ST. CLARE MEMORIAL 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 , COFINITY , COMMUNITY CARE FAMILY CARE , FIRST HEALTH NETWORK , HEALTHEOS , HUMANA , HUMANA CHOICE CARE PPO , HUMANA MEDICARE ADVANTAGE , HUMANA NATIIONAL POS HMO , HUMANA PREFERRED BHCG , INTERPLAN HEALTH GROUP , MANAGED HEALTH SERVICES MCD , 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 , 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 TRUST PPP/TRUST PREFERRED , WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION 
ST. CLARE MEMORIAL HOSPITAL (ACU),N/A,216,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,120,1 ,"$60,517.70 ","$30,258.85 ","$8,250.00 ","$60,517.70 ","$32,185.90 ","$60,517.70 ","$60,517.70 ","$38,806.24 ","$48,414.16 ","$51,440.05 ","$37,823.56 ","$54,465.93 ","$47,496.39 ","$57,491.82 ","$54,465.93 ","$51,440.05 ","$51,440.05 ","$38,806.24 ","$51,440.05 ","$51,440.05 ","$54,465.93 ","$31,703.11 ","$60,517.70 ","$54,465.93 ", Inpatient Medicare +100% ,"$55,676.28 ","$54,465.93 ","$60,517.70 ","$60,517.70 ","$36,855.28 ","$60,517.70 ","$39,336.51 ","$42,150.58 ","$26,808.78 ","$47,808.98 ","$50,346.17 ","$60,517.70 ","$60,517.70 ","$38,806.24 ","$60,517.70 ","$8,250.00 ","$57,491.82 ","$49,624.51 ","$49,624.51 ","$48,414.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),N/A,473,CERVICAL SPINAL FUSION WITHOUT CC/MCC,120,1 ,"$15,305.70 ","$7,652.85 ","$1,100.00 ","$15,305.70 ","$7,916.10 ","$15,305.70 ","$15,305.70 ","$5,279.76 ","$12,244.56 ","$13,009.85 ","$9,566.06 ","$13,775.13 ","$10,645.45 ","$14,540.42 ","$13,775.13 ","$13,009.85 ","$13,009.85 ","$5,279.76 ","$13,009.85 ","$13,009.85 ","$13,775.13 ","$7,797.36 ","$15,305.70 ","$13,775.13 ", Inpatient Medicare +100% ,"$14,081.24 ","$13,775.13 ","$15,305.70 ","$15,305.70 ","$9,321.17 ","$15,305.70 ","$9,948.71 ","$10,660.42 ","$3,647.45 ","$12,091.50 ","$11,284.18 ","$15,305.70 ","$15,305.70 ","$5,279.76 ","$15,305.70 ","$1,100.00 ","$14,540.42 ","$12,550.67 ","$12,550.67 ","$12,244.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),N/A,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,120,1 ,"$11,455.16 ","$5,727.58 ","$1,100.00 ","$11,583.51 ","$5,849.13 ","$11,455.16 ","$11,455.16 ","$5,279.76 ","$9,164.13 ","$9,736.89 ","$7,159.48 ","$10,309.64 ","$10,927.84 ","$10,882.40 ","$10,309.64 ","$9,736.89 ","$9,736.89 ","$5,279.76 ","$9,736.89 ","$9,736.89 ","$10,309.64 ","$5,761.39 ","$11,455.16 ","$10,309.64 ", Inpatient Medicare +100% ,"$10,538.75 ","$10,309.64 ","$11,455.16 ","$11,455.16 ","$6,976.19 ","$11,455.16 ","$7,445.85 ","$7,978.52 ","$3,647.45 ","$9,049.58 ","$11,583.51 ","$11,455.16 ","$11,455.16 ","$5,279.76 ","$11,455.16 ","$1,100.00 ","$10,882.40 ","$9,393.23 ","$9,393.23 ","$9,164.13 "
ST. CLARE MEMORIAL HOSPITAL (ACU),N/A,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,120,1 ,"$23,694.57 ","$11,847.29 ","$1,650.00 ","$23,694.57 ","$12,419.25 ","$23,694.57 ","$23,694.57 ","$7,761.25 ","$18,955.66 ","$20,140.38 ","$14,809.11 ","$21,325.11 ","$18,611.02 ","$22,509.84 ","$21,325.11 ","$20,140.38 ","$20,140.38 ","$7,761.25 ","$20,140.38 ","$20,140.38 ","$21,325.11 ","$12,232.96 ","$23,694.57 ","$21,325.11 ", Inpatient Medicare +100% ,"$21,799.00 ","$21,325.11 ","$23,694.57 ","$23,694.57 ","$14,429.99 ","$23,694.57 ","$15,401.47 ","$16,503.27 ","$5,361.76 ","$18,718.71 ","$19,727.68 ","$23,694.57 ","$23,694.57 ","$7,761.25 ","$23,694.57 ","$1,650.00 ","$22,509.84 ","$19,429.55 ","$19,429.55 ","$18,955.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),N/A,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,120,1 ,"$6,828.61 ","$3,414.31 ","$1,100.00 ","$6,828.61 ","$4,428.45 ","$6,828.61 ","$6,828.61 ","$5,279.76 ","$5,462.89 ","$5,804.32 ","$4,267.88 ","$6,145.75 ","$5,765.03 ","$6,487.18 ","$6,145.75 ","$5,804.32 ","$5,804.32 ","$5,279.76 ","$5,804.32 ","$5,804.32 ","$6,145.75 ","$4,362.02 ","$6,828.61 ","$6,145.75 ", Inpatient Medicare +100% ,"$6,282.32 ","$6,145.75 ","$6,828.61 ","$6,828.61 ","$4,158.62 ","$6,828.61 ","$4,438.60 ","$4,756.13 ","$3,647.45 ","$5,394.60 ","$6,110.93 ","$6,828.61 ","$6,828.61 ","$5,279.76 ","$6,828.61 ","$1,100.00 ","$6,487.18 ","$5,599.46 ","$5,599.46 ","$5,462.89 "
ST. CLARE MEMORIAL HOSPITAL (ACU),10021072,10021,HC ASP FINE NDL W/O IMAGING GUIDE,510,1 ,$430.00 ,$215.00 ,$64.61 ,"$1,179.94 ","$1,113.15 ",$129.00 ,$103.00 ,$146.20 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,"$1,113.15 ",$408.50 ,$387.00 ,$365.50 ,$365.50 ,$146.20 ,$365.50 ,$365.50 ,$387.00 ,"$1,113.15 ",$64.61 ,$387.00 ,$794.25 ,$395.60 ,$387.00 ,$286.55 ,$286.55 ,$261.87 ,$286.55 ,$279.50 ,$299.50 ,$95.55 ,$339.70 ,"$1,179.94 ",$215.00 ,$215.00 ,$146.20 ,$215.00 ,$353.00 ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),10060072,10060,HC I AND D SKIN ABSCESS,510,1 ,$447.00 ,$223.50 ,$64.61 ,$447.00 ,$288.25 ,$129.00 ,$103.00 ,$151.98 ,$357.60 ,$379.95 ,$279.38 ,$402.30 ,$288.25 ,$424.65 ,$402.30 ,$379.95 ,$379.95 ,$151.98 ,$379.95 ,$379.95 ,$402.30 ,$288.25 ,$64.61 ,$402.30 ,$412.65 ,$411.24 ,$402.30 ,$297.88 ,$297.88 ,$272.22 ,$297.88 ,$290.55 ,$311.34 ,$99.32 ,$353.13 ,$305.55 ,$223.50 ,$223.50 ,$151.98 ,$223.50 ,$183.40 ,$424.65 ,$366.54 ,$366.54 ,$357.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),10080072,10080,HC DRAIN PILONIDAL CYST SIMPLE-PREV 72 HR,510,1 ,$694.00 ,$347.00 ,$64.61 ,"$1,429.97 ",$288.25 ,$129.00 ,$103.00 ,$235.96 ,$555.20 ,$589.90 ,$433.75 ,$624.60 ,$288.25 ,$659.30 ,$624.60 ,$589.90 ,$589.90 ,$235.96 ,$589.90 ,$589.90 ,$624.60 ,$288.25 ,$64.61 ,$624.60 ,"$1,429.97 ",$638.48 ,$624.60 ,$462.48 ,$462.48 ,$422.65 ,$462.48 ,$451.10 ,$483.37 ,$154.21 ,$548.26 ,$305.55 ,$347.00 ,$347.00 ,$235.96 ,$347.00 ,$635.54 ,$659.30 ,$569.08 ,$569.08 ,$555.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),10140072,10140,HC I AND D HEMATOMA,975,1 ,$469.00 ,$234.50 ,$104.21 ,"$3,233.23 ","$1,935.34 ",$396.73 ,$396.73 ,$124.99 ,$375.20 ,$398.65 ,$293.13 ,$422.10 ,"$1,935.34 ",$445.55 ,$422.10 ,$398.65 ,$398.65 ,$124.99 ,$398.65 ,$398.65 ,$422.10 ,"$1,935.34 ",$196.98 ,$422.10 ,"$3,233.23 ",$431.48 ,$422.10 ,$312.54 ,$312.54 ,$285.62 ,$312.54 ,$304.85 ,$326.66 ,$104.21 ,$370.51 ,"$2,051.46 ", N/A , N/A ,$124.99 , N/A ,"$1,436.99 ",$445.55 ,$384.58 ,$384.58 ,$375.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),11042072,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM,510,1 ,$424.00 ,$212.00 ,$64.61 ,$794.25 ,$662.74 ,$129.00 ,$103.00 ,$144.16 ,$339.20 ,$360.40 ,$265.00 ,$381.60 ,$662.74 ,$402.80 ,$381.60 ,$360.40 ,$360.40 ,$144.16 ,$360.40 ,$360.40 ,$381.60 ,$662.74 ,$64.61 ,$381.60 ,$794.25 ,$390.08 ,$381.60 ,$282.55 ,$282.55 ,$258.22 ,$282.55 ,$275.60 ,$295.32 ,$94.21 ,$334.96 ,$702.50 ,$212.00 ,$212.00 ,$144.16 ,$212.00 ,$353.00 ,$402.80 ,$347.68 ,$347.68 ,$339.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),11100010,N/A,HC DAILY SERVICE W/TELEMETRY,111,1 ,"$1,532.00 ",$766.00 ,$766.00 ,"$1,532.00 ", Inpatient Medicaid ,"$9,167.00 ","$9,167.00 ", Inpatient Medicare ,"$1,225.60 ","$1,302.20 ",$957.50 ,"$1,378.80 ", Inpatient Medicaid ,"$1,455.40 ","$1,378.80 ","$1,302.20 ","$1,302.20 ", Inpatient Medicare ,"$1,302.20 ","$1,302.20 ","$1,378.80 ", Inpatient Medicaid ,"$11,879.79 ","$1,378.80 ", Inpatient Medicare +100% ,"$1,409.44 ","$1,378.80 ","$8,508.05 ","$8,508.05 ",$932.99 ,"$8,508.05 ",$995.80 ,"$1,067.04 ", Inpatient Medicaid ,"$1,210.28 ", Inpatient Medicaid +6% ,"$9,035.00 ","$9,035.00 ", Inpatient Medicare ,"$10,328.00 ",$550.00 ,"$1,455.40 ","$1,256.24 ","$1,256.24 ","$1,225.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),11200072,11200,HC RM SKIN TAG LESION <15-PRV 72 HR,975,1 ,$313.00 ,$156.50 ,$69.55 ,$412.65 ,$288.25 ,$264.77 ,$264.77 ,$80.64 ,$250.40 ,$266.05 ,$195.63 ,$281.70 ,$288.25 ,$297.35 ,$281.70 ,$266.05 ,$266.05 ,$80.64 ,$266.05 ,$266.05 ,$281.70 ,$288.25 ,$131.46 ,$281.70 ,$412.65 ,$287.96 ,$281.70 ,$208.58 ,$208.58 ,$190.62 ,$208.58 ,$203.45 ,$218.00 ,$69.55 ,$247.27 ,$305.55 , N/A , N/A ,$80.64 , N/A ,$183.40 ,$297.35 ,$256.66 ,$256.66 ,$250.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),11406072,11406,HC EXC B9 LESION >4.0CM,983,1 ,$606.00 ,$303.00 ,$134.65 ,"$3,303.80 ","$3,116.79 ",$512.62 ,$512.62 ,$258.53 ,$484.80 ,$515.10 ,$378.75 ,$545.40 ,"$3,116.79 ",$575.70 ,$545.40 ,$515.10 ,$515.10 ,$258.53 ,$515.10 ,$515.10 ,$545.40 ,"$3,116.79 ",$254.52 ,$545.40 ,"$3,233.23 ",$557.52 ,$545.40 ,$403.84 ,$403.84 ,$369.05 ,$403.84 ,$393.90 ,$422.08 ,$134.65 ,$478.74 ,"$3,303.80 ", N/A , N/A ,$258.53 , N/A ,"$1,436.99 ",$575.70 ,$496.92 ,$496.92 ,$484.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),11422072,11422,HC EXC BENUGN LES 1.1-2 CM,983,1 ,$746.00 ,$373.00 ,$143.47 ,"$3,233.23 ","$2,025.40 ",$631.04 ,$631.04 ,$143.47 ,$596.80 ,$634.10 ,$466.25 ,$671.40 ,"$2,025.40 ",$708.70 ,$671.40 ,$634.10 ,$634.10 ,$143.47 ,$634.10 ,$634.10 ,$671.40 ,"$2,025.40 ",$313.32 ,$671.40 ,"$3,233.23 ",$686.32 ,$671.40 ,$497.13 ,$497.13 ,$454.31 ,$497.13 ,$484.90 ,$519.59 ,$165.76 ,$589.34 ,"$2,146.92 ", N/A , N/A ,$143.47 , N/A ,"$1,436.99 ",$708.70 ,$611.72 ,$611.72 ,$596.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),11426072,11426,HC EXC SKIN BENIG >4CM,975,1 ,"$1,315.00 ",$657.50 ,$285.01 ,"$5,448.49 ","$3,116.79 ","$1,112.36 ","$1,112.36 ",$285.01 ,"$1,052.00 ","$1,117.75 ",$821.88 ,"$1,183.50 ","$3,116.79 ","$1,249.25 ","$1,183.50 ","$1,117.75 ","$1,117.75 ",$285.01 ,"$1,117.75 ","$1,117.75 ","$1,183.50 ","$3,116.79 ",$552.30 ,"$1,183.50 ","$5,448.49 ","$1,209.80 ","$1,183.50 ",$876.32 ,$876.32 ,$800.84 ,$876.32 ,$854.75 ,$915.90 ,$292.19 ,"$1,038.85 ","$3,303.80 ", N/A , N/A ,$285.01 , N/A ,"$2,421.55 ","$1,249.25 ","$1,078.30 ","$1,078.30 ","$1,052.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),11441072,11441,HC EXC SKIN BENIG 0.6-1CM FACE 72 HR,510,1 ,$353.00 ,$176.50 ,$64.61 ,"$1,429.97 ",$785.45 ,$129.00 ,$103.00 ,$120.02 ,$282.40 ,$300.05 ,$220.63 ,$317.70 ,$785.45 ,$335.35 ,$317.70 ,$300.05 ,$300.05 ,$120.02 ,$300.05 ,$300.05 ,$317.70 ,$785.45 ,$64.61 ,$317.70 ,"$1,429.97 ",$324.76 ,$317.70 ,$235.24 ,$235.24 ,$214.98 ,$235.24 ,$229.45 ,$245.86 ,$78.44 ,$278.87 ,$832.58 ,$176.50 ,$176.50 ,$120.02 ,$176.50 ,$635.54 ,$335.35 ,$289.46 ,$289.46 ,$282.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),11450072,11450,HC EXC SKIN SUBQ TISSUE,975,1 ,"$1,554.00 ",$777.00 ,$272.52 ,"$5,448.49 ","$3,116.79 ","$1,314.53 ","$1,314.53 ",$272.52 ,"$1,243.20 ","$1,320.90 ",$971.25 ,"$1,398.60 ","$3,116.79 ","$1,476.30 ","$1,398.60 ","$1,320.90 ","$1,320.90 ",$272.52 ,"$1,320.90 ","$1,320.90 ","$1,398.60 ","$3,116.79 ",$652.68 ,"$1,398.60 ","$5,448.49 ","$1,429.68 ","$1,398.60 ","$1,035.59 ","$1,035.59 ",$946.39 ,"$1,035.59 ","$1,010.10 ","$1,082.36 ",$345.30 ,"$1,227.66 ","$3,303.80 ", N/A , N/A ,$272.52 , N/A ,"$2,421.55 ","$1,476.30 ","$1,274.28 ","$1,274.28 ","$1,243.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),11602072,11602,HC EXC MALIG LES W MARG,510,1 ,$405.00 ,$202.50 ,$64.61 ,$832.58 ,$785.45 ,$129.00 ,$103.00 ,$137.70 ,$324.00 ,$344.25 ,$253.13 ,$364.50 ,$785.45 ,$384.75 ,$364.50 ,$344.25 ,$344.25 ,$137.70 ,$344.25 ,$344.25 ,$364.50 ,$785.45 ,$64.61 ,$364.50 ,$794.25 ,$372.60 ,$364.50 ,$269.89 ,$269.89 ,$246.65 ,$269.89 ,$263.25 ,$282.08 ,$89.99 ,$319.95 ,$832.58 ,$202.50 ,$202.50 ,$137.70 ,$202.50 ,$353.00 ,$384.75 ,$332.10 ,$332.10 ,$324.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),11603072,11603,HC EXC SKIN MALIG 2.1-3CM TAL 72 HR,510,1 ,$378.00 ,$189.00 ,$64.61 ,"$1,429.97 ",$785.45 ,$129.00 ,$103.00 ,$128.52 ,$302.40 ,$321.30 ,$236.25 ,$340.20 ,$785.45 ,$359.10 ,$340.20 ,$321.30 ,$321.30 ,$128.52 ,$321.30 ,$321.30 ,$340.20 ,$785.45 ,$64.61 ,$340.20 ,"$1,429.97 ",$347.76 ,$340.20 ,$251.90 ,$251.90 ,$230.20 ,$251.90 ,$245.70 ,$263.28 ,$83.99 ,$298.62 ,$832.58 ,$189.00 ,$189.00 ,$128.52 ,$189.00 ,$635.54 ,$359.10 ,$309.96 ,$309.96 ,$302.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),11606072,11606,HC EXC MAL LES MRG>4CM,983,1 ,"$1,594.00 ",$797.00 ,$330.53 ,"$3,303.80 ","$3,116.79 ","$1,348.36 ","$1,348.36 ",$330.53 ,"$1,275.20 ","$1,354.90 ",$996.25 ,"$1,434.60 ","$3,116.79 ","$1,514.30 ","$1,434.60 ","$1,354.90 ","$1,354.90 ",$330.53 ,"$1,354.90 ","$1,354.90 ","$1,434.60 ","$3,116.79 ",$669.48 ,"$1,434.60 ","$3,233.23 ","$1,466.48 ","$1,434.60 ","$1,062.24 ","$1,062.24 ",$970.75 ,"$1,062.24 ","$1,036.10 ","$1,110.22 ",$354.19 ,"$1,259.26 ","$3,303.80 ", N/A , N/A ,$330.53 , N/A ,"$1,436.99 ","$1,514.30 ","$1,307.08 ","$1,307.08 ","$1,275.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),11622072,11622,HC EXC MAL LESION W/M,510,1 ,$656.00 ,$328.00 ,$64.61 ,"$1,429.97 ",$785.45 ,$129.00 ,$103.00 ,$223.04 ,$524.80 ,$557.60 ,$410.00 ,$590.40 ,$785.45 ,$623.20 ,$590.40 ,$557.60 ,$557.60 ,$223.04 ,$557.60 ,$557.60 ,$590.40 ,$785.45 ,$64.61 ,$590.40 ,"$1,429.97 ",$603.52 ,$590.40 ,$437.16 ,$437.16 ,$399.50 ,$437.16 ,$426.40 ,$456.90 ,$145.76 ,$518.24 ,$832.58 ,$328.00 ,$328.00 ,$223.04 ,$328.00 ,$635.54 ,$623.20 ,$537.92 ,$537.92 ,$524.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),11623072,11623,HC EXC SKIN MALIG 2.1-3CM REMAINDER BODY,975,1 ,"$1,044.00 ",$522.00 ,$220.30 ,"$3,233.23 ","$2,025.40 ",$883.12 ,$883.12 ,$220.30 ,$835.20 ,$887.40 ,$652.50 ,$939.60 ,"$2,025.40 ",$991.80 ,$939.60 ,$887.40 ,$887.40 ,$220.30 ,$887.40 ,$887.40 ,$939.60 ,"$2,025.40 ",$438.48 ,$939.60 ,"$3,233.23 ",$960.48 ,$939.60 ,$695.72 ,$695.72 ,$635.80 ,$695.72 ,$678.60 ,$727.15 ,$231.98 ,$824.76 ,"$2,146.92 ", N/A , N/A ,$220.30 , N/A ,"$1,436.99 ",$991.80 ,$856.08 ,$856.08 ,$835.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),11644072,11644,HC EXC SKIN MALIG 3.1-4CM FACE 72 HR,510,1 ,$808.00 ,$404.00 ,$64.61 ,"$3,233.23 ","$2,025.40 ",$129.00 ,$103.00 ,$274.72 ,$646.40 ,$686.80 ,$505.00 ,$727.20 ,"$2,025.40 ",$767.60 ,$727.20 ,$686.80 ,$686.80 ,$274.72 ,$686.80 ,$686.80 ,$727.20 ,"$2,025.40 ",$64.61 ,$727.20 ,"$3,233.23 ",$743.36 ,$727.20 ,$538.45 ,$538.45 ,$492.07 ,$538.45 ,$525.20 ,$562.77 ,$179.54 ,$638.32 ,"$2,146.92 ",$404.00 ,$404.00 ,$274.72 ,$404.00 ,"$1,436.99 ",$767.60 ,$662.56 ,$662.56 ,$646.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),11730072,11730,HC AVULSION PLATE SINGLE-72HR,975,1 ,$250.00 ,$125.00 ,$55.55 ,$412.65 ,$115.63 ,$211.48 ,$211.48 ,$57.43 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$115.63 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$57.43 ,$212.50 ,$212.50 ,$225.00 ,$115.63 ,$105.00 ,$225.00 ,$412.65 ,$230.00 ,$225.00 ,$166.60 ,$166.60 ,$152.25 ,$166.60 ,$162.50 ,$174.13 ,$55.55 ,$197.50 ,$122.57 , N/A , N/A ,$57.43 , N/A ,$183.40 ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),11750072,11750,HC REMOVAL NAIL BED PRV 72 HR,510,1 ,$306.00 ,$153.00 ,$64.61 ,$832.58 ,$785.45 ,$129.00 ,$103.00 ,$104.04 ,$244.80 ,$260.10 ,$191.25 ,$275.40 ,$785.45 ,$290.70 ,$275.40 ,$260.10 ,$260.10 ,$104.04 ,$260.10 ,$260.10 ,$275.40 ,$785.45 ,$64.61 ,$275.40 ,$794.25 ,$281.52 ,$275.40 ,$203.92 ,$203.92 ,$186.35 ,$203.92 ,$198.90 ,$213.13 ,$67.99 ,$241.74 ,$832.58 ,$153.00 ,$153.00 ,$104.04 ,$153.00 ,$353.00 ,$290.70 ,$250.92 ,$250.92 ,$244.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),11981072,11981,HC INSERT DRUG IMPLANT DEVICE,983,1 ,$265.00 ,$132.50 ,$58.88 ,$305.55 ,$288.25 ,$224.16 ,$224.16 ,$65.33 ,$212.00 ,$225.25 ,$165.63 ,$238.50 ,$288.25 ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$65.33 ,$225.25 ,$225.25 ,$238.50 ,$288.25 ,$111.30 ,$238.50 ,$259.11 ,$243.80 ,$238.50 ,$176.60 ,$176.60 ,$161.39 ,$176.60 ,$172.25 ,$184.57 ,$58.88 ,$209.35 ,$305.55 , N/A , N/A ,$65.33 , N/A ,$115.16 ,$251.75 ,$217.30 ,$217.30 ,$212.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),12006072,12006,HC RP SPRF CL WOUNDS 20.1-30CM,981,1 ,$519.00 ,$259.50 ,$119.57 ,$794.25 ,$329.51 ,$439.02 ,$439.02 ,$119.57 ,$415.20 ,$441.15 ,$324.38 ,$467.10 ,$329.51 ,$493.05 ,$467.10 ,$441.15 ,$441.15 ,$119.57 ,$441.15 ,$441.15 ,$467.10 ,$329.51 ,$217.98 ,$467.10 ,$794.25 ,$477.48 ,$467.10 ,$345.86 ,$345.86 ,$316.07 ,$345.86 ,$337.35 ,$361.48 ,$120.77 ,$410.01 ,$349.28 , N/A , N/A ,$119.57 , N/A ,$353.00 ,$493.05 ,$425.58 ,$425.58 ,$415.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),12011072,12011,HC REPR SUPERF WND FACE <2.5CM,975,1 ,$464.00 ,$232.00 ,$56.66 ,$464.00 ,$329.51 ,$392.50 ,$392.50 ,$56.66 ,$371.20 ,$394.40 ,$290.00 ,$417.60 ,$329.51 ,$440.80 ,$417.60 ,$394.40 ,$394.40 ,$56.66 ,$394.40 ,$394.40 ,$417.60 ,$329.51 ,$194.88 ,$417.60 ,$412.65 ,$426.88 ,$417.60 ,$309.21 ,$309.21 ,$282.58 ,$309.21 ,$301.60 ,$323.18 ,$103.10 ,$366.56 ,$349.28 , N/A , N/A ,$56.66 , N/A ,$183.40 ,$440.80 ,$380.48 ,$380.48 ,$371.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),12035072,12035,HC LAYR CLOS WND TRUNK ARM LEG 12.6-20,975,1 ,$920.00 ,$460.00 ,$204.42 ,$920.00 ,$662.74 ,$778.23 ,$778.23 ,$250.70 ,$736.00 ,$782.00 ,$575.00 ,$828.00 ,$662.74 ,$874.00 ,$828.00 ,$782.00 ,$782.00 ,$250.70 ,$782.00 ,$782.00 ,$828.00 ,$662.74 ,$386.40 ,$828.00 ,$794.25 ,$846.40 ,$828.00 ,$613.09 ,$613.09 ,$560.28 ,$613.09 ,$598.00 ,$640.78 ,$204.42 ,$726.80 ,$702.50 , N/A , N/A ,$250.70 , N/A ,$353.00 ,$874.00 ,$754.40 ,$754.40 ,$736.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),12044072,12044,HC LAYER CLOS WND REST BODY,975,1 ,$793.00 ,$396.50 ,$176.20 ,"$1,203.50 ",$662.74 ,$670.80 ,$670.80 ,$224.24 ,$634.40 ,$674.05 ,$495.63 ,$713.70 ,$662.74 ,$753.35 ,$713.70 ,$674.05 ,$674.05 ,$224.24 ,$674.05 ,$674.05 ,$713.70 ,$662.74 ,$333.06 ,$713.70 ,"$1,203.50 ",$729.56 ,$713.70 ,$528.46 ,$528.46 ,$482.94 ,$528.46 ,$515.45 ,$552.32 ,$176.20 ,$626.47 ,$702.50 , N/A , N/A ,$224.24 , N/A ,$534.89 ,$753.35 ,$650.26 ,$650.26 ,$634.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),12052072,12052,HC LAYR CLOS WND FACE,975,1 ,$764.00 ,$382.00 ,$169.76 ,$794.25 ,$662.74 ,$646.27 ,$646.27 ,$210.07 ,$611.20 ,$649.40 ,$477.50 ,$687.60 ,$662.74 ,$725.80 ,$687.60 ,$649.40 ,$649.40 ,$210.07 ,$649.40 ,$649.40 ,$687.60 ,$662.74 ,$320.88 ,$687.60 ,$794.25 ,$702.88 ,$687.60 ,$509.13 ,$509.13 ,$465.28 ,$509.13 ,$496.60 ,$532.13 ,$169.76 ,$603.56 ,$702.50 , N/A , N/A ,$210.07 , N/A ,$353.00 ,$725.80 ,$626.48 ,$626.48 ,$611.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),12100001,N/A,HC DAILY SERVICE,121,1 ,"$1,532.00 ",$766.00 ,$766.00 ,"$1,532.00 ", Inpatient Medicaid ,"$9,167.00 ","$9,167.00 ", Inpatient Medicare ,"$1,225.60 ","$1,302.20 ",$957.50 ,"$1,378.80 ", Inpatient Medicaid ,"$1,455.40 ","$1,378.80 ","$1,302.20 ","$1,302.20 ", Inpatient Medicare ,"$1,302.20 ","$1,302.20 ","$1,378.80 ", Inpatient Medicaid ,"$11,879.79 ","$1,378.80 ", Inpatient Medicare +100% ,"$1,409.44 ","$1,378.80 ","$8,508.05 ","$8,508.05 ",$932.99 ,"$8,508.05 ",$995.80 ,"$1,067.04 ", Inpatient Medicaid ,"$1,210.28 ", Inpatient Medicaid +6% ,"$9,035.00 ","$9,035.00 ", Inpatient Medicare ,"$10,328.00 ",$550.00 ,"$1,455.40 ","$1,256.24 ","$1,256.24 ","$1,225.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),12800001,N/A,HC DAILY REHAB SERVICE,128,1 ,$466.00 ,$233.00 ,$233.00 ,$466.00 , Inpatient Medicaid ,"$9,167.00 ","$9,167.00 ", Inpatient Medicare ,$372.80 ,$396.10 ,$291.25 ,$419.40 , Inpatient Medicaid ,$442.70 ,$419.40 ,$396.10 ,$396.10 , Inpatient Medicare ,$396.10 ,$396.10 ,$419.40 , Inpatient Medicaid ,"$2,036.53 ",$419.40 , Inpatient Medicare +100% ,$428.72 ,$419.40 ,"$8,508.05 ","$8,508.05 ",$283.79 ,"$8,508.05 ",$302.90 ,$324.57 , Inpatient Medicaid ,$368.14 , Inpatient Medicaid +6% ,"$1,427.00 ","$1,427.00 ", Inpatient Medicare ,"$1,598.00 ",$550.00 ,$442.70 ,$382.12 ,$382.12 ,$372.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),15120072,15120,HC AUTOGRPH F F DG 100SQCM-72 HR,975,1 ,"$3,387.00 ","$1,693.50 ",$722.93 ,"$8,091.50 ","$3,452.13 ","$2,865.06 ","$2,865.06 ",$722.93 ,"$2,709.60 ","$2,878.95 ","$2,116.88 ","$3,048.30 ","$3,452.13 ","$3,217.65 ","$3,048.30 ","$2,878.95 ","$2,878.95 ",$722.93 ,"$2,878.95 ","$2,878.95 ","$3,048.30 ","$3,452.13 ","$1,422.54 ","$3,048.30 ","$8,091.50 ","$3,116.04 ","$3,048.30 ","$2,257.10 ","$2,257.10 ","$2,062.68 ","$2,257.10 ","$2,201.55 ","$2,359.05 ",$752.59 ,"$2,675.73 ","$3,659.26 ", N/A , N/A ,$722.93 , N/A ,"$3,596.22 ","$3,217.65 ","$2,777.34 ","$2,777.34 ","$2,709.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),16900000,N/A,HC DAILY SERVICE PROLONGED STAY,169,1 ,$466.00 ,$233.00 ,$233.00 ,$466.00 , Inpatient Medicaid ,"$9,167.00 ","$9,167.00 ", Inpatient Medicare ,$372.80 ,$396.10 ,$291.25 ,$419.40 , Inpatient Medicaid ,$442.70 ,$419.40 ,$396.10 ,$396.10 , Inpatient Medicare ,$396.10 ,$396.10 ,$419.40 , Inpatient Medicaid ,"$11,879.79 ",$419.40 , Inpatient Medicare +100% ,$428.72 ,$419.40 ,"$8,508.05 ","$8,508.05 ",$283.79 ,"$8,508.05 ",$302.90 ,$324.57 , Inpatient Medicaid ,$368.14 , Inpatient Medicaid +6% ,"$9,035.00 ","$9,035.00 ", Inpatient Medicare ,"$10,328.00 ",$550.00 ,$442.70 ,$382.12 ,$382.12 ,$372.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),17110072,17110,HC DESTRUCT BENIGN LESION <15 FACIL-PRV 72HR,983,1 ,$281.00 ,$140.50 ,$62.44 ,$412.65 ,$288.25 ,$237.70 ,$237.70 ,$70.76 ,$224.80 ,$238.85 ,$175.63 ,$252.90 ,$288.25 ,$266.95 ,$252.90 ,$238.85 ,$238.85 ,$70.76 ,$238.85 ,$238.85 ,$252.90 ,$288.25 ,$118.02 ,$252.90 ,$412.65 ,$258.52 ,$252.90 ,$187.26 ,$187.26 ,$171.13 ,$187.26 ,$182.65 ,$195.72 ,$62.44 ,$221.99 ,$305.55 , N/A , N/A ,$70.76 , N/A ,$183.40 ,$266.95 ,$230.42 ,$230.42 ,$224.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),19120072,19120,HC EXC FIBROADNOMA BREAST-PRV 72HR,975,1 ,"$2,015.00 ","$1,007.50 ",$431.33 ,"$7,256.25 ","$2,466.42 ","$1,704.49 ","$1,704.49 ",$431.33 ,"$1,612.00 ","$1,712.75 ","$1,259.38 ","$1,813.50 ","$2,466.42 ","$1,914.25 ","$1,813.50 ","$1,712.75 ","$1,712.75 ",$431.33 ,"$1,712.75 ","$1,712.75 ","$1,813.50 ","$2,466.42 ",$846.30 ,"$1,813.50 ","$7,256.25 ","$1,853.80 ","$1,813.50 ","$1,342.80 ","$1,342.80 ","$1,227.14 ","$1,342.80 ","$1,309.75 ","$1,403.45 ",$447.73 ,"$1,591.85 ","$2,614.41 ", N/A , N/A ,$431.33 , N/A ,"$3,225.00 ","$1,914.25 ","$1,652.30 ","$1,652.30 ","$1,612.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),19125072,19125,HC EXC LESION BREAST OPEN MARKER-PRV 72HR,975,1 ,"$2,420.00 ","$1,210.00 ",$476.96 ,"$7,256.25 ","$2,466.42 ","$2,047.08 ","$2,047.08 ",$476.96 ,"$1,936.00 ","$2,057.00 ","$1,512.50 ","$2,178.00 ","$2,466.42 ","$2,299.00 ","$2,178.00 ","$2,057.00 ","$2,057.00 ",$476.96 ,"$2,057.00 ","$2,057.00 ","$2,178.00 ","$2,466.42 ","$1,016.40 ","$2,178.00 ","$7,256.25 ","$2,226.40 ","$2,178.00 ","$1,612.69 ","$1,612.69 ","$1,473.78 ","$1,612.69 ","$1,573.00 ","$1,685.53 ",$537.72 ,"$1,911.80 ","$2,614.41 ", N/A , N/A ,$476.96 , N/A ,"$3,225.00 ","$2,299.00 ","$1,984.40 ","$1,984.40 ","$1,936.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),19301072,19301,HC MASTECTOMY PARTIAL,975,1 ,"$1,935.00 ",$967.50 ,$429.96 ,"$7,256.25 ","$5,708.39 ","$1,636.82 ","$1,636.82 ",$680.90 ,"$1,548.00 ","$1,644.75 ","$1,209.38 ","$1,741.50 ","$5,708.39 ","$1,838.25 ","$1,741.50 ","$1,644.75 ","$1,644.75 ",$680.90 ,"$1,644.75 ","$1,644.75 ","$1,741.50 ","$5,708.39 ",$812.70 ,"$1,741.50 ","$7,256.25 ","$1,780.20 ","$1,741.50 ","$1,289.48 ","$1,289.48 ","$1,178.42 ","$1,289.48 ","$1,257.75 ","$1,347.73 ",$429.96 ,"$1,528.65 ","$6,050.89 ", N/A , N/A ,$680.90 , N/A ,"$3,225.00 ","$1,838.25 ","$1,586.70 ","$1,586.70 ","$1,548.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),20600002,N/A,HC DAILY SERVICE IMCU,206,1 ,"$3,105.00 ","$1,552.50 ","$1,552.50 ","$3,105.00 ", Inpatient Medicaid ,"$9,167.00 ","$9,167.00 ", Inpatient Medicare ,"$2,484.00 ","$2,639.25 ","$1,940.63 ","$2,794.50 ", Inpatient Medicaid ,"$2,949.75 ","$2,794.50 ","$2,639.25 ","$2,639.25 ", Inpatient Medicare ,"$2,639.25 ","$2,639.25 ","$2,794.50 ", Inpatient Medicaid ,"$11,879.79 ","$2,794.50 ", Inpatient Medicare +100% ,"$2,856.60 ","$2,794.50 ","$8,508.05 ","$8,508.05 ","$1,890.95 ","$8,508.05 ","$2,018.25 ","$2,162.63 ", Inpatient Medicaid ,"$2,452.95 ", Inpatient Medicaid +6% ,"$9,035.00 ","$9,035.00 ", Inpatient Medicare ,"$10,328.00 ",$550.00 ,"$2,949.75 ","$2,546.10 ","$2,546.10 ","$2,484.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),25000275,N/A,HC VISCOAT 0.5ML,250,1 ,$72.00 ,$36.00 ,$16.00 ,$72.00 , N/A ,$60.90 ,$60.90 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 , N/A ,$30.24 ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 , N/A ,$36.00 ,$36.00 ,$24.48 ,$36.00 , N/A ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$448.00 ,$224.00 ,$99.55 ,$566.19 ,$534.14 ,$378.96 ,$378.96 ,$152.32 ,$358.40 ,$380.80 ,$280.00 ,$403.20 ,$534.14 ,$425.60 ,$403.20 ,$380.80 ,$380.80 ,$152.32 ,$380.80 ,$380.80 ,$403.20 ,$534.14 ,$188.16 ,$403.20 ,$470.09 ,$412.16 ,$403.20 ,$298.55 ,$298.55 ,$272.83 ,$298.55 ,$291.20 ,$312.03 ,$99.55 ,$353.92 ,$566.19 ,$425.00 ,$425.00 ,$152.32 ,$448.00 ,$208.93 ,$425.60 ,$367.36 ,$367.36 ,$358.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$179.00 ,$89.50 ,$39.77 ,$958.24 ,$904.00 ,$151.42 ,$151.42 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$904.00 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$904.00 ,$75.18 ,$161.10 ,$91.96 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$958.24 ,$179.00 ,$179.00 ,$60.86 ,$179.00 ,$40.87 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$538.00 ,$269.00 ,$119.54 ,$566.19 ,$534.14 ,$455.09 ,$455.09 ,$182.92 ,$430.40 ,$457.30 ,$336.25 ,$484.20 ,$534.14 ,$511.10 ,$484.20 ,$457.30 ,$457.30 ,$182.92 ,$457.30 ,$457.30 ,$484.20 ,$534.14 ,$225.96 ,$484.20 ,$470.09 ,$494.96 ,$484.20 ,$358.52 ,$358.52 ,$327.64 ,$358.52 ,$349.70 ,$374.72 ,$119.54 ,$425.02 ,$566.19 ,$425.00 ,$425.00 ,$182.92 ,$472.00 ,$208.93 ,$511.10 ,$441.16 ,$441.16 ,$430.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$179.00 ,$89.50 ,$39.77 ,$958.24 ,$904.00 ,$151.42 ,$151.42 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$904.00 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$904.00 ,$75.18 ,$161.10 ,$91.96 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$958.24 ,$179.00 ,$179.00 ,$60.86 ,$179.00 ,$40.87 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$168.00 ,$84.00 ,$37.33 ,$566.19 ,$534.14 ,$142.11 ,$142.11 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$534.14 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$534.14 ,$70.56 ,$151.20 ,$142.47 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$566.19 ,$168.00 ,$168.00 ,$57.12 ,$168.00 ,$63.32 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000005,96368,HC INFUS CONCURRENT,260,1 ,$258.00 ,$129.00 ,$57.33 ,$566.19 ,$534.14 ,$218.24 ,$218.24 ,$87.72 ,$206.40 ,$219.30 ,$161.25 ,$232.20 ,$534.14 ,$245.10 ,$232.20 ,$219.30 ,$219.30 ,$87.72 ,$219.30 ,$219.30 ,$232.20 ,$534.14 ,$108.36 ,$232.20 , N/A ,$237.36 ,$232.20 ,$171.93 ,$171.93 ,$157.12 ,$171.93 ,$167.70 ,$179.70 ,$57.33 ,$203.82 ,$566.19 ,$258.00 ,$258.00 ,$87.72 ,$258.00 , N/A ,$245.10 ,$211.56 ,$211.56 ,$206.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000014,M0239,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB",260,1 ,$697.00 ,$348.50 ,$154.87 ,$697.00 ,$309.60 ,$589.59 ,$589.59 ,$236.98 ,$557.60 ,$592.45 ,$435.63 ,$627.30 ,$309.60 ,$662.15 ,$627.30 ,$592.45 ,$592.45 ,$236.98 ,$592.45 ,$592.45 ,$627.30 ,$309.60 ,$292.74 ,$627.30 , N/A ,$641.24 ,$627.30 ,$464.48 ,$464.48 ,$424.47 ,$464.48 ,$453.05 ,$485.46 ,$154.87 ,$550.63 ,$328.18 ,$425.00 ,$425.00 ,$236.98 ,$472.00 , N/A ,$662.15 ,$571.54 ,$571.54 ,$557.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000015,M0243,"HC INTRAVENOUS INFUSION, CASIRIVIMAB AND IMDEVIMAB ADMINISTRATION",260,1 ,$932.00 ,$466.00 ,$207.09 ,"$1,013.63 ",$450.00 ,$788.38 ,$788.38 ,$316.88 ,$745.60 ,$792.20 ,$582.50 ,$838.80 ,$450.00 ,$885.40 ,$838.80 ,$792.20 ,$792.20 ,$316.88 ,$792.20 ,$792.20 ,$838.80 ,$450.00 ,$391.44 ,$838.80 ,"$1,013.63 ",$857.44 ,$838.80 ,$621.08 ,$621.08 ,$567.59 ,$621.08 ,$605.80 ,$649.14 ,$207.09 ,$736.28 ,$477.00 ,$425.00 ,$425.00 ,$316.88 ,$472.00 ,$450.50 ,$885.40 ,$764.24 ,$764.24 ,$745.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000016,M0245,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB AND ETESEVIMAB ADMINISTRATION",260,1 ,$804.00 ,$402.00 ,$178.65 ,"$1,013.63 ",$450.00 ,$680.10 ,$680.10 ,$273.36 ,$643.20 ,$683.40 ,$502.50 ,$723.60 ,$450.00 ,$763.80 ,$723.60 ,$683.40 ,$683.40 ,$273.36 ,$683.40 ,$683.40 ,$723.60 ,$450.00 ,$337.68 ,$723.60 ,"$1,013.63 ",$739.68 ,$723.60 ,$535.79 ,$535.79 ,$489.64 ,$535.79 ,$522.60 ,$559.99 ,$178.65 ,$635.16 ,$477.00 ,$425.00 ,$425.00 ,$273.36 ,$472.00 ,$450.50 ,$763.80 ,$659.28 ,$659.28 ,$643.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,164.00 ",$582.00 ,$258.64 ,"$1,164.00 ",$450.00 ,$984.63 ,$984.63 ,$395.76 ,$931.20 ,$989.40 ,$727.50 ,"$1,047.60 ",$450.00 ,"$1,105.80 ","$1,047.60 ",$989.40 ,$989.40 ,$395.76 ,$989.40 ,$989.40 ,"$1,047.60 ",$450.00 ,$488.88 ,"$1,047.60 ","$1,013.63 ","$1,070.88 ","$1,047.60 ",$775.69 ,$775.69 ,$708.88 ,$775.69 ,$756.60 ,$810.73 ,$258.64 ,$919.56 ,$477.00 ,$425.00 ,$425.00 ,$395.76 ,$472.00 ,$450.50 ,"$1,105.80 ",$954.48 ,$954.48 ,$931.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27000126,N/A,HC DISPOSABLE LINER,270,1 ,$43.00 ,$21.50 ,$9.55 ,$43.00 , N/A ,$36.37 ,$36.37 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 , N/A ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 , N/A ,$18.06 ,$38.70 , N/A ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 , N/A ,$21.50 ,$21.50 ,$14.62 ,$21.50 , N/A ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100032,N/A,HC CEMENT MIXER,272,1 ,$182.00 ,$91.00 ,$40.44 ,$182.00 , N/A ,$153.95 ,$153.95 ,$61.88 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$61.88 ,$154.70 ,$154.70 ,$163.80 , N/A ,$76.44 ,$163.80 , N/A ,$167.44 ,$163.80 ,$121.28 ,$121.28 ,$110.84 ,$121.28 ,$118.30 ,$126.76 ,$40.44 ,$143.78 , N/A ,$91.00 ,$91.00 ,$61.88 ,$91.00 , N/A ,$172.90 ,$149.24 ,$149.24 ,$145.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100095,N/A,HC MONTGOMERY STRAPS,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100107,N/A,HC OXYGEN HOURLY,271,1 ,$23.00 ,$11.50 ,$5.11 ,$23.00 , N/A ,$19.46 ,$19.46 ,$7.82 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$7.82 ,$19.55 ,$19.55 ,$20.70 , N/A ,$9.66 ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.33 ,$15.33 ,$14.01 ,$15.33 ,$14.95 ,$16.02 ,$5.11 ,$18.17 , N/A ,$11.50 ,$11.50 ,$7.82 ,$11.50 , N/A ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100111,N/A,HC PAD WEBRIL 2IN,271,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100118,N/A,HC POST OP SHOE,271,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100148,L3908,HC SPLINT THUMB SPICA FIT AND ADJUST,274,1 ,$155.00 ,$77.50 ,$34.44 ,$196.47 , N/A ,$70.40 ,$70.40 ,$52.70 ,$124.00 ,$131.75 ,$96.88 ,$139.50 , N/A ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$52.70 ,$131.75 ,$131.75 ,$139.50 , N/A ,$65.10 ,$139.50 ,$196.47 ,$142.60 ,$139.50 ,$103.29 ,$103.29 ,$94.40 ,$103.29 ,$100.75 ,$107.96 ,$34.44 ,$122.45 , N/A , N/A , N/A ,$52.70 , N/A ,$87.32 ,$147.25 ,$127.10 ,$127.10 ,$124.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100150,N/A,HC WRIST/FOREARM SPLINT,271,1 ,$76.00 ,$38.00 ,$16.89 ,$76.00 , N/A ,$64.29 ,$64.29 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 , N/A ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 , N/A ,$31.92 ,$68.40 , N/A ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 , N/A ,$38.00 ,$38.00 ,$25.84 ,$38.00 , N/A ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100156,N/A,"HC TOURNIQUET  AND  TUBING 18 """,271,1 ,$63.00 ,$31.50 ,$14.00 ,$63.00 , N/A ,$53.29 ,$53.29 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 , N/A ,$26.46 ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 , N/A ,$31.50 ,$31.50 ,$21.42 ,$31.50 , N/A ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100157,N/A,"HC TOURNIQUET  AND  TUBING 24 """,271,1 ,$71.00 ,$35.50 ,$15.78 ,$71.00 , N/A ,$60.06 ,$60.06 ,$24.14 ,$56.80 ,$60.35 ,$44.38 ,$63.90 , N/A ,$67.45 ,$63.90 ,$60.35 ,$60.35 ,$24.14 ,$60.35 ,$60.35 ,$63.90 , N/A ,$29.82 ,$63.90 , N/A ,$65.32 ,$63.90 ,$47.31 ,$47.31 ,$43.24 ,$47.31 ,$46.15 ,$49.45 ,$15.78 ,$56.09 , N/A ,$35.50 ,$35.50 ,$24.14 ,$35.50 , N/A ,$67.45 ,$58.22 ,$58.22 ,$56.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100158,N/A,HC TOURNIQUET\TUBING 34-44,271,1 ,$82.00 ,$41.00 ,$18.22 ,$82.00 , N/A ,$69.36 ,$69.36 ,$27.88 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$27.88 ,$69.70 ,$69.70 ,$73.80 , N/A ,$34.44 ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.64 ,$54.64 ,$49.94 ,$54.64 ,$53.30 ,$57.11 ,$18.22 ,$64.78 , N/A ,$41.00 ,$41.00 ,$27.88 ,$41.00 , N/A ,$77.90 ,$67.24 ,$67.24 ,$65.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100174,N/A,HC RIB BELT UNIVERSAL,271,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100177,N/A,HC SHIELD EYE,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100179,N/A,HC SURGICAL BRA,271,1 ,$63.00 ,$31.50 ,$14.00 ,$63.00 , N/A ,$53.29 ,$53.29 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 , N/A ,$26.46 ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 , N/A ,$31.50 ,$31.50 ,$21.42 ,$31.50 , N/A ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100183,N/A,HC WALKING BRACE LOW TIDE,271,1 ,$68.00 ,$34.00 ,$15.11 ,$68.00 , N/A ,$57.52 ,$57.52 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 , N/A ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 , N/A ,$28.56 ,$61.20 , N/A ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 , N/A ,$34.00 ,$34.00 ,$23.12 ,$34.00 , N/A ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200005,B4087,HC MAGNA PORT G-TUBE SET,272,1 ,$55.00 ,$27.50 ,$18.70 ,$55.00 , N/A ,$31.30 ,$31.30 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 , N/A ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 , N/A ,$23.10 ,$49.50 ,$33.00 ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 , N/A ,$43.45 , N/A ,$27.50 ,$27.50 ,$18.70 ,$27.50 , N/A ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200020,C1726,HC CATH RELIEVA SINUS BAL 6X16,272,1 ,"$2,435.00 ","$1,217.50 ",$541.06 ,"$2,435.00 ", N/A ,"$2,059.77 ","$2,059.77 ",$827.90 ,"$1,948.00 ","$2,069.75 ","$1,521.88 ","$2,191.50 ", N/A ,"$2,313.25 ","$2,191.50 ","$2,069.75 ","$2,069.75 ",$827.90 ,"$2,069.75 ","$2,069.75 ","$2,191.50 ", N/A ,"$1,022.70 ","$2,191.50 ", N/A ,"$2,240.20 ","$2,191.50 ","$1,622.68 ","$1,622.68 ","$1,482.92 ","$1,622.68 ","$1,582.75 ","$1,695.98 ",$541.06 ,"$1,923.65 ", N/A ,"$1,217.50 ","$1,217.50 ",$827.90 ,"$1,217.50 ", N/A ,"$2,313.25 ","$1,996.70 ","$1,996.70 ","$1,948.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200021,C1726,HC CATH RELIVEA SINUS BAL 7X24,272,1 ,"$3,796.00 ","$1,898.00 ",$843.47 ,"$3,796.00 ", N/A ,"$3,211.04 ","$3,211.04 ","$1,290.64 ","$3,036.80 ","$3,226.60 ","$2,372.50 ","$3,416.40 ", N/A ,"$3,606.20 ","$3,416.40 ","$3,226.60 ","$3,226.60 ","$1,290.64 ","$3,226.60 ","$3,226.60 ","$3,416.40 ", N/A ,"$1,594.32 ","$3,416.40 ", N/A ,"$3,492.32 ","$3,416.40 ","$2,529.65 ","$2,529.65 ","$2,311.76 ","$2,529.65 ","$2,467.40 ","$2,643.91 ",$843.47 ,"$2,998.84 ", N/A ,"$1,898.00 ","$1,898.00 ","$1,290.64 ","$1,898.00 ", N/A ,"$3,606.20 ","$3,112.72 ","$3,112.72 ","$3,036.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200022,C1726,HC CATH UROMAX ULTRA BALOON,272,1 ,"$1,022.00 ",$511.00 ,$227.09 ,"$1,022.00 ", N/A ,$864.51 ,$864.51 ,$347.48 ,$817.60 ,$868.70 ,$638.75 ,$919.80 , N/A ,$970.90 ,$919.80 ,$868.70 ,$868.70 ,$347.48 ,$868.70 ,$868.70 ,$919.80 , N/A ,$429.24 ,$919.80 , N/A ,$940.24 ,$919.80 ,$681.06 ,$681.06 ,$622.40 ,$681.06 ,$664.30 ,$711.82 ,$227.09 ,$807.38 , N/A ,$511.00 ,$511.00 ,$347.48 ,$511.00 , N/A ,$970.90 ,$838.04 ,$838.04 ,$817.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200025,C1726,SVG HC CRE BALLOON,272,1 ,$594.00 ,$297.00 ,$131.99 ,$594.00 , N/A ,$502.46 ,$502.46 ,$201.96 ,$475.20 ,$504.90 ,$371.25 ,$534.60 , N/A ,$564.30 ,$534.60 ,$504.90 ,$504.90 ,$201.96 ,$504.90 ,$504.90 ,$534.60 , N/A ,$249.48 ,$534.60 , N/A ,$546.48 ,$534.60 ,$395.84 ,$395.84 ,$361.75 ,$395.84 ,$386.10 ,$413.72 ,$131.99 ,$469.26 , N/A ,$297.00 ,$297.00 ,$201.96 ,$297.00 , N/A ,$564.30 ,$487.08 ,$487.08 ,$475.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200034,C1729,HC CATHETER DRAINAGE,272,1 ,$537.00 ,$268.50 ,$119.32 ,$537.00 , N/A ,$454.25 ,$454.25 ,$182.58 ,$429.60 ,$456.45 ,$335.63 ,$483.30 , N/A ,$510.15 ,$483.30 ,$456.45 ,$456.45 ,$182.58 ,$456.45 ,$456.45 ,$483.30 , N/A ,$225.54 ,$483.30 , N/A ,$494.04 ,$483.30 ,$357.86 ,$357.86 ,$327.03 ,$357.86 ,$349.05 ,$374.02 ,$119.32 ,$424.23 , N/A ,$268.50 ,$268.50 ,$182.58 ,$268.50 , N/A ,$510.15 ,$440.34 ,$440.34 ,$429.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200051,C1729,HC CATHETERS CONE 8FR,272,1 ,$53.00 ,$26.50 ,$11.78 ,$53.00 , N/A ,$44.83 ,$44.83 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 , N/A ,$22.26 ,$47.70 , N/A ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 , N/A ,$26.50 ,$26.50 ,$18.02 ,$26.50 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200067,C1757,HC CATH EMBOLECTOMY,272,1 ,$350.00 ,$175.00 ,$77.77 ,$350.00 , N/A ,$296.07 ,$296.07 ,$119.00 ,$280.00 ,$297.50 ,$218.75 ,$315.00 , N/A ,$332.50 ,$315.00 ,$297.50 ,$297.50 ,$119.00 ,$297.50 ,$297.50 ,$315.00 , N/A ,$147.00 ,$315.00 , N/A ,$322.00 ,$315.00 ,$233.24 ,$233.24 ,$213.15 ,$233.24 ,$227.50 ,$243.78 ,$77.77 ,$276.50 , N/A ,$175.00 ,$175.00 ,$119.00 ,$175.00 , N/A ,$332.50 ,$287.00 ,$287.00 ,$280.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200068,C1757,HC CATH FOGARTY ADHERENT 4F,272,1 ,"$1,473.00 ",$736.50 ,$327.30 ,"$1,473.00 ", N/A ,"$1,246.01 ","$1,246.01 ",$500.82 ,"$1,178.40 ","$1,252.05 ",$920.63 ,"$1,325.70 ", N/A ,"$1,399.35 ","$1,325.70 ","$1,252.05 ","$1,252.05 ",$500.82 ,"$1,252.05 ","$1,252.05 ","$1,325.70 ", N/A ,$618.66 ,"$1,325.70 ", N/A ,"$1,355.16 ","$1,325.70 ",$981.61 ,$981.61 ,$897.06 ,$981.61 ,$957.45 ,"$1,025.94 ",$327.30 ,"$1,163.67 ", N/A ,$736.50 ,$736.50 ,$500.82 ,$736.50 , N/A ,"$1,399.35 ","$1,207.86 ","$1,207.86 ","$1,178.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200075,C1758,HC CATHETER URETERAL,272,1 ,$277.00 ,$138.50 ,$61.55 ,$277.00 , N/A ,$234.31 ,$234.31 ,$94.18 ,$221.60 ,$235.45 ,$173.13 ,$249.30 , N/A ,$263.15 ,$249.30 ,$235.45 ,$235.45 ,$94.18 ,$235.45 ,$235.45 ,$249.30 , N/A ,$116.34 ,$249.30 , N/A ,$254.84 ,$249.30 ,$184.59 ,$184.59 ,$168.69 ,$184.59 ,$180.05 ,$192.93 ,$61.55 ,$218.83 , N/A ,$138.50 ,$138.50 ,$94.18 ,$138.50 , N/A ,$263.15 ,$227.14 ,$227.14 ,$221.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200076,C1758,HC OPEN END 5FR ACCESS (021305),272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200098,C1769,SVG HC GUIDEWIRE,272,1 ,$36.00 ,$18.00 ,$8.00 ,$36.00 , N/A ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 , N/A ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 , N/A ,$18.00 ,$18.00 ,$12.24 ,$18.00 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200100,C1769,HC GUIDEWIRE - STIFF,272,1 ,$178.00 ,$89.00 ,$39.55 ,$178.00 , N/A ,$150.57 ,$150.57 ,$60.52 ,$142.40 ,$151.30 ,$111.25 ,$160.20 , N/A ,$169.10 ,$160.20 ,$151.30 ,$151.30 ,$60.52 ,$151.30 ,$151.30 ,$160.20 , N/A ,$74.76 ,$160.20 , N/A ,$163.76 ,$160.20 ,$118.62 ,$118.62 ,$108.40 ,$118.62 ,$115.70 ,$123.98 ,$39.55 ,$140.62 , N/A ,$89.00 ,$89.00 ,$60.52 ,$89.00 , N/A ,$169.10 ,$145.96 ,$145.96 ,$142.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200102,C1769,HC GUIDEWIRE .35 SENSOR STRAIGHT,272,1 ,$140.00 ,$70.00 ,$31.11 ,$140.00 , N/A ,$118.43 ,$118.43 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 , N/A ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 , N/A ,$58.80 ,$126.00 , N/A ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 , N/A ,$70.00 ,$70.00 ,$47.60 ,$70.00 , N/A ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200105,C1769,HC GUIDEWIRE 3MM J TIP,272,1 ,$36.00 ,$18.00 ,$8.00 ,$36.00 , N/A ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 , N/A ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 , N/A ,$18.00 ,$18.00 ,$12.24 ,$18.00 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200110,C1769,HC GUIDEWIRE SYN 2.8 THREADED,272,1 ,$147.00 ,$73.50 ,$32.66 ,$147.00 , N/A ,$124.35 ,$124.35 ,$49.98 ,$117.60 ,$124.95 ,$91.88 ,$132.30 , N/A ,$139.65 ,$132.30 ,$124.95 ,$124.95 ,$49.98 ,$124.95 ,$124.95 ,$132.30 , N/A ,$61.74 ,$132.30 , N/A ,$135.24 ,$132.30 ,$97.96 ,$97.96 ,$89.52 ,$97.96 ,$95.55 ,$102.39 ,$32.66 ,$116.13 , N/A ,$73.50 ,$73.50 ,$49.98 ,$73.50 , N/A ,$139.65 ,$120.54 ,$120.54 ,$117.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200126,C1769,HC WIRE NON THREAD GUIDE,272,1 ,$84.00 ,$42.00 ,$18.66 ,$84.00 , N/A ,$71.06 ,$71.06 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 , N/A ,$35.28 ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 , N/A ,$42.00 ,$42.00 ,$28.56 ,$42.00 , N/A ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200131,C1769,HC WIRE SYN 3.2MM GUIDE,272,1 ,$288.00 ,$144.00 ,$63.99 ,$288.00 , N/A ,$243.62 ,$243.62 ,$97.92 ,$230.40 ,$244.80 ,$180.00 ,$259.20 , N/A ,$273.60 ,$259.20 ,$244.80 ,$244.80 ,$97.92 ,$244.80 ,$244.80 ,$259.20 , N/A ,$120.96 ,$259.20 , N/A ,$264.96 ,$259.20 ,$191.92 ,$191.92 ,$175.39 ,$191.92 ,$187.20 ,$200.59 ,$63.99 ,$227.52 , N/A ,$144.00 ,$144.00 ,$97.92 ,$144.00 , N/A ,$273.60 ,$236.16 ,$236.16 ,$230.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200134,C1769,HC WIRE SYNTHES 1.25 THRDED GUIDE,272,1 ,$96.00 ,$48.00 ,$21.33 ,$96.00 , N/A ,$81.21 ,$81.21 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 , N/A ,$40.32 ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 , N/A ,$48.00 ,$48.00 ,$32.64 ,$48.00 , N/A ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200154,C1887,HC CATH RELIEVA SINUS GUIDE F-70,272,1 ,"$1,154.00 ",$577.00 ,$256.42 ,"$1,154.00 ", N/A ,$976.17 ,$976.17 ,$392.36 ,$923.20 ,$980.90 ,$721.25 ,"$1,038.60 ", N/A ,"$1,096.30 ","$1,038.60 ",$980.90 ,$980.90 ,$392.36 ,$980.90 ,$980.90 ,"$1,038.60 ", N/A ,$484.68 ,"$1,038.60 ", N/A ,"$1,061.68 ","$1,038.60 ",$769.03 ,$769.03 ,$702.79 ,$769.03 ,$750.10 ,$803.76 ,$256.42 ,$911.66 , N/A ,$577.00 ,$577.00 ,$392.36 ,$577.00 , N/A ,"$1,096.30 ",$946.28 ,$946.28 ,$923.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200155,C1887,HC CATH RELIEVA SINUS GUIDE M-110,272,1 ,"$1,154.00 ",$577.00 ,$256.42 ,"$1,154.00 ", N/A ,$976.17 ,$976.17 ,$392.36 ,$923.20 ,$980.90 ,$721.25 ,"$1,038.60 ", N/A ,"$1,096.30 ","$1,038.60 ",$980.90 ,$980.90 ,$392.36 ,$980.90 ,$980.90 ,"$1,038.60 ", N/A ,$484.68 ,"$1,038.60 ", N/A ,"$1,061.68 ","$1,038.60 ",$769.03 ,$769.03 ,$702.79 ,$769.03 ,$750.10 ,$803.76 ,$256.42 ,$911.66 , N/A ,$577.00 ,$577.00 ,$392.36 ,$577.00 , N/A ,"$1,096.30 ",$946.28 ,$946.28 ,$923.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200196,N/A,HC 5FR CATH,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200200,N/A,HC ABDOMINAL BINDERS,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200210,N/A,HC RETRACTOR RING,272,1 ,$143.00 ,$71.50 ,$31.77 ,$143.00 , N/A ,$120.96 ,$120.96 ,$48.62 ,$114.40 ,$121.55 ,$89.38 ,$128.70 , N/A ,$135.85 ,$128.70 ,$121.55 ,$121.55 ,$48.62 ,$121.55 ,$121.55 ,$128.70 , N/A ,$60.06 ,$128.70 , N/A ,$131.56 ,$128.70 ,$95.30 ,$95.30 ,$87.09 ,$95.30 ,$92.95 ,$99.60 ,$31.77 ,$112.97 , N/A ,$71.50 ,$71.50 ,$48.62 ,$71.50 , N/A ,$135.85 ,$117.26 ,$117.26 ,$114.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200211,N/A,HC ADAPT PASTE 0.5 OZ,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200218,N/A,HC ADAPTER URETERAL CATH CO,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$73.00 ,$36.50 ,$16.22 ,$73.00 , N/A ,$61.75 ,$61.75 ,$24.82 ,$58.40 ,$62.05 ,$45.63 ,$65.70 , N/A ,$69.35 ,$65.70 ,$62.05 ,$62.05 ,$24.82 ,$62.05 ,$62.05 ,$65.70 , N/A ,$30.66 ,$65.70 , N/A ,$67.16 ,$65.70 ,$48.65 ,$48.65 ,$44.46 ,$48.65 ,$47.45 ,$50.84 ,$16.22 ,$57.67 , N/A ,$36.50 ,$36.50 ,$24.82 ,$36.50 , N/A ,$69.35 ,$59.86 ,$59.86 ,$58.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200251,N/A,HC ANTI FOG FRED,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200257,N/A,HC AQUACEL DRESSINGS,272,1 ,$55.00 ,$27.50 ,$12.22 ,$55.00 , N/A ,$46.52 ,$46.52 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 , N/A ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 , N/A ,$23.10 ,$49.50 , N/A ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 , N/A ,$27.50 ,$27.50 ,$18.70 ,$27.50 , N/A ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200266,N/A,HC CANNULA GEMINI 8.25 X 9CM,272,1 ,$13.20 ,$6.60 ,$2.93 ,$13.20 , N/A ,$11.17 ,$11.17 ,$4.49 ,$10.56 ,$11.22 ,$8.25 ,$11.88 , N/A ,$12.54 ,$11.88 ,$11.22 ,$11.22 ,$4.49 ,$11.22 ,$11.22 ,$11.88 , N/A ,$5.54 ,$11.88 , N/A ,$12.14 ,$11.88 ,$8.80 ,$8.80 ,$8.04 ,$8.80 ,$8.58 ,$9.19 ,$2.93 ,$10.43 , N/A ,$6.60 ,$6.60 ,$4.49 ,$6.60 , N/A ,$12.54 ,$10.82 ,$10.82 ,$10.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200275,N/A,HC ARTHROSCOPY CUTTER,272,1 ,$404.00 ,$202.00 ,$89.77 ,$404.00 , N/A ,$341.74 ,$341.74 ,$137.36 ,$323.20 ,$343.40 ,$252.50 ,$363.60 , N/A ,$383.80 ,$363.60 ,$343.40 ,$343.40 ,$137.36 ,$343.40 ,$343.40 ,$363.60 , N/A ,$169.68 ,$363.60 , N/A ,$371.68 ,$363.60 ,$269.23 ,$269.23 ,$246.04 ,$269.23 ,$262.60 ,$281.39 ,$89.77 ,$319.16 , N/A ,$202.00 ,$202.00 ,$137.36 ,$202.00 , N/A ,$383.80 ,$331.28 ,$331.28 ,$323.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200277,N/A,HC ARTHROSCOPY TUBE SET,272,1 ,$321.00 ,$160.50 ,$71.33 ,$321.00 , N/A ,$271.53 ,$271.53 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 , N/A ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 , N/A ,$134.82 ,$288.90 , N/A ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 , N/A ,$160.50 ,$160.50 ,$109.14 ,$160.50 , N/A ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200283,N/A,HC ATRIUM CHEST DRAINAGE,272,1 ,$208.00 ,$104.00 ,$46.22 ,$208.00 , N/A ,$175.95 ,$175.95 ,$70.72 ,$166.40 ,$176.80 ,$130.00 ,$187.20 , N/A ,$197.60 ,$187.20 ,$176.80 ,$176.80 ,$70.72 ,$176.80 ,$176.80 ,$187.20 , N/A ,$87.36 ,$187.20 , N/A ,$191.36 ,$187.20 ,$138.61 ,$138.61 ,$126.67 ,$138.61 ,$135.20 ,$144.87 ,$46.22 ,$164.32 , N/A ,$104.00 ,$104.00 ,$70.72 ,$104.00 , N/A ,$197.60 ,$170.56 ,$170.56 ,$166.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200290,N/A,HC BAG BILE,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200295,N/A,HC BAG GENTLE TOUCH COLSTMY,272,1 ,$66.00 ,$33.00 ,$14.67 ,$66.00 , N/A ,$55.83 ,$55.83 ,$22.44 ,$52.80 ,$56.10 ,$41.25 ,$59.40 , N/A ,$62.70 ,$59.40 ,$56.10 ,$56.10 ,$22.44 ,$56.10 ,$56.10 ,$59.40 , N/A ,$27.72 ,$59.40 , N/A ,$60.72 ,$59.40 ,$43.98 ,$43.98 ,$40.19 ,$43.98 ,$42.90 ,$45.97 ,$14.67 ,$52.14 , N/A ,$33.00 ,$33.00 ,$22.44 ,$33.00 , N/A ,$62.70 ,$54.12 ,$54.12 ,$52.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200300,N/A,HC BAG URINARY DRAINAGE 1 LITER,272,1 ,$19.00 ,$9.50 ,$4.22 ,$19.00 , N/A ,$16.07 ,$16.07 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 , N/A ,$7.98 ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 , N/A ,$9.50 ,$9.50 ,$6.46 ,$9.50 , N/A ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200302,N/A,HC BAG URINE LEG STD,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200315,N/A,HC BANDAGE ACE 6 IN DBL STERILE CARD,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200318,N/A,HC BANDAGE ESMARK 4IN,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200320,N/A,HC BANDER/LIGATOR,272,1 ,$373.00 ,$186.50 ,$82.88 ,$373.00 , N/A ,$315.52 ,$315.52 ,$126.82 ,$298.40 ,$317.05 ,$233.13 ,$335.70 , N/A ,$354.35 ,$335.70 ,$317.05 ,$317.05 ,$126.82 ,$317.05 ,$317.05 ,$335.70 , N/A ,$156.66 ,$335.70 , N/A ,$343.16 ,$335.70 ,$248.57 ,$248.57 ,$227.16 ,$248.57 ,$242.45 ,$259.79 ,$82.88 ,$294.67 , N/A ,$186.50 ,$186.50 ,$126.82 ,$186.50 , N/A ,$354.35 ,$305.86 ,$305.86 ,$298.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200323,N/A,HC BASKET ESCAPE STONE 1.9FR,272,1 ,$660.00 ,$330.00 ,$146.65 ,$660.00 , N/A ,$558.29 ,$558.29 ,$224.40 ,$528.00 ,$561.00 ,$412.50 ,$594.00 , N/A ,$627.00 ,$594.00 ,$561.00 ,$561.00 ,$224.40 ,$561.00 ,$561.00 ,$594.00 , N/A ,$277.20 ,$594.00 , N/A ,$607.20 ,$594.00 ,$439.82 ,$439.82 ,$401.94 ,$439.82 ,$429.00 ,$459.69 ,$146.65 ,$521.40 , N/A ,$330.00 ,$330.00 ,$224.40 ,$330.00 , N/A ,$627.00 ,$541.20 ,$541.20 ,$528.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200350,N/A,HC GRASPING DEVICE 4 PRONG,272,1 ,$308.00 ,$154.00 ,$68.44 ,$308.00 , N/A ,$260.54 ,$260.54 ,$104.72 ,$246.40 ,$261.80 ,$192.50 ,$277.20 , N/A ,$292.60 ,$277.20 ,$261.80 ,$261.80 ,$104.72 ,$261.80 ,$261.80 ,$277.20 , N/A ,$129.36 ,$277.20 , N/A ,$283.36 ,$277.20 ,$205.25 ,$205.25 ,$187.57 ,$205.25 ,$200.20 ,$214.52 ,$68.44 ,$243.32 , N/A ,$154.00 ,$154.00 ,$104.72 ,$154.00 , N/A ,$292.60 ,$252.56 ,$252.56 ,$246.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200361,N/A,HC DRILL BIT 1.1,272,1 ,$237.00 ,$118.50 ,$52.66 ,$237.00 , N/A ,$200.48 ,$200.48 ,$80.58 ,$189.60 ,$201.45 ,$148.13 ,$213.30 , N/A ,$225.15 ,$213.30 ,$201.45 ,$201.45 ,$80.58 ,$201.45 ,$201.45 ,$213.30 , N/A ,$99.54 ,$213.30 , N/A ,$218.04 ,$213.30 ,$157.94 ,$157.94 ,$144.33 ,$157.94 ,$154.05 ,$165.07 ,$52.66 ,$187.23 , N/A ,$118.50 ,$118.50 ,$80.58 ,$118.50 , N/A ,$225.15 ,$194.34 ,$194.34 ,$189.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200362,N/A,HC DRILL BIT 1.5,272,1 ,$255.00 ,$127.50 ,$56.66 ,$255.00 , N/A ,$215.70 ,$215.70 ,$86.70 ,$204.00 ,$216.75 ,$159.38 ,$229.50 , N/A ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$86.70 ,$216.75 ,$216.75 ,$229.50 , N/A ,$107.10 ,$229.50 , N/A ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 , N/A ,$127.50 ,$127.50 ,$86.70 ,$127.50 , N/A ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200365,N/A,HC DRILL BIT 2.4,272,1 ,$247.00 ,$123.50 ,$54.88 ,$247.00 , N/A ,$208.94 ,$208.94 ,$83.98 ,$197.60 ,$209.95 ,$154.38 ,$222.30 , N/A ,$234.65 ,$222.30 ,$209.95 ,$209.95 ,$83.98 ,$209.95 ,$209.95 ,$222.30 , N/A ,$103.74 ,$222.30 , N/A ,$227.24 ,$222.30 ,$164.60 ,$164.60 ,$150.42 ,$164.60 ,$160.55 ,$172.04 ,$54.88 ,$195.13 , N/A ,$123.50 ,$123.50 ,$83.98 ,$123.50 , N/A ,$234.65 ,$202.54 ,$202.54 ,$197.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200366,N/A,HC DRILL BIT 1.0-4.5 X 12.7-10 SHANK,272,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 , N/A ,$76.13 ,$76.13 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 , N/A ,$37.80 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 , N/A ,$45.00 ,$45.00 ,$30.60 ,$45.00 , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200376,N/A,HC DRILL BIT SYNTHES 2.0,272,1 ,$225.00 ,$112.50 ,$50.00 ,$225.00 , N/A ,$190.33 ,$190.33 ,$76.50 ,$180.00 ,$191.25 ,$140.63 ,$202.50 , N/A ,$213.75 ,$202.50 ,$191.25 ,$191.25 ,$76.50 ,$191.25 ,$191.25 ,$202.50 , N/A ,$94.50 ,$202.50 , N/A ,$207.00 ,$202.50 ,$149.94 ,$149.94 ,$137.03 ,$149.94 ,$146.25 ,$156.71 ,$50.00 ,$177.75 , N/A ,$112.50 ,$112.50 ,$76.50 ,$112.50 , N/A ,$213.75 ,$184.50 ,$184.50 ,$180.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200394,N/A,HC BIT DRILL SYNTHES 3.5,272,1 ,$225.00 ,$112.50 ,$50.00 ,$225.00 , N/A ,$190.33 ,$190.33 ,$76.50 ,$180.00 ,$191.25 ,$140.63 ,$202.50 , N/A ,$213.75 ,$202.50 ,$191.25 ,$191.25 ,$76.50 ,$191.25 ,$191.25 ,$202.50 , N/A ,$94.50 ,$202.50 , N/A ,$207.00 ,$202.50 ,$149.94 ,$149.94 ,$137.03 ,$149.94 ,$146.25 ,$156.71 ,$50.00 ,$177.75 , N/A ,$112.50 ,$112.50 ,$76.50 ,$112.50 , N/A ,$213.75 ,$184.50 ,$184.50 ,$180.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200409,N/A,HC BIT SYN 4.0MM 3FLUTE 195MM,272,1 ,$425.00 ,$212.50 ,$94.44 ,$425.00 , N/A ,$359.51 ,$359.51 ,$144.50 ,$340.00 ,$361.25 ,$265.63 ,$382.50 , N/A ,$403.75 ,$382.50 ,$361.25 ,$361.25 ,$144.50 ,$361.25 ,$361.25 ,$382.50 , N/A ,$178.50 ,$382.50 , N/A ,$391.00 ,$382.50 ,$283.22 ,$283.22 ,$258.83 ,$283.22 ,$276.25 ,$296.01 ,$94.44 ,$335.75 , N/A ,$212.50 ,$212.50 ,$144.50 ,$212.50 , N/A ,$403.75 ,$348.50 ,$348.50 ,$340.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200411,N/A,HC BIT SYN 4.0MM 3FLUTED 150MM,272,1 ,$750.00 ,$375.00 ,$166.65 ,$750.00 , N/A ,$634.43 ,$634.43 ,$255.00 ,$600.00 ,$637.50 ,$468.75 ,$675.00 , N/A ,$712.50 ,$675.00 ,$637.50 ,$637.50 ,$255.00 ,$637.50 ,$637.50 ,$675.00 , N/A ,$315.00 ,$675.00 , N/A ,$690.00 ,$675.00 ,$499.80 ,$499.80 ,$456.75 ,$499.80 ,$487.50 ,$522.38 ,$166.65 ,$592.50 , N/A ,$375.00 ,$375.00 ,$255.00 ,$375.00 , N/A ,$712.50 ,$615.00 ,$615.00 ,$600.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200421,N/A,HC BIT SYNTHES 2.4 100MM,272,1 ,$446.00 ,$223.00 ,$99.10 ,$446.00 , N/A ,$377.27 ,$377.27 ,$151.64 ,$356.80 ,$379.10 ,$278.75 ,$401.40 , N/A ,$423.70 ,$401.40 ,$379.10 ,$379.10 ,$151.64 ,$379.10 ,$379.10 ,$401.40 , N/A ,$187.32 ,$401.40 , N/A ,$410.32 ,$401.40 ,$297.21 ,$297.21 ,$271.61 ,$297.21 ,$289.90 ,$310.64 ,$99.10 ,$352.34 , N/A ,$223.00 ,$223.00 ,$151.64 ,$223.00 , N/A ,$423.70 ,$365.72 ,$365.72 ,$356.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200422,N/A,HC BIT SYNTHES 2.7 CANULATD DRILL,272,1 ,"$1,429.00 ",$714.50 ,$317.52 ,"$1,429.00 ", N/A ,"$1,208.79 ","$1,208.79 ",$485.86 ,"$1,143.20 ","$1,214.65 ",$893.13 ,"$1,286.10 ", N/A ,"$1,357.55 ","$1,286.10 ","$1,214.65 ","$1,214.65 ",$485.86 ,"$1,214.65 ","$1,214.65 ","$1,286.10 ", N/A ,$600.18 ,"$1,286.10 ", N/A ,"$1,314.68 ","$1,286.10 ",$952.29 ,$952.29 ,$870.26 ,$952.29 ,$928.85 ,$995.30 ,$317.52 ,"$1,128.91 ", N/A ,$714.50 ,$714.50 ,$485.86 ,$714.50 , N/A ,"$1,357.55 ","$1,171.78 ","$1,171.78 ","$1,143.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200424,N/A,HC BIT SYNTHES 2.8MM,272,1 ,$299.00 ,$149.50 ,$66.44 ,$299.00 , N/A ,$252.92 ,$252.92 ,$101.66 ,$239.20 ,$254.15 ,$186.88 ,$269.10 , N/A ,$284.05 ,$269.10 ,$254.15 ,$254.15 ,$101.66 ,$254.15 ,$254.15 ,$269.10 , N/A ,$125.58 ,$269.10 , N/A ,$275.08 ,$269.10 ,$199.25 ,$199.25 ,$182.09 ,$199.25 ,$194.35 ,$208.25 ,$66.44 ,$236.21 , N/A ,$149.50 ,$149.50 ,$101.66 ,$149.50 , N/A ,$284.05 ,$245.18 ,$245.18 ,$239.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200425,N/A,HC BIT SYNTHES 3.2 DRILL,272,1 ,$217.00 ,$108.50 ,$48.22 ,$217.00 , N/A ,$183.56 ,$183.56 ,$73.78 ,$173.60 ,$184.45 ,$135.63 ,$195.30 , N/A ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$73.78 ,$184.45 ,$184.45 ,$195.30 , N/A ,$91.14 ,$195.30 , N/A ,$199.64 ,$195.30 ,$144.61 ,$144.61 ,$132.15 ,$144.61 ,$141.05 ,$151.14 ,$48.22 ,$171.43 , N/A ,$108.50 ,$108.50 ,$73.78 ,$108.50 , N/A ,$206.15 ,$177.94 ,$177.94 ,$173.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200426,N/A,HC BIT SYNTHES 4.3M,272,1 ,$373.00 ,$186.50 ,$82.88 ,$373.00 , N/A ,$315.52 ,$315.52 ,$126.82 ,$298.40 ,$317.05 ,$233.13 ,$335.70 , N/A ,$354.35 ,$335.70 ,$317.05 ,$317.05 ,$126.82 ,$317.05 ,$317.05 ,$335.70 , N/A ,$156.66 ,$335.70 , N/A ,$343.16 ,$335.70 ,$248.57 ,$248.57 ,$227.16 ,$248.57 ,$242.45 ,$259.79 ,$82.88 ,$294.67 , N/A ,$186.50 ,$186.50 ,$126.82 ,$186.50 , N/A ,$354.35 ,$305.86 ,$305.86 ,$298.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200427,N/A,HC BIT SYNTHES 4.5,272,1 ,$361.00 ,$180.50 ,$80.21 ,$361.00 , N/A ,$305.37 ,$305.37 ,$122.74 ,$288.80 ,$306.85 ,$225.63 ,$324.90 , N/A ,$342.95 ,$324.90 ,$306.85 ,$306.85 ,$122.74 ,$306.85 ,$306.85 ,$324.90 , N/A ,$151.62 ,$324.90 , N/A ,$332.12 ,$324.90 ,$240.57 ,$240.57 ,$219.85 ,$240.57 ,$234.65 ,$251.44 ,$80.21 ,$285.19 , N/A ,$180.50 ,$180.50 ,$122.74 ,$180.50 , N/A ,$342.95 ,$296.02 ,$296.02 ,$288.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200428,N/A,HC BIT SYNTHES 5.0 CANNLTED DRILL,272,1 ,"$1,348.00 ",$674.00 ,$299.53 ,"$1,348.00 ", N/A ,"$1,140.27 ","$1,140.27 ",$458.32 ,"$1,078.40 ","$1,145.80 ",$842.50 ,"$1,213.20 ", N/A ,"$1,280.60 ","$1,213.20 ","$1,145.80 ","$1,145.80 ",$458.32 ,"$1,145.80 ","$1,145.80 ","$1,213.20 ", N/A ,$566.16 ,"$1,213.20 ", N/A ,"$1,240.16 ","$1,213.20 ",$898.31 ,$898.31 ,$820.93 ,$898.31 ,$876.20 ,$938.88 ,$299.53 ,"$1,064.92 ", N/A ,$674.00 ,$674.00 ,$458.32 ,$674.00 , N/A ,"$1,280.60 ","$1,105.36 ","$1,105.36 ","$1,078.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200430,N/A,HC BIT SYNTHES DRILL 1.5MM,272,1 ,$188.00 ,$94.00 ,$41.77 ,$188.00 , N/A ,$159.03 ,$159.03 ,$63.92 ,$150.40 ,$159.80 ,$117.50 ,$169.20 , N/A ,$178.60 ,$169.20 ,$159.80 ,$159.80 ,$63.92 ,$159.80 ,$159.80 ,$169.20 , N/A ,$78.96 ,$169.20 , N/A ,$172.96 ,$169.20 ,$125.28 ,$125.28 ,$114.49 ,$125.28 ,$122.20 ,$130.94 ,$41.77 ,$148.52 , N/A ,$94.00 ,$94.00 ,$63.92 ,$94.00 , N/A ,$178.60 ,$154.16 ,$154.16 ,$150.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200433,N/A,HC BLADE 3M SPECIALTY FOR CLIPPER,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200435,N/A,HC BLADE,272,1 ,$437.00 ,$218.50 ,$97.10 ,$437.00 , N/A ,$369.66 ,$369.66 ,$148.58 ,$349.60 ,$371.45 ,$273.13 ,$393.30 , N/A ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$148.58 ,$371.45 ,$371.45 ,$393.30 , N/A ,$183.54 ,$393.30 , N/A ,$402.04 ,$393.30 ,$291.22 ,$291.22 ,$266.13 ,$291.22 ,$284.05 ,$304.37 ,$97.10 ,$345.23 , N/A ,$218.50 ,$218.50 ,$148.58 ,$218.50 , N/A ,$415.15 ,$358.34 ,$358.34 ,$349.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200437,N/A,HC BLADE AGGRESSIVE + ANGLED 5.0,272,1 ,$153.00 ,$76.50 ,$34.00 ,$153.00 , N/A ,$129.42 ,$129.42 ,$52.02 ,$122.40 ,$130.05 ,$95.63 ,$137.70 , N/A ,$145.35 ,$137.70 ,$130.05 ,$130.05 ,$52.02 ,$130.05 ,$130.05 ,$137.70 , N/A ,$64.26 ,$137.70 , N/A ,$140.76 ,$137.70 ,$101.96 ,$101.96 ,$93.18 ,$101.96 ,$99.45 ,$106.56 ,$34.00 ,$120.87 , N/A ,$76.50 ,$76.50 ,$52.02 ,$76.50 , N/A ,$145.35 ,$125.46 ,$125.46 ,$122.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200445,N/A,HC BLADE BEAVER 6400,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200459,N/A,HC BLADE GIGLI SAW,272,1 ,$41.00 ,$20.50 ,$9.11 ,$41.00 , N/A ,$34.68 ,$34.68 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 , N/A ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 , N/A ,$17.22 ,$36.90 , N/A ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 , N/A ,$20.50 ,$20.50 ,$13.94 ,$20.50 , N/A ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200461,N/A,HC BLADE HELICAL 95MM,272,1 ,"$1,916.00 ",$958.00 ,$425.74 ,"$1,916.00 ", N/A ,"$1,620.74 ","$1,620.74 ",$651.44 ,"$1,532.80 ","$1,628.60 ","$1,197.50 ","$1,724.40 ", N/A ,"$1,820.20 ","$1,724.40 ","$1,628.60 ","$1,628.60 ",$651.44 ,"$1,628.60 ","$1,628.60 ","$1,724.40 ", N/A ,$804.72 ,"$1,724.40 ", N/A ,"$1,762.72 ","$1,724.40 ","$1,276.82 ","$1,276.82 ","$1,166.84 ","$1,276.82 ","$1,245.40 ","$1,334.49 ",$425.74 ,"$1,513.64 ", N/A ,$958.00 ,$958.00 ,$651.44 ,$958.00 , N/A ,"$1,820.20 ","$1,571.12 ","$1,571.12 ","$1,532.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200465,N/A,HC BLADE MANUAL DERMATOME,272,1 ,$117.00 ,$58.50 ,$26.00 ,$117.00 , N/A ,$98.97 ,$98.97 ,$39.78 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$39.78 ,$99.45 ,$99.45 ,$105.30 , N/A ,$49.14 ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.97 ,$77.97 ,$71.25 ,$77.97 ,$76.05 ,$81.49 ,$26.00 ,$92.43 , N/A ,$58.50 ,$58.50 ,$39.78 ,$58.50 , N/A ,$111.15 ,$95.94 ,$95.94 ,$93.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200466,N/A,HC BLADE ANGLED SPEAR,272,1 ,$40.00 ,$20.00 ,$8.89 ,$40.00 , N/A ,$33.84 ,$33.84 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 , N/A ,$16.80 ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 , N/A ,$20.00 ,$20.00 ,$13.60 ,$20.00 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200474,N/A,HC BLADE MICRO WIDE 225,272,1 ,$40.00 ,$20.00 ,$8.89 ,$40.00 , N/A ,$33.84 ,$33.84 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 , N/A ,$16.80 ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 , N/A ,$20.00 ,$20.00 ,$13.60 ,$20.00 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200485,N/A,HC BLADE REG LEN 3.5MM OR 4.3,272,1 ,$404.00 ,$202.00 ,$89.77 ,$404.00 , N/A ,$341.74 ,$341.74 ,$137.36 ,$323.20 ,$343.40 ,$252.50 ,$363.60 , N/A ,$383.80 ,$363.60 ,$343.40 ,$343.40 ,$137.36 ,$343.40 ,$343.40 ,$363.60 , N/A ,$169.68 ,$363.60 , N/A ,$371.68 ,$363.60 ,$269.23 ,$269.23 ,$246.04 ,$269.23 ,$262.60 ,$281.39 ,$89.77 ,$319.16 , N/A ,$202.00 ,$202.00 ,$137.36 ,$202.00 , N/A ,$383.80 ,$331.28 ,$331.28 ,$323.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200486,N/A,HC BLADE REG LEN 3.5MM BUR,272,1 ,$555.00 ,$277.50 ,$123.32 ,$555.00 , N/A ,$469.47 ,$469.47 ,$188.70 ,$444.00 ,$471.75 ,$346.88 ,$499.50 , N/A ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$188.70 ,$471.75 ,$471.75 ,$499.50 , N/A ,$233.10 ,$499.50 , N/A ,$510.60 ,$499.50 ,$369.85 ,$369.85 ,$338.00 ,$369.85 ,$360.75 ,$386.56 ,$123.32 ,$438.45 , N/A ,$277.50 ,$277.50 ,$188.70 ,$277.50 , N/A ,$527.25 ,$455.10 ,$455.10 ,$444.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200487,N/A,HC BLADE REG LENGTH 4.0MM OR 4.3MM,272,1 ,$621.00 ,$310.50 ,$137.99 ,$621.00 , N/A ,$525.30 ,$525.30 ,$211.14 ,$496.80 ,$527.85 ,$388.13 ,$558.90 , N/A ,$589.95 ,$558.90 ,$527.85 ,$527.85 ,$211.14 ,$527.85 ,$527.85 ,$558.90 , N/A ,$260.82 ,$558.90 , N/A ,$571.32 ,$558.90 ,$413.83 ,$413.83 ,$378.19 ,$413.83 ,$403.65 ,$432.53 ,$137.99 ,$490.59 , N/A ,$310.50 ,$310.50 ,$211.14 ,$310.50 , N/A ,$589.95 ,$509.22 ,$509.22 ,$496.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200524,N/A,HC BLADE STRYKER RECIPRO DBLE SIDE,272,1 ,$122.00 ,$61.00 ,$27.11 ,$122.00 , N/A ,$103.20 ,$103.20 ,$41.48 ,$97.60 ,$103.70 ,$76.25 ,$109.80 , N/A ,$115.90 ,$109.80 ,$103.70 ,$103.70 ,$41.48 ,$103.70 ,$103.70 ,$109.80 , N/A ,$51.24 ,$109.80 , N/A ,$112.24 ,$109.80 ,$81.30 ,$81.30 ,$74.30 ,$81.30 ,$79.30 ,$84.97 ,$27.11 ,$96.38 , N/A ,$61.00 ,$61.00 ,$41.48 ,$61.00 , N/A ,$115.90 ,$100.04 ,$100.04 ,$97.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200525,N/A,HC BLADE STRYKER TPS,272,1 ,$40.00 ,$20.00 ,$8.89 ,$40.00 , N/A ,$33.84 ,$33.84 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 , N/A ,$16.80 ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 , N/A ,$20.00 ,$20.00 ,$13.60 ,$20.00 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200526,N/A,HC BLADE STRYKR SAG 13MM X 1.37 X 90,272,1 ,$246.00 ,$123.00 ,$54.66 ,$246.00 , N/A ,$208.09 ,$208.09 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 , N/A ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 , N/A ,$103.32 ,$221.40 , N/A ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 , N/A ,$123.00 ,$123.00 ,$83.64 ,$123.00 , N/A ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200527,N/A,HC BLADE STRYKR SAG 25MM X 1.37 X 90,272,1 ,$142.00 ,$71.00 ,$31.55 ,$142.00 , N/A ,$120.12 ,$120.12 ,$48.28 ,$113.60 ,$120.70 ,$88.75 ,$127.80 , N/A ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$48.28 ,$120.70 ,$120.70 ,$127.80 , N/A ,$59.64 ,$127.80 , N/A ,$130.64 ,$127.80 ,$94.63 ,$94.63 ,$86.48 ,$94.63 ,$92.30 ,$98.90 ,$31.55 ,$112.18 , N/A ,$71.00 ,$71.00 ,$48.28 ,$71.00 , N/A ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200538,N/A,HC KNIFE BEAVER 45DEG 33MM,272,1 ,$57.00 ,$28.50 ,$12.67 ,$57.00 , N/A ,$48.22 ,$48.22 ,$19.38 ,$45.60 ,$48.45 ,$35.63 ,$51.30 , N/A ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$19.38 ,$48.45 ,$48.45 ,$51.30 , N/A ,$23.94 ,$51.30 , N/A ,$52.44 ,$51.30 ,$37.98 ,$37.98 ,$34.71 ,$37.98 ,$37.05 ,$39.70 ,$12.67 ,$45.03 , N/A ,$28.50 ,$28.50 ,$19.38 ,$28.50 , N/A ,$54.15 ,$46.74 ,$46.74 ,$45.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200540,N/A,HC BLD ANGLD AGGRES PLS CUT 4.5MM,272,1 ,$170.00 ,$85.00 ,$37.77 ,$170.00 , N/A ,$143.80 ,$143.80 ,$57.80 ,$136.00 ,$144.50 ,$106.25 ,$153.00 , N/A ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$57.80 ,$144.50 ,$144.50 ,$153.00 , N/A ,$71.40 ,$153.00 , N/A ,$156.40 ,$153.00 ,$113.29 ,$113.29 ,$103.53 ,$113.29 ,$110.50 ,$118.41 ,$37.77 ,$134.30 , N/A ,$85.00 ,$85.00 ,$57.80 ,$85.00 , N/A ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200547,N/A,HC BONE BIOPSY DEVICE F07,272,1 ,$407.00 ,$203.50 ,$90.44 ,$407.00 , N/A ,$344.28 ,$344.28 ,$138.38 ,$325.60 ,$345.95 ,$254.38 ,$366.30 , N/A ,$386.65 ,$366.30 ,$345.95 ,$345.95 ,$138.38 ,$345.95 ,$345.95 ,$366.30 , N/A ,$170.94 ,$366.30 , N/A ,$374.44 ,$366.30 ,$271.22 ,$271.22 ,$247.86 ,$271.22 ,$264.55 ,$283.48 ,$90.44 ,$321.53 , N/A ,$203.50 ,$203.50 ,$138.38 ,$203.50 , N/A ,$386.65 ,$333.74 ,$333.74 ,$325.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200550,N/A,HC BONE CEMENT RADIOPAQUE,272,1 ,$114.00 ,$57.00 ,$25.33 ,$114.00 , N/A ,$96.43 ,$96.43 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 , N/A ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 , N/A ,$47.88 ,$102.60 , N/A ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 , N/A ,$57.00 ,$57.00 ,$38.76 ,$57.00 , N/A ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200553,N/A,HC BONE MARROW KIT,272,1 ,$82.00 ,$41.00 ,$18.22 ,$82.00 , N/A ,$69.36 ,$69.36 ,$27.88 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$27.88 ,$69.70 ,$69.70 ,$73.80 , N/A ,$34.44 ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.64 ,$54.64 ,$49.94 ,$54.64 ,$53.30 ,$57.11 ,$18.22 ,$64.78 , N/A ,$41.00 ,$41.00 ,$27.88 ,$41.00 , N/A ,$77.90 ,$67.24 ,$67.24 ,$65.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200562,N/A,HC BOVIE LIGASURE LAPRSCPY 10MM,272,1 ,"$1,506.00 ",$753.00 ,$334.63 ,"$1,506.00 ", N/A ,"$1,273.93 ","$1,273.93 ",$512.04 ,"$1,204.80 ","$1,280.10 ",$941.25 ,"$1,355.40 ", N/A ,"$1,430.70 ","$1,355.40 ","$1,280.10 ","$1,280.10 ",$512.04 ,"$1,280.10 ","$1,280.10 ","$1,355.40 ", N/A ,$632.52 ,"$1,355.40 ", N/A ,"$1,385.52 ","$1,355.40 ","$1,003.60 ","$1,003.60 ",$917.15 ,"$1,003.60 ",$978.90 ,"$1,048.93 ",$334.63 ,"$1,189.74 ", N/A ,$753.00 ,$753.00 ,$512.04 ,$753.00 , N/A ,"$1,430.70 ","$1,234.92 ","$1,234.92 ","$1,204.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200579,N/A,HC BRUSH CYTOLOGY,272,1 ,$37.00 ,$18.50 ,$8.22 ,$37.00 , N/A ,$31.30 ,$31.30 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 , N/A ,$15.54 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 , N/A ,$18.50 ,$18.50 ,$12.58 ,$18.50 , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200591,N/A,HC BUR ROUND 2.0,272,1 ,$31.00 ,$15.50 ,$6.89 ,$31.00 , N/A ,$26.22 ,$26.22 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 , N/A ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 , N/A ,$13.02 ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 , N/A ,$15.50 ,$15.50 ,$10.54 ,$15.50 , N/A ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200597,N/A,HC BUR STRYKER,272,1 ,$117.00 ,$58.50 ,$26.00 ,$117.00 , N/A ,$98.97 ,$98.97 ,$39.78 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$39.78 ,$99.45 ,$99.45 ,$105.30 , N/A ,$49.14 ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.97 ,$77.97 ,$71.25 ,$77.97 ,$76.05 ,$81.49 ,$26.00 ,$92.43 , N/A ,$58.50 ,$58.50 ,$39.78 ,$58.50 , N/A ,$111.15 ,$95.94 ,$95.94 ,$93.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200634,N/A,HC BURR STRYKER BARREL LONG HIP,272,1 ,$580.00 ,$290.00 ,$128.88 ,$580.00 , N/A ,$490.62 ,$490.62 ,$197.20 ,$464.00 ,$493.00 ,$362.50 ,$522.00 , N/A ,$551.00 ,$522.00 ,$493.00 ,$493.00 ,$197.20 ,$493.00 ,$493.00 ,$522.00 , N/A ,$243.60 ,$522.00 , N/A ,$533.60 ,$522.00 ,$386.51 ,$386.51 ,$353.22 ,$386.51 ,$377.00 ,$403.97 ,$128.88 ,$458.20 , N/A ,$290.00 ,$290.00 ,$197.20 ,$290.00 , N/A ,$551.00 ,$475.60 ,$475.60 ,$464.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200640,N/A,HC BURR STRYKER ROUND,272,1 ,$161.00 ,$80.50 ,$35.77 ,$161.00 , N/A ,$136.19 ,$136.19 ,$54.74 ,$128.80 ,$136.85 ,$100.63 ,$144.90 , N/A ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$54.74 ,$136.85 ,$136.85 ,$144.90 , N/A ,$67.62 ,$144.90 , N/A ,$148.12 ,$144.90 ,$107.29 ,$107.29 ,$98.05 ,$107.29 ,$104.65 ,$112.14 ,$35.77 ,$127.19 , N/A ,$80.50 ,$80.50 ,$54.74 ,$80.50 , N/A ,$152.95 ,$132.02 ,$132.02 ,$128.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200656,N/A,"HC BX NEEDLE TRU-CUT 4 1/2 """,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200657,N/A,HC BX NEEDLE TRU-CUT 6IN,272,1 ,$55.00 ,$27.50 ,$12.22 ,$55.00 , N/A ,$46.52 ,$46.52 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 , N/A ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 , N/A ,$23.10 ,$49.50 , N/A ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 , N/A ,$27.50 ,$27.50 ,$18.70 ,$27.50 , N/A ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200659,N/A,HC CABLE FOR LEADS,272,1 ,$624.00 ,$312.00 ,$138.65 ,$624.00 , N/A ,$527.84 ,$527.84 ,$212.16 ,$499.20 ,$530.40 ,$390.00 ,$561.60 , N/A ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$212.16 ,$530.40 ,$530.40 ,$561.60 , N/A ,$262.08 ,$561.60 , N/A ,$574.08 ,$561.60 ,$415.83 ,$415.83 ,$380.02 ,$415.83 ,$405.60 ,$434.62 ,$138.65 ,$492.96 , N/A ,$312.00 ,$312.00 ,$212.16 ,$312.00 , N/A ,$592.80 ,$511.68 ,$511.68 ,$499.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200672,N/A,HC CANNULA 5MM X 7MM STRYKER,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200687,N/A,HC CANNULA ARTHREX NOTCHED,272,1 ,$10.40 ,$5.20 ,$2.31 ,$10.40 , N/A ,$8.80 ,$8.80 ,$3.54 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$3.54 ,$8.84 ,$8.84 ,$9.36 , N/A ,$4.37 ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.93 ,$6.93 ,$6.33 ,$6.93 ,$6.76 ,$7.24 ,$2.31 ,$8.22 , N/A ,$5.20 ,$5.20 ,$3.54 ,$5.20 , N/A ,$9.88 ,$8.53 ,$8.53 ,$8.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200689,N/A,HC CANNULA ARTHROSCOPIC DYN,272,1 ,$49.00 ,$24.50 ,$10.89 ,$49.00 , N/A ,$41.45 ,$41.45 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 , N/A ,$20.58 ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 , N/A ,$24.50 ,$24.50 ,$16.66 ,$24.50 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200709,N/A,HC CANNULA PASSPORT BUTTON,272,1 ,$69.00 ,$34.50 ,$15.33 ,$69.00 , N/A ,$58.37 ,$58.37 ,$23.46 ,$55.20 ,$58.65 ,$43.13 ,$62.10 , N/A ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$23.46 ,$58.65 ,$58.65 ,$62.10 , N/A ,$28.98 ,$62.10 , N/A ,$63.48 ,$62.10 ,$45.98 ,$45.98 ,$42.02 ,$45.98 ,$44.85 ,$48.06 ,$15.33 ,$54.51 , N/A ,$34.50 ,$34.50 ,$23.46 ,$34.50 , N/A ,$65.55 ,$56.58 ,$56.58 ,$55.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200741,N/A,HC CATH ABLATION THERMA CHOICE,272,1 ,"$2,739.00 ","$1,369.50 ",$608.61 ,"$2,739.00 ", N/A ,"$2,316.92 ","$2,316.92 ",$931.26 ,"$2,191.20 ","$2,328.15 ","$1,711.88 ","$2,465.10 ", N/A ,"$2,602.05 ","$2,465.10 ","$2,328.15 ","$2,328.15 ",$931.26 ,"$2,328.15 ","$2,328.15 ","$2,465.10 ", N/A ,"$1,150.38 ","$2,465.10 ", N/A ,"$2,519.88 ","$2,465.10 ","$1,825.27 ","$1,825.27 ","$1,668.05 ","$1,825.27 ","$1,780.35 ","$1,907.71 ",$608.61 ,"$2,163.81 ", N/A ,"$1,369.50 ","$1,369.50 ",$931.26 ,"$1,369.50 ", N/A ,"$2,602.05 ","$2,245.98 ","$2,245.98 ","$2,191.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200778,N/A,HC CATH COUDE 16FR 5CC,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200779,N/A,HC CATH COUDE 18FR 5CC,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200780,N/A,HC CATH COUNCIL,272,1 ,$39.00 ,$19.50 ,$8.67 ,$39.00 , N/A ,$32.99 ,$32.99 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 , N/A ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 , N/A ,$16.38 ,$35.10 , N/A ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 , N/A ,$19.50 ,$19.50 ,$13.26 ,$19.50 , N/A ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200783,N/A,HC CATH EX PEN FOR PAIN PUMP,272,1 ,$624.00 ,$312.00 ,$138.65 ,$624.00 , N/A ,$527.84 ,$527.84 ,$212.16 ,$499.20 ,$530.40 ,$390.00 ,$561.60 , N/A ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$212.16 ,$530.40 ,$530.40 ,$561.60 , N/A ,$262.08 ,$561.60 , N/A ,$574.08 ,$561.60 ,$415.83 ,$415.83 ,$380.02 ,$415.83 ,$405.60 ,$434.62 ,$138.65 ,$492.96 , N/A ,$312.00 ,$312.00 ,$212.16 ,$312.00 , N/A ,$592.80 ,$511.68 ,$511.68 ,$499.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200784,N/A,HC CATH FOGARTY ART 3FR,272,1 ,$316.00 ,$158.00 ,$70.22 ,$316.00 , N/A ,$267.30 ,$267.30 ,$107.44 ,$252.80 ,$268.60 ,$197.50 ,$284.40 , N/A ,$300.20 ,$284.40 ,$268.60 ,$268.60 ,$107.44 ,$268.60 ,$268.60 ,$284.40 , N/A ,$132.72 ,$284.40 , N/A ,$290.72 ,$284.40 ,$210.58 ,$210.58 ,$192.44 ,$210.58 ,$205.40 ,$220.09 ,$70.22 ,$249.64 , N/A ,$158.00 ,$158.00 ,$107.44 ,$158.00 , N/A ,$300.20 ,$259.12 ,$259.12 ,$252.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200785,N/A,HC CATH FOGARTY ART 4FR,272,1 ,$316.00 ,$158.00 ,$70.22 ,$316.00 , N/A ,$267.30 ,$267.30 ,$107.44 ,$252.80 ,$268.60 ,$197.50 ,$284.40 , N/A ,$300.20 ,$284.40 ,$268.60 ,$268.60 ,$107.44 ,$268.60 ,$268.60 ,$284.40 , N/A ,$132.72 ,$284.40 , N/A ,$290.72 ,$284.40 ,$210.58 ,$210.58 ,$192.44 ,$210.58 ,$205.40 ,$220.09 ,$70.22 ,$249.64 , N/A ,$158.00 ,$158.00 ,$107.44 ,$158.00 , N/A ,$300.20 ,$259.12 ,$259.12 ,$252.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200786,N/A,HC CATH FOGARTY ART 5FR,272,1 ,$316.00 ,$158.00 ,$70.22 ,$316.00 , N/A ,$267.30 ,$267.30 ,$107.44 ,$252.80 ,$268.60 ,$197.50 ,$284.40 , N/A ,$300.20 ,$284.40 ,$268.60 ,$268.60 ,$107.44 ,$268.60 ,$268.60 ,$284.40 , N/A ,$132.72 ,$284.40 , N/A ,$290.72 ,$284.40 ,$210.58 ,$210.58 ,$192.44 ,$210.58 ,$205.40 ,$220.09 ,$70.22 ,$249.64 , N/A ,$158.00 ,$158.00 ,$107.44 ,$158.00 , N/A ,$300.20 ,$259.12 ,$259.12 ,$252.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200792,N/A,HC CATH FOLEY 18FR 5CC 3-WAY,272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200793,N/A,HC CATH FOLEY 22FR 30CC 2WAY EMMET,272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200795,N/A,HC CATH FRANKLIN ENDO CHOLE,272,1 ,$150.00 ,$75.00 ,$33.33 ,$150.00 , N/A ,$126.89 ,$126.89 ,$51.00 ,$120.00 ,$127.50 ,$93.75 ,$135.00 , N/A ,$142.50 ,$135.00 ,$127.50 ,$127.50 ,$51.00 ,$127.50 ,$127.50 ,$135.00 , N/A ,$63.00 ,$135.00 , N/A ,$138.00 ,$135.00 ,$99.96 ,$99.96 ,$91.35 ,$99.96 ,$97.50 ,$104.48 ,$33.33 ,$118.50 , N/A ,$75.00 ,$75.00 ,$51.00 ,$75.00 , N/A ,$142.50 ,$123.00 ,$123.00 ,$120.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200797,N/A,HC CATH ILLUMINATING,272,1 ,$513.00 ,$256.50 ,$113.99 ,$513.00 , N/A ,$433.95 ,$433.95 ,$174.42 ,$410.40 ,$436.05 ,$320.63 ,$461.70 , N/A ,$487.35 ,$461.70 ,$436.05 ,$436.05 ,$174.42 ,$436.05 ,$436.05 ,$461.70 , N/A ,$215.46 ,$461.70 , N/A ,$471.96 ,$461.70 ,$341.86 ,$341.86 ,$312.42 ,$341.86 ,$333.45 ,$357.30 ,$113.99 ,$405.27 , N/A ,$256.50 ,$256.50 ,$174.42 ,$256.50 , N/A ,$487.35 ,$420.66 ,$420.66 ,$410.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200798,N/A,HC CATH INTRODUCER,272,1 ,$82.00 ,$41.00 ,$18.22 ,$82.00 , N/A ,$69.36 ,$69.36 ,$27.88 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$27.88 ,$69.70 ,$69.70 ,$73.80 , N/A ,$34.44 ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.64 ,$54.64 ,$49.94 ,$54.64 ,$53.30 ,$57.11 ,$18.22 ,$64.78 , N/A ,$41.00 ,$41.00 ,$27.88 ,$41.00 , N/A ,$77.90 ,$67.24 ,$67.24 ,$65.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200800,N/A,HC CATH LAP CHOLANGIOGR,272,1 ,$92.00 ,$46.00 ,$20.44 ,$92.00 , N/A ,$77.82 ,$77.82 ,$31.28 ,$73.60 ,$78.20 ,$57.50 ,$82.80 , N/A ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$31.28 ,$78.20 ,$78.20 ,$82.80 , N/A ,$38.64 ,$82.80 , N/A ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 , N/A ,$46.00 ,$46.00 ,$31.28 ,$46.00 , N/A ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200821,N/A,HC CATH RED RUBBER 8FR,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200827,N/A,HC CATH TAUT CHOLANGIO,272,1 ,$96.00 ,$48.00 ,$21.33 ,$96.00 , N/A ,$81.21 ,$81.21 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 , N/A ,$40.32 ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 , N/A ,$48.00 ,$48.00 ,$32.64 ,$48.00 , N/A ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200828,N/A,HC CATH FOLEY TEMPERATURE PROBE 16FR,272,1 ,$122.00 ,$61.00 ,$27.11 ,$122.00 , N/A ,$103.20 ,$103.20 ,$41.48 ,$97.60 ,$103.70 ,$76.25 ,$109.80 , N/A ,$115.90 ,$109.80 ,$103.70 ,$103.70 ,$41.48 ,$103.70 ,$103.70 ,$109.80 , N/A ,$51.24 ,$109.80 , N/A ,$112.24 ,$109.80 ,$81.30 ,$81.30 ,$74.30 ,$81.30 ,$79.30 ,$84.97 ,$27.11 ,$96.38 , N/A ,$61.00 ,$61.00 ,$41.48 ,$61.00 , N/A ,$115.90 ,$100.04 ,$100.04 ,$97.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200829,N/A,HC CATH THORACIC 16FR TO 36FR,272,1 ,$53.00 ,$26.50 ,$11.78 ,$53.00 , N/A ,$44.83 ,$44.83 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 , N/A ,$22.26 ,$47.70 , N/A ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 , N/A ,$26.50 ,$26.50 ,$18.02 ,$26.50 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200832,N/A,HC CATH TRAY WITH FOLEY,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200834,N/A,HC CATH URETERAL CONE,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200836,N/A,HC CATH URETERAL OLIVE,272,1 ,$276.00 ,$138.00 ,$61.33 ,$276.00 , N/A ,$233.47 ,$233.47 ,$93.84 ,$220.80 ,$234.60 ,$172.50 ,$248.40 , N/A ,$262.20 ,$248.40 ,$234.60 ,$234.60 ,$93.84 ,$234.60 ,$234.60 ,$248.40 , N/A ,$115.92 ,$248.40 , N/A ,$253.92 ,$248.40 ,$183.93 ,$183.93 ,$168.08 ,$183.93 ,$179.40 ,$192.23 ,$61.33 ,$218.04 , N/A ,$138.00 ,$138.00 ,$93.84 ,$138.00 , N/A ,$262.20 ,$226.32 ,$226.32 ,$220.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200842,N/A,HC CATH VNUS CLSR FST 7FRX100/60,272,1 ,"$2,634.00 ","$1,317.00 ",$585.27 ,"$2,634.00 ", N/A ,"$2,228.10 ","$2,228.10 ",$895.56 ,"$2,107.20 ","$2,238.90 ","$1,646.25 ","$2,370.60 ", N/A ,"$2,502.30 ","$2,370.60 ","$2,238.90 ","$2,238.90 ",$895.56 ,"$2,238.90 ","$2,238.90 ","$2,370.60 ", N/A ,"$1,106.28 ","$2,370.60 ", N/A ,"$2,423.28 ","$2,370.60 ","$1,755.30 ","$1,755.30 ","$1,604.11 ","$1,755.30 ","$1,712.10 ","$1,834.58 ",$585.27 ,"$2,080.86 ", N/A ,"$1,317.00 ","$1,317.00 ",$895.56 ,"$1,317.00 ", N/A ,"$2,502.30 ","$2,159.88 ","$2,159.88 ","$2,107.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200849,N/A,HC CATHETER - FOLEY,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200853,N/A,HC CATHETER COUDE,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200856,N/A,HC CATHETER FOLEY 3-WAY,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200858,N/A,HC CATHETER SET 5X40,272,1 ,$346.00 ,$173.00 ,$76.88 ,$346.00 , N/A ,$292.68 ,$292.68 ,$117.64 ,$276.80 ,$294.10 ,$216.25 ,$311.40 , N/A ,$328.70 ,$311.40 ,$294.10 ,$294.10 ,$117.64 ,$294.10 ,$294.10 ,$311.40 , N/A ,$145.32 ,$311.40 , N/A ,$318.32 ,$311.40 ,$230.57 ,$230.57 ,$210.71 ,$230.57 ,$224.90 ,$240.99 ,$76.88 ,$273.34 , N/A ,$173.00 ,$173.00 ,$117.64 ,$173.00 , N/A ,$328.70 ,$283.72 ,$283.72 ,$276.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200862,N/A,HC CATHETERIZATION KIT,272,1 ,$834.00 ,$417.00 ,$185.31 ,$834.00 , N/A ,$705.48 ,$705.48 ,$283.56 ,$667.20 ,$708.90 ,$521.25 ,$750.60 , N/A ,$792.30 ,$750.60 ,$708.90 ,$708.90 ,$283.56 ,$708.90 ,$708.90 ,$750.60 , N/A ,$350.28 ,$750.60 , N/A ,$767.28 ,$750.60 ,$555.78 ,$555.78 ,$507.91 ,$555.78 ,$542.10 ,$580.88 ,$185.31 ,$658.86 , N/A ,$417.00 ,$417.00 ,$283.56 ,$417.00 , N/A ,$792.30 ,$683.88 ,$683.88 ,$667.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200869,N/A,HC CAUT ELECTROHESIVE PENCIL,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200871,N/A,HC CAUT ELLMAN TIP,272,1 ,$23.00 ,$11.50 ,$5.11 ,$23.00 , N/A ,$19.46 ,$19.46 ,$7.82 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$7.82 ,$19.55 ,$19.55 ,$20.70 , N/A ,$9.66 ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.33 ,$15.33 ,$14.01 ,$15.33 ,$14.95 ,$16.02 ,$5.11 ,$18.17 , N/A ,$11.50 ,$11.50 ,$7.82 ,$11.50 , N/A ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200875,N/A,HC CAUT KNIFE CLEANER CARD,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200887,N/A,HC CEMENT MIXER - STRYKER,272,1 ,$546.00 ,$273.00 ,$121.32 ,$546.00 , N/A ,$461.86 ,$461.86 ,$185.64 ,$436.80 ,$464.10 ,$341.25 ,$491.40 , N/A ,$518.70 ,$491.40 ,$464.10 ,$464.10 ,$185.64 ,$464.10 ,$464.10 ,$491.40 , N/A ,$229.32 ,$491.40 , N/A ,$502.32 ,$491.40 ,$363.85 ,$363.85 ,$332.51 ,$363.85 ,$354.90 ,$380.29 ,$121.32 ,$431.34 , N/A ,$273.00 ,$273.00 ,$185.64 ,$273.00 , N/A ,$518.70 ,$447.72 ,$447.72 ,$436.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200888,N/A,HC CHARGING SYSTEM,272,1 ,"$4,645.00 ","$2,322.50 ","$1,032.12 ","$4,645.00 ", N/A ,"$3,929.21 ","$3,929.21 ","$1,579.30 ","$3,716.00 ","$3,948.25 ","$2,903.13 ","$4,180.50 ", N/A ,"$4,412.75 ","$4,180.50 ","$3,948.25 ","$3,948.25 ","$1,579.30 ","$3,948.25 ","$3,948.25 ","$4,180.50 ", N/A ,"$1,950.90 ","$4,180.50 ", N/A ,"$4,273.40 ","$4,180.50 ","$3,095.43 ","$3,095.43 ","$2,828.81 ","$3,095.43 ","$3,019.25 ","$3,235.24 ","$1,032.12 ","$3,669.55 ", N/A ,"$2,322.50 ","$2,322.50 ","$1,579.30 ","$2,322.50 ", N/A ,"$4,412.75 ","$3,808.90 ","$3,808.90 ","$3,716.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200889,N/A,HC CHEST DRAIN VALVE PNEUO ATRIUM,272,1 ,$97.00 ,$48.50 ,$21.55 ,$97.00 , N/A ,$82.05 ,$82.05 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 , N/A ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 , N/A ,$40.74 ,$87.30 , N/A ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 , N/A ,$48.50 ,$48.50 ,$32.98 ,$48.50 , N/A ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200914,N/A,SVG HC CL ADULT DEFIB PADS,272,1 ,$156.00 ,$78.00 ,$34.66 ,$156.00 , N/A ,$131.96 ,$131.96 ,$53.04 ,$124.80 ,$132.60 ,$97.50 ,$140.40 , N/A ,$148.20 ,$140.40 ,$132.60 ,$132.60 ,$53.04 ,$132.60 ,$132.60 ,$140.40 , N/A ,$65.52 ,$140.40 , N/A ,$143.52 ,$140.40 ,$103.96 ,$103.96 ,$95.00 ,$103.96 ,$101.40 ,$108.65 ,$34.66 ,$123.24 , N/A ,$78.00 ,$78.00 ,$53.04 ,$78.00 , N/A ,$148.20 ,$127.92 ,$127.92 ,$124.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200917,N/A,HC CLAMP SYN 4 POS MULTI PN,272,1 ,"$2,329.00 ","$1,164.50 ",$517.50 ,"$2,329.00 ", N/A ,"$1,970.10 ","$1,970.10 ",$791.86 ,"$1,863.20 ","$1,979.65 ","$1,455.63 ","$2,096.10 ", N/A ,"$2,212.55 ","$2,096.10 ","$1,979.65 ","$1,979.65 ",$791.86 ,"$1,979.65 ","$1,979.65 ","$2,096.10 ", N/A ,$978.18 ,"$2,096.10 ", N/A ,"$2,142.68 ","$2,096.10 ","$1,552.05 ","$1,552.05 ","$1,418.36 ","$1,552.05 ","$1,513.85 ","$1,622.15 ",$517.50 ,"$1,839.91 ", N/A ,"$1,164.50 ","$1,164.50 ",$791.86 ,"$1,164.50 ", N/A ,"$2,212.55 ","$1,909.78 ","$1,909.78 ","$1,863.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200918,N/A,HC CLAMP SYN 6 POS MULTI PN,272,1 ,"$2,619.00 ","$1,309.50 ",$581.94 ,"$2,619.00 ", N/A ,"$2,215.41 ","$2,215.41 ",$890.46 ,"$2,095.20 ","$2,226.15 ","$1,636.88 ","$2,357.10 ", N/A ,"$2,488.05 ","$2,357.10 ","$2,226.15 ","$2,226.15 ",$890.46 ,"$2,226.15 ","$2,226.15 ","$2,357.10 ", N/A ,"$1,099.98 ","$2,357.10 ", N/A ,"$2,409.48 ","$2,357.10 ","$1,745.30 ","$1,745.30 ","$1,594.97 ","$1,745.30 ","$1,702.35 ","$1,824.13 ",$581.94 ,"$2,069.01 ", N/A ,"$1,309.50 ","$1,309.50 ",$890.46 ,"$1,309.50 ", N/A ,"$2,488.05 ","$2,147.58 ","$2,147.58 ","$2,095.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200919,N/A,HC CLAMP SYN ADJ F/RADIUS,272,1 ,"$2,578.00 ","$1,289.00 ",$572.83 ,"$2,578.00 ", N/A ,"$2,180.73 ","$2,180.73 ",$876.52 ,"$2,062.40 ","$2,191.30 ","$1,611.25 ","$2,320.20 ", N/A ,"$2,449.10 ","$2,320.20 ","$2,191.30 ","$2,191.30 ",$876.52 ,"$2,191.30 ","$2,191.30 ","$2,320.20 ", N/A ,"$1,082.76 ","$2,320.20 ", N/A ,"$2,371.76 ","$2,320.20 ","$1,717.98 ","$1,717.98 ","$1,570.00 ","$1,717.98 ","$1,675.70 ","$1,795.58 ",$572.83 ,"$2,036.62 ", N/A ,"$1,289.00 ","$1,289.00 ",$876.52 ,"$1,289.00 ", N/A ,"$2,449.10 ","$2,113.96 ","$2,113.96 ","$2,062.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200921,N/A,HC CLAMP SYN ROD ATTACHMENT,272,1 ,"$1,466.00 ",$733.00 ,$325.75 ,"$1,466.00 ", N/A ,"$1,240.09 ","$1,240.09 ",$498.44 ,"$1,172.80 ","$1,246.10 ",$916.25 ,"$1,319.40 ", N/A ,"$1,392.70 ","$1,319.40 ","$1,246.10 ","$1,246.10 ",$498.44 ,"$1,246.10 ","$1,246.10 ","$1,319.40 ", N/A ,$615.72 ,"$1,319.40 ", N/A ,"$1,348.72 ","$1,319.40 ",$976.94 ,$976.94 ,$892.79 ,$976.94 ,$952.90 ,"$1,021.07 ",$325.75 ,"$1,158.14 ", N/A ,$733.00 ,$733.00 ,$498.44 ,$733.00 , N/A ,"$1,392.70 ","$1,202.12 ","$1,202.12 ","$1,172.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200923,N/A,HC CLAMP SYN TUBE TO TUBE,272,1 ,"$2,252.00 ","$1,126.00 ",$500.39 ,"$2,252.00 ", N/A ,"$1,904.97 ","$1,904.97 ",$765.68 ,"$1,801.60 ","$1,914.20 ","$1,407.50 ","$2,026.80 ", N/A ,"$2,139.40 ","$2,026.80 ","$1,914.20 ","$1,914.20 ",$765.68 ,"$1,914.20 ","$1,914.20 ","$2,026.80 ", N/A ,$945.84 ,"$2,026.80 ", N/A ,"$2,071.84 ","$2,026.80 ","$1,500.73 ","$1,500.73 ","$1,371.47 ","$1,500.73 ","$1,463.80 ","$1,568.52 ",$500.39 ,"$1,779.08 ", N/A ,"$1,126.00 ","$1,126.00 ",$765.68 ,"$1,126.00 ", N/A ,"$2,139.40 ","$1,846.64 ","$1,846.64 ","$1,801.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200924,N/A,HC CLAMP SYNTHES ADJUSTABLE,272,1 ,"$1,807.00 ",$903.50 ,$401.52 ,"$1,807.00 ", N/A ,"$1,528.54 ","$1,528.54 ",$614.38 ,"$1,445.60 ","$1,535.95 ","$1,129.38 ","$1,626.30 ", N/A ,"$1,716.65 ","$1,626.30 ","$1,535.95 ","$1,535.95 ",$614.38 ,"$1,535.95 ","$1,535.95 ","$1,626.30 ", N/A ,$758.94 ,"$1,626.30 ", N/A ,"$1,662.44 ","$1,626.30 ","$1,204.18 ","$1,204.18 ","$1,100.46 ","$1,204.18 ","$1,174.55 ","$1,258.58 ",$401.52 ,"$1,427.53 ", N/A ,$903.50 ,$903.50 ,$614.38 ,$903.50 , N/A ,"$1,716.65 ","$1,481.74 ","$1,481.74 ","$1,445.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200925,N/A,HC CLAMP SYNTHES COMBINATION,272,1 ,"$2,302.00 ","$1,151.00 ",$511.50 ,"$2,302.00 ", N/A ,"$1,947.26 ","$1,947.26 ",$782.68 ,"$1,841.60 ","$1,956.70 ","$1,438.75 ","$2,071.80 ", N/A ,"$2,186.90 ","$2,071.80 ","$1,956.70 ","$1,956.70 ",$782.68 ,"$1,956.70 ","$1,956.70 ","$2,071.80 ", N/A ,$966.84 ,"$2,071.80 ", N/A ,"$2,117.84 ","$2,071.80 ","$1,534.05 ","$1,534.05 ","$1,401.92 ","$1,534.05 ","$1,496.30 ","$1,603.34 ",$511.50 ,"$1,818.58 ", N/A ,"$1,151.00 ","$1,151.00 ",$782.68 ,"$1,151.00 ", N/A ,"$2,186.90 ","$1,887.64 ","$1,887.64 ","$1,841.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200927,N/A,HC CLIP APPLIER ETHICON 5MM,272,1 ,$465.00 ,$232.50 ,$103.32 ,$465.00 , N/A ,$393.34 ,$393.34 ,$158.10 ,$372.00 ,$395.25 ,$290.63 ,$418.50 , N/A ,$441.75 ,$418.50 ,$395.25 ,$395.25 ,$158.10 ,$395.25 ,$395.25 ,$418.50 , N/A ,$195.30 ,$418.50 , N/A ,$427.80 ,$418.50 ,$309.88 ,$309.88 ,$283.19 ,$309.88 ,$302.25 ,$323.87 ,$103.32 ,$367.35 , N/A ,$232.50 ,$232.50 ,$158.10 ,$232.50 , N/A ,$441.75 ,$381.30 ,$381.30 ,$372.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200928,N/A,"HC CLIP APPLIER SM,MED,LRG",272,1 ,$182.00 ,$91.00 ,$40.44 ,$182.00 , N/A ,$153.95 ,$153.95 ,$61.88 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$61.88 ,$154.70 ,$154.70 ,$163.80 , N/A ,$76.44 ,$163.80 , N/A ,$167.44 ,$163.80 ,$121.28 ,$121.28 ,$110.84 ,$121.28 ,$118.30 ,$126.76 ,$40.44 ,$143.78 , N/A ,$91.00 ,$91.00 ,$61.88 ,$91.00 , N/A ,$172.90 ,$149.24 ,$149.24 ,$145.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200933,N/A,HC CLIP HEMOSTASIS,272,1 ,$490.00 ,$245.00 ,$108.88 ,$490.00 , N/A ,$414.49 ,$414.49 ,$166.60 ,$392.00 ,$416.50 ,$306.25 ,$441.00 , N/A ,$465.50 ,$441.00 ,$416.50 ,$416.50 ,$166.60 ,$416.50 ,$416.50 ,$441.00 , N/A ,$205.80 ,$441.00 , N/A ,$450.80 ,$441.00 ,$326.54 ,$326.54 ,$298.41 ,$326.54 ,$318.50 ,$341.29 ,$108.88 ,$387.10 , N/A ,$245.00 ,$245.00 ,$166.60 ,$245.00 , N/A ,$465.50 ,$401.80 ,$401.80 ,$392.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200943,N/A,"HC COBAN 1 PER ROLL """,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200944,N/A,"HC COBAN 2 """,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200945,N/A,"HC COBAN 3 """,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200960,N/A,HC CONNECTOR LARGE Y,272,1 ,$14.50 ,$7.25 ,$3.22 ,$14.50 , N/A ,$12.27 ,$12.27 ,$4.93 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$4.93 ,$12.33 ,$12.33 ,$13.05 , N/A ,$6.09 ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.66 ,$9.66 ,$8.83 ,$9.66 ,$9.43 ,$10.10 ,$3.22 ,$11.46 , N/A ,$7.25 ,$7.25 ,$4.93 ,$7.25 , N/A ,$13.78 ,$11.89 ,$11.89 ,$11.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200963,N/A,HC CONNECTOR PLASTIC 5 IN 1,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200969,N/A,HC CONNECTOR Y 3/8 CARMEDA,272,1 ,$14.50 ,$7.25 ,$3.22 ,$14.50 , N/A ,$12.27 ,$12.27 ,$4.93 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$4.93 ,$12.33 ,$12.33 ,$13.05 , N/A ,$6.09 ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.66 ,$9.66 ,$8.83 ,$9.66 ,$9.43 ,$10.10 ,$3.22 ,$11.46 , N/A ,$7.25 ,$7.25 ,$4.93 ,$7.25 , N/A ,$13.78 ,$11.89 ,$11.89 ,$11.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200986,N/A,HC CORD ACTIVE ELECTRODE,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200987,N/A,HC CORD BIPOLAR DISP,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200998,N/A,HC COTTONOIDS 1X3 10PK,272,1 ,$26.00 ,$13.00 ,$5.78 ,$26.00 , N/A ,$21.99 ,$21.99 ,$8.84 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$8.84 ,$22.10 ,$22.10 ,$23.40 , N/A ,$10.92 ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.33 ,$17.33 ,$15.83 ,$17.33 ,$16.90 ,$18.11 ,$5.78 ,$20.54 , N/A ,$13.00 ,$13.00 ,$8.84 ,$13.00 , N/A ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200999,N/A,HC COUNTERSINK 3.5/4.0,272,1 ,$504.00 ,$252.00 ,$111.99 ,$504.00 , N/A ,$426.33 ,$426.33 ,$171.36 ,$403.20 ,$428.40 ,$315.00 ,$453.60 , N/A ,$478.80 ,$453.60 ,$428.40 ,$428.40 ,$171.36 ,$428.40 ,$428.40 ,$453.60 , N/A ,$211.68 ,$453.60 , N/A ,$463.68 ,$453.60 ,$335.87 ,$335.87 ,$306.94 ,$335.87 ,$327.60 ,$351.04 ,$111.99 ,$398.16 , N/A ,$252.00 ,$252.00 ,$171.36 ,$252.00 , N/A ,$478.80 ,$413.28 ,$413.28 ,$403.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201007,N/A,HC CRE BALLOON DILATOR,272,1 ,$888.00 ,$444.00 ,$197.31 ,$888.00 , N/A ,$751.16 ,$751.16 ,$301.92 ,$710.40 ,$754.80 ,$555.00 ,$799.20 , N/A ,$843.60 ,$799.20 ,$754.80 ,$754.80 ,$301.92 ,$754.80 ,$754.80 ,$799.20 , N/A ,$372.96 ,$799.20 , N/A ,$816.96 ,$799.20 ,$591.76 ,$591.76 ,$540.79 ,$591.76 ,$577.20 ,$618.49 ,$197.31 ,$701.52 , N/A ,$444.00 ,$444.00 ,$301.92 ,$444.00 , N/A ,$843.60 ,$728.16 ,$728.16 ,$710.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201016,N/A,HC CT NEEDLE MONOPTY 18G,272,1 ,$83.00 ,$41.50 ,$18.44 ,$83.00 , N/A ,$70.21 ,$70.21 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 , N/A ,$34.86 ,$74.70 , N/A ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 , N/A ,$41.50 ,$41.50 ,$28.22 ,$41.50 , N/A ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201020,N/A,HC CT TRAPLCK BONE MROW BX NEEDLE,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201023,N/A,HC CUFF TOURNIQUET 42IN DUAL,272,1 ,$89.00 ,$44.50 ,$19.78 ,$89.00 , N/A ,$75.29 ,$75.29 ,$30.26 ,$71.20 ,$75.65 ,$55.63 ,$80.10 , N/A ,$84.55 ,$80.10 ,$75.65 ,$75.65 ,$30.26 ,$75.65 ,$75.65 ,$80.10 , N/A ,$37.38 ,$80.10 , N/A ,$81.88 ,$80.10 ,$59.31 ,$59.31 ,$54.20 ,$59.31 ,$57.85 ,$61.99 ,$19.78 ,$70.31 , N/A ,$44.50 ,$44.50 ,$30.26 ,$44.50 , N/A ,$84.55 ,$72.98 ,$72.98 ,$71.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201024,N/A,HC CUFF TOURNIQUET 8IN,272,1 ,$51.00 ,$25.50 ,$11.33 ,$51.00 , N/A ,$43.14 ,$43.14 ,$17.34 ,$40.80 ,$43.35 ,$31.88 ,$45.90 , N/A ,$48.45 ,$45.90 ,$43.35 ,$43.35 ,$17.34 ,$43.35 ,$43.35 ,$45.90 , N/A ,$21.42 ,$45.90 , N/A ,$46.92 ,$45.90 ,$33.99 ,$33.99 ,$31.06 ,$33.99 ,$33.15 ,$35.52 ,$11.33 ,$40.29 , N/A ,$25.50 ,$25.50 ,$17.34 ,$25.50 , N/A ,$48.45 ,$41.82 ,$41.82 ,$40.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201025,N/A,HC CUFF TOURNIQUET PEDIATRIC,272,1 ,$82.00 ,$41.00 ,$18.22 ,$82.00 , N/A ,$69.36 ,$69.36 ,$27.88 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$27.88 ,$69.70 ,$69.70 ,$73.80 , N/A ,$34.44 ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.64 ,$54.64 ,$49.94 ,$54.64 ,$53.30 ,$57.11 ,$18.22 ,$64.78 , N/A ,$41.00 ,$41.00 ,$27.88 ,$41.00 , N/A ,$77.90 ,$67.24 ,$67.24 ,$65.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201042,N/A,HC DERMABOND,272,1 ,$73.00 ,$36.50 ,$16.22 ,$73.00 , N/A ,$61.75 ,$61.75 ,$24.82 ,$58.40 ,$62.05 ,$45.63 ,$65.70 , N/A ,$69.35 ,$65.70 ,$62.05 ,$62.05 ,$24.82 ,$62.05 ,$62.05 ,$65.70 , N/A ,$30.66 ,$65.70 , N/A ,$67.16 ,$65.70 ,$48.65 ,$48.65 ,$44.46 ,$48.65 ,$47.45 ,$50.84 ,$16.22 ,$57.67 , N/A ,$36.50 ,$36.50 ,$24.82 ,$36.50 , N/A ,$69.35 ,$59.86 ,$59.86 ,$58.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201043,N/A,HC DERMACARRIER I,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201051,N/A,HC DEVICE BONE FILLER,272,1 ,$345.00 ,$172.50 ,$76.66 ,$345.00 , N/A ,$291.84 ,$291.84 ,$117.30 ,$276.00 ,$293.25 ,$215.63 ,$310.50 , N/A ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$117.30 ,$293.25 ,$293.25 ,$310.50 , N/A ,$144.90 ,$310.50 , N/A ,$317.40 ,$310.50 ,$229.91 ,$229.91 ,$210.11 ,$229.91 ,$224.25 ,$240.29 ,$76.66 ,$272.55 , N/A ,$172.50 ,$172.50 ,$117.30 ,$172.50 , N/A ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201058,N/A,HC DEVICE RELIEVA INFLATION,272,1 ,$234.00 ,$117.00 ,$51.99 ,$234.00 , N/A ,$197.94 ,$197.94 ,$79.56 ,$187.20 ,$198.90 ,$146.25 ,$210.60 , N/A ,$222.30 ,$210.60 ,$198.90 ,$198.90 ,$79.56 ,$198.90 ,$198.90 ,$210.60 , N/A ,$98.28 ,$210.60 , N/A ,$215.28 ,$210.60 ,$155.94 ,$155.94 ,$142.51 ,$155.94 ,$152.10 ,$162.98 ,$51.99 ,$184.86 , N/A ,$117.00 ,$117.00 ,$79.56 ,$117.00 , N/A ,$222.30 ,$191.88 ,$191.88 ,$187.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201059,N/A,HC DEVICE TACKER 5MM W/20 TACKS,272,1 ,"$1,745.00 ",$872.50 ,$387.74 ,"$1,745.00 ", N/A ,"$1,476.10 ","$1,476.10 ",$593.30 ,"$1,396.00 ","$1,483.25 ","$1,090.63 ","$1,570.50 ", N/A ,"$1,657.75 ","$1,570.50 ","$1,483.25 ","$1,483.25 ",$593.30 ,"$1,483.25 ","$1,483.25 ","$1,570.50 ", N/A ,$732.90 ,"$1,570.50 ", N/A ,"$1,605.40 ","$1,570.50 ","$1,162.87 ","$1,162.87 ","$1,062.71 ","$1,162.87 ","$1,134.25 ","$1,215.39 ",$387.74 ,"$1,378.55 ", N/A ,$872.50 ,$872.50 ,$593.30 ,$872.50 , N/A ,"$1,657.75 ","$1,430.90 ","$1,430.90 ","$1,396.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27201061,N/A,HC DIALATOR URETERAL,272,1 ,$652.00 ,$326.00 ,$144.87 ,$652.00 , N/A ,$551.53 ,$551.53 ,$221.68 ,$521.60 ,$554.20 ,$407.50 ,$586.80 , N/A ,$619.40 ,$586.80 ,$554.20 ,$554.20 ,$221.68 ,$554.20 ,$554.20 ,$586.80 , N/A ,$273.84 ,$586.80 , N/A ,$599.84 ,$586.80 ,$434.49 ,$434.49 ,$397.07 ,$434.49 ,$423.80 ,$454.12 ,$144.87 ,$515.08 , N/A ,$326.00 ,$326.00 ,$221.68 ,$326.00 , N/A ,$619.40 ,$534.64 ,$534.64 ,$521.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201082,N/A,HC DISP DERMATOME HEAD,272,1 ,$85.00 ,$42.50 ,$18.89 ,$85.00 , N/A ,$71.90 ,$71.90 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 , N/A ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 , N/A ,$35.70 ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 , N/A ,$42.50 ,$42.50 ,$28.90 ,$42.50 , N/A ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201093,N/A,HC DRAIN BLAKE HUBLESS 19FR,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201098,N/A,HC DRAIN HEMOVAC 2505/2545,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201107,N/A,HC DRAIN PENROSE 1/4IN,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201110,N/A,HC DRAIN 10MM FLAT,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201147,N/A,HC DRESSING ADAPTIC 3X8,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201148,N/A,HC DRESSING AQUACELL W/HYDROFIBER,272,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A ,$14.00 ,$14.00 ,$9.52 ,$14.00 , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201152,N/A,HC DRESSING SURGICEL 4X8,272,1 ,$217.00 ,$108.50 ,$48.22 ,$217.00 , N/A ,$183.56 ,$183.56 ,$73.78 ,$173.60 ,$184.45 ,$135.63 ,$195.30 , N/A ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$73.78 ,$184.45 ,$184.45 ,$195.30 , N/A ,$91.14 ,$195.30 , N/A ,$199.64 ,$195.30 ,$144.61 ,$144.61 ,$132.15 ,$144.61 ,$141.05 ,$151.14 ,$48.22 ,$171.43 , N/A ,$108.50 ,$108.50 ,$73.78 ,$108.50 , N/A ,$206.15 ,$177.94 ,$177.94 ,$173.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201157,N/A,HC DRSG ADAPTIC 3X3 PK,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201158,N/A,HC DRSG BIO PATCH,272,1 ,$23.00 ,$11.50 ,$5.11 ,$23.00 , N/A ,$19.46 ,$19.46 ,$7.82 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$7.82 ,$19.55 ,$19.55 ,$20.70 , N/A ,$9.66 ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.33 ,$15.33 ,$14.01 ,$15.33 ,$14.95 ,$16.02 ,$5.11 ,$18.17 , N/A ,$11.50 ,$11.50 ,$7.82 ,$11.50 , N/A ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201161,N/A,HC DRSG DUO DERM 6X6,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201162,N/A,HC GIA RELOADS,272,1 ,$369.00 ,$184.50 ,$81.99 ,$369.00 , N/A ,$312.14 ,$312.14 ,$125.46 ,$295.20 ,$313.65 ,$230.63 ,$332.10 , N/A ,$350.55 ,$332.10 ,$313.65 ,$313.65 ,$125.46 ,$313.65 ,$313.65 ,$332.10 , N/A ,$154.98 ,$332.10 , N/A ,$339.48 ,$332.10 ,$245.90 ,$245.90 ,$224.72 ,$245.90 ,$239.85 ,$257.01 ,$81.99 ,$291.51 , N/A ,$184.50 ,$184.50 ,$125.46 ,$184.50 , N/A ,$350.55 ,$302.58 ,$302.58 ,$295.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201165,N/A,HC MORGAN LENS,272,1 ,$59.00 ,$29.50 ,$13.11 ,$59.00 , N/A ,$49.91 ,$49.91 ,$20.06 ,$47.20 ,$50.15 ,$36.88 ,$53.10 , N/A ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$20.06 ,$50.15 ,$50.15 ,$53.10 , N/A ,$24.78 ,$53.10 , N/A ,$54.28 ,$53.10 ,$39.32 ,$39.32 ,$35.93 ,$39.32 ,$38.35 ,$41.09 ,$13.11 ,$46.61 , N/A ,$29.50 ,$29.50 ,$20.06 ,$29.50 , N/A ,$56.05 ,$48.38 ,$48.38 ,$47.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201191,N/A,HC ELECTRODE ACMI KNIFE 24FR,272,1 ,$255.00 ,$127.50 ,$56.66 ,$255.00 , N/A ,$215.70 ,$215.70 ,$86.70 ,$204.00 ,$216.75 ,$159.38 ,$229.50 , N/A ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$86.70 ,$216.75 ,$216.75 ,$229.50 , N/A ,$107.10 ,$229.50 , N/A ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 , N/A ,$127.50 ,$127.50 ,$86.70 ,$127.50 , N/A ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201193,N/A,HC ELECTRODE ACMI ROLLER BALL,272,1 ,$255.00 ,$127.50 ,$56.66 ,$255.00 , N/A ,$215.70 ,$215.70 ,$86.70 ,$204.00 ,$216.75 ,$159.38 ,$229.50 , N/A ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$86.70 ,$216.75 ,$216.75 ,$229.50 , N/A ,$107.10 ,$229.50 , N/A ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 , N/A ,$127.50 ,$127.50 ,$86.70 ,$127.50 , N/A ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201197,N/A,HC ELECTRODE CUTTING LOOP,272,1 ,$199.00 ,$99.50 ,$44.22 ,$199.00 , N/A ,$168.33 ,$168.33 ,$67.66 ,$159.20 ,$169.15 ,$124.38 ,$179.10 , N/A ,$189.05 ,$179.10 ,$169.15 ,$169.15 ,$67.66 ,$169.15 ,$169.15 ,$179.10 , N/A ,$83.58 ,$179.10 , N/A ,$183.08 ,$179.10 ,$132.61 ,$132.61 ,$121.19 ,$132.61 ,$129.35 ,$138.60 ,$44.22 ,$157.21 , N/A ,$99.50 ,$99.50 ,$67.66 ,$99.50 , N/A ,$189.05 ,$163.18 ,$163.18 ,$159.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201200,N/A,HC ELECTRODE LEEP 2X1CM,272,1 ,$62.00 ,$31.00 ,$13.78 ,$62.00 , N/A ,$52.45 ,$52.45 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 , N/A ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 , N/A ,$26.04 ,$55.80 , N/A ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 , N/A ,$31.00 ,$31.00 ,$21.08 ,$31.00 , N/A ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201208,N/A,HC ELECTRODE RESECTION LOOP WEDGE HF24/26FR,272,1 ,$859.00 ,$429.50 ,$190.87 ,$859.00 , N/A ,$726.63 ,$726.63 ,$292.06 ,$687.20 ,$730.15 ,$536.88 ,$773.10 , N/A ,$816.05 ,$773.10 ,$730.15 ,$730.15 ,$292.06 ,$730.15 ,$730.15 ,$773.10 , N/A ,$360.78 ,$773.10 , N/A ,$790.28 ,$773.10 ,$572.44 ,$572.44 ,$523.13 ,$572.44 ,$558.35 ,$598.29 ,$190.87 ,$678.61 , N/A ,$429.50 ,$429.50 ,$292.06 ,$429.50 , N/A ,$816.05 ,$704.38 ,$704.38 ,$687.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201210,N/A,HC ELECTRODE ROLLER LOOP,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201220,N/A,HC ENDIPOUCH/ENDOCATCH,272,1 ,$230.00 ,$115.00 ,$51.11 ,$230.00 , N/A ,$194.56 ,$194.56 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 , N/A ,$96.60 ,$207.00 , N/A ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 , N/A ,$115.00 ,$115.00 ,$78.20 ,$115.00 , N/A ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201225,N/A,HC ENDO CLIP APPLIER,272,1 ,"$1,002.00 ",$501.00 ,$222.64 ,"$1,002.00 ", N/A ,$847.59 ,$847.59 ,$340.68 ,$801.60 ,$851.70 ,$626.25 ,$901.80 , N/A ,$951.90 ,$901.80 ,$851.70 ,$851.70 ,$340.68 ,$851.70 ,$851.70 ,$901.80 , N/A ,$420.84 ,$901.80 , N/A ,$921.84 ,$901.80 ,$667.73 ,$667.73 ,$610.22 ,$667.73 ,$651.30 ,$697.89 ,$222.64 ,$791.58 , N/A ,$501.00 ,$501.00 ,$340.68 ,$501.00 , N/A ,$951.90 ,$821.64 ,$821.64 ,$801.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201228,N/A,HC ENDO GIA RELOADS,272,1 ,$369.00 ,$184.50 ,$81.99 ,$369.00 , N/A ,$312.14 ,$312.14 ,$125.46 ,$295.20 ,$313.65 ,$230.63 ,$332.10 , N/A ,$350.55 ,$332.10 ,$313.65 ,$313.65 ,$125.46 ,$313.65 ,$313.65 ,$332.10 , N/A ,$154.98 ,$332.10 , N/A ,$339.48 ,$332.10 ,$245.90 ,$245.90 ,$224.72 ,$245.90 ,$239.85 ,$257.01 ,$81.99 ,$291.51 , N/A ,$184.50 ,$184.50 ,$125.46 ,$184.50 , N/A ,$350.55 ,$302.58 ,$302.58 ,$295.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201230,N/A,HC ENDO PEANUT,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201231,N/A,HC ENDO RETRACT,272,1 ,"$1,016.00 ",$508.00 ,$225.76 ,"$1,016.00 ", N/A ,$859.43 ,$859.43 ,$345.44 ,$812.80 ,$863.60 ,$635.00 ,$914.40 , N/A ,$965.20 ,$914.40 ,$863.60 ,$863.60 ,$345.44 ,$863.60 ,$863.60 ,$914.40 , N/A ,$426.72 ,$914.40 , N/A ,$934.72 ,$914.40 ,$677.06 ,$677.06 ,$618.74 ,$677.06 ,$660.40 ,$707.64 ,$225.76 ,$802.64 , N/A ,$508.00 ,$508.00 ,$345.44 ,$508.00 , N/A ,$965.20 ,$833.12 ,$833.12 ,$812.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201242,N/A,HC ENDOSCOPIC LIGATOR,272,1 ,$117.00 ,$58.50 ,$26.00 ,$117.00 , N/A ,$98.97 ,$98.97 ,$39.78 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$39.78 ,$99.45 ,$99.45 ,$105.30 , N/A ,$49.14 ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.97 ,$77.97 ,$71.25 ,$77.97 ,$76.05 ,$81.49 ,$26.00 ,$92.43 , N/A ,$58.50 ,$58.50 ,$39.78 ,$58.50 , N/A ,$111.15 ,$95.94 ,$95.94 ,$93.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201243,N/A,HC ENDOSTITCH 0/2-0 BRALON,272,1 ,$193.00 ,$96.50 ,$42.88 ,$193.00 , N/A ,$163.26 ,$163.26 ,$65.62 ,$154.40 ,$164.05 ,$120.63 ,$173.70 , N/A ,$183.35 ,$173.70 ,$164.05 ,$164.05 ,$65.62 ,$164.05 ,$164.05 ,$173.70 , N/A ,$81.06 ,$173.70 , N/A ,$177.56 ,$173.70 ,$128.62 ,$128.62 ,$117.54 ,$128.62 ,$125.45 ,$134.42 ,$42.88 ,$152.47 , N/A ,$96.50 ,$96.50 ,$65.62 ,$96.50 , N/A ,$183.35 ,$158.26 ,$158.26 ,$154.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201245,N/A,HC ENDOSTITCH SUTURE DEVICE,272,1 ,$894.00 ,$447.00 ,$198.65 ,$894.00 , N/A ,$756.23 ,$756.23 ,$303.96 ,$715.20 ,$759.90 ,$558.75 ,$804.60 , N/A ,$849.30 ,$804.60 ,$759.90 ,$759.90 ,$303.96 ,$759.90 ,$759.90 ,$804.60 , N/A ,$375.48 ,$804.60 , N/A ,$822.48 ,$804.60 ,$595.76 ,$595.76 ,$544.45 ,$595.76 ,$581.10 ,$622.67 ,$198.65 ,$706.26 , N/A ,$447.00 ,$447.00 ,$303.96 ,$447.00 , N/A ,$849.30 ,$733.08 ,$733.08 ,$715.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201247,N/A,HC ENDOTRACH TUBE HOLDER,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201250,N/A,HC EPIDURAL TRAY SNGL USE,272,1 ,$41.00 ,$20.50 ,$9.11 ,$41.00 , N/A ,$34.68 ,$34.68 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 , N/A ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 , N/A ,$17.22 ,$36.90 , N/A ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 , N/A ,$20.50 ,$20.50 ,$13.94 ,$20.50 , N/A ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201257,N/A,HC EVACUATOR ONLY RELIAVAC,272,1 ,$61.00 ,$30.50 ,$13.55 ,$61.00 , N/A ,$51.60 ,$51.60 ,$20.74 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$20.74 ,$51.85 ,$51.85 ,$54.90 , N/A ,$25.62 ,$54.90 , N/A ,$56.12 ,$54.90 ,$40.65 ,$40.65 ,$37.15 ,$40.65 ,$39.65 ,$42.49 ,$13.55 ,$48.19 , N/A ,$30.50 ,$30.50 ,$20.74 ,$30.50 , N/A ,$57.95 ,$50.02 ,$50.02 ,$48.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201274,N/A,HC EYE PACK,272,1 ,$64.00 ,$32.00 ,$14.22 ,$64.00 , N/A ,$54.14 ,$54.14 ,$21.76 ,$51.20 ,$54.40 ,$40.00 ,$57.60 , N/A ,$60.80 ,$57.60 ,$54.40 ,$54.40 ,$21.76 ,$54.40 ,$54.40 ,$57.60 , N/A ,$26.88 ,$57.60 , N/A ,$58.88 ,$57.60 ,$42.65 ,$42.65 ,$38.98 ,$42.65 ,$41.60 ,$44.58 ,$14.22 ,$50.56 , N/A ,$32.00 ,$32.00 ,$21.76 ,$32.00 , N/A ,$60.80 ,$52.48 ,$52.48 ,$51.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201282,N/A,HC FEEDING TUBE,272,1 ,$21.00 ,$10.50 ,$4.67 ,$21.00 , N/A ,$17.76 ,$17.76 ,$7.14 ,$16.80 ,$17.85 ,$13.13 ,$18.90 , N/A ,$19.95 ,$18.90 ,$17.85 ,$17.85 ,$7.14 ,$17.85 ,$17.85 ,$18.90 , N/A ,$8.82 ,$18.90 , N/A ,$19.32 ,$18.90 ,$13.99 ,$13.99 ,$12.79 ,$13.99 ,$13.65 ,$14.63 ,$4.67 ,$16.59 , N/A ,$10.50 ,$10.50 ,$7.14 ,$10.50 , N/A ,$19.95 ,$17.22 ,$17.22 ,$16.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201287,N/A,HC FIBER WIRE SUTURE,272,1 ,$59.00 ,$29.50 ,$13.11 ,$59.00 , N/A ,$49.91 ,$49.91 ,$20.06 ,$47.20 ,$50.15 ,$36.88 ,$53.10 , N/A ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$20.06 ,$50.15 ,$50.15 ,$53.10 , N/A ,$24.78 ,$53.10 , N/A ,$54.28 ,$53.10 ,$39.32 ,$39.32 ,$35.93 ,$39.32 ,$38.35 ,$41.09 ,$13.11 ,$46.61 , N/A ,$29.50 ,$29.50 ,$20.06 ,$29.50 , N/A ,$56.05 ,$48.38 ,$48.38 ,$47.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201288,N/A,HC FIBERLOOP #2 W/SUTURE NEEDLE,272,1 ,$127.00 ,$63.50 ,$28.22 ,$127.00 , N/A ,$107.43 ,$107.43 ,$43.18 ,$101.60 ,$107.95 ,$79.38 ,$114.30 , N/A ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$43.18 ,$107.95 ,$107.95 ,$114.30 , N/A ,$53.34 ,$114.30 , N/A ,$116.84 ,$114.30 ,$84.63 ,$84.63 ,$77.34 ,$84.63 ,$82.55 ,$88.46 ,$28.22 ,$100.33 , N/A ,$63.50 ,$63.50 ,$43.18 ,$63.50 , N/A ,$120.65 ,$104.14 ,$104.14 ,$101.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201317,N/A,HC FOLEY 30CC,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201319,N/A,HC FOLEY CATH W/URINE METER,272,1 ,$56.00 ,$28.00 ,$12.44 ,$56.00 , N/A ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 , N/A ,$23.52 ,$50.40 , N/A ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 , N/A ,$28.00 ,$28.00 ,$19.04 ,$28.00 , N/A ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201323,N/A,HC FOREIGN BODY RETRIEVAL NET,272,1 ,$304.00 ,$152.00 ,$67.55 ,$304.00 , N/A ,$257.15 ,$257.15 ,$103.36 ,$243.20 ,$258.40 ,$190.00 ,$273.60 , N/A ,$288.80 ,$273.60 ,$258.40 ,$258.40 ,$103.36 ,$258.40 ,$258.40 ,$273.60 , N/A ,$127.68 ,$273.60 , N/A ,$279.68 ,$273.60 ,$202.59 ,$202.59 ,$185.14 ,$202.59 ,$197.60 ,$211.74 ,$67.55 ,$240.16 , N/A ,$152.00 ,$152.00 ,$103.36 ,$152.00 , N/A ,$288.80 ,$249.28 ,$249.28 ,$243.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201332,N/A,HC GASTRIC LAVAGE KIT,272,1 ,$162.00 ,$81.00 ,$36.00 ,$162.00 , N/A ,$137.04 ,$137.04 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 , N/A ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 , N/A ,$68.04 ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 , N/A ,$81.00 ,$81.00 ,$55.08 ,$81.00 , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201334,N/A,HC GASTROSTOMY TUBE,272,1 ,$61.00 ,$30.50 ,$13.55 ,$61.00 , N/A ,$51.60 ,$51.60 ,$20.74 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$20.74 ,$51.85 ,$51.85 ,$54.90 , N/A ,$25.62 ,$54.90 , N/A ,$56.12 ,$54.90 ,$40.65 ,$40.65 ,$37.15 ,$40.65 ,$39.65 ,$42.49 ,$13.55 ,$48.19 , N/A ,$30.50 ,$30.50 ,$20.74 ,$30.50 , N/A ,$57.95 ,$50.02 ,$50.02 ,$48.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201336,N/A,HC GAUZE 4 X 4,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201379,N/A,HC GYRUS BLADE,272,1 ,$422.00 ,$211.00 ,$93.77 ,$422.00 , N/A ,$356.97 ,$356.97 ,$143.48 ,$337.60 ,$358.70 ,$263.75 ,$379.80 , N/A ,$400.90 ,$379.80 ,$358.70 ,$358.70 ,$143.48 ,$358.70 ,$358.70 ,$379.80 , N/A ,$177.24 ,$379.80 , N/A ,$388.24 ,$379.80 ,$281.22 ,$281.22 ,$257.00 ,$281.22 ,$274.30 ,$293.92 ,$93.77 ,$333.38 , N/A ,$211.00 ,$211.00 ,$143.48 ,$211.00 , N/A ,$400.90 ,$346.04 ,$346.04 ,$337.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201385,N/A,HC HANDLE RELIEVA SIDEKICK,272,1 ,$172.00 ,$86.00 ,$38.22 ,$172.00 , N/A ,$145.49 ,$145.49 ,$58.48 ,$137.60 ,$146.20 ,$107.50 ,$154.80 , N/A ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$58.48 ,$146.20 ,$146.20 ,$154.80 , N/A ,$72.24 ,$154.80 , N/A ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 , N/A ,$86.00 ,$86.00 ,$58.48 ,$86.00 , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201388,N/A,HC HARMONIC SCALPEL 36 CM,272,1 ,"$1,688.00 ",$844.00 ,$375.07 ,"$1,688.00 ", N/A ,"$1,427.88 ","$1,427.88 ",$573.92 ,"$1,350.40 ","$1,434.80 ","$1,055.00 ","$1,519.20 ", N/A ,"$1,603.60 ","$1,519.20 ","$1,434.80 ","$1,434.80 ",$573.92 ,"$1,434.80 ","$1,434.80 ","$1,519.20 ", N/A ,$708.96 ,"$1,519.20 ", N/A ,"$1,552.96 ","$1,519.20 ","$1,124.88 ","$1,124.88 ","$1,027.99 ","$1,124.88 ","$1,097.20 ","$1,175.69 ",$375.07 ,"$1,333.52 ", N/A ,$844.00 ,$844.00 ,$573.92 ,$844.00 , N/A ,"$1,603.60 ","$1,384.16 ","$1,384.16 ","$1,350.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27201389,N/A,HC HEAD RESTRAINT,272,1 ,$85.00 ,$42.50 ,$18.89 ,$85.00 , N/A ,$71.90 ,$71.90 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 , N/A ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 , N/A ,$35.70 ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 , N/A ,$42.50 ,$42.50 ,$28.90 ,$42.50 , N/A ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201390,N/A,HC HEADREST/DAY,272,1 ,$25.00 ,$12.50 ,$5.56 ,$25.00 , N/A ,$21.15 ,$21.15 ,$8.50 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$8.50 ,$21.25 ,$21.25 ,$22.50 , N/A ,$10.50 ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.66 ,$16.66 ,$15.23 ,$16.66 ,$16.25 ,$17.41 ,$5.56 ,$19.75 , N/A ,$12.50 ,$12.50 ,$8.50 ,$12.50 , N/A ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201419,N/A,HC HUBER NEEDLE,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201429,N/A,HC ILLUMINATOR RELIEVA SINUS,272,1 ,"$1,337.00 ",$668.50 ,$297.08 ,"$1,337.00 ", N/A ,"$1,130.97 ","$1,130.97 ",$454.58 ,"$1,069.60 ","$1,136.45 ",$835.63 ,"$1,203.30 ", N/A ,"$1,270.15 ","$1,203.30 ","$1,136.45 ","$1,136.45 ",$454.58 ,"$1,136.45 ","$1,136.45 ","$1,203.30 ", N/A ,$561.54 ,"$1,203.30 ", N/A ,"$1,230.04 ","$1,203.30 ",$890.98 ,$890.98 ,$814.23 ,$890.98 ,$869.05 ,$931.22 ,$297.08 ,"$1,056.23 ", N/A ,$668.50 ,$668.50 ,$454.58 ,$668.50 , N/A ,"$1,270.15 ","$1,096.34 ","$1,096.34 ","$1,069.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27201431,N/A,HC INFLATION DEVICE,272,1 ,$135.00 ,$67.50 ,$30.00 ,$135.00 , N/A ,$114.20 ,$114.20 ,$45.90 ,$108.00 ,$114.75 ,$84.38 ,$121.50 , N/A ,$128.25 ,$121.50 ,$114.75 ,$114.75 ,$45.90 ,$114.75 ,$114.75 ,$121.50 , N/A ,$56.70 ,$121.50 , N/A ,$124.20 ,$121.50 ,$89.96 ,$89.96 ,$82.22 ,$89.96 ,$87.75 ,$94.03 ,$30.00 ,$106.65 , N/A ,$67.50 ,$67.50 ,$45.90 ,$67.50 , N/A ,$128.25 ,$110.70 ,$110.70 ,$108.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201432,N/A,SNS HC INFLATION SYRINGE,272,1 ,$356.00 ,$178.00 ,$79.10 ,$356.00 , N/A ,$301.14 ,$301.14 ,$121.04 ,$284.80 ,$302.60 ,$222.50 ,$320.40 , N/A ,$338.20 ,$320.40 ,$302.60 ,$302.60 ,$121.04 ,$302.60 ,$302.60 ,$320.40 , N/A ,$149.52 ,$320.40 , N/A ,$327.52 ,$320.40 ,$237.24 ,$237.24 ,$216.80 ,$237.24 ,$231.40 ,$247.95 ,$79.10 ,$281.24 , N/A ,$178.00 ,$178.00 ,$121.04 ,$178.00 , N/A ,$338.20 ,$291.92 ,$291.92 ,$284.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201463,N/A,HC IRRIGATION CATH,272,1 ,$37.00 ,$18.50 ,$8.22 ,$37.00 , N/A ,$31.30 ,$31.30 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 , N/A ,$15.54 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 , N/A ,$18.50 ,$18.50 ,$12.58 ,$18.50 , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201478,N/A,HC JURGAN BALLS,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201483,N/A,HC KERLIX,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201486,N/A,HC CHEST TUBE DRAINAGE SYSTEM,272,1 ,$519.00 ,$259.50 ,$115.32 ,$519.00 , N/A ,$439.02 ,$439.02 ,$176.46 ,$415.20 ,$441.15 ,$324.38 ,$467.10 , N/A ,$493.05 ,$467.10 ,$441.15 ,$441.15 ,$176.46 ,$441.15 ,$441.15 ,$467.10 , N/A ,$217.98 ,$467.10 , N/A ,$477.48 ,$467.10 ,$345.86 ,$345.86 ,$316.07 ,$345.86 ,$337.35 ,$361.48 ,$115.32 ,$410.01 , N/A ,$259.50 ,$259.50 ,$176.46 ,$259.50 , N/A ,$493.05 ,$425.58 ,$425.58 ,$415.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201496,N/A,HC KIT CENTRAL VEIN ARROW,272,1 ,$63.00 ,$31.50 ,$14.00 ,$63.00 , N/A ,$53.29 ,$53.29 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 , N/A ,$26.46 ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 , N/A ,$31.50 ,$31.50 ,$21.42 ,$31.50 , N/A ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201506,N/A,HC KIT EDLICH GASTRIC LAVAGE,272,1 ,$176.00 ,$88.00 ,$39.11 ,$176.00 , N/A ,$148.88 ,$148.88 ,$59.84 ,$140.80 ,$149.60 ,$110.00 ,$158.40 , N/A ,$167.20 ,$158.40 ,$149.60 ,$149.60 ,$59.84 ,$149.60 ,$149.60 ,$158.40 , N/A ,$73.92 ,$158.40 , N/A ,$161.92 ,$158.40 ,$117.29 ,$117.29 ,$107.18 ,$117.29 ,$114.40 ,$122.58 ,$39.11 ,$139.04 , N/A ,$88.00 ,$88.00 ,$59.84 ,$88.00 , N/A ,$167.20 ,$144.32 ,$144.32 ,$140.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201519,N/A,HC KIT INLET CLOSE SURE PROC,272,1 ,$361.00 ,$180.50 ,$80.21 ,$361.00 , N/A ,$305.37 ,$305.37 ,$122.74 ,$288.80 ,$306.85 ,$225.63 ,$324.90 , N/A ,$342.95 ,$324.90 ,$306.85 ,$306.85 ,$122.74 ,$306.85 ,$306.85 ,$324.90 , N/A ,$151.62 ,$324.90 , N/A ,$332.12 ,$324.90 ,$240.57 ,$240.57 ,$219.85 ,$240.57 ,$234.65 ,$251.44 ,$80.21 ,$285.19 , N/A ,$180.50 ,$180.50 ,$122.74 ,$180.50 , N/A ,$342.95 ,$296.02 ,$296.02 ,$288.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201521,N/A,HC KIT INTRODUCER,272,1 ,$86.00 ,$43.00 ,$19.11 ,$86.00 , N/A ,$72.75 ,$72.75 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 , N/A ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 , N/A ,$36.12 ,$77.40 , N/A ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 , N/A ,$43.00 ,$43.00 ,$29.24 ,$43.00 , N/A ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201523,N/A,HC KIT MEDTRONIC ACCESSORY,272,1 ,$624.00 ,$312.00 ,$138.65 ,$624.00 , N/A ,$527.84 ,$527.84 ,$212.16 ,$499.20 ,$530.40 ,$390.00 ,$561.60 , N/A ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$212.16 ,$530.40 ,$530.40 ,$561.60 , N/A ,$262.08 ,$561.60 , N/A ,$574.08 ,$561.60 ,$415.83 ,$415.83 ,$380.02 ,$415.83 ,$405.60 ,$434.62 ,$138.65 ,$492.96 , N/A ,$312.00 ,$312.00 ,$212.16 ,$312.00 , N/A ,$592.80 ,$511.68 ,$511.68 ,$499.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201527,N/A,HC KIT NASAL BLIMP(RHINO ROCKET),272,1 ,$87.00 ,$43.50 ,$19.33 ,$87.00 , N/A ,$73.59 ,$73.59 ,$29.58 ,$69.60 ,$73.95 ,$54.38 ,$78.30 , N/A ,$82.65 ,$78.30 ,$73.95 ,$73.95 ,$29.58 ,$73.95 ,$73.95 ,$78.30 , N/A ,$36.54 ,$78.30 , N/A ,$80.04 ,$78.30 ,$57.98 ,$57.98 ,$52.98 ,$57.98 ,$56.55 ,$60.60 ,$19.33 ,$68.73 , N/A ,$43.50 ,$43.50 ,$29.58 ,$43.50 , N/A ,$82.65 ,$71.34 ,$71.34 ,$69.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201529,N/A,HC KIT NOVASURE ABLATION,272,1 ,"$3,802.00 ","$1,901.00 ",$844.80 ,"$3,802.00 ", N/A ,"$3,216.11 ","$3,216.11 ","$1,292.68 ","$3,041.60 ","$3,231.70 ","$2,376.25 ","$3,421.80 ", N/A ,"$3,611.90 ","$3,421.80 ","$3,231.70 ","$3,231.70 ","$1,292.68 ","$3,231.70 ","$3,231.70 ","$3,421.80 ", N/A ,"$1,596.84 ","$3,421.80 ", N/A ,"$3,497.84 ","$3,421.80 ","$2,533.65 ","$2,533.65 ","$2,315.42 ","$2,533.65 ","$2,471.30 ","$2,648.09 ",$844.80 ,"$3,003.58 ", N/A ,"$1,901.00 ","$1,901.00 ","$1,292.68 ","$1,901.00 ", N/A ,"$3,611.90 ","$3,117.64 ","$3,117.64 ","$3,041.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27201531,N/A,HC KIT PEG SAFETY 20F,272,1 ,$269.00 ,$134.50 ,$59.77 ,$269.00 , N/A ,$227.55 ,$227.55 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 , N/A ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 , N/A ,$112.98 ,$242.10 , N/A ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 , N/A ,$134.50 ,$134.50 ,$91.46 ,$134.50 , N/A ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201534,N/A,HC KIT PREP BONE,272,1 ,$184.00 ,$92.00 ,$40.88 ,$184.00 , N/A ,$155.65 ,$155.65 ,$62.56 ,$147.20 ,$156.40 ,$115.00 ,$165.60 , N/A ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$62.56 ,$156.40 ,$156.40 ,$165.60 , N/A ,$77.28 ,$165.60 , N/A ,$169.28 ,$165.60 ,$122.62 ,$122.62 ,$112.06 ,$122.62 ,$119.60 ,$128.16 ,$40.88 ,$145.36 , N/A ,$92.00 ,$92.00 ,$62.56 ,$92.00 , N/A ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201540,N/A,HC KIT SHOULDER SUSPENSION,272,1 ,$240.00 ,$120.00 ,$53.33 ,$240.00 , N/A ,$203.02 ,$203.02 ,$81.60 ,$192.00 ,$204.00 ,$150.00 ,$216.00 , N/A ,$228.00 ,$216.00 ,$204.00 ,$204.00 ,$81.60 ,$204.00 ,$204.00 ,$216.00 , N/A ,$100.80 ,$216.00 , N/A ,$220.80 ,$216.00 ,$159.94 ,$159.94 ,$146.16 ,$159.94 ,$156.00 ,$167.16 ,$53.33 ,$189.60 , N/A ,$120.00 ,$120.00 ,$81.60 ,$120.00 , N/A ,$228.00 ,$196.80 ,$196.80 ,$192.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201572,N/A,HC LAP ENDO SHEARS,272,1 ,$201.00 ,$100.50 ,$44.66 ,$201.00 , N/A ,$170.03 ,$170.03 ,$68.34 ,$160.80 ,$170.85 ,$125.63 ,$180.90 , N/A ,$190.95 ,$180.90 ,$170.85 ,$170.85 ,$68.34 ,$170.85 ,$170.85 ,$180.90 , N/A ,$84.42 ,$180.90 , N/A ,$184.92 ,$180.90 ,$133.95 ,$133.95 ,$122.41 ,$133.95 ,$130.65 ,$140.00 ,$44.66 ,$158.79 , N/A ,$100.50 ,$100.50 ,$68.34 ,$100.50 , N/A ,$190.95 ,$164.82 ,$164.82 ,$160.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201590,N/A,HC LAPAROSCOPY PK,272,1 ,$64.00 ,$32.00 ,$14.22 ,$64.00 , N/A ,$54.14 ,$54.14 ,$21.76 ,$51.20 ,$54.40 ,$40.00 ,$57.60 , N/A ,$60.80 ,$57.60 ,$54.40 ,$54.40 ,$21.76 ,$54.40 ,$54.40 ,$57.60 , N/A ,$26.88 ,$57.60 , N/A ,$58.88 ,$57.60 ,$42.65 ,$42.65 ,$38.98 ,$42.65 ,$41.60 ,$44.58 ,$14.22 ,$50.56 , N/A ,$32.00 ,$32.00 ,$21.76 ,$32.00 , N/A ,$60.80 ,$52.48 ,$52.48 ,$51.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201604,N/A,HC LG CEMENT,272,1 ,$285.00 ,$142.50 ,$63.33 ,$285.00 , N/A ,$241.08 ,$241.08 ,$96.90 ,$228.00 ,$242.25 ,$178.13 ,$256.50 , N/A ,$270.75 ,$256.50 ,$242.25 ,$242.25 ,$96.90 ,$242.25 ,$242.25 ,$256.50 , N/A ,$119.70 ,$256.50 , N/A ,$262.20 ,$256.50 ,$189.92 ,$189.92 ,$173.57 ,$189.92 ,$185.25 ,$198.50 ,$63.33 ,$225.15 , N/A ,$142.50 ,$142.50 ,$96.90 ,$142.50 , N/A ,$270.75 ,$233.70 ,$233.70 ,$228.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201613,N/A,HC LINER DISP SUCTION,272,1 ,$68.00 ,$34.00 ,$15.11 ,$68.00 , N/A ,$57.52 ,$57.52 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 , N/A ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 , N/A ,$28.56 ,$61.20 , N/A ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 , N/A ,$34.00 ,$34.00 ,$23.12 ,$34.00 , N/A ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201626,N/A,HC LOOPS VESSEL,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201645,N/A,HC MENISCAL APPLIER,272,1 ,$421.00 ,$210.50 ,$93.55 ,$421.00 , N/A ,$356.12 ,$356.12 ,$143.14 ,$336.80 ,$357.85 ,$263.13 ,$378.90 , N/A ,$399.95 ,$378.90 ,$357.85 ,$357.85 ,$143.14 ,$357.85 ,$357.85 ,$378.90 , N/A ,$176.82 ,$378.90 , N/A ,$387.32 ,$378.90 ,$280.55 ,$280.55 ,$256.39 ,$280.55 ,$273.65 ,$293.23 ,$93.55 ,$332.59 , N/A ,$210.50 ,$210.50 ,$143.14 ,$210.50 , N/A ,$399.95 ,$345.22 ,$345.22 ,$336.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201647,N/A,HC METER URINE,272,1 ,$21.00 ,$10.50 ,$4.67 ,$21.00 , N/A ,$17.76 ,$17.76 ,$7.14 ,$16.80 ,$17.85 ,$13.13 ,$18.90 , N/A ,$19.95 ,$18.90 ,$17.85 ,$17.85 ,$7.14 ,$17.85 ,$17.85 ,$18.90 , N/A ,$8.82 ,$18.90 , N/A ,$19.32 ,$18.90 ,$13.99 ,$13.99 ,$12.79 ,$13.99 ,$13.65 ,$14.63 ,$4.67 ,$16.59 , N/A ,$10.50 ,$10.50 ,$7.14 ,$10.50 , N/A ,$19.95 ,$17.22 ,$17.22 ,$16.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201660,N/A,HC MINI CAP TRANSFER SET W/TWIST,272,1 ,$277.00 ,$138.50 ,$61.55 ,$277.00 , N/A ,$234.31 ,$234.31 ,$94.18 ,$221.60 ,$235.45 ,$173.13 ,$249.30 , N/A ,$263.15 ,$249.30 ,$235.45 ,$235.45 ,$94.18 ,$235.45 ,$235.45 ,$249.30 , N/A ,$116.34 ,$249.30 , N/A ,$254.84 ,$249.30 ,$184.59 ,$184.59 ,$168.69 ,$184.59 ,$180.05 ,$192.93 ,$61.55 ,$218.83 , N/A ,$138.50 ,$138.50 ,$94.18 ,$138.50 , N/A ,$263.15 ,$227.14 ,$227.14 ,$221.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201663,N/A,HC DRSG GAUZE PACKING 2X72,272,1 ,$25.00 ,$12.50 ,$5.56 ,$25.00 , N/A ,$21.15 ,$21.15 ,$8.50 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$8.50 ,$21.25 ,$21.25 ,$22.50 , N/A ,$10.50 ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.66 ,$16.66 ,$15.23 ,$16.66 ,$16.25 ,$17.41 ,$5.56 ,$19.75 , N/A ,$12.50 ,$12.50 ,$8.50 ,$12.50 , N/A ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201675,N/A,HC DRSG TEGADERM 1629,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201676,N/A,HC DRSG TEGADERM 2X3,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201677,N/A,HC DRSG VASELINE GAUZE 1X8,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201690,N/A,HC NDLE BONE MARROW ASP(IMBIBE) 8GAX15,272,1 ,$39.00 ,$19.50 ,$8.67 ,$39.00 , N/A ,$32.99 ,$32.99 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 , N/A ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 , N/A ,$16.38 ,$35.10 , N/A ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 , N/A ,$19.50 ,$19.50 ,$13.26 ,$19.50 , N/A ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201692,N/A,HC NDLE SPINAL 22GA X 5-7IN ARAUJO,272,1 ,$10.40 ,$5.20 ,$2.31 ,$10.40 , N/A ,$8.80 ,$8.80 ,$3.54 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$3.54 ,$8.84 ,$8.84 ,$9.36 , N/A ,$4.37 ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.93 ,$6.93 ,$6.33 ,$6.93 ,$6.76 ,$7.24 ,$2.31 ,$8.22 , N/A ,$5.20 ,$5.20 ,$3.54 ,$5.20 , N/A ,$9.88 ,$8.53 ,$8.53 ,$8.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201699,N/A,HC NEEDLE ENTRY 18 GAUGE,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201707,N/A,HC NEEDLE PAIN PUMP INTRODUCER,272,1 ,$125.00 ,$62.50 ,$27.78 ,$125.00 , N/A ,$105.74 ,$105.74 ,$42.50 ,$100.00 ,$106.25 ,$78.13 ,$112.50 , N/A ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$42.50 ,$106.25 ,$106.25 ,$112.50 , N/A ,$52.50 ,$112.50 , N/A ,$115.00 ,$112.50 ,$83.30 ,$83.30 ,$76.13 ,$83.30 ,$81.25 ,$87.06 ,$27.78 ,$98.75 , N/A ,$62.50 ,$62.50 ,$42.50 ,$62.50 , N/A ,$118.75 ,$102.50 ,$102.50 ,$100.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201709,N/A,HC NEEDLE PERCUTANEUS ACCESS,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201711,N/A,HC NEEDLE SCORPION,272,1 ,$70.00 ,$35.00 ,$15.55 ,$70.00 , N/A ,$59.21 ,$59.21 ,$23.80 ,$56.00 ,$59.50 ,$43.75 ,$63.00 , N/A ,$66.50 ,$63.00 ,$59.50 ,$59.50 ,$23.80 ,$59.50 ,$59.50 ,$63.00 , N/A ,$29.40 ,$63.00 , N/A ,$64.40 ,$63.00 ,$46.65 ,$46.65 ,$42.63 ,$46.65 ,$45.50 ,$48.76 ,$15.55 ,$55.30 , N/A ,$35.00 ,$35.00 ,$23.80 ,$35.00 , N/A ,$66.50 ,$57.40 ,$57.40 ,$56.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201714,N/A,HC NEEDLE SPINAL 22GA X 8IN,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201716,N/A,HC NEEDLE SUTURE DISPOSABLE,272,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201731,N/A,HC HF NEEDLE,272,1 ,$123.00 ,$61.50 ,$27.33 ,$123.00 , N/A ,$104.05 ,$104.05 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 , N/A ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A ,$61.50 ,$61.50 ,$41.82 ,$61.50 , N/A ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201744,N/A,HC NOZZLE HUMERAL,272,1 ,$48.00 ,$24.00 ,$10.67 ,$48.00 , N/A ,$40.60 ,$40.60 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 , N/A ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 , N/A ,$20.16 ,$43.20 , N/A ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 , N/A ,$24.00 ,$24.00 ,$16.32 ,$24.00 , N/A ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201779,N/A,HC PACK CUSTOM BASIC,272,1 ,$54.00 ,$27.00 ,$12.00 ,$54.00 , N/A ,$45.68 ,$45.68 ,$18.36 ,$43.20 ,$45.90 ,$33.75 ,$48.60 , N/A ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$18.36 ,$45.90 ,$45.90 ,$48.60 , N/A ,$22.68 ,$48.60 , N/A ,$49.68 ,$48.60 ,$35.99 ,$35.99 ,$32.89 ,$35.99 ,$35.10 ,$37.61 ,$12.00 ,$42.66 , N/A ,$27.00 ,$27.00 ,$18.36 ,$27.00 , N/A ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201780,N/A,HC PACK CYSTO III,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201784,N/A,HC PACK MEROCEL NASL 400402,272,1 ,$49.00 ,$24.50 ,$10.89 ,$49.00 , N/A ,$41.45 ,$41.45 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 , N/A ,$20.58 ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 , N/A ,$24.50 ,$24.50 ,$16.66 ,$24.50 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201786,N/A,HC PACK NASAL SZ-4CM FIRM,272,1 ,$96.00 ,$48.00 ,$21.33 ,$96.00 , N/A ,$81.21 ,$81.21 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 , N/A ,$40.32 ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 , N/A ,$48.00 ,$48.00 ,$32.64 ,$48.00 , N/A ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201798,N/A,HC PACK VNUS CLOSURE,272,1 ,$254.00 ,$127.00 ,$56.44 ,$254.00 , N/A ,$214.86 ,$214.86 ,$86.36 ,$203.20 ,$215.90 ,$158.75 ,$228.60 , N/A ,$241.30 ,$228.60 ,$215.90 ,$215.90 ,$86.36 ,$215.90 ,$215.90 ,$228.60 , N/A ,$106.68 ,$228.60 , N/A ,$233.68 ,$228.60 ,$169.27 ,$169.27 ,$154.69 ,$169.27 ,$165.10 ,$176.91 ,$56.44 ,$200.66 , N/A ,$127.00 ,$127.00 ,$86.36 ,$127.00 , N/A ,$241.30 ,$208.28 ,$208.28 ,$203.