARRY),312,1 ,$146.00 ,$73.00 ,$6.95 ,$146.00 ,$6.95 ,$146.00 ,$146.00 ,$32.92 ,$87.60 ,$124.10 ,$102.20 ,$6.95 ,$138.70 ,$105.12 ,$106.58 ,$131.95 ,$124.10 ,$32.92 ,$131.95 ,$124.10 ,$106.58 ,$6.95 ,$32.92 ,$61.32 ,$124.10 ,$74.07 ,$134.32 ,$102.20 ,$76.30 ,$82.03 ,$88.91 ,$76.30 ,$100.89 ,$105.12 ,$101.69 ,$33.25 ,$105.12 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$105.12 ,$90.52 ,$105.12 ,$105.12 ,$87.60 
ST MARY'S HOSPITAL,31200151,88313,HC SPECIAL STAIN II (ESTERASE MIX),312,1 ,$115.00 ,$57.50 ,$6.95 ,$115.00 ,$6.95 ,$115.00 ,$115.00 ,$32.92 ,$69.00 ,$97.75 ,$80.50 ,$6.95 ,$109.25 ,$82.80 ,$83.95 ,$115.00 ,$97.75 ,$32.92 ,$115.00 ,$97.75 ,$83.95 ,$6.95 ,$32.92 ,$48.30 ,$97.75 ,$74.07 ,$105.80 ,$80.50 ,$76.30 ,$82.03 ,$70.04 ,$76.30 ,$79.47 ,$82.80 ,$80.10 ,$33.25 ,$82.80 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$82.80 ,$71.30 ,$82.80 ,$82.80 ,$69.00 
ST MARY'S HOSPITAL,31200152,88313,HC SPECIAL STAIN II (ESTERASE SPEC),312,1 ,$171.00 ,$85.50 ,$6.95 ,$171.00 ,$6.95 ,$171.00 ,$171.00 ,$32.92 ,$102.60 ,$145.35 ,$119.70 ,$6.95 ,$162.45 ,$123.12 ,$124.83 ,$131.95 ,$145.35 ,$32.92 ,$131.95 ,$145.35 ,$124.83 ,$6.95 ,$32.92 ,$71.82 ,$145.35 ,$74.07 ,$157.32 ,$119.70 ,$76.30 ,$82.03 ,$104.14 ,$76.30 ,$118.16 ,$123.12 ,$119.10 ,$33.25 ,$123.12 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$123.12 ,$106.02 ,$123.12 ,$123.12 ,$102.60 
ST MARY'S HOSPITAL,31200153,88313,HC SPECIAL STAIN II (ESTERASE NONSPEC),312,1 ,$184.00 ,$92.00 ,$6.95 ,$184.00 ,$6.95 ,$184.00 ,$175.24 ,$32.92 ,$110.40 ,$156.40 ,$128.80 ,$6.95 ,$174.80 ,$132.48 ,$134.32 ,$131.95 ,$156.40 ,$32.92 ,$131.95 ,$156.40 ,$134.32 ,$6.95 ,$32.92 ,$77.28 ,$156.40 ,$74.07 ,$169.28 ,$128.80 ,$76.30 ,$82.03 ,$112.06 ,$76.30 ,$127.14 ,$132.48 ,$128.16 ,$33.25 ,$132.48 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$132.48 ,$114.08 ,$132.48 ,$132.48 ,$110.40 
ST MARY'S HOSPITAL,31200155,88313,HC HISTOCHEM CHEMICAL STAIN,312,1 ,$262.00 ,$131.00 ,$6.95 ,$262.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$157.20 ,$222.70 ,$183.40 ,$6.95 ,$248.90 ,$188.64 ,$191.26 ,$131.95 ,$222.70 ,$32.92 ,$131.95 ,$222.70 ,$191.26 ,$6.95 ,$32.92 ,$110.04 ,$222.70 ,$74.07 ,$241.04 ,$183.40 ,$76.30 ,$82.03 ,$159.56 ,$76.30 ,$181.04 ,$188.64 ,$182.48 ,$33.25 ,$188.64 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$188.64 ,$162.44 ,$188.64 ,$188.64 ,$157.20 
ST MARY'S HOSPITAL,31200156,88319,HC HISTOCHEM ENZYME STAIN,312,1 ,$246.00 ,$123.00 ,$12.70 ,"$1,433.98 ",$12.70 ,$237.04 ,$203.17 ,$637.32 ,$147.60 ,$209.10 ,$172.20 ,$12.70 ,$233.70 ,$177.12 ,$179.58 ,$228.45 ,$209.10 ,$637.32 ,$228.45 ,$209.10 ,$179.58 ,$12.70 ,$637.32 ,$103.32 ,$209.10 ,"$1,433.98 ",$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$177.12 ,$171.34 ,$643.69 ,$177.12 ,$13.46 ,$246.00 ,$246.00 ,$637.32 ,$246.00 ,$637.32 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,31200157,88319,HC HISTOCHEM ENZYME STAIN (LEUKO),312,1 ,$246.00 ,$123.00 ,$12.70 ,"$1,433.98 ",$12.70 ,$237.04 ,$203.17 ,$637.32 ,$147.60 ,$209.10 ,$172.20 ,$12.70 ,$233.70 ,$177.12 ,$179.58 ,$228.45 ,$209.10 ,$637.32 ,$228.45 ,$209.10 ,$179.58 ,$12.70 ,$637.32 ,$103.32 ,$209.10 ,"$1,433.98 ",$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$177.12 ,$171.34 ,$643.69 ,$177.12 ,$13.46 ,$246.00 ,$246.00 ,$637.32 ,$246.00 ,$637.32 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$249.00 ,$124.50 ,$11.57 ,$249.00 ,$11.57 ,$249.00 ,$249.00 ,$32.92 ,$149.40 ,$211.65 ,$174.30 ,$11.57 ,$236.55 ,$179.28 ,$181.77 ,$158.97 ,$211.65 ,$32.92 ,$158.97 ,$211.65 ,$181.77 ,$11.57 ,$32.92 ,$104.58 ,$211.65 ,$74.07 ,$229.08 ,$174.30 ,$76.30 ,$82.03 ,$151.64 ,$76.30 ,$172.06 ,$179.28 ,$173.43 ,$33.25 ,$179.28 ,$12.26 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$179.28 ,$154.38 ,$179.28 ,$179.28 ,$149.40 
ST MARY'S HOSPITAL,31200162,88321,HC CONSULT REFERRED SLIDES (MUSCLE),312,1 ,$737.00 ,$368.50 ,$11.57 ,$737.00 ,$11.57 ,$294.81 ,$252.69 ,$32.92 ,$442.20 ,$626.45 ,$515.90 ,$11.57 ,$700.15 ,$530.64 ,$538.01 ,$158.97 ,$626.45 ,$32.92 ,$158.97 ,$626.45 ,$538.01 ,$11.57 ,$32.92 ,$309.54 ,$626.45 ,$74.07 ,$678.04 ,$515.90 ,$76.30 ,$82.03 ,$448.83 ,$76.30 ,$509.27 ,$530.64 ,$513.32 ,$33.25 ,$530.64 ,$12.26 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$530.64 ,$456.94 ,$530.64 ,$530.64 ,$442.20 
ST MARY'S HOSPITAL,31200163,88321,HC CONSULT REFERRED SLIDES (MAYO),312,1 ,$515.00 ,$257.50 ,$11.57 ,$515.00 ,$11.57 ,$294.81 ,$252.69 ,$32.92 ,$309.00 ,$437.75 ,$360.50 ,$11.57 ,$489.25 ,$370.80 ,$375.95 ,$158.97 ,$437.75 ,$32.92 ,$158.97 ,$437.75 ,$375.95 ,$11.57 ,$32.92 ,$216.30 ,$437.75 ,$74.07 ,$473.80 ,$360.50 ,$76.30 ,$82.03 ,$313.64 ,$76.30 ,$355.87 ,$370.80 ,$358.70 ,$33.25 ,$370.80 ,$12.26 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$309.00 
ST MARY'S HOSPITAL,31200164,88323,HC CONSULT/SLIDE PREP,312,1 ,$414.00 ,$207.00 ,$11.57 ,$414.00 ,$11.57 ,$89.77 ,$76.94 ,$48.33 ,$248.40 ,$351.90 ,$289.80 ,$11.57 ,$393.30 ,$298.08 ,$302.22 ,$187.99 ,$351.90 ,$48.33 ,$187.99 ,$351.90 ,$302.22 ,$11.57 ,$48.33 ,$173.88 ,$351.90 ,$108.73 ,$380.88 ,$289.80 ,$140.48 ,$151.04 ,$252.13 ,$140.48 ,$286.07 ,$298.08 ,$288.35 ,$48.81 ,$298.08 ,$12.26 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$248.40 
ST MARY'S HOSPITAL,31200165,88323,HC CONSULT/SLIDE PREP (CUTAN),312,1 ,$74.00 ,$37.00 ,$11.57 ,$108.73 ,$11.57 ,$74.00 ,$74.00 ,$48.33 ,$44.40 ,$62.90 ,$51.80 ,$11.57 ,$70.30 ,$53.28 ,$54.02 ,$74.00 ,$62.90 ,$48.33 ,$74.00 ,$62.90 ,$54.02 ,$11.57 ,$48.33 ,$31.08 ,$62.90 ,$108.73 ,$68.08 ,$51.80 ,$74.00 ,$74.00 ,$45.07 ,$74.00 ,$51.13 ,$53.28 ,$51.54 ,$48.81 ,$53.28 ,$12.26 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$53.28 ,$45.88 ,$53.28 ,$53.28 ,$44.40 
ST MARY'S HOSPITAL,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 ,$145.05 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$806.40 ,$817.60 ,$259.54 ,$952.00 ,$145.05 ,$259.54 ,$952.00 ,$817.60 ,$11.57 ,$145.05 ,$470.40 ,$952.00 ,$326.35 ,"$1,030.40 ",$784.00 ,$236.35 ,$254.11 ,$682.08 ,$236.35 ,$773.92 ,$806.40 ,$780.08 ,$146.50 ,$806.40 ,$12.26 ,$59.36 ,$59.36 ,$145.05 ,$59.36 ,$145.05 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$145.05 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$806.40 ,$817.60 ,$259.54 ,$952.00 ,$145.05 ,$259.54 ,$952.00 ,$817.60 ,$11.57 ,$145.05 ,$470.40 ,$952.00 ,$326.35 ,"$1,030.40 ",$784.00 ,$236.35 ,$254.11 ,$682.08 ,$236.35 ,$773.92 ,$806.40 ,$780.08 ,$146.50 ,$806.40 ,$12.26 ,$59.36 ,$59.36 ,$145.05 ,$59.36 ,$145.05 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$145.05 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$806.40 ,$817.60 ,$259.54 ,$952.00 ,$145.05 ,$259.54 ,$952.00 ,$817.60 ,$11.57 ,$145.05 ,$470.40 ,$952.00 ,$326.35 ,"$1,030.40 ",$784.00 ,$236.35 ,$254.11 ,$682.08 ,$236.35 ,$773.92 ,$806.40 ,$780.08 ,$146.50 ,$806.40 ,$12.26 ,$59.36 ,$59.36 ,$145.05 ,$59.36 ,$145.05 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$145.05 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$806.40 ,$817.60 ,$259.54 ,$952.00 ,$145.05 ,$259.54 ,$952.00 ,$817.60 ,$11.57 ,$145.05 ,$470.40 ,$952.00 ,$326.35 ,"$1,030.40 ",$784.00 ,$236.35 ,$254.11 ,$682.08 ,$236.35 ,$773.92 ,$806.40 ,$780.08 ,$146.50 ,$806.40 ,$12.26 ,$59.36 ,$59.36 ,$145.05 ,$59.36 ,$145.05 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$145.05 ,$672.00 ,$952.00 ,$784.00 ,$11.57 ,"$1,064.00 ",$806.40 ,$817.60 ,$259.54 ,$952.00 ,$145.05 ,$259.54 ,$952.00 ,$817.60 ,$11.57 ,$145.05 ,$470.40 ,$952.00 ,$326.35 ,"$1,030.40 ",$784.00 ,$236.35 ,$254.11 ,$682.08 ,$236.35 ,$773.92 ,$806.40 ,$780.08 ,$146.50 ,$806.40 ,$12.26 ,$59.36 ,$59.36 ,$145.05 ,$59.36 ,$145.05 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$258.00 ,$129.00 ,$11.57 ,$326.35 ,$11.57 ,$111.49 ,$95.57 ,$145.05 ,$154.80 ,$219.30 ,$180.60 ,$11.57 ,$245.10 ,$185.76 ,$188.34 ,$168.62 ,$219.30 ,$145.05 ,$168.62 ,$219.30 ,$188.34 ,$11.57 ,$145.05 ,$108.36 ,$219.30 ,$326.35 ,$237.36 ,$180.60 ,$140.48 ,$151.04 ,$157.12 ,$140.48 ,$178.28 ,$185.76 ,$179.70 ,$146.50 ,$185.76 ,$12.26 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,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 ,$136.80 ,$138.70 ,$89.37 ,$161.50 , N/A ,$89.37 ,$161.50 ,$138.70 ,$11.57 , N/A ,$79.80 ,$161.50 , N/A ,$174.80 ,$133.00 ,$65.43 ,$70.35 ,$115.71 ,$65.43 ,$131.29 ,$136.80 ,$132.34 , N/A ,$136.80 ,$12.26 ,$27.72 ,$27.72 , N/A ,$27.72 , N/A ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,31200175,88333,HC CONSULT PATH SURG CYTO INIT,312,1 ,$123.00 ,$61.50 ,$11.57 ,"$1,433.98 ",$11.57 ,$84.94 ,$72.80 ,$637.32 ,$73.80 ,$104.55 ,$86.10 ,$11.57 ,$116.85 ,$88.56 ,$89.79 ,$123.00 ,$104.55 ,$637.32 ,$123.00 ,$104.55 ,$89.79 ,$11.57 ,$637.32 ,$51.66 ,$104.55 ,"$1,433.98 ",$113.16 ,$86.10 ,$123.00 ,$123.00 ,$74.91 ,$123.00 ,$84.99 ,$88.56 ,$85.67 ,$643.69 ,$88.56 ,$12.26 ,$123.00 ,$123.00 ,$637.32 ,$123.00 ,$637.32 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$125.28 ,$127.02 ,$92.99 ,$147.90 , N/A ,$92.99 ,$147.90 ,$127.02 ,$11.57 , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$65.43 ,$70.35 ,$105.97 ,$65.43 ,$120.23 ,$125.28 ,$121.19 , N/A ,$125.28 ,$12.26 ,$21.65 ,$21.65 , N/A ,$21.65 , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$104.40 
ST MARY'S HOSPITAL,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 ,$72.72 ,$73.73 ,$101.00 ,$85.85 , N/A ,$101.00 ,$85.85 ,$73.73 ,$12.70 , N/A ,$42.42 ,$85.85 , N/A ,$92.92 ,$70.70 ,$51.23 ,$61.48 ,$61.51 ,$57.38 ,$69.79 ,$72.72 ,$70.35 , N/A ,$72.72 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$197.28 ,$200.02 ,$145.06 ,$232.90 , N/A ,$145.06 ,$232.90 ,$200.02 ,$12.70 , N/A ,$115.08 ,$232.90 , N/A ,$252.08 ,$191.80 ,$138.97 ,$166.78 ,$166.87 ,$155.66 ,$189.33 ,$197.28 ,$190.84 , N/A ,$197.28 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$164.40 
ST MARY'S HOSPITAL,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 ,$246.24 ,$249.66 ,$145.06 ,$290.70 , N/A ,$145.06 ,$290.70 ,$249.66 ,$12.70 , N/A ,$143.64 ,$290.70 , N/A ,$314.64 ,$239.40 ,$173.46 ,$208.18 ,$208.28 ,$194.29 ,$236.32 ,$246.24 ,$238.20 , N/A ,$246.24 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$246.24 ,$212.04 ,$246.24 ,$246.24 ,$205.20 
ST MARY'S HOSPITAL,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 ,$195.84 ,$198.56 ,$145.06 ,$231.20 , N/A ,$145.06 ,$231.20 ,$198.56 ,$12.70 , N/A ,$114.24 ,$231.20 , N/A ,$250.24 ,$190.40 ,$137.96 ,$165.57 ,$165.65 ,$154.52 ,$187.95 ,$195.84 ,$189.45 , N/A ,$195.84 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$195.84 ,$168.64 ,$195.84 ,$195.84 ,$163.20 
ST MARY'S HOSPITAL,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 ,$263.52 ,$267.18 ,$145.06 ,$311.10 , N/A ,$145.06 ,$311.10 ,$267.18 ,$12.70 , N/A ,$153.72 ,$311.10 , N/A ,$336.72 ,$256.20 ,$185.64 ,$222.78 ,$222.89 ,$207.92 ,$252.91 ,$263.52 ,$254.92 , N/A ,$263.52 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$263.52 ,$226.92 ,$263.52 ,$263.52 ,$219.60 
ST MARY'S HOSPITAL,31200186,88346,HC IF DIRECT,312,1 ,$101.00 ,$50.50 ,$12.70 ,$637.30 ,$12.70 ,$101.00 ,$101.00 ,$283.24 ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$72.72 ,$73.73 ,$101.00 ,$85.85 ,$283.24 ,$101.00 ,$85.85 ,$73.73 ,$12.70 ,$283.24 ,$42.42 ,$85.85 ,$637.30 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$72.72 ,$70.35 ,$286.07 ,$72.72 ,$13.46 ,$101.00 ,$101.00 ,$283.24 ,$101.00 ,$283.24 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,31200187,88346,HC IF DIRECT (RENAL BX),312,1 ,$101.00 ,$50.50 ,$12.70 ,$637.30 ,$12.70 ,$101.00 ,$101.00 ,$283.24 ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$72.72 ,$73.73 ,$101.00 ,$85.85 ,$283.24 ,$101.00 ,$85.85 ,$73.73 ,$12.70 ,$283.24 ,$42.42 ,$85.85 ,$637.30 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$72.72 ,$70.35 ,$286.07 ,$72.72 ,$13.46 ,$101.00 ,$101.00 ,$283.24 ,$101.00 ,$283.24 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,31200188,88346,HC IF DIRECT (CUTANEOUS),312,1 ,$101.00 ,$50.50 ,$12.70 ,$637.30 ,$12.70 ,$101.00 ,$101.00 ,$283.24 ,$60.60 ,$85.85 ,$70.70 ,$12.70 ,$95.95 ,$72.72 ,$73.73 ,$101.00 ,$85.85 ,$283.24 ,$101.00 ,$85.85 ,$73.73 ,$12.70 ,$283.24 ,$42.42 ,$85.85 ,$637.30 ,$92.92 ,$70.70 ,$101.00 ,$101.00 ,$61.51 ,$101.00 ,$69.79 ,$72.72 ,$70.35 ,$286.07 ,$72.72 ,$13.46 ,$101.00 ,$101.00 ,$283.24 ,$101.00 ,$283.24 ,$72.72 ,$62.62 ,$72.72 ,$72.72 ,$60.60 
ST MARY'S HOSPITAL,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 ,$637.32 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$12.70 ,"$3,192.00 ","$2,419.20 ","$2,452.80 ",$742.65 ,"$2,856.00 ",$637.32 ,$742.65 ,"$2,856.00 ","$2,452.80 ",$12.70 ,$637.32 ,"$1,411.20 ","$2,856.00 ","$1,433.98 ","$3,091.20 ","$2,352.00 ",$690.91 ,$742.83 ,"$2,046.24 ",$690.91 ,"$2,321.76 ","$2,419.20 ","$2,340.24 ",$643.69 ,"$2,419.20 ",$13.46 ,$753.84 ,$753.84 ,$637.32 ,$753.84 ,$637.32 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,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 ,$637.32 ,$981.00 ,"$1,389.75 ","$1,144.50 ",$12.70 ,"$1,553.25 ","$1,177.20 ","$1,193.55 ",$742.65 ,"$1,389.75 ",$637.32 ,$742.65 ,"$1,389.75 ","$1,193.55 ",$12.70 ,$637.32 ,$686.70 ,"$1,389.75 ","$1,433.98 ","$1,504.20 ","$1,144.50 ",$690.91 ,$742.83 ,$995.72 ,$690.91 ,"$1,129.79 ","$1,177.20 ","$1,138.78 ",$643.69 ,"$1,177.20 ",$13.46 ,$753.84 ,$753.84 ,$637.32 ,$753.84 ,$637.32 ,"$1,177.20 ","$1,013.70 ","$1,177.20 ","$1,177.20 ",$981.00 
ST MARY'S HOSPITAL,31200191,88360,HC MORPHO ANLYS TUMOR MAN (PR),312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$145.05 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$290.16 ,$294.19 ,$198.32 ,$342.55 ,$145.05 ,$198.32 ,$342.55 ,$294.19 ,$12.70 ,$145.05 ,$169.26 ,$342.55 ,$326.35 ,$370.76 ,$282.10 ,$140.48 ,$151.04 ,$245.43 ,$140.48 ,$278.47 ,$290.16 ,$280.69 ,$146.50 ,$290.16 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,31200192,88360,HC MORPHO ANLYS TUMOR MAN (ER),312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$145.05 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$290.16 ,$294.19 ,$198.32 ,$342.55 ,$145.05 ,$198.32 ,$342.55 ,$294.19 ,$12.70 ,$145.05 ,$169.26 ,$342.55 ,$326.35 ,$370.76 ,$282.10 ,$140.48 ,$151.04 ,$245.43 ,$140.48 ,$278.47 ,$290.16 ,$280.69 ,$146.50 ,$290.16 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$145.05 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$290.16 ,$294.19 ,$198.32 ,$342.55 ,$145.05 ,$198.32 ,$342.55 ,$294.19 ,$12.70 ,$145.05 ,$169.26 ,$342.55 ,$326.35 ,$370.76 ,$282.10 ,$140.48 ,$151.04 ,$245.43 ,$140.48 ,$278.47 ,$290.16 ,$280.69 ,$146.50 ,$290.16 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,31200194,88360,HC MORPHO ANLYS TUMOR MAN (HER2),312,1 ,$403.00 ,$201.50 ,$12.70 ,$403.00 ,$12.70 ,$285.32 ,$244.56 ,$145.05 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$290.16 ,$294.19 ,$198.32 ,$342.55 ,$145.05 ,$198.32 ,$342.55 ,$294.19 ,$12.70 ,$145.05 ,$169.26 ,$342.55 ,$326.35 ,$370.76 ,$282.10 ,$140.48 ,$151.04 ,$245.43 ,$140.48 ,$278.47 ,$290.16 ,$280.69 ,$146.50 ,$290.16 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,31200201,88360,HC MORPHO ANLYS TUMOR MAN (DCMH),312,1 ,$319.00 ,$159.50 ,$12.70 ,$326.35 ,$12.70 ,$285.32 ,$244.56 ,$145.05 ,$191.40 ,$271.15 ,$223.30 ,$12.70 ,$303.05 ,$229.68 ,$232.87 ,$198.32 ,$271.15 ,$145.05 ,$198.32 ,$271.15 ,$232.87 ,$12.70 ,$145.05 ,$133.98 ,$271.15 ,$326.35 ,$293.48 ,$223.30 ,$140.48 ,$151.04 ,$194.27 ,$140.48 ,$220.43 ,$229.68 ,$222.18 ,$146.50 ,$229.68 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$229.68 ,$197.78 ,$229.68 ,$229.68 ,$191.40 
ST MARY'S HOSPITAL,31200202,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$479.00 ,$239.50 ,$12.70 ,$637.30 ,$12.70 ,$288.94 ,$247.66 ,$283.24 ,$287.40 ,$407.15 ,$335.30 ,$12.70 ,$455.05 ,$344.88 ,$349.67 ,$198.10 ,$407.15 ,$283.24 ,$198.10 ,$407.15 ,$349.67 ,$12.70 ,$283.24 ,$201.18 ,$407.15 ,$637.30 ,$440.68 ,$335.30 ,$140.48 ,$151.04 ,$291.71 ,$140.48 ,$330.99 ,$344.88 ,$333.62 ,$286.07 ,$344.88 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$344.88 ,$296.98 ,$344.88 ,$344.88 ,$287.40 
ST MARY'S HOSPITAL,31200203,88363,HC EXAM ARCHIVE TISS MOL ANLYS,312,1 ,$125.00 ,$62.50 ,$3.02 ,$125.00 ,$3.02 ,$69.27 ,$59.38 ,$24.03 ,$75.00 ,$106.25 ,$87.50 ,$3.02 ,$118.75 ,$90.00 ,$91.25 ,$37.64 ,$106.25 ,$24.03 ,$37.64 ,$106.25 ,$91.25 ,$3.02 ,$24.03 ,$52.50 ,$106.25 ,$54.06 ,$115.00 ,$87.50 ,$76.30 ,$82.03 ,$76.13 ,$76.30 ,$86.38 ,$90.00 ,$87.06 ,$24.27 ,$90.00 ,$3.20 ,$27.59 ,$27.59 ,$24.03 ,$27.59 ,$24.03 ,$90.00 ,$77.50 ,$90.00 ,$90.00 ,$75.00 
ST MARY'S HOSPITAL,31200204,88365,HC IN SITU HYBRID (FISH),312,1 ,$557.00 ,$278.50 ,$12.70 ,$557.00 ,$12.70 ,$448.28 ,$384.24 ,$145.05 ,$334.20 ,$473.45 ,$389.90 ,$12.70 ,$529.15 ,$401.04 ,$406.61 ,$294.10 ,$473.45 ,$145.05 ,$294.10 ,$473.45 ,$406.61 ,$12.70 ,$145.05 ,$233.94 ,$473.45 ,$326.35 ,$512.44 ,$389.90 ,$140.48 ,$151.04 ,$339.21 ,$140.48 ,$384.89 ,$401.04 ,$387.95 ,$146.50 ,$401.04 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$334.20 
ST MARY'S HOSPITAL,31200207,88365,HC IN SITU HYBRID (FISH) HER2,312,1 ,$557.00 ,$278.50 ,$12.70 ,$557.00 ,$12.70 ,$448.28 ,$384.24 ,$145.05 ,$334.20 ,$473.45 ,$389.90 ,$12.70 ,$529.15 ,$401.04 ,$406.61 ,$294.10 ,$473.45 ,$145.05 ,$294.10 ,$473.45 ,$406.61 ,$12.70 ,$145.05 ,$233.94 ,$473.45 ,$326.35 ,$512.44 ,$389.90 ,$140.48 ,$151.04 ,$339.21 ,$140.48 ,$384.89 ,$401.04 ,$387.95 ,$146.50 ,$401.04 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$334.20 
ST MARY'S HOSPITAL,31200208,88368,HC MORPHO ANLYS IN SITU HYBRID,312,1 ,$414.00 ,$207.00 ,$12.70 ,$637.30 ,$12.70 ,$286.53 ,$245.59 ,$283.24 ,$248.40 ,$351.90 ,$289.80 ,$12.70 ,$393.30 ,$298.08 ,$302.22 ,$222.99 ,$351.90 ,$283.24 ,$222.99 ,$351.90 ,$302.22 ,$12.70 ,$283.24 ,$173.88 ,$351.90 ,$637.30 ,$380.88 ,$289.80 ,$140.48 ,$151.04 ,$252.13 ,$140.48 ,$286.07 ,$298.08 ,$288.35 ,$286.07 ,$298.08 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$248.40 
ST MARY'S HOSPITAL,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 ",$48.33 ,"$1,233.00 ","$1,746.75 ","$1,438.50 ",$3.02 ,"$1,952.25 ","$1,479.60 ","$1,500.15 ", N/A ,"$1,746.75 ",$48.33 , N/A ,"$1,746.75 ","$1,500.15 ",$3.02 ,$48.33 ,$863.10 ,"$1,746.75 ",$108.73 ,"$1,890.60 ","$1,438.50 ",$76.30 ,$82.03 ,"$1,251.50 ",$76.30 ,"$1,420.01 ","$1,479.60 ","$1,431.31 ",$48.81 ,"$1,479.60 ",$3.20 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,"$1,479.60 ","$1,274.10 ","$1,479.60 ","$1,479.60 ","$1,233.00 "
ST MARY'S HOSPITAL,31200212,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$521.00 ,$260.50 ,$12.70 ,$637.30 ,$12.70 ,$337.03 ,$337.03 ,$283.24 ,$312.60 ,$442.85 ,$364.70 ,$12.70 ,$494.95 ,$375.12 ,$380.33 ,$521.00 ,$442.85 ,$283.24 ,$521.00 ,$442.85 ,$380.33 ,$12.70 ,$283.24 ,$218.82 ,$442.85 ,$637.30 ,$479.32 ,$364.70 ,$521.00 ,$521.00 ,$317.29 ,$521.00 ,$360.01 ,$375.12 ,$362.88 ,$286.07 ,$375.12 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$375.12 ,$323.02 ,$375.12 ,$375.12 ,$312.60 
ST MARY'S HOSPITAL,31200213,88313,HC SPECIAL STAIN II (BM CLOT),312,1 ,$217.00 ,$108.50 ,$6.95 ,$217.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$130.20 ,$184.45 ,$151.90 ,$6.95 ,$206.15 ,$156.24 ,$158.41 ,$131.95 ,$184.45 ,$32.92 ,$131.95 ,$184.45 ,$158.41 ,$6.95 ,$32.92 ,$91.14 ,$184.45 ,$74.07 ,$199.64 ,$151.90 ,$76.30 ,$82.03 ,$132.15 ,$76.30 ,$149.95 ,$156.24 ,$151.14 ,$33.25 ,$156.24 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$156.24 ,$134.54 ,$156.24 ,$156.24 ,$130.20 
ST MARY'S HOSPITAL,31200214,88348,HC ELECTROMICROSCOPE SCAN,312,1 ,"$1,120.00 ",$560.00 ,$12.70 ,"$1,433.98 ",$12.70 ,$954.61 ,$818.24 ,$637.32 ,$672.00 ,$952.00 ,$784.00 ,$12.70 ,"$1,064.00 ",$806.40 ,$817.60 ,$742.65 ,$952.00 ,$637.32 ,$742.65 ,$952.00 ,$817.60 ,$12.70 ,$637.32 ,$470.40 ,$952.00 ,"$1,433.98 ","$1,030.40 ",$784.00 ,$690.91 ,$742.83 ,$682.08 ,$690.91 ,$773.92 ,$806.40 ,$780.08 ,$643.69 ,$806.40 ,$13.46 ,$753.84 ,$753.84 ,$637.32 ,$753.84 ,$637.32 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$145.06 ,$314.50 , N/A ,$145.06 ,$314.50 ,$270.10 ,$12.70 , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$210.20 ,$255.67 ,$266.40 ,$257.71 , N/A ,$266.40 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$145.06 ,$314.50 , N/A ,$145.06 ,$314.50 ,$270.10 ,$12.70 , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$210.20 ,$255.67 ,$266.40 ,$257.71 , N/A ,$266.40 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$145.06 ,$314.50 , N/A ,$145.06 ,$314.50 ,$270.10 ,$12.70 , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$210.20 ,$255.67 ,$266.40 ,$257.71 , N/A ,$266.40 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$145.06 ,$314.50 , N/A ,$145.06 ,$314.50 ,$270.10 ,$12.70 , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$210.20 ,$255.67 ,$266.40 ,$257.71 , N/A ,$266.40 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$291.00 ,$145.50 ,$12.70 ,$326.35 ,$12.70 ,$238.24 ,$204.21 ,$145.05 ,$174.60 ,$247.35 ,$203.70 ,$12.70 ,$276.45 ,$209.52 ,$212.43 ,$165.67 ,$247.35 ,$145.05 ,$165.67 ,$247.35 ,$212.43 ,$12.70 ,$145.05 ,$122.22 ,$247.35 ,$326.35 ,$267.72 ,$203.70 ,$139.84 ,$150.35 ,$177.22 ,$139.84 ,$201.08 ,$209.52 ,$202.68 ,$146.50 ,$209.52 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$266.40 ,$270.10 ,$145.06 ,$314.50 , N/A ,$145.06 ,$314.50 ,$270.10 ,$12.70 , N/A ,$155.40 ,$314.50 , N/A ,$340.40 ,$259.00 ,$187.66 ,$225.22 ,$225.33 ,$210.20 ,$255.67 ,$266.40 ,$257.71 , N/A ,$266.40 ,$13.46 ,$77.52 ,$77.52 , N/A ,$77.52 , N/A ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,31200226,88323,HC CONSULT SLIDE PREP LV II,312,1 ,$448.00 ,$224.00 ,$11.57 ,$448.00 ,$11.57 ,$89.77 ,$76.94 ,$48.33 ,$268.80 ,$380.80 ,$313.60 ,$11.57 ,$425.60 ,$322.56 ,$327.04 ,$187.99 ,$380.80 ,$48.33 ,$187.99 ,$380.80 ,$327.04 ,$11.57 ,$48.33 ,$188.16 ,$380.80 ,$108.73 ,$412.16 ,$313.60 ,$140.48 ,$151.04 ,$272.83 ,$140.48 ,$309.57 ,$322.56 ,$312.03 ,$48.81 ,$322.56 ,$12.26 ,$59.36 ,$59.36 ,$48.33 ,$59.36 ,$48.33 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 , N/A ,$152.15 , N/A , N/A ,$152.15 ,$130.67 ,$13.61 , N/A ,$75.18 ,$152.15 ,$107.40 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$101.69 ,$123.69 ,$128.88 ,$124.67 , N/A ,$128.88 ,$14.43 ,$89.50 ,$89.50 , N/A ,$89.50 , N/A ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,31200229,88368,HC I KAPPA ISH,312,1 ,$896.00 ,$448.00 ,$12.70 ,$896.00 ,$12.70 ,$286.53 ,$245.59 ,$283.24 ,$537.60 ,$761.60 ,$627.20 ,$12.70 ,$851.20 ,$645.12 ,$654.08 ,$222.99 ,$761.60 ,$283.24 ,$222.99 ,$761.60 ,$654.08 ,$12.70 ,$283.24 ,$376.32 ,$761.60 ,$637.30 ,$824.32 ,$627.20 ,$140.48 ,$151.04 ,$545.66 ,$140.48 ,$619.14 ,$645.12 ,$624.06 ,$286.07 ,$645.12 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,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 ,$290.16 ,$294.19 ,$188.94 ,$342.55 , N/A ,$188.94 ,$342.55 ,$294.19 ,$12.70 , N/A ,$169.26 ,$342.55 , N/A ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$228.94 ,$278.47 ,$290.16 ,$280.69 , N/A ,$290.16 ,$13.46 ,$99.18 ,$99.18 , N/A ,$99.18 , N/A ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,31200231,88313,HC PERIODIC ACID SCHIFF STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200232,88313,HC MASSONS TRICHROME STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200233,88313,HC JONES METH SILVER STAIN II,312,1 ,$291.00 ,$145.50 ,$6.95 ,$291.00 ,$6.95 ,$204.44 ,$175.24 ,$32.92 ,$174.60 ,$247.35 ,$203.70 ,$6.95 ,$276.45 ,$209.52 ,$212.43 ,$131.95 ,$247.35 ,$32.92 ,$131.95 ,$247.35 ,$212.43 ,$6.95 ,$32.92 ,$122.22 ,$247.35 ,$74.07 ,$267.72 ,$203.70 ,$76.30 ,$82.03 ,$177.22 ,$76.30 ,$201.08 ,$209.52 ,$202.68 ,$33.25 ,$209.52 ,$7.37 ,$40.12 ,$40.12 ,$32.92 ,$40.12 ,$32.92 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,31200234,88346,HC IGG1 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$637.30 ,$12.70 ,$153.00 ,$153.00 ,$283.24 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$110.16 ,$111.69 ,$153.00 ,$130.05 ,$283.24 ,$153.00 ,$130.05 ,$111.69 ,$12.70 ,$283.24 ,$64.26 ,$130.05 ,$637.30 ,$140.76 ,$107.10 ,$140.48 ,$151.04 ,$93.18 ,$140.48 ,$105.72 ,$110.16 ,$106.56 ,$286.07 ,$110.16 ,$13.46 ,$153.00 ,$153.00 ,$283.24 ,$153.00 ,$283.24 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,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 ,$201.60 ,$204.40 ,$280.00 ,$238.00 , N/A ,$280.00 ,$238.00 ,$204.40 ,$6.95 , N/A ,$117.60 ,$238.00 , N/A ,$257.60 ,$196.00 ,$280.00 ,$280.00 ,$170.52 ,$280.00 ,$193.48 ,$201.60 ,$195.02 , N/A ,$201.60 ,$7.37 ,$188.39 ,$188.39 , N/A ,$188.39 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,31200236,88346,HC IGG3 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$637.30 ,$12.70 ,$153.00 ,$153.00 ,$283.24 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$110.16 ,$111.69 ,$153.00 ,$130.05 ,$283.24 ,$153.00 ,$130.05 ,$111.69 ,$12.70 ,$283.24 ,$64.26 ,$130.05 ,$637.30 ,$140.76 ,$107.10 ,$140.48 ,$151.04 ,$93.18 ,$140.48 ,$105.72 ,$110.16 ,$106.56 ,$286.07 ,$110.16 ,$13.46 ,$153.00 ,$153.00 ,$283.24 ,$153.00 ,$283.24 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,31200237,88346,HC IGG4 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$637.30 ,$12.70 ,$153.00 ,$153.00 ,$283.24 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$110.16 ,$111.69 ,$153.00 ,$130.05 ,$283.24 ,$153.00 ,$130.05 ,$111.69 ,$12.70 ,$283.24 ,$64.26 ,$130.05 ,$637.30 ,$140.76 ,$107.10 ,$140.48 ,$151.04 ,$93.18 ,$140.48 ,$105.72 ,$110.16 ,$106.56 ,$286.07 ,$110.16 ,$13.46 ,$153.00 ,$153.00 ,$283.24 ,$153.00 ,$283.24 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,31200238,88346,HC IGG2 IF,312,1 ,$153.00 ,$76.50 ,$12.70 ,$637.30 ,$12.70 ,$153.00 ,$153.00 ,$283.24 ,$91.80 ,$130.05 ,$107.10 ,$12.70 ,$145.35 ,$110.16 ,$111.69 ,$153.00 ,$130.05 ,$283.24 ,$153.00 ,$130.05 ,$111.69 ,$12.70 ,$283.24 ,$64.26 ,$130.05 ,$637.30 ,$140.76 ,$107.10 ,$140.48 ,$151.04 ,$93.18 ,$140.48 ,$105.72 ,$110.16 ,$106.56 ,$286.07 ,$110.16 ,$13.46 ,$153.00 ,$153.00 ,$283.24 ,$153.00 ,$283.24 ,$110.16 ,$94.86 ,$110.16 ,$110.16 ,$91.80 
ST MARY'S HOSPITAL,31200239,88368,HC HER2 DUAL ISH,312,1 ,$896.00 ,$448.00 ,$12.70 ,$896.00 ,$12.70 ,$286.53 ,$245.59 ,$283.24 ,$537.60 ,$761.60 ,$627.20 ,$12.70 ,$851.20 ,$645.12 ,$654.08 ,$222.99 ,$761.60 ,$283.24 ,$222.99 ,$761.60 ,$654.08 ,$12.70 ,$283.24 ,$376.32 ,$761.60 ,$637.30 ,$824.32 ,$627.20 ,$140.48 ,$151.04 ,$545.66 ,$140.48 ,$619.14 ,$645.12 ,$624.06 ,$286.07 ,$645.12 ,$13.46 ,$340.09 ,$340.09 ,$283.24 ,$340.09 ,$283.24 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,31200240,88365,HC EPSTEIN BARR ISH,312,1 ,$347.00 ,$173.50 ,$12.70 ,$347.00 ,$12.70 ,$347.00 ,$347.00 ,$145.05 ,$208.20 ,$294.95 ,$242.90 ,$12.70 ,$329.65 ,$249.84 ,$253.31 ,$294.10 ,$294.95 ,$145.05 ,$294.10 ,$294.95 ,$253.31 ,$12.70 ,$145.05 ,$145.74 ,$294.95 ,$326.35 ,$319.24 ,$242.90 ,$140.48 ,$151.04 ,$211.32 ,$140.48 ,$239.78 ,$249.84 ,$241.69 ,$146.50 ,$249.84 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$208.20 
ST MARY'S HOSPITAL,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 ,$290.16 ,$294.19 ,$188.94 ,$342.55 , N/A ,$188.94 ,$342.55 ,$294.19 ,$12.70 , N/A ,$169.26 ,$342.55 , N/A ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$228.94 ,$278.47 ,$290.16 ,$280.69 , N/A ,$290.16 ,$13.46 ,$99.18 ,$99.18 , N/A ,$99.18 , N/A ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,31200242,88368,HC ISH,312,1 ,$311.00 ,$155.50 ,$12.70 ,$637.30 ,$12.70 ,$286.53 ,$245.59 ,$283.24 ,$186.60 ,$264.35 ,$217.70 ,$12.70 ,$295.45 ,$223.92 ,$227.03 ,$222.99 ,$264.35 ,$283.24 ,$222.99 ,$264.35 ,$227.03 ,$12.70 ,$283.24 ,$130.62 ,$264.35 ,$637.30 ,$286.12 ,$217.70 ,$140.48 ,$151.04 ,$189.40 ,$140.48 ,$214.90 ,$223.92 ,$216.61 ,$286.07 ,$223.92 ,$13.46 ,$311.00 ,$311.00 ,$283.24 ,$311.00 ,$283.24 ,$223.92 ,$192.82 ,$223.92 ,$223.92 ,$186.60 
ST MARY'S HOSPITAL,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 ,$223.92 ,$227.03 ,$188.94 ,$264.35 , N/A ,$188.94 ,$264.35 ,$227.03 ,$12.70 , N/A ,$130.62 ,$264.35 , N/A ,$286.12 ,$217.70 ,$157.74 ,$189.31 ,$189.40 ,$176.68 ,$214.90 ,$223.92 ,$216.61 , N/A ,$223.92 ,$13.46 ,$99.18 ,$99.18 , N/A ,$99.18 , N/A ,$223.92 ,$192.82 ,$223.92 ,$223.92 ,$186.60 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$193.56 ,$199.75 , N/A ,$193.56 ,$199.75 ,$171.55 ,$12.70 , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$133.50 ,$162.39 ,$169.20 ,$163.68 , N/A ,$169.20 ,$13.46 ,$76.66 ,$76.66 , N/A ,$76.66 , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$123.00 ,$104.55 , N/A ,$123.00 ,$104.55 ,$89.79 ,$12.70 , N/A ,$51.66 ,$104.55 , N/A ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$69.88 ,$84.99 ,$88.56 ,$85.67 , N/A ,$88.56 ,$13.46 ,$76.66 ,$76.66 , N/A ,$76.66 , N/A ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$401.04 ,$406.61 ,$226.07 ,$473.45 , N/A ,$226.07 ,$473.45 ,$406.61 ,$12.70 , N/A ,$233.94 ,$473.45 , N/A ,$512.44 ,$389.90 ,$282.51 ,$339.05 ,$339.21 ,$316.43 ,$384.89 ,$401.04 ,$387.95 , N/A ,$401.04 ,$13.46 ,$125.16 ,$125.16 , N/A ,$125.16 , N/A ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$334.20 
ST MARY'S HOSPITAL,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 ,$145.05 ,$312.60 ,$442.85 ,$364.70 ,$12.70 ,$494.95 ,$375.12 ,$380.33 ,$521.00 ,$442.85 ,$145.05 ,$521.00 ,$442.85 ,$380.33 ,$12.70 ,$145.05 ,$218.82 ,$442.85 ,$326.35 ,$479.32 ,$364.70 ,$521.00 ,$521.00 ,$317.29 ,$521.00 ,$360.01 ,$375.12 ,$362.88 ,$146.50 ,$375.12 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$375.12 ,$323.02 ,$375.12 ,$375.12 ,$312.60 
ST MARY'S HOSPITAL,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 ,$145.05 ,$241.80 ,$342.55 ,$282.10 ,$12.70 ,$382.85 ,$290.16 ,$294.19 ,$198.32 ,$342.55 ,$145.05 ,$198.32 ,$342.55 ,$294.19 ,$12.70 ,$145.05 ,$169.26 ,$342.55 ,$326.35 ,$370.76 ,$282.10 ,$140.48 ,$151.04 ,$245.43 ,$140.48 ,$278.47 ,$290.16 ,$280.69 ,$146.50 ,$290.16 ,$13.46 ,$172.20 ,$172.20 ,$145.05 ,$172.20 ,$145.05 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$123.00 ,$104.55 , N/A ,$123.00 ,$104.55 ,$89.79 ,$6.95 , N/A ,$51.66 ,$104.55 , N/A ,$113.16 ,$86.10 ,$123.00 ,$123.00 ,$74.91 ,$123.00 ,$84.99 ,$88.56 ,$85.67 , N/A ,$88.56 ,$7.37 ,$123.00 ,$123.00 , N/A ,$123.00 , N/A ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,32000003,22510,HC VERTEBROPLASTY INJ PERC THOR,320,1 ,"$5,500.00 ","$2,750.00 ",$451.00 ,"$8,056.00 ","$1,461.70 ","$3,557.95 ","$3,557.95 ","$2,754.14 ","$3,300.00 ","$4,675.00 ","$3,850.00 ","$1,461.70 ","$5,225.00 ","$3,960.00 ","$4,015.00 ",$832.05 ,"$4,675.00 ","$2,754.14 ",$832.05 ,"$4,675.00 ","$4,015.00 ","$1,461.70 ","$2,754.14 ","$2,310.00 ","$4,675.00 ","$6,196.83 ","$5,060.00 ","$3,850.00 ","$5,993.67 ","$8,056.00 ","$3,349.50 ","$7,491.83 ","$3,800.50 ","$3,960.00 ","$3,830.75 ","$2,781.68 ","$3,960.00 ","$1,549.40 ",$451.00 ,$451.00 ,"$2,754.14 ",$451.00 ,"$2,754.14 ","$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$3,300.00 "
ST MARY'S HOSPITAL,32000004,22511,HC VERTEBROPLASTY INJ PERC LUMBAR,320,1 ,"$5,500.00 ","$2,750.00 ",$451.00 ,"$8,056.00 ","$1,461.70 ","$3,557.95 ","$3,557.95 ","$2,754.14 ","$3,300.00 ","$4,675.00 ","$3,850.00 ","$1,461.70 ","$5,225.00 ","$3,960.00 ","$4,015.00 ",$782.75 ,"$4,675.00 ","$2,754.14 ",$782.75 ,"$4,675.00 ","$4,015.00 ","$1,461.70 ","$2,754.14 ","$2,310.00 ","$4,675.00 ","$6,196.83 ","$5,060.00 ","$3,850.00 ","$5,993.67 ","$8,056.00 ","$3,349.50 ","$7,491.83 ","$3,800.50 ","$3,960.00 ","$3,830.75 ","$2,781.68 ","$3,960.00 ","$1,549.40 ",$451.00 ,$451.00 ,"$2,754.14 ",$451.00 ,"$2,754.14 ","$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$3,300.00 "
ST MARY'S HOSPITAL,32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$5,500.00 ","$2,750.00 ",$392.10 ,"$8,056.00 ","$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 ","$3,960.00 ","$4,015.00 ",$392.10 ,"$4,675.00 ", N/A ,$392.10 ,"$4,675.00 ","$4,015.00 ","$1,461.70 ", N/A ,"$2,310.00 ","$4,675.00 ", N/A ,"$5,060.00 ","$3,850.00 ","$5,993.67 ","$8,056.00 ","$3,349.50 ","$7,491.83 ","$3,800.50 ","$3,960.00 ","$3,830.75 ", N/A ,"$3,960.00 ","$1,549.40 ",$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$3,300.00 "
ST MARY'S HOSPITAL,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 ,$713.52 ,$723.43 ,$97.56 ,$842.35 , N/A ,$97.56 ,$842.35 ,$723.43 ,$142.69 , N/A ,$416.22 ,$842.35 , N/A ,$911.72 ,$693.70 ,$991.00 ,$991.00 ,$603.52 ,$991.00 ,$684.78 ,$713.52 ,$690.23 , N/A ,$713.52 ,$151.25 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$713.52 ,$614.42 ,$713.52 ,$713.52 ,$594.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$97.56 ,$561.85 , N/A ,$97.56 ,$561.85 ,$482.53 ,$95.13 , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$129.54 ,$561.85 , N/A ,$129.54 ,$561.85 ,$482.53 ,$95.13 , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$142.80 ,$561.85 , N/A ,$142.80 ,$561.85 ,$482.53 ,$95.13 , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$132.16 ,$561.85 , N/A ,$132.16 ,$561.85 ,$482.53 ,$95.13 , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$158.24 ,$561.85 , N/A ,$158.24 ,$561.85 ,$482.53 ,$95.13 , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$686.88 ,$696.42 ,$76.77 ,$810.90 , N/A ,$76.77 ,$810.90 ,$696.42 ,$142.69 , N/A ,$400.68 ,$810.90 , N/A ,$877.68 ,$667.80 ,$954.00 ,$954.00 ,$580.99 ,$954.00 ,$659.21 ,$686.88 ,$664.46 , N/A ,$686.88 ,$151.25 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$686.88 ,$591.48 ,$686.88 ,$686.88 ,$572.40 
ST MARY'S HOSPITAL,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 ,$457.92 ,$464.28 ,$76.77 ,$540.60 , N/A ,$76.77 ,$540.60 ,$464.28 ,$95.13 , N/A ,$267.12 ,$540.60 , N/A ,$585.12 ,$445.20 ,$636.00 ,$636.00 ,$387.32 ,$636.00 ,$439.48 ,$457.92 ,$442.97 , N/A ,$457.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$381.60 
ST MARY'S HOSPITAL,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 ,$475.92 ,$482.53 ,$98.69 ,$561.85 , N/A ,$98.69 ,$561.85 ,$482.53 ,$95.13 , N/A ,$277.62 ,$561.85 , N/A ,$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 , N/A ,$475.92 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,32000017,28899,HC UNLISTED PROCEDURE TOE OR FOOT,361,1 ,$590.00 ,$295.00 ,$139.53 ,$590.00 ,$139.53 ,$590.00 ,$590.00 ,$200.45 ,$354.00 ,$501.50 ,$413.00 ,$139.53 ,$560.50 ,$424.80 ,$430.70 ,$590.00 ,$501.50 ,$200.45 ,$590.00 ,$501.50 ,$430.70 ,$139.53 ,$200.45 ,$590.00 ,$501.50 ,$451.00 ,$542.80 ,$413.00 , N/A , N/A ,$359.31 , N/A ,$407.69 ,$424.80 ,$410.94 ,$202.45 ,$424.80 ,$147.90 ,$590.00 ,$590.00 ,$200.45 ,$590.00 ,$200.45 ,$424.80 ,$365.80 ,$424.80 ,$424.80 ,$354.00 
ST MARY'S HOSPITAL,32000018,32550,HC INSERT CATH PLEURAL INDWELL W/,320,1 ,"$4,202.00 ","$2,101.00 ",$299.20 ,"$6,961.86 ",$299.20 ,"$2,718.27 ","$2,718.27 ","$3,094.16 ","$2,521.20 ","$3,571.70 ","$2,941.40 ",$299.20 ,"$3,991.90 ","$3,025.44 ","$3,067.46 ",$391.67 ,"$3,571.70 ","$3,094.16 ",$391.67 ,"$3,571.70 ","$3,067.46 ",$299.20 ,"$3,094.16 ","$1,764.84 ","$3,571.70 ","$6,961.86 ","$3,865.84 ","$2,941.40 ","$1,489.75 ","$2,002.44 ","$2,559.02 ","$1,862.71 ","$2,903.58 ","$3,025.44 ","$2,926.69 ","$3,125.10 ","$3,025.44 ",$317.15 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$3,025.44 ","$2,605.24 ","$3,025.44 ","$3,025.44 ","$2,521.20 "
ST MARY'S HOSPITAL,32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,185.00 ",$592.50 ,$295.38 ,"$3,077.03 ",$299.20 ,$766.58 ,$766.58 ,"$1,367.57 ",$711.00 ,"$1,007.25 ",$829.50 ,$299.20 ,"$1,125.75 ",$853.20 ,$865.05 ,$295.38 ,"$1,007.25 ","$1,367.57 ",$295.38 ,"$1,007.25 ",$865.05 ,$299.20 ,"$1,367.57 ",$497.70 ,"$1,007.25 ","$3,077.03 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,"$1,381.25 ",$853.20 ,$317.15 ,$451.00 ,$451.00 ,"$1,367.57 ",$451.00 ,"$1,367.57 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,32000020,32552,HC REMOVAL TUNNELED PLEURAL CATH,320,1 ,"$1,401.00 ",$700.50 ,$299.20 ,"$1,401.00 ",$299.20 ,$906.31 ,$906.31 ,$525.67 ,$840.60 ,"$1,190.85 ",$980.70 ,$299.20 ,"$1,330.95 ","$1,008.72 ","$1,022.73 ",$303.11 ,"$1,190.85 ",$525.67 ,$303.11 ,"$1,190.85 ","$1,022.73 ",$299.20 ,$525.67 ,$588.42 ,"$1,190.85 ","$1,182.77 ","$1,288.92 ",$980.70 ,"$1,401.00 ","$1,401.00 ",$853.21 ,"$1,401.00 ",$968.09 ,"$1,008.72 ",$975.80 ,$530.93 ,"$1,008.72 ",$317.15 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,"$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ",$840.60 
ST MARY'S HOSPITAL,32000021,32561,HC INSTILL FIBRO CHEST TUBE INIT,320,1 ,$870.00 ,$435.00 ,$131.59 ,"$1,182.77 ",$299.20 ,$562.80 ,$562.80 ,$525.67 ,$522.00 ,$739.50 ,$609.00 ,$299.20 ,$826.50 ,$626.40 ,$635.10 ,$131.59 ,$739.50 ,$525.67 ,$131.59 ,$739.50 ,$635.10 ,$299.20 ,$525.67 ,$365.40 ,$739.50 ,"$1,182.77 ",$800.40 ,$609.00 ,$870.00 ,$870.00 ,$529.83 ,$870.00 ,$601.17 ,$626.40 ,$605.96 ,$530.93 ,$626.40 ,$317.15 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,$626.40 ,$539.40 ,$626.40 ,$626.40 ,$522.00 
ST MARY'S HOSPITAL,32000022,32562,HC INSTILL FIBRO CHEST TUBE SUBSQ DAY,320,1 ,$870.00 ,$435.00 ,$116.54 ,"$1,182.77 ",$299.20 ,$562.80 ,$562.80 ,$525.67 ,$522.00 ,$739.50 ,$609.00 ,$299.20 ,$826.50 ,$626.40 ,$635.10 ,$116.54 ,$739.50 ,$525.67 ,$116.54 ,$739.50 ,$635.10 ,$299.20 ,$525.67 ,$365.40 ,$739.50 ,"$1,182.77 ",$800.40 ,$609.00 ,$870.00 ,$870.00 ,$529.83 ,$870.00 ,$601.17 ,$626.40 ,$605.96 ,$530.93 ,$626.40 ,$317.15 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,$626.40 ,$539.40 ,$626.40 ,$626.40 ,$522.00 
ST MARY'S HOSPITAL,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 ,$100.08 ,$101.47 ,$17.65 ,$118.15 , N/A ,$17.65 ,$118.15 ,$101.47 ,$18.43 , N/A ,$58.38 ,$118.15 , N/A ,$127.88 ,$97.30 ,$139.00 ,$139.00 ,$84.65 ,$139.00 ,$96.05 ,$100.08 ,$96.81 , N/A ,$100.08 ,$19.54 ,$139.00 ,$139.00 , N/A ,$139.00 , N/A ,$100.08 ,$86.18 ,$100.08 ,$100.08 ,$83.40 
ST MARY'S HOSPITAL,32000027,36002,HC INJ PSEUDOANEURYSM (THROMBIN),320,1 ,$717.00 ,$358.50 ,$197.27 ,"$1,182.77 ",$264.62 ,$463.83 ,$463.83 ,$525.67 ,$430.20 ,$609.45 ,$501.90 ,$264.62 ,$681.15 ,$516.24 ,$523.41 ,$197.27 ,$609.45 ,$525.67 ,$197.27 ,$609.45 ,$523.41 ,$264.62 ,$525.67 ,$301.14 ,$609.45 ,"$1,182.77 ",$659.64 ,$501.90 ,$717.00 ,$717.00 ,$436.65 ,$717.00 ,$495.45 ,$516.24 ,$499.39 ,$530.93 ,$516.24 ,$280.50 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$430.20 
ST MARY'S HOSPITAL,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 ,$593.28 ,$601.52 ,$90.38 ,$700.40 , N/A ,$90.38 ,$700.40 ,$601.52 ,$199.61 , N/A ,$346.08 ,$700.40 , N/A ,$758.08 ,$576.80 ,$824.00 ,$824.00 ,$501.82 ,$824.00 ,$569.38 ,$593.28 ,$573.92 , N/A ,$593.28 ,$211.59 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$593.28 ,$510.88 ,$593.28 ,$593.28 ,$494.40 
ST MARY'S HOSPITAL,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 ,$77.76 ,$78.84 ,$108.00 ,$91.80 , N/A ,$108.00 ,$91.80 ,$78.84 ,$18.43 , N/A ,$108.00 ,$91.80 , N/A ,$99.36 ,$75.60 , N/A , N/A ,$65.77 , N/A ,$74.63 ,$77.76 ,$75.22 , N/A ,$77.76 ,$19.54 , N/A , N/A , N/A , N/A , N/A ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,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 ,$198.95 ,$329.40 ,$466.65 ,$384.30 ,$95.13 ,$521.55 ,$395.28 ,$400.77 ,$70.21 ,$466.65 ,$198.95 ,$70.21 ,$466.65 ,$400.77 ,$95.13 ,$198.95 ,$230.58 ,$466.65 ,$447.64 ,$505.08 ,$384.30 ,$549.00 ,$549.00 ,$334.34 ,$549.00 ,$379.36 ,$395.28 ,$382.38 ,$200.94 ,$395.28 ,$100.84 ,$451.00 ,$451.00 ,$198.95 ,$451.00 ,$198.95 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$329.40 
ST MARY'S HOSPITAL,32000032,42400,HC BX GLAND SALIVARY NEEDLE,320,1 ,"$1,185.00 ",$592.50 ,$102.66 ,"$1,361.67 ",$288.55 ,$766.58 ,$766.58 ,$605.19 ,$711.00 ,"$1,007.25 ",$829.50 ,$288.55 ,"$1,125.75 ",$853.20 ,$865.05 ,$102.66 ,"$1,007.25 ",$605.19 ,$102.66 ,"$1,007.25 ",$865.05 ,$288.55 ,$605.19 ,$497.70 ,"$1,007.25 ","$1,361.67 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$611.24 ,$853.20 ,$305.86 ,$451.00 ,$451.00 ,$605.19 ,$451.00 ,$605.19 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,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 ,$308.16 ,$312.44 ,$120.85 ,$363.80 , N/A ,$120.85 ,$363.80 ,$312.44 ,$95.13 , N/A ,$179.76 ,$363.80 , N/A ,$393.76 ,$299.60 ,$428.00 ,$428.00 ,$260.65 ,$428.00 ,$295.75 ,$308.16 ,$298.10 , N/A ,$308.16 ,$100.84 ,$428.00 ,$428.00 , N/A ,$428.00 , N/A ,$308.16 ,$265.36 ,$308.16 ,$308.16 ,$256.80 
ST MARY'S HOSPITAL,32000034,43274,HC ERCP W/PLACE STENT,320,1 ,"$3,160.00 ","$1,580.00 ",$451.00 ,"$11,014.48 ","$1,349.46 ","$2,044.20 ","$2,044.20 ","$4,895.32 ","$1,896.00 ","$2,686.00 ","$2,212.00 ","$1,349.46 ","$3,002.00 ","$2,275.20 ","$2,306.80 ",$895.54 ,"$2,686.00 ","$4,895.32 ",$895.54 ,"$2,686.00 ","$2,306.80 ","$1,349.46 ","$4,895.32 ","$1,327.20 ","$2,686.00 ","$11,014.48 ","$2,907.20 ","$2,212.00 ","$1,680.96 ","$2,259.84 ","$1,924.44 ","$2,101.20 ","$2,183.56 ","$2,275.20 ","$2,200.94 ","$4,944.27 ","$2,275.20 ","$1,430.43 ",$451.00 ,$451.00 ,"$4,895.32 ",$451.00 ,"$4,895.32 ","$2,275.20 ","$1,959.20 ","$2,275.20 ","$2,275.20 ","$1,896.00 "
ST MARY'S HOSPITAL,32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$431.00 ,$215.50 ,$78.06 ,$593.87 ,$211.20 ,$278.81 ,$278.81 ,$263.94 ,$258.60 ,$366.35 ,$301.70 ,$211.20 ,$409.45 ,$310.32 ,$314.63 ,$78.06 ,$366.35 ,$263.94 ,$78.06 ,$366.35 ,$314.63 ,$211.20 ,$263.94 ,$181.02 ,$366.35 ,$593.87 ,$396.52 ,$301.70 ,$431.00 ,$431.00 ,$262.48 ,$431.00 ,$297.82 ,$310.32 ,$300.19 ,$266.58 ,$310.32 ,$223.87 ,$431.00 ,$431.00 ,$263.94 ,$431.00 ,$263.94 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,32000036,43761,HC REPOSITION G-TUBE,320,1 ,$905.00 ,$452.50 ,$62.73 ,$905.00 ,$62.73 ,$585.44 ,$585.44 ,$258.79 ,$543.00 ,$769.25 ,$633.50 ,$62.73 ,$859.75 ,$651.60 ,$660.65 ,$198.09 ,$769.25 ,$258.79 ,$198.09 ,$769.25 ,$660.65 ,$62.73 ,$258.79 ,$380.10 ,$769.25 ,$582.28 ,$832.60 ,$633.50 ,$905.00 ,$905.00 ,$551.15 ,$905.00 ,$625.36 ,$651.60 ,$630.33 ,$261.38 ,$651.60 ,$66.49 ,$451.00 ,$451.00 ,$258.79 ,$451.00 ,$258.79 ,$651.60 ,$561.10 ,$651.60 ,$651.60 ,$543.00 
ST MARY'S HOSPITAL,32000038,44500,HC INTRO TUBE GI LONG,320,1 ,$566.00 ,$283.00 ,$37.86 ,"$1,770.57 ",$211.20 ,$366.15 ,$366.15 ,$786.92 ,$339.60 ,$481.10 ,$396.20 ,$211.20 ,$537.70 ,$407.52 ,$413.18 ,$37.86 ,$481.10 ,$786.92 ,$37.86 ,$481.10 ,$413.18 ,$211.20 ,$786.92 ,$237.72 ,$481.10 ,"$1,770.57 ",$520.72 ,$396.20 ,$566.00 ,$566.00 ,$344.69 ,$566.00 ,$391.11 ,$407.52 ,$394.22 ,$794.79 ,$407.52 ,$223.87 ,$451.00 ,$451.00 ,$786.92 ,$451.00 ,$786.92 ,$407.52 ,$350.92 ,$407.52 ,$407.52 ,$339.60 
ST MARY'S HOSPITAL,32000043,47536,HC CHG PERC BIL DRAIN CATH,320,1 ,"$2,500.00 ","$1,250.00 ",$253.69 ,"$6,961.86 ",$791.20 ,"$1,617.25 ","$1,617.25 ","$3,094.16 ","$1,500.00 ","$2,125.00 ","$1,750.00 ",$791.20 ,"$2,375.00 ","$1,800.00 ","$1,825.00 ",$253.69 ,"$2,125.00 ","$3,094.16 ",$253.69 ,"$2,125.00 ","$1,825.00 ",$791.20 ,"$3,094.16 ","$1,050.00 ","$2,125.00 ","$6,961.86 ","$2,300.00 ","$1,750.00 ","$1,680.96 ","$2,259.84 ","$1,522.50 ","$2,101.20 ","$1,727.50 ","$1,800.00 ","$1,741.25 ","$3,125.10 ","$1,800.00 ",$838.67 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$1,800.00 ","$1,550.00 ","$1,800.00 ","$1,800.00 ","$1,500.00 "
ST MARY'S HOSPITAL,32000044,47535,HC REVISE/REINSERT TUBE TRNSHEPAT,320,1 ,"$3,590.00 ","$1,795.00 ",$378.45 ,"$6,961.86 ",$791.20 ,"$2,322.37 ","$2,322.37 ","$3,094.16 ","$2,154.00 ","$3,051.50 ","$2,513.00 ",$791.20 ,"$3,410.50 ","$2,584.80 ","$2,620.70 ",$378.45 ,"$3,051.50 ","$3,094.16 ",$378.45 ,"$3,051.50 ","$2,620.70 ",$791.20 ,"$3,094.16 ","$1,507.80 ","$3,051.50 ","$6,961.86 ","$3,302.80 ","$2,513.00 ","$1,680.96 ","$2,259.84 ","$2,186.31 ","$2,101.20 ","$2,480.69 ","$2,584.80 ","$2,500.44 ","$3,125.10 ","$2,584.80 ",$838.67 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$2,584.80 ","$2,225.80 ","$2,584.80 ","$2,584.80 ","$2,154.00 "
ST MARY'S HOSPITAL,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 ","$1,800.00 ","$1,825.00 ",$261.56 ,"$2,125.00 ", N/A ,$261.56 ,"$2,125.00 ","$1,825.00 ",$791.20 , N/A ,"$1,050.00 ","$2,125.00 ", N/A ,"$2,300.00 ","$1,750.00 ","$1,680.96 ","$2,259.84 ","$1,522.50 ","$2,101.20 ","$1,727.50 ","$1,800.00 ","$1,741.25 ", N/A ,"$1,800.00 ",$838.67 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$1,800.00 ","$1,550.00 ","$1,800.00 ","$1,800.00 ","$1,500.00 "
ST MARY'S HOSPITAL,32000046,47539,HC ENDO BILIARY DIL DUCT W/STENT,320,1 ,"$2,586.00 ","$1,293.00 ",$451.00 ,"$11,071.98 ",$791.20 ,"$1,672.88 ","$1,672.88 ","$4,920.88 ","$1,551.60 ","$2,198.10 ","$1,810.20 ",$791.20 ,"$2,456.70 ","$1,861.92 ","$1,887.78 ",$812.56 ,"$2,198.10 ","$4,920.88 ",$812.56 ,"$2,198.10 ","$1,887.78 ",$791.20 ,"$4,920.88 ","$1,086.12 ","$2,198.10 ","$11,071.98 ","$2,379.12 ","$1,810.20 ","$5,993.67 ","$8,056.00 ","$1,574.87 ","$7,491.83 ","$1,786.93 ","$1,861.92 ","$1,801.15 ","$4,970.09 ","$1,861.92 ",$838.67 ,$451.00 ,$451.00 ,"$4,920.88 ",$451.00 ,"$4,920.88 ","$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$1,551.60 "
ST MARY'S HOSPITAL,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 ","$1,368.36 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$232.13 ,"$3,895.00 ","$2,952.00 ","$2,993.00 ",$378.00 ,"$3,485.00 ","$1,368.36 ",$378.00 ,"$3,485.00 ","$2,993.00 ",$232.13 ,"$1,368.36 ","$1,722.00 ","$3,485.00 ","$3,078.81 ","$3,772.00 ","$2,870.00 ","$1,680.96 ","$2,259.84 ","$2,496.90 ","$2,101.20 ","$2,833.10 ","$2,952.00 ","$2,855.65 ","$1,382.04 ","$2,952.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ","$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$2,460.00 "
ST MARY'S HOSPITAL,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 ","$1,368.36 ","$2,621.40 ","$3,713.65 ","$3,058.30 ",$232.13 ,"$4,150.55 ","$3,145.68 ","$3,189.37 ",$378.00 ,"$3,713.65 ","$1,368.36 ",$378.00 ,"$3,713.65 ","$3,189.37 ",$232.13 ,"$1,368.36 ","$1,834.98 ","$3,713.65 ","$3,078.81 ","$4,019.48 ","$3,058.30 ","$1,680.96 ","$2,259.84 ","$2,660.72 ","$2,101.20 ","$3,018.98 ","$3,145.68 ","$3,043.01 ","$1,382.04 ","$3,145.68 ",$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ","$3,145.68 ","$2,708.78 ","$3,145.68 ","$3,145.68 ","$2,621.40 "
ST MARY'S HOSPITAL,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 ,$401.76 ,$407.34 ,$558.00 ,$474.30 , N/A ,$558.00 ,$474.30 ,$407.34 ,$95.13 , N/A ,$558.00 ,$474.30 , N/A ,$513.36 ,$390.60 ,$558.00 ,$558.00 ,$339.82 ,$558.00 ,$385.58 ,$401.76 ,$388.65 , N/A ,$401.76 ,$100.84 ,$558.00 ,$558.00 , N/A ,$558.00 , N/A ,$401.76 ,$345.96 ,$401.76 ,$401.76 ,$334.80 
ST MARY'S HOSPITAL,32000053,49423,HC EXCHG CATH ABSC/CYST DRAIN,320,1 ,"$2,000.00 ","$1,000.00 ",$136.16 ,"$3,554.07 ",$232.13 ,"$1,293.80 ","$1,293.80 ","$1,579.59 ","$1,200.00 ","$1,700.00 ","$1,400.00 ",$232.13 ,"$1,900.00 ","$1,440.00 ","$1,460.00 ",$136.16 ,"$1,700.00 ","$1,579.59 ",$136.16 ,"$1,700.00 ","$1,460.00 ",$232.13 ,"$1,579.59 ",$840.00 ,"$1,700.00 ","$3,554.07 ","$1,840.00 ","$1,400.00 ","$1,489.75 ","$2,000.00 ","$1,218.00 ","$1,862.71 ","$1,382.00 ","$1,440.00 ","$1,393.00 ","$1,595.39 ","$1,440.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,579.59 ",$451.00 ,"$1,579.59 ","$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,200.00 "
ST MARY'S HOSPITAL,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 ,$548.64 ,$556.26 ,$72.98 ,$647.70 , N/A ,$72.98 ,$647.70 ,$556.26 ,$95.13 , N/A ,$320.04 ,$647.70 , N/A ,$701.04 ,$533.40 ,$762.00 ,$762.00 ,$464.06 ,$762.00 ,$526.54 ,$548.64 ,$530.73 , N/A ,$548.64 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,32000055,49427,HC INJ PREV PLACED SHUNT,320,1 ,$490.00 ,$245.00 ,$75.05 ,$490.00 ,$95.13 ,$316.98 ,$316.98 , N/A ,$294.00 ,$416.50 ,$343.00 ,$95.13 ,$465.50 ,$352.80 ,$357.70 ,$75.05 ,$416.50 , N/A ,$75.05 ,$416.50 ,$357.70 ,$95.13 , N/A ,$205.80 ,$416.50 , N/A ,$450.80 ,$343.00 ,$490.00 ,$490.00 ,$298.41 ,$490.00 ,$338.59 ,$352.80 ,$341.29 , N/A ,$352.80 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$352.80 ,$303.80 ,$352.80 ,$352.80 ,$294.00 
ST MARY'S HOSPITAL,32000056,49440,HC INSERT GASTRO TUBE FLUORO,320,1 ,"$1,831.00 ",$915.50 ,$211.20 ,"$3,554.07 ",$211.20 ,"$1,184.47 ","$1,184.47 ","$1,579.59 ","$1,098.60 ","$1,556.35 ","$1,281.70 ",$211.20 ,"$1,739.45 ","$1,318.32 ","$1,336.63 ",$392.58 ,"$1,556.35 ","$1,579.59 ",$392.58 ,"$1,556.35 ","$1,336.63 ",$211.20 ,"$1,579.59 ",$769.02 ,"$1,556.35 ","$3,554.07 ","$1,684.52 ","$1,281.70 ","$1,680.96 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,318.32 ","$1,275.29 ","$1,595.39 ","$1,318.32 ",$223.87 ,$451.00 ,$451.00 ,"$1,579.59 ",$451.00 ,"$1,579.59 ","$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,098.60 "
ST MARY'S HOSPITAL,32000057,49441,HC INSERT DUODEN/JEJUN TBE FLUORO,320,1 ,"$3,189.00 ","$1,594.50 ",$211.20 ,"$3,554.07 ",$211.20 ,"$2,062.96 ","$2,062.96 ","$1,579.59 ","$1,913.40 ","$2,710.65 ","$2,232.30 ",$211.20 ,"$3,029.55 ","$2,296.08 ","$2,327.97 ",$456.92 ,"$2,710.65 ","$1,579.59 ",$456.92 ,"$2,710.65 ","$2,327.97 ",$211.20 ,"$1,579.59 ","$1,339.38 ","$2,710.65 ","$3,554.07 ","$2,933.88 ","$2,232.30 ","$1,680.96 ","$2,259.84 ","$1,942.10 ","$2,101.20 ","$2,203.60 ","$2,296.08 ","$2,221.14 ","$1,595.39 ","$2,296.08 ",$223.87 ,$451.00 ,$451.00 ,"$1,579.59 ",$451.00 ,"$1,579.59 ","$2,296.08 ","$1,977.18 ","$2,296.08 ","$2,296.08 ","$1,913.40 "
ST MARY'S HOSPITAL,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 ","$1,008.48 ","$1,810.20 ","$2,564.45 ","$2,111.90 ",$705.71 ,"$2,866.15 ","$2,172.24 ","$2,202.41 ",$401.51 ,"$2,564.45 ","$1,008.48 ",$401.51 ,"$2,564.45 ","$2,202.41 ",$705.71 ,"$1,008.48 ","$1,267.14 ","$2,564.45 ","$2,269.08 ","$2,775.64 ","$2,111.90 ","$1,680.96 ","$2,259.84 ","$1,837.35 ","$2,101.20 ","$2,084.75 ","$2,172.24 ","$2,101.34 ","$1,018.56 ","$2,172.24 ",$748.05 ,$451.00 ,$451.00 ,"$1,008.48 ",$451.00 ,"$1,008.48 ","$2,172.24 ","$1,870.54 ","$2,172.24 ","$2,172.24 ","$1,810.20 "
ST MARY'S HOSPITAL,32000059,49446,HC CHG G-TB TO GJ-TB PERC FLUORO,320,1 ,"$2,047.00 ","$1,023.50 ",$211.20 ,"$3,554.07 ",$211.20 ,"$1,324.20 ","$1,324.20 ","$1,579.59 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$211.20 ,"$1,944.65 ","$1,473.84 ","$1,494.31 ",$283.78 ,"$1,739.95 ","$1,579.59 ",$283.78 ,"$1,739.95 ","$1,494.31 ",$211.20 ,"$1,579.59 ",$859.74 ,"$1,739.95 ","$3,554.07 ","$1,883.24 ","$1,432.90 ","$1,680.96 ","$2,047.00 ","$1,246.62 ","$2,047.00 ","$1,414.48 ","$1,473.84 ","$1,425.74 ","$1,595.39 ","$1,473.84 ",$223.87 ,$451.00 ,$451.00 ,"$1,579.59 ",$451.00 ,"$1,579.59 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,228.20 "
ST MARY'S HOSPITAL,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 ",$786.92 ,"$1,457.40 ","$2,064.65 ","$1,700.30 ",$211.20 ,"$2,307.55 ","$1,748.88 ","$1,773.17 ",$126.40 ,"$2,064.65 ",$786.92 ,$126.40 ,"$2,064.65 ","$1,773.17 ",$211.20 ,$786.92 ,"$1,020.18 ","$2,064.65 ","$1,770.57 ","$2,234.68 ","$1,700.30 ","$1,489.75 ","$2,002.44 ","$1,479.26 ","$1,862.71 ","$1,678.44 ","$1,748.88 ","$1,691.80 ",$794.79 ,"$1,748.88 ",$223.87 ,$451.00 ,$451.00 ,$786.92 ,$451.00 ,$786.92 ,"$1,748.88 ","$1,505.98 ","$1,748.88 ","$1,748.88 ","$1,457.40 "
ST MARY'S HOSPITAL,32000061,49451,HC RPLC DUODEN/JEJUN TB FLUORO,320,1 ,"$1,293.00 ",$646.50 ,$171.95 ,"$1,770.57 ",$211.20 ,$836.44 ,$836.44 ,$786.92 ,$775.80 ,"$1,099.05 ",$905.10 ,$211.20 ,"$1,228.35 ",$930.96 ,$943.89 ,$171.95 ,"$1,099.05 ",$786.92 ,$171.95 ,"$1,099.05 ",$943.89 ,$211.20 ,$786.92 ,$543.06 ,"$1,099.05 ","$1,770.57 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$794.79 ,$930.96 ,$223.87 ,$451.00 ,$451.00 ,$786.92 ,$451.00 ,$786.92 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,32000062,49452,HC RPLC GASTRO-JEJUN TB FLUORO,361,1 ,"$1,185.00 ",$592.50 ,$211.20 ,"$1,770.57 ",$211.20 ,"$1,185.00 ","$1,185.00 ",$786.92 ,$711.00 ,"$1,007.25 ",$829.50 ,$211.20 ,"$1,125.75 ",$853.20 ,$865.05 ,"$1,185.00 ","$1,007.25 ",$786.92 ,"$1,185.00 ","$1,007.25 ",$865.05 ,$211.20 ,$786.92 ,"$1,185.00 ","$1,007.25 ","$1,770.57 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$794.79 ,$853.20 ,$223.87 ,"$1,185.00 ","$1,185.00 ",$786.92 ,"$1,185.00 ",$786.92 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$474.00 ,$237.00 ,$37.92 ,$503.50 ,$37.92 ,$306.63 ,$306.63 ,$223.78 ,$284.40 ,$402.90 ,$331.80 ,$37.92 ,$450.30 ,$341.28 ,$346.02 ,$59.06 ,$402.90 ,$223.78 ,$59.06 ,$402.90 ,$346.02 ,$37.92 ,$223.78 ,$199.08 ,$402.90 ,$503.50 ,$436.08 ,$331.80 ,$474.00 ,$474.00 ,$288.67 ,$474.00 ,$327.53 ,$341.28 ,$330.14 ,$226.02 ,$341.28 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,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 ",$786.92 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$232.13 ,"$2,280.00 ","$1,728.00 ","$1,752.00 ", N/A ,"$2,040.00 ",$786.92 , N/A ,"$2,040.00 ","$1,752.00 ",$232.13 ,$786.92 ,"$1,008.00 ","$2,040.00 ","$1,770.57 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,363.44 ","$1,658.40 ","$1,728.00 ","$1,671.60 ",$794.79 ,"$1,728.00 ",$246.06 ,$451.00 ,$451.00 ,$786.92 ,$451.00 ,$786.92 ,"$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,440.00 "
ST MARY'S HOSPITAL,32000066,49405,HC DRN ABSC PERIRENAL  PERC,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,078.81 ",$232.13 ,$905.66 ,$905.66 ,"$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$378.66 ,"$1,190.00 ","$1,368.36 ",$378.66 ,"$1,190.00 ","$1,022.00 ",$232.13 ,"$1,368.36 ",$588.00 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,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 ","$1,741.31 ","$2,391.60 ","$3,388.10 ","$2,790.20 ",$474.08 ,"$3,786.70 ","$2,869.92 ","$2,909.78 ",$487.86 ,"$3,388.10 ","$1,741.31 ",$487.86 ,"$3,388.10 ","$2,909.78 ",$474.08 ,"$1,741.31 ","$1,674.12 ","$3,388.10 ","$3,917.96 ","$3,667.12 ","$2,790.20 ","$1,489.75 ","$2,002.44 ","$2,427.47 ","$1,862.71 ","$2,754.33 ","$2,869.92 ","$2,776.25 ","$1,758.72 ","$2,869.92 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,869.92 ","$2,471.32 ","$2,869.92 ","$2,869.92 ","$2,391.60 "
ST MARY'S HOSPITAL,32000068,50384,HC REM URETERAL STENT PERCU,320,1 ,"$2,801.00 ","$1,400.50 ",$437.78 ,"$3,917.96 ",$474.08 ,"$1,811.97 ","$1,811.97 ","$1,741.31 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$474.08 ,"$2,660.95 ","$2,016.72 ","$2,044.73 ",$437.78 ,"$2,380.85 ","$1,741.31 ",$437.78 ,"$2,380.85 ","$2,044.73 ",$474.08 ,"$1,741.31 ","$1,176.42 ","$2,380.85 ","$3,917.96 ","$2,576.92 ","$1,960.70 ","$1,489.75 ","$2,002.44 ","$1,705.81 ","$1,862.71 ","$1,935.49 ","$2,016.72 ","$1,950.90 ","$1,758.72 ","$2,016.72 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$1,680.60 "
ST MARY'S HOSPITAL,32000069,50385,HC URETERAL STENT CHNG USING SNARE,320,1 ,"$3,500.00 ","$1,750.00 ",$416.77 ,"$3,917.96 ",$474.08 ,"$2,264.15 ","$2,264.15 ","$1,741.31 ","$2,100.00 ","$2,975.00 ","$2,450.00 ",$474.08 ,"$3,325.00 ","$2,520.00 ","$2,555.00 ",$416.77 ,"$2,975.00 ","$1,741.31 ",$416.77 ,"$2,975.00 ","$2,555.00 ",$474.08 ,"$1,741.31 ","$1,470.00 ","$2,975.00 ","$3,917.96 ","$3,220.00 ","$2,450.00 ","$1,489.75 ","$2,002.44 ","$2,131.50 ","$1,862.71 ","$2,418.50 ","$2,520.00 ","$2,437.75 ","$1,758.72 ","$2,520.00 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,100.00 "
ST MARY'S HOSPITAL,32000070,50386,HC URETERAL STENT REMOVAL USNG SNARE,320,1 ,"$1,500.00 ",$750.00 ,$310.39 ,"$3,917.96 ",$474.08 ,$970.35 ,$970.35 ,"$1,741.31 ",$900.00 ,"$1,275.00 ","$1,050.00 ",$474.08 ,"$1,425.00 ","$1,080.00 ","$1,095.00 ",$310.39 ,"$1,275.00 ","$1,741.31 ",$310.39 ,"$1,275.00 ","$1,095.00 ",$474.08 ,"$1,741.31 ",$630.00 ,"$1,275.00 ","$3,917.96 ","$1,380.00 ","$1,050.00 ","$1,489.75 ","$1,500.00 ",$913.50 ,"$1,500.00 ","$1,036.50 ","$1,080.00 ","$1,044.75 ","$1,758.72 ","$1,080.00 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ",$900.00 
ST MARY'S HOSPITAL,32000071,50387,HC CHANGE EXT/INT URET STENT,320,1 ,"$2,187.00 ","$1,093.50 ",$161.13 ,"$3,917.96 ",$474.08 ,"$1,414.77 ","$1,414.77 ","$1,741.31 ","$1,312.20 ","$1,858.95 ","$1,530.90 ",$474.08 ,"$2,077.65 ","$1,574.64 ","$1,596.51 ",$161.13 ,"$1,858.95 ","$1,741.31 ",$161.13 ,"$1,858.95 ","$1,596.51 ",$474.08 ,"$1,741.31 ",$918.54 ,"$1,858.95 ","$3,917.96 ","$2,012.04 ","$1,530.90 ","$1,489.75 ","$2,002.44 ","$1,331.88 ","$1,862.71 ","$1,511.22 ","$1,574.64 ","$1,523.25 ","$1,758.72 ","$1,574.64 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$1,574.64 ","$1,355.94 ","$1,574.64 ","$1,574.64 ","$1,312.20 "
ST MARY'S HOSPITAL,32000072,50389,HC REM NEPHRO TUBE FLUORO,320,1 ,"$1,000.00 ",$500.00 ,$102.85 ,"$1,258.87 ",$119.36 ,$646.90 ,$646.90 ,$559.50 ,$600.00 ,$850.00 ,$700.00 ,$119.36 ,$950.00 ,$720.00 ,$730.00 ,$102.85 ,$850.00 ,$559.50 ,$102.85 ,$850.00 ,$730.00 ,$119.36 ,$559.50 ,$420.00 ,$850.00 ,"$1,258.87 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$720.00 ,$696.50 ,$565.10 ,$720.00 ,$126.52 ,$451.00 ,$451.00 ,$559.50 ,$451.00 ,$559.50 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$3,017.00 ","$1,508.50 ",$392.53 ,"$6,727.66 ",$924.12 ,"$1,951.70 ","$1,951.70 ","$2,990.07 ","$1,810.20 ","$2,564.45 ","$2,111.90 ",$924.12 ,"$2,866.15 ","$2,172.24 ","$2,202.41 ",$392.53 ,"$2,564.45 ","$2,990.07 ",$392.53 ,"$2,564.45 ","$2,202.41 ",$924.12 ,"$2,990.07 ","$1,267.14 ","$2,564.45 ","$6,727.66 ","$2,775.64 ","$2,111.90 ","$1,489.75 ","$2,002.44 ","$1,837.35 ","$1,862.71 ","$2,084.75 ","$2,172.24 ","$2,101.34 ","$3,019.97 ","$2,172.24 ",$979.57 ,$451.00 ,$451.00 ,"$2,990.07 ",$451.00 ,"$2,990.07 ","$2,172.24 ","$1,870.54 ","$2,172.24 ","$2,172.24 ","$1,810.20 "
ST MARY'S HOSPITAL,32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$4,526.00 ","$2,263.00 ",$392.53 ,"$6,727.66 ","$1,386.17 ","$2,927.87 ","$2,927.87 ","$2,990.07 ","$2,715.60 ","$3,847.10 ","$3,168.20 ","$1,386.17 ","$4,299.70 ","$3,258.72 ","$3,303.98 ",$392.53 ,"$3,847.10 ","$2,990.07 ",$392.53 ,"$3,847.10 ","$3,303.98 ","$1,386.17 ","$2,990.07 ","$1,900.92 ","$3,847.10 ","$6,727.66 ","$4,163.92 ","$3,168.20 ","$2,234.63 ","$3,003.66 ","$2,756.33 ","$2,794.07 ","$3,127.47 ","$3,258.72 ","$3,152.36 ","$3,019.97 ","$3,258.72 ","$1,469.34 ",$451.00 ,$451.00 ,"$2,990.07 ",$451.00 ,"$2,990.07 ","$3,258.72 ","$2,806.12 ","$3,258.72 ","$3,258.72 ","$2,715.60 "
ST MARY'S HOSPITAL,32000078,50396,HC MANOMETRIC STUDIES-NEPHROSTOMY,320,1 ,$776.00 ,$388.00 ,$119.36 ,"$1,258.87 ",$119.36 ,$501.99 ,$501.99 ,$559.50 ,$465.60 ,$659.60 ,$543.20 ,$119.36 ,$737.20 ,$558.72 ,$566.48 ,$226.24 ,$659.60 ,$559.50 ,$226.24 ,$659.60 ,$566.48 ,$119.36 ,$559.50 ,$325.92 ,$659.60 ,"$1,258.87 ",$713.92 ,$543.20 ,$776.00 ,$776.00 ,$472.58 ,$776.00 ,$536.22 ,$558.72 ,$540.48 ,$565.10 ,$558.72 ,$126.52 ,$451.00 ,$451.00 ,$559.50 ,$451.00 ,$559.50 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$2,801.00 ","$1,400.50 ",$192.37 ,"$3,917.96 ",$474.08 ,"$1,811.97 ","$1,811.97 ","$1,741.31 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$474.08 ,"$2,660.95 ","$2,016.72 ","$2,044.73 ",$192.37 ,"$2,380.85 ","$1,741.31 ",$192.37 ,"$2,380.85 ","$2,044.73 ",$474.08 ,"$1,741.31 ","$1,176.42 ","$2,380.85 ","$3,917.96 ","$2,576.92 ","$1,960.70 ","$1,489.75 ","$2,002.44 ","$1,705.81 ","$1,862.71 ","$1,935.49 ","$2,016.72 ","$1,950.90 ","$1,758.72 ","$2,016.72 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$1,680.60 "
ST MARY'S HOSPITAL,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 ","$1,741.31 ","$2,520.60 ","$3,570.85 ","$2,940.70 ",$711.12 ,"$3,990.95 ","$3,024.72 ","$3,066.73 ",$192.37 ,"$3,570.85 ","$1,741.31 ",$192.37 ,"$3,570.85 ","$3,066.73 ",$711.12 ,"$1,741.31 ","$1,764.42 ","$3,570.85 ","$3,917.96 ","$3,864.92 ","$2,940.70 ","$2,234.63 ","$3,003.66 ","$2,558.41 ","$2,794.07 ","$2,902.89 ","$3,024.72 ","$2,926.00 ","$1,758.72 ","$3,024.72 ",$753.79 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$3,024.72 ","$2,604.62 ","$3,024.72 ","$3,024.72 ","$2,520.60 "
ST MARY'S HOSPITAL,32000080,50553,HC ENDO RENAL ESTAB W/CATH,320,1 ,"$3,375.00 ","$1,687.50 ",$451.00 ,"$9,654.05 ",$924.12 ,"$2,183.29 ","$2,183.29 ","$4,290.69 ","$2,025.00 ","$2,868.75 ","$2,362.50 ",$924.12 ,"$3,206.25 ","$2,430.00 ","$2,463.75 ",$600.40 ,"$2,868.75 ","$4,290.69 ",$600.40 ,"$2,868.75 ","$2,463.75 ",$924.12 ,"$4,290.69 ","$1,417.50 ","$2,868.75 ","$9,654.05 ","$3,105.00 ","$2,362.50 ","$1,489.75 ","$2,002.44 ","$2,055.38 ","$1,862.71 ","$2,332.13 ","$2,430.00 ","$2,350.69 ","$4,333.60 ","$2,430.00 ",$979.57 ,$451.00 ,$451.00 ,"$4,290.69 ",$451.00 ,"$4,290.69 ","$2,430.00 ","$2,092.50 ","$2,430.00 ","$2,430.00 ","$2,025.00 "
ST MARY'S HOSPITAL,32000082,50688,HC CHG TUBE URETEROSTOMY,320,1 ,"$4,201.00 ","$2,100.50 ",$149.59 ,"$4,201.00 ",$474.08 ,"$2,717.63 ","$2,717.63 ","$1,741.31 ","$2,520.60 ","$3,570.85 ","$2,940.70 ",$474.08 ,"$3,990.95 ","$3,024.72 ","$3,066.73 ",$149.59 ,"$3,570.85 ","$1,741.31 ",$149.59 ,"$3,570.85 ","$3,066.73 ",$474.08 ,"$1,741.31 ","$1,764.42 ","$3,570.85 ","$3,917.96 ","$3,864.92 ","$2,940.70 ","$2,234.63 ","$3,003.66 ","$2,558.41 ","$2,794.07 ","$2,902.89 ","$3,024.72 ","$2,926.00 ","$1,758.72 ","$3,024.72 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$3,024.72 ","$2,604.62 ","$3,024.72 ","$3,024.72 ","$2,520.60 "
ST MARY'S HOSPITAL,32000082,50688,HC CHG TUBE URETEROSTOMY,320,1 ,"$2,801.00 ","$1,400.50 ",$149.59 ,"$3,917.96 ",$474.08 ,"$1,811.97 ","$1,811.97 ","$1,741.31 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$474.08 ,"$2,660.95 ","$2,016.72 ","$2,044.73 ",$149.59 ,"$2,380.85 ","$1,741.31 ",$149.59 ,"$2,380.85 ","$2,044.73 ",$474.08 ,"$1,741.31 ","$1,176.42 ","$2,380.85 ","$3,917.96 ","$2,576.92 ","$1,960.70 ","$1,489.75 ","$2,002.44 ","$1,705.81 ","$1,862.71 ","$1,935.49 ","$2,016.72 ","$1,950.90 ","$1,758.72 ","$2,016.72 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$1,680.60 "
ST MARY'S HOSPITAL,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 ,$443.52 ,$449.68 ,$134.73 ,$523.60 , N/A ,$134.73 ,$523.60 ,$449.68 ,$95.13 , N/A ,$258.72 ,$523.60 , N/A ,$566.72 ,$431.20 ,$616.00 ,$616.00 ,$375.14 ,$616.00 ,$425.66 ,$443.52 ,$429.04 , N/A ,$443.52 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$369.60 
ST MARY'S HOSPITAL,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 ,$378.72 ,$383.98 ,$85.03 ,$447.10 , N/A ,$85.03 ,$447.10 ,$383.98 ,$95.13 , N/A ,$220.92 ,$447.10 , N/A ,$483.92 ,$368.20 ,$526.00 ,$526.00 ,$320.33 ,$526.00 ,$363.47 ,$378.72 ,$366.36 , N/A ,$378.72 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$315.60 
ST MARY'S HOSPITAL,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 ,$411.12 ,$416.83 ,$123.57 ,$485.35 , N/A ,$123.57 ,$485.35 ,$416.83 ,$95.13 , N/A ,$239.82 ,$485.35 , N/A ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$411.12 ,$397.70 , N/A ,$411.12 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$342.60 
ST MARY'S HOSPITAL,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 ,$411.12 ,$416.83 ,$109.06 ,$485.35 , N/A ,$109.06 ,$485.35 ,$416.83 ,$95.13 , N/A ,$239.82 ,$485.35 , N/A ,$525.32 ,$399.70 ,$571.00 ,$571.00 ,$347.74 ,$571.00 ,$394.56 ,$411.12 ,$397.70 , N/A ,$411.12 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$342.60 
ST MARY'S HOSPITAL,32000089,61070,HC PUNCT ASP/INJ SHUNT TUBE,320,1 ,$873.00 ,$436.50 ,$107.48 ,"$1,389.48 ",$136.73 ,$564.74 ,$564.74 ,$617.55 ,$523.80 ,$742.05 ,$611.10 ,$136.73 ,$829.35 ,$628.56 ,$637.29 ,$107.48 ,$742.05 ,$617.55 ,$107.48 ,$742.05 ,$637.29 ,$136.73 ,$617.55 ,$366.66 ,$742.05 ,"$1,389.48 ",$803.16 ,$611.10 ,$873.00 ,$873.00 ,$531.66 ,$873.00 ,$603.24 ,$628.56 ,$608.04 ,$623.73 ,$628.56 ,$144.93 ,$451.00 ,$451.00 ,$617.55 ,$451.00 ,$617.55 ,$628.56 ,$541.26 ,$628.56 ,$628.56 ,$523.80 
ST MARY'S HOSPITAL,32000090,62272,HC LUMBAR PUNCTURE DRAIN,320,1 ,$894.00 ,$447.00 ,$164.39 ,"$1,389.48 ",$268.66 ,$578.33 ,$578.33 ,$617.55 ,$536.40 ,$759.90 ,$625.80 ,$268.66 ,$849.30 ,$643.68 ,$652.62 ,$164.39 ,$759.90 ,$617.55 ,$164.39 ,$759.90 ,$652.62 ,$268.66 ,$617.55 ,$375.48 ,$759.90 ,"$1,389.48 ",$822.48 ,$625.80 ,$894.00 ,$894.00 ,$544.45 ,$894.00 ,$617.75 ,$643.68 ,$622.67 ,$623.73 ,$643.68 ,$284.78 ,$451.00 ,$451.00 ,$617.55 ,$451.00 ,$617.55 ,$643.68 ,$554.28 ,$643.68 ,$643.68 ,$536.40 
ST MARY'S HOSPITAL,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 ,$669.60 ,$678.90 ,$163.82 ,$790.50 , N/A ,$163.82 ,$790.50 ,$678.90 ,$95.13 , N/A ,$390.60 ,$790.50 , N/A ,$855.60 ,$651.00 ,$930.00 ,$930.00 ,$566.37 ,$930.00 ,$642.63 ,$669.60 ,$647.75 , N/A ,$669.60 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$558.00 
ST MARY'S HOSPITAL,32000092,62287,HC DECOMP DISC LUMBAR PERC,320,1 ,"$7,757.00 ","$3,878.50 ",$451.00 ,"$8,056.00 ","$1,461.70 ","$5,018.00 ","$5,018.00 ","$1,707.66 ","$4,654.20 ","$6,593.45 ","$5,429.90 ","$1,461.70 ","$7,369.15 ","$5,585.04 ","$5,662.61 ","$1,127.03 ","$6,593.45 ","$1,707.66 ","$1,127.03 ","$6,593.45 ","$5,662.61 ","$1,461.70 ","$1,707.66 ","$3,257.94 ","$6,593.45 ","$3,842.24 ","$7,136.44 ","$5,429.90 ","$5,993.67 ","$8,056.00 ","$4,724.01 ","$7,491.83 ","$5,360.09 ","$5,585.04 ","$5,402.75 ","$1,724.74 ","$5,585.04 ","$1,549.40 ",$451.00 ,$451.00 ,"$1,707.66 ",$451.00 ,"$1,707.66 ","$5,585.04 ","$4,809.34 ","$5,585.04 ","$5,585.04 ","$4,654.20 "
ST MARY'S HOSPITAL,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 ","$1,370.88 ","$1,389.92 ",$313.38 ,"$1,618.40 ", N/A ,$313.38 ,"$1,618.40 ","$1,389.92 ",$95.13 , N/A ,$799.68 ,"$1,618.40 ", N/A ,"$1,751.68 ","$1,332.80 ","$1,489.75 ","$1,904.00 ","$1,159.54 ","$1,862.71 ","$1,315.66 ","$1,370.88 ","$1,326.14 ", N/A ,"$1,370.88 ",$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,142.40 "
ST MARY'S HOSPITAL,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 ",$846.72 ,$858.48 ,$290.55 ,$999.60 , N/A ,$290.55 ,$999.60 ,$858.48 ,$95.13 , 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 ,$846.72 ,$819.08 , N/A ,$846.72 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$846.72 ,$729.12 ,$846.72 ,$846.72 ,$705.60 
ST MARY'S HOSPITAL,32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$280.00 ,$140.00 ,$17.98 ,$280.00 ,$17.98 ,$90.58 ,$80.52 ,$78.66 ,$168.00 ,$238.00 ,$196.00 ,$17.98 ,$266.00 ,$201.60 ,$204.40 ,$47.01 ,$238.00 ,$78.66 ,$47.01 ,$238.00 ,$204.40 ,$17.98 ,$78.66 ,$117.60 ,$238.00 ,$177.00 ,$257.60 ,$196.00 ,$190.57 ,$204.59 ,$170.52 ,$190.57 ,$193.48 ,$201.60 ,$195.02 ,$79.45 ,$201.60 ,$19.06 ,$280.00 ,$280.00 ,$78.66 ,$280.00 ,$78.66 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,32000099,70030,HC FOREIGN BODY EYE BOTH,320,1 ,$280.00 ,$140.00 ,$17.98 ,$280.00 ,$17.98 ,$90.58 ,$80.52 ,$78.66 ,$168.00 ,$238.00 ,$196.00 ,$17.98 ,$266.00 ,$201.60 ,$204.40 ,$47.01 ,$238.00 ,$78.66 ,$47.01 ,$238.00 ,$204.40 ,$17.98 ,$78.66 ,$117.60 ,$238.00 ,$177.00 ,$257.60 ,$196.00 ,$190.57 ,$204.59 ,$170.52 ,$190.57 ,$193.48 ,$201.60 ,$195.02 ,$79.45 ,$201.60 ,$19.06 ,$280.00 ,$280.00 ,$78.66 ,$280.00 ,$78.66 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$118.52 ,$105.35 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$63.69 ,$390.15 ,$105.88 ,$63.69 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$302.03 ,$324.25 ,$279.53 ,$302.03 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000101,70130,HC MASTOIDS MN 3VW PER SIDE,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$172.84 ,$153.63 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$92.43 ,$314.50 ,$105.88 ,$92.43 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000102,70134,HC INT AUD MEATI BILAT,320,1 ,$459.00 ,$229.50 ,$17.98 ,"$1,057.30 ",$17.98 ,$155.77 ,$138.46 ,$469.91 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$88.44 ,$390.15 ,$469.91 ,$88.44 ,$390.15 ,$335.07 ,$17.98 ,$469.91 ,$192.78 ,$390.15 ,"$1,057.30 ",$422.28 ,$321.30 ,$190.57 ,$204.59 ,$279.53 ,$190.57 ,$317.17 ,$330.48 ,$319.69 ,$474.61 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$469.91 ,$451.00 ,$469.91 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$87.48 ,$77.76 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$44.32 ,$314.50 ,$78.66 ,$44.32 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$130.93 ,$116.38 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$69.72 ,$390.15 ,$105.88 ,$69.72 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$302.03 ,$324.25 ,$279.53 ,$302.03 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$110.76 ,$98.45 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$59.02 ,$314.50 ,$78.66 ,$59.02 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$69.70 ,$390.15 ,$105.88 ,$69.70 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$190.57 ,$204.59 ,$279.53 ,$190.57 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$98.34 ,$87.41 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.66 ,$314.50 ,$78.66 ,$47.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$113.86 ,$101.21 ,$78.66 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$54.35 ,$390.15 ,$78.66 ,$54.35 ,$390.15 ,$335.07 ,$17.98 ,$78.66 ,$192.78 ,$390.15 ,$177.00 ,$422.28 ,$321.30 ,$190.57 ,$204.59 ,$279.53 ,$190.57 ,$317.17 ,$330.48 ,$319.69 ,$79.45 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000109,70240,HC SELLA TURCICA,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.66 ,$314.50 ,$78.66 ,$47.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$53.69 ,$314.50 ,$105.88 ,$53.69 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$129.38 ,$115.01 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$62.36 ,$390.15 ,$105.88 ,$62.36 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$302.03 ,$324.25 ,$279.53 ,$302.03 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$160.42 ,$142.60 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$83.74 ,$314.50 ,$78.66 ,$83.74 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$223.78 ,"$2,016.00 ","$2,856.00 ","$2,352.00 ",$79.99 ,"$3,192.00 ","$2,419.20 ","$2,452.80 ",$422.77 ,"$2,856.00 ",$223.78 ,$422.77 ,"$2,856.00 ","$2,452.80 ",$79.99 ,$223.78 ,"$1,411.20 ","$2,856.00 ",$503.50 ,"$3,091.20 ","$2,352.00 ",$979.56 ,"$1,051.63 ","$2,046.24 ",$979.56 ,"$2,321.76 ","$2,419.20 ","$2,340.24 ",$226.02 ,"$2,419.20 ",$84.79 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,32000115,70355,HC XRAY PAN MANDIBLE/MAXLA,320,1 ,$370.00 ,$185.00 ,$15.58 ,$370.00 ,$17.98 ,$37.81 ,$33.61 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$15.58 ,$314.50 ,$78.66 ,$15.58 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$141.67 ,$152.09 ,$225.33 ,$141.67 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$45.00 ,$314.50 ,$78.66 ,$45.00 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000120,70390,HC XRAY SIALOGRAPHY,320,1 ,$622.00 ,$311.00 ,$37.92 ,$622.00 ,$37.92 ,$365.29 ,$324.70 ,$223.78 ,$373.20 ,$528.70 ,$435.40 ,$37.92 ,$590.90 ,$447.84 ,$454.06 ,$204.69 ,$528.70 ,$223.78 ,$204.69 ,$528.70 ,$454.06 ,$37.92 ,$223.78 ,$261.24 ,$528.70 ,$503.50 ,$572.24 ,$435.40 ,$622.00 ,$622.00 ,$378.80 ,$622.00 ,$429.80 ,$447.84 ,$433.22 ,$226.02 ,$447.84 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$447.84 ,$385.64 ,$447.84 ,$447.84 ,$373.20 
ST MARY'S HOSPITAL,32000121,71045,HC XR CHEST 1V,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$33.64 ,$272.85 ,$78.66 ,$33.64 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000122,71045,HC XR CHEST 1V OR,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$33.64 ,$272.85 ,$78.66 ,$33.64 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000124,71045,HC XR CHEST 1V EMPLOYEE,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$33.64 ,$272.85 ,$78.66 ,$33.64 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000125,71045,HC XR CHEST 1V PORTABLE,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$33.64 ,$272.85 ,$78.66 ,$33.64 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000126,71045,HC XR CHEST 1V INFANT,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$67.30 ,$59.82 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$33.64 ,$272.85 ,$78.66 ,$33.64 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000127,71046,HC XR CHEST 2V,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$45.65 ,$272.85 ,$78.66 ,$45.65 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000129,71046,HC XR CHEST 2V PORTABLE,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$45.65 ,$272.85 ,$78.66 ,$45.65 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$110.76 ,$98.45 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$58.34 ,$272.85 ,$78.66 ,$58.34 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$439.00 ,$219.50 ,$17.98 ,$439.00 ,$17.98 ,$115.41 ,$102.59 ,$105.88 ,$263.40 ,$373.15 ,$307.30 ,$17.98 ,$417.05 ,$316.08 ,$320.47 ,$62.36 ,$373.15 ,$105.88 ,$62.36 ,$373.15 ,$320.47 ,$17.98 ,$105.88 ,$184.38 ,$373.15 ,$238.23 ,$403.88 ,$307.30 ,$390.44 ,$419.17 ,$267.35 ,$390.44 ,$303.35 ,$316.08 ,$305.76 ,$106.94 ,$316.08 ,$19.06 ,$439.00 ,$439.00 ,$105.88 ,$439.00 ,$105.88 ,$316.08 ,$272.18 ,$316.08 ,$316.08 ,$263.40 
ST MARY'S HOSPITAL,32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$321.00 ,$160.50 ,$17.98 ,$321.00 ,$17.98 ,$89.03 ,$79.14 ,$78.66 ,$192.60 ,$272.85 ,$224.70 ,$17.98 ,$304.95 ,$231.12 ,$234.33 ,$45.65 ,$272.85 ,$78.66 ,$45.65 ,$272.85 ,$234.33 ,$17.98 ,$78.66 ,$134.82 ,$272.85 ,$177.00 ,$295.32 ,$224.70 ,$204.25 ,$219.27 ,$195.49 ,$204.25 ,$221.81 ,$231.12 ,$223.58 ,$79.45 ,$231.12 ,$19.06 ,$321.00 ,$321.00 ,$78.66 ,$321.00 ,$78.66 ,$231.12 ,$199.02 ,$231.12 ,$231.12 ,$192.60 
ST MARY'S HOSPITAL,32000137,71100,HC XR RIBS 2V UNI,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$99.89 ,$88.79 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$51.66 ,$314.50 ,$78.66 ,$51.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$336.00 ,$476.00 ,$392.00 ,$17.98 ,$532.00 ,$403.20 ,$408.80 ,$58.34 ,$476.00 ,$105.88 ,$58.34 ,$476.00 ,$408.80 ,$17.98 ,$105.88 ,$235.20 ,$476.00 ,$238.23 ,$515.20 ,$392.00 ,$302.03 ,$324.25 ,$341.04 ,$302.03 ,$386.96 ,$403.20 ,$390.04 ,$106.94 ,$403.20 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$113.86 ,$101.21 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$59.70 ,$390.15 ,$105.88 ,$59.70 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$302.03 ,$324.25 ,$279.53 ,$302.03 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,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 ,$105.88 ,$336.00 ,$476.00 ,$392.00 ,$17.98 ,$532.00 ,$403.20 ,$408.80 ,$74.39 ,$476.00 ,$105.88 ,$74.39 ,$476.00 ,$408.80 ,$17.98 ,$105.88 ,$235.20 ,$476.00 ,$238.23 ,$515.20 ,$392.00 ,$302.03 ,$324.25 ,$341.04 ,$302.03 ,$386.96 ,$403.20 ,$390.04 ,$106.94 ,$403.20 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,32000141,71120,HC XR STERNUM 2+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$90.58 ,$80.52 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$48.32 ,$314.50 ,$78.66 ,$48.32 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$113.86 ,$101.21 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$61.71 ,$314.50 ,$78.66 ,$61.71 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$695.77 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$695.77 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$695.77 ,"$1,422.18 ","$2,677.50 ","$1,565.49 ","$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$702.73 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$695.77 ,"$1,350.00 ",$695.77 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$32.94 ,$333.20 ,$78.66 ,$32.94 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000156,72020,HC XR C-SPINE 1V,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$32.94 ,$333.20 ,$78.66 ,$32.94 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000157,72020,HC XR SPINE 1V (L SPINE/ T SPINE) OR,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$32.94 ,$333.20 ,$78.66 ,$32.94 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000158,72020,HC XR SPINE 1V (C SPINE/L SPINE),320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$32.94 ,$333.20 ,$78.66 ,$32.94 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$32.94 ,$333.20 ,$78.66 ,$32.94 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000161,72020,HC XR L-SPINE 1V,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$65.75 ,$58.44 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$32.94 ,$333.20 ,$78.66 ,$32.94 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000162,72040,HC XR C-SPINE 2V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$78.66 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$354.96 ,$359.89 ,$57.01 ,$419.05 ,$78.66 ,$57.01 ,$419.05 ,$359.89 ,$17.98 ,$78.66 ,$207.06 ,$419.05 ,$177.00 ,$453.56 ,$345.10 ,$190.57 ,$204.59 ,$300.24 ,$190.57 ,$340.66 ,$354.96 ,$343.37 ,$79.45 ,$354.96 ,$19.06 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,32000163,72040,HC XR C-SPINE 3V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$78.66 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$354.96 ,$359.89 ,$57.01 ,$419.05 ,$78.66 ,$57.01 ,$419.05 ,$359.89 ,$17.98 ,$78.66 ,$207.06 ,$419.05 ,$177.00 ,$453.56 ,$345.10 ,$190.57 ,$204.59 ,$300.24 ,$190.57 ,$340.66 ,$354.96 ,$343.37 ,$79.45 ,$354.96 ,$19.06 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$78.66 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$354.96 ,$359.89 ,$57.01 ,$419.05 ,$78.66 ,$57.01 ,$419.05 ,$359.89 ,$17.98 ,$78.66 ,$207.06 ,$419.05 ,$177.00 ,$453.56 ,$345.10 ,$190.57 ,$204.59 ,$300.24 ,$190.57 ,$340.66 ,$354.96 ,$343.37 ,$79.45 ,$354.96 ,$19.06 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,32000165,72040,HC XR C-SPINE CLEAR 3V,320,1 ,$493.00 ,$246.50 ,$17.98 ,$493.00 ,$17.98 ,$109.20 ,$97.07 ,$78.66 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$354.96 ,$359.89 ,$57.01 ,$419.05 ,$78.66 ,$57.01 ,$419.05 ,$359.89 ,$17.98 ,$78.66 ,$207.06 ,$419.05 ,$177.00 ,$453.56 ,$345.10 ,$190.57 ,$204.59 ,$300.24 ,$190.57 ,$340.66 ,$354.96 ,$343.37 ,$79.45 ,$354.96 ,$19.06 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$78.66 ,$295.80 ,$419.05 ,$345.10 ,$17.98 ,$468.35 ,$354.96 ,$359.89 ,$57.01 ,$419.05 ,$78.66 ,$57.01 ,$419.05 ,$359.89 ,$17.98 ,$78.66 ,$207.06 ,$419.05 ,$177.00 ,$453.56 ,$345.10 ,$190.57 ,$204.59 ,$300.24 ,$190.57 ,$340.66 ,$354.96 ,$343.37 ,$79.45 ,$354.96 ,$19.06 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$105.88 ,$315.60 ,$447.10 ,$368.20 ,$17.98 ,$499.70 ,$378.72 ,$383.98 ,$79.75 ,$447.10 ,$105.88 ,$79.75 ,$447.10 ,$383.98 ,$17.98 ,$105.88 ,$220.92 ,$447.10 ,$238.23 ,$483.92 ,$368.20 ,$302.03 ,$324.25 ,$320.33 ,$302.03 ,$363.47 ,$378.72 ,$366.36 ,$106.94 ,$378.72 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$315.60 
ST MARY'S HOSPITAL,32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$180.60 ,$160.53 ,$105.88 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$491.76 ,$498.59 ,$95.10 ,$580.55 ,$105.88 ,$95.10 ,$580.55 ,$498.59 ,$17.98 ,$105.88 ,$286.86 ,$580.55 ,$238.23 ,$628.36 ,$478.10 ,$302.03 ,$324.25 ,$415.95 ,$302.03 ,$471.95 ,$491.76 ,$475.71 ,$106.94 ,$491.76 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,32000172,72070,HC XR T-SPINE 2V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$98.34 ,$87.41 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$45.65 ,$314.50 ,$105.88 ,$45.65 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000174,72072,HC XR T-SPINE 3V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$56.35 ,$314.50 ,$105.88 ,$56.35 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$302.03 ,$324.25 ,$225.33 ,$302.03 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000177,72100,HC XR L-SPINE 2 VIEW,320,1 ,$426.00 ,$213.00 ,$17.98 ,$426.00 ,$17.98 ,$109.20 ,$97.07 ,$105.88 ,$255.60 ,$362.10 ,$298.20 ,$17.98 ,$404.70 ,$306.72 ,$310.98 ,$57.69 ,$362.10 ,$105.88 ,$57.69 ,$362.10 ,$310.98 ,$17.98 ,$105.88 ,$178.92 ,$362.10 ,$238.23 ,$391.92 ,$298.20 ,$190.57 ,$204.59 ,$259.43 ,$190.57 ,$294.37 ,$306.72 ,$296.71 ,$106.94 ,$306.72 ,$19.06 ,$426.00 ,$426.00 ,$105.88 ,$426.00 ,$105.88 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$255.60 
ST MARY'S HOSPITAL,32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$426.00 ,$213.00 ,$17.98 ,$426.00 ,$17.98 ,$109.20 ,$97.07 ,$105.88 ,$255.60 ,$362.10 ,$298.20 ,$17.98 ,$404.70 ,$306.72 ,$310.98 ,$57.69 ,$362.10 ,$105.88 ,$57.69 ,$362.10 ,$310.98 ,$17.98 ,$105.88 ,$178.92 ,$362.10 ,$238.23 ,$391.92 ,$298.20 ,$190.57 ,$204.59 ,$259.43 ,$190.57 ,$294.37 ,$306.72 ,$296.71 ,$106.94 ,$306.72 ,$19.06 ,$426.00 ,$426.00 ,$105.88 ,$426.00 ,$105.88 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$255.60 
ST MARY'S HOSPITAL,32000180,72100,HC XR L-SPINE 2V OR,320,1 ,$426.00 ,$213.00 ,$17.98 ,$426.00 ,$17.98 ,$109.20 ,$97.07 ,$105.88 ,$255.60 ,$362.10 ,$298.20 ,$17.98 ,$404.70 ,$306.72 ,$310.98 ,$57.69 ,$362.10 ,$105.88 ,$57.69 ,$362.10 ,$310.98 ,$17.98 ,$105.88 ,$178.92 ,$362.10 ,$238.23 ,$391.92 ,$298.20 ,$190.57 ,$204.59 ,$259.43 ,$190.57 ,$294.37 ,$306.72 ,$296.71 ,$106.94 ,$306.72 ,$19.06 ,$426.00 ,$426.00 ,$105.88 ,$426.00 ,$105.88 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$255.60 
ST MARY'S HOSPITAL,32000181,72110,HC XR L-SPINE 4+V,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$152.66 ,$135.70 ,$105.88 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$491.76 ,$498.59 ,$77.06 ,$580.55 ,$105.88 ,$77.06 ,$580.55 ,$498.59 ,$17.98 ,$105.88 ,$286.86 ,$580.55 ,$238.23 ,$628.36 ,$478.10 ,$302.03 ,$324.25 ,$415.95 ,$302.03 ,$471.95 ,$491.76 ,$475.71 ,$106.94 ,$491.76 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,32000182,72110,HC XR L-SPINE 5V OBLIQUES,320,1 ,$683.00 ,$341.50 ,$17.98 ,$683.00 ,$17.98 ,$152.66 ,$135.70 ,$105.88 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$491.76 ,$498.59 ,$77.06 ,$580.55 ,$105.88 ,$77.06 ,$580.55 ,$498.59 ,$17.98 ,$105.88 ,$286.86 ,$580.55 ,$238.23 ,$628.36 ,$478.10 ,$302.03 ,$324.25 ,$415.95 ,$302.03 ,$471.95 ,$491.76 ,$475.71 ,$106.94 ,$491.76 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,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 ,$105.88 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$491.76 ,$498.59 ,$59.70 ,$580.55 ,$105.88 ,$59.70 ,$580.55 ,$498.59 ,$17.98 ,$105.88 ,$286.86 ,$580.55 ,$238.23 ,$628.36 ,$478.10 ,$302.03 ,$324.25 ,$415.95 ,$302.03 ,$471.95 ,$491.76 ,$475.71 ,$106.94 ,$491.76 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,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 ,$105.88 ,$409.80 ,$580.55 ,$478.10 ,$17.98 ,$648.85 ,$491.76 ,$498.59 ,$94.42 ,$580.55 ,$105.88 ,$94.42 ,$580.55 ,$498.59 ,$17.98 ,$105.88 ,$286.86 ,$580.55 ,$238.23 ,$628.36 ,$478.10 ,$302.03 ,$324.25 ,$415.95 ,$302.03 ,$471.95 ,$491.76 ,$475.71 ,$106.94 ,$491.76 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,32000186,72170,HC XR PELVIS 1-2V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$104.55 ,$92.93 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$38.29 ,$314.50 ,$105.88 ,$38.29 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000187,72170,HC XR PELVIS 1-2V OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$104.55 ,$92.93 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$38.29 ,$314.50 ,$105.88 ,$38.29 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000188,72170,HC XR PELVIS 1-2V FROG,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$104.55 ,$92.93 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$38.29 ,$314.50 ,$105.88 ,$38.29 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$124.72 ,$110.87 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$59.70 ,$314.50 ,$105.88 ,$59.70 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$56.35 ,$314.50 ,$105.88 ,$56.35 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.66 ,$314.50 ,$78.66 ,$47.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ",$695.77 ,"$1,357.20 ","$1,922.70 ","$1,583.40 ",$184.15 ,"$2,148.90 ","$1,628.64 ","$1,651.26 ",$233.50 ,"$1,922.70 ",$695.77 ,$233.50 ,"$1,922.70 ","$1,651.26 ",$184.15 ,$695.77 ,$950.04 ,"$1,922.70 ","$1,565.49 ","$2,081.04 ","$1,583.40 ","$1,489.75 ","$2,002.44 ","$1,377.56 ","$1,862.71 ","$1,563.04 ","$1,628.64 ","$1,575.48 ",$702.73 ,"$1,628.64 ",$195.20 ,$451.00 ,$451.00 ,$695.77 ,$451.00 ,$695.77 ,"$1,628.64 ","$1,402.44 ","$1,628.64 ","$1,628.64 ","$1,357.20 "
ST MARY'S HOSPITAL,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 ",$695.77 ,"$1,098.60 ","$1,556.35 ","$1,281.70 ",$184.15 ,"$1,739.45 ","$1,318.32 ","$1,336.63 ",$234.15 ,"$1,556.35 ",$695.77 ,$234.15 ,"$1,556.35 ","$1,336.63 ",$184.15 ,$695.77 ,$769.02 ,"$1,556.35 ","$1,565.49 ","$1,684.52 ","$1,281.70 ","$1,489.75 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,318.32 ","$1,275.29 ",$702.73 ,"$1,318.32 ",$195.20 ,$451.00 ,$451.00 ,$695.77 ,$451.00 ,$695.77 ,"$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,098.60 "
ST MARY'S HOSPITAL,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 ",$695.77 ,"$1,098.60 ","$1,556.35 ","$1,281.70 ",$184.15 ,"$1,739.45 ","$1,318.32 ","$1,336.63 ",$229.99 ,"$1,556.35 ",$695.77 ,$229.99 ,"$1,556.35 ","$1,336.63 ",$184.15 ,$695.77 ,$769.02 ,"$1,556.35 ","$1,565.49 ","$1,684.52 ","$1,281.70 ","$1,489.75 ","$1,831.00 ","$1,115.08 ","$1,831.00 ","$1,265.22 ","$1,318.32 ","$1,275.29 ",$702.73 ,"$1,318.32 ",$195.20 ,$451.00 ,$451.00 ,$695.77 ,$451.00 ,$695.77 ,"$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,098.60 "
ST MARY'S HOSPITAL,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 ",$695.77 ,"$1,293.00 ","$1,831.75 ","$1,508.50 ",$184.15 ,"$2,047.25 ","$1,551.60 ","$1,573.15 ",$239.95 ,"$1,831.75 ",$695.77 ,$239.95 ,"$1,831.75 ","$1,573.15 ",$184.15 ,$695.77 ,$905.10 ,"$1,831.75 ","$1,565.49 ","$1,982.60 ","$1,508.50 ","$1,489.75 ","$2,002.44 ","$1,312.40 ","$1,862.71 ","$1,489.11 ","$1,551.60 ","$1,500.96 ",$702.73 ,"$1,551.60 ",$195.20 ,$451.00 ,$451.00 ,$695.77 ,$451.00 ,$695.77 ,"$1,551.60 ","$1,336.10 ","$1,551.60 ","$1,551.60 ","$1,293.00 "
ST MARY'S HOSPITAL,32000198,72285,HC XR DISKOGRAM C- OR T-SPINE,320,1 ,"$2,240.00 ","$1,120.00 ",$142.56 ,"$3,842.24 ",$184.15 ,$251.99 ,$223.99 ,"$1,707.66 ","$1,344.00 ","$1,904.00 ","$1,568.00 ",$184.15 ,"$2,128.00 ","$1,612.80 ","$1,635.20 ",$142.56 ,"$1,904.00 ","$1,707.66 ",$142.56 ,"$1,904.00 ","$1,635.20 ",$184.15 ,"$1,707.66 ",$940.80 ,"$1,904.00 ","$3,842.24 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$1,612.80 ","$1,560.16 ","$1,724.74 ","$1,612.80 ",$195.20 ,$451.00 ,$451.00 ,"$1,707.66 ",$451.00 ,"$1,707.66 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,32000200,72295,HC XR DISKOGRAM L-SPINE,320,1 ,"$2,912.00 ","$1,456.00 ",$144.57 ,"$3,842.24 ",$184.15 ,$258.20 ,$229.51 ,"$1,707.66 ","$1,747.20 ","$2,475.20 ","$2,038.40 ",$184.15 ,"$2,766.40 ","$2,096.64 ","$2,125.76 ",$144.57 ,"$2,475.20 ","$1,707.66 ",$144.57 ,"$2,475.20 ","$2,125.76 ",$184.15 ,"$1,707.66 ","$1,223.04 ","$2,475.20 ","$3,842.24 ","$2,679.04 ","$2,038.40 ","$2,912.00 ","$2,912.00 ","$1,773.41 ","$2,912.00 ","$2,012.19 ","$2,096.64 ","$2,028.21 ","$1,724.74 ","$2,096.64 ",$195.20 ,$451.00 ,$451.00 ,"$1,707.66 ",$451.00 ,"$1,707.66 ","$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$1,747.20 "
ST MARY'S HOSPITAL,32000201,73000,HC XRAY CLAVICLE,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$89.03 ,$79.14 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$47.66 ,$333.20 ,$78.66 ,$47.66 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000202,73000,HC XRAY CLAVICLE 2V OR,320,1 ,$392.00 ,$196.00 ,$17.98 ,$392.00 ,$17.98 ,$89.03 ,$79.14 ,$78.66 ,$235.20 ,$333.20 ,$274.40 ,$17.98 ,$372.40 ,$282.24 ,$286.16 ,$47.66 ,$333.20 ,$78.66 ,$47.66 ,$333.20 ,$286.16 ,$17.98 ,$78.66 ,$164.64 ,$333.20 ,$177.00 ,$360.64 ,$274.40 ,$190.57 ,$204.59 ,$238.73 ,$190.57 ,$270.87 ,$282.24 ,$273.03 ,$79.45 ,$282.24 ,$19.06 ,$392.00 ,$392.00 ,$78.66 ,$392.00 ,$78.66 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,32000204,73010,HC XRAY SCAPULA,320,1 ,$414.00 ,$207.00 ,$17.98 ,$414.00 ,$17.98 ,$98.34 ,$87.41 ,$105.88 ,$248.40 ,$351.90 ,$289.80 ,$17.98 ,$393.30 ,$298.08 ,$302.22 ,$29.62 ,$351.90 ,$105.88 ,$29.62 ,$351.90 ,$302.22 ,$17.98 ,$105.88 ,$173.88 ,$351.90 ,$238.23 ,$380.88 ,$289.80 ,$190.57 ,$204.59 ,$252.13 ,$190.57 ,$286.07 ,$298.08 ,$288.35 ,$106.94 ,$298.08 ,$19.06 ,$414.00 ,$414.00 ,$105.88 ,$414.00 ,$105.88 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$248.40 
ST MARY'S HOSPITAL,32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$67.30 ,$59.82 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$27.61 ,$314.50 ,$78.66 ,$27.61 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$50.33 ,$314.50 ,$78.66 ,$50.33 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$50.33 ,$314.50 ,$78.66 ,$50.33 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000209,73030,HC XRAY SHOULDER TRAUMA (MIN 2V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$50.33 ,$314.50 ,$78.66 ,$50.33 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,792.00 ",$896.00 ,$56.88 ,"$1,792.00 ",$56.88 ,$362.18 ,$321.94 ,$358.13 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$56.88 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$212.05 ,"$1,523.20 ",$358.13 ,$212.05 ,"$1,523.20 ","$1,308.16 ",$56.88 ,$358.13 ,$752.64 ,"$1,523.20 ",$805.79 ,"$1,648.64 ","$1,254.40 ","$1,691.40 ","$1,792.00 ","$1,091.33 ","$1,691.40 ","$1,238.27 ","$1,290.24 ","$1,248.13 ",$361.71 ,"$1,290.24 ",$60.29 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,792.00 ",$896.00 ,$56.88 ,"$1,792.00 ",$56.88 ,$362.18 ,$321.94 ,$358.13 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$56.88 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$212.05 ,"$1,523.20 ",$358.13 ,$212.05 ,"$1,523.20 ","$1,308.16 ",$56.88 ,$358.13 ,$752.64 ,"$1,523.20 ",$805.79 ,"$1,648.64 ","$1,254.40 ","$1,691.40 ","$1,792.00 ","$1,091.33 ","$1,691.40 ","$1,238.27 ","$1,290.24 ","$1,248.13 ",$361.71 ,"$1,290.24 ",$60.29 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,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 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$38.29 ,$314.50 ,$78.66 ,$38.29 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.64 ,$314.50 ,$78.66 ,$47.64 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$93.68 ,$83.27 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.64 ,$314.50 ,$78.66 ,$47.64 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$81.27 ,$72.24 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$41.66 ,$314.50 ,$78.66 ,$41.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$81.27 ,$72.24 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$41.66 ,$314.50 ,$78.66 ,$41.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000219,73070,HC XRAY ELBOW (2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$81.27 ,$72.24 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$41.66 ,$314.50 ,$78.66 ,$41.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$90.58 ,$80.52 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.66 ,$314.50 ,$78.66 ,$47.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$90.58 ,$80.52 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.66 ,$314.50 ,$78.66 ,$47.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,$974.00 ,$487.00 ,$37.92 ,$974.00 ,$37.92 ,$335.80 ,$298.49 ,$358.13 ,$584.40 ,$827.90 ,$681.80 ,$37.92 ,$925.30 ,$701.28 ,$711.02 ,$172.63 ,$827.90 ,$358.13 ,$172.63 ,$827.90 ,$711.02 ,$37.92 ,$358.13 ,$409.08 ,$827.90 ,$805.79 ,$896.08 ,$681.80 ,$974.00 ,$974.00 ,$593.17 ,$974.00 ,$673.03 ,$701.28 ,$678.39 ,$361.71 ,$701.28 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$584.40 
ST MARY'S HOSPITAL,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$84.37 ,$75.00 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$42.31 ,$314.50 ,$78.66 ,$42.31 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$84.37 ,$75.00 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$42.31 ,$314.50 ,$78.66 ,$42.31 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000225,73090,HC XRAY FOREARM (2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$84.37 ,$75.00 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$42.31 ,$314.50 ,$78.66 ,$42.31 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$47.64 ,$314.50 ,$105.88 ,$47.64 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$302.03 ,$324.25 ,$225.33 ,$302.03 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000228,73100,HC XRAY WRIST 2 VIEWS NAVICULAR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$101.44 ,$90.17 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$51.00 ,$314.50 ,$78.66 ,$51.00 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$101.44 ,$90.17 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$51.00 ,$314.50 ,$78.66 ,$51.00 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$101.44 ,$90.17 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$51.00 ,$314.50 ,$78.66 ,$51.00 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000232,73100,HC XRAY WRIST 2 VIEWS OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$101.44 ,$90.17 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$51.00 ,$314.50 ,$78.66 ,$51.00 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$120.07 ,$106.73 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$64.35 ,$314.50 ,$78.66 ,$64.35 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$120.07 ,$106.73 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$64.35 ,$314.50 ,$78.66 ,$64.35 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$64.35 ,$314.50 ,$78.66 ,$64.35 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,$974.00 ,$487.00 ,$37.92 ,$974.00 ,$37.92 ,$390.12 ,$346.77 ,$358.13 ,$584.40 ,$827.90 ,$681.80 ,$37.92 ,$925.30 ,$701.28 ,$711.02 ,$221.42 ,$827.90 ,$358.13 ,$221.42 ,$827.90 ,$711.02 ,$37.92 ,$358.13 ,$409.08 ,$827.90 ,$805.79 ,$896.08 ,$681.80 ,$974.00 ,$974.00 ,$593.17 ,$974.00 ,$673.03 ,$701.28 ,$678.39 ,$361.71 ,$701.28 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$701.28 ,$603.88 ,$701.28 ,$701.28 ,$584.40 
ST MARY'S HOSPITAL,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$45.65 ,$314.50 ,$105.88 ,$45.65 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$89.03 ,$79.14 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$45.65 ,$314.50 ,$105.88 ,$45.65 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$106.10 ,$94.31 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$55.68 ,$314.50 ,$78.66 ,$55.68 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$106.10 ,$94.31 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$55.68 ,$314.50 ,$78.66 ,$55.68 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$115.41 ,$102.59 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$61.01 ,$314.50 ,$78.66 ,$61.01 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$61.01 ,$314.50 ,$78.66 ,$61.01 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,792.00 ",$896.00 ,$37.92 ,"$1,792.00 ",$37.92 ,$363.74 ,$323.32 ,$358.13 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$37.92 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$214.06 ,"$1,523.20 ",$358.13 ,$214.06 ,"$1,523.20 ","$1,308.16 ",$37.92 ,$358.13 ,$752.64 ,"$1,523.20 ",$805.79 ,"$1,648.64 ","$1,254.40 ","$1,127.60 ","$1,210.57 ","$1,091.33 ","$1,127.60 ","$1,238.27 ","$1,290.24 ","$1,248.13 ",$361.71 ,"$1,290.24 ",$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,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 ,$358.13 ,"$1,075.20 ","$1,523.20 ","$1,254.40 ",$37.92 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$214.06 ,"$1,523.20 ",$358.13 ,$214.06 ,"$1,523.20 ","$1,308.16 ",$37.92 ,$358.13 ,$752.64 ,"$1,523.20 ",$805.79 ,"$1,648.64 ","$1,254.40 ","$1,127.60 ","$1,210.57 ","$1,091.33 ","$1,127.60 ","$1,238.27 ","$1,290.24 ","$1,248.13 ",$361.71 ,"$1,290.24 ",$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$103.00 ,$91.55 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$51.68 ,$314.50 ,$78.66 ,$51.68 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$103.00 ,$91.55 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$51.68 ,$314.50 ,$78.66 ,$51.68 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000262,73560,HC XRAY KNEE (1 OR 2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$103.00 ,$91.55 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$51.68 ,$314.50 ,$78.66 ,$51.68 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$120.07 ,$106.73 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$63.04 ,$314.50 ,$78.66 ,$63.04 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000263,73562,HC XRAY KNEE (3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$120.07 ,$106.73 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$63.04 ,$314.50 ,$78.66 ,$63.04 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$130.93 ,$116.38 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$70.38 ,$314.50 ,$105.88 ,$70.38 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$130.93 ,$116.38 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$70.38 ,$314.50 ,$105.88 ,$70.38 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000267,73565,HC XR KNEE STAND,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$123.17 ,$109.49 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$63.69 ,$314.50 ,$78.66 ,$63.69 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,120.00 ",$560.00 ,$37.92 ,"$1,120.00 ",$37.92 ,$428.92 ,$381.26 ,$358.13 ,$672.00 ,$952.00 ,$784.00 ,$37.92 ,"$1,064.00 ",$806.40 ,$817.60 ,$242.13 ,$952.00 ,$358.13 ,$242.13 ,$952.00 ,$817.60 ,$37.92 ,$358.13 ,$470.40 ,$952.00 ,$805.79 ,"$1,030.40 ",$784.00 ,"$1,120.00 ","$1,120.00 ",$682.08 ,"$1,120.00 ",$773.92 ,$806.40 ,$780.08 ,$361.71 ,$806.40 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,120.00 ",$560.00 ,$37.92 ,"$1,120.00 ",$37.92 ,$428.92 ,$381.26 ,$358.13 ,$672.00 ,$952.00 ,$784.00 ,$37.92 ,"$1,064.00 ",$806.40 ,$817.60 ,$242.13 ,$952.00 ,$358.13 ,$242.13 ,$952.00 ,$817.60 ,$37.92 ,$358.13 ,$470.40 ,$952.00 ,$805.79 ,"$1,030.40 ",$784.00 ,"$1,120.00 ","$1,120.00 ",$682.08 ,"$1,120.00 ",$773.92 ,$806.40 ,$780.08 ,$361.71 ,$806.40 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$92.13 ,$81.90 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$46.99 ,$314.50 ,$78.66 ,$46.99 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$92.13 ,$81.90 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$46.99 ,$314.50 ,$78.66 ,$46.99 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000271,73590,HC XRAY TIBIA/FIBULA 2 VIEW OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$92.13 ,$81.90 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$46.99 ,$314.50 ,$78.66 ,$46.99 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$47.64 ,$314.50 ,$78.66 ,$47.64 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$89.03 ,$79.14 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$47.64 ,$314.50 ,$78.66 ,$47.64 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$96.79 ,$86.03 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$48.32 ,$314.50 ,$78.66 ,$48.32 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$96.79 ,$86.03 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$48.32 ,$314.50 ,$78.66 ,$48.32 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000275,73600,HC XRAY ANKLE (2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$96.79 ,$86.03 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$48.32 ,$314.50 ,$78.66 ,$48.32 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$106.10 ,$94.31 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$56.33 ,$314.50 ,$78.66 ,$56.33 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$106.10 ,$94.31 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$56.33 ,$314.50 ,$78.66 ,$56.33 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,456.00 ",$728.00 ,$37.92 ,"$1,456.00 ",$37.92 ,$388.57 ,$345.39 ,$358.13 ,$873.60 ,"$1,237.60 ","$1,019.20 ",$37.92 ,"$1,383.20 ","$1,048.32 ","$1,062.88 ",$213.38 ,"$1,237.60 ",$358.13 ,$213.38 ,"$1,237.60 ","$1,062.88 ",$37.92 ,$358.13 ,$611.52 ,"$1,237.60 ",$805.79 ,"$1,339.52 ","$1,019.20 ","$1,127.60 ","$1,210.57 ",$886.70 ,"$1,127.60 ","$1,006.10 ","$1,048.32 ","$1,014.10 ",$361.71 ,"$1,048.32 ",$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$82.82 ,$73.62 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$40.98 ,$314.50 ,$78.66 ,$40.98 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000279,73620,HC XRAY FOOT (2 V),320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$82.82 ,$73.62 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$40.98 ,$314.50 ,$78.66 ,$40.98 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$285.86 ,$306.89 ,$225.33 ,$285.86 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000280,73620,HC XRAY FOOT (2 V) OR,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$40.98 ,$314.50 ,$78.66 ,$40.98 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$555.00 ,$277.50 ,$26.97 ,$555.00 ,$26.97 ,$98.34 ,$87.41 ,$78.66 ,$333.00 ,$471.75 ,$388.50 ,$26.97 ,$527.25 ,$399.60 ,$405.15 ,$52.34 ,$471.75 ,$78.66 ,$52.34 ,$471.75 ,$405.15 ,$26.97 ,$78.66 ,$233.10 ,$471.75 ,$177.00 ,$510.60 ,$388.50 ,$285.86 ,$306.89 ,$338.00 ,$285.86 ,$383.51 ,$399.60 ,$386.56 ,$79.45 ,$399.60 ,$28.59 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$333.00 
ST MARY'S HOSPITAL,32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$98.34 ,$87.41 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$52.34 ,$314.50 ,$78.66 ,$52.34 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$81.27 ,$72.24 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$41.64 ,$314.50 ,$78.66 ,$41.64 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$555.00 ,$277.50 ,$26.97 ,$555.00 ,$26.97 ,$81.27 ,$72.24 ,$78.66 ,$333.00 ,$471.75 ,$388.50 ,$26.97 ,$527.25 ,$399.60 ,$405.15 ,$41.64 ,$471.75 ,$78.66 ,$41.64 ,$471.75 ,$405.15 ,$26.97 ,$78.66 ,$233.10 ,$471.75 ,$177.00 ,$510.60 ,$388.50 ,$285.86 ,$306.89 ,$338.00 ,$285.86 ,$383.51 ,$399.60 ,$386.56 ,$79.45 ,$399.60 ,$28.59 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$333.00 
ST MARY'S HOSPITAL,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$555.00 ,$277.50 ,$26.97 ,$555.00 ,$26.97 ,$95.24 ,$84.65 ,$78.66 ,$333.00 ,$471.75 ,$388.50 ,$26.97 ,$527.25 ,$399.60 ,$405.15 ,$44.98 ,$471.75 ,$78.66 ,$44.98 ,$471.75 ,$405.15 ,$26.97 ,$78.66 ,$233.10 ,$471.75 ,$177.00 ,$510.60 ,$388.50 ,$285.86 ,$306.89 ,$338.00 ,$285.86 ,$383.51 ,$399.60 ,$386.56 ,$79.45 ,$399.60 ,$28.59 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$333.00 
ST MARY'S HOSPITAL,32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$95.24 ,$84.65 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$44.98 ,$314.50 ,$78.66 ,$44.98 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$42.31 ,$314.50 ,$78.66 ,$42.31 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$204.25 ,$219.27 ,$225.33 ,$204.25 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000292,74018,HC XRAY ABDOMEN 1V SHUNTOGRAM,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$42.31 ,$314.50 ,$78.66 ,$42.31 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$204.25 ,$219.27 ,$225.33 ,$204.25 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$50.98 ,$314.50 ,$105.88 ,$50.98 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$50.98 ,$314.50 ,$105.88 ,$50.98 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$50.98 ,$314.50 ,$105.88 ,$50.98 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$50.98 ,$314.50 ,$105.88 ,$50.98 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$370.00 ,$370.00 ,$225.33 ,$370.00 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$315.60 ,$447.10 ,$368.20 ,$17.98 ,$499.70 ,$378.72 ,$383.98 ,$69.04 ,$447.10 ,$105.88 ,$69.04 ,$447.10 ,$383.98 ,$17.98 ,$105.88 ,$220.92 ,$447.10 ,$238.23 ,$483.92 ,$368.20 ,$302.03 ,$324.25 ,$320.33 ,$302.03 ,$363.47 ,$378.72 ,$366.36 ,$106.94 ,$378.72 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$315.60 
ST MARY'S HOSPITAL,32000299,74190,HC S AND I PERITONEOGRAM,320,1 ,$661.00 ,$330.50 ,$37.92 ,"$1,057.30 ",$37.92 ,$146.01 ,$129.78 ,$469.91 ,$396.60 ,$561.85 ,$462.70 ,$37.92 ,$627.95 ,$475.92 ,$482.53 ,$108.24 ,$561.85 ,$469.91 ,$108.24 ,$561.85 ,$482.53 ,$37.92 ,$469.91 ,$277.62 ,$561.85 ,"$1,057.30 ",$608.12 ,$462.70 ,$661.00 ,$661.00 ,$402.55 ,$661.00 ,$456.75 ,$475.92 ,$460.39 ,$474.61 ,$475.92 ,$40.20 ,$451.00 ,$451.00 ,$469.91 ,$451.00 ,$469.91 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$605.00 ,$302.50 ,$17.98 ,$605.00 ,$17.98 ,$273.72 ,$243.31 ,$173.72 ,$363.00 ,$514.25 ,$423.50 ,$17.98 ,$574.75 ,$435.60 ,$441.65 ,$143.89 ,$514.25 ,$173.72 ,$143.89 ,$514.25 ,$441.65 ,$17.98 ,$173.72 ,$254.10 ,$514.25 ,$390.86 ,$556.60 ,$423.50 ,$338.43 ,$363.33 ,$368.45 ,$338.43 ,$418.06 ,$435.60 ,$421.38 ,$175.46 ,$435.60 ,$19.06 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$363.00 
ST MARY'S HOSPITAL,32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$616.00 ,$308.00 ,$37.92 ,$616.00 ,$37.92 ,$438.23 ,$389.54 ,$173.72 ,$369.60 ,$523.60 ,$431.20 ,$37.92 ,$585.20 ,$443.52 ,$449.68 ,$209.39 ,$523.60 ,$173.72 ,$209.39 ,$523.60 ,$449.68 ,$37.92 ,$173.72 ,$258.72 ,$523.60 ,$390.86 ,$566.72 ,$431.20 ,$338.43 ,$363.33 ,$375.14 ,$338.43 ,$425.66 ,$443.52 ,$429.04 ,$175.46 ,$443.52 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$369.60 
ST MARY'S HOSPITAL,32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,$616.00 ,$308.00 ,$37.92 ,$616.00 ,$37.92 ,$380.81 ,$338.50 ,$173.72 ,$369.60 ,$523.60 ,$431.20 ,$37.92 ,$585.20 ,$443.52 ,$449.68 ,$175.97 ,$523.60 ,$173.72 ,$175.97 ,$523.60 ,$449.68 ,$37.92 ,$173.72 ,$258.72 ,$523.60 ,$390.86 ,$566.72 ,$431.20 ,$502.55 ,$539.52 ,$375.14 ,$502.55 ,$425.66 ,$443.52 ,$429.04 ,$175.46 ,$443.52 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$369.60 
ST MARY'S HOSPITAL,32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,$952.00 ,$476.00 ,$37.92 ,$952.00 ,$37.92 ,$442.89 ,$393.68 ,$173.72 ,$571.20 ,$809.20 ,$666.40 ,$37.92 ,$904.40 ,$685.44 ,$694.96 ,$202.68 ,$809.20 ,$173.72 ,$202.68 ,$809.20 ,$694.96 ,$37.92 ,$173.72 ,$399.84 ,$809.20 ,$390.86 ,$875.84 ,$666.40 ,$502.55 ,$539.52 ,$579.77 ,$502.55 ,$657.83 ,$685.44 ,$663.07 ,$175.46 ,$685.44 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$571.20 
ST MARY'S HOSPITAL,32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,$952.00 ,$476.00 ,$37.92 ,$952.00 ,$37.92 ,$442.89 ,$393.68 ,$173.72 ,$571.20 ,$809.20 ,$666.40 ,$37.92 ,$904.40 ,$685.44 ,$694.96 ,$202.68 ,$809.20 ,$173.72 ,$202.68 ,$809.20 ,$694.96 ,$37.92 ,$173.72 ,$399.84 ,$809.20 ,$390.86 ,$875.84 ,$666.40 ,$502.55 ,$539.52 ,$579.77 ,$502.55 ,$657.83 ,$685.44 ,$663.07 ,$175.46 ,$685.44 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$571.20 
ST MARY'S HOSPITAL,32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$717.00 ,$358.50 ,$37.92 ,$717.00 ,$37.92 ,$388.57 ,$345.39 ,$173.72 ,$430.20 ,$609.45 ,$501.90 ,$37.92 ,$681.15 ,$516.24 ,$523.41 ,$174.64 ,$609.45 ,$173.72 ,$174.64 ,$609.45 ,$523.41 ,$37.92 ,$173.72 ,$301.14 ,$609.45 ,$390.86 ,$659.64 ,$501.90 ,$338.43 ,$363.33 ,$436.65 ,$338.43 ,$495.45 ,$516.24 ,$499.39 ,$175.46 ,$516.24 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$430.20 
ST MARY'S HOSPITAL,32000312,74018,HC SITZ MARKER STUDY,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$82.82 ,$73.62 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$42.31 ,$314.50 ,$78.66 ,$42.31 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$204.25 ,$219.27 ,$225.33 ,$204.25 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000315,74270,HC XRAY COLON BARIUM,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$551.53 ,$490.25 ,$173.72 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$548.64 ,$556.26 ,$218.08 ,$647.70 ,$173.72 ,$218.08 ,$647.70 ,$556.26 ,$37.92 ,$173.72 ,$320.04 ,$647.70 ,$390.86 ,$701.04 ,$533.40 ,$502.55 ,$539.52 ,$464.06 ,$502.55 ,$526.54 ,$548.64 ,$530.73 ,$175.46 ,$548.64 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$551.53 ,$490.25 ,$173.72 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$548.64 ,$556.26 ,$218.08 ,$647.70 ,$173.72 ,$218.08 ,$647.70 ,$556.26 ,$37.92 ,$173.72 ,$320.04 ,$647.70 ,$390.86 ,$701.04 ,$533.40 ,$502.55 ,$539.52 ,$464.06 ,$502.55 ,$526.54 ,$548.64 ,$530.73 ,$175.46 ,$548.64 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$551.53 ,$490.25 ,$173.72 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$548.64 ,$556.26 ,$218.08 ,$647.70 ,$173.72 ,$218.08 ,$647.70 ,$556.26 ,$37.92 ,$173.72 ,$320.04 ,$647.70 ,$390.86 ,$701.04 ,$533.40 ,$502.55 ,$539.52 ,$464.06 ,$502.55 ,$526.54 ,$548.64 ,$530.73 ,$175.46 ,$548.64 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,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 ,$173.72 ,$658.80 ,$933.30 ,$768.60 ,$37.92 ,"$1,043.10 ",$790.56 ,$801.54 ,$336.36 ,$933.30 ,$173.72 ,$336.36 ,$933.30 ,$801.54 ,$37.92 ,$173.72 ,$461.16 ,$933.30 ,$390.86 ,"$1,010.16 ",$768.60 ,$502.55 ,$539.52 ,$668.68 ,$502.55 ,$758.72 ,$790.56 ,$764.76 ,$175.46 ,$790.56 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$790.56 ,$680.76 ,$790.56 ,$790.56 ,$658.80 
ST MARY'S HOSPITAL,32000322,74283,HC THERAPEUTIC COLON,320,1 ,$762.00 ,$381.00 ,$37.92 ,$762.00 ,$37.92 ,$568.60 ,$505.43 ,$173.72 ,$457.20 ,$647.70 ,$533.40 ,$37.92 ,$723.90 ,$548.64 ,$556.26 ,$323.65 ,$647.70 ,$173.72 ,$323.65 ,$647.70 ,$556.26 ,$37.92 ,$173.72 ,$320.04 ,$647.70 ,$390.86 ,$701.04 ,$533.40 ,$502.55 ,$539.52 ,$464.06 ,$502.55 ,$526.54 ,$548.64 ,$530.73 ,$175.46 ,$548.64 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$773.00 ,$386.50 ,$56.46 ,$773.00 ,$56.46 ,$145.60 ,$129.42 , N/A ,$463.80 ,$657.05 ,$541.10 ,$56.46 ,$734.35 ,$556.56 ,$564.29 ,$98.36 ,$657.05 , N/A ,$98.36 ,$657.05 ,$564.29 ,$56.46 , N/A ,$324.66 ,$657.05 , N/A ,$711.16 ,$541.10 ,$392.07 ,$470.53 ,$470.76 ,$439.14 ,$534.14 ,$556.56 ,$538.39 , N/A ,$556.56 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$556.56 ,$479.26 ,$556.56 ,$556.56 ,$463.80 
ST MARY'S HOSPITAL,32000325,47531,HC XRAY CHOLANGIOGRAM THRU CATH,320,1 ,"$1,680.00 ",$840.00 ,$135.98 ,"$6,961.86 ",$573.58 ,"$1,086.79 ","$1,086.79 ","$3,094.16 ","$1,008.00 ","$1,428.00 ","$1,176.00 ",$573.58 ,"$1,596.00 ","$1,209.60 ","$1,226.40 ",$135.98 ,"$1,428.00 ","$3,094.16 ",$135.98 ,"$1,428.00 ","$1,226.40 ",$573.58 ,"$3,094.16 ",$705.60 ,"$1,428.00 ","$6,961.86 ","$1,545.60 ","$1,176.00 ","$1,680.00 ","$1,680.00 ","$1,023.12 ","$1,680.00 ","$1,160.88 ","$1,209.60 ","$1,170.12 ","$3,125.10 ","$1,209.60 ",$607.99 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,32000326,47532,HC PERCUTAN CHOLANGIOGRAM,320,1 ,"$2,128.00 ","$1,064.00 ",$407.68 ,"$6,961.86 ",$573.58 ,"$1,376.60 ","$1,376.60 ","$3,094.16 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$573.58 ,"$2,021.60 ","$1,532.16 ","$1,553.44 ",$407.68 ,"$1,808.80 ","$3,094.16 ",$407.68 ,"$1,808.80 ","$1,553.44 ",$573.58 ,"$3,094.16 ",$893.76 ,"$1,808.80 ","$6,961.86 ","$1,957.76 ","$1,489.60 ","$1,680.96 ","$2,128.00 ","$1,295.95 ","$2,101.20 ","$1,470.45 ","$1,532.16 ","$1,482.15 ","$3,125.10 ","$1,532.16 ",$607.99 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,276.80 "
ST MARY'S HOSPITAL,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 ","$2,564.64 ","$2,600.26 ",$300.02 ,"$3,027.70 ", N/A ,$300.02 ,"$3,027.70 ","$2,600.26 ",$791.20 , N/A ,"$1,496.04 ","$3,027.70 ", N/A ,"$3,277.04 ","$2,493.40 ","$1,680.96 ","$2,259.84 ","$2,169.26 ","$2,101.20 ","$2,461.34 ","$2,564.64 ","$2,480.93 ", N/A ,"$2,564.64 ",$838.67 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,564.64 ","$2,208.44 ","$2,564.64 ","$2,564.64 ","$2,137.20 "
ST MARY'S HOSPITAL,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 ",$798.48 ,$809.57 ,$261.13 ,$942.65 , N/A ,$261.13 ,$942.65 ,$809.57 ,$56.46 , N/A ,$465.78 ,$942.65 , N/A ,"$1,020.28 ",$776.30 ,$562.48 ,$675.05 ,$675.38 ,$630.02 ,$766.32 ,$798.48 ,$772.42 , N/A ,$798.48 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$798.48 ,$687.58 ,$798.48 ,$798.48 ,$665.40 
ST MARY'S HOSPITAL,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 ",$798.48 ,$809.57 ,$261.13 ,$942.65 , N/A ,$261.13 ,$942.65 ,$809.57 ,$56.46 , N/A ,$465.78 ,$942.65 , N/A ,"$1,020.28 ",$776.30 ,$562.48 ,$675.05 ,$675.38 ,$630.02 ,$766.32 ,$798.48 ,$772.42 , N/A ,$798.48 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$798.48 ,$687.58 ,$798.48 ,$798.48 ,$665.40 
ST MARY'S HOSPITAL,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 ","$1,048.32 ","$1,062.88 ",$261.13 ,"$1,237.60 ", N/A ,$261.13 ,"$1,237.60 ","$1,062.88 ",$56.46 , N/A ,$611.52 ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$827.15 ,"$1,006.10 ","$1,048.32 ","$1,014.10 ", N/A ,"$1,048.32 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,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 ,$463.68 ,$470.12 ,$217.22 ,$547.40 , N/A ,$217.22 ,$547.40 ,$470.12 ,$56.46 , N/A ,$270.48 ,$547.40 , N/A ,$592.48 ,$450.80 ,$326.64 ,$392.00 ,$392.20 ,$365.86 ,$445.00 ,$463.68 ,$448.55 , N/A ,$463.68 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$463.68 ,$399.28 ,$463.68 ,$463.68 ,$386.40 
ST MARY'S HOSPITAL,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 ","$1,234.08 ","$1,251.22 ",$217.22 ,"$1,456.90 ", N/A ,$217.22 ,"$1,456.90 ","$1,251.22 ",$56.46 , N/A ,$719.88 ,"$1,456.90 ", N/A ,"$1,576.88 ","$1,199.80 ",$869.34 ,"$1,043.31 ","$1,043.83 ",$973.72 ,"$1,184.37 ","$1,234.08 ","$1,193.80 ", N/A ,"$1,234.08 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$1,234.08 ","$1,062.68 ","$1,234.08 ","$1,234.08 ","$1,028.40 "
ST MARY'S HOSPITAL,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 ,$173.72 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$230.11 ,$761.60 ,$173.72 ,$230.11 ,$761.60 ,$654.08 ,$37.92 ,$173.72 ,$376.32 ,$761.60 ,$390.86 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$175.46 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000337,74410,HC XRAY UROGRAM IVP DRIP TECH,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$421.16 ,$374.37 ,$173.72 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$239.46 ,$761.60 ,$173.72 ,$239.46 ,$761.60 ,$654.08 ,$37.92 ,$173.72 ,$376.32 ,$761.60 ,$390.86 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$175.46 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$173.72 ,$451.00 ,$173.72 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,$739.00 ,$369.50 ,$37.92 ,$805.79 ,$37.92 ,$199.22 ,$177.09 ,$358.13 ,$443.40 ,$628.15 ,$517.30 ,$37.92 ,$702.05 ,$532.08 ,$539.47 ,$104.45 ,$628.15 ,$358.13 ,$104.45 ,$628.15 ,$539.47 ,$37.92 ,$358.13 ,$310.38 ,$628.15 ,$805.79 ,$679.88 ,$517.30 ,$739.00 ,$739.00 ,$450.05 ,$739.00 ,$510.65 ,$532.08 ,$514.71 ,$361.71 ,$532.08 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$532.08 ,$458.18 ,$532.08 ,$532.08 ,$443.40 
ST MARY'S HOSPITAL,32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,$739.00 ,$369.50 ,$37.92 ,$805.79 ,$37.92 ,$478.06 ,$478.06 ,$358.13 ,$443.40 ,$628.15 ,$517.30 ,$37.92 ,$702.05 ,$532.08 ,$539.47 ,$230.75 ,$628.15 ,$358.13 ,$230.75 ,$628.15 ,$539.47 ,$37.92 ,$358.13 ,$310.38 ,$628.15 ,$805.79 ,$679.88 ,$517.30 ,$739.00 ,$739.00 ,$450.05 ,$739.00 ,$510.65 ,$532.08 ,$514.71 ,$361.71 ,$532.08 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$532.08 ,$458.18 ,$532.08 ,$532.08 ,$443.40 
ST MARY'S HOSPITAL,32000341,50431,HC ANGIO NEPHROSTGRAM,320,1 ,$762.00 ,$381.00 ,$119.36 ,"$1,258.87 ",$119.36 ,$492.94 ,$492.94 ,$559.50 ,$457.20 ,$647.70 ,$533.40 ,$119.36 ,$723.90 ,$548.64 ,$556.26 ,$126.24 ,$647.70 ,$559.50 ,$126.24 ,$647.70 ,$556.26 ,$119.36 ,$559.50 ,$320.04 ,$647.70 ,"$1,258.87 ",$701.04 ,$533.40 ,$762.00 ,$762.00 ,$464.06 ,$762.00 ,$526.54 ,$548.64 ,$530.73 ,$565.10 ,$548.64 ,$126.52 ,$451.00 ,$451.00 ,$559.50 ,$451.00 ,$559.50 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,32000342,74425,HC XR UROGRAM ANTE (LOOPOGRAM SVG),320,1 ,$739.00 ,$369.50 ,$37.92 ,$805.79 ,$37.92 ,$478.06 ,$478.06 ,$358.13 ,$443.40 ,$628.15 ,$517.30 ,$37.92 ,$702.05 ,$532.08 ,$539.47 ,$230.75 ,$628.15 ,$358.13 ,$230.75 ,$628.15 ,$539.47 ,$37.92 ,$358.13 ,$310.38 ,$628.15 ,$805.79 ,$679.88 ,$517.30 ,$739.00 ,$739.00 ,$450.05 ,$739.00 ,$510.65 ,$532.08 ,$514.71 ,$361.71 ,$532.08 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$532.08 ,$458.18 ,$532.08 ,$532.08 ,$443.40 
ST MARY'S HOSPITAL,32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$941.00 ,$470.50 ,$37.92 ,$941.00 ,$37.92 ,$99.89 ,$88.79 ,$358.13 ,$564.60 ,$799.85 ,$658.70 ,$37.92 ,$893.95 ,$677.52 ,$686.93 ,$51.00 ,$799.85 ,$358.13 ,$51.00 ,$799.85 ,$686.93 ,$37.92 ,$358.13 ,$395.22 ,$799.85 ,$805.79 ,$865.72 ,$658.70 ,$856.00 ,$918.99 ,$573.07 ,$856.00 ,$650.23 ,$677.52 ,$655.41 ,$361.71 ,$677.52 ,$40.20 ,$451.00 ,$451.00 ,$358.13 ,$451.00 ,$358.13 ,$677.52 ,$583.42 ,$677.52 ,$677.52 ,$564.60 
ST MARY'S HOSPITAL,32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$226.89 ,$201.68 ,$223.78 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$120.77 ,$761.60 ,$223.78 ,$120.77 ,$761.60 ,$654.08 ,$37.92 ,$223.78 ,$376.32 ,$761.60 ,$503.50 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$226.02 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000345,74450,HC CYSTOURETHROGRAM RETRO OR,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$226.89 ,$201.68 ,$223.78 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$120.77 ,$761.60 ,$223.78 ,$120.77 ,$761.60 ,$654.08 ,$37.92 ,$223.78 ,$376.32 ,$761.60 ,$503.50 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$226.02 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$321.83 ,$286.07 ,$223.78 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$181.98 ,$761.60 ,$223.78 ,$181.98 ,$761.60 ,$654.08 ,$37.92 ,$223.78 ,$376.32 ,$761.60 ,$503.50 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$226.02 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000347,74455,HC XRAY VOID CYSTOURETH OR,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$321.83 ,$286.07 ,$223.78 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$181.98 ,$761.60 ,$223.78 ,$181.98 ,$761.60 ,$654.08 ,$37.92 ,$223.78 ,$376.32 ,$761.60 ,$503.50 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$226.02 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000348,74470,HC RENAL CYST STUDY S AND I,320,1 ,$750.00 ,$375.00 ,$37.92 ,"$1,057.30 ",$37.92 ,$194.33 ,$172.74 ,$469.91 ,$450.00 ,$637.50 ,$525.00 ,$37.92 ,$712.50 ,$540.00 ,$547.50 ,$103.46 ,$637.50 ,$469.91 ,$103.46 ,$637.50 ,$547.50 ,$37.92 ,$469.91 ,$315.00 ,$637.50 ,"$1,057.30 ",$690.00 ,$525.00 ,$750.00 ,$750.00 ,$456.75 ,$750.00 ,$518.25 ,$540.00 ,$522.38 ,$474.61 ,$540.00 ,$40.20 ,$451.00 ,$451.00 ,$469.91 ,$451.00 ,$469.91 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,100.00 ","$2,050.00 ",$395.36 ,"$4,100.00 ",$474.08 ,"$2,652.29 ","$2,652.29 ","$1,741.31 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$474.08 ,"$3,895.00 ","$2,952.00 ","$2,993.00 ",$395.36 ,"$3,485.00 ","$1,741.31 ",$395.36 ,"$3,485.00 ","$2,993.00 ",$474.08 ,"$1,741.31 ","$1,722.00 ","$3,485.00 ","$3,917.96 ","$3,772.00 ","$2,870.00 ","$1,680.96 ","$2,259.84 ","$2,496.90 ","$2,101.20 ","$2,833.10 ","$2,952.00 ","$2,855.65 ","$1,758.72 ","$2,952.00 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$2,460.00 "
ST MARY'S HOSPITAL,32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,100.00 ","$2,050.00 ",$395.36 ,"$4,100.00 ",$474.08 ,"$2,652.29 ","$2,652.29 ","$1,741.31 ","$2,460.00 ","$3,485.00 ","$2,870.00 ",$474.08 ,"$3,895.00 ","$2,952.00 ","$2,993.00 ",$395.36 ,"$3,485.00 ","$1,741.31 ",$395.36 ,"$3,485.00 ","$2,993.00 ",$474.08 ,"$1,741.31 ","$1,722.00 ","$3,485.00 ","$3,917.96 ","$3,772.00 ","$2,870.00 ","$1,680.96 ","$2,259.84 ","$2,496.90 ","$2,101.20 ","$2,833.10 ","$2,952.00 ","$2,855.65 ","$1,758.72 ","$2,952.00 ",$502.52 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$2,460.00 "
ST MARY'S HOSPITAL,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$1,904.00 ",$952.00 ,$56.46 ,"$3,917.96 ",$56.46 ,$290.79 ,$258.48 ,"$1,741.31 ","$1,142.40 ","$1,618.40 ","$1,332.80 ",$56.46 ,"$1,808.80 ","$1,370.88 ","$1,389.92 ",$163.26 ,"$1,618.40 ","$1,741.31 ",$163.26 ,"$1,618.40 ","$1,389.92 ",$56.46 ,"$1,741.31 ",$799.68 ,"$1,618.40 ","$3,917.96 ","$1,751.68 ","$1,332.80 ","$1,904.00 ","$1,904.00 ","$1,159.54 ","$1,904.00 ","$1,315.66 ","$1,370.88 ","$1,326.14 ","$1,758.72 ","$1,370.88 ",$59.85 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,142.40 "
ST MARY'S HOSPITAL,32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$1,904.00 ",$952.00 ,$56.46 ,"$3,917.96 ",$56.46 ,$290.79 ,$258.48 ,"$1,741.31 ","$1,142.40 ","$1,618.40 ","$1,332.80 ",$56.46 ,"$1,808.80 ","$1,370.88 ","$1,389.92 ",$163.26 ,"$1,618.40 ","$1,741.31 ",$163.26 ,"$1,618.40 ","$1,389.92 ",$56.46 ,"$1,741.31 ",$799.68 ,"$1,618.40 ","$3,917.96 ","$1,751.68 ","$1,332.80 ","$1,904.00 ","$1,904.00 ","$1,159.54 ","$1,904.00 ","$1,315.66 ","$1,370.88 ","$1,326.14 ","$1,758.72 ","$1,370.88 ",$59.85 ,$451.00 ,$451.00 ,"$1,741.31 ",$451.00 ,"$1,741.31 ","$1,370.88 ","$1,180.48 ","$1,370.88 ","$1,370.88 ","$1,142.40 "
ST MARY'S HOSPITAL,32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$750.00 ,$375.00 ,$37.92 ,$750.00 ,$37.92 ,$275.27 ,$244.69 ,$223.78 ,$450.00 ,$637.50 ,$525.00 ,$37.92 ,$712.50 ,$540.00 ,$547.50 ,$159.92 ,$637.50 ,$223.78 ,$159.92 ,$637.50 ,$547.50 ,$37.92 ,$223.78 ,$315.00 ,$637.50 ,$503.50 ,$690.00 ,$525.00 ,$750.00 ,$750.00 ,$456.75 ,$750.00 ,$518.25 ,$540.00 ,$522.38 ,$226.02 ,$540.00 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,32000355,75605,HC THORACIC AORTA,320,1 ,"$4,144.00 ","$2,072.00 ",$135.40 ,"$10,434.71 ","$1,293.09 ",$340.46 ,$302.63 ,"$4,637.65 ","$2,486.40 ","$3,522.40 ","$2,900.80 ","$1,293.09 ","$3,936.80 ","$2,983.68 ","$3,025.12 ",$135.40 ,"$3,522.40 ","$4,637.65 ",$135.40 ,"$3,522.40 ","$3,025.12 ","$1,293.09 ","$4,637.65 ","$1,740.48 ","$3,522.40 ","$10,434.71 ","$3,812.48 ","$2,900.80 ","$4,144.00 ","$4,144.00 ","$2,523.70 ","$4,144.00 ","$2,863.50 ","$2,983.68 ","$2,886.30 ","$4,684.03 ","$2,983.68 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$2,486.40 "
ST MARY'S HOSPITAL,32000356,75625,HC ABDOMINAL AORTAGRAM 75625,320,1 ,"$4,144.00 ","$2,072.00 ",$121.16 ,"$6,263.99 ",$573.58 ,$332.70 ,$295.73 ,"$2,784.00 ","$2,486.40 ","$3,522.40 ","$2,900.80 ",$573.58 ,"$3,936.80 ","$2,983.68 ","$3,025.12 ",$121.16 ,"$3,522.40 ","$2,784.00 ",$121.16 ,"$3,522.40 ","$3,025.12 ",$573.58 ,"$2,784.00 ","$1,740.48 ","$3,522.40 ","$6,263.99 ","$3,812.48 ","$2,900.80 ","$4,144.00 ","$4,144.00 ","$2,523.70 ","$4,144.00 ","$2,863.50 ","$2,983.68 ","$2,886.30 ","$2,811.84 ","$2,983.68 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$2,486.40 "
ST MARY'S HOSPITAL,32000357,75630,HC AORTA WITH RUNOFF 75630,320,1 ,"$4,368.00 ","$2,184.00 ",$129.87 ,"$6,263.99 ",$573.58 ,$338.90 ,$301.25 ,"$2,784.00 ","$2,620.80 ","$3,712.80 ","$3,057.60 ",$573.58 ,"$4,149.60 ","$3,144.96 ","$3,188.64 ",$129.87 ,"$3,712.80 ","$2,784.00 ",$129.87 ,"$3,712.80 ","$3,188.64 ",$573.58 ,"$2,784.00 ","$1,834.56 ","$3,712.80 ","$6,263.99 ","$4,018.56 ","$3,057.60 ","$4,368.00 ","$4,368.00 ","$2,660.11 ","$4,368.00 ","$3,018.29 ","$3,144.96 ","$3,042.31 ","$2,811.84 ","$3,144.96 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$3,144.96 ","$2,708.16 ","$3,144.96 ","$3,144.96 ","$2,620.80 "
ST MARY'S HOSPITAL,32000370,75705,HC ANGIO SPINAL,320,1 ,"$2,240.00 ","$1,120.00 ",$257.71 ,"$10,434.71 ","$1,293.09 ",$589.34 ,$523.86 ,"$4,637.65 ","$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,612.80 ","$1,635.20 ",$257.71 ,"$1,904.00 ","$4,637.65 ",$257.71 ,"$1,904.00 ","$1,635.20 ","$1,293.09 ","$4,637.65 ",$940.80 ,"$1,904.00 ","$10,434.71 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$1,612.80 ","$1,560.16 ","$4,684.03 ","$1,612.80 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,32000371,75710,HC ANGIO EXTREMITY UNI 75710,320,1 ,"$1,792.00 ",$896.00 ,$138.54 ,"$6,263.99 ",$573.58 ,$352.87 ,$313.66 ,"$2,784.00 ","$1,075.20 ","$1,523.20 ","$1,254.40 ",$573.58 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$138.54 ,"$1,523.20 ","$2,784.00 ",$138.54 ,"$1,523.20 ","$1,308.16 ",$573.58 ,"$2,784.00 ",$752.64 ,"$1,523.20 ","$6,263.99 ","$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,290.24 ","$1,248.13 ","$2,811.84 ","$1,290.24 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,32000372,75710,HC ANGIO EXTREMITY UNI OR,320,1 ,"$1,792.00 ",$896.00 ,$138.54 ,"$6,263.99 ",$573.58 ,$352.87 ,$313.66 ,"$2,784.00 ","$1,075.20 ","$1,523.20 ","$1,254.40 ",$573.58 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$138.54 ,"$1,523.20 ","$2,784.00 ",$138.54 ,"$1,523.20 ","$1,308.16 ",$573.58 ,"$2,784.00 ",$752.64 ,"$1,523.20 ","$6,263.99 ","$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,290.24 ","$1,248.13 ","$2,811.84 ","$1,290.24 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,32000373,75716,HC ANGIO EXTREMITY BILAT 75716,320,1 ,"$2,688.00 ","$1,344.00 ",$142.78 ,"$6,263.99 ",$573.58 ,$357.53 ,$317.80 ,"$2,784.00 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$573.58 ,"$2,553.60 ","$1,935.36 ","$1,962.24 ",$142.78 ,"$2,284.80 ","$2,784.00 ",$142.78 ,"$2,284.80 ","$1,962.24 ",$573.58 ,"$2,784.00 ","$1,128.96 ","$2,284.80 ","$6,263.99 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$1,935.36 ","$1,872.19 ","$2,811.84 ","$1,935.36 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$1,612.80 "
ST MARY'S HOSPITAL,32000375,36251,HC ANGIO SEL RENAL UNILA 36251,320,1 ,"$3,248.00 ","$1,624.00 ",$451.00 ,"$6,263.99 ","$1,293.09 ","$2,101.13 ","$2,101.13 ","$2,784.00 ","$1,948.80 ","$2,760.80 ","$2,273.60 ","$1,293.09 ","$3,085.60 ","$2,338.56 ","$2,371.04 ",$480.07 ,"$2,760.80 ","$2,784.00 ",$480.07 ,"$2,760.80 ","$2,371.04 ","$1,293.09 ","$2,784.00 ","$1,364.16 ","$2,760.80 ","$6,263.99 ","$2,988.16 ","$2,273.60 ","$1,489.75 ","$2,002.44 ","$1,978.03 ","$1,862.71 ","$2,244.37 ","$2,338.56 ","$2,262.23 ","$2,811.84 ","$2,338.56 ","$1,370.68 ",$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,338.56 ","$2,013.76 ","$2,338.56 ","$2,338.56 ","$1,948.80 "
ST MARY'S HOSPITAL,32000376,36252,HC ANGIO SEL RENAL BILAT 36252,320,1 ,"$3,248.00 ","$1,624.00 ",$451.00 ,"$6,263.99 ","$1,293.09 ","$2,101.13 ","$2,101.13 ","$2,784.00 ","$1,948.80 ","$2,760.80 ","$2,273.60 ","$1,293.09 ","$3,085.60 ","$2,338.56 ","$2,371.04 ",$659.59 ,"$2,760.80 ","$2,784.00 ",$659.59 ,"$2,760.80 ","$2,371.04 ","$1,293.09 ","$2,784.00 ","$1,364.16 ","$2,760.80 ","$6,263.99 ","$2,988.16 ","$2,273.60 ","$1,489.75 ","$2,002.44 ","$1,978.03 ","$1,862.71 ","$2,244.37 ","$2,338.56 ","$2,262.23 ","$2,811.84 ","$2,338.56 ","$1,370.68 ",$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,338.56 ","$2,013.76 ","$2,338.56 ","$2,338.56 ","$1,948.80 "
ST MARY'S HOSPITAL,32000378,75726,"HC ANGIO VISERAL, SEL, OR SUPRASEL 75726",320,1 ,"$2,240.00 ","$1,120.00 ",$154.12 ,"$10,434.71 ","$1,293.09 ",$390.12 ,$346.77 ,"$4,637.65 ","$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,612.80 ","$1,635.20 ",$154.12 ,"$1,904.00 ","$4,637.65 ",$154.12 ,"$1,904.00 ","$1,635.20 ","$1,293.09 ","$4,637.65 ",$940.80 ,"$1,904.00 ","$10,434.71 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$1,612.80 ","$1,560.16 ","$4,684.03 ","$1,612.80 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,32000382,75731,HC ANGIO ADRENAL UNILATERAL,320,1 ,"$2,912.00 ","$1,456.00 ",$192.88 ,"$6,263.99 ",$573.58 ,$479.15 ,$425.91 ,"$2,784.00 ","$1,747.20 ","$2,475.20 ","$2,038.40 ",$573.58 ,"$2,766.40 ","$2,096.64 ","$2,125.76 ",$192.88 ,"$2,475.20 ","$2,784.00 ",$192.88 ,"$2,475.20 ","$2,125.76 ",$573.58 ,"$2,784.00 ","$1,223.04 ","$2,475.20 ","$6,263.99 ","$2,679.04 ","$2,038.40 ","$2,912.00 ","$2,912.00 ","$1,773.41 ","$2,912.00 ","$2,012.19 ","$2,096.64 ","$2,028.21 ","$2,811.84 ","$2,096.64 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$1,747.20 "
ST MARY'S HOSPITAL,32000383,75733,HC ANGIO ADRENAL BILATERAL,320,1 ,"$5,712.00 ","$2,856.00 ",$212.03 ,"$6,263.99 ",$573.58 ,$506.10 ,$449.86 ,"$2,784.00 ","$3,427.20 ","$4,855.20 ","$3,998.40 ",$573.58 ,"$5,426.40 ","$4,112.64 ","$4,169.76 ",$212.03 ,"$4,855.20 ","$2,784.00 ",$212.03 ,"$4,855.20 ","$4,169.76 ",$573.58 ,"$2,784.00 ","$2,399.04 ","$4,855.20 ","$6,263.99 ","$5,255.04 ","$3,998.40 ","$5,712.00 ","$5,712.00 ","$3,478.61 ","$5,712.00 ","$3,946.99 ","$4,112.64 ","$3,978.41 ","$2,811.84 ","$4,112.64 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$4,112.64 ","$3,541.44 ","$4,112.64 ","$4,112.64 ","$3,427.20 "
ST MARY'S HOSPITAL,32000384,75736,HC ANGIO PELVIC SELECT,320,1 ,"$2,240.00 ","$1,120.00 ",$176.85 ,"$10,434.71 ","$1,293.09 ",$435.69 ,$387.28 ,"$4,637.65 ","$1,344.00 ","$1,904.00 ","$1,568.00 ","$1,293.09 ","$2,128.00 ","$1,612.80 ","$1,635.20 ",$176.85 ,"$1,904.00 ","$4,637.65 ",$176.85 ,"$1,904.00 ","$1,635.20 ","$1,293.09 ","$4,637.65 ",$940.80 ,"$1,904.00 ","$10,434.71 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$1,612.80 ","$1,560.16 ","$4,684.03 ","$1,612.80 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,32000385,75741,HC ANGIO PULMONARY UNILAT,320,1 ,"$3,360.00 ","$1,680.00 ",$141.20 ,"$6,263.99 ",$573.58 ,$360.63 ,$320.56 ,"$2,784.00 ","$2,016.00 ","$2,856.00 ","$2,352.00 ",$573.58 ,"$3,192.00 ","$2,419.20 ","$2,452.80 ",$141.20 ,"$2,856.00 ","$2,784.00 ",$141.20 ,"$2,856.00 ","$2,452.80 ",$573.58 ,"$2,784.00 ","$1,411.20 ","$2,856.00 ","$6,263.99 ","$3,091.20 ","$2,352.00 ","$3,360.00 ","$3,360.00 ","$2,046.24 ","$3,360.00 ","$2,321.76 ","$2,419.20 ","$2,340.24 ","$2,811.84 ","$2,419.20 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,32000386,75743,HC ANGIO PULMONARY BILAT,320,1 ,"$3,920.00 ","$1,960.00 ",$143.42 ,"$6,263.99 ",$573.58 ,$365.29 ,$324.70 ,"$2,784.00 ","$2,352.00 ","$3,332.00 ","$2,744.00 ",$573.58 ,"$3,724.00 ","$2,822.40 ","$2,861.60 ",$143.42 ,"$3,332.00 ","$2,784.00 ",$143.42 ,"$3,332.00 ","$2,861.60 ",$573.58 ,"$2,784.00 ","$1,646.40 ","$3,332.00 ","$6,263.99 ","$3,606.40 ","$2,744.00 ","$3,920.00 ","$3,920.00 ","$2,387.28 ","$3,920.00 ","$2,708.72 ","$2,822.40 ","$2,730.28 ","$2,811.84 ","$2,822.40 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,822.40 ","$2,430.40 ","$2,822.40 ","$2,822.40 ","$2,352.00 "
ST MARY'S HOSPITAL,32000387,75746,HC ANGIO PULMONARY NONSELECT,320,1 ,"$2,688.00 ","$1,344.00 ",$160.80 ,"$6,263.99 ",$573.58 ,$399.43 ,$355.05 ,"$2,784.00 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$573.58 ,"$2,553.60 ","$1,935.36 ","$1,962.24 ",$160.80 ,"$2,284.80 ","$2,784.00 ",$160.80 ,"$2,284.80 ","$1,962.24 ",$573.58 ,"$2,784.00 ","$1,128.96 ","$2,284.80 ","$6,263.99 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$1,935.36 ","$1,872.19 ","$2,811.84 ","$1,935.36 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$1,612.80 "
ST MARY'S HOSPITAL,32000388,75756,HC ANGIO INTERNAL MAMMARY,320,1 ,"$2,240.00 ","$1,120.00 ",$206.25 ,"$6,263.99 ",$573.58 ,$490.01 ,$435.57 ,"$2,784.00 ","$1,344.00 ","$1,904.00 ","$1,568.00 ",$573.58 ,"$2,128.00 ","$1,612.80 ","$1,635.20 ",$206.25 ,"$1,904.00 ","$2,784.00 ",$206.25 ,"$1,904.00 ","$1,635.20 ",$573.58 ,"$2,784.00 ",$940.80 ,"$1,904.00 ","$6,263.99 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$1,612.80 ","$1,560.16 ","$2,811.84 ","$1,612.80 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,32000389,75774,HC ANGIO EA VESSEL ADDL 75774,320,1 ,"$1,120.00 ",$560.00 ,$102.44 ,"$1,370.68 ","$1,293.09 ",$284.58 ,$252.96 , N/A ,$672.00 ,$952.00 ,$784.00 ,"$1,293.09 ","$1,064.00 ",$806.40 ,$817.60 ,$102.44 ,$952.00 , N/A ,$102.44 ,$952.00 ,$817.60 ,"$1,293.09 ", N/A ,$470.40 ,$952.00 , N/A ,"$1,030.40 ",$784.00 ,$568.06 ,$681.74 ,$682.08 ,$636.27 ,$773.92 ,$806.40 ,$780.08 , N/A ,$806.40 ,"$1,370.68 ",$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,32000391,75803,HC LYMPHANGIOGRAPHY LEGS,320,1 ,"$2,240.00 ","$1,120.00 ",$264.62 ,"$3,077.03 ",$264.62 ,$857.23 ,$761.98 ,"$1,367.57 ","$1,344.00 ","$1,904.00 ","$1,568.00 ",$264.62 ,"$2,128.00 ","$1,612.80 ","$1,635.20 ",$448.56 ,"$1,904.00 ","$1,367.57 ",$448.56 ,"$1,904.00 ","$1,635.20 ",$264.62 ,"$1,367.57 ",$940.80 ,"$1,904.00 ","$3,077.03 ","$2,060.80 ","$1,568.00 ","$2,240.00 ","$2,240.00 ","$1,364.16 ","$2,240.00 ","$1,547.84 ","$1,612.80 ","$1,560.16 ","$1,381.25 ","$1,612.80 ",$280.50 ,$451.00 ,$451.00 ,"$1,367.57 ",$451.00 ,"$1,367.57 ","$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,32000392,75807,HC LYMPHANGIOGRAPHY ABDOM,320,1 ,"$2,128.00 ","$1,064.00 ",$451.00 ,"$6,263.99 ",$573.58 ,$920.83 ,$818.51 ,"$2,784.00 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$573.58 ,"$2,021.60 ","$1,532.16 ","$1,553.44 ",$758.56 ,"$1,808.80 ","$2,784.00 ",$758.56 ,"$1,808.80 ","$1,553.44 ",$573.58 ,"$2,784.00 ",$893.76 ,"$1,808.80 ","$6,263.99 ","$1,957.76 ","$1,489.60 ","$2,128.00 ","$2,128.00 ","$1,295.95 ","$2,128.00 ","$1,470.45 ","$1,532.16 ","$1,482.15 ","$2,811.84 ","$1,532.16 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,276.80 "
ST MARY'S HOSPITAL,32000393,75809,HC SHUNTOGRAM NONVASCULAR,320,1 ,$627.00 ,$313.50 ,$37.92 ,$627.00 ,$37.92 ,$310.97 ,$276.42 ,$105.88 ,$376.20 ,$532.95 ,$438.90 ,$37.92 ,$595.65 ,$451.44 ,$457.71 ,$118.49 ,$532.95 ,$105.88 ,$118.49 ,$532.95 ,$457.71 ,$37.92 ,$105.88 ,$263.34 ,$532.95 ,$238.23 ,$576.84 ,$438.90 ,$302.03 ,$324.25 ,$381.84 ,$302.03 ,$433.26 ,$451.44 ,$436.71 ,$106.94 ,$451.44 ,$40.20 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$376.20 
ST MARY'S HOSPITAL,32000394,75810,HC SPLENOPORTOGRAPHY,320,1 ,"$3,584.00 ","$1,792.00 ",$264.62 ,"$6,263.99 ",$264.62 ,"$1,683.43 ","$1,496.38 ","$2,784.00 ","$2,150.40 ","$3,046.40 ","$2,508.80 ",$264.62 ,"$3,404.80 ","$2,580.48 ","$2,616.32 ","$1,042.38 ","$3,046.40 ","$2,784.00 ","$1,042.38 ","$3,046.40 ","$2,616.32 ",$264.62 ,"$2,784.00 ","$1,505.28 ","$3,046.40 ","$6,263.99 ","$3,297.28 ","$2,508.80 ","$3,584.00 ","$3,584.00 ","$2,182.66 ","$3,584.00 ","$2,476.54 ","$2,580.48 ","$2,496.26 ","$2,811.84 ","$2,580.48 ",$280.50 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,580.48 ","$2,222.08 ","$2,580.48 ","$2,580.48 ","$2,150.40 "
ST MARY'S HOSPITAL,32000395,75820,HC VENOGRAM EXTREMITY UNI 75820,320,1 ,"$1,456.00 ",$728.00 ,$121.83 ,"$3,077.03 ",$264.62 ,$334.25 ,$297.11 ,"$1,367.57 ",$873.60 ,"$1,237.60 ","$1,019.20 ",$264.62 ,"$1,383.20 ","$1,048.32 ","$1,062.88 ",$121.83 ,"$1,237.60 ","$1,367.57 ",$121.83 ,"$1,237.60 ","$1,062.88 ",$264.62 ,"$1,367.57 ",$611.52 ,"$1,237.60 ","$3,077.03 ","$1,339.52 ","$1,019.20 ","$1,456.00 ","$1,456.00 ",$886.70 ,"$1,456.00 ","$1,006.10 ","$1,048.32 ","$1,014.10 ","$1,381.25 ","$1,048.32 ",$280.50 ,$451.00 ,$451.00 ,"$1,367.57 ",$451.00 ,"$1,367.57 ","$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,32000397,75822,HC VENOGRAM EXTREMITY BILAT,320,1 ,"$1,792.00 ",$896.00 ,$131.20 ,"$3,077.03 ",$264.62 ,$342.01 ,$304.01 ,"$1,367.57 ","$1,075.20 ","$1,523.20 ","$1,254.40 ",$264.62 ,"$1,702.40 ","$1,290.24 ","$1,308.16 ",$131.20 ,"$1,523.20 ","$1,367.57 ",$131.20 ,"$1,523.20 ","$1,308.16 ",$264.62 ,"$1,367.57 ",$752.64 ,"$1,523.20 ","$3,077.03 ","$1,648.64 ","$1,254.40 ","$1,792.00 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,290.24 ","$1,248.13 ","$1,381.25 ","$1,290.24 ",$280.50 ,$451.00 ,$451.00 ,"$1,367.57 ",$451.00 ,"$1,367.57 ","$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,32000398,75825,HC VENOGRAPHY CAVAL INFERIOR,320,1 ,"$3,248.00 ","$1,624.00 ",$123.18 ,"$6,263.99 ",$573.58 ,$324.94 ,$288.83 ,"$2,784.00 ","$1,948.80 ","$2,760.80 ","$2,273.60 ",$573.58 ,"$3,085.60 ","$2,338.56 ","$2,371.04 ",$123.18 ,"$2,760.80 ","$2,784.00 ",$123.18 ,"$2,760.80 ","$2,371.04 ",$573.58 ,"$2,784.00 ","$1,364.16 ","$2,760.80 ","$6,263.99 ","$2,988.16 ","$2,273.60 ","$3,248.00 ","$3,248.00 ","$1,978.03 ","$3,248.00 ","$2,244.37 ","$2,338.56 ","$2,262.23 ","$2,811.84 ","$2,338.56 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,338.56 ","$2,013.76 ","$2,338.56 ","$2,338.56 ","$1,948.80 "
ST MARY'S HOSPITAL,32000399,75827,HC VENOGRAPHY CAVAL SUPERIOR,320,1 ,"$2,576.00 ","$1,288.00 ",$133.87 ,"$3,077.03 ",$264.62 ,$343.56 ,$305.39 ,"$1,367.57 ","$1,545.60 ","$2,189.60 ","$1,803.20 ",$264.62 ,"$2,447.20 ","$1,854.72 ","$1,880.48 ",$133.87 ,"$2,189.60 ","$1,367.57 ",$133.87 ,"$2,189.60 ","$1,880.48 ",$264.62 ,"$1,367.57 ","$1,081.92 ","$2,189.60 ","$3,077.03 ","$2,369.92 ","$1,803.20 ","$2,576.00 ","$2,576.00 ","$1,568.78 ","$2,576.00 ","$1,780.02 ","$1,854.72 ","$1,794.18 ","$1,381.25 ","$1,854.72 ",$280.50 ,$451.00 ,$451.00 ,"$1,367.57 ",$451.00 ,"$1,367.57 ","$1,854.72 ","$1,597.12 ","$1,854.72 ","$1,854.72 ","$1,545.60 "
ST MARY'S HOSPITAL,32000400,75831,HC VENOGRAM RENAL UNILAT,320,1 ,"$3,024.00 ","$1,512.00 ",$135.87 ,"$6,263.99 ",$573.58 ,$352.87 ,$313.66 ,"$2,784.00 ","$1,814.40 ","$2,570.40 ","$2,116.80 ",$573.58 ,"$2,872.80 ","$2,177.28 ","$2,207.52 ",$135.87 ,"$2,570.40 ","$2,784.00 ",$135.87 ,"$2,570.40 ","$2,207.52 ",$573.58 ,"$2,784.00 ","$1,270.08 ","$2,570.40 ","$6,263.99 ","$2,782.08 ","$2,116.80 ","$3,024.00 ","$3,024.00 ","$1,841.62 ","$3,024.00 ","$2,089.58 ","$2,177.28 ","$2,106.22 ","$2,811.84 ","$2,177.28 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$1,814.40 "
ST MARY'S HOSPITAL,32000401,75833,HC VENOGRAM RENAL BILAT,320,1 ,"$3,360.00 ","$1,680.00 ",$155.45 ,"$6,263.99 ",$573.58 ,$382.92 ,$340.38 ,"$2,784.00 ","$2,016.00 ","$2,856.00 ","$2,352.00 ",$573.58 ,"$3,192.00 ","$2,419.20 ","$2,452.80 ",$155.45 ,"$2,856.00 ","$2,784.00 ",$155.45 ,"$2,856.00 ","$2,452.80 ",$573.58 ,"$2,784.00 ","$1,411.20 ","$2,856.00 ","$6,263.99 ","$3,091.20 ","$2,352.00 ","$3,360.00 ","$3,360.00 ","$2,046.24 ","$3,360.00 ","$2,321.76 ","$2,419.20 ","$2,340.24 ","$2,811.84 ","$2,419.20 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,32000402,75840,HC VENOGRAM ADRENAL UNILAT,320,1 ,"$2,688.00 ","$1,344.00 ",$149.24 ,"$6,263.99 ",$573.58 ,$379.26 ,$337.12 ,"$2,784.00 ","$1,612.80 ","$2,284.80 ","$1,881.60 ",$573.58 ,"$2,553.60 ","$1,935.36 ","$1,962.24 ",$149.24 ,"$2,284.80 ","$2,784.00 ",$149.24 ,"$2,284.80 ","$1,962.24 ",$573.58 ,"$2,784.00 ","$1,128.96 ","$2,284.80 ","$6,263.99 ","$2,472.96 ","$1,881.60 ","$2,688.00 ","$2,688.00 ","$1,636.99 ","$2,688.00 ","$1,857.41 ","$1,935.36 ","$1,872.19 ","$2,811.84 ","$1,935.36 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$1,612.80 "
ST MARY'S HOSPITAL,32000403,75842,HC VENOGRAM ADRENAL BILAT,320,1 ,"$2,912.00 ","$1,456.00 ",$173.49 ,"$10,434.71 ","$1,293.09 ",$435.69 ,$387.28 ,"$4,637.65 ","$1,747.20 ","$2,475.20 ","$2,038.40 ","$1,293.09 ","$2,766.40 ","$2,096.64 ","$2,125.76 ",$173.49 ,"$2,475.20 ","$4,637.65 ",$173.49 ,"$2,475.20 ","$2,125.76 ","$1,293.09 ","$4,637.65 ","$1,223.04 ","$2,475.20 ","$10,434.71 ","$2,679.04 ","$2,038.40 ","$2,912.00 ","$2,912.00 ","$1,773.41 ","$2,912.00 ","$2,012.19 ","$2,096.64 ","$2,028.21 ","$4,684.03 ","$2,096.64 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$1,747.20 "
ST MARY'S HOSPITAL,32000404,75860,HC VENOGRAPHY SINUS/ JUGULAR,320,1 ,"$2,128.00 ","$1,064.00 ",$145.22 ,"$6,263.99 ",$573.58 ,$369.94 ,$328.84 ,"$2,784.00 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$573.58 ,"$2,021.60 ","$1,532.16 ","$1,553.44 ",$145.22 ,"$1,808.80 ","$2,784.00 ",$145.22 ,"$1,808.80 ","$1,553.44 ",$573.58 ,"$2,784.00 ",$893.76 ,"$1,808.80 ","$6,263.99 ","$1,957.76 ","$1,489.60 ","$2,128.00 ","$2,128.00 ","$1,295.95 ","$2,128.00 ","$1,470.45 ","$1,532.16 ","$1,482.15 ","$2,811.84 ","$1,532.16 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,276.80 "
ST MARY'S HOSPITAL,32000406,75870,HC VENOGRAM SUPERIOR SAGITTAL,320,1 ,"$2,016.00 ","$1,008.00 ",$204.71 ,"$6,263.99 ",$264.62 ,$537.56 ,$477.83 ,"$2,784.00 ","$1,209.60 ","$1,713.60 ","$1,411.20 ",$264.62 ,"$1,915.20 ","$1,451.52 ","$1,471.68 ",$204.71 ,"$1,713.60 ","$2,784.00 ",$204.71 ,"$1,713.60 ","$1,471.68 ",$264.62 ,"$2,784.00 ",$846.72 ,"$1,713.60 ","$6,263.99 ","$1,854.72 ","$1,411.20 ","$1,056.43 ","$1,134.16 ","$1,227.74 ","$1,056.43 ","$1,393.06 ","$1,451.52 ","$1,404.14 ","$2,811.84 ","$1,451.52 ",$280.50 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$1,451.52 ","$1,249.92 ","$1,451.52 ","$1,451.52 ","$1,209.60 "
ST MARY'S HOSPITAL,32000407,75872,HC VENOGRAM EPIDURAL,320,1 ,"$2,352.00 ","$1,176.00 ",$149.24 ,"$2,352.00 ",$264.62 ,$379.26 ,$337.12 ,$525.67 ,"$1,411.20 ","$1,999.20 ","$1,646.40 ",$264.62 ,"$2,234.40 ","$1,693.44 ","$1,716.96 ",$149.24 ,"$1,999.20 ",$525.67 ,$149.24 ,"$1,999.20 ","$1,716.96 ",$264.62 ,$525.67 ,$987.84 ,"$1,999.20 ","$1,182.77 ","$2,163.84 ","$1,646.40 ","$2,352.00 ","$2,352.00 ","$1,432.37 ","$2,352.00 ","$1,625.23 ","$1,693.44 ","$1,638.17 ",$530.93 ,"$1,693.44 ",$280.50 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,411.20 "
ST MARY'S HOSPITAL,32000408,75880,HC VENOGRAM ORBITAL,320,1 ,"$1,456.00 ",$728.00 ,$148.58 ,"$1,456.00 ",$264.62 ,$377.70 ,$335.74 ,$525.67 ,$873.60 ,"$1,237.60 ","$1,019.20 ",$264.62 ,"$1,383.20 ","$1,048.32 ","$1,062.88 ",$148.58 ,"$1,237.60 ",$525.67 ,$148.58 ,"$1,237.60 ","$1,062.88 ",$264.62 ,$525.67 ,$611.52 ,"$1,237.60 ","$1,182.77 ","$1,339.52 ","$1,019.20 ","$1,456.00 ","$1,456.00 ",$886.70 ,"$1,456.00 ","$1,006.10 ","$1,048.32 ","$1,014.10 ",$530.93 ,"$1,048.32 ",$280.50 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,32000409,75885,HC TRANSHEPATIC PORTOGRAPHY W/ HEMO,320,1 ,"$3,584.00 ","$1,792.00 ",$142.54 ,"$6,263.99 ",$573.58 ,$366.84 ,$326.08 ,"$2,784.00 ","$2,150.40 ","$3,046.40 ","$2,508.80 ",$573.58 ,"$3,404.80 ","$2,580.48 ","$2,616.32 ",$142.54 ,"$3,046.40 ","$2,784.00 ",$142.54 ,"$3,046.40 ","$2,616.32 ",$573.58 ,"$2,784.00 ","$1,505.28 ","$3,046.40 ","$6,263.99 ","$3,297.28 ","$2,508.80 ","$3,584.00 ","$3,584.00 ","$2,182.66 ","$3,584.00 ","$2,476.54 ","$2,580.48 ","$2,496.26 ","$2,811.84 ","$2,580.48 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,580.48 ","$2,222.08 ","$2,580.48 ","$2,580.48 ","$2,150.40 "
ST MARY'S HOSPITAL,32000411,75889,HC VENOGRAM HEPATIC W/HEMO,320,1 ,$776.00 ,$388.00 ,$143.89 ,"$6,263.99 ",$573.58 ,$368.39 ,$327.46 ,"$2,784.00 ",$465.60 ,$659.60 ,$543.20 ,$573.58 ,$737.20 ,$558.72 ,$566.48 ,$143.89 ,$659.60 ,"$2,784.00 ",$143.89 ,$659.60 ,$566.48 ,$573.58 ,"$2,784.00 ",$325.92 ,$659.60 ,"$6,263.99 ",$713.92 ,$543.20 ,$776.00 ,$776.00 ,$472.58 ,$776.00 ,$536.22 ,$558.72 ,$540.48 ,"$2,811.84 ",$558.72 ,$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ",$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,32000412,75891,HC VENOGRAM HEPATIC W/O HEMO,320,1 ,"$3,472.00 ","$1,736.00 ",$144.57 ,"$6,263.99 ",$573.58 ,$373.05 ,$331.60 ,"$2,784.00 ","$2,083.20 ","$2,951.20 ","$2,430.40 ",$573.58 ,"$3,298.40 ","$2,499.84 ","$2,534.56 ",$144.57 ,"$2,951.20 ","$2,784.00 ",$144.57 ,"$2,951.20 ","$2,534.56 ",$573.58 ,"$2,784.00 ","$1,458.24 ","$2,951.20 ","$6,263.99 ","$3,194.24 ","$2,430.40 ","$3,472.00 ","$3,472.00 ","$2,114.45 ","$3,472.00 ","$2,399.15 ","$2,499.84 ","$2,418.25 ","$2,811.84 ","$2,499.84 ",$607.99 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ","$2,499.84 ","$2,152.64 ","$2,499.84 ","$2,499.84 ","$2,083.20 "
ST MARY'S HOSPITAL,32000413,75893,HC VENOGRAM SAMPLING CATH,320,1 ,"$4,704.00 ","$2,352.00 ",$155.92 ,"$10,434.71 ","$1,293.09 ",$394.78 ,$350.91 ,"$4,637.65 ","$2,822.40 ","$3,998.40 ","$3,292.80 ","$1,293.09 ","$4,468.80 ","$3,386.88 ","$3,433.92 ",$155.92 ,"$3,998.40 ","$4,637.65 ",$155.92 ,"$3,998.40 ","$3,433.92 ","$1,293.09 ","$4,637.65 ","$1,975.68 ","$3,998.40 ","$10,434.71 ","$4,327.68 ","$3,292.80 ","$4,704.00 ","$4,704.00 ","$2,864.74 ","$4,704.00 ","$3,250.46 ","$3,386.88 ","$3,276.34 ","$4,684.03 ","$3,386.88 ","$1,370.68 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$3,386.88 ","$2,916.48 ","$3,386.88 ","$3,386.88 ","$2,822.40 "
ST MARY'S HOSPITAL,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 ","$3,386.88 ","$3,433.92 ","$1,997.46 ","$3,998.40 ", N/A ,"$1,997.46 ","$3,998.40 ","$3,433.92 ",$56.46 , 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 ","$2,672.34 ","$3,250.46 ","$3,386.88 ","$3,276.34 ", N/A ,"$3,386.88 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$3,386.88 ","$2,916.48 ","$3,386.88 ","$3,386.88 ","$2,822.40 "
ST MARY'S HOSPITAL,32000417,75898,HC TRANSCATH ANGIO EXIST 75898,320,1 ,"$1,120.00 ",$560.00 ,$86.98 ,"$6,263.99 ",$264.62 ,$190.79 ,$169.59 ,"$2,784.00 ",$672.00 ,$952.00 ,$784.00 ,$264.62 ,"$1,064.00 ",$806.40 ,$817.60 ,$86.98 ,$952.00 ,"$2,784.00 ",$86.98 ,$952.00 ,$817.60 ,$264.62 ,"$2,784.00 ",$470.40 ,$952.00 ,"$6,263.99 ","$1,030.40 ",$784.00 ,"$1,120.00 ","$1,120.00 ",$682.08 ,"$1,120.00 ",$773.92 ,$806.40 ,$780.08 ,"$2,811.84 ",$806.40 ,$280.50 ,$451.00 ,$451.00 ,"$2,784.00 ",$451.00 ,"$2,784.00 ",$806.40 ,$694.40 ,$806.40 ,$806.40 ,$672.00 
ST MARY'S HOSPITAL,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 ,$580.32 ,$588.38 ,$433.45 ,$685.10 , N/A ,$433.45 ,$685.10 ,$588.38 ,$56.46 , N/A ,$338.52 ,$685.10 , N/A ,$741.52 ,$564.20 ,$408.80 ,$490.61 ,$490.85 ,$457.89 ,$556.95 ,$580.32 ,$561.38 , N/A ,$580.32 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$483.60 
ST MARY'S HOSPITAL,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 ,$483.84 ,$490.56 ,$150.57 ,$571.20 , N/A ,$150.57 ,$571.20 ,$490.56 ,$56.46 , N/A ,$282.24 ,$571.20 , N/A ,$618.24 ,$470.40 ,$340.84 ,$409.05 ,$409.25 ,$381.76 ,$464.35 ,$483.84 ,$468.05 , N/A ,$483.84 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$483.84 ,$416.64 ,$483.84 ,$483.84 ,$403.20 
ST MARY'S HOSPITAL,32000423,37191,HC IVC FILTER PLACEMENT 37191,320,1 ,"$8,300.00 ","$4,150.00 ",$420.11 ,"$10,434.71 ","$1,123.24 ","$5,369.27 ","$5,369.27 ","$4,637.65 ","$4,980.00 ","$7,055.00 ","$5,810.00 ","$1,123.24 ","$7,885.00 ","$5,976.00 ","$6,059.00 ",$420.11 ,"$7,055.00 ","$4,637.65 ",$420.11 ,"$7,055.00 ","$6,059.00 ","$1,123.24 ","$4,637.65 ","$3,486.00 ","$7,055.00 ","$10,434.71 ","$7,636.00 ","$5,810.00 ","$5,993.67 ","$8,056.00 ","$5,054.70 ","$7,491.83 ","$5,735.30 ","$5,976.00 ","$5,780.95 ","$4,684.03 ","$5,976.00 ","$1,190.63 ",$451.00 ,$451.00 ,"$4,637.65 ",$451.00 ,"$4,637.65 ","$5,976.00 ","$5,146.00 ","$5,976.00 ","$5,976.00 ","$4,980.00 "
ST MARY'S HOSPITAL,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 ","$2,016.00 ","$2,044.00 ",$954.50 ,"$2,380.00 ", N/A ,$954.50 ,"$2,380.00 ","$2,044.00 ",$56.46 , 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 ","$1,590.68 ","$1,934.80 ","$2,016.00 ","$1,950.20 ", N/A ,"$2,016.00 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,016.00 ","$1,736.00 ","$2,016.00 ","$2,016.00 ","$1,680.00 "
ST MARY'S HOSPITAL,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 ","$2,016.00 ","$2,044.00 ",$954.50 ,"$2,380.00 ", N/A ,$954.50 ,"$2,380.00 ","$2,044.00 ",$56.46 , 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 ","$1,590.68 ","$1,934.80 ","$2,016.00 ","$1,950.20 ", N/A ,"$2,016.00 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,016.00 ","$1,736.00 ","$2,016.00 ","$2,016.00 ","$1,680.00 "
ST MARY'S HOSPITAL,32000438,47533,HC TRANSHEPATIC DRAINAGE,320,1 ,"$6,572.00 ","$3,286.00 ",$451.00 ,"$6,961.86 ",$791.20 ,"$4,251.43 ","$4,251.43 ","$3,094.16 ","$3,943.20 ","$5,586.20 ","$4,600.40 ",$791.20 ,"$6,243.40 ","$4,731.84 ","$4,797.56 ",$511.13 ,"$5,586.20 ","$3,094.16 ",$511.13 ,"$5,586.20 ","$4,797.56 ",$791.20 ,"$3,094.16 ","$2,760.24 ","$5,586.20 ","$6,961.86 ","$6,046.24 ","$4,600.40 ","$1,489.75 ","$2,002.44 ","$4,002.35 ","$1,862.71 ","$4,541.25 ","$4,731.84 ","$4,577.40 ","$3,125.10 ","$4,731.84 ",$838.67 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$4,731.84 ","$4,074.64 ","$4,731.84 ","$4,731.84 ","$3,943.20 "
ST MARY'S HOSPITAL,32000439,47534,HC PLACE BILIARY DRAINAGE CATH,320,1 ,"$6,895.00 ","$3,447.50 ",$451.00 ,"$8,056.00 ",$791.20 ,"$4,460.38 ","$4,460.38 ","$3,094.16 ","$4,137.00 ","$5,860.75 ","$4,826.50 ",$791.20 ,"$6,550.25 ","$4,964.40 ","$5,033.35 ",$713.15 ,"$5,860.75 ","$3,094.16 ",$713.15 ,"$5,860.75 ","$5,033.35 ",$791.20 ,"$3,094.16 ","$2,895.90 ","$5,860.75 ","$6,961.86 ","$6,343.40 ","$4,826.50 ","$5,993.67 ","$8,056.00 ","$4,199.06 ","$7,491.83 ","$4,764.45 ","$4,964.40 ","$4,802.37 ","$3,125.10 ","$4,964.40 ",$838.67 ,$451.00 ,$451.00 ,"$3,094.16 ",$451.00 ,"$3,094.16 ","$4,964.40 ","$4,274.90 ","$4,964.40 ","$4,964.40 ","$4,137.00 "
ST MARY'S HOSPITAL,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 ,$629.28 ,$638.02 ,$119.82 ,$742.90 , N/A ,$119.82 ,$742.90 ,$638.02 ,$56.46 , N/A ,$367.08 ,$742.90 , N/A ,$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$496.52 ,$603.93 ,$629.28 ,$608.74 , N/A ,$629.28 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$524.40 
ST MARY'S HOSPITAL,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 ,$629.28 ,$638.02 ,$119.82 ,$742.90 , N/A ,$119.82 ,$742.90 ,$638.02 ,$56.46 , N/A ,$367.08 ,$742.90 , N/A ,$804.08 ,$611.80 ,$443.29 ,$532.00 ,$532.27 ,$496.52 ,$603.93 ,$629.28 ,$608.74 , N/A ,$629.28 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$629.28 ,$541.88 ,$629.28 ,$629.28 ,$524.40 
ST MARY'S HOSPITAL,32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$1,300.00 ",$650.00 ,$232.13 ,"$3,078.81 ",$232.13 ,$840.97 ,$840.97 ,"$1,368.36 ",$780.00 ,"$1,105.00 ",$910.00 ,$232.13 ,"$1,235.00 ",$936.00 ,$949.00 ,$378.00 ,"$1,105.00 ","$1,368.36 ",$378.00 ,"$1,105.00 ",$949.00 ,$232.13 ,"$1,368.36 ",$546.00 ,"$1,105.00 ","$3,078.81 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,$936.00 ,$905.45 ,"$1,382.04 ",$936.00 ,$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ",$936.00 ,$806.00 ,$936.00 ,$936.00 ,$780.00 
ST MARY'S HOSPITAL,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 ","$1,048.32 ","$1,062.88 ",$118.51 ,"$1,237.60 ", N/A ,$118.51 ,"$1,237.60 ","$1,062.88 ",$56.46 , N/A ,$611.52 ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$827.15 ,"$1,006.10 ","$1,048.32 ","$1,014.10 ", N/A ,"$1,048.32 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,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 ","$1,048.32 ","$1,062.88 ",$118.51 ,"$1,237.60 ", N/A ,$118.51 ,"$1,237.60 ","$1,062.88 ",$56.46 , N/A ,$611.52 ,"$1,237.60 ", N/A ,"$1,339.52 ","$1,019.20 ",$738.48 ,$886.27 ,$886.70 ,$827.15 ,"$1,006.10 ","$1,048.32 ","$1,014.10 ", N/A ,"$1,048.32 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$560.00 ,$280.00 ,$37.92 ,$560.00 ,$37.92 ,$137.14 ,$121.90 ,$223.78 ,$336.00 ,$476.00 ,$392.00 ,$37.92 ,$532.00 ,$403.20 ,$408.80 ,$55.00 ,$476.00 ,$223.78 ,$55.00 ,$476.00 ,$408.80 ,$37.92 ,$223.78 ,$235.20 ,$476.00 ,$503.50 ,$515.20 ,$392.00 ,$520.62 ,$558.93 ,$341.04 ,$520.62 ,$386.96 ,$403.20 ,$390.04 ,$226.02 ,$403.20 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,32000450,76000,HC FLUORO CARM < 1 HR,320,1 ,$560.00 ,$280.00 ,$37.92 ,$560.00 ,$37.92 ,$137.14 ,$121.90 ,$223.78 ,$336.00 ,$476.00 ,$392.00 ,$37.92 ,$532.00 ,$403.20 ,$408.80 ,$55.00 ,$476.00 ,$223.78 ,$55.00 ,$476.00 ,$408.80 ,$37.92 ,$223.78 ,$235.20 ,$476.00 ,$503.50 ,$515.20 ,$392.00 ,$520.62 ,$558.93 ,$341.04 ,$520.62 ,$386.96 ,$403.20 ,$390.04 ,$226.02 ,$403.20 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$710.64 ,$720.51 , N/A ,$838.95 , N/A , N/A ,$838.95 ,$720.51 , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$560.71 ,$682.02 ,$710.64 ,$687.45 , N/A ,$710.64 , N/A , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$592.20 
ST MARY'S HOSPITAL,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 ,$710.64 ,$720.51 , N/A ,$838.95 , N/A , N/A ,$838.95 ,$720.51 , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$560.71 ,$682.02 ,$710.64 ,$687.45 , N/A ,$710.64 , N/A , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$592.20 
ST MARY'S HOSPITAL,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 ,$756.00 ,$766.50 , N/A ,$892.50 , N/A , N/A ,$892.50 ,$766.50 , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,32000464,76010,HC BABYGRAM,320,1 ,$336.00 ,$168.00 ,$17.98 ,$336.00 ,$17.98 ,$78.16 ,$69.48 ,$78.66 ,$201.60 ,$285.60 ,$235.20 ,$17.98 ,$319.20 ,$241.92 ,$245.28 ,$41.66 ,$285.60 ,$78.66 ,$41.66 ,$285.60 ,$245.28 ,$17.98 ,$78.66 ,$141.12 ,$285.60 ,$177.00 ,$309.12 ,$235.20 ,$190.57 ,$204.59 ,$204.62 ,$190.57 ,$232.18 ,$241.92 ,$234.02 ,$79.45 ,$241.92 ,$19.06 ,$336.00 ,$336.00 ,$78.66 ,$336.00 ,$78.66 ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,$728.00 ,$364.00 ,$37.92 ,"$1,057.30 ",$37.92 ,$134.04 ,$119.14 ,$469.91 ,$436.80 ,$618.80 ,$509.60 ,$37.92 ,$691.60 ,$524.16 ,$531.44 ,$71.05 ,$618.80 ,$469.91 ,$71.05 ,$618.80 ,$531.44 ,$37.92 ,$469.91 ,$305.76 ,$618.80 ,"$1,057.30 ",$669.76 ,$509.60 ,$728.00 ,$728.00 ,$443.35 ,$728.00 ,$503.05 ,$524.16 ,$507.05 ,$474.61 ,$524.16 ,$40.20 ,$451.00 ,$451.00 ,$469.91 ,$451.00 ,$469.91 ,$524.16 ,$451.36 ,$524.16 ,$524.16 ,$436.80 
ST MARY'S HOSPITAL,32000466,76080,HC ABSCESS FISTULA DRAINAGE CATH CHECK,320,1 ,$728.00 ,$364.00 ,$37.92 ,"$1,057.30 ",$37.92 ,$134.04 ,$119.14 ,$469.91 ,$436.80 ,$618.80 ,$509.60 ,$37.92 ,$691.60 ,$524.16 ,$531.44 ,$71.05 ,$618.80 ,$469.91 ,$71.05 ,$618.80 ,$531.44 ,$37.92 ,$469.91 ,$305.76 ,$618.80 ,"$1,057.30 ",$669.76 ,$509.60 ,$728.00 ,$728.00 ,$443.35 ,$728.00 ,$503.05 ,$524.16 ,$507.05 ,$474.61 ,$524.16 ,$40.20 ,$451.00 ,$451.00 ,$469.91 ,$451.00 ,$469.91 ,$524.16 ,$451.36 ,$524.16 ,$524.16 ,$436.80 
ST MARY'S HOSPITAL,32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$428.00 ,$214.00 ,$32.23 ,"$1,057.30 ",$37.92 ,$36.26 ,$32.23 ,$469.91 ,$256.80 ,$363.80 ,$299.60 ,$37.92 ,$406.60 ,$308.16 ,$312.44 ,$50.35 ,$363.80 ,$469.91 ,$50.35 ,$363.80 ,$312.44 ,$37.92 ,$469.91 ,$179.76 ,$363.80 ,"$1,057.30 ",$393.76 ,$299.60 ,$428.00 ,$428.00 ,$260.65 ,$428.00 ,$295.75 ,$308.16 ,$298.10 ,$474.61 ,$308.16 ,$40.20 ,$428.00 ,$428.00 ,$469.91 ,$428.00 ,$469.91 ,$308.16 ,$265.36 ,$308.16 ,$308.16 ,$256.80 
ST MARY'S HOSPITAL,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 ,$362.88 ,$367.92 ,$169.29 ,$428.40 , N/A ,$169.29 ,$428.40 ,$367.92 ,$56.46 , N/A ,$211.68 ,$428.40 , N/A ,$463.68 ,$352.80 ,$255.63 ,$306.78 ,$306.94 ,$286.32 ,$348.26 ,$362.88 ,$351.04 , N/A ,$362.88 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$302.40 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$179.31 ,$476.00 , N/A ,$179.31 ,$476.00 ,$408.80 ,$56.46 , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$179.31 ,$476.00 , N/A ,$179.31 ,$476.00 ,$408.80 ,$56.46 , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$179.31 ,$476.00 , N/A ,$179.31 ,$476.00 ,$408.80 ,$56.46 , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$403.20 ,$408.80 ,$179.31 ,$476.00 , N/A ,$179.31 ,$476.00 ,$408.80 ,$56.46 , N/A ,$235.20 ,$476.00 , N/A ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 , N/A ,$403.20 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$443.52 ,$449.68 ,$153.91 ,$523.60 , N/A ,$153.91 ,$523.60 ,$449.68 ,$56.46 , N/A ,$258.72 ,$523.60 , N/A ,$566.72 ,$431.20 ,$312.44 ,$374.96 ,$375.14 ,$349.95 ,$425.66 ,$443.52 ,$429.04 , N/A ,$443.52 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$443.52 ,$381.92 ,$443.52 ,$443.52 ,$369.60 
ST MARY'S HOSPITAL,32000483,19283,HC MAMM STER GUIDE BRST NDL PL,320,1 ,"$1,300.00 ",$650.00 ,$194.20 ,"$1,361.67 ",$258.03 ,$840.97 ,$840.97 ,$605.19 ,$780.00 ,"$1,105.00 ",$910.00 ,$258.03 ,"$1,235.00 ",$936.00 ,$949.00 ,$194.20 ,"$1,105.00 ",$605.19 ,$194.20 ,"$1,105.00 ",$949.00 ,$258.03 ,$605.19 ,$546.00 ,"$1,105.00 ","$1,361.67 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,$936.00 ,$905.45 ,$611.24 ,$936.00 ,$273.51 ,$451.00 ,$451.00 ,$605.19 ,$451.00 ,$605.19 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,$780.00 
ST MARY'S HOSPITAL,32000486,19283,HC MAMM STER GUIDE BRST STEREO CORE,320,1 ,"$1,300.00 ",$650.00 ,$194.20 ,"$1,361.67 ",$258.03 ,$840.97 ,$840.97 ,$605.19 ,$780.00 ,"$1,105.00 ",$910.00 ,$258.03 ,"$1,235.00 ",$936.00 ,$949.00 ,$194.20 ,"$1,105.00 ",$605.19 ,$194.20 ,"$1,105.00 ",$949.00 ,$258.03 ,$605.19 ,$546.00 ,"$1,105.00 ","$1,361.67 ","$1,196.00 ",$910.00 ,"$1,300.00 ","$1,300.00 ",$791.70 ,"$1,300.00 ",$898.30 ,$936.00 ,$905.45 ,$611.24 ,$936.00 ,$273.51 ,$451.00 ,$451.00 ,$605.19 ,$451.00 ,$605.19 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,$780.00 
ST MARY'S HOSPITAL,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,000.00 ","$1,500.00 ",$319.86 ,"$5,188.27 ",$659.19 ,"$1,940.70 ","$1,940.70 ","$2,305.90 ","$1,800.00 ","$2,550.00 ","$2,100.00 ",$659.19 ,"$2,850.00 ","$2,160.00 ","$2,190.00 ",$319.86 ,"$2,550.00 ","$2,305.90 ",$319.86 ,"$2,550.00 ","$2,190.00 ",$659.19 ,"$2,305.90 ","$1,260.00 ","$2,550.00 ","$5,188.27 ","$2,760.00 ","$2,100.00 ","$2,521.44 ","$3,000.00 ","$1,827.00 ","$3,000.00 ","$2,073.00 ","$2,160.00 ","$2,089.50 ","$2,328.96 ","$2,160.00 ",$698.74 ,$451.00 ,$451.00 ,"$2,305.90 ",$451.00 ,"$2,305.90 ","$2,160.00 ","$1,860.00 ","$2,160.00 ","$2,160.00 ","$1,800.00 "
ST MARY'S HOSPITAL,32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,000.00 ","$1,500.00 ",$319.86 ,"$5,188.27 ",$659.19 ,"$1,940.70 ","$1,940.70 ","$2,305.90 ","$1,800.00 ","$2,550.00 ","$2,100.00 ",$659.19 ,"$2,850.00 ","$2,160.00 ","$2,190.00 ",$319.86 ,"$2,550.00 ","$2,305.90 ",$319.86 ,"$2,550.00 ","$2,190.00 ",$659.19 ,"$2,305.90 ","$1,260.00 ","$2,550.00 ","$5,188.27 ","$2,760.00 ","$2,100.00 ","$2,521.44 ","$3,000.00 ","$1,827.00 ","$3,000.00 ","$2,073.00 ","$2,160.00 ","$2,089.50 ","$2,328.96 ","$2,160.00 ",$698.74 ,$451.00 ,$451.00 ,"$2,305.90 ",$451.00 ,"$2,305.90 ","$2,160.00 ","$1,860.00 ","$2,160.00 ","$2,160.00 ","$1,800.00 "
ST MARY'S HOSPITAL,32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$740.00 ,$370.00 ,$193.79 ,"$1,361.67 ",$258.03 ,$478.71 ,$478.71 ,$605.19 ,$444.00 ,$629.00 ,$518.00 ,$258.03 ,$703.00 ,$532.80 ,$540.20 ,$193.79 ,$629.00 ,$605.19 ,$193.79 ,$629.00 ,$540.20 ,$258.03 ,$605.19 ,$310.80 ,$629.00 ,"$1,361.67 ",$680.80 ,$518.00 ,$740.00 ,$740.00 ,$450.66 ,$740.00 ,$511.34 ,$532.80 ,$515.41 ,$611.24 ,$532.80 ,$273.51 ,$451.00 ,$451.00 ,$605.19 ,$451.00 ,$605.19 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$444.00 
ST MARY'S HOSPITAL,32000490,77053,HC GALACTOGRAM SINGLE DUCT,320,1 ,$856.00 ,$428.00 ,$37.92 ,$856.00 ,$37.92 ,$171.29 ,$152.25 ,$223.78 ,$513.60 ,$727.60 ,$599.20 ,$37.92 ,$813.20 ,$616.32 ,$624.88 ,$71.71 ,$727.60 ,$223.78 ,$71.71 ,$727.60 ,$624.88 ,$37.92 ,$223.78 ,$359.52 ,$727.60 ,$503.50 ,$787.52 ,$599.20 ,$856.00 ,$856.00 ,$521.30 ,$856.00 ,$591.50 ,$616.32 ,$596.20 ,$226.02 ,$616.32 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$616.32 ,$530.72 ,$616.32 ,$616.32 ,$513.60 
ST MARY'S HOSPITAL,32000491,77054,HC GALACTOGRAM MULTI DUCT,320,1 ,$856.00 ,$428.00 ,$37.92 ,$856.00 ,$37.92 ,$227.16 ,$201.92 ,$223.78 ,$513.60 ,$727.60 ,$599.20 ,$37.92 ,$813.20 ,$616.32 ,$624.88 ,$94.44 ,$727.60 ,$223.78 ,$94.44 ,$727.60 ,$624.88 ,$37.92 ,$223.78 ,$359.52 ,$727.60 ,$503.50 ,$787.52 ,$599.20 ,$856.00 ,$856.00 ,$521.30 ,$856.00 ,$591.50 ,$616.32 ,$596.20 ,$226.02 ,$616.32 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$616.32 ,$530.72 ,$616.32 ,$616.32 ,$513.60 
ST MARY'S HOSPITAL,32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$99.89 ,$88.79 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$63.69 ,$390.15 ,$105.88 ,$63.69 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$190.57 ,$204.59 ,$279.53 ,$190.57 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,$605.00 ,$302.50 ,$37.92 ,$605.00 ,$37.92 ,$283.03 ,$251.58 ,$105.88 ,$363.00 ,$514.25 ,$423.50 ,$37.92 ,$574.75 ,$435.60 ,$441.65 ,$145.90 ,$514.25 ,$105.88 ,$145.90 ,$514.25 ,$441.65 ,$37.92 ,$105.88 ,$254.10 ,$514.25 ,$238.23 ,$556.60 ,$423.50 ,$302.03 ,$324.25 ,$368.45 ,$302.03 ,$418.06 ,$435.60 ,$421.38 ,$106.94 ,$435.60 ,$40.20 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$363.00 
ST MARY'S HOSPITAL,32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$459.00 ,$229.50 ,$17.98 ,$459.00 ,$17.98 ,$286.14 ,$254.34 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$147.23 ,$390.15 ,$105.88 ,$147.23 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$302.03 ,$324.25 ,$279.53 ,$302.03 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,32000496,77080,HC BONE DENSITY DXA,320,1 ,$694.00 ,$347.00 ,$24.93 ,$694.00 ,$24.93 ,$130.93 ,$116.38 ,$105.88 ,$416.40 ,$589.90 ,$485.80 ,$24.93 ,$659.30 ,$499.68 ,$506.62 ,$54.33 ,$589.90 ,$105.88 ,$54.33 ,$589.90 ,$506.62 ,$24.93 ,$105.88 ,$291.48 ,$589.90 ,$238.23 ,$638.48 ,$485.80 ,$299.62 ,$321.67 ,$422.65 ,$299.62 ,$479.55 ,$499.68 ,$483.37 ,$106.94 ,$499.68 ,$26.43 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$416.40 
ST MARY'S HOSPITAL,32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$638.00 ,$319.00 ,$24.93 ,$638.00 ,$24.93 ,$99.89 ,$88.79 ,$78.66 ,$382.80 ,$542.30 ,$446.60 ,$24.93 ,$606.10 ,$459.36 ,$465.74 ,$41.66 ,$542.30 ,$78.66 ,$41.66 ,$542.30 ,$465.74 ,$24.93 ,$78.66 ,$267.96 ,$542.30 ,$177.00 ,$586.96 ,$446.60 ,$170.18 ,$182.71 ,$388.54 ,$170.18 ,$440.86 ,$459.36 ,$444.37 ,$79.45 ,$459.36 ,$26.43 ,$451.00 ,$451.00 ,$78.66 ,$451.00 ,$78.66 ,$459.36 ,$395.56 ,$459.36 ,$459.36 ,$382.80 
ST MARY'S HOSPITAL,32000499,0238T,HC TRNLUM PERIP ATHRC ILIAC ARTY 0238T,320,1 ,"$12,928.00 ","$6,464.00 ",$451.00 ,"$35,142.61 ","$3,445.58 ","$8,363.12 ","$8,363.12 ","$15,618.94 ","$7,756.80 ","$10,988.80 ","$9,049.60 ","$3,445.58 ","$12,281.60 ","$9,308.16 ","$9,437.44 ","$12,928.00 ","$10,988.80 ","$15,618.94 ","$12,928.00 ","$10,988.80 ","$9,437.44 ","$3,445.58 ","$15,618.94 ","$5,429.76 ","$10,988.80 ","$35,142.61 ","$11,893.76 ","$9,049.60 ","$1,489.75 ","$2,002.44 ","$7,873.15 ","$1,862.71 ","$8,933.25 ","$9,308.16 ","$9,004.35 ","$15,775.13 ","$9,308.16 ","$3,652.31 ",$451.00 ,$451.00 ,"$15,618.94 ",$451.00 ,"$15,618.94 ","$9,308.16 ","$8,015.36 ","$9,308.16 ","$9,308.16 ","$7,756.80 "
ST MARY'S HOSPITAL,32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$560.00 ,$280.00 ,$37.92 ,$560.00 ,$37.92 ,$137.14 ,$121.90 ,$223.78 ,$336.00 ,$476.00 ,$392.00 ,$37.92 ,$532.00 ,$403.20 ,$408.80 ,$55.00 ,$476.00 ,$223.78 ,$55.00 ,$476.00 ,$408.80 ,$37.92 ,$223.78 ,$235.20 ,$476.00 ,$503.50 ,$515.20 ,$392.00 ,$520.62 ,$558.93 ,$341.04 ,$520.62 ,$386.96 ,$403.20 ,$390.04 ,$226.02 ,$403.20 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,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 ,$325.44 ,$329.96 ,$72.30 ,$384.20 , N/A ,$72.30 ,$384.20 ,$329.96 ,$95.13 , N/A ,$189.84 ,$384.20 , N/A ,$415.84 ,$316.40 ,$452.00 ,$452.00 ,$275.27 ,$452.00 ,$312.33 ,$325.44 ,$314.82 , N/A ,$325.44 ,$100.84 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$271.20 
ST MARY'S HOSPITAL,32000504,20550,HC INJ SINGLE TENDON/LIGAMENT,320,1 ,$129.00 ,$64.50 ,$54.18 ,$571.69 ,$75.55 ,$83.45 ,$83.45 ,$254.09 ,$77.40 ,$109.65 ,$90.30 ,$75.55 ,$122.55 ,$92.88 ,$94.17 ,$75.36 ,$109.65 ,$254.09 ,$75.36 ,$109.65 ,$94.17 ,$75.55 ,$254.09 ,$54.18 ,$109.65 ,$571.69 ,$118.68 ,$90.30 ,$129.00 ,$129.00 ,$78.56 ,$129.00 ,$89.14 ,$92.88 ,$89.85 ,$256.63 ,$92.88 ,$80.08 ,$129.00 ,$129.00 ,$254.09 ,$129.00 ,$254.09 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$388.00 ,$194.00 ,$72.78 ,$571.69 ,$75.55 ,$251.00 ,$251.00 ,$254.09 ,$232.80 ,$329.80 ,$271.60 ,$75.55 ,$368.60 ,$279.36 ,$283.24 ,$72.78 ,$329.80 ,$254.09 ,$72.78 ,$329.80 ,$283.24 ,$75.55 ,$254.09 ,$162.96 ,$329.80 ,$571.69 ,$356.96 ,$271.60 ,$388.00 ,$388.00 ,$236.29 ,$388.00 ,$268.11 ,$279.36 ,$270.24 ,$256.63 ,$279.36 ,$80.08 ,$388.00 ,$388.00 ,$254.09 ,$388.00 ,$254.09 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$232.80 
ST MARY'S HOSPITAL,32000506,20553,HC INJ TRIGGER PT 3+ MUSC GROUP,320,1 ,$431.00 ,$215.50 ,$75.55 ,$571.69 ,$75.55 ,$278.81 ,$278.81 ,$254.09 ,$258.60 ,$366.35 ,$301.70 ,$75.55 ,$409.45 ,$310.32 ,$314.63 ,$82.70 ,$366.35 ,$254.09 ,$82.70 ,$366.35 ,$314.63 ,$75.55 ,$254.09 ,$181.02 ,$366.35 ,$571.69 ,$396.52 ,$301.70 ,$431.00 ,$431.00 ,$262.48 ,$431.00 ,$297.82 ,$310.32 ,$300.19 ,$256.63 ,$310.32 ,$80.08 ,$431.00 ,$431.00 ,$254.09 ,$431.00 ,$254.09 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,32000508,74775,HC VAGINOGRAM,320,1 ,$896.00 ,$448.00 ,$37.92 ,$896.00 ,$37.92 ,$229.95 ,$204.40 ,$223.78 ,$537.60 ,$761.60 ,$627.20 ,$37.92 ,$851.20 ,$645.12 ,$654.08 ,$120.77 ,$761.60 ,$223.78 ,$120.77 ,$761.60 ,$654.08 ,$37.92 ,$223.78 ,$376.32 ,$761.60 ,$503.50 ,$824.32 ,$627.20 ,$856.00 ,$896.00 ,$545.66 ,$856.00 ,$619.14 ,$645.12 ,$624.06 ,$226.02 ,$645.12 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,32000509,77072,HC BONE AGE STUDIES,320,1 ,$594.00 ,$297.00 ,$17.98 ,$594.00 ,$17.98 ,$62.64 ,$55.68 ,$105.88 ,$356.40 ,$504.90 ,$415.80 ,$17.98 ,$564.30 ,$427.68 ,$433.62 ,$33.62 ,$504.90 ,$105.88 ,$33.62 ,$504.90 ,$433.62 ,$17.98 ,$105.88 ,$249.48 ,$504.90 ,$238.23 ,$546.48 ,$415.80 ,$190.57 ,$204.59 ,$361.75 ,$190.57 ,$410.45 ,$427.68 ,$413.72 ,$106.94 ,$427.68 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$356.40 
ST MARY'S HOSPITAL,32000515,G0278,HC ILIAC ARTERY ANGIO W CATH G0278,320,1 ,$683.00 ,$341.50 ,$25.22 ,"$1,370.68 ","$1,293.09 ",$441.83 ,$441.83 , N/A ,$409.80 ,$580.55 ,$478.10 ,"$1,293.09 ",$648.85 ,$491.76 ,$498.59 ,$25.22 ,$580.55 , N/A ,$25.22 ,$580.55 ,$498.59 ,"$1,293.09 ", N/A ,$286.86 ,$580.55 , N/A ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$388.01 ,$471.95 ,$491.76 ,$475.71 , N/A ,$491.76 ,"$1,370.68 ",$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,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 ,$710.64 ,$720.51 , N/A ,$838.95 , N/A , N/A ,$838.95 ,$720.51 , N/A , N/A , N/A ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$560.71 ,$682.02 ,$710.64 ,$687.45 , N/A ,$710.64 , N/A , N/A , N/A , N/A , N/A , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$592.20 
ST MARY'S HOSPITAL,32000528,47543,HC ENDO BILIARY PERC DX WITH SPECIMEN,320,1 ,"$3,000.00 ","$1,500.00 ",$276.89 ,"$3,000.00 ",$791.20 ,"$1,940.70 ","$1,940.70 ", N/A ,"$1,800.00 ","$2,550.00 ","$2,100.00 ",$791.20 ,"$2,850.00 ","$2,160.00 ","$2,190.00 ",$276.89 ,"$2,550.00 ", N/A ,$276.89 ,"$2,550.00 ","$2,190.00 ",$791.20 , N/A ,"$1,260.00 ","$2,550.00 ", N/A ,"$2,760.00 ","$2,100.00 ","$1,680.96 ","$2,259.84 ","$1,827.00 ","$2,101.20 ","$2,073.00 ","$2,160.00 ","$2,089.50 ", N/A ,"$2,160.00 ",$838.67 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,160.00 ","$1,860.00 ","$2,160.00 ","$2,160.00 ","$1,800.00 "
ST MARY'S HOSPITAL,32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$1,185.00 ",$592.50 ,$173.41 ,"$1,185.00 ",$299.20 ,$766.58 ,$766.58 ,$525.67 ,$711.00 ,"$1,007.25 ",$829.50 ,$299.20 ,"$1,125.75 ",$853.20 ,$865.05 ,$173.41 ,"$1,007.25 ",$525.67 ,$173.41 ,"$1,007.25 ",$865.05 ,$299.20 ,$525.67 ,$497.70 ,"$1,007.25 ","$1,182.77 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$530.93 ,$853.20 ,$317.15 ,$451.00 ,$451.00 ,$525.67 ,$451.00 ,$525.67 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,293.00 ",$646.50 ,$214.70 ,"$1,774.15 ",$448.80 ,$836.44 ,$836.44 ,$788.51 ,$775.80 ,"$1,099.05 ",$905.10 ,$448.80 ,"$1,228.35 ",$930.96 ,$943.89 ,$214.70 ,"$1,099.05 ",$788.51 ,$214.70 ,"$1,099.05 ",$943.89 ,$448.80 ,$788.51 ,$543.06 ,"$1,099.05 ","$1,774.15 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$796.40 ,$930.96 ,$475.73 ,$451.00 ,$451.00 ,$788.51 ,$451.00 ,$788.51 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,293.00 ",$646.50 ,$214.70 ,"$1,774.15 ",$448.80 ,$836.44 ,$836.44 ,$788.51 ,$775.80 ,"$1,099.05 ",$905.10 ,$448.80 ,"$1,228.35 ",$930.96 ,$943.89 ,$214.70 ,"$1,099.05 ",$788.51 ,$214.70 ,"$1,099.05 ",$943.89 ,$448.80 ,$788.51 ,$543.06 ,"$1,099.05 ","$1,774.15 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$796.40 ,$930.96 ,$475.73 ,$451.00 ,$451.00 ,$788.51 ,$451.00 ,$788.51 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,32000532,32556,HC PLEURAL DRAINAGE W/O IMAGING 32556,450,1 ,"$1,185.00 ",$592.50 ,$299.20 ,"$3,554.07 ",$299.20 ,$766.58 ,$766.58 ,"$1,579.59 ",$711.00 ,"$1,007.25 ",$829.50 ,$299.20 ,"$1,125.75 ",$853.20 ,$865.05 ,$770.25 ,"$1,007.25 ","$1,579.59 ",$770.25 ,"$1,007.25 ",$865.05 ,$299.20 ,"$1,579.59 ",$571.36 ,"$1,007.25 ","$3,554.07 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$673.20 ,$818.84 ,$853.20 ,$825.35 ,"$1,595.39 ",$853.20 ,$317.15 ,$685.00 ,$685.00 ,"$1,579.59 ",$685.00 ,"$1,579.59 ",$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,32000533,32557,HC PLEURAL DRAINAGE W/IMAGING 32557,320,1 ,"$1,939.00 ",$969.50 ,$291.84 ,"$3,077.03 ",$299.20 ,"$1,254.34 ","$1,254.34 ","$1,367.57 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$299.20 ,"$1,842.05 ","$1,396.08 ","$1,415.47 ",$291.84 ,"$1,648.15 ","$1,367.57 ",$291.84 ,"$1,648.15 ","$1,415.47 ",$299.20 ,"$1,367.57 ",$814.38 ,"$1,648.15 ","$3,077.03 ","$1,783.88 ","$1,357.30 ","$1,489.75 ","$1,939.00 ","$1,180.85 ","$1,862.71 ","$1,339.85 ","$1,396.08 ","$1,350.51 ","$1,381.25 ","$1,396.08 ",$317.15 ,$451.00 ,$451.00 ,"$1,367.57 ",$451.00 ,"$1,367.57 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,163.40 "
ST MARY'S HOSPITAL,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 ,$756.00 ,$766.50 , N/A ,$892.50 , N/A , N/A ,$892.50 ,$766.50 , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,32000542,20551,HC INJ TENDON ORIGIN,320,1 ,$431.00 ,$215.50 ,$75.55 ,$571.69 ,$75.55 ,$278.81 ,$278.81 ,$254.09 ,$258.60 ,$366.35 ,$301.70 ,$75.55 ,$409.45 ,$310.32 ,$314.63 ,$75.81 ,$366.35 ,$254.09 ,$75.81 ,$366.35 ,$314.63 ,$75.55 ,$254.09 ,$181.02 ,$366.35 ,$571.69 ,$396.52 ,$301.70 ,$431.00 ,$431.00 ,$262.48 ,$431.00 ,$297.82 ,$310.32 ,$300.19 ,$256.63 ,$310.32 ,$80.08 ,$431.00 ,$431.00 ,$254.09 ,$431.00 ,$254.09 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,32000543,72074,HC XR T-SPINE 4 + VIEWS,320,1 ,$317.00 ,$158.50 ,$17.98 ,$317.00 ,$17.98 ,$124.72 ,$110.87 ,$105.88 ,$190.20 ,$269.45 ,$221.90 ,$17.98 ,$301.15 ,$228.24 ,$231.41 ,$65.03 ,$269.45 ,$105.88 ,$65.03 ,$269.45 ,$231.41 ,$17.98 ,$105.88 ,$133.14 ,$269.45 ,$238.23 ,$291.64 ,$221.90 ,$190.57 ,$204.59 ,$193.05 ,$190.57 ,$219.05 ,$228.24 ,$220.79 ,$106.94 ,$228.24 ,$19.06 ,$317.00 ,$317.00 ,$105.88 ,$317.00 ,$105.88 ,$228.24 ,$196.54 ,$228.24 ,$228.24 ,$190.20 
ST MARY'S HOSPITAL,32000548,51100,HC ASPIRATE BLADDER BY NEEDLE,320,1 ,$399.00 ,$199.50 ,$74.60 ,$582.28 ,$119.36 ,$258.11 ,$258.11 ,$258.79 ,$239.40 ,$339.15 ,$279.30 ,$119.36 ,$379.05 ,$287.28 ,$291.27 ,$74.60 ,$339.15 ,$258.79 ,$74.60 ,$339.15 ,$291.27 ,$119.36 ,$258.79 ,$167.58 ,$339.15 ,$582.28 ,$367.08 ,$279.30 ,$399.00 ,$399.00 ,$242.99 ,$399.00 ,$275.71 ,$287.28 ,$277.90 ,$261.38 ,$287.28 ,$126.52 ,$399.00 ,$399.00 ,$258.79 ,$399.00 ,$258.79 ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$239.40 
ST MARY'S HOSPITAL,32000560,49460,HC MECHAN REMOVAL OF OBSTRUCT MATERIAL FROM G/J/D TUBE FLUOR/CONT,320,1 ,"$1,100.00 ",$550.00 ,$93.81 ,"$1,770.57 ",$211.20 ,$711.59 ,$711.59 ,$786.92 ,$660.00 ,$935.00 ,$770.00 ,$211.20 ,"$1,045.00 ",$792.00 ,$803.00 ,$93.81 ,$935.00 ,$786.92 ,$93.81 ,$935.00 ,$803.00 ,$211.20 ,$786.92 ,$462.00 ,$935.00 ,"$1,770.57 ","$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$792.00 ,$766.15 ,$794.79 ,$792.00 ,$223.87 ,$451.00 ,$451.00 ,$786.92 ,$451.00 ,$786.92 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,32000561,49405,HC ABSCESS DRAIN KIDN/LIV/SPLN/LUNG VISERAL 49405,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,078.81 ",$232.13 ,$905.66 ,$905.66 ,"$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$378.66 ,"$1,190.00 ","$1,368.36 ",$378.66 ,"$1,190.00 ","$1,022.00 ",$232.13 ,"$1,368.36 ",$588.00 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,32000562,49406,HC ABSCESS DRAIN PERI/ RETROPER PERC 49406,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,078.81 ",$232.13 ,$905.66 ,$905.66 ,"$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$378.00 ,"$1,190.00 ","$1,368.36 ",$378.00 ,"$1,190.00 ","$1,022.00 ",$232.13 ,"$1,368.36 ",$588.00 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,32000563,49407,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER TV OR TR,320,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,078.81 ",$232.13 ,$905.66 ,$905.66 ,"$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$398.99 ,"$1,190.00 ","$1,368.36 ",$398.99 ,"$1,190.00 ","$1,022.00 ",$232.13 ,"$1,368.36 ",$588.00 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$246.06 ,$451.00 ,$451.00 ,"$1,368.36 ",$451.00 ,"$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,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 ","$5,972.40 ","$6,055.35 ","$2,589.23 ","$7,050.75 ", N/A ,"$2,589.23 ","$7,050.75 ","$6,055.35 ","$1,851.24 ", N/A ,"$3,483.90 ","$7,050.75 ", N/A ,"$7,631.40 ","$5,806.50 ","$5,993.67 ","$8,056.00 ","$5,051.66 ","$7,491.83 ","$5,731.85 ","$5,972.40 ","$5,777.47 ", N/A ,"$5,972.40 ","$1,962.31 ",$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$5,972.40 ","$5,142.90 ","$5,972.40 ","$5,972.40 ","$4,977.00 "
ST MARY'S HOSPITAL,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 ",$847.44 ,$859.21 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,000.45 ",$859.21 ,"$3,529.80 ", N/A ,$494.34 ,"$1,000.45 ", N/A ,"$1,082.84 ",$823.90 ,$596.97 ,$716.44 ,$716.79 ,$668.65 ,$813.31 ,$847.44 ,$819.78 , N/A ,$847.44 ,"$3,741.59 ",$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$847.44 ,$729.74 ,$847.44 ,$847.44 ,$706.20 
ST MARY'S HOSPITAL,32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$109.20 ,$97.07 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$59.02 ,$314.50 ,$78.66 ,$59.02 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000568,70190,HC XR EYE SOCKETS,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$110.76 ,$98.45 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$54.35 ,$314.50 ,$78.66 ,$54.35 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$59.70 ,$314.50 ,$78.66 ,$59.70 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$187.25 ,$201.02 ,$225.33 ,$187.25 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$109.82 ,$314.50 ,$105.88 ,$109.82 ,$314.50 ,$270.10 ,$17.98 ,$105.88 ,$155.40 ,$314.50 ,$238.23 ,$340.40 ,$259.00 ,$310.09 ,$332.91 ,$225.33 ,$310.09 ,$255.67 ,$266.40 ,$257.71 ,$106.94 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$105.88 ,$370.00 ,$105.88 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$248.40 ,$351.90 ,$289.80 ,$17.98 ,$393.30 ,$298.08 ,$302.22 ,$122.51 ,$351.90 ,$105.88 ,$122.51 ,$351.90 ,$302.22 ,$17.98 ,$105.88 ,$173.88 ,$351.90 ,$238.23 ,$380.88 ,$289.80 ,$414.00 ,$414.00 ,$252.13 ,$414.00 ,$286.07 ,$298.08 ,$288.35 ,$106.94 ,$298.08 ,$19.06 ,$414.00 ,$414.00 ,$105.88 ,$414.00 ,$105.88 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$248.40 
ST MARY'S HOSPITAL,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 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$156.58 ,$390.15 ,$105.88 ,$156.58 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$459.00 ,$459.00 ,$279.53 ,$459.00 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,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 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$46.33 ,$314.50 ,$78.66 ,$46.33 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$187.25 ,$201.02 ,$225.33 ,$187.25 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,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 ,$78.66 ,$248.40 ,$351.90 ,$289.80 ,$17.98 ,$393.30 ,$298.08 ,$302.22 ,$71.71 ,$351.90 ,$78.66 ,$71.71 ,$351.90 ,$302.22 ,$17.98 ,$78.66 ,$173.88 ,$351.90 ,$177.00 ,$380.88 ,$289.80 ,$187.25 ,$201.02 ,$252.13 ,$187.25 ,$286.07 ,$298.08 ,$288.35 ,$79.45 ,$298.08 ,$19.06 ,$414.00 ,$414.00 ,$78.66 ,$414.00 ,$78.66 ,$298.08 ,$256.68 ,$298.08 ,$298.08 ,$248.40 
ST MARY'S HOSPITAL,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 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$91.10 ,$390.15 ,$105.88 ,$91.10 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$310.09 ,$332.91 ,$279.53 ,$310.09 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,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 ,$105.88 ,$275.40 ,$390.15 ,$321.30 ,$17.98 ,$436.05 ,$330.48 ,$335.07 ,$60.35 ,$390.15 ,$105.88 ,$60.35 ,$390.15 ,$335.07 ,$17.98 ,$105.88 ,$192.78 ,$390.15 ,$238.23 ,$422.28 ,$321.30 ,$310.09 ,$332.91 ,$279.53 ,$310.09 ,$317.17 ,$330.48 ,$319.69 ,$106.94 ,$330.48 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$330.48 ,$284.58 ,$330.48 ,$330.48 ,$275.40 
ST MARY'S HOSPITAL,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 ,$105.88 ,$302.40 ,$428.40 ,$352.80 ,$17.98 ,$478.80 ,$362.88 ,$367.92 ,$78.39 ,$428.40 ,$105.88 ,$78.39 ,$428.40 ,$367.92 ,$17.98 ,$105.88 ,$211.68 ,$428.40 ,$238.23 ,$463.68 ,$352.80 ,$310.09 ,$332.91 ,$306.94 ,$310.09 ,$348.26 ,$362.88 ,$351.04 ,$106.94 ,$362.88 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$362.88 ,$312.48 ,$362.88 ,$362.88 ,$302.40 
ST MARY'S HOSPITAL,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 ,$105.88 ,$329.40 ,$466.65 ,$384.30 ,$17.98 ,$521.55 ,$395.28 ,$400.77 ,$92.43 ,$466.65 ,$105.88 ,$92.43 ,$466.65 ,$400.77 ,$17.98 ,$105.88 ,$230.58 ,$466.65 ,$238.23 ,$505.08 ,$384.30 ,$549.00 ,$549.00 ,$334.34 ,$549.00 ,$379.36 ,$395.28 ,$382.38 ,$106.94 ,$395.28 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$329.40 
ST MARY'S HOSPITAL,32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$370.00 ,$185.00 ,$17.98 ,$370.00 ,$17.98 ,$85.92 ,$76.38 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$41.66 ,$314.50 ,$78.66 ,$41.66 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$187.25 ,$201.02 ,$225.33 ,$187.25 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$104.55 ,$92.93 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$52.34 ,$314.50 ,$78.66 ,$52.34 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$280.88 ,$301.53 ,$225.33 ,$280.88 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$370.00 ,$185.00 ,$26.97 ,$370.00 ,$26.97 ,$104.55 ,$92.93 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$26.97 ,$351.50 ,$266.40 ,$270.10 ,$52.34 ,$314.50 ,$78.66 ,$52.34 ,$314.50 ,$270.10 ,$26.97 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$280.88 ,$301.53 ,$225.33 ,$280.88 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$28.59 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,32000586,72265,HC XR MYELOGRAPHY L-SPINE,320,1 ,"$2,078.00 ","$1,039.00 ",$140.55 ,"$2,078.00 ",$184.15 ,$245.78 ,$218.47 ,$695.77 ,"$1,246.80 ","$1,766.30 ","$1,454.60 ",$184.15 ,"$1,974.10 ","$1,496.16 ","$1,516.94 ",$140.55 ,"$1,766.30 ",$695.77 ,$140.55 ,"$1,766.30 ","$1,516.94 ",$184.15 ,$695.77 ,$872.76 ,"$1,766.30 ","$1,565.49 ","$1,911.76 ","$1,454.60 ","$1,985.24 ","$2,078.00 ","$1,265.50 ","$1,985.24 ","$1,435.90 ","$1,496.16 ","$1,447.33 ",$702.73 ,"$1,496.16 ",$195.20 ,$451.00 ,$451.00 ,$695.77 ,$451.00 ,$695.77 ,"$1,496.16 ","$1,288.36 ","$1,496.16 ","$1,496.16 ","$1,246.80 "
ST MARY'S HOSPITAL,32000591,75956,HC ENDOVASC REPR THOR AORTA W/SUBCL S AND I,320,1 ,"$4,144.00 ","$2,072.00 ",$56.46 ,"$4,144.00 ",$56.46 ,"$1,448.25 ","$1,287.34 ", N/A ,"$2,486.40 ","$3,522.40 ","$2,900.80 ",$56.46 ,"$3,936.80 ","$2,983.68 ","$3,025.12 ", N/A ,"$3,522.40 ", N/A , N/A ,"$3,522.40 ","$3,025.12 ",$56.46 , N/A ,"$1,740.48 ","$3,522.40 ", N/A ,"$3,812.48 ","$2,900.80 ","$2,101.84 ","$2,522.45 ","$2,523.70 ","$2,354.21 ","$2,863.50 ","$2,983.68 ","$2,886.30 ", N/A ,"$2,983.68 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$2,486.40 "
ST MARY'S HOSPITAL,32000592,75957,HC ENDOVASC REPR THOR AORTA W/O SUBCL S AND I,320,1 ,"$4,144.00 ","$2,072.00 ",$56.46 ,"$4,144.00 ",$56.46 ,"$1,241.38 ","$1,103.45 ", N/A ,"$2,486.40 ","$3,522.40 ","$2,900.80 ",$56.46 ,"$3,936.80 ","$2,983.68 ","$3,025.12 ", N/A ,"$3,522.40 ", N/A , N/A ,"$3,522.40 ","$3,025.12 ",$56.46 , N/A ,"$1,740.48 ","$3,522.40 ", N/A ,"$3,812.48 ","$2,900.80 ","$2,101.84 ","$2,522.45 ","$2,523.70 ","$2,354.21 ","$2,863.50 ","$2,983.68 ","$2,886.30 ", N/A ,"$2,983.68 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$2,486.40 "
ST MARY'S HOSPITAL,32000593,75958,HC PLACE PROX EXT PROSTH ENDOVASC THOR AORTA S AND I,320,1 ,"$4,144.00 ","$2,072.00 ",$56.46 ,"$4,144.00 ",$56.46 ,$826.79 ,$734.92 , N/A ,"$2,486.40 ","$3,522.40 ","$2,900.80 ",$56.46 ,"$3,936.80 ","$2,983.68 ","$3,025.12 ", N/A ,"$3,522.40 ", N/A , N/A ,"$3,522.40 ","$3,025.12 ",$56.46 , N/A ,"$1,740.48 ","$3,522.40 ", N/A ,"$3,812.48 ","$2,900.80 ","$2,101.84 ","$2,522.45 ","$2,523.70 ","$2,354.21 ","$2,863.50 ","$2,983.68 ","$2,886.30 ", N/A ,"$2,983.68 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$2,486.40 "
ST MARY'S HOSPITAL,32000594,75959,HC PLACE DISTAL EXT PROSTH POST RPR THOR AORTA S AND I,320,1 ,"$4,144.00 ","$2,072.00 ",$56.46 ,"$4,144.00 ",$56.46 ,$721.45 ,$641.29 , N/A ,"$2,486.40 ","$3,522.40 ","$2,900.80 ",$56.46 ,"$3,936.80 ","$2,983.68 ","$3,025.12 ", N/A ,"$3,522.40 ", N/A , N/A ,"$3,522.40 ","$3,025.12 ",$56.46 , N/A ,"$1,740.48 ","$3,522.40 ", N/A ,"$3,812.48 ","$2,900.80 ","$2,101.84 ","$2,522.45 ","$2,523.70 ","$2,354.21 ","$2,863.50 ","$2,983.68 ","$2,886.30 ", N/A ,"$2,983.68 ",$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,"$2,983.68 ","$2,569.28 ","$2,983.68 ","$2,983.68 ","$2,486.40 "
ST MARY'S HOSPITAL,32000603,74742,HC TRANSCERV CATH FALLOPIAN TUBE S AND I,320,1 ,$750.00 ,$375.00 ,$56.46 ,$750.00 ,$56.46 ,$245.07 ,$217.84 , N/A ,$450.00 ,$637.50 ,$525.00 ,$56.46 ,$712.50 ,$540.00 ,$547.50 ,$113.92 ,$637.50 , N/A ,$113.92 ,$637.50 ,$547.50 ,$56.46 , N/A ,$315.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,$380.40 ,$456.53 ,$456.75 ,$426.08 ,$518.25 ,$540.00 ,$522.38 , N/A ,$540.00 ,$59.85 ,$451.00 ,$451.00 , N/A ,$451.00 , N/A ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,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 ,$223.78 ,$396.60 ,$561.85 ,$462.70 ,$37.92 ,$627.95 ,$475.92 ,$482.53 ,$129.19 ,$561.85 ,$223.78 ,$129.19 ,$561.85 ,$482.53 ,$37.92 ,$223.78 ,$277.62 ,$561.85 ,$503.50 ,$608.12 ,$462.70 ,$520.62 ,$558.93 ,$402.55 ,$520.62 ,$456.75 ,$475.92 ,$460.39 ,$226.02 ,$475.92 ,$40.20 ,$451.00 ,$451.00 ,$223.78 ,$451.00 ,$223.78 ,$475.92 ,$409.82 ,$475.92 ,$475.92 ,$396.60 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$103.14 ,$142.80 , N/A ,$103.14 ,$142.80 ,$122.64 ,$37.92 , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 , N/A ,$120.96 ,$40.20 ,$168.00 ,$168.00 , N/A ,$168.00 , N/A ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,32000640,76499,HC RADIOGRAPHIC 2 VIEWS PENIS,320,1 ,$230.37 ,$115.19 ,$17.98 ,$230.37 ,$17.98 ,$149.03 ,$149.03 ,$78.66 ,$138.22 ,$195.81 ,$161.26 ,$17.98 ,$218.85 ,$165.87 ,$168.17 , N/A ,$195.81 ,$78.66 , N/A ,$195.81 ,$168.17 ,$17.98 ,$78.66 ,$96.76 ,$195.81 ,$177.00 ,$211.94 ,$161.26 ,$190.57 ,$204.59 ,$140.30 ,$190.57 ,$159.19 ,$165.87 ,$160.45 ,$79.45 ,$165.87 ,$19.06 ,$230.37 ,$230.37 ,$78.66 ,$230.37 ,$78.66 ,$165.87 ,$142.83 ,$165.87 ,$165.87 ,$138.22 
ST MARY'S HOSPITAL,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 ",$329.33 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$60.15 ,"$1,434.50 ","$1,087.20 ","$1,102.30 ",$981.50 ,"$1,283.50 ",$329.33 ,$981.50 ,"$1,283.50 ","$1,102.30 ",$60.15 ,$329.33 ,$400.52 ,"$1,283.50 ",$741.00 ,"$1,389.20 ","$1,057.00 ","$1,034.69 ","$1,110.82 ",$919.59 ,"$1,034.69 ","$1,043.41 ","$1,087.20 ","$1,051.72 ",$332.62 ,"$1,087.20 ",$63.76 ,"$1,510.00 ","$1,510.00 ",$329.33 ,"$1,510.00 ",$329.33 ,"$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ",$906.00 
ST MARY'S HOSPITAL,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 ",$329.33 ,"$1,877.40 ","$2,659.65 ","$2,190.30 ",$60.15 ,"$2,972.55 ","$2,252.88 ","$2,284.17 ","$2,033.85 ","$2,659.65 ",$329.33 ,"$2,033.85 ","$2,659.65 ","$2,284.17 ",$60.15 ,$329.33 ,$400.52 ,"$2,659.65 ",$741.00 ,"$2,878.68 ","$2,190.30 ","$1,034.69 ","$1,110.82 ","$1,905.56 ","$1,034.69 ","$2,162.14 ","$2,252.88 ","$2,179.35 ",$332.62 ,"$2,252.88 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$329.33 ,"$1,859.00 ",$329.33 ,"$2,252.88 ","$1,939.98 ","$2,252.88 ","$2,252.88 ","$1,877.40 "
ST MARY'S HOSPITAL,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 ","$1,228.08 ","$4,207.80 ","$5,961.05 ","$4,909.10 ",$345.96 ,"$6,662.35 ","$5,049.36 ","$5,119.49 ","$4,558.45 ","$5,961.05 ","$1,228.08 ","$4,558.45 ","$5,961.05 ","$5,119.49 ",$345.96 ,"$1,228.08 ",$400.52 ,"$5,961.05 ","$2,763.17 ","$6,451.96 ","$4,909.10 ","$3,443.97 ","$3,697.37 ","$4,270.92 ","$3,443.97 ","$4,845.98 ","$5,049.36 ","$4,884.55 ","$1,240.36 ","$5,049.36 ",$366.72 ,"$1,859.00 ","$1,859.00 ","$1,228.08 ","$1,859.00 ","$1,228.08 ","$5,049.36 ","$4,348.06 ","$5,049.36 ","$5,049.36 ","$4,207.80 "
ST MARY'S HOSPITAL,33300015,77300,HC DOSIMETRY CALCULATION BASIC,333,1 ,$842.00 ,$421.00 ,$60.15 ,$842.00 ,$60.15 ,$148.01 ,$131.56 ,$123.40 ,$505.20 ,$715.70 ,$589.40 ,$60.15 ,$799.90 ,$606.24 ,$614.66 ,$547.30 ,$715.70 ,$123.40 ,$547.30 ,$715.70 ,$614.66 ,$60.15 ,$123.40 ,$400.52 ,$715.70 ,$277.65 ,$774.64 ,$589.40 ,$380.99 ,$409.02 ,$512.78 ,$380.99 ,$581.82 ,$606.24 ,$586.45 ,$124.63 ,$606.24 ,$63.76 ,$842.00 ,$842.00 ,$123.40 ,$842.00 ,$123.40 ,$606.24 ,$522.04 ,$606.24 ,$606.24 ,$505.20 
ST MARY'S HOSPITAL,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 ","$1,228.08 ","$3,366.00 ","$4,768.50 ","$3,927.00 ",$345.96 ,"$5,329.50 ","$4,039.20 ","$4,095.30 ","$3,646.50 ","$4,768.50 ","$1,228.08 ","$3,646.50 ","$4,768.50 ","$4,095.30 ",$345.96 ,"$1,228.08 ",$400.52 ,"$4,768.50 ","$2,763.17 ","$5,161.20 ","$3,927.00 ","$3,443.97 ","$3,697.37 ","$3,416.49 ","$3,443.97 ","$3,876.51 ","$4,039.20 ","$3,907.37 ","$1,240.36 ","$4,039.20 ",$366.72 ,"$1,859.00 ","$1,859.00 ","$1,228.08 ","$1,859.00 ","$1,228.08 ","$4,039.20 ","$3,478.20 ","$4,039.20 ","$4,039.20 ","$3,366.00 "
ST MARY'S HOSPITAL,33300019,77306,HC ISODOSE PLAN SIMPLE COMPUTER PLAN,333,1 ,$831.00 ,$415.50 ,$36.91 ,$831.00 ,$36.91 ,$333.26 ,$296.23 ,$329.33 ,$498.60 ,$706.35 ,$581.70 ,$36.91 ,$789.45 ,$598.32 ,$606.63 ,$540.15 ,$706.35 ,$329.33 ,$540.15 ,$706.35 ,$606.63 ,$36.91 ,$329.33 ,$400.52 ,$706.35 ,$741.00 ,$764.52 ,$581.70 ,$369.56 ,$396.76 ,$506.08 ,$369.56 ,$574.22 ,$598.32 ,$578.79 ,$332.62 ,$598.32 ,$39.12 ,$831.00 ,$831.00 ,$329.33 ,$831.00 ,$329.33 ,$598.32 ,$515.22 ,$598.32 ,$598.32 ,$498.60 
ST MARY'S HOSPITAL,33300024,77321,HC PORT PLAN SPECIAL,333,1 ,"$1,942.00 ",$971.00 ,$60.15 ,"$1,942.00 ",$60.15 ,$191.46 ,$170.19 ,$329.33 ,"$1,165.20 ","$1,650.70 ","$1,359.40 ",$60.15 ,"$1,844.90 ","$1,398.24 ","$1,417.66 ","$1,262.30 ","$1,650.70 ",$329.33 ,"$1,262.30 ","$1,650.70 ","$1,417.66 ",$60.15 ,$329.33 ,$400.52 ,"$1,650.70 ",$741.00 ,"$1,786.64 ","$1,359.40 ","$1,034.69 ","$1,110.82 ","$1,182.68 ","$1,034.69 ","$1,341.92 ","$1,398.24 ","$1,352.60 ",$332.62 ,"$1,398.24 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$329.33 ,"$1,859.00 ",$329.33 ,"$1,398.24 ","$1,204.04 ","$1,398.24 ","$1,398.24 ","$1,165.20 "
ST MARY'S HOSPITAL,33300029,77331,HC DOSIMETRY CALCULATION SPECIAL,333,1 ,$604.00 ,$302.00 ,$36.91 ,$604.00 ,$36.91 ,$82.82 ,$73.62 ,$123.40 ,$362.40 ,$513.40 ,$422.80 ,$36.91 ,$573.80 ,$434.88 ,$440.92 ,$392.60 ,$513.40 ,$123.40 ,$392.60 ,$513.40 ,$440.92 ,$36.91 ,$123.40 ,$400.52 ,$513.40 ,$277.65 ,$555.68 ,$422.80 ,$380.99 ,$409.02 ,$367.84 ,$380.99 ,$417.36 ,$434.88 ,$420.69 ,$124.63 ,$434.88 ,$39.12 ,$604.00 ,$604.00 ,$123.40 ,$604.00 ,$123.40 ,$434.88 ,$374.48 ,$434.88 ,$434.88 ,$362.40 
ST MARY'S HOSPITAL,33300030,77332,HC TREATMENT DEVICE SIMPLE,333,1 ,$723.00 ,$361.50 ,$36.91 ,$723.00 ,$36.91 ,$124.72 ,$110.87 ,$123.40 ,$433.80 ,$614.55 ,$506.10 ,$36.91 ,$686.85 ,$520.56 ,$527.79 ,$469.95 ,$614.55 ,$123.40 ,$469.95 ,$614.55 ,$527.79 ,$36.91 ,$123.40 ,$400.52 ,$614.55 ,$277.65 ,$665.16 ,$506.10 ,$709.44 ,$723.00 ,$440.31 ,$709.44 ,$499.59 ,$520.56 ,$503.57 ,$124.63 ,$520.56 ,$39.12 ,$723.00 ,$723.00 ,$123.40 ,$723.00 ,$123.40 ,$520.56 ,$448.26 ,$520.56 ,$520.56 ,$433.80 
ST MARY'S HOSPITAL,33300031,77333,HC TREATMENT DEVICE INTERM,333,1 ,"$1,079.00 ",$539.50 ,$36.91 ,"$1,079.00 ",$36.91 ,$306.31 ,$272.28 ,$123.40 ,$647.40 ,$917.15 ,$755.30 ,$36.91 ,"$1,025.05 ",$776.88 ,$787.67 ,$701.35 ,$917.15 ,$123.40 ,$701.35 ,$917.15 ,$787.67 ,$36.91 ,$123.40 ,$400.52 ,$917.15 ,$277.65 ,$992.68 ,$755.30 ,$709.44 ,$761.64 ,$657.11 ,$709.44 ,$745.59 ,$776.88 ,$751.52 ,$124.63 ,$776.88 ,$39.12 ,"$1,079.00 ","$1,079.00 ",$123.40 ,"$1,079.00 ",$123.40 ,$776.88 ,$668.98 ,$776.88 ,$776.88 ,$647.40 
ST MARY'S HOSPITAL,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 ,$329.33 ,"$1,230.00 ","$1,742.50 ","$1,435.00 ",$60.15 ,"$1,947.50 ","$1,476.00 ","$1,496.50 ","$1,332.50 ","$1,742.50 ",$329.33 ,"$1,332.50 ","$1,742.50 ","$1,496.50 ",$60.15 ,$329.33 ,$400.52 ,"$1,742.50 ",$741.00 ,"$1,886.00 ","$1,435.00 ",$709.44 ,$761.64 ,"$1,248.45 ",$709.44 ,"$1,416.55 ","$1,476.00 ","$1,427.83 ",$332.62 ,"$1,476.00 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$329.33 ,"$1,859.00 ",$329.33 ,"$1,476.00 ","$1,271.00 ","$1,476.00 ","$1,476.00 ","$1,230.00 "
ST MARY'S HOSPITAL,33300033,77336,HC MEDICAL PHYSICS CONTINUING,333,1 ,$896.00 ,$448.00 ,$36.91 ,$896.00 ,$36.91 ,$344.82 ,$306.51 ,$123.40 ,$537.60 ,$761.60 ,$627.20 ,$36.91 ,$851.20 ,$645.12 ,$654.08 ,$582.40 ,$761.60 ,$123.40 ,$582.40 ,$761.60 ,$654.08 ,$36.91 ,$123.40 ,$400.52 ,$761.60 ,$277.65 ,$824.32 ,$627.20 ,$380.99 ,$409.02 ,$545.66 ,$380.99 ,$619.14 ,$645.12 ,$624.06 ,$124.63 ,$645.12 ,$39.12 ,$896.00 ,$896.00 ,$123.40 ,$896.00 ,$123.40 ,$645.12 ,$555.52 ,$645.12 ,$645.12 ,$537.60 
ST MARY'S HOSPITAL,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 ",$329.33 ,"$1,618.20 ","$2,292.45 ","$1,887.90 ",$60.15 ,"$2,562.15 ","$1,941.84 ","$1,968.81 ","$1,753.05 ","$2,292.45 ",$329.33 ,"$1,753.05 ","$2,292.45 ","$1,968.81 ",$60.15 ,$329.33 ,$400.52 ,"$2,292.45 ",$741.00 ,"$2,481.24 ","$1,887.90 ","$1,034.69 ","$1,110.82 ","$1,642.47 ","$1,034.69 ","$1,863.63 ","$1,941.84 ","$1,878.46 ",$332.62 ,"$1,941.84 ",$63.76 ,"$1,859.00 ","$1,859.00 ",$329.33 ,"$1,859.00 ",$329.33 ,"$1,941.84 ","$1,672.14 ","$1,941.84 ","$1,941.84 ","$1,618.20 "
ST MARY'S HOSPITAL,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 ,$123.40 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$36.91 ,"$1,434.50 ","$1,087.20 ","$1,102.30 ",$981.50 ,"$1,283.50 ",$123.40 ,$981.50 ,"$1,283.50 ","$1,102.30 ",$36.91 ,$123.40 ,$400.52 ,"$1,283.50 ",$277.65 ,"$1,389.20 ","$1,057.00 ",$380.99 ,$409.02 ,$919.59 ,$380.99 ,"$1,043.41 ","$1,087.20 ","$1,051.72 ",$124.63 ,"$1,087.20 ",$39.12 ,"$1,510.00 ","$1,510.00 ",$123.40 ,"$1,510.00 ",$123.40 ,"$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ",$906.00 
ST MARY'S HOSPITAL,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 ,$116.50 ,$712.20 ,"$1,008.95 ",$830.90 ,$57.48 ,"$1,127.65 ",$854.64 ,$866.51 ,$771.55 ,"$1,008.95 ",$116.50 ,$771.55 ,"$1,008.95 ",$866.51 ,$57.48 ,$116.50 ,$400.52 ,"$1,008.95 ",$262.12 ,"$1,092.04 ",$830.90 ,$346.44 ,$371.93 ,$722.88 ,$346.44 ,$820.22 ,$854.64 ,$826.75 ,$117.67 ,$854.64 ,$60.93 ,"$1,187.00 ","$1,187.00 ",$116.50 ,"$1,187.00 ",$116.50 ,$854.64 ,$735.94 ,$854.64 ,$854.64 ,$712.20 
ST MARY'S HOSPITAL,33300041,77407,HC RAD THRPY INTERMEDIATE,333,1 ,"$1,079.00 ",$539.50 ,$57.48 ,"$1,079.00 ",$57.48 ,$863.49 ,$767.54 ,$235.08 ,$647.40 ,$917.15 ,$755.30 ,$57.48 ,"$1,025.05 ",$776.88 ,$787.67 ,$701.35 ,$917.15 ,$235.08 ,$701.35 ,$917.15 ,$787.67 ,$57.48 ,$235.08 ,$400.52 ,$917.15 ,$528.93 ,$992.68 ,$755.30 ,$346.44 ,$371.93 ,$657.11 ,$346.44 ,$745.59 ,$776.88 ,$751.52 ,$237.43 ,$776.88 ,$60.93 ,"$1,079.00 ","$1,079.00 ",$235.08 ,"$1,079.00 ",$235.08 ,$776.88 ,$668.98 ,$776.88 ,$776.88 ,$647.40 
ST MARY'S HOSPITAL,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 ",$235.08 ,$906.00 ,"$1,283.50 ","$1,057.00 ",$57.48 ,"$1,434.50 ","$1,087.20 ","$1,102.30 ",$981.50 ,"$1,283.50 ",$235.08 ,$981.50 ,"$1,283.50 ","$1,102.30 ",$57.48 ,$235.08 ,$400.52 ,"$1,283.50 ",$528.93 ,"$1,389.20 ","$1,057.00 ",$638.95 ,$685.96 ,$919.59 ,$638.95 ,"$1,043.41 ","$1,087.20 ","$1,051.72 ",$237.43 ,"$1,087.20 ",$60.93 ,"$1,510.00 ","$1,510.00 ",$235.08 ,"$1,510.00 ",$235.08 ,"$1,087.20 ",$936.20 ,"$1,087.20 ","$1,087.20 ",$906.00 
ST MARY'S HOSPITAL,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 ",$527.66 ,"$2,395.20 ","$3,393.20 ","$2,794.40 ",$152.93 ,"$3,792.40 ","$2,874.24 ","$2,914.16 ","$2,594.80 ","$3,393.20 ",$527.66 ,"$2,594.80 ","$3,393.20 ","$2,914.16 ",$152.93 ,$527.66 ,$400.52 ,"$3,393.20 ","$1,187.22 ","$3,672.64 ","$2,794.40 ","$1,658.20 ","$1,780.21 ","$2,431.13 ","$1,658.20 ","$2,758.47 ","$2,874.24 ","$2,780.43 ",$532.94 ,"$2,874.24 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$527.66 ,"$1,859.00 ",$527.66 ,"$2,874.24 ","$2,475.04 ","$2,874.24 ","$2,874.24 ","$2,395.20 "
ST MARY'S HOSPITAL,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 ,$411.84 ,$417.56 ,$371.80 ,$486.20 , N/A ,$371.80 ,$486.20 ,$417.56 ,$17.98 , N/A ,$400.52 ,$486.20 , N/A ,$526.24 ,$400.40 ,$290.12 ,$348.18 ,$348.35 ,$324.95 ,$395.25 ,$411.84 ,$398.40 , N/A ,$411.84 ,$19.06 ,$572.00 ,$572.00 , N/A ,$572.00 , N/A ,$411.84 ,$354.64 ,$411.84 ,$411.84 ,$343.20 
ST MARY'S HOSPITAL,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 ",$527.66 ,"$2,136.00 ","$3,026.00 ","$2,492.00 ",$152.93 ,"$3,382.00 ","$2,563.20 ","$2,598.80 ","$2,314.00 ","$3,026.00 ",$527.66 ,"$2,314.00 ","$3,026.00 ","$2,598.80 ",$152.93 ,$527.66 ,$400.52 ,"$3,026.00 ","$1,187.22 ","$3,275.20 ","$2,492.00 ","$1,658.20 ","$1,780.21 ","$2,168.04 ","$1,658.20 ","$2,459.96 ","$2,563.20 ","$2,479.54 ",$532.94 ,"$2,563.20 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$527.66 ,"$1,859.00 ",$527.66 ,"$2,563.20 ","$2,207.20 ","$2,563.20 ","$2,563.20 ","$2,136.00 "
ST MARY'S HOSPITAL,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 ,$365.04 ,$370.11 ,$329.55 ,$430.95 , N/A ,$329.55 ,$430.95 ,$370.11 ,$36.91 , N/A ,$400.52 ,$430.95 , N/A ,$466.44 ,$354.90 ,$257.15 ,$308.61 ,$308.76 ,$288.03 ,$350.34 ,$365.04 ,$353.13 , N/A ,$365.04 ,$39.12 ,$507.00 ,$507.00 , N/A ,$507.00 , N/A ,$365.04 ,$314.34 ,$365.04 ,$365.04 ,$304.20 
ST MARY'S HOSPITAL,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 ,$527.66 ,"$1,424.40 ","$2,017.90 ","$1,661.80 ",$152.93 ,"$2,255.30 ","$1,709.28 ","$1,733.02 ","$1,543.10 ","$2,017.90 ",$527.66 ,"$1,543.10 ","$2,017.90 ","$1,733.02 ",$152.93 ,$527.66 ,$400.52 ,"$2,017.90 ","$1,187.22 ","$2,184.08 ","$1,661.80 ","$1,373.15 ","$1,474.18 ","$1,445.77 ","$1,373.15 ","$1,640.43 ","$1,709.28 ","$1,653.49 ",$532.94 ,"$1,709.28 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$527.66 ,"$1,859.00 ",$527.66 ,"$1,709.28 ","$1,471.88 ","$1,709.28 ","$1,709.28 ","$1,424.40 "
ST MARY'S HOSPITAL,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 ,$527.66 ,"$1,424.40 ","$2,017.90 ","$1,661.80 ",$152.93 ,"$2,255.30 ","$1,709.28 ","$1,733.02 ","$1,543.10 ","$2,017.90 ",$527.66 ,"$1,543.10 ","$2,017.90 ","$1,733.02 ",$152.93 ,$527.66 ,$400.52 ,"$2,017.90 ","$1,187.22 ","$2,184.08 ","$1,661.80 ","$1,373.15 ","$1,474.18 ","$1,445.77 ","$1,373.15 ","$1,640.43 ","$1,709.28 ","$1,653.49 ",$532.94 ,"$1,709.28 ",$162.11 ,"$1,859.00 ","$1,859.00 ",$527.66 ,"$1,859.00 ",$527.66 ,"$1,709.28 ","$1,471.88 ","$1,709.28 ","$1,709.28 ","$1,424.40 "
ST MARY'S HOSPITAL,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 ","$1,686.68 ","$6,343.80 ","$8,987.05 ","$7,401.10 ",$452.88 ,"$10,044.35 ","$7,612.56 ","$7,718.29 ","$6,872.45 ","$8,987.05 ","$1,686.68 ","$6,872.45 ","$8,987.05 ","$7,718.29 ",$452.88 ,"$1,686.68 ", N/A ,"$8,987.05 ","$3,795.04 ","$9,727.16 ","$7,401.10 ","$6,384.56 ","$6,854.32 ","$6,438.96 ","$6,384.56 ","$7,305.94 ","$7,612.56 ","$7,364.09 ","$1,703.55 ","$7,612.56 ",$480.05 ,"$4,105.00 ","$4,105.00 ","$1,686.68 ","$4,105.00 ","$1,686.68 ","$7,612.56 ","$6,555.26 ","$7,612.56 ","$7,612.56 ","$6,343.80 "
ST MARY'S HOSPITAL,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 ,$427.68 ,$433.62 ,$386.10 ,$504.90 , N/A ,$386.10 ,$504.90 ,$433.62 ,$36.91 , N/A ,$400.52 ,$504.90 , N/A ,$546.48 ,$415.80 ,$301.28 ,$361.57 ,$361.75 ,$337.45 ,$410.45 ,$427.68 ,$413.72 , N/A ,$427.68 ,$39.12 ,$594.00 ,$594.00 , N/A ,$594.00 , N/A ,$427.68 ,$368.28 ,$427.68 ,$427.68 ,$356.40 
ST MARY'S HOSPITAL,33301001,31575,HC LARYNGOSCOPY FLEX FIBEROPTC,333,1 ,$275.00 ,$137.50 ,$34.89 ,$360.20 ,$34.89 ,$177.90 ,$177.90 ,$160.09 ,$165.00 ,$233.75 ,$192.50 ,$34.89 ,$261.25 ,$198.00 ,$200.75 ,$178.75 ,$233.75 ,$160.09 ,$178.75 ,$233.75 ,$200.75 ,$34.89 ,$160.09 ,$275.00 ,$233.75 ,$360.20 ,$253.00 ,$192.50 ,$275.00 ,$275.00 ,$167.48 ,$275.00 ,$190.03 ,$198.00 ,$191.54 ,$161.69 ,$198.00 ,$36.98 ,$275.00 ,$275.00 ,$160.09 ,$275.00 ,$160.09 ,$198.00 ,$170.50 ,$198.00 ,$198.00 ,$165.00 
ST MARY'S HOSPITAL,33301005,77280,HC SIMULATION SMP,333,1 ,"$1,079.00 ",$539.50 ,$36.91 ,"$1,079.00 ",$36.91 ,"$1,051.28 ",$934.47 ,$123.40 ,$647.40 ,$917.15 ,$755.30 ,$36.91 ,"$1,025.05 ",$776.88 ,$787.67 ,$701.35 ,$917.15 ,$123.40 ,$701.35 ,$917.15 ,$787.67 ,$36.91 ,$123.40 ,$400.52 ,$917.15 ,$277.65 ,$992.68 ,$755.30 ,$380.99 ,$409.02 ,$657.11 ,$380.99 ,$745.59 ,$776.88 ,$751.52 ,$124.63 ,$776.88 ,$39.12 ,"$1,079.00 ","$1,079.00 ",$123.40 ,"$1,079.00 ",$123.40 ,$776.88 ,$668.98 ,$776.88 ,$776.88 ,$647.40 
ST MARY'S HOSPITAL,33301008,77399,HC IMAGE FUSION DOSIMETRY,333,1 ,$281.00 ,$140.50 ,$36.91 ,$281.00 ,$36.91 ,$181.78 ,$181.78 ,$123.40 ,$168.60 ,$238.85 ,$196.70 ,$36.91 ,$266.95 ,$202.32 ,$205.13 ,$182.65 ,$238.85 ,$123.40 ,$182.65 ,$238.85 ,$205.13 ,$36.91 ,$123.40 ,$281.00 ,$238.85 ,$277.65 ,$258.52 ,$196.70 ,$281.00 ,$281.00 ,$171.13 ,$281.00 ,$194.17 ,$202.32 ,$195.72 ,$124.63 ,$202.32 ,$39.12 ,$281.00 ,$281.00 ,$123.40 ,$281.00 ,$123.40 ,$202.32 ,$174.22 ,$202.32 ,$202.32 ,$168.60 
ST MARY'S HOSPITAL,33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$358.00 ,$179.00 ,$13.88 ,$358.00 ,$13.88 ,$231.59 ,$231.59 ,$60.30 ,$214.80 ,$304.30 ,$250.60 ,$13.88 ,$340.10 ,$257.76 ,$261.34 ,$232.70 ,$304.30 ,$60.30 ,$232.70 ,$304.30 ,$261.34 ,$13.88 ,$60.30 ,$279.46 ,$304.30 ,$135.67 ,$329.36 ,$250.60 ,$181.58 ,$217.91 ,$218.02 ,$203.38 ,$247.38 ,$257.76 ,$249.35 ,$60.90 ,$257.76 ,$14.71 ,$358.00 ,$358.00 ,$60.30 ,$358.00 ,$60.30 ,$257.76 ,$221.96 ,$257.76 ,$257.76 ,$214.80 
ST MARY'S HOSPITAL,33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$605.00 ,$302.50 ,$13.88 ,$605.00 ,$13.88 ,$391.37 ,$391.37 ,$198.95 ,$363.00 ,$514.25 ,$423.50 ,$13.88 ,$574.75 ,$435.60 ,$441.65 ,$393.25 ,$514.25 ,$198.95 ,$393.25 ,$514.25 ,$441.65 ,$13.88 ,$198.95 ,$279.46 ,$514.25 ,$447.64 ,$556.60 ,$423.50 ,$306.86 ,$368.26 ,$368.45 ,$343.70 ,$418.06 ,$435.60 ,$421.38 ,$200.94 ,$435.60 ,$14.71 ,$605.00 ,$605.00 ,$198.95 ,$605.00 ,$198.95 ,$435.60 ,$375.10 ,$435.60 ,$435.60 ,$363.00 
ST MARY'S HOSPITAL,33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$347.00 ,$173.50 ,$13.88 ,$347.00 ,$13.88 ,$224.47 ,$224.47 ,$60.30 ,$208.20 ,$294.95 ,$242.90 ,$13.88 ,$329.65 ,$249.84 ,$253.31 ,$225.55 ,$294.95 ,$60.30 ,$225.55 ,$294.95 ,$253.31 ,$13.88 ,$60.30 ,$279.46 ,$294.95 ,$135.67 ,$319.24 ,$242.90 ,$176.00 ,$211.22 ,$211.32 ,$197.13 ,$239.78 ,$249.84 ,$241.69 ,$60.90 ,$249.84 ,$14.71 ,$347.00 ,$347.00 ,$60.30 ,$347.00 ,$60.30 ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$208.20 
ST MARY'S HOSPITAL,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 ,$310.09 ,$558.00 ,$790.50 ,$651.00 ,$95.17 ,$883.50 ,$669.60 ,$678.90 ,$604.50 ,$790.50 ,$310.09 ,$604.50 ,$790.50 ,$678.90 ,$95.17 ,$310.09 ,$279.46 ,$790.50 ,$697.70 ,$855.60 ,$651.00 ,$471.70 ,$566.09 ,$566.37 ,$528.33 ,$642.63 ,$669.60 ,$647.75 ,$313.19 ,$669.60 ,$100.88 ,$930.00 ,$930.00 ,$310.09 ,$930.00 ,$310.09 ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$558.00 
ST MARY'S HOSPITAL,33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$235.00 ,$117.50 ,$60.30 ,$235.00 ,$161.07 ,$152.02 ,$152.02 ,$60.30 ,$141.00 ,$199.75 ,$164.50 ,$161.07 ,$223.25 ,$169.20 ,$171.55 ,$152.75 ,$199.75 ,$60.30 ,$152.75 ,$199.75 ,$171.55 ,$161.07 ,$60.30 ,$235.00 ,$199.75 ,$135.67 ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$133.50 ,$162.39 ,$169.20 ,$163.68 ,$60.90 ,$169.20 ,$170.73 ,$235.00 ,$235.00 ,$60.30 ,$235.00 ,$60.30 ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,33500012,96450,HC CHEMO CNS,335,1 ,"$1,019.00 ",$509.50 ,$161.07 ,"$1,019.00 ",$161.07 ,$659.19 ,$659.19 ,$310.09 ,$611.40 ,$866.15 ,$713.30 ,$161.07 ,$968.05 ,$733.68 ,$743.87 ,$662.35 ,$866.15 ,$310.09 ,$662.35 ,$866.15 ,$743.87 ,$161.07 ,$310.09 ,$279.46 ,$866.15 ,$697.70 ,$937.48 ,$713.30 ,$516.84 ,$620.27 ,$620.57 ,$578.89 ,$704.13 ,$733.68 ,$709.73 ,$313.19 ,$733.68 ,$170.73 ,"$1,019.00 ","$1,019.00 ",$310.09 ,"$1,019.00 ",$310.09 ,$733.68 ,$631.78 ,$733.68 ,$733.68 ,$611.40 
ST MARY'S HOSPITAL,33500021,G6015,HC IMRT TX DELIVERY SINGLE OR MULT FIELDS G6015,333,1 ,"$2,110.00 ","$1,055.00 ",$152.93 ,"$2,110.00 ",$152.93 ,"$1,557.38 ","$1,384.34 ", N/A ,"$1,266.00 ","$1,793.50 ","$1,477.00 ",$152.93 ,"$2,004.50 ","$1,519.20 ","$1,540.30 ","$1,371.50 ","$1,793.50 ", N/A ,"$1,371.50 ","$1,793.50 ","$1,540.30 ",$152.93 , N/A ,$400.52 ,"$1,793.50 ", N/A ,"$1,941.20 ","$1,477.00 ","$1,070.19 ","$1,284.36 ","$1,284.99 ","$1,198.69 ","$1,458.01 ","$1,519.20 ","$1,469.62 ", N/A ,"$1,519.20 ",$162.11 ,"$1,859.00 ","$1,859.00 ", N/A ,"$1,859.00 ", N/A ,"$1,519.20 ","$1,308.20 ","$1,519.20 ","$1,519.20 ","$1,266.00 "
ST MARY'S HOSPITAL,34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$512.00 ,$256.00 ,$120.53 ,$824.86 ,$120.53 ,$319.29 ,$283.81 ,$366.60 ,$307.20 ,$435.20 ,$358.40 ,$120.53 ,$486.40 ,$368.64 ,$373.76 ,$332.80 ,$435.20 ,$366.60 ,$332.80 ,$435.20 ,$373.76 ,$120.53 ,$366.60 ,$512.00 ,$435.20 ,$824.86 ,$471.04 ,$358.40 ,$466.51 ,$500.84 ,$311.81 ,$466.51 ,$353.79 ,$368.64 ,$356.61 ,$370.27 ,$368.64 ,$127.76 ,$512.00 ,$512.00 ,$366.60 ,$512.00 ,$366.60 ,$368.64 ,$317.44 ,$368.64 ,$368.64 ,$307.20 
ST MARY'S HOSPITAL,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 ,$366.60 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$120.53 ,"$1,490.55 ","$1,129.68 ","$1,145.37 ","$1,019.85 ","$1,333.65 ",$366.60 ,"$1,019.85 ","$1,333.65 ","$1,145.37 ",$120.53 ,$366.60 ,$580.41 ,"$1,333.65 ",$824.86 ,"$1,443.48 ","$1,098.30 ",$953.51 ,"$1,023.66 ",$955.52 ,$953.51 ,"$1,084.18 ","$1,129.68 ","$1,092.81 ",$370.27 ,"$1,129.68 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ",$941.40 
ST MARY'S HOSPITAL,34000006,78013,HC NM THYROID SCAN,340,1 ,$994.00 ,$497.00 ,$120.53 ,$994.00 ,$120.53 ,$776.15 ,$689.91 ,$366.60 ,$596.40 ,$844.90 ,$695.80 ,$120.53 ,$944.30 ,$715.68 ,$725.62 ,$646.10 ,$844.90 ,$366.60 ,$646.10 ,$844.90 ,$725.62 ,$120.53 ,$366.60 ,$580.41 ,$844.90 ,$824.86 ,$914.48 ,$695.80 ,$609.44 ,$654.28 ,$605.35 ,$609.44 ,$686.85 ,$715.68 ,$692.32 ,$370.27 ,$715.68 ,$127.76 ,$994.00 ,$994.00 ,$366.60 ,$994.00 ,$366.60 ,$715.68 ,$616.28 ,$715.68 ,$715.68 ,$596.40 
ST MARY'S HOSPITAL,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 ",$475.91 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$120.53 ,"$1,987.40 ","$1,506.24 ","$1,527.16 ","$1,359.80 ","$1,778.20 ",$475.91 ,"$1,359.80 ","$1,778.20 ","$1,527.16 ",$120.53 ,$475.91 ,$580.41 ,"$1,778.20 ","$1,070.80 ","$1,924.64 ","$1,464.40 ","$1,271.95 ","$1,365.53 ","$1,274.03 ","$1,271.95 ","$1,445.57 ","$1,506.24 ","$1,457.08 ",$480.67 ,"$1,506.24 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,255.20 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$366.60 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$302.87 ,$366.60 ,$580.41 ,"$1,422.05 ",$824.86 ,"$1,539.16 ","$1,171.10 ",$953.51 ,"$1,023.66 ","$1,018.86 ",$953.51 ,"$1,156.04 ","$1,204.56 ","$1,165.24 ",$370.27 ,"$1,204.56 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,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 ",$475.91 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$302.87 ,"$1,987.40 ","$1,506.24 ","$1,527.16 ","$1,359.80 ","$1,778.20 ",$475.91 ,"$1,359.80 ","$1,778.20 ","$1,527.16 ",$302.87 ,$475.91 ,$580.41 ,"$1,778.20 ","$1,070.80 ","$1,924.64 ","$1,464.40 ","$1,150.91 ","$1,235.60 ","$1,274.03 ","$1,150.91 ","$1,445.57 ","$1,506.24 ","$1,457.08 ",$480.67 ,"$1,506.24 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,255.20 "
ST MARY'S HOSPITAL,34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,360.00 ",$680.00 ,$302.87 ,"$1,360.00 ",$302.87 ,$760.63 ,$676.11 ,$366.60 ,$816.00 ,"$1,156.00 ",$952.00 ,$302.87 ,"$1,292.00 ",$979.20 ,$992.80 ,$884.00 ,"$1,156.00 ",$366.60 ,$884.00 ,"$1,156.00 ",$992.80 ,$302.87 ,$366.60 ,$580.41 ,"$1,156.00 ",$824.86 ,"$1,251.20 ",$952.00 ,"$1,238.07 ","$1,329.17 ",$828.24 ,"$1,238.07 ",$939.76 ,$979.20 ,$947.24 ,$370.27 ,$979.20 ,$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,$816.00 
ST MARY'S HOSPITAL,34000020,78216,HC LIVER SPLEEN STATIC FLOW,340,1 ,"$1,778.00 ",$889.00 ,$302.87 ,"$1,778.00 ",$302.87 ,$447.12 ,$397.44 ,$366.60 ,"$1,066.80 ","$1,511.30 ","$1,244.60 ",$302.87 ,"$1,689.10 ","$1,280.16 ","$1,297.94 ","$1,155.70 ","$1,511.30 ",$366.60 ,"$1,155.70 ","$1,511.30 ","$1,297.94 ",$302.87 ,$366.60 ,$580.41 ,"$1,511.30 ",$824.86 ,"$1,635.76 ","$1,244.60 ","$1,238.07 ","$1,329.17 ","$1,082.80 ","$1,238.07 ","$1,228.60 ","$1,280.16 ","$1,238.38 ",$370.27 ,"$1,280.16 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,280.16 ","$1,102.36 ","$1,280.16 ","$1,280.16 ","$1,066.80 "
ST MARY'S HOSPITAL,34000021,78216,HC RBC LIVER SCAN,340,1 ,"$1,778.00 ",$889.00 ,$302.87 ,"$1,778.00 ",$302.87 ,$447.12 ,$397.44 ,$366.60 ,"$1,066.80 ","$1,511.30 ","$1,244.60 ",$302.87 ,"$1,689.10 ","$1,280.16 ","$1,297.94 ","$1,155.70 ","$1,511.30 ",$366.60 ,"$1,155.70 ","$1,511.30 ","$1,297.94 ",$302.87 ,$366.60 ,$580.41 ,"$1,511.30 ",$824.86 ,"$1,635.76 ","$1,244.60 ","$1,238.07 ","$1,329.17 ","$1,082.80 ","$1,238.07 ","$1,228.60 ","$1,280.16 ","$1,238.38 ",$370.27 ,"$1,280.16 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,280.16 ","$1,102.36 ","$1,280.16 ","$1,280.16 ","$1,066.80 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,255.20 ","$1,778.20 ","$1,464.40 ",$120.53 ,"$1,987.40 ","$1,506.24 ","$1,527.16 ","$1,359.80 ","$1,778.20 ",$366.60 ,"$1,359.80 ","$1,778.20 ","$1,527.16 ",$120.53 ,$366.60 ,$580.41 ,"$1,778.20 ",$824.86 ,"$1,924.64 ","$1,464.40 ","$1,238.07 ","$1,329.17 ","$1,274.03 ","$1,238.07 ","$1,445.57 ","$1,506.24 ","$1,457.08 ",$370.27 ,"$1,506.24 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,255.20 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$120.53 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$366.60 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$120.53 ,$366.60 ,$580.41 ,"$1,422.05 ",$824.86 ,"$1,539.16 ","$1,171.10 ","$1,075.92 ","$1,155.09 ","$1,018.86 ","$1,075.92 ","$1,156.04 ","$1,204.56 ","$1,165.24 ",$370.27 ,"$1,204.56 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,129.80 ","$1,600.55 ","$1,318.10 ",$302.87 ,"$1,788.85 ","$1,355.76 ","$1,374.59 ","$1,223.95 ","$1,600.55 ",$366.60 ,"$1,223.95 ","$1,600.55 ","$1,374.59 ",$302.87 ,$366.60 ,$580.41 ,"$1,600.55 ",$824.86 ,"$1,732.36 ","$1,318.10 ","$1,075.92 ","$1,155.09 ","$1,146.75 ","$1,075.92 ","$1,301.15 ","$1,355.76 ","$1,311.51 ",$370.27 ,"$1,355.76 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,355.76 ","$1,167.46 ","$1,355.76 ","$1,355.76 ","$1,129.80 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,066.80 ","$1,511.30 ","$1,244.60 ",$120.53 ,"$1,689.10 ","$1,280.16 ","$1,297.94 ","$1,155.70 ","$1,511.30 ",$366.60 ,"$1,155.70 ","$1,511.30 ","$1,297.94 ",$120.53 ,$366.60 ,$580.41 ,"$1,511.30 ",$824.86 ,"$1,635.76 ","$1,244.60 ","$1,075.92 ","$1,155.09 ","$1,082.80 ","$1,075.92 ","$1,228.60 ","$1,280.16 ","$1,238.38 ",$370.27 ,"$1,280.16 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,280.16 ","$1,102.36 ","$1,280.16 ","$1,280.16 ","$1,066.80 "
ST MARY'S HOSPITAL,34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,360.00 ",$680.00 ,$120.53 ,"$1,360.00 ",$120.53 ,$890.44 ,$791.50 ,$366.60 ,$816.00 ,"$1,156.00 ",$952.00 ,$120.53 ,"$1,292.00 ",$979.20 ,$992.80 ,$884.00 ,"$1,156.00 ",$366.60 ,$884.00 ,"$1,156.00 ",$992.80 ,$120.53 ,$366.60 ,$580.41 ,"$1,156.00 ",$824.86 ,"$1,251.20 ",$952.00 ,"$1,076.48 ","$1,155.68 ",$828.24 ,"$1,076.48 ",$939.76 ,$979.20 ,$947.24 ,$370.27 ,$979.20 ,$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,$816.00 
ST MARY'S HOSPITAL,34000030,78305,HC BONE SCAN MULTIPLE,340,1 ,"$1,673.00 ",$836.50 ,$120.53 ,"$1,673.00 ",$120.53 ,"$1,069.48 ",$950.65 ,$366.60 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$120.53 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$366.60 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$120.53 ,$366.60 ,$580.41 ,"$1,422.05 ",$824.86 ,"$1,539.16 ","$1,171.10 ","$1,076.48 ","$1,155.68 ","$1,018.86 ","$1,076.48 ","$1,156.04 ","$1,204.56 ","$1,165.24 ",$370.27 ,"$1,204.56 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,192.20 ","$1,688.95 ","$1,390.90 ",$120.53 ,"$1,887.65 ","$1,430.64 ","$1,450.51 ","$1,291.55 ","$1,688.95 ",$366.60 ,"$1,291.55 ","$1,688.95 ","$1,450.51 ",$120.53 ,$366.60 ,$580.41 ,"$1,688.95 ",$824.86 ,"$1,828.04 ","$1,390.90 ","$1,076.48 ","$1,155.68 ","$1,210.08 ","$1,076.48 ","$1,373.02 ","$1,430.64 ","$1,383.95 ",$370.27 ,"$1,430.64 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,430.64 ","$1,231.94 ","$1,430.64 ","$1,430.64 ","$1,192.20 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,581.12 ","$1,603.08 ","$1,427.40 ","$1,866.60 ",$366.60 ,"$1,427.40 ","$1,866.60 ","$1,603.08 ",$120.53 ,$366.60 ,$580.41 ,"$1,866.60 ",$824.86 ,"$2,020.32 ","$1,537.20 ","$1,076.48 ","$1,155.68 ","$1,337.36 ","$1,076.48 ","$1,517.44 ","$1,581.12 ","$1,529.51 ",$370.27 ,"$1,581.12 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,317.60 "
ST MARY'S HOSPITAL,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 ","$1,270.88 ","$2,635.80 ","$3,734.05 ","$3,075.10 ",$302.87 ,"$4,173.35 ","$3,162.96 ","$3,206.89 ","$2,855.45 ","$3,734.05 ","$1,270.88 ","$2,855.45 ","$3,734.05 ","$3,206.89 ",$302.87 ,"$1,270.88 ",$580.41 ,"$3,734.05 ","$2,859.48 ","$4,041.56 ","$3,075.10 ","$3,833.52 ","$4,115.58 ","$2,675.34 ","$3,833.52 ","$3,035.56 ","$3,162.96 ","$3,059.72 ","$1,283.59 ","$3,162.96 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$3,162.96 ","$2,723.66 ","$3,162.96 ","$3,162.96 ","$2,635.80 "
ST MARY'S HOSPITAL,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 ","$1,270.88 ","$2,635.80 ","$3,734.05 ","$3,075.10 ",$302.87 ,"$4,173.35 ","$3,162.96 ","$3,206.89 ","$2,855.45 ","$3,734.05 ","$1,270.88 ","$2,855.45 ","$3,734.05 ","$3,206.89 ",$302.87 ,"$1,270.88 ",$580.41 ,"$3,734.05 ","$2,859.48 ","$4,041.56 ","$3,075.10 ","$3,833.52 ","$4,115.58 ","$2,675.34 ","$3,833.52 ","$3,035.56 ","$3,162.96 ","$3,059.72 ","$1,283.59 ","$3,162.96 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$3,162.96 ","$2,723.66 ","$3,162.96 ","$3,162.96 ","$2,635.80 "
ST MARY'S HOSPITAL,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 ","$1,270.88 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$302.87 ,"$4,570.45 ","$3,463.92 ","$3,512.03 ","$3,127.15 ","$4,089.35 ","$1,270.88 ","$3,127.15 ","$4,089.35 ","$3,512.03 ",$302.87 ,"$1,270.88 ",$580.41 ,"$4,089.35 ","$2,859.48 ","$4,426.12 ","$3,367.70 ","$3,833.52 ","$4,115.58 ","$2,929.90 ","$3,833.52 ","$3,324.40 ","$3,463.92 ","$3,350.86 ","$1,283.59 ","$3,463.92 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$2,886.60 "
ST MARY'S HOSPITAL,34000038,78452,HC STRESS/RST/REINJCT SPECT,340,1 ,"$4,811.00 ","$2,405.50 ",$302.87 ,"$4,811.00 ",$302.87 ,"$1,757.16 ","$1,561.92 ","$1,270.88 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$302.87 ,"$4,570.45 ","$3,463.92 ","$3,512.03 ","$3,127.15 ","$4,089.35 ","$1,270.88 ","$3,127.15 ","$4,089.35 ","$3,512.03 ",$302.87 ,"$1,270.88 ",$580.41 ,"$4,089.35 ","$2,859.48 ","$4,426.12 ","$3,367.70 ","$3,833.52 ","$4,115.58 ","$2,929.90 ","$3,833.52 ","$3,324.40 ","$3,463.92 ","$3,350.86 ","$1,283.59 ","$3,463.92 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$2,886.60 "
ST MARY'S HOSPITAL,34000042,78454,HC HT MUSC IMAGE PLANAR MULTI,340,1 ,"$3,556.00 ","$1,778.00 ",$302.87 ,"$3,556.00 ",$302.87 ,"$1,651.06 ","$1,467.61 ","$1,270.88 ","$2,133.60 ","$3,022.60 ","$2,489.20 ",$302.87 ,"$3,378.20 ","$2,560.32 ","$2,595.88 ","$2,311.40 ","$3,022.60 ","$1,270.88 ","$2,311.40 ","$3,022.60 ","$2,595.88 ",$302.87 ,"$1,270.88 ",$580.41 ,"$3,022.60 ","$2,859.48 ","$3,271.52 ","$2,489.20 ","$3,556.00 ","$3,556.00 ","$2,165.60 ","$3,556.00 ","$2,457.20 ","$2,560.32 ","$2,476.75 ","$1,283.59 ","$2,560.32 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$2,560.32 ","$2,204.72 ","$2,560.32 ","$2,560.32 ","$2,133.60 "
ST MARY'S HOSPITAL,34000043,78466,HC CARDIAC SCAN,340,1 ,"$1,360.00 ",$680.00 ,$120.53 ,"$1,360.00 ",$120.53 ,$723.38 ,$643.00 ,$366.60 ,$816.00 ,"$1,156.00 ",$952.00 ,$120.53 ,"$1,292.00 ",$979.20 ,$992.80 ,$884.00 ,"$1,156.00 ",$366.60 ,$884.00 ,"$1,156.00 ",$992.80 ,$120.53 ,$366.60 ,$580.41 ,"$1,156.00 ",$824.86 ,"$1,251.20 ",$952.00 ,"$1,273.09 ","$1,360.00 ",$828.24 ,"$1,273.09 ",$939.76 ,$979.20 ,$947.24 ,$370.27 ,$979.20 ,$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,$816.00 
ST MARY'S HOSPITAL,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 ,$366.60 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,581.12 ","$1,603.08 ","$1,427.40 ","$1,866.60 ",$366.60 ,"$1,427.40 ","$1,866.60 ","$1,603.08 ",$120.53 ,$366.60 ,$580.41 ,"$1,866.60 ",$824.86 ,"$2,020.32 ","$1,537.20 ","$1,273.09 ","$1,366.76 ","$1,337.36 ","$1,273.09 ","$1,517.44 ","$1,581.12 ","$1,529.51 ",$370.27 ,"$1,581.12 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,317.60 "
ST MARY'S HOSPITAL,34000047,78580,HC LUNG PERFUS,340,1 ,"$1,569.00 ",$784.50 ,$302.87 ,"$1,569.00 ",$302.87 ,$901.86 ,$801.66 ,$366.60 ,$941.40 ,"$1,333.65 ","$1,098.30 ",$302.87 ,"$1,490.55 ","$1,129.68 ","$1,145.37 ","$1,019.85 ","$1,333.65 ",$366.60 ,"$1,019.85 ","$1,333.65 ","$1,145.37 ",$302.87 ,$366.60 ,$580.41 ,"$1,333.65 ",$824.86 ,"$1,443.48 ","$1,098.30 ","$1,016.89 ","$1,091.71 ",$955.52 ,"$1,016.89 ","$1,084.18 ","$1,129.68 ","$1,092.81 ",$370.27 ,"$1,129.68 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,129.68 ",$972.78 ,"$1,129.68 ","$1,129.68 ",$941.40 
ST MARY'S HOSPITAL,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 ",$475.91 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$475.91 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$302.87 ,$475.91 ,$580.41 ,"$1,422.05 ","$1,070.80 ","$1,539.16 ","$1,171.10 ","$1,431.78 ","$1,537.13 ","$1,018.86 ","$1,431.78 ","$1,156.04 ","$1,204.56 ","$1,165.24 ",$480.67 ,"$1,204.56 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,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 ,$366.60 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$366.60 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$302.87 ,$366.60 ,$580.41 ,"$1,422.05 ",$824.86 ,"$1,539.16 ","$1,171.10 ","$1,016.89 ","$1,091.71 ","$1,018.86 ","$1,016.89 ","$1,156.04 ","$1,204.56 ","$1,165.24 ",$370.27 ,"$1,204.56 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,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 ",$475.91 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$475.91 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$302.87 ,$475.91 ,$580.41 ,"$1,422.05 ","$1,070.80 ","$1,539.16 ","$1,171.10 ","$1,431.78 ","$1,537.13 ","$1,018.86 ","$1,431.78 ","$1,156.04 ","$1,204.56 ","$1,165.24 ",$480.67 ,"$1,204.56 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,34000052,78579,HC LUNG SCAN-VENTILATION,340,1 ,"$1,673.00 ",$836.50 ,$302.87 ,"$1,673.00 ",$302.87 ,$724.37 ,$643.88 ,$366.60 ,"$1,003.80 ","$1,422.05 ","$1,171.10 ",$302.87 ,"$1,589.35 ","$1,204.56 ","$1,221.29 ","$1,087.45 ","$1,422.05 ",$366.60 ,"$1,087.45 ","$1,422.05 ","$1,221.29 ",$302.87 ,$366.60 ,$580.41 ,"$1,422.05 ",$824.86 ,"$1,539.16 ","$1,171.10 ","$1,016.89 ","$1,091.71 ","$1,018.86 ","$1,016.89 ","$1,156.04 ","$1,204.56 ","$1,165.24 ",$370.27 ,"$1,204.56 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,204.56 ","$1,037.26 ","$1,204.56 ","$1,204.56 ","$1,003.80 "
ST MARY'S HOSPITAL,34000053,78601,HC BRAIN W/FLOW < 4 VIEWS STAT,340,1 ,"$2,196.00 ","$1,098.00 ",$120.53 ,"$2,196.00 ",$120.53 ,$855.30 ,$760.27 ,$366.60 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,581.12 ","$1,603.08 ","$1,427.40 ","$1,866.60 ",$366.60 ,"$1,427.40 ","$1,866.60 ","$1,603.08 ",$120.53 ,$366.60 ,$580.41 ,"$1,866.60 ",$824.86 ,"$2,020.32 ","$1,537.20 ","$1,771.78 ","$1,902.15 ","$1,337.36 ","$1,771.78 ","$1,517.44 ","$1,581.12 ","$1,529.51 ",$370.27 ,"$1,581.12 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,317.60 "
ST MARY'S HOSPITAL,34000054,78606,HC BRAIN SC W/VASCULAR FLOW > 4 VIEWS,340,1 ,"$2,615.00 ","$1,307.50 ",$120.53 ,"$2,615.00 ",$120.53 ,"$1,332.34 ","$1,184.30 ",$475.91 ,"$1,569.00 ","$2,222.75 ","$1,830.50 ",$120.53 ,"$2,484.25 ","$1,882.80 ","$1,908.95 ","$1,699.75 ","$2,222.75 ",$475.91 ,"$1,699.75 ","$2,222.75 ","$1,908.95 ",$120.53 ,$475.91 ,$580.41 ,"$2,222.75 ","$1,070.80 ","$2,405.80 ","$1,830.50 ","$1,771.78 ","$1,902.15 ","$1,592.54 ","$1,771.78 ","$1,806.97 ","$1,882.80 ","$1,821.35 ",$480.67 ,"$1,882.80 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,882.80 ","$1,621.30 ","$1,882.80 ","$1,882.80 ","$1,569.00 "
ST MARY'S HOSPITAL,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 ",$475.91 ,"$1,569.00 ","$2,222.75 ","$1,830.50 ",$302.87 ,"$2,484.25 ","$1,882.80 ","$1,908.95 ","$1,699.75 ","$2,222.75 ",$475.91 ,"$1,699.75 ","$2,222.75 ","$1,908.95 ",$302.87 ,$475.91 ,$580.41 ,"$2,222.75 ","$1,070.80 ","$2,405.80 ","$1,830.50 ","$1,771.78 ","$1,902.15 ","$1,592.54 ","$1,771.78 ","$1,806.97 ","$1,882.80 ","$1,821.35 ",$480.67 ,"$1,882.80 ",$321.04 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,882.80 ","$1,621.30 ","$1,882.80 ","$1,882.80 ","$1,569.00 "
ST MARY'S HOSPITAL,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 ,$475.91 ,"$1,443.00 ","$2,044.25 ","$1,683.50 ",$120.53 ,"$2,284.75 ","$1,731.60 ","$1,755.65 ","$1,563.25 ","$2,044.25 ",$475.91 ,"$1,563.25 ","$2,044.25 ","$1,755.65 ",$120.53 ,$475.91 ,$580.41 ,"$2,044.25 ","$1,070.80 ","$2,212.60 ","$1,683.50 ","$1,385.77 ","$1,487.74 ","$1,464.65 ","$1,385.77 ","$1,661.86 ","$1,731.60 ","$1,675.08 ",$480.67 ,"$1,731.60 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,443.00 "
ST MARY'S HOSPITAL,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 ,$475.91 ,"$1,443.00 ","$2,044.25 ","$1,683.50 ",$120.53 ,"$2,284.75 ","$1,731.60 ","$1,755.65 ","$1,563.25 ","$2,044.25 ",$475.91 ,"$1,563.25 ","$2,044.25 ","$1,755.65 ",$120.53 ,$475.91 ,$580.41 ,"$2,044.25 ","$1,070.80 ","$2,212.60 ","$1,683.50 ","$1,385.77 ","$1,487.74 ","$1,464.65 ","$1,385.77 ","$1,661.86 ","$1,731.60 ","$1,675.08 ",$480.67 ,"$1,731.60 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,443.00 "
ST MARY'S HOSPITAL,34000067,78761,HC TESTICULAR IMAG W/FLOW,340,1 ,"$1,464.00 ",$732.00 ,$120.53 ,"$1,464.00 ",$120.53 ,$783.91 ,$696.81 ,$366.60 ,$878.40 ,"$1,244.40 ","$1,024.80 ",$120.53 ,"$1,390.80 ","$1,054.08 ","$1,068.72 ",$951.60 ,"$1,244.40 ",$366.60 ,$951.60 ,"$1,244.40 ","$1,068.72 ",$120.53 ,$366.60 ,$580.41 ,"$1,244.40 ",$824.86 ,"$1,346.88 ","$1,024.80 ","$1,385.77 ","$1,464.00 ",$891.58 ,"$1,385.77 ","$1,011.62 ","$1,054.08 ","$1,019.68 ",$370.27 ,"$1,054.08 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,054.08 ",$907.68 ,"$1,054.08 ","$1,054.08 ",$878.40 