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201804,N/A,HC PAD GROUND BOVIE,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201807,N/A,HC PAD PERINEAL POST,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201810,N/A,HC PAIN PUMP KIT 400ML,272,1 ,$79.00 ,$39.50 ,$17.55 ,$79.00 , N/A ,$66.83 ,$66.83 ,$26.86 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$26.86 ,$67.15 ,$67.15 ,$71.10 , N/A ,$33.18 ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.65 ,$52.65 ,$48.11 ,$52.65 ,$51.35 ,$55.02 ,$17.55 ,$62.41 , N/A ,$39.50 ,$39.50 ,$26.86 ,$39.50 , N/A ,$75.05 ,$64.78 ,$64.78 ,$63.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201823,N/A,HC PATIENT PROGRAMMER,272,1 ,"$3,100.00 ","$1,550.00 ",$688.82 ,"$3,100.00 ", N/A ,"$2,622.29 ","$2,622.29 ","$1,054.00 ","$2,480.00 ","$2,635.00 ","$1,937.50 ","$2,790.00 ", N/A ,"$2,945.00 ","$2,790.00 ","$2,635.00 ","$2,635.00 ","$1,054.00 ","$2,635.00 ","$2,635.00 ","$2,790.00 ", N/A ,"$1,302.00 ","$2,790.00 ", N/A ,"$2,852.00 ","$2,790.00 ","$2,065.84 ","$2,065.84 ","$1,887.90 ","$2,065.84 ","$2,015.00 ","$2,159.15 ",$688.82 ,"$2,449.00 ", N/A ,"$1,550.00 ","$1,550.00 ","$1,054.00 ","$1,550.00 ", N/A ,"$2,945.00 ","$2,542.00 ","$2,542.00 ","$2,480.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27201838,C1887,SVG HC PERIPHERAL GUIDE CATHETER,272,1 ,$58.00 ,$29.00 ,$12.89 ,$58.00 , N/A ,$49.06 ,$49.06 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 , N/A ,$24.36 ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 , N/A ,$29.00 ,$29.00 ,$19.72 ,$29.00 , N/A ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201842,N/A,HC PERSONAL THERAPY MANAGER,272,1 ,"$1,715.00 ",$857.50 ,$381.07 ,"$1,715.00 ", N/A ,"$1,450.72 ","$1,450.72 ",$583.10 ,"$1,372.00 ","$1,457.75 ","$1,071.88 ","$1,543.50 ", N/A ,"$1,629.25 ","$1,543.50 ","$1,457.75 ","$1,457.75 ",$583.10 ,"$1,457.75 ","$1,457.75 ","$1,543.50 ", N/A ,$720.30 ,"$1,543.50 ", N/A ,"$1,577.80 ","$1,543.50 ","$1,142.88 ","$1,142.88 ","$1,044.44 ","$1,142.88 ","$1,114.75 ","$1,194.50 ",$381.07 ,"$1,354.85 ", N/A ,$857.50 ,$857.50 ,$583.10 ,$857.50 , N/A ,"$1,629.25 ","$1,406.30 ","$1,406.30 ","$1,372.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27201845,N/A,HC PILLOW ABDUCTION MEDIUM,272,1 ,$78.00 ,$39.00 ,$17.33 ,$78.00 , N/A ,$65.98 ,$65.98 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 , N/A ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 , N/A ,$32.76 ,$70.20 , N/A ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 , N/A ,$39.00 ,$39.00 ,$26.52 ,$39.00 , N/A ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201846,N/A,HC PILLOW ABDUCTION SMALL,272,1 ,$56.00 ,$28.00 ,$12.44 ,$56.00 , N/A ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 , N/A ,$23.52 ,$50.40 , N/A ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 , N/A ,$28.00 ,$28.00 ,$19.04 ,$28.00 , N/A ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201847,N/A,HC PILLOW ABDUCTIONLARGE,272,1 ,$78.00 ,$39.00 ,$17.33 ,$78.00 , N/A ,$65.98 ,$65.98 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 , N/A ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 , N/A ,$32.76 ,$70.20 , N/A ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 , N/A ,$39.00 ,$39.00 ,$26.52 ,$39.00 , N/A ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201856,N/A,HC PIN CASPER DISTRACTOR 12MM,272,1 ,$96.00 ,$48.00 ,$21.33 ,$96.00 , N/A ,$81.21 ,$81.21 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 , N/A ,$40.32 ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 , N/A ,$48.00 ,$48.00 ,$32.64 ,$48.00 , N/A ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201863,N/A,HC PIN SKULL,272,1 ,$72.00 ,$36.00 ,$16.00 ,$72.00 , N/A ,$60.90 ,$60.90 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 , N/A ,$30.24 ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 , N/A ,$36.00 ,$36.00 ,$24.48 ,$36.00 , N/A ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201867,N/A,HC PLEURX DRAINAGE KIT,272,1 ,$827.00 ,$413.50 ,$183.76 ,$827.00 , N/A ,$699.56 ,$699.56 ,$281.18 ,$661.60 ,$702.95 ,$516.88 ,$744.30 , N/A ,$785.65 ,$744.30 ,$702.95 ,$702.95 ,$281.18 ,$702.95 ,$702.95 ,$744.30 , N/A ,$347.34 ,$744.30 , N/A ,$760.84 ,$744.30 ,$551.11 ,$551.11 ,$503.64 ,$551.11 ,$537.55 ,$576.01 ,$183.76 ,$653.33 , N/A ,$413.50 ,$413.50 ,$281.18 ,$413.50 , N/A ,$785.65 ,$678.14 ,$678.14 ,$661.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201877,N/A,HC PNEUMOTHORAX KIT,272,1 ,$216.00 ,$108.00 ,$48.00 ,$216.00 , N/A ,$182.71 ,$182.71 ,$73.44 ,$172.80 ,$183.60 ,$135.00 ,$194.40 , N/A ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$73.44 ,$183.60 ,$183.60 ,$194.40 , N/A ,$90.72 ,$194.40 , N/A ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$48.00 ,$170.64 , N/A ,$108.00 ,$108.00 ,$73.44 ,$108.00 , N/A ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201882,N/A,HC POLYPECTOMY SNARE,272,1 ,$58.00 ,$29.00 ,$12.89 ,$58.00 , N/A ,$49.06 ,$49.06 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 , N/A ,$24.36 ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 , N/A ,$29.00 ,$29.00 ,$19.72 ,$29.00 , N/A ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201887,N/A,HC POWDER GELFOAM,272,1 ,$145.00 ,$72.50 ,$32.22 ,$145.00 , N/A ,$122.66 ,$122.66 ,$49.30 ,$116.00 ,$123.25 ,$90.63 ,$130.50 , N/A ,$137.75 ,$130.50 ,$123.25 ,$123.25 ,$49.30 ,$123.25 ,$123.25 ,$130.50 , N/A ,$60.90 ,$130.50 , N/A ,$133.40 ,$130.50 ,$96.63 ,$96.63 ,$88.31 ,$96.63 ,$94.25 ,$100.99 ,$32.22 ,$114.55 , N/A ,$72.50 ,$72.50 ,$49.30 ,$72.50 , N/A ,$137.75 ,$118.90 ,$118.90 ,$116.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201895,N/A,HC DILATION SYRINGE,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201920,N/A,HC PROBE SURFACE 90 S,272,1 ,$327.00 ,$163.50 ,$72.66 ,$327.00 , N/A ,$276.61 ,$276.61 ,$111.18 ,$261.60 ,$277.95 ,$204.38 ,$294.30 , N/A ,$310.65 ,$294.30 ,$277.95 ,$277.95 ,$111.18 ,$277.95 ,$277.95 ,$294.30 , N/A ,$137.34 ,$294.30 , N/A ,$300.84 ,$294.30 ,$217.91 ,$217.91 ,$199.14 ,$217.91 ,$212.55 ,$227.76 ,$72.66 ,$258.33 , N/A ,$163.50 ,$163.50 ,$111.18 ,$163.50 , N/A ,$310.65 ,$268.14 ,$268.14 ,$261.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201921,N/A,HC PROBES ARTH 90% ABLATION,272,1 ,$372.00 ,$186.00 ,$82.66 ,$372.00 , N/A ,$314.67 ,$314.67 ,$126.48 ,$297.60 ,$316.20 ,$232.50 ,$334.80 , N/A ,$353.40 ,$334.80 ,$316.20 ,$316.20 ,$126.48 ,$316.20 ,$316.20 ,$334.80 , N/A ,$156.24 ,$334.80 , N/A ,$342.24 ,$334.80 ,$247.90 ,$247.90 ,$226.55 ,$247.90 ,$241.80 ,$259.10 ,$82.66 ,$293.88 , N/A ,$186.00 ,$186.00 ,$126.48 ,$186.00 , N/A ,$353.40 ,$305.04 ,$305.04 ,$297.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201935,N/A,HC PUDENDAL BLOCK TRAY,272,1 ,$19.00 ,$9.50 ,$4.22 ,$19.00 , N/A ,$16.07 ,$16.07 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 , N/A ,$7.98 ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 , N/A ,$9.50 ,$9.50 ,$6.46 ,$9.50 , N/A ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201937,N/A,HC PULSAVAC WND DEBR SUPPLY,272,1 ,$126.00 ,$63.00 ,$28.00 ,$126.00 , N/A ,$106.58 ,$106.58 ,$42.84 ,$100.80 ,$107.10 ,$78.75 ,$113.40 , N/A ,$119.70 ,$113.40 ,$107.10 ,$107.10 ,$42.84 ,$107.10 ,$107.10 ,$113.40 , N/A ,$52.92 ,$113.40 , N/A ,$115.92 ,$113.40 ,$83.97 ,$83.97 ,$76.73 ,$83.97 ,$81.90 ,$87.76 ,$28.00 ,$99.54 , N/A ,$63.00 ,$63.00 ,$42.84 ,$63.00 , N/A ,$119.70 ,$103.32 ,$103.32 ,$100.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201980,N/A,HC RETRACTOR V-CARE VAG/CERV,272,1 ,$104.00 ,$52.00 ,$23.11 ,$104.00 , N/A ,$87.97 ,$87.97 ,$35.36 ,$83.20 ,$88.40 ,$65.00 ,$93.60 , N/A ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$35.36 ,$88.40 ,$88.40 ,$93.60 , N/A ,$43.68 ,$93.60 , N/A ,$95.68 ,$93.60 ,$69.31 ,$69.31 ,$63.34 ,$69.31 ,$67.60 ,$72.44 ,$23.11 ,$82.16 , N/A ,$52.00 ,$52.00 ,$35.36 ,$52.00 , N/A ,$98.80 ,$85.28 ,$85.28 ,$83.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$174.00 ,$87.00 ,$38.66 ,$174.00 , N/A ,$147.19 ,$147.19 ,$59.16 ,$139.20 ,$147.90 ,$108.75 ,$156.60 , N/A ,$165.30 ,$156.60 ,$147.90 ,$147.90 ,$59.16 ,$147.90 ,$147.90 ,$156.60 , N/A ,$73.08 ,$156.60 , N/A ,$160.08 ,$156.60 ,$115.95 ,$115.95 ,$105.97 ,$115.95 ,$113.10 ,$121.19 ,$38.66 ,$137.46 , N/A ,$87.00 ,$87.00 ,$59.16 ,$87.00 , N/A ,$165.30 ,$142.68 ,$142.68 ,$139.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202008,N/A,HC SCREW SYN 5.0 LOCKING STARDRV,272,1 ,$442.00 ,$221.00 ,$98.21 ,$442.00 , N/A ,$373.89 ,$373.89 ,$150.28 ,$353.60 ,$375.70 ,$276.25 ,$397.80 , N/A ,$419.90 ,$397.80 ,$375.70 ,$375.70 ,$150.28 ,$375.70 ,$375.70 ,$397.80 , N/A ,$185.64 ,$397.80 , N/A ,$406.64 ,$397.80 ,$294.55 ,$294.55 ,$269.18 ,$294.55 ,$287.30 ,$307.85 ,$98.21 ,$349.18 , N/A ,$221.00 ,$221.00 ,$150.28 ,$221.00 , N/A ,$419.90 ,$362.44 ,$362.44 ,$353.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202013,N/A,HC SEALANT FLOSEAL MATRIX,272,1 ,$294.00 ,$147.00 ,$65.33 ,$294.00 , N/A ,$248.69 ,$248.69 ,$99.96 ,$235.20 ,$249.90 ,$183.75 ,$264.60 , N/A ,$279.30 ,$264.60 ,$249.90 ,$249.90 ,$99.96 ,$249.90 ,$249.90 ,$264.60 , N/A ,$123.48 ,$264.60 , N/A ,$270.48 ,$264.60 ,$195.92 ,$195.92 ,$179.05 ,$195.92 ,$191.10 ,$204.77 ,$65.33 ,$232.26 , N/A ,$147.00 ,$147.00 ,$99.96 ,$147.00 , N/A ,$279.30 ,$241.08 ,$241.08 ,$235.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202016,N/A,HC SEALS SCOPE WARMER,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202020,N/A,HC SHOULDER PACK,272,1 ,$345.00 ,$172.50 ,$76.66 ,$345.00 , N/A ,$291.84 ,$291.84 ,$117.30 ,$276.00 ,$293.25 ,$215.63 ,$310.50 , N/A ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$117.30 ,$293.25 ,$293.25 ,$310.50 , N/A ,$144.90 ,$310.50 , N/A ,$317.40 ,$310.50 ,$229.91 ,$229.91 ,$210.11 ,$229.91 ,$224.25 ,$240.29 ,$76.66 ,$272.55 , N/A ,$172.50 ,$172.50 ,$117.30 ,$172.50 , N/A ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202045,N/A,HC SHEARS HARMONIC 9MM CURVED,272,1 ,"$1,547.00 ",$773.50 ,$343.74 ,"$1,547.00 ", N/A ,"$1,308.61 ","$1,308.61 ",$525.98 ,"$1,237.60 ","$1,314.95 ",$966.88 ,"$1,392.30 ", N/A ,"$1,469.65 ","$1,392.30 ","$1,314.95 ","$1,314.95 ",$525.98 ,"$1,314.95 ","$1,314.95 ","$1,392.30 ", N/A ,$649.74 ,"$1,392.30 ", N/A ,"$1,423.24 ","$1,392.30 ","$1,030.92 ","$1,030.92 ",$942.12 ,"$1,030.92 ","$1,005.55 ","$1,077.49 ",$343.74 ,"$1,222.13 ", N/A ,$773.50 ,$773.50 ,$525.98 ,$773.50 , N/A ,"$1,469.65 ","$1,268.54 ","$1,268.54 ","$1,237.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27202068,N/A,HC SPONGE EYE WECK,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202070,N/A,HC SPONGE LAP 5 PACK CARD,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202072,N/A,HC SPONGE MEROCEL 440406,272,1 ,$248.00 ,$124.00 ,$55.11 ,$248.00 , N/A ,$209.78 ,$209.78 ,$84.32 ,$198.40 ,$210.80 ,$155.00 ,$223.20 , N/A ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$84.32 ,$210.80 ,$210.80 ,$223.20 , N/A ,$104.16 ,$223.20 , N/A ,$228.16 ,$223.20 ,$165.27 ,$165.27 ,$151.03 ,$165.27 ,$161.20 ,$172.73 ,$55.11 ,$195.92 , N/A ,$124.00 ,$124.00 ,$84.32 ,$124.00 , N/A ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202074,N/A,HC SPONGE PEANUT,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202075,N/A,HC SPONGE RAYTEC 3X3,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202078,N/A,HC SPONGE TONSIL,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202079,N/A,HC SPONGE TONSIL MEDIUM,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202084,N/A,HC STAPLER 35W ROTATING HEAD,272,1 ,$64.00 ,$32.00 ,$14.22 ,$64.00 , N/A ,$54.14 ,$54.14 ,$21.76 ,$51.20 ,$54.40 ,$40.00 ,$57.60 , N/A ,$60.80 ,$57.60 ,$54.40 ,$54.40 ,$21.76 ,$54.40 ,$54.40 ,$57.60 , N/A ,$26.88 ,$57.60 , N/A ,$58.88 ,$57.60 ,$42.65 ,$42.65 ,$38.98 ,$42.65 ,$41.60 ,$44.58 ,$14.22 ,$50.56 , N/A ,$32.00 ,$32.00 ,$21.76 ,$32.00 , N/A ,$60.80 ,$52.48 ,$52.48 ,$51.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202087,N/A,HC STAPLER CEEA 29,272,1 ,$806.00 ,$403.00 ,$179.09 ,$806.00 , N/A ,$681.80 ,$681.80 ,$274.04 ,$644.80 ,$685.10 ,$503.75 ,$725.40 , N/A ,$765.70 ,$725.40 ,$685.10 ,$685.10 ,$274.04 ,$685.10 ,$685.10 ,$725.40 , N/A ,$338.52 ,$725.40 , N/A ,$741.52 ,$725.40 ,$537.12 ,$537.12 ,$490.85 ,$537.12 ,$523.90 ,$561.38 ,$179.09 ,$636.74 , N/A ,$403.00 ,$403.00 ,$274.04 ,$403.00 , N/A ,$765.70 ,$660.92 ,$660.92 ,$644.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202088,N/A,HC STAPLER CEEA 33,272,1 ,$806.00 ,$403.00 ,$179.09 ,$806.00 , N/A ,$681.80 ,$681.80 ,$274.04 ,$644.80 ,$685.10 ,$503.75 ,$725.40 , N/A ,$765.70 ,$725.40 ,$685.10 ,$685.10 ,$274.04 ,$685.10 ,$685.10 ,$725.40 , N/A ,$338.52 ,$725.40 , N/A ,$741.52 ,$725.40 ,$537.12 ,$537.12 ,$490.85 ,$537.12 ,$523.90 ,$561.38 ,$179.09 ,$636.74 , N/A ,$403.00 ,$403.00 ,$274.04 ,$403.00 , N/A ,$765.70 ,$660.92 ,$660.92 ,$644.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202091,N/A,HC STAPLER CURVED CUTTER,272,1 ,$806.00 ,$403.00 ,$179.09 ,$806.00 , N/A ,$681.80 ,$681.80 ,$274.04 ,$644.80 ,$685.10 ,$503.75 ,$725.40 , N/A ,$765.70 ,$725.40 ,$685.10 ,$685.10 ,$274.04 ,$685.10 ,$685.10 ,$725.40 , N/A ,$338.52 ,$725.40 , N/A ,$741.52 ,$725.40 ,$537.12 ,$537.12 ,$490.85 ,$537.12 ,$523.90 ,$561.38 ,$179.09 ,$636.74 , N/A ,$403.00 ,$403.00 ,$274.04 ,$403.00 , N/A ,$765.70 ,$660.92 ,$660.92 ,$644.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202095,N/A,HC STAPLER ENDO GIA 30-3.5,272,1 ,$995.00 ,$497.50 ,$221.09 ,$995.00 , N/A ,$841.67 ,$841.67 ,$338.30 ,$796.00 ,$845.75 ,$621.88 ,$895.50 , N/A ,$945.25 ,$895.50 ,$845.75 ,$845.75 ,$338.30 ,$845.75 ,$845.75 ,$895.50 , N/A ,$417.90 ,$895.50 , N/A ,$915.40 ,$895.50 ,$663.07 ,$663.07 ,$605.96 ,$663.07 ,$646.75 ,$693.02 ,$221.09 ,$786.05 , N/A ,$497.50 ,$497.50 ,$338.30 ,$497.50 , N/A ,$945.25 ,$815.90 ,$815.90 ,$796.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202097,N/A,HC STAPLER ENDO LINEAR CUTTER,272,1 ,$816.00 ,$408.00 ,$181.32 ,$816.00 , N/A ,$690.25 ,$690.25 ,$277.44 ,$652.80 ,$693.60 ,$510.00 ,$734.40 , N/A ,$775.20 ,$734.40 ,$693.60 ,$693.60 ,$277.44 ,$693.60 ,$693.60 ,$734.40 , N/A ,$342.72 ,$734.40 , N/A ,$750.72 ,$734.40 ,$543.78 ,$543.78 ,$496.94 ,$543.78 ,$530.40 ,$568.34 ,$181.32 ,$644.64 , N/A ,$408.00 ,$408.00 ,$277.44 ,$408.00 , N/A ,$775.20 ,$669.12 ,$669.12 ,$652.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202100,N/A,HC STAPLER FLEX 60 ENDO LINEAR CUTTER,272,1 ,$865.00 ,$432.50 ,$192.20 ,$865.00 , N/A ,$731.70 ,$731.70 ,$294.10 ,$692.00 ,$735.25 ,$540.63 ,$778.50 , N/A ,$821.75 ,$778.50 ,$735.25 ,$735.25 ,$294.10 ,$735.25 ,$735.25 ,$778.50 , N/A ,$363.30 ,$778.50 , N/A ,$795.80 ,$778.50 ,$576.44 ,$576.44 ,$526.79 ,$576.44 ,$562.25 ,$602.47 ,$192.20 ,$683.35 , N/A ,$432.50 ,$432.50 ,$294.10 ,$432.50 , N/A ,$821.75 ,$709.30 ,$709.30 ,$692.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202103,N/A,HC STAPLER EAA 4.8,272,1 ,"$2,731.00 ","$1,365.50 ",$606.83 ,"$2,731.00 ", N/A ,"$2,310.15 ","$2,310.15 ",$928.54 ,"$2,184.80 ","$2,321.35 ","$1,706.88 ","$2,457.90 ", N/A ,"$2,594.45 ","$2,457.90 ","$2,321.35 ","$2,321.35 ",$928.54 ,"$2,321.35 ","$2,321.35 ","$2,457.90 ", N/A ,"$1,147.02 ","$2,457.90 ", N/A ,"$2,512.52 ","$2,457.90 ","$1,819.94 ","$1,819.94 ","$1,663.18 ","$1,819.94 ","$1,775.15 ","$1,902.14 ",$606.83 ,"$2,157.49 ", N/A ,"$1,365.50 ","$1,365.50 ",$928.54 ,"$1,365.50 ", N/A ,"$2,594.45 ","$2,239.42 ","$2,239.42 ","$2,184.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27202104,N/A,HC STAPLER GIA 55,272,1 ,$295.00 ,$147.50 ,$65.55 ,$295.00 , N/A ,$249.54 ,$249.54 ,$100.30 ,$236.00 ,$250.75 ,$184.38 ,$265.50 , N/A ,$280.25 ,$265.50 ,$250.75 ,$250.75 ,$100.30 ,$250.75 ,$250.75 ,$265.50 , N/A ,$123.90 ,$265.50 , N/A ,$271.40 ,$265.50 ,$196.59 ,$196.59 ,$179.66 ,$196.59 ,$191.75 ,$205.47 ,$65.55 ,$233.05 , N/A ,$147.50 ,$147.50 ,$100.30 ,$147.50 , N/A ,$280.25 ,$241.90 ,$241.90 ,$236.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202106,N/A,HC STAPLER EAA 3.5,272,1 ,"$2,363.00 ","$1,181.50 ",$525.06 ,"$2,363.00 ", N/A ,"$1,998.86 ","$1,998.86 ",$803.42 ,"$1,890.40 ","$2,008.55 ","$1,476.88 ","$2,126.70 ", N/A ,"$2,244.85 ","$2,126.70 ","$2,008.55 ","$2,008.55 ",$803.42 ,"$2,008.55 ","$2,008.55 ","$2,126.70 ", N/A ,$992.46 ,"$2,126.70 ", N/A ,"$2,173.96 ","$2,126.70 ","$1,574.70 ","$1,574.70 ","$1,439.07 ","$1,574.70 ","$1,535.95 ","$1,645.83 ",$525.06 ,"$1,866.77 ", N/A ,"$1,181.50 ","$1,181.50 ",$803.42 ,"$1,181.50 ", N/A ,"$2,244.85 ","$1,937.66 ","$1,937.66 ","$1,890.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27202110,N/A,HC STAPLER LIN CUTTER 60,272,1 ,$288.00 ,$144.00 ,$63.99 ,$288.00 , N/A ,$243.62 ,$243.62 ,$97.92 ,$230.40 ,$244.80 ,$180.00 ,$259.20 , N/A ,$273.60 ,$259.20 ,$244.80 ,$244.80 ,$97.92 ,$244.80 ,$244.80 ,$259.20 , N/A ,$120.96 ,$259.20 , N/A ,$264.96 ,$259.20 ,$191.92 ,$191.92 ,$175.39 ,$191.92 ,$187.20 ,$200.59 ,$63.99 ,$227.52 , N/A ,$144.00 ,$144.00 ,$97.92 ,$144.00 , N/A ,$273.60 ,$236.16 ,$236.16 ,$230.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202111,N/A,HC STAPLER LIN CUTTER 75,272,1 ,$45.00 ,$22.50 ,$10.00 ,$45.00 , N/A ,$38.07 ,$38.07 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 , N/A ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 , N/A ,$18.90 ,$40.50 , N/A ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 , N/A ,$22.50 ,$22.50 ,$15.30 ,$22.50 , N/A ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202117,N/A,HC STAPLE RELOAD,272,1 ,$409.00 ,$204.50 ,$90.88 ,$409.00 , N/A ,$345.97 ,$345.97 ,$139.06 ,$327.20 ,$347.65 ,$255.63 ,$368.10 , N/A ,$388.55 ,$368.10 ,$347.65 ,$347.65 ,$139.06 ,$347.65 ,$347.65 ,$368.10 , N/A ,$171.78 ,$368.10 , N/A ,$376.28 ,$368.10 ,$272.56 ,$272.56 ,$249.08 ,$272.56 ,$265.85 ,$284.87 ,$90.88 ,$323.11 , N/A ,$204.50 ,$204.50 ,$139.06 ,$204.50 , N/A ,$388.55 ,$335.38 ,$335.38 ,$327.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202118,N/A,HC STAPLER ROTICUL TA55 3.5,272,1 ,$595.00 ,$297.50 ,$132.21 ,$595.00 , N/A ,$503.31 ,$503.31 ,$202.30 ,$476.00 ,$505.75 ,$371.88 ,$535.50 , N/A ,$565.25 ,$535.50 ,$505.75 ,$505.75 ,$202.30 ,$505.75 ,$505.75 ,$535.50 , N/A ,$249.90 ,$535.50 , N/A ,$547.40 ,$535.50 ,$396.51 ,$396.51 ,$362.36 ,$396.51 ,$386.75 ,$414.42 ,$132.21 ,$470.05 , N/A ,$297.50 ,$297.50 ,$202.30 ,$297.50 , N/A ,$565.25 ,$487.90 ,$487.90 ,$476.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202119,N/A,HC STAPLER ROTICUL TA55 4.8,272,1 ,$595.00 ,$297.50 ,$132.21 ,$595.00 , N/A ,$503.31 ,$503.31 ,$202.30 ,$476.00 ,$505.75 ,$371.88 ,$535.50 , N/A ,$565.25 ,$535.50 ,$505.75 ,$505.75 ,$202.30 ,$505.75 ,$505.75 ,$535.50 , N/A ,$249.90 ,$535.50 , N/A ,$547.40 ,$535.50 ,$396.51 ,$396.51 ,$362.36 ,$396.51 ,$386.75 ,$414.42 ,$132.21 ,$470.05 , N/A ,$297.50 ,$297.50 ,$202.30 ,$297.50 , N/A ,$565.25 ,$487.90 ,$487.90 ,$476.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202120,N/A,HC STAPLER SKIN,272,1 ,$23.00 ,$11.50 ,$5.11 ,$23.00 , N/A ,$19.46 ,$19.46 ,$7.82 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$7.82 ,$19.55 ,$19.55 ,$20.70 , N/A ,$9.66 ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.33 ,$15.33 ,$14.01 ,$15.33 ,$14.95 ,$16.02 ,$5.11 ,$18.17 , N/A ,$11.50 ,$11.50 ,$7.82 ,$11.50 , N/A ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202123,N/A,HC STAPLER SKIN W PRW35,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202128,N/A,HC STAPLER VISI-STAT,272,1 ,$907.00 ,$453.50 ,$201.54 ,$907.00 , N/A ,$767.23 ,$767.23 ,$308.38 ,$725.60 ,$770.95 ,$566.88 ,$816.30 , N/A ,$861.65 ,$816.30 ,$770.95 ,$770.95 ,$308.38 ,$770.95 ,$770.95 ,$816.30 , N/A ,$380.94 ,$816.30 , N/A ,$834.44 ,$816.30 ,$604.42 ,$604.42 ,$552.36 ,$604.42 ,$589.55 ,$631.73 ,$201.54 ,$716.53 , N/A ,$453.50 ,$453.50 ,$308.38 ,$453.50 , N/A ,$861.65 ,$743.74 ,$743.74 ,$725.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202130,N/A,HC STAPLER-PURSE STRING 45,272,1 ,$527.00 ,$263.50 ,$117.10 ,$527.00 , N/A ,$445.79 ,$445.79 ,$179.18 ,$421.60 ,$447.95 ,$329.38 ,$474.30 , N/A ,$500.65 ,$474.30 ,$447.95 ,$447.95 ,$179.18 ,$447.95 ,$447.95 ,$474.30 , N/A ,$221.34 ,$474.30 , N/A ,$484.84 ,$474.30 ,$351.19 ,$351.19 ,$320.94 ,$351.19 ,$342.55 ,$367.06 ,$117.10 ,$416.33 , N/A ,$263.50 ,$263.50 ,$179.18 ,$263.50 , N/A ,$500.65 ,$432.14 ,$432.14 ,$421.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202146,N/A,HC STIMULATOR NERVE LOCATOR,272,1 ,$142.00 ,$71.00 ,$31.55 ,$142.00 , N/A ,$120.12 ,$120.12 ,$48.28 ,$113.60 ,$120.70 ,$88.75 ,$127.80 , N/A ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$48.28 ,$120.70 ,$120.70 ,$127.80 , N/A ,$59.64 ,$127.80 , N/A ,$130.64 ,$127.80 ,$94.63 ,$94.63 ,$86.48 ,$94.63 ,$92.30 ,$98.90 ,$31.55 ,$112.18 , N/A ,$71.00 ,$71.00 ,$48.28 ,$71.00 , N/A ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202149,N/A,HC STOCKINETTE DOUBLE LG,272,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202150,N/A,HC STOCKINETTE DOUBLE MD,272,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202151,N/A,HC STOCKING TED KNEE HIGH,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202152,N/A,HC STOCKING TED THIGH HIGH,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202153,N/A,HC STONE BASKET,272,1 ,$597.00 ,$298.50 ,$132.65 ,$597.00 , N/A ,$505.00 ,$505.00 ,$202.98 ,$477.60 ,$507.45 ,$373.13 ,$537.30 , N/A ,$567.15 ,$537.30 ,$507.45 ,$507.45 ,$202.98 ,$507.45 ,$507.45 ,$537.30 , N/A ,$250.74 ,$537.30 , N/A ,$549.24 ,$537.30 ,$397.84 ,$397.84 ,$363.57 ,$397.84 ,$388.05 ,$415.81 ,$132.65 ,$471.63 , N/A ,$298.50 ,$298.50 ,$202.98 ,$298.50 , N/A ,$567.15 ,$489.54 ,$489.54 ,$477.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202162,N/A,HC STERI STRIP,272,1 ,$31.00 ,$15.50 ,$6.89 ,$31.00 , N/A ,$26.22 ,$26.22 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 , N/A ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 , N/A ,$13.02 ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 , N/A ,$15.50 ,$15.50 ,$10.54 ,$15.50 , N/A ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202167,N/A,HC STYLET VNUS RFS 6F 12CM,272,1 ,"$1,870.00 ",$935.00 ,$415.51 ,"$1,870.00 ", N/A ,"$1,581.83 ","$1,581.83 ",$635.80 ,"$1,496.00 ","$1,589.50 ","$1,168.75 ","$1,683.00 ", N/A ,"$1,776.50 ","$1,683.00 ","$1,589.50 ","$1,589.50 ",$635.80 ,"$1,589.50 ","$1,589.50 ","$1,683.00 ", N/A ,$785.40 ,"$1,683.00 ", N/A ,"$1,720.40 ","$1,683.00 ","$1,246.17 ","$1,246.17 ","$1,138.83 ","$1,246.17 ","$1,215.50 ","$1,302.46 ",$415.51 ,"$1,477.30 ", N/A ,$935.00 ,$935.00 ,$635.80 ,$935.00 , N/A ,"$1,776.50 ","$1,533.40 ","$1,533.40 ","$1,496.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27202168,N/A,HC SUCT VACUUM CURETTE,272,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202182,N/A,HC SUPPORTER ADULT,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202187,N/A,HC SUT 2-0 ETHIBOND 30IN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202195,N/A,HC SUT BUTTONS 520G,272,1 ,$10.40 ,$5.20 ,$2.31 ,$10.40 , N/A ,$8.80 ,$8.80 ,$3.54 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$3.54 ,$8.84 ,$8.84 ,$9.36 , N/A ,$4.37 ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.93 ,$6.93 ,$6.33 ,$6.93 ,$6.76 ,$7.24 ,$2.31 ,$8.22 , N/A ,$5.20 ,$5.20 ,$3.54 ,$5.20 , N/A ,$9.88 ,$8.53 ,$8.53 ,$8.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202199,N/A,HC SUT CHRMIC 2-0 GS-24/21 36IN,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202200,N/A,HC SUT CHROMIC 0 914H/CG914,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202201,N/A,HC SUT CHROMIC 0 924H,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202202,N/A,HC SUT CHROMIC 0 MO-4 27IN 4924H,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202206,N/A,HC SUT CHROMIC 1-0 915H/CG915,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202209,N/A,HC SUT CHROMIC 2-0 G123H/GG123,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202210,N/A,HC SUT CHROMIC 2-0 L113G/LG113,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202212,N/A,HC SUT CHROMIC 3-0 636H,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202214,N/A,HC SUT CHROMIC 3-0 922H/CG922,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202215,N/A,HC SUT CHROMIC 3-0 G122H/GG122,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202216,N/A,HC SUT CHROMIC 3-0 L112G/LG112,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202217,N/A,HC SUT CHROMIC 4-0 1637G/SG1637G,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202218,N/A,HC SUT CHROMIC 4-0 1659G,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202222,N/A,HC SUT CHROMIC 4-0 G121H/GG121,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202224,N/A,HC SUT CHROMIC 5-0 687G/SG1687G,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202229,N/A,HC SUT ENDO STITCH 2-0 17004,272,1 ,$181.00 ,$90.50 ,$40.22 ,$181.00 , N/A ,$153.11 ,$153.11 ,$61.54 ,$144.80 ,$153.85 ,$113.13 ,$162.90 , N/A ,$171.95 ,$162.90 ,$153.85 ,$153.85 ,$61.54 ,$153.85 ,$153.85 ,$162.90 , N/A ,$76.02 ,$162.90 , N/A ,$166.52 ,$162.90 ,$120.62 ,$120.62 ,$110.23 ,$120.62 ,$117.65 ,$126.07 ,$40.22 ,$142.99 , N/A ,$90.50 ,$90.50 ,$61.54 ,$90.50 , N/A ,$171.95 ,$148.42 ,$148.42 ,$144.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202240,N/A,HC SUT ETHIBOND 2 DC493,272,1 ,$51.00 ,$25.50 ,$11.33 ,$51.00 , N/A ,$43.14 ,$43.14 ,$17.34 ,$40.80 ,$43.35 ,$31.88 ,$45.90 , N/A ,$48.45 ,$45.90 ,$43.35 ,$43.35 ,$17.34 ,$43.35 ,$43.35 ,$45.90 , N/A ,$21.42 ,$45.90 , N/A ,$46.92 ,$45.90 ,$33.99 ,$33.99 ,$31.06 ,$33.99 ,$33.15 ,$35.52 ,$11.33 ,$40.29 , N/A ,$25.50 ,$25.50 ,$17.34 ,$25.50 , N/A ,$48.45 ,$41.82 ,$41.82 ,$40.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202253,N/A,HC SUT ETHIBOND 2-0 X519H/CD519,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202254,N/A,HC SUT ETHIBOND 2-0 X523H/3256-51,272,1 ,$6.40 ,$3.20 ,$1.42 ,$6.40 , N/A ,$5.41 ,$5.41 ,$2.18 ,$5.12 ,$5.44 ,$4.00 ,$5.76 , N/A ,$6.08 ,$5.76 ,$5.44 ,$5.44 ,$2.18 ,$5.44 ,$5.44 ,$5.76 , N/A ,$2.69 ,$5.76 , N/A ,$5.89 ,$5.76 ,$4.27 ,$4.27 ,$3.90 ,$4.27 ,$4.16 ,$4.46 ,$1.42 ,$5.06 , N/A ,$3.20 ,$3.20 ,$2.18 ,$3.20 , N/A ,$6.08 ,$5.25 ,$5.25 ,$5.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202259,N/A,HC SUT ETHIBOND 4.0 X557H,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202261,N/A,HC SUT ETHIBOND 4-0 X761/3369-31,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202263,N/A,HC SUT ETHIBOND EXTRA SZ 2-0 30IN,272,1 ,$56.00 ,$28.00 ,$12.44 ,$56.00 , N/A ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 , N/A ,$23.52 ,$50.40 , N/A ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 , N/A ,$28.00 ,$28.00 ,$19.04 ,$28.00 , N/A ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202266,N/A,HC SUT ETHILON 3-0 669H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202267,N/A,HC SUT ETHILON 3-0 FSLX 30IN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202268,N/A,HC SUT ETHILON 3-0 PS-2 18 1669H,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202269,N/A,HC SUT ETHILON 4-0 PS-2 18 1667H,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202270,N/A,HC SUT ETHILON 6-0 697G,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202293,N/A,HC SUT MONOCRYL 2-0 Y375H/UM345 AU,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202299,N/A,HC SUT MONOCRYL 3-0 Y416H,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202300,N/A,HC SUT MONOCRYL 3-0 Y936H/SC1780G,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202304,N/A,HC SUT MONOCRYL 5-0 Y213H,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202305,N/A,HC SUT MONOCYRL 4-0 PS-2 Y426H,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202306,N/A,HC SUT NUROLON 0 C541D/1909-62,272,1 ,$40.00 ,$20.00 ,$8.89 ,$40.00 , N/A ,$33.84 ,$33.84 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 , N/A ,$16.80 ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 , N/A ,$20.00 ,$20.00 ,$13.60 ,$20.00 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202308,N/A,HC SUT NUROLON 1-0 5425H/1971-71,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202310,N/A,HC SUT NUROLON 2-0 CT-2 C526D,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202319,N/A,HC SUT NYLON 10-0 9000G/CS160-6,272,1 ,$62.00 ,$31.00 ,$13.78 ,$62.00 , N/A ,$52.45 ,$52.45 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 , N/A ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 , N/A ,$26.04 ,$55.80 , N/A ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 , N/A ,$31.00 ,$31.00 ,$21.08 ,$31.00 , N/A ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202321,N/A,HC SUT NYLON 2-0 490T/CN490,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202330,N/A,HC SUT NYLON 5-0 1666H/SN1666G,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202335,N/A,HC SUT PDS 1 CTX 36IN,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202336,N/A,HC SUT PDS 1 Z371T,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202345,N/A,HC SUT PDS II 0 Z340H/6267-61/CM812,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202346,N/A,HC SUT PDS II 1 TIES Z880G,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202347,N/A,HC SUT PDS II 2-0 CL,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202349,N/A,HC SUT PDS II 4-0 Z304H/6207-31,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202353,N/A,HC SUT PLAIN 4-0 1644G/SG1654G,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202354,N/A,HC SUT PLAIN 4-0 1828H/SG828,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202356,N/A,HC SUT PLAIN 5-0 686G/SG2686,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202361,N/A,HC SUT PLAIN 6-0 774,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202368,N/A,HC SUT PROLENE 0 8424H/CP424,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202369,N/A,HC SUT PROLENE 0 8434H/CP434,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202370,N/A,HC SUT PROLENE 0 8834H/VP834,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202373,N/A,HC SUT PROLENE 1-0 8435H/CP435,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202374,N/A,HC SUT PROLENE 1-0 D4412,272,1 ,$76.00 ,$38.00 ,$16.89 ,$76.00 , N/A ,$64.29 ,$64.29 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 , N/A ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 , N/A ,$31.92 ,$68.40 , N/A ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 , N/A ,$38.00 ,$38.00 ,$25.84 ,$38.00 , N/A ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202377,N/A,HC SUT PROLENE 10-0 788G,272,1 ,$76.00 ,$38.00 ,$16.89 ,$76.00 , N/A ,$64.29 ,$64.29 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 , N/A ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 , N/A ,$31.92 ,$68.40 , N/A ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 , N/A ,$38.00 ,$38.00 ,$25.84 ,$38.00 , N/A ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202381,N/A,HC SUT PROLENE 2-0 8685H/SP868,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202383,N/A,HC SUT PROLENE 3-0 8522H ET,272,1 ,$19.00 ,$9.50 ,$4.22 ,$19.00 , N/A ,$16.07 ,$16.07 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 , N/A ,$7.98 ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 , N/A ,$9.50 ,$9.50 ,$6.46 ,$9.50 , N/A ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202385,N/A,HC SUT PROLENE 3-0 8663H/SP1663G,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202395,N/A,HC SUT PROLENE 4-0 PS2 8682H,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202402,N/A,HC SUT PROLENE 5-0 8686,272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202404,N/A,HC SUT PROLENE 5-0,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202413,N/A,HC SUT PROLENE 6-0 M8709 ET,272,1 ,$170.00 ,$85.00 ,$37.77 ,$170.00 , N/A ,$143.80 ,$143.80 ,$57.80 ,$136.00 ,$144.50 ,$106.25 ,$153.00 , N/A ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$57.80 ,$144.50 ,$144.50 ,$153.00 , N/A ,$71.40 ,$153.00 , N/A ,$156.40 ,$153.00 ,$113.29 ,$113.29 ,$103.53 ,$113.29 ,$110.50 ,$118.41 ,$37.77 ,$134.30 , N/A ,$85.00 ,$85.00 ,$57.80 ,$85.00 , N/A ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202415,N/A,HC SUT PROLENE 7-0 8648G/SP1647G,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202416,N/A,HC SUT PROLENE 7-0 8701H/VP701X,272,1 ,$43.00 ,$21.50 ,$9.55 ,$43.00 , N/A ,$36.37 ,$36.37 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 , N/A ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 , N/A ,$18.06 ,$38.70 , N/A ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 , N/A ,$21.50 ,$21.50 ,$14.62 ,$21.50 , N/A ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202417,N/A,HC SUT PROLENE 7-0 8703H ET,272,1 ,$45.00 ,$22.50 ,$10.00 ,$45.00 , N/A ,$38.07 ,$38.07 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 , N/A ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 , N/A ,$18.90 ,$40.50 , N/A ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 , N/A ,$22.50 ,$22.50 ,$15.30 ,$22.50 , N/A ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202423,N/A,HC SUT RETENSION BOLSTER,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202424,N/A,HC SUT RETENSION BRIDGE,272,1 ,$23.00 ,$11.50 ,$5.11 ,$23.00 , N/A ,$19.46 ,$19.46 ,$7.82 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$7.82 ,$19.55 ,$19.55 ,$20.70 , N/A ,$9.66 ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.33 ,$15.33 ,$14.01 ,$15.33 ,$14.95 ,$16.02 ,$5.11 ,$18.17 , N/A ,$11.50 ,$11.50 ,$7.82 ,$11.50 , N/A ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202425,N/A,HC SUT SILK 0 18IN 580H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202427,N/A,HC SUT SILK 0 30IN TIES,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202428,N/A,HC SUT SILK 0 424H/CS424,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202431,N/A,HC SUT SILK 0 A186H/S196,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202432,N/A,HC SUT SILK 0 A306H/S316,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202435,N/A,HC SUT SILK 0 K834H/GS834,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202441,N/A,HC SUT SILK 2-0 1588H/SS1685G,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202444,N/A,HC SUT SILK 2-0 A185H/S195,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202445,N/A,HC SUT SILK 2-0 C012D/GS62M/CS10M,272,1 ,$34.00 ,$17.00 ,$7.55 ,$34.00 , N/A ,$28.76 ,$28.76 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 , N/A ,$14.28 ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 , N/A ,$17.00 ,$17.00 ,$11.56 ,$17.00 , N/A ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202446,N/A,HC SUT SILK 2-0 C016/GS66M,272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202448,N/A,HC SUT SILK 2-0 K833H/GS833,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202449,N/A,HC SUT SILK 2-0 PS-2 18 583H,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202452,N/A,HC SUT SILK 2-0 SH 30IN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202458,N/A,HC SUT SILK 3-0 632G/SS732,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202459,N/A,HC SUT SILK 3-0 A184H/S404,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202461,N/A,HC SUT SILK 3-0 C013D/GS63M,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202462,N/A,HC SUT SILK 3-0 C017T/GS67M,272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202464,N/A,HC SUT SILK 3-0 K832H/GS832,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202469,N/A,HC SUT SILK 4-0 A183H/S183,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202470,N/A,HC SUT SILK 4-0 C014D/GS64M,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202472,N/A,HC SUT SILK 4-0 K831H/GS831,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202473,N/A,HC SUT SILK 4-0 K871H/VS871,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202474,N/A,HC SUT SILK 4-0 K891H/VS622,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202483,N/A,HC SUT STEEL 4-0 603G,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202497,N/A,HC SUT UMBILICAL TAPE 1/8 X 18IN,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202500,N/A,HC SUT VICRYL 0 CP-2 27 J870H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202501,N/A,HC SUT VICRYL 0 CT 36IN J603H,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202502,N/A,HC SUT VICRYL 0 CT-1 36IN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202503,N/A,HC SUT VICRYL 0 CT-1 CR J840D,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202507,N/A,HC SUT VICRYL 0 J267H,272,1 ,$2.70 ,$1.35 ,$0.60 ,$2.70 , N/A ,$2.28 ,$2.28 ,$0.92 ,$2.16 ,$2.30 ,$1.69 ,$2.43 , N/A ,$2.57 ,$2.43 ,$2.30 ,$2.30 ,$0.92 ,$2.30 ,$2.30 ,$2.43 , N/A ,$1.13 ,$2.43 , N/A ,$2.48 ,$2.43 ,$1.80 ,$1.80 ,$1.64 ,$1.80 ,$1.76 ,$1.88 ,$0.60 ,$2.13 , N/A ,$1.35 ,$1.35 ,$0.92 ,$1.35 , N/A ,$2.57 ,$2.21 ,$2.21 ,$2.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202508,N/A,HC SUT VICRYL 0 J270H/CL831LN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202513,N/A,HC SUT VICRYL 0 J946H/CL954,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202515,N/A,HC SUT VICRYL 0 JJ41G,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202520,N/A,HC SUT VICRYL 0 VIL 8-18 CR CT-2,272,1 ,$37.00 ,$18.50 ,$8.22 ,$37.00 , N/A ,$31.30 ,$31.30 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 , N/A ,$15.54 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 , N/A ,$18.50 ,$18.50 ,$12.58 ,$18.50 , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202524,N/A,HC SUT VICRYL 1 CTX 36IN J977H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202527,N/A,HC SUT VICRYL 1-0 J268H/CL545LN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202528,N/A,HC SUT VICRYL 1-0 J947H/CL955,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202529,N/A,HC SUT VICRYL 1-0 J959/CL965,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202531,N/A,HC SUT VICRYL 1CP-2,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202532,N/A,HC SUT VICRYL 2-0,272,1 ,$2.70 ,$1.35 ,$0.60 ,$2.70 , N/A ,$2.28 ,$2.28 ,$0.92 ,$2.16 ,$2.30 ,$1.69 ,$2.43 , N/A ,$2.57 ,$2.43 ,$2.30 ,$2.30 ,$0.92 ,$2.30 ,$2.30 ,$2.43 , N/A ,$1.13 ,$2.43 , N/A ,$2.48 ,$2.43 ,$1.80 ,$1.80 ,$1.64 ,$1.80 ,$1.76 ,$1.88 ,$0.60 ,$2.13 , N/A ,$1.35 ,$1.35 ,$0.92 ,$1.35 , N/A ,$2.57 ,$2.21 ,$2.21 ,$2.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202533,N/A,HC SUT VICRYL 2-0 CT-1 36IN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202535,N/A,HC SUT VICRYL 2-0 J266H/CL543LN,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202536,N/A,HC SUT VICRYL 2-0 J269/CL830LN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202538,N/A,HC SUT VICRYL 2-0 J602H,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202539,N/A,HC SUT VICRYL 2-0 J719,272,1 ,$27.00 ,$13.50 ,$6.00 ,$27.00 , N/A ,$22.84 ,$22.84 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 , N/A ,$11.34 ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 , N/A ,$13.50 ,$13.50 ,$9.18 ,$13.50 , N/A ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202540,N/A,HC SUT VICRYL 2-0 J762D,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202541,N/A,HC SUT VICRYL 2-0 J839G/CL13MG,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202542,N/A,HC SUT VICRYL 2-0 J869H/CL839LN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202544,N/A,HC SUT VICRYL 2-0 SH 27 J417H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202547,N/A,HC SUT VICRYL 2-0 TIES 18 J111T,272,1 ,$27.00 ,$13.50 ,$6.00 ,$27.00 , N/A ,$22.84 ,$22.84 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 , N/A ,$11.34 ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 , N/A ,$13.50 ,$13.50 ,$9.18 ,$13.50 , N/A ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202550,N/A,HC SUT VICRYL 3-0 CT 36IN J956H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202551,N/A,HC SUT VICRYL 3-0 CT 36IN J980H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202553,N/A,HC SUT VICRYL 3-0 J215H/UL215LN,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202556,N/A,HC SUT VICRYL 3-0 J416 ET,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202557,N/A,HC SUT VICRYL 3-0 J427H/SL1638LN,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202559,N/A,HC SUT VICRYL 3-0 J864G/GL69MG,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202562,N/A,HC SUT VICRYL 3-0 TIES 18 J110T,272,1 ,$27.00 ,$13.50 ,$6.00 ,$27.00 , N/A ,$22.84 ,$22.84 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 , N/A ,$11.34 ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 , N/A ,$13.50 ,$13.50 ,$9.18 ,$13.50 , N/A ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202567,N/A,HC SUT VICRYL 4-0 J494G/SL1690,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202569,N/A,HC SUT VICRYL 4-0 J936H,272,1 ,$14.50 ,$7.25 ,$3.22 ,$14.50 , N/A ,$12.27 ,$12.27 ,$4.93 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$4.93 ,$12.33 ,$12.33 ,$13.05 , N/A ,$6.09 ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.66 ,$9.66 ,$8.83 ,$9.66 ,$9.43 ,$10.10 ,$3.22 ,$11.46 , N/A ,$7.25 ,$7.25 ,$4.93 ,$7.25 , N/A ,$13.78 ,$11.89 ,$11.89 ,$11.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202570,N/A,HC SUT VICRYL 4-0 PS-2 18 J496H,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202573,N/A,HC SUT VICRYL 4-0 RB-1 27 J214H,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202575,N/A,HC SUT VICRYL 4-0 SH 18IN J415,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202577,N/A,HC SUT VICRYL 5-0 J490G/SL1689G,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202578,N/A,HC SUT VICRYL 5-0 J493/SL1687/SL3687,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202581,N/A,HC SUT VICRYL 5-0 PS-2 18 J495G,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202611,N/A,HC SUTURE PDS MONO,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202615,N/A,HC SUTURE PASSERS (YELLOW/BLUE),272,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 , N/A ,$84.59 ,$84.59 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 , N/A ,$42.00 ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 , N/A ,$50.00 ,$50.00 ,$34.00 ,$50.00 , N/A ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202637,N/A,HC SYRINGE INFLATION,272,1 ,$104.00 ,$52.00 ,$23.11 ,$104.00 , N/A ,$87.97 ,$87.97 ,$35.36 ,$83.20 ,$88.40 ,$65.00 ,$93.60 , N/A ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$35.36 ,$88.40 ,$88.40 ,$93.60 , N/A ,$43.68 ,$93.60 , N/A ,$95.68 ,$93.60 ,$69.31 ,$69.31 ,$63.34 ,$69.31 ,$67.60 ,$72.44 ,$23.11 ,$82.16 , N/A ,$52.00 ,$52.00 ,$35.36 ,$52.00 , N/A ,$98.80 ,$85.28 ,$85.28 ,$83.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202662,N/A,HC TENSION RING STABIL EYES,272,1 ,"$1,232.00 ",$616.00 ,$273.75 ,"$1,232.00 ", N/A ,"$1,042.15 ","$1,042.15 ",$418.88 ,$985.60 ,"$1,047.20 ",$770.00 ,"$1,108.80 ", N/A ,"$1,170.40 ","$1,108.80 ","$1,047.20 ","$1,047.20 ",$418.88 ,"$1,047.20 ","$1,047.20 ","$1,108.80 ", N/A ,$517.44 ,"$1,108.80 ", N/A ,"$1,133.44 ","$1,108.80 ",$821.00 ,$821.00 ,$750.29 ,$821.00 ,$800.80 ,$858.09 ,$273.75 ,$973.28 , N/A ,$616.00 ,$616.00 ,$418.88 ,$616.00 , N/A ,"$1,170.40 ","$1,010.24 ","$1,010.24 ",$985.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202665,N/A,HC THORACENTESIS TRAY,272,1 ,$130.00 ,$65.00 ,$28.89 ,$130.00 , N/A ,$109.97 ,$109.97 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 , N/A ,$54.60 ,$117.00 , N/A ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 , N/A ,$65.00 ,$65.00 ,$44.20 ,$65.00 , N/A ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202671,N/A,HC TIP CLEAR SUCTION HANDLE,272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202694,N/A,HC TIP SURGILAV BONE CLEANING,272,1 ,$463.00 ,$231.50 ,$102.88 ,$463.00 , N/A ,$391.65 ,$391.65 ,$157.42 ,$370.40 ,$393.55 ,$289.38 ,$416.70 , N/A ,$439.85 ,$416.70 ,$393.55 ,$393.55 ,$157.42 ,$393.55 ,$393.55 ,$416.70 , N/A ,$194.46 ,$416.70 , N/A ,$425.96 ,$416.70 ,$308.54 ,$308.54 ,$281.97 ,$308.54 ,$300.95 ,$322.48 ,$102.88 ,$365.77 , N/A ,$231.50 ,$231.50 ,$157.42 ,$231.50 , N/A ,$439.85 ,$379.66 ,$379.66 ,$370.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202714,N/A,HC TRACH T-TUBES 6.0,272,1 ,$97.00 ,$48.50 ,$21.55 ,$97.00 , N/A ,$82.05 ,$82.05 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 , N/A ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 , N/A ,$40.74 ,$87.30 , N/A ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 , N/A ,$48.50 ,$48.50 ,$32.98 ,$48.50 , N/A ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202715,N/A,HC TRACH T-TUBES 8.0,272,1 ,$101.00 ,$50.50 ,$22.44 ,$101.00 , N/A ,$85.44 ,$85.44 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 , N/A ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 , N/A ,$42.42 ,$90.90 , N/A ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 , N/A ,$50.50 ,$50.50 ,$34.34 ,$50.50 , N/A ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202731,N/A,HC TRAY 16FOLEY W/URIM-DISP,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202759,N/A,HC TRAY EPIDURAL CONTINUOUS,272,1 ,$60.00 ,$30.00 ,$13.33 ,$60.00 , N/A ,$50.75 ,$50.75 ,$20.40 ,$48.00 ,$51.00 ,$37.50 ,$54.00 , N/A ,$57.00 ,$54.00 ,$51.00 ,$51.00 ,$20.40 ,$51.00 ,$51.00 ,$54.00 , N/A ,$25.20 ,$54.00 , N/A ,$55.20 ,$54.00 ,$39.98 ,$39.98 ,$36.54 ,$39.98 ,$39.00 ,$41.79 ,$13.33 ,$47.40 , N/A ,$30.00 ,$30.00 ,$20.40 ,$30.00 , N/A ,$57.00 ,$49.20 ,$49.20 ,$48.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202761,N/A,HC TRAY CANNULATION SET,272,1 ,$257.00 ,$128.50 ,$57.11 ,$257.00 , N/A ,$217.40 ,$217.40 ,$87.38 ,$205.60 ,$218.45 ,$160.63 ,$231.30 , N/A ,$244.15 ,$231.30 ,$218.45 ,$218.45 ,$87.38 ,$218.45 ,$218.45 ,$231.30 , N/A ,$107.94 ,$231.30 , N/A ,$236.44 ,$231.30 ,$171.26 ,$171.26 ,$156.51 ,$171.26 ,$167.05 ,$179.00 ,$57.11 ,$203.03 , N/A ,$128.50 ,$128.50 ,$87.38 ,$128.50 , N/A ,$244.15 ,$210.74 ,$210.74 ,$205.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202773,N/A,HC TRAY KIT BLOCK,272,1 ,$72.00 ,$36.00 ,$16.00 ,$72.00 , N/A ,$60.90 ,$60.90 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 , N/A ,$30.24 ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 , N/A ,$36.00 ,$36.00 ,$24.48 ,$36.00 , N/A ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202775,N/A,HC TRAY KYPHOPAK 20/3 FIRST FX,272,1 ,"$10,759.00 ","$5,379.50 ","$2,390.65 ","$10,759.00 ", N/A ,"$9,101.04 ","$9,101.04 ","$3,658.06 ","$8,607.20 ","$9,145.15 ","$6,724.38 ","$9,683.10 ", N/A ,"$10,221.05 ","$9,683.10 ","$9,145.15 ","$9,145.15 ","$3,658.06 ","$9,145.15 ","$9,145.15 ","$9,683.10 ", N/A ,"$4,518.78 ","$9,683.10 ", N/A ,"$9,898.28 ","$9,683.10 ","$7,169.80 ","$7,169.80 ","$6,552.23 ","$7,169.80 ","$6,993.35 ","$7,493.64 ","$2,390.65 ","$8,499.61 ", N/A ,"$5,379.50 ","$5,379.50 ","$3,658.06 ","$5,379.50 ", N/A ,"$10,221.05 ","$8,822.38 ","$8,822.38 ","$8,607.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27202778,N/A,SVG HC TRAY LUMBAR PUNCTURE,272,1 ,$49.00 ,$24.50 ,$10.89 ,$49.00 , N/A ,$41.45 ,$41.45 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 , N/A ,$20.58 ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 , N/A ,$24.50 ,$24.50 ,$16.66 ,$24.50 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202807,N/A,HC TRAY SPINAL,272,1 ,$266.00 ,$133.00 ,$59.11 ,$266.00 , N/A ,$225.01 ,$225.01 ,$90.44 ,$212.80 ,$226.10 ,$166.25 ,$239.40 , N/A ,$252.70 ,$239.40 ,$226.10 ,$226.10 ,$90.44 ,$226.10 ,$226.10 ,$239.40 , N/A ,$111.72 ,$239.40 , N/A ,$244.72 ,$239.40 ,$177.26 ,$177.26 ,$161.99 ,$177.26 ,$172.90 ,$185.27 ,$59.11 ,$210.14 , N/A ,$133.00 ,$133.00 ,$90.44 ,$133.00 , N/A ,$252.70 ,$218.12 ,$218.12 ,$212.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202863,N/A,HC TROCAR ENDOPATH BLUNT,272,1 ,$300.00 ,$150.00 ,$66.66 ,$300.00 , N/A ,$253.77 ,$253.77 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 , N/A ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 , N/A ,$126.00 ,$270.00 , N/A ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 , N/A ,$150.00 ,$150.00 ,$102.00 ,$150.00 , N/A ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202873,N/A,HC TROCAR VERSAPORT 5MM,272,1 ,$468.00 ,$234.00 ,$103.99 ,$468.00 , N/A ,$395.88 ,$395.88 ,$159.12 ,$374.40 ,$397.80 ,$292.50 ,$421.20 , N/A ,$444.60 ,$421.20 ,$397.80 ,$397.80 ,$159.12 ,$397.80 ,$397.80 ,$421.20 , N/A ,$196.56 ,$421.20 , N/A ,$430.56 ,$421.20 ,$311.88 ,$311.88 ,$285.01 ,$311.88 ,$304.20 ,$325.96 ,$103.99 ,$369.72 , N/A ,$234.00 ,$234.00 ,$159.12 ,$234.00 , N/A ,$444.60 ,$383.76 ,$383.76 ,$374.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202880,N/A,HC T-TUBES,272,1 ,$20.00 ,$10.00 ,$4.44 ,$20.00 , N/A ,$16.92 ,$16.92 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 , N/A ,$8.40 ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 , N/A ,$10.00 ,$10.00 ,$6.80 ,$10.00 , N/A ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202888,N/A,HC TUBE TRACH CUFFLESS,272,1 ,$104.00 ,$52.00 ,$23.11 ,$104.00 , N/A ,$87.97 ,$87.97 ,$35.36 ,$83.20 ,$88.40 ,$65.00 ,$93.60 , N/A ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$35.36 ,$88.40 ,$88.40 ,$93.60 , N/A ,$43.68 ,$93.60 , N/A ,$95.68 ,$93.60 ,$69.31 ,$69.31 ,$63.34 ,$69.31 ,$67.60 ,$72.44 ,$23.11 ,$82.16 , N/A ,$52.00 ,$52.00 ,$35.36 ,$52.00 , N/A ,$98.80 ,$85.28 ,$85.28 ,$83.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202896,N/A,HC TUBE VINYL CONNECTING,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202899,N/A,HC TUBE YANKAUER SUCTION,272,1 ,$590.00 ,$295.00 ,$131.10 ,$590.00 , N/A ,$499.08 ,$499.08 ,$200.60 ,$472.00 ,$501.50 ,$368.75 ,$531.00 , N/A ,$560.50 ,$531.00 ,$501.50 ,$501.50 ,$200.60 ,$501.50 ,$501.50 ,$531.00 , N/A ,$247.80 ,$531.00 , N/A ,$542.80 ,$531.00 ,$393.18 ,$393.18 ,$359.31 ,$393.18 ,$383.50 ,$410.94 ,$131.10 ,$466.10 , N/A ,$295.00 ,$295.00 ,$200.60 ,$295.00 , N/A ,$560.50 ,$483.80 ,$483.80 ,$472.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202931,N/A,HC TUBING LEEP,272,1 ,$291.00 ,$145.50 ,$64.66 ,$291.00 , N/A ,$246.16 ,$246.16 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 , N/A ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 , N/A ,$122.22 ,$261.90 , N/A ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 , N/A ,$145.50 ,$145.50 ,$98.94 ,$145.50 , N/A ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202936,N/A,HC TUBING SMOKE EVACUATN 3/8X4FT,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202938,N/A,HC TUBING STRYKER INFLO/OUTFLO,272,1 ,$188.00 ,$94.00 ,$41.77 ,$188.00 , N/A ,$159.03 ,$159.03 ,$63.92 ,$150.40 ,$159.80 ,$117.50 ,$169.20 , N/A ,$178.60 ,$169.20 ,$159.80 ,$159.80 ,$63.92 ,$159.80 ,$159.80 ,$169.20 , N/A ,$78.96 ,$169.20 , N/A ,$172.96 ,$169.20 ,$125.28 ,$125.28 ,$114.49 ,$125.28 ,$122.20 ,$130.94 ,$41.77 ,$148.52 , N/A ,$94.00 ,$94.00 ,$63.92 ,$94.00 , N/A ,$178.60 ,$154.16 ,$154.16 ,$150.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202947,N/A,HC TUOHY NEEDLE,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202951,N/A,HC ULTRA SLING,272,1 ,$151.00 ,$75.50 ,$33.55 ,$151.00 , N/A ,$127.73 ,$127.73 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 , N/A ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 , N/A ,$63.42 ,$135.90 , N/A ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 , N/A ,$75.50 ,$75.50 ,$51.34 ,$75.50 , N/A ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202979,N/A,HC VEIN STRIPPER,272,1 ,$102.00 ,$51.00 ,$22.66 ,$102.00 , N/A ,$86.28 ,$86.28 ,$34.68 ,$81.60 ,$86.70 ,$63.75 ,$91.80 , N/A ,$96.90 ,$91.80 ,$86.70 ,$86.70 ,$34.68 ,$86.70 ,$86.70 ,$91.80 , N/A ,$42.84 ,$91.80 , N/A ,$93.84 ,$91.80 ,$67.97 ,$67.97 ,$62.12 ,$67.97 ,$66.30 ,$71.04 ,$22.66 ,$80.58 , N/A ,$51.00 ,$51.00 ,$34.68 ,$51.00 , N/A ,$96.90 ,$83.64 ,$83.64 ,$81.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202982,N/A,HC VEST SURGICAL,272,1 ,$113.00 ,$56.50 ,$25.11 ,$113.00 , N/A ,$95.59 ,$95.59 ,$38.42 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$38.42 ,$96.05 ,$96.05 ,$101.70 , N/A ,$47.46 ,$101.70 , N/A ,$103.96 ,$101.70 ,$75.30 ,$75.30 ,$68.82 ,$75.30 ,$73.45 ,$78.70 ,$25.11 ,$89.27 , N/A ,$56.50 ,$56.50 ,$38.42 ,$56.50 , N/A ,$107.35 ,$92.66 ,$92.66 ,$90.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202990,N/A,HC WAND PLASMA FOR COBLATOR II,272,1 ,$734.00 ,$367.00 ,$163.09 ,$734.00 , N/A ,$620.89 ,$620.89 ,$249.56 ,$587.20 ,$623.90 ,$458.75 ,$660.60 , N/A ,$697.30 ,$660.60 ,$623.90 ,$623.90 ,$249.56 ,$623.90 ,$623.90 ,$660.60 , N/A ,$308.28 ,$660.60 , N/A ,$675.28 ,$660.60 ,$489.14 ,$489.14 ,$447.01 ,$489.14 ,$477.10 ,$511.23 ,$163.09 ,$579.86 , N/A ,$367.00 ,$367.00 ,$249.56 ,$367.00 , N/A ,$697.30 ,$601.88 ,$601.88 ,$587.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202991,N/A,HC WAND REFLEX PLASMA,272,1 ,$794.00 ,$397.00 ,$176.43 ,$794.00 , N/A ,$671.64 ,$671.64 ,$269.96 ,$635.20 ,$674.90 ,$496.25 ,$714.60 , N/A ,$754.30 ,$714.60 ,$674.90 ,$674.90 ,$269.96 ,$674.90 ,$674.90 ,$714.60 , N/A ,$333.48 ,$714.60 , N/A ,$730.48 ,$714.60 ,$529.12 ,$529.12 ,$483.55 ,$529.12 ,$516.10 ,$553.02 ,$176.43 ,$627.26 , N/A ,$397.00 ,$397.00 ,$269.96 ,$397.00 , N/A ,$754.30 ,$651.08 ,$651.08 ,$635.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202993,N/A,HC WASHER SYNTHES 7.0MM,272,1 ,$79.00 ,$39.50 ,$17.55 ,$79.00 , N/A ,$66.83 ,$66.83 ,$26.86 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$26.86 ,$67.15 ,$67.15 ,$71.10 , N/A ,$33.18 ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.65 ,$52.65 ,$48.11 ,$52.65 ,$51.35 ,$55.02 ,$17.55 ,$62.41 , N/A ,$39.50 ,$39.50 ,$26.86 ,$39.50 , N/A ,$75.05 ,$64.78 ,$64.78 ,$63.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203003,N/A,HC WIRE GUIDE VNUS .025 X 150CM,272,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 , N/A ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 , N/A ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 , N/A ,$19.00 ,$19.00 ,$12.92 ,$19.00 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203050,N/A,HC NASAL BALLOON,272,1 ,"$3,796.00 ","$1,898.00 ",$843.47 ,"$3,796.00 ", N/A ,"$3,211.04 ","$3,211.04 ","$1,290.64 ","$3,036.80 ","$3,226.60 ","$2,372.50 ","$3,416.40 ", N/A ,"$3,606.20 ","$3,416.40 ","$3,226.60 ","$3,226.60 ","$1,290.64 ","$3,226.60 ","$3,226.60 ","$3,416.40 ", N/A ,"$1,594.32 ","$3,416.40 ", N/A ,"$3,492.32 ","$3,416.40 ","$2,529.65 ","$2,529.65 ","$2,311.76 ","$2,529.65 ","$2,467.40 ","$2,643.91 ",$843.47 ,"$2,998.84 ", N/A ,"$1,898.00 ","$1,898.00 ","$1,290.64 ","$1,898.00 ", N/A ,"$3,606.20 ","$3,112.72 ","$3,112.72 ","$3,036.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27203054,N/A,HC SCISSORS RET REVL 25GA CURVED,272,1 ,$189.00 ,$94.50 ,$42.00 ,$189.00 , N/A ,$159.88 ,$159.88 ,$64.26 ,$151.20 ,$160.65 ,$118.13 ,$170.10 , N/A ,$179.55 ,$170.10 ,$160.65 ,$160.65 ,$64.26 ,$160.65 ,$160.65 ,$170.10 , N/A ,$79.38 ,$170.10 , N/A ,$173.88 ,$170.10 ,$125.95 ,$125.95 ,$115.10 ,$125.95 ,$122.85 ,$131.64 ,$42.00 ,$149.31 , N/A ,$94.50 ,$94.50 ,$64.26 ,$94.50 , N/A ,$179.55 ,$154.98 ,$154.98 ,$151.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203058,N/A,HC SHUNT BRENER CAROTID BYPASS,272,1 ,$609.00 ,$304.50 ,$135.32 ,$609.00 , N/A ,$515.15 ,$515.15 ,$207.06 ,$487.20 ,$517.65 ,$380.63 ,$548.10 , N/A ,$578.55 ,$548.10 ,$517.65 ,$517.65 ,$207.06 ,$517.65 ,$517.65 ,$548.10 , N/A ,$255.78 ,$548.10 , N/A ,$560.28 ,$548.10 ,$405.84 ,$405.84 ,$370.88 ,$405.84 ,$395.85 ,$424.17 ,$135.32 ,$481.11 , N/A ,$304.50 ,$304.50 ,$207.06 ,$304.50 , N/A ,$578.55 ,$499.38 ,$499.38 ,$487.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203059,N/A,HC SHUNT CAROTID ARGYLE,272,1 ,$149.00 ,$74.50 ,$33.11 ,$149.00 , N/A ,$126.04 ,$126.04 ,$50.66 ,$119.20 ,$126.65 ,$93.13 ,$134.10 , N/A ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$50.66 ,$126.65 ,$126.65 ,$134.10 , N/A ,$62.58 ,$134.10 , N/A ,$137.08 ,$134.10 ,$99.29 ,$99.29 ,$90.74 ,$99.29 ,$96.85 ,$103.78 ,$33.11 ,$117.71 , N/A ,$74.50 ,$74.50 ,$50.66 ,$74.50 , N/A ,$141.55 ,$122.18 ,$122.18 ,$119.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203082,N/A,HC SMOKE/SUCTION COLLECTOR,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203099,N/A,HC DRSG MASTISOL 2/3CC CARD,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203204,N/A,HC DRSG TEGADERM 1628,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203215,N/A,HC DRAIN BLAKE HUBLESS 15FR ROUND,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203218,N/A,HC SWIVELOCK BIO 5.5MM,272,1 ,$828.00 ,$414.00 ,$183.98 ,$828.00 , N/A ,$700.41 ,$700.41 ,$281.52 ,$662.40 ,$703.80 ,$517.50 ,$745.20 , N/A ,$786.60 ,$745.20 ,$703.80 ,$703.80 ,$281.52 ,$703.80 ,$703.80 ,$745.20 , N/A ,$347.76 ,$745.20 , N/A ,$761.76 ,$745.20 ,$551.78 ,$551.78 ,$504.25 ,$551.78 ,$538.20 ,$576.70 ,$183.98 ,$654.12 , N/A ,$414.00 ,$414.00 ,$281.52 ,$414.00 , N/A ,$786.60 ,$678.96 ,$678.96 ,$662.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203254,N/A,HC LUMBAR ROLL,272,1 ,$37.00 ,$18.50 ,$8.22 ,$37.00 , N/A ,$31.30 ,$31.30 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 , N/A ,$15.54 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 , N/A ,$18.50 ,$18.50 ,$12.58 ,$18.50 , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203265,N/A,HC ELECTRODES,272,1 ,$94.00 ,$47.00 ,$20.89 ,$94.00 , N/A ,$79.51 ,$79.51 ,$31.96 ,$75.20 ,$79.90 ,$58.75 ,$84.60 , N/A ,$89.30 ,$84.60 ,$79.90 ,$79.90 ,$31.96 ,$79.90 ,$79.90 ,$84.60 , N/A ,$39.48 ,$84.60 , N/A ,$86.48 ,$84.60 ,$62.64 ,$62.64 ,$57.25 ,$62.64 ,$61.10 ,$65.47 ,$20.89 ,$74.26 , N/A ,$47.00 ,$47.00 ,$31.96 ,$47.00 , N/A ,$89.30 ,$77.08 ,$77.08 ,$75.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203281,N/A,HC BLADE CUTTER 2.5MM AND 2.0MM,272,1 ,$440.00 ,$220.00 ,$97.77 ,$440.00 , N/A ,$372.20 ,$372.20 ,$149.60 ,$352.00 ,$374.00 ,$275.00 ,$396.00 , N/A ,$418.00 ,$396.00 ,$374.00 ,$374.00 ,$149.60 ,$374.00 ,$374.00 ,$396.00 , N/A ,$184.80 ,$396.00 , N/A ,$404.80 ,$396.00 ,$293.22 ,$293.22 ,$267.96 ,$293.22 ,$286.00 ,$306.46 ,$97.77 ,$347.60 , N/A ,$220.00 ,$220.00 ,$149.60 ,$220.00 , N/A ,$418.00 ,$360.80 ,$360.80 ,$352.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203282,N/A,HC TUBE CONNECT BTL TO BTL,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203298,N/A,HC HEMOSTATIC PARTICLES,272,1 ,$443.00 ,$221.50 ,$98.43 ,$443.00 , N/A ,$374.73 ,$374.73 ,$150.62 ,$354.40 ,$376.55 ,$276.88 ,$398.70 , N/A ,$420.85 ,$398.70 ,$376.55 ,$376.55 ,$150.62 ,$376.55 ,$376.55 ,$398.70 , N/A ,$186.06 ,$398.70 , N/A ,$407.56 ,$398.70 ,$295.22 ,$295.22 ,$269.79 ,$295.22 ,$287.95 ,$308.55 ,$98.43 ,$349.97 , N/A ,$221.50 ,$221.50 ,$150.62 ,$221.50 , N/A ,$420.85 ,$363.26 ,$363.26 ,$354.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203301,N/A,HC MENISCAL DEPLOYMENT GUN,272,1 ,"$1,368.00 ",$684.00 ,$303.97 ,"$1,368.00 ", N/A ,"$1,157.19 ","$1,157.19 ",$465.12 ,"$1,094.40 ","$1,162.80 ",$855.00 ,"$1,231.20 ", N/A ,"$1,299.60 ","$1,231.20 ","$1,162.80 ","$1,162.80 ",$465.12 ,"$1,162.80 ","$1,162.80 ","$1,231.20 ", N/A ,$574.56 ,"$1,231.20 ", N/A ,"$1,258.56 ","$1,231.20 ",$911.64 ,$911.64 ,$833.11 ,$911.64 ,$889.20 ,$952.81 ,$303.97 ,"$1,080.72 ", N/A ,$684.00 ,$684.00 ,$465.12 ,$684.00 , N/A ,"$1,299.60 ","$1,121.76 ","$1,121.76 ","$1,094.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27203316,N/A,HC REAMER PILOTED HEAD,272,1 ,$212.00 ,$106.00 ,$47.11 ,$212.00 , N/A ,$179.33 ,$179.33 ,$72.08 ,$169.60 ,$180.20 ,$132.50 ,$190.80 , N/A ,$201.40 ,$190.80 ,$180.20 ,$180.20 ,$72.08 ,$180.20 ,$180.20 ,$190.80 , N/A ,$89.04 ,$190.80 , N/A ,$195.04 ,$190.80 ,$141.28 ,$141.28 ,$129.11 ,$141.28 ,$137.80 ,$147.66 ,$47.11 ,$167.48 , N/A ,$106.00 ,$106.00 ,$72.08 ,$106.00 , N/A ,$201.40 ,$173.84 ,$173.84 ,$169.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203317,N/A,HC IMPL SYSTEM CPR MINI SCORPION,272,1 ,"$3,954.00 ","$1,977.00 ",$878.58 ,"$3,954.00 ", N/A ,"$3,344.69 ","$3,344.69 ","$1,344.36 ","$3,163.20 ","$3,360.90 ","$2,471.25 ","$3,558.60 ", N/A ,"$3,756.30 ","$3,558.60 ","$3,360.90 ","$3,360.90 ","$1,344.36 ","$3,360.90 ","$3,360.90 ","$3,558.60 ", N/A ,"$1,660.68 ","$3,558.60 ", N/A ,"$3,637.68 ","$3,558.60 ","$2,634.95 ","$2,634.95 ","$2,407.99 ","$2,634.95 ","$2,570.10 ","$2,753.96 ",$878.58 ,"$3,123.66 ", N/A ,"$1,977.00 ","$1,977.00 ","$1,344.36 ","$1,977.00 ", N/A ,"$3,756.30 ","$3,242.28 ","$3,242.28 ","$3,163.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27203318,N/A,HC TOPAZ HANDPIECE,272,1 ,$883.00 ,$441.50 ,$196.20 ,$883.00 , N/A ,$746.93 ,$746.93 ,$300.22 ,$706.40 ,$750.55 ,$551.88 ,$794.70 , N/A ,$838.85 ,$794.70 ,$750.55 ,$750.55 ,$300.22 ,$750.55 ,$750.55 ,$794.70 , N/A ,$370.86 ,$794.70 , N/A ,$812.36 ,$794.70 ,$588.43 ,$588.43 ,$537.75 ,$588.43 ,$573.95 ,$615.01 ,$196.20 ,$697.57 , N/A ,$441.50 ,$441.50 ,$300.22 ,$441.50 , N/A ,$838.85 ,$724.06 ,$724.06 ,$706.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203327,N/A,HC GELPORT,272,1 ,"$1,706.00 ",$853.00 ,$379.07 ,"$1,706.00 ", N/A ,"$1,443.11 ","$1,443.11 ",$580.04 ,"$1,364.80 ","$1,450.10 ","$1,066.25 ","$1,535.40 ", N/A ,"$1,620.70 ","$1,535.40 ","$1,450.10 ","$1,450.10 ",$580.04 ,"$1,450.10 ","$1,450.10 ","$1,535.40 ", N/A ,$716.52 ,"$1,535.40 ", N/A ,"$1,569.52 ","$1,535.40 ","$1,136.88 ","$1,136.88 ","$1,038.95 ","$1,136.88 ","$1,108.90 ","$1,188.23 ",$379.07 ,"$1,347.74 ", N/A ,$853.00 ,$853.00 ,$580.04 ,$853.00 , N/A ,"$1,620.70 ","$1,398.92 ","$1,398.92 ","$1,364.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27203587,N/A,HC SNARE POLYP,272,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A ,$14.00 ,$14.00 ,$9.52 ,$14.00 , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203649,C1725,HC BALLOON CATHETER,272,1 ,$149.00 ,$74.50 ,$33.11 ,$149.00 , N/A ,$126.04 ,$126.04 ,$50.66 ,$119.20 ,$126.65 ,$93.13 ,$134.10 , N/A ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$50.66 ,$126.65 ,$126.65 ,$134.10 , N/A ,$62.58 ,$134.10 , N/A ,$137.08 ,$134.10 ,$99.29 ,$99.29 ,$90.74 ,$99.29 ,$96.85 ,$103.78 ,$33.11 ,$117.71 , N/A ,$74.50 ,$74.50 ,$50.66 ,$74.50 , N/A ,$141.55 ,$122.18 ,$122.18 ,$119.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203657,C1769,HC GUIDEWIRE,272,1 ,$135.00 ,$67.50 ,$30.00 ,$135.00 , N/A ,$114.20 ,$114.20 ,$45.90 ,$108.00 ,$114.75 ,$84.38 ,$121.50 , N/A ,$128.25 ,$121.50 ,$114.75 ,$114.75 ,$45.90 ,$114.75 ,$114.75 ,$121.50 , N/A ,$56.70 ,$121.50 , N/A ,$124.20 ,$121.50 ,$89.96 ,$89.96 ,$82.22 ,$89.96 ,$87.75 ,$94.03 ,$30.00 ,$106.65 , N/A ,$67.50 ,$67.50 ,$45.90 ,$67.50 , N/A ,$128.25 ,$110.70 ,$110.70 ,$108.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203680,N/A,HC SET NEEDLE ACCESS,272,1 ,$294.00 ,$147.00 ,$65.33 ,$294.00 , N/A ,$248.69 ,$248.69 ,$99.96 ,$235.20 ,$249.90 ,$183.75 ,$264.60 , N/A ,$279.30 ,$264.60 ,$249.90 ,$249.90 ,$99.96 ,$249.90 ,$249.90 ,$264.60 , N/A ,$123.48 ,$264.60 , N/A ,$270.48 ,$264.60 ,$195.92 ,$195.92 ,$179.05 ,$195.92 ,$191.10 ,$204.77 ,$65.33 ,$232.26 , N/A ,$147.00 ,$147.00 ,$99.96 ,$147.00 , N/A ,$279.30 ,$241.08 ,$241.08 ,$235.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27204596,N/A,HC SUCTION TIP,272,1 ,$588.00 ,$294.00 ,$130.65 ,$588.00 , N/A ,$497.39 ,$497.39 ,$199.92 ,$470.40 ,$499.80 ,$367.50 ,$529.20 , N/A ,$558.60 ,$529.20 ,$499.80 ,$499.80 ,$199.92 ,$499.80 ,$499.80 ,$529.20 , N/A ,$246.96 ,$529.20 , N/A ,$540.96 ,$529.20 ,$391.84 ,$391.84 ,$358.09 ,$391.84 ,$382.20 ,$409.54 ,$130.65 ,$464.52 , N/A ,$294.00 ,$294.00 ,$199.92 ,$294.00 , N/A ,$558.60 ,$482.16 ,$482.16 ,$470.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27204598,N/A,HC SUTURE MONOCRYL,272,1 ,$36.00 ,$18.00 ,$8.00 ,$36.00 , N/A ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 , N/A ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 , N/A ,$18.00 ,$18.00 ,$12.24 ,$18.00 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27204600,N/A,HC SUTURE VICRYL,272,1 ,$25.00 ,$12.50 ,$5.56 ,$25.00 , N/A ,$21.15 ,$21.15 ,$8.50 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$8.50 ,$21.25 ,$21.25 ,$22.50 , N/A ,$10.50 ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.66 ,$16.66 ,$15.23 ,$16.66 ,$16.25 ,$17.41 ,$5.56 ,$19.75 , N/A ,$12.50 ,$12.50 ,$8.50 ,$12.50 , N/A ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27204612,N/A,HC TUBING EXTENSION,272,1 ,$56.00 ,$28.00 ,$12.44 ,$56.00 , N/A ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 , N/A ,$23.52 ,$50.40 , N/A ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 , N/A ,$28.00 ,$28.00 ,$19.04 ,$28.00 , N/A ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205023,N/A,HC SNARE OVAL,272,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A ,$14.00 ,$14.00 ,$9.52 ,$14.00 , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205041,N/A,HC SUTURE SILK,272,1 ,$2.60 ,$1.30 ,$0.58 ,$2.60 , N/A ,$2.20 ,$2.20 ,$0.88 ,$2.08 ,$2.21 ,$1.63 ,$2.34 , N/A ,$2.47 ,$2.34 ,$2.21 ,$2.21 ,$0.88 ,$2.21 ,$2.21 ,$2.34 , N/A ,$1.09 ,$2.34 , N/A ,$2.39 ,$2.34 ,$1.73 ,$1.73 ,$1.58 ,$1.73 ,$1.69 ,$1.81 ,$0.58 ,$2.05 , N/A ,$1.30 ,$1.30 ,$0.88 ,$1.30 , N/A ,$2.47 ,$2.13 ,$2.13 ,$2.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205228,N/A,HC INSTRUMENT TRACKER - ENT,272,1 ,$285.00 ,$142.50 ,$63.33 ,$285.00 , N/A ,$241.08 ,$241.08 ,$96.90 ,$228.00 ,$242.25 ,$178.13 ,$256.50 , N/A ,$270.75 ,$256.50 ,$242.25 ,$242.25 ,$96.90 ,$242.25 ,$242.25 ,$256.50 , N/A ,$119.70 ,$256.50 , N/A ,$262.20 ,$256.50 ,$189.92 ,$189.92 ,$173.57 ,$189.92 ,$185.25 ,$198.50 ,$63.33 ,$225.15 , N/A ,$142.50 ,$142.50 ,$96.90 ,$142.50 , N/A ,$270.75 ,$233.70 ,$233.70 ,$228.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205229,N/A,HC PATIENT TRACKER NON-INVASIVE - ENT,272,1 ,$352.00 ,$176.00 ,$78.21 ,$352.00 , N/A ,$297.76 ,$297.76 ,$119.68 ,$281.60 ,$299.20 ,$220.00 ,$316.80 , N/A ,$334.40 ,$316.80 ,$299.20 ,$299.20 ,$119.68 ,$299.20 ,$299.20 ,$316.80 , N/A ,$147.84 ,$316.80 , N/A ,$323.84 ,$316.80 ,$234.57 ,$234.57 ,$214.37 ,$234.57 ,$228.80 ,$245.17 ,$78.21 ,$278.08 , N/A ,$176.00 ,$176.00 ,$119.68 ,$176.00 , N/A ,$334.40 ,$288.64 ,$288.64 ,$281.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205357,N/A,HC BLADE SCOPE MOUNTED,272,1 ,"$1,163.00 ",$581.50 ,$258.42 ,"$1,163.00 ", N/A ,$983.78 ,$983.78 ,$395.42 ,$930.40 ,$988.55 ,$726.88 ,"$1,046.70 ", N/A ,"$1,104.85 ","$1,046.70 ",$988.55 ,$988.55 ,$395.42 ,$988.55 ,$988.55 ,"$1,046.70 ", N/A ,$488.46 ,"$1,046.70 ", N/A ,"$1,069.96 ","$1,046.70 ",$775.02 ,$775.02 ,$708.27 ,$775.02 ,$755.95 ,$810.03 ,$258.42 ,$918.77 , N/A ,$581.50 ,$581.50 ,$395.42 ,$581.50 , N/A ,"$1,104.85 ",$953.66 ,$953.66 ,$930.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205411,N/A,HC DRESSING ELASTIC NET,272,1 ,$36.00 ,$18.00 ,$8.00 ,$36.00 , N/A ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 , N/A ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 , N/A ,$18.00 ,$18.00 ,$12.24 ,$18.00 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205449,N/A,HC NEEDLE SUTURE 1/2 CIRC TROCAR PT MAYO CATGUT,272,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205461,N/A,HC SUTURE MONOCRYL 4-0 Y415H,272,1 ,$4.40 ,$2.20 ,$0.98 ,$4.40 , N/A ,$3.72 ,$3.72 ,$1.50 ,$3.52 ,$3.74 ,$2.75 ,$3.96 , N/A ,$4.18 ,$3.96 ,$3.74 ,$3.74 ,$1.50 ,$3.74 ,$3.74 ,$3.96 , N/A ,$1.85 ,$3.96 , N/A ,$4.05 ,$3.96 ,$2.93 ,$2.93 ,$2.68 ,$2.93 ,$2.86 ,$3.06 ,$0.98 ,$3.48 , N/A ,$2.20 ,$2.20 ,$1.50 ,$2.20 , N/A ,$4.18 ,$3.61 ,$3.61 ,$3.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205476,N/A,HC NOSEBLEED TRAY,272,1 ,$45.00 ,$22.50 ,$10.00 ,$45.00 , N/A ,$38.07 ,$38.07 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 , N/A ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 , N/A ,$18.90 ,$40.50 , N/A ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 , N/A ,$22.50 ,$22.50 ,$15.30 ,$22.50 , N/A ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205477,N/A,HC WALKER AIR SM-XL,272,1 ,$68.00 ,$34.00 ,$15.11 ,$68.00 , N/A ,$57.52 ,$57.52 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 , N/A ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 , N/A ,$28.56 ,$61.20 , N/A ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 , N/A ,$34.00 ,$34.00 ,$23.12 ,$34.00 , N/A ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205478,N/A,HC 11MM/130 DEG TI CANN 320-440MM,272,1 ,"$2,332.00 ","$1,166.00 ",$518.17 ,"$2,332.00 ", N/A ,"$1,972.64 ","$1,972.64 ",$792.88 ,"$1,865.60 ","$1,982.20 ","$1,457.50 ","$2,098.80 ", N/A ,"$2,215.40 ","$2,098.80 ","$1,982.20 ","$1,982.20 ",$792.88 ,"$1,982.20 ","$1,982.20 ","$2,098.80 ", N/A ,$979.44 ,"$2,098.80 ", N/A ,"$2,145.44 ","$2,098.80 ","$1,554.04 ","$1,554.04 ","$1,420.19 ","$1,554.04 ","$1,515.80 ","$1,624.24 ",$518.17 ,"$1,842.28 ", N/A ,"$1,166.00 ","$1,166.00 ",$792.88 ,"$1,166.00 ", N/A ,"$2,215.40 ","$1,912.24 ","$1,912.24 ","$1,865.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27205479,N/A,HC FENESTRATED SCREW 75-125MM,272,1 ,$694.00 ,$347.00 ,$154.21 ,$694.00 , N/A ,$587.05 ,$587.05 ,$235.96 ,$555.20 ,$589.90 ,$433.75 ,$624.60 , N/A ,$659.30 ,$624.60 ,$589.90 ,$589.90 ,$235.96 ,$589.90 ,$589.90 ,$624.60 , N/A ,$291.48 ,$624.60 , N/A ,$638.48 ,$624.60 ,$462.48 ,$462.48 ,$422.65 ,$462.48 ,$451.10 ,$483.37 ,$154.21 ,$548.26 , N/A ,$347.00 ,$347.00 ,$235.96 ,$347.00 , N/A ,$659.30 ,$569.08 ,$569.08 ,$555.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205480,N/A,HC FENESTRATED HELICAL BLADE 75-125MM,272,1 ,$731.00 ,$365.50 ,$162.43 ,$731.00 , N/A ,$618.35 ,$618.35 ,$248.54 ,$584.80 ,$621.35 ,$456.88 ,$657.90 , N/A ,$694.45 ,$657.90 ,$621.35 ,$621.35 ,$248.54 ,$621.35 ,$621.35 ,$657.90 , N/A ,$307.02 ,$657.90 , N/A ,$672.52 ,$657.90 ,$487.14 ,$487.14 ,$445.18 ,$487.14 ,$475.15 ,$509.14 ,$162.43 ,$577.49 , N/A ,$365.50 ,$365.50 ,$248.54 ,$365.50 , N/A ,$694.45 ,$599.42 ,$599.42 ,$584.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205481,N/A,HC SCREW 5.0 LOCKING STRDRV 60-80MM,272,1 ,$221.00 ,$110.50 ,$49.11 ,$221.00 , N/A ,$186.94 ,$186.94 ,$75.14 ,$176.80 ,$187.85 ,$138.13 ,$198.90 , N/A ,$209.95 ,$198.90 ,$187.85 ,$187.85 ,$75.14 ,$187.85 ,$187.85 ,$198.90 , N/A ,$92.82 ,$198.90 , N/A ,$203.32 ,$198.90 ,$147.27 ,$147.27 ,$134.59 ,$147.27 ,$143.65 ,$153.93 ,$49.11 ,$174.59 , N/A ,$110.50 ,$110.50 ,$75.14 ,$110.50 , N/A ,$209.95 ,$181.22 ,$181.22 ,$176.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205482,N/A,HC SUT VICRYL+2OS-8,272,1 ,$20.00 ,$10.00 ,$4.44 ,$20.00 , N/A ,$16.92 ,$16.92 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 , N/A ,$8.40 ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 , N/A ,$10.00 ,$10.00 ,$6.80 ,$10.00 , N/A ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205483,N/A,HC SUT TI-CRON 2 T-56 HGS-21 30,272,1 ,$24.00 ,$12.00 ,$5.33 ,$24.00 , N/A ,$20.30 ,$20.30 ,$8.16 ,$19.20 ,$20.40 ,$15.00 ,$21.60 , N/A ,$22.80 ,$21.60 ,$20.40 ,$20.40 ,$8.16 ,$20.40 ,$20.40 ,$21.60 , N/A ,$10.08 ,$21.60 , N/A ,$22.08 ,$21.60 ,$15.99 ,$15.99 ,$14.62 ,$15.99 ,$15.60 ,$16.72 ,$5.33 ,$18.96 , N/A ,$12.00 ,$12.00 ,$8.16 ,$12.00 , N/A ,$22.80 ,$19.68 ,$19.68 ,$19.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280000,N/A,HC APPLIER LIGACLIP 10MM,272,1 ,$278.00 ,$139.00 ,$61.77 ,$278.00 , N/A ,$235.16 ,$235.16 ,$94.52 ,$222.40 ,$236.30 ,$173.75 ,$250.20 , N/A ,$264.10 ,$250.20 ,$236.30 ,$236.30 ,$94.52 ,$236.30 ,$236.30 ,$250.20 , N/A ,$116.76 ,$250.20 , N/A ,$255.76 ,$250.20 ,$185.26 ,$185.26 ,$169.30 ,$185.26 ,$180.70 ,$193.63 ,$61.77 ,$219.62 , N/A ,$139.00 ,$139.00 ,$94.52 ,$139.00 , N/A ,$264.10 ,$227.96 ,$227.96 ,$222.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280001,N/A,HC AQUACELL AG SILVER 8X12,272,1 ,$109.00 ,$54.50 ,$24.22 ,$109.00 , N/A ,$92.20 ,$92.20 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 , N/A ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 , N/A ,$45.78 ,$98.10 , N/A ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 , N/A ,$54.50 ,$54.50 ,$37.06 ,$54.50 , N/A ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280002,N/A,HC ASPIRATORS,272,1 ,$244.00 ,$122.00 ,$54.22 ,$244.00 , N/A ,$206.40 ,$206.40 ,$82.96 ,$195.20 ,$207.40 ,$152.50 ,$219.60 , N/A ,$231.80 ,$219.60 ,$207.40 ,$207.40 ,$82.96 ,$207.40 ,$207.40 ,$219.60 , N/A ,$102.48 ,$219.60 , N/A ,$224.48 ,$219.60 ,$162.60 ,$162.60 ,$148.60 ,$162.60 ,$158.60 ,$169.95 ,$54.22 ,$192.76 , N/A ,$122.00 ,$122.00 ,$82.96 ,$122.00 , N/A ,$231.80 ,$200.08 ,$200.08 ,$195.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280003,N/A,"HC BAG, DRAINAGE;URO-CATCHER",272,1 ,$34.00 ,$17.00 ,$7.55 ,$34.00 , N/A ,$28.76 ,$28.76 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 , N/A ,$14.28 ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 , N/A ,$17.00 ,$17.00 ,$11.56 ,$17.00 , N/A ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280004,N/A,HC BLADE STRYKER AGG,272,1 ,$108.00 ,$54.00 ,$24.00 ,$108.00 , N/A ,$91.36 ,$91.36 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 , N/A ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 , N/A ,$45.36 ,$97.20 , N/A ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 , N/A ,$54.00 ,$54.00 ,$36.72 ,$54.00 , N/A ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280005,N/A,HC BLADE BARREL BURR 5.0MM,272,1 ,$161.00 ,$80.50 ,$35.77 ,$161.00 , N/A ,$136.19 ,$136.19 ,$54.74 ,$128.80 ,$136.85 ,$100.63 ,$144.90 , N/A ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$54.74 ,$136.85 ,$136.85 ,$144.90 , N/A ,$67.62 ,$144.90 , N/A ,$148.12 ,$144.90 ,$107.29 ,$107.29 ,$98.05 ,$107.29 ,$104.65 ,$112.14 ,$35.77 ,$127.19 , N/A ,$80.50 ,$80.50 ,$54.74 ,$80.50 , N/A ,$152.95 ,$132.02 ,$132.02 ,$128.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280006,N/A,HC BLADE RECIP HVY DTY LONG,272,1 ,$140.00 ,$70.00 ,$31.11 ,$140.00 , N/A ,$118.43 ,$118.43 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 , N/A ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 , N/A ,$58.80 ,$126.00 , N/A ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 , N/A ,$70.00 ,$70.00 ,$47.60 ,$70.00 , N/A ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280007,N/A,HC BLADE RESECTOR 4.0MM,272,1 ,$153.00 ,$76.50 ,$34.00 ,$153.00 , N/A ,$129.42 ,$129.42 ,$52.02 ,$122.40 ,$130.05 ,$95.63 ,$137.70 , N/A ,$145.35 ,$137.70 ,$130.05 ,$130.05 ,$52.02 ,$130.05 ,$130.05 ,$137.70 , N/A ,$64.26 ,$137.70 , N/A ,$140.76 ,$137.70 ,$101.96 ,$101.96 ,$93.18 ,$101.96 ,$99.45 ,$106.56 ,$34.00 ,$120.87 , N/A ,$76.50 ,$76.50 ,$52.02 ,$76.50 , N/A ,$145.35 ,$125.46 ,$125.46 ,$122.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280008,N/A,HC BLADE SAG MED LONG,272,1 ,$105.00 ,$52.50 ,$23.33 ,$105.00 , N/A ,$88.82 ,$88.82 ,$35.70 ,$84.00 ,$89.25 ,$65.63 ,$94.50 , N/A ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$35.70 ,$89.25 ,$89.25 ,$94.50 , N/A ,$44.10 ,$94.50 , N/A ,$96.60 ,$94.50 ,$69.97 ,$69.97 ,$63.95 ,$69.97 ,$68.25 ,$73.13 ,$23.33 ,$82.95 , N/A ,$52.50 ,$52.50 ,$35.70 ,$52.50 , N/A ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280009,N/A,HC BLADE SAG SAW NARROW/THIC,272,1 ,$105.00 ,$52.50 ,$23.33 ,$105.00 , N/A ,$88.82 ,$88.82 ,$35.70 ,$84.00 ,$89.25 ,$65.63 ,$94.50 , N/A ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$35.70 ,$89.25 ,$89.25 ,$94.50 , N/A ,$44.10 ,$94.50 , N/A ,$96.60 ,$94.50 ,$69.97 ,$69.97 ,$63.95 ,$69.97 ,$68.25 ,$73.13 ,$23.33 ,$82.95 , N/A ,$52.50 ,$52.50 ,$35.70 ,$52.50 , N/A ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280010,N/A,HC BLADE SURG STAINLESS,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280011,N/A,HC BLADE AGGR 3.5-4.0MM,272,1 ,$153.00 ,$76.50 ,$34.00 ,$153.00 , N/A ,$129.42 ,$129.42 ,$52.02 ,$122.40 ,$130.05 ,$95.63 ,$137.70 , N/A ,$145.35 ,$137.70 ,$130.05 ,$130.05 ,$52.02 ,$130.05 ,$130.05 ,$137.70 , N/A ,$64.26 ,$137.70 , N/A ,$140.76 ,$137.70 ,$101.96 ,$101.96 ,$93.18 ,$101.96 ,$99.45 ,$106.56 ,$34.00 ,$120.87 , N/A ,$76.50 ,$76.50 ,$52.02 ,$76.50 , N/A ,$145.35 ,$125.46 ,$125.46 ,$122.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280012,N/A,"HC BLADE, ELECTRODE MOD 6.5",272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280013,N/A,HC CANNISTER BERKELEY D AND C,272,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A ,$14.00 ,$14.00 ,$9.52 ,$14.00 , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280014,N/A,HC CANNULA CLEAR W/1 WAY VAL,272,1 ,$49.00 ,$24.50 ,$10.89 ,$49.00 , N/A ,$41.45 ,$41.45 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 , N/A ,$20.58 ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 , N/A ,$24.50 ,$24.50 ,$16.66 ,$24.50 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280015,N/A,HC CANNULA CURVED,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280016,N/A,HC CANNULA DRY-LOK STRKER,272,1 ,$75.00 ,$37.50 ,$16.67 ,$75.00 , N/A ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 , N/A ,$31.50 ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 , N/A ,$37.50 ,$37.50 ,$25.50 ,$37.50 , N/A ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280017,N/A,HC CATH FOLEY 8FR 3CC PEDI,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280018,N/A,HC CATH FOLEY IRRIG 24FR,272,1 ,$30.00 ,$15.00 ,$6.67 ,$30.00 , N/A ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 , N/A ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 , N/A ,$15.00 ,$15.00 ,$10.20 ,$15.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280019,N/A,HC CATH FOLEY 14-16 FR,272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280020,N/A,HC CATH SECURE,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280021,N/A,HC CATH SINUS GUIDE GC110S,272,1 ,$974.00 ,$487.00 ,$216.42 ,$974.00 , N/A ,$823.91 ,$823.91 ,$331.16 ,$779.20 ,$827.90 ,$608.75 ,$876.60 , N/A ,$925.30 ,$876.60 ,$827.90 ,$827.90 ,$331.16 ,$827.90 ,$827.90 ,$876.60 , N/A ,$409.08 ,$876.60 , N/A ,$896.08 ,$876.60 ,$649.07 ,$649.07 ,$593.17 ,$649.07 ,$633.10 ,$678.39 ,$216.42 ,$769.46 , N/A ,$487.00 ,$487.00 ,$331.16 ,$487.00 , N/A ,$925.30 ,$798.68 ,$798.68 ,$779.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280022,N/A,HC CATH SINUS IRR RELIEVA V2,272,1 ,$483.00 ,$241.50 ,$107.32 ,$483.00 , N/A ,$408.57 ,$408.57 ,$164.22 ,$386.40 ,$410.55 ,$301.88 ,$434.70 , N/A ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$164.22 ,$410.55 ,$410.55 ,$434.70 , N/A ,$202.86 ,$434.70 , N/A ,$444.36 ,$434.70 ,$321.87 ,$321.87 ,$294.15 ,$321.87 ,$313.95 ,$336.41 ,$107.32 ,$381.57 , N/A ,$241.50 ,$241.50 ,$164.22 ,$241.50 , N/A ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280023,N/A,HC CRADLE;ARM PAIR DISP,272,1 ,$20.00 ,$10.00 ,$4.44 ,$20.00 , N/A ,$16.92 ,$16.92 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 , N/A ,$8.40 ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 , N/A ,$10.00 ,$10.00 ,$6.80 ,$10.00 , N/A ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280024,N/A,HC CUTTER ENDO ETS RELOAD,272,1 ,$300.00 ,$150.00 ,$66.66 ,$300.00 , N/A ,$253.77 ,$253.77 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 , N/A ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 , N/A ,$126.00 ,$270.00 , N/A ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 , N/A ,$150.00 ,$150.00 ,$102.00 ,$150.00 , N/A ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280025,N/A,HC DILATOR SINGLE STEP 12FR,272,1 ,$594.00 ,$297.00 ,$131.99 ,$594.00 , N/A ,$502.46 ,$502.46 ,$201.96 ,$475.20 ,$504.90 ,$371.25 ,$534.60 , N/A ,$564.30 ,$534.60 ,$504.90 ,$504.90 ,$201.96 ,$504.90 ,$504.90 ,$534.60 , N/A ,$249.48 ,$534.60 , N/A ,$546.48 ,$534.60 ,$395.84 ,$395.84 ,$361.75 ,$395.84 ,$386.10 ,$413.72 ,$131.99 ,$469.26 , N/A ,$297.00 ,$297.00 ,$201.96 ,$297.00 , N/A ,$564.30 ,$487.08 ,$487.08 ,$475.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280026,N/A,HC DRAIN CHANNEL HUBLESS 10F,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280027,N/A,HC DRILL BIT 3 FLUTED QC-125MM,272,1 ,$384.00 ,$192.00 ,$85.32 ,$384.00 , N/A ,$324.83 ,$324.83 ,$130.56 ,$307.20 ,$326.40 ,$240.00 ,$345.60 , N/A ,$364.80 ,$345.60 ,$326.40 ,$326.40 ,$130.56 ,$326.40 ,$326.40 ,$345.60 , N/A ,$161.28 ,$345.60 , N/A ,$353.28 ,$345.60 ,$255.90 ,$255.90 ,$233.86 ,$255.90 ,$249.60 ,$267.46 ,$85.32 ,$303.36 , N/A ,$192.00 ,$192.00 ,$130.56 ,$192.00 , N/A ,$364.80 ,$314.88 ,$314.88 ,$307.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280028,N/A,HC DRILL BIT QC 110 MM GOLD,272,1 ,$225.00 ,$112.50 ,$50.00 ,$225.00 , N/A ,$190.33 ,$190.33 ,$76.50 ,$180.00 ,$191.25 ,$140.63 ,$202.50 , N/A ,$213.75 ,$202.50 ,$191.25 ,$191.25 ,$76.50 ,$191.25 ,$191.25 ,$202.50 , N/A ,$94.50 ,$202.50 , N/A ,$207.00 ,$202.50 ,$149.94 ,$149.94 ,$137.03 ,$149.94 ,$146.25 ,$156.71 ,$50.00 ,$177.75 , N/A ,$112.50 ,$112.50 ,$76.50 ,$112.50 , N/A ,$213.75 ,$184.50 ,$184.50 ,$180.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280029,N/A,HC DRILL BIT QC 2/125 MM,272,1 ,$219.00 ,$109.50 ,$48.66 ,$219.00 , N/A ,$185.25 ,$185.25 ,$74.46 ,$175.20 ,$186.15 ,$136.88 ,$197.10 , N/A ,$208.05 ,$197.10 ,$186.15 ,$186.15 ,$74.46 ,$186.15 ,$186.15 ,$197.10 , N/A ,$91.98 ,$197.10 , N/A ,$201.48 ,$197.10 ,$145.94 ,$145.94 ,$133.37 ,$145.94 ,$142.35 ,$152.53 ,$48.66 ,$173.01 , N/A ,$109.50 ,$109.50 ,$74.46 ,$109.50 , N/A ,$208.05 ,$179.58 ,$179.58 ,$175.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280030,N/A,HC DRILL BIT W DEPTH MRK 1.8,272,1 ,$489.00 ,$244.50 ,$108.66 ,$489.00 , N/A ,$413.65 ,$413.65 ,$166.26 ,$391.20 ,$415.65 ,$305.63 ,$440.10 , N/A ,$464.55 ,$440.10 ,$415.65 ,$415.65 ,$166.26 ,$415.65 ,$415.65 ,$440.10 , N/A ,$205.38 ,$440.10 , N/A ,$449.88 ,$440.10 ,$325.87 ,$325.87 ,$297.80 ,$325.87 ,$317.85 ,$340.59 ,$108.66 ,$386.31 , N/A ,$244.50 ,$244.50 ,$166.26 ,$244.50 , N/A ,$464.55 ,$400.98 ,$400.98 ,$391.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280031,N/A,"HC DRILL BIT,LGND 14CM 3MM",272,1 ,$434.00 ,$217.00 ,$96.43 ,$434.00 , N/A ,$367.12 ,$367.12 ,$147.56 ,$347.20 ,$368.90 ,$271.25 ,$390.60 , N/A ,$412.30 ,$390.60 ,$368.90 ,$368.90 ,$147.56 ,$368.90 ,$368.90 ,$390.60 , N/A ,$182.28 ,$390.60 , N/A ,$399.28 ,$390.60 ,$289.22 ,$289.22 ,$264.31 ,$289.22 ,$282.10 ,$302.28 ,$96.43 ,$342.86 , N/A ,$217.00 ,$217.00 ,$147.56 ,$217.00 , N/A ,$412.30 ,$355.88 ,$355.88 ,$347.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280032,N/A,HC DRSG NASAL HOLDER,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280033,N/A,HC DRSG NASOPORE,272,1 ,$448.00 ,$224.00 ,$99.55 ,$448.00 , N/A ,$378.96 ,$378.96 ,$152.32 ,$358.40 ,$380.80 ,$280.00 ,$403.20 , N/A ,$425.60 ,$403.20 ,$380.80 ,$380.80 ,$152.32 ,$380.80 ,$380.80 ,$403.20 , N/A ,$188.16 ,$403.20 , N/A ,$412.16 ,$403.20 ,$298.55 ,$298.55 ,$272.83 ,$298.55 ,$291.20 ,$312.03 ,$99.55 ,$353.92 , N/A ,$224.00 ,$224.00 ,$152.32 ,$224.00 , N/A ,$425.60 ,$367.36 ,$367.36 ,$358.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280034,N/A,HC ELECTRODE ADULT D DESPERS,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280035,N/A,"HC ELECTRODE BALL EZ CLN 5""",272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280036,N/A,HC ELECTRODE BLADE EZ STD 6.5,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280037,N/A,HC ELECTRODE BLADE MOD 2.5,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280038,N/A,HC ELECTRODE LAP L-HOOK 27,272,1 ,$75.00 ,$37.50 ,$16.67 ,$75.00 , N/A ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 , N/A ,$31.50 ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 , N/A ,$37.50 ,$37.50 ,$25.50 ,$37.50 , N/A ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280039,N/A,HC ELECTRODE NEEDLE EZ 2.75,272,1 ,$12.40 ,$6.20 ,$2.76 ,$12.40 , N/A ,$10.49 ,$10.49 ,$4.22 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$4.22 ,$10.54 ,$10.54 ,$11.16 , N/A ,$5.21 ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.26 ,$8.26 ,$7.55 ,$8.26 ,$8.06 ,$8.64 ,$2.76 ,$9.80 , N/A ,$6.20 ,$6.20 ,$4.22 ,$6.20 , N/A ,$11.78 ,$10.17 ,$10.17 ,$9.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280040,N/A,HC ELECTRODE PED D DISPERSIV,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280041,N/A,HC ELECTRODE SPTLA 5MMX27CM,272,1 ,$75.00 ,$37.50 ,$16.67 ,$75.00 , N/A ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 , N/A ,$31.50 ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 , N/A ,$37.50 ,$37.50 ,$25.50 ,$37.50 , N/A ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280042,N/A,HC ELECTORDE ZOLL STAT PADZ,272,1 ,$94.00 ,$47.00 ,$20.89 ,$94.00 , N/A ,$79.51 ,$79.51 ,$31.96 ,$75.20 ,$79.90 ,$58.75 ,$84.60 , N/A ,$89.30 ,$84.60 ,$79.90 ,$79.90 ,$31.96 ,$79.90 ,$79.90 ,$84.60 , N/A ,$39.48 ,$84.60 , N/A ,$86.48 ,$84.60 ,$62.64 ,$62.64 ,$57.25 ,$62.64 ,$61.10 ,$65.47 ,$20.89 ,$74.26 , N/A ,$47.00 ,$47.00 ,$31.96 ,$47.00 , N/A ,$89.30 ,$77.08 ,$77.08 ,$75.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280043,N/A,HC EVAC RESERVOIR WOUND,272,1 ,$14.50 ,$7.25 ,$3.22 ,$14.50 , N/A ,$12.27 ,$12.27 ,$4.93 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$4.93 ,$12.33 ,$12.33 ,$13.05 , N/A ,$6.09 ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.66 ,$9.66 ,$8.83 ,$9.66 ,$9.43 ,$10.10 ,$3.22 ,$11.46 , N/A ,$7.25 ,$7.25 ,$4.93 ,$7.25 , N/A ,$13.78 ,$11.89 ,$11.89 ,$11.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280044,N/A,HC FORCEPS BX YELLOW JAW 4,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280045,N/A,HC FORCEPS BX JUMBO JAW 4,272,1 ,$119.00 ,$59.50 ,$26.44 ,$119.00 , N/A ,$100.66 ,$100.66 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 , N/A ,$49.98 ,$107.10 , N/A ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 , N/A ,$59.50 ,$59.50 ,$40.46 ,$59.50 , N/A ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280047,N/A,HC GELFOAM PLAIN SPONGE,272,1 ,$58.00 ,$29.00 ,$12.89 ,$58.00 , N/A ,$49.06 ,$49.06 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 , N/A ,$24.36 ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 , N/A ,$29.00 ,$29.00 ,$19.72 ,$29.00 , N/A ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280048,N/A,HC GENESYS HTA PROCEDURE KIT,272,1 ,"$3,172.00 ","$1,586.00 ",$704.82 ,"$3,172.00 ", N/A ,"$2,683.19 ","$2,683.19 ","$1,078.48 ","$2,537.60 ","$2,696.20 ","$1,982.50 ","$2,854.80 ", N/A ,"$3,013.40 ","$2,854.80 ","$2,696.20 ","$2,696.20 ","$1,078.48 ","$2,696.20 ","$2,696.20 ","$2,854.80 ", N/A ,"$1,332.24 ","$2,854.80 ", N/A ,"$2,918.24 ","$2,854.80 ","$2,113.82 ","$2,113.82 ","$1,931.75 ","$2,113.82 ","$2,061.80 ","$2,209.30 ",$704.82 ,"$2,505.88 ", N/A ,"$1,586.00 ","$1,586.00 ","$1,078.48 ","$1,586.00 ", N/A ,"$3,013.40 ","$2,601.04 ","$2,601.04 ","$2,537.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280049,N/A,HC HAND CONTROL UNIV STRAIGHT,272,1 ,$182.00 ,$91.00 ,$40.44 ,$182.00 , N/A ,$153.95 ,$153.95 ,$61.88 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$61.88 ,$154.70 ,$154.70 ,$163.80 , N/A ,$76.44 ,$163.80 , N/A ,$167.44 ,$163.80 ,$121.28 ,$121.28 ,$110.84 ,$121.28 ,$118.30 ,$126.76 ,$40.44 ,$143.78 , N/A ,$91.00 ,$91.00 ,$61.88 ,$91.00 , N/A ,$172.90 ,$149.24 ,$149.24 ,$145.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280050,N/A,HC IRRIGATION KIT 2 PC BULB,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280051,N/A,HC KIT COLOSTOMY 45MM,272,1 ,$20.00 ,$10.00 ,$4.44 ,$20.00 , N/A ,$16.92 ,$16.92 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 , N/A ,$8.40 ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 , N/A ,$10.00 ,$10.00 ,$6.80 ,$10.00 , N/A ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280052,N/A,HC KIT COOLED RF,272,1 ,"$2,522.00 ","$1,261.00 ",$560.39 ,"$2,522.00 ", N/A ,"$2,133.36 ","$2,133.36 ",$857.48 ,"$2,017.60 ","$2,143.70 ","$1,576.25 ","$2,269.80 ", N/A ,"$2,395.90 ","$2,269.80 ","$2,143.70 ","$2,143.70 ",$857.48 ,"$2,143.70 ","$2,143.70 ","$2,269.80 ", N/A ,"$1,059.24 ","$2,269.80 ", N/A ,"$2,320.24 ","$2,269.80 ","$1,680.66 ","$1,680.66 ","$1,535.90 ","$1,680.66 ","$1,639.30 ","$1,756.57 ",$560.39 ,"$1,992.38 ", N/A ,"$1,261.00 ","$1,261.00 ",$857.48 ,"$1,261.00 ", N/A ,"$2,395.90 ","$2,068.04 ","$2,068.04 ","$2,017.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280053,N/A,HC KIT CV CATH 7FR MULTILUM PRESSURE,272,1 ,$257.00 ,$128.50 ,$57.11 ,$257.00 , N/A ,$217.40 ,$217.40 ,$87.38 ,$205.60 ,$218.45 ,$160.63 ,$231.30 , N/A ,$244.15 ,$231.30 ,$218.45 ,$218.45 ,$87.38 ,$218.45 ,$218.45 ,$231.30 , N/A ,$107.94 ,$231.30 , N/A ,$236.44 ,$231.30 ,$171.26 ,$171.26 ,$156.51 ,$171.26 ,$167.05 ,$179.00 ,$57.11 ,$203.03 , N/A ,$128.50 ,$128.50 ,$87.38 ,$128.50 , N/A ,$244.15 ,$210.74 ,$210.74 ,$205.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280054,N/A,HC KIT CVC BUNDLE,272,1 ,$177.00 ,$88.50 ,$39.33 ,$177.00 , N/A ,$149.72 ,$149.72 ,$60.18 ,$141.60 ,$150.45 ,$110.63 ,$159.30 , N/A ,$168.15 ,$159.30 ,$150.45 ,$150.45 ,$60.18 ,$150.45 ,$150.45 ,$159.30 , N/A ,$74.34 ,$159.30 , N/A ,$162.84 ,$159.30 ,$117.95 ,$117.95 ,$107.79 ,$117.95 ,$115.05 ,$123.28 ,$39.33 ,$139.83 , N/A ,$88.50 ,$88.50 ,$60.18 ,$88.50 , N/A ,$168.15 ,$145.14 ,$145.14 ,$141.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280055,N/A,HC KIT OSTOMY LOOP GENTLE TH,272,1 ,$130.00 ,$65.00 ,$28.89 ,$130.00 , N/A ,$109.97 ,$109.97 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 , N/A ,$54.60 ,$117.00 , N/A ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 , N/A ,$65.00 ,$65.00 ,$44.20 ,$65.00 , N/A ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280056,N/A,HC KIT PILLOW GT FRAME,272,1 ,$84.00 ,$42.00 ,$18.66 ,$84.00 , N/A ,$71.06 ,$71.06 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 , N/A ,$35.28 ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 , N/A ,$42.00 ,$42.00 ,$28.56 ,$42.00 , N/A ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280057,N/A,HC KNIFE OPTH GOLD 15 DEGREE,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280058,N/A,HC LANCE; MYRINGOTOMY,272,1 ,$42.00 ,$21.00 ,$9.33 ,$42.00 , N/A ,$35.53 ,$35.53 ,$14.28 ,$33.60 ,$35.70 ,$26.25 ,$37.80 , N/A ,$39.90 ,$37.80 ,$35.70 ,$35.70 ,$14.28 ,$35.70 ,$35.70 ,$37.80 , N/A ,$17.64 ,$37.80 , N/A ,$38.64 ,$37.80 ,$27.99 ,$27.99 ,$25.58 ,$27.99 ,$27.30 ,$29.25 ,$9.33 ,$33.18 , N/A ,$21.00 ,$21.00 ,$14.28 ,$21.00 , N/A ,$39.90 ,$34.44 ,$34.44 ,$33.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280059,N/A,HC MONSELS SOLUTION,272,1 ,$33.00 ,$16.50 ,$7.33 ,$33.00 , N/A ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$13.86 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280060,N/A,HC NEEDLE SPINAL 25G X 5,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280061,N/A,HC NEEDLE SPINAL 25X6,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280062,N/A,HC NEEDLE PULM INSUFL 120-150 CM,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280063,N/A,HC PROT CAP 1.6 AND 2.0MM KWIRE,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280064,N/A,HC NEEDLE ACUJET,272,1 ,$113.00 ,$56.50 ,$25.11 ,$113.00 , N/A ,$95.59 ,$95.59 ,$38.42 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$38.42 ,$96.05 ,$96.05 ,$101.70 , N/A ,$47.46 ,$101.70 , N/A ,$103.96 ,$101.70 ,$75.30 ,$75.30 ,$68.82 ,$75.30 ,$73.45 ,$78.70 ,$25.11 ,$89.27 , N/A ,$56.50 ,$56.50 ,$38.42 ,$56.50 , N/A ,$107.35 ,$92.66 ,$92.66 ,$90.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280065,N/A,HC NEEDLE EPID KIT 3550 28,272,1 ,$173.00 ,$86.50 ,$38.44 ,$173.00 , N/A ,$146.34 ,$146.34 ,$58.82 ,$138.40 ,$147.05 ,$108.13 ,$155.70 , N/A ,$164.35 ,$155.70 ,$147.05 ,$147.05 ,$58.82 ,$147.05 ,$147.05 ,$155.70 , N/A ,$72.66 ,$155.70 , N/A ,$159.16 ,$155.70 ,$115.29 ,$115.29 ,$105.36 ,$115.29 ,$112.45 ,$120.49 ,$38.44 ,$136.67 , N/A ,$86.50 ,$86.50 ,$58.82 ,$86.50 , N/A ,$164.35 ,$141.86 ,$141.86 ,$138.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280066,N/A,HC OSTOMY LOOP  AND  FLANGE,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280067,N/A,HC PACK EENT,272,1 ,$220.00 ,$110.00 ,$48.88 ,$220.00 , N/A ,$186.10 ,$186.10 ,$74.80 ,$176.00 ,$187.00 ,$137.50 ,$198.00 , N/A ,$209.00 ,$198.00 ,$187.00 ,$187.00 ,$74.80 ,$187.00 ,$187.00 ,$198.00 , N/A ,$92.40 ,$198.00 , N/A ,$202.40 ,$198.00 ,$146.61 ,$146.61 ,$133.98 ,$146.61 ,$143.00 ,$153.23 ,$48.88 ,$173.80 , N/A ,$110.00 ,$110.00 ,$74.80 ,$110.00 , N/A ,$209.00 ,$180.40 ,$180.40 ,$176.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280068,N/A,HC PACK LAMINECTOMY,272,1 ,$220.00 ,$110.00 ,$48.88 ,$220.00 , N/A ,$186.10 ,$186.10 ,$74.80 ,$176.00 ,$187.00 ,$137.50 ,$198.00 , N/A ,$209.00 ,$198.00 ,$187.00 ,$187.00 ,$74.80 ,$187.00 ,$187.00 ,$198.00 , N/A ,$92.40 ,$198.00 , N/A ,$202.40 ,$198.00 ,$146.61 ,$146.61 ,$133.98 ,$146.61 ,$143.00 ,$153.23 ,$48.88 ,$173.80 , N/A ,$110.00 ,$110.00 ,$74.80 ,$110.00 , N/A ,$209.00 ,$180.40 ,$180.40 ,$176.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280069,N/A,HC PACK LAPAROTOMY VI,272,1 ,$49.00 ,$24.50 ,$10.89 ,$49.00 , N/A ,$41.45 ,$41.45 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 , N/A ,$20.58 ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 , N/A ,$24.50 ,$24.50 ,$16.66 ,$24.50 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280070,N/A,HC PROBE,272,1 ,$470.00 ,$235.00 ,$104.43 ,$470.00 , N/A ,$397.57 ,$397.57 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 , N/A ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 , N/A ,$197.40 ,$423.00 , N/A ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 , N/A ,$235.00 ,$235.00 ,$159.80 ,$235.00 , N/A ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280071,N/A,HC RASP TPS CROSSCUT LG,272,1 ,$345.00 ,$172.50 ,$76.66 ,$345.00 , N/A ,$291.84 ,$291.84 ,$117.30 ,$276.00 ,$293.25 ,$215.63 ,$310.50 , N/A ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$117.30 ,$293.25 ,$293.25 ,$310.50 , N/A ,$144.90 ,$310.50 , N/A ,$317.40 ,$310.50 ,$229.91 ,$229.91 ,$210.11 ,$229.91 ,$224.25 ,$240.29 ,$76.66 ,$272.55 , N/A ,$172.50 ,$172.50 ,$117.30 ,$172.50 , N/A ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280072,N/A,HC RASP TPS CROSSCUT,272,1 ,$332.00 ,$166.00 ,$73.77 ,$332.00 , N/A ,$280.84 ,$280.84 ,$112.88 ,$265.60 ,$282.20 ,$207.50 ,$298.80 , N/A ,$315.40 ,$298.80 ,$282.20 ,$282.20 ,$112.88 ,$282.20 ,$282.20 ,$298.80 , N/A ,$139.44 ,$298.80 , N/A ,$305.44 ,$298.80 ,$221.24 ,$221.24 ,$202.19 ,$221.24 ,$215.80 ,$231.24 ,$73.77 ,$262.28 , N/A ,$166.00 ,$166.00 ,$112.88 ,$166.00 , N/A ,$315.40 ,$272.24 ,$272.24 ,$265.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280073,N/A,HC REAMG ROD 2.5MM BALL 950M,272,1 ,$365.00 ,$182.50 ,$81.10 ,$365.00 , N/A ,$308.75 ,$308.75 ,$124.10 ,$292.00 ,$310.25 ,$228.13 ,$328.50 , N/A ,$346.75 ,$328.50 ,$310.25 ,$310.25 ,$124.10 ,$310.25 ,$310.25 ,$328.50 , N/A ,$153.30 ,$328.50 , N/A ,$335.80 ,$328.50 ,$243.24 ,$243.24 ,$222.29 ,$243.24 ,$237.25 ,$254.22 ,$81.10 ,$288.35 , N/A ,$182.50 ,$182.50 ,$124.10 ,$182.50 , N/A ,$346.75 ,$299.30 ,$299.30 ,$292.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280074,N/A,HC REDUCER CAP ENDOPATH SEAL,272,1 ,$14.50 ,$7.25 ,$3.22 ,$14.50 , N/A ,$12.27 ,$12.27 ,$4.93 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$4.93 ,$12.33 ,$12.33 ,$13.05 , N/A ,$6.09 ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.66 ,$9.66 ,$8.83 ,$9.66 ,$9.43 ,$10.10 ,$3.22 ,$11.46 , N/A ,$7.25 ,$7.25 ,$4.93 ,$7.25 , N/A ,$13.78 ,$11.89 ,$11.89 ,$11.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280075,N/A,HC RELIEVEA DEPLOYMENT GUIDE,272,1 ,"$1,089.00 ",$544.50 ,$241.98 ,"$1,089.00 ", N/A ,$921.19 ,$921.19 ,$370.26 ,$871.20 ,$925.65 ,$680.63 ,$980.10 , N/A ,"$1,034.55 ",$980.10 ,$925.65 ,$925.65 ,$370.26 ,$925.65 ,$925.65 ,$980.10 , N/A ,$457.38 ,$980.10 , N/A ,"$1,001.88 ",$980.10 ,$725.71 ,$725.71 ,$663.20 ,$725.71 ,$707.85 ,$758.49 ,$241.98 ,$860.31 , N/A ,$544.50 ,$544.50 ,$370.26 ,$544.50 , N/A ,"$1,034.55 ",$892.98 ,$892.98 ,$871.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280076,N/A,HC RELIEVA MICROFLOW SPACER,272,1 ,"$2,478.00 ","$1,239.00 ",$550.61 ,"$2,478.00 ", N/A ,"$2,096.14 ","$2,096.14 ",$842.52 ,"$1,982.40 ","$2,106.30 ","$1,548.75 ","$2,230.20 ", N/A ,"$2,354.10 ","$2,230.20 ","$2,106.30 ","$2,106.30 ",$842.52 ,"$2,106.30 ","$2,106.30 ","$2,230.20 ", N/A ,"$1,040.76 ","$2,230.20 ", N/A ,"$2,279.76 ","$2,230.20 ","$1,651.34 ","$1,651.34 ","$1,509.10 ","$1,651.34 ","$1,610.70 ","$1,725.93 ",$550.61 ,"$1,957.62 ", N/A ,"$1,239.00 ","$1,239.00 ",$842.52 ,"$1,239.00 ", N/A ,"$2,354.10 ","$2,031.96 ","$2,031.96 ","$1,982.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280077,N/A,HC RELIEVA SINUS IRRIGATION,272,1 ,$391.00 ,$195.50 ,$86.88 ,$391.00 , N/A ,$330.75 ,$330.75 ,$132.94 ,$312.80 ,$332.35 ,$244.38 ,$351.90 , N/A ,$371.45 ,$351.90 ,$332.35 ,$332.35 ,$132.94 ,$332.35 ,$332.35 ,$351.90 , N/A ,$164.22 ,$351.90 , N/A ,$359.72 ,$351.90 ,$260.56 ,$260.56 ,$238.12 ,$260.56 ,$254.15 ,$272.33 ,$86.88 ,$308.89 , N/A ,$195.50 ,$195.50 ,$132.94 ,$195.50 , N/A ,$371.45 ,$320.62 ,$320.62 ,$312.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280078,N/A,HC RETAINER GLASSMAN VISCERA,272,1 ,$92.00 ,$46.00 ,$20.44 ,$92.00 , N/A ,$77.82 ,$77.82 ,$31.28 ,$73.60 ,$78.20 ,$57.50 ,$82.80 , N/A ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$31.28 ,$78.20 ,$78.20 ,$82.80 , N/A ,$38.64 ,$82.80 , N/A ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 , N/A ,$46.00 ,$46.00 ,$31.28 ,$46.00 , N/A ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280079,N/A,HC RETAINER VISCERA XL,272,1 ,$95.00 ,$47.50 ,$21.11 ,$95.00 , N/A ,$80.36 ,$80.36 ,$32.30 ,$76.00 ,$80.75 ,$59.38 ,$85.50 , N/A ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$32.30 ,$80.75 ,$80.75 ,$85.50 , N/A ,$39.90 ,$85.50 , N/A ,$87.40 ,$85.50 ,$63.31 ,$63.31 ,$57.86 ,$63.31 ,$61.75 ,$66.17 ,$21.11 ,$75.05 , N/A ,$47.50 ,$47.50 ,$32.30 ,$47.50 , N/A ,$90.25 ,$77.90 ,$77.90 ,$76.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280080,N/A,HC RETRACTOR ENDOPADDLE 12MM,272,1 ,"$1,122.00 ",$561.00 ,$249.31 ,"$1,122.00 ", N/A ,$949.10 ,$949.10 ,$381.48 ,$897.60 ,$953.70 ,$701.25 ,"$1,009.80 ", N/A ,"$1,065.90 ","$1,009.80 ",$953.70 ,$953.70 ,$381.48 ,$953.70 ,$953.70 ,"$1,009.80 ", N/A ,$471.24 ,"$1,009.80 ", N/A ,"$1,032.24 ","$1,009.80 ",$747.70 ,$747.70 ,$683.30 ,$747.70 ,$729.30 ,$781.47 ,$249.31 ,$886.38 , N/A ,$561.00 ,$561.00 ,$381.48 ,$561.00 , N/A ,"$1,065.90 ",$920.04 ,$920.04 ,$897.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280081,N/A,HC RUMI OCCLUDER,272,1 ,$175.00 ,$87.50 ,$38.89 ,$175.00 , N/A ,$148.03 ,$148.03 ,$59.50 ,$140.00 ,$148.75 ,$109.38 ,$157.50 , N/A ,$166.25 ,$157.50 ,$148.75 ,$148.75 ,$59.50 ,$148.75 ,$148.75 ,$157.50 , N/A ,$73.50 ,$157.50 , N/A ,$161.00 ,$157.50 ,$116.62 ,$116.62 ,$106.58 ,$116.62 ,$113.75 ,$121.89 ,$38.89 ,$138.25 , N/A ,$87.50 ,$87.50 ,$59.50 ,$87.50 , N/A ,$166.25 ,$143.50 ,$143.50 ,$140.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280082,N/A,HC RUMI TIP,272,1 ,$139.00 ,$69.50 ,$30.89 ,$139.00 , N/A ,$117.58 ,$117.58 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 , N/A ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 , N/A ,$58.38 ,$125.10 , N/A ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 , N/A ,$69.50 ,$69.50 ,$47.26 ,$69.50 , N/A ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280086,N/A,HC SACRO LUMBAR SUPPORT,272,1 ,$81.00 ,$40.50 ,$18.00 ,$81.00 , N/A ,$68.52 ,$68.52 ,$27.54 ,$64.80 ,$68.85 ,$50.63 ,$72.90 , N/A ,$76.95 ,$72.90 ,$68.85 ,$68.85 ,$27.54 ,$68.85 ,$68.85 ,$72.90 , N/A ,$34.02 ,$72.90 , N/A ,$74.52 ,$72.90 ,$53.98 ,$53.98 ,$49.33 ,$53.98 ,$52.65 ,$56.42 ,$18.00 ,$63.99 , N/A ,$40.50 ,$40.50 ,$27.54 ,$40.50 , N/A ,$76.95 ,$66.42 ,$66.42 ,$64.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280089,N/A,HC SET SPLINT AIRWAY DOYLEII,272,1 ,$154.00 ,$77.00 ,$34.22 ,$154.00 , N/A ,$130.27 ,$130.27 ,$52.36 ,$123.20 ,$130.90 ,$96.25 ,$138.60 , N/A ,$146.30 ,$138.60 ,$130.90 ,$130.90 ,$52.36 ,$130.90 ,$130.90 ,$138.60 , N/A ,$64.68 ,$138.60 , N/A ,$141.68 ,$138.60 ,$102.63 ,$102.63 ,$93.79 ,$102.63 ,$100.10 ,$107.26 ,$34.22 ,$121.66 , N/A ,$77.00 ,$77.00 ,$52.36 ,$77.00 , N/A ,$146.30 ,$126.28 ,$126.28 ,$123.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280090,N/A,HC SET INFUSSLATOR TUBE,272,1 ,$26.00 ,$13.00 ,$5.78 ,$26.00 , N/A ,$21.99 ,$21.99 ,$8.84 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$8.84 ,$22.10 ,$22.10 ,$23.40 , N/A ,$10.92 ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.33 ,$17.33 ,$15.83 ,$17.33 ,$16.90 ,$18.11 ,$5.78 ,$20.54 , N/A ,$13.00 ,$13.00 ,$8.84 ,$13.00 , N/A ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280091,N/A,HC SHEATH TUBE ENDO2 4MM,272,1 ,$172.00 ,$86.00 ,$38.22 ,$172.00 , N/A ,$145.49 ,$145.49 ,$58.48 ,$137.60 ,$146.20 ,$107.50 ,$154.80 , N/A ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$58.48 ,$146.20 ,$146.20 ,$154.80 , N/A ,$72.24 ,$154.80 , N/A ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 , N/A ,$86.00 ,$86.00 ,$58.48 ,$86.00 , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280092,N/A,HC SINUS GUIDE TIP MAXILLARY,272,1 ,$998.00 ,$499.00 ,$221.76 ,$998.00 , N/A ,$844.21 ,$844.21 ,$339.32 ,$798.40 ,$848.30 ,$623.75 ,$898.20 , N/A ,$948.10 ,$898.20 ,$848.30 ,$848.30 ,$339.32 ,$848.30 ,$848.30 ,$898.20 , N/A ,$419.16 ,$898.20 , N/A ,$918.16 ,$898.20 ,$665.07 ,$665.07 ,$607.78 ,$665.07 ,$648.70 ,$695.11 ,$221.76 ,$788.42 , N/A ,$499.00 ,$499.00 ,$339.32 ,$499.00 , N/A ,$948.10 ,$818.36 ,$818.36 ,$798.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280093,N/A,HC SUCTION GOAG HAND 10FR,272,1 ,$40.00 ,$20.00 ,$8.89 ,$40.00 , N/A ,$33.84 ,$33.84 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 , N/A ,$16.80 ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 , N/A ,$20.00 ,$20.00 ,$13.60 ,$20.00 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280094,N/A,HC SNARE GASTRO,272,1 ,$31.00 ,$15.50 ,$6.89 ,$31.00 , N/A ,$26.22 ,$26.22 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 , N/A ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 , N/A ,$13.02 ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 , N/A ,$15.50 ,$15.50 ,$10.54 ,$15.50 , N/A ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280095,N/A,"HC SNARE, ROTATABLE OVAL",272,1 ,$71.00 ,$35.50 ,$15.78 ,$71.00 , N/A ,$60.06 ,$60.06 ,$24.14 ,$56.80 ,$60.35 ,$44.38 ,$63.90 , N/A ,$67.45 ,$63.90 ,$60.35 ,$60.35 ,$24.14 ,$60.35 ,$60.35 ,$63.90 , N/A ,$29.82 ,$63.90 , N/A ,$65.32 ,$63.90 ,$47.31 ,$47.31 ,$43.24 ,$47.31 ,$46.15 ,$49.45 ,$15.78 ,$56.09 , N/A ,$35.50 ,$35.50 ,$24.14 ,$35.50 , N/A ,$67.45 ,$58.22 ,$58.22 ,$56.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280096,N/A,HC SORBAFIX 30 ABSORB FASTEN,272,1 ,"$2,884.00 ","$1,442.00 ",$640.82 ,"$2,884.00 ", N/A ,"$2,439.58 ","$2,439.58 ",$980.56 ,"$2,307.20 ","$2,451.40 ","$1,802.50 ","$2,595.60 ", N/A ,"$2,739.80 ","$2,595.60 ","$2,451.40 ","$2,451.40 ",$980.56 ,"$2,451.40 ","$2,451.40 ","$2,595.60 ", N/A ,"$1,211.28 ","$2,595.60 ", N/A ,"$2,653.28 ","$2,595.60 ","$1,921.90 ","$1,921.90 ","$1,756.36 ","$1,921.90 ","$1,874.60 ","$2,008.71 ",$640.82 ,"$2,278.36 ", N/A ,"$1,442.00 ","$1,442.00 ",$980.56 ,"$1,442.00 ", N/A ,"$2,739.80 ","$2,364.88 ","$2,364.88 ","$2,307.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280097,N/A,"HC STOCKINETTE STERILE 6""",272,1 ,$3.10 ,$1.55 ,$0.69 ,$3.10 , N/A ,$2.62 ,$2.62 ,$1.05 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$1.05 ,$2.64 ,$2.64 ,$2.79 , N/A ,$1.30 ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.07 ,$2.07 ,$1.89 ,$2.07 ,$2.02 ,$2.16 ,$0.69 ,$2.45 , N/A ,$1.55 ,$1.55 ,$1.05 ,$1.55 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280098,N/A,HC SURGICEL ABS HEMOSTAT 2X3,272,1 ,$126.00 ,$63.00 ,$28.00 ,$126.00 , N/A ,$106.58 ,$106.58 ,$42.84 ,$100.80 ,$107.10 ,$78.75 ,$113.40 , N/A ,$119.70 ,$113.40 ,$107.10 ,$107.10 ,$42.84 ,$107.10 ,$107.10 ,$113.40 , N/A ,$52.92 ,$113.40 , N/A ,$115.92 ,$113.40 ,$83.97 ,$83.97 ,$76.73 ,$83.97 ,$81.90 ,$87.76 ,$28.00 ,$99.54 , N/A ,$63.00 ,$63.00 ,$42.84 ,$63.00 , N/A ,$119.70 ,$103.32 ,$103.32 ,$100.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280100,N/A,HC SUTURE ETH 4.0 BLK MONO,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280101,N/A,HC SUTURE CHR GUT 0 47T,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280102,N/A,HC SUTURE ETHILON MONO  830H,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280103,N/A,HC SUTURE MONOCRYL 0 Y398H,272,1 ,$13.50 ,$6.75 ,$3.00 ,$13.50 , N/A ,$11.42 ,$11.42 ,$4.59 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$4.59 ,$11.48 ,$11.48 ,$12.15 , N/A ,$5.67 ,$12.15 , N/A ,$12.42 ,$12.15 ,$9.00 ,$9.00 ,$8.22 ,$9.00 ,$8.78 ,$9.40 ,$3.00 ,$10.67 , N/A ,$6.75 ,$6.75 ,$4.59 ,$6.75 , N/A ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280104,N/A,HC SUTURE SET W RULER,272,1 ,$7.20 ,$3.60 ,$1.60 ,$7.20 , N/A ,$6.09 ,$6.09 ,$2.45 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$2.45 ,$6.12 ,$6.12 ,$6.48 , N/A ,$3.02 ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.80 ,$4.80 ,$4.38 ,$4.80 ,$4.68 ,$5.01 ,$1.60 ,$5.69 , N/A ,$3.60 ,$3.60 ,$2.45 ,$3.60 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280105,N/A,HC SUTURE SILK 2-0 SA65H,272,1 ,$8.30 ,$4.15 ,$1.85 ,$8.30 , N/A ,$7.02 ,$7.02 ,$2.82 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.82 ,$7.06 ,$7.06 ,$7.47 , N/A ,$3.49 ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.53 ,$5.53 ,$5.05 ,$5.53 ,$5.40 ,$5.78 ,$1.85 ,$6.56 , N/A ,$4.15 ,$4.15 ,$2.82 ,$4.15 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280106,N/A,HC TISSUE TRAP SAFETOUCH,272,1 ,$31.00 ,$15.50 ,$6.89 ,$31.00 , N/A ,$26.22 ,$26.22 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 , N/A ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 , N/A ,$13.02 ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 , N/A ,$15.50 ,$15.50 ,$10.54 ,$15.50 , N/A ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280107,N/A,HC TRAP POLYP QUICK CATH,272,1 ,$10.40 ,$5.20 ,$2.31 ,$10.40 , N/A ,$8.80 ,$8.80 ,$3.54 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$3.54 ,$8.84 ,$8.84 ,$9.36 , N/A ,$4.37 ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.93 ,$6.93 ,$6.33 ,$6.93 ,$6.76 ,$7.24 ,$2.31 ,$8.22 , N/A ,$5.20 ,$5.20 ,$3.54 ,$5.20 , N/A ,$9.88 ,$8.53 ,$8.53 ,$8.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280108,N/A,HC TROCAR 11MM D11LT,272,1 ,$177.00 ,$88.50 ,$39.33 ,$177.00 , N/A ,$149.72 ,$149.72 ,$60.18 ,$141.60 ,$150.45 ,$110.63 ,$159.30 , N/A ,$168.15 ,$159.30 ,$150.45 ,$150.45 ,$60.18 ,$150.45 ,$150.45 ,$159.30 , N/A ,$74.34 ,$159.30 , N/A ,$162.84 ,$159.30 ,$117.95 ,$117.95 ,$107.79 ,$117.95 ,$115.05 ,$123.28 ,$39.33 ,$139.83 , N/A ,$88.50 ,$88.50 ,$60.18 ,$88.50 , N/A ,$168.15 ,$145.14 ,$145.14 ,$141.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280109,N/A,HC TROCAR 5MM D5LT,272,1 ,$139.00 ,$69.50 ,$30.89 ,$139.00 , N/A ,$117.58 ,$117.58 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 , N/A ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 , N/A ,$58.38 ,$125.10 , N/A ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 , N/A ,$69.50 ,$69.50 ,$47.26 ,$69.50 , N/A ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280110,N/A,HC TROCAR BLUNT 10/12 MM,272,1 ,$201.00 ,$100.50 ,$44.66 ,$201.00 , N/A ,$170.03 ,$170.03 ,$68.34 ,$160.80 ,$170.85 ,$125.63 ,$180.90 , N/A ,$190.95 ,$180.90 ,$170.85 ,$170.85 ,$68.34 ,$170.85 ,$170.85 ,$180.90 , N/A ,$84.42 ,$180.90 , N/A ,$184.92 ,$180.90 ,$133.95 ,$133.95 ,$122.41 ,$133.95 ,$130.65 ,$140.00 ,$44.66 ,$158.79 , N/A ,$100.50 ,$100.50 ,$68.34 ,$100.50 , N/A ,$190.95 ,$164.82 ,$164.82 ,$160.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280111,N/A,HC TROCAR ENDOPATH 12 MM,272,1 ,$182.00 ,$91.00 ,$40.44 ,$182.00 , N/A ,$153.95 ,$153.95 ,$61.88 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$61.88 ,$154.70 ,$154.70 ,$163.80 , N/A ,$76.44 ,$163.80 , N/A ,$167.44 ,$163.80 ,$121.28 ,$121.28 ,$110.84 ,$121.28 ,$118.30 ,$126.76 ,$40.44 ,$143.78 , N/A ,$91.00 ,$91.00 ,$61.88 ,$91.00 , N/A ,$172.90 ,$149.24 ,$149.24 ,$145.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280112,N/A,HC TROCAR SPACE BALLOON DISS,272,1 ,"$1,186.00 ",$593.00 ,$263.53 ,"$1,186.00 ", N/A ,"$1,003.24 ","$1,003.24 ",$403.24 ,$948.80 ,"$1,008.10 ",$741.25 ,"$1,067.40 ", N/A ,"$1,126.70 ","$1,067.40 ","$1,008.10 ","$1,008.10 ",$403.24 ,"$1,008.10 ","$1,008.10 ","$1,067.40 ", N/A ,$498.12 ,"$1,067.40 ", N/A ,"$1,091.12 ","$1,067.40 ",$790.35 ,$790.35 ,$722.27 ,$790.35 ,$770.90 ,$826.05 ,$263.53 ,$936.94 , N/A ,$593.00 ,$593.00 ,$403.24 ,$593.00 , N/A ,"$1,126.70 ",$972.52 ,$972.52 ,$948.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280113,N/A,HC TROCAR SPACE BALLOON STRU,272,1 ,$736.00 ,$368.00 ,$163.54 ,$736.00 , N/A ,$622.58 ,$622.58 ,$250.24 ,$588.80 ,$625.60 ,$460.00 ,$662.40 , N/A ,$699.20 ,$662.40 ,$625.60 ,$625.60 ,$250.24 ,$625.60 ,$625.60 ,$662.40 , N/A ,$309.12 ,$662.40 , N/A ,$677.12 ,$662.40 ,$490.47 ,$490.47 ,$448.22 ,$490.47 ,$478.40 ,$512.62 ,$163.54 ,$581.44 , N/A ,$368.00 ,$368.00 ,$250.24 ,$368.00 , N/A ,$699.20 ,$603.52 ,$603.52 ,$588.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280114,N/A,"HC TROCAR, BLUNT 10-11 MM",272,1 ,$110.00 ,$55.00 ,$24.44 ,$110.00 , N/A ,$93.05 ,$93.05 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 , N/A ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 , N/A ,$46.20 ,$99.00 , N/A ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 , N/A ,$55.00 ,$55.00 ,$37.40 ,$55.00 , N/A ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280115,N/A,HC TUBE FILTER D AND C,272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280116,N/A,HC TUBE NG SUMP 18 FR,272,1 ,$5.20 ,$2.60 ,$1.15 ,$5.20 , N/A ,$4.40 ,$4.40 ,$1.77 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.77 ,$4.42 ,$4.42 ,$4.68 , N/A ,$2.18 ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.47 ,$3.47 ,$3.17 ,$3.47 ,$3.38 ,$3.62 ,$1.15 ,$4.11 , N/A ,$2.60 ,$2.60 ,$1.77 ,$2.60 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280117,N/A,"HC TUBE RECTAL 25 FR 20""",272,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280118,N/A,HC TUBING DIEGO,272,1 ,$82.00 ,$41.00 ,$18.22 ,$82.00 , N/A ,$69.36 ,$69.36 ,$27.88 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$27.88 ,$69.70 ,$69.70 ,$73.80 , N/A ,$34.44 ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.64 ,$54.64 ,$49.94 ,$54.64 ,$53.30 ,$57.11 ,$18.22 ,$64.78 , N/A ,$41.00 ,$41.00 ,$27.88 ,$41.00 , N/A ,$77.90 ,$67.24 ,$67.24 ,$65.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280119,N/A,HC TUBING FLOCONTROL SET,272,1 ,$275.00 ,$137.50 ,$61.11 ,$275.00 , N/A ,$232.62 ,$232.62 ,$93.50 ,$220.00 ,$233.75 ,$171.88 ,$247.50 , N/A ,$261.25 ,$247.50 ,$233.75 ,$233.75 ,$93.50 ,$233.75 ,$233.75 ,$247.50 , N/A ,$115.50 ,$247.50 , N/A ,$253.00 ,$247.50 ,$183.26 ,$183.26 ,$167.48 ,$183.26 ,$178.75 ,$191.54 ,$61.11 ,$217.25 , N/A ,$137.50 ,$137.50 ,$93.50 ,$137.50 , N/A ,$261.25 ,$225.50 ,$225.50 ,$220.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280120,N/A,HC TUBING PUMP ARTHRO,272,1 ,$141.00 ,$70.50 ,$31.33 ,$141.00 , N/A ,$119.27 ,$119.27 ,$47.94 ,$112.80 ,$119.85 ,$88.13 ,$126.90 , N/A ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$47.94 ,$119.85 ,$119.85 ,$126.90 , N/A ,$59.22 ,$126.90 , N/A ,$129.72 ,$126.90 ,$93.96 ,$93.96 ,$85.87 ,$93.96 ,$91.65 ,$98.21 ,$31.33 ,$111.39 , N/A ,$70.50 ,$70.50 ,$47.94 ,$70.50 , N/A ,$133.95 ,$115.62 ,$115.62 ,$112.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280121,N/A,HC TUBING SET COMPACT PHACO,272,1 ,$164.00 ,$82.00 ,$36.44 ,$164.00 , N/A ,$138.73 ,$138.73 ,$55.76 ,$131.20 ,$139.40 ,$102.50 ,$147.60 , N/A ,$155.80 ,$147.60 ,$139.40 ,$139.40 ,$55.76 ,$139.40 ,$139.40 ,$147.60 , N/A ,$68.88 ,$147.60 , N/A ,$150.88 ,$147.60 ,$109.29 ,$109.29 ,$99.88 ,$109.29 ,$106.60 ,$114.23 ,$36.44 ,$129.56 , N/A ,$82.00 ,$82.00 ,$55.76 ,$82.00 , N/A ,$155.80 ,$134.48 ,$134.48 ,$131.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280122,N/A,HC TUBING SUCTION 6.4MM X 10,272,1 ,$4.10 ,$2.05 ,$0.91 ,$4.10 , N/A ,$3.47 ,$3.47 ,$1.39 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.39 ,$3.49 ,$3.49 ,$3.69 , N/A ,$1.72 ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.73 ,$2.73 ,$2.50 ,$2.73 ,$2.67 ,$2.86 ,$0.91 ,$3.24 , N/A ,$2.05 ,$2.05 ,$1.39 ,$2.05 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280123,N/A,"HC TUBING,IRRIG. (CYSTO)",272,1 ,$9.30 ,$4.65 ,$2.07 ,$9.30 , N/A ,$7.87 ,$7.87 ,$3.16 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$3.16 ,$7.91 ,$7.91 ,$8.37 , N/A ,$3.91 ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.20 ,$6.20 ,$5.66 ,$6.20 ,$6.05 ,$6.48 ,$2.07 ,$7.35 , N/A ,$4.65 ,$4.65 ,$3.16 ,$4.65 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280124,N/A,"HC TUBING,IRRIGATION (TUR)",272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280125,N/A,"HC TUBING,SUC. D AND C 6 FT.",272,1 ,$26.00 ,$13.00 ,$5.78 ,$26.00 , N/A ,$21.99 ,$21.99 ,$8.84 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$8.84 ,$22.10 ,$22.10 ,$23.40 , N/A ,$10.92 ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.33 ,$17.33 ,$15.83 ,$17.33 ,$16.90 ,$18.11 ,$5.78 ,$20.54 , N/A ,$13.00 ,$13.00 ,$8.84 ,$13.00 , N/A ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280126,N/A,HC UNNA BOOT,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280127,N/A,HC VERSIVA 10X8,272,1 ,$47.00 ,$23.50 ,$10.44 ,$47.00 , N/A ,$39.76 ,$39.76 ,$15.98 ,$37.60 ,$39.95 ,$29.38 ,$42.30 , N/A ,$44.65 ,$42.30 ,$39.95 ,$39.95 ,$15.98 ,$39.95 ,$39.95 ,$42.30 , N/A ,$19.74 ,$42.30 , N/A ,$43.24 ,$42.30 ,$31.32 ,$31.32 ,$28.62 ,$31.32 ,$30.55 ,$32.74 ,$10.44 ,$37.13 , N/A ,$23.50 ,$23.50 ,$15.98 ,$23.50 , N/A ,$44.65 ,$38.54 ,$38.54 ,$37.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280128,N/A,HC VERSIVA 5.5X5.5,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280129,N/A,HC VIAL DECANTER II,272,1 ,$6.20 ,$3.10 ,$1.37 ,$6.20 , N/A ,$5.24 ,$5.24 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$2.60 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280130,N/A,HC WRAP KNEE DYN PULL UNIV,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280131,N/A,HC LIGATING LOOP,272,1 ,$87.00 ,$43.50 ,$19.33 ,$87.00 , N/A ,$73.59 ,$73.59 ,$29.58 ,$69.60 ,$73.95 ,$54.38 ,$78.30 , N/A ,$82.65 ,$78.30 ,$73.95 ,$73.95 ,$29.58 ,$73.95 ,$73.95 ,$78.30 , N/A ,$36.54 ,$78.30 , N/A ,$80.04 ,$78.30 ,$57.98 ,$57.98 ,$52.98 ,$57.98 ,$56.55 ,$60.60 ,$19.33 ,$68.73 , N/A ,$43.50 ,$43.50 ,$29.58 ,$43.50 , N/A ,$82.65 ,$71.34 ,$71.34 ,$69.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280132,N/A,HC SYSTEM MALYUGIN RING 6.25,272,1 ,$391.00 ,$195.50 ,$86.88 ,$391.00 , N/A ,$330.75 ,$330.75 ,$132.94 ,$312.80 ,$332.35 ,$244.38 ,$351.90 , N/A ,$371.45 ,$351.90 ,$332.35 ,$332.35 ,$132.94 ,$332.35 ,$332.35 ,$351.90 , N/A ,$164.22 ,$351.90 , N/A ,$359.72 ,$351.90 ,$260.56 ,$260.56 ,$238.12 ,$260.56 ,$254.15 ,$272.33 ,$86.88 ,$308.89 , N/A ,$195.50 ,$195.50 ,$132.94 ,$195.50 , N/A ,$371.45 ,$320.62 ,$320.62 ,$312.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280133,N/A,HC CANNULA CEMENT VERTEPORT 10G,272,1 ,$261.00 ,$130.50 ,$57.99 ,$261.00 , N/A ,$220.78 ,$220.78 ,$88.74 ,$208.80 ,$221.85 ,$163.13 ,$234.90 , N/A ,$247.95 ,$234.90 ,$221.85 ,$221.85 ,$88.74 ,$221.85 ,$221.85 ,$234.90 , N/A ,$109.62 ,$234.90 , N/A ,$240.12 ,$234.90 ,$173.93 ,$173.93 ,$158.95 ,$173.93 ,$169.65 ,$181.79 ,$57.99 ,$206.19 , N/A ,$130.50 ,$130.50 ,$88.74 ,$130.50 , N/A ,$247.95 ,$214.02 ,$214.02 ,$208.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280134,N/A,HC HHC DRILL HAND IVAS 10G,272,1 ,$422.00 ,$211.00 ,$93.77 ,$422.00 , N/A ,$356.97 ,$356.97 ,$143.48 ,$337.60 ,$358.70 ,$263.75 ,$379.80 , N/A ,$400.90 ,$379.80 ,$358.70 ,$358.70 ,$143.48 ,$358.70 ,$358.70 ,$379.80 , N/A ,$177.24 ,$379.80 , N/A ,$388.24 ,$379.80 ,$281.22 ,$281.22 ,$257.00 ,$281.22 ,$274.30 ,$293.92 ,$93.77 ,$333.38 , N/A ,$211.00 ,$211.00 ,$143.48 ,$211.00 , N/A ,$400.90 ,$346.04 ,$346.04 ,$337.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280135,N/A,HC KIT BALLOON SYS IVAS 10G 15MM,272,1 ,"$3,923.00 ","$1,961.50 ",$871.69 ,"$3,923.00 ", N/A ,"$3,318.47 ","$3,318.47 ","$1,333.82 ","$3,138.40 ","$3,334.55 ","$2,451.88 ","$3,530.70 ", N/A ,"$3,726.85 ","$3,530.70 ","$3,334.55 ","$3,334.55 ","$1,333.82 ","$3,334.55 ","$3,334.55 ","$3,530.70 ", N/A ,"$1,647.66 ","$3,530.70 ", N/A ,"$3,609.16 ","$3,530.70 ","$2,614.29 ","$2,614.29 ","$2,389.11 ","$2,614.29 ","$2,549.95 ","$2,732.37 ",$871.69 ,"$3,099.17 ", N/A ,"$1,961.50 ","$1,961.50 ","$1,333.82 ","$1,961.50 ", N/A ,"$3,726.85 ","$3,216.86 ","$3,216.86 ","$3,138.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280137,N/A,HC TROCAR MINI FINESSE 5MM,272,1 ,$79.00 ,$39.50 ,$17.55 ,$79.00 , N/A ,$66.83 ,$66.83 ,$26.86 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$26.86 ,$67.15 ,$67.15 ,$71.10 , N/A ,$33.18 ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.65 ,$52.65 ,$48.11 ,$52.65 ,$51.35 ,$55.02 ,$17.55 ,$62.41 , N/A ,$39.50 ,$39.50 ,$26.86 ,$39.50 , N/A ,$75.05 ,$64.78 ,$64.78 ,$63.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280138,N/A,HC TROCAR ONE PORT LONG 5MM,272,1 ,$125.00 ,$62.50 ,$27.78 ,$125.00 , N/A ,$105.74 ,$105.74 ,$42.50 ,$100.00 ,$106.25 ,$78.13 ,$112.50 , N/A ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$42.50 ,$106.25 ,$106.25 ,$112.50 , N/A ,$52.50 ,$112.50 , N/A ,$115.00 ,$112.50 ,$83.30 ,$83.30 ,$76.13 ,$83.30 ,$81.25 ,$87.06 ,$27.78 ,$98.75 , N/A ,$62.50 ,$62.50 ,$42.50 ,$62.50 , N/A ,$118.75 ,$102.50 ,$102.50 ,$100.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280139,N/A,HC TROCAR ONE PROT 11MM,272,1 ,$119.00 ,$59.50 ,$26.44 ,$119.00 , N/A ,$100.66 ,$100.66 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 , N/A ,$49.98 ,$107.10 , N/A ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 , N/A ,$59.50 ,$59.50 ,$40.46 ,$59.50 , N/A ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280140,N/A,HC CATH FOLEY 6 FR W/STYLET,270,1 ,$35.00 ,$17.50 ,$7.78 ,$35.00 , N/A ,$29.61 ,$29.61 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 , N/A ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 , N/A ,$14.70 ,$31.50 , N/A ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 , N/A ,$17.50 ,$17.50 ,$11.90 ,$17.50 , N/A ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280141,N/A,HC TRAY CENTRAL LINE DRS CHANGE,272,1 ,$63.00 ,$31.50 ,$14.00 ,$63.00 , N/A ,$53.29 ,$53.29 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 , N/A ,$26.46 ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 , N/A ,$31.50 ,$31.50 ,$21.42 ,$31.50 , N/A ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280142,N/A,HC MANIPULATOR UTERINE,272,1 ,$276.00 ,$138.00 ,$61.33 ,$276.00 , N/A ,$233.47 ,$233.47 ,$93.84 ,$220.80 ,$234.60 ,$172.50 ,$248.40 , N/A ,$262.20 ,$248.40 ,$234.60 ,$234.60 ,$93.84 ,$234.60 ,$234.60 ,$248.40 , N/A ,$115.92 ,$248.40 , N/A ,$253.92 ,$248.40 ,$183.93 ,$183.93 ,$168.08 ,$183.93 ,$179.40 ,$192.23 ,$61.33 ,$218.04 , N/A ,$138.00 ,$138.00 ,$93.84 ,$138.00 , N/A ,$262.20 ,$226.32 ,$226.32 ,$220.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280144,N/A,HC FORCEPS DISSECTING LYONS,270,1 ,$811.00 ,$405.50 ,$180.20 ,$811.00 , N/A ,$686.02 ,$686.02 ,$275.74 ,$648.80 ,$689.35 ,$506.88 ,$729.90 , N/A ,$770.45 ,$729.90 ,$689.35 ,$689.35 ,$275.74 ,$689.35 ,$689.35 ,$729.90 , N/A ,$340.62 ,$729.90 , N/A ,$746.12 ,$729.90 ,$540.45 ,$540.45 ,$493.90 ,$540.45 ,$527.15 ,$564.86 ,$180.20 ,$640.69 , N/A ,$405.50 ,$405.50 ,$275.74 ,$405.50 , N/A ,$770.45 ,$665.02 ,$665.02 ,$648.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280145,N/A,HC PKS OMNI 33CM 5MM,270,1 ,"$1,762.00 ",$881.00 ,$391.52 ,"$1,762.00 ", N/A ,"$1,490.48 ","$1,490.48 ",$599.08 ,"$1,409.60 ","$1,497.70 ","$1,101.25 ","$1,585.80 ", N/A ,"$1,673.90 ","$1,585.80 ","$1,497.70 ","$1,497.70 ",$599.08 ,"$1,497.70 ","$1,497.70 ","$1,585.80 ", N/A ,$740.04 ,"$1,585.80 ", N/A ,"$1,621.04 ","$1,585.80 ","$1,174.20 ","$1,174.20 ","$1,073.06 ","$1,174.20 ","$1,145.30 ","$1,227.23 ",$391.52 ,"$1,391.98 ", N/A ,$881.00 ,$881.00 ,$599.08 ,$881.00 , N/A ,"$1,673.90 ","$1,444.84 ","$1,444.84 ","$1,409.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280146,N/A,HC SPATULA PLASMA,270,1 ,$629.00 ,$314.50 ,$139.76 ,$629.00 , N/A ,$532.07 ,$532.07 ,$213.86 ,$503.20 ,$534.65 ,$393.13 ,$566.10 , N/A ,$597.55 ,$566.10 ,$534.65 ,$534.65 ,$213.86 ,$534.65 ,$534.65 ,$566.10 , N/A ,$264.18 ,$566.10 , N/A ,$578.68 ,$566.10 ,$419.17 ,$419.17 ,$383.06 ,$419.17 ,$408.85 ,$438.10 ,$139.76 ,$496.91 , N/A ,$314.50 ,$314.50 ,$213.86 ,$314.50 , N/A ,$597.55 ,$515.78 ,$515.78 ,$503.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280147,N/A,HC HANDPIECE THUNDERBEAT,272,1 ,$828.00 ,$414.00 ,$183.98 ,$828.00 , N/A ,$700.41 ,$700.41 ,$281.52 ,$662.40 ,$703.80 ,$517.50 ,$745.20 , N/A ,$786.60 ,$745.20 ,$703.80 ,$703.80 ,$281.52 ,$703.80 ,$703.80 ,$745.20 , N/A ,$347.76 ,$745.20 , N/A ,$761.76 ,$745.20 ,$551.78 ,$551.78 ,$504.25 ,$551.78 ,$538.20 ,$576.70 ,$183.98 ,$654.12 , N/A ,$414.00 ,$414.00 ,$281.52 ,$414.00 , N/A ,$786.60 ,$678.96 ,$678.96 ,$662.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280148,N/A,HC NEEDLE MONOPTY 14G X 9,272,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 , N/A ,$76.13 ,$76.13 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 , N/A ,$37.80 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 , N/A ,$45.00 ,$45.00 ,$30.60 ,$45.00 , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280151,N/A,HC TRIGGER SWITCH DIEGO,272,1 ,$95.00 ,$47.50 ,$21.11 ,$95.00 , N/A ,$80.36 ,$80.36 ,$32.30 ,$76.00 ,$80.75 ,$59.38 ,$85.50 , N/A ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$32.30 ,$80.75 ,$80.75 ,$85.50 , N/A ,$39.90 ,$85.50 , N/A ,$87.40 ,$85.50 ,$63.31 ,$63.31 ,$57.86 ,$63.31 ,$61.75 ,$66.17 ,$21.11 ,$75.05 , N/A ,$47.50 ,$47.50 ,$32.30 ,$47.50 , N/A ,$90.25 ,$77.90 ,$77.90 ,$76.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280152,N/A,HC TUBE PEG REPLACEMENT,272,1 ,$117.00 ,$58.50 ,$26.00 ,$117.00 , N/A ,$98.97 ,$98.97 ,$39.78 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$39.78 ,$99.45 ,$99.45 ,$105.30 , N/A ,$49.14 ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.97 ,$77.97 ,$71.25 ,$77.97 ,$76.05 ,$81.49 ,$26.00 ,$92.43 , N/A ,$58.50 ,$58.50 ,$39.78 ,$58.50 , N/A ,$111.15 ,$95.94 ,$95.94 ,$93.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280154,N/A,HC PASSER CATHETER 38CM,272,1 ,$305.00 ,$152.50 ,$67.77 ,$305.00 , N/A ,$258.00 ,$258.00 ,$103.70 ,$244.00 ,$259.25 ,$190.63 ,$274.50 , N/A ,$289.75 ,$274.50 ,$259.25 ,$259.25 ,$103.70 ,$259.25 ,$259.25 ,$274.50 , N/A ,$128.10 ,$274.50 , N/A ,$280.60 ,$274.50 ,$203.25 ,$203.25 ,$185.75 ,$203.25 ,$198.25 ,$212.43 ,$67.77 ,$240.95 , N/A ,$152.50 ,$152.50 ,$103.70 ,$152.50 , N/A ,$289.75 ,$250.10 ,$250.10 ,$244.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280155,N/A,HC PACK ARTHRO COLD,272,1 ,$98.00 ,$49.00 ,$21.78 ,$98.00 , N/A ,$82.90 ,$82.90 ,$33.32 ,$78.40 ,$83.30 ,$61.25 ,$88.20 , N/A ,$93.10 ,$88.20 ,$83.30 ,$83.30 ,$33.32 ,$83.30 ,$83.30 ,$88.20 , N/A ,$41.16 ,$88.20 , N/A ,$90.16 ,$88.20 ,$65.31 ,$65.31 ,$59.68 ,$65.31 ,$63.70 ,$68.26 ,$21.78 ,$77.42 , N/A ,$49.00 ,$49.00 ,$33.32 ,$49.00 , N/A ,$93.10 ,$80.36 ,$80.36 ,$78.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280158,N/A,HC DILATOR,270,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280159,N/A,HC SINU FOAM STAMMBERGER,272,1 ,$306.00 ,$153.00 ,$67.99 ,$306.00 , N/A ,$258.85 ,$258.85 ,$104.04 ,$244.80 ,$260.10 ,$191.25 ,$275.40 , N/A ,$290.70 ,$275.40 ,$260.10 ,$260.10 ,$104.04 ,$260.10 ,$260.10 ,$275.40 , N/A ,$128.52 ,$275.40 , N/A ,$281.52 ,$275.40 ,$203.92 ,$203.92 ,$186.35 ,$203.92 ,$198.90 ,$213.13 ,$67.99 ,$241.74 , N/A ,$153.00 ,$153.00 ,$104.04 ,$153.00 , N/A ,$290.70 ,$250.92 ,$250.92 ,$244.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280160,N/A,HC DETECTOR CO2,272,1 ,$43.00 ,$21.50 ,$9.55 ,$43.00 , N/A ,$36.37 ,$36.37 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 , N/A ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 , N/A ,$18.06 ,$38.70 , N/A ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 , N/A ,$21.50 ,$21.50 ,$14.62 ,$21.50 , N/A ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280161,N/A,HC DRESS KIT FOAM W/SOFT PORT,272,1 ,$95.00 ,$47.50 ,$21.11 ,$95.00 , N/A ,$80.36 ,$80.36 ,$32.30 ,$76.00 ,$80.75 ,$59.38 ,$85.50 , N/A ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$32.30 ,$80.75 ,$80.75 ,$85.50 , N/A ,$39.90 ,$85.50 , N/A ,$87.40 ,$85.50 ,$63.31 ,$63.31 ,$57.86 ,$63.31 ,$61.75 ,$66.17 ,$21.11 ,$75.05 , N/A ,$47.50 ,$47.50 ,$32.30 ,$47.50 , N/A ,$90.25 ,$77.90 ,$77.90 ,$76.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280162,N/A,HC MIXING BOWL KIT ADVANCED CEMENT,272,1 ,$307.00 ,$153.50 ,$68.22 ,$307.00 , N/A ,$259.69 ,$259.69 ,$104.38 ,$245.60 ,$260.95 ,$191.88 ,$276.30 , N/A ,$291.65 ,$276.30 ,$260.95 ,$260.95 ,$104.38 ,$260.95 ,$260.95 ,$276.30 , N/A ,$128.94 ,$276.30 , N/A ,$282.44 ,$276.30 ,$204.58 ,$204.58 ,$186.96 ,$204.58 ,$199.55 ,$213.83 ,$68.22 ,$242.53 , N/A ,$153.50 ,$153.50 ,$104.38 ,$153.50 , N/A ,$291.65 ,$251.74 ,$251.74 ,$245.