ST MARY'S HOSPITAL,34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$2,092.00 ","$1,046.00 ",$302.87 ,"$2,859.48 ",$302.87 ,"$1,254.73 ","$1,115.32 ","$1,270.88 ","$1,255.20 ","$1,778.20 ","$1,464.40 ",$302.87 ,"$1,987.40 ","$1,506.24 ","$1,527.16 ","$1,359.80 ","$1,778.20 ","$1,270.88 ","$1,359.80 ","$1,778.20 ","$1,527.16 ",$302.87 ,"$1,270.88 ",$580.41 ,"$1,778.20 ","$2,859.48 ","$1,924.64 ","$1,464.40 ","$2,092.00 ","$2,092.00 ","$1,274.03 ","$2,092.00 ","$1,445.57 ","$1,506.24 ","$1,457.08 ","$1,283.59 ","$1,506.24 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$1,506.24 ","$1,297.04 ","$1,506.24 ","$1,506.24 ","$1,255.20 "
ST MARY'S HOSPITAL,34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$2,405.00 ","$1,202.50 ",$302.87 ,"$2,859.48 ",$302.87 ,"$1,288.88 ","$1,145.67 ","$1,270.88 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$302.87 ,"$2,284.75 ","$1,731.60 ","$1,755.65 ","$1,563.25 ","$2,044.25 ","$1,270.88 ","$1,563.25 ","$2,044.25 ","$1,755.65 ",$302.87 ,"$1,270.88 ",$580.41 ,"$2,044.25 ","$2,859.48 ","$2,212.60 ","$1,683.50 ","$2,183.14 ","$2,343.77 ","$1,464.65 ","$2,183.14 ","$1,661.86 ","$1,731.60 ","$1,675.08 ","$1,283.59 ","$1,731.60 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,443.00 "
ST MARY'S HOSPITAL,34000072,78803,HC TUMOR IMAGING (SPECT) MIBG,340,1 ,"$2,405.00 ","$1,202.50 ",$302.87 ,"$2,859.48 ",$302.87 ,"$1,288.88 ","$1,145.67 ","$1,270.88 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$302.87 ,"$2,284.75 ","$1,731.60 ","$1,755.65 ","$1,563.25 ","$2,044.25 ","$1,270.88 ","$1,563.25 ","$2,044.25 ","$1,755.65 ",$302.87 ,"$1,270.88 ",$580.41 ,"$2,044.25 ","$2,859.48 ","$2,212.60 ","$1,683.50 ","$2,183.14 ","$2,343.77 ","$1,464.65 ","$2,183.14 ","$1,661.86 ","$1,731.60 ","$1,675.08 ","$1,283.59 ","$1,731.60 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,443.00 "
ST MARY'S HOSPITAL,34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$2,405.00 ","$1,202.50 ",$302.87 ,"$2,859.48 ",$302.87 ,"$1,288.88 ","$1,145.67 ","$1,270.88 ","$1,443.00 ","$2,044.25 ","$1,683.50 ",$302.87 ,"$2,284.75 ","$1,731.60 ","$1,755.65 ","$1,563.25 ","$2,044.25 ","$1,270.88 ","$1,563.25 ","$2,044.25 ","$1,755.65 ",$302.87 ,"$1,270.88 ",$580.41 ,"$2,044.25 ","$2,859.48 ","$2,212.60 ","$1,683.50 ","$2,183.14 ","$2,343.77 ","$1,464.65 ","$2,183.14 ","$1,661.86 ","$1,731.60 ","$1,675.08 ","$1,283.59 ","$1,731.60 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$1,731.60 ","$1,491.10 ","$1,731.60 ","$1,731.60 ","$1,443.00 "
ST MARY'S HOSPITAL,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 ","$1,270.88 ","$2,886.60 ","$4,089.35 ","$3,367.70 ",$302.87 ,"$4,570.45 ","$3,463.92 ","$3,512.03 ","$3,127.15 ","$4,089.35 ","$1,270.88 ","$3,127.15 ","$4,089.35 ","$3,512.03 ",$302.87 ,"$1,270.88 ",$580.41 ,"$4,089.35 ","$2,859.48 ","$4,426.12 ","$3,367.70 ","$3,846.14 ","$4,129.14 ","$2,929.90 ","$3,846.14 ","$3,324.40 ","$3,463.92 ","$3,350.86 ","$1,283.59 ","$3,463.92 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$3,463.92 ","$2,982.82 ","$3,463.92 ","$3,463.92 ","$2,886.60 "
ST MARY'S HOSPITAL,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 ,$246.08 ,$816.00 ,"$1,156.00 ",$952.00 ,$98.11 ,"$1,292.00 ",$979.20 ,$992.80 ,$884.00 ,"$1,156.00 ",$246.08 ,$884.00 ,"$1,156.00 ",$992.80 ,$98.11 ,$246.08 ,$580.41 ,"$1,156.00 ",$553.68 ,"$1,251.20 ",$952.00 ,$850.06 ,$912.60 ,$828.24 ,$850.06 ,$939.76 ,$979.20 ,$947.24 ,$248.54 ,$979.20 ,$104.00 ,"$1,192.00 ","$1,192.00 ",$246.08 ,"$1,192.00 ",$246.08 ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,$816.00 
ST MARY'S HOSPITAL,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 ,$246.08 ,$816.00 ,"$1,156.00 ",$952.00 ,$98.11 ,"$1,292.00 ",$979.20 ,$992.80 ,$884.00 ,"$1,156.00 ",$246.08 ,$884.00 ,"$1,156.00 ",$992.80 ,$98.11 ,$246.08 ,$580.41 ,"$1,156.00 ",$553.68 ,"$1,251.20 ",$952.00 ,$850.06 ,$912.60 ,$828.24 ,$850.06 ,$939.76 ,$979.20 ,$947.24 ,$248.54 ,$979.20 ,$104.00 ,"$1,192.00 ","$1,192.00 ",$246.08 ,"$1,192.00 ",$246.08 ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,$816.00 
ST MARY'S HOSPITAL,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 ",$475.91 ,"$1,317.60 ","$1,866.60 ","$1,537.20 ",$120.53 ,"$2,086.20 ","$1,581.12 ","$1,603.08 ","$1,427.40 ","$1,866.60 ",$475.91 ,"$1,427.40 ","$1,866.60 ","$1,603.08 ",$120.53 ,$475.91 ,$580.41 ,"$1,866.60 ","$1,070.80 ","$2,020.32 ","$1,537.20 ","$1,238.07 ","$1,329.17 ","$1,337.36 ","$1,238.07 ","$1,517.44 ","$1,581.12 ","$1,529.51 ",$480.67 ,"$1,581.12 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,581.12 ","$1,361.52 ","$1,581.12 ","$1,581.12 ","$1,317.60 "
ST MARY'S HOSPITAL,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 ",$366.60 ,"$1,380.60 ","$1,955.85 ","$1,610.70 ",$120.53 ,"$2,185.95 ","$1,656.72 ","$1,679.73 ","$1,495.65 ","$1,955.85 ",$366.60 ,"$1,495.65 ","$1,955.85 ","$1,679.73 ",$120.53 ,$366.60 ,$580.41 ,"$1,955.85 ",$824.86 ,"$2,116.92 ","$1,610.70 ","$2,301.00 ","$2,301.00 ","$1,401.31 ","$2,301.00 ","$1,589.99 ","$1,656.72 ","$1,602.65 ",$370.27 ,"$1,656.72 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$366.60 ,"$1,192.00 ",$366.60 ,"$1,656.72 ","$1,426.62 ","$1,656.72 ","$1,656.72 ","$1,380.60 "
ST MARY'S HOSPITAL,34000094,78072,HC PARATHYROID IMG W/SPECT AND CT 78072,340,1 ,"$2,510.00 ","$1,255.00 ",$120.53 ,"$2,510.00 ",$120.53 ,"$1,395.97 ","$1,240.86 ",$475.91 ,"$1,506.00 ","$2,133.50 ","$1,757.00 ",$120.53 ,"$2,384.50 ","$1,807.20 ","$1,832.30 ","$1,631.50 ","$2,133.50 ",$475.91 ,"$1,631.50 ","$2,133.50 ","$1,832.30 ",$120.53 ,$475.91 ,$580.41 ,"$2,133.50 ","$1,070.80 ","$2,309.20 ","$1,757.00 ","$2,454.67 ","$2,510.00 ","$1,528.59 ","$2,454.67 ","$1,734.41 ","$1,807.20 ","$1,748.22 ",$480.67 ,"$1,807.20 ",$127.76 ,"$1,192.00 ","$1,192.00 ",$475.91 ,"$1,192.00 ",$475.91 ,"$1,807.20 ","$1,556.20 ","$1,807.20 ","$1,807.20 ","$1,506.00 "
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$46.70 ,$76.50 , N/A ,$46.70 ,$76.50 ,$65.70 , N/A , N/A ,$37.80 ,$76.50 , N/A ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 , N/A ,$64.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,34100020,0042T,HC CT CEREBRAL PERFUSION W/BLOOD FLOW,351,1 ,"$2,100.00 ","$1,050.00 ",$99.26 ,"$2,100.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,260.00 ","$1,785.00 ","$1,470.00 ",$99.26 ,"$1,995.00 ","$1,512.00 ","$1,533.00 ","$1,171.00 ","$1,785.00 ", N/A ,"$1,171.00 ","$1,785.00 ","$1,533.00 ",$99.26 , N/A ,$471.80 ,"$1,785.00 ", N/A ,"$1,932.00 ","$1,470.00 ","$1,065.12 ","$1,278.27 ","$1,278.90 ","$1,193.01 ","$1,451.10 ","$1,512.00 ","$1,462.65 ", N/A ,"$1,512.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,260.00 "
ST MARY'S HOSPITAL,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 ,"$2,859.48 ",$302.87 ,"$2,562.00 ","$2,435.98 ","$1,270.88 ","$1,537.20 ","$2,177.70 ","$1,793.40 ",$302.87 ,"$2,433.90 ","$1,844.64 ","$1,870.26 ","$1,665.30 ","$2,177.70 ","$1,270.88 ","$1,665.30 ","$2,177.70 ","$1,870.26 ",$302.87 ,"$1,270.88 ",$580.41 ,"$2,177.70 ","$2,859.48 ","$2,357.04 ","$1,793.40 ","$2,562.00 ","$2,562.00 ","$1,560.26 ","$2,562.00 ","$1,770.34 ","$1,844.64 ","$1,784.43 ","$1,283.59 ","$1,844.64 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$1,844.64 ","$1,588.44 ","$1,844.64 ","$1,844.64 ","$1,537.20 "
ST MARY'S HOSPITAL,34100034,78830,HC TUMOR IMAGING SPECT W/CT SGL AREA 1 DAY,341,1 ,"$2,562.00 ","$1,281.00 ",$302.87 ,"$2,859.48 ",$302.87 ,"$1,846.99 ","$1,641.77 ","$1,270.88 ","$1,537.20 ","$2,177.70 ","$1,793.40 ",$302.87 ,"$2,433.90 ","$1,844.64 ","$1,870.26 ","$1,665.30 ","$2,177.70 ","$1,270.88 ","$1,665.30 ","$2,177.70 ","$1,870.26 ",$302.87 ,"$1,270.88 ",$580.41 ,"$2,177.70 ","$2,859.48 ","$2,357.04 ","$1,793.40 ","$2,562.00 ","$2,562.00 ","$1,560.26 ","$2,562.00 ","$1,770.34 ","$1,844.64 ","$1,784.43 ","$1,283.59 ","$1,844.64 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,270.88 ","$1,192.00 ","$1,270.88 ","$1,844.64 ","$1,588.44 ","$1,844.64 ","$1,844.64 ","$1,537.20 "
ST MARY'S HOSPITAL,34100035,78832,HC TUMOR LOCAL SPECT W/CT MULT AREA 1 DAY OR SGL AREA W/MULT DAYS,341,1 ,"$2,897.00 ","$1,448.50 ",$302.87 ,"$3,238.58 ",$302.87 ,"$2,897.00 ","$2,897.00 ","$1,439.37 ","$1,738.20 ","$2,462.45 ","$2,027.90 ",$302.87 ,"$2,752.15 ","$2,085.84 ","$2,114.81 ","$1,883.05 ","$2,462.45 ","$1,439.37 ","$1,883.05 ","$2,462.45 ","$2,114.81 ",$302.87 ,"$1,439.37 ",$580.41 ,"$2,462.45 ","$3,238.58 ","$2,665.24 ","$2,027.90 ","$2,897.00 ","$2,897.00 ","$1,764.27 ","$2,897.00 ","$2,001.83 ","$2,085.84 ","$2,017.76 ","$1,453.76 ","$2,085.84 ",$321.04 ,"$1,192.00 ","$1,192.00 ","$1,439.37 ","$1,192.00 ","$1,439.37 ","$2,085.84 ","$1,796.14 ","$2,085.84 ","$2,085.84 ","$1,738.20 "
ST MARY'S HOSPITAL,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 ,$326.88 ,$331.42 ,$218.42 ,$385.90 , N/A ,$218.42 ,$385.90 ,$331.42 , N/A , N/A ,$190.68 ,$385.90 , N/A ,$417.68 ,$317.80 ,$230.27 ,$276.35 ,$276.49 ,$257.92 ,$313.71 ,$326.88 ,$316.21 , N/A ,$326.88 , N/A , N/A , N/A , N/A , N/A , N/A ,$326.88 ,$281.48 ,$326.88 ,$326.88 ,$272.40 
ST MARY'S HOSPITAL,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 ,$116.64 ,$118.26 ,$33.56 ,$137.70 , N/A ,$33.56 ,$137.70 ,$118.26 , N/A , N/A ,$68.04 ,$137.70 , N/A ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$92.03 ,$111.94 ,$116.64 ,$112.83 , N/A ,$116.64 , N/A , N/A , N/A , N/A , N/A , N/A ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$61.98 ,$113.90 , N/A ,$61.98 ,$113.90 ,$97.82 , N/A , N/A ,$56.28 ,$113.90 , N/A ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$76.13 ,$92.59 ,$96.48 ,$93.33 , N/A ,$96.48 , N/A , N/A , N/A , N/A , N/A , N/A ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$36.00 ,$36.50 ,$37.40 ,$42.50 , N/A ,$37.40 ,$42.50 ,$36.50 , N/A , N/A ,$21.00 ,$42.50 , N/A ,$46.00 ,$35.00 ,$25.36 ,$30.44 ,$30.45 ,$28.41 ,$34.55 ,$36.00 ,$34.83 , N/A ,$36.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$36.00 ,$31.00 ,$36.00 ,$36.00 ,$30.00 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$84.00 ,$71.40 , N/A ,$84.00 ,$71.40 ,$61.32 , N/A , N/A ,$35.28 ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$47.72 ,$58.04 ,$60.48 ,$58.51 , N/A ,$60.48 , N/A , N/A , N/A , N/A , N/A , N/A ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 ,$72.83 ,$195.50 ,$20.12 ,$72.83 ,$195.50 ,$167.90 ,$142.31 ,$20.12 ,$23.42 ,$195.50 ,$45.27 ,$211.60 ,$161.00 ,$30.00 ,$32.28 ,$140.07 ,$30.00 ,$158.93 ,$165.60 ,$160.20 ,$20.32 ,$165.60 ,$150.85 ,$33.20 ,$33.20 ,$20.12 ,$33.20 ,$20.12 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ","$1,870.56 ","$1,896.54 ","$2,598.00 ","$2,208.30 ", N/A ,"$2,598.00 ","$2,208.30 ","$1,896.54 ", 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 ","$1,475.92 ","$1,795.22 ","$1,870.56 ","$1,809.51 ", N/A ,"$1,870.56 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,870.56 ","$1,610.76 ","$1,870.56 ","$1,870.56 ","$1,558.80 "
ST MARY'S HOSPITAL,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 ,$40.32 ,$40.88 ,$36.40 ,$47.60 ,$13.34 ,$36.40 ,$47.60 ,$40.88 ,$142.31 ,$13.34 ,$15.12 ,$47.60 ,$30.02 ,$51.52 ,$39.20 ,$19.37 ,$20.84 ,$34.10 ,$19.37 ,$38.70 ,$40.32 ,$39.00 ,$13.47 ,$40.32 ,$150.85 ,$22.01 ,$22.01 ,$13.34 ,$22.01 ,$13.34 ,$40.32 ,$34.72 ,$40.32 ,$40.32 ,$33.60 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$101.66 ,$171.70 , N/A ,$101.66 ,$171.70 ,$147.46 , N/A , N/A ,$84.84 ,$171.70 , N/A ,$185.84 ,$141.40 ,$102.45 ,$122.96 ,$123.02 ,$114.76 ,$139.58 ,$145.44 ,$140.69 , N/A ,$145.44 , N/A , N/A , N/A , N/A , N/A , N/A ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$125.28 ,$127.02 ,$63.92 ,$147.90 , N/A ,$63.92 ,$147.90 ,$127.02 , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$98.85 ,$120.23 ,$125.28 ,$121.19 , N/A ,$125.28 , N/A , N/A , N/A , N/A , N/A , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$104.40 
ST MARY'S HOSPITAL,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 ,$508.32 ,$515.38 ,$61.20 ,$600.10 , N/A ,$61.20 ,$600.10 ,$515.38 , N/A , N/A ,$296.52 ,$600.10 , N/A ,$649.52 ,$494.20 ,$358.08 ,$429.74 ,$429.95 ,$401.08 ,$487.85 ,$508.32 ,$491.73 , N/A ,$508.32 , N/A , N/A , N/A , N/A , N/A , N/A ,$508.32 ,$437.72 ,$508.32 ,$508.32 ,$423.60 
ST MARY'S HOSPITAL,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 ,$193.68 ,$196.37 ,$269.00 ,$228.65 , N/A ,$269.00 ,$228.65 ,$196.37 , N/A , N/A ,$112.98 ,$228.65 , N/A ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$152.82 ,$185.88 ,$193.68 ,$187.36 , N/A ,$193.68 , N/A , N/A , N/A , N/A , N/A , N/A ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ","$2,096.64 ","$2,125.76 ","$2,912.00 ","$2,475.20 ", N/A ,"$2,912.00 ","$2,475.20 ","$2,125.76 ", 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 ","$1,654.31 ","$2,012.19 ","$2,096.64 ","$2,028.21 ", N/A ,"$2,096.64 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$1,747.20 "
ST MARY'S HOSPITAL,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 ","$3,495.60 ","$3,544.15 ",$842.91 ,"$4,126.75 ", N/A ,$842.91 ,"$4,126.75 ","$3,544.15 ", 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 ","$2,758.13 ","$3,354.81 ","$3,495.60 ","$3,381.51 ", N/A ,"$3,495.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,495.60 ","$3,010.10 ","$3,495.60 ","$3,495.60 ","$2,913.00 "
ST MARY'S HOSPITAL,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 ","$3,495.60 ","$3,544.15 ",$842.91 ,"$4,126.75 ", N/A ,$842.91 ,"$4,126.75 ","$3,544.15 ", 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 ","$2,758.13 ","$3,354.81 ","$3,495.60 ","$3,381.51 ", N/A ,"$3,495.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,495.60 ","$3,010.10 ","$3,495.60 ","$3,495.60 ","$2,913.00 "
ST MARY'S HOSPITAL,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 ",$838.80 ,$850.45 ,$544.34 ,$990.25 , N/A ,$544.34 ,$990.25 ,$850.45 , N/A , N/A ,$489.30 ,$990.25 , N/A ,"$1,071.80 ",$815.50 ,$590.89 ,$709.14 ,$709.49 ,$661.84 ,$805.02 ,$838.80 ,$811.42 , N/A ,$838.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$838.80 ,$722.30 ,$838.80 ,$838.80 ,$699.00 
ST MARY'S HOSPITAL,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 ,$88.56 ,$89.79 ,$123.00 ,$104.55 , N/A ,$123.00 ,$104.55 ,$89.79 , N/A , N/A ,$51.66 ,$104.55 , N/A ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$69.88 ,$84.99 ,$88.56 ,$85.67 , N/A ,$88.56 , N/A , N/A , N/A , N/A , N/A , N/A ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,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 ,$249.84 ,$253.31 ,$181.42 ,$294.95 , N/A ,$181.42 ,$294.95 ,$253.31 , N/A , N/A ,$145.74 ,$294.95 , N/A ,$319.24 ,$242.90 ,$176.00 ,$211.22 ,$211.32 ,$197.13 ,$239.78 ,$249.84 ,$241.69 , N/A ,$249.84 , N/A , N/A , N/A , N/A , N/A , N/A ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$208.20 
ST MARY'S HOSPITAL,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 ,$249.84 ,$253.31 ,$181.42 ,$294.95 , N/A ,$181.42 ,$294.95 ,$253.31 , N/A , N/A ,$145.74 ,$294.95 , N/A ,$319.24 ,$242.90 ,$176.00 ,$211.22 ,$211.32 ,$197.13 ,$239.78 ,$249.84 ,$241.69 , N/A ,$249.84 , N/A , N/A , N/A , N/A , N/A , N/A ,$249.84 ,$215.14 ,$249.84 ,$249.84 ,$208.20 
ST MARY'S HOSPITAL,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 ,$709.92 ,$719.78 ,$986.00 ,$838.10 , N/A ,$986.00 ,$838.10 ,$719.78 , N/A , N/A ,$414.12 ,$838.10 , N/A ,$907.12 ,$690.20 ,$500.10 ,$600.18 ,$600.47 ,$560.15 ,$681.33 ,$709.92 ,$686.75 , N/A ,$709.92 , N/A , N/A , N/A , N/A , N/A , N/A ,$709.92 ,$611.32 ,$709.92 ,$709.92 ,$591.60 
ST MARY'S HOSPITAL,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 ","$5,640.48 ","$5,718.82 ","$7,834.00 ","$6,658.90 ", N/A ,"$7,834.00 ","$6,658.90 ","$5,718.82 ", 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 ","$4,450.50 ","$5,413.29 ","$5,640.48 ","$5,456.38 ", N/A ,"$5,640.48 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$5,640.48 ","$4,857.08 ","$5,640.48 ","$5,640.48 ","$4,700.40 "
ST MARY'S HOSPITAL,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 ,$197.28 ,$200.02 ,$196.61 ,$232.90 , N/A ,$196.61 ,$232.90 ,$200.02 ,$26.29 , N/A ,$130.89 ,$232.90 , N/A ,$252.08 ,$191.80 ,$167.69 ,$180.41 ,$166.87 ,$167.69 ,$189.33 ,$197.28 ,$190.84 , N/A ,$197.28 ,$27.87 , N/A , N/A , N/A , N/A , N/A ,$197.28 ,$169.88 ,$197.28 ,$197.28 ,$164.40 
ST MARY'S HOSPITAL,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 ,$387.36 ,$392.74 ,$538.00 ,$457.30 , N/A ,$538.00 ,$457.30 ,$392.74 , N/A , N/A ,$225.96 ,$457.30 , N/A ,$494.96 ,$376.60 ,$272.87 ,$327.48 ,$327.64 ,$305.64 ,$371.76 ,$387.36 ,$374.72 , N/A ,$387.36 , N/A , N/A , N/A , N/A , N/A , N/A ,$387.36 ,$333.56 ,$387.36 ,$387.36 ,$322.80 
ST MARY'S HOSPITAL,34300051,A9541,HC DIAGNUCLIDE FILT SULF 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 ,$193.68 ,$196.37 ,$269.00 ,$228.65 , N/A ,$269.00 ,$228.65 ,$196.37 , N/A , N/A ,$112.98 ,$228.65 , N/A ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$152.82 ,$185.88 ,$193.68 ,$187.36 , N/A ,$193.68 , N/A , N/A , N/A , N/A , N/A , N/A ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,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 ,$125.28 ,$127.02 ,$63.92 ,$147.90 , N/A ,$63.92 ,$147.90 ,$127.02 , N/A , N/A ,$73.08 ,$147.90 , N/A ,$160.08 ,$121.80 ,$88.25 ,$105.91 ,$105.97 ,$98.85 ,$120.23 ,$125.28 ,$121.19 , N/A ,$125.28 , N/A , N/A , N/A , N/A , N/A , N/A ,$125.28 ,$107.88 ,$125.28 ,$125.28 ,$104.40 
ST MARY'S HOSPITAL,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 ,$149.04 ,$151.11 ,$207.00 ,$175.95 ,$148.93 ,$207.00 ,$175.95 ,$151.11 ,"$4,157.83 ",$148.93 , N/A ,$175.95 ,$335.08 ,$190.44 ,$144.90 , N/A , N/A ,$126.06 , N/A ,$143.04 ,$149.04 ,$144.18 ,$150.42 ,$149.04 ,"$4,407.30 ",$207.00 ,$207.00 ,$148.93 ,$207.00 ,$148.93 ,$149.04 ,$128.34 ,$149.04 ,$149.04 ,$124.20 
ST MARY'S HOSPITAL,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 ,$101.52 ,$102.93 ,$132.23 ,$119.85 , N/A ,$132.23 ,$119.85 ,$102.93 , N/A , N/A ,$59.22 ,$119.85 , N/A ,$129.72 ,$98.70 ,$71.52 ,$85.83 ,$85.87 ,$80.10 ,$97.43 ,$101.52 ,$98.21 , N/A ,$101.52 , N/A , N/A , N/A , N/A , N/A , N/A ,$101.52 ,$87.42 ,$101.52 ,$101.52 ,$84.60 
ST MARY'S HOSPITAL,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 ,$685.44 ,$694.96 ,$817.02 ,$809.20 , N/A ,$817.02 ,$809.20 ,$694.96 , N/A , N/A ,$399.84 ,$809.20 , N/A ,$875.84 ,$666.40 ,$482.85 ,$579.48 ,$579.77 ,$540.83 ,$657.83 ,$685.44 ,$663.07 , N/A ,$685.44 , N/A , N/A , N/A , N/A , N/A , N/A ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$571.20 
ST MARY'S HOSPITAL,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 ",$841.68 ,$853.37 ,$958.39 ,$993.65 , N/A ,$958.39 ,$993.65 ,$853.37 , N/A , N/A ,$490.98 ,$993.65 , N/A ,"$1,075.48 ",$818.30 ,$592.92 ,$711.57 ,$711.92 ,$664.11 ,$807.78 ,$841.68 ,$814.21 , N/A ,$841.68 , N/A , N/A , N/A , N/A , N/A , N/A ,$841.68 ,$724.78 ,$841.68 ,$841.68 ,$701.40 
ST MARY'S HOSPITAL,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 ,$7.92 ,$8.03 ,$7.15 ,$9.35 ,$10.00 ,$7.15 ,$9.35 ,$8.03 , N/A ,$10.00 ,$4.62 ,$9.35 ,$22.50 ,$10.12 ,$7.70 ,$5.58 ,$6.70 ,$6.70 ,$6.25 ,$7.60 ,$7.92 ,$7.66 ,$10.10 ,$7.92 , N/A ,$11.00 ,$11.00 ,$10.00 ,$11.00 ,$10.00 ,$7.92 ,$6.82 ,$7.92 ,$7.92 ,$6.60 
ST MARY'S HOSPITAL,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 ","$2,052.00 ","$2,080.50 ","$1,852.50 ","$2,422.50 ",$918.52 ,"$1,852.50 ","$2,422.50 ","$2,080.50 ", N/A ,$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 ","$1,619.09 ","$1,969.35 ","$2,052.00 ","$1,985.03 ",$927.71 ,"$2,052.00 ", N/A ,"$1,515.56 ","$1,515.56 ",$918.52 ,"$1,515.56 ",$918.52 ,"$2,052.00 ","$1,767.00 ","$2,052.00 ","$2,052.00 ","$1,710.00 "
ST MARY'S HOSPITAL,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 ","$1,136.88 ","$1,152.67 ","$1,026.35 ","$1,342.15 ",$541.78 ,"$1,026.35 ","$1,342.15 ","$1,152.67 ", N/A ,$541.78 ,$663.18 ,"$1,342.15 ","$1,219.00 ","$1,452.68 ","$1,105.30 ",$800.87 ,$961.14 ,$961.61 ,$897.03 ,"$1,091.09 ","$1,136.88 ","$1,099.77 ",$547.20 ,"$1,136.88 ", N/A ,$893.94 ,$893.94 ,$541.78 ,$893.94 ,$541.78 ,"$1,136.88 ",$978.98 ,"$1,136.88 ","$1,136.88 ",$947.40 
ST MARY'S HOSPITAL,35000002,20615,HC ASP/INJ CYST BONE,350,1 ,$991.00 ,$495.50 ,$154.70 ,"$4,439.84 ",$154.70 ,$991.00 ,$991.00 ,$605.19 ,$594.60 ,$842.35 ,$693.70 ,$154.70 ,$941.45 ,$713.52 ,$723.43 ,$991.00 ,$842.35 ,$605.19 ,$991.00 ,$842.35 ,$723.43 ,$154.70 ,$605.19 ,$471.80 ,$842.35 ,"$1,361.67 ",$911.72 ,$693.70 ,"$3,303.09 ","$4,439.84 ",$603.52 ,"$4,128.86 ",$684.78 ,$713.52 ,$690.23 ,$611.24 ,$713.52 ,$163.98 ,$991.00 ,$991.00 ,$605.19 ,$991.00 ,$605.19 ,$713.52 ,$614.42 ,$713.52 ,$713.52 ,$594.60 
ST MARY'S HOSPITAL,35000003,20982,HC ABLATION BONE TUMOR RADIOFREQUENCY,350,1 ,"$5,279.00 ","$2,639.50 ",$471.80 ,"$13,705.94 ",$547.96 ,"$1,119.00 ","$1,119.00 ","$6,091.53 ","$3,167.40 ","$4,487.15 ","$3,695.30 ",$547.96 ,"$5,015.05 ","$3,800.88 ","$3,853.67 ","$1,171.00 ","$4,487.15 ","$6,091.53 ","$1,171.00 ","$4,487.15 ","$3,853.67 ",$547.96 ,"$6,091.53 ",$471.80 ,"$4,487.15 ","$13,705.94 ","$4,856.68 ","$3,695.30 ","$1,489.75 ","$2,002.44 ","$3,214.91 ","$1,862.71 ","$3,647.79 ","$3,800.88 ","$3,676.82 ","$6,152.45 ","$3,800.88 ",$580.84 ,"$1,136.00 ","$1,136.00 ","$6,091.53 ","$1,136.00 ","$6,091.53 ","$3,800.88 ","$3,272.98 ","$3,800.88 ","$3,800.88 ","$3,167.40 "
ST MARY'S HOSPITAL,35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$2,370.00 ","$1,185.00 ",$471.80 ,"$3,078.81 ",$704.46 ,"$1,119.00 ","$1,119.00 ","$1,368.36 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$704.46 ,"$2,251.50 ","$1,706.40 ","$1,730.10 ","$1,171.00 ","$2,014.50 ","$1,368.36 ","$1,171.00 ","$2,014.50 ","$1,730.10 ",$704.46 ,"$1,368.36 ",$471.80 ,"$2,014.50 ","$3,078.81 ","$2,180.40 ","$1,659.00 ","$1,489.75 ","$2,002.44 ","$1,443.33 ","$1,862.71 ","$1,637.67 ","$1,706.40 ","$1,650.71 ","$1,382.04 ","$1,706.40 ",$746.73 ,"$1,136.00 ","$1,136.00 ","$1,368.36 ","$1,136.00 ","$1,368.36 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,422.00 "
ST MARY'S HOSPITAL,35000013,32400,HC BX PLEURA NEEDLE PERC,350,1 ,"$1,100.00 ",$550.00 ,$299.20 ,"$3,078.81 ",$299.20 ,"$1,100.00 ","$1,100.00 ","$1,368.36 ",$660.00 ,$935.00 ,$770.00 ,$299.20 ,"$1,045.00 ",$792.00 ,$803.00 ,"$1,100.00 ",$935.00 ,"$1,368.36 ","$1,100.00 ",$935.00 ,$803.00 ,$299.20 ,"$1,368.36 ",$471.80 ,$935.00 ,"$3,078.81 ","$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$792.00 ,$766.15 ,"$1,382.04 ",$792.00 ,$317.15 ,"$1,100.00 ","$1,100.00 ","$1,368.36 ","$1,100.00 ","$1,368.36 ",$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,35000017,32998,HC LUNG ABLATION,350,1 ,"$8,070.00 ","$4,035.00 ",$471.80 ,"$11,071.98 ","$1,632.88 ","$1,119.00 ","$1,119.00 ","$4,920.88 ","$4,842.00 ","$6,859.50 ","$5,649.00 ","$1,632.88 ","$7,666.50 ","$5,810.40 ","$5,891.10 ","$1,171.00 ","$6,859.50 ","$4,920.88 ","$1,171.00 ","$6,859.50 ","$5,891.10 ","$1,632.88 ","$4,920.88 ",$471.80 ,"$6,859.50 ","$11,071.98 ","$7,424.40 ","$5,649.00 ","$5,993.67 ","$8,056.00 ","$4,914.63 ","$7,491.83 ","$5,576.37 ","$5,810.40 ","$5,620.76 ","$4,970.09 ","$5,810.40 ","$1,730.85 ","$1,136.00 ","$1,136.00 ","$4,920.88 ","$1,136.00 ","$4,920.88 ","$5,810.40 ","$5,003.40 ","$5,810.40 ","$5,810.40 ","$4,842.00 "
ST MARY'S HOSPITAL,35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$1,724.00 ",$862.00 ,$232.13 ,"$3,078.81 ",$232.13 ,"$1,119.00 ","$1,119.00 ","$1,368.36 ","$1,034.40 ","$1,465.40 ","$1,206.80 ",$232.13 ,"$1,637.80 ","$1,241.28 ","$1,258.52 ","$1,171.00 ","$1,465.40 ","$1,368.36 ","$1,171.00 ","$1,465.40 ","$1,258.52 ",$232.13 ,"$1,368.36 ",$471.80 ,"$1,465.40 ","$3,078.81 ","$1,586.08 ","$1,206.80 ","$1,489.75 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,241.28 ","$1,200.77 ","$1,382.04 ","$1,241.28 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,368.36 ","$1,136.00 ","$1,368.36 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,034.40 "
ST MARY'S HOSPITAL,35000019,47001,HC BIOPSY LIVER OTHER PROC,350,1 ,"$2,330.00 ","$1,165.00 ",$232.13 ,"$2,330.00 ",$232.13 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,398.00 ","$1,980.50 ","$1,631.00 ",$232.13 ,"$2,213.50 ","$1,677.60 ","$1,700.90 ","$1,171.00 ","$1,980.50 ", N/A ,"$1,171.00 ","$1,980.50 ","$1,700.90 ",$232.13 , N/A ,$471.80 ,"$1,980.50 ", N/A ,"$2,143.60 ","$1,631.00 ","$1,489.75 ","$2,002.44 ","$1,418.97 ","$1,862.71 ","$1,610.03 ","$1,677.60 ","$1,622.85 ", N/A ,"$1,677.60 ",$246.06 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,677.60 ","$1,444.60 ","$1,677.60 ","$1,677.60 ","$1,398.00 "
ST MARY'S HOSPITAL,35000020,49405,HC PERC DRN ABSC/HEM/CYST VISCERAL,350,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,078.81 ",$232.13 ,"$1,119.00 ","$1,119.00 ","$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ","$1,171.00 ","$1,190.00 ","$1,368.36 ","$1,171.00 ","$1,190.00 ","$1,022.00 ",$232.13 ,"$1,368.36 ",$471.80 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,368.36 ","$1,136.00 ","$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,35000021,47382,HC ABLATION TUMR LIVER RADIO PERC,350,1 ,"$7,200.00 ","$3,600.00 ",$471.80 ,"$11,071.98 ","$2,004.41 ","$1,119.00 ","$1,119.00 ","$4,920.88 ","$4,320.00 ","$6,120.00 ","$5,040.00 ","$2,004.41 ","$6,840.00 ","$5,184.00 ","$5,256.00 ","$1,171.00 ","$6,120.00 ","$4,920.88 ","$1,171.00 ","$6,120.00 ","$5,256.00 ","$2,004.41 ","$4,920.88 ",$471.80 ,"$6,120.00 ","$11,071.98 ","$6,624.00 ","$5,040.00 ","$5,993.67 ","$8,056.00 ","$4,384.80 ","$7,491.83 ","$4,975.20 ","$5,184.00 ","$5,014.80 ","$4,970.09 ","$5,184.00 ","$2,124.67 ","$1,136.00 ","$1,136.00 ","$4,920.88 ","$1,136.00 ","$4,920.88 ","$5,184.00 ","$4,464.00 ","$5,184.00 ","$5,184.00 ","$4,320.00 "
ST MARY'S HOSPITAL,35000023,48102,HC BX PANCREAS NEEDLE PERC,350,1 ,"$1,400.00 ",$700.00 ,$232.13 ,"$3,078.81 ",$232.13 ,"$1,119.00 ","$1,119.00 ","$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$232.13 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ","$1,171.00 ","$1,190.00 ","$1,368.36 ","$1,171.00 ","$1,190.00 ","$1,022.00 ",$232.13 ,"$1,368.36 ",$471.80 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,"$1,400.00 ","$1,400.00 ",$852.60 ,"$1,400.00 ",$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,368.36 ","$1,136.00 ","$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$1,508.00 ",$754.00 ,$232.13 ,"$3,078.81 ",$232.13 ,"$1,119.00 ","$1,119.00 ","$1,368.36 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$232.13 ,"$1,432.60 ","$1,085.76 ","$1,100.84 ","$1,171.00 ","$1,281.80 ","$1,368.36 ","$1,171.00 ","$1,281.80 ","$1,100.84 ",$232.13 ,"$1,368.36 ",$471.80 ,"$1,281.80 ","$3,078.81 ","$1,387.36 ","$1,055.60 ","$1,489.75 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,085.76 ","$1,050.32 ","$1,382.04 ","$1,085.76 ",$246.06 ,"$1,136.00 ","$1,136.00 ","$1,368.36 ","$1,136.00 ","$1,368.36 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ",$904.80 
ST MARY'S HOSPITAL,35000026,50200,"HC PERC BIOPSY/KIDNEY, NEEDLE",350,1 ,"$1,724.00 ",$862.00 ,$471.80 ,"$3,078.81 ",$474.08 ,"$1,119.00 ","$1,119.00 ","$1,368.36 ","$1,034.40 ","$1,465.40 ","$1,206.80 ",$474.08 ,"$1,637.80 ","$1,241.28 ","$1,258.52 ","$1,171.00 ","$1,465.40 ","$1,368.36 ","$1,171.00 ","$1,465.40 ","$1,258.52 ",$474.08 ,"$1,368.36 ",$471.80 ,"$1,465.40 ","$3,078.81 ","$1,586.08 ","$1,206.80 ","$1,489.75 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,241.28 ","$1,200.77 ","$1,382.04 ","$1,241.28 ",$502.52 ,"$1,136.00 ","$1,136.00 ","$1,368.36 ","$1,136.00 ","$1,368.36 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,034.40 "
ST MARY'S HOSPITAL,35000027,50390,HC RENAL CYST/PELVIS ASP/INJ,350,1 ,"$1,508.00 ",$754.00 ,$119.36 ,"$1,508.00 ",$119.36 ,"$1,119.00 ","$1,119.00 ",$605.19 ,$904.80 ,"$1,281.80 ","$1,055.60 ",$119.36 ,"$1,432.60 ","$1,085.76 ","$1,100.84 ","$1,171.00 ","$1,281.80 ",$605.19 ,"$1,171.00 ","$1,281.80 ","$1,100.84 ",$119.36 ,$605.19 ,$471.80 ,"$1,281.80 ","$1,361.67 ","$1,387.36 ","$1,055.60 ","$1,489.75 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,085.76 ","$1,050.32 ",$611.24 ,"$1,085.76 ",$126.52 ,"$1,136.00 ","$1,136.00 ",$605.19 ,"$1,136.00 ",$605.19 ,"$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ",$904.80 
ST MARY'S HOSPITAL,35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,$948.00 ,$474.00 ,$288.55 ,"$1,361.67 ",$288.55 ,$948.00 ,$948.00 ,$605.19 ,$568.80 ,$805.80 ,$663.60 ,$288.55 ,$900.60 ,$682.56 ,$692.04 ,$948.00 ,$805.80 ,$605.19 ,$948.00 ,$805.80 ,$692.04 ,$288.55 ,$605.19 ,$471.80 ,$805.80 ,"$1,361.67 ",$872.16 ,$663.60 ,$948.00 ,$948.00 ,$577.33 ,$948.00 ,$655.07 ,$682.56 ,$660.28 ,$611.24 ,$682.56 ,$305.86 ,$948.00 ,$948.00 ,$605.19 ,$948.00 ,$605.19 ,$682.56 ,$587.76 ,$682.56 ,$682.56 ,$568.80 
ST MARY'S HOSPITAL,35000029,60699,HC UNLISTED PROCEDURE ENDOCRINE SYSTEM,350,1 ,"$3,300.00 ","$1,650.00 ",$471.80 ,"$11,071.98 ",$907.87 ,"$1,119.00 ","$1,119.00 ","$4,920.88 ","$1,980.00 ","$2,805.00 ","$2,310.00 ",$907.87 ,"$3,135.00 ","$2,376.00 ","$2,409.00 ","$1,171.00 ","$2,805.00 ","$4,920.88 ","$1,171.00 ","$2,805.00 ","$2,409.00 ",$907.87 ,"$4,920.88 ",$471.80 ,"$2,805.00 ","$11,071.98 ","$3,036.00 ","$2,310.00 ","$1,673.76 ","$2,008.71 ","$2,009.70 ","$1,874.73 ","$2,280.30 ","$2,376.00 ","$2,298.45 ","$4,970.09 ","$2,376.00 ",$962.34 ,"$1,136.00 ","$1,136.00 ","$4,920.88 ","$1,136.00 ","$4,920.88 ","$2,376.00 ","$2,046.00 ","$2,376.00 ","$2,376.00 ","$1,980.00 "
ST MARY'S HOSPITAL,35000035,64680,HC DEST NERVE CELIAC PLEXUS,350,1 ,"$1,724.00 ",$862.00 ,$364.34 ,"$1,801.30 ",$364.34 ,"$1,119.00 ","$1,119.00 ",$800.58 ,"$1,034.40 ","$1,465.40 ","$1,206.80 ",$364.34 ,"$1,637.80 ","$1,241.28 ","$1,258.52 ","$1,171.00 ","$1,465.40 ",$800.58 ,"$1,171.00 ","$1,465.40 ","$1,258.52 ",$364.34 ,$800.58 ,$471.80 ,"$1,465.40 ","$1,801.30 ","$1,586.08 ","$1,206.80 ","$1,680.96 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,241.28 ","$1,200.77 ",$808.59 ,"$1,241.28 ",$386.20 ,"$1,136.00 ","$1,136.00 ",$800.58 ,"$1,136.00 ",$800.58 ,"$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,034.40 "
ST MARY'S HOSPITAL,35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$99.26 ,"$1,800.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$99.26 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$99.26 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000044,70486,HC CT SINUSES UNENHANCED/STEREOTACTIC,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$99.26 ,"$2,280.00 ","$1,728.00 ","$1,752.00 ","$1,171.00 ","$2,040.00 ",$173.72 ,"$1,171.00 ","$2,040.00 ","$1,752.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,040.00 ",$390.86 ,"$2,208.00 ","$1,680.00 ",$931.76 ,"$1,000.32 ","$1,461.60 ",$931.76 ,"$1,658.40 ","$1,728.00 ","$1,671.60 ",$175.46 ,"$1,728.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,440.00 "
ST MARY'S HOSPITAL,35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$1,400.00 ",$700.00 ,$121.52 ,"$1,400.00 ",$121.52 ,"$1,119.00 ","$1,119.00 ",$173.72 ,$840.00 ,"$1,190.00 ",$980.00 ,$121.52 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ","$1,171.00 ","$1,190.00 ",$173.72 ,"$1,171.00 ","$1,190.00 ","$1,022.00 ",$121.52 ,$173.72 ,$471.80 ,"$1,190.00 ",$390.86 ,"$1,288.00 ",$980.00 ,$970.20 ,"$1,041.58 ",$852.60 ,$970.20 ,$967.40 ,"$1,008.00 ",$975.10 ,$175.46 ,"$1,008.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$358.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$358.13 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$358.13 ,$471.80 ,"$1,870.00 ",$805.79 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$361.71 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$358.13 ,"$1,136.00 ",$358.13 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$358.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$358.13 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$358.13 ,$471.80 ,"$1,870.00 ",$805.79 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$361.71 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$358.13 ,"$1,136.00 ",$358.13 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,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 ,$710.64 ,$720.51 ,$987.00 ,$838.95 , N/A ,$987.00 ,$838.95 ,$720.51 , N/A , N/A ,$471.80 ,$838.95 , N/A ,$908.04 ,$690.90 ,$500.61 ,$600.79 ,$601.08 ,$560.71 ,$682.02 ,$710.64 ,$687.45 , N/A ,$710.64 , N/A ,$987.00 ,$987.00 , N/A ,$987.00 , N/A ,$710.64 ,$611.94 ,$710.64 ,$710.64 ,$592.20 
ST MARY'S HOSPITAL,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$358.13 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$358.13 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$358.13 ,$471.80 ,"$1,870.00 ",$805.79 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$361.71 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$358.13 ,"$1,136.00 ",$358.13 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,400.00 ","$1,200.00 ",$99.26 ,"$2,400.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$99.26 ,"$2,280.00 ","$1,728.00 ","$1,752.00 ","$1,171.00 ","$2,040.00 ",$173.72 ,"$1,171.00 ","$2,040.00 ","$1,752.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,040.00 ",$390.86 ,"$2,208.00 ","$1,680.00 ",$931.76 ,"$1,000.32 ","$1,461.60 ",$931.76 ,"$1,658.40 ","$1,728.00 ","$1,671.60 ",$175.46 ,"$1,728.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,440.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,600.00 ","$1,300.00 ",$99.26 ,"$2,600.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$36.64 ,"$1,800.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$36.64 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$105.88 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,530.00 ",$238.23 ,"$1,656.00 ","$1,260.00 ",$420.26 ,$451.18 ,"$1,096.20 ",$420.26 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$106.94 ,"$1,296.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$99.26 ,"$2,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$99.26 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,171.00 ","$1,870.00 ",$173.72 ,"$1,171.00 ","$1,870.00 ","$1,606.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,870.00 ",$390.86 ,"$2,024.00 ","$1,540.00 ",$827.42 ,$888.30 ,"$1,339.80 ",$827.42 ,"$1,520.20 ","$1,584.00 ","$1,532.30 ",$175.46 ,"$1,584.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$99.26 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$99.26 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$931.76 ,"$1,000.32 ","$1,583.40 ",$931.76 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$3,600.00 ","$1,800.00 ",$99.26 ,"$3,600.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$223.78 ,"$2,160.00 ","$3,060.00 ","$2,520.00 ",$99.26 ,"$3,420.00 ","$2,592.00 ","$2,628.00 ","$1,171.00 ","$3,060.00 ",$223.78 ,"$1,171.00 ","$3,060.00 ","$2,628.00 ",$99.26 ,$223.78 ,$471.80 ,"$3,060.00 ",$503.50 ,"$3,312.00 ","$2,520.00 ",$803.46 ,$862.58 ,"$2,192.40 ",$803.46 ,"$2,487.60 ","$2,592.00 ","$2,507.40 ",$226.02 ,"$2,592.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$223.78 ,"$1,136.00 ",$223.78 ,"$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,160.00 "
ST MARY'S HOSPITAL,35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$4,200.00 ","$2,100.00 ",$99.26 ,"$4,200.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$358.13 ,"$2,520.00 ","$3,570.00 ","$2,940.00 ",$99.26 ,"$3,990.00 ","$3,024.00 ","$3,066.00 ","$1,171.00 ","$3,570.00 ",$358.13 ,"$1,171.00 ","$3,570.00 ","$3,066.00 ",$99.26 ,$358.13 ,$471.80 ,"$3,570.00 ",$805.79 ,"$3,864.00 ","$2,940.00 ","$1,296.40 ","$1,391.79 ","$2,557.80 ","$1,296.40 ","$2,902.20 ","$3,024.00 ","$2,925.30 ",$361.71 ,"$3,024.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$358.13 ,"$1,136.00 ",$358.13 ,"$3,024.00 ","$2,604.00 ","$3,024.00 ","$3,024.00 ","$2,520.00 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$358.13 ,"$2,940.00 ","$4,165.00 ","$3,430.00 ",$99.26 ,"$4,655.00 ","$3,528.00 ","$3,577.00 ","$1,171.00 ","$4,165.00 ",$358.13 ,"$1,171.00 ","$4,165.00 ","$3,577.00 ",$99.26 ,$358.13 ,$471.80 ,"$4,165.00 ",$805.79 ,"$4,508.00 ","$3,430.00 ","$1,296.40 ","$1,391.79 ","$2,984.10 ","$1,296.40 ","$3,385.90 ","$3,528.00 ","$3,412.85 ",$361.71 ,"$3,528.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$358.13 ,"$1,136.00 ",$358.13 ,"$3,528.00 ","$3,038.00 ","$3,528.00 ","$3,528.00 ","$2,940.00 "
ST MARY'S HOSPITAL,35000086,74261,HC CT VIRTUAL COLONOSCOPY DX,350,1 ,"$1,600.00 ",$800.00 ,$36.64 ,"$1,600.00 ",$36.64 ,"$1,119.00 ","$1,119.00 ",$105.88 ,$960.00 ,"$1,360.00 ","$1,120.00 ",$36.64 ,"$1,520.00 ","$1,152.00 ","$1,168.00 ","$1,171.00 ","$1,360.00 ",$105.88 ,"$1,171.00 ","$1,360.00 ","$1,168.00 ",$36.64 ,$105.88 ,$471.80 ,"$1,360.00 ",$238.23 ,"$1,472.00 ","$1,120.00 ",$420.26 ,$451.18 ,$974.40 ,$420.26 ,"$1,105.60 ","$1,152.00 ","$1,114.40 ",$106.94 ,"$1,152.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$105.88 ,"$1,136.00 ",$105.88 ,"$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ",$960.00 
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$78.66 ,$960.00 ,"$1,360.00 ","$1,120.00 ",$36.64 ,"$1,520.00 ","$1,152.00 ","$1,168.00 ","$1,171.00 ","$1,360.00 ",$78.66 ,"$1,171.00 ","$1,360.00 ","$1,168.00 ",$36.64 ,$78.66 ,$471.80 ,"$1,360.00 ",$177.00 ,"$1,472.00 ","$1,120.00 ",$73.45 ,$78.86 ,$974.40 ,$73.45 ,"$1,105.60 ","$1,152.00 ","$1,114.40 ",$79.45 ,"$1,152.00 ",$38.84 ,"$1,136.00 ","$1,136.00 ",$78.66 ,"$1,136.00 ",$78.66 ,"$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ",$960.00 
ST MARY'S HOSPITAL,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 ,$35.96 ,$36.46 ,$49.95 ,$42.46 , N/A ,$49.95 ,$42.46 ,$36.46 , N/A , N/A ,$49.95 ,$42.46 , N/A ,$45.95 ,$34.97 ,$25.33 ,$30.40 ,$30.42 ,$28.38 ,$34.52 ,$35.96 ,$34.79 , N/A ,$35.96 , N/A ,$49.95 ,$49.95 , N/A ,$49.95 , N/A ,$35.96 ,$30.97 ,$35.96 ,$35.96 ,$29.97 
ST MARY'S HOSPITAL,35000089,75572,HC CT HEART WO/W CONT FUNCT EVAL,350,1 ,"$1,800.00 ",$900.00 ,$99.26 ,"$1,800.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$99.26 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$173.72 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,530.00 ",$390.86 ,"$1,656.00 ","$1,260.00 ",$737.74 ,$792.02 ,"$1,096.20 ",$737.74 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$175.46 ,"$1,296.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000090,75573,HC CT HRT W/3D IMAGE CONGEN,350,1 ,"$1,800.00 ",$900.00 ,$99.26 ,"$1,800.00 ",$99.26 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$99.26 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$173.72 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$99.26 ,$173.72 ,$471.80 ,"$1,530.00 ",$390.86 ,"$1,656.00 ","$1,260.00 ",$737.74 ,$792.02 ,"$1,096.20 ",$737.74 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$175.46 ,"$1,296.00 ",$105.22 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000091,75574,HC CT CARD ANGIO W/CALC SCORING,350,1 ,"$1,800.00 ",$900.00 ,$121.52 ,"$1,800.00 ",$121.52 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$121.52 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$173.72 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$121.52 ,$173.72 ,$471.80 ,"$1,530.00 ",$390.86 ,"$1,656.00 ","$1,260.00 ",$737.74 ,$792.02 ,"$1,096.20 ",$737.74 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$175.46 ,"$1,296.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000094,75574,HC CTA HEART CORONARY W/CONTRAST 3D POST,350,1 ,"$1,800.00 ",$900.00 ,$121.52 ,"$1,800.00 ",$121.52 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$121.52 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,171.00 ","$1,530.00 ",$173.72 ,"$1,171.00 ","$1,530.00 ","$1,314.00 ",$121.52 ,$173.72 ,$471.80 ,"$1,530.00 ",$390.86 ,"$1,656.00 ","$1,260.00 ",$737.74 ,$792.02 ,"$1,096.20 ",$737.74 ,"$1,243.80 ","$1,296.00 ","$1,253.70 ",$175.46 ,"$1,296.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$2,600.00 ","$1,300.00 ",$121.52 ,"$2,600.00 ",$121.52 ,"$1,119.00 ","$1,119.00 ",$173.72 ,"$1,560.00 ","$2,210.00 ","$1,820.00 ",$121.52 ,"$2,470.00 ","$1,872.00 ","$1,898.00 ","$1,171.00 ","$2,210.00 ",$173.72 ,"$1,171.00 ","$2,210.00 ","$1,898.00 ",$121.52 ,$173.72 ,$471.80 ,"$2,210.00 ",$390.86 ,"$2,392.00 ","$1,820.00 ",$970.20 ,"$1,041.58 ","$1,583.40 ",$970.20 ,"$1,796.60 ","$1,872.00 ","$1,810.90 ",$175.46 ,"$1,872.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$173.72 ,"$1,136.00 ",$173.72 ,"$1,872.00 ","$1,612.00 ","$1,872.00 ","$1,872.00 ","$1,560.00 "
ST MARY'S HOSPITAL,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 ,$499.68 ,$506.62 ,$694.00 ,$589.90 , N/A ,$694.00 ,$589.90 ,$506.62 , N/A , N/A ,$471.80 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$394.26 ,$479.55 ,$499.68 ,$483.37 , N/A ,$499.68 , N/A ,$694.00 ,$694.00 , N/A ,$694.00 , N/A ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$416.40 
ST MARY'S HOSPITAL,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 ,$564.48 ,$572.32 ,$784.00 ,$666.40 , N/A ,$784.00 ,$666.40 ,$572.32 , N/A , N/A ,$471.80 ,$666.40 , N/A ,$721.28 ,$548.80 ,$397.64 ,$477.22 ,$477.46 ,$445.39 ,$541.74 ,$564.48 ,$546.06 , N/A ,$564.48 , N/A ,$784.00 ,$784.00 , N/A ,$784.00 , N/A ,$564.48 ,$486.08 ,$564.48 ,$564.48 ,$470.40 
ST MARY'S HOSPITAL,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 ",$78.66 ,$660.00 ,$935.00 ,$770.00 ,$36.64 ,"$1,045.00 ",$792.00 ,$803.00 ,"$1,100.00 ",$935.00 ,$78.66 ,"$1,100.00 ",$935.00 ,$803.00 ,$36.64 ,$78.66 ,$471.80 ,$935.00 ,$177.00 ,"$1,012.00 ",$770.00 ,$264.39 ,$283.85 ,$669.90 ,$264.39 ,$760.10 ,$792.00 ,$766.15 ,$79.45 ,$792.00 ,$38.84 ,"$1,100.00 ","$1,100.00 ",$78.66 ,"$1,100.00 ",$78.66 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,35000103,76497,HC UNLISTED CT PROC,350,1 ,$475.00 ,$237.50 ,$36.64 ,$475.00 ,$36.64 ,$475.00 ,$475.00 ,$78.66 ,$285.00 ,$403.75 ,$332.50 ,$36.64 ,$451.25 ,$342.00 ,$346.75 ,$475.00 ,$403.75 ,$78.66 ,$475.00 ,$403.75 ,$346.75 ,$36.64 ,$78.66 ,$471.80 ,$403.75 ,$177.00 ,$437.00 ,$332.50 ,$264.39 ,$283.85 ,$289.28 ,$264.39 ,$328.23 ,$342.00 ,$330.84 ,$79.45 ,$342.00 ,$38.84 ,$475.00 ,$475.00 ,$78.66 ,$475.00 ,$78.66 ,$342.00 ,$294.50 ,$342.00 ,$342.00 ,$285.00 
ST MARY'S HOSPITAL,35000104,77011,HC CT GUIDED LOCALIZATION STEREO,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,224.00 ","$1,241.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,445.00 ","$1,241.00 ",$29.23 , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,35000105,77011,HC CT GUIDED LOCALIZATION STEREO SINUS,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,224.00 ","$1,241.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,445.00 ","$1,241.00 ",$29.23 , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,224.00 ","$1,241.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,445.00 ","$1,241.00 ",$29.23 , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,35000108,77012,HC CT GUIDED NEEDLE PLACEMENT JOINT INJ,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,224.00 ","$1,241.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,445.00 ","$1,241.00 ",$29.23 , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,35000109,77013,HC CT GUIDED FOR ABLATION,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,224.00 ","$1,241.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,445.00 ","$1,241.00 ",$29.23 , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,35000110,77014,HC CT GUIDED THRPY PLACEMENT,350,1 ,"$1,700.00 ",$850.00 ,$29.23 ,"$1,700.00 ",$29.23 ,"$1,119.00 ","$1,119.00 ", N/A ,"$1,020.00 ","$1,445.00 ","$1,190.00 ",$29.23 ,"$1,615.00 ","$1,224.00 ","$1,241.00 ","$1,171.00 ","$1,445.00 ", N/A ,"$1,171.00 ","$1,445.00 ","$1,241.00 ",$29.23 , N/A ,$471.80 ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$30.98 ,"$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,35000113,51102,HC ASPIRATION OF BLADDER AND INSERT SUPRAPUBIC CATH,350,1 ,"$3,447.00 ","$1,723.50 ",$471.80 ,"$3,917.96 ",$490.13 ,"$1,119.00 ","$1,119.00 ","$1,741.31 ","$2,068.20 ","$2,929.95 ","$2,412.90 ",$490.13 ,"$3,274.65 ","$2,481.84 ","$2,516.31 ","$1,171.00 ","$2,929.95 ","$1,741.31 ","$1,171.00 ","$2,929.95 ","$2,516.31 ",$490.13 ,"$1,741.31 ",$471.80 ,"$2,929.95 ","$3,917.96 ","$3,171.24 ","$2,412.90 ","$1,489.75 ","$2,002.44 ","$2,099.22 ","$1,862.71 ","$2,381.88 ","$2,481.84 ","$2,400.84 ","$1,758.72 ","$2,481.84 ",$519.54 ,"$1,136.00 ","$1,136.00 ","$1,741.31 ","$1,136.00 ","$1,741.31 ","$2,481.84 ","$2,137.14 ","$2,481.84 ","$2,481.84 ","$2,068.20 "
ST MARY'S HOSPITAL,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 ,"$1,119.00 ","$1,119.00 ",$358.13 ,"$2,880.00 ","$4,080.00 ","$3,360.00 ",$121.52 ,"$4,560.00 ","$3,456.00 ","$3,504.00 ","$1,171.00 ","$4,080.00 ",$358.13 ,"$1,171.00 ","$4,080.00 ","$3,504.00 ",$121.52 ,$358.13 ,$471.80 ,"$4,080.00 ",$805.79 ,"$4,416.00 ","$3,360.00 ","$1,296.40 ","$1,391.79 ","$2,923.20 ","$1,296.40 ","$3,316.80 ","$3,456.00 ","$3,343.20 ",$361.71 ,"$3,456.00 ",$128.81 ,"$1,136.00 ","$1,136.00 ",$358.13 ,"$1,136.00 ",$358.13 ,"$3,456.00 ","$2,976.00 ","$3,456.00 ","$3,456.00 ","$2,880.00 "
ST MARY'S HOSPITAL,35000135,22513,HC VERTEBROPLASTY INJ PERC THOR  KYPHOPLASTY,350,1 ,"$5,200.00 ","$2,600.00 ",$471.80 ,"$13,705.94 ","$1,461.70 ","$1,119.00 ","$1,119.00 ","$6,091.53 ","$3,120.00 ","$4,420.00 ","$3,640.00 ","$1,461.70 ","$4,940.00 ","$3,744.00 ","$3,796.00 ","$1,171.00 ","$4,420.00 ","$6,091.53 ","$1,171.00 ","$4,420.00 ","$3,796.00 ","$1,461.70 ","$6,091.53 ",$471.80 ,"$4,420.00 ","$13,705.94 ","$4,784.00 ","$3,640.00 ","$5,993.67 ","$8,056.00 ","$3,166.80 ","$7,491.83 ","$3,593.20 ","$3,744.00 ","$3,621.80 ","$6,152.45 ","$3,744.00 ","$1,549.40 ","$1,136.00 ","$1,136.00 ","$6,091.53 ","$1,136.00 ","$6,091.53 ","$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$3,120.00 "
ST MARY'S HOSPITAL,35000136,22514,HC VERTEBROPLASTY INJ PERC LUMBAR KYPHOPLASTY,350,1 ,"$5,200.00 ","$2,600.00 ",$471.80 ,"$13,705.94 ","$1,461.70 ","$1,119.00 ","$1,119.00 ","$6,091.53 ","$3,120.00 ","$4,420.00 ","$3,640.00 ","$1,461.70 ","$4,940.00 ","$3,744.00 ","$3,796.00 ","$1,171.00 ","$4,420.00 ","$6,091.53 ","$1,171.00 ","$4,420.00 ","$3,796.00 ","$1,461.70 ","$6,091.53 ",$471.80 ,"$4,420.00 ","$13,705.94 ","$4,784.00 ","$3,640.00 ","$5,993.67 ","$8,056.00 ","$3,166.80 ","$7,491.83 ","$3,593.20 ","$3,744.00 ","$3,621.80 ","$6,152.45 ","$3,744.00 ","$1,549.40 ","$1,136.00 ","$1,136.00 ","$6,091.53 ","$1,136.00 ","$6,091.53 ","$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$3,120.00 "
ST MARY'S HOSPITAL,35000137,22515,HC VERTEBROPLASTY INJ PERC EA ADDNT THOR OR LUMB KYPHO,350,1 ,"$5,200.00 ","$2,600.00 ",$471.80 ,"$8,056.00 ","$3,220.01 ","$1,119.00 ","$1,119.00 ", N/A ,"$3,120.00 ","$4,420.00 ","$3,640.00 ","$3,220.01 ","$4,940.00 ","$3,744.00 ","$3,796.00 ","$1,171.00 ","$4,420.00 ", N/A ,"$1,171.00 ","$4,420.00 ","$3,796.00 ","$3,220.01 ", N/A ,$471.80 ,"$4,420.00 ", N/A ,"$4,784.00 ","$3,640.00 ","$5,993.67 ","$8,056.00 ","$3,166.80 ","$7,491.83 ","$3,593.20 ","$3,744.00 ","$3,621.80 ", N/A ,"$3,744.00 ","$3,413.21 ","$1,136.00 ","$1,136.00 ", N/A ,"$1,136.00 ", N/A ,"$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$3,120.00 "
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$220.00 ,$187.00 , N/A ,$220.00 ,$187.00 ,$160.60 , N/A , N/A ,$220.00 ,$187.00 , N/A ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 , N/A ,$158.40 , N/A ,$220.00 ,$220.00 , N/A ,$220.00 , N/A ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$113.76 ,$115.34 , N/A ,$134.30 , N/A , N/A ,$134.30 ,$115.34 , N/A , N/A , N/A ,$134.30 , N/A ,$145.36 ,$110.60 ,$80.14 ,$96.17 ,$96.22 ,$89.76 ,$109.18 ,$113.76 ,$110.05 , N/A ,$113.76 , N/A , N/A , N/A , N/A , N/A , N/A ,$113.76 ,$97.96 ,$113.76 ,$113.76 ,$94.80 
ST MARY'S HOSPITAL,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 ","$1,209.60 ","$1,226.40 ", N/A ,"$1,428.00 ", N/A , N/A ,"$1,428.00 ","$1,226.40 ", 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 ",$954.41 ,"$1,160.88 ","$1,209.60 ","$1,170.12 ", N/A ,"$1,209.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,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 ,$673.20 ,$682.55 , N/A ,$794.75 , N/A , N/A ,$794.75 ,$682.55 , N/A , N/A , N/A ,$794.75 , N/A ,$860.20 ,$654.50 ,$474.23 ,$569.13 ,$569.42 ,$531.17 ,$646.09 ,$673.20 ,$651.23 , N/A ,$673.20 , N/A , N/A , N/A , N/A , N/A , N/A ,$673.20 ,$579.70 ,$673.20 ,$673.20 ,$561.00 
ST MARY'S HOSPITAL,36000010,N/A,HC CARDIAC TEAM MAJOR 3 PER UNIT 40710,360,1 ,$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 ,$302.40 ,$306.60 , N/A ,$357.00 , N/A , N/A ,$357.00 ,$306.60 , N/A , N/A , N/A ,$357.00 , N/A ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$238.60 ,$290.22 ,$302.40 ,$292.53 , N/A ,$302.40 , N/A , N/A , N/A , N/A , N/A , N/A ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,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 ,$756.00 ,$766.50 , N/A ,$892.50 , N/A , N/A ,$892.50 ,$766.50 , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,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 ",$907.20 ,$919.80 , N/A ,"$1,071.00 ", N/A , N/A ,"$1,071.00 ",$919.80 , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$715.81 ,$870.66 ,$907.20 ,$877.59 , N/A ,$907.20 , N/A , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,$756.00 
ST MARY'S HOSPITAL,36000020,N/A,HC U/S CENTRAL LINE PLACEMENT,360,1 ,"$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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ,$159.12 ,$161.33 , N/A ,$187.85 , N/A , N/A ,$187.85 ,$161.33 , N/A , N/A , N/A ,$187.85 , N/A ,$203.32 ,$154.70 ,$112.09 ,$134.52 ,$134.59 ,$125.55 ,$152.71 ,$159.12 ,$153.93 , N/A ,$159.12 , N/A , N/A , N/A , N/A , N/A , N/A ,$159.12 ,$137.02 ,$159.12 ,$159.12 ,$132.60 
ST MARY'S HOSPITAL,36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$291.00 ,$145.50 ,$51.36 ,$392.94 ,$51.36 ,$291.00 ,$291.00 ,$174.64 ,$174.60 ,$247.35 ,$203.70 ,$51.36 ,$276.45 ,$209.52 ,$212.43 ,$291.00 ,$247.35 ,$174.64 ,$291.00 ,$247.35 ,$212.43 ,$51.36 ,$174.64 ,$291.00 ,$247.35 ,$392.94 ,$267.72 ,$203.70 ,$291.00 ,$291.00 ,$177.22 ,$291.00 ,$201.08 ,$209.52 ,$202.68 ,$176.39 ,$209.52 ,$54.44 ,$291.00 ,$291.00 ,$174.64 ,$291.00 ,$174.64 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,"$1,939.00 ",$969.50 ,$344.84 ,"$3,078.81 ",$344.84 ,"$1,939.00 ","$1,939.00 ","$1,368.36 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$344.84 ,"$1,842.05 ","$1,396.08 ","$1,415.47 ","$1,939.00 ","$1,648.15 ","$1,368.36 ","$1,939.00 ","$1,648.15 ","$1,415.47 ",$344.84 ,"$1,368.36 ","$1,939.00 ","$1,648.15 ","$3,078.81 ","$1,783.88 ","$1,357.30 ","$1,489.75 ","$1,939.00 ","$1,180.85 ","$1,862.71 ","$1,339.85 ","$1,396.08 ","$1,350.51 ","$1,382.04 ","$1,396.08 ",$365.53 ,"$1,939.00 ","$1,939.00 ","$1,368.36 ","$1,939.00 ","$1,368.36 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,163.40 "
ST MARY'S HOSPITAL,36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$463.00 ,$231.50 ,$51.36 ,$756.32 ,$51.36 ,$463.00 ,$463.00 ,$336.14 ,$277.80 ,$393.55 ,$324.10 ,$51.36 ,$439.85 ,$333.36 ,$337.99 ,$463.00 ,$393.55 ,$336.14 ,$463.00 ,$393.55 ,$337.99 ,$51.36 ,$336.14 ,$463.00 ,$393.55 ,$756.32 ,$425.96 ,$324.10 ,$463.00 ,$463.00 ,$281.97 ,$463.00 ,$319.93 ,$333.36 ,$322.48 ,$339.50 ,$333.36 ,$54.44 ,$463.00 ,$463.00 ,$336.14 ,$463.00 ,$336.14 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$277.80 
ST MARY'S HOSPITAL,36000035,10030,HC GUIDE CATHET FLUID DRAINAGE,360,1 ,"$1,293.00 ",$646.50 ,$344.84 ,"$1,361.67 ",$344.84 ,"$1,293.00 ","$1,293.00 ",$605.19 ,$775.80 ,"$1,099.05 ",$905.10 ,$344.84 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ",$605.19 ,"$1,293.00 ","$1,099.05 ",$943.89 ,$344.84 ,$605.19 ,"$1,293.00 ","$1,099.05 ","$1,361.67 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$611.24 ,$930.96 ,$365.53 ,"$1,293.00 ","$1,293.00 ",$605.19 ,"$1,293.00 ",$605.19 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36000040,31652,HC BRONCH RIGID/FLEX EBUS 1 OR 2 NODES,360,1 ,"$3,500.00 ","$1,750.00 ","$1,069.97 ","$8,056.00 ","$1,069.97 ","$3,500.00 ","$3,500.00 ","$3,012.49 ","$2,100.00 ","$2,975.00 ","$2,450.00 ","$1,069.97 ","$3,325.00 ","$2,520.00 ","$2,555.00 ","$3,500.00 ","$2,975.00 ","$3,012.49 ","$3,500.00 ","$2,975.00 ","$2,555.00 ","$1,069.97 ","$3,012.49 ","$3,500.00 ","$2,975.00 ","$6,778.10 ","$3,220.00 ","$2,450.00 ","$5,993.67 ","$8,056.00 ","$2,131.50 ","$7,491.83 ","$2,418.50 ","$2,520.00 ","$2,437.75 ","$3,042.61 ","$2,520.00 ","$1,134.17 ","$3,500.00 ","$3,500.00 ","$3,012.49 ","$3,500.00 ","$3,012.49 ","$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,100.00 "
ST MARY'S HOSPITAL,36000041,31653,HC BRONCH RIGID/FLEX EBUS 3 OR MORE NODES,360,1 ,"$3,600.00 ","$1,800.00 ","$1,069.97 ","$6,778.10 ","$1,069.97 ","$3,600.00 ","$3,600.00 ","$3,012.49 ","$2,160.00 ","$3,060.00 ","$2,520.00 ","$1,069.97 ","$3,420.00 ","$2,592.00 ","$2,628.00 ","$3,600.00 ","$3,060.00 ","$3,012.49 ","$3,600.00 ","$3,060.00 ","$2,628.00 ","$1,069.97 ","$3,012.49 ","$3,600.00 ","$3,060.00 ","$6,778.10 ","$3,312.00 ","$2,520.00 ","$3,303.09 ","$4,439.84 ","$2,192.40 ","$4,128.86 ","$2,487.60 ","$2,592.00 ","$2,507.40 ","$3,042.61 ","$2,592.00 ","$1,134.17 ","$3,600.00 ","$3,600.00 ","$3,012.49 ","$3,600.00 ","$3,012.49 ","$2,592.00 ","$2,232.00 ","$2,592.00 ","$2,592.00 ","$2,160.00 "
ST MARY'S HOSPITAL,36000078,19000,HC ASP CYST BREAST,360,1 ,$797.00 ,$398.50 ,$198.34 ,"$1,361.67 ",$198.34 ,$797.00 ,$797.00 ,$605.19 ,$478.20 ,$677.45 ,$557.90 ,$198.34 ,$757.15 ,$573.84 ,$581.81 ,$797.00 ,$677.45 ,$605.19 ,$797.00 ,$677.45 ,$581.81 ,$198.34 ,$605.19 ,$797.00 ,$677.45 ,"$1,361.67 ",$733.24 ,$557.90 ,$797.00 ,$797.00 ,$485.37 ,$797.00 ,$550.73 ,$573.84 ,$555.11 ,$611.24 ,$573.84 ,$210.24 ,$797.00 ,$797.00 ,$605.19 ,$797.00 ,$605.19 ,$573.84 ,$494.14 ,$573.84 ,$573.84 ,$478.20 
ST MARY'S HOSPITAL,36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$409.00 ,$204.50 ,$198.34 ,"$2,002.44 ",$198.34 ,$409.00 ,$409.00 , N/A ,$245.40 ,$347.65 ,$286.30 ,$198.34 ,$388.55 ,$294.48 ,$298.57 ,$409.00 ,$347.65 , N/A ,$409.00 ,$347.65 ,$298.57 ,$198.34 , N/A ,$409.00 ,$347.65 , N/A ,$376.28 ,$286.30 ,"$1,489.75 ","$2,002.44 ",$249.08 ,"$1,862.71 ",$282.62 ,$294.48 ,$284.87 , N/A ,$294.48 ,$210.24 ,$409.00 ,$409.00 , N/A ,$409.00 , N/A ,$294.48 ,$253.58 ,$294.48 ,$294.48 ,$245.40 
ST MARY'S HOSPITAL,36000080,19020,HC BREAST ABSCESS DRAINAGE,360,1 ,"$2,681.00 ","$1,340.50 ",$439.46 ,"$3,078.81 ",$439.46 ,"$2,681.00 ","$2,681.00 ","$1,368.36 ","$1,608.60 ","$2,278.85 ","$1,876.70 ",$439.46 ,"$2,546.95 ","$1,930.32 ","$1,957.13 ","$2,681.00 ","$2,278.85 ","$1,368.36 ","$2,681.00 ","$2,278.85 ","$1,957.13 ",$439.46 ,"$1,368.36 ","$2,681.00 ","$2,278.85 ","$3,078.81 ","$2,466.52 ","$1,876.70 ","$1,680.96 ","$2,259.84 ","$1,632.73 ","$2,101.20 ","$1,852.57 ","$1,930.32 ","$1,867.32 ","$1,382.04 ","$1,930.32 ",$465.83 ,"$2,681.00 ","$2,681.00 ","$1,368.36 ","$2,681.00 ","$1,368.36 ","$1,930.32 ","$1,662.22 ","$1,930.32 ","$1,930.32 ","$1,608.60 "
ST MARY'S HOSPITAL,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 ,$228.24 ,$231.41 ,$317.00 ,$269.45 , N/A ,$317.00 ,$269.45 ,$231.41 ,$95.13 , N/A ,$317.00 ,$269.45 , N/A ,$291.64 ,$221.90 ,$317.00 ,$317.00 ,$193.05 ,$317.00 ,$219.05 ,$228.24 ,$220.79 , N/A ,$228.24 ,$100.84 ,$317.00 ,$317.00 , N/A ,$317.00 , N/A ,$228.24 ,$196.54 ,$228.24 ,$228.24 ,$190.20 
ST MARY'S HOSPITAL,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,000.00 ","$2,000.00 ",$659.19 ,"$5,188.27 ",$659.19 ,"$4,000.00 ","$3,641.00 ","$2,305.90 ","$2,400.00 ","$3,400.00 ","$2,800.00 ",$659.19 ,"$3,800.00 ","$2,880.00 ","$2,920.00 ","$4,000.00 ","$3,400.00 ","$2,305.90 ","$4,000.00 ","$3,400.00 ","$2,920.00 ",$659.19 ,"$2,305.90 ","$3,733.65 ","$3,400.00 ","$5,188.27 ","$3,680.00 ","$2,800.00 ","$2,521.44 ","$3,389.76 ","$2,436.00 ","$3,151.80 ","$2,764.00 ","$2,880.00 ","$2,786.00 ","$2,328.96 ","$2,880.00 ",$698.74 ,"$4,000.00 ","$4,000.00 ","$2,305.90 ","$4,000.00 ","$2,305.90 ","$2,880.00 ","$2,480.00 ","$2,880.00 ","$2,880.00 ","$2,400.00 "
ST MARY'S HOSPITAL,36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,000.00 ","$2,000.00 ",$659.19 ,"$5,188.27 ",$659.19 ,"$4,000.00 ","$3,641.00 ","$2,305.90 ","$2,400.00 ","$3,400.00 ","$2,800.00 ",$659.19 ,"$3,800.00 ","$2,880.00 ","$2,920.00 ","$4,000.00 ","$3,400.00 ","$2,305.90 ","$4,000.00 ","$3,400.00 ","$2,920.00 ",$659.19 ,"$2,305.90 ","$3,733.65 ","$3,400.00 ","$5,188.27 ","$3,680.00 ","$2,800.00 ","$2,521.44 ","$3,389.76 ","$2,436.00 ","$3,151.80 ","$2,764.00 ","$2,880.00 ","$2,786.00 ","$2,328.96 ","$2,880.00 ",$698.74 ,"$4,000.00 ","$4,000.00 ","$2,305.90 ","$4,000.00 ","$2,305.90 ","$2,880.00 ","$2,480.00 ","$2,880.00 ","$2,880.00 ","$2,400.00 "
ST MARY'S HOSPITAL,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 ",$605.19 ,$900.00 ,"$1,275.00 ","$1,050.00 ",$258.03 ,"$1,425.00 ","$1,080.00 ","$1,095.00 ","$1,500.00 ","$1,275.00 ",$605.19 ,"$1,500.00 ","$1,275.00 ","$1,095.00 ",$258.03 ,$605.19 ,"$1,500.00 ","$1,275.00 ","$1,361.67 ","$1,380.00 ","$1,050.00 ","$1,500.00 ","$1,500.00 ",$913.50 ,"$1,500.00 ","$1,036.50 ","$1,080.00 ","$1,044.75 ",$611.24 ,"$1,080.00 ",$273.51 ,"$1,500.00 ","$1,500.00 ",$605.19 ,"$1,500.00 ",$605.19 ,"$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ",$900.00 
ST MARY'S HOSPITAL,36000086,19286,HC PLCMNT NEEDLE LOC WIRE BRST ADDL,360,1 ,$130.00 ,$65.00 ,$65.00 ,"$2,259.84 ",$258.03 ,$130.00 ,$130.00 , N/A ,$78.00 ,$110.50 ,$91.00 ,$258.03 ,$123.50 ,$93.60 ,$94.90 ,$130.00 ,$110.50 , N/A ,$130.00 ,$110.50 ,$94.90 ,$258.03 , N/A ,$130.00 ,$110.50 , N/A ,$119.60 ,$91.00 ,"$1,680.96 ","$2,259.84 ",$79.17 ,"$2,101.20 ",$89.83 ,$93.60 ,$90.55 , N/A ,$93.60 ,$273.51 ,$130.00 ,$130.00 , N/A ,$130.00 , N/A ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$1,293.00 ",$646.50 ,$198.34 ,"$3,078.81 ",$198.34 ,"$1,293.00 ","$1,293.00 ","$1,368.36 ",$775.80 ,"$1,099.05 ",$905.10 ,$198.34 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ","$1,368.36 ","$1,293.00 ","$1,099.05 ",$943.89 ,$198.34 ,"$1,368.36 ","$1,293.00 ","$1,099.05 ","$3,078.81 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,"$1,382.04 ",$930.96 ,$210.24 ,"$1,293.00 ","$1,293.00 ","$1,368.36 ","$1,293.00 ","$1,368.36 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$1,508.00 ",$754.00 ,$198.34 ,"$3,078.81 ",$198.34 ,"$1,508.00 ","$1,508.00 ","$1,368.36 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$198.34 ,"$1,432.60 ","$1,085.76 ","$1,100.84 ","$1,508.00 ","$1,281.80 ","$1,368.36 ","$1,508.00 ","$1,281.80 ","$1,100.84 ",$198.34 ,"$1,368.36 ","$1,508.00 ","$1,281.80 ","$3,078.81 ","$1,387.36 ","$1,055.60 ","$1,489.75 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,085.76 ","$1,050.32 ","$1,382.04 ","$1,085.76 ",$210.24 ,"$1,508.00 ","$1,508.00 ","$1,368.36 ","$1,508.00 ","$1,368.36 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ",$904.80 
ST MARY'S HOSPITAL,36000090,20225,HC BX BONE NEEDLE DEEP,360,1 ,"$2,370.00 ","$1,185.00 ",$547.96 ,"$3,078.81 ",$547.96 ,"$2,370.00 ","$2,370.00 ","$1,368.36 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$547.96 ,"$2,251.50 ","$1,706.40 ","$1,730.10 ","$2,370.00 ","$2,014.50 ","$1,368.36 ","$2,370.00 ","$2,014.50 ","$1,730.10 ",$547.96 ,"$1,368.36 ","$2,370.00 ","$2,014.50 ","$3,078.81 ","$2,180.40 ","$1,659.00 ","$1,680.96 ","$2,259.84 ","$1,443.33 ","$2,101.20 ","$1,637.67 ","$1,706.40 ","$1,650.71 ","$1,382.04 ","$1,706.40 ",$580.84 ,"$2,370.00 ","$2,370.00 ","$1,368.36 ","$2,370.00 ","$1,368.36 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,422.00 "
ST MARY'S HOSPITAL,36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,$250.00 ,$125.00 ,$125.00 ,"$2,259.84 ",$439.46 ,$250.00 ,$250.00 , N/A ,$150.00 ,$212.50 ,$175.00 ,$439.46 ,$237.50 ,$180.00 ,$182.50 ,$250.00 ,$212.50 , N/A ,$250.00 ,$212.50 ,$182.50 ,$439.46 , N/A ,$250.00 ,$212.50 , N/A ,$230.00 ,$175.00 ,"$1,680.96 ","$2,259.84 ",$152.25 ,"$2,101.20 ",$172.75 ,$180.00 ,$174.13 , N/A ,$180.00 ,$465.83 ,$250.00 ,$250.00 , N/A ,$250.00 , N/A ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$150.00 
ST MARY'S HOSPITAL,36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,$230.00 ,$115.00 ,$115.00 ,"$2,259.84 ",$439.46 ,$230.00 ,$230.00 , N/A ,$138.00 ,$195.50 ,$161.00 ,$439.46 ,$218.50 ,$165.60 ,$167.90 ,$230.00 ,$195.50 , N/A ,$230.00 ,$195.50 ,$167.90 ,$439.46 , N/A ,$230.00 ,$195.50 , N/A ,$211.60 ,$161.00 ,"$1,680.96 ","$2,259.84 ",$140.07 ,"$2,101.20 ",$158.93 ,$165.60 ,$160.20 , N/A ,$165.60 ,$465.83 ,$230.00 ,$230.00 , N/A ,$230.00 , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,36000110,19085,HC BX BREAST 1ST LESION MR IMAG,360,1 ,"$1,000.00 ",$500.00 ,$439.46 ,"$3,078.81 ",$439.46 ,"$1,000.00 ","$1,000.00 ","$1,368.36 ",$600.00 ,$850.00 ,$700.00 ,$439.46 ,$950.00 ,$720.00 ,$730.00 ,"$1,000.00 ",$850.00 ,"$1,368.36 ","$1,000.00 ",$850.00 ,$730.00 ,$439.46 ,"$1,368.36 ","$1,000.00 ",$850.00 ,"$3,078.81 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$720.00 ,$696.50 ,"$1,382.04 ",$720.00 ,$465.83 ,"$1,000.00 ","$1,000.00 ","$1,368.36 ","$1,000.00 ","$1,368.36 ",$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,36000111,19086,HC BX BREAST ADDN LESION MR IMAG,360,1 ,$280.00 ,$140.00 ,$140.00 ,"$2,259.84 ",$439.46 ,$280.00 ,$280.00 , N/A ,$168.00 ,$238.00 ,$196.00 ,$439.46 ,$266.00 ,$201.60 ,$204.40 ,$280.00 ,$238.00 , N/A ,$280.00 ,$238.00 ,$204.40 ,$439.46 , N/A ,$280.00 ,$238.00 , N/A ,$257.60 ,$196.00 ,"$1,680.96 ","$2,259.84 ",$170.52 ,"$2,101.20 ",$193.48 ,$201.60 ,$195.02 , N/A ,$201.60 ,$465.83 ,$280.00 ,$280.00 , N/A ,$280.00 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,36000112,19287,HC PERCUTAN DEV BREAST 1ST MR GUIDE,360,1 ,$340.00 ,$170.00 ,$170.00 ,"$1,361.67 ",$258.03 ,$340.00 ,$340.00 ,$605.19 ,$204.00 ,$289.00 ,$238.00 ,$258.03 ,$323.00 ,$244.80 ,$248.20 ,$340.00 ,$289.00 ,$605.19 ,$340.00 ,$289.00 ,$248.20 ,$258.03 ,$605.19 ,$340.00 ,$289.00 ,"$1,361.67 ",$312.80 ,$238.00 ,$340.00 ,$340.00 ,$207.06 ,$340.00 ,$234.94 ,$244.80 ,$236.81 ,$611.24 ,$244.80 ,$273.51 ,$340.00 ,$340.00 ,$605.19 ,$340.00 ,$605.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,36000113,19288,HC PERCUTAN DEV BREAST ADDN MR GUIDE,360,1 ,$105.00 ,$52.50 ,$52.50 ,"$2,259.84 ",$258.03 ,$105.00 ,$105.00 , N/A ,$63.00 ,$89.25 ,$73.50 ,$258.03 ,$99.75 ,$75.60 ,$76.65 ,$105.00 ,$89.25 , N/A ,$105.00 ,$89.25 ,$76.65 ,$258.03 , N/A ,$105.00 ,$89.25 , N/A ,$96.60 ,$73.50 ,"$1,680.96 ","$2,259.84 ",$63.95 ,"$2,101.20 ",$72.56 ,$75.60 ,$73.13 , N/A ,$75.60 ,$273.51 ,$105.00 ,$105.00 , N/A ,$105.00 , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$63.00 
ST MARY'S HOSPITAL,36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$150.00 ,$75.00 ,$75.00 ,"$2,259.84 ",$258.03 ,$150.00 ,$150.00 , N/A ,$90.00 ,$127.50 ,$105.00 ,$258.03 ,$142.50 ,$108.00 ,$109.50 ,$150.00 ,$127.50 , N/A ,$150.00 ,$127.50 ,$109.50 ,$258.03 , N/A ,$150.00 ,$127.50 , N/A ,$138.00 ,$105.00 ,"$1,680.96 ","$2,259.84 ",$91.35 ,"$2,101.20 ",$103.65 ,$108.00 ,$104.48 , N/A ,$108.00 ,$273.51 ,$150.00 ,$150.00 , N/A ,$150.00 , N/A ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$90.00 
ST MARY'S HOSPITAL,36000115,19284,HC BREAST STEREO NDL LOC BX ADDN LESION,360,1 ,$150.00 ,$75.00 ,$75.00 ,"$2,259.84 ",$258.03 ,$150.00 ,$150.00 , N/A ,$90.00 ,$127.50 ,$105.00 ,$258.03 ,$142.50 ,$108.00 ,$109.50 ,$150.00 ,$127.50 , N/A ,$150.00 ,$127.50 ,$109.50 ,$258.03 , N/A ,$150.00 ,$127.50 , N/A ,$138.00 ,$105.00 ,"$1,680.96 ","$2,259.84 ",$91.35 ,"$2,101.20 ",$103.65 ,$108.00 ,$104.48 , N/A ,$108.00 ,$273.51 ,$150.00 ,$150.00 , N/A ,$150.00 , N/A ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$90.00 
ST MARY'S HOSPITAL,36000116,19286,HC BREAST NDL LOC BX ULTRA  ADDN LESION,360,1 ,$130.00 ,$65.00 ,$65.00 ,"$2,259.84 ",$258.03 ,$130.00 ,$130.00 , N/A ,$78.00 ,$110.50 ,$91.00 ,$258.03 ,$123.50 ,$93.60 ,$94.90 ,$130.00 ,$110.50 , N/A ,$130.00 ,$110.50 ,$94.90 ,$258.03 , N/A ,$130.00 ,$110.50 , N/A ,$119.60 ,$91.00 ,"$1,680.96 ","$2,259.84 ",$79.17 ,"$2,101.20 ",$89.83 ,$93.60 ,$90.55 , N/A ,$93.60 ,$273.51 ,$130.00 ,$130.00 , N/A ,$130.00 , N/A ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,36000119,36471,HC INJ SCLEROSING SOLUTN MULT VEIN,360,1 ,$356.00 ,$178.00 ,$177.80 ,$756.32 ,$177.80 ,$356.00 ,$356.00 ,$336.14 ,$213.60 ,$302.60 ,$249.20 ,$177.80 ,$338.20 ,$256.32 ,$259.88 ,$356.00 ,$302.60 ,$336.14 ,$356.00 ,$302.60 ,$259.88 ,$177.80 ,$336.14 ,$356.00 ,$302.60 ,$756.32 ,$327.52 ,$249.20 ,$356.00 ,$356.00 ,$216.80 ,$356.00 ,$246.00 ,$256.32 ,$247.95 ,$339.50 ,$256.32 ,$188.47 ,$356.00 ,$356.00 ,$336.14 ,$356.00 ,$336.14 ,$256.32 ,$220.72 ,$256.32 ,$256.32 ,$213.60 
ST MARY'S HOSPITAL,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 ","$1,407.60 ","$1,427.15 ","$1,955.00 ","$1,661.75 ", N/A ,"$1,955.00 ","$1,661.75 ","$1,427.15 ",$199.61 , N/A ,"$1,955.00 ","$1,661.75 ", N/A ,"$1,798.60 ","$1,368.50 ","$1,489.75 ","$1,955.00 ","$1,190.60 ","$1,862.71 ","$1,350.91 ","$1,407.60 ","$1,361.66 ", N/A ,"$1,407.60 ",$211.59 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$1,407.60 ","$1,212.10 ","$1,407.60 ","$1,407.60 ","$1,173.00 "
ST MARY'S HOSPITAL,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 ,$720.00 ,$730.00 ,"$1,000.00 ",$850.00 , N/A ,"$1,000.00 ",$850.00 ,$730.00 ,$199.61 , 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 ,$720.00 ,$696.50 , N/A ,$720.00 ,$211.59 ,"$1,000.00 ","$1,000.00 ", N/A ,"$1,000.00 ", N/A ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,36000122,36555,HC INS CATH CV NON-TUNL <5 YRS,360,1 ,"$3,124.00 ","$1,562.00 ",$353.23 ,"$6,263.99 ",$353.23 ,"$3,124.00 ","$3,124.00 ","$2,784.00 ","$1,874.40 ","$2,655.40 ","$2,186.80 ",$353.23 ,"$2,967.80 ","$2,249.28 ","$2,280.52 ","$2,815.00 ","$2,655.40 ","$2,784.00 ","$2,815.00 ","$2,655.40 ","$2,280.52 ",$353.23 ,"$2,784.00 ","$2,489.10 ","$2,655.40 ","$6,263.99 ","$2,874.08 ","$2,186.80 ","$1,489.75 ","$2,002.44 ","$1,902.52 ","$1,862.71 ","$2,158.68 ","$2,249.28 ","$2,175.87 ","$2,811.84 ","$2,249.28 ",$374.42 ,"$2,687.00 ","$2,687.00 ","$2,784.00 ","$2,687.00 ","$2,784.00 ","$2,249.28 ","$1,936.88 ","$2,249.28 ","$2,249.28 ","$1,874.40 "
ST MARY'S HOSPITAL,36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$2,693.00 ","$1,346.50 ",$353.23 ,"$6,263.99 ",$353.23 ,"$2,693.00 ","$2,693.00 ","$2,784.00 ","$1,615.80 ","$2,289.05 ","$1,885.10 ",$353.23 ,"$2,558.35 ","$1,938.96 ","$1,965.89 ","$2,693.00 ","$2,289.05 ","$2,784.00 ","$2,693.00 ","$2,289.05 ","$1,965.89 ",$353.23 ,"$2,784.00 ","$2,489.10 ","$2,289.05 ","$6,263.99 ","$2,477.56 ","$1,885.10 ","$1,489.75 ","$2,002.44 ","$1,640.04 ","$1,862.71 ","$1,860.86 ","$1,938.96 ","$1,875.67 ","$2,811.84 ","$1,938.96 ",$374.42 ,"$2,687.00 ","$2,687.00 ","$2,784.00 ","$2,687.00 ","$2,784.00 ","$1,938.96 ","$1,669.66 ","$1,938.96 ","$1,938.96 ","$1,615.80 "
ST MARY'S HOSPITAL,36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$4,632.00 ","$2,316.00 ",$689.93 ,"$6,263.99 ",$689.93 ,"$4,632.00 ","$4,632.00 ","$2,784.00 ","$2,779.20 ","$3,937.20 ","$3,242.40 ",$689.93 ,"$4,400.40 ","$3,335.04 ","$3,381.36 ","$4,620.00 ","$3,937.20 ","$2,784.00 ","$4,620.00 ","$3,937.20 ","$3,381.36 ",$689.93 ,"$2,784.00 ","$4,632.00 ","$3,937.20 ","$6,263.99 ","$4,261.44 ","$3,242.40 ","$1,680.96 ","$2,259.84 ","$2,820.89 ","$2,101.20 ","$3,200.71 ","$3,335.04 ","$3,226.19 ","$2,811.84 ","$3,335.04 ",$731.33 ,"$4,632.00 ","$4,632.00 ","$2,784.00 ","$4,632.00 ","$2,784.00 ","$3,335.04 ","$2,871.84 ","$3,335.04 ","$3,335.04 ","$2,779.20 "
ST MARY'S HOSPITAL,36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$5,925.00 ","$2,962.50 ",$689.93 ,"$6,263.99 ",$689.93 ,"$5,925.00 ","$5,925.00 ","$2,784.00 ","$3,555.00 ","$5,036.25 ","$4,147.50 ",$689.93 ,"$5,628.75 ","$4,266.00 ","$4,325.25 ","$5,925.00 ","$5,036.25 ","$2,784.00 ","$5,925.00 ","$5,036.25 ","$4,325.25 ",$689.93 ,"$2,784.00 ","$5,657.04 ","$5,036.25 ","$6,263.99 ","$5,451.00 ","$4,147.50 ","$3,303.09 ","$4,439.84 ","$3,608.33 ","$4,128.86 ","$4,094.18 ","$4,266.00 ","$4,126.76 ","$2,811.84 ","$4,266.00 ",$731.33 ,"$5,925.00 ","$5,925.00 ","$2,784.00 ","$5,925.00 ","$2,784.00 ","$4,266.00 ","$3,673.50 ","$4,266.00 ","$4,266.00 ","$3,555.00 "
ST MARY'S HOSPITAL,36000131,36568,HC INS CATH PERIPH CV W/O PORT <5,360,1 ,"$1,293.00 ",$646.50 ,$353.23 ,"$3,077.03 ",$353.23 ,"$1,293.00 ","$1,293.00 ","$1,367.57 ",$775.80 ,"$1,099.05 ",$905.10 ,$353.23 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ","$1,367.57 ","$1,293.00 ","$1,099.05 ",$943.89 ,$353.23 ,"$1,367.57 ","$1,293.00 ","$1,099.05 ","$3,077.03 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,"$1,381.25 ",$930.96 ,$374.42 ,"$1,293.00 ","$1,293.00 ","$1,367.57 ","$1,293.00 ","$1,367.57 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$1,616.00 ",$808.00 ,$353.23 ,"$3,077.03 ",$353.23 ,"$1,616.00 ","$1,616.00 ","$1,367.57 ",$969.60 ,"$1,373.60 ","$1,131.20 ",$353.23 ,"$1,535.20 ","$1,163.52 ","$1,179.68 ","$1,616.00 ","$1,373.60 ","$1,367.57 ","$1,616.00 ","$1,373.60 ","$1,179.68 ",$353.23 ,"$1,367.57 ","$1,616.00 ","$1,373.60 ","$3,077.03 ","$1,486.72 ","$1,131.20 ","$1,489.75 ","$1,616.00 ",$984.14 ,"$1,616.00 ","$1,116.66 ","$1,163.52 ","$1,125.54 ","$1,381.25 ","$1,163.52 ",$374.42 ,"$1,616.00 ","$1,616.00 ","$1,367.57 ","$1,616.00 ","$1,367.57 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ",$969.60 
ST MARY'S HOSPITAL,36000134,36578,HC REPLACE CATH CV W/PORT/PUMP,360,1 ,"$2,973.00 ","$1,486.50 ",$229.60 ,"$6,263.99 ",$229.60 ,"$2,973.00 ","$2,973.00 ","$2,784.00 ","$1,783.80 ","$2,527.05 ","$2,081.10 ",$229.60 ,"$2,824.35 ","$2,140.56 ","$2,170.29 ","$2,973.00 ","$2,527.05 ","$2,784.00 ","$2,973.00 ","$2,527.05 ","$2,170.29 ",$229.60 ,"$2,784.00 ","$2,973.00 ","$2,527.05 ","$6,263.99 ","$2,735.16 ","$2,081.10 ","$1,680.96 ","$2,259.84 ","$1,810.56 ","$2,101.20 ","$2,054.34 ","$2,140.56 ","$2,070.69 ","$2,811.84 ","$2,140.56 ",$243.38 ,"$2,973.00 ","$2,973.00 ","$2,784.00 ","$2,973.00 ","$2,784.00 ","$2,140.56 ","$1,843.26 ","$2,140.56 ","$2,140.56 ","$1,783.80 "
ST MARY'S HOSPITAL,36000135,36580,HC REPL CATH CV NON-TNL W/O PORT,360,1 ,"$2,586.00 ","$1,293.00 ",$353.23 ,"$3,077.03 ",$353.23 ,"$2,586.00 ","$2,586.00 ","$1,367.57 ","$1,551.60 ","$2,198.10 ","$1,810.20 ",$353.23 ,"$2,456.70 ","$1,861.92 ","$1,887.78 ","$2,586.00 ","$2,198.10 ","$1,367.57 ","$2,586.00 ","$2,198.10 ","$1,887.78 ",$353.23 ,"$1,367.57 ","$2,489.10 ","$2,198.10 ","$3,077.03 ","$2,379.12 ","$1,810.20 ","$1,489.75 ","$2,002.44 ","$1,574.87 ","$1,862.71 ","$1,786.93 ","$1,861.92 ","$1,801.15 ","$1,381.25 ","$1,861.92 ",$374.42 ,"$2,586.00 ","$2,586.00 ","$1,367.57 ","$2,586.00 ","$1,367.57 ","$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$1,551.60 "
ST MARY'S HOSPITAL,36000136,36581,HC REPL CATH CV TNL W/O PORT,360,1 ,"$3,986.00 ","$1,993.00 ",$689.93 ,"$6,263.99 ",$689.93 ,"$3,986.00 ","$3,986.00 ","$2,784.00 ","$2,391.60 ","$3,388.10 ","$2,790.20 ",$689.93 ,"$3,786.70 ","$2,869.92 ","$2,909.78 ","$3,986.00 ","$3,388.10 ","$2,784.00 ","$3,986.00 ","$3,388.10 ","$2,909.78 ",$689.93 ,"$2,784.00 ","$3,986.00 ","$3,388.10 ","$6,263.99 ","$3,667.12 ","$2,790.20 ","$1,680.96 ","$2,259.84 ","$2,427.47 ","$2,101.20 ","$2,754.33 ","$2,869.92 ","$2,776.25 ","$2,811.84 ","$2,869.92 ",$731.33 ,"$3,986.00 ","$3,986.00 ","$2,784.00 ","$3,986.00 ","$2,784.00 ","$2,869.92 ","$2,471.32 ","$2,869.92 ","$2,869.92 ","$2,391.60 "
ST MARY'S HOSPITAL,36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$6,033.00 ","$3,016.50 ",$689.93 ,"$6,263.99 ",$689.93 ,"$6,033.00 ","$6,033.00 ","$2,784.00 ","$3,619.80 ","$5,128.05 ","$4,223.10 ",$689.93 ,"$5,731.35 ","$4,343.76 ","$4,404.09 ","$6,033.00 ","$5,128.05 ","$2,784.00 ","$6,033.00 ","$5,128.05 ","$4,404.09 ",$689.93 ,"$2,784.00 ","$5,657.04 ","$5,128.05 ","$6,263.99 ","$5,550.36 ","$4,223.10 ","$3,303.09 ","$4,439.84 ","$3,674.10 ","$4,128.86 ","$4,168.80 ","$4,343.76 ","$4,201.98 ","$2,811.84 ","$4,343.76 ",$731.33 ,"$6,033.00 ","$6,033.00 ","$2,784.00 ","$6,033.00 ","$2,784.00 ","$4,343.76 ","$3,740.46 ","$4,343.76 ","$4,343.76 ","$3,619.80 "
ST MARY'S HOSPITAL,36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$2,370.00 ","$1,185.00 ",$353.23 ,"$3,077.03 ",$353.23 ,"$2,370.00 ","$2,370.00 ","$1,367.57 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$353.23 ,"$2,251.50 ","$1,706.40 ","$1,730.10 ","$2,370.00 ","$2,014.50 ","$1,367.57 ","$2,370.00 ","$2,014.50 ","$1,730.10 ",$353.23 ,"$1,367.57 ","$2,370.00 ","$2,014.50 ","$3,077.03 ","$2,180.40 ","$1,659.00 ","$1,489.75 ","$2,002.44 ","$1,443.33 ","$1,862.71 ","$1,637.67 ","$1,706.40 ","$1,650.71 ","$1,381.25 ","$1,706.40 ",$374.42 ,"$2,370.00 ","$2,370.00 ","$1,367.57 ","$2,370.00 ","$1,367.57 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,422.00 "
ST MARY'S HOSPITAL,36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$1,077.00 ",$538.50 ,$229.60 ,"$1,182.77 ",$229.60 ,"$1,077.00 ","$1,077.00 ",$525.67 ,$646.20 ,$915.45 ,$753.90 ,$229.60 ,"$1,023.15 ",$775.44 ,$786.21 ,"$1,077.00 ",$915.45 ,$525.67 ,"$1,077.00 ",$915.45 ,$786.21 ,$229.60 ,$525.67 ,"$1,077.00 ",$915.45 ,"$1,182.77 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$775.44 ,$750.13 ,$530.93 ,$775.44 ,$243.38 ,"$1,077.00 ","$1,077.00 ",$525.67 ,"$1,077.00 ",$525.67 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$646.20 
ST MARY'S HOSPITAL,36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$2,370.00 ","$1,185.00 ",$229.60 ,"$3,077.03 ",$229.60 ,"$2,370.00 ","$2,081.00 ","$1,367.57 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$229.60 ,"$2,251.50 ","$1,706.40 ","$1,730.10 ","$2,370.00 ","$2,014.50 ","$1,367.57 ","$2,370.00 ","$2,014.50 ","$1,730.10 ",$229.60 ,"$1,367.57 ","$2,370.00 ","$2,014.50 ","$3,077.03 ","$2,180.40 ","$1,659.00 ","$1,489.75 ","$2,002.44 ","$1,443.33 ","$1,862.71 ","$1,637.67 ","$1,706.40 ","$1,650.71 ","$1,381.25 ","$1,706.40 ",$243.38 ,"$2,370.00 ","$2,370.00 ","$1,367.57 ","$2,370.00 ","$1,367.57 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,422.00 "
ST MARY'S HOSPITAL,36000144,36595,HC REM PERICATHETER MAT CV DEV,360,1 ,"$3,986.00 ","$1,993.00 ",$229.60 ,"$6,263.99 ",$229.60 ,"$3,986.00 ","$3,986.00 ","$2,784.00 ","$2,391.60 ","$3,388.10 ","$2,790.20 ",$229.60 ,"$3,786.70 ","$2,869.92 ","$2,909.78 ","$3,986.00 ","$3,388.10 ","$2,784.00 ","$3,986.00 ","$3,388.10 ","$2,909.78 ",$229.60 ,"$2,784.00 ","$3,986.00 ","$3,388.10 ","$6,263.99 ","$3,667.12 ","$2,790.20 ","$1,489.75 ","$2,002.44 ","$2,427.47 ","$1,862.71 ","$2,754.33 ","$2,869.92 ","$2,776.25 ","$2,811.84 ","$2,869.92 ",$243.38 ,"$3,986.00 ","$3,986.00 ","$2,784.00 ","$3,986.00 ","$2,784.00 ","$2,869.92 ","$2,471.32 ","$2,869.92 ","$2,869.92 ","$2,391.60 "
ST MARY'S HOSPITAL,36000145,36596,HC REM INTRALUM MAT CV LUMEN,360,1 ,"$1,783.00 ",$891.50 ,$229.60 ,"$3,077.03 ",$229.60 ,"$1,783.00 ","$1,783.00 ","$1,367.57 ","$1,069.80 ","$1,515.55 ","$1,248.10 ",$229.60 ,"$1,693.85 ","$1,283.76 ","$1,301.59 ","$1,783.00 ","$1,515.55 ","$1,367.57 ","$1,783.00 ","$1,515.55 ","$1,301.59 ",$229.60 ,"$1,367.57 ","$1,783.00 ","$1,515.55 ","$3,077.03 ","$1,640.36 ","$1,248.10 ","$1,489.75 ","$1,783.00 ","$1,085.85 ","$1,783.00 ","$1,232.05 ","$1,283.76 ","$1,241.86 ","$1,381.25 ","$1,283.76 ",$243.38 ,"$1,783.00 ","$1,783.00 ","$1,367.57 ","$1,783.00 ","$1,367.57 ","$1,283.76 ","$1,105.46 ","$1,283.76 ","$1,283.76 ","$1,069.80 "
ST MARY'S HOSPITAL,36000146,36597,HC REPOSITION CENTRAL VENOUS CATH,360,1 ,"$2,047.00 ","$1,023.50 ",$229.60 ,"$3,077.03 ",$229.60 ,"$2,047.00 ","$2,047.00 ","$1,367.57 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$229.60 ,"$1,944.65 ","$1,473.84 ","$1,494.31 ","$2,047.00 ","$1,739.95 ","$1,367.57 ","$2,047.00 ","$1,739.95 ","$1,494.31 ",$229.60 ,"$1,367.57 ","$2,047.00 ","$1,739.95 ","$3,077.03 ","$1,883.24 ","$1,432.90 ","$1,489.75 ","$2,002.44 ","$1,246.62 ","$1,862.71 ","$1,414.48 ","$1,473.84 ","$1,425.74 ","$1,381.25 ","$1,473.84 ",$243.38 ,"$2,047.00 ","$2,047.00 ","$1,367.57 ","$2,047.00 ","$1,367.57 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,228.20 "
ST MARY'S HOSPITAL,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 ,$501.12 ,$508.08 ,$696.00 ,$591.60 , N/A ,$696.00 ,$591.60 ,$508.08 ,$199.61 , N/A ,$696.00 ,$591.60 , N/A ,$640.32 ,$487.20 ,$353.01 ,$423.66 ,$423.86 ,$395.40 ,$480.94 ,$501.12 ,$484.76 , N/A ,$501.12 ,$211.59 ,$696.00 ,$696.00 , N/A ,$696.00 , N/A ,$501.12 ,$431.52 ,$501.12 ,$501.12 ,$417.60 
ST MARY'S HOSPITAL,36000154,37182,HC TIPS,360,1 ,"$12,928.00 ","$6,464.00 ","$1,680.96 ","$12,928.00 ","$3,445.58 ","$9,884.00 ","$7,413.00 ", N/A ,"$7,756.80 ","$10,988.80 ","$9,049.60 ","$3,445.58 ","$12,281.60 ","$9,308.16 ","$9,437.44 ","$6,993.00 ","$10,988.80 ", N/A ,"$6,993.00 ","$10,988.80 ","$9,437.44 ","$3,445.58 ", N/A ,"$12,928.00 ","$10,988.80 ", N/A ,"$11,893.76 ","$9,049.60 ","$1,680.96 ","$2,259.84 ","$7,873.15 ","$2,101.20 ","$8,933.25 ","$9,308.16 ","$9,004.35 ", N/A ,"$9,308.16 ","$3,652.31 ","$10,114.00 ","$10,114.00 ", N/A ,"$10,114.00 ", N/A ,"$9,308.16 ","$8,015.36 ","$9,308.16 ","$9,308.16 ","$7,756.80 "
ST MARY'S HOSPITAL,36000156,37183,HC TIPS REVISION,360,1 ,"$11,851.00 ","$5,925.50 ","$1,680.96 ","$11,851.00 ","$1,851.24 ","$11,851.00 ","$9,884.00 ","$4,820.13 ","$7,110.60 ","$10,073.35 ","$8,295.70 ","$1,851.24 ","$11,258.45 ","$8,532.72 ","$8,651.23 ","$6,993.00 ","$10,073.35 ","$4,820.13 ","$6,993.00 ","$10,073.35 ","$8,651.23 ","$1,851.24 ","$4,820.13 ","$7,919.86 ","$10,073.35 ","$10,845.30 ","$10,902.92 ","$8,295.70 ","$1,680.96 ","$2,259.84 ","$7,217.26 ","$2,101.20 ","$8,189.04 ","$8,532.72 ","$8,254.22 ","$4,868.33 ","$8,532.72 ","$1,962.31 ","$10,114.00 ","$10,114.00 ","$4,820.13 ","$10,114.00 ","$4,820.13 ","$8,532.72 ","$7,347.62 ","$8,532.72 ","$8,532.72 ","$7,110.60 "
ST MARY'S HOSPITAL,36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$1,077.00 ",$538.50 ,$373.15 ,"$3,078.81 ",$373.15 ,"$1,077.00 ","$1,077.00 ","$1,368.36 ",$646.20 ,$915.45 ,$753.90 ,$373.15 ,"$1,023.15 ",$775.44 ,$786.21 ,"$1,077.00 ",$915.45 ,"$1,368.36 ","$1,077.00 ",$915.45 ,$786.21 ,$373.15 ,"$1,368.36 ","$1,077.00 ",$915.45 ,"$3,078.81 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$775.44 ,$750.13 ,"$1,382.04 ",$775.44 ,$395.54 ,"$1,077.00 ","$1,077.00 ","$1,368.36 ","$1,077.00 ","$1,368.36 ",$775.44 ,$667.74 ,$775.44 ,$775.44 ,$646.20 
ST MARY'S HOSPITAL,36000158,38221,HC BX BONE MARROW ONLY,360,1 ,$776.00 ,$388.00 ,$373.15 ,"$3,078.81 ",$373.15 ,$776.00 ,$776.00 ,"$1,368.36 ",$465.60 ,$659.60 ,$543.20 ,$373.15 ,$737.20 ,$558.72 ,$566.48 ,$776.00 ,$659.60 ,"$1,368.36 ",$776.00 ,$659.60 ,$566.48 ,$373.15 ,"$1,368.36 ",$776.00 ,$659.60 ,"$3,078.81 ",$713.92 ,$543.20 ,$776.00 ,$776.00 ,$472.58 ,$776.00 ,$536.22 ,$558.72 ,$540.48 ,"$1,382.04 ",$558.72 ,$395.54 ,$776.00 ,$776.00 ,"$1,368.36 ",$776.00 ,"$1,368.36 ",$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$1,939.00 ",$969.50 ,$360.88 ,"$3,078.81 ",$360.88 ,"$1,939.00 ","$1,939.00 ","$1,368.36 ","$1,163.40 ","$1,648.15 ","$1,357.30 ",$360.88 ,"$1,842.05 ","$1,396.08 ","$1,415.47 ","$1,939.00 ","$1,648.15 ","$1,368.36 ","$1,939.00 ","$1,648.15 ","$1,415.47 ",$360.88 ,"$1,368.36 ","$1,939.00 ","$1,648.15 ","$3,078.81 ","$1,783.88 ","$1,357.30 ","$1,489.75 ","$1,939.00 ","$1,180.85 ","$1,862.71 ","$1,339.85 ","$1,396.08 ","$1,350.51 ","$1,382.04 ","$1,396.08 ",$382.53 ,"$1,939.00 ","$1,939.00 ","$1,368.36 ","$1,939.00 ","$1,368.36 ","$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,163.40 "
ST MARY'S HOSPITAL,36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,$851.00 ,$425.50 ,$120.53 ,$851.00 ,$120.53 ,$851.00 ,$851.00 ,$366.60 ,$510.60 ,$723.35 ,$595.70 ,$120.53 ,$808.45 ,$612.72 ,$621.23 ,$851.00 ,$723.35 ,$366.60 ,$851.00 ,$723.35 ,$621.23 ,$120.53 ,$366.60 ,$851.00 ,$723.35 ,$824.86 ,$782.92 ,$595.70 ,$851.00 ,$851.00 ,$518.26 ,$851.00 ,$588.04 ,$612.72 ,$592.72 ,$370.27 ,$612.72 ,$127.76 ,$851.00 ,$851.00 ,$366.60 ,$851.00 ,$366.60 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$510.60 
ST MARY'S HOSPITAL,36000163,43246,HC PLACE G-TUBE PERC,360,1 ,"$2,205.00 ","$1,102.50 ",$300.43 ,"$3,554.07 ",$300.43 ,"$2,205.00 ","$2,205.00 ","$1,579.59 ","$1,323.00 ","$1,874.25 ","$1,543.50 ",$300.43 ,"$2,094.75 ","$1,587.60 ","$1,609.65 ","$2,205.00 ","$1,874.25 ","$1,579.59 ","$2,205.00 ","$1,874.25 ","$1,609.65 ",$300.43 ,"$1,579.59 ","$2,205.00 ","$1,874.25 ","$3,554.07 ","$2,028.60 ","$1,543.50 ","$1,680.96 ","$2,205.00 ","$1,342.85 ","$2,101.20 ","$1,523.66 ","$1,587.60 ","$1,535.78 ","$1,595.39 ","$1,587.60 ",$318.46 ,"$2,205.00 ","$2,205.00 ","$1,579.59 ","$2,205.00 ","$1,579.59 ","$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,36000167,44640,HC TISSUE CLOSURE INTESTNL FISTULA,360,1 ,$220.00 ,$110.00 ,$110.00 ,"$8,056.00 ","$1,584.98 ",$220.00 ,$220.00 , N/A ,$132.00 ,$187.00 ,$154.00 ,"$1,584.98 ",$209.00 ,$158.40 ,$160.60 ,$220.00 ,$187.00 , N/A ,$220.00 ,$187.00 ,$160.60 ,"$1,584.98 ", N/A ,$220.00 ,$187.00 , N/A ,$202.40 ,$154.00 ,"$5,993.67 ","$8,056.00 ",$133.98 ,"$7,491.83 ",$152.02 ,$158.40 ,$153.23 , N/A ,$158.40 ,"$1,680.08 ",$220.00 ,$220.00 , N/A ,$220.00 , N/A ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,36000168,44799,"HC UNLISTED PROC, INTESTINE",360,1 ,$500.00 ,$250.00 ,$250.00 ,"$1,770.57 ",$627.59 ,$500.00 ,$500.00 ,$786.92 ,$300.00 ,$425.00 ,$350.00 ,$627.59 ,$475.00 ,$360.00 ,$365.00 ,$500.00 ,$425.00 ,$786.92 ,$500.00 ,$425.00 ,$365.00 ,$627.59 ,$786.92 ,$500.00 ,$425.00 ,"$1,770.57 ",$460.00 ,$350.00 , N/A , N/A ,$304.50 , N/A ,$345.50 ,$360.00 ,$348.25 ,$794.79 ,$360.00 ,$665.25 ,$500.00 ,$500.00 ,$786.92 ,$500.00 ,$786.92 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$300.00 
ST MARY'S HOSPITAL,36000171,47490,HC CHOLECYSTOSTOMY PERC,360,1 ,"$3,400.00 ","$1,700.00 ",$791.20 ,"$8,056.00 ",$791.20 ,"$3,400.00 ","$3,400.00 ","$3,094.16 ","$2,040.00 ","$2,890.00 ","$2,380.00 ",$791.20 ,"$3,230.00 ","$2,448.00 ","$2,482.00 ","$2,815.00 ","$2,890.00 ","$3,094.16 ","$2,815.00 ","$2,890.00 ","$2,482.00 ",$791.20 ,"$3,094.16 ","$3,400.00 ","$2,890.00 ","$6,961.86 ","$3,128.00 ","$2,380.00 ","$5,993.67 ","$8,056.00 ","$2,070.60 ","$7,491.83 ","$2,349.40 ","$2,448.00 ","$2,368.10 ","$3,125.10 ","$2,448.00 ",$838.67 ,"$3,400.00 ","$3,400.00 ","$3,094.16 ","$3,400.00 ","$3,094.16 ","$2,448.00 ","$2,108.00 ","$2,448.00 ","$2,448.00 ","$2,040.00 "
ST MARY'S HOSPITAL,36000175,49220,HC STAGING CELIOTOMY,360,1 ,$555.00 ,$277.50 ,$277.50 ,"$8,056.00 ", N/A , N/A , N/A , N/A ,$333.00 ,$471.75 ,$388.50 , N/A ,$527.25 ,$399.60 ,$405.15 ,$555.00 ,$471.75 , N/A ,$555.00 ,$471.75 ,$405.15 , N/A , N/A ,$555.00 ,$471.75 , N/A ,$510.60 ,$388.50 ,"$5,993.67 ","$8,056.00 ",$338.00 ,"$7,491.83 ",$383.51 ,$399.60 ,$386.56 , N/A ,$399.60 , N/A , N/A , N/A , N/A , N/A , N/A ,$399.60 ,$344.10 ,$399.60 ,$399.60 ,$333.00 
ST MARY'S HOSPITAL,36000176,49418,HC INSERT INTRAPERITONEAL CATH,360,1 ,"$6,572.00 ","$3,286.00 ","$1,169.72 ","$6,961.86 ","$1,169.72 ","$6,572.00 ","$6,572.00 ","$3,094.16 ","$3,943.20 ","$5,586.20 ","$4,600.40 ","$1,169.72 ","$6,243.40 ","$4,731.84 ","$4,797.56 ","$6,572.00 ","$5,586.20 ","$3,094.16 ","$6,572.00 ","$5,586.20 ","$4,797.56 ","$1,169.72 ","$3,094.16 ","$5,657.04 ","$5,586.20 ","$6,961.86 ","$6,046.24 ","$4,600.40 ","$1,489.75 ","$2,002.44 ","$4,002.35 ","$1,862.71 ","$4,541.25 ","$4,731.84 ","$4,577.40 ","$3,125.10 ","$4,731.84 ","$1,239.90 ","$6,572.00 ","$6,572.00 ","$3,094.16 ","$6,572.00 ","$3,094.16 ","$4,731.84 ","$4,074.64 ","$4,731.84 ","$4,731.84 ","$3,943.20 "
ST MARY'S HOSPITAL,36000177,49421,HC INS CATH DRAIN PERITONEAL PERM,360,1 ,"$4,655.00 ","$2,327.50 ","$1,169.72 ","$6,961.86 ","$1,169.72 ","$4,655.00 ","$4,655.00 ","$3,094.16 ","$2,793.00 ","$3,956.75 ","$3,258.50 ","$1,169.72 ","$4,422.25 ","$3,351.60 ","$3,398.15 ","$2,815.00 ","$3,956.75 ","$3,094.16 ","$2,815.00 ","$3,956.75 ","$3,398.15 ","$1,169.72 ","$3,094.16 ","$4,655.00 ","$3,956.75 ","$6,961.86 ","$4,282.60 ","$3,258.50 ","$1,489.75 ","$2,002.44 ","$2,834.90 ","$1,862.71 ","$3,216.61 ","$3,351.60 ","$3,242.21 ","$3,125.10 ","$3,351.60 ","$1,239.90 ","$4,655.00 ","$4,655.00 ","$3,094.16 ","$4,655.00 ","$3,094.16 ","$3,351.60 ","$2,886.10 ","$3,351.60 ","$3,351.60 ","$2,793.00 "
ST MARY'S HOSPITAL,36000178,49422,HC REM CATH INTRAPERITONEAL,360,1 ,"$4,740.00 ","$2,370.00 ",$232.13 ,"$6,263.99 ",$232.13 ,"$4,740.00 ","$4,740.00 ","$2,784.00 ","$2,844.00 ","$4,029.00 ","$3,318.00 ",$232.13 ,"$4,503.00 ","$3,412.80 ","$3,460.20 ","$2,815.00 ","$4,029.00 ","$2,784.00 ","$2,815.00 ","$4,029.00 ","$3,460.20 ",$232.13 ,"$2,784.00 ","$4,525.63 ","$4,029.00 ","$6,263.99 ","$4,360.80 ","$3,318.00 ","$1,489.75 ","$2,002.44 ","$2,886.66 ","$1,862.71 ","$3,275.34 ","$3,412.80 ","$3,301.41 ","$2,811.84 ","$3,412.80 ",$246.06 ,"$4,740.00 ","$4,740.00 ","$2,784.00 ","$4,740.00 ","$2,784.00 ","$3,412.80 ","$2,938.80 ","$3,412.80 ","$3,412.80 ","$2,844.00 "
ST MARY'S HOSPITAL,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 ",$559.50 ,"$1,163.40 ","$1,648.15 ","$1,357.30 ",$62.73 ,"$1,842.05 ","$1,396.08 ","$1,415.47 ","$1,939.00 ","$1,648.15 ",$559.50 ,"$1,939.00 ","$1,648.15 ","$1,415.47 ",$62.73 ,$559.50 ,"$1,697.11 ","$1,648.15 ","$1,258.87 ","$1,783.88 ","$1,357.30 ","$1,489.75 ","$1,939.00 ","$1,180.85 ","$1,862.71 ","$1,339.85 ","$1,396.08 ","$1,350.51 ",$565.10 ,"$1,396.08 ",$66.49 ,"$1,939.00 ","$1,939.00 ",$559.50 ,"$1,939.00 ",$559.50 ,"$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,163.40 "
ST MARY'S HOSPITAL,36000184,51784,HC EMG BOWEL/BLADDER SPHINCTER,360,1 ,$237.00 ,$118.50 ,$42.84 ,$305.50 ,$42.84 ,$237.00 ,$237.00 ,$135.78 ,$142.20 ,$201.45 ,$165.90 ,$42.84 ,$225.15 ,$170.64 ,$173.01 ,$237.00 ,$201.45 ,$135.78 ,$237.00 ,$201.45 ,$173.01 ,$42.84 ,$135.78 ,$237.00 ,$201.45 ,$305.50 ,$218.04 ,$165.90 ,$237.00 ,$237.00 ,$144.33 ,$237.00 ,$163.77 ,$170.64 ,$165.07 ,$137.14 ,$170.64 ,$45.41 ,$237.00 ,$237.00 ,$135.78 ,$237.00 ,$135.78 ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$142.20 
ST MARY'S HOSPITAL,36000186,53899,HC URINARY SYSTEM UNLSTD PROC,360,1 ,"$1,170.00 ",$585.00 ,$258.79 ,"$1,170.00 ",$474.08 ,"$1,170.00 ","$1,170.00 ",$258.79 ,$702.00 ,$994.50 ,$819.00 ,$474.08 ,"$1,111.50 ",$842.40 ,$854.10 ,"$1,170.00 ",$994.50 ,$258.79 ,"$1,170.00 ",$994.50 ,$854.10 ,$474.08 ,$258.79 ,"$1,170.00 ",$994.50 ,$582.28 ,"$1,076.40 ",$819.00 , N/A , N/A ,$712.53 , N/A ,$808.47 ,$842.40 ,$814.91 ,$261.38 ,$842.40 ,$502.52 ,"$1,170.00 ","$1,170.00 ",$258.79 ,"$1,170.00 ",$258.79 ,$842.40 ,$725.40 ,$842.40 ,$842.40 ,$702.00 
ST MARY'S HOSPITAL,36000187,54150,HC CIRCUMCISION OP,360,1 ,"$1,293.00 ",$646.50 ,$616.68 ,"$3,917.96 ",$616.68 ,"$1,293.00 ","$1,293.00 ","$1,741.31 ",$775.80 ,"$1,099.05 ",$905.10 ,$616.68 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ","$1,741.31 ","$1,293.00 ","$1,099.05 ",$943.89 ,$616.68 ,"$1,741.31 ","$1,293.00 ","$1,099.05 ","$3,917.96 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,"$1,758.72 ",$930.96 ,$653.68 ,"$1,293.00 ","$1,293.00 ","$1,741.31 ","$1,293.00 ","$1,741.31 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36000188,55700,HC BX PROSTATE NEEDLE/PUNCH,360,1 ,"$2,478.00 ","$1,239.00 ",$478.93 ,"$3,917.96 ",$478.93 ,"$2,478.00 ","$2,478.00 ","$1,741.31 ","$1,486.80 ","$2,106.30 ","$1,734.60 ",$478.93 ,"$2,354.10 ","$1,784.16 ","$1,808.94 ","$2,478.00 ","$2,106.30 ","$1,741.31 ","$2,478.00 ","$2,106.30 ","$1,808.94 ",$478.93 ,"$1,741.31 ","$2,478.00 ","$2,106.30 ","$3,917.96 ","$2,279.76 ","$1,734.60 ","$1,680.96 ","$2,259.84 ","$1,509.10 ","$2,101.20 ","$1,712.30 ","$1,784.16 ","$1,725.93 ","$1,758.72 ","$1,784.16 ",$507.67 ,"$2,478.00 ","$2,478.00 ","$1,741.31 ","$2,478.00 ","$1,741.31 ","$1,784.16 ","$1,536.36 ","$1,784.16 ","$1,784.16 ","$1,486.80 "
ST MARY'S HOSPITAL,36000189,58100,HC BIOPSY OF UTERUS PERCUTANEOUS,360,1 ,$549.00 ,$274.50 ,$143.77 ,$549.00 ,$143.77 ,$549.00 ,$549.00 ,$165.68 ,$329.40 ,$466.65 ,$384.30 ,$143.77 ,$521.55 ,$395.28 ,$400.77 ,$549.00 ,$466.65 ,$165.68 ,$549.00 ,$466.65 ,$400.77 ,$143.77 ,$165.68 ,$549.00 ,$466.65 ,$372.78 ,$505.08 ,$384.30 ,$549.00 ,$549.00 ,$334.34 ,$549.00 ,$379.36 ,$395.28 ,$382.38 ,$167.34 ,$395.28 ,$152.40 ,$549.00 ,$549.00 ,$165.68 ,$549.00 ,$165.68 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$329.40 
ST MARY'S HOSPITAL,36000190,61624,HC OCC/EMB TRANSCATH CNS PERC,360,1 ,"$5,200.00 ","$2,600.00 ","$2,600.00 ","$8,056.00 ","$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 ","$3,744.00 ","$3,796.00 ","$2,815.00 ","$4,420.00 ", N/A ,"$2,815.00 ","$4,420.00 ","$3,796.00 ","$3,529.80 ", N/A ,"$5,200.00 ","$4,420.00 ", N/A ,"$4,784.00 ","$3,640.00 ","$5,993.67 ","$8,056.00 ","$3,166.80 ","$7,491.83 ","$3,593.20 ","$3,744.00 ","$3,621.80 ", N/A ,"$3,744.00 ","$3,741.59 ","$5,200.00 ","$5,200.00 ", N/A ,"$5,200.00 ", N/A ,"$3,744.00 ","$3,224.00 ","$3,744.00 ","$3,744.00 ","$3,120.00 "
ST MARY'S HOSPITAL,36000191,61626,HC OCC/EMB TRANSCATH EXT CRAN VSS,360,1 ,"$12,000.00 ","$6,000.00 ","$3,529.80 ","$21,979.23 ","$3,529.80 ","$12,000.00 ","$11,705.00 ","$9,768.54 ","$7,200.00 ","$10,200.00 ","$8,400.00 ","$3,529.80 ","$11,400.00 ","$8,640.00 ","$8,760.00 ","$6,993.00 ","$10,200.00 ","$9,768.54 ","$6,993.00 ","$10,200.00 ","$8,760.00 ","$3,529.80 ","$9,768.54 ","$12,000.00 ","$10,200.00 ","$21,979.23 ","$11,040.00 ","$8,400.00 ","$5,993.67 ","$8,056.00 ","$7,308.00 ","$7,491.83 ","$8,292.00 ","$8,640.00 ","$8,358.00 ","$9,866.23 ","$8,640.00 ","$3,741.59 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$8,640.00 ","$7,440.00 ","$8,640.00 ","$8,640.00 ","$7,200.00 "
ST MARY'S HOSPITAL,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 ",$605.19 ,$904.80 ,"$1,281.80 ","$1,055.60 ",$268.66 ,"$1,432.60 ","$1,085.76 ","$1,100.84 ","$1,508.00 ","$1,281.80 ",$605.19 ,"$1,508.00 ","$1,281.80 ","$1,100.84 ",$268.66 ,$605.19 ,"$1,508.00 ","$1,281.80 ","$1,361.67 ","$1,387.36 ","$1,055.60 ","$1,489.75 ","$1,508.00 ",$918.37 ,"$1,508.00 ","$1,042.03 ","$1,085.76 ","$1,050.32 ",$611.24 ,"$1,085.76 ",$284.78 ,"$1,508.00 ","$1,508.00 ",$605.19 ,"$1,508.00 ",$605.19 ,"$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ",$904.80 
ST MARY'S HOSPITAL,36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,077.00 ",$538.50 ,$268.66 ,"$1,389.48 ",$268.66 ,"$1,077.00 ","$1,077.00 ",$617.55 ,$646.20 ,$915.45 ,$753.90 ,$268.66 ,"$1,023.15 ",$775.44 ,$786.21 ,"$1,077.00 ",$915.45 ,$617.55 ,"$1,077.00 ",$915.45 ,$786.21 ,$268.66 ,$617.55 ,"$1,077.00 ",$915.45 ,"$1,389.48 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$775.44 ,$750.13 ,$623.73 ,$775.44 ,$284.78 ,"$1,077.00 ","$1,077.00 ",$617.55 ,"$1,077.00 ",$617.55 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$646.20 
ST MARY'S HOSPITAL,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 ",$525.67 ,"$1,083.00 ","$1,534.25 ","$1,263.50 ",$229.60 ,"$1,714.75 ","$1,299.60 ","$1,317.65 ","$1,805.00 ","$1,534.25 ",$525.67 ,"$1,805.00 ","$1,534.25 ","$1,317.65 ",$229.60 ,$525.67 ,"$1,697.11 ","$1,534.25 ","$1,182.77 ","$1,660.60 ","$1,263.50 ","$1,680.96 ","$1,805.00 ","$1,099.25 ","$1,805.00 ","$1,247.26 ","$1,299.60 ","$1,257.18 ",$530.93 ,"$1,299.60 ",$243.38 ,"$1,805.00 ","$1,805.00 ",$525.67 ,"$1,805.00 ",$525.67 ,"$1,299.60 ","$1,119.10 ","$1,299.60 ","$1,299.60 ","$1,083.00 "
ST MARY'S HOSPITAL,36000240,42300,HC DRAIN ABSC PAROTID SMP,360,1 ,"$1,724.00 ",$862.00 ,$288.55 ,"$2,960.00 ",$288.55 ,"$1,724.00 ","$1,724.00 ","$1,315.56 ","$1,034.40 ","$1,465.40 ","$1,206.80 ",$288.55 ,"$1,637.80 ","$1,241.28 ","$1,258.52 ","$1,724.00 ","$1,465.40 ","$1,315.56 ","$1,724.00 ","$1,465.40 ","$1,258.52 ",$288.55 ,"$1,315.56 ","$1,724.00 ","$1,465.40 ","$2,960.00 ","$1,586.08 ","$1,206.80 ","$1,489.75 ","$1,724.00 ","$1,049.92 ","$1,724.00 ","$1,191.28 ","$1,241.28 ","$1,200.77 ","$1,328.72 ","$1,241.28 ",$305.86 ,"$1,724.00 ","$1,724.00 ","$1,315.56 ","$1,724.00 ","$1,315.56 ","$1,241.28 ","$1,068.88 ","$1,241.28 ","$1,241.28 ","$1,034.40 "
ST MARY'S HOSPITAL,36000250,49419,HC INSERT TUN IP CATH W/PORT,360,1 ,"$4,756.00 ","$2,378.00 ","$1,169.72 ","$10,434.71 ","$1,169.72 ","$4,756.00 ","$4,756.00 ","$4,637.65 ","$2,853.60 ","$4,042.60 ","$3,329.20 ","$1,169.72 ","$4,518.20 ","$3,424.32 ","$3,471.88 ","$2,815.00 ","$4,042.60 ","$4,637.65 ","$2,815.00 ","$4,042.60 ","$3,471.88 ","$1,169.72 ","$4,637.65 ","$4,756.00 ","$4,042.60 ","$10,434.71 ","$4,375.52 ","$3,329.20 ","$1,489.75 ","$2,002.44 ","$2,896.40 ","$1,862.71 ","$3,286.40 ","$3,424.32 ","$3,312.55 ","$4,684.03 ","$3,424.32 ","$1,239.90 ","$4,756.00 ","$4,756.00 ","$4,637.65 ","$4,756.00 ","$4,637.65 ","$3,424.32 ","$2,948.72 ","$3,424.32 ","$3,424.32 ","$2,853.60 "
ST MARY'S HOSPITAL,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 ",$800.58 ,"$1,486.80 ","$2,106.30 ","$1,734.60 ",$268.66 ,"$2,354.10 ","$1,784.16 ","$1,808.94 ","$2,478.00 ","$2,106.30 ",$800.58 ,"$2,478.00 ","$2,106.30 ","$1,808.94 ",$268.66 ,$800.58 ,"$1,697.11 ","$2,106.30 ","$1,801.30 ","$2,279.76 ","$1,734.60 ","$1,489.75 ","$2,002.44 ","$1,509.10 ","$1,862.71 ","$1,712.30 ","$1,784.16 ","$1,725.93 ",$808.59 ,"$1,784.16 ",$284.78 ,"$2,478.00 ","$2,478.00 ",$800.58 ,"$2,478.00 ",$800.58 ,"$1,784.16 ","$1,536.36 ","$1,784.16 ","$1,784.16 ","$1,486.80 "
ST MARY'S HOSPITAL,36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$1,541.00 ",$770.50 ,$268.66 ,"$1,801.30 ",$268.66 ,"$1,541.00 ","$1,541.00 ",$800.58 ,$924.60 ,"$1,309.85 ","$1,078.70 ",$268.66 ,"$1,463.95 ","$1,109.52 ","$1,124.93 ","$1,541.00 ","$1,309.85 ",$800.58 ,"$1,541.00 ","$1,309.85 ","$1,124.93 ",$268.66 ,$800.58 ,"$1,541.00 ","$1,309.85 ","$1,801.30 ","$1,417.72 ","$1,078.70 ","$1,489.75 ","$1,541.00 ",$938.47 ,"$1,541.00 ","$1,064.83 ","$1,109.52 ","$1,073.31 ",$808.59 ,"$1,109.52 ",$284.78 ,"$1,541.00 ","$1,541.00 ",$800.58 ,"$1,541.00 ",$800.58 ,"$1,109.52 ",$955.42 ,"$1,109.52 ","$1,109.52 ",$924.60 
ST MARY'S HOSPITAL,36000323,64480,HC INJ TRANSF CERV/THORACIC ADDL,360,1 ,$786.00 ,$393.00 ,$268.66 ,"$2,002.44 ",$268.66 ,$786.00 ,$786.00 , N/A ,$471.60 ,$668.10 ,$550.20 ,$268.66 ,$746.70 ,$565.92 ,$573.78 ,$786.00 ,$668.10 , N/A ,$786.00 ,$668.10 ,$573.78 ,$268.66 , N/A ,$786.00 ,$668.10 , N/A ,$723.12 ,$550.20 ,"$1,489.75 ","$2,002.44 ",$478.67 ,"$1,862.71 ",$543.13 ,$565.92 ,$547.45 , N/A ,$565.92 ,$284.78 ,$786.00 ,$786.00 , N/A ,$786.00 , N/A ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$471.60 
ST MARY'S HOSPITAL,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 ",$800.58 ,"$1,163.40 ","$1,648.15 ","$1,357.30 ",$268.66 ,"$1,842.05 ","$1,396.08 ","$1,415.47 ","$1,939.00 ","$1,648.15 ",$800.58 ,"$1,939.00 ","$1,648.15 ","$1,415.47 ",$268.66 ,$800.58 ,"$1,697.11 ","$1,648.15 ","$1,801.30 ","$1,783.88 ","$1,357.30 ","$1,489.75 ","$1,939.00 ","$1,180.85 ","$1,862.71 ","$1,339.85 ","$1,396.08 ","$1,350.51 ",$808.59 ,"$1,396.08 ",$284.78 ,"$1,939.00 ","$1,939.00 ",$800.58 ,"$1,939.00 ",$800.58 ,"$1,396.08 ","$1,202.18 ","$1,396.08 ","$1,396.08 ","$1,163.40 "
ST MARY'S HOSPITAL,36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,$786.00 ,$393.00 ,$268.66 ,"$2,002.44 ",$268.66 ,$786.00 ,$786.00 , N/A ,$471.60 ,$668.10 ,$550.20 ,$268.66 ,$746.70 ,$565.92 ,$573.78 ,$786.00 ,$668.10 , N/A ,$786.00 ,$668.10 ,$573.78 ,$268.66 , N/A ,$786.00 ,$668.10 , N/A ,$723.12 ,$550.20 ,"$1,489.75 ","$2,002.44 ",$478.67 ,"$1,862.71 ",$543.13 ,$565.92 ,$547.45 , N/A ,$565.92 ,$284.78 ,$786.00 ,$786.00 , N/A ,$786.00 , N/A ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$471.60 
ST MARY'S HOSPITAL,36000339,64461,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC SINGLE,360,1 ,$830.00 ,$415.00 ,$268.66 ,"$1,389.48 ",$268.66 ,$830.00 ,$830.00 ,$617.55 ,$498.00 ,$705.50 ,$581.00 ,$268.66 ,$788.50 ,$597.60 ,$605.90 ,$830.00 ,$705.50 ,$617.55 ,$830.00 ,$705.50 ,$605.90 ,$268.66 ,$617.55 ,$830.00 ,$705.50 ,"$1,389.48 ",$763.60 ,$581.00 ,$830.00 ,$830.00 ,$505.47 ,$830.00 ,$573.53 ,$597.60 ,$578.10 ,$623.73 ,$597.60 ,$284.78 ,$830.00 ,$830.00 ,$617.55 ,$830.00 ,$617.55 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$498.00 
ST MARY'S HOSPITAL,36000340,64462,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC 2ND AND ADDN ADD ON,360,1 ,$215.00 ,$107.50 ,$107.50 ,"$2,002.44 ",$268.66 ,$215.00 ,$215.00 , N/A ,$129.00 ,$182.75 ,$150.50 ,$268.66 ,$204.25 ,$154.80 ,$156.95 ,$215.00 ,$182.75 , N/A ,$215.00 ,$182.75 ,$156.95 ,$268.66 , N/A ,$215.00 ,$182.75 , N/A ,$197.80 ,$150.50 ,"$1,489.75 ","$2,002.44 ",$130.94 ,"$1,862.71 ",$148.57 ,$154.80 ,$149.75 , N/A ,$154.80 ,$284.78 ,$215.00 ,$215.00 , N/A ,$215.00 , N/A ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$129.00 
ST MARY'S HOSPITAL,36000341,64463,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC CATH CONTINUOUS,360,1 ,$792.00 ,$396.00 ,$268.66 ,"$1,389.48 ",$268.66 ,$792.00 ,$792.00 ,$617.55 ,$475.20 ,$673.20 ,$554.40 ,$268.66 ,$752.40 ,$570.24 ,$578.16 ,$792.00 ,$673.20 ,$617.55 ,$792.00 ,$673.20 ,$578.16 ,$268.66 ,$617.55 ,$792.00 ,$673.20 ,"$1,389.48 ",$728.64 ,$554.40 ,$792.00 ,$792.00 ,$482.33 ,$792.00 ,$547.27 ,$570.24 ,$551.63 ,$623.73 ,$570.24 ,$284.78 ,$792.00 ,$792.00 ,$617.55 ,$792.00 ,$617.55 ,$570.24 ,$491.04 ,$570.24 ,$570.24 ,$475.20 
ST MARY'S HOSPITAL,36000359,33880,HC ENDOVASC REPAIR TAA W/LT SUBCLVN ARTERY,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", N/A ,"$18,996.34 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$5,993.67 ","$8,056.00 ","$14,987.49 ","$7,491.83 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,36000360,33881,HC ENDOVASC REPAIR TAA W/O LT SUBCLVN ARTERY,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", N/A ,"$18,996.34 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$5,993.67 ","$8,056.00 ","$14,987.49 ","$7,491.83 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,36000361,33883,HC PLACE ENDOVASC PROSTHESIS PROXM EXT TAA INIT,360,1 ,"$3,531.00 ","$1,765.50 ","$1,765.50 ","$8,056.00 ","$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 ","$2,542.32 ","$2,577.63 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$3,001.35 ","$2,577.63 ","$5,616.20 ", N/A ,"$3,531.00 ","$3,001.35 ", N/A ,"$3,248.52 ","$2,471.70 ","$5,993.67 ","$8,056.00 ","$2,150.38 ","$7,491.83 ","$2,439.92 ","$2,542.32 ","$2,459.34 ", N/A ,"$2,542.32 ","$5,953.17 ","$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ", N/A ,"$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,118.60 "
ST MARY'S HOSPITAL,36000362,33884,HC PLACE ENDOVASC PROSTHESIS PROXM EXT TAA EA ADDL,360,1 ,"$3,959.00 ","$1,979.50 ","$1,979.50 ","$8,056.00 ","$5,616.20 ","$3,959.00 ","$3,959.00 ", N/A ,"$2,375.40 ","$3,365.15 ","$2,771.30 ","$5,616.20 ","$3,761.05 ","$2,850.48 ","$2,890.07 ","$3,959.00 ","$3,365.15 ", N/A ,"$3,959.00 ","$3,365.15 ","$2,890.07 ","$5,616.20 ", N/A ,"$3,959.00 ","$3,365.15 ", N/A ,"$3,642.28 ","$2,771.30 ","$5,993.67 ","$8,056.00 ","$2,411.03 ","$7,491.83 ","$2,735.67 ","$2,850.48 ","$2,757.44 ", N/A ,"$2,850.48 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$2,850.48 ","$2,454.58 ","$2,850.48 ","$2,850.48 ","$2,375.40 "
ST MARY'S HOSPITAL,36000363,33886,HC PLACE PROSTHESIS DISTAL EXT POST ENDOVASC RPR,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", N/A ,"$18,996.34 ","$20,918.50 ", N/A ,"$22,641.20 ","$17,227.00 ","$5,993.67 ","$8,056.00 ","$14,987.49 ","$7,491.83 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,36000368,34808,HC ENDOVASC PLACEMENT ILIAC ARTRY OCCLUSION DEVICE,360,1 ,$482.00 ,$241.00 ,$241.00 ,"$8,056.00 ","$5,616.20 ",$482.00 ,$482.00 , N/A ,$289.20 ,$409.70 ,$337.40 ,"$5,616.20 ",$457.90 ,$347.04 ,$351.86 ,$482.00 ,$409.70 , N/A ,$482.00 ,$409.70 ,$351.86 ,"$5,616.20 ", N/A ,$482.00 ,$409.70 , N/A ,$443.44 ,$337.40 ,"$5,993.67 ","$8,056.00 ",$293.54 ,"$7,491.83 ",$333.06 ,$347.04 ,$335.71 , N/A ,$347.04 ,"$5,953.17 ",$482.00 ,$482.00 , N/A ,$482.00 , N/A ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,36000440,31622,HC BRONCHOSCOPY DIAG W/W/O WASHING,360,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,273.80 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,088.00 ","$2,117.00 ","$2,815.00 ","$2,465.00 ","$1,455.02 ","$2,815.00 ","$2,465.00 ","$2,117.00 ",$515.71 ,"$1,455.02 ","$2,489.10 ","$2,465.00 ","$3,273.80 ","$2,668.00 ","$2,030.00 ","$1,489.75 ","$2,002.44 ","$1,766.10 ","$1,862.71 ","$2,003.90 ","$2,088.00 ","$2,019.85 ","$1,469.57 ","$2,088.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$2,900.00 ","$1,455.02 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,36000498,N/A,HC BOWEL RESECTION,360,1 ,"$3,775.00 ","$1,887.50 ","$1,887.50 ","$3,775.00 ", N/A , N/A , N/A , N/A ,"$2,265.00 ","$3,208.75 ","$2,642.50 ", N/A ,"$3,586.25 ","$2,718.00 ","$2,755.75 ", N/A ,"$3,208.75 ", N/A , N/A ,"$3,208.75 ","$2,755.75 ", N/A , N/A , N/A ,"$3,208.75 ", N/A ,"$3,473.00 ","$2,642.50 ","$1,914.68 ","$2,297.84 ","$2,298.98 ","$2,144.58 ","$2,608.53 ","$2,718.00 ","$2,629.29 ", N/A ,"$2,718.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,718.00 ","$2,340.50 ","$2,718.00 ","$2,718.00 ","$2,265.00 "
ST MARY'S HOSPITAL,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 ,$682.56 ,$692.04 ,$948.00 ,$805.80 , N/A ,$948.00 ,$805.80 ,$692.04 ,$136.73 , N/A ,$948.00 ,$805.80 , N/A ,$872.16 ,$663.60 ,$948.00 ,$948.00 ,$577.33 ,$948.00 ,$655.07 ,$682.56 ,$660.28 , N/A ,$682.56 ,$144.93 ,$948.00 ,$948.00 , N/A ,$948.00 , N/A ,$682.56 ,$587.76 ,$682.56 ,$682.56 ,$568.80 
ST MARY'S HOSPITAL,36000609,34813,HC PLACE FEMORAL ENDOVASC GRAFT,360,1 ,"$17,120.00 ","$8,560.00 ","$2,815.00 ","$17,120.00 ","$5,616.20 ","$7,283.00 ","$6,763.00 ", N/A ,"$10,272.00 ","$14,552.00 ","$11,984.00 ","$5,616.20 ","$16,264.00 ","$12,326.40 ","$12,497.60 ","$2,815.00 ","$14,552.00 ", N/A ,"$2,815.00 ","$14,552.00 ","$12,497.60 ","$5,616.20 ", N/A ,"$15,834.06 ","$14,552.00 ", N/A ,"$15,750.40 ","$11,984.00 ","$5,993.67 ","$8,056.00 ","$10,426.08 ","$7,491.83 ","$11,829.92 ","$12,326.40 ","$11,924.08 ", N/A ,"$12,326.40 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$12,326.40 ","$10,614.40 ","$12,326.40 ","$12,326.40 ","$10,272.00 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", 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 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$24,652.80 ","$24,995.20 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$29,104.00 ","$24,995.20 ","$5,616.20 ", 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 ","$19,451.74 ","$23,659.84 ","$24,652.80 ","$23,848.16 ", N/A ,"$24,652.80 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$20,544.00 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", 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 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$24,652.80 ","$24,995.20 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$29,104.00 ","$24,995.20 ","$5,616.20 ", 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 ","$19,451.74 ","$23,659.84 ","$24,652.80 ","$23,848.16 ", N/A ,"$24,652.80 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$20,544.00 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", 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 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$24,652.80 ","$24,995.20 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$29,104.00 ","$24,995.20 ","$5,616.20 ", 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 ","$19,451.74 ","$23,659.84 ","$24,652.80 ","$23,848.16 ", N/A ,"$24,652.80 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$20,544.00 "
ST MARY'S HOSPITAL,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 ","$2,542.32 ","$2,577.63 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$3,001.35 ","$2,577.63 ","$5,616.20 ", 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 ","$2,005.96 ","$2,439.92 ","$2,542.32 ","$2,459.34 ", N/A ,"$2,542.32 ","$5,953.17 ","$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ", N/A ,"$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,118.60 "
ST MARY'S HOSPITAL,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 ","$16,646.00 ","$9,884.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", 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 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ","$2,542.32 ","$2,577.63 ","$3,531.00 ","$3,001.35 ", N/A ,"$3,531.00 ","$3,001.35 ","$2,577.63 ","$5,616.20 ", 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 ","$2,005.96 ","$2,439.92 ","$2,542.32 ","$2,459.34 ", N/A ,"$2,542.32 ","$5,953.17 ","$3,531.00 ","$3,531.00 ", N/A ,"$3,531.00 ", N/A ,"$2,542.32 ","$2,189.22 ","$2,542.32 ","$2,542.32 ","$2,118.60 "
ST MARY'S HOSPITAL,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 ","$16,646.00 ","$9,884.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", 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 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ","$16,646.00 ","$9,884.00 ", N/A ,"$20,544.00 ","$29,104.00 ","$23,968.00 ","$5,616.20 ","$32,528.00 ","$24,652.80 ","$24,995.20 ","$6,993.00 ","$29,104.00 ", N/A ,"$6,993.00 ","$29,104.00 ","$24,995.20 ","$5,616.20 ", 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 ","$19,451.74 ","$23,659.84 ","$24,652.80 ","$23,848.16 ", N/A ,"$24,652.80 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$24,652.80 ","$21,228.80 ","$24,652.80 ","$24,652.80 ","$20,544.00 "
ST MARY'S HOSPITAL,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 ","$2,419.20 ","$2,452.80 ", N/A ,"$2,856.00 ", N/A , N/A ,"$2,856.00 ","$2,452.80 ", 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 ","$1,908.82 ","$2,321.76 ","$2,419.20 ","$2,340.24 ", N/A ,"$2,419.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,36000723,34717,HC ENDOVASC REPAIR ARTERY ILIAC W/ENDOGRAFT,360,1 ,"$10,700.00 ","$5,350.00 ","$3,803.00 ","$10,700.00 ","$5,616.20 ","$10,700.00 ","$10,700.00 ", N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$5,616.20 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ", N/A ,"$6,993.00 ","$9,095.00 ","$7,811.00 ","$5,616.20 ", 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 ","$6,078.67 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,36000724,34718,HC ENDOVASC REPAIR ARTERY ILIAC W/O ENDOGRAFT,360,1 ,"$24,610.00 ","$12,305.00 ","$3,803.00 ","$24,610.00 ","$5,616.20 ","$18,727.00 ","$11,705.00 ", N/A ,"$14,766.00 ","$20,918.50 ","$17,227.00 ","$5,616.20 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ", N/A ,"$6,993.00 ","$20,918.50 ","$17,965.30 ","$5,616.20 ", 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 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ", N/A ,"$17,719.20 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,36000729,31631,HC BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT,360,1 ,"$6,200.00 ","$3,100.00 ","$1,069.97 ","$12,742.71 ","$1,069.97 ","$6,200.00 ","$6,200.00 ","$5,663.43 ","$3,720.00 ","$5,270.00 ","$4,340.00 ","$1,069.97 ","$5,890.00 ","$4,464.00 ","$4,526.00 ","$4,620.00 ","$5,270.00 ","$5,663.43 ","$4,620.00 ","$5,270.00 ","$4,526.00 ","$1,069.97 ","$5,663.43 ","$6,200.00 ","$5,270.00 ","$12,742.71 ","$5,704.00 ","$4,340.00 ","$1,680.96 ","$2,259.84 ","$3,775.80 ","$2,101.20 ","$4,284.20 ","$4,464.00 ","$4,318.30 ","$5,720.06 ","$4,464.00 ","$1,134.17 ","$6,200.00 ","$6,200.00 ","$5,663.43 ","$6,200.00 ","$5,663.43 ","$4,464.00 ","$3,844.00 ","$4,464.00 ","$4,464.00 ","$3,720.00 "
ST MARY'S HOSPITAL,36000730,31632,HC BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE ADDITIONAL,360,1 ,"$1,800.00 ",$900.00 ,$515.71 ,"$2,259.84 ",$515.71 ,"$1,800.00 ","$1,800.00 ", N/A ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$515.71 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,800.00 ","$1,530.00 ", N/A ,"$1,800.00 ","$1,530.00 ","$1,314.00 ",$515.71 , N/A ,"$1,800.00 ","$1,530.00 ", N/A ,"$1,656.00 ","$1,260.00 ","$1,680.96 ","$2,259.84 ","$1,096.20 ","$2,101.20 ","$1,243.80 ","$1,296.00 ","$1,253.70 ", N/A ,"$1,296.00 ",$546.65 ,"$1,800.00 ","$1,800.00 ", N/A ,"$1,800.00 ", N/A ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,36000731,31633,HC BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE ADDITIONAL,360,1 ,"$1,800.00 ",$900.00 ,$515.71 ,"$2,259.84 ",$515.71 ,"$1,800.00 ","$1,800.00 ", N/A ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$515.71 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,800.00 ","$1,530.00 ", N/A ,"$1,800.00 ","$1,530.00 ","$1,314.00 ",$515.71 , N/A ,"$1,800.00 ","$1,530.00 ", N/A ,"$1,656.00 ","$1,260.00 ","$1,680.96 ","$2,259.84 ","$1,096.20 ","$2,101.20 ","$1,243.80 ","$1,296.00 ","$1,253.70 ", N/A ,"$1,296.00 ",$546.65 ,"$1,800.00 ","$1,800.00 ", N/A ,"$1,800.00 ", N/A ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,36000732,31636,HC BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS,360,1 ,"$6,200.00 ","$3,100.00 ","$1,069.97 ","$12,742.71 ","$1,069.97 ","$6,200.00 ","$6,200.00 ","$5,663.43 ","$3,720.00 ","$5,270.00 ","$4,340.00 ","$1,069.97 ","$5,890.00 ","$4,464.00 ","$4,526.00 ","$4,620.00 ","$5,270.00 ","$5,663.43 ","$4,620.00 ","$5,270.00 ","$4,526.00 ","$1,069.97 ","$5,663.43 ","$6,200.00 ","$5,270.00 ","$12,742.71 ","$5,704.00 ","$4,340.00 ","$1,680.96 ","$2,259.84 ","$3,775.80 ","$2,101.20 ","$4,284.20 ","$4,464.00 ","$4,318.30 ","$5,720.06 ","$4,464.00 ","$1,134.17 ","$6,200.00 ","$6,200.00 ","$5,663.43 ","$6,200.00 ","$5,663.43 ","$4,464.00 ","$3,844.00 ","$4,464.00 ","$4,464.00 ","$3,720.00 "