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280163,N/A,HC CATH FOLEY 20FR 5CC,272,1 ,$20.00 ,$10.00 ,$4.44 ,$20.00 , N/A ,$16.92 ,$16.92 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 , N/A ,$8.40 ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 , N/A ,$10.00 ,$10.00 ,$6.80 ,$10.00 , N/A ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280164,N/A,HC MEDTRONIC ANTENNA,272,1 ,$249.00 ,$124.50 ,$55.33 ,$249.00 , N/A ,$210.63 ,$210.63 ,$84.66 ,$199.20 ,$211.65 ,$155.63 ,$224.10 , N/A ,$236.55 ,$224.10 ,$211.65 ,$211.65 ,$84.66 ,$211.65 ,$211.65 ,$224.10 , N/A ,$104.58 ,$224.10 , N/A ,$229.08 ,$224.10 ,$165.93 ,$165.93 ,$151.64 ,$165.93 ,$161.85 ,$173.43 ,$55.33 ,$196.71 , N/A ,$124.50 ,$124.50 ,$84.66 ,$124.50 , N/A ,$236.55 ,$204.18 ,$204.18 ,$199.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280165,N/A,HC NEG PRESSURE DRSG FOAM MD,272,1 ,$119.00 ,$59.50 ,$26.44 ,$119.00 , N/A ,$100.66 ,$100.66 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 , N/A ,$49.98 ,$107.10 , N/A ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 , N/A ,$59.50 ,$59.50 ,$40.46 ,$59.50 , N/A ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280166,N/A,HC NEG PRESSURE CANISTER 300ML,272,1 ,$77.00 ,$38.50 ,$17.11 ,$77.00 , N/A ,$65.13 ,$65.13 ,$26.18 ,$61.60 ,$65.45 ,$48.13 ,$69.30 , N/A ,$73.15 ,$69.30 ,$65.45 ,$65.45 ,$26.18 ,$65.45 ,$65.45 ,$69.30 , N/A ,$32.34 ,$69.30 , N/A ,$70.84 ,$69.30 ,$51.31 ,$51.31 ,$46.89 ,$51.31 ,$50.05 ,$53.63 ,$17.11 ,$60.83 , N/A ,$38.50 ,$38.50 ,$26.18 ,$38.50 , N/A ,$73.15 ,$63.14 ,$63.14 ,$61.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280167,C1769,HC GUIDEWIRE ZIP .018 X 150CM STRAIGHT,272,1 ,$171.00 ,$85.50 ,$38.00 ,$171.00 , N/A ,$144.65 ,$144.65 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 , N/A ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 , N/A ,$71.82 ,$153.90 , N/A ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 , N/A ,$85.50 ,$85.50 ,$58.14 ,$85.50 , N/A ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280168,N/A,HC CLIP LIGATING TITANIUM MD,272,1 ,$25.00 ,$12.50 ,$5.56 ,$25.00 , N/A ,$21.15 ,$21.15 ,$8.50 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$8.50 ,$21.25 ,$21.25 ,$22.50 , N/A ,$10.50 ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.66 ,$16.66 ,$15.23 ,$16.66 ,$16.25 ,$17.41 ,$5.56 ,$19.75 , N/A ,$12.50 ,$12.50 ,$8.50 ,$12.50 , N/A ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280169,N/A,HC CLIP LIGATING TITANIUM MD/LG,272,1 ,$35.00 ,$17.50 ,$7.78 ,$35.00 , N/A ,$29.61 ,$29.61 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 , N/A ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 , N/A ,$14.70 ,$31.50 , N/A ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 , N/A ,$17.50 ,$17.50 ,$11.90 ,$17.50 , N/A ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280170,N/A,HC SUTURE STRATAFIX 14 X 14,272,1 ,$58.00 ,$29.00 ,$12.89 ,$58.00 , N/A ,$49.06 ,$49.06 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 , N/A ,$24.36 ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 , N/A ,$29.00 ,$29.00 ,$19.72 ,$29.00 , N/A ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280171,N/A,HC SUTURE STRATAFIX 24 X 24,272,1 ,$70.00 ,$35.00 ,$15.55 ,$70.00 , N/A ,$59.21 ,$59.21 ,$23.80 ,$56.00 ,$59.50 ,$43.75 ,$63.00 , N/A ,$66.50 ,$63.00 ,$59.50 ,$59.50 ,$23.80 ,$59.50 ,$59.50 ,$63.00 , N/A ,$29.40 ,$63.00 , N/A ,$64.40 ,$63.00 ,$46.65 ,$46.65 ,$42.63 ,$46.65 ,$45.50 ,$48.76 ,$15.55 ,$55.30 , N/A ,$35.00 ,$35.00 ,$23.80 ,$35.00 , N/A ,$66.50 ,$57.40 ,$57.40 ,$56.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280172,N/A,HC NEEDLE 1/2 CIRC REV CUT MART UTE,272,1 ,$15.50 ,$7.75 ,$3.44 ,$15.50 , N/A ,$13.11 ,$13.11 ,$5.27 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$5.27 ,$13.18 ,$13.18 ,$13.95 , N/A ,$6.51 ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.33 ,$10.33 ,$9.44 ,$10.33 ,$10.08 ,$10.80 ,$3.44 ,$12.25 , N/A ,$7.75 ,$7.75 ,$5.27 ,$7.75 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280173,N/A,HC MICROINTRODUCER SET 4.5 AND 5OF 7CM,272,1 ,$105.00 ,$52.50 ,$23.33 ,$105.00 , N/A ,$88.82 ,$88.82 ,$35.70 ,$84.00 ,$89.25 ,$65.63 ,$94.50 , N/A ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$35.70 ,$89.25 ,$89.25 ,$94.50 , N/A ,$44.10 ,$94.50 , N/A ,$96.60 ,$94.50 ,$69.97 ,$69.97 ,$63.95 ,$69.97 ,$68.25 ,$73.13 ,$23.33 ,$82.95 , N/A ,$52.50 ,$52.50 ,$35.70 ,$52.50 , N/A ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280174,N/A,HC SUCTION IRR STRYK FLOW,272,1 ,$151.00 ,$75.50 ,$33.55 ,$151.00 , N/A ,$127.73 ,$127.73 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 , N/A ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 , N/A ,$63.42 ,$135.90 , N/A ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 , N/A ,$75.50 ,$75.50 ,$51.34 ,$75.50 , N/A ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280175,N/A,HC PKS SEAL OPEN FORCEPS CURV JAW,272,1 ,$973.00 ,$486.50 ,$216.20 ,$973.00 , N/A ,$823.06 ,$823.06 ,$330.82 ,$778.40 ,$827.05 ,$608.13 ,$875.70 , N/A ,$924.35 ,$875.70 ,$827.05 ,$827.05 ,$330.82 ,$827.05 ,$827.05 ,$875.70 , N/A ,$408.66 ,$875.70 , N/A ,$895.16 ,$875.70 ,$648.41 ,$648.41 ,$592.56 ,$648.41 ,$632.45 ,$677.69 ,$216.20 ,$768.67 , N/A ,$486.50 ,$486.50 ,$330.82 ,$486.50 , N/A ,$924.35 ,$797.86 ,$797.86 ,$778.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280176,N/A,HC LEG HOLDER PAD,270,1 ,$58.00 ,$29.00 ,$12.89 ,$58.00 , N/A ,$49.06 ,$49.06 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 , N/A ,$24.36 ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 , N/A ,$29.00 ,$29.00 ,$19.72 ,$29.00 , N/A ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280177,N/A,HC SUTURE MAXBRAID PE2 W/LG NEEDLE,272,1 ,$83.00 ,$41.50 ,$18.44 ,$83.00 , N/A ,$70.21 ,$70.21 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 , N/A ,$34.86 ,$74.70 , N/A ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 , N/A ,$41.50 ,$41.50 ,$28.22 ,$41.50 , N/A ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280178,N/A,HC ORTHOCORD W DOUBL MENISCAL NEEDLE,272,1 ,$321.00 ,$160.50 ,$71.33 ,$321.00 , N/A ,$271.53 ,$271.53 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 , N/A ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 , N/A ,$134.82 ,$288.90 , N/A ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 , N/A ,$160.50 ,$160.50 ,$109.14 ,$160.50 , N/A ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280179,N/A,HC PENCIL FORCE TRIVERSE,272,1 ,$129.00 ,$64.50 ,$28.66 ,$129.00 , N/A ,$109.12 ,$109.12 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 , N/A ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 , N/A ,$54.18 ,$116.10 , N/A ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 , N/A ,$64.50 ,$64.50 ,$43.86 ,$64.50 , N/A ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280180,N/A,HC DRILL BIT MINI .76  6-14MM,272,1 ,$550.00 ,$275.00 ,$122.21 ,$550.00 , N/A ,$465.25 ,$465.25 ,$187.00 ,$440.00 ,$467.50 ,$343.75 ,$495.00 , N/A ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$187.00 ,$467.50 ,$467.50 ,$495.00 , N/A ,$231.00 ,$495.00 , N/A ,$506.00 ,$495.00 ,$366.52 ,$366.52 ,$334.95 ,$366.52 ,$357.50 ,$383.08 ,$122.21 ,$434.50 , N/A ,$275.00 ,$275.00 ,$187.00 ,$275.00 , N/A ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280181,N/A,HC NEEDLE SET EZ-10 FLUID TRANS 45,272,1 ,$357.00 ,$178.50 ,$79.33 ,$357.00 , N/A ,$301.99 ,$301.99 ,$121.38 ,$285.60 ,$303.45 ,$223.13 ,$321.30 , N/A ,$339.15 ,$321.30 ,$303.45 ,$303.45 ,$121.38 ,$303.45 ,$303.45 ,$321.30 , N/A ,$149.94 ,$321.30 , N/A ,$328.44 ,$321.30 ,$237.90 ,$237.90 ,$217.41 ,$237.90 ,$232.05 ,$248.65 ,$79.33 ,$282.03 , N/A ,$178.50 ,$178.50 ,$121.38 ,$178.50 , N/A ,$339.15 ,$292.74 ,$292.74 ,$285.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280182,N/A,HC DRILL BIT E-FLTD QD 260MM,272,1 ,$409.00 ,$204.50 ,$90.88 ,$409.00 , N/A ,$345.97 ,$345.97 ,$139.06 ,$327.20 ,$347.65 ,$255.63 ,$368.10 , N/A ,$388.55 ,$368.10 ,$347.65 ,$347.65 ,$139.06 ,$347.65 ,$347.65 ,$368.10 , N/A ,$171.78 ,$368.10 , N/A ,$376.28 ,$368.10 ,$272.56 ,$272.56 ,$249.08 ,$272.56 ,$265.85 ,$284.87 ,$90.88 ,$323.11 , N/A ,$204.50 ,$204.50 ,$139.06 ,$204.50 , N/A ,$388.55 ,$335.38 ,$335.38 ,$327.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280183,N/A,HC KIT PATIENT POSITIONING PINK PAD,270,1 ,$289.00 ,$144.50 ,$64.22 ,$289.00 , N/A ,$244.47 ,$244.47 ,$98.26 ,$231.20 ,$245.65 ,$180.63 ,$260.10 , N/A ,$274.55 ,$260.10 ,$245.65 ,$245.65 ,$98.26 ,$245.65 ,$245.65 ,$260.10 , N/A ,$121.38 ,$260.10 , N/A ,$265.88 ,$260.10 ,$192.59 ,$192.59 ,$176.00 ,$192.59 ,$187.85 ,$201.29 ,$64.22 ,$228.31 , N/A ,$144.50 ,$144.50 ,$98.26 ,$144.50 , N/A ,$274.55 ,$236.98 ,$236.98 ,$231.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280184,N/A,HC ACCESSORY KIT 3550-29,272,1 ,$468.00 ,$234.00 ,$103.99 ,$468.00 , N/A ,$395.88 ,$395.88 ,$159.12 ,$374.40 ,$397.80 ,$292.50 ,$421.20 , N/A ,$444.60 ,$421.20 ,$397.80 ,$397.80 ,$159.12 ,$397.80 ,$397.80 ,$421.20 , N/A ,$196.56 ,$421.20 , N/A ,$430.56 ,$421.20 ,$311.88 ,$311.88 ,$285.01 ,$311.88 ,$304.20 ,$325.96 ,$103.99 ,$369.72 , N/A ,$234.00 ,$234.00 ,$159.12 ,$234.00 , N/A ,$444.60 ,$383.76 ,$383.76 ,$374.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280185,N/A,HC ACCESSORY KIT 3550-63,272,1 ,$235.00 ,$117.50 ,$52.22 ,$235.00 , N/A ,$198.79 ,$198.79 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 , N/A ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 , N/A ,$98.70 ,$211.50 , N/A ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 , N/A ,$117.50 ,$117.50 ,$79.90 ,$117.50 , N/A ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280187,N/A,HC ELECTRODE ARTHROSCOPIC ANGLED,272,1 ,$114.00 ,$57.00 ,$25.33 ,$114.00 , N/A ,$96.43 ,$96.43 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 , N/A ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 , N/A ,$47.88 ,$102.60 , N/A ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 , N/A ,$57.00 ,$57.00 ,$38.76 ,$57.00 , N/A ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280188,N/A,HC INSTRUMENT MONOPTY 18GX20CM 22MM,272,1 ,$129.00 ,$64.50 ,$28.66 ,$129.00 , N/A ,$109.12 ,$109.12 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 , N/A ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 , N/A ,$54.18 ,$116.10 , N/A ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 , N/A ,$64.50 ,$64.50 ,$43.86 ,$64.50 , N/A ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280189,N/A,HC INSTRUMENT MONOPTY 14G X 10MM,272,1 ,$149.00 ,$74.50 ,$33.11 ,$149.00 , N/A ,$126.04 ,$126.04 ,$50.66 ,$119.20 ,$126.65 ,$93.13 ,$134.10 , N/A ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$50.66 ,$126.65 ,$126.65 ,$134.10 , N/A ,$62.58 ,$134.10 , N/A ,$137.08 ,$134.10 ,$99.29 ,$99.29 ,$90.74 ,$99.29 ,$96.85 ,$103.78 ,$33.11 ,$117.71 , N/A ,$74.50 ,$74.50 ,$50.66 ,$74.50 , N/A ,$141.55 ,$122.18 ,$122.18 ,$119.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280190,N/A,HC BASKET RETRIEVER TWISTER,272,1 ,$233.00 ,$116.50 ,$51.77 ,$233.00 , N/A ,$197.09 ,$197.09 ,$79.22 ,$186.40 ,$198.05 ,$145.63 ,$209.70 , N/A ,$221.35 ,$209.70 ,$198.05 ,$198.05 ,$79.22 ,$198.05 ,$198.05 ,$209.70 , N/A ,$97.86 ,$209.70 , N/A ,$214.36 ,$209.70 ,$155.27 ,$155.27 ,$141.90 ,$155.27 ,$151.45 ,$162.28 ,$51.77 ,$184.07 , N/A ,$116.50 ,$116.50 ,$79.22 ,$116.50 , N/A ,$221.35 ,$191.06 ,$191.06 ,$186.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280191,N/A,HC NEEDLE SUTURE PASSER CHAMPION,272,1 ,$476.00 ,$238.00 ,$105.77 ,$476.00 , N/A ,$402.65 ,$402.65 ,$161.84 ,$380.80 ,$404.60 ,$297.50 ,$428.40 , N/A ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$161.84 ,$404.60 ,$404.60 ,$428.40 , N/A ,$199.92 ,$428.40 , N/A ,$437.92 ,$428.40 ,$317.21 ,$317.21 ,$289.88 ,$317.21 ,$309.40 ,$331.53 ,$105.77 ,$376.04 , N/A ,$238.00 ,$238.00 ,$161.84 ,$238.00 , N/A ,$452.20 ,$390.32 ,$390.32 ,$380.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280192,N/A,HC TUBING ENDO GATOR,272,1 ,$36.00 ,$18.00 ,$8.00 ,$36.00 , N/A ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 , N/A ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 , N/A ,$18.00 ,$18.00 ,$12.24 ,$18.00 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280193,N/A,HC MARKER ENDOSCOPIC,272,1 ,$94.00 ,$47.00 ,$20.89 ,$94.00 , N/A ,$79.51 ,$79.51 ,$31.96 ,$75.20 ,$79.90 ,$58.75 ,$84.60 , N/A ,$89.30 ,$84.60 ,$79.90 ,$79.90 ,$31.96 ,$79.90 ,$79.90 ,$84.60 , N/A ,$39.48 ,$84.60 , N/A ,$86.48 ,$84.60 ,$62.64 ,$62.64 ,$57.25 ,$62.64 ,$61.10 ,$65.47 ,$20.89 ,$74.26 , N/A ,$47.00 ,$47.00 ,$31.96 ,$47.00 , N/A ,$89.30 ,$77.08 ,$77.08 ,$75.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280194,N/A,HC KIT CLEARIFY VISUALIZATION SYSTEM,272,1 ,$203.00 ,$101.50 ,$45.11 ,$203.00 , N/A ,$171.72 ,$171.72 ,$69.02 ,$162.40 ,$172.55 ,$126.88 ,$182.70 , N/A ,$192.85 ,$182.70 ,$172.55 ,$172.55 ,$69.02 ,$172.55 ,$172.55 ,$182.70 , N/A ,$85.26 ,$182.70 , N/A ,$186.76 ,$182.70 ,$135.28 ,$135.28 ,$123.63 ,$135.28 ,$131.95 ,$141.39 ,$45.11 ,$160.37 , N/A ,$101.50 ,$101.50 ,$69.02 ,$101.50 , N/A ,$192.85 ,$166.46 ,$166.46 ,$162.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280195,N/A,HC CUTTER LINEAR ETS FLEX 45MM,272,1 ,$680.00 ,$340.00 ,$151.10 ,$680.00 , N/A ,$575.21 ,$575.21 ,$231.20 ,$544.00 ,$578.00 ,$425.00 ,$612.00 , N/A ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$231.20 ,$578.00 ,$578.00 ,$612.00 , N/A ,$285.60 ,$612.00 , N/A ,$625.60 ,$612.00 ,$453.15 ,$453.15 ,$414.12 ,$453.15 ,$442.00 ,$473.62 ,$151.10 ,$537.20 , N/A ,$340.00 ,$340.00 ,$231.20 ,$340.00 , N/A ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280197,N/A,HC NEEDLE VERRES,272,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A ,$14.00 ,$14.00 ,$9.52 ,$14.00 , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280198,N/A,HC SLEEVE TROCAR,272,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A ,$9.00 ,$9.00 ,$6.12 ,$9.00 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280199,N/A,HC TROCAR 11 12,272,1 ,$59.00 ,$29.50 ,$13.11 ,$59.00 , N/A ,$49.91 ,$49.91 ,$20.06 ,$47.20 ,$50.15 ,$36.88 ,$53.10 , N/A ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$20.06 ,$50.15 ,$50.15 ,$53.10 , N/A ,$24.78 ,$53.10 , N/A ,$54.28 ,$53.10 ,$39.32 ,$39.32 ,$35.93 ,$39.32 ,$38.35 ,$41.09 ,$13.11 ,$46.61 , N/A ,$29.50 ,$29.50 ,$20.06 ,$29.50 , N/A ,$56.05 ,$48.38 ,$48.38 ,$47.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280200,N/A,HC TROCAR 5,272,1 ,$37.00 ,$18.50 ,$8.22 ,$37.00 , N/A ,$31.30 ,$31.30 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 , N/A ,$15.54 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 , N/A ,$18.50 ,$18.50 ,$12.58 ,$18.50 , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280201,N/A,HC SUTURE LIGATURE,272,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A ,$25.00 ,$25.00 ,$17.00 ,$25.00 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27282049,N/A,HC SUTURE MONOCRYL 2-0 Y417H,272,1 ,$1.50 ,$0.75 ,$0.33 ,$1.50 , N/A ,$1.27 ,$1.27 ,$0.51 ,$1.20 ,$1.28 ,$0.94 ,$1.35 , N/A ,$1.43 ,$1.35 ,$1.28 ,$1.28 ,$0.51 ,$1.28 ,$1.28 ,$1.35 , N/A ,$0.63 ,$1.35 , N/A ,$1.38 ,$1.35 ,$1.00 ,$1.00 ,$0.91 ,$1.00 ,$0.98 ,$1.04 ,$0.33 ,$1.19 , N/A ,$0.75 ,$0.75 ,$0.51 ,$0.75 , N/A ,$1.43 ,$1.23 ,$1.23 ,$1.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400000,N/A,"HC STABILIZER,PATELLA;CONCISE",274,1 ,$64.00 ,$32.00 ,$14.22 ,$64.00 , N/A ,$54.14 ,$54.14 ,$21.76 ,$51.20 ,$54.40 ,$40.00 ,$57.60 , N/A ,$60.80 ,$57.60 ,$54.40 ,$54.40 ,$21.76 ,$54.40 ,$54.40 ,$57.60 , N/A ,$26.88 ,$57.60 , N/A ,$58.88 ,$57.60 ,$42.65 ,$42.65 ,$38.98 ,$42.65 ,$41.60 ,$44.58 ,$14.22 ,$50.56 , N/A , N/A , N/A ,$21.76 , N/A , N/A ,$60.80 ,$52.48 ,$52.48 ,$51.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400003,L0120,HC CERVICAL COLLAR,274,1 ,$69.00 ,$34.50 ,$15.33 ,$81.27 , N/A ,$27.90 ,$27.90 ,$23.46 ,$55.20 ,$58.65 ,$43.13 ,$62.10 , N/A ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$23.46 ,$58.65 ,$58.65 ,$62.10 , N/A ,$28.98 ,$62.10 ,$81.27 ,$63.48 ,$62.10 ,$45.98 ,$45.98 ,$42.02 ,$45.98 ,$44.85 ,$48.06 ,$15.33 ,$54.51 , N/A , N/A , N/A ,$23.46 , N/A ,$36.12 ,$65.55 ,$56.58 ,$56.58 ,$55.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400004,L0140,HC CERVICAL COLLAR ADJUSTABLE,274,1 ,$198.00 ,$99.00 ,$44.00 ,$202.77 , N/A ,$63.15 ,$63.15 ,$67.32 ,$158.40 ,$168.30 ,$123.75 ,$178.20 , N/A ,$188.10 ,$178.20 ,$168.30 ,$168.30 ,$67.32 ,$168.30 ,$168.30 ,$178.20 , N/A ,$83.16 ,$178.20 ,$202.77 ,$182.16 ,$178.20 ,$131.95 ,$131.95 ,$120.58 ,$131.95 ,$128.70 ,$137.91 ,$44.00 ,$156.42 , N/A , N/A , N/A ,$67.32 , N/A ,$90.12 ,$188.10 ,$162.36 ,$162.36 ,$158.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400006,L0150,HC PHILADELPHA COLLAR,274,1 ,$127.00 ,$63.50 ,$28.22 ,$260.42 , N/A ,$112.93 ,$112.93 ,$43.18 ,$101.60 ,$107.95 ,$79.38 ,$114.30 , N/A ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$43.18 ,$107.95 ,$107.95 ,$114.30 , N/A ,$53.34 ,$114.30 ,$260.42 ,$116.84 ,$114.30 ,$84.63 ,$84.63 ,$77.34 ,$84.63 ,$82.55 ,$88.46 ,$28.22 ,$100.33 , N/A , N/A , N/A ,$43.18 , N/A ,$115.74 ,$120.65 ,$104.14 ,$104.14 ,$101.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400010,L0172,HC CERVICAL COLLAR TWO PIECE,274,1 ,$291.00 ,$145.50 ,$64.66 ,$399.91 , N/A ,$149.42 ,$149.42 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 , N/A ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 , N/A ,$122.22 ,$261.90 ,$399.91 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 , N/A , N/A , N/A ,$98.94 , N/A ,$177.74 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400014,L1830,HC IMMOB KNEE REG 20 LARGE,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400018,L1830,HC KNEE BRACE - HINGED,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400019,L1830,HC KNEE IMMOBILIZER,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400020,L1830,HC KNEE IMMOBILIZER 16 IN,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400021,L1830,HC KNEE IMMOBILIZER 26 IN,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400023,L1830,HC KNEE IMMOBILIZER 22IN,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400028,L1830,HC KNEE IMMOBILIZER FIT  AND  ADJ,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400029,L1830,HC KNEE IMMOBILIZER ZIMMER 24INCH,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400031,L1832,HC BRACE KNEE EZ,274,1 ,$186.00 ,$93.00 ,$41.33 ,"$1,391.76 ", N/A ,$186.00 ,$186.00 ,$63.24 ,$148.80 ,$158.10 ,$116.25 ,$167.40 , N/A ,$176.70 ,$167.40 ,$158.10 ,$158.10 ,$63.24 ,$158.10 ,$158.10 ,$167.40 , N/A ,$78.12 ,$167.40 ,"$1,391.76 ",$171.12 ,$167.40 ,$123.95 ,$123.95 ,$113.27 ,$123.95 ,$120.90 ,$129.55 ,$41.33 ,$146.94 , N/A , N/A , N/A ,$63.24 , N/A ,$618.56 ,$176.70 ,$152.52 ,$152.52 ,$148.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400032,N/A,HC BRACE TROM ADV COOL REGULAR,272,1 ,$139.00 ,$69.50 ,$30.89 ,$139.00 , N/A ,$117.58 ,$117.58 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 , N/A ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 , N/A ,$58.38 ,$125.10 , N/A ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 , N/A ,$69.50 ,$69.50 ,$47.26 ,$69.50 , N/A ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400043,L3807,HC FUNCT POSITION HAND SPLT,274,1 ,$230.00 ,$115.00 ,$51.11 ,$535.64 , N/A ,$230.00 ,$230.00 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 , N/A ,$96.60 ,$207.00 ,$535.64 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 , N/A , N/A , N/A ,$78.20 , N/A ,$238.06 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400044,L3908,HC COCK UP WRIST SPLINT/FIT  AND  ADJ,274,1 ,$155.00 ,$77.50 ,$34.44 ,$196.47 , N/A ,$70.40 ,$70.40 ,$52.70 ,$124.00 ,$131.75 ,$96.88 ,$139.50 , N/A ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$52.70 ,$131.75 ,$131.75 ,$139.50 , N/A ,$65.10 ,$139.50 ,$196.47 ,$142.60 ,$139.50 ,$103.29 ,$103.29 ,$94.40 ,$103.29 ,$100.75 ,$107.96 ,$34.44 ,$122.45 , N/A , N/A , N/A ,$52.70 , N/A ,$87.32 ,$147.25 ,$127.10 ,$127.10 ,$124.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400049,L3913,HC HAND FINGER SPLINT INCL FITTING,274,1 ,$507.00 ,$253.50 ,$112.66 ,$696.20 , N/A ,$260.03 ,$260.03 ,$172.38 ,$405.60 ,$430.95 ,$316.88 ,$456.30 , N/A ,$481.65 ,$456.30 ,$430.95 ,$430.95 ,$172.38 ,$430.95 ,$430.95 ,$456.30 , N/A ,$212.94 ,$456.30 ,$696.20 ,$466.44 ,$456.30 ,$337.86 ,$337.86 ,$308.76 ,$337.86 ,$329.55 ,$353.13 ,$112.66 ,$400.53 , N/A , N/A , N/A ,$172.38 , N/A ,$309.42 ,$481.65 ,$415.74 ,$415.74 ,$405.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400063,L4350,HC AIR CAST/FIT  AND  ADJ,274,1 ,$198.00 ,$99.00 ,$44.00 ,$272.84 , N/A ,$102.08 ,$102.08 ,$67.32 ,$158.40 ,$168.30 ,$123.75 ,$178.20 , N/A ,$188.10 ,$178.20 ,$168.30 ,$168.30 ,$67.32 ,$168.30 ,$168.30 ,$178.20 , N/A ,$83.16 ,$178.20 ,$272.84 ,$182.16 ,$178.20 ,$131.95 ,$131.95 ,$120.58 ,$131.95 ,$128.70 ,$137.91 ,$44.00 ,$156.42 , N/A , N/A , N/A ,$67.32 , N/A ,$121.26 ,$188.10 ,$162.36 ,$162.36 ,$158.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400064,L4360,HC AIRWALKER SPLINT INCL FITTING,274,1 ,$522.00 ,$261.00 ,$115.99 ,$726.57 , N/A ,$273.15 ,$273.15 ,$177.48 ,$417.60 ,$443.70 ,$326.25 ,$469.80 , N/A ,$495.90 ,$469.80 ,$443.70 ,$443.70 ,$177.48 ,$443.70 ,$443.70 ,$469.80 , N/A ,$219.24 ,$469.80 ,$726.57 ,$480.24 ,$469.80 ,$347.86 ,$347.86 ,$317.90 ,$347.86 ,$339.30 ,$363.57 ,$115.99 ,$412.38 , N/A , N/A , N/A ,$177.48 , N/A ,$322.92 ,$495.90 ,$428.04 ,$428.04 ,$417.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400065,L4386,HC ROM WALKER BOOT FIT  AND  ADJ,274,1 ,$324.00 ,$162.00 ,$71.99 ,$446.90 , N/A ,$167.28 ,$167.28 ,$110.16 ,$259.20 ,$275.40 ,$202.50 ,$291.60 , N/A ,$307.80 ,$291.60 ,$275.40 ,$275.40 ,$110.16 ,$275.40 ,$275.40 ,$291.60 , N/A ,$136.08 ,$291.60 ,$446.90 ,$298.08 ,$291.60 ,$215.91 ,$215.91 ,$197.32 ,$215.91 ,$210.60 ,$225.67 ,$71.99 ,$255.96 , N/A , N/A , N/A ,$110.16 , N/A ,$198.62 ,$307.80 ,$265.68 ,$265.68 ,$259.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400069,L8501,HC PASSEY MUIR VALVE,274,1 ,$278.00 ,$139.00 ,$61.77 ,$353.63 , N/A ,$126.96 ,$126.96 ,$94.52 ,$222.40 ,$236.30 ,$173.75 ,$250.20 , N/A ,$264.10 ,$250.20 ,$236.30 ,$236.30 ,$94.52 ,$236.30 ,$236.30 ,$250.20 , N/A ,$116.76 ,$250.20 ,$353.63 ,$255.76 ,$250.20 ,$185.26 ,$185.26 ,$169.30 ,$185.26 ,$180.70 ,$193.63 ,$61.77 ,$219.62 , N/A , N/A , N/A ,$94.52 , N/A ,$157.17 ,$264.10 ,$227.96 ,$227.96 ,$222.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400109,L3702,HC ORTHOSIS ELBOW W/O JOINTS CUSTOM,274,1 ,$476.00 ,$238.00 ,$105.77 ,$713.27 , N/A ,$277.26 ,$277.26 ,$161.84 ,$380.80 ,$404.60 ,$297.50 ,$428.40 , N/A ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$161.84 ,$404.60 ,$404.60 ,$428.40 , N/A ,$199.92 ,$428.40 ,$713.27 ,$437.92 ,$428.40 ,$317.21 ,$317.21 ,$289.88 ,$317.21 ,$309.40 ,$331.53 ,$105.77 ,$376.04 , N/A , N/A , N/A ,$161.84 , N/A ,$317.01 ,$452.20 ,$390.32 ,$390.32 ,$380.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400110,L3808,HC ORTHOSIS WHFO RIGID W/O JOINTS,274,1 ,$662.00 ,$331.00 ,$147.10 ,$913.55 , N/A ,$342.03 ,$342.03 ,$225.08 ,$529.60 ,$562.70 ,$413.75 ,$595.80 , N/A ,$628.90 ,$595.80 ,$562.70 ,$562.70 ,$225.08 ,$562.70 ,$562.70 ,$595.80 , N/A ,$278.04 ,$595.80 ,$913.55 ,$609.04 ,$595.80 ,$441.16 ,$441.16 ,$403.16 ,$441.16 ,$430.30 ,$461.08 ,$147.10 ,$522.98 , N/A , N/A , N/A ,$225.08 , N/A ,$406.02 ,$628.90 ,$542.84 ,$542.84 ,$529.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400112,L3906,HC ORTHOSIS WHO GAUNTLET MOLDED CUSTOM,274,1 ,$932.00 ,$466.00 ,$207.09 ,"$1,295.24 ", N/A ,$486.58 ,$486.58 ,$316.88 ,$745.60 ,$792.20 ,$582.50 ,$838.80 , N/A ,$885.40 ,$838.80 ,$792.20 ,$792.20 ,$316.88 ,$792.20 ,$792.20 ,$838.80 , N/A ,$391.44 ,$838.80 ,"$1,295.24 ",$857.44 ,$838.80 ,$621.08 ,$621.08 ,$567.59 ,$621.08 ,$605.80 ,$649.14 ,$207.09 ,$736.28 , N/A , N/A , N/A ,$316.88 , N/A ,$575.66 ,$885.40 ,$764.24 ,$764.24 ,$745.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400220,L3806,HC WRIST/HAND/FINGER ORTHOSIS W/JOINT CUSTOM FAB FIT AND ADJUST,274,1 ,$838.00 ,$419.00 ,$186.20 ,"$1,162.13 ", N/A ,$436.13 ,$436.13 ,$284.92 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$284.92 ,$712.30 ,$712.30 ,$754.20 , N/A ,$351.96 ,$754.20 ,"$1,162.13 ",$770.96 ,$754.20 ,$558.44 ,$558.44 ,$510.34 ,$558.44 ,$544.70 ,$583.67 ,$186.20 ,$662.02 , N/A , N/A , N/A ,$284.92 , N/A ,$516.50 ,$796.10 ,$687.16 ,$687.16 ,$670.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400221,L3809,HC WRIST/HAND/FINGER ORTHOSIS W/O JOINT PREFAB,274,1 ,$476.00 ,$238.00 ,$105.77 ,$646.34 , N/A ,$240.08 ,$240.08 ,$161.84 ,$380.80 ,$404.60 ,$297.50 ,$428.40 , N/A ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$161.84 ,$404.60 ,$404.60 ,$428.40 , N/A ,$199.92 ,$428.40 ,$646.34 ,$437.92 ,$428.40 ,$317.21 ,$317.21 ,$289.88 ,$317.21 ,$309.40 ,$331.53 ,$105.77 ,$376.04 , N/A , N/A , N/A ,$161.84 , N/A ,$287.26 ,$452.20 ,$390.32 ,$390.32 ,$380.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400222,L3933,HC FINGER ORTHOSIS W/O JOINTS CUSTOM FAB FIT AND ADJUST,274,1 ,$404.00 ,$202.00 ,$89.77 ,$550.57 , N/A ,$204.87 ,$204.87 ,$137.36 ,$323.20 ,$343.40 ,$252.50 ,$363.60 , N/A ,$383.80 ,$363.60 ,$343.40 ,$343.40 ,$137.36 ,$343.40 ,$343.40 ,$363.60 , N/A ,$169.68 ,$363.60 ,$550.57 ,$371.68 ,$363.60 ,$269.23 ,$269.23 ,$246.04 ,$269.23 ,$262.60 ,$281.39 ,$89.77 ,$319.16 , N/A , N/A , N/A ,$137.36 , N/A ,$244.70 ,$383.80 ,$331.28 ,$331.28 ,$323.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400223,L3807,HC RADIAL NERVE PALSY SPLINT,274,1 ,$230.00 ,$115.00 ,$51.11 ,$535.64 , N/A ,$230.00 ,$230.00 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 , N/A ,$96.60 ,$207.00 ,$535.64 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 , N/A , N/A , N/A ,$78.20 , N/A ,$238.06 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480001,L3000,HC FOOT INSERT UCB LT,274,1 ,$184.00 ,$92.00 ,$40.88 ,$679.36 , N/A ,$184.00 ,$184.00 ,$62.56 ,$147.20 ,$156.40 ,$115.00 ,$165.60 , N/A ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$62.56 ,$156.40 ,$156.40 ,$165.60 , N/A ,$77.28 ,$165.60 ,$679.36 ,$169.28 ,$165.60 ,$122.62 ,$122.62 ,$112.06 ,$122.62 ,$119.60 ,$128.16 ,$40.88 ,$145.36 , N/A , N/A , N/A ,$62.56 , N/A ,$301.94 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480002,L3000,HC FOOT INSERT UCB RT,274,1 ,$184.00 ,$92.00 ,$40.88 ,$679.36 , N/A ,$184.00 ,$184.00 ,$62.56 ,$147.20 ,$156.40 ,$115.00 ,$165.60 , N/A ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$62.56 ,$156.40 ,$156.40 ,$165.60 , N/A ,$77.28 ,$165.60 ,$679.36 ,$169.28 ,$165.60 ,$122.62 ,$122.62 ,$112.06 ,$122.62 ,$119.60 ,$128.16 ,$40.88 ,$145.36 , N/A , N/A , N/A ,$62.56 , N/A ,$301.94 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480003,L3808,HC GALVESTON METACARPAL BRACE ALL SIZES,274,1 ,$167.00 ,$83.50 ,$37.11 ,$690.80 , N/A ,$167.00 ,$167.00 ,$56.78 ,$133.60 ,$141.95 ,$104.38 ,$150.30 , N/A ,$158.65 ,$150.30 ,$141.95 ,$141.95 ,$56.78 ,$141.95 ,$141.95 ,$150.30 , N/A ,$70.14 ,$150.30 ,$690.80 ,$153.64 ,$150.30 ,$111.29 ,$111.29 ,$101.70 ,$111.29 ,$108.55 ,$116.32 ,$37.11 ,$131.93 , N/A , N/A , N/A ,$56.78 , N/A ,$307.02 ,$158.65 ,$136.94 ,$136.94 ,$133.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480004,L1830,HC KNEE IMMOBILIZER 28 IN,274,1 ,$123.00 ,$61.50 ,$27.33 ,$185.13 , N/A ,$72.10 ,$72.10 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 , N/A ,$51.66 ,$110.70 ,$185.13 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 , N/A , N/A , N/A ,$41.82 , N/A ,$82.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27500004,C1778,HC NEURO STIMULATOR LEAD,275,1 ,"$2,493.00 ","$1,246.50 ",$553.94 ,"$2,493.00 ", N/A ,"$2,108.83 ","$2,108.83 ",$847.62 ,"$1,994.40 ","$2,119.05 ","$1,558.13 ","$2,243.70 ", N/A ,"$2,368.35 ","$2,243.70 ","$2,119.05 ","$2,119.05 ",$847.62 ,"$2,119.05 ","$2,119.05 ","$2,243.70 ", N/A ,"$1,047.06 ","$2,243.70 ", N/A ,"$2,293.56 ","$2,243.70 ","$1,661.34 ","$1,661.34 ","$1,518.24 ","$1,661.34 ","$1,620.45 ","$1,736.37 ",$553.94 ,"$1,969.47 ", N/A , N/A , N/A ,$847.62 , N/A , N/A ,"$2,368.35 ","$2,044.26 ","$2,044.26 ","$1,994.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27600003,C1780,HC IMPLANT INTRAOCULAR LENS,276,1 ,$362.00 ,$181.00 ,$80.44 ,$362.00 , N/A ,$306.22 ,$306.22 ,$123.08 ,$289.60 ,$307.70 ,$226.25 ,$325.80 , N/A ,$343.90 ,$325.80 ,$307.70 ,$307.70 ,$123.08 ,$307.70 ,$307.70 ,$325.80 , N/A ,$152.04 ,$325.80 , N/A ,$333.04 ,$325.80 ,$241.24 ,$241.24 ,$220.46 ,$241.24 ,$235.30 ,$252.13 ,$80.44 ,$285.98 , N/A , N/A , N/A ,$123.08 , N/A , N/A ,$343.90 ,$296.84 ,$296.84 ,$289.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27600012,V2632,HC INTRAOCULAR LENS POST CHAMBER,276,1 ,$456.00 ,$228.00 ,$101.32 ,$456.00 , N/A ,$125.10 ,$125.10 ,$155.04 ,$364.80 ,$387.60 ,$285.00 ,$410.40 , N/A ,$433.20 ,$410.40 ,$387.60 ,$387.60 ,$155.04 ,$387.60 ,$387.60 ,$410.40 , N/A ,$191.52 ,$410.40 , N/A ,$419.52 ,$410.40 ,$303.88 ,$303.88 ,$277.70 ,$303.88 ,$296.40 ,$317.60 ,$101.32 ,$360.24 , N/A , N/A , N/A ,$155.04 , N/A , N/A ,$433.20 ,$373.92 ,$373.92 ,$364.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800001,C1713,HC 1.3MM TI EXTENDED H PLT R/L,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800002,C1713,HC 1.3MM TI STRGHT PLT 12HLS/47MM,278,1 ,$912.00 ,$456.00 ,$202.65 ,$912.00 , N/A ,$771.46 ,$771.46 ,$310.08 ,$729.60 ,$775.20 ,$570.00 ,$820.80 , N/A ,$866.40 ,$820.80 ,$775.20 ,$775.20 ,$310.08 ,$775.20 ,$775.20 ,$820.80 , N/A ,$383.04 ,$820.80 , N/A ,$839.04 ,$820.80 ,$607.76 ,$607.76 ,$555.41 ,$607.76 ,$592.80 ,$635.21 ,$202.65 ,$720.48 , N/A , N/A , N/A ,$310.08 , N/A , N/A ,$866.40 ,$747.84 ,$747.84 ,$729.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800003,C1713,HC 1.3MM TI STRGHT PLT 6 HLS/23MM,278,1 ,$725.00 ,$362.50 ,$161.10 ,$725.00 , N/A ,$613.28 ,$613.28 ,$246.50 ,$580.00 ,$616.25 ,$453.13 ,$652.50 , N/A ,$688.75 ,$652.50 ,$616.25 ,$616.25 ,$246.50 ,$616.25 ,$616.25 ,$652.50 , N/A ,$304.50 ,$652.50 , N/A ,$667.00 ,$652.50 ,$483.14 ,$483.14 ,$441.53 ,$483.14 ,$471.25 ,$504.96 ,$161.10 ,$572.75 , N/A , N/A , N/A ,$246.50 , N/A , N/A ,$688.75 ,$594.50 ,$594.50 ,$580.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800005,C1713,HC 1.3MM TI T/Y PLT 3HLS HD/8HLS,278,1 ,$837.00 ,$418.50 ,$185.98 ,$837.00 , N/A ,$708.02 ,$708.02 ,$284.58 ,$669.60 ,$711.45 ,$523.13 ,$753.30 , N/A ,$795.15 ,$753.30 ,$711.45 ,$711.45 ,$284.58 ,$711.45 ,$711.45 ,$753.30 , N/A ,$351.54 ,$753.30 , N/A ,$770.04 ,$753.30 ,$557.78 ,$557.78 ,$509.73 ,$557.78 ,$544.05 ,$582.97 ,$185.98 ,$661.23 , N/A , N/A , N/A ,$284.58 , N/A , N/A ,$795.15 ,$686.34 ,$686.34 ,$669.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800006,C1713,HC 1.5MM TI CNDLR PLT 7HLS/36MM R/L,278,1 ,"$1,086.00 ",$543.00 ,$241.31 ,"$1,086.00 ", N/A ,$918.65 ,$918.65 ,$369.24 ,$868.80 ,$923.10 ,$678.75 ,$977.40 , N/A ,"$1,031.70 ",$977.40 ,$923.10 ,$923.10 ,$369.24 ,$923.10 ,$923.10 ,$977.40 , N/A ,$456.12 ,$977.40 , N/A ,$999.12 ,$977.40 ,$723.71 ,$723.71 ,$661.37 ,$723.71 ,$705.90 ,$756.40 ,$241.31 ,$857.94 , N/A , N/A , N/A ,$369.24 , N/A , N/A ,"$1,031.70 ",$890.52 ,$890.52 ,$868.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800007,C1713,HC 1.5MM TI EXTENDED H PLATE R/L,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800008,C1713,HC 1.5MM TI STRGHT PLT 12HLS/59MM,278,1 ,$912.00 ,$456.00 ,$202.65 ,$912.00 , N/A ,$771.46 ,$771.46 ,$310.08 ,$729.60 ,$775.20 ,$570.00 ,$820.80 , N/A ,$866.40 ,$820.80 ,$775.20 ,$775.20 ,$310.08 ,$775.20 ,$775.20 ,$820.80 , N/A ,$383.04 ,$820.80 , N/A ,$839.04 ,$820.80 ,$607.76 ,$607.76 ,$555.41 ,$607.76 ,$592.80 ,$635.21 ,$202.65 ,$720.48 , N/A , N/A , N/A ,$310.08 , N/A , N/A ,$866.40 ,$747.84 ,$747.84 ,$729.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800009,C1713,HC 1.5MM TI STRGHT PLT 6HLS/29MM,278,1 ,$725.00 ,$362.50 ,$161.10 ,$725.00 , N/A ,$613.28 ,$613.28 ,$246.50 ,$580.00 ,$616.25 ,$453.13 ,$652.50 , N/A ,$688.75 ,$652.50 ,$616.25 ,$616.25 ,$246.50 ,$616.25 ,$616.25 ,$652.50 , N/A ,$304.50 ,$652.50 , N/A ,$667.00 ,$652.50 ,$483.14 ,$483.14 ,$441.53 ,$483.14 ,$471.25 ,$504.96 ,$161.10 ,$572.75 , N/A , N/A , N/A ,$246.50 , N/A , N/A ,$688.75 ,$594.50 ,$594.50 ,$580.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800010,C1713,HC 1.5MM TI T PLT 4HLS HD/8HLS SHF,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800011,C1713,HC 1.5MM TI TPLT 3HLS HD/8HLS SF,278,1 ,$838.00 ,$419.00 ,$186.20 ,$838.00 , N/A ,$708.86 ,$708.86 ,$284.92 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$284.92 ,$712.30 ,$712.30 ,$754.20 , N/A ,$351.96 ,$754.20 , N/A ,$770.96 ,$754.20 ,$558.44 ,$558.44 ,$510.34 ,$558.44 ,$544.70 ,$583.67 ,$186.20 ,$662.02 , N/A , N/A , N/A ,$284.92 , N/A , N/A ,$796.10 ,$687.16 ,$687.16 ,$670.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800012,C1713,HC 1.5MM TI Y PLATE 3X8 HOLES,278,1 ,$838.00 ,$419.00 ,$186.20 ,$838.00 , N/A ,$708.86 ,$708.86 ,$284.92 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$284.92 ,$712.30 ,$712.30 ,$754.20 , N/A ,$351.96 ,$754.20 , N/A ,$770.96 ,$754.20 ,$558.44 ,$558.44 ,$510.34 ,$558.44 ,$544.70 ,$583.67 ,$186.20 ,$662.02 , N/A , N/A , N/A ,$284.92 , N/A , N/A ,$796.10 ,$687.16 ,$687.16 ,$670.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800013,C1713,HC 2.0MM TI CONDYLAR PLT 7HL/39MM R/L,278,1 ,"$1,128.00 ",$564.00 ,$250.64 ,"$1,128.00 ", N/A ,$954.18 ,$954.18 ,$383.52 ,$902.40 ,$958.80 ,$705.00 ,"$1,015.20 ", N/A ,"$1,071.60 ","$1,015.20 ",$958.80 ,$958.80 ,$383.52 ,$958.80 ,$958.80 ,"$1,015.20 ", N/A ,$473.76 ,"$1,015.20 ", N/A ,"$1,037.76 ","$1,015.20 ",$751.70 ,$751.70 ,$686.95 ,$751.70 ,$733.20 ,$785.65 ,$250.64 ,$891.12 , N/A , N/A , N/A ,$383.52 , N/A , N/A ,"$1,071.60 ",$924.96 ,$924.96 ,$902.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800014,C1713,HC 2.0MM TI LC-DCP PLT 4HLS 24MM,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800015,C1713,HC 2.0MM TI LC-DCP PLT 6HLS 36MM,278,1 ,"$1,032.00 ",$516.00 ,$229.31 ,"$1,032.00 ", N/A ,$872.97 ,$872.97 ,$350.88 ,$825.60 ,$877.20 ,$645.00 ,$928.80 , N/A ,$980.40 ,$928.80 ,$877.20 ,$877.20 ,$350.88 ,$877.20 ,$877.20 ,$928.80 , N/A ,$433.44 ,$928.80 , N/A ,$949.44 ,$928.80 ,$687.72 ,$687.72 ,$628.49 ,$687.72 ,$670.80 ,$718.79 ,$229.31 ,$815.28 , N/A , N/A , N/A ,$350.88 , N/A , N/A ,$980.40 ,$846.24 ,$846.24 ,$825.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800016,C1713,HC 2.0MM TI LC-DCP PLT 8HLS 48MM,278,1 ,"$1,169.00 ",$584.50 ,$259.75 ,"$1,169.00 ", N/A ,$988.86 ,$988.86 ,$397.46 ,$935.20 ,$993.65 ,$730.63 ,"$1,052.10 ", N/A ,"$1,110.55 ","$1,052.10 ",$993.65 ,$993.65 ,$397.46 ,$993.65 ,$993.65 ,"$1,052.10 ", N/A ,$490.98 ,"$1,052.10 ", N/A ,"$1,075.48 ","$1,052.10 ",$779.02 ,$779.02 ,$711.92 ,$779.02 ,$759.85 ,$814.21 ,$259.75 ,$923.51 , N/A , N/A , N/A ,$397.46 , N/A , N/A ,"$1,110.55 ",$958.58 ,$958.58 ,$935.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800017,C1713,HC 2.0MM TI STGHT PLT 8HLS/35MM,278,1 ,$798.00 ,$399.00 ,$177.32 ,$798.00 , N/A ,$675.03 ,$675.03 ,$271.32 ,$638.40 ,$678.30 ,$498.75 ,$718.20 , N/A ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$271.32 ,$678.30 ,$678.30 ,$718.20 , N/A ,$335.16 ,$718.20 , N/A ,$734.16 ,$718.20 ,$531.79 ,$531.79 ,$485.98 ,$531.79 ,$518.70 ,$555.81 ,$177.32 ,$630.42 , N/A , N/A , N/A ,$271.32 , N/A , N/A ,$758.10 ,$654.36 ,$654.36 ,$638.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800018,C1713,HC 2.0MM TI STRGHT PLT 12HLS/71MM,278,1 ,$952.00 ,$476.00 ,$211.53 ,$952.00 , N/A ,$805.30 ,$805.30 ,$323.68 ,$761.60 ,$809.20 ,$595.00 ,$856.80 , N/A ,$904.40 ,$856.80 ,$809.20 ,$809.20 ,$323.68 ,$809.20 ,$809.20 ,$856.80 , N/A ,$399.84 ,$856.80 , N/A ,$875.84 ,$856.80 ,$634.41 ,$634.41 ,$579.77 ,$634.41 ,$618.80 ,$663.07 ,$211.53 ,$752.08 , N/A , N/A , N/A ,$323.68 , N/A , N/A ,$904.40 ,$780.64 ,$780.64 ,$761.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800019,C1713,HC 2.0MM TI T/YPLT 3HLS HD/8HLS SHFT,278,1 ,$188.00 ,$94.00 ,$41.77 ,$188.00 , N/A ,$159.03 ,$159.03 ,$63.92 ,$150.40 ,$159.80 ,$117.50 ,$169.20 , N/A ,$178.60 ,$169.20 ,$159.80 ,$159.80 ,$63.92 ,$159.80 ,$159.80 ,$169.20 , N/A ,$78.96 ,$169.20 , N/A ,$172.96 ,$169.20 ,$125.28 ,$125.28 ,$114.49 ,$125.28 ,$122.20 ,$130.94 ,$41.77 ,$148.52 , N/A , N/A , N/A ,$63.92 , N/A , N/A ,$178.60 ,$154.16 ,$154.16 ,$150.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800021,C1713,HC 2.4MM TI CNDLR PLT 8HLS/57MM R/L,278,1 ,"$1,146.00 ",$573.00 ,$254.64 ,"$1,146.00 ", N/A ,$969.40 ,$969.40 ,$389.64 ,$916.80 ,$974.10 ,$716.25 ,"$1,031.40 ", N/A ,"$1,088.70 ","$1,031.40 ",$974.10 ,$974.10 ,$389.64 ,$974.10 ,$974.10 ,"$1,031.40 ", N/A ,$481.32 ,"$1,031.40 ", N/A ,"$1,054.32 ","$1,031.40 ",$763.69 ,$763.69 ,$697.91 ,$763.69 ,$744.90 ,$798.19 ,$254.64 ,$905.34 , N/A , N/A , N/A ,$389.64 , N/A , N/A ,"$1,088.70 ",$939.72 ,$939.72 ,$916.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800022,C1713,HC 2.4MM TI LC-DCP PLT 4HLS/31MM,278,1 ,$214.00 ,$107.00 ,$47.55 ,$214.00 , N/A ,$181.02 ,$181.02 ,$72.76 ,$171.20 ,$181.90 ,$133.75 ,$192.60 , N/A ,$203.30 ,$192.60 ,$181.90 ,$181.90 ,$72.76 ,$181.90 ,$181.90 ,$192.60 , N/A ,$89.88 ,$192.60 , N/A ,$196.88 ,$192.60 ,$142.61 ,$142.61 ,$130.33 ,$142.61 ,$139.10 ,$149.05 ,$47.55 ,$169.06 , N/A , N/A , N/A ,$72.76 , N/A , N/A ,$203.30 ,$175.48 ,$175.48 ,$171.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800023,C1713,HC 2.4MM TI LC-DCP PLT 6HLS/47MM,278,1 ,$252.00 ,$126.00 ,$55.99 ,$252.00 , N/A ,$213.17 ,$213.17 ,$85.68 ,$201.60 ,$214.20 ,$157.50 ,$226.80 , N/A ,$239.40 ,$226.80 ,$214.20 ,$214.20 ,$85.68 ,$214.20 ,$214.20 ,$226.80 , N/A ,$105.84 ,$226.80 , N/A ,$231.84 ,$226.80 ,$167.93 ,$167.93 ,$153.47 ,$167.93 ,$163.80 ,$175.52 ,$55.99 ,$199.08 , N/A , N/A , N/A ,$85.68 , N/A , N/A ,$239.40 ,$206.64 ,$206.64 ,$201.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800024,C1713,HC 2.4MM TI LC-DCP PLT 8HLS/63MM,278,1 ,"$1,479.00 ",$739.50 ,$328.63 ,"$1,479.00 ", N/A ,"$1,251.09 ","$1,251.09 ",$502.86 ,"$1,183.20 ","$1,257.15 ",$924.38 ,"$1,331.10 ", N/A ,"$1,405.05 ","$1,331.10 ","$1,257.15 ","$1,257.15 ",$502.86 ,"$1,257.15 ","$1,257.15 ","$1,331.10 ", N/A ,$621.18 ,"$1,331.10 ", N/A ,"$1,360.68 ","$1,331.10 ",$985.61 ,$985.61 ,$900.71 ,$985.61 ,$961.35 ,"$1,030.12 ",$328.63 ,"$1,168.41 ", N/A , N/A , N/A ,$502.86 , N/A , N/A ,"$1,405.05 ","$1,212.78 ","$1,212.78 ","$1,183.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800026,C1713,HC 2.4MM TI TPLT 2HLS/8HLS SHFT/54MM,278,1 ,$283.00 ,$141.50 ,$62.88 ,$283.00 , N/A ,$239.39 ,$239.39 ,$96.22 ,$226.40 ,$240.55 ,$176.88 ,$254.70 , N/A ,$268.85 ,$254.70 ,$240.55 ,$240.55 ,$96.22 ,$240.55 ,$240.55 ,$254.70 , N/A ,$118.86 ,$254.70 , N/A ,$260.36 ,$254.70 ,$188.59 ,$188.59 ,$172.35 ,$188.59 ,$183.95 ,$197.11 ,$62.88 ,$223.57 , N/A , N/A , N/A ,$96.22 , N/A , N/A ,$268.85 ,$232.06 ,$232.06 ,$226.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800027,C1713,HC 2.4MM TI TPLT 3HLS HD/8HLS SHFT 54MM,278,1 ,"$1,046.00 ",$523.00 ,$232.42 ,"$1,046.00 ", N/A ,$884.81 ,$884.81 ,$355.64 ,$836.80 ,$889.10 ,$653.75 ,$941.40 , N/A ,$993.70 ,$941.40 ,$889.10 ,$889.10 ,$355.64 ,$889.10 ,$889.10 ,$941.40 , N/A ,$439.32 ,$941.40 , N/A ,$962.32 ,$941.40 ,$697.05 ,$697.05 ,$637.01 ,$697.05 ,$679.90 ,$728.54 ,$232.42 ,$826.34 , N/A , N/A , N/A ,$355.64 , N/A , N/A ,$993.70 ,$857.72 ,$857.72 ,$836.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800028,C1713,HC 2.4MM TI YPLT 3HLS HD/8HLS SHFT 56MM,278,1 ,"$1,010.00 ",$505.00 ,$224.42 ,"$1,010.00 ", N/A ,$854.36 ,$854.36 ,$343.40 ,$808.00 ,$858.50 ,$631.25 ,$909.00 , N/A ,$959.50 ,$909.00 ,$858.50 ,$858.50 ,$343.40 ,$858.50 ,$858.50 ,$909.00 , N/A ,$424.20 ,$909.00 , N/A ,$929.20 ,$909.00 ,$673.06 ,$673.06 ,$615.09 ,$673.06 ,$656.50 ,$703.47 ,$224.42 ,$797.90 , N/A , N/A , N/A ,$343.40 , N/A , N/A ,$959.50 ,$828.20 ,$828.20 ,$808.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800034,C1713,HC BLADE 11MM HELICAL 80-120MM,278,1 ,"$1,916.00 ",$958.00 ,$425.74 ,"$1,916.00 ", N/A ,"$1,620.74 ","$1,620.74 ",$651.44 ,"$1,532.80 ","$1,628.60 ","$1,197.50 ","$1,724.40 ", N/A ,"$1,820.20 ","$1,724.40 ","$1,628.60 ","$1,628.60 ",$651.44 ,"$1,628.60 ","$1,628.60 ","$1,724.40 ", N/A ,$804.72 ,"$1,724.40 ", N/A ,"$1,762.72 ","$1,724.40 ","$1,276.82 ","$1,276.82 ","$1,166.84 ","$1,276.82 ","$1,245.40 ","$1,334.49 ",$425.74 ,"$1,513.64 ", N/A , N/A , N/A ,$651.44 , N/A , N/A ,"$1,820.20 ","$1,571.12 ","$1,571.12 ","$1,532.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800041,C1713,HC BONE PUTTY,278,1 ,"$2,278.00 ","$1,139.00 ",$506.17 ,"$2,278.00 ", N/A ,"$1,926.96 ","$1,926.96 ",$774.52 ,"$1,822.40 ","$1,936.30 ","$1,423.75 ","$2,050.20 ", N/A ,"$2,164.10 ","$2,050.20 ","$1,936.30 ","$1,936.30 ",$774.52 ,"$1,936.30 ","$1,936.30 ","$2,050.20 ", N/A ,$956.76 ,"$2,050.20 ", N/A ,"$2,095.76 ","$2,050.20 ","$1,518.06 ","$1,518.06 ","$1,387.30 ","$1,518.06 ","$1,480.70 ","$1,586.63 ",$506.17 ,"$1,799.62 ", N/A , N/A , N/A ,$774.52 , N/A , N/A ,"$2,164.10 ","$1,867.96 ","$1,867.96 ","$1,822.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800043,C1713,HC ENDO BUTTON,278,1 ,$244.00 ,$122.00 ,$54.22 ,$244.00 , N/A ,$206.40 ,$206.40 ,$82.96 ,$195.20 ,$207.40 ,$152.50 ,$219.60 , N/A ,$231.80 ,$219.60 ,$207.40 ,$207.40 ,$82.96 ,$207.40 ,$207.40 ,$219.60 , N/A ,$102.48 ,$219.60 , N/A ,$224.48 ,$219.60 ,$162.60 ,$162.60 ,$148.60 ,$162.60 ,$158.60 ,$169.95 ,$54.22 ,$192.76 , N/A , N/A , N/A ,$82.96 , N/A , N/A ,$231.80 ,$200.08 ,$200.08 ,$195.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800054,C1713,HC MISC ANCHOR/SCREW IMPLANT,278,1 ,"$1,249.00 ",$624.50 ,$277.53 ,"$1,249.00 ", N/A ,"$1,056.53 ","$1,056.53 ",$424.66 ,$999.20 ,"$1,061.65 ",$780.63 ,"$1,124.10 ", N/A ,"$1,186.55 ","$1,124.10 ","$1,061.65 ","$1,061.65 ",$424.66 ,"$1,061.65 ","$1,061.65 ","$1,124.10 ", N/A ,$524.58 ,"$1,124.10 ", N/A ,"$1,149.08 ","$1,124.10 ",$832.33 ,$832.33 ,$760.64 ,$832.33 ,$811.85 ,$869.93 ,$277.53 ,$986.71 , N/A , N/A , N/A ,$424.66 , N/A , N/A ,"$1,186.55 ","$1,024.18 ","$1,024.18 ",$999.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800061,C1713,HC PIN SYN TRANSFIXATION,278,1 ,$415.00 ,$207.50 ,$92.21 ,$415.00 , N/A ,$351.05 ,$351.05 ,$141.10 ,$332.00 ,$352.75 ,$259.38 ,$373.50 , N/A ,$394.25 ,$373.50 ,$352.75 ,$352.75 ,$141.10 ,$352.75 ,$352.75 ,$373.50 , N/A ,$174.30 ,$373.50 , N/A ,$381.80 ,$373.50 ,$276.56 ,$276.56 ,$252.74 ,$276.56 ,$269.75 ,$289.05 ,$92.21 ,$327.85 , N/A , N/A , N/A ,$141.10 , N/A , N/A ,$394.25 ,$340.30 ,$340.30 ,$332.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800071,C1713,HC PLATE SYN 3.5 LCP 8 HOLE 168MM RT/LT,278,1 ,"$1,925.00 ",$962.50 ,$427.74 ,"$1,925.00 ", N/A ,"$1,628.36 ","$1,628.36 ",$654.50 ,"$1,540.00 ","$1,636.25 ","$1,203.13 ","$1,732.50 ", N/A ,"$1,828.75 ","$1,732.50 ","$1,636.25 ","$1,636.25 ",$654.50 ,"$1,636.25 ","$1,636.25 ","$1,732.50 ", N/A ,$808.50 ,"$1,732.50 ", N/A ,"$1,771.00 ","$1,732.50 ","$1,282.82 ","$1,282.82 ","$1,172.33 ","$1,282.82 ","$1,251.25 ","$1,340.76 ",$427.74 ,"$1,520.75 ", N/A , N/A , N/A ,$654.50 , N/A , N/A ,"$1,828.75 ","$1,578.50 ","$1,578.50 ","$1,540.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800072,C1713,HC PLATE SYN 4.5 BRD LCKING 12 H,278,1 ,"$2,169.00 ","$1,084.50 ",$481.95 ,"$2,169.00 ", N/A ,"$1,834.76 ","$1,834.76 ",$737.46 ,"$1,735.20 ","$1,843.65 ","$1,355.63 ","$1,952.10 ", N/A ,"$2,060.55 ","$1,952.10 ","$1,843.65 ","$1,843.65 ",$737.46 ,"$1,843.65 ","$1,843.65 ","$1,952.10 ", N/A ,$910.98 ,"$1,952.10 ", N/A ,"$1,995.48 ","$1,952.10 ","$1,445.42 ","$1,445.42 ","$1,320.92 ","$1,445.42 ","$1,409.85 ","$1,510.71 ",$481.95 ,"$1,713.51 ", N/A , N/A , N/A ,$737.46 , N/A , N/A ,"$2,060.55 ","$1,778.58 ","$1,778.58 ","$1,735.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800073,C1713,HC PLATE SYN 4.5 LCP12 14 16 HOLE,278,1 ,"$2,432.00 ","$1,216.00 ",$540.39 ,"$2,432.00 ", N/A ,"$2,057.23 ","$2,057.23 ",$826.88 ,"$1,945.60 ","$2,067.20 ","$1,520.00 ","$2,188.80 ", N/A ,"$2,310.40 ","$2,188.80 ","$2,067.20 ","$2,067.20 ",$826.88 ,"$2,067.20 ","$2,067.20 ","$2,188.80 ", N/A ,"$1,021.44 ","$2,188.80 ", N/A ,"$2,237.44 ","$2,188.80 ","$1,620.68 ","$1,620.68 ","$1,481.09 ","$1,620.68 ","$1,580.80 ","$1,693.89 ",$540.39 ,"$1,921.28 ", N/A , N/A , N/A ,$826.88 , N/A , N/A ,"$2,310.40 ","$1,994.24 ","$1,994.24 ","$1,945.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800074,C1713,HC PLATE SYN LCP 9 HOLE,278,1 ,"$1,115.00 ",$557.50 ,$247.75 ,"$1,115.00 ", N/A ,$943.18 ,$943.18 ,$379.10 ,$892.00 ,$947.75 ,$696.88 ,"$1,003.50 ", N/A ,"$1,059.25 ","$1,003.50 ",$947.75 ,$947.75 ,$379.10 ,$947.75 ,$947.75 ,"$1,003.50 ", N/A ,$468.30 ,"$1,003.50 ", N/A ,"$1,025.80 ","$1,003.50 ",$743.04 ,$743.04 ,$679.04 ,$743.04 ,$724.75 ,$776.60 ,$247.75 ,$880.85 , N/A , N/A , N/A ,$379.10 , N/A , N/A ,"$1,059.25 ",$914.30 ,$914.30 ,$892.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800076,C1713,HC PLATE SYN LCP DIST RADIUS SHRT,278,1 ,"$2,573.00 ","$1,286.50 ",$571.72 ,"$2,573.00 ", N/A ,"$2,176.50 ","$2,176.50 ",$874.82 ,"$2,058.40 ","$2,187.05 ","$1,608.13 ","$2,315.70 ", N/A ,"$2,444.35 ","$2,315.70 ","$2,187.05 ","$2,187.05 ",$874.82 ,"$2,187.05 ","$2,187.05 ","$2,315.70 ", N/A ,"$1,080.66 ","$2,315.70 ", N/A ,"$2,367.16 ","$2,315.70 ","$1,714.65 ","$1,714.65 ","$1,566.96 ","$1,714.65 ","$1,672.45 ","$1,792.09 ",$571.72 ,"$2,032.67 ", N/A , N/A , N/A ,$874.82 , N/A , N/A ,"$2,444.35 ","$2,109.86 ","$2,109.86 ","$2,058.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800077,C1713,HC PLATE SYN LCP VOLAR DIST RAD,278,1 ,"$2,461.00 ","$1,230.50 ",$546.83 ,"$2,461.00 ", N/A ,"$2,081.76 ","$2,081.76 ",$836.74 ,"$1,968.80 ","$2,091.85 ","$1,538.13 ","$2,214.90 ", N/A ,"$2,337.95 ","$2,214.90 ","$2,091.85 ","$2,091.85 ",$836.74 ,"$2,091.85 ","$2,091.85 ","$2,214.90 ", N/A ,"$1,033.62 ","$2,214.90 ", N/A ,"$2,264.12 ","$2,214.90 ","$1,640.01 ","$1,640.01 ","$1,498.75 ","$1,640.01 ","$1,599.65 ","$1,714.09 ",$546.83 ,"$1,944.19 ", N/A , N/A , N/A ,$836.74 , N/A , N/A ,"$2,337.95 ","$2,018.02 ","$2,018.02 ","$1,968.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800082,C1713,HC PLATE VOLAR RT/LT LONG,278,1 ,"$2,610.00 ","$1,305.00 ",$579.94 ,"$2,610.00 ", N/A ,"$2,207.80 ","$2,207.80 ",$887.40 ,"$2,088.00 ","$2,218.50 ","$1,631.25 ","$2,349.00 ", N/A ,"$2,479.50 ","$2,349.00 ","$2,218.50 ","$2,218.50 ",$887.40 ,"$2,218.50 ","$2,218.50 ","$2,349.00 ", N/A ,"$1,096.20 ","$2,349.00 ", N/A ,"$2,401.20 ","$2,349.00 ","$1,739.30 ","$1,739.30 ","$1,589.49 ","$1,739.30 ","$1,696.50 ","$1,817.87 ",$579.94 ,"$2,061.90 ", N/A , N/A , N/A ,$887.40 , N/A , N/A ,"$2,479.50 ","$2,140.20 ","$2,140.20 ","$2,088.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800083,C1713,HC PLATE VOLAR RT/LT SHORT,278,1 ,"$2,461.00 ","$1,230.50 ",$546.83 ,"$2,461.00 ", N/A ,"$2,081.76 ","$2,081.76 ",$836.74 ,"$1,968.80 ","$2,091.85 ","$1,538.13 ","$2,214.90 ", N/A ,"$2,337.95 ","$2,214.90 ","$2,091.85 ","$2,091.85 ",$836.74 ,"$2,091.85 ","$2,091.85 ","$2,214.90 ", N/A ,"$1,033.62 ","$2,214.90 ", N/A ,"$2,264.12 ","$2,214.90 ","$1,640.01 ","$1,640.01 ","$1,498.75 ","$1,640.01 ","$1,599.65 ","$1,714.09 ",$546.83 ,"$1,944.19 ", N/A , N/A , N/A ,$836.74 , N/A , N/A ,"$2,337.95 ","$2,018.02 ","$2,018.02 ","$1,968.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800084,C1713,HC PLT SYN LCP DIST RAD VOLAR 4HL,278,1 ,"$2,610.00 ","$1,305.00 ",$579.94 ,"$2,610.00 ", N/A ,"$2,207.80 ","$2,207.80 ",$887.40 ,"$2,088.00 ","$2,218.50 ","$1,631.25 ","$2,349.00 ", N/A ,"$2,479.50 ","$2,349.00 ","$2,218.50 ","$2,218.50 ",$887.40 ,"$2,218.50 ","$2,218.50 ","$2,349.00 ", N/A ,"$1,096.20 ","$2,349.00 ", N/A ,"$2,401.20 ","$2,349.00 ","$1,739.30 ","$1,739.30 ","$1,589.49 ","$1,739.30 ","$1,696.50 ","$1,817.87 ",$579.94 ,"$2,061.90 ", N/A , N/A , N/A ,$887.40 , N/A , N/A ,"$2,479.50 ","$2,140.20 ","$2,140.20 ","$2,088.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800093,C1713,HC SCREW 2.4 CORTEX,278,1 ,$304.00 ,$152.00 ,$67.55 ,$304.00 , N/A ,$257.15 ,$257.15 ,$103.36 ,$243.20 ,$258.40 ,$190.00 ,$273.60 , N/A ,$288.80 ,$273.60 ,$258.40 ,$258.40 ,$103.36 ,$258.40 ,$258.40 ,$273.60 , N/A ,$127.68 ,$273.60 , N/A ,$279.68 ,$273.60 ,$202.59 ,$202.59 ,$185.14 ,$202.59 ,$197.60 ,$211.74 ,$67.55 ,$240.16 , N/A , N/A , N/A ,$103.36 , N/A , N/A ,$288.80 ,$249.28 ,$249.28 ,$243.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800108,C1713,HC SCREW SYNTHES SCHANZ 4.0/3.0,278,1 ,$343.00 ,$171.50 ,$76.21 ,$343.00 , N/A ,$290.14 ,$290.14 ,$116.62 ,$274.40 ,$291.55 ,$214.38 ,$308.70 , N/A ,$325.85 ,$308.70 ,$291.55 ,$291.55 ,$116.62 ,$291.55 ,$291.55 ,$308.70 , N/A ,$144.06 ,$308.70 , N/A ,$315.56 ,$308.70 ,$228.58 ,$228.58 ,$208.89 ,$228.58 ,$222.95 ,$238.90 ,$76.21 ,$270.97 , N/A , N/A , N/A ,$116.62 , N/A , N/A ,$325.85 ,$281.26 ,$281.26 ,$274.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800118,C1713,HC SCW SYN 1.5 CORTEX 4MM-8MM,278,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 , N/A ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 , N/A ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 , N/A , N/A , N/A ,$27.20 , N/A , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800119,C1713,HC SCW SYN 1.5 CORTEX TI 4MM-8MM,278,1 ,$130.00 ,$65.00 ,$28.89 ,$130.00 , N/A ,$109.97 ,$109.97 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 , N/A ,$54.60 ,$117.00 , N/A ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 , N/A , N/A , N/A ,$44.20 , N/A , N/A ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800121,C1713,HC VITOSS FOAM,278,1 ,$915.00 ,$457.50 ,$203.31 ,$915.00 , N/A ,$774.00 ,$774.00 ,$311.10 ,$732.00 ,$777.75 ,$571.88 ,$823.50 , N/A ,$869.25 ,$823.50 ,$777.75 ,$777.75 ,$311.10 ,$777.75 ,$777.75 ,$823.50 , N/A ,$384.30 ,$823.50 , N/A ,$841.80 ,$823.50 ,$609.76 ,$609.76 ,$557.24 ,$609.76 ,$594.75 ,$637.30 ,$203.31 ,$722.85 , N/A , N/A , N/A ,$311.10 , N/A , N/A ,$869.25 ,$750.30 ,$750.30 ,$732.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800129,C1751,HC POWER PICC DUAL,278,1 ,$469.00 ,$234.50 ,$104.21 ,$469.00 , N/A ,$396.73 ,$396.73 ,$159.46 ,$375.20 ,$398.65 ,$293.13 ,$422.10 , N/A ,$445.55 ,$422.10 ,$398.65 ,$398.65 ,$159.46 ,$398.65 ,$398.65 ,$422.10 , N/A ,$196.98 ,$422.10 , N/A ,$431.48 ,$422.10 ,$312.54 ,$312.54 ,$285.62 ,$312.54 ,$304.85 ,$326.66 ,$104.21 ,$370.51 , N/A , N/A , N/A ,$159.46 , N/A , N/A ,$445.55 ,$384.58 ,$384.58 ,$375.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800148,C1751,HC CATH GROSHONG SNG,278,1 ,$360.00 ,$180.00 ,$79.99 ,$360.00 , N/A ,$304.52 ,$304.52 ,$122.40 ,$288.00 ,$306.00 ,$225.00 ,$324.00 , N/A ,$342.00 ,$324.00 ,$306.00 ,$306.00 ,$122.40 ,$306.00 ,$306.00 ,$324.00 , N/A ,$151.20 ,$324.00 , N/A ,$331.20 ,$324.00 ,$239.90 ,$239.90 ,$219.24 ,$239.90 ,$234.00 ,$250.74 ,$79.99 ,$284.40 , N/A , N/A , N/A ,$122.40 , N/A , N/A ,$342.00 ,$295.20 ,$295.20 ,$288.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800151,C1751,HC POWER PICC TRAY 4FR SINGLE,278,1 ,$483.00 ,$241.50 ,$107.32 ,$483.00 , N/A ,$408.57 ,$408.57 ,$164.22 ,$386.40 ,$410.55 ,$301.88 ,$434.70 , N/A ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$164.22 ,$410.55 ,$410.55 ,$434.70 , N/A ,$202.86 ,$434.70 , N/A ,$444.36 ,$434.70 ,$321.87 ,$321.87 ,$294.15 ,$321.87 ,$313.95 ,$336.41 ,$107.32 ,$381.57 , N/A , N/A , N/A ,$164.22 , N/A , N/A ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800162,C1755,HC CATH INDURA INTRATHECAL 8709,278,1 ,"$2,153.00 ","$1,076.50 ",$478.40 ,"$2,153.00 ", N/A ,"$1,821.22 ","$1,821.22 ",$732.02 ,"$1,722.40 ","$1,830.05 ","$1,345.63 ","$1,937.70 ", N/A ,"$2,045.35 ","$1,937.70 ","$1,830.05 ","$1,830.05 ",$732.02 ,"$1,830.05 ","$1,830.05 ","$1,937.70 ", N/A ,$904.26 ,"$1,937.70 ", N/A ,"$1,980.76 ","$1,937.70 ","$1,434.76 ","$1,434.76 ","$1,311.18 ","$1,434.76 ","$1,399.45 ","$1,499.56 ",$478.40 ,"$1,700.87 ", N/A , N/A , N/A ,$732.02 , N/A , N/A ,"$2,045.35 ","$1,765.46 ","$1,765.46 ","$1,722.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800184,C1713,HC STIMULAN 5CC,278,1 ,"$1,553.00 ",$776.50 ,$345.08 ,"$1,553.00 ", N/A ,"$1,313.68 ","$1,313.68 ",$528.02 ,"$1,242.40 ","$1,320.05 ",$970.63 ,"$1,397.70 ", N/A ,"$1,475.35 ","$1,397.70 ","$1,320.05 ","$1,320.05 ",$528.02 ,"$1,320.05 ","$1,320.05 ","$1,397.70 ", N/A ,$652.26 ,"$1,397.70 ", N/A ,"$1,428.76 ","$1,397.70 ","$1,034.92 ","$1,034.92 ",$945.78 ,"$1,034.92 ","$1,009.45 ","$1,081.66 ",$345.08 ,"$1,226.87 ", N/A , N/A , N/A ,$528.02 , N/A , N/A ,"$1,475.35 ","$1,273.46 ","$1,273.46 ","$1,242.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800187,C1763,HC MATRIX XENFORM TISSUE,278,1 ,"$1,333.00 ",$666.50 ,$296.19 ,"$1,333.00 ", N/A ,"$1,127.58 ","$1,127.58 ",$453.22 ,"$1,066.40 ","$1,133.05 ",$833.13 ,"$1,199.70 ", N/A ,"$1,266.35 ","$1,199.70 ","$1,133.05 ","$1,133.05 ",$453.22 ,"$1,133.05 ","$1,133.05 ","$1,199.70 ", N/A ,$559.86 ,"$1,199.70 ", N/A ,"$1,226.36 ","$1,199.70 ",$888.31 ,$888.31 ,$811.80 ,$888.31 ,$866.45 ,$928.43 ,$296.19 ,"$1,053.07 ", N/A , N/A , N/A ,$453.22 , N/A , N/A ,"$1,266.35 ","$1,093.06 ","$1,093.06 ","$1,066.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800213,C1768,HC GRAFT VASCUGARD,278,1 ,$668.00 ,$334.00 ,$148.43 ,$668.00 , N/A ,$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 , N/A ,$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 , N/A ,$280.56 ,$601.20 , N/A ,$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 , N/A , N/A , N/A ,$227.12 , N/A , N/A ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800220,C1771,HC DEVICE URINARY W/SLING GRAFT,278,1 ,"$2,945.00 ","$1,472.50 ",$654.38 ,"$2,945.00 ", N/A ,"$2,491.18 ","$2,491.18 ","$1,001.30 ","$2,356.00 ","$2,503.25 ","$1,840.63 ","$2,650.50 ", N/A ,"$2,797.75 ","$2,650.50 ","$2,503.25 ","$2,503.25 ","$1,001.30 ","$2,503.25 ","$2,503.25 ","$2,650.50 ", N/A ,"$1,236.90 ","$2,650.50 ", N/A ,"$2,709.40 ","$2,650.50 ","$1,962.55 ","$1,962.55 ","$1,793.51 ","$1,962.55 ","$1,914.25 ","$2,051.19 ",$654.38 ,"$2,326.55 ", N/A , N/A , N/A ,"$1,001.30 ", N/A , N/A ,"$2,797.75 ","$2,414.90 ","$2,414.90 ","$2,356.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800223,C1771,HC SLING MONARC PLUS,278,1 ,"$2,166.00 ","$1,083.00 ",$481.29 ,"$2,166.00 ", N/A ,"$1,832.22 ","$1,832.22 ",$736.44 ,"$1,732.80 ","$1,841.10 ","$1,353.75 ","$1,949.40 ", N/A ,"$2,057.70 ","$1,949.40 ","$1,841.10 ","$1,841.10 ",$736.44 ,"$1,841.10 ","$1,841.10 ","$1,949.40 ", N/A ,$909.72 ,"$1,949.40 ", N/A ,"$1,992.72 ","$1,949.40 ","$1,443.42 ","$1,443.42 ","$1,319.09 ","$1,443.42 ","$1,407.90 ","$1,508.62 ",$481.29 ,"$1,711.14 ", N/A , N/A , N/A ,$736.44 , N/A , N/A ,"$2,057.70 ","$1,776.12 ","$1,776.12 ","$1,732.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800224,C1771,HC SLING SPARC,278,1 ,"$2,969.00 ","$1,484.50 ",$659.71 ,"$2,969.00 ", N/A ,"$2,511.48 ","$2,511.48 ","$1,009.46 ","$2,375.20 ","$2,523.65 ","$1,855.63 ","$2,672.10 ", N/A ,"$2,820.55 ","$2,672.10 ","$2,523.65 ","$2,523.65 ","$1,009.46 ","$2,523.65 ","$2,523.65 ","$2,672.10 ", N/A ,"$1,246.98 ","$2,672.10 ", N/A ,"$2,731.48 ","$2,672.10 ","$1,978.54 ","$1,978.54 ","$1,808.12 ","$1,978.54 ","$1,929.85 ","$2,067.91 ",$659.71 ,"$2,345.51 ", N/A , N/A , N/A ,"$1,009.46 ", N/A , N/A ,"$2,820.55 ","$2,434.58 ","$2,434.58 ","$2,375.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800225,C1772,HC PAIN PUMP,278,1 ,$500.00 ,$250.00 ,$111.10 ,$500.00 , N/A ,$422.95 ,$422.95 ,$170.00 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$170.00 ,$425.00 ,$425.00 ,$450.00 , N/A ,$210.00 ,$450.00 , N/A ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$111.10 ,$395.00 , N/A , N/A , N/A ,$170.00 , N/A , N/A ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800227,C1772,HC PUMP SYNCHROMED INTRATHECAL,278,1 ,"$24,737.00 ","$12,368.50 ","$5,496.56 ","$24,737.00 ", N/A ,"$20,925.03 ","$20,925.03 ","$8,410.58 ","$19,789.60 ","$21,026.45 ","$15,460.63 ","$22,263.30 ", N/A ,"$23,500.15 ","$22,263.30 ","$21,026.45 ","$21,026.45 ","$8,410.58 ","$21,026.45 ","$21,026.45 ","$22,263.30 ", N/A ,"$10,389.54 ","$22,263.30 ", N/A ,"$22,758.04 ","$22,263.30 ","$16,484.74 ","$16,484.74 ","$15,064.83 ","$16,484.74 ","$16,079.05 ","$17,229.32 ","$5,496.56 ","$19,542.23 ", N/A ,"$12,368.50 ","$12,368.50 ","$8,410.58 ","$12,368.50 ", N/A ,"$23,500.15 ","$20,284.34 ","$20,284.34 ","$19,789.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800401,C1776,HC ACT CUP,278,1 ,"$1,755.00 ",$877.50 ,$389.96 ,"$1,755.00 ", N/A ,"$1,484.55 ","$1,484.55 ",$596.70 ,"$1,404.00 ","$1,491.75 ","$1,096.88 ","$1,579.50 ", N/A ,"$1,667.25 ","$1,579.50 ","$1,491.75 ","$1,491.75 ",$596.70 ,"$1,491.75 ","$1,491.75 ","$1,579.50 ", N/A ,$737.10 ,"$1,579.50 ", N/A ,"$1,614.60 ","$1,579.50 ","$1,169.53 ","$1,169.53 ","$1,068.80 ","$1,169.53 ","$1,140.75 ","$1,222.36 ",$389.96 ,"$1,386.45 ", N/A , N/A , N/A ,$596.70 , N/A , N/A ,"$1,667.25 ","$1,439.10 ","$1,439.10 ","$1,404.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800429,C1781,HC MESH,278,1 ,"$6,005.00 ","$3,002.50 ","$1,334.31 ","$6,005.00 ", N/A ,"$5,079.63 ","$5,079.63 ","$2,041.70 ","$4,804.00 ","$5,104.25 ","$3,753.13 ","$5,404.50 ", N/A ,"$5,704.75 ","$5,404.50 ","$5,104.25 ","$5,104.25 ","$2,041.70 ","$5,104.25 ","$5,104.25 ","$5,404.50 ", N/A ,"$2,522.10 ","$5,404.50 ", N/A ,"$5,524.60 ","$5,404.50 ","$4,001.73 ","$4,001.73 ","$3,657.05 ","$4,001.73 ","$3,903.25 ","$4,182.48 ","$1,334.31 ","$4,743.95 ", N/A ,"$3,002.50 ","$3,002.50 ","$2,041.70 ","$3,002.50 ", N/A ,"$5,704.75 ","$4,924.10 ","$4,924.10 ","$4,804.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800430,C1781,HC MESH 3D MAX L/R,278,1 ,$730.00 ,$365.00 ,$162.21 ,$730.00 , N/A ,$617.51 ,$617.51 ,$248.20 ,$584.00 ,$620.50 ,$456.25 ,$657.00 , N/A ,$693.50 ,$657.00 ,$620.50 ,$620.50 ,$248.20 ,$620.50 ,$620.50 ,$657.00 , N/A ,$306.60 ,$657.00 , N/A ,$671.60 ,$657.00 ,$486.47 ,$486.47 ,$444.57 ,$486.47 ,$474.50 ,$508.45 ,$162.21 ,$576.70 , N/A , N/A , N/A ,$248.20 , N/A , N/A ,$693.50 ,$598.60 ,$598.60 ,$584.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800441,C1781,HC MESH KUGEL HERNIA MED OV,278,1 ,"$2,377.00 ","$1,188.50 ",$528.17 ,"$2,377.00 ", N/A ,"$2,010.70 ","$2,010.70 ",$808.18 ,"$1,901.60 ","$2,020.45 ","$1,485.63 ","$2,139.30 ", N/A ,"$2,258.15 ","$2,139.30 ","$2,020.45 ","$2,020.45 ",$808.18 ,"$2,020.45 ","$2,020.45 ","$2,139.30 ", N/A ,$998.34 ,"$2,139.30 ", N/A ,"$2,186.84 ","$2,139.30 ","$1,584.03 ","$1,584.03 ","$1,447.59 ","$1,584.03 ","$1,545.05 ","$1,655.58 ",$528.17 ,"$1,877.83 ", N/A , N/A , N/A ,$808.18 , N/A , N/A ,"$2,258.15 ","$1,949.14 ","$1,949.14 ","$1,901.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800443,C1781,HC MESH KUGEL HERNIA SM OVL,278,1 ,$717.00 ,$358.50 ,$159.32 ,$717.00 , N/A ,$606.51 ,$606.51 ,$243.78 ,$573.60 ,$609.45 ,$448.13 ,$645.30 , N/A ,$681.15 ,$645.30 ,$609.45 ,$609.45 ,$243.78 ,$609.45 ,$609.45 ,$645.30 , N/A ,$301.14 ,$645.30 , N/A ,$659.64 ,$645.30 ,$477.81 ,$477.81 ,$436.65 ,$477.81 ,$466.05 ,$499.39 ,$159.32 ,$566.43 , N/A , N/A , N/A ,$243.78 , N/A , N/A ,$681.15 ,$587.94 ,$587.94 ,$573.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800446,C1781,HC MESH MARLEX 10X14,278,1 ,$320.00 ,$160.00 ,$71.10 ,$320.00 , N/A ,$270.69 ,$270.69 ,$108.80 ,$256.00 ,$272.00 ,$200.00 ,$288.00 , N/A ,$304.00 ,$288.00 ,$272.00 ,$272.00 ,$108.80 ,$272.00 ,$272.00 ,$288.00 , N/A ,$134.40 ,$288.00 , N/A ,$294.40 ,$288.00 ,$213.25 ,$213.25 ,$194.88 ,$213.25 ,$208.00 ,$222.88 ,$71.10 ,$252.80 , N/A , N/A , N/A ,$108.80 , N/A , N/A ,$304.00 ,$262.40 ,$262.40 ,$256.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800448,C1781,HC MESH MARLEX 2X4,278,1 ,$159.00 ,$79.50 ,$35.33 ,$159.00 , N/A ,$134.50 ,$134.50 ,$54.06 ,$127.20 ,$135.15 ,$99.38 ,$143.10 , N/A ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$54.06 ,$135.15 ,$135.15 ,$143.10 , N/A ,$66.78 ,$143.10 , N/A ,$146.28 ,$143.10 ,$105.96 ,$105.96 ,$96.83 ,$105.96 ,$103.35 ,$110.74 ,$35.33 ,$125.61 , N/A , N/A , N/A ,$54.06 , N/A , N/A ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800449,C1781,HC MESH MARLEX 3X6IN,278,1 ,$166.00 ,$83.00 ,$36.89 ,$166.00 , N/A ,$140.42 ,$140.42 ,$56.44 ,$132.80 ,$141.10 ,$103.75 ,$149.40 , N/A ,$157.70 ,$149.40 ,$141.10 ,$141.10 ,$56.44 ,$141.10 ,$141.10 ,$149.40 , N/A ,$69.72 ,$149.40 , N/A ,$152.72 ,$149.40 ,$110.62 ,$110.62 ,$101.09 ,$110.62 ,$107.90 ,$115.62 ,$36.89 ,$131.14 , N/A , N/A , N/A ,$56.44 , N/A , N/A ,$157.70 ,$136.12 ,$136.12 ,$132.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800450,C1781,HC MESH MARLEX 6X6,278,1 ,$401.00 ,$200.50 ,$89.10 ,$401.00 , N/A ,$339.21 ,$339.21 ,$136.34 ,$320.80 ,$340.85 ,$250.63 ,$360.90 , N/A ,$380.95 ,$360.90 ,$340.85 ,$340.85 ,$136.34 ,$340.85 ,$340.85 ,$360.90 , N/A ,$168.42 ,$360.90 , N/A ,$368.92 ,$360.90 ,$267.23 ,$267.23 ,$244.21 ,$267.23 ,$260.65 ,$279.30 ,$89.10 ,$316.79 , N/A , N/A , N/A ,$136.34 , N/A , N/A ,$380.95 ,$328.82 ,$328.82 ,$320.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800451,C1781,HC MESH MARLEX PLUG,278,1 ,$457.00 ,$228.50 ,$101.55 ,$457.00 , N/A ,$386.58 ,$386.58 ,$155.38 ,$365.60 ,$388.45 ,$285.63 ,$411.30 , N/A ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$155.38 ,$388.45 ,$388.45 ,$411.30 , N/A ,$191.94 ,$411.30 , N/A ,$420.44 ,$411.30 ,$304.54 ,$304.54 ,$278.31 ,$304.54 ,$297.05 ,$318.30 ,$101.55 ,$361.03 , N/A , N/A , N/A ,$155.38 , N/A , N/A ,$434.15 ,$374.74 ,$374.74 ,$365.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800452,C1781,HC MESH MARLEX PLUG LG,278,1 ,$457.00 ,$228.50 ,$101.55 ,$457.00 , N/A ,$386.58 ,$386.58 ,$155.38 ,$365.60 ,$388.45 ,$285.63 ,$411.30 , N/A ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$155.38 ,$388.45 ,$388.45 ,$411.30 , N/A ,$191.94 ,$411.30 , N/A ,$420.44 ,$411.30 ,$304.54 ,$304.54 ,$278.31 ,$304.54 ,$297.05 ,$318.30 ,$101.55 ,$361.03 , N/A , N/A , N/A ,$155.38 , N/A , N/A ,$434.15 ,$374.74 ,$374.74 ,$365.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800453,C1781,HC MESH MARLEX PLUG MED,278,1 ,$457.00 ,$228.50 ,$101.55 ,$457.00 , N/A ,$386.58 ,$386.58 ,$155.38 ,$365.60 ,$388.45 ,$285.63 ,$411.30 , N/A ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$155.38 ,$388.45 ,$388.45 ,$411.30 , N/A ,$191.94 ,$411.30 , N/A ,$420.44 ,$411.30 ,$304.54 ,$304.54 ,$278.31 ,$304.54 ,$297.05 ,$318.30 ,$101.55 ,$361.03 , N/A , N/A , N/A ,$155.38 , N/A , N/A ,$434.15 ,$374.74 ,$374.74 ,$365.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800454,C1781,HC MESH MARLEX PLUG SMALL,278,1 ,$503.00 ,$251.50 ,$111.77 ,$503.00 , N/A ,$425.49 ,$425.49 ,$171.02 ,$402.40 ,$427.55 ,$314.38 ,$452.70 , N/A ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$171.02 ,$427.55 ,$427.55 ,$452.70 , N/A ,$211.26 ,$452.70 , N/A ,$462.76 ,$452.70 ,$335.20 ,$335.20 ,$306.33 ,$335.20 ,$326.95 ,$350.34 ,$111.77 ,$397.37 , N/A , N/A , N/A ,$171.02 , N/A , N/A ,$477.85 ,$412.46 ,$412.46 ,$402.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800455,C1781,HC MESH MARLEX PLUG XLG,278,1 ,$536.00 ,$268.00 ,$119.10 ,$536.00 , N/A ,$453.40 ,$453.40 ,$182.24 ,$428.80 ,$455.60 ,$335.00 ,$482.40 , N/A ,$509.20 ,$482.40 ,$455.60 ,$455.60 ,$182.24 ,$455.60 ,$455.60 ,$482.40 , N/A ,$225.12 ,$482.40 , N/A ,$493.12 ,$482.40 ,$357.19 ,$357.19 ,$326.42 ,$357.19 ,$348.40 ,$373.32 ,$119.10 ,$423.44 , N/A , N/A , N/A ,$182.24 , N/A , N/A ,$509.20 ,$439.52 ,$439.52 ,$428.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800457,C1781,HC MESH PARIETEX 13 X 9CM,278,1 ,$815.00 ,$407.50 ,$181.09 ,$815.00 , N/A ,$689.41 ,$689.41 ,$277.10 ,$652.00 ,$692.75 ,$509.38 ,$733.50 , N/A ,$774.25 ,$733.50 ,$692.75 ,$692.75 ,$277.10 ,$692.75 ,$692.75 ,$733.50 , N/A ,$342.30 ,$733.50 , N/A ,$749.80 ,$733.50 ,$543.12 ,$543.12 ,$496.34 ,$543.12 ,$529.75 ,$567.65 ,$181.09 ,$643.85 , N/A , N/A , N/A ,$277.10 , N/A , N/A ,$774.25 ,$668.30 ,$668.30 ,$652.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800463,C1781,HC MESH PROCEED VENTRAL PATCH MED,278,1 ,"$1,400.00 ",$700.00 ,$311.08 ,"$1,400.00 ", N/A ,"$1,184.26 ","$1,184.26 ",$476.00 ,"$1,120.00 ","$1,190.00 ",$875.00 ,"$1,260.00 ", N/A ,"$1,330.00 ","$1,260.00 ","$1,190.00 ","$1,190.00 ",$476.00 ,"$1,190.00 ","$1,190.00 ","$1,260.00 ", N/A ,$588.00 ,"$1,260.00 ", N/A ,"$1,288.00 ","$1,260.00 ",$932.96 ,$932.96 ,$852.60 ,$932.96 ,$910.00 ,$975.10 ,$311.08 ,"$1,106.00 ", N/A , N/A , N/A ,$476.00 , N/A , N/A ,"$1,330.00 ","$1,148.00 ","$1,148.00 ","$1,120.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800468,C1781,HC MESH 3D MAX MED LRG,278,1 ,$774.00 ,$387.00 ,$171.98 ,$774.00 , N/A ,$654.73 ,$654.73 ,$263.16 ,$619.20 ,$657.90 ,$483.75 ,$696.60 , N/A ,$735.30 ,$696.60 ,$657.90 ,$657.90 ,$263.16 ,$657.90 ,$657.90 ,$696.60 , N/A ,$325.08 ,$696.60 , N/A ,$712.08 ,$696.60 ,$515.79 ,$515.79 ,$471.37 ,$515.79 ,$503.10 ,$539.09 ,$171.98 ,$611.46 , N/A , N/A , N/A ,$263.16 , N/A , N/A ,$735.30 ,$634.68 ,$634.68 ,$619.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800478,C1781,HC MESH VENTRAL X LARGE,278,1 ,"$1,751.00 ",$875.50 ,$389.07 ,"$1,751.00 ", N/A ,"$1,481.17 ","$1,481.17 ",$595.34 ,"$1,400.80 ","$1,488.35 ","$1,094.38 ","$1,575.90 ", N/A ,"$1,663.45 ","$1,575.90 ","$1,488.35 ","$1,488.35 ",$595.34 ,"$1,488.35 ","$1,488.35 ","$1,575.90 ", N/A ,$735.42 ,"$1,575.90 ", N/A ,"$1,610.92 ","$1,575.90 ","$1,166.87 ","$1,166.87 ","$1,066.36 ","$1,166.87 ","$1,138.15 ","$1,219.57 ",$389.07 ,"$1,383.29 ", N/A , N/A , N/A ,$595.34 , N/A , N/A ,"$1,663.45 ","$1,435.82 ","$1,435.82 ","$1,400.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800480,C1781,HC MESH VENTRALEX SMALL (0010301),278,1 ,"$1,169.00 ",$584.50 ,$259.75 ,"$1,169.00 ", N/A ,$988.86 ,$988.86 ,$397.46 ,$935.20 ,$993.65 ,$730.63 ,"$1,052.10 ", N/A ,"$1,110.55 ","$1,052.10 ",$993.65 ,$993.65 ,$397.46 ,$993.65 ,$993.65 ,"$1,052.10 ", N/A ,$490.98 ,"$1,052.10 ", N/A ,"$1,075.48 ","$1,052.10 ",$779.02 ,$779.02 ,$711.92 ,$779.02 ,$759.85 ,$814.21 ,$259.75 ,$923.51 , N/A , N/A , N/A ,$397.46 , N/A , N/A ,"$1,110.55 ",$958.58 ,$958.58 ,$935.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800484,C1783,HC IMPLANT GLACOM VALV AHMED,278,1 ,"$1,284.00 ",$642.00 ,$285.30 ,"$1,284.00 ", N/A ,"$1,086.14 ","$1,086.14 ",$436.56 ,"$1,027.20 ","$1,091.40 ",$802.50 ,"$1,155.60 ", N/A ,"$1,219.80 ","$1,155.60 ","$1,091.40 ","$1,091.40 ",$436.56 ,"$1,091.40 ","$1,091.40 ","$1,155.60 ", N/A ,$539.28 ,"$1,155.60 ", N/A ,"$1,181.28 ","$1,155.60 ",$855.66 ,$855.66 ,$781.96 ,$855.66 ,$834.60 ,$894.31 ,$285.30 ,"$1,014.36 ", N/A , N/A , N/A ,$436.56 , N/A , N/A ,"$1,219.80 ","$1,052.88 ","$1,052.88 ","$1,027.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800561,C1894,SNS HC INTRODUCER SHEATH PLEURX,278,1 ,$79.00 ,$39.50 ,$17.55 ,$79.00 , N/A ,$66.83 ,$66.83 ,$26.86 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$26.86 ,$67.15 ,$67.15 ,$71.10 , N/A ,$33.18 ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.65 ,$52.65 ,$48.11 ,$52.65 ,$51.35 ,$55.02 ,$17.55 ,$62.41 , N/A , N/A , N/A ,$26.86 , N/A , N/A ,$75.05 ,$64.78 ,$64.78 ,$63.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800569,C2617,HC STENT URETERAL FILI 6FRX24CM,278,1 ,$412.00 ,$206.00 ,$91.55 ,$412.00 , N/A ,$348.51 ,$348.51 ,$140.08 ,$329.60 ,$350.20 ,$257.50 ,$370.80 , N/A ,$391.40 ,$370.80 ,$350.20 ,$350.20 ,$140.08 ,$350.20 ,$350.20 ,$370.80 , N/A ,$173.04 ,$370.80 , N/A ,$379.04 ,$370.80 ,$274.56 ,$274.56 ,$250.91 ,$274.56 ,$267.80 ,$286.96 ,$91.55 ,$325.48 , N/A , N/A , N/A ,$140.08 , N/A , N/A ,$391.40 ,$337.84 ,$337.84 ,$329.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800586,C1713,HC 30CC CANC CHIPS,278,1 ,$838.00 ,$419.00 ,$186.20 ,$838.00 , N/A ,$708.86 ,$708.86 ,$284.92 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$284.92 ,$712.30 ,$712.30 ,$754.20 , N/A ,$351.96 ,$754.20 , N/A ,$770.96 ,$754.20 ,$558.44 ,$558.44 ,$510.34 ,$558.44 ,$544.70 ,$583.67 ,$186.20 ,$662.02 , N/A , N/A , N/A ,$284.92 , N/A , N/A ,$796.10 ,$687.16 ,$687.16 ,$670.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800607,N/A,HC CABLE WITH CRIMP,278,1 ,"$1,528.00 ",$764.00 ,$339.52 ,"$1,528.00 ", N/A ,"$1,292.54 ","$1,292.54 ",$519.52 ,"$1,222.40 ","$1,298.80 ",$955.00 ,"$1,375.20 ", N/A ,"$1,451.60 ","$1,375.20 ","$1,298.80 ","$1,298.80 ",$519.52 ,"$1,298.80 ","$1,298.80 ","$1,375.20 ", N/A ,$641.76 ,"$1,375.20 ", N/A ,"$1,405.76 ","$1,375.20 ","$1,018.26 ","$1,018.26 ",$930.55 ,"$1,018.26 ",$993.20 ,"$1,064.25 ",$339.52 ,"$1,207.12 ", N/A , N/A , N/A ,$519.52 , N/A , N/A ,"$1,451.60 ","$1,252.96 ","$1,252.96 ","$1,222.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800617,N/A,HC CAR FIB ROD 8MM X 200MM,278,1 ,$500.00 ,$250.00 ,$111.10 ,$500.00 , N/A ,$422.95 ,$422.95 ,$170.00 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$170.00 ,$425.00 ,$425.00 ,$450.00 , N/A ,$210.00 ,$450.00 , N/A ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$111.10 ,$395.00 , N/A , N/A , N/A ,$170.00 , N/A , N/A ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800618,N/A,HC CAR FIB ROD 8MM X 220MM,278,1 ,$500.00 ,$250.00 ,$111.10 ,$500.00 , N/A ,$422.95 ,$422.95 ,$170.00 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$170.00 ,$425.00 ,$425.00 ,$450.00 , N/A ,$210.00 ,$450.00 , N/A ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$111.10 ,$395.00 , N/A , N/A , N/A ,$170.00 , N/A , N/A ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800619,N/A,HC CAR FIB ROD 8MM X 240MM,278,1 ,$500.00 ,$250.00 ,$111.10 ,$500.00 , N/A ,$422.95 ,$422.95 ,$170.00 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$170.00 ,$425.00 ,$425.00 ,$450.00 , N/A ,$210.00 ,$450.00 , N/A ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$111.10 ,$395.00 , N/A , N/A , N/A ,$170.00 , N/A , N/A ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800624,N/A,HC CEMENT,278,1 ,"$3,186.00 ","$1,593.00 ",$707.93 ,"$3,186.00 ", N/A ,"$2,695.04 ","$2,695.04 ","$1,083.24 ","$2,548.80 ","$2,708.10 ","$1,991.25 ","$2,867.40 ", N/A ,"$3,026.70 ","$2,867.40 ","$2,708.10 ","$2,708.10 ","$1,083.24 ","$2,708.10 ","$2,708.10 ","$2,867.40 ", N/A ,"$1,338.12 ","$2,867.40 ", N/A ,"$2,931.12 ","$2,867.40 ","$2,123.15 ","$2,123.15 ","$1,940.27 ","$2,123.15 ","$2,070.90 ","$2,219.05 ",$707.93 ,"$2,516.94 ", N/A , N/A , N/A ,"$1,083.24 ", N/A , N/A ,"$3,026.70 ","$2,612.52 ","$2,612.52 ","$2,548.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800625,N/A,HC CEMENT BONE WITH TROBRAMYCIN F,278,1 ,$538.00 ,$269.00 ,$119.54 ,$538.00 , N/A ,$455.09 ,$455.09 ,$182.92 ,$430.40 ,$457.30 ,$336.25 ,$484.20 , N/A ,$511.10 ,$484.20 ,$457.30 ,$457.30 ,$182.92 ,$457.30 ,$457.30 ,$484.20 , N/A ,$225.96 ,$484.20 , N/A ,$494.96 ,$484.20 ,$358.52 ,$358.52 ,$327.64 ,$358.52 ,$349.70 ,$374.72 ,$119.54 ,$425.02 , N/A , N/A , N/A ,$182.92 , N/A , N/A ,$511.10 ,$441.16 ,$441.16 ,$430.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800627,C1776,HC CEMENT FULL DOSE ANTIBOTIC,278,1 ,"$1,018.00 ",$509.00 ,$226.20 ,"$1,018.00 ", N/A ,$861.13 ,$861.13 ,$346.12 ,$814.40 ,$865.30 ,$636.25 ,$916.20 , N/A ,$967.10 ,$916.20 ,$865.30 ,$865.30 ,$346.12 ,$865.30 ,$865.30 ,$916.20 , N/A ,$427.56 ,$916.20 , N/A ,$936.56 ,$916.20 ,$678.40 ,$678.40 ,$619.96 ,$678.40 ,$661.70 ,$709.04 ,$226.20 ,$804.22 , N/A , N/A , N/A ,$346.12 , N/A , N/A ,$967.10 ,$834.76 ,$834.76 ,$814.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800628,N/A,HC CEMENT HALF DOSE,278,1 ,$120.00 ,$60.00 ,$26.66 ,$120.00 , N/A ,$101.51 ,$101.51 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 , N/A ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 , N/A ,$50.40 ,$108.00 , N/A ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 , N/A , N/A , N/A ,$40.80 , N/A , N/A ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800629,N/A,HC CEMENT W/MIXER KYPHON,278,1 ,$221.00 ,$110.50 ,$49.11 ,$221.00 , N/A ,$186.94 ,$186.94 ,$75.14 ,$176.80 ,$187.85 ,$138.13 ,$198.90 , N/A ,$209.95 ,$198.90 ,$187.85 ,$187.85 ,$75.14 ,$187.85 ,$187.85 ,$198.90 , N/A ,$92.82 ,$198.90 , N/A ,$203.32 ,$198.90 ,$147.27 ,$147.27 ,$134.59 ,$147.27 ,$143.65 ,$153.93 ,$49.11 ,$174.59 , N/A , N/A , N/A ,$75.14 , N/A , N/A ,$209.95 ,$181.22 ,$181.22 ,$176.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800644,N/A,HC EAR VENT,278,1 ,$65.00 ,$32.50 ,$14.44 ,$65.00 , N/A ,$54.98 ,$54.98 ,$22.10 ,$52.00 ,$55.25 ,$40.63 ,$58.50 , N/A ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$22.10 ,$55.25 ,$55.25 ,$58.50 , N/A ,$27.30 ,$58.50 , N/A ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 , N/A , N/A , N/A ,$22.10 , N/A , N/A ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800661,N/A,HC FIBER HOLMIUM 400UM,278,1 ,$79.00 ,$39.50 ,$17.55 ,$79.00 , N/A ,$66.83 ,$66.83 ,$26.86 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$26.86 ,$67.15 ,$67.15 ,$71.10 , N/A ,$33.18 ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.65 ,$52.65 ,$48.11 ,$52.65 ,$51.35 ,$55.02 ,$17.55 ,$62.41 , N/A , N/A , N/A ,$26.86 , N/A , N/A ,$75.05 ,$64.78 ,$64.78 ,$63.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800689,C1769,HC GUIDE WIRE SYNTH 3.2,278,1 ,$83.00 ,$41.50 ,$18.44 ,$83.00 , N/A ,$70.21 ,$70.21 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 , N/A ,$34.86 ,$74.70 , N/A ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 , N/A , N/A , N/A ,$28.22 , N/A , N/A ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800742,N/A,HC K-WIRE 1.6MM,278,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A , N/A , N/A ,$9.52 , N/A , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800743,N/A,HC K-WIRE ALL SIZES,278,1 ,$19.00 ,$9.50 ,$4.22 ,$19.00 , N/A ,$16.07 ,$16.07 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 , N/A ,$7.98 ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 , N/A , N/A , N/A ,$6.46 , N/A , N/A ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800770,N/A,HC MIX DBX 10CC,278,1 ,"$4,581.00 ","$2,290.50 ","$1,017.90 ","$4,581.00 ", N/A ,"$3,875.07 ","$3,875.07 ","$1,557.54 ","$3,664.80 ","$3,893.85 ","$2,863.13 ","$4,122.90 ", N/A ,"$4,351.95 ","$4,122.90 ","$3,893.85 ","$3,893.85 ","$1,557.54 ","$3,893.85 ","$3,893.85 ","$4,122.90 ", N/A ,"$1,924.02 ","$4,122.90 ", N/A ,"$4,214.52 ","$4,122.90 ","$3,052.78 ","$3,052.78 ","$2,789.83 ","$3,052.78 ","$2,977.65 ","$3,190.67 ","$1,017.90 ","$3,618.99 ", N/A , N/A , N/A ,"$1,557.54 ", N/A , N/A ,"$4,351.95 ","$3,756.42 ","$3,756.42 ","$3,664.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800793,N/A,HC PIN STEINMAN-THREADED,278,1 ,$392.00 ,$196.00 ,$87.10 ,$392.00 , N/A ,$331.59 ,$331.59 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 , N/A ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 , N/A ,$164.64 ,$352.80 , N/A ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 , N/A , N/A , N/A ,$133.28 , N/A , N/A ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800797,N/A,HC PIN-ORTHOSORB REUNITE 1.5,278,1 ,"$2,066.00 ","$1,033.00 ",$459.07 ,"$2,066.00 ", N/A ,"$1,747.63 ","$1,747.63 ",$702.44 ,"$1,652.80 ","$1,756.10 ","$1,291.25 ","$1,859.40 ", N/A ,"$1,962.70 ","$1,859.40 ","$1,756.10 ","$1,756.10 ",$702.44 ,"$1,756.10 ","$1,756.10 ","$1,859.40 ", N/A ,$867.72 ,"$1,859.40 ", N/A ,"$1,900.72 ","$1,859.40 ","$1,376.78 ","$1,376.78 ","$1,258.19 ","$1,376.78 ","$1,342.90 ","$1,438.97 ",$459.07 ,"$1,632.14 ", N/A , N/A , N/A ,$702.44 , N/A , N/A ,"$1,962.70 ","$1,694.12 ","$1,694.12 ","$1,652.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800802,C1713,HC PLATE 1/3 TUBULAR 10 HOLE 117,278,1 ,$566.00 ,$283.00 ,$125.77 ,$566.00 , N/A ,$478.78 ,$478.78 ,$192.44 ,$452.80 ,$481.10 ,$353.75 ,$509.40 , N/A ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$192.44 ,$481.10 ,$481.10 ,$509.40 , N/A ,$237.72 ,$509.40 , N/A ,$520.72 ,$509.40 ,$377.18 ,$377.18 ,$344.69 ,$377.18 ,$367.90 ,$394.22 ,$125.77 ,$447.14 , N/A , N/A , N/A ,$192.44 , N/A , N/A ,$537.70 ,$464.12 ,$464.12 ,$452.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800803,C1713,HC PLATE 1/3 TUBULAR 12 HOLE 141,278,1 ,$618.00 ,$309.00 ,$137.32 ,$618.00 , N/A ,$522.77 ,$522.77 ,$210.12 ,$494.40 ,$525.30 ,$386.25 ,$556.20 , N/A ,$587.10 ,$556.20 ,$525.30 ,$525.30 ,$210.12 ,$525.30 ,$525.30 ,$556.20 , N/A ,$259.56 ,$556.20 , N/A ,$568.56 ,$556.20 ,$411.84 ,$411.84 ,$376.36 ,$411.84 ,$401.70 ,$430.44 ,$137.32 ,$488.22 , N/A , N/A , N/A ,$210.12 , N/A , N/A ,$587.10 ,$506.76 ,$506.76 ,$494.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800804,C1713,HC PLATE 1/3 TUBULAR 5 HOLE 57,278,1 ,$555.00 ,$277.50 ,$123.32 ,$555.00 , N/A ,$469.47 ,$469.47 ,$188.70 ,$444.00 ,$471.75 ,$346.88 ,$499.50 , N/A ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$188.70 ,$471.75 ,$471.75 ,$499.50 , N/A ,$233.10 ,$499.50 , N/A ,$510.60 ,$499.50 ,$369.85 ,$369.85 ,$338.00 ,$369.85 ,$360.75 ,$386.56 ,$123.32 ,$438.45 , N/A , N/A , N/A ,$188.70 , N/A , N/A ,$527.25 ,$455.10 ,$455.10 ,$444.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800805,C1713,HC PLATE 1/3 TUBULAR 6 HOLE 69,278,1 ,$555.00 ,$277.50 ,$123.32 ,$555.00 , N/A ,$469.47 ,$469.47 ,$188.70 ,$444.00 ,$471.75 ,$346.88 ,$499.50 , N/A ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$188.70 ,$471.75 ,$471.75 ,$499.50 , N/A ,$233.10 ,$499.50 , N/A ,$510.60 ,$499.50 ,$369.85 ,$369.85 ,$338.00 ,$369.85 ,$360.75 ,$386.56 ,$123.32 ,$438.45 , N/A , N/A , N/A ,$188.70 , N/A , N/A ,$527.25 ,$455.10 ,$455.10 ,$444.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800806,C1713,HC PLATE 1/3 TUBULAR 7 HOLE 81,278,1 ,$566.00 ,$283.00 ,$125.77 ,$566.00 , N/A ,$478.78 ,$478.78 ,$192.44 ,$452.80 ,$481.10 ,$353.75 ,$509.40 , N/A ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$192.44 ,$481.10 ,$481.10 ,$509.40 , N/A ,$237.72 ,$509.40 , N/A ,$520.72 ,$509.40 ,$377.18 ,$377.18 ,$344.69 ,$377.18 ,$367.90 ,$394.22 ,$125.77 ,$447.14 , N/A , N/A , N/A ,$192.44 , N/A , N/A ,$537.70 ,$464.12 ,$464.12 ,$452.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800807,C1713,HC PLATE 1/3 TUBULAR 8 HOLE 93,278,1 ,$566.00 ,$283.00 ,$125.77 ,$566.00 , N/A ,$478.78 ,$478.78 ,$192.44 ,$452.80 ,$481.10 ,$353.75 ,$509.40 , N/A ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$192.44 ,$481.10 ,$481.10 ,$509.40 , N/A ,$237.72 ,$509.40 , N/A ,$520.72 ,$509.40 ,$377.18 ,$377.18 ,$344.69 ,$377.18 ,$367.90 ,$394.22 ,$125.77 ,$447.14 , N/A , N/A , N/A ,$192.44 , N/A , N/A ,$537.70 ,$464.12 ,$464.12 ,$452.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800820,C1713,HC PLATE 3.5 RECON 10 HOLE 140 MM,278,1 ,"$1,773.00 ",$886.50 ,$393.96 ,"$1,773.00 ", N/A ,"$1,499.78 ","$1,499.78 ",$602.82 ,"$1,418.40 ","$1,507.05 ","$1,108.13 ","$1,595.70 ", N/A ,"$1,684.35 ","$1,595.70 ","$1,507.05 ","$1,507.05 ",$602.82 ,"$1,507.05 ","$1,507.05 ","$1,595.70 ", N/A ,$744.66 ,"$1,595.70 ", N/A ,"$1,631.16 ","$1,595.70 ","$1,181.53 ","$1,181.53 ","$1,079.76 ","$1,181.53 ","$1,152.45 ","$1,234.89 ",$393.96 ,"$1,400.67 ", N/A , N/A , N/A ,$602.82 , N/A , N/A ,"$1,684.35 ","$1,453.86 ","$1,453.86 ","$1,418.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800822,C1713,HC PLATE 3.5 RECON 5 HOLE 70 MM,278,1 ,"$1,354.00 ",$677.00 ,$300.86 ,"$1,354.00 ", N/A ,"$1,145.35 ","$1,145.35 ",$460.36 ,"$1,083.20 ","$1,150.90 ",$846.25 ,"$1,218.60 ", N/A ,"$1,286.30 ","$1,218.60 ","$1,150.90 ","$1,150.90 ",$460.36 ,"$1,150.90 ","$1,150.90 ","$1,218.60 ", N/A ,$568.68 ,"$1,218.60 ", N/A ,"$1,245.68 ","$1,218.60 ",$902.31 ,$902.31 ,$824.59 ,$902.31 ,$880.10 ,$943.06 ,$300.86 ,"$1,069.66 ", N/A , N/A , N/A ,$460.36 , N/A , N/A ,"$1,286.30 ","$1,110.28 ","$1,110.28 ","$1,083.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800823,C1713,HC PLATE 3.5 RECON 6 HOLE 84 MM,278,1 ,"$1,566.00 ",$783.00 ,$347.97 ,"$1,566.00 ", N/A ,"$1,324.68 ","$1,324.68 ",$532.44 ,"$1,252.80 ","$1,331.10 ",$978.75 ,"$1,409.40 ", N/A ,"$1,487.70 ","$1,409.40 ","$1,331.10 ","$1,331.10 ",$532.44 ,"$1,331.10 ","$1,331.10 ","$1,409.40 ", N/A ,$657.72 ,"$1,409.40 ", N/A ,"$1,440.72 ","$1,409.40 ","$1,043.58 ","$1,043.58 ",$953.69 ,"$1,043.58 ","$1,017.90 ","$1,090.72 ",$347.97 ,"$1,237.14 ", N/A , N/A , N/A ,$532.44 , N/A , N/A ,"$1,487.70 ","$1,284.12 ","$1,284.12 ","$1,252.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800824,C1713,HC PLATE 3.5 RECON 7 HOLE 98 MM,278,1 ,"$1,645.00 ",$822.50 ,$365.52 ,"$1,645.00 ", N/A ,"$1,391.51 ","$1,391.51 ",$559.30 ,"$1,316.00 ","$1,398.25 ","$1,028.13 ","$1,480.50 ", N/A ,"$1,562.75 ","$1,480.50 ","$1,398.25 ","$1,398.25 ",$559.30 ,"$1,398.25 ","$1,398.25 ","$1,480.50 ", N/A ,$690.90 ,"$1,480.50 ", N/A ,"$1,513.40 ","$1,480.50 ","$1,096.23 ","$1,096.23 ","$1,001.81 ","$1,096.23 ","$1,069.25 ","$1,145.74 ",$365.52 ,"$1,299.55 ", N/A , N/A , N/A ,$559.30 , N/A , N/A ,"$1,562.75 ","$1,348.90 ","$1,348.90 ","$1,316.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800825,C1713,HC PLATE 3.5 RECON 8 HOLE 112 MM,278,1 ,"$1,716.00 ",$858.00 ,$381.30 ,"$1,716.00 ", N/A ,"$1,451.56 ","$1,451.56 ",$583.44 ,"$1,372.80 ","$1,458.60 ","$1,072.50 ","$1,544.40 ", N/A ,"$1,630.20 ","$1,544.40 ","$1,458.60 ","$1,458.60 ",$583.44 ,"$1,458.60 ","$1,458.60 ","$1,544.40 ", N/A ,$720.72 ,"$1,544.40 ", N/A ,"$1,578.72 ","$1,544.40 ","$1,143.54 ","$1,143.54 ","$1,045.04 ","$1,143.54 ","$1,115.40 ","$1,195.19 ",$381.30 ,"$1,355.64 ", N/A , N/A , N/A ,$583.44 , N/A , N/A ,"$1,630.20 ","$1,407.12 ","$1,407.12 ","$1,372.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800841,C1713,HC PLATE BROAD DCP 6,278,1 ,"$1,272.00 ",$636.00 ,$282.64 ,"$1,272.00 ", N/A ,"$1,075.98 ","$1,075.98 ",$432.48 ,"$1,017.60 ","$1,081.20 ",$795.00 ,"$1,144.80 ", N/A ,"$1,208.40 ","$1,144.80 ","$1,081.20 ","$1,081.20 ",$432.48 ,"$1,081.20 ","$1,081.20 ","$1,144.80 ", N/A ,$534.24 ,"$1,144.80 ", N/A ,"$1,170.24 ","$1,144.80 ",$847.66 ,$847.66 ,$774.65 ,$847.66 ,$826.80 ,$885.95 ,$282.64 ,"$1,004.88 ", N/A , N/A , N/A ,$432.48 , N/A , N/A ,"$1,208.40 ","$1,043.04 ","$1,043.04 ","$1,017.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800843,C1713,HC PLATE BROAD DCP 8,278,1 ,"$1,650.00 ",$825.00 ,$366.63 ,"$1,650.00 ", N/A ,"$1,395.74 ","$1,395.74 ",$561.00 ,"$1,320.00 ","$1,402.50 ","$1,031.25 ","$1,485.00 ", N/A ,"$1,567.50 ","$1,485.00 ","$1,402.50 ","$1,402.50 ",$561.00 ,"$1,402.50 ","$1,402.50 ","$1,485.00 ", N/A ,$693.00 ,"$1,485.00 ", N/A ,"$1,518.00 ","$1,485.00 ","$1,099.56 ","$1,099.56 ","$1,004.85 ","$1,099.56 ","$1,072.50 ","$1,149.23 ",$366.63 ,"$1,303.50 ", N/A , N/A , N/A ,$561.00 , N/A , N/A ,"$1,567.50 ","$1,353.00 ","$1,353.00 ","$1,320.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800849,C1713,HC PLATE DCP 4,278,1 ,"$1,221.00 ",$610.50 ,$271.31 ,"$1,221.00 ", N/A ,"$1,032.84 ","$1,032.84 ",$415.14 ,$976.80 ,"$1,037.85 ",$763.13 ,"$1,098.90 ", N/A ,"$1,159.95 ","$1,098.90 ","$1,037.85 ","$1,037.85 ",$415.14 ,"$1,037.85 ","$1,037.85 ","$1,098.90 ", N/A ,$512.82 ,"$1,098.90 ", N/A ,"$1,123.32 ","$1,098.90 ",$813.67 ,$813.67 ,$743.59 ,$813.67 ,$793.65 ,$850.43 ,$271.31 ,$964.59 , N/A , N/A , N/A ,$415.14 , N/A , N/A ,"$1,159.95 ","$1,001.22 ","$1,001.22 ",$976.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800853,C1713,HC PLATE DCP 6,278,1 ,"$1,369.00 ",$684.50 ,$304.19 ,"$1,369.00 ", N/A ,"$1,158.04 ","$1,158.04 ",$465.46 ,"$1,095.20 ","$1,163.65 ",$855.63 ,"$1,232.10 ", N/A ,"$1,300.55 ","$1,232.10 ","$1,163.65 ","$1,163.65 ",$465.46 ,"$1,163.65 ","$1,163.65 ","$1,232.10 ", N/A ,$574.98 ,"$1,232.10 ", N/A ,"$1,259.48 ","$1,232.10 ",$912.30 ,$912.30 ,$833.72 ,$912.30 ,$889.85 ,$953.51 ,$304.19 ,"$1,081.51 ", N/A , N/A , N/A ,$465.46 , N/A , N/A ,"$1,300.55 ","$1,122.58 ","$1,122.58 ","$1,095.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800885,C1713,HC PLATE NARROW DCP 4,278,1 ,"$1,053.00 ",$526.50 ,$233.98 ,"$1,053.00 ", N/A ,$890.73 ,$890.73 ,$358.02 ,$842.40 ,$895.05 ,$658.13 ,$947.70 , N/A ,"$1,000.35 ",$947.70 ,$895.05 ,$895.05 ,$358.02 ,$895.05 ,$895.05 ,$947.70 , N/A ,$442.26 ,$947.70 , N/A ,$968.76 ,$947.70 ,$701.72 ,$701.72 ,$641.28 ,$701.72 ,$684.45 ,$733.41 ,$233.98 ,$831.87 , N/A , N/A , N/A ,$358.02 , N/A , N/A ,"$1,000.35 ",$863.46 ,$863.46 ,$842.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800887,C1713,HC PLATE NARROW DCP 6,278,1 ,"$1,191.00 ",$595.50 ,$264.64 ,"$1,191.00 ", N/A ,"$1,007.47 ","$1,007.47 ",$404.94 ,$952.80 ,"$1,012.35 ",$744.38 ,"$1,071.90 ", N/A ,"$1,131.45 ","$1,071.90 ","$1,012.35 ","$1,012.35 ",$404.94 ,"$1,012.35 ","$1,012.35 ","$1,071.90 ", N/A ,$500.22 ,"$1,071.90 ", N/A ,"$1,095.72 ","$1,071.90 ",$793.68 ,$793.68 ,$725.32 ,$793.68 ,$774.15 ,$829.53 ,$264.64 ,$940.89 , N/A , N/A , N/A ,$404.94 , N/A , N/A ,"$1,131.45 ",$976.62 ,$976.62 ,$952.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800922,C1713,HC PLATE SYN 3.5 LCP 10 HOLE,278,1 ,"$1,147.00 ",$573.50 ,$254.86 ,"$1,147.00 ", N/A ,$970.25 ,$970.25 ,$389.98 ,$917.60 ,$974.95 ,$716.88 ,"$1,032.30 ", N/A ,"$1,089.65 ","$1,032.30 ",$974.95 ,$974.95 ,$389.98 ,$974.95 ,$974.95 ,"$1,032.30 ", N/A ,$481.74 ,"$1,032.30 ", N/A ,"$1,055.24 ","$1,032.30 ",$764.36 ,$764.36 ,$698.52 ,$764.36 ,$745.55 ,$798.89 ,$254.86 ,$906.13 , N/A , N/A , N/A ,$389.98 , N/A , N/A ,"$1,089.65 ",$940.54 ,$940.54 ,$917.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800923,C1713,HC PLATE SYN 3.5 LCP 5 HOLE,278,1 ,$920.00 ,$460.00 ,$204.42 ,$920.00 , N/A ,$778.23 ,$778.23 ,$312.80 ,$736.00 ,$782.00 ,$575.00 ,$828.00 , N/A ,$874.00 ,$828.00 ,$782.00 ,$782.00 ,$312.80 ,$782.00 ,$782.00 ,$828.00 , N/A ,$386.40 ,$828.00 , N/A ,$846.40 ,$828.00 ,$613.09 ,$613.09 ,$560.28 ,$613.09 ,$598.00 ,$640.78 ,$204.42 ,$726.80 , N/A , N/A , N/A ,$312.80 , N/A , N/A ,$874.00 ,$754.40 ,$754.40 ,$736.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800924,C1713,HC PLATE SYN 3.5 LCP 8 HOLE,278,1 ,"$1,074.00 ",$537.00 ,$238.64 ,"$1,074.00 ", N/A ,$908.50 ,$908.50 ,$365.16 ,$859.20 ,$912.90 ,$671.25 ,$966.60 , N/A ,"$1,020.30 ",$966.60 ,$912.90 ,$912.90 ,$365.16 ,$912.90 ,$912.90 ,$966.60 , N/A ,$451.08 ,$966.60 , N/A ,$988.08 ,$966.60 ,$715.71 ,$715.71 ,$654.07 ,$715.71 ,$698.10 ,$748.04 ,$238.64 ,$848.46 , N/A , N/A , N/A ,$365.16 , N/A , N/A ,"$1,020.30 ",$880.68 ,$880.68 ,$859.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800934,C1713,HC PLATE SYN 4.5 LCP CONDYLAR 12H,278,1 ,"$1,269.00 ",$634.50 ,$281.97 ,"$1,269.00 ", N/A ,"$1,073.45 ","$1,073.45 ",$431.46 ,"$1,015.20 ","$1,078.65 ",$793.13 ,"$1,142.10 ", N/A ,"$1,205.55 ","$1,142.10 ","$1,078.65 ","$1,078.65 ",$431.46 ,"$1,078.65 ","$1,078.65 ","$1,142.10 ", N/A ,$532.98 ,"$1,142.10 ", N/A ,"$1,167.48 ","$1,142.10 ",$845.66 ,$845.66 ,$772.82 ,$845.66 ,$824.85 ,$883.86 ,$281.97 ,"$1,002.51 ", N/A , N/A , N/A ,$431.46 , N/A , N/A ,"$1,205.55 ","$1,040.58 ","$1,040.58 ","$1,015.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800937,C1713,HC PLATE SYN 4.5 LCP TIBIA 6H,278,1 ,$982.00 ,$491.00 ,$218.20 ,$982.00 , N/A ,$830.67 ,$830.67 ,$333.88 ,$785.60 ,$834.70 ,$613.75 ,$883.80 , N/A ,$932.90 ,$883.80 ,$834.70 ,$834.70 ,$333.88 ,$834.70 ,$834.70 ,$883.80 , N/A ,$412.44 ,$883.80 , N/A ,$903.44 ,$883.80 ,$654.40 ,$654.40 ,$598.04 ,$654.40 ,$638.30 ,$683.96 ,$218.20 ,$775.78 , N/A , N/A , N/A ,$333.88 , N/A , N/A ,$932.90 ,$805.24 ,$805.24 ,$785.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800938,C1713,HC PLATE SYN 4.5 LCP TIBIA 8H,278,1 ,"$4,389.00 ","$2,194.50 ",$975.24 ,"$4,389.00 ", N/A ,"$3,712.66 ","$3,712.66 ","$1,492.26 ","$3,511.20 ","$3,730.65 ","$2,743.13 ","$3,950.10 ", N/A ,"$4,169.55 ","$3,950.10 ","$3,730.65 ","$3,730.65 ","$1,492.26 ","$3,730.65 ","$3,730.65 ","$3,950.10 ", N/A ,"$1,843.38 ","$3,950.10 ", N/A ,"$4,037.88 ","$3,950.10 ","$2,924.83 ","$2,924.83 ","$2,672.90 ","$2,924.83 ","$2,852.85 ","$3,056.94 ",$975.24 ,"$3,467.31 ", N/A , N/A , N/A ,"$1,492.26 ", N/A , N/A ,"$4,169.55 ","$3,598.98 ","$3,598.98 ","$3,511.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800955,C1713,HC PLATE T SHAPE 4,278,1 ,"$1,840.00 ",$920.00 ,$408.85 ,"$1,840.00 ", N/A ,"$1,556.46 ","$1,556.46 ",$625.60 ,"$1,472.00 ","$1,564.00 ","$1,150.00 ","$1,656.00 ", N/A ,"$1,748.00 ","$1,656.00 ","$1,564.00 ","$1,564.00 ",$625.60 ,"$1,564.00 ","$1,564.00 ","$1,656.00 ", N/A ,$772.80 ,"$1,656.00 ", N/A ,"$1,692.80 ","$1,656.00 ","$1,226.18 ","$1,226.18 ","$1,120.56 ","$1,226.18 ","$1,196.00 ","$1,281.56 ",$408.85 ,"$1,453.60 ", N/A , N/A , N/A ,$625.60 , N/A , N/A ,"$1,748.00 ","$1,508.80 ","$1,508.80 ","$1,472.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800956,C1713,HC PLATE T SHAPE 6,278,1 ,"$2,117.00 ","$1,058.50 ",$470.40 ,"$2,117.00 ", N/A ,"$1,790.77 ","$1,790.77 ",$719.78 ,"$1,693.60 ","$1,799.45 ","$1,323.13 ","$1,905.30 ", N/A ,"$2,011.15 ","$1,905.30 ","$1,799.45 ","$1,799.45 ",$719.78 ,"$1,799.45 ","$1,799.45 ","$1,905.30 ", N/A ,$889.14 ,"$1,905.30 ", N/A ,"$1,947.64 ","$1,905.30 ","$1,410.77 ","$1,410.77 ","$1,289.25 ","$1,410.77 ","$1,376.05 ","$1,474.49 ",$470.40 ,"$1,672.43 ", N/A , N/A , N/A ,$719.78 , N/A , N/A ,"$2,011.15 ","$1,735.94 ","$1,735.94 ","$1,693.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801013,C9359,HC PUTTY DBX BONE 5CC,278,1 ,"$2,884.00 ","$1,442.00 ",$640.82 ,"$2,884.00 ", N/A ,"$2,439.58 ","$2,439.58 ",$980.56 ,"$2,307.20 ","$2,451.40 ","$1,802.50 ","$2,595.60 ", N/A ,"$2,739.80 ","$2,595.60 ","$2,451.40 ","$2,451.40 ",$980.56 ,"$2,451.40 ","$2,451.40 ","$2,595.60 ", N/A ,"$1,211.28 ","$2,595.60 ", N/A ,"$2,653.28 ","$2,595.60 ","$1,921.90 ","$1,921.90 ","$1,756.36 ","$1,921.90 ","$1,874.60 ","$2,008.71 ",$640.82 ,"$2,278.36 ", N/A , N/A , N/A ,$980.56 , N/A , N/A ,"$2,739.80 ","$2,364.88 ","$2,364.88 ","$2,307.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801014,C9359,HC PUTTY DMB PLUS 5CC,278,1 ,"$3,743.00 ","$1,871.50 ",$831.69 ,"$3,743.00 ", N/A ,"$3,166.20 ","$3,166.20 ","$1,272.62 ","$2,994.40 ","$3,181.55 ","$2,339.38 ","$3,368.70 ", N/A ,"$3,555.85 ","$3,368.70 ","$3,181.55 ","$3,181.55 ","$1,272.62 ","$3,181.55 ","$3,181.55 ","$3,368.70 ", N/A ,"$1,572.06 ","$3,368.70 ", N/A ,"$3,443.56 ","$3,368.70 ","$2,494.34 ","$2,494.34 ","$2,279.49 ","$2,494.34 ","$2,432.95 ","$2,607.00 ",$831.69 ,"$2,956.97 ", N/A , N/A , N/A ,"$1,272.62 ", N/A , N/A ,"$3,555.85 ","$3,069.26 ","$3,069.26 ","$2,994.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801023,N/A,HC ROD 200,278,1 ,$744.00 ,$372.00 ,$165.32 ,$744.00 , N/A ,$629.35 ,$629.35 ,$252.96 ,$595.20 ,$632.40 ,$465.00 ,$669.60 , N/A ,$706.80 ,$669.60 ,$632.40 ,$632.40 ,$252.96 ,$632.40 ,$632.40 ,$669.60 , N/A ,$312.48 ,$669.60 , N/A ,$684.48 ,$669.60 ,$495.80 ,$495.80 ,$453.10 ,$495.80 ,$483.60 ,$518.20 ,$165.32 ,$587.76 , N/A , N/A , N/A ,$252.96 , N/A , N/A ,$706.80 ,$610.08 ,$610.08 ,$595.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801024,N/A,HC ROD 250,278,1 ,$798.00 ,$399.00 ,$177.32 ,$798.00 , N/A ,$675.03 ,$675.03 ,$271.32 ,$638.40 ,$678.30 ,$498.75 ,$718.20 , N/A ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$271.32 ,$678.30 ,$678.30 ,$718.20 , N/A ,$335.16 ,$718.20 , N/A ,$734.16 ,$718.20 ,$531.79 ,$531.79 ,$485.98 ,$531.79 ,$518.70 ,$555.81 ,$177.32 ,$630.42 , N/A , N/A , N/A ,$271.32 , N/A , N/A ,$758.10 ,$654.36 ,$654.36 ,$638.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801025,N/A,HC ROD 300,278,1 ,$798.00 ,$399.00 ,$177.32 ,$798.00 , N/A ,$675.03 ,$675.03 ,$271.32 ,$638.40 ,$678.30 ,$498.75 ,$718.20 , N/A ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$271.32 ,$678.30 ,$678.30 ,$718.20 , N/A ,$335.16 ,$718.20 , N/A ,$734.16 ,$718.20 ,$531.79 ,$531.79 ,$485.98 ,$531.79 ,$518.70 ,$555.81 ,$177.32 ,$630.42 , N/A , N/A , N/A ,$271.32 , N/A , N/A ,$758.10 ,$654.36 ,$654.36 ,$638.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801026,N/A,HC ROD 350,278,1 ,$836.00 ,$418.00 ,$185.76 ,$836.00 , N/A ,$707.17 ,$707.17 ,$284.24 ,$668.80 ,$710.60 ,$522.50 ,$752.40 , N/A ,$794.20 ,$752.40 ,$710.60 ,$710.60 ,$284.24 ,$710.60 ,$710.60 ,$752.40 , N/A ,$351.12 ,$752.40 , N/A ,$769.12 ,$752.40 ,$557.11 ,$557.11 ,$509.12 ,$557.11 ,$543.40 ,$582.27 ,$185.76 ,$660.44 , N/A , N/A , N/A ,$284.24 , N/A , N/A ,$794.20 ,$685.52 ,$685.52 ,$668.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801027,N/A,HC ROD 400,278,1 ,$877.00 ,$438.50 ,$194.87 ,$877.00 , N/A ,$741.85 ,$741.85 ,$298.18 ,$701.60 ,$745.45 ,$548.13 ,$789.30 , N/A ,$833.15 ,$789.30 ,$745.45 ,$745.45 ,$298.18 ,$745.45 ,$745.45 ,$789.30 , N/A ,$368.34 ,$789.30 , N/A ,$806.84 ,$789.30 ,$584.43 ,$584.43 ,$534.09 ,$584.43 ,$570.05 ,$610.83 ,$194.87 ,$692.83 , N/A , N/A , N/A ,$298.18 , N/A , N/A ,$833.15 ,$719.14 ,$719.14 ,$701.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801036,C1713,HC SCREW 2.7 CORTEX FRAG,278,1 ,$126.00 ,$63.00 ,$28.00 ,$126.00 , N/A ,$106.58 ,$106.58 ,$42.84 ,$100.80 ,$107.10 ,$78.75 ,$113.40 , N/A ,$119.70 ,$113.40 ,$107.10 ,$107.10 ,$42.84 ,$107.10 ,$107.10 ,$113.40 , N/A ,$52.92 ,$113.40 , N/A ,$115.92 ,$113.40 ,$83.97 ,$83.97 ,$76.73 ,$83.97 ,$81.90 ,$87.76 ,$28.00 ,$99.54 , N/A , N/A , N/A ,$42.84 , N/A , N/A ,$119.70 ,$103.32 ,$103.32 ,$100.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801038,C1713,HC SCREW 3.5 CORTEX,278,1 ,$83.00 ,$41.50 ,$18.44 ,$83.00 , N/A ,$70.21 ,$70.21 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 , N/A ,$34.86 ,$74.70 , N/A ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 , N/A , N/A , N/A ,$28.22 , N/A , N/A ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801071,C1713,HC SCREW LOCKING,278,1 ,$446.00 ,$223.00 ,$99.10 ,$446.00 , N/A ,$377.27 ,$377.27 ,$151.64 ,$356.80 ,$379.10 ,$278.75 ,$401.40 , N/A ,$423.70 ,$401.40 ,$379.10 ,$379.10 ,$151.64 ,$379.10 ,$379.10 ,$401.40 , N/A ,$187.32 ,$401.40 , N/A ,$410.32 ,$401.40 ,$297.21 ,$297.21 ,$271.61 ,$297.21 ,$289.90 ,$310.64 ,$99.10 ,$352.34 , N/A , N/A , N/A ,$151.64 , N/A , N/A ,$423.70 ,$365.72 ,$365.72 ,$356.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801083,C1713,HC SCREW SCHANS 4.0,278,1 ,$441.00 ,$220.50 ,$97.99 ,$441.00 , N/A ,$373.04 ,$373.04 ,$149.94 ,$352.80 ,$374.85 ,$275.63 ,$396.90 , N/A ,$418.95 ,$396.90 ,$374.85 ,$374.85 ,$149.94 ,$374.85 ,$374.85 ,$396.90 , N/A ,$185.22 ,$396.90 , N/A ,$405.72 ,$396.90 ,$293.88 ,$293.88 ,$268.57 ,$293.88 ,$286.65 ,$307.16 ,$97.99 ,$348.39 , N/A , N/A , N/A ,$149.94 , N/A , N/A ,$418.95 ,$361.62 ,$361.62 ,$352.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801084,C1713,HC SCREW SCHANZ 5.0,278,1 ,$597.00 ,$298.50 ,$132.65 ,$597.00 , N/A ,$505.00 ,$505.00 ,$202.98 ,$477.60 ,$507.45 ,$373.13 ,$537.30 , N/A ,$567.15 ,$537.30 ,$507.45 ,$507.45 ,$202.98 ,$507.45 ,$507.45 ,$537.30 , N/A ,$250.74 ,$537.30 , N/A ,$549.24 ,$537.30 ,$397.84 ,$397.84 ,$363.57 ,$397.84 ,$388.05 ,$415.81 ,$132.65 ,$471.63 , N/A , N/A , N/A ,$202.98 , N/A , N/A ,$567.15 ,$489.54 ,$489.54 ,$477.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801085,C1713,HC SCREW SCHANZ 5MM SELF DR,278,1 ,$569.00 ,$284.50 ,$126.43 ,$569.00 , N/A ,$481.32 ,$481.32 ,$193.46 ,$455.20 ,$483.65 ,$355.63 ,$512.10 , N/A ,$540.55 ,$512.10 ,$483.65 ,$483.65 ,$193.46 ,$483.65 ,$483.65 ,$512.10 , N/A ,$238.98 ,$512.10 , N/A ,$523.48 ,$512.10 ,$379.18 ,$379.18 ,$346.52 ,$379.18 ,$369.85 ,$396.31 ,$126.43 ,$449.51 , N/A , N/A , N/A ,$193.46 , N/A , N/A ,$540.55 ,$466.58 ,$466.58 ,$455.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801094,C1713,HC SCREW SYN 3.5MM LOCKING,278,1 ,$420.00 ,$210.00 ,$93.32 ,$420.00 , N/A ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 , N/A ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 , N/A ,$176.40 ,$378.00 , N/A ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 , N/A , N/A , N/A ,$142.80 , N/A , N/A ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801101,C1713,HC SCREW SYN CAN 4.0 10-60,278,1 ,$63.00 ,$31.50 ,$14.00 ,$63.00 , N/A ,$53.29 ,$53.29 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 , N/A ,$26.46 ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 , N/A , N/A , N/A ,$21.42 , N/A , N/A ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801105,C1713,HC SCREW SYNTHES 7.3 CANNULATED,278,1 ,$633.00 ,$316.50 ,$140.65 ,$633.00 , N/A ,$535.45 ,$535.45 ,$215.22 ,$506.40 ,$538.05 ,$395.63 ,$569.70 , N/A ,$601.35 ,$569.70 ,$538.05 ,$538.05 ,$215.22 ,$538.05 ,$538.05 ,$569.70 , N/A ,$265.86 ,$569.70 , N/A ,$582.36 ,$569.70 ,$421.83 ,$421.83 ,$385.50 ,$421.83 ,$411.45 ,$440.88 ,$140.65 ,$500.07 , N/A , N/A , N/A ,$215.22 , N/A , N/A ,$601.35 ,$519.06 ,$519.06 ,$506.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801125,C1713,HC SCREWS CANNULATED 6.5 SYNTHES,278,1 ,$826.00 ,$413.00 ,$183.54 ,$826.00 , N/A ,$698.71 ,$698.71 ,$280.84 ,$660.80 ,$702.10 ,$516.25 ,$743.40 , N/A ,$784.70 ,$743.40 ,$702.10 ,$702.10 ,$280.84 ,$702.10 ,$702.10 ,$743.40 , N/A ,$346.92 ,$743.40 , N/A ,$759.92 ,$743.40 ,$550.45 ,$550.45 ,$503.03 ,$550.45 ,$536.90 ,$575.31 ,$183.54 ,$652.54 , N/A , N/A , N/A ,$280.84 , N/A , N/A ,$784.70 ,$677.32 ,$677.32 ,$660.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801169,N/A,HC STAPLE ENDO 60-3.5 RELOAD,278,1 ,$486.00 ,$243.00 ,$107.99 ,$486.00 , N/A ,$411.11 ,$411.11 ,$165.24 ,$388.80 ,$413.10 ,$303.75 ,$437.40 , N/A ,$461.70 ,$437.40 ,$413.10 ,$413.10 ,$165.24 ,$413.10 ,$413.10 ,$437.40 , N/A ,$204.12 ,$437.40 , N/A ,$447.12 ,$437.40 ,$323.87 ,$323.87 ,$295.97 ,$323.87 ,$315.90 ,$338.50 ,$107.99 ,$383.94 , N/A , N/A , N/A ,$165.24 , N/A , N/A ,$461.70 ,$398.52 ,$398.52 ,$388.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801175,N/A,HC STAPLE ENDO GIA 45 RELOAD,278,1 ,$338.00 ,$169.00 ,$75.10 ,$338.00 , N/A ,$285.91 ,$285.91 ,$114.92 ,$270.40 ,$287.30 ,$211.25 ,$304.20 , N/A ,$321.10 ,$304.20 ,$287.30 ,$287.30 ,$114.92 ,$287.30 ,$287.30 ,$304.20 , N/A ,$141.96 ,$304.20 , N/A ,$310.96 ,$304.20 ,$225.24 ,$225.24 ,$205.84 ,$225.24 ,$219.70 ,$235.42 ,$75.10 ,$267.02 , N/A , N/A , N/A ,$114.92 , N/A , N/A ,$321.10 ,$277.16 ,$277.16 ,$270.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801177,N/A,HC STAPLE ENDO GIA 60,278,1 ,$144.00 ,$72.00 ,$32.00 ,$144.00 , N/A ,$121.81 ,$121.81 ,$48.96 ,$115.20 ,$122.40 ,$90.00 ,$129.60 , N/A ,$136.80 ,$129.60 ,$122.40 ,$122.40 ,$48.96 ,$122.40 ,$122.40 ,$129.60 , N/A ,$60.48 ,$129.60 , N/A ,$132.48 ,$129.60 ,$95.96 ,$95.96 ,$87.70 ,$95.96 ,$93.60 ,$100.30 ,$32.00 ,$113.76 , N/A , N/A , N/A ,$48.96 , N/A , N/A ,$136.80 ,$118.08 ,$118.08 ,$115.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801189,N/A,HC STAPLE GIA 60 ROTIC RELOAD,278,1 ,"$1,117.00 ",$558.50 ,$248.20 ,"$1,117.00 ", N/A ,$944.87 ,$944.87 ,$379.78 ,$893.60 ,$949.45 ,$698.13 ,"$1,005.30 ", N/A ,"$1,061.15 ","$1,005.30 ",$949.45 ,$949.45 ,$379.78 ,$949.45 ,$949.45 ,"$1,005.30 ", N/A ,$469.14 ,"$1,005.30 ", N/A ,"$1,027.64 ","$1,005.30 ",$744.37 ,$744.37 ,$680.25 ,$744.37 ,$726.05 ,$777.99 ,$248.20 ,$882.43 , N/A , N/A , N/A ,$379.78 , N/A , N/A ,"$1,061.15 ",$915.94 ,$915.94 ,$893.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801192,N/A,HC STAPLE LIN CTR 55 RELOAD,278,1 ,$158.00 ,$79.00 ,$35.11 ,$158.00 , N/A ,$133.65 ,$133.65 ,$53.72 ,$126.40 ,$134.30 ,$98.75 ,$142.20 , N/A ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$53.72 ,$134.30 ,$134.30 ,$142.20 , N/A ,$66.36 ,$142.20 , N/A ,$145.36 ,$142.20 ,$105.29 ,$105.29 ,$96.22 ,$105.29 ,$102.70 ,$110.05 ,$35.11 ,$124.82 , N/A , N/A , N/A ,$53.72 , N/A , N/A ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801193,N/A,HC STAPLE LIN CTR 75 RELOAD,278,1 ,$236.00 ,$118.00 ,$52.44 ,$236.00 , N/A ,$199.63 ,$199.63 ,$80.24 ,$188.80 ,$200.60 ,$147.50 ,$212.40 , N/A ,$224.20 ,$212.40 ,$200.60 ,$200.60 ,$80.24 ,$200.60 ,$200.60 ,$212.40 , N/A ,$99.12 ,$212.40 , N/A ,$217.12 ,$212.40 ,$157.27 ,$157.27 ,$143.72 ,$157.27 ,$153.40 ,$164.37 ,$52.44 ,$186.44 , N/A , N/A , N/A ,$80.24 , N/A , N/A ,$224.20 ,$193.52 ,$193.52 ,$188.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801204,N/A,HC STAPLE TA90B,278,1 ,$677.00 ,$338.50 ,$150.43 ,$677.00 , N/A ,$572.67 ,$572.67 ,$230.18 ,$541.60 ,$575.45 ,$423.13 ,$609.30 , N/A ,$643.15 ,$609.30 ,$575.45 ,$575.45 ,$230.18 ,$575.45 ,$575.45 ,$609.30 , N/A ,$284.34 ,$609.30 , N/A ,$622.84 ,$609.30 ,$451.15 ,$451.15 ,$412.29 ,$451.15 ,$440.05 ,$471.53 ,$150.43 ,$534.83 , N/A , N/A , N/A ,$230.18 , N/A , N/A ,$643.15 ,$555.14 ,$555.14 ,$541.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801217,N/A,HC STENT RAINS FRONTL SINUS,278,1 ,$176.00 ,$88.00 ,$39.11 ,$176.00 , N/A ,$148.88 ,$148.88 ,$59.84 ,$140.80 ,$149.60 ,$110.00 ,$158.40 , N/A ,$167.20 ,$158.40 ,$149.60 ,$149.60 ,$59.84 ,$149.60 ,$149.60 ,$158.40 , N/A ,$73.92 ,$158.40 , N/A ,$161.92 ,$158.40 ,$117.29 ,$117.29 ,$107.18 ,$117.29 ,$114.40 ,$122.58 ,$39.11 ,$139.04 , N/A , N/A , N/A ,$59.84 , N/A , N/A ,$167.20 ,$144.32 ,$144.32 ,$140.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801229,N/A,HC SUT ANCHOR BIO-SWIVELOCK,278,1 ,$173.00 ,$86.50 ,$38.44 ,$173.00 , N/A ,$146.34 ,$146.34 ,$58.82 ,$138.40 ,$147.05 ,$108.13 ,$155.70 , N/A ,$164.35 ,$155.70 ,$147.05 ,$147.05 ,$58.82 ,$147.05 ,$147.05 ,$155.70 , N/A ,$72.66 ,$155.70 , N/A ,$159.16 ,$155.70 ,$115.29 ,$115.29 ,$105.36 ,$115.29 ,$112.45 ,$120.49 ,$38.44 ,$136.67 , N/A , N/A , N/A ,$58.82 , N/A , N/A ,$164.35 ,$141.86 ,$141.86 ,$138.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801230,N/A,HC SUT BONE WAX W31G,278,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 , N/A ,$15.23 ,$15.23 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 , N/A ,$7.56 ,$16.20 , N/A ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 , N/A , N/A , N/A ,$6.12 , N/A , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801263,N/A,HC TUBE DONALDSON EAR,278,1 ,$36.00 ,$18.00 ,$8.00 ,$36.00 , N/A ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 , N/A ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 , N/A , N/A , N/A ,$12.24 , N/A , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801266,N/A,HC TUBE REUTER-BOBBIN,278,1 ,$22.00 ,$11.00 ,$4.89 ,$22.00 , N/A ,$18.61 ,$18.61 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$9.24 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A , N/A , N/A ,$7.48 , N/A , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801267,N/A,HC T TUBE GOODE,278,1 ,$66.00 ,$33.00 ,$14.67 ,$66.00 , N/A ,$55.83 ,$55.83 ,$22.44 ,$52.80 ,$56.10 ,$41.25 ,$59.40 , N/A ,$62.70 ,$59.40 ,$56.10 ,$56.10 ,$22.44 ,$56.10 ,$56.10 ,$59.40 , N/A ,$27.72 ,$59.40 , N/A ,$60.72 ,$59.40 ,$43.98 ,$43.98 ,$40.19 ,$43.98 ,$42.90 ,$45.97 ,$14.67 ,$52.14 , N/A , N/A , N/A ,$22.44 , N/A , N/A ,$62.70 ,$54.12 ,$54.12 ,$52.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801268,N/A,HC TUBE SHEEHY COLLAR BUTTN,278,1 ,$34.00 ,$17.00 ,$7.55 ,$34.00 , N/A ,$28.76 ,$28.76 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 , N/A ,$14.28 ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 , N/A , N/A , N/A ,$11.56 , N/A , N/A ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801329,N/A,HC WASHER SYNTHES,278,1 ,$83.00 ,$41.50 ,$18.44 ,$83.00 , N/A ,$70.21 ,$70.21 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 , N/A ,$34.86 ,$74.70 , N/A ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 , N/A , N/A , N/A ,$28.22 , N/A , N/A ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801332,N/A,HC WIRE-KIRSCHNER 1.6,278,1 ,$53.00 ,$26.50 ,$11.78 ,$53.00 , N/A ,$44.83 ,$44.83 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 , N/A ,$22.26 ,$47.70 , N/A ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 , N/A , N/A , N/A ,$18.02 , N/A , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801335,N/A,HC WIRES KIRCHNER EA,278,1 ,$28.00 ,$14.00 ,$6.22 ,$28.00 , N/A ,$23.69 ,$23.69 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 , N/A ,$11.76 ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 , N/A , N/A , N/A ,$9.52 , N/A , N/A ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801344,N/A,HC MEMBRANE SEPRAFILM,278,1 ,$600.00 ,$300.00 ,$133.32 ,$600.00 , N/A ,$507.54 ,$507.54 ,$204.00 ,$480.00 ,$510.00 ,$375.00 ,$540.00 , N/A ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$204.00 ,$510.00 ,$510.00 ,$540.00 , N/A ,$252.00 ,$540.00 , N/A ,$552.00 ,$540.00 ,$399.84 ,$399.84 ,$365.40 ,$399.84 ,$390.00 ,$417.90 ,$133.32 ,$474.00 , N/A , N/A , N/A ,$204.00 , N/A , N/A ,$570.00 ,$492.00 ,$492.00 ,$480.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801346,N/A,HC PATCH PERIPHERAL VASC,278,1 ,$282.00 ,$141.00 ,$62.66 ,$282.00 , N/A ,$238.54 ,$238.54 ,$95.88 ,$225.60 ,$239.70 ,$176.25 ,$253.80 , N/A ,$267.90 ,$253.80 ,$239.70 ,$239.70 ,$95.88 ,$239.70 ,$239.70 ,$253.80 , N/A ,$118.44 ,$253.80 , N/A ,$259.44 ,$253.80 ,$187.92 ,$187.92 ,$171.74 ,$187.92 ,$183.30 ,$196.41 ,$62.66 ,$222.78 , N/A , N/A , N/A ,$95.88 , N/A , N/A ,$267.90 ,$231.24 ,$231.24 ,$225.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801382,C1781,HC MESH VENTRALIGHT ST ECHO 6X8,278,1 ,"$2,493.00 ","$1,246.50 ",$553.94 ,"$2,493.00 ", N/A ,"$2,108.83 ","$2,108.83 ",$847.62 ,"$1,994.40 ","$2,119.05 ","$1,558.13 ","$2,243.70 ", N/A ,"$2,368.35 ","$2,243.70 ","$2,119.05 ","$2,119.05 ",$847.62 ,"$2,119.05 ","$2,119.05 ","$2,243.70 ", N/A ,"$1,047.06 ","$2,243.70 ", N/A ,"$2,293.56 ","$2,243.70 ","$1,661.34 ","$1,661.34 ","$1,518.24 ","$1,661.34 ","$1,620.45 ","$1,736.37 ",$553.94 ,"$1,969.47 ", N/A , N/A , N/A ,$847.62 , N/A , N/A ,"$2,368.35 ","$2,044.26 ","$2,044.26 ","$1,994.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801383,C1781,HC MESH VENTRALIGHT ST ECHO 7X9,278,1 ,"$3,389.00 ","$1,694.50 ",$753.04 ,"$3,389.00 ", N/A ,"$2,866.76 ","$2,866.76 ","$1,152.26 ","$2,711.20 ","$2,880.65 ","$2,118.13 ","$3,050.10 ", N/A ,"$3,219.55 ","$3,050.10 ","$2,880.65 ","$2,880.65 ","$1,152.26 ","$2,880.65 ","$2,880.65 ","$3,050.10 ", N/A ,"$1,423.38 ","$3,050.10 ", N/A ,"$3,117.88 ","$3,050.10 ","$2,258.43 ","$2,258.43 ","$2,063.90 ","$2,258.43 ","$2,202.85 ","$2,360.44 ",$753.04 ,"$2,677.31 ", N/A , N/A , N/A ,"$1,152.26 ", N/A , N/A ,"$3,219.55 ","$2,778.98 ","$2,778.98 ","$2,711.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801384,C1781,HC MESH VENTRALIGHT ST ECHO 8X10,278,1 ,"$3,942.00 ","$1,971.00 ",$875.91 ,"$3,942.00 ", N/A ,"$3,334.54 ","$3,334.54 ","$1,340.28 ","$3,153.60 ","$3,350.70 ","$2,463.75 ","$3,547.80 ", N/A ,"$3,744.90 ","$3,547.80 ","$3,350.70 ","$3,350.70 ","$1,340.28 ","$3,350.70 ","$3,350.70 ","$3,547.80 ", N/A ,"$1,655.64 ","$3,547.80 ", N/A ,"$3,626.64 ","$3,547.80 ","$2,626.95 ","$2,626.95 ","$2,400.68 ","$2,626.95 ","$2,562.30 ","$2,745.60 ",$875.91 ,"$3,114.18 ", N/A , N/A , N/A ,"$1,340.28 ", N/A , N/A ,"$3,744.90 ","$3,232.44 ","$3,232.44 ","$3,153.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801471,C1713,HC ANCHOR SUTURE,278,1 ,$180.00 ,$90.00 ,$40.00 ,$180.00 , N/A ,$152.26 ,$152.26 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 , N/A ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 , N/A ,$75.60 ,$162.00 , N/A ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 , N/A , N/A , N/A ,$61.20 , N/A , N/A ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801491,C1781,HC MESH VENTRALIGHT ST ECHO 4X6,278,1 ,"$1,147.00 ",$573.50 ,$254.86 ,"$1,147.00 ", N/A ,$970.25 ,$970.25 ,$389.98 ,$917.60 ,$974.95 ,$716.88 ,"$1,032.30 ", N/A ,"$1,089.65 ","$1,032.30 ",$974.95 ,$974.95 ,$389.98 ,$974.95 ,$974.95 ,"$1,032.30 ", N/A ,$481.74 ,"$1,032.30 ", N/A ,"$1,055.24 ","$1,032.30 ",$764.36 ,$764.36 ,$698.52 ,$764.36 ,$745.55 ,$798.89 ,$254.86 ,$906.13 , N/A , N/A , N/A ,$389.98 , N/A , N/A ,"$1,089.65 ",$940.54 ,$940.54 ,$917.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801492,C1781,HC MESH VENTRALIGHT ST ECHO 12X14,278,1 ,"$4,806.00 ","$2,403.00 ","$1,067.89 ","$4,806.00 ", N/A ,"$4,065.40 ","$4,065.40 ","$1,634.04 ","$3,844.80 ","$4,085.10 ","$3,003.75 ","$4,325.40 ", N/A ,"$4,565.70 ","$4,325.40 ","$4,085.10 ","$4,085.10 ","$1,634.04 ","$4,085.10 ","$4,085.10 ","$4,325.40 ", N/A ,"$2,018.52 ","$4,325.40 ", N/A ,"$4,421.52 ","$4,325.40 ","$3,202.72 ","$3,202.72 ","$2,926.85 ","$3,202.72 ","$3,123.90 ","$3,347.38 ","$1,067.89 ","$3,796.74 ", N/A , N/A , N/A ,"$1,634.04 ", N/A , N/A ,"$4,565.70 ","$3,940.92 ","$3,940.92 ","$3,844.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801575,C1713,HC KIT BONE CEMENT,278,1 ,$81.00 ,$40.50 ,$18.00 ,$81.00 , N/A ,$68.52 ,$68.52 ,$27.54 ,$64.80 ,$68.85 ,$50.63 ,$72.90 , N/A ,$76.95 ,$72.90 ,$68.85 ,$68.85 ,$27.54 ,$68.85 ,$68.85 ,$72.90 , N/A ,$34.02 ,$72.90 , N/A ,$74.52 ,$72.90 ,$53.98 ,$53.98 ,$49.33 ,$53.98 ,$52.65 ,$56.42 ,$18.00 ,$63.99 , N/A , N/A , N/A ,$27.54 , N/A , N/A ,$76.95 ,$66.42 ,$66.42 ,$64.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27802174,C1713,HC SUTURE TAPE 1.3MM BLUE,278,1 ,$6.10 ,$3.05 ,$1.35 ,$6.10 , N/A ,$5.16 ,$5.16 ,$2.07 ,$4.88 ,$5.19 ,$3.81 ,$5.49 , N/A ,$5.80 ,$5.49 ,$5.19 ,$5.19 ,$2.07 ,$5.19 ,$5.19 ,$5.49 , N/A ,$2.56 ,$5.49 , N/A ,$5.61 ,$5.49 ,$4.07 ,$4.07 ,$3.71 ,$4.07 ,$3.97 ,$4.25 ,$1.35 ,$4.82 , N/A , N/A , N/A ,$2.07 , N/A , N/A ,$5.80 ,$5.00 ,$5.00 ,$4.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),27802175,C1713,HC SUTURE TAPE 1.3MM BLACK,278,1 ,$14.60 ,$7.30 ,$3.24 ,$14.60 , N/A ,$12.35 ,$12.35 ,$4.96 ,$11.68 ,$12.41 ,$9.13 ,$13.14 , N/A ,$13.87 ,$13.14 ,$12.41 ,$12.41 ,$4.96 ,$12.41 ,$12.41 ,$13.14 , N/A ,$6.13 ,$13.14 , N/A ,$13.43 ,$13.14 ,$9.73 ,$9.73 ,$8.89 ,$9.73 ,$9.49 ,$10.17 ,$3.24 ,$11.53 , N/A , N/A , N/A ,$4.96 , N/A , N/A ,$13.87 ,$11.97 ,$11.97 ,$11.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),27802176,C1713,HC TAPE FIBER 2MM BLUE,278,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A , N/A , N/A ,$5.78 , N/A , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27872625,C2625,HC STENT NON-CORONARY TEMPORARY WITH DELIVERY SYSTEM(PROPEL),278,1 ,"$1,853.00 ",$926.50 ,$411.74 ,"$1,853.00 ", N/A ,"$1,567.45 ","$1,567.45 ",$630.02 ,"$1,482.40 ","$1,575.05 ","$1,158.13 ","$1,667.70 ", N/A ,"$1,760.35 ","$1,667.70 ","$1,575.05 ","$1,575.05 ",$630.02 ,"$1,575.05 ","$1,575.05 ","$1,667.70 ", N/A ,$778.26 ,"$1,667.70 ", N/A ,"$1,704.76 ","$1,667.70 ","$1,234.84 ","$1,234.84 ","$1,128.48 ","$1,234.84 ","$1,204.45 ","$1,290.61 ",$411.74 ,"$1,463.87 ", N/A , N/A , N/A ,$630.02 , N/A , N/A ,"$1,760.35 ","$1,519.46 ","$1,519.46 ","$1,482.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27878699,L8699,HC PROSTHETIC IMPLANTS NOS,278,1 ,"$1,997.00 ",$998.50 ,$443.73 ,"$1,997.00 ", N/A ,"$1,689.26 ","$1,689.26 ",$678.98 ,"$1,597.60 ","$1,697.45 ","$1,248.13 ","$1,797.30 ", N/A ,"$1,897.15 ","$1,797.30 ","$1,697.45 ","$1,697.45 ",$678.98 ,"$1,697.45 ","$1,697.45 ","$1,797.30 ", N/A ,$838.74 ,"$1,797.30 ", N/A ,"$1,837.24 ","$1,797.30 ","$1,330.80 ","$1,330.80 ","$1,216.17 ","$1,330.80 ","$1,298.05 ","$1,390.91 ",$443.73 ,"$1,577.63 ", N/A , N/A , N/A ,$678.98 , N/A , N/A ,"$1,897.15 ","$1,637.54 ","$1,637.54 ","$1,597.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880000,C1713,HC ANCHOR SUTURE FTPRNT 4.5/5.5,278,1 ,"$1,067.00 ",$533.50 ,$237.09 ,"$1,067.00 ", N/A ,$902.58 ,$902.58 ,$362.78 ,$853.60 ,$906.95 ,$666.88 ,$960.30 , N/A ,"$1,013.65 ",$960.30 ,$906.95 ,$906.95 ,$362.78 ,$906.95 ,$906.95 ,$960.30 , N/A ,$448.14 ,$960.30 , N/A ,$981.64 ,$960.30 ,$711.05 ,$711.05 ,$649.80 ,$711.05 ,$693.55 ,$743.17 ,$237.09 ,$842.93 , N/A , N/A , N/A ,$362.78 , N/A , N/A ,"$1,013.65 ",$874.94 ,$874.94 ,$853.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880001,C1713,HC ANCHOR SUTURE TWNFLX 4.5/5.5,278,1 ,$982.00 ,$491.00 ,$218.20 ,$982.00 , N/A ,$830.67 ,$830.67 ,$333.88 ,$785.60 ,$834.70 ,$613.75 ,$883.80 , N/A ,$932.90 ,$883.80 ,$834.70 ,$834.70 ,$333.88 ,$834.70 ,$834.70 ,$883.80 , N/A ,$412.44 ,$883.80 , N/A ,$903.44 ,$883.80 ,$654.40 ,$654.40 ,$598.04 ,$654.40 ,$638.30 ,$683.96 ,$218.20 ,$775.78 , N/A , N/A , N/A ,$333.88 , N/A , N/A ,$932.90 ,$805.24 ,$805.24 ,$785.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880002,N/A,HC KIT PELVIC FLOOR PINNACLE,278,1 ,"$3,995.00 ","$1,997.50 ",$887.69 ,"$3,995.00 ", N/A ,"$3,379.37 ","$3,379.37 ","$1,358.30 ","$3,196.00 ","$3,395.75 ","$2,496.88 ","$3,595.50 ", N/A ,"$3,795.25 ","$3,595.50 ","$3,395.75 ","$3,395.75 ","$1,358.30 ","$3,395.75 ","$3,395.75 ","$3,595.50 ", N/A ,"$1,677.90 ","$3,595.50 ", N/A ,"$3,675.40 ","$3,595.50 ","$2,662.27 ","$2,662.27 ","$2,432.96 ","$2,662.27 ","$2,596.75 ","$2,782.52 ",$887.69 ,"$3,156.05 ", N/A , N/A , N/A ,"$1,358.30 ", N/A , N/A ,"$3,795.25 ","$3,275.90 ","$3,275.90 ","$3,196.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880003,N/A,HC LEAD SPINAL 45CM,278,1 ,"$4,333.00 ","$2,166.50 ",$962.79 ,"$4,333.00 ", N/A ,"$3,665.28 ","$3,665.28 ","$1,473.22 ","$3,466.40 ","$3,683.05 ","$2,708.13 ","$3,899.70 ", N/A ,"$4,116.35 ","$3,899.70 ","$3,683.05 ","$3,683.05 ","$1,473.22 ","$3,683.05 ","$3,683.05 ","$3,899.70 ", N/A ,"$1,819.86 ","$3,899.70 ", N/A ,"$3,986.36 ","$3,899.70 ","$2,887.51 ","$2,887.51 ","$2,638.80 ","$2,887.51 ","$2,816.45 ","$3,017.93 ",$962.79 ,"$3,423.07 ", N/A , N/A , N/A ,"$1,473.22 ", N/A , N/A ,"$4,116.35 ","$3,553.06 ","$3,553.06 ","$3,466.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880004,C1781,HC MESH DUAL PLUS 10X15 CM,278,1 ,"$3,113.00 ","$1,556.50 ",$691.71 ,"$3,113.00 ", N/A ,"$2,633.29 ","$2,633.29 ","$1,058.42 ","$2,490.40 ","$2,646.05 ","$1,945.63 ","$2,801.70 ", N/A ,"$2,957.35 ","$2,801.70 ","$2,646.05 ","$2,646.05 ","$1,058.42 ","$2,646.05 ","$2,646.05 ","$2,801.70 ", N/A ,"$1,307.46 ","$2,801.70 ", N/A ,"$2,863.96 ","$2,801.70 ","$2,074.50 ","$2,074.50 ","$1,895.82 ","$2,074.50 ","$2,023.45 ","$2,168.20 ",$691.71 ,"$2,459.27 ", N/A , N/A , N/A ,"$1,058.42 ", N/A , N/A ,"$2,957.35 ","$2,552.66 ","$2,552.66 ","$2,490.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880005,C1781,HC MESH VENTRALIGHT W/POSIT,278,1 ,"$4,985.00 ","$2,492.50 ","$1,107.67 ","$4,985.00 ", N/A ,"$4,216.81 ","$4,216.81 ","$1,694.90 ","$3,988.00 ","$4,237.25 ","$3,115.63 ","$4,486.50 ", N/A ,"$4,735.75 ","$4,486.50 ","$4,237.25 ","$4,237.25 ","$1,694.90 ","$4,237.25 ","$4,237.25 ","$4,486.50 ", N/A ,"$2,093.70 ","$4,486.50 ", N/A ,"$4,586.20 ","$4,486.50 ","$3,322.00 ","$3,322.00 ","$3,035.87 ","$3,322.00 ","$3,240.25 ","$3,472.05 ","$1,107.67 ","$3,938.15 ", N/A , N/A , N/A ,"$1,694.90 ", N/A , N/A ,"$4,735.75 ","$4,087.70 ","$4,087.70 ","$3,988.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880006,C1781,"HC MESH,VAG.SUPPORT SYS",278,1 ,"$5,341.00 ","$2,670.50 ","$1,186.77 ","$5,341.00 ", N/A ,"$4,517.95 ","$4,517.95 ","$1,815.94 ","$4,272.80 ","$4,539.85 ","$3,338.13 ","$4,806.90 ", N/A ,"$5,073.95 ","$4,806.90 ","$4,539.85 ","$4,539.85 ","$1,815.94 ","$4,539.85 ","$4,539.85 ","$4,806.90 ", N/A ,"$2,243.22 ","$4,806.90 ", N/A ,"$4,913.72 ","$4,806.90 ","$3,559.24 ","$3,559.24 ","$3,252.67 ","$3,559.24 ","$3,471.65 ","$3,720.01 ","$1,186.77 ","$4,219.39 ", N/A , N/A , N/A ,"$1,815.94 ", N/A , N/A ,"$5,073.95 ","$4,379.62 ","$4,379.62 ","$4,272.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880007,C1781,HC MESH DUAL PLUS 15X19 CM,278,1 ,"$5,982.00 ","$2,991.00 ","$1,329.20 ","$5,982.00 ", N/A ,"$5,060.17 ","$5,060.17 ","$2,033.88 ","$4,785.60 ","$5,084.70 ","$3,738.75 ","$5,383.80 ", N/A ,"$5,682.90 ","$5,383.80 ","$5,084.70 ","$5,084.70 ","$2,033.88 ","$5,084.70 ","$5,084.70 ","$5,383.80 ", N/A ,"$2,512.44 ","$5,383.80 ", N/A ,"$5,503.44 ","$5,383.80 ","$3,986.40 ","$3,986.40 ","$3,643.04 ","$3,986.40 ","$3,888.30 ","$4,166.46 ","$1,329.20 ","$4,725.78 ", N/A ,"$2,991.00 ","$2,991.00 ","$2,033.88 ","$2,991.00 ", N/A ,"$5,682.90 ","$4,905.24 ","$4,905.24 ","$4,785.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880008,C1781,"HC MESH,PROLIFT,PELV.FLR REP",278,1 ,"$8,908.00 ","$4,454.00 ","$1,979.36 ","$8,908.00 ", N/A ,"$7,535.28 ","$7,535.28 ","$3,028.72 ","$7,126.40 ","$7,571.80 ","$5,567.50 ","$8,017.20 ", N/A ,"$8,462.60 ","$8,017.20 ","$7,571.80 ","$7,571.80 ","$3,028.72 ","$7,571.80 ","$7,571.80 ","$8,017.20 ", N/A ,"$3,741.36 ","$8,017.20 ", N/A ,"$8,195.36 ","$8,017.20 ","$5,936.29 ","$5,936.29 ","$5,424.97 ","$5,936.29 ","$5,790.20 ","$6,204.42 ","$1,979.36 ","$7,037.32 ", N/A ,"$4,454.00 ","$4,454.00 ","$3,028.72 ","$4,454.00 ", N/A ,"$8,462.60 ","$7,304.56 ","$7,304.56 ","$7,126.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880009,C1713,HC NAIL TI CANN TRO FIX 11MM/135,278,1 ,"$4,109.00 ","$2,054.50 ",$913.02 ,"$4,109.00 ", N/A ,"$3,475.80 ","$3,475.80 ","$1,397.06 ","$3,287.20 ","$3,492.65 ","$2,568.13 ","$3,698.10 ", N/A ,"$3,903.55 ","$3,698.10 ","$3,492.65 ","$3,492.65 ","$1,397.06 ","$3,492.65 ","$3,492.65 ","$3,698.10 ", N/A ,"$1,725.78 ","$3,698.10 ", N/A ,"$3,780.28 ","$3,698.10 ","$2,738.24 ","$2,738.24 ","$2,502.38 ","$2,738.24 ","$2,670.85 ","$2,861.92 ",$913.02 ,"$3,246.11 ", N/A , N/A , N/A ,"$1,397.06 ", N/A , N/A ,"$3,903.55 ","$3,369.38 ","$3,369.38 ","$3,287.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880010,C1713,HC NAIL DEG TI TRO FIX 170MM,278,1 ,"$4,314.00 ","$2,157.00 ",$958.57 ,"$4,314.00 ", N/A ,"$3,649.21 ","$3,649.21 ","$1,466.76 ","$3,451.20 ","$3,666.90 ","$2,696.25 ","$3,882.60 ", N/A ,"$4,098.30 ","$3,882.60 ","$3,666.90 ","$3,666.90 ","$1,466.76 ","$3,666.90 ","$3,666.90 ","$3,882.60 ", N/A ,"$1,811.88 ","$3,882.60 ", N/A ,"$3,968.88 ","$3,882.60 ","$2,874.85 ","$2,874.85 ","$2,627.23 ","$2,874.85 ","$2,804.10 ","$3,004.70 ",$958.57 ,"$3,408.06 ", N/A , N/A , N/A ,"$1,466.76 ", N/A , N/A ,"$4,098.30 ","$3,537.48 ","$3,537.48 ","$3,451.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880011,C1713,HC NAIL DEG TRO FIX 300-420,278,1 ,"$5,407.00 ","$2,703.50 ","$1,201.44 ","$5,407.00 ", N/A ,"$4,573.78 ","$4,573.78 ","$1,838.38 ","$4,325.60 ","$4,595.95 ","$3,379.38 ","$4,866.30 ", N/A ,"$5,136.65 ","$4,866.30 ","$4,595.95 ","$4,595.95 ","$1,838.38 ","$4,595.95 ","$4,595.95 ","$4,866.30 ", N/A ,"$2,270.94 ","$4,866.30 ", N/A ,"$4,974.44 ","$4,866.30 ","$3,603.22 ","$3,603.22 ","$3,292.86 ","$3,603.22 ","$3,514.55 ","$3,765.98 ","$1,201.44 ","$4,271.53 ", N/A , N/A , N/A ,"$1,838.38 ", N/A , N/A ,"$5,136.65 ","$4,433.74 ","$4,433.74 ","$4,325.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880012,C1713,HC NAIL DEG TI TRO FIX 11MM/130,278,1 ,"$5,678.00 ","$2,839.00 ","$1,261.65 ","$5,678.00 ", N/A ,"$4,803.02 ","$4,803.02 ","$1,930.52 ","$4,542.40 ","$4,826.30 ","$3,548.75 ","$5,110.20 ", N/A ,"$5,394.10 ","$5,110.20 ","$4,826.30 ","$4,826.30 ","$1,930.52 ","$4,826.30 ","$4,826.30 ","$5,110.20 ", N/A ,"$2,384.76 ","$5,110.20 ", N/A ,"$5,223.76 ","$5,110.20 ","$3,783.82 ","$3,783.82 ","$3,457.90 ","$3,783.82 ","$3,690.70 ","$3,954.73 ","$1,261.65 ","$4,485.62 ", N/A , N/A , N/A ,"$1,930.52 ", N/A , N/A ,"$5,394.10 ","$4,655.96 ","$4,655.96 ","$4,542.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880013,C1713,"HC PIN,CERCLAGE POS.THREADED",278,1 ,$487.00 ,$243.50 ,$108.21 ,$487.00 , N/A ,$411.95 ,$411.95 ,$165.58 ,$389.60 ,$413.95 ,$304.38 ,$438.30 , N/A ,$462.65 ,$438.30 ,$413.95 ,$413.95 ,$165.58 ,$413.95 ,$413.95 ,$438.30 , N/A ,$204.54 ,$438.30 , N/A ,$448.04 ,$438.30 ,$324.54 ,$324.54 ,$296.58 ,$324.54 ,$316.55 ,$339.20 ,$108.21 ,$384.73 , N/A , N/A , N/A ,$165.58 , N/A , N/A ,$462.65 ,$399.34 ,$399.34 ,$389.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880014,C1713,HC PLAT TIB W/O TAB 10 H LT,278,1 ,"$4,435.00 ","$2,217.50 ",$985.46 ,"$4,435.00 ", N/A ,"$3,751.57 ","$3,751.57 ","$1,507.90 ","$3,548.00 ","$3,769.75 ","$2,771.88 ","$3,991.50 ", N/A ,"$4,213.25 ","$3,991.50 ","$3,769.75 ","$3,769.75 ","$1,507.90 ","$3,769.75 ","$3,769.75 ","$3,991.50 ", N/A ,"$1,862.70 ","$3,991.50 ", N/A ,"$4,080.20 ","$3,991.50 ","$2,955.48 ","$2,955.48 ","$2,700.92 ","$2,955.48 ","$2,882.75 ","$3,088.98 ",$985.46 ,"$3,503.65 ", N/A , N/A , N/A ,"$1,507.90 ", N/A , N/A ,"$4,213.25 ","$3,636.70 ","$3,636.70 ","$3,548.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880015,C1713,HC PLAT DIST FIB ALL SIZES,278,1 ,"$1,949.00 ",$974.50 ,$433.07 ,"$1,949.00 ", N/A ,"$1,648.66 ","$1,648.66 ",$662.66 ,"$1,559.20 ","$1,656.65 ","$1,218.13 ","$1,754.10 ", N/A ,"$1,851.55 ","$1,754.10 ","$1,656.65 ","$1,656.65 ",$662.66 ,"$1,656.65 ","$1,656.65 ","$1,754.10 ", N/A ,$818.58 ,"$1,754.10 ", N/A ,"$1,793.08 ","$1,754.10 ","$1,298.81 ","$1,298.81 ","$1,186.94 ","$1,298.81 ","$1,266.85 ","$1,357.48 ",$433.07 ,"$1,539.71 ", N/A , N/A , N/A ,$662.66 , N/A , N/A ,"$1,851.55 ","$1,598.18 ","$1,598.18 ","$1,559.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880016,C1713,HC PLATE L 2.0-2.7MM OBLQ,278,1 ,$171.00 ,$85.50 ,$38.00 ,$171.00 , N/A ,$144.65 ,$144.65 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 , N/A ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 , N/A ,$71.82 ,$153.90 , N/A ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 , N/A , N/A , N/A ,$58.14 , N/A , N/A ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880017,C1713,HC PLATE LCP VOLAR COL DIS RAD ALL SIZES,278,1 ,"$2,709.00 ","$1,354.50 ",$601.94 ,"$2,709.00 ", N/A ,"$2,291.54 ","$2,291.54 ",$921.06 ,"$2,167.20 ","$2,302.65 ","$1,693.13 ","$2,438.10 ", N/A ,"$2,573.55 ","$2,438.10 ","$2,302.65 ","$2,302.65 ",$921.06 ,"$2,302.65 ","$2,302.65 ","$2,438.10 ", N/A ,"$1,137.78 ","$2,438.10 ", N/A ,"$2,492.28 ","$2,438.10 ","$1,805.28 ","$1,805.28 ","$1,649.78 ","$1,805.28 ","$1,760.85 ","$1,886.82 ",$601.94 ,"$2,140.11 ", N/A , N/A , N/A ,$921.06 , N/A , N/A ,"$2,573.55 ","$2,221.38 ","$2,221.38 ","$2,167.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880018,C1713,HC PLAT T 2.0-2.7,278,1 ,$171.00 ,$85.50 ,$38.00 ,$171.00 , N/A ,$144.65 ,$144.65 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 , N/A ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 , N/A ,$71.82 ,$153.90 , N/A ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 , N/A , N/A , N/A ,$58.14 , N/A , N/A ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880019,C1713,HC PLATE TIB W/O TAB 10 RT,278,1 ,"$4,435.00 ","$2,217.50 ",$985.46 ,"$4,435.00 ", N/A ,"$3,751.57 ","$3,751.57 ","$1,507.90 ","$3,548.00 ","$3,769.75 ","$2,771.88 ","$3,991.50 ", N/A ,"$4,213.25 ","$3,991.50 ","$3,769.75 ","$3,769.75 ","$1,507.90 ","$3,769.75 ","$3,769.75 ","$3,991.50 ", N/A ,"$1,862.70 ","$3,991.50 ", N/A ,"$4,080.20 ","$3,991.50 ","$2,955.48 ","$2,955.48 ","$2,700.92 ","$2,955.48 ","$2,882.75 ","$3,088.98 ",$985.46 ,"$3,503.65 ", N/A , N/A , N/A ,"$1,507.90 ", N/A , N/A ,"$4,213.25 ","$3,636.70 ","$3,636.70 ","$3,548.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880020,C1713,HC PLATE W/O TAB 4H,278,1 ,"$4,298.00 ","$2,149.00 ",$955.02 ,"$4,298.00 ", N/A ,"$3,635.68 ","$3,635.68 ","$1,461.32 ","$3,438.40 ","$3,653.30 ","$2,686.25 ","$3,868.20 ", N/A ,"$4,083.10 ","$3,868.20 ","$3,653.30 ","$3,653.30 ","$1,461.32 ","$3,653.30 ","$3,653.30 ","$3,868.20 ", N/A ,"$1,805.16 ","$3,868.20 ", N/A ,"$3,954.16 ","$3,868.20 ","$2,864.19 ","$2,864.19 ","$2,617.48 ","$2,864.19 ","$2,793.70 ","$2,993.56 ",$955.02 ,"$3,395.42 ", N/A , N/A , N/A ,"$1,461.32 ", N/A , N/A ,"$4,083.10 ","$3,524.36 ","$3,524.36 ","$3,438.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880021,C1713,HC PLATE W/O TAB 6 H,278,1 ,"$4,346.00 ","$2,173.00 ",$965.68 ,"$4,346.00 ", N/A ,"$3,676.28 ","$3,676.28 ","$1,477.64 ","$3,476.80 ","$3,694.10 ","$2,716.25 ","$3,911.40 ", N/A ,"$4,128.70 ","$3,911.40 ","$3,694.10 ","$3,694.10 ","$1,477.64 ","$3,694.10 ","$3,694.10 ","$3,911.40 ", N/A ,"$1,825.32 ","$3,911.40 ", N/A ,"$3,998.32 ","$3,911.40 ","$2,896.17 ","$2,896.17 ","$2,646.71 ","$2,896.17 ","$2,824.90 ","$3,026.99 ",$965.68 ,"$3,433.34 ", N/A , N/A , N/A ,"$1,477.64 ", N/A , N/A ,"$4,128.70 ","$3,563.72 ","$3,563.72 ","$3,476.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880022,C1713,HC PLATE NARROW 10 HOLE 4.5MM,278,1 ,"$1,659.00 ",$829.50 ,$368.63 ,"$1,659.00 ", N/A ,"$1,403.35 ","$1,403.35 ",$564.06 ,"$1,327.20 ","$1,410.15 ","$1,036.88 ","$1,493.10 ", N/A ,"$1,576.05 ","$1,493.10 ","$1,410.15 ","$1,410.15 ",$564.06 ,"$1,410.15 ","$1,410.15 ","$1,493.10 ", N/A ,$696.78 ,"$1,493.10 ", N/A ,"$1,526.28 ","$1,493.10 ","$1,105.56 ","$1,105.56 ","$1,010.33 ","$1,105.56 ","$1,078.35 ","$1,155.49 ",$368.63 ,"$1,310.61 ", N/A , N/A , N/A ,$564.06 , N/A , N/A ,"$1,576.05 ","$1,360.38 ","$1,360.38 ","$1,327.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880023,C1713,HC PLATE NARROW 12 HOLE 4.5 MM,278,1 ,"$1,918.00 ",$959.00 ,$426.18 ,"$1,918.00 ", N/A ,"$1,622.44 ","$1,622.44 ",$652.12 ,"$1,534.40 ","$1,630.30 ","$1,198.75 ","$1,726.20 ", N/A ,"$1,822.10 ","$1,726.20 ","$1,630.30 ","$1,630.30 ",$652.12 ,"$1,630.30 ","$1,630.30 ","$1,726.20 ", N/A ,$805.56 ,"$1,726.20 ", N/A ,"$1,764.56 ","$1,726.20 ","$1,278.16 ","$1,278.16 ","$1,168.06 ","$1,278.16 ","$1,246.70 ","$1,335.89 ",$426.18 ,"$1,515.22 ", N/A , N/A , N/A ,$652.12 , N/A , N/A ,"$1,822.10 ","$1,572.76 ","$1,572.76 ","$1,534.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880024,C1713,HC PLATE NARROW 14 HOLE 4.5 MM,278,1 ,"$2,175.00 ","$1,087.50 ",$483.29 ,"$2,175.00 ", N/A ,"$1,839.83 ","$1,839.83 ",$739.50 ,"$1,740.00 ","$1,848.75 ","$1,359.38 ","$1,957.50 ", N/A ,"$2,066.25 ","$1,957.50 ","$1,848.75 ","$1,848.75 ",$739.50 ,"$1,848.75 ","$1,848.75 ","$1,957.50 ", N/A ,$913.50 ,"$1,957.50 ", N/A ,"$2,001.00 ","$1,957.50 ","$1,449.42 ","$1,449.42 ","$1,324.58 ","$1,449.42 ","$1,413.75 ","$1,514.89 ",$483.29 ,"$1,718.25 ", N/A , N/A , N/A ,$739.50 , N/A , N/A ,"$2,066.25 ","$1,783.50 ","$1,783.50 ","$1,740.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880025,C1713,HC PLATE NARROW 16 HOLE 4.5 MM,278,1 ,"$1,716.00 ",$858.00 ,$381.30 ,"$1,716.00 ", N/A ,"$1,451.56 ","$1,451.56 ",$583.44 ,"$1,372.80 ","$1,458.60 ","$1,072.50 ","$1,544.40 ", N/A ,"$1,630.20 ","$1,544.40 ","$1,458.60 ","$1,458.60 ",$583.44 ,"$1,458.60 ","$1,458.60 ","$1,544.40 ", N/A ,$720.72 ,"$1,544.40 ", N/A ,"$1,578.72 ","$1,544.40 ","$1,143.54 ","$1,143.54 ","$1,045.04 ","$1,143.54 ","$1,115.40 ","$1,195.19 ",$381.30 ,"$1,355.64 ", N/A , N/A , N/A ,$583.44 , N/A , N/A ,"$1,630.20 ","$1,407.12 ","$1,407.12 ","$1,372.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880026,C1713,HC PLATE NARROW 8 HOLE 4.5 MM,278,1 ,"$1,456.00 ",$728.00 ,$323.52 ,"$1,456.00 ", N/A ,"$1,231.63 ","$1,231.63 ",$495.04 ,"$1,164.80 ","$1,237.60 ",$910.00 ,"$1,310.40 ", N/A ,"$1,383.20 ","$1,310.40 ","$1,237.60 ","$1,237.60 ",$495.04 ,"$1,237.60 ","$1,237.60 ","$1,310.40 ", N/A ,$611.52 ,"$1,310.40 ", N/A ,"$1,339.52 ","$1,310.40 ",$970.28 ,$970.28 ,$886.70 ,$970.28 ,$946.40 ,"$1,014.10 ",$323.52 ,"$1,150.24 ", N/A , N/A , N/A ,$495.04 , N/A , N/A ,"$1,383.20 ","$1,193.92 ","$1,193.92 ","$1,164.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880027,C1713,HC PLATE PROX HUM 5 HOLE,278,1 ,"$4,813.00 ","$2,406.50 ","$1,069.45 ","$4,813.00 ", N/A ,"$4,071.32 ","$4,071.32 ","$1,636.42 ","$3,850.40 ","$4,091.05 ","$3,008.13 ","$4,331.70 ", N/A ,"$4,572.35 ","$4,331.70 ","$4,091.05 ","$4,091.05 ","$1,636.42 ","$4,091.05 ","$4,091.05 ","$4,331.70 ", N/A ,"$2,021.46 ","$4,331.70 ", N/A ,"$4,427.96 ","$4,331.70 ","$3,207.38 ","$3,207.38 ","$2,931.12 ","$3,207.38 ","$3,128.45 ","$3,352.25 ","$1,069.45 ","$3,802.27 ", N/A , N/A , N/A ,"$1,636.42 ", N/A , N/A ,"$4,572.35 ","$3,946.66 ","$3,946.66 ","$3,850.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880028,C1713,HC PLATE PROX HUM 3 HOLE,278,1 ,"$4,898.00 ","$2,449.00 ","$1,088.34 ","$4,898.00 ", N/A ,"$4,143.22 ","$4,143.22 ","$1,665.32 ","$3,918.40 ","$4,163.30 ","$3,061.25 ","$4,408.20 ", N/A ,"$4,653.10 ","$4,408.20 ","$4,163.30 ","$4,163.30 ","$1,665.32 ","$4,163.30 ","$4,163.30 ","$4,408.20 ", N/A ,"$2,057.16 ","$4,408.20 ", N/A ,"$4,506.16 ","$4,408.20 ","$3,264.03 ","$3,264.03 ","$2,982.88 ","$3,264.03 ","$3,183.70 ","$3,411.46 ","$1,088.34 ","$3,869.42 ", N/A , N/A , N/A ,"$1,665.32 ", N/A , N/A ,"$4,653.10 ","$4,016.36 ","$4,016.36 ","$3,918.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880029,C1713,"HC PLATE,QTR-TUBE W COL. 3H",278,1 ,$202.00 ,$101.00 ,$44.88 ,$202.00 , N/A ,$170.87 ,$170.87 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 , N/A ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 , N/A ,$84.84 ,$181.80 , N/A ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 , N/A , N/A , N/A ,$68.68 , N/A , N/A ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880030,C1713,"HC PLATE,QTR-TUBE W COL. 5H",278,1 ,$230.00 ,$115.00 ,$51.11 ,$230.00 , N/A ,$194.56 ,$194.56 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 , N/A ,$96.60 ,$207.00 , N/A ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 , N/A , N/A , N/A ,$78.20 , N/A , N/A ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880031,C1713,HC PLATE QTR TUBE W COL 7H,278,1 ,$265.00 ,$132.50 ,$58.88 ,$265.00 , N/A ,$224.16 ,$224.16 ,$90.10 ,$212.00 ,$225.25 ,$165.63 ,$238.50 , N/A ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$90.10 ,$225.25 ,$225.25 ,$238.50 , N/A ,$111.30 ,$238.50 , N/A ,$243.80 ,$238.50 ,$176.60 ,$176.60 ,$161.39 ,$176.60 ,$172.25 ,$184.57 ,$58.88 ,$209.35 , N/A , N/A , N/A ,$90.10 , N/A , N/A ,$251.75 ,$217.30 ,$217.30 ,$212.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880032,C1788,HC PORT W SUT PLUGS MRI IMPL,278,1 ,"$1,466.00 ",$733.00 ,$325.75 ,"$1,466.00 ", N/A ,"$1,240.09 ","$1,240.09 ",$498.44 ,"$1,172.80 ","$1,246.10 ",$916.25 ,"$1,319.40 ", N/A ,"$1,392.70 ","$1,319.40 ","$1,246.10 ","$1,246.10 ",$498.44 ,"$1,246.10 ","$1,246.10 ","$1,319.40 ", N/A ,$615.72 ,"$1,319.40 ", N/A ,"$1,348.72 ","$1,319.40 ",$976.94 ,$976.94 ,$892.79 ,$976.94 ,$952.90 ,"$1,021.07 ",$325.75 ,"$1,158.14 ", N/A , N/A , N/A ,$498.44 , N/A , N/A ,"$1,392.70 ","$1,202.12 ","$1,202.12 ","$1,172.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880033,C1713,HC RAPIDLOC MENISCAL,278,1 ,$793.00 ,$396.50 ,$176.20 ,$793.00 , N/A ,$670.80 ,$670.80 ,$269.62 ,$634.40 ,$674.05 ,$495.63 ,$713.70 , N/A ,$753.35 ,$713.70 ,$674.05 ,$674.05 ,$269.62 ,$674.05 ,$674.05 ,$713.70 , N/A ,$333.06 ,$713.70 , N/A ,$729.56 ,$713.70 ,$528.46 ,$528.46 ,$482.94 ,$528.46 ,$515.45 ,$552.32 ,$176.20 ,$626.47 , N/A , N/A , N/A ,$269.62 , N/A , N/A ,$753.35 ,$650.26 ,$650.26 ,$634.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880034,C1713,HC SCREW LOCK SFL TAP W/STAR,278,1 ,$404.00 ,$202.00 ,$89.77 ,$404.00 , N/A ,$341.74 ,$341.74 ,$137.36 ,$323.20 ,$343.40 ,$252.50 ,$363.60 , N/A ,$383.80 ,$363.60 ,$343.40 ,$343.40 ,$137.36 ,$343.40 ,$343.40 ,$363.60 , N/A ,$169.68 ,$363.60 , N/A ,$371.68 ,$363.60 ,$269.23 ,$269.23 ,$246.04 ,$269.23 ,$262.60 ,$281.39 ,$89.77 ,$319.16 , N/A , N/A , N/A ,$137.36 , N/A , N/A ,$383.80 ,$331.28 ,$331.28 ,$323.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880035,C1713,HC SCREW CORTEX 2.0 SLF TAP,278,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 , N/A ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 , N/A ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 , N/A , N/A , N/A ,$27.20 , N/A , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880036,C1713,HC SCREW CORTEX 2.7 SLF TAP,278,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 , N/A ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 , N/A ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 , N/A , N/A , N/A ,$27.20 , N/A , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880037,C1713,HC SCREW 6.5 CANNUL 16MM THREAD,278,1 ,$267.00 ,$133.50 ,$59.33 ,$267.00 , N/A ,$225.86 ,$225.86 ,$90.78 ,$213.60 ,$226.95 ,$166.88 ,$240.30 , N/A ,$253.65 ,$240.30 ,$226.95 ,$226.95 ,$90.78 ,$226.95 ,$226.95 ,$240.30 , N/A ,$112.14 ,$240.30 , N/A ,$245.64 ,$240.30 ,$177.93 ,$177.93 ,$162.60 ,$177.93 ,$173.55 ,$185.97 ,$59.33 ,$210.93 , N/A , N/A , N/A ,$90.78 , N/A , N/A ,$253.65 ,$218.94 ,$218.94 ,$213.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880038,C1713,HC SCREW TI LOCK IM NAIL,278,1 ,$557.00 ,$278.50 ,$123.77 ,$557.00 , N/A ,$471.17 ,$471.17 ,$189.38 ,$445.60 ,$473.45 ,$348.13 ,$501.30 , N/A ,$529.15 ,$501.30 ,$473.45 ,$473.45 ,$189.38 ,$473.45 ,$473.45 ,$501.30 , N/A ,$233.94 ,$501.30 , N/A ,$512.44 ,$501.30 ,$371.18 ,$371.18 ,$339.21 ,$371.18 ,$362.05 ,$387.95 ,$123.77 ,$440.03 , N/A , N/A , N/A ,$189.38 , N/A , N/A ,$529.15 ,$456.74 ,$456.74 ,$445.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880039,C1713,HC SCREW 5.0 TI LOCK IM NAIL,278,1 ,$584.00 ,$292.00 ,$129.76 ,$584.00 , N/A ,$494.01 ,$494.01 ,$198.56 ,$467.20 ,$496.40 ,$365.00 ,$525.60 , N/A ,$554.80 ,$525.60 ,$496.40 ,$496.40 ,$198.56 ,$496.40 ,$496.40 ,$525.60 , N/A ,$245.28 ,$525.60 , N/A ,$537.28 ,$525.60 ,$389.18 ,$389.18 ,$355.66 ,$389.18 ,$379.60 ,$406.76 ,$129.76 ,$461.36 , N/A , N/A , N/A ,$198.56 , N/A , N/A ,$554.80 ,$478.88 ,$478.88 ,$467.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880040,C1713,HC SCREW CANLTD 4.0 SHRT,278,1 ,$734.00 ,$367.00 ,$163.09 ,$734.00 , N/A ,$620.89 ,$620.89 ,$249.56 ,$587.20 ,$623.90 ,$458.75 ,$660.60 , N/A ,$697.30 ,$660.60 ,$623.90 ,$623.90 ,$249.56 ,$623.90 ,$623.90 ,$660.60 , N/A ,$308.28 ,$660.60 , N/A ,$675.28 ,$660.60 ,$489.14 ,$489.14 ,$447.01 ,$489.14 ,$477.10 ,$511.23 ,$163.09 ,$579.86 , N/A , N/A , N/A ,$249.56 , N/A , N/A ,$697.30 ,$601.88 ,$601.88 ,$587.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880041,C1713,HC SCREW 4.5MM CORTEX SLF TAP,278,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 , N/A ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 , N/A ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 , N/A , N/A , N/A ,$27.20 , N/A , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880042,C1713,HC SCREW 6.5MM CANCEL BONE THRD,278,1 ,$129.00 ,$64.50 ,$28.66 ,$129.00 , N/A ,$109.12 ,$109.12 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 , N/A ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 , N/A ,$54.18 ,$116.10 , N/A ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 , N/A , N/A , N/A ,$43.86 , N/A , N/A ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880043,C1713,HC SCREW 6.5 CANC FULL THRD,278,1 ,$119.00 ,$59.50 ,$26.44 ,$119.00 , N/A ,$100.66 ,$100.66 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 , N/A ,$49.98 ,$107.10 , N/A ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 , N/A , N/A , N/A ,$40.46 , N/A , N/A ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880044,C1713,HC SCREW 2.7 CORTEX SLF TAP,278,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 , N/A ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 , N/A ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 , N/A , N/A , N/A ,$27.20 , N/A , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880045,C1713,HC SCREW LCK SLF TAP STAR T8,278,1 ,$420.00 ,$210.00 ,$93.32 ,$420.00 , N/A ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 , N/A ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 , N/A ,$176.40 ,$378.00 , N/A ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 , N/A , N/A , N/A ,$142.80 , N/A , N/A ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880046,C1781,"HC SLING,INCONT.TVT ADV FIT",278,1 ,"$1,920.00 ",$960.00 ,$426.62 ,"$1,920.00 ", N/A ,"$1,624.13 ","$1,624.13 ",$652.80 ,"$1,536.00 ","$1,632.00 ","$1,200.00 ","$1,728.00 ", N/A ,"$1,824.00 ","$1,728.00 ","$1,632.00 ","$1,632.00 ",$652.80 ,"$1,632.00 ","$1,632.00 ","$1,728.00 ", N/A ,$806.40 ,"$1,728.00 ", N/A ,"$1,766.40 ","$1,728.00 ","$1,279.49 ","$1,279.49 ","$1,169.28 ","$1,279.49 ","$1,248.00 ","$1,337.28 ",$426.62 ,"$1,516.80 ", N/A , N/A , N/A ,$652.80 , N/A , N/A ,"$1,824.00 ","$1,574.40 ","$1,574.40 ","$1,536.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880047,C1728,HC TRAY BRACH SAVI,278,1 ,"$8,569.00 ","$4,284.50 ","$1,904.03 ","$8,569.00 ", N/A ,"$7,248.52 ","$7,248.52 ","$2,913.46 ","$6,855.20 ","$7,283.65 ","$5,355.63 ","$7,712.10 ", N/A ,"$8,140.55 ","$7,712.10 ","$7,283.65 ","$7,283.65 ","$2,913.46 ","$7,283.65 ","$7,283.65 ","$7,712.10 ", N/A ,"$3,598.98 ","$7,712.10 ", N/A ,"$7,883.48 ","$7,712.10 ","$5,710.38 ","$5,710.38 ","$5,218.52 ","$5,710.38 ","$5,569.85 ","$5,968.31 ","$1,904.03 ","$6,769.51 ", N/A ,"$4,284.50 ","$4,284.50 ","$2,913.46 ","$4,284.50 ", N/A ,"$8,140.55 ","$7,026.58 ","$7,026.58 ","$6,855.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880049,C1772,HC KIT POUCH MESH PAIN PUMP,278,1 ,$266.00 ,$133.00 ,$59.11 ,$266.00 , N/A ,$225.01 ,$225.01 ,$90.44 ,$212.80 ,$226.10 ,$166.25 ,$239.40 , N/A ,$252.70 ,$239.40 ,$226.10 ,$226.10 ,$90.44 ,$226.10 ,$226.10 ,$239.40 , N/A ,$111.72 ,$239.40 , N/A ,$244.72 ,$239.40 ,$177.26 ,$177.26 ,$161.99 ,$177.26 ,$172.90 ,$185.27 ,$59.11 ,$210.14 , N/A , N/A , N/A ,$90.44 , N/A , N/A ,$252.70 ,$218.12 ,$218.12 ,$212.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880050,C1781,HC MESH SURGIMESH WN PLUT RND STD,278,1 ,"$2,125.00 ","$1,062.50 ",$472.18 ,"$2,125.00 ", N/A ,"$1,797.54 ","$1,797.54 ",$722.50 ,"$1,700.00 ","$1,806.25 ","$1,328.13 ","$1,912.50 ", N/A ,"$2,018.75 ","$1,912.50 ","$1,806.25 ","$1,806.25 ",$722.50 ,"$1,806.25 ","$1,806.25 ","$1,912.50 ", N/A ,$892.50 ,"$1,912.50 ", N/A ,"$1,955.00 ","$1,912.50 ","$1,416.10 ","$1,416.10 ","$1,294.13 ","$1,416.10 ","$1,381.25 ","$1,480.06 ",$472.18 ,"$1,678.75 ", N/A , N/A , N/A ,$722.50 , N/A , N/A ,"$2,018.75 ","$1,742.50 ","$1,742.50 ","$1,700.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880051,N/A,HC LEAD KIT,278,1 ,"$4,294.00 ","$2,147.00 ",$954.13 ,"$4,294.00 ", N/A ,"$3,632.29 ","$3,632.29 ","$1,459.96 ","$3,435.20 ","$3,649.90 ","$2,683.75 ","$3,864.60 ", N/A ,"$4,079.30 ","$3,864.60 ","$3,649.90 ","$3,649.90 ","$1,459.96 ","$3,649.90 ","$3,649.90 ","$3,864.60 ", N/A ,"$1,803.48 ","$3,864.60 ", N/A ,"$3,950.48 ","$3,864.60 ","$2,861.52 ","$2,861.52 ","$2,615.05 ","$2,861.52 ","$2,791.10 ","$2,990.77 ",$954.13 ,"$3,392.26 ", N/A , N/A , N/A ,"$1,459.96 ", N/A , N/A ,"$4,079.30 ","$3,521.08 ","$3,521.08 ","$3,435.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880052,N/A,HC BUMPY ANCHOR,278,1 ,$858.00 ,$429.00 ,$190.65 ,$858.00 , N/A ,$725.78 ,$725.78 ,$291.72 ,$686.40 ,$729.30 ,$536.25 ,$772.20 , N/A ,$815.10 ,$772.20 ,$729.30 ,$729.30 ,$291.72 ,$729.30 ,$729.30 ,$772.20 , N/A ,$360.36 ,$772.20 , N/A ,$789.36 ,$772.20 ,$571.77 ,$571.77 ,$522.52 ,$571.77 ,$557.70 ,$597.60 ,$190.65 ,$677.82 , N/A , N/A , N/A ,$291.72 , N/A , N/A ,$815.10 ,$703.56 ,$703.56 ,$686.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880053,C1767,HC RESTORE SENSOR,278,1 ,"$47,467.00 ","$23,733.50 ","$10,547.17 ","$47,467.00 ", N/A ,"$40,152.34 ","$40,152.34 ","$16,138.78 ","$37,973.60 ","$40,346.95 ","$29,666.88 ","$42,720.30 ", N/A ,"$45,093.65 ","$42,720.30 ","$40,346.95 ","$40,346.95 ","$16,138.78 ","$40,346.95 ","$40,346.95 ","$42,720.30 ", N/A ,"$19,936.14 ","$42,720.30 ", N/A ,"$43,669.64 ","$42,720.30 ","$31,632.01 ","$31,632.01 ","$28,907.40 ","$31,632.01 ","$30,853.55 ","$33,060.77 ","$10,547.17 ","$37,498.93 ", N/A ,"$23,733.50 ","$23,733.50 ","$16,138.78 ","$23,733.50 ", N/A ,"$45,093.65 ","$38,922.94 ","$38,922.94 ","$37,973.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880055,C1769,HC GUIDEWIRE AMPLATZ SS STR TIP 75 CM.035,278,1 ,$85.00 ,$42.50 ,$18.89 ,$85.00 , N/A ,$71.90 ,$71.90 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 , N/A ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 , N/A ,$35.70 ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 , N/A , N/A , N/A ,$28.90 , N/A , N/A ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880056,C1766,HC INTRODUCER SET MICROPUNCTURE 5FR,278,1 ,$113.00 ,$56.50 ,$25.11 ,$113.00 , N/A ,$95.59 ,$95.59 ,$38.42 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$38.42 ,$96.05 ,$96.05 ,$101.70 , N/A ,$47.46 ,$101.70 , N/A ,$103.96 ,$101.70 ,$75.30 ,$75.30 ,$68.82 ,$75.30 ,$73.45 ,$78.70 ,$25.11 ,$89.27 , N/A , N/A , N/A ,$38.42 , N/A , N/A ,$107.35 ,$92.66 ,$92.66 ,$90.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880057,C1729,HC CATH DRAINAGE FLEXIMA REGULAR,278,1 ,$252.00 ,$126.00 ,$55.99 ,$252.00 , N/A ,$213.17 ,$213.17 ,$85.68 ,$201.60 ,$214.20 ,$157.50 ,$226.80 , N/A ,$239.40 ,$226.80 ,$214.20 ,$214.20 ,$85.68 ,$214.20 ,$214.20 ,$226.80 , N/A ,$105.84 ,$226.80 , N/A ,$231.84 ,$226.80 ,$167.93 ,$167.93 ,$153.47 ,$167.93 ,$163.80 ,$175.52 ,$55.99 ,$199.08 , N/A , N/A , N/A ,$85.68 , N/A , N/A ,$239.40 ,$206.64 ,$206.64 ,$201.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880058,C1781,HC MESH SURGIMESH XB 7CM,278,1 ,"$2,648.00 ","$1,324.00 ",$588.39 ,"$2,648.00 ", N/A ,"$2,239.94 ","$2,239.94 ",$900.32 ,"$2,118.40 ","$2,250.80 ","$1,655.00 ","$2,383.20 ", N/A ,"$2,515.60 ","$2,383.20 ","$2,250.80 ","$2,250.80 ",$900.32 ,"$2,250.80 ","$2,250.80 ","$2,383.20 ", N/A ,"$1,112.16 ","$2,383.20 ", N/A ,"$2,436.16 ","$2,383.20 ","$1,764.63 ","$1,764.63 ","$1,612.63 ","$1,764.63 ","$1,721.20 ","$1,844.33 ",$588.39 ,"$2,091.92 ", N/A , N/A , N/A ,$900.32 , N/A , N/A ,"$2,515.60 ","$2,171.36 ","$2,171.36 ","$2,118.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880059,C1781,HC MESH SURGIMESH XB 10CM,278,1 ,"$2,832.00 ","$1,416.00 ",$629.27 ,"$2,832.00 ", N/A ,"$2,395.59 ","$2,395.59 ",$962.88 ,"$2,265.60 ","$2,407.20 ","$1,770.00 ","$2,548.80 ", N/A ,"$2,690.40 ","$2,548.80 ","$2,407.20 ","$2,407.20 ",$962.88 ,"$2,407.20 ","$2,407.20 ","$2,548.80 ", N/A ,"$1,189.44 ","$2,548.80 ", N/A ,"$2,605.44 ","$2,548.80 ","$1,887.24 ","$1,887.24 ","$1,724.69 ","$1,887.24 ","$1,840.80 ","$1,972.49 ",$629.27 ,"$2,237.28 ", N/A , N/A , N/A ,$962.88 , N/A , N/A ,"$2,690.40 ","$2,322.24 ","$2,322.24 ","$2,265.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880060,C1781,HC MESH SURGIMESH XB 10X15CM,278,1 ,"$3,739.00 ","$1,869.50 ",$830.81 ,"$3,739.00 ", N/A ,"$3,162.82 ","$3,162.82 ","$1,271.26 ","$2,991.20 ","$3,178.15 ","$2,336.88 ","$3,365.10 ", N/A ,"$3,552.05 ","$3,365.10 ","$3,178.15 ","$3,178.15 ","$1,271.26 ","$3,178.15 ","$3,178.15 ","$3,365.10 ", N/A ,"$1,570.38 ","$3,365.10 ", N/A ,"$3,439.88 ","$3,365.10 ","$2,491.67 ","$2,491.67 ","$2,277.05 ","$2,491.67 ","$2,430.35 ","$2,604.21 ",$830.81 ,"$2,953.81 ", N/A , N/A , N/A ,"$1,271.26 ", N/A , N/A ,"$3,552.05 ","$3,065.98 ","$3,065.98 ","$2,991.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880061,C1781,HC MESH SURGMESH XB 15X22CM,278,1 ,"$6,457.00 ","$3,228.50 ","$1,434.75 ","$6,457.00 ", N/A ,"$5,461.98 ","$5,461.98 ","$2,195.38 ","$5,165.60 ","$5,488.45 ","$4,035.63 ","$5,811.30 ", N/A ,"$6,134.15 ","$5,811.30 ","$5,488.45 ","$5,488.45 ","$2,195.38 ","$5,488.45 ","$5,488.45 ","$5,811.30 ", N/A ,"$2,711.94 ","$5,811.30 ", N/A ,"$5,940.44 ","$5,811.30 ","$4,302.94 ","$4,302.94 ","$3,932.31 ","$4,302.94 ","$4,197.05 ","$4,497.30 ","$1,434.75 ","$5,101.03 ", N/A ,"$3,228.50 ","$3,228.50 ","$2,195.38 ","$3,228.50 ", N/A ,"$6,134.15 ","$5,294.74 ","$5,294.74 ","$5,165.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880062,C1781,HC MESH SURGIMESH WN PLUG 10LG,278,1 ,"$1,169.00 ",$584.50 ,$259.75 ,"$1,169.00 ", N/A ,$988.86 ,$988.86 ,$397.46 ,$935.20 ,$993.65 ,$730.63 ,"$1,052.10 ", N/A ,"$1,110.55 ","$1,052.10 ",$993.65 ,$993.65 ,$397.46 ,$993.65 ,$993.65 ,"$1,052.10 ", N/A ,$490.98 ,"$1,052.10 ", N/A ,"$1,075.48 ","$1,052.10 ",$779.02 ,$779.02 ,$711.92 ,$779.02 ,$759.85 ,$814.21 ,$259.75 ,$923.51 , N/A , N/A , N/A ,$397.46 , N/A , N/A ,"$1,110.55 ",$958.58 ,$958.58 ,$935.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880063,C1781,HC MESH SURGIMESH WN 30X30CM,278,1 ,"$2,727.00 ","$1,363.50 ",$605.94 ,"$2,727.00 ", N/A ,"$2,306.77 ","$2,306.77 ",$927.18 ,"$2,181.60 ","$2,317.95 ","$1,704.38 ","$2,454.30 ", N/A ,"$2,590.65 ","$2,454.30 ","$2,317.95 ","$2,317.95 ",$927.18 ,"$2,317.95 ","$2,317.95 ","$2,454.30 ", N/A ,"$1,145.34 ","$2,454.30 ", N/A ,"$2,508.84 ","$2,454.30 ","$1,817.27 ","$1,817.27 ","$1,660.74 ","$1,817.27 ","$1,772.55 ","$1,899.36 ",$605.94 ,"$2,154.33 ", N/A , N/A , N/A ,$927.18 , N/A , N/A ,"$2,590.65 ","$2,236.14 ","$2,236.14 ","$2,181.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880064,C1781,HC MESH PARIETEX 5.2 X 3.6,278,1 ,$430.00 ,$215.00 ,$95.55 ,$430.00 , N/A ,$363.74 ,$363.74 ,$146.20 ,$344.00 ,$365.50 ,$268.75 ,$387.00 , N/A ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$146.20 ,$365.50 ,$365.50 ,$387.00 , N/A ,$180.60 ,$387.00 , N/A ,$395.60 ,$387.00 ,$286.55 ,$286.55 ,$261.87 ,$286.55 ,$279.50 ,$299.50 ,$95.55 ,$339.70 , N/A , N/A , N/A ,$146.20 , N/A , N/A ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880065,C1781,HC MESH PARIETEX 6 X 6,278,1 ,$590.00 ,$295.00 ,$131.10 ,$590.00 , N/A ,$499.08 ,$499.08 ,$200.60 ,$472.00 ,$501.50 ,$368.75 ,$531.00 , N/A ,$560.50 ,$531.00 ,$501.50 ,$501.50 ,$200.60 ,$501.50 ,$501.50 ,$531.00 , N/A ,$247.80 ,$531.00 , N/A ,$542.80 ,$531.00 ,$393.18 ,$393.18 ,$359.31 ,$393.18 ,$383.50 ,$410.94 ,$131.10 ,$466.10 , N/A , N/A , N/A ,$200.60 , N/A , N/A ,$560.50 ,$483.80 ,$483.80 ,$472.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880066,C1781,HC MESH PARIETEX PLUT PATCH 6CM 5X10,278,1 ,$781.00 ,$390.50 ,$173.54 ,$781.00 , N/A ,$660.65 ,$660.65 ,$265.54 ,$624.80 ,$663.85 ,$488.13 ,$702.90 , N/A ,$741.95 ,$702.90 ,$663.85 ,$663.85 ,$265.54 ,$663.85 ,$663.85 ,$702.90 , N/A ,$328.02 ,$702.90 , N/A ,$718.52 ,$702.90 ,$520.46 ,$520.46 ,$475.63 ,$520.46 ,$507.65 ,$543.97 ,$173.54 ,$616.99 , N/A , N/A , N/A ,$265.54 , N/A , N/A ,$741.95 ,$640.42 ,$640.42 ,$624.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880067,C1781,HC MESH PARIETEX ROUND 15CM,278,1 ,"$2,561.00 ","$1,280.50 ",$569.05 ,"$2,561.00 ", N/A ,"$2,166.35 ","$2,166.35 ",$870.74 ,"$2,048.80 ","$2,176.85 ","$1,600.63 ","$2,304.90 ", N/A ,"$2,432.95 ","$2,304.90 ","$2,176.85 ","$2,176.85 ",$870.74 ,"$2,176.85 ","$2,176.85 ","$2,304.90 ", N/A ,"$1,075.62 ","$2,304.90 ", N/A ,"$2,356.12 ","$2,304.90 ","$1,706.65 ","$1,706.65 ","$1,559.65 ","$1,706.65 ","$1,664.65 ","$1,783.74 ",$569.05 ,"$2,023.19 ", N/A , N/A , N/A ,$870.74 , N/A , N/A ,"$2,432.95 ","$2,100.02 ","$2,100.02 ","$2,048.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880068,C1781,HC MESH PARIETEX OVAL 30CMX20CM,278,1 ,"$4,744.00 ","$2,372.00 ","$1,054.12 ","$4,744.00 ", N/A ,"$4,012.95 ","$4,012.95 ","$1,612.96 ","$3,795.20 ","$4,032.40 ","$2,965.00 ","$4,269.60 ", N/A ,"$4,506.80 ","$4,269.60 ","$4,032.40 ","$4,032.40 ","$1,612.96 ","$4,032.40 ","$4,032.40 ","$4,269.60 ", N/A ,"$1,992.48 ","$4,269.60 ", N/A ,"$4,364.48 ","$4,269.60 ","$3,161.40 ","$3,161.40 ","$2,889.10 ","$3,161.40 ","$3,083.60 ","$3,304.20 ","$1,054.12 ","$3,747.76 ", N/A , N/A , N/A ,"$1,612.96 ", N/A , N/A ,"$4,506.80 ","$3,890.08 ","$3,890.08 ","$3,795.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880069,C1781,HC MESH PARIETEX OVAL 15CMX10CM,278,1 ,"$1,957.00 ",$978.50 ,$434.85 ,"$1,957.00 ", N/A ,"$1,655.43 ","$1,655.43 ",$665.38 ,"$1,565.60 ","$1,663.45 ","$1,223.13 ","$1,761.30 ", N/A ,"$1,859.15 ","$1,761.30 ","$1,663.45 ","$1,663.45 ",$665.38 ,"$1,663.45 ","$1,663.45 ","$1,761.30 ", N/A ,$821.94 ,"$1,761.30 ", N/A ,"$1,800.44 ","$1,761.30 ","$1,304.14 ","$1,304.14 ","$1,191.81 ","$1,304.14 ","$1,272.05 ","$1,363.05 ",$434.85 ,"$1,546.03 ", N/A , N/A , N/A ,$665.38 , N/A , N/A ,"$1,859.15 ","$1,604.74 ","$1,604.74 ","$1,565.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880070,C1781,HC MESH PARIETEX OVAL 20CMX15CM,278,1 ,"$2,283.00 ","$1,141.50 ",$507.28 ,"$2,283.00 ", N/A ,"$1,931.19 ","$1,931.19 ",$776.22 ,"$1,826.40 ","$1,940.55 ","$1,426.88 ","$2,054.70 ", N/A ,"$2,168.85 ","$2,054.70 ","$1,940.55 ","$1,940.55 ",$776.22 ,"$1,940.55 ","$1,940.55 ","$2,054.70 ", N/A ,$958.86 ,"$2,054.70 ", N/A ,"$2,100.36 ","$2,054.70 ","$1,521.39 ","$1,521.39 ","$1,390.35 ","$1,521.39 ","$1,483.95 ","$1,590.11 ",$507.28 ,"$1,803.57 ", N/A , N/A , N/A ,$776.22 , N/A , N/A ,"$2,168.85 ","$1,872.06 ","$1,872.06 ","$1,826.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880071,C1781,HC MESH PARIETEX COMP 25X20CM,278,1 ,"$3,270.00 ","$1,635.00 ",$726.59 ,"$3,270.00 ", N/A ,"$2,766.09 ","$2,766.09 ","$1,111.80 ","$2,616.00 ","$2,779.50 ","$2,043.75 ","$2,943.00 ", N/A ,"$3,106.50 ","$2,943.00 ","$2,779.50 ","$2,779.50 ","$1,111.80 ","$2,779.50 ","$2,779.50 ","$2,943.00 ", N/A ,"$1,373.40 ","$2,943.00 ", N/A ,"$3,008.40 ","$2,943.00 ","$2,179.13 ","$2,179.13 ","$1,991.43 ","$2,179.13 ","$2,125.50 ","$2,277.56 ",$726.59 ,"$2,583.30 ", N/A , N/A , N/A ,"$1,111.80 ", N/A , N/A ,"$3,106.50 ","$2,681.40 ","$2,681.40 ","$2,616.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880072,C1781,HC MESH PARIETEX FLAT 5.2X3.6 SLIT,278,1 ,$493.00 ,$246.50 ,$109.54 ,$493.00 , N/A ,$417.03 ,$417.03 ,$167.62 ,$394.40 ,$419.05 ,$308.13 ,$443.70 , N/A ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$167.62 ,$419.05 ,$419.05 ,$443.70 , N/A ,$207.06 ,$443.70 , N/A ,$453.56 ,$443.70 ,$328.54 ,$328.54 ,$300.24 ,$328.54 ,$320.45 ,$343.37 ,$109.54 ,$389.47 , N/A , N/A , N/A ,$167.62 , N/A , N/A ,$468.35 ,$404.26 ,$404.26 ,$394.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880073,C1769,HC KIRSCH WIRE 1-2MM TR PTS 150,278,1 ,$39.00 ,$19.50 ,$8.67 ,$39.00 , N/A ,$32.99 ,$32.99 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 , N/A ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 , N/A ,$16.38 ,$35.10 , N/A ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 , N/A , N/A , N/A ,$13.26 , N/A , N/A ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880074,C1769,HC KIRSCH WIRE 1.6MM W 15 MM TTP,278,1 ,$62.00 ,$31.00 ,$13.78 ,$62.00 , N/A ,$52.45 ,$52.45 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 , N/A ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 , N/A ,$26.04 ,$55.80 , N/A ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 , N/A , N/A , N/A ,$21.08 , N/A , N/A ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880075,C1769,HC KIRSCH WIRE 2.0MM W15MMTTP,278,1 ,"$1,310.00 ",$655.00 ,$291.08 ,"$1,310.00 ", N/A ,"$1,108.13 ","$1,108.13 ",$445.40 ,"$1,048.00 ","$1,113.50 ",$818.75 ,"$1,179.00 ", N/A ,"$1,244.50 ","$1,179.00 ","$1,113.50 ","$1,113.50 ",$445.40 ,"$1,113.50 ","$1,113.50 ","$1,179.00 ", N/A ,$550.20 ,"$1,179.00 ", N/A ,"$1,205.20 ","$1,179.00 ",$872.98 ,$872.98 ,$797.79 ,$872.98 ,$851.50 ,$912.42 ,$291.08 ,"$1,034.90 ", N/A , N/A , N/A ,$445.40 , N/A , N/A ,"$1,244.50 ","$1,074.20 ","$1,074.20 ","$1,048.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880076,C1713,HC SCREW CORTEX TI 1.0MM 6-14MM,278,1 ,$273.00 ,$136.50 ,$60.66 ,$273.00 , N/A ,$230.93 ,$230.93 ,$92.82 ,$218.40 ,$232.05 ,$170.63 ,$245.70 , N/A ,$259.35 ,$245.70 ,$232.05 ,$232.05 ,$92.82 ,$232.05 ,$232.05 ,$245.70 , N/A ,$114.66 ,$245.70 , N/A ,$251.16 ,$245.70 ,$181.93 ,$181.93 ,$166.26 ,$181.93 ,$177.45 ,$190.14 ,$60.66 ,$215.67 , N/A , N/A , N/A ,$92.82 , N/A , N/A ,$259.35 ,$223.86 ,$223.86 ,$218.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880077,C1713,HC SCREW CORTEX TI 1.3MM 6-18MM,278,1 ,$287.00 ,$143.50 ,$63.77 ,$287.00 , N/A ,$242.77 ,$242.77 ,$97.58 ,$229.60 ,$243.95 ,$179.38 ,$258.30 , N/A ,$272.65 ,$258.30 ,$243.95 ,$243.95 ,$97.58 ,$243.95 ,$243.95 ,$258.30 , N/A ,$120.54 ,$258.30 , N/A ,$264.04 ,$258.30 ,$191.26 ,$191.26 ,$174.78 ,$191.26 ,$186.55 ,$199.90 ,$63.77 ,$226.73 , N/A , N/A , N/A ,$97.58 , N/A , N/A ,$272.65 ,$235.34 ,$235.34 ,$229.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880078,C1713,HC SCREW CORTEX TI 2.0MM 6-32MM,278,1 ,$130.00 ,$65.00 ,$28.89 ,$130.00 , N/A ,$109.97 ,$109.97 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 , N/A ,$54.60 ,$117.00 , N/A ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 , N/A , N/A , N/A ,$44.20 , N/A , N/A ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880079,C1776,HC PIN BUTTRESS TITAN 1.8MM,278,1 ,$231.00 ,$115.50 ,$51.33 ,$231.00 , N/A ,$195.40 ,$195.40 ,$78.54 ,$184.80 ,$196.35 ,$144.38 ,$207.90 , N/A ,$219.45 ,$207.90 ,$196.35 ,$196.35 ,$78.54 ,$196.35 ,$196.35 ,$207.90 , N/A ,$97.02 ,$207.90 , N/A ,$212.52 ,$207.90 ,$153.94 ,$153.94 ,$140.68 ,$153.94 ,$150.15 ,$160.89 ,$51.33 ,$182.49 , N/A , N/A , N/A ,$78.54 , N/A , N/A ,$219.45 ,$189.42 ,$189.42 ,$184.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880080,C1713,HC 1.3MM TI T PLATE 4X8 HOLE,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880081,C1713,HC 2.0MM TI T PLATE 2X8 HOLE,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880082,C1713,HC 2.0 TI Y PLATE 3X8 HOLE,278,1 ,$952.00 ,$476.00 ,$211.53 ,$952.00 , N/A ,$805.30 ,$805.30 ,$323.68 ,$761.60 ,$809.20 ,$595.00 ,$856.80 , N/A ,$904.40 ,$856.80 ,$809.20 ,$809.20 ,$323.68 ,$809.20 ,$809.20 ,$856.80 , N/A ,$399.84 ,$856.80 , N/A ,$875.84 ,$856.80 ,$634.41 ,$634.41 ,$579.77 ,$634.41 ,$618.80 ,$663.07 ,$211.53 ,$752.08 , N/A , N/A , N/A ,$323.68 , N/A , N/A ,$904.40 ,$780.64 ,$780.64 ,$761.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880083,C1713,HC 2.4MM TI STRAIGHT PLATE 6H 36MM,278,1 ,$874.00 ,$437.00 ,$194.20 ,$874.00 , N/A ,$739.32 ,$739.32 ,$297.16 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$297.16 ,$742.90 ,$742.90 ,$786.60 , N/A ,$367.08 ,$786.60 , N/A ,$804.08 ,$786.60 ,$582.43 ,$582.43 ,$532.27 ,$582.43 ,$568.10 ,$608.74 ,$194.20 ,$690.46 , N/A , N/A , N/A ,$297.16 , N/A , N/A ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880084,C1713,HC 2.4 TI STRAIGHT PLATE 12H 72 MM,278,1 ,"$1,031.00 ",$515.50 ,$229.09 ,"$1,031.00 ", N/A ,$872.12 ,$872.12 ,$350.54 ,$824.80 ,$876.35 ,$644.38 ,$927.90 , N/A ,$979.45 ,$927.90 ,$876.35 ,$876.35 ,$350.54 ,$876.35 ,$876.35 ,$927.90 , N/A ,$433.02 ,$927.90 , N/A ,$948.52 ,$927.90 ,$687.06 ,$687.06 ,$627.88 ,$687.06 ,$670.15 ,$718.09 ,$229.09 ,$814.49 , N/A , N/A , N/A ,$350.54 , N/A , N/A ,$979.45 ,$845.42 ,$845.42 ,$824.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880085,C1713,HC 204MM TI T PLATE 2X8 HOLE 54MM,278,1 ,$980.00 ,$490.00 ,$217.76 ,$980.00 , N/A ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 , N/A ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 , N/A ,$411.60 ,$882.00 , N/A ,$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 , N/A , N/A , N/A ,$333.20 , N/A , N/A ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880086,N/A,HC LEAD KIT 977A290,278,1 ,"$4,861.00 ","$2,430.50 ","$1,080.11 ","$4,861.00 ", N/A ,"$4,111.92 ","$4,111.92 ","$1,652.74 ","$3,888.80 ","$4,131.85 ","$3,038.13 ","$4,374.90 ", N/A ,"$4,617.95 ","$4,374.90 ","$4,131.85 ","$4,131.85 ","$1,652.74 ","$4,131.85 ","$4,131.85 ","$4,374.90 ", N/A ,"$2,041.62 ","$4,374.90 ", N/A ,"$4,472.12 ","$4,374.90 ","$3,239.37 ","$3,239.37 ","$2,960.35 ","$3,239.37 ","$3,159.65 ","$3,385.69 ","$1,080.11 ","$3,840.19 ", N/A , N/A , N/A ,"$1,652.74 ", N/A , N/A ,"$4,617.95 ","$3,986.02 ","$3,986.02 ","$3,888.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880087,N/A,HC BI-WING ANCHOR 97792,278,1 ,$858.00 ,$429.00 ,$190.65 ,$858.00 , N/A ,$725.78 ,$725.78 ,$291.72 ,$686.40 ,$729.30 ,$536.25 ,$772.20 , N/A ,$815.10 ,$772.20 ,$729.30 ,$729.30 ,$291.72 ,$729.30 ,$729.30 ,$772.20 , N/A ,$360.36 ,$772.20 , N/A ,$789.36 ,$772.20 ,$571.77 ,$571.77 ,$522.52 ,$571.77 ,$557.70 ,$597.60 ,$190.65 ,$677.82 , N/A , N/A , N/A ,$291.72 , N/A , N/A ,$815.10 ,$703.56 ,$703.56 ,$686.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880088,C1713,HC 2.4MM VA-LCP 2-CLMN VLR DSTL RADIUS PL 6H HD/2H SHAFT,278,1 ,"$2,532.00 ","$1,266.00 ",$562.61 ,"$2,532.00 ", N/A ,"$2,141.82 ","$2,141.82 ",$860.88 ,"$2,025.60 ","$2,152.20 ","$1,582.50 ","$2,278.80 ", N/A ,"$2,405.40 ","$2,278.80 ","$2,152.20 ","$2,152.20 ",$860.88 ,"$2,152.20 ","$2,152.20 ","$2,278.80 ", N/A ,"$1,063.44 ","$2,278.80 ", N/A ,"$2,329.44 ","$2,278.80 ","$1,687.32 ","$1,687.32 ","$1,541.99 ","$1,687.32 ","$1,645.80 ","$1,763.54 ",$562.61 ,"$2,000.28 ", N/A , N/A , N/A ,$860.88 , N/A , N/A ,"$2,405.40 ","$2,076.24 ","$2,076.24 ","$2,025.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880089,C1713,HC 2.4MM VA-LCP 2-CLMN VLR DSTL RADIUS PL 6H HD/3H SHAFT,278,1 ,"$2,633.00 ","$1,316.50 ",$585.05 ,"$2,633.00 ", N/A ,"$2,227.25 ","$2,227.25 ",$895.22 ,"$2,106.40 ","$2,238.05 ","$1,645.63 ","$2,369.70 ", N/A ,"$2,501.35 ","$2,369.70 ","$2,238.05 ","$2,238.05 ",$895.22 ,"$2,238.05 ","$2,238.05 ","$2,369.70 ", N/A ,"$1,105.86 ","$2,369.70 ", N/A ,"$2,422.36 ","$2,369.70 ","$1,754.63 ","$1,754.63 ","$1,603.50 ","$1,754.63 ","$1,711.45 ","$1,833.88 ",$585.05 ,"$2,080.07 ", N/A , N/A , N/A ,$895.22 , N/A , N/A ,"$2,501.35 ","$2,159.06 ","$2,159.06 ","$2,106.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880090,C1713,HC 2.4MM VA-LCP 2-CLMN VLR DSTL RADIUS PL 6H HD/4H SHAFT,278,1 ,"$2,732.00 ","$1,366.00 ",$607.05 ,"$2,732.00 ", N/A ,"$2,311.00 ","$2,311.00 ",$928.88 ,"$2,185.60 ","$2,322.20 ","$1,707.50 ","$2,458.80 ", N/A ,"$2,595.40 ","$2,458.80 ","$2,322.20 ","$2,322.20 ",$928.88 ,"$2,322.20 ","$2,322.20 ","$2,458.80 ", N/A ,"$1,147.44 ","$2,458.80 ", N/A ,"$2,513.44 ","$2,458.80 ","$1,820.60 ","$1,820.60 ","$1,663.79 ","$1,820.60 ","$1,775.80 ","$1,902.84 ",$607.05 ,"$2,158.28 ", N/A , N/A , N/A ,$928.88 , N/A , N/A ,"$2,595.40 ","$2,240.24 ","$2,240.24 ","$2,185.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880091,C1713,HC 10-12MM/130 DEG TI CANN TROCH FIXATION NAIL 235MM STERILE,278,1 ,"$3,633.00 ","$1,816.50 ",$807.25 ,"$3,633.00 ", N/A ,"$3,073.15 ","$3,073.15 ","$1,235.22 ","$2,906.40 ","$3,088.05 ","$2,270.63 ","$3,269.70 ", N/A ,"$3,451.35 ","$3,269.70 ","$3,088.05 ","$3,088.05 ","$1,235.22 ","$3,088.05 ","$3,088.05 ","$3,269.70 ", N/A ,"$1,525.86 ","$3,269.70 ", N/A ,"$3,342.36 ","$3,269.70 ","$2,421.03 ","$2,421.03 ","$2,212.50 ","$2,421.03 ","$2,361.45 ","$2,530.38 ",$807.25 ,"$2,870.07 ", N/A , N/A , N/A ,"$1,235.22 ", N/A , N/A ,"$3,451.35 ","$2,979.06 ","$2,979.06 ","$2,906.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880092,N/A,HC TISSUEMEND,278,1 ,"$5,786.00 ","$2,893.00 ","$1,285.65 ","$5,786.00 ", N/A ,"$4,894.38 ","$4,894.38 ","$1,967.24 ","$4,628.80 ","$4,918.10 ","$3,616.25 ","$5,207.40 ", N/A ,"$5,496.70 ","$5,207.40 ","$4,918.10 ","$4,918.10 ","$1,967.24 ","$4,918.10 ","$4,918.10 ","$5,207.40 ", N/A ,"$2,430.12 ","$5,207.40 ", N/A ,"$5,323.12 ","$5,207.40 ","$3,855.79 ","$3,855.79 ","$3,523.67 ","$3,855.79 ","$3,760.90 ","$4,029.95 ","$1,285.65 ","$4,570.94 ", N/A ,"$2,893.00 ","$2,893.00 ","$1,967.24 ","$2,893.00 ", N/A ,"$5,496.70 ","$4,744.52 ","$4,744.52 ","$4,628.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880093,N/A,HC TISSUE BIO-A,278,1 ,"$1,289.00 ",$644.50 ,$286.42 ,"$1,289.00 ", N/A ,"$1,090.37 ","$1,090.37 ",$438.26 ,"$1,031.20 ","$1,095.65 ",$805.63 ,"$1,160.10 ", N/A ,"$1,224.55 ","$1,160.10 ","$1,095.65 ","$1,095.65 ",$438.26 ,"$1,095.65 ","$1,095.65 ","$1,160.10 ", N/A ,$541.38 ,"$1,160.10 ", N/A ,"$1,185.88 ","$1,160.10 ",$858.99 ,$858.99 ,$785.00 ,$858.99 ,$837.85 ,$897.79 ,$286.42 ,"$1,018.31 ", N/A , N/A , N/A ,$438.26 , N/A , N/A ,"$1,224.55 ","$1,056.98 ","$1,056.98 ","$1,031.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880094,Q4104,HC INTEGRA BILAYER MTRX WND 2X2 PER SQ CM,278,1 ,$290.00 ,$145.00 ,$64.44 ,$290.00 , N/A ,$245.31 ,$245.31 ,$98.60 ,$232.00 ,$246.50 ,$181.25 ,$261.00 , N/A ,$275.50 ,$261.00 ,$246.50 ,$246.50 ,$98.60 ,$246.50 ,$246.50 ,$261.00 , N/A ,$121.80 ,$261.00 , N/A ,$266.80 ,$261.00 ,$193.26 ,$193.26 ,$176.61 ,$193.26 ,$188.50 ,$201.99 ,$64.44 ,$229.10 , N/A , N/A , N/A ,$98.60 , N/A , N/A ,$275.50 ,$237.80 ,$237.80 ,$232.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880095,Q4104,HC INTEGRA BILAYER MTRX WND 4X5 PER SQ CM,278,1 ,$101.00 ,$50.50 ,$22.44 ,$101.00 , N/A ,$85.44 ,$85.44 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 , N/A ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 , N/A ,$42.42 ,$90.90 , N/A ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 , N/A , N/A , N/A ,$34.34 , N/A , N/A ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880162,C1781,HC MESH SURGIMESH,278,1 ,"$1,326.00 ",$663.00 ,$294.64 ,"$1,326.00 ", N/A ,"$1,121.66 ","$1,121.66 ",$450.84 ,"$1,060.80 ","$1,127.10 ",$828.75 ,"$1,193.40 ", N/A ,"$1,259.70 ","$1,193.40 ","$1,127.10 ","$1,127.10 ",$450.84 ,"$1,127.10 ","$1,127.10 ","$1,193.40 ", N/A ,$556.92 ,"$1,193.40 ", N/A ,"$1,219.92 ","$1,193.40 ",$883.65 ,$883.65 ,$807.53 ,$883.65 ,$861.90 ,$923.56 ,$294.64 ,"$1,047.54 ", N/A , N/A , N/A ,$450.84 , N/A , N/A ,"$1,259.70 ","$1,087.32 ","$1,087.32 ","$1,060.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),28005072,28005,HC INC BONE CORTEX FOOT,975,1 ,"$1,491.00 ",$745.50 ,$331.30 ,"$9,772.47 ","$9,219.31 ","$1,261.24 ","$1,261.24 ",$614.62 ,"$1,192.80 ","$1,267.35 ",$931.88 ,"$1,341.90 ","$9,219.31 ","$1,416.45 ","$1,341.90 ","$1,267.35 ","$1,267.35 ",$614.62 ,"$1,267.35 ","$1,267.35 ","$1,341.90 ","$9,219.31 ",$626.22 ,"$1,341.90 ","$6,507.63 ","$1,371.72 ","$1,341.90 ",$993.60 ,$993.60 ,$908.02 ,$993.60 ,$969.15 ,"$1,038.48 ",$331.30 ,"$1,177.89 ","$9,772.47 ", N/A , N/A ,$614.62 , N/A ,"$2,892.28 ","$1,416.45 ","$1,222.62 ","$1,222.62 ","$1,192.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),28039072,28039,HC EXC TUMOR FOOT 1.5CM,510,1 ,$741.00 ,$370.50 ,$64.61 ,"$5,448.49 ","$3,802.54 ",$129.00 ,$103.00 ,$251.94 ,$592.80 ,$629.85 ,$463.13 ,$666.90 ,"$3,802.54 ",$703.95 ,$666.90 ,$629.85 ,$629.85 ,$251.94 ,$629.85 ,$629.85 ,$666.90 ,"$3,802.54 ",$64.61 ,$666.90 ,"$5,448.49 ",$681.72 ,$666.90 ,$493.80 ,$493.80 ,$451.27 ,$493.80 ,$481.65 ,$516.11 ,$164.65 ,$585.39 ,"$4,030.69 ",$370.50 ,$370.50 ,$251.94 ,$370.50 ,"$2,421.55 ",$703.95 ,$607.62 ,$607.62 ,$592.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),28285072,28285,HC CORRECT HAMMERTOE,975,1 ,"$1,864.00 ",$932.00 ,$409.45 ,"$6,507.63 ","$3,802.54 ","$1,576.76 ","$1,576.76 ",$409.45 ,"$1,491.20 ","$1,584.40 ","$1,165.00 ","$1,677.60 ","$3,802.54 ","$1,770.80 ","$1,677.60 ","$1,584.40 ","$1,584.40 ",$409.45 ,"$1,584.40 ","$1,584.40 ","$1,677.60 ","$3,802.54 ",$782.88 ,"$1,677.60 ","$6,507.63 ","$1,714.88 ","$1,677.60 ","$1,242.17 ","$1,242.17 ","$1,135.18 ","$1,242.17 ","$1,211.60 ","$1,298.28 ",$414.18 ,"$1,472.56 ","$4,030.69 ", N/A , N/A ,$409.45 , N/A ,"$2,892.28 ","$1,770.80 ","$1,528.48 ","$1,528.48 ","$1,491.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),28810072,28810,HC AMPUTATION METATARSAL TOE-PREV 72 HR,983,1 ,"$2,130.00 ","$1,065.00 ",$446.49 ,"$9,772.47 ","$9,219.31 ","$1,801.77 ","$1,801.77 ",$446.49 ,"$1,704.00 ","$1,810.50 ","$1,331.25 ","$1,917.00 ","$9,219.31 ","$2,023.50 ","$1,917.00 ","$1,810.50 ","$1,810.50 ",$446.49 ,"$1,810.50 ","$1,810.50 ","$1,917.00 ","$9,219.31 ",$894.60 ,"$1,917.00 ","$6,507.63 ","$1,959.60 ","$1,917.00 ","$1,419.43 ","$1,419.43 ","$1,297.17 ","$1,419.43 ","$1,384.50 ","$1,483.55 ",$473.29 ,"$1,682.70 ","$9,772.47 ", N/A , N/A ,$446.49 , N/A ,"$2,892.28 ","$2,023.50 ","$1,746.60 ","$1,746.60 ","$1,704.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30000004,N/A,HC POC GLUCOSE,300,1 ,$34.00 ,$17.00 ,$7.55 ,$34.00 , N/A ,$28.76 ,$28.76 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 , N/A ,$14.28 ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 , N/A ,$17.00 ,$17.00 ,$11.56 ,$17.00 , N/A ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$30.00 ,$15.00 ,$3.47 ,$30.00 ,$4.12 ,$8.00 ,$6.00 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 ,$4.12 ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 ,$4.12 ,$12.60 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 ,$4.37 ,$3.47 ,$3.47 ,$10.20 ,$3.47 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000010,36415,HC VENIPUNCTURE,300,1 ,$15.00 ,$7.50 ,$3.00 ,$15.00 ,$4.12 ,$8.00 ,$6.00 ,$5.10 ,$12.00 ,$12.75 ,$9.38 ,$13.50 ,$4.12 ,$14.25 ,$13.50 ,$12.75 ,$12.75 ,$5.10 ,$12.75 ,$12.75 ,$13.50 ,$4.12 ,$3.40 ,$13.50 ,$6.75 ,$13.80 ,$13.50 ,$10.00 ,$10.00 ,$9.14 ,$10.00 ,$9.75 ,$10.45 ,$3.33 ,$11.85 ,$4.37 ,$3.60 ,$3.60 ,$5.10 ,$3.60 ,$3.00 ,$14.25 ,$12.30 ,$12.30 ,$12.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000011,36415,HC CATHETER COLLECTION,300,1 ,$15.00 ,$7.50 ,$3.00 ,$15.00 ,$4.12 ,$8.00 ,$6.00 ,$5.10 ,$12.00 ,$12.75 ,$9.38 ,$13.50 ,$4.12 ,$14.25 ,$13.50 ,$12.75 ,$12.75 ,$5.10 ,$12.75 ,$12.75 ,$13.50 ,$4.12 ,$3.40 ,$13.50 ,$6.75 ,$13.80 ,$13.50 ,$10.00 ,$10.00 ,$9.14 ,$10.00 ,$9.75 ,$10.45 ,$3.33 ,$11.85 ,$4.37 ,$3.60 ,$3.60 ,$5.10 ,$3.60 ,$3.00 ,$14.25 ,$12.30 ,$12.30 ,$12.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000014,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$119.00 ,$59.50 ,$26.44 ,$259.11 ,$103.42 ,$100.66 ,$100.66 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 ,$103.42 ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 ,$103.42 ,$49.98 ,$107.10 ,$259.11 ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 ,$109.63 , N/A , N/A ,$40.46 , N/A ,$115.16 ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$65.00 ,$32.50 ,$14.44 ,$259.11 ,$103.42 ,$54.98 ,$54.98 ,$22.10 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$103.42 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$22.10 ,$55.25 ,$55.25 ,$58.50 ,$103.42 ,$27.30 ,$58.50 ,$259.11 ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 ,$109.63 , N/A , N/A ,$22.10 , N/A ,$115.16 ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$129.00 ,$64.50 ,$28.66 ,$259.11 ,$103.42 ,$109.12 ,$109.12 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 ,$103.42 ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 ,$103.42 ,$54.18 ,$116.10 ,$259.11 ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 ,$109.63 , N/A , N/A ,$43.86 , N/A ,$115.16 ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$22.10 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$5.79 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$22.10 ,$55.25 ,$55.25 ,$58.50 ,$5.79 ,$6.34 ,$58.50 ,$12.60 ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 ,$6.14 ,$6.72 ,$6.72 ,$22.10 ,$6.72 ,$5.60 ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$5.79 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$5.79 ,$6.34 ,$89.10 ,$12.60 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$6.14 ,$6.72 ,$6.72 ,$33.66 ,$6.72 ,$5.60 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$41.00 ,$20.50 ,$4.27 ,$41.00 ,$4.41 ,$16.63 ,$14.25 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$4.41 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$4.41 ,$4.83 ,$36.90 ,$9.61 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$4.67 ,$5.12 ,$5.12 ,$13.94 ,$5.12 ,$4.27 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$53.00 ,$26.50 ,$7.33 ,$53.00 ,$7.57 ,$27.83 ,$23.85 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$7.57 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$7.57 ,$8.30 ,$47.70 ,$16.49 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$8.02 ,$8.80 ,$8.80 ,$18.02 ,$8.80 ,$7.33 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000106,89125,HC FAT STAIN,300,1 ,$39.00 ,$19.50 ,$5.88 ,$39.00 ,$6.08 ,$20.58 ,$17.64 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$6.08 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$6.08 ,$6.66 ,$35.10 ,$13.23 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$6.44 ,$7.06 ,$7.06 ,$13.26 ,$7.06 ,$5.88 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000107,89190,HC SMEAR NASAL EOSINOPHILS,300,1 ,$41.00 ,$20.50 ,$5.79 ,$41.00 ,$5.98 ,$20.27 ,$17.37 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$5.98 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$5.98 ,$6.55 ,$36.90 ,$13.03 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$6.34 ,$6.95 ,$6.95 ,$13.94 ,$6.95 ,$5.79 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000120,80306,HC DRUG SCREEN URINE,300,1 ,$300.00 ,$150.00 ,$17.14 ,$300.00 ,$17.71 ,$59.99 ,$51.42 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$17.71 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 ,$17.71 ,$19.40 ,$270.00 ,$38.57 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,$18.77 ,$20.57 ,$20.57 ,$102.00 ,$20.57 ,$17.14 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000121,80306,HC DRUG SCREEN SGL CLASS PRESUMPTIVE INSTRMNT,300,1 ,$61.00 ,$30.50 ,$13.55 ,$61.00 ,$17.71 ,$59.99 ,$51.42 ,$20.74 ,$48.80 ,$51.85 ,$38.13 ,$54.90 ,$17.71 ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$20.74 ,$51.85 ,$51.85 ,$54.90 ,$17.71 ,$19.40 ,$54.90 ,$38.57 ,$56.12 ,$54.90 ,$40.65 ,$40.65 ,$37.15 ,$40.65 ,$39.65 ,$42.49 ,$13.55 ,$48.19 ,$18.77 ,$20.57 ,$20.57 ,$20.74 ,$20.57 ,$17.14 ,$57.95 ,$50.02 ,$50.02 ,$48.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000123,80306,HC DRUG SCREEN (HYDROXYBUTYRIC),300,1 ,$183.00 ,$91.50 ,$17.14 ,$183.00 ,$17.71 ,$59.99 ,$51.42 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$17.71 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$17.71 ,$19.40 ,$164.70 ,$38.57 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$18.77 ,$20.57 ,$20.57 ,$62.22 ,$20.57 ,$17.14 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000125,G0432,HC HIV I-II SCREEN,300,1 ,$90.00 ,$45.00 ,$12.71 ,$90.00 ,$12.71 ,$68.50 ,$58.71 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.71 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.71 ,$22.15 ,$81.00 ,$44.03 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.47 ,$23.48 ,$23.48 ,$30.60 ,$23.48 ,$19.57 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000200,80307,HC MECONIUM SCREEN MAYO,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$63.40 ,$70.33 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$125.80 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000205,84311,HC PM SCREEN OXIDANT,300,1 ,$103.00 ,$51.50 ,$8.10 ,$103.00 ,$8.37 ,$28.35 ,$24.30 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$8.37 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$8.37 ,$9.17 ,$92.70 ,$18.23 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$8.87 ,$9.72 ,$9.72 ,$35.02 ,$9.72 ,$8.10 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000206,80307,HC DRUG SCREEN PANEL 9,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$63.40 ,$70.33 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$125.80 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000207,80307,HC DRUG SCREEN PANEL 20,300,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$63.40 ,$70.33 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$125.80 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000208,86674,HC ANTIBODY GIARDIA LAMBLIA,300,1 ,$101.00 ,$50.50 ,$14.72 ,$101.00 ,$15.21 ,$57.23 ,$49.05 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$15.21 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$15.21 ,$16.66 ,$90.90 ,$33.12 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$16.12 ,$17.66 ,$17.66 ,$34.34 ,$17.66 ,$14.72 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000227,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$259.00 ,$129.50 ,$12.05 ,$259.00 ,$12.45 ,$46.87 ,$40.17 ,$88.06 ,$207.20 ,$220.15 ,$161.88 ,$233.10 ,$12.45 ,$246.05 ,$233.10 ,$220.15 ,$220.15 ,$88.06 ,$220.15 ,$220.15 ,$233.10 ,$12.45 ,$13.64 ,$233.10 ,$27.11 ,$238.28 ,$233.10 ,$172.60 ,$172.60 ,$157.73 ,$172.60 ,$168.35 ,$180.39 ,$57.55 ,$204.61 ,$13.20 ,$14.46 ,$14.46 ,$88.06 ,$14.46 ,$12.05 ,$246.05 ,$212.38 ,$212.38 ,$207.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000236,80307,HC DRUG SCREEN PANEL 4,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$63.40 ,$70.33 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$125.80 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000237,80307,HC DRUG SCREEN PANEL 6,301,1 ,$370.00 ,$185.00 ,$62.14 ,$370.00 ,$63.40 ,$226.28 ,$193.95 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$63.40 ,$70.33 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$125.80 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30010201,86332,HC IMMUNE COMPLEX ASSAY,300,1 ,$185.00 ,$92.50 ,$24.37 ,$185.00 ,$25.18 ,$94.78 ,$81.24 ,$62.90 ,$148.00 ,$157.25 ,$115.63 ,$166.50 ,$25.18 ,$175.75 ,$166.50 ,$157.25 ,$157.25 ,$62.90 ,$157.25 ,$157.25 ,$166.50 ,$25.18 ,$27.58 ,$166.50 ,$54.83 ,$170.20 ,$166.50 ,$123.28 ,$123.28 ,$112.67 ,$123.28 ,$120.25 ,$128.85 ,$41.11 ,$146.15 ,$26.69 ,$29.24 ,$29.24 ,$62.90 ,$29.24 ,$24.37 ,$175.75 ,$151.70 ,$151.70 ,$148.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30080001,87804,HC FLU PRV 72HR,300,1 ,$100.00 ,$50.00 ,$16.55 ,$100.00 ,$16.86 ,$57.93 ,$49.65 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$16.86 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$16.86 ,$18.73 ,$90.00 ,$37.24 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$17.87 ,$19.86 ,$19.86 ,$34.00 ,$19.86 ,$16.55 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100101,80048,HC BASIC METABOLIC PANEL,301,1 ,$97.00 ,$48.50 ,$8.46 ,$97.00 ,$8.74 ,$32.90 ,$28.20 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$8.74 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$8.74 ,$9.58 ,$87.30 ,$19.04 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$9.26 ,$10.15 ,$10.15 ,$32.98 ,$10.15 ,$8.46 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100102,80050,HC GENERAL HEALTH PANEL,301,1 ,$340.00 ,$170.00 ,$14.57 ,$340.00 ,$14.57 ,$158.13 ,$135.54 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$14.57 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$14.57 ,$142.80 ,$306.00 , N/A ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$15.44 ,$56.74 ,$56.74 ,$115.60 ,$56.74 , N/A ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100103,80051,HC ELECTROLYTE PANEL,301,1 ,$55.00 ,$27.50 ,$7.01 ,$55.00 ,$7.24 ,$27.27 ,$23.37 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 ,$7.24 ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 ,$7.24 ,$7.93 ,$49.50 ,$15.77 ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 ,$7.67 ,$8.41 ,$8.41 ,$18.70 ,$8.41 ,$7.01 ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$134.00 ,$67.00 ,$10.56 ,$134.00 ,$10.91 ,$41.09 ,$35.22 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$10.91 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$10.91 ,$11.95 ,$120.60 ,$23.76 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$11.56 ,$12.67 ,$12.67 ,$45.56 ,$12.67 ,$10.56 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100107,80061,HC LIPID PANEL,301,1 ,$101.00 ,$50.50 ,$13.39 ,$101.00 ,$13.84 ,$52.08 ,$44.64 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.84 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.84 ,$15.15 ,$90.90 ,$30.13 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.67 ,$16.07 ,$16.07 ,$34.34 ,$16.07 ,$13.39 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100108,80069,HC RENAL PANEL,301,1 ,$112.00 ,$56.00 ,$8.68 ,$112.00 ,$8.97 ,$33.78 ,$28.95 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$8.97 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$8.97 ,$9.82 ,$100.80 ,$19.53 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$9.51 ,$10.42 ,$10.42 ,$38.08 ,$10.42 ,$8.68 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100109,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$358.00 ,$179.00 ,$47.63 ,$358.00 ,$49.22 ,$185.26 ,$158.79 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$49.22 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$49.22 ,$53.91 ,$322.20 ,$107.17 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$52.17 ,$57.16 ,$57.16 ,$121.72 ,$57.16 ,$47.63 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100110,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.44 ,$31.78 ,$27.24 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.44 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.44 ,$9.25 ,$70.20 ,$18.38 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$8.95 ,$9.80 ,$9.80 ,$26.52 ,$9.80 ,$8.17 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100111,80150,HC AMIKACIN,301,1 ,$119.00 ,$59.50 ,$15.08 ,$119.00 ,$15.58 ,$58.63 ,$50.25 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 ,$15.58 ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 ,$15.58 ,$17.07 ,$107.10 ,$33.93 ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 ,$16.51 ,$18.10 ,$18.10 ,$40.46 ,$18.10 ,$15.08 ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100112,80335,HC AMITRIPTYLINE,301,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 ,$21.41 ,$80.88 ,$69.32 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$21.41 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$21.41 ,$37.80 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$22.69 , N/A , N/A ,$30.60 , N/A , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100113,80346,HC LORAZEPAM,301,1 ,$106.00 ,$53.00 ,$21.41 ,$106.00 ,$21.41 ,$80.88 ,$69.32 ,$36.04 ,$84.80 ,$90.10 ,$66.25 ,$95.40 ,$21.41 ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$36.04 ,$90.10 ,$90.10 ,$95.40 ,$21.41 ,$44.52 ,$95.40 , N/A ,$97.52 ,$95.40 ,$70.64 ,$70.64 ,$64.55 ,$70.64 ,$68.90 ,$73.83 ,$23.55 ,$83.74 ,$22.69 , N/A , N/A ,$36.04 , N/A , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100114,80346,HC CLONOPIN,301,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 ,$21.41 ,$38.00 ,$38.00 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$21.41 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$21.41 ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$22.69 , N/A , N/A ,$12.92 , N/A , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100115,80346,HC BENZODIAZEPINE GC/MS,301,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 ,$21.41 ,$38.00 ,$38.00 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$21.41 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$21.41 ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$22.69 , N/A , N/A ,$12.92 , N/A , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100116,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$108.00 ,$54.00 ,$14.57 ,$108.00 ,$15.06 ,$56.63 ,$48.54 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$15.06 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$15.06 ,$16.49 ,$97.20 ,$32.78 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$15.96 ,$17.48 ,$17.48 ,$36.72 ,$17.48 ,$14.57 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100117,80157,HC CARBAMAZEPINE FREE,301,1 ,$124.00 ,$62.00 ,$13.25 ,$124.00 ,$13.69 ,$51.56 ,$44.19 ,$42.16 ,$99.20 ,$105.40 ,$77.50 ,$111.60 ,$13.69 ,$117.80 ,$111.60 ,$105.40 ,$105.40 ,$42.16 ,$105.40 ,$105.40 ,$111.60 ,$13.69 ,$15.00 ,$111.60 ,$29.81 ,$114.08 ,$111.60 ,$82.63 ,$82.63 ,$75.52 ,$82.63 ,$80.60 ,$86.37 ,$27.55 ,$97.96 ,$14.51 ,$15.90 ,$15.90 ,$42.16 ,$15.90 ,$13.25 ,$117.80 ,$101.68 ,$101.68 ,$99.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100118,80158,HC CYCLOSPORINE,301,1 ,$90.00 ,$45.00 ,$18.05 ,$90.00 ,$18.65 ,$70.21 ,$60.18 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$18.65 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$18.65 ,$20.43 ,$81.00 ,$40.61 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$19.77 ,$21.66 ,$21.66 ,$30.60 ,$21.66 ,$18.05 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100119,80335,HC DESIPRAMINE,301,1 ,$42.00 ,$21.00 ,$9.33 ,$42.00 ,$21.41 ,$42.00 ,$42.00 ,$14.28 ,$33.60 ,$35.70 ,$26.25 ,$37.80 ,$21.41 ,$39.90 ,$37.80 ,$35.70 ,$35.70 ,$14.28 ,$35.70 ,$35.70 ,$37.80 ,$21.41 ,$17.64 ,$37.80 , N/A ,$38.64 ,$37.80 ,$27.99 ,$27.99 ,$25.58 ,$27.99 ,$27.30 ,$29.25 ,$9.33 ,$33.18 ,$22.69 , N/A , N/A ,$14.28 , N/A , N/A ,$39.90 ,$34.44 ,$34.44 ,$33.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100120,80162,HC DIGOXIN LEVELS,301,1 ,$76.00 ,$38.00 ,$13.28 ,$76.00 ,$13.72 ,$51.63 ,$44.25 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 ,$13.72 ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 ,$13.72 ,$15.03 ,$68.40 ,$29.88 ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 ,$14.54 ,$15.94 ,$15.94 ,$25.84 ,$15.94 ,$13.28 ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100121,80164,HC VALPROIC ACID,301,1 ,$97.00 ,$48.50 ,$13.54 ,$97.00 ,$13.99 ,$52.68 ,$45.15 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$13.99 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$13.99 ,$15.32 ,$87.30 ,$30.47 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$14.83 ,$16.25 ,$16.25 ,$32.98 ,$16.25 ,$13.54 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100122,80335,HC DOXEPIN,301,1 ,$62.00 ,$31.00 ,$13.78 ,$62.00 ,$21.41 ,$62.00 ,$62.00 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$21.41 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$21.41 ,$26.04 ,$55.80 , N/A ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$22.69 , N/A , N/A ,$21.08 , N/A , N/A ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100123,80168,HC ZARONTIN,301,1 ,$119.00 ,$59.50 ,$16.34 ,$119.00 ,$16.88 ,$63.53 ,$54.45 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 ,$16.88 ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 ,$16.88 ,$18.49 ,$107.10 ,$36.77 ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 ,$17.89 ,$19.61 ,$19.61 ,$40.46 ,$19.61 ,$16.34 ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100124,80170,HC GENTAMICIN,301,1 ,$173.00 ,$86.50 ,$16.38 ,$173.00 ,$16.93 ,$63.70 ,$54.60 ,$58.82 ,$138.40 ,$147.05 ,$108.13 ,$155.70 ,$16.93 ,$164.35 ,$155.70 ,$147.05 ,$147.05 ,$58.82 ,$147.05 ,$147.05 ,$155.70 ,$16.93 ,$18.54 ,$155.70 ,$36.86 ,$159.16 ,$155.70 ,$115.29 ,$115.29 ,$105.36 ,$115.29 ,$112.45 ,$120.49 ,$38.44 ,$136.67 ,$17.95 ,$19.66 ,$19.66 ,$58.82 ,$19.66 ,$16.38 ,$164.35 ,$141.86 ,$141.86 ,$138.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100125,80335,HC IMIPRAMINE,301,1 ,$65.00 ,$32.50 ,$14.44 ,$65.00 ,$21.41 ,$65.00 ,$65.00 ,$22.10 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$21.41 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$22.10 ,$55.25 ,$55.25 ,$58.50 ,$21.41 ,$27.30 ,$58.50 , N/A ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 ,$22.69 , N/A , N/A ,$22.10 , N/A , N/A ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100126,80176,HC LIDOCAINE,301,1 ,$194.00 ,$97.00 ,$14.69 ,$194.00 ,$15.18 ,$57.12 ,$48.96 ,$65.96 ,$155.20 ,$164.90 ,$121.25 ,$174.60 ,$15.18 ,$184.30 ,$174.60 ,$164.90 ,$164.90 ,$65.96 ,$164.90 ,$164.90 ,$174.60 ,$15.18 ,$16.63 ,$174.60 ,$33.05 ,$178.48 ,$174.60 ,$129.28 ,$129.28 ,$118.15 ,$129.28 ,$126.10 ,$135.12 ,$43.11 ,$153.26 ,$16.09 ,$17.63 ,$17.63 ,$65.96 ,$17.63 ,$14.69 ,$184.30 ,$159.08 ,$159.08 ,$155.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100127,80178,HC LITHIUM,301,1 ,$49.00 ,$24.50 ,$6.61 ,$49.00 ,$6.83 ,$25.73 ,$22.05 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 ,$6.83 ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 ,$6.83 ,$7.48 ,$44.10 ,$14.87 ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 ,$7.24 ,$7.93 ,$7.93 ,$16.66 ,$7.93 ,$6.61 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100128,80335,HC NORTRIPTYLINE,301,1 ,$85.00 ,$42.50 ,$18.89 ,$85.00 ,$21.41 ,$80.88 ,$69.32 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$21.41 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$21.41 ,$35.70 ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$22.69 , N/A , N/A ,$28.90 , N/A , N/A ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100129,80184,HC PHENOBARBITAL,301,1 ,$97.00 ,$48.50 ,$15.30 ,$97.00 ,$15.81 ,$53.55 ,$45.90 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$15.81 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$15.81 ,$17.32 ,$87.30 ,$34.43 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$16.76 ,$18.36 ,$18.36 ,$32.98 ,$18.36 ,$15.30 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100130,80185,HC PHENYTOIN TOTAL,301,1 ,$97.00 ,$48.50 ,$13.25 ,$97.00 ,$13.69 ,$51.56 ,$44.19 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$13.69 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$13.69 ,$15.00 ,$87.30 ,$29.81 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$14.51 ,$15.90 ,$15.90 ,$32.98 ,$15.90 ,$13.25 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100131,80186,HC PHENYTOIN FREE,301,1 ,$76.00 ,$38.00 ,$13.76 ,$76.00 ,$14.22 ,$53.52 ,$45.87 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 ,$14.22 ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 ,$14.22 ,$15.57 ,$68.40 ,$30.96 ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 ,$15.07 ,$16.51 ,$16.51 ,$25.84 ,$16.51 ,$13.76 ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100132,80188,HC PRIMIDONE,301,1 ,$97.00 ,$48.50 ,$16.59 ,$97.00 ,$17.14 ,$64.54 ,$55.32 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$17.14 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$17.14 ,$18.78 ,$87.30 ,$37.33 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$18.17 ,$19.91 ,$19.91 ,$32.98 ,$19.91 ,$16.59 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100133,80192,HC PROCAINEAMIDE,301,1 ,$115.00 ,$57.50 ,$16.75 ,$115.00 ,$17.31 ,$65.14 ,$55.83 ,$39.10 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$17.31 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$39.10 ,$97.75 ,$97.75 ,$103.50 ,$17.31 ,$18.96 ,$103.50 ,$37.69 ,$105.80 ,$103.50 ,$76.64 ,$76.64 ,$70.04 ,$76.64 ,$74.75 ,$80.10 ,$25.55 ,$90.85 ,$18.35 ,$20.10 ,$20.10 ,$39.10 ,$20.10 ,$16.75 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100134,80194,HC QUINIDINE,301,1 ,$110.00 ,$55.00 ,$14.60 ,$110.00 ,$15.09 ,$56.77 ,$48.66 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$15.09 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$15.09 ,$16.52 ,$99.00 ,$32.85 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$16.00 ,$17.52 ,$17.52 ,$37.40 ,$17.52 ,$14.60 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100135,80195,HC RAPAMYCIN (SIROLIMUS),301,1 ,$86.00 ,$43.00 ,$13.73 ,$86.00 ,$14.19 ,$53.41 ,$45.78 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$14.19 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 ,$14.19 ,$15.54 ,$77.40 ,$30.89 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 ,$15.04 ,$16.48 ,$16.48 ,$29.24 ,$16.48 ,$13.73 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100136,G0480,HC SALICYLATE,301,1 ,$180.00 ,$90.00 ,$40.00 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$63.95 ,$129.51 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$61.20 ,$137.32 ,$114.43 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100137,80197,HC TACROLIMUS,301,1 ,$97.00 ,$48.50 ,$13.73 ,$97.00 ,$14.19 ,$53.41 ,$45.78 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$14.19 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$14.19 ,$15.54 ,$87.30 ,$30.89 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$15.04 ,$16.48 ,$16.48 ,$32.98 ,$16.48 ,$13.73 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100138,80198,HC THEOPHYLLINE,301,1 ,$86.00 ,$43.00 ,$14.14 ,$86.00 ,$14.61 ,$54.99 ,$47.13 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$14.61 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 ,$14.61 ,$16.00 ,$77.40 ,$31.82 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 ,$15.49 ,$16.97 ,$16.97 ,$29.24 ,$16.97 ,$14.14 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100139,80200,HC TOBRAMYCIN,301,1 ,$97.00 ,$48.50 ,$16.13 ,$97.00 ,$16.67 ,$62.72 ,$53.76 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$16.67 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$16.67 ,$18.26 ,$87.30 ,$36.29 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$17.67 ,$19.36 ,$19.36 ,$32.98 ,$19.36 ,$16.13 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100140,80201,HC TOPIRAMATE,301,1 ,$97.00 ,$48.50 ,$11.92 ,$97.00 ,$12.32 ,$46.34 ,$39.72 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$12.32 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$12.32 ,$13.49 ,$87.30 ,$26.82 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$13.06 ,$14.30 ,$14.30 ,$32.98 ,$14.30 ,$11.92 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100141,80202,HC VANCOMYCIN,301,1 ,$119.00 ,$59.50 ,$13.54 ,$119.00 ,$13.99 ,$52.68 ,$45.15 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 ,$13.99 ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 ,$13.99 ,$15.32 ,$107.10 ,$30.47 ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 ,$14.83 ,$16.25 ,$16.25 ,$40.46 ,$16.25 ,$13.54 ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100142,80299,HC WARFARIN,301,1 ,$156.00 ,$78.00 ,$18.64 ,$156.00 ,$19.26 ,$65.24 ,$55.92 ,$53.04 ,$124.80 ,$132.60 ,$97.50 ,$140.40 ,$19.26 ,$148.20 ,$140.40 ,$132.60 ,$132.60 ,$53.04 ,$132.60 ,$132.60 ,$140.40 ,$19.26 ,$21.10 ,$140.40 ,$41.94 ,$143.52 ,$140.40 ,$103.96 ,$103.96 ,$95.00 ,$103.96 ,$101.40 ,$108.65 ,$34.66 ,$123.24 ,$20.42 ,$22.37 ,$22.37 ,$53.04 ,$22.37 ,$18.64 ,$148.20 ,$127.92 ,$127.92 ,$124.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100143,80299,HC FELBAMATE,301,1 ,$162.00 ,$81.00 ,$18.64 ,$162.00 ,$19.26 ,$65.24 ,$55.92 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$19.26 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$19.26 ,$21.10 ,$145.80 ,$41.94 ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$20.42 ,$22.37 ,$22.37 ,$55.08 ,$22.37 ,$18.64 ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100144,80299,HC IBUPROFEN,301,1 ,$123.00 ,$61.50 ,$18.64 ,$123.00 ,$19.26 ,$65.24 ,$55.92 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$19.26 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$19.26 ,$21.10 ,$110.70 ,$41.94 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$20.42 ,$22.37 ,$22.37 ,$41.82 ,$22.37 ,$18.64 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100145,80187,HC FLECAINAIDE,301,1 ,$50.00 ,$25.00 ,$11.11 ,$61.00 ,$21.69 ,$50.00 ,$50.00 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$21.69 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$21.69 ,$30.68 ,$45.00 ,$61.00 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$22.99 ,$32.53 ,$32.53 ,$17.00 ,$32.53 ,$27.11 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100146,80171,HC GABAPENTIN PLASMA,301,1 ,$110.00 ,$55.00 ,$14.48 ,$110.00 ,$14.48 ,$75.85 ,$65.01 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$14.48 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$14.48 ,$24.53 ,$99.00 ,$48.76 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$15.35 ,$26.00 ,$26.00 ,$37.40 ,$26.00 ,$21.67 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100147,80175,HC LAMOTRIGINE,301,1 ,$90.00 ,$45.00 ,$13.25 ,$90.00 ,$13.69 ,$51.56 ,$44.19 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$13.69 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$13.69 ,$15.00 ,$81.00 ,$29.81 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$14.51 ,$15.90 ,$15.90 ,$30.60 ,$15.90 ,$13.25 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100148,80183,HC TRILEPTAL,301,1 ,$100.00 ,$50.00 ,$13.25 ,$100.00 ,$13.69 ,$51.56 ,$44.19 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$13.69 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$13.69 ,$15.00 ,$90.00 ,$29.81 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$34.00 ,$15.90 ,$13.25 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100149,80177,HC KEPPRA,301,1 ,$110.00 ,$55.00 ,$13.25 ,$110.00 ,$13.69 ,$51.56 ,$44.19 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$13.69 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$13.69 ,$15.00 ,$99.00 ,$29.81 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$14.51 ,$15.90 ,$15.90 ,$37.40 ,$15.90 ,$13.25 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100150,80203,HC ZONISAMIDE,301,1 ,$100.00 ,$50.00 ,$13.25 ,$100.00 ,$13.69 ,$51.56 ,$44.19 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$13.69 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$13.69 ,$15.00 ,$90.00 ,$29.81 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$34.00 ,$15.90 ,$13.25 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100151,80199,HC TIAGABINE,301,1 ,$120.00 ,$60.00 ,$19.70 ,$120.00 ,$19.70 ,$94.89 ,$81.33 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$19.70 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 ,$19.70 ,$30.68 ,$108.00 ,$61.00 ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 ,$20.88 ,$32.53 ,$32.53 ,$40.80 ,$32.53 ,$27.11 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100152,80299,HC TRAZODONE,301,1 ,$162.00 ,$81.00 ,$18.64 ,$162.00 ,$19.26 ,$65.24 ,$55.92 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$19.26 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$19.26 ,$21.10 ,$145.80 ,$41.94 ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$20.42 ,$22.37 ,$22.37 ,$55.08 ,$22.37 ,$18.64 ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100153,80299,HC RITALIN,301,1 ,$91.00 ,$45.50 ,$18.64 ,$91.00 ,$19.26 ,$65.24 ,$55.92 ,$30.94 ,$72.80 ,$77.35 ,$56.88 ,$81.90 ,$19.26 ,$86.45 ,$81.90 ,$77.35 ,$77.35 ,$30.94 ,$77.35 ,$77.35 ,$81.90 ,$19.26 ,$21.10 ,$81.90 ,$41.94 ,$83.72 ,$81.90 ,$60.64 ,$60.64 ,$55.42 ,$60.64 ,$59.15 ,$63.38 ,$20.22 ,$71.89 ,$20.42 ,$22.37 ,$22.37 ,$30.94 ,$22.37 ,$18.64 ,$86.45 ,$74.62 ,$74.62 ,$72.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100155,81099,HC INBORN ERR METABOLISM,301,1 ,$661.00 ,$330.50 ,$4.87 ,$661.00 ,$4.87 ,$559.14 ,$559.14 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$4.87 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$4.87 ,$277.62 ,$594.90 ,$396.60 ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 , N/A ,$522.19 ,$5.16 ,$330.50 ,$330.50 ,$224.74 ,$330.50 , N/A ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100156,G0480,HC ACETAMINOPHEN,301,1 ,$200.00 ,$100.00 ,$44.44 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$68.00 ,$160.00 ,$170.00 ,$125.00 ,$180.00 ,$63.95 ,$190.00 ,$180.00 ,$170.00 ,$170.00 ,$68.00 ,$170.00 ,$170.00 ,$180.00 ,$63.95 ,$129.51 ,$180.00 ,$257.47 ,$184.00 ,$180.00 ,$133.28 ,$133.28 ,$121.80 ,$133.28 ,$130.00 ,$139.30 ,$44.44 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$68.00 ,$137.32 ,$114.43 ,$190.00 ,$164.00 ,$164.00 ,$160.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100157,82009,HC ACETONE SERUM,301,1 ,$48.00 ,$24.00 ,$4.52 ,$48.00 ,$4.67 ,$17.57 ,$15.06 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$4.67 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$4.67 ,$5.12 ,$43.20 ,$10.17 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$4.95 ,$5.42 ,$5.42 ,$16.32 ,$5.42 ,$4.52 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$55.00 ,$27.50 ,$8.17 ,$55.00 ,$8.44 ,$31.78 ,$27.24 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 ,$8.44 ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 ,$8.44 ,$9.25 ,$49.50 ,$18.38 ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 ,$8.95 ,$9.80 ,$9.80 ,$18.70 ,$9.80 ,$8.17 ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100159,82017,HC ACYLCARNITINES QN EA SPEC,301,1 ,$482.00 ,$241.00 ,$16.87 ,$482.00 ,$17.43 ,$65.59 ,$56.22 ,$163.88 ,$385.60 ,$409.70 ,$301.25 ,$433.80 ,$17.43 ,$457.90 ,$433.80 ,$409.70 ,$409.70 ,$163.88 ,$409.70 ,$409.70 ,$433.80 ,$17.43 ,$19.09 ,$433.80 ,$37.96 ,$443.44 ,$433.80 ,$321.20 ,$321.20 ,$293.54 ,$321.20 ,$313.30 ,$335.71 ,$107.10 ,$380.78 ,$18.48 ,$20.24 ,$20.24 ,$163.88 ,$20.24 ,$16.87 ,$457.90 ,$395.24 ,$395.24 ,$385.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100162,82017,HC ACYLCARNITINES QN PLASMA MAYO,301,1 ,$433.00 ,$216.50 ,$16.87 ,$433.00 ,$17.43 ,$65.59 ,$56.22 ,$147.22 ,$346.40 ,$368.05 ,$270.63 ,$389.70 ,$17.43 ,$411.35 ,$389.70 ,$368.05 ,$368.05 ,$147.22 ,$368.05 ,$368.05 ,$389.70 ,$17.43 ,$19.09 ,$389.70 ,$37.96 ,$398.36 ,$389.70 ,$288.55 ,$288.55 ,$263.70 ,$288.55 ,$281.45 ,$301.58 ,$96.21 ,$342.07 ,$18.48 ,$20.24 ,$20.24 ,$147.22 ,$20.24 ,$16.87 ,$411.35 ,$355.06 ,$355.06 ,$346.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100163,82024,HC ACTH,301,1 ,$291.00 ,$145.50 ,$38.62 ,$291.00 ,$39.91 ,$150.19 ,$128.73 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.91 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.91 ,$43.71 ,$261.90 ,$86.90 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$42.30 ,$46.34 ,$46.34 ,$98.94 ,$46.34 ,$38.62 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100164,82040,HC ALBUMIN,301,1 ,$38.00 ,$19.00 ,$4.95 ,$38.00 ,$5.11 ,$19.25 ,$16.50 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$5.11 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$5.11 ,$5.60 ,$34.20 ,$11.14 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$5.42 ,$5.94 ,$5.94 ,$12.92 ,$5.94 ,$4.95 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100165,82040,HC ALBUMIN SERUM,301,1 ,$35.00 ,$17.50 ,$4.95 ,$35.00 ,$5.11 ,$19.25 ,$16.50 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$5.11 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 ,$5.11 ,$5.60 ,$31.50 ,$11.14 ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 ,$5.42 ,$5.94 ,$5.94 ,$11.90 ,$5.94 ,$4.95 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100166,82042,HC ALBUMIN BODY FLUID,301,1 ,$67.00 ,$33.50 ,$7.27 ,$67.00 ,$7.27 ,$27.23 ,$23.34 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$7.27 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$7.27 ,$8.81 ,$60.30 ,$17.51 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$7.71 ,$9.34 ,$9.34 ,$22.78 ,$9.34 ,$7.78 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100167,82042,HC ALBUMIN CSF,301,1 ,$67.00 ,$33.50 ,$7.27 ,$67.00 ,$7.27 ,$27.23 ,$23.34 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$7.27 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$7.27 ,$8.81 ,$60.30 ,$17.51 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$7.71 ,$9.34 ,$9.34 ,$22.78 ,$9.34 ,$7.78 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$54.00 ,$27.00 ,$5.78 ,$54.00 ,$5.97 ,$22.47 ,$19.26 ,$18.36 ,$43.20 ,$45.90 ,$33.75 ,$48.60 ,$5.97 ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$18.36 ,$45.90 ,$45.90 ,$48.60 ,$5.97 ,$6.54 ,$48.60 ,$13.01 ,$49.68 ,$48.60 ,$35.99 ,$35.99 ,$32.89 ,$35.99 ,$35.10 ,$37.61 ,$12.00 ,$42.66 ,$6.33 ,$6.94 ,$6.94 ,$18.36 ,$6.94 ,$5.78 ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100169,G0480,HC ALCOHOL (ETOH),301,1 ,$180.00 ,$90.00 ,$40.00 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$63.95 ,$129.51 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$61.20 ,$137.32 ,$114.43 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100170,82085,HC ALDOLASE,301,1 ,$67.00 ,$33.50 ,$9.71 ,$67.00 ,$10.03 ,$37.77 ,$32.37 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$10.03 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$10.03 ,$10.99 ,$60.30 ,$21.85 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$10.63 ,$11.65 ,$11.65 ,$22.78 ,$11.65 ,$9.71 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100171,82088,HC ALDOSTERONE,301,1 ,$314.00 ,$157.00 ,$40.75 ,$314.00 ,$42.11 ,$158.48 ,$135.84 ,$106.76 ,$251.20 ,$266.90 ,$196.25 ,$282.60 ,$42.11 ,$298.30 ,$282.60 ,$266.90 ,$266.90 ,$106.76 ,$266.90 ,$266.90 ,$282.60 ,$42.11 ,$46.12 ,$282.60 ,$91.69 ,$288.88 ,$282.60 ,$209.25 ,$209.25 ,$191.23 ,$209.25 ,$204.10 ,$218.70 ,$69.77 ,$248.06 ,$44.64 ,$48.90 ,$48.90 ,$106.76 ,$48.90 ,$40.75 ,$298.30 ,$257.48 ,$257.48 ,$251.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100172,82103,HC ALPHA-1 ANTITRYPSIN TOTAL,301,1 ,$103.00 ,$51.50 ,$13.44 ,$103.00 ,$13.89 ,$52.26 ,$44.79 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$13.89 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$13.89 ,$15.21 ,$92.70 ,$30.24 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$14.72 ,$16.13 ,$16.13 ,$35.02 ,$16.13 ,$13.44 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100174,82104,HC ANTITRYPSIN PHENO,301,1 ,$148.00 ,$74.00 ,$14.46 ,$148.00 ,$14.94 ,$56.25 ,$48.21 ,$50.32 ,$118.40 ,$125.80 ,$92.50 ,$133.20 ,$14.94 ,$140.60 ,$133.20 ,$125.80 ,$125.80 ,$50.32 ,$125.80 ,$125.80 ,$133.20 ,$14.94 ,$16.37 ,$133.20 ,$32.54 ,$136.16 ,$133.20 ,$98.63 ,$98.63 ,$90.13 ,$98.63 ,$96.20 ,$103.08 ,$32.89 ,$116.92 ,$15.84 ,$17.35 ,$17.35 ,$50.32 ,$17.35 ,$14.46 ,$140.60 ,$121.36 ,$121.36 ,$118.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100175,82105,HC ALPHA FETOPROTEIN SERUM,301,1 ,$123.00 ,$61.50 ,$16.77 ,$123.00 ,$17.33 ,$65.24 ,$55.92 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$17.33 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$17.33 ,$18.98 ,$110.70 ,$37.73 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$18.37 ,$20.12 ,$20.12 ,$41.82 ,$20.12 ,$16.77 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100178,82105,HC AFP MATERNAL,301,1 ,$123.00 ,$61.50 ,$16.77 ,$123.00 ,$17.33 ,$65.24 ,$55.92 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$17.33 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$17.33 ,$18.98 ,$110.70 ,$37.73 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$18.37 ,$20.12 ,$20.12 ,$41.82 ,$20.12 ,$16.77 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100179,82108,HC ALUMINUM,301,1 ,$157.00 ,$78.50 ,$25.48 ,$157.00 ,$26.33 ,$99.09 ,$84.93 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$26.33 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$26.33 ,$28.84 ,$141.30 ,$57.33 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$27.91 ,$30.58 ,$30.58 ,$53.38 ,$30.58 ,$25.48 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100180,82131,HC AMINO ACID QN SINGLE,301,1 ,$170.00 ,$85.00 ,$21.01 ,$170.00 ,$21.01 ,$80.43 ,$68.94 ,$57.80 ,$136.00 ,$144.50 ,$106.25 ,$153.00 ,$21.01 ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$57.80 ,$144.50 ,$144.50 ,$153.00 ,$21.01 ,$26.01 ,$153.00 ,$51.71 ,$156.40 ,$153.00 ,$113.29 ,$113.29 ,$103.53 ,$113.29 ,$110.50 ,$118.41 ,$37.77 ,$134.30 ,$22.27 ,$27.58 ,$27.58 ,$57.80 ,$27.58 ,$22.98 ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$380.80 ,$896.00 ,$952.00 ,$700.00 ,"$1,008.00 ",$17.43 ,"$1,064.00 ","$1,008.00 ",$952.00 ,$952.00 ,$380.80 ,$952.00 ,$952.00 ,"$1,008.00 ",$17.43 ,$19.09 ,"$1,008.00 ",$37.96 ,"$1,030.40 ","$1,008.00 ",$746.37 ,$746.37 ,$682.08 ,$746.37 ,$728.00 ,$780.08 ,$248.86 ,$884.80 ,$18.48 ,$20.24 ,$20.24 ,$380.80 ,$20.24 ,$16.87 ,"$1,064.00 ",$918.40 ,$918.40 ,$896.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100186,82140,HC AMMONIA,301,1 ,$112.00 ,$56.00 ,$14.57 ,$112.00 ,$15.06 ,$56.67 ,$48.57 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.06 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.06 ,$16.49 ,$100.80 ,$32.78 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.96 ,$17.48 ,$17.48 ,$38.08 ,$17.48 ,$14.57 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100187,80324,HC AMPHETAMINE,301,1 ,$46.00 ,$23.00 ,$10.22 ,$46.00 ,$21.41 ,$46.00 ,$46.00 ,$15.64 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$21.41 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$15.64 ,$39.10 ,$39.10 ,$41.40 ,$21.41 ,$19.32 ,$41.40 , N/A ,$42.32 ,$41.40 ,$30.65 ,$30.65 ,$28.01 ,$30.65 ,$29.90 ,$32.04 ,$10.22 ,$36.34 ,$22.69 , N/A , N/A ,$15.64 , N/A , N/A ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100188,82150,HC AMYLASE,301,1 ,$67.00 ,$33.50 ,$6.48 ,$67.00 ,$6.70 ,$25.20 ,$21.60 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$6.70 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$6.70 ,$7.33 ,$60.30 ,$14.58 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$7.10 ,$7.78 ,$7.78 ,$22.78 ,$7.78 ,$6.48 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100189,82157,HC ANDROSTENEDIONE,301,1 ,$224.00 ,$112.00 ,$29.28 ,$224.00 ,$30.26 ,$113.86 ,$97.59 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$30.26 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$30.26 ,$33.14 ,$201.60 ,$65.88 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$32.08 ,$35.14 ,$35.14 ,$76.16 ,$35.14 ,$29.28 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100190,82164,"HC ACE, CSF",301,1 ,$112.00 ,$56.00 ,$14.60 ,$112.00 ,$15.09 ,$56.77 ,$48.66 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.09 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.09 ,$16.52 ,$100.80 ,$32.85 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.00 ,$17.52 ,$17.52 ,$38.08 ,$17.52 ,$14.60 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100191,82164,HC ANGIOTENSIN 1 ENZYME (ACE),301,1 ,$112.00 ,$56.00 ,$14.60 ,$112.00 ,$15.09 ,$56.77 ,$48.66 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.09 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.09 ,$16.52 ,$100.80 ,$32.85 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.00 ,$17.52 ,$17.52 ,$38.08 ,$17.52 ,$14.60 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100192,82172,HC APOLIPOPROTEIN SERUM,301,1 ,$101.00 ,$50.50 ,$21.09 ,$101.00 ,$21.79 ,$73.82 ,$63.27 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$21.79 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$21.79 ,$23.87 ,$90.90 ,$47.45 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$23.10 ,$25.31 ,$25.31 ,$34.34 ,$25.31 ,$21.09 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100193,82175,HC ARSENIC,301,1 ,$53.00 ,$26.50 ,$11.78 ,$53.00 ,$19.60 ,$53.00 ,$53.00 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$19.60 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$19.60 ,$21.47 ,$47.70 ,$42.68 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$20.78 ,$22.76 ,$22.76 ,$18.02 ,$22.76 ,$18.97 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100194,82175,HC ARSENIC BLOOD,301,1 ,$90.00 ,$45.00 ,$18.97 ,$90.00 ,$19.60 ,$73.78 ,$63.24 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$19.60 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$19.60 ,$21.47 ,$81.00 ,$42.68 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$20.78 ,$22.76 ,$22.76 ,$30.60 ,$22.76 ,$18.97 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100195,82175,HC ARSENIC URINE,301,1 ,$90.00 ,$45.00 ,$18.97 ,$90.00 ,$19.60 ,$73.78 ,$63.24 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$19.60 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$19.60 ,$21.47 ,$81.00 ,$42.68 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$20.78 ,$22.76 ,$22.76 ,$30.60 ,$22.76 ,$18.97 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100196,82175,HC ARESNIC 24 HR URINE,301,1 ,$90.00 ,$45.00 ,$18.97 ,$90.00 ,$19.60 ,$73.78 ,$63.24 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$19.60 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$19.60 ,$21.47 ,$81.00 ,$42.68 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$20.78 ,$22.76 ,$22.76 ,$30.60 ,$22.76 ,$18.97 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100197,82180,HC VITAMIN C (ASCORBIC ACID),301,1 ,$78.00 ,$39.00 ,$9.89 ,$78.00 ,$10.22 ,$38.43 ,$32.94 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.22 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.22 ,$11.19 ,$70.20 ,$22.25 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.83 ,$11.87 ,$11.87 ,$26.52 ,$11.87 ,$9.89 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100199,80345,HC BARBITURATE,301,1 ,$38.00 ,$19.00 ,$8.44 ,$38.00 ,$21.41 ,$38.00 ,$38.00 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$21.41 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$21.41 ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$22.69 , N/A , N/A ,$12.92 , N/A , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100201,82232,HC BETA 2 MICROGLOBULIN,301,1 ,$123.00 ,$61.50 ,$16.18 ,$123.00 ,$16.72 ,$62.90 ,$53.91 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.72 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.72 ,$18.31 ,$110.70 ,$36.41 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$17.72 ,$19.42 ,$19.42 ,$41.82 ,$19.42 ,$16.18 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$38.00 ,$19.00 ,$4.24 ,$38.00 ,$4.24 ,$19.50 ,$16.71 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.24 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.24 ,$5.68 ,$34.20 ,$11.30 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.49 ,$6.02 ,$6.02 ,$12.92 ,$6.02 ,$5.02 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$38.00 ,$19.00 ,$4.70 ,$38.00 ,$4.70 ,$19.50 ,$16.71 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.70 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.70 ,$5.68 ,$34.20 ,$11.30 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.98 ,$6.02 ,$6.02 ,$12.92 ,$6.02 ,$5.02 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100205,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$26.00 ,$13.00 ,$3.66 ,$26.00 ,$3.66 ,$15.33 ,$13.14 ,$8.84 ,$20.80 ,$22.10 ,$16.25 ,$23.40 ,$3.66 ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$8.84 ,$22.10 ,$22.10 ,$23.40 ,$3.66 ,$4.96 ,$23.40 ,$9.86 ,$23.92 ,$23.40 ,$17.33 ,$17.33 ,$15.83 ,$17.33 ,$16.90 ,$18.11 ,$5.78 ,$20.54 ,$3.88 ,$5.26 ,$5.26 ,$8.84 ,$5.26 ,$4.38 ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100206,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$26.00 ,$13.00 ,$4.26 ,$26.00 ,$4.26 ,$18.62 ,$15.96 ,$8.84 ,$20.80 ,$22.10 ,$16.25 ,$23.40 ,$4.26 ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$8.84 ,$22.10 ,$22.10 ,$23.40 ,$4.26 ,$6.02 ,$23.40 ,$11.97 ,$23.92 ,$23.40 ,$17.33 ,$17.33 ,$15.83 ,$17.33 ,$16.90 ,$18.11 ,$5.78 ,$20.54 ,$4.52 ,$6.38 ,$6.38 ,$8.84 ,$6.38 ,$5.32 ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100207,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$25.00 ,$12.50 ,$4.23 ,$25.00 ,$4.26 ,$14.81 ,$12.69 ,$8.50 ,$20.00 ,$21.25 ,$15.63 ,$22.50 ,$4.26 ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$8.50 ,$21.25 ,$21.25 ,$22.50 ,$4.26 ,$4.79 ,$22.50 ,$9.52 ,$23.00 ,$22.50 ,$16.66 ,$16.66 ,$15.23 ,$16.66 ,$16.25 ,$17.41 ,$5.56 ,$19.75 ,$4.52 ,$5.08 ,$5.08 ,$8.50 ,$5.08 ,$4.23 ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100208,82274,HC OCCULT BLOOD FECAL HGB,301,1 ,$114.00 ,$57.00 ,$15.92 ,$114.00 ,$16.45 ,$61.85 ,$53.01 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 ,$16.45 ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 ,$16.45 ,$18.02 ,$102.60 ,$35.82 ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 ,$17.44 ,$19.10 ,$19.10 ,$38.76 ,$19.10 ,$15.92 ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100209,82300,HC CADMIUM,301,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 ,$24.43 ,$90.00 ,$77.16 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$24.43 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$24.43 ,$26.76 ,$81.00 ,$53.19 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$25.90 ,$28.37 ,$28.37 ,$30.60 ,$28.37 ,$23.64 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100210,82300,HC CADMIUM URINE,301,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 ,$24.43 ,$90.00 ,$77.16 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$24.43 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$24.43 ,$26.76 ,$81.00 ,$53.19 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$25.90 ,$28.37 ,$28.37 ,$30.60 ,$28.37 ,$23.64 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100211,82300,HC CADMIUM 24 HR URINE,301,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 ,$24.43 ,$90.00 ,$77.16 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$24.43 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$24.43 ,$26.76 ,$81.00 ,$53.19 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$25.90 ,$28.37 ,$28.37 ,$30.60 ,$28.37 ,$23.64 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100212,82306,HC VITAMIN D 25 OH,301,1 ,$224.00 ,$112.00 ,$29.60 ,$224.00 ,$30.59 ,$115.12 ,$98.67 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$30.59 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$30.59 ,$33.50 ,$201.60 ,$66.60 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$32.43 ,$35.52 ,$35.52 ,$76.16 ,$35.52 ,$29.60 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100213,82308,HC CALCITONIN,301,1 ,$157.00 ,$78.50 ,$26.79 ,$157.00 ,$27.68 ,$104.20 ,$89.31 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$27.68 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$27.68 ,$30.32 ,$141.30 ,$60.28 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$29.34 ,$32.15 ,$32.15 ,$53.38 ,$32.15 ,$26.79 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100214,82310,HC CALCIUM,301,1 ,$38.00 ,$19.00 ,$5.16 ,$38.00 ,$5.33 ,$20.06 ,$17.19 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$5.33 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$5.33 ,$5.84 ,$34.20 ,$11.61 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$5.65 ,$6.19 ,$6.19 ,$12.92 ,$6.19 ,$5.16 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100215,82330,HC CALCIUM IONIZED,301,1 ,$101.00 ,$50.50 ,$13.68 ,$101.00 ,$14.14 ,$53.20 ,$45.60 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.14 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.14 ,$15.48 ,$90.90 ,$30.78 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.99 ,$16.42 ,$16.42 ,$34.34 ,$16.42 ,$13.68 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$46.00 ,$23.00 ,$6.03 ,$46.00 ,$6.23 ,$23.45 ,$20.10 ,$15.64 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$6.23 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$15.64 ,$39.10 ,$39.10 ,$41.40 ,$6.23 ,$6.82 ,$41.40 ,$13.57 ,$42.32 ,$41.40 ,$30.65 ,$30.65 ,$28.01 ,$30.65 ,$29.90 ,$32.04 ,$10.22 ,$36.34 ,$6.60 ,$7.24 ,$7.24 ,$15.64 ,$7.24 ,$6.03 ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100217,82360,HC CALCULUS ANALYSIS QN,301,1 ,$110.00 ,$55.00 ,$12.87 ,$110.00 ,$13.30 ,$50.05 ,$42.90 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$13.30 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$13.30 ,$14.57 ,$99.00 ,$28.96 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$14.10 ,$15.44 ,$15.44 ,$37.40 ,$15.44 ,$12.87 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100218,82365,HC CALCULUS ANLYS (SA) INFRARED,301,1 ,$118.00 ,$59.00 ,$12.90 ,$118.00 ,$13.33 ,$50.16 ,$42.99 ,$40.12 ,$94.40 ,$100.30 ,$73.75 ,$106.20 ,$13.33 ,$112.10 ,$106.20 ,$100.30 ,$100.30 ,$40.12 ,$100.30 ,$100.30 ,$106.20 ,$13.33 ,$14.60 ,$106.20 ,$29.03 ,$108.56 ,$106.20 ,$78.64 ,$78.64 ,$71.86 ,$78.64 ,$76.70 ,$82.19 ,$26.22 ,$93.22 ,$14.13 ,$15.48 ,$15.48 ,$40.12 ,$15.48 ,$12.90 ,$112.10 ,$96.76 ,$96.76 ,$94.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100221,82373,HC CARBOHY DEFICIENT TRANSFER,301,1 ,$517.00 ,$258.50 ,$10.38 ,$517.00 ,$10.38 ,$70.21 ,$60.18 ,$175.78 ,$413.60 ,$439.45 ,$323.13 ,$465.30 ,$10.38 ,$491.15 ,$465.30 ,$439.45 ,$439.45 ,$175.78 ,$439.45 ,$439.45 ,$465.30 ,$10.38 ,$20.44 ,$465.30 ,$40.64 ,$475.64 ,$465.30 ,$344.53 ,$344.53 ,$314.85 ,$344.53 ,$336.05 ,$360.09 ,$114.88 ,$408.43 ,$11.00 ,$21.67 ,$21.67 ,$175.78 ,$21.67 ,$18.06 ,$491.15 ,$423.94 ,$423.94 ,$413.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100222,82374,HC BICARBONATE,301,1 ,$101.00 ,$50.50 ,$4.88 ,$101.00 ,$5.04 ,$19.01 ,$16.29 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$5.04 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$5.04 ,$5.52 ,$90.90 ,$10.98 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$5.34 ,$5.86 ,$5.86 ,$34.34 ,$5.86 ,$4.88 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100223,82374,HC CO2,301,1 ,$43.00 ,$21.50 ,$4.88 ,$43.00 ,$5.04 ,$19.01 ,$16.29 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 ,$5.04 ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 ,$5.04 ,$5.52 ,$38.70 ,$10.98 ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 ,$5.34 ,$5.86 ,$5.86 ,$14.62 ,$5.86 ,$4.88 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100224,82375,HC CARBON MONOXIDE,301,1 ,$168.00 ,$84.00 ,$12.32 ,$168.00 ,$12.73 ,$47.92 ,$41.07 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$12.73 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$12.73 ,$13.94 ,$151.20 ,$27.72 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$13.49 ,$14.78 ,$14.78 ,$57.12 ,$14.78 ,$12.32 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100225,82375,HC CARBOXYHEMOGLOBIN,301,1 ,$168.00 ,$84.00 ,$12.32 ,$168.00 ,$12.73 ,$47.92 ,$41.07 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$12.73 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$12.73 ,$13.94 ,$151.20 ,$27.72 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$13.49 ,$14.78 ,$14.78 ,$57.12 ,$14.78 ,$12.32 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100226,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$146.00 ,$73.00 ,$18.96 ,$146.00 ,$19.59 ,$73.75 ,$63.21 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.59 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.59 ,$21.46 ,$131.40 ,$42.66 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$20.77 ,$22.75 ,$22.75 ,$49.64 ,$22.75 ,$18.96 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100227,82378,HC CEA BODY FLUID,301,1 ,$235.00 ,$117.50 ,$18.96 ,$235.00 ,$19.59 ,$73.75 ,$63.21 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 ,$19.59 ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 ,$19.59 ,$21.46 ,$211.50 ,$42.66 ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 ,$20.77 ,$22.75 ,$22.75 ,$79.90 ,$22.75 ,$18.96 ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100230,82379,HC CARNITINE,301,1 ,$426.00 ,$213.00 ,$16.87 ,$426.00 ,$17.43 ,$65.59 ,$56.22 ,$144.84 ,$340.80 ,$362.10 ,$266.25 ,$383.40 ,$17.43 ,$404.70 ,$383.40 ,$362.10 ,$362.10 ,$144.84 ,$362.10 ,$362.10 ,$383.40 ,$17.43 ,$19.09 ,$383.40 ,$37.96 ,$391.92 ,$383.40 ,$283.89 ,$283.89 ,$259.43 ,$283.89 ,$276.90 ,$296.71 ,$94.66 ,$336.54 ,$18.48 ,$20.24 ,$20.24 ,$144.84 ,$20.24 ,$16.87 ,$404.70 ,$349.32 ,$349.32 ,$340.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100231,82380,HC CAROTENE,301,1 ,$57.00 ,$28.50 ,$9.22 ,$57.00 ,$9.53 ,$35.88 ,$30.75 ,$19.38 ,$45.60 ,$48.45 ,$35.63 ,$51.30 ,$9.53 ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$19.38 ,$48.45 ,$48.45 ,$51.30 ,$9.53 ,$10.44 ,$51.30 ,$20.75 ,$52.44 ,$51.30 ,$37.98 ,$37.98 ,$34.71 ,$37.98 ,$37.05 ,$39.70 ,$12.67 ,$45.03 ,$10.10 ,$11.06 ,$11.06 ,$19.38 ,$11.06 ,$9.22 ,$54.15 ,$46.74 ,$46.74 ,$45.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100232,82384,HC CATECHOLAMINE FRACTION,301,1 ,$190.00 ,$95.00 ,$25.25 ,$190.00 ,$26.09 ,$98.21 ,$84.18 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$26.09 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$26.09 ,$28.58 ,$171.00 ,$56.81 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$27.66 ,$30.30 ,$30.30 ,$64.60 ,$30.30 ,$25.25 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100234,82384,HC CATECHOLAMINE PLASMA,301,1 ,$84.00 ,$42.00 ,$18.66 ,$84.00 ,$26.09 ,$84.00 ,$84.00 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 ,$26.09 ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 ,$26.09 ,$28.58 ,$75.60 ,$56.81 ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 ,$27.66 ,$30.30 ,$30.30 ,$28.56 ,$30.30 ,$25.25 ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100235,82390,HC CERULOPLASMIN,301,1 ,$78.00 ,$39.00 ,$10.74 ,$78.00 ,$11.10 ,$41.76 ,$35.79 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$11.10 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$11.10 ,$12.16 ,$70.20 ,$24.17 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.77 ,$12.89 ,$12.89 ,$26.52 ,$12.89 ,$10.74 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100236,82397,HC CHEMILUMINESCENT ASSAY,301,1 ,$112.00 ,$56.00 ,$14.12 ,$112.00 ,$14.59 ,$54.92 ,$47.07 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.59 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.59 ,$15.98 ,$100.80 ,$31.77 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.47 ,$16.94 ,$16.94 ,$38.08 ,$16.94 ,$14.12 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100237,82435,HC CHLORIDE,301,1 ,$67.00 ,$33.50 ,$4.60 ,$67.00 ,$4.75 ,$17.89 ,$15.33 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$4.75 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$4.75 ,$5.21 ,$60.30 ,$10.35 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$5.04 ,$5.52 ,$5.52 ,$22.78 ,$5.52 ,$4.60 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100238,82436,HC CHLORIDE URINE,301,1 ,$48.00 ,$24.00 ,$5.75 ,$48.00 ,$5.94 ,$20.13 ,$17.25 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$5.94 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$5.94 ,$6.51 ,$43.20 ,$12.94 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$6.30 ,$6.90 ,$6.90 ,$16.32 ,$6.90 ,$5.75 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100240,82438,HC CHLORIDE OTHER SOURCE,301,1 ,$76.00 ,$38.00 ,$5.00 ,$76.00 ,$5.17 ,$19.01 ,$16.29 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 ,$5.17 ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 ,$5.17 ,$5.66 ,$68.40 ,$11.25 ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 ,$5.48 ,$6.00 ,$6.00 ,$25.84 ,$6.00 ,$5.00 ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100241,82465,HC CHOLESTEROL,301,1 ,$56.00 ,$28.00 ,$4.35 ,$56.00 ,$4.49 ,$16.94 ,$14.52 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$4.49 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$4.49 ,$4.92 ,$50.40 ,$9.79 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$4.76 ,$5.22 ,$5.22 ,$19.04 ,$5.22 ,$4.35 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100242,82542,HC CHROMATO QN SGL COLUMN,301,1 ,$157.00 ,$78.50 ,$24.09 ,$157.00 ,$24.89 ,$84.32 ,$72.27 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$24.89 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$24.89 ,$27.27 ,$141.30 ,$54.20 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$26.38 ,$28.91 ,$28.91 ,$53.38 ,$28.91 ,$24.09 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100243,80299,HC CHROMATO QN MLT COLUMN,301,1 ,$183.00 ,$91.50 ,$18.64 ,$183.00 ,$19.26 ,$65.24 ,$55.92 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$19.26 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$19.26 ,$21.10 ,$164.70 ,$41.94 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$20.42 ,$22.37 ,$22.37 ,$62.22 ,$22.37 ,$18.64 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100245,82495,HC CHROMIUM SERUM,301,1 ,$123.00 ,$61.50 ,$10.23 ,$123.00 ,$10.23 ,$78.86 ,$67.59 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$10.23 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$10.23 ,$22.95 ,$110.70 ,$45.63 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$10.84 ,$24.34 ,$24.34 ,$41.82 ,$24.34 ,$20.28 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100246,82507,HC CITRATE,301,1 ,$206.00 ,$103.00 ,$27.80 ,$206.00 ,$28.73 ,$108.12 ,$92.67 ,$70.04 ,$164.80 ,$175.10 ,$128.75 ,$185.40 ,$28.73 ,$195.70 ,$185.40 ,$175.10 ,$175.10 ,$70.04 ,$175.10 ,$175.10 ,$185.40 ,$28.73 ,$31.46 ,$185.40 ,$62.55 ,$189.52 ,$185.40 ,$137.28 ,$137.28 ,$125.45 ,$137.28 ,$133.90 ,$143.48 ,$45.77 ,$162.74 ,$30.45 ,$33.36 ,$33.36 ,$70.04 ,$33.36 ,$27.80 ,$195.70 ,$168.92 ,$168.92 ,$164.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100247,80343,HC COCAINE QN,301,1 ,$36.00 ,$18.00 ,$8.00 ,$59.76 ,$56.38 ,$30.45 ,$30.45 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 ,$56.38 ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 ,$56.38 ,$15.12 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 ,$59.76 , N/A , N/A ,$12.24 , N/A , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100252,82525,HC COPPER,301,1 ,$67.00 ,$33.50 ,$12.41 ,$67.00 ,$12.82 ,$48.27 ,$41.37 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.82 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.82 ,$14.05 ,$60.30 ,$27.92 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.59 ,$14.89 ,$14.89 ,$22.78 ,$14.89 ,$12.41 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100253,82530,HC CORTISOL FREE,301,1 ,$123.00 ,$61.50 ,$16.71 ,$123.00 ,$17.27 ,$65.00 ,$55.71 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$17.27 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$17.27 ,$18.91 ,$110.70 ,$37.60 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$18.31 ,$20.05 ,$20.05 ,$41.82 ,$20.05 ,$16.71 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100254,82533,HC CORTISOL TOTAL,301,1 ,$123.00 ,$61.50 ,$16.30 ,$123.00 ,$16.84 ,$63.39 ,$54.33 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.84 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.84 ,$18.45 ,$110.70 ,$36.68 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$17.85 ,$19.56 ,$19.56 ,$41.82 ,$19.56 ,$16.30 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100255,G0480,HC RISPERIDONE,301,1 ,$128.00 ,$64.00 ,$28.44 ,$257.47 ,$63.95 ,$128.00 ,$128.00 ,$43.52 ,$102.40 ,$108.80 ,$80.00 ,$115.20 ,$63.95 ,$121.60 ,$115.20 ,$108.80 ,$108.80 ,$43.52 ,$108.80 ,$108.80 ,$115.20 ,$63.95 ,$128.00 ,$115.20 ,$257.47 ,$117.76 ,$115.20 ,$85.30 ,$85.30 ,$77.95 ,$85.30 ,$83.20 ,$89.15 ,$28.44 ,$101.12 ,$67.79 ,$128.00 ,$128.00 ,$43.52 ,$128.00 ,$114.43 ,$121.60 ,$104.96 ,$104.96 ,$102.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100256,G0480,HC THC CONFIRMATION,301,1 ,$100.00 ,$50.00 ,$22.22 ,$225.00 ,$63.95 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$63.95 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$63.95 ,$100.00 ,$90.00 ,$225.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$67.79 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$100.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$52.00 ,$26.00 ,$6.51 ,$52.00 ,$6.73 ,$25.31 ,$21.69 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$6.73 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$6.73 ,$7.37 ,$46.80 ,$14.65 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$7.13 ,$7.81 ,$7.81 ,$17.68 ,$7.81 ,$6.51 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100260,82552,HC CREATINE KINASE (CPK) ISO,301,1 ,$92.00 ,$46.00 ,$13.39 ,$92.00 ,$13.84 ,$52.08 ,$44.64 ,$31.28 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$13.84 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$31.28 ,$78.20 ,$78.20 ,$82.80 ,$13.84 ,$15.15 ,$82.80 ,$30.13 ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 ,$14.67 ,$16.07 ,$16.07 ,$31.28 ,$16.07 ,$13.39 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$67.00 ,$33.50 ,$8.66 ,$67.00 ,$8.66 ,$44.91 ,$38.49 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.66 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.66 ,$13.07 ,$60.30 ,$25.99 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.18 ,$13.86 ,$13.86 ,$22.78 ,$13.86 ,$11.55 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100262,82565,HC CREATININE,301,1 ,$39.00 ,$19.50 ,$5.12 ,$39.00 ,$5.29 ,$19.92 ,$17.07 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$5.29 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$5.29 ,$5.79 ,$35.10 ,$11.52 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$5.61 ,$6.14 ,$6.14 ,$13.26 ,$6.14 ,$5.12 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$39.00 ,$19.50 ,$5.18 ,$39.00 ,$5.35 ,$20.13 ,$17.25 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$5.35 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$5.35 ,$5.86 ,$35.10 ,$11.66 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$5.67 ,$6.22 ,$6.22 ,$13.26 ,$6.22 ,$5.18 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100266,82575,HC CREATININE CLEARANCE,301,1 ,$90.00 ,$45.00 ,$9.46 ,$90.00 ,$9.78 ,$36.79 ,$31.53 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$9.78 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$9.78 ,$10.71 ,$81.00 ,$21.29 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$10.37 ,$11.35 ,$11.35 ,$30.60 ,$11.35 ,$9.46 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100267,82585,HC CRYOFIBRINOGEN,301,1 ,$52.00 ,$26.00 ,$9.02 ,$52.00 ,$9.02 ,$49.49 ,$42.42 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$9.02 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$9.02 ,$16.00 ,$46.80 ,$31.82 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$9.56 ,$16.97 ,$16.97 ,$17.68 ,$16.97 ,$14.14 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100268,82595,HC CRYOGLOBULIN,301,1 ,$168.00 ,$84.00 ,$6.47 ,$168.00 ,$6.69 ,$25.13 ,$21.54 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$6.69 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$6.69 ,$7.32 ,$151.20 ,$14.56 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$7.09 ,$7.76 ,$7.76 ,$57.12 ,$7.76 ,$6.47 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100269,82607,HC VITAMIN B12,301,1 ,$112.00 ,$56.00 ,$15.08 ,$112.00 ,$15.58 ,$58.63 ,$50.25 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.58 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.58 ,$17.07 ,$100.80 ,$33.93 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.51 ,$18.10 ,$18.10 ,$38.08 ,$18.10 ,$15.08 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100270,82626,HC DHEA,301,1 ,$190.00 ,$95.00 ,$25.27 ,$190.00 ,$26.11 ,$98.28 ,$84.24 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$26.11 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$26.11 ,$28.60 ,$171.00 ,$56.86 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$27.68 ,$30.32 ,$30.32 ,$64.60 ,$30.32 ,$25.27 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100271,82627,HC DHEA SULFATE,301,1 ,$168.00 ,$84.00 ,$22.23 ,$168.00 ,$22.97 ,$86.49 ,$74.13 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$22.97 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$22.97 ,$25.16 ,$151.20 ,$50.02 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$24.35 ,$26.68 ,$26.68 ,$57.12 ,$26.68 ,$22.23 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100272,82652,HC VITAMIN D (1 25 DIHYDROXY),301,1 ,$291.00 ,$145.50 ,$38.50 ,$291.00 ,$39.78 ,$149.73 ,$128.34 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.78 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.78 ,$43.57 ,$261.90 ,$86.63 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$42.17 ,$46.20 ,$46.20 ,$98.94 ,$46.20 ,$38.50 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100274,82664,HC ELECTROPHORETIC TEST,301,1 ,$224.00 ,$112.00 ,$48.31 ,$224.00 ,$48.31 ,$215.25 ,$184.50 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$48.31 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$48.31 ,$69.61 ,$201.60 ,$138.38 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$51.21 ,$73.80 ,$73.80 ,$76.16 ,$73.80 ,$61.50 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100275,82668,HC ERYTHROPOIETIN,301,1 ,$101.00 ,$50.50 ,$18.79 ,$101.00 ,$19.42 ,$73.08 ,$62.64 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.42 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.42 ,$21.27 ,$90.90 ,$42.28 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.59 ,$22.55 ,$22.55 ,$34.34 ,$22.55 ,$18.79 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100276,82670,HC ESTRADIOL,301,1 ,$213.00 ,$106.50 ,$27.94 ,$213.00 ,$28.87 ,$108.64 ,$93.12 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$28.87 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$28.87 ,$31.62 ,$191.70 ,$62.87 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$30.60 ,$33.53 ,$33.53 ,$72.42 ,$33.53 ,$27.94 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100278,82672,HC ESTROGEN TOTAL,301,1 ,$168.00 ,$84.00 ,$21.70 ,$168.00 ,$22.42 ,$84.39 ,$72.33 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$22.42 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$22.42 ,$24.56 ,$151.20 ,$48.83 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$23.77 ,$26.04 ,$26.04 ,$57.12 ,$26.04 ,$21.70 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100280,82677,HC ESTRIOL,301,1 ,$202.00 ,$101.00 ,$24.18 ,$202.00 ,$24.99 ,$94.05 ,$80.61 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$24.99 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$24.99 ,$27.37 ,$181.80 ,$54.41 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$26.49 ,$29.02 ,$29.02 ,$68.68 ,$29.02 ,$24.18 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100285,82679,HC ESTRONE,301,1 ,$183.00 ,$91.50 ,$24.95 ,$183.00 ,$25.78 ,$97.06 ,$83.19 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$25.78 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$25.78 ,$28.24 ,$164.70 ,$56.14 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$27.33 ,$29.94 ,$29.94 ,$62.22 ,$29.94 ,$24.95 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100287,82710,HC FECAL FAT QN,301,1 ,$280.00 ,$140.00 ,$16.80 ,$280.00 ,$17.36 ,$65.35 ,$56.01 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$17.36 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$17.36 ,$19.01 ,$252.00 ,$37.80 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$18.40 ,$20.16 ,$20.16 ,$95.20 ,$20.16 ,$16.80 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100288,82725,HC FATTY ACIDS NONESTERIFIED,301,1 ,$157.00 ,$78.50 ,$18.72 ,$157.00 ,$18.72 ,$65.70 ,$56.31 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$18.72 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$18.72 ,$21.24 ,$141.30 ,$42.23 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$19.84 ,$22.52 ,$22.52 ,$53.38 ,$22.52 ,$18.77 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100289,82726,HC VLFC FATTY ACIDS,301,1 ,$280.00 ,$140.00 ,$19.75 ,$280.00 ,$20.41 ,$70.21 ,$60.18 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$20.41 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$20.41 ,$22.35 ,$252.00 ,$44.44 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$21.63 ,$23.70 ,$23.70 ,$95.20 ,$23.70 ,$19.75 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100290,82728,HC FERRITIN,301,1 ,$101.00 ,$50.50 ,$13.63 ,$101.00 ,$14.08 ,$53.03 ,$45.45 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.08 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.08 ,$15.43 ,$90.90 ,$30.67 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.92 ,$16.36 ,$16.36 ,$34.34 ,$16.36 ,$13.63 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$493.00 ,$246.50 ,$64.41 ,$493.00 ,$66.55 ,$250.50 ,$214.71 ,$167.62 ,$394.40 ,$419.05 ,$308.13 ,$443.70 ,$66.55 ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$167.62 ,$419.05 ,$419.05 ,$443.70 ,$66.55 ,$72.90 ,$443.70 ,$144.92 ,$453.56 ,$443.70 ,$328.54 ,$328.54 ,$300.24 ,$328.54 ,$320.45 ,$343.37 ,$109.54 ,$389.47 ,$70.54 ,$77.29 ,$77.29 ,$167.62 ,$77.29 ,$64.41 ,$468.35 ,$404.26 ,$404.26 ,$394.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100292,82746,HC FOLIC ACID SERUM,301,1 ,$112.00 ,$56.00 ,$14.70 ,$112.00 ,$15.19 ,$57.19 ,$49.02 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.19 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.19 ,$16.64 ,$100.80 ,$33.08 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.10 ,$17.64 ,$17.64 ,$38.08 ,$17.64 ,$14.70 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100293,82747,HC FOLIC ACID RBC,301,1 ,$90.00 ,$45.00 ,$16.37 ,$90.00 ,$16.37 ,$67.38 ,$57.75 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$16.37 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$16.37 ,$19.98 ,$81.00 ,$39.71 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$17.35 ,$21.18 ,$21.18 ,$30.60 ,$21.18 ,$17.65 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100294,82775,HC GALACTOSE TRANSFERASE QN,301,1 ,$123.00 ,$61.50 ,$21.07 ,$123.00 ,$21.77 ,$81.94 ,$70.23 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$21.77 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$21.77 ,$23.85 ,$110.70 ,$47.41 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$23.08 ,$25.28 ,$25.28 ,$41.82 ,$25.28 ,$21.07 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100295,82784,HC GAMMAGLOBULIN,301,1 ,$67.00 ,$33.50 ,$9.30 ,$67.00 ,$9.61 ,$36.19 ,$31.02 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$9.61 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$9.61 ,$10.53 ,$60.30 ,$20.93 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$10.19 ,$11.16 ,$11.16 ,$22.78 ,$11.16 ,$9.30 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100298,82784,HC GAMMAGLOBULIN TOTAL,301,1 ,$67.00 ,$33.50 ,$9.30 ,$67.00 ,$9.61 ,$36.19 ,$31.02 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$9.61 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$9.61 ,$10.53 ,$60.30 ,$20.93 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$10.19 ,$11.16 ,$11.16 ,$22.78 ,$11.16 ,$9.30 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100300,82784,HC IGD SERUM,301,1 ,$71.00 ,$35.50 ,$9.30 ,$71.00 ,$9.61 ,$36.19 ,$31.02 ,$24.14 ,$56.80 ,$60.35 ,$44.38 ,$63.90 ,$9.61 ,$67.45 ,$63.90 ,$60.35 ,$60.35 ,$24.14 ,$60.35 ,$60.35 ,$63.90 ,$9.61 ,$10.53 ,$63.90 ,$20.93 ,$65.32 ,$63.90 ,$47.31 ,$47.31 ,$43.24 ,$47.31 ,$46.15 ,$49.45 ,$15.78 ,$56.09 ,$10.19 ,$11.16 ,$11.16 ,$24.14 ,$11.16 ,$9.30 ,$67.45 ,$58.22 ,$58.22 ,$56.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100302,82785,HC GAMMAGLOBULIN IGE,301,1 ,$123.00 ,$61.50 ,$16.46 ,$123.00 ,$17.01 ,$64.02 ,$54.87 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$17.01 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$17.01 ,$18.63 ,$110.70 ,$37.04 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$18.03 ,$19.75 ,$19.75 ,$41.82 ,$19.75 ,$16.46 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100303,82787,HC IGG SUBCLASS1-3,301,1 ,$41.00 ,$20.50 ,$5.90 ,$41.00 ,$5.90 ,$31.19 ,$26.73 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$5.90 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$5.90 ,$9.08 ,$36.90 ,$18.05 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$6.25 ,$9.62 ,$9.62 ,$13.94 ,$9.62 ,$8.02 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100304,82787,HC IGG SUBCLASS 4,301,1 ,$41.00 ,$20.50 ,$5.90 ,$41.00 ,$5.90 ,$31.19 ,$26.73 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$5.90 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$5.90 ,$9.08 ,$36.90 ,$18.05 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$6.25 ,$9.62 ,$9.62 ,$13.94 ,$9.62 ,$8.02 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$26.94 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$26.94 ,$29.51 ,$131.40 ,$58.66 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$28.56 ,$31.28 ,$31.28 ,$49.64 ,$31.28 ,$26.07 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100307,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$213.00 ,$106.50 ,$39.91 ,$213.00 ,$39.91 ,$213.00 ,$213.00 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$39.91 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$39.91 ,$89.15 ,$191.70 ,$177.23 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$42.30 ,$94.52 ,$94.52 ,$72.42 ,$94.52 ,$78.77 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100308,82810,HC BLOOD GAS O2 SAT ONLY,301,1 ,$151.00 ,$75.50 ,$9.77 ,$151.00 ,$10.10 ,$34.20 ,$29.31 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 ,$10.10 ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 ,$10.10 ,$11.06 ,$135.90 ,$21.98 ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 ,$10.71 ,$11.72 ,$11.72 ,$51.34 ,$11.72 ,$9.77 ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100309,82941,HC GASTRIN,301,1 ,$101.00 ,$50.50 ,$17.63 ,$101.00 ,$18.22 ,$68.57 ,$58.77 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$18.22 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$18.22 ,$19.95 ,$90.90 ,$39.67 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$19.31 ,$21.16 ,$21.16 ,$34.34 ,$21.16 ,$17.63 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100310,82943,HC GLUCAGON PLASMA,301,1 ,$62.00 ,$31.00 ,$13.78 ,$62.00 ,$13.88 ,$55.58 ,$47.64 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$13.88 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$13.88 ,$16.17 ,$55.80 ,$32.15 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$14.71 ,$17.15 ,$17.15 ,$21.08 ,$17.15 ,$14.29 ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$54.00 ,$27.00 ,$3.93 ,$54.00 ,$4.06 ,$15.30 ,$13.11 ,$18.36 ,$43.20 ,$45.90 ,$33.75 ,$48.60 ,$4.06 ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$18.36 ,$45.90 ,$45.90 ,$48.60 ,$4.06 ,$4.45 ,$48.60 ,$8.84 ,$49.68 ,$48.60 ,$35.99 ,$35.99 ,$32.89 ,$35.99 ,$35.10 ,$37.61 ,$12.00 ,$42.66 ,$4.30 ,$4.72 ,$4.72 ,$18.36 ,$4.72 ,$3.93 ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100312,82947,HC GLUCOSE,301,1 ,$30.00 ,$15.00 ,$3.93 ,$30.00 ,$4.06 ,$15.30 ,$13.11 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 ,$4.06 ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 ,$4.06 ,$4.45 ,$27.00 ,$8.84 ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 ,$4.30 ,$4.72 ,$4.72 ,$10.20 ,$4.72 ,$3.93 ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100313,82950,HC GLUCOSE SCREEN,301,1 ,$90.00 ,$45.00 ,$4.75 ,$90.00 ,$4.91 ,$18.45 ,$15.81 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$4.91 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$4.91 ,$5.38 ,$81.00 ,$10.69 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$5.20 ,$5.70 ,$5.70 ,$30.60 ,$5.70 ,$4.75 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$112.00 ,$56.00 ,$12.87 ,$112.00 ,$13.30 ,$50.05 ,$42.90 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$13.30 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$13.30 ,$14.57 ,$100.80 ,$28.96 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$14.10 ,$15.44 ,$15.44 ,$38.08 ,$15.44 ,$12.87 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$31.00 ,$15.50 ,$3.92 ,$31.00 ,$4.05 ,$15.26 ,$13.08 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 ,$4.05 ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 ,$4.05 ,$4.44 ,$27.90 ,$8.82 ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 ,$4.29 ,$4.70 ,$4.70 ,$10.54 ,$4.70 ,$3.92 ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100316,82955,HC G6PD ENZYME QN,301,1 ,$431.00 ,$215.50 ,$9.70 ,$431.00 ,$10.02 ,$37.70 ,$32.31 ,$146.54 ,$344.80 ,$366.35 ,$269.38 ,$387.90 ,$10.02 ,$409.45 ,$387.90 ,$366.35 ,$366.35 ,$146.54 ,$366.35 ,$366.35 ,$387.90 ,$10.02 ,$10.98 ,$387.90 ,$21.83 ,$396.52 ,$387.90 ,$287.22 ,$287.22 ,$262.48 ,$287.22 ,$280.15 ,$300.19 ,$95.77 ,$340.49 ,$10.62 ,$11.64 ,$11.64 ,$146.54 ,$11.64 ,$9.70 ,$409.45 ,$353.42 ,$353.42 ,$344.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100317,82955,HC GLUCOSE 6 PHOS DEHYDROGN,301,1 ,$78.00 ,$39.00 ,$9.70 ,$78.00 ,$10.02 ,$37.70 ,$32.31 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.02 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.02 ,$10.98 ,$70.20 ,$21.83 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.62 ,$11.64 ,$11.64 ,$26.52 ,$11.64 ,$9.70 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100318,82962,HC GLUCOSE BY DEVICE,301,1 ,$19.00 ,$9.50 ,$3.28 ,$19.00 ,$3.30 ,$11.48 ,$9.84 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 ,$3.30 ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 ,$3.30 ,$3.71 ,$17.10 ,$7.38 ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 ,$3.50 ,$3.94 ,$3.94 ,$6.46 ,$3.94 ,$3.28 ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100319,82977,HC GGT/GGTP,301,1 ,$55.00 ,$27.50 ,$7.20 ,$55.00 ,$7.44 ,$28.00 ,$24.00 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 ,$7.44 ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 ,$7.44 ,$8.15 ,$49.50 ,$16.20 ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 ,$7.89 ,$8.64 ,$8.64 ,$18.70 ,$8.64 ,$7.20 ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100321,82985,HC FRUCTOSAMINE,301,1 ,$90.00 ,$45.00 ,$16.62 ,$90.00 ,$16.62 ,$58.66 ,$50.28 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$16.62 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$16.62 ,$18.97 ,$81.00 ,$37.71 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$17.62 ,$20.11 ,$20.11 ,$30.60 ,$20.11 ,$16.76 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100323,83001,HC FSH,301,1 ,$146.00 ,$73.00 ,$18.58 ,$146.00 ,$19.20 ,$72.28 ,$61.95 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.20 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.20 ,$21.03 ,$131.40 ,$41.81 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$20.35 ,$22.30 ,$22.30 ,$49.64 ,$22.30 ,$18.58 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100325,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$146.00 ,$73.00 ,$18.52 ,$146.00 ,$19.14 ,$72.00 ,$61.71 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.14 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.14 ,$20.96 ,$131.40 ,$41.67 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$20.29 ,$22.22 ,$22.22 ,$49.64 ,$22.22 ,$18.52 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100326,83003,HC GROWTH HORMONE,301,1 ,$101.00 ,$50.50 ,$16.67 ,$101.00 ,$17.23 ,$64.82 ,$55.56 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.23 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.23 ,$18.87 ,$90.90 ,$37.51 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.26 ,$20.00 ,$20.00 ,$34.34 ,$20.00 ,$16.67 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100327,83010,HC HAPTOGLOBIN,301,1 ,$101.00 ,$50.50 ,$12.58 ,$101.00 ,$13.00 ,$48.90 ,$41.91 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.00 ,$14.24 ,$90.90 ,$28.31 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$13.78 ,$15.10 ,$15.10 ,$34.34 ,$15.10 ,$12.58 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100328,83018,HC HEAVY METAL EACH,301,1 ,$123.00 ,$61.50 ,$21.96 ,$123.00 ,$22.69 ,$85.44 ,$73.23 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$22.69 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$22.69 ,$24.85 ,$110.70 ,$49.41 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$24.05 ,$26.35 ,$26.35 ,$41.82 ,$26.35 ,$21.96 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100329,83018,HC HEAVY METAL 24HR EACH,301,1 ,$123.00 ,$61.50 ,$21.96 ,$123.00 ,$22.69 ,$85.44 ,$73.23 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$22.69 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$22.69 ,$24.85 ,$110.70 ,$49.41 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$24.05 ,$26.35 ,$26.35 ,$41.82 ,$26.35 ,$21.96 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100331,83020,HC HGB ELECTROPHORESIS (MAYO),301,1 ,$99.00 ,$49.50 ,$6.41 ,$99.00 ,$6.41 ,$50.05 ,$42.90 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$6.41 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$6.41 ,$14.57 ,$89.10 ,$28.96 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$6.79 ,$15.44 ,$15.44 ,$33.66 ,$15.44 ,$12.87 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100334,83021,HC HEMOGLOBIN FRACT QN,301,1 ,$190.00 ,$95.00 ,$18.06 ,$190.00 ,$18.66 ,$70.21 ,$60.18 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$18.66 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$18.66 ,$20.44 ,$171.00 ,$40.64 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$19.78 ,$21.67 ,$21.67 ,$64.60 ,$21.67 ,$18.06 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$78.00 ,$39.00 ,$9.71 ,$78.00 ,$10.03 ,$37.77 ,$32.37 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.03 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.03 ,$10.99 ,$70.20 ,$21.85 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.63 ,$11.65 ,$11.65 ,$26.52 ,$11.65 ,$9.71 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100338,83050,HC METHEMOGLOBIN,301,1 ,$67.00 ,$33.50 ,$4.12 ,$67.00 ,$4.12 ,$28.70 ,$24.60 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$4.12 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$4.12 ,$9.28 ,$60.30 ,$18.45 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$4.37 ,$9.84 ,$9.84 ,$22.78 ,$9.84 ,$8.20 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100340,83051,HC HEMOGLOBIN PLASMA (MAYO),301,1 ,$58.00 ,$29.00 ,$4.90 ,$58.00 ,$4.90 ,$28.42 ,$24.36 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 ,$4.90 ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 ,$4.90 ,$8.27 ,$52.20 ,$16.45 ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 ,$5.19 ,$8.77 ,$8.77 ,$19.72 ,$8.77 ,$7.31 ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100343,83068,HC HEMOGLOBIN UNSTABLE,301,1 ,$121.00 ,$60.50 ,$9.47 ,$121.00 ,$9.79 ,$33.15 ,$28.41 ,$41.14 ,$96.80 ,$102.85 ,$75.63 ,$108.90 ,$9.79 ,$114.95 ,$108.90 ,$102.85 ,$102.85 ,$41.14 ,$102.85 ,$102.85 ,$108.90 ,$9.79 ,$10.72 ,$108.90 ,$21.31 ,$111.32 ,$108.90 ,$80.63 ,$80.63 ,$73.69 ,$80.63 ,$78.65 ,$84.28 ,$26.89 ,$95.59 ,$10.38 ,$11.36 ,$11.36 ,$41.14 ,$11.36 ,$9.47 ,$114.95 ,$99.22 ,$99.22 ,$96.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100344,83070,HC HEMOSIDERIN,301,1 ,$56.00 ,$28.00 ,$4.75 ,$56.00 ,$4.91 ,$18.45 ,$15.81 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$4.91 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$4.91 ,$5.38 ,$50.40 ,$10.69 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$5.20 ,$5.70 ,$5.70 ,$19.04 ,$5.70 ,$4.75 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100345,83088,HC HISTAMINE,301,1 ,$213.00 ,$106.50 ,$29.53 ,$213.00 ,$30.51 ,$114.84 ,$98.43 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$30.51 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$30.51 ,$33.42 ,$191.70 ,$66.44 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$32.34 ,$35.44 ,$35.44 ,$72.42 ,$35.44 ,$29.53 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100346,83090,HC HOMOCYSTEINE,301,1 ,$134.00 ,$67.00 ,$17.92 ,$134.00 ,$18.52 ,$65.59 ,$56.22 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.52 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.52 ,$20.28 ,$120.60 ,$40.32 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.63 ,$21.50 ,$21.50 ,$45.56 ,$21.50 ,$17.92 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100347,83150,HC HOMOVANILLIC ACID (HVA24),301,1 ,$112.00 ,$56.00 ,$19.62 ,$112.00 ,$19.62 ,$78.44 ,$67.23 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$19.62 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$19.62 ,$25.36 ,$100.80 ,$50.42 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$20.80 ,$26.89 ,$26.89 ,$38.08 ,$26.89 ,$22.41 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100349,83491,HC CORTICOSTEROIDS 17D,301,1 ,$125.00 ,$62.50 ,$17.90 ,$125.00 ,$18.50 ,$68.15 ,$58.41 ,$42.50 ,$100.00 ,$106.25 ,$78.13 ,$112.50 ,$18.50 ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$42.50 ,$106.25 ,$106.25 ,$112.50 ,$18.50 ,$20.26 ,$112.50 ,$40.28 ,$115.00 ,$112.50 ,$83.30 ,$83.30 ,$76.13 ,$83.30 ,$81.25 ,$87.06 ,$27.78 ,$98.75 ,$19.61 ,$21.48 ,$21.48 ,$42.50 ,$21.48 ,$17.90 ,$118.75 ,$102.50 ,$102.50 ,$100.