ST MARY'S HOSPITAL,36000733,31637,HC BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED ADDITIONAL,360,1 ,"$1,800.00 ",$900.00 ,$900.00 ,"$2,259.84 ","$1,069.97 ","$1,800.00 ","$1,800.00 ", N/A ,"$1,080.00 ","$1,530.00 ","$1,260.00 ","$1,069.97 ","$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,800.00 ","$1,530.00 ", N/A ,"$1,800.00 ","$1,530.00 ","$1,314.00 ","$1,069.97 ", N/A ,"$1,800.00 ","$1,530.00 ", N/A ,"$1,656.00 ","$1,260.00 ","$1,680.96 ","$2,259.84 ","$1,096.20 ","$2,101.20 ","$1,243.80 ","$1,296.00 ","$1,253.70 ", N/A ,"$1,296.00 ","$1,134.17 ","$1,800.00 ","$1,800.00 ", N/A ,"$1,800.00 ", N/A ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,36000734,31638,HC BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS,360,1 ,"$6,200.00 ","$3,100.00 ","$1,069.97 ","$12,742.71 ","$1,069.97 ","$6,200.00 ","$6,200.00 ","$5,663.43 ","$3,720.00 ","$5,270.00 ","$4,340.00 ","$1,069.97 ","$5,890.00 ","$4,464.00 ","$4,526.00 ","$4,620.00 ","$5,270.00 ","$5,663.43 ","$4,620.00 ","$5,270.00 ","$4,526.00 ","$1,069.97 ","$5,663.43 ","$6,200.00 ","$5,270.00 ","$12,742.71 ","$5,704.00 ","$4,340.00 ","$1,680.96 ","$2,259.84 ","$3,775.80 ","$2,101.20 ","$4,284.20 ","$4,464.00 ","$4,318.30 ","$5,720.06 ","$4,464.00 ","$1,134.17 ","$6,200.00 ","$6,200.00 ","$5,663.43 ","$6,200.00 ","$5,663.43 ","$4,464.00 ","$3,844.00 ","$4,464.00 ","$4,464.00 ","$3,720.00 "
ST MARY'S HOSPITAL,36000743,43775,HC GASTRIC SLEEVE,360,1 ,"$5,675.00 ","$2,837.50 ","$1,010.01 ","$8,145.30 ","$1,010.01 ","$5,675.00 ","$5,675.00 ", N/A ,"$3,405.00 ","$4,823.75 ","$3,972.50 ","$1,010.01 ","$5,391.25 ","$4,086.00 ","$4,142.75 ","$5,675.00 ","$4,823.75 ", N/A ,"$5,675.00 ","$4,823.75 ","$4,142.75 ","$1,010.01 ", N/A ,"$5,675.00 ","$4,823.75 ","$3,405.00 ","$5,221.00 ","$3,972.50 ","$6,059.86 ","$8,145.30 ","$3,456.08 ","$7,574.83 ","$3,921.43 ","$4,086.00 ","$3,952.64 ", N/A ,"$4,086.00 ","$1,070.61 ","$5,675.00 ","$5,675.00 ", N/A ,"$5,675.00 ", N/A ,"$4,086.00 ","$3,518.50 ","$4,086.00 ","$4,086.00 ","$3,405.00 "
ST MARY'S HOSPITAL,36000752,45390,HC COLONOSCOPY W/RESECTION,360,1 ,"$7,347.00 ","$3,673.50 ",$642.82 ,"$7,347.00 ",$642.82 ,"$4,058.00 ","$3,641.00 ","$2,375.88 ","$4,408.20 ","$6,244.95 ","$5,142.90 ",$642.82 ,"$6,979.65 ","$5,289.84 ","$5,363.31 ","$6,993.00 ","$6,244.95 ","$2,375.88 ","$6,993.00 ","$6,244.95 ","$5,363.31 ",$642.82 ,"$2,375.88 ","$2,489.10 ","$6,244.95 ","$5,345.72 ","$6,759.24 ","$5,142.90 ","$1,680.96 ","$2,259.84 ","$4,474.32 ","$2,101.20 ","$5,076.78 ","$5,289.84 ","$5,117.19 ","$2,399.64 ","$5,289.84 ",$681.39 ,"$4,016.00 ","$4,016.00 ","$2,375.88 ","$4,016.00 ","$2,375.88 ","$5,289.84 ","$4,555.14 ","$5,289.84 ","$5,289.84 ","$4,408.20 "
ST MARY'S HOSPITAL,36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$7,359.00 ","$3,679.50 ",$616.68 ,"$7,359.00 ",$616.68 ,"$7,283.00 ","$6,763.00 ","$2,305.90 ","$4,415.40 ","$6,255.15 ","$5,151.30 ",$616.68 ,"$6,991.05 ","$5,298.48 ","$5,372.07 ","$2,815.00 ","$6,255.15 ","$2,305.90 ","$2,815.00 ","$6,255.15 ","$5,372.07 ",$616.68 ,"$2,305.90 ","$4,525.63 ","$6,255.15 ","$5,188.27 ","$6,770.28 ","$5,151.30 ","$1,489.75 ","$2,002.44 ","$4,481.63 ","$1,862.71 ","$5,085.07 ","$5,298.48 ","$5,125.54 ","$2,328.96 ","$5,298.48 ",$653.68 ,"$5,058.00 ","$5,058.00 ","$2,305.90 ","$5,058.00 ","$2,305.90 ","$5,298.48 ","$4,562.58 ","$5,298.48 ","$5,298.48 ","$4,415.40 "
ST MARY'S HOSPITAL,36010026,N/A,HC CAPSULECTOMY,360,1 ,"$1,637.00 ",$818.50 ,$818.50 ,"$1,637.00 ", N/A , N/A , N/A , N/A ,$982.20 ,"$1,391.45 ","$1,145.90 ", N/A ,"$1,555.15 ","$1,178.64 ","$1,195.01 ", N/A ,"$1,391.45 ", N/A , N/A ,"$1,391.45 ","$1,195.01 ", N/A , N/A , N/A ,"$1,391.45 ", N/A ,"$1,506.04 ","$1,145.90 ",$830.29 ,$996.44 ,$996.93 ,$929.98 ,"$1,131.17 ","$1,178.64 ","$1,140.17 ", N/A ,"$1,178.64 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,178.64 ","$1,014.94 ","$1,178.64 ","$1,178.64 ",$982.20 
ST MARY'S HOSPITAL,36010071,N/A,HC FASCIOTOMY,360,1 ,"$3,528.00 ","$1,764.00 ","$1,764.00 ","$3,528.00 ", N/A , N/A , N/A , N/A ,"$2,116.80 ","$2,998.80 ","$2,469.60 ", N/A ,"$3,351.60 ","$2,540.16 ","$2,575.44 ", N/A ,"$2,998.80 ", N/A , N/A ,"$2,998.80 ","$2,575.44 ", N/A , N/A , N/A ,"$2,998.80 ", N/A ,"$3,245.76 ","$2,469.60 ","$1,789.40 ","$2,147.49 ","$2,148.55 ","$2,004.26 ","$2,437.85 ","$2,540.16 ","$2,457.25 ", N/A ,"$2,540.16 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,540.16 ","$2,187.36 ","$2,540.16 ","$2,540.16 ","$2,116.80 "
ST MARY'S HOSPITAL,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 ,$725.76 ,$735.84 , N/A ,$856.80 , N/A , N/A ,$856.80 ,$735.84 , N/A , N/A , N/A ,$856.80 , N/A ,$927.36 ,$705.60 ,$511.26 ,$613.57 ,$613.87 ,$572.64 ,$696.53 ,$725.76 ,$702.07 , N/A ,$725.76 , N/A , N/A , N/A , N/A , N/A , N/A ,$725.76 ,$624.96 ,$725.76 ,$725.76 ,$604.80 
ST MARY'S HOSPITAL,36010163,N/A,HC OTOPLASTY (BILATERAL),360,1 ,"$2,066.00 ","$1,033.00 ","$1,033.00 ","$2,066.00 ", N/A , N/A , N/A , N/A ,"$1,239.60 ","$1,756.10 ","$1,446.20 ", N/A ,"$1,962.70 ","$1,487.52 ","$1,508.18 ", N/A ,"$1,756.10 ", N/A , N/A ,"$1,756.10 ","$1,508.18 ", N/A , N/A , N/A ,"$1,756.10 ", N/A ,"$1,900.72 ","$1,446.20 ","$1,047.88 ","$1,257.57 ","$1,258.19 ","$1,173.69 ","$1,427.61 ","$1,487.52 ","$1,438.97 ", N/A ,"$1,487.52 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,487.52 ","$1,280.92 ","$1,487.52 ","$1,487.52 ","$1,239.60 "
ST MARY'S HOSPITAL,36010230,N/A,HC TENOTOMY UPPER,360,1 ,"$5,292.00 ","$2,646.00 ","$2,646.00 ","$5,292.00 ", N/A , N/A , N/A , N/A ,"$3,175.20 ","$4,498.20 ","$3,704.40 ", N/A ,"$5,027.40 ","$3,810.24 ","$3,863.16 ", N/A ,"$4,498.20 ", N/A , N/A ,"$4,498.20 ","$3,863.16 ", N/A , N/A , N/A ,"$4,498.20 ", N/A ,"$4,868.64 ","$3,704.40 ","$2,684.10 ","$3,221.24 ","$3,222.83 ","$3,006.39 ","$3,656.77 ","$3,810.24 ","$3,685.88 ", N/A ,"$3,810.24 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,810.24 ","$3,281.04 ","$3,810.24 ","$3,810.24 ","$3,175.20 "
ST MARY'S HOSPITAL,36010231,N/A,HC TENOTOMY LOWER,360,1 ,"$3,528.00 ","$1,764.00 ","$1,764.00 ","$3,528.00 ", N/A , N/A , N/A , N/A ,"$2,116.80 ","$2,998.80 ","$2,469.60 ", N/A ,"$3,351.60 ","$2,540.16 ","$2,575.44 ", N/A ,"$2,998.80 ", N/A , N/A ,"$2,998.80 ","$2,575.44 ", N/A , N/A , N/A ,"$2,998.80 ", N/A ,"$3,245.76 ","$2,469.60 ","$1,789.40 ","$2,147.49 ","$2,148.55 ","$2,004.26 ","$2,437.85 ","$2,540.16 ","$2,457.25 ", N/A ,"$2,540.16 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,540.16 ","$2,187.36 ","$2,540.16 ","$2,540.16 ","$2,116.80 "
ST MARY'S HOSPITAL,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 ","$2,001.60 ","$2,029.40 ", N/A ,"$2,363.00 ", N/A , N/A ,"$2,363.00 ","$2,029.40 ", 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 ","$1,579.32 ","$1,920.98 ","$2,001.60 ","$1,936.27 ", N/A ,"$2,001.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$1,668.00 "
ST MARY'S HOSPITAL,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 ","$2,440.08 ","$2,473.97 ", N/A ,"$2,880.65 ", N/A , N/A ,"$2,880.65 ","$2,473.97 ", 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 ","$1,925.29 ","$2,341.80 ","$2,440.08 ","$2,360.44 ", N/A ,"$2,440.08 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,440.08 ","$2,101.18 ","$2,440.08 ","$2,440.08 ","$2,033.40 "
ST MARY'S HOSPITAL,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 ","$1,121.76 ","$1,137.34 ", N/A ,"$1,324.30 ", N/A , N/A ,"$1,324.30 ","$1,137.34 ", N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$885.10 ,"$1,076.58 ","$1,121.76 ","$1,085.15 ", N/A ,"$1,121.76 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ",$934.80 
ST MARY'S HOSPITAL,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 ,$682.56 ,$692.04 , N/A ,$805.80 , N/A , N/A ,$805.80 ,$692.04 , N/A , N/A , N/A ,$805.80 , N/A ,$872.16 ,$663.60 ,$480.83 ,$577.05 ,$577.33 ,$538.56 ,$655.07 ,$682.56 ,$660.28 , N/A ,$682.56 , N/A , N/A , N/A , N/A , N/A , N/A ,$682.56 ,$587.76 ,$682.56 ,$682.56 ,$568.80 
ST MARY'S HOSPITAL,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 ","$1,562.40 ","$1,584.10 ", N/A ,"$1,844.50 ", N/A , N/A ,"$1,844.50 ","$1,584.10 ", 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 ","$1,232.78 ","$1,499.47 ","$1,562.40 ","$1,511.41 ", N/A ,"$1,562.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,302.00 "
ST MARY'S HOSPITAL,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 ","$2,001.60 ","$2,029.40 ", N/A ,"$2,363.00 ", N/A , N/A ,"$2,363.00 ","$2,029.40 ", 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 ","$1,579.32 ","$1,920.98 ","$2,001.60 ","$1,936.27 ", N/A ,"$2,001.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$1,668.00 "
ST MARY'S HOSPITAL,36030007,N/A,HC BREAST AUG TRANSUMBILIC (TUBA),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 ","$1,562.40 ","$1,584.10 ", N/A ,"$1,844.50 ", N/A , N/A ,"$1,844.50 ","$1,584.10 ", 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 ","$1,232.78 ","$1,499.47 ","$1,562.40 ","$1,511.41 ", N/A ,"$1,562.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,302.00 "
ST MARY'S HOSPITAL,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 ","$1,562.40 ","$1,584.10 ", N/A ,"$1,844.50 ", N/A , N/A ,"$1,844.50 ","$1,584.10 ", 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 ","$1,232.78 ","$1,499.47 ","$1,562.40 ","$1,511.41 ", N/A ,"$1,562.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,302.00 "
ST MARY'S HOSPITAL,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 ","$3,320.64 ","$3,366.76 ", N/A ,"$3,920.20 ", N/A , N/A ,"$3,920.20 ","$3,366.76 ", 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 ","$2,620.08 ","$3,186.89 ","$3,320.64 ","$3,212.26 ", N/A ,"$3,320.64 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,320.64 ","$2,859.44 ","$3,320.64 ","$3,320.64 ","$2,767.20 "
ST MARY'S HOSPITAL,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 ","$2,001.60 ","$2,029.40 ", N/A ,"$2,363.00 ", N/A , N/A ,"$2,363.00 ","$2,029.40 ", 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 ","$1,579.32 ","$1,920.98 ","$2,001.60 ","$1,936.27 ", N/A ,"$2,001.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$1,668.00 "
ST MARY'S HOSPITAL,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 ","$2,880.72 ","$2,920.73 ", N/A ,"$3,400.85 ", N/A , N/A ,"$3,400.85 ","$2,920.73 ", 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 ","$2,272.97 ","$2,764.69 ","$2,880.72 ","$2,786.70 ", N/A ,"$2,880.72 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,880.72 ","$2,480.62 ","$2,880.72 ","$2,880.72 ","$2,400.60 "
ST MARY'S HOSPITAL,36030012,N/A,HC BREAST REDUCTION UNILATERAL,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 ","$1,121.76 ","$1,137.34 ", N/A ,"$1,324.30 ", N/A , N/A ,"$1,324.30 ","$1,137.34 ", N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$885.10 ,"$1,076.58 ","$1,121.76 ","$1,085.15 ", N/A ,"$1,121.76 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ",$934.80 
ST MARY'S HOSPITAL,36030013,N/A,HC BREAST REVISION,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 ","$1,121.76 ","$1,137.34 ", N/A ,"$1,324.30 ", N/A , N/A ,"$1,324.30 ","$1,137.34 ", N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$885.10 ,"$1,076.58 ","$1,121.76 ","$1,085.15 ", N/A ,"$1,121.76 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ",$934.80 
ST MARY'S HOSPITAL,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 ","$2,440.08 ","$2,473.97 ", N/A ,"$2,880.65 ", N/A , N/A ,"$2,880.65 ","$2,473.97 ", 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 ","$1,925.29 ","$2,341.80 ","$2,440.08 ","$2,360.44 ", N/A ,"$2,440.08 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,440.08 ","$2,101.18 ","$2,440.08 ","$2,440.08 ","$2,033.40 "
ST MARY'S HOSPITAL,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 ","$1,562.40 ","$1,584.10 ", N/A ,"$1,844.50 ", N/A , N/A ,"$1,844.50 ","$1,584.10 ", 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 ","$1,232.78 ","$1,499.47 ","$1,562.40 ","$1,511.41 ", N/A ,"$1,562.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,302.00 "
ST MARY'S HOSPITAL,36030016,N/A,HC COSMETIC SCAR REVISION,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 ","$1,121.76 ","$1,137.34 ", N/A ,"$1,324.30 ", N/A , N/A ,"$1,324.30 ","$1,137.34 ", N/A , N/A , N/A ,"$1,324.30 ", N/A ,"$1,433.36 ","$1,090.60 ",$790.22 ,$948.35 ,$948.82 ,$885.10 ,"$1,076.58 ","$1,121.76 ","$1,085.15 ", N/A ,"$1,121.76 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,121.76 ",$965.96 ,"$1,121.76 ","$1,121.76 ",$934.80 
ST MARY'S HOSPITAL,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 ","$3,320.64 ","$3,366.76 ", N/A ,"$3,920.20 ", N/A , N/A ,"$3,920.20 ","$3,366.76 ", 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 ","$2,620.08 ","$3,186.89 ","$3,320.64 ","$3,212.26 ", N/A ,"$3,320.64 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,320.64 ","$2,859.44 ","$3,320.64 ","$3,320.64 ","$2,767.20 "
ST MARY'S HOSPITAL,36030018,N/A,HC GYNCOMASTIA W/LIPOSUCTION,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 ","$1,562.40 ","$1,584.10 ", N/A ,"$1,844.50 ", N/A , N/A ,"$1,844.50 ","$1,584.10 ", 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 ","$1,232.78 ","$1,499.47 ","$1,562.40 ","$1,511.41 ", N/A ,"$1,562.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,302.00 "
ST MARY'S HOSPITAL,36030019,N/A,HC LASER SKIN RESURFACING/SITE,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 ","$1,562.40 ","$1,584.10 ", N/A ,"$1,844.50 ", N/A , N/A ,"$1,844.50 ","$1,584.10 ", 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 ","$1,232.78 ","$1,499.47 ","$1,562.40 ","$1,511.41 ", N/A ,"$1,562.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,562.40 ","$1,345.40 ","$1,562.40 ","$1,562.40 ","$1,302.00 "
ST MARY'S HOSPITAL,36030054,N/A,HC LIPOSUCTION TOUCH UP 1/2 HOUR,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 ",$828.00 ,$839.50 , N/A ,$977.50 , N/A , N/A ,$977.50 ,$839.50 , N/A , N/A , N/A ,$977.50 , N/A ,"$1,058.00 ",$805.00 ,$583.28 ,$700.01 ,$700.35 ,$653.32 ,$794.65 ,$828.00 ,$800.98 , N/A ,$828.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$828.00 ,$713.00 ,$828.00 ,$828.00 ,$690.00 
ST MARY'S HOSPITAL,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 ","$2,001.60 ","$2,029.40 ", N/A ,"$2,363.00 ", N/A , N/A ,"$2,363.00 ","$2,029.40 ", 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 ","$1,579.32 ","$1,920.98 ","$2,001.60 ","$1,936.27 ", N/A ,"$2,001.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,001.60 ","$1,723.60 ","$2,001.60 ","$2,001.60 ","$1,668.00 "
ST MARY'S HOSPITAL,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 ","$2,440.08 ","$2,473.97 ", N/A ,"$2,880.65 ", N/A , N/A ,"$2,880.65 ","$2,473.97 ", 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 ","$1,925.29 ","$2,341.80 ","$2,440.08 ","$2,360.44 ", N/A ,"$2,440.08 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,440.08 ","$2,101.18 ","$2,440.08 ","$2,440.08 ","$2,033.40 "
ST MARY'S HOSPITAL,36030057,S2055,HC TISSUE HARVEST/ORGAN PROC,360,1 ,$840.00 ,$420.00 ,$420.00 ,"$8,056.00 ", N/A , N/A , N/A , N/A ,$504.00 ,$714.00 ,$588.00 , N/A ,$798.00 ,$604.80 ,$613.20 ,$840.00 ,$714.00 , N/A ,$840.00 ,$714.00 ,$613.20 , N/A , N/A , N/A ,$714.00 , N/A ,$772.80 ,$588.00 ,"$5,993.67 ","$8,056.00 ",$511.56 ,"$7,491.83 ",$580.44 ,$604.80 ,$585.06 , N/A ,$604.80 , N/A , N/A , N/A , N/A , N/A , N/A ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,36030058,N/A,HC LABIALPLASTY,360,1 ,"$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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,36030059,19328,HC BREAST IMPLANT REMOVAL,360,1 ,"$1,773.00 ",$886.50 ,$886.50 ,"$6,909.69 ","$1,017.11 ","$1,773.00 ","$1,773.00 ","$3,070.97 ","$1,063.80 ","$1,507.05 ","$1,241.10 ","$1,017.11 ","$1,684.35 ","$1,276.56 ","$1,294.29 ","$1,773.00 ","$1,507.05 ","$3,070.97 ","$1,773.00 ","$1,507.05 ","$1,294.29 ","$1,017.11 ","$3,070.97 ","$1,773.00 ","$1,507.05 ","$6,909.69 ","$1,631.16 ","$1,241.10 ","$1,489.75 ","$1,773.00 ","$1,079.76 ","$1,773.00 ","$1,225.14 ","$1,276.56 ","$1,234.89 ","$3,101.68 ","$1,276.56 ","$1,078.14 ","$1,773.00 ","$1,773.00 ","$3,070.97 ","$1,773.00 ","$3,070.97 ","$1,276.56 ","$1,099.26 ","$1,276.56 ","$1,276.56 ","$1,063.80 "
ST MARY'S HOSPITAL,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 ","$4,762.80 ","$4,828.95 ", N/A ,"$5,622.75 ", N/A , N/A ,"$5,622.75 ","$4,828.95 ", 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 ","$3,757.98 ","$4,570.97 ","$4,762.80 ","$4,607.35 ", N/A ,"$4,762.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,762.80 ","$4,101.30 ","$4,762.80 ","$4,762.80 ","$3,969.00 "
ST MARY'S HOSPITAL,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 ",$907.20 ,$919.80 , N/A ,"$1,071.00 ", N/A , N/A ,"$1,071.00 ",$919.80 , N/A , N/A , N/A ,"$1,071.00 ", N/A ,"$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$715.81 ,$870.66 ,$907.20 ,$877.59 , N/A ,$907.20 , N/A , N/A , N/A , N/A , N/A , N/A ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,$756.00 
ST MARY'S HOSPITAL,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 ","$1,360.80 ","$1,379.70 ", N/A ,"$1,606.50 ", N/A , N/A ,"$1,606.50 ","$1,379.70 ", 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 ","$1,073.71 ","$1,305.99 ","$1,360.80 ","$1,316.39 ", N/A ,"$1,360.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,360.80 ","$1,171.80 ","$1,360.80 ","$1,360.80 ","$1,134.00 "
ST MARY'S HOSPITAL,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 ",$979.20 ,$992.80 , N/A ,"$1,156.00 ", N/A , N/A ,"$1,156.00 ",$992.80 , N/A , N/A , N/A ,"$1,156.00 ", N/A ,"$1,251.20 ",$952.00 ,$689.79 ,$827.83 ,$828.24 ,$772.62 ,$939.76 ,$979.20 ,$947.24 , N/A ,$979.20 , N/A , N/A , N/A , N/A , N/A , N/A ,$979.20 ,$843.20 ,$979.20 ,$979.20 ,$816.00 
ST MARY'S HOSPITAL,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 ","$1,467.36 ","$1,487.74 ", N/A ,"$1,732.30 ", N/A , N/A ,"$1,732.30 ","$1,487.74 ", 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 ","$1,157.79 ","$1,408.26 ","$1,467.36 ","$1,419.47 ", N/A ,"$1,467.36 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,467.36 ","$1,263.56 ","$1,467.36 ","$1,467.36 ","$1,222.80 "
ST MARY'S HOSPITAL,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 ","$1,956.24 ","$1,983.41 ", N/A ,"$2,309.45 ", N/A , N/A ,"$2,309.45 ","$1,983.41 ", 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 ","$1,543.53 ","$1,877.45 ","$1,956.24 ","$1,892.39 ", N/A ,"$1,956.24 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,956.24 ","$1,684.54 ","$1,956.24 ","$1,956.24 ","$1,630.20 "
ST MARY'S HOSPITAL,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 ","$1,199.52 ","$1,216.18 ", N/A ,"$1,416.10 ", N/A , N/A ,"$1,416.10 ","$1,216.18 ", 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 ",$946.45 ,"$1,151.21 ","$1,199.52 ","$1,160.37 ", N/A ,"$1,199.52 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,199.52 ","$1,032.92 ","$1,199.52 ","$1,199.52 ",$999.60 
ST MARY'S HOSPITAL,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 ","$1,688.40 ","$1,711.85 ", N/A ,"$1,993.25 ", N/A , N/A ,"$1,993.25 ","$1,711.85 ", 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 ","$1,332.19 ","$1,620.40 ","$1,688.40 ","$1,633.29 ", N/A ,"$1,688.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,688.40 ","$1,453.90 ","$1,688.40 ","$1,688.40 ","$1,407.00 "
ST MARY'S HOSPITAL,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 ","$2,177.28 ","$2,207.52 ", N/A ,"$2,570.40 ", N/A , N/A ,"$2,570.40 ","$2,207.52 ", 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 ","$1,717.93 ","$2,089.58 ","$2,177.28 ","$2,106.22 ", N/A ,"$2,177.28 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$1,814.40 "
ST MARY'S HOSPITAL,36030126,N/A,HC INSERT GASTRIC BALLOON,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 ","$3,931.20 ","$3,985.80 ", N/A ,"$4,641.00 ", N/A , N/A ,"$4,641.00 ","$3,985.80 ", 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 ","$3,101.83 ","$3,772.86 ","$3,931.20 ","$3,802.89 ", N/A ,"$3,931.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,931.20 ","$3,385.20 ","$3,931.20 ","$3,931.20 ","$3,276.00 "
ST MARY'S HOSPITAL,36030127,N/A,HC VASOVASOSTOMY,360,1 ,"$5,250.00 ","$2,625.00 ","$2,625.00 ","$5,250.00 ", N/A , N/A , N/A , N/A ,"$3,150.00 ","$4,462.50 ","$3,675.00 ", N/A ,"$4,987.50 ","$3,780.00 ","$3,832.50 ", N/A ,"$4,462.50 ", N/A , N/A ,"$4,462.50 ","$3,832.50 ", N/A , N/A , N/A ,"$4,462.50 ", N/A ,"$4,830.00 ","$3,675.00 ","$2,662.80 ","$3,195.68 ","$3,197.25 ","$2,982.53 ","$3,627.75 ","$3,780.00 ","$3,656.63 ", N/A ,"$3,780.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,780.00 ","$3,255.00 ","$3,780.00 ","$3,780.00 ","$3,150.00 "
ST MARY'S HOSPITAL,36030128,N/A,HC GASTRECTOMY SLEEVE,360,1 ,"$14,516.00 ","$7,258.00 ","$7,258.00 ","$14,516.00 ", N/A , N/A , N/A , N/A ,"$8,709.60 ","$12,338.60 ","$10,161.20 ", N/A ,"$13,790.20 ","$10,451.52 ","$10,596.68 ", N/A ,"$12,338.60 ", N/A , N/A ,"$12,338.60 ","$10,596.68 ", N/A , N/A , N/A ,"$12,338.60 ", N/A ,"$13,354.72 ","$10,161.20 ","$7,362.52 ","$8,835.89 ","$8,840.24 ","$8,246.54 ","$10,030.56 ","$10,451.52 ","$10,110.39 ", N/A ,"$10,451.52 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$10,451.52 ","$8,999.92 ","$10,451.52 ","$10,451.52 ","$8,709.60 "
ST MARY'S HOSPITAL,36030129,N/A,HC MONSPLASTY,360,1 ,$903.00 ,$451.50 ,$451.50 ,$903.00 , N/A , N/A , N/A , N/A ,$541.80 ,$767.55 ,$632.10 , N/A ,$857.85 ,$650.16 ,$659.19 , N/A ,$767.55 , N/A , N/A ,$767.55 ,$659.19 , N/A , N/A , N/A ,$767.55 , N/A ,$830.76 ,$632.10 ,$458.00 ,$549.66 ,$549.93 ,$512.99 ,$623.97 ,$650.16 ,$628.94 , N/A ,$650.16 , N/A , N/A , N/A , N/A , N/A , N/A ,$650.16 ,$559.86 ,$650.16 ,$650.16 ,$541.80 
ST MARY'S HOSPITAL,36030405,0232T,HC INJECTION PLATELET RICH PLASMA,360,1 ,$377.00 ,$188.50 ,$144.58 ,$593.87 ,$144.58 ,$377.00 ,$377.00 ,$263.94 ,$226.20 ,$320.45 ,$263.90 ,$144.58 ,$358.15 ,$271.44 ,$275.21 ,$377.00 ,$320.45 ,$263.94 ,$377.00 ,$320.45 ,$275.21 ,$144.58 ,$263.94 ,$377.00 ,$320.45 ,$593.87 ,$346.84 ,$263.90 ,$377.00 ,$377.00 ,$229.59 ,$377.00 ,$260.51 ,$271.44 ,$262.58 ,$266.58 ,$271.44 ,$153.25 ,$377.00 ,$377.00 ,$263.94 ,$377.00 ,$263.94 ,$271.44 ,$233.74 ,$271.44 ,$271.44 ,$226.20 
ST MARY'S HOSPITAL,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 ",$263.94 ,$711.00 ,"$1,007.25 ",$829.50 ,$144.58 ,"$1,125.75 ",$853.20 ,$865.05 ,"$1,185.00 ","$1,007.25 ",$263.94 ,"$1,185.00 ","$1,007.25 ",$865.05 ,$144.58 ,$263.94 ,"$1,185.00 ","$1,007.25 ",$593.87 ,"$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$266.58 ,$853.20 ,$153.25 ,"$1,185.00 ","$1,185.00 ",$263.94 ,"$1,185.00 ",$263.94 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,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 ,$756.00 ,$766.50 , N/A ,$892.50 , N/A , N/A ,$892.50 ,$766.50 , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,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 ,$756.00 ,$766.50 , N/A ,$892.50 , N/A , N/A ,$892.50 ,$766.50 , N/A , N/A , N/A ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A , N/A , N/A , N/A , N/A , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,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 ","$3,240.00 ","$3,285.00 ", N/A ,"$3,825.00 ", N/A , N/A ,"$3,825.00 ","$3,285.00 ", 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 ","$2,556.45 ","$3,109.50 ","$3,240.00 ","$3,134.25 ", N/A ,"$3,240.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,240.00 ","$2,790.00 ","$3,240.00 ","$3,240.00 ","$2,700.00 "
ST MARY'S HOSPITAL,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 ,$439.92 ,$446.03 , N/A ,$519.35 , N/A , N/A ,$519.35 ,$446.03 , N/A , N/A , N/A ,$519.35 , N/A ,$562.12 ,$427.70 ,$309.90 ,$371.92 ,$372.10 ,$347.11 ,$422.20 ,$439.92 ,$425.56 , N/A ,$439.92 , N/A , N/A , N/A , N/A , N/A , N/A ,$439.92 ,$378.82 ,$439.92 ,$439.92 ,$366.60 
ST MARY'S HOSPITAL,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 ","$2,721.60 ","$2,759.40 ", N/A ,"$3,213.00 ", N/A , N/A ,"$3,213.00 ","$2,759.40 ", 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 ","$2,147.42 ","$2,611.98 ","$2,721.60 ","$2,632.77 ", N/A ,"$2,721.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$2,268.00 "
ST MARY'S HOSPITAL,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 ","$3,931.20 ","$3,985.80 ", N/A ,"$4,641.00 ", N/A , N/A ,"$4,641.00 ","$3,985.80 ", 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 ","$3,101.83 ","$3,772.86 ","$3,931.20 ","$3,802.89 ", N/A ,"$3,931.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,931.20 ","$3,385.20 ","$3,931.20 ","$3,931.20 ","$3,276.00 "
ST MARY'S HOSPITAL,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 ","$5,065.20 ","$5,135.55 ", N/A ,"$5,979.75 ", N/A , N/A ,"$5,979.75 ","$5,135.55 ", 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 ","$3,996.58 ","$4,861.19 ","$5,065.20 ","$4,899.88 ", N/A ,"$5,065.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$5,065.20 ","$4,361.70 ","$5,065.20 ","$5,065.20 ","$4,221.00 "
ST MARY'S HOSPITAL,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 ","$7,030.80 ","$7,128.45 ", N/A ,"$8,300.25 ", N/A , N/A ,"$8,300.25 ","$7,128.45 ", 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 ","$5,547.50 ","$6,747.62 ","$7,030.80 ","$6,801.32 ", N/A ,"$7,030.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$7,030.80 ","$6,054.30 ","$7,030.80 ","$7,030.80 ","$5,859.00 "
ST MARY'S HOSPITAL,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 ","$8,316.00 ","$8,431.50 ", N/A ,"$9,817.50 ", N/A , N/A ,"$9,817.50 ","$8,431.50 ", 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 ","$6,561.56 ","$7,981.05 ","$8,316.00 ","$8,044.58 ", N/A ,"$8,316.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$8,316.00 ","$7,161.00 ","$8,316.00 ","$8,316.00 ","$6,930.00 "
ST MARY'S HOSPITAL,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 ","$10,584.00 ","$10,731.00 ", N/A ,"$12,495.00 ", N/A , N/A ,"$12,495.00 ","$10,731.00 ", 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 ","$8,351.07 ","$10,157.70 ","$10,584.00 ","$10,238.55 ", N/A ,"$10,584.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$10,584.00 ","$9,114.00 ","$10,584.00 ","$10,584.00 ","$8,820.00 "
ST MARY'S HOSPITAL,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 ,$11.34 ,$11.50 , N/A ,$13.39 , N/A , N/A ,$13.39 ,$11.50 , N/A , N/A , N/A ,$13.39 , N/A ,$14.49 ,$11.03 ,$7.99 ,$9.59 ,$9.59 ,$8.95 ,$10.88 ,$11.34 ,$10.97 , N/A ,$11.34 , N/A , N/A , N/A , N/A , N/A , N/A ,$11.34 ,$9.77 ,$11.34 ,$11.34 ,$9.45 
ST MARY'S HOSPITAL,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 ,$27.36 ,$27.74 , N/A ,$32.30 , N/A , N/A ,$32.30 ,$27.74 , N/A , N/A , N/A ,$32.30 , N/A ,$34.96 ,$26.60 ,$19.27 ,$23.13 ,$23.14 ,$21.59 ,$26.26 ,$27.36 ,$26.47 , N/A ,$27.36 , N/A , N/A , N/A , N/A , N/A , N/A ,$27.36 ,$23.56 ,$27.36 ,$27.36 ,$22.80 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 , N/A ,$45.05 , N/A , N/A ,$45.05 ,$38.69 , N/A , N/A , N/A ,$45.05 , N/A ,$48.76 ,$37.10 ,$26.88 ,$32.26 ,$32.28 ,$30.11 ,$36.62 ,$38.16 ,$36.91 , N/A ,$38.16 , N/A , N/A , N/A , N/A , N/A , N/A ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 , N/A ,$71.40 , N/A , N/A ,$71.40 ,$61.32 , N/A , N/A , N/A ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$47.72 ,$58.04 ,$60.48 ,$58.51 , N/A ,$60.48 , N/A , N/A , N/A , N/A , N/A , N/A ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,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 ,$68.40 ,$69.35 , N/A ,$80.75 , N/A , N/A ,$80.75 ,$69.35 , N/A , N/A , N/A ,$80.75 , N/A ,$87.40 ,$66.50 ,$48.18 ,$57.83 ,$57.86 ,$53.97 ,$65.65 ,$68.40 ,$66.17 , N/A ,$68.40 , N/A , N/A , N/A , N/A , N/A , N/A ,$68.40 ,$58.90 ,$68.40 ,$68.40 ,$57.00 
ST MARY'S HOSPITAL,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 ,$75.60 ,$76.65 , N/A ,$89.25 , N/A , N/A ,$89.25 ,$76.65 , N/A , N/A , N/A ,$89.25 , N/A ,$96.60 ,$73.50 ,$53.26 ,$63.91 ,$63.95 ,$59.65 ,$72.56 ,$75.60 ,$73.13 , N/A ,$75.60 , N/A , N/A , N/A , N/A , N/A , N/A ,$75.60 ,$65.10 ,$75.60 ,$75.60 ,$63.00 
ST MARY'S HOSPITAL,36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$809.00 ,$404.50 ,$136.73 ,$809.00 ,$136.73 ,$809.00 ,$809.00 ,$254.09 ,$485.40 ,$687.65 ,$566.30 ,$136.73 ,$768.55 ,$582.48 ,$590.57 ,$809.00 ,$687.65 ,$254.09 ,$809.00 ,$687.65 ,$590.57 ,$136.73 ,$254.09 ,$809.00 ,$687.65 ,$571.69 ,$744.28 ,$566.30 ,$809.00 ,$809.00 ,$492.68 ,$809.00 ,$559.02 ,$582.48 ,$563.47 ,$256.63 ,$582.48 ,$144.93 ,$809.00 ,$809.00 ,$254.09 ,$809.00 ,$254.09 ,$582.48 ,$501.58 ,$582.48 ,$582.48 ,$485.40 
ST MARY'S HOSPITAL,36100001,47537,HC REM BIL CATH W G SI CHOLANG,361,1 ,"$1,500.00 ",$750.00 ,$62.73 ,"$1,770.57 ",$62.73 ,"$1,500.00 ","$1,500.00 ",$786.92 ,$900.00 ,"$1,275.00 ","$1,050.00 ",$62.73 ,"$1,425.00 ","$1,080.00 ","$1,095.00 ","$1,500.00 ","$1,275.00 ",$786.92 ,"$1,500.00 ","$1,275.00 ","$1,095.00 ",$62.73 ,$786.92 ,"$1,500.00 ","$1,275.00 ","$1,770.57 ","$1,380.00 ","$1,050.00 ","$1,500.00 ","$1,500.00 ",$913.50 ,"$1,500.00 ","$1,036.50 ","$1,080.00 ","$1,044.75 ",$794.79 ,"$1,080.00 ",$66.49 ,"$1,500.00 ","$1,500.00 ",$786.92 ,"$1,500.00 ",$786.92 ,"$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ",$900.00 
ST MARY'S HOSPITAL,36100002,47538,HC PLC BILE SNT W G SI EX/REMOVAL CHOLANG,361,1 ,"$8,295.00 ","$4,147.50 ",$791.20 ,"$11,071.98 ",$791.20 ,"$8,295.00 ","$8,295.00 ","$4,920.88 ","$4,977.00 ","$7,050.75 ","$5,806.50 ",$791.20 ,"$7,880.25 ","$5,972.40 ","$6,055.35 ","$6,993.00 ","$7,050.75 ","$4,920.88 ","$6,993.00 ","$7,050.75 ","$6,055.35 ",$791.20 ,"$4,920.88 ","$7,919.86 ","$7,050.75 ","$11,071.98 ","$7,631.40 ","$5,806.50 ","$5,993.67 ","$8,056.00 ","$5,051.66 ","$7,491.83 ","$5,731.85 ","$5,972.40 ","$5,777.47 ","$4,970.09 ","$5,972.40 ",$838.67 ,"$8,295.00 ","$8,295.00 ","$4,920.88 ","$8,295.00 ","$4,920.88 ","$5,972.40 ","$5,142.90 ","$5,972.40 ","$5,972.40 ","$4,977.00 "
ST MARY'S HOSPITAL,36100003,47540,HC PLC BILE SNT W GD SI  NEW ACCESS,361,1 ,"$10,000.00 ","$5,000.00 ","$2,004.41 ","$11,071.98 ","$2,004.41 ","$10,000.00 ","$9,468.00 ","$4,920.88 ","$6,000.00 ","$8,500.00 ","$7,000.00 ","$2,004.41 ","$9,500.00 ","$7,200.00 ","$7,300.00 ","$6,993.00 ","$8,500.00 ","$4,920.88 ","$6,993.00 ","$8,500.00 ","$7,300.00 ","$2,004.41 ","$4,920.88 ","$7,919.86 ","$8,500.00 ","$11,071.98 ","$9,200.00 ","$7,000.00 ","$3,934.50 ","$5,287.67 ","$6,090.00 ","$4,917.86 ","$6,910.00 ","$7,200.00 ","$6,965.00 ","$4,970.09 ","$7,200.00 ","$2,124.67 ","$8,832.00 ","$8,832.00 ","$4,920.88 ","$8,832.00 ","$4,920.88 ","$7,200.00 ","$6,200.00 ","$7,200.00 ","$7,200.00 ","$6,000.00 "
ST MARY'S HOSPITAL,36100004,50430,HC INJ NEPH URET W G SI NEW ACCESS,361,1 ,"$2,016.00 ","$1,008.00 ",$119.36 ,"$5,656.43 ",$119.36 ,"$2,016.00 ","$2,016.00 ",$559.50 ,"$1,209.60 ","$1,713.60 ","$1,411.20 ",$119.36 ,"$1,915.20 ","$1,451.52 ","$1,471.68 ","$2,016.00 ","$1,713.60 ",$559.50 ,"$2,016.00 ","$1,713.60 ","$1,471.68 ",$119.36 ,$559.50 ,"$1,697.11 ","$1,713.60 ","$1,258.87 ","$1,854.72 ","$1,411.20 ","$4,208.70 ","$5,656.43 ","$1,227.74 ","$5,260.35 ","$1,393.06 ","$1,451.52 ","$1,404.14 ",$565.10 ,"$1,451.52 ",$126.52 ,"$2,016.00 ","$2,016.00 ",$559.50 ,"$2,016.00 ",$559.50 ,"$1,451.52 ","$1,249.92 ","$1,451.52 ","$1,451.52 ","$1,209.60 "
ST MARY'S HOSPITAL,36100005,50433,HC PL NEPH CAT W GD S AND I NEW ACCESS,361,1 ,"$6,400.00 ","$3,200.00 ",$924.12 ,"$6,727.66 ",$924.12 ,"$4,058.00 ","$3,641.00 ","$2,990.07 ","$3,840.00 ","$5,440.00 ","$4,480.00 ",$924.12 ,"$6,080.00 ","$4,608.00 ","$4,672.00 ","$6,400.00 ","$5,440.00 ","$2,990.07 ","$6,400.00 ","$5,440.00 ","$4,672.00 ",$924.12 ,"$2,990.07 ","$4,525.63 ","$5,440.00 ","$6,727.66 ","$5,888.00 ","$4,480.00 ","$1,680.96 ","$2,259.84 ","$3,897.60 ","$2,101.20 ","$4,422.40 ","$4,608.00 ","$4,457.60 ","$3,019.97 ","$4,608.00 ",$979.57 ,"$5,058.00 ","$5,058.00 ","$2,990.07 ","$5,058.00 ","$2,990.07 ","$4,608.00 ","$3,968.00 ","$4,608.00 ","$4,608.00 ","$3,840.00 "
ST MARY'S HOSPITAL,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 ,"$4,058.00 ","$3,641.00 ","$1,741.31 ","$3,960.00 ","$5,610.00 ","$4,620.00 ",$474.08 ,"$6,270.00 ","$4,752.00 ","$4,818.00 ","$6,600.00 ","$5,610.00 ","$1,741.31 ","$6,600.00 ","$5,610.00 ","$4,818.00 ",$474.08 ,"$1,741.31 ","$2,489.10 ","$5,610.00 ","$3,917.96 ","$6,072.00 ","$4,620.00 ","$1,680.96 ","$2,259.84 ","$4,019.40 ","$2,101.20 ","$4,560.60 ","$4,752.00 ","$4,596.90 ","$1,758.72 ","$4,752.00 ",$502.52 ,"$2,687.00 ","$2,687.00 ","$1,741.31 ","$2,687.00 ","$1,741.31 ","$4,752.00 ","$4,092.00 ","$4,752.00 ","$4,752.00 ","$3,960.00 "
ST MARY'S HOSPITAL,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 ,$338.40 ,$343.10 ,$470.00 ,$399.50 , N/A ,$470.00 ,$399.50 ,$343.10 ,"$2,178.23 ", N/A ,$470.00 ,$399.50 , N/A ,$432.40 ,$329.00 ,"$1,489.75 ","$2,002.44 ",$286.23 ,"$1,862.71 ",$324.77 ,$338.40 ,$327.36 , N/A ,$338.40 ,"$2,308.92 ",$470.00 ,$470.00 , N/A ,$470.00 , N/A ,$338.40 ,$291.40 ,$338.40 ,$338.40 ,$282.00 
ST MARY'S HOSPITAL,36100008,50694,HC PL URT STNT W G SI NEW ACCESS WO NEPH CATH,361,1 ,"$6,033.00 ","$3,016.50 ",$924.12 ,"$6,727.66 ",$924.12 ,"$6,033.00 ","$6,033.00 ","$2,990.07 ","$3,619.80 ","$5,128.05 ","$4,223.10 ",$924.12 ,"$5,731.35 ","$4,343.76 ","$4,404.09 ","$6,033.00 ","$5,128.05 ","$2,990.07 ","$6,033.00 ","$5,128.05 ","$4,404.09 ",$924.12 ,"$2,990.07 ","$5,657.04 ","$5,128.05 ","$6,727.66 ","$5,550.36 ","$4,223.10 ","$1,680.96 ","$2,259.84 ","$3,674.10 ","$2,101.20 ","$4,168.80 ","$4,343.76 ","$4,201.98 ","$3,019.97 ","$4,343.76 ",$979.57 ,"$6,033.00 ","$6,033.00 ","$2,990.07 ","$6,033.00 ","$2,990.07 ","$4,343.76 ","$3,740.46 ","$4,343.76 ","$4,343.76 ","$3,619.80 "
ST MARY'S HOSPITAL,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 ,"$7,283.00 ","$6,763.00 ","$2,990.07 ","$11,635.20 ","$16,483.20 ","$13,574.40 ",$924.12 ,"$18,422.40 ","$13,962.24 ","$14,156.16 ","$6,993.00 ","$16,483.20 ","$2,990.07 ","$6,993.00 ","$16,483.20 ","$14,156.16 ",$924.12 ,"$2,990.07 ","$5,657.04 ","$16,483.20 ","$6,727.66 ","$17,840.64 ","$13,574.40 ","$3,934.50 ","$5,287.67 ","$11,809.73 ","$4,917.86 ","$13,399.87 ","$13,962.24 ","$13,506.53 ","$3,019.97 ","$13,962.24 ",$979.57 ,"$6,651.00 ","$6,651.00 ","$2,990.07 ","$6,651.00 ","$2,990.07 ","$13,962.24 ","$12,023.04 ","$13,962.24 ","$13,962.24 ","$11,635.20 "
ST MARY'S HOSPITAL,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 ,$288.00 ,$292.00 ,$400.00 ,$340.00 , N/A ,$400.00 ,$340.00 ,$292.00 ,"$2,178.23 ", N/A ,$400.00 ,$340.00 , N/A ,$368.00 ,$280.00 ,"$1,489.75 ","$2,002.44 ",$243.60 ,"$1,862.71 ",$276.40 ,$288.00 ,$278.60 , N/A ,$288.00 ,"$2,308.92 ",$400.00 ,$400.00 , N/A ,$400.00 , N/A ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$240.00 
ST MARY'S HOSPITAL,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 ",$605.19 ,"$1,551.60 ","$2,198.10 ","$1,810.20 ",$232.13 ,"$2,456.70 ","$1,861.92 ","$1,887.78 ","$2,586.00 ","$2,198.10 ",$605.19 ,"$2,586.00 ","$2,198.10 ","$1,887.78 ",$232.13 ,$605.19 ,"$2,489.10 ","$2,198.10 ","$1,361.67 ","$2,379.12 ","$1,810.20 ","$1,489.75 ","$2,002.44 ","$1,574.87 ","$1,862.71 ","$1,786.93 ","$1,861.92 ","$1,801.15 ",$611.24 ,"$1,861.92 ",$246.06 ,"$2,586.00 ","$2,586.00 ",$605.19 ,"$2,586.00 ",$605.19 ,"$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$1,551.60 "
ST MARY'S HOSPITAL,36100012,50706,HC BALLOON DILATION URETERAL IG SI,361,1 ,$580.00 ,$290.00 ,$290.00 ,"$2,308.92 ","$2,178.23 ",$580.00 ,$580.00 , N/A ,$348.00 ,$493.00 ,$406.00 ,"$2,178.23 ",$551.00 ,$417.60 ,$423.40 ,$580.00 ,$493.00 , N/A ,$580.00 ,$493.00 ,$423.40 ,"$2,178.23 ", N/A ,$580.00 ,$493.00 , N/A ,$533.60 ,$406.00 ,"$1,680.96 ","$2,259.84 ",$353.22 ,"$2,101.20 ",$400.78 ,$417.60 ,$403.97 , N/A ,$417.60 ,"$2,308.92 ",$580.00 ,$580.00 , N/A ,$580.00 , N/A ,$417.60 ,$359.60 ,$417.60 ,$417.60 ,$348.00 
ST MARY'S HOSPITAL,36100013,47541,HC PLCMENT ACCESS BILIARY TREE BOWEL PERC IG SI,361,1 ,"$4,400.00 ","$2,200.00 ","$1,489.75 ","$6,961.86 ","$2,004.41 ","$4,400.00 ","$4,400.00 ","$3,094.16 ","$2,640.00 ","$3,740.00 ","$3,080.00 ","$2,004.41 ","$4,180.00 ","$3,168.00 ","$3,212.00 ","$4,400.00 ","$3,740.00 ","$3,094.16 ","$4,400.00 ","$3,740.00 ","$3,212.00 ","$2,004.41 ","$3,094.16 ","$4,400.00 ","$3,740.00 ","$6,961.86 ","$4,048.00 ","$3,080.00 ","$1,489.75 ","$2,002.44 ","$2,679.60 ","$1,862.71 ","$3,040.40 ","$3,168.00 ","$3,064.60 ","$3,125.10 ","$3,168.00 ","$2,124.67 ","$4,400.00 ","$4,400.00 ","$3,094.16 ","$4,400.00 ","$3,094.16 ","$3,168.00 ","$2,728.00 ","$3,168.00 ","$3,168.00 ","$2,640.00 "
ST MARY'S HOSPITAL,36100028,47383,HC ABLATION TUMOR LIVER CRYOABLATION,361,1 ,"$4,200.00 ","$2,100.00 ","$2,004.41 ","$11,071.98 ","$2,004.41 ","$4,200.00 ","$4,200.00 ","$4,920.88 ","$2,520.00 ","$3,570.00 ","$2,940.00 ","$2,004.41 ","$3,990.00 ","$3,024.00 ","$3,066.00 ","$4,200.00 ","$3,570.00 ","$4,920.88 ","$4,200.00 ","$3,570.00 ","$3,066.00 ","$2,004.41 ","$4,920.88 ","$4,200.00 ","$3,570.00 ","$11,071.98 ","$3,864.00 ","$2,940.00 ","$5,993.67 ","$8,056.00 ","$2,557.80 ","$7,491.83 ","$2,902.20 ","$3,024.00 ","$2,925.30 ","$4,970.09 ","$3,024.00 ","$2,124.67 ","$4,200.00 ","$4,200.00 ","$4,920.88 ","$4,200.00 ","$4,920.88 ","$3,024.00 ","$2,604.00 ","$3,024.00 ","$3,024.00 ","$2,520.00 "
ST MARY'S HOSPITAL,36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,389.48 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$617.55 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ",$617.55 ,"$1,293.00 ","$1,099.05 ",$943.89 ,$268.66 ,$617.55 ,"$1,293.00 ","$1,099.05 ","$1,389.48 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$623.73 ,$930.96 ,$284.78 ,"$1,293.00 ","$1,293.00 ",$617.55 ,"$1,293.00 ",$617.55 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,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 ",$617.55 ,"$1,228.20 ","$1,739.95 ","$1,432.90 ",$268.66 ,"$1,944.65 ","$1,473.84 ","$1,494.31 ","$2,047.00 ","$1,739.95 ",$617.55 ,"$2,047.00 ","$1,739.95 ","$1,494.31 ",$268.66 ,$617.55 ,"$2,047.00 ","$1,739.95 ","$1,389.48 ","$1,883.24 ","$1,432.90 ","$1,489.75 ","$2,002.44 ","$1,246.62 ","$1,862.71 ","$1,414.48 ","$1,473.84 ","$1,425.74 ",$623.73 ,"$1,473.84 ",$284.78 ,"$2,047.00 ","$2,047.00 ",$617.55 ,"$2,047.00 ",$617.55 ,"$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,228.20 "
ST MARY'S HOSPITAL,36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,389.48 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$617.55 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ",$617.55 ,"$1,293.00 ","$1,099.05 ",$943.89 ,$268.66 ,$617.55 ,"$1,293.00 ","$1,099.05 ","$1,389.48 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$623.73 ,$930.96 ,$284.78 ,"$1,293.00 ","$1,293.00 ",$617.55 ,"$1,293.00 ",$617.55 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,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 ",$617.55 ,$969.60 ,"$1,373.60 ","$1,131.20 ",$268.66 ,"$1,535.20 ","$1,163.52 ","$1,179.68 ","$1,616.00 ","$1,373.60 ",$617.55 ,"$1,616.00 ","$1,373.60 ","$1,179.68 ",$268.66 ,$617.55 ,"$1,616.00 ","$1,373.60 ","$1,389.48 ","$1,486.72 ","$1,131.20 ","$1,489.75 ","$1,616.00 ",$984.14 ,"$1,616.00 ","$1,116.66 ","$1,163.52 ","$1,125.54 ",$623.73 ,"$1,163.52 ",$284.78 ,"$1,616.00 ","$1,616.00 ",$617.55 ,"$1,616.00 ",$617.55 ,"$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ",$969.60 
ST MARY'S HOSPITAL,36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,801.30 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$800.58 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ",$800.58 ,"$1,293.00 ","$1,099.05 ",$943.89 ,$268.66 ,$800.58 ,"$1,293.00 ","$1,099.05 ","$1,801.30 ","$1,189.56 ",$905.10 ,"$1,293.00 ","$1,293.00 ",$787.44 ,"$1,293.00 ",$893.46 ,$930.96 ,$900.57 ,$808.59 ,$930.96 ,$284.78 ,"$1,293.00 ","$1,293.00 ",$800.58 ,"$1,293.00 ",$800.58 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36100107,62327,HC INJ W/CATH LUM/SAC W/GUIDE,361,1 ,"$1,616.00 ",$808.00 ,$268.66 ,"$1,801.30 ",$268.66 ,"$1,616.00 ","$1,616.00 ",$800.58 ,$969.60 ,"$1,373.60 ","$1,131.20 ",$268.66 ,"$1,535.20 ","$1,163.52 ","$1,179.68 ","$1,616.00 ","$1,373.60 ",$800.58 ,"$1,616.00 ","$1,373.60 ","$1,179.68 ",$268.66 ,$800.58 ,"$1,616.00 ","$1,373.60 ","$1,801.30 ","$1,486.72 ","$1,131.20 ","$1,489.75 ","$1,616.00 ",$984.14 ,"$1,616.00 ","$1,116.66 ","$1,163.52 ","$1,125.54 ",$808.59 ,"$1,163.52 ",$284.78 ,"$1,616.00 ","$1,616.00 ",$800.58 ,"$1,616.00 ",$800.58 ,"$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ",$969.60 
ST MARY'S HOSPITAL,36100135,31625,HC BRONCHOSCOPY BX SGL/MULT SITES,361,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,273.80 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,088.00 ","$2,117.00 ","$2,900.00 ","$2,465.00 ","$1,455.02 ","$2,900.00 ","$2,465.00 ","$2,117.00 ",$515.71 ,"$1,455.02 ","$2,489.10 ","$2,465.00 ","$3,273.80 ","$2,668.00 ","$2,030.00 ","$1,680.96 ","$2,259.84 ","$1,766.10 ","$2,101.20 ","$2,003.90 ","$2,088.00 ","$2,019.85 ","$1,469.57 ","$2,088.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$2,900.00 ","$1,455.02 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,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 ","$2,088.00 ","$2,117.00 ","$2,900.00 ","$2,465.00 ", N/A ,"$2,900.00 ","$2,465.00 ","$2,117.00 ",$56.46 , N/A ,"$2,900.00 ","$2,465.00 ", N/A ,"$2,668.00 ","$2,030.00 ","$1,680.96 ","$2,259.84 ","$1,766.10 ","$2,101.20 ","$2,003.90 ","$2,088.00 ","$2,019.85 ", N/A ,"$2,088.00 ",$59.85 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,36100137,31629,HC BRONCHOSCOPY W/ASP BX TRANSHC BRONCH,361,1 ,"$3,200.00 ","$1,600.00 ",$515.71 ,"$6,778.10 ",$515.71 ,"$3,200.00 ","$3,200.00 ","$3,012.49 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$515.71 ,"$3,040.00 ","$2,304.00 ","$2,336.00 ","$3,200.00 ","$2,720.00 ","$3,012.49 ","$3,200.00 ","$2,720.00 ","$2,336.00 ",$515.71 ,"$3,012.49 ","$3,200.00 ","$2,720.00 ","$6,778.10 ","$2,944.00 ","$2,240.00 ","$1,680.96 ","$2,259.84 ","$1,948.80 ","$2,101.20 ","$2,211.20 ","$2,304.00 ","$2,228.80 ","$3,042.61 ","$2,304.00 ",$546.65 ,"$3,200.00 ","$3,200.00 ","$3,012.49 ","$3,200.00 ","$3,012.49 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$1,920.00 "
ST MARY'S HOSPITAL,36100140,31623,HC BRONCHOSCOPY W/BRUSHING,361,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,273.80 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,088.00 ","$2,117.00 ","$2,900.00 ","$2,465.00 ","$1,455.02 ","$2,900.00 ","$2,465.00 ","$2,117.00 ",$515.71 ,"$1,455.02 ","$2,489.10 ","$2,465.00 ","$3,273.80 ","$2,668.00 ","$2,030.00 ","$1,680.96 ","$2,259.84 ","$1,766.10 ","$2,101.20 ","$2,003.90 ","$2,088.00 ","$2,019.85 ","$1,469.57 ","$2,088.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$2,900.00 ","$1,455.02 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,36100141,31628,HC BRONCHOSCOPY W/BX TRANSHC BRONCH SGL,361,1 ,"$3,200.00 ","$1,600.00 ",$515.71 ,"$6,778.10 ",$515.71 ,"$3,200.00 ","$3,200.00 ","$3,012.49 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$515.71 ,"$3,040.00 ","$2,304.00 ","$2,336.00 ","$3,200.00 ","$2,720.00 ","$3,012.49 ","$3,200.00 ","$2,720.00 ","$2,336.00 ",$515.71 ,"$3,012.49 ","$3,200.00 ","$2,720.00 ","$6,778.10 ","$2,944.00 ","$2,240.00 ","$1,680.96 ","$2,259.84 ","$1,948.80 ","$2,101.20 ","$2,211.20 ","$2,304.00 ","$2,228.80 ","$3,042.61 ","$2,304.00 ",$546.65 ,"$3,200.00 ","$3,200.00 ","$3,012.49 ","$3,200.00 ","$3,012.49 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$1,920.00 "
ST MARY'S HOSPITAL,36100143,31624,HC BRONCHOSCOPY W/LAVAGE ALVEOLAR,361,1 ,"$2,900.00 ","$1,450.00 ",$515.71 ,"$3,273.80 ",$515.71 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$1,740.00 ","$2,465.00 ","$2,030.00 ",$515.71 ,"$2,755.00 ","$2,088.00 ","$2,117.00 ","$2,900.00 ","$2,465.00 ","$1,455.02 ","$2,900.00 ","$2,465.00 ","$2,117.00 ",$515.71 ,"$1,455.02 ","$2,489.10 ","$2,465.00 ","$3,273.80 ","$2,668.00 ","$2,030.00 ","$1,680.96 ","$2,259.84 ","$1,766.10 ","$2,101.20 ","$2,003.90 ","$2,088.00 ","$2,019.85 ","$1,469.57 ","$2,088.00 ",$546.65 ,"$2,900.00 ","$2,900.00 ","$1,455.02 ","$2,900.00 ","$1,455.02 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,36100158,20983,HC ABLATION TUMOR BONE PERC W/GUIDANCE CRYO,361,1 ,"$5,279.00 ","$2,639.50 ",$547.96 ,"$13,705.94 ",$547.96 ,"$5,279.00 ","$5,279.00 ","$6,091.53 ","$3,167.40 ","$4,487.15 ","$3,695.30 ",$547.96 ,"$5,015.05 ","$3,800.88 ","$3,853.67 ","$5,279.00 ","$4,487.15 ","$6,091.53 ","$5,279.00 ","$4,487.15 ","$3,853.67 ",$547.96 ,"$6,091.53 ","$5,279.00 ","$4,487.15 ","$13,705.94 ","$4,856.68 ","$3,695.30 ","$1,489.75 ","$2,002.44 ","$3,214.91 ","$1,862.71 ","$3,647.79 ","$3,800.88 ","$3,676.82 ","$6,152.45 ","$3,800.88 ",$580.84 ,"$5,279.00 ","$5,279.00 ","$6,091.53 ","$5,279.00 ","$6,091.53 ","$3,800.88 ","$3,272.98 ","$3,800.88 ","$3,800.88 ","$3,167.40 "
ST MARY'S HOSPITAL,36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,$668.00 ,$334.00 ,$136.73 ,"$1,389.48 ",$136.73 ,$668.00 ,$668.00 ,$617.55 ,$400.80 ,$567.80 ,$467.60 ,$136.73 ,$634.60 ,$480.96 ,$487.64 ,$668.00 ,$567.80 ,$617.55 ,$668.00 ,$567.80 ,$487.64 ,$136.73 ,$617.55 ,$668.00 ,$567.80 ,"$1,389.48 ",$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$480.96 ,$465.26 ,$623.73 ,$480.96 ,$144.93 ,$668.00 ,$668.00 ,$617.55 ,$668.00 ,$617.55 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$400.80 
ST MARY'S HOSPITAL,36100226,58345,HC TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING,361,1 ,"$1,722.00 ",$861.00 ,$713.62 ,"$5,741.06 ",$713.62 ,"$1,722.00 ","$1,722.00 ","$2,551.58 ","$1,033.20 ","$1,463.70 ","$1,205.40 ",$713.62 ,"$1,635.90 ","$1,239.84 ","$1,257.06 ","$1,722.00 ","$1,463.70 ","$2,551.58 ","$1,722.00 ","$1,463.70 ","$1,257.06 ",$713.62 ,"$2,551.58 ","$1,722.00 ","$1,463.70 ","$5,741.06 ","$1,584.24 ","$1,205.40 ","$1,489.75 ","$1,722.00 ","$1,048.70 ","$1,722.00 ","$1,189.90 ","$1,239.84 ","$1,199.37 ","$2,577.10 ","$1,239.84 ",$756.44 ,"$1,722.00 ","$1,722.00 ","$2,551.58 ","$1,722.00 ","$2,551.58 ","$1,239.84 ","$1,067.64 ","$1,239.84 ","$1,239.84 ","$1,033.20 "
ST MARY'S HOSPITAL,36100227,31635,HC BRONCHOSCOPY W/REM FOREIGN BODY,361,1 ,"$3,200.00 ","$1,600.00 ",$515.71 ,"$3,273.80 ",$515.71 ,"$3,200.00 ","$3,200.00 ","$1,455.02 ","$1,920.00 ","$2,720.00 ","$2,240.00 ",$515.71 ,"$3,040.00 ","$2,304.00 ","$2,336.00 ","$3,200.00 ","$2,720.00 ","$1,455.02 ","$3,200.00 ","$2,720.00 ","$2,336.00 ",$515.71 ,"$1,455.02 ","$2,489.10 ","$2,720.00 ","$3,273.80 ","$2,944.00 ","$2,240.00 ","$1,680.96 ","$2,259.84 ","$1,948.80 ","$2,101.20 ","$2,211.20 ","$2,304.00 ","$2,228.80 ","$1,469.57 ","$2,304.00 ",$546.65 ,"$3,200.00 ","$3,200.00 ","$1,455.02 ","$3,200.00 ","$1,455.02 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$1,920.00 "
ST MARY'S HOSPITAL,36100228,31641,HC BRONCHOSCOPY W/TUMOR DESTRUCTION,361,1 ,"$3,200.00 ","$1,600.00 ","$1,069.97 ","$6,778.10 ","$1,069.97 ","$3,200.00 ","$3,200.00 ","$3,012.49 ","$1,920.00 ","$2,720.00 ","$2,240.00 ","$1,069.97 ","$3,040.00 ","$2,304.00 ","$2,336.00 ","$3,200.00 ","$2,720.00 ","$3,012.49 ","$3,200.00 ","$2,720.00 ","$2,336.00 ","$1,069.97 ","$3,012.49 ","$3,200.00 ","$2,720.00 ","$6,778.10 ","$2,944.00 ","$2,240.00 ","$1,680.96 ","$2,259.84 ","$1,948.80 ","$2,101.20 ","$2,211.20 ","$2,304.00 ","$2,228.80 ","$3,042.61 ","$2,304.00 ","$1,134.17 ","$3,200.00 ","$3,200.00 ","$3,012.49 ","$3,200.00 ","$3,012.49 ","$2,304.00 ","$1,984.00 ","$2,304.00 ","$2,304.00 ","$1,920.00 "
ST MARY'S HOSPITAL,36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,$334.00 ,$167.00 ,$139.95 ,"$1,146.02 ",$139.95 ,$334.00 ,$334.00 ,$509.34 ,$200.40 ,$283.90 ,$233.80 ,$139.95 ,$317.30 ,$240.48 ,$243.82 ,$334.00 ,$283.90 ,$509.34 ,$334.00 ,$283.90 ,$243.82 ,$139.95 ,$509.34 ,$334.00 ,$283.90 ,"$1,146.02 ",$307.28 ,$233.80 ,$334.00 ,$334.00 ,$203.41 ,$334.00 ,$230.79 ,$240.48 ,$232.63 ,$514.43 ,$240.48 ,$148.35 ,$334.00 ,$334.00 ,$509.34 ,$334.00 ,$509.34 ,$240.48 ,$207.08 ,$240.48 ,$240.48 ,$200.40 
ST MARY'S HOSPITAL,36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$198.34 ,"$1,361.67 ",$198.34 ,"$1,185.00 ","$1,185.00 ",$605.19 ,$711.00 ,"$1,007.25 ",$829.50 ,$198.34 ,"$1,125.75 ",$853.20 ,$865.05 ,"$1,185.00 ","$1,007.25 ",$605.19 ,"$1,185.00 ","$1,007.25 ",$865.05 ,$198.34 ,$605.19 ,"$1,185.00 ","$1,007.25 ","$1,361.67 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$611.24 ,$853.20 ,$210.24 ,"$1,185.00 ","$1,185.00 ",$605.19 ,"$1,185.00 ",$605.19 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$198.34 ,"$2,259.84 ",$198.34 , N/A , N/A , N/A ,$355.80 ,$504.05 ,$415.10 ,$198.34 ,$563.35 ,$426.96 ,$432.89 ,$593.00 ,$504.05 , N/A ,$593.00 ,$504.05 ,$432.89 ,$198.34 , N/A , N/A ,$504.05 , N/A ,$545.56 ,$415.10 ,"$1,680.96 ","$2,259.84 ",$361.14 ,"$2,101.20 ",$409.76 ,$426.96 ,$413.02 , N/A ,$426.96 ,$210.24 ,$593.00 ,$593.00 , N/A ,$593.00 , N/A ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$355.80 
ST MARY'S HOSPITAL,36100240,10007,HC ASP FINE NDL W/FLUORO GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$198.34 ,"$1,361.67 ",$198.34 ,"$1,185.00 ","$1,185.00 ",$605.19 ,$711.00 ,"$1,007.25 ",$829.50 ,$198.34 ,"$1,125.75 ",$853.20 ,$865.05 ,"$1,185.00 ","$1,007.25 ",$605.19 ,"$1,185.00 ","$1,007.25 ",$865.05 ,$198.34 ,$605.19 ,"$1,185.00 ","$1,007.25 ","$1,361.67 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$611.24 ,$853.20 ,$210.24 ,"$1,185.00 ","$1,185.00 ",$605.19 ,"$1,185.00 ",$605.19 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,36100241,10008,HC ASP FINE NDL W/FLUORO GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$198.34 ,"$2,259.84 ",$198.34 , N/A , N/A , N/A ,$355.80 ,$504.05 ,$415.10 ,$198.34 ,$563.35 ,$426.96 ,$432.89 ,$593.00 ,$504.05 , N/A ,$593.00 ,$504.05 ,$432.89 ,$198.34 , N/A , N/A ,$504.05 , N/A ,$545.56 ,$415.10 ,"$1,680.96 ","$2,259.84 ",$361.14 ,"$2,101.20 ",$409.76 ,$426.96 ,$413.02 , N/A ,$426.96 ,$210.24 ,$593.00 ,$593.00 , N/A ,$593.00 , N/A ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$355.80 
ST MARY'S HOSPITAL,36100242,10009,HC ASP FINE NDL W/CT GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$198.34 ,"$1,361.67 ",$198.34 ,"$1,185.00 ","$1,185.00 ",$605.19 ,$711.00 ,"$1,007.25 ",$829.50 ,$198.34 ,"$1,125.75 ",$853.20 ,$865.05 ,"$1,185.00 ","$1,007.25 ",$605.19 ,"$1,185.00 ","$1,007.25 ",$865.05 ,$198.34 ,$605.19 ,"$1,185.00 ","$1,007.25 ","$1,361.67 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$611.24 ,$853.20 ,$210.24 ,"$1,185.00 ","$1,185.00 ",$605.19 ,"$1,185.00 ",$605.19 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,36100243,10010,HC ASP FINE NDL W/CT GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$198.34 ,"$2,259.84 ",$198.34 , N/A , N/A , N/A ,$355.80 ,$504.05 ,$415.10 ,$198.34 ,$563.35 ,$426.96 ,$432.89 ,$593.00 ,$504.05 , N/A ,$593.00 ,$504.05 ,$432.89 ,$198.34 , N/A , N/A ,$504.05 , N/A ,$545.56 ,$415.10 ,"$1,680.96 ","$2,259.84 ",$361.14 ,"$2,101.20 ",$409.76 ,$426.96 ,$413.02 , N/A ,$426.96 ,$210.24 ,$593.00 ,$593.00 , N/A ,$593.00 , N/A ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$355.80 
ST MARY'S HOSPITAL,36100246,36572,HC INS CATH PERIPH CV W/O PORT W/GUIDANCE <5,361,1 ,"$2,856.00 ","$1,428.00 ",$353.23 ,"$4,439.84 ",$353.23 ,"$2,601.00 ","$2,081.00 ",$525.67 ,"$1,713.60 ","$2,427.60 ","$1,999.20 ",$353.23 ,"$2,713.20 ","$2,056.32 ","$2,084.88 ","$2,856.00 ","$2,427.60 ",$525.67 ,"$2,856.00 ","$2,427.60 ","$2,084.88 ",$353.23 ,$525.67 ,"$2,856.00 ","$2,427.60 ","$1,182.77 ","$2,627.52 ","$1,999.20 ","$3,303.09 ","$4,439.84 ","$1,739.30 ","$4,128.86 ","$1,973.50 ","$2,056.32 ","$1,989.20 ",$530.93 ,"$2,056.32 ",$374.42 ,"$2,687.00 ","$2,687.00 ",$525.67 ,"$2,687.00 ",$525.67 ,"$2,056.32 ","$1,770.72 ","$2,056.32 ","$2,056.32 ","$1,713.60 "
ST MARY'S HOSPITAL,36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$3,124.00 ","$1,562.00 ",$353.23 ,"$4,439.84 ",$353.23 ,"$3,124.00 ","$3,124.00 ","$1,367.57 ","$1,874.40 ","$2,655.40 ","$2,186.80 ",$353.23 ,"$2,967.80 ","$2,249.28 ","$2,280.52 ","$3,124.00 ","$2,655.40 ","$1,367.57 ","$3,124.00 ","$2,655.40 ","$2,280.52 ",$353.23 ,"$1,367.57 ","$3,124.00 ","$2,655.40 ","$3,077.03 ","$2,874.08 ","$2,186.80 ","$3,303.09 ","$4,439.84 ","$1,902.52 ","$4,128.86 ","$2,158.68 ","$2,249.28 ","$2,175.87 ","$1,381.25 ","$2,249.28 ",$374.42 ,"$3,124.00 ","$3,124.00 ","$1,367.57 ","$3,124.00 ","$1,367.57 ","$2,249.28 ","$1,936.88 ","$2,249.28 ","$2,249.28 ","$1,874.40 "
ST MARY'S HOSPITAL,36100264,33016,HC PERICARDIOCENTESIS W/ OR W/O IMAGING,361,1 ,"$1,819.00 ",$909.50 ,$299.20 ,"$3,077.03 ",$299.20 ,"$1,819.00 ","$1,819.00 ","$1,367.57 ","$1,091.40 ","$1,546.15 ","$1,273.30 ",$299.20 ,"$1,728.05 ","$1,309.68 ","$1,327.87 ","$1,819.00 ","$1,546.15 ","$1,367.57 ","$1,819.00 ","$1,546.15 ","$1,327.87 ",$299.20 ,"$1,367.57 ","$1,819.00 ","$1,546.15 ","$3,077.03 ","$1,673.48 ","$1,273.30 ",$922.60 ,"$1,107.23 ","$1,107.77 ","$1,033.37 ","$1,256.93 ","$1,309.68 ","$1,266.93 ","$1,381.25 ","$1,309.68 ",$317.15 ,"$1,819.00 ","$1,819.00 ","$1,367.57 ","$1,819.00 ","$1,367.57 ","$1,309.68 ","$1,127.78 ","$1,309.68 ","$1,309.68 ","$1,091.40 "
ST MARY'S HOSPITAL,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 ","$1,617.84 ","$1,640.31 ","$2,247.00 ","$1,909.95 ", N/A ,"$2,247.00 ","$1,909.95 ","$1,640.31 ",$299.20 , 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 ","$1,276.52 ","$1,552.68 ","$1,617.84 ","$1,565.04 ", N/A ,"$1,617.84 ",$317.15 ,"$2,247.00 ","$2,247.00 ", N/A ,"$2,247.00 ", N/A ,"$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,348.20 "
ST MARY'S HOSPITAL,36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,389.48 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$617.55 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ",$617.55 ,"$1,293.00 ","$1,099.05 ",$943.89 ,$268.66 ,$617.55 ,"$1,293.00 ","$1,099.05 ","$1,389.48 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$623.73 ,$930.96 ,$284.78 ,"$1,293.00 ","$1,293.00 ",$617.55 ,"$1,293.00 ",$617.55 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36100271,62329,HC LUMBAR PUNCTURE THERAPEUTIC/DRAINAGE W//FLUORO OR CT GUID,361,1 ,"$1,293.00 ",$646.50 ,$268.66 ,"$1,389.48 ",$268.66 ,"$1,293.00 ","$1,293.00 ",$617.55 ,$775.80 ,"$1,099.05 ",$905.10 ,$268.66 ,"$1,228.35 ",$930.96 ,$943.89 ,"$1,293.00 ","$1,099.05 ",$617.55 ,"$1,293.00 ","$1,099.05 ",$943.89 ,$268.66 ,$617.55 ,"$1,293.00 ","$1,099.05 ","$1,389.48 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$623.73 ,$930.96 ,$284.78 ,"$1,293.00 ","$1,293.00 ",$617.55 ,"$1,293.00 ",$617.55 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,36100275,64625,HC ABLATION RF NERVES SI JOINT W/FLUORO OR CT GUID,361,1 ,"$3,555.00 ","$1,777.50 ",$432.02 ,"$3,842.24 ",$432.02 ,"$3,555.00 ","$3,555.00 ","$1,707.66 ","$2,133.00 ","$3,021.75 ","$2,488.50 ",$432.02 ,"$3,377.25 ","$2,559.60 ","$2,595.15 ","$3,555.00 ","$3,021.75 ","$1,707.66 ","$3,555.00 ","$3,021.75 ","$2,595.15 ",$432.02 ,"$1,707.66 ","$3,555.00 ","$3,021.75 ","$3,842.24 ","$3,270.60 ","$2,488.50 ","$1,803.10 ","$2,163.93 ","$2,165.00 ","$2,019.60 ","$2,456.51 ","$2,559.60 ","$2,476.06 ","$1,724.74 ","$2,559.60 ",$457.94 ,"$3,555.00 ","$3,555.00 ","$1,707.66 ","$3,555.00 ","$1,707.66 ","$2,559.60 ","$2,204.10 ","$2,559.60 ","$2,559.60 ","$2,133.00 "
ST MARY'S HOSPITAL,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 ,"$4,058.00 ","$3,641.00 ","$1,368.36 ","$2,642.40 ","$3,743.40 ","$3,082.80 ",$299.20 ,"$4,183.80 ","$3,170.88 ","$3,214.92 ","$4,404.00 ","$3,743.40 ","$1,368.36 ","$4,404.00 ","$3,743.40 ","$3,214.92 ",$299.20 ,"$1,368.36 ","$3,959.93 ","$3,743.40 ","$3,078.81 ","$4,051.68 ","$3,082.80 ","$2,233.71 ","$2,680.71 ","$2,682.04 ","$2,501.91 ","$3,043.16 ","$3,170.88 ","$3,067.39 ","$1,382.04 ","$3,170.88 ",$317.15 ,"$4,016.00 ","$4,016.00 ","$1,368.36 ","$4,016.00 ","$1,368.36 ","$3,170.88 ","$2,730.48 ","$3,170.88 ","$3,170.88 ","$2,642.40 "
ST MARY'S HOSPITAL,36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$250.00 ,$125.00 ,$125.00 ,"$3,917.96 ",$922.69 ,$161.73 ,$161.73 ,"$1,741.31 ",$150.00 ,$212.50 ,$175.00 ,$922.69 ,$237.50 ,$180.00 ,$182.50 ,$162.50 ,$212.50 ,"$1,741.31 ",$162.50 ,$212.50 ,$182.50 ,$922.69 ,"$1,741.31 ",$250.00 ,$212.50 ,"$3,917.96 ",$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$142.03 ,$172.75 ,$180.00 ,$174.13 ,"$1,758.72 ",$180.00 ,$978.05 ,$250.00 ,$250.00 ,"$1,741.31 ",$250.00 ,"$1,741.31 ",$180.00 ,$155.00 ,$180.00 ,$180.00 ,$150.00 
ST MARY'S HOSPITAL,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 ,$665.28 ,$674.52 ,$600.60 ,$785.40 , N/A ,$600.60 ,$785.40 ,$674.52 , N/A , N/A ,$388.08 ,$785.40 , N/A ,$850.08 ,$646.80 ,$468.65 ,$562.44 ,$562.72 ,$524.92 ,$638.48 ,$665.28 ,$643.57 , N/A ,$665.28 , N/A ,$554.40 ,$554.40 , N/A ,$554.40 , N/A ,$665.28 ,$572.88 ,$665.28 ,$665.28 ,$554.40 
ST MARY'S HOSPITAL,37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,"$1,100.00 ",$550.00 ,$205.75 ,"$1,100.00 ",$285.38 ,"$1,100.00 ","$1,100.00 ",$205.75 ,$660.00 ,$935.00 ,$770.00 ,$285.38 ,"$1,045.00 ",$792.00 ,$803.00 ,"$1,100.00 ",$935.00 ,$205.75 ,"$1,100.00 ",$935.00 ,$803.00 ,$285.38 ,$205.75 ,"$1,100.00 ",$935.00 ,$462.94 ,"$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$792.00 ,$766.15 ,$207.81 ,$792.00 ,$302.50 ,"$1,100.00 ","$1,100.00 ",$205.75 ,"$1,100.00 ",$205.75 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,$819.00 ,$409.50 ,$343.98 ,"$1,801.30 ",$364.34 ,$529.81 ,$529.81 ,$800.58 ,$491.40 ,$696.15 ,$573.30 ,$364.34 ,$778.05 ,$589.68 ,$597.87 ,$532.35 ,$696.15 ,$800.58 ,$532.35 ,$696.15 ,$597.87 ,$364.34 ,$800.58 ,$343.98 ,$696.15 ,"$1,801.30 ",$753.48 ,$573.30 ,$819.00 ,$819.00 ,$498.77 ,$819.00 ,$565.93 ,$589.68 ,$570.43 ,$808.59 ,$589.68 ,$386.20 ,$491.40 ,$491.40 ,$800.58 ,$491.40 ,$800.58 ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$491.40 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$52.00 ,$68.00 , N/A ,$52.00 ,$68.00 ,$58.40 ,$7.51 , N/A ,$33.60 ,$68.00 , N/A ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$45.45 ,$55.28 ,$57.60 ,$55.72 , N/A ,$57.60 ,$7.96 ,$48.00 ,$48.00 , N/A ,$48.00 , N/A ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$52.00 ,$68.00 , N/A ,$52.00 ,$68.00 ,$58.40 ,$7.51 , N/A ,$33.60 ,$68.00 , N/A ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$45.45 ,$55.28 ,$57.60 ,$55.72 , N/A ,$57.60 ,$7.96 ,$48.00 ,$48.00 , N/A ,$48.00 , N/A ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,$668.00 ,$334.00 ,$136.73 ,"$1,389.48 ",$136.73 ,$432.13 ,$432.13 ,$617.55 ,$400.80 ,$567.80 ,$467.60 ,$136.73 ,$634.60 ,$480.96 ,$487.64 ,$434.20 ,$567.80 ,$617.55 ,$434.20 ,$567.80 ,$487.64 ,$136.73 ,$617.55 ,$280.56 ,$567.80 ,"$1,389.48 ",$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$480.96 ,$465.26 ,$623.73 ,$480.96 ,$144.93 ,$400.80 ,$400.80 ,$617.55 ,$400.80 ,$617.55 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$400.80 
ST MARY'S HOSPITAL,37000022,64415,HC INTRASCALENE BLOCK SINGLE,370,1 ,$668.00 ,$334.00 ,$280.56 ,"$1,801.30 ",$364.34 ,$432.13 ,$432.13 ,$800.58 ,$400.80 ,$567.80 ,$467.60 ,$364.34 ,$634.60 ,$480.96 ,$487.64 ,$434.20 ,$567.80 ,$800.58 ,$434.20 ,$567.80 ,$487.64 ,$364.34 ,$800.58 ,$280.56 ,$567.80 ,"$1,801.30 ",$614.56 ,$467.60 ,$668.00 ,$668.00 ,$406.81 ,$668.00 ,$461.59 ,$480.96 ,$465.26 ,$808.59 ,$480.96 ,$386.20 ,$400.80 ,$400.80 ,$800.58 ,$400.80 ,$800.58 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$400.80 
ST MARY'S HOSPITAL,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 ",$800.58 ,"$1,483.80 ","$2,102.05 ","$1,731.10 ",$364.34 ,"$2,349.35 ","$1,780.56 ","$1,805.29 ","$1,607.45 ","$2,102.05 ",$800.58 ,"$1,607.45 ","$2,102.05 ","$1,805.29 ",$364.34 ,$800.58 ,"$1,038.66 ","$2,102.05 ","$1,801.30 ","$2,275.16 ","$1,731.10 ","$1,489.75 ","$2,002.44 ","$1,506.06 ","$1,862.71 ","$1,708.84 ","$1,780.56 ","$1,722.44 ",$808.59 ,"$1,780.56 ",$386.20 ,"$1,483.80 ","$1,483.80 ",$800.58 ,"$1,483.80 ",$800.58 ,"$1,780.56 ","$1,533.26 ","$1,780.56 ","$1,780.56 ","$1,483.80 "
ST MARY'S HOSPITAL,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 ,$468.72 ,$475.23 ,$423.15 ,$553.35 , N/A ,$423.15 ,$553.35 ,$475.23 , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$369.83 ,$449.84 ,$468.72 ,$453.42 , N/A ,$468.72 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 , N/A ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$390.60 
ST MARY'S HOSPITAL,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 ,$468.72 ,$475.23 ,$423.15 ,$553.35 , N/A ,$423.15 ,$553.35 ,$475.23 , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$369.83 ,$449.84 ,$468.72 ,$453.42 , N/A ,$468.72 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 , N/A ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$390.60 
ST MARY'S HOSPITAL,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 ,$468.72 ,$475.23 ,$423.15 ,$553.35 , N/A ,$423.15 ,$553.35 ,$475.23 , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$369.83 ,$449.84 ,$468.72 ,$453.42 , N/A ,$468.72 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 , N/A ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$390.60 
ST MARY'S HOSPITAL,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 ,$468.72 ,$475.23 ,$423.15 ,$553.35 , N/A ,$423.15 ,$553.35 ,$475.23 , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$369.83 ,$449.84 ,$468.72 ,$453.42 , N/A ,$468.72 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 , N/A ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$390.60 
ST MARY'S HOSPITAL,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 ,$589.68 ,$597.87 ,$532.35 ,$696.15 , N/A ,$532.35 ,$696.15 ,$597.87 , N/A , N/A ,$343.98 ,$696.15 , N/A ,$753.48 ,$573.30 ,$415.40 ,$498.53 ,$498.77 ,$465.27 ,$565.93 ,$589.68 ,$570.43 , N/A ,$589.68 , N/A ,$491.40 ,$491.40 , N/A ,$491.40 , N/A ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$491.40 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$109.20 ,$142.80 , N/A ,$109.20 ,$142.80 ,$122.64 , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 , N/A ,$120.96 , N/A ,$100.80 ,$100.80 , N/A ,$100.80 , N/A ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ","$1,058.40 ","$1,073.10 ",$955.50 ,"$1,249.50 ", N/A ,$955.50 ,"$1,249.50 ","$1,073.10 ", N/A , N/A ,$617.40 ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$835.11 ,"$1,015.77 ","$1,058.40 ","$1,023.86 ", N/A ,"$1,058.40 ", N/A ,$882.00 ,$882.00 , N/A ,$882.00 , N/A ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ",$882.00 
ST MARY'S HOSPITAL,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 ,$144.00 ,$146.00 ,$130.00 ,$170.00 , N/A ,$130.00 ,$170.00 ,$146.00 , N/A , N/A ,$84.00 ,$170.00 , N/A ,$184.00 ,$140.00 ,$101.44 ,$121.74 ,$121.80 ,$113.62 ,$138.20 ,$144.00 ,$139.30 , N/A ,$144.00 , N/A ,$120.00 ,$120.00 , N/A ,$120.00 , N/A ,$144.00 ,$124.00 ,$144.00 ,$144.00 ,$120.00 
ST MARY'S HOSPITAL,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 ,$468.72 ,$475.23 ,$423.15 ,$553.35 , N/A ,$423.15 ,$553.35 ,$475.23 , N/A , N/A ,$273.42 ,$553.35 , N/A ,$598.92 ,$455.70 ,$330.19 ,$396.26 ,$396.46 ,$369.83 ,$449.84 ,$468.72 ,$453.42 , N/A ,$468.72 , N/A ,$390.60 ,$390.60 , N/A ,$390.60 , N/A ,$468.72 ,$403.62 ,$468.72 ,$468.72 ,$390.60 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$109.20 ,$142.80 , N/A ,$109.20 ,$142.80 ,$122.64 , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 , N/A ,$120.96 , N/A ,$100.80 ,$100.80 , N/A ,$100.80 , N/A ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ","$1,058.40 ","$1,073.10 ",$955.50 ,"$1,249.50 ", N/A ,$955.50 ,"$1,249.50 ","$1,073.10 ", N/A , N/A ,$617.40 ,"$1,249.50 ", N/A ,"$1,352.40 ","$1,029.00 ",$745.58 ,$894.79 ,$895.23 ,$835.11 ,"$1,015.77 ","$1,058.40 ","$1,023.86 ", N/A ,"$1,058.40 ", N/A ,$882.00 ,$882.00 , N/A ,$882.00 , N/A ,"$1,058.40 ",$911.40 ,"$1,058.40 ","$1,058.40 ",$882.00 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$109.20 ,$142.80 , N/A ,$109.20 ,$142.80 ,$122.64 , N/A , N/A ,$70.56 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 , N/A ,$120.96 , N/A ,$100.80 ,$100.80 , N/A ,$100.80 , N/A ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ","$3,099.60 ","$3,142.65 ","$2,798.25 ","$3,659.25 ", N/A ,"$2,798.25 ","$3,659.25 ","$3,142.65 ", 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 ","$2,445.67 ","$2,974.76 ","$3,099.60 ","$2,998.43 ", N/A ,"$3,099.60 ", N/A ,"$2,583.00 ","$2,583.00 ", N/A ,"$2,583.00 ", N/A ,"$3,099.60 ","$2,669.10 ","$3,099.60 ","$3,099.60 ","$2,583.00 "
ST MARY'S HOSPITAL,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 ,$234.72 ,$237.98 ,$211.90 ,$277.10 , N/A ,$211.90 ,$277.10 ,$237.98 , N/A , N/A ,$136.92 ,$277.10 , N/A ,$299.92 ,$228.20 ,$165.35 ,$198.44 ,$198.53 ,$185.20 ,$225.27 ,$234.72 ,$227.06 , N/A ,$234.72 , N/A ,$195.60 ,$195.60 , N/A ,$195.60 , N/A ,$234.72 ,$202.12 ,$234.72 ,$234.72 ,$195.60 
ST MARY'S HOSPITAL,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 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$7.51 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,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 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$7.51 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,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 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$7.51 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,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 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$7.51 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,37000090,99152,HC BRONCH 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 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$7.51 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$7.96 ,$228.00 ,$228.00 , N/A ,$228.00 , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,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 ,$616.32 ,$624.88 ,$556.40 ,$727.60 , N/A ,$556.40 ,$727.60 ,$624.88 , N/A , N/A ,$359.52 ,$727.60 , N/A ,$787.52 ,$599.20 ,$434.16 ,$521.05 ,$521.30 ,$486.29 ,$591.50 ,$616.32 ,$596.20 , N/A ,$616.32 , N/A ,$513.60 ,$513.60 , N/A ,$513.60 , N/A ,$616.32 ,$530.72 ,$616.32 ,$616.32 ,$513.60 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$131.30 ,$171.70 ,$81.53 ,$131.30 ,$171.70 ,$147.46 ,$46.72 ,$81.53 ,$202.00 ,$171.70 ,$183.44 ,$185.84 ,$141.40 ,$202.00 ,$202.00 ,$123.02 ,$202.00 ,$139.58 ,$145.44 ,$140.69 ,$82.35 ,$145.44 ,$49.52 ,$202.00 ,$202.00 ,$81.53 ,$202.00 ,$81.53 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$131.30 ,$171.70 ,$81.53 ,$131.30 ,$171.70 ,$147.46 ,$46.72 ,$81.53 ,$202.00 ,$171.70 ,$183.44 ,$185.84 ,$141.40 ,$202.00 ,$202.00 ,$123.02 ,$202.00 ,$139.58 ,$145.44 ,$140.69 ,$82.35 ,$145.44 ,$49.52 ,$202.00 ,$202.00 ,$81.53 ,$202.00 ,$81.53 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$282.24 ,$286.16 ,$254.80 ,$333.20 ,$192.39 ,$254.80 ,$333.20 ,$286.16 ,$392.00 ,$192.39 ,$392.00 ,$333.20 ,$432.88 ,$360.64 ,$274.40 ,$392.00 ,$392.00 ,$238.73 ,$392.00 ,$270.87 ,$282.24 ,$273.03 ,$194.31 ,$282.24 ,$415.52 ,$392.00 ,$392.00 ,$192.39 ,$392.00 ,$192.39 ,$282.24 ,$243.04 ,$282.24 ,$282.24 ,$235.20 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$159.90 ,$209.10 ,$84.40 ,$159.90 ,$209.10 ,$179.58 ,$38.65 ,$84.40 ,$246.00 ,$209.10 ,$189.90 ,$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$177.12 ,$171.34 ,$85.24 ,$177.12 ,$40.97 ,$246.00 ,$246.00 ,$84.40 ,$246.00 ,$84.40 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,39000111,P9017,HC FRESH FROZEN PLASMA EA (PED),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 ,$177.12 ,$179.58 ,$159.90 ,$209.10 ,$84.40 ,$159.90 ,$209.10 ,$179.58 ,$38.65 ,$84.40 ,$246.00 ,$209.10 ,$189.90 ,$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$177.12 ,$171.34 ,$85.24 ,$177.12 ,$40.97 ,$246.00 ,$246.00 ,$84.40 ,$246.00 ,$84.40 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$159.90 ,$209.10 ,$84.40 ,$159.90 ,$209.10 ,$179.58 ,$38.65 ,$84.40 ,$246.00 ,$209.10 ,$189.90 ,$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$177.12 ,$171.34 ,$85.24 ,$177.12 ,$40.97 ,$246.00 ,$246.00 ,$84.40 ,$246.00 ,$84.40 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,39000114,P9019,HC PLATELETS EA UNIT,390,1 ,$246.00 ,$123.00 ,$64.42 ,$246.00 ,$64.42 ,$159.14 ,$159.14 ,$72.79 ,$147.60 ,$209.10 ,$172.20 ,$64.42 ,$233.70 ,$177.12 ,$179.58 ,$159.90 ,$209.10 ,$72.79 ,$159.90 ,$209.10 ,$179.58 ,$64.42 ,$72.79 ,$246.00 ,$209.10 ,$163.78 ,$226.32 ,$172.20 ,$246.00 ,$246.00 ,$149.81 ,$246.00 ,$169.99 ,$177.12 ,$171.34 ,$73.52 ,$177.12 ,$68.29 ,$246.00 ,$246.00 ,$72.79 ,$246.00 ,$72.79 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,39000115,P9021,HC RED CELLS PACKED EA (AUTOLOGOUS),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 ,$322.56 ,$327.04 ,$291.20 ,$380.80 ,$140.53 ,$291.20 ,$380.80 ,$327.04 ,$46.72 ,$140.53 ,$448.00 ,$380.80 ,$316.19 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$322.56 ,$312.03 ,$141.94 ,$322.56 ,$49.52 ,$448.00 ,$448.00 ,$140.53 ,$448.00 ,$140.53 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,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 ,$322.56 ,$327.04 ,$291.20 ,$380.80 ,$140.53 ,$291.20 ,$380.80 ,$327.04 ,$46.72 ,$140.53 ,$448.00 ,$380.80 ,$316.19 ,$412.16 ,$313.60 ,$448.00 ,$448.00 ,$272.83 ,$448.00 ,$309.57 ,$322.56 ,$312.03 ,$141.94 ,$322.56 ,$49.52 ,$448.00 ,$448.00 ,$140.53 ,$448.00 ,$140.53 ,$322.56 ,$277.76 ,$322.56 ,$322.56 ,$268.80 
ST MARY'S HOSPITAL,39000117,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,$353.00 ,$176.50 ,$46.72 ,$353.00 ,$46.72 ,$228.36 ,$228.36 ,$153.07 ,$211.80 ,$300.05 ,$247.10 ,$46.72 ,$335.35 ,$254.16 ,$257.69 ,$229.45 ,$300.05 ,$153.07 ,$229.45 ,$300.05 ,$257.69 ,$46.72 ,$153.07 ,$353.00 ,$300.05 ,$344.41 ,$324.76 ,$247.10 ,$353.00 ,$353.00 ,$214.98 ,$353.00 ,$243.92 ,$254.16 ,$245.86 ,$154.60 ,$254.16 ,$49.52 ,$353.00 ,$353.00 ,$153.07 ,$353.00 ,$153.07 ,$254.16 ,$218.86 ,$254.16 ,$254.16 ,$211.80 
ST MARY'S HOSPITAL,39000119,P9033,HC PLATELETS L/R IRR EA,390,1 ,$515.00 ,$257.50 ,$117.41 ,$515.00 ,$117.41 ,$333.15 ,$333.15 ,$217.66 ,$309.00 ,$437.75 ,$360.50 ,$117.41 ,$489.25 ,$370.80 ,$375.95 ,$334.75 ,$437.75 ,$217.66 ,$334.75 ,$437.75 ,$375.95 ,$117.41 ,$217.66 ,$454.83 ,$437.75 ,$489.74 ,$473.80 ,$360.50 ,$515.00 ,$515.00 ,$313.64 ,$515.00 ,$355.87 ,$370.80 ,$358.70 ,$219.84 ,$370.80 ,$124.45 ,$460.00 ,$460.00 ,$217.66 ,$460.00 ,$217.66 ,$370.80 ,$319.30 ,$370.80 ,$370.80 ,$309.00 
ST MARY'S HOSPITAL,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 ","$1,128.96 ","$1,144.64 ","$1,019.20 ","$1,332.80 ",$496.91 ,"$1,019.20 ","$1,332.80 ","$1,144.64 ",$117.41 ,$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 ","$1,128.96 ","$1,092.11 ",$501.88 ,"$1,128.96 ",$124.45 ,$460.00 ,$460.00 ,$496.91 ,$460.00 ,$496.91 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ","$1,128.96 ","$1,144.64 ","$1,019.20 ","$1,332.80 ",$630.32 ,"$1,019.20 ","$1,332.80 ","$1,144.64 ",$117.41 ,$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 ","$1,128.96 ","$1,092.11 ",$636.62 ,"$1,128.96 ",$124.45 ,$460.00 ,$460.00 ,$630.32 ,$460.00 ,$630.32 ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ,$620.64 ,$629.26 ,$560.30 ,$732.70 ,$266.03 ,$560.30 ,$732.70 ,$629.26 ,$46.72 ,$266.03 ,$454.83 ,$732.70 ,$598.57 ,$793.04 ,$603.40 ,$862.00 ,$862.00 ,$524.96 ,$862.00 ,$595.64 ,$620.64 ,$600.38 ,$268.69 ,$620.64 ,$49.52 ,$460.00 ,$460.00 ,$266.03 ,$460.00 ,$266.03 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$517.20 
ST MARY'S HOSPITAL,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 ,$620.64 ,$629.26 ,$560.30 ,$732.70 ,$266.03 ,$560.30 ,$732.70 ,$629.26 ,$46.72 ,$266.03 ,$454.83 ,$732.70 ,$598.57 ,$793.04 ,$603.40 ,$862.00 ,$862.00 ,$524.96 ,$862.00 ,$595.64 ,$620.64 ,$600.38 ,$268.69 ,$620.64 ,$49.52 ,$460.00 ,$460.00 ,$266.03 ,$460.00 ,$266.03 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$517.20 
ST MARY'S HOSPITAL,39000131,P9051,HC RBC L/R CMV NEG EA,390,1 ,$638.00 ,$319.00 ,$46.72 ,$638.00 ,$46.72 ,$412.72 ,$412.72 ,$216.68 ,$382.80 ,$542.30 ,$446.60 ,$46.72 ,$606.10 ,$459.36 ,$465.74 ,$414.70 ,$542.30 ,$216.68 ,$414.70 ,$542.30 ,$465.74 ,$46.72 ,$216.68 ,$454.83 ,$542.30 ,$487.53 ,$586.96 ,$446.60 ,$638.00 ,$638.00 ,$388.54 ,$638.00 ,$440.86 ,$459.36 ,$444.37 ,$218.85 ,$459.36 ,$49.52 ,$460.00 ,$460.00 ,$216.68 ,$460.00 ,$216.68 ,$459.36 ,$395.56 ,$459.36 ,$459.36 ,$382.80 
ST MARY'S HOSPITAL,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 ","$1,693.44 ","$1,716.96 ","$1,528.80 ","$1,999.20 ",$822.11 ,"$1,528.80 ","$1,999.20 ","$1,716.96 ",$117.41 ,$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 ","$1,693.44 ","$1,638.17 ",$830.33 ,"$1,693.44 ",$124.45 ,$460.00 ,$460.00 ,$822.11 ,$460.00 ,$822.11 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,411.20 "
ST MARY'S HOSPITAL,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 ","$1,693.44 ","$1,716.96 ","$1,528.80 ","$1,999.20 ",$822.11 ,"$1,528.80 ","$1,999.20 ","$1,716.96 ",$117.41 ,$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 ","$1,693.44 ","$1,638.17 ",$830.33 ,"$1,693.44 ",$124.45 ,$460.00 ,$460.00 ,$822.11 ,$460.00 ,$822.11 ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,411.20 "
ST MARY'S HOSPITAL,39000134,P9053,HC PLTS PHERESIS LEUKORED CMV IRR,390,1 ,"$2,016.00 ","$1,008.00 ",$117.41 ,"$2,016.00 ",$117.41 ,"$1,304.15 ","$1,304.15 ",$456.71 ,"$1,209.60 ","$1,713.60 ","$1,411.20 ",$117.41 ,"$1,915.20 ","$1,451.52 ","$1,471.68 ","$1,310.40 ","$1,713.60 ",$456.71 ,"$1,310.40 ","$1,713.60 ","$1,471.68 ",$117.41 ,$456.71 ,$454.83 ,"$1,713.60 ","$1,027.60 ","$1,854.72 ","$1,411.20 ","$2,016.00 ","$2,016.00 ","$1,227.74 ","$2,016.00 ","$1,393.06 ","$1,451.52 ","$1,404.14 ",$461.28 ,"$1,451.52 ",$124.45 ,$460.00 ,$460.00 ,$456.71 ,$460.00 ,$456.71 ,"$1,451.52 ","$1,249.92 ","$1,451.52 ","$1,451.52 ","$1,209.60 "
ST MARY'S HOSPITAL,39000137,P9016,HC RBC L/R WASHED SALINE (RC),390,1 ,$946.00 ,$473.00 ,$192.39 ,$946.00 ,$449.49 ,$611.97 ,$611.97 ,$192.39 ,$567.60 ,$804.10 ,$662.20 ,$449.49 ,$898.70 ,$681.12 ,$690.58 ,$614.90 ,$804.10 ,$192.39 ,$614.90 ,$804.10 ,$690.58 ,$449.49 ,$192.39 ,$454.83 ,$804.10 ,$432.88 ,$870.32 ,$662.20 ,$733.36 ,$788.47 ,$576.11 ,$733.36 ,$653.69 ,$681.12 ,$658.89 ,$194.31 ,$681.12 ,$476.46 ,$460.00 ,$460.00 ,$192.39 ,$460.00 ,$192.39 ,$681.12 ,$586.52 ,$681.12 ,$681.12 ,$567.60 
ST MARY'S HOSPITAL,39000138,P9055,HC PHER PLT LR CMV NEG,390,1 ,"$1,596.00 ",$798.00 ,$117.41 ,"$1,596.00 ",$117.41 ,"$1,032.45 ","$1,032.45 ",$490.13 ,$957.60 ,"$1,356.60 ","$1,117.20 ",$117.41 ,"$1,516.20 ","$1,149.12 ","$1,165.08 ","$1,037.40 ","$1,356.60 ",$490.13 ,"$1,037.40 ","$1,356.60 ","$1,165.08 ",$117.41 ,$490.13 ,$454.83 ,"$1,356.60 ","$1,102.79 ","$1,468.32 ","$1,117.20 ","$1,596.00 ","$1,596.00 ",$971.96 ,"$1,596.00 ","$1,102.84 ","$1,149.12 ","$1,111.61 ",$495.03 ,"$1,149.12 ",$124.45 ,$460.00 ,$460.00 ,$490.13 ,$460.00 ,$490.13 ,"$1,149.12 ",$989.52 ,"$1,149.12 ","$1,149.12 ",$957.60 
ST MARY'S HOSPITAL,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 ,$580.32 ,$588.38 ,$523.90 ,$685.10 ,$248.99 ,$523.90 ,$685.10 ,$588.38 ,$46.72 ,$248.99 ,$454.83 ,$685.10 ,$560.23 ,$741.52 ,$564.20 ,$806.00 ,$806.00 ,$490.85 ,$806.00 ,$556.95 ,$580.32 ,$561.38 ,$251.48 ,$580.32 ,$49.52 ,$460.00 ,$460.00 ,$248.99 ,$460.00 ,$248.99 ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$483.60 
ST MARY'S HOSPITAL,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 ",$820.08 ,$831.47 ,$740.35 ,$968.15 ,$596.13 ,$740.35 ,$968.15 ,$831.47 ,$117.41 ,$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 ,$820.08 ,$793.31 ,$602.09 ,$820.08 ,$124.45 ,$460.00 ,$460.00 ,$596.13 ,$460.00 ,$596.13 ,$820.08 ,$706.18 ,$820.08 ,$820.08 ,$683.40 
ST MARY'S HOSPITAL,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 ,$681.12 ,$690.58 ,$614.90 ,$804.10 ,$266.03 ,$614.90 ,$804.10 ,$690.58 ,$46.72 ,$266.03 ,$454.83 ,$804.10 ,$598.57 ,$870.32 ,$662.20 ,$946.00 ,$946.00 ,$576.11 ,$946.00 ,$653.69 ,$681.12 ,$658.89 ,$268.69 ,$681.12 ,$49.52 ,$460.00 ,$460.00 ,$266.03 ,$460.00 ,$266.03 ,$681.12 ,$586.52 ,$681.12 ,$681.12 ,$567.60 
ST MARY'S HOSPITAL,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 ","$1,147.68 ","$1,163.62 ","$1,036.10 ","$1,354.90 ",$72.64 ,"$1,036.10 ","$1,354.90 ","$1,163.62 ",$46.72 ,$72.64 ,$454.83 ,"$1,354.90 ",$163.44 ,"$1,466.48 ","$1,115.80 ",$267.64 ,$287.75 ,$970.75 ,$267.64 ,"$1,101.45 ","$1,147.68 ","$1,110.22 ",$73.37 ,"$1,147.68 ",$49.52 ,$460.00 ,$460.00 ,$72.64 ,$460.00 ,$72.64 ,"$1,147.68 ",$988.28 ,"$1,147.68 ","$1,147.68 ",$956.40 
ST MARY'S HOSPITAL,39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$937.00 ,$468.50 ,$144.58 ,$937.00 ,$144.58 ,$606.15 ,$606.15 ,$386.01 ,$562.20 ,$796.45 ,$655.90 ,$144.58 ,$890.15 ,$674.64 ,$684.01 ,$609.05 ,$796.45 ,$386.01 ,$609.05 ,$796.45 ,$684.01 ,$144.58 ,$386.01 ,$454.83 ,$796.45 ,$868.52 ,$862.04 ,$655.90 ,$475.25 ,$570.35 ,$570.63 ,$532.31 ,$647.47 ,$674.64 ,$652.62 ,$389.87 ,$674.64 ,$153.25 ,$460.00 ,$460.00 ,$386.01 ,$460.00 ,$386.01 ,$674.64 ,$580.94 ,$674.64 ,$674.64 ,$562.20 
ST MARY'S HOSPITAL,39100002,36430,HC MASSIVE TRANSFUSION,391,1 ,$937.00 ,$468.50 ,$144.58 ,$937.00 ,$144.58 ,$606.15 ,$606.15 ,$386.01 ,$562.20 ,$796.45 ,$655.90 ,$144.58 ,$890.15 ,$674.64 ,$684.01 ,$609.05 ,$796.45 ,$386.01 ,$609.05 ,$796.45 ,$684.01 ,$144.58 ,$386.01 ,$454.83 ,$796.45 ,$868.52 ,$862.04 ,$655.90 ,$475.25 ,$570.35 ,$570.63 ,$532.31 ,$647.47 ,$674.64 ,$652.62 ,$389.87 ,$674.64 ,$153.25 ,$460.00 ,$460.00 ,$386.01 ,$460.00 ,$386.01 ,$674.64 ,$580.94 ,$674.64 ,$674.64 ,$562.20 
ST MARY'S HOSPITAL,40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$312.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$331.20 ,$335.80 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$391.00 ,$335.80 ,$15.90 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$354.69 ,$380.79 ,$280.14 ,$354.69 ,$317.86 ,$331.20 ,$320.39 ,$109.75 ,$331.20 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$108.66 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$276.00 
ST MARY'S HOSPITAL,40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$312.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$331.20 ,$335.80 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$391.00 ,$335.80 ,$15.90 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$354.69 ,$380.79 ,$280.14 ,$354.69 ,$317.86 ,$331.20 ,$320.39 ,$109.75 ,$331.20 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$108.66 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$276.00 
ST MARY'S HOSPITAL,40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$312.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$331.20 ,$335.80 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$391.00 ,$335.80 ,$15.90 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$354.69 ,$380.79 ,$280.14 ,$354.69 ,$317.86 ,$331.20 ,$320.39 ,$109.75 ,$331.20 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$108.66 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$276.00 
ST MARY'S HOSPITAL,40100006,77066,HC MAMMOGRAM DIAG W/CAD UPGRADE BIL,401,1 ,$460.00 ,$230.00 ,$15.90 ,$460.00 ,$15.90 ,$312.00 ,$208.00 ,$108.66 ,$276.00 ,$391.00 ,$322.00 ,$15.90 ,$437.00 ,$331.20 ,$335.80 ,$222.75 ,$391.00 ,$108.66 ,$222.75 ,$391.00 ,$335.80 ,$15.90 ,$108.66 ,$158.40 ,$391.00 ,$244.49 ,$423.20 ,$322.00 ,$354.69 ,$380.79 ,$280.14 ,$354.69 ,$317.86 ,$331.20 ,$320.39 ,$109.75 ,$331.20 ,$16.85 ,$163.00 ,$163.00 ,$108.66 ,$163.00 ,$108.66 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$276.00 
ST MARY'S HOSPITAL,40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$312.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$252.00 ,$255.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$297.50 ,$255.50 ,$15.90 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$277.51 ,$297.93 ,$213.15 ,$277.51 ,$241.85 ,$252.00 ,$243.78 ,$86.04 ,$252.00 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$85.19 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$312.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$252.00 ,$255.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$297.50 ,$255.50 ,$15.90 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$277.51 ,$297.93 ,$213.15 ,$277.51 ,$241.85 ,$252.00 ,$243.78 ,$86.04 ,$252.00 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$85.19 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$312.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$252.00 ,$255.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$297.50 ,$255.50 ,$15.90 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$277.51 ,$297.93 ,$213.15 ,$277.51 ,$241.85 ,$252.00 ,$243.78 ,$86.04 ,$252.00 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$85.19 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,40100010,77065,HC MAMMOGRAM DIAG UNIL W/CAD UPGRADE,401,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$312.00 ,$208.00 ,$85.19 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$252.00 ,$255.50 ,$174.64 ,$297.50 ,$85.19 ,$174.64 ,$297.50 ,$255.50 ,$15.90 ,$85.19 ,$158.40 ,$297.50 ,$191.68 ,$322.00 ,$245.00 ,$277.51 ,$297.93 ,$213.15 ,$277.51 ,$241.85 ,$252.00 ,$243.78 ,$86.04 ,$252.00 ,$16.85 ,$163.00 ,$163.00 ,$85.19 ,$163.00 ,$85.19 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,40200004,21920,HC BX SOFT TISSUE BACK/FLANK SUP,402,1 ,"$1,465.00 ",$732.50 ,$302.13 ,"$3,078.81 ",$547.96 ,$572.00 ,$536.00 ,"$1,368.36 ",$879.00 ,"$1,245.25 ","$1,025.50 ",$547.96 ,"$1,391.75 ","$1,054.80 ","$1,069.45 ",$302.13 ,"$1,245.25 ","$1,368.36 ",$302.13 ,"$1,245.25 ","$1,069.45 ",$547.96 ,"$1,368.36 ",$305.48 ,"$1,245.25 ","$3,078.81 ","$1,347.80 ","$1,025.50 ","$1,465.00 ","$1,465.00 ",$892.19 ,"$1,465.00 ","$1,012.32 ","$1,054.80 ","$1,020.37 ","$1,382.04 ","$1,054.80 ",$580.84 ,$512.00 ,$512.00 ,"$1,368.36 ",$512.00 ,"$1,368.36 ","$1,054.80 ",$908.30 ,"$1,054.80 ","$1,054.80 ",$879.00 
ST MARY'S HOSPITAL,40200005,21925,HC BX SOFT TISSUE BACK/FLANK DEEP,402,1 ,"$3,878.00 ","$1,939.00 ",$305.48 ,"$3,878.00 ",$547.96 ,$572.00 ,$536.00 ,"$1,368.36 ","$2,326.80 ","$3,296.30 ","$2,714.60 ",$547.96 ,"$3,684.10 ","$2,792.16 ","$2,830.94 ",$722.36 ,"$3,296.30 ","$1,368.36 ",$722.36 ,"$3,296.30 ","$2,830.94 ",$547.96 ,"$1,368.36 ",$305.48 ,"$3,296.30 ","$3,078.81 ","$3,567.76 ","$2,714.60 ","$1,680.96 ","$2,259.84 ","$2,361.70 ","$2,101.20 ","$2,679.70 ","$2,792.16 ","$2,701.03 ","$1,382.04 ","$2,792.16 ",$580.84 ,$512.00 ,$512.00 ,"$1,368.36 ",$512.00 ,"$1,368.36 ","$2,792.16 ","$2,404.36 ","$2,792.16 ","$2,792.16 ","$2,326.80 "
ST MARY'S HOSPITAL,40200007,51798,HC US BLADDER SCAN,402,1 ,$183.00 ,$91.50 ,$20.25 ,$183.00 ,$22.63 ,$183.00 ,$183.00 ,$54.13 ,$109.80 ,$155.55 ,$128.10 ,$22.63 ,$173.85 ,$131.76 ,$133.59 ,$20.25 ,$155.55 ,$54.13 ,$20.25 ,$155.55 ,$133.59 ,$22.63 ,$54.13 ,$183.00 ,$155.55 ,$121.80 ,$168.36 ,$128.10 ,$183.00 ,$183.00 ,$111.45 ,$183.00 ,$126.45 ,$131.76 ,$127.46 ,$54.67 ,$131.76 ,$23.99 ,$183.00 ,$183.00 ,$54.13 ,$183.00 ,$54.13 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,40200009,49407,HC DRAIN ABSC PELVIC TRNSVAG PERC,402,1 ,"$2,400.00 ","$1,200.00 ",$232.13 ,"$3,078.81 ",$232.13 ,$572.00 ,$536.00 ,"$1,368.36 ","$1,440.00 ","$2,040.00 ","$1,680.00 ",$232.13 ,"$2,280.00 ","$1,728.00 ","$1,752.00 ",$398.99 ,"$2,040.00 ","$1,368.36 ",$398.99 ,"$2,040.00 ","$1,752.00 ",$232.13 ,"$1,368.36 ",$305.48 ,"$2,040.00 ","$3,078.81 ","$2,208.00 ","$1,680.00 ","$1,680.96 ","$2,259.84 ","$1,461.60 ","$2,101.20 ","$1,658.40 ","$1,728.00 ","$1,671.60 ","$1,382.04 ","$1,728.00 ",$246.06 ,$512.00 ,$512.00 ,"$1,368.36 ",$512.00 ,"$1,368.36 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,440.00 "
ST MARY'S HOSPITAL,40200010,59000,HC AMNIOCENTESIS DIAGNOSTIC,402,1 ,$619.00 ,$309.50 ,$146.10 ,"$1,387.23 ",$204.42 ,$572.00 ,$536.00 ,$616.55 ,$371.40 ,$526.15 ,$433.30 ,$204.42 ,$588.05 ,$445.68 ,$451.87 ,$146.10 ,$526.15 ,$616.55 ,$146.10 ,$526.15 ,$451.87 ,$204.42 ,$616.55 ,$305.48 ,$526.15 ,"$1,387.23 ",$569.48 ,$433.30 ,$619.00 ,$619.00 ,$376.97 ,$619.00 ,$427.73 ,$445.68 ,$431.13 ,$622.72 ,$445.68 ,$216.69 ,$512.00 ,$512.00 ,$616.55 ,$512.00 ,$616.55 ,$445.68 ,$383.78 ,$445.68 ,$445.68 ,$371.40 
ST MARY'S HOSPITAL,40200012,76506,HC US ENCEPHALOGRAM,402,1 ,$900.00 ,$450.00 ,$34.74 ,$900.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$540.00 ,$765.00 ,$630.00 ,$34.74 ,$855.00 ,$648.00 ,$657.00 ,$170.62 ,$765.00 ,$105.88 ,$170.62 ,$765.00 ,$657.00 ,$34.74 ,$105.88 ,$305.48 ,$765.00 ,$238.23 ,$828.00 ,$630.00 ,$447.17 ,$480.07 ,$548.10 ,$447.17 ,$621.90 ,$648.00 ,$626.85 ,$106.94 ,$648.00 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$648.00 ,$558.00 ,$648.00 ,$648.00 ,$540.00 
ST MARY'S HOSPITAL,40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,$790.00 ,$395.00 ,$34.74 ,$790.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$474.00 ,$671.50 ,$553.00 ,$34.74 ,$750.50 ,$568.80 ,$576.70 ,$170.60 ,$671.50 ,$105.88 ,$170.60 ,$671.50 ,$576.70 ,$34.74 ,$105.88 ,$305.48 ,$671.50 ,$238.23 ,$726.80 ,$553.00 ,$447.17 ,$480.07 ,$481.11 ,$447.17 ,$545.89 ,$568.80 ,$550.24 ,$106.94 ,$568.80 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$568.80 ,$489.80 ,$568.80 ,$568.80 ,$474.00 
ST MARY'S HOSPITAL,40200014,76604,HC US CHEST,402,1 ,$580.00 ,$290.00 ,$34.74 ,$580.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$348.00 ,$493.00 ,$406.00 ,$34.74 ,$551.00 ,$417.60 ,$423.40 ,$61.03 ,$493.00 ,$105.88 ,$61.03 ,$493.00 ,$423.40 ,$34.74 ,$105.88 ,$305.48 ,$493.00 ,$238.23 ,$533.60 ,$406.00 ,$447.17 ,$480.07 ,$353.22 ,$447.17 ,$400.78 ,$417.60 ,$403.97 ,$106.94 ,$417.60 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$417.60 ,$359.60 ,$417.60 ,$417.60 ,$348.00 
ST MARY'S HOSPITAL,40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$340.00 ,$34.74 ,$680.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$408.00 ,$578.00 ,$476.00 ,$34.74 ,$646.00 ,$489.60 ,$496.40 ,$137.86 ,$578.00 ,$105.88 ,$137.86 ,$578.00 ,$496.40 ,$34.74 ,$105.88 ,$305.48 ,$578.00 ,$238.23 ,$625.60 ,$476.00 ,$299.44 ,$321.47 ,$414.12 ,$299.44 ,$469.88 ,$489.60 ,$473.62 ,$106.94 ,$489.60 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$408.00 
ST MARY'S HOSPITAL,40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$340.00 ,$34.74 ,$680.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$408.00 ,$578.00 ,$476.00 ,$34.74 ,$646.00 ,$489.60 ,$496.40 ,$137.86 ,$578.00 ,$105.88 ,$137.86 ,$578.00 ,$496.40 ,$34.74 ,$105.88 ,$305.48 ,$578.00 ,$238.23 ,$625.60 ,$476.00 ,$299.44 ,$321.47 ,$414.12 ,$299.44 ,$469.88 ,$489.60 ,$473.62 ,$106.94 ,$489.60 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$408.00 
ST MARY'S HOSPITAL,40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$275.00 ,$52.11 ,$550.00 ,$52.11 ,$550.00 ,$536.00 ,$78.66 ,$330.00 ,$467.50 ,$385.00 ,$52.11 ,$522.50 ,$396.00 ,$401.50 ,$105.12 ,$467.50 ,$78.66 ,$105.12 ,$467.50 ,$401.50 ,$52.11 ,$78.66 ,$305.48 ,$467.50 ,$177.00 ,$506.00 ,$385.00 ,$449.16 ,$482.21 ,$334.95 ,$449.16 ,$380.05 ,$396.00 ,$383.08 ,$79.45 ,$396.00 ,$55.24 ,$512.00 ,$512.00 ,$78.66 ,$512.00 ,$78.66 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$330.00 
ST MARY'S HOSPITAL,40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$275.00 ,$52.11 ,$550.00 ,$52.11 ,$550.00 ,$536.00 ,$78.66 ,$330.00 ,$467.50 ,$385.00 ,$52.11 ,$522.50 ,$396.00 ,$401.50 ,$105.12 ,$467.50 ,$78.66 ,$105.12 ,$467.50 ,$401.50 ,$52.11 ,$78.66 ,$305.48 ,$467.50 ,$177.00 ,$506.00 ,$385.00 ,$449.16 ,$482.21 ,$334.95 ,$449.16 ,$380.05 ,$396.00 ,$383.08 ,$79.45 ,$396.00 ,$55.24 ,$512.00 ,$512.00 ,$78.66 ,$512.00 ,$78.66 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$330.00 
ST MARY'S HOSPITAL,40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$572.00 ,$536.00 ,$105.88 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$792.00 ,$803.00 ,$159.26 ,$935.00 ,$105.88 ,$159.26 ,$935.00 ,$803.00 ,$52.74 ,$105.88 ,$305.48 ,$935.00 ,$238.23 ,"$1,012.00 ",$770.00 ,$447.17 ,$480.07 ,$669.90 ,$447.17 ,$760.10 ,$792.00 ,$766.15 ,$106.94 ,$792.00 ,$55.90 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,40200018,76705,HC US ABDOMEN LTD,402,1 ,$820.00 ,$410.00 ,$34.74 ,$820.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$492.00 ,$697.00 ,$574.00 ,$34.74 ,$779.00 ,$590.40 ,$598.60 ,$119.84 ,$697.00 ,$105.88 ,$119.84 ,$697.00 ,$598.60 ,$34.74 ,$105.88 ,$305.48 ,$697.00 ,$238.23 ,$754.40 ,$574.00 ,$447.17 ,$480.07 ,$499.38 ,$447.17 ,$566.62 ,$590.40 ,$571.13 ,$106.94 ,$590.40 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$492.00 
ST MARY'S HOSPITAL,40200019,76770,HC US RETROPERITIONEAL,402,1 ,$810.00 ,$405.00 ,$52.74 ,$810.00 ,$52.74 ,$572.00 ,$536.00 ,$105.88 ,$486.00 ,$688.50 ,$567.00 ,$52.74 ,$769.50 ,$583.20 ,$591.30 ,$148.58 ,$688.50 ,$105.88 ,$148.58 ,$688.50 ,$591.30 ,$52.74 ,$105.88 ,$305.48 ,$688.50 ,$238.23 ,$745.20 ,$567.00 ,$447.17 ,$480.07 ,$493.29 ,$447.17 ,$559.71 ,$583.20 ,$564.17 ,$106.94 ,$583.20 ,$55.90 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$486.00 
ST MARY'S HOSPITAL,40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$740.00 ,$370.00 ,$34.74 ,$740.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$444.00 ,$629.00 ,$518.00 ,$34.74 ,$703.00 ,$532.80 ,$540.20 ,$60.35 ,$629.00 ,$105.88 ,$60.35 ,$629.00 ,$540.20 ,$34.74 ,$105.88 ,$305.48 ,$629.00 ,$238.23 ,$680.80 ,$518.00 ,$447.17 ,$480.07 ,$450.66 ,$447.17 ,$511.34 ,$532.80 ,$515.41 ,$106.94 ,$532.80 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$444.00 
ST MARY'S HOSPITAL,40200021,76776,HC US KIDNEY TRANSPLANT W/DOPPLER,402,1 ,$820.00 ,$410.00 ,$34.74 ,$820.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$492.00 ,$697.00 ,$574.00 ,$34.74 ,$779.00 ,$590.40 ,$598.60 ,$227.63 ,$697.00 ,$105.88 ,$227.63 ,$697.00 ,$598.60 ,$34.74 ,$105.88 ,$305.48 ,$697.00 ,$238.23 ,$754.40 ,$574.00 ,$447.17 ,$480.07 ,$499.38 ,$447.17 ,$566.62 ,$590.40 ,$571.13 ,$106.94 ,$590.40 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$492.00 
ST MARY'S HOSPITAL,40200022,76800,HC US SPINAL CANAL  AND  CONTENTS,402,1 ,$500.00 ,$250.00 ,$34.74 ,$500.00 ,$34.74 ,$500.00 ,$500.00 ,$105.88 ,$300.00 ,$425.00 ,$350.00 ,$34.74 ,$475.00 ,$360.00 ,$365.00 ,$175.30 ,$425.00 ,$105.88 ,$175.30 ,$425.00 ,$365.00 ,$34.74 ,$105.88 ,$305.48 ,$425.00 ,$238.23 ,$460.00 ,$350.00 ,$299.22 ,$321.24 ,$304.50 ,$299.22 ,$345.50 ,$360.00 ,$348.25 ,$106.94 ,$360.00 ,$36.82 ,$500.00 ,$500.00 ,$105.88 ,$500.00 ,$105.88 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$300.00 
ST MARY'S HOSPITAL,40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,$650.00 ,$325.00 ,$31.94 ,$650.00 ,$31.94 ,$572.00 ,$536.00 ,$105.88 ,$390.00 ,$552.50 ,$455.00 ,$31.94 ,$617.50 ,$468.00 ,$474.50 ,$141.88 ,$552.50 ,$105.88 ,$141.88 ,$552.50 ,$474.50 ,$31.94 ,$105.88 ,$305.48 ,$552.50 ,$238.23 ,$598.00 ,$455.00 ,$447.17 ,$480.07 ,$395.85 ,$447.17 ,$449.15 ,$468.00 ,$452.73 ,$106.94 ,$468.00 ,$33.86 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$390.00 
ST MARY'S HOSPITAL,40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$360.00 ,$180.00 ,$31.94 ,$360.00 ,$31.94 ,$360.00 ,$360.00 , N/A ,$216.00 ,$306.00 ,$252.00 ,$31.94 ,$342.00 ,$259.20 ,$262.80 ,$42.76 ,$306.00 , N/A ,$42.76 ,$306.00 ,$262.80 ,$31.94 , N/A ,$305.48 ,$306.00 , N/A ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$204.52 ,$248.76 ,$259.20 ,$250.74 , N/A ,$259.20 ,$33.86 ,$360.00 ,$360.00 , N/A ,$360.00 , N/A ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$216.00 
ST MARY'S HOSPITAL,40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,$820.00 ,$410.00 ,$31.94 ,$820.00 ,$31.94 ,$572.00 ,$536.00 ,$105.88 ,$492.00 ,$697.00 ,$574.00 ,$31.94 ,$779.00 ,$590.40 ,$598.60 ,$176.65 ,$697.00 ,$105.88 ,$176.65 ,$697.00 ,$598.60 ,$31.94 ,$105.88 ,$305.48 ,$697.00 ,$238.23 ,$754.40 ,$574.00 ,$447.17 ,$480.07 ,$499.38 ,$447.17 ,$566.62 ,$590.40 ,$571.13 ,$106.94 ,$590.40 ,$33.86 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$492.00 
ST MARY'S HOSPITAL,40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,$930.00 ,$465.00 ,$31.94 ,$930.00 ,$31.94 ,$572.00 ,$536.00 ,$223.78 ,$558.00 ,$790.50 ,$651.00 ,$31.94 ,$883.50 ,$669.60 ,$678.90 ,$165.23 ,$790.50 ,$223.78 ,$165.23 ,$790.50 ,$678.90 ,$31.94 ,$223.78 ,$305.48 ,$790.50 ,$503.50 ,$855.60 ,$651.00 ,$634.17 ,$680.83 ,$566.37 ,$634.17 ,$642.63 ,$669.60 ,$647.75 ,$226.02 ,$669.60 ,$33.86 ,$512.00 ,$512.00 ,$223.78 ,$512.00 ,$223.78 ,$669.60 ,$576.60 ,$669.60 ,$669.60 ,$558.00 
ST MARY'S HOSPITAL,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 ,$306.00 ,$310.25 ,$216.28 ,$361.25 , N/A ,$216.28 ,$361.25 ,$310.25 ,$31.94 , N/A ,$305.48 ,$361.25 , N/A ,$391.00 ,$297.50 ,$215.56 ,$258.70 ,$258.83 ,$241.44 ,$293.68 ,$306.00 ,$296.01 , N/A ,$306.00 ,$33.86 ,$425.00 ,$425.00 , N/A ,$425.00 , N/A ,$306.00 ,$263.50 ,$306.00 ,$306.00 ,$255.00 
ST MARY'S HOSPITAL,40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$460.00 ,$230.00 ,$31.94 ,$460.00 ,$31.94 ,$460.00 ,$460.00 ,$105.88 ,$276.00 ,$391.00 ,$322.00 ,$31.94 ,$437.00 ,$331.20 ,$335.80 ,$138.54 ,$391.00 ,$105.88 ,$138.54 ,$391.00 ,$335.80 ,$31.94 ,$105.88 ,$305.48 ,$391.00 ,$238.23 ,$423.20 ,$322.00 ,$299.22 ,$321.24 ,$280.14 ,$299.22 ,$317.86 ,$331.20 ,$320.39 ,$106.94 ,$331.20 ,$33.86 ,$460.00 ,$460.00 ,$105.88 ,$460.00 ,$105.88 ,$331.20 ,$285.20 ,$331.20 ,$331.20 ,$276.00 
ST MARY'S HOSPITAL,40200031,76815,HC US FETAL HEART BEAT,402,1 ,$480.00 ,$240.00 ,$31.94 ,$480.00 ,$31.94 ,$480.00 ,$480.00 ,$105.88 ,$288.00 ,$408.00 ,$336.00 ,$31.94 ,$456.00 ,$345.60 ,$350.40 ,$101.13 ,$408.00 ,$105.88 ,$101.13 ,$408.00 ,$350.40 ,$31.94 ,$105.88 ,$305.48 ,$408.00 ,$238.23 ,$441.60 ,$336.00 ,$447.17 ,$480.00 ,$292.32 ,$447.17 ,$331.68 ,$345.60 ,$334.32 ,$106.94 ,$345.60 ,$33.86 ,$480.00 ,$480.00 ,$105.88 ,$480.00 ,$105.88 ,$345.60 ,$297.60 ,$345.60 ,$345.60 ,$288.00 
ST MARY'S HOSPITAL,40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$630.00 ,$315.00 ,$31.94 ,$630.00 ,$31.94 ,$572.00 ,$536.00 ,$105.88 ,$378.00 ,$535.50 ,$441.00 ,$31.94 ,$598.50 ,$453.60 ,$459.90 ,$114.49 ,$535.50 ,$105.88 ,$114.49 ,$535.50 ,$459.90 ,$31.94 , N/A ,$305.48 ,$535.50 ,$238.23 ,$579.60 ,$441.00 ,$447.17 ,$480.07 ,$383.67 ,$447.17 ,$435.33 ,$453.60 ,$438.80 , N/A ,$453.60 ,$33.86 ,$512.00 ,$512.00 ,$105.88 ,$512.00 , N/A ,$453.60 ,$390.60 ,$453.60 ,$453.60 ,$378.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$342.00 ,$484.50 ,$399.00 ,$31.94 ,$541.50 ,$410.40 ,$416.10 ,$93.11 ,$484.50 ,$105.88 ,$93.11 ,$484.50 ,$416.10 ,$31.94 ,$105.88 ,$305.48 ,$484.50 ,$238.23 ,$524.40 ,$399.00 ,$447.17 ,$480.07 ,$347.13 ,$447.17 ,$393.87 ,$410.40 ,$397.01 ,$106.94 ,$410.40 ,$33.86 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$410.40 ,$353.40 ,$410.40 ,$410.40 ,$342.00 
ST MARY'S HOSPITAL,40200038,76830,HC US TRANSVAGINAL,402,1 ,$760.00 ,$380.00 ,$34.74 ,$760.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$456.00 ,$646.00 ,$532.00 ,$34.74 ,$722.00 ,$547.20 ,$554.80 ,$175.30 ,$646.00 ,$105.88 ,$175.30 ,$646.00 ,$554.80 ,$34.74 ,$105.88 ,$305.48 ,$646.00 ,$238.23 ,$699.20 ,$532.00 ,$447.17 ,$480.07 ,$462.84 ,$447.17 ,$525.16 ,$547.20 ,$529.34 ,$106.94 ,$547.20 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,40200039,76831,HC US HYSTEROSONOGRAM,402,1 ,$700.00 ,$350.00 ,$52.74 ,$700.00 ,$52.74 ,$572.00 ,$536.00 ,$223.78 ,$420.00 ,$595.00 ,$490.00 ,$52.74 ,$665.00 ,$504.00 ,$511.00 ,$165.27 ,$595.00 ,$223.78 ,$165.27 ,$595.00 ,$511.00 ,$52.74 ,$223.78 ,$305.48 ,$595.00 ,$503.50 ,$644.00 ,$490.00 ,$634.17 ,$680.83 ,$426.30 ,$634.17 ,$483.70 ,$504.00 ,$487.55 ,$226.02 ,$504.00 ,$55.90 ,$512.00 ,$512.00 ,$223.78 ,$512.00 ,$223.78 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,40200040,76856,HC US PELVIS NON OB,402,1 ,$880.00 ,$440.00 ,$52.74 ,$880.00 ,$52.74 ,$572.00 ,$536.00 ,$105.88 ,$528.00 ,$748.00 ,$616.00 ,$52.74 ,$836.00 ,$633.60 ,$642.40 ,$147.23 ,$748.00 ,$105.88 ,$147.23 ,$748.00 ,$642.40 ,$52.74 ,$105.88 ,$305.48 ,$748.00 ,$238.23 ,$809.60 ,$616.00 ,$447.17 ,$480.07 ,$535.92 ,$447.17 ,$608.08 ,$633.60 ,$612.92 ,$106.94 ,$633.60 ,$55.90 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$528.00 
ST MARY'S HOSPITAL,40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$690.00 ,$345.00 ,$34.74 ,$690.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$414.00 ,$586.50 ,$483.00 ,$34.74 ,$655.50 ,$496.80 ,$503.70 ,$48.32 ,$586.50 ,$105.88 ,$48.32 ,$586.50 ,$503.70 ,$34.74 ,$105.88 ,$305.48 ,$586.50 ,$238.23 ,$634.80 ,$483.00 ,$299.22 ,$321.24 ,$420.21 ,$299.22 ,$476.79 ,$496.80 ,$480.59 ,$106.94 ,$496.80 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$496.80 ,$427.80 ,$496.80 ,$496.80 ,$414.00 
ST MARY'S HOSPITAL,40200042,76870,HC US SCROTUM,402,1 ,$740.00 ,$370.00 ,$34.74 ,$740.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$444.00 ,$629.00 ,$518.00 ,$34.74 ,$703.00 ,$532.80 ,$540.20 ,$141.88 ,$629.00 ,$105.88 ,$141.88 ,$629.00 ,$540.20 ,$34.74 ,$105.88 ,$305.48 ,$629.00 ,$238.23 ,$680.80 ,$518.00 ,$447.17 ,$480.07 ,$450.66 ,$447.17 ,$511.34 ,$532.80 ,$515.41 ,$106.94 ,$532.80 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$532.80 ,$458.80 ,$532.80 ,$532.80 ,$444.00 
ST MARY'S HOSPITAL,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$405.00 ,$34.74 ,$810.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$486.00 ,$688.50 ,$567.00 ,$34.74 ,$769.50 ,$583.20 ,$591.30 ,$56.35 ,$688.50 ,$105.88 ,$56.35 ,$688.50 ,$591.30 ,$34.74 ,$105.88 ,$305.48 ,$688.50 ,$238.23 ,$745.20 ,$567.00 ,$670.76 ,$720.11 ,$493.29 ,$670.76 ,$559.71 ,$583.20 ,$564.17 ,$106.94 ,$583.20 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$486.00 
ST MARY'S HOSPITAL,40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$405.00 ,$34.74 ,$810.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$486.00 ,$688.50 ,$567.00 ,$34.74 ,$769.50 ,$583.20 ,$591.30 ,$56.35 ,$688.50 ,$105.88 ,$56.35 ,$688.50 ,$591.30 ,$34.74 ,$105.88 ,$305.48 ,$688.50 ,$238.23 ,$745.20 ,$567.00 ,$670.76 ,$720.11 ,$493.29 ,$670.76 ,$559.71 ,$583.20 ,$564.17 ,$106.94 ,$583.20 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$583.20 ,$502.20 ,$583.20 ,$583.20 ,$486.00 
ST MARY'S HOSPITAL,40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$550.00 ,$275.00 ,$34.74 ,$550.00 ,$34.74 ,$550.00 ,$536.00 ,$105.88 ,$330.00 ,$467.50 ,$385.00 ,$34.74 ,$522.50 ,$396.00 ,$401.50 ,$65.70 ,$467.50 ,$105.88 ,$65.70 ,$467.50 ,$401.50 ,$34.74 ,$105.88 ,$305.48 ,$467.50 ,$238.23 ,$506.00 ,$385.00 ,$299.22 ,$321.24 ,$334.95 ,$299.22 ,$380.05 ,$396.00 ,$383.08 ,$106.94 ,$396.00 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$330.00 
ST MARY'S HOSPITAL,40200047,76882,HC US EXTREMITY NON VASCULAR KNEE,402,1 ,$550.00 ,$275.00 ,$34.74 ,$550.00 ,$34.74 ,$550.00 ,$536.00 ,$105.88 ,$330.00 ,$467.50 ,$385.00 ,$34.74 ,$522.50 ,$396.00 ,$401.50 ,$65.70 ,$467.50 ,$105.88 ,$65.70 ,$467.50 ,$401.50 ,$34.74 ,$105.88 ,$305.48 ,$467.50 ,$238.23 ,$506.00 ,$385.00 ,$299.22 ,$321.24 ,$334.95 ,$299.22 ,$380.05 ,$396.00 ,$383.08 ,$106.94 ,$396.00 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$396.00 ,$341.00 ,$396.00 ,$396.00 ,$330.00 
ST MARY'S HOSPITAL,40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$540.00 ,$270.00 ,$34.74 ,$540.00 ,$34.74 ,$540.00 ,$536.00 ,$78.66 ,$324.00 ,$459.00 ,$378.00 ,$34.74 ,$513.00 ,$388.80 ,$394.20 ,$205.57 ,$459.00 ,$78.66 ,$205.57 ,$459.00 ,$394.20 ,$34.74 ,$78.66 ,$305.48 ,$459.00 ,$177.00 ,$496.80 ,$378.00 ,$299.22 ,$321.24 ,$328.86 ,$299.22 ,$373.14 ,$388.80 ,$376.11 ,$79.45 ,$388.80 ,$36.82 ,$512.00 ,$512.00 ,$78.66 ,$512.00 ,$78.66 ,$388.80 ,$334.80 ,$388.80 ,$388.80 ,$324.00 
ST MARY'S HOSPITAL,40200050,76936,HC US GUIDED COMPRESSION RPR,402,1 ,$952.00 ,$476.00 ,$56.46 ,$952.00 ,$56.46 ,$572.00 ,$536.00 ,$257.38 ,$571.20 ,$809.20 ,$666.40 ,$56.46 ,$904.40 ,$685.44 ,$694.96 ,$336.32 ,$809.20 ,$257.38 ,$336.32 ,$809.20 ,$694.96 ,$56.46 ,$257.38 ,$305.48 ,$809.20 ,$579.11 ,$875.84 ,$666.40 ,$435.53 ,$467.58 ,$579.77 ,$435.53 ,$657.83 ,$685.44 ,$663.07 ,$259.95 ,$685.44 ,$59.85 ,$512.00 ,$512.00 ,$257.38 ,$512.00 ,$257.38 ,$685.44 ,$590.24 ,$685.44 ,$685.44 ,$571.20 
ST MARY'S HOSPITAL,40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$530.00 ,$265.00 ,$35.55 ,$530.00 ,$35.55 ,$530.00 ,$530.00 , N/A ,$318.00 ,$450.50 ,$371.00 ,$35.55 ,$503.50 ,$381.60 ,$386.90 ,$51.48 ,$450.50 , N/A ,$51.48 ,$450.50 ,$386.90 ,$35.55 , N/A ,$305.48 ,$450.50 , N/A ,$487.60 ,$371.00 ,$268.82 ,$322.61 ,$322.77 ,$301.09 ,$366.23 ,$381.60 ,$369.15 , N/A ,$381.60 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 , N/A ,$381.60 ,$328.60 ,$381.60 ,$381.60 ,$318.00 
ST MARY'S HOSPITAL,40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,000.00 ",$500.00 ,$35.55 ,"$1,000.00 ",$35.55 ,$572.00 ,$536.00 , N/A ,$600.00 ,$850.00 ,$700.00 ,$35.55 ,$950.00 ,$720.00 ,$730.00 ,$54.35 ,$850.00 , N/A ,$54.35 ,$850.00 ,$730.00 ,$35.55 , N/A ,$305.48 ,$850.00 , N/A ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$568.10 ,$691.00 ,$720.00 ,$696.50 , N/A ,$720.00 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 , N/A ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,40200057,76942,HC US GUIDED NEEDLE BX THORA,402,1 ,"$1,000.00 ",$500.00 ,$35.55 ,"$1,000.00 ",$35.55 ,$572.00 ,$536.00 , N/A ,$600.00 ,$850.00 ,$700.00 ,$35.55 ,$950.00 ,$720.00 ,$730.00 ,$54.35 ,$850.00 , N/A ,$54.35 ,$850.00 ,$730.00 ,$35.55 , N/A ,$305.48 ,$850.00 , N/A ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$568.10 ,$691.00 ,$720.00 ,$696.50 , N/A ,$720.00 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 , N/A ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,40200059,76946,HC US GUIDED AMNIOCENTESIS,402,1 ,$220.00 ,$110.00 ,$27.59 ,$220.00 ,$35.55 ,$220.00 ,$220.00 , N/A ,$132.00 ,$187.00 ,$154.00 ,$35.55 ,$209.00 ,$158.40 ,$160.60 ,$27.59 ,$187.00 , N/A ,$27.59 ,$187.00 ,$160.60 ,$35.55 , N/A ,$220.00 ,$187.00 , N/A ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 , N/A ,$158.40 ,$37.68 ,$220.00 ,$220.00 , N/A ,$220.00 , N/A ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,40200062,76998,HC US INTRAOPERATIVE,402,1 ,"$1,200.00 ",$600.00 ,$35.55 ,"$1,200.00 ",$35.55 ,$572.00 ,$536.00 , N/A ,$720.00 ,"$1,020.00 ",$840.00 ,$35.55 ,"$1,140.00 ",$864.00 ,$876.00 ,$103.26 ,"$1,020.00 ", N/A ,$103.26 ,"$1,020.00 ",$876.00 ,$35.55 , N/A ,$305.48 ,"$1,020.00 ", N/A ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$681.72 ,$829.20 ,$864.00 ,$835.80 , N/A ,$864.00 ,$37.68 ,$512.00 ,$512.00 , N/A ,$512.00 , N/A ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$720.00 
ST MARY'S HOSPITAL,40200063,76999,HC UNLISTED PROCEDURE ULTRASOUND,402,1 ,$420.00 ,$210.00 ,$34.74 ,$420.00 ,$34.74 ,$420.00 ,$420.00 ,$78.66 ,$252.00 ,$357.00 ,$294.00 ,$34.74 ,$399.00 ,$302.40 ,$306.60 , N/A ,$357.00 ,$78.66 , N/A ,$357.00 ,$306.60 ,$34.74 ,$78.66 ,$305.48 ,$357.00 ,$177.00 ,$386.40 ,$294.00 ,$299.22 ,$321.24 ,$255.78 ,$299.22 ,$290.22 ,$302.40 ,$292.53 ,$79.45 ,$302.40 ,$36.82 ,$420.00 ,$420.00 ,$78.66 ,$420.00 ,$78.66 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$572.00 ,$536.00 ,$223.78 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$792.00 ,$803.00 ,$423.86 ,$935.00 ,$223.78 ,$423.86 ,$935.00 ,$803.00 ,$52.74 ,$223.78 ,$305.48 ,$935.00 ,$503.50 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$624.91 ,$760.10 ,$792.00 ,$766.15 ,$226.02 ,$792.00 ,$55.90 ,$512.00 ,$512.00 ,$223.78 ,$512.00 ,$223.78 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,40200066,93975,HC DUPLEX ABD/PEL/RETRO CMPL RENAL,402,1 ,"$1,100.00 ",$550.00 ,$52.74 ,"$1,100.00 ",$52.74 ,$572.00 ,$536.00 ,$223.78 ,$660.00 ,$935.00 ,$770.00 ,$52.74 ,"$1,045.00 ",$792.00 ,$803.00 ,$423.86 ,$935.00 ,$223.78 ,$423.86 ,$935.00 ,$803.00 ,$52.74 ,$223.78 ,$305.48 ,$935.00 ,$503.50 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$624.91 ,$760.10 ,$792.00 ,$766.15 ,$226.02 ,$792.00 ,$55.90 ,$512.00 ,$512.00 ,$223.78 ,$512.00 ,$223.78 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,"$1,000.00 ",$500.00 ,$52.74 ,"$1,000.00 ",$52.74 ,$572.00 ,$536.00 ,$105.88 ,$600.00 ,$850.00 ,$700.00 ,$52.74 ,$950.00 ,$720.00 ,$730.00 ,$241.67 ,$850.00 ,$105.88 ,$241.67 ,$850.00 ,$730.00 ,$52.74 ,$105.88 ,$305.48 ,$850.00 ,$238.23 ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$568.10 ,$691.00 ,$720.00 ,$696.50 ,$106.94 ,$720.00 ,$55.90 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,000.00 ",$500.00 ,$52.74 ,"$1,000.00 ",$52.74 ,$572.00 ,$536.00 ,$105.88 ,$600.00 ,$850.00 ,$700.00 ,$52.74 ,$950.00 ,$720.00 ,$730.00 ,$241.67 ,$850.00 ,$105.88 ,$241.67 ,$850.00 ,$730.00 ,$52.74 ,$105.88 ,$305.48 ,$850.00 ,$238.23 ,$920.00 ,$700.00 ,$507.20 ,$608.70 ,$609.00 ,$568.10 ,$691.00 ,$720.00 ,$696.50 ,$106.94 ,$720.00 ,$55.90 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,921,1 ,$860.00 ,$430.00 ,$52.74 ,$860.00 ,$52.74 ,$556.33 ,$556.33 ,$223.78 ,$516.00 ,$731.00 ,$602.00 ,$52.74 ,$817.00 ,$619.20 ,$627.80 ,$559.00 ,$731.00 ,$223.78 ,$559.00 ,$731.00 ,$627.80 ,$52.74 ,$223.78 ,$305.48 ,$731.00 ,$503.50 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$488.57 ,$594.26 ,$619.20 ,$598.99 ,$226.02 ,$619.20 ,$55.90 ,$465.00 ,$465.00 ,$223.78 ,$465.00 ,$223.78 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$516.00 
ST MARY'S HOSPITAL,40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,$660.00 ,$330.00 ,$34.74 ,$660.00 ,$34.74 ,$572.00 ,$536.00 ,$105.88 ,$396.00 ,$561.00 ,$462.00 ,$34.74 ,$627.00 ,$475.20 ,$481.80 ,$188.87 ,$561.00 ,$105.88 ,$188.87 ,$561.00 ,$481.80 ,$34.74 ,$105.88 ,$305.48 ,$561.00 ,$238.23 ,$607.20 ,$462.00 ,$334.75 ,$401.74 ,$401.94 ,$374.95 ,$456.06 ,$475.20 ,$459.69 ,$106.94 ,$475.20 ,$36.82 ,$512.00 ,$512.00 ,$105.88 ,$512.00 ,$105.88 ,$475.20 ,$409.20 ,$475.20 ,$475.20 ,$396.00 
ST MARY'S HOSPITAL,40200075,76706,HC US AORTA (SCREENING),402,1 ,$500.00 ,$250.00 ,$34.74 ,$500.00 ,$34.74 ,$500.00 ,$500.00 ,$105.88 ,$300.00 ,$425.00 ,$350.00 ,$34.74 ,$475.00 ,$360.00 ,$365.00 ,$161.93 ,$425.00 ,$105.88 ,$161.93 ,$425.00 ,$365.00 ,$34.74 ,$105.88 ,$305.48 ,$425.00 ,$238.23 ,$460.00 ,$350.00 ,$362.97 ,$389.68 ,$304.50 ,$362.97 ,$345.50 ,$360.00 ,$348.25 ,$106.94 ,$360.00 ,$36.82 ,$500.00 ,$500.00 ,$105.88 ,$500.00 ,$105.88 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$300.00 
ST MARY'S HOSPITAL,40200092,76813,HC US FETAL NUCHAL TRANSLUCENCY SNG,402,1 ,$420.00 ,$210.00 ,$31.94 ,$420.00 ,$31.94 ,$420.00 ,$420.00 ,$105.88 ,$252.00 ,$357.00 ,$294.00 ,$31.94 ,$399.00 ,$302.40 ,$306.60 ,$123.86 ,$357.00 ,$105.88 ,$123.86 ,$357.00 ,$306.60 ,$31.94 ,$105.88 ,$305.48 ,$357.00 ,$238.23 ,$386.40 ,$294.00 ,$420.00 ,$420.00 ,$255.78 ,$420.00 ,$290.22 ,$302.40 ,$292.53 ,$106.94 ,$302.40 ,$33.86 ,$420.00 ,$420.00 ,$105.88 ,$420.00 ,$105.88 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,40200093,76814,HC US FETAL NUCHAL TRANSLUCENCY ADDL,402,1 ,$330.00 ,$165.00 ,$31.94 ,$330.00 ,$31.94 ,$330.00 ,$330.00 , N/A ,$198.00 ,$280.50 ,$231.00 ,$31.94 ,$313.50 ,$237.60 ,$240.90 ,$56.33 ,$280.50 , N/A ,$56.33 ,$280.50 ,$240.90 ,$31.94 , N/A ,$305.48 ,$280.50 , N/A ,$303.60 ,$231.00 ,$167.38 ,$200.87 ,$200.97 ,$187.47 ,$228.03 ,$237.60 ,$229.85 , N/A ,$237.60 ,$33.86 ,$330.00 ,$330.00 , N/A ,$330.00 , N/A ,$237.60 ,$204.60 ,$237.60 ,$237.60 ,$198.00 
ST MARY'S HOSPITAL,40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$312.00 ,$208.00 ,$89.75 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$252.00 ,$255.50 ,$183.99 ,$297.50 ,$89.75 ,$183.99 ,$297.50 ,$255.50 ,$15.90 ,$89.75 ,$158.40 ,$297.50 ,$201.94 ,$322.00 ,$245.00 ,$293.37 ,$314.96 ,$213.15 ,$293.37 ,$241.85 ,$252.00 ,$243.78 ,$90.65 ,$252.00 ,$16.85 ,$163.00 ,$163.00 ,$89.75 ,$163.00 ,$89.75 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$350.00 ,$175.00 ,$15.90 ,$350.00 ,$15.90 ,$312.00 ,$208.00 ,$89.75 ,$210.00 ,$297.50 ,$245.00 ,$15.90 ,$332.50 ,$252.00 ,$255.50 ,$183.99 ,$297.50 ,$89.75 ,$183.99 ,$297.50 ,$255.50 ,$15.90 ,$89.75 ,$158.40 ,$297.50 ,$201.94 ,$322.00 ,$245.00 ,$293.37 ,$314.96 ,$213.15 ,$293.37 ,$241.85 ,$252.00 ,$243.78 ,$90.65 ,$252.00 ,$16.85 ,$163.00 ,$163.00 ,$89.75 ,$163.00 ,$89.75 ,$252.00 ,$217.00 ,$252.00 ,$252.00 ,$210.00 
ST MARY'S HOSPITAL,40400003,78814,HC PET W/CT TUMR LIMITED AREA,404,1 ,"$7,007.00 ","$3,503.50 ",$411.24 ,"$7,007.00 ",$411.24 ,"$4,474.00 ","$4,266.00 ","$1,439.37 ","$4,204.20 ","$5,955.95 ","$4,904.90 ",$411.24 ,"$6,656.65 ","$5,045.04 ","$5,115.11 ","$5,800.64 ","$5,955.95 ","$1,439.37 ","$5,800.64 ","$5,955.95 ","$5,115.11 ",$411.24 ,"$1,439.37 ","$2,559.25 ","$5,955.95 ","$3,238.58 ","$6,446.44 ","$4,904.90 ","$4,355.16 ","$4,675.60 ","$4,267.26 ","$4,355.16 ","$4,841.84 ","$5,045.04 ","$4,880.38 ","$1,453.76 ","$5,045.04 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,439.37 ","$3,879.00 ","$1,439.37 ","$5,045.04 ","$4,344.34 ","$5,045.04 ","$5,045.04 ","$4,204.20 "
ST MARY'S HOSPITAL,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 ,"$4,474.00 ","$4,266.00 ","$1,439.37 ","$4,392.60 ","$6,222.85 ","$5,124.70 ",$411.24 ,"$6,954.95 ","$5,271.12 ","$5,344.33 ","$5,800.64 ","$6,222.85 ","$1,439.37 ","$5,800.64 ","$6,222.85 ","$5,344.33 ",$411.24 ,"$1,439.37 ","$2,559.25 ","$6,222.85 ","$3,238.58 ","$6,735.32 ","$5,124.70 ","$4,355.16 ","$4,675.60 ","$4,458.49 ","$4,355.16 ","$5,058.81 ","$5,271.12 ","$5,099.08 ","$1,453.76 ","$5,271.12 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,439.37 ","$3,879.00 ","$1,439.37 ","$5,271.12 ","$4,539.02 ","$5,271.12 ","$5,271.12 ","$4,392.60 "