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100350,83497,HC HYDROXYINDOLACET 5 (HIAA),301,1 ,$101.00 ,$50.50 ,$12.90 ,$101.00 ,$13.33 ,$50.16 ,$42.99 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.33 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.33 ,$14.60 ,$90.90 ,$29.03 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.13 ,$15.48 ,$15.48 ,$34.34 ,$15.48 ,$12.90 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100352,83498,HC HYDROXYPROGESTERONE 17D,301,1 ,$213.00 ,$106.50 ,$27.17 ,$213.00 ,$28.07 ,$105.67 ,$90.57 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$28.07 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$28.07 ,$30.75 ,$191.70 ,$61.13 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$29.75 ,$32.60 ,$32.60 ,$72.42 ,$32.60 ,$27.17 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100354,83505,HC HYDROXYPROLIN,301,1 ,$180.00 ,$90.00 ,$24.30 ,$180.00 ,$25.11 ,$94.54 ,$81.03 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$25.11 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$25.11 ,$27.50 ,$162.00 ,$54.68 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$26.62 ,$29.16 ,$29.16 ,$61.20 ,$29.16 ,$24.30 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100355,83516,HC IMMUNO QL/SQ MLT,301,1 ,$90.00 ,$45.00 ,$11.53 ,$90.00 ,$11.91 ,$44.84 ,$38.43 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$11.91 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$11.91 ,$13.05 ,$81.00 ,$25.94 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$12.62 ,$13.84 ,$13.84 ,$30.60 ,$13.84 ,$11.53 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100357,83516,HC HISTONE ANTIBODY,301,1 ,$101.00 ,$50.50 ,$11.53 ,$101.00 ,$11.91 ,$44.84 ,$38.43 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$11.91 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$11.91 ,$13.05 ,$90.90 ,$25.94 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$12.62 ,$13.84 ,$13.84 ,$34.34 ,$13.84 ,$11.53 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100358,83516,HC ACTIN AB,301,1 ,$80.00 ,$40.00 ,$11.53 ,$80.00 ,$11.91 ,$44.84 ,$38.43 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$11.91 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 ,$11.91 ,$13.05 ,$72.00 ,$25.94 ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 ,$12.62 ,$13.84 ,$13.84 ,$27.20 ,$13.84 ,$11.53 ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100359,83516,HC IMMUNO QL/SQ MLT (2),301,1 ,$83.00 ,$41.50 ,$11.53 ,$83.00 ,$11.91 ,$44.84 ,$38.43 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 ,$11.91 ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 ,$11.91 ,$13.05 ,$74.70 ,$25.94 ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 ,$12.62 ,$13.84 ,$13.84 ,$28.22 ,$13.84 ,$11.53 ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100363,83519,HC ACETYLCHOLINE RECEPTR AB,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.00 ,$20.83 ,$90.90 ,$41.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$34.34 ,$22.08 ,$18.40 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100365,83519,HC GAD 65 AB,301,1 ,$103.00 ,$51.50 ,$18.40 ,$103.00 ,$19.00 ,$64.40 ,$55.20 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$19.00 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$19.00 ,$20.83 ,$92.70 ,$41.40 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$20.14 ,$22.08 ,$22.08 ,$35.02 ,$22.08 ,$18.40 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100367,83519,HC PTH RELATED PROTEIN,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.00 ,$20.83 ,$90.90 ,$41.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$34.34 ,$22.08 ,$18.40 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100368,83519,HC NEOPTERIN,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.00 ,$20.83 ,$90.90 ,$41.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$34.34 ,$22.08 ,$18.40 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100369,83519,HC IGF BINDING PROTEIN,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.00 ,$20.83 ,$90.90 ,$41.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$34.34 ,$22.08 ,$18.40 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100370,83519,HC ACHR BINDING AB,301,1 ,$169.00 ,$84.50 ,$18.40 ,$169.00 ,$19.00 ,$64.40 ,$55.20 ,$57.46 ,$135.20 ,$143.65 ,$105.63 ,$152.10 ,$19.00 ,$160.55 ,$152.10 ,$143.65 ,$143.65 ,$57.46 ,$143.65 ,$143.65 ,$152.10 ,$19.00 ,$20.83 ,$152.10 ,$41.40 ,$155.48 ,$152.10 ,$112.62 ,$112.62 ,$102.92 ,$112.62 ,$109.85 ,$117.71 ,$37.55 ,$133.51 ,$20.14 ,$22.08 ,$22.08 ,$57.46 ,$22.08 ,$18.40 ,$160.55 ,$138.58 ,$138.58 ,$135.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100371,83519,HC MUSK ANTIBODY,301,1 ,$560.00 ,$280.00 ,$18.40 ,$560.00 ,$19.00 ,$64.40 ,$55.20 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$19.00 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$19.00 ,$20.83 ,$504.00 ,$41.40 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$20.14 ,$22.08 ,$22.08 ,$190.40 ,$22.08 ,$18.40 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100372,83519,HC ACEYTLCHOLINE RECPT AB (BK),301,1 ,$93.00 ,$46.50 ,$18.40 ,$93.00 ,$19.00 ,$64.40 ,$55.20 ,$31.62 ,$74.40 ,$79.05 ,$58.13 ,$83.70 ,$19.00 ,$88.35 ,$83.70 ,$79.05 ,$79.05 ,$31.62 ,$79.05 ,$79.05 ,$83.70 ,$19.00 ,$20.83 ,$83.70 ,$41.40 ,$85.56 ,$83.70 ,$61.98 ,$61.98 ,$56.64 ,$61.98 ,$60.45 ,$64.77 ,$20.66 ,$73.47 ,$20.14 ,$22.08 ,$22.08 ,$31.62 ,$22.08 ,$18.40 ,$88.35 ,$76.26 ,$76.26 ,$74.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100373,83519,HC ACEYTLCHOLINE RECPT AB (MD),301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.00 ,$20.83 ,$90.90 ,$41.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$34.34 ,$22.08 ,$18.40 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100375,80155,HC CAFFEINE,301,1 ,$180.00 ,$90.00 ,$15.44 ,$180.00 ,$15.44 ,$135.00 ,$115.71 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$15.44 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$15.44 ,$43.65 ,$162.00 ,$86.78 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$16.37 ,$46.28 ,$46.28 ,$61.20 ,$46.28 ,$38.57 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100376,83520,HC METHOTREXATE,301,1 ,$336.00 ,$168.00 ,$17.27 ,$336.00 ,$17.85 ,$60.45 ,$51.81 ,$114.24 ,$268.80 ,$285.60 ,$210.00 ,$302.40 ,$17.85 ,$319.20 ,$302.40 ,$285.60 ,$285.60 ,$114.24 ,$285.60 ,$285.60 ,$302.40 ,$17.85 ,$19.55 ,$302.40 ,$38.86 ,$309.12 ,$302.40 ,$223.91 ,$223.91 ,$204.62 ,$223.91 ,$218.40 ,$234.02 ,$74.66 ,$265.44 ,$18.92 ,$20.72 ,$20.72 ,$114.24 ,$20.72 ,$17.27 ,$319.20 ,$275.52 ,$275.52 ,$268.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100378,83520,HC C1 ESTERASE IHHIB FUNCTN,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.85 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.85 ,$19.55 ,$90.90 ,$38.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$34.34 ,$20.72 ,$17.27 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100379,83520,HC IMMUNOASSAY QN PROTEIN,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.85 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.85 ,$19.55 ,$90.90 ,$38.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$34.34 ,$20.72 ,$17.27 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100381,83520,HC C3 A,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.85 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.85 ,$19.55 ,$90.90 ,$38.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$34.34 ,$20.72 ,$17.27 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100384,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.85 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.85 ,$19.55 ,$90.90 ,$38.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$34.34 ,$20.72 ,$17.27 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100385,83520,HC CD ANTI GLIADIN,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$17.85 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$17.85 ,$19.55 ,$89.10 ,$38.86 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$33.66 ,$20.72 ,$17.27 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100386,83520,HC FIBROSPECT TIMP 1,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$17.85 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$17.85 ,$19.55 ,$89.10 ,$38.86 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$33.66 ,$20.72 ,$17.27 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100389,83520,HC TRYPTASE,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.85 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.85 ,$19.55 ,$90.90 ,$38.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$34.34 ,$20.72 ,$17.27 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100390,82397,HC INHIBIN B,301,1 ,$224.00 ,$112.00 ,$14.12 ,$224.00 ,$14.59 ,$54.92 ,$47.07 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$14.59 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$14.59 ,$15.98 ,$201.60 ,$31.77 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$15.47 ,$16.94 ,$16.94 ,$76.16 ,$16.94 ,$14.12 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100392,83525,HC INSULIN TOTAL,301,1 ,$78.00 ,$39.00 ,$11.43 ,$78.00 ,$11.81 ,$44.45 ,$38.10 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$11.81 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$11.81 ,$12.94 ,$70.20 ,$25.72 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$12.52 ,$13.72 ,$13.72 ,$26.52 ,$13.72 ,$11.43 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100393,83540,HC IRON TOTAL,301,1 ,$49.00 ,$24.50 ,$6.47 ,$49.00 ,$6.69 ,$25.17 ,$21.57 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 ,$6.69 ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 ,$6.69 ,$7.32 ,$44.10 ,$14.56 ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 ,$7.09 ,$7.76 ,$7.76 ,$16.66 ,$7.76 ,$6.47 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$67.00 ,$33.50 ,$8.74 ,$67.00 ,$9.03 ,$33.99 ,$29.13 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$9.03 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$9.03 ,$9.89 ,$60.30 ,$19.67 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.57 ,$10.49 ,$10.49 ,$22.78 ,$10.49 ,$8.74 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100395,83586,HC KETOSTEROIDS (17-KS),301,1 ,$92.00 ,$46.00 ,$12.80 ,$92.00 ,$13.23 ,$49.77 ,$42.66 ,$31.28 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$13.23 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$31.28 ,$78.20 ,$78.20 ,$82.80 ,$13.23 ,$14.49 ,$82.80 ,$28.80 ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 ,$14.02 ,$15.36 ,$15.36 ,$31.28 ,$15.36 ,$12.80 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$90.00 ,$45.00 ,$11.57 ,$90.00 ,$11.96 ,$41.55 ,$35.61 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$11.96 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$11.96 ,$13.09 ,$81.00 ,$26.03 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$12.68 ,$13.88 ,$13.88 ,$30.60 ,$13.88 ,$11.57 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$49.00 ,$24.50 ,$6.04 ,$49.00 ,$6.24 ,$23.49 ,$20.13 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 ,$6.24 ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 ,$6.24 ,$6.84 ,$44.10 ,$13.59 ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 ,$6.61 ,$7.25 ,$7.25 ,$16.66 ,$7.25 ,$6.04 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100399,83625,HC LDH ISOENZYMES,301,1 ,$78.00 ,$39.00 ,$12.79 ,$78.00 ,$13.22 ,$49.77 ,$42.66 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$13.22 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$13.22 ,$14.48 ,$70.20 ,$28.78 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$14.01 ,$15.35 ,$15.35 ,$26.52 ,$15.35 ,$12.79 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100401,83655,HC LEAD,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.51 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.51 ,$13.71 ,$81.00 ,$27.25 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$30.60 ,$14.53 ,$12.11 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100402,83655,HC LEAD BLOOD HMP,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.51 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.51 ,$13.71 ,$81.00 ,$27.25 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$30.60 ,$14.53 ,$12.11 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100404,83655,HC LEAD URINE,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.51 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.51 ,$13.71 ,$81.00 ,$27.25 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$30.60 ,$14.53 ,$12.11 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100406,83655,HC LEAD 24HR URINE,301,1 ,$90.00 ,$45.00 ,$12.11 ,$90.00 ,$12.51 ,$47.08 ,$40.35 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.51 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.51 ,$13.71 ,$81.00 ,$27.25 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.26 ,$14.53 ,$14.53 ,$30.60 ,$14.53 ,$12.11 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100408,83663,HC FETAL LUNG MATURITY,301,1 ,$541.00 ,$270.50 ,$13.65 ,$541.00 ,$13.65 ,$73.54 ,$63.03 ,$183.94 ,$432.80 ,$459.85 ,$338.13 ,$486.90 ,$13.65 ,$513.95 ,$486.90 ,$459.85 ,$459.85 ,$183.94 ,$459.85 ,$459.85 ,$486.90 ,$13.65 ,$21.40 ,$486.90 ,$42.55 ,$497.72 ,$486.90 ,$360.52 ,$360.52 ,$329.47 ,$360.52 ,$351.65 ,$376.81 ,$120.21 ,$427.39 ,$14.47 ,$22.69 ,$22.69 ,$183.94 ,$22.69 ,$18.91 ,$513.95 ,$443.62 ,$443.62 ,$432.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100409,83690,HC LIPASE,301,1 ,$78.00 ,$39.00 ,$6.89 ,$78.00 ,$7.12 ,$26.78 ,$22.95 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$7.12 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$7.12 ,$7.80 ,$70.20 ,$15.50 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$7.55 ,$8.27 ,$8.27 ,$26.52 ,$8.27 ,$6.89 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100410,83695,HC LIPOPROTEIN,301,1 ,$78.00 ,$39.00 ,$14.32 ,$78.00 ,$14.80 ,$50.37 ,$43.17 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$14.80 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$14.80 ,$16.21 ,$70.20 ,$32.22 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$15.69 ,$17.18 ,$17.18 ,$26.52 ,$17.18 ,$14.32 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100414,83704,HC NMR LIPOPROFILE LIP,301,1 ,$129.00 ,$64.50 ,$28.66 ,$129.00 ,$35.33 ,$122.71 ,$105.18 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 ,$35.33 ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 ,$35.33 ,$38.70 ,$116.10 ,$76.93 ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 ,$37.45 ,$41.03 ,$41.03 ,$43.86 ,$41.03 ,$34.19 ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100415,83718,HC CHOLESTEROL HDL,301,1 ,$67.00 ,$33.50 ,$8.19 ,$67.00 ,$8.46 ,$31.85 ,$27.30 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.46 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.46 ,$9.27 ,$60.30 ,$18.43 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.97 ,$9.83 ,$9.83 ,$22.78 ,$9.83 ,$8.19 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100416,83721,HC CHOLESTEROL LDL,301,1 ,$78.00 ,$39.00 ,$10.50 ,$78.00 ,$10.85 ,$37.10 ,$31.80 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.85 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.85 ,$11.88 ,$70.20 ,$23.63 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.50 ,$12.60 ,$12.60 ,$26.52 ,$12.60 ,$10.50 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100417,83735,HC MAGNESIUM,301,1 ,$52.00 ,$26.00 ,$6.70 ,$52.00 ,$6.92 ,$26.04 ,$22.32 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$6.92 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$6.92 ,$7.58 ,$46.80 ,$15.08 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$7.34 ,$8.04 ,$8.04 ,$17.68 ,$8.04 ,$6.70 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100418,83785,HC MANGANESE (MAYO),301,1 ,$157.00 ,$78.50 ,$26.65 ,$157.00 ,$27.54 ,$95.66 ,$81.99 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$27.54 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$27.54 ,$30.16 ,$141.30 ,$59.96 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$29.19 ,$31.98 ,$31.98 ,$53.38 ,$31.98 ,$26.65 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100419,83785,HC MANGANESE,301,1 ,$157.00 ,$78.50 ,$26.65 ,$157.00 ,$27.54 ,$95.66 ,$81.99 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$27.54 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$27.54 ,$30.16 ,$141.30 ,$59.96 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$29.19 ,$31.98 ,$31.98 ,$53.38 ,$31.98 ,$26.65 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100421,82542,HC BILE ACIDS,301,1 ,$314.00 ,$157.00 ,$24.09 ,$314.00 ,$24.89 ,$84.32 ,$72.27 ,$106.76 ,$251.20 ,$266.90 ,$196.25 ,$282.60 ,$24.89 ,$298.30 ,$282.60 ,$266.90 ,$266.90 ,$106.76 ,$266.90 ,$266.90 ,$282.60 ,$24.89 ,$27.27 ,$282.60 ,$54.20 ,$288.88 ,$282.60 ,$209.25 ,$209.25 ,$191.23 ,$209.25 ,$204.10 ,$218.70 ,$69.77 ,$248.06 ,$26.38 ,$28.91 ,$28.91 ,$106.76 ,$28.91 ,$24.09 ,$298.30 ,$257.48 ,$257.48 ,$251.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100423,G0480,HC ETHYL GLUCUR/SULFATE,301,1 ,$180.00 ,$90.00 ,$40.00 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$63.95 ,$129.51 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$61.20 ,$137.32 ,$114.43 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100424,80183,HC TRILEPTAL,301,1 ,$100.00 ,$50.00 ,$13.25 ,$100.00 ,$13.69 ,$51.56 ,$44.19 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$13.69 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$13.69 ,$15.00 ,$90.00 ,$29.81 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$34.00 ,$15.90 ,$13.25 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100428,83825,HC MERCURY BLOOD,301,1 ,$101.00 ,$50.50 ,$16.26 ,$101.00 ,$16.80 ,$63.21 ,$54.18 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$16.80 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$16.80 ,$18.40 ,$90.90 ,$36.59 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$17.81 ,$19.51 ,$19.51 ,$34.34 ,$19.51 ,$16.26 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100429,83825,HC MERCURY 24HR URINE,301,1 ,$101.00 ,$50.50 ,$16.26 ,$101.00 ,$16.80 ,$63.21 ,$54.18 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$16.80 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$16.80 ,$18.40 ,$90.90 ,$36.59 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$17.81 ,$19.51 ,$19.51 ,$34.34 ,$19.51 ,$16.26 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100430,83835,HC METANEPHRINES,301,1 ,$134.00 ,$67.00 ,$16.94 ,$134.00 ,$17.50 ,$65.87 ,$56.46 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$17.50 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$17.50 ,$19.17 ,$120.60 ,$38.12 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$18.55 ,$20.33 ,$20.33 ,$45.56 ,$20.33 ,$16.94 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100431,83835,HC METANEPHRINES PLASMA,301,1 ,$134.00 ,$67.00 ,$16.94 ,$134.00 ,$17.50 ,$65.87 ,$56.46 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$17.50 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$17.50 ,$19.17 ,$120.60 ,$38.12 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$18.55 ,$20.33 ,$20.33 ,$45.56 ,$20.33 ,$16.94 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100432,83835,HC METANEPHRINES RANDM URINE,301,1 ,$134.00 ,$67.00 ,$16.94 ,$134.00 ,$17.50 ,$65.87 ,$56.46 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$17.50 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$17.50 ,$19.17 ,$120.60 ,$38.12 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$18.55 ,$20.33 ,$20.33 ,$45.56 ,$20.33 ,$16.94 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100433,80358,HC METHADONE,301,1 ,$210.00 ,$105.00 ,$8.59 ,$210.00 ,$8.59 ,$80.88 ,$69.32 ,$71.40 ,$168.00 ,$178.50 ,$131.25 ,$189.00 ,$8.59 ,$199.50 ,$189.00 ,$178.50 ,$178.50 ,$71.40 ,$178.50 ,$178.50 ,$189.00 ,$8.59 ,$88.20 ,$189.00 , N/A ,$193.20 ,$189.00 ,$139.94 ,$139.94 ,$127.89 ,$139.94 ,$136.50 ,$146.27 ,$46.66 ,$165.90 ,$9.11 , N/A , N/A ,$71.40 , N/A , N/A ,$199.50 ,$172.20 ,$172.20 ,$168.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100434,83873,HC MYELIN BASIC PROTEIN,301,1 ,$112.00 ,$56.00 ,$17.20 ,$112.00 ,$17.77 ,$66.92 ,$57.36 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$17.77 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$17.77 ,$19.47 ,$100.80 ,$38.70 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$18.84 ,$20.64 ,$20.64 ,$38.08 ,$20.64 ,$17.20 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100435,83874,HC MYOGLOBIN,301,1 ,$112.00 ,$56.00 ,$12.92 ,$112.00 ,$13.35 ,$50.23 ,$43.05 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$13.35 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$13.35 ,$14.62 ,$100.80 ,$29.07 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$14.15 ,$15.50 ,$15.50 ,$38.08 ,$15.50 ,$12.92 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100436,83874,HC MYOGLOBIN URINE,301,1 ,$112.00 ,$56.00 ,$12.92 ,$112.00 ,$13.35 ,$50.23 ,$43.05 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$13.35 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$13.35 ,$14.62 ,$100.80 ,$29.07 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$14.15 ,$15.50 ,$15.50 ,$38.08 ,$15.50 ,$12.92 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$258.00 ,$129.00 ,$39.26 ,$258.00 ,$40.57 ,$137.41 ,$117.78 ,$87.72 ,$206.40 ,$219.30 ,$161.25 ,$232.20 ,$40.57 ,$245.10 ,$232.20 ,$219.30 ,$219.30 ,$87.72 ,$219.30 ,$219.30 ,$232.20 ,$40.57 ,$44.43 ,$232.20 ,$88.34 ,$237.36 ,$232.20 ,$171.93 ,$171.93 ,$157.12 ,$171.93 ,$167.70 ,$179.70 ,$57.33 ,$203.82 ,$43.00 ,$47.11 ,$47.11 ,$87.72 ,$47.11 ,$39.26 ,$245.10 ,$211.56 ,$211.56 ,$206.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100439,83883,HC NEPHELOMETRY EA ANALYTE,301,1 ,$101.00 ,$50.50 ,$13.60 ,$101.00 ,$14.05 ,$52.89 ,$45.33 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.05 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.05 ,$15.39 ,$90.90 ,$30.60 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.89 ,$16.32 ,$16.32 ,$34.34 ,$16.32 ,$13.60 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100440,83883,HC NEPHELOMETRY EA AN (MAYO),301,1 ,$101.00 ,$50.50 ,$13.60 ,$101.00 ,$14.05 ,$52.89 ,$45.33 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.05 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.05 ,$15.39 ,$90.90 ,$30.60 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.89 ,$16.32 ,$16.32 ,$34.34 ,$16.32 ,$13.60 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100445,G0480,HC NICOTINE W/METABOLITE,301,1 ,$120.00 ,$60.00 ,$26.66 ,$257.47 ,$63.95 ,$120.00 ,$120.00 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$63.95 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 ,$63.95 ,$120.00 ,$108.00 ,$257.47 ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 ,$67.79 ,$120.00 ,$120.00 ,$40.80 ,$120.00 ,$114.43 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100460,84311,HC FUNGITELL (1-3)-B-D-GLUCAN,301,1 ,$24.00 ,$12.00 ,$5.33 ,$24.00 ,$8.37 ,$24.00 ,$24.00 ,$8.16 ,$19.20 ,$20.40 ,$15.00 ,$21.60 ,$8.37 ,$22.80 ,$21.60 ,$20.40 ,$20.40 ,$8.16 ,$20.40 ,$20.40 ,$21.60 ,$8.37 ,$9.17 ,$21.60 ,$18.23 ,$22.08 ,$21.60 ,$15.99 ,$15.99 ,$14.62 ,$15.99 ,$15.60 ,$16.72 ,$5.33 ,$18.96 ,$8.87 ,$9.72 ,$9.72 ,$8.16 ,$9.72 ,$8.10 ,$22.80 ,$19.68 ,$19.68 ,$19.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100486,80165,HC VALPROIC ACID FREE,301,1 ,$72.00 ,$36.00 ,$13.54 ,$72.00 ,$13.99 ,$52.68 ,$45.15 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 ,$13.99 ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 ,$13.99 ,$15.32 ,$64.80 ,$30.47 ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 ,$14.83 ,$16.25 ,$16.25 ,$24.48 ,$16.25 ,$13.54 ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100660,83915,HC NUCLEOTIDASE,301,1 ,$146.00 ,$73.00 ,$11.15 ,$146.00 ,$11.52 ,$43.37 ,$37.17 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$11.52 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$11.52 ,$12.62 ,$131.40 ,$25.09 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$12.21 ,$13.38 ,$13.38 ,$49.64 ,$13.38 ,$11.15 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100661,83916,HC OLIGOCLONAL BANDS,301,1 ,$146.00 ,$73.00 ,$27.39 ,$146.00 ,$28.28 ,$95.87 ,$82.17 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$28.28 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$28.28 ,$31.00 ,$131.40 ,$61.63 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$29.98 ,$32.87 ,$32.87 ,$49.64 ,$32.87 ,$27.39 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100662,83918,HC ORGANIC ACIDS QD,301,1 ,$661.00 ,$330.50 ,$23.14 ,$661.00 ,$23.14 ,$82.60 ,$70.80 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$23.14 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$23.14 ,$26.71 ,$594.90 ,$53.10 ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 ,$146.87 ,$522.19 ,$24.53 ,$28.32 ,$28.32 ,$224.74 ,$28.32 ,$23.60 ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100664,83918,HC ORGANIC ACIDS URINE,301,1 ,"$1,185.00 ",$592.50 ,$23.14 ,"$1,185.00 ",$23.14 ,$82.60 ,$70.80 ,$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ",$23.14 ,"$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ",$23.14 ,$26.71 ,"$1,066.50 ",$53.10 ,"$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,$24.53 ,$28.32 ,$28.32 ,$402.90 ,$28.32 ,$23.60 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100666,83921,HC ORGANIC ACID SNG QN (MEHTYL),301,1 ,$123.00 ,$61.50 ,$21.21 ,$123.00 ,$21.92 ,$74.24 ,$63.63 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$21.92 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$21.92 ,$24.01 ,$110.70 ,$47.72 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$23.24 ,$25.45 ,$25.45 ,$41.82 ,$25.45 ,$21.21 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100667,80364,HC OPIATES EXP,301,1 ,$37.00 ,$18.50 ,$8.22 ,$37.00 ,$8.59 ,$31.30 ,$31.30 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 ,$8.59 ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 ,$8.59 ,$15.54 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 ,$9.11 , N/A , N/A ,$12.58 , N/A , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100668,83930,HC OSMOLALITY BLOOD,301,1 ,$50.00 ,$25.00 ,$6.61 ,$50.00 ,$6.83 ,$25.73 ,$22.05 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$6.83 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$6.83 ,$7.48 ,$45.00 ,$14.87 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$7.24 ,$7.93 ,$7.93 ,$17.00 ,$7.93 ,$6.61 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100669,83935,HC OSMOLALITY URINE,301,1 ,$53.00 ,$26.50 ,$6.82 ,$53.00 ,$7.05 ,$26.50 ,$22.71 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$7.05 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$7.05 ,$7.72 ,$47.70 ,$15.35 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$7.47 ,$8.18 ,$8.18 ,$18.02 ,$8.18 ,$6.82 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$314.00 ,$157.00 ,$41.28 ,$314.00 ,$42.65 ,$160.51 ,$137.58 ,$106.76 ,$251.20 ,$266.90 ,$196.25 ,$282.60 ,$42.65 ,$298.30 ,$282.60 ,$266.90 ,$266.90 ,$106.76 ,$266.90 ,$266.90 ,$282.60 ,$42.65 ,$46.72 ,$282.60 ,$92.88 ,$288.88 ,$282.60 ,$209.25 ,$209.25 ,$191.23 ,$209.25 ,$204.10 ,$218.70 ,$69.77 ,$248.06 ,$45.21 ,$49.54 ,$49.54 ,$106.76 ,$49.54 ,$41.28 ,$298.30 ,$257.48 ,$257.48 ,$251.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100673,83986,HC PH BODY FLUID,301,1 ,$27.00 ,$13.50 ,$3.58 ,$27.00 ,$3.70 ,$13.93 ,$11.94 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 ,$3.70 ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 ,$3.70 ,$4.05 ,$24.30 ,$8.06 ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 ,$3.92 ,$4.30 ,$4.30 ,$9.18 ,$4.30 ,$3.58 ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100674,83986,HC PH BODY FLUID (FECES),301,1 ,$27.00 ,$13.50 ,$3.58 ,$27.00 ,$3.70 ,$13.93 ,$11.94 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 ,$3.70 ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 ,$3.70 ,$4.05 ,$24.30 ,$8.06 ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 ,$3.92 ,$4.30 ,$4.30 ,$9.18 ,$4.30 ,$3.58 ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100675,83992,HC PHENCYCLIDINE (PCP),301,1 ,$112.00 ,$56.00 ,$20.67 ,$112.00 ,$20.67 ,$112.00 ,$112.00 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$20.67 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$20.67 ,$47.04 ,$100.80 , N/A ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$21.91 ,$51.97 ,$51.97 ,$38.08 ,$51.97 , N/A ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100677,84060,HC ACID PHOSPHATASE,301,1 ,$104.00 ,$52.00 ,$7.64 ,$104.00 ,$7.89 ,$28.74 ,$24.63 ,$35.36 ,$83.20 ,$88.40 ,$65.00 ,$93.60 ,$7.89 ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$35.36 ,$88.40 ,$88.40 ,$93.60 ,$7.89 ,$8.65 ,$93.60 ,$17.19 ,$95.68 ,$93.60 ,$69.31 ,$69.31 ,$63.34 ,$69.31 ,$67.60 ,$72.44 ,$23.11 ,$82.16 ,$8.36 ,$9.17 ,$9.17 ,$35.36 ,$9.17 ,$7.64 ,$98.80 ,$85.28 ,$85.28 ,$83.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$28.00 ,$14.00 ,$5.18 ,$28.00 ,$5.35 ,$20.13 ,$17.25 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 ,$5.35 ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 ,$5.35 ,$5.86 ,$25.20 ,$11.66 ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 ,$5.67 ,$6.22 ,$6.22 ,$9.52 ,$6.22 ,$5.18 ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100681,84080,HC ALK PHOS ISOENZ,301,1 ,$112.00 ,$56.00 ,$14.78 ,$112.00 ,$15.27 ,$57.51 ,$49.29 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.27 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.27 ,$16.73 ,$100.80 ,$33.26 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.19 ,$17.74 ,$17.74 ,$38.08 ,$17.74 ,$14.78 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100682,84081,HC PHOSPHATIDYLYCEROL (PG),301,1 ,$436.00 ,$218.00 ,$16.52 ,$436.00 ,$17.07 ,$64.23 ,$55.05 ,$148.24 ,$348.80 ,$370.60 ,$272.50 ,$392.40 ,$17.07 ,$414.20 ,$392.40 ,$370.60 ,$370.60 ,$148.24 ,$370.60 ,$370.60 ,$392.40 ,$17.07 ,$18.70 ,$392.40 ,$37.17 ,$401.12 ,$392.40 ,$290.55 ,$290.55 ,$265.52 ,$290.55 ,$283.40 ,$303.67 ,$96.88 ,$344.44 ,$18.09 ,$19.82 ,$19.82 ,$148.24 ,$19.82 ,$16.52 ,$414.20 ,$357.52 ,$357.52 ,$348.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100684,84100,HC PHOSPHORUS,301,1 ,$36.00 ,$18.00 ,$4.74 ,$36.00 ,$4.90 ,$18.45 ,$15.81 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 ,$4.90 ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 ,$4.90 ,$5.36 ,$32.40 ,$10.67 ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 ,$5.19 ,$5.69 ,$5.69 ,$12.24 ,$5.69 ,$4.74 ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100685,84105,HC PHOSPHORUS URINE,301,1 ,$39.00 ,$19.50 ,$5.78 ,$39.00 ,$5.97 ,$20.23 ,$17.34 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$5.97 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$5.97 ,$6.54 ,$35.10 ,$13.01 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$6.33 ,$6.94 ,$6.94 ,$13.26 ,$6.94 ,$5.78 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100687,84110,HC PORPHOBILINOGEN QN (24),301,1 ,$67.00 ,$33.50 ,$8.44 ,$67.00 ,$8.72 ,$32.83 ,$28.14 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.72 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.72 ,$9.55 ,$60.30 ,$18.99 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.24 ,$10.13 ,$10.13 ,$22.78 ,$10.13 ,$8.44 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100689,84120,HC PORPHYRINS QN FRACT,301,1 ,$134.00 ,$67.00 ,$14.71 ,$134.00 ,$15.20 ,$57.23 ,$49.05 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$15.20 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$15.20 ,$16.65 ,$120.60 ,$33.10 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$16.11 ,$17.65 ,$17.65 ,$45.56 ,$17.65 ,$14.71 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100690,84120,HC PORPHYRINS QN FRACT RNDM,301,1 ,$168.00 ,$84.00 ,$14.71 ,$168.00 ,$15.20 ,$57.23 ,$49.05 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$15.20 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$15.20 ,$16.65 ,$151.20 ,$33.10 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$16.11 ,$17.65 ,$17.65 ,$57.12 ,$17.65 ,$14.71 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100691,84132,HC POTASSIUM,301,1 ,$35.00 ,$17.50 ,$4.76 ,$35.00 ,$4.92 ,$17.89 ,$15.33 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$4.92 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 ,$4.92 ,$5.39 ,$31.50 ,$10.71 ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 ,$5.22 ,$5.71 ,$5.71 ,$11.90 ,$5.71 ,$4.76 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100694,84133,HC POTASSIUM URINE,301,1 ,$32.00 ,$16.00 ,$4.73 ,$32.00 ,$4.89 ,$16.77 ,$14.37 ,$10.88 ,$25.60 ,$27.20 ,$20.00 ,$28.80 ,$4.89 ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$10.88 ,$27.20 ,$27.20 ,$28.80 ,$4.89 ,$5.35 ,$28.80 ,$10.64 ,$29.44 ,$28.80 ,$21.32 ,$21.32 ,$19.49 ,$21.32 ,$20.80 ,$22.29 ,$7.11 ,$25.28 ,$5.18 ,$5.68 ,$5.68 ,$10.88 ,$5.68 ,$4.73 ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100695,84134,HC PREALBUMIN,301,1 ,$50.00 ,$25.00 ,$7.85 ,$50.00 ,$7.85 ,$50.00 ,$48.63 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$7.85 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$7.85 ,$16.51 ,$45.00 ,$32.83 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$8.32 ,$17.51 ,$17.51 ,$17.00 ,$17.51 ,$14.59 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100696,84144,HC PROGESTERONE,301,1 ,$146.00 ,$73.00 ,$20.86 ,$146.00 ,$21.55 ,$81.13 ,$69.54 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$21.55 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$21.55 ,$23.61 ,$131.40 ,$46.94 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$22.84 ,$25.03 ,$25.03 ,$49.64 ,$25.03 ,$20.86 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100697,84146,HC PROLACTIN,301,1 ,$146.00 ,$73.00 ,$19.38 ,$146.00 ,$20.03 ,$75.36 ,$64.59 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$20.03 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$20.03 ,$21.93 ,$131.40 ,$43.61 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$21.23 ,$23.26 ,$23.26 ,$49.64 ,$23.26 ,$19.38 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100698,84153,HC PSA TOTAL,301,1 ,$146.00 ,$73.00 ,$18.39 ,$146.00 ,$19.00 ,$71.54 ,$61.32 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.00 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.00 ,$20.81 ,$131.40 ,$41.38 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$20.14 ,$22.07 ,$22.07 ,$49.64 ,$22.07 ,$18.39 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100699,84154,HC PSA FREE,301,1 ,$146.00 ,$73.00 ,$18.39 ,$146.00 ,$19.00 ,$71.54 ,$61.32 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.00 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.00 ,$20.81 ,$131.40 ,$41.38 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$20.14 ,$22.07 ,$22.07 ,$49.64 ,$22.07 ,$18.39 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100700,84155,HC PROTEIN TOTAL,301,1 ,$29.00 ,$14.50 ,$3.67 ,$29.00 ,$3.79 ,$14.25 ,$12.21 ,$9.86 ,$23.20 ,$24.65 ,$18.13 ,$26.10 ,$3.79 ,$27.55 ,$26.10 ,$24.65 ,$24.65 ,$9.86 ,$24.65 ,$24.65 ,$26.10 ,$3.79 ,$4.15 ,$26.10 ,$8.26 ,$26.68 ,$26.10 ,$19.33 ,$19.33 ,$17.66 ,$19.33 ,$18.85 ,$20.20 ,$6.44 ,$22.91 ,$4.02 ,$4.40 ,$4.40 ,$9.86 ,$4.40 ,$3.67 ,$27.55 ,$23.78 ,$23.78 ,$23.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$35.00 ,$17.50 ,$3.67 ,$35.00 ,$3.79 ,$14.25 ,$12.21 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$3.79 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 ,$3.79 ,$4.15 ,$31.50 ,$8.26 ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 ,$4.02 ,$4.40 ,$4.40 ,$11.90 ,$4.40 ,$3.67 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100702,84156,HC PROTEIN TOTAL 24HR URINE,301,1 ,$28.00 ,$14.00 ,$3.67 ,$28.00 ,$3.79 ,$14.25 ,$12.21 ,$9.52 ,$22.40 ,$23.80 ,$17.50 ,$25.20 ,$3.79 ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$9.52 ,$23.80 ,$23.80 ,$25.20 ,$3.79 ,$4.15 ,$25.20 ,$8.26 ,$25.76 ,$25.20 ,$18.66 ,$18.66 ,$17.05 ,$18.66 ,$18.20 ,$19.50 ,$6.22 ,$22.12 ,$4.02 ,$4.40 ,$4.40 ,$9.52 ,$4.40 ,$3.67 ,$26.60 ,$22.96 ,$22.96 ,$22.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$53.00 ,$26.50 ,$4.00 ,$53.00 ,$4.13 ,$14.25 ,$12.21 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$4.13 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$4.13 ,$4.53 ,$47.70 ,$9.00 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$4.38 ,$4.80 ,$4.80 ,$18.02 ,$4.80 ,$4.00 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100704,84157,HC PROTEIN TOTAL SPINAL FLUID,301,1 ,$53.00 ,$26.50 ,$4.00 ,$53.00 ,$4.13 ,$14.25 ,$12.21 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$4.13 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$4.13 ,$4.53 ,$47.70 ,$9.00 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$4.38 ,$4.80 ,$4.80 ,$18.02 ,$4.80 ,$4.00 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100705,84165,HC PROTEIN ELECTROPHORESIS,301,1 ,$78.00 ,$39.00 ,$10.74 ,$78.00 ,$11.10 ,$41.76 ,$35.79 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$11.10 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$11.10 ,$12.16 ,$70.20 ,$24.17 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.77 ,$12.89 ,$12.89 ,$26.52 ,$12.89 ,$10.74 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100706,84166,HC PROTEIN EP OTH FLUID,301,1 ,$134.00 ,$67.00 ,$17.83 ,$134.00 ,$18.42 ,$69.34 ,$59.43 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.42 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.42 ,$20.18 ,$120.60 ,$40.12 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.53 ,$21.40 ,$21.40 ,$45.56 ,$21.40 ,$17.83 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100709,84202,HC PROTOPORPHYRIN,301,1 ,$90.00 ,$45.00 ,$14.35 ,$90.00 ,$14.83 ,$55.79 ,$47.82 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$14.83 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$14.83 ,$16.24 ,$81.00 ,$32.29 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$15.72 ,$17.22 ,$17.22 ,$30.60 ,$17.22 ,$14.35 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100710,84206,HC PROINSULIN,301,1 ,$291.00 ,$145.50 ,$25.05 ,$291.00 ,$25.05 ,$93.42 ,$80.07 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$25.05 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$25.05 ,$30.21 ,$261.90 ,$60.05 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$26.55 ,$32.03 ,$32.03 ,$98.94 ,$32.03 ,$26.69 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100711,84207,HC VITAMIN B6,301,1 ,$213.00 ,$106.50 ,$28.10 ,$213.00 ,$29.04 ,$109.27 ,$93.66 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$29.04 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$29.04 ,$31.80 ,$191.70 ,$63.23 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$30.78 ,$33.72 ,$33.72 ,$72.42 ,$33.72 ,$28.10 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100712,84210,HC PYRUVATE,301,1 ,$112.00 ,$56.00 ,$14.48 ,$112.00 ,$14.96 ,$50.68 ,$43.44 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.96 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.96 ,$16.39 ,$100.80 ,$32.58 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.86 ,$17.38 ,$17.38 ,$38.08 ,$17.38 ,$14.48 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100713,84220,HC PYRUVATE KINASE,301,1 ,$227.00 ,$113.50 ,$9.44 ,$227.00 ,$9.75 ,$36.72 ,$31.47 ,$77.18 ,$181.60 ,$192.95 ,$141.88 ,$204.30 ,$9.75 ,$215.65 ,$204.30 ,$192.95 ,$192.95 ,$77.18 ,$192.95 ,$192.95 ,$204.30 ,$9.75 ,$10.68 ,$204.30 ,$21.24 ,$208.84 ,$204.30 ,$151.27 ,$151.27 ,$138.24 ,$151.27 ,$147.55 ,$158.11 ,$50.44 ,$179.33 ,$10.34 ,$11.33 ,$11.33 ,$77.18 ,$11.33 ,$9.44 ,$215.65 ,$186.14 ,$186.14 ,$181.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100715,84244,HC RENIN,301,1 ,$168.00 ,$84.00 ,$21.99 ,$168.00 ,$22.72 ,$85.54 ,$73.32 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$22.72 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$22.72 ,$24.89 ,$151.20 ,$49.48 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$24.08 ,$26.39 ,$26.39 ,$57.12 ,$26.39 ,$21.99 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100717,84255,HC SELENIUM,301,1 ,$190.00 ,$95.00 ,$25.53 ,$190.00 ,$26.38 ,$99.30 ,$85.11 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$26.38 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$26.38 ,$28.89 ,$171.00 ,$57.44 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$27.96 ,$30.64 ,$30.64 ,$64.60 ,$30.64 ,$25.53 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100718,84260,HC SEROTONIN,301,1 ,$190.00 ,$95.00 ,$30.98 ,$190.00 ,$32.01 ,$120.51 ,$103.29 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$32.01 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$32.01 ,$35.06 ,$171.00 ,$69.71 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$33.93 ,$37.18 ,$37.18 ,$64.60 ,$37.18 ,$30.98 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100719,84260,HC SEROTONIN WHOLE BLOOD,301,1 ,$228.00 ,$114.00 ,$30.98 ,$228.00 ,$32.01 ,$120.51 ,$103.29 ,$77.52 ,$182.40 ,$193.80 ,$142.50 ,$205.20 ,$32.01 ,$216.60 ,$205.20 ,$193.80 ,$193.80 ,$77.52 ,$193.80 ,$193.80 ,$205.20 ,$32.01 ,$35.06 ,$205.20 ,$69.71 ,$209.76 ,$205.20 ,$151.94 ,$151.94 ,$138.85 ,$151.94 ,$148.20 ,$158.80 ,$50.66 ,$180.12 ,$33.93 ,$37.18 ,$37.18 ,$77.52 ,$37.18 ,$30.98 ,$216.60 ,$186.96 ,$186.96 ,$182.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100720,84270,HC SEX HORMONE BIND GLOB,301,1 ,$168.00 ,$84.00 ,$21.73 ,$168.00 ,$22.45 ,$84.53 ,$72.45 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$22.45 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$22.45 ,$24.59 ,$151.20 ,$48.89 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$23.80 ,$26.08 ,$26.08 ,$57.12 ,$26.08 ,$21.73 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100721,84295,HC SODIUM,301,1 ,$24.00 ,$12.00 ,$4.81 ,$24.00 ,$4.97 ,$18.73 ,$16.05 ,$8.16 ,$19.20 ,$20.40 ,$15.00 ,$21.60 ,$4.97 ,$22.80 ,$21.60 ,$20.40 ,$20.40 ,$8.16 ,$20.40 ,$20.40 ,$21.60 ,$4.97 ,$5.44 ,$21.60 ,$10.82 ,$22.08 ,$21.60 ,$15.99 ,$15.99 ,$14.62 ,$15.99 ,$15.60 ,$16.72 ,$5.33 ,$18.96 ,$5.27 ,$5.77 ,$5.77 ,$8.16 ,$5.77 ,$4.81 ,$22.80 ,$19.68 ,$19.68 ,$19.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100724,84300,HC SODIUM URINE,301,1 ,$37.00 ,$18.50 ,$5.06 ,$37.00 ,$5.23 ,$18.90 ,$16.20 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 ,$5.23 ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 ,$5.23 ,$5.73 ,$33.30 ,$11.39 ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 ,$5.54 ,$6.07 ,$6.07 ,$12.58 ,$6.07 ,$5.06 ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100725,84302,HC SODIUM OTHER FLUID,301,1 ,$37.00 ,$18.50 ,$4.86 ,$37.00 ,$5.02 ,$18.90 ,$16.20 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 ,$5.02 ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 ,$5.02 ,$5.50 ,$33.30 ,$10.94 ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 ,$5.32 ,$5.83 ,$5.83 ,$12.58 ,$5.83 ,$4.86 ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100726,84305,HC SOMATOMEDINC,301,1 ,$168.00 ,$84.00 ,$21.26 ,$168.00 ,$21.97 ,$82.71 ,$70.89 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$21.97 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$21.97 ,$24.06 ,$151.20 ,$47.84 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$23.29 ,$25.51 ,$25.51 ,$57.12 ,$25.51 ,$21.26 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100727,84311,HC SPECTROPHOTOMETRY,301,1 ,$213.00 ,$106.50 ,$8.10 ,$213.00 ,$8.37 ,$28.35 ,$24.30 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$8.37 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$8.37 ,$9.17 ,$191.70 ,$18.23 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$8.87 ,$9.72 ,$9.72 ,$72.42 ,$9.72 ,$8.10 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100728,84376,HC SUGARS SINGLE QL,301,1 ,$67.00 ,$33.50 ,$5.50 ,$67.00 ,$5.68 ,$21.39 ,$18.33 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$5.68 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$5.68 ,$6.22 ,$60.30 ,$12.38 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$6.02 ,$6.60 ,$6.60 ,$22.78 ,$6.60 ,$5.50 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100730,84315,HC SPEC GRAVITY NON UR,301,1 ,$15.70 ,$7.85 ,$3.28 ,$15.70 ,$3.39 ,$11.48 ,$9.84 ,$5.34 ,$12.56 ,$13.35 ,$9.81 ,$14.13 ,$3.39 ,$14.92 ,$14.13 ,$13.35 ,$13.35 ,$5.34 ,$13.35 ,$13.35 ,$14.13 ,$3.39 ,$3.71 ,$14.13 ,$7.38 ,$14.44 ,$14.13 ,$10.46 ,$10.46 ,$9.56 ,$10.46 ,$10.21 ,$10.94 ,$3.48 ,$12.40 ,$3.59 ,$3.94 ,$3.94 ,$5.34 ,$3.94 ,$3.28 ,$14.92 ,$12.87 ,$12.87 ,$12.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100732,84402,HC TESTOSTERONE FREE,301,1 ,$190.00 ,$95.00 ,$25.47 ,$190.00 ,$26.32 ,$99.05 ,$84.90 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$26.32 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$26.32 ,$28.83 ,$171.00 ,$57.31 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$27.90 ,$30.56 ,$30.56 ,$64.60 ,$30.56 ,$25.47 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100733,84403,HC TESTOSTERONE TOTAL,301,1 ,$190.00 ,$95.00 ,$25.81 ,$190.00 ,$26.67 ,$100.38 ,$86.04 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$26.67 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$26.67 ,$29.21 ,$171.00 ,$58.07 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$28.27 ,$30.97 ,$30.97 ,$64.60 ,$30.97 ,$25.81 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100735,84425,HC VITAMIN B1,301,1 ,$134.00 ,$67.00 ,$21.23 ,$134.00 ,$21.94 ,$82.57 ,$70.77 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$21.94 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$21.94 ,$24.03 ,$120.60 ,$47.77 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$23.26 ,$25.48 ,$25.48 ,$45.56 ,$25.48 ,$21.23 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100737,84432,HC THYROGLOBULIN,301,1 ,$123.00 ,$61.50 ,$16.06 ,$123.00 ,$16.59 ,$62.44 ,$53.52 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.59 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.59 ,$18.18 ,$110.70 ,$36.14 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$17.59 ,$19.27 ,$19.27 ,$41.82 ,$19.27 ,$16.06 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100738,84432,HC THYROGLOBULIN 2,301,1 ,$358.00 ,$179.00 ,$16.06 ,$358.00 ,$16.59 ,$62.44 ,$53.52 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$16.59 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$16.59 ,$18.18 ,$322.20 ,$36.14 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$17.59 ,$19.27 ,$19.27 ,$121.72 ,$19.27 ,$16.06 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100739,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$39.00 ,$19.50 ,$6.87 ,$39.00 ,$7.10 ,$26.71 ,$22.89 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$7.10 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$7.10 ,$7.78 ,$35.10 ,$15.46 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$7.53 ,$8.24 ,$8.24 ,$13.26 ,$8.24 ,$6.87 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100740,84439,HC T4 FREE,301,1 ,$67.00 ,$33.50 ,$9.02 ,$67.00 ,$9.32 ,$35.07 ,$30.06 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$9.32 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$9.32 ,$10.21 ,$60.30 ,$20.30 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.88 ,$10.82 ,$10.82 ,$22.78 ,$10.82 ,$9.02 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100742,84442,HC THYROXINE BIND GLOB,301,1 ,$81.00 ,$40.50 ,$14.78 ,$81.00 ,$15.27 ,$57.51 ,$49.29 ,$27.54 ,$64.80 ,$68.85 ,$50.63 ,$72.90 ,$15.27 ,$76.95 ,$72.90 ,$68.85 ,$68.85 ,$27.54 ,$68.85 ,$68.85 ,$72.90 ,$15.27 ,$16.73 ,$72.90 ,$33.26 ,$74.52 ,$72.90 ,$53.98 ,$53.98 ,$49.33 ,$53.98 ,$52.65 ,$56.42 ,$18.00 ,$63.99 ,$16.19 ,$17.74 ,$17.74 ,$27.54 ,$17.74 ,$14.78 ,$76.95 ,$66.42 ,$66.42 ,$64.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$123.00 ,$61.50 ,$16.80 ,$123.00 ,$17.36 ,$65.35 ,$56.01 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$17.36 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$17.36 ,$19.01 ,$110.70 ,$37.80 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$18.40 ,$20.16 ,$20.16 ,$41.82 ,$20.16 ,$16.80 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100744,84445,HC THYROID STIM IMMUNO GLOB,301,1 ,$291.00 ,$145.50 ,$32.70 ,$291.00 ,$32.70 ,$197.79 ,$169.53 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$32.70 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$32.70 ,$57.56 ,$261.90 ,$114.44 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$34.66 ,$61.03 ,$61.03 ,$98.94 ,$61.03 ,$50.86 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100745,84446,HC VITAMIN E,301,1 ,$112.00 ,$56.00 ,$14.18 ,$112.00 ,$14.65 ,$55.13 ,$47.25 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.65 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.65 ,$16.05 ,$100.80 ,$31.91 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.53 ,$17.02 ,$17.02 ,$38.08 ,$17.02 ,$14.18 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100746,84450,HC AST,301,1 ,$39.00 ,$19.50 ,$5.18 ,$39.00 ,$5.35 ,$20.13 ,$17.25 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$5.35 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$5.35 ,$5.86 ,$35.10 ,$11.66 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$5.67 ,$6.22 ,$6.22 ,$13.26 ,$6.22 ,$5.18 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100747,84460,HC ALT,301,1 ,$40.00 ,$20.00 ,$5.30 ,$40.00 ,$5.48 ,$20.62 ,$17.67 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 ,$5.48 ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 ,$5.48 ,$6.00 ,$36.00 ,$11.93 ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 ,$5.81 ,$6.36 ,$6.36 ,$13.60 ,$6.36 ,$5.30 ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100748,84466,HC TRANSFERRIN,301,1 ,$54.00 ,$27.00 ,$12.00 ,$54.00 ,$13.18 ,$49.63 ,$42.54 ,$18.36 ,$43.20 ,$45.90 ,$33.75 ,$48.60 ,$13.18 ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$18.36 ,$45.90 ,$45.90 ,$48.60 ,$13.18 ,$14.44 ,$48.60 ,$28.71 ,$49.68 ,$48.60 ,$35.99 ,$35.99 ,$32.89 ,$35.99 ,$35.10 ,$37.61 ,$12.00 ,$42.66 ,$13.97 ,$15.31 ,$15.31 ,$18.36 ,$15.31 ,$12.76 ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100750,84478,HC TRIGLYCERIDES,301,1 ,$44.00 ,$22.00 ,$5.74 ,$44.00 ,$5.93 ,$22.33 ,$19.14 ,$14.96 ,$35.20 ,$37.40 ,$27.50 ,$39.60 ,$5.93 ,$41.80 ,$39.60 ,$37.40 ,$37.40 ,$14.96 ,$37.40 ,$37.40 ,$39.60 ,$5.93 ,$6.50 ,$39.60 ,$12.92 ,$40.48 ,$39.60 ,$29.32 ,$29.32 ,$26.80 ,$29.32 ,$28.60 ,$30.65 ,$9.78 ,$34.76 ,$6.29 ,$6.89 ,$6.89 ,$14.96 ,$6.89 ,$5.74 ,$41.80 ,$36.08 ,$36.08 ,$35.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100752,84478,HC TRICGLYCERIDES BODY FLUID,301,1 ,$44.00 ,$22.00 ,$5.74 ,$44.00 ,$5.93 ,$22.33 ,$19.14 ,$14.96 ,$35.20 ,$37.40 ,$27.50 ,$39.60 ,$5.93 ,$41.80 ,$39.60 ,$37.40 ,$37.40 ,$14.96 ,$37.40 ,$37.40 ,$39.60 ,$5.93 ,$6.50 ,$39.60 ,$12.92 ,$40.48 ,$39.60 ,$29.32 ,$29.32 ,$26.80 ,$29.32 ,$28.60 ,$30.65 ,$9.78 ,$34.76 ,$6.29 ,$6.89 ,$6.89 ,$14.96 ,$6.89 ,$5.74 ,$41.80 ,$36.08 ,$36.08 ,$35.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100753,84479,HC T3 UPTAKE,301,1 ,$67.00 ,$33.50 ,$6.47 ,$67.00 ,$6.69 ,$25.13 ,$21.54 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$6.69 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$6.69 ,$7.32 ,$60.30 ,$14.56 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$7.09 ,$7.76 ,$7.76 ,$22.78 ,$7.76 ,$6.47 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100754,84480,HC T3 TOTAL,301,1 ,$112.00 ,$56.00 ,$14.18 ,$112.00 ,$14.65 ,$55.13 ,$47.25 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.65 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.65 ,$16.05 ,$100.80 ,$31.91 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.53 ,$17.02 ,$17.02 ,$38.08 ,$17.02 ,$14.18 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100755,84481,HC T3 FREE,301,1 ,$90.00 ,$45.00 ,$16.62 ,$90.00 ,$16.62 ,$65.87 ,$56.46 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$16.62 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$16.62 ,$19.17 ,$81.00 ,$38.12 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$17.62 ,$20.33 ,$20.33 ,$30.60 ,$20.33 ,$16.94 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100758,84484,HC TROPONIN QN,301,1 ,$101.00 ,$50.50 ,$12.47 ,$101.00 ,$12.89 ,$43.65 ,$37.41 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$12.89 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$12.89 ,$14.11 ,$90.90 ,$28.06 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$13.66 ,$14.96 ,$14.96 ,$34.34 ,$14.96 ,$12.47 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100760,84510,HC TYROSINE,301,1 ,$142.00 ,$71.00 ,$10.63 ,$142.00 ,$10.98 ,$40.46 ,$34.68 ,$48.28 ,$113.60 ,$120.70 ,$88.75 ,$127.80 ,$10.98 ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$48.28 ,$120.70 ,$120.70 ,$127.80 ,$10.98 ,$12.03 ,$127.80 ,$23.92 ,$130.64 ,$127.80 ,$94.63 ,$94.63 ,$86.48 ,$94.63 ,$92.30 ,$98.90 ,$31.55 ,$112.18 ,$11.64 ,$12.76 ,$12.76 ,$48.28 ,$12.76 ,$10.63 ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100761,84520,HC BUN,301,1 ,$30.00 ,$15.00 ,$3.95 ,$30.00 ,$4.08 ,$15.37 ,$13.17 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 ,$4.08 ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 ,$4.08 ,$4.47 ,$27.00 ,$8.89 ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 ,$4.32 ,$4.74 ,$4.74 ,$10.20 ,$4.74 ,$3.95 ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100762,84520,HC BUN BODY FLUID,301,1 ,$38.00 ,$19.00 ,$3.95 ,$38.00 ,$4.08 ,$15.37 ,$13.17 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.08 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.08 ,$4.47 ,$34.20 ,$8.89 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.32 ,$4.74 ,$4.74 ,$12.92 ,$4.74 ,$3.95 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100764,84540,HC UREA URINE,301,1 ,$67.00 ,$33.50 ,$5.56 ,$67.00 ,$5.75 ,$19.46 ,$16.68 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$5.75 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$5.75 ,$6.29 ,$60.30 ,$12.51 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$6.10 ,$6.67 ,$6.67 ,$22.78 ,$6.67 ,$5.56 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100765,84550,HC URIC ACID,301,1 ,$38.00 ,$19.00 ,$4.52 ,$38.00 ,$4.67 ,$17.57 ,$15.06 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.67 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.67 ,$5.12 ,$34.20 ,$10.17 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.95 ,$5.42 ,$5.42 ,$12.92 ,$5.42 ,$4.52 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100766,84560,HC URIC ACID OTH SRC,301,1 ,$36.00 ,$18.00 ,$5.08 ,$36.00 ,$5.25 ,$18.45 ,$15.81 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 ,$5.25 ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 ,$5.25 ,$5.75 ,$32.40 ,$11.43 ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 ,$5.57 ,$6.10 ,$6.10 ,$12.24 ,$6.10 ,$5.08 ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100768,84585,HC VANILLYLMAND AC (VMA),301,1 ,$112.00 ,$56.00 ,$15.50 ,$112.00 ,$16.02 ,$60.27 ,$51.66 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$16.02 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$16.02 ,$17.54 ,$100.80 ,$34.88 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.98 ,$18.60 ,$18.60 ,$38.08 ,$18.60 ,$15.50 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100769,84586,HC VASOACTIVE INTEST PEPTIDE,301,1 ,$190.00 ,$95.00 ,$17.93 ,$190.00 ,$17.93 ,$137.41 ,$117.78 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$17.93 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$17.93 ,$39.99 ,$171.00 ,$79.49 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$19.01 ,$42.40 ,$42.40 ,$64.60 ,$42.40 ,$35.33 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100770,84588,HC VASOPRESSIN (ADH),301,1 ,$258.00 ,$129.00 ,$33.94 ,$258.00 ,$35.07 ,$131.99 ,$113.13 ,$87.72 ,$206.40 ,$219.30 ,$161.25 ,$232.20 ,$35.07 ,$245.10 ,$232.20 ,$219.30 ,$219.30 ,$87.72 ,$219.30 ,$219.30 ,$232.20 ,$35.07 ,$38.41 ,$232.20 ,$76.37 ,$237.36 ,$232.20 ,$171.93 ,$171.93 ,$157.12 ,$171.93 ,$167.70 ,$179.70 ,$57.33 ,$203.82 ,$37.17 ,$40.73 ,$40.73 ,$87.72 ,$40.73 ,$33.94 ,$245.10 ,$211.56 ,$211.56 ,$206.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100771,84590,HC VITAMIN A,301,1 ,$90.00 ,$45.00 ,$11.61 ,$90.00 ,$12.00 ,$45.15 ,$38.70 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.00 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.00 ,$13.14 ,$81.00 ,$26.12 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$12.72 ,$13.93 ,$13.93 ,$30.60 ,$13.93 ,$11.61 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100772,84597,HC VITAMIN K,301,1 ,$392.00 ,$196.00 ,$13.72 ,$392.00 ,$14.18 ,$53.34 ,$45.72 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$14.18 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$14.18 ,$15.53 ,$352.80 ,$30.87 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$15.03 ,$16.46 ,$16.46 ,$133.28 ,$16.46 ,$13.72 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100773,80320,HC VOLATILES,301,1 ,$250.00 ,$125.00 ,$21.41 ,$250.00 ,$21.41 ,$80.88 ,$69.32 ,$85.00 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$21.41 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$85.00 ,$212.50 ,$212.50 ,$225.00 ,$21.41 ,$105.00 ,$225.00 , N/A ,$230.00 ,$225.00 ,$166.60 ,$166.60 ,$152.25 ,$166.60 ,$162.50 ,$174.13 ,$55.55 ,$197.50 ,$22.69 , N/A , N/A ,$85.00 , N/A , N/A ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100776,84630,HC ZINC,301,1 ,$78.00 ,$39.00 ,$11.39 ,$78.00 ,$11.77 ,$44.28 ,$37.95 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$11.77 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$11.77 ,$12.89 ,$70.20 ,$25.63 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$12.48 ,$13.67 ,$13.67 ,$26.52 ,$13.67 ,$11.39 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100778,84630,HC ZINC PLASMA,301,1 ,$34.00 ,$17.00 ,$7.55 ,$34.00 ,$11.77 ,$34.00 ,$34.00 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 ,$11.77 ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 ,$11.77 ,$12.89 ,$30.60 ,$25.63 ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 ,$12.48 ,$13.67 ,$13.67 ,$11.56 ,$13.67 ,$11.39 ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100801,84681,HC C PEPTIDE,301,1 ,$101.00 ,$50.50 ,$7.34 ,$101.00 ,$7.34 ,$80.96 ,$69.39 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$7.34 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$7.34 ,$23.55 ,$90.90 ,$46.82 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$7.78 ,$24.97 ,$24.97 ,$34.34 ,$24.97 ,$20.81 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100802,84702,HC HCG QN,301,1 ,$112.00 ,$56.00 ,$15.05 ,$112.00 ,$15.55 ,$58.56 ,$50.19 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.55 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.55 ,$17.03 ,$100.80 ,$33.86 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.48 ,$18.06 ,$18.06 ,$38.08 ,$18.06 ,$15.05 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100808,84703,HC HCG QL,301,1 ,$67.00 ,$33.50 ,$7.52 ,$67.00 ,$7.77 ,$29.26 ,$25.08 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$7.77 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$7.77 ,$8.51 ,$60.30 ,$16.92 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.24 ,$9.02 ,$9.02 ,$22.78 ,$9.02 ,$7.52 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100813,G0103,HC PSA ANNUAL SCREENING,301,1 ,$146.00 ,$73.00 ,$19.31 ,$146.00 ,$19.95 ,$71.54 ,$61.32 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.95 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.95 ,$21.86 ,$131.40 ,$43.45 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$21.15 ,$23.17 ,$23.17 ,$49.64 ,$23.17 ,$19.31 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100814,G0123,HC PAP SMEAR THIN PREP SCREEN (CMH),301,1 ,$151.00 ,$75.50 ,$20.26 ,$151.00 ,$20.93 ,$78.79 ,$67.53 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 ,$20.93 ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 ,$20.93 ,$22.93 ,$135.90 ,$45.59 ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 ,$22.19 ,$24.31 ,$24.31 ,$51.34 ,$24.31 ,$20.26 ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100815,G0123,HC PAP SMEAR THIN PREP SCREEN,311,1 ,$151.00 ,$75.50 ,$20.26 ,$151.00 ,$20.93 ,$78.79 ,$67.53 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 ,$20.93 ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 ,$20.93 ,$22.93 ,$135.90 ,$45.59 ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 ,$22.19 ,$24.31 ,$24.31 ,$51.34 ,$24.31 ,$20.26 ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100820,83664,HC LAMELLAR BODY CT,301,1 ,$164.00 ,$82.00 ,$6.82 ,$164.00 ,$6.82 ,$73.54 ,$63.03 ,$55.76 ,$131.20 ,$139.40 ,$102.50 ,$147.60 ,$6.82 ,$155.80 ,$147.60 ,$139.40 ,$139.40 ,$55.76 ,$139.40 ,$139.40 ,$147.60 ,$6.82 ,$21.87 ,$147.60 ,$43.47 ,$150.88 ,$147.60 ,$109.29 ,$109.29 ,$99.88 ,$109.29 ,$106.60 ,$114.23 ,$36.44 ,$129.56 ,$7.23 ,$23.18 ,$23.18 ,$55.76 ,$23.18 ,$19.32 ,$155.80 ,$134.48 ,$134.48 ,$131.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100821,80159,HC CLOZAPINE,301,1 ,$100.00 ,$50.00 ,$20.15 ,$100.00 ,$20.18 ,$71.93 ,$61.65 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$20.18 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$20.18 ,$22.81 ,$90.00 ,$45.34 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$21.39 ,$24.18 ,$24.18 ,$34.00 ,$24.18 ,$20.15 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100838,83033,HC FETAL HGB QI,301,1 ,$55.00 ,$27.50 ,$8.00 ,$55.00 ,$8.27 ,$28.00 ,$24.00 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 ,$8.27 ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 ,$8.27 ,$9.05 ,$49.50 ,$18.00 ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 ,$8.77 ,$9.60 ,$9.60 ,$18.70 ,$9.60 ,$8.00 ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$18.00 ,$9.00 ,$4.00 ,$18.00 ,$4.45 ,$17.64 ,$15.12 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 ,$4.45 ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 ,$4.45 ,$5.70 ,$16.20 ,$11.34 ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 ,$4.72 ,$6.05 ,$6.05 ,$6.12 ,$6.05 ,$5.04 ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100860,84145,HC PROCALCITONIN,301,1 ,$202.00 ,$101.00 ,$27.22 ,$202.00 ,$28.13 ,$104.20 ,$89.31 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$28.13 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$28.13 ,$30.81 ,$181.80 ,$61.25 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$29.82 ,$32.66 ,$32.66 ,$68.68 ,$32.66 ,$27.22 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100950,G0328,HC OCCULT BLOOD FECAL SCRN - AMB,301,1 ,$125.00 ,$62.50 ,$18.05 ,$125.00 ,$18.39 ,$63.18 ,$54.15 ,$42.50 ,$100.00 ,$106.25 ,$78.13 ,$112.50 ,$18.39 ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$42.50 ,$106.25 ,$106.25 ,$112.50 ,$18.39 ,$20.43 ,$112.50 ,$40.61 ,$115.00 ,$112.50 ,$83.30 ,$83.30 ,$76.13 ,$83.30 ,$81.25 ,$87.06 ,$27.78 ,$98.75 ,$19.49 ,$21.66 ,$21.66 ,$42.50 ,$21.66 ,$18.05 ,$118.75 ,$102.50 ,$102.50 ,$100.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100961,83993,HC CALPROTECTIN STOOL,301,1 ,$157.00 ,$78.50 ,$19.63 ,$157.00 ,$20.28 ,$76.34 ,$65.43 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$20.28 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$20.28 ,$22.22 ,$141.30 ,$44.17 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$21.50 ,$23.56 ,$23.56 ,$53.38 ,$23.56 ,$19.63 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100962,82656,"HC ELASTASE,PANCREATIC EL1 FECAL QT",301,1 ,$213.00 ,$106.50 ,$11.53 ,$213.00 ,$11.91 ,$44.84 ,$38.43 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$11.91 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$11.91 ,$13.05 ,$191.70 ,$25.94 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$12.62 ,$13.84 ,$13.84 ,$72.42 ,$13.84 ,$11.53 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100965,80361,HC DIHYDROCODEINONE,301,1 ,$172.00 ,$86.00 ,$38.22 ,$172.00 ,$56.38 ,$80.88 ,$69.32 ,$58.48 ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$56.38 ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$58.48 ,$146.20 ,$146.20 ,$154.80 ,$56.38 ,$72.24 ,$154.80 , N/A ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 ,$59.76 , N/A , N/A ,$58.48 , N/A , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100979,G0480,HC TRAMADOL,301,1 ,$160.00 ,$80.00 ,$35.55 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$63.95 ,$129.51 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$54.40 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100982,82530,HC CORTISOL SALIVA 2 SAMPLES,301,1 ,$114.00 ,$57.00 ,$16.71 ,$114.00 ,$17.27 ,$65.00 ,$55.71 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 ,$17.27 ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 ,$17.27 ,$18.91 ,$102.60 ,$37.60 ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 ,$18.31 ,$20.05 ,$20.05 ,$38.76 ,$20.05 ,$16.71 ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101006,82787,HC IMMUNOGLOBULIN SUBCLASSES,301,1 ,$63.00 ,$31.50 ,$5.90 ,$63.00 ,$5.90 ,$31.19 ,$26.73 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 ,$5.90 ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 ,$5.90 ,$9.08 ,$56.70 ,$18.05 ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 ,$6.25 ,$9.62 ,$9.62 ,$21.42 ,$9.62 ,$8.02 ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101010,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$157.00 ,$78.50 ,$17.27 ,$157.00 ,$17.85 ,$60.45 ,$51.81 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$17.85 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$17.85 ,$19.55 ,$141.30 ,$38.86 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$18.92 ,$20.72 ,$20.72 ,$53.38 ,$20.72 ,$17.27 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101024,G0480,HC DRUG CONFIRMATION EA PROC 1-7 CLASSES,301,1 ,$160.00 ,$80.00 ,$35.55 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$63.95 ,$129.51 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$54.40 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101050,82610,HC CYSTATIN C,301,1 ,$123.00 ,$61.50 ,$18.52 ,$123.00 ,$19.00 ,$64.82 ,$55.56 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$19.00 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$19.00 ,$20.96 ,$110.70 ,$41.67 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$20.14 ,$22.22 ,$22.22 ,$41.82 ,$22.22 ,$18.52 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$117.98 ,$277.60 ,$294.95 ,$216.88 ,$312.30 ,$24.91 ,$329.65 ,$312.30 ,$294.95 ,$294.95 ,$117.98 ,$294.95 ,$294.95 ,$312.30 ,$24.91 ,$27.29 ,$312.30 ,$54.25 ,$319.24 ,$312.30 ,$231.24 ,$231.24 ,$211.32 ,$231.24 ,$225.55 ,$241.69 ,$77.10 ,$274.13 ,$26.40 ,$28.93 ,$28.93 ,$117.98 ,$28.93 ,$24.11 ,$329.65 ,$284.54 ,$284.54 ,$277.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$30.26 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$30.26 ,$33.14 ,$161.10 ,$65.88 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$32.08 ,$35.14 ,$35.14 ,$60.86 ,$35.14 ,$29.28 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101053,80235,HC LACOSAMIDE LC/MS/MS,301,1 ,$110.00 ,$55.00 ,$21.69 ,$110.00 ,$21.69 ,$94.89 ,$81.33 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$21.69 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$21.69 ,$30.68 ,$99.00 ,$61.00 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$22.99 ,$32.53 ,$32.53 ,$37.40 ,$32.53 ,$27.11 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101054,83520,HC GANGLIOSIDE GQ1B AB IGG EIA,301,1 ,$101.00 ,$50.50 ,$17.27 ,$101.00 ,$17.85 ,$60.45 ,$51.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$17.85 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$17.85 ,$19.55 ,$90.90 ,$38.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$18.92 ,$20.72 ,$20.72 ,$34.34 ,$20.72 ,$17.27 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101055,83519,HC CALCIUM CHAN AB VOLTAGE-GATED,301,1 ,$101.00 ,$50.50 ,$18.40 ,$101.00 ,$19.00 ,$64.40 ,$55.20 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$19.00 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$19.00 ,$20.83 ,$90.90 ,$41.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$20.14 ,$22.08 ,$22.08 ,$34.34 ,$22.08 ,$18.40 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101057,84140,HC PREGNENOLONE,301,1 ,$106.00 ,$53.00 ,$20.67 ,$106.00 ,$21.36 ,$80.40 ,$68.91 ,$36.04 ,$84.80 ,$90.10 ,$66.25 ,$95.40 ,$21.36 ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$36.04 ,$90.10 ,$90.10 ,$95.40 ,$21.36 ,$23.39 ,$95.40 ,$46.51 ,$97.52 ,$95.40 ,$70.64 ,$70.64 ,$64.55 ,$70.64 ,$68.90 ,$73.83 ,$23.55 ,$83.74 ,$22.64 ,$24.80 ,$24.80 ,$36.04 ,$24.80 ,$20.67 ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101058,82679,HC ESTRONE LC/MS/MS,301,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 ,$25.78 ,$97.06 ,$83.19 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$25.78 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$25.78 ,$28.24 ,$90.00 ,$56.14 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$27.33 ,$29.94 ,$29.94 ,$34.00 ,$29.94 ,$24.95 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101066,G0480,HC IF PREGABALIN,301,1 ,$282.00 ,$141.00 ,$62.66 ,$282.00 ,$63.95 ,$282.00 ,$282.00 ,$95.88 ,$225.60 ,$239.70 ,$176.25 ,$253.80 ,$63.95 ,$267.90 ,$253.80 ,$239.70 ,$239.70 ,$95.88 ,$239.70 ,$239.70 ,$253.80 ,$63.95 ,$129.51 ,$253.80 ,$257.47 ,$259.44 ,$253.80 ,$187.92 ,$187.92 ,$171.74 ,$187.92 ,$183.30 ,$196.41 ,$62.66 ,$222.78 ,$67.79 ,$137.32 ,$137.32 ,$95.88 ,$137.32 ,$114.43 ,$267.90 ,$231.24 ,$231.24 ,$225.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101067,G0480,HC IF MARIJUANA GC/MS URINE,301,1 ,$160.00 ,$80.00 ,$35.55 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$63.95 ,$129.51 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$54.40 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101068,84630,HC ZINC RBC,301,1 ,$80.00 ,$40.00 ,$11.39 ,$80.00 ,$11.77 ,$44.28 ,$37.95 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$11.77 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 ,$11.77 ,$12.89 ,$72.00 ,$25.63 ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 ,$12.48 ,$13.67 ,$13.67 ,$27.20 ,$13.67 ,$11.39 ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101071,84432,HC THYROGLOBULIN MASS SPEC,301,1 ,$325.00 ,$162.50 ,$16.06 ,$325.00 ,$16.59 ,$62.44 ,$53.52 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$16.59 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$16.59 ,$18.18 ,$292.50 ,$36.14 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$17.59 ,$19.27 ,$19.27 ,$110.50 ,$19.27 ,$16.06 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101127,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$165.00 ,$82.50 ,$18.64 ,$165.00 ,$19.26 ,$65.24 ,$55.92 ,$56.10 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$19.26 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$56.10 ,$140.25 ,$140.25 ,$148.50 ,$19.26 ,$21.10 ,$148.50 ,$41.94 ,$151.80 ,$148.50 ,$109.96 ,$109.96 ,$100.49 ,$109.96 ,$107.25 ,$114.92 ,$36.66 ,$130.35 ,$20.42 ,$22.37 ,$22.37 ,$56.10 ,$22.37 ,$18.64 ,$156.75 ,$135.30 ,$135.30 ,$132.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101466,82600,HC CYANIDE BLOOD,301,1 ,$146.00 ,$73.00 ,$19.40 ,$146.00 ,$20.05 ,$75.43 ,$64.65 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$20.05 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$20.05 ,$21.96 ,$131.40 ,$43.65 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$21.25 ,$23.28 ,$23.28 ,$49.64 ,$23.28 ,$19.40 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101467,84238,HC RECEPTOR ASSAY TRASFERRIN,301,1 ,$224.00 ,$112.00 ,$36.57 ,$224.00 ,$37.79 ,$142.21 ,$121.89 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$37.79 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$37.79 ,$41.39 ,$201.60 ,$82.28 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$40.06 ,$43.88 ,$43.88 ,$76.16 ,$43.88 ,$36.57 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101468,83013,HC H PYLORI BREATH TEST,301,1 ,$274.00 ,$137.00 ,$60.88 ,$274.00 ,$69.60 ,$261.94 ,$224.52 ,$93.16 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$69.60 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$93.16 ,$232.90 ,$232.90 ,$246.60 ,$69.60 ,$76.24 ,$246.60 ,$151.56 ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$60.88 ,$216.46 ,$73.78 ,$80.83 ,$80.83 ,$93.16 ,$80.83 ,$67.36 ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101501,84999,HC OSMOLALITY FECAL,301,1 ,$129.00 ,$64.50 ,$21.41 ,$129.00 ,$21.41 ,$109.12 ,$109.12 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 ,$21.41 ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 ,$21.41 ,$54.18 ,$116.10 ,$77.40 ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 , N/A ,$101.91 ,$22.69 ,$64.50 ,$64.50 ,$43.86 ,$64.50 , N/A ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101502,83520,HC IMMUNOASSAY QN MYELIN ASSOC GLYCOPROTEIN,301,1 ,$155.00 ,$77.50 ,$17.27 ,$155.00 ,$17.85 ,$60.45 ,$51.81 ,$52.70 ,$124.00 ,$131.75 ,$96.88 ,$139.50 ,$17.85 ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$52.70 ,$131.75 ,$131.75 ,$139.50 ,$17.85 ,$19.55 ,$139.50 ,$38.86 ,$142.60 ,$139.50 ,$103.29 ,$103.29 ,$94.40 ,$103.29 ,$100.75 ,$107.96 ,$34.44 ,$122.45 ,$18.92 ,$20.72 ,$20.72 ,$52.70 ,$20.72 ,$17.27 ,$147.25 ,$127.10 ,$127.10 ,$124.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101504,80285,HC VORICONAZOLE,301,1 ,$140.00 ,$70.00 ,$21.69 ,$140.00 ,$21.69 ,$94.89 ,$81.33 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 ,$21.69 ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 ,$21.69 ,$30.68 ,$126.00 ,$61.00 ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 ,$22.99 ,$32.53 ,$32.53 ,$47.60 ,$32.53 ,$27.11 ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$340.00 ,$800.00 ,$850.00 ,$625.00 ,$900.00 ,$172.18 ,$950.00 ,$900.00 ,$850.00 ,$850.00 ,$340.00 ,$850.00 ,$850.00 ,$900.00 ,$172.18 ,$279.46 ,$900.00 ,$555.57 ,$920.00 ,$900.00 ,$666.40 ,$666.40 ,$609.00 ,$666.40 ,$650.00 ,$696.50 ,$222.20 ,$790.00 ,$182.51 ,$296.30 ,$296.30 ,$340.00 ,$296.30 ,$246.92 ,$950.00 ,$820.00 ,$820.00 ,$800.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$63.40 ,$70.33 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$125.80 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101508,G0480,HC TRICYCLIC QN URINE,301,1 ,$99.00 ,$49.50 ,$22.00 ,$222.75 ,$63.95 ,$99.00 ,$99.00 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$63.95 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$63.95 ,$99.00 ,$89.10 ,$222.75 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$67.79 ,$99.00 ,$99.00 ,$33.66 ,$99.00 ,$99.00 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101519,83520,HC POLYMERASE III RNA ANTIBODY,301,1 ,$99.00 ,$49.50 ,$17.27 ,$99.00 ,$17.85 ,$60.45 ,$51.81 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$17.85 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$17.85 ,$19.55 ,$89.10 ,$38.86 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$18.92 ,$20.72 ,$20.72 ,$33.66 ,$20.72 ,$17.27 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101523,84181,HC NEURONAL NUCLEAR AB/WB,301,1 ,$197.00 ,$98.50 ,$17.03 ,$197.00 ,$17.60 ,$66.22 ,$56.76 ,$66.98 ,$157.60 ,$167.45 ,$123.13 ,$177.30 ,$17.60 ,$187.15 ,$177.30 ,$167.45 ,$167.45 ,$66.98 ,$167.45 ,$167.45 ,$177.30 ,$17.60 ,$19.27 ,$177.30 ,$38.32 ,$181.24 ,$177.30 ,$131.28 ,$131.28 ,$119.97 ,$131.28 ,$128.05 ,$137.21 ,$43.77 ,$155.63 ,$18.66 ,$20.44 ,$20.44 ,$66.98 ,$20.44 ,$17.03 ,$187.15 ,$161.54 ,$161.54 ,$157.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$84.00 ,$42.00 ,$6.04 ,$84.00 ,$6.24 ,$23.49 ,$20.13 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 ,$6.24 ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 ,$6.24 ,$6.84 ,$75.60 ,$13.59 ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 ,$6.61 ,$7.25 ,$7.25 ,$28.56 ,$7.25 ,$6.04 ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101595,83690,HC LIPASE,301,1 ,$179.00 ,$89.50 ,$6.89 ,$179.00 ,$7.12 ,$26.78 ,$22.95 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$7.12 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$7.12 ,$7.80 ,$161.10 ,$15.50 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$7.55 ,$8.27 ,$8.27 ,$60.86 ,$8.27 ,$6.89 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101683,83519,HC IMMUNOASSAY QN CHANNEL/NEURONAL AB,301,1 ,$211.00 ,$105.50 ,$18.40 ,$211.00 ,$19.00 ,$64.40 ,$55.20 ,$71.74 ,$168.80 ,$179.35 ,$131.88 ,$189.90 ,$19.00 ,$200.45 ,$189.90 ,$179.35 ,$179.35 ,$71.74 ,$179.35 ,$179.35 ,$189.90 ,$19.00 ,$20.83 ,$189.90 ,$41.40 ,$194.12 ,$189.90 ,$140.61 ,$140.61 ,$128.50 ,$140.61 ,$137.15 ,$146.96 ,$46.88 ,$166.69 ,$20.14 ,$22.08 ,$22.08 ,$71.74 ,$22.08 ,$18.40 ,$200.45 ,$173.02 ,$173.02 ,$168.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101684,83520,HC IMMUNOASSAY QN STRIATIONAL AB,301,1 ,$169.00 ,$84.50 ,$17.27 ,$169.00 ,$17.85 ,$60.45 ,$51.81 ,$57.46 ,$135.20 ,$143.65 ,$105.63 ,$152.10 ,$17.85 ,$160.55 ,$152.10 ,$143.65 ,$143.65 ,$57.46 ,$143.65 ,$143.65 ,$152.10 ,$17.85 ,$19.55 ,$152.10 ,$38.86 ,$155.48 ,$152.10 ,$112.62 ,$112.62 ,$102.92 ,$112.62 ,$109.85 ,$117.71 ,$37.55 ,$133.51 ,$18.92 ,$20.72 ,$20.72 ,$57.46 ,$20.72 ,$17.27 ,$160.55 ,$138.58 ,$138.58 ,$135.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101737,82784,HC IMMUNOGLOBIN G,301,1 ,$39.00 ,$19.50 ,$8.67 ,$39.00 ,$9.61 ,$36.19 ,$31.02 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$9.61 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$9.61 ,$10.53 ,$35.10 ,$20.93 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$10.19 ,$11.16 ,$11.16 ,$13.26 ,$11.16 ,$9.30 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101741,84545,"HC UREA NITROGEN, CLEARANCE",301,1 ,$270.00 ,$135.00 ,$7.20 ,$270.00 ,$7.44 ,$25.73 ,$22.05 ,$91.80 ,$216.00 ,$229.50 ,$168.75 ,$243.00 ,$7.44 ,$256.50 ,$243.00 ,$229.50 ,$229.50 ,$91.80 ,$229.50 ,$229.50 ,$243.00 ,$7.44 ,$8.15 ,$243.00 ,$16.20 ,$248.40 ,$243.00 ,$179.93 ,$179.93 ,$164.43 ,$179.93 ,$175.50 ,$188.06 ,$59.99 ,$213.30 ,$7.89 ,$8.64 ,$8.64 ,$91.80 ,$8.64 ,$7.20 ,$256.50 ,$221.40 ,$221.40 ,$216.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101746,G0480,HC DRUG SCRN DEFINT 1-7 CLASS T1,301,1 ,$52.00 ,$26.00 ,$11.55 ,$117.00 ,$52.00 ,$52.00 ,$52.00 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$52.00 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$52.00 ,$52.00 ,$46.80 ,$117.00 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$55.12 ,$52.00 ,$52.00 ,$17.68 ,$52.00 ,$52.00 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101747,80362,HC OPIOIDS  AND  OPIATE ANALOGS 1/2,301,1 ,$52.00 ,$26.00 ,$11.55 ,$59.76 ,$56.38 ,$52.00 ,$52.00 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$56.38 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$56.38 ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$59.76 , N/A , N/A ,$17.68 , N/A , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101748,80372,HC DRUG SCREENING TAPENTADOL,301,1 ,$52.00 ,$26.00 ,$8.59 ,$52.00 ,$8.59 ,$52.00 ,$52.00 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$8.59 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$8.59 ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$9.11 , N/A , N/A ,$17.68 , N/A , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101749,80355,HC DRUG SCREENING GABAPENTIN NON-BLOOD,301,1 ,$52.00 ,$26.00 ,$8.59 ,$52.00 ,$8.59 ,$52.00 ,$52.00 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$8.59 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$8.59 ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$9.11 , N/A , N/A ,$17.68 , N/A , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30108000,84620,HC XYLOSE TOLERANCE TEST,301,1 ,$155.00 ,$77.50 ,$12.91 ,$155.00 ,$13.34 ,$46.06 ,$39.48 ,$52.70 ,$124.00 ,$131.75 ,$96.88 ,$139.50 ,$13.34 ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$52.70 ,$131.75 ,$131.75 ,$139.50 ,$13.34 ,$14.61 ,$139.50 ,$29.05 ,$142.60 ,$139.50 ,$103.29 ,$103.29 ,$94.40 ,$103.29 ,$100.75 ,$107.96 ,$34.44 ,$122.45 ,$14.14 ,$15.49 ,$15.49 ,$52.70 ,$15.49 ,$12.91 ,$147.25 ,$127.10 ,$127.10 ,$124.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30110162,82017,HC ACYLCARNITINES QN PLASMA MAYO-CMH,301,1 ,$184.00 ,$92.00 ,$16.87 ,$184.00 ,$17.43 ,$65.59 ,$56.22 ,$62.56 ,$147.20 ,$156.40 ,$115.00 ,$165.60 ,$17.43 ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$62.56 ,$156.40 ,$156.40 ,$165.60 ,$17.43 ,$19.09 ,$165.60 ,$37.96 ,$169.28 ,$165.60 ,$122.62 ,$122.62 ,$112.06 ,$122.62 ,$119.60 ,$128.16 ,$40.88 ,$145.36 ,$18.48 ,$20.24 ,$20.24 ,$62.56 ,$20.24 ,$16.87 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30120750,84478,HC TRIGLYCERIDES-CLIN,301,1 ,$58.00 ,$29.00 ,$5.74 ,$58.00 ,$5.93 ,$22.33 ,$19.14 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 ,$5.93 ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 ,$5.93 ,$6.50 ,$52.20 ,$12.92 ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 ,$6.29 ,$6.89 ,$6.89 ,$19.72 ,$6.89 ,$5.74 ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30140757,84482,HC T3 REVERSE-REF,301,1 ,$328.00 ,$164.00 ,$10.82 ,$328.00 ,$10.82 ,$61.29 ,$52.53 ,$111.52 ,$262.40 ,$278.80 ,$205.00 ,$295.20 ,$10.82 ,$311.60 ,$295.20 ,$278.80 ,$278.80 ,$111.52 ,$278.80 ,$278.80 ,$295.20 ,$10.82 ,$17.84 ,$295.20 ,$35.46 ,$301.76 ,$295.20 ,$218.58 ,$218.58 ,$199.75 ,$218.58 ,$213.20 ,$228.45 ,$72.88 ,$259.12 ,$11.47 ,$18.91 ,$18.91 ,$111.52 ,$18.91 ,$15.76 ,$311.60 ,$268.96 ,$268.96 ,$262.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200103,86021,HC LEUKO AB ID,302,1 ,$123.00 ,$61.50 ,$15.05 ,$123.00 ,$15.55 ,$58.56 ,$50.19 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$15.55 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$15.55 ,$17.03 ,$110.70 ,$33.86 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$16.48 ,$18.06 ,$18.06 ,$41.82 ,$18.06 ,$15.05 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200105,86021,HC LEUKO AB ID (ANCA),302,1 ,$78.00 ,$39.00 ,$15.05 ,$78.00 ,$15.55 ,$58.56 ,$50.19 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$15.55 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$15.55 ,$17.03 ,$70.20 ,$33.86 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$16.48 ,$18.06 ,$18.06 ,$26.52 ,$18.06 ,$15.05 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200106,86021,HC LEUKO AB ID (MYELO),302,1 ,$101.00 ,$50.50 ,$15.05 ,$101.00 ,$15.55 ,$58.56 ,$50.19 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$15.55 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$15.55 ,$17.03 ,$90.90 ,$33.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$16.48 ,$18.06 ,$18.06 ,$34.34 ,$18.06 ,$15.05 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200107,86021,HC LEUKO AB ID (PROTEIN),302,1 ,$101.00 ,$50.50 ,$15.05 ,$101.00 ,$15.55 ,$58.56 ,$50.19 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$15.55 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$15.55 ,$17.03 ,$90.90 ,$33.86 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$16.48 ,$18.06 ,$18.06 ,$34.34 ,$18.06 ,$15.05 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200108,86022,HC PLATELET AB ID (HIT),302,1 ,$202.00 ,$101.00 ,$18.37 ,$202.00 ,$18.98 ,$71.44 ,$61.23 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$18.98 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$18.98 ,$20.79 ,$181.80 ,$41.33 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$20.12 ,$22.04 ,$22.04 ,$68.68 ,$22.04 ,$18.37 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200113,86022,HC PLATELET AB-ID,302,1 ,$202.00 ,$101.00 ,$18.37 ,$202.00 ,$18.98 ,$71.44 ,$61.23 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$18.98 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$18.98 ,$20.79 ,$181.80 ,$41.33 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$20.12 ,$22.04 ,$22.04 ,$68.68 ,$22.04 ,$18.37 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200118,86023,HC PLATELET ASSOC AB ID IGG,302,1 ,$101.00 ,$50.50 ,$12.46 ,$101.00 ,$12.87 ,$48.44 ,$41.52 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$12.87 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$12.87 ,$14.10 ,$90.90 ,$28.04 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$13.64 ,$14.95 ,$14.95 ,$34.34 ,$14.95 ,$12.46 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200119,86038,HC ANA SCREEN,302,1 ,$78.00 ,$39.00 ,$12.09 ,$78.00 ,$12.49 ,$47.01 ,$40.29 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$12.49 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$12.49 ,$13.68 ,$70.20 ,$27.20 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$13.24 ,$14.51 ,$14.51 ,$26.52 ,$14.51 ,$12.09 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200120,86039,HC ANA TITER,302,1 ,$90.00 ,$45.00 ,$11.16 ,$90.00 ,$11.53 ,$43.40 ,$37.20 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$11.53 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$11.53 ,$12.63 ,$81.00 ,$25.11 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$12.22 ,$13.39 ,$13.39 ,$30.60 ,$13.39 ,$11.16 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200121,86060,HC ASO,302,1 ,$123.00 ,$61.50 ,$7.30 ,$123.00 ,$7.54 ,$28.39 ,$24.33 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$7.54 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$7.54 ,$8.26 ,$110.70 ,$16.43 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$7.99 ,$8.76 ,$8.76 ,$41.82 ,$8.76 ,$7.30 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200122,86063,HC ASO SCREEN,302,1 ,$105.00 ,$52.50 ,$5.77 ,$105.00 ,$5.96 ,$22.44 ,$19.23 ,$35.70 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$5.96 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$35.70 ,$89.25 ,$89.25 ,$94.50 ,$5.96 ,$6.53 ,$94.50 ,$12.98 ,$96.60 ,$94.50 ,$69.97 ,$69.97 ,$63.95 ,$69.97 ,$68.25 ,$73.13 ,$23.33 ,$82.95 ,$6.32 ,$6.92 ,$6.92 ,$35.70 ,$6.92 ,$5.77 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$45.00 ,$22.50 ,$5.18 ,$45.00 ,$5.35 ,$20.13 ,$17.25 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 ,$5.35 ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 ,$5.35 ,$5.86 ,$40.50 ,$11.66 ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 ,$5.67 ,$6.22 ,$6.22 ,$15.30 ,$6.22 ,$5.18 ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200124,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$168.00 ,$84.00 ,$12.95 ,$168.00 ,$13.38 ,$50.37 ,$43.17 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$13.38 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$13.38 ,$14.66 ,$151.20 ,$29.14 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$14.18 ,$15.54 ,$15.54 ,$57.12 ,$15.54 ,$12.95 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200125,86146,HC BETA 2 GLYCO AB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$78.00 ,$78.00 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.17 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.17 ,$28.80 ,$70.20 ,$57.26 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$8.66 ,$30.54 ,$30.54 ,$26.52 ,$30.54 ,$25.45 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200126,86147,HC CARDIOLIPIN AB EA,302,1 ,$67.00 ,$33.50 ,$8.17 ,$67.00 ,$8.17 ,$67.00 ,$67.00 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.17 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.17 ,$28.80 ,$60.30 ,$57.26 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.66 ,$30.54 ,$30.54 ,$22.78 ,$30.54 ,$25.45 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200128,86147,HC CARDIOLIPIN AB EA (PHOSPH),302,1 ,$76.00 ,$38.00 ,$8.17 ,$76.00 ,$8.17 ,$76.00 ,$76.00 ,$25.84 ,$60.80 ,$64.60 ,$47.50 ,$68.40 ,$8.17 ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$25.84 ,$64.60 ,$64.60 ,$68.40 ,$8.17 ,$28.80 ,$68.40 ,$57.26 ,$69.92 ,$68.40 ,$50.65 ,$50.65 ,$46.28 ,$50.65 ,$49.40 ,$52.93 ,$16.89 ,$60.04 ,$8.66 ,$30.54 ,$30.54 ,$25.84 ,$30.54 ,$25.45 ,$72.20 ,$62.32 ,$62.32 ,$60.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200130,86160,HC COMPLEMENT AG EA (C3),302,1 ,$90.00 ,$45.00 ,$12.00 ,$90.00 ,$12.40 ,$46.66 ,$39.99 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.40 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.40 ,$13.58 ,$81.00 ,$27.00 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.14 ,$14.40 ,$14.40 ,$30.60 ,$14.40 ,$12.00 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200131,86160,HC COMPLEMENT AG EA (C4),302,1 ,$90.00 ,$45.00 ,$12.00 ,$90.00 ,$12.40 ,$46.66 ,$39.99 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.40 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.40 ,$13.58 ,$81.00 ,$27.00 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.14 ,$14.40 ,$14.40 ,$30.60 ,$14.40 ,$12.00 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200133,86161,HC C1 ESTERASE INHIBITOR,302,1 ,$86.00 ,$43.00 ,$12.00 ,$86.00 ,$12.40 ,$46.66 ,$39.99 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$12.40 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 ,$12.40 ,$13.58 ,$77.40 ,$27.00 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 ,$13.14 ,$14.40 ,$14.40 ,$29.24 ,$14.40 ,$12.00 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200134,86162,HC COMPLEMENT TOTAL,302,1 ,$146.00 ,$73.00 ,$20.32 ,$146.00 ,$21.00 ,$79.03 ,$67.74 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$21.00 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$21.00 ,$23.00 ,$131.40 ,$45.72 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$22.26 ,$24.38 ,$24.38 ,$49.64 ,$24.38 ,$20.32 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200135,86200,HC CCP AB,302,1 ,$101.00 ,$50.50 ,$12.95 ,$101.00 ,$13.38 ,$50.37 ,$43.17 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.38 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.38 ,$14.66 ,$90.90 ,$29.14 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.18 ,$15.54 ,$15.54 ,$34.34 ,$15.54 ,$12.95 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200136,86215,HC DEOXYRIBONUCLEASE AB,302,1 ,$78.00 ,$39.00 ,$13.25 ,$78.00 ,$13.69 ,$51.52 ,$44.16 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$13.69 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$13.69 ,$15.00 ,$70.20 ,$29.81 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$14.51 ,$15.90 ,$15.90 ,$26.52 ,$15.90 ,$13.25 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200137,86225,HC DNA DOUBLE STRAND AB,302,1 ,$101.00 ,$50.50 ,$13.74 ,$101.00 ,$14.20 ,$53.45 ,$45.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.20 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.20 ,$15.55 ,$90.90 ,$30.92 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$15.05 ,$16.49 ,$16.49 ,$34.34 ,$16.49 ,$13.74 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200138,86235,HC ENA AB,302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.53 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.53 ,$20.29 ,$120.60 ,$40.34 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$45.56 ,$21.52 ,$17.93 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200139,86235,HC ENA AB (SCL70),302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.53 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.53 ,$20.29 ,$120.60 ,$40.34 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$45.56 ,$21.52 ,$17.93 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200140,86235,HC ENA AB (JO1),302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.53 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.53 ,$20.29 ,$120.60 ,$40.34 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$45.56 ,$21.52 ,$17.93 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200141,86235,HC ENA AB (SSA/SSB),302,1 ,$134.00 ,$67.00 ,$17.93 ,$134.00 ,$18.53 ,$69.76 ,$59.79 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.53 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.53 ,$20.29 ,$120.60 ,$40.34 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.64 ,$21.52 ,$21.52 ,$45.56 ,$21.52 ,$17.93 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200142,86255,HC FLUOR AB SCR (MITOCHONDRIAL),302,1 ,$56.00 ,$28.00 ,$12.05 ,$56.00 ,$12.45 ,$46.87 ,$40.17 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$12.45 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$12.45 ,$13.64 ,$50.40 ,$27.11 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$13.20 ,$14.46 ,$14.46 ,$19.04 ,$14.46 ,$12.05 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200143,86255,HC FLUOR AB SCR (MUSCLE),302,1 ,$41.00 ,$20.50 ,$9.11 ,$41.00 ,$12.45 ,$41.00 ,$40.17 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$12.45 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$12.45 ,$13.64 ,$36.90 ,$27.11 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$13.20 ,$14.46 ,$14.46 ,$13.94 ,$14.46 ,$12.05 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200144,86255,HC FLUOR AB SCR (RETICULIN),302,1 ,$130.00 ,$65.00 ,$12.05 ,$130.00 ,$12.45 ,$46.87 ,$40.17 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$12.45 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$12.45 ,$13.64 ,$117.00 ,$27.11 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$13.20 ,$14.46 ,$14.46 ,$44.20 ,$14.46 ,$12.05 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200146,86255,HC FLUOR AB SCR (ENDOMYSIAL),302,1 ,$112.00 ,$56.00 ,$12.05 ,$112.00 ,$12.45 ,$46.87 ,$40.17 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$12.45 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$12.45 ,$13.64 ,$100.80 ,$27.11 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$13.20 ,$14.46 ,$14.46 ,$38.08 ,$14.46 ,$12.05 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$12.45 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$12.45 ,$13.64 ,$141.30 ,$27.11 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$13.20 ,$14.46 ,$14.46 ,$53.38 ,$14.46 ,$12.05 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200148,86255,HC FLUOR AB SCR (PURKINJE),302,1 ,$157.00 ,$78.50 ,$12.05 ,$157.00 ,$12.45 ,$46.87 ,$40.17 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$12.45 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$12.45 ,$13.64 ,$141.30 ,$27.11 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$13.20 ,$14.46 ,$14.46 ,$53.38 ,$14.46 ,$12.05 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200149,86225,HC YO AB IFA,302,1 ,$101.00 ,$50.50 ,$13.74 ,$101.00 ,$14.20 ,$53.45 ,$45.81 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.20 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.20 ,$15.55 ,$90.90 ,$30.92 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$15.05 ,$16.49 ,$16.49 ,$34.34 ,$16.49 ,$13.74 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200150,86256,HC FLUOR AB TITER (C ANCA),302,1 ,$90.00 ,$45.00 ,$12.05 ,$90.00 ,$12.45 ,$46.87 ,$40.17 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.45 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.45 ,$13.64 ,$81.00 ,$27.11 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.20 ,$14.46 ,$14.46 ,$30.60 ,$14.46 ,$12.05 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200151,86256,HC FLUOR AB TITER (P ANCA),302,1 ,$90.00 ,$45.00 ,$12.05 ,$90.00 ,$12.45 ,$46.87 ,$40.17 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.45 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.45 ,$13.64 ,$81.00 ,$27.11 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.20 ,$14.46 ,$14.46 ,$30.60 ,$14.46 ,$12.05 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200156,86256,HC FLUOR AB TITER (MUSCLE),302,1 ,$103.00 ,$51.50 ,$12.05 ,$103.00 ,$12.45 ,$46.87 ,$40.17 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$12.45 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$12.45 ,$13.64 ,$92.70 ,$27.11 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$13.20 ,$14.46 ,$14.46 ,$35.02 ,$14.46 ,$12.05 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200157,82677,HC ESTRIOL SERUM,302,1 ,$114.00 ,$57.00 ,$24.18 ,$114.00 ,$24.99 ,$94.05 ,$80.61 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 ,$24.99 ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 ,$24.99 ,$27.37 ,$102.60 ,$54.41 ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 ,$26.49 ,$29.02 ,$29.02 ,$38.76 ,$29.02 ,$24.18 ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$21.50 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$21.50 ,$23.55 ,$141.30 ,$46.82 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$53.38 ,$24.97 ,$20.81 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200160,86301,HC TUMOR AG CA 19-9,302,1 ,$157.00 ,$78.50 ,$20.81 ,$157.00 ,$21.50 ,$80.96 ,$69.39 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$21.50 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$21.50 ,$23.55 ,$141.30 ,$46.82 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$53.38 ,$24.97 ,$20.81 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200162,86304,HC TUMOR AG CA 125,302,1 ,$157.00 ,$78.50 ,$20.81 ,$157.00 ,$21.50 ,$80.96 ,$69.39 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$21.50 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$21.50 ,$23.55 ,$141.30 ,$46.82 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$22.79 ,$24.97 ,$24.97 ,$53.38 ,$24.97 ,$20.81 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$78.00 ,$39.00 ,$5.18 ,$78.00 ,$5.35 ,$20.13 ,$17.25 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$5.35 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$5.35 ,$5.86 ,$70.20 ,$11.66 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$5.67 ,$6.22 ,$6.22 ,$26.52 ,$6.22 ,$5.18 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200164,86316,HC TUMOR AG OTHER AG QN,302,1 ,$168.00 ,$84.00 ,$20.81 ,$168.00 ,$21.50 ,$80.96 ,$69.39 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$21.50 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$21.50 ,$23.55 ,$151.20 ,$46.82 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$22.79 ,$24.97 ,$24.97 ,$57.12 ,$24.97 ,$20.81 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200165,86317,HC INFECTIOUS AB QN,302,1 ,$112.00 ,$56.00 ,$14.99 ,$112.00 ,$15.49 ,$58.28 ,$49.95 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.49 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.49 ,$16.97 ,$100.80 ,$33.73 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.42 ,$17.99 ,$17.99 ,$38.08 ,$17.99 ,$14.99 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200167,86331,HC IMMUNODIFF EL EA AG AB QL,302,1 ,$48.00 ,$24.00 ,$10.67 ,$48.00 ,$12.38 ,$46.59 ,$39.93 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$12.38 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$12.38 ,$13.56 ,$43.20 ,$26.96 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$13.12 ,$14.38 ,$14.38 ,$16.32 ,$14.38 ,$11.98 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200168,86331,HC IMMUNODIFF EL EA AG AB QL (TEICH),302,1 ,$48.00 ,$24.00 ,$10.67 ,$48.00 ,$12.38 ,$46.59 ,$39.93 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$12.38 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$12.38 ,$13.56 ,$43.20 ,$26.96 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$13.12 ,$14.38 ,$14.38 ,$16.32 ,$14.38 ,$11.98 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200169,86334,HC IMMUNOFIX ELECTRO SERUM,302,1 ,$168.00 ,$84.00 ,$22.34 ,$168.00 ,$23.08 ,$86.91 ,$74.49 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$23.08 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$23.08 ,$25.28 ,$151.20 ,$50.27 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$24.46 ,$26.81 ,$26.81 ,$57.12 ,$26.81 ,$22.34 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200170,86334,HC IMMUNOFIX ELECTRO REFLEX,302,1 ,$235.00 ,$117.50 ,$22.34 ,$235.00 ,$23.08 ,$86.91 ,$74.49 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 ,$23.08 ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 ,$23.08 ,$25.28 ,$211.50 ,$50.27 ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 ,$24.46 ,$26.81 ,$26.81 ,$79.90 ,$26.81 ,$22.34 ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200171,86335,HC IMMUNOFIX ELECTRO OTH,302,1 ,$224.00 ,$112.00 ,$29.35 ,$224.00 ,$30.33 ,$114.14 ,$97.83 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$30.33 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$30.33 ,$33.22 ,$201.60 ,$66.04 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$32.15 ,$35.22 ,$35.22 ,$76.16 ,$35.22 ,$29.35 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200172,86335,HC IMMUNOFIX ELECTRO OTH (TRANS),302,1 ,$224.00 ,$112.00 ,$29.35 ,$224.00 ,$30.33 ,$114.14 ,$97.83 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$30.33 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$30.33 ,$33.22 ,$201.60 ,$66.04 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$32.15 ,$35.22 ,$35.22 ,$76.16 ,$35.22 ,$29.35 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200173,86336,HC INHIBIN A,302,1 ,$123.00 ,$61.50 ,$15.59 ,$123.00 ,$16.11 ,$60.62 ,$51.96 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.11 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.11 ,$17.64 ,$110.70 ,$35.08 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$17.08 ,$18.71 ,$18.71 ,$41.82 ,$18.71 ,$15.59 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200175,86337,HC INSULIN AB (HS),302,1 ,$255.00 ,$127.50 ,$21.41 ,$255.00 ,$22.12 ,$83.27 ,$71.37 ,$86.70 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$22.12 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$86.70 ,$216.75 ,$216.75 ,$229.50 ,$22.12 ,$24.23 ,$229.50 ,$48.17 ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,$23.45 ,$25.69 ,$25.69 ,$86.70 ,$25.69 ,$21.41 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200177,86340,HC INTRINSIC FACTOR AB,302,1 ,$112.00 ,$56.00 ,$14.28 ,$112.00 ,$14.28 ,$58.63 ,$50.25 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.28 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.28 ,$17.07 ,$100.80 ,$33.93 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.14 ,$18.10 ,$18.10 ,$38.08 ,$18.10 ,$15.08 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200179,86355,HC B CELLS TOTAL COUNT (CD19),302,1 ,$252.00 ,$126.00 ,$37.73 ,$252.00 ,$38.99 ,$146.72 ,$125.76 ,$85.68 ,$201.60 ,$214.20 ,$157.50 ,$226.80 ,$38.99 ,$239.40 ,$226.80 ,$214.20 ,$214.20 ,$85.68 ,$214.20 ,$214.20 ,$226.80 ,$38.99 ,$42.70 ,$226.80 ,$84.89 ,$231.84 ,$226.80 ,$167.93 ,$167.93 ,$153.47 ,$167.93 ,$163.80 ,$175.52 ,$55.99 ,$199.08 ,$41.33 ,$45.28 ,$45.28 ,$85.68 ,$45.28 ,$37.73 ,$239.40 ,$206.64 ,$206.64 ,$201.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200180,86355,HC B CELLS TOTAL COUNT (CD20),302,1 ,$252.00 ,$126.00 ,$37.73 ,$252.00 ,$38.99 ,$146.72 ,$125.76 ,$85.68 ,$201.60 ,$214.20 ,$157.50 ,$226.80 ,$38.99 ,$239.40 ,$226.80 ,$214.20 ,$214.20 ,$85.68 ,$214.20 ,$214.20 ,$226.80 ,$38.99 ,$42.70 ,$226.80 ,$84.89 ,$231.84 ,$226.80 ,$167.93 ,$167.93 ,$153.47 ,$167.93 ,$163.80 ,$175.52 ,$55.99 ,$199.08 ,$41.33 ,$45.28 ,$45.28 ,$85.68 ,$45.28 ,$37.73 ,$239.40 ,$206.64 ,$206.64 ,$201.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200181,86355,HC B CELLS TOTAL COUNT,302,1 ,$291.00 ,$145.50 ,$37.73 ,$291.00 ,$38.99 ,$146.72 ,$125.76 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$38.99 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$38.99 ,$42.70 ,$261.90 ,$84.89 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.33 ,$45.28 ,$45.28 ,$98.94 ,$45.28 ,$37.73 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200182,86357,HC CD8 TOTAL COUNT,302,1 ,$291.00 ,$145.50 ,$37.73 ,$291.00 ,$38.99 ,$146.72 ,$125.76 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$38.99 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$38.99 ,$42.70 ,$261.90 ,$84.89 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.33 ,$45.28 ,$45.28 ,$98.94 ,$45.28 ,$37.73 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$48.54 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$48.54 ,$53.17 ,$322.20 ,$105.71 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$51.45 ,$56.38 ,$56.38 ,$121.72 ,$56.38 ,$46.98 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$48.54 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$48.54 ,$53.17 ,$322.20 ,$105.71 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$51.45 ,$56.38 ,$56.38 ,$121.72 ,$56.38 ,$46.98 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200187,86361,HC T CELLS CD4 COUNT,302,1 ,$196.00 ,$98.00 ,$26.78 ,$196.00 ,$27.67 ,$104.13 ,$89.25 ,$66.64 ,$156.80 ,$166.60 ,$122.50 ,$176.40 ,$27.67 ,$186.20 ,$176.40 ,$166.60 ,$166.60 ,$66.64 ,$166.60 ,$166.60 ,$176.40 ,$27.67 ,$30.31 ,$176.40 ,$60.26 ,$180.32 ,$176.40 ,$130.61 ,$130.61 ,$119.36 ,$130.61 ,$127.40 ,$136.51 ,$43.55 ,$154.84 ,$29.33 ,$32.14 ,$32.14 ,$66.64 ,$32.14 ,$26.78 ,$186.20 ,$160.72 ,$160.72 ,$156.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200189,86376,HC MICROSOMAL AB,302,1 ,$112.00 ,$56.00 ,$14.55 ,$112.00 ,$15.03 ,$56.60 ,$48.51 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.03 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.03 ,$16.47 ,$100.80 ,$32.74 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.93 ,$17.46 ,$17.46 ,$38.08 ,$17.46 ,$14.55 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200191,86403,HC PARTICLE AGG SCREEN,302,1 ,$103.00 ,$51.50 ,$11.54 ,$103.00 ,$11.92 ,$40.39 ,$34.62 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$11.92 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$11.92 ,$13.06 ,$92.70 ,$25.97 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$12.64 ,$13.85 ,$13.85 ,$35.02 ,$13.85 ,$11.54 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200193,86403,HC STREPTOZYME,302,1 ,$57.00 ,$28.50 ,$11.54 ,$57.00 ,$11.92 ,$40.39 ,$34.62 ,$19.38 ,$45.60 ,$48.45 ,$35.63 ,$51.30 ,$11.92 ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$19.38 ,$48.45 ,$48.45 ,$51.30 ,$11.92 ,$13.06 ,$51.30 ,$25.97 ,$52.44 ,$51.30 ,$37.98 ,$37.98 ,$34.71 ,$37.98 ,$37.05 ,$39.70 ,$12.67 ,$45.03 ,$12.64 ,$13.85 ,$13.85 ,$19.38 ,$13.85 ,$11.54 ,$54.15 ,$46.74 ,$46.74 ,$45.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200194,86403,HC CRYPTOCOCCUS AB,302,1 ,$91.00 ,$45.50 ,$11.54 ,$91.00 ,$11.92 ,$40.39 ,$34.62 ,$30.94 ,$72.80 ,$77.35 ,$56.88 ,$81.90 ,$11.92 ,$86.45 ,$81.90 ,$77.35 ,$77.35 ,$30.94 ,$77.35 ,$77.35 ,$81.90 ,$11.92 ,$13.06 ,$81.90 ,$25.97 ,$83.72 ,$81.90 ,$60.64 ,$60.64 ,$55.42 ,$60.64 ,$59.15 ,$63.38 ,$20.22 ,$71.89 ,$12.64 ,$13.85 ,$13.85 ,$30.94 ,$13.85 ,$11.54 ,$86.45 ,$74.62 ,$74.62 ,$72.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200196,86406,HC PARTICLE AGGLUT TITER,302,1 ,$80.00 ,$40.00 ,$9.85 ,$80.00 ,$9.85 ,$41.37 ,$35.46 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$9.85 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 ,$9.85 ,$12.04 ,$72.00 ,$23.94 ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 ,$10.44 ,$12.77 ,$12.77 ,$27.20 ,$12.77 ,$10.64 ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200197,86430,HC RHEUMATOID FACTOR,302,1 ,$47.00 ,$23.50 ,$6.14 ,$47.00 ,$6.34 ,$22.05 ,$18.90 ,$15.98 ,$37.60 ,$39.95 ,$29.38 ,$42.30 ,$6.34 ,$44.65 ,$42.30 ,$39.95 ,$39.95 ,$15.98 ,$39.95 ,$39.95 ,$42.30 ,$6.34 ,$6.95 ,$42.30 ,$13.82 ,$43.24 ,$42.30 ,$31.32 ,$31.32 ,$28.62 ,$31.32 ,$30.55 ,$32.74 ,$10.44 ,$37.13 ,$6.72 ,$7.37 ,$7.37 ,$15.98 ,$7.37 ,$6.14 ,$44.65 ,$38.54 ,$38.54 ,$37.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200198,86431,HC RHEUMATOID FACTOR QN,302,1 ,$44.00 ,$22.00 ,$5.67 ,$44.00 ,$5.86 ,$22.05 ,$18.90 ,$14.96 ,$35.20 ,$37.40 ,$27.50 ,$39.60 ,$5.86 ,$41.80 ,$39.60 ,$37.40 ,$37.40 ,$14.96 ,$37.40 ,$37.40 ,$39.60 ,$5.86 ,$6.42 ,$39.60 ,$12.76 ,$40.48 ,$39.60 ,$29.32 ,$29.32 ,$26.80 ,$29.32 ,$28.60 ,$30.65 ,$9.78 ,$34.76 ,$6.21 ,$6.80 ,$6.80 ,$14.96 ,$6.80 ,$5.67 ,$41.80 ,$36.08 ,$36.08 ,$35.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200199,86480,HC TB QUANTIFERON GOLD,302,1 ,$435.00 ,$217.50 ,$61.98 ,$435.00 ,$64.04 ,$241.05 ,$206.61 ,$147.90 ,$348.00 ,$369.75 ,$271.88 ,$391.50 ,$64.04 ,$413.25 ,$391.50 ,$369.75 ,$369.75 ,$147.90 ,$369.75 ,$369.75 ,$391.50 ,$64.04 ,$70.15 ,$391.50 ,$139.46 ,$400.20 ,$391.50 ,$289.88 ,$289.88 ,$264.92 ,$289.88 ,$282.75 ,$302.98 ,$96.66 ,$343.65 ,$67.88 ,$74.38 ,$74.38 ,$147.90 ,$74.38 ,$61.98 ,$413.25 ,$356.70 ,$356.70 ,$348.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$67.00 ,$33.50 ,$14.89 ,$67.00 ,$18.39 ,$28.20 ,$24.17 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$18.39 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$18.39 ,$28.14 ,$60.30 ,$56.77 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$19.49 ,$27.59 ,$27.59 ,$22.78 ,$27.59 ,$25.23 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200201,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$32.00 ,$16.00 ,$4.27 ,$32.00 ,$4.41 ,$16.63 ,$14.25 ,$10.88 ,$25.60 ,$27.20 ,$20.00 ,$28.80 ,$4.41 ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$10.88 ,$27.20 ,$27.20 ,$28.80 ,$4.41 ,$4.83 ,$28.80 ,$9.61 ,$29.44 ,$28.80 ,$21.32 ,$21.32 ,$19.49 ,$21.32 ,$20.80 ,$22.29 ,$7.11 ,$25.28 ,$4.67 ,$5.12 ,$5.12 ,$10.88 ,$5.12 ,$4.27 ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200204,86593,HC SYPHILIS VDRL RPR QN,302,1 ,$47.00 ,$23.50 ,$4.40 ,$47.00 ,$4.55 ,$17.12 ,$14.67 ,$15.98 ,$37.60 ,$39.95 ,$29.38 ,$42.30 ,$4.55 ,$44.65 ,$42.30 ,$39.95 ,$39.95 ,$15.98 ,$39.95 ,$39.95 ,$42.30 ,$4.55 ,$4.98 ,$42.30 ,$9.90 ,$43.24 ,$42.30 ,$31.32 ,$31.32 ,$28.62 ,$31.32 ,$30.55 ,$32.74 ,$10.44 ,$37.13 ,$4.82 ,$5.28 ,$5.28 ,$15.98 ,$5.28 ,$4.40 ,$44.65 ,$38.54 ,$38.54 ,$37.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200207,86606,HC ASPERGILLUS AB,302,1 ,$68.00 ,$34.00 ,$8.17 ,$68.00 ,$8.17 ,$58.56 ,$50.19 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 ,$8.17 ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 ,$8.17 ,$17.03 ,$61.20 ,$33.86 ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 ,$8.66 ,$18.06 ,$18.06 ,$23.12 ,$18.06 ,$15.05 ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200208,86606,HC ASPERGILLUS AB (ASPER),302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$56.00 ,$50.19 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$8.17 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$8.17 ,$17.03 ,$50.40 ,$33.86 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$8.66 ,$18.06 ,$18.06 ,$19.04 ,$18.06 ,$15.05 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200211,86609,HC BACTERIUM AB NOS,302,1 ,$35.00 ,$17.50 ,$7.78 ,$35.00 ,$8.17 ,$35.00 ,$35.00 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$8.17 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 ,$8.17 ,$14.58 ,$31.50 ,$28.98 ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 ,$8.66 ,$15.46 ,$15.46 ,$11.90 ,$15.46 ,$12.88 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200212,86611,HC BARTONELLA SCREEN AB,302,1 ,$57.00 ,$28.50 ,$8.17 ,$57.00 ,$8.17 ,$39.59 ,$33.93 ,$19.38 ,$45.60 ,$48.45 ,$35.63 ,$51.30 ,$8.17 ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$19.38 ,$48.45 ,$48.45 ,$51.30 ,$8.17 ,$11.52 ,$51.30 ,$22.91 ,$52.44 ,$51.30 ,$37.98 ,$37.98 ,$34.71 ,$37.98 ,$37.05 ,$39.70 ,$12.67 ,$45.03 ,$8.66 ,$12.22 ,$12.22 ,$19.38 ,$12.22 ,$10.18 ,$54.15 ,$46.74 ,$46.74 ,$45.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200213,86612,HC BLASTOMYCES AB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.19 ,$43.02 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.17 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.17 ,$14.60 ,$70.20 ,$29.03 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$8.66 ,$15.48 ,$15.48 ,$26.52 ,$15.48 ,$12.90 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200214,86612,HC BLASTOMYCES AB (CF/ID),302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.19 ,$43.02 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.17 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.17 ,$14.60 ,$70.20 ,$29.03 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$8.66 ,$15.48 ,$15.48 ,$26.52 ,$15.48 ,$12.90 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200217,86617,HC LYME DISEASE AB CONFIRM (IGG),302,1 ,$123.00 ,$61.50 ,$15.49 ,$123.00 ,$16.01 ,$60.24 ,$51.63 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.01 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.01 ,$17.53 ,$110.70 ,$34.85 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$16.97 ,$18.59 ,$18.59 ,$41.82 ,$18.59 ,$15.49 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200218,86617,HC LYME DISEASE AB CONFIRM (IGM),302,1 ,$123.00 ,$61.50 ,$15.49 ,$123.00 ,$16.01 ,$60.24 ,$51.63 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.01 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.01 ,$17.53 ,$110.70 ,$34.85 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$16.97 ,$18.59 ,$18.59 ,$41.82 ,$18.59 ,$15.49 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200219,86618,HC LYME AB,302,1 ,$134.00 ,$67.00 ,$17.03 ,$134.00 ,$17.60 ,$66.22 ,$56.76 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$17.60 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$17.60 ,$19.27 ,$120.60 ,$38.32 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$18.66 ,$20.44 ,$20.44 ,$45.56 ,$20.44 ,$17.03 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200220,86622,HC BRUCELLA AB (IGG/IGM),302,1 ,$67.00 ,$33.50 ,$8.17 ,$67.00 ,$8.17 ,$34.72 ,$29.76 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.17 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.17 ,$10.11 ,$60.30 ,$20.09 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.66 ,$10.72 ,$10.72 ,$22.78 ,$10.72 ,$8.93 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200221,86622,HC BRUCELLA AB,302,1 ,$60.00 ,$30.00 ,$8.17 ,$60.00 ,$8.17 ,$34.72 ,$29.76 ,$20.40 ,$48.00 ,$51.00 ,$37.50 ,$54.00 ,$8.17 ,$57.00 ,$54.00 ,$51.00 ,$51.00 ,$20.40 ,$51.00 ,$51.00 ,$54.00 ,$8.17 ,$10.11 ,$54.00 ,$20.09 ,$55.20 ,$54.00 ,$39.98 ,$39.98 ,$36.54 ,$39.98 ,$39.00 ,$41.79 ,$13.33 ,$47.40 ,$8.66 ,$10.72 ,$10.72 ,$20.40 ,$10.72 ,$8.93 ,$57.00 ,$49.20 ,$49.20 ,$48.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200222,86628,HC CANDIDA AB,302,1 ,$62.00 ,$31.00 ,$8.17 ,$62.00 ,$8.17 ,$46.69 ,$40.02 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$8.17 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$8.17 ,$13.59 ,$55.80 ,$27.02 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$8.66 ,$14.41 ,$14.41 ,$21.08 ,$14.41 ,$12.01 ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200224,86631,HC CHLAMYDIA AB IGG,302,1 ,$48.00 ,$24.00 ,$8.17 ,$48.00 ,$8.17 ,$45.99 ,$39.42 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$8.17 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$8.17 ,$13.38 ,$43.20 ,$26.60 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$8.66 ,$14.18 ,$14.18 ,$16.32 ,$14.18 ,$11.82 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200225,86631,HC CHLAMYDIA AB (GRP AB),302,1 ,$146.00 ,$73.00 ,$8.17 ,$146.00 ,$8.17 ,$45.99 ,$39.42 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$8.17 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$8.17 ,$13.38 ,$131.40 ,$26.60 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$8.66 ,$14.18 ,$14.18 ,$49.64 ,$14.18 ,$11.82 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200226,86631,HC CHLAMYDIA AB (PSITT IGG/IGA),302,1 ,$17.00 ,$8.50 ,$3.78 ,$26.60 ,$8.17 ,$17.00 ,$17.00 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 ,$8.17 ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 ,$8.17 ,$13.38 ,$15.30 ,$26.60 ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 ,$8.66 ,$14.18 ,$14.18 ,$5.78 ,$14.18 ,$11.82 ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200227,86631,HC CHLAMYDIA AB IGG 2,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$45.99 ,$39.42 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$8.17 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$8.17 ,$13.38 ,$50.40 ,$26.60 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$8.66 ,$14.18 ,$14.18 ,$19.04 ,$14.18 ,$11.82 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200229,86632,HC CHLAMYDIA AB IGM PSITTACI,302,1 ,$17.00 ,$8.50 ,$3.78 ,$28.53 ,$8.17 ,$17.00 ,$17.00 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 ,$8.17 ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 ,$8.17 ,$14.35 ,$15.30 ,$28.53 ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 ,$8.66 ,$15.22 ,$15.22 ,$5.78 ,$15.22 ,$12.68 ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200230,86632,HC CHLAMYDIA AB IGM,302,1 ,$55.00 ,$27.50 ,$8.17 ,$55.00 ,$8.17 ,$49.32 ,$42.27 ,$18.70 ,$44.00 ,$46.75 ,$34.38 ,$49.50 ,$8.17 ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$18.70 ,$46.75 ,$46.75 ,$49.50 ,$8.17 ,$14.35 ,$49.50 ,$28.53 ,$50.60 ,$49.50 ,$36.65 ,$36.65 ,$33.50 ,$36.65 ,$35.75 ,$38.31 ,$12.22 ,$43.45 ,$8.66 ,$15.22 ,$15.22 ,$18.70 ,$15.22 ,$12.68 ,$52.25 ,$45.10 ,$45.10 ,$44.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200231,86635,HC COCCIDIOIDES AB,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$44.63 ,$38.25 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$8.17 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$8.17 ,$12.98 ,$50.40 ,$25.81 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$8.66 ,$13.76 ,$13.76 ,$19.04 ,$13.76 ,$11.47 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200233,86638,HC Q FEVER AB IGG,302,1 ,$72.00 ,$36.00 ,$8.17 ,$72.00 ,$8.17 ,$47.15 ,$40.41 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 ,$8.17 ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 ,$8.17 ,$13.72 ,$64.80 ,$27.27 ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 ,$8.66 ,$14.54 ,$14.54 ,$24.48 ,$14.54 ,$12.12 ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200234,86638,HC Q FEVER AB IGM,302,1 ,$72.00 ,$36.00 ,$8.17 ,$72.00 ,$8.17 ,$47.15 ,$40.41 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 ,$8.17 ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 ,$8.17 ,$13.72 ,$64.80 ,$27.27 ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 ,$8.66 ,$14.54 ,$14.54 ,$24.48 ,$14.54 ,$12.12 ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200235,86645,HC CMV AB IGM,302,1 ,$101.00 ,$50.50 ,$8.17 ,$101.00 ,$8.17 ,$65.52 ,$56.16 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$8.17 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$8.17 ,$19.07 ,$90.90 ,$37.91 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$8.66 ,$20.22 ,$20.22 ,$34.34 ,$20.22 ,$16.85 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200236,86651,HC ENCEPHALITIS CALIFORNIA AB,302,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$51.28 ,$43.95 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$8.17 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$8.17 ,$14.93 ,$50.40 ,$29.68 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$8.66 ,$15.83 ,$15.83 ,$19.04 ,$15.83 ,$13.19 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200237,86652,HC ENCEPHALITIS EQUINE AB,302,1 ,$68.00 ,$34.00 ,$8.17 ,$68.00 ,$8.17 ,$51.28 ,$43.95 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 ,$8.17 ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 ,$8.17 ,$14.93 ,$61.20 ,$29.68 ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 ,$8.66 ,$15.83 ,$15.83 ,$23.12 ,$15.83 ,$13.19 ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200238,86653,HC ENCEPHALITIS ST LOUIS AB,302,1 ,$69.00 ,$34.50 ,$8.17 ,$69.00 ,$8.17 ,$51.28 ,$43.95 ,$23.46 ,$55.20 ,$58.65 ,$43.13 ,$62.10 ,$8.17 ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$23.46 ,$58.65 ,$58.65 ,$62.10 ,$8.17 ,$14.93 ,$62.10 ,$29.68 ,$63.48 ,$62.10 ,$45.98 ,$45.98 ,$42.02 ,$45.98 ,$44.85 ,$48.06 ,$15.33 ,$54.51 ,$8.66 ,$15.83 ,$15.83 ,$23.46 ,$15.83 ,$13.19 ,$65.55 ,$56.58 ,$56.58 ,$55.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200239,86654,HC ENCEPHALITIS WEST EQUINE AB,302,1 ,$68.00 ,$34.00 ,$8.17 ,$68.00 ,$8.17 ,$51.28 ,$43.95 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 ,$8.17 ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 ,$8.17 ,$14.93 ,$61.20 ,$29.68 ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 ,$8.66 ,$15.83 ,$15.83 ,$23.12 ,$15.83 ,$13.19 ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200240,86658,HC ENTEROVIRUS A COXSACKIE,302,1 ,$67.00 ,$33.50 ,$8.17 ,$67.00 ,$8.17 ,$50.65 ,$43.41 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.17 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.17 ,$14.75 ,$60.30 ,$29.32 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.66 ,$15.64 ,$15.64 ,$22.78 ,$15.64 ,$13.03 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200244,86663,HC EBV EARLY AG,302,1 ,$101.00 ,$50.50 ,$13.12 ,$101.00 ,$13.56 ,$51.03 ,$43.74 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.56 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.56 ,$14.85 ,$90.90 ,$29.52 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.37 ,$15.74 ,$15.74 ,$34.34 ,$15.74 ,$13.12 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200245,86664,HC EBV NUCLEAR AG,302,1 ,$112.00 ,$56.00 ,$15.29 ,$112.00 ,$15.80 ,$59.47 ,$50.97 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.80 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.80 ,$17.31 ,$100.80 ,$34.40 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.75 ,$18.35 ,$18.35 ,$38.08 ,$18.35 ,$15.29 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200246,86665,HC EBV VIRAL CAP,302,1 ,$134.00 ,$67.00 ,$18.14 ,$134.00 ,$18.74 ,$70.56 ,$60.48 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$18.74 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$18.74 ,$20.53 ,$120.60 ,$40.82 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$19.86 ,$21.77 ,$21.77 ,$45.56 ,$21.77 ,$18.14 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200247,86666,HC EHRICHIA AB,302,1 ,$39.00 ,$19.50 ,$8.17 ,$39.00 ,$8.17 ,$39.00 ,$33.93 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$8.17 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$8.17 ,$11.52 ,$35.10 ,$22.91 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$8.66 ,$12.22 ,$12.22 ,$13.26 ,$12.22 ,$10.18 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200250,86671,HC FUNGUS AB NOS,302,1 ,$52.00 ,$26.00 ,$7.15 ,$52.00 ,$7.15 ,$47.67 ,$40.86 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$7.15 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$7.15 ,$13.86 ,$46.80 ,$27.56 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$7.58 ,$14.70 ,$14.70 ,$17.68 ,$14.70 ,$12.25 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200251,86677,HC H PYLORI AB,302,1 ,$90.00 ,$45.00 ,$8.17 ,$90.00 ,$8.17 ,$58.98 ,$50.55 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$8.17 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$8.17 ,$19.07 ,$81.00 ,$37.91 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$8.66 ,$20.22 ,$20.22 ,$30.60 ,$20.22 ,$16.85 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200252,86684,HC HAEMOPHILUS INFLUENZA AB,302,1 ,$157.00 ,$78.50 ,$15.84 ,$157.00 ,$16.37 ,$61.60 ,$52.80 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$16.37 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$16.37 ,$17.93 ,$141.30 ,$35.64 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$17.35 ,$19.01 ,$19.01 ,$53.38 ,$19.01 ,$15.84 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200253,86689,HC HIV WESTERN BLOT,302,1 ,$353.00 ,$176.50 ,$19.35 ,$353.00 ,$19.99 ,$75.29 ,$64.53 ,$120.02 ,$282.40 ,$300.05 ,$220.63 ,$317.70 ,$19.99 ,$335.35 ,$317.70 ,$300.05 ,$300.05 ,$120.02 ,$300.05 ,$300.05 ,$317.70 ,$19.99 ,$21.90 ,$317.70 ,$43.54 ,$324.76 ,$317.70 ,$235.24 ,$235.24 ,$214.98 ,$235.24 ,$229.45 ,$245.86 ,$78.44 ,$278.87 ,$21.19 ,$23.22 ,$23.22 ,$120.02 ,$23.22 ,$19.35 ,$335.35 ,$289.46 ,$289.46 ,$282.