ST MARY'S HOSPITAL,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 ,"$4,474.00 ","$4,266.00 ","$1,439.37 ","$4,392.60 ","$6,222.85 ","$5,124.70 ",$411.24 ,"$6,954.95 ","$5,271.12 ","$5,344.33 ","$5,800.64 ","$6,222.85 ","$1,439.37 ","$5,800.64 ","$6,222.85 ","$5,344.33 ",$411.24 ,"$1,439.37 ","$2,559.25 ","$6,222.85 ","$3,238.58 ","$6,735.32 ","$5,124.70 ","$4,355.16 ","$4,675.60 ","$4,458.49 ","$4,355.16 ","$5,058.81 ","$5,271.12 ","$5,099.08 ","$1,453.76 ","$5,271.12 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,439.37 ","$3,879.00 ","$1,439.37 ","$5,271.12 ","$4,539.02 ","$5,271.12 ","$5,271.12 ","$4,392.60 "
ST MARY'S HOSPITAL,40400006,78608,HC PET BRAIN LIMITED ALZHEIMERS,404,1 ,"$7,007.00 ","$3,503.50 ",$411.24 ,"$7,007.00 ",$411.24 ,"$4,474.00 ","$4,266.00 ","$1,439.37 ","$4,204.20 ","$5,955.95 ","$4,904.90 ",$411.24 ,"$6,656.65 ","$5,045.04 ","$5,115.11 ","$4,640.52 ","$5,955.95 ","$1,439.37 ","$4,640.52 ","$5,955.95 ","$5,115.11 ",$411.24 ,"$1,439.37 ","$2,559.25 ","$5,955.95 ","$3,238.58 ","$6,446.44 ","$4,904.90 ","$4,355.16 ","$4,675.60 ","$4,267.26 ","$4,355.16 ","$4,841.84 ","$5,045.04 ","$4,880.38 ","$1,453.76 ","$5,045.04 ",$435.91 ,"$3,879.00 ","$3,879.00 ","$1,439.37 ","$3,879.00 ","$1,439.37 ","$5,045.04 ","$4,344.34 ","$5,045.04 ","$5,045.04 ","$4,204.20 "
ST MARY'S HOSPITAL,41000002,31502,HC CHG TUBE TRACHEOTOMY,410,1 ,$485.00 ,$242.50 ,$34.89 ,$485.00 ,$34.89 ,$313.75 ,$313.75 ,$205.75 ,$291.00 ,$412.25 ,$339.50 ,$34.89 ,$460.75 ,$349.20 ,$354.05 ,$315.25 ,$412.25 ,$205.75 ,$315.25 ,$412.25 ,$354.05 ,$34.89 ,$205.75 ,$89.38 ,$412.25 ,$462.94 ,$446.20 ,$339.50 ,$485.00 ,$485.00 ,$295.37 ,$485.00 ,$335.14 ,$349.20 ,$337.80 ,$207.81 ,$349.20 ,$36.98 ,$91.00 ,$91.00 ,$205.75 ,$91.00 ,$205.75 ,$349.20 ,$300.70 ,$349.20 ,$349.20 ,$291.00 
ST MARY'S HOSPITAL,41000004,N/A,HC COUGH ASSIST,410,1 ,$158.00 ,$79.00 ,$79.00 ,$158.00 , N/A ,$102.21 ,$102.21 , N/A ,$94.80 ,$134.30 ,$110.60 , N/A ,$150.10 ,$113.76 ,$115.34 ,$102.70 ,$134.30 , N/A ,$102.70 ,$134.30 ,$115.34 , N/A , N/A ,$89.38 ,$134.30 , N/A ,$145.36 ,$110.60 ,$80.14 ,$96.17 ,$96.22 ,$89.76 ,$109.18 ,$113.76 ,$110.05 , N/A ,$113.76 , N/A ,$91.00 ,$91.00 , N/A ,$91.00 , N/A ,$113.76 ,$97.96 ,$113.76 ,$113.76 ,$94.80 
ST MARY'S HOSPITAL,41000005,92950,HC CPR,480,1 ,$749.00 ,$374.50 ,$257.38 ,$749.00 ,$285.38 ,$484.53 ,$484.53 ,$257.38 ,$449.40 ,$636.65 ,$524.30 ,$285.38 ,$711.55 ,$539.28 ,$546.77 ,$486.85 ,$636.65 ,$257.38 ,$486.85 ,$636.65 ,$546.77 ,$285.38 ,$257.38 ,$749.00 ,$636.65 ,$579.11 ,$689.08 ,$524.30 ,$379.89 ,$455.92 ,$456.14 ,$425.51 ,$517.56 ,$539.28 ,$521.68 ,$259.95 ,$539.28 ,$302.50 ,$749.00 ,$749.00 ,$257.38 ,$749.00 ,$257.38 ,$539.28 ,$464.38 ,$539.28 ,$539.28 ,$449.40 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$54.60 ,$71.40 , N/A ,$54.60 ,$71.40 ,$61.32 , N/A , N/A ,$84.00 ,$71.40 , N/A ,$77.28 ,$58.80 ,$42.60 ,$51.13 ,$51.16 ,$47.72 ,$58.04 ,$60.48 ,$58.51 , N/A ,$60.48 , N/A ,$84.00 ,$84.00 , N/A ,$84.00 , N/A ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$640.43 ,$640.43 ,$473.78 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$712.80 ,$722.70 ,$643.50 ,$841.50 ,$473.78 ,$643.50 ,$841.50 ,$722.70 ,$202.16 ,$473.78 ,$89.38 ,$841.50 ,"$1,066.00 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$562.42 ,$684.09 ,$712.80 ,$689.54 ,$478.52 ,$712.80 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$594.00 
ST MARY'S HOSPITAL,41000010,94002,HC VENTIL HI FREQ INTL DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$640.43 ,$640.43 ,$473.78 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$712.80 ,$722.70 ,$643.50 ,$841.50 ,$473.78 ,$643.50 ,$841.50 ,$722.70 ,$202.16 ,$473.78 ,$89.38 ,$841.50 ,"$1,066.00 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$562.42 ,$684.09 ,$712.80 ,$689.54 ,$478.52 ,$712.80 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$594.00 
ST MARY'S HOSPITAL,41000012,94002,HC VENT SEDATED INTL DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$640.43 ,$640.43 ,$473.78 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$712.80 ,$722.70 ,$643.50 ,$841.50 ,$473.78 ,$643.50 ,$841.50 ,$722.70 ,$202.16 ,$473.78 ,$89.38 ,$841.50 ,"$1,066.00 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$562.42 ,$684.09 ,$712.80 ,$689.54 ,$478.52 ,$712.80 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$594.00 
ST MARY'S HOSPITAL,41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$280.00 ,$140.00 ,$38.97 ,$411.30 ,$38.97 ,$181.13 ,$181.13 ,$182.80 ,$168.00 ,$238.00 ,$196.00 ,$38.97 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$182.80 ,$182.00 ,$238.00 ,$204.40 ,$38.97 ,$182.80 ,$89.38 ,$238.00 ,$411.30 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$184.63 ,$201.60 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,41000014,94002,HC VENT WEANING FIRST DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$640.43 ,$640.43 ,$473.78 ,$594.00 ,$841.50 ,$693.00 ,$202.16 ,$940.50 ,$712.80 ,$722.70 ,$643.50 ,$841.50 ,$473.78 ,$643.50 ,$841.50 ,$722.70 ,$202.16 ,$473.78 ,$89.38 ,$841.50 ,"$1,066.00 ",$910.80 ,$693.00 ,$502.13 ,$602.61 ,$602.91 ,$562.42 ,$684.09 ,$712.80 ,$689.54 ,$478.52 ,$712.80 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$712.80 ,$613.80 ,$712.80 ,$712.80 ,$594.00 
ST MARY'S HOSPITAL,41000018,94660,HC VENT NONINVAS PEDS INTL DAY,410,1 ,$820.00 ,$410.00 ,$38.97 ,$820.00 ,$38.97 ,$530.46 ,$530.46 ,$182.80 ,$492.00 ,$697.00 ,$574.00 ,$38.97 ,$779.00 ,$590.40 ,$598.60 ,$533.00 ,$697.00 ,$182.80 ,$533.00 ,$697.00 ,$598.60 ,$38.97 ,$182.80 ,$89.38 ,$697.00 ,$411.30 ,$754.40 ,$574.00 ,$415.90 ,$499.13 ,$499.38 ,$465.84 ,$566.62 ,$590.40 ,$571.13 ,$184.63 ,$590.40 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$590.40 ,$508.40 ,$590.40 ,$590.40 ,$492.00 
ST MARY'S HOSPITAL,41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$491.64 ,$491.64 ,$473.78 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$547.20 ,$554.80 ,$494.00 ,$646.00 ,$473.78 ,$494.00 ,$646.00 ,$554.80 ,$202.16 ,$473.78 ,$89.38 ,$646.00 ,"$1,066.00 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$431.76 ,$525.16 ,$547.20 ,$529.34 ,$478.52 ,$547.20 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,41000028,94003,HC VENT HI FREQ SUBQ DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$491.64 ,$491.64 ,$473.78 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$547.20 ,$554.80 ,$494.00 ,$646.00 ,$473.78 ,$494.00 ,$646.00 ,$554.80 ,$202.16 ,$473.78 ,$89.38 ,$646.00 ,"$1,066.00 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$431.76 ,$525.16 ,$547.20 ,$529.34 ,$478.52 ,$547.20 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$280.00 ,$140.00 ,$38.97 ,$411.30 ,$38.97 ,$181.13 ,$181.13 ,$182.80 ,$168.00 ,$238.00 ,$196.00 ,$38.97 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$182.80 ,$182.00 ,$238.00 ,$204.40 ,$38.97 ,$182.80 ,$89.38 ,$238.00 ,$411.30 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$184.63 ,$201.60 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,41000030,94003,HC VENT WEANING SUBQ DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$491.64 ,$491.64 ,$473.78 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$547.20 ,$554.80 ,$494.00 ,$646.00 ,$473.78 ,$494.00 ,$646.00 ,$554.80 ,$202.16 ,$473.78 ,$89.38 ,$646.00 ,"$1,066.00 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$431.76 ,$525.16 ,$547.20 ,$529.34 ,$478.52 ,$547.20 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,41000031,94003,HC VENT NEONATL SUBQ DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,066.00 ",$202.16 ,$491.64 ,$491.64 ,$473.78 ,$456.00 ,$646.00 ,$532.00 ,$202.16 ,$722.00 ,$547.20 ,$554.80 ,$494.00 ,$646.00 ,$473.78 ,$494.00 ,$646.00 ,$554.80 ,$202.16 ,$473.78 ,$89.38 ,$646.00 ,"$1,066.00 ",$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$431.76 ,$525.16 ,$547.20 ,$529.34 ,$478.52 ,$547.20 ,$214.29 ,$91.00 ,$91.00 ,$473.78 ,$91.00 ,$473.78 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$291.00 ,$145.50 ,$16.35 ,$411.30 ,$16.35 ,$188.25 ,$188.25 ,$182.80 ,$174.60 ,$247.35 ,$203.70 ,$16.35 ,$276.45 ,$209.52 ,$212.43 ,$189.15 ,$247.35 ,$182.80 ,$189.15 ,$247.35 ,$212.43 ,$16.35 ,$182.80 ,$89.38 ,$247.35 ,$411.30 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 ,$184.63 ,$209.52 ,$17.33 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,41000036,94640,HC HELI OX PROCEDURE,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000040,94640,HC EZ PAP TREATMENT,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000042,94640,HC SPUTUM SPECIMEN INDUCTION,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000043,94640,HC PERI NEB WITH INSTRUCTION,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000044,94640,HC UPDRAFT W/INSTRUCT AND EVAL,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000045,94640,HC AEROSOL GENERATOR CONT,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000046,94640,HC HIGH EFF NEB AERO EACH,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000047,94640,HC HIGH EFF NEB AERO W/INSTR/TEACH DEVICE,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000049,94642,HC AEROSOL INHALATION PENTAMIDINE,410,1 ,$183.00 ,$91.50 ,$16.35 ,$411.30 ,$16.35 ,$118.38 ,$118.38 ,$182.80 ,$109.80 ,$155.55 ,$128.10 ,$16.35 ,$173.85 ,$131.76 ,$133.59 ,$118.95 ,$155.55 ,$182.80 ,$118.95 ,$155.55 ,$133.59 ,$16.35 ,$182.80 ,$89.38 ,$155.55 ,$411.30 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$103.96 ,$126.45 ,$131.76 ,$127.46 ,$184.63 ,$131.76 ,$17.33 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$246.00 ,$123.00 ,$16.35 ,$246.74 ,$16.35 ,$159.14 ,$159.14 ,$109.66 ,$147.60 ,$209.10 ,$172.20 ,$16.35 ,$233.70 ,$177.12 ,$179.58 ,$159.90 ,$209.10 ,$109.66 ,$159.90 ,$209.10 ,$179.58 ,$16.35 ,$109.66 ,$89.38 ,$209.10 ,$246.74 ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$139.75 ,$169.99 ,$177.12 ,$171.34 ,$110.76 ,$177.12 ,$17.33 ,$91.00 ,$91.00 ,$109.66 ,$91.00 ,$109.66 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,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 ,$33.12 ,$33.58 ,$29.90 ,$39.10 , N/A ,$29.90 ,$39.10 ,$33.58 ,$16.35 , N/A ,$46.00 ,$39.10 , N/A ,$42.32 ,$32.20 ,$23.33 ,$28.00 ,$28.01 ,$26.13 ,$31.79 ,$33.12 ,$32.04 , N/A ,$33.12 ,$17.33 ,$46.00 ,$46.00 , N/A ,$46.00 , N/A ,$33.12 ,$28.52 ,$33.12 ,$33.12 ,$27.60 
ST MARY'S HOSPITAL,41000052,94660,HC CPAP,410,1 ,$310.00 ,$155.00 ,$38.97 ,$411.30 ,$38.97 ,$200.54 ,$200.54 ,$182.80 ,$186.00 ,$263.50 ,$217.00 ,$38.97 ,$294.50 ,$223.20 ,$226.30 ,$201.50 ,$263.50 ,$182.80 ,$201.50 ,$263.50 ,$226.30 ,$38.97 ,$182.80 ,$89.38 ,$263.50 ,$411.30 ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$176.11 ,$214.21 ,$223.20 ,$215.92 ,$184.63 ,$223.20 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$186.00 
ST MARY'S HOSPITAL,41000053,94660,HC CPAP DAILY EST PT,410,1 ,$140.00 ,$70.00 ,$38.97 ,$411.30 ,$38.97 ,$90.57 ,$90.57 ,$182.80 ,$84.00 ,$119.00 ,$98.00 ,$38.97 ,$133.00 ,$100.80 ,$102.20 ,$91.00 ,$119.00 ,$182.80 ,$91.00 ,$119.00 ,$102.20 ,$38.97 ,$182.80 ,$89.38 ,$119.00 ,$411.30 ,$128.80 ,$98.00 ,$71.01 ,$85.22 ,$85.26 ,$79.53 ,$96.74 ,$100.80 ,$97.51 ,$184.63 ,$100.80 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$100.80 ,$86.80 ,$100.80 ,$100.80 ,$84.00 
ST MARY'S HOSPITAL,41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$183.00 ,$91.50 ,$16.35 ,$411.30 ,$16.35 ,$118.38 ,$118.38 ,$182.80 ,$109.80 ,$155.55 ,$128.10 ,$16.35 ,$173.85 ,$131.76 ,$133.59 ,$118.95 ,$155.55 ,$182.80 ,$118.95 ,$155.55 ,$133.59 ,$16.35 ,$182.80 ,$89.38 ,$155.55 ,$411.30 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$103.96 ,$126.45 ,$131.76 ,$127.46 ,$184.63 ,$131.76 ,$17.33 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$97.00 ,$48.50 ,$16.35 ,$246.74 ,$16.35 ,$62.75 ,$62.75 ,$109.66 ,$58.20 ,$82.45 ,$67.90 ,$16.35 ,$92.15 ,$69.84 ,$70.81 ,$63.05 ,$82.45 ,$109.66 ,$63.05 ,$82.45 ,$70.81 ,$16.35 ,$109.66 ,$89.38 ,$82.45 ,$246.74 ,$89.24 ,$67.90 ,$49.20 ,$59.04 ,$59.07 ,$55.11 ,$67.03 ,$69.84 ,$67.56 ,$110.76 ,$69.84 ,$17.33 ,$91.00 ,$91.00 ,$109.66 ,$91.00 ,$109.66 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$97.00 ,$48.50 ,$16.35 ,$246.74 ,$16.35 ,$62.75 ,$62.75 ,$109.66 ,$58.20 ,$82.45 ,$67.90 ,$16.35 ,$92.15 ,$69.84 ,$70.81 ,$63.05 ,$82.45 ,$109.66 ,$63.05 ,$82.45 ,$70.81 ,$16.35 ,$109.66 ,$89.38 ,$82.45 ,$246.74 ,$89.24 ,$67.90 ,$49.20 ,$59.04 ,$59.07 ,$55.11 ,$67.03 ,$69.84 ,$67.56 ,$110.76 ,$69.84 ,$17.33 ,$91.00 ,$91.00 ,$109.66 ,$91.00 ,$109.66 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$75.00 ,$37.50 ,$16.35 ,$246.74 ,$16.35 ,$48.52 ,$48.52 ,$109.66 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$109.66 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$109.66 ,$75.00 ,$63.75 ,$246.74 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$110.76 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$109.66 ,$75.00 ,$109.66 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$75.00 ,$37.50 ,$16.35 ,$246.74 ,$16.35 ,$48.52 ,$48.52 ,$109.66 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$109.66 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$109.66 ,$75.00 ,$63.75 ,$246.74 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$110.76 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$109.66 ,$75.00 ,$109.66 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,41000065,94799,HC CARBON MONOXIDE TEST,410,1 ,$123.00 ,$61.50 ,$16.35 ,$305.50 ,$16.35 ,$79.57 ,$79.57 ,$135.78 ,$73.80 ,$104.55 ,$86.10 ,$16.35 ,$116.85 ,$88.56 ,$89.79 ,$79.95 ,$104.55 ,$135.78 ,$79.95 ,$104.55 ,$89.79 ,$16.35 ,$135.78 ,$89.38 ,$104.55 ,$305.50 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$69.88 ,$84.99 ,$88.56 ,$85.67 ,$137.14 ,$88.56 ,$17.33 ,$91.00 ,$91.00 ,$135.78 ,$91.00 ,$135.78 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,41000066,94799,HC SEDATION BAGGING,410,1 ,$123.00 ,$61.50 ,$16.35 ,$305.50 ,$16.35 ,$79.57 ,$79.57 ,$135.78 ,$73.80 ,$104.55 ,$86.10 ,$16.35 ,$116.85 ,$88.56 ,$89.79 ,$79.95 ,$104.55 ,$135.78 ,$79.95 ,$104.55 ,$89.79 ,$16.35 ,$135.78 ,$89.38 ,$104.55 ,$305.50 ,$113.16 ,$86.10 ,$62.39 ,$74.87 ,$74.91 ,$69.88 ,$84.99 ,$88.56 ,$85.67 ,$137.14 ,$88.56 ,$17.33 ,$91.00 ,$91.00 ,$135.78 ,$91.00 ,$135.78 ,$88.56 ,$76.26 ,$88.56 ,$88.56 ,$73.80 
ST MARY'S HOSPITAL,41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$86.00 ,$43.00 ,$11.17 ,$86.00 ,$11.17 ,$55.63 ,$55.63 ,$24.03 ,$51.60 ,$73.10 ,$60.20 ,$11.17 ,$81.70 ,$61.92 ,$62.78 ,$55.90 ,$73.10 ,$24.03 ,$55.90 ,$73.10 ,$62.78 ,$11.17 ,$24.03 ,$86.00 ,$73.10 ,$54.06 ,$79.12 ,$60.20 ,$43.62 ,$52.35 ,$52.37 ,$48.86 ,$59.43 ,$61.92 ,$59.90 ,$24.27 ,$61.92 ,$11.84 ,$86.00 ,$86.00 ,$24.03 ,$86.00 ,$24.03 ,$61.92 ,$53.32 ,$61.92 ,$61.92 ,$51.60 
ST MARY'S HOSPITAL,41000069,G0238,HC RESP THRP FUNCTION,410,1 ,$92.00 ,$46.00 ,$11.17 ,$92.00 ,$11.17 ,$59.51 ,$59.51 ,$24.03 ,$55.20 ,$78.20 ,$64.40 ,$11.17 ,$87.40 ,$66.24 ,$67.16 ,$59.80 ,$78.20 ,$24.03 ,$59.80 ,$78.20 ,$67.16 ,$11.17 ,$24.03 ,$89.38 ,$78.20 ,$54.06 ,$84.64 ,$64.40 ,$46.66 ,$56.00 ,$56.03 ,$52.27 ,$63.57 ,$66.24 ,$64.08 ,$24.27 ,$66.24 ,$11.84 ,$91.00 ,$91.00 ,$24.03 ,$91.00 ,$24.03 ,$66.24 ,$57.04 ,$66.24 ,$66.24 ,$55.20 
ST MARY'S HOSPITAL,41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$183.00 ,$91.50 ,$11.17 ,$183.00 ,$11.17 ,$118.38 ,$118.38 ,$32.92 ,$109.80 ,$155.55 ,$128.10 ,$11.17 ,$173.85 ,$131.76 ,$133.59 ,$118.95 ,$155.55 ,$32.92 ,$118.95 ,$155.55 ,$133.59 ,$11.17 ,$32.92 ,$89.38 ,$155.55 ,$74.07 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$103.96 ,$126.45 ,$131.76 ,$127.46 ,$33.25 ,$131.76 ,$11.84 ,$91.00 ,$91.00 ,$32.92 ,$91.00 ,$32.92 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,41000073,94660,HC VENT NONINVAS NEON SUBQ DAY,410,1 ,$280.00 ,$140.00 ,$38.97 ,$411.30 ,$38.97 ,$181.13 ,$181.13 ,$182.80 ,$168.00 ,$238.00 ,$196.00 ,$38.97 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$182.80 ,$182.00 ,$238.00 ,$204.40 ,$38.97 ,$182.80 ,$89.38 ,$238.00 ,$411.30 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$184.63 ,$201.60 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$533.00 ,$266.50 ,$38.97 ,$533.00 ,$38.97 ,$344.80 ,$344.80 ,$182.80 ,$319.80 ,$453.05 ,$373.10 ,$38.97 ,$506.35 ,$383.76 ,$389.09 ,$346.45 ,$453.05 ,$182.80 ,$346.45 ,$453.05 ,$389.09 ,$38.97 ,$182.80 ,$89.38 ,$453.05 ,$411.30 ,$490.36 ,$373.10 ,$270.34 ,$324.44 ,$324.60 ,$302.80 ,$368.30 ,$383.76 ,$371.23 ,$184.63 ,$383.76 ,$41.31 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$383.76 ,$330.46 ,$383.76 ,$383.76 ,$319.80 
ST MARY'S HOSPITAL,41000087,94669,HC MECHANICAL CHEST WALL OSCILLATION INITIAL,410,1 ,$567.00 ,$283.50 ,$16.35 ,$567.00 ,$16.35 ,$366.79 ,$366.79 ,$182.80 ,$340.20 ,$481.95 ,$396.90 ,$16.35 ,$538.65 ,$408.24 ,$413.91 ,$368.55 ,$481.95 ,$182.80 ,$368.55 ,$481.95 ,$413.91 ,$16.35 ,$182.80 ,$89.38 ,$481.95 ,$411.30 ,$521.64 ,$396.90 ,$287.58 ,$345.13 ,$345.30 ,$322.11 ,$391.80 ,$408.24 ,$394.92 ,$184.63 ,$408.24 ,$17.33 ,$91.00 ,$91.00 ,$182.80 ,$91.00 ,$182.80 ,$408.24 ,$351.54 ,$408.24 ,$408.24 ,$340.20 
ST MARY'S HOSPITAL,41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$75.00 ,$37.50 ,$16.35 ,$411.30 ,$16.35 ,$48.52 ,$48.52 ,$182.80 ,$45.00 ,$63.75 ,$52.50 ,$16.35 ,$71.25 ,$54.00 ,$54.75 ,$48.75 ,$63.75 ,$182.80 ,$48.75 ,$63.75 ,$54.75 ,$16.35 ,$182.80 ,$75.00 ,$63.75 ,$411.30 ,$69.00 ,$52.50 ,$38.04 ,$45.65 ,$45.68 ,$42.61 ,$51.83 ,$54.00 ,$52.24 ,$184.63 ,$54.00 ,$17.33 ,$75.00 ,$75.00 ,$182.80 ,$75.00 ,$182.80 ,$54.00 ,$46.50 ,$54.00 ,$54.00 ,$45.00 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$87.10 ,$113.90 ,$42.34 ,$87.10 ,$113.90 ,$97.82 , N/A ,$42.34 ,$109.75 ,$113.90 ,$95.27 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$76.13 ,$92.59 ,$96.48 ,$93.33 ,$42.76 ,$96.48 ,$12.86 ,$134.00 ,$134.00 ,$42.34 ,$134.00 ,$42.34 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$13.97 ,$65.00 ,$85.00 ,$73.00 , N/A ,$13.97 ,$100.00 ,$85.00 ,$31.43 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$14.11 ,$72.00 ,$10.75 ,$100.00 ,$100.00 ,$13.97 ,$100.00 ,$13.97 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$11.55 ,$58.50 ,$76.50 ,$65.70 , N/A ,$11.55 ,$90.00 ,$76.50 ,$25.99 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$11.67 ,$64.80 ,$10.75 ,$90.00 ,$90.00 ,$11.55 ,$90.00 ,$11.55 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,42000015,97022,HC WHIRLPOOL BATH,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$16.74 ,$71.50 ,$93.50 ,$80.30 , N/A ,$16.74 ,$109.75 ,$93.50 ,$37.67 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$16.91 ,$79.20 ,$10.75 ,$110.00 ,$110.00 ,$16.74 ,$110.00 ,$16.74 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$16.74 ,$71.50 ,$93.50 ,$80.30 , N/A ,$16.74 ,$109.75 ,$93.50 ,$37.67 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$16.91 ,$79.20 ,$10.75 ,$110.00 ,$110.00 ,$16.74 ,$110.00 ,$16.74 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$14.30 ,$58.50 ,$76.50 ,$65.70 , N/A ,$14.30 ,$90.00 ,$76.50 ,$32.18 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$14.44 ,$64.80 ,$10.75 ,$90.00 ,$90.00 ,$14.30 ,$90.00 ,$14.30 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$14.30 ,$58.50 ,$76.50 ,$65.70 , N/A ,$14.30 ,$90.00 ,$76.50 ,$32.18 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$14.44 ,$64.80 ,$10.75 ,$90.00 ,$90.00 ,$14.30 ,$90.00 ,$14.30 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$19.21 ,$71.50 ,$93.50 ,$80.30 , N/A ,$19.21 ,$109.75 ,$93.50 ,$43.22 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$19.40 ,$79.20 ,$10.75 ,$110.00 ,$110.00 ,$19.21 ,$110.00 ,$19.21 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$13.89 ,$58.50 ,$76.50 ,$65.70 , N/A ,$13.89 ,$90.00 ,$76.50 ,$31.25 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$14.03 ,$64.80 ,$10.75 ,$90.00 ,$90.00 ,$13.89 ,$90.00 ,$13.89 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$28.82 ,$65.00 ,$85.00 ,$73.00 , N/A ,$28.82 ,$100.00 ,$85.00 ,$64.85 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$29.11 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$28.82 ,$100.00 ,$28.82 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$84.50 ,$110.50 ,$33.48 ,$84.50 ,$110.50 ,$94.90 , N/A ,$33.48 ,$109.75 ,$110.50 ,$75.33 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$73.85 ,$89.83 ,$93.60 ,$90.55 ,$33.81 ,$93.60 ,$12.86 ,$130.00 ,$130.00 ,$33.48 ,$130.00 ,$33.48 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$28.82 ,$65.00 ,$85.00 ,$73.00 , N/A ,$28.82 ,$100.00 ,$85.00 ,$64.85 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$29.11 ,$72.00 ,$10.75 ,$100.00 ,$100.00 ,$28.82 ,$100.00 ,$28.82 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$29.17 ,$65.00 ,$85.00 ,$73.00 , N/A ,$29.17 ,$100.00 ,$85.00 ,$65.63 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$29.46 ,$72.00 ,$10.75 ,$100.00 ,$100.00 ,$29.17 ,$100.00 ,$29.17 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$26.50 ,$65.00 ,$85.00 ,$73.00 , N/A ,$26.50 ,$100.00 ,$85.00 ,$59.63 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$26.77 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$26.50 ,$100.00 ,$26.50 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,42000063,97150,HC GROUP TREATMENT 15MIN,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$17.31 ,$65.00 ,$85.00 ,$73.00 , N/A ,$17.31 ,$100.00 ,$85.00 ,$38.95 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$17.48 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$17.31 ,$100.00 ,$17.31 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$86.40 ,$87.60 ,$78.00 ,$102.00 ,$36.29 ,$78.00 ,$102.00 ,$87.60 , N/A ,$36.29 ,$109.75 ,$102.00 ,$81.65 ,$110.40 ,$84.00 ,$60.86 ,$73.04 ,$73.08 ,$68.17 ,$82.92 ,$86.40 ,$83.58 ,$36.65 ,$86.40 ,$12.86 ,$120.00 ,$120.00 ,$36.29 ,$120.00 ,$36.29 ,$86.40 ,$74.40 ,$86.40 ,$86.40 ,$72.00 
ST MARY'S HOSPITAL,42000068,97597,HC DEBR SKIN PART THICKNESS <20CM,420,1 ,$388.00 ,$194.00 ,$42.35 ,$388.00 ,$42.35 ,$270.00 ,$218.00 ,$98.76 ,$232.80 ,$329.80 ,$271.60 ,$42.35 ,$368.60 ,$279.36 ,$283.24 ,$252.20 ,$329.80 ,$98.76 ,$252.20 ,$329.80 ,$283.24 , N/A ,$98.76 ,$109.75 ,$329.80 ,$222.21 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$220.42 ,$268.11 ,$279.36 ,$270.24 ,$99.75 ,$279.36 ,$62.23 ,$258.00 ,$258.00 ,$98.76 ,$258.00 ,$98.76 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$232.80 
ST MARY'S HOSPITAL,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 ,$123.84 ,$125.56 ,$111.80 ,$146.20 , N/A ,$111.80 ,$146.20 ,$125.56 , N/A , N/A ,$109.75 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$97.71 ,$118.85 ,$123.84 ,$119.80 , N/A ,$123.84 ,$334.00 ,$172.00 ,$172.00 , N/A ,$172.00 , N/A ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$103.20 
ST MARY'S HOSPITAL,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 ,$108.72 ,$110.23 ,$98.15 ,$128.35 , N/A ,$98.15 ,$128.35 ,$110.23 , N/A , N/A ,$109.75 ,$128.35 , N/A ,$138.92 ,$105.70 ,$76.59 ,$91.91 ,$91.96 ,$85.78 ,$104.34 ,$108.72 ,$105.17 , N/A ,$108.72 ,$125.18 ,$151.00 ,$151.00 , N/A ,$151.00 , N/A ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$90.60 
ST MARY'S HOSPITAL,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 ,$154.80 ,$156.95 ,$139.75 ,$182.75 ,$41.41 ,$139.75 ,$182.75 ,$156.95 , N/A ,$41.41 ,$109.75 ,$182.75 ,$93.17 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$122.14 ,$148.57 ,$154.80 ,$149.75 ,$41.82 ,$154.80 ,$62.23 ,$215.00 ,$215.00 ,$41.41 ,$215.00 ,$41.41 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$129.00 
ST MARY'S HOSPITAL,42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$280.00 ,$140.00 ,$49.00 ,$280.00 , N/A ,$270.00 ,$218.00 ,$49.00 ,$168.00 ,$238.00 ,$196.00 , N/A ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$49.00 ,$182.00 ,$238.00 ,$204.40 , N/A ,$49.00 ,$109.75 ,$238.00 ,$110.25 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$49.49 ,$201.60 ,$125.18 ,$258.00 ,$258.00 ,$49.00 ,$258.00 ,$49.00 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$32.73 ,$65.00 ,$85.00 ,$73.00 , N/A ,$32.73 ,$100.00 ,$85.00 ,$73.64 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$33.06 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$32.73 ,$100.00 ,$32.73 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$40.65 ,$65.00 ,$85.00 ,$73.00 , N/A ,$40.65 ,$100.00 ,$85.00 ,$91.46 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$41.06 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$40.65 ,$100.00 ,$40.65 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,42000095,97763,HC ORTHTC/PRSTHTC CHECK EA 15MIN,420,1 ,$100.00 ,$50.00 ,$12.86 ,$118.51 ,$28.15 ,$100.00 ,$100.00 ,$52.67 ,$60.00 ,$85.00 ,$70.00 ,$28.15 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$52.67 ,$65.00 ,$85.00 ,$73.00 , N/A ,$52.67 ,$100.00 ,$85.00 ,$118.51 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$53.20 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$52.67 ,$100.00 ,$52.67 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,42000108,G0281,HC ELECT STIM(UNATTENDED) ULCER,420,1 ,$97.00 ,$48.50 ,$11.87 ,$97.00 ,$22.38 ,$97.00 ,$97.00 ,$11.87 ,$58.20 ,$82.45 ,$67.90 ,$22.38 ,$92.15 ,$69.84 ,$70.81 ,$63.05 ,$82.45 ,$11.87 ,$63.05 ,$82.45 ,$70.81 , N/A ,$11.87 ,$97.00 ,$82.45 ,$26.71 ,$89.24 ,$67.90 ,$49.20 ,$59.04 ,$59.07 ,$55.11 ,$67.03 ,$69.84 ,$67.56 ,$11.99 ,$69.84 ,$62.23 ,$97.00 ,$97.00 ,$11.87 ,$97.00 ,$11.87 ,$69.84 ,$60.14 ,$69.84 ,$69.84 ,$58.20 
ST MARY'S HOSPITAL,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 ,$85.68 ,$86.87 ,$77.35 ,$101.15 ,$11.87 ,$77.35 ,$101.15 ,$86.87 , N/A ,$11.87 ,$109.75 ,$101.15 ,$26.71 ,$109.48 ,$83.30 ,$60.36 ,$72.44 ,$72.47 ,$67.60 ,$82.23 ,$85.68 ,$82.88 ,$11.99 ,$85.68 ,$10.75 ,$119.00 ,$119.00 ,$11.87 ,$119.00 ,$11.87 ,$85.68 ,$73.78 ,$85.68 ,$85.68 ,$71.40 
ST MARY'S HOSPITAL,42000120,97150,HC GROUP TREATMENT 30MIN,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$17.31 ,$65.00 ,$85.00 ,$73.00 , N/A ,$17.31 ,$100.00 ,$85.00 ,$38.95 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$17.48 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$17.31 ,$100.00 ,$17.31 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,42000121,97150,HC GROUP TREATMENT 45MIN,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$17.31 ,$65.00 ,$85.00 ,$73.00 , N/A ,$17.31 ,$100.00 ,$85.00 ,$38.95 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$17.48 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$17.31 ,$100.00 ,$17.31 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$17.31 ,$65.00 ,$85.00 ,$73.00 , N/A ,$17.31 ,$100.00 ,$85.00 ,$38.95 ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 ,$17.48 ,$72.00 ,$12.86 ,$100.00 ,$100.00 ,$17.31 ,$100.00 ,$17.31 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$96.48 ,$97.82 ,$87.10 ,$113.90 , N/A ,$87.10 ,$113.90 ,$97.82 , N/A , N/A ,$109.75 ,$113.90 , N/A ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$76.13 ,$92.59 ,$96.48 ,$93.33 , N/A ,$96.48 ,$34.50 ,$134.00 ,$134.00 , N/A ,$134.00 , N/A ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$151.20 ,$153.30 ,$136.50 ,$178.50 ,$98.02 ,$136.50 ,$178.50 ,$153.30 , N/A ,$98.02 ,$109.75 ,$178.50 ,$220.55 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$99.00 ,$151.20 ,$79.69 ,$210.00 ,$210.00 ,$98.02 ,$210.00 ,$98.02 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$93.50 ,$80.30 , N/A ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$68.21 ,$79.20 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$67.53 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$93.50 ,$80.30 , N/A ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$68.21 ,$79.20 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$67.53 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$93.50 ,$80.30 , N/A ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$68.21 ,$79.20 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$67.53 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$67.53 ,$71.50 ,$93.50 ,$80.30 , N/A ,$67.53 ,$109.75 ,$93.50 ,$151.94 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$68.21 ,$79.20 ,$79.69 ,$110.00 ,$110.00 ,$67.53 ,$110.00 ,$67.53 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$32.08 ,$71.50 ,$93.50 ,$80.30 , N/A ,$32.08 ,$109.75 ,$93.50 ,$72.18 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$32.40 ,$79.20 ,$10.75 ,$110.00 ,$110.00 ,$32.08 ,$110.00 ,$32.08 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,43000017,97535,HC SELF CARE ADL TRAINING EA 15MIN MODIFICT,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$32.08 ,$71.50 ,$93.50 ,$80.30 , N/A ,$32.08 ,$109.75 ,$93.50 ,$72.18 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$32.40 ,$79.20 ,$10.75 ,$110.00 ,$110.00 ,$32.08 ,$110.00 ,$32.08 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$57.60 ,$58.40 ,$52.00 ,$68.00 ,$31.16 ,$52.00 ,$68.00 ,$58.40 , N/A ,$31.16 ,$80.00 ,$68.00 ,$70.11 ,$73.60 ,$56.00 ,$40.58 ,$48.70 ,$48.72 ,$45.45 ,$55.28 ,$57.60 ,$55.72 ,$31.47 ,$57.60 ,$12.86 ,$80.00 ,$80.00 ,$31.16 ,$80.00 ,$31.16 ,$57.60 ,$49.60 ,$57.60 ,$57.60 ,$48.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 ,$47.50 ,$71.50 ,$93.50 ,$80.30 , N/A ,$47.50 ,$109.75 ,$93.50 ,$106.88 ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 ,$47.98 ,$79.20 ,$12.86 ,$110.00 ,$110.00 ,$47.50 ,$110.00 ,$47.50 ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$22.40 ,$58.50 ,$76.50 ,$65.70 , N/A ,$22.40 ,$90.00 ,$76.50 ,$50.40 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$22.62 ,$64.80 ,$12.86 ,$90.00 ,$90.00 ,$22.40 ,$90.00 ,$22.40 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$21.71 ,$58.50 ,$76.50 ,$65.70 , N/A ,$21.71 ,$90.00 ,$76.50 ,$48.85 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$21.93 ,$64.80 ,$12.86 ,$90.00 ,$90.00 ,$21.71 ,$90.00 ,$21.71 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$158.40 ,$160.60 ,$143.00 ,$187.00 ,$98.67 ,$143.00 ,$187.00 ,$160.60 , N/A ,$98.67 ,$109.75 ,$187.00 ,$222.01 ,$202.40 ,$154.00 ,$111.58 ,$133.91 ,$133.98 ,$124.98 ,$152.02 ,$158.40 ,$153.23 ,$99.66 ,$158.40 ,$61.48 ,$220.00 ,$220.00 ,$98.67 ,$220.00 ,$98.67 ,$158.40 ,$136.40 ,$158.40 ,$158.40 ,$132.00 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$110.50 ,$94.90 , N/A ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$73.85 ,$89.83 ,$93.60 ,$90.55 ,$68.54 ,$93.60 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$67.86 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$110.50 ,$94.90 , N/A ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$73.85 ,$89.83 ,$93.60 ,$90.55 ,$68.54 ,$93.60 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$67.86 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$110.50 ,$94.90 , N/A ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$73.85 ,$89.83 ,$93.60 ,$90.55 ,$68.54 ,$93.60 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$67.86 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$84.50 ,$110.50 ,$67.86 ,$84.50 ,$110.50 ,$94.90 , N/A ,$67.86 ,$109.75 ,$110.50 ,$152.69 ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$73.85 ,$89.83 ,$93.60 ,$90.55 ,$68.54 ,$93.60 ,$61.48 ,$130.00 ,$130.00 ,$67.86 ,$130.00 ,$67.86 ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$270.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$238.00 ,$204.40 ,$86.63 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$75.92 ,$201.60 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$75.17 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$270.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$238.00 ,$204.40 ,$86.63 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$75.92 ,$201.60 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$75.17 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$270.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$238.00 ,$204.40 ,$86.63 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$75.92 ,$201.60 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$75.17 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$270.00 ,$218.00 ,$75.17 ,$168.00 ,$238.00 ,$196.00 ,$47.91 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$75.17 ,$182.00 ,$238.00 ,$204.40 ,$86.63 ,$75.17 ,$109.75 ,$238.00 ,$169.13 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$75.92 ,$201.60 ,$76.91 ,$258.00 ,$258.00 ,$75.17 ,$258.00 ,$75.17 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000008,92520,HC LARYNGEAL FUNCTION STUDY,440,1 ,$314.00 ,$157.00 ,$31.07 ,$314.00 ,$31.07 ,$270.00 ,$218.00 ,$79.83 ,$188.40 ,$266.90 ,$219.80 ,$31.07 ,$298.30 ,$226.08 ,$229.22 ,$204.10 ,$266.90 ,$79.83 ,$204.10 ,$266.90 ,$229.22 , N/A ,$79.83 ,$109.75 ,$266.90 ,$179.62 ,$288.88 ,$219.80 ,$159.26 ,$191.13 ,$191.23 ,$178.38 ,$216.97 ,$226.08 ,$218.70 ,$80.63 ,$226.08 ,$48.23 ,$258.00 ,$258.00 ,$79.83 ,$258.00 ,$79.83 ,$226.08 ,$194.68 ,$226.08 ,$226.08 ,$188.40 
ST MARY'S HOSPITAL,44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$270.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$238.00 ,$204.40 , N/A ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$84.23 ,$201.60 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$83.40 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$270.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$238.00 ,$204.40 , N/A ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$84.23 ,$201.60 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$83.40 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$270.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$238.00 ,$204.40 , N/A ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$84.23 ,$201.60 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$83.40 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$280.00 ,$140.00 ,$12.86 ,$280.00 ,$48.82 ,$270.00 ,$218.00 ,$83.40 ,$168.00 ,$238.00 ,$196.00 ,$48.82 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$83.40 ,$182.00 ,$238.00 ,$204.40 , N/A ,$83.40 ,$109.75 ,$238.00 ,$187.65 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$84.23 ,$201.60 ,$12.86 ,$258.00 ,$258.00 ,$83.40 ,$258.00 ,$83.40 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,44400016,92610,HC DYSHPAGIA THERAPY,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400021,92610,HC DYSPHAGIA REEVALUATION 15MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400022,92610,HC DYSPHAGIA REEVALUATION 30MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400023,92610,HC DYSPHAGIA REEVALUATION 45MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400025,92610,HC DYSPHAGIA EVALUATION,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400029,92611,HC DYSPHAGIA EVAL-VIDEO 15MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,44400030,92611,HC DYSPHAGIA EVAL-VIDEO 30MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,44400031,92611,HC DYSPHAGIA EVAL-VIDEO 45MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,44400032,92611,HC DYSPHAGIA EVAL-VIDEO 60MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,44400034,92611,HC DYSPHAGIA RE-EVAL VIDEO 15MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$221.00 ,$189.80 , N/A ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$131.57 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$130.27 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$221.00 ,$189.80 , N/A ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$110.18 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$109.09 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$270.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$309.60 ,$313.90 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$365.50 ,$313.90 , N/A ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$244.28 ,$297.13 ,$309.60 ,$299.50 ,$225.34 ,$309.60 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$223.11 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$258.00 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$195.50 ,$167.90 , N/A ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$108.53 ,$165.60 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$107.46 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,44400048,92610,HC DYSPHAGIA REEVALUATION 60MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$270.00 ,$218.00 ,$83.19 ,$204.00 ,$289.00 ,$238.00 ,$72.23 ,$323.00 ,$244.80 ,$248.20 ,$221.00 ,$289.00 ,$83.19 ,$221.00 ,$289.00 ,$248.20 , N/A ,$83.19 ,$109.75 ,$289.00 ,$187.18 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$84.02 ,$244.80 ,$76.91 ,$258.00 ,$258.00 ,$83.19 ,$258.00 ,$83.19 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,44400049,92611,HC DYSPHAGIA RE-EVAL VIDEO 30MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,44400050,92611,HC DYSPHAGIA RE-EVAL VIDEO 45MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,44400051,92611,HC DYSPHAGIA RE-EVAL VIDEO 60MIN,444,1 ,$390.00 ,$195.00 ,$40.20 ,$390.00 ,$116.92 ,$270.00 ,$218.00 ,$89.02 ,$234.00 ,$331.50 ,$273.00 ,$116.92 ,$370.50 ,$280.80 ,$284.70 ,$253.50 ,$331.50 ,$89.02 ,$253.50 ,$331.50 ,$284.70 , N/A ,$89.02 ,$109.75 ,$331.50 ,$200.30 ,$358.80 ,$273.00 ,$197.81 ,$237.39 ,$237.51 ,$221.56 ,$269.49 ,$280.80 ,$271.64 ,$89.91 ,$280.80 ,$40.20 ,$258.00 ,$258.00 ,$89.02 ,$258.00 ,$89.02 ,$280.80 ,$241.80 ,$280.80 ,$280.80 ,$234.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$221.00 ,$189.80 , N/A ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$131.57 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$130.27 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$221.00 ,$189.80 , N/A ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$131.57 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$130.27 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$130.27 ,$169.00 ,$221.00 ,$189.80 , N/A ,$130.27 ,$109.75 ,$221.00 ,$293.11 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$131.57 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$130.27 ,$258.00 ,$130.27 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$221.00 ,$189.80 , N/A ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$110.18 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$109.09 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$221.00 ,$189.80 , N/A ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$110.18 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$109.09 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,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 ,$187.20 ,$189.80 ,$169.00 ,$221.00 ,$109.09 ,$169.00 ,$221.00 ,$189.80 , N/A ,$109.09 ,$109.75 ,$221.00 ,$245.45 ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 ,$110.18 ,$187.20 ,$76.91 ,$258.00 ,$258.00 ,$109.09 ,$258.00 ,$109.09 ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$270.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$309.60 ,$313.90 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$365.50 ,$313.90 , N/A ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$244.28 ,$297.13 ,$309.60 ,$299.50 ,$225.34 ,$309.60 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$223.11 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$258.00 
ST MARY'S HOSPITAL,44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$270.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$309.60 ,$313.90 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$365.50 ,$313.90 , N/A ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$244.28 ,$297.13 ,$309.60 ,$299.50 ,$225.34 ,$309.60 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$223.11 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$258.00 
ST MARY'S HOSPITAL,44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$270.00 ,$218.00 ,$223.11 ,$258.00 ,$365.50 ,$301.00 ,$48.63 ,$408.50 ,$309.60 ,$313.90 ,$279.50 ,$365.50 ,$223.11 ,$279.50 ,$365.50 ,$313.90 , N/A ,$223.11 ,$109.75 ,$365.50 ,$502.00 ,$395.60 ,$301.00 ,$218.10 ,$261.74 ,$261.87 ,$244.28 ,$297.13 ,$309.60 ,$299.50 ,$225.34 ,$309.60 ,$76.91 ,$258.00 ,$258.00 ,$223.11 ,$258.00 ,$223.11 ,$309.60 ,$266.60 ,$309.60 ,$309.60 ,$258.00 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$195.50 ,$167.90 , N/A ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$108.53 ,$165.60 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$107.46 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$195.50 ,$167.90 , N/A ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$108.53 ,$165.60 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$107.46 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 ,$149.50 ,$195.50 ,$107.46 ,$149.50 ,$195.50 ,$167.90 , N/A ,$107.46 ,$109.75 ,$195.50 ,$241.79 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$108.53 ,$165.60 ,$76.91 ,$230.00 ,$230.00 ,$107.46 ,$230.00 ,$107.46 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$840.00 ,$420.00 ,$51.36 ,$840.00 ,$51.36 ,$543.40 ,$543.40 ,$336.14 ,$504.00 ,$714.00 ,$588.00 ,$51.36 ,$798.00 ,$604.80 ,$613.20 ,$546.00 ,$714.00 ,$336.14 ,$546.00 ,$714.00 ,$613.20 ,$51.36 ,$336.14 ,$571.36 ,$714.00 ,$756.32 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$477.20 ,$580.44 ,$604.80 ,$585.06 ,$339.50 ,$604.80 ,$54.44 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$474.00 ,$237.00 ,$51.36 ,"$1,361.67 ",$51.36 ,$306.63 ,$306.63 ,$605.19 ,$284.40 ,$402.90 ,$331.80 ,$51.36 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$605.19 ,$308.10 ,$402.90 ,$346.02 ,$51.36 ,$605.19 ,$474.00 ,$402.90 ,"$1,361.67 ",$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$611.24 ,$341.28 ,$54.44 ,$474.00 ,$474.00 ,$605.19 ,$474.00 ,$605.19 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,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 ",$605.19 ,"$1,551.60 ","$2,198.10 ","$1,810.20 ",$344.84 ,"$2,456.70 ","$1,861.92 ","$1,887.78 ","$1,680.90 ","$2,198.10 ",$605.19 ,"$1,680.90 ","$2,198.10 ","$1,887.78 ",$344.84 ,$605.19 ,$571.36 ,"$2,198.10 ","$1,361.67 ","$2,379.12 ","$1,810.20 ","$1,311.62 ","$1,574.10 ","$1,574.87 ","$1,469.11 ","$1,786.93 ","$1,861.92 ","$1,801.15 ",$611.24 ,"$1,861.92 ",$365.53 ,$685.00 ,$685.00 ,$605.19 ,$685.00 ,$605.19 ,"$1,861.92 ","$1,603.32 ","$1,861.92 ","$1,861.92 ","$1,551.60 "
ST MARY'S HOSPITAL,45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$388.00 ,$194.00 ,$51.36 ,$756.32 ,$51.36 ,$251.00 ,$251.00 ,$336.14 ,$232.80 ,$329.80 ,$271.60 ,$51.36 ,$368.60 ,$279.36 ,$283.24 ,$252.20 ,$329.80 ,$336.14 ,$252.20 ,$329.80 ,$283.24 ,$51.36 ,$336.14 ,$388.00 ,$329.80 ,$756.32 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$220.42 ,$268.11 ,$279.36 ,$270.24 ,$339.50 ,$279.36 ,$54.44 ,$388.00 ,$388.00 ,$336.14 ,$388.00 ,$336.14 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$232.80 
ST MARY'S HOSPITAL,45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$291.00 ,$145.50 ,$20.60 ,$392.94 ,$20.60 ,$188.25 ,$188.25 ,$174.64 ,$174.60 ,$247.35 ,$203.70 ,$20.60 ,$276.45 ,$209.52 ,$212.43 ,$189.15 ,$247.35 ,$174.64 ,$189.15 ,$247.35 ,$212.43 ,$20.60 ,$174.64 ,$291.00 ,$247.35 ,$392.94 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 ,$176.39 ,$209.52 ,$21.84 ,$291.00 ,$291.00 ,$174.64 ,$291.00 ,$174.64 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,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 ,$167.04 ,$169.36 ,$150.80 ,$197.20 , N/A ,$150.80 ,$197.20 ,$169.36 ,$20.60 , N/A ,$232.00 ,$197.20 , N/A ,$213.44 ,$162.40 ,$117.67 ,$141.22 ,$141.29 ,$131.80 ,$160.31 ,$167.04 ,$161.59 , N/A ,$167.04 ,$21.84 ,$232.00 ,$232.00 , N/A ,$232.00 , N/A ,$167.04 ,$143.84 ,$167.04 ,$167.04 ,$139.20 
ST MARY'S HOSPITAL,45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$151.00 ,$75.50 ,$20.60 ,$246.74 ,$20.60 ,$97.68 ,$97.68 ,$109.66 ,$90.60 ,$128.35 ,$105.70 ,$20.60 ,$143.45 ,$108.72 ,$110.23 ,$98.15 ,$128.35 ,$109.66 ,$98.15 ,$128.35 ,$110.23 ,$20.60 ,$109.66 ,$151.00 ,$128.35 ,$246.74 ,$138.92 ,$105.70 ,$76.59 ,$91.91 ,$91.96 ,$85.78 ,$104.34 ,$108.72 ,$105.17 ,$110.76 ,$108.72 ,$21.84 ,$151.00 ,$151.00 ,$109.66 ,$151.00 ,$109.66 ,$108.72 ,$93.62 ,$108.72 ,$108.72 ,$90.60 
ST MARY'S HOSPITAL,45000012,11760,HC REPAIR NAIL BED,450,1 ,$463.00 ,$231.50 ,$20.60 ,"$1,146.02 ",$20.60 ,$299.51 ,$299.51 ,$509.34 ,$277.80 ,$393.55 ,$324.10 ,$20.60 ,$439.85 ,$333.36 ,$337.99 ,$300.95 ,$393.55 ,$509.34 ,$300.95 ,$393.55 ,$337.99 ,$20.60 ,$509.34 ,$463.00 ,$393.55 ,"$1,146.02 ",$425.96 ,$324.10 ,$234.83 ,$281.83 ,$281.97 ,$263.03 ,$319.93 ,$333.36 ,$322.48 ,$514.43 ,$333.36 ,$21.84 ,$463.00 ,$463.00 ,$509.34 ,$463.00 ,$509.34 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$277.80 
ST MARY'S HOSPITAL,45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,$399.00 ,$199.50 ,$20.60 ,$756.32 ,$20.60 ,$258.11 ,$258.11 ,$336.14 ,$239.40 ,$339.15 ,$279.30 ,$20.60 ,$379.05 ,$287.28 ,$291.27 ,$259.35 ,$339.15 ,$336.14 ,$259.35 ,$339.15 ,$291.27 ,$20.60 ,$336.14 ,$399.00 ,$339.15 ,$756.32 ,$367.08 ,$279.30 ,$202.37 ,$242.87 ,$242.99 ,$226.67 ,$275.71 ,$287.28 ,$277.90 ,$339.50 ,$287.28 ,$21.84 ,$399.00 ,$399.00 ,$336.14 ,$399.00 ,$336.14 ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$239.40 
ST MARY'S HOSPITAL,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 ,$174.64 ,$329.40 ,$466.65 ,$384.30 ,$58.71 ,$521.55 ,$395.28 ,$400.77 ,$356.85 ,$466.65 ,$174.64 ,$356.85 ,$466.65 ,$400.77 ,$58.71 ,$174.64 ,$549.00 ,$466.65 ,$392.94 ,$505.08 ,$384.30 ,$278.45 ,$334.18 ,$334.34 ,$311.89 ,$379.36 ,$395.28 ,$382.38 ,$176.39 ,$395.28 ,$62.23 ,$549.00 ,$549.00 ,$174.64 ,$549.00 ,$174.64 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$329.40 
ST MARY'S HOSPITAL,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 ,$174.64 ,$361.80 ,$512.55 ,$422.10 ,$58.71 ,$572.85 ,$434.16 ,$440.19 ,$391.95 ,$512.55 ,$174.64 ,$391.95 ,$512.55 ,$440.19 ,$58.71 ,$174.64 ,$571.36 ,$512.55 ,$392.94 ,$554.76 ,$422.10 ,$305.84 ,$367.05 ,$367.23 ,$342.56 ,$416.67 ,$434.16 ,$419.99 ,$176.39 ,$434.16 ,$62.23 ,$603.00 ,$603.00 ,$174.64 ,$603.00 ,$174.64 ,$434.16 ,$373.86 ,$434.16 ,$434.16 ,$361.80 
ST MARY'S HOSPITAL,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 ,$174.64 ,$394.20 ,$558.45 ,$459.90 ,$58.71 ,$624.15 ,$473.04 ,$479.61 ,$427.05 ,$558.45 ,$174.64 ,$427.05 ,$558.45 ,$479.61 ,$58.71 ,$174.64 ,$571.36 ,$558.45 ,$392.94 ,$604.44 ,$459.90 ,$333.23 ,$399.92 ,$400.11 ,$373.24 ,$453.99 ,$473.04 ,$457.60 ,$176.39 ,$473.04 ,$62.23 ,$657.00 ,$657.00 ,$174.64 ,$657.00 ,$174.64 ,$473.04 ,$407.34 ,$473.04 ,$473.04 ,$394.20 
ST MARY'S HOSPITAL,45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$711.00 ,$355.50 ,$58.71 ,$756.32 ,$58.71 ,$459.95 ,$459.95 ,$336.14 ,$426.60 ,$604.35 ,$497.70 ,$58.71 ,$675.45 ,$511.92 ,$519.03 ,$462.15 ,$604.35 ,$336.14 ,$462.15 ,$604.35 ,$519.03 ,$58.71 ,$336.14 ,$571.36 ,$604.35 ,$756.32 ,$654.12 ,$497.70 ,$360.62 ,$432.79 ,$433.00 ,$403.92 ,$491.30 ,$511.92 ,$495.21 ,$339.50 ,$511.92 ,$62.23 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$511.92 ,$440.82 ,$511.92 ,$511.92 ,$426.60 
ST MARY'S HOSPITAL,45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$765.00 ,$382.50 ,$58.71 ,$765.00 ,$58.71 ,$494.88 ,$494.88 ,$336.14 ,$459.00 ,$650.25 ,$535.50 ,$58.71 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$336.14 ,$497.25 ,$650.25 ,$558.45 ,$58.71 ,$336.14 ,$571.36 ,$650.25 ,$756.32 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$339.50 ,$550.80 ,$62.23 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,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 ,$174.64 ,$471.60 ,$668.10 ,$550.20 ,$58.71 ,$746.70 ,$565.92 ,$573.78 ,$510.90 ,$668.10 ,$174.64 ,$510.90 ,$668.10 ,$573.78 ,$58.71 ,$174.64 ,$571.36 ,$668.10 ,$392.94 ,$723.12 ,$550.20 ,$398.66 ,$478.44 ,$478.67 ,$446.53 ,$543.13 ,$565.92 ,$547.45 ,$176.39 ,$565.92 ,$62.23 ,$685.00 ,$685.00 ,$174.64 ,$685.00 ,$174.64 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$471.60 
ST MARY'S HOSPITAL,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 ,$174.64 ,$407.40 ,$577.15 ,$475.30 ,$58.71 ,$645.05 ,$488.88 ,$495.67 ,$441.35 ,$577.15 ,$174.64 ,$441.35 ,$577.15 ,$495.67 ,$58.71 ,$174.64 ,$571.36 ,$577.15 ,$392.94 ,$624.68 ,$475.30 ,$344.39 ,$413.31 ,$413.51 ,$385.74 ,$469.19 ,$488.88 ,$472.92 ,$176.39 ,$488.88 ,$62.23 ,$679.00 ,$679.00 ,$174.64 ,$679.00 ,$174.64 ,$488.88 ,$420.98 ,$488.88 ,$488.88 ,$407.40 
ST MARY'S HOSPITAL,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 ,$174.64 ,$445.80 ,$631.55 ,$520.10 ,$58.71 ,$705.85 ,$534.96 ,$542.39 ,$482.95 ,$631.55 ,$174.64 ,$482.95 ,$631.55 ,$542.39 ,$58.71 ,$174.64 ,$571.36 ,$631.55 ,$392.94 ,$683.56 ,$520.10 ,$376.85 ,$452.26 ,$452.49 ,$422.10 ,$513.41 ,$534.96 ,$517.50 ,$176.39 ,$534.96 ,$62.23 ,$685.00 ,$685.00 ,$174.64 ,$685.00 ,$174.64 ,$534.96 ,$460.66 ,$534.96 ,$534.96 ,$445.80 
ST MARY'S HOSPITAL,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 ,$174.64 ,$459.00 ,$650.25 ,$535.50 ,$58.71 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$174.64 ,$497.25 ,$650.25 ,$558.45 ,$58.71 ,$174.64 ,$571.36 ,$650.25 ,$392.94 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$176.39 ,$550.80 ,$62.23 ,$685.00 ,$685.00 ,$174.64 ,$685.00 ,$174.64 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,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 ,$174.64 ,$471.60 ,$668.10 ,$550.20 ,$58.71 ,$746.70 ,$565.92 ,$573.78 ,$510.90 ,$668.10 ,$174.64 ,$510.90 ,$668.10 ,$573.78 ,$58.71 ,$174.64 ,$571.36 ,$668.10 ,$392.94 ,$723.12 ,$550.20 ,$398.66 ,$478.44 ,$478.67 ,$446.53 ,$543.13 ,$565.92 ,$547.45 ,$176.39 ,$565.92 ,$62.23 ,$685.00 ,$685.00 ,$174.64 ,$685.00 ,$174.64 ,$565.92 ,$487.32 ,$565.92 ,$565.92 ,$471.60 
ST MARY'S HOSPITAL,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 ,$336.14 ,$478.20 ,$677.45 ,$557.90 ,$58.71 ,$757.15 ,$573.84 ,$581.81 ,$518.05 ,$677.45 ,$336.14 ,$518.05 ,$677.45 ,$581.81 ,$58.71 ,$336.14 ,$571.36 ,$677.45 ,$756.32 ,$733.24 ,$557.90 ,$404.24 ,$485.13 ,$485.37 ,$452.78 ,$550.73 ,$573.84 ,$555.11 ,$339.50 ,$573.84 ,$62.23 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$573.84 ,$494.14 ,$573.84 ,$573.84 ,$478.20 
ST MARY'S HOSPITAL,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 ,$336.14 ,$491.40 ,$696.15 ,$573.30 ,$58.71 ,$778.05 ,$589.68 ,$597.87 ,$532.35 ,$696.15 ,$336.14 ,$532.35 ,$696.15 ,$597.87 ,$58.71 ,$336.14 ,$571.36 ,$696.15 ,$756.32 ,$753.48 ,$573.30 ,$415.40 ,$498.53 ,$498.77 ,$465.27 ,$565.93 ,$589.68 ,$570.43 ,$339.50 ,$589.68 ,$62.23 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$589.68 ,$507.78 ,$589.68 ,$589.68 ,$491.40 
ST MARY'S HOSPITAL,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 ,$174.64 ,$504.00 ,$714.00 ,$588.00 ,$58.71 ,$798.00 ,$604.80 ,$613.20 ,$546.00 ,$714.00 ,$174.64 ,$546.00 ,$714.00 ,$613.20 ,$58.71 ,$174.64 ,$571.36 ,$714.00 ,$392.94 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$477.20 ,$580.44 ,$604.80 ,$585.06 ,$176.39 ,$604.80 ,$62.23 ,$685.00 ,$685.00 ,$174.64 ,$685.00 ,$174.64 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$1,293.00 ",$118.09 ,$836.44 ,$836.44 ,$509.34 ,$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ",$509.34 ,$840.45 ,"$1,099.05 ",$943.89 ,$118.09 ,$509.34 ,$571.36 ,"$1,099.05 ","$1,146.02 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$514.43 ,$930.96 ,$125.18 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,45000028,12021,HC SIMP SUPERFICIAL DEHISCENC/PAK,450,1 ,$508.00 ,$254.00 ,$118.09 ,$756.32 ,$118.09 ,$328.63 ,$328.63 ,$336.14 ,$304.80 ,$431.80 ,$355.60 ,$118.09 ,$482.60 ,$365.76 ,$370.84 ,$330.20 ,$431.80 ,$336.14 ,$330.20 ,$431.80 ,$370.84 ,$118.09 ,$336.14 ,$508.00 ,$431.80 ,$756.32 ,$467.36 ,$355.60 ,$257.66 ,$309.22 ,$309.37 ,$288.59 ,$351.03 ,$365.76 ,$353.82 ,$339.50 ,$365.76 ,$125.18 ,$508.00 ,$508.00 ,$336.14 ,$508.00 ,$336.14 ,$365.76 ,$314.96 ,$365.76 ,$365.76 ,$304.80 
ST MARY'S HOSPITAL,45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$700.00 ,$350.00 ,$118.09 ,$756.32 ,$118.09 ,$452.83 ,$452.83 ,$336.14 ,$420.00 ,$595.00 ,$490.00 ,$118.09 ,$665.00 ,$504.00 ,$511.00 ,$455.00 ,$595.00 ,$336.14 ,$455.00 ,$595.00 ,$511.00 ,$118.09 ,$336.14 ,$571.36 ,$595.00 ,$756.32 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$339.50 ,$504.00 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,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 ,$336.14 ,$465.60 ,$659.60 ,$543.20 ,$118.09 ,$737.20 ,$558.72 ,$566.48 ,$504.40 ,$659.60 ,$336.14 ,$504.40 ,$659.60 ,$566.48 ,$118.09 ,$336.14 ,$571.36 ,$659.60 ,$756.32 ,$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$440.85 ,$536.22 ,$558.72 ,$540.48 ,$339.50 ,$558.72 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,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 ,$336.14 ,$504.00 ,$714.00 ,$588.00 ,$118.09 ,$798.00 ,$604.80 ,$613.20 ,$546.00 ,$714.00 ,$336.14 ,$546.00 ,$714.00 ,$613.20 ,$118.09 ,$336.14 ,$571.36 ,$714.00 ,$756.32 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$477.20 ,$580.44 ,$604.80 ,$585.06 ,$339.50 ,$604.80 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,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 ,$336.14 ,$549.60 ,$778.60 ,$641.20 ,$118.09 ,$870.20 ,$659.52 ,$668.68 ,$595.40 ,$778.60 ,$336.14 ,$595.40 ,$778.60 ,$668.68 ,$118.09 ,$336.14 ,$571.36 ,$778.60 ,$756.32 ,$842.72 ,$641.20 ,$464.60 ,$557.57 ,$557.84 ,$520.38 ,$632.96 ,$659.52 ,$637.99 ,$339.50 ,$659.52 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$659.52 ,$567.92 ,$659.52 ,$659.52 ,$549.60 
ST MARY'S HOSPITAL,45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,$980.00 ,$490.00 ,$118.09 ,"$1,146.02 ",$118.09 ,$633.96 ,$633.96 ,$509.34 ,$588.00 ,$833.00 ,$686.00 ,$118.09 ,$931.00 ,$705.60 ,$715.40 ,$637.00 ,$833.00 ,$509.34 ,$637.00 ,$833.00 ,$715.40 ,$118.09 ,$509.34 ,$571.36 ,$833.00 ,"$1,146.02 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$556.74 ,$677.18 ,$705.60 ,$682.57 ,$514.43 ,$705.60 ,$125.18 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$588.00 
ST MARY'S HOSPITAL,45000034,12037,HC INTRM S/A/T/EXT OVER 30CM,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$3,747.86 ",$118.09 ,$836.44 ,$836.44 ,"$1,665.72 ",$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ","$1,665.72 ",$840.45 ,"$1,099.05 ",$943.89 ,$118.09 ,"$1,665.72 ",$571.36 ,"$1,099.05 ","$3,747.86 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,"$1,682.38 ",$930.96 ,$125.18 ,$685.00 ,$685.00 ,"$1,665.72 ",$685.00 ,"$1,665.72 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$636.00 ,$318.00 ,$118.09 ,$756.32 ,$118.09 ,$411.43 ,$411.43 ,$336.14 ,$381.60 ,$540.60 ,$445.20 ,$118.09 ,$604.20 ,$457.92 ,$464.28 ,$413.40 ,$540.60 ,$336.14 ,$413.40 ,$540.60 ,$464.28 ,$118.09 ,$336.14 ,$571.36 ,$540.60 ,$756.32 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$361.31 ,$439.48 ,$457.92 ,$442.97 ,$339.50 ,$457.92 ,$125.18 ,$636.00 ,$636.00 ,$336.14 ,$636.00 ,$336.14 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$381.60 
ST MARY'S HOSPITAL,45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$700.00 ,$350.00 ,$118.09 ,$756.32 ,$118.09 ,$452.83 ,$452.83 ,$336.14 ,$420.00 ,$595.00 ,$490.00 ,$118.09 ,$665.00 ,$504.00 ,$511.00 ,$455.00 ,$595.00 ,$336.14 ,$455.00 ,$595.00 ,$511.00 ,$118.09 ,$336.14 ,$571.36 ,$595.00 ,$756.32 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$339.50 ,$504.00 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$776.00 ,$388.00 ,$118.09 ,"$1,146.02 ",$118.09 ,$501.99 ,$501.99 ,$509.34 ,$465.60 ,$659.60 ,$543.20 ,$118.09 ,$737.20 ,$558.72 ,$566.48 ,$504.40 ,$659.60 ,$509.34 ,$504.40 ,$659.60 ,$566.48 ,$118.09 ,$509.34 ,$571.36 ,$659.60 ,"$1,146.02 ",$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$440.85 ,$536.22 ,$558.72 ,$540.48 ,$514.43 ,$558.72 ,$125.18 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,$916.00 ,$458.00 ,$118.09 ,"$1,146.02 ",$118.09 ,$592.56 ,$592.56 ,$509.34 ,$549.60 ,$778.60 ,$641.20 ,$118.09 ,$870.20 ,$659.52 ,$668.68 ,$595.40 ,$778.60 ,$509.34 ,$595.40 ,$778.60 ,$668.68 ,$118.09 ,$509.34 ,$571.36 ,$778.60 ,"$1,146.02 ",$842.72 ,$641.20 ,$464.60 ,$557.57 ,$557.84 ,$520.38 ,$632.96 ,$659.52 ,$637.99 ,$514.43 ,$659.52 ,$125.18 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$659.52 ,$567.92 ,$659.52 ,$659.52 ,$549.60 
ST MARY'S HOSPITAL,45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,$980.00 ,$490.00 ,$118.09 ,"$1,146.02 ",$118.09 ,$633.96 ,$633.96 ,$509.34 ,$588.00 ,$833.00 ,$686.00 ,$118.09 ,$931.00 ,$705.60 ,$715.40 ,$637.00 ,$833.00 ,$509.34 ,$637.00 ,$833.00 ,$715.40 ,$118.09 ,$509.34 ,$571.36 ,$833.00 ,"$1,146.02 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$556.74 ,$677.18 ,$705.60 ,$682.57 ,$514.43 ,$705.60 ,$125.18 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$588.00 
ST MARY'S HOSPITAL,45000040,12047,HC INTRM N/H/F/GEN OVER 30CM,450,1 ,"$1,293.00 ",$646.50 ,$118.09 ,"$3,747.86 ",$118.09 ,$836.44 ,$836.44 ,"$1,665.72 ",$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ","$1,665.72 ",$840.45 ,"$1,099.05 ",$943.89 ,$118.09 ,"$1,665.72 ",$571.36 ,"$1,099.05 ","$3,747.86 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,"$1,682.38 ",$930.96 ,$125.18 ,$685.00 ,$685.00 ,"$1,665.72 ",$685.00 ,"$1,665.72 ",$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$679.00 ,$339.50 ,$118.09 ,$756.32 ,$118.09 ,$439.25 ,$439.25 ,$336.14 ,$407.40 ,$577.15 ,$475.30 ,$118.09 ,$645.05 ,$488.88 ,$495.67 ,$441.35 ,$577.15 ,$336.14 ,$441.35 ,$577.15 ,$495.67 ,$118.09 ,$336.14 ,$571.36 ,$577.15 ,$756.32 ,$624.68 ,$475.30 ,$344.39 ,$413.31 ,$413.51 ,$385.74 ,$469.19 ,$488.88 ,$472.92 ,$339.50 ,$488.88 ,$125.18 ,$679.00 ,$679.00 ,$336.14 ,$679.00 ,$336.14 ,$488.88 ,$420.98 ,$488.88 ,$488.88 ,$407.40 
ST MARY'S HOSPITAL,45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$743.00 ,$371.50 ,$118.09 ,$756.32 ,$118.09 ,$480.65 ,$480.65 ,$336.14 ,$445.80 ,$631.55 ,$520.10 ,$118.09 ,$705.85 ,$534.96 ,$542.39 ,$482.95 ,$631.55 ,$336.14 ,$482.95 ,$631.55 ,$542.39 ,$118.09 ,$336.14 ,$571.36 ,$631.55 ,$756.32 ,$683.56 ,$520.10 ,$376.85 ,$452.26 ,$452.49 ,$422.10 ,$513.41 ,$534.96 ,$517.50 ,$339.50 ,$534.96 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$534.96 ,$460.66 ,$534.96 ,$534.96 ,$445.80 
ST MARY'S HOSPITAL,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 ,$336.14 ,$484.80 ,$686.80 ,$565.60 ,$118.09 ,$767.60 ,$581.76 ,$589.84 ,$525.20 ,$686.80 ,$336.14 ,$525.20 ,$686.80 ,$589.84 ,$118.09 ,$336.14 ,$571.36 ,$686.80 ,$756.32 ,$743.36 ,$565.60 ,$409.82 ,$491.83 ,$492.07 ,$459.02 ,$558.33 ,$581.76 ,$562.77 ,$339.50 ,$581.76 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$581.76 ,$500.96 ,$581.76 ,$581.76 ,$484.80 
ST MARY'S HOSPITAL,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 ,$336.14 ,$529.80 ,$750.55 ,$618.10 ,$118.09 ,$838.85 ,$635.76 ,$644.59 ,$573.95 ,$750.55 ,$336.14 ,$573.95 ,$750.55 ,$644.59 ,$118.09 ,$336.14 ,$571.36 ,$750.55 ,$756.32 ,$812.36 ,$618.10 ,$447.86 ,$537.48 ,$537.75 ,$501.63 ,$610.15 ,$635.76 ,$615.01 ,$339.50 ,$635.76 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$635.76 ,$547.46 ,$635.76 ,$635.76 ,$529.80 
ST MARY'S HOSPITAL,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 ,$336.14 ,$565.80 ,$801.55 ,$660.10 ,$118.09 ,$895.85 ,$678.96 ,$688.39 ,$612.95 ,$801.55 ,$336.14 ,$612.95 ,$801.55 ,$688.39 ,$118.09 ,$336.14 ,$571.36 ,$801.55 ,$756.32 ,$867.56 ,$660.10 ,$478.29 ,$574.00 ,$574.29 ,$535.72 ,$651.61 ,$678.96 ,$656.80 ,$339.50 ,$678.96 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$678.96 ,$584.66 ,$678.96 ,$678.96 ,$565.80 
ST MARY'S HOSPITAL,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 ,$336.14 ,$588.00 ,$833.00 ,$686.00 ,$118.09 ,$931.00 ,$705.60 ,$715.40 ,$637.00 ,$833.00 ,$336.14 ,$637.00 ,$833.00 ,$715.40 ,$118.09 ,$336.14 ,$571.36 ,$833.00 ,$756.32 ,$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$556.74 ,$677.18 ,$705.60 ,$682.57 ,$339.50 ,$705.60 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$588.00 
ST MARY'S HOSPITAL,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 ,$336.14 ,$775.80 ,"$1,099.05 ",$905.10 ,$118.09 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ",$336.14 ,$840.45 ,"$1,099.05 ",$943.89 ,$118.09 ,$336.14 ,$571.36 ,"$1,099.05 ",$756.32 ,"$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$339.50 ,$930.96 ,$125.18 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,$980.00 ,$490.00 ,$139.95 ,"$1,146.02 ",$139.95 ,$633.96 ,$633.96 ,$509.34 ,$588.00 ,$833.00 ,$686.00 ,$139.95 ,$931.00 ,$705.60 ,$715.40 ,$637.00 ,$833.00 ,$509.34 ,$637.00 ,$833.00 ,$715.40 ,$139.95 ,$509.34 ,$571.36 ,$833.00 ,"$1,146.02 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$556.74 ,$677.18 ,$705.60 ,$682.57 ,$514.43 ,$705.60 ,$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$588.00 
ST MARY'S HOSPITAL,45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,$980.00 ,$490.00 ,$139.95 ,"$1,146.02 ",$139.95 ,$633.96 ,$633.96 ,$509.34 ,$588.00 ,$833.00 ,$686.00 ,$139.95 ,$931.00 ,$705.60 ,$715.40 ,$637.00 ,$833.00 ,$509.34 ,$637.00 ,$833.00 ,$715.40 ,$139.95 ,$509.34 ,$571.36 ,$833.00 ,"$1,146.02 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$556.74 ,$677.18 ,$705.60 ,$682.57 ,$514.43 ,$705.60 ,$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$588.00 
ST MARY'S HOSPITAL,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 ,$388.08 ,$393.47 ,$350.35 ,$458.15 , N/A ,$350.35 ,$458.15 ,$393.47 ,$139.95 , N/A ,$539.00 ,$458.15 , N/A ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$306.21 ,$372.45 ,$388.08 ,$375.41 , N/A ,$388.08 ,$148.35 ,$539.00 ,$539.00 , N/A ,$539.00 , N/A ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$323.40 
ST MARY'S HOSPITAL,45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,$980.00 ,$490.00 ,$139.95 ,"$1,146.02 ",$139.95 ,$633.96 ,$633.96 ,$509.34 ,$588.00 ,$833.00 ,$686.00 ,$139.95 ,$931.00 ,$705.60 ,$715.40 ,$637.00 ,$833.00 ,$509.34 ,$637.00 ,$833.00 ,$715.40 ,$139.95 ,$509.34 ,$571.36 ,$833.00 ,"$1,146.02 ",$901.60 ,$686.00 ,$497.06 ,$596.53 ,$596.82 ,$556.74 ,$677.18 ,$705.60 ,$682.57 ,$514.43 ,$705.60 ,$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$705.60 ,$607.60 ,$705.60 ,$705.60 ,$588.00 
ST MARY'S HOSPITAL,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 ,$509.34 ,$775.80 ,"$1,099.05 ",$905.10 ,$139.95 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ",$509.34 ,$840.45 ,"$1,099.05 ",$943.89 ,$139.95 ,$509.34 ,$571.36 ,"$1,099.05 ","$1,146.02 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$514.43 ,$930.96 ,$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,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 ,$388.08 ,$393.47 ,$350.35 ,$458.15 , N/A ,$350.35 ,$458.15 ,$393.47 ,$139.95 , N/A ,$539.00 ,$458.15 , N/A ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$306.21 ,$372.45 ,$388.08 ,$375.41 , N/A ,$388.08 ,$148.35 ,$539.00 ,$539.00 , N/A ,$539.00 , N/A ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$323.40 
ST MARY'S HOSPITAL,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 ,$336.14 ,$775.80 ,"$1,099.05 ",$905.10 ,$139.95 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ",$336.14 ,$840.45 ,"$1,099.05 ",$943.89 ,$139.95 ,$336.14 ,$571.36 ,"$1,099.05 ",$756.32 ,"$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$339.50 ,$930.96 ,$148.35 ,$685.00 ,$685.00 ,$336.14 ,$685.00 ,$336.14 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,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 ,$509.34 ,$840.60 ,"$1,190.85 ",$980.70 ,$139.95 ,"$1,330.95 ","$1,008.72 ","$1,022.73 ",$910.65 ,"$1,190.85 ",$509.34 ,$910.65 ,"$1,190.85 ","$1,022.73 ",$139.95 ,$509.34 ,$571.36 ,"$1,190.85 ","$1,146.02 ","$1,288.92 ",$980.70 ,$710.59 ,$852.79 ,$853.21 ,$795.91 ,$968.09 ,"$1,008.72 ",$975.80 ,$514.43 ,"$1,008.72 ",$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,"$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ",$840.60 
ST MARY'S HOSPITAL,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 ,$388.08 ,$393.47 ,$350.35 ,$458.15 , N/A ,$350.35 ,$458.15 ,$393.47 ,$139.95 , N/A ,$539.00 ,$458.15 , N/A ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$306.21 ,$372.45 ,$388.08 ,$375.41 , N/A ,$388.08 ,$148.35 ,$539.00 ,$539.00 , N/A ,$539.00 , N/A ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$323.40 
ST MARY'S HOSPITAL,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 ,$509.34 ,$775.80 ,"$1,099.05 ",$905.10 ,$139.95 ,"$1,228.35 ",$930.96 ,$943.89 ,$840.45 ,"$1,099.05 ",$509.34 ,$840.45 ,"$1,099.05 ",$943.89 ,$139.95 ,$509.34 ,$571.36 ,"$1,099.05 ","$1,146.02 ","$1,189.56 ",$905.10 ,$655.81 ,$787.05 ,$787.44 ,$734.55 ,$893.46 ,$930.96 ,$900.57 ,$514.43 ,$930.96 ,$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,$930.96 ,$801.66 ,$930.96 ,$930.96 ,$775.80 
ST MARY'S HOSPITAL,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 ,$509.34 ,$840.60 ,"$1,190.85 ",$980.70 ,$139.95 ,"$1,330.95 ","$1,008.72 ","$1,022.73 ",$910.65 ,"$1,190.85 ",$509.34 ,$910.65 ,"$1,190.85 ","$1,022.73 ",$139.95 ,$509.34 ,$571.36 ,"$1,190.85 ","$1,146.02 ","$1,288.92 ",$980.70 ,$710.59 ,$852.79 ,$853.21 ,$795.91 ,$968.09 ,"$1,008.72 ",$975.80 ,$514.43 ,"$1,008.72 ",$148.35 ,$685.00 ,$685.00 ,$509.34 ,$685.00 ,$509.34 ,"$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ",$840.60 
ST MARY'S HOSPITAL,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 ,$534.96 ,$542.39 ,$482.95 ,$631.55 , N/A ,$482.95 ,$631.55 ,$542.39 ,$360.88 , N/A ,$571.36 ,$631.55 , N/A ,$683.56 ,$520.10 ,$376.85 ,$452.26 ,$452.49 ,$422.10 ,$513.41 ,$534.96 ,$517.50 , N/A ,$534.96 ,$382.53 ,$685.00 ,$685.00 , N/A ,$685.00 , N/A ,$534.96 ,$460.66 ,$534.96 ,$534.96 ,$445.80 
ST MARY'S HOSPITAL,45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$183.00 ,$91.50 ,$58.71 ,$392.94 ,$58.71 ,$118.38 ,$118.38 ,$174.64 ,$109.80 ,$155.55 ,$128.10 ,$58.71 ,$173.85 ,$131.76 ,$133.59 ,$118.95 ,$155.55 ,$174.64 ,$118.95 ,$155.55 ,$133.59 ,$58.71 ,$174.64 ,$183.00 ,$155.55 ,$392.94 ,$168.36 ,$128.10 ,$92.82 ,$111.39 ,$111.45 ,$103.96 ,$126.45 ,$131.76 ,$127.46 ,$176.39 ,$131.76 ,$62.23 ,$183.00 ,$183.00 ,$174.64 ,$183.00 ,$174.64 ,$131.76 ,$113.46 ,$131.76 ,$131.76 ,$109.80 
ST MARY'S HOSPITAL,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 ,$174.64 ,$245.40 ,$347.65 ,$286.30 ,$58.71 ,$388.55 ,$294.48 ,$298.57 ,$265.85 ,$347.65 ,$174.64 ,$265.85 ,$347.65 ,$298.57 ,$58.71 ,$174.64 ,$409.00 ,$347.65 ,$392.94 ,$376.28 ,$286.30 ,$207.44 ,$248.96 ,$249.08 ,$232.35 ,$282.62 ,$294.48 ,$284.87 ,$176.39 ,$294.48 ,$62.23 ,$409.00 ,$409.00 ,$174.64 ,$409.00 ,$174.64 ,$294.48 ,$253.58 ,$294.48 ,$294.48 ,$245.40 
ST MARY'S HOSPITAL,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 ,$174.64 ,$284.40 ,$402.90 ,$331.80 ,$58.71 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$174.64 ,$308.10 ,$402.90 ,$346.02 ,$58.71 ,$174.64 ,$474.00 ,$402.90 ,$392.94 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$176.39 ,$341.28 ,$62.23 ,$474.00 ,$474.00 ,$174.64 ,$474.00 ,$174.64 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$571.00 ,$285.50 ,$118.09 ,$756.32 ,$118.09 ,$369.38 ,$369.38 ,$336.14 ,$342.60 ,$485.35 ,$399.70 ,$118.09 ,$542.45 ,$411.12 ,$416.83 ,$371.15 ,$485.35 ,$336.14 ,$371.15 ,$485.35 ,$416.83 ,$118.09 ,$336.14 ,$571.00 ,$485.35 ,$756.32 ,$525.32 ,$399.70 ,$289.61 ,$347.57 ,$347.74 ,$324.39 ,$394.56 ,$411.12 ,$397.70 ,$339.50 ,$411.12 ,$125.18 ,$571.00 ,$571.00 ,$336.14 ,$571.00 ,$336.14 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$342.60 
ST MARY'S HOSPITAL,45000065,16035,HC ESCHARATOMY; INITIAL,450,1 ,$474.00 ,$237.00 ,$118.09 ,$756.32 ,$118.09 ,$306.63 ,$306.63 ,$336.14 ,$284.40 ,$402.90 ,$331.80 ,$118.09 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$336.14 ,$308.10 ,$402.90 ,$346.02 ,$118.09 ,$336.14 ,$474.00 ,$402.90 ,$756.32 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$339.50 ,$341.28 ,$125.18 ,$474.00 ,$474.00 ,$336.14 ,$474.00 ,$336.14 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,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 ,$162.72 ,$164.98 ,$146.90 ,$192.10 , N/A ,$146.90 ,$192.10 ,$164.98 ,$118.09 , N/A ,$226.00 ,$192.10 , N/A ,$207.92 ,$158.20 ,$114.63 ,$137.57 ,$137.63 ,$128.39 ,$156.17 ,$162.72 ,$157.41 , N/A ,$162.72 ,$125.18 ,$226.00 ,$226.00 , N/A ,$226.00 , N/A ,$162.72 ,$140.12 ,$162.72 ,$162.72 ,$135.60 
ST MARY'S HOSPITAL,45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$388.00 ,$194.00 ,$51.36 ,$392.94 ,$51.36 ,$251.00 ,$251.00 ,$174.64 ,$232.80 ,$329.80 ,$271.60 ,$51.36 ,$368.60 ,$279.36 ,$283.24 ,$252.20 ,$329.80 ,$174.64 ,$252.20 ,$329.80 ,$283.24 ,$51.36 ,$174.64 ,$388.00 ,$329.80 ,$392.94 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$220.42 ,$268.11 ,$279.36 ,$270.24 ,$176.39 ,$279.36 ,$54.44 ,$388.00 ,$388.00 ,$174.64 ,$388.00 ,$174.64 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$232.80 
ST MARY'S HOSPITAL,45000068,20103,HC EXPL PENTR WOUND EXTREMITY,450,1 ,"$1,185.00 ",$592.50 ,$118.09 ,"$1,361.67 ",$118.09 ,$766.58 ,$766.58 ,$605.19 ,$711.00 ,"$1,007.25 ",$829.50 ,$118.09 ,"$1,125.75 ",$853.20 ,$865.05 ,$770.25 ,"$1,007.25 ",$605.19 ,$770.25 ,"$1,007.25 ",$865.05 ,$118.09 ,$605.19 ,$571.36 ,"$1,007.25 ","$1,361.67 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$673.20 ,$818.84 ,$853.20 ,$825.35 ,$611.24 ,$853.20 ,$125.18 ,$685.00 ,$685.00 ,$605.19 ,$685.00 ,$605.19 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$474.00 ,$237.00 ,$75.55 ,$571.69 ,$75.55 ,$306.63 ,$306.63 ,$254.09 ,$284.40 ,$402.90 ,$331.80 ,$75.55 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$254.09 ,$308.10 ,$402.90 ,$346.02 ,$75.55 ,$254.09 ,$474.00 ,$402.90 ,$571.69 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$256.63 ,$341.28 ,$80.08 ,$474.00 ,$474.00 ,$254.09 ,$474.00 ,$254.09 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$700.00 ,$350.00 ,$75.55 ,$700.00 ,$75.55 ,$452.83 ,$452.83 ,$254.09 ,$420.00 ,$595.00 ,$490.00 ,$75.55 ,$665.00 ,$504.00 ,$511.00 ,$455.00 ,$595.00 ,$254.09 ,$455.00 ,$595.00 ,$511.00 ,$75.55 ,$254.09 ,$571.36 ,$595.00 ,$571.69 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$256.63 ,$504.00 ,$80.08 ,$685.00 ,$685.00 ,$254.09 ,$685.00 ,$254.09 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$700.00 ,$350.00 ,$75.55 ,$700.00 ,$75.55 ,$452.83 ,$452.83 ,$254.09 ,$420.00 ,$595.00 ,$490.00 ,$75.55 ,$665.00 ,$504.00 ,$511.00 ,$455.00 ,$595.00 ,$254.09 ,$455.00 ,$595.00 ,$511.00 ,$75.55 ,$254.09 ,$571.36 ,$595.00 ,$571.69 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$256.63 ,$504.00 ,$80.08 ,$685.00 ,$685.00 ,$254.09 ,$685.00 ,$254.09 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$700.00 ,$350.00 ,$75.55 ,$700.00 ,$75.55 ,$452.83 ,$452.83 ,$254.09 ,$420.00 ,$595.00 ,$490.00 ,$75.55 ,$665.00 ,$504.00 ,$511.00 ,$455.00 ,$595.00 ,$254.09 ,$455.00 ,$595.00 ,$511.00 ,$75.55 ,$254.09 ,$571.36 ,$595.00 ,$571.69 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$256.63 ,$504.00 ,$80.08 ,$685.00 ,$685.00 ,$254.09 ,$685.00 ,$254.09 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,45000072,20612,HC INJ GANGLION CYST,450,1 ,$528.00 ,$264.00 ,$75.55 ,$571.69 ,$75.55 ,$341.56 ,$341.56 ,$254.09 ,$316.80 ,$448.80 ,$369.60 ,$75.55 ,$501.60 ,$380.16 ,$385.44 ,$343.20 ,$448.80 ,$254.09 ,$343.20 ,$448.80 ,$385.44 ,$75.55 ,$254.09 ,$528.00 ,$448.80 ,$571.69 ,$485.76 ,$369.60 ,$267.80 ,$321.39 ,$321.55 ,$299.96 ,$364.85 ,$380.16 ,$367.75 ,$256.63 ,$380.16 ,$80.08 ,$528.00 ,$528.00 ,$254.09 ,$528.00 ,$254.09 ,$380.16 ,$327.36 ,$380.16 ,$380.16 ,$316.80 
ST MARY'S HOSPITAL,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 ,$200.45 ,$536.40 ,$759.90 ,$625.80 ,$139.53 ,$849.30 ,$643.68 ,$652.62 ,$581.10 ,$759.90 ,$200.45 ,$581.10 ,$759.90 ,$652.62 ,$139.53 ,$200.45 ,$571.36 ,$759.90 ,$451.00 ,$822.48 ,$625.80 ,$453.44 ,$544.18 ,$544.45 ,$507.88 ,$617.75 ,$643.68 ,$622.67 ,$202.45 ,$643.68 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$643.68 ,$554.28 ,$643.68 ,$643.68 ,$536.40 
ST MARY'S HOSPITAL,45000075,23655,HC TX DISL SHLDR W/MAN/ANES CLS,450,1 ,"$1,508.00 ",$754.00 ,$310.07 ,"$3,047.78 ",$310.07 ,$975.53 ,$975.53 ,"$1,354.57 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$310.07 ,"$1,432.60 ","$1,085.76 ","$1,100.84 ",$980.20 ,"$1,281.80 ","$1,354.57 ",$980.20 ,"$1,281.80 ","$1,100.84 ",$310.07 ,"$1,354.57 ",$571.36 ,"$1,281.80 ","$3,047.78 ","$1,387.36 ","$1,055.60 ",$764.86 ,$917.92 ,$918.37 ,$856.69 ,"$1,042.03 ","$1,085.76 ","$1,050.32 ","$1,368.12 ","$1,085.76 ",$328.67 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ",$904.80 
ST MARY'S HOSPITAL,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 ,$200.45 ,$342.60 ,$485.35 ,$399.70 ,$139.53 ,$542.45 ,$411.12 ,$416.83 ,$371.15 ,$485.35 ,$200.45 ,$371.15 ,$485.35 ,$416.83 ,$139.53 ,$200.45 ,$571.00 ,$485.35 ,$451.00 ,$525.32 ,$399.70 ,$289.61 ,$347.57 ,$347.74 ,$324.39 ,$394.56 ,$411.12 ,$397.70 ,$202.45 ,$411.12 ,$147.90 ,$571.00 ,$571.00 ,$200.45 ,$571.00 ,$200.45 ,$411.12 ,$354.02 ,$411.12 ,$411.12 ,$342.60 
ST MARY'S HOSPITAL,45000077,24605,HC CL TX ELBOW DISLOCATION W ANESTH,450,1 ,"$1,427.00 ",$713.50 ,$310.07 ,"$3,047.78 ",$310.07 ,$923.13 ,$923.13 ,"$1,354.57 ",$856.20 ,"$1,212.95 ",$998.90 ,$310.07 ,"$1,355.65 ","$1,027.44 ","$1,041.71 ",$927.55 ,"$1,212.95 ","$1,354.57 ",$927.55 ,"$1,212.95 ","$1,041.71 ",$310.07 ,"$1,354.57 ",$571.36 ,"$1,212.95 ","$3,047.78 ","$1,312.84 ",$998.90 ,$723.77 ,$868.61 ,$869.04 ,$810.68 ,$986.06 ,"$1,027.44 ",$993.91 ,"$1,368.12 ","$1,027.44 ",$328.67 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,027.44 ",$884.74 ,"$1,027.44 ","$1,027.44 ",$856.20 
ST MARY'S HOSPITAL,45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$528.00 ,$264.00 ,$139.53 ,$528.00 ,$139.53 ,$341.56 ,$341.56 ,$200.45 ,$316.80 ,$448.80 ,$369.60 ,$139.53 ,$501.60 ,$380.16 ,$385.44 ,$343.20 ,$448.80 ,$200.45 ,$343.20 ,$448.80 ,$385.44 ,$139.53 ,$200.45 ,$528.00 ,$448.80 ,$451.00 ,$485.76 ,$369.60 ,$267.80 ,$321.39 ,$321.55 ,$299.96 ,$364.85 ,$380.16 ,$367.75 ,$202.45 ,$380.16 ,$147.90 ,$528.00 ,$528.00 ,$200.45 ,$528.00 ,$200.45 ,$380.16 ,$327.36 ,$380.16 ,$380.16 ,$316.80 
ST MARY'S HOSPITAL,45000081,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP,450,1 ,$830.00 ,$415.00 ,$139.53 ,"$3,047.78 ",$139.53 ,$536.93 ,$536.93 ,"$1,354.57 ",$498.00 ,$705.50 ,$581.00 ,$139.53 ,$788.50 ,$597.60 ,$605.90 ,$539.50 ,$705.50 ,"$1,354.57 ",$539.50 ,$705.50 ,$605.90 ,$139.53 ,"$1,354.57 ",$571.36 ,$705.50 ,"$3,047.78 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$471.52 ,$573.53 ,$597.60 ,$578.10 ,"$1,368.12 ",$597.60 ,$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ",$597.60 ,$514.60 ,$597.60 ,$597.60 ,$498.00 
ST MARY'S HOSPITAL,45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$830.00 ,$415.00 ,$139.53 ,"$3,047.78 ",$139.53 ,$536.93 ,$536.93 ,"$1,354.57 ",$498.00 ,$705.50 ,$581.00 ,$139.53 ,$788.50 ,$597.60 ,$605.90 ,$539.50 ,$705.50 ,"$1,354.57 ",$539.50 ,$705.50 ,$605.90 ,$139.53 ,"$1,354.57 ",$571.36 ,$705.50 ,"$3,047.78 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$471.52 ,$573.53 ,$597.60 ,$578.10 ,"$1,368.12 ",$597.60 ,$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ",$597.60 ,$514.60 ,$597.60 ,$597.60 ,$498.00 
ST MARY'S HOSPITAL,45000083,26010,HC DRAIN ABSC FINGER SIMPLE,450,1 ,$431.00 ,$215.50 ,$51.36 ,$431.00 ,$51.36 ,$278.81 ,$278.81 ,$174.64 ,$258.60 ,$366.35 ,$301.70 ,$51.36 ,$409.45 ,$310.32 ,$314.63 ,$280.15 ,$366.35 ,$174.64 ,$280.15 ,$366.35 ,$314.63 ,$51.36 ,$174.64 ,$431.00 ,$366.35 ,$392.94 ,$396.52 ,$301.70 ,$218.60 ,$262.35 ,$262.48 ,$244.85 ,$297.82 ,$310.32 ,$300.19 ,$176.39 ,$310.32 ,$54.44 ,$431.00 ,$431.00 ,$174.64 ,$431.00 ,$174.64 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,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 ","$1,368.36 ","$2,532.60 ","$3,587.85 ","$2,954.70 ",$344.84 ,"$4,009.95 ","$3,039.12 ","$3,081.33 ","$2,743.65 ","$3,587.85 ","$1,368.36 ","$2,743.65 ","$3,587.85 ","$3,081.33 ",$344.84 ,"$1,368.36 ",$571.36 ,"$3,587.85 ","$3,078.81 ","$3,883.32 ","$2,954.70 ","$2,140.89 ","$2,569.32 ","$2,570.59 ","$2,397.95 ","$2,916.71 ","$3,039.12 ","$2,939.93 ","$1,382.04 ","$3,039.12 ",$365.53 ,$685.00 ,$685.00 ,"$1,368.36 ",$685.00 ,"$1,368.36 ","$3,039.12 ","$2,617.02 ","$3,039.12 ","$3,039.12 ","$2,532.60 "
ST MARY'S HOSPITAL,45000085,26410,HC RPR TENDON HAND EXTEN W/O,450,1 ,"$2,047.00 ","$1,023.50 ",$415.99 ,"$3,047.78 ",$415.99 ,"$1,324.20 ","$1,324.20 ","$1,354.57 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$415.99 ,"$1,944.65 ","$1,473.84 ","$1,494.31 ","$1,330.55 ","$1,739.95 ","$1,354.57 ","$1,330.55 ","$1,739.95 ","$1,494.31 ",$415.99 ,"$1,354.57 ",$571.36 ,"$1,739.95 ","$3,047.78 ","$1,883.24 ","$1,432.90 ","$1,038.24 ","$1,246.01 ","$1,246.62 ","$1,162.90 ","$1,414.48 ","$1,473.84 ","$1,425.74 ","$1,368.12 ","$1,473.84 ",$440.95 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,228.20 "
ST MARY'S HOSPITAL,45000086,26418,HC RPR EXTEN TENDON FNGR W/O FREE,450,1 ,"$2,047.00 ","$1,023.50 ",$415.99 ,"$3,047.78 ",$415.99 ,"$1,324.20 ","$1,324.20 ","$1,354.57 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$415.99 ,"$1,944.65 ","$1,473.84 ","$1,494.31 ","$1,330.55 ","$1,739.95 ","$1,354.57 ","$1,330.55 ","$1,739.95 ","$1,494.31 ",$415.99 ,"$1,354.57 ",$571.36 ,"$1,739.95 ","$3,047.78 ","$1,883.24 ","$1,432.90 ","$1,038.24 ","$1,246.01 ","$1,246.62 ","$1,162.90 ","$1,414.48 ","$1,473.84 ","$1,425.74 ","$1,368.12 ","$1,473.84 ",$440.95 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,228.20 "
ST MARY'S HOSPITAL,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 ,$200.45 ,$459.00 ,$650.25 ,$535.50 ,$139.53 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$200.45 ,$497.25 ,$650.25 ,$558.45 ,$139.53 ,$200.45 ,$571.36 ,$650.25 ,$451.00 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$202.45 ,$550.80 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,45000088,26742,HC TX FX (M-P)(I-P) JT W/MAN,450,1 ,$808.00 ,$404.00 ,$139.53 ,"$3,047.78 ",$139.53 ,$522.70 ,$522.70 ,"$1,354.57 ",$484.80 ,$686.80 ,$565.60 ,$139.53 ,$767.60 ,$581.76 ,$589.84 ,$525.20 ,$686.80 ,"$1,354.57 ",$525.20 ,$686.80 ,$589.84 ,$139.53 ,"$1,354.57 ",$571.36 ,$686.80 ,"$3,047.78 ",$743.36 ,$565.60 ,$409.82 ,$491.83 ,$492.07 ,$459.02 ,$558.33 ,$581.76 ,$562.77 ,"$1,368.12 ",$581.76 ,$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ",$581.76 ,$500.96 ,$581.76 ,$581.76 ,$484.80 
ST MARY'S HOSPITAL,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 ,$200.45 ,$459.00 ,$650.25 ,$535.50 ,$139.53 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$200.45 ,$497.25 ,$650.25 ,$558.45 ,$139.53 ,$200.45 ,$571.36 ,$650.25 ,$451.00 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$202.45 ,$550.80 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,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 ,$200.45 ,$510.60 ,$723.35 ,$595.70 ,$139.53 ,$808.45 ,$612.72 ,$621.23 ,$553.15 ,$723.35 ,$200.45 ,$553.15 ,$723.35 ,$621.23 ,$139.53 ,$200.45 ,$571.36 ,$723.35 ,$451.00 ,$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$483.45 ,$588.04 ,$612.72 ,$592.72 ,$202.45 ,$612.72 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$510.60 
ST MARY'S HOSPITAL,45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$2,801.00 ","$1,400.50 ",$415.99 ,"$6,196.83 ",$415.99 ,"$1,811.97 ","$1,811.97 ","$2,754.14 ","$1,680.60 ","$2,380.85 ","$1,960.70 ",$415.99 ,"$2,660.95 ","$2,016.72 ","$2,044.73 ","$1,820.65 ","$2,380.85 ","$2,754.14 ","$1,820.65 ","$2,380.85 ","$2,044.73 ",$415.99 ,"$2,754.14 ",$571.36 ,"$2,380.85 ","$6,196.83 ","$2,576.92 ","$1,960.70 ","$1,420.67 ","$1,704.97 ","$1,705.81 ","$1,591.25 ","$1,935.49 ","$2,016.72 ","$1,950.90 ","$2,781.68 ","$2,016.72 ",$440.95 ,$685.00 ,$685.00 ,"$2,754.14 ",$685.00 ,"$2,754.14 ","$2,016.72 ","$1,736.62 ","$2,016.72 ","$2,016.72 ","$1,680.60 "
ST MARY'S HOSPITAL,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 ,$200.45 ,$433.20 ,$613.70 ,$505.40 ,$139.53 ,$685.90 ,$519.84 ,$527.06 ,$469.30 ,$613.70 ,$200.45 ,$469.30 ,$613.70 ,$527.06 ,$139.53 ,$200.45 ,$571.36 ,$613.70 ,$451.00 ,$664.24 ,$505.40 ,$366.20 ,$439.48 ,$439.70 ,$410.17 ,$498.90 ,$519.84 ,$502.87 ,$202.45 ,$519.84 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$519.84 ,$447.64 ,$519.84 ,$519.84 ,$433.20 
ST MARY'S HOSPITAL,45000093,27252,HC CL TX HIP DISLOCATION; TRAUMATIC W ANESTH,450,1 ,"$1,160.00 ",$580.00 ,$310.07 ,"$3,047.78 ",$310.07 ,$750.40 ,$750.40 ,"$1,354.57 ",$696.00 ,$986.00 ,$812.00 ,$310.07 ,"$1,102.00 ",$835.20 ,$846.80 ,$754.00 ,$986.00 ,"$1,354.57 ",$754.00 ,$986.00 ,$846.80 ,$310.07 ,"$1,354.57 ",$571.36 ,$986.00 ,"$3,047.78 ","$1,067.20 ",$812.00 ,$588.35 ,$706.09 ,$706.44 ,$659.00 ,$801.56 ,$835.20 ,$807.94 ,"$1,368.12 ",$835.20 ,$328.67 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ",$835.20 ,$719.20 ,$835.20 ,$835.20 ,$696.00 
ST MARY'S HOSPITAL,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 ,$200.45 ,$510.60 ,$723.35 ,$595.70 ,$139.53 ,$808.45 ,$612.72 ,$621.23 ,$553.15 ,$723.35 ,$200.45 ,$553.15 ,$723.35 ,$621.23 ,$139.53 ,$200.45 ,$571.36 ,$723.35 ,$451.00 ,$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$483.45 ,$588.04 ,$612.72 ,$592.72 ,$202.45 ,$612.72 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$510.60 
ST MARY'S HOSPITAL,45000095,27266,HC CL TX POST HIP ARTHROPLASTY DISLOCAT W ANESTH,450,1 ,"$1,831.00 ",$915.50 ,$310.07 ,"$3,047.78 ",$310.07 ,"$1,184.47 ","$1,184.47 ","$1,354.57 ","$1,098.60 ","$1,556.35 ","$1,281.70 ",$310.07 ,"$1,739.45 ","$1,318.32 ","$1,336.63 ","$1,190.15 ","$1,556.35 ","$1,354.57 ","$1,190.15 ","$1,556.35 ","$1,336.63 ",$310.07 ,"$1,354.57 ",$571.36 ,"$1,556.35 ","$3,047.78 ","$1,684.52 ","$1,281.70 ",$928.68 ,"$1,114.53 ","$1,115.08 ","$1,040.19 ","$1,265.22 ","$1,318.32 ","$1,275.29 ","$1,368.12 ","$1,318.32 ",$328.67 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,318.32 ","$1,135.22 ","$1,318.32 ","$1,318.32 ","$1,098.60 "
ST MARY'S HOSPITAL,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 ,$200.45 ,$433.20 ,$613.70 ,$505.40 ,$139.53 ,$685.90 ,$519.84 ,$527.06 ,$469.30 ,$613.70 ,$200.45 ,$469.30 ,$613.70 ,$527.06 ,$139.53 ,$200.45 ,$571.36 ,$613.70 ,$451.00 ,$664.24 ,$505.40 ,$366.20 ,$439.48 ,$439.70 ,$410.17 ,$498.90 ,$519.84 ,$502.87 ,$202.45 ,$519.84 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$519.84 ,$447.64 ,$519.84 ,$519.84 ,$433.20 
ST MARY'S HOSPITAL,45000097,28190,HC REM FB FOOT SUBQ,450,1 ,$905.00 ,$452.50 ,$139.95 ,"$1,361.67 ",$139.95 ,$585.44 ,$585.44 ,$605.19 ,$543.00 ,$769.25 ,$633.50 ,$139.95 ,$859.75 ,$651.60 ,$660.65 ,$588.25 ,$769.25 ,$605.19 ,$588.25 ,$769.25 ,$660.65 ,$139.95 ,$605.19 ,$571.36 ,$769.25 ,"$1,361.67 ",$832.60 ,$633.50 ,$459.02 ,$550.87 ,$551.15 ,$514.13 ,$625.36 ,$651.60 ,$630.33 ,$611.24 ,$651.60 ,$148.35 ,$685.00 ,$685.00 ,$605.19 ,$685.00 ,$605.19 ,$651.60 ,$561.10 ,$651.60 ,$651.60 ,$543.00 
ST MARY'S HOSPITAL,45000098,29065,HC APPL CAST ARM LONG,450,1 ,$302.00 ,$151.00 ,$59.15 ,$527.88 ,$59.15 ,$195.36 ,$195.36 ,$234.61 ,$181.20 ,$256.70 ,$211.40 ,$59.15 ,$286.90 ,$217.44 ,$220.46 ,$196.30 ,$256.70 ,$234.61 ,$196.30 ,$256.70 ,$220.46 ,$59.15 ,$234.61 ,$302.00 ,$256.70 ,$527.88 ,$277.84 ,$211.40 ,$153.17 ,$183.83 ,$183.92 ,$171.57 ,$208.68 ,$217.44 ,$210.34 ,$236.96 ,$217.44 ,$62.70 ,$302.00 ,$302.00 ,$234.61 ,$302.00 ,$234.61 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$181.20 
ST MARY'S HOSPITAL,45000099,29075,HC CAST APPL; ELBOW TO FINGERS,450,1 ,$302.00 ,$151.00 ,$59.15 ,$527.88 ,$59.15 ,$195.36 ,$195.36 ,$234.61 ,$181.20 ,$256.70 ,$211.40 ,$59.15 ,$286.90 ,$217.44 ,$220.46 ,$196.30 ,$256.70 ,$234.61 ,$196.30 ,$256.70 ,$220.46 ,$59.15 ,$234.61 ,$302.00 ,$256.70 ,$527.88 ,$277.84 ,$211.40 ,$153.17 ,$183.83 ,$183.92 ,$171.57 ,$208.68 ,$217.44 ,$210.34 ,$236.96 ,$217.44 ,$62.70 ,$302.00 ,$302.00 ,$234.61 ,$302.00 ,$234.61 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$181.20 
ST MARY'S HOSPITAL,45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$420.00 ,$210.00 ,$13.65 ,$420.00 ,$13.65 ,$271.70 ,$271.70 ,$137.40 ,$252.00 ,$357.00 ,$294.00 ,$13.65 ,$399.00 ,$302.40 ,$306.60 ,$273.00 ,$357.00 ,$137.40 ,$273.00 ,$357.00 ,$306.60 ,$13.65 ,$137.40 ,$420.00 ,$357.00 ,$309.15 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$238.60 ,$290.22 ,$302.40 ,$292.53 ,$138.77 ,$302.40 ,$14.47 ,$420.00 ,$420.00 ,$137.40 ,$420.00 ,$137.40 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$302.00 ,$151.00 ,$13.65 ,$302.00 ,$13.65 ,$195.36 ,$195.36 ,$109.66 ,$181.20 ,$256.70 ,$211.40 ,$13.65 ,$286.90 ,$217.44 ,$220.46 ,$196.30 ,$256.70 ,$109.66 ,$196.30 ,$256.70 ,$220.46 ,$13.65 ,$109.66 ,$302.00 ,$256.70 ,$246.74 ,$277.84 ,$211.40 ,$153.17 ,$183.83 ,$183.92 ,$171.57 ,$208.68 ,$217.44 ,$210.34 ,$110.76 ,$217.44 ,$14.47 ,$302.00 ,$302.00 ,$109.66 ,$302.00 ,$109.66 ,$217.44 ,$187.24 ,$217.44 ,$217.44 ,$181.20 
ST MARY'S HOSPITAL,45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$269.00 ,$134.50 ,$13.65 ,$269.00 ,$13.65 ,$174.02 ,$174.02 ,$109.66 ,$161.40 ,$228.65 ,$188.30 ,$13.65 ,$255.55 ,$193.68 ,$196.37 ,$174.85 ,$228.65 ,$109.66 ,$174.85 ,$228.65 ,$196.37 ,$13.65 ,$109.66 ,$269.00 ,$228.65 ,$246.74 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$152.82 ,$185.88 ,$193.68 ,$187.36 ,$110.76 ,$193.68 ,$14.47 ,$269.00 ,$269.00 ,$109.66 ,$269.00 ,$109.66 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$345.00 ,$172.50 ,$13.65 ,$345.00 ,$13.65 ,$223.18 ,$223.18 ,$109.66 ,$207.00 ,$293.25 ,$241.50 ,$13.65 ,$327.75 ,$248.40 ,$251.85 ,$224.25 ,$293.25 ,$109.66 ,$224.25 ,$293.25 ,$251.85 ,$13.65 ,$109.66 ,$345.00 ,$293.25 ,$246.74 ,$317.40 ,$241.50 ,$174.98 ,$210.00 ,$210.11 ,$195.99 ,$238.40 ,$248.40 ,$240.29 ,$110.76 ,$248.40 ,$14.47 ,$345.00 ,$345.00 ,$109.66 ,$345.00 ,$109.66 ,$248.40 ,$213.90 ,$248.40 ,$248.40 ,$207.00 
ST MARY'S HOSPITAL,45000104,29131,HC APPL FINGER SPLINT DYNAMIC,450,1 ,$269.00 ,$134.50 ,$13.65 ,$269.00 ,$13.65 ,$174.02 ,$174.02 ,$54.13 ,$161.40 ,$228.65 ,$188.30 ,$13.65 ,$255.55 ,$193.68 ,$196.37 ,$174.85 ,$228.65 ,$54.13 ,$174.85 ,$228.65 ,$196.37 ,$13.65 ,$54.13 ,$269.00 ,$228.65 ,$121.80 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$152.82 ,$185.88 ,$193.68 ,$187.36 ,$54.67 ,$193.68 ,$14.47 ,$269.00 ,$269.00 ,$54.13 ,$269.00 ,$54.13 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,45000105,29240,HC STRAPPING SHLDR,450,1 ,$269.00 ,$134.50 ,$13.65 ,$269.00 ,$13.65 ,$174.02 ,$174.02 ,$109.66 ,$161.40 ,$228.65 ,$188.30 ,$13.65 ,$255.55 ,$193.68 ,$196.37 ,$174.85 ,$228.65 ,$109.66 ,$174.85 ,$228.65 ,$196.37 ,$13.65 ,$109.66 ,$269.00 ,$228.65 ,$246.74 ,$247.48 ,$188.30 ,$136.44 ,$163.74 ,$163.82 ,$152.82 ,$185.88 ,$193.68 ,$187.36 ,$110.76 ,$193.68 ,$14.47 ,$269.00 ,$269.00 ,$109.66 ,$269.00 ,$109.66 ,$193.68 ,$166.78 ,$193.68 ,$193.68 ,$161.40 
ST MARY'S HOSPITAL,45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$420.00 ,$210.00 ,$59.15 ,$527.88 ,$59.15 ,$271.70 ,$271.70 ,$234.61 ,$252.00 ,$357.00 ,$294.00 ,$59.15 ,$399.00 ,$302.40 ,$306.60 ,$273.00 ,$357.00 ,$234.61 ,$273.00 ,$357.00 ,$306.60 ,$59.15 ,$234.61 ,$420.00 ,$357.00 ,$527.88 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$238.60 ,$290.22 ,$302.40 ,$292.53 ,$236.96 ,$302.40 ,$62.70 ,$420.00 ,$420.00 ,$234.61 ,$420.00 ,$234.61 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$420.00 ,$210.00 ,$13.65 ,$420.00 ,$13.65 ,$271.70 ,$271.70 ,$137.40 ,$252.00 ,$357.00 ,$294.00 ,$13.65 ,$399.00 ,$302.40 ,$306.60 ,$273.00 ,$357.00 ,$137.40 ,$273.00 ,$357.00 ,$306.60 ,$13.65 ,$137.40 ,$420.00 ,$357.00 ,$309.15 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$238.60 ,$290.22 ,$302.40 ,$292.53 ,$138.77 ,$302.40 ,$14.47 ,$420.00 ,$420.00 ,$137.40 ,$420.00 ,$137.40 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$420.00 ,$210.00 ,$13.65 ,$420.00 ,$13.65 ,$271.70 ,$271.70 ,$137.40 ,$252.00 ,$357.00 ,$294.00 ,$13.65 ,$399.00 ,$302.40 ,$306.60 ,$273.00 ,$357.00 ,$137.40 ,$273.00 ,$357.00 ,$306.60 ,$13.65 ,$137.40 ,$420.00 ,$357.00 ,$309.15 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$238.60 ,$290.22 ,$302.40 ,$292.53 ,$138.77 ,$302.40 ,$14.47 ,$420.00 ,$420.00 ,$137.40 ,$420.00 ,$137.40 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,45000109,29705,HC REM/BIV CAST ARM/LEG,450,1 ,$474.00 ,$237.00 ,$59.15 ,$527.88 ,$59.15 ,$306.63 ,$306.63 ,$234.61 ,$284.40 ,$402.90 ,$331.80 ,$59.15 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$234.61 ,$308.10 ,$402.90 ,$346.02 ,$59.15 ,$234.61 ,$474.00 ,$402.90 ,$527.88 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$236.96 ,$341.28 ,$62.70 ,$474.00 ,$474.00 ,$234.61 ,$474.00 ,$234.61 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,45000110,30300,HC REM FB INTRANASAL,450,1 ,$377.00 ,$188.50 ,$34.89 ,$377.00 ,$34.89 ,$243.88 ,$243.88 ,$109.66 ,$226.20 ,$320.45 ,$263.90 ,$34.89 ,$358.15 ,$271.44 ,$275.21 ,$245.05 ,$320.45 ,$109.66 ,$245.05 ,$320.45 ,$275.21 ,$34.89 ,$109.66 ,$377.00 ,$320.45 ,$246.74 ,$346.84 ,$263.90 ,$191.21 ,$229.48 ,$229.59 ,$214.17 ,$260.51 ,$271.44 ,$262.58 ,$110.76 ,$271.44 ,$36.98 ,$377.00 ,$377.00 ,$109.66 ,$377.00 ,$109.66 ,$271.44 ,$233.74 ,$271.44 ,$271.44 ,$226.20 
ST MARY'S HOSPITAL,45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$388.00 ,$194.00 ,$34.89 ,$388.00 ,$34.89 ,$251.00 ,$251.00 ,$109.66 ,$232.80 ,$329.80 ,$271.60 ,$34.89 ,$368.60 ,$279.36 ,$283.24 ,$252.20 ,$329.80 ,$109.66 ,$252.20 ,$329.80 ,$283.24 ,$34.89 ,$109.66 ,$388.00 ,$329.80 ,$246.74 ,$356.96 ,$271.60 ,$196.79 ,$236.18 ,$236.29 ,$220.42 ,$268.11 ,$279.36 ,$270.24 ,$110.76 ,$279.36 ,$36.98 ,$388.00 ,$388.00 ,$109.66 ,$388.00 ,$109.66 ,$279.36 ,$240.56 ,$279.36 ,$279.36 ,$232.80 
ST MARY'S HOSPITAL,45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$474.00 ,$237.00 ,$34.89 ,$474.00 ,$34.89 ,$306.63 ,$306.63 ,$109.66 ,$284.40 ,$402.90 ,$331.80 ,$34.89 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$109.66 ,$308.10 ,$402.90 ,$346.02 ,$34.89 ,$109.66 ,$474.00 ,$402.90 ,$246.74 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$110.76 ,$341.28 ,$36.98 ,$474.00 ,$474.00 ,$109.66 ,$474.00 ,$109.66 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$431.00 ,$215.50 ,$34.89 ,$431.00 ,$34.89 ,$278.81 ,$278.81 ,$109.66 ,$258.60 ,$366.35 ,$301.70 ,$34.89 ,$409.45 ,$310.32 ,$314.63 ,$280.15 ,$366.35 ,$109.66 ,$280.15 ,$366.35 ,$314.63 ,$34.89 ,$109.66 ,$431.00 ,$366.35 ,$246.74 ,$396.52 ,$301.70 ,$218.60 ,$262.35 ,$262.48 ,$244.85 ,$297.82 ,$310.32 ,$300.19 ,$110.76 ,$310.32 ,$36.98 ,$431.00 ,$431.00 ,$109.66 ,$431.00 ,$109.66 ,$310.32 ,$267.22 ,$310.32 ,$310.32 ,$258.60 
ST MARY'S HOSPITAL,45000114,31238,HC NASAL ENDO W EPISTAX CONTROL,450,1 ,"$3,100.00 ","$1,550.00 ",$571.36 ,"$3,273.80 ",$611.34 ,"$2,005.39 ","$2,005.39 ","$1,455.02 ","$1,860.00 ","$2,635.00 ","$2,170.00 ",$611.34 ,"$2,945.00 ","$2,232.00 ","$2,263.00 ","$2,015.00 ","$2,635.00 ","$1,455.02 ","$2,015.00 ","$2,635.00 ","$2,263.00 ",$611.34 ,"$1,455.02 ",$571.36 ,"$2,635.00 ","$3,273.80 ","$2,852.00 ","$2,170.00 ","$1,572.32 ","$1,886.97 ","$1,887.90 ","$1,761.11 ","$2,142.10 ","$2,232.00 ","$2,159.15 ","$1,469.57 ","$2,232.00 ",$648.02 ,$685.00 ,$685.00 ,"$1,455.02 ",$685.00 ,"$1,455.02 ","$2,232.00 ","$1,922.00 ","$2,232.00 ","$2,232.00 ","$1,860.00 "
ST MARY'S HOSPITAL,45000116,31720,HC ASP CATH NASOTRACHEAL,450,1 ,$248.00 ,$124.00 ,$16.35 ,$411.30 ,$16.35 ,$160.43 ,$160.43 ,$182.80 ,$148.80 ,$210.80 ,$173.60 ,$16.35 ,$235.60 ,$178.56 ,$181.04 ,$161.20 ,$210.80 ,$182.80 ,$161.20 ,$210.80 ,$181.04 ,$16.35 ,$182.80 ,$248.00 ,$210.80 ,$411.30 ,$228.16 ,$173.60 ,$125.79 ,$150.96 ,$151.03 ,$140.89 ,$171.37 ,$178.56 ,$172.73 ,$184.63 ,$178.56 ,$17.33 ,$248.00 ,$248.00 ,$182.80 ,$248.00 ,$182.80 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$148.80 
ST MARY'S HOSPITAL,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 ,$123.84 ,$125.56 ,$111.80 ,$146.20 , N/A ,$111.80 ,$146.20 ,$125.56 ,$0.73 , N/A ,$172.00 ,$146.20 , N/A ,$158.24 ,$120.40 ,$87.24 ,$104.70 ,$104.75 ,$97.71 ,$118.85 ,$123.84 ,$119.80 , N/A ,$123.84 ,$0.77 ,$172.00 ,$172.00 , N/A ,$172.00 , N/A ,$123.84 ,$106.64 ,$123.84 ,$123.84 ,$103.20 
ST MARY'S HOSPITAL,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 ,$21.60 ,$21.90 ,$19.50 ,$25.50 , N/A ,$19.50 ,$25.50 ,$21.90 ,$0.73 , N/A ,$30.00 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$17.04 ,$20.73 ,$21.60 ,$20.90 , N/A ,$21.60 ,$0.77 ,$30.00 ,$30.00 , N/A ,$30.00 , N/A ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$18.00 
ST MARY'S HOSPITAL,45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$582.00 ,$291.00 ,$75.55 ,$593.87 ,$75.55 ,$376.50 ,$376.50 ,$263.94 ,$349.20 ,$494.70 ,$407.40 ,$75.55 ,$552.90 ,$419.04 ,$424.86 ,$378.30 ,$494.70 ,$263.94 ,$378.30 ,$494.70 ,$424.86 ,$75.55 ,$263.94 ,$571.36 ,$494.70 ,$593.87 ,$535.44 ,$407.40 ,$295.19 ,$354.26 ,$354.44 ,$330.63 ,$402.16 ,$419.04 ,$405.36 ,$266.58 ,$419.04 ,$80.08 ,$582.00 ,$582.00 ,$263.94 ,$582.00 ,$263.94 ,$419.04 ,$360.84 ,$419.04 ,$419.04 ,$349.20 
ST MARY'S HOSPITAL,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 ,$439.84 ,$646.20 ,$915.45 ,$753.90 ,$288.55 ,"$1,023.15 ",$775.44 ,$786.21 ,$700.05 ,$915.45 ,$439.84 ,$700.05 ,$915.45 ,$786.21 ,$288.55 ,$439.84 ,$571.36 ,$915.45 ,$989.64 ,$990.84 ,$753.90 ,$546.25 ,$655.57 ,$655.89 ,$611.84 ,$744.21 ,$775.44 ,$750.13 ,$444.24 ,$775.44 ,$305.86 ,$685.00 ,$685.00 ,$439.84 ,$685.00 ,$439.84 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$646.20 
ST MARY'S HOSPITAL,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 ,$439.84 ,$646.20 ,$915.45 ,$753.90 ,$288.55 ,"$1,023.15 ",$775.44 ,$786.21 ,$700.05 ,$915.45 ,$439.84 ,$700.05 ,$915.45 ,$786.21 ,$288.55 ,$439.84 ,$571.36 ,$915.45 ,$989.64 ,$990.84 ,$753.90 ,$546.25 ,$655.57 ,$655.89 ,$611.84 ,$744.21 ,$775.44 ,$750.13 ,$444.24 ,$775.44 ,$305.86 ,$685.00 ,$685.00 ,$439.84 ,$685.00 ,$439.84 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$646.20 
ST MARY'S HOSPITAL,45000135,40654,HC RPR LIP CPLX,450,1 ,"$1,508.00 ",$754.00 ,$288.55 ,"$2,960.00 ",$288.55 ,$975.53 ,$975.53 ,"$1,315.56 ",$904.80 ,"$1,281.80 ","$1,055.60 ",$288.55 ,"$1,432.60 ","$1,085.76 ","$1,100.84 ",$980.20 ,"$1,281.80 ","$1,315.56 ",$980.20 ,"$1,281.80 ","$1,100.84 ",$288.55 ,"$1,315.56 ",$571.36 ,"$1,281.80 ","$2,960.00 ","$1,387.36 ","$1,055.60 ",$764.86 ,$917.92 ,$918.37 ,$856.69 ,"$1,042.03 ","$1,085.76 ","$1,050.32 ","$1,328.72 ","$1,085.76 ",$305.86 ,$685.00 ,$685.00 ,"$1,315.56 ",$685.00 ,"$1,315.56 ","$1,085.76 ",$934.96 ,"$1,085.76 ","$1,085.76 ",$904.80 
ST MARY'S HOSPITAL,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 ",$605.19 ,"$1,087.80 ","$1,541.05 ","$1,269.10 ",$34.89 ,"$1,722.35 ","$1,305.36 ","$1,323.49 ","$1,178.45 ","$1,541.05 ",$605.19 ,"$1,178.45 ","$1,541.05 ","$1,323.49 ",$34.89 ,$605.19 ,$571.36 ,"$1,541.05 ","$1,361.67 ","$1,667.96 ","$1,269.10 ",$919.55 ,"$1,103.57 ","$1,104.12 ","$1,029.97 ","$1,252.78 ","$1,305.36 ","$1,262.75 ",$611.24 ,"$1,305.36 ",$36.98 ,$685.00 ,$685.00 ,$605.19 ,$685.00 ,$605.19 ,"$1,305.36 ","$1,124.06 ","$1,305.36 ","$1,305.36 ","$1,087.80 "
ST MARY'S HOSPITAL,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 ,$205.75 ,$381.60 ,$540.60 ,$445.20 ,$34.89 ,$604.20 ,$457.92 ,$464.28 ,$413.40 ,$540.60 ,$205.75 ,$413.40 ,$540.60 ,$464.28 ,$34.89 ,$205.75 ,$571.36 ,$540.60 ,$462.94 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$361.31 ,$439.48 ,$457.92 ,$442.97 ,$207.81 ,$457.92 ,$36.98 ,$636.00 ,$636.00 ,$205.75 ,$636.00 ,$205.75 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$381.60 
ST MARY'S HOSPITAL,45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$560.00 ,$280.00 ,$34.89 ,$593.87 ,$34.89 ,$362.26 ,$362.26 ,$263.94 ,$336.00 ,$476.00 ,$392.00 ,$34.89 ,$532.00 ,$403.20 ,$408.80 ,$364.00 ,$476.00 ,$263.94 ,$364.00 ,$476.00 ,$408.80 ,$34.89 ,$263.94 ,$560.00 ,$476.00 ,$593.87 ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 ,$266.58 ,$403.20 ,$36.98 ,$560.00 ,$560.00 ,$263.94 ,$560.00 ,$263.94 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$420.00 ,$210.00 ,$34.89 ,$420.00 ,$34.89 ,$271.70 ,$271.70 ,$109.66 ,$252.00 ,$357.00 ,$294.00 ,$34.89 ,$399.00 ,$302.40 ,$306.60 ,$273.00 ,$357.00 ,$109.66 ,$273.00 ,$357.00 ,$306.60 ,$34.89 ,$109.66 ,$420.00 ,$357.00 ,$246.74 ,$386.40 ,$294.00 ,$213.02 ,$255.65 ,$255.78 ,$238.60 ,$290.22 ,$302.40 ,$292.53 ,$110.76 ,$302.40 ,$36.98 ,$420.00 ,$420.00 ,$109.66 ,$420.00 ,$109.66 ,$302.40 ,$260.40 ,$302.40 ,$302.40 ,$252.00 
ST MARY'S HOSPITAL,45000140,42700,HC I AND D ABSC PERITONSILLAR,450,1 ,$636.00 ,$318.00 ,$34.89 ,$636.00 ,$34.89 ,$411.43 ,$411.43 ,$205.75 ,$381.60 ,$540.60 ,$445.20 ,$34.89 ,$604.20 ,$457.92 ,$464.28 ,$413.40 ,$540.60 ,$205.75 ,$413.40 ,$540.60 ,$464.28 ,$34.89 ,$205.75 ,$571.36 ,$540.60 ,$462.94 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$361.31 ,$439.48 ,$457.92 ,$442.97 ,$207.81 ,$457.92 ,$36.98 ,$636.00 ,$636.00 ,$205.75 ,$636.00 ,$205.75 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$381.60 
ST MARY'S HOSPITAL,45000141,42809,HC REMOVE PHARYNX FOREIGN BODY,450,1 ,$215.00 ,$107.50 ,$34.89 ,$593.87 ,$34.89 ,$139.08 ,$139.08 ,$263.94 ,$129.00 ,$182.75 ,$150.50 ,$34.89 ,$204.25 ,$154.80 ,$156.95 ,$139.75 ,$182.75 ,$263.94 ,$139.75 ,$182.75 ,$156.95 ,$34.89 ,$263.94 ,$215.00 ,$182.75 ,$593.87 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$122.14 ,$148.57 ,$154.80 ,$149.75 ,$266.58 ,$154.80 ,$36.98 ,$215.00 ,$215.00 ,$263.94 ,$215.00 ,$263.94 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$129.00 
ST MARY'S HOSPITAL,45000143,43753,HC GASTRIC LAVAGE,450,1 ,$636.00 ,$318.00 ,$211.20 ,$636.00 ,$211.20 ,$411.43 ,$411.43 ,$257.38 ,$381.60 ,$540.60 ,$445.20 ,$211.20 ,$604.20 ,$457.92 ,$464.28 ,$413.40 ,$540.60 ,$257.38 ,$413.40 ,$540.60 ,$464.28 ,$211.20 ,$257.38 ,$571.36 ,$540.60 ,$579.11 ,$585.12 ,$445.20 ,$322.58 ,$387.13 ,$387.32 ,$361.31 ,$439.48 ,$457.92 ,$442.97 ,$259.95 ,$457.92 ,$223.87 ,$636.00 ,$636.00 ,$257.38 ,$636.00 ,$257.38 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$381.60 
ST MARY'S HOSPITAL,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 ","$1,008.48 ","$1,615.80 ","$2,289.05 ","$1,885.10 ",$462.68 ,"$2,558.35 ","$1,938.96 ","$1,965.89 ","$1,750.45 ","$2,289.05 ","$1,008.48 ","$1,750.45 ","$2,289.05 ","$1,965.89 ",$462.68 ,"$1,008.48 ",$571.36 ,"$2,289.05 ","$2,269.08 ","$2,477.56 ","$1,885.10 ","$1,365.89 ","$1,639.23 ","$1,640.04 ","$1,529.89 ","$1,860.86 ","$1,938.96 ","$1,875.67 ","$1,018.56 ","$1,938.96 ",$490.44 ,$685.00 ,$685.00 ,"$1,008.48 ",$685.00 ,"$1,008.48 ","$1,938.96 ","$1,669.66 ","$1,938.96 ","$1,938.96 ","$1,615.80 "
ST MARY'S HOSPITAL,45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$1,185.00 ",$592.50 ,$462.68 ,"$1,736.49 ",$462.68 ,$766.58 ,$766.58 ,$771.77 ,$711.00 ,"$1,007.25 ",$829.50 ,$462.68 ,"$1,125.75 ",$853.20 ,$865.05 ,$770.25 ,"$1,007.25 ",$771.77 ,$770.25 ,"$1,007.25 ",$865.05 ,$462.68 ,$771.77 ,$571.36 ,"$1,007.25 ","$1,736.49 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$673.20 ,$818.84 ,$853.20 ,$825.35 ,$779.49 ,$853.20 ,$490.44 ,$685.00 ,$685.00 ,$771.77 ,$685.00 ,$771.77 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$474.00 ,$237.00 ,$237.00 ,$582.28 ,$462.68 ,$306.63 ,$306.63 ,$258.79 ,$284.40 ,$402.90 ,$331.80 ,$462.68 ,$450.30 ,$341.28 ,$346.02 ,$308.10 ,$402.90 ,$258.79 ,$308.10 ,$402.90 ,$346.02 ,$462.68 ,$258.79 ,$474.00 ,$402.90 ,$582.28 ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 ,$261.38 ,$341.28 ,$490.44 ,$474.00 ,$474.00 ,$258.79 ,$474.00 ,$258.79 ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,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 ","$1,008.48 ","$1,422.00 ","$2,014.50 ","$1,659.00 ",$462.68 ,"$2,251.50 ","$1,706.40 ","$1,730.10 ","$1,540.50 ","$2,014.50 ","$1,008.48 ","$1,540.50 ","$2,014.50 ","$1,730.10 ",$462.68 ,"$1,008.48 ",$571.36 ,"$2,014.50 ","$2,269.08 ","$2,180.40 ","$1,659.00 ","$1,202.06 ","$1,442.62 ","$1,443.33 ","$1,346.40 ","$1,637.67 ","$1,706.40 ","$1,650.71 ","$1,018.56 ","$1,706.40 ",$490.44 ,$685.00 ,$685.00 ,"$1,008.48 ",$685.00 ,"$1,008.48 ","$1,706.40 ","$1,469.40 ","$1,706.40 ","$1,706.40 ","$1,422.00 "
ST MARY'S HOSPITAL,45000150,46600,HC ANOSCOPY,450,1 ,$230.00 ,$115.00 ,$56.46 ,$246.74 ,$56.46 ,$148.79 ,$148.79 ,$109.66 ,$138.00 ,$195.50 ,$161.00 ,$56.46 ,$218.50 ,$165.60 ,$167.90 ,$149.50 ,$195.50 ,$109.66 ,$149.50 ,$195.50 ,$167.90 ,$56.46 ,$109.66 ,$230.00 ,$195.50 ,$246.74 ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 ,$110.76 ,$165.60 ,$59.85 ,$230.00 ,$230.00 ,$109.66 ,$230.00 ,$109.66 ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ",$771.77 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$304.93 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$1,430.00 ","$1,870.00 ",$771.77 ,"$1,430.00 ","$1,870.00 ","$1,606.00 ",$304.93 ,$771.77 ,$571.36 ,"$1,870.00 ","$1,736.49 ","$2,024.00 ","$1,540.00 ","$1,115.84 ","$1,339.14 ","$1,339.80 ","$1,249.82 ","$1,520.20 ","$1,584.00 ","$1,532.30 ",$779.49 ,"$1,584.00 ",$323.23 ,$685.00 ,$685.00 ,$771.77 ,$685.00 ,$771.77 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$517.00 ,$258.50 ,$22.63 ,$582.28 ,$22.63 ,$334.45 ,$334.45 ,$258.79 ,$310.20 ,$439.45 ,$361.90 ,$22.63 ,$491.15 ,$372.24 ,$377.41 ,$336.05 ,$439.45 ,$258.79 ,$336.05 ,$439.45 ,$377.41 ,$22.63 ,$258.79 ,$517.00 ,$439.45 ,$582.28 ,$475.64 ,$361.90 ,$262.22 ,$314.70 ,$314.85 ,$293.71 ,$357.25 ,$372.24 ,$360.09 ,$261.38 ,$372.24 ,$23.99 ,$517.00 ,$517.00 ,$258.79 ,$517.00 ,$258.79 ,$372.24 ,$320.54 ,$372.24 ,$372.24 ,$310.20 
ST MARY'S HOSPITAL,45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$593.00 ,$296.50 ,$62.73 ,$593.00 ,$62.73 ,$383.61 ,$383.61 ,$258.79 ,$355.80 ,$504.05 ,$415.10 ,$62.73 ,$563.35 ,$426.96 ,$432.89 ,$385.45 ,$504.05 ,$258.79 ,$385.45 ,$504.05 ,$432.89 ,$62.73 ,$258.79 ,$571.36 ,$504.05 ,$582.28 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$336.88 ,$409.76 ,$426.96 ,$413.02 ,$261.38 ,$426.96 ,$66.49 ,$593.00 ,$593.00 ,$258.79 ,$593.00 ,$258.79 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$355.80 
ST MARY'S HOSPITAL,45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$452.00 ,$226.00 ,$22.63 ,$582.28 ,$22.63 ,$292.40 ,$292.40 ,$258.79 ,$271.20 ,$384.20 ,$316.40 ,$22.63 ,$429.40 ,$325.44 ,$329.96 ,$293.80 ,$384.20 ,$258.79 ,$293.80 ,$384.20 ,$329.96 ,$22.63 ,$258.79 ,$452.00 ,$384.20 ,$582.28 ,$415.84 ,$316.40 ,$229.25 ,$275.13 ,$275.27 ,$256.78 ,$312.33 ,$325.44 ,$314.82 ,$261.38 ,$325.44 ,$23.99 ,$452.00 ,$452.00 ,$258.79 ,$452.00 ,$258.79 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$271.20 
ST MARY'S HOSPITAL,45000160,54450,HC MANIP FORESKIN STRETCH,450,1 ,$776.00 ,$388.00 ,$119.36 ,$776.00 ,$119.36 ,$501.99 ,$501.99 ,$258.79 ,$465.60 ,$659.60 ,$543.20 ,$119.36 ,$737.20 ,$558.72 ,$566.48 ,$504.40 ,$659.60 ,$258.79 ,$504.40 ,$659.60 ,$566.48 ,$119.36 ,$258.79 ,$571.36 ,$659.60 ,$582.28 ,$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$440.85 ,$536.22 ,$558.72 ,$540.48 ,$261.38 ,$558.72 ,$126.52 ,$685.00 ,$685.00 ,$258.79 ,$685.00 ,$258.79 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$2,047.00 ","$1,023.50 ",$571.36 ,"$3,917.96 ",$646.68 ,"$1,324.20 ","$1,324.20 ","$1,741.31 ","$1,228.20 ","$1,739.95 ","$1,432.90 ",$646.68 ,"$1,944.65 ","$1,473.84 ","$1,494.31 ","$1,330.55 ","$1,739.95 ","$1,741.31 ","$1,330.55 ","$1,739.95 ","$1,494.31 ",$646.68 ,"$1,741.31 ",$571.36 ,"$1,739.95 ","$3,917.96 ","$1,883.24 ","$1,432.90 ","$1,038.24 ","$1,246.01 ","$1,246.62 ","$1,162.90 ","$1,414.48 ","$1,473.84 ","$1,425.74 ","$1,758.72 ","$1,473.84 ",$685.48 ,$685.00 ,$685.00 ,"$1,741.31 ",$685.00 ,"$1,741.31 ","$1,473.84 ","$1,269.14 ","$1,473.84 ","$1,473.84 ","$1,228.20 "
ST MARY'S HOSPITAL,45000162,55100,HC DRAIN ABSC SCROTAL WALL,450,1 ,$937.00 ,$468.50 ,$468.50 ,"$3,078.81 ",$646.68 ,$606.15 ,$606.15 ,"$1,368.36 ",$562.20 ,$796.45 ,$655.90 ,$646.68 ,$890.15 ,$674.64 ,$684.01 ,$609.05 ,$796.45 ,"$1,368.36 ",$609.05 ,$796.45 ,$684.01 ,$646.68 ,"$1,368.36 ",$571.36 ,$796.45 ,"$3,078.81 ",$862.04 ,$655.90 ,$475.25 ,$570.35 ,$570.63 ,$532.31 ,$647.47 ,$674.64 ,$652.62 ,"$1,382.04 ",$674.64 ,$685.48 ,$685.00 ,$685.00 ,"$1,368.36 ",$685.00 ,"$1,368.36 ",$674.64 ,$580.94 ,$674.64 ,$674.64 ,$562.20 
ST MARY'S HOSPITAL,45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$593.00 ,$296.50 ,$61.96 ,$617.14 ,$61.96 ,$383.61 ,$383.61 ,$274.28 ,$355.80 ,$504.05 ,$415.10 ,$61.96 ,$563.35 ,$426.96 ,$432.89 ,$385.45 ,$504.05 ,$274.28 ,$385.45 ,$504.05 ,$432.89 ,$61.96 ,$274.28 ,$571.36 ,$504.05 ,$617.14 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$336.88 ,$409.76 ,$426.96 ,$413.02 ,$277.02 ,$426.96 ,$65.68 ,$593.00 ,$593.00 ,$274.28 ,$593.00 ,$274.28 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$355.80 
ST MARY'S HOSPITAL,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 ,$165.68 ,$303.60 ,$430.10 ,$354.20 ,$61.96 ,$480.70 ,$364.32 ,$369.38 ,$328.90 ,$430.10 ,$165.68 ,$328.90 ,$430.10 ,$369.38 ,$61.96 ,$165.68 ,$506.00 ,$430.10 ,$372.78 ,$465.52 ,$354.20 ,$256.64 ,$308.00 ,$308.15 ,$287.46 ,$349.65 ,$364.32 ,$352.43 ,$167.34 ,$364.32 ,$65.68 ,$506.00 ,$506.00 ,$165.68 ,$506.00 ,$165.68 ,$364.32 ,$313.72 ,$364.32 ,$364.32 ,$303.60 
ST MARY'S HOSPITAL,45000165,58301,HC REM DVC INTRAUTERINE,450,1 ,$226.00 ,$113.00 ,$61.96 ,$617.14 ,$61.96 ,$146.20 ,$146.20 ,$274.28 ,$135.60 ,$192.10 ,$158.20 ,$61.96 ,$214.70 ,$162.72 ,$164.98 ,$146.90 ,$192.10 ,$274.28 ,$146.90 ,$192.10 ,$164.98 ,$61.96 ,$274.28 ,$226.00 ,$192.10 ,$617.14 ,$207.92 ,$158.20 ,$114.63 ,$137.57 ,$137.63 ,$128.39 ,$156.17 ,$162.72 ,$157.41 ,$277.02 ,$162.72 ,$65.68 ,$226.00 ,$226.00 ,$274.28 ,$226.00 ,$274.28 ,$162.72 ,$140.12 ,$162.72 ,$162.72 ,$135.60 
ST MARY'S HOSPITAL,45000166,59414,HC DELIVERY OF PLACENTA,450,1 ,"$3,447.00 ","$1,723.50 ",$571.36 ,"$5,741.06 ",$595.75 ,"$2,229.86 ","$2,229.86 ","$2,551.58 ","$2,068.20 ","$2,929.95 ","$2,412.90 ",$595.75 ,"$3,274.65 ","$2,481.84 ","$2,516.31 ","$2,240.55 ","$2,929.95 ","$2,551.58 ","$2,240.55 ","$2,929.95 ","$2,516.31 ",$595.75 ,"$2,551.58 ",$571.36 ,"$2,929.95 ","$5,741.06 ","$3,171.24 ","$2,412.90 ","$1,748.32 ","$2,098.19 ","$2,099.22 ","$1,958.24 ","$2,381.88 ","$2,481.84 ","$2,400.84 ","$2,577.10 ","$2,481.84 ",$631.50 ,$685.00 ,$685.00 ,"$2,551.58 ",$685.00 ,"$2,551.58 ","$2,481.84 ","$2,137.14 ","$2,481.84 ","$2,481.84 ","$2,068.20 "
ST MARY'S HOSPITAL,45000168,64400,HC DENTAL BLOCK,450,1 ,$765.00 ,$382.50 ,$136.73 ,$765.00 ,$136.73 ,$494.88 ,$494.88 ,$254.09 ,$459.00 ,$650.25 ,$535.50 ,$136.73 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$254.09 ,$497.25 ,$650.25 ,$558.45 ,$136.73 ,$254.09 ,$571.36 ,$650.25 ,$571.69 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$256.63 ,$550.80 ,$144.93 ,$685.00 ,$685.00 ,$254.09 ,$685.00 ,$254.09 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$380.00 ,$190.00 ,$136.73 ,$571.69 ,$136.73 ,$245.82 ,$245.82 ,$254.09 ,$228.00 ,$323.00 ,$266.00 ,$136.73 ,$361.00 ,$273.60 ,$277.40 ,$247.00 ,$323.00 ,$254.09 ,$247.00 ,$323.00 ,$277.40 ,$136.73 ,$254.09 ,$380.00 ,$323.00 ,$571.69 ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 ,$256.63 ,$273.60 ,$144.93 ,$380.00 ,$380.00 ,$254.09 ,$380.00 ,$254.09 ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,$830.00 ,$415.00 ,$136.73 ,"$1,389.48 ",$136.73 ,$536.93 ,$536.93 ,$617.55 ,$498.00 ,$705.50 ,$581.00 ,$136.73 ,$788.50 ,$597.60 ,$605.90 ,$539.50 ,$705.50 ,$617.55 ,$539.50 ,$705.50 ,$605.90 ,$136.73 ,$617.55 ,$571.36 ,$705.50 ,"$1,389.48 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$471.52 ,$573.53 ,$597.60 ,$578.10 ,$623.73 ,$597.60 ,$144.93 ,$685.00 ,$685.00 ,$617.55 ,$685.00 ,$617.55 ,$597.60 ,$514.60 ,$597.60 ,$597.60 ,$498.00 
ST MARY'S HOSPITAL,45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$381.00 ,$190.50 ,$22.85 ,$381.00 ,$22.85 ,$246.47 ,$246.47 ,$109.66 ,$228.60 ,$323.85 ,$266.70 ,$22.85 ,$361.95 ,$274.32 ,$278.13 ,$247.65 ,$323.85 ,$109.66 ,$247.65 ,$323.85 ,$278.13 ,$22.85 ,$109.66 ,$381.00 ,$323.85 ,$246.74 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$216.45 ,$263.27 ,$274.32 ,$265.37 ,$110.76 ,$274.32 ,$24.22 ,$381.00 ,$381.00 ,$109.66 ,$381.00 ,$109.66 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$228.60 
ST MARY'S HOSPITAL,45000172,65210,HC REM EYE FB CONJUCT EMBED,450,1 ,$381.00 ,$190.50 ,$22.85 ,$593.87 ,$22.85 ,$246.47 ,$246.47 ,$263.94 ,$228.60 ,$323.85 ,$266.70 ,$22.85 ,$361.95 ,$274.32 ,$278.13 ,$247.65 ,$323.85 ,$263.94 ,$247.65 ,$323.85 ,$278.13 ,$22.85 ,$263.94 ,$381.00 ,$323.85 ,$593.87 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$216.45 ,$263.27 ,$274.32 ,$265.37 ,$266.58 ,$274.32 ,$24.22 ,$381.00 ,$381.00 ,$263.94 ,$381.00 ,$263.94 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$228.60 
ST MARY'S HOSPITAL,45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$381.00 ,$190.50 ,$22.85 ,$593.87 ,$22.85 ,$246.47 ,$246.47 ,$263.94 ,$228.60 ,$323.85 ,$266.70 ,$22.85 ,$361.95 ,$274.32 ,$278.13 ,$247.65 ,$323.85 ,$263.94 ,$247.65 ,$323.85 ,$278.13 ,$22.85 ,$263.94 ,$381.00 ,$323.85 ,$593.87 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$216.45 ,$263.27 ,$274.32 ,$265.37 ,$266.58 ,$274.32 ,$24.22 ,$381.00 ,$381.00 ,$263.94 ,$381.00 ,$263.94 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$228.60 