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200256,86689,HC HIV1 WESTERN BLOT,302,1 ,$141.00 ,$70.50 ,$19.35 ,$141.00 ,$19.99 ,$75.29 ,$64.53 ,$47.94 ,$112.80 ,$119.85 ,$88.13 ,$126.90 ,$19.99 ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$47.94 ,$119.85 ,$119.85 ,$126.90 ,$19.99 ,$21.90 ,$126.90 ,$43.54 ,$129.72 ,$126.90 ,$93.96 ,$93.96 ,$85.87 ,$93.96 ,$91.65 ,$98.21 ,$31.33 ,$111.39 ,$21.19 ,$23.22 ,$23.22 ,$47.94 ,$23.22 ,$19.35 ,$133.95 ,$115.62 ,$115.62 ,$112.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200257,86689,HC HIV2 WESTERN BLOT,302,1 ,$141.00 ,$70.50 ,$19.35 ,$141.00 ,$19.99 ,$75.29 ,$64.53 ,$47.94 ,$112.80 ,$119.85 ,$88.13 ,$126.90 ,$19.99 ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$47.94 ,$119.85 ,$119.85 ,$126.90 ,$19.99 ,$21.90 ,$126.90 ,$43.54 ,$129.72 ,$126.90 ,$93.96 ,$93.96 ,$85.87 ,$93.96 ,$91.65 ,$98.21 ,$31.33 ,$111.39 ,$21.19 ,$23.22 ,$23.22 ,$47.94 ,$23.22 ,$19.35 ,$133.95 ,$115.62 ,$115.62 ,$112.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200258,86692,HC HEPATITIS D AB,302,1 ,$132.00 ,$66.00 ,$17.16 ,$132.00 ,$17.73 ,$66.75 ,$57.21 ,$44.88 ,$105.60 ,$112.20 ,$82.50 ,$118.80 ,$17.73 ,$125.40 ,$118.80 ,$112.20 ,$112.20 ,$44.88 ,$112.20 ,$112.20 ,$118.80 ,$17.73 ,$19.42 ,$118.80 ,$38.61 ,$121.44 ,$118.80 ,$87.96 ,$87.96 ,$80.39 ,$87.96 ,$85.80 ,$91.94 ,$29.33 ,$104.28 ,$18.79 ,$20.59 ,$20.59 ,$44.88 ,$20.59 ,$17.16 ,$125.40 ,$108.24 ,$108.24 ,$105.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200259,86694,HC HERPES SIMPLEX AB,302,1 ,$111.00 ,$55.50 ,$14.39 ,$111.00 ,$14.87 ,$55.97 ,$47.97 ,$37.74 ,$88.80 ,$94.35 ,$69.38 ,$99.90 ,$14.87 ,$105.45 ,$99.90 ,$94.35 ,$94.35 ,$37.74 ,$94.35 ,$94.35 ,$99.90 ,$14.87 ,$16.29 ,$99.90 ,$32.38 ,$102.12 ,$99.90 ,$73.97 ,$73.97 ,$67.60 ,$73.97 ,$72.15 ,$77.31 ,$24.66 ,$87.69 ,$15.76 ,$17.27 ,$17.27 ,$37.74 ,$17.27 ,$14.39 ,$105.45 ,$91.02 ,$91.02 ,$88.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200261,86695,HC HERPES SIMPLEX AB I,302,1 ,$101.00 ,$50.50 ,$13.19 ,$101.00 ,$13.63 ,$51.28 ,$43.95 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.63 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.63 ,$14.93 ,$90.90 ,$29.68 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.45 ,$15.83 ,$15.83 ,$34.34 ,$15.83 ,$13.19 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200262,86695,HC HERPES SIMPLEX IGG I,302,1 ,$96.00 ,$48.00 ,$13.19 ,$96.00 ,$13.63 ,$51.28 ,$43.95 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 ,$13.63 ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 ,$13.63 ,$14.93 ,$86.40 ,$29.68 ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 ,$14.45 ,$15.83 ,$15.83 ,$32.64 ,$15.83 ,$13.19 ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200263,86696,HC HERPES SIMPLEX AB II,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.99 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.99 ,$21.90 ,$131.40 ,$43.54 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$49.64 ,$23.22 ,$19.35 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200264,86696,HC HERPES SIMPLEX IGG II,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.99 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.99 ,$21.90 ,$131.40 ,$43.54 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$49.64 ,$23.22 ,$19.35 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200265,86698,HC HISTOPLASMA AB,302,1 ,$78.00 ,$39.00 ,$13.79 ,$78.00 ,$14.25 ,$48.58 ,$41.64 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$14.25 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$14.25 ,$15.61 ,$70.20 ,$31.03 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$15.11 ,$16.55 ,$16.55 ,$26.52 ,$16.55 ,$13.79 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.17 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.17 ,$15.52 ,$90.90 ,$30.85 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$15.02 ,$16.45 ,$16.45 ,$34.34 ,$16.45 ,$13.71 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200271,86704,HC HEP CORE AB,302,1 ,$90.00 ,$45.00 ,$12.05 ,$90.00 ,$12.45 ,$46.87 ,$40.17 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$12.45 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$12.45 ,$13.64 ,$81.00 ,$27.11 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$13.20 ,$14.46 ,$14.46 ,$30.60 ,$14.46 ,$12.05 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200272,86704,HC HEP CORE AB (ATB),302,1 ,$108.00 ,$54.00 ,$12.05 ,$108.00 ,$12.45 ,$46.87 ,$40.17 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$12.45 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$12.45 ,$13.64 ,$97.20 ,$27.11 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$13.20 ,$14.46 ,$14.46 ,$36.72 ,$14.46 ,$12.05 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200273,86706,HC HEP B SURFACE AB,302,1 ,$78.00 ,$39.00 ,$10.74 ,$78.00 ,$11.10 ,$41.76 ,$35.79 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$11.10 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$11.10 ,$12.16 ,$70.20 ,$24.17 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.77 ,$12.89 ,$12.89 ,$26.52 ,$12.89 ,$10.74 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200274,86706,HC HEP B SURFACE AB (ATB),302,1 ,$59.00 ,$29.50 ,$10.74 ,$59.00 ,$11.10 ,$41.76 ,$35.79 ,$20.06 ,$47.20 ,$50.15 ,$36.88 ,$53.10 ,$11.10 ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$20.06 ,$50.15 ,$50.15 ,$53.10 ,$11.10 ,$12.16 ,$53.10 ,$24.17 ,$54.28 ,$53.10 ,$39.32 ,$39.32 ,$35.93 ,$39.32 ,$38.35 ,$41.09 ,$13.11 ,$46.61 ,$11.77 ,$12.89 ,$12.89 ,$20.06 ,$12.89 ,$10.74 ,$56.05 ,$48.38 ,$48.38 ,$47.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200275,86707,HC HEP B E AB,302,1 ,$67.00 ,$33.50 ,$11.57 ,$67.00 ,$11.96 ,$44.98 ,$38.55 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$11.96 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$11.96 ,$13.09 ,$60.30 ,$26.03 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$12.68 ,$13.88 ,$13.88 ,$22.78 ,$13.88 ,$11.57 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200276,86708,HC HEP A AB TOTAL,302,1 ,$78.00 ,$39.00 ,$12.39 ,$78.00 ,$12.80 ,$48.16 ,$41.28 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$12.80 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$12.80 ,$14.02 ,$70.20 ,$27.88 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$13.57 ,$14.87 ,$14.87 ,$26.52 ,$14.87 ,$12.39 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200277,86709,HC HEP A AB IGM,302,1 ,$157.00 ,$78.50 ,$11.26 ,$157.00 ,$11.63 ,$43.79 ,$37.53 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$11.63 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$11.63 ,$12.74 ,$141.30 ,$25.34 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$12.33 ,$13.51 ,$13.51 ,$53.38 ,$13.51 ,$11.26 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200278,86709,HC HEP ABC AB IGM,302,1 ,$101.00 ,$50.50 ,$11.26 ,$101.00 ,$11.63 ,$43.79 ,$37.53 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$11.63 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$11.63 ,$12.74 ,$90.90 ,$25.34 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$12.33 ,$13.51 ,$13.51 ,$34.34 ,$13.51 ,$11.26 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200279,86713,HC LEGIONELLA AB (PNEUM),302,1 ,$101.00 ,$50.50 ,$15.30 ,$101.00 ,$15.81 ,$59.50 ,$51.00 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$15.81 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$15.81 ,$17.32 ,$90.90 ,$34.43 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$16.76 ,$18.36 ,$18.36 ,$34.34 ,$18.36 ,$15.30 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200280,86713,HC LEGIONELLA AB (IGM),302,1 ,$101.00 ,$50.50 ,$15.30 ,$101.00 ,$15.81 ,$59.50 ,$51.00 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$15.81 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$15.81 ,$17.32 ,$90.90 ,$34.43 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$16.76 ,$18.36 ,$18.36 ,$34.34 ,$18.36 ,$15.30 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200281,86720,HC LEPTOSPIRA AB,302,1 ,$99.00 ,$49.50 ,$8.17 ,$99.00 ,$8.17 ,$56.70 ,$48.60 ,$33.66 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$8.17 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$33.66 ,$84.15 ,$84.15 ,$89.10 ,$8.17 ,$18.34 ,$89.10 ,$36.45 ,$91.08 ,$89.10 ,$65.97 ,$65.97 ,$60.29 ,$65.97 ,$64.35 ,$68.95 ,$22.00 ,$78.21 ,$8.66 ,$19.44 ,$19.44 ,$33.66 ,$19.44 ,$16.20 ,$94.05 ,$81.18 ,$81.18 ,$79.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200282,86735,HC MUMPS AB,302,1 ,$123.00 ,$61.50 ,$13.05 ,$123.00 ,$13.48 ,$50.75 ,$43.50 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$13.48 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$13.48 ,$14.77 ,$110.70 ,$29.36 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$14.29 ,$15.66 ,$15.66 ,$41.82 ,$15.66 ,$13.05 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200283,86735,HC MUMPS QN,302,1 ,$45.00 ,$22.50 ,$10.00 ,$45.00 ,$13.48 ,$45.00 ,$43.50 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 ,$13.48 ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 ,$13.48 ,$14.77 ,$40.50 ,$29.36 ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 ,$14.29 ,$15.66 ,$15.66 ,$15.30 ,$15.66 ,$13.05 ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200284,86738,HC MYCOPLASMA AB,302,1 ,$78.00 ,$39.00 ,$13.24 ,$78.00 ,$13.68 ,$51.49 ,$44.13 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$13.68 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$13.68 ,$14.99 ,$70.20 ,$29.79 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$14.50 ,$15.89 ,$15.89 ,$26.52 ,$15.89 ,$13.24 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200285,86744,HC NOCARDIA AB,302,1 ,$41.00 ,$20.50 ,$8.17 ,$41.00 ,$8.17 ,$41.00 ,$41.00 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$8.17 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$8.17 ,$18.10 ,$36.90 ,$35.98 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$8.66 ,$19.19 ,$19.19 ,$13.94 ,$19.19 ,$15.99 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200286,86747,HC PARVOVIRUS AB,302,1 ,$90.00 ,$45.00 ,$15.03 ,$90.00 ,$15.53 ,$58.45 ,$50.10 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$15.53 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$15.53 ,$17.01 ,$81.00 ,$33.82 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$16.46 ,$18.04 ,$18.04 ,$30.60 ,$18.04 ,$15.03 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200287,86753,HC PROTOZOA AB,302,1 ,$48.00 ,$24.00 ,$8.17 ,$48.00 ,$8.17 ,$48.00 ,$41.28 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$8.17 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$8.17 ,$14.02 ,$43.20 ,$27.88 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$8.66 ,$14.87 ,$14.87 ,$16.32 ,$14.87 ,$12.39 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200288,86762,HC RUBELLA AB,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.87 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.87 ,$16.29 ,$100.80 ,$32.38 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$38.08 ,$17.27 ,$14.39 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200289,86762,HC RUBELLA AB QN,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.87 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.87 ,$16.29 ,$100.80 ,$32.38 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$38.08 ,$17.27 ,$14.39 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200290,86762,HC RUBELLA AB IGG/IGM,302,1 ,$116.00 ,$58.00 ,$14.39 ,$116.00 ,$14.87 ,$55.97 ,$47.97 ,$39.44 ,$92.80 ,$98.60 ,$72.50 ,$104.40 ,$14.87 ,$110.20 ,$104.40 ,$98.60 ,$98.60 ,$39.44 ,$98.60 ,$98.60 ,$104.40 ,$14.87 ,$16.29 ,$104.40 ,$32.38 ,$106.72 ,$104.40 ,$77.30 ,$77.30 ,$70.64 ,$77.30 ,$75.40 ,$80.79 ,$25.78 ,$91.64 ,$15.76 ,$17.27 ,$17.27 ,$39.44 ,$17.27 ,$14.39 ,$110.20 ,$95.12 ,$95.12 ,$92.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200291,86765,HC RUBEOLA AB,302,1 ,$101.00 ,$50.50 ,$12.88 ,$101.00 ,$13.31 ,$50.09 ,$42.93 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.31 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.31 ,$14.58 ,$90.90 ,$28.98 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.11 ,$15.46 ,$15.46 ,$34.34 ,$15.46 ,$12.88 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200292,86765,HC RUBEOLA AB QN,302,1 ,$101.00 ,$50.50 ,$12.88 ,$101.00 ,$13.31 ,$50.09 ,$42.93 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.31 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.31 ,$14.58 ,$90.90 ,$28.98 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.11 ,$15.46 ,$15.46 ,$34.34 ,$15.46 ,$12.88 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200294,86768,HC SALMONELLA,302,1 ,$75.00 ,$37.50 ,$11.50 ,$75.00 ,$11.50 ,$51.28 ,$43.95 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$11.50 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$11.50 ,$14.93 ,$67.50 ,$29.68 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$12.19 ,$15.83 ,$15.83 ,$25.50 ,$15.83 ,$13.19 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200295,86774,HC TETANUS AB,302,1 ,$112.00 ,$56.00 ,$14.80 ,$112.00 ,$15.29 ,$57.54 ,$49.32 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$15.29 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$15.29 ,$16.75 ,$100.80 ,$33.30 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$16.21 ,$17.76 ,$17.76 ,$38.08 ,$17.76 ,$14.80 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200296,86777,HC TOXOPLASMA AB,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.87 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.87 ,$16.29 ,$100.80 ,$32.38 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$38.08 ,$17.27 ,$14.39 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200297,86778,HC TOXOPLASMA AB IGM,302,1 ,$101.00 ,$50.50 ,$14.41 ,$101.00 ,$14.89 ,$56.04 ,$48.03 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$14.89 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$14.89 ,$16.31 ,$90.90 ,$32.42 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$15.78 ,$17.29 ,$17.29 ,$34.34 ,$17.29 ,$14.41 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200298,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$43.00 ,$21.50 ,$9.55 ,$43.00 ,$11.13 ,$43.00 ,$43.00 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 ,$11.13 ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 ,$11.13 ,$14.99 ,$38.70 ,$29.79 ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 ,$11.80 ,$15.89 ,$15.89 ,$14.62 ,$15.89 ,$13.24 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200299,86787,HC VARICELLA ZOSTER ATB,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$50.09 ,$42.93 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.17 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.17 ,$14.58 ,$70.20 ,$28.98 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$8.66 ,$15.46 ,$15.46 ,$26.52 ,$15.46 ,$12.88 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200301,86787,HC VARICELLA ZOSTER QN,302,1 ,$45.00 ,$22.50 ,$8.17 ,$45.00 ,$8.17 ,$45.00 ,$42.93 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 ,$8.17 ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 ,$8.17 ,$14.58 ,$40.50 ,$28.98 ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 ,$8.66 ,$15.46 ,$15.46 ,$15.30 ,$15.46 ,$12.88 ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200303,86788,HC WEST NILE VIRUS AB IGM,302,1 ,$78.00 ,$39.00 ,$8.17 ,$78.00 ,$8.17 ,$65.52 ,$56.16 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.17 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.17 ,$19.07 ,$70.20 ,$37.91 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$8.66 ,$20.22 ,$20.22 ,$26.52 ,$20.22 ,$16.85 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200304,86789,HC WEST NILE AB,302,1 ,$90.00 ,$45.00 ,$14.39 ,$90.00 ,$14.87 ,$55.97 ,$47.97 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$14.87 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$14.87 ,$16.29 ,$81.00 ,$32.38 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$15.76 ,$17.27 ,$17.27 ,$30.60 ,$17.27 ,$14.39 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200305,86790,HC HTLV I/II AB,302,1 ,$78.00 ,$39.00 ,$12.88 ,$78.00 ,$18.39 ,$50.09 ,$42.93 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$18.39 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$18.39 ,$14.58 ,$70.20 ,$28.98 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$19.49 ,$15.46 ,$15.46 ,$26.52 ,$15.46 ,$12.88 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200306,86790,HC HHV6 IGM/IGG,302,1 ,$78.00 ,$39.00 ,$12.88 ,$78.00 ,$18.39 ,$50.09 ,$42.93 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$18.39 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$18.39 ,$14.58 ,$70.20 ,$28.98 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$19.49 ,$15.46 ,$15.46 ,$26.52 ,$15.46 ,$12.88 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200307,86790,HC HERPES VIRUS 7 IGM/IGG,302,1 ,$78.00 ,$39.00 ,$12.88 ,$78.00 ,$18.39 ,$50.09 ,$42.93 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$18.39 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$18.39 ,$14.58 ,$70.20 ,$28.98 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$19.49 ,$15.46 ,$15.46 ,$26.52 ,$15.46 ,$12.88 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200308,86790,HC HERPES VIRUS 8 IGM,302,1 ,$130.00 ,$65.00 ,$12.88 ,$130.00 ,$18.39 ,$50.09 ,$42.93 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$18.39 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$18.39 ,$14.58 ,$117.00 ,$28.98 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$19.49 ,$15.46 ,$15.46 ,$44.20 ,$15.46 ,$12.88 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200310,86694,HC HSV IGM,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.87 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.87 ,$16.29 ,$100.80 ,$32.38 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$38.08 ,$17.27 ,$14.39 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200312,86800,HC THYROGLOBULIN AB,302,1 ,$123.00 ,$61.50 ,$15.91 ,$123.00 ,$16.44 ,$61.85 ,$53.01 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$16.44 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$16.44 ,$18.01 ,$110.70 ,$35.80 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$17.43 ,$19.09 ,$19.09 ,$41.82 ,$19.09 ,$15.91 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200314,86803,HC HEP C AB,302,1 ,$112.00 ,$56.00 ,$14.27 ,$112.00 ,$14.75 ,$55.48 ,$47.55 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.75 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.75 ,$16.15 ,$100.80 ,$32.11 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.64 ,$17.12 ,$17.12 ,$38.08 ,$17.12 ,$14.27 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200316,86804,HC HEP C AB CONFIRM,302,1 ,$164.00 ,$82.00 ,$15.49 ,$164.00 ,$16.01 ,$60.24 ,$51.63 ,$55.76 ,$131.20 ,$139.40 ,$102.50 ,$147.60 ,$16.01 ,$155.80 ,$147.60 ,$139.40 ,$139.40 ,$55.76 ,$139.40 ,$139.40 ,$147.60 ,$16.01 ,$17.53 ,$147.60 ,$34.85 ,$150.88 ,$147.60 ,$109.29 ,$109.29 ,$99.88 ,$109.29 ,$106.60 ,$114.23 ,$36.44 ,$129.56 ,$16.97 ,$18.59 ,$18.59 ,$55.76 ,$18.59 ,$15.49 ,$155.80 ,$134.48 ,$134.48 ,$131.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200319,86808,HC CYTOTOXIC PRA QUICK SCR,302,1 ,$62.00 ,$31.00 ,$13.78 ,$66.78 ,$30.67 ,$62.00 ,$62.00 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$30.67 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$30.67 ,$33.59 ,$55.80 ,$66.78 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$32.51 ,$35.62 ,$35.62 ,$21.08 ,$35.62 ,$29.68 ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 ,$26.67 ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 ,$26.67 ,$29.21 ,$211.50 ,$58.07 ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 ,$28.27 ,$30.97 ,$30.97 ,$79.90 ,$30.97 ,$25.81 ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$200.60 ,$472.00 ,$501.50 ,$368.75 ,$531.00 ,$59.93 ,$560.50 ,$531.00 ,$501.50 ,$501.50 ,$200.60 ,$501.50 ,$501.50 ,$531.00 ,$59.93 ,$65.64 ,$531.00 ,$130.50 ,$542.80 ,$531.00 ,$393.18 ,$393.18 ,$359.31 ,$393.18 ,$383.50 ,$410.94 ,$131.10 ,$466.10 ,$63.53 ,$69.60 ,$69.60 ,$200.60 ,$69.60 ,$58.00 ,$560.50 ,$483.80 ,$483.80 ,$472.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200324,86849,HC IMMUNOASSAY UNLISTED (LEUKO),302,1 ,$62.00 ,$31.00 ,$18.39 ,$62.00 ,$18.39 ,$52.45 ,$52.45 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$18.39 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$18.39 ,$26.04 ,$55.80 ,$37.20 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 , N/A ,$48.98 ,$19.49 ,$31.00 ,$31.00 ,$21.08 ,$31.00 , N/A ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200327,86850,HC AB SCREEN,302,1 ,$90.00 ,$45.00 ,$5.38 ,$114.19 ,$5.38 ,$34.20 ,$29.31 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$5.38 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$5.38 ,$11.06 ,$81.00 ,$114.19 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$5.70 ,$11.72 ,$11.72 ,$30.60 ,$11.72 ,$50.75 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200329,86860,HC ELUTION,302,1 ,$146.00 ,$73.00 ,$32.44 ,$342.72 ,$46.18 ,$109.85 ,$94.16 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$46.18 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$46.18 ,$61.32 ,$131.40 ,$342.72 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$48.95 ,$146.00 ,$146.00 ,$49.64 ,$146.00 ,$152.32 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200331,86870,HC RBC AB ID PANEL,302,1 ,$269.00 ,$134.50 ,$46.18 ,$669.26 ,$46.18 ,$150.89 ,$129.34 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$46.18 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$46.18 ,$112.98 ,$242.10 ,$669.26 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$48.95 ,$269.00 ,$269.00 ,$91.46 ,$269.00 ,$297.45 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200334,86880,HC COOMBS DIRECT,302,1 ,$56.00 ,$28.00 ,$5.57 ,$127.91 ,$5.57 ,$20.97 ,$17.97 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$5.57 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$5.57 ,$6.10 ,$50.40 ,$127.91 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$5.90 ,$6.47 ,$6.47 ,$19.04 ,$6.47 ,$56.85 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200338,86885,HC INDIRECT COOMBS,302,1 ,$80.00 ,$40.00 ,$5.91 ,$342.72 ,$5.91 ,$22.26 ,$19.08 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$5.91 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 ,$5.91 ,$6.47 ,$72.00 ,$342.72 ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 ,$6.26 ,$6.86 ,$6.86 ,$27.20 ,$6.86 ,$152.32 ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200340,86886,HC INDIRECT TITER,302,1 ,$67.00 ,$33.50 ,$5.35 ,$342.72 ,$5.35 ,$20.13 ,$17.25 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$5.35 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$5.35 ,$5.86 ,$60.30 ,$342.72 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$5.67 ,$6.22 ,$6.22 ,$22.78 ,$6.22 ,$152.32 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200342,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$381.00 ,$190.50 ,$46.89 ,$381.00 ,$46.89 ,$346.45 ,$296.95 ,$129.54 ,$304.80 ,$323.85 ,$238.13 ,$342.90 ,$46.89 ,$361.95 ,$342.90 ,$323.85 ,$323.85 ,$129.54 ,$323.85 ,$323.85 ,$342.90 ,$46.89 ,$160.02 ,$342.90 ,$342.72 ,$350.52 ,$342.90 ,$253.90 ,$253.90 ,$232.03 ,$253.90 ,$247.65 ,$265.37 ,$84.66 ,$300.99 ,$49.70 ,$172.20 ,$172.20 ,$129.54 ,$172.20 ,$152.32 ,$361.95 ,$312.42 ,$312.42 ,$304.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200344,86900,HC BLOOD TYPING ABO,302,1 ,$40.00 ,$20.00 ,$3.09 ,$259.11 ,$3.09 ,$11.62 ,$9.96 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 ,$3.09 ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 ,$3.09 ,$3.38 ,$36.00 ,$259.11 ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 ,$3.28 ,$3.59 ,$3.59 ,$13.60 ,$3.59 ,$115.16 ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200346,86901,HC BLOOD TYPING RH,302,1 ,$44.00 ,$22.00 ,$3.09 ,$77.78 ,$3.09 ,$11.62 ,$9.96 ,$14.96 ,$35.20 ,$37.40 ,$27.50 ,$39.60 ,$3.09 ,$41.80 ,$39.60 ,$37.40 ,$37.40 ,$14.96 ,$37.40 ,$37.40 ,$39.60 ,$3.09 ,$3.38 ,$39.60 ,$77.78 ,$40.48 ,$39.60 ,$29.32 ,$29.32 ,$26.80 ,$29.32 ,$28.60 ,$30.65 ,$9.78 ,$34.76 ,$3.28 ,$3.59 ,$3.59 ,$14.96 ,$3.59 ,$34.57 ,$41.80 ,$36.08 ,$36.08 ,$35.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200349,86902,HC RBC AG SCR RGT SERUM,302,1 ,$78.00 ,$39.00 ,$5.37 ,$669.26 ,$5.37 ,$22.23 ,$19.05 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$5.37 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$5.37 ,$7.19 ,$70.20 ,$669.26 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$5.69 ,$7.62 ,$7.62 ,$26.52 ,$7.62 ,$297.45 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200350,86902,HC RBC AG SCR RGT SERUM PER UNIT,302,1 ,$114.00 ,$57.00 ,$5.37 ,$669.26 ,$5.37 ,$22.23 ,$19.05 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 ,$5.37 ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 ,$5.37 ,$7.19 ,$102.60 ,$669.26 ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 ,$5.69 ,$7.62 ,$7.62 ,$38.76 ,$7.62 ,$297.45 ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200352,86904,HC RBC AG SCR PAT SERUM,302,1 ,$86.00 ,$43.00 ,$13.37 ,$86.00 ,$13.37 ,$57.19 ,$49.02 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$13.37 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 ,$13.37 ,$18.49 ,$77.40 ,$77.78 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 ,$14.17 ,$19.61 ,$19.61 ,$29.24 ,$19.61 ,$34.57 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200356,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$157.00 ,$78.50 ,$7.15 ,$342.72 ,$7.15 ,$121.92 ,$104.50 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$7.15 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$7.15 ,$65.94 ,$141.30 ,$342.72 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$7.58 ,$157.00 ,$157.00 ,$53.38 ,$157.00 ,$152.32 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200360,86922,HC CROSSMATCH AHG,302,1 ,$157.00 ,$78.50 ,$34.89 ,$342.72 ,$46.18 ,$130.37 ,$111.75 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$46.18 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$46.18 ,$65.94 ,$141.30 ,$342.72 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$48.95 ,$157.00 ,$157.00 ,$53.38 ,$157.00 ,$152.32 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200362,86923,HC CROSSMATCH ELECTRONIC,302,1 ,$157.00 ,$78.50 ,$34.89 ,$342.72 ,$46.18 ,$97.78 ,$83.81 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$46.18 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$46.18 ,$65.94 ,$141.30 ,$342.72 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$48.95 ,$157.00 ,$157.00 ,$53.38 ,$157.00 ,$152.32 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200363,86927,HC FFP THAWING EACH UNIT,302,1 ,$168.00 ,$84.00 ,$37.33 ,$342.72 ,$46.89 ,$68.81 ,$58.98 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$46.89 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$46.89 ,$70.56 ,$151.20 ,$342.72 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$49.70 ,$168.00 ,$168.00 ,$57.12 ,$168.00 ,$152.32 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200364,86940,HC HEOLYSIN AGG AUTO SCREEN,302,1 ,$96.00 ,$48.00 ,$8.77 ,$96.00 ,$9.06 ,$31.89 ,$27.33 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 ,$9.06 ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 ,$9.06 ,$9.93 ,$86.40 ,$19.73 ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 ,$9.60 ,$10.52 ,$10.52 ,$32.64 ,$10.52 ,$8.77 ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200365,86945,HC BLOOD PRODUCT IRRADIATION,302,1 ,$115.00 ,$57.50 ,$25.55 ,$115.00 ,$46.89 ,$102.61 ,$87.95 ,$39.10 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$46.89 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$39.10 ,$97.75 ,$97.75 ,$103.50 ,$46.89 ,$48.30 ,$103.50 ,$77.78 ,$105.80 ,$103.50 ,$76.64 ,$76.64 ,$70.04 ,$76.64 ,$74.75 ,$80.10 ,$25.55 ,$90.85 ,$49.70 ,$40.12 ,$40.12 ,$39.10 ,$40.12 ,$34.57 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200368,86965,HC BLOOD PRODUCT POOL,302,1 ,$127.00 ,$63.50 ,$28.22 ,$342.72 ,$46.89 ,$114.68 ,$98.29 ,$43.18 ,$101.60 ,$107.95 ,$79.38 ,$114.30 ,$46.89 ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$43.18 ,$107.95 ,$107.95 ,$114.30 ,$46.89 ,$53.34 ,$114.30 ,$342.72 ,$116.84 ,$114.30 ,$84.63 ,$84.63 ,$77.34 ,$84.63 ,$82.55 ,$88.46 ,$28.22 ,$100.33 ,$49.70 ,$127.00 ,$127.00 ,$43.18 ,$127.00 ,$152.32 ,$120.65 ,$104.14 ,$104.14 ,$101.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$39.10 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$11.92 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$39.10 ,$97.75 ,$97.75 ,$103.50 ,$11.92 ,$13.06 ,$103.50 ,$25.97 ,$105.80 ,$103.50 ,$76.64 ,$76.64 ,$70.04 ,$76.64 ,$74.75 ,$80.10 ,$25.55 ,$90.85 ,$12.64 ,$13.85 ,$13.85 ,$39.10 ,$13.85 ,$11.54 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200375,86880,HC C3 DIRECT COOMBS,302,1 ,$52.00 ,$26.00 ,$5.57 ,$127.91 ,$5.57 ,$20.97 ,$17.97 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$5.57 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$5.57 ,$6.10 ,$46.80 ,$127.91 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$5.90 ,$6.47 ,$6.47 ,$17.68 ,$6.47 ,$56.85 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$308.38 ,$725.60 ,$770.95 ,$566.88 ,$816.30 ,$139.23 ,$861.65 ,$816.30 ,$770.95 ,$770.95 ,$308.38 ,$770.95 ,$770.95 ,$816.30 ,$139.23 ,$366.42 ,$816.30 ,$728.44 ,$834.44 ,$816.30 ,$604.42 ,$604.42 ,$552.36 ,$604.42 ,$589.55 ,$631.73 ,$201.54 ,$716.53 ,$147.58 ,$388.50 ,$388.50 ,$308.38 ,$388.50 ,$323.75 ,$861.65 ,$743.74 ,$743.74 ,$725.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200448,86757,HC RICKETTSIA IGG,302,1 ,$112.00 ,$56.00 ,$19.35 ,$112.00 ,$19.99 ,$75.29 ,$64.53 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$19.99 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$19.99 ,$21.90 ,$100.80 ,$43.54 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$21.19 ,$23.22 ,$23.22 ,$38.08 ,$23.22 ,$19.35 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200449,86757,HC RICKETTSIA IGM,302,1 ,$112.00 ,$56.00 ,$19.35 ,$112.00 ,$19.99 ,$75.29 ,$64.53 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$19.99 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$19.99 ,$21.90 ,$100.80 ,$43.54 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$21.19 ,$23.22 ,$23.22 ,$38.08 ,$23.22 ,$19.35 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200450,86635,HC COCCID AB IGG/IGM,302,1 ,$137.00 ,$68.50 ,$8.17 ,$137.00 ,$8.17 ,$44.63 ,$38.25 ,$46.58 ,$109.60 ,$116.45 ,$85.63 ,$123.30 ,$8.17 ,$130.15 ,$123.30 ,$116.45 ,$116.45 ,$46.58 ,$116.45 ,$116.45 ,$123.30 ,$8.17 ,$12.98 ,$123.30 ,$25.81 ,$126.04 ,$123.30 ,$91.30 ,$91.30 ,$83.43 ,$91.30 ,$89.05 ,$95.42 ,$30.44 ,$108.23 ,$8.66 ,$13.76 ,$13.76 ,$46.58 ,$13.76 ,$11.47 ,$130.15 ,$112.34 ,$112.34 ,$109.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200460,86038,HC ANA CENTROMERE B AB,302,1 ,$78.00 ,$39.00 ,$12.09 ,$78.00 ,$12.49 ,$47.01 ,$40.29 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$12.49 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$12.49 ,$13.68 ,$70.20 ,$27.20 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$13.24 ,$14.51 ,$14.51 ,$26.52 ,$14.51 ,$12.09 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200500,87804,HC INFLUENZA ASSAY W/OPTIC,302,1 ,$101.00 ,$50.50 ,$16.55 ,$101.00 ,$16.86 ,$57.93 ,$49.65 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$16.86 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$16.86 ,$18.73 ,$90.90 ,$37.24 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$17.87 ,$19.86 ,$19.86 ,$34.34 ,$19.86 ,$16.55 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200501,86682,HC HELMINTH ANTIBODY,302,1 ,$160.00 ,$80.00 ,$8.17 ,$160.00 ,$8.17 ,$50.58 ,$43.35 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$8.17 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$8.17 ,$14.72 ,$144.00 ,$29.27 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$8.66 ,$15.61 ,$15.61 ,$54.40 ,$15.61 ,$13.01 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200502,87272,HC CRYPTOSPORIDIUM,302,1 ,$101.00 ,$50.50 ,$11.98 ,$101.00 ,$12.38 ,$46.62 ,$39.96 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$12.38 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$12.38 ,$13.56 ,$90.90 ,$26.96 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$13.12 ,$14.38 ,$14.38 ,$34.34 ,$14.38 ,$11.98 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200511,86226,HC DNA SINGLE STRAND AB,302,1 ,$115.00 ,$57.50 ,$12.11 ,$115.00 ,$12.51 ,$47.08 ,$40.35 ,$39.10 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$12.51 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$39.10 ,$97.75 ,$97.75 ,$103.50 ,$12.51 ,$13.71 ,$103.50 ,$27.25 ,$105.80 ,$103.50 ,$76.64 ,$76.64 ,$70.04 ,$76.64 ,$74.75 ,$80.10 ,$25.55 ,$90.85 ,$13.26 ,$14.53 ,$14.53 ,$39.10 ,$14.53 ,$12.11 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200513,86256,HC FLUOR AB TITER,302,1 ,$86.00 ,$43.00 ,$12.05 ,$86.00 ,$12.45 ,$46.87 ,$40.17 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$12.45 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 ,$12.45 ,$13.64 ,$77.40 ,$27.11 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 ,$13.20 ,$14.46 ,$14.46 ,$29.24 ,$14.46 ,$12.05 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200540,86701,HC HIV-1 AB,302,1 ,$90.00 ,$45.00 ,$8.89 ,$90.00 ,$9.19 ,$34.55 ,$29.61 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$9.19 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$9.19 ,$10.06 ,$81.00 ,$20.00 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$9.74 ,$10.67 ,$10.67 ,$30.60 ,$10.67 ,$8.89 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200541,86702,HC HIV-2 AB,302,1 ,$90.00 ,$45.00 ,$13.52 ,$90.00 ,$13.97 ,$52.57 ,$45.06 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$13.97 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$13.97 ,$15.30 ,$81.00 ,$30.42 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$14.81 ,$16.22 ,$16.22 ,$30.60 ,$16.22 ,$13.52 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 ,$90.12 ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 ,$90.12 ,$113.18 ,$423.00 ,$225.00 ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 ,$95.53 ,$120.00 ,$120.00 ,$159.80 ,$120.00 ,$100.00 ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200582,86382,HC RABIES VACCINE RESPONSE TTR,302,1 ,$157.00 ,$78.50 ,$16.91 ,$157.00 ,$17.47 ,$65.77 ,$56.37 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$17.47 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$17.47 ,$19.14 ,$141.30 ,$38.05 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$18.52 ,$20.29 ,$20.29 ,$53.38 ,$20.29 ,$16.91 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200583,86382,HC POLIOVIRUS AB NEUTRALIZATION,302,1 ,$44.00 ,$22.00 ,$9.78 ,$44.00 ,$17.47 ,$44.00 ,$44.00 ,$14.96 ,$35.20 ,$37.40 ,$27.50 ,$39.60 ,$17.47 ,$41.80 ,$39.60 ,$37.40 ,$37.40 ,$14.96 ,$37.40 ,$37.40 ,$39.60 ,$17.47 ,$19.14 ,$39.60 ,$38.05 ,$40.48 ,$39.60 ,$29.32 ,$29.32 ,$26.80 ,$29.32 ,$28.60 ,$30.65 ,$9.78 ,$34.76 ,$18.52 ,$20.29 ,$20.29 ,$14.96 ,$20.29 ,$16.91 ,$41.80 ,$36.08 ,$36.08 ,$35.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200584,86658,HC ENTEROVIRUS PANEL CF SERUM,302,1 ,$146.00 ,$73.00 ,$8.17 ,$146.00 ,$8.17 ,$50.65 ,$43.41 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$8.17 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$8.17 ,$14.75 ,$131.40 ,$29.32 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$8.66 ,$15.64 ,$15.64 ,$49.64 ,$15.64 ,$13.03 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200585,86800,HC THYROGLOBULIN AB CANCER MONITORING,302,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 ,$16.44 ,$50.00 ,$50.00 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$16.44 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$16.44 ,$18.01 ,$45.00 ,$35.80 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$17.43 ,$19.09 ,$19.09 ,$17.00 ,$19.09 ,$15.91 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200586,86790,HC VIRUS AB DENGUE FEVER IGG/IGMA,302,1 ,$112.00 ,$56.00 ,$12.88 ,$112.00 ,$18.39 ,$50.09 ,$42.93 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$18.39 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$18.39 ,$14.58 ,$100.80 ,$28.98 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$19.49 ,$15.46 ,$15.46 ,$38.08 ,$15.46 ,$12.88 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200587,86753,HC PROTOZOA AB ENTAMOEBA HISTOLYTICA IGG,302,1 ,$95.00 ,$47.50 ,$8.17 ,$95.00 ,$8.17 ,$48.16 ,$41.28 ,$32.30 ,$76.00 ,$80.75 ,$59.38 ,$85.50 ,$8.17 ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$32.30 ,$80.75 ,$80.75 ,$85.50 ,$8.17 ,$14.02 ,$85.50 ,$27.88 ,$87.40 ,$85.50 ,$63.31 ,$63.31 ,$57.86 ,$63.31 ,$61.75 ,$66.17 ,$21.11 ,$75.05 ,$8.66 ,$14.87 ,$14.87 ,$32.30 ,$14.87 ,$12.39 ,$90.25 ,$77.90 ,$77.90 ,$76.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200822,86705,HC HEP B CORE IGM,302,1 ,$168.00 ,$84.00 ,$11.77 ,$168.00 ,$12.16 ,$45.78 ,$39.24 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$12.16 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$12.16 ,$13.32 ,$151.20 ,$26.48 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$12.89 ,$14.12 ,$14.12 ,$57.12 ,$14.12 ,$11.77 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200824,86644,HC CMV AB,302,1 ,$112.00 ,$56.00 ,$14.39 ,$112.00 ,$14.87 ,$55.97 ,$47.97 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.87 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.87 ,$16.29 ,$100.80 ,$32.38 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.76 ,$17.27 ,$17.27 ,$38.08 ,$17.27 ,$14.39 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200825,86671,HC FUNGUS AB NOS 2-REF,302,1 ,$52.00 ,$26.00 ,$7.15 ,$52.00 ,$7.15 ,$47.67 ,$40.86 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$7.15 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$7.15 ,$13.86 ,$46.80 ,$27.56 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$7.58 ,$14.70 ,$14.70 ,$17.68 ,$14.70 ,$12.25 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200830,87801,HC INFECT MLT  ORG AMP,302,1 ,$538.00 ,$269.00 ,$50.62 ,$538.00 ,$50.62 ,$272.97 ,$233.97 ,$182.92 ,$430.40 ,$457.30 ,$336.25 ,$484.20 ,$50.62 ,$511.10 ,$484.20 ,$457.30 ,$457.30 ,$182.92 ,$457.30 ,$457.30 ,$484.20 ,$50.62 ,$79.45 ,$484.20 ,$157.95 ,$494.96 ,$484.20 ,$358.52 ,$358.52 ,$327.64 ,$358.52 ,$349.70 ,$374.72 ,$119.54 ,$425.02 ,$53.66 ,$84.24 ,$84.24 ,$182.92 ,$84.24 ,$70.20 ,$511.10 ,$441.16 ,$441.16 ,$430.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200833,86406,HC STREPTOZYME TITER,302,1 ,$77.00 ,$38.50 ,$9.85 ,$77.00 ,$9.85 ,$41.37 ,$35.46 ,$26.18 ,$61.60 ,$65.45 ,$48.13 ,$69.30 ,$9.85 ,$73.15 ,$69.30 ,$65.45 ,$65.45 ,$26.18 ,$65.45 ,$65.45 ,$69.30 ,$9.85 ,$12.04 ,$69.30 ,$23.94 ,$70.84 ,$69.30 ,$51.31 ,$51.31 ,$46.89 ,$51.31 ,$50.05 ,$53.63 ,$17.11 ,$60.83 ,$10.44 ,$12.77 ,$12.77 ,$26.18 ,$12.77 ,$10.64 ,$73.15 ,$63.14 ,$63.14 ,$61.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200835,86790,HC HANTAVIRUS (SIN NOMBRE) ELISA,302,1 ,$68.00 ,$34.00 ,$12.88 ,$68.00 ,$18.39 ,$50.09 ,$42.93 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 ,$18.39 ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 ,$18.39 ,$14.58 ,$61.20 ,$28.98 ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 ,$19.49 ,$15.46 ,$15.46 ,$23.12 ,$15.46 ,$12.88 ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200836,86790,HC HANTAVIRUS (SIN NOMBRE) IGG,302,1 ,$120.00 ,$60.00 ,$12.88 ,$120.00 ,$18.39 ,$50.09 ,$42.93 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$18.39 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 ,$18.39 ,$14.58 ,$108.00 ,$28.98 ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 ,$19.49 ,$15.46 ,$15.46 ,$40.80 ,$15.46 ,$12.88 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200837,86790,HC HANTAVIRUS (SIN NOMBRE) IGM,302,1 ,$68.00 ,$34.00 ,$12.88 ,$68.00 ,$18.39 ,$50.09 ,$42.93 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 ,$18.39 ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 ,$18.39 ,$14.58 ,$61.20 ,$28.98 ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 ,$19.49 ,$15.46 ,$15.46 ,$23.12 ,$15.46 ,$12.88 ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200841,86671,HC FUNGUS AB SACC CEREVISIAE,302,1 ,$147.00 ,$73.50 ,$7.15 ,$147.00 ,$7.15 ,$47.67 ,$40.86 ,$49.98 ,$117.60 ,$124.95 ,$91.88 ,$132.30 ,$7.15 ,$139.65 ,$132.30 ,$124.95 ,$124.95 ,$49.98 ,$124.95 ,$124.95 ,$132.30 ,$7.15 ,$13.86 ,$132.30 ,$27.56 ,$135.24 ,$132.30 ,$97.96 ,$97.96 ,$89.52 ,$97.96 ,$95.55 ,$102.39 ,$32.66 ,$116.13 ,$7.58 ,$14.70 ,$14.70 ,$49.98 ,$14.70 ,$12.25 ,$139.65 ,$120.54 ,$120.54 ,$117.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$609.28 ,"$1,433.60 ","$1,523.20 ","$1,120.00 ","$1,612.80 ",$15.79 ,"$1,702.40 ","$1,612.80 ","$1,523.20 ","$1,523.20 ",$609.28 ,"$1,523.20 ","$1,523.20 ","$1,612.80 ",$15.79 ,$19.12 ,"$1,612.80 ",$38.00 ,"$1,648.64 ","$1,612.80 ","$1,194.19 ","$1,194.19 ","$1,091.33 ","$1,194.19 ","$1,164.80 ","$1,248.13 ",$398.18 ,"$1,415.68 ",$16.74 ,$20.27 ,$20.27 ,$609.28 ,$20.27 ,$16.89 ,"$1,702.40 ","$1,469.44 ","$1,469.44 ","$1,433.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$238.68 ,$561.60 ,$596.70 ,$438.75 ,$631.80 ,$15.79 ,$666.90 ,$631.80 ,$596.70 ,$596.70 ,$238.68 ,$596.70 ,$596.70 ,$631.80 ,$15.79 ,$19.12 ,$631.80 ,$38.00 ,$645.84 ,$631.80 ,$467.81 ,$467.81 ,$427.52 ,$467.81 ,$456.30 ,$488.94 ,$155.98 ,$554.58 ,$16.74 ,$20.27 ,$20.27 ,$238.68 ,$20.27 ,$16.89 ,$666.90 ,$575.64 ,$575.64 ,$561.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201080,G0472,HC HEPATITIS C SCREEN HIGH RISK,302,1 ,$108.00 ,$54.00 ,$24.00 ,$108.00 ,$53.37 ,$108.00 ,$108.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$53.37 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$53.37 ,$52.46 ,$97.20 ,$104.29 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$56.57 ,$55.62 ,$55.62 ,$36.72 ,$55.62 ,$46.35 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201081,86695,HC HERPES SIMPLEX IGM I,302,1 ,$101.00 ,$50.50 ,$13.19 ,$101.00 ,$13.63 ,$51.28 ,$43.95 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$13.63 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$13.63 ,$14.93 ,$90.90 ,$29.68 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$14.45 ,$15.83 ,$15.83 ,$34.34 ,$15.83 ,$13.19 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201082,86696,HC HERPES SIMPLEX IGM II,302,1 ,$146.00 ,$73.00 ,$19.35 ,$146.00 ,$19.99 ,$75.29 ,$64.53 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$19.99 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$19.99 ,$21.90 ,$131.40 ,$43.54 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$21.19 ,$23.22 ,$23.22 ,$49.64 ,$23.22 ,$19.35 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201085,86481,HC TSPOT TB AG RESPONSE GAMMA INTER T-CELL SUSP,302,1 ,$291.00 ,$145.50 ,$64.66 ,$291.00 ,$90.12 ,$291.00 ,$291.00 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$90.12 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$90.12 ,$113.18 ,$261.90 ,$225.00 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$95.53 ,$120.00 ,$120.00 ,$98.94 ,$120.00 ,$100.00 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201087,86317,HC INFECTIOUS STREPTOCOCCUS PNEUMONIAE EA AB,302,1 ,$90.00 ,$45.00 ,$14.99 ,$90.00 ,$15.49 ,$58.28 ,$49.95 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$15.49 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$15.49 ,$16.97 ,$81.00 ,$33.73 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$16.42 ,$17.99 ,$17.99 ,$30.60 ,$17.99 ,$14.99 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201090,86780,HC TREPONEMA P AB SCREEN,302,1 ,$43.00 ,$21.50 ,$9.55 ,$43.00 ,$11.13 ,$43.00 ,$43.00 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 ,$11.13 ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 ,$11.13 ,$14.99 ,$38.70 ,$29.79 ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 ,$11.80 ,$15.89 ,$15.89 ,$14.62 ,$15.89 ,$13.24 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 ,$12.45 ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 ,$12.45 ,$13.64 ,$126.00 ,$27.11 ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 ,$13.20 ,$14.46 ,$14.46 ,$47.60 ,$14.46 ,$12.05 ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201182,86255,HC FLUOR AB SCR (CRITHIDIA TITER W/REFLEX)-REF,302,1 ,$18.00 ,$9.00 ,$4.00 ,$27.11 ,$12.45 ,$18.00 ,$18.00 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 ,$12.45 ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 ,$12.45 ,$13.64 ,$16.20 ,$27.11 ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 ,$13.20 ,$14.46 ,$14.46 ,$6.12 ,$14.46 ,$12.05 ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30240102,86003,HC ALLERGEN IGE QN EA-REF,302,1 ,$10.10 ,$5.05 ,$2.24 ,$11.75 ,$4.57 ,$10.10 ,$10.10 ,$3.43 ,$8.08 ,$8.59 ,$6.31 ,$9.09 ,$4.57 ,$9.60 ,$9.09 ,$8.59 ,$8.59 ,$3.43 ,$8.59 ,$8.59 ,$9.09 ,$4.57 ,$5.91 ,$9.09 ,$11.75 ,$9.29 ,$9.09 ,$6.73 ,$6.73 ,$6.15 ,$6.73 ,$6.57 ,$7.03 ,$2.24 ,$7.98 ,$4.84 ,$6.26 ,$6.26 ,$3.43 ,$6.26 ,$5.22 ,$9.60 ,$8.28 ,$8.28 ,$8.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30240129,86157,HC COLD AGGLUTININ TITER-REF,302,1 ,$10.00 ,$5.00 ,$2.22 ,$18.14 ,$8.17 ,$10.00 ,$10.00 ,$3.40 ,$8.00 ,$8.50 ,$6.25 ,$9.00 ,$8.17 ,$9.50 ,$9.00 ,$8.50 ,$8.50 ,$3.40 ,$8.50 ,$8.50 ,$9.00 ,$8.17 ,$9.12 ,$9.00 ,$18.14 ,$9.20 ,$9.00 ,$6.66 ,$6.66 ,$6.09 ,$6.66 ,$6.50 ,$6.97 ,$2.22 ,$7.90 ,$8.66 ,$9.67 ,$9.67 ,$3.40 ,$9.67 ,$8.06 ,$9.50 ,$8.20 ,$8.20 ,$8.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30240192,86403,HC CRYPTOCOCAL ANTIGEN-REF,302,1 ,$20.00 ,$10.00 ,$4.44 ,$25.97 ,$11.92 ,$20.00 ,$20.00 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 ,$11.92 ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 ,$11.92 ,$13.06 ,$18.00 ,$25.97 ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 ,$12.64 ,$13.85 ,$13.85 ,$6.80 ,$13.85 ,$11.54 ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500098,85421,HC PLASMINOGEN ANTIGENIC,305,1 ,$143.00 ,$71.50 ,$10.18 ,$143.00 ,$10.52 ,$39.62 ,$33.96 ,$48.62 ,$114.40 ,$121.55 ,$89.38 ,$128.70 ,$10.52 ,$135.85 ,$128.70 ,$121.55 ,$121.55 ,$48.62 ,$121.55 ,$121.55 ,$128.70 ,$10.52 ,$11.52 ,$128.70 ,$22.91 ,$131.56 ,$128.70 ,$95.30 ,$95.30 ,$87.09 ,$95.30 ,$92.95 ,$99.60 ,$31.77 ,$112.97 ,$11.15 ,$12.22 ,$12.22 ,$48.62 ,$12.22 ,$10.18 ,$135.85 ,$117.26 ,$117.26 ,$114.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$35.00 ,$17.50 ,$3.80 ,$35.00 ,$3.93 ,$13.37 ,$11.46 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$3.93 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 ,$3.93 ,$4.30 ,$31.50 ,$8.55 ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 ,$7.78 ,$27.65 ,$4.17 ,$4.56 ,$4.56 ,$11.90 ,$4.56 ,$3.80 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500104,85014,HC HEMATOCRIT,305,1 ,$18.00 ,$9.00 ,$2.37 ,$18.00 ,$2.45 ,$9.21 ,$7.89 ,$6.12 ,$14.40 ,$15.30 ,$11.25 ,$16.20 ,$2.45 ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$6.12 ,$15.30 ,$15.30 ,$16.20 ,$2.45 ,$2.68 ,$16.20 ,$5.33 ,$16.56 ,$16.20 ,$12.00 ,$12.00 ,$10.96 ,$12.00 ,$11.70 ,$12.54 ,$4.00 ,$14.22 ,$2.60 ,$2.84 ,$2.84 ,$6.12 ,$2.84 ,$2.37 ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500106,85018,HC HGB,305,1 ,$19.00 ,$9.50 ,$2.37 ,$19.00 ,$2.45 ,$9.21 ,$7.89 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 ,$2.45 ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 ,$2.45 ,$2.68 ,$17.10 ,$5.33 ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 ,$2.60 ,$2.84 ,$2.84 ,$6.46 ,$2.84 ,$2.37 ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$67.00 ,$33.50 ,$7.77 ,$67.00 ,$8.03 ,$30.21 ,$25.89 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.03 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.03 ,$8.79 ,$60.30 ,$17.48 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.51 ,$9.32 ,$9.32 ,$22.78 ,$9.32 ,$7.77 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500108,85027,HC CBC W/O DIFF,305,1 ,$49.00 ,$24.50 ,$6.47 ,$49.00 ,$6.69 ,$25.13 ,$21.54 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 ,$6.69 ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 ,$6.69 ,$7.32 ,$44.10 ,$14.56 ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 ,$7.09 ,$7.76 ,$7.76 ,$16.66 ,$7.76 ,$6.47 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500109,85027,HC HISTOGRAM,305,1 ,$49.00 ,$24.50 ,$6.47 ,$49.00 ,$6.69 ,$25.13 ,$21.54 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 ,$6.69 ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 ,$6.69 ,$7.32 ,$44.10 ,$14.56 ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 ,$7.09 ,$7.76 ,$7.76 ,$16.66 ,$7.76 ,$6.47 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500110,85044,HC RETIC COUNT MANUAL,305,1 ,$146.00 ,$73.00 ,$4.31 ,$146.00 ,$4.45 ,$16.77 ,$14.37 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$4.45 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$4.45 ,$4.88 ,$131.40 ,$9.70 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$4.72 ,$5.17 ,$5.17 ,$49.64 ,$5.17 ,$4.31 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500111,85045,HC RETIC COUNT AUTO,305,1 ,$34.00 ,$17.00 ,$3.99 ,$34.00 ,$4.12 ,$15.54 ,$13.32 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 ,$4.12 ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 ,$4.12 ,$4.52 ,$30.60 ,$8.98 ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 ,$4.37 ,$4.79 ,$4.79 ,$11.56 ,$4.79 ,$3.99 ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$19.00 ,$9.50 ,$2.54 ,$19.00 ,$2.62 ,$9.87 ,$8.46 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 ,$2.62 ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 ,$2.62 ,$2.87 ,$17.10 ,$5.72 ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 ,$2.78 ,$3.05 ,$3.05 ,$6.46 ,$3.05 ,$2.54 ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$38.00 ,$19.00 ,$4.48 ,$38.00 ,$4.63 ,$17.40 ,$14.91 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.63 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.63 ,$5.07 ,$34.20 ,$10.08 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.91 ,$5.38 ,$5.38 ,$12.92 ,$5.38 ,$4.48 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500117,85097,HC BONE MARROW SMEAR INTERP (MAYO),305,1 ,$457.00 ,$228.50 ,$69.95 ,"$1,505.90 ",$69.95 ,$172.66 ,$148.00 ,$155.38 ,$365.60 ,$388.45 ,$285.63 ,$411.30 ,$69.95 ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$155.38 ,$388.45 ,$388.45 ,$411.30 ,$69.95 ,$191.94 ,$411.30 ,"$1,505.90 ",$420.44 ,$411.30 ,$304.54 ,$304.54 ,$278.31 ,$304.54 ,$297.05 ,$318.30 ,$101.55 ,$361.03 ,$74.15 ,$457.00 ,$457.00 ,$155.38 ,$457.00 ,$669.29 ,$434.15 ,$374.74 ,$374.74 ,$365.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500119,85175,HC CLOT LYSIS TIME,305,1 ,$78.00 ,$39.00 ,$6.40 ,$78.00 ,$6.40 ,$71.30 ,$61.11 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$6.40 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$6.40 ,$23.05 ,$70.20 ,$45.83 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$6.78 ,$24.44 ,$24.44 ,$26.52 ,$24.44 ,$20.37 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500121,85210,HC FACTOR II,305,1 ,$101.00 ,$50.50 ,$8.17 ,$101.00 ,$8.17 ,$50.51 ,$43.29 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$8.17 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$8.17 ,$14.69 ,$90.90 ,$29.21 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$8.66 ,$15.58 ,$15.58 ,$34.34 ,$15.58 ,$12.98 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500123,85220,HC FACTOR V,305,1 ,$168.00 ,$84.00 ,$17.65 ,$168.00 ,$18.24 ,$68.64 ,$58.83 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$18.24 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$18.24 ,$19.98 ,$151.20 ,$39.71 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$19.33 ,$21.18 ,$21.18 ,$57.12 ,$21.18 ,$17.65 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500125,85230,HC FACTOR VII,305,1 ,$168.00 ,$84.00 ,$17.90 ,$168.00 ,$18.50 ,$69.62 ,$59.67 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$18.50 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$18.50 ,$20.26 ,$151.20 ,$40.28 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$19.61 ,$21.48 ,$21.48 ,$57.12 ,$21.48 ,$17.90 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500126,85240,HC FACTOR VIII AHG,305,1 ,$101.00 ,$50.50 ,$9.84 ,$101.00 ,$9.84 ,$69.62 ,$59.67 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$9.84 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$9.84 ,$20.26 ,$90.90 ,$40.28 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$10.43 ,$21.48 ,$21.48 ,$34.34 ,$21.48 ,$17.90 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500131,85245,HC FACTOR VIII VW RISTO (VW),305,1 ,$179.00 ,$89.50 ,$22.94 ,$179.00 ,$23.70 ,$89.22 ,$76.47 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$23.70 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$23.70 ,$25.96 ,$161.10 ,$51.62 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$25.12 ,$27.53 ,$27.53 ,$60.86 ,$27.53 ,$22.94 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500132,85246,HC FACTOR VIII VW AG,305,1 ,$157.00 ,$78.50 ,$22.94 ,$157.00 ,$23.70 ,$89.22 ,$76.47 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$23.70 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$23.70 ,$25.96 ,$141.30 ,$51.62 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$25.12 ,$27.53 ,$27.53 ,$53.38 ,$27.53 ,$22.94 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500136,85247,HC FACTOR VW MULTIM ANALY,305,1 ,$213.00 ,$106.50 ,$22.94 ,$213.00 ,$23.70 ,$89.22 ,$76.47 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$23.70 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$23.70 ,$25.96 ,$191.70 ,$51.62 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$25.12 ,$27.53 ,$27.53 ,$72.42 ,$27.53 ,$22.94 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500138,85250,HC FACTOR IX,305,1 ,$224.00 ,$112.00 ,$19.04 ,$224.00 ,$19.67 ,$74.06 ,$63.48 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$19.67 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$19.67 ,$21.55 ,$201.60 ,$42.84 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$20.85 ,$22.85 ,$22.85 ,$76.16 ,$22.85 ,$19.04 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500142,85260,HC FACTOR X,305,1 ,$157.00 ,$78.50 ,$17.90 ,$157.00 ,$18.50 ,$69.62 ,$59.67 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$18.50 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$18.50 ,$20.26 ,$141.30 ,$40.28 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$19.61 ,$21.48 ,$21.48 ,$53.38 ,$21.48 ,$17.90 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500144,85270,HC FACTOR XI,305,1 ,$168.00 ,$84.00 ,$17.90 ,$168.00 ,$18.50 ,$69.62 ,$59.67 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$18.50 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$18.50 ,$20.26 ,$151.20 ,$40.28 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$19.61 ,$21.48 ,$21.48 ,$57.12 ,$21.48 ,$17.90 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500146,85280,HC FACTOR XII,305,1 ,$123.00 ,$61.50 ,$19.35 ,$123.00 ,$19.99 ,$75.25 ,$64.50 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$19.99 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$19.99 ,$21.90 ,$110.70 ,$43.54 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$21.19 ,$23.22 ,$23.22 ,$41.82 ,$23.22 ,$19.35 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500147,85291,HC FACTOR XIII SOL SCR,305,1 ,$56.00 ,$28.00 ,$9.11 ,$56.00 ,$9.41 ,$34.58 ,$29.64 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$9.41 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$9.41 ,$10.31 ,$50.40 ,$20.50 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$9.97 ,$10.93 ,$10.93 ,$19.04 ,$10.93 ,$9.11 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500149,85300,HC ANTITHROMBIN III ACT,305,1 ,$146.00 ,$73.00 ,$11.85 ,$146.00 ,$12.24 ,$46.10 ,$39.51 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$12.24 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$12.24 ,$13.41 ,$131.40 ,$26.66 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$12.97 ,$14.22 ,$14.22 ,$49.64 ,$14.22 ,$11.85 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500150,85300,HC ANTITHROMBIN III,305,1 ,$146.00 ,$73.00 ,$11.85 ,$146.00 ,$12.24 ,$46.10 ,$39.51 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$12.24 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$12.24 ,$13.41 ,$131.40 ,$26.66 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$12.97 ,$14.22 ,$14.22 ,$49.64 ,$14.22 ,$11.85 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500151,85301,HC ANTITHROMBIN III AG,305,1 ,$101.00 ,$50.50 ,$10.81 ,$101.00 ,$11.17 ,$42.04 ,$36.03 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$11.17 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$11.17 ,$12.23 ,$90.90 ,$24.32 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$11.84 ,$12.97 ,$12.97 ,$34.34 ,$12.97 ,$10.81 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500153,85302,HC PROTEIN C AG,305,1 ,$146.00 ,$73.00 ,$12.01 ,$146.00 ,$12.41 ,$46.73 ,$40.05 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$12.41 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$12.41 ,$13.59 ,$131.40 ,$27.02 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$13.15 ,$14.41 ,$14.41 ,$49.64 ,$14.41 ,$12.01 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500154,85303,HC PROTEIN C ACTIVITY,305,1 ,$123.00 ,$61.50 ,$13.84 ,$123.00 ,$14.30 ,$53.80 ,$46.11 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$14.30 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$14.30 ,$15.66 ,$110.70 ,$31.14 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$15.16 ,$16.61 ,$16.61 ,$41.82 ,$16.61 ,$13.84 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500156,85305,HC PROTEIN S TOTAL,305,1 ,$146.00 ,$73.00 ,$11.61 ,$146.00 ,$12.00 ,$45.15 ,$38.70 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$12.00 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$12.00 ,$13.14 ,$131.40 ,$26.12 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$12.72 ,$13.93 ,$13.93 ,$49.64 ,$13.93 ,$11.61 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500158,85306,HC PROTEIN S FREE (2),305,1 ,$246.00 ,$123.00 ,$15.32 ,$246.00 ,$15.83 ,$59.61 ,$51.09 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$15.83 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$15.83 ,$17.34 ,$221.40 ,$34.47 ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$16.78 ,$18.38 ,$18.38 ,$83.64 ,$18.38 ,$15.32 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500159,85306,HC PROTEIN S FREE,305,1 ,$146.00 ,$73.00 ,$15.32 ,$146.00 ,$15.83 ,$59.61 ,$51.09 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$15.83 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$15.83 ,$17.34 ,$131.40 ,$34.47 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$16.78 ,$18.38 ,$18.38 ,$49.64 ,$18.38 ,$15.32 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500164,85307,HC ACTIV PROTEIN C RESIST,305,1 ,$134.00 ,$67.00 ,$15.32 ,$134.00 ,$15.83 ,$59.61 ,$51.09 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$15.83 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$15.83 ,$17.34 ,$120.60 ,$34.47 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$16.78 ,$18.38 ,$18.38 ,$45.56 ,$18.38 ,$15.32 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500165,85335,HC FACTOR VIII INHIB,305,1 ,$224.00 ,$112.00 ,$12.87 ,$224.00 ,$13.30 ,$50.05 ,$42.90 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$13.30 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$13.30 ,$14.57 ,$201.60 ,$28.96 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$14.10 ,$15.44 ,$15.44 ,$76.16 ,$15.44 ,$12.87 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500166,85335,HC FACTOR IX INHIB,305,1 ,$228.00 ,$114.00 ,$12.87 ,$228.00 ,$13.30 ,$50.05 ,$42.90 ,$77.52 ,$182.40 ,$193.80 ,$142.50 ,$205.20 ,$13.30 ,$216.60 ,$205.20 ,$193.80 ,$193.80 ,$77.52 ,$193.80 ,$193.80 ,$205.20 ,$13.30 ,$14.57 ,$205.20 ,$28.96 ,$209.76 ,$205.20 ,$151.94 ,$151.94 ,$138.85 ,$151.94 ,$148.20 ,$158.80 ,$50.66 ,$180.12 ,$14.10 ,$15.44 ,$15.44 ,$77.52 ,$15.44 ,$12.87 ,$216.60 ,$186.96 ,$186.96 ,$182.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500168,85347,HC ACTIVATED CLOTTING TIME,305,1 ,$105.00 ,$52.50 ,$4.28 ,$105.00 ,$4.42 ,$16.56 ,$14.19 ,$35.70 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$4.42 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$35.70 ,$89.25 ,$89.25 ,$94.50 ,$4.42 ,$4.84 ,$94.50 ,$9.63 ,$96.60 ,$94.50 ,$69.97 ,$69.97 ,$63.95 ,$69.97 ,$68.25 ,$73.13 ,$23.33 ,$82.95 ,$4.69 ,$5.14 ,$5.14 ,$35.70 ,$5.14 ,$4.28 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500174,85362,HC FDP/FSP AGGLUT SQ,305,1 ,$53.00 ,$26.50 ,$6.89 ,$53.00 ,$7.12 ,$26.78 ,$22.95 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$7.12 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$7.12 ,$7.80 ,$47.70 ,$15.50 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$7.55 ,$8.27 ,$8.27 ,$18.02 ,$8.27 ,$6.89 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500175,85379,HC D DIMER QN,305,1 ,$78.00 ,$39.00 ,$10.18 ,$78.00 ,$10.52 ,$39.59 ,$33.93 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.52 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.52 ,$11.52 ,$70.20 ,$22.91 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.15 ,$12.22 ,$12.22 ,$26.52 ,$12.22 ,$10.18 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500176,85384,HC FIBRINOGEN,305,1 ,$78.00 ,$39.00 ,$9.72 ,$78.00 ,$10.04 ,$34.02 ,$29.16 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.04 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.04 ,$11.00 ,$70.20 ,$21.87 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.64 ,$11.66 ,$11.66 ,$26.52 ,$11.66 ,$9.72 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500179,85385,HC FIBRINOGEN AG,305,1 ,$67.00 ,$33.50 ,$11.94 ,$67.00 ,$11.94 ,$50.61 ,$43.38 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$11.94 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$11.94 ,$16.37 ,$60.30 ,$32.54 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$12.66 ,$17.35 ,$17.35 ,$22.78 ,$17.35 ,$14.46 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500181,85410,HC ALPHA 2 ANTIPLASMIN,305,1 ,$202.00 ,$101.00 ,$7.71 ,$202.00 ,$7.97 ,$29.96 ,$25.68 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$7.97 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$7.97 ,$8.73 ,$181.80 ,$17.35 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$8.45 ,$9.25 ,$9.25 ,$68.68 ,$9.25 ,$7.71 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500185,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$168.00 ,$84.00 ,$7.73 ,$168.00 ,$7.99 ,$30.07 ,$25.77 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$7.99 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$7.99 ,$8.75 ,$151.20 ,$17.39 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$8.47 ,$9.28 ,$9.28 ,$57.12 ,$9.28 ,$7.73 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500186,85461,HC FETAL HGB ROSETTE,305,1 ,$67.00 ,$33.50 ,$9.33 ,$67.00 ,$9.33 ,$32.76 ,$28.08 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$9.33 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$9.33 ,$10.59 ,$60.30 ,$21.06 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.89 ,$11.23 ,$11.23 ,$22.78 ,$11.23 ,$9.36 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500187,85520,HC HEPARIN ASSAY,305,1 ,$190.00 ,$95.00 ,$13.09 ,$190.00 ,$13.53 ,$50.93 ,$43.65 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$13.53 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$13.53 ,$14.82 ,$171.00 ,$29.45 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$14.34 ,$15.71 ,$15.71 ,$64.60 ,$15.71 ,$13.09 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500190,85540,HC LEUKOCYTE ALK PHOS,305,1 ,$140.00 ,$70.00 ,$8.60 ,$140.00 ,$8.89 ,$33.46 ,$28.68 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 ,$8.89 ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 ,$8.89 ,$9.73 ,$126.00 ,$19.35 ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 ,$9.42 ,$10.32 ,$10.32 ,$47.60 ,$10.32 ,$8.60 ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500191,85557,HC OSMOTIC FRAG RBC INCUB,305,1 ,$259.00 ,$129.50 ,$13.36 ,$259.00 ,$13.80 ,$51.94 ,$44.52 ,$88.06 ,$207.20 ,$220.15 ,$161.88 ,$233.10 ,$13.80 ,$246.05 ,$233.10 ,$220.15 ,$220.15 ,$88.06 ,$220.15 ,$220.15 ,$233.10 ,$13.80 ,$15.12 ,$233.10 ,$30.06 ,$238.28 ,$233.10 ,$172.60 ,$172.60 ,$157.73 ,$172.60 ,$168.35 ,$180.39 ,$57.55 ,$204.61 ,$14.63 ,$16.03 ,$16.03 ,$88.06 ,$16.03 ,$13.36 ,$246.05 ,$212.38 ,$212.38 ,$207.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500192,85576,HC PLATELET AGGREGATION EA,305,1 ,$213.00 ,$106.50 ,$24.91 ,$213.00 ,$25.74 ,$87.19 ,$74.73 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$25.74 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$25.74 ,$28.19 ,$191.70 ,$56.05 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$27.28 ,$29.89 ,$29.89 ,$72.42 ,$29.89 ,$24.91 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$36.00 ,$18.00 ,$4.29 ,$36.00 ,$4.43 ,$15.30 ,$13.11 ,$12.24 ,$28.80 ,$30.60 ,$22.50 ,$32.40 ,$4.43 ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$12.24 ,$30.60 ,$30.60 ,$32.40 ,$4.43 ,$4.86 ,$32.40 ,$9.65 ,$33.12 ,$32.40 ,$23.99 ,$23.99 ,$21.92 ,$23.99 ,$23.40 ,$25.07 ,$8.00 ,$28.44 ,$4.70 ,$5.15 ,$5.15 ,$12.24 ,$5.15 ,$4.29 ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500197,85611,HC PT MIX STUDY,305,1 ,$48.00 ,$24.00 ,$3.94 ,$48.00 ,$4.07 ,$15.33 ,$13.14 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$4.07 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$4.07 ,$4.46 ,$43.20 ,$8.87 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$4.31 ,$4.73 ,$4.73 ,$16.32 ,$4.73 ,$3.94 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500198,85613,HC RUSSELL VIPER VENOM SCR,305,1 ,$78.00 ,$39.00 ,$9.58 ,$78.00 ,$9.90 ,$37.24 ,$31.92 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$9.90 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$9.90 ,$10.84 ,$70.20 ,$21.56 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.49 ,$11.50 ,$11.50 ,$26.52 ,$11.50 ,$9.58 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500200,85613,HC RUSSELL VIPER VENOM CONF,305,1 ,$78.00 ,$39.00 ,$9.58 ,$78.00 ,$9.90 ,$37.24 ,$31.92 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$9.90 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$9.90 ,$10.84 ,$70.20 ,$21.56 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.49 ,$11.50 ,$11.50 ,$26.52 ,$11.50 ,$9.58 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500201,85613,HC RUSSELL VIPER VENOM DIL (DRVVT),305,1 ,$78.00 ,$39.00 ,$9.58 ,$78.00 ,$9.90 ,$37.24 ,$31.92 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$9.90 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$9.90 ,$10.84 ,$70.20 ,$21.56 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.49 ,$11.50 ,$11.50 ,$26.52 ,$11.50 ,$9.58 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500205,85652,HC SED RATE AUTO,305,1 ,$40.00 ,$20.00 ,$2.70 ,$40.00 ,$2.79 ,$10.50 ,$9.00 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 ,$2.79 ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 ,$2.79 ,$3.06 ,$36.00 ,$6.08 ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 ,$2.96 ,$3.24 ,$3.24 ,$13.60 ,$3.24 ,$2.70 ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500206,85660,HC SICKLE CELL RBC,305,1 ,$67.00 ,$33.50 ,$5.51 ,$67.00 ,$5.69 ,$21.42 ,$18.36 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$5.69 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$5.69 ,$6.24 ,$60.30 ,$12.40 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$6.03 ,$6.61 ,$6.61 ,$22.78 ,$6.61 ,$5.51 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500207,85670,HC THROMBIN TIME PLASMA,305,1 ,$101.00 ,$50.50 ,$5.77 ,$101.00 ,$6.53 ,$22.44 ,$19.23 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$6.53 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$6.53 ,$6.53 ,$90.90 ,$12.98 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$6.92 ,$6.92 ,$6.92 ,$34.34 ,$6.92 ,$5.77 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500208,85705,HC HEX PHOSPHOLIPID NEUT,305,1 ,$56.00 ,$28.00 ,$8.17 ,$56.00 ,$8.17 ,$37.45 ,$32.10 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$8.17 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$8.17 ,$10.90 ,$50.40 ,$21.67 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$8.66 ,$11.56 ,$11.56 ,$19.04 ,$11.56 ,$9.63 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500209,85730,HC PTT (LUPUS),305,1 ,$52.00 ,$26.00 ,$6.01 ,$52.00 ,$6.21 ,$23.35 ,$20.01 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$6.21 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 ,$6.21 ,$6.80 ,$46.80 ,$13.52 ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 ,$6.58 ,$7.21 ,$7.21 ,$17.68 ,$7.21 ,$6.01 ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500211,85730,HC PTT,305,1 ,$56.00 ,$28.00 ,$6.01 ,$56.00 ,$6.21 ,$23.35 ,$20.01 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$6.21 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$6.21 ,$6.80 ,$50.40 ,$13.52 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$6.58 ,$7.21 ,$7.21 ,$19.04 ,$7.21 ,$6.01 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500212,85730,HC APTT,305,1 ,$103.00 ,$51.50 ,$6.01 ,$103.00 ,$6.21 ,$23.35 ,$20.01 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$6.21 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$6.21 ,$6.80 ,$92.70 ,$13.52 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$6.58 ,$7.21 ,$7.21 ,$35.02 ,$7.21 ,$6.01 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500213,85732,HC PTT MIXING STUDY,305,1 ,$78.00 ,$39.00 ,$6.47 ,$78.00 ,$6.69 ,$25.13 ,$21.54 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$6.69 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$6.69 ,$7.32 ,$70.20 ,$14.56 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$7.09 ,$7.76 ,$7.76 ,$26.52 ,$7.76 ,$6.47 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500216,85732,HC PTT MIXING STUDY (PLASMA),305,1 ,$157.00 ,$78.50 ,$6.47 ,$157.00 ,$6.69 ,$25.13 ,$21.54 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$6.69 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$6.69 ,$7.32 ,$141.30 ,$14.56 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$7.09 ,$7.76 ,$7.76 ,$53.38 ,$7.76 ,$6.47 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500228,85397,HC VW FACTOR ACTIVITY MAYO,305,1 ,$288.00 ,$144.00 ,$30.86 ,$288.00 ,$31.89 ,$108.01 ,$92.58 ,$97.92 ,$230.40 ,$244.80 ,$180.00 ,$259.20 ,$31.89 ,$273.60 ,$259.20 ,$244.80 ,$244.80 ,$97.92 ,$244.80 ,$244.80 ,$259.20 ,$31.89 ,$34.93 ,$259.20 ,$69.44 ,$264.96 ,$259.20 ,$191.92 ,$191.92 ,$175.39 ,$191.92 ,$187.20 ,$200.59 ,$63.99 ,$227.52 ,$33.80 ,$37.03 ,$37.03 ,$97.92 ,$37.03 ,$30.86 ,$273.60 ,$236.16 ,$236.16 ,$230.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500231,85260,HC FACTOR X CHROMOGENIC,305,1 ,$190.00 ,$95.00 ,$17.90 ,$190.00 ,$18.50 ,$69.62 ,$59.67 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$18.50 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$18.50 ,$20.26 ,$171.00 ,$40.28 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$19.61 ,$21.48 ,$21.48 ,$64.60 ,$21.48 ,$17.90 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500343,85549,HC MURAMIDASE,305,1 ,$88.00 ,$44.00 ,$18.75 ,$88.00 ,$19.37 ,$72.91 ,$62.49 ,$29.92 ,$70.40 ,$74.80 ,$55.00 ,$79.20 ,$19.37 ,$83.60 ,$79.20 ,$74.80 ,$74.80 ,$29.92 ,$74.80 ,$74.80 ,$79.20 ,$19.37 ,$21.22 ,$79.20 ,$42.19 ,$80.96 ,$79.20 ,$58.64 ,$58.64 ,$53.59 ,$58.64 ,$57.20 ,$61.29 ,$19.55 ,$69.52 ,$20.53 ,$22.50 ,$22.50 ,$29.92 ,$22.50 ,$18.75 ,$83.60 ,$72.16 ,$72.16 ,$70.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30540180,85397,HC MBC ADAMTS13 ACTIVITY-REF,305,1 ,$250.00 ,$125.00 ,$30.86 ,$250.00 ,$31.89 ,$108.01 ,$92.58 ,$85.00 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$31.89 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$85.00 ,$212.50 ,$212.50 ,$225.00 ,$31.89 ,$34.93 ,$225.00 ,$69.44 ,$230.00 ,$225.00 ,$166.60 ,$166.60 ,$152.25 ,$166.60 ,$162.50 ,$174.13 ,$55.55 ,$197.50 ,$33.80 ,$37.03 ,$37.03 ,$85.00 ,$37.03 ,$30.86 ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600096,87480,HC CANDIDA SPECIES DNA SCREEN,306,1 ,$157.00 ,$78.50 ,$20.05 ,$157.00 ,$20.72 ,$77.98 ,$66.84 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$20.72 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$20.72 ,$22.69 ,$141.30 ,$45.11 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$21.96 ,$24.06 ,$24.06 ,$53.38 ,$24.06 ,$20.05 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600097,87660,HC TRICHOMONAS DNA SCREEN,306,1 ,$157.00 ,$78.50 ,$20.05 ,$157.00 ,$20.72 ,$77.98 ,$66.84 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$20.72 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$20.72 ,$22.69 ,$141.30 ,$45.11 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$21.96 ,$24.06 ,$24.06 ,$53.38 ,$24.06 ,$20.05 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600098,87510,HC G VAGINALIS DNA SCREEN,306,1 ,$157.00 ,$78.50 ,$20.05 ,$157.00 ,$20.72 ,$77.98 ,$66.84 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$20.72 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$20.72 ,$22.69 ,$141.30 ,$45.11 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$21.96 ,$24.06 ,$24.06 ,$53.38 ,$24.06 ,$20.05 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600099,87496,HC CMV DNA QUAL PCR,306,1 ,$291.00 ,$145.50 ,$35.09 ,$291.00 ,$36.26 ,$136.47 ,$116.97 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$36.26 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$36.26 ,$39.71 ,$261.90 ,$78.95 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$38.44 ,$42.11 ,$42.11 ,$98.94 ,$42.11 ,$35.09 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600101,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$40.00 ,$20.00 ,$5.25 ,$40.00 ,$5.25 ,$25.97 ,$22.26 ,$13.60 ,$32.00 ,$34.00 ,$25.00 ,$36.00 ,$5.25 ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$13.60 ,$34.00 ,$34.00 ,$36.00 ,$5.25 ,$7.56 ,$36.00 ,$15.03 ,$36.80 ,$36.00 ,$26.66 ,$26.66 ,$24.36 ,$26.66 ,$26.00 ,$27.86 ,$8.89 ,$31.60 ,$5.57 ,$8.02 ,$8.02 ,$13.60 ,$8.02 ,$6.68 ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600102,87040,HC BLOOD CULTURE,306,1 ,$112.00 ,$56.00 ,$10.32 ,$112.00 ,$10.66 ,$40.15 ,$34.41 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$10.66 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$10.66 ,$11.68 ,$100.80 ,$23.22 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$11.30 ,$12.38 ,$12.38 ,$38.08 ,$12.38 ,$10.32 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600103,87045,HC STOOL CULTURE,306,1 ,$78.00 ,$39.00 ,$9.44 ,$78.00 ,$9.75 ,$36.72 ,$31.47 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$9.75 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$9.75 ,$10.68 ,$70.20 ,$21.24 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$10.34 ,$11.33 ,$11.33 ,$26.52 ,$11.33 ,$9.44 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600104,87046,HC STOOL CULTURE ADD ISO,306,1 ,$67.00 ,$33.50 ,$3.40 ,$67.00 ,$3.40 ,$36.72 ,$31.47 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$3.40 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$3.40 ,$10.68 ,$60.30 ,$21.24 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$3.60 ,$11.33 ,$11.33 ,$22.78 ,$11.33 ,$9.44 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600108,87081,HC BODY FLUID CULTURE (MRSA),306,1 ,$108.00 ,$54.00 ,$6.63 ,$108.00 ,$6.85 ,$25.76 ,$22.08 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$6.85 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$6.85 ,$7.50 ,$97.20 ,$14.92 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$7.26 ,$7.96 ,$7.96 ,$36.72 ,$7.96 ,$6.63 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600109,87070,HC BODY FLUID CULTURE,306,1 ,$101.00 ,$50.50 ,$8.62 ,$101.00 ,$8.91 ,$33.50 ,$28.71 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$8.91 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$8.91 ,$9.76 ,$90.90 ,$19.40 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$9.44 ,$10.34 ,$10.34 ,$34.34 ,$10.34 ,$8.62 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 ,$8.91 ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 ,$8.91 ,$9.76 ,$153.90 ,$19.40 ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 ,$9.44 ,$10.34 ,$10.34 ,$58.14 ,$10.34 ,$8.62 ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600112,87070,HC BODY FLUID CULTURE (WOUND),306,1 ,$171.00 ,$85.50 ,$8.62 ,$171.00 ,$8.91 ,$33.50 ,$28.71 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 ,$8.91 ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 ,$8.91 ,$9.76 ,$153.90 ,$19.40 ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 ,$9.44 ,$10.34 ,$10.34 ,$58.14 ,$10.34 ,$8.62 ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600120,87075,HC CULTURE ANAEROBIC,306,1 ,$101.00 ,$50.50 ,$9.47 ,$101.00 ,$9.79 ,$36.82 ,$31.56 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$9.79 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$9.79 ,$10.72 ,$90.90 ,$21.31 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$10.38 ,$11.36 ,$11.36 ,$34.34 ,$11.36 ,$9.47 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600121,87076,HC CULTURE ANAEROBIC ID,306,1 ,$67.00 ,$33.50 ,$8.08 ,$67.00 ,$8.35 ,$31.40 ,$26.91 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.35 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.35 ,$9.14 ,$60.30 ,$18.18 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.85 ,$9.70 ,$9.70 ,$22.78 ,$9.70 ,$8.08 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600122,87076,HC CULTURE ANAEROBIC ID (ORGANISM),306,1 ,$67.00 ,$33.50 ,$8.08 ,$67.00 ,$8.35 ,$31.40 ,$26.91 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.35 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.35 ,$9.14 ,$60.30 ,$18.18 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.85 ,$9.70 ,$9.70 ,$22.78 ,$9.70 ,$8.08 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600123,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$67.00 ,$33.50 ,$8.08 ,$67.00 ,$8.35 ,$31.40 ,$26.91 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.35 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.35 ,$9.14 ,$60.30 ,$18.18 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.85 ,$9.70 ,$9.70 ,$22.78 ,$9.70 ,$8.08 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600124,87081,HC CULTURE SCR (MRSA),306,1 ,$56.00 ,$28.00 ,$6.63 ,$56.00 ,$6.85 ,$25.76 ,$22.08 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$6.85 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$6.85 ,$7.50 ,$50.40 ,$14.92 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$7.26 ,$7.96 ,$7.96 ,$19.04 ,$7.96 ,$6.63 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600125,87081,HC CULTURE SCR (GRP B STREP),306,1 ,$74.00 ,$37.00 ,$6.63 ,$74.00 ,$6.85 ,$25.76 ,$22.08 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$6.85 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$6.85 ,$7.50 ,$66.60 ,$14.92 ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$7.26 ,$7.96 ,$7.96 ,$25.16 ,$7.96 ,$6.63 ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600126,87081,HC CULTURE SCR (GC ONLY),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$6.85 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$6.85 ,$7.50 ,$45.00 ,$14.92 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$17.00 ,$7.96 ,$6.63 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600127,87081,HC CULTURE SCR (LEGIONELLA),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$6.85 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$6.85 ,$7.50 ,$45.00 ,$14.92 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$17.00 ,$7.96 ,$6.63 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600129,87081,HC CULTURE SCR (GRP A STREP),306,1 ,$50.00 ,$25.00 ,$6.63 ,$50.00 ,$6.85 ,$25.76 ,$22.08 ,$17.00 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$6.85 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$17.00 ,$42.50 ,$42.50 ,$45.00 ,$6.85 ,$7.50 ,$45.00 ,$14.92 ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 ,$7.26 ,$7.96 ,$7.96 ,$17.00 ,$7.96 ,$6.63 ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600130,87081,HC CULTURE SCR (VRE),306,1 ,$116.00 ,$58.00 ,$6.63 ,$116.00 ,$6.85 ,$25.76 ,$22.08 ,$39.44 ,$92.80 ,$98.60 ,$72.50 ,$104.40 ,$6.85 ,$110.20 ,$104.40 ,$98.60 ,$98.60 ,$39.44 ,$98.60 ,$98.60 ,$104.40 ,$6.85 ,$7.50 ,$104.40 ,$14.92 ,$106.72 ,$104.40 ,$77.30 ,$77.30 ,$70.64 ,$77.30 ,$75.40 ,$80.79 ,$25.78 ,$91.64 ,$7.26 ,$7.96 ,$7.96 ,$39.44 ,$7.96 ,$6.63 ,$110.20 ,$95.12 ,$95.12 ,$92.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600131,87081,HC CULTURE (MRSA),306,1 ,$56.00 ,$28.00 ,$6.63 ,$56.00 ,$6.85 ,$25.76 ,$22.08 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$6.85 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$6.85 ,$7.50 ,$50.40 ,$14.92 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$7.26 ,$7.96 ,$7.96 ,$19.04 ,$7.96 ,$6.63 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600132,87081,HC CULTURE (CLO TEST),306,1 ,$73.00 ,$36.50 ,$6.63 ,$73.00 ,$6.85 ,$25.76 ,$22.08 ,$24.82 ,$58.40 ,$62.05 ,$45.63 ,$65.70 ,$6.85 ,$69.35 ,$65.70 ,$62.05 ,$62.05 ,$24.82 ,$62.05 ,$62.05 ,$65.70 ,$6.85 ,$7.50 ,$65.70 ,$14.92 ,$67.16 ,$65.70 ,$48.65 ,$48.65 ,$44.46 ,$48.65 ,$47.45 ,$50.84 ,$16.22 ,$57.67 ,$7.26 ,$7.96 ,$7.96 ,$24.82 ,$7.96 ,$6.63 ,$69.35 ,$59.86 ,$59.86 ,$58.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600133,87081,HC CULTURE SCR (BRUCELLA),306,1 ,$64.00 ,$32.00 ,$6.63 ,$64.00 ,$6.85 ,$25.76 ,$22.08 ,$21.76 ,$51.20 ,$54.40 ,$40.00 ,$57.60 ,$6.85 ,$60.80 ,$57.60 ,$54.40 ,$54.40 ,$21.76 ,$54.40 ,$54.40 ,$57.60 ,$6.85 ,$7.50 ,$57.60 ,$14.92 ,$58.88 ,$57.60 ,$42.65 ,$42.65 ,$38.98 ,$42.65 ,$41.60 ,$44.58 ,$14.22 ,$50.56 ,$7.26 ,$7.96 ,$7.96 ,$21.76 ,$7.96 ,$6.63 ,$60.80 ,$52.48 ,$52.48 ,$51.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600134,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$67.00 ,$33.50 ,$8.07 ,$67.00 ,$8.34 ,$31.40 ,$26.91 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.34 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.34 ,$9.13 ,$60.30 ,$18.16 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.84 ,$9.68 ,$9.68 ,$22.78 ,$9.68 ,$8.07 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600135,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$67.00 ,$33.50 ,$8.09 ,$67.00 ,$8.36 ,$31.47 ,$26.97 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.36 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.36 ,$9.16 ,$60.30 ,$18.20 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$8.86 ,$9.71 ,$9.71 ,$22.78 ,$9.71 ,$8.09 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600136,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$134.00 ,$67.00 ,$7.71 ,$134.00 ,$7.97 ,$29.96 ,$25.68 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$7.97 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$7.97 ,$8.73 ,$120.60 ,$17.35 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$8.45 ,$9.25 ,$9.25 ,$45.56 ,$9.25 ,$7.71 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600138,87102,HC CULTURE FUNGUS OTHER,306,1 ,$78.00 ,$39.00 ,$8.41 ,$78.00 ,$8.69 ,$32.69 ,$28.02 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$8.69 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$8.69 ,$9.52 ,$70.20 ,$18.92 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$9.21 ,$10.09 ,$10.09 ,$26.52 ,$10.09 ,$8.41 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600140,87103,HC CULTURE FUNGUS BLOOD,306,1 ,$168.00 ,$84.00 ,$12.68 ,$168.00 ,$12.68 ,$71.61 ,$61.38 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$12.68 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$12.68 ,$23.16 ,$151.20 ,$46.04 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$13.44 ,$24.55 ,$24.55 ,$57.12 ,$24.55 ,$20.46 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600142,87106,HC CULTURE FUNGUS ID,306,1 ,$96.00 ,$48.00 ,$10.32 ,$96.00 ,$10.66 ,$40.15 ,$34.41 ,$32.64 ,$76.80 ,$81.60 ,$60.00 ,$86.40 ,$10.66 ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$32.64 ,$81.60 ,$81.60 ,$86.40 ,$10.66 ,$11.68 ,$86.40 ,$23.22 ,$88.32 ,$86.40 ,$63.97 ,$63.97 ,$58.46 ,$63.97 ,$62.40 ,$66.86 ,$21.33 ,$75.84 ,$11.30 ,$12.38 ,$12.38 ,$32.64 ,$12.38 ,$10.32 ,$91.20 ,$78.72 ,$78.72 ,$76.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600145,87107,HC CULTURE FUNGUS ID MOLD,306,1 ,$78.00 ,$39.00 ,$10.32 ,$78.00 ,$10.66 ,$40.15 ,$34.41 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.66 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.66 ,$11.68 ,$70.20 ,$23.22 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.30 ,$12.38 ,$12.38 ,$26.52 ,$12.38 ,$10.32 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600146,87109,HC CULTURE MYCOPLASMA,306,1 ,$90.00 ,$45.00 ,$14.01 ,$90.00 ,$14.01 ,$59.85 ,$51.30 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$14.01 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$14.01 ,$17.42 ,$81.00 ,$34.63 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$14.85 ,$18.47 ,$18.47 ,$30.60 ,$18.47 ,$15.39 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600148,87116,HC CULTURE AFB/TB/MYCOBACT,306,1 ,$78.00 ,$39.00 ,$10.80 ,$78.00 ,$11.16 ,$42.00 ,$36.00 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$11.16 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$11.16 ,$12.22 ,$70.20 ,$24.30 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.83 ,$12.96 ,$12.96 ,$26.52 ,$12.96 ,$10.80 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600149,87116,HC CULTURE AFB/TB/MYCOBACT (BLOOD),306,1 ,$162.00 ,$81.00 ,$10.80 ,$162.00 ,$11.16 ,$42.00 ,$36.00 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$11.16 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$11.16 ,$12.22 ,$145.80 ,$24.30 ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$11.83 ,$12.96 ,$12.96 ,$55.08 ,$12.96 ,$10.80 ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600151,87118,HC MYCOBACTERIA ID BY HPLC,306,1 ,$157.00 ,$78.50 ,$14.61 ,$157.00 ,$15.10 ,$51.14 ,$43.83 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$15.10 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$15.10 ,$16.54 ,$141.30 ,$32.87 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$16.01 ,$17.53 ,$17.53 ,$53.38 ,$17.53 ,$14.61 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600152,87140,HC CLT TYP IF EA ANTISER (RESP),306,1 ,$19.00 ,$9.50 ,$4.22 ,$19.00 ,$5.76 ,$19.00 ,$18.57 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 ,$5.76 ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 ,$5.76 ,$6.30 ,$17.10 ,$12.53 ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 ,$6.11 ,$6.68 ,$6.68 ,$6.46 ,$6.68 ,$5.57 ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$5.76 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$5.76 ,$6.30 ,$34.20 ,$12.53 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$6.11 ,$6.68 ,$6.68 ,$12.92 ,$6.68 ,$5.57 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$5.76 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$5.76 ,$6.30 ,$34.20 ,$12.53 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$6.11 ,$6.68 ,$6.68 ,$12.92 ,$6.68 ,$5.57 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600157,87140,HC CLT TYP IF EA ANTISER (ADENO/ENTERO),306,1 ,$21.00 ,$10.50 ,$4.67 ,$21.00 ,$5.76 ,$21.00 ,$18.57 ,$7.14 ,$16.80 ,$17.85 ,$13.13 ,$18.90 ,$5.76 ,$19.95 ,$18.90 ,$17.85 ,$17.85 ,$7.14 ,$17.85 ,$17.85 ,$18.90 ,$5.76 ,$6.30 ,$18.90 ,$12.53 ,$19.32 ,$18.90 ,$13.99 ,$13.99 ,$12.79 ,$13.99 ,$13.65 ,$14.63 ,$4.67 ,$16.59 ,$6.11 ,$6.68 ,$6.68 ,$7.14 ,$6.68 ,$5.57 ,$19.95 ,$17.22 ,$17.22 ,$16.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600159,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$133.00 ,$66.50 ,$5.18 ,$133.00 ,$5.35 ,$20.13 ,$17.25 ,$45.22 ,$106.40 ,$113.05 ,$83.13 ,$119.70 ,$5.35 ,$126.35 ,$119.70 ,$113.05 ,$113.05 ,$45.22 ,$113.05 ,$113.05 ,$119.70 ,$5.35 ,$5.86 ,$119.70 ,$11.66 ,$122.36 ,$119.70 ,$88.63 ,$88.63 ,$81.00 ,$88.63 ,$86.45 ,$92.63 ,$29.55 ,$105.07 ,$5.67 ,$6.22 ,$6.22 ,$45.22 ,$6.22 ,$5.18 ,$126.35 ,$109.06 ,$109.06 ,$106.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600161,87168,HC EXAM ARTHROPOD,306,1 ,$78.00 ,$39.00 ,$4.27 ,$78.00 ,$4.41 ,$16.63 ,$14.25 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$4.41 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$4.41 ,$4.83 ,$70.20 ,$9.61 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$4.67 ,$5.12 ,$5.12 ,$26.52 ,$5.12 ,$4.27 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600162,87169,HC PARASITE ID,306,1 ,$78.00 ,$39.00 ,$4.31 ,$78.00 ,$4.45 ,$16.63 ,$14.25 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$4.45 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$4.45 ,$4.88 ,$70.20 ,$9.70 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$4.72 ,$5.17 ,$5.17 ,$26.52 ,$5.17 ,$4.31 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600163,87172,HC PINWORM EXAM,306,1 ,$27.00 ,$13.50 ,$4.27 ,$27.00 ,$4.41 ,$16.63 ,$14.25 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 ,$4.41 ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 ,$4.41 ,$4.83 ,$24.30 ,$9.61 ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 ,$4.67 ,$5.12 ,$5.12 ,$9.18 ,$5.12 ,$4.27 ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600164,87177,HC SMEAR OVA PARASITE CONC/ID,306,1 ,$67.00 ,$33.50 ,$8.90 ,$67.00 ,$9.20 ,$34.62 ,$29.67 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$9.20 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$9.20 ,$10.07 ,$60.30 ,$20.03 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.75 ,$10.68 ,$10.68 ,$22.78 ,$10.68 ,$8.90 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600168,87184,HC SENSITIVITY DISK KB (HAEMOPHILUS),306,1 ,$56.00 ,$28.00 ,$7.48 ,$56.00 ,$7.73 ,$26.81 ,$22.98 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$7.73 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$7.73 ,$8.47 ,$50.40 ,$16.83 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$8.19 ,$8.98 ,$8.98 ,$19.04 ,$8.98 ,$7.48 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600172,87186,HC SENSITIVITY MIC,306,1 ,$67.00 ,$33.50 ,$8.65 ,$67.00 ,$8.94 ,$33.64 ,$28.83 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.94 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.94 ,$9.79 ,$60.30 ,$19.46 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.48 ,$10.38 ,$10.38 ,$22.78 ,$10.38 ,$8.65 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$45.00 ,$22.50 ,$4.27 ,$45.00 ,$4.41 ,$16.63 ,$14.25 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 ,$4.41 ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 ,$4.41 ,$4.83 ,$40.50 ,$9.61 ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 ,$4.67 ,$5.12 ,$5.12 ,$15.30 ,$5.12 ,$4.27 ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600176,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$46.00 ,$23.00 ,$5.39 ,$46.00 ,$5.57 ,$20.97 ,$17.97 ,$15.64 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$5.57 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$15.64 ,$39.10 ,$39.10 ,$41.40 ,$5.57 ,$6.10 ,$41.40 ,$12.13 ,$42.32 ,$41.40 ,$30.65 ,$30.65 ,$28.01 ,$30.65 ,$29.90 ,$32.04 ,$10.22 ,$36.34 ,$5.90 ,$6.47 ,$6.47 ,$15.64 ,$6.47 ,$5.39 ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600177,87206,HC SMEAR ACID FAST/FLUOR (FUNGUS),306,1 ,$134.00 ,$67.00 ,$5.39 ,$134.00 ,$5.57 ,$20.97 ,$17.97 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$5.57 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$5.57 ,$6.10 ,$120.60 ,$12.13 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$5.90 ,$6.47 ,$6.47 ,$45.56 ,$6.47 ,$5.39 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600179,87207,HC SPECIAL STAIN (MALARIA),306,1 ,$146.00 ,$73.00 ,$5.99 ,$146.00 ,$6.19 ,$23.31 ,$19.98 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$6.19 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$6.19 ,$6.78 ,$131.40 ,$13.48 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$6.56 ,$7.19 ,$7.19 ,$49.64 ,$7.19 ,$5.99 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600180,87207,HC SPECIAL STAIN (TZANCK EVAL),306,1 ,$74.00 ,$37.00 ,$5.99 ,$74.00 ,$6.19 ,$23.31 ,$19.98 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$6.19 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$6.19 ,$6.78 ,$66.60 ,$13.48 ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$6.56 ,$7.19 ,$7.19 ,$25.16 ,$7.19 ,$5.99 ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600182,87209,HC OVA  AND  PARASITE W/STAIN,306,1 ,$90.00 ,$45.00 ,$17.98 ,$90.00 ,$18.58 ,$69.90 ,$59.91 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$18.58 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$18.58 ,$20.35 ,$81.00 ,$40.46 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$19.69 ,$21.58 ,$21.58 ,$30.60 ,$21.58 ,$17.98 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600183,87210,HC SMEAR WET MOUNT,306,1 ,$32.00 ,$16.00 ,$5.82 ,$32.00 ,$6.00 ,$20.37 ,$17.46 ,$10.88 ,$25.60 ,$27.20 ,$20.00 ,$28.80 ,$6.00 ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$10.88 ,$27.20 ,$27.20 ,$28.80 ,$6.00 ,$6.59 ,$28.80 ,$13.10 ,$29.44 ,$28.80 ,$21.32 ,$21.32 ,$19.49 ,$21.32 ,$20.80 ,$22.29 ,$7.11 ,$25.28 ,$6.36 ,$6.98 ,$6.98 ,$10.88 ,$6.98 ,$5.82 ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600184,87210,HC SMEAR WET MOUNT (FUNGUS),306,1 ,$45.00 ,$22.50 ,$5.82 ,$45.00 ,$6.00 ,$20.37 ,$17.46 ,$15.30 ,$36.00 ,$38.25 ,$28.13 ,$40.50 ,$6.00 ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$15.30 ,$38.25 ,$38.25 ,$40.50 ,$6.00 ,$6.59 ,$40.50 ,$13.10 ,$41.40 ,$40.50 ,$29.99 ,$29.99 ,$27.41 ,$29.99 ,$29.25 ,$31.34 ,$10.00 ,$35.55 ,$6.36 ,$6.98 ,$6.98 ,$15.30 ,$6.98 ,$5.82 ,$42.75 ,$36.90 ,$36.90 ,$36.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600185,87220,HC TISSUE KOH PREP,306,1 ,$53.00 ,$26.50 ,$4.27 ,$53.00 ,$4.41 ,$16.63 ,$14.25 ,$18.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$4.41 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$18.02 ,$45.05 ,$45.05 ,$47.70 ,$4.41 ,$4.83 ,$47.70 ,$9.61 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$11.78 ,$41.87 ,$4.67 ,$5.12 ,$5.12 ,$18.02 ,$5.12 ,$4.27 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600186,87230,HC TOXIN ANTITOXIN ASSAY,306,1 ,$131.00 ,$65.50 ,$19.74 ,$131.00 ,$20.40 ,$76.76 ,$65.79 ,$44.54 ,$104.80 ,$111.35 ,$81.88 ,$117.90 ,$20.40 ,$124.45 ,$117.90 ,$111.35 ,$111.35 ,$44.54 ,$111.35 ,$111.35 ,$117.90 ,$20.40 ,$22.34 ,$117.90 ,$44.42 ,$120.52 ,$117.90 ,$87.30 ,$87.30 ,$79.78 ,$87.30 ,$85.15 ,$91.24 ,$29.11 ,$103.49 ,$21.62 ,$23.69 ,$23.69 ,$44.54 ,$23.69 ,$19.74 ,$124.45 ,$107.42 ,$107.42 ,$104.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600187,87252,HC CULTURE VIRUS ID TISS (CMV),306,1 ,$202.00 ,$101.00 ,$26.07 ,$202.00 ,$26.94 ,$101.40 ,$86.91 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$26.94 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$26.94 ,$29.51 ,$181.80 ,$58.66 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$28.56 ,$31.28 ,$31.28 ,$68.68 ,$31.28 ,$26.07 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600188,87252,HC CULTURE VIRUS ID TISS (HERPES),306,1 ,$202.00 ,$101.00 ,$26.07 ,$202.00 ,$26.94 ,$101.40 ,$86.91 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$26.94 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$26.94 ,$29.51 ,$181.80 ,$58.66 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$28.56 ,$31.28 ,$31.28 ,$68.68 ,$31.28 ,$26.07 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600189,87252,HC CULTURE VIRUS ID TISS (RESP),306,1 ,$114.00 ,$57.00 ,$25.33 ,$114.00 ,$26.94 ,$101.40 ,$86.91 ,$38.76 ,$91.20 ,$96.90 ,$71.25 ,$102.60 ,$26.94 ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$38.76 ,$96.90 ,$96.90 ,$102.60 ,$26.94 ,$29.51 ,$102.60 ,$58.66 ,$104.88 ,$102.60 ,$75.97 ,$75.97 ,$69.43 ,$75.97 ,$74.10 ,$79.40 ,$25.33 ,$90.06 ,$28.56 ,$31.28 ,$31.28 ,$38.76 ,$31.28 ,$26.07 ,$108.30 ,$93.48 ,$93.48 ,$91.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600193,87254,HC VIRUS ISOL SHELL ID (CMV),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$7.06 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$7.06 ,$22.14 ,$131.40 ,$44.01 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$49.64 ,$23.47 ,$19.56 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600194,87254,HC VIRUS ISOL SHELL ID (RESP),306,1 ,$92.00 ,$46.00 ,$7.06 ,$92.00 ,$7.06 ,$76.06 ,$65.19 ,$31.28 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$7.06 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$31.28 ,$78.20 ,$78.20 ,$82.80 ,$7.06 ,$22.14 ,$82.80 ,$44.01 ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 ,$7.48 ,$23.47 ,$23.47 ,$31.28 ,$23.47 ,$19.56 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600195,87254,HC VIRUS ISOL SHELL ID (VARI),306,1 ,$146.00 ,$73.00 ,$7.06 ,$146.00 ,$7.06 ,$76.06 ,$65.19 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$7.06 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$7.06 ,$22.14 ,$131.40 ,$44.01 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$49.64 ,$23.47 ,$19.56 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$7.06 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$7.06 ,$22.14 ,$131.40 ,$44.01 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$49.64 ,$23.47 ,$19.56 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$7.06 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$7.06 ,$22.14 ,$131.40 ,$44.01 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$49.64 ,$23.47 ,$19.56 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$7.06 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$7.06 ,$22.14 ,$131.40 ,$44.01 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$49.64 ,$23.47 ,$19.56 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600200,87260,HC IF ADENOVIRUS AG,306,1 ,$85.00 ,$42.50 ,$14.43 ,$85.00 ,$14.91 ,$50.51 ,$43.29 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$14.91 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$14.91 ,$16.33 ,$76.50 ,$32.47 ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$15.80 ,$17.32 ,$17.32 ,$28.90 ,$17.32 ,$14.43 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600202,87273,HC IF HERPES SIMPLEX 2 AG,306,1 ,$85.00 ,$42.50 ,$11.98 ,$85.00 ,$12.38 ,$46.62 ,$39.96 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$12.38 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$12.38 ,$13.56 ,$76.50 ,$26.96 ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$13.12 ,$14.38 ,$14.38 ,$28.90 ,$14.38 ,$11.98 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600203,87274,HC IF HERPES SIMPLEX 1 AG,306,1 ,$85.00 ,$42.50 ,$11.98 ,$85.00 ,$12.38 ,$46.62 ,$39.96 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$12.38 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$12.38 ,$13.56 ,$76.50 ,$26.96 ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$13.12 ,$14.38 ,$14.38 ,$28.90 ,$14.38 ,$11.98 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600204,87275,HC IF INFLUENZA B AG,306,1 ,$109.00 ,$54.50 ,$12.25 ,$109.00 ,$12.66 ,$46.62 ,$39.96 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$12.66 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$12.66 ,$13.86 ,$98.10 ,$27.56 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$13.42 ,$14.70 ,$14.70 ,$37.06 ,$14.70 ,$12.25 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600205,87276,HC IF INFLUENZA A AG,306,1 ,$109.00 ,$54.50 ,$16.07 ,$109.00 ,$16.61 ,$56.25 ,$48.21 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$16.61 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$16.61 ,$18.19 ,$98.10 ,$36.16 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$17.61 ,$19.28 ,$19.28 ,$37.06 ,$19.28 ,$16.07 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600206,87278,HC IF LEGIONELLA AG,306,1 ,$67.00 ,$33.50 ,$14.89 ,$67.00 ,$16.12 ,$54.60 ,$46.80 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$16.12 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$16.12 ,$17.66 ,$60.30 ,$35.10 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$17.09 ,$18.72 ,$18.72 ,$22.78 ,$18.72 ,$15.60 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600207,87279,HC IF PARAFLUENZA AG,306,1 ,$85.00 ,$42.50 ,$16.43 ,$85.00 ,$16.86 ,$57.51 ,$49.29 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$16.86 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$16.86 ,$18.60 ,$76.50 ,$36.97 ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$17.87 ,$19.72 ,$19.72 ,$28.90 ,$19.72 ,$16.43 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600208,87280,HC IF RSV AG,306,1 ,$112.00 ,$56.00 ,$13.42 ,$112.00 ,$13.87 ,$46.97 ,$40.26 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$13.87 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$13.87 ,$15.19 ,$100.80 ,$30.20 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$14.70 ,$16.10 ,$16.10 ,$38.08 ,$16.10 ,$13.42 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600209,87281,HC IF PNEUMOCYST CARINII AG,306,1 ,$112.00 ,$56.00 ,$11.98 ,$112.00 ,$12.38 ,$46.62 ,$39.96 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$12.38 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$12.38 ,$13.56 ,$100.80 ,$26.96 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$13.12 ,$14.38 ,$14.38 ,$38.08 ,$14.38 ,$11.98 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600210,87290,HC IF VARICELLA ZOETER AG,306,1 ,$109.00 ,$54.50 ,$13.42 ,$109.00 ,$13.87 ,$46.97 ,$40.26 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$13.87 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$13.87 ,$15.19 ,$98.10 ,$30.20 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$14.70 ,$16.10 ,$16.10 ,$37.06 ,$16.10 ,$13.42 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600211,87300,HC IF POLYVALENT MLT ORG AG,306,1 ,$85.00 ,$42.50 ,$8.66 ,$85.00 ,$8.66 ,$46.62 ,$39.96 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$8.66 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$8.66 ,$13.56 ,$76.50 ,$26.96 ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$9.18 ,$14.38 ,$14.38 ,$28.90 ,$14.38 ,$11.98 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600212,87305,HC EIA QL ASPERGILLUS AG,306,1 ,$134.00 ,$67.00 ,$11.98 ,$134.00 ,$12.38 ,$46.62 ,$39.96 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$12.38 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$12.38 ,$13.56 ,$120.60 ,$26.96 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$13.12 ,$14.38 ,$14.38 ,$45.56 ,$14.38 ,$11.98 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$12.38 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$12.38 ,$13.56 ,$98.10 ,$26.96 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$13.12 ,$14.38 ,$14.38 ,$37.06 ,$14.38 ,$11.98 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600214,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$109.00 ,$54.50 ,$13.42 ,$109.00 ,$13.87 ,$46.97 ,$40.26 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$13.87 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$13.87 ,$15.19 ,$98.10 ,$30.20 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$14.70 ,$16.10 ,$16.10 ,$37.06 ,$16.10 ,$13.42 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600215,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$48.00 ,$24.00 ,$10.67 ,$48.00 ,$14.28 ,$48.00 ,$41.46 ,$16.32 ,$38.40 ,$40.80 ,$30.00 ,$43.20 ,$14.28 ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$16.32 ,$40.80 ,$40.80 ,$43.20 ,$14.28 ,$15.64 ,$43.20 ,$31.10 ,$44.16 ,$43.20 ,$31.99 ,$31.99 ,$29.23 ,$31.99 ,$31.20 ,$33.43 ,$10.67 ,$37.92 ,$15.14 ,$16.58 ,$16.58 ,$16.32 ,$16.58 ,$13.82 ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600216,87329,HC EIA QL GIARDIA AG,306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.38 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.38 ,$13.56 ,$60.30 ,$26.96 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$22.78 ,$14.38 ,$11.98 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$14.86 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$14.86 ,$16.28 ,$120.60 ,$32.36 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$15.75 ,$17.26 ,$17.26 ,$45.56 ,$17.26 ,$14.38 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600218,87340,HC EIA QL HEPATITIS B AG,306,1 ,$78.00 ,$39.00 ,$10.33 ,$78.00 ,$10.67 ,$40.18 ,$34.44 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.67 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.67 ,$11.69 ,$70.20 ,$23.24 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.31 ,$12.40 ,$12.40 ,$26.52 ,$12.40 ,$10.33 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600219,87340,HC EIA QL HEPATITIS ABC B AG,306,1 ,$78.00 ,$39.00 ,$10.33 ,$78.00 ,$10.67 ,$40.18 ,$34.44 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.67 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.67 ,$11.69 ,$70.20 ,$23.24 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.31 ,$12.40 ,$12.40 ,$26.52 ,$12.40 ,$10.33 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$10.67 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$10.67 ,$11.69 ,$70.20 ,$23.24 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$11.31 ,$12.40 ,$12.40 ,$26.52 ,$12.40 ,$10.33 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600221,87350,HC HEPATITIS BE AG QL,306,1 ,$67.00 ,$33.50 ,$11.53 ,$67.00 ,$11.91 ,$44.84 ,$38.43 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$11.91 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$11.91 ,$13.05 ,$60.30 ,$25.94 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$12.62 ,$13.84 ,$13.84 ,$22.78 ,$13.84 ,$11.53 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600222,87385,HC EIA QL HISTOPLASMA AG,306,1 ,$157.00 ,$78.50 ,$13.25 ,$157.00 ,$13.69 ,$46.62 ,$39.96 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$13.69 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$13.69 ,$15.00 ,$141.30 ,$29.81 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$14.51 ,$15.90 ,$15.90 ,$53.38 ,$15.90 ,$13.25 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600223,87385,HC EIA QL HISTOPLASMA AG (URINE),306,1 ,$146.00 ,$73.00 ,$13.25 ,$146.00 ,$13.69 ,$46.62 ,$39.96 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$13.69 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$13.69 ,$15.00 ,$131.40 ,$29.81 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$14.51 ,$15.90 ,$15.90 ,$49.64 ,$15.90 ,$13.25 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$27.54 ,$64.80 ,$68.85 ,$50.63 ,$72.90 ,$8.66 ,$76.95 ,$72.90 ,$68.85 ,$68.85 ,$27.54 ,$68.85 ,$68.85 ,$72.90 ,$8.66 ,$15.99 ,$72.90 ,$31.79 ,$74.52 ,$72.90 ,$53.98 ,$53.98 ,$49.33 ,$53.98 ,$52.65 ,$56.42 ,$18.00 ,$63.99 ,$9.18 ,$16.96 ,$16.96 ,$27.54 ,$16.96 ,$14.13 ,$76.95 ,$66.42 ,$66.42 ,$64.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600226,87420,HC RSV AG QL,306,1 ,$112.00 ,$56.00 ,$13.91 ,$112.00 ,$14.37 ,$48.69 ,$41.73 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$14.37 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$14.37 ,$15.74 ,$100.80 ,$31.30 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$15.23 ,$16.69 ,$16.69 ,$38.08 ,$16.69 ,$13.91 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600227,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$67.00 ,$33.50 ,$11.98 ,$67.00 ,$12.38 ,$46.62 ,$39.96 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.38 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.38 ,$13.56 ,$60.30 ,$26.96 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$22.78 ,$14.38 ,$11.98 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.38 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.38 ,$13.56 ,$60.30 ,$26.96 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$22.78 ,$14.38 ,$11.98 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.38 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.38 ,$13.56 ,$60.30 ,$26.96 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$22.78 ,$14.38 ,$11.98 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.38 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.38 ,$13.56 ,$60.30 ,$26.96 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$22.78 ,$14.38 ,$11.98 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$12.38 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$12.38 ,$13.56 ,$60.30 ,$26.96 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$13.12 ,$14.38 ,$14.38 ,$22.78 ,$14.38 ,$11.98 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600235,87476,HC LYMES DNA DETECT PCR,306,1 ,$354.00 ,$177.00 ,$35.09 ,$354.00 ,$36.26 ,$136.47 ,$116.97 ,$120.36 ,$283.20 ,$300.90 ,$221.25 ,$318.60 ,$36.26 ,$336.30 ,$318.60 ,$300.90 ,$300.90 ,$120.36 ,$300.90 ,$300.90 ,$318.60 ,$36.26 ,$39.71 ,$318.60 ,$78.95 ,$325.68 ,$318.60 ,$235.91 ,$235.91 ,$215.59 ,$235.91 ,$230.10 ,$246.56 ,$78.66 ,$279.66 ,$38.44 ,$42.11 ,$42.11 ,$120.36 ,$42.11 ,$35.09 ,$336.30 ,$290.28 ,$290.28 ,$283.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600236,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600237,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$269.00 ,$134.50 ,$37.27 ,$269.00 ,$38.51 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$38.51 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$38.51 ,$42.18 ,$242.10 ,$83.86 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$40.82 ,$44.72 ,$44.72 ,$91.46 ,$44.72 ,$37.27 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600238,87497,HC CMV QN,306,1 ,$258.00 ,$129.00 ,$42.84 ,$258.00 ,$44.27 ,$166.60 ,$142.80 ,$87.72 ,$206.40 ,$219.30 ,$161.25 ,$232.20 ,$44.27 ,$245.10 ,$232.20 ,$219.30 ,$219.30 ,$87.72 ,$219.30 ,$219.30 ,$232.20 ,$44.27 ,$48.49 ,$232.20 ,$96.39 ,$237.36 ,$232.20 ,$171.93 ,$171.93 ,$157.12 ,$171.93 ,$167.70 ,$179.70 ,$57.33 ,$203.82 ,$46.93 ,$51.41 ,$51.41 ,$87.72 ,$51.41 ,$42.84 ,$245.10 ,$211.56 ,$211.56 ,$206.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600239,87498,HC ENTEROVIRUS AMP PROBE,306,1 ,$248.00 ,$124.00 ,$35.09 ,$248.00 ,$36.26 ,$136.47 ,$116.97 ,$84.32 ,$198.40 ,$210.80 ,$155.00 ,$223.20 ,$36.26 ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$84.32 ,$210.80 ,$210.80 ,$223.20 ,$36.26 ,$39.71 ,$223.20 ,$78.95 ,$228.16 ,$223.20 ,$165.27 ,$165.27 ,$151.03 ,$165.27 ,$161.20 ,$172.73 ,$55.11 ,$195.92 ,$38.44 ,$42.11 ,$42.11 ,$84.32 ,$42.11 ,$35.09 ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600241,87517,HC HEPATITIS B QN (PCR),306,1 ,$370.00 ,$185.00 ,$42.84 ,$370.00 ,$44.27 ,$166.60 ,$142.80 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$44.27 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$44.27 ,$48.49 ,$333.00 ,$96.39 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$46.93 ,$51.41 ,$51.41 ,$125.80 ,$51.41 ,$42.84 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600242,87522,HC HEPATITIS C QN,306,1 ,$325.00 ,$162.50 ,$42.84 ,$325.00 ,$44.27 ,$166.60 ,$142.80 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$44.27 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$44.27 ,$48.49 ,$292.50 ,$96.39 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$110.50 ,$51.41 ,$42.84 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600244,87529,HC HERPES SIMPLEX AMP,306,1 ,$179.00 ,$89.50 ,$35.09 ,$179.00 ,$36.26 ,$136.47 ,$116.97 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$36.26 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$36.26 ,$39.71 ,$161.10 ,$78.95 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$38.44 ,$42.11 ,$42.11 ,$60.86 ,$42.11 ,$35.09 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600245,87535,HC PROBE HIV-1 AMP,306,1 ,$325.00 ,$162.50 ,$35.09 ,$325.00 ,$36.26 ,$136.47 ,$116.97 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$36.26 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$36.26 ,$39.71 ,$292.50 ,$78.95 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$38.44 ,$42.11 ,$42.11 ,$110.50 ,$42.11 ,$35.09 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600246,87536,HC HIV-1 QN,306,1 ,$325.00 ,$162.50 ,$72.22 ,$325.00 ,$87.93 ,$325.00 ,$283.65 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$87.93 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$87.93 ,$96.32 ,$292.50 ,$191.48 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$93.21 ,$102.12 ,$102.12 ,$110.50 ,$102.12 ,$85.10 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600248,87556,HC MTB COMPLEX PCR,306,1 ,$224.00 ,$112.00 ,$41.68 ,$224.00 ,$43.07 ,$145.88 ,$125.04 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$43.07 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$43.07 ,$47.17 ,$201.60 ,$93.78 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$45.65 ,$50.02 ,$50.02 ,$76.16 ,$50.02 ,$41.68 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600249,87591,HC NEISSERIA AMP,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600250,87624,HC HPV AMP,306,1 ,$141.00 ,$70.50 ,$31.33 ,$141.00 ,$36.26 ,$136.47 ,$116.97 ,$47.94 ,$112.80 ,$119.85 ,$88.13 ,$126.90 ,$36.26 ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$47.94 ,$119.85 ,$119.85 ,$126.90 ,$36.26 ,$39.71 ,$126.90 ,$78.95 ,$129.72 ,$126.90 ,$93.96 ,$93.96 ,$85.87 ,$93.96 ,$91.65 ,$98.21 ,$31.33 ,$111.39 ,$38.44 ,$42.11 ,$42.11 ,$47.94 ,$42.11 ,$35.09 ,$133.95 ,$115.62 ,$115.62 ,$112.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600254,87640,HC STAPH AURE AMP PROBE,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600255,87641,HC MRSA AMP,306,1 ,$123.00 ,$61.50 ,$27.33 ,$123.00 ,$36.26 ,$123.00 ,$116.97 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$36.26 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$36.26 ,$39.71 ,$110.70 ,$78.95 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$38.44 ,$42.11 ,$42.11 ,$41.82 ,$42.11 ,$35.09 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600256,87798,HC INFECT AMP (BORDETELLA),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600257,87653,HC INFECT AMP (GRP B STREP),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600258,87798,HC INFECT AMP (PNEUMO),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600259,87798,HC INFECT AMP (WEST NILE),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600260,87798,HC INFECT AMP (PARVOVIRUS),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600262,87798,HC INFECT AMP (A PHAGO),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600263,87798,HC INFECT AMP (RSV),306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600267,87799,HC INFECT AGENT QN,306,1 ,$325.00 ,$162.50 ,$42.84 ,$325.00 ,$44.27 ,$166.60 ,$142.80 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$44.27 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$44.27 ,$48.49 ,$292.50 ,$96.39 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$110.50 ,$51.41 ,$42.84 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600270,87880,HC OPTICAL STREP,306,1 ,$90.00 ,$45.00 ,$16.53 ,$90.00 ,$16.86 ,$57.86 ,$49.59 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$16.86 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$16.86 ,$18.71 ,$81.00 ,$37.19 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$17.87 ,$19.84 ,$19.84 ,$30.60 ,$19.84 ,$16.53 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$67.00 ,$33.50 ,$14.89 ,$67.00 ,$16.61 ,$56.25 ,$48.21 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$16.61 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$16.61 ,$18.19 ,$60.30 ,$36.16 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$17.61 ,$19.28 ,$19.28 ,$22.78 ,$19.28 ,$16.07 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$533.12 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$266.02 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$533.12 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$266.02 ,$291.38 ,"$1,411.20 ",$579.26 ,"$1,442.56 ","$1,411.20 ","$1,044.92 ","$1,044.92 ",$954.91 ,"$1,044.92 ","$1,019.20 ","$1,092.11 ",$348.41 ,"$1,238.72 ",$281.98 ,$308.94 ,$308.94 ,$533.12 ,$308.94 ,$257.45 ,"$1,489.60 ","$1,285.76 ","$1,285.76 ","$1,254.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30600273,87801,HC INFECT MLT ORG AMP STAPH,306,1 ,$362.00 ,$181.00 ,$50.62 ,$362.00 ,$50.62 ,$272.97 ,$233.97 ,$123.08 ,$289.60 ,$307.70 ,$226.25 ,$325.80 ,$50.62 ,$343.90 ,$325.80 ,$307.70 ,$307.70 ,$123.08 ,$307.70 ,$307.70 ,$325.80 ,$50.62 ,$79.45 ,$325.80 ,$157.95 ,$333.04 ,$325.80 ,$241.24 ,$241.24 ,$220.46 ,$241.24 ,$235.30 ,$252.13 ,$80.44 ,$285.98 ,$53.66 ,$84.24 ,$84.24 ,$123.08 ,$84.24 ,$70.20 ,$343.90 ,$296.84 ,$296.84 ,$289.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600275,87153,HC MYCOBACTERIA ID BY DNA SEQUENCING,306,1 ,$672.00 ,$336.00 ,$115.36 ,$672.00 ,$119.20 ,$448.60 ,$384.51 ,$228.48 ,$537.60 ,$571.20 ,$420.00 ,$604.80 ,$119.20 ,$638.40 ,$604.80 ,$571.20 ,$571.20 ,$228.48 ,$571.20 ,$571.20 ,$604.80 ,$119.20 ,$130.56 ,$604.80 ,$259.56 ,$618.24 ,$604.80 ,$447.82 ,$447.82 ,$409.25 ,$447.82 ,$436.80 ,$468.05 ,$149.32 ,$530.88 ,$126.35 ,$138.43 ,$138.43 ,$228.48 ,$138.43 ,$115.36 ,$638.40 ,$551.04 ,$551.04 ,$537.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600280,87491,HC C TACH RNA TMA,306,1 ,$246.00 ,$123.00 ,$35.09 ,$246.00 ,$36.26 ,$136.47 ,$116.97 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$36.26 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$36.26 ,$39.71 ,$221.40 ,$78.95 ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$38.44 ,$42.11 ,$42.11 ,$83.64 ,$42.11 ,$35.09 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600281,87591,HC N GONOR RNA TMA,306,1 ,$246.00 ,$123.00 ,$35.09 ,$246.00 ,$36.26 ,$136.47 ,$116.97 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$36.26 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$36.26 ,$39.71 ,$221.40 ,$78.95 ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$38.44 ,$42.11 ,$42.11 ,$83.64 ,$42.11 ,$35.09 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600282,87899,HC INFECT AGENT DETECT OPT (SHIGA),306,1 ,$67.00 ,$33.50 ,$14.89 ,$67.00 ,$16.61 ,$56.25 ,$48.21 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$16.61 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$16.61 ,$18.19 ,$60.30 ,$36.16 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$17.61 ,$19.28 ,$19.28 ,$22.78 ,$19.28 ,$16.07 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600285,87624,HC HPV HR GENOTYPES,306,1 ,$157.00 ,$78.50 ,$34.89 ,$157.00 ,$36.26 ,$136.47 ,$116.97 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$36.26 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$36.26 ,$39.71 ,$141.30 ,$78.95 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$38.44 ,$42.11 ,$42.11 ,$53.38 ,$42.11 ,$35.09 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600286,87625,HC HPV GENOTYPE 16 18/45,306,1 ,$157.00 ,$78.50 ,$34.89 ,$157.00 ,$38.30 ,$141.93 ,$121.65 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$38.30 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$38.30 ,$45.89 ,$141.30 ,$91.24 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$40.60 ,$48.66 ,$48.66 ,$53.38 ,$48.66 ,$40.55 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600288,87633,HC RESP VIRUS MAP-TECH 17 TARGETS,306,1 ,$896.00 ,$448.00 ,$199.09 ,$937.76 ,$430.66 ,$896.00 ,$896.00 ,$304.64 ,$716.80 ,$761.60 ,$560.00 ,$806.40 ,$430.66 ,$851.20 ,$806.40 ,$761.60 ,$761.60 ,$304.64 ,$761.60 ,$761.60 ,$806.40 ,$430.66 ,$471.71 ,$806.40 ,$937.76 ,$824.32 ,$806.40 ,$597.09 ,$597.09 ,$545.66 ,$597.09 ,$582.40 ,$624.06 ,$199.09 ,$707.84 ,$456.50 ,$500.14 ,$500.14 ,$304.64 ,$500.14 ,$416.78 ,$851.20 ,$734.72 ,$734.72 ,$716.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600289,87798,HC B. PERTUSSIS AP-TECH,306,1 ,$269.00 ,$134.50 ,$35.09 ,$269.00 ,$36.26 ,$136.47 ,$116.97 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600290,87486,HC C PNEUMONIAE AP-TECH,306,1 ,$224.00 ,$112.00 ,$35.09 ,$224.00 ,$36.26 ,$136.47 ,$116.97 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$36.26 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$36.26 ,$39.71 ,$201.60 ,$78.95 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$38.44 ,$42.11 ,$42.11 ,$76.16 ,$42.11 ,$35.09 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600291,87581,HC M PNEUMONIAS AP-TECH,306,1 ,$224.00 ,$112.00 ,$35.09 ,$224.00 ,$36.26 ,$136.47 ,$116.97 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$36.26 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$36.26 ,$39.71 ,$201.60 ,$78.95 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$38.44 ,$42.11 ,$42.11 ,$76.16 ,$42.11 ,$35.09 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600292,87798,HC INFECT AMP (EA ORG) MENI,306,1 ,$206.00 ,$103.00 ,$35.09 ,$206.00 ,$36.26 ,$136.47 ,$116.97 ,$70.04 ,$164.80 ,$175.10 ,$128.75 ,$185.40 ,$36.26 ,$195.70 ,$185.40 ,$175.10 ,$175.10 ,$70.04 ,$175.10 ,$175.10 ,$185.40 ,$36.26 ,$39.71 ,$185.40 ,$78.95 ,$189.52 ,$185.40 ,$137.28 ,$137.28 ,$125.45 ,$137.28 ,$133.90 ,$143.48 ,$45.77 ,$162.74 ,$38.44 ,$42.11 ,$42.11 ,$70.04 ,$42.11 ,$35.09 ,$195.70 ,$168.92 ,$168.92 ,$164.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600293,87653,HC INFECT AMP (STREP B) MENI,306,1 ,$206.00 ,$103.00 ,$35.09 ,$206.00 ,$36.26 ,$136.47 ,$116.97 ,$70.04 ,$164.80 ,$175.10 ,$128.75 ,$185.40 ,$36.26 ,$195.70 ,$185.40 ,$175.10 ,$175.10 ,$70.04 ,$175.10 ,$175.10 ,$185.40 ,$36.26 ,$39.71 ,$185.40 ,$78.95 ,$189.52 ,$185.40 ,$137.28 ,$137.28 ,$125.45 ,$137.28 ,$133.90 ,$143.48 ,$45.77 ,$162.74 ,$38.44 ,$42.11 ,$42.11 ,$70.04 ,$42.11 ,$35.09 ,$195.70 ,$168.92 ,$168.92 ,$164.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600294,87496,HC INFECT AMP (CMV) MENI,306,1 ,$159.00 ,$79.50 ,$35.09 ,$159.00 ,$36.26 ,$136.47 ,$116.97 ,$54.06 ,$127.20 ,$135.15 ,$99.38 ,$143.10 ,$36.26 ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$54.06 ,$135.15 ,$135.15 ,$143.10 ,$36.26 ,$39.71 ,$143.10 ,$78.95 ,$146.28 ,$143.10 ,$105.96 ,$105.96 ,$96.83 ,$105.96 ,$103.35 ,$110.74 ,$35.33 ,$125.61 ,$38.44 ,$42.11 ,$42.11 ,$54.06 ,$42.11 ,$35.09 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600295,87532,HC INFECT AMP (HHSV6) MENI,306,1 ,$159.00 ,$79.50 ,$35.09 ,$159.00 ,$36.26 ,$136.47 ,$116.97 ,$54.06 ,$127.20 ,$135.15 ,$99.38 ,$143.10 ,$36.26 ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$54.06 ,$135.15 ,$135.15 ,$143.10 ,$36.26 ,$39.71 ,$143.10 ,$78.95 ,$146.28 ,$143.10 ,$105.96 ,$105.96 ,$96.83 ,$105.96 ,$103.35 ,$110.74 ,$35.33 ,$125.61 ,$38.44 ,$42.11 ,$42.11 ,$54.06 ,$42.11 ,$35.09 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$54.06 ,$127.20 ,$135.15 ,$99.38 ,$143.10 ,$36.26 ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$54.06 ,$135.15 ,$135.15 ,$143.10 ,$36.26 ,$39.71 ,$143.10 ,$78.95 ,$146.28 ,$143.10 ,$105.96 ,$105.96 ,$96.83 ,$105.96 ,$103.35 ,$110.74 ,$35.33 ,$125.61 ,$38.44 ,$42.11 ,$42.11 ,$54.06 ,$42.11 ,$35.09 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600297,87798,HC BABESIA SPECIES PCR B,306,1 ,$78.00 ,$39.00 ,$17.33 ,$78.95 ,$36.26 ,$78.00 ,$78.00 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$36.26 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$36.26 ,$39.71 ,$70.20 ,$78.95 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$38.44 ,$42.11 ,$42.11 ,$26.52 ,$42.11 ,$35.09 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600298,87798,HC DETECT AGENT NOS DNA AMP,306,1 ,$78.00 ,$39.00 ,$17.33 ,$78.95 ,$36.26 ,$78.00 ,$78.00 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$36.26 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$36.26 ,$39.71 ,$70.20 ,$78.95 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$38.44 ,$42.11 ,$42.11 ,$26.52 ,$42.11 ,$35.09 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600306,87207,HC SPECIAL STAIN INCL BODIES/PARASITES,306,1 ,$67.00 ,$33.50 ,$5.99 ,$67.00 ,$6.19 ,$23.31 ,$19.98 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$6.19 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$6.19 ,$6.78 ,$60.30 ,$13.48 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$6.56 ,$7.19 ,$7.19 ,$22.78 ,$7.19 ,$5.99 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$24.88 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$24.88 ,$27.25 ,$100.80 ,$54.18 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$26.37 ,$28.90 ,$28.90 ,$38.08 ,$28.90 ,$24.08 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600332,87651,HC INFECT AMP (GRP A STREP),306,1 ,$248.00 ,$124.00 ,$35.09 ,$248.00 ,$36.26 ,$136.47 ,$116.97 ,$84.32 ,$198.40 ,$210.80 ,$155.00 ,$223.20 ,$36.26 ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$84.32 ,$210.80 ,$210.80 ,$223.20 ,$36.26 ,$39.71 ,$223.20 ,$78.95 ,$228.16 ,$223.20 ,$165.27 ,$165.27 ,$151.03 ,$165.27 ,$161.20 ,$172.73 ,$55.11 ,$195.92 ,$38.44 ,$42.11 ,$42.11 ,$84.32 ,$42.11 ,$35.09 ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600335,87799,HC INFECT AGENT QN BK VIRUS DNA,306,1 ,$300.00 ,$150.00 ,$42.84 ,$300.00 ,$44.27 ,$166.60 ,$142.80 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$44.27 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 ,$44.27 ,$48.49 ,$270.00 ,$96.39 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,$46.93 ,$51.41 ,$51.41 ,$102.00 ,$51.41 ,$42.84 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600339,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,$896.00 ,$448.00 ,$199.09 ,$937.76 ,$430.66 ,$896.00 ,$896.00 ,$304.64 ,$716.80 ,$761.60 ,$560.00 ,$806.40 ,$430.66 ,$851.20 ,$806.40 ,$761.60 ,$761.60 ,$304.64 ,$761.60 ,$761.60 ,$806.40 ,$430.66 ,$471.71 ,$806.40 ,$937.76 ,$824.32 ,$806.40 ,$597.09 ,$597.09 ,$545.66 ,$597.09 ,$582.40 ,$624.06 ,$199.09 ,$707.84 ,$456.50 ,$500.14 ,$500.14 ,$304.64 ,$500.14 ,$416.78 ,$851.20 ,$734.72 ,$734.72 ,$716.