ST MARY'S HOSPITAL,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 ,$109.66 ,$241.80 ,$342.55 ,$282.10 ,$22.85 ,$382.85 ,$290.16 ,$294.19 ,$261.95 ,$342.55 ,$109.66 ,$261.95 ,$342.55 ,$294.19 ,$22.85 ,$109.66 ,$403.00 ,$342.55 ,$246.74 ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$228.94 ,$278.47 ,$290.16 ,$280.69 ,$110.76 ,$290.16 ,$24.22 ,$403.00 ,$403.00 ,$109.66 ,$403.00 ,$109.66 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,45000175,65235,HC REMOVE FB EYE; INTRAOCULAR ANTERIOR CHAMBER,450,1 ,"$2,128.00 ","$1,064.00 ",$288.75 ,"$4,544.03 ",$288.75 ,"$1,376.60 ","$1,376.60 ","$2,019.57 ","$1,276.80 ","$1,808.80 ","$1,489.60 ",$288.75 ,"$2,021.60 ","$1,532.16 ","$1,553.44 ","$1,383.20 ","$1,808.80 ","$2,019.57 ","$1,383.20 ","$1,808.80 ","$1,553.44 ",$288.75 ,"$2,019.57 ",$571.36 ,"$1,808.80 ","$4,544.03 ","$1,957.76 ","$1,489.60 ","$1,079.32 ","$1,295.31 ","$1,295.95 ","$1,208.92 ","$1,470.45 ","$1,532.16 ","$1,482.15 ","$2,039.77 ","$1,532.16 ",$306.08 ,$685.00 ,$685.00 ,"$2,019.57 ",$685.00 ,"$2,019.57 ","$1,532.16 ","$1,319.36 ","$1,532.16 ","$1,532.16 ","$1,276.80 "
ST MARY'S HOSPITAL,45000176,65260,HC REMOVE FB EYE; INTRAOCULAR POSTERIOR SEGMENT,450,1 ,$974.00 ,$487.00 ,$340.28 ,"$4,544.03 ",$340.28 ,$630.08 ,$630.08 ,"$2,019.57 ",$584.40 ,$827.90 ,$681.80 ,$340.28 ,$925.30 ,$701.28 ,$711.02 ,$633.10 ,$827.90 ,"$2,019.57 ",$633.10 ,$827.90 ,$711.02 ,$340.28 ,"$2,019.57 ",$571.36 ,$827.90 ,"$4,544.03 ",$896.08 ,$681.80 ,$494.01 ,$592.87 ,$593.17 ,$553.33 ,$673.03 ,$701.28 ,$678.39 ,"$2,039.77 ",$701.28 ,$360.70 ,$685.00 ,$685.00 ,"$2,019.57 ",$685.00 ,"$2,019.57 ",$701.28 ,$603.88 ,$701.28 ,$701.28 ,$584.40 
ST MARY'S HOSPITAL,45000177,67700,HC I AND D ABSCESS EYELID,450,1 ,$560.00 ,$280.00 ,$98.99 ,$572.40 ,$98.99 ,$362.26 ,$362.26 ,$254.40 ,$336.00 ,$476.00 ,$392.00 ,$98.99 ,$532.00 ,$403.20 ,$408.80 ,$364.00 ,$476.00 ,$254.40 ,$364.00 ,$476.00 ,$408.80 ,$98.99 ,$254.40 ,$560.00 ,$476.00 ,$572.40 ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 ,$256.94 ,$403.20 ,$104.93 ,$560.00 ,$560.00 ,$254.40 ,$560.00 ,$254.40 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$526.00 ,$263.00 ,$98.99 ,$572.40 ,$98.99 ,$340.27 ,$340.27 ,$254.40 ,$315.60 ,$447.10 ,$368.20 ,$98.99 ,$499.70 ,$378.72 ,$383.98 ,$341.90 ,$447.10 ,$254.40 ,$341.90 ,$447.10 ,$383.98 ,$98.99 ,$254.40 ,$526.00 ,$447.10 ,$572.40 ,$483.92 ,$368.20 ,$266.79 ,$320.18 ,$320.33 ,$298.82 ,$363.47 ,$378.72 ,$366.36 ,$256.94 ,$378.72 ,$104.93 ,$526.00 ,$526.00 ,$254.40 ,$526.00 ,$254.40 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$315.60 
ST MARY'S HOSPITAL,45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,$496.00 ,$248.00 ,$34.89 ,"$1,361.67 ",$34.89 ,$320.86 ,$320.86 ,$605.19 ,$297.60 ,$421.60 ,$347.20 ,$34.89 ,$471.20 ,$357.12 ,$362.08 ,$322.40 ,$421.60 ,$605.19 ,$322.40 ,$421.60 ,$362.08 ,$34.89 ,$605.19 ,$496.00 ,$421.60 ,"$1,361.67 ",$456.32 ,$347.20 ,$251.57 ,$301.92 ,$302.06 ,$281.78 ,$342.74 ,$357.12 ,$345.46 ,$611.24 ,$357.12 ,$36.98 ,$496.00 ,$496.00 ,$605.19 ,$496.00 ,$605.19 ,$357.12 ,$307.52 ,$357.12 ,$357.12 ,$297.60 
ST MARY'S HOSPITAL,45000180,69005,HC I AND D ABSCESS EXTERNAL EAR CMPLX,450,1 ,"$1,454.00 ",$727.00 ,$288.55 ,"$3,078.81 ",$288.55 ,$940.59 ,$940.59 ,"$1,368.36 ",$872.40 ,"$1,235.90 ","$1,017.80 ",$288.55 ,"$1,381.30 ","$1,046.88 ","$1,061.42 ",$945.10 ,"$1,235.90 ","$1,368.36 ",$945.10 ,"$1,235.90 ","$1,061.42 ",$288.55 ,"$1,368.36 ",$571.36 ,"$1,235.90 ","$3,078.81 ","$1,337.68 ","$1,017.80 ",$737.47 ,$885.05 ,$885.49 ,$826.02 ,"$1,004.71 ","$1,046.88 ","$1,012.71 ","$1,382.04 ","$1,046.88 ",$305.86 ,$685.00 ,$685.00 ,"$1,368.36 ",$685.00 ,"$1,368.36 ","$1,046.88 ",$901.48 ,"$1,046.88 ","$1,046.88 ",$872.40 
ST MARY'S HOSPITAL,45000181,69200,HC FB REMOVAL EAR,450,1 ,$215.00 ,$107.50 ,$34.89 ,$246.74 ,$34.89 ,$139.08 ,$139.08 ,$109.66 ,$129.00 ,$182.75 ,$150.50 ,$34.89 ,$204.25 ,$154.80 ,$156.95 ,$139.75 ,$182.75 ,$109.66 ,$139.75 ,$182.75 ,$156.95 ,$34.89 ,$109.66 ,$215.00 ,$182.75 ,$246.74 ,$197.80 ,$150.50 ,$109.05 ,$130.87 ,$130.94 ,$122.14 ,$148.57 ,$154.80 ,$149.75 ,$110.76 ,$154.80 ,$36.98 ,$215.00 ,$215.00 ,$109.66 ,$215.00 ,$109.66 ,$154.80 ,$133.30 ,$154.80 ,$154.80 ,$129.00 
ST MARY'S HOSPITAL,45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$108.00 ,$54.00 ,$34.89 ,$121.80 ,$34.89 ,$69.87 ,$69.87 ,$54.13 ,$64.80 ,$91.80 ,$75.60 ,$34.89 ,$102.60 ,$77.76 ,$78.84 ,$70.20 ,$91.80 ,$54.13 ,$70.20 ,$91.80 ,$78.84 ,$34.89 ,$54.13 ,$108.00 ,$91.80 ,$121.80 ,$99.36 ,$75.60 ,$54.78 ,$65.74 ,$65.77 ,$61.35 ,$74.63 ,$77.76 ,$75.22 ,$54.67 ,$77.76 ,$36.98 ,$108.00 ,$108.00 ,$54.13 ,$108.00 ,$54.13 ,$77.76 ,$66.96 ,$77.76 ,$77.76 ,$64.80 
ST MARY'S HOSPITAL,45000185,92511,HC NASOPHARYNGOSCOPY,450,1 ,$310.00 ,$155.00 ,$34.89 ,$360.20 ,$34.89 ,$200.54 ,$200.54 ,$160.09 ,$186.00 ,$263.50 ,$217.00 ,$34.89 ,$294.50 ,$223.20 ,$226.30 ,$201.50 ,$263.50 ,$160.09 ,$201.50 ,$263.50 ,$226.30 ,$34.89 ,$160.09 ,$310.00 ,$263.50 ,$360.20 ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$176.11 ,$214.21 ,$223.20 ,$215.92 ,$161.69 ,$223.20 ,$36.98 ,$310.00 ,$310.00 ,$160.09 ,$310.00 ,$160.09 ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$186.00 
ST MARY'S HOSPITAL,45000186,92953,HC TEMPORARY EXTERNAL PACING,450,1 ,"$1,185.00 ",$592.50 ,$202.92 ,"$1,229.24 ",$202.92 ,$766.58 ,$766.58 ,$546.33 ,$711.00 ,"$1,007.25 ",$829.50 ,$202.92 ,"$1,125.75 ",$853.20 ,$865.05 ,$770.25 ,"$1,007.25 ",$546.33 ,$770.25 ,"$1,007.25 ",$865.05 ,$202.92 ,$546.33 ,$571.36 ,"$1,007.25 ","$1,229.24 ","$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$673.20 ,$818.84 ,$853.20 ,$825.35 ,$551.79 ,$853.20 ,$215.10 ,$685.00 ,$685.00 ,$546.33 ,$685.00 ,$546.33 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,45000187,92977,HC THROMBOLYSIS CORONARY IV INFS,450,1 ,$863.00 ,$431.50 ,$161.07 ,$863.00 ,$161.07 ,$558.27 ,$558.27 ,$310.09 ,$517.80 ,$733.55 ,$604.10 ,$161.07 ,$819.85 ,$621.36 ,$629.99 ,$560.95 ,$733.55 ,$310.09 ,$560.95 ,$733.55 ,$629.99 ,$161.07 ,$310.09 ,$571.36 ,$733.55 ,$697.70 ,$793.96 ,$604.10 ,$437.71 ,$525.31 ,$525.57 ,$490.27 ,$596.33 ,$621.36 ,$601.08 ,$313.19 ,$621.36 ,$170.73 ,$685.00 ,$685.00 ,$310.09 ,$685.00 ,$310.09 ,$621.36 ,$535.06 ,$621.36 ,$621.36 ,$517.80 
ST MARY'S HOSPITAL,45000188,99281,HC ER LEVEL 1,450,1 ,$170.00 ,$85.00 ,$38.23 ,$170.00 ,$38.23 ,$170.00 ,$170.00 ,$70.54 ,$102.00 ,$144.50 ,$119.00 ,$38.23 ,$161.50 ,$122.40 ,$124.10 ,$170.00 ,$144.50 ,$70.54 ,$170.00 ,$144.50 ,$124.10 ,$38.23 ,$70.54 ,$170.00 ,$144.50 ,$158.72 ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$96.58 ,$117.47 ,$122.40 ,$118.41 ,$71.25 ,$122.40 ,$40.52 ,$170.00 ,$170.00 ,$70.54 ,$170.00 ,$70.54 ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$102.00 
ST MARY'S HOSPITAL,45000189,99282,HC ER LEVEL 2,450,1 ,$340.00 ,$170.00 ,$38.23 ,$340.00 ,$38.23 ,$340.00 ,$340.00 ,$127.74 ,$204.00 ,$289.00 ,$238.00 ,$38.23 ,$323.00 ,$244.80 ,$248.20 ,$340.00 ,$289.00 ,$127.74 ,$340.00 ,$289.00 ,$248.20 ,$38.23 ,$127.74 ,$340.00 ,$289.00 ,$287.42 ,$312.80 ,$238.00 ,$172.45 ,$206.96 ,$207.06 ,$193.15 ,$234.94 ,$244.80 ,$236.81 ,$129.02 ,$244.80 ,$40.52 ,$340.00 ,$340.00 ,$127.74 ,$340.00 ,$127.74 ,$244.80 ,$210.80 ,$244.80 ,$244.80 ,$204.00 
ST MARY'S HOSPITAL,45000190,99283,HC ER LEVEL 3,450,1 ,"$1,200.00 ",$600.00 ,$38.23 ,"$1,200.00 ",$38.23 ,"$1,092.00 ",$988.00 ,$225.06 ,$720.00 ,"$1,020.00 ",$840.00 ,$38.23 ,"$1,140.00 ",$864.00 ,$876.00 ,"$1,200.00 ","$1,020.00 ",$225.06 ,"$1,200.00 ","$1,020.00 ",$876.00 ,$38.23 ,$225.06 ,"$1,074.84 ","$1,020.00 ",$506.39 ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$681.72 ,$829.20 ,$864.00 ,$835.80 ,$227.31 ,$864.00 ,$40.52 ,"$1,200.00 ","$1,200.00 ",$225.06 ,"$1,200.00 ",$225.06 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$720.00 
ST MARY'S HOSPITAL,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 ",$353.78 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$38.23 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,800.00 ","$1,530.00 ",$353.78 ,"$1,800.00 ","$1,530.00 ","$1,314.00 ",$38.23 ,$353.78 ,"$1,800.00 ","$1,530.00 ",$796.00 ,"$1,656.00 ","$1,260.00 ",$912.96 ,"$1,095.66 ","$1,096.20 ","$1,022.58 ","$1,243.80 ","$1,296.00 ","$1,253.70 ",$357.32 ,"$1,296.00 ",$40.52 ,"$1,800.00 ","$1,800.00 ",$353.78 ,"$1,800.00 ",$353.78 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,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 ",$507.80 ,"$1,440.00 ","$2,040.00 ","$1,680.00 ",$38.23 ,"$2,280.00 ","$1,728.00 ","$1,752.00 ","$2,400.00 ","$2,040.00 ",$507.80 ,"$2,400.00 ","$2,040.00 ","$1,752.00 ",$38.23 ,$507.80 ,"$2,375.96 ","$2,040.00 ","$1,142.55 ","$2,208.00 ","$1,680.00 ","$1,217.28 ","$1,460.88 ","$1,461.60 ","$1,363.44 ","$1,658.40 ","$1,728.00 ","$1,671.60 ",$512.88 ,"$1,728.00 ",$40.52 ,"$2,400.00 ","$2,400.00 ",$507.80 ,"$2,400.00 ",$507.80 ,"$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,440.00 "
ST MARY'S HOSPITAL,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 ",$724.41 ,"$1,740.00 ","$2,465.00 ","$2,030.00 ",$38.23 ,"$2,755.00 ","$2,088.00 ","$2,117.00 ","$2,900.00 ","$2,465.00 ",$724.41 ,"$2,900.00 ","$2,465.00 ","$2,117.00 ",$38.23 ,$724.41 ,"$2,900.00 ","$2,465.00 ","$1,629.92 ","$2,668.00 ","$2,030.00 ","$1,470.88 ","$1,765.23 ","$1,766.10 ","$1,647.49 ","$2,003.90 ","$2,088.00 ","$2,019.85 ",$731.65 ,"$2,088.00 ",$40.52 ,"$2,900.00 ","$2,900.00 ",$724.41 ,"$2,900.00 ",$724.41 ,"$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,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 ,$367.20 ,$372.30 ,$331.50 ,$433.50 , N/A ,$331.50 ,$433.50 ,$372.30 ,$38.23 , N/A ,$510.00 ,$433.50 , N/A ,$469.20 ,$357.00 ,$258.67 ,$310.44 ,$310.59 ,$289.73 ,$352.41 ,$367.20 ,$355.22 , N/A ,$367.20 ,$40.52 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$367.20 ,$316.20 ,$367.20 ,$367.20 ,$306.00 
ST MARY'S HOSPITAL,45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,$830.00 ,$415.00 ,$139.53 ,"$3,047.78 ",$139.53 ,$536.93 ,$536.93 ,"$1,354.57 ",$498.00 ,$705.50 ,$581.00 ,$139.53 ,$788.50 ,$597.60 ,$605.90 ,$539.50 ,$705.50 ,"$1,354.57 ",$539.50 ,$705.50 ,$605.90 ,$139.53 ,"$1,354.57 ",$571.36 ,$705.50 ,"$3,047.78 ",$763.60 ,$581.00 ,$420.98 ,$505.22 ,$505.47 ,$471.52 ,$573.53 ,$597.60 ,$578.10 ,"$1,368.12 ",$597.60 ,$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ",$597.60 ,$514.60 ,$597.60 ,$597.60 ,$498.00 
ST MARY'S HOSPITAL,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 ,$200.45 ,$459.00 ,$650.25 ,$535.50 ,$139.53 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$200.45 ,$497.25 ,$650.25 ,$558.45 ,$139.53 ,$200.45 ,$571.36 ,$650.25 ,$451.00 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$202.45 ,$550.80 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$463.00 ,$231.50 ,$34.89 ,$463.00 ,$34.89 ,$299.51 ,$299.51 ,$200.45 ,$277.80 ,$393.55 ,$324.10 ,$34.89 ,$439.85 ,$333.36 ,$337.99 ,$300.95 ,$393.55 ,$200.45 ,$300.95 ,$393.55 ,$337.99 ,$34.89 ,$200.45 ,$463.00 ,$393.55 ,$451.00 ,$425.96 ,$324.10 ,$234.83 ,$281.83 ,$281.97 ,$263.03 ,$319.93 ,$333.36 ,$322.48 ,$202.45 ,$333.36 ,$36.98 ,$463.00 ,$463.00 ,$200.45 ,$463.00 ,$200.45 ,$333.36 ,$287.06 ,$333.36 ,$333.36 ,$277.80 
ST MARY'S HOSPITAL,45000199,35207,HC RPR VESSEL HAND/FINGER,450,1 ,"$3,638.00 ","$1,819.00 ",$571.36 ,"$6,263.99 ",$681.85 ,"$2,353.42 ","$2,353.42 ","$2,784.00 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$681.85 ,"$3,456.10 ","$2,619.36 ","$2,655.74 ","$2,364.70 ","$3,092.30 ","$2,784.00 ","$2,364.70 ","$3,092.30 ","$2,655.74 ",$681.85 ,"$2,784.00 ",$571.36 ,"$3,092.30 ","$6,263.99 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,066.75 ","$2,513.86 ","$2,619.36 ","$2,533.87 ","$2,811.84 ","$2,619.36 ",$722.76 ,$685.00 ,$685.00 ,"$2,784.00 ",$685.00 ,"$2,784.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,182.80 "
ST MARY'S HOSPITAL,45000200,35206,HC RPR VESSEL EXTREM UPR,450,1 ,"$3,638.00 ","$1,819.00 ",$571.36 ,"$6,263.99 ",$681.85 ,"$2,353.42 ","$2,353.42 ","$2,784.00 ","$2,182.80 ","$3,092.30 ","$2,546.60 ",$681.85 ,"$3,456.10 ","$2,619.36 ","$2,655.74 ","$2,364.70 ","$3,092.30 ","$2,784.00 ","$2,364.70 ","$3,092.30 ","$2,655.74 ",$681.85 ,"$2,784.00 ",$571.36 ,"$3,092.30 ","$6,263.99 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,066.75 ","$2,513.86 ","$2,619.36 ","$2,533.87 ","$2,811.84 ","$2,619.36 ",$722.76 ,$685.00 ,$685.00 ,"$2,784.00 ",$685.00 ,"$2,784.00 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,182.80 "
ST MARY'S HOSPITAL,45000202,26645,HC CL TX CARPOMETACARPAL FRAC DISLOC THUMB,450,1 ,$733.00 ,$366.50 ,$139.53 ,"$3,047.78 ",$139.53 ,$474.18 ,$474.18 ,"$1,354.57 ",$439.80 ,$623.05 ,$513.10 ,$139.53 ,$696.35 ,$527.76 ,$535.09 ,$476.45 ,$623.05 ,"$1,354.57 ",$476.45 ,$623.05 ,$535.09 ,$139.53 ,"$1,354.57 ",$571.36 ,$623.05 ,"$3,047.78 ",$674.36 ,$513.10 ,$371.78 ,$446.18 ,$446.40 ,$416.42 ,$506.50 ,$527.76 ,$510.53 ,"$1,368.12 ",$527.76 ,$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ",$527.76 ,$454.46 ,$527.76 ,$527.76 ,$439.80 
ST MARY'S HOSPITAL,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 ,$200.45 ,$355.80 ,$504.05 ,$415.10 ,$139.53 ,$563.35 ,$426.96 ,$432.89 ,$385.45 ,$504.05 ,$200.45 ,$385.45 ,$504.05 ,$432.89 ,$139.53 ,$200.45 ,$571.36 ,$504.05 ,$451.00 ,$545.56 ,$415.10 ,$300.77 ,$360.96 ,$361.14 ,$336.88 ,$409.76 ,$426.96 ,$413.02 ,$202.45 ,$426.96 ,$147.90 ,$593.00 ,$593.00 ,$200.45 ,$593.00 ,$200.45 ,$426.96 ,$367.66 ,$426.96 ,$426.96 ,$355.80 
ST MARY'S HOSPITAL,45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$1,400.00 ",$700.00 ,$547.96 ,"$3,078.81 ",$547.96 ,$905.66 ,$905.66 ,"$1,368.36 ",$840.00 ,"$1,190.00 ",$980.00 ,$547.96 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$910.00 ,"$1,190.00 ","$1,368.36 ",$910.00 ,"$1,190.00 ","$1,022.00 ",$547.96 ,"$1,368.36 ",$571.36 ,"$1,190.00 ","$3,078.81 ","$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$795.34 ,$967.40 ,"$1,008.00 ",$975.10 ,"$1,382.04 ","$1,008.00 ",$580.84 ,$685.00 ,$685.00 ,"$1,368.36 ",$685.00 ,"$1,368.36 ","$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,45000205,31605,HC TRACHEOSTOMY,450,1 ,"$1,300.00 ",$650.00 ,$205.75 ,"$1,300.00 ",$647.13 ,$840.97 ,$840.97 ,$205.75 ,$780.00 ,"$1,105.00 ",$910.00 ,$647.13 ,"$1,235.00 ",$936.00 ,$949.00 ,$845.00 ,"$1,105.00 ",$205.75 ,$845.00 ,"$1,105.00 ",$949.00 ,$647.13 ,$205.75 ,$571.36 ,"$1,105.00 ",$462.94 ,"$1,196.00 ",$910.00 ,$659.36 ,$791.31 ,$791.70 ,$738.53 ,$898.30 ,$936.00 ,$905.45 ,$207.81 ,$936.00 ,$685.96 ,$685.00 ,$685.00 ,$205.75 ,$685.00 ,$205.75 ,$936.00 ,$806.00 ,$936.00 ,$936.00 ,$780.00 
ST MARY'S HOSPITAL,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 ,$32.40 ,$32.85 ,$29.25 ,$38.25 , N/A ,$29.25 ,$38.25 ,$32.85 ,$0.73 , N/A ,$45.00 ,$38.25 , N/A ,$41.40 ,$31.50 ,$22.82 ,$27.39 ,$27.41 ,$25.56 ,$31.10 ,$32.40 ,$31.34 , N/A ,$32.40 ,$0.77 ,$45.00 ,$45.00 , N/A ,$45.00 , N/A ,$32.40 ,$27.90 ,$32.40 ,$32.40 ,$27.00 
ST MARY'S HOSPITAL,45000207,49084,HC PERITONEAL LAVAGE,450,1 ,$965.00 ,$482.50 ,$232.13 ,"$1,770.57 ",$232.13 ,$624.26 ,$624.26 ,$786.92 ,$579.00 ,$820.25 ,$675.50 ,$232.13 ,$916.75 ,$694.80 ,$704.45 ,$627.25 ,$820.25 ,$786.92 ,$627.25 ,$820.25 ,$704.45 ,$232.13 ,$786.92 ,$571.36 ,$820.25 ,"$1,770.57 ",$887.80 ,$675.50 ,$489.45 ,$587.40 ,$587.69 ,$548.22 ,$666.82 ,$694.80 ,$672.12 ,$794.79 ,$694.80 ,$246.06 ,$685.00 ,$685.00 ,$786.92 ,$685.00 ,$786.92 ,$694.80 ,$598.30 ,$694.80 ,$694.80 ,$579.00 
ST MARY'S HOSPITAL,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 ","$1,354.57 ","$2,509.54 ","$3,555.18 ","$2,927.80 ",$139.53 ,"$3,973.44 ","$3,011.45 ","$3,053.28 ","$2,718.67 ","$3,555.18 ","$1,354.57 ","$2,718.67 ","$3,555.18 ","$3,053.28 ",$139.53 ,"$1,354.57 ",$571.36 ,"$3,555.18 ","$3,047.78 ","$3,847.96 ","$2,927.80 ","$2,121.40 ","$2,545.93 ","$2,547.19 ","$2,376.12 ","$2,890.16 ","$3,011.45 ","$2,913.16 ","$1,368.12 ","$3,011.45 ",$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$3,011.45 ","$2,593.19 ","$3,011.45 ","$3,011.45 ","$2,509.54 "
ST MARY'S HOSPITAL,45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$755.00 ,$377.50 ,$95.17 ,$755.00 ,$95.17 ,$488.41 ,$488.41 ,$310.09 ,$453.00 ,$641.75 ,$528.50 ,$95.17 ,$717.25 ,$543.60 ,$551.15 ,$490.75 ,$641.75 ,$310.09 ,$490.75 ,$641.75 ,$551.15 ,$95.17 ,$310.09 ,$571.36 ,$641.75 ,$697.70 ,$694.60 ,$528.50 ,$382.94 ,$459.57 ,$459.80 ,$428.92 ,$521.71 ,$543.60 ,$525.86 ,$313.19 ,$543.60 ,$100.88 ,$685.00 ,$685.00 ,$310.09 ,$685.00 ,$310.09 ,$543.60 ,$468.10 ,$543.60 ,$543.60 ,$453.00 
ST MARY'S HOSPITAL,45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$1,394.00 ",$697.00 ,$139.53 ,"$3,047.78 ",$139.53 ,$901.78 ,$901.78 ,"$1,354.57 ",$836.40 ,"$1,184.90 ",$975.80 ,$139.53 ,"$1,324.30 ","$1,003.68 ","$1,017.62 ",$906.10 ,"$1,184.90 ","$1,354.57 ",$906.10 ,"$1,184.90 ","$1,017.62 ",$139.53 ,"$1,354.57 ",$571.36 ,"$1,184.90 ","$3,047.78 ","$1,282.48 ",$975.80 ,$707.04 ,$848.53 ,$848.95 ,$791.93 ,$963.25 ,"$1,003.68 ",$970.92 ,"$1,368.12 ","$1,003.68 ",$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,003.68 ",$864.28 ,"$1,003.68 ","$1,003.68 ",$836.40 
ST MARY'S HOSPITAL,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 ,$200.45 ,$360.52 ,$510.74 ,$420.61 ,$139.53 ,$570.83 ,$432.63 ,$438.64 ,$390.57 ,$510.74 ,$200.45 ,$390.57 ,$510.74 ,$438.64 ,$139.53 ,$200.45 ,$571.36 ,$510.74 ,$451.00 ,$552.80 ,$420.61 ,$304.76 ,$365.75 ,$365.93 ,$341.35 ,$415.20 ,$432.63 ,$418.51 ,$202.45 ,$432.63 ,$147.90 ,$600.87 ,$600.87 ,$200.45 ,$600.87 ,$200.45 ,$432.63 ,$372.54 ,$432.63 ,$432.63 ,$360.52 
ST MARY'S HOSPITAL,45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$668.00 ,$334.00 ,$139.53 ,$668.00 ,$139.53 ,$432.13 ,$432.13 ,$200.45 ,$400.80 ,$567.80 ,$467.60 ,$139.53 ,$634.60 ,$480.96 ,$487.64 ,$434.20 ,$567.80 ,$200.45 ,$434.20 ,$567.80 ,$487.64 ,$139.53 ,$200.45 ,$571.36 ,$567.80 ,$451.00 ,$614.56 ,$467.60 ,$338.81 ,$406.61 ,$406.81 ,$379.49 ,$461.59 ,$480.96 ,$465.26 ,$202.45 ,$480.96 ,$147.90 ,$668.00 ,$668.00 ,$200.45 ,$668.00 ,$200.45 ,$480.96 ,$414.16 ,$480.96 ,$480.96 ,$400.80 
ST MARY'S HOSPITAL,45000244,28495,HC GREAT TOE RED FX,510,1 ,$620.00 ,$310.00 ,$64.61 ,$620.00 ,$139.53 ,$131.00 ,$104.00 ,$200.45 ,$372.00 ,$527.00 ,$434.00 ,$139.53 ,$589.00 ,$446.40 ,$452.60 ,$104.00 ,$527.00 ,$200.45 ,$104.00 ,$527.00 ,$452.60 ,$139.53 ,$200.45 ,$64.61 ,$527.00 ,$451.00 ,$570.40 ,$434.00 ,$620.00 ,$620.00 ,$377.58 ,$620.00 ,$428.42 ,$446.40 ,$431.83 ,$202.45 ,$446.40 ,$147.90 ,$372.00 ,$372.00 ,$200.45 ,$372.00 ,$200.45 ,$446.40 ,$384.40 ,$446.40 ,$446.40 ,$372.00 
ST MARY'S HOSPITAL,45000246,24505,HC HUMERAL CLOSED RED FX,450,1 ,"$1,616.00 ",$808.00 ,$139.53 ,"$3,047.78 ",$139.53 ,"$1,045.39 ","$1,045.39 ","$1,354.57 ",$969.60 ,"$1,373.60 ","$1,131.20 ",$139.53 ,"$1,535.20 ","$1,163.52 ","$1,179.68 ","$1,050.40 ","$1,373.60 ","$1,354.57 ","$1,050.40 ","$1,373.60 ","$1,179.68 ",$139.53 ,"$1,354.57 ",$571.36 ,"$1,373.60 ","$3,047.78 ","$1,486.72 ","$1,131.20 ",$819.64 ,$983.66 ,$984.14 ,$918.05 ,"$1,116.66 ","$1,163.52 ","$1,125.54 ","$1,368.12 ","$1,163.52 ",$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ",$969.60 
ST MARY'S HOSPITAL,45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$599.00 ,$299.50 ,$139.53 ,$599.00 ,$139.53 ,$387.49 ,$387.49 ,$200.45 ,$359.40 ,$509.15 ,$419.30 ,$139.53 ,$569.05 ,$431.28 ,$437.27 ,$389.35 ,$509.15 ,$200.45 ,$389.35 ,$509.15 ,$437.27 ,$139.53 ,$200.45 ,$571.36 ,$509.15 ,$451.00 ,$551.08 ,$419.30 ,$303.81 ,$364.61 ,$364.79 ,$340.29 ,$413.91 ,$431.28 ,$417.20 ,$202.45 ,$431.28 ,$147.90 ,$599.00 ,$599.00 ,$200.45 ,$599.00 ,$200.45 ,$431.28 ,$371.38 ,$431.28 ,$431.28 ,$359.40 
ST MARY'S HOSPITAL,45000249,28515,HC TOE FX W/MANIP,450,1 ,$620.00 ,$310.00 ,$139.53 ,$620.00 ,$139.53 ,$401.08 ,$401.08 ,$200.45 ,$372.00 ,$527.00 ,$434.00 ,$139.53 ,$589.00 ,$446.40 ,$452.60 ,$403.00 ,$527.00 ,$200.45 ,$403.00 ,$527.00 ,$452.60 ,$139.53 ,$200.45 ,$571.36 ,$527.00 ,$451.00 ,$570.40 ,$434.00 ,$314.46 ,$377.39 ,$377.58 ,$352.22 ,$428.42 ,$446.40 ,$431.83 ,$202.45 ,$446.40 ,$147.90 ,$620.00 ,$620.00 ,$200.45 ,$620.00 ,$200.45 ,$446.40 ,$384.40 ,$446.40 ,$446.40 ,$372.00 
ST MARY'S HOSPITAL,45000250,28510,HC TOE FX W/O MANIP EACH,450,1 ,$697.00 ,$348.50 ,$139.53 ,$697.00 ,$139.53 ,$450.89 ,$450.89 ,$200.45 ,$418.20 ,$592.45 ,$487.90 ,$139.53 ,$662.15 ,$501.84 ,$508.81 ,$453.05 ,$592.45 ,$200.45 ,$453.05 ,$592.45 ,$508.81 ,$139.53 ,$200.45 ,$571.36 ,$592.45 ,$451.00 ,$641.24 ,$487.90 ,$353.52 ,$424.26 ,$424.47 ,$395.97 ,$481.63 ,$501.84 ,$485.46 ,$202.45 ,$501.84 ,$147.90 ,$685.00 ,$685.00 ,$200.45 ,$685.00 ,$200.45 ,$501.84 ,$432.14 ,$501.84 ,$501.84 ,$418.20 
ST MARY'S HOSPITAL,45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$647.00 ,$323.50 ,$139.53 ,$647.00 ,$139.53 ,$418.54 ,$418.54 ,$200.45 ,$388.20 ,$549.95 ,$452.90 ,$139.53 ,$614.65 ,$465.84 ,$472.31 ,$420.55 ,$549.95 ,$200.45 ,$420.55 ,$549.95 ,$472.31 ,$139.53 ,$200.45 ,$571.36 ,$549.95 ,$451.00 ,$595.24 ,$452.90 ,$328.16 ,$393.83 ,$394.02 ,$367.56 ,$447.08 ,$465.84 ,$450.64 ,$202.45 ,$465.84 ,$147.90 ,$647.00 ,$647.00 ,$200.45 ,$647.00 ,$200.45 ,$465.84 ,$401.14 ,$465.84 ,$465.84 ,$388.20 
ST MARY'S HOSPITAL,45000264,11400,HC EXC LESION 0.5<,450,1 ,"$4,100.00 ","$2,050.00 ",$139.95 ,"$4,100.00 ",$139.95 ,"$2,652.29 ","$2,652.29 ",$605.19 ,"$2,460.00 ","$3,485.00 ","$2,870.00 ",$139.95 ,"$3,895.00 ","$2,952.00 ","$2,993.00 ","$2,665.00 ","$3,485.00 ",$605.19 ,"$2,665.00 ","$3,485.00 ","$2,993.00 ",$139.95 ,$605.19 ,$571.36 ,"$3,485.00 ","$1,361.67 ","$3,772.00 ","$2,870.00 ","$2,079.52 ","$2,495.67 ","$2,496.90 ","$2,329.21 ","$2,833.10 ","$2,952.00 ","$2,855.65 ",$611.24 ,"$2,952.00 ",$148.35 ,$685.00 ,$685.00 ,$605.19 ,$685.00 ,$605.19 ,"$2,952.00 ","$2,542.00 ","$2,952.00 ","$2,952.00 ","$2,460.00 "
ST MARY'S HOSPITAL,45000270,20606,HC ARTHROCNT ASP/INJ JT INTRM W/ULTRA,450,1 ,$959.00 ,$479.50 ,$154.70 ,"$1,389.48 ",$154.70 ,$620.38 ,$620.38 ,$617.55 ,$575.40 ,$815.15 ,$671.30 ,$154.70 ,$911.05 ,$690.48 ,$700.07 ,$623.35 ,$815.15 ,$617.55 ,$623.35 ,$815.15 ,$700.07 ,$154.70 ,$617.55 ,$571.36 ,$815.15 ,"$1,389.48 ",$882.28 ,$671.30 ,$486.40 ,$583.74 ,$584.03 ,$544.81 ,$662.67 ,$690.48 ,$667.94 ,$623.73 ,$690.48 ,$163.98 ,$685.00 ,$685.00 ,$617.55 ,$685.00 ,$617.55 ,$690.48 ,$594.58 ,$690.48 ,$690.48 ,$575.40 
ST MARY'S HOSPITAL,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 ,$254.09 ,$556.20 ,$787.95 ,$648.90 ,$154.70 ,$880.65 ,$667.44 ,$676.71 ,$602.55 ,$787.95 ,$254.09 ,$602.55 ,$787.95 ,$676.71 ,$154.70 ,$254.09 ,$571.36 ,$787.95 ,$571.69 ,$852.84 ,$648.90 ,$470.17 ,$564.26 ,$564.54 ,$526.63 ,$640.56 ,$667.44 ,$645.66 ,$256.63 ,$667.44 ,$163.98 ,$685.00 ,$685.00 ,$254.09 ,$685.00 ,$254.09 ,$667.44 ,$574.74 ,$667.44 ,$667.44 ,$556.20 
ST MARY'S HOSPITAL,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 ,$254.09 ,$711.00 ,"$1,007.25 ",$829.50 ,$154.70 ,"$1,125.75 ",$853.20 ,$865.05 ,$770.25 ,"$1,007.25 ",$254.09 ,$770.25 ,"$1,007.25 ",$865.05 ,$154.70 ,$254.09 ,$571.36 ,"$1,007.25 ",$571.69 ,"$1,090.20 ",$829.50 ,$601.03 ,$721.31 ,$721.67 ,$673.20 ,$818.84 ,$853.20 ,$825.35 ,$256.63 ,$853.20 ,$163.98 ,$685.00 ,$685.00 ,$254.09 ,$685.00 ,$254.09 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,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 ,$54.13 ,$77.40 ,$109.65 ,$90.30 ,$34.89 ,$122.55 ,$92.88 ,$94.17 ,$83.85 ,$109.65 ,$54.13 ,$83.85 ,$109.65 ,$94.17 ,$34.89 ,$54.13 ,$129.00 ,$109.65 ,$121.80 ,$118.68 ,$90.30 ,$65.43 ,$78.52 ,$78.56 ,$73.28 ,$89.14 ,$92.88 ,$89.85 ,$54.67 ,$92.88 ,$36.98 ,$129.00 ,$129.00 ,$54.13 ,$129.00 ,$54.13 ,$92.88 ,$79.98 ,$92.88 ,$92.88 ,$77.40 
ST MARY'S HOSPITAL,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 ,$226.80 ,$229.95 ,$204.75 ,$267.75 , N/A ,$204.75 ,$267.75 ,$229.95 , N/A , N/A ,$315.00 ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$178.95 ,$217.67 ,$226.80 ,$219.40 , N/A ,$226.80 , N/A ,$315.00 ,$315.00 , N/A ,$315.00 , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$189.00 
ST MARY'S HOSPITAL,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 ,$378.00 ,$383.25 ,$341.25 ,$446.25 , N/A ,$341.25 ,$446.25 ,$383.25 , N/A , N/A ,$525.00 ,$446.25 , N/A ,$483.00 ,$367.50 ,$266.28 ,$319.57 ,$319.73 ,$298.25 ,$362.78 ,$378.00 ,$365.66 , N/A ,$378.00 , N/A ,$525.00 ,$525.00 , N/A ,$525.00 , N/A ,$378.00 ,$325.50 ,$378.00 ,$378.00 ,$315.00 
ST MARY'S HOSPITAL,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 ,$756.00 ,$766.50 ,$682.50 ,$892.50 , N/A ,$682.50 ,$892.50 ,$766.50 , N/A , N/A ,$571.36 ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A ,$685.00 ,$685.00 , N/A ,$685.00 , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,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 ","$1,512.00 ","$1,533.00 ","$1,365.00 ","$1,785.00 ", N/A ,"$1,365.00 ","$1,785.00 ","$1,533.00 ", 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 ","$1,193.01 ","$1,451.10 ","$1,512.00 ","$1,462.65 ", N/A ,"$1,512.00 ", N/A ,$685.00 ,$685.00 , N/A ,$685.00 , N/A ,"$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,260.00 "
ST MARY'S HOSPITAL,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 ","$2,268.00 ","$2,299.50 ","$2,047.50 ","$2,677.50 ", N/A ,"$2,047.50 ","$2,677.50 ","$2,299.50 ", 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 ","$1,789.52 ","$2,176.65 ","$2,268.00 ","$2,193.98 ", N/A ,"$2,268.00 ", N/A ,$685.00 ,$685.00 , N/A ,$685.00 , N/A ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,45000287,11402,HC EXCISION LESION BENIGN TRUNK/ARM/LEG 1.1-2.0CM,450,1 ,"$1,260.00 ",$630.00 ,$139.95 ,"$1,361.67 ",$139.95 ,$815.09 ,$815.09 ,$605.19 ,$756.00 ,"$1,071.00 ",$882.00 ,$139.95 ,"$1,197.00 ",$907.20 ,$919.80 ,$819.00 ,"$1,071.00 ",$605.19 ,$819.00 ,"$1,071.00 ",$919.80 ,$139.95 ,$605.19 ,$571.36 ,"$1,071.00 ","$1,361.67 ","$1,159.20 ",$882.00 ,$639.07 ,$766.96 ,$767.34 ,$715.81 ,$870.66 ,$907.20 ,$877.59 ,$611.24 ,$907.20 ,$148.35 ,$685.00 ,$685.00 ,$605.19 ,$685.00 ,$605.19 ,$907.20 ,$781.20 ,$907.20 ,$907.20 ,$756.00 
ST MARY'S HOSPITAL,45000289,11406,HC EXCISION LESION BENIGN TRUNK/ARM/LEG >4.0CM,450,1 ,"$4,250.00 ","$2,125.00 ",$555.34 ,"$4,250.00 ",$555.34 ,"$2,749.33 ","$2,749.33 ","$1,368.36 ","$2,550.00 ","$3,612.50 ","$2,975.00 ",$555.34 ,"$4,037.50 ","$3,060.00 ","$3,102.50 ","$2,762.50 ","$3,612.50 ","$1,368.36 ","$2,762.50 ","$3,612.50 ","$3,102.50 ",$555.34 ,"$1,368.36 ",$571.36 ,"$3,612.50 ","$3,078.81 ","$3,910.00 ","$2,975.00 ","$2,155.60 ","$2,586.98 ","$2,588.25 ","$2,414.43 ","$2,936.75 ","$3,060.00 ","$2,960.13 ","$1,382.04 ","$3,060.00 ",$588.66 ,$685.00 ,$685.00 ,"$1,368.36 ",$685.00 ,"$1,368.36 ","$3,060.00 ","$2,635.00 ","$3,060.00 ","$3,060.00 ","$2,550.00 "
ST MARY'S HOSPITAL,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 ,$200.45 ,$402.00 ,$569.50 ,$469.00 ,$139.53 ,$636.50 ,$482.40 ,$489.10 ,$435.50 ,$569.50 ,$200.45 ,$435.50 ,$569.50 ,$489.10 ,$139.53 ,$200.45 ,$571.36 ,$569.50 ,$451.00 ,$616.40 ,$469.00 ,$339.82 ,$407.83 ,$408.03 ,$380.63 ,$462.97 ,$482.40 ,$466.66 ,$202.45 ,$482.40 ,$147.90 ,$670.00 ,$670.00 ,$200.45 ,$670.00 ,$200.45 ,$482.40 ,$415.40 ,$482.40 ,$482.40 ,$402.00 
ST MARY'S HOSPITAL,45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$493.00 ,$246.50 ,$34.89 ,$493.00 ,$34.89 ,$318.92 ,$318.92 ,$160.09 ,$295.80 ,$419.05 ,$345.10 ,$34.89 ,$468.35 ,$354.96 ,$359.89 ,$320.45 ,$419.05 ,$160.09 ,$320.45 ,$419.05 ,$359.89 ,$34.89 ,$160.09 ,$493.00 ,$419.05 ,$360.20 ,$453.56 ,$345.10 ,$250.05 ,$300.09 ,$300.24 ,$280.07 ,$340.66 ,$354.96 ,$343.37 ,$161.69 ,$354.96 ,$36.98 ,$493.00 ,$493.00 ,$160.09 ,$493.00 ,$160.09 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,45000314,41252,HC RPR LAC MOUTH/TONGUE >2.6CM OR COMPLEX,450,1 ,$615.00 ,$307.50 ,$34.89 ,$615.00 ,$34.89 ,$397.84 ,$397.84 ,$205.75 ,$369.00 ,$522.75 ,$430.50 ,$34.89 ,$584.25 ,$442.80 ,$448.95 ,$399.75 ,$522.75 ,$205.75 ,$399.75 ,$522.75 ,$448.95 ,$34.89 ,$205.75 ,$571.36 ,$522.75 ,$462.94 ,$565.80 ,$430.50 ,$311.93 ,$374.35 ,$374.54 ,$349.38 ,$424.97 ,$442.80 ,$428.35 ,$207.81 ,$442.80 ,$36.98 ,$615.00 ,$615.00 ,$205.75 ,$615.00 ,$205.75 ,$442.80 ,$381.30 ,$442.80 ,$442.80 ,$369.00 
ST MARY'S HOSPITAL,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 ,$200.45 ,$334.80 ,$474.30 ,$390.60 ,$139.53 ,$530.10 ,$401.76 ,$407.34 ,$362.70 ,$474.30 ,$200.45 ,$362.70 ,$474.30 ,$407.34 ,$139.53 ,$200.45 ,$558.00 ,$474.30 ,$451.00 ,$513.36 ,$390.60 ,$283.02 ,$339.65 ,$339.82 ,$317.00 ,$385.58 ,$401.76 ,$388.65 ,$202.45 ,$401.76 ,$147.90 ,$558.00 ,$558.00 ,$200.45 ,$558.00 ,$200.45 ,$401.76 ,$345.96 ,$401.76 ,$401.76 ,$334.80 
ST MARY'S HOSPITAL,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 ,$200.45 ,$359.46 ,$509.24 ,$419.37 ,$139.53 ,$569.15 ,$431.35 ,$437.34 ,$389.42 ,$509.24 ,$200.45 ,$389.42 ,$509.24 ,$437.34 ,$139.53 ,$200.45 ,$571.36 ,$509.24 ,$451.00 ,$551.17 ,$419.37 ,$303.86 ,$364.67 ,$364.85 ,$340.35 ,$413.98 ,$431.35 ,$417.27 ,$202.45 ,$431.35 ,$147.90 ,$599.10 ,$599.10 ,$200.45 ,$599.10 ,$200.45 ,$431.35 ,$371.44 ,$431.35 ,$431.35 ,$359.46 
ST MARY'S HOSPITAL,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 ,$200.45 ,$329.40 ,$466.65 ,$384.30 ,$139.53 ,$521.55 ,$395.28 ,$400.77 ,$356.85 ,$466.65 ,$200.45 ,$356.85 ,$466.65 ,$400.77 ,$139.53 ,$200.45 ,$549.00 ,$466.65 ,$451.00 ,$505.08 ,$384.30 ,$278.45 ,$334.18 ,$334.34 ,$311.89 ,$379.36 ,$395.28 ,$382.38 ,$202.45 ,$395.28 ,$147.90 ,$549.00 ,$549.00 ,$200.45 ,$549.00 ,$200.45 ,$395.28 ,$340.38 ,$395.28 ,$395.28 ,$329.40 
ST MARY'S HOSPITAL,45000336,29550,HC STRAPPING TOES,450,1 ,$178.00 ,$89.00 ,$13.65 ,$178.00 ,$13.65 ,$115.15 ,$115.15 ,$54.13 ,$106.80 ,$151.30 ,$124.60 ,$13.65 ,$169.10 ,$128.16 ,$129.94 ,$115.70 ,$151.30 ,$54.13 ,$115.70 ,$151.30 ,$129.94 ,$13.65 ,$54.13 ,$178.00 ,$151.30 ,$121.80 ,$163.76 ,$124.60 ,$90.28 ,$108.35 ,$108.40 ,$101.12 ,$123.00 ,$128.16 ,$123.98 ,$54.67 ,$128.16 ,$14.47 ,$178.00 ,$178.00 ,$54.13 ,$178.00 ,$54.13 ,$128.16 ,$110.36 ,$128.16 ,$128.16 ,$106.80 
ST MARY'S HOSPITAL,45000340,31511,HC LARYNGOSCOPY INDIRECT W/REM FB BODY,450,1 ,$479.07 ,$239.54 ,$34.89 ,$479.07 ,$34.89 ,$309.91 ,$309.91 ,$160.09 ,$287.44 ,$407.21 ,$335.35 ,$34.89 ,$455.12 ,$344.93 ,$349.72 ,$311.40 ,$407.21 ,$160.09 ,$311.40 ,$407.21 ,$349.72 ,$34.89 ,$160.09 ,$479.07 ,$407.21 ,$360.20 ,$440.74 ,$335.35 ,$242.98 ,$291.61 ,$291.75 ,$272.16 ,$331.04 ,$344.93 ,$333.67 ,$161.69 ,$344.93 ,$36.98 ,$479.07 ,$479.07 ,$160.09 ,$479.07 ,$160.09 ,$344.93 ,$297.02 ,$344.93 ,$344.93 ,$287.44 
ST MARY'S HOSPITAL,45001118,30000,HC DRAIN ABSCESS/HEMATOMA NASAL,450,1 ,$615.00 ,$307.50 ,$34.89 ,$615.00 ,$34.89 ,$397.84 ,$397.84 ,$205.75 ,$369.00 ,$522.75 ,$430.50 ,$34.89 ,$584.25 ,$442.80 ,$448.95 ,$399.75 ,$522.75 ,$205.75 ,$399.75 ,$522.75 ,$448.95 ,$34.89 ,$205.75 ,$571.36 ,$522.75 ,$462.94 ,$565.80 ,$430.50 ,$311.93 ,$374.35 ,$374.54 ,$349.38 ,$424.97 ,$442.80 ,$428.35 ,$207.81 ,$442.80 ,$36.98 ,$615.00 ,$615.00 ,$205.75 ,$615.00 ,$205.75 ,$442.80 ,$381.30 ,$442.80 ,$442.80 ,$369.00 
ST MARY'S HOSPITAL,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 ","$1,741.31 ","$3,123.01 ","$4,424.26 ","$3,643.51 ",$490.13 ,"$4,944.76 ","$3,747.61 ","$3,799.66 ","$3,383.26 ","$4,424.26 ","$1,741.31 ","$3,383.26 ","$4,424.26 ","$3,799.66 ",$490.13 ,"$1,741.31 ",$571.36 ,"$4,424.26 ","$3,917.96 ","$4,788.61 ","$3,643.51 ","$2,639.98 ","$3,168.29 ","$3,169.85 ","$2,956.97 ","$3,596.66 ","$3,747.61 ","$3,625.29 ","$1,758.72 ","$3,747.61 ",$519.54 ,$685.00 ,$685.00 ,"$1,741.31 ",$685.00 ,"$1,741.31 ","$3,747.61 ","$3,227.11 ","$3,747.61 ","$3,747.61 ","$3,123.01 "
ST MARY'S HOSPITAL,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 ","$1,354.57 ","$2,628.00 ","$3,723.00 ","$3,066.00 ",$139.53 ,"$4,161.00 ","$3,153.60 ","$3,197.40 ","$2,847.00 ","$3,723.00 ","$1,354.57 ","$2,847.00 ","$3,723.00 ","$3,197.40 ",$139.53 ,"$1,354.57 ",$571.36 ,"$3,723.00 ","$3,047.78 ","$4,029.60 ","$3,066.00 ","$2,221.54 ","$2,666.11 ","$2,667.42 ","$2,488.28 ","$3,026.58 ","$3,153.60 ","$3,050.67 ","$1,368.12 ","$3,153.60 ",$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$3,153.60 ","$2,715.60 ","$3,153.60 ","$3,153.60 ","$2,628.00 "
ST MARY'S HOSPITAL,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 ","$1,354.57 ","$2,434.50 ","$3,448.88 ","$2,840.25 ",$139.53 ,"$3,854.63 ","$2,921.40 ","$2,961.98 ","$2,637.38 ","$3,448.88 ","$1,354.57 ","$2,637.38 ","$3,448.88 ","$2,961.98 ",$139.53 ,"$1,354.57 ",$571.36 ,"$3,448.88 ","$3,047.78 ","$3,732.90 ","$2,840.25 ","$2,057.96 ","$2,469.80 ","$2,471.02 ","$2,305.07 ","$2,803.73 ","$2,921.40 ","$2,826.05 ","$1,368.12 ","$2,921.40 ",$147.90 ,$685.00 ,$685.00 ,"$1,354.57 ",$685.00 ,"$1,354.57 ","$2,921.40 ","$2,515.65 ","$2,921.40 ","$2,921.40 ","$2,434.50 "
ST MARY'S HOSPITAL,45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$765.00 ,$382.50 ,$62.73 ,$765.00 ,$62.73 ,$494.88 ,$494.88 ,$258.79 ,$459.00 ,$650.25 ,$535.50 ,$62.73 ,$726.75 ,$550.80 ,$558.45 ,$497.25 ,$650.25 ,$258.79 ,$497.25 ,$650.25 ,$558.45 ,$62.73 ,$258.79 ,$571.36 ,$650.25 ,$582.28 ,$703.80 ,$535.50 ,$388.01 ,$465.66 ,$465.89 ,$434.60 ,$528.62 ,$550.80 ,$532.82 ,$261.38 ,$550.80 ,$66.49 ,$685.00 ,$685.00 ,$258.79 ,$685.00 ,$258.79 ,$550.80 ,$474.30 ,$550.80 ,$550.80 ,$459.00 
ST MARY'S HOSPITAL,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 ,$258.79 ,$604.80 ,$856.80 ,$705.60 ,$62.73 ,$957.60 ,$725.76 ,$735.84 ,$655.20 ,$856.80 ,$258.79 ,$655.20 ,$856.80 ,$735.84 ,$62.73 ,$258.79 ,$571.36 ,$856.80 ,$582.28 ,$927.36 ,$705.60 ,$511.26 ,$613.57 ,$613.87 ,$572.64 ,$696.53 ,$725.76 ,$702.07 ,$261.38 ,$725.76 ,$66.49 ,$685.00 ,$685.00 ,$258.79 ,$685.00 ,$258.79 ,$725.76 ,$624.96 ,$725.76 ,$725.76 ,$604.80 
ST MARY'S HOSPITAL,45001337,26020,HC DRAIN HAND TENDON SHEATH,450,1 ,"$8,491.00 ","$4,245.50 ",$415.99 ,"$8,491.00 ",$415.99 ,"$5,492.83 ","$5,492.83 ","$2,754.14 ","$5,094.60 ","$7,217.35 ","$5,943.70 ",$415.99 ,"$8,066.45 ","$6,113.52 ","$6,198.43 ","$5,519.15 ","$7,217.35 ","$2,754.14 ","$5,519.15 ","$7,217.35 ","$6,198.43 ",$415.99 ,"$2,754.14 ",$571.36 ,"$7,217.35 ","$6,196.83 ","$7,811.72 ","$5,943.70 ","$4,306.64 ","$5,168.47 ","$5,171.02 ","$4,823.74 ","$5,867.28 ","$6,113.52 ","$5,913.98 ","$2,781.68 ","$6,113.52 ",$440.95 ,$685.00 ,$685.00 ,"$2,754.14 ",$685.00 ,"$2,754.14 ","$6,113.52 ","$5,264.42 ","$6,113.52 ","$6,113.52 ","$5,094.60 "
ST MARY'S HOSPITAL,45001339,13160,HC SECD CLOS SURG WND EXTEN/COMPLIC,450,1 ,"$5,036.00 ","$2,518.00 ",$315.09 ,"$5,036.00 ",$315.09 ,"$3,257.79 ","$3,257.79 ","$1,665.72 ","$3,021.60 ","$4,280.60 ","$3,525.20 ",$315.09 ,"$4,784.20 ","$3,625.92 ","$3,676.28 ","$3,273.40 ","$4,280.60 ","$1,665.72 ","$3,273.40 ","$4,280.60 ","$3,676.28 ",$315.09 ,"$1,665.72 ",$571.36 ,"$4,280.60 ","$3,747.86 ","$4,633.12 ","$3,525.20 ","$2,554.26 ","$3,065.41 ","$3,066.92 ","$2,860.95 ","$3,479.88 ","$3,625.92 ","$3,507.57 ","$1,682.38 ","$3,625.92 ",$334.00 ,$685.00 ,$685.00 ,"$1,665.72 ",$685.00 ,"$1,665.72 ","$3,625.92 ","$3,122.32 ","$3,625.92 ","$3,625.92 ","$3,021.60 "
ST MARY'S HOSPITAL,45001343,37799,HC REPAIR/SUTURE MINOR VESSEL,450,1 ,"$1,628.00 ",$814.00 ,$525.67 ,"$1,628.00 ",$681.85 ,"$1,053.15 ","$1,053.15 ",$525.67 ,$976.80 ,"$1,383.80 ","$1,139.60 ",$681.85 ,"$1,546.60 ","$1,172.16 ","$1,188.44 ","$1,058.20 ","$1,383.80 ",$525.67 ,"$1,058.20 ","$1,383.80 ","$1,188.44 ",$681.85 ,$525.67 ,$571.36 ,"$1,383.80 ","$1,182.77 ","$1,497.76 ","$1,139.60 ",$825.72 ,$990.96 ,$991.45 ,$924.87 ,"$1,124.95 ","$1,172.16 ","$1,133.90 ",$530.93 ,"$1,172.16 ",$722.76 ,$685.00 ,$685.00 ,$525.67 ,$685.00 ,$525.67 ,"$1,172.16 ","$1,009.36 ","$1,172.16 ","$1,172.16 ",$976.80 
ST MARY'S HOSPITAL,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 ,$200.45 ,$388.20 ,$549.95 ,$452.90 ,$139.53 ,$614.65 ,$465.84 ,$472.31 ,$420.55 ,$549.95 ,$200.45 ,$420.55 ,$549.95 ,$472.31 ,$139.53 ,$200.45 ,$571.36 ,$549.95 ,$451.00 ,$595.24 ,$452.90 ,$328.16 ,$393.83 ,$394.02 ,$367.56 ,$447.08 ,$465.84 ,$450.64 ,$202.45 ,$465.84 ,$147.90 ,$647.00 ,$647.00 ,$200.45 ,$647.00 ,$200.45 ,$465.84 ,$401.14 ,$465.84 ,$465.84 ,$388.20 
ST MARY'S HOSPITAL,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 ,$365.55 ,$658.20 ,$932.45 ,$767.90 ,$238.77 ,"$1,042.15 ",$789.84 ,$800.81 ,$713.05 ,$932.45 ,$365.55 ,$713.05 ,$932.45 ,$800.81 ,$238.77 ,$365.55 ,$571.36 ,$932.45 ,$822.48 ,"$1,009.24 ",$767.90 ,$556.40 ,$667.74 ,$668.07 ,$623.21 ,$758.03 ,$789.84 ,$764.06 ,$369.21 ,$789.84 ,$253.10 ,$685.00 ,$685.00 ,$365.55 ,$685.00 ,$365.55 ,$789.84 ,$680.14 ,$789.84 ,$789.84 ,$658.20 
ST MARY'S HOSPITAL,45080001,10060,HC I AND D ABSC SMP,450,1 ,$542.00 ,$271.00 ,$51.36 ,$542.00 ,$51.36 ,$350.62 ,$350.62 ,$174.64 ,$325.20 ,$460.70 ,$379.40 ,$51.36 ,$514.90 ,$390.24 ,$395.66 ,$352.30 ,$460.70 ,$174.64 ,$352.30 ,$460.70 ,$395.66 ,$51.36 ,$174.64 ,$542.00 ,$460.70 ,$392.94 ,$498.64 ,$379.40 ,$274.90 ,$329.92 ,$330.08 ,$307.91 ,$374.52 ,$390.24 ,$377.50 ,$176.39 ,$390.24 ,$54.44 ,$542.00 ,$542.00 ,$174.64 ,$542.00 ,$174.64 ,$390.24 ,$336.04 ,$390.24 ,$390.24 ,$325.20 
ST MARY'S HOSPITAL,45080003,59409,HC DELIVERY VAGINAL,450,1 ,"$7,889.00 ","$3,944.50 ",$571.36 ,"$7,889.00 ",$681.83 ,"$5,103.39 ","$5,103.39 ","$2,551.58 ","$4,733.40 ","$6,705.65 ","$5,522.30 ",$681.83 ,"$7,494.55 ","$5,680.08 ","$5,758.97 ","$5,127.85 ","$6,705.65 ","$2,551.58 ","$5,127.85 ","$6,705.65 ","$5,758.97 ",$681.83 ,"$2,551.58 ",$571.36 ,"$6,705.65 ","$5,741.06 ","$7,257.88 ","$5,522.30 ","$4,001.30 ","$4,802.03 ","$4,804.40 ","$4,481.74 ","$5,451.30 ","$5,680.08 ","$5,494.69 ","$2,577.10 ","$5,680.08 ",$722.74 ,$685.00 ,$685.00 ,"$2,551.58 ",$685.00 ,"$2,551.58 ","$5,680.08 ","$4,891.18 ","$5,680.08 ","$5,680.08 ","$4,733.40 "
ST MARY'S HOSPITAL,46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$426.00 ,$213.00 ,$16.35 ,$426.00 ,$16.35 ,$275.58 ,$275.58 ,$135.78 ,$255.60 ,$362.10 ,$298.20 ,$16.35 ,$404.70 ,$306.72 ,$310.98 ,$276.90 ,$362.10 ,$135.78 ,$276.90 ,$362.10 ,$310.98 ,$16.35 ,$135.78 ,$348.47 ,$362.10 ,$305.50 ,$391.92 ,$298.20 ,$216.07 ,$259.31 ,$259.43 ,$242.01 ,$294.37 ,$306.72 ,$296.71 ,$137.14 ,$306.72 ,$17.33 ,$426.00 ,$426.00 ,$135.78 ,$426.00 ,$135.78 ,$306.72 ,$264.12 ,$306.72 ,$306.72 ,$255.60 
ST MARY'S HOSPITAL,46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$762.00 ,$381.00 ,$32.14 ,$762.00 ,$32.14 ,$492.94 ,$492.94 ,$257.38 ,$457.20 ,$647.70 ,$533.40 ,$32.14 ,$723.90 ,$548.64 ,$556.26 ,$495.30 ,$647.70 ,$257.38 ,$495.30 ,$647.70 ,$556.26 ,$32.14 ,$257.38 ,$348.47 ,$647.70 ,$579.11 ,$701.04 ,$533.40 ,$386.49 ,$463.83 ,$464.06 ,$432.89 ,$526.54 ,$548.64 ,$530.73 ,$259.95 ,$548.64 ,$34.07 ,$625.00 ,$625.00 ,$257.38 ,$625.00 ,$257.38 ,$548.64 ,$472.44 ,$548.64 ,$548.64 ,$457.20 
ST MARY'S HOSPITAL,46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,086.00 ",$543.00 ,$32.14 ,"$1,086.00 ",$32.14 ,$702.53 ,$702.53 ,$257.38 ,$651.60 ,$923.10 ,$760.20 ,$32.14 ,"$1,031.70 ",$781.92 ,$792.78 ,$705.90 ,$923.10 ,$257.38 ,$705.90 ,$923.10 ,$792.78 ,$32.14 ,$257.38 ,$348.47 ,$923.10 ,$579.11 ,$999.12 ,$760.20 ,$550.82 ,$661.05 ,$661.37 ,$616.96 ,$750.43 ,$781.92 ,$756.40 ,$259.95 ,$781.92 ,$34.07 ,$625.00 ,$625.00 ,$257.38 ,$625.00 ,$257.38 ,$781.92 ,$673.32 ,$781.92 ,$781.92 ,$651.60 
ST MARY'S HOSPITAL,46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$168.00 ,$84.00 ,$16.35 ,$305.50 ,$16.35 ,$108.68 ,$108.68 ,$135.78 ,$100.80 ,$142.80 ,$117.60 ,$16.35 ,$159.60 ,$120.96 ,$122.64 ,$109.20 ,$142.80 ,$135.78 ,$109.20 ,$142.80 ,$122.64 ,$16.35 ,$135.78 ,$168.00 ,$142.80 ,$305.50 ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 ,$137.14 ,$120.96 ,$17.33 ,$168.00 ,$168.00 ,$135.78 ,$168.00 ,$135.78 ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$218.40 ,$285.60 , N/A ,$218.40 ,$285.60 ,$245.28 ,$16.35 , N/A ,$336.00 ,$285.60 , N/A ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$190.88 ,$232.18 ,$241.92 ,$234.02 , N/A ,$241.92 ,$17.33 ,$336.00 ,$336.00 , N/A ,$336.00 , N/A ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,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 ,$120.96 ,$122.64 ,$109.20 ,$142.80 , N/A ,$109.20 ,$142.80 ,$122.64 , N/A , N/A ,$168.00 ,$142.80 , N/A ,$154.56 ,$117.60 ,$85.21 ,$102.26 ,$102.31 ,$95.44 ,$116.09 ,$120.96 ,$117.01 , N/A ,$120.96 , N/A ,$168.00 ,$168.00 , N/A ,$168.00 , N/A ,$120.96 ,$104.16 ,$120.96 ,$120.96 ,$100.80 
ST MARY'S HOSPITAL,46000010,94726,HC THORACIC GAS VOLUME,460,1 ,$560.00 ,$280.00 ,$32.14 ,$579.11 ,$32.14 ,$362.26 ,$362.26 ,$257.38 ,$336.00 ,$476.00 ,$392.00 ,$32.14 ,$532.00 ,$403.20 ,$408.80 ,$364.00 ,$476.00 ,$257.38 ,$364.00 ,$476.00 ,$408.80 ,$32.14 ,$257.38 ,$348.47 ,$476.00 ,$579.11 ,$515.20 ,$392.00 ,$284.03 ,$340.87 ,$341.04 ,$318.14 ,$386.96 ,$403.20 ,$390.04 ,$259.95 ,$403.20 ,$34.07 ,$560.00 ,$560.00 ,$257.38 ,$560.00 ,$257.38 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,46000011,94727,HC NITROGEN WASHOUT CURVE,460,1 ,$325.00 ,$162.50 ,$16.35 ,$325.00 ,$16.35 ,$210.24 ,$210.24 ,$135.78 ,$195.00 ,$276.25 ,$227.50 ,$16.35 ,$308.75 ,$234.00 ,$237.25 ,$211.25 ,$276.25 ,$135.78 ,$211.25 ,$276.25 ,$237.25 ,$16.35 ,$135.78 ,$325.00 ,$276.25 ,$305.50 ,$299.00 ,$227.50 ,$164.84 ,$197.83 ,$197.93 ,$184.63 ,$224.58 ,$234.00 ,$226.36 ,$137.14 ,$234.00 ,$17.33 ,$325.00 ,$325.00 ,$135.78 ,$325.00 ,$135.78 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,46000012,94728,HC AIRFLOW RESISTANCE,460,1 ,$246.00 ,$123.00 ,$32.14 ,$579.11 ,$32.14 ,$159.14 ,$159.14 ,$257.38 ,$147.60 ,$209.10 ,$172.20 ,$32.14 ,$233.70 ,$177.12 ,$179.58 ,$159.90 ,$209.10 ,$257.38 ,$159.90 ,$209.10 ,$179.58 ,$32.14 ,$257.38 ,$246.00 ,$209.10 ,$579.11 ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$139.75 ,$169.99 ,$177.12 ,$171.34 ,$259.95 ,$177.12 ,$34.07 ,$246.00 ,$246.00 ,$257.38 ,$246.00 ,$257.38 ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,46000014,94618,HC WALK TEST 6 MIN,460,1 ,$526.00 ,$263.00 ,$16.35 ,$526.00 ,$16.35 ,$340.27 ,$340.27 ,$109.66 ,$315.60 ,$447.10 ,$368.20 ,$16.35 ,$499.70 ,$378.72 ,$383.98 ,$341.90 ,$447.10 ,$109.66 ,$341.90 ,$447.10 ,$383.98 ,$16.35 ,$109.66 ,$348.47 ,$447.10 ,$246.74 ,$483.92 ,$368.20 ,$266.79 ,$320.18 ,$320.33 ,$298.82 ,$363.47 ,$378.72 ,$366.36 ,$110.76 ,$378.72 ,$17.33 ,$526.00 ,$526.00 ,$109.66 ,$526.00 ,$109.66 ,$378.72 ,$326.12 ,$378.72 ,$378.72 ,$315.60 
ST MARY'S HOSPITAL,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 ,$241.92 ,$245.28 ,$218.40 ,$285.60 , N/A ,$218.40 ,$285.60 ,$245.28 ,$16.35 , N/A ,$336.00 ,$285.60 , N/A ,$309.12 ,$235.20 ,$170.42 ,$204.52 ,$204.62 ,$190.88 ,$232.18 ,$241.92 ,$234.02 , N/A ,$241.92 ,$17.33 ,$336.00 ,$336.00 , N/A ,$336.00 , N/A ,$241.92 ,$208.32 ,$241.92 ,$241.92 ,$201.60 
ST MARY'S HOSPITAL,46000020,95801,HC APNEALINK STUDY/SAT,460,1 ,$360.00 ,$180.00 ,$44.39 ,$360.00 ,$44.39 ,$232.88 ,$232.88 ,$109.66 ,$216.00 ,$306.00 ,$252.00 ,$44.39 ,$342.00 ,$259.20 ,$262.80 ,$234.00 ,$306.00 ,$109.66 ,$234.00 ,$306.00 ,$262.80 ,$44.39 ,$109.66 ,$348.47 ,$306.00 ,$246.74 ,$331.20 ,$252.00 ,$182.59 ,$219.13 ,$219.24 ,$204.52 ,$248.76 ,$259.20 ,$250.74 ,$110.76 ,$259.20 ,$47.05 ,$360.00 ,$360.00 ,$109.66 ,$360.00 ,$109.66 ,$259.20 ,$223.20 ,$259.20 ,$259.20 ,$216.00 
ST MARY'S HOSPITAL,46000022,94200,HC MAXIMAL VOL VENTILATION,942,1 ,$224.00 ,$112.00 ,$16.35 ,$224.00 ,$16.35 ,$144.91 ,$144.91 ,$54.13 ,$134.40 ,$190.40 ,$156.80 ,$16.35 ,$212.80 ,$161.28 ,$163.52 ,$145.60 ,$190.40 ,$54.13 ,$145.60 ,$190.40 ,$163.52 ,$16.35 ,$54.13 ,$130.11 ,$190.40 ,$121.80 ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$127.25 ,$154.78 ,$161.28 ,$156.02 ,$54.67 ,$161.28 ,$17.33 ,$133.00 ,$133.00 ,$54.13 ,$133.00 ,$54.13 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,46000031,94681,HC CO2/O2 UPTAKE EXPIRED GAS,460,1 ,$795.00 ,$397.50 ,$32.14 ,$795.00 ,$32.14 ,$514.29 ,$514.29 ,$257.38 ,$477.00 ,$675.75 ,$556.50 ,$32.14 ,$755.25 ,$572.40 ,$580.35 ,$516.75 ,$675.75 ,$257.38 ,$516.75 ,$675.75 ,$580.35 ,$32.14 ,$257.38 ,$348.47 ,$675.75 ,$579.11 ,$731.40 ,$556.50 ,$403.22 ,$483.92 ,$484.16 ,$451.64 ,$549.35 ,$572.40 ,$553.72 ,$259.95 ,$572.40 ,$34.07 ,$625.00 ,$625.00 ,$257.38 ,$625.00 ,$257.38 ,$572.40 ,$492.90 ,$572.40 ,$572.40 ,$477.00 
ST MARY'S HOSPITAL,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 ,$209.52 ,$212.43 ,$189.15 ,$247.35 , N/A ,$189.15 ,$247.35 ,$212.43 , N/A , N/A ,$291.00 ,$247.35 , N/A ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 , N/A ,$209.52 , N/A ,$291.00 ,$291.00 , N/A ,$291.00 , N/A ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,46000033,94617,HC EXERCISE TEST BRONCHOSPASM,460,1 ,$291.00 ,$145.50 ,$16.35 ,$291.00 ,$16.35 ,$188.25 ,$188.25 ,$109.66 ,$174.60 ,$247.35 ,$203.70 ,$16.35 ,$276.45 ,$209.52 ,$212.43 ,$189.15 ,$247.35 ,$109.66 ,$189.15 ,$247.35 ,$212.43 ,$16.35 ,$109.66 ,$291.00 ,$247.35 ,$246.74 ,$267.72 ,$203.70 ,$147.60 ,$177.13 ,$177.22 ,$165.32 ,$201.08 ,$209.52 ,$202.68 ,$110.76 ,$209.52 ,$17.33 ,$291.00 ,$291.00 ,$109.66 ,$291.00 ,$109.66 ,$209.52 ,$180.42 ,$209.52 ,$209.52 ,$174.60 
ST MARY'S HOSPITAL,46000034,95070,HC INHALATION BRONCHIAL CHALLENGE TEST W/HISTAMINE/METHACHOLINE,460,1 ,$709.00 ,$354.50 ,$13.37 ,"$1,068.12 ",$13.37 ,$458.65 ,$458.65 ,$474.72 ,$425.40 ,$602.65 ,$496.30 ,$13.37 ,$673.55 ,$510.48 ,$517.57 ,$460.85 ,$602.65 ,$474.72 ,$460.85 ,$602.65 ,$517.57 ,$13.37 ,$474.72 ,$348.47 ,$602.65 ,"$1,068.12 ",$652.28 ,$496.30 ,$359.60 ,$431.57 ,$431.78 ,$402.78 ,$489.92 ,$510.48 ,$493.82 ,$479.47 ,$510.48 ,$14.17 ,$625.00 ,$625.00 ,$474.72 ,$625.00 ,$474.72 ,$510.48 ,$439.58 ,$510.48 ,$510.48 ,$425.40 
ST MARY'S HOSPITAL,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 ,$580.32 ,$588.38 ,$523.90 ,$685.10 , N/A ,$523.90 ,$685.10 ,$588.38 , N/A , N/A ,$76.94 ,$685.10 , N/A ,$741.52 ,$564.20 ,$408.80 ,$490.61 ,$490.85 ,$457.89 ,$556.95 ,$580.32 ,$561.38 , N/A ,$580.32 , N/A ,$79.00 ,$79.00 , N/A ,$79.00 , N/A ,$580.32 ,$499.72 ,$580.32 ,$580.32 ,$483.60 
ST MARY'S HOSPITAL,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 ,$201.60 ,$204.40 ,$182.00 ,$238.00 , N/A ,$182.00 ,$238.00 ,$204.40 , N/A , N/A ,$76.94 ,$238.00 , N/A ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 , N/A ,$201.60 , N/A ,$79.00 ,$79.00 , N/A ,$79.00 , N/A ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,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 ",$546.33 ,$969.60 ,"$1,373.60 ","$1,131.20 ",$202.92 ,"$1,535.20 ","$1,163.52 ","$1,179.68 ","$1,050.40 ","$1,373.60 ",$546.33 ,"$1,050.40 ","$1,373.60 ","$1,179.68 ",$202.92 ,$546.33 ,$930.02 ,"$1,373.60 ","$1,229.24 ","$1,486.72 ","$1,131.20 ",$819.64 ,$983.66 ,$984.14 ,$918.05 ,"$1,116.66 ","$1,163.52 ","$1,125.54 ",$551.79 ,"$1,163.52 ",$215.10 ,"$1,292.00 ","$1,292.00 ",$546.33 ,"$1,292.00 ",$546.33 ,"$1,163.52 ","$1,001.92 ","$1,163.52 ","$1,163.52 ",$969.60 
ST MARY'S HOSPITAL,48000007,93281,HC MULTI CHAM PACEMAKER ANALYSIS,480,1 ,$157.00 ,$78.50 ,$12.10 ,$157.00 ,$12.10 ,$101.56 ,$101.56 ,$36.21 ,$94.20 ,$133.45 ,$109.90 ,$12.10 ,$149.15 ,$113.04 ,$114.61 ,$102.05 ,$133.45 ,$36.21 ,$102.05 ,$133.45 ,$114.61 ,$12.10 ,$36.21 ,$157.00 ,$133.45 ,$81.48 ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$89.19 ,$108.49 ,$113.04 ,$109.35 ,$36.57 ,$113.04 ,$12.83 ,$157.00 ,$157.00 ,$36.21 ,$157.00 ,$36.21 ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,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 ,$341.28 ,$346.02 ,$308.10 ,$402.90 , N/A ,$308.10 ,$402.90 ,$346.02 , N/A , N/A ,$474.00 ,$402.90 , N/A ,$436.08 ,$331.80 ,$240.41 ,$288.52 ,$288.67 ,$269.28 ,$327.53 ,$341.28 ,$330.14 , N/A ,$341.28 , N/A ,$474.00 ,$474.00 , N/A ,$474.00 , N/A ,$341.28 ,$293.88 ,$341.28 ,$341.28 ,$284.40 
ST MARY'S HOSPITAL,48000011,93285,HC LOOP RECORDER PROGRAMMING,480,1 ,$118.00 ,$59.00 ,$12.10 ,$118.00 ,$12.10 ,$76.33 ,$76.33 ,$36.21 ,$70.80 ,$100.30 ,$82.60 ,$12.10 ,$112.10 ,$84.96 ,$86.14 ,$76.70 ,$100.30 ,$36.21 ,$76.70 ,$100.30 ,$86.14 ,$12.10 ,$36.21 ,$118.00 ,$100.30 ,$81.48 ,$108.56 ,$82.60 ,$59.85 ,$71.83 ,$71.86 ,$67.04 ,$81.54 ,$84.96 ,$82.19 ,$36.57 ,$84.96 ,$12.83 ,$118.00 ,$118.00 ,$36.21 ,$118.00 ,$36.21 ,$84.96 ,$73.16 ,$84.96 ,$84.96 ,$70.80 
ST MARY'S HOSPITAL,48000013,93260,HC S-ICD PROGRAMMING,480,1 ,$112.00 ,$56.00 ,$12.10 ,$112.00 ,$12.10 ,$72.45 ,$72.45 ,$36.21 ,$67.20 ,$95.20 ,$78.40 ,$12.10 ,$106.40 ,$80.64 ,$81.76 ,$72.80 ,$95.20 ,$36.21 ,$72.80 ,$95.20 ,$81.76 ,$12.10 ,$36.21 ,$112.00 ,$95.20 ,$81.48 ,$103.04 ,$78.40 ,$56.81 ,$68.17 ,$68.21 ,$63.63 ,$77.39 ,$80.64 ,$78.01 ,$36.57 ,$80.64 ,$12.83 ,$112.00 ,$112.00 ,$36.21 ,$112.00 ,$36.21 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,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 ","$2,131.92 ","$2,161.53 ","$1,924.65 ","$2,516.85 ", N/A ,"$1,924.65 ","$2,516.85 ","$2,161.53 ","$1,946.45 ", N/A ,$930.02 ,"$2,516.85 ", N/A ,"$2,724.12 ","$2,072.70 ","$1,501.82 ","$1,802.36 ","$1,803.25 ","$1,682.14 ","$2,046.05 ","$2,131.92 ","$2,062.34 ", N/A ,"$2,131.92 ","$2,063.24 ","$1,292.00 ","$1,292.00 ", N/A ,"$1,292.00 ", N/A ,"$2,131.92 ","$1,835.82 ","$2,131.92 ","$2,131.92 ","$1,776.60 "
ST MARY'S HOSPITAL,48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$109.00 ,$54.50 ,$52.64 ,$121.80 ,$52.64 ,$70.51 ,$70.51 ,$54.13 ,$65.40 ,$92.65 ,$76.30 ,$52.64 ,$103.55 ,$78.48 ,$79.57 ,$70.85 ,$92.65 ,$54.13 ,$70.85 ,$92.65 ,$79.57 ,$52.64 ,$54.13 ,$109.00 ,$92.65 ,$121.80 ,$100.28 ,$76.30 ,$55.28 ,$66.35 ,$66.38 ,$61.92 ,$75.32 ,$78.48 ,$75.92 ,$54.67 ,$78.48 ,$55.80 ,$109.00 ,$109.00 ,$54.13 ,$109.00 ,$54.13 ,$78.48 ,$67.58 ,$78.48 ,$78.48 ,$65.40 
ST MARY'S HOSPITAL,48100002,33206,HC INS/REPL PCMKR PERM ATRIAL 33206,481,1 ,"$7,918.00 ","$3,959.00 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$7,918.00 ","$7,918.00 ","$10,112.14 ","$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,606.72 ","$7,522.10 ","$5,700.96 ","$5,780.14 ","$7,918.00 ","$6,730.30 ","$10,112.14 ","$7,918.00 ","$6,730.30 ","$5,780.14 ","$2,606.72 ","$10,112.14 ","$7,918.00 ","$6,730.30 ","$22,752.32 ","$7,284.56 ","$5,542.60 ","$5,993.67 ","$8,056.00 ","$4,822.06 ","$7,491.83 ","$5,471.34 ","$5,700.96 ","$5,514.89 ","$10,213.26 ","$5,700.96 ","$2,763.12 ","$7,918.00 ","$7,918.00 ","$10,112.14 ","$7,918.00 ","$10,112.14 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$4,750.80 "
ST MARY'S HOSPITAL,48100003,33207,HC INS/REPL PACEMKR PERM VENTRIC 33207,481,1 ,"$7,918.00 ","$3,959.00 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$7,918.00 ","$7,918.00 ","$10,112.14 ","$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,606.72 ","$7,522.10 ","$5,700.96 ","$5,780.14 ","$7,918.00 ","$6,730.30 ","$10,112.14 ","$7,918.00 ","$6,730.30 ","$5,780.14 ","$2,606.72 ","$10,112.14 ","$7,918.00 ","$6,730.30 ","$22,752.32 ","$7,284.56 ","$5,542.60 ","$5,993.67 ","$8,056.00 ","$4,822.06 ","$7,491.83 ","$5,471.34 ","$5,700.96 ","$5,514.89 ","$10,213.26 ","$5,700.96 ","$2,763.12 ","$7,918.00 ","$7,918.00 ","$10,112.14 ","$7,918.00 ","$10,112.14 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$4,750.80 "
ST MARY'S HOSPITAL,48100004,33208,HC INS/REPL PACEMKR PERM A/V 33208,481,1 ,"$8,881.00 ","$4,440.50 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$8,881.00 ","$8,881.00 ","$10,112.14 ","$5,328.60 ","$7,548.85 ","$6,216.70 ","$2,606.72 ","$8,436.95 ","$6,394.32 ","$6,483.13 ","$8,881.00 ","$7,548.85 ","$10,112.14 ","$8,881.00 ","$7,548.85 ","$6,483.13 ","$2,606.72 ","$10,112.14 ","$8,881.00 ","$7,548.85 ","$22,752.32 ","$8,170.52 ","$6,216.70 ","$5,993.67 ","$8,056.00 ","$5,408.53 ","$7,491.83 ","$6,136.77 ","$6,394.32 ","$6,185.62 ","$10,213.26 ","$6,394.32 ","$2,763.12 ","$8,881.00 ","$8,881.00 ","$10,112.14 ","$8,881.00 ","$10,112.14 ","$6,394.32 ","$5,506.22 ","$6,394.32 ","$6,394.32 ","$5,328.60 "
ST MARY'S HOSPITAL,48100005,33210,HC INS/REPL TPM SGL ELEC/CATH 33210,481,1 ,"$4,280.00 ","$2,140.00 ",$533.72 ,"$17,852.44 ",$533.72 ,"$4,280.00 ","$4,280.00 ","$7,934.42 ","$2,568.00 ","$3,638.00 ","$2,996.00 ",$533.72 ,"$4,066.00 ","$3,081.60 ","$3,124.40 ","$4,280.00 ","$3,638.00 ","$7,934.42 ","$4,280.00 ","$3,638.00 ","$3,124.40 ",$533.72 ,"$7,934.42 ","$4,280.00 ","$3,638.00 ","$17,852.44 ","$3,937.60 ","$2,996.00 ","$5,993.67 ","$8,056.00 ","$2,606.52 ","$7,491.83 ","$2,957.48 ","$3,081.60 ","$2,981.02 ","$8,013.76 ","$3,081.60 ",$565.74 ,"$4,280.00 ","$4,280.00 ","$7,934.42 ","$4,280.00 ","$7,934.42 ","$3,081.60 ","$2,653.60 ","$3,081.60 ","$3,081.60 ","$2,568.00 "
ST MARY'S HOSPITAL,48100006,33212,HC INS PULSE GEN SGL CHAMBER 33212,481,1 ,"$7,918.00 ","$3,959.00 ","$2,606.72 ","$17,852.44 ","$2,606.72 ","$7,918.00 ","$7,918.00 ","$7,934.42 ","$4,750.80 ","$6,730.30 ","$5,542.60 ","$2,606.72 ","$7,522.10 ","$5,700.96 ","$5,780.14 ","$6,668.00 ","$6,730.30 ","$7,934.42 ","$6,668.00 ","$6,730.30 ","$5,780.14 ","$2,606.72 ","$7,934.42 ","$7,918.00 ","$6,730.30 ","$17,852.44 ","$7,284.56 ","$5,542.60 ","$5,993.67 ","$8,056.00 ","$4,822.06 ","$7,491.83 ","$5,471.34 ","$5,700.96 ","$5,514.89 ","$8,013.76 ","$5,700.96 ","$2,763.12 ","$7,918.00 ","$7,918.00 ","$7,934.42 ","$7,918.00 ","$7,934.42 ","$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$4,750.80 "
ST MARY'S HOSPITAL,48100007,33213,HC INS PULSE GEN DUAL CHAMBER 33213,481,1 ,"$10,031.00 ","$5,015.50 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$10,031.00 ","$10,031.00 ","$10,112.14 ","$6,018.60 ","$8,526.35 ","$7,021.70 ","$2,606.72 ","$9,529.45 ","$7,222.32 ","$7,322.63 ","$6,668.00 ","$8,526.35 ","$10,112.14 ","$6,668.00 ","$8,526.35 ","$7,322.63 ","$2,606.72 ","$10,112.14 ","$10,031.00 ","$8,526.35 ","$22,752.32 ","$9,228.52 ","$7,021.70 ","$3,303.09 ","$4,439.84 ","$6,108.88 ","$4,128.86 ","$6,931.42 ","$7,222.32 ","$6,986.59 ","$10,213.26 ","$7,222.32 ","$2,763.12 ","$10,031.00 ","$10,031.00 ","$10,112.14 ","$10,031.00 ","$10,112.14 ","$7,222.32 ","$6,219.22 ","$7,222.32 ","$7,222.32 ","$6,018.60 "
ST MARY'S HOSPITAL,48100008,33214,HC UPGRADE PACEMAKER SYSTEM 33214,481,1 ,"$14,156.00 ","$7,078.00 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$14,156.00 ","$11,705.00 ","$10,112.14 ","$8,493.60 ","$12,032.60 ","$9,909.20 ","$2,606.72 ","$13,448.20 ","$10,192.32 ","$10,333.88 ","$14,156.00 ","$12,032.60 ","$10,112.14 ","$14,156.00 ","$12,032.60 ","$10,333.88 ","$2,606.72 ","$10,112.14 ","$14,156.00 ","$12,032.60 ","$22,752.32 ","$13,023.52 ","$9,909.20 ","$5,993.67 ","$8,056.00 ","$8,621.00 ","$7,491.83 ","$9,781.80 ","$10,192.32 ","$9,859.65 ","$10,213.26 ","$10,192.32 ","$2,763.12 ","$14,156.00 ","$14,156.00 ","$10,112.14 ","$14,156.00 ","$10,112.14 ","$10,192.32 ","$8,776.72 ","$10,192.32 ","$10,192.32 ","$8,493.60 "
ST MARY'S HOSPITAL,48100009,33215,HC REPOSITION PACE/DEFIB LEAD 33215,481,1 ,"$3,424.00 ","$1,712.00 ",$533.72 ,"$8,056.00 ",$533.72 ,"$3,424.00 ","$3,424.00 ","$2,784.00 ","$2,054.40 ","$2,910.40 ","$2,396.80 ",$533.72 ,"$3,252.80 ","$2,465.28 ","$2,499.52 ","$3,424.00 ","$2,910.40 ","$2,784.00 ","$3,424.00 ","$2,910.40 ","$2,499.52 ",$533.72 ,"$2,784.00 ","$3,424.00 ","$2,910.40 ","$6,263.99 ","$3,150.08 ","$2,396.80 ","$5,993.67 ","$8,056.00 ","$2,085.22 ","$7,491.83 ","$2,365.98 ","$2,465.28 ","$2,384.82 ","$2,811.84 ","$2,465.28 ",$565.74 ,"$3,424.00 ","$3,424.00 ","$2,784.00 ","$3,424.00 ","$2,784.00 ","$2,465.28 ","$2,122.88 ","$2,465.28 ","$2,465.28 ","$2,054.40 "
ST MARY'S HOSPITAL,48100010,33216,HC INS ELECTRODE SGL CHAMBER 33216,481,1 ,"$5,901.00 ","$2,950.50 ",$533.72 ,"$17,852.44 ",$533.72 ,"$5,901.00 ","$5,901.00 ","$7,934.42 ","$3,540.60 ","$5,015.85 ","$4,130.70 ",$533.72 ,"$5,605.95 ","$4,248.72 ","$4,307.73 ","$5,901.00 ","$5,015.85 ","$7,934.42 ","$5,901.00 ","$5,015.85 ","$4,307.73 ",$533.72 ,"$7,934.42 ","$5,901.00 ","$5,015.85 ","$17,852.44 ","$5,428.92 ","$4,130.70 ","$5,993.67 ","$8,056.00 ","$3,593.71 ","$7,491.83 ","$4,077.59 ","$4,248.72 ","$4,110.05 ","$8,013.76 ","$4,248.72 ",$565.74 ,"$5,901.00 ","$5,901.00 ","$7,934.42 ","$5,901.00 ","$7,934.42 ","$4,248.72 ","$3,658.62 ","$4,248.72 ","$4,248.72 ","$3,540.60 "
ST MARY'S HOSPITAL,48100011,33217,HC INS ELECTRODE DUAL CHAMBER 33217,481,1 ,"$5,778.00 ","$2,889.00 ",$533.72 ,"$17,852.44 ",$533.72 ,"$5,778.00 ","$5,778.00 ","$7,934.42 ","$3,466.80 ","$4,911.30 ","$4,044.60 ",$533.72 ,"$5,489.10 ","$4,160.16 ","$4,217.94 ","$5,778.00 ","$4,911.30 ","$7,934.42 ","$5,778.00 ","$4,911.30 ","$4,217.94 ",$533.72 ,"$7,934.42 ","$5,778.00 ","$4,911.30 ","$17,852.44 ","$5,315.76 ","$4,044.60 ","$5,993.67 ","$8,056.00 ","$3,518.80 ","$7,491.83 ","$3,992.60 ","$4,160.16 ","$4,024.38 ","$8,013.76 ","$4,160.16 ",$565.74 ,"$5,778.00 ","$5,778.00 ","$7,934.42 ","$5,778.00 ","$7,934.42 ","$4,160.16 ","$3,582.36 ","$4,160.16 ","$4,160.16 ","$3,466.80 "
ST MARY'S HOSPITAL,48100012,33222,HC REVISE PACEMAKER POCKET 33222,481,1 ,"$3,424.00 ","$1,712.00 ",$533.72 ,"$3,747.86 ",$533.72 ,"$3,424.00 ","$3,424.00 ","$1,665.72 ","$2,054.40 ","$2,910.40 ","$2,396.80 ",$533.72 ,"$3,252.80 ","$2,465.28 ","$2,499.52 ","$3,424.00 ","$2,910.40 ","$1,665.72 ","$3,424.00 ","$2,910.40 ","$2,499.52 ",$533.72 ,"$1,665.72 ","$3,424.00 ","$2,910.40 ","$3,747.86 ","$3,150.08 ","$2,396.80 ","$1,489.75 ","$2,002.44 ","$2,085.22 ","$1,862.71 ","$2,365.98 ","$2,465.28 ","$2,384.82 ","$1,682.38 ","$2,465.28 ",$565.74 ,"$3,424.00 ","$3,424.00 ","$1,665.72 ","$3,424.00 ","$1,665.72 ","$2,465.28 ","$2,122.88 ","$2,465.28 ","$2,465.28 ","$2,054.40 "
ST MARY'S HOSPITAL,48100013,33223,HC REVISE C-D POCKET 33223,481,1 ,"$3,007.00 ","$1,503.50 ",$533.72 ,"$3,747.86 ",$533.72 ,"$3,007.00 ","$3,007.00 ","$1,665.72 ","$1,804.20 ","$2,555.95 ","$2,104.90 ",$533.72 ,"$2,856.65 ","$2,165.04 ","$2,195.11 ","$3,007.00 ","$2,555.95 ","$1,665.72 ","$3,007.00 ","$2,555.95 ","$2,195.11 ",$533.72 ,"$1,665.72 ","$3,007.00 ","$2,555.95 ","$3,747.86 ","$2,766.44 ","$2,104.90 ","$1,489.75 ","$2,002.44 ","$1,831.26 ","$1,862.71 ","$2,077.84 ","$2,165.04 ","$2,094.38 ","$1,682.38 ","$2,165.04 ",$565.74 ,"$3,007.00 ","$3,007.00 ","$1,665.72 ","$3,007.00 ","$1,665.72 ","$2,165.04 ","$1,864.34 ","$2,165.04 ","$2,165.04 ","$1,804.20 "
ST MARY'S HOSPITAL,48100014,33224,HC INSERT LV PACING ELECTRODE 33224,481,1 ,"$8,507.00 ","$4,253.50 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$8,507.00 ","$8,507.00 ","$10,112.14 ","$5,104.20 ","$7,230.95 ","$5,954.90 ","$2,606.72 ","$8,081.65 ","$6,125.04 ","$6,210.11 ","$6,993.00 ","$7,230.95 ","$10,112.14 ","$6,993.00 ","$7,230.95 ","$6,210.11 ","$2,606.72 ","$10,112.14 ","$8,507.00 ","$7,230.95 ","$22,752.32 ","$7,826.44 ","$5,954.90 ","$5,993.67 ","$8,056.00 ","$5,180.76 ","$7,491.83 ","$5,878.34 ","$6,125.04 ","$5,925.13 ","$10,213.26 ","$6,125.04 ","$2,763.12 ","$8,507.00 ","$8,507.00 ","$10,112.14 ","$8,507.00 ","$10,112.14 ","$6,125.04 ","$5,274.34 ","$6,125.04 ","$6,125.04 ","$5,104.20 "
ST MARY'S HOSPITAL,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 ","$6,009.12 ","$6,092.58 ","$6,993.00 ","$7,094.10 ", N/A ,"$6,993.00 ","$7,094.10 ","$6,092.58 ","$2,606.72 ", N/A ,"$8,346.00 ","$7,094.10 ", N/A ,"$7,678.32 ","$5,842.20 ","$5,993.67 ","$8,056.00 ","$5,082.71 ","$7,491.83 ","$5,767.09 ","$6,009.12 ","$5,812.99 ", N/A ,"$6,009.12 ","$2,763.12 ","$8,346.00 ","$8,346.00 ", N/A ,"$8,346.00 ", N/A ,"$6,009.12 ","$5,174.52 ","$6,009.12 ","$6,009.12 ","$5,007.60 "
ST MARY'S HOSPITAL,48100016,33226,HC REPOSITION LV ELECTRODE 33226,481,1 ,"$3,852.00 ","$1,926.00 ","$1,926.00 ","$8,056.00 ","$2,195.90 ","$3,852.00 ","$3,852.00 ","$2,784.00 ","$2,311.20 ","$3,274.20 ","$2,696.40 ","$2,195.90 ","$3,659.40 ","$2,773.44 ","$2,811.96 ","$3,852.00 ","$3,274.20 ","$2,784.00 ","$3,852.00 ","$3,274.20 ","$2,811.96 ","$2,195.90 ","$2,784.00 ","$3,852.00 ","$3,274.20 ","$6,263.99 ","$3,543.84 ","$2,696.40 ","$5,993.67 ","$8,056.00 ","$2,345.87 ","$7,491.83 ","$2,661.73 ","$2,773.44 ","$2,682.92 ","$2,811.84 ","$2,773.44 ","$2,327.65 ","$3,852.00 ","$3,852.00 ","$2,784.00 ","$3,852.00 ","$2,784.00 ","$2,773.44 ","$2,388.24 ","$2,773.44 ","$2,773.44 ","$2,311.20 "
ST MARY'S HOSPITAL,48100017,33233,HC REMOVE PPM 33233,481,1 ,"$3,638.00 ","$1,819.00 ","$1,819.00 ","$17,852.44 ","$2,195.90 ","$3,638.00 ","$3,638.00 ","$7,934.42 ","$2,182.80 ","$3,092.30 ","$2,546.60 ","$2,195.90 ","$3,456.10 ","$2,619.36 ","$2,655.74 ","$3,638.00 ","$3,092.30 ","$7,934.42 ","$3,638.00 ","$3,092.30 ","$2,655.74 ","$2,195.90 ","$7,934.42 ","$3,638.00 ","$3,092.30 ","$17,852.44 ","$3,346.96 ","$2,546.60 ","$5,993.67 ","$8,056.00 ","$2,215.54 ","$7,491.83 ","$2,513.86 ","$2,619.36 ","$2,533.87 ","$8,013.76 ","$2,619.36 ","$2,327.65 ","$3,638.00 ","$3,638.00 ","$7,934.42 ","$3,638.00 ","$7,934.42 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,182.80 "
ST MARY'S HOSPITAL,48100018,33234,HC REMOVE ELECTRODE SGL 33234,481,1 ,"$3,092.00 ","$1,546.00 ",$533.72 ,"$8,056.00 ",$533.72 ,"$3,092.00 ","$3,092.00 ","$3,348.86 ","$1,855.20 ","$2,628.20 ","$2,164.40 ",$533.72 ,"$2,937.40 ","$2,226.24 ","$2,257.16 ","$2,815.00 ","$2,628.20 ","$3,348.86 ","$2,815.00 ","$2,628.20 ","$2,257.16 ",$533.72 ,"$3,348.86 ","$3,092.00 ","$2,628.20 ","$7,534.93 ","$2,844.64 ","$2,164.40 ","$5,993.67 ","$8,056.00 ","$1,883.03 ","$7,491.83 ","$2,136.57 ","$2,226.24 ","$2,153.58 ","$3,382.35 ","$2,226.24 ",$565.74 ,"$3,092.00 ","$3,092.00 ","$3,348.86 ","$3,092.00 ","$3,348.86 ","$2,226.24 ","$1,917.04 ","$2,226.24 ","$2,226.24 ","$1,855.20 "
ST MARY'S HOSPITAL,48100019,33235,HC REMOVE ELECTRODE DUAL 33235,481,1 ,"$2,461.00 ","$1,230.50 ",$533.72 ,"$8,056.00 ",$533.72 ,"$2,461.00 ","$2,461.00 ","$3,348.86 ","$1,476.60 ","$2,091.85 ","$1,722.70 ",$533.72 ,"$2,337.95 ","$1,771.92 ","$1,796.53 ","$2,461.00 ","$2,091.85 ","$3,348.86 ","$2,461.00 ","$2,091.85 ","$1,796.53 ",$533.72 ,"$3,348.86 ","$2,461.00 ","$2,091.85 ","$7,534.93 ","$2,264.12 ","$1,722.70 ","$5,993.67 ","$8,056.00 ","$1,498.75 ","$7,491.83 ","$1,700.55 ","$1,771.92 ","$1,714.09 ","$3,382.35 ","$1,771.92 ",$565.74 ,"$2,461.00 ","$2,461.00 ","$3,348.86 ","$2,461.00 ","$3,348.86 ","$1,771.92 ","$1,525.82 ","$1,771.92 ","$1,771.92 ","$1,476.60 "
ST MARY'S HOSPITAL,48100020,33240,HC INSERT SGL/DUAL CHAMBER C-D 33240,481,1 ,"$12,498.00 ","$6,249.00 ","$5,993.67 ","$50,458.64 ","$7,815.70 ","$12,498.00 ","$12,498.00 ","$22,426.06 ","$7,498.80 ","$10,623.30 ","$8,748.60 ","$7,815.70 ","$11,873.10 ","$8,998.56 ","$9,123.54 ","$12,498.00 ","$10,623.30 ","$22,426.06 ","$12,498.00 ","$10,623.30 ","$9,123.54 ","$7,815.70 ","$22,426.06 ","$12,498.00 ","$10,623.30 ","$50,458.64 ","$11,498.16 ","$8,748.60 ","$5,993.67 ","$8,056.00 ","$7,611.28 ","$7,491.83 ","$8,636.12 ","$8,998.56 ","$8,704.86 ","$22,650.32 ","$8,998.56 ","$8,284.64 ","$12,498.00 ","$12,498.00 ","$22,426.06 ","$12,498.00 ","$22,426.06 ","$8,998.56 ","$7,748.76 ","$8,998.56 ","$8,998.56 ","$7,498.80 "
ST MARY'S HOSPITAL,48100022,33241,HC REMOVE C-D PULSE GENERATOR 33241,481,1 ,"$3,103.00 ","$1,551.50 ","$1,551.50 ","$8,056.00 ","$2,195.90 ","$3,103.00 ","$3,103.00 ","$3,348.86 ","$1,861.80 ","$2,637.55 ","$2,172.10 ","$2,195.90 ","$2,947.85 ","$2,234.16 ","$2,265.19 ","$2,815.00 ","$2,637.55 ","$3,348.86 ","$2,815.00 ","$2,637.55 ","$2,265.19 ","$2,195.90 ","$3,348.86 ","$3,103.00 ","$2,637.55 ","$7,534.93 ","$2,854.76 ","$2,172.10 ","$5,993.67 ","$8,056.00 ","$1,889.73 ","$7,491.83 ","$2,144.17 ","$2,234.16 ","$2,161.24 ","$3,382.35 ","$2,234.16 ","$2,327.65 ","$3,103.00 ","$3,103.00 ","$3,348.86 ","$3,103.00 ","$3,348.86 ","$2,234.16 ","$1,923.86 ","$2,234.16 ","$2,234.16 ","$1,861.80 "
ST MARY'S HOSPITAL,48100023,33244,HC REMOVE C-D ELECTRODES 33244,481,1 ,"$2,782.00 ","$1,391.00 ",$533.72 ,"$8,056.00 ",$533.72 ,"$2,782.00 ","$2,782.00 ","$3,348.86 ","$1,669.20 ","$2,364.70 ","$1,947.40 ",$533.72 ,"$2,642.90 ","$2,003.04 ","$2,030.86 ","$2,782.00 ","$2,364.70 ","$3,348.86 ","$2,782.00 ","$2,364.70 ","$2,030.86 ",$533.72 ,"$3,348.86 ","$2,782.00 ","$2,364.70 ","$7,534.93 ","$2,559.44 ","$1,947.40 ","$5,993.67 ","$8,056.00 ","$1,694.24 ","$7,491.83 ","$1,922.36 ","$2,003.04 ","$1,937.66 ","$3,382.35 ","$2,003.04 ",$565.74 ,"$2,782.00 ","$2,782.00 ","$3,348.86 ","$2,782.00 ","$3,348.86 ","$2,003.04 ","$1,724.84 ","$2,003.04 ","$2,003.04 ","$1,669.20 "
ST MARY'S HOSPITAL,48100024,33249,HC INS/REPOS DEFIB LEAD/GEN 33249,481,1 ,"$19,260.00 ","$9,630.00 ","$5,993.67 ","$71,875.85 ","$7,815.70 ","$19,260.00 ","$13,525.00 ","$31,944.82 ","$11,556.00 ","$16,371.00 ","$13,482.00 ","$7,815.70 ","$18,297.00 ","$13,867.20 ","$14,059.80 ","$19,260.00 ","$16,371.00 ","$31,944.82 ","$19,260.00 ","$16,371.00 ","$14,059.80 ","$7,815.70 ","$31,944.82 ","$19,260.00 ","$16,371.00 ","$71,875.85 ","$17,719.20 ","$13,482.00 ","$5,993.67 ","$8,056.00 ","$11,729.34 ","$7,491.83 ","$13,308.66 ","$13,867.20 ","$13,414.59 ","$32,264.27 ","$13,867.20 ","$8,284.64 ","$19,260.00 ","$19,260.00 ","$31,944.82 ","$19,260.00 ","$31,944.82 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$11,556.00 "
ST MARY'S HOSPITAL,48100028,33285,HC IMPLANT CARDIAC EVENT RECORDER,481,1 ,"$6,099.00 ","$3,049.50 ","$2,606.72 ","$17,852.44 ","$2,606.72 ","$6,099.00 ","$6,099.00 ","$7,934.42 ","$3,659.40 ","$5,184.15 ","$4,269.30 ","$2,606.72 ","$5,794.05 ","$4,391.28 ","$4,452.27 ","$6,099.00 ","$5,184.15 ","$7,934.42 ","$6,099.00 ","$5,184.15 ","$4,452.27 ","$2,606.72 ","$7,934.42 ","$6,099.00 ","$5,184.15 ","$17,852.44 ","$5,611.08 ","$4,269.30 ","$5,993.67 ","$8,056.00 ","$3,714.29 ","$7,491.83 ","$4,214.41 ","$4,391.28 ","$4,247.95 ","$8,013.76 ","$4,391.28 ","$2,763.12 ","$6,099.00 ","$6,099.00 ","$7,934.42 ","$6,099.00 ","$7,934.42 ","$4,391.28 ","$3,781.38 ","$4,391.28 ","$4,391.28 ","$3,659.40 "
ST MARY'S HOSPITAL,48100029,33286,HC REMOVE CARDIAC EVENT RECORDER,481,1 ,"$1,712.00 ",$856.00 ,$533.72 ,"$8,056.00 ",$533.72 ,"$1,712.00 ","$1,712.00 ",$605.19 ,"$1,027.20 ","$1,455.20 ","$1,198.40 ",$533.72 ,"$1,626.40 ","$1,232.64 ","$1,249.76 ","$1,712.00 ","$1,455.20 ",$605.19 ,"$1,712.00 ","$1,455.20 ","$1,249.76 ",$533.72 ,$605.19 ,"$1,712.00 ","$1,455.20 ","$1,361.67 ","$1,575.04 ","$1,198.40 ","$5,993.67 ","$8,056.00 ","$1,042.61 ","$7,491.83 ","$1,182.99 ","$1,232.64 ","$1,192.41 ",$611.24 ,"$1,232.64 ",$565.74 ,"$1,712.00 ","$1,712.00 ",$605.19 ,"$1,712.00 ",$605.19 ,"$1,232.64 ","$1,061.44 ","$1,232.64 ","$1,232.64 ","$1,027.20 "
ST MARY'S HOSPITAL,48100030,33967,HC IABP INSERTION 33967,481,1 ,"$2,247.00 ","$1,123.50 ","$1,123.50 ","$8,056.00 ","$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 ","$1,617.84 ","$1,640.31 ","$2,247.00 ","$1,909.95 ", N/A ,"$2,247.00 ","$1,909.95 ","$1,640.31 ","$2,606.72 ", N/A ,"$2,247.00 ","$1,909.95 ", N/A ,"$2,067.24 ","$1,572.90 ","$5,993.67 ","$8,056.00 ","$1,368.42 ","$7,491.83 ","$1,552.68 ","$1,617.84 ","$1,565.04 ", N/A ,"$1,617.84 ","$2,763.12 ","$2,247.00 ","$2,247.00 ", N/A ,"$2,247.00 ", N/A ,"$1,617.84 ","$1,393.14 ","$1,617.84 ","$1,617.84 ","$1,348.20 "
ST MARY'S HOSPITAL,48100032,33968,HC REMV BALLN INTRA-AORTIC PERC,481,1 ,"$2,262.00 ","$1,131.00 ","$1,131.00 ","$8,056.00 ","$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 ","$1,628.64 ","$1,651.26 ","$2,262.00 ","$1,922.70 ", N/A ,"$2,262.00 ","$1,922.70 ","$1,651.26 ","$2,195.90 ", N/A ,"$2,262.00 ","$1,922.70 ", N/A ,"$2,081.04 ","$1,583.40 ","$5,993.67 ","$8,056.00 ","$1,377.56 ","$7,491.83 ","$1,563.04 ","$1,628.64 ","$1,575.48 ", N/A ,"$1,628.64 ","$2,327.65 ","$2,262.00 ","$2,262.00 ", N/A ,"$2,262.00 ", N/A ,"$1,628.64 ","$1,402.44 ","$1,628.64 ","$1,628.64 ","$1,357.20 "
ST MARY'S HOSPITAL,48100034,35226,HC REPAIR BLOOD VESSEL,481,1 ,"$1,876.00 ",$938.00 ,$605.19 ,"$8,056.00 ",$681.85 ,"$1,876.00 ","$1,876.00 ",$605.19 ,"$1,125.60 ","$1,594.60 ","$1,313.20 ",$681.85 ,"$1,782.20 ","$1,350.72 ","$1,369.48 ","$1,876.00 ","$1,594.60 ",$605.19 ,"$1,876.00 ","$1,594.60 ","$1,369.48 ",$681.85 ,$605.19 ,"$1,876.00 ","$1,594.60 ","$1,361.67 ","$1,725.92 ","$1,313.20 ","$5,993.67 ","$8,056.00 ","$1,142.48 ","$7,491.83 ","$1,296.32 ","$1,350.72 ","$1,306.63 ",$611.24 ,"$1,350.72 ",$722.76 ,"$1,876.00 ","$1,876.00 ",$605.19 ,"$1,876.00 ",$605.19 ,"$1,350.72 ","$1,163.12 ","$1,350.72 ","$1,350.72 ","$1,125.60 "
ST MARY'S HOSPITAL,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 ",$887.04 ,$899.36 ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,232.00 ","$1,047.20 ",$899.36 ,$199.61 , 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 ,$887.04 ,$858.09 , N/A ,$887.04 ,$211.59 ,"$1,232.00 ","$1,232.00 ", N/A ,"$1,232.00 ", N/A ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,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 ,$732.24 ,$742.41 ,"$1,017.00 ",$864.45 , N/A ,"$1,017.00 ",$864.45 ,$742.41 ,$199.61 , 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 ,$732.24 ,$708.34 , N/A ,$732.24 ,$211.59 ,"$1,017.00 ","$1,017.00 ", N/A ,"$1,017.00 ", N/A ,$732.24 ,$630.54 ,$732.24 ,$732.24 ,$610.20 
ST MARY'S HOSPITAL,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 ",$847.44 ,$859.21 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,000.45 ",$859.21 ,$199.61 , 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 ,$847.44 ,$819.78 , N/A ,$847.44 ,$211.59 ,"$1,177.00 ","$1,177.00 ", N/A ,"$1,177.00 ", N/A ,$847.44 ,$729.74 ,$847.44 ,$847.44 ,$706.20 
ST MARY'S HOSPITAL,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 ,$578.16 ,$586.19 ,$803.00 ,$682.55 , N/A ,$803.00 ,$682.55 ,$586.19 ,$199.61 , N/A ,$803.00 ,$682.55 , N/A ,$738.76 ,$562.10 ,$803.00 ,$803.00 ,$489.03 ,$803.00 ,$554.87 ,$578.16 ,$559.29 , N/A ,$578.16 ,$211.59 ,$803.00 ,$803.00 , N/A ,$803.00 , N/A ,$578.16 ,$497.86 ,$578.16 ,$578.16 ,$481.80 
ST MARY'S HOSPITAL,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 ",$847.44 ,$859.21 ,"$1,177.00 ","$1,000.45 ", N/A ,"$1,177.00 ","$1,000.45 ",$859.21 ,$199.61 , 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 ,$847.44 ,$819.78 , N/A ,$847.44 ,$211.59 ,"$1,177.00 ","$1,177.00 ", N/A ,"$1,177.00 ", N/A ,$847.44 ,$729.74 ,$847.44 ,$847.44 ,$706.20 
ST MARY'S HOSPITAL,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 ,$554.40 ,$562.10 ,$770.00 ,$654.50 , N/A ,$770.00 ,$654.50 ,$562.10 ,$199.61 , N/A ,$770.00 ,$654.50 , N/A ,$708.40 ,$539.00 ,$770.00 ,$770.00 ,$468.93 ,$770.00 ,$532.07 ,$554.40 ,$536.31 , N/A ,$554.40 ,$211.59 ,$770.00 ,$770.00 , N/A ,$770.00 , N/A ,$554.40 ,$477.40 ,$554.40 ,$554.40 ,$462.00 
ST MARY'S HOSPITAL,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 ","$1,128.96 ","$1,144.64 ","$1,568.00 ","$1,332.80 ", N/A ,"$1,568.00 ","$1,332.80 ","$1,144.64 ",$199.61 , N/A ,"$1,568.00 ","$1,332.80 ", N/A ,"$1,442.56 ","$1,097.60 ","$1,489.75 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,128.96 ","$1,092.11 ", N/A ,"$1,128.96 ",$211.59 ,"$1,568.00 ","$1,568.00 ", N/A ,"$1,568.00 ", N/A ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ",$887.04 ,$899.36 ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,232.00 ","$1,047.20 ",$899.36 ,$199.61 , 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 ,$887.04 ,$858.09 , N/A ,$887.04 ,$211.59 ,"$1,232.00 ","$1,232.00 ", N/A ,"$1,232.00 ", N/A ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,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 ","$1,128.96 ","$1,144.64 ","$1,568.00 ","$1,332.80 ", N/A ,"$1,568.00 ","$1,332.80 ","$1,144.64 ",$199.61 , N/A ,"$1,568.00 ","$1,332.80 ", N/A ,"$1,442.56 ","$1,097.60 ","$1,489.75 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,128.96 ","$1,092.11 ", N/A ,"$1,128.96 ",$211.59 ,"$1,568.00 ","$1,568.00 ", N/A ,"$1,568.00 ", N/A ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ,$556.56 ,$564.29 ,$773.00 ,$657.05 , N/A ,$773.00 ,$657.05 ,$564.29 ,$199.61 , N/A ,$773.00 ,$657.05 , N/A ,$711.16 ,$541.10 ,$773.00 ,$773.00 ,$470.76 ,$773.00 ,$534.14 ,$556.56 ,$538.39 , N/A ,$556.56 ,$211.59 ,$773.00 ,$773.00 , N/A ,$773.00 , N/A ,$556.56 ,$479.26 ,$556.56 ,$556.56 ,$463.80 
ST MARY'S HOSPITAL,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 ","$1,128.96 ","$1,144.64 ","$1,568.00 ","$1,332.80 ", N/A ,"$1,568.00 ","$1,332.80 ","$1,144.64 ",$199.61 , N/A ,"$1,568.00 ","$1,332.80 ", N/A ,"$1,442.56 ","$1,097.60 ","$1,489.75 ","$1,568.00 ",$954.91 ,"$1,568.00 ","$1,083.49 ","$1,128.96 ","$1,092.11 ", N/A ,"$1,128.96 ",$211.59 ,"$1,568.00 ","$1,568.00 ", N/A ,"$1,568.00 ", N/A ,"$1,128.96 ",$972.16 ,"$1,128.96 ","$1,128.96 ",$940.80 
ST MARY'S HOSPITAL,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 ","$1,209.60 ","$1,226.40 ","$1,680.00 ","$1,428.00 ", N/A ,"$1,680.00 ","$1,428.00 ","$1,226.40 ",$199.61 , N/A ,"$1,680.00 ","$1,428.00 ", N/A ,"$1,545.60 ","$1,176.00 ","$1,489.75 ","$1,680.00 ","$1,023.12 ","$1,680.00 ","$1,160.88 ","$1,209.60 ","$1,170.12 ", N/A ,"$1,209.60 ",$211.59 ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,680.00 ", N/A ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,48100055,36218,HC PL CATH THOR/BRAC ADDL 36218,481,1 ,$750.00 ,$375.00 ,$199.61 ,"$2,002.44 ",$199.61 ,$750.00 ,$750.00 , N/A ,$450.00 ,$637.50 ,$525.00 ,$199.61 ,$712.50 ,$540.00 ,$547.50 ,$750.00 ,$637.50 , N/A ,$750.00 ,$637.50 ,$547.50 ,$199.61 , N/A ,$750.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,"$1,489.75 ","$2,002.44 ",$456.75 ,"$1,862.71 ",$518.25 ,$540.00 ,$522.38 , N/A ,$540.00 ,$211.59 ,$750.00 ,$750.00 , N/A ,$750.00 , N/A ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,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 ","$1,290.24 ","$1,308.16 ","$1,792.00 ","$1,523.20 ", N/A ,"$1,792.00 ","$1,523.20 ","$1,308.16 ",$199.61 , N/A ,"$1,792.00 ","$1,523.20 ", N/A ,"$1,648.64 ","$1,254.40 ","$1,489.75 ","$1,792.00 ","$1,091.33 ","$1,792.00 ","$1,238.27 ","$1,290.24 ","$1,248.13 ", N/A ,"$1,290.24 ",$211.59 ,"$1,792.00 ","$1,792.00 ", N/A ,"$1,792.00 ", N/A ,"$1,290.24 ","$1,111.04 ","$1,290.24 ","$1,290.24 ","$1,075.20 "
ST MARY'S HOSPITAL,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 ","$1,048.32 ","$1,062.88 ","$1,456.00 ","$1,237.60 ", N/A ,"$1,456.00 ","$1,237.60 ","$1,062.88 ",$199.61 , 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 ","$1,048.32 ","$1,014.10 ", N/A ,"$1,048.32 ",$211.59 ,"$1,456.00 ","$1,456.00 ", N/A ,"$1,456.00 ", N/A ,"$1,048.32 ",$902.72 ,"$1,048.32 ","$1,048.32 ",$873.60 
ST MARY'S HOSPITAL,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 ","$1,209.60 ","$1,226.40 ","$1,680.00 ","$1,428.00 ", N/A ,"$1,680.00 ","$1,428.00 ","$1,226.40 ",$199.61 , N/A ,"$1,680.00 ","$1,428.00 ", N/A ,"$1,545.60 ","$1,176.00 ","$1,489.75 ","$1,680.00 ","$1,023.12 ","$1,680.00 ","$1,160.88 ","$1,209.60 ","$1,170.12 ", N/A ,"$1,209.60 ",$211.59 ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,680.00 ", N/A ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,48100059,36248,HC ABD ADDL 2ND/PLUS ORDER 36248,481,1 ,"$1,232.00 ",$616.00 ,$199.61 ,"$2,002.44 ",$199.61 ,"$1,232.00 ","$1,232.00 ", N/A ,$739.20 ,"$1,047.20 ",$862.40 ,$199.61 ,"$1,170.40 ",$887.04 ,$899.36 ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,232.00 ","$1,047.20 ",$899.36 ,$199.61 , N/A ,"$1,232.00 ","$1,047.20 ", N/A ,"$1,133.44 ",$862.40 ,"$1,489.75 ","$2,002.44 ",$750.29 ,"$1,862.71 ",$851.31 ,$887.04 ,$858.09 , N/A ,$887.04 ,$211.59 ,"$1,232.00 ","$1,232.00 ", N/A ,"$1,232.00 ", N/A ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,48100060,37184,HC PERIPH THROMBECK ONLY W/TPA 37184,481,1 ,"$4,600.00 ","$2,300.00 ","$1,851.24 ","$21,979.23 ","$1,851.24 ","$4,600.00 ","$4,600.00 ","$9,768.54 ","$2,760.00 ","$3,910.00 ","$3,220.00 ","$1,851.24 ","$4,370.00 ","$3,312.00 ","$3,358.00 ","$4,600.00 ","$3,910.00 ","$9,768.54 ","$4,600.00 ","$3,910.00 ","$3,358.00 ","$1,851.24 ","$9,768.54 ","$4,600.00 ","$3,910.00 ","$21,979.23 ","$4,232.00 ","$3,220.00 ","$5,993.67 ","$8,056.00 ","$2,801.40 ","$7,491.83 ","$3,178.60 ","$3,312.00 ","$3,203.90 ","$9,866.23 ","$3,312.00 ","$1,962.31 ","$4,600.00 ","$4,600.00 ","$9,768.54 ","$4,600.00 ","$9,768.54 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$2,760.00 "
ST MARY'S HOSPITAL,48100061,37185,HC PRIM PERC THROMB EA ADDL 37185,481,1 ,"$3,500.00 ","$1,750.00 ","$1,750.00 ","$8,056.00 ","$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 ","$2,520.00 ","$2,555.00 ","$3,500.00 ","$2,975.00 ", N/A ,"$3,500.00 ","$2,975.00 ","$2,555.00 ","$1,851.24 ", N/A ,"$3,500.00 ","$2,975.00 ", N/A ,"$3,220.00 ","$2,450.00 ","$5,993.67 ","$8,056.00 ","$2,131.50 ","$7,491.83 ","$2,418.50 ","$2,520.00 ","$2,437.75 ", N/A ,"$2,520.00 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,100.00 "
ST MARY'S HOSPITAL,48100062,37186,HC SEC PERC THROMB EA VESSEL ADDL 37186,481,1 ,"$3,500.00 ","$1,750.00 ","$1,750.00 ","$8,056.00 ","$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 ","$2,520.00 ","$2,555.00 ","$3,500.00 ","$2,975.00 ", N/A ,"$3,500.00 ","$2,975.00 ","$2,555.00 ","$3,445.58 ", N/A ,"$3,500.00 ","$2,975.00 ", N/A ,"$3,220.00 ","$2,450.00 ","$5,993.67 ","$8,056.00 ","$2,131.50 ","$7,491.83 ","$2,418.50 ","$2,520.00 ","$2,437.75 ", N/A ,"$2,520.00 ","$3,652.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$2,520.00 ","$2,170.00 ","$2,520.00 ","$2,520.00 ","$2,100.00 "
ST MARY'S HOSPITAL,48100063,37187,HC PRIMARY VENOUS THROMBECTOMY,481,1 ,"$4,700.00 ","$2,350.00 ","$1,123.24 ","$21,979.23 ","$1,123.24 ","$4,700.00 ","$4,700.00 ","$9,768.54 ","$2,820.00 ","$3,995.00 ","$3,290.00 ","$1,123.24 ","$4,465.00 ","$3,384.00 ","$3,431.00 ","$4,700.00 ","$3,995.00 ","$9,768.54 ","$4,700.00 ","$3,995.00 ","$3,431.00 ","$1,123.24 ","$9,768.54 ","$4,700.00 ","$3,995.00 ","$21,979.23 ","$4,324.00 ","$3,290.00 ","$5,993.67 ","$8,056.00 ","$2,862.30 ","$7,491.83 ","$3,247.70 ","$3,384.00 ","$3,273.55 ","$9,866.23 ","$3,384.00 ","$1,190.63 ","$4,700.00 ","$4,700.00 ","$9,768.54 ","$4,700.00 ","$9,768.54 ","$3,384.00 ","$2,914.00 ","$3,384.00 ","$3,384.00 ","$2,820.00 "
ST MARY'S HOSPITAL,48100064,37188,HC SUBSEQUENT VENOUS THROMBECTOMY,481,1 ,"$3,080.00 ","$1,540.00 ","$1,123.24 ","$8,056.00 ","$1,123.24 ","$3,080.00 ","$3,080.00 ","$2,784.00 ","$1,848.00 ","$2,618.00 ","$2,156.00 ","$1,123.24 ","$2,926.00 ","$2,217.60 ","$2,248.40 ","$3,080.00 ","$2,618.00 ","$2,784.00 ","$3,080.00 ","$2,618.00 ","$2,248.40 ","$1,123.24 ","$2,784.00 ","$3,080.00 ","$2,618.00 ","$6,263.99 ","$2,833.60 ","$2,156.00 ","$5,993.67 ","$8,056.00 ","$1,875.72 ","$7,491.83 ","$2,128.28 ","$2,217.60 ","$2,145.22 ","$2,811.84 ","$2,217.60 ","$1,190.63 ","$3,080.00 ","$3,080.00 ","$2,784.00 ","$3,080.00 ","$2,784.00 ","$2,217.60 ","$1,909.60 ","$2,217.60 ","$2,217.60 ","$1,848.00 "
ST MARY'S HOSPITAL,48100065,37200,HC BIOPSY TRANSCATHETER,481,1 ,"$2,300.00 ","$1,150.00 ","$1,123.24 ","$10,434.71 ","$1,123.24 ","$2,300.00 ","$2,300.00 ","$4,637.65 ","$1,380.00 ","$1,955.00 ","$1,610.00 ","$1,123.24 ","$2,185.00 ","$1,656.00 ","$1,679.00 ","$2,300.00 ","$1,955.00 ","$4,637.65 ","$2,300.00 ","$1,955.00 ","$1,679.00 ","$1,123.24 ","$4,637.65 ","$2,300.00 ","$1,955.00 ","$10,434.71 ","$2,116.00 ","$1,610.00 ","$5,993.67 ","$8,056.00 ","$1,400.70 ","$7,491.83 ","$1,589.30 ","$1,656.00 ","$1,601.95 ","$4,684.03 ","$1,656.00 ","$1,190.63 ","$2,300.00 ","$2,300.00 ","$4,637.65 ","$2,300.00 ","$4,637.65 ","$1,656.00 ","$1,426.00 ","$1,656.00 ","$1,656.00 ","$1,380.00 "
ST MARY'S HOSPITAL,48100067,61650,HC THPY INFS NON-THROMBO INTITIAL,481,1 ,"$1,600.00 ",$800.00 ,$800.00 ,"$8,056.00 ","$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 ","$1,152.00 ","$1,168.00 ","$1,600.00 ","$1,360.00 ", N/A ,"$1,600.00 ","$1,360.00 ","$1,168.00 ","$3,529.80 ", N/A ,"$1,600.00 ","$1,360.00 ", N/A ,"$1,472.00 ","$1,120.00 ","$5,993.67 ","$8,056.00 ",$974.40 ,"$7,491.83 ","$1,105.60 ","$1,152.00 ","$1,114.40 ", N/A ,"$1,152.00 ","$3,741.59 ","$1,600.00 ","$1,600.00 ", N/A ,"$1,600.00 ", N/A ,"$1,152.00 ",$992.00 ,"$1,152.00 ","$1,152.00 ",$960.00 
ST MARY'S HOSPITAL,48100069,37241,HC OCCL/EMBOL TRANSCATH PERC 37241,481,1 ,"$6,700.00 ","$3,350.00 ","$3,350.00 ","$21,979.23 ","$3,445.58 ","$6,700.00 ","$6,700.00 ","$9,768.54 ","$4,020.00 ","$5,695.00 ","$4,690.00 ","$3,445.58 ","$6,365.00 ","$4,824.00 ","$4,891.00 ","$6,700.00 ","$5,695.00 ","$9,768.54 ","$6,700.00 ","$5,695.00 ","$4,891.00 ","$3,445.58 ","$9,768.54 ","$6,700.00 ","$5,695.00 ","$21,979.23 ","$6,164.00 ","$4,690.00 ","$5,993.67 ","$8,056.00 ","$4,080.30 ","$7,491.83 ","$4,629.70 ","$4,824.00 ","$4,666.55 ","$9,866.23 ","$4,824.00 ","$3,652.31 ","$6,700.00 ","$6,700.00 ","$9,768.54 ","$6,700.00 ","$9,768.54 ","$4,824.00 ","$4,154.00 ","$4,824.00 ","$4,824.00 ","$4,020.00 "
ST MARY'S HOSPITAL,48100070,37236,HC PL STENT INTRAVAS PERC INIT 37236,481,1 ,"$8,132.00 ","$4,066.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$8,132.00 ","$8,132.00 ","$9,768.54 ","$4,879.20 ","$6,912.20 ","$5,692.40 ","$3,445.58 ","$7,725.40 ","$5,855.04 ","$5,936.36 ","$6,993.00 ","$6,912.20 ","$9,768.54 ","$6,993.00 ","$6,912.20 ","$5,936.36 ","$3,445.58 ","$9,768.54 ","$8,132.00 ","$6,912.20 ","$21,979.23 ","$7,481.44 ","$5,692.40 ","$5,993.67 ","$8,056.00 ","$4,952.39 ","$7,491.83 ","$5,619.21 ","$5,855.04 ","$5,663.94 ","$9,866.23 ","$5,855.04 ","$3,652.31 ","$8,132.00 ","$8,132.00 ","$9,768.54 ","$8,132.00 ","$9,768.54 ","$5,855.04 ","$5,041.84 ","$5,855.04 ","$5,855.04 ","$4,879.20 "
ST MARY'S HOSPITAL,48100071,37237,HC PLACE STENT PERC ADDL 37237,481,1 ,"$6,992.00 ","$3,496.00 ","$3,445.58 ","$8,056.00 ","$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 ","$5,034.24 ","$5,104.16 ","$6,992.00 ","$5,943.20 ", N/A ,"$6,992.00 ","$5,943.20 ","$5,104.16 ","$3,445.58 ", N/A ,"$3,959.93 ","$5,943.20 ", N/A ,"$6,432.64 ","$4,894.40 ","$5,993.67 ","$8,056.00 ","$4,258.13 ","$7,491.83 ","$4,831.47 ","$5,034.24 ","$4,869.93 ", N/A ,"$5,034.24 ","$3,652.31 ","$6,992.00 ","$6,992.00 ", N/A ,"$6,992.00 ", N/A ,"$5,034.24 ","$4,335.04 ","$5,034.24 ","$5,034.24 ","$4,195.20 "
ST MARY'S HOSPITAL,48100075,37243,HC EMBOLIZATION UTERINE FIBROID,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,408.00 ","$6,497.00 ","$6,993.00 ","$7,565.00 ","$9,768.54 ","$6,993.00 ","$7,565.00 ","$6,497.00 ","$3,445.58 ","$9,768.54 ","$8,900.00 ","$7,565.00 ","$21,979.23 ","$8,188.00 ","$6,230.00 ","$5,993.67 ","$8,056.00 ","$5,420.10 ","$7,491.83 ","$6,149.90 ","$6,408.00 ","$6,198.85 ","$9,866.23 ","$6,408.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$8,900.00 ","$9,768.54 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$5,340.00 "
ST MARY'S HOSPITAL,48100076,37215,HC PL STENT TRNSCATH CAROT ART W/ 37215,481,1 ,"$6,700.00 ","$3,350.00 ","$3,350.00 ","$8,056.00 ","$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 ","$4,824.00 ","$4,891.00 ","$6,700.00 ","$5,695.00 ", N/A ,"$6,700.00 ","$5,695.00 ","$4,891.00 ","$3,529.80 ", N/A ,"$6,700.00 ","$5,695.00 ", N/A ,"$6,164.00 ","$4,690.00 ","$5,993.67 ","$8,056.00 ","$4,080.30 ","$7,491.83 ","$4,629.70 ","$4,824.00 ","$4,666.55 ", N/A ,"$4,824.00 ","$3,741.59 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$4,824.00 ","$4,154.00 ","$4,824.00 ","$4,824.00 ","$4,020.00 "
ST MARY'S HOSPITAL,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$7,597.00 ","$3,798.50 ","$2,776.86 ","$21,979.23 ","$2,776.86 ","$7,597.00 ","$7,597.00 ","$9,768.54 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$2,776.86 ","$7,217.15 ","$5,469.84 ","$5,545.81 ","$7,597.00 ","$6,457.45 ","$9,768.54 ","$7,597.00 ","$6,457.45 ","$5,545.81 ","$2,776.86 ","$9,768.54 ","$7,597.00 ","$6,457.45 ","$21,979.23 ","$6,989.24 ","$5,317.90 ","$8,990.51 ","$12,084.00 ","$4,626.57 ","$11,237.75 ","$5,249.53 ","$5,469.84 ","$5,291.31 ","$9,866.23 ","$5,469.84 ","$2,943.47 ","$7,597.00 ","$7,597.00 ","$9,768.54 ","$7,597.00 ","$9,768.54 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$4,558.20 "
ST MARY'S HOSPITAL,48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$7,597.00 ","$3,798.50 ","$2,776.86 ","$21,979.23 ","$2,776.86 ","$7,597.00 ","$7,597.00 ","$9,768.54 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$2,776.86 ","$7,217.15 ","$5,469.84 ","$5,545.81 ","$7,597.00 ","$6,457.45 ","$9,768.54 ","$7,597.00 ","$6,457.45 ","$5,545.81 ","$2,776.86 ","$9,768.54 ","$7,597.00 ","$6,457.45 ","$21,979.23 ","$6,989.24 ","$5,317.90 ","$8,990.51 ","$12,084.00 ","$4,626.57 ","$11,237.75 ","$5,249.53 ","$5,469.84 ","$5,291.31 ","$9,866.23 ","$5,469.84 ","$2,943.47 ","$7,597.00 ","$7,597.00 ","$9,768.54 ","$7,597.00 ","$9,768.54 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$4,558.20 "
ST MARY'S HOSPITAL,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,190.00 ","$9,095.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$18,190.00 ","$11,705.00 ","$9,768.54 ","$10,914.00 ","$15,461.50 ","$12,733.00 ","$3,445.58 ","$17,280.50 ","$13,096.80 ","$13,278.70 ","$6,993.00 ","$15,461.50 ","$9,768.54 ","$6,993.00 ","$15,461.50 ","$13,278.70 ","$3,445.58 ","$9,768.54 ","$15,834.06 ","$15,461.50 ","$21,979.23 ","$16,734.80 ","$12,733.00 ","$5,993.67 ","$8,056.00 ","$11,077.71 ","$7,491.83 ","$12,569.29 ","$13,096.80 ","$12,669.34 ","$9,866.23 ","$13,096.80 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$10,914.00 "
ST MARY'S HOSPITAL,48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$18,190.00 ","$9,095.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$18,190.00 ","$11,705.00 ","$9,768.54 ","$10,914.00 ","$15,461.50 ","$12,733.00 ","$3,445.58 ","$17,280.50 ","$13,096.80 ","$13,278.70 ","$6,993.00 ","$15,461.50 ","$9,768.54 ","$6,993.00 ","$15,461.50 ","$13,278.70 ","$3,445.58 ","$9,768.54 ","$15,834.06 ","$15,461.50 ","$21,979.23 ","$16,734.80 ","$12,733.00 ","$5,993.67 ","$8,056.00 ","$11,077.71 ","$7,491.83 ","$12,569.29 ","$13,096.80 ","$12,669.34 ","$9,866.23 ","$13,096.80 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$10,914.00 "
ST MARY'S HOSPITAL,48100079,37222,HC RVC EN PRC ICA W/ANG EA AD VS 37222,481,1 ,"$6,206.00 ","$3,103.00 ","$3,103.00 ","$8,056.00 ","$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 ","$4,468.32 ","$4,530.38 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$5,275.10 ","$4,530.38 ","$3,445.58 ", N/A ,"$3,959.93 ","$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$5,993.67 ","$8,056.00 ","$3,779.45 ","$7,491.83 ","$4,288.35 ","$4,468.32 ","$4,322.48 ", N/A ,"$4,468.32 ","$3,652.31 ","$6,206.00 ","$6,206.00 ", N/A ,"$6,206.00 ", N/A ,"$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$3,723.60 "
ST MARY'S HOSPITAL,48100080,37223,HC RVC EN PRC ICA W/TRN ST AD VS 37223,481,1 ,"$7,918.00 ","$3,959.00 ","$3,445.58 ","$8,056.00 ","$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 ","$5,700.96 ","$5,780.14 ","$6,993.00 ","$6,730.30 ", N/A ,"$6,993.00 ","$6,730.30 ","$5,780.14 ","$3,445.58 ", N/A ,"$3,959.93 ","$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$5,993.67 ","$8,056.00 ","$4,822.06 ","$7,491.83 ","$5,471.34 ","$5,700.96 ","$5,514.89 ", N/A ,"$5,700.96 ","$3,652.31 ","$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ", N/A ,"$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$4,750.80 "
ST MARY'S HOSPITAL,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$6,955.00 ","$3,477.50 ","$2,776.86 ","$21,979.23 ","$2,776.86 ","$6,955.00 ","$6,955.00 ","$9,768.54 ","$4,173.00 ","$5,911.75 ","$4,868.50 ","$2,776.86 ","$6,607.25 ","$5,007.60 ","$5,077.15 ","$6,955.00 ","$5,911.75 ","$9,768.54 ","$6,955.00 ","$5,911.75 ","$5,077.15 ","$2,776.86 ","$9,768.54 ","$6,955.00 ","$5,911.75 ","$21,979.23 ","$6,398.60 ","$4,868.50 ","$8,990.51 ","$12,084.00 ","$4,235.60 ","$11,237.75 ","$4,805.91 ","$5,007.60 ","$4,844.16 ","$9,866.23 ","$5,007.60 ","$2,943.47 ","$6,955.00 ","$6,955.00 ","$9,768.54 ","$6,955.00 ","$9,768.54 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$4,173.00 "
ST MARY'S HOSPITAL,48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$6,955.00 ","$3,477.50 ","$2,776.86 ","$21,979.23 ","$2,776.86 ","$6,955.00 ","$6,955.00 ","$9,768.54 ","$4,173.00 ","$5,911.75 ","$4,868.50 ","$2,776.86 ","$6,607.25 ","$5,007.60 ","$5,077.15 ","$6,955.00 ","$5,911.75 ","$9,768.54 ","$6,955.00 ","$5,911.75 ","$5,077.15 ","$2,776.86 ","$9,768.54 ","$6,955.00 ","$5,911.75 ","$21,979.23 ","$6,398.60 ","$4,868.50 ","$8,990.51 ","$12,084.00 ","$4,235.60 ","$11,237.75 ","$4,805.91 ","$5,007.60 ","$4,844.16 ","$9,866.23 ","$5,007.60 ","$2,943.47 ","$6,955.00 ","$6,955.00 ","$9,768.54 ","$6,955.00 ","$9,768.54 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$4,173.00 "
ST MARY'S HOSPITAL,48100082,37225,HC RVC EN PRC F/P W/ANT INT VSL 37225,481,1 ,"$20,330.00 ","$10,165.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$18,727.00 ","$11,705.00 ","$9,768.54 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$3,445.58 ","$19,313.50 ","$14,637.60 ","$14,840.90 ","$6,993.00 ","$17,280.50 ","$9,768.54 ","$6,993.00 ","$17,280.50 ","$14,840.90 ","$3,445.58 ","$9,768.54 ","$15,834.06 ","$17,280.50 ","$21,979.23 ","$18,703.60 ","$14,231.00 ","$5,993.67 ","$8,056.00 ","$12,380.97 ","$7,491.83 ","$14,048.03 ","$14,637.60 ","$14,159.85 ","$9,866.23 ","$14,637.60 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$12,198.00 "
ST MARY'S HOSPITAL,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$20,330.00 ","$10,165.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$18,727.00 ","$11,705.00 ","$9,768.54 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$3,445.58 ","$19,313.50 ","$14,637.60 ","$14,840.90 ","$6,993.00 ","$17,280.50 ","$9,768.54 ","$6,993.00 ","$17,280.50 ","$14,840.90 ","$3,445.58 ","$9,768.54 ","$15,834.06 ","$17,280.50 ","$21,979.23 ","$18,703.60 ","$14,231.00 ","$5,993.67 ","$8,056.00 ","$12,380.97 ","$7,491.83 ","$14,048.03 ","$14,637.60 ","$14,159.85 ","$9,866.23 ","$14,637.60 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$12,198.00 "
ST MARY'S HOSPITAL,48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$20,330.00 ","$10,165.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$18,727.00 ","$11,705.00 ","$9,768.54 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$3,445.58 ","$19,313.50 ","$14,637.60 ","$14,840.90 ","$6,993.00 ","$17,280.50 ","$9,768.54 ","$6,993.00 ","$17,280.50 ","$14,840.90 ","$3,445.58 ","$9,768.54 ","$15,834.06 ","$17,280.50 ","$21,979.23 ","$18,703.60 ","$14,231.00 ","$5,993.67 ","$8,056.00 ","$12,380.97 ","$7,491.83 ","$14,048.03 ","$14,637.60 ","$14,159.85 ","$9,866.23 ","$14,637.60 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$12,198.00 "
ST MARY'S HOSPITAL,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 ","$35,142.61 ","$3,445.58 ","$19,768.00 ","$13,525.00 ","$15,618.94 ","$13,482.00 ","$19,099.50 ","$15,729.00 ","$3,445.58 ","$21,346.50 ","$16,178.40 ","$16,403.10 ","$6,993.00 ","$19,099.50 ","$15,618.94 ","$6,993.00 ","$19,099.50 ","$16,403.10 ","$3,445.58 ","$15,618.94 ","$18,996.34 ","$19,099.50 ","$35,142.61 ","$20,672.40 ","$15,729.00 ","$5,993.67 ","$8,056.00 ","$13,684.23 ","$7,491.83 ","$15,526.77 ","$16,178.40 ","$15,650.36 ","$15,775.13 ","$16,178.40 ","$3,652.31 ","$14,302.00 ","$14,302.00 ","$15,618.94 ","$14,302.00 ","$15,618.94 ","$16,178.40 ","$13,931.40 ","$16,178.40 ","$16,178.40 ","$13,482.00 "
ST MARY'S HOSPITAL,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$7,276.00 ","$3,638.00 ","$2,776.86 ","$21,979.23 ","$2,776.86 ","$7,276.00 ","$7,276.00 ","$9,768.54 ","$4,365.60 ","$6,184.60 ","$5,093.20 ","$2,776.86 ","$6,912.20 ","$5,238.72 ","$5,311.48 ","$7,276.00 ","$6,184.60 ","$9,768.54 ","$7,276.00 ","$6,184.60 ","$5,311.48 ","$2,776.86 ","$9,768.54 ","$7,276.00 ","$6,184.60 ","$21,979.23 ","$6,693.92 ","$5,093.20 ","$8,990.51 ","$12,084.00 ","$4,431.08 ","$11,237.75 ","$5,027.72 ","$5,238.72 ","$5,067.73 ","$9,866.23 ","$5,238.72 ","$2,943.47 ","$7,276.00 ","$7,276.00 ","$9,768.54 ","$7,276.00 ","$9,768.54 ","$5,238.72 ","$4,511.12 ","$5,238.72 ","$5,238.72 ","$4,365.60 "
ST MARY'S HOSPITAL,48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$7,276.00 ","$3,638.00 ","$2,776.86 ","$21,979.23 ","$2,776.86 ","$7,276.00 ","$7,276.00 ","$9,768.54 ","$4,365.60 ","$6,184.60 ","$5,093.20 ","$2,776.86 ","$6,912.20 ","$5,238.72 ","$5,311.48 ","$7,276.00 ","$6,184.60 ","$9,768.54 ","$7,276.00 ","$6,184.60 ","$5,311.48 ","$2,776.86 ","$9,768.54 ","$7,276.00 ","$6,184.60 ","$21,979.23 ","$6,693.92 ","$5,093.20 ","$8,990.51 ","$12,084.00 ","$4,431.08 ","$11,237.75 ","$5,027.72 ","$5,238.72 ","$5,067.73 ","$9,866.23 ","$5,238.72 ","$2,943.47 ","$7,276.00 ","$7,276.00 ","$9,768.54 ","$7,276.00 ","$9,768.54 ","$5,238.72 ","$4,511.12 ","$5,238.72 ","$5,238.72 ","$4,365.60 "
ST MARY'S HOSPITAL,48100086,37229,HC RVC EN PRC T/P W/ANT INT VSL 37229,481,1 ,"$19,260.00 ","$9,630.00 ","$3,445.58 ","$35,142.61 ","$3,445.58 ","$19,260.00 ","$13,525.00 ","$15,618.94 ","$11,556.00 ","$16,371.00 ","$13,482.00 ","$3,445.58 ","$18,297.00 ","$13,867.20 ","$14,059.80 ","$6,993.00 ","$16,371.00 ","$15,618.94 ","$6,993.00 ","$16,371.00 ","$14,059.80 ","$3,445.58 ","$15,618.94 ","$18,996.34 ","$16,371.00 ","$35,142.61 ","$17,719.20 ","$13,482.00 ","$5,993.67 ","$8,056.00 ","$11,729.34 ","$7,491.83 ","$13,308.66 ","$13,867.20 ","$13,414.59 ","$15,775.13 ","$13,867.20 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$15,618.94 ","$10,114.00 ","$15,618.94 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$11,556.00 "
ST MARY'S HOSPITAL,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 ","$35,142.61 ","$3,445.58 ","$19,260.00 ","$13,525.00 ","$15,618.94 ","$11,556.00 ","$16,371.00 ","$13,482.00 ","$3,445.58 ","$18,297.00 ","$13,867.20 ","$14,059.80 ","$6,993.00 ","$16,371.00 ","$15,618.94 ","$6,993.00 ","$16,371.00 ","$14,059.80 ","$3,445.58 ","$15,618.94 ","$18,996.34 ","$16,371.00 ","$35,142.61 ","$17,719.20 ","$13,482.00 ","$5,993.67 ","$8,056.00 ","$11,729.34 ","$7,491.83 ","$13,308.66 ","$13,867.20 ","$13,414.59 ","$15,775.13 ","$13,867.20 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$15,618.94 ","$10,114.00 ","$15,618.94 ","$13,867.20 ","$11,941.20 ","$13,867.20 ","$13,867.20 ","$11,556.00 "
ST MARY'S HOSPITAL,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 ","$35,142.61 ","$3,445.58 ","$19,768.00 ","$13,525.00 ","$15,618.94 ","$14,766.00 ","$20,918.50 ","$17,227.00 ","$3,445.58 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ","$15,618.94 ","$6,993.00 ","$20,918.50 ","$17,965.30 ","$3,445.58 ","$15,618.94 ","$18,996.34 ","$20,918.50 ","$35,142.61 ","$22,641.20 ","$17,227.00 ","$5,993.67 ","$8,056.00 ","$14,987.49 ","$7,491.83 ","$17,005.51 ","$17,719.20 ","$17,140.87 ","$15,775.13 ","$17,719.20 ","$3,652.31 ","$14,302.00 ","$14,302.00 ","$15,618.94 ","$14,302.00 ","$15,618.94 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ","$8,056.00 ","$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 ","$4,391.28 ","$4,452.27 ","$6,099.00 ","$5,184.15 ", N/A ,"$6,099.00 ","$5,184.15 ","$4,452.27 ","$3,445.58 ", N/A ,"$3,959.93 ","$5,184.15 ", N/A ,"$5,611.08 ","$4,269.30 ","$5,993.67 ","$8,056.00 ","$3,714.29 ","$7,491.83 ","$4,214.41 ","$4,391.28 ","$4,247.95 ", N/A ,"$4,391.28 ","$3,652.31 ","$6,099.00 ","$6,099.00 ", N/A ,"$6,099.00 ", N/A ,"$4,391.28 ","$3,781.38 ","$4,391.28 ","$4,391.28 ","$3,659.40 "
ST MARY'S HOSPITAL,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 ","$8,739.00 ","$4,923.00 ", N/A ,"$8,529.00 ","$12,082.75 ","$9,950.50 ","$3,445.58 ","$13,504.25 ","$10,234.80 ","$10,376.95 ","$6,993.00 ","$12,082.75 ", N/A ,"$6,993.00 ","$12,082.75 ","$10,376.95 ","$3,445.58 ", N/A ,"$3,959.93 ","$12,082.75 ", N/A ,"$13,077.80 ","$9,950.50 ","$5,993.67 ","$8,056.00 ","$8,656.94 ","$7,491.83 ","$9,822.57 ","$10,234.80 ","$9,900.75 ", N/A ,"$10,234.80 ","$3,652.31 ","$10,114.00 ","$10,114.00 ", N/A ,"$10,114.00 ", N/A ,"$10,234.80 ","$8,813.30 ","$10,234.80 ","$10,234.80 ","$8,529.00 "
ST MARY'S HOSPITAL,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 ","$8,739.00 ","$4,923.00 ", N/A ,"$5,521.20 ","$7,821.70 ","$6,441.40 ","$3,445.58 ","$8,741.90 ","$6,625.44 ","$6,717.46 ","$6,993.00 ","$7,821.70 ", N/A ,"$6,993.00 ","$7,821.70 ","$6,717.46 ","$3,445.58 ", N/A ,"$3,959.93 ","$7,821.70 ", N/A ,"$8,465.84 ","$6,441.40 ","$5,993.67 ","$8,056.00 ","$5,604.02 ","$7,491.83 ","$6,358.58 ","$6,625.44 ","$6,409.19 ", N/A ,"$6,625.44 ","$3,652.31 ","$8,832.00 ","$8,832.00 ", N/A ,"$8,832.00 ", N/A ,"$6,625.44 ","$5,705.24 ","$6,625.44 ","$6,625.44 ","$5,521.20 "
ST MARY'S HOSPITAL,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 ","$8,739.00 ","$4,923.00 ", N/A ,"$5,328.60 ","$7,548.85 ","$6,216.70 ","$3,445.58 ","$8,436.95 ","$6,394.32 ","$6,483.13 ","$6,993.00 ","$7,548.85 ", N/A ,"$6,993.00 ","$7,548.85 ","$6,483.13 ","$3,445.58 ", N/A ,"$3,959.93 ","$7,548.85 ", N/A ,"$8,170.52 ","$6,216.70 ","$5,993.67 ","$8,056.00 ","$5,408.53 ","$7,491.83 ","$6,136.77 ","$6,394.32 ","$6,185.62 ", N/A ,"$6,394.32 ","$3,652.31 ","$8,832.00 ","$8,832.00 ", N/A ,"$8,832.00 ", N/A ,"$6,394.32 ","$5,506.22 ","$6,394.32 ","$6,394.32 ","$5,328.60 "
ST MARY'S HOSPITAL,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 ","$1,584.00 ","$1,606.00 ","$2,200.00 ","$1,870.00 ", N/A ,"$2,200.00 ","$1,870.00 ","$1,606.00 ",$573.58 , N/A ,"$2,200.00 ","$1,870.00 ", N/A ,"$2,024.00 ","$1,540.00 ","$1,489.75 ","$2,002.44 ","$1,339.80 ","$1,862.71 ","$1,520.20 ","$1,584.00 ","$1,532.30 ", N/A ,"$1,584.00 ",$607.99 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,48100094,37253,HC US VASCULAR NON-CORON ADDL EA 37253,481,1 ,"$2,000.00 ","$1,000.00 ",$573.58 ,"$2,002.44 ",$573.58 ,"$2,000.00 ","$2,000.00 ", N/A ,"$1,200.00 ","$1,700.00 ","$1,400.00 ",$573.58 ,"$1,900.00 ","$1,440.00 ","$1,460.00 ","$2,000.00 ","$1,700.00 ", N/A ,"$2,000.00 ","$1,700.00 ","$1,460.00 ",$573.58 , N/A ,"$2,000.00 ","$1,700.00 ", N/A ,"$1,840.00 ","$1,400.00 ","$1,489.75 ","$2,002.44 ","$1,218.00 ","$1,862.71 ","$1,382.00 ","$1,440.00 ","$1,393.00 ", N/A ,"$1,440.00 ",$607.99 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,200.00 "
ST MARY'S HOSPITAL,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 ","$3,312.72 ","$3,358.73 ","$4,601.00 ","$3,910.85 ", N/A ,"$4,601.00 ","$3,910.85 ","$3,358.73 ","$2,701.18 ", N/A , N/A ,"$3,910.85 ", N/A ,"$4,232.92 ","$3,220.70 ","$2,333.63 ","$2,800.63 ","$2,802.01 ","$2,613.83 ","$3,179.29 ","$3,312.72 ","$3,204.60 ", N/A ,"$3,312.72 ","$2,863.25 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$3,312.72 ","$2,852.62 ","$3,312.72 ","$3,312.72 ","$2,760.60 "
ST MARY'S HOSPITAL,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 ","$1,584.00 ","$1,606.00 ","$2,200.00 ","$1,870.00 ", N/A ,"$2,200.00 ","$1,870.00 ","$1,606.00 ",$56.46 , N/A , N/A ,"$1,870.00 ", N/A ,"$2,024.00 ","$1,540.00 ","$1,115.84 ","$1,339.14 ","$1,339.80 ","$1,249.82 ","$1,520.20 ","$1,584.00 ","$1,532.30 ", N/A ,"$1,584.00 ",$59.85 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,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 ","$1,224.00 ","$1,241.00 ","$1,700.00 ","$1,445.00 ", N/A ,"$1,700.00 ","$1,445.00 ","$1,241.00 ",$56.46 , N/A , N/A ,"$1,445.00 ", N/A ,"$1,564.00 ","$1,190.00 ",$862.24 ,"$1,034.79 ","$1,035.30 ",$965.77 ,"$1,174.70 ","$1,224.00 ","$1,184.05 ", N/A ,"$1,224.00 ",$59.85 ,"$1,700.00 ","$1,700.00 ", N/A ,"$1,700.00 ", N/A ,"$1,224.00 ","$1,054.00 ","$1,224.00 ","$1,224.00 ","$1,020.00 "
ST MARY'S HOSPITAL,48100103,92986,HC VALVULOPLASTY AORTIC VALVE 92986,481,1 ,"$8,025.00 ","$4,012.50 ","$2,701.18 ","$10,845.30 ","$2,701.18 ","$8,025.00 ","$8,025.00 ","$4,820.13 ","$4,815.00 ","$6,821.25 ","$5,617.50 ","$2,701.18 ","$7,623.75 ","$5,778.00 ","$5,858.25 ","$2,815.00 ","$6,821.25 ","$4,820.13 ","$2,815.00 ","$6,821.25 ","$5,858.25 ","$2,701.18 ","$4,820.13 ","$7,919.86 ","$6,821.25 ","$10,845.30 ","$7,383.00 ","$5,617.50 ","$4,070.28 ","$4,884.82 ","$4,887.23 ","$4,559.00 ","$5,545.28 ","$5,778.00 ","$5,589.41 ","$4,868.33 ","$5,778.00 ","$2,863.25 ","$8,025.00 ","$8,025.00 ","$4,820.13 ","$8,025.00 ","$4,820.13 ","$5,778.00 ","$4,975.50 ","$5,778.00 ","$5,778.00 ","$4,815.00 "
ST MARY'S HOSPITAL,48100104,92987,HC VALVULOPLASTY MITRAL VALVE 92987,481,1 ,"$9,630.00 ","$4,815.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$9,630.00 ","$9,630.00 ","$9,768.54 ","$5,778.00 ","$8,185.50 ","$6,741.00 ","$2,701.18 ","$9,148.50 ","$6,933.60 ","$7,029.90 ","$2,815.00 ","$8,185.50 ","$9,768.54 ","$2,815.00 ","$8,185.50 ","$7,029.90 ","$2,701.18 ","$9,768.54 ","$9,630.00 ","$8,185.50 ","$21,979.23 ","$8,859.60 ","$6,741.00 ","$4,884.34 ","$5,861.78 ","$5,864.67 ","$5,470.80 ","$6,654.33 ","$6,933.60 ","$6,707.30 ","$9,866.23 ","$6,933.60 ","$2,863.25 ","$8,832.00 ","$8,832.00 ","$9,768.54 ","$8,832.00 ","$9,768.54 ","$6,933.60 ","$5,970.60 ","$6,933.60 ","$6,933.60 ","$5,778.00 "
ST MARY'S HOSPITAL,48100107,93451,HC CATH RIGHT HEART 93451,481,1 ,"$5,778.00 ","$2,889.00 ",$739.39 ,"$6,345.18 ",$739.39 ,"$5,778.00 ","$5,778.00 ","$2,820.08 ","$3,466.80 ","$4,911.30 ","$4,044.60 ",$739.39 ,"$5,489.10 ","$4,160.16 ","$4,217.94 ","$5,778.00 ","$4,911.30 ","$2,820.08 ","$5,778.00 ","$4,911.30 ","$4,217.94 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$4,911.30 ","$6,345.18 ","$5,315.76 ","$4,044.60 ","$2,930.60 ","$3,517.07 ","$3,518.80 ","$3,282.48 ","$3,992.60 ","$4,160.16 ","$4,024.38 ","$2,848.28 ","$4,160.16 ",$783.75 ,"$5,778.00 ","$5,778.00 ","$2,820.08 ","$5,778.00 ","$2,820.08 ","$4,160.16 ","$3,582.36 ","$4,160.16 ","$4,160.16 ","$3,466.80 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$4,494.00 ","$6,366.50 ","$5,243.00 ",$739.39 ,"$7,115.50 ","$5,392.80 ","$5,467.70 ","$6,993.00 ","$6,366.50 ","$2,820.08 ","$6,993.00 ","$6,366.50 ","$5,467.70 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$6,366.50 ","$6,345.18 ","$6,890.80 ","$5,243.00 ","$3,798.93 ","$4,559.16 ","$4,561.41 ","$4,255.07 ","$5,175.59 ","$5,392.80 ","$5,216.79 ","$2,848.28 ","$5,392.80 ",$783.75 ,"$7,490.00 ","$7,490.00 ","$2,820.08 ","$7,490.00 ","$2,820.08 ","$5,392.80 ","$4,643.80 ","$5,392.80 ","$5,392.80 ","$4,494.00 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$5,007.60 ","$7,094.10 ","$5,842.20 ",$739.39 ,"$7,928.70 ","$6,009.12 ","$6,092.58 ","$6,993.00 ","$7,094.10 ","$2,820.08 ","$6,993.00 ","$7,094.10 ","$6,092.58 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$7,094.10 ","$6,345.18 ","$7,678.32 ","$5,842.20 ","$4,233.09 ","$5,080.21 ","$5,082.71 ","$4,741.36 ","$5,767.09 ","$6,009.12 ","$5,812.99 ","$2,848.28 ","$6,009.12 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$6,009.12 ","$5,174.52 ","$6,009.12 ","$6,009.12 ","$5,007.60 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$739.39 ,"$11,181.50 ","$8,474.40 ","$8,592.10 ","$6,993.00 ","$10,004.50 ","$2,820.08 ","$6,993.00 ","$10,004.50 ","$8,592.10 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$10,004.50 ","$6,345.18 ","$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$6,686.54 ","$8,133.07 ","$8,474.40 ","$8,197.81 ","$2,848.28 ","$8,474.40 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$7,062.00 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$739.39 ,"$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ","$2,820.08 ","$6,993.00 ","$9,095.00 ","$7,811.00 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$9,095.00 ","$6,345.18 ","$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,078.67 ","$7,393.70 ","$7,704.00 ","$7,452.55 ","$2,848.28 ","$7,704.00 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$5,649.60 ","$8,003.60 ","$6,591.20 ",$739.39 ,"$8,945.20 ","$6,779.52 ","$6,873.68 ","$6,993.00 ","$8,003.60 ","$2,820.08 ","$6,993.00 ","$8,003.60 ","$6,873.68 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$8,003.60 ","$6,345.18 ","$8,662.72 ","$6,591.20 ","$4,775.80 ","$5,731.52 ","$5,734.34 ","$5,349.23 ","$6,506.46 ","$6,779.52 ","$6,558.24 ","$2,848.28 ","$6,779.52 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$6,779.52 ","$5,837.92 ","$6,779.52 ","$6,779.52 ","$5,649.60 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$6,227.40 ","$8,822.15 ","$7,265.30 ",$739.39 ,"$9,860.05 ","$7,472.88 ","$7,576.67 ","$6,993.00 ","$8,822.15 ","$2,820.08 ","$6,993.00 ","$8,822.15 ","$7,576.67 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$8,822.15 ","$6,345.18 ","$9,548.68 ","$7,265.30 ","$5,264.23 ","$6,317.70 ","$6,320.81 ","$5,896.31 ","$7,171.89 ","$7,472.88 ","$7,228.97 ","$2,848.28 ","$7,472.88 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$7,472.88 ","$6,434.98 ","$7,472.88 ","$7,472.88 ","$6,227.40 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$6,420.00 ","$9,095.00 ","$7,490.00 ",$739.39 ,"$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ","$2,820.08 ","$6,993.00 ","$9,095.00 ","$7,811.00 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$9,095.00 ","$6,345.18 ","$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,078.67 ","$7,393.70 ","$7,704.00 ","$7,452.55 ","$2,848.28 ","$7,704.00 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$5,264.40 ","$7,457.90 ","$6,141.80 ",$739.39 ,"$8,335.30 ","$6,317.28 ","$6,405.02 ","$6,993.00 ","$7,457.90 ","$2,820.08 ","$6,993.00 ","$7,457.90 ","$6,405.02 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$7,457.90 ","$6,345.18 ","$8,072.08 ","$6,141.80 ","$4,450.17 ","$5,340.73 ","$5,343.37 ","$4,984.51 ","$6,062.83 ","$6,317.28 ","$6,111.09 ","$2,848.28 ","$6,317.28 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$6,317.28 ","$5,439.88 ","$6,317.28 ","$6,317.28 ","$5,264.40 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$5,585.40 ","$7,912.65 ","$6,516.30 ",$739.39 ,"$8,843.55 ","$6,702.48 ","$6,795.57 ","$6,993.00 ","$7,912.65 ","$2,820.08 ","$6,993.00 ","$7,912.65 ","$6,795.57 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$7,912.65 ","$6,345.18 ","$8,564.28 ","$6,516.30 ","$4,721.52 ","$5,666.39 ","$5,669.18 ","$5,288.44 ","$6,432.52 ","$6,702.48 ","$6,483.72 ","$2,848.28 ","$6,702.48 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$6,702.48 ","$5,771.58 ","$6,702.48 ","$6,702.48 ","$5,585.40 "
ST MARY'S HOSPITAL,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 ","$2,820.08 ","$7,062.00 ","$10,004.50 ","$8,239.00 ",$739.39 ,"$11,181.50 ","$8,474.40 ","$8,592.10 ","$6,993.00 ","$10,004.50 ","$2,820.08 ","$6,993.00 ","$10,004.50 ","$8,592.10 ",$739.39 ,"$2,820.08 ","$5,657.04 ","$10,004.50 ","$6,345.18 ","$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$6,686.54 ","$8,133.07 ","$8,474.40 ","$8,197.81 ","$2,848.28 ","$8,474.40 ",$783.75 ,"$7,543.00 ","$7,543.00 ","$2,820.08 ","$7,543.00 ","$2,820.08 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$7,062.00 "
ST MARY'S HOSPITAL,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 ,$347.04 ,$351.86 ,$482.00 ,$409.70 , N/A ,$482.00 ,$409.70 ,$351.86 ,$13.88 , N/A , N/A ,$409.70 , N/A ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$273.82 ,$333.06 ,$347.04 ,$335.71 , N/A ,$347.04 ,$14.71 ,$482.00 ,$482.00 , N/A ,$482.00 , N/A ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,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 ,$608.40 ,$616.85 ,$845.00 ,$718.25 , N/A ,$845.00 ,$718.25 ,$616.85 ,$95.13 , N/A , N/A ,$718.25 , N/A ,$777.40 ,$591.50 ,$428.58 ,$514.35 ,$514.61 ,$480.04 ,$583.90 ,$608.40 ,$588.54 , N/A ,$608.40 ,$100.84 ,$845.00 ,$845.00 , N/A ,$845.00 , N/A ,$608.40 ,$523.90 ,$608.40 ,$608.40 ,$507.00 
ST MARY'S HOSPITAL,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 ","$1,080.00 ","$1,095.00 ","$1,500.00 ","$1,275.00 ", N/A ,"$1,500.00 ","$1,275.00 ","$1,095.00 ",$573.58 , N/A ,"$1,500.00 ","$1,275.00 ", N/A ,"$1,380.00 ","$1,050.00 ",$760.80 ,$913.05 ,$913.50 ,$852.15 ,"$1,036.50 ","$1,080.00 ","$1,044.75 ", N/A ,"$1,080.00 ",$607.99 ,"$1,500.00 ","$1,500.00 ", N/A ,"$1,500.00 ", N/A ,"$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ",$900.00 
ST MARY'S HOSPITAL,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 ,$561.60 ,$569.40 ,$780.00 ,$663.00 , N/A ,$780.00 ,$663.00 ,$569.40 ,$573.58 , N/A , N/A ,$663.00 , N/A ,$717.60 ,$546.00 ,$395.62 ,$474.79 ,$475.02 ,$443.12 ,$538.98 ,$561.60 ,$543.27 , N/A ,$561.60 ,$607.99 ,$780.00 ,$780.00 , N/A ,$780.00 , N/A ,$561.60 ,$483.60 ,$561.60 ,$561.60 ,$468.00 
ST MARY'S HOSPITAL,48100122,93580,HC PTC W/IMPLNT ATRIAL 93580,481,1 ,"$11,770.00 ","$5,885.00 ","$3,174.49 ","$35,142.61 ","$3,174.49 ","$11,770.00 ","$11,770.00 ","$15,618.94 ","$7,062.00 ","$10,004.50 ","$8,239.00 ","$3,174.49 ","$11,181.50 ","$8,474.40 ","$8,592.10 ","$6,993.00 ","$10,004.50 ","$15,618.94 ","$6,993.00 ","$10,004.50 ","$8,592.10 ","$3,174.49 ","$15,618.94 ","$11,770.00 ","$10,004.50 ","$35,142.61 ","$10,828.40 ","$8,239.00 ","$5,969.74 ","$7,164.40 ","$7,167.93 ","$6,686.54 ","$8,133.07 ","$8,474.40 ","$8,197.81 ","$15,775.13 ","$8,474.40 ","$3,364.96 ","$11,770.00 ","$11,770.00 ","$15,618.94 ","$11,770.00 ","$15,618.94 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$7,062.00 "
ST MARY'S HOSPITAL,48100123,93600,HC HIS BUNDLE RECORDING,481,1 ,"$3,638.00 ","$1,819.00 ","$1,819.00 ","$13,300.55 ","$1,946.45 ","$3,638.00 ","$3,638.00 ","$5,911.35 ","$2,182.80 ","$3,092.30 ","$2,546.60 ","$1,946.45 ","$3,456.10 ","$2,619.36 ","$2,655.74 ","$3,638.00 ","$3,092.30 ","$5,911.35 ","$3,638.00 ","$3,092.30 ","$2,655.74 ","$1,946.45 ","$5,911.35 ","$3,638.00 ","$3,092.30 ","$13,300.55 ","$3,346.96 ","$2,546.60 ","$1,845.19 ","$2,214.45 ","$2,215.54 ","$2,066.75 ","$2,513.86 ","$2,619.36 ","$2,533.87 ","$5,970.46 ","$2,619.36 ","$2,063.24 ","$3,638.00 ","$3,638.00 ","$5,911.35 ","$3,638.00 ","$5,911.35 ","$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,182.80 "
ST MARY'S HOSPITAL,48100124,93602,HC INTRA-ATRIAL RECORDING,481,1 ,"$3,782.00 ","$1,891.00 ","$1,891.00 ","$13,300.55 ","$1,946.45 ","$3,782.00 ","$3,782.00 ","$5,911.35 ","$2,269.20 ","$3,214.70 ","$2,647.40 ","$1,946.45 ","$3,592.90 ","$2,723.04 ","$2,760.86 ","$3,782.00 ","$3,214.70 ","$5,911.35 ","$3,782.00 ","$3,214.70 ","$2,760.86 ","$1,946.45 ","$5,911.35 ","$3,782.00 ","$3,214.70 ","$13,300.55 ","$3,479.44 ","$2,647.40 ","$1,918.23 ","$2,302.10 ","$2,303.24 ","$2,148.55 ","$2,613.36 ","$2,723.04 ","$2,634.16 ","$5,970.46 ","$2,723.04 ","$2,063.24 ","$3,782.00 ","$3,782.00 ","$5,911.35 ","$3,782.00 ","$5,911.35 ","$2,723.04 ","$2,344.84 ","$2,723.04 ","$2,723.04 ","$2,269.20 "
ST MARY'S HOSPITAL,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 ","$2,719.44 ","$2,757.21 ","$3,777.00 ","$3,210.45 ", N/A ,"$3,777.00 ","$3,210.45 ","$2,757.21 ","$5,133.18 ", 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 ","$2,145.71 ","$2,609.91 ","$2,719.44 ","$2,630.68 ", N/A ,"$2,719.44 ","$5,441.17 ","$3,777.00 ","$3,777.00 ", N/A ,"$3,777.00 ", N/A ,"$2,719.44 ","$2,341.74 ","$2,719.44 ","$2,719.44 ","$2,266.20 "
ST MARY'S HOSPITAL,48100126,93612,HC EP INTRAVENTRIC PACING,481,1 ,"$5,152.00 ","$2,576.00 ","$1,946.45 ","$13,300.55 ","$1,946.45 ","$5,152.00 ","$5,152.00 ","$5,911.35 ","$3,091.20 ","$4,379.20 ","$3,606.40 ","$1,946.45 ","$4,894.40 ","$3,709.44 ","$3,760.96 ","$5,152.00 ","$4,379.20 ","$5,911.35 ","$5,152.00 ","$4,379.20 ","$3,760.96 ","$1,946.45 ","$5,911.35 ","$5,152.00 ","$4,379.20 ","$13,300.55 ","$4,739.84 ","$3,606.40 ","$2,613.09 ","$3,136.02 ","$3,137.57 ","$2,926.85 ","$3,560.03 ","$3,709.44 ","$3,588.37 ","$5,970.46 ","$3,709.44 ","$2,063.24 ","$5,152.00 ","$5,152.00 ","$5,911.35 ","$5,152.00 ","$5,911.35 ","$3,709.44 ","$3,194.24 ","$3,709.44 ","$3,709.44 ","$3,091.20 "
ST MARY'S HOSPITAL,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 ","$7,704.00 ","$7,811.00 ","$10,700.00 ","$9,095.00 ", N/A ,"$10,700.00 ","$9,095.00 ","$7,811.00 ","$5,133.18 ", 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 ","$6,078.67 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$5,441.17 ","$6,801.00 ","$6,801.00 ", N/A ,"$6,801.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,48100128,93619,HC EP COMPREHENSIVE W/O ARRHYTHMI 93619,481,1 ,"$8,400.00 ","$4,200.00 ","$4,200.00 ","$13,300.55 ","$5,133.18 ","$8,400.00 ","$8,400.00 ","$5,911.35 ","$5,040.00 ","$7,140.00 ","$5,880.00 ","$5,133.18 ","$7,980.00 ","$6,048.00 ","$6,132.00 ","$8,400.00 ","$7,140.00 ","$5,911.35 ","$8,400.00 ","$7,140.00 ","$6,132.00 ","$5,133.18 ","$5,911.35 ","$8,400.00 ","$7,140.00 ","$13,300.55 ","$7,728.00 ","$5,880.00 ","$4,260.48 ","$5,113.08 ","$5,115.60 ","$4,772.04 ","$5,804.40 ","$6,048.00 ","$5,850.60 ","$5,970.46 ","$6,048.00 ","$5,441.17 ","$8,400.00 ","$8,400.00 ","$5,911.35 ","$8,400.00 ","$5,911.35 ","$6,048.00 ","$5,208.00 ","$6,048.00 ","$6,048.00 ","$5,040.00 "
ST MARY'S HOSPITAL,48100129,93620,HC EP COMPREHENSIVE W/ ARRHYTHMIA 93620,481,1 ,"$7,952.00 ","$3,976.00 ","$3,976.00 ","$13,300.55 ","$5,133.18 ","$7,952.00 ","$7,952.00 ","$5,911.35 ","$4,771.20 ","$6,759.20 ","$5,566.40 ","$5,133.18 ","$7,554.40 ","$5,725.44 ","$5,804.96 ","$7,952.00 ","$6,759.20 ","$5,911.35 ","$7,952.00 ","$6,759.20 ","$5,804.96 ","$5,133.18 ","$5,911.35 ","$7,952.00 ","$6,759.20 ","$13,300.55 ","$7,315.84 ","$5,566.40 ","$4,033.25 ","$4,840.38 ","$4,842.77 ","$4,517.53 ","$5,494.83 ","$5,725.44 ","$5,538.57 ","$5,970.46 ","$5,725.44 ","$5,441.17 ","$7,952.00 ","$7,952.00 ","$5,911.35 ","$7,952.00 ","$5,911.35 ","$5,725.44 ","$4,930.24 ","$5,725.44 ","$5,725.44 ","$4,771.20 "
ST MARY'S HOSPITAL,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 ","$5,644.80 ","$5,723.20 ","$7,840.00 ","$6,664.00 ", N/A ,"$7,840.00 ","$6,664.00 ","$5,723.20 ","$5,133.18 ", 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 ","$4,453.90 ","$5,417.44 ","$5,644.80 ","$5,460.56 ", N/A ,"$5,644.80 ","$5,441.17 ","$6,801.00 ","$6,801.00 ", N/A ,"$6,801.00 ", N/A ,"$5,644.80 ","$4,860.80 ","$5,644.80 ","$5,644.80 ","$4,704.00 "
ST MARY'S HOSPITAL,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 ","$3,870.72 ","$3,924.48 ","$5,376.00 ","$4,569.60 ", N/A ,"$5,376.00 ","$4,569.60 ","$3,924.48 ","$5,133.18 ", 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 ","$3,054.11 ","$3,714.82 ","$3,870.72 ","$3,744.38 ", N/A ,"$3,870.72 ","$5,441.17 ","$5,376.00 ","$5,376.00 ", N/A ,"$5,376.00 ", N/A ,"$3,870.72 ","$3,333.12 ","$3,870.72 ","$3,870.72 ","$3,225.60 "
ST MARY'S HOSPITAL,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 ","$2,003.04 ","$2,030.86 ","$2,782.00 ","$2,364.70 ", N/A ,"$2,782.00 ","$2,364.70 ","$2,030.86 ","$5,133.18 ", 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 ","$1,580.45 ","$1,922.36 ","$2,003.04 ","$1,937.66 ", N/A ,"$2,003.04 ","$5,441.17 ","$2,782.00 ","$2,782.00 ", N/A ,"$2,782.00 ", N/A ,"$2,003.04 ","$1,724.84 ","$2,003.04 ","$2,003.04 ","$1,669.20 "
ST MARY'S HOSPITAL,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 ","$1,774.08 ","$1,798.72 ","$2,464.00 ","$2,094.40 ", N/A ,"$2,464.00 ","$2,094.40 ","$1,798.72 ","$1,946.45 ", N/A , N/A ,"$2,094.40 ", N/A ,"$2,266.88 ","$1,724.80 ","$1,249.74 ","$1,499.84 ","$1,500.58 ","$1,399.80 ","$1,702.62 ","$1,774.08 ","$1,716.18 ", N/A ,"$1,774.08 ","$2,063.24 ","$2,464.00 ","$2,464.00 ", N/A ,"$2,464.00 ", N/A ,"$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,478.40 "
ST MARY'S HOSPITAL,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 ","$1,774.08 ","$1,798.72 ","$2,464.00 ","$2,094.40 ", N/A ,"$2,464.00 ","$2,094.40 ","$1,798.72 ","$1,946.45 ", N/A , N/A ,"$2,094.40 ", N/A ,"$2,266.88 ","$1,724.80 ","$1,249.74 ","$1,499.84 ","$1,500.58 ","$1,399.80 ","$1,702.62 ","$1,774.08 ","$1,716.18 ", N/A ,"$1,774.08 ","$2,063.24 ","$2,464.00 ","$2,464.00 ", N/A ,"$2,464.00 ", N/A ,"$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,478.40 "
ST MARY'S HOSPITAL,48100135,93642,HC EP EVAL CARDIO/DEFIB SGL/DUAL 93642,481,1 ,"$2,464.00 ","$1,232.00 ","$1,083.19 ","$2,464.00 ","$1,946.45 ", N/A , N/A ,"$1,083.19 ","$1,478.40 ","$2,094.40 ","$1,724.80 ","$1,946.45 ","$2,340.80 ","$1,774.08 ","$1,798.72 ","$2,464.00 ","$2,094.40 ","$1,083.19 ","$2,464.00 ","$2,094.40 ","$1,798.72 ","$1,946.45 ","$1,083.19 ", N/A ,"$2,094.40 ","$2,437.18 ","$2,266.88 ","$1,724.80 ","$1,249.74 ","$1,499.84 ","$1,500.58 ","$1,399.80 ","$1,702.62 ","$1,774.08 ","$1,716.18 ","$1,094.02 ","$1,774.08 ","$2,063.24 ","$2,464.00 ","$2,464.00 ","$1,083.19 ","$2,464.00 ","$1,083.19 ","$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,478.40 "
ST MARY'S HOSPITAL,48100136,93650,HC ABLATION ATRIOVENTRICULAR FNCT 93650,481,1 ,"$5,671.00 ","$2,835.50 ","$2,835.50 ","$13,300.55 ","$5,133.18 ","$5,671.00 ","$5,671.00 ","$5,911.35 ","$3,402.60 ","$4,820.35 ","$3,969.70 ","$5,133.18 ","$5,387.45 ","$4,083.12 ","$4,139.83 ","$5,671.00 ","$4,820.35 ","$5,911.35 ","$5,671.00 ","$4,820.35 ","$4,139.83 ","$5,133.18 ","$5,911.35 ","$5,671.00 ","$4,820.35 ","$13,300.55 ","$5,217.32 ","$3,969.70 ","$2,876.33 ","$3,451.94 ","$3,453.64 ","$3,221.70 ","$3,918.66 ","$4,083.12 ","$3,949.85 ","$5,970.46 ","$4,083.12 ","$5,441.17 ","$5,671.00 ","$5,671.00 ","$5,911.35 ","$5,671.00 ","$5,911.35 ","$4,083.12 ","$3,516.02 ","$4,083.12 ","$4,083.12 ","$3,402.60 "
ST MARY'S HOSPITAL,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 ",$474.72 ,"$1,050.60 ","$1,488.35 ","$1,225.70 ",$52.64 ,"$1,663.45 ","$1,260.72 ","$1,278.23 ","$1,751.00 ","$1,488.35 ",$474.72 ,"$1,751.00 ","$1,488.35 ","$1,278.23 ",$52.64 ,$474.72 ,"$1,751.00 ","$1,488.35 ","$1,068.12 ","$1,610.92 ","$1,225.70 ",$888.11 ,"$1,065.83 ","$1,066.36 ",$994.74 ,"$1,209.94 ","$1,260.72 ","$1,219.57 ",$479.47 ,"$1,260.72 ",$55.80 ,"$1,751.00 ","$1,751.00 ",$474.72 ,"$1,751.00 ",$474.72 ,"$1,260.72 ","$1,085.62 ","$1,260.72 ","$1,260.72 ","$1,050.60 "
ST MARY'S HOSPITAL,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 ","$2,743.92 ","$2,782.03 ","$3,811.00 ","$3,239.35 ", N/A ,"$3,811.00 ","$3,239.35 ","$2,782.03 ","$5,133.18 ", N/A , N/A ,"$3,239.35 ", N/A ,"$3,506.12 ","$2,667.70 ","$1,932.94 ","$2,319.76 ","$2,320.90 ","$2,165.03 ","$2,633.40 ","$2,743.92 ","$2,654.36 ", N/A ,"$2,743.92 ","$5,441.17 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$2,743.92 ","$2,362.82 ","$2,743.92 ","$2,743.92 ","$2,286.60 "
ST MARY'S HOSPITAL,48100150,93503,HC PLACEMENT SWANZ GAN CATH MONIT 93503,481,1 ,"$2,675.00 ","$1,337.50 ",$353.23 ,"$3,077.03 ",$353.23 ,"$2,675.00 ","$2,675.00 ","$1,367.57 ","$1,605.00 ","$2,273.75 ","$1,872.50 ",$353.23 ,"$2,541.25 ","$1,926.00 ","$1,952.75 ","$2,675.00 ","$2,273.75 ","$1,367.57 ","$2,675.00 ","$2,273.75 ","$1,952.75 ",$353.23 ,"$1,367.57 ","$2,675.00 ","$2,273.75 ","$3,077.03 ","$2,461.00 ","$1,872.50 ","$1,356.76 ","$1,628.27 ","$1,629.08 ","$1,519.67 ","$1,848.43 ","$1,926.00 ","$1,863.14 ","$1,381.25 ","$1,926.00 ",$374.42 ,"$2,675.00 ","$2,675.00 ","$1,367.57 ","$2,675.00 ","$1,367.57 ","$1,926.00 ","$1,658.50 ","$1,926.00 ","$1,926.00 ","$1,605.00 "
ST MARY'S HOSPITAL,48100151,33227,HC REM/REPL PCMKR PUL GEN SGL 33227,481,1 ,"$5,564.00 ","$2,782.00 ","$2,606.72 ","$17,852.44 ","$2,606.72 ","$5,564.00 ","$5,564.00 ","$7,934.42 ","$3,338.40 ","$4,729.40 ","$3,894.80 ","$2,606.72 ","$5,285.80 ","$4,006.08 ","$4,061.72 ","$5,564.00 ","$4,729.40 ","$7,934.42 ","$5,564.00 ","$4,729.40 ","$4,061.72 ","$2,606.72 ","$7,934.42 ","$5,564.00 ","$4,729.40 ","$17,852.44 ","$5,118.88 ","$3,894.80 ","$5,993.67 ","$8,056.00 ","$3,388.48 ","$7,491.83 ","$3,844.72 ","$4,006.08 ","$3,875.33 ","$8,013.76 ","$4,006.08 ","$2,763.12 ","$5,564.00 ","$5,564.00 ","$7,934.42 ","$5,564.00 ","$7,934.42 ","$4,006.08 ","$3,449.68 ","$4,006.08 ","$4,006.08 ","$3,338.40 "
ST MARY'S HOSPITAL,48100152,33228,HC REM/REPL PCMKR PUL GEN DUAL 33228,481,1 ,"$6,313.00 ","$3,156.50 ","$2,606.72 ","$22,752.32 ","$2,606.72 ","$6,313.00 ","$6,313.00 ","$10,112.14 ","$3,787.80 ","$5,366.05 ","$4,419.10 ","$2,606.72 ","$5,997.35 ","$4,545.36 ","$4,608.49 ","$6,313.00 ","$5,366.05 ","$10,112.14 ","$6,313.00 ","$5,366.05 ","$4,608.49 ","$2,606.72 ","$10,112.14 ","$6,313.00 ","$5,366.05 ","$22,752.32 ","$5,807.96 ","$4,419.10 ","$5,993.67 ","$8,056.00 ","$3,844.62 ","$7,491.83 ","$4,362.28 ","$4,545.36 ","$4,397.00 ","$10,213.26 ","$4,545.36 ","$2,763.12 ","$6,313.00 ","$6,313.00 ","$10,112.14 ","$6,313.00 ","$10,112.14 ","$4,545.36 ","$3,914.06 ","$4,545.36 ","$4,545.36 ","$3,787.80 "
ST MARY'S HOSPITAL,48100153,33229,HC REM/REPL PCMKR PUL GEN MULT 33229,481,1 ,"$8,667.00 ","$4,333.50 ","$2,606.72 ","$40,752.80 ","$2,606.72 ","$8,667.00 ","$8,667.00 ","$18,112.36 ","$5,200.20 ","$7,366.95 ","$6,066.90 ","$2,606.72 ","$8,233.65 ","$6,240.24 ","$6,326.91 ","$8,667.00 ","$7,366.95 ","$18,112.36 ","$8,667.00 ","$7,366.95 ","$6,326.91 ","$2,606.72 ","$18,112.36 ","$8,667.00 ","$7,366.95 ","$40,752.80 ","$7,973.64 ","$6,066.90 ","$5,993.67 ","$8,056.00 ","$5,278.20 ","$7,491.83 ","$5,988.90 ","$6,240.24 ","$6,036.57 ","$18,293.48 ","$6,240.24 ","$2,763.12 ","$8,667.00 ","$8,667.00 ","$18,112.36 ","$8,667.00 ","$18,112.36 ","$6,240.24 ","$5,373.54 ","$6,240.24 ","$6,240.24 ","$5,200.20 "
ST MARY'S HOSPITAL,48100154,33262,HC REM/REPL DEFIB PUL GEN SGL 33262,481,1 ,"$13,910.00 ","$6,955.00 ","$5,993.67 ","$50,458.64 ","$7,815.70 ","$13,910.00 ","$13,525.00 ","$22,426.06 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$7,815.70 ","$13,214.50 ","$10,015.20 ","$10,154.30 ","$13,910.00 ","$11,823.50 ","$22,426.06 ","$13,910.00 ","$11,823.50 ","$10,154.30 ","$7,815.70 ","$22,426.06 ","$13,910.00 ","$11,823.50 ","$50,458.64 ","$12,797.20 ","$9,737.00 ","$5,993.67 ","$8,056.00 ","$8,471.19 ","$7,491.83 ","$9,611.81 ","$10,015.20 ","$9,688.32 ","$22,650.32 ","$10,015.20 ","$8,284.64 ","$13,910.00 ","$13,910.00 ","$22,426.06 ","$13,910.00 ","$22,426.06 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$8,346.00 "
ST MARY'S HOSPITAL,48100155,33263,HC REM/REPL DEFIB PUL GEN DUAL 33263,481,1 ,"$13,910.00 ","$6,955.00 ","$5,993.67 ","$50,458.64 ","$7,815.70 ","$13,910.00 ","$13,525.00 ","$22,426.06 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$7,815.70 ","$13,214.50 ","$10,015.20 ","$10,154.30 ","$13,910.00 ","$11,823.50 ","$22,426.06 ","$13,910.00 ","$11,823.50 ","$10,154.30 ","$7,815.70 ","$22,426.06 ","$13,910.00 ","$11,823.50 ","$50,458.64 ","$12,797.20 ","$9,737.00 ","$5,993.67 ","$8,056.00 ","$8,471.19 ","$7,491.83 ","$9,611.81 ","$10,015.20 ","$9,688.32 ","$22,650.32 ","$10,015.20 ","$8,284.64 ","$13,910.00 ","$13,910.00 ","$22,426.06 ","$13,910.00 ","$22,426.06 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$8,346.00 "
ST MARY'S HOSPITAL,48100156,33264,HC REM/REPL DEFIB PUL GEN MULT 33264,481,1 ,"$18,190.00 ","$9,095.00 ","$5,993.67 ","$71,875.85 ","$7,815.70 ","$18,190.00 ","$13,525.00 ","$31,944.82 ","$10,914.00 ","$15,461.50 ","$12,733.00 ","$7,815.70 ","$17,280.50 ","$13,096.80 ","$13,278.70 ","$18,190.00 ","$15,461.50 ","$31,944.82 ","$18,190.00 ","$15,461.50 ","$13,278.70 ","$7,815.70 ","$31,944.82 ","$18,190.00 ","$15,461.50 ","$71,875.85 ","$16,734.80 ","$12,733.00 ","$5,993.67 ","$8,056.00 ","$11,077.71 ","$7,491.83 ","$12,569.29 ","$13,096.80 ","$12,669.34 ","$32,264.27 ","$13,096.80 ","$8,284.64 ","$18,190.00 ","$18,190.00 ","$31,944.82 ","$18,190.00 ","$31,944.82 ","$13,096.80 ","$11,277.80 ","$13,096.80 ","$13,096.80 ","$10,914.00 "
ST MARY'S HOSPITAL,48100157,0075T,HC TRANSCATH XCRAN STENT PLCMT,481,1 ,"$8,295.00 ","$4,147.50 ","$1,851.24 ","$8,295.00 ","$1,851.24 ","$7,283.00 ","$6,763.00 ", N/A ,"$4,977.00 ","$7,050.75 ","$5,806.50 ","$1,851.24 ","$7,880.25 ","$5,972.40 ","$6,055.35 ","$6,993.00 ","$7,050.75 ", N/A ,"$6,993.00 ","$7,050.75 ","$6,055.35 ","$1,851.24 ", N/A ,"$8,295.00 ","$7,050.75 ", N/A ,"$7,631.40 ","$5,806.50 ","$5,993.67 ","$8,056.00 ","$5,051.66 ","$7,491.83 ","$5,731.85 ","$5,972.40 ","$5,777.47 ", N/A ,"$5,972.40 ","$1,962.31 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$5,972.40 ","$5,142.90 ","$5,972.40 ","$5,972.40 ","$4,977.00 "
ST MARY'S HOSPITAL,48100158,0237T,HC ARTHERECTOMY BRACHIOCEPHA PERC 0237T,481,1 ,"$10,849.00 ","$5,424.50 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$10,849.00 ","$10,849.00 ","$9,768.54 ","$6,509.40 ","$9,221.65 ","$7,594.30 ","$3,445.58 ","$10,306.55 ","$7,811.28 ","$7,919.77 ","$6,993.00 ","$9,221.65 ","$9,768.54 ","$6,993.00 ","$9,221.65 ","$7,919.77 ","$3,445.58 ","$9,768.54 ","$10,849.00 ","$9,221.65 ","$21,979.23 ","$9,981.08 ","$7,594.30 ","$5,993.67 ","$8,056.00 ","$6,607.04 ","$7,491.83 ","$7,496.66 ","$7,811.28 ","$7,556.33 ","$9,866.23 ","$7,811.28 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$7,811.28 ","$6,726.38 ","$7,811.28 ","$7,811.28 ","$6,509.40 "
ST MARY'S HOSPITAL,48100160,33270,HC INS/REP SUBQ DEFIBRILLATOR 33270,481,1 ,"$25,129.00 ","$12,564.50 ","$5,993.67 ","$71,875.85 ","$7,815.70 ","$19,768.00 ","$13,525.00 ","$31,944.82 ","$15,077.40 ","$21,359.65 ","$17,590.30 ","$7,815.70 ","$23,872.55 ","$18,092.88 ","$18,344.17 ","$6,993.00 ","$21,359.65 ","$31,944.82 ","$6,993.00 ","$21,359.65 ","$18,344.17 ","$7,815.70 ","$31,944.82 ","$18,996.34 ","$21,359.65 ","$71,875.85 ","$23,118.68 ","$17,590.30 ","$5,993.67 ","$8,056.00 ","$15,303.56 ","$7,491.83 ","$17,364.14 ","$18,092.88 ","$17,502.35 ","$32,264.27 ","$18,092.88 ","$8,284.64 ","$25,129.00 ","$25,129.00 ","$31,944.82 ","$25,129.00 ","$31,944.82 ","$18,092.88 ","$15,579.98 ","$18,092.88 ","$18,092.88 ","$15,077.40 "
ST MARY'S HOSPITAL,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 ","$4,083.12 ","$4,139.83 ","$5,671.00 ","$4,820.35 ", N/A ,"$5,671.00 ","$4,820.35 ","$4,139.83 ",$739.39 , N/A , N/A ,"$4,820.35 ", N/A ,"$5,217.32 ","$3,969.70 ","$2,876.33 ","$3,451.94 ","$3,453.64 ","$3,221.70 ","$3,918.66 ","$4,083.12 ","$3,949.85 ", N/A ,"$4,083.12 ",$783.75 ,"$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$4,083.12 ","$3,516.02 ","$4,083.12 ","$4,083.12 ","$3,402.60 "
ST MARY'S HOSPITAL,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 ",$882.00 ,$894.25 ,"$1,225.00 ","$1,041.25 ", N/A ,"$1,225.00 ","$1,041.25 ",$894.25 ,$95.13 , N/A , N/A ,"$1,041.25 ", N/A ,"$1,127.00 ",$857.50 ,$621.32 ,$745.66 ,$746.03 ,$695.92 ,$846.48 ,$882.00 ,$853.21 , N/A ,$882.00 ,$100.84 ,"$1,225.00 ","$1,225.00 ", N/A ,"$1,225.00 ", N/A ,$882.00 ,$759.50 ,$882.00 ,$882.00 ,$735.00 
ST MARY'S HOSPITAL,48100171,36253,HC PLC CATH RENAL ANGIO 1< UNI,481,1 ,"$2,464.00 ","$1,232.00 ","$1,232.00 ","$10,434.71 ","$1,293.09 ","$2,464.00 ","$2,464.00 ","$4,637.65 ","$1,478.40 ","$2,094.40 ","$1,724.80 ","$1,293.09 ","$2,340.80 ","$1,774.08 ","$1,798.72 ","$2,464.00 ","$2,094.40 ","$4,637.65 ","$2,464.00 ","$2,094.40 ","$1,798.72 ","$1,293.09 ","$4,637.65 ","$2,464.00 ","$2,094.40 ","$10,434.71 ","$2,266.88 ","$1,724.80 ","$1,489.75 ","$2,002.44 ","$1,500.58 ","$1,862.71 ","$1,702.62 ","$1,774.08 ","$1,716.18 ","$4,684.03 ","$1,774.08 ","$1,370.68 ","$2,464.00 ","$2,464.00 ","$4,637.65 ","$2,464.00 ","$4,637.65 ","$1,774.08 ","$1,527.68 ","$1,774.08 ","$1,774.08 ","$1,478.40 "
ST MARY'S HOSPITAL,48100173,37193,HC FILTER REMOVAL,481,1 ,"$5,885.00 ","$2,942.50 ","$1,123.24 ","$8,056.00 ","$1,123.24 ","$5,885.00 ","$5,885.00 ","$2,784.00 ","$3,531.00 ","$5,002.25 ","$4,119.50 ","$1,123.24 ","$5,590.75 ","$4,237.20 ","$4,296.05 ","$5,885.00 ","$5,002.25 ","$2,784.00 ","$5,885.00 ","$5,002.25 ","$4,296.05 ","$1,123.24 ","$2,784.00 ","$5,657.04 ","$5,002.25 ","$6,263.99 ","$5,414.20 ","$4,119.50 ","$5,993.67 ","$8,056.00 ","$3,583.97 ","$7,491.83 ","$4,066.54 ","$4,237.20 ","$4,098.90 ","$2,811.84 ","$4,237.20 ","$1,190.63 ","$5,885.00 ","$5,885.00 ","$2,784.00 ","$5,885.00 ","$2,784.00 ","$4,237.20 ","$3,648.70 ","$4,237.20 ","$4,237.20 ","$3,531.00 "
ST MARY'S HOSPITAL,48100174,33230,HC INS DEFIB PULSE GEN W/EST DUAL,481,1 ,"$15,103.00 ","$7,551.50 ","$5,993.67 ","$50,458.64 ","$7,815.70 ","$15,103.00 ","$13,525.00 ","$22,426.06 ","$9,061.80 ","$12,837.55 ","$10,572.10 ","$7,815.70 ","$14,347.85 ","$10,874.16 ","$11,025.19 ","$15,103.00 ","$12,837.55 ","$22,426.06 ","$15,103.00 ","$12,837.55 ","$11,025.19 ","$7,815.70 ","$22,426.06 ","$15,103.00 ","$12,837.55 ","$50,458.64 ","$13,894.76 ","$10,572.10 ","$5,993.67 ","$8,056.00 ","$9,197.73 ","$7,491.83 ","$10,436.17 ","$10,874.16 ","$10,519.24 ","$22,650.32 ","$10,874.16 ","$8,284.64 ","$15,103.00 ","$15,103.00 ","$22,426.06 ","$15,103.00 ","$22,426.06 ","$10,874.16 ","$9,363.86 ","$10,874.16 ","$10,874.16 ","$9,061.80 "
ST MARY'S HOSPITAL,48100175,33231,HC INS DEFIB PULSE GEN W/EST MULT,481,1 ,"$16,280.00 ","$8,140.00 ","$5,993.67 ","$71,875.85 ","$7,815.70 ","$16,280.00 ","$13,525.00 ","$31,944.82 ","$9,768.00 ","$13,838.00 ","$11,396.00 ","$7,815.70 ","$15,466.00 ","$11,721.60 ","$11,884.40 ","$16,280.00 ","$13,838.00 ","$31,944.82 ","$16,280.00 ","$13,838.00 ","$11,884.40 ","$7,815.70 ","$31,944.82 ","$16,280.00 ","$13,838.00 ","$71,875.85 ","$14,977.60 ","$11,396.00 ","$5,993.67 ","$8,056.00 ","$9,914.52 ","$7,491.83 ","$11,249.48 ","$11,721.60 ","$11,339.02 ","$32,264.27 ","$11,721.60 ","$8,284.64 ","$16,280.00 ","$16,280.00 ","$31,944.82 ","$16,280.00 ","$31,944.82 ","$11,721.60 ","$10,093.60 ","$11,721.60 ","$11,721.60 ","$9,768.00 "
ST MARY'S HOSPITAL,48100176,37216,HC PL STENT TRNSCATH CAROT ART W/O,481,1 ,"$5,500.00 ","$2,750.00 ","$2,750.00 ","$8,056.00 ","$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 ","$3,960.00 ","$4,015.00 ","$5,500.00 ","$4,675.00 ", N/A ,"$5,500.00 ","$4,675.00 ","$4,015.00 ","$3,529.80 ", N/A ,"$5,500.00 ","$4,675.00 ", N/A ,"$5,060.00 ","$3,850.00 ","$5,993.67 ","$8,056.00 ","$3,349.50 ","$7,491.83 ","$3,800.50 ","$3,960.00 ","$3,830.75 ", N/A ,"$3,960.00 ","$3,741.59 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$3,960.00 ","$3,410.00 ","$3,960.00 ","$3,960.00 ","$3,300.00 "
ST MARY'S HOSPITAL,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 ,$508.32 ,$515.38 ,$706.00 ,$600.10 , N/A ,$706.00 ,$600.10 ,$515.38 ,$52.64 , N/A , N/A ,$600.10 , N/A ,$649.52 ,$494.20 ,$358.08 ,$429.74 ,$429.95 ,$401.08 ,$487.85 ,$508.32 ,$491.73 , N/A ,$508.32 ,$55.80 ,$706.00 ,$706.00 , N/A ,$706.00 , N/A ,$508.32 ,$437.72 ,$508.32 ,$508.32 ,$423.60 
ST MARY'S HOSPITAL,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 ",$816.48 ,$827.82 ,"$1,134.00 ",$963.90 , N/A ,"$1,134.00 ",$963.90 ,$827.82 ,$95.13 , N/A , N/A ,$963.90 , N/A ,"$1,043.28 ",$793.80 ,$575.16 ,$690.27 ,$690.61 ,$644.23 ,$783.59 ,$816.48 ,$789.83 , N/A ,$816.48 ,$100.84 ,"$1,134.00 ","$1,134.00 ", N/A ,"$1,134.00 ", N/A ,$816.48 ,$703.08 ,$816.48 ,$816.48 ,$680.40 
ST MARY'S HOSPITAL,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 ","$1,059.12 ","$1,073.83 ","$1,471.00 ","$1,250.35 ", N/A ,"$1,471.00 ","$1,250.35 ","$1,073.83 ",$95.13 , N/A , N/A ,"$1,250.35 ", N/A ,"$1,353.32 ","$1,029.70 ",$746.09 ,$895.40 ,$895.84 ,$835.68 ,"$1,016.46 ","$1,059.12 ","$1,024.55 ", N/A ,"$1,059.12 ",$100.84 ,"$1,471.00 ","$1,471.00 ", N/A ,"$1,471.00 ", N/A ,"$1,059.12 ",$912.02 ,"$1,059.12 ","$1,059.12 ",$882.60 
ST MARY'S HOSPITAL,48100181,37212,HC VENOUS THROMBOLYSIS; INIT DAY 37212,481,1 ,"$3,100.00 ","$1,550.00 ","$1,123.24 ","$8,056.00 ","$1,123.24 ","$3,100.00 ","$3,100.00 ","$2,784.00 ","$1,860.00 ","$2,635.00 ","$2,170.00 ","$1,123.24 ","$2,945.00 ","$2,232.00 ","$2,263.00 ","$3,100.00 ","$2,635.00 ","$2,784.00 ","$3,100.00 ","$2,635.00 ","$2,263.00 ","$1,123.24 ","$2,784.00 ","$3,100.00 ","$2,635.00 ","$6,263.99 ","$2,852.00 ","$2,170.00 ","$5,993.67 ","$8,056.00 ","$1,887.90 ","$7,491.83 ","$2,142.10 ","$2,232.00 ","$2,159.15 ","$2,811.84 ","$2,232.00 ","$1,190.63 ","$3,100.00 ","$3,100.00 ","$2,784.00 ","$3,100.00 ","$2,784.00 ","$2,232.00 ","$1,922.00 ","$2,232.00 ","$2,232.00 ","$1,860.00 "
ST MARY'S HOSPITAL,48100182,37214,HC THROMBO CESS/CLOS; SUBSQ DAY 37214,481,1 ,"$3,800.00 ","$1,900.00 ","$1,123.24 ","$8,056.00 ","$1,123.24 ","$3,800.00 ","$3,641.00 ","$2,784.00 ","$2,280.00 ","$3,230.00 ","$2,660.00 ","$1,123.24 ","$3,610.00 ","$2,736.00 ","$2,774.00 ","$3,800.00 ","$3,230.00 ","$2,784.00 ","$3,800.00 ","$3,230.00 ","$2,774.00 ","$1,123.24 ","$2,784.00 ","$3,800.00 ","$3,230.00 ","$6,263.99 ","$3,496.00 ","$2,660.00 ","$5,993.67 ","$8,056.00 ","$2,314.20 ","$7,491.83 ","$2,625.80 ","$2,736.00 ","$2,646.70 ","$2,811.84 ","$2,736.00 ","$1,190.63 ","$2,687.00 ","$2,687.00 ","$2,784.00 ","$2,687.00 ","$2,784.00 ","$2,736.00 ","$2,356.00 ","$2,736.00 ","$2,736.00 ","$2,280.00 "
ST MARY'S HOSPITAL,48100183,36225,HC CATH PLCMT SEL SUBCL/INOM VERTEB UNI 36225,481,1 ,"$5,824.00 ","$2,912.00 ","$1,293.09 ","$6,263.99 ","$1,293.09 ","$5,824.00 ","$5,824.00 ","$2,784.00 ","$3,494.40 ","$4,950.40 ","$4,076.80 ","$1,293.09 ","$5,532.80 ","$4,193.28 ","$4,251.52 ","$5,824.00 ","$4,950.40 ","$2,784.00 ","$5,824.00 ","$4,950.40 ","$4,251.52 ","$1,293.09 ","$2,784.00 ","$5,657.04 ","$4,950.40 ","$6,263.99 ","$5,358.08 ","$4,076.80 ","$1,489.75 ","$2,002.44 ","$3,546.82 ","$1,862.71 ","$4,024.38 ","$4,193.28 ","$4,056.42 ","$2,811.84 ","$4,193.28 ","$1,370.68 ","$5,824.00 ","$5,824.00 ","$2,784.00 ","$5,824.00 ","$2,784.00 ","$4,193.28 ","$3,610.88 ","$4,193.28 ","$4,193.28 ","$3,494.40 "
ST MARY'S HOSPITAL,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 ","$1,935.36 ","$1,962.24 ","$2,688.00 ","$2,284.80 ", N/A ,"$2,688.00 ","$2,284.80 ","$1,962.24 ","$1,293.09 ", N/A ,"$2,688.00 ","$2,284.80 ", N/A ,"$2,472.96 ","$1,881.60 ","$1,489.75 ","$2,002.44 ","$1,636.99 ","$1,862.71 ","$1,857.41 ","$1,935.36 ","$1,872.19 ", N/A ,"$1,935.36 ","$1,370.68 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$1,612.80 "
ST MARY'S HOSPITAL,48100185,37211,HC ARTRL THROMBOLYSIS; INIT DAY 37211,481,1 ,"$4,600.00 ","$2,300.00 ","$1,123.24 ","$10,434.71 ","$1,123.24 ","$4,600.00 ","$4,600.00 ","$4,637.65 ","$2,760.00 ","$3,910.00 ","$3,220.00 ","$1,123.24 ","$4,370.00 ","$3,312.00 ","$3,358.00 ","$4,600.00 ","$3,910.00 ","$4,637.65 ","$4,600.00 ","$3,910.00 ","$3,358.00 ","$1,123.24 ","$4,637.65 ","$4,600.00 ","$3,910.00 ","$10,434.71 ","$4,232.00 ","$3,220.00 ","$5,993.67 ","$8,056.00 ","$2,801.40 ","$7,491.83 ","$3,178.60 ","$3,312.00 ","$3,203.90 ","$4,684.03 ","$3,312.00 ","$1,190.63 ","$4,600.00 ","$4,600.00 ","$4,637.65 ","$4,600.00 ","$4,637.65 ","$3,312.00 ","$2,852.00 ","$3,312.00 ","$3,312.00 ","$2,760.00 "
ST MARY'S HOSPITAL,48100186,37213,HC ARTRL/VENOUS THROMBOLYSIS; SUBSQ DAY 37213,481,1 ,"$3,800.00 ","$1,900.00 ","$1,123.24 ","$8,056.00 ","$1,123.24 ","$3,800.00 ","$3,641.00 ","$2,784.00 ","$2,280.00 ","$3,230.00 ","$2,660.00 ","$1,123.24 ","$3,610.00 ","$2,736.00 ","$2,774.00 ","$3,800.00 ","$3,230.00 ","$2,784.00 ","$3,800.00 ","$3,230.00 ","$2,774.00 ","$1,123.24 ","$2,784.00 ","$3,800.00 ","$3,230.00 ","$6,263.99 ","$3,496.00 ","$2,660.00 ","$5,993.67 ","$8,056.00 ","$2,314.20 ","$7,491.83 ","$2,625.80 ","$2,736.00 ","$2,646.70 ","$2,811.84 ","$2,736.00 ","$1,190.63 ","$2,687.00 ","$2,687.00 ","$2,784.00 ","$2,687.00 ","$2,784.00 ","$2,736.00 ","$2,356.00 ","$2,736.00 ","$2,736.00 ","$2,280.00 "
ST MARY'S HOSPITAL,48100187,37197,HC TRANSCATH RETRVAL FOREIGN BODY 37197,481,1 ,"$2,900.00 ","$1,450.00 ","$1,123.24 ","$8,056.00 ","$1,123.24 ","$2,900.00 ","$2,900.00 ","$2,784.00 ","$1,740.00 ","$2,465.00 ","$2,030.00 ","$1,123.24 ","$2,755.00 ","$2,088.00 ","$2,117.00 ","$2,900.00 ","$2,465.00 ","$2,784.00 ","$2,900.00 ","$2,465.00 ","$2,117.00 ","$1,123.24 ","$2,784.00 ","$2,900.00 ","$2,465.00 ","$6,263.99 ","$2,668.00 ","$2,030.00 ","$5,993.67 ","$8,056.00 ","$1,766.10 ","$7,491.83 ","$2,003.90 ","$2,088.00 ","$2,019.85 ","$2,811.84 ","$2,088.00 ","$1,190.63 ","$2,900.00 ","$2,900.00 ","$2,784.00 ","$2,900.00 ","$2,784.00 ","$2,088.00 ","$1,798.00 ","$2,088.00 ","$2,088.00 ","$1,740.00 "
ST MARY'S HOSPITAL,48100188,36221,HC CATH PLCMT NON SEL THORAC AORTA 36221,481,1 ,"$4,928.00 ","$2,464.00 ","$1,293.09 ","$6,263.99 ","$1,293.09 ","$4,928.00 ","$4,928.00 ","$2,784.00 ","$2,956.80 ","$4,188.80 ","$3,449.60 ","$1,293.09 ","$4,681.60 ","$3,548.16 ","$3,597.44 ","$4,928.00 ","$4,188.80 ","$2,784.00 ","$4,928.00 ","$4,188.80 ","$3,597.44 ","$1,293.09 ","$2,784.00 ","$4,928.00 ","$4,188.80 ","$6,263.99 ","$4,533.76 ","$3,449.60 ","$1,489.75 ","$2,002.44 ","$3,001.15 ","$1,862.71 ","$3,405.25 ","$3,548.16 ","$3,432.35 ","$2,811.84 ","$3,548.16 ","$1,370.68 ","$4,928.00 ","$4,928.00 ","$2,784.00 ","$4,928.00 ","$2,784.00 ","$3,548.16 ","$3,055.36 ","$3,548.16 ","$3,548.16 ","$2,956.80 "
ST MARY'S HOSPITAL,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$5,488.00 ","$2,744.00 ","$1,293.09 ","$6,263.99 ","$1,293.09 ","$5,488.00 ","$5,488.00 ","$2,784.00 ","$3,292.80 ","$4,664.80 ","$3,841.60 ","$1,293.09 ","$5,213.60 ","$3,951.36 ","$4,006.24 ","$5,488.00 ","$4,664.80 ","$2,784.00 ","$5,488.00 ","$4,664.80 ","$4,006.24 ","$1,293.09 ","$2,784.00 ","$5,488.00 ","$4,664.80 ","$6,263.99 ","$5,048.96 ","$3,841.60 ","$1,489.75 ","$2,002.44 ","$3,342.19 ","$1,862.71 ","$3,792.21 ","$3,951.36 ","$3,822.39 ","$2,811.84 ","$3,951.36 ","$1,370.68 ","$5,488.00 ","$5,488.00 ","$2,784.00 ","$5,488.00 ","$2,784.00 ","$3,951.36 ","$3,402.56 ","$3,951.36 ","$3,951.36 ","$3,292.80 "
ST MARY'S HOSPITAL,48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$5,488.00 ","$2,744.00 ","$1,293.09 ","$6,263.99 ","$1,293.09 ","$5,488.00 ","$5,488.00 ","$2,784.00 ","$3,292.80 ","$4,664.80 ","$3,841.60 ","$1,293.09 ","$5,213.60 ","$3,951.36 ","$4,006.24 ","$5,488.00 ","$4,664.80 ","$2,784.00 ","$5,488.00 ","$4,664.80 ","$4,006.24 ","$1,293.09 ","$2,784.00 ","$5,488.00 ","$4,664.80 ","$6,263.99 ","$5,048.96 ","$3,841.60 ","$1,489.75 ","$2,002.44 ","$3,342.19 ","$1,862.71 ","$3,792.21 ","$3,951.36 ","$3,822.39 ","$2,811.84 ","$3,951.36 ","$1,370.68 ","$5,488.00 ","$5,488.00 ","$2,784.00 ","$5,488.00 ","$2,784.00 ","$3,951.36 ","$3,402.56 ","$3,951.36 ","$3,951.36 ","$3,292.80 "
ST MARY'S HOSPITAL,48100190,36223,HC CATH PLCMT SEL COM CAR/INOM INTRACRN UNI 36223,481,1 ,"$9,968.00 ","$4,984.00 ","$1,293.09 ","$10,434.71 ","$1,293.09 ","$9,884.00 ","$7,413.00 ","$4,637.65 ","$5,980.80 ","$8,472.80 ","$6,977.60 ","$1,293.09 ","$9,469.60 ","$7,176.96 ","$7,276.64 ","$6,993.00 ","$8,472.80 ","$4,637.65 ","$6,993.00 ","$8,472.80 ","$7,276.64 ","$1,293.09 ","$4,637.65 ","$5,657.04 ","$8,472.80 ","$10,434.71 ","$9,170.56 ","$6,977.60 ","$1,489.75 ","$2,002.44 ","$6,070.51 ","$1,862.71 ","$6,887.89 ","$7,176.96 ","$6,942.71 ","$4,684.03 ","$7,176.96 ","$1,370.68 ","$8,832.00 ","$8,832.00 ","$4,637.65 ","$8,832.00 ","$4,637.65 ","$7,176.96 ","$6,180.16 ","$7,176.96 ","$7,176.96 ","$5,980.80 "
ST MARY'S HOSPITAL,48100191,36224,HC CATH PLCMT SEL INTERNAL CAR UNI 36224,481,1 ,"$5,152.00 ","$2,576.00 ","$1,293.09 ","$10,434.71 ","$1,293.09 ","$5,152.00 ","$5,152.00 ","$4,637.65 ","$3,091.20 ","$4,379.20 ","$3,606.40 ","$1,293.09 ","$4,894.40 ","$3,709.44 ","$3,760.96 ","$5,152.00 ","$4,379.20 ","$4,637.65 ","$5,152.00 ","$4,379.20 ","$3,760.96 ","$1,293.09 ","$4,637.65 ","$5,152.00 ","$4,379.20 ","$10,434.71 ","$4,739.84 ","$3,606.40 ","$1,489.75 ","$2,002.44 ","$3,137.57 ","$1,862.71 ","$3,560.03 ","$3,709.44 ","$3,588.37 ","$4,684.03 ","$3,709.44 ","$1,370.68 ","$5,152.00 ","$5,152.00 ","$4,637.65 ","$5,152.00 ","$4,637.65 ","$3,709.44 ","$3,194.24 ","$3,709.44 ","$3,709.44 ","$3,091.20 "
ST MARY'S HOSPITAL,48100192,36226,HC CATH PLCMT SEL VERTEBRAL UNI 36226,481,1 ,"$7,840.00 ","$3,920.00 ","$1,293.09 ","$10,434.71 ","$1,293.09 ","$7,840.00 ","$7,413.00 ","$4,637.65 ","$4,704.00 ","$6,664.00 ","$5,488.00 ","$1,293.09 ","$7,448.00 ","$5,644.80 ","$5,723.20 ","$6,993.00 ","$6,664.00 ","$4,637.65 ","$6,993.00 ","$6,664.00 ","$5,723.20 ","$1,293.09 ","$4,637.65 ","$7,840.00 ","$6,664.00 ","$10,434.71 ","$7,212.80 ","$5,488.00 ","$1,489.75 ","$2,002.44 ","$4,774.56 ","$1,862.71 ","$5,417.44 ","$5,644.80 ","$5,460.56 ","$4,684.03 ","$5,644.80 ","$1,370.68 ","$7,840.00 ","$7,840.00 ","$4,637.65 ","$7,840.00 ","$4,637.65 ","$5,644.80 ","$4,860.80 ","$5,644.80 ","$5,644.80 ","$4,704.00 "
ST MARY'S HOSPITAL,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 ","$1,612.80 ","$1,635.20 ","$2,240.00 ","$1,904.00 ", N/A ,"$2,240.00 ","$1,904.00 ","$1,635.20 ","$1,293.09 ", N/A ,"$2,240.00 ","$1,904.00 ", N/A ,"$2,060.80 ","$1,568.00 ","$1,489.75 ","$2,002.44 ","$1,364.16 ","$1,862.71 ","$1,547.84 ","$1,612.80 ","$1,560.16 ", N/A ,"$1,612.80 ","$1,370.68 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,48100200,92920,HC PTCA SINGL MAJ ART/BRANCH 92920,481,1 ,"$7,597.00 ","$3,798.50 ","$2,701.18 ","$10,845.30 ","$2,701.18 ","$7,597.00 ","$7,597.00 ","$4,820.13 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$2,701.18 ","$7,217.15 ","$5,469.84 ","$5,545.81 ","$7,597.00 ","$6,457.45 ","$4,820.13 ","$7,597.00 ","$6,457.45 ","$5,545.81 ","$2,701.18 ","$4,820.13 ","$7,597.00 ","$6,457.45 ","$10,845.30 ","$6,989.24 ","$5,317.90 ","$5,993.67 ","$8,056.00 ","$4,626.57 ","$7,491.83 ","$5,249.53 ","$5,469.84 ","$5,291.31 ","$4,868.33 ","$5,469.84 ","$2,863.25 ","$7,597.00 ","$7,597.00 ","$4,820.13 ","$7,597.00 ","$4,820.13 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$4,558.20 "
ST MARY'S HOSPITAL,48100201,92921,HC PTCA EA ADDL BRANCH MAJ ART 92921,481,1 ,"$5,136.00 ","$2,568.00 ","$2,568.00 ","$8,056.00 ","$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 ","$3,697.92 ","$3,749.28 ","$5,136.00 ","$4,365.60 ", N/A ,"$5,136.00 ","$4,365.60 ","$3,749.28 ","$2,701.18 ", N/A , N/A ,"$4,365.60 ", N/A ,"$4,725.12 ","$3,595.20 ","$5,993.67 ","$8,056.00 ","$3,127.82 ","$7,491.83 ","$3,548.98 ","$3,697.92 ","$3,577.22 ", N/A ,"$3,697.92 ","$2,863.25 ","$5,136.00 ","$5,136.00 ", N/A ,"$5,136.00 ", N/A ,"$3,697.92 ","$3,184.32 ","$3,697.92 ","$3,697.92 ","$3,081.60 "
ST MARY'S HOSPITAL,48100202,92924,HC ROTOBLATOR SINGL MAJ ART/BRANCH 92924,481,1 ,"$14,980.00 ","$7,490.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$14,980.00 ","$14,980.00 ","$9,768.54 ","$8,988.00 ","$12,733.00 ","$10,486.00 ","$2,701.18 ","$14,231.00 ","$10,785.60 ","$10,935.40 ","$14,980.00 ","$12,733.00 ","$9,768.54 ","$14,980.00 ","$12,733.00 ","$10,935.40 ","$2,701.18 ","$9,768.54 ","$14,980.00 ","$12,733.00 ","$21,979.23 ","$13,781.60 ","$10,486.00 ","$5,993.67 ","$8,056.00 ","$9,122.82 ","$7,491.83 ","$10,351.18 ","$10,785.60 ","$10,433.57 ","$9,866.23 ","$10,785.60 ","$2,863.25 ","$13,600.00 ","$13,600.00 ","$9,768.54 ","$13,600.00 ","$9,768.54 ","$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$8,988.00 "
ST MARY'S HOSPITAL,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 ","$6,371.28 ","$6,459.77 ","$8,849.00 ","$7,521.65 ", N/A ,"$8,849.00 ","$7,521.65 ","$6,459.77 ","$2,701.18 ", N/A , N/A ,"$7,521.65 ", N/A ,"$8,141.08 ","$6,194.30 ","$5,993.67 ","$8,056.00 ","$5,389.04 ","$7,491.83 ","$6,114.66 ","$6,371.28 ","$6,163.33 ", N/A ,"$6,371.28 ","$2,863.25 ","$8,849.00 ","$8,849.00 ", N/A ,"$8,849.00 ", N/A ,"$6,371.28 ","$5,486.38 ","$6,371.28 ","$6,371.28 ","$5,309.40 "
ST MARY'S HOSPITAL,48100204,92928,HC BMS SINGL MAJ ART/BRANCH 92928,481,1 ,"$10,700.00 ","$5,350.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$10,700.00 ","$10,700.00 ","$9,768.54 ","$6,420.00 ","$9,095.00 ","$7,490.00 ","$2,701.18 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ","$9,768.54 ","$6,993.00 ","$9,095.00 ","$7,811.00 ","$2,701.18 ","$9,768.54 ","$10,700.00 ","$9,095.00 ","$21,979.23 ","$9,844.00 ","$7,490.00 ","$5,993.67 ","$8,056.00 ","$6,516.30 ","$7,491.83 ","$7,393.70 ","$7,704.00 ","$7,452.55 ","$9,866.23 ","$7,704.00 ","$2,863.25 ","$10,700.00 ","$10,700.00 ","$9,768.54 ","$10,700.00 ","$9,768.54 ","$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,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 ","$8,474.40 ","$8,592.10 ","$6,993.00 ","$10,004.50 ", N/A ,"$6,993.00 ","$10,004.50 ","$8,592.10 ","$2,701.18 ", N/A ,"$11,770.00 ","$10,004.50 ", N/A ,"$10,828.40 ","$8,239.00 ","$5,993.67 ","$8,056.00 ","$7,167.93 ","$7,491.83 ","$8,133.07 ","$8,474.40 ","$8,197.81 ", N/A ,"$8,474.40 ","$2,863.25 ","$11,770.00 ","$11,770.00 ", N/A ,"$11,770.00 ", N/A ,"$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$7,062.00 "
ST MARY'S HOSPITAL,48100206,92933,HC ROTOBLATOR/BMS SINGL MAJ ART/BRANCH 92933,481,1 ,"$20,330.00 ","$10,165.00 ","$2,701.18 ","$35,142.61 ","$2,701.18 ","$20,330.00 ","$20,330.00 ","$15,618.94 ","$12,198.00 ","$17,280.50 ","$14,231.00 ","$2,701.18 ","$19,313.50 ","$14,637.60 ","$14,840.90 ","$6,993.00 ","$17,280.50 ","$15,618.94 ","$6,993.00 ","$17,280.50 ","$14,840.90 ","$2,701.18 ","$15,618.94 ","$16,836.49 ","$17,280.50 ","$35,142.61 ","$18,703.60 ","$14,231.00 ","$5,993.67 ","$8,056.00 ","$12,380.97 ","$7,491.83 ","$14,048.03 ","$14,637.60 ","$14,159.85 ","$15,775.13 ","$14,637.60 ","$2,863.25 ","$16,692.00 ","$16,692.00 ","$15,618.94 ","$16,692.00 ","$15,618.94 ","$14,637.60 ","$12,604.60 ","$14,637.60 ","$14,637.60 ","$12,198.00 "
ST MARY'S HOSPITAL,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 ","$11,043.36 ","$11,196.74 ","$6,993.00 ","$13,037.30 ", N/A ,"$6,993.00 ","$13,037.30 ","$11,196.74 ","$2,701.18 ", N/A ,"$15,338.00 ","$13,037.30 ", N/A ,"$14,110.96 ","$10,736.60 ","$5,993.67 ","$8,056.00 ","$9,340.84 ","$7,491.83 ","$10,598.56 ","$11,043.36 ","$10,682.92 ", N/A ,"$11,043.36 ","$2,863.25 ","$15,338.00 ","$15,338.00 ", N/A ,"$15,338.00 ", N/A ,"$11,043.36 ","$9,509.56 ","$11,043.36 ","$11,043.36 ","$9,202.80 "
ST MARY'S HOSPITAL,48100208,92937,HC BYPASS GRAFT BMS SINGL MAJ ART/BRANCH 92937,481,1 ,"$13,910.00 ","$6,955.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$13,910.00 ","$13,910.00 ","$9,768.54 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$2,701.18 ","$13,214.50 ","$10,015.20 ","$10,154.30 ","$6,993.00 ","$11,823.50 ","$9,768.54 ","$6,993.00 ","$11,823.50 ","$10,154.30 ","$2,701.18 ","$9,768.54 ","$13,910.00 ","$11,823.50 ","$21,979.23 ","$12,797.20 ","$9,737.00 ","$5,993.67 ","$8,056.00 ","$8,471.19 ","$7,491.83 ","$9,611.81 ","$10,015.20 ","$9,688.32 ","$9,866.23 ","$10,015.20 ","$2,863.25 ","$13,910.00 ","$13,910.00 ","$9,768.54 ","$13,910.00 ","$9,768.54 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$8,346.00 "
ST MARY'S HOSPITAL,48100209,92938,HC BYPASS GRAFT BMS EA ADDL BRNCH MAJ ART 92938,481,1 ,"$7,918.00 ","$3,959.00 ","$2,701.18 ","$8,056.00 ","$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 ","$5,700.96 ","$5,780.14 ","$6,993.00 ","$6,730.30 ", N/A ,"$6,993.00 ","$6,730.30 ","$5,780.14 ","$2,701.18 ", N/A ,"$7,918.00 ","$6,730.30 ", N/A ,"$7,284.56 ","$5,542.60 ","$5,993.67 ","$8,056.00 ","$4,822.06 ","$7,491.83 ","$5,471.34 ","$5,700.96 ","$5,514.89 ", N/A ,"$5,700.96 ","$2,863.25 ","$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ", N/A ,"$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$4,750.80 "
ST MARY'S HOSPITAL,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 ","$10,785.60 ","$10,935.40 ","$6,993.00 ","$12,733.00 ", N/A ,"$6,993.00 ","$12,733.00 ","$10,935.40 ","$2,701.18 ", N/A ,"$14,980.00 ","$12,733.00 ", N/A ,"$13,781.60 ","$10,486.00 ","$5,993.67 ","$8,056.00 ","$9,122.82 ","$7,491.83 ","$10,351.18 ","$10,785.60 ","$10,433.57 ", N/A ,"$10,785.60 ","$2,863.25 ","$14,980.00 ","$14,980.00 ", N/A ,"$14,980.00 ", N/A ,"$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$8,988.00 "
ST MARY'S HOSPITAL,48100211,92943,HC CTO BMS SING MAJ ART/BRNCH 92943,481,1 ,"$16,050.00 ","$8,025.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$16,050.00 ","$16,050.00 ","$9,768.54 ","$9,630.00 ","$13,642.50 ","$11,235.00 ","$2,701.18 ","$15,247.50 ","$11,556.00 ","$11,716.50 ","$6,993.00 ","$13,642.50 ","$9,768.54 ","$6,993.00 ","$13,642.50 ","$11,716.50 ","$2,701.18 ","$9,768.54 ","$16,050.00 ","$13,642.50 ","$21,979.23 ","$14,766.00 ","$11,235.00 ","$5,993.67 ","$8,056.00 ","$9,774.45 ","$7,491.83 ","$11,090.55 ","$11,556.00 ","$11,178.83 ","$9,866.23 ","$11,556.00 ","$2,863.25 ","$16,050.00 ","$16,050.00 ","$9,768.54 ","$16,050.00 ","$9,768.54 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$9,630.00 "
ST MARY'S HOSPITAL,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 ","$9,244.80 ","$9,373.20 ","$6,993.00 ","$10,914.00 ", N/A ,"$6,993.00 ","$10,914.00 ","$9,373.20 ","$2,701.18 ", N/A ,"$12,840.00 ","$10,914.00 ", N/A ,"$11,812.80 ","$8,988.00 ","$5,993.67 ","$8,056.00 ","$7,819.56 ","$7,491.83 ","$8,872.44 ","$9,244.80 ","$8,943.06 ", N/A ,"$9,244.80 ","$2,863.25 ","$12,840.00 ","$12,840.00 ", N/A ,"$12,840.00 ", N/A ,"$9,244.80 ","$7,960.80 ","$9,244.80 ","$9,244.80 ","$7,704.00 "
ST MARY'S HOSPITAL,48100213,93653,HC EP STUDY PLUS SVT ABLATION 93653,481,1 ,"$21,400.00 ","$10,700.00 ","$5,133.18 ","$46,955.01 ","$5,133.18 ","$21,400.00 ","$21,400.00 ","$20,868.89 ","$12,840.00 ","$18,190.00 ","$14,980.00 ","$5,133.18 ","$20,330.00 ","$15,408.00 ","$15,622.00 ","$15,977.00 ","$18,190.00 ","$20,868.89 ","$15,977.00 ","$18,190.00 ","$15,622.00 ","$5,133.18 ","$20,868.89 ","$15,839.71 ","$18,190.00 ","$46,955.01 ","$19,688.00 ","$14,980.00 ","$10,854.08 ","$13,026.18 ","$13,032.60 ","$12,157.34 ","$14,787.40 ","$15,408.00 ","$14,905.10 ","$21,077.58 ","$15,408.00 ","$5,441.17 ","$18,544.00 ","$18,544.00 ","$20,868.89 ","$18,544.00 ","$20,868.89 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$12,840.00 "
ST MARY'S HOSPITAL,48100214,93654,HC EP STUDY PLUS VT ABLATION 93654,481,1 ,"$21,400.00 ","$10,700.00 ","$5,133.18 ","$46,955.01 ","$5,133.18 ","$21,400.00 ","$21,400.00 ","$20,868.89 ","$12,840.00 ","$18,190.00 ","$14,980.00 ","$5,133.18 ","$20,330.00 ","$15,408.00 ","$15,622.00 ","$15,977.00 ","$18,190.00 ","$20,868.89 ","$15,977.00 ","$18,190.00 ","$15,622.00 ","$5,133.18 ","$20,868.89 ","$15,839.71 ","$18,190.00 ","$46,955.01 ","$19,688.00 ","$14,980.00 ","$10,854.08 ","$13,026.18 ","$13,032.60 ","$12,157.34 ","$14,787.40 ","$15,408.00 ","$14,905.10 ","$21,077.58 ","$15,408.00 ","$5,441.17 ","$18,544.00 ","$18,544.00 ","$20,868.89 ","$18,544.00 ","$20,868.89 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$12,840.00 "
ST MARY'S HOSPITAL,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 ","$2,619.36 ","$2,655.74 ","$3,638.00 ","$3,092.30 ", N/A ,"$3,638.00 ","$3,092.30 ","$2,655.74 ","$5,133.18 ", 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 ","$2,066.75 ","$2,513.86 ","$2,619.36 ","$2,533.87 ", N/A ,"$2,619.36 ","$5,441.17 ","$3,638.00 ","$3,638.00 ", N/A ,"$3,638.00 ", N/A ,"$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,182.80 "
ST MARY'S HOSPITAL,48100216,93656,HC EP STUDY PLUS AFIB ABLATION 93656,481,1 ,"$21,400.00 ","$10,700.00 ","$5,133.18 ","$46,955.01 ","$5,133.18 ","$21,400.00 ","$21,400.00 ","$20,868.89 ","$12,840.00 ","$18,190.00 ","$14,980.00 ","$5,133.18 ","$20,330.00 ","$15,408.00 ","$15,622.00 ","$15,977.00 ","$18,190.00 ","$20,868.89 ","$15,977.00 ","$18,190.00 ","$15,622.00 ","$5,133.18 ","$20,868.89 ","$15,839.71 ","$18,190.00 ","$46,955.01 ","$19,688.00 ","$14,980.00 ","$10,854.08 ","$13,026.18 ","$13,032.60 ","$12,157.34 ","$14,787.40 ","$15,408.00 ","$14,905.10 ","$21,077.58 ","$15,408.00 ","$5,441.17 ","$18,544.00 ","$18,544.00 ","$20,868.89 ","$18,544.00 ","$20,868.89 ","$15,408.00 ","$13,268.00 ","$15,408.00 ","$15,408.00 ","$12,840.00 "
ST MARY'S HOSPITAL,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 ","$2,619.36 ","$2,655.74 ","$3,638.00 ","$3,092.30 ", N/A ,"$3,638.00 ","$3,092.30 ","$2,655.74 ","$5,133.18 ", 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 ","$2,066.75 ","$2,513.86 ","$2,619.36 ","$2,533.87 ", N/A ,"$2,619.36 ","$5,441.17 ","$3,638.00 ","$3,638.00 ", N/A ,"$3,638.00 ", N/A ,"$2,619.36 ","$2,255.56 ","$2,619.36 ","$2,619.36 ","$2,182.80 "
ST MARY'S HOSPITAL,48100218,C9600,HC DES SING MAJ ART/BRNCH C9600,481,1 ,"$11,770.00 ","$5,885.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$11,770.00 ","$11,770.00 ","$9,768.54 ","$7,062.00 ","$10,004.50 ","$8,239.00 ","$2,701.18 ","$11,181.50 ","$8,474.40 ","$8,592.10 ","$11,770.00 ","$10,004.50 ","$9,768.54 ","$11,770.00 ","$10,004.50 ","$8,592.10 ","$2,701.18 ","$9,768.54 ","$11,770.00 ","$10,004.50 ","$21,979.23 ","$10,828.40 ","$8,239.00 ","$5,993.67 ","$8,056.00 ","$7,167.93 ","$7,491.83 ","$8,133.07 ","$8,474.40 ","$8,197.81 ","$9,866.23 ","$8,474.40 ","$2,863.25 ","$11,770.00 ","$11,770.00 ","$9,768.54 ","$11,770.00 ","$9,768.54 ","$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$7,062.00 "
ST MARY'S HOSPITAL,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 ","$8,474.40 ","$8,592.10 ","$11,770.00 ","$10,004.50 ", N/A ,"$11,770.00 ","$10,004.50 ","$8,592.10 ","$2,701.18 ", 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 ","$6,686.54 ","$8,133.07 ","$8,474.40 ","$8,197.81 ", N/A ,"$8,474.40 ","$2,863.25 ","$11,770.00 ","$11,770.00 ", N/A ,"$11,770.00 ", N/A ,"$8,474.40 ","$7,297.40 ","$8,474.40 ","$8,474.40 ","$7,062.00 "
ST MARY'S HOSPITAL,48100220,C9602,HC ROTOBLAT/DES SING MAJ ART/BRNCH C9602,481,1 ,"$16,050.00 ","$8,025.00 ","$2,701.18 ","$35,142.61 ","$2,701.18 ","$16,050.00 ","$16,050.00 ","$15,618.94 ","$9,630.00 ","$13,642.50 ","$11,235.00 ","$2,701.18 ","$15,247.50 ","$11,556.00 ","$11,716.50 ","$16,050.00 ","$13,642.50 ","$15,618.94 ","$16,050.00 ","$13,642.50 ","$11,716.50 ","$2,701.18 ","$15,618.94 ","$16,050.00 ","$13,642.50 ","$35,142.61 ","$14,766.00 ","$11,235.00 ","$8,140.56 ","$9,769.64 ","$9,774.45 ","$9,118.01 ","$11,090.55 ","$11,556.00 ","$11,178.83 ","$15,775.13 ","$11,556.00 ","$2,863.25 ","$16,050.00 ","$16,050.00 ","$15,618.94 ","$16,050.00 ","$15,618.94 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$9,630.00 "
ST MARY'S HOSPITAL,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 ","$11,043.36 ","$11,196.74 ","$15,338.00 ","$13,037.30 ", N/A ,"$15,338.00 ","$13,037.30 ","$11,196.74 ","$2,701.18 ", 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 ","$8,713.52 ","$10,598.56 ","$11,043.36 ","$10,682.92 ", N/A ,"$11,043.36 ","$2,863.25 ","$15,338.00 ","$15,338.00 ", N/A ,"$15,338.00 ", N/A ,"$11,043.36 ","$9,509.56 ","$11,043.36 ","$11,043.36 ","$9,202.80 "
ST MARY'S HOSPITAL,48100222,C9604,HC BYPASS GRAFT DES SING MAJ ART/BRNCH C9604,481,1 ,"$13,910.00 ","$6,955.00 ","$2,701.18 ","$21,979.23 ","$2,701.18 ","$13,910.00 ","$13,910.00 ","$9,768.54 ","$8,346.00 ","$11,823.50 ","$9,737.00 ","$2,701.18 ","$13,214.50 ","$10,015.20 ","$10,154.30 ","$13,910.00 ","$11,823.50 ","$9,768.54 ","$13,910.00 ","$11,823.50 ","$10,154.30 ","$2,701.18 ","$9,768.54 ","$13,910.00 ","$11,823.50 ","$21,979.23 ","$12,797.20 ","$9,737.00 ","$7,055.15 ","$8,467.02 ","$8,471.19 ","$7,902.27 ","$9,611.81 ","$10,015.20 ","$9,688.32 ","$9,866.23 ","$10,015.20 ","$2,863.25 ","$13,910.00 ","$13,910.00 ","$9,768.54 ","$13,910.00 ","$9,768.54 ","$10,015.20 ","$8,624.20 ","$10,015.20 ","$10,015.20 ","$8,346.00 "
ST MARY'S HOSPITAL,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 ","$5,700.96 ","$5,780.14 ","$7,918.00 ","$6,730.30 ", N/A ,"$7,918.00 ","$6,730.30 ","$5,780.14 ","$2,701.18 ", 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 ","$4,498.22 ","$5,471.34 ","$5,700.96 ","$5,514.89 ", N/A ,"$5,700.96 ","$2,863.25 ","$7,918.00 ","$7,918.00 ", N/A ,"$7,918.00 ", N/A ,"$5,700.96 ","$4,909.16 ","$5,700.96 ","$5,700.96 ","$4,750.80 "
ST MARY'S HOSPITAL,48100224,C9607,HC CTO DES SING MAJ ART/BRNCH C9607,481,1 ,"$16,050.00 ","$8,025.00 ","$2,701.18 ","$35,142.61 ","$2,701.18 ","$16,050.00 ","$16,050.00 ","$15,618.94 ","$9,630.00 ","$13,642.50 ","$11,235.00 ","$2,701.18 ","$15,247.50 ","$11,556.00 ","$11,716.50 ","$16,050.00 ","$13,642.50 ","$15,618.94 ","$16,050.00 ","$13,642.50 ","$11,716.50 ","$2,701.18 ","$15,618.94 ","$16,050.00 ","$13,642.50 ","$35,142.61 ","$14,766.00 ","$11,235.00 ","$8,140.56 ","$9,769.64 ","$9,774.45 ","$9,118.01 ","$11,090.55 ","$11,556.00 ","$11,178.83 ","$15,775.13 ","$11,556.00 ","$2,863.25 ","$16,050.00 ","$16,050.00 ","$15,618.94 ","$16,050.00 ","$15,618.94 ","$11,556.00 ","$9,951.00 ","$11,556.00 ","$11,556.00 ","$9,630.00 "
ST MARY'S HOSPITAL,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 ","$9,175.68 ","$9,303.12 ","$12,744.00 ","$10,832.40 ", N/A ,"$12,744.00 ","$10,832.40 ","$9,303.12 ","$2,701.18 ", 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 ","$7,239.87 ","$8,806.10 ","$9,175.68 ","$8,876.20 ", N/A ,"$9,175.68 ","$2,863.25 ","$12,744.00 ","$12,744.00 ", N/A ,"$12,744.00 ", N/A ,"$9,175.68 ","$7,901.28 ","$9,175.68 ","$9,175.68 ","$7,646.40 "
ST MARY'S HOSPITAL,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 ","$10,785.60 ","$10,935.40 ","$14,980.00 ","$12,733.00 ", N/A ,"$14,980.00 ","$12,733.00 ","$10,935.40 ","$2,701.18 ", 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 ","$8,510.14 ","$10,351.18 ","$10,785.60 ","$10,433.57 ", N/A ,"$10,785.60 ","$2,863.25 ","$14,980.00 ","$14,980.00 ", N/A ,"$14,980.00 ", N/A ,"$10,785.60 ","$9,287.60 ","$10,785.60 ","$10,785.60 ","$8,988.00 "
ST MARY'S HOSPITAL,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 ,$153.36 ,$155.49 ,$213.00 ,$181.05 , N/A ,$213.00 ,$181.05 ,$155.49 ,$12.10 , N/A , N/A ,$181.05 , N/A ,$195.96 ,$149.10 ,$108.03 ,$129.65 ,$129.72 ,$121.01 ,$147.18 ,$153.36 ,$148.35 , N/A ,$153.36 ,$12.83 , N/A , N/A , N/A , N/A , N/A ,$153.36 ,$132.06 ,$153.36 ,$153.36 ,$127.80 
ST MARY'S HOSPITAL,48100230,37241,HC VENOUS EMBO FOR VEIN MALFORMATION 37241,481,1 ,"$6,700.00 ","$3,350.00 ","$3,350.00 ","$21,979.23 ","$3,445.58 ","$6,700.00 ","$6,700.00 ","$9,768.54 ","$4,020.00 ","$5,695.00 ","$4,690.00 ","$3,445.58 ","$6,365.00 ","$4,824.00 ","$4,891.00 ","$6,700.00 ","$5,695.00 ","$9,768.54 ","$6,700.00 ","$5,695.00 ","$4,891.00 ","$3,445.58 ","$9,768.54 ","$6,700.00 ","$5,695.00 ","$21,979.23 ","$6,164.00 ","$4,690.00 ","$5,993.67 ","$8,056.00 ","$4,080.30 ","$7,491.83 ","$4,629.70 ","$4,824.00 ","$4,666.55 ","$9,866.23 ","$4,824.00 ","$3,652.31 ","$6,700.00 ","$6,700.00 ","$9,768.54 ","$6,700.00 ","$9,768.54 ","$4,824.00 ","$4,154.00 ","$4,824.00 ","$4,824.00 ","$4,020.00 "
ST MARY'S HOSPITAL,48100231,37242,HC ARTERIAL EMBO FOR AVM ANER PRE/PST AAA 37242,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,408.00 ","$6,497.00 ","$6,993.00 ","$7,565.00 ","$9,768.54 ","$6,993.00 ","$7,565.00 ","$6,497.00 ","$3,445.58 ","$9,768.54 ","$8,900.00 ","$7,565.00 ","$21,979.23 ","$8,188.00 ","$6,230.00 ","$5,993.67 ","$8,056.00 ","$5,420.10 ","$7,491.83 ","$6,149.90 ","$6,408.00 ","$6,198.85 ","$9,866.23 ","$6,408.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$8,900.00 ","$9,768.54 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$5,340.00 "
ST MARY'S HOSPITAL,48100232,37243,HC EMBOLIZATION OF TUMOR UFE CHEMO 37243,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,408.00 ","$6,497.00 ","$6,993.00 ","$7,565.00 ","$9,768.54 ","$6,993.00 ","$7,565.00 ","$6,497.00 ","$3,445.58 ","$9,768.54 ","$8,900.00 ","$7,565.00 ","$21,979.23 ","$8,188.00 ","$6,230.00 ","$5,993.67 ","$8,056.00 ","$5,420.10 ","$7,491.83 ","$6,149.90 ","$6,408.00 ","$6,198.85 ","$9,866.23 ","$6,408.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$8,900.00 ","$9,768.54 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$5,340.00 "
ST MARY'S HOSPITAL,48100233,37244,HC EMBOLIZATION FOR HEMORRAGE ART/VEN 37244,481,1 ,"$8,900.00 ","$4,450.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$5,340.00 ","$7,565.00 ","$6,230.00 ","$3,445.58 ","$8,455.00 ","$6,408.00 ","$6,497.00 ","$6,993.00 ","$7,565.00 ","$9,768.54 ","$6,993.00 ","$7,565.00 ","$6,497.00 ","$3,445.58 ","$9,768.54 ","$8,900.00 ","$7,565.00 ","$21,979.23 ","$8,188.00 ","$6,230.00 ","$5,993.67 ","$8,056.00 ","$5,420.10 ","$7,491.83 ","$6,149.90 ","$6,408.00 ","$6,198.85 ","$9,866.23 ","$6,408.00 ","$3,652.31 ","$8,900.00 ","$8,900.00 ","$9,768.54 ","$8,900.00 ","$9,768.54 ","$6,408.00 ","$5,518.00 ","$6,408.00 ","$6,408.00 ","$5,340.00 "
ST MARY'S HOSPITAL,48100234,37236,HC STENT INIT ARTERY UPPER EXT VISCERAL 37236,481,1 ,"$8,132.00 ","$4,066.00 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$8,132.00 ","$8,132.00 ","$9,768.54 ","$4,879.20 ","$6,912.20 ","$5,692.40 ","$3,445.58 ","$7,725.40 ","$5,855.04 ","$5,936.36 ","$6,993.00 ","$6,912.20 ","$9,768.54 ","$6,993.00 ","$6,912.20 ","$5,936.36 ","$3,445.58 ","$9,768.54 ","$8,132.00 ","$6,912.20 ","$21,979.23 ","$7,481.44 ","$5,692.40 ","$5,993.67 ","$8,056.00 ","$4,952.39 ","$7,491.83 ","$5,619.21 ","$5,855.04 ","$5,663.94 ","$9,866.23 ","$5,855.04 ","$3,652.31 ","$8,132.00 ","$8,132.00 ","$9,768.54 ","$8,132.00 ","$9,768.54 ","$5,855.04 ","$5,041.84 ","$5,855.04 ","$5,855.04 ","$4,879.20 "
ST MARY'S HOSPITAL,48100235,37237,HC STENT ADDN ARTERY UPPER EXT VISERAL 37237,481,1 ,"$6,992.00 ","$3,496.00 ","$3,445.58 ","$8,056.00 ","$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 ","$5,034.24 ","$5,104.16 ","$6,992.00 ","$5,943.20 ", N/A ,"$6,992.00 ","$5,943.20 ","$5,104.16 ","$3,445.58 ", N/A ,"$3,959.93 ","$5,943.20 ", N/A ,"$6,432.64 ","$4,894.40 ","$5,993.67 ","$8,056.00 ","$4,258.13 ","$7,491.83 ","$4,831.47 ","$5,034.24 ","$4,869.93 ", N/A ,"$5,034.24 ","$3,652.31 ","$6,992.00 ","$6,992.00 ", N/A ,"$6,992.00 ", N/A ,"$5,034.24 ","$4,335.04 ","$5,034.24 ","$5,034.24 ","$4,195.20 "
ST MARY'S HOSPITAL,48100236,37238,HC STENT INIT VENOUS UPPER EXT VISERAL 37238,481,1 ,"$9,523.00 ","$4,761.50 ","$3,445.58 ","$21,979.23 ","$3,445.58 ","$9,523.00 ","$9,523.00 ","$9,768.54 ","$5,713.80 ","$8,094.55 ","$6,666.10 ","$3,445.58 ","$9,046.85 ","$6,856.56 ","$6,951.79 ","$6,993.00 ","$8,094.55 ","$9,768.54 ","$6,993.00 ","$8,094.55 ","$6,951.79 ","$3,445.58 ","$9,768.54 ","$9,523.00 ","$8,094.55 ","$21,979.23 ","$8,761.16 ","$6,666.10 ","$5,993.67 ","$8,056.00 ","$5,799.51 ","$7,491.83 ","$6,580.39 ","$6,856.56 ","$6,632.77 ","$9,866.23 ","$6,856.56 ","$3,652.31 ","$9,523.00 ","$9,523.00 ","$9,768.54 ","$9,523.00 ","$9,768.54 ","$6,856.56 ","$5,904.26 ","$6,856.56 ","$6,856.56 ","$5,713.80 "
ST MARY'S HOSPITAL,48100237,37239,HC STENT ADDN VENOUS UPPER EXT VISERAL 37239,481,1 ,"$4,815.00 ","$2,407.50 ","$2,407.50 ","$8,056.00 ","$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 ","$3,466.80 ","$3,514.95 ","$4,815.00 ","$4,092.75 ", N/A ,"$4,815.00 ","$4,092.75 ","$3,514.95 ","$3,445.58 ", N/A ,"$3,959.93 ","$4,092.75 ", N/A ,"$4,429.80 ","$3,370.50 ","$5,993.67 ","$8,056.00 ","$2,932.34 ","$7,491.83 ","$3,327.17 ","$3,466.80 ","$3,353.65 ", N/A ,"$3,466.80 ","$3,652.31 ","$4,815.00 ","$4,815.00 ", N/A ,"$4,815.00 ", N/A ,"$3,466.80 ","$2,985.30 ","$3,466.80 ","$3,466.80 ","$2,889.00 "
ST MARY'S HOSPITAL,48100238,37217,HC STENT CAROTID OPEN 37217,481,1 ,"$6,490.00 ","$3,245.00 ","$3,245.00 ","$8,056.00 ","$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 ","$4,672.80 ","$4,737.70 ","$6,490.00 ","$5,516.50 ", N/A ,"$6,490.00 ","$5,516.50 ","$4,737.70 ","$3,529.80 ", N/A ,"$6,490.00 ","$5,516.50 ", N/A ,"$5,970.80 ","$4,543.00 ","$5,993.67 ","$8,056.00 ","$3,952.41 ","$7,491.83 ","$4,484.59 ","$4,672.80 ","$4,520.29 ", N/A ,"$4,672.80 ","$3,741.59 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$4,672.80 ","$4,023.80 ","$4,672.80 ","$4,672.80 ","$3,894.00 "
ST MARY'S HOSPITAL,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 ,$265.54 ,"$1,344.00 ","$1,904.00 ","$1,568.00 ",$46.02 ,"$2,128.00 ","$1,612.80 ","$1,635.20 ","$2,240.00 ","$1,904.00 ",$265.54 ,"$2,240.00 ","$1,904.00 ","$1,635.20 ",$46.02 ,$265.54 , N/A ,"$1,904.00 ",$597.47 ,"$2,060.80 ","$1,568.00 ","$1,136.13 ","$1,363.49 ","$1,364.16 ","$1,272.54 ","$1,547.84 ","$1,612.80 ","$1,560.16 ",$268.20 ,"$1,612.80 ",$48.78 , N/A , N/A ,$265.54 , N/A ,$265.54 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,48100240,93644,HC S-ICD TESTING ONLY,481,1 ,$157.00 ,$78.50 ,$78.50 ,"$2,063.24 ","$1,946.45 ", N/A , N/A , N/A ,$94.20 ,$133.45 ,$109.90 ,"$1,946.45 ",$149.15 ,$113.04 ,$114.61 ,$157.00 ,$133.45 , N/A ,$157.00 ,$133.45 ,$114.61 ,"$1,946.45 ", N/A , N/A ,$133.45 , N/A ,$144.44 ,$109.90 ,$79.63 ,$95.57 ,$95.61 ,$89.19 ,$108.49 ,$113.04 ,$109.35 , N/A ,$113.04 ,"$2,063.24 ",$157.00 ,$157.00 , N/A ,$157.00 , N/A ,$113.04 ,$97.34 ,$113.04 ,$113.04 ,$94.20 
ST MARY'S HOSPITAL,48100252,33271,HC INSERT SUBQ DEFIBRILLATOR,481,1 ,"$15,478.00 ","$7,739.00 ",$533.72 ,"$17,852.44 ",$533.72 ,"$15,478.00 ","$11,705.00 ","$7,934.42 ","$9,286.80 ","$13,156.30 ","$10,834.60 ",$533.72 ,"$14,704.10 ","$11,144.16 ","$11,298.94 ","$6,993.00 ","$13,156.30 ","$7,934.42 ","$6,993.00 ","$13,156.30 ","$11,298.94 ",$533.72 ,"$7,934.42 ","$15,478.00 ","$13,156.30 ","$17,852.44 ","$14,239.76 ","$10,834.60 ","$5,993.67 ","$8,056.00 ","$9,426.10 ","$7,491.83 ","$10,695.30 ","$11,144.16 ","$10,780.43 ","$8,013.76 ","$11,144.16 ",$565.74 ,"$15,478.00 ","$15,478.00 ","$7,934.42 ","$15,478.00 ","$7,934.42 ","$11,144.16 ","$9,596.36 ","$11,144.16 ","$11,144.16 ","$9,286.80 "
ST MARY'S HOSPITAL,48100253,33272,HC REMOVAL SUBQ DEFIBRILATOR,481,1 ,"$4,783.00 ","$2,391.50 ",$533.72 ,"$8,056.00 ",$533.72 ,"$4,783.00 ","$4,783.00 ","$3,348.86 ","$2,869.80 ","$4,065.55 ","$3,348.10 ",$533.72 ,"$4,543.85 ","$3,443.76 ","$3,491.59 ","$4,783.00 ","$4,065.55 ","$3,348.86 ","$4,783.00 ","$4,065.55 ","$3,491.59 ",$533.72 ,"$3,348.86 ","$4,783.00 ","$4,065.55 ","$7,534.93 ","$4,400.36 ","$3,348.10 ","$5,993.67 ","$8,056.00 ","$2,912.85 ","$7,491.83 ","$3,305.05 ","$3,443.76 ","$3,331.36 ","$3,382.35 ","$3,443.76 ",$565.74 ,"$4,783.00 ","$4,783.00 ","$3,348.86 ","$4,783.00 ","$3,348.86 ","$3,443.76 ","$2,965.46 ","$3,443.76 ","$3,443.76 ","$2,869.80 "
ST MARY'S HOSPITAL,48100254,33273,HC REPOSTION SUBQ DEFIBRILLATIOR,481,1 ,"$4,783.00 ","$2,391.50 ",$533.72 ,"$8,056.00 ",$533.72 ,"$4,783.00 ","$4,783.00 ","$3,348.86 ","$2,869.80 ","$4,065.55 ","$3,348.10 ",$533.72 ,"$4,543.85 ","$3,443.76 ","$3,491.59 ","$4,783.00 ","$4,065.55 ","$3,348.86 ","$4,783.00 ","$4,065.55 ","$3,491.59 ",$533.72 ,"$3,348.86 ","$4,783.00 ","$4,065.55 ","$7,534.93 ","$4,400.36 ","$3,348.10 ","$5,993.67 ","$8,056.00 ","$2,912.85 ","$7,491.83 ","$3,305.05 ","$3,443.76 ","$3,331.36 ","$3,382.35 ","$3,443.76 ",$565.74 ,"$4,783.00 ","$4,783.00 ","$3,348.86 ","$4,783.00 ","$3,348.86 ","$3,443.76 ","$2,965.46 ","$3,443.76 ","$3,443.76 ","$2,869.80 "
ST MARY'S HOSPITAL,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 ,$586.80 ,$594.95 ,$815.00 ,$692.75 , N/A ,$815.00 ,$692.75 ,$594.95 ,"$3,529.80 ", N/A ,$815.00 ,$692.75 , N/A ,$749.80 ,$570.50 ,"$1,489.75 ","$2,002.44 ",$496.34 ,"$1,862.71 ",$563.17 ,$586.80 ,$567.65 , N/A ,$586.80 ,"$3,741.59 ",$815.00 ,$815.00 , N/A ,$815.00 , N/A ,$586.80 ,$505.30 ,$586.80 ,$586.80 ,$489.00 
ST MARY'S HOSPITAL,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 ","$4,820.13 ","$8,641.20 ","$12,241.70 ","$10,081.40 ","$1,123.24 ","$13,681.90 ","$10,369.44 ","$10,513.46 ","$6,993.00 ","$12,241.70 ","$4,820.13 ","$6,993.00 ","$12,241.70 ","$10,513.46 ","$1,123.24 ","$4,820.13 ","$7,919.86 ","$12,241.70 ","$10,845.30 ","$13,249.84 ","$10,081.40 ","$1,489.75 ","$2,002.44 ","$8,770.82 ","$1,862.71 ","$9,951.78 ","$10,369.44 ","$10,030.99 ","$4,868.33 ","$10,369.44 ","$1,190.63 ","$8,832.00 ","$8,832.00 ","$4,820.13 ","$8,832.00 ","$4,820.13 ","$10,369.44 ","$8,929.24 ","$10,369.44 ","$10,369.44 ","$8,641.20 "
ST MARY'S HOSPITAL,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 ","$18,727.00 ","$11,705.00 ","$9,768.54 ","$17,508.00 ","$24,803.00 ","$20,426.00 ","$1,851.24 ","$27,721.00 ","$21,009.60 ","$21,301.40 ","$6,993.00 ","$24,803.00 ","$9,768.54 ","$6,993.00 ","$24,803.00 ","$21,301.40 ","$1,851.24 ","$9,768.54 ","$15,834.06 ","$24,803.00 ","$21,979.23 ","$26,845.60 ","$20,426.00 ","$5,993.67 ","$8,056.00 ","$17,770.62 ","$7,491.83 ","$20,163.38 ","$21,009.60 ","$20,323.87 ","$9,866.23 ","$21,009.60 ","$1,962.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$21,009.60 ","$18,091.60 ","$21,009.60 ","$21,009.60 ","$17,508.00 "
ST MARY'S HOSPITAL,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 ","$6,826.32 ","$6,921.13 ","$6,993.00 ","$8,058.85 ", N/A ,"$6,993.00 ","$8,058.85 ","$6,921.13 ","$1,851.24 ", N/A , N/A ,"$8,058.85 ", N/A ,"$8,722.52 ","$6,636.70 ","$5,993.67 ","$8,056.00 ","$5,773.93 ","$7,491.83 ","$6,551.37 ","$6,826.32 ","$6,603.52 ", N/A ,"$6,826.32 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$6,826.32 ","$5,878.22 ","$6,826.32 ","$6,826.32 ","$5,688.60 "
ST MARY'S HOSPITAL,48100266,37246,HC ANGIOPLASTY TRANLUM BALN INIT ARTERY 37246,481,1 ,"$7,597.00 ","$3,798.50 ","$1,123.24 ","$10,845.30 ","$1,123.24 ","$7,597.00 ","$7,597.00 ","$4,820.13 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$1,123.24 ","$7,217.15 ","$5,469.84 ","$5,545.81 ","$6,993.00 ","$6,457.45 ","$4,820.13 ","$6,993.00 ","$6,457.45 ","$5,545.81 ","$1,123.24 ","$4,820.13 ","$7,597.00 ","$6,457.45 ","$10,845.30 ","$6,989.24 ","$5,317.90 ","$5,993.67 ","$8,056.00 ","$4,626.57 ","$7,491.83 ","$5,249.53 ","$5,469.84 ","$5,291.31 ","$4,868.33 ","$5,469.84 ","$1,190.63 ","$7,597.00 ","$7,597.00 ","$4,820.13 ","$7,597.00 ","$4,820.13 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$4,558.20 "
ST MARY'S HOSPITAL,48100267,37247,HC ANGIOPLASTY TRANLUM BALN ADDL ARTERY 37247,481,1 ,"$6,206.00 ","$3,103.00 ","$1,851.24 ","$8,056.00 ","$1,851.24 ", N/A , N/A , N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ","$1,851.24 ","$5,895.70 ","$4,468.32 ","$4,530.38 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$5,275.10 ","$4,530.38 ","$1,851.24 ", N/A , N/A ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$5,993.67 ","$8,056.00 ","$3,779.45 ","$7,491.83 ","$4,288.35 ","$4,468.32 ","$4,322.48 ", N/A ,"$4,468.32 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$3,723.60 "
ST MARY'S HOSPITAL,48100268,37248,HC ANGIOPLASTY TRANLUM BALN INIT VEIN 37248,481,1 ,"$7,597.00 ","$3,798.50 ","$1,123.24 ","$10,845.30 ","$1,123.24 ","$7,597.00 ","$7,597.00 ","$4,820.13 ","$4,558.20 ","$6,457.45 ","$5,317.90 ","$1,123.24 ","$7,217.15 ","$5,469.84 ","$5,545.81 ","$6,993.00 ","$6,457.45 ","$4,820.13 ","$6,993.00 ","$6,457.45 ","$5,545.81 ","$1,123.24 ","$4,820.13 ","$7,597.00 ","$6,457.45 ","$10,845.30 ","$6,989.24 ","$5,317.90 ","$5,993.67 ","$8,056.00 ","$4,626.57 ","$7,491.83 ","$5,249.53 ","$5,469.84 ","$5,291.31 ","$4,868.33 ","$5,469.84 ","$1,190.63 ","$7,597.00 ","$7,597.00 ","$4,820.13 ","$7,597.00 ","$4,820.13 ","$5,469.84 ","$4,710.14 ","$5,469.84 ","$5,469.84 ","$4,558.20 "
ST MARY'S HOSPITAL,48100269,37249,HC ANGIOPLASTY TRANLUM BALN ADDL VEIN 37249,481,1 ,"$6,206.00 ","$3,103.00 ","$1,851.24 ","$8,056.00 ","$1,851.24 ", N/A , N/A , N/A ,"$3,723.60 ","$5,275.10 ","$4,344.20 ","$1,851.24 ","$5,895.70 ","$4,468.32 ","$4,530.38 ","$6,206.00 ","$5,275.10 ", N/A ,"$6,206.00 ","$5,275.10 ","$4,530.38 ","$1,851.24 ", N/A , N/A ,"$5,275.10 ", N/A ,"$5,709.52 ","$4,344.20 ","$5,993.67 ","$8,056.00 ","$3,779.45 ","$7,491.83 ","$4,288.35 ","$4,468.32 ","$4,322.48 ", N/A ,"$4,468.32 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$4,468.32 ","$3,847.72 ","$4,468.32 ","$4,468.32 ","$3,723.60 "
ST MARY'S HOSPITAL,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 ","$7,961.76 ","$8,072.34 ","$6,993.00 ","$9,399.30 ", N/A ,"$6,993.00 ","$9,399.30 ","$8,072.34 ","$1,851.24 ", N/A , N/A ,"$9,399.30 ", N/A ,"$10,173.36 ","$7,740.60 ","$5,993.67 ","$8,056.00 ","$6,734.32 ","$7,491.83 ","$7,641.08 ","$7,961.76 ","$7,701.90 ", N/A ,"$7,961.76 ","$1,962.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$7,961.76 ","$6,855.96 ","$7,961.76 ","$7,961.76 ","$6,634.80 "
ST MARY'S HOSPITAL,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 ","$6,856.56 ","$6,951.79 ","$6,993.00 ","$8,094.55 ", N/A ,"$6,993.00 ","$8,094.55 ","$6,951.79 ","$3,445.58 ", N/A , N/A ,"$8,094.55 ", N/A ,"$8,761.16 ","$6,666.10 ","$5,993.67 ","$8,056.00 ","$5,799.51 ","$7,491.83 ","$6,580.39 ","$6,856.56 ","$6,632.77 ", N/A ,"$6,856.56 ","$3,652.31 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$6,856.56 ","$5,904.26 ","$6,856.56 ","$6,856.56 ","$5,713.80 "
ST MARY'S HOSPITAL,48100272,36901,HC INTRO CATH DIALYSIS CIRCUIT 36901,481,1 ,"$4,086.00 ","$2,043.00 ",$573.58 ,"$4,086.00 ",$573.58 ,"$4,058.00 ","$3,641.00 ","$1,367.57 ","$2,451.60 ","$3,473.10 ","$2,860.20 ",$573.58 ,"$3,881.70 ","$2,941.92 ","$2,982.78 ","$4,086.00 ","$3,473.10 ","$1,367.57 ","$4,086.00 ","$3,473.10 ","$2,982.78 ",$573.58 ,"$1,367.57 ","$4,086.00 ","$3,473.10 ","$3,077.03 ","$3,759.12 ","$2,860.20 ","$1,489.75 ","$2,002.44 ","$2,488.37 ","$1,862.71 ","$2,823.43 ","$2,941.92 ","$2,845.90 ","$1,381.25 ","$2,941.92 ",$607.99 ,"$4,016.00 ","$4,016.00 ","$1,367.57 ","$4,016.00 ","$1,367.57 ","$2,941.92 ","$2,533.32 ","$2,941.92 ","$2,941.92 ","$2,451.60 "
ST MARY'S HOSPITAL,48100273,36903,HC INTRO CATH/CIRCUIT W/STENT 36903,481,1 ,"$29,180.00 ","$14,590.00 ","$1,489.75 ","$29,180.00 ","$3,445.58 ","$18,727.00 ","$11,705.00 ","$9,768.54 ","$17,508.00 ","$24,803.00 ","$20,426.00 ","$3,445.58 ","$27,721.00 ","$21,009.60 ","$21,301.40 ","$6,993.00 ","$24,803.00 ","$9,768.54 ","$6,993.00 ","$24,803.00 ","$21,301.40 ","$3,445.58 ","$9,768.54 ","$15,834.06 ","$24,803.00 ","$21,979.23 ","$26,845.60 ","$20,426.00 ","$1,489.75 ","$2,002.44 ","$17,770.62 ","$1,862.71 ","$20,163.38 ","$21,009.60 ","$20,323.87 ","$9,866.23 ","$21,009.60 ","$3,652.31 ","$10,114.00 ","$10,114.00 ","$9,768.54 ","$10,114.00 ","$9,768.54 ","$21,009.60 ","$18,091.60 ","$21,009.60 ","$21,009.60 ","$17,508.00 "
ST MARY'S HOSPITAL,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 ","$4,820.13 ","$8,641.20 ","$12,241.70 ","$10,081.40 ","$1,123.24 ","$13,681.90 ","$10,369.44 ","$10,513.46 ","$6,993.00 ","$12,241.70 ","$4,820.13 ","$6,993.00 ","$12,241.70 ","$10,513.46 ","$1,123.24 ","$4,820.13 ","$7,919.86 ","$12,241.70 ","$10,845.30 ","$13,249.84 ","$10,081.40 ","$1,489.75 ","$2,002.44 ","$8,770.82 ","$1,862.71 ","$9,951.78 ","$10,369.44 ","$10,030.99 ","$4,868.33 ","$10,369.44 ","$1,190.63 ","$8,832.00 ","$8,832.00 ","$4,820.13 ","$8,832.00 ","$4,820.13 ","$10,369.44 ","$8,929.24 ","$10,369.44 ","$10,369.44 ","$8,641.20 "
ST MARY'S HOSPITAL,48100275,36906,HC THROMBECTOMY/INFUS CIRCUIT W/STENT 36906,481,1 ,"$46,674.00 ","$23,337.00 ","$1,489.75 ","$46,674.00 ","$3,445.58 ","$19,768.00 ","$13,525.00 ","$15,618.94 ","$28,004.40 ","$39,672.90 ","$32,671.80 ","$3,445.58 ","$44,340.30 ","$33,605.28 ","$34,072.02 ","$6,993.00 ","$39,672.90 ","$15,618.94 ","$6,993.00 ","$39,672.90 ","$34,072.02 ","$3,445.58 ","$15,618.94 ","$18,996.34 ","$39,672.90 ","$35,142.61 ","$42,940.08 ","$32,671.80 ","$1,489.75 ","$2,002.44 ","$28,424.47 ","$1,862.71 ","$32,251.73 ","$33,605.28 ","$32,508.44 ","$15,775.13 ","$33,605.28 ","$3,652.31 ","$14,302.00 ","$14,302.00 ","$15,618.94 ","$14,302.00 ","$15,618.94 ","$33,605.28 ","$28,937.88 ","$33,605.28 ","$33,605.28 ","$28,004.40 "
ST MARY'S HOSPITAL,48100277,93288,HC INTERROG DEVICE EVAL PACEMAKER SYSTEM,481,1 ,$134.00 ,$67.00 ,$12.10 ,$134.00 ,$12.10 ,$134.00 ,$134.00 ,$36.21 ,$80.40 ,$113.90 ,$93.80 ,$12.10 ,$127.30 ,$96.48 ,$97.82 ,$134.00 ,$113.90 ,$36.21 ,$134.00 ,$113.90 ,$97.82 ,$12.10 ,$36.21 , N/A ,$113.90 ,$81.48 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$76.13 ,$92.59 ,$96.48 ,$93.33 ,$36.57 ,$96.48 ,$12.83 , N/A , N/A ,$36.21 , N/A ,$36.21 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,48100443,34812,HC EXPOSE FEMORAL ARTERY W/PROSTHESIS UNILATERAL,481,1 ,"$8,560.00 ","$4,280.00 ","$1,150.81 ","$8,560.00 ","$1,150.81 ","$4,058.00 ","$3,641.00 ", N/A ,"$5,136.00 ","$7,276.00 ","$5,992.00 ","$1,150.81 ","$8,132.00 ","$6,163.20 ","$6,248.80 ","$2,815.00 ","$7,276.00 ", N/A ,"$2,815.00 ","$7,276.00 ","$6,248.80 ","$1,150.81 ", N/A ,"$8,560.00 ","$7,276.00 ", N/A ,"$7,875.20 ","$5,992.00 ","$5,993.67 ","$8,056.00 ","$5,213.04 ","$7,491.83 ","$5,914.96 ","$6,163.20 ","$5,962.04 ", N/A ,"$6,163.20 ","$1,219.86 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$6,163.20 ","$5,307.20 ","$6,163.20 ","$6,163.20 ","$5,136.00 "
ST MARY'S HOSPITAL,48100484,33274,HC TRANSCATH INS/REPLC VENTRIC PACEMAKER LEADLESS W/GUIDE,481,1 ,"$8,453.00 ","$4,226.50 ","$2,606.72 ","$35,142.61 ","$2,606.72 ","$8,453.00 ","$8,453.00 ","$15,618.94 ","$5,071.80 ","$7,185.05 ","$5,917.10 ","$2,606.72 ","$8,030.35 ","$6,086.16 ","$6,170.69 ","$6,993.00 ","$7,185.05 ","$15,618.94 ","$6,993.00 ","$7,185.05 ","$6,170.69 ","$2,606.72 ","$15,618.94 ","$8,453.00 ","$7,185.05 ","$35,142.61 ","$7,776.76 ","$5,917.10 ","$4,287.36 ","$5,145.34 ","$5,147.88 ","$4,802.15 ","$5,841.02 ","$6,086.16 ","$5,887.51 ","$15,775.13 ","$6,086.16 ","$2,763.12 ","$8,453.00 ","$8,453.00 ","$15,618.94 ","$8,453.00 ","$15,618.94 ","$6,086.16 ","$5,240.86 ","$6,086.16 ","$6,086.16 ","$5,071.80 "
ST MARY'S HOSPITAL,48100485,33275,HC TRANSCATH REMOVE VENTRIC PACEMAKER LEADLESS,481,1 ,"$6,238.00 ","$3,119.00 ","$2,195.90 ","$6,263.99 ","$2,195.90 ","$6,238.00 ","$6,238.00 ","$2,784.00 ","$3,742.80 ","$5,302.30 ","$4,366.60 ","$2,195.90 ","$5,926.10 ","$4,491.36 ","$4,553.74 ","$6,238.00 ","$5,302.30 ","$2,784.00 ","$6,238.00 ","$5,302.30 ","$4,553.74 ","$2,195.90 ","$2,784.00 ","$4,525.63 ","$5,302.30 ","$6,263.99 ","$5,738.96 ","$4,366.60 ","$3,163.91 ","$3,797.07 ","$3,798.94 ","$3,543.81 ","$4,310.46 ","$4,491.36 ","$4,344.77 ","$2,811.84 ","$4,491.36 ","$2,327.65 ","$6,238.00 ","$6,238.00 ","$2,784.00 ","$6,238.00 ","$2,784.00 ","$4,491.36 ","$3,867.56 ","$4,491.36 ","$4,491.36 ","$3,742.80 "
ST MARY'S HOSPITAL,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 ",$770.40 ,$781.10 ,"$1,070.00 ",$909.50 , N/A ,"$1,070.00 ",$909.50 ,$781.10 ,"$5,616.20 ", N/A ,"$1,070.00 ",$909.50 , N/A ,$984.40 ,$749.00 ,$542.70 ,$651.31 ,$651.63 ,$607.87 ,$739.37 ,$770.40 ,$745.26 , N/A ,$770.40 ,"$5,953.17 ","$1,070.00 ","$1,070.00 ", N/A ,"$1,070.00 ", N/A ,$770.40 ,$663.40 ,$770.40 ,$770.40 ,$642.00 
ST MARY'S HOSPITAL,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 ,$339.12 ,$343.83 ,$471.00 ,$400.35 , N/A ,$471.00 ,$400.35 ,$343.83 ,"$5,616.20 ", N/A , N/A ,$400.35 , N/A ,$433.32 ,$329.70 ,$238.89 ,$286.70 ,$286.84 ,$267.58 ,$325.46 ,$339.12 ,$328.05 , N/A ,$339.12 ,"$5,953.17 ",$471.00 ,$471.00 , N/A ,$471.00 , N/A ,$339.12 ,$292.02 ,$339.12 ,$339.12 ,$282.60 
ST MARY'S HOSPITAL,48100499,33889,HC ARTERY TRANSPOSE/ENDO TAA,481,1 ,"$10,700.00 ","$5,350.00 ","$3,704.23 ","$10,700.00 ","$3,704.23 ","$10,700.00 ","$10,700.00 ", N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$3,704.23 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ", N/A ,"$6,993.00 ","$9,095.00 ","$7,811.00 ","$3,704.23 ", N/A ,"$10,700.00 ","$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,993.67 ","$8,056.00 ","$6,516.30 ","$7,491.83 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$3,926.48 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,48100500,34714,HC OPEN FEM ARTERY EXPOSE CONDUIT,481,1 ,"$10,700.00 ","$5,350.00 ","$1,150.81 ","$10,700.00 ","$1,150.81 ", N/A , N/A , N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$1,150.81 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ", N/A ,"$6,993.00 ","$9,095.00 ","$7,811.00 ","$1,150.81 ", N/A , N/A ,"$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,078.67 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$1,219.86 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,48100501,34715,HC OPEN AXIL/SUBCLA ARTERY EXPOSE,481,1 ,"$8,560.00 ","$4,280.00 ","$1,150.81 ","$8,560.00 ","$1,150.81 ", N/A , N/A , N/A ,"$5,136.00 ","$7,276.00 ","$5,992.00 ","$1,150.81 ","$8,132.00 ","$6,163.20 ","$6,248.80 ","$6,993.00 ","$7,276.00 ", N/A ,"$6,993.00 ","$7,276.00 ","$6,248.80 ","$1,150.81 ", N/A , N/A ,"$7,276.00 ", N/A ,"$7,875.20 ","$5,992.00 ","$4,341.63 ","$5,210.47 ","$5,213.04 ","$4,862.94 ","$5,914.96 ","$6,163.20 ","$5,962.04 ", N/A ,"$6,163.20 ","$1,219.86 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$6,163.20 ","$5,307.20 ","$6,163.20 ","$6,163.20 ","$5,136.00 "
ST MARY'S HOSPITAL,48100502,34716,HC OPEN AXIL/SUBCLA ARTERY EXPOSE CONDUIT,481,1 ,"$10,700.00 ","$5,350.00 ","$1,150.81 ","$10,700.00 ","$1,150.81 ", N/A , N/A , N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$1,150.81 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ", N/A ,"$6,993.00 ","$9,095.00 ","$7,811.00 ","$1,150.81 ", N/A , N/A ,"$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,427.04 ","$6,513.09 ","$6,516.30 ","$6,078.67 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$1,219.86 ","$1,902.00 ","$1,902.00 ", N/A ,"$1,902.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,48100503,34820,HC OPEN ILIAC ART EXPOSE,481,1 ,"$10,700.00 ","$5,350.00 ","$2,815.00 ","$10,700.00 ","$5,616.20 ","$7,283.00 ","$6,763.00 ", N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$5,616.20 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$2,815.00 ","$9,095.00 ", N/A ,"$2,815.00 ","$9,095.00 ","$7,811.00 ","$5,616.20 ", N/A ,"$10,700.00 ","$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,993.67 ","$8,056.00 ","$6,516.30 ","$7,491.83 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,48100504,34830,HC OPEN AORTIC TUBE PROSTH REPAIR,481,1 ,"$42,800.00 ","$21,400.00 ","$3,704.23 ","$42,800.00 ","$3,704.23 ","$18,727.00 ","$11,705.00 ", N/A ,"$25,680.00 ","$36,380.00 ","$29,960.00 ","$3,704.23 ","$40,660.00 ","$30,816.00 ","$31,244.00 ","$13,430.00 ","$36,380.00 ", N/A ,"$13,430.00 ","$36,380.00 ","$31,244.00 ","$3,704.23 ", N/A ,"$18,996.34 ","$36,380.00 ", N/A ,"$39,376.00 ","$29,960.00 ","$5,993.67 ","$8,056.00 ","$26,065.20 ","$7,491.83 ","$29,574.80 ","$30,816.00 ","$29,810.20 ", N/A ,"$30,816.00 ","$3,926.48 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$30,816.00 ","$26,536.00 ","$30,816.00 ","$30,816.00 ","$25,680.00 "
ST MARY'S HOSPITAL,48100505,34831,HC OPEN AORTOILIAC PROSTH REPAIR,481,1 ,"$42,800.00 ","$21,400.00 ","$3,704.23 ","$42,800.00 ","$3,704.23 ","$18,727.00 ","$11,705.00 ", N/A ,"$25,680.00 ","$36,380.00 ","$29,960.00 ","$3,704.23 ","$40,660.00 ","$30,816.00 ","$31,244.00 ","$10,301.00 ","$36,380.00 ", N/A ,"$10,301.00 ","$36,380.00 ","$31,244.00 ","$3,704.23 ", N/A ,"$18,996.34 ","$36,380.00 ", N/A ,"$39,376.00 ","$29,960.00 ","$5,993.67 ","$8,056.00 ","$26,065.20 ","$7,491.83 ","$29,574.80 ","$30,816.00 ","$29,810.20 ", N/A ,"$30,816.00 ","$3,926.48 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$30,816.00 ","$26,536.00 ","$30,816.00 ","$30,816.00 ","$25,680.00 "
ST MARY'S HOSPITAL,48100506,34832,HC OPEN AORTOFEMOR PROSTH REPAIR,481,1 ,"$42,800.00 ","$21,400.00 ","$3,704.23 ","$42,800.00 ","$3,704.23 ","$18,727.00 ","$11,705.00 ", N/A ,"$25,680.00 ","$36,380.00 ","$29,960.00 ","$3,704.23 ","$40,660.00 ","$30,816.00 ","$31,244.00 ","$10,301.00 ","$36,380.00 ", N/A ,"$10,301.00 ","$36,380.00 ","$31,244.00 ","$3,704.23 ", N/A ,"$18,996.34 ","$36,380.00 ", N/A ,"$39,376.00 ","$29,960.00 ","$5,993.67 ","$8,056.00 ","$26,065.20 ","$7,491.83 ","$29,574.80 ","$30,816.00 ","$29,810.20 ", N/A ,"$30,816.00 ","$3,926.48 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$30,816.00 ","$26,536.00 ","$30,816.00 ","$30,816.00 ","$25,680.00 "
ST MARY'S HOSPITAL,48100507,34833,HC OPEN ILIAC ARTERY EXPOSE CONDUIT,481,1 ,"$10,700.00 ","$5,350.00 ","$3,803.00 ","$10,700.00 ","$5,616.20 ","$7,283.00 ","$6,763.00 ", N/A ,"$6,420.00 ","$9,095.00 ","$7,490.00 ","$5,616.20 ","$10,165.00 ","$7,704.00 ","$7,811.00 ","$6,993.00 ","$9,095.00 ", N/A ,"$6,993.00 ","$9,095.00 ","$7,811.00 ","$5,616.20 ", N/A ,"$10,700.00 ","$9,095.00 ", N/A ,"$9,844.00 ","$7,490.00 ","$5,993.67 ","$8,056.00 ","$6,516.30 ","$7,491.83 ","$7,393.70 ","$7,704.00 ","$7,452.55 ", N/A ,"$7,704.00 ","$5,953.17 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$7,704.00 ","$6,634.00 ","$7,704.00 ","$7,704.00 ","$6,420.00 "
ST MARY'S HOSPITAL,48100508,34834,HC OPEN BRACHIAL ARTY EXPOS ENDO PROST,481,1 ,"$8,560.00 ","$4,280.00 ","$1,150.81 ","$8,560.00 ","$1,150.81 ","$4,058.00 ","$3,641.00 ", N/A ,"$5,136.00 ","$7,276.00 ","$5,992.00 ","$1,150.81 ","$8,132.00 ","$6,163.20 ","$6,248.80 ","$6,993.00 ","$7,276.00 ", N/A ,"$6,993.00 ","$7,276.00 ","$6,248.80 ","$1,150.81 ", N/A ,"$8,560.00 ","$7,276.00 ", N/A ,"$7,875.20 ","$5,992.00 ","$5,993.67 ","$8,056.00 ","$5,213.04 ","$7,491.83 ","$5,914.96 ","$6,163.20 ","$5,962.04 ", N/A ,"$6,163.20 ","$1,219.86 ","$3,803.00 ","$3,803.00 ", N/A ,"$3,803.00 ", N/A ,"$6,163.20 ","$5,307.20 ","$6,163.20 ","$6,163.20 ","$5,136.00 "
ST MARY'S HOSPITAL,48100523,93287,HC PERI-PROC DEVICE EVAL/PROGRAM DEFIB SYSTEM,481,1 ,$241.00 ,$120.50 ,$12.10 ,$241.00 ,$12.10 , N/A , N/A , N/A ,$144.60 ,$204.85 ,$168.70 ,$12.10 ,$228.95 ,$173.52 ,$175.93 ,$241.00 ,$204.85 , N/A ,$241.00 ,$204.85 ,$175.93 ,$12.10 , N/A , N/A ,$204.85 , N/A ,$221.72 ,$168.70 ,$122.24 ,$146.70 ,$146.77 ,$136.91 ,$166.53 ,$173.52 ,$167.86 , N/A ,$173.52 ,$12.83 , N/A , N/A , N/A , N/A , N/A ,$173.52 ,$149.42 ,$173.52 ,$173.52 ,$144.60 
ST MARY'S HOSPITAL,48100536,C9764,HC REVASC INTRAVASC LITHOTRIPSY,481,1 ,"$6,955.00 ","$3,477.50 ","$1,123.24 ","$21,979.23 ","$1,123.24 ", N/A , N/A ,"$9,768.54 ","$4,173.00 ","$5,911.75 ","$4,868.50 ","$1,123.24 ","$6,607.25 ","$5,007.60 ","$5,077.15 ","$6,955.00 ","$5,911.75 ","$9,768.54 ","$6,955.00 ","$5,911.75 ","$5,077.15 ","$1,123.24 ","$9,768.54 ", N/A ,"$5,911.75 ","$21,979.23 ","$6,398.60 ","$4,868.50 ","$3,527.58 ","$4,233.51 ","$4,235.60 ","$3,951.14 ","$4,805.91 ","$5,007.60 ","$4,844.16 ","$9,866.23 ","$5,007.60 ","$1,190.63 ", N/A , N/A ,"$9,768.54 ", N/A ,"$9,768.54 ","$5,007.60 ","$4,312.10 ","$5,007.60 ","$5,007.60 ","$4,173.00 "
ST MARY'S HOSPITAL,48100537,C9765,HC REVASC INTRA LITHOTRIP-STENT,481,1 ,"$10,775.00 ","$5,387.50 ","$1,851.24 ","$35,142.61 ","$1,851.24 ", N/A , N/A ,"$15,618.94 ","$6,465.00 ","$9,158.75 ","$7,542.50 ","$1,851.24 ","$10,236.25 ","$7,758.00 ","$7,865.75 ","$6,993.00 ","$9,158.75 ","$15,618.94 ","$6,993.00 ","$9,158.75 ","$7,865.75 ","$1,851.24 ","$15,618.94 ", N/A ,"$9,158.75 ","$35,142.61 ","$9,913.00 ","$7,542.50 ","$5,465.08 ","$6,558.74 ","$6,561.98 ","$6,121.28 ","$7,445.53 ","$7,758.00 ","$7,504.79 ","$15,775.13 ","$7,758.00 ","$1,962.31 ", N/A , N/A ,"$15,618.94 ", N/A ,"$15,618.94 ","$7,758.00 ","$6,680.50 ","$7,758.00 ","$7,758.00 ","$6,465.00 "
ST MARY'S HOSPITAL,48100538,C9766,HC REVASC INTRA LITHOTRIP-ATHER,481,1 ,"$10,775.00 ","$5,387.50 ","$1,851.24 ","$35,142.61 ","$1,851.24 ", N/A , N/A ,"$15,618.94 ","$6,465.00 ","$9,158.75 ","$7,542.50 ","$1,851.24 ","$10,236.25 ","$7,758.00 ","$7,865.75 ","$6,993.00 ","$9,158.75 ","$15,618.94 ","$6,993.00 ","$9,158.75 ","$7,865.75 ","$1,851.24 ","$15,618.94 ", N/A ,"$9,158.75 ","$35,142.61 ","$9,913.00 ","$7,542.50 ","$5,465.08 ","$6,558.74 ","$6,561.98 ","$6,121.28 ","$7,445.53 ","$7,758.00 ","$7,504.79 ","$15,775.13 ","$7,758.00 ","$1,962.31 ", N/A , N/A ,"$15,618.94 ", N/A ,"$15,618.94 ","$7,758.00 ","$6,680.50 ","$7,758.00 ","$7,758.00 ","$6,465.00 "
ST MARY'S HOSPITAL,48100539,C9767,HC REVASC LITHOTRIP-STENT-ATHER,481,1 ,"$24,610.00 ","$12,305.00 ","$3,445.58 ","$35,142.61 ","$3,445.58 ", N/A , N/A ,"$15,618.94 ","$14,766.00 ","$20,918.50 ","$17,227.00 ","$3,445.58 ","$23,379.50 ","$17,719.20 ","$17,965.30 ","$6,993.00 ","$20,918.50 ","$15,618.94 ","$6,993.00 ","$20,918.50 ","$17,965.30 ","$3,445.58 ","$15,618.94 ", N/A ,"$20,918.50 ","$35,142.61 ","$22,641.20 ","$17,227.00 ","$12,482.19 ","$14,980.11 ","$14,987.49 ","$13,980.94 ","$17,005.51 ","$17,719.20 ","$17,140.87 ","$15,775.13 ","$17,719.20 ","$3,652.31 ", N/A , N/A ,"$15,618.94 ", N/A ,"$15,618.94 ","$17,719.20 ","$15,258.20 ","$17,719.20 ","$17,719.20 ","$14,766.00 "
ST MARY'S HOSPITAL,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 ,$257.38 ,$739.20 ,"$1,047.20 ",$862.40 ,$52.64 ,"$1,170.40 ",$887.04 ,$899.36 ,$800.80 ,"$1,047.20 ",$257.38 ,$800.80 ,"$1,047.20 ",$899.36 ,$52.64 ,$257.38 ,$633.59 ,"$1,047.20 ",$579.11 ,"$1,133.44 ",$862.40 ,$827.79 ,$890.21 ,$750.29 ,$827.79 ,$851.31 ,$887.04 ,$858.09 ,$259.95 ,$887.04 ,$55.80 ,$784.00 ,$784.00 ,$257.38 ,$784.00 ,$257.38 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,48200006,93017,HC STRESS TEST TRACING ONLY ECHO,482,1 ,"$1,232.00 ",$616.00 ,$52.64 ,"$1,232.00 ",$52.64 ,$796.98 ,$796.98 ,$257.38 ,$739.20 ,"$1,047.20 ",$862.40 ,$52.64 ,"$1,170.40 ",$887.04 ,$899.36 ,$800.80 ,"$1,047.20 ",$257.38 ,$800.80 ,"$1,047.20 ",$899.36 ,$52.64 ,$257.38 ,$633.59 ,"$1,047.20 ",$579.11 ,"$1,133.44 ",$862.40 ,$827.79 ,$890.21 ,$750.29 ,$827.79 ,$851.31 ,$887.04 ,$858.09 ,$259.95 ,$887.04 ,$55.80 ,$784.00 ,$784.00 ,$257.38 ,$784.00 ,$257.38 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,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 ",$469.91 ,"$1,200.00 ","$1,700.00 ","$1,400.00 ",$145.75 ,"$1,900.00 ","$1,440.00 ","$1,460.00 ","$1,300.00 ","$1,700.00 ",$469.91 ,"$1,300.00 ","$1,700.00 ","$1,460.00 ",$145.75 ,$469.91 ,$305.48 ,"$1,700.00 ","$1,057.30 ","$1,840.00 ","$1,400.00 ","$1,448.33 ","$1,557.54 ","$1,218.00 ","$1,448.33 ","$1,382.00 ","$1,440.00 ","$1,393.00 ",$474.61 ,"$1,440.00 ",$154.50 ,$516.00 ,$516.00 ,$469.91 ,$516.00 ,$469.91 ,"$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,200.00 "
ST MARY'S HOSPITAL,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 ",$223.78 ,"$1,032.00 ","$1,462.00 ","$1,204.00 ",$145.75 ,"$1,634.00 ","$1,238.40 ","$1,255.60 ","$1,118.00 ","$1,462.00 ",$223.78 ,"$1,118.00 ","$1,462.00 ","$1,255.60 ",$145.75 ,$223.78 ,$305.48 ,"$1,462.00 ",$503.50 ,"$1,582.40 ","$1,204.00 ","$1,448.33 ","$1,557.54 ","$1,047.48 ","$1,448.33 ","$1,188.52 ","$1,238.40 ","$1,197.98 ",$226.02 ,"$1,238.40 ",$154.50 ,$516.00 ,$516.00 ,$223.78 ,$516.00 ,$223.78 ,"$1,238.40 ","$1,066.40 ","$1,238.40 ","$1,238.40 ","$1,032.00 "
ST MARY'S HOSPITAL,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 ,$223.78 ,$528.00 ,$748.00 ,$616.00 ,$145.75 ,$836.00 ,$633.60 ,$642.40 ,$572.00 ,$748.00 ,$223.78 ,$572.00 ,$748.00 ,$642.40 ,$145.75 ,$223.78 ,$305.48 ,$748.00 ,$503.50 ,$809.60 ,$616.00 ,$849.71 ,$880.00 ,$535.92 ,$849.71 ,$608.08 ,$633.60 ,$612.92 ,$226.02 ,$633.60 ,$154.50 ,$516.00 ,$516.00 ,$223.78 ,$516.00 ,$223.78 ,$633.60 ,$545.60 ,$633.60 ,$633.60 ,$528.00 
ST MARY'S HOSPITAL,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 ",$469.91 ,"$1,500.00 ","$2,125.00 ","$1,750.00 ",$145.75 ,"$2,375.00 ","$1,800.00 ","$1,825.00 ","$1,625.00 ","$2,125.00 ",$469.91 ,"$1,625.00 ","$2,125.00 ","$1,825.00 ",$145.75 ,$469.91 ,$305.48 ,"$2,125.00 ","$1,057.30 ","$2,300.00 ","$1,750.00 ","$2,014.86 ","$2,166.80 ","$1,522.50 ","$2,014.86 ","$1,727.50 ","$1,800.00 ","$1,741.25 ",$474.61 ,"$1,800.00 ",$154.50 ,$516.00 ,$516.00 ,$469.91 ,$516.00 ,$469.91 ,"$1,800.00 ","$1,550.00 ","$1,800.00 ","$1,800.00 ","$1,500.00 "
ST MARY'S HOSPITAL,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 ,$388.80 ,$394.20 ,$351.00 ,$459.00 , N/A ,$351.00 ,$459.00 ,$394.20 ,$145.75 , N/A ,$305.48 ,$459.00 , N/A ,$496.80 ,$378.00 ,$273.89 ,$328.70 ,$328.86 ,$306.77 ,$373.14 ,$388.80 ,$376.11 , N/A ,$388.80 ,$154.50 ,$516.00 ,$516.00 , N/A ,$516.00 , N/A ,$388.80 ,$334.80 ,$388.80 ,$388.80 ,$324.00 
ST MARY'S HOSPITAL,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 ,$360.00 ,$365.00 ,$325.00 ,$425.00 , N/A ,$325.00 ,$425.00 ,$365.00 ,$34.74 , N/A ,$305.48 ,$425.00 , N/A ,$460.00 ,$350.00 ,$253.60 ,$304.35 ,$304.50 ,$284.05 ,$345.50 ,$360.00 ,$348.25 , N/A ,$360.00 ,$36.82 ,$500.00 ,$500.00 , N/A ,$500.00 , N/A ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$300.00 
ST MARY'S HOSPITAL,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 ",$469.91 ,"$1,140.00 ","$1,615.00 ","$1,330.00 ",$145.75 ,"$1,805.00 ","$1,368.00 ","$1,387.00 ","$1,235.00 ","$1,615.00 ",$469.91 ,"$1,235.00 ","$1,615.00 ","$1,387.00 ",$145.75 ,$469.91 ,$305.48 ,"$1,615.00 ","$1,057.30 ","$1,748.00 ","$1,330.00 ","$1,448.33 ","$1,557.54 ","$1,157.10 ","$1,448.33 ","$1,312.90 ","$1,368.00 ","$1,323.35 ",$474.61 ,"$1,368.00 ",$154.50 ,$516.00 ,$516.00 ,$469.91 ,$516.00 ,$469.91 ,"$1,368.00 ","$1,178.00 ","$1,368.00 ","$1,368.00 ","$1,140.00 "
ST MARY'S HOSPITAL,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 ",$469.91 ,"$1,455.00 ","$2,061.25 ","$1,697.50 ",$145.75 ,"$2,303.75 ","$1,746.00 ","$1,770.25 ","$1,576.25 ","$2,061.25 ",$469.91 ,"$1,576.25 ","$2,061.25 ","$1,770.25 ",$145.75 ,$469.91 ,$305.48 ,"$2,061.25 ","$1,057.30 ","$2,231.00 ","$1,697.50 ","$2,014.86 ","$2,166.80 ","$1,476.83 ","$2,014.86 ","$1,675.68 ","$1,746.00 ","$1,689.01 ",$474.61 ,"$1,746.00 ",$154.50 ,$516.00 ,$516.00 ,$469.91 ,$516.00 ,$469.91 ,"$1,746.00 ","$1,503.50 ","$1,746.00 ","$1,746.00 ","$1,455.00 "
ST MARY'S HOSPITAL,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 ",$469.91 ,"$1,086.00 ","$1,538.50 ","$1,267.00 ",$145.75 ,"$1,719.50 ","$1,303.20 ","$1,321.30 ","$1,176.50 ","$1,538.50 ",$469.91 ,"$1,176.50 ","$1,538.50 ","$1,321.30 ",$145.75 ,$469.91 ,$305.48 ,"$1,538.50 ","$1,057.30 ","$1,665.20 ","$1,267.00 ","$1,448.33 ","$1,557.54 ","$1,102.29 ","$1,448.33 ","$1,250.71 ","$1,303.20 ","$1,260.67 ",$474.61 ,"$1,303.20 ",$154.50 ,$516.00 ,$516.00 ,$469.91 ,$516.00 ,$469.91 ,"$1,303.20 ","$1,122.20 ","$1,303.20 ","$1,303.20 ","$1,086.00 "
ST MARY'S HOSPITAL,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 ,$327.60 ,$332.15 ,$295.75 ,$386.75 , N/A ,$295.75 ,$386.75 ,$332.15 ,$145.75 , N/A ,$305.48 ,$386.75 , N/A ,$418.60 ,$318.50 ,$230.78 ,$276.96 ,$277.10 ,$258.49 ,$314.41 ,$327.60 ,$316.91 , N/A ,$327.60 ,$154.50 ,$455.00 ,$455.00 , N/A ,$455.00 , N/A ,$327.60 ,$282.10 ,$327.60 ,$327.60 ,$273.00 
ST MARY'S HOSPITAL,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 ",$469.91 ,"$1,455.00 ","$2,061.25 ","$1,697.50 ",$145.75 ,"$2,303.75 ","$1,746.00 ","$1,770.25 ","$1,576.25 ","$2,061.25 ",$469.91 ,"$1,576.25 ","$2,061.25 ","$1,770.25 ",$145.75 ,$469.91 ,$305.48 ,"$2,061.25 ","$1,057.30 ","$2,231.00 ","$1,697.50 ","$2,014.86 ","$2,166.80 ","$1,476.83 ","$2,014.86 ","$1,675.68 ","$1,746.00 ","$1,689.01 ",$474.61 ,"$1,746.00 ",$154.50 ,$516.00 ,$516.00 ,$469.91 ,$516.00 ,$469.91 ,"$1,746.00 ","$1,503.50 ","$1,746.00 ","$1,746.00 ","$1,455.00 "
ST MARY'S HOSPITAL,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 ,$358.13 ,$660.00 ,$935.00 ,$770.00 ,$145.75 ,"$1,045.00 ",$792.00 ,$803.00 ,$715.00 ,$935.00 ,$358.13 ,$715.00 ,$935.00 ,$803.00 ,$145.75 ,$358.13 ,$305.48 ,$935.00 ,$805.79 ,"$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$792.00 ,$766.15 ,$361.71 ,$792.00 ,$154.50 ,$516.00 ,$516.00 ,$358.13 ,$516.00 ,$358.13 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,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 ",$695.77 ,"$1,176.60 ","$1,666.85 ","$1,372.70 ",$145.75 ,"$1,862.95 ","$1,411.92 ","$1,431.53 ","$1,274.65 ","$1,666.85 ",$695.77 ,"$1,274.65 ","$1,666.85 ","$1,431.53 ",$145.75 ,$695.77 ,$305.48 ,"$1,666.85 ","$1,565.49 ","$1,804.12 ","$1,372.70 ","$1,961.00 ","$1,961.00 ","$1,194.25 ","$1,961.00 ","$1,355.05 ","$1,411.92 ","$1,365.84 ",$702.73 ,"$1,411.92 ",$154.50 ,$516.00 ,$516.00 ,$695.77 ,$516.00 ,$695.77 ,"$1,411.92 ","$1,215.82 ","$1,411.92 ","$1,411.92 ","$1,176.60 "
ST MARY'S HOSPITAL,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 ",$695.77 ,"$1,176.60 ","$1,666.85 ","$1,372.70 ",$145.75 ,"$1,862.95 ","$1,411.92 ","$1,431.53 ","$1,274.65 ","$1,666.85 ",$695.77 ,"$1,274.65 ","$1,666.85 ","$1,431.53 ",$145.75 ,$695.77 ,$305.48 ,"$1,666.85 ","$1,565.49 ","$1,804.12 ","$1,372.70 ","$1,961.00 ","$1,961.00 ","$1,194.25 ","$1,961.00 ","$1,355.05 ","$1,411.92 ","$1,365.84 ",$702.73 ,"$1,411.92 ",$154.50 ,$516.00 ,$516.00 ,$695.77 ,$516.00 ,$695.77 ,"$1,411.92 ","$1,215.82 ","$1,411.92 ","$1,411.92 ","$1,176.60 "
ST MARY'S HOSPITAL,51000001,N/A,HC DISCONTINUED PROCEDURE,510,1 ,"$1,050.00 ",$525.00 ,$64.61 ,"$1,050.00 ", N/A ,$131.00 ,$104.00 , N/A ,$630.00 ,$892.50 ,$735.00 , N/A ,$997.50 ,$756.00 ,$766.50 ,$104.00 ,$892.50 , N/A ,$104.00 ,$892.50 ,$766.50 , N/A , N/A ,$64.61 ,$892.50 , N/A ,$966.00 ,$735.00 ,$532.56 ,$639.14 ,$639.45 ,$596.51 ,$725.55 ,$756.00 ,$731.33 , N/A ,$756.00 , N/A ,$630.00 ,$630.00 , N/A ,$630.00 , N/A ,$756.00 ,$651.00 ,$756.00 ,$756.00 ,$630.00 
ST MARY'S HOSPITAL,51000002,95117,HC ALLERGY SHOTS 2 OR MORE,510,1 ,$62.00 ,$31.00 ,$7.30 ,$87.57 ,$7.30 ,$62.00 ,$62.00 ,$38.92 ,$37.20 ,$52.70 ,$43.40 ,$7.30 ,$58.90 ,$44.64 ,$45.26 ,$62.00 ,$52.70 ,$38.92 ,$62.00 ,$52.70 ,$45.26 ,$7.30 ,$38.92 ,$62.00 ,$52.70 ,$87.57 ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$35.22 ,$42.84 ,$44.64 ,$43.18 ,$39.31 ,$44.64 ,$7.74 ,$37.20 ,$37.20 ,$38.92 ,$37.20 ,$38.92 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,51000003,10180,HC I AND D WOUND POST OP COMPLEX,510,1 ,"$7,127.00 ","$3,563.50 ",$64.61 ,"$7,127.00 ",$315.09 ,$131.00 ,$104.00 ,"$2,305.90 ","$4,276.20 ","$6,057.95 ","$4,988.90 ",$315.09 ,"$6,770.65 ","$5,131.44 ","$5,202.71 ",$104.00 ,"$6,057.95 ","$2,305.90 ",$104.00 ,"$6,057.95 ","$5,202.71 ",$315.09 ,"$2,305.90 ",$64.61 ,"$6,057.95 ","$5,188.27 ","$6,556.84 ","$4,988.90 ","$1,680.96 ","$2,259.84 ","$4,340.34 ","$2,101.20 ","$4,924.76 ","$5,131.44 ","$4,963.96 ","$2,328.96 ","$5,131.44 ",$334.00 ,"$4,276.20 ","$4,276.20 ","$2,305.90 ","$4,276.20 ","$2,305.90 ","$5,131.44 ","$4,418.74 ","$5,131.44 ","$5,131.44 ","$4,276.20 "
ST MARY'S HOSPITAL,51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$506.00 ,$253.00 ,$64.61 ,$756.32 ,$118.09 ,$131.00 ,$104.00 ,$336.14 ,$303.60 ,$430.10 ,$354.20 ,$118.09 ,$480.70 ,$364.32 ,$369.38 ,$104.00 ,$430.10 ,$336.14 ,$104.00 ,$430.10 ,$369.38 ,$118.09 ,$336.14 ,$64.61 ,$430.10 ,$756.32 ,$465.52 ,$354.20 ,$506.00 ,$506.00 ,$308.15 ,$506.00 ,$349.65 ,$364.32 ,$352.43 ,$339.50 ,$364.32 ,$125.18 ,$303.60 ,$303.60 ,$336.14 ,$303.60 ,$336.14 ,$364.32 ,$313.72 ,$364.32 ,$364.32 ,$303.60 
ST MARY'S HOSPITAL,51000006,11043,HC DEBR SKIN/SUBQ TISSUE/MUSCLE FAC,510,1 ,"$1,077.00 ",$538.50 ,$64.61 ,"$1,146.02 ",$118.09 ,$131.00 ,$104.00 ,$509.34 ,$646.20 ,$915.45 ,$753.90 ,$118.09 ,"$1,023.15 ",$775.44 ,$786.21 ,$104.00 ,$915.45 ,$509.34 ,$104.00 ,$915.45 ,$786.21 ,$118.09 ,$509.34 ,$64.61 ,$915.45 ,"$1,146.02 ",$990.84 ,$753.90 ,"$1,077.00 ","$1,077.00 ",$655.89 ,"$1,077.00 ",$744.21 ,$775.44 ,$750.13 ,$514.43 ,$775.44 ,$125.18 ,$646.20 ,$646.20 ,$509.34 ,$646.20 ,$509.34 ,$775.44 ,$667.74 ,$775.44 ,$775.44 ,$646.20 
ST MARY'S HOSPITAL,51000012,11055,HC PARING LESN BENIGN 1 FAC,510,1 ,$162.00 ,$81.00 ,$51.36 ,$392.94 ,$51.36 ,$131.00 ,$104.00 ,$174.64 ,$97.20 ,$137.70 ,$113.40 ,$51.36 ,$153.90 ,$116.64 ,$118.26 ,$104.00 ,$137.70 ,$174.64 ,$104.00 ,$137.70 ,$118.26 ,$51.36 ,$174.64 ,$64.61 ,$137.70 ,$392.94 ,$149.04 ,$113.40 ,$162.00 ,$162.00 ,$98.66 ,$162.00 ,$111.94 ,$116.64 ,$112.83 ,$176.39 ,$116.64 ,$54.44 ,$97.20 ,$97.20 ,$174.64 ,$97.20 ,$174.64 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,"$1,185.00 ",$592.50 ,$64.61 ,"$1,185.00 ",$139.95 ,$131.00 ,$104.00 ,$336.14 ,$711.00 ,"$1,007.25 ",$829.50 ,$139.95 ,"$1,125.75 ",$853.20 ,$865.05 ,$104.00 ,"$1,007.25 ",$336.14 ,$104.00 ,"$1,007.25 ",$865.05 ,$139.95 ,$336.14 ,$64.61 ,"$1,007.25 ",$756.32 ,"$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$339.50 ,$853.20 ,$148.35 ,$711.00 ,$711.00 ,$336.14 ,$711.00 ,$336.14 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$636.00 ,$318.00 ,$64.61 ,$697.70 ,$95.17 ,$131.00 ,$104.00 ,$310.09 ,$381.60 ,$540.60 ,$445.20 ,$95.17 ,$604.20 ,$457.92 ,$464.28 ,$104.00 ,$540.60 ,$310.09 ,$104.00 ,$540.60 ,$464.28 ,$95.17 ,$310.09 ,$64.61 ,$540.60 ,$697.70 ,$585.12 ,$445.20 ,$636.00 ,$636.00 ,$387.32 ,$636.00 ,$439.48 ,$457.92 ,$442.97 ,$313.19 ,$457.92 ,$100.88 ,$381.60 ,$381.60 ,$310.09 ,$381.60 ,$310.09 ,$457.92 ,$394.32 ,$457.92 ,$457.92 ,$381.60 
ST MARY'S HOSPITAL,51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$112.00 ,$56.00 ,$13.88 ,$135.67 ,$13.88 ,$72.45 ,$72.45 ,$60.30 ,$67.20 ,$95.20 ,$78.40 ,$13.88 ,$106.40 ,$80.64 ,$81.76 ,$72.80 ,$95.20 ,$60.30 ,$72.80 ,$95.20 ,$81.76 ,$13.88 ,$60.30 ,$47.04 ,$95.20 ,$135.67 ,$103.04 ,$78.40 ,$56.81 ,$68.17 ,$68.21 ,$63.63 ,$77.39 ,$80.64 ,$78.01 ,$60.90 ,$80.64 ,$14.71 ,$56.00 ,$56.00 ,$60.30 ,$56.00 ,$60.30 ,$80.64 ,$69.44 ,$80.64 ,$80.64 ,$67.20 
ST MARY'S HOSPITAL,51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$224.00 ,$112.00 ,$13.88 ,$447.64 ,$13.88 ,$144.91 ,$144.91 ,$198.95 ,$134.40 ,$190.40 ,$156.80 ,$13.88 ,$212.80 ,$161.28 ,$163.52 ,$145.60 ,$190.40 ,$198.95 ,$145.60 ,$190.40 ,$163.52 ,$13.88 ,$198.95 ,$94.08 ,$190.40 ,$447.64 ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$127.25 ,$154.78 ,$161.28 ,$156.02 ,$200.94 ,$161.28 ,$14.71 ,$112.00 ,$112.00 ,$198.95 ,$112.00 ,$198.95 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,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 ,$38.92 ,$107.40 ,$152.15 ,$125.30 ,$13.88 ,$170.05 ,$128.88 ,$130.67 ,$116.35 ,$152.15 ,$38.92 ,$116.35 ,$152.15 ,$130.67 ,$13.88 ,$38.92 ,$75.18 ,$152.15 ,$87.57 ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$101.69 ,$123.69 ,$128.88 ,$124.67 ,$39.31 ,$128.88 ,$14.71 ,$89.50 ,$89.50 ,$38.92 ,$89.50 ,$38.92 ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,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 ,$128.88 ,$130.67 ,$116.35 ,$152.15 , N/A ,$116.35 ,$152.15 ,$130.67 ,$13.88 , N/A ,$75.18 ,$152.15 , N/A ,$164.68 ,$125.30 ,$90.79 ,$108.96 ,$109.01 ,$101.69 ,$123.69 ,$128.88 ,$124.67 , N/A ,$128.88 ,$14.71 ,$89.50 ,$89.50 , N/A ,$89.50 , N/A ,$128.88 ,$110.98 ,$128.88 ,$128.88 ,$107.40 
ST MARY'S HOSPITAL,51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$134.00 ,$67.00 ,$13.88 ,$134.00 ,$13.88 ,$131.00 ,$104.00 ,$54.13 ,$80.40 ,$113.90 ,$93.80 ,$13.88 ,$127.30 ,$96.48 ,$97.82 ,$104.00 ,$113.90 ,$54.13 ,$104.00 ,$113.90 ,$97.82 ,$13.88 ,$54.13 ,$64.61 ,$113.90 ,$121.80 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$76.13 ,$92.59 ,$96.48 ,$93.33 ,$54.67 ,$96.48 ,$14.71 ,$80.40 ,$80.40 ,$54.13 ,$80.40 ,$54.13 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$247.00 ,$123.50 ,$38.23 ,$247.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$148.20 ,$209.95 ,$172.90 ,$38.23 ,$234.65 ,$177.84 ,$180.31 ,$104.00 ,$209.95 , N/A ,$104.00 ,$209.95 ,$180.31 ,$38.23 , N/A ,$64.61 ,$209.95 , N/A ,$227.24 ,$172.90 ,$125.28 ,$150.35 ,$150.42 ,$140.32 ,$170.68 ,$177.84 ,$172.04 , N/A ,$177.84 ,$40.52 ,$148.20 ,$148.20 , N/A ,$148.20 , N/A ,$177.84 ,$153.14 ,$177.84 ,$177.84 ,$148.20 
ST MARY'S HOSPITAL,51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$299.00 ,$149.50 ,$38.23 ,$299.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$179.40 ,$254.15 ,$209.30 ,$38.23 ,$284.05 ,$215.28 ,$218.27 ,$104.00 ,$254.15 , N/A ,$104.00 ,$254.15 ,$218.27 ,$38.23 , N/A ,$64.61 ,$254.15 , N/A ,$275.08 ,$209.30 ,$151.65 ,$182.00 ,$182.09 ,$169.86 ,$206.61 ,$215.28 ,$208.25 , N/A ,$215.28 ,$40.52 ,$179.40 ,$179.40 , N/A ,$179.40 , N/A ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$179.40 
ST MARY'S HOSPITAL,51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$227.00 ,$113.50 ,$38.23 ,$227.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$136.20 ,$192.95 ,$158.90 ,$38.23 ,$215.65 ,$163.44 ,$165.71 ,$104.00 ,$192.95 , N/A ,$104.00 ,$192.95 ,$165.71 ,$38.23 , N/A ,$64.61 ,$192.95 , N/A ,$208.84 ,$158.90 ,$115.13 ,$138.17 ,$138.24 ,$128.96 ,$156.86 ,$163.44 ,$158.11 , N/A ,$163.44 ,$40.52 ,$136.20 ,$136.20 , N/A ,$136.20 , N/A ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$136.20 
ST MARY'S HOSPITAL,51000115,99211,HC LACTATION EST PAT-BRIEF,510,1 ,$227.00 ,$113.50 ,$38.23 ,$227.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$136.20 ,$192.95 ,$158.90 ,$38.23 ,$215.65 ,$163.44 ,$165.71 ,$104.00 ,$192.95 , N/A ,$104.00 ,$192.95 ,$165.71 ,$38.23 , N/A ,$64.61 ,$192.95 , N/A ,$208.84 ,$158.90 ,$115.13 ,$138.17 ,$138.24 ,$128.96 ,$156.86 ,$163.44 ,$158.11 , N/A ,$163.44 ,$40.52 ,$136.20 ,$136.20 , N/A ,$136.20 , N/A ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$136.20 
ST MARY'S HOSPITAL,51000119,99211,HC CLINIC VISIT BRIEF EST CATH CARE,510,1 ,$227.00 ,$113.50 ,$38.23 ,$227.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$136.20 ,$192.95 ,$158.90 ,$38.23 ,$215.65 ,$163.44 ,$165.71 ,$104.00 ,$192.95 , N/A ,$104.00 ,$192.95 ,$165.71 ,$38.23 , N/A ,$64.61 ,$192.95 , N/A ,$208.84 ,$158.90 ,$115.13 ,$138.17 ,$138.24 ,$128.96 ,$156.86 ,$163.44 ,$158.11 , N/A ,$163.44 ,$40.52 ,$136.20 ,$136.20 , N/A ,$136.20 , N/A ,$163.44 ,$140.74 ,$163.44 ,$163.44 ,$136.20 
ST MARY'S HOSPITAL,51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$237.00 ,$118.50 ,$38.23 ,$237.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$142.20 ,$201.45 ,$165.90 ,$38.23 ,$225.15 ,$170.64 ,$173.01 ,$104.00 ,$201.45 , N/A ,$104.00 ,$201.45 ,$173.01 ,$38.23 , N/A ,$64.61 ,$201.45 , N/A ,$218.04 ,$165.90 ,$120.21 ,$144.26 ,$144.33 ,$134.64 ,$163.77 ,$170.64 ,$165.07 , N/A ,$170.64 ,$40.52 ,$142.20 ,$142.20 , N/A ,$142.20 , N/A ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$142.20 
ST MARY'S HOSPITAL,51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$288.00 ,$144.00 ,$38.23 ,$288.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$172.80 ,$244.80 ,$201.60 ,$38.23 ,$273.60 ,$207.36 ,$210.24 ,$104.00 ,$244.80 , N/A ,$104.00 ,$244.80 ,$210.24 ,$38.23 , N/A ,$64.61 ,$244.80 , N/A ,$264.96 ,$201.60 ,$146.07 ,$175.31 ,$175.39 ,$163.61 ,$199.01 ,$207.36 ,$200.59 , N/A ,$207.36 ,$40.52 ,$172.80 ,$172.80 , N/A ,$172.80 , N/A ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$172.80 
ST MARY'S HOSPITAL,51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$319.00 ,$159.50 ,$38.23 ,$319.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$191.40 ,$271.15 ,$223.30 ,$38.23 ,$303.05 ,$229.68 ,$232.87 ,$104.00 ,$271.15 , N/A ,$104.00 ,$271.15 ,$232.87 ,$38.23 , N/A ,$64.61 ,$271.15 , N/A ,$293.48 ,$223.30 ,$161.80 ,$194.18 ,$194.27 ,$181.22 ,$220.43 ,$229.68 ,$222.18 , N/A ,$229.68 ,$40.52 ,$191.40 ,$191.40 , N/A ,$191.40 , N/A ,$229.68 ,$197.78 ,$229.68 ,$229.68 ,$191.40 
ST MARY'S HOSPITAL,51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$402.00 ,$201.00 ,$38.23 ,$402.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$241.20 ,$341.70 ,$281.40 ,$38.23 ,$381.90 ,$289.44 ,$293.46 ,$104.00 ,$341.70 , N/A ,$104.00 ,$341.70 ,$293.46 ,$38.23 , N/A ,$64.61 ,$341.70 , N/A ,$369.84 ,$281.40 ,$203.89 ,$244.70 ,$244.82 ,$228.38 ,$277.78 ,$289.44 ,$279.99 , N/A ,$289.44 ,$40.52 ,$241.20 ,$241.20 , N/A ,$241.20 , N/A ,$289.44 ,$249.24 ,$289.44 ,$289.44 ,$241.20 
ST MARY'S HOSPITAL,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 ,$33.84 ,$34.31 ,$5.10 ,$39.95 ,$3.00 ,$5.10 ,$39.95 ,$34.31 ,$0.73 ,$3.00 ,$3.40 ,$39.95 ,$6.75 ,$43.24 ,$32.90 ,$10.69 ,$11.49 ,$28.62 ,$10.69 ,$32.48 ,$33.84 ,$32.74 ,$3.03 ,$33.84 ,$0.77 ,$3.60 ,$3.60 ,$3.00 ,$3.60 ,$3.00 ,$33.84 ,$29.14 ,$33.84 ,$33.84 ,$28.20 
ST MARY'S HOSPITAL,51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$205.00 ,$102.50 ,$22.63 ,$246.74 ,$22.63 ,$131.00 ,$104.00 ,$109.66 ,$123.00 ,$174.25 ,$143.50 ,$22.63 ,$194.75 ,$147.60 ,$149.65 ,$104.00 ,$174.25 ,$109.66 ,$104.00 ,$174.25 ,$149.65 ,$22.63 ,$109.66 ,$64.61 ,$174.25 ,$246.74 ,$188.60 ,$143.50 ,$205.00 ,$205.00 ,$124.85 ,$205.00 ,$141.66 ,$147.60 ,$142.78 ,$110.76 ,$147.60 ,$23.99 ,$123.00 ,$123.00 ,$109.66 ,$123.00 ,$109.66 ,$147.60 ,$127.10 ,$147.60 ,$147.60 ,$123.00 
ST MARY'S HOSPITAL,51000172,51702,HC CATH BLADDER SMP,510,1 ,$205.00 ,$102.50 ,$22.63 ,$246.74 ,$22.63 ,$131.00 ,$104.00 ,$109.66 ,$123.00 ,$174.25 ,$143.50 ,$22.63 ,$194.75 ,$147.60 ,$149.65 ,$104.00 ,$174.25 ,$109.66 ,$104.00 ,$174.25 ,$149.65 ,$22.63 ,$109.66 ,$64.61 ,$174.25 ,$246.74 ,$188.60 ,$143.50 ,$205.00 ,$205.00 ,$124.85 ,$205.00 ,$141.66 ,$147.60 ,$142.78 ,$110.76 ,$147.60 ,$23.99 ,$123.00 ,$123.00 ,$109.66 ,$123.00 ,$109.66 ,$147.60 ,$127.10 ,$147.60 ,$147.60 ,$123.00 
ST MARY'S HOSPITAL,51000173,51703,HC CATH BLADDER CPLX,510,1 ,$366.00 ,$183.00 ,$22.63 ,$366.00 ,$22.63 ,$131.00 ,$104.00 ,$135.78 ,$219.60 ,$311.10 ,$256.20 ,$22.63 ,$347.70 ,$263.52 ,$267.18 ,$104.00 ,$311.10 ,$135.78 ,$104.00 ,$311.10 ,$267.18 ,$22.63 ,$135.78 ,$64.61 ,$311.10 ,$305.50 ,$336.72 ,$256.20 ,$366.00 ,$366.00 ,$222.89 ,$366.00 ,$252.91 ,$263.52 ,$254.92 ,$137.14 ,$263.52 ,$23.99 ,$219.60 ,$219.60 ,$135.78 ,$219.60 ,$135.78 ,$263.52 ,$226.92 ,$263.52 ,$263.52 ,$219.60 
ST MARY'S HOSPITAL,51000175,94780,HC CARSEAT ANALYSIS FIRST 60MIN,510,1 ,$190.00 ,$95.00 ,$16.35 ,$190.00 ,$16.35 ,$131.00 ,$104.00 ,$32.92 ,$114.00 ,$161.50 ,$133.00 ,$16.35 ,$180.50 ,$136.80 ,$138.70 ,$104.00 ,$161.50 ,$32.92 ,$104.00 ,$161.50 ,$138.70 ,$16.35 ,$32.92 ,$64.61 ,$161.50 ,$74.07 ,$174.80 ,$133.00 ,$96.37 ,$115.65 ,$115.71 ,$107.94 ,$131.29 ,$136.80 ,$132.34 ,$33.25 ,$136.80 ,$17.33 ,$114.00 ,$114.00 ,$32.92 ,$114.00 ,$32.92 ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,51000187,99212,HC LACTATION EST PAT-LIMITED,510,1 ,$237.00 ,$118.50 ,$38.23 ,$237.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$142.20 ,$201.45 ,$165.90 ,$38.23 ,$225.15 ,$170.64 ,$173.01 ,$104.00 ,$201.45 , N/A ,$104.00 ,$201.45 ,$173.01 ,$38.23 , N/A ,$64.61 ,$201.45 , N/A ,$218.04 ,$165.90 ,$120.21 ,$144.26 ,$144.33 ,$134.64 ,$163.77 ,$170.64 ,$165.07 , N/A ,$170.64 ,$40.52 ,$142.20 ,$142.20 , N/A ,$142.20 , N/A ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$142.20 
ST MARY'S HOSPITAL,51000188,99213,HC LACTATION EST PAT-INTERM,510,1 ,$288.00 ,$144.00 ,$38.23 ,$288.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$172.80 ,$244.80 ,$201.60 ,$38.23 ,$273.60 ,$207.36 ,$210.24 ,$104.00 ,$244.80 , N/A ,$104.00 ,$244.80 ,$210.24 ,$38.23 , N/A ,$64.61 ,$244.80 , N/A ,$264.96 ,$201.60 ,$146.07 ,$175.31 ,$175.39 ,$163.61 ,$199.01 ,$207.36 ,$200.59 , N/A ,$207.36 ,$40.52 ,$172.80 ,$172.80 , N/A ,$172.80 , N/A ,$207.36 ,$178.56 ,$207.36 ,$207.36 ,$172.80 
ST MARY'S HOSPITAL,51000189,99214,HC LACTATION EST PAT-COMPLEX,510,1 ,$319.00 ,$159.50 ,$38.23 ,$319.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$191.40 ,$271.15 ,$223.30 ,$38.23 ,$303.05 ,$229.68 ,$232.87 ,$104.00 ,$271.15 , N/A ,$104.00 ,$271.15 ,$232.87 ,$38.23 , N/A ,$64.61 ,$271.15 , N/A ,$293.48 ,$223.30 ,$161.80 ,$194.18 ,$194.27 ,$181.22 ,$220.43 ,$229.68 ,$222.18 , N/A ,$229.68 ,$40.52 ,$191.40 ,$191.40 , N/A ,$191.40 , N/A ,$229.68 ,$197.78 ,$229.68 ,$229.68 ,$191.40 
ST MARY'S HOSPITAL,51000190,99215,HC LACTATION EST PAT-COMPRH,510,1 ,$402.00 ,$201.00 ,$38.23 ,$402.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$241.20 ,$341.70 ,$281.40 ,$38.23 ,$381.90 ,$289.44 ,$293.46 ,$104.00 ,$341.70 , N/A ,$104.00 ,$341.70 ,$293.46 ,$38.23 , N/A ,$64.61 ,$341.70 , N/A ,$369.84 ,$281.40 ,$203.89 ,$244.70 ,$244.82 ,$228.38 ,$277.78 ,$289.44 ,$279.99 , N/A ,$289.44 ,$40.52 ,$241.20 ,$241.20 , N/A ,$241.20 , N/A ,$289.44 ,$249.24 ,$289.44 ,$289.44 ,$241.20 
ST MARY'S HOSPITAL,51000192,99212,HC PEG CHECK OR REMOVAL (NON INCISIONAL),510,1 ,$237.00 ,$118.50 ,$38.23 ,$237.00 ,$38.23 ,$131.00 ,$104.00 , N/A ,$142.20 ,$201.45 ,$165.90 ,$38.23 ,$225.15 ,$170.64 ,$173.01 ,$104.00 ,$201.45 , N/A ,$104.00 ,$201.45 ,$173.01 ,$38.23 , N/A ,$64.61 ,$201.45 , N/A ,$218.04 ,$165.90 ,$120.21 ,$144.26 ,$144.33 ,$134.64 ,$163.77 ,$170.64 ,$165.07 , N/A ,$170.64 ,$40.52 ,$142.20 ,$142.20 , N/A ,$142.20 , N/A ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$142.20 
ST MARY'S HOSPITAL,51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,675.00 ",$837.50 ,$64.61 ,"$1,675.00 ",$490.13 ,$131.00 ,$104.00 ,$559.50 ,"$1,005.00 ","$1,423.75 ","$1,172.50 ",$490.13 ,"$1,591.25 ","$1,206.00 ","$1,222.75 ",$104.00 ,"$1,423.75 ",$559.50 ,$104.00 ,"$1,423.75 ","$1,222.75 ",$490.13 ,$559.50 ,$64.61 ,"$1,423.75 ","$1,258.87 ","$1,541.00 ","$1,172.50 ","$1,489.75 ","$1,675.00 ","$1,020.08 ","$1,675.00 ","$1,157.43 ","$1,206.00 ","$1,166.64 ",$565.10 ,"$1,206.00 ",$519.54 ,"$1,005.00 ","$1,005.00 ",$559.50 ,"$1,005.00 ",$559.50 ,"$1,206.00 ","$1,038.50 ","$1,206.00 ","$1,206.00 ","$1,005.00 "
ST MARY'S HOSPITAL,51000225,56605,HC BX VULVA/PERINEUM ONE LESION,510,1 ,"$1,982.00 ",$991.00 ,$64.61 ,"$1,982.00 ",$143.77 ,$131.00 ,$104.00 ,$616.55 ,"$1,189.20 ","$1,684.70 ","$1,387.40 ",$143.77 ,"$1,882.90 ","$1,427.04 ","$1,446.86 ",$104.00 ,"$1,684.70 ",$616.55 ,$104.00 ,"$1,684.70 ","$1,446.86 ",$143.77 ,$616.55 ,$64.61 ,"$1,684.70 ","$1,387.23 ","$1,823.44 ","$1,387.40 ","$1,489.75 ","$1,982.00 ","$1,207.04 ","$1,862.71 ","$1,369.56 ","$1,427.04 ","$1,380.46 ",$622.72 ,"$1,427.04 ",$152.40 ,"$1,189.20 ","$1,189.20 ",$616.55 ,"$1,189.20 ",$616.55 ,"$1,427.04 ","$1,228.84 ","$1,427.04 ","$1,427.04 ","$1,189.20 "
ST MARY'S HOSPITAL,51000233,57500,HC BIOPSY/EXCISE CERVICAL LESION,510,1 ,"$1,185.00 ",$592.50 ,$64.61 ,"$1,387.23 ",$143.77 ,$131.00 ,$104.00 ,$616.55 ,$711.00 ,"$1,007.25 ",$829.50 ,$143.77 ,"$1,125.75 ",$853.20 ,$865.05 ,$104.00 ,"$1,007.25 ",$616.55 ,$104.00 ,"$1,007.25 ",$865.05 ,$143.77 ,$616.55 ,$64.61 ,"$1,007.25 ","$1,387.23 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$622.72 ,$853.20 ,$152.40 ,$711.00 ,$711.00 ,$616.55 ,$711.00 ,$616.55 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,51000315,38222,HC BM ASPIRATION (BX/ASP SAME SITE),360,1 ,"$1,401.00 ",$700.50 ,$373.15 ,"$5,188.27 ",$373.15 ,"$1,401.00 ","$1,401.00 ","$2,305.90 ",$840.60 ,"$1,190.85 ",$980.70 ,$373.15 ,"$1,330.95 ","$1,008.72 ","$1,022.73 ","$1,401.00 ","$1,190.85 ","$2,305.90 ","$1,401.00 ","$1,190.85 ","$1,022.73 ",$373.15 ,"$2,305.90 ","$1,401.00 ","$1,190.85 ","$5,188.27 ","$1,288.92 ",$980.70 ,"$1,401.00 ","$1,401.00 ",$853.21 ,"$1,401.00 ",$968.09 ,"$1,008.72 ",$975.80 ,"$2,328.96 ","$1,008.72 ",$395.54 ,"$1,401.00 ","$1,401.00 ","$2,305.90 ","$1,401.00 ","$2,305.90 ","$1,008.72 ",$868.62 ,"$1,008.72 ","$1,008.72 ",$840.60 
ST MARY'S HOSPITAL,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 ,$93.60 ,$94.90 ,$104.00 ,$110.50 , N/A ,$104.00 ,$110.50 ,$94.90 ,$16.35 , N/A ,$64.61 ,$110.50 , N/A ,$119.60 ,$91.00 ,$65.94 ,$79.13 ,$79.17 ,$73.85 ,$89.83 ,$93.60 ,$90.55 , N/A ,$93.60 ,$17.33 ,$78.00 ,$78.00 , N/A ,$78.00 , N/A ,$93.60 ,$80.60 ,$93.60 ,$93.60 ,$78.00 
ST MARY'S HOSPITAL,51000427,17999,HC UNLISTED SKIN TISSUE PROCEDURE,510,1 ,$210.00 ,$105.00 ,$51.36 ,$392.94 ,$51.36 ,$131.00 ,$104.00 ,$174.64 ,$126.00 ,$178.50 ,$147.00 ,$51.36 ,$199.50 ,$151.20 ,$153.30 ,$104.00 ,$178.50 ,$174.64 ,$104.00 ,$178.50 ,$153.30 ,$51.36 ,$174.64 ,$64.61 ,$178.50 ,$392.94 ,$193.20 ,$147.00 ,$106.51 ,$127.83 ,$127.89 ,$119.30 ,$145.11 ,$151.20 ,$146.27 ,$176.39 ,$151.20 ,$54.44 ,$126.00 ,$126.00 ,$174.64 ,$126.00 ,$174.64 ,$151.20 ,$130.20 ,$151.20 ,$151.20 ,$126.00 
ST MARY'S HOSPITAL,51000444,11982,HC REMOVAL DRUG IMPLANT DEVICE,510,1 ,$812.00 ,$406.00 ,$51.36 ,$812.00 ,$51.36 ,$131.00 ,$104.00 ,$263.94 ,$487.20 ,$690.20 ,$568.40 ,$51.36 ,$771.40 ,$584.64 ,$592.76 ,$104.00 ,$690.20 ,$263.94 ,$104.00 ,$690.20 ,$592.76 ,$51.36 ,$263.94 ,$64.61 ,$690.20 ,$593.87 ,$747.04 ,$568.40 ,$812.00 ,$812.00 ,$494.51 ,$812.00 ,$561.09 ,$584.64 ,$565.56 ,$266.58 ,$584.64 ,$54.44 ,$487.20 ,$487.20 ,$263.94 ,$487.20 ,$263.94 ,$584.64 ,$503.44 ,$584.64 ,$584.64 ,$487.20 
ST MARY'S HOSPITAL,51000477,96377,HC APPL ON-BODY INJECTOR FOR SUBQ INJ,510,1 ,$134.00 ,$67.00 ,$13.88 ,$134.00 ,$13.88 ,$131.00 ,$104.00 ,$38.92 ,$80.40 ,$113.90 ,$93.80 ,$13.88 ,$127.30 ,$96.48 ,$97.82 ,$104.00 ,$113.90 ,$38.92 ,$104.00 ,$113.90 ,$97.82 ,$13.88 ,$38.92 ,$64.61 ,$113.90 ,$87.57 ,$123.28 ,$93.80 ,$67.96 ,$81.57 ,$81.61 ,$76.13 ,$92.59 ,$96.48 ,$93.33 ,$39.31 ,$96.48 ,$14.71 ,$80.40 ,$80.40 ,$38.92 ,$80.40 ,$38.92 ,$96.48 ,$83.08 ,$96.48 ,$96.48 ,$80.40 
ST MARY'S HOSPITAL,51000479,99495,HC TRANSITIONAL CARE MGMT SERV MOD COMPLEXITY,510,1 ,$224.00 ,$112.00 ,$32.55 ,$260.00 ,$32.55 ,$131.00 ,$104.00 ,$115.55 ,$134.40 ,$190.40 ,$156.80 ,$32.55 ,$212.80 ,$161.28 ,$163.52 ,$104.00 ,$190.40 ,$115.55 ,$104.00 ,$190.40 ,$163.52 ,$32.55 ,$115.55 ,$64.61 ,$190.40 ,$260.00 ,$206.08 ,$156.80 ,$113.61 ,$136.35 ,$136.42 ,$127.25 ,$154.78 ,$161.28 ,$156.02 ,$116.71 ,$161.28 ,$34.50 ,$134.40 ,$134.40 ,$115.55 ,$134.40 ,$115.55 ,$161.28 ,$138.88 ,$161.28 ,$161.28 ,$134.40 
ST MARY'S HOSPITAL,51000480,99496,HC TRANSITIONAL CARE MGMT SERV HIGH COMPLEXITY,510,1 ,$293.00 ,$146.50 ,$32.55 ,$293.00 ,$32.55 ,$131.00 ,$104.00 ,$115.55 ,$175.80 ,$249.05 ,$205.10 ,$32.55 ,$278.35 ,$210.96 ,$213.89 ,$104.00 ,$249.05 ,$115.55 ,$104.00 ,$249.05 ,$213.89 ,$32.55 ,$115.55 ,$64.61 ,$249.05 ,$260.00 ,$269.56 ,$205.10 ,$148.61 ,$178.35 ,$178.44 ,$166.45 ,$202.46 ,$210.96 ,$204.07 ,$116.71 ,$210.96 ,$34.50 ,$175.80 ,$175.80 ,$115.55 ,$175.80 ,$115.55 ,$210.96 ,$181.66 ,$210.96 ,$210.96 ,$175.80 