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$44.27 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$44.27 ,$48.49 ,$181.80 ,$96.39 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$46.93 ,$51.41 ,$51.41 ,$68.68 ,$51.41 ,$42.84 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$44.27 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$44.27 ,$48.49 ,$292.50 ,$96.39 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$46.93 ,$51.41 ,$51.41 ,$110.50 ,$51.41 ,$42.84 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$36.26 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$36.26 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$38.44 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600347,87505,HC GI ENTERIC PATHOGEN PANEL 3-5 TARGETS,306,1 ,$437.00 ,$218.50 ,$97.10 ,$437.00 ,$132.56 ,$437.00 ,$427.62 ,$148.58 ,$349.60 ,$371.45 ,$273.13 ,$393.30 ,$132.56 ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$148.58 ,$371.45 ,$371.45 ,$393.30 ,$132.56 ,$145.20 ,$393.30 ,$288.65 ,$402.04 ,$393.30 ,$291.22 ,$291.22 ,$266.13 ,$291.22 ,$284.05 ,$304.37 ,$97.10 ,$345.23 ,$140.51 ,$153.95 ,$153.95 ,$148.58 ,$153.95 ,$128.29 ,$415.15 ,$358.34 ,$358.34 ,$349.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ",$647.36 ,"$1,523.20 ","$1,618.40 ","$1,190.00 ","$1,713.60 ",$333.42 ,"$1,808.80 ","$1,713.60 ","$1,618.40 ","$1,618.40 ",$647.36 ,"$1,618.40 ","$1,618.40 ","$1,713.60 ",$333.42 ,$471.71 ,"$1,713.60 ",$937.76 ,"$1,751.68 ","$1,713.60 ","$1,268.83 ","$1,268.83 ","$1,159.54 ","$1,268.83 ","$1,237.60 ","$1,326.14 ",$423.07 ,"$1,504.16 ",$353.43 ,$500.14 ,$500.14 ,$647.36 ,$500.14 ,$416.78 ,"$1,808.80 ","$1,561.28 ","$1,561.28 ","$1,523.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30600349,87798,HC INFECT AMP (ZIKA PCR SERUM),306,1 ,$327.00 ,$163.50 ,$35.09 ,$327.00 ,$36.26 ,$136.47 ,$116.97 ,$111.18 ,$261.60 ,$277.95 ,$204.38 ,$294.30 ,$36.26 ,$310.65 ,$294.30 ,$277.95 ,$277.95 ,$111.18 ,$277.95 ,$277.95 ,$294.30 ,$36.26 ,$39.71 ,$294.30 ,$78.95 ,$300.84 ,$294.30 ,$217.91 ,$217.91 ,$199.14 ,$217.91 ,$212.55 ,$227.76 ,$72.66 ,$258.33 ,$38.44 ,$42.11 ,$42.11 ,$111.18 ,$42.11 ,$35.09 ,$310.65 ,$268.14 ,$268.14 ,$261.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$36.26 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$36.26 ,$39.71 ,$504.00 ,$78.95 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$38.44 ,$42.11 ,$42.11 ,$190.40 ,$42.11 ,$35.09 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600351,86628,HC CANDIDA AB  IGA IGG IBM,306,1 ,$41.00 ,$20.50 ,$8.17 ,$41.00 ,$8.17 ,$41.00 ,$40.02 ,$13.94 ,$32.80 ,$34.85 ,$25.63 ,$36.90 ,$8.17 ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$13.94 ,$34.85 ,$34.85 ,$36.90 ,$8.17 ,$13.59 ,$36.90 ,$27.02 ,$37.72 ,$36.90 ,$27.32 ,$27.32 ,$24.97 ,$27.32 ,$26.65 ,$28.56 ,$9.11 ,$32.39 ,$8.66 ,$14.41 ,$14.41 ,$13.94 ,$14.41 ,$12.01 ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$28.07 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$28.07 ,$39.71 ,$242.10 ,$78.95 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$29.75 ,$42.11 ,$42.11 ,$91.46 ,$42.11 ,$35.09 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600406,87254,HC VIRUS ISOL SHELL ID,306,1 ,$125.00 ,$62.50 ,$7.06 ,$125.00 ,$7.06 ,$76.06 ,$65.19 ,$42.50 ,$100.00 ,$106.25 ,$78.13 ,$112.50 ,$7.06 ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$42.50 ,$106.25 ,$106.25 ,$112.50 ,$7.06 ,$22.14 ,$112.50 ,$44.01 ,$115.00 ,$112.50 ,$83.30 ,$83.30 ,$76.13 ,$83.30 ,$81.25 ,$87.06 ,$27.78 ,$98.75 ,$7.48 ,$23.47 ,$23.47 ,$42.50 ,$23.47 ,$19.56 ,$118.75 ,$102.50 ,$102.50 ,$100.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600498,87506,HC GI ENTERIC PATHOGEN PANEL 6-8 TARGETS,306,1 ,$526.00 ,$263.00 ,$116.88 ,$591.73 ,$232.94 ,$526.00 ,$526.00 ,$178.84 ,$420.80 ,$447.10 ,$328.75 ,$473.40 ,$232.94 ,$499.70 ,$473.40 ,$447.10 ,$447.10 ,$178.84 ,$447.10 ,$447.10 ,$473.40 ,$232.94 ,$297.65 ,$473.40 ,$591.73 ,$483.92 ,$473.40 ,$350.53 ,$350.53 ,$320.33 ,$350.53 ,$341.90 ,$366.36 ,$116.88 ,$415.54 ,$246.92 ,$315.59 ,$315.59 ,$178.84 ,$315.59 ,$262.99 ,$499.70 ,$431.32 ,$431.32 ,$420.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600499,87506,HC GI ENTERIC PATHOGEN PANEL 9-11 TARGETS,306,1 ,$605.00 ,$302.50 ,$134.43 ,$605.00 ,$232.94 ,$605.00 ,$605.00 ,$205.70 ,$484.00 ,$514.25 ,$378.13 ,$544.50 ,$232.94 ,$574.75 ,$544.50 ,$514.25 ,$514.25 ,$205.70 ,$514.25 ,$514.25 ,$544.50 ,$232.94 ,$297.65 ,$544.50 ,$591.73 ,$556.60 ,$544.50 ,$403.17 ,$403.17 ,$368.45 ,$403.17 ,$393.25 ,$421.38 ,$134.43 ,$477.95 ,$246.92 ,$315.59 ,$315.59 ,$205.70 ,$315.59 ,$262.99 ,$574.75 ,$496.10 ,$496.10 ,$484.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$49.64 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$7.06 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$49.64 ,$124.10 ,$124.10 ,$131.40 ,$7.06 ,$22.14 ,$131.40 ,$44.01 ,$134.32 ,$131.40 ,$97.29 ,$97.29 ,$88.91 ,$97.29 ,$94.90 ,$101.69 ,$32.44 ,$115.34 ,$7.48 ,$23.47 ,$23.47 ,$49.64 ,$23.47 ,$19.56 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$24.14 ,$56.80 ,$60.35 ,$44.38 ,$63.90 ,$5.76 ,$67.45 ,$63.90 ,$60.35 ,$60.35 ,$24.14 ,$60.35 ,$60.35 ,$63.90 ,$5.76 ,$6.30 ,$63.90 ,$12.53 ,$65.32 ,$63.90 ,$47.31 ,$47.31 ,$43.24 ,$47.31 ,$46.15 ,$49.45 ,$15.78 ,$56.09 ,$6.11 ,$6.68 ,$6.68 ,$24.14 ,$6.68 ,$5.57 ,$67.45 ,$58.22 ,$58.22 ,$56.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$36.26 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$36.26 ,$39.71 ,$322.20 ,$78.95 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$38.44 ,$42.11 ,$42.11 ,$121.72 ,$42.11 ,$35.09 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600594,87150,HC CULTURE TYPING ID AMP PROBE TECH,306,1 ,$67.00 ,$33.50 ,$14.89 ,$78.95 ,$36.26 ,$67.00 ,$67.00 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$36.26 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$36.26 ,$39.71 ,$60.30 ,$78.95 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$38.44 ,$42.11 ,$42.11 ,$22.78 ,$42.11 ,$35.09 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$67.66 ,$159.20 ,$169.15 ,$124.38 ,$179.10 ,$36.26 ,$189.05 ,$179.10 ,$169.15 ,$169.15 ,$67.66 ,$169.15 ,$169.15 ,$179.10 ,$36.26 ,$39.71 ,$179.10 ,$78.95 ,$183.08 ,$179.10 ,$132.61 ,$132.61 ,$121.19 ,$132.61 ,$129.35 ,$138.60 ,$44.22 ,$157.21 ,$38.44 ,$42.11 ,$42.11 ,$67.66 ,$42.11 ,$35.09 ,$189.05 ,$163.18 ,$163.18 ,$159.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600596,87801,HC INFECT MLT ORG AMP TICK,306,1 ,$388.00 ,$194.00 ,$50.62 ,$388.00 ,$50.62 ,$272.97 ,$233.97 ,$131.92 ,$310.40 ,$329.80 ,$242.50 ,$349.20 ,$50.62 ,$368.60 ,$349.20 ,$329.80 ,$329.80 ,$131.92 ,$329.80 ,$329.80 ,$349.20 ,$50.62 ,$79.45 ,$349.20 ,$157.95 ,$356.96 ,$349.20 ,$258.56 ,$258.56 ,$236.29 ,$258.56 ,$252.20 ,$270.24 ,$86.21 ,$306.52 ,$53.66 ,$84.24 ,$84.24 ,$131.92 ,$84.24 ,$70.20 ,$368.60 ,$318.16 ,$318.16 ,$310.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600597,87186,HC SENSITIVITY MIC FUNGUS,306,1 ,$403.00 ,$201.50 ,$8.65 ,$403.00 ,$8.94 ,$33.64 ,$28.83 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$8.94 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$8.94 ,$9.79 ,$362.70 ,$19.46 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$9.48 ,$10.38 ,$10.38 ,$137.02 ,$10.38 ,$8.65 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682011,87635,HC COVID-19 LAB TEST NON-CDC,306,1 ,$121.00 ,$60.50 ,$26.89 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$41.14 ,$96.80 ,$102.85 ,$75.63 ,$108.90 ,$51.31 ,$114.95 ,$108.90 ,$102.85 ,$102.85 ,$41.14 ,$102.85 ,$102.85 ,$108.90 ,$51.31 ,$58.07 ,$108.90 ,$115.45 ,$111.32 ,$108.90 ,$80.63 ,$80.63 ,$73.69 ,$80.63 ,$78.65 ,$84.28 ,$26.89 ,$95.59 ,$54.39 ,$61.60 ,$61.60 ,$41.14 ,$51.33 ,$51.31 ,$114.95 ,$99.22 ,$99.22 ,$96.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682013,87635,HC COVID-19 LAB TEST,306,1 ,$121.00 ,$60.50 ,$26.89 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$41.14 ,$96.80 ,$102.85 ,$75.63 ,$108.90 ,$51.31 ,$114.95 ,$108.90 ,$102.85 ,$102.85 ,$41.14 ,$102.85 ,$102.85 ,$108.90 ,$51.31 ,$58.07 ,$108.90 ,$115.45 ,$111.32 ,$108.90 ,$80.63 ,$80.63 ,$73.69 ,$80.63 ,$78.65 ,$84.28 ,$26.89 ,$95.59 ,$54.39 ,$61.60 ,$61.60 ,$41.14 ,$51.33 ,$51.31 ,$114.95 ,$99.22 ,$99.22 ,$96.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682014,86769,HC SARS-COV-2 COVID-19 ANTIBODY,306,1 ,$87.00 ,$43.50 ,$19.33 ,$94.79 ,$42.13 ,$87.00 ,$87.00 ,$29.58 ,$69.60 ,$73.95 ,$54.38 ,$78.30 ,$42.13 ,$82.65 ,$78.30 ,$73.95 ,$73.95 ,$29.58 ,$73.95 ,$73.95 ,$78.30 ,$42.13 ,$47.68 ,$78.30 ,$94.79 ,$80.04 ,$78.30 ,$57.98 ,$57.98 ,$52.98 ,$57.98 ,$56.55 ,$60.60 ,$19.33 ,$68.73 ,$44.66 ,$50.56 ,$50.56 ,$29.58 ,$42.13 ,$42.13 ,$82.65 ,$71.34 ,$71.34 ,$69.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682021,86769,HC SARS-COV-2 COVID-19 ANTIBODY IN-HOUSE,306,1 ,$87.00 ,$43.50 ,$19.33 ,$94.79 ,$42.13 ,$87.00 ,$87.00 ,$29.58 ,$69.60 ,$73.95 ,$54.38 ,$78.30 ,$42.13 ,$82.65 ,$78.30 ,$73.95 ,$73.95 ,$29.58 ,$73.95 ,$73.95 ,$78.30 ,$42.13 ,$47.68 ,$78.30 ,$94.79 ,$80.04 ,$78.30 ,$57.98 ,$57.98 ,$52.98 ,$57.98 ,$56.55 ,$60.60 ,$19.33 ,$68.73 ,$44.66 ,$50.56 ,$50.56 ,$29.58 ,$42.13 ,$42.13 ,$82.65 ,$71.34 ,$71.34 ,$69.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$84.00 ,$42.00 ,$18.66 ,$84.00 ,$35.33 ,$84.00 ,$84.00 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 ,$35.33 ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 ,$35.33 ,$39.99 ,$75.60 ,$79.49 ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 ,$37.45 ,$54.44 ,$54.44 ,$28.56 ,$54.44 ,$35.33 ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$121.00 ,$60.50 ,$26.89 ,$121.00 ,$51.31 ,$121.00 ,$121.00 ,$41.14 ,$96.80 ,$102.85 ,$75.63 ,$108.90 ,$51.31 ,$114.95 ,$108.90 ,$102.85 ,$102.85 ,$41.14 ,$102.85 ,$102.85 ,$108.90 ,$51.31 ,$58.07 ,$108.90 ,$115.45 ,$111.32 ,$108.90 ,$80.63 ,$80.63 ,$73.69 ,$80.63 ,$78.65 ,$84.28 ,$26.89 ,$95.59 ,$54.39 ,$61.60 ,$61.60 ,$41.14 ,$51.33 ,$51.31 ,$114.95 ,$99.22 ,$99.22 ,$96.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$43.00 ,$21.50 ,$3.17 ,$43.00 ,$3.28 ,$12.32 ,$10.56 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 ,$3.28 ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 ,$3.28 ,$3.59 ,$38.70 ,$7.13 ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$9.55 ,$33.97 ,$3.48 ,$3.80 ,$3.80 ,$14.62 ,$3.80 ,$3.17 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$31.00 ,$15.50 ,$2.25 ,$31.00 ,$2.32 ,$8.72 ,$7.47 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 ,$2.32 ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 ,$2.32 ,$2.55 ,$27.90 ,$5.06 ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 ,$2.46 ,$2.70 ,$2.70 ,$10.54 ,$2.70 ,$2.25 ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$24.00 ,$12.00 ,$3.05 ,$24.00 ,$3.15 ,$11.87 ,$10.17 ,$8.16 ,$19.20 ,$20.40 ,$15.00 ,$21.60 ,$3.15 ,$22.80 ,$21.60 ,$20.40 ,$20.40 ,$8.16 ,$20.40 ,$20.40 ,$21.60 ,$3.15 ,$3.45 ,$21.60 ,$6.86 ,$22.08 ,$21.60 ,$15.99 ,$15.99 ,$14.62 ,$15.99 ,$15.60 ,$16.72 ,$5.33 ,$18.96 ,$3.34 ,$3.66 ,$3.66 ,$8.16 ,$3.66 ,$3.05 ,$22.80 ,$19.68 ,$19.68 ,$19.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$67.00 ,$33.50 ,$8.61 ,$67.00 ,$8.90 ,$30.14 ,$25.83 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$8.90 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$8.90 ,$9.74 ,$60.30 ,$19.37 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$9.43 ,$10.33 ,$10.33 ,$22.78 ,$10.33 ,$8.61 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30900002,89300,HC POST VASECTOMY SEMEN ANALYSIS,309,1 ,$83.00 ,$41.50 ,$9.84 ,$83.00 ,$10.17 ,$34.72 ,$29.76 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 ,$10.17 ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 ,$10.17 ,$11.14 ,$74.70 ,$22.14 ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 ,$10.78 ,$11.81 ,$11.81 ,$28.22 ,$11.81 ,$9.84 ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000010,81206,HC BCR/ABL1 GENE MAJOR BP,310,1 ,$851.00 ,$425.50 ,$163.96 ,$851.00 ,$169.42 ,$637.63 ,$546.54 ,$289.34 ,$680.80 ,$723.35 ,$531.88 ,$765.90 ,$169.42 ,$808.45 ,$765.90 ,$723.35 ,$723.35 ,$289.34 ,$723.35 ,$723.35 ,$765.90 ,$169.42 ,$185.57 ,$765.90 ,$368.91 ,$782.92 ,$765.90 ,$567.11 ,$567.11 ,$518.26 ,$567.11 ,$553.15 ,$592.72 ,$189.09 ,$672.29 ,$179.59 ,$196.75 ,$196.75 ,$289.34 ,$196.75 ,$163.96 ,$808.45 ,$697.82 ,$697.82 ,$680.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000011,81206,HC BCR/ABL1 GENE MAJOR BP QUEST,310,1 ,$470.00 ,$235.00 ,$104.43 ,$470.00 ,$169.42 ,$470.00 ,$470.00 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 ,$169.42 ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 ,$169.42 ,$185.57 ,$423.00 ,$368.91 ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 ,$179.59 ,$196.75 ,$196.75 ,$159.80 ,$196.75 ,$163.96 ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$350.20 ,$824.00 ,$875.50 ,$643.75 ,$927.00 ,$149.66 ,$978.50 ,$927.00 ,$875.50 ,$875.50 ,$350.20 ,$875.50 ,$875.50 ,$927.00 ,$149.66 ,$163.93 ,$927.00 ,$325.89 ,$947.60 ,$927.00 ,$686.39 ,$686.39 ,$627.27 ,$686.39 ,$669.50 ,$717.40 ,$228.87 ,$813.70 ,$158.64 ,$173.81 ,$173.81 ,$350.20 ,$173.81 ,$144.84 ,$978.50 ,$844.60 ,$844.60 ,$824.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000013,81226,HC CYP2D6 GENE COM VARIANTS,310,1 ,"$1,792.00 ",$896.00 ,$398.18 ,"$1,792.00 ",$712.19 ,"$1,578.19 ","$1,352.73 ",$609.28 ,"$1,433.60 ","$1,523.20 ","$1,120.00 ","$1,612.80 ",$712.19 ,"$1,702.40 ","$1,612.80 ","$1,523.20 ","$1,523.20 ",$609.28 ,"$1,523.20 ","$1,523.20 ","$1,612.80 ",$712.19 ,$510.34 ,"$1,612.80 ","$1,014.55 ","$1,648.64 ","$1,612.80 ","$1,194.19 ","$1,194.19 ","$1,091.33 ","$1,194.19 ","$1,164.80 ","$1,248.13 ",$398.18 ,"$1,415.68 ",$754.92 ,$541.09 ,$541.09 ,$609.28 ,$541.09 ,$450.91 ,"$1,702.40 ","$1,469.44 ","$1,469.44 ","$1,433.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$53.70 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$53.70 ,$74.35 ,$242.10 ,$147.80 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$56.92 ,$78.83 ,$78.83 ,$91.46 ,$78.83 ,$65.69 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000016,81241,HC F5 GENE ANAL LEIDEN VAR,310,1 ,$269.00 ,$134.50 ,$59.77 ,$269.00 ,$66.70 ,$256.80 ,$220.11 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$66.70 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$66.70 ,$83.04 ,$242.10 ,$165.08 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$70.70 ,$88.04 ,$88.04 ,$91.46 ,$88.04 ,$73.37 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000017,81243,HC FMR1 GENE CHARACTERZTN,310,1 ,$269.00 ,$134.50 ,$54.46 ,$269.00 ,$54.46 ,$199.64 ,$171.12 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$54.46 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$54.46 ,$64.56 ,$242.10 ,$161.40 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 , N/A ,$212.51 ,$57.73 ,$68.45 ,$68.45 ,$91.46 ,$68.45 , N/A ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000018,81256,HC HFE GENE,310,1 ,$482.00 ,$241.00 ,$65.36 ,$482.00 ,$67.54 ,$254.17 ,$217.86 ,$163.88 ,$385.60 ,$409.70 ,$301.25 ,$433.80 ,$67.54 ,$457.90 ,$433.80 ,$409.70 ,$409.70 ,$163.88 ,$409.70 ,$409.70 ,$433.80 ,$67.54 ,$73.97 ,$433.80 ,$147.06 ,$443.44 ,$433.80 ,$321.20 ,$321.20 ,$293.54 ,$321.20 ,$313.30 ,$335.71 ,$107.10 ,$380.78 ,$71.59 ,$78.43 ,$78.43 ,$163.88 ,$78.43 ,$65.36 ,$457.90 ,$395.24 ,$395.24 ,$385.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$616.42 ,"$1,450.40 ","$1,541.05 ","$1,133.13 ","$1,631.70 ",$204.58 ,"$1,722.35 ","$1,631.70 ","$1,541.05 ","$1,541.05 ",$616.42 ,"$1,541.05 ","$1,541.05 ","$1,631.70 ",$204.58 ,$224.09 ,"$1,631.70 ",$445.48 ,"$1,667.96 ","$1,631.70 ","$1,208.18 ","$1,208.18 ","$1,104.12 ","$1,208.18 ","$1,178.45 ","$1,262.75 ",$402.85 ,"$1,432.27 ",$216.85 ,$237.59 ,$237.59 ,$616.42 ,$237.59 ,$197.99 ,"$1,722.35 ","$1,486.66 ","$1,486.66 ","$1,450.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31000021,81275,HC KRAS GENE,310,1 ,"$1,053.00 ",$526.50 ,$157.98 ,"$1,053.00 ",$157.98 ,$676.38 ,$579.75 ,$358.02 ,$842.40 ,$895.05 ,$658.13 ,$947.70 ,$157.98 ,"$1,000.35 ",$947.70 ,$895.05 ,$895.05 ,$358.02 ,$895.05 ,$895.05 ,$947.70 ,$157.98 ,$218.72 ,$947.70 ,$434.81 ,$968.76 ,$947.70 ,$701.72 ,$701.72 ,$641.28 ,$701.72 ,$684.45 ,$733.41 ,$233.98 ,$831.87 ,$167.46 ,$231.90 ,$231.90 ,$358.02 ,$231.90 ,$193.25 ,"$1,000.35 ",$863.46 ,$863.46 ,$842.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000022,81291,HC MTHFR ISOLATION,310,1 ,$314.00 ,$157.00 ,$65.34 ,$314.00 ,$76.38 ,$228.69 ,$196.02 ,$106.76 ,$251.20 ,$266.90 ,$196.25 ,$282.60 ,$76.38 ,$298.30 ,$282.60 ,$266.90 ,$266.90 ,$106.76 ,$266.90 ,$266.90 ,$282.60 ,$76.38 ,$73.95 ,$282.60 ,$147.02 ,$288.88 ,$282.60 ,$209.25 ,$209.25 ,$191.23 ,$209.25 ,$204.10 ,$218.70 ,$69.77 ,$248.06 ,$80.96 ,$78.41 ,$78.41 ,$106.76 ,$78.41 ,$65.34 ,$298.30 ,$257.48 ,$257.48 ,$251.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000023,81301,HC MSI MICROSAT INSTAB,310,1 ,"$1,221.00 ",$610.50 ,$271.31 ,"$1,221.00 ",$316.03 ,"$1,219.96 ","$1,045.68 ",$415.14 ,$976.80 ,"$1,037.85 ",$763.13 ,"$1,098.90 ",$316.03 ,"$1,159.95 ","$1,098.90 ","$1,037.85 ","$1,037.85 ",$415.14 ,"$1,037.85 ","$1,037.85 ","$1,098.90 ",$316.03 ,$394.50 ,"$1,098.90 ",$784.26 ,"$1,123.32 ","$1,098.90 ",$813.67 ,$813.67 ,$743.59 ,$813.67 ,$793.65 ,$850.43 ,$271.31 ,$964.59 ,$334.99 ,$418.27 ,$418.27 ,$415.14 ,$418.27 ,$348.56 ,"$1,159.95 ","$1,001.22 ","$1,001.22 ",$976.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000025,81301,HC HNCP MICROSATL INSTABLTY,310,1 ,$585.00 ,$292.50 ,$129.99 ,$784.26 ,$316.03 ,$585.00 ,$585.00 ,$198.90 ,$468.00 ,$497.25 ,$365.63 ,$526.50 ,$316.03 ,$555.75 ,$526.50 ,$497.25 ,$497.25 ,$198.90 ,$497.25 ,$497.25 ,$526.50 ,$316.03 ,$394.50 ,$526.50 ,$784.26 ,$538.20 ,$526.50 ,$389.84 ,$389.84 ,$356.27 ,$389.84 ,$380.25 ,$407.45 ,$129.99 ,$462.15 ,$334.99 ,$418.27 ,$418.27 ,$198.90 ,$418.27 ,$348.56 ,$555.75 ,$479.70 ,$479.70 ,$468.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000026,81315,HC PML/RARAL COM BRKPNTS,310,1 ,$974.00 ,$487.00 ,$207.31 ,$974.00 ,$214.21 ,$806.23 ,$691.05 ,$331.16 ,$779.20 ,$827.90 ,$608.75 ,$876.60 ,$214.21 ,$925.30 ,$876.60 ,$827.90 ,$827.90 ,$331.16 ,$827.90 ,$827.90 ,$876.60 ,$214.21 ,$234.63 ,$876.60 ,$466.45 ,$896.08 ,$876.60 ,$649.07 ,$649.07 ,$593.17 ,$649.07 ,$633.10 ,$678.39 ,$216.42 ,$769.46 ,$227.06 ,$248.77 ,$248.77 ,$331.16 ,$248.77 ,$207.31 ,$925.30 ,$798.68 ,$798.68 ,$779.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000027,81331,HC SNRPN/UBE3A GENE,310,1 ,$370.00 ,$185.00 ,$51.07 ,$370.00 ,$52.77 ,$178.75 ,$153.21 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$52.77 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$52.77 ,$57.80 ,$333.00 ,$114.91 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$55.94 ,$61.28 ,$61.28 ,$125.80 ,$61.28 ,$51.07 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000028,81332,HC SERPINA1 GENE,310,1 ,"$1,062.00 ",$531.00 ,$43.65 ,"$1,062.00 ",$76.38 ,$169.75 ,$145.50 ,$361.08 ,$849.60 ,$902.70 ,$663.75 ,$955.80 ,$76.38 ,"$1,008.90 ",$955.80 ,$902.70 ,$902.70 ,$361.08 ,$902.70 ,$902.70 ,$955.80 ,$76.38 ,$49.40 ,$955.80 ,$98.21 ,$977.04 ,$955.80 ,$707.72 ,$707.72 ,$646.76 ,$707.72 ,$690.30 ,$739.68 ,$235.98 ,$838.98 ,$80.96 ,$52.38 ,$52.38 ,$361.08 ,$52.38 ,$43.65 ,"$1,008.90 ",$870.84 ,$870.84 ,$849.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000029,81383,HC HLA II TYPING ALLELE HR,310,1 ,$712.00 ,$356.00 ,$109.13 ,$712.00 ,$112.76 ,$424.41 ,$363.78 ,$242.08 ,$569.60 ,$605.20 ,$445.00 ,$640.80 ,$112.76 ,$676.40 ,$640.80 ,$605.20 ,$605.20 ,$242.08 ,$605.20 ,$605.20 ,$640.80 ,$112.76 ,$123.51 ,$640.80 ,$245.54 ,$655.04 ,$640.80 ,$474.48 ,$474.48 ,$433.61 ,$474.48 ,$462.80 ,$495.91 ,$158.21 ,$562.48 ,$119.53 ,$130.96 ,$130.96 ,$242.08 ,$130.96 ,$109.13 ,$676.40 ,$583.84 ,$583.84 ,$569.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000030,81400,HC DPD MOPATH PROCEDURE L1,310,1 ,$420.00 ,$210.00 ,$51.17 ,$420.00 ,$51.17 ,$223.86 ,$191.88 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$51.17 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$51.17 ,$72.39 ,$378.00 ,$143.91 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 ,$54.24 ,$76.75 ,$76.75 ,$142.80 ,$76.75 ,$63.96 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000032,81402,HC TCR MOPATH PROCED L3,310,1 ,$588.00 ,$294.00 ,$120.26 ,$588.00 ,$120.26 ,$526.16 ,$450.99 ,$199.92 ,$470.40 ,$499.80 ,$367.50 ,$529.20 ,$120.26 ,$558.60 ,$529.20 ,$499.80 ,$499.80 ,$199.92 ,$499.80 ,$499.80 ,$529.20 ,$120.26 ,$170.14 ,$529.20 ,$352.80 ,$540.96 ,$529.20 ,$391.84 ,$391.84 ,$358.09 ,$391.84 ,$382.20 ,$409.54 , N/A ,$464.52 ,$127.48 ,$180.40 ,$180.40 ,$199.92 ,$180.40 , N/A ,$558.60 ,$482.16 ,$482.16 ,$470.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000033,81270,HC JAK2 GENE,310,1 ,$560.00 ,$280.00 ,$91.66 ,$560.00 ,$94.71 ,$356.48 ,$305.55 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$94.71 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$94.71 ,$103.74 ,$504.00 ,$206.24 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$100.39 ,$109.99 ,$109.99 ,$190.40 ,$109.99 ,$91.66 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000054,81261,HC AMPLIFIED METH IG GRA,310,1 ,$493.00 ,$246.50 ,$109.54 ,$493.00 ,$204.58 ,$493.00 ,$493.00 ,$167.62 ,$394.40 ,$419.05 ,$308.13 ,$443.70 ,$204.58 ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$167.62 ,$419.05 ,$419.05 ,$443.70 ,$204.58 ,$224.09 ,$443.70 ,$445.48 ,$453.56 ,$443.70 ,$328.54 ,$328.54 ,$300.24 ,$328.54 ,$320.45 ,$343.37 ,$109.54 ,$389.47 ,$216.85 ,$237.59 ,$237.59 ,$167.62 ,$237.59 ,$197.99 ,$468.35 ,$404.26 ,$404.26 ,$394.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000056,81403,HC MO PATH LEVEL 4,310,1 ,$978.00 ,$489.00 ,$148.16 ,$978.00 ,$148.16 ,$648.20 ,$555.60 ,$332.52 ,$782.40 ,$831.30 ,$611.25 ,$880.20 ,$148.16 ,$929.10 ,$880.20 ,$831.30 ,$831.30 ,$332.52 ,$831.30 ,$831.30 ,$880.20 ,$148.16 ,$209.61 ,$880.20 ,$586.80 ,$899.76 ,$880.20 ,$651.74 ,$651.74 ,$595.60 ,$651.74 ,$635.70 ,$681.18 , N/A ,$772.62 ,$157.05 ,$222.24 ,$222.24 ,$332.52 ,$222.24 , N/A ,$929.10 ,$801.96 ,$801.96 ,$782.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000073,81207,HC BCR/ABL1 GENE MINOR BP QUEST,310,1 ,$336.00 ,$168.00 ,$74.66 ,$336.00 ,$149.66 ,$336.00 ,$336.00 ,$114.24 ,$268.80 ,$285.60 ,$210.00 ,$302.40 ,$149.66 ,$319.20 ,$302.40 ,$285.60 ,$285.60 ,$114.24 ,$285.60 ,$285.60 ,$302.40 ,$149.66 ,$163.93 ,$302.40 ,$325.89 ,$309.12 ,$302.40 ,$223.91 ,$223.91 ,$204.62 ,$223.91 ,$218.40 ,$234.02 ,$74.66 ,$265.44 ,$158.64 ,$173.81 ,$173.81 ,$114.24 ,$173.81 ,$144.84 ,$319.20 ,$275.52 ,$275.52 ,$268.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000101,83540,HC IRON LIVER TISSUE,310,1 ,$112.00 ,$56.00 ,$6.47 ,$112.00 ,$6.69 ,$25.17 ,$21.57 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$6.69 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$6.69 ,$7.32 ,$100.80 ,$14.56 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$7.09 ,$7.76 ,$7.76 ,$38.08 ,$7.76 ,$6.47 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000107,81235,HC EGFR GENE COM VARIANTS,310,1 ,$769.00 ,$384.50 ,$170.87 ,$769.00 ,$264.01 ,$769.00 ,$769.00 ,$261.46 ,$615.20 ,$653.65 ,$480.63 ,$692.10 ,$264.01 ,$730.55 ,$692.10 ,$653.65 ,$653.65 ,$261.46 ,$653.65 ,$653.65 ,$692.10 ,$264.01 ,$367.36 ,$692.10 ,$730.31 ,$707.48 ,$692.10 ,$512.46 ,$512.46 ,$468.32 ,$512.46 ,$499.85 ,$535.61 ,$170.87 ,$607.51 ,$279.85 ,$389.50 ,$389.50 ,$261.46 ,$389.50 ,$324.58 ,$730.55 ,$630.58 ,$630.58 ,$615.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000109,81170,HC ABL1 GENE ANALYSIS KINASE DOMAIN,310,1 ,$470.00 ,$235.00 ,$104.43 ,$675.00 ,$195.07 ,$470.00 ,$470.00 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 ,$195.07 ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 ,$195.07 ,$339.54 ,$423.00 ,$675.00 ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 ,$206.77 ,$360.00 ,$360.00 ,$159.80 ,$360.00 ,$300.00 ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000110,81218,HC CEBPA GENE ANALYSIS FULL SEQUENCE,310,1 ,$470.00 ,$235.00 ,$104.43 ,$544.28 ,$195.07 ,$470.00 ,$470.00 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 ,$195.07 ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 ,$195.07 ,$273.78 ,$423.00 ,$544.28 ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 ,$206.77 ,$290.28 ,$290.28 ,$159.80 ,$290.28 ,$241.90 ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000111,81219,HC CALR GENE ANALYSIS EXON 9,310,1 ,$470.00 ,$235.00 ,$98.08 ,$470.00 ,$98.08 ,$470.00 ,$405.42 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 ,$98.08 ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 ,$98.08 ,$137.66 ,$423.00 ,$273.67 ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 ,$103.96 ,$145.96 ,$145.96 ,$159.80 ,$145.96 ,$121.63 ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000112,81226,HC CYP2D6 GENE ANALYSIS COMMON VARIANTS,310,1 ,$605.00 ,$302.50 ,$134.43 ,"$1,014.55 ",$712.19 ,$605.00 ,$605.00 ,$205.70 ,$484.00 ,$514.25 ,$378.13 ,$544.50 ,$712.19 ,$574.75 ,$544.50 ,$514.25 ,$514.25 ,$205.70 ,$514.25 ,$514.25 ,$544.50 ,$712.19 ,$510.34 ,$544.50 ,"$1,014.55 ",$556.60 ,$544.50 ,$403.17 ,$403.17 ,$368.45 ,$403.17 ,$393.25 ,$421.38 ,$134.43 ,$477.95 ,$754.92 ,$541.09 ,$541.09 ,$205.70 ,$541.09 ,$450.91 ,$574.75 ,$496.10 ,$496.10 ,$484.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000113,81245,HC FLT3 GENE ANALYSIS INT TANDEM DUP VARIANTS,310,1 ,$280.00 ,$140.00 ,$62.22 ,$372.40 ,$132.74 ,$280.00 ,$280.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$132.74 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$132.74 ,$187.32 ,$252.00 ,$372.40 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$140.70 ,$198.61 ,$198.61 ,$95.20 ,$198.61 ,$165.51 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000114,81246,HC FL53 GENE ANALYSIS TYROSINE KINASE VARIANTS,310,1 ,$235.00 ,$117.50 ,$52.22 ,$235.00 ,$85.76 ,$235.00 ,$235.00 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 ,$85.76 ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 ,$85.76 ,$93.94 ,$211.50 ,$186.75 ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 ,$90.91 ,$99.60 ,$99.60 ,$79.90 ,$99.60 ,$83.00 ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$213.18 ,$501.60 ,$532.95 ,$391.88 ,$564.30 ,$105.67 ,$595.65 ,$564.30 ,$532.95 ,$532.95 ,$213.18 ,$532.95 ,$532.95 ,$564.30 ,$105.67 ,$115.74 ,$564.30 ,$376.20 ,$576.84 ,$564.30 ,$417.83 ,$417.83 ,$381.84 ,$417.83 ,$407.55 ,$436.71 , N/A ,$495.33 ,$112.01 ,$122.71 ,$122.71 ,$213.18 ,$122.71 , N/A ,$595.65 ,$514.14 ,$514.14 ,$501.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000116,81261,HC IGH GENE ANALYSIS REARRANGEMENT AMP,310,1 ,$595.00 ,$297.50 ,$132.21 ,$595.00 ,$204.58 ,$595.00 ,$595.00 ,$202.30 ,$476.00 ,$505.75 ,$371.88 ,$535.50 ,$204.58 ,$565.25 ,$535.50 ,$505.75 ,$505.75 ,$202.30 ,$505.75 ,$505.75 ,$535.50 ,$204.58 ,$224.09 ,$535.50 ,$445.48 ,$547.40 ,$535.50 ,$396.51 ,$396.51 ,$362.36 ,$396.51 ,$386.75 ,$414.42 ,$132.21 ,$470.05 ,$216.85 ,$237.59 ,$237.59 ,$202.30 ,$237.59 ,$197.99 ,$565.25 ,$487.90 ,$487.90 ,$476.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000117,81263,HC IGH VAR REG SOMATIC MUTATION ANALYSIS,310,1 ,$773.00 ,$386.50 ,$171.76 ,$773.00 ,$304.33 ,$773.00 ,$773.00 ,$262.82 ,$618.40 ,$657.05 ,$483.13 ,$695.70 ,$304.33 ,$734.35 ,$695.70 ,$657.05 ,$657.05 ,$262.82 ,$657.05 ,$657.05 ,$695.70 ,$304.33 ,$333.34 ,$695.70 ,$662.67 ,$711.16 ,$695.70 ,$515.13 ,$515.13 ,$470.76 ,$515.13 ,$502.45 ,$538.39 ,$171.76 ,$610.67 ,$322.59 ,$353.42 ,$353.42 ,$262.82 ,$353.42 ,$294.52 ,$734.35 ,$633.86 ,$633.86 ,$618.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000118,81272,HC V KIT GENE ANALYSIS TARGETED SEQ,310,1 ,$560.00 ,$280.00 ,$124.43 ,$741.40 ,$195.07 ,$560.00 ,$560.00 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$195.07 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$195.07 ,$372.94 ,$504.00 ,$741.40 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$206.77 ,$395.41 ,$395.41 ,$190.40 ,$395.41 ,$329.51 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000119,81315,HC PML/RARALPHA ANALYSIS COMMON BRKPNTS QL/QN,310,1 ,$571.00 ,$285.50 ,$126.88 ,$571.00 ,$214.21 ,$571.00 ,$571.00 ,$194.14 ,$456.80 ,$485.35 ,$356.88 ,$513.90 ,$214.21 ,$542.45 ,$513.90 ,$485.35 ,$485.35 ,$194.14 ,$485.35 ,$485.35 ,$513.90 ,$214.21 ,$234.63 ,$513.90 ,$466.45 ,$525.32 ,$513.90 ,$380.51 ,$380.51 ,$347.74 ,$380.51 ,$371.15 ,$397.70 ,$126.88 ,$451.09 ,$227.06 ,$248.77 ,$248.77 ,$194.14 ,$248.77 ,$207.31 ,$542.45 ,$468.22 ,$468.22 ,$456.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000120,81350,HC UGT1A1 GENE ANALYSIS COM VARIANTS,310,1 ,$700.00 ,$350.00 ,$155.54 ,$700.00 ,$209.40 ,$700.00 ,$700.00 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$209.40 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$209.40 ,$264.84 ,$630.00 ,$526.50 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$221.96 ,$280.80 ,$280.80 ,$238.00 ,$280.80 ,$234.00 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000121,81401,HC MOPATH PROC (ABL),310,1 ,$560.00 ,$280.00 ,$109.60 ,$560.00 ,$109.60 ,$479.50 ,$411.00 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$109.60 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$109.60 ,$155.06 ,$504.00 ,$336.00 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 , N/A ,$442.40 ,$116.18 ,$164.40 ,$164.40 ,$190.40 ,$164.40 , N/A ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000123,81401,HC MOPATH PROC (CBFB),310,1 ,$560.00 ,$280.00 ,$109.60 ,$560.00 ,$109.60 ,$479.50 ,$411.00 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$109.60 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$109.60 ,$155.06 ,$504.00 ,$336.00 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 , N/A ,$442.40 ,$116.18 ,$164.40 ,$164.40 ,$190.40 ,$164.40 , N/A ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000124,81402,HC MOPATH PROC (BCL2) L3,310,1 ,$560.00 ,$280.00 ,$120.26 ,$560.00 ,$120.26 ,$526.16 ,$450.99 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$120.26 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$120.26 ,$170.14 ,$504.00 ,$336.00 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 , N/A ,$442.40 ,$127.48 ,$180.40 ,$180.40 ,$190.40 ,$180.40 , N/A ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000202,81229,HC CYTOGENOMIC MICROARRAY ASSAY,310,1 ,"$2,128.00 ","$1,064.00 ",$472.84 ,"$2,610.00 ",$608.00 ,"$2,128.00 ","$2,128.00 ",$723.52 ,"$1,702.40 ","$1,808.80 ","$1,330.00 ","$1,915.20 ",$608.00 ,"$2,021.60 ","$1,915.20 ","$1,808.80 ","$1,808.80 ",$723.52 ,"$1,808.80 ","$1,808.80 ","$1,915.20 ",$608.00 ,"$1,312.89 ","$1,915.20 ","$2,610.00 ","$1,957.76 ","$1,915.20 ","$1,418.10 ","$1,418.10 ","$1,295.95 ","$1,418.10 ","$1,383.20 ","$1,482.15 ",$472.84 ,"$1,681.12 ",$644.48 ,"$1,392.00 ","$1,392.00 ",$723.52 ,"$1,392.00 ","$1,160.00 ","$2,021.60 ","$1,744.96 ","$1,744.96 ","$1,702.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31000235,81219,HC MUTATION ANALYSIS CALRETICULIN,310,1 ,$588.00 ,$294.00 ,$98.08 ,$588.00 ,$98.08 ,$472.99 ,$405.42 ,$199.92 ,$470.40 ,$499.80 ,$367.50 ,$529.20 ,$98.08 ,$558.60 ,$529.20 ,$499.80 ,$499.80 ,$199.92 ,$499.80 ,$499.80 ,$529.20 ,$98.08 ,$137.66 ,$529.20 ,$273.67 ,$540.96 ,$529.20 ,$391.84 ,$391.84 ,$358.09 ,$391.84 ,$382.20 ,$409.54 ,$130.65 ,$464.52 ,$103.96 ,$145.96 ,$145.96 ,$199.92 ,$145.96 ,$121.63 ,$558.60 ,$482.16 ,$482.16 ,$470.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$152.32 ,$358.40 ,$380.80 ,$280.00 ,$403.20 ,$148.16 ,$425.60 ,$403.20 ,$380.80 ,$380.80 ,$152.32 ,$380.80 ,$380.80 ,$403.20 ,$148.16 ,$209.61 ,$403.20 ,$268.80 ,$412.16 ,$403.20 ,$298.55 ,$298.55 ,$272.83 ,$298.55 ,$291.20 ,$312.03 , N/A ,$353.92 ,$157.05 ,$222.24 ,$222.24 ,$152.32 ,$222.24 , N/A ,$425.60 ,$367.36 ,$367.36 ,$358.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000237,81402,HC MOLECULAR PATH MUTATION ANALYSIS MPL,310,1 ,$420.00 ,$210.00 ,$120.26 ,$420.00 ,$120.26 ,$420.00 ,$420.00 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$120.26 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$120.26 ,$170.14 ,$378.00 ,$252.00 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 , N/A ,$331.80 ,$127.48 ,$180.40 ,$180.40 ,$142.80 ,$180.40 , N/A ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000238,81479,HC MUTATION ANALYSIS CSF3R,310,1 ,$336.00 ,$168.00 ,$76.38 ,$336.00 ,$76.38 ,$284.22 ,$284.22 ,$114.24 ,$268.80 ,$285.60 ,$210.00 ,$302.40 ,$76.38 ,$319.20 ,$302.40 ,$285.60 ,$285.60 ,$114.24 ,$285.60 ,$285.60 ,$302.40 ,$76.38 ,$141.12 ,$302.40 ,$201.60 ,$309.12 ,$302.40 ,$223.91 ,$223.91 ,$204.62 ,$223.91 ,$218.40 ,$234.02 , N/A ,$265.44 ,$80.96 ,$168.00 ,$168.00 ,$114.24 ,$168.00 , N/A ,$319.20 ,$275.52 ,$275.52 ,$268.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000239,81270,HC JAK2 MUTATION ANALYSIS,310,1 ,$403.00 ,$201.50 ,$89.55 ,$403.00 ,$94.71 ,$356.48 ,$305.55 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$94.71 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$94.71 ,$103.74 ,$362.70 ,$206.24 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$100.39 ,$109.99 ,$109.99 ,$137.02 ,$109.99 ,$91.66 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$168.00 ,$84.00 ,$16.94 ,$168.00 ,$16.94 ,$139.26 ,$119.36 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$16.94 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$16.94 ,$70.56 ,$151.20 ,$77.78 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$17.96 ,$40.12 ,$40.12 ,$57.12 ,$40.12 ,$34.57 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$235.00 ,$117.50 ,$16.94 ,$235.00 ,$16.94 ,$127.19 ,$109.02 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 ,$16.94 ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 ,$16.94 ,$98.70 ,$211.50 ,$77.78 ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 ,$17.96 ,$40.12 ,$40.12 ,$79.90 ,$40.12 ,$34.57 ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$190.00 ,$95.00 ,$42.22 ,$190.00 ,$50.86 ,$130.81 ,$112.12 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$50.86 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$50.86 ,$79.80 ,$171.00 ,$114.19 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$53.91 ,$59.36 ,$59.36 ,$64.60 ,$59.36 ,$50.75 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100106,88142,HC THINPREP PAP (CMH),311,1 ,$157.00 ,$78.50 ,$20.26 ,$157.00 ,$20.93 ,$78.79 ,$67.53 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$20.93 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$20.93 ,$22.93 ,$141.30 ,$45.59 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$22.19 ,$24.31 ,$24.31 ,$53.38 ,$24.31 ,$20.26 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100107,88142,HC THINPREP PAP,311,1 ,$157.00 ,$78.50 ,$20.26 ,$157.00 ,$20.93 ,$78.79 ,$67.53 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$20.93 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$20.93 ,$22.93 ,$141.30 ,$45.59 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$22.19 ,$24.31 ,$24.31 ,$53.38 ,$24.31 ,$20.26 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$190.00 ,$95.00 ,$16.94 ,$190.00 ,$16.94 ,$151.33 ,$129.71 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$16.94 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$16.94 ,$79.80 ,$171.00 ,$56.77 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$17.96 ,$27.59 ,$27.59 ,$64.60 ,$27.59 ,$25.23 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100114,88172,HC FINE NEEDLE EVAL,311,1 ,$141.00 ,$70.50 ,$31.33 ,$342.72 ,$69.95 ,$65.62 ,$56.25 ,$47.94 ,$112.80 ,$119.85 ,$88.13 ,$126.90 ,$69.95 ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$47.94 ,$119.85 ,$119.85 ,$126.90 ,$69.95 ,$59.22 ,$126.90 ,$342.72 ,$129.72 ,$126.90 ,$93.96 ,$93.96 ,$85.87 ,$93.96 ,$91.65 ,$98.21 ,$31.33 ,$111.39 ,$74.15 ,$141.00 ,$141.00 ,$47.94 ,$141.00 ,$152.32 ,$133.95 ,$115.62 ,$115.62 ,$112.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$403.00 ,$201.50 ,$50.75 ,$403.00 ,$64.93 ,$272.48 ,$233.55 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$64.93 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$64.93 ,$169.26 ,$362.70 ,$114.19 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$68.83 ,$59.36 ,$59.36 ,$137.02 ,$59.36 ,$50.75 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100117,88182,HC T AND B CELL QN FLOWCYT,311,1 ,$151.00 ,$75.50 ,$33.55 ,$151.00 ,$69.95 ,$151.00 ,$151.00 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 ,$69.95 ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 ,$69.95 ,$63.42 ,$135.90 ,$114.19 ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 ,$74.15 ,$59.36 ,$59.36 ,$51.34 ,$59.36 ,$50.75 ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100121,88184,HC FLOW CYTO 1ST MARKER,311,1 ,$470.00 ,$235.00 ,$50.86 ,$669.26 ,$50.86 ,$225.40 ,$193.20 ,$159.80 ,$376.00 ,$399.50 ,$293.75 ,$423.00 ,$50.86 ,$446.50 ,$423.00 ,$399.50 ,$399.50 ,$159.80 ,$399.50 ,$399.50 ,$423.00 ,$50.86 ,$197.40 ,$423.00 ,$669.26 ,$432.40 ,$423.00 ,$313.21 ,$313.21 ,$286.23 ,$313.21 ,$305.50 ,$327.36 ,$104.43 ,$371.30 ,$53.91 ,$340.09 ,$340.09 ,$159.80 ,$340.09 ,$297.45 ,$446.50 ,$385.40 ,$385.40 ,$376.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100126,88185,HC FLOW CYTO EA ADD MARKER,311,1 ,$291.00 ,$145.50 ,$26.86 ,$291.00 ,$69.95 ,$83.29 ,$71.39 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$69.95 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$69.95 ,$122.22 ,$261.90 , N/A ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$74.15 ,$26.86 ,$26.86 ,$98.94 ,$26.86 , N/A ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100128,88185,HC T AND B MAKERS ADDL,311,1 ,$77.00 ,$38.50 ,$17.11 ,$77.00 ,$69.95 ,$77.00 ,$71.39 ,$26.18 ,$61.60 ,$65.45 ,$48.13 ,$69.30 ,$69.95 ,$73.15 ,$69.30 ,$65.45 ,$65.45 ,$26.18 ,$65.45 ,$65.45 ,$69.30 ,$69.95 ,$32.34 ,$69.30 , N/A ,$70.84 ,$69.30 ,$51.31 ,$51.31 ,$46.89 ,$51.31 ,$50.05 ,$53.63 ,$17.11 ,$60.83 ,$74.15 ,$26.86 ,$26.86 ,$26.18 ,$26.86 , N/A ,$73.15 ,$63.14 ,$63.14 ,$61.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100131,88230,HC TISSUE CLT NONNEO (CHROMO),311,1 ,$561.00 ,$280.50 ,$70.04 ,$561.00 ,$70.04 ,$453.04 ,$388.32 ,$190.74 ,$448.80 ,$476.85 ,$350.63 ,$504.90 ,$70.04 ,$532.95 ,$504.90 ,$476.85 ,$476.85 ,$190.74 ,$476.85 ,$476.85 ,$504.90 ,$70.04 ,$131.84 ,$504.90 ,$262.10 ,$516.12 ,$504.90 ,$373.85 ,$373.85 ,$341.65 ,$373.85 ,$364.65 ,$390.74 ,$124.65 ,$443.19 ,$74.24 ,$139.79 ,$139.79 ,$190.74 ,$139.79 ,$116.49 ,$532.95 ,$460.02 ,$460.02 ,$448.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100137,88233,HC TISSUE CULT SKIN/OTH SOLID,311,1 ,$399.00 ,$199.50 ,$70.04 ,$399.00 ,$70.04 ,$399.00 ,$399.00 ,$135.66 ,$319.20 ,$339.15 ,$249.38 ,$359.10 ,$70.04 ,$379.05 ,$359.10 ,$339.15 ,$339.15 ,$135.66 ,$339.15 ,$339.15 ,$359.10 ,$70.04 ,$159.28 ,$359.10 ,$316.64 ,$367.08 ,$359.10 ,$265.89 ,$265.89 ,$242.99 ,$265.89 ,$259.35 ,$277.90 ,$88.66 ,$315.21 ,$74.24 ,$168.88 ,$168.88 ,$135.66 ,$168.88 ,$140.73 ,$379.05 ,$327.18 ,$327.18 ,$319.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100139,88235,HC TISSUE CULT AMNIO/CHORION,311,1 ,$602.00 ,$301.00 ,$70.04 ,$602.00 ,$70.04 ,$572.71 ,$490.89 ,$204.68 ,$481.60 ,$511.70 ,$376.25 ,$541.80 ,$70.04 ,$571.90 ,$541.80 ,$511.70 ,$511.70 ,$204.68 ,$511.70 ,$511.70 ,$541.80 ,$70.04 ,$170.11 ,$541.80 ,$338.18 ,$553.84 ,$541.80 ,$401.17 ,$401.17 ,$366.62 ,$401.17 ,$391.30 ,$419.29 ,$133.76 ,$475.58 ,$74.24 ,$180.36 ,$180.36 ,$204.68 ,$180.36 ,$150.30 ,$571.90 ,$493.64 ,$493.64 ,$481.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$149.26 ,$351.20 ,$373.15 ,$274.38 ,$395.10 ,$70.04 ,$417.05 ,$395.10 ,$373.15 ,$373.15 ,$149.26 ,$373.15 ,$373.15 ,$395.10 ,$70.04 ,$162.70 ,$395.10 ,$323.44 ,$403.88 ,$395.10 ,$292.55 ,$292.55 ,$267.35 ,$292.55 ,$285.35 ,$305.76 ,$97.55 ,$346.81 ,$74.24 ,$172.50 ,$172.50 ,$149.26 ,$172.50 ,$143.75 ,$417.05 ,$359.98 ,$359.98 ,$351.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100143,88237,HC TISSUE CULT BONE/BLD (CHROMO),311,1 ,$367.00 ,$183.50 ,$70.04 ,$367.00 ,$70.04 ,$367.00 ,$367.00 ,$124.78 ,$293.60 ,$311.95 ,$229.38 ,$330.30 ,$70.04 ,$348.65 ,$330.30 ,$311.95 ,$311.95 ,$124.78 ,$311.95 ,$311.95 ,$330.30 ,$70.04 ,$162.70 ,$330.30 ,$323.44 ,$337.64 ,$330.30 ,$244.57 ,$244.57 ,$223.50 ,$244.57 ,$238.55 ,$255.62 ,$81.55 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$124.78 ,$172.50 ,$143.75 ,$348.65 ,$300.94 ,$300.94 ,$293.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100144,88237,HC TISSUE CULT BONE/BLD,311,1 ,$367.00 ,$183.50 ,$70.04 ,$367.00 ,$70.04 ,$367.00 ,$367.00 ,$124.78 ,$293.60 ,$311.95 ,$229.38 ,$330.30 ,$70.04 ,$348.65 ,$330.30 ,$311.95 ,$311.95 ,$124.78 ,$311.95 ,$311.95 ,$330.30 ,$70.04 ,$162.70 ,$330.30 ,$323.44 ,$337.64 ,$330.30 ,$244.57 ,$244.57 ,$223.50 ,$244.57 ,$238.55 ,$255.62 ,$81.55 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$124.78 ,$172.50 ,$143.75 ,$348.65 ,$300.94 ,$300.94 ,$293.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$124.78 ,$293.60 ,$311.95 ,$229.38 ,$330.30 ,$70.04 ,$348.65 ,$330.30 ,$311.95 ,$311.95 ,$124.78 ,$311.95 ,$311.95 ,$330.30 ,$70.04 ,$162.70 ,$330.30 ,$323.44 ,$337.64 ,$330.30 ,$244.57 ,$244.57 ,$223.50 ,$244.57 ,$238.55 ,$255.62 ,$81.55 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$124.78 ,$172.50 ,$143.75 ,$348.65 ,$300.94 ,$300.94 ,$293.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$124.78 ,$293.60 ,$311.95 ,$229.38 ,$330.30 ,$70.04 ,$348.65 ,$330.30 ,$311.95 ,$311.95 ,$124.78 ,$311.95 ,$311.95 ,$330.30 ,$70.04 ,$162.70 ,$330.30 ,$323.44 ,$337.64 ,$330.30 ,$244.57 ,$244.57 ,$223.50 ,$244.57 ,$238.55 ,$255.62 ,$81.55 ,$289.93 ,$74.24 ,$172.50 ,$172.50 ,$124.78 ,$172.50 ,$143.75 ,$348.65 ,$300.94 ,$300.94 ,$293.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100148,88239,HC TISSUE CULT TUMOR,311,1 ,$496.00 ,$248.00 ,$70.04 ,$496.00 ,$70.04 ,$496.00 ,$491.73 ,$168.64 ,$396.80 ,$421.60 ,$310.00 ,$446.40 ,$70.04 ,$471.20 ,$446.40 ,$421.60 ,$421.60 ,$168.64 ,$421.60 ,$421.60 ,$446.40 ,$70.04 ,$166.96 ,$446.40 ,$331.92 ,$456.32 ,$446.40 ,$330.53 ,$330.53 ,$302.06 ,$330.53 ,$322.40 ,$345.46 ,$110.21 ,$391.84 ,$74.24 ,$177.02 ,$177.02 ,$168.64 ,$177.02 ,$147.52 ,$471.20 ,$406.72 ,$406.72 ,$396.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100150,88239,HC TISSUE CULT TUMOR (LYM),311,1 ,$648.00 ,$324.00 ,$70.04 ,$648.00 ,$70.04 ,$573.69 ,$491.73 ,$220.32 ,$518.40 ,$550.80 ,$405.00 ,$583.20 ,$70.04 ,$615.60 ,$583.20 ,$550.80 ,$550.80 ,$220.32 ,$550.80 ,$550.80 ,$583.20 ,$70.04 ,$166.96 ,$583.20 ,$331.92 ,$596.16 ,$583.20 ,$431.83 ,$431.83 ,$394.63 ,$431.83 ,$421.20 ,$451.33 ,$143.99 ,$511.92 ,$74.24 ,$177.02 ,$177.02 ,$220.32 ,$177.02 ,$147.52 ,$615.60 ,$531.36 ,$531.36 ,$518.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100151,88240,HC CRYOPRESERVATION,311,1 ,$49.00 ,$24.50 ,$9.83 ,$49.00 ,$9.83 ,$45.75 ,$39.21 ,$16.66 ,$39.20 ,$41.65 ,$30.63 ,$44.10 ,$9.83 ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$16.66 ,$41.65 ,$41.65 ,$44.10 ,$9.83 ,$14.79 ,$44.10 ,$29.41 ,$45.08 ,$44.10 ,$32.65 ,$32.65 ,$29.84 ,$32.65 ,$31.85 ,$34.13 ,$10.89 ,$38.71 ,$10.42 ,$15.68 ,$15.68 ,$16.66 ,$15.68 ,$13.07 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100155,88299,HC CYTOGENIC STUDY (LYMPH),311,1 ,$464.00 ,$232.00 ,$50.75 ,$464.00 ,$76.38 ,$392.50 ,$392.50 ,$157.76 ,$371.20 ,$394.40 ,$290.00 ,$417.60 ,$76.38 ,$440.80 ,$417.60 ,$394.40 ,$394.40 ,$157.76 ,$394.40 ,$394.40 ,$417.60 ,$76.38 ,$194.88 ,$417.60 ,$114.19 ,$426.88 ,$417.60 ,$309.21 ,$309.21 ,$282.58 ,$309.21 ,$301.60 ,$323.18 ,$103.10 ,$366.56 ,$80.96 ,$59.36 ,$59.36 ,$157.76 ,$59.36 ,$50.75 ,$440.80 ,$380.48 ,$380.48 ,$371.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100161,88262,HC CHROM COUNT 15-20/2,311,1 ,$486.00 ,$243.00 ,$107.99 ,$486.00 ,$129.67 ,$484.72 ,$415.47 ,$165.24 ,$388.80 ,$413.10 ,$303.75 ,$437.40 ,$129.67 ,$461.70 ,$437.40 ,$413.10 ,$413.10 ,$165.24 ,$413.10 ,$413.10 ,$437.40 ,$129.67 ,$142.03 ,$437.40 ,$282.35 ,$447.12 ,$437.40 ,$323.87 ,$323.87 ,$295.97 ,$323.87 ,$315.90 ,$338.50 ,$107.99 ,$383.94 ,$137.45 ,$150.59 ,$150.59 ,$165.24 ,$150.59 ,$125.49 ,$461.70 ,$398.52 ,$398.52 ,$388.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100165,88264,HC CYTOGENIC STUDY (HEMA BLD),311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$311.78 ,$733.60 ,$779.45 ,$573.13 ,$825.30 ,$149.43 ,$871.15 ,$825.30 ,$779.45 ,$779.45 ,$311.78 ,$779.45 ,$779.45 ,$825.30 ,$149.43 ,$163.67 ,$825.30 ,$325.37 ,$843.64 ,$825.30 ,$611.09 ,$611.09 ,$558.45 ,$611.09 ,$596.05 ,$638.69 ,$203.76 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$311.78 ,$173.53 ,$144.61 ,$871.15 ,$751.94 ,$751.94 ,$733.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100166,88264,HC CHROM ANLYS ANALYZE 20,311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$311.78 ,$733.60 ,$779.45 ,$573.13 ,$825.30 ,$149.43 ,$871.15 ,$825.30 ,$779.45 ,$779.45 ,$311.78 ,$779.45 ,$779.45 ,$825.30 ,$149.43 ,$163.67 ,$825.30 ,$325.37 ,$843.64 ,$825.30 ,$611.09 ,$611.09 ,$558.45 ,$611.09 ,$596.05 ,$638.69 ,$203.76 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$311.78 ,$173.53 ,$144.61 ,$871.15 ,$751.94 ,$751.94 ,$733.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100169,88264,HC CYTOGENIC STUDY (BM),311,1 ,$917.00 ,$458.50 ,$144.61 ,$917.00 ,$149.43 ,$506.14 ,$433.83 ,$311.78 ,$733.60 ,$779.45 ,$573.13 ,$825.30 ,$149.43 ,$871.15 ,$825.30 ,$779.45 ,$779.45 ,$311.78 ,$779.45 ,$779.45 ,$825.30 ,$149.43 ,$163.67 ,$825.30 ,$325.37 ,$843.64 ,$825.30 ,$611.09 ,$611.09 ,$558.45 ,$611.09 ,$596.05 ,$638.69 ,$203.76 ,$724.43 ,$158.40 ,$173.53 ,$173.53 ,$311.78 ,$173.53 ,$144.61 ,$871.15 ,$751.94 ,$751.94 ,$733.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100170,88299,HC CYTOGENIC STUDY (SOLID),311,1 ,$594.00 ,$297.00 ,$50.75 ,$594.00 ,$76.38 ,$502.46 ,$502.46 ,$201.96 ,$475.20 ,$504.90 ,$371.25 ,$534.60 ,$76.38 ,$564.30 ,$534.60 ,$504.90 ,$504.90 ,$201.96 ,$504.90 ,$504.90 ,$534.60 ,$76.38 ,$249.48 ,$534.60 ,$114.19 ,$546.48 ,$534.60 ,$395.84 ,$395.84 ,$361.75 ,$395.84 ,$386.10 ,$413.72 ,$131.99 ,$469.26 ,$80.96 ,$59.36 ,$59.36 ,$201.96 ,$59.36 ,$50.75 ,$564.30 ,$487.08 ,$487.08 ,$475.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100171,88269,HC CHROM CT AMNIOTIC INSITU,311,1 ,$917.00 ,$458.50 ,$173.66 ,$917.00 ,$179.44 ,$646.84 ,$554.43 ,$311.78 ,$733.60 ,$779.45 ,$573.13 ,$825.30 ,$179.44 ,$871.15 ,$825.30 ,$779.45 ,$779.45 ,$311.78 ,$779.45 ,$779.45 ,$825.30 ,$179.44 ,$196.55 ,$825.30 ,$390.74 ,$843.64 ,$825.30 ,$611.09 ,$611.09 ,$558.45 ,$611.09 ,$596.05 ,$638.69 ,$203.76 ,$724.43 ,$190.21 ,$208.39 ,$208.39 ,$311.78 ,$208.39 ,$173.66 ,$871.15 ,$751.94 ,$751.94 ,$733.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100172,88271,HC MCG DNA PROBE (HER2),311,1 ,$248.00 ,$124.00 ,$20.36 ,$248.00 ,$20.36 ,$83.30 ,$71.40 ,$84.32 ,$198.40 ,$210.80 ,$155.00 ,$223.20 ,$20.36 ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$84.32 ,$210.80 ,$210.80 ,$223.20 ,$20.36 ,$24.24 ,$223.20 ,$48.20 ,$228.16 ,$223.20 ,$165.27 ,$165.27 ,$151.03 ,$165.27 ,$161.20 ,$172.73 ,$55.11 ,$195.92 ,$21.58 ,$25.70 ,$25.70 ,$84.32 ,$25.70 ,$21.42 ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100173,88271,HC MCG DNA PROBE (PARDER WILLI),311,1 ,$432.00 ,$216.00 ,$20.36 ,$432.00 ,$20.36 ,$83.30 ,$71.40 ,$146.88 ,$345.60 ,$367.20 ,$270.00 ,$388.80 ,$20.36 ,$410.40 ,$388.80 ,$367.20 ,$367.20 ,$146.88 ,$367.20 ,$367.20 ,$388.80 ,$20.36 ,$24.24 ,$388.80 ,$48.20 ,$397.44 ,$388.80 ,$287.88 ,$287.88 ,$263.09 ,$287.88 ,$280.80 ,$300.89 ,$95.99 ,$341.28 ,$21.58 ,$25.70 ,$25.70 ,$146.88 ,$25.70 ,$21.42 ,$410.40 ,$354.24 ,$354.24 ,$345.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100174,88271,HC MCG DNA PROBE(FISH),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100178,88271,HC MCG DNA PROBE (T CELL),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100180,88271,HC MCG DNA PROBE (AML),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100181,88271,HC MCG DNA PROBE (MYCN),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100182,88271,HC MCG DNA PROBE (MDS),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100183,88271,HC MCG DNA PROBE (EACH),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100185,88271,HC MCG DNA PROBE (CLL),311,1 ,$216.00 ,$108.00 ,$20.36 ,$216.00 ,$20.36 ,$83.30 ,$71.40 ,$73.44 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$20.36 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$73.44 ,$183.60 ,$183.60 ,$194.40 ,$20.36 ,$24.24 ,$194.40 ,$48.20 ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$48.00 ,$170.64 ,$21.58 ,$25.70 ,$25.70 ,$73.44 ,$25.70 ,$21.42 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100186,88271,HC MCG DNA PROBE (BCR),311,1 ,$108.00 ,$54.00 ,$20.36 ,$108.00 ,$20.36 ,$83.30 ,$71.40 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$20.36 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$20.36 ,$24.24 ,$97.20 ,$48.20 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$21.58 ,$25.70 ,$25.70 ,$36.72 ,$25.70 ,$21.42 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$168.64 ,$396.80 ,$421.60 ,$310.00 ,$446.40 ,$35.97 ,$471.20 ,$446.40 ,$421.60 ,$421.60 ,$168.64 ,$421.60 ,$421.60 ,$446.40 ,$35.97 ,$39.40 ,$446.40 ,$78.32 ,$456.32 ,$446.40 ,$330.53 ,$330.53 ,$302.06 ,$330.53 ,$322.40 ,$345.46 ,$110.21 ,$391.84 ,$38.13 ,$41.77 ,$41.77 ,$168.64 ,$41.77 ,$34.81 ,$471.20 ,$406.72 ,$406.72 ,$396.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100193,88274,HC MCG INTERPHASE INSITU 25 (HER2),311,1 ,$216.00 ,$108.00 ,$42.38 ,$216.00 ,$43.79 ,$148.33 ,$127.14 ,$73.44 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$43.79 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$73.44 ,$183.60 ,$183.60 ,$194.40 ,$43.79 ,$47.97 ,$194.40 ,$95.36 ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$48.00 ,$170.64 ,$46.42 ,$50.86 ,$50.86 ,$73.44 ,$50.86 ,$42.38 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100194,88274,HC MCG INTERPHASE INSITU 25 (MYCN),311,1 ,$216.00 ,$108.00 ,$42.38 ,$216.00 ,$43.79 ,$148.33 ,$127.14 ,$73.44 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$43.79 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$73.44 ,$183.60 ,$183.60 ,$194.40 ,$43.79 ,$47.97 ,$194.40 ,$95.36 ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$48.00 ,$170.64 ,$46.42 ,$50.86 ,$50.86 ,$73.44 ,$50.86 ,$42.38 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100197,88275,HC MCG INTERPH INSITU 100 ADDITIONAL,311,1 ,$108.00 ,$54.00 ,$24.00 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$52.89 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$52.89 ,$57.94 ,$97.20 ,$115.18 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$36.72 ,$61.43 ,$51.19 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100200,88275,HC MCG INTERPH INSITU 100 (AML),311,1 ,$227.00 ,$113.50 ,$50.44 ,$227.00 ,$52.89 ,$179.17 ,$153.57 ,$77.18 ,$181.60 ,$192.95 ,$141.88 ,$204.30 ,$52.89 ,$215.65 ,$204.30 ,$192.95 ,$192.95 ,$77.18 ,$192.95 ,$192.95 ,$204.30 ,$52.89 ,$57.94 ,$204.30 ,$115.18 ,$208.84 ,$204.30 ,$151.27 ,$151.27 ,$138.24 ,$151.27 ,$147.55 ,$158.11 ,$50.44 ,$179.33 ,$56.06 ,$61.43 ,$61.43 ,$77.18 ,$61.43 ,$51.19 ,$215.65 ,$186.14 ,$186.14 ,$181.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100201,88275,HC MCG INTERPH INSITU 100 (MDS),311,1 ,$324.00 ,$162.00 ,$51.19 ,$324.00 ,$52.89 ,$179.17 ,$153.57 ,$110.16 ,$259.20 ,$275.40 ,$202.50 ,$291.60 ,$52.89 ,$307.80 ,$291.60 ,$275.40 ,$275.40 ,$110.16 ,$275.40 ,$275.40 ,$291.60 ,$52.89 ,$57.94 ,$291.60 ,$115.18 ,$298.08 ,$291.60 ,$215.91 ,$215.91 ,$197.32 ,$215.91 ,$210.60 ,$225.67 ,$71.99 ,$255.96 ,$56.06 ,$61.43 ,$61.43 ,$110.16 ,$61.43 ,$51.19 ,$307.80 ,$265.68 ,$265.68 ,$259.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100202,88275,HC MCG INTERPH INSITU 100 (PCPD),311,1 ,$108.00 ,$54.00 ,$24.00 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$52.89 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$52.89 ,$57.94 ,$97.20 ,$115.18 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$36.72 ,$61.43 ,$51.19 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100204,88275,HC MCG INTERPH INSITU 100 (CLL),311,1 ,$108.00 ,$54.00 ,$24.00 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$52.89 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$52.89 ,$57.94 ,$97.20 ,$115.18 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$36.72 ,$61.43 ,$51.19 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100205,88275,HC MCG INTERPH INSITU 100 (BCR),311,1 ,$216.00 ,$108.00 ,$48.00 ,$216.00 ,$52.89 ,$179.17 ,$153.57 ,$73.44 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$52.89 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$73.44 ,$183.60 ,$183.60 ,$194.40 ,$52.89 ,$57.94 ,$194.40 ,$115.18 ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$48.00 ,$170.64 ,$56.06 ,$61.43 ,$61.43 ,$73.44 ,$61.43 ,$51.19 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100207,88275,HC MCG INTERPH INSITU 100 (B CELL ALL),311,1 ,$108.00 ,$54.00 ,$24.00 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$52.89 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$52.89 ,$57.94 ,$97.20 ,$115.18 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$36.72 ,$61.43 ,$51.19 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100208,88275,HC MCG INTERPH INSITU 100 (T CELL LYMPH),311,1 ,$108.00 ,$54.00 ,$24.00 ,$115.18 ,$52.89 ,$108.00 ,$108.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$52.89 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$52.89 ,$57.94 ,$97.20 ,$115.18 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$56.06 ,$61.43 ,$61.43 ,$36.72 ,$61.43 ,$51.19 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100210,88275,HC MCG INTERPH INSITU 100 (B CELL LYMPHOMA),311,1 ,$194.00 ,$97.00 ,$43.11 ,$194.00 ,$52.89 ,$179.17 ,$153.57 ,$65.96 ,$155.20 ,$164.90 ,$121.25 ,$174.60 ,$52.89 ,$184.30 ,$174.60 ,$164.90 ,$164.90 ,$65.96 ,$164.90 ,$164.90 ,$174.60 ,$52.89 ,$57.94 ,$174.60 ,$115.18 ,$178.48 ,$174.60 ,$129.28 ,$129.28 ,$118.15 ,$129.28 ,$126.10 ,$135.12 ,$43.11 ,$153.26 ,$56.06 ,$61.43 ,$61.43 ,$65.96 ,$61.43 ,$51.19 ,$184.30 ,$159.08 ,$159.08 ,$155.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100211,88280,HC CHROM ADDL KARYO,311,1 ,$270.00 ,$135.00 ,$33.47 ,$270.00 ,$34.58 ,$117.15 ,$100.41 ,$91.80 ,$216.00 ,$229.50 ,$168.75 ,$243.00 ,$34.58 ,$256.50 ,$243.00 ,$229.50 ,$229.50 ,$91.80 ,$229.50 ,$229.50 ,$243.00 ,$34.58 ,$37.88 ,$243.00 ,$75.31 ,$248.40 ,$243.00 ,$179.93 ,$179.93 ,$164.43 ,$179.93 ,$175.50 ,$188.06 ,$59.99 ,$213.30 ,$36.65 ,$40.16 ,$40.16 ,$91.80 ,$40.16 ,$33.47 ,$256.50 ,$221.40 ,$221.40 ,$216.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100214,88289,HC CHROM ADDL HIGH RES (HRS),311,1 ,$299.00 ,$149.50 ,$34.43 ,$299.00 ,$35.58 ,$133.91 ,$114.78 ,$101.66 ,$239.20 ,$254.15 ,$186.88 ,$269.10 ,$35.58 ,$284.05 ,$269.10 ,$254.15 ,$254.15 ,$101.66 ,$254.15 ,$254.15 ,$269.10 ,$35.58 ,$38.97 ,$269.10 ,$77.47 ,$275.08 ,$269.10 ,$199.25 ,$199.25 ,$182.09 ,$199.25 ,$194.35 ,$208.25 ,$66.44 ,$236.21 ,$37.71 ,$41.32 ,$41.32 ,$101.66 ,$41.32 ,$34.43 ,$284.05 ,$245.18 ,$245.18 ,$239.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100222,88299,HC CYTOGENIC STUDY,311,1 ,$532.00 ,$266.00 ,$50.75 ,$532.00 ,$76.38 ,$450.02 ,$450.02 ,$180.88 ,$425.60 ,$452.20 ,$332.50 ,$478.80 ,$76.38 ,$505.40 ,$478.80 ,$452.20 ,$452.20 ,$180.88 ,$452.20 ,$452.20 ,$478.80 ,$76.38 ,$223.44 ,$478.80 ,$114.19 ,$489.44 ,$478.80 ,$354.52 ,$354.52 ,$323.99 ,$354.52 ,$345.80 ,$370.54 ,$118.21 ,$420.28 ,$80.96 ,$59.36 ,$59.36 ,$180.88 ,$59.36 ,$50.75 ,$505.40 ,$436.24 ,$436.24 ,$425.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100232,88271,HC MCG DNA PROBE (QST EACH),311,1 ,$162.00 ,$81.00 ,$20.36 ,$162.00 ,$20.36 ,$83.30 ,$71.40 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$20.36 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$20.36 ,$24.24 ,$145.80 ,$48.20 ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$21.58 ,$25.70 ,$25.70 ,$55.08 ,$25.70 ,$21.42 ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$82.28 ,$193.60 ,$205.70 ,$151.25 ,$217.80 ,$52.89 ,$229.90 ,$217.80 ,$205.70 ,$205.70 ,$82.28 ,$205.70 ,$205.70 ,$217.80 ,$52.89 ,$57.94 ,$217.80 ,$115.18 ,$222.64 ,$217.80 ,$161.27 ,$161.27 ,$147.38 ,$161.27 ,$157.30 ,$168.55 ,$53.77 ,$191.18 ,$56.06 ,$61.43 ,$61.43 ,$82.28 ,$61.43 ,$51.19 ,$229.90 ,$198.44 ,$198.44 ,$193.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$82.28 ,$193.60 ,$205.70 ,$151.25 ,$217.80 ,$52.89 ,$229.90 ,$217.80 ,$205.70 ,$205.70 ,$82.28 ,$205.70 ,$205.70 ,$217.80 ,$52.89 ,$57.94 ,$217.80 ,$115.18 ,$222.64 ,$217.80 ,$161.27 ,$161.27 ,$147.38 ,$161.27 ,$157.30 ,$168.55 ,$53.77 ,$191.18 ,$56.06 ,$61.43 ,$61.43 ,$82.28 ,$61.43 ,$51.19 ,$229.90 ,$198.44 ,$198.44 ,$193.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$82.28 ,$193.60 ,$205.70 ,$151.25 ,$217.80 ,$52.89 ,$229.90 ,$217.80 ,$205.70 ,$205.70 ,$82.28 ,$205.70 ,$205.70 ,$217.80 ,$52.89 ,$57.94 ,$217.80 ,$115.18 ,$222.64 ,$217.80 ,$161.27 ,$161.27 ,$147.38 ,$161.27 ,$157.30 ,$168.55 ,$53.77 ,$191.18 ,$56.06 ,$61.43 ,$61.43 ,$82.28 ,$61.43 ,$51.19 ,$229.90 ,$198.44 ,$198.44 ,$193.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$86.02 ,$202.40 ,$215.05 ,$158.13 ,$227.70 ,$52.89 ,$240.35 ,$227.70 ,$215.05 ,$215.05 ,$86.02 ,$215.05 ,$215.05 ,$227.70 ,$52.89 ,$57.94 ,$227.70 ,$115.18 ,$232.76 ,$227.70 ,$168.60 ,$168.60 ,$154.08 ,$168.60 ,$164.45 ,$176.21 ,$56.22 ,$199.87 ,$56.06 ,$61.43 ,$61.43 ,$86.02 ,$61.43 ,$51.19 ,$240.35 ,$207.46 ,$207.46 ,$202.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$95.54 ,$224.80 ,$238.85 ,$175.63 ,$252.90 ,$52.89 ,$266.95 ,$252.90 ,$238.85 ,$238.85 ,$95.54 ,$238.85 ,$238.85 ,$252.90 ,$52.89 ,$57.94 ,$252.90 ,$115.18 ,$258.52 ,$252.90 ,$187.26 ,$187.26 ,$171.13 ,$187.26 ,$182.65 ,$195.72 ,$62.44 ,$221.99 ,$56.06 ,$61.43 ,$61.43 ,$95.54 ,$61.43 ,$51.19 ,$266.95 ,$230.42 ,$230.42 ,$224.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100250,81479,HC UNLISTED MOLECULAR PATHOLOGY,311,1 ,$451.00 ,$225.50 ,$76.38 ,$451.00 ,$76.38 ,$381.50 ,$381.50 ,$153.34 ,$360.80 ,$383.35 ,$281.88 ,$405.90 ,$76.38 ,$428.45 ,$405.90 ,$383.35 ,$383.35 ,$153.34 ,$383.35 ,$383.35 ,$405.90 ,$76.38 ,$189.42 ,$405.90 ,$270.60 ,$414.92 ,$405.90 ,$300.55 ,$300.55 ,$274.66 ,$300.55 ,$293.15 ,$314.12 , N/A ,$356.29 ,$80.96 ,$225.50 ,$225.50 ,$153.34 ,$225.50 , N/A ,$428.45 ,$369.82 ,$369.82 ,$360.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$109.00 ,$54.50 ,$24.22 ,$109.00 ,$39.00 ,$37.86 ,$32.45 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$39.00 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$39.00 ,$45.78 ,$98.10 ,$56.77 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$41.34 ,$27.59 ,$27.59 ,$37.06 ,$27.59 ,$25.23 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$224.00 ,$112.00 ,$25.23 ,$224.00 ,$39.00 ,$80.11 ,$68.66 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$39.00 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$39.00 ,$94.08 ,$201.60 ,$56.77 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$41.34 ,$27.59 ,$27.59 ,$76.16 ,$27.59 ,$25.23 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$280.00 ,$140.00 ,$39.00 ,$280.00 ,$39.00 ,$97.01 ,$83.15 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$39.00 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$39.00 ,$117.60 ,$252.00 ,$114.19 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$41.34 ,$59.36 ,$59.36 ,$95.20 ,$59.36 ,$50.75 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200104,88304,HC GROSS  AND  MICRO LEVEL III (CMH),312,1 ,$280.00 ,$140.00 ,$39.00 ,$280.00 ,$39.00 ,$97.01 ,$83.15 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$39.00 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$39.00 ,$117.60 ,$252.00 ,$114.19 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$41.34 ,$59.36 ,$59.36 ,$95.20 ,$59.36 ,$50.75 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200107,88305,HC GROSS  AND  MICRO LEVEL IV (CMH),312,1 ,$336.00 ,$168.00 ,$50.75 ,$336.00 ,$71.26 ,$101.84 ,$87.29 ,$114.24 ,$268.80 ,$285.60 ,$210.00 ,$302.40 ,$71.26 ,$319.20 ,$302.40 ,$285.60 ,$285.60 ,$114.24 ,$285.60 ,$285.60 ,$302.40 ,$71.26 ,$141.12 ,$302.40 ,$114.19 ,$309.12 ,$302.40 ,$223.91 ,$223.91 ,$204.62 ,$223.91 ,$218.40 ,$234.02 ,$74.66 ,$265.44 ,$75.54 ,$59.36 ,$59.36 ,$114.24 ,$59.36 ,$50.75 ,$319.20 ,$275.52 ,$275.52 ,$268.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$336.00 ,$168.00 ,$50.75 ,$336.00 ,$71.26 ,$101.84 ,$87.29 ,$114.24 ,$268.80 ,$285.60 ,$210.00 ,$302.40 ,$71.26 ,$319.20 ,$302.40 ,$285.60 ,$285.60 ,$114.24 ,$285.60 ,$285.60 ,$302.40 ,$71.26 ,$141.12 ,$302.40 ,$114.19 ,$309.12 ,$302.40 ,$223.91 ,$223.91 ,$204.62 ,$223.91 ,$218.40 ,$234.02 ,$74.66 ,$265.44 ,$75.54 ,$59.36 ,$59.36 ,$114.24 ,$59.36 ,$50.75 ,$319.20 ,$275.52 ,$275.52 ,$268.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200109,88305,HC GROSS  AND  MICRO LEVEL IV (BM),312,1 ,$286.00 ,$143.00 ,$50.75 ,$286.00 ,$71.26 ,$101.84 ,$87.29 ,$97.24 ,$228.80 ,$243.10 ,$178.75 ,$257.40 ,$71.26 ,$271.70 ,$257.40 ,$243.10 ,$243.10 ,$97.24 ,$243.10 ,$243.10 ,$257.40 ,$71.26 ,$120.12 ,$257.40 ,$114.19 ,$263.12 ,$257.40 ,$190.59 ,$190.59 ,$174.17 ,$190.59 ,$185.90 ,$199.20 ,$63.55 ,$225.94 ,$75.54 ,$59.36 ,$59.36 ,$97.24 ,$59.36 ,$50.75 ,$271.70 ,$234.52 ,$234.52 ,$228.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,"$1,098.00 ",$549.00 ,$71.26 ,"$1,098.00 ",$71.26 ,$623.75 ,$534.65 ,$373.32 ,$878.40 ,$933.30 ,$686.25 ,$988.20 ,$71.26 ,"$1,043.10 ",$988.20 ,$933.30 ,$933.30 ,$373.32 ,$933.30 ,$933.30 ,$988.20 ,$71.26 ,$461.16 ,$988.20 ,$669.26 ,"$1,010.16 ",$988.20 ,$731.71 ,$731.71 ,$668.68 ,$731.71 ,$713.70 ,$764.76 ,$243.98 ,$867.42 ,$75.54 ,$340.09 ,$340.09 ,$373.32 ,$340.09 ,$297.45 ,"$1,043.10 ",$900.36 ,$900.36 ,$878.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200111,88307,HC GROSS  AND  MICRO LEVEL V (CMH),312,1 ,"$1,098.00 ",$549.00 ,$71.26 ,"$1,098.00 ",$71.26 ,$623.75 ,$534.65 ,$373.32 ,$878.40 ,$933.30 ,$686.25 ,$988.20 ,$71.26 ,"$1,043.10 ",$988.20 ,$933.30 ,$933.30 ,$373.32 ,$933.30 ,$933.30 ,$988.20 ,$71.26 ,$461.16 ,$988.20 ,$669.26 ,"$1,010.16 ",$988.20 ,$731.71 ,$731.71 ,$668.68 ,$731.71 ,$713.70 ,$764.76 ,$243.98 ,$867.42 ,$75.54 ,$340.09 ,$340.09 ,$373.32 ,$340.09 ,$297.45 ,"$1,043.10 ",$900.36 ,$900.36 ,$878.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,568.00 ",$784.00 ,$71.26 ,"$1,568.00 ",$71.26 ,$875.27 ,$750.24 ,$533.12 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$71.26 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$533.12 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$71.26 ,$658.56 ,"$1,411.20 ","$1,505.90 ","$1,442.56 ","$1,411.20 ","$1,044.92 ","$1,044.92 ",$954.91 ,"$1,044.92 ","$1,019.20 ","$1,092.11 ",$348.41 ,"$1,238.72 ",$75.54 ,$753.84 ,$753.84 ,$533.12 ,$753.84 ,$669.29 ,"$1,489.60 ","$1,285.76 ","$1,285.76 ","$1,254.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200114,88309,HC GROSS  AND  MICRO LEVEL VI (CMH),312,1 ,"$1,568.00 ",$784.00 ,$71.26 ,"$1,568.00 ",$71.26 ,$875.27 ,$750.24 ,$533.12 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$71.26 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$533.12 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$71.26 ,$658.56 ,"$1,411.20 ","$1,505.90 ","$1,442.56 ","$1,411.20 ","$1,044.92 ","$1,044.92 ",$954.91 ,"$1,044.92 ","$1,019.20 ","$1,092.11 ",$348.41 ,"$1,238.72 ",$75.54 ,$753.84 ,$753.84 ,$533.12 ,$753.84 ,$669.29 ,"$1,489.60 ","$1,285.76 ","$1,285.76 ","$1,254.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200116,88311,HC DECALCIFICATION,312,1 ,$78.00 ,$39.00 ,$10.82 ,$78.00 ,$71.26 ,$29.41 ,$25.21 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$71.26 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$71.26 ,$32.76 ,$70.20 , N/A ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$75.54 ,$10.82 ,$10.82 ,$26.52 ,$10.82 , N/A ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200123,88312,HC SPECIAL STAIN I,312,1 ,$358.00 ,$179.00 ,$39.00 ,$358.00 ,$39.00 ,$247.90 ,$212.49 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$39.00 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$39.00 ,$150.36 ,$322.20 ,$114.19 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$41.34 ,$59.36 ,$59.36 ,$121.72 ,$59.36 ,$50.75 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200124,88312,HC SPECIAL STAIN I (GIEMSA OR PAS),312,1 ,$358.00 ,$179.00 ,$39.00 ,$358.00 ,$39.00 ,$247.90 ,$212.49 ,$121.72 ,$286.40 ,$304.30 ,$223.75 ,$322.20 ,$39.00 ,$340.10 ,$322.20 ,$304.30 ,$304.30 ,$121.72 ,$304.30 ,$304.30 ,$322.20 ,$39.00 ,$150.36 ,$322.20 ,$114.19 ,$329.36 ,$322.20 ,$238.57 ,$238.57 ,$218.02 ,$238.57 ,$232.70 ,$249.35 ,$79.55 ,$282.82 ,$41.34 ,$59.36 ,$59.36 ,$121.72 ,$59.36 ,$50.75 ,$340.10 ,$293.56 ,$293.56 ,$286.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200125,88313,HC SPECIAL STAIN II,312,1 ,$291.00 ,$145.50 ,$34.57 ,$291.00 ,$39.00 ,$204.44 ,$175.24 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.00 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.00 ,$122.22 ,$261.90 ,$77.78 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.34 ,$40.12 ,$40.12 ,$98.94 ,$40.12 ,$34.57 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200127,88313,HC SPECIAL STAIN II (SUDAN BLACK),312,1 ,$291.00 ,$145.50 ,$34.57 ,$291.00 ,$39.00 ,$204.44 ,$175.24 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.00 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.00 ,$122.22 ,$261.90 ,$77.78 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.34 ,$40.12 ,$40.12 ,$98.94 ,$40.12 ,$34.57 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200128,88313,HC SPECIAL STAIN II (MISC),312,1 ,$291.00 ,$145.50 ,$34.57 ,$291.00 ,$39.00 ,$204.44 ,$175.24 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.00 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.00 ,$122.22 ,$261.90 ,$77.78 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.34 ,$40.12 ,$40.12 ,$98.94 ,$40.12 ,$34.57 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200129,88313,HC SPECIAL STAIN II (MAST CELL),312,1 ,$143.00 ,$71.50 ,$31.77 ,$143.00 ,$39.00 ,$143.00 ,$143.00 ,$48.62 ,$114.40 ,$121.55 ,$89.38 ,$128.70 ,$39.00 ,$135.85 ,$128.70 ,$121.55 ,$121.55 ,$48.62 ,$121.55 ,$121.55 ,$128.70 ,$39.00 ,$60.06 ,$128.70 ,$77.78 ,$131.56 ,$128.70 ,$95.30 ,$95.30 ,$87.09 ,$95.30 ,$92.95 ,$99.60 ,$31.77 ,$112.97 ,$41.34 ,$40.12 ,$40.12 ,$48.62 ,$40.12 ,$34.57 ,$135.85 ,$117.26 ,$117.26 ,$114.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200130,88313,HC SPECIAL STAIN II (CONGO RED),312,1 ,$160.00 ,$80.00 ,$34.57 ,$160.00 ,$39.00 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$39.00 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$39.00 ,$67.20 ,$144.00 ,$77.78 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$41.34 ,$40.12 ,$40.12 ,$54.40 ,$40.12 ,$34.57 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200131,88313,HC SPECIAL STAIN II (FE),312,1 ,$160.00 ,$80.00 ,$34.57 ,$160.00 ,$39.00 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$39.00 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$39.00 ,$67.20 ,$144.00 ,$77.78 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$41.34 ,$40.12 ,$40.12 ,$54.40 ,$40.12 ,$34.57 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200132,88313,HC SPECIAL STAIN II (PAS),312,1 ,$160.00 ,$80.00 ,$34.57 ,$160.00 ,$39.00 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$39.00 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$39.00 ,$67.20 ,$144.00 ,$77.78 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$41.34 ,$40.12 ,$40.12 ,$54.40 ,$40.12 ,$34.57 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200133,88313,HC SPECIAL STAIN II (ALCIAN BLUE/PAS),312,1 ,$274.00 ,$137.00 ,$34.57 ,$274.00 ,$39.00 ,$204.44 ,$175.24 ,$93.16 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$39.00 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$93.16 ,$232.90 ,$232.90 ,$246.60 ,$39.00 ,$115.08 ,$246.60 ,$77.78 ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$60.88 ,$216.46 ,$41.34 ,$40.12 ,$40.12 ,$93.16 ,$40.12 ,$34.57 ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200134,88313,HC SPECIAL STAIN II (ELASTIC),312,1 ,$251.00 ,$125.50 ,$34.57 ,$251.00 ,$39.00 ,$204.44 ,$175.24 ,$85.34 ,$200.80 ,$213.35 ,$156.88 ,$225.90 ,$39.00 ,$238.45 ,$225.90 ,$213.35 ,$213.35 ,$85.34 ,$213.35 ,$213.35 ,$225.90 ,$39.00 ,$105.42 ,$225.90 ,$77.78 ,$230.92 ,$225.90 ,$167.27 ,$167.27 ,$152.86 ,$167.27 ,$163.15 ,$174.82 ,$55.77 ,$198.29 ,$41.34 ,$40.12 ,$40.12 ,$85.34 ,$40.12 ,$34.57 ,$238.45 ,$205.82 ,$205.82 ,$200.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200136,88313,HC SPECIAL STAIN II (MUCICARMINE),312,1 ,$255.00 ,$127.50 ,$34.57 ,$255.00 ,$39.00 ,$204.44 ,$175.24 ,$86.70 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$39.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$86.70 ,$216.75 ,$216.75 ,$229.50 ,$39.00 ,$107.10 ,$229.50 ,$77.78 ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,$41.34 ,$40.12 ,$40.12 ,$86.70 ,$40.12 ,$34.57 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200137,88313,HC SPECIAL STAIN II (ALCIAN BL W/HYALUR),312,1 ,$255.00 ,$127.50 ,$34.57 ,$255.00 ,$39.00 ,$204.44 ,$175.24 ,$86.70 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$39.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$86.70 ,$216.75 ,$216.75 ,$229.50 ,$39.00 ,$107.10 ,$229.50 ,$77.78 ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,$41.34 ,$40.12 ,$40.12 ,$86.70 ,$40.12 ,$34.57 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200143,88313,HC SPECIAL STAIN II (TRICHROME),312,1 ,$160.00 ,$80.00 ,$34.57 ,$160.00 ,$39.00 ,$160.00 ,$160.00 ,$54.40 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$39.00 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$54.40 ,$136.00 ,$136.00 ,$144.00 ,$39.00 ,$67.20 ,$144.00 ,$77.78 ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$41.34 ,$40.12 ,$40.12 ,$54.40 ,$40.12 ,$34.57 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200144,88313,HC SPECIAL STAIN II (RETICULUM),312,1 ,$251.00 ,$125.50 ,$34.57 ,$251.00 ,$39.00 ,$204.44 ,$175.24 ,$85.34 ,$200.80 ,$213.35 ,$156.88 ,$225.90 ,$39.00 ,$238.45 ,$225.90 ,$213.35 ,$213.35 ,$85.34 ,$213.35 ,$213.35 ,$225.90 ,$39.00 ,$105.42 ,$225.90 ,$77.78 ,$230.92 ,$225.90 ,$167.27 ,$167.27 ,$152.86 ,$167.27 ,$163.15 ,$174.82 ,$55.77 ,$198.29 ,$41.34 ,$40.12 ,$40.12 ,$85.34 ,$40.12 ,$34.57 ,$238.45 ,$205.82 ,$205.82 ,$200.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200145,88313,HC SPECIAL STAIN II (ALCIAN BLUE),312,1 ,$274.00 ,$137.00 ,$34.57 ,$274.00 ,$39.00 ,$204.44 ,$175.24 ,$93.16 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$39.00 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$93.16 ,$232.90 ,$232.90 ,$246.60 ,$39.00 ,$115.08 ,$246.60 ,$77.78 ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$60.88 ,$216.46 ,$41.34 ,$40.12 ,$40.12 ,$93.16 ,$40.12 ,$34.57 ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200146,88313,HC SPECIAL STAIN II (PAS W/DIGEST),312,1 ,$274.00 ,$137.00 ,$34.57 ,$274.00 ,$39.00 ,$204.44 ,$175.24 ,$93.16 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$39.00 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$93.16 ,$232.90 ,$232.90 ,$246.60 ,$39.00 ,$115.08 ,$246.60 ,$77.78 ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$60.88 ,$216.46 ,$41.34 ,$40.12 ,$40.12 ,$93.16 ,$40.12 ,$34.57 ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200156,88319,HC HISTOCHEM ENZYME STAIN,312,1 ,$246.00 ,$123.00 ,$54.66 ,"$1,505.90 ",$71.26 ,$237.04 ,$203.17 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$71.26 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$71.26 ,$103.32 ,$221.40 ,"$1,505.90 ",$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$75.54 ,$246.00 ,$246.00 ,$83.64 ,$246.00 ,$669.29 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200158,88321,HC CONSULT SLIDES,312,1 ,$414.00 ,$207.00 ,$34.57 ,$414.00 ,$64.93 ,$294.81 ,$252.69 ,$140.76 ,$331.20 ,$351.90 ,$258.75 ,$372.60 ,$64.93 ,$393.30 ,$372.60 ,$351.90 ,$351.90 ,$140.76 ,$351.90 ,$351.90 ,$372.60 ,$64.93 ,$173.88 ,$372.60 ,$77.78 ,$380.88 ,$372.60 ,$275.89 ,$275.89 ,$252.13 ,$275.89 ,$269.10 ,$288.35 ,$91.99 ,$327.06 ,$68.83 ,$40.12 ,$40.12 ,$140.76 ,$40.12 ,$34.57 ,$393.30 ,$339.48 ,$339.48 ,$331.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200164,88323,HC CONSULT/SLIDE PREP,312,1 ,$414.00 ,$207.00 ,$50.75 ,$414.00 ,$64.93 ,$89.77 ,$76.94 ,$140.76 ,$331.20 ,$351.90 ,$258.75 ,$372.60 ,$64.93 ,$393.30 ,$372.60 ,$351.90 ,$351.90 ,$140.76 ,$351.90 ,$351.90 ,$372.60 ,$64.93 ,$173.88 ,$372.60 ,$114.19 ,$380.88 ,$372.60 ,$275.89 ,$275.89 ,$252.13 ,$275.89 ,$269.10 ,$288.35 ,$91.99 ,$327.06 ,$68.83 ,$59.36 ,$59.36 ,$140.76 ,$59.36 ,$50.75 ,$393.30 ,$339.48 ,$339.48 ,$331.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200165,88323,HC CONSULT/SLIDE PREP (CUTAN),312,1 ,$74.00 ,$37.00 ,$16.44 ,$114.19 ,$64.93 ,$74.00 ,$74.00 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$64.93 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$64.93 ,$31.08 ,$66.60 ,$114.19 ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$68.83 ,$59.36 ,$59.36 ,$25.16 ,$59.36 ,$50.75 ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200169,88325,HC CONSULT PATH REV/REP (HEMATOPATH),312,1 ,"$1,120.00 ",$560.00 ,$59.36 ,"$1,120.00 ",$64.93 ,$522.54 ,$447.90 ,$380.80 ,$896.00 ,$952.00 ,$700.00 ,"$1,008.00 ",$64.93 ,"$1,064.00 ","$1,008.00 ",$952.00 ,$952.00 ,$380.80 ,$952.00 ,$952.00 ,"$1,008.00 ",$64.93 ,$470.40 ,"$1,008.00 ",$342.72 ,"$1,030.40 ","$1,008.00 ",$746.37 ,$746.37 ,$682.08 ,$746.37 ,$728.00 ,$780.08 ,$248.86 ,$884.80 ,$68.83 ,$59.36 ,$59.36 ,$380.80 ,$59.36 ,$152.32 ,"$1,064.00 ",$918.40 ,$918.40 ,$896.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200170,88325,HC CONSULT PATH REV/REP (RENAL PATH),312,1 ,"$1,120.00 ",$560.00 ,$59.36 ,"$1,120.00 ",$64.93 ,$522.54 ,$447.90 ,$380.80 ,$896.00 ,$952.00 ,$700.00 ,"$1,008.00 ",$64.93 ,"$1,064.00 ","$1,008.00 ",$952.00 ,$952.00 ,$380.80 ,$952.00 ,$952.00 ,"$1,008.00 ",$64.93 ,$470.40 ,"$1,008.00 ",$342.72 ,"$1,030.40 ","$1,008.00 ",$746.37 ,$746.37 ,$682.08 ,$746.37 ,$728.00 ,$780.08 ,$248.86 ,$884.80 ,$68.83 ,$59.36 ,$59.36 ,$380.80 ,$59.36 ,$152.32 ,"$1,064.00 ",$918.40 ,$918.40 ,$896.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200172,88329,HC CONSULT PATH SURGERY,312,1 ,$398.00 ,$199.00 ,$34.57 ,$398.00 ,$64.93 ,$126.10 ,$108.08 ,$135.32 ,$318.40 ,$338.30 ,$248.75 ,$358.20 ,$64.93 ,$378.10 ,$358.20 ,$338.30 ,$338.30 ,$135.32 ,$338.30 ,$338.30 ,$358.20 ,$64.93 ,$167.16 ,$358.20 ,$77.78 ,$366.16 ,$358.20 ,$265.23 ,$265.23 ,$242.38 ,$265.23 ,$258.70 ,$277.21 ,$88.44 ,$314.42 ,$68.83 ,$40.12 ,$40.12 ,$135.32 ,$40.12 ,$34.57 ,$378.10 ,$326.36 ,$326.36 ,$318.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$258.00 ,$129.00 ,$57.33 ,$342.72 ,$64.93 ,$111.49 ,$95.57 ,$87.72 ,$206.40 ,$219.30 ,$161.25 ,$232.20 ,$64.93 ,$245.10 ,$232.20 ,$219.30 ,$219.30 ,$87.72 ,$219.30 ,$219.30 ,$232.20 ,$64.93 ,$108.36 ,$232.20 ,$342.72 ,$237.36 ,$232.20 ,$171.93 ,$171.93 ,$157.12 ,$171.93 ,$167.70 ,$179.70 ,$57.33 ,$203.82 ,$68.83 ,$172.20 ,$172.20 ,$87.72 ,$172.20 ,$152.32 ,$245.10 ,$211.56 ,$211.56 ,$206.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$190.00 ,$95.00 ,$27.72 ,$190.00 ,$64.93 ,$72.87 ,$62.46 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$64.93 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$64.93 ,$79.80 ,$171.00 , N/A ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$68.83 ,$27.72 ,$27.72 ,$64.60 ,$27.72 , N/A ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200175,88333,HC CONSULT PATH SURG CYTO INIT,312,1 ,$123.00 ,$61.50 ,$27.33 ,"$1,505.90 ",$64.93 ,$84.94 ,$72.80 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$64.93 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$64.93 ,$51.66 ,$110.70 ,"$1,505.90 ",$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$68.83 ,$123.00 ,$123.00 ,$41.82 ,$123.00 , N/A ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200176,88334,HC CONSULT PATH SURG EA ADDL,312,1 ,$174.00 ,$87.00 ,$21.65 ,$174.00 ,$64.93 ,$56.74 ,$48.63 ,$59.16 ,$139.20 ,$147.90 ,$108.75 ,$156.60 ,$64.93 ,$165.30 ,$156.60 ,$147.90 ,$147.90 ,$59.16 ,$147.90 ,$147.90 ,$156.60 ,$64.93 ,$73.08 ,$156.60 , N/A ,$160.08 ,$156.60 ,$115.95 ,$115.95 ,$105.97 ,$115.95 ,$113.10 ,$121.19 ,$38.66 ,$137.46 ,$68.83 ,$21.65 ,$21.65 ,$59.16 ,$21.65 , N/A ,$165.30 ,$142.68 ,$142.68 ,$139.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200177,88341,HC IMMUNOHISTOCHEM EA AB,312,1 ,$101.00 ,$50.50 ,$22.44 ,$101.00 ,$71.26 ,$101.00 ,$101.00 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$71.26 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$71.26 ,$42.42 ,$90.90 , N/A ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$75.54 ,$77.52 ,$77.52 ,$34.34 ,$77.52 , N/A ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200182,88341,HC IMMUNOHISTOCHEM EA AB T2,312,1 ,$274.00 ,$137.00 ,$60.88 ,$274.00 ,$71.26 ,$216.08 ,$185.21 ,$93.16 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$71.26 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$93.16 ,$232.90 ,$232.90 ,$246.60 ,$71.26 ,$115.08 ,$246.60 , N/A ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$60.88 ,$216.46 ,$75.54 ,$77.52 ,$77.52 ,$93.16 ,$77.52 , N/A ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200184,88341,HC IMMUNOHISTOCHEM EA AB T4,312,1 ,$272.00 ,$136.00 ,$60.44 ,$272.00 ,$71.26 ,$216.08 ,$185.21 ,$92.48 ,$217.60 ,$231.20 ,$170.00 ,$244.80 ,$71.26 ,$258.40 ,$244.80 ,$231.20 ,$231.20 ,$92.48 ,$231.20 ,$231.20 ,$244.80 ,$71.26 ,$114.24 ,$244.80 , N/A ,$250.24 ,$244.80 ,$181.26 ,$181.26 ,$165.65 ,$181.26 ,$176.80 ,$189.45 ,$60.44 ,$214.88 ,$75.54 ,$77.52 ,$77.52 ,$92.48 ,$77.52 , N/A ,$258.40 ,$223.04 ,$223.04 ,$217.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200187,88346,HC IF DIRECT (RENAL BX),312,1 ,$101.00 ,$50.50 ,$22.44 ,$669.26 ,$71.26 ,$101.00 ,$101.00 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$71.26 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$71.26 ,$42.42 ,$90.90 ,$669.26 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$75.54 ,$101.00 ,$101.00 ,$34.34 ,$101.00 ,$297.45 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200188,88346,HC IF DIRECT (CUTANEOUS),312,1 ,$101.00 ,$50.50 ,$22.44 ,$669.26 ,$71.26 ,$101.00 ,$101.00 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$71.26 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$71.26 ,$42.42 ,$90.90 ,$669.26 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$75.54 ,$101.00 ,$101.00 ,$34.34 ,$101.00 ,$297.45 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200189,88348,HC ELECTRON MICRO DIAG,312,1 ,"$3,360.00 ","$1,680.00 ",$71.26 ,"$3,360.00 ",$71.26 ,$954.61 ,$818.24 ,"$1,142.40 ","$2,688.00 ","$2,856.00 ","$2,100.00 ","$3,024.00 ",$71.26 ,"$3,192.00 ","$3,024.00 ","$2,856.00 ","$2,856.00 ","$1,142.40 ","$2,856.00 ","$2,856.00 ","$3,024.00 ",$71.26 ,"$1,411.20 ","$3,024.00 ","$1,505.90 ","$3,091.20 ","$3,024.00 ","$2,239.10 ","$2,239.10 ","$2,046.24 ","$2,239.10 ","$2,184.00 ","$2,340.24 ",$746.59 ,"$2,654.40 ",$75.54 ,$753.84 ,$753.84 ,"$1,142.40 ",$753.84 ,$669.29 ,"$3,192.00 ","$2,755.20 ","$2,755.20 ","$2,688.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200190,88348,HC ELECTRON MICRO DIAG MAYO,312,1 ,"$1,635.00 ",$817.50 ,$71.26 ,"$1,635.00 ",$71.26 ,$954.61 ,$818.24 ,$555.90 ,"$1,308.00 ","$1,389.75 ","$1,021.88 ","$1,471.50 ",$71.26 ,"$1,553.25 ","$1,471.50 ","$1,389.75 ","$1,389.75 ",$555.90 ,"$1,389.75 ","$1,389.75 ","$1,471.50 ",$71.26 ,$686.70 ,"$1,471.50 ","$1,505.90 ","$1,504.20 ","$1,471.50 ","$1,089.56 ","$1,089.56 ",$995.72 ,"$1,089.56 ","$1,062.75 ","$1,138.78 ",$363.30 ,"$1,291.65 ",$75.54 ,$753.84 ,$753.84 ,$555.90 ,$753.84 ,$669.29 ,"$1,553.25 ","$1,340.70 ","$1,340.70 ","$1,308.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200191,88360,HC MORPHO ANLYS TUMOR MAN (PR),312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$285.32 ,$244.56 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 ,$342.72 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$172.20 ,$172.20 ,$137.02 ,$172.20 ,$152.32 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200192,88360,HC MORPHO ANLYS TUMOR MAN (ER),312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$285.32 ,$244.56 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 ,$342.72 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$172.20 ,$172.20 ,$137.02 ,$172.20 ,$152.32 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$285.32 ,$244.56 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 ,$342.72 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$172.20 ,$172.20 ,$137.02 ,$172.20 ,$152.32 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200194,88360,HC MORPHO ANLYS TUMOR MAN (HER2),312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$285.32 ,$244.56 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 ,$342.72 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$172.20 ,$172.20 ,$137.02 ,$172.20 ,$152.32 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200202,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$479.00 ,$239.50 ,$71.26 ,$669.26 ,$71.26 ,$288.94 ,$247.66 ,$162.86 ,$383.20 ,$407.15 ,$299.38 ,$431.10 ,$71.26 ,$455.05 ,$431.10 ,$407.15 ,$407.15 ,$162.86 ,$407.15 ,$407.15 ,$431.10 ,$71.26 ,$201.18 ,$431.10 ,$669.26 ,$440.68 ,$431.10 ,$319.21 ,$319.21 ,$291.71 ,$319.21 ,$311.35 ,$333.62 ,$106.43 ,$378.41 ,$75.54 ,$340.09 ,$340.09 ,$162.86 ,$340.09 ,$297.45 ,$455.05 ,$392.78 ,$392.78 ,$383.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200203,88363,HC EXAM ARCHIVE TISS MOL ANLYS,312,1 ,$125.00 ,$62.50 ,$16.94 ,$125.00 ,$16.94 ,$69.27 ,$59.38 ,$42.50 ,$100.00 ,$106.25 ,$78.13 ,$112.50 ,$16.94 ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$42.50 ,$106.25 ,$106.25 ,$112.50 ,$16.94 ,$52.50 ,$112.50 ,$56.77 ,$115.00 ,$112.50 ,$83.30 ,$83.30 ,$76.13 ,$83.30 ,$81.25 ,$87.06 ,$27.78 ,$98.75 ,$17.96 ,$27.59 ,$27.59 ,$42.50 ,$27.59 ,$25.23 ,$118.75 ,$102.50 ,$102.50 ,$100.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200204,88365,HC IN SITU HYBRID (FISH),312,1 ,$557.00 ,$278.50 ,$71.26 ,$557.00 ,$71.26 ,$448.28 ,$384.24 ,$189.38 ,$445.60 ,$473.45 ,$348.13 ,$501.30 ,$71.26 ,$529.15 ,$501.30 ,$473.45 ,$473.45 ,$189.38 ,$473.45 ,$473.45 ,$501.30 ,$71.26 ,$233.94 ,$501.30 ,$342.72 ,$512.44 ,$501.30 ,$371.18 ,$371.18 ,$339.21 ,$371.18 ,$362.05 ,$387.95 ,$123.77 ,$440.03 ,$75.54 ,$172.20 ,$172.20 ,$189.38 ,$172.20 ,$152.32 ,$529.15 ,$456.74 ,$456.74 ,$445.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200208,88368,HC MORPHO ANLYS IN SITU HYBRID,312,1 ,$414.00 ,$207.00 ,$71.26 ,$669.26 ,$71.26 ,$286.53 ,$245.59 ,$140.76 ,$331.20 ,$351.90 ,$258.75 ,$372.60 ,$71.26 ,$393.30 ,$372.60 ,$351.90 ,$351.90 ,$140.76 ,$351.90 ,$351.90 ,$372.60 ,$71.26 ,$173.88 ,$372.60 ,$669.26 ,$380.88 ,$372.60 ,$275.89 ,$275.89 ,$252.13 ,$275.89 ,$269.10 ,$288.35 ,$91.99 ,$327.06 ,$75.54 ,$340.09 ,$340.09 ,$140.76 ,$340.09 ,$297.45 ,$393.30 ,$339.48 ,$339.48 ,$331.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200210,88399,HC ACGH ARRAY,312,1 ,"$2,055.00 ","$1,027.50 ",$16.94 ,"$2,055.00 ",$16.94 ,"$1,738.32 ","$1,738.32 ",$698.70 ,"$1,644.00 ","$1,746.75 ","$1,284.38 ","$1,849.50 ",$16.94 ,"$1,952.25 ","$1,849.50 ","$1,746.75 ","$1,746.75 ",$698.70 ,"$1,746.75 ","$1,746.75 ","$1,849.50 ",$16.94 ,$863.10 ,"$1,849.50 ",$114.19 ,"$1,890.60 ","$1,849.50 ","$1,369.45 ","$1,369.45 ","$1,251.50 ","$1,369.45 ","$1,335.75 ","$1,431.31 ",$456.62 ,"$1,623.45 ",$17.96 ,$59.36 ,$59.36 ,$698.70 ,$59.36 ,$50.75 ,"$1,952.25 ","$1,685.10 ","$1,685.10 ","$1,644.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200212,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$521.00 ,$260.50 ,$71.26 ,$669.26 ,$71.26 ,$440.71 ,$440.71 ,$177.14 ,$416.80 ,$442.85 ,$325.63 ,$468.90 ,$71.26 ,$494.95 ,$468.90 ,$442.85 ,$442.85 ,$177.14 ,$442.85 ,$442.85 ,$468.90 ,$71.26 ,$218.82 ,$468.90 ,$669.26 ,$479.32 ,$468.90 ,$347.19 ,$347.19 ,$317.29 ,$347.19 ,$338.65 ,$362.88 ,$115.77 ,$411.59 ,$75.54 ,$340.09 ,$340.09 ,$177.14 ,$340.09 ,$297.45 ,$494.95 ,$427.22 ,$427.22 ,$416.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200213,88313,HC SPECIAL STAIN II (BM CLOT),312,1 ,$217.00 ,$108.50 ,$34.57 ,$217.00 ,$39.00 ,$204.44 ,$175.24 ,$73.78 ,$173.60 ,$184.45 ,$135.63 ,$195.30 ,$39.00 ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$73.78 ,$184.45 ,$184.45 ,$195.30 ,$39.00 ,$91.14 ,$195.30 ,$77.78 ,$199.64 ,$195.30 ,$144.61 ,$144.61 ,$132.15 ,$144.61 ,$141.05 ,$151.14 ,$48.22 ,$171.43 ,$41.34 ,$40.12 ,$40.12 ,$73.78 ,$40.12 ,$34.57 ,$206.15 ,$177.94 ,$177.94 ,$173.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200214,88348,HC ELECTROMICROSCOPE SCAN,312,1 ,"$1,120.00 ",$560.00 ,$71.26 ,"$1,505.90 ",$71.26 ,$954.61 ,$818.24 ,$380.80 ,$896.00 ,$952.00 ,$700.00 ,"$1,008.00 ",$71.26 ,"$1,064.00 ","$1,008.00 ",$952.00 ,$952.00 ,$380.80 ,$952.00 ,$952.00 ,"$1,008.00 ",$71.26 ,$470.40 ,"$1,008.00 ","$1,505.90 ","$1,030.40 ","$1,008.00 ",$746.37 ,$746.37 ,$682.08 ,$746.37 ,$728.00 ,$780.08 ,$248.86 ,$884.80 ,$75.54 ,$753.84 ,$753.84 ,$380.80 ,$753.84 ,$669.29 ,"$1,064.00 ",$918.40 ,$918.40 ,$896.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200215,88341,HC MLH-1 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$71.26 ,$370.00 ,$71.26 ,$216.08 ,$185.21 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$71.26 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$71.26 ,$155.40 ,$333.00 , N/A ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$75.54 ,$77.52 ,$77.52 ,$125.80 ,$77.52 , N/A ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200216,88341,HC MSH-2 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$71.26 ,$370.00 ,$71.26 ,$216.08 ,$185.21 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$71.26 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$71.26 ,$155.40 ,$333.00 , N/A ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$75.54 ,$77.52 ,$77.52 ,$125.80 ,$77.52 , N/A ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200217,88341,HC MSH-3 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$71.26 ,$370.00 ,$71.26 ,$216.08 ,$185.21 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$71.26 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$71.26 ,$155.40 ,$333.00 , N/A ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$75.54 ,$77.52 ,$77.52 ,$125.80 ,$77.52 , N/A ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200218,88341,HC PMS-2 IMMUNOSTAIN,312,1 ,$370.00 ,$185.00 ,$71.26 ,$370.00 ,$71.26 ,$216.08 ,$185.21 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$71.26 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$71.26 ,$155.40 ,$333.00 , N/A ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$75.54 ,$77.52 ,$77.52 ,$125.80 ,$77.52 , N/A ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$291.00 ,$145.50 ,$64.66 ,$342.72 ,$71.26 ,$238.24 ,$204.21 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$71.26 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$71.26 ,$122.22 ,$261.90 ,$342.72 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$75.54 ,$172.20 ,$172.20 ,$98.94 ,$172.20 ,$152.32 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200221,88341,HC IP STAIN ADDITIONAL,312,1 ,$370.00 ,$185.00 ,$71.26 ,$370.00 ,$71.26 ,$216.08 ,$185.21 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$71.26 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$71.26 ,$155.40 ,$333.00 , N/A ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$75.54 ,$77.52 ,$77.52 ,$125.80 ,$77.52 , N/A ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200229,88368,HC I KAPPA ISH,312,1 ,$896.00 ,$448.00 ,$71.26 ,$896.00 ,$71.26 ,$286.53 ,$245.59 ,$304.64 ,$716.80 ,$761.60 ,$560.00 ,$806.40 ,$71.26 ,$851.20 ,$806.40 ,$761.60 ,$761.60 ,$304.64 ,$761.60 ,$761.60 ,$806.40 ,$71.26 ,$376.32 ,$806.40 ,$669.26 ,$824.32 ,$806.40 ,$597.09 ,$597.09 ,$545.66 ,$597.09 ,$582.40 ,$624.06 ,$199.09 ,$707.84 ,$75.54 ,$340.09 ,$340.09 ,$304.64 ,$340.09 ,$297.45 ,$851.20 ,$734.72 ,$734.72 ,$716.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200230,88369,HC I LAMBDA ISH-ADDITIONAL,312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$264.80 ,$226.97 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 , N/A ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$99.18 ,$99.18 ,$137.02 ,$99.18 , N/A ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200231,88313,HC PERIODIC ACID SCHIFF STAIN II,312,1 ,$291.00 ,$145.50 ,$34.57 ,$291.00 ,$39.00 ,$204.44 ,$175.24 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.00 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.00 ,$122.22 ,$261.90 ,$77.78 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.34 ,$40.12 ,$40.12 ,$98.94 ,$40.12 ,$34.57 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200232,88313,HC MASSONS TRICHROME STAIN II,312,1 ,$291.00 ,$145.50 ,$34.57 ,$291.00 ,$39.00 ,$204.44 ,$175.24 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.00 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.00 ,$122.22 ,$261.90 ,$77.78 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.34 ,$40.12 ,$40.12 ,$98.94 ,$40.12 ,$34.57 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200233,88313,HC JONES METH SILVER STAIN II,312,1 ,$291.00 ,$145.50 ,$34.57 ,$291.00 ,$39.00 ,$204.44 ,$175.24 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$39.00 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$39.00 ,$122.22 ,$261.90 ,$77.78 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$41.34 ,$40.12 ,$40.12 ,$98.94 ,$40.12 ,$34.57 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200235,88381,HC MICRODISSECTION MANUAL,312,1 ,$280.00 ,$140.00 ,$39.00 ,$280.00 ,$39.00 ,$280.00 ,$280.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$39.00 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$39.00 ,$117.60 ,$252.00 , N/A ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$41.34 ,$188.39 ,$188.39 ,$95.20 ,$188.39 , N/A ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200239,88368,HC HER2 DUAL ISH,312,1 ,$896.00 ,$448.00 ,$71.26 ,$896.00 ,$71.26 ,$286.53 ,$245.59 ,$304.64 ,$716.80 ,$761.60 ,$560.00 ,$806.40 ,$71.26 ,$851.20 ,$806.40 ,$761.60 ,$761.60 ,$304.64 ,$761.60 ,$761.60 ,$806.40 ,$71.26 ,$376.32 ,$806.40 ,$669.26 ,$824.32 ,$806.40 ,$597.09 ,$597.09 ,$545.66 ,$597.09 ,$582.40 ,$624.06 ,$199.09 ,$707.84 ,$75.54 ,$340.09 ,$340.09 ,$304.64 ,$340.09 ,$297.45 ,$851.20 ,$734.72 ,$734.72 ,$716.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200240,88365,HC EPSTEIN BARR ISH,312,1 ,$347.00 ,$173.50 ,$71.26 ,$347.00 ,$71.26 ,$347.00 ,$347.00 ,$117.98 ,$277.60 ,$294.95 ,$216.88 ,$312.30 ,$71.26 ,$329.65 ,$312.30 ,$294.95 ,$294.95 ,$117.98 ,$294.95 ,$294.95 ,$312.30 ,$71.26 ,$145.74 ,$312.30 ,$342.72 ,$319.24 ,$312.30 ,$231.24 ,$231.24 ,$211.32 ,$231.24 ,$225.55 ,$241.69 ,$77.10 ,$274.13 ,$75.54 ,$172.20 ,$172.20 ,$117.98 ,$172.20 ,$152.32 ,$329.65 ,$284.54 ,$284.54 ,$277.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200241,88369,HC HER2 DUAL ISH - ADDITIONAL,312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$264.80 ,$226.97 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 , N/A ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$99.18 ,$99.18 ,$137.02 ,$99.18 , N/A ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200242,88368,HC ISH,312,1 ,$311.00 ,$155.50 ,$69.10 ,$669.26 ,$71.26 ,$286.53 ,$245.59 ,$105.74 ,$248.80 ,$264.35 ,$194.38 ,$279.90 ,$71.26 ,$295.45 ,$279.90 ,$264.35 ,$264.35 ,$105.74 ,$264.35 ,$264.35 ,$279.90 ,$71.26 ,$130.62 ,$279.90 ,$669.26 ,$286.12 ,$279.90 ,$207.25 ,$207.25 ,$189.40 ,$207.25 ,$202.15 ,$216.61 ,$69.10 ,$245.69 ,$75.54 ,$311.00 ,$311.00 ,$105.74 ,$311.00 ,$297.45 ,$295.45 ,$255.02 ,$255.02 ,$248.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200243,88369,HC ISH ADDITIONAL,312,1 ,$311.00 ,$155.50 ,$69.10 ,$311.00 ,$71.26 ,$264.80 ,$226.97 ,$105.74 ,$248.80 ,$264.35 ,$194.38 ,$279.90 ,$71.26 ,$295.45 ,$279.90 ,$264.35 ,$264.35 ,$105.74 ,$264.35 ,$264.35 ,$279.90 ,$71.26 ,$130.62 ,$279.90 , N/A ,$286.12 ,$279.90 ,$207.25 ,$207.25 ,$189.40 ,$207.25 ,$202.15 ,$216.61 ,$69.10 ,$245.69 ,$75.54 ,$99.18 ,$99.18 ,$105.74 ,$99.18 , N/A ,$295.45 ,$255.02 ,$255.02 ,$248.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$557.00 ,$278.50 ,$71.26 ,$557.00 ,$71.26 ,$328.78 ,$281.81 ,$189.38 ,$445.60 ,$473.45 ,$348.13 ,$501.30 ,$71.26 ,$529.15 ,$501.30 ,$473.45 ,$473.45 ,$189.38 ,$473.45 ,$473.45 ,$501.30 ,$71.26 ,$233.94 ,$501.30 , N/A ,$512.44 ,$501.30 ,$371.18 ,$371.18 ,$339.21 ,$371.18 ,$362.05 ,$387.95 ,$123.77 ,$440.03 ,$75.54 ,$125.16 ,$125.16 ,$189.38 ,$125.16 , N/A ,$529.15 ,$456.74 ,$456.74 ,$445.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200291,88360,HC MORPHO ANALYSIS TUMOR MANUAL PD-L1,312,1 ,$403.00 ,$201.50 ,$71.26 ,$403.00 ,$71.26 ,$285.32 ,$244.56 ,$137.02 ,$322.40 ,$342.55 ,$251.88 ,$362.70 ,$71.26 ,$382.85 ,$362.70 ,$342.55 ,$342.55 ,$137.02 ,$342.55 ,$342.55 ,$362.70 ,$71.26 ,$169.26 ,$362.70 ,$342.72 ,$370.76 ,$362.70 ,$268.56 ,$268.56 ,$245.43 ,$268.56 ,$261.95 ,$280.69 ,$89.55 ,$318.37 ,$75.54 ,$172.20 ,$172.20 ,$137.02 ,$172.20 ,$152.32 ,$382.85 ,$330.46 ,$330.46 ,$322.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$661.00 ,$330.50 ,$146.87 ,$661.00 ,$533.89 ,$559.14 ,$559.14 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$533.89 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$533.89 ,$277.62 ,$594.90 , N/A ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 ,$146.87 ,$522.19 ,$565.92 ,$380.00 ,$380.00 ,$224.74 ,$427.00 , N/A ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$661.00 ,$330.50 ,$146.87 ,$661.00 ,$533.89 ,$559.14 ,$559.14 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$533.89 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$533.89 ,$277.62 ,$594.90 , N/A ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 ,$146.87 ,$522.19 ,$565.92 ,$380.00 ,$380.00 ,$224.74 ,$427.00 , N/A ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$661.00 ,$330.50 ,$146.87 ,$661.00 ,$533.89 ,$559.14 ,$559.14 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$533.89 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$533.89 ,$277.62 ,$594.90 , N/A ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 ,$146.87 ,$522.19 ,$565.92 ,$380.00 ,$380.00 ,$224.74 ,$427.00 , N/A ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$661.00 ,$330.50 ,$146.87 ,$661.00 ,$533.89 ,$559.14 ,$559.14 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$533.89 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$533.89 ,$277.62 ,$594.90 , N/A ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 ,$146.87 ,$522.19 ,$565.92 ,$380.00 ,$380.00 ,$224.74 ,$427.00 , N/A ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$636.00 ,$318.00 ,$141.32 ,$636.00 ,$533.89 ,$537.99 ,$537.99 ,$216.24 ,$508.80 ,$540.60 ,$397.50 ,$572.40 ,$533.89 ,$604.20 ,$572.40 ,$540.60 ,$540.60 ,$216.24 ,$540.60 ,$540.60 ,$572.40 ,$533.89 ,$267.12 ,$572.40 , N/A ,$585.12 ,$572.40 ,$423.83 ,$423.83 ,$387.32 ,$423.83 ,$413.40 ,$442.97 ,$141.32 ,$502.44 ,$565.92 ,$380.00 ,$380.00 ,$216.24 ,$427.00 , N/A ,$604.20 ,$521.52 ,$521.52 ,$508.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$661.00 ,$330.50 ,$146.87 ,$661.00 ,$533.89 ,$559.14 ,$559.14 ,$224.74 ,$528.80 ,$561.85 ,$413.13 ,$594.90 ,$533.89 ,$627.95 ,$594.90 ,$561.85 ,$561.85 ,$224.74 ,$561.85 ,$561.85 ,$594.90 ,$533.89 ,$277.62 ,$594.90 , N/A ,$608.12 ,$594.90 ,$440.49 ,$440.49 ,$402.55 ,$440.49 ,$429.65 ,$460.39 ,$146.87 ,$522.19 ,$565.92 ,$380.00 ,$380.00 ,$224.74 ,$427.00 , N/A ,$627.95 ,$542.02 ,$542.02 ,$528.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$3,231.36 ","$1,679.20 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$1,679.20 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$1,679.20 ",$497.70 ,"$1,066.50 ","$3,231.36 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$1,779.95 ",$380.00 ,$380.00 ,$402.90 ,$427.00 ,"$1,436.16 ","$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000026,36000,HC IV START > 3YR OLD,320,1 ,$139.00 ,$69.50 ,$30.89 ,$139.00 ,$103.42 ,$117.58 ,$117.58 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 ,$103.42 ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 ,$103.42 ,$58.38 ,$125.10 , N/A ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 ,$109.63 ,$139.00 ,$139.00 ,$47.26 ,$139.00 , N/A ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,361,1 ,$108.00 ,$54.00 ,$24.00 ,$109.63 ,$103.42 ,$91.36 ,$91.36 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$103.42 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$103.42 ,$108.00 ,$97.20 , N/A ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$109.63 , N/A , N/A ,$36.72 , N/A , N/A ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$549.00 ,$274.50 ,$121.99 ,$565.92 ,$533.89 ,$464.40 ,$464.40 ,$186.66 ,$439.20 ,$466.65 ,$343.13 ,$494.10 ,$533.89 ,$521.55 ,$494.10 ,$466.65 ,$466.65 ,$186.66 ,$466.65 ,$466.65 ,$494.10 ,$533.89 ,$230.58 ,$494.10 ,$470.09 ,$505.08 ,$494.10 ,$365.85 ,$365.85 ,$334.34 ,$365.85 ,$356.85 ,$382.38 ,$121.99 ,$433.71 ,$565.92 ,$380.00 ,$380.00 ,$186.66 ,$427.00 ,$208.93 ,$521.55 ,$450.18 ,$450.18 ,$439.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$431.00 ,$215.50 ,$95.77 ,"$1,256.44 ","$1,185.32 ",$364.58 ,$364.58 ,$146.54 ,$344.80 ,$366.35 ,$269.38 ,$387.90 ,"$1,185.32 ",$409.45 ,$387.90 ,$366.35 ,$366.35 ,$146.54 ,$366.35 ,$366.35 ,$387.90 ,"$1,185.32 ",$181.02 ,$387.90 ,$623.66 ,$396.52 ,$387.90 ,$287.22 ,$287.22 ,$262.48 ,$287.22 ,$280.15 ,$300.19 ,$95.77 ,$340.49 ,"$1,256.44 ",$380.00 ,$380.00 ,$146.54 ,$427.00 ,$277.18 ,$409.45 ,$353.42 ,$353.42 ,$344.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000036,43761,HC REPOSITION G-TUBE,320,1 ,$905.00 ,$452.50 ,$201.09 ,$905.00 ,$352.07 ,$765.54 ,$765.54 ,$307.70 ,$724.00 ,$769.25 ,$565.63 ,$814.50 ,$352.07 ,$859.75 ,$814.50 ,$769.25 ,$769.25 ,$307.70 ,$769.25 ,$769.25 ,$814.50 ,$352.07 ,$380.10 ,$814.50 ,$611.48 ,$832.60 ,$814.50 ,$603.09 ,$603.09 ,$551.15 ,$603.09 ,$588.25 ,$630.33 ,$201.09 ,$714.95 ,$373.19 ,$380.00 ,$380.00 ,$307.70 ,$427.00 ,$271.77 ,$859.75 ,$742.10 ,$742.10 ,$724.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000054,49424,HC INJ CONTRAST ABSC/CYST,320,1 ,$762.00 ,$381.00 ,$169.32 ,$762.00 ,$533.89 ,$644.58 ,$644.58 ,$259.08 ,$609.60 ,$647.70 ,$476.25 ,$685.80 ,$533.89 ,$723.90 ,$685.80 ,$647.70 ,$647.70 ,$259.08 ,$647.70 ,$647.70 ,$685.80 ,$533.89 ,$320.04 ,$685.80 , N/A ,$701.04 ,$685.80 ,$507.80 ,$507.80 ,$464.06 ,$507.80 ,$495.30 ,$530.73 ,$169.32 ,$601.98 ,$565.92 ,$380.00 ,$380.00 ,$259.08 ,$427.00 , N/A ,$723.90 ,$624.84 ,$624.84 ,$609.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000056,49440,HC INSERT GASTRO TUBE FLUORO,320,1 ,"$1,831.00 ",$915.50 ,$380.00 ,"$3,732.32 ","$1,185.32 ","$1,548.84 ","$1,548.84 ",$622.54 ,"$1,464.80 ","$1,556.35 ","$1,144.38 ","$1,647.90 ","$1,185.32 ","$1,739.45 ","$1,647.90 ","$1,556.35 ","$1,556.35 ",$622.54 ,"$1,556.35 ","$1,556.35 ","$1,647.90 ","$1,185.32 ",$769.02 ,"$1,647.90 ","$3,732.32 ","$1,684.52 ","$1,647.90 ","$1,220.18 ","$1,220.18 ","$1,115.08 ","$1,220.18 ","$1,190.15 ","$1,275.29 ",$406.85 ,"$1,446.49 ","$1,256.44 ",$380.00 ,$380.00 ,$622.54 ,$427.00 ,"$1,658.81 ","$1,739.45 ","$1,501.42 ","$1,501.42 ","$1,464.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$2,429.00 ","$1,214.50 ",$380.00 ,"$2,429.00 ","$1,185.32 ","$2,054.69 ","$2,054.69 ",$825.86 ,"$1,943.20 ","$2,064.65 ","$1,518.13 ","$2,186.10 ","$1,185.32 ","$2,307.55 ","$2,186.10 ","$2,064.65 ","$2,064.65 ",$825.86 ,"$2,064.65 ","$2,064.65 ","$2,186.10 ","$1,185.32 ","$1,020.18 ","$2,186.10 ","$1,859.38 ","$2,234.68 ","$2,186.10 ","$1,618.69 ","$1,618.69 ","$1,479.26 ","$1,618.69 ","$1,578.85 ","$1,691.80 ",$539.72 ,"$1,918.91 ","$1,256.44 ",$380.00 ,$380.00 ,$825.86 ,$427.00 ,$826.39 ,"$2,307.55 ","$1,991.78 ","$1,991.78 ","$1,943.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$474.00 ,$237.00 ,$105.32 ,$528.75 ,$212.82 ,$400.96 ,$400.96 ,$161.16 ,$379.20 ,$402.90 ,$296.25 ,$426.60 ,$212.82 ,$450.30 ,$426.60 ,$402.90 ,$402.90 ,$161.16 ,$402.90 ,$402.90 ,$426.60 ,$212.82 ,$199.08 ,$426.60 ,$528.75 ,$436.08 ,$426.60 ,$315.87 ,$315.87 ,$288.67 ,$315.87 ,$308.10 ,$330.14 ,$105.32 ,$374.46 ,$225.59 ,$380.00 ,$380.00 ,$161.16 ,$427.00 ,$235.00 ,$450.30 ,$388.68 ,$388.68 ,$379.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000085,51600,HC INJ CYSTOGRAM,320,1 ,$554.00 ,$277.00 ,$123.10 ,$565.92 ,$533.89 ,$468.63 ,$468.63 ,$188.36 ,$443.20 ,$470.90 ,$346.25 ,$498.60 ,$533.89 ,$526.30 ,$498.60 ,$470.90 ,$470.90 ,$188.36 ,$470.90 ,$470.90 ,$498.60 ,$533.89 ,$232.68 ,$498.60 , N/A ,$509.68 ,$498.60 ,$369.19 ,$369.19 ,$337.39 ,$369.19 ,$360.10 ,$385.86 ,$123.10 ,$437.66 ,$565.92 ,$380.00 ,$380.00 ,$188.36 ,$427.00 , N/A ,$526.30 ,$454.28 ,$454.28 ,$443.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$280.00 ,$140.00 ,$62.22 ,$280.00 ,$100.91 ,$90.58 ,$80.52 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$100.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$100.91 ,$117.60 ,$252.00 ,$185.87 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$106.96 ,$280.00 ,$280.00 ,$95.20 ,$280.00 ,$82.61 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$118.52 ,$105.35 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$370.00 ,$185.00 ,$77.76 ,$370.00 ,$100.91 ,$87.48 ,$77.76 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$130.93 ,$116.38 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$110.76 ,$98.45 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$129.38 ,$115.01 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$98.34 ,$87.41 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$459.00 ,$229.50 ,$82.61 ,$459.00 ,$100.91 ,$113.86 ,$101.21 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$185.87 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$82.61 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000109,70240,HC SELLA TURCICA,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$93.68 ,$83.27 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$109.20 ,$97.07 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$129.38 ,$115.01 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$160.42 ,$142.60 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000114,70336,HC MRI TMJ,320,1 ,"$3,360.00 ","$1,680.00 ",$235.00 ,"$3,360.00 ",$448.91 ,"$1,048.74 ",$932.21 ,"$1,142.40 ","$2,688.00 ","$2,856.00 ","$2,100.00 ","$3,024.00 ",$448.91 ,"$3,192.00 ","$3,024.00 ","$2,856.00 ","$2,856.00 ","$1,142.40 ","$2,856.00 ","$2,856.00 ","$3,024.00 ",$448.91 ,"$1,411.20 ","$3,024.00 ",$528.75 ,"$3,091.20 ","$3,024.00 ","$2,239.10 ","$2,239.10 ","$2,046.24 ","$2,239.10 ","$2,184.00 ","$2,340.24 ",$746.59 ,"$2,654.40 ",$475.84 ,$380.00 ,$380.00 ,"$1,142.40 ",$427.00 ,$235.00 ,"$3,192.00 ","$2,755.20 ","$2,755.20 ","$2,688.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000115,70355,HC XRAY PAN MANDIBLE/MAXLA,320,1 ,$370.00 ,$185.00 ,$33.61 ,$370.00 ,$100.91 ,$37.81 ,$33.61 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$93.68 ,$83.27 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000118,74230,HC XRAY SPEECH EVAL W/CINE/VIDEO,320,1 ,$616.00 ,$308.00 ,$136.88 ,$616.00 ,$212.82 ,$438.23 ,$389.54 ,$209.44 ,$492.80 ,$523.60 ,$385.00 ,$554.40 ,$212.82 ,$585.20 ,$554.40 ,$523.60 ,$523.60 ,$209.44 ,$523.60 ,$523.60 ,$554.40 ,$212.82 ,$258.72 ,$554.40 ,$410.47 ,$566.72 ,$554.40 ,$410.50 ,$410.50 ,$375.14 ,$410.50 ,$400.40 ,$429.04 ,$136.88 ,$486.64 ,$225.59 ,$380.00 ,$380.00 ,$209.44 ,$427.00 ,$182.43 ,$585.20 ,$505.12 ,$505.12 ,$492.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000121,71045,HC XR CHEST 1V,320,1 ,$321.00 ,$160.50 ,$59.82 ,$321.00 ,$100.91 ,$67.30 ,$59.82 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 ,$100.91 ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 ,$100.91 ,$134.82 ,$288.90 ,$185.87 ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 ,$106.96 ,$321.00 ,$321.00 ,$109.14 ,$321.00 ,$82.61 ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000123,71045,HC XR CHEST 1V POST OP,320,1 ,$321.00 ,$160.50 ,$59.82 ,$321.00 ,$100.91 ,$67.30 ,$59.82 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 ,$100.91 ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 ,$100.91 ,$134.82 ,$288.90 ,$185.87 ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 ,$106.96 ,$321.00 ,$321.00 ,$109.14 ,$321.00 ,$82.61 ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000126,71045,HC XR CHEST 1V INFANT,320,1 ,$321.00 ,$160.50 ,$59.82 ,$321.00 ,$100.91 ,$67.30 ,$59.82 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 ,$100.91 ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 ,$100.91 ,$134.82 ,$288.90 ,$185.87 ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 ,$106.96 ,$321.00 ,$321.00 ,$109.14 ,$321.00 ,$82.61 ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000127,71046,HC XR CHEST 2V,320,1 ,$321.00 ,$160.50 ,$71.33 ,$321.00 ,$100.91 ,$89.03 ,$79.14 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 ,$100.91 ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 ,$100.91 ,$134.82 ,$288.90 ,$185.87 ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 ,$106.96 ,$321.00 ,$321.00 ,$109.14 ,$321.00 ,$82.61 ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$439.00 ,$219.50 ,$97.55 ,$439.00 ,$100.91 ,$115.41 ,$102.59 ,$149.26 ,$351.20 ,$373.15 ,$274.38 ,$395.10 ,$100.91 ,$417.05 ,$395.10 ,$373.15 ,$373.15 ,$149.26 ,$373.15 ,$373.15 ,$395.10 ,$100.91 ,$184.38 ,$395.10 ,$250.18 ,$403.88 ,$395.10 ,$292.55 ,$292.55 ,$267.35 ,$292.55 ,$285.35 ,$305.76 ,$97.55 ,$346.81 ,$106.96 ,$380.00 ,$380.00 ,$149.26 ,$427.00 ,$111.19 ,$417.05 ,$359.98 ,$359.98 ,$351.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000133,71048,HC XR CHEST 4+V,320,1 ,$439.00 ,$219.50 ,$97.55 ,$439.00 ,$100.91 ,$115.41 ,$102.59 ,$149.26 ,$351.20 ,$373.15 ,$274.38 ,$395.10 ,$100.91 ,$417.05 ,$395.10 ,$373.15 ,$373.15 ,$149.26 ,$373.15 ,$373.15 ,$395.10 ,$100.91 ,$184.38 ,$395.10 ,$250.18 ,$403.88 ,$395.10 ,$292.55 ,$292.55 ,$267.35 ,$292.55 ,$285.35 ,$305.76 ,$97.55 ,$346.81 ,$106.96 ,$380.00 ,$380.00 ,$149.26 ,$427.00 ,$111.19 ,$417.05 ,$359.98 ,$359.98 ,$351.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$321.00 ,$160.50 ,$71.33 ,$321.00 ,$100.91 ,$89.03 ,$79.14 ,$109.14 ,$256.80 ,$272.85 ,$200.63 ,$288.90 ,$100.91 ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$109.14 ,$272.85 ,$272.85 ,$288.90 ,$100.91 ,$134.82 ,$288.90 ,$185.87 ,$295.32 ,$288.90 ,$213.91 ,$213.91 ,$195.49 ,$213.91 ,$208.65 ,$223.58 ,$71.33 ,$253.59 ,$106.96 ,$321.00 ,$321.00 ,$109.14 ,$321.00 ,$82.61 ,$304.95 ,$263.22 ,$263.22 ,$256.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000137,71100,HC XR RIBS 2V UNI,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$99.89 ,$88.79 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$560.00 ,$280.00 ,$98.45 ,$560.00 ,$100.91 ,$110.76 ,$98.45 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$100.91 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$100.91 ,$235.20 ,$504.00 ,$250.18 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$106.96 ,$380.00 ,$380.00 ,$190.40 ,$427.00 ,$111.19 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$113.86 ,$101.21 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$560.00 ,$280.00 ,$100.91 ,$560.00 ,$100.91 ,$140.24 ,$124.66 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$100.91 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$100.91 ,$235.20 ,$504.00 ,$250.18 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$106.96 ,$380.00 ,$380.00 ,$190.40 ,$427.00 ,$111.19 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000141,71120,HC XR STERNUM 2+V,320,1 ,$370.00 ,$185.00 ,$80.52 ,$370.00 ,$100.91 ,$90.58 ,$80.52 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$235.00 ,"$3,150.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$448.91 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$448.91 ,"$1,422.18 ","$2,835.00 ",$528.75 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$475.84 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$235.00 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$699.93 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ","$1,644.01 ","$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$730.67 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000158,72020,HC XR SPINE 1V (C SPINE/L SPINE),320,1 ,$392.00 ,$196.00 ,$58.44 ,$392.00 ,$100.91 ,$65.75 ,$58.44 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$100.91 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$100.91 ,$164.64 ,$352.80 ,$185.87 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$106.96 ,$380.00 ,$380.00 ,$133.28 ,$392.00 ,$82.61 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$392.00 ,$196.00 ,$58.44 ,$392.00 ,$100.91 ,$65.75 ,$58.44 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$100.91 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$100.91 ,$164.64 ,$352.80 ,$185.87 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$106.96 ,$380.00 ,$380.00 ,$133.28 ,$392.00 ,$82.61 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000161,72020,HC XR L-SPINE 1V,320,1 ,$392.00 ,$196.00 ,$58.44 ,$392.00 ,$100.91 ,$65.75 ,$58.44 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$100.91 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$100.91 ,$164.64 ,$352.80 ,$185.87 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$106.96 ,$380.00 ,$380.00 ,$133.28 ,$392.00 ,$82.61 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$493.00 ,$246.50 ,$82.61 ,$493.00 ,$100.91 ,$109.20 ,$97.07 ,$167.62 ,$394.40 ,$419.05 ,$308.13 ,$443.70 ,$100.91 ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$167.62 ,$419.05 ,$419.05 ,$443.70 ,$100.91 ,$207.06 ,$443.70 ,$185.87 ,$453.56 ,$443.70 ,$328.54 ,$328.54 ,$300.24 ,$328.54 ,$320.45 ,$343.37 ,$109.54 ,$389.47 ,$106.96 ,$380.00 ,$380.00 ,$167.62 ,$427.00 ,$82.61 ,$468.35 ,$404.26 ,$404.26 ,$394.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$526.00 ,$263.00 ,$100.91 ,$526.00 ,$100.91 ,$149.56 ,$132.94 ,$178.84 ,$420.80 ,$447.10 ,$328.75 ,$473.40 ,$100.91 ,$499.70 ,$473.40 ,$447.10 ,$447.10 ,$178.84 ,$447.10 ,$447.10 ,$473.40 ,$100.91 ,$220.92 ,$473.40 ,$250.18 ,$483.92 ,$473.40 ,$350.53 ,$350.53 ,$320.33 ,$350.53 ,$341.90 ,$366.36 ,$116.88 ,$415.54 ,$106.96 ,$380.00 ,$380.00 ,$178.84 ,$427.00 ,$111.19 ,$499.70 ,$431.32 ,$431.32 ,$420.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$683.00 ,$341.50 ,$100.91 ,$683.00 ,$100.91 ,$180.60 ,$160.53 ,$232.22 ,$546.40 ,$580.55 ,$426.88 ,$614.70 ,$100.91 ,$648.85 ,$614.70 ,$580.55 ,$580.55 ,$232.22 ,$580.55 ,$580.55 ,$614.70 ,$100.91 ,$286.86 ,$614.70 ,$250.18 ,$628.36 ,$614.70 ,$455.15 ,$455.15 ,$415.95 ,$455.15 ,$443.95 ,$475.71 ,$151.76 ,$539.57 ,$106.96 ,$380.00 ,$380.00 ,$232.22 ,$427.00 ,$111.19 ,$648.85 ,$560.06 ,$560.06 ,$546.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000172,72070,HC XR T-SPINE 2V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$98.34 ,$87.41 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000174,72072,HC XR T-SPINE 3V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$109.20 ,$97.07 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$426.00 ,$213.00 ,$94.66 ,$426.00 ,$100.91 ,$109.20 ,$97.07 ,$144.84 ,$340.80 ,$362.10 ,$266.25 ,$383.40 ,$100.91 ,$404.70 ,$383.40 ,$362.10 ,$362.10 ,$144.84 ,$362.10 ,$362.10 ,$383.40 ,$100.91 ,$178.92 ,$383.40 ,$250.18 ,$391.92 ,$383.40 ,$283.89 ,$283.89 ,$259.43 ,$283.89 ,$276.90 ,$296.71 ,$94.66 ,$336.54 ,$106.96 ,$380.00 ,$380.00 ,$144.84 ,$426.00 ,$111.19 ,$404.70 ,$349.32 ,$349.32 ,$340.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000181,72110,HC XR L-SPINE 4+V,320,1 ,$683.00 ,$341.50 ,$100.91 ,$683.00 ,$100.91 ,$152.66 ,$135.70 ,$232.22 ,$546.40 ,$580.55 ,$426.88 ,$614.70 ,$100.91 ,$648.85 ,$614.70 ,$580.55 ,$580.55 ,$232.22 ,$580.55 ,$580.55 ,$614.70 ,$100.91 ,$286.86 ,$614.70 ,$250.18 ,$628.36 ,$614.70 ,$455.15 ,$455.15 ,$415.95 ,$455.15 ,$443.95 ,$475.71 ,$151.76 ,$539.57 ,$106.96 ,$380.00 ,$380.00 ,$232.22 ,$427.00 ,$111.19 ,$648.85 ,$560.06 ,$560.06 ,$546.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,$683.00 ,$341.50 ,$100.91 ,$683.00 ,$100.91 ,$180.60 ,$160.53 ,$232.22 ,$546.40 ,$580.55 ,$426.88 ,$614.70 ,$100.91 ,$648.85 ,$614.70 ,$580.55 ,$580.55 ,$232.22 ,$580.55 ,$580.55 ,$614.70 ,$100.91 ,$286.86 ,$614.70 ,$250.18 ,$628.36 ,$614.70 ,$455.15 ,$455.15 ,$415.95 ,$455.15 ,$443.95 ,$475.71 ,$151.76 ,$539.57 ,$106.96 ,$380.00 ,$380.00 ,$232.22 ,$427.00 ,$111.19 ,$648.85 ,$560.06 ,$560.06 ,$546.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000186,72170,HC XR PELVIS 1-2V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$104.55 ,$92.93 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$366.00 ,$183.00 ,$81.33 ,$366.00 ,$100.91 ,$124.72 ,$110.87 ,$124.44 ,$292.80 ,$311.10 ,$228.75 ,$329.40 ,$100.91 ,$347.70 ,$329.40 ,$311.10 ,$311.10 ,$124.44 ,$311.10 ,$311.10 ,$329.40 ,$100.91 ,$153.72 ,$329.40 ,$250.18 ,$336.72 ,$329.40 ,$243.90 ,$243.90 ,$222.89 ,$243.90 ,$237.90 ,$254.92 ,$81.33 ,$289.14 ,$106.96 ,$366.00 ,$366.00 ,$124.44 ,$366.00 ,$111.19 ,$347.70 ,$300.12 ,$300.12 ,$292.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$109.20 ,$97.07 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$93.68 ,$83.27 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000196,62304,HC XR MYELOGRAM L-SPINE,320,1 ,"$1,831.00 ",$915.50 ,$380.00 ,"$1,831.00 ","$1,033.50 ","$1,548.84 ","$1,548.84 ",$622.54 ,"$1,464.80 ","$1,556.35 ","$1,144.38 ","$1,647.90 ","$1,033.50 ","$1,739.45 ","$1,647.90 ","$1,556.35 ","$1,556.35 ",$622.54 ,"$1,556.35 ","$1,556.35 ","$1,647.90 ","$1,033.50 ",$769.02 ,"$1,647.90 ","$1,644.01 ","$1,684.52 ","$1,647.90 ","$1,220.18 ","$1,220.18 ","$1,115.08 ","$1,220.18 ","$1,190.15 ","$1,275.29 ",$406.85 ,"$1,446.49 ","$1,095.51 ",$380.00 ,$380.00 ,$622.54 ,$427.00 ,$730.67 ,"$1,739.45 ","$1,501.42 ","$1,501.42 ","$1,464.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000201,73000,HC XRAY CLAVICLE,320,1 ,$392.00 ,$196.00 ,$79.14 ,$392.00 ,$100.91 ,$89.03 ,$79.14 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$100.91 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$100.91 ,$164.64 ,$352.80 ,$185.87 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$106.96 ,$380.00 ,$380.00 ,$133.28 ,$392.00 ,$82.61 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000204,73010,HC XRAY SCAPULA,320,1 ,$414.00 ,$207.00 ,$87.41 ,$414.00 ,$100.91 ,$98.34 ,$87.41 ,$140.76 ,$331.20 ,$351.90 ,$258.75 ,$372.60 ,$100.91 ,$393.30 ,$372.60 ,$351.90 ,$351.90 ,$140.76 ,$351.90 ,$351.90 ,$372.60 ,$100.91 ,$173.88 ,$372.60 ,$250.18 ,$380.88 ,$372.60 ,$275.89 ,$275.89 ,$252.13 ,$275.89 ,$269.10 ,$288.35 ,$91.99 ,$327.06 ,$106.96 ,$380.00 ,$380.00 ,$140.76 ,$414.00 ,$111.19 ,$393.30 ,$339.48 ,$339.48 ,$331.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$370.00 ,$185.00 ,$59.82 ,$370.00 ,$100.91 ,$67.30 ,$59.82 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$370.00 ,$185.00 ,$79.14 ,$370.00 ,$100.91 ,$89.03 ,$79.14 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$370.00 ,$185.00 ,$79.14 ,$370.00 ,$100.91 ,$89.03 ,$79.14 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$1,792.00 ",$896.00 ,$212.82 ,"$1,792.00 ",$212.82 ,$362.18 ,$321.94 ,$609.28 ,"$1,433.60 ","$1,523.20 ","$1,120.00 ","$1,612.80 ",$212.82 ,"$1,702.40 ","$1,612.80 ","$1,523.20 ","$1,523.20 ",$609.28 ,"$1,523.20 ","$1,523.20 ","$1,612.80 ",$212.82 ,$752.64 ,"$1,612.80 ",$846.20 ,"$1,648.64 ","$1,612.80 ","$1,194.19 ","$1,194.19 ","$1,091.33 ","$1,194.19 ","$1,164.80 ","$1,248.13 ",$398.18 ,"$1,415.68 ",$225.59 ,$380.00 ,$380.00 ,$609.28 ,$427.00 ,$376.09 ,"$1,702.40 ","$1,469.44 ","$1,469.44 ","$1,433.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$115.41 ,$102.59 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$93.68 ,$83.27 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$370.00 ,$185.00 ,$72.24 ,$370.00 ,$100.91 ,$81.27 ,$72.24 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$80.52 ,$370.00 ,$100.91 ,$90.58 ,$80.52 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,$974.00 ,$487.00 ,$212.82 ,$974.00 ,$212.82 ,$335.80 ,$298.49 ,$331.16 ,$779.20 ,$827.90 ,$608.75 ,$876.60 ,$212.82 ,$925.30 ,$876.60 ,$827.90 ,$827.90 ,$331.16 ,$827.90 ,$827.90 ,$876.60 ,$212.82 ,$409.08 ,$876.60 ,$846.20 ,$896.08 ,$876.60 ,$649.07 ,$649.07 ,$593.17 ,$649.07 ,$633.10 ,$678.39 ,$216.42 ,$769.46 ,$225.59 ,$380.00 ,$380.00 ,$331.16 ,$427.00 ,$376.09 ,$925.30 ,$798.68 ,$798.68 ,$779.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$370.00 ,$185.00 ,$75.00 ,$370.00 ,$151.36 ,$84.37 ,$75.00 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$370.00 ,$185.00 ,$75.00 ,$370.00 ,$151.36 ,$84.37 ,$75.00 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$79.14 ,$370.00 ,$100.91 ,$89.03 ,$79.14 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$101.44 ,$90.17 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$101.44 ,$90.17 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$120.07 ,$106.73 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$120.07 ,$106.73 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000235,73110,HC XRAY WRIST COMP MIN 3 V + NAVIC,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$120.07 ,$106.73 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,$974.00 ,$487.00 ,$212.82 ,$974.00 ,$212.82 ,$390.12 ,$346.77 ,$331.16 ,$779.20 ,$827.90 ,$608.75 ,$876.60 ,$212.82 ,$925.30 ,$876.60 ,$827.90 ,$827.90 ,$331.16 ,$827.90 ,$827.90 ,$876.60 ,$212.82 ,$409.08 ,$876.60 ,$846.20 ,$896.08 ,$876.60 ,$649.07 ,$649.07 ,$593.17 ,$649.07 ,$633.10 ,$678.39 ,$216.42 ,$769.46 ,$225.59 ,$380.00 ,$380.00 ,$331.16 ,$427.00 ,$376.09 ,$925.30 ,$798.68 ,$798.68 ,$779.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$370.00 ,$185.00 ,$79.14 ,$370.00 ,$100.91 ,$89.03 ,$79.14 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$106.10 ,$94.31 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$106.10 ,$94.31 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$115.41 ,$102.59 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$1,792.00 ",$896.00 ,$212.82 ,"$1,792.00 ",$212.82 ,$363.74 ,$323.32 ,$609.28 ,"$1,433.60 ","$1,523.20 ","$1,120.00 ","$1,612.80 ",$212.82 ,"$1,702.40 ","$1,612.80 ","$1,523.20 ","$1,523.20 ",$609.28 ,"$1,523.20 ","$1,523.20 ","$1,612.80 ",$212.82 ,$752.64 ,"$1,612.80 ",$846.20 ,"$1,648.64 ","$1,612.80 ","$1,194.19 ","$1,194.19 ","$1,091.33 ","$1,194.19 ","$1,164.80 ","$1,248.13 ",$398.18 ,"$1,415.68 ",$225.59 ,$380.00 ,$380.00 ,$609.28 ,$427.00 ,$376.09 ,"$1,702.40 ","$1,469.44 ","$1,469.44 ","$1,433.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$103.00 ,$91.55 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$103.00 ,$91.55 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$120.07 ,$106.73 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$120.07 ,$106.73 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$130.93 ,$116.38 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$130.93 ,$116.38 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000267,73565,HC XR KNEE STAND,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$123.17 ,$109.49 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,120.00 ",$560.00 ,$212.82 ,"$1,120.00 ",$212.82 ,$428.92 ,$381.26 ,$380.80 ,$896.00 ,$952.00 ,$700.00 ,"$1,008.00 ",$212.82 ,"$1,064.00 ","$1,008.00 ",$952.00 ,$952.00 ,$380.80 ,$952.00 ,$952.00 ,"$1,008.00 ",$212.82 ,$470.40 ,"$1,008.00 ",$846.20 ,"$1,030.40 ","$1,008.00 ",$746.37 ,$746.37 ,$682.08 ,$746.37 ,$728.00 ,$780.08 ,$248.86 ,$884.80 ,$225.59 ,$380.00 ,$380.00 ,$380.80 ,$427.00 ,$376.09 ,"$1,064.00 ",$918.40 ,$918.40 ,$896.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$370.00 ,$185.00 ,$81.90 ,$370.00 ,$151.36 ,$92.13 ,$81.90 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$370.00 ,$185.00 ,$81.90 ,$370.00 ,$151.36 ,$92.13 ,$81.90 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$370.00 ,$185.00 ,$79.14 ,$370.00 ,$100.91 ,$89.03 ,$79.14 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$96.79 ,$86.03 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$96.79 ,$86.03 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$106.10 ,$94.31 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$151.36 ,$106.10 ,$94.31 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,236.00 ",$618.00 ,$212.82 ,"$1,236.00 ",$212.82 ,$388.57 ,$345.39 ,$420.24 ,$988.80 ,"$1,050.60 ",$772.50 ,"$1,112.40 ",$212.82 ,"$1,174.20 ","$1,112.40 ","$1,050.60 ","$1,050.60 ",$420.24 ,"$1,050.60 ","$1,050.60 ","$1,112.40 ",$212.82 ,$519.12 ,"$1,112.40 ",$846.20 ,"$1,137.12 ","$1,112.40 ",$823.67 ,$823.67 ,$752.72 ,$823.67 ,$803.40 ,$860.87 ,$274.64 ,$976.44 ,$225.59 ,$380.00 ,$380.00 ,$420.24 ,$427.00 ,$376.09 ,"$1,174.20 ","$1,013.52 ","$1,013.52 ",$988.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$370.00 ,$185.00 ,$73.62 ,$370.00 ,$151.36 ,$82.82 ,$73.62 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$370.00 ,$185.00 ,$73.62 ,$370.00 ,$151.36 ,$82.82 ,$73.62 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$151.36 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$151.36 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$160.44 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$98.34 ,$87.41 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$98.34 ,$87.41 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$370.00 ,$185.00 ,$72.24 ,$370.00 ,$100.91 ,$81.27 ,$72.24 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$95.24 ,$84.65 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$370.00 ,$185.00 ,$73.62 ,$370.00 ,$100.91 ,$82.82 ,$73.62 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$99.89 ,$88.79 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000297,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V)FLAT,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$99.89 ,$88.79 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$526.00 ,$263.00 ,$100.91 ,$526.00 ,$100.91 ,$130.93 ,$116.38 ,$178.84 ,$420.80 ,$447.10 ,$328.75 ,$473.40 ,$100.91 ,$499.70 ,$473.40 ,$447.10 ,$447.10 ,$178.84 ,$447.10 ,$447.10 ,$473.40 ,$100.91 ,$220.92 ,$473.40 ,$250.18 ,$483.92 ,$473.40 ,$350.53 ,$350.53 ,$320.33 ,$350.53 ,$341.90 ,$366.36 ,$116.88 ,$415.54 ,$106.96 ,$380.00 ,$380.00 ,$178.84 ,$427.00 ,$111.19 ,$499.70 ,$431.32 ,$431.32 ,$420.