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$156.81 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 , N/A ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ", N/A ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ", N/A ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$508.38 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$508.38 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$119.98 ,$508.38 ,"$1,422.18 ","$2,052.75 ","$1,143.86 ","$2,221.80 ","$1,690.50 ","$1,469.34 ","$1,577.45 ","$1,470.74 ","$1,469.34 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$513.46 ,"$1,738.80 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$508.38 ,"$1,350.00 ",$508.38 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$508.38 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$508.38 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$119.98 ,$508.38 ,"$1,422.18 ","$2,052.75 ","$1,143.86 ","$2,221.80 ","$1,690.50 ","$1,469.34 ","$1,577.45 ","$1,470.74 ","$1,469.34 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$513.46 ,"$1,738.80 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$508.38 ,"$1,350.00 ",$508.38 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,327.00 ","$1,327.00 ",$820.03 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$820.03 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$210.22 ,$820.03 ,"$1,422.18 ","$2,052.75 ","$1,845.07 ","$2,221.80 ","$1,690.50 ","$2,125.88 ","$2,282.30 ","$1,470.74 ","$2,125.88 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$828.23 ,"$1,738.80 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$820.03 ,"$1,350.00 ",$820.03 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,327.00 ","$1,327.00 ",$820.03 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$820.03 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$210.22 ,$820.03 ,"$1,422.18 ","$2,052.75 ","$1,845.07 ","$2,221.80 ","$1,690.50 ","$2,125.88 ","$2,282.30 ","$1,470.74 ","$2,125.88 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$828.23 ,"$1,738.80 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$820.03 ,"$1,350.00 ",$820.03 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$119.98 ,"$2,415.00 ",$119.98 ,"$1,327.00 ","$1,327.00 ",$508.38 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$508.38 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$119.98 ,$508.38 ,"$1,422.18 ","$2,052.75 ","$1,143.86 ","$2,221.80 ","$1,690.50 ","$1,469.34 ","$1,577.45 ","$1,470.74 ","$1,469.34 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$513.46 ,"$1,738.80 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$508.38 ,"$1,350.00 ",$508.38 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$119.98 ,"$2,415.00 ",$119.98 ,"$1,327.00 ","$1,327.00 ",$508.38 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$508.38 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$119.98 ,$508.38 ,"$1,422.18 ","$2,052.75 ","$1,143.86 ","$2,221.80 ","$1,690.50 ","$1,469.34 ","$1,577.45 ","$1,470.74 ","$1,469.34 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$513.46 ,"$1,738.80 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$508.38 ,"$1,350.00 ",$508.38 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,327.00 ","$1,327.00 ",$820.03 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$820.03 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$210.22 ,$820.03 ,"$1,422.18 ","$2,052.75 ","$1,845.07 ","$2,221.80 ","$1,690.50 ","$2,125.88 ","$2,282.30 ","$1,470.74 ","$2,125.88 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$828.23 ,"$1,738.80 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$820.03 ,"$1,350.00 ",$820.03 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,327.00 ","$1,327.00 ",$820.03 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$820.03 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$210.22 ,$820.03 ,"$1,422.18 ","$2,052.75 ","$1,845.07 ","$2,221.80 ","$1,690.50 ","$2,125.88 ","$2,282.30 ","$1,470.74 ","$2,125.88 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$828.23 ,"$1,738.80 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$820.03 ,"$1,350.00 ",$820.03 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$140.15 ,"$2,415.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$508.38 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$508.38 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$119.98 ,$508.38 ,"$1,422.18 ","$2,052.75 ","$1,143.86 ","$2,221.80 ","$1,690.50 ","$1,469.34 ","$1,577.45 ","$1,470.74 ","$1,469.34 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$513.46 ,"$1,738.80 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$508.38 ,"$1,350.00 ",$508.38 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$508.38 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$119.98 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$508.38 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$119.98 ,$508.38 ,"$1,422.18 ","$2,052.75 ","$1,143.86 ","$2,221.80 ","$1,690.50 ","$1,469.34 ","$1,577.45 ","$1,470.74 ","$1,469.34 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$513.46 ,"$1,738.80 ",$127.18 ,"$1,350.00 ","$1,350.00 ",$508.38 ,"$1,350.00 ",$508.38 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,327.00 ","$1,327.00 ",$820.03 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$820.03 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$210.22 ,$820.03 ,"$1,422.18 ","$2,052.75 ","$1,845.07 ","$2,221.80 ","$1,690.50 ","$2,125.88 ","$2,282.30 ","$1,470.74 ","$2,125.88 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$828.23 ,"$1,738.80 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$820.03 ,"$1,350.00 ",$820.03 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$210.22 ,"$2,415.00 ",$210.22 ,"$1,327.00 ","$1,327.00 ",$820.03 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$210.22 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$820.03 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$210.22 ,$820.03 ,"$1,422.18 ","$2,052.75 ","$1,845.07 ","$2,221.80 ","$1,690.50 ","$2,125.88 ","$2,282.30 ","$1,470.74 ","$2,125.88 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$828.23 ,"$1,738.80 ",$222.83 ,"$1,350.00 ","$1,350.00 ",$820.03 ,"$1,350.00 ",$820.03 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$140.15 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,638.00 ","$1,758.52 ","$1,470.74 ","$1,638.00 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000041,75557,HC MRI CARDIAC W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000042,75561,HC MRI CARD W/O AND W CON,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000043,76390,HC MRI SPECTROSCOPY,610,1 ,"$3,150.00 ","$1,575.00 ",$78.66 ,"$3,150.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$78.66 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$78.66 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$78.66 ,"$1,422.18 ","$2,677.50 ",$177.00 ,"$2,898.00 ","$2,205.00 ","$1,597.68 ","$1,917.41 ","$1,918.35 ","$1,789.52 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$79.45 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$78.66 ,"$1,350.00 ",$78.66 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000044,76498,HC UNLISTED MRI PROC,610,1 ,"$2,415.00 ","$1,207.50 ",$78.66 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$78.66 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$78.66 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$78.66 ,"$1,422.18 ","$2,052.75 ",$177.00 ,"$2,221.80 ","$1,690.50 ",$979.56 ,"$1,051.63 ","$1,470.74 ",$979.56 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$79.45 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$78.66 ,"$1,350.00 ",$78.66 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000048,19085,HC BREAST BIOPSY MRI GUIDE NEEDLE PLACE,610,1 ,"$1,000.00 ",$500.00 ,$439.46 ,"$3,078.81 ",$439.46 ,"$1,000.00 ","$1,000.00 ","$1,368.36 ",$600.00 ,$850.00 ,$700.00 ,$439.46 ,$950.00 ,$720.00 ,$730.00 ,"$1,000.00 ",$850.00 ,"$1,368.36 ","$1,000.00 ",$850.00 ,$730.00 ,$439.46 ,"$1,368.36 ","$1,000.00 ",$850.00 ,"$3,078.81 ",$920.00 ,$700.00 ,"$1,000.00 ","$1,000.00 ",$609.00 ,"$1,000.00 ",$691.00 ,$720.00 ,$696.50 ,"$1,382.04 ",$720.00 ,$465.83 ,"$1,000.00 ","$1,000.00 ","$1,368.36 ","$1,000.00 ","$1,368.36 ",$720.00 ,$620.00 ,$720.00 ,$720.00 ,$600.00 
ST MARY'S HOSPITAL,61000049,19287,HC MRI GUIDE NEEDLE PLACE LOC,610,1 ,"$2,200.00 ","$1,100.00 ",$258.03 ,"$2,200.00 ",$258.03 ,"$1,327.00 ","$1,327.00 ",$605.19 ,"$1,320.00 ","$1,870.00 ","$1,540.00 ",$258.03 ,"$2,090.00 ","$1,584.00 ","$1,606.00 ","$2,194.00 ","$1,870.00 ",$605.19 ,"$2,194.00 ","$1,870.00 ","$1,606.00 ",$258.03 ,$605.19 ,"$1,422.18 ","$1,870.00 ","$1,361.67 ","$2,024.00 ","$1,540.00 ","$1,680.96 ","$2,200.00 ","$1,339.80 ","$2,101.20 ","$1,520.20 ","$1,584.00 ","$1,532.30 ",$611.24 ,"$1,584.00 ",$273.51 ,"$1,350.00 ","$1,350.00 ",$605.19 ,"$1,350.00 ",$605.19 ,"$1,584.00 ","$1,364.00 ","$1,584.00 ","$1,584.00 ","$1,320.00 "
ST MARY'S HOSPITAL,61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ",$979.56 ,"$1,051.63 ","$1,918.35 ",$979.56 ,"$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$79.99 ,"$3,150.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$79.99 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$223.78 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,677.50 ",$503.50 ,"$2,898.00 ","$2,205.00 ","$3,150.00 ","$3,150.00 ","$1,918.35 ","$3,150.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$226.02 ,"$2,268.00 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$156.81 ,"$3,150.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$156.81 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000071,C8934,HC MRA UPPR EXT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$156.81 ,"$2,415.00 ",$156.81 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$156.81 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$358.13 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$156.81 ,$358.13 ,"$1,422.18 ","$2,052.75 ",$805.79 ,"$2,221.80 ","$1,690.50 ","$1,417.25 ","$1,521.53 ","$1,470.74 ","$1,417.25 ","$1,668.77 ","$1,738.80 ","$1,682.05 ",$361.71 ,"$1,738.80 ",$166.22 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,638.00 ","$1,758.52 ","$1,918.35 ","$1,638.00 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$140.15 ,"$3,150.00 ",$140.15 ,"$1,327.00 ","$1,327.00 ",$358.13 ,"$1,890.00 ","$2,677.50 ","$2,205.00 ",$140.15 ,"$2,992.50 ","$2,268.00 ","$2,299.50 ","$2,194.00 ","$2,677.50 ",$358.13 ,"$2,194.00 ","$2,677.50 ","$2,299.50 ",$140.15 ,$358.13 ,"$1,422.18 ","$2,677.50 ",$805.79 ,"$2,898.00 ","$2,205.00 ","$1,417.25 ","$1,521.53 ","$1,918.35 ","$1,417.25 ","$2,176.65 ","$2,268.00 ","$2,193.98 ",$361.71 ,"$2,268.00 ",$148.56 ,"$1,350.00 ","$1,350.00 ",$358.13 ,"$1,350.00 ",$358.13 ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,61000077,74712,HC MRI FETAL PLACENTA/MATERN PELVIC SINGLE,610,1 ,"$2,415.00 ","$1,207.50 ",$79.99 ,"$2,415.00 ",$79.99 ,"$1,327.00 ","$1,327.00 ",$223.78 ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ",$223.78 ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 ,$223.78 ,"$1,422.18 ","$2,052.75 ",$503.50 ,"$2,221.80 ","$1,690.50 ",$842.42 ,$904.41 ,"$1,470.74 ",$842.42 ,"$1,668.77 ","$1,738.80 ","$1,682.05 ",$226.02 ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ",$223.78 ,"$1,350.00 ",$223.78 ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,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 ,"$1,327.00 ","$1,327.00 ", N/A ,"$1,449.00 ","$2,052.75 ","$1,690.50 ",$79.99 ,"$2,294.25 ","$1,738.80 ","$1,762.95 ","$2,194.00 ","$2,052.75 ", N/A ,"$2,194.00 ","$2,052.75 ","$1,762.95 ",$79.99 , 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 ","$1,371.96 ","$1,668.77 ","$1,738.80 ","$1,682.05 ", N/A ,"$1,738.80 ",$84.79 ,"$1,350.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,738.80 ","$1,497.30 ","$1,738.80 ","$1,738.80 ","$1,449.00 "
ST MARY'S HOSPITAL,61000105,70551,HC MRI BRAIN W/O CONTR SHUNT EVAL LIMITED,610,1 ,$500.00 ,$250.00 ,$79.99 ,$503.50 ,$79.99 ,$500.00 ,$500.00 ,$223.78 ,$300.00 ,$425.00 ,$350.00 ,$79.99 ,$475.00 ,$360.00 ,$365.00 ,$500.00 ,$425.00 ,$223.78 ,$500.00 ,$425.00 ,$365.00 ,$79.99 ,$223.78 ,$500.00 ,$425.00 ,$503.50 ,$460.00 ,$350.00 ,$500.00 ,$500.00 ,$304.50 ,$500.00 ,$345.50 ,$360.00 ,$348.25 ,$226.02 ,$360.00 ,$84.79 ,$500.00 ,$500.00 ,$223.78 ,$500.00 ,$223.78 ,$360.00 ,$310.00 ,$360.00 ,$360.00 ,$300.00 
ST MARY'S HOSPITAL,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 ,$540.00 ,$547.50 ,$487.50 ,$637.50 , N/A ,$487.50 ,$637.50 ,$547.50 , N/A , N/A ,$315.00 ,$637.50 , N/A ,$690.00 ,$525.00 ,$380.40 ,$456.53 ,$456.75 ,$426.08 ,$518.25 ,$540.00 ,$522.38 , N/A ,$540.00 , N/A ,$450.00 ,$450.00 , N/A ,$450.00 , N/A ,$540.00 ,$465.00 ,$540.00 ,$540.00 ,$450.00 
ST MARY'S HOSPITAL,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 ,$145.44 ,$147.46 ,$131.30 ,$171.70 , N/A ,$131.30 ,$171.70 ,$147.46 , N/A , N/A ,$84.84 ,$171.70 , N/A ,$185.84 ,$141.40 ,$102.45 ,$122.96 ,$123.02 ,$114.76 ,$139.58 ,$145.44 ,$140.69 , N/A ,$145.44 , N/A ,$121.20 ,$121.20 , N/A ,$121.20 , N/A ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,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 ,$491.76 ,$498.59 ,$443.95 ,$580.55 , N/A ,$443.95 ,$580.55 ,$498.59 , N/A , N/A ,$286.86 ,$580.55 , N/A ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$388.01 ,$471.95 ,$491.76 ,$475.71 , N/A ,$491.76 , N/A ,$409.80 ,$409.80 , N/A ,$409.80 , N/A ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,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 ",$849.60 ,$861.40 ,$767.00 ,"$1,003.00 ", N/A ,$767.00 ,"$1,003.00 ",$861.40 , N/A , N/A ,$495.60 ,"$1,003.00 ", N/A ,"$1,085.60 ",$826.00 ,$598.50 ,$718.27 ,$718.62 ,$670.36 ,$815.38 ,$849.60 ,$821.87 , N/A ,$849.60 , N/A ,$708.00 ,$708.00 , N/A ,$708.00 , N/A ,$849.60 ,$731.60 ,$849.60 ,$849.60 ,$708.00 
ST MARY'S HOSPITAL,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 ","$1,926.00 ","$1,952.75 ","$1,738.75 ","$2,273.75 ", N/A ,"$1,738.75 ","$2,273.75 ","$1,952.75 ", 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 ","$1,519.67 ","$1,848.43 ","$1,926.00 ","$1,863.14 ", N/A ,"$1,926.00 ", N/A ,"$1,605.00 ","$1,605.00 ", N/A ,"$1,605.00 ", N/A ,"$1,926.00 ","$1,658.50 ","$1,926.00 ","$1,926.00 ","$1,605.00 "
ST MARY'S HOSPITAL,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 ","$4,248.00 ","$4,307.00 ","$3,835.00 ","$5,015.00 ", N/A ,"$3,835.00 ","$5,015.00 ","$4,307.00 ", 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 ","$3,351.79 ","$4,076.90 ","$4,248.00 ","$4,109.35 ", N/A ,"$4,248.00 ", N/A ,"$3,540.00 ","$3,540.00 ", N/A ,"$3,540.00 ", N/A ,"$4,248.00 ","$3,658.00 ","$4,248.00 ","$4,248.00 ","$3,540.00 "
ST MARY'S HOSPITAL,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 ,$327.60 ,$332.15 ,$295.75 ,$386.75 , N/A ,$295.75 ,$386.75 ,$332.15 , N/A , N/A ,$191.10 ,$386.75 , N/A ,$418.60 ,$318.50 ,$230.78 ,$276.96 ,$277.10 ,$258.49 ,$314.41 ,$327.60 ,$316.91 , N/A ,$327.60 , N/A ,$273.00 ,$273.00 , N/A ,$273.00 , N/A ,$327.60 ,$282.10 ,$327.60 ,$327.60 ,$273.00 
ST MARY'S HOSPITAL,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 ,$59.76 ,$60.59 ,$51.75 ,$70.55 , N/A ,$51.75 ,$70.55 ,$60.59 , N/A , N/A ,$34.45 ,$70.55 , N/A ,$76.36 ,$58.10 ,$44.14 ,$47.49 ,$50.55 ,$44.14 ,$57.35 ,$59.76 ,$57.81 , N/A ,$59.76 , N/A , N/A , N/A , N/A , N/A , N/A ,$59.76 ,$51.46 ,$59.76 ,$59.76 ,$49.80 
ST MARY'S HOSPITAL,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 ,$56.88 ,$57.67 ,$74.49 ,$67.15 , N/A ,$74.49 ,$67.15 ,$57.67 , N/A , N/A ,$49.60 ,$67.15 , N/A ,$72.68 ,$55.30 ,$63.54 ,$68.36 ,$48.11 ,$63.54 ,$54.59 ,$56.88 ,$55.02 , N/A ,$56.88 , N/A , N/A , N/A , N/A , N/A , N/A ,$56.88 ,$48.98 ,$56.88 ,$56.88 ,$47.40 
ST MARY'S HOSPITAL,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 ,$190.08 ,$192.72 ,$188.11 ,$224.40 , N/A ,$188.11 ,$224.40 ,$192.72 , N/A , N/A ,$125.23 ,$224.40 , N/A ,$242.88 ,$184.80 ,$160.44 ,$172.61 ,$160.78 ,$160.44 ,$182.42 ,$190.08 ,$183.88 , N/A ,$190.08 , N/A , N/A , N/A , N/A , N/A , N/A ,$190.08 ,$163.68 ,$190.08 ,$190.08 ,$158.40 
ST MARY'S HOSPITAL,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 ,$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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 
ST MARY'S HOSPITAL,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 ,$2.30 ,$2.34 ,$0.20 ,$2.72 , N/A ,$0.20 ,$2.72 ,$2.34 , N/A , N/A ,$0.14 ,$2.72 , N/A ,$2.94 ,$2.24 ,$0.17 ,$0.19 ,$1.95 ,$0.17 ,$2.21 ,$2.30 ,$2.23 , N/A ,$2.30 , N/A , N/A , N/A , N/A , N/A , N/A ,$2.30 ,$1.98 ,$2.30 ,$2.30 ,$1.92 
ST MARY'S HOSPITAL,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 ,$2.30 ,$2.34 ,$0.20 ,$2.72 , N/A ,$0.20 ,$2.72 ,$2.34 , N/A , N/A ,$0.14 ,$2.72 , N/A ,$2.94 ,$2.24 ,$0.17 ,$0.19 ,$1.95 ,$0.17 ,$2.21 ,$2.30 ,$2.23 , N/A ,$2.30 , N/A , N/A , N/A , N/A , N/A , N/A ,$2.30 ,$1.98 ,$2.30 ,$2.30 ,$1.92 
ST MARY'S HOSPITAL,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 ,$9.14 ,$9.27 ,$0.43 ,$10.80 , N/A ,$0.43 ,$10.80 ,$9.27 , N/A , N/A ,$0.28 ,$10.80 , N/A ,$11.68 ,$8.89 ,$0.36 ,$0.39 ,$7.73 ,$0.36 ,$8.78 ,$9.14 ,$8.85 , N/A ,$9.14 , N/A , N/A , N/A , N/A , N/A , N/A ,$9.14 ,$7.87 ,$9.14 ,$9.14 ,$7.62 
ST MARY'S HOSPITAL,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 ,$0.14 ,$0.12 , N/A , N/A ,$0.08 ,$0.14 , N/A ,$0.15 ,$0.11 ,$0.10 ,$0.11 ,$0.10 ,$0.10 ,$0.11 ,$0.12 ,$0.11 , N/A ,$0.12 , N/A , N/A , N/A , N/A , N/A , N/A ,$0.12 ,$0.10 ,$0.12 ,$0.12 ,$0.10 
ST MARY'S HOSPITAL,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 ","$2,419.20 ","$2,452.80 ","$2,184.00 ","$2,856.00 ", N/A ,"$2,184.00 ","$2,856.00 ","$2,452.80 ", 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 ","$1,908.82 ","$2,321.76 ","$2,419.20 ","$2,340.24 ", N/A ,"$2,419.20 ", N/A ,"$2,016.00 ","$2,016.00 ", N/A ,"$2,016.00 ", N/A ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,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 ","$2,096.64 ","$2,125.76 ","$1,892.80 ","$2,475.20 ", N/A ,"$1,892.80 ","$2,475.20 ","$2,125.76 ",$38.23 , 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 ","$1,654.31 ","$2,012.19 ","$2,096.64 ","$2,028.21 ", N/A ,"$2,096.64 ",$40.52 ,"$1,747.20 ","$1,747.20 ", N/A ,"$1,747.20 ", N/A ,"$2,096.64 ","$1,805.44 ","$2,096.64 ","$2,096.64 ","$1,747.20 "
ST MARY'S HOSPITAL,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 ,$401.04 ,$406.61 ,$362.05 ,$473.45 , N/A ,$362.05 ,$473.45 ,$406.61 , N/A , N/A ,$233.94 ,$473.45 , N/A ,$512.44 ,$389.90 ,$282.51 ,$339.05 ,$339.21 ,$316.43 ,$384.89 ,$401.04 ,$387.95 , N/A ,$401.04 , N/A ,$334.20 ,$334.20 , N/A ,$334.20 , N/A ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$334.20 
ST MARY'S HOSPITAL,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 ,$476.64 ,$483.26 ,$430.30 ,$562.70 , N/A ,$430.30 ,$562.70 ,$483.26 , N/A , N/A ,$278.04 ,$562.70 , N/A ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$376.08 ,$457.44 ,$476.64 ,$461.08 , N/A ,$476.64 , N/A ,$397.20 ,$397.20 , N/A ,$397.20 , N/A ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$397.20 
ST MARY'S HOSPITAL,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 ,$559.44 ,$567.21 ,$505.05 ,$660.45 , N/A ,$505.05 ,$660.45 ,$567.21 , N/A , N/A ,$326.34 ,$660.45 , N/A ,$714.84 ,$543.90 ,$394.09 ,$472.96 ,$473.19 ,$441.41 ,$536.91 ,$559.44 ,$541.18 , N/A ,$559.44 , N/A ,$466.20 ,$466.20 , N/A ,$466.20 , N/A ,$559.44 ,$481.74 ,$559.44 ,$559.44 ,$466.20 
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ","$1,433.25 ","$1,874.25 ", N/A ,"$1,433.25 ","$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A ,"$1,323.00 ","$1,323.00 ", N/A ,"$1,323.00 ", N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ",$831.60 ,$843.15 ,$750.75 ,$981.75 , N/A ,$750.75 ,$981.75 ,$843.15 , N/A , N/A ,$485.10 ,$981.75 , N/A ,"$1,062.60 ",$808.50 ,$585.82 ,$703.05 ,$703.40 ,$656.16 ,$798.11 ,$831.60 ,$804.46 , N/A ,$831.60 , N/A ,$693.00 ,$693.00 , N/A ,$693.00 , N/A ,$831.60 ,$716.10 ,$831.60 ,$831.60 ,$693.00 
ST MARY'S HOSPITAL,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 ,$559.44 ,$567.21 ,$505.05 ,$660.45 , N/A ,$505.05 ,$660.45 ,$567.21 , N/A , N/A ,$326.34 ,$660.45 , N/A ,$714.84 ,$543.90 ,$394.09 ,$472.96 ,$473.19 ,$441.41 ,$536.91 ,$559.44 ,$541.18 , N/A ,$559.44 , N/A ,$466.20 ,$466.20 , N/A ,$466.20 , N/A ,$559.44 ,$481.74 ,$559.44 ,$559.44 ,$466.20 
ST MARY'S HOSPITAL,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 ,$401.04 ,$406.61 ,$362.05 ,$473.45 , N/A ,$362.05 ,$473.45 ,$406.61 , N/A , N/A ,$233.94 ,$473.45 , N/A ,$512.44 ,$389.90 ,$282.51 ,$339.05 ,$339.21 ,$316.43 ,$384.89 ,$401.04 ,$387.95 , N/A ,$401.04 , N/A ,$334.20 ,$334.20 , N/A ,$334.20 , N/A ,$401.04 ,$345.34 ,$401.04 ,$401.04 ,$334.20 
ST MARY'S HOSPITAL,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 ",$831.60 ,$843.15 ,$750.75 ,$981.75 , N/A ,$750.75 ,$981.75 ,$843.15 , N/A , N/A ,$485.10 ,$981.75 , N/A ,"$1,062.60 ",$808.50 ,$585.82 ,$703.05 ,$703.40 ,$656.16 ,$798.11 ,$831.60 ,$804.46 , N/A ,$831.60 , N/A ,$693.00 ,$693.00 , N/A ,$693.00 , N/A ,$831.60 ,$716.10 ,$831.60 ,$831.60 ,$693.00 
ST MARY'S HOSPITAL,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 ,$317.52 ,$321.93 ,$286.65 ,$374.85 , N/A ,$286.65 ,$374.85 ,$321.93 , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$250.53 ,$304.73 ,$317.52 ,$307.16 , N/A ,$317.52 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 , N/A ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$264.60 
ST MARY'S HOSPITAL,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 ,$317.52 ,$321.93 ,$286.65 ,$374.85 , N/A ,$286.65 ,$374.85 ,$321.93 , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$250.53 ,$304.73 ,$317.52 ,$307.16 , N/A ,$317.52 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 , N/A ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$264.60 
ST MARY'S HOSPITAL,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 ,$476.64 ,$483.26 ,$430.30 ,$562.70 , N/A ,$430.30 ,$562.70 ,$483.26 , N/A , N/A ,$278.04 ,$562.70 , N/A ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$376.08 ,$457.44 ,$476.64 ,$461.08 , N/A ,$476.64 , N/A ,$397.20 ,$397.20 , N/A ,$397.20 , N/A ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$397.20 
ST MARY'S HOSPITAL,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 ,$317.52 ,$321.93 ,$286.65 ,$374.85 , N/A ,$286.65 ,$374.85 ,$321.93 , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$250.53 ,$304.73 ,$317.52 ,$307.16 , N/A ,$317.52 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 , N/A ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$264.60 
ST MARY'S HOSPITAL,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 ,$635.04 ,$643.86 ,$573.30 ,$749.70 , N/A ,$573.30 ,$749.70 ,$643.86 , N/A , N/A ,$370.44 ,$749.70 , N/A ,$811.44 ,$617.40 ,$447.35 ,$536.87 ,$537.14 ,$501.06 ,$609.46 ,$635.04 ,$614.31 , N/A ,$635.04 , N/A ,$529.20 ,$529.20 , N/A ,$529.20 , N/A ,$635.04 ,$546.84 ,$635.04 ,$635.04 ,$529.20 
ST MARY'S HOSPITAL,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 ,$317.52 ,$321.93 ,$286.65 ,$374.85 , N/A ,$286.65 ,$374.85 ,$321.93 , N/A , N/A ,$185.22 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$250.53 ,$304.73 ,$317.52 ,$307.16 , N/A ,$317.52 , N/A ,$264.60 ,$264.60 , N/A ,$264.60 , N/A ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$264.60 
ST MARY'S HOSPITAL,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 ",$831.60 ,$843.15 ,$750.75 ,$981.75 , N/A ,$750.75 ,$981.75 ,$843.15 , N/A , N/A ,$485.10 ,$981.75 , N/A ,"$1,062.60 ",$808.50 ,$585.82 ,$703.05 ,$703.40 ,$656.16 ,$798.11 ,$831.60 ,$804.46 , N/A ,$831.60 , N/A ,$693.00 ,$693.00 , N/A ,$693.00 , N/A ,$831.60 ,$716.10 ,$831.60 ,$831.60 ,$693.00 
ST MARY'S HOSPITAL,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 ,$476.64 ,$483.26 ,$430.30 ,$562.70 , N/A ,$430.30 ,$562.70 ,$483.26 , N/A , N/A ,$278.04 ,$562.70 , N/A ,$609.04 ,$463.40 ,$335.77 ,$402.96 ,$403.16 ,$376.08 ,$457.44 ,$476.64 ,$461.08 , N/A ,$476.64 , N/A ,$397.20 ,$397.20 , N/A ,$397.20 , N/A ,$476.64 ,$410.44 ,$476.64 ,$476.64 ,$397.20 
ST MARY'S HOSPITAL,71000257,N/A,HC RECOVERY BRONCH 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 ,$559.44 ,$567.21 ,$505.05 ,$660.45 , N/A ,$505.05 ,$660.45 ,$567.21 , N/A , N/A ,$326.34 ,$660.45 , N/A ,$714.84 ,$543.90 ,$394.09 ,$472.96 ,$473.19 ,$441.41 ,$536.91 ,$559.44 ,$541.18 , N/A ,$559.44 , N/A ,$466.20 ,$466.20 , N/A ,$466.20 , N/A ,$559.44 ,$481.74 ,$559.44 ,$559.44 ,$466.20 
ST MARY'S HOSPITAL,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 ,$105.88 ,$336.00 ,$476.00 ,$392.00 ,$17.98 ,$532.00 ,$403.20 ,$408.80 ,$58.34 ,$476.00 ,$105.88 ,$58.34 ,$476.00 ,$408.80 ,$17.98 ,$105.88 ,$235.20 ,$476.00 ,$238.23 ,$515.20 ,$392.00 ,$302.03 ,$324.25 ,$341.04 ,$302.03 ,$386.96 ,$403.20 ,$390.04 ,$106.94 ,$403.20 ,$19.06 ,$451.00 ,$451.00 ,$105.88 ,$451.00 ,$105.88 ,$403.20 ,$347.20 ,$403.20 ,$403.20 ,$336.00 
ST MARY'S HOSPITAL,72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,"$2,400.00 ","$1,200.00 ",$204.42 ,"$5,741.06 ",$204.42 ,"$1,552.56 ","$1,552.56 ","$2,551.58 ","$1,440.00 ","$2,040.00 ","$1,680.00 ",$204.42 ,"$2,280.00 ","$1,728.00 ","$1,752.00 ","$1,560.00 ","$2,040.00 ","$2,551.58 ","$1,560.00 ","$2,040.00 ","$1,752.00 ",$204.42 ,"$2,551.58 ",$438.99 ,"$2,040.00 ","$5,741.06 ","$2,208.00 ","$1,680.00 ","$1,489.75 ","$2,002.44 ","$1,461.60 ","$1,862.71 ","$1,658.40 ","$1,728.00 ","$1,671.60 ","$2,577.10 ","$1,728.00 ",$216.69 ,"$1,314.00 ","$1,314.00 ","$2,551.58 ","$1,314.00 ","$2,551.58 ","$1,728.00 ","$1,488.00 ","$1,728.00 ","$1,728.00 ","$1,440.00 "
ST MARY'S HOSPITAL,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 ,$215.28 ,$218.27 ,$194.35 ,$254.15 , N/A ,$194.35 ,$254.15 ,$218.27 , N/A , N/A ,$299.00 ,$254.15 , N/A ,$275.08 ,$209.30 ,$151.65 ,$182.00 ,$182.09 ,$169.86 ,$206.61 ,$215.28 ,$208.25 , N/A ,$215.28 , N/A ,$299.00 ,$299.00 , N/A ,$299.00 , N/A ,$215.28 ,$185.38 ,$215.28 ,$215.28 ,$179.40 
ST MARY'S HOSPITAL,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 ,$77.04 ,$78.11 ,$69.55 ,$90.95 , N/A ,$69.55 ,$90.95 ,$78.11 , N/A , N/A ,$107.00 ,$90.95 , N/A ,$98.44 ,$74.90 ,$54.27 ,$65.13 ,$65.16 ,$60.79 ,$73.94 ,$77.04 ,$74.53 , N/A ,$77.04 , N/A ,$107.00 ,$107.00 , N/A ,$107.00 , N/A ,$77.04 ,$66.34 ,$77.04 ,$77.04 ,$64.20 
ST MARY'S HOSPITAL,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 ,$115.20 ,$116.80 ,$104.00 ,$136.00 , N/A ,$104.00 ,$136.00 ,$116.80 , N/A , N/A ,$160.00 ,$136.00 , N/A ,$147.20 ,$112.00 ,$81.15 ,$97.39 ,$97.44 ,$90.90 ,$110.56 ,$115.20 ,$111.44 , N/A ,$115.20 , N/A ,$160.00 ,$160.00 , N/A ,$160.00 , N/A ,$115.20 ,$99.20 ,$115.20 ,$115.20 ,$96.00 
ST MARY'S HOSPITAL,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 ,$129.60 ,$131.40 ,$117.00 ,$153.00 , N/A ,$117.00 ,$153.00 ,$131.40 , N/A , N/A ,$180.00 ,$153.00 , N/A ,$165.60 ,$126.00 ,$91.30 ,$109.57 ,$109.62 ,$102.26 ,$124.38 ,$129.60 ,$125.37 , N/A ,$129.60 , N/A ,$180.00 ,$180.00 , N/A ,$180.00 , N/A ,$129.60 ,$111.60 ,$129.60 ,$129.60 ,$108.00 
ST MARY'S HOSPITAL,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 ","$1,568.88 ","$1,590.67 ","$1,416.35 ","$1,852.15 ", N/A ,"$1,416.35 ","$1,852.15 ","$1,590.67 ", 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 ","$1,237.89 ","$1,505.69 ","$1,568.88 ","$1,517.67 ", N/A ,"$1,568.88 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ", N/A ,"$1,568.88 ","$1,350.98 ","$1,568.88 ","$1,568.88 ","$1,307.40 "
ST MARY'S HOSPITAL,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 ","$2,948.40 ","$2,989.35 ","$2,661.75 ","$3,480.75 ", N/A ,"$2,661.75 ","$3,480.75 ","$2,989.35 ", 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 ","$2,326.37 ","$2,829.65 ","$2,948.40 ","$2,852.17 ", N/A ,"$2,948.40 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ", N/A ,"$2,948.40 ","$2,538.90 ","$2,948.40 ","$2,948.40 ","$2,457.00 "
ST MARY'S HOSPITAL,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 ","$3,175.20 ","$3,219.30 ","$2,866.50 ","$3,748.50 ", N/A ,"$2,866.50 ","$3,748.50 ","$3,219.30 ", 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 ","$2,505.32 ","$3,047.31 ","$3,175.20 ","$3,071.57 ", N/A ,"$3,175.20 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ", N/A ,"$3,175.20 ","$2,734.20 ","$3,175.20 ","$3,175.20 ","$2,646.00 "
ST MARY'S HOSPITAL,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 ","$3,175.20 ","$3,219.30 ","$2,866.50 ","$3,748.50 ", N/A ,"$2,866.50 ","$3,748.50 ","$3,219.30 ", 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 ","$2,505.32 ","$3,047.31 ","$3,175.20 ","$3,071.57 ", N/A ,"$3,175.20 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ", N/A ,"$3,175.20 ","$2,734.20 ","$3,175.20 ","$3,175.20 ","$2,646.00 "
ST MARY'S HOSPITAL,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 ,$317.52 ,$321.93 ,$286.65 ,$374.85 , N/A ,$286.65 ,$374.85 ,$321.93 , N/A , N/A ,$438.99 ,$374.85 , N/A ,$405.72 ,$308.70 ,$223.68 ,$268.44 ,$268.57 ,$250.53 ,$304.73 ,$317.52 ,$307.16 , N/A ,$317.52 , N/A ,$441.00 ,$441.00 , N/A ,$441.00 , N/A ,$317.52 ,$273.42 ,$317.52 ,$317.52 ,$264.60 
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ","$2,388.75 ","$3,123.75 ", N/A ,"$2,388.75 ","$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ", N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ","$2,525.25 ","$3,302.25 ", N/A ,"$2,525.25 ","$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A ,"$1,314.00 ","$1,314.00 ", N/A ,"$1,314.00 ", N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$3,024.00 ","$3,066.00 ", N/A ,"$3,570.00 ", N/A , N/A ,"$3,570.00 ","$3,066.00 ", 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 ","$2,386.02 ","$2,902.20 ","$3,024.00 ","$2,925.30 ", N/A ,"$3,024.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,024.00 ","$2,604.00 ","$3,024.00 ","$3,024.00 ","$2,520.00 "
ST MARY'S HOSPITAL,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 ,$71.28 ,$72.27 ,$64.35 ,$84.15 , N/A ,$64.35 ,$84.15 ,$72.27 , N/A , N/A ,$41.58 ,$84.15 , N/A ,$91.08 ,$69.30 ,$50.21 ,$60.26 ,$60.29 ,$56.24 ,$68.41 ,$71.28 ,$68.95 , N/A ,$71.28 , N/A ,$59.40 ,$59.40 , N/A ,$59.40 , N/A ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,73000002,93005,HC EKG,730,1 ,$202.00 ,$101.00 ,$8.28 ,$202.00 ,$8.28 ,$130.67 ,$130.67 ,$54.13 ,$121.20 ,$171.70 ,$141.40 ,$8.28 ,$191.90 ,$145.44 ,$147.46 ,$131.30 ,$171.70 ,$54.13 ,$131.30 ,$171.70 ,$147.46 ,$8.28 ,$54.13 ,$140.29 ,$171.70 ,$121.80 ,$185.84 ,$141.40 ,$91.92 ,$98.85 ,$123.02 ,$91.92 ,$139.58 ,$145.44 ,$140.69 ,$54.67 ,$145.44 ,$8.78 ,$142.00 ,$142.00 ,$54.13 ,$142.00 ,$54.13 ,$145.44 ,$125.24 ,$145.44 ,$145.44 ,$121.20 
ST MARY'S HOSPITAL,73000004,93242,HC EXT ECG >48HR LESS THN EQUAL TO 7D RECORDING,730,1 ,$114.00 ,$57.00 ,$21.45 ,$121.80 ,$21.45 ,$73.75 ,$73.75 ,$54.13 ,$68.40 ,$96.90 ,$79.80 ,$21.45 ,$108.30 ,$82.08 ,$83.22 ,$74.10 ,$96.90 ,$54.13 ,$74.10 ,$96.90 ,$83.22 ,$21.45 ,$54.13 ,$114.00 ,$96.90 ,$121.80 ,$104.88 ,$79.80 ,$57.82 ,$69.39 ,$69.43 ,$64.76 ,$78.77 ,$82.08 ,$79.40 ,$54.67 ,$82.08 ,$22.74 ,$114.00 ,$114.00 ,$54.13 ,$114.00 ,$54.13 ,$82.08 ,$70.68 ,$82.08 ,$82.08 ,$68.40 
ST MARY'S HOSPITAL,73000005,93243,HC EXT ECG >48HR LESS THN EQUAL TO 7D SCAN A/R,730,1 ,$187.00 ,$93.50 ,$21.45 ,$246.74 ,$21.45 ,$120.97 ,$120.97 ,$109.66 ,$112.20 ,$158.95 ,$130.90 ,$21.45 ,$177.65 ,$134.64 ,$136.51 ,$121.55 ,$158.95 ,$109.66 ,$121.55 ,$158.95 ,$136.51 ,$21.45 ,$109.66 ,$140.29 ,$158.95 ,$246.74 ,$172.04 ,$130.90 ,$94.85 ,$113.83 ,$113.88 ,$106.23 ,$129.22 ,$134.64 ,$130.25 ,$110.76 ,$134.64 ,$22.74 ,$142.00 ,$142.00 ,$109.66 ,$142.00 ,$109.66 ,$134.64 ,$115.94 ,$134.64 ,$134.64 ,$112.20 
ST MARY'S HOSPITAL,73000006,93246,HC EXT ECG >7D<15D RECORDING,730,1 ,$187.00 ,$93.50 ,$21.45 ,$187.00 ,$21.45 ,$120.97 ,$120.97 ,$54.13 ,$112.20 ,$158.95 ,$130.90 ,$21.45 ,$177.65 ,$134.64 ,$136.51 ,$121.55 ,$158.95 ,$54.13 ,$121.55 ,$158.95 ,$136.51 ,$21.45 ,$54.13 ,$140.29 ,$158.95 ,$121.80 ,$172.04 ,$130.90 ,$94.85 ,$113.83 ,$113.88 ,$106.23 ,$129.22 ,$134.64 ,$130.25 ,$54.67 ,$134.64 ,$22.74 ,$142.00 ,$142.00 ,$54.13 ,$142.00 ,$54.13 ,$134.64 ,$115.94 ,$134.64 ,$134.64 ,$112.20 
ST MARY'S HOSPITAL,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 ,$109.66 ,$225.60 ,$319.60 ,$263.20 ,$21.45 ,$357.20 ,$270.72 ,$274.48 ,$244.40 ,$319.60 ,$109.66 ,$244.40 ,$319.60 ,$274.48 ,$21.45 ,$109.66 ,$140.29 ,$319.60 ,$246.74 ,$345.92 ,$263.20 ,$190.71 ,$228.87 ,$228.98 ,$213.61 ,$259.82 ,$270.72 ,$261.88 ,$110.76 ,$270.72 ,$22.74 ,$142.00 ,$142.00 ,$109.66 ,$142.00 ,$109.66 ,$270.72 ,$233.12 ,$270.72 ,$270.72 ,$225.60 
ST MARY'S HOSPITAL,73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$493.00 ,$246.50 ,$21.45 ,$493.00 ,$21.45 ,$318.92 ,$318.92 ,$109.66 ,$295.80 ,$419.05 ,$345.10 ,$21.45 ,$468.35 ,$354.96 ,$359.89 ,$320.45 ,$419.05 ,$109.66 ,$320.45 ,$419.05 ,$359.89 ,$21.45 ,$109.66 ,$211.57 ,$419.05 ,$246.74 ,$453.56 ,$345.10 ,$250.05 ,$300.09 ,$300.24 ,$280.07 ,$340.66 ,$354.96 ,$343.37 ,$110.76 ,$354.96 ,$22.74 ,$493.00 ,$493.00 ,$109.66 ,$493.00 ,$109.66 ,$354.96 ,$305.66 ,$354.96 ,$354.96 ,$295.80 
ST MARY'S HOSPITAL,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 ,$109.66 ,$376.20 ,$532.95 ,$438.90 ,$21.45 ,$595.65 ,$451.44 ,$457.71 ,$407.55 ,$532.95 ,$109.66 ,$407.55 ,$532.95 ,$457.71 ,$21.45 ,$109.66 ,$211.57 ,$532.95 ,$246.74 ,$576.84 ,$438.90 ,$318.01 ,$381.65 ,$381.84 ,$356.20 ,$433.26 ,$451.44 ,$436.71 ,$110.76 ,$451.44 ,$22.74 ,$539.00 ,$539.00 ,$109.66 ,$539.00 ,$109.66 ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$376.20 
ST MARY'S HOSPITAL,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 ,$109.66 ,$430.20 ,$609.45 ,$501.90 ,$21.45 ,$681.15 ,$516.24 ,$523.41 ,$466.05 ,$609.45 ,$109.66 ,$466.05 ,$609.45 ,$523.41 ,$21.45 ,$109.66 ,$211.57 ,$609.45 ,$246.74 ,$659.64 ,$501.90 ,$363.66 ,$436.44 ,$436.65 ,$407.33 ,$495.45 ,$516.24 ,$499.39 ,$110.76 ,$516.24 ,$22.74 ,$539.00 ,$539.00 ,$109.66 ,$539.00 ,$109.66 ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$430.20 
ST MARY'S HOSPITAL,73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$280.00 ,$140.00 ,$21.45 ,$280.00 ,$21.45 ,$181.13 ,$181.13 ,$36.21 ,$168.00 ,$238.00 ,$196.00 ,$21.45 ,$266.00 ,$201.60 ,$204.40 ,$182.00 ,$238.00 ,$36.21 ,$182.00 ,$238.00 ,$204.40 ,$21.45 ,$36.21 ,$211.57 ,$238.00 ,$81.48 ,$257.60 ,$196.00 ,$142.02 ,$170.44 ,$170.52 ,$159.07 ,$193.48 ,$201.60 ,$195.02 ,$36.57 ,$201.60 ,$22.74 ,$280.00 ,$280.00 ,$36.21 ,$280.00 ,$36.21 ,$201.60 ,$173.60 ,$201.60 ,$201.60 ,$168.00 
ST MARY'S HOSPITAL,73100005,93271,HC CARDIAC EVENT MONITOR,731,1 ,$840.00 ,$420.00 ,$21.45 ,$840.00 ,$21.45 ,$543.40 ,$543.40 ,$97.63 ,$504.00 ,$714.00 ,$588.00 ,$21.45 ,$798.00 ,$604.80 ,$613.20 ,$546.00 ,$714.00 ,$97.63 ,$546.00 ,$714.00 ,$613.20 ,$21.45 ,$97.63 ,$211.57 ,$714.00 ,$219.67 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$477.20 ,$580.44 ,$604.80 ,$585.06 ,$98.61 ,$604.80 ,$22.74 ,$539.00 ,$539.00 ,$97.63 ,$539.00 ,$97.63 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,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 ,$451.44 ,$457.71 ,$407.55 ,$532.95 , N/A ,$407.55 ,$532.95 ,$457.71 , N/A , N/A ,$211.57 ,$532.95 , N/A ,$576.84 ,$438.90 ,$318.01 ,$381.65 ,$381.84 ,$356.20 ,$433.26 ,$451.44 ,$436.71 , N/A ,$451.44 , N/A ,$539.00 ,$539.00 , N/A ,$539.00 , N/A ,$451.44 ,$388.74 ,$451.44 ,$451.44 ,$376.20 
ST MARY'S HOSPITAL,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 ,$516.24 ,$523.41 ,$466.05 ,$609.45 , N/A ,$466.05 ,$609.45 ,$523.41 , N/A , N/A ,$211.57 ,$609.45 , N/A ,$659.64 ,$501.90 ,$363.66 ,$436.44 ,$436.65 ,$407.33 ,$495.45 ,$516.24 ,$499.39 , N/A ,$516.24 , N/A ,$539.00 ,$539.00 , N/A ,$539.00 , N/A ,$516.24 ,$444.54 ,$516.24 ,$516.24 ,$430.20 
ST MARY'S HOSPITAL,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 ,$78.66 ,$222.00 ,$314.50 ,$259.00 ,$17.98 ,$351.50 ,$266.40 ,$270.10 ,$44.98 ,$314.50 ,$78.66 ,$44.98 ,$314.50 ,$270.10 ,$17.98 ,$78.66 ,$155.40 ,$314.50 ,$177.00 ,$340.40 ,$259.00 ,$190.57 ,$204.59 ,$225.33 ,$190.57 ,$255.67 ,$266.40 ,$257.71 ,$79.45 ,$266.40 ,$19.06 ,$370.00 ,$370.00 ,$78.66 ,$370.00 ,$78.66 ,$266.40 ,$229.40 ,$266.40 ,$266.40 ,$222.00 
ST MARY'S HOSPITAL,74000012,95812,HC EEG MONITOR 41-60 MIN,740,1 ,$963.00 ,$481.50 ,$159.10 ,$963.00 ,$159.10 ,$622.96 ,$622.96 ,$257.38 ,$577.80 ,$818.55 ,$674.10 ,$159.10 ,$914.85 ,$693.36 ,$702.99 ,$625.95 ,$818.55 ,$257.38 ,$625.95 ,$818.55 ,$702.99 ,$159.10 ,$257.38 ,$404.46 ,$818.55 ,$579.11 ,$885.96 ,$674.10 ,$488.43 ,$586.18 ,$586.47 ,$547.08 ,$665.43 ,$693.36 ,$670.73 ,$259.95 ,$693.36 ,$168.65 ,$452.00 ,$452.00 ,$257.38 ,$452.00 ,$257.38 ,$693.36 ,$597.06 ,$693.36 ,$693.36 ,$577.80 
ST MARY'S HOSPITAL,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 ",$257.38 ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$159.10 ,"$1,596.00 ","$1,209.60 ","$1,226.40 ","$1,092.00 ","$1,428.00 ",$257.38 ,"$1,092.00 ","$1,428.00 ","$1,226.40 ",$159.10 ,$257.38 ,$705.60 ,"$1,428.00 ",$579.11 ,"$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ",$954.41 ,"$1,160.88 ","$1,209.60 ","$1,170.12 ",$259.95 ,"$1,209.60 ",$168.65 ,$452.00 ,$452.00 ,$257.38 ,$452.00 ,$257.38 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,74000014,95816,HC EEG AWAKE/DROWSY,740,1 ,$851.00 ,$425.50 ,$100.32 ,$851.00 ,$100.32 ,$550.51 ,$550.51 ,$257.38 ,$510.60 ,$723.35 ,$595.70 ,$100.32 ,$808.45 ,$612.72 ,$621.23 ,$553.15 ,$723.35 ,$257.38 ,$553.15 ,$723.35 ,$621.23 ,$100.32 ,$257.38 ,$357.42 ,$723.35 ,$579.11 ,$782.92 ,$595.70 ,$431.63 ,$518.00 ,$518.26 ,$483.45 ,$588.04 ,$612.72 ,$592.72 ,$259.95 ,$612.72 ,$106.34 ,$452.00 ,$452.00 ,$257.38 ,$452.00 ,$257.38 ,$612.72 ,$527.62 ,$612.72 ,$612.72 ,$510.60 
ST MARY'S HOSPITAL,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 ",$257.38 ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$100.32 ,"$1,596.00 ","$1,209.60 ","$1,226.40 ","$1,092.00 ","$1,428.00 ",$257.38 ,"$1,092.00 ","$1,428.00 ","$1,226.40 ",$100.32 ,$257.38 ,$705.60 ,"$1,428.00 ",$579.11 ,"$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ",$954.41 ,"$1,160.88 ","$1,209.60 ","$1,170.12 ",$259.95 ,"$1,209.60 ",$106.34 ,$452.00 ,$452.00 ,$257.38 ,$452.00 ,$257.38 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,74000018,95822,HC EEG COMA OR SLEEP ONLY,740,1 ,"$1,344.00 ",$672.00 ,$100.32 ,"$1,344.00 ",$100.32 ,$869.43 ,$869.43 ,$257.38 ,$806.40 ,"$1,142.40 ",$940.80 ,$100.32 ,"$1,276.80 ",$967.68 ,$981.12 ,$873.60 ,"$1,142.40 ",$257.38 ,$873.60 ,"$1,142.40 ",$981.12 ,$100.32 ,$257.38 ,$564.48 ,"$1,142.40 ",$579.11 ,"$1,236.48 ",$940.80 ,$681.68 ,$818.09 ,$818.50 ,$763.53 ,$928.70 ,$967.68 ,$936.10 ,$259.95 ,$967.68 ,$106.34 ,$452.00 ,$452.00 ,$257.38 ,$452.00 ,$257.38 ,$967.68 ,$833.28 ,$967.68 ,$967.68 ,$806.40 
ST MARY'S HOSPITAL,74000020,95824,HC EEG CEREBRAL DEATH EVAL,740,1 ,"$1,075.00 ",$537.50 ,$100.32 ,"$1,075.00 ",$100.32 ,$695.42 ,$695.42 ,$474.72 ,$645.00 ,$913.75 ,$752.50 ,$100.32 ,"$1,021.25 ",$774.00 ,$784.75 ,$698.75 ,$913.75 ,$474.72 ,$698.75 ,$913.75 ,$784.75 ,$100.32 ,$474.72 ,$451.50 ,$913.75 ,"$1,068.12 ",$989.00 ,$752.50 ,$545.24 ,$654.35 ,$654.68 ,$610.71 ,$742.83 ,$774.00 ,$748.74 ,$479.47 ,$774.00 ,$106.34 ,$452.00 ,$452.00 ,$474.72 ,$452.00 ,$474.72 ,$774.00 ,$666.50 ,$774.00 ,$774.00 ,$645.00 
ST MARY'S HOSPITAL,74000024,95929,HC TCMEP LWR LIMBS,740,1 ,$672.00 ,$336.00 ,$42.84 ,"$1,068.12 ",$42.84 ,$434.72 ,$434.72 ,$474.72 ,$403.20 ,$571.20 ,$470.40 ,$42.84 ,$638.40 ,$483.84 ,$490.56 ,$436.80 ,$571.20 ,$474.72 ,$436.80 ,$571.20 ,$490.56 ,$42.84 ,$474.72 ,$282.24 ,$571.20 ,"$1,068.12 ",$618.24 ,$470.40 ,$340.84 ,$409.05 ,$409.25 ,$381.76 ,$464.35 ,$483.84 ,$468.05 ,$479.47 ,$483.84 ,$45.41 ,$452.00 ,$452.00 ,$474.72 ,$452.00 ,$474.72 ,$483.84 ,$416.64 ,$483.84 ,$483.84 ,$403.20 
ST MARY'S HOSPITAL,74000033,95939,HC TCMEP UPPER AND LOWER,740,1 ,$784.00 ,$392.00 ,$42.84 ,"$2,013.15 ",$42.84 ,$507.17 ,$507.17 ,$894.73 ,$470.40 ,$666.40 ,$548.80 ,$42.84 ,$744.80 ,$564.48 ,$572.32 ,$509.60 ,$666.40 ,$894.73 ,$509.60 ,$666.40 ,$572.32 ,$42.84 ,$894.73 ,$329.28 ,$666.40 ,"$2,013.15 ",$721.28 ,$548.80 ,$397.64 ,$477.22 ,$477.46 ,$445.39 ,$541.74 ,$564.48 ,$546.06 ,$903.68 ,$564.48 ,$45.41 ,$452.00 ,$452.00 ,$894.73 ,$452.00 ,$894.73 ,$564.48 ,$486.08 ,$564.48 ,$564.48 ,$470.40 
ST MARY'S HOSPITAL,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 ,$177.12 ,$179.58 ,$159.90 ,$209.10 , N/A ,$159.90 ,$209.10 ,$179.58 , N/A , N/A ,$103.32 ,$209.10 , N/A ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$139.75 ,$169.99 ,$177.12 ,$171.34 , N/A ,$177.12 , N/A ,$246.00 ,$246.00 , N/A ,$246.00 , N/A ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,74000044,95941,HC NEURO TEST INTRAOPER REMOTE/> 1 OR PER HR,740,1 ,$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 ,$499.68 ,$506.62 ,$451.10 ,$589.90 , N/A ,$451.10 ,$589.90 ,$506.62 , N/A , N/A ,$291.48 ,$589.90 , N/A ,$638.48 ,$485.80 ,$352.00 ,$422.44 ,$422.65 ,$394.26 ,$479.55 ,$499.68 ,$483.37 , N/A ,$499.68 , N/A ,$452.00 ,$452.00 , N/A ,$452.00 , N/A ,$499.68 ,$430.28 ,$499.68 ,$499.68 ,$416.40 
ST MARY'S HOSPITAL,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 ","$2,494.80 ","$2,529.45 ", N/A ,"$2,945.25 ", N/A , N/A ,"$2,945.25 ","$2,529.45 ", 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 ","$1,968.47 ","$2,394.32 ","$2,494.80 ","$2,413.37 ", N/A ,"$2,494.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,079.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,192.40 ","$2,222.85 ", N/A ,"$2,588.25 ", N/A , N/A ,"$2,588.25 ","$2,222.85 ", 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 ","$1,729.86 ","$2,104.10 ","$2,192.40 ","$2,120.84 ", N/A ,"$2,192.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,192.40 ","$1,887.90 ","$2,192.40 ","$2,192.40 ","$1,827.00 "
ST MARY'S HOSPITAL,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 ","$2,343.60 ","$2,376.15 ", N/A ,"$2,766.75 ", N/A , N/A ,"$2,766.75 ","$2,376.15 ", 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 ","$1,849.17 ","$2,249.21 ","$2,343.60 ","$2,267.11 ", N/A ,"$2,343.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,343.60 ","$2,018.10 ","$2,343.60 ","$2,343.60 ","$1,953.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$2,721.60 ","$2,759.40 ", N/A ,"$3,213.00 ", N/A , N/A ,"$3,213.00 ","$2,759.40 ", 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 ","$2,147.42 ","$2,611.98 ","$2,721.60 ","$2,632.77 ", N/A ,"$2,721.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$2,268.00 "
ST MARY'S HOSPITAL,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 ","$2,721.60 ","$2,759.40 ", N/A ,"$3,213.00 ", N/A , N/A ,"$3,213.00 ","$2,759.40 ", 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 ","$2,147.42 ","$2,611.98 ","$2,721.60 ","$2,632.77 ", N/A ,"$2,721.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$2,268.00 "
ST MARY'S HOSPITAL,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 ","$1,285.20 ","$1,303.05 ", N/A ,"$1,517.25 ", N/A , N/A ,"$1,517.25 ","$1,303.05 ", 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 ","$1,014.06 ","$1,233.44 ","$1,285.20 ","$1,243.25 ", N/A ,"$1,285.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,285.20 ","$1,106.70 ","$1,285.20 ","$1,285.20 ","$1,071.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$2,494.80 ","$2,529.45 ", N/A ,"$2,945.25 ", N/A , N/A ,"$2,945.25 ","$2,529.45 ", 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 ","$1,968.47 ","$2,394.32 ","$2,494.80 ","$2,413.37 ", N/A ,"$2,494.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,079.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ", N/A ,"$1,874.25 ", N/A , N/A ,"$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ","$2,494.80 ","$2,529.45 ", N/A ,"$2,945.25 ", N/A , N/A ,"$2,945.25 ","$2,529.45 ", 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 ","$1,968.47 ","$2,394.32 ","$2,494.80 ","$2,413.37 ", N/A ,"$2,494.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,079.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$3,628.80 ","$3,679.20 ", N/A ,"$4,284.00 ", N/A , N/A ,"$4,284.00 ","$3,679.20 ", 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 ","$2,863.22 ","$3,482.64 ","$3,628.80 ","$3,510.36 ", N/A ,"$3,628.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$3,024.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$3,628.80 ","$3,679.20 ", N/A ,"$4,284.00 ", N/A , N/A ,"$4,284.00 ","$3,679.20 ", 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 ","$2,863.22 ","$3,482.64 ","$3,628.80 ","$3,510.36 ", N/A ,"$3,628.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$3,024.00 "
ST MARY'S HOSPITAL,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 ","$3,628.80 ","$3,679.20 ", N/A ,"$4,284.00 ", N/A , N/A ,"$4,284.00 ","$3,679.20 ", 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 ","$2,863.22 ","$3,482.64 ","$3,628.80 ","$3,510.36 ", N/A ,"$3,628.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$3,024.00 "
ST MARY'S HOSPITAL,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 ","$3,628.80 ","$3,679.20 ", N/A ,"$4,284.00 ", N/A , N/A ,"$4,284.00 ","$3,679.20 ", 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 ","$2,863.22 ","$3,482.64 ","$3,628.80 ","$3,510.36 ", N/A ,"$3,628.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$3,024.00 "
ST MARY'S HOSPITAL,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 ","$3,628.80 ","$3,679.20 ", N/A ,"$4,284.00 ", N/A , N/A ,"$4,284.00 ","$3,679.20 ", 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 ","$2,863.22 ","$3,482.64 ","$3,628.80 ","$3,510.36 ", N/A ,"$3,628.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$3,024.00 "
ST MARY'S HOSPITAL,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 ","$3,628.80 ","$3,679.20 ", N/A ,"$4,284.00 ", N/A , N/A ,"$4,284.00 ","$3,679.20 ", 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 ","$2,863.22 ","$3,482.64 ","$3,628.80 ","$3,510.36 ", N/A ,"$3,628.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,628.80 ","$3,124.80 ","$3,628.80 ","$3,628.80 ","$3,024.00 "
ST MARY'S HOSPITAL,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 ","$2,268.00 ","$2,299.50 ", N/A ,"$2,677.50 ", N/A , N/A ,"$2,677.50 ","$2,299.50 ", 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 ","$1,789.52 ","$2,176.65 ","$2,268.00 ","$2,193.98 ", N/A ,"$2,268.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,268.00 ","$1,953.00 ","$2,268.00 ","$2,268.00 ","$1,890.00 "
ST MARY'S HOSPITAL,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 ","$3,553.20 ","$3,602.55 ", N/A ,"$4,194.75 ", N/A , N/A ,"$4,194.75 ","$3,602.55 ", 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 ","$2,803.57 ","$3,410.09 ","$3,553.20 ","$3,437.23 ", N/A ,"$3,553.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,553.20 ","$3,059.70 ","$3,553.20 ","$3,553.20 ","$2,961.00 "
ST MARY'S HOSPITAL,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 ","$3,553.20 ","$3,602.55 ", N/A ,"$4,194.75 ", N/A , N/A ,"$4,194.75 ","$3,602.55 ", 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 ","$2,803.57 ","$3,410.09 ","$3,553.20 ","$3,437.23 ", N/A ,"$3,553.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,553.20 ","$3,059.70 ","$3,553.20 ","$3,553.20 ","$2,961.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ", N/A ,"$1,874.25 ", N/A , N/A ,"$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ,$431.28 ,$437.27 , N/A ,$509.15 , N/A , N/A ,$509.15 ,$437.27 , N/A , N/A , N/A ,$509.15 , N/A ,$551.08 ,$419.30 ,$303.81 ,$364.61 ,$364.79 ,$340.29 ,$413.91 ,$431.28 ,$417.20 , N/A ,$431.28 , N/A , N/A , N/A , N/A , N/A , N/A ,$431.28 ,$371.38 ,$431.28 ,$431.28 ,$359.40 
ST MARY'S HOSPITAL,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 ","$2,419.20 ","$2,452.80 ", N/A ,"$2,856.00 ", N/A , N/A ,"$2,856.00 ","$2,452.80 ", 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 ","$1,908.82 ","$2,321.76 ","$2,419.20 ","$2,340.24 ", N/A ,"$2,419.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,419.20 ","$2,083.20 ","$2,419.20 ","$2,419.20 ","$2,016.00 "
ST MARY'S HOSPITAL,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 ","$2,721.60 ","$2,759.40 ", N/A ,"$3,213.00 ", N/A , N/A ,"$3,213.00 ","$2,759.40 ", 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 ","$2,147.42 ","$2,611.98 ","$2,721.60 ","$2,632.77 ", N/A ,"$2,721.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$2,268.00 "
ST MARY'S HOSPITAL,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 ","$1,285.20 ","$1,303.05 ", N/A ,"$1,517.25 ", N/A , N/A ,"$1,517.25 ","$1,303.05 ", 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 ","$1,014.06 ","$1,233.44 ","$1,285.20 ","$1,243.25 ", N/A ,"$1,285.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,285.20 ","$1,106.70 ","$1,285.20 ","$1,285.20 ","$1,071.00 "
ST MARY'S HOSPITAL,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 ","$2,494.80 ","$2,529.45 ", N/A ,"$2,945.25 ", N/A , N/A ,"$2,945.25 ","$2,529.45 ", 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 ","$1,968.47 ","$2,394.32 ","$2,494.80 ","$2,413.37 ", N/A ,"$2,494.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,494.80 ","$2,148.30 ","$2,494.80 ","$2,494.80 ","$2,079.00 "
ST MARY'S HOSPITAL,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 ","$2,721.60 ","$2,759.40 ", N/A ,"$3,213.00 ", N/A , N/A ,"$3,213.00 ","$2,759.40 ", 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 ","$2,147.42 ","$2,611.98 ","$2,721.60 ","$2,632.77 ", N/A ,"$2,721.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,721.60 ","$2,343.60 ","$2,721.60 ","$2,721.60 ","$2,268.00 "
ST MARY'S HOSPITAL,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 ","$1,436.40 ","$1,456.35 ", N/A ,"$1,695.75 ", N/A , N/A ,"$1,695.75 ","$1,456.35 ", 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 ","$1,133.36 ","$1,378.55 ","$1,436.40 ","$1,389.52 ", N/A ,"$1,436.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,436.40 ","$1,236.90 ","$1,436.40 ","$1,436.40 ","$1,197.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$2,797.20 ","$2,836.05 ", N/A ,"$3,302.25 ", N/A , N/A ,"$3,302.25 ","$2,836.05 ", 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 ","$2,207.07 ","$2,684.54 ","$2,797.20 ","$2,705.90 ", N/A ,"$2,797.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,797.20 ","$2,408.70 ","$2,797.20 ","$2,797.20 ","$2,331.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$1,360.80 ","$1,379.70 ", N/A ,"$1,606.50 ", N/A , N/A ,"$1,606.50 ","$1,379.70 ", 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 ","$1,073.71 ","$1,305.99 ","$1,360.80 ","$1,316.39 ", N/A ,"$1,360.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,360.80 ","$1,171.80 ","$1,360.80 ","$1,360.80 ","$1,134.00 "
ST MARY'S HOSPITAL,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 ","$2,646.00 ","$2,682.75 ", N/A ,"$3,123.75 ", N/A , N/A ,"$3,123.75 ","$2,682.75 ", 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 ","$2,087.77 ","$2,539.43 ","$2,646.00 ","$2,559.64 ", N/A ,"$2,646.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,646.00 ","$2,278.50 ","$2,646.00 ","$2,646.00 ","$2,205.00 "
ST MARY'S HOSPITAL,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 ,$287.28 ,$291.27 , N/A ,$339.15 , N/A , N/A ,$339.15 ,$291.27 , N/A , N/A , N/A ,$339.15 , N/A ,$367.08 ,$279.30 ,$202.37 ,$242.87 ,$242.99 ,$226.67 ,$275.71 ,$287.28 ,$277.90 , N/A ,$287.28 , N/A , N/A , N/A , N/A , N/A , N/A ,$287.28 ,$247.38 ,$287.28 ,$287.28 ,$239.40 
ST MARY'S HOSPITAL,75000095,78267,HC UREA BREATH TEST C-14 ISOTO,300,1 ,$502.00 ,$251.00 ,$9.88 ,$502.00 ,$9.88 ,$38.71 ,$33.18 ,$11.06 ,$301.20 ,$426.70 ,$351.40 ,$9.88 ,$476.90 ,$361.44 ,$366.46 ,$18.80 ,$426.70 ,$11.06 ,$18.80 ,$426.70 ,$366.46 ,$9.88 ,$11.06 ,$12.52 ,$426.70 ,$24.89 ,$461.84 ,$351.40 ,$33.05 ,$35.48 ,$305.72 ,$33.05 ,$346.88 ,$361.44 ,$349.64 ,$11.17 ,$361.44 ,$10.47 , N/A , N/A ,$11.06 , N/A ,$11.06 ,$361.44 ,$311.24 ,$361.44 ,$361.44 ,$301.20 
ST MARY'S HOSPITAL,75000097,91034,HC ACID REFLUX TEST NASAL PH ELEC,750,1 ,$862.00 ,$431.00 ,$211.20 ,"$1,068.12 ",$211.20 ,$862.00 ,$862.00 ,$474.72 ,$517.20 ,$732.70 ,$603.40 ,$211.20 ,$818.90 ,$620.64 ,$629.26 ,$862.00 ,$732.70 ,$474.72 ,$862.00 ,$732.70 ,$629.26 ,$211.20 ,$474.72 ,$862.00 ,$732.70 ,"$1,068.12 ",$793.04 ,$603.40 , N/A , N/A ,$524.96 , N/A ,$595.64 ,$620.64 ,$600.38 ,$479.47 ,$620.64 ,$223.87 ,$862.00 ,$862.00 ,$474.72 ,$862.00 ,$474.72 ,$620.64 ,$534.44 ,$620.64 ,$620.64 ,$517.20 
ST MARY'S HOSPITAL,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 ",$786.92 ,"$1,080.00 ","$1,530.00 ","$1,260.00 ",$232.13 ,"$1,710.00 ","$1,296.00 ","$1,314.00 ","$1,800.00 ","$1,530.00 ",$786.92 ,"$1,800.00 ","$1,530.00 ","$1,314.00 ",$232.13 ,$786.92 ,"$1,697.11 ","$1,530.00 ","$1,770.57 ","$1,656.00 ","$1,260.00 ","$1,680.96 ","$1,800.00 ","$1,096.20 ","$1,800.00 ","$1,243.80 ","$1,296.00 ","$1,253.70 ",$794.79 ,"$1,296.00 ",$246.06 ,"$1,800.00 ","$1,800.00 ",$786.92 ,"$1,800.00 ",$786.92 ,"$1,296.00 ","$1,116.00 ","$1,296.00 ","$1,296.00 ","$1,080.00 "
ST MARY'S HOSPITAL,75000099,90945,HC PERITONEAL SUBSQ,750,1 ,$700.00 ,$350.00 ,$240.37 ,$796.00 ,$240.37 , N/A , N/A ,$353.78 ,$420.00 ,$595.00 ,$490.00 ,$240.37 ,$665.00 ,$504.00 ,$511.00 ,$700.00 ,$595.00 ,$353.78 ,$700.00 ,$595.00 ,$511.00 ,$240.37 ,$353.78 , N/A ,$595.00 ,$796.00 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$357.32 ,$504.00 ,$254.79 , N/A , N/A ,$353.78 , N/A ,$353.78 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ", N/A ,"$1,874.25 ", N/A , N/A ,"$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$2,041.20 ","$2,069.55 ", N/A ,"$2,409.75 ", N/A , N/A ,"$2,409.75 ","$2,069.55 ", 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 ","$1,610.56 ","$1,958.99 ","$2,041.20 ","$1,974.58 ", N/A ,"$2,041.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,041.20 ","$1,757.70 ","$2,041.20 ","$2,041.20 ","$1,701.00 "
ST MARY'S HOSPITAL,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 ","$1,663.20 ","$1,686.30 ", N/A ,"$1,963.50 ", N/A , N/A ,"$1,963.50 ","$1,686.30 ", 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 ","$1,312.31 ","$1,596.21 ","$1,663.20 ","$1,608.92 ", N/A ,"$1,663.20 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,663.20 ","$1,432.20 ","$1,663.20 ","$1,663.20 ","$1,386.00 "
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ", N/A ,"$1,874.25 ", N/A , N/A ,"$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ", N/A ,"$1,874.25 ", N/A , N/A ,"$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ",$771.77 ,"$1,260.00 ","$1,785.00 ","$1,470.00 ",$462.68 ,"$1,995.00 ","$1,512.00 ","$1,533.00 ","$2,100.00 ","$1,785.00 ",$771.77 ,"$2,100.00 ","$1,785.00 ","$1,533.00 ",$462.68 ,$771.77 ,"$2,100.00 ","$1,785.00 ","$1,736.49 ","$1,932.00 ","$1,470.00 ", N/A , N/A ,"$1,278.90 ", N/A ,"$1,451.10 ","$1,512.00 ","$1,462.65 ",$779.49 ,"$1,512.00 ",$490.44 ,"$2,100.00 ","$2,100.00 ",$771.77 ,"$2,100.00 ",$771.77 ,"$1,512.00 ","$1,302.00 ","$1,512.00 ","$1,512.00 ","$1,260.00 "
ST MARY'S HOSPITAL,75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,"$1,100.00 ",$550.00 ,$232.13 ,"$1,770.57 ",$232.13 ,"$1,100.00 ","$1,100.00 ",$786.92 ,$660.00 ,$935.00 ,$770.00 ,$232.13 ,"$1,045.00 ",$792.00 ,$803.00 ,"$1,100.00 ",$935.00 ,$786.92 ,"$1,100.00 ",$935.00 ,$803.00 ,$232.13 ,$786.92 ,"$1,100.00 ",$935.00 ,"$1,770.57 ","$1,012.00 ",$770.00 ,"$1,100.00 ","$1,100.00 ",$669.90 ,"$1,100.00 ",$760.10 ,$792.00 ,$766.15 ,$794.79 ,$792.00 ,$246.06 ,"$1,100.00 ","$1,100.00 ",$786.92 ,"$1,100.00 ",$786.92 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,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 ","$1,587.60 ","$1,609.65 ", N/A ,"$1,874.25 ", N/A , N/A ,"$1,874.25 ","$1,609.65 ", 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 ","$1,252.66 ","$1,523.66 ","$1,587.60 ","$1,535.78 ", N/A ,"$1,587.60 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,587.60 ","$1,367.10 ","$1,587.60 ","$1,587.60 ","$1,323.00 "
ST MARY'S HOSPITAL,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 ,$289.44 ,$293.46 ,$402.00 ,$341.70 , N/A ,$402.00 ,$341.70 ,$293.46 ,$38.23 , N/A , N/A ,$341.70 , N/A ,$369.84 ,$281.40 ,$203.89 ,$244.70 ,$244.82 ,$228.38 ,$277.78 ,$289.44 ,$279.99 , N/A ,$289.44 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$289.44 ,$249.24 ,$289.44 ,$289.44 ,$241.20 
ST MARY'S HOSPITAL,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 ","$4,384.80 ","$4,445.70 ", N/A ,"$5,176.50 ", N/A , N/A ,"$5,176.50 ","$4,445.70 ", 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 ","$3,459.73 ","$4,208.19 ","$4,384.80 ","$4,241.69 ", N/A ,"$4,384.80 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$4,384.80 ","$3,775.80 ","$4,384.80 ","$4,384.80 ","$3,654.00 "
ST MARY'S HOSPITAL,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 ","$1,693.44 ","$1,716.96 ", N/A ,"$1,999.20 ", N/A , N/A ,"$1,999.20 ","$1,716.96 ", 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 ","$1,336.17 ","$1,625.23 ","$1,693.44 ","$1,638.17 ", N/A ,"$1,693.44 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,693.44 ","$1,458.24 ","$1,693.44 ","$1,693.44 ","$1,411.20 "
ST MARY'S HOSPITAL,75001094,N/A,HC ERCP W/BRUSH/WASH - 43260,750,1 ,"$4,566.00 ","$2,283.00 ","$2,283.00 ","$4,566.00 ", N/A , N/A , N/A , N/A ,"$2,739.60 ","$3,881.10 ","$3,196.20 ", N/A ,"$4,337.70 ","$3,287.52 ","$3,333.18 ", N/A ,"$3,881.10 ", N/A , N/A ,"$3,881.10 ","$3,333.18 ", N/A , N/A , N/A ,"$3,881.10 ", N/A ,"$4,200.72 ","$3,196.20 ","$2,315.88 ","$2,779.32 ","$2,780.69 ","$2,593.94 ","$3,155.11 ","$3,287.52 ","$3,180.22 ", N/A ,"$3,287.52 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,287.52 ","$2,830.92 ","$3,287.52 ","$3,287.52 ","$2,739.60 "
ST MARY'S HOSPITAL,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 ","$6,444.90 ","$6,534.41 ", N/A ,"$7,608.56 ", N/A , N/A ,"$7,608.56 ","$6,534.41 ", 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 ","$5,085.21 ","$6,185.31 ","$6,444.90 ","$6,234.55 ", N/A ,"$6,444.90 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$6,444.90 ","$5,549.78 ","$6,444.90 ","$6,444.90 ","$5,370.75 "
ST MARY'S HOSPITAL,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 ","$2,570.40 ","$2,606.10 ", N/A ,"$3,034.50 ", N/A , N/A ,"$3,034.50 ","$2,606.10 ", 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 ","$2,028.12 ","$2,466.87 ","$2,570.40 ","$2,486.51 ", N/A ,"$2,570.40 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,570.40 ","$2,213.40 ","$2,570.40 ","$2,570.40 ","$2,142.00 "
ST MARY'S HOSPITAL,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 ","$1,134.00 ","$1,149.75 ", N/A ,"$1,338.75 ", N/A , N/A ,"$1,338.75 ","$1,149.75 ", N/A , N/A , N/A ,"$1,338.75 ", N/A ,"$1,449.00 ","$1,102.50 ",$798.84 ,$958.70 ,$959.18 ,$894.76 ,"$1,088.33 ","$1,134.00 ","$1,096.99 ", N/A ,"$1,134.00 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,134.00 ",$976.50 ,"$1,134.00 ","$1,134.00 ",$945.00 
ST MARY'S HOSPITAL,75001140,N/A,HC PROCTOSIGMOIDOSCOPY RIGID W/FB REMOVAL - 45307,750,1 ,"$7,099.00 ","$3,549.50 ","$3,549.50 ","$7,099.00 ", N/A , N/A , N/A , N/A ,"$4,259.40 ","$6,034.15 ","$4,969.30 ", N/A ,"$6,744.05 ","$5,111.28 ","$5,182.27 ", N/A ,"$6,034.15 ", N/A , N/A ,"$6,034.15 ","$5,182.27 ", N/A , N/A , N/A ,"$6,034.15 ", N/A ,"$6,531.08 ","$4,969.30 ","$3,600.61 ","$4,321.16 ","$4,323.29 ","$4,032.94 ","$4,905.41 ","$5,111.28 ","$4,944.45 ", N/A ,"$5,111.28 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$5,111.28 ","$4,401.38 ","$5,111.28 ","$5,111.28 ","$4,259.40 "
ST MARY'S HOSPITAL,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 ","$2,175.84 ","$2,206.06 ", N/A ,"$2,568.70 ", N/A , N/A ,"$2,568.70 ","$2,206.06 ", 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 ","$1,716.80 ","$2,088.20 ","$2,175.84 ","$2,104.82 ", N/A ,"$2,175.84 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$2,175.84 ","$1,873.64 ","$2,175.84 ","$2,175.84 ","$1,813.20 "
ST MARY'S HOSPITAL,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 ","$1,444.32 ","$1,464.38 ", N/A ,"$1,705.10 ", N/A , N/A ,"$1,705.10 ","$1,464.38 ", 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 ","$1,139.61 ","$1,386.15 ","$1,444.32 ","$1,397.18 ", N/A ,"$1,444.32 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$1,444.32 ","$1,243.72 ","$1,444.32 ","$1,444.32 ","$1,203.60 "
ST MARY'S HOSPITAL,75001224,N/A,HC ENDOSCOPIC PANCREATOSCOPY-43273,750,1 ,"$4,277.00 ","$2,138.50 ","$2,138.50 ","$4,277.00 ", N/A , N/A , N/A , N/A ,"$2,566.20 ","$3,635.45 ","$2,993.90 ", N/A ,"$4,063.15 ","$3,079.44 ","$3,122.21 ", N/A ,"$3,635.45 ", N/A , N/A ,"$3,635.45 ","$3,122.21 ", N/A , N/A , N/A ,"$3,635.45 ", N/A ,"$3,934.84 ","$2,993.90 ","$2,169.29 ","$2,603.41 ","$2,604.69 ","$2,429.76 ","$2,955.41 ","$3,079.44 ","$2,978.93 ", N/A ,"$3,079.44 ", N/A , N/A , N/A , N/A , N/A , N/A ,"$3,079.44 ","$2,651.74 ","$3,079.44 ","$3,079.44 ","$2,566.20 "
ST MARY'S HOSPITAL,76000013,36516,HC IMMUNO COLUMN-2 HOURS,361,1 ,"$5,387.00 ","$2,693.50 ","$1,313.98 ","$8,849.68 ","$1,313.98 ","$5,387.00 ","$5,387.00 ","$3,933.19 ","$3,232.20 ","$4,578.95 ","$3,770.90 ","$1,313.98 ","$5,117.65 ","$3,878.64 ","$3,932.51 ","$5,387.00 ","$4,578.95 ","$3,933.19 ","$5,387.00 ","$4,578.95 ","$3,932.51 ","$1,313.98 ","$3,933.19 ","$5,387.00 ","$4,578.95 ","$8,849.68 ","$4,956.04 ","$3,770.90 ", N/A , N/A ,"$3,280.68 ", N/A ,"$3,722.42 ","$3,878.64 ","$3,752.05 ","$3,972.52 ","$3,878.64 ","$1,392.82 ","$5,387.00 ","$5,387.00 ","$3,933.19 ","$5,387.00 ","$3,933.19 ","$3,878.64 ","$3,339.94 ","$3,878.64 ","$3,878.64 ","$3,232.20 "
ST MARY'S HOSPITAL,76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,185.00 ",$592.50 ,$268.66 ,"$1,389.48 ",$268.66 ,$766.58 ,$766.58 ,$617.55 ,$711.00 ,"$1,007.25 ",$829.50 ,$268.66 ,"$1,125.75 ",$853.20 ,$865.05 ,$770.25 ,"$1,007.25 ",$617.55 ,$770.25 ,"$1,007.25 ",$865.05 ,$268.66 ,$617.55 ,$497.70 ,"$1,007.25 ","$1,389.48 ","$1,090.20 ",$829.50 ,"$1,185.00 ","$1,185.00 ",$721.67 ,"$1,185.00 ",$818.84 ,$853.20 ,$825.35 ,$623.73 ,$853.20 ,$284.78 ,$711.00 ,$711.00 ,$617.55 ,$711.00 ,$617.55 ,$853.20 ,$734.70 ,$853.20 ,$853.20 ,$711.00 
ST MARY'S HOSPITAL,76100001,29700,HC REMOVE/REVISION CAST,761,1 ,$237.00 ,$118.50 ,$59.15 ,$527.88 ,$59.15 ,$237.00 ,$237.00 ,$234.61 ,$142.20 ,$201.45 ,$165.90 ,$59.15 ,$225.15 ,$170.64 ,$173.01 ,$237.00 ,$201.45 ,$234.61 ,$237.00 ,$201.45 ,$173.01 ,$59.15 ,$234.61 ,$99.54 ,$201.45 ,$527.88 ,$218.04 ,$165.90 ,$237.00 ,$237.00 ,$144.33 ,$237.00 ,$163.77 ,$170.64 ,$165.07 ,$236.96 ,$170.64 ,$62.70 ,$142.20 ,$142.20 ,$234.61 ,$142.20 ,$234.61 ,$170.64 ,$146.94 ,$170.64 ,$170.64 ,$142.20 
ST MARY'S HOSPITAL,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 ,$119.52 ,$121.18 ,$107.90 ,$141.10 , N/A ,$107.90 ,$141.10 ,$121.18 , N/A , N/A ,$166.00 ,$141.10 , N/A ,$152.72 ,$116.20 ,$84.20 ,$101.04 ,$101.09 ,$94.30 ,$114.71 ,$119.52 ,$115.62 , N/A ,$119.52 , N/A ,$166.00 ,$166.00 , N/A ,$166.00 , N/A ,$119.52 ,$102.92 ,$119.52 ,$119.52 ,$99.60 
ST MARY'S HOSPITAL,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 ,$149.04 ,$151.11 ,$134.55 ,$175.95 , N/A ,$134.55 ,$175.95 ,$151.11 , N/A , N/A ,$207.00 ,$175.95 , N/A ,$190.44 ,$144.90 ,$104.99 ,$126.00 ,$126.06 ,$117.60 ,$143.04 ,$149.04 ,$144.18 , N/A ,$149.04 , N/A ,$207.00 ,$207.00 , N/A ,$207.00 , N/A ,$149.04 ,$128.34 ,$149.04 ,$149.04 ,$124.20 
ST MARY'S HOSPITAL,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 ,$275.76 ,$279.59 ,$248.95 ,$325.55 , N/A ,$248.95 ,$325.55 ,$279.59 ,$38.23 , N/A ,$383.00 ,$325.55 , N/A ,$352.36 ,$268.10 ,$194.26 ,$233.13 ,$233.25 ,$217.58 ,$264.65 ,$275.76 ,$266.76 , N/A ,$275.76 ,$40.52 ,$383.00 ,$383.00 , N/A ,$383.00 , N/A ,$275.76 ,$237.46 ,$275.76 ,$275.76 ,$229.80 
ST MARY'S HOSPITAL,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 ,$275.76 ,$279.59 ,$248.95 ,$325.55 , N/A ,$248.95 ,$325.55 ,$279.59 , N/A , N/A ,$383.00 ,$325.55 , N/A ,$352.36 ,$268.10 ,$194.26 ,$233.13 ,$233.25 ,$217.58 ,$264.65 ,$275.76 ,$266.76 , N/A ,$275.76 , N/A ,$383.00 ,$383.00 , N/A ,$383.00 , N/A ,$275.76 ,$237.46 ,$275.76 ,$275.76 ,$229.80 
ST MARY'S HOSPITAL,77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$78.00 ,$39.00 ,$12.08 ,$135.67 ,$12.08 ,$50.46 ,$50.46 ,$60.30 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$56.16 ,$56.94 ,$50.70 ,$66.30 ,$60.30 ,$50.70 ,$66.30 ,$56.94 ,$12.08 ,$60.30 ,$32.76 ,$66.30 ,$135.67 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$44.31 ,$53.90 ,$56.16 ,$54.33 ,$60.90 ,$56.16 ,$12.80 , N/A , N/A ,$60.30 , N/A ,$60.30 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,77100001,90471,HC RABIES VACC ADMIN IM,771,1 ,$78.00 ,$39.00 ,$12.08 ,$135.67 ,$12.08 ,$50.46 ,$50.46 ,$60.30 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$56.16 ,$56.94 ,$50.70 ,$66.30 ,$60.30 ,$50.70 ,$66.30 ,$56.94 ,$12.08 ,$60.30 ,$32.76 ,$66.30 ,$135.67 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$44.31 ,$53.90 ,$56.16 ,$54.33 ,$60.90 ,$56.16 ,$12.80 , N/A , N/A ,$60.30 , N/A ,$60.30 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$38.16 ,$38.69 ,$34.45 ,$45.05 , N/A ,$34.45 ,$45.05 ,$38.69 ,$12.08 , N/A ,$22.26 ,$45.05 , N/A ,$48.76 ,$37.10 ,$26.88 ,$32.26 ,$32.28 ,$30.11 ,$36.62 ,$38.16 ,$36.91 , N/A ,$38.16 ,$12.80 , N/A , N/A , N/A , N/A , N/A ,$38.16 ,$32.86 ,$38.16 ,$38.16 ,$31.80 
ST MARY'S HOSPITAL,77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$78.00 ,$39.00 ,$12.08 ,$87.57 ,$12.08 ,$50.46 ,$50.46 ,$38.92 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$56.16 ,$56.94 ,$50.70 ,$66.30 ,$38.92 ,$50.70 ,$66.30 ,$56.94 ,$12.08 ,$38.92 ,$32.76 ,$66.30 ,$87.57 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$44.31 ,$53.90 ,$56.16 ,$54.33 ,$39.31 ,$56.16 ,$12.80 , N/A , N/A ,$38.92 , N/A ,$38.92 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$90.00 ,$45.00 ,$12.08 ,$90.00 ,$12.08 ,$58.22 ,$58.22 ,$38.92 ,$54.00 ,$76.50 ,$63.00 ,$12.08 ,$85.50 ,$64.80 ,$65.70 ,$58.50 ,$76.50 ,$38.92 ,$58.50 ,$76.50 ,$65.70 ,$12.08 ,$38.92 ,$37.80 ,$76.50 ,$87.57 ,$82.80 ,$63.00 ,$45.65 ,$54.78 ,$54.81 ,$51.13 ,$62.19 ,$64.80 ,$62.69 ,$39.31 ,$64.80 ,$12.80 , N/A , N/A ,$38.92 , N/A ,$38.92 ,$64.80 ,$55.80 ,$64.80 ,$64.80 ,$54.00 
ST MARY'S HOSPITAL,77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$78.00 ,$39.00 ,$12.08 ,$87.57 ,$12.08 ,$50.46 ,$50.46 ,$38.92 ,$46.80 ,$66.30 ,$54.60 ,$12.08 ,$74.10 ,$56.16 ,$56.94 ,$50.70 ,$66.30 ,$38.92 ,$50.70 ,$66.30 ,$56.94 ,$12.08 ,$38.92 ,$32.76 ,$66.30 ,$87.57 ,$71.76 ,$54.60 ,$39.56 ,$47.48 ,$47.50 ,$44.31 ,$53.90 ,$56.16 ,$54.33 ,$39.31 ,$56.16 ,$12.80 , N/A , N/A ,$38.92 , N/A ,$38.92 ,$56.16 ,$48.36 ,$56.16 ,$56.16 ,$46.80 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$85.00 ,$73.00 ,$12.08 , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 , N/A ,$72.00 ,$12.80 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$85.00 ,$73.00 ,$12.08 , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 , N/A ,$72.00 ,$12.80 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$85.00 ,$73.00 ,$12.08 , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 , N/A ,$72.00 ,$12.80 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$85.00 ,$73.00 ,$12.08 , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 , N/A ,$72.00 ,$12.80 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$38.09 ,$60.00 ,$85.00 ,$70.00 ,$12.08 ,$95.00 ,$72.00 ,$73.00 ,$65.00 ,$85.00 ,$38.09 ,$65.00 ,$85.00 ,$73.00 ,$12.08 ,$38.09 ,$42.00 ,$85.00 ,$85.70 ,$92.00 ,$70.00 ,$100.00 ,$100.00 ,$60.90 ,$100.00 ,$69.10 ,$72.00 ,$69.65 ,$38.47 ,$72.00 ,$12.80 , N/A , N/A ,$38.09 , N/A ,$38.09 ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$72.00 ,$73.00 ,$65.00 ,$85.00 , N/A ,$65.00 ,$85.00 ,$73.00 ,$13.88 , N/A ,$42.00 ,$85.00 , N/A ,$92.00 ,$70.00 ,$50.72 ,$60.87 ,$60.90 ,$56.81 ,$69.10 ,$72.00 ,$69.65 , N/A ,$72.00 ,$14.71 , N/A , N/A , N/A , N/A , N/A ,$72.00 ,$62.00 ,$72.00 ,$72.00 ,$60.00 
ST MARY'S HOSPITAL,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 ,$180.00 ,$182.50 ,$54.91 ,$212.50 ,$27.59 ,$54.91 ,$212.50 ,$182.50 ,$2.57 ,$27.59 ,$105.00 ,$212.50 ,$62.08 ,$230.00 ,$175.00 ,$126.80 ,$152.18 ,$152.25 ,$142.03 ,$172.75 ,$180.00 ,$174.13 ,$27.87 ,$180.00 ,$2.72 ,$27.00 ,$27.00 ,$27.59 ,$27.00 ,$27.59 ,$180.00 ,$155.00 ,$180.00 ,$180.00 ,$150.00 
ST MARY'S HOSPITAL,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 ,$133.20 ,$135.05 ,$120.25 ,$157.25 , N/A ,$120.25 ,$157.25 ,$135.05 ,$38.23 , N/A ,$77.70 ,$157.25 , N/A ,$170.20 ,$129.50 ,$93.83 ,$112.61 ,$112.67 ,$105.10 ,$127.84 ,$133.20 ,$128.85 , N/A ,$133.20 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$133.20 ,$114.70 ,$133.20 ,$133.20 ,$111.00 
ST MARY'S HOSPITAL,80100001,N/A,HC DIALYSIS-BELLIN/ICU,801,1 ,$730.00 ,$365.00 ,$306.60 ,$730.00 , N/A ,$472.24 ,$472.24 , N/A ,$438.00 ,$620.50 ,$511.00 , N/A ,$693.50 ,$525.60 ,$532.90 ,$474.50 ,$620.50 , N/A ,$474.50 ,$620.50 ,$532.90 , N/A , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 , N/A ,$525.60 , N/A ,$438.00 ,$438.00 , N/A ,$438.00 , N/A ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,80100003,N/A,HC PRISMA HEMOFILTRATION-ICU,801,1 ,"$2,800.00 ","$1,400.00 ","$1,176.00 ","$2,800.00 ", N/A ,"$1,811.32 ","$1,811.32 ", N/A ,"$1,680.00 ","$2,380.00 ","$1,960.00 ", N/A ,"$2,660.00 ","$2,016.00 ","$2,044.00 ","$1,820.00 ","$2,380.00 ", N/A ,"$1,820.00 ","$2,380.00 ","$2,044.00 ", 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 ","$1,590.68 ","$1,934.80 ","$2,016.00 ","$1,950.20 ", N/A ,"$2,016.00 ", N/A ,"$1,680.00 ","$1,680.00 ", N/A ,"$1,680.00 ", N/A ,"$2,016.00 ","$1,736.00 ","$2,016.00 ","$2,016.00 ","$1,680.00 "
ST MARY'S HOSPITAL,80100005,90999,HC RENAL DIALYSIS-ACUTE/ICU,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 ,$525.60 ,$532.90 ,$474.50 ,$620.50 , N/A ,$474.50 ,$620.50 ,$532.90 ,$240.37 , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 , N/A ,$525.60 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 , N/A ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,80100006,90999,HC RENAL DIALYSIS-ACUTE,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 ,$525.60 ,$532.90 ,$474.50 ,$620.50 , N/A ,$474.50 ,$620.50 ,$532.90 ,$240.37 , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 , N/A ,$525.60 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 , N/A ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,80100007,90935,HC HEMODIALYSIS ONE EVALUATION,821,1 ,$730.00 ,$365.00 ,$240.37 ,"$1,433.17 ",$240.37 ,$730.00 ,$730.00 ,$636.96 ,$438.00 ,$620.50 ,$511.00 ,$240.37 ,$693.50 ,$525.60 ,$532.90 ,$474.50 ,$620.50 ,$636.96 ,$474.50 ,$620.50 ,$532.90 ,$240.37 ,$636.96 ,$306.60 ,$620.50 ,"$1,433.17 ",$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 ,$643.33 ,$525.60 ,$254.79 ,$730.00 ,$730.00 ,$636.96 ,$730.00 ,$636.96 ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,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 ,$525.60 ,$532.90 ,$474.50 ,$620.50 , N/A ,$474.50 ,$620.50 ,$532.90 ,$240.37 , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 , N/A ,$525.60 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 , N/A ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,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 ,$525.60 ,$532.90 ,$474.50 ,$620.50 , N/A ,$474.50 ,$620.50 ,$532.90 ,$240.37 , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 , N/A ,$525.60 ,$254.79 ,$438.00 ,$438.00 , N/A ,$438.00 , N/A ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,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 ,$525.60 ,$532.90 ,$474.50 ,$620.50 , N/A ,$474.50 ,$620.50 ,$532.90 ,$240.37 , N/A ,$306.60 ,$620.50 , N/A ,$671.60 ,$511.00 ,$370.26 ,$444.35 ,$444.57 ,$414.71 ,$504.43 ,$525.60 ,$508.45 , N/A ,$525.60 ,$254.79 ,$730.00 ,$730.00 , N/A ,$730.00 , N/A ,$525.60 ,$452.60 ,$525.60 ,$525.60 ,$438.00 
ST MARY'S HOSPITAL,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 ,$60.48 ,$61.32 ,$76.89 ,$71.40 ,$35.33 ,$76.89 ,$71.40 ,$61.32 ,$35.33 ,$35.33 ,$39.99 ,$71.40 ,$79.49 ,$77.28 ,$58.80 ,$84.00 ,$84.00 ,$51.16 ,$84.00 ,$58.04 ,$60.48 ,$58.51 ,$35.68 ,$60.48 ,$37.45 ,$54.44 ,$54.44 ,$35.33 ,$54.44 ,$35.33 ,$60.48 ,$52.08 ,$60.48 ,$60.48 ,$50.40 
ST MARY'S HOSPITAL,92000001,59020,HC TEST STRESS FETAL,920,1 ,$539.00 ,$269.50 ,$57.86 ,$539.00 ,$57.86 ,$348.68 ,$348.68 ,$165.68 ,$323.40 ,$458.15 ,$377.30 ,$57.86 ,$512.05 ,$388.08 ,$393.47 ,$350.35 ,$458.15 ,$165.68 ,$350.35 ,$458.15 ,$393.47 ,$57.86 ,$165.68 ,$305.48 ,$458.15 ,$372.78 ,$495.88 ,$377.30 ,$273.38 ,$328.09 ,$328.25 ,$306.21 ,$372.45 ,$388.08 ,$375.41 ,$167.34 ,$388.08 ,$61.33 ,$449.00 ,$449.00 ,$165.68 ,$449.00 ,$165.68 ,$388.08 ,$334.18 ,$388.08 ,$388.08 ,$323.40 
ST MARY'S HOSPITAL,92000002,59025,HC TEST NON STRESS FETAL,920,1 ,$452.00 ,$226.00 ,$57.86 ,$452.00 ,$57.86 ,$292.40 ,$292.40 ,$165.68 ,$271.20 ,$384.20 ,$316.40 ,$57.86 ,$429.40 ,$325.44 ,$329.96 ,$293.80 ,$384.20 ,$165.68 ,$293.80 ,$384.20 ,$329.96 ,$57.86 ,$165.68 ,$305.48 ,$384.20 ,$372.78 ,$415.84 ,$316.40 ,$229.25 ,$275.13 ,$275.27 ,$256.78 ,$312.33 ,$325.44 ,$314.82 ,$167.34 ,$325.44 ,$61.33 ,$449.00 ,$449.00 ,$165.68 ,$449.00 ,$165.68 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$271.20 
ST MARY'S HOSPITAL,92000003,93786,HC AMBUL BLOOD PRESS MONITR,920,1 ,$258.00 ,$129.00 ,$21.45 ,$258.00 ,$21.45 ,$166.90 ,$166.90 ,$109.66 ,$154.80 ,$219.30 ,$180.60 ,$21.45 ,$245.10 ,$185.76 ,$188.34 ,$167.70 ,$219.30 ,$109.66 ,$167.70 ,$219.30 ,$188.34 ,$21.45 ,$109.66 ,$258.00 ,$219.30 ,$246.74 ,$237.36 ,$180.60 ,$130.86 ,$157.04 ,$157.12 ,$146.57 ,$178.28 ,$185.76 ,$179.70 ,$110.76 ,$185.76 ,$22.74 ,$258.00 ,$258.00 ,$109.66 ,$258.00 ,$109.66 ,$185.76 ,$159.96 ,$185.76 ,$185.76 ,$154.80 
ST MARY'S HOSPITAL,92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,200.00 ",$600.00 ,$52.74 ,"$1,200.00 ",$52.74 ,$776.28 ,$776.28 ,$223.78 ,$720.00 ,"$1,020.00 ",$840.00 ,$52.74 ,"$1,140.00 ",$864.00 ,$876.00 ,$780.00 ,"$1,020.00 ",$223.78 ,$780.00 ,"$1,020.00 ",$876.00 ,$52.74 ,$223.78 ,$305.48 ,"$1,020.00 ",$503.50 ,"$1,104.00 ",$840.00 ,$608.64 ,$730.44 ,$730.80 ,$681.72 ,$829.20 ,$864.00 ,$835.80 ,$226.02 ,$864.00 ,$55.90 ,$465.00 ,$465.00 ,$223.78 ,$465.00 ,$223.78 ,$864.00 ,$744.00 ,$864.00 ,$864.00 ,$720.00 
ST MARY'S HOSPITAL,92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,$590.00 ,$295.00 ,$34.74 ,$590.00 ,$34.74 ,$381.67 ,$381.67 ,$105.88 ,$354.00 ,$501.50 ,$413.00 ,$34.74 ,$560.50 ,$424.80 ,$430.70 ,$383.50 ,$501.50 ,$105.88 ,$383.50 ,$501.50 ,$430.70 ,$34.74 ,$105.88 ,$305.48 ,$501.50 ,$238.23 ,$542.80 ,$413.00 ,$299.25 ,$359.13 ,$359.31 ,$335.18 ,$407.69 ,$424.80 ,$410.94 ,$106.94 ,$424.80 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$424.80 ,$365.80 ,$424.80 ,$424.80 ,$354.00 
ST MARY'S HOSPITAL,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$54.83 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$347.04 ,$351.86 ,$313.30 ,$409.70 ,$54.83 ,$313.30 ,$409.70 ,$351.86 ,$34.74 ,$54.83 ,$305.48 ,$409.70 ,$123.37 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$273.82 ,$333.06 ,$347.04 ,$335.71 ,$55.38 ,$347.04 ,$36.82 ,$465.00 ,$465.00 ,$54.83 ,$465.00 ,$54.83 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$482.00 ,$241.00 ,$34.74 ,$482.00 ,$34.74 ,$311.81 ,$311.81 ,$54.83 ,$289.20 ,$409.70 ,$337.40 ,$34.74 ,$457.90 ,$347.04 ,$351.86 ,$313.30 ,$409.70 ,$54.83 ,$313.30 ,$409.70 ,$351.86 ,$34.74 ,$54.83 ,$305.48 ,$409.70 ,$123.37 ,$443.44 ,$337.40 ,$244.47 ,$293.39 ,$293.54 ,$273.82 ,$333.06 ,$347.04 ,$335.71 ,$55.38 ,$347.04 ,$36.82 ,$465.00 ,$465.00 ,$54.83 ,$465.00 ,$54.83 ,$347.04 ,$298.84 ,$347.04 ,$347.04 ,$289.20 
ST MARY'S HOSPITAL,92100023,93923,HC TCPO2/ABI/PPG MULT LEVELS,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$135.78 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$491.76 ,$498.59 ,$443.95 ,$580.55 ,$135.78 ,$443.95 ,$580.55 ,$498.59 ,$52.64 ,$135.78 ,$305.48 ,$580.55 ,$305.50 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$388.01 ,$471.95 ,$491.76 ,$475.71 ,$137.14 ,$491.76 ,$55.80 ,$465.00 ,$465.00 ,$135.78 ,$465.00 ,$135.78 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$135.78 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$491.76 ,$498.59 ,$443.95 ,$580.55 ,$135.78 ,$443.95 ,$580.55 ,$498.59 ,$52.64 ,$135.78 ,$305.48 ,$580.55 ,$305.50 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$388.01 ,$471.95 ,$491.76 ,$475.71 ,$137.14 ,$491.76 ,$55.80 ,$465.00 ,$465.00 ,$135.78 ,$465.00 ,$135.78 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,$683.00 ,$341.50 ,$52.64 ,$683.00 ,$52.64 ,$441.83 ,$441.83 ,$135.78 ,$409.80 ,$580.55 ,$478.10 ,$52.64 ,$648.85 ,$491.76 ,$498.59 ,$443.95 ,$580.55 ,$135.78 ,$443.95 ,$580.55 ,$498.59 ,$52.64 ,$135.78 ,$305.48 ,$580.55 ,$305.50 ,$628.36 ,$478.10 ,$346.42 ,$415.74 ,$415.95 ,$388.01 ,$471.95 ,$491.76 ,$475.71 ,$137.14 ,$491.76 ,$55.80 ,$465.00 ,$465.00 ,$135.78 ,$465.00 ,$135.78 ,$491.76 ,$423.46 ,$491.76 ,$491.76 ,$409.80 
ST MARY'S HOSPITAL,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 ,$257.38 ,$739.20 ,"$1,047.20 ",$862.40 ,$34.74 ,"$1,170.40 ",$887.04 ,$899.36 ,$800.80 ,"$1,047.20 ",$257.38 ,$800.80 ,"$1,047.20 ",$899.36 ,$34.74 ,$257.38 ,$305.48 ,"$1,047.20 ",$579.11 ,"$1,133.44 ",$862.40 ,$624.87 ,$749.92 ,$750.29 ,$699.90 ,$851.31 ,$887.04 ,$858.09 ,$259.95 ,$887.04 ,$36.82 ,$465.00 ,$465.00 ,$257.38 ,$465.00 ,$257.38 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,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 ,$223.78 ,$840.00 ,"$1,190.00 ",$980.00 ,$52.74 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$910.00 ,"$1,190.00 ",$223.78 ,$910.00 ,"$1,190.00 ","$1,022.00 ",$52.74 ,$223.78 ,$305.48 ,"$1,190.00 ",$503.50 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$795.34 ,$967.40 ,"$1,008.00 ",$975.10 ,$226.02 ,"$1,008.00 ",$55.90 ,$465.00 ,$465.00 ,$223.78 ,$465.00 ,$223.78 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$504.00 ,$714.00 ,$588.00 ,$34.74 ,$798.00 ,$604.80 ,$613.20 ,$546.00 ,$714.00 ,$105.88 ,$546.00 ,$714.00 ,$613.20 ,$34.74 ,$105.88 ,$305.48 ,$714.00 ,$238.23 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$477.20 ,$580.44 ,$604.80 ,$585.06 ,$106.94 ,$604.80 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$504.00 ,$714.00 ,$588.00 ,$34.74 ,$798.00 ,$604.80 ,$613.20 ,$546.00 ,$714.00 ,$105.88 ,$546.00 ,$714.00 ,$613.20 ,$34.74 ,$105.88 ,$305.48 ,$714.00 ,$238.23 ,$772.80 ,$588.00 ,$426.05 ,$511.31 ,$511.56 ,$477.20 ,$580.44 ,$604.80 ,$585.06 ,$106.94 ,$604.80 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$604.80 ,$520.80 ,$604.80 ,$604.80 ,$504.00 
ST MARY'S HOSPITAL,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 ,$223.78 ,$660.00 ,$935.00 ,$770.00 ,$34.74 ,"$1,045.00 ",$792.00 ,$803.00 ,$715.00 ,$935.00 ,$223.78 ,$715.00 ,$935.00 ,$803.00 ,$34.74 ,$223.78 ,$305.48 ,$935.00 ,$503.50 ,"$1,012.00 ",$770.00 ,$557.92 ,$669.57 ,$669.90 ,$624.91 ,$760.10 ,$792.00 ,$766.15 ,$226.02 ,$792.00 ,$36.82 ,$465.00 ,$465.00 ,$223.78 ,$465.00 ,$223.78 ,$792.00 ,$682.00 ,$792.00 ,$792.00 ,$660.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$456.00 ,$646.00 ,$532.00 ,$34.74 ,$722.00 ,$547.20 ,$554.80 ,$494.00 ,$646.00 ,$105.88 ,$494.00 ,$646.00 ,$554.80 ,$34.74 ,$105.88 ,$305.48 ,$646.00 ,$238.23 ,$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$431.76 ,$525.16 ,$547.20 ,$529.34 ,$106.94 ,$547.20 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$456.00 ,$646.00 ,$532.00 ,$34.74 ,$722.00 ,$547.20 ,$554.80 ,$494.00 ,$646.00 ,$105.88 ,$494.00 ,$646.00 ,$554.80 ,$34.74 ,$105.88 ,$305.48 ,$646.00 ,$238.23 ,$699.20 ,$532.00 ,$385.47 ,$462.61 ,$462.84 ,$431.76 ,$525.16 ,$547.20 ,$529.34 ,$106.94 ,$547.20 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$547.20 ,$471.20 ,$547.20 ,$547.20 ,$456.00 
ST MARY'S HOSPITAL,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 ,$223.78 ,$840.00 ,"$1,190.00 ",$980.00 ,$52.74 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$910.00 ,"$1,190.00 ",$223.78 ,$910.00 ,"$1,190.00 ","$1,022.00 ",$52.74 ,$223.78 ,$305.48 ,"$1,190.00 ",$503.50 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$795.34 ,$967.40 ,"$1,008.00 ",$975.10 ,$226.02 ,"$1,008.00 ",$55.90 ,$465.00 ,$465.00 ,$223.78 ,$465.00 ,$223.78 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,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 ,$223.78 ,$840.00 ,"$1,190.00 ",$980.00 ,$52.74 ,"$1,330.00 ","$1,008.00 ","$1,022.00 ",$910.00 ,"$1,190.00 ",$223.78 ,$910.00 ,"$1,190.00 ","$1,022.00 ",$52.74 ,$223.78 ,$305.48 ,"$1,190.00 ",$503.50 ,"$1,288.00 ",$980.00 ,$710.08 ,$852.18 ,$852.60 ,$795.34 ,$967.40 ,"$1,008.00 ",$975.10 ,$226.02 ,"$1,008.00 ",$55.90 ,$465.00 ,$465.00 ,$223.78 ,$465.00 ,$223.78 ,"$1,008.00 ",$868.00 ,"$1,008.00 ","$1,008.00 ",$840.00 
ST MARY'S HOSPITAL,92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,$860.00 ,$430.00 ,$34.74 ,$860.00 ,$34.74 ,$556.33 ,$556.33 ,$105.88 ,$516.00 ,$731.00 ,$602.00 ,$34.74 ,$817.00 ,$619.20 ,$627.80 ,$559.00 ,$731.00 ,$105.88 ,$559.00 ,$731.00 ,$627.80 ,$34.74 ,$105.88 ,$305.48 ,$731.00 ,$238.23 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$488.57 ,$594.26 ,$619.20 ,$598.99 ,$106.94 ,$619.20 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$516.00 
ST MARY'S HOSPITAL,92100044,93971,HC VENOUS REFLUX ASSESSMENT UNILAT,921,1 ,$860.00 ,$430.00 ,$34.74 ,$860.00 ,$34.74 ,$556.33 ,$556.33 ,$105.88 ,$516.00 ,$731.00 ,$602.00 ,$34.74 ,$817.00 ,$619.20 ,$627.80 ,$559.00 ,$731.00 ,$105.88 ,$559.00 ,$731.00 ,$627.80 ,$34.74 ,$105.88 ,$305.48 ,$731.00 ,$238.23 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$488.57 ,$594.26 ,$619.20 ,$598.99 ,$106.94 ,$619.20 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$516.00 
ST MARY'S HOSPITAL,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 ,$105.88 ,$516.00 ,$731.00 ,$602.00 ,$34.74 ,$817.00 ,$619.20 ,$627.80 ,$559.00 ,$731.00 ,$105.88 ,$559.00 ,$731.00 ,$627.80 ,$34.74 ,$105.88 ,$305.48 ,$731.00 ,$238.23 ,$791.20 ,$602.00 ,$436.19 ,$523.48 ,$523.74 ,$488.57 ,$594.26 ,$619.20 ,$598.99 ,$106.94 ,$619.20 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$619.20 ,$533.20 ,$619.20 ,$619.20 ,$516.00 
ST MARY'S HOSPITAL,92100046,93990,HC DUPLEX HEMODIALYSIS ACCESS,921,1 ,$700.00 ,$350.00 ,$34.74 ,$700.00 ,$34.74 ,$452.83 ,$452.83 ,$105.88 ,$420.00 ,$595.00 ,$490.00 ,$34.74 ,$665.00 ,$504.00 ,$511.00 ,$455.00 ,$595.00 ,$105.88 ,$455.00 ,$595.00 ,$511.00 ,$34.74 ,$105.88 ,$305.48 ,$595.00 ,$238.23 ,$644.00 ,$490.00 ,$355.04 ,$426.09 ,$426.30 ,$397.67 ,$483.70 ,$504.00 ,$487.55 ,$106.94 ,$504.00 ,$36.82 ,$465.00 ,$465.00 ,$105.88 ,$465.00 ,$105.88 ,$504.00 ,$434.00 ,$504.00 ,$504.00 ,$420.00 
ST MARY'S HOSPITAL,92200000,95860,HC EMG ONE EXTREMITY,922,1 ,$452.00 ,$226.00 ,$42.84 ,$452.00 ,$42.84 ,$292.40 ,$292.40 ,$109.66 ,$271.20 ,$384.20 ,$316.40 ,$42.84 ,$429.40 ,$325.44 ,$329.96 ,$293.80 ,$384.20 ,$109.66 ,$293.80 ,$384.20 ,$329.96 ,$42.84 ,$109.66 ,$257.96 ,$384.20 ,$246.74 ,$415.84 ,$316.40 ,$229.25 ,$275.13 ,$275.27 ,$256.78 ,$312.33 ,$325.44 ,$314.82 ,$110.76 ,$325.44 ,$45.41 ,$452.00 ,$452.00 ,$109.66 ,$452.00 ,$109.66 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$271.20 
ST MARY'S HOSPITAL,92200001,95861,HC EMG TWO EXTREMITIES,922,1 ,$582.00 ,$291.00 ,$42.84 ,$582.00 ,$42.84 ,$376.50 ,$376.50 ,$109.66 ,$349.20 ,$494.70 ,$407.40 ,$42.84 ,$552.90 ,$419.04 ,$424.86 ,$378.30 ,$494.70 ,$109.66 ,$378.30 ,$494.70 ,$424.86 ,$42.84 ,$109.66 ,$257.96 ,$494.70 ,$246.74 ,$535.44 ,$407.40 ,$295.19 ,$354.26 ,$354.44 ,$330.63 ,$402.16 ,$419.04 ,$405.36 ,$110.76 ,$419.04 ,$45.41 ,$582.00 ,$582.00 ,$109.66 ,$582.00 ,$109.66 ,$419.04 ,$360.84 ,$419.04 ,$419.04 ,$349.20 
ST MARY'S HOSPITAL,92200002,95863,HC EMG THREE EXTREMITIES,922,1 ,$646.00 ,$323.00 ,$42.84 ,$646.00 ,$42.84 ,$417.90 ,$417.90 ,$135.78 ,$387.60 ,$549.10 ,$452.20 ,$42.84 ,$613.70 ,$465.12 ,$471.58 ,$419.90 ,$549.10 ,$135.78 ,$419.90 ,$549.10 ,$471.58 ,$42.84 ,$135.78 ,$257.96 ,$549.10 ,$305.50 ,$594.32 ,$452.20 ,$327.65 ,$393.22 ,$393.41 ,$366.99 ,$446.39 ,$465.12 ,$449.94 ,$137.14 ,$465.12 ,$45.41 ,$646.00 ,$646.00 ,$135.78 ,$646.00 ,$135.78 ,$465.12 ,$400.52 ,$465.12 ,$465.12 ,$387.60 
ST MARY'S HOSPITAL,92200003,95867,HC EMG CRANIAL NERVE UNI,922,1 ,$452.00 ,$226.00 ,$42.84 ,$579.11 ,$42.84 ,$292.40 ,$292.40 ,$257.38 ,$271.20 ,$384.20 ,$316.40 ,$42.84 ,$429.40 ,$325.44 ,$329.96 ,$293.80 ,$384.20 ,$257.38 ,$293.80 ,$384.20 ,$329.96 ,$42.84 ,$257.38 ,$257.96 ,$384.20 ,$579.11 ,$415.84 ,$316.40 ,$229.25 ,$275.13 ,$275.27 ,$256.78 ,$312.33 ,$325.44 ,$314.82 ,$259.95 ,$325.44 ,$45.41 ,$452.00 ,$452.00 ,$257.38 ,$452.00 ,$257.38 ,$325.44 ,$280.24 ,$325.44 ,$325.44 ,$271.20 
ST MARY'S HOSPITAL,92200011,95886,HC EMG ADD ON >5 MUSCLES,922,1 ,$246.00 ,$123.00 ,$42.84 ,$246.00 ,$42.84 ,$159.14 ,$159.14 , N/A ,$147.60 ,$209.10 ,$172.20 ,$42.84 ,$233.70 ,$177.12 ,$179.58 ,$159.90 ,$209.10 , N/A ,$159.90 ,$209.10 ,$179.58 ,$42.84 , N/A ,$246.00 ,$209.10 , N/A ,$226.32 ,$172.20 ,$124.77 ,$149.74 ,$149.81 ,$139.75 ,$169.99 ,$177.12 ,$171.34 , N/A ,$177.12 ,$45.41 ,$246.00 ,$246.00 , N/A ,$246.00 , N/A ,$177.12 ,$152.52 ,$177.12 ,$177.12 ,$147.60 
ST MARY'S HOSPITAL,92200012,95864,HC EMG 4 EXTREMITIES,922,1 ,$776.00 ,$388.00 ,$42.84 ,$776.00 ,$42.84 ,$501.99 ,$501.99 ,$135.78 ,$465.60 ,$659.60 ,$543.20 ,$42.84 ,$737.20 ,$558.72 ,$566.48 ,$504.40 ,$659.60 ,$135.78 ,$504.40 ,$659.60 ,$566.48 ,$42.84 ,$135.78 ,$257.96 ,$659.60 ,$305.50 ,$713.92 ,$543.20 ,$393.59 ,$472.35 ,$472.58 ,$440.85 ,$536.22 ,$558.72 ,$540.48 ,$137.14 ,$558.72 ,$45.41 ,$776.00 ,$776.00 ,$135.78 ,$776.00 ,$135.78 ,$558.72 ,$481.12 ,$558.72 ,$558.72 ,$465.60 
ST MARY'S HOSPITAL,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 ",$474.72 ,"$1,008.00 ","$1,428.00 ","$1,176.00 ",$42.84 ,"$1,596.00 ","$1,209.60 ","$1,226.40 ","$1,092.00 ","$1,428.00 ",$474.72 ,"$1,092.00 ","$1,428.00 ","$1,226.40 ",$42.84 ,$474.72 ,$257.96 ,"$1,428.00 ","$1,068.12 ","$1,545.60 ","$1,176.00 ",$852.10 ,"$1,022.62 ","$1,023.12 ",$954.41 ,"$1,160.88 ","$1,209.60 ","$1,170.12 ",$479.47 ,"$1,209.60 ",$45.41 ,$812.00 ,$812.00 ,$474.72 ,$812.00 ,$474.72 ,"$1,209.60 ","$1,041.60 ","$1,209.60 ","$1,209.60 ","$1,008.00 "
ST MARY'S HOSPITAL,92200016,95885,HC EMG ADD ON <5 MUSCLES,922,1 ,$190.00 ,$95.00 ,$42.84 ,$190.00 ,$42.84 ,$122.91 ,$122.91 , N/A ,$114.00 ,$161.50 ,$133.00 ,$42.84 ,$180.50 ,$136.80 ,$138.70 ,$123.50 ,$161.50 , N/A ,$123.50 ,$161.50 ,$138.70 ,$42.84 , N/A ,$190.00 ,$161.50 , N/A ,$174.80 ,$133.00 ,$96.37 ,$115.65 ,$115.71 ,$107.94 ,$131.29 ,$136.80 ,$132.34 , N/A ,$136.80 ,$45.41 ,$190.00 ,$190.00 , N/A ,$190.00 , N/A ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,92200017,95887,HC EMG ADD ON CRANIAL,922,1 ,$190.00 ,$95.00 ,$42.84 ,$190.00 ,$42.84 ,$122.91 ,$122.91 , N/A ,$114.00 ,$161.50 ,$133.00 ,$42.84 ,$180.50 ,$136.80 ,$138.70 ,$123.50 ,$161.50 , N/A ,$123.50 ,$161.50 ,$138.70 ,$42.84 , N/A ,$190.00 ,$161.50 , N/A ,$174.80 ,$133.00 ,$96.37 ,$115.65 ,$115.71 ,$107.94 ,$131.29 ,$136.80 ,$132.34 , N/A ,$136.80 ,$45.41 ,$190.00 ,$190.00 , N/A ,$190.00 , N/A ,$136.80 ,$117.80 ,$136.80 ,$136.80 ,$114.00 
ST MARY'S HOSPITAL,92200021,95907,HC NVR CNDJ TST 1-2 STUDIES,922,1 ,$403.00 ,$201.50 ,$42.84 ,$403.00 ,$42.84 ,$260.70 ,$260.70 ,$135.78 ,$241.80 ,$342.55 ,$282.10 ,$42.84 ,$382.85 ,$290.16 ,$294.19 ,$261.95 ,$342.55 ,$135.78 ,$261.95 ,$342.55 ,$294.19 ,$42.84 ,$135.78 ,$257.96 ,$342.55 ,$305.50 ,$370.76 ,$282.10 ,$204.40 ,$245.31 ,$245.43 ,$228.94 ,$278.47 ,$290.16 ,$280.69 ,$137.14 ,$290.16 ,$45.41 ,$403.00 ,$403.00 ,$135.78 ,$403.00 ,$135.78 ,$290.16 ,$249.86 ,$290.16 ,$290.16 ,$241.80 
ST MARY'S HOSPITAL,92200022,95908,HC NVR CNDJ TST 3-4 STUDIES,922,1 ,$638.00 ,$319.00 ,$42.84 ,$638.00 ,$42.84 ,$412.72 ,$412.72 ,$257.38 ,$382.80 ,$542.30 ,$446.60 ,$42.84 ,$606.10 ,$459.36 ,$465.74 ,$414.70 ,$542.30 ,$257.38 ,$414.70 ,$542.30 ,$465.74 ,$42.84 ,$257.38 ,$257.96 ,$542.30 ,$579.11 ,$586.96 ,$446.60 ,$323.59 ,$388.35 ,$388.54 ,$362.45 ,$440.86 ,$459.36 ,$444.37 ,$259.95 ,$459.36 ,$45.41 ,$638.00 ,$638.00 ,$257.38 ,$638.00 ,$257.38 ,$459.36 ,$395.56 ,$459.36 ,$459.36 ,$382.80 
ST MARY'S HOSPITAL,92200023,95909,HC NVR CNDJ TST 5-6 STUDIES,922,1 ,$885.00 ,$442.50 ,$42.84 ,$885.00 ,$42.84 ,$572.51 ,$572.51 ,$257.38 ,$531.00 ,$752.25 ,$619.50 ,$42.84 ,$840.75 ,$637.20 ,$646.05 ,$575.25 ,$752.25 ,$257.38 ,$575.25 ,$752.25 ,$646.05 ,$42.84 ,$257.38 ,$257.96 ,$752.25 ,$579.11 ,$814.20 ,$619.50 ,$448.87 ,$538.70 ,$538.97 ,$502.77 ,$611.54 ,$637.20 ,$616.40 ,$259.95 ,$637.20 ,$45.41 ,$812.00 ,$812.00 ,$257.38 ,$812.00 ,$257.38 ,$637.20 ,$548.70 ,$637.20 ,$637.20 ,$531.00 
ST MARY'S HOSPITAL,92200024,95910,HC NVR CNDJ TST 7-8 STUDIES,922,1 ,"$1,232.00 ",$616.00 ,$42.84 ,"$1,232.00 ",$42.84 ,$796.98 ,$796.98 ,$257.38 ,$739.20 ,"$1,047.20 ",$862.40 ,$42.84 ,"$1,170.40 ",$887.04 ,$899.36 ,$800.80 ,"$1,047.20 ",$257.38 ,$800.80 ,"$1,047.20 ",$899.36 ,$42.84 ,$257.38 ,$257.96 ,"$1,047.20 ",$579.11 ,"$1,133.44 ",$862.40 ,$624.87 ,$749.92 ,$750.29 ,$699.90 ,$851.31 ,$887.04 ,$858.09 ,$259.95 ,$887.04 ,$45.41 ,$812.00 ,$812.00 ,$257.38 ,$812.00 ,$257.38 ,$887.04 ,$763.84 ,$887.04 ,$887.04 ,$739.20 
ST MARY'S HOSPITAL,92200025,95911,HC NVR CNDJ TST 9-10 STUDIES,922,1 ,"$2,240.00 ","$1,120.00 ",$42.84 ,"$2,240.00 ",$42.84 ,"$1,449.06 ","$1,449.06 ",$474.72 ,"$1,344.00 ","$1,904.00 ","$1,568.00 ",$42.84 ,"$2,128.00 ","$1,612.80 ","$1,635.20 ","$1,456.00 ","$1,904.00 ",$474.72 ,"$1,456.00 ","$1,904.00 ","$1,635.20 ",$42.84 ,$474.72 ,$257.96 ,"$1,904.00 ","$1,068.12 ","$2,060.80 ","$1,568.00 ","$1,136.13 ","$1,363.49 ","$1,364.16 ","$1,272.54 ","$1,547.84 ","$1,612.80 ","$1,560.16 ",$479.47 ,"$1,612.80 ",$45.41 ,$812.00 ,$812.00 ,$474.72 ,$812.00 ,$474.72 ,"$1,612.80 ","$1,388.80 ","$1,612.80 ","$1,612.80 ","$1,344.00 "
ST MARY'S HOSPITAL,92200026,95912,HC NVR CNDJ TST 11-12 STUDIES,922,1 ,"$3,024.00 ","$1,512.00 ",$42.84 ,"$3,024.00 ",$42.84 ,"$1,956.23 ","$1,956.23 ",$474.72 ,"$1,814.40 ","$2,570.40 ","$2,116.80 ",$42.84 ,"$2,872.80 ","$2,177.28 ","$2,207.52 ","$1,965.60 ","$2,570.40 ",$474.72 ,"$1,965.60 ","$2,570.40 ","$2,207.52 ",$42.84 ,$474.72 ,$257.96 ,"$2,570.40 ","$1,068.12 ","$2,782.08 ","$2,116.80 ","$1,533.77 ","$1,840.71 ","$1,841.62 ","$1,717.93 ","$2,089.58 ","$2,177.28 ","$2,106.22 ",$479.47 ,"$2,177.28 ",$45.41 ,$812.00 ,$812.00 ,$474.72 ,$812.00 ,$474.72 ,"$2,177.28 ","$1,874.88 ","$2,177.28 ","$2,177.28 ","$1,814.40 "
ST MARY'S HOSPITAL,92200027,95913,HC NVR CNDJ TST 13 AND > STUDIES,922,1 ,"$2,688.00 ","$1,344.00 ",$42.84 ,"$2,688.00 ",$42.84 ,"$1,738.87 ","$1,738.87 ",$474.72 ,"$1,612.80 ","$2,284.80 ","$1,881.60 ",$42.84 ,"$2,553.60 ","$1,935.36 ","$1,962.24 ","$1,747.20 ","$2,284.80 ",$474.72 ,"$1,747.20 ","$2,284.80 ","$1,962.24 ",$42.84 ,$474.72 ,$257.96 ,"$2,284.80 ","$1,068.12 ","$2,472.96 ","$1,881.60 ","$1,363.35 ","$1,636.19 ","$1,636.99 ","$1,527.05 ","$1,857.41 ","$1,935.36 ","$1,872.19 ",$479.47 ,"$1,935.36 ",$45.41 ,$812.00 ,$812.00 ,$474.72 ,$812.00 ,$474.72 ,"$1,935.36 ","$1,666.56 ","$1,935.36 ","$1,935.36 ","$1,612.80 "
ST MARY'S HOSPITAL,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 ,$36.21 ,$69.60 ,$98.60 ,$81.20 ,$12.10 ,$110.20 ,$83.52 ,$84.68 ,$75.40 ,$98.60 ,$36.21 ,$75.40 ,$98.60 ,$84.68 ,$12.10 ,$36.21 ,$116.00 ,$98.60 ,$81.48 ,$106.72 ,$81.20 ,$58.84 ,$70.61 ,$70.64 ,$65.90 ,$80.16 ,$83.52 ,$80.79 ,$36.57 ,$83.52 ,$12.83 ,$116.00 ,$116.00 ,$36.21 ,$116.00 ,$36.21 ,$83.52 ,$71.92 ,$83.52 ,$83.52 ,$69.60 
ST MARY'S HOSPITAL,94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$248.00 ,$124.00 ,$18.43 ,$248.00 ,$18.43 ,$160.43 ,$160.43 ,$109.66 ,$148.80 ,$210.80 ,$173.60 ,$18.43 ,$235.60 ,$178.56 ,$181.04 ,$161.20 ,$210.80 ,$109.66 ,$161.20 ,$210.80 ,$181.04 ,$18.43 ,$109.66 ,$216.10 ,$210.80 ,$246.74 ,$228.16 ,$173.60 ,$125.79 ,$150.96 ,$151.03 ,$140.89 ,$171.37 ,$178.56 ,$172.73 ,$110.76 ,$178.56 ,$19.54 ,$219.00 ,$219.00 ,$109.66 ,$219.00 ,$109.66 ,$178.56 ,$153.76 ,$178.56 ,$178.56 ,$148.80 
ST MARY'S HOSPITAL,94200008,99406,HC SMOKING CESSATION PULM 3-10MIN,942,1 ,$43.00 ,$21.50 ,$7.57 ,$57.51 ,$7.57 ,$27.82 ,$27.82 ,$25.56 ,$25.80 ,$36.55 ,$30.10 ,$7.57 ,$40.85 ,$30.96 ,$31.39 ,$27.95 ,$36.55 ,$25.56 ,$27.95 ,$36.55 ,$31.39 ,$7.57 ,$25.56 ,$43.00 ,$36.55 ,$57.51 ,$39.56 ,$30.10 ,$21.81 ,$26.17 ,$26.19 ,$24.43 ,$29.71 ,$30.96 ,$29.95 ,$25.82 ,$30.96 ,$8.02 ,$43.00 ,$43.00 ,$25.56 ,$43.00 ,$25.56 ,$30.96 ,$26.66 ,$30.96 ,$30.96 ,$25.80 
ST MARY'S HOSPITAL,94200009,99407,HC SMOKING CESSATION PULM >10 MIN,942,1 ,$62.00 ,$31.00 ,$7.57 ,$62.00 ,$7.57 ,$40.11 ,$40.11 ,$25.56 ,$37.20 ,$52.70 ,$43.40 ,$7.57 ,$58.90 ,$44.64 ,$45.26 ,$40.30 ,$52.70 ,$25.56 ,$40.30 ,$52.70 ,$45.26 ,$7.57 ,$25.56 ,$62.00 ,$52.70 ,$57.51 ,$57.04 ,$43.40 ,$31.45 ,$37.74 ,$37.76 ,$35.22 ,$42.84 ,$44.64 ,$43.18 ,$25.82 ,$44.64 ,$8.02 ,$62.00 ,$62.00 ,$25.56 ,$62.00 ,$25.56 ,$44.64 ,$38.44 ,$44.64 ,$44.64 ,$37.20 
ST MARY'S HOSPITAL,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 ,$112.89 ,$228.60 ,$323.85 ,$266.70 ,$47.12 ,$361.95 ,$274.32 ,$278.13 ,$247.65 ,$323.85 ,$112.89 ,$247.65 ,$323.85 ,$278.13 ,$47.12 ,$112.89 ,$130.11 ,$323.85 ,$254.00 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$216.45 ,$263.27 ,$274.32 ,$265.37 ,$114.02 ,$274.32 ,$49.95 ,$381.00 ,$381.00 ,$112.89 ,$381.00 ,$112.89 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$228.60 
ST MARY'S HOSPITAL,94300006,93798,HC CARDIAC REHAB W/EKG SESSION (LV1),943,1 ,$381.00 ,$190.50 ,$47.12 ,$381.00 ,$47.12 ,$381.00 ,$381.00 ,$112.89 ,$228.60 ,$323.85 ,$266.70 ,$47.12 ,$361.95 ,$274.32 ,$278.13 ,$247.65 ,$323.85 ,$112.89 ,$247.65 ,$323.85 ,$278.13 ,$47.12 ,$112.89 ,$130.11 ,$323.85 ,$254.00 ,$350.52 ,$266.70 ,$193.24 ,$231.91 ,$232.03 ,$216.45 ,$263.27 ,$274.32 ,$265.37 ,$114.02 ,$274.32 ,$49.95 ,$381.00 ,$381.00 ,$112.89 ,$381.00 ,$112.89 ,$274.32 ,$236.22 ,$274.32 ,$274.32 ,$228.60 
ST MARY'S HOSPITAL,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 ,$54.13 ,$97.20 ,$137.70 ,$113.40 ,$11.17 ,$153.90 ,$116.64 ,$118.26 ,$105.30 ,$137.70 ,$54.13 ,$105.30 ,$137.70 ,$118.26 ,$11.17 ,$54.13 ,$68.04 ,$137.70 ,$121.80 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$92.03 ,$111.94 ,$116.64 ,$112.83 ,$54.67 ,$116.64 ,$11.84 ,$81.00 ,$81.00 ,$54.13 ,$81.00 ,$54.13 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,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 ,$54.13 ,$97.20 ,$137.70 ,$113.40 ,$11.17 ,$153.90 ,$116.64 ,$118.26 ,$105.30 ,$137.70 ,$54.13 ,$105.30 ,$137.70 ,$118.26 ,$11.17 ,$54.13 ,$68.04 ,$137.70 ,$121.80 ,$149.04 ,$113.40 ,$82.17 ,$98.61 ,$98.66 ,$92.03 ,$111.94 ,$116.64 ,$112.83 ,$54.67 ,$116.64 ,$11.84 ,$81.00 ,$81.00 ,$54.13 ,$81.00 ,$54.13 ,$116.64 ,$100.44 ,$116.64 ,$116.64 ,$97.20 
ST MARY'S HOSPITAL,96000050,G2010,PC REMOTE IMAGE SUBMIT BY PATIENT,960,1 ,$25.00 ,$12.50 ,$10.50 ,$25.00 ,$13.65 ,$16.17 ,$16.17 , N/A ,$15.00 ,$21.25 ,$17.50 ,$13.65 ,$23.75 ,$18.00 ,$18.25 ,$16.25 ,$21.25 , N/A ,$16.25 ,$21.25 ,$18.25 ,$13.65 , N/A ,$10.50 ,$21.25 , N/A ,$23.00 ,$17.50 ,$12.68 ,$15.22 ,$15.23 ,$14.20 ,$17.28 ,$18.00 ,$17.41 , N/A ,$18.00 ,$14.47 , N/A , N/A , N/A , N/A , N/A ,$18.00 ,$15.50 ,$18.00 ,$18.00 ,$15.00 
ST MARY'S HOSPITAL,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 ,$21.60 ,$21.90 ,$19.50 ,$25.50 , N/A ,$19.50 ,$25.50 ,$21.90 ,$13.65 , N/A ,$12.60 ,$25.50 , N/A ,$27.60 ,$21.00 ,$15.22 ,$18.26 ,$18.27 ,$17.04 ,$20.73 ,$21.60 ,$20.90 , N/A ,$21.60 ,$14.47 , N/A , N/A , N/A , N/A , N/A ,$21.60 ,$18.60 ,$21.60 ,$21.60 ,$18.00 
ST MARY'S HOSPITAL,96080007,38221,PC BX BONE MARROW NEEDLE,960,1 ,$850.00 ,$425.00 ,$357.00 ,"$3,078.81 ",$373.15 ,$549.87 ,$549.87 ,"$1,368.36 ",$510.00 ,$722.50 ,$595.00 ,$373.15 ,$807.50 ,$612.00 ,$620.50 ,$552.50 ,$722.50 ,"$1,368.36 ",$552.50 ,$722.50 ,$620.50 ,$373.15 ,"$1,368.36 ",$357.00 ,$722.50 ,"$3,078.81 ",$782.00 ,$595.00 ,$850.00 ,$850.00 ,$517.65 ,$850.00 ,$587.35 ,$612.00 ,$592.03 ,"$1,382.04 ",$612.00 ,$395.54 , N/A , N/A ,"$1,368.36 ", N/A ,"$1,368.36 ",$612.00 ,$527.00 ,$612.00 ,$612.00 ,$510.00 
ST MARY'S HOSPITAL,96080009,38222,PC BONE MARROW ASPIRATE (WHEN DONE WITH BIOPSY) FOR MEDICARE PTS ONLY,960,1 ,$665.00 ,$332.50 ,$279.30 ,"$5,188.27 ",$373.15 ,$430.19 ,$430.19 ,"$2,305.90 ",$399.00 ,$565.25 ,$465.50 ,$373.15 ,$631.75 ,$478.80 ,$485.45 ,$432.25 ,$565.25 ,"$2,305.90 ",$432.25 ,$565.25 ,$485.45 ,$373.15 ,"$2,305.90 ",$279.30 ,$565.25 ,"$5,188.27 ",$611.80 ,$465.50 ,$665.00 ,$665.00 ,$404.99 ,$665.00 ,$459.52 ,$478.80 ,$463.17 ,"$2,328.96 ",$478.80 ,$395.54 , N/A , N/A ,"$2,305.90 ", N/A ,"$2,305.90 ",$478.80 ,$412.30 ,$478.80 ,$478.80 ,$399.00 
ST MARY'S HOSPITAL,96080010,57410,PC PELVIC EXAM UNDER ANEST 57410,960,1 ,$485.00 ,$242.50 ,$61.96 ,"$5,741.06 ",$61.96 ,$313.75 ,$313.75 ,"$2,551.58 ",$291.00 ,$412.25 ,$339.50 ,$61.96 ,$460.75 ,$349.20 ,$354.05 ,$315.25 ,$412.25 ,"$2,551.58 ",$315.25 ,$412.25 ,$354.05 ,$61.96 ,"$2,551.58 ",$203.70 ,$412.25 ,"$5,741.06 ",$446.20 ,$339.50 ,$485.00 ,$485.00 ,$295.37 ,$485.00 ,$335.14 ,$349.20 ,$337.80 ,"$2,577.10 ",$349.20 ,$65.68 , N/A , N/A ,"$2,551.58 ", N/A ,"$2,551.58 ",$349.20 ,$300.70 ,$349.20 ,$349.20 ,$291.00 
ST MARY'S HOSPITAL,96100003,90792,PC EVAL PSYCH DIAG W/MED SERVICE MD,961,1 ,$150.00 ,$75.00 ,$63.00 ,$292.78 ,$82.53 ,$97.04 ,$97.04 ,$130.12 ,$90.00 ,$127.50 ,$105.00 ,$82.53 ,$142.50 ,$108.00 ,$109.50 ,$97.50 ,$127.50 ,$130.12 ,$97.50 ,$127.50 ,$109.50 ,$82.53 ,$130.12 ,$63.00 ,$127.50 ,$292.78 ,$138.00 ,$105.00 ,$76.08 ,$91.31 ,$91.35 ,$85.22 ,$103.65 ,$108.00 ,$104.48 ,$131.42 ,$108.00 ,$87.48 , N/A , N/A ,$130.12 , N/A ,$130.12 ,$108.00 ,$93.00 ,$108.00 ,$108.00 ,$90.00 
ST MARY'S HOSPITAL,97280000,77014,PC CT GUIDED THRPY PLACEMENT,972,1 ,$400.00 ,$200.00 ,$29.23 ,$400.00 ,$29.23 ,$258.76 ,$258.76 , N/A ,$240.00 ,$340.00 ,$280.00 ,$29.23 ,$380.00 ,$288.00 ,$292.00 ,$260.00 ,$340.00 , N/A ,$260.00 ,$340.00 ,$292.00 ,$29.23 , N/A ,$168.00 ,$340.00 , N/A ,$368.00 ,$280.00 ,$202.88 ,$243.48 ,$243.60 ,$227.24 ,$276.40 ,$288.00 ,$278.60 , N/A ,$288.00 ,$30.98 , N/A , N/A , N/A , N/A , N/A ,$288.00 ,$248.00 ,$288.00 ,$288.00 ,$240.00 
ST MARY'S HOSPITAL,97280001,76000,PC FLUOROSCOPY UP TO 1 HR 76000,972,1 ,$95.00 ,$47.50 ,$37.92 ,$503.50 ,$37.92 ,$61.46 ,$61.46 ,$223.78 ,$57.00 ,$80.75 ,$66.50 ,$37.92 ,$90.25 ,$68.40 ,$69.35 ,$61.75 ,$80.75 ,$223.78 ,$61.75 ,$80.75 ,$69.35 ,$37.92 ,$223.78 ,$39.90 ,$80.75 ,$503.50 ,$87.40 ,$66.50 ,$95.00 ,$95.00 ,$57.86 ,$95.00 ,$65.65 ,$68.40 ,$66.17 ,$226.02 ,$68.40 ,$40.20 , N/A , N/A ,$223.78 , N/A ,$223.78 ,$68.40 ,$58.90 ,$68.40 ,$68.40 ,$57.00 
ST MARY'S HOSPITAL,97380005,77261,PC CLINICAL TREATMENT PLANNING: SIMPLE,973,1 ,"$1,575.00 ",$787.50 ,$36.91 ,"$1,575.00 ",$36.91 ,"$1,018.87 ","$1,018.87 ", N/A ,$945.00 ,"$1,338.75 ","$1,102.50 ",$36.91 ,"$1,496.25 ","$1,134.00 ","$1,149.75 ","$1,023.75 ","$1,338.75 ", N/A ,"$1,023.75 ","$1,338.75 ","$1,149.75 ",$36.91 , N/A ,$661.50 ,"$1,338.75 ", N/A ,"$1,449.00 ","$1,102.50 ",$798.84 ,$958.70 ,$959.18 ,$894.76 ,"$1,088.33 ","$1,134.00 ","$1,096.99 ", N/A ,"$1,134.00 ",$39.12 , N/A , N/A , N/A , N/A , N/A ,"$1,134.00 ",$976.50 ,"$1,134.00 ","$1,134.00 ",$945.00 
ST MARY'S HOSPITAL,97380007,77263,PC CLINICAL TREATMENT PLANNING: COMPLEX,973,1 ,"$2,810.00 ","$1,405.00 ",$36.91 ,"$2,810.00 ",$36.91 ,"$1,817.79 ","$1,817.79 ", N/A ,"$1,686.00 ","$2,388.50 ","$1,967.00 ",$36.91 ,"$2,669.50 ","$2,023.20 ","$2,051.30 ","$1,826.50 ","$2,388.50 ", N/A ,"$1,826.50 ","$2,388.50 ","$2,051.30 ",$36.91 , N/A ,"$1,180.20 ","$2,388.50 ", N/A ,"$2,585.20 ","$1,967.00 ","$1,425.23 ","$1,710.45 ","$1,711.29 ","$1,596.36 ","$1,941.71 ","$2,023.20 ","$1,957.17 ", N/A ,"$2,023.20 ",$39.12 , N/A , N/A , N/A , N/A , N/A ,"$2,023.20 ","$1,742.20 ","$2,023.20 ","$2,023.20 ","$1,686.00 "
ST MARY'S HOSPITAL,97380008,77280,PC SIMULATION SIMPLE,973,1 ,$920.00 ,$460.00 ,$36.91 ,$920.00 ,$36.91 ,$595.15 ,$595.15 ,$123.40 ,$552.00 ,$782.00 ,$644.00 ,$36.91 ,$874.00 ,$662.40 ,$671.60 ,$598.00 ,$782.00 ,$123.40 ,$598.00 ,$782.00 ,$671.60 ,$36.91 ,$123.40 ,$386.40 ,$782.00 ,$277.65 ,$846.40 ,$644.00 ,$380.99 ,$409.02 ,$560.28 ,$380.99 ,$635.72 ,$662.40 ,$640.78 ,$124.63 ,$662.40 ,$39.12 , N/A , N/A ,$123.40 , N/A ,$123.40 ,$662.40 ,$570.40 ,$662.40 ,$662.40 ,$552.00 
ST MARY'S HOSPITAL,97380010,77290,PC SIMULATION COMPLEX,973,1 ,"$1,505.00 ",$752.50 ,$60.15 ,"$1,505.00 ",$60.15 ,$973.58 ,$973.58 ,$329.33 ,$903.00 ,"$1,279.25 ","$1,053.50 ",$60.15 ,"$1,429.75 ","$1,083.60 ","$1,098.65 ",$978.25 ,"$1,279.25 ",$329.33 ,$978.25 ,"$1,279.25 ","$1,098.65 ",$60.15 ,$329.33 ,$632.10 ,"$1,279.25 ",$741.00 ,"$1,384.60 ","$1,053.50 ","$1,034.69 ","$1,110.82 ",$916.55 ,"$1,034.69 ","$1,039.96 ","$1,083.60 ","$1,048.23 ",$332.62 ,"$1,083.60 ",$63.76 , N/A , N/A ,$329.33 , N/A ,$329.33 ,"$1,083.60 ",$933.10 ,"$1,083.60 ","$1,083.60 ",$903.00 
ST MARY'S HOSPITAL,97380013,77295,PC SIMULATION 3 DIMENSIONAL,973,1 ,"$2,000.00 ","$1,000.00 ",$345.96 ,"$2,763.17 ",$345.96 ,"$1,293.80 ","$1,293.80 ","$1,228.08 ","$1,200.00 ","$1,700.00 ","$1,400.00 ",$345.96 ,"$1,900.00 ","$1,440.00 ","$1,460.00 ","$1,300.00 ","$1,700.00 ","$1,228.08 ","$1,300.00 ","$1,700.00 ","$1,460.00 ",$345.96 ,"$1,228.08 ",$840.00 ,"$1,700.00 ","$2,763.17 ","$1,840.00 ","$1,400.00 ","$2,000.00 ","$2,000.00 ","$1,218.00 ","$2,000.00 ","$1,382.00 ","$1,440.00 ","$1,393.00 ","$1,240.36 ","$1,440.00 ",$366.72 , N/A , N/A ,"$1,228.08 ", N/A ,"$1,228.08 ","$1,440.00 ","$1,240.00 ","$1,440.00 ","$1,440.00 ","$1,200.00 "
ST MARY'S HOSPITAL,97380014,77300,PC DOSIMETRY CALCULATION BASIC,973,1 ,$325.00 ,$162.50 ,$60.15 ,$325.00 ,$60.15 ,$210.24 ,$210.24 ,$123.40 ,$195.00 ,$276.25 ,$227.50 ,$60.15 ,$308.75 ,$234.00 ,$237.25 ,$211.25 ,$276.25 ,$123.40 ,$211.25 ,$276.25 ,$237.25 ,$60.15 ,$123.40 ,$136.50 ,$276.25 ,$277.65 ,$299.00 ,$227.50 ,$325.00 ,$325.00 ,$197.93 ,$325.00 ,$224.58 ,$234.00 ,$226.36 ,$124.63 ,$234.00 ,$63.76 , N/A , N/A ,$123.40 , N/A ,$123.40 ,$234.00 ,$201.50 ,$234.00 ,$234.00 ,$195.00 
ST MARY'S HOSPITAL,97380017,77307,PC ISODOSE PLAN COMPLEX,973,1 ,"$1,720.00 ",$860.00 ,$60.15 ,"$1,720.00 ",$60.15 ,"$1,112.67 ","$1,112.67 ",$329.33 ,"$1,032.00 ","$1,462.00 ","$1,204.00 ",$60.15 ,"$1,634.00 ","$1,238.40 ","$1,255.60 ","$1,118.00 ","$1,462.00 ",$329.33 ,"$1,118.00 ","$1,462.00 ","$1,255.60 ",$60.15 ,$329.33 ,$722.40 ,"$1,462.00 ",$741.00 ,"$1,582.40 ","$1,204.00 ",$369.56 ,$396.76 ,"$1,047.48 ",$369.56 ,"$1,188.52 ","$1,238.40 ","$1,197.98 ",$332.62 ,"$1,238.40 ",$63.76 , N/A , N/A ,$329.33 , N/A ,$329.33 ,"$1,238.40 ","$1,066.40 ","$1,238.40 ","$1,238.40 ","$1,032.00 "
ST MARY'S HOSPITAL,97380022,77334,PC TREATMENT DEVICE COMPLEX,973,1 ,$650.00 ,$325.00 ,$60.15 ,$741.00 ,$60.15 ,$420.49 ,$420.49 ,$329.33 ,$390.00 ,$552.50 ,$455.00 ,$60.15 ,$617.50 ,$468.00 ,$474.50 ,$422.50 ,$552.50 ,$329.33 ,$422.50 ,$552.50 ,$474.50 ,$60.15 ,$329.33 ,$273.00 ,$552.50 ,$741.00 ,$598.00 ,$455.00 ,$650.00 ,$650.00 ,$395.85 ,$650.00 ,$449.15 ,$468.00 ,$452.73 ,$332.62 ,$468.00 ,$63.76 , N/A , N/A ,$329.33 , N/A ,$329.33 ,$468.00 ,$403.00 ,$468.00 ,$468.00 ,$390.00 
ST MARY'S HOSPITAL,97380024,77427,PC TREATMENT MANAGEMENT EVERY 5 TREATMENTS,973,1 ,"$1,555.00 ",$777.50 ,$99.26 ,"$1,555.00 ",$99.26 ,"$1,005.93 ","$1,005.93 ", N/A ,$933.00 ,"$1,321.75 ","$1,088.50 ",$99.26 ,"$1,477.25 ","$1,119.60 ","$1,135.15 ","$1,010.75 ","$1,321.75 ", N/A ,"$1,010.75 ","$1,321.75 ","$1,135.15 ",$99.26 , N/A ,$653.10 ,"$1,321.75 ", N/A ,"$1,430.60 ","$1,088.50 ",$788.70 ,$946.53 ,$947.00 ,$883.40 ,"$1,074.51 ","$1,119.60 ","$1,083.06 ", N/A ,"$1,119.60 ",$105.22 , N/A , N/A , N/A , N/A , N/A ,"$1,119.60 ",$964.10 ,"$1,119.60 ","$1,119.60 ",$933.00 
ST MARY'S HOSPITAL,97380025,77431,PC SHORT COURSE TREATMENT MANAGEMENT,973,1 ,$735.00 ,$367.50 ,$99.26 ,$735.00 ,$99.26 ,$475.47 ,$475.47 , N/A ,$441.00 ,$624.75 ,$514.50 ,$99.26 ,$698.25 ,$529.20 ,$536.55 ,$477.75 ,$624.75 , N/A ,$477.75 ,$624.75 ,$536.55 ,$99.26 , N/A ,$308.70 ,$624.75 , N/A ,$676.20 ,$514.50 ,$372.79 ,$447.39 ,$447.62 ,$417.55 ,$507.89 ,$529.20 ,$511.93 , N/A ,$529.20 ,$105.22 , N/A , N/A , N/A , N/A , N/A ,$529.20 ,$455.70 ,$529.20 ,$529.20 ,$441.00 
ST MARY'S HOSPITAL,97380032,77432,PC STEREOTACTIC RADIATION TX CRANIAL LESION 77432,973,1 ,"$1,500.00 ",$750.00 ,$99.26 ,"$1,500.00 ",$99.26 ,$970.35 ,$970.35 , N/A ,$900.00 ,"$1,275.00 ","$1,050.00 ",$99.26 ,"$1,425.00 ","$1,080.00 ","$1,095.00 ",$975.00 ,"$1,275.00 ", N/A ,$975.00 ,"$1,275.00 ","$1,095.00 ",$99.26 , N/A ,$630.00 ,"$1,275.00 ", N/A ,"$1,380.00 ","$1,050.00 ",$760.80 ,$913.05 ,$913.50 ,$852.15 ,"$1,036.50 ","$1,080.00 ","$1,044.75 ", N/A ,"$1,080.00 ",$105.22 , N/A , N/A , N/A , N/A , N/A ,"$1,080.00 ",$930.00 ,"$1,080.00 ","$1,080.00 ",$900.00 
ST MARY'S HOSPITAL,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 ,$432.00 ,$438.00 ,$390.00 ,$510.00 , N/A ,$390.00 ,$510.00 ,$438.00 ,$38.23 , N/A ,$252.00 ,$510.00 , N/A ,$552.00 ,$420.00 ,$304.32 ,$365.22 ,$365.40 ,$340.86 ,$414.60 ,$432.00 ,$417.90 , N/A ,$432.00 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$432.00 ,$372.00 ,$432.00 ,$432.00 ,$360.00 
ST MARY'S HOSPITAL,98280000,99217,PC OBSERVATION CARE DISCHARGE,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 ,$169.20 ,$171.55 ,$152.75 ,$199.75 , N/A ,$152.75 ,$199.75 ,$171.55 ,$38.23 , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$133.50 ,$162.39 ,$169.20 ,$163.68 , N/A ,$169.20 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,98300052,99464,PC ATTEND HIGH RISK DELIVERY NNP,983,1 ,$155.00 ,$77.50 ,$65.10 ,$155.00 , N/A ,$100.27 ,$100.27 , N/A ,$93.00 ,$131.75 ,$108.50 , N/A ,$147.25 ,$111.60 ,$113.15 ,$100.75 ,$131.75 , N/A ,$100.75 ,$131.75 ,$113.15 , N/A , N/A ,$65.10 ,$131.75 , N/A ,$142.60 ,$108.50 ,$78.62 ,$94.35 ,$94.40 ,$88.06 ,$107.11 ,$111.60 ,$107.96 , N/A ,$111.60 , N/A , N/A , N/A , N/A , N/A , N/A ,$111.60 ,$96.10 ,$111.60 ,$111.60 ,$93.00 
ST MARY'S HOSPITAL,98300053,99465,PC DELIV/BIRTH RM RESUSCIT NNP,983,1 ,$315.00 ,$157.50 ,$132.30 ,"$1,229.24 ",$285.38 ,$203.77 ,$203.77 ,$546.33 ,$189.00 ,$267.75 ,$220.50 ,$285.38 ,$299.25 ,$226.80 ,$229.95 ,$204.75 ,$267.75 ,$546.33 ,$204.75 ,$267.75 ,$229.95 ,$285.38 ,$546.33 ,$132.30 ,$267.75 ,"$1,229.24 ",$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$178.95 ,$217.67 ,$226.80 ,$219.40 ,$551.79 ,$226.80 ,$302.50 , N/A , N/A ,$546.33 , N/A ,$546.33 ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$189.00 
ST MARY'S HOSPITAL,98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$51.00 ,$25.50 ,$8.28 ,$51.00 ,$8.28 ,$32.99 ,$32.99 , N/A ,$30.60 ,$43.35 ,$35.70 ,$8.28 ,$48.45 ,$36.72 ,$37.23 ,$33.15 ,$43.35 , N/A ,$33.15 ,$43.35 ,$37.23 ,$8.28 , N/A ,$21.42 ,$43.35 , N/A ,$46.92 ,$35.70 ,$25.87 ,$31.04 ,$31.06 ,$28.97 ,$35.24 ,$36.72 ,$35.52 , N/A ,$36.72 ,$8.78 , N/A , N/A , N/A , N/A , N/A ,$36.72 ,$31.62 ,$36.72 ,$36.72 ,$30.60 
ST MARY'S HOSPITAL,98500001,93042,PC EKG RHYTHM STRIP INTER AND REPORT PRO,985,1 ,$51.00 ,$25.50 ,$8.28 ,$51.00 ,$8.28 ,$32.99 ,$32.99 , N/A ,$30.60 ,$43.35 ,$35.70 ,$8.28 ,$48.45 ,$36.72 ,$37.23 ,$33.15 ,$43.35 , N/A ,$33.15 ,$43.35 ,$37.23 ,$8.28 , N/A ,$21.42 ,$43.35 , N/A ,$46.92 ,$35.70 ,$25.87 ,$31.04 ,$31.06 ,$28.97 ,$35.24 ,$36.72 ,$35.52 , N/A ,$36.72 ,$8.78 , N/A , N/A , N/A , N/A , N/A ,$36.72 ,$31.62 ,$36.72 ,$36.72 ,$30.60 
ST MARY'S HOSPITAL,98500002,93016,PC CARDIAC STRESS TEST SUPERVISION,985,1 ,$70.00 ,$35.00 ,$29.40 ,$70.00 ,$52.64 ,$45.28 ,$45.28 , N/A ,$42.00 ,$59.50 ,$49.00 ,$52.64 ,$66.50 ,$50.40 ,$51.10 ,$45.50 ,$59.50 , N/A ,$45.50 ,$59.50 ,$51.10 ,$52.64 , N/A ,$29.40 ,$59.50 , N/A ,$64.40 ,$49.00 ,$35.50 ,$42.61 ,$42.63 ,$39.77 ,$48.37 ,$50.40 ,$48.76 , N/A ,$50.40 ,$55.80 , N/A , N/A , N/A , N/A , N/A ,$50.40 ,$43.40 ,$50.40 ,$50.40 ,$42.00 
ST MARY'S HOSPITAL,98780000,99218,PC OBSERVATION CARE 1,982,1 ,$380.00 ,$190.00 ,$38.23 ,$380.00 ,$38.23 ,$245.82 ,$245.82 , N/A ,$228.00 ,$323.00 ,$266.00 ,$38.23 ,$361.00 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$38.23 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,98780006,99238,PC HOSPITAL DISCHARGE DAY <31MIN,987,1 ,$260.00 ,$130.00 ,$32.55 ,$260.00 ,$32.55 ,$168.19 ,$168.19 , N/A ,$156.00 ,$221.00 ,$182.00 ,$32.55 ,$247.00 ,$187.20 ,$189.80 ,$169.00 ,$221.00 , N/A ,$169.00 ,$221.00 ,$189.80 ,$32.55 , N/A ,$109.20 ,$221.00 , N/A ,$239.20 ,$182.00 ,$131.87 ,$158.26 ,$158.34 ,$147.71 ,$179.66 ,$187.20 ,$181.09 , N/A ,$187.20 ,$34.50 , N/A , N/A , N/A , N/A , N/A ,$187.20 ,$161.20 ,$187.20 ,$187.20 ,$156.00 
ST MARY'S HOSPITAL,98780007,99239,PC HOSPITAL DISCHARGE DAY >30MIN,987,1 ,$380.00 ,$190.00 ,$32.55 ,$380.00 ,$32.55 ,$245.82 ,$245.82 , N/A ,$228.00 ,$323.00 ,$266.00 ,$32.55 ,$361.00 ,$273.60 ,$277.40 ,$247.00 ,$323.00 , N/A ,$247.00 ,$323.00 ,$277.40 ,$32.55 , N/A ,$159.60 ,$323.00 , N/A ,$349.60 ,$266.00 ,$192.74 ,$231.31 ,$231.42 ,$215.88 ,$262.58 ,$273.60 ,$264.67 , N/A ,$273.60 ,$34.50 , N/A , N/A , N/A , N/A , N/A ,$273.60 ,$235.60 ,$273.60 ,$273.60 ,$228.00 
ST MARY'S HOSPITAL,98780008,99224,PC SUBSQ OBSERVATION CARE LEV 1,987,1 ,$99.00 ,$49.50 ,$38.23 ,$99.00 ,$38.23 ,$64.04 ,$64.04 , N/A ,$59.40 ,$84.15 ,$69.30 ,$38.23 ,$94.05 ,$71.28 ,$72.27 ,$64.35 ,$84.15 , N/A ,$64.35 ,$84.15 ,$72.27 ,$38.23 , N/A ,$41.58 ,$84.15 , N/A ,$91.08 ,$69.30 ,$50.21 ,$60.26 ,$60.29 ,$56.24 ,$68.41 ,$71.28 ,$68.95 , N/A ,$71.28 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$71.28 ,$61.38 ,$71.28 ,$71.28 ,$59.40 
ST MARY'S HOSPITAL,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 ,$165.60 ,$167.90 ,$149.50 ,$195.50 , N/A ,$149.50 ,$195.50 ,$167.90 ,$38.23 , N/A ,$96.60 ,$195.50 , N/A ,$211.60 ,$161.00 ,$116.66 ,$140.00 ,$140.07 ,$130.66 ,$158.93 ,$165.60 ,$160.20 , N/A ,$165.60 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$165.60 ,$142.60 ,$165.60 ,$165.60 ,$138.00 
ST MARY'S HOSPITAL,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 ,$223.20 ,$226.30 ,$201.50 ,$263.50 , N/A ,$201.50 ,$263.50 ,$226.30 ,$38.23 , N/A ,$130.20 ,$263.50 , N/A ,$285.20 ,$217.00 ,$157.23 ,$188.70 ,$188.79 ,$176.11 ,$214.21 ,$223.20 ,$215.92 , N/A ,$223.20 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$223.20 ,$192.20 ,$223.20 ,$223.20 ,$186.00 
ST MARY'S HOSPITAL,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 ,$324.00 ,$328.50 ,$292.50 ,$382.50 , N/A ,$292.50 ,$382.50 ,$328.50 ,$38.23 , N/A ,$189.00 ,$382.50 , N/A ,$414.00 ,$315.00 ,$228.24 ,$273.92 ,$274.05 ,$255.65 ,$310.95 ,$324.00 ,$313.43 , N/A ,$324.00 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$324.00 ,$279.00 ,$324.00 ,$324.00 ,$270.00 
ST MARY'S HOSPITAL,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 ,$79.20 ,$80.30 ,$71.50 ,$93.50 , N/A ,$71.50 ,$93.50 ,$80.30 ,$38.23 , N/A ,$46.20 ,$93.50 , N/A ,$101.20 ,$77.00 ,$55.79 ,$66.96 ,$66.99 ,$62.49 ,$76.01 ,$79.20 ,$76.62 , N/A ,$79.20 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$79.20 ,$68.20 ,$79.20 ,$79.20 ,$66.00 
ST MARY'S HOSPITAL,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 ,$122.40 ,$124.10 ,$110.50 ,$144.50 , N/A ,$110.50 ,$144.50 ,$124.10 ,$38.23 , N/A ,$71.40 ,$144.50 , N/A ,$156.40 ,$119.00 ,$86.22 ,$103.48 ,$103.53 ,$96.58 ,$117.47 ,$122.40 ,$118.41 , N/A ,$122.40 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$122.40 ,$105.40 ,$122.40 ,$122.40 ,$102.00 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$152.75 ,$199.75 , N/A ,$152.75 ,$199.75 ,$171.55 ,$38.23 , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$133.50 ,$162.39 ,$169.20 ,$163.68 , N/A ,$169.20 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$169.20 ,$171.55 ,$152.75 ,$199.75 , N/A ,$152.75 ,$199.75 ,$171.55 ,$38.23 , N/A ,$98.70 ,$199.75 , N/A ,$216.20 ,$164.50 ,$119.19 ,$143.04 ,$143.12 ,$133.50 ,$162.39 ,$169.20 ,$163.68 , N/A ,$169.20 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$169.20 ,$145.70 ,$169.20 ,$169.20 ,$141.00 
ST MARY'S HOSPITAL,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 ,$226.80 ,$229.95 ,$204.75 ,$267.75 , N/A ,$204.75 ,$267.75 ,$229.95 ,$38.23 , N/A ,$132.30 ,$267.75 , N/A ,$289.80 ,$220.50 ,$159.77 ,$191.74 ,$191.84 ,$178.95 ,$217.67 ,$226.80 ,$219.40 , N/A ,$226.80 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$226.80 ,$195.30 ,$226.80 ,$226.80 ,$189.00 
ST MARY'S HOSPITAL,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 ,$284.40 ,$288.35 ,$256.75 ,$335.75 , N/A ,$256.75 ,$335.75 ,$288.35 ,$38.23 , N/A ,$165.90 ,$335.75 , N/A ,$363.40 ,$276.50 ,$200.34 ,$240.44 ,$240.56 ,$224.40 ,$272.95 ,$284.40 ,$275.12 , N/A ,$284.40 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$284.40 ,$244.90 ,$284.40 ,$284.40 ,$237.00 
ST MARY'S HOSPITAL,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 ,$392.40 ,$397.85 ,$354.25 ,$463.25 , N/A ,$354.25 ,$463.25 ,$397.85 ,$38.23 , N/A ,$228.90 ,$463.25 , N/A ,$501.40 ,$381.50 ,$276.42 ,$331.74 ,$331.91 ,$309.61 ,$376.60 ,$392.40 ,$379.59 , N/A ,$392.40 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$392.40 ,$337.90 ,$392.40 ,$392.40 ,$327.00 
ST MARY'S HOSPITAL,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 ,$489.60 ,$496.40 ,$442.00 ,$578.00 , N/A ,$442.00 ,$578.00 ,$496.40 ,$38.23 , N/A ,$285.60 ,$578.00 , N/A ,$625.60 ,$476.00 ,$344.90 ,$413.92 ,$414.12 ,$386.31 ,$469.88 ,$489.60 ,$473.62 , N/A ,$489.60 ,$40.52 , N/A , N/A , N/A , N/A , N/A ,$489.60 ,$421.60 ,$489.60 ,$489.60 ,$408.00