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$605.00 ,$302.50 ,$100.91 ,$605.00 ,$100.91 ,$273.72 ,$243.31 ,$205.70 ,$484.00 ,$514.25 ,$378.13 ,$544.50 ,$100.91 ,$574.75 ,$544.50 ,$514.25 ,$514.25 ,$205.70 ,$514.25 ,$514.25 ,$544.50 ,$100.91 ,$254.10 ,$544.50 ,$410.47 ,$556.60 ,$544.50 ,$403.17 ,$403.17 ,$368.45 ,$403.17 ,$393.25 ,$421.38 ,$134.43 ,$477.95 ,$106.96 ,$380.00 ,$380.00 ,$205.70 ,$427.00 ,$182.43 ,$574.75 ,$496.10 ,$496.10 ,$484.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$616.00 ,$308.00 ,$136.88 ,$616.00 ,$212.82 ,$438.23 ,$389.54 ,$209.44 ,$492.80 ,$523.60 ,$385.00 ,$554.40 ,$212.82 ,$585.20 ,$554.40 ,$523.60 ,$523.60 ,$209.44 ,$523.60 ,$523.60 ,$554.40 ,$212.82 ,$258.72 ,$554.40 ,$410.47 ,$566.72 ,$554.40 ,$410.50 ,$410.50 ,$375.14 ,$410.50 ,$400.40 ,$429.04 ,$136.88 ,$486.64 ,$225.59 ,$380.00 ,$380.00 ,$209.44 ,$427.00 ,$182.43 ,$585.20 ,$505.12 ,$505.12 ,$492.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,$952.00 ,$476.00 ,$182.43 ,$952.00 ,$212.82 ,$442.89 ,$393.68 ,$323.68 ,$761.60 ,$809.20 ,$595.00 ,$856.80 ,$212.82 ,$904.40 ,$856.80 ,$809.20 ,$809.20 ,$323.68 ,$809.20 ,$809.20 ,$856.80 ,$212.82 ,$399.84 ,$856.80 ,$410.47 ,$875.84 ,$856.80 ,$634.41 ,$634.41 ,$579.77 ,$634.41 ,$618.80 ,$663.07 ,$211.53 ,$752.08 ,$225.59 ,$380.00 ,$380.00 ,$323.68 ,$427.00 ,$182.43 ,$904.40 ,$780.64 ,$780.64 ,$761.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,$952.00 ,$476.00 ,$182.43 ,$952.00 ,$212.82 ,$442.89 ,$393.68 ,$323.68 ,$761.60 ,$809.20 ,$595.00 ,$856.80 ,$212.82 ,$904.40 ,$856.80 ,$809.20 ,$809.20 ,$323.68 ,$809.20 ,$809.20 ,$856.80 ,$212.82 ,$399.84 ,$856.80 ,$410.47 ,$875.84 ,$856.80 ,$634.41 ,$634.41 ,$579.77 ,$634.41 ,$618.80 ,$663.07 ,$211.53 ,$752.08 ,$225.59 ,$380.00 ,$380.00 ,$323.68 ,$427.00 ,$182.43 ,$904.40 ,$780.64 ,$780.64 ,$761.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$717.00 ,$358.50 ,$159.32 ,$717.00 ,$212.82 ,$388.57 ,$345.39 ,$243.78 ,$573.60 ,$609.45 ,$448.13 ,$645.30 ,$212.82 ,$681.15 ,$645.30 ,$609.45 ,$609.45 ,$243.78 ,$609.45 ,$609.45 ,$645.30 ,$212.82 ,$301.14 ,$645.30 ,$410.47 ,$659.64 ,$645.30 ,$477.81 ,$477.81 ,$436.65 ,$477.81 ,$466.05 ,$499.39 ,$159.32 ,$566.43 ,$225.59 ,$380.00 ,$380.00 ,$243.78 ,$427.00 ,$182.43 ,$681.15 ,$587.94 ,$587.94 ,$573.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000315,74270,HC XRAY COLON BARIUM,320,1 ,$762.00 ,$381.00 ,$169.32 ,$762.00 ,$212.82 ,$551.53 ,$490.25 ,$259.08 ,$609.60 ,$647.70 ,$476.25 ,$685.80 ,$212.82 ,$723.90 ,$685.80 ,$647.70 ,$647.70 ,$259.08 ,$647.70 ,$647.70 ,$685.80 ,$212.82 ,$320.04 ,$685.80 ,$410.47 ,$701.04 ,$685.80 ,$507.80 ,$507.80 ,$464.06 ,$507.80 ,$495.30 ,$530.73 ,$169.32 ,$601.98 ,$225.59 ,$380.00 ,$380.00 ,$259.08 ,$427.00 ,$182.43 ,$723.90 ,$624.84 ,$624.84 ,$609.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,$762.00 ,$381.00 ,$169.32 ,$762.00 ,$212.82 ,$551.53 ,$490.25 ,$259.08 ,$609.60 ,$647.70 ,$476.25 ,$685.80 ,$212.82 ,$723.90 ,$685.80 ,$647.70 ,$647.70 ,$259.08 ,$647.70 ,$647.70 ,$685.80 ,$212.82 ,$320.04 ,$685.80 ,$410.47 ,$701.04 ,$685.80 ,$507.80 ,$507.80 ,$464.06 ,$507.80 ,$495.30 ,$530.73 ,$169.32 ,$601.98 ,$225.59 ,$380.00 ,$380.00 ,$259.08 ,$427.00 ,$182.43 ,$723.90 ,$624.84 ,$624.84 ,$609.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$773.00 ,$386.50 ,$129.42 ,$773.00 ,$316.90 ,$145.60 ,$129.42 ,$262.82 ,$618.40 ,$657.05 ,$483.13 ,$695.70 ,$316.90 ,$734.35 ,$695.70 ,$657.05 ,$657.05 ,$262.82 ,$657.05 ,$657.05 ,$695.70 ,$316.90 ,$324.66 ,$695.70 , N/A ,$711.16 ,$695.70 ,$515.13 ,$515.13 ,$470.76 ,$515.13 ,$502.45 ,$538.39 ,$171.76 ,$610.67 ,$335.91 ,$380.00 ,$380.00 ,$262.82 ,$427.00 , N/A ,$734.35 ,$633.86 ,$633.86 ,$618.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000324,74301,HC CHOLANGIOGRAPHY OPERATIVE ADDL,320,1 ,$454.00 ,$227.00 ,$74.62 ,$454.00 ,$316.90 ,$83.95 ,$74.62 ,$154.36 ,$363.20 ,$385.90 ,$283.75 ,$408.60 ,$316.90 ,$431.30 ,$408.60 ,$385.90 ,$385.90 ,$154.36 ,$385.90 ,$385.90 ,$408.60 ,$316.90 ,$190.68 ,$408.60 , N/A ,$417.68 ,$408.60 ,$302.55 ,$302.55 ,$276.49 ,$302.55 ,$295.10 ,$316.21 ,$100.88 ,$358.66 ,$335.91 ,$380.00 ,$380.00 ,$154.36 ,$427.00 , N/A ,$431.30 ,$372.28 ,$372.28 ,$363.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,$739.00 ,$369.50 ,$164.21 ,$846.20 ,$212.82 ,$199.22 ,$177.09 ,$251.26 ,$591.20 ,$628.15 ,$461.88 ,$665.10 ,$212.82 ,$702.05 ,$665.10 ,$628.15 ,$628.15 ,$251.26 ,$628.15 ,$628.15 ,$665.10 ,$212.82 ,$310.38 ,$665.10 ,$846.20 ,$679.88 ,$665.10 ,$492.47 ,$492.47 ,$450.05 ,$492.47 ,$480.35 ,$514.71 ,$164.21 ,$583.81 ,$225.59 ,$380.00 ,$380.00 ,$251.26 ,$427.00 ,$376.09 ,$702.05 ,$605.98 ,$605.98 ,$591.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,$739.00 ,$369.50 ,$164.21 ,$846.20 ,$212.82 ,$625.12 ,$625.12 ,$251.26 ,$591.20 ,$628.15 ,$461.88 ,$665.10 ,$212.82 ,$702.05 ,$665.10 ,$628.15 ,$628.15 ,$251.26 ,$628.15 ,$628.15 ,$665.10 ,$212.82 ,$310.38 ,$665.10 ,$846.20 ,$679.88 ,$665.10 ,$492.47 ,$492.47 ,$450.05 ,$492.47 ,$480.35 ,$514.71 ,$164.21 ,$583.81 ,$225.59 ,$380.00 ,$380.00 ,$251.26 ,$427.00 ,$376.09 ,$702.05 ,$605.98 ,$605.98 ,$591.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000342,74425,HC XR UROGRAM ANTE (LOOPOGRAM SVG),320,1 ,$739.00 ,$369.50 ,$164.21 ,$846.20 ,$212.82 ,$625.12 ,$625.12 ,$251.26 ,$591.20 ,$628.15 ,$461.88 ,$665.10 ,$212.82 ,$702.05 ,$665.10 ,$628.15 ,$628.15 ,$251.26 ,$628.15 ,$628.15 ,$665.10 ,$212.82 ,$310.38 ,$665.10 ,$846.20 ,$679.88 ,$665.10 ,$492.47 ,$492.47 ,$450.05 ,$492.47 ,$480.35 ,$514.71 ,$164.21 ,$583.81 ,$225.59 ,$380.00 ,$380.00 ,$251.26 ,$427.00 ,$376.09 ,$702.05 ,$605.98 ,$605.98 ,$591.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,"$1,143.00 ",$571.50 ,$88.79 ,"$1,143.00 ",$212.82 ,$99.89 ,$88.79 ,$388.62 ,$914.40 ,$971.55 ,$714.38 ,"$1,028.70 ",$212.82 ,"$1,085.85 ","$1,028.70 ",$971.55 ,$971.55 ,$388.62 ,$971.55 ,$971.55 ,"$1,028.70 ",$212.82 ,$480.06 ,"$1,028.70 ",$846.20 ,"$1,051.56 ","$1,028.70 ",$761.70 ,$761.70 ,$696.09 ,$761.70 ,$742.95 ,$796.10 ,$253.97 ,$902.97 ,$225.59 ,$380.00 ,$380.00 ,$388.62 ,$427.00 ,$376.09 ,"$1,085.85 ",$937.26 ,$937.26 ,$914.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,$896.00 ,$448.00 ,$199.09 ,$896.00 ,$212.82 ,$321.83 ,$286.07 ,$304.64 ,$716.80 ,$761.60 ,$560.00 ,$806.40 ,$212.82 ,$851.20 ,$806.40 ,$761.60 ,$761.60 ,$304.64 ,$761.60 ,$761.60 ,$806.40 ,$212.82 ,$376.32 ,$806.40 ,$528.75 ,$824.32 ,$806.40 ,$597.09 ,$597.09 ,$545.66 ,$597.09 ,$582.40 ,$624.06 ,$199.09 ,$707.84 ,$225.59 ,$380.00 ,$380.00 ,$304.64 ,$427.00 ,$235.00 ,$851.20 ,$734.72 ,$734.72 ,$716.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$750.00 ,$375.00 ,$166.65 ,$750.00 ,$212.82 ,$275.27 ,$244.69 ,$255.00 ,$600.00 ,$637.50 ,$468.75 ,$675.00 ,$212.82 ,$712.50 ,$675.00 ,$637.50 ,$637.50 ,$255.00 ,$637.50 ,$637.50 ,$675.00 ,$212.82 ,$315.00 ,$675.00 ,$528.75 ,$690.00 ,$675.00 ,$499.80 ,$499.80 ,$456.75 ,$499.80 ,$487.50 ,$522.38 ,$166.65 ,$592.50 ,$225.59 ,$380.00 ,$380.00 ,$255.00 ,$427.00 ,$235.00 ,$712.50 ,$615.00 ,$615.00 ,$600.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$1,300.00 ",$650.00 ,$288.86 ,"$3,233.23 ","$1,302.81 ","$1,099.67 ","$1,099.67 ",$442.00 ,"$1,040.00 ","$1,105.00 ",$812.50 ,"$1,170.00 ","$1,302.81 ","$1,235.00 ","$1,170.00 ","$1,105.00 ","$1,105.00 ",$442.00 ,"$1,105.00 ","$1,105.00 ","$1,170.00 ","$1,302.81 ",$546.00 ,"$1,170.00 ","$3,233.23 ","$1,196.00 ","$1,170.00 ",$866.32 ,$866.32 ,$791.70 ,$866.32 ,$845.00 ,$905.45 ,$288.86 ,"$1,027.00 ","$1,380.98 ",$380.00 ,$380.00 ,$442.00 ,$427.00 ,"$1,436.99 ","$1,235.00 ","$1,066.00 ","$1,066.00 ","$1,040.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$1,456.00 ",$728.00 ,$243.31 ,"$1,456.00 ",$316.90 ,$273.72 ,$243.31 ,$495.04 ,"$1,164.80 ","$1,237.60 ",$910.00 ,"$1,310.40 ",$316.90 ,"$1,383.20 ","$1,310.40 ","$1,237.60 ","$1,237.60 ",$495.04 ,"$1,237.60 ","$1,237.60 ","$1,310.40 ",$316.90 ,$611.52 ,"$1,310.40 ", N/A ,"$1,339.52 ","$1,310.40 ",$970.28 ,$970.28 ,$886.70 ,$970.28 ,$946.40 ,"$1,014.10 ",$323.52 ,"$1,150.24 ",$335.91 ,$380.00 ,$380.00 ,$495.04 ,$427.00 , N/A ,"$1,383.20 ","$1,193.92 ","$1,193.92 ","$1,164.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$560.00 ,$280.00 ,$121.90 ,$560.00 ,$212.82 ,$137.14 ,$121.90 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$212.82 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$212.82 ,$235.20 ,$504.00 ,$528.75 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$225.59 ,$380.00 ,$380.00 ,$190.40 ,$427.00 ,$235.00 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000452,N/A,HC FLUORO  OARM/CARM <1 HR OR,360,1 ,$987.00 ,$493.50 ,$219.31 ,$987.00 , N/A ,$834.90 ,$834.90 ,$335.58 ,$789.60 ,$838.95 ,$616.88 ,$888.30 , N/A ,$937.65 ,$888.30 ,$838.95 ,$838.95 ,$335.58 ,$838.95 ,$838.95 ,$888.30 , N/A , N/A ,$888.30 , N/A ,$908.04 ,$888.30 ,$657.74 ,$657.74 ,$601.08 ,$657.74 ,$641.55 ,$687.45 ,$219.31 ,$779.73 , N/A , N/A , N/A ,$335.58 , N/A , N/A ,$937.65 ,$809.34 ,$809.34 ,$789.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000456,N/A,HC CARM FLUORO > 1 HR OR,360,1 ,"$1,050.00 ",$525.00 ,$233.31 ,"$1,050.00 ", N/A ,$888.20 ,$888.20 ,$357.00 ,$840.00 ,$892.50 ,$656.25 ,$945.00 , N/A ,$997.50 ,$945.00 ,$892.50 ,$892.50 ,$357.00 ,$892.50 ,$892.50 ,$945.00 , N/A , N/A ,$945.00 , N/A ,$966.00 ,$945.00 ,$699.72 ,$699.72 ,$639.45 ,$699.72 ,$682.50 ,$731.33 ,$233.31 ,$829.50 , N/A , N/A , N/A ,$357.00 , N/A , N/A ,$997.50 ,$861.00 ,$861.00 ,$840.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,$728.00 ,$364.00 ,$119.14 ,"$1,110.33 ",$212.82 ,$134.04 ,$119.14 ,$247.52 ,$582.40 ,$618.80 ,$455.00 ,$655.20 ,$212.82 ,$691.60 ,$655.20 ,$618.80 ,$618.80 ,$247.52 ,$618.80 ,$618.80 ,$655.20 ,$212.82 ,$305.76 ,$655.20 ,"$1,110.33 ",$669.76 ,$655.20 ,$485.14 ,$485.14 ,$443.35 ,$485.14 ,$473.20 ,$507.05 ,$161.76 ,$575.12 ,$225.59 ,$380.00 ,$380.00 ,$247.52 ,$427.00 ,$493.48 ,$691.60 ,$596.96 ,$596.96 ,$582.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000466,76080,HC ABSCESS FISTULA DRAINAGE CATH CHECK,320,1 ,$728.00 ,$364.00 ,$119.14 ,"$1,110.33 ",$212.82 ,$134.04 ,$119.14 ,$247.52 ,$582.40 ,$618.80 ,$455.00 ,$655.20 ,$212.82 ,$691.60 ,$655.20 ,$618.80 ,$618.80 ,$247.52 ,$618.80 ,$618.80 ,$655.20 ,$212.82 ,$305.76 ,$655.20 ,"$1,110.33 ",$669.76 ,$655.20 ,$485.14 ,$485.14 ,$443.35 ,$485.14 ,$473.20 ,$507.05 ,$161.76 ,$575.12 ,$225.59 ,$380.00 ,$380.00 ,$247.52 ,$427.00 ,$493.48 ,$691.60 ,$596.96 ,$596.96 ,$582.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$504.00 ,$252.00 ,$111.99 ,$504.00 ,$316.90 ,$312.52 ,$277.80 ,$171.36 ,$403.20 ,$428.40 ,$315.00 ,$453.60 ,$316.90 ,$478.80 ,$453.60 ,$428.40 ,$428.40 ,$171.36 ,$428.40 ,$428.40 ,$453.60 ,$316.90 ,$211.68 ,$453.60 , N/A ,$463.68 ,$453.60 ,$335.87 ,$335.87 ,$306.94 ,$335.87 ,$327.60 ,$351.04 ,$111.99 ,$398.16 ,$335.91 ,$380.00 ,$380.00 ,$171.36 ,$427.00 , N/A ,$478.80 ,$413.28 ,$413.28 ,$403.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$560.00 ,$280.00 ,$124.43 ,$560.00 ,$316.90 ,$320.28 ,$284.69 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$316.90 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$316.90 ,$235.20 ,$504.00 , N/A ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$335.91 ,$380.00 ,$380.00 ,$190.40 ,$427.00 , N/A ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000479,77002,HC FLUORO NEEDLE PLACEMENT HIP,320,1 ,$560.00 ,$280.00 ,$124.43 ,$560.00 ,$316.90 ,$320.28 ,$284.69 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$316.90 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$316.90 ,$235.20 ,$504.00 , N/A ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$335.91 ,$380.00 ,$380.00 ,$190.40 ,$427.00 , N/A ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$616.00 ,$308.00 ,$136.88 ,$616.00 ,$316.90 ,$295.45 ,$262.62 ,$209.44 ,$492.80 ,$523.60 ,$385.00 ,$554.40 ,$316.90 ,$585.20 ,$554.40 ,$523.60 ,$523.60 ,$209.44 ,$523.60 ,$523.60 ,$554.40 ,$316.90 ,$258.72 ,$554.40 , N/A ,$566.72 ,$554.40 ,$410.50 ,$410.50 ,$375.14 ,$410.50 ,$400.40 ,$429.04 ,$136.88 ,$486.64 ,$335.91 ,$380.00 ,$380.00 ,$209.44 ,$427.00 , N/A ,$585.20 ,$505.12 ,$505.12 ,$492.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$740.00 ,$370.00 ,$164.43 ,"$1,535.03 ","$1,448.14 ",$625.97 ,$625.97 ,$251.60 ,$592.00 ,$629.00 ,$462.50 ,$666.00 ,"$1,448.14 ",$703.00 ,$666.00 ,$629.00 ,$629.00 ,$251.60 ,$629.00 ,$629.00 ,$666.00 ,"$1,448.14 ",$310.80 ,$666.00 ,"$1,429.97 ",$680.80 ,$666.00 ,$493.14 ,$493.14 ,$450.66 ,$493.14 ,$481.00 ,$515.41 ,$164.43 ,$584.60 ,"$1,535.03 ",$380.00 ,$380.00 ,$251.60 ,$427.00 ,$635.54 ,$703.00 ,$606.80 ,$606.80 ,$592.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$459.00 ,$229.50 ,$88.79 ,$459.00 ,$100.91 ,$99.89 ,$88.79 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000493,77074,HC BONE SURVEY LIMITED,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$194.57 ,$172.95 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,$605.00 ,$302.50 ,$111.19 ,$605.00 ,$212.82 ,$283.03 ,$251.58 ,$205.70 ,$484.00 ,$514.25 ,$378.13 ,$544.50 ,$212.82 ,$574.75 ,$544.50 ,$514.25 ,$514.25 ,$205.70 ,$514.25 ,$514.25 ,$544.50 ,$212.82 ,$254.10 ,$544.50 ,$250.18 ,$556.60 ,$544.50 ,$403.17 ,$403.17 ,$368.45 ,$403.17 ,$393.25 ,$421.38 ,$134.43 ,$477.95 ,$225.59 ,$380.00 ,$380.00 ,$205.70 ,$427.00 ,$111.19 ,$574.75 ,$496.10 ,$496.10 ,$484.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000496,77080,HC BONE DENSITY DXA,320,1 ,$694.00 ,$347.00 ,$111.19 ,$694.00 ,$139.90 ,$130.93 ,$116.38 ,$235.96 ,$555.20 ,$589.90 ,$433.75 ,$624.60 ,$139.90 ,$659.30 ,$624.60 ,$589.90 ,$589.90 ,$235.96 ,$589.90 ,$589.90 ,$624.60 ,$139.90 ,$291.48 ,$624.60 ,$250.18 ,$638.48 ,$624.60 ,$462.48 ,$462.48 ,$422.65 ,$462.48 ,$451.10 ,$483.37 ,$154.21 ,$548.26 ,$148.29 ,$380.00 ,$380.00 ,$235.96 ,$427.00 ,$111.19 ,$659.30 ,$569.08 ,$569.08 ,$555.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$638.00 ,$319.00 ,$82.61 ,$638.00 ,$139.90 ,$99.89 ,$88.79 ,$216.92 ,$510.40 ,$542.30 ,$398.75 ,$574.20 ,$139.90 ,$606.10 ,$574.20 ,$542.30 ,$542.30 ,$216.92 ,$542.30 ,$542.30 ,$574.20 ,$139.90 ,$267.96 ,$574.20 ,$185.87 ,$586.96 ,$574.20 ,$425.16 ,$425.16 ,$388.54 ,$425.16 ,$414.70 ,$444.37 ,$141.76 ,$504.02 ,$148.29 ,$380.00 ,$380.00 ,$216.92 ,$427.00 ,$82.61 ,$606.10 ,$523.16 ,$523.16 ,$510.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$560.00 ,$280.00 ,$121.90 ,$560.00 ,$212.82 ,$137.14 ,$121.90 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$212.82 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$212.82 ,$235.20 ,$504.00 ,$528.75 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$225.59 ,$380.00 ,$380.00 ,$190.40 ,$427.00 ,$235.00 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$388.00 ,$194.00 ,$86.21 ,$600.37 ,$424.03 ,$328.21 ,$328.21 ,$131.92 ,$310.40 ,$329.80 ,$242.50 ,$349.20 ,$424.03 ,$368.60 ,$349.20 ,$329.80 ,$329.80 ,$131.92 ,$329.80 ,$329.80 ,$349.20 ,$424.03 ,$162.96 ,$349.20 ,$600.37 ,$356.96 ,$349.20 ,$258.56 ,$258.56 ,$236.29 ,$258.56 ,$252.20 ,$270.24 ,$86.21 ,$306.52 ,$449.47 ,$380.00 ,$380.00 ,$131.92 ,$388.00 ,$266.83 ,$368.60 ,$318.16 ,$318.16 ,$310.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000509,77072,HC BONE AGE STUDIES,320,1 ,$594.00 ,$297.00 ,$55.68 ,$594.00 ,$100.91 ,$62.64 ,$55.68 ,$201.96 ,$475.20 ,$504.90 ,$371.25 ,$534.60 ,$100.91 ,$564.30 ,$534.60 ,$504.90 ,$504.90 ,$201.96 ,$504.90 ,$504.90 ,$534.60 ,$100.91 ,$249.48 ,$534.60 ,$250.18 ,$546.48 ,$534.60 ,$395.84 ,$395.84 ,$361.75 ,$395.84 ,$386.10 ,$413.72 ,$131.99 ,$469.26 ,$106.96 ,$380.00 ,$380.00 ,$201.96 ,$427.00 ,$111.19 ,$564.30 ,$487.08 ,$487.08 ,$475.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000523,72020,HC XR SPINE 1V (C SPINE CLEAR LAT),320,1 ,$392.00 ,$196.00 ,$58.44 ,$392.00 ,$100.91 ,$65.75 ,$58.44 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$100.91 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$100.91 ,$164.64 ,$352.80 ,$185.87 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$106.96 ,$380.00 ,$380.00 ,$133.28 ,$392.00 ,$82.61 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000525,N/A,HC CARM FLUORO <1 HR OR,360,1 ,$987.00 ,$493.50 ,$219.31 ,$987.00 , N/A ,$834.90 ,$834.90 ,$335.58 ,$789.60 ,$838.95 ,$616.88 ,$888.30 , N/A ,$937.65 ,$888.30 ,$838.95 ,$838.95 ,$335.58 ,$838.95 ,$838.95 ,$888.30 , N/A , N/A ,$888.30 , N/A ,$908.04 ,$888.30 ,$657.74 ,$657.74 ,$601.08 ,$657.74 ,$641.55 ,$687.45 ,$219.31 ,$779.73 , N/A , N/A , N/A ,$335.58 , N/A , N/A ,$937.65 ,$809.34 ,$809.34 ,$789.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$1,779.95 ","$1,679.20 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$1,679.20 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$1,679.20 ",$497.70 ,"$1,066.50 ","$1,242.09 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$1,779.95 ",$380.00 ,$380.00 ,$402.90 ,$427.00 ,$552.04 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,779.95 ","$1,679.20 ","$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ","$1,679.20 ","$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ","$1,679.20 ",$543.06 ,"$1,163.70 ","$1,242.09 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ","$1,779.95 ",$380.00 ,$380.00 ,$439.62 ,$427.00 ,$552.04 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$109.20 ,$97.07 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$115.41 ,$102.59 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$211.64 ,$188.12 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$250.18 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$111.19 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$370.00 ,$185.00 ,$81.90 ,$370.00 ,$100.91 ,$92.13 ,$81.90 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$414.00 ,$207.00 ,$82.61 ,$414.00 ,$100.91 ,$137.14 ,$121.90 ,$140.76 ,$331.20 ,$351.90 ,$258.75 ,$372.60 ,$100.91 ,$393.30 ,$372.60 ,$351.90 ,$351.90 ,$140.76 ,$351.90 ,$351.90 ,$372.60 ,$100.91 ,$173.88 ,$372.60 ,$185.87 ,$380.88 ,$372.60 ,$275.89 ,$275.89 ,$252.13 ,$275.89 ,$269.10 ,$288.35 ,$91.99 ,$327.06 ,$106.96 ,$380.00 ,$380.00 ,$140.76 ,$414.00 ,$82.61 ,$393.30 ,$339.48 ,$339.48 ,$331.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$171.29 ,$152.25 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$459.00 ,$229.50 ,$100.91 ,$459.00 ,$100.91 ,$116.96 ,$103.97 ,$156.06 ,$367.20 ,$390.15 ,$286.88 ,$413.10 ,$100.91 ,$436.05 ,$413.10 ,$390.15 ,$390.15 ,$156.06 ,$390.15 ,$390.15 ,$413.10 ,$100.91 ,$192.78 ,$413.10 ,$250.18 ,$422.28 ,$413.10 ,$305.88 ,$305.88 ,$279.53 ,$305.88 ,$298.35 ,$319.69 ,$101.99 ,$362.61 ,$106.96 ,$380.00 ,$380.00 ,$156.06 ,$427.00 ,$111.19 ,$436.05 ,$376.38 ,$376.38 ,$367.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$504.00 ,$252.00 ,$100.91 ,$504.00 ,$100.91 ,$151.11 ,$134.32 ,$171.36 ,$403.20 ,$428.40 ,$315.00 ,$453.60 ,$100.91 ,$478.80 ,$453.60 ,$428.40 ,$428.40 ,$171.36 ,$428.40 ,$428.40 ,$453.60 ,$100.91 ,$211.68 ,$453.60 ,$250.18 ,$463.68 ,$453.60 ,$335.87 ,$335.87 ,$306.94 ,$335.87 ,$327.60 ,$351.04 ,$111.99 ,$398.16 ,$106.96 ,$380.00 ,$380.00 ,$171.36 ,$427.00 ,$111.19 ,$478.80 ,$413.28 ,$413.28 ,$403.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$549.00 ,$274.50 ,$100.91 ,$549.00 ,$100.91 ,$183.70 ,$163.29 ,$186.66 ,$439.20 ,$466.65 ,$343.13 ,$494.10 ,$100.91 ,$521.55 ,$494.10 ,$466.65 ,$466.65 ,$186.66 ,$466.65 ,$466.65 ,$494.10 ,$100.91 ,$230.58 ,$494.10 ,$250.18 ,$505.08 ,$494.10 ,$365.85 ,$365.85 ,$334.34 ,$365.85 ,$356.85 ,$382.38 ,$121.99 ,$433.71 ,$106.96 ,$380.00 ,$380.00 ,$186.66 ,$427.00 ,$111.19 ,$521.55 ,$450.18 ,$450.18 ,$439.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$370.00 ,$185.00 ,$76.38 ,$370.00 ,$100.91 ,$85.92 ,$76.38 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$370.00 ,$185.00 ,$82.21 ,$370.00 ,$100.91 ,$104.55 ,$92.93 ,$125.80 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$100.91 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$125.80 ,$314.50 ,$314.50 ,$333.00 ,$100.91 ,$155.40 ,$333.00 ,$185.87 ,$340.40 ,$333.00 ,$246.57 ,$246.57 ,$225.33 ,$246.57 ,$240.50 ,$257.71 ,$82.21 ,$292.30 ,$106.96 ,$370.00 ,$370.00 ,$125.80 ,$370.00 ,$82.61 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000586,72265,HC XR MYELOGRAPHY L-SPINE,320,1 ,"$2,146.00 ","$1,073.00 ",$218.47 ,"$2,146.00 ","$1,033.50 ",$245.78 ,$218.47 ,$729.64 ,"$1,716.80 ","$1,824.10 ","$1,341.25 ","$1,931.40 ","$1,033.50 ","$2,038.70 ","$1,931.40 ","$1,824.10 ","$1,824.10 ",$729.64 ,"$1,824.10 ","$1,824.10 ","$1,931.40 ","$1,033.50 ",$901.32 ,"$1,931.40 ","$1,644.01 ","$1,974.32 ","$1,931.40 ","$1,430.09 ","$1,430.09 ","$1,306.91 ","$1,430.09 ","$1,394.90 ","$1,494.69 ",$476.84 ,"$1,695.34 ","$1,095.51 ",$380.00 ,$380.00 ,$729.64 ,$427.00 ,$730.67 ,"$2,038.70 ","$1,759.72 ","$1,759.72 ","$1,716.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A , N/A ,$0.01 , N/A ,$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 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$605.00 ,$302.50 ,$77.89 ,$605.00 ,$77.89 ,$511.77 ,$511.77 ,$205.70 ,$484.00 ,$514.25 ,$378.13 ,$544.50 ,$77.89 ,$574.75 ,$544.50 ,$514.25 ,$514.25 ,$205.70 ,$514.25 ,$514.25 ,$544.50 ,$77.89 ,$279.46 ,$544.50 ,$470.09 ,$556.60 ,$544.50 ,$403.17 ,$403.17 ,$368.45 ,$403.17 ,$393.25 ,$421.38 ,$134.43 ,$477.95 ,$82.56 ,$577.00 ,$577.00 ,$205.70 ,$605.00 ,$208.93 ,$574.75 ,$496.10 ,$496.10 ,$484.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$347.00 ,$173.50 ,$63.32 ,$347.00 ,$77.89 ,$293.53 ,$293.53 ,$117.98 ,$277.60 ,$294.95 ,$216.88 ,$312.30 ,$77.89 ,$329.65 ,$312.30 ,$294.95 ,$294.95 ,$117.98 ,$294.95 ,$294.95 ,$312.30 ,$77.89 ,$279.46 ,$312.30 ,$142.47 ,$319.24 ,$312.30 ,$231.24 ,$231.24 ,$211.32 ,$231.24 ,$225.55 ,$241.69 ,$77.10 ,$274.13 ,$82.56 ,$347.00 ,$347.00 ,$117.98 ,$347.00 ,$63.32 ,$329.65 ,$284.54 ,$284.54 ,$277.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$930.00 ,$465.00 ,$206.65 ,$930.00 ,$534.14 ,$786.69 ,$786.69 ,$316.20 ,$744.00 ,$790.50 ,$581.25 ,$837.00 ,$534.14 ,$883.50 ,$837.00 ,$790.50 ,$790.50 ,$316.20 ,$790.50 ,$790.50 ,$837.00 ,$534.14 ,$279.46 ,$837.00 ,$732.69 ,$855.60 ,$837.00 ,$619.75 ,$619.75 ,$566.37 ,$619.75 ,$604.50 ,$647.75 ,$206.65 ,$734.70 ,$566.19 ,$577.00 ,$577.00 ,$316.20 ,$657.00 ,$325.64 ,$883.50 ,$762.60 ,$762.60 ,$744.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$235.00 ,$117.50 ,$52.22 ,$958.24 ,$904.00 ,$198.79 ,$198.79 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 ,$904.00 ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 ,$904.00 ,$235.00 ,$211.50 ,$142.47 ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 ,$958.24 ,$235.00 ,$235.00 ,$79.90 ,$235.00 ,$63.32 ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$336.00 ,$168.00 ,$63.32 ,$566.19 ,$534.14 ,$284.22 ,$284.22 ,$114.24 ,$268.80 ,$285.60 ,$210.00 ,$302.40 ,$534.14 ,$319.20 ,$302.40 ,$285.60 ,$285.60 ,$114.24 ,$285.60 ,$285.60 ,$302.40 ,$534.14 ,$279.46 ,$302.40 ,$142.47 ,$309.12 ,$302.40 ,$223.91 ,$223.91 ,$204.62 ,$223.91 ,$218.40 ,$234.02 ,$74.66 ,$265.44 ,$566.19 ,$336.00 ,$336.00 ,$114.24 ,$336.00 ,$63.32 ,$319.20 ,$275.52 ,$275.52 ,$268.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$512.00 ,$256.00 ,$113.77 ,$866.23 ,$676.46 ,$319.29 ,$283.81 ,$174.08 ,$409.60 ,$435.20 ,$320.00 ,$460.80 ,$676.46 ,$486.40 ,$460.80 ,$435.20 ,$435.20 ,$174.08 ,$435.20 ,$435.20 ,$460.80 ,$676.46 ,$512.00 ,$460.80 ,$866.23 ,$471.04 ,$460.80 ,$341.20 ,$341.20 ,$311.81 ,$341.20 ,$332.80 ,$356.61 ,$113.77 ,$404.48 ,$717.05 ,$512.00 ,$512.00 ,$174.08 ,$512.00 ,$384.99 ,$486.40 ,$419.84 ,$419.84 ,$409.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,569.00 ",$784.50 ,$348.63 ,"$1,569.00 ",$676.46 ,$967.05 ,$859.60 ,$533.46 ,"$1,255.20 ","$1,333.65 ",$980.63 ,"$1,412.10 ",$676.46 ,"$1,490.55 ","$1,412.10 ","$1,333.65 ","$1,333.65 ",$533.46 ,"$1,333.65 ","$1,333.65 ","$1,412.10 ",$676.46 ,$580.41 ,"$1,412.10 ",$866.23 ,"$1,443.48 ","$1,412.10 ","$1,045.58 ","$1,045.58 ",$955.52 ,"$1,045.58 ","$1,019.85 ","$1,092.81 ",$348.63 ,"$1,239.51 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$533.46 ,"$1,478.00 ",$384.99 ,"$1,490.55 ","$1,286.58 ","$1,286.58 ","$1,255.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000006,78013,HC NM THYROID SCAN,340,1 ,$994.00 ,$497.00 ,$220.87 ,$994.00 ,$676.46 ,$776.15 ,$689.91 ,$337.96 ,$795.20 ,$844.90 ,$621.25 ,$894.60 ,$676.46 ,$944.30 ,$894.60 ,$844.90 ,$844.90 ,$337.96 ,$844.90 ,$844.90 ,$894.60 ,$676.46 ,$580.41 ,$894.60 ,$866.23 ,$914.48 ,$894.60 ,$662.40 ,$662.40 ,$605.35 ,$662.40 ,$646.10 ,$692.32 ,$220.87 ,$785.26 ,$717.05 ,$994.00 ,$994.00 ,$337.96 ,$994.00 ,$384.99 ,$944.30 ,$815.08 ,$815.08 ,$795.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,673.00 ",$836.50 ,$371.74 ,"$1,801.80 ","$1,699.81 ","$1,161.05 ","$1,032.04 ",$568.82 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ","$1,699.81 ","$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$568.82 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ","$1,699.81 ",$580.41 ,"$1,505.70 ",$866.23 ,"$1,539.16 ","$1,505.70 ","$1,114.89 ","$1,114.89 ","$1,018.86 ","$1,114.89 ","$1,087.45 ","$1,165.24 ",$371.74 ,"$1,321.67 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$568.82 ,"$1,478.00 ",$384.99 ,"$1,589.35 ","$1,371.86 ","$1,371.86 ","$1,338.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$2,092.00 ","$1,046.00 ",$464.84 ,"$2,092.00 ","$1,699.81 ","$1,330.78 ","$1,182.92 ",$711.28 ,"$1,673.60 ","$1,778.20 ","$1,307.50 ","$1,882.80 ","$1,699.81 ","$1,987.40 ","$1,882.80 ","$1,778.20 ","$1,778.20 ",$711.28 ,"$1,778.20 ","$1,778.20 ","$1,882.80 ","$1,699.81 ",$580.41 ,"$1,882.80 ","$1,124.51 ","$1,924.64 ","$1,882.80 ","$1,394.11 ","$1,394.11 ","$1,274.03 ","$1,394.11 ","$1,359.80 ","$1,457.08 ",$464.84 ,"$1,652.68 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$711.28 ,"$1,478.00 ",$499.78 ,"$1,987.40 ","$1,715.44 ","$1,715.44 ","$1,673.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000015,78201,HC LIVER IMAGING STATIC,340,1 ,"$1,150.00 ",$575.00 ,$255.53 ,"$1,801.80 ","$1,699.81 ",$755.97 ,$671.97 ,$391.00 ,$920.00 ,$977.50 ,$718.75 ,"$1,035.00 ","$1,699.81 ","$1,092.50 ","$1,035.00 ",$977.50 ,$977.50 ,$391.00 ,$977.50 ,$977.50 ,"$1,035.00 ","$1,699.81 ",$580.41 ,"$1,035.00 ","$1,124.51 ","$1,058.00 ","$1,035.00 ",$766.36 ,$766.36 ,$700.35 ,$766.36 ,$747.50 ,$800.98 ,$255.53 ,$908.50 ,"$1,801.80 ","$1,150.00 ","$1,150.00 ",$391.00 ,"$1,150.00 ",$499.78 ,"$1,092.50 ",$943.00 ,$943.00 ,$920.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000016,78202,HC LIVER IMAGING STATIC FLOW,340,1 ,"$1,046.00 ",$523.00 ,$232.42 ,"$1,801.80 ","$1,699.81 ",$796.32 ,$707.84 ,$355.64 ,$836.80 ,$889.10 ,$653.75 ,$941.40 ,"$1,699.81 ",$993.70 ,$941.40 ,$889.10 ,$889.10 ,$355.64 ,$889.10 ,$889.10 ,$941.40 ,"$1,699.81 ",$580.41 ,$941.40 ,"$1,124.51 ",$962.32 ,$941.40 ,$697.05 ,$697.05 ,$637.01 ,$697.05 ,$679.90 ,$728.54 ,$232.42 ,$826.34 ,"$1,801.80 ","$1,046.00 ","$1,046.00 ",$355.64 ,"$1,046.00 ",$499.78 ,$993.70 ,$857.72 ,$857.72 ,$836.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,360.00 ",$680.00 ,$302.19 ,"$1,801.80 ","$1,699.81 ",$760.63 ,$676.11 ,$462.40 ,"$1,088.00 ","$1,156.00 ",$850.00 ,"$1,224.00 ","$1,699.81 ","$1,292.00 ","$1,224.00 ","$1,156.00 ","$1,156.00 ",$462.40 ,"$1,156.00 ","$1,156.00 ","$1,224.00 ","$1,699.81 ",$580.41 ,"$1,224.00 ",$866.23 ,"$1,251.20 ","$1,224.00 ",$906.30 ,$906.30 ,$828.24 ,$906.30 ,$884.00 ,$947.24 ,$302.19 ,"$1,074.40 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$462.40 ,"$1,360.00 ",$384.99 ,"$1,292.00 ","$1,115.20 ","$1,115.20 ","$1,088.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000020,78216,HC LIVER SPLEEN STATIC FLOW,340,1 ,"$1,778.00 ",$889.00 ,$384.99 ,"$1,801.80 ","$1,699.81 ",$447.12 ,$397.44 ,$604.52 ,"$1,422.40 ","$1,511.30 ","$1,111.25 ","$1,600.20 ","$1,699.81 ","$1,689.10 ","$1,600.20 ","$1,511.30 ","$1,511.30 ",$604.52 ,"$1,511.30 ","$1,511.30 ","$1,600.20 ","$1,699.81 ",$580.41 ,"$1,600.20 ",$866.23 ,"$1,635.76 ","$1,600.20 ","$1,184.86 ","$1,184.86 ","$1,082.80 ","$1,184.86 ","$1,155.70 ","$1,238.38 ",$395.07 ,"$1,404.62 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$604.52 ,"$1,478.00 ",$384.99 ,"$1,689.10 ","$1,457.96 ","$1,457.96 ","$1,422.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000021,78216,HC RBC LIVER SCAN,340,1 ,"$1,778.00 ",$889.00 ,$384.99 ,"$1,801.80 ","$1,699.81 ",$447.12 ,$397.44 ,$604.52 ,"$1,422.40 ","$1,511.30 ","$1,111.25 ","$1,600.20 ","$1,699.81 ","$1,689.10 ","$1,600.20 ","$1,511.30 ","$1,511.30 ",$604.52 ,"$1,511.30 ","$1,511.30 ","$1,600.20 ","$1,699.81 ",$580.41 ,"$1,600.20 ",$866.23 ,"$1,635.76 ","$1,600.20 ","$1,184.86 ","$1,184.86 ","$1,082.80 ","$1,184.86 ","$1,155.70 ","$1,238.38 ",$395.07 ,"$1,404.62 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$604.52 ,"$1,478.00 ",$384.99 ,"$1,689.10 ","$1,457.96 ","$1,457.96 ","$1,422.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$2,092.00 ","$1,046.00 ",$384.99 ,"$2,092.00 ",$676.46 ,"$1,312.16 ","$1,166.36 ",$711.28 ,"$1,673.60 ","$1,778.20 ","$1,307.50 ","$1,882.80 ",$676.46 ,"$1,987.40 ","$1,882.80 ","$1,778.20 ","$1,778.20 ",$711.28 ,"$1,778.20 ","$1,778.20 ","$1,882.80 ",$676.46 ,$580.41 ,"$1,882.80 ",$866.23 ,"$1,924.64 ","$1,882.80 ","$1,394.11 ","$1,394.11 ","$1,274.03 ","$1,394.11 ","$1,359.80 ","$1,457.08 ",$464.84 ,"$1,652.68 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$711.28 ,"$1,478.00 ",$384.99 ,"$1,987.40 ","$1,715.44 ","$1,715.44 ","$1,673.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,673.00 ",$836.50 ,$371.74 ,"$1,673.00 ",$676.46 ,"$1,323.02 ","$1,176.02 ",$568.82 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ",$676.46 ,"$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$568.82 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ",$676.46 ,$580.41 ,"$1,505.70 ",$866.23 ,"$1,539.16 ","$1,505.70 ","$1,114.89 ","$1,114.89 ","$1,018.86 ","$1,114.89 ","$1,087.45 ","$1,165.24 ",$371.74 ,"$1,321.67 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$568.82 ,"$1,478.00 ",$384.99 ,"$1,589.35 ","$1,371.86 ","$1,371.86 ","$1,338.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,778.00 ",$889.00 ,$384.99 ,"$1,778.00 ",$676.46 ,"$1,327.68 ","$1,180.16 ",$604.52 ,"$1,422.40 ","$1,511.30 ","$1,111.25 ","$1,600.20 ",$676.46 ,"$1,689.10 ","$1,600.20 ","$1,511.30 ","$1,511.30 ",$604.52 ,"$1,511.30 ","$1,511.30 ","$1,600.20 ",$676.46 ,$580.41 ,"$1,600.20 ",$866.23 ,"$1,635.76 ","$1,600.20 ","$1,184.86 ","$1,184.86 ","$1,082.80 ","$1,184.86 ","$1,155.70 ","$1,238.38 ",$395.07 ,"$1,404.62 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$604.52 ,"$1,478.00 ",$384.99 ,"$1,689.10 ","$1,457.96 ","$1,457.96 ","$1,422.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$1,987.00 ",$993.50 ,$384.99 ,"$1,987.00 ",$676.46 ,"$1,162.60 ","$1,033.42 ",$675.58 ,"$1,589.60 ","$1,688.95 ","$1,241.88 ","$1,788.30 ",$676.46 ,"$1,887.65 ","$1,788.30 ","$1,688.95 ","$1,688.95 ",$675.58 ,"$1,688.95 ","$1,688.95 ","$1,788.30 ",$676.46 ,$580.41 ,"$1,788.30 ",$866.23 ,"$1,828.04 ","$1,788.30 ","$1,324.14 ","$1,324.14 ","$1,210.08 ","$1,324.14 ","$1,291.55 ","$1,383.95 ",$441.51 ,"$1,569.73 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$675.58 ,"$1,478.00 ",$384.99 ,"$1,887.65 ","$1,629.34 ","$1,629.34 ","$1,589.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$2,196.00 ","$1,098.00 ",$384.99 ,"$2,196.00 ",$676.46 ,"$1,324.58 ","$1,177.40 ",$746.64 ,"$1,756.80 ","$1,866.60 ","$1,372.50 ","$1,976.40 ",$676.46 ,"$2,086.20 ","$1,976.40 ","$1,866.60 ","$1,866.60 ",$746.64 ,"$1,866.60 ","$1,866.60 ","$1,976.40 ",$676.46 ,$580.41 ,"$1,976.40 ",$866.23 ,"$2,020.32 ","$1,976.40 ","$1,463.41 ","$1,463.41 ","$1,337.36 ","$1,463.41 ","$1,427.40 ","$1,529.51 ",$487.95 ,"$1,734.84 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$746.64 ,"$1,478.00 ",$384.99 ,"$2,086.20 ","$1,800.72 ","$1,800.72 ","$1,756.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$4,393.00 ","$2,196.50 ",$580.41 ,"$4,393.00 ","$1,699.81 ","$1,215.93 ","$1,080.83 ","$1,493.62 ","$3,514.40 ","$3,734.05 ","$2,745.63 ","$3,953.70 ","$1,699.81 ","$4,173.35 ","$3,953.70 ","$3,734.05 ","$3,734.05 ","$1,493.62 ","$3,734.05 ","$3,734.05 ","$3,953.70 ","$1,699.81 ",$580.41 ,"$3,953.70 ","$3,002.90 ","$4,041.56 ","$3,953.70 ","$2,927.50 ","$2,927.50 ","$2,675.34 ","$2,927.50 ","$2,855.45 ","$3,059.72 ",$976.12 ,"$3,470.47 ","$1,801.80 ","$1,304.00 ","$1,304.00 ","$1,493.62 ","$1,478.00 ","$1,334.62 ","$4,173.35 ","$3,602.26 ","$3,602.26 ","$3,514.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000036,78451,HC HT MUSCLE IMAGE SPECT SINGLE REST ONLY,340,1 ,"$4,393.00 ","$2,196.50 ",$580.41 ,"$4,393.00 ","$1,699.81 ","$1,215.93 ","$1,080.83 ","$1,493.62 ","$3,514.40 ","$3,734.05 ","$2,745.63 ","$3,953.70 ","$1,699.81 ","$4,173.35 ","$3,953.70 ","$3,734.05 ","$3,734.05 ","$1,493.62 ","$3,734.05 ","$3,734.05 ","$3,953.70 ","$1,699.81 ",$580.41 ,"$3,953.70 ","$3,002.90 ","$4,041.56 ","$3,953.70 ","$2,927.50 ","$2,927.50 ","$2,675.34 ","$2,927.50 ","$2,855.45 ","$3,059.72 ",$976.12 ,"$3,470.47 ","$1,801.80 ","$1,304.00 ","$1,304.00 ","$1,493.62 ","$1,478.00 ","$1,334.62 ","$4,173.35 ","$3,602.26 ","$3,602.26 ","$3,514.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$4,811.00 ","$2,405.50 ",$580.41 ,"$4,811.00 ","$1,699.81 ","$1,757.16 ","$1,561.92 ","$1,635.74 ","$3,848.80 ","$4,089.35 ","$3,006.88 ","$4,329.90 ","$1,699.81 ","$4,570.45 ","$4,329.90 ","$4,089.35 ","$4,089.35 ","$1,635.74 ","$4,089.35 ","$4,089.35 ","$4,329.90 ","$1,699.81 ",$580.41 ,"$4,329.90 ","$3,002.90 ","$4,426.12 ","$4,329.90 ","$3,206.05 ","$3,206.05 ","$2,929.90 ","$3,206.05 ","$3,127.15 ","$3,350.86 ","$1,069.00 ","$3,800.69 ","$1,801.80 ","$1,304.00 ","$1,304.00 ","$1,635.74 ","$1,478.00 ","$1,334.62 ","$4,570.45 ","$3,945.02 ","$3,945.02 ","$3,848.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000038,78452,HC STRESS/RST/REINJCT SPECT,340,1 ,"$4,811.00 ","$2,405.50 ",$580.41 ,"$4,811.00 ","$1,699.81 ","$1,757.16 ","$1,561.92 ","$1,635.74 ","$3,848.80 ","$4,089.35 ","$3,006.88 ","$4,329.90 ","$1,699.81 ","$4,570.45 ","$4,329.90 ","$4,089.35 ","$4,089.35 ","$1,635.74 ","$4,089.35 ","$4,089.35 ","$4,329.90 ","$1,699.81 ",$580.41 ,"$4,329.90 ","$3,002.90 ","$4,426.12 ","$4,329.90 ","$3,206.05 ","$3,206.05 ","$2,929.90 ","$3,206.05 ","$3,127.15 ","$3,350.86 ","$1,069.00 ","$3,800.69 ","$1,801.80 ","$1,304.00 ","$1,304.00 ","$1,635.74 ","$1,478.00 ","$1,334.62 ","$4,570.45 ","$3,945.02 ","$3,945.02 ","$3,848.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,196.00 ","$1,098.00 ",$384.99 ,"$2,196.00 ",$676.46 ,$807.19 ,$717.50 ,$746.64 ,"$1,756.80 ","$1,866.60 ","$1,372.50 ","$1,976.40 ",$676.46 ,"$2,086.20 ","$1,976.40 ","$1,866.60 ","$1,866.60 ",$746.64 ,"$1,866.60 ","$1,866.60 ","$1,976.40 ",$676.46 ,$580.41 ,"$1,976.40 ",$866.23 ,"$2,020.32 ","$1,976.40 ","$1,463.41 ","$1,463.41 ","$1,337.36 ","$1,463.41 ","$1,427.40 ","$1,529.51 ",$487.95 ,"$1,734.84 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$746.64 ,"$1,478.00 ",$384.99 ,"$2,086.20 ","$1,800.72 ","$1,800.72 ","$1,756.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000045,78473,HC MUGA RESTING MULTI,340,1 ,"$2,301.00 ","$1,150.50 ",$384.99 ,"$2,301.00 ",$676.46 ,$974.81 ,$866.50 ,$782.34 ,"$1,840.80 ","$1,955.85 ","$1,438.13 ","$2,070.90 ",$676.46 ,"$2,185.95 ","$2,070.90 ","$1,955.85 ","$1,955.85 ",$782.34 ,"$1,955.85 ","$1,955.85 ","$2,070.90 ",$676.46 ,$580.41 ,"$2,070.90 ",$866.23 ,"$2,116.92 ","$2,070.90 ","$1,533.39 ","$1,533.39 ","$1,401.31 ","$1,533.39 ","$1,495.65 ","$1,602.65 ",$511.28 ,"$1,817.79 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$782.34 ,"$1,478.00 ",$384.99 ,"$2,185.95 ","$1,886.82 ","$1,886.82 ","$1,840.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000047,78580,HC LUNG PERFUS,340,1 ,"$1,569.00 ",$784.50 ,$348.63 ,"$1,801.80 ","$1,699.81 ",$901.86 ,$801.66 ,$533.46 ,"$1,255.20 ","$1,333.65 ",$980.63 ,"$1,412.10 ","$1,699.81 ","$1,490.55 ","$1,412.10 ","$1,333.65 ","$1,333.65 ",$533.46 ,"$1,333.65 ","$1,333.65 ","$1,412.10 ","$1,699.81 ",$580.41 ,"$1,412.10 ",$866.23 ,"$1,443.48 ","$1,412.10 ","$1,045.58 ","$1,045.58 ",$955.52 ,"$1,045.58 ","$1,019.85 ","$1,092.81 ",$348.63 ,"$1,239.51 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$533.46 ,"$1,478.00 ",$384.99 ,"$1,490.55 ","$1,286.58 ","$1,286.58 ","$1,255.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$1,673.00 ",$836.50 ,$371.74 ,"$1,801.80 ","$1,699.81 ","$1,259.39 ","$1,119.46 ",$568.82 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ","$1,699.81 ","$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$568.82 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ","$1,699.81 ",$580.41 ,"$1,505.70 ","$1,124.51 ","$1,539.16 ","$1,505.70 ","$1,114.89 ","$1,114.89 ","$1,018.86 ","$1,114.89 ","$1,087.45 ","$1,165.24 ",$371.74 ,"$1,321.67 ","$1,801.80 ","$1,304.00 ","$1,304.00 ",$568.82 ,"$1,478.00 ",$499.78 ,"$1,589.35 ","$1,371.86 ","$1,371.86 ","$1,338.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000061,78701,HC KIDNEY SCAN W/FLOW,340,1 ,"$1,673.00 ",$836.50 ,$371.74 ,"$1,673.00 ",$676.46 ,$861.51 ,$765.79 ,$568.82 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ",$676.46 ,"$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$568.82 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ",$676.46 ,$580.41 ,"$1,505.70 ",$866.23 ,"$1,539.16 ","$1,505.70 ","$1,114.89 ","$1,114.89 ","$1,018.86 ","$1,114.89 ","$1,087.45 ","$1,165.24 ",$371.74 ,"$1,321.67 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$568.82 ,"$1,478.00 ",$384.99 ,"$1,589.35 ","$1,371.86 ","$1,371.86 ","$1,338.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$2,405.00 ","$1,202.50 ",$499.78 ,"$2,405.00 ",$676.46 ,$830.47 ,$738.19 ,$817.70 ,"$1,924.00 ","$2,044.25 ","$1,503.13 ","$2,164.50 ",$676.46 ,"$2,284.75 ","$2,164.50 ","$2,044.25 ","$2,044.25 ",$817.70 ,"$2,044.25 ","$2,044.25 ","$2,164.50 ",$676.46 ,$580.41 ,"$2,164.50 ","$1,124.51 ","$2,212.60 ","$2,164.50 ","$1,602.69 ","$1,602.69 ","$1,464.65 ","$1,602.69 ","$1,563.25 ","$1,675.08 ",$534.39 ,"$1,899.95 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$817.70 ,"$1,478.00 ",$499.78 ,"$2,284.75 ","$1,972.10 ","$1,972.10 ","$1,924.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$2,405.00 ","$1,202.50 ",$466.92 ,"$2,405.00 ",$676.46 ,$525.28 ,$466.92 ,$817.70 ,"$1,924.00 ","$2,044.25 ","$1,503.13 ","$2,164.50 ",$676.46 ,"$2,284.75 ","$2,164.50 ","$2,044.25 ","$2,044.25 ",$817.70 ,"$2,044.25 ","$2,044.25 ","$2,164.50 ",$676.46 ,$580.41 ,"$2,164.50 ","$1,124.51 ","$2,212.60 ","$2,164.50 ","$1,602.69 ","$1,602.69 ","$1,464.65 ","$1,602.69 ","$1,563.25 ","$1,675.08 ",$534.39 ,"$1,899.95 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$817.70 ,"$1,478.00 ",$499.78 ,"$2,284.75 ","$1,972.10 ","$1,972.10 ","$1,924.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$2,405.00 ","$1,202.50 ",$499.78 ,"$2,405.00 ",$676.46 ,"$1,340.10 ","$1,191.20 ",$817.70 ,"$1,924.00 ","$2,044.25 ","$1,503.13 ","$2,164.50 ",$676.46 ,"$2,284.75 ","$2,164.50 ","$2,044.25 ","$2,044.25 ",$817.70 ,"$2,044.25 ","$2,044.25 ","$2,164.50 ",$676.46 ,$580.41 ,"$2,164.50 ","$1,124.51 ","$2,212.60 ","$2,164.50 ","$1,602.69 ","$1,602.69 ","$1,464.65 ","$1,602.69 ","$1,563.25 ","$1,675.08 ",$534.39 ,"$1,899.95 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$817.70 ,"$1,478.00 ",$499.78 ,"$2,284.75 ","$1,972.10 ","$1,972.10 ","$1,924.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$3,326.00 ","$1,663.00 ",$580.41 ,"$3,326.00 ","$1,699.81 ","$1,288.88 ","$1,145.67 ","$1,130.84 ","$2,660.80 ","$2,827.10 ","$2,078.75 ","$2,993.40 ","$1,699.81 ","$3,159.70 ","$2,993.40 ","$2,827.10 ","$2,827.10 ","$1,130.84 ","$2,827.10 ","$2,827.10 ","$2,993.40 ","$1,699.81 ",$580.41 ,"$2,993.40 ","$3,002.90 ","$3,059.92 ","$2,993.40 ","$2,216.45 ","$2,216.45 ","$2,025.53 ","$2,216.45 ","$2,161.90 ","$2,316.56 ",$739.04 ,"$2,627.54 ","$1,801.80 ","$1,304.00 ","$1,304.00 ","$1,130.84 ","$1,478.00 ","$1,334.62 ","$3,159.70 ","$2,727.32 ","$2,727.32 ","$2,660.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$2,196.00 ","$1,098.00 ",$487.95 ,"$2,196.00 ",$676.46 ,"$1,795.40 ","$1,595.91 ",$746.64 ,"$1,756.80 ","$1,866.60 ","$1,372.50 ","$1,976.40 ",$676.46 ,"$2,086.20 ","$1,976.40 ","$1,866.60 ","$1,866.60 ",$746.64 ,"$1,866.60 ","$1,866.60 ","$1,976.40 ",$676.46 ,$580.41 ,"$1,976.40 ","$1,124.51 ","$2,020.32 ","$1,976.40 ","$1,463.41 ","$1,463.41 ","$1,337.36 ","$1,463.41 ","$1,427.40 ","$1,529.51 ",$487.95 ,"$1,734.84 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$746.64 ,"$1,478.00 ",$499.78 ,"$2,086.20 ","$1,800.72 ","$1,800.72 ","$1,756.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$2,301.00 ","$1,150.50 ",$384.99 ,"$2,301.00 ",$676.46 ,"$1,330.78 ","$1,182.92 ",$782.34 ,"$1,840.80 ","$1,955.85 ","$1,438.13 ","$2,070.90 ",$676.46 ,"$2,185.95 ","$2,070.90 ","$1,955.85 ","$1,955.85 ",$782.34 ,"$1,955.85 ","$1,955.85 ","$2,070.90 ",$676.46 ,$580.41 ,"$2,070.90 ",$866.23 ,"$2,116.92 ","$2,070.90 ","$1,533.39 ","$1,533.39 ","$1,401.31 ","$1,533.39 ","$1,495.65 ","$1,602.65 ",$511.28 ,"$1,817.79 ",$717.05 ,"$1,304.00 ","$1,304.00 ",$782.34 ,"$1,478.00 ",$384.99 ,"$2,185.95 ","$1,886.82 ","$1,886.82 ","$1,840.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$454.00 ,$227.00 ,$100.88 ,$454.00 , N/A ,$384.04 ,$384.04 ,$154.36 ,$363.20 ,$385.90 ,$283.75 ,$408.60 , N/A ,$431.30 ,$408.60 ,$385.90 ,$385.90 ,$154.36 ,$385.90 ,$385.90 ,$408.60 , N/A ,$190.68 ,$408.60 , N/A ,$417.68 ,$408.60 ,$302.55 ,$302.55 ,$276.49 ,$302.55 ,$295.10 ,$316.21 ,$100.88 ,$358.66 , N/A ,$227.00 ,$227.00 ,$154.36 ,$227.00 , N/A ,$431.30 ,$372.28 ,$372.28 ,$363.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$162.00 ,$81.00 ,$36.00 ,$162.00 , N/A ,$137.04 ,$137.04 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 , N/A ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 , N/A ,$68.04 ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 , N/A ,$81.00 ,$81.00 ,$55.08 ,$81.00 , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$84.00 ,$42.00 ,$18.66 ,$84.00 , N/A ,$71.06 ,$71.06 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 , N/A ,$35.28 ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 , N/A ,$42.00 ,$42.00 ,$28.56 ,$42.00 , N/A ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$202.00 ,$101.00 ,$44.88 ,$202.00 , N/A ,$170.87 ,$170.87 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 , N/A ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 , N/A ,$84.84 ,$181.80 , N/A ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 , N/A ,$101.00 ,$101.00 ,$68.68 ,$101.00 , N/A ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$174.00 ,$87.00 ,$38.66 ,$174.00 , N/A ,$147.19 ,$147.19 ,$59.16 ,$139.20 ,$147.90 ,$108.75 ,$156.60 , N/A ,$165.30 ,$156.60 ,$147.90 ,$147.90 ,$59.16 ,$147.90 ,$147.90 ,$156.60 , N/A ,$73.08 ,$156.60 , N/A ,$160.08 ,$156.60 ,$115.95 ,$115.95 ,$105.97 ,$115.95 ,$113.10 ,$121.19 ,$38.66 ,$137.46 , N/A ,$87.00 ,$87.00 ,$59.16 ,$87.00 , N/A ,$165.30 ,$142.68 ,$142.68 ,$139.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$706.00 ,$353.00 ,$156.87 ,$706.00 , N/A ,$597.21 ,$597.21 ,$240.04 ,$564.80 ,$600.10 ,$441.25 ,$635.40 , N/A ,$670.70 ,$635.40 ,$600.10 ,$600.10 ,$240.04 ,$600.10 ,$600.10 ,$635.40 , N/A ,$296.52 ,$635.40 , N/A ,$649.52 ,$635.40 ,$470.48 ,$470.48 ,$429.95 ,$470.48 ,$458.90 ,$491.73 ,$156.87 ,$557.74 , N/A ,$353.00 ,$353.00 ,$240.04 ,$353.00 , N/A ,$670.70 ,$578.92 ,$578.92 ,$564.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$269.00 ,$134.50 ,$59.77 ,$269.00 , N/A ,$227.55 ,$227.55 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 , N/A ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 , N/A ,$112.98 ,$242.10 , N/A ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 , N/A ,$134.50 ,$134.50 ,$91.46 ,$134.50 , N/A ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$2,912.00 ","$1,456.00 ",$647.05 ,"$2,912.00 ", N/A ,"$2,463.26 ","$2,463.26 ",$990.08 ,"$2,329.60 ","$2,475.20 ","$1,820.00 ","$2,620.80 ", N/A ,"$2,766.40 ","$2,620.80 ","$2,475.20 ","$2,475.20 ",$990.08 ,"$2,475.20 ","$2,475.20 ","$2,620.80 ", N/A ,"$1,223.04 ","$2,620.80 ", N/A ,"$2,679.04 ","$2,620.80 ","$1,940.56 ","$1,940.56 ","$1,773.41 ","$1,940.56 ","$1,892.80 ","$2,028.21 ",$647.05 ,"$2,300.48 ", N/A ,"$1,456.00 ","$1,456.00 ",$990.08 ,"$1,456.00 ", N/A ,"$2,766.40 ","$2,387.84 ","$2,387.84 ","$2,329.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34300035,A9560,HC TC99M GI BLD MUGA UP TO 30MCI,343,1 ,$347.00 ,$173.50 ,$77.10 ,$347.00 , N/A ,$293.53 ,$293.53 ,$117.98 ,$277.60 ,$294.95 ,$216.88 ,$312.30 , N/A ,$329.65 ,$312.30 ,$294.95 ,$294.95 ,$117.98 ,$294.95 ,$294.95 ,$312.30 , N/A ,$145.74 ,$312.30 , N/A ,$319.24 ,$312.30 ,$231.24 ,$231.24 ,$211.32 ,$231.24 ,$225.55 ,$241.69 ,$77.10 ,$274.13 , N/A ,$173.50 ,$173.50 ,$117.98 ,$173.50 , N/A ,$329.65 ,$284.54 ,$284.54 ,$277.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$347.00 ,$173.50 ,$77.10 ,$347.00 , N/A ,$293.53 ,$293.53 ,$117.98 ,$277.60 ,$294.95 ,$216.88 ,$312.30 , N/A ,$329.65 ,$312.30 ,$294.95 ,$294.95 ,$117.98 ,$294.95 ,$294.95 ,$312.30 , N/A ,$145.74 ,$312.30 , N/A ,$319.24 ,$312.30 ,$231.24 ,$231.24 ,$211.32 ,$231.24 ,$225.55 ,$241.69 ,$77.10 ,$274.13 , N/A ,$173.50 ,$173.50 ,$117.98 ,$173.50 , N/A ,$329.65 ,$284.54 ,$284.54 ,$277.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,$986.00 ,$493.00 ,$219.09 ,$986.00 , N/A ,$834.06 ,$834.06 ,$335.24 ,$788.80 ,$838.10 ,$616.25 ,$887.40 , N/A ,$936.70 ,$887.40 ,$838.10 ,$838.10 ,$335.24 ,$838.10 ,$838.10 ,$887.40 , N/A ,$414.12 ,$887.40 , N/A ,$907.12 ,$887.40 ,$657.07 ,$657.07 ,$600.47 ,$657.07 ,$640.90 ,$686.75 ,$219.09 ,$778.94 , N/A ,$493.00 ,$493.00 ,$335.24 ,$493.00 , N/A ,$936.70 ,$808.52 ,$808.52 ,$788.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$274.00 ,$137.00 ,$60.88 ,$274.00 ,$147.54 ,$260.21 ,$173.48 ,$93.16 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$147.54 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$93.16 ,$232.90 ,$232.90 ,$246.60 ,$147.54 ,$130.89 ,$246.60 , N/A ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$60.88 ,$216.46 ,$156.39 ,$137.00 ,$137.00 ,$93.16 ,$137.00 , N/A ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300052,A9539,HC DIAGNUCLIDE DTPA AEROSOL,343,1 ,$174.00 ,$87.00 ,$38.66 ,$174.00 , N/A ,$147.19 ,$147.19 ,$59.16 ,$139.20 ,$147.90 ,$108.75 ,$156.60 , N/A ,$165.30 ,$156.60 ,$147.90 ,$147.90 ,$59.16 ,$147.90 ,$147.90 ,$156.60 , N/A ,$73.08 ,$156.60 , N/A ,$160.08 ,$156.60 ,$115.95 ,$115.95 ,$105.97 ,$115.95 ,$113.10 ,$121.19 ,$38.66 ,$137.46 , N/A ,$87.00 ,$87.00 ,$59.16 ,$87.00 , N/A ,$165.30 ,$142.68 ,$142.68 ,$139.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300066,Q9969,HC TC-99M NON-HUE ADD-ON PER STUDY DOSE,343,1 ,$11.20 ,$5.60 ,$2.48 ,$22.50 , N/A ,$9.47 ,$9.47 ,$3.81 ,$8.96 ,$9.52 ,$7.00 ,$10.08 , N/A ,$10.64 ,$10.08 ,$9.52 ,$9.52 ,$3.81 ,$9.52 ,$9.52 ,$10.08 , N/A ,$4.70 ,$10.08 ,$22.50 ,$10.30 ,$10.08 ,$7.46 ,$7.46 ,$6.82 ,$7.46 ,$7.28 ,$7.80 ,$2.48 ,$8.85 , N/A ,$5.60 ,$5.60 ,$3.81 ,$5.60 ,$10.00 ,$10.64 ,$9.18 ,$9.18 ,$8.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300071,A9592,HC COPPER CU-64 DOTATATE DIAGNOSTIC 1 MILLICURIE,343,1 ,"$2,850.00 ","$1,425.00 ",$633.27 ,"$2,850.00 ", N/A ,"$2,410.82 ","$2,410.82 ",$969.00 ,"$2,280.00 ","$2,422.50 ","$1,781.25 ","$2,565.00 ", N/A ,"$2,707.50 ","$2,565.00 ","$2,422.50 ","$2,422.50 ",$969.00 ,"$2,422.50 ","$2,422.50 ","$2,565.00 ", N/A ,"$1,197.00 ","$2,565.00 ","$2,066.68 ","$2,622.00 ","$2,565.00 ","$1,899.24 ","$1,899.24 ","$1,735.65 ","$1,899.24 ","$1,852.50 ","$1,985.03 ",$633.27 ,"$2,251.50 ", N/A ,"$1,425.00 ","$1,425.00 ",$969.00 ,"$1,425.00 ",$918.52 ,"$2,707.50 ","$2,337.00 ","$2,337.00 ","$2,280.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34300072,A9595,"HC PIFLUFOLASTAT F-18, DIAGNOSTIC, 1 MILLICURIE",343,1 ,"$1,579.00 ",$789.50 ,$350.85 ,"$1,579.00 ", N/A ,"$1,335.68 ","$1,335.68 ",$536.86 ,"$1,263.20 ","$1,342.15 ",$986.88 ,"$1,421.10 ", N/A ,"$1,500.05 ","$1,421.10 ","$1,342.15 ","$1,342.15 ",$536.86 ,"$1,342.15 ","$1,342.15 ","$1,421.10 ", N/A ,$663.18 ,"$1,421.10 ","$1,219.00 ","$1,452.68 ","$1,421.10 ","$1,052.25 ","$1,052.25 ",$961.61 ,"$1,052.25 ","$1,026.35 ","$1,099.77 ",$350.85 ,"$1,247.41 ", N/A ,$789.50 ,$789.50 ,$536.86 ,$789.50 ,$541.78 ,"$1,500.05 ","$1,294.78 ","$1,294.78 ","$1,263.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$1,724.00 ",$862.00 ,$383.07 ,"$3,233.23 ","$1,302.81 ","$1,107.00 ","$1,107.00 ",$586.16 ,"$1,379.20 ","$1,465.40 ","$1,077.50 ","$1,551.60 ","$1,302.81 ","$1,637.80 ","$1,551.60 ","$1,465.40 ","$1,465.40 ",$586.16 ,"$1,465.40 ","$1,465.40 ","$1,551.60 ","$1,302.81 ",$471.80 ,"$1,551.60 ","$3,233.23 ","$1,586.08 ","$1,551.60 ","$1,148.87 ","$1,148.87 ","$1,049.92 ","$1,148.87 ","$1,120.60 ","$1,200.77 ",$383.07 ,"$1,361.96 ","$1,380.98 ","$1,482.00 ","$1,482.00 ",$586.16 ,"$1,696.00 ","$1,436.99 ","$1,637.80 ","$1,413.68 ","$1,413.68 ","$1,379.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$1,508.00 ",$754.00 ,$335.08 ,"$3,233.23 ","$1,302.81 ","$1,107.00 ","$1,107.00 ",$512.72 ,"$1,206.40 ","$1,281.80 ",$942.50 ,"$1,357.20 ","$1,302.81 ","$1,432.60 ","$1,357.20 ","$1,281.80 ","$1,281.80 ",$512.72 ,"$1,281.80 ","$1,281.80 ","$1,357.20 ","$1,302.81 ",$471.80 ,"$1,357.20 ","$3,233.23 ","$1,387.36 ","$1,357.20 ","$1,004.93 ","$1,004.93 ",$918.37 ,"$1,004.93 ",$980.20 ,"$1,050.32 ",$335.08 ,"$1,191.32 ","$1,380.98 ","$1,482.00 ","$1,482.00 ",$512.72 ,"$1,508.00 ","$1,436.99 ","$1,432.60 ","$1,236.56 ","$1,236.56 ","$1,206.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,$948.00 ,$474.00 ,$210.65 ,"$1,716.62 ","$1,619.45 ",$948.00 ,$948.00 ,$322.32 ,$758.40 ,$805.80 ,$592.50 ,$853.20 ,"$1,619.45 ",$900.60 ,$853.20 ,$805.80 ,$805.80 ,$322.32 ,$805.80 ,$805.80 ,$853.20 ,"$1,619.45 ",$471.80 ,$853.20 ,"$1,429.97 ",$872.16 ,$853.20 ,$631.75 ,$631.75 ,$577.33 ,$631.75 ,$616.20 ,$660.28 ,$210.65 ,$748.92 ,"$1,716.62 ",$948.00 ,$948.00 ,$322.32 ,$948.00 ,$635.54 ,$900.60 ,$777.36 ,$777.36 ,$758.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000031,64425,HC INJ ANESTH; ILIOINGUINAL NERVE,350,1 ,$646.00 ,$323.00 ,$143.54 ,"$1,459.17 ",$767.36 ,$646.00 ,$646.00 ,$219.64 ,$516.80 ,$549.10 ,$403.75 ,$581.40 ,$767.36 ,$613.70 ,$581.40 ,$549.10 ,$549.10 ,$219.64 ,$549.10 ,$549.10 ,$581.40 ,$767.36 ,$471.80 ,$581.40 ,"$1,459.17 ",$594.32 ,$581.40 ,$430.49 ,$430.49 ,$393.41 ,$430.49 ,$419.90 ,$449.94 ,$143.54 ,$510.34 ,$813.40 ,$646.00 ,$646.00 ,$219.64 ,$646.00 ,$648.52 ,$613.70 ,$529.72 ,$529.72 ,$516.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$557.05 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$557.05 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000044,70486,HC CT SINUSES UNENHANCED/STEREOTACTIC,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$2,400.00 ","$1,200.00 ",$182.43 ,"$2,400.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$816.00 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$557.05 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$816.00 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ",$557.05 ,$471.80 ,"$2,160.00 ",$410.47 ,"$2,208.00 ","$2,160.00 ","$1,599.36 ","$1,599.36 ","$1,461.60 ","$1,599.36 ","$1,560.00 ","$1,671.60 ",$533.28 ,"$1,896.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$816.00 ,"$1,696.00 ",$182.43 ,"$2,280.00 ","$1,968.00 ","$1,968.00 ","$1,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$235.00 ,"$3,150.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$448.91 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$448.91 ,"$1,422.18 ","$2,835.00 ",$528.75 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$475.84 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$235.00 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$376.09 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$846.20 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$376.09 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$410.47 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ", N/A ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$376.09 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$846.20 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$376.09 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$229.05 ,"$1,800.00 ",$308.45 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$308.45 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$308.45 ,$471.80 ,"$1,620.00 ",$515.36 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$326.96 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$229.05 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$229.05 ,"$1,800.00 ",$308.45 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$308.45 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$308.45 ,$471.80 ,"$1,620.00 ",$515.36 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$326.96 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$229.05 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,200.00 ","$1,100.00 ",$444.56 ,"$2,200.00 ",$835.58 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$835.58 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$835.58 ,$471.80 ,"$1,980.00 ","$1,000.26 ","$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$885.71 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$444.56 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,200.00 ","$1,100.00 ",$444.56 ,"$2,200.00 ",$835.58 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$835.58 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$835.58 ,$471.80 ,"$1,980.00 ","$1,000.26 ","$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$885.71 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$444.56 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,400.00 ","$1,200.00 ",$444.56 ,"$2,400.00 ",$835.58 ,"$1,107.00 ","$1,107.00 ",$816.00 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$835.58 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$816.00 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ",$835.58 ,$471.80 ,"$2,160.00 ","$1,000.26 ","$2,208.00 ","$2,160.00 ","$1,599.36 ","$1,599.36 ","$1,461.60 ","$1,599.36 ","$1,560.00 ","$1,671.60 ",$533.28 ,"$1,896.00 ",$885.71 ,"$1,482.00 ","$1,482.00 ",$816.00 ,"$1,696.00 ",$444.56 ,"$2,280.00 ","$1,968.00 ","$1,968.00 ","$1,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$2,400.00 ","$1,200.00 ",$444.56 ,"$2,400.00 ",$835.58 ,"$1,107.00 ","$1,107.00 ",$816.00 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$835.58 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$816.00 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ",$835.58 ,$471.80 ,"$2,160.00 ","$1,000.26 ","$2,208.00 ","$2,160.00 ","$1,599.36 ","$1,599.36 ","$1,461.60 ","$1,599.36 ","$1,560.00 ","$1,671.60 ",$533.28 ,"$1,896.00 ",$885.71 ,"$1,482.00 ","$1,482.00 ",$816.00 ,"$1,696.00 ",$444.56 ,"$2,280.00 ","$1,968.00 ","$1,968.00 ","$1,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$229.05 ,"$1,800.00 ",$308.45 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$308.45 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$308.45 ,$471.80 ,"$1,620.00 ",$515.36 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$326.96 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$229.05 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$1,800.00 ",$900.00 ,$229.05 ,"$1,800.00 ",$308.45 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$308.45 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$308.45 ,$471.80 ,"$1,620.00 ",$515.36 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$326.96 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$229.05 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,200.00 ","$1,100.00 ",$444.56 ,"$2,200.00 ",$835.58 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$835.58 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$835.58 ,$471.80 ,"$1,980.00 ","$1,000.26 ","$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$885.71 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$444.56 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,200.00 ","$1,100.00 ",$444.56 ,"$2,200.00 ",$835.58 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$835.58 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$835.58 ,$471.80 ,"$1,980.00 ","$1,000.26 ","$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$885.71 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$444.56 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$1,800.00 ",$900.00 ,$111.19 ,"$1,800.00 ",$205.64 ,"$1,107.00 ","$1,107.00 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$205.64 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$205.64 ,$471.80 ,"$1,620.00 ",$250.18 ,"$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$217.98 ,"$1,482.00 ","$1,482.00 ",$612.00 ,"$1,696.00 ",$111.19 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$2,200.00 ","$1,100.00 ",$182.43 ,"$2,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$748.00 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$557.05 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$748.00 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ",$557.05 ,$471.80 ,"$1,980.00 ",$410.47 ,"$2,024.00 ","$1,980.00 ","$1,466.08 ","$1,466.08 ","$1,339.80 ","$1,466.08 ","$1,430.00 ","$1,532.30 ",$488.84 ,"$1,738.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$748.00 ,"$1,696.00 ",$182.43 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$557.05 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$557.05 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$3,600.00 ","$1,800.00 ",$235.00 ,"$3,600.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ","$1,224.00 ","$2,880.00 ","$3,060.00 ","$2,250.00 ","$3,240.00 ",$557.05 ,"$3,420.00 ","$3,240.00 ","$3,060.00 ","$3,060.00 ","$1,224.00 ","$3,060.00 ","$3,060.00 ","$3,240.00 ",$557.05 ,$471.80 ,"$3,240.00 ",$528.75 ,"$3,312.00 ","$3,240.00 ","$2,399.04 ","$2,399.04 ","$2,192.40 ","$2,399.04 ","$2,340.00 ","$2,507.40 ",$799.92 ,"$2,844.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ","$1,224.00 ","$1,696.00 ",$235.00 ,"$3,420.00 ","$2,952.00 ","$2,952.00 ","$2,880.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$4,200.00 ","$2,100.00 ",$376.09 ,"$4,200.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ","$1,428.00 ","$3,360.00 ","$3,570.00 ","$2,625.00 ","$3,780.00 ",$557.05 ,"$3,990.00 ","$3,780.00 ","$3,570.00 ","$3,570.00 ","$1,428.00 ","$3,570.00 ","$3,570.00 ","$3,780.00 ",$557.05 ,$471.80 ,"$3,780.00 ",$846.20 ,"$3,864.00 ","$3,780.00 ","$2,798.88 ","$2,798.88 ","$2,557.80 ","$2,798.88 ","$2,730.00 ","$2,925.30 ",$933.24 ,"$3,318.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ","$1,428.00 ","$1,696.00 ",$376.09 ,"$3,990.00 ","$3,444.00 ","$3,444.00 ","$3,360.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$4,900.00 ","$2,450.00 ",$376.09 ,"$4,900.00 ",$557.05 ,"$1,107.00 ","$1,107.00 ","$1,666.00 ","$3,920.00 ","$4,165.00 ","$3,062.50 ","$4,410.00 ",$557.05 ,"$4,655.00 ","$4,410.00 ","$4,165.00 ","$4,165.00 ","$1,666.00 ","$4,165.00 ","$4,165.00 ","$4,410.00 ",$557.05 ,$471.80 ,"$4,410.00 ",$846.20 ,"$4,508.00 ","$4,410.00 ","$3,265.36 ","$3,265.36 ","$2,984.10 ","$3,265.36 ","$3,185.00 ","$3,412.85 ","$1,088.78 ","$3,871.00 ",$590.47 ,"$1,482.00 ","$1,482.00 ","$1,666.00 ","$1,696.00 ",$376.09 ,"$4,655.00 ","$4,018.00 ","$4,018.00 ","$3,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000088,N/A,HC CT HRT W/O DYE W/CA TEST (PROMO),350,1 ,$49.95 ,$24.98 ,$11.10 ,$49.95 , N/A ,$49.95 ,$49.95 ,$16.98 ,$39.96 ,$42.46 ,$31.22 ,$44.96 , N/A ,$47.45 ,$44.96 ,$42.46 ,$42.46 ,$16.98 ,$42.46 ,$42.46 ,$44.96 , N/A ,$49.95 ,$44.96 , N/A ,$45.95 ,$44.96 ,$33.29 ,$33.29 ,$30.42 ,$33.29 ,$32.47 ,$34.79 ,$11.10 ,$39.46 , N/A ,$49.95 ,$49.95 ,$16.98 ,$49.95 , N/A ,$47.45 ,$40.96 ,$40.96 ,$39.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$2,600.00 ","$1,300.00 ",$182.43 ,"$2,600.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ",$884.00 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$682.03 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$884.00 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ",$682.03 ,$471.80 ,"$2,340.00 ",$410.47 ,"$2,392.00 ","$2,340.00 ","$1,732.64 ","$1,732.64 ","$1,583.40 ","$1,732.64 ","$1,690.00 ","$1,810.90 ",$577.72 ,"$2,054.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ",$884.00 ,"$1,696.00 ",$182.43 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$1,100.00 ",$550.00 ,$82.61 ,"$1,100.00 ",$205.64 ,"$1,100.00 ","$1,100.00 ",$374.00 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$205.64 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$374.00 ,$935.00 ,$935.00 ,$990.00 ,$205.64 ,$471.80 ,$990.00 ,$185.87 ,"$1,012.00 ",$990.00 ,$733.04 ,$733.04 ,$669.90 ,$733.04 ,$715.00 ,$766.15 ,$244.42 ,$869.00 ,$217.98 ,"$1,100.00 ","$1,100.00 ",$374.00 ,"$1,100.00 ",$82.61 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000103,76497,HC UNLISTED CT PROC,350,1 ,$243.00 ,$121.50 ,$53.99 ,$243.00 ,$205.64 ,$243.00 ,$243.00 ,$82.62 ,$194.40 ,$206.55 ,$151.88 ,$218.70 ,$205.64 ,$230.85 ,$218.70 ,$206.55 ,$206.55 ,$82.62 ,$206.55 ,$206.55 ,$218.70 ,$205.64 ,$243.00 ,$218.70 ,$185.87 ,$223.56 ,$218.70 ,$161.94 ,$161.94 ,$147.99 ,$161.94 ,$157.95 ,$169.25 ,$53.99 ,$191.97 ,$217.98 ,$243.00 ,$243.00 ,$82.62 ,$243.00 ,$82.61 ,$230.85 ,$199.26 ,$199.26 ,$194.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000104,77011,HC CT GUIDED LOCALIZATION STEREO,350,1 ,"$3,693.50 ","$1,846.75 ",$164.03 ,"$3,693.50 ",$164.03 ,"$1,107.00 ","$1,107.00 ","$1,255.79 ","$2,954.80 ","$3,139.48 ","$2,308.44 ","$3,324.15 ",$164.03 ,"$3,508.83 ","$3,324.15 ","$3,139.48 ","$3,139.48 ","$1,255.79 ","$3,139.48 ","$3,139.48 ","$3,324.15 ",$164.03 ,$471.80 ,"$3,324.15 ", N/A ,"$3,398.02 ","$3,324.15 ","$2,461.35 ","$2,461.35 ","$2,249.34 ","$2,461.35 ","$2,400.78 ","$2,572.52 ",$820.70 ,"$2,917.87 ",$173.87 ,"$1,482.00 ","$1,482.00 ","$1,255.79 ","$1,696.00 ", N/A ,"$3,508.83 ","$3,028.67 ","$3,028.67 ","$2,954.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$1,700.00 ",$850.00 ,$164.03 ,"$1,700.00 ",$164.03 ,"$1,107.00 ","$1,107.00 ",$578.00 ,"$1,360.00 ","$1,445.00 ","$1,062.50 ","$1,530.00 ",$164.03 ,"$1,615.00 ","$1,530.00 ","$1,445.00 ","$1,445.00 ",$578.00 ,"$1,445.00 ","$1,445.00 ","$1,530.00 ",$164.03 ,$471.80 ,"$1,530.00 ", N/A ,"$1,564.00 ","$1,530.00 ","$1,132.88 ","$1,132.88 ","$1,035.30 ","$1,132.88 ","$1,105.00 ","$1,184.05 ",$377.74 ,"$1,343.00 ",$173.87 ,"$1,482.00 ","$1,482.00 ",$578.00 ,"$1,696.00 ", N/A ,"$1,615.00 ","$1,394.00 ","$1,394.00 ","$1,360.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000120,74174,HC CT ANGIO ABD/PELV W  AND  WO CONTRAST,350,1 ,"$4,800.00 ","$2,400.00 ",$376.09 ,"$4,800.00 ",$682.03 ,"$1,107.00 ","$1,107.00 ","$1,632.00 ","$3,840.00 ","$4,080.00 ","$3,000.00 ","$4,320.00 ",$682.03 ,"$4,560.00 ","$4,320.00 ","$4,080.00 ","$4,080.00 ","$1,632.00 ","$4,080.00 ","$4,080.00 ","$4,320.00 ",$682.03 ,$471.80 ,"$4,320.00 ",$846.20 ,"$4,416.00 ","$4,320.00 ","$3,198.72 ","$3,198.72 ","$2,923.20 ","$3,198.72 ","$3,120.00 ","$3,343.20 ","$1,066.56 ","$3,792.00 ",$722.95 ,"$1,482.00 ","$1,482.00 ","$1,632.00 ","$1,696.00 ",$376.09 ,"$4,560.00 ","$3,936.00 ","$3,936.00 ","$3,840.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000132,G0260,HC INJECTION SACRO JOINT W/ ANESTH,350,1 ,"$2,050.00 ","$1,025.00 ",$455.51 ,"$2,050.00 ",$868.22 ,"$1,107.00 ","$1,107.00 ",$697.00 ,"$1,640.00 ","$1,742.50 ","$1,281.25 ","$1,845.00 ",$868.22 ,"$1,947.50 ","$1,845.00 ","$1,742.50 ","$1,742.50 ",$697.00 ,"$1,742.50 ","$1,742.50 ","$1,845.00 ",$868.22 ,$471.80 ,"$1,845.00 ","$1,459.17 ","$1,886.00 ","$1,845.00 ","$1,366.12 ","$1,366.12 ","$1,248.45 ","$1,366.12 ","$1,332.50 ","$1,427.83 ",$455.51 ,"$1,619.50 ",$920.31 ,"$1,482.00 ","$1,482.00 ",$697.00 ,"$1,696.00 ",$648.52 ,"$1,947.50 ","$1,681.00 ","$1,681.00 ","$1,640.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,"$1,100.00 ",$550.00 ,$111.19 ,"$1,100.00 ",$205.64 ,"$1,100.00 ","$1,100.00 ",$374.00 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$205.64 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$374.00 ,$935.00 ,$935.00 ,$990.00 ,$205.64 ,$471.80 ,$990.00 ,$250.18 ,"$1,012.00 ",$990.00 ,$733.04 ,$733.04 ,$669.90 ,$733.04 ,$715.00 ,$766.15 ,$244.42 ,$869.00 ,$217.98 ,"$1,100.00 ","$1,100.00 ",$374.00 ,"$1,100.00 ",$111.19 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000003,N/A,HC SCHEDULED PROCEDURE,360,1 ,"$1,680.00 ",$840.00 ,$373.30 ,"$1,680.00 ", N/A ,"$1,421.11 ","$1,421.11 ",$571.20 ,"$1,344.00 ","$1,428.00 ","$1,050.00 ","$1,512.00 ", N/A ,"$1,596.00 ","$1,512.00 ","$1,428.00 ","$1,428.00 ",$571.20 ,"$1,428.00 ","$1,428.00 ","$1,512.00 ", N/A , N/A ,"$1,512.00 ", N/A ,"$1,545.60 ","$1,512.00 ","$1,119.55 ","$1,119.55 ","$1,023.12 ","$1,119.55 ","$1,092.00 ","$1,170.12 ",$373.30 ,"$1,327.20 ", N/A , N/A , N/A ,$571.20 , N/A , N/A ,"$1,596.00 ","$1,377.60 ","$1,377.60 ","$1,344.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000004,N/A,HC SCHEDULED PROCEDURE LIMITED,360,1 ,$935.00 ,$467.50 ,$207.76 ,$935.00 , N/A ,$790.92 ,$790.92 ,$317.90 ,$748.00 ,$794.75 ,$584.38 ,$841.50 , N/A ,$888.25 ,$841.50 ,$794.75 ,$794.75 ,$317.90 ,$794.75 ,$794.75 ,$841.50 , N/A , N/A ,$841.50 , N/A ,$860.20 ,$841.50 ,$623.08 ,$623.08 ,$569.42 ,$623.08 ,$607.75 ,$651.23 ,$207.76 ,$738.65 , N/A , N/A , N/A ,$317.90 , N/A , N/A ,$888.25 ,$766.70 ,$766.70 ,$748.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$291.00 ,$145.50 ,$64.66 ,$412.65 ,$288.25 ,$246.16 ,$246.16 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$288.25 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$288.25 ,$291.00 ,$261.90 ,$412.65 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$305.55 ,$291.00 ,$291.00 ,$98.94 ,$291.00 ,$183.40 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$463.00 ,$231.50 ,$102.88 ,$794.25 ,$288.25 ,$391.65 ,$391.65 ,$157.42 ,$370.40 ,$393.55 ,$289.38 ,$416.70 ,$288.25 ,$439.85 ,$416.70 ,$393.55 ,$393.55 ,$157.42 ,$393.55 ,$393.55 ,$416.70 ,$288.25 ,$463.00 ,$416.70 ,$794.25 ,$425.96 ,$416.70 ,$308.54 ,$308.54 ,$281.97 ,$308.54 ,$300.95 ,$322.48 ,$102.88 ,$365.77 ,$305.55 ,$463.00 ,$463.00 ,$157.42 ,$463.00 ,$353.00 ,$439.85 ,$379.66 ,$379.66 ,$370.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000078,19000,HC ASP CYST BREAST,360,1 ,$797.00 ,$398.50 ,$177.09 ,"$1,429.97 ","$1,113.15 ",$674.18 ,$674.18 ,$270.98 ,$637.60 ,$677.45 ,$498.13 ,$717.30 ,"$1,113.15 ",$757.15 ,$717.30 ,$677.45 ,$677.45 ,$270.98 ,$677.45 ,$677.45 ,$717.30 ,"$1,113.15 ",$797.00 ,$717.30 ,"$1,429.97 ",$733.24 ,$717.30 ,$531.12 ,$531.12 ,$485.37 ,$531.12 ,$518.05 ,$555.11 ,$177.09 ,$629.63 ,"$1,179.94 ",$797.00 ,$797.00 ,$270.98 ,$797.00 ,$635.54 ,$757.15 ,$653.54 ,$653.54 ,$637.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$669.00 ,$334.50 ,$148.65 ,"$1,179.94 ","$1,113.15 ",$565.91 ,$565.91 ,$227.46 ,$535.20 ,$568.65 ,$418.13 ,$602.10 ,"$1,113.15 ",$635.55 ,$602.10 ,$568.65 ,$568.65 ,$227.46 ,$568.65 ,$568.65 ,$602.10 ,"$1,113.15 ",$669.00 ,$602.10 , N/A ,$615.48 ,$602.10 ,$445.82 ,$445.82 ,$407.42 ,$445.82 ,$434.85 ,$465.96 ,$148.65 ,$528.51 ,"$1,179.94 ",$623.00 ,$623.00 ,$227.46 ,$669.00 , N/A ,$635.55 ,$548.58 ,$548.58 ,$535.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,000.00 ","$2,000.00 ",$888.80 ,"$4,000.00 ","$2,466.42 ","$3,383.60 ","$3,383.60 ","$1,360.00 ","$3,200.00 ","$3,400.00 ","$2,500.00 ","$3,600.00 ","$2,466.42 ","$3,800.00 ","$3,600.00 ","$3,400.00 ","$3,400.00 ","$1,360.00 ","$3,400.00 ","$3,400.00 ","$3,600.00 ","$2,466.42 ","$2,489.10 ","$3,600.00 ","$3,233.23 ","$3,680.00 ","$3,600.00 ","$2,665.60 ","$2,665.60 ","$2,436.00 ","$2,665.60 ","$2,600.00 ","$2,786.00 ",$888.80 ,"$3,160.00 ","$2,614.41 ","$2,368.00 ","$2,368.00 ","$1,360.00 ","$2,604.00 ","$1,436.99 ","$3,800.00 ","$3,280.00 ","$3,280.00 ","$3,200.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,500.00 ",$750.00 ,$333.30 ,"$1,535.03 ","$1,448.14 ","$1,268.85 ","$1,268.85 ",$510.00 ,"$1,200.00 ","$1,275.00 ",$937.50 ,"$1,350.00 ","$1,448.14 ","$1,425.00 ","$1,350.00 ","$1,275.00 ","$1,275.00 ",$510.00 ,"$1,275.00 ","$1,275.00 ","$1,350.00 ","$1,448.14 ","$1,500.00 ","$1,350.00 ","$1,429.97 ","$1,380.00 ","$1,350.00 ",$999.60 ,$999.60 ,$913.50 ,$999.60 ,$975.00 ,"$1,044.75 ",$333.30 ,"$1,185.00 ","$1,535.03 ","$1,500.00 ","$1,500.00 ",$510.00 ,"$1,500.00 ",$635.54 ,"$1,425.00 ","$1,230.00 ","$1,230.00 ","$1,200.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$3,233.23 ","$1,113.15 ","$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ","$1,113.15 ","$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ","$1,113.15 ","$1,293.00 ","$1,163.70 ","$3,233.23 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ","$1,179.94 ","$1,293.00 ","$1,293.00 ",$439.62 ,"$1,293.00 ","$1,436.99 ","$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$1,508.00 ",$754.00 ,$335.08 ,"$3,233.23 ","$1,113.15 ","$1,275.62 ","$1,275.62 ",$512.72 ,"$1,206.40 ","$1,281.80 ",$942.50 ,"$1,357.20 ","$1,113.15 ","$1,432.60 ","$1,357.20 ","$1,281.80 ","$1,281.80 ",$512.72 ,"$1,281.80 ","$1,281.80 ","$1,357.20 ","$1,113.15 ","$1,508.00 ","$1,357.20 ","$3,233.23 ","$1,387.36 ","$1,357.20 ","$1,004.93 ","$1,004.93 ",$918.37 ,"$1,004.93 ",$980.20 ,"$1,050.32 ",$335.08 ,"$1,191.32 ","$1,179.94 ","$1,508.00 ","$1,508.00 ",$512.72 ,"$1,508.00 ","$1,436.99 ","$1,432.60 ","$1,236.56 ","$1,236.56 ","$1,206.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$150.00 ,$75.00 ,$33.33 ,"$1,535.03 ","$1,448.14 ",$126.89 ,$126.89 ,$51.00 ,$120.00 ,$127.50 ,$93.75 ,$135.00 ,"$1,448.14 ",$142.50 ,$135.00 ,$127.50 ,$127.50 ,$51.00 ,$127.50 ,$127.50 ,$135.00 ,"$1,448.14 ",$150.00 ,$135.00 , N/A ,$138.00 ,$135.00 ,$99.96 ,$99.96 ,$91.35 ,$99.96 ,$97.50 ,$104.48 ,$33.33 ,$118.50 ,"$1,535.03 ",$150.00 ,$150.00 ,$51.00 ,$150.00 , N/A ,$142.50 ,$123.00 ,$123.00 ,$120.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000118,36470,HC INJ SCLEROSING SOLUTION SINGLE VEIN,360,1 ,$312.00 ,$156.00 ,$69.33 ,"$1,057.74 ",$997.87 ,$263.92 ,$263.92 ,$106.08 ,$249.60 ,$265.20 ,$195.00 ,$280.80 ,$997.87 ,$296.40 ,$280.80 ,$265.20 ,$265.20 ,$106.08 ,$265.20 ,$265.20 ,$280.80 ,$997.87 ,$312.00 ,$280.80 ,$794.25 ,$287.04 ,$280.80 ,$207.92 ,$207.92 ,$190.01 ,$207.92 ,$202.80 ,$217.31 ,$69.33 ,$246.48 ,"$1,057.74 ",$312.00 ,$312.00 ,$106.08 ,$312.00 ,$353.00 ,$296.40 ,$255.84 ,$255.84 ,$249.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$2,693.00 ","$1,346.50 ",$598.38 ,"$6,578.17 ","$1,982.43 ","$2,278.01 ","$2,278.01 ",$915.62 ,"$2,154.40 ","$2,289.05 ","$1,683.13 ","$2,423.70 ","$1,982.43 ","$2,558.35 ","$2,423.70 ","$2,289.05 ","$2,289.05 ",$915.62 ,"$2,289.05 ","$2,289.05 ","$2,423.70 ","$1,982.43 ","$2,489.10 ","$2,423.70 ","$6,578.17 ","$2,477.56 ","$2,423.70 ","$1,794.62 ","$1,794.62 ","$1,640.04 ","$1,794.62 ","$1,750.45 ","$1,875.67 ",$598.38 ,"$2,127.47 ","$2,101.38 ","$1,935.00 ","$1,935.00 ",$915.62 ,"$2,007.00 ","$2,923.63 ","$2,558.35 ","$2,208.26 ","$2,208.26 ","$2,154.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$5,925.00 ","$2,962.50 ","$1,316.54 ","$6,578.17 ","$3,872.14 ","$5,011.96 ","$5,011.96 ","$2,014.50 ","$4,740.00 ","$5,036.25 ","$3,703.13 ","$5,332.50 ","$3,872.14 ","$5,628.75 ","$5,332.50 ","$5,036.25 ","$5,036.25 ","$2,014.50 ","$5,036.25 ","$5,036.25 ","$5,332.50 ","$3,872.14 ","$5,657.04 ","$5,332.50 ","$6,578.17 ","$5,451.00 ","$5,332.50 ","$3,948.42 ","$3,948.42 ","$3,608.33 ","$3,948.42 ","$3,851.25 ","$4,126.76 ","$1,316.54 ","$4,680.75 ","$4,104.47 ","$3,873.00 ","$3,873.00 ","$2,014.50 ","$4,126.00 ","$2,923.63 ","$5,628.75 ","$4,858.50 ","$4,858.50 ","$4,740.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$1,616.00 ",$808.00 ,$359.08 ,"$3,231.36 ","$1,982.43 ","$1,366.97 ","$1,366.97 ",$549.44 ,"$1,292.80 ","$1,373.60 ","$1,010.00 ","$1,454.40 ","$1,982.43 ","$1,535.20 ","$1,454.40 ","$1,373.60 ","$1,373.60 ",$549.44 ,"$1,373.60 ","$1,373.60 ","$1,454.40 ","$1,982.43 ","$1,616.00 ","$1,454.40 ","$3,231.36 ","$1,486.72 ","$1,454.40 ","$1,076.90 ","$1,076.90 ",$984.14 ,"$1,076.90 ","$1,050.40 ","$1,125.54 ",$359.08 ,"$1,276.64 ","$2,101.38 ","$1,616.00 ","$1,616.00 ",$549.44 ,"$1,616.00 ","$1,436.16 ","$1,535.20 ","$1,325.12 ","$1,325.12 ","$1,292.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$6,033.00 ","$3,016.50 ","$1,340.53 ","$6,578.17 ","$3,872.14 ","$5,103.31 ","$5,103.31 ","$2,051.22 ","$4,826.40 ","$5,128.05 ","$3,770.63 ","$5,429.70 ","$3,872.14 ","$5,731.35 ","$5,429.70 ","$5,128.05 ","$5,128.05 ","$2,051.22 ","$5,128.05 ","$5,128.05 ","$5,429.70 ","$3,872.14 ","$5,657.04 ","$5,429.70 ","$6,578.17 ","$5,550.36 ","$5,429.70 ","$4,020.39 ","$4,020.39 ","$3,674.10 ","$4,020.39 ","$3,921.45 ","$4,201.98 ","$1,340.53 ","$4,766.07 ","$4,104.47 ","$3,873.00 ","$3,873.00 ","$2,051.22 ","$4,126.00 ","$2,923.63 ","$5,731.35 ","$4,947.06 ","$4,947.06 ","$4,826.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$1,077.00 ",$538.50 ,$239.31 ,"$1,365.91 ","$1,288.59 ",$911.03 ,$911.03 ,$366.18 ,$861.60 ,$915.45 ,$673.13 ,$969.30 ,"$1,288.59 ","$1,023.15 ",$969.30 ,$915.45 ,$915.45 ,$366.18 ,$915.45 ,$915.45 ,$969.30 ,"$1,288.59 ","$1,077.00 ",$969.30 ,"$1,242.09 ",$990.84 ,$969.30 ,$717.71 ,$717.71 ,$655.89 ,$717.71 ,$700.05 ,$750.13 ,$239.31 ,$850.83 ,"$1,365.91 ","$1,077.00 ","$1,077.00 ",$366.18 ,"$1,077.00 ",$552.04 ,"$1,023.15 ",$883.14 ,$883.14 ,$861.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$2,370.00 ","$1,185.00 ",$526.61 ,"$3,231.36 ","$1,288.59 ","$2,004.78 ","$2,004.78 ",$805.80 ,"$1,896.00 ","$2,014.50 ","$1,481.25 ","$2,133.00 ","$1,288.59 ","$2,251.50 ","$2,133.00 ","$2,014.50 ","$2,014.50 ",$805.80 ,"$2,014.50 ","$2,014.50 ","$2,133.00 ","$1,288.59 ","$2,370.00 ","$2,133.00 ","$3,231.36 ","$2,180.40 ","$2,133.00 ","$1,579.37 ","$1,579.37 ","$1,443.33 ","$1,579.37 ","$1,540.50 ","$1,650.71 ",$526.61 ,"$1,872.30 ","$1,365.91 ","$2,368.00 ","$2,368.00 ",$805.80 ,"$2,370.00 ","$1,436.16 ","$2,251.50 ","$1,943.40 ","$1,943.40 ","$1,896.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,$696.00 ,$348.00 ,$154.65 ,"$1,187.51 ","$1,120.29 ",$588.75 ,$588.75 ,$236.64 ,$556.80 ,$591.60 ,$435.00 ,$626.40 ,"$1,120.29 ",$661.20 ,$626.40 ,$591.60 ,$591.60 ,$236.64 ,$591.60 ,$591.60 ,$626.40 ,"$1,120.29 ",$696.00 ,$626.40 , N/A ,$640.32 ,$626.40 ,$463.81 ,$463.81 ,$423.86 ,$463.81 ,$452.40 ,$484.76 ,$154.65 ,$549.84 ,"$1,187.51 ",$623.00 ,$623.00 ,$236.64 ,$683.00 , N/A ,$661.20 ,$570.72 ,$570.72 ,$556.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$1,077.00 ",$538.50 ,$239.31 ,"$3,233.23 ","$2,094.24 ",$911.03 ,$911.03 ,$366.18 ,$861.60 ,$915.45 ,$673.13 ,$969.30 ,"$2,094.24 ","$1,023.15 ",$969.30 ,$915.45 ,$915.45 ,$366.18 ,$915.45 ,$915.45 ,$969.30 ,"$2,094.24 ","$1,077.00 ",$969.30 ,"$3,233.23 ",$990.84 ,$969.30 ,$717.71 ,$717.71 ,$655.89 ,$717.71 ,$700.05 ,$750.13 ,$239.31 ,$850.83 ,"$2,219.89 ","$1,077.00 ","$1,077.00 ",$366.18 ,"$1,077.00 ","$1,436.99 ","$1,023.15 ",$883.14 ,$883.14 ,$861.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000158,38221,HC BX BONE MARROW ONLY,360,1 ,$776.00 ,$388.00 ,$172.43 ,"$3,233.23 ","$2,094.24 ",$656.42 ,$656.42 ,$263.84 ,$620.80 ,$659.60 ,$485.00 ,$698.40 ,"$2,094.24 ",$737.20 ,$698.40 ,$659.60 ,$659.60 ,$263.84 ,$659.60 ,$659.60 ,$698.40 ,"$2,094.24 ",$776.00 ,$698.40 ,"$3,233.23 ",$713.92 ,$698.40 ,$517.13 ,$517.13 ,$472.58 ,$517.13 ,$504.40 ,$540.48 ,$172.43 ,$613.04 ,"$2,219.89 ",$776.00 ,$776.00 ,$263.84 ,$776.00 ,"$1,436.99 ",$737.20 ,$636.32 ,$636.32 ,$620.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$1,939.00 ",$969.50 ,$430.85 ,"$3,233.23 ","$2,025.40 ","$1,640.20 ","$1,640.20 ",$659.26 ,"$1,551.20 ","$1,648.15 ","$1,211.88 ","$1,745.10 ","$2,025.40 ","$1,842.05 ","$1,745.10 ","$1,648.15 ","$1,648.15 ",$659.26 ,"$1,648.15 ","$1,648.15 ","$1,745.10 ","$2,025.40 ","$1,939.00 ","$1,745.10 ","$3,233.23 ","$1,783.88 ","$1,745.10 ","$1,292.15 ","$1,292.15 ","$1,180.85 ","$1,292.15 ","$1,260.35 ","$1,350.51 ",$430.85 ,"$1,531.81 ","$2,146.92 ","$1,939.00 ","$1,939.00 ",$659.26 ,"$1,939.00 ","$1,436.99 ","$1,842.05 ","$1,589.98 ","$1,589.98 ","$1,551.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,077.00 ",$538.50 ,$239.31 ,"$1,598.31 ","$1,507.84 ",$911.03 ,$911.03 ,$366.18 ,$861.60 ,$915.45 ,$673.13 ,$969.30 ,"$1,507.84 ","$1,023.15 ",$969.30 ,$915.45 ,$915.45 ,$366.18 ,$915.45 ,$915.45 ,$969.30 ,"$1,507.84 ","$1,077.00 ",$969.30 ,"$1,459.17 ",$990.84 ,$969.30 ,$717.71 ,$717.71 ,$655.89 ,$717.71 ,$700.05 ,$750.13 ,$239.31 ,$850.83 ,"$1,598.31 ","$1,077.00 ","$1,077.00 ",$366.18 ,"$1,077.00 ",$648.52 ,"$1,023.15 ",$883.14 ,$883.14 ,$861.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000305,23700,HC SHOULDER MANIPULATION W/ANESTHESIA,360,1 ,"$2,462.00 ","$1,231.00 ",$547.06 ,"$3,200.65 ","$1,740.21 ","$2,082.61 ","$2,082.61 ",$837.08 ,"$1,969.60 ","$2,092.70 ","$1,538.75 ","$2,215.80 ","$1,740.21 ","$2,338.90 ","$2,215.80 ","$2,092.70 ","$2,092.70 ",$837.08 ,"$2,092.70 ","$2,092.70 ","$2,215.80 ","$1,740.21 ","$2,462.00 ","$2,215.80 ","$3,200.65 ","$2,265.04 ","$2,215.80 ","$1,640.68 ","$1,640.68 ","$1,499.36 ","$1,640.68 ","$1,600.30 ","$1,714.78 ",$547.06 ,"$1,944.98 ","$1,844.62 ","$2,368.00 ","$2,368.00 ",$837.08 ,"$2,462.00 ","$1,422.51 ","$2,338.90 ","$2,018.84 ","$2,018.84 ","$1,969.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000309,27096,HC INJECTION SACRAL JOINT,360,1 ,"$1,126.00 ",$563.00 ,$250.20 ,"$1,126.00 ",$868.22 ,$952.48 ,$952.48 ,$382.84 ,$900.80 ,$957.10 ,$703.75 ,"$1,013.40 ",$868.22 ,"$1,069.70 ","$1,013.40 ",$957.10 ,$957.10 ,$382.84 ,$957.10 ,$957.10 ,"$1,013.40 ",$868.22 ,"$1,126.00 ","$1,013.40 ", N/A ,"$1,035.92 ","$1,013.40 ",$750.37 ,$750.37 ,$685.73 ,$750.37 ,$731.90 ,$784.26 ,$250.20 ,$889.54 ,$920.31 ,$623.00 ,$623.00 ,$382.84 ,$683.00 , N/A ,"$1,069.70 ",$923.32 ,$923.32 ,$900.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000310,64421,HC INJ ANES INTERCOSTAL NERVE EA ADDNT LEVEL,360,1 ,"$1,077.00 ",$538.50 ,$239.31 ,"$2,167.48 ","$2,044.79 ",$911.03 ,$911.03 ,$366.18 ,$861.60 ,$915.45 ,$673.13 ,$969.30 ,"$2,044.79 ","$1,023.15 ",$969.30 ,$915.45 ,$915.45 ,$366.18 ,$915.45 ,$915.45 ,$969.30 ,"$2,044.79 ","$1,077.00 ",$969.30 ,"$1,891.64 ",$990.84 ,$969.30 ,$717.71 ,$717.71 ,$655.89 ,$717.71 ,$700.05 ,$750.13 ,$239.31 ,$850.83 ,"$2,167.48 ","$1,077.00 ","$1,077.00 ",$366.18 ,"$1,077.00 ",$840.73 ,"$1,023.15 ",$883.14 ,$883.14 ,$861.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000311,64420,HC INJ INTERCOSTAL NERVE;SINGLE,360,1 ,$803.00 ,$401.50 ,$178.43 ,"$1,459.17 ",$767.36 ,$679.26 ,$679.26 ,$273.02 ,$642.40 ,$682.55 ,$501.88 ,$722.70 ,$767.36 ,$762.85 ,$722.70 ,$682.55 ,$682.55 ,$273.02 ,$682.55 ,$682.55 ,$722.70 ,$767.36 ,$803.00 ,$722.70 ,"$1,459.17 ",$738.76 ,$722.70 ,$535.12 ,$535.12 ,$489.03 ,$535.12 ,$521.95 ,$559.29 ,$178.43 ,$634.37 ,$813.40 ,$803.00 ,$803.00 ,$273.02 ,$803.00 ,$648.52 ,$762.85 ,$658.46 ,$658.46 ,$642.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000313,64493,HC INJ FACET LUMBO SACRAL;SINGLE,360,1 ,"$2,478.00 ","$1,239.00 ",$550.61 ,"$2,478.00 ","$1,507.84 ","$2,096.14 ","$2,096.14 ",$842.52 ,"$1,982.40 ","$2,106.30 ","$1,548.75 ","$2,230.20 ","$1,507.84 ","$2,354.10 ","$2,230.20 ","$2,106.30 ","$2,106.30 ",$842.52 ,"$2,106.30 ","$2,106.30 ","$2,230.20 ","$1,507.84 ","$1,697.11 ","$2,230.20 ","$1,891.64 ","$2,279.76 ","$2,230.20 ","$1,651.34 ","$1,651.34 ","$1,509.10 ","$1,651.34 ","$1,610.70 ","$1,725.93 ",$550.61 ,"$1,957.62 ","$1,598.31 ","$1,935.00 ","$1,935.00 ",$842.52 ,"$2,007.00 ",$840.73 ,"$2,354.10 ","$2,031.96 ","$2,031.96 ","$1,982.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000314,64494,HC INJ FACET LUMBO/SACRAL;2ND LEVEL,360,1 ,$431.00 ,$215.50 ,$95.77 ,"$1,598.31 ","$1,507.84 ",$364.58 ,$364.58 ,$146.54 ,$344.80 ,$366.35 ,$269.38 ,$387.90 ,"$1,507.84 ",$409.45 ,$387.90 ,$366.35 ,$366.35 ,$146.54 ,$366.35 ,$366.35 ,$387.90 ,"$1,507.84 ",$431.00 ,$387.90 , N/A ,$396.52 ,$387.90 ,$287.22 ,$287.22 ,$262.48 ,$287.22 ,$280.15 ,$300.19 ,$95.77 ,$340.49 ,"$1,598.31 ",$431.00 ,$431.00 ,$146.54 ,$431.00 , N/A ,$409.45 ,$353.42 ,$353.42 ,$344.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000315,64495,HC INJ FACET LUMBO/SACRAL;3RD LEVEL,360,1 ,$431.00 ,$215.50 ,$95.77 ,"$1,598.31 ","$1,507.84 ",$364.58 ,$364.58 ,$146.54 ,$344.80 ,$366.35 ,$269.38 ,$387.90 ,"$1,507.84 ",$409.45 ,$387.90 ,$366.35 ,$366.35 ,$146.54 ,$366.35 ,$366.35 ,$387.90 ,"$1,507.84 ",$431.00 ,$387.90 , N/A ,$396.52 ,$387.90 ,$287.22 ,$287.22 ,$262.48 ,$287.22 ,$280.15 ,$300.19 ,$95.77 ,$340.49 ,"$1,598.31 ",$431.00 ,$431.00 ,$146.54 ,$431.00 , N/A ,$409.45 ,$353.42 ,$353.42 ,$344.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$1,541.00 ",$770.50 ,$342.41 ,"$1,891.64 ","$1,507.84 ","$1,303.53 ","$1,303.53 ",$523.94 ,"$1,232.80 ","$1,309.85 ",$963.13 ,"$1,386.90 ","$1,507.84 ","$1,463.95 ","$1,386.90 ","$1,309.85 ","$1,309.85 ",$523.94 ,"$1,309.85 ","$1,309.85 ","$1,386.90 ","$1,507.84 ","$1,541.00 ","$1,386.90 ","$1,891.64 ","$1,417.72 ","$1,386.90 ","$1,026.92 ","$1,026.92 ",$938.47 ,"$1,026.92 ","$1,001.65 ","$1,073.31 ",$342.41 ,"$1,217.39 ","$1,598.31 ","$1,541.00 ","$1,541.00 ",$523.94 ,"$1,541.00 ",$840.73 ,"$1,463.95 ","$1,263.62 ","$1,263.62 ","$1,232.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000323,64480,HC INJ TRANSF CERV/THORACIC ADDL,360,1 ,$786.00 ,$393.00 ,$174.65 ,"$1,598.31 ","$1,507.84 ",$664.88 ,$664.88 ,$267.24 ,$628.80 ,$668.10 ,$491.25 ,$707.40 ,"$1,507.84 ",$746.70 ,$707.40 ,$668.10 ,$668.10 ,$267.24 ,$668.10 ,$668.10 ,$707.40 ,"$1,507.84 ",$786.00 ,$707.40 , N/A ,$723.12 ,$707.40 ,$523.79 ,$523.79 ,$478.67 ,$523.79 ,$510.90 ,$547.45 ,$174.65 ,$620.94 ,"$1,598.31 ",$623.00 ,$623.00 ,$267.24 ,$683.00 , N/A ,$746.70 ,$644.52 ,$644.52 ,$628.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000324,64483,HC INJ TRANSF LUMBAR SACRAL SINGLE,360,1 ,"$1,939.00 ",$969.50 ,$430.85 ,"$1,939.00 ","$1,507.84 ","$1,640.20 ","$1,640.20 ",$659.26 ,"$1,551.20 ","$1,648.15 ","$1,211.88 ","$1,745.10 ","$1,507.84 ","$1,842.05 ","$1,745.10 ","$1,648.15 ","$1,648.15 ",$659.26 ,"$1,648.15 ","$1,648.15 ","$1,745.10 ","$1,507.84 ","$1,697.11 ","$1,745.10 ","$1,891.64 ","$1,783.88 ","$1,745.10 ","$1,292.15 ","$1,292.15 ","$1,180.85 ","$1,292.15 ","$1,260.35 ","$1,350.51 ",$430.85 ,"$1,531.81 ","$1,598.31 ","$1,935.00 ","$1,935.00 ",$659.26 ,"$1,939.00 ",$840.73 ,"$1,842.05 ","$1,589.98 ","$1,589.98 ","$1,551.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,$786.00 ,$393.00 ,$174.65 ,"$1,598.31 ","$1,507.84 ",$664.88 ,$664.88 ,$267.24 ,$628.80 ,$668.10 ,$491.25 ,$707.40 ,"$1,507.84 ",$746.70 ,$707.40 ,$668.10 ,$668.10 ,$267.24 ,$668.10 ,$668.10 ,$707.40 ,"$1,507.84 ",$786.00 ,$707.40 , N/A ,$723.12 ,$707.40 ,$523.79 ,$523.79 ,$478.67 ,$523.79 ,$510.90 ,$547.45 ,$174.65 ,$620.94 ,"$1,598.31 ",$623.00 ,$623.00 ,$267.24 ,$683.00 , N/A ,$746.70 ,$644.52 ,$644.52 ,$628.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000326,64405,HC NERVE BLOCK; OCCIPITAL,360,1 ,"$1,002.00 ",$501.00 ,$222.64 ,"$1,002.00 ",$767.36 ,$847.59 ,$847.59 ,$340.68 ,$801.60 ,$851.70 ,$626.25 ,$901.80 ,$767.36 ,$951.90 ,$901.80 ,$851.70 ,$851.70 ,$340.68 ,$851.70 ,$851.70 ,$901.80 ,$767.36 ,"$1,002.00 ",$901.80 ,$600.37 ,$921.84 ,$901.80 ,$667.73 ,$667.73 ,$610.22 ,$667.73 ,$651.30 ,$697.89 ,$222.64 ,$791.58 ,$813.40 ,$623.00 ,$623.00 ,$340.68 ,$683.00 ,$266.83 ,$951.90 ,$821.64 ,$821.64 ,$801.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000327,64445,HC NERVE BLOCK;SCIATIC SINGLE,360,1 ,"$1,616.00 ",$808.00 ,$359.08 ,"$1,616.00 ",$767.36 ,"$1,366.97 ","$1,366.97 ",$549.44 ,"$1,292.80 ","$1,373.60 ","$1,010.00 ","$1,454.40 ",$767.36 ,"$1,535.20 ","$1,454.40 ","$1,373.60 ","$1,373.60 ",$549.44 ,"$1,373.60 ","$1,373.60 ","$1,454.40 ",$767.36 ,"$1,616.00 ","$1,454.40 ","$1,459.17 ","$1,486.72 ","$1,454.40 ","$1,076.90 ","$1,076.90 ",$984.14 ,"$1,076.90 ","$1,050.40 ","$1,125.54 ",$359.08 ,"$1,276.64 ",$813.40 ,"$1,616.00 ","$1,616.00 ",$549.44 ,"$1,616.00 ",$648.52 ,"$1,535.20 ","$1,325.12 ","$1,325.12 ","$1,292.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000328,64418,HC NERVE BLOCK;SUPRACAPULAR,360,1 ,$786.00 ,$393.00 ,$174.65 ,"$1,459.17 ",$767.36 ,$664.88 ,$664.88 ,$267.24 ,$628.80 ,$668.10 ,$491.25 ,$707.40 ,$767.36 ,$746.70 ,$707.40 ,$668.10 ,$668.10 ,$267.24 ,$668.10 ,$668.10 ,$707.40 ,$767.36 ,$786.00 ,$707.40 ,"$1,459.17 ",$723.12 ,$707.40 ,$523.79 ,$523.79 ,$478.67 ,$523.79 ,$510.90 ,$547.45 ,$174.65 ,$620.94 ,$813.40 ,$786.00 ,$786.00 ,$267.24 ,$786.00 ,$648.52 ,$746.70 ,$644.52 ,$644.52 ,$628.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000330,N/A,HC GI ROOM PRE-OP CARE,750,1 ,$210.00 ,$105.00 ,$46.66 ,$210.00 , N/A ,$177.64 ,$177.64 ,$71.40 ,$168.00 ,$178.50 ,$131.25 ,$189.00 , N/A ,$199.50 ,$189.00 ,$178.50 ,$178.50 ,$71.40 ,$178.50 ,$178.50 ,$189.00 , N/A , N/A ,$189.00 , N/A ,$193.20 ,$189.00 ,$139.94 ,$139.94 ,$127.89 ,$139.94 ,$136.50 ,$146.27 ,$46.66 ,$165.90 , N/A , N/A , N/A ,$71.40 , N/A , N/A ,$199.50 ,$172.20 ,$172.20 ,$168.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000331,64520,HC NERVE BLOCK;L/S PARAVERTEBAL SYMP,360,1 ,"$1,304.00 ",$652.00 ,$289.75 ,"$1,891.64 ","$1,507.84 ","$1,103.05 ","$1,103.05 ",$443.36 ,"$1,043.20 ","$1,108.40 ",$815.00 ,"$1,173.60 ","$1,507.84 ","$1,238.80 ","$1,173.60 ","$1,108.40 ","$1,108.40 ",$443.36 ,"$1,108.40 ","$1,108.40 ","$1,173.60 ","$1,507.84 ","$1,304.00 ","$1,173.60 ","$1,891.64 ","$1,199.68 ","$1,173.60 ",$868.99 ,$868.99 ,$794.14 ,$868.99 ,$847.60 ,$908.24 ,$289.75 ,"$1,030.16 ","$1,598.31 ","$1,304.00 ","$1,304.00 ",$443.36 ,"$1,304.00 ",$840.73 ,"$1,238.80 ","$1,069.28 ","$1,069.28 ","$1,043.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000338,N/A,HC EMERGENCY/URGENT,360,1 ,$641.00 ,$320.50 ,$142.43 ,$641.00 , N/A ,$542.22 ,$542.22 ,$217.94 ,$512.80 ,$544.85 ,$400.63 ,$576.90 , N/A ,$608.95 ,$576.90 ,$544.85 ,$544.85 ,$217.94 ,$544.85 ,$544.85 ,$576.90 , N/A , N/A ,$576.90 , N/A ,$589.72 ,$576.90 ,$427.16 ,$427.16 ,$390.37 ,$427.16 ,$416.65 ,$446.46 ,$142.43 ,$506.39 , N/A , N/A , N/A ,$217.94 , N/A , N/A ,$608.95 ,$525.62 ,$525.62 ,$512.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000339,64461,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC SINGLE,360,1 ,$830.00 ,$415.00 ,$184.43 ,"$1,598.31 ","$1,507.84 ",$702.10 ,$702.10 ,$282.20 ,$664.00 ,$705.50 ,$518.75 ,$747.00 ,"$1,507.84 ",$788.50 ,$747.00 ,$705.50 ,$705.50 ,$282.20 ,$705.50 ,$705.50 ,$747.00 ,"$1,507.84 ",$830.00 ,$747.00 ,"$1,459.17 ",$763.60 ,$747.00 ,$553.11 ,$553.11 ,$505.47 ,$553.11 ,$539.50 ,$578.10 ,$184.43 ,$655.70 ,"$1,598.31 ",$830.00 ,$830.00 ,$282.20 ,$830.00 ,$648.52 ,$788.50 ,$680.60 ,$680.60 ,$664.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000340,64462,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC 2ND AND ADDN ADD ON,360,1 ,$215.00 ,$107.50 ,$47.77 ,"$1,598.31 ","$1,507.84 ",$181.87 ,$181.87 ,$73.10 ,$172.00 ,$182.75 ,$134.38 ,$193.50 ,"$1,507.84 ",$204.25 ,$193.50 ,$182.75 ,$182.75 ,$73.10 ,$182.75 ,$182.75 ,$193.50 ,"$1,507.84 ",$215.00 ,$193.50 , N/A ,$197.80 ,$193.50 ,$143.28 ,$143.28 ,$130.94 ,$143.28 ,$139.75 ,$149.75 ,$47.77 ,$169.85 ,"$1,598.31 ",$215.00 ,$215.00 ,$73.10 ,$215.00 , N/A ,$204.25 ,$176.30 ,$176.30 ,$172.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000341,64463,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC CATH CONTINUOUS,360,1 ,$792.00 ,$396.00 ,$175.98 ,"$1,598.31 ","$1,507.84 ",$669.95 ,$669.95 ,$269.28 ,$633.60 ,$673.20 ,$495.00 ,$712.80 ,"$1,507.84 ",$752.40 ,$712.80 ,$673.20 ,$673.20 ,$269.28 ,$673.20 ,$673.20 ,$712.80 ,"$1,507.84 ",$792.00 ,$712.80 ,"$1,459.17 ",$728.64 ,$712.80 ,$527.79 ,$527.79 ,$482.33 ,$527.79 ,$514.80 ,$551.63 ,$175.98 ,$625.68 ,"$1,598.31 ",$792.00 ,$792.00 ,$269.28 ,$792.00 ,$648.52 ,$752.40 ,$649.44 ,$649.44 ,$633.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000569,64486,HC TAP BLOCK W/INJ UNILT,360,1 ,$948.00 ,$474.00 ,$210.65 ,$948.00 ,$767.36 ,$801.91 ,$801.91 ,$322.32 ,$758.40 ,$805.80 ,$592.50 ,$853.20 ,$767.36 ,$900.60 ,$853.20 ,$805.80 ,$805.80 ,$322.32 ,$805.80 ,$805.80 ,$853.20 ,$767.36 ,$948.00 ,$853.20 , N/A ,$872.16 ,$853.20 ,$631.75 ,$631.75 ,$577.33 ,$631.75 ,$616.20 ,$660.28 ,$210.65 ,$748.92 ,$813.40 ,$623.00 ,$623.00 ,$322.32 ,$683.00 , N/A ,$900.60 ,$777.36 ,$777.36 ,$758.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000718,64449,HC NERVE BLOCK INJ LUMBAR PLEXUS CONTINUOUS,360,1 ,$819.00 ,$409.50 ,$181.98 ,"$2,167.48 ","$2,044.79 ",$692.79 ,$692.79 ,$278.46 ,$655.20 ,$696.15 ,$511.88 ,$737.10 ,"$2,044.79 ",$778.05 ,$737.10 ,$696.15 ,$696.15 ,$278.46 ,$696.15 ,$696.15 ,$737.10 ,"$2,044.79 ",$819.00 ,$737.10 ,"$1,891.64 ",$753.48 ,$737.10 ,$545.78 ,$545.78 ,$498.77 ,$545.78 ,$532.35 ,$570.43 ,$181.98 ,$647.01 ,"$2,167.48 ",$819.00 ,$819.00 ,$278.46 ,$819.00 ,$840.73 ,$778.05 ,$671.58 ,$671.58 ,$655.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000720,64446,HC NERVE BLOCK SCIATIC CONTINUOUS INFUSION,360,1 ,"$2,467.00 ","$1,233.50 ",$548.17 ,"$2,467.00 ","$2,044.79 ","$2,086.84 ","$2,086.84 ",$838.78 ,"$1,973.60 ","$2,096.95 ","$1,541.88 ","$2,220.30 ","$2,044.79 ","$2,343.65 ","$2,220.30 ","$2,096.95 ","$2,096.95 ",$838.78 ,"$2,096.95 ","$2,096.95 ","$2,220.30 ","$2,044.79 ","$1,697.11 ","$2,220.30 ","$1,891.64 ","$2,269.64 ","$2,220.30 ","$1,644.01 ","$1,644.01 ","$1,502.40 ","$1,644.01 ","$1,603.55 ","$1,718.27 ",$548.17 ,"$1,948.93 ","$2,167.48 ","$1,935.00 ","$1,935.00 ",$838.78 ,"$2,007.00 ",$840.73 ,"$2,343.65 ","$2,022.94 ","$2,022.94 ","$1,973.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$7,359.00 ","$3,679.50 ","$1,635.17 ","$7,359.00 ","$3,461.02 ","$6,224.98 ","$6,224.98 ","$2,502.06 ","$5,887.20 ","$6,255.15 ","$4,599.38 ","$6,623.10 ","$3,461.02 ","$6,991.05 ","$6,623.10 ","$6,255.15 ","$6,255.15 ","$2,502.06 ","$6,255.15 ","$6,255.15 ","$6,623.10 ","$3,461.02 ","$4,525.63 ","$6,623.10 ","$5,448.49 ","$6,770.28 ","$6,623.10 ","$4,904.04 ","$4,904.04 ","$4,481.63 ","$4,904.04 ","$4,783.35 ","$5,125.54 ","$1,635.17 ","$5,813.61 ","$3,668.68 ","$2,838.00 ","$2,838.00 ","$2,502.06 ","$3,348.00 ","$2,421.55 ","$6,991.05 ","$6,034.38 ","$6,034.38 ","$5,887.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36010060,N/A,HC ENDOSCOPY PROCEDURE LEVEL I,360,1 ,"$2,993.00 ","$1,496.50 ",$665.04 ,"$2,993.00 ", N/A ,"$2,531.78 ","$2,531.78 ","$1,017.62 ","$2,394.40 ","$2,544.05 ","$1,870.63 ","$2,693.70 ", N/A ,"$2,843.35 ","$2,693.70 ","$2,544.05 ","$2,544.05 ","$1,017.62 ","$2,544.05 ","$2,544.05 ","$2,693.70 ", N/A , N/A ,"$2,693.70 ", N/A ,"$2,753.56 ","$2,693.70 ","$1,994.54 ","$1,994.54 ","$1,822.74 ","$1,994.54 ","$1,945.45 ","$2,084.62 ",$665.04 ,"$2,364.47 ", N/A , N/A , N/A ,"$1,017.62 ", N/A , N/A ,"$2,843.35 ","$2,454.26 ","$2,454.26 ","$2,394.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36010061,N/A,HC ENDOSCOPY PROCEDURE LEVEL 1 SECONDARY,360,1 ,"$1,281.00 ",$640.50 ,$284.64 ,"$1,281.00 ", N/A ,"$1,083.60 ","$1,083.60 ",$435.54 ,"$1,024.80 ","$1,088.85 ",$800.63 ,"$1,152.90 ", N/A ,"$1,216.95 ","$1,152.90 ","$1,088.85 ","$1,088.85 ",$435.54 ,"$1,088.85 ","$1,088.85 ","$1,152.90 ", N/A , N/A ,"$1,152.90 ", N/A ,"$1,178.52 ","$1,152.90 ",$853.66 ,$853.66 ,$780.13 ,$853.66 ,$832.65 ,$892.22 ,$284.64 ,"$1,011.99 ", N/A , N/A , N/A ,$435.54 , N/A , N/A ,"$1,216.95 ","$1,050.42 ","$1,050.42 ","$1,024.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36030112,N/A,HC DENTAL 0-90 MIN ASC,360,1 ,"$6,615.00 ","$3,307.50 ","$1,469.85 ","$6,615.00 ", N/A ,"$5,595.63 ","$5,595.63 ","$2,249.10 ","$5,292.00 ","$5,622.75 ","$4,134.38 ","$5,953.50 ", N/A ,"$6,284.25 ","$5,953.50 ","$5,622.75 ","$5,622.75 ","$2,249.10 ","$5,622.75 ","$5,622.75 ","$5,953.50 ", N/A , N/A ,"$5,953.50 ", N/A ,"$6,085.80 ","$5,953.50 ","$4,408.24 ","$4,408.24 ","$4,028.54 ","$4,408.24 ","$4,299.75 ","$4,607.35 ","$1,469.85 ","$5,225.85 ", N/A , N/A , N/A ,"$2,249.10 ", N/A , N/A ,"$6,284.25 ","$5,424.30 ","$5,424.30 ","$5,292.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36030113,N/A,HC DENTAL 91-150 MIN ASC,360,1 ,"$1,260.00 ",$630.00 ,$279.97 ,"$1,260.00 ", N/A ,"$1,065.83 ","$1,065.83 ",$428.40 ,"$1,008.00 ","$1,071.00 ",$787.50 ,"$1,134.00 ", N/A ,"$1,197.00 ","$1,134.00 ","$1,071.00 ","$1,071.00 ",$428.40 ,"$1,071.00 ","$1,071.00 ","$1,134.00 ", N/A , N/A ,"$1,134.00 ", N/A ,"$1,159.20 ","$1,134.00 ",$839.66 ,$839.66 ,$767.34 ,$839.66 ,$819.00 ,$877.59 ,$279.97 ,$995.40 , N/A , N/A , N/A ,$428.40 , N/A , N/A ,"$1,197.00 ","$1,033.20 ","$1,033.20 ","$1,008.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36030114,N/A,HC DENTAL 151 AND GREATER ASC,360,1 ,"$1,890.00 ",$945.00 ,$419.96 ,"$1,890.00 ", N/A ,"$1,598.75 ","$1,598.75 ",$642.60 ,"$1,512.00 ","$1,606.50 ","$1,181.25 ","$1,701.00 ", N/A ,"$1,795.50 ","$1,701.00 ","$1,606.50 ","$1,606.50 ",$642.60 ,"$1,606.50 ","$1,606.50 ","$1,701.00 ", N/A , N/A ,"$1,701.00 ", N/A ,"$1,738.80 ","$1,701.00 ","$1,259.50 ","$1,259.50 ","$1,151.01 ","$1,259.50 ","$1,228.50 ","$1,316.39 ",$419.96 ,"$1,493.10 ", N/A , N/A , N/A ,$642.60 , N/A , N/A ,"$1,795.50 ","$1,549.80 ","$1,549.80 ","$1,512.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36050017,N/A,HC BANDAGE COBAN 4IN STERILE,272,1 ,$11.40 ,$5.70 ,$2.54 ,$11.40 , N/A ,$9.64 ,$9.64 ,$3.88 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.88 ,$9.69 ,$9.69 ,$10.26 , N/A ,$4.79 ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.60 ,$7.60 ,$6.94 ,$7.60 ,$7.41 ,$7.94 ,$2.54 ,$9.01 , N/A ,$5.70 ,$5.70 ,$3.88 ,$5.70 , N/A ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050019,N/A,HC BANDAGE COBAN 6IN STERILE,272,1 ,$17.00 ,$8.50 ,$3.78 ,$17.00 , N/A ,$14.38 ,$14.38 ,$5.78 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$5.78 ,$14.45 ,$14.45 ,$15.30 , N/A ,$7.14 ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.33 ,$11.33 ,$10.35 ,$11.33 ,$11.05 ,$11.84 ,$3.78 ,$13.43 , N/A ,$8.50 ,$8.50 ,$5.78 ,$8.50 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050034,C9363,HC BILAYER MATRIX WOUND DRESS PER SQCM,278,1 ,"$1,811.00 ",$905.50 ,$402.40 ,"$1,811.00 ", N/A ,"$1,531.92 ","$1,531.92 ",$615.74 ,"$1,448.80 ","$1,539.35 ","$1,131.88 ","$1,629.90 ", N/A ,"$1,720.45 ","$1,629.90 ","$1,539.35 ","$1,539.35 ",$615.74 ,"$1,539.35 ","$1,539.35 ","$1,629.90 ", N/A ,$760.62 ,"$1,629.90 ", N/A ,"$1,666.12 ","$1,629.90 ","$1,206.85 ","$1,206.85 ","$1,102.90 ","$1,206.85 ","$1,177.15 ","$1,261.36 ",$402.40 ,"$1,430.69 ", N/A , N/A , N/A ,$615.74 , N/A , N/A ,"$1,720.45 ","$1,485.02 ","$1,485.02 ","$1,448.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36050038,N/A,HC BOLSTER KNEE,272,1 ,$52.00 ,$26.00 ,$11.55 ,$52.00 , N/A ,$43.99 ,$43.99 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$21.84 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050113,N/A,HC DRSG FLAT COTTON,272,1 ,$32.00 ,$16.00 ,$7.11 ,$32.00 , N/A ,$27.07 ,$27.07 ,$10.88 ,$25.60 ,$27.20 ,$20.00 ,$28.80 , N/A ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$10.88 ,$27.20 ,$27.20 ,$28.80 , N/A ,$13.44 ,$28.80 , N/A ,$29.44 ,$28.80 ,$21.32 ,$21.32 ,$19.49 ,$21.32 ,$20.80 ,$22.29 ,$7.11 ,$25.28 , N/A ,$16.00 ,$16.00 ,$10.88 ,$16.00 , N/A ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050117,N/A,HC ELECTRODE LIGASURE SEALER/DIV,360,1 ,"$1,649.00 ",$824.50 ,$366.41 ,"$1,649.00 ", N/A ,"$1,394.89 ","$1,394.89 ",$560.66 ,"$1,319.20 ","$1,401.65 ","$1,030.63 ","$1,484.10 ", N/A ,"$1,566.55 ","$1,484.10 ","$1,401.65 ","$1,401.65 ",$560.66 ,"$1,401.65 ","$1,401.65 ","$1,484.10 ", N/A , N/A ,"$1,484.10 ", N/A ,"$1,517.08 ","$1,484.10 ","$1,098.89 ","$1,098.89 ","$1,004.24 ","$1,098.89 ","$1,071.85 ","$1,148.53 ",$366.41 ,"$1,302.71 ", N/A , N/A , N/A ,$560.66 , N/A , N/A ,"$1,566.55 ","$1,352.18 ","$1,352.18 ","$1,319.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36050199,N/A,HC PACK BASIC,360,1 ,$120.00 ,$60.00 ,$26.66 ,$120.00 , N/A ,$101.51 ,$101.51 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 , N/A ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 , N/A , N/A ,$108.00 , N/A ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 , N/A , N/A , N/A ,$40.80 , N/A , N/A ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050200,N/A,HC PACK ORTHO,360,1 ,$72.00 ,$36.00 ,$16.00 ,$72.00 , N/A ,$60.90 ,$60.90 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 , N/A , N/A ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 , N/A , N/A , N/A ,$24.48 , N/A , N/A ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050216,N/A,HC PACK SHOULDER,360,1 ,$75.00 ,$37.50 ,$16.67 ,$75.00 , N/A ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 , N/A , N/A ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 , N/A , N/A , N/A ,$25.50 , N/A , N/A ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050625,N/A,HC LOCAL ANESTHETIC,360,1 ,$163.00 ,$81.50 ,$36.22 ,$163.00 , N/A ,$137.88 ,$137.88 ,$55.42 ,$130.40 ,$138.55 ,$101.88 ,$146.70 , N/A ,$154.85 ,$146.70 ,$138.55 ,$138.55 ,$55.42 ,$138.55 ,$138.55 ,$146.70 , N/A , N/A ,$146.70 , N/A ,$149.96 ,$146.70 ,$108.62 ,$108.62 ,$99.27 ,$108.62 ,$105.95 ,$113.53 ,$36.22 ,$128.77 , N/A , N/A , N/A ,$55.42 , N/A , N/A ,$154.85 ,$133.66 ,$133.66 ,$130.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080000,N/A,HC SURGERY CARE PREOP CMH,360,1 ,$326.00 ,$163.00 ,$72.44 ,$326.00 , N/A ,$275.76 ,$275.76 ,$110.84 ,$260.80 ,$277.10 ,$203.75 ,$293.40 , N/A ,$309.70 ,$293.40 ,$277.10 ,$277.10 ,$110.84 ,$277.10 ,$277.10 ,$293.40 , N/A , N/A ,$293.40 , N/A ,$299.92 ,$293.40 ,$217.25 ,$217.25 ,$198.53 ,$217.25 ,$211.90 ,$227.06 ,$72.44 ,$257.54 , N/A , N/A , N/A ,$110.84 , N/A , N/A ,$309.70 ,$267.32 ,$267.32 ,$260.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080003,N/A,HC GI PRE OP W/O IV,360,1 ,$173.00 ,$86.50 ,$38.44 ,$173.00 , N/A ,$146.34 ,$146.34 ,$58.82 ,$138.40 ,$147.05 ,$108.13 ,$155.70 , N/A ,$164.35 ,$155.70 ,$147.05 ,$147.05 ,$58.82 ,$147.05 ,$147.05 ,$155.70 , N/A , N/A ,$155.70 , N/A ,$159.16 ,$155.70 ,$115.29 ,$115.29 ,$105.36 ,$115.29 ,$112.45 ,$120.49 ,$38.44 ,$136.67 , N/A , N/A , N/A ,$58.82 , N/A , N/A ,$164.35 ,$141.86 ,$141.86 ,$138.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,$916.00 ,$458.00 ,$203.54 ,"$2,167.48 ","$2,044.79 ",$774.84 ,$774.84 ,$311.44 ,$732.80 ,$778.60 ,$572.50 ,$824.40 ,"$2,044.79 ",$870.20 ,$824.40 ,$778.60 ,$778.60 ,$311.44 ,$778.60 ,$778.60 ,$824.40 ,"$2,044.79 ",$916.00 ,$824.40 ,"$1,891.64 ",$842.72 ,$824.40 ,$610.42 ,$610.42 ,$557.84 ,$610.42 ,$595.40 ,$637.99 ,$203.54 ,$723.64 ,"$2,167.48 ",$916.00 ,$916.00 ,$311.44 ,$916.00 ,$840.73 ,$870.20 ,$751.12 ,$751.12 ,$732.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080009,64447,HC NERVE FEMORAL BLOCK CMH PAIN,360,1 ,$668.00 ,$334.00 ,$148.43 ,"$1,459.17 ",$767.36 ,$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 ,$767.36 ,$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 ,$767.36 ,$668.00 ,$601.20 ,"$1,459.17 ",$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 ,$813.40 ,$668.00 ,$668.00 ,$227.12 ,$668.00 ,$648.52 ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080010,64455,HC INJ ANES AGENT DIGITAL NERVES,360,1 ,$571.00 ,$285.50 ,$126.88 ,$813.40 ,$767.36 ,$483.01 ,$483.01 ,$194.14 ,$456.80 ,$485.35 ,$356.88 ,$513.90 ,$767.36 ,$542.45 ,$513.90 ,$485.35 ,$485.35 ,$194.14 ,$485.35 ,$485.35 ,$513.90 ,$767.36 ,$571.00 ,$513.90 ,$600.37 ,$525.32 ,$513.90 ,$380.51 ,$380.51 ,$347.74 ,$380.51 ,$371.15 ,$397.70 ,$126.88 ,$451.09 ,$813.40 ,$571.00 ,$571.00 ,$194.14 ,$571.00 ,$266.83 ,$542.45 ,$468.22 ,$468.22 ,$456.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,598.31 ","$1,507.84 ","$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ","$1,507.84 ","$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ","$1,507.84 ","$1,293.00 ","$1,163.70 ","$1,459.17 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ","$1,598.31 ","$1,293.00 ","$1,293.00 ",$439.62 ,"$1,293.00 ",$648.52 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$2,047.00 ","$1,023.50 ",$454.84 ,"$2,047.00 ","$1,507.84 ","$1,731.56 ","$1,731.56 ",$695.98 ,"$1,637.60 ","$1,739.95 ","$1,279.38 ","$1,842.30 ","$1,507.84 ","$1,944.65 ","$1,842.30 ","$1,739.95 ","$1,739.95 ",$695.98 ,"$1,739.95 ","$1,739.95 ","$1,842.30 ","$1,507.84 ","$2,047.00 ","$1,842.30 ","$1,459.17 ","$1,883.24 ","$1,842.30 ","$1,364.12 ","$1,364.12 ","$1,246.62 ","$1,364.12 ","$1,330.55 ","$1,425.74 ",$454.84 ,"$1,617.13 ","$1,598.31 ","$1,935.00 ","$1,935.00 ",$695.98 ,"$2,007.00 ",$648.52 ,"$1,944.65 ","$1,678.54 ","$1,678.54 ","$1,637.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,598.31 ","$1,507.84 ","$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ","$1,507.84 ","$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ","$1,507.84 ","$1,293.00 ","$1,163.70 ","$1,459.17 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ","$1,598.31 ","$1,293.00 ","$1,293.00 ",$439.62 ,"$1,293.00 ",$648.52 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$1,616.00 ",$808.00 ,$359.08 ,"$1,616.00 ","$1,507.84 ","$1,366.97 ","$1,366.97 ",$549.44 ,"$1,292.80 ","$1,373.60 ","$1,010.00 ","$1,454.40 ","$1,507.84 ","$1,535.20 ","$1,454.40 ","$1,373.60 ","$1,373.60 ",$549.44 ,"$1,373.60 ","$1,373.60 ","$1,454.40 ","$1,507.84 ","$1,616.00 ","$1,454.40 ","$1,459.17 ","$1,486.72 ","$1,454.40 ","$1,076.90 ","$1,076.90 ",$984.14 ,"$1,076.90 ","$1,050.40 ","$1,125.54 ",$359.08 ,"$1,276.64 ","$1,598.31 ","$1,616.00 ","$1,616.00 ",$549.44 ,"$1,616.00 ",$648.52 ,"$1,535.20 ","$1,325.12 ","$1,325.12 ","$1,292.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,891.64 ","$1,507.84 ","$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ","$1,507.84 ","$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ","$1,507.84 ","$1,293.00 ","$1,163.70 ","$1,891.64 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ","$1,598.31 ","$1,293.00 ","$1,293.00 ",$439.62 ,"$1,293.00 ",$840.73 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100148,64488,HC INJ TAP BLOCK W/GUIDE- BIL,361,1 ,"$1,050.00 ",$525.00 ,$233.31 ,"$1,050.00 ",$767.36 ,$888.20 ,$888.20 ,$357.00 ,$840.00 ,$892.50 ,$656.25 ,$945.00 ,$767.36 ,$997.50 ,$945.00 ,$892.50 ,$892.50 ,$357.00 ,$892.50 ,$892.50 ,$945.00 ,$767.36 ,"$1,050.00 ",$945.00 , N/A ,$966.00 ,$945.00 ,$699.72 ,$699.72 ,$639.45 ,$699.72 ,$682.50 ,$731.33 ,$233.31 ,$829.50 ,$813.40 ,$623.00 ,$623.00 ,$357.00 ,$683.00 , N/A ,$997.50 ,$861.00 ,$861.00 ,$840.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,$668.00 ,$334.00 ,$148.43 ,"$1,459.17 ",$767.36 ,$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 ,$767.36 ,$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 ,$767.36 ,$668.00 ,$601.20 ,"$1,459.17 ",$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 ,$813.40 ,$668.00 ,$668.00 ,$227.12 ,$668.00 ,$648.52 ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100232,11103,HC BIOPSY SKIN TANGENTIAL ADDL LESN,361,1 ,$162.00 ,$81.00 ,$36.00 ,$832.58 ,$785.45 ,$137.04 ,$137.04 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$785.45 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$785.45 , N/A ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$832.58 ,$162.00 ,$162.00 ,$55.08 ,$162.00 , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100233,11105,HC BIOPSY SKIN PUNCH ADDL LESN,361,1 ,$162.00 ,$81.00 ,$36.00 ,$832.58 ,$785.45 ,$137.04 ,$137.04 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$785.45 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$785.45 , N/A ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$832.58 ,$162.00 ,$162.00 ,$55.08 ,$162.00 , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100234,11107,HC BIOPSY SKIN INCISIONAL ADDL LESN,361,1 ,$162.00 ,$81.00 ,$36.00 ,$832.58 ,$785.45 ,$137.04 ,$137.04 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$785.45 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$785.45 , N/A ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$832.58 ,$162.00 ,$162.00 ,$55.08 ,$162.00 , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,$334.00 ,$167.00 ,$74.21 ,$832.58 ,$785.45 ,$282.53 ,$282.53 ,$113.56 ,$267.20 ,$283.90 ,$208.75 ,$300.60 ,$785.45 ,$317.30 ,$300.60 ,$283.90 ,$283.90 ,$113.56 ,$283.90 ,$283.90 ,$300.60 ,$785.45 ,$334.00 ,$300.60 ,$412.65 ,$307.28 ,$300.60 ,$222.58 ,$222.58 ,$203.41 ,$222.58 ,$217.10 ,$232.63 ,$74.21 ,$263.86 ,$832.58 ,$334.00 ,$334.00 ,$113.56 ,$334.00 ,$183.40 ,$317.30 ,$273.88 ,$273.88 ,$267.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,$334.00 ,$167.00 ,$74.21 ,$832.58 ,$785.45 ,$282.53 ,$282.53 ,$113.56 ,$267.20 ,$283.90 ,$208.75 ,$300.60 ,$785.45 ,$317.30 ,$300.60 ,$283.90 ,$283.90 ,$113.56 ,$283.90 ,$283.90 ,$300.60 ,$785.45 ,$334.00 ,$300.60 ,$794.25 ,$307.28 ,$300.60 ,$222.58 ,$222.58 ,$203.41 ,$222.58 ,$217.10 ,$232.63 ,$74.21 ,$263.86 ,$832.58 ,$334.00 ,$334.00 ,$113.56 ,$334.00 ,$353.00 ,$317.30 ,$273.88 ,$273.88 ,$267.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,$334.00 ,$167.00 ,$74.21 ,"$1,203.50 ",$785.45 ,$282.53 ,$282.53 ,$113.56 ,$267.20 ,$283.90 ,$208.75 ,$300.60 ,$785.45 ,$317.30 ,$300.60 ,$283.90 ,$283.90 ,$113.56 ,$283.90 ,$283.90 ,$300.60 ,$785.45 ,$334.00 ,$300.60 ,"$1,203.50 ",$307.28 ,$300.60 ,$222.58 ,$222.58 ,$203.41 ,$222.58 ,$217.10 ,$232.63 ,$74.21 ,$263.86 ,$832.58 ,$334.00 ,$334.00 ,$113.56 ,$334.00 ,$534.89 ,$317.30 ,$273.88 ,$273.88 ,$267.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$1,429.97 ","$1,113.15 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$1,113.15 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$1,113.15 ","$1,185.00 ","$1,066.50 ","$1,429.97 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$1,179.94 ","$1,185.00 ","$1,185.00 ",$402.90 ,"$1,185.00 ",$635.54 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$131.76 ,"$1,179.94 ","$1,113.15 ",$501.62 ,$501.62 ,$201.62 ,$474.40 ,$504.05 ,$370.63 ,$533.70 ,"$1,113.15 ",$563.35 ,$533.70 ,$504.05 ,$504.05 ,$201.62 ,$504.05 ,$504.05 ,$533.70 ,"$1,113.15 ", N/A ,$533.70 , N/A ,$545.56 ,$533.70 ,$395.18 ,$395.18 ,$361.14 ,$395.18 ,$385.45 ,$413.02 ,$131.76 ,$468.47 ,"$1,179.94 ",$593.00 ,$593.00 ,$201.62 ,$593.00 , N/A ,$563.35 ,$486.26 ,$486.26 ,$474.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100240,10007,HC ASP FINE NDL W/FLUORO GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$1,429.97 ","$1,113.15 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$1,113.15 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$1,113.15 ","$1,185.00 ","$1,066.50 ","$1,429.97 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$1,179.94 ","$1,185.00 ","$1,185.00 ",$402.90 ,"$1,185.00 ",$635.54 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100241,10008,HC ASP FINE NDL W/FLUORO GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$131.76 ,"$1,179.94 ","$1,113.15 ",$501.62 ,$501.62 ,$201.62 ,$474.40 ,$504.05 ,$370.63 ,$533.70 ,"$1,113.15 ",$563.35 ,$533.70 ,$504.05 ,$504.05 ,$201.62 ,$504.05 ,$504.05 ,$533.70 ,"$1,113.15 ", N/A ,$533.70 , N/A ,$545.56 ,$533.70 ,$395.18 ,$395.18 ,$361.14 ,$395.18 ,$385.45 ,$413.02 ,$131.76 ,$468.47 ,"$1,179.94 ",$593.00 ,$593.00 ,$201.62 ,$593.00 , N/A ,$563.35 ,$486.26 ,$486.26 ,$474.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100242,10009,HC ASP FINE NDL W/CT GUIDE INIT LESN,361,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$1,429.97 ","$1,113.15 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$1,113.15 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$1,113.15 ","$1,185.00 ","$1,066.50 ","$1,429.97 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$1,179.94 ","$1,185.00 ","$1,185.00 ",$402.90 ,"$1,185.00 ",$635.54 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100243,10010,HC ASP FINE NDL W/CT GUIDE EA ADDL LESN,361,1 ,$593.00 ,$296.50 ,$131.76 ,"$1,179.94 ","$1,113.15 ",$501.62 ,$501.62 ,$201.62 ,$474.40 ,$504.05 ,$370.63 ,$533.70 ,"$1,113.15 ",$563.35 ,$533.70 ,$504.05 ,$504.05 ,$201.62 ,$504.05 ,$504.05 ,$533.70 ,"$1,113.15 ", N/A ,$533.70 , N/A ,$545.56 ,$533.70 ,$395.18 ,$395.18 ,$361.14 ,$395.18 ,$385.45 ,$413.02 ,$131.76 ,$468.47 ,"$1,179.94 ",$593.00 ,$593.00 ,$201.62 ,$593.00 , N/A ,$563.35 ,$486.26 ,$486.26 ,$474.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100246,36572,HC INS CATH PERIPH CV W/O PORT W/GUIDANCE <5,361,1 ,"$2,856.00 ","$1,428.00 ",$552.04 ,"$2,856.00 ","$1,982.43 ","$2,415.89 ","$2,415.89 ",$971.04 ,"$2,284.80 ","$2,427.60 ","$1,785.00 ","$2,570.40 ","$1,982.43 ","$2,713.20 ","$2,570.40 ","$2,427.60 ","$2,427.60 ",$971.04 ,"$2,427.60 ","$2,427.60 ","$2,570.40 ","$1,982.43 ","$2,856.00 ","$2,570.40 ","$1,242.09 ","$2,627.52 ","$2,570.40 ","$1,903.24 ","$1,903.24 ","$1,739.30 ","$1,903.24 ","$1,856.40 ","$1,989.20 ",$634.60 ,"$2,256.24 ","$2,101.38 ","$1,935.00 ","$1,935.00 ",$971.04 ,"$2,007.00 ",$552.04 ,"$2,713.20 ","$2,341.92 ","$2,341.92 ","$2,284.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$3,124.00 ","$1,562.00 ",$694.15 ,"$3,231.36 ","$1,982.43 ","$2,642.59 ","$2,642.59 ","$1,062.16 ","$2,499.20 ","$2,655.40 ","$1,952.50 ","$2,811.60 ","$1,982.43 ","$2,967.80 ","$2,811.60 ","$2,655.40 ","$2,655.40 ","$1,062.16 ","$2,655.40 ","$2,655.40 ","$2,811.60 ","$1,982.43 ","$3,124.00 ","$2,811.60 ","$3,231.36 ","$2,874.08 ","$2,811.60 ","$2,081.83 ","$2,081.83 ","$1,902.52 ","$2,081.83 ","$2,030.60 ","$2,175.87 ",$694.15 ,"$2,467.96 ","$2,101.38 ","$2,368.00 ","$2,368.00 ","$1,062.16 ","$2,604.00 ","$1,436.16 ","$2,967.80 ","$2,561.68 ","$2,561.68 ","$2,499.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,598.31 ","$1,507.84 ","$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ","$1,507.84 ","$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ","$1,507.84 ","$1,293.00 ","$1,163.70 ","$1,459.17 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ","$1,598.31 ","$1,293.00 ","$1,293.00 ",$439.62 ,"$1,293.00 ",$648.52 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100281,32408,HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG,361,1 ,"$4,547.00 ","$2,273.50 ","$1,010.34 ","$4,547.00 ","$1,679.20 ","$3,846.31 ","$3,846.31 ","$1,545.98 ","$3,637.60 ","$3,864.95 ","$2,841.88 ","$4,092.30 ","$1,679.20 ","$4,319.65 ","$4,092.30 ","$3,864.95 ","$3,864.95 ","$1,545.98 ","$3,864.95 ","$3,864.95 ","$4,092.30 ","$1,679.20 ","$3,959.93 ","$4,092.30 ","$3,233.23 ","$4,183.24 ","$4,092.30 ","$3,030.12 ","$3,030.12 ","$2,769.12 ","$3,030.12 ","$2,955.55 ","$3,166.99 ","$1,010.34 ","$3,592.13 ","$1,779.95 ","$2,368.00 ","$2,368.00 ","$1,545.98 ","$2,604.00 ","$1,436.99 ","$4,319.65 ","$3,728.54 ","$3,728.54 ","$3,637.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$258.00 ,$129.00 ,$57.33 ,"$5,489.18 ","$5,178.47 ",$218.24 ,$218.24 ,$87.72 ,$206.40 ,$219.30 ,$161.25 ,$232.20 ,"$5,178.47 ",$245.10 ,$232.20 ,$219.30 ,$219.30 ,$87.72 ,$219.30 ,$219.30 ,$232.20 ,"$5,178.47 ",$258.00 ,$232.20 ,"$4,114.46 ",$237.36 ,$232.20 ,$171.93 ,$171.93 ,$157.12 ,$171.93 ,$167.70 ,$179.70 ,$57.33 ,$203.82 ,"$5,489.18 ",$258.00 ,$258.00 ,$87.72 ,$258.00 ,"$1,828.65 ",$245.10 ,$211.56 ,$211.56 ,$206.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100286,64489,HC TAP BLOCK BIL BY INFUSION,361,1 ,"$5,347.36 ","$2,673.68 ",$623.00 ,"$5,347.36 ",$767.36 ,"$4,523.33 ","$4,523.33 ","$1,818.10 ","$4,277.89 ","$4,545.26 ","$3,342.10 ","$4,812.62 ",$767.36 ,"$5,079.99 ","$4,812.62 ","$4,545.26 ","$4,545.26 ","$1,818.10 ","$4,545.26 ","$4,545.26 ","$4,812.62 ",$767.36 ,"$3,959.93 ","$4,812.62 ", N/A ,"$4,919.57 ","$4,812.62 ","$3,563.48 ","$3,563.48 ","$3,256.54 ","$3,563.48 ","$3,475.78 ","$3,724.44 ","$1,188.18 ","$4,224.41 ",$813.40 ,$623.00 ,$623.00 ,"$1,818.10 ",$683.00 , N/A ,"$5,079.99 ","$4,384.84 ","$4,384.84 ","$4,277.89 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36415072,36415,HC VENIPUNCTURE-PRV 72 HR,300,1 ,$38.00 ,$19.00 ,$3.00 ,$38.00 ,$4.12 ,$8.00 ,$6.00 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.12 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.12 ,$3.40 ,$34.20 ,$6.75 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.37 ,$3.60 ,$3.60 ,$12.92 ,$3.60 ,$3.00 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36416072,36416,HC CAPILLARY COLLECTION-PRV 72 HR,300,1 ,$38.00 ,$19.00 ,$3.47 ,$38.00 ,$4.12 ,$8.00 ,$6.00 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.12 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.12 ,$15.96 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.37 ,$3.47 ,$3.47 ,$12.92 ,$3.47 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),36561072,36561,HC INSRT CENT VEN ACC DEV >AGE 5,975,1 ,"$4,849.00 ","$2,424.50 ",$347.40 ,"$6,578.17 ","$3,872.14 ","$4,101.77 ","$4,101.77 ",$347.40 ,"$3,879.20 ","$4,121.65 ","$3,030.63 ","$4,364.10 ","$3,872.14 ","$4,606.55 ","$4,364.10 ","$4,121.65 ","$4,121.65 ",$347.40 ,"$4,121.65 ","$4,121.65 ","$4,364.10 ","$3,872.14 ","$2,036.58 ","$4,364.10 ","$6,578.17 ","$4,461.08 ","$4,364.10 ","$3,231.37 ","$3,231.37 ","$2,953.04 ","$3,231.37 ","$3,151.85 ","$3,377.33 ","$1,077.45 ","$3,830.71 ","$4,104.47 ", N/A , N/A ,$347.40 , N/A ,"$2,923.63 ","$4,606.55 ","$3,976.18 ","$3,976.18 ","$3,879.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,"$1,100.00 ",$550.00 ,$216.07 ,"$1,697.76 ","$1,601.66 ",$930.49 ,$930.49 ,$374.00 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,"$1,601.66 ","$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$374.00 ,$935.00 ,$935.00 ,$990.00 ,"$1,601.66 ","$1,100.00 ",$990.00 ,$486.16 ,"$1,012.00 ",$990.00 ,$733.04 ,$733.04 ,$669.90 ,$733.04 ,$715.00 ,$766.15 ,$244.42 ,$869.00 ,"$1,697.76 ",$623.00 ,$623.00 ,$374.00 ,$683.00 ,$216.07 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,$819.00 ,$409.50 ,$181.98 ,"$2,167.48 ","$2,044.79 ",$692.79 ,$692.79 ,$278.46 ,$655.20 ,$696.15 ,$511.88 ,$737.10 ,"$2,044.79 ",$778.05 ,$737.10 ,$696.15 ,$696.15 ,$278.46 ,$696.15 ,$696.15 ,$737.10 ,"$2,044.79 ",$343.98 ,$737.10 ,"$1,891.64 ",$753.48 ,$737.10 ,$545.78 ,$545.78 ,$498.77 ,$545.78 ,$532.35 ,$570.43 ,$181.98 ,$647.01 ,"$2,167.48 ",$409.50 ,$409.50 ,$278.46 ,$409.50 ,$840.73 ,$778.05 ,$671.58 ,$671.58 ,$655.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 ,$42.16 ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$42.16 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 ,$42.16 ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 ,$44.69 ,$40.00 ,$40.00 ,$27.20 ,$40.00 , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 ,$42.16 ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$42.16 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 ,$42.16 ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 ,$44.69 ,$40.00 ,$40.00 ,$27.20 ,$40.00 , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,$668.00 ,$334.00 ,$148.43 ,"$1,459.17 ",$767.36 ,$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 ,$767.36 ,$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 ,$767.36 ,$280.56 ,$601.20 ,"$1,459.17 ",$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 ,$813.40 ,$334.00 ,$334.00 ,$227.12 ,$334.00 ,$648.52 ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000022,64415,HC INTRASCALENE BLOCK SINGLE,370,1 ,$668.00 ,$334.00 ,$148.43 ,"$2,167.48 ","$2,044.79 ",$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 ,"$2,044.79 ",$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 ,"$2,044.79 ",$280.56 ,$601.20 ,"$1,891.64 ",$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 ,"$2,167.48 ",$334.00 ,$334.00 ,$227.12 ,$334.00 ,$840.73 ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$1,390.00 ",$695.00 ,$308.86 ,"$2,167.48 ","$2,044.79 ","$1,175.80 ","$1,175.80 ",$472.60 ,"$1,112.00 ","$1,181.50 ",$868.75 ,"$1,251.00 ","$2,044.79 ","$1,320.50 ","$1,251.00 ","$1,181.50 ","$1,181.50 ",$472.60 ,"$1,181.50 ","$1,181.50 ","$1,251.00 ","$2,044.79 ",$583.80 ,"$1,251.00 ","$1,891.64 ","$1,278.80 ","$1,251.00 ",$926.30 ,$926.30 ,$846.51 ,$926.30 ,$903.50 ,$968.14 ,$308.86 ,"$1,098.10 ","$2,167.48 ",$695.00 ,$695.00 ,$472.60 ,$695.00 ,$840.73 ,"$1,320.50 ","$1,139.80 ","$1,139.80 ","$1,112.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$42.16 ,$380.00 ,$42.16 ,$321.44 ,$321.44 ,$129.20 ,$304.00 ,$323.00 ,$237.50 ,$342.00 ,$42.16 ,$361.00 ,$342.00 ,$323.00 ,$323.00 ,$129.20 ,$323.00 ,$323.00 ,$342.00 ,$42.16 ,$159.60 ,$342.00 , N/A ,$349.60 ,$342.00 ,$253.23 ,$253.23 ,$231.42 ,$253.23 ,$247.00 ,$264.67 ,$84.44 ,$300.20 ,$44.69 ,$190.00 ,$190.00 ,$129.20 ,$190.00 , N/A ,$361.00 ,$311.60 ,$311.60 ,$304.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$42.16 ,$380.00 ,$42.16 ,$321.44 ,$321.44 ,$129.20 ,$304.00 ,$323.00 ,$237.50 ,$342.00 ,$42.16 ,$361.00 ,$342.00 ,$323.00 ,$323.00 ,$129.20 ,$323.00 ,$323.00 ,$342.00 ,$42.16 ,$159.60 ,$342.00 , N/A ,$349.60 ,$342.00 ,$253.23 ,$253.23 ,$231.42 ,$253.23 ,$247.00 ,$264.67 ,$84.44 ,$300.20 ,$44.69 ,$190.00 ,$190.00 ,$129.20 ,$190.00 , N/A ,$361.00 ,$311.60 ,$311.60 ,$304.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$380.00 ,$190.00 ,$42.16 ,$380.00 ,$42.16 ,$321.44 ,$321.44 ,$129.20 ,$304.00 ,$323.00 ,$237.50 ,$342.00 ,$42.16 ,$361.00 ,$342.00 ,$323.00 ,$323.00 ,$129.20 ,$323.00 ,$323.00 ,$342.00 ,$42.16 ,$159.60 ,$342.00 , N/A ,$349.60 ,$342.00 ,$253.23 ,$253.23 ,$231.42 ,$253.23 ,$247.00 ,$264.67 ,$84.44 ,$300.20 ,$44.69 ,$190.00 ,$190.00 ,$129.20 ,$190.00 , N/A ,$361.00 ,$311.60 ,$311.60 ,$304.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,$668.00 ,$334.00 ,$148.43 ,"$1,459.17 ",$767.36 ,$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 ,$767.36 ,$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 ,$767.36 ,$668.00 ,$601.20 ,"$1,459.17 ",$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 ,$813.40 ,$668.00 ,$668.00 ,$227.12 ,$668.00 ,$648.52 ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),37080001,64415,HC INTRASCALENE BLOCK SINGLE,360,1 ,$668.00 ,$334.00 ,$148.43 ,"$2,167.48 ","$2,044.79 ",$565.06 ,$565.06 ,$227.12 ,$534.40 ,$567.80 ,$417.50 ,$601.20 ,"$2,044.79 ",$634.60 ,$601.20 ,$567.80 ,$567.80 ,$227.12 ,$567.80 ,$567.80 ,$601.20 ,"$2,044.79 ",$668.00 ,$601.20 ,"$1,891.64 ",$614.56 ,$601.20 ,$445.16 ,$445.16 ,$406.81 ,$445.16 ,$434.20 ,$465.26 ,$148.43 ,$527.72 ,"$2,167.48 ",$668.00 ,$668.00 ,$227.12 ,$668.00 ,$840.73 ,$634.60 ,$547.76 ,$547.76 ,$534.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),37609072,37609,"HC LIGAT, BX TEMP ARTERY",975,1 ,"$1,647.00 ",$823.50 ,$211.72 ,"$4,056.38 ","$3,826.77 ","$1,393.20 ","$1,393.20 ",$211.72 ,"$1,317.60 ","$1,399.95 ","$1,029.38 ","$1,482.30 ","$3,826.77 ","$1,564.65 ","$1,482.30 ","$1,399.95 ","$1,399.95 ",$211.72 ,"$1,399.95 ","$1,399.95 ","$1,482.30 ","$3,826.77 ",$691.74 ,"$1,482.30 ","$3,233.23 ","$1,515.24 ","$1,482.30 ","$1,097.56 ","$1,097.56 ","$1,003.02 ","$1,097.56 ","$1,070.55 ","$1,147.14 ",$365.96 ,"$1,301.13 ","$4,056.38 ", N/A , N/A ,$211.72 , N/A ,"$1,436.99 ","$1,564.65 ","$1,350.54 ","$1,350.54 ","$1,317.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37616072,37616,"HC LIGATION JMR ARTERY,CHEST",975,1 ,"$5,009.00 ","$2,504.50 ","$1,113.00 ","$22,036.77 ","$20,789.41 ","$4,237.11 ","$4,237.11 ","$1,118.56 ","$4,007.20 ","$4,257.65 ","$3,130.63 ","$4,508.10 ","$20,789.41 ","$4,758.55 ","$4,508.10 ","$4,257.65 ","$4,257.65 ","$1,118.56 ","$4,257.65 ","$4,257.65 ","$4,508.10 ","$20,789.41 ","$2,103.78 ","$4,508.10 ", N/A ,"$4,608.28 ","$4,508.10 ","$3,338.00 ","$3,338.00 ","$3,050.48 ","$3,338.00 ","$3,255.85 ","$3,488.77 ","$1,113.00 ","$3,957.11 ","$22,036.77 ", N/A , N/A ,"$1,118.56 ", N/A , N/A ,"$4,758.55 ","$4,107.38 ","$4,107.38 ","$4,007.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),39000107,P9016,HC RED CELLS L/R EA,390,1 ,$392.00 ,$196.00 ,$87.10 ,$432.88 ,$392.00 ,$331.59 ,$331.59 ,$133.28 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$392.00 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$133.28 ,$333.20 ,$333.20 ,$352.80 ,$392.00 ,$392.00 ,$352.80 ,$432.88 ,$360.64 ,$352.80 ,$261.23 ,$261.23 ,$238.73 ,$261.23 ,$254.80 ,$273.03 ,$87.10 ,$309.68 ,$415.52 ,$293.00 ,$293.00 ,$133.28 ,$293.00 ,$192.39 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000110,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$246.00 ,$123.00 ,$38.65 ,$246.00 ,$38.65 ,$208.09 ,$208.09 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$38.65 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$38.65 ,$246.00 ,$221.40 ,$189.90 ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$83.64 ,$246.00 ,$84.40 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000112,P9017,HC FRESH FROZEN PLASMA EA (AD-RC),390,1 ,$246.00 ,$123.00 ,$38.65 ,$246.00 ,$38.65 ,$208.09 ,$208.09 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$38.65 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$38.65 ,$246.00 ,$221.40 ,$189.90 ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$83.64 ,$246.00 ,$84.40 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000117,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,$353.00 ,$176.50 ,$78.44 ,$353.00 ,$262.22 ,$298.60 ,$298.60 ,$120.02 ,$282.40 ,$300.05 ,$220.63 ,$317.70 ,$262.22 ,$335.35 ,$317.70 ,$300.05 ,$300.05 ,$120.02 ,$300.05 ,$300.05 ,$317.70 ,$262.22 ,$353.00 ,$317.70 ,$344.41 ,$324.76 ,$317.70 ,$235.24 ,$235.24 ,$214.98 ,$235.24 ,$229.45 ,$245.86 ,$78.44 ,$278.87 ,$277.95 ,$293.00 ,$293.00 ,$120.02 ,$293.00 ,$153.07 ,$335.35 ,$289.46 ,$289.46 ,$282.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000120,P9035,HC PLATELETS PHER L/R EA,390,1 ,"$1,568.00 ",$784.00 ,$293.00 ,"$1,568.00 ",$658.97 ,"$1,326.37 ","$1,326.37 ",$533.12 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$658.97 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$533.12 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$658.97 ,$454.83 ,"$1,411.20 ","$1,118.05 ","$1,442.56 ","$1,411.20 ","$1,044.92 ","$1,044.92 ",$954.91 ,"$1,044.92 ","$1,019.20 ","$1,092.11 ",$348.41 ,"$1,238.72 ",$698.51 ,$293.00 ,$293.00 ,$533.12 ,$293.00 ,$496.91 ,"$1,489.60 ","$1,285.76 ","$1,285.76 ","$1,254.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),39000122,P9037,HC PLATELETS PHER L/R IRR EA,390,1 ,"$1,568.00 ",$784.00 ,$293.00 ,"$1,568.00 ",$658.97 ,"$1,326.37 ","$1,326.37 ",$533.12 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$658.97 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$533.12 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$658.97 ,$454.83 ,"$1,411.20 ","$1,418.22 ","$1,442.56 ","$1,411.20 ","$1,044.92 ","$1,044.92 ",$954.91 ,"$1,044.92 ","$1,019.20 ","$1,092.11 ",$348.41 ,"$1,238.72 ",$698.51 ,$293.00 ,$293.00 ,$533.12 ,$293.00 ,$630.32 ,"$1,489.60 ","$1,285.76 ","$1,285.76 ","$1,254.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),39000124,P9040,HC RED CELLS L/R IRR EA,390,1 ,$862.00 ,$431.00 ,$191.54 ,$862.00 ,$262.22 ,$729.17 ,$729.17 ,$293.08 ,$689.60 ,$732.70 ,$538.75 ,$775.80 ,$262.22 ,$818.90 ,$775.80 ,$732.70 ,$732.70 ,$293.08 ,$732.70 ,$732.70 ,$775.80 ,$262.22 ,$454.83 ,$775.80 ,$598.57 ,$793.04 ,$775.80 ,$574.44 ,$574.44 ,$524.96 ,$574.44 ,$560.30 ,$600.38 ,$191.54 ,$680.98 ,$277.95 ,$293.00 ,$293.00 ,$293.08 ,$293.00 ,$266.03 ,$818.90 ,$706.84 ,$706.84 ,$689.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000131,P9051,HC RBC L/R CMV NEG EA,390,1 ,$638.00 ,$319.00 ,$141.76 ,$638.00 ,$262.22 ,$539.68 ,$539.68 ,$216.92 ,$510.40 ,$542.30 ,$398.75 ,$574.20 ,$262.22 ,$606.10 ,$574.20 ,$542.30 ,$542.30 ,$216.92 ,$542.30 ,$542.30 ,$574.20 ,$262.22 ,$454.83 ,$574.20 ,$487.53 ,$586.96 ,$574.20 ,$425.16 ,$425.16 ,$388.54 ,$425.16 ,$414.70 ,$444.37 ,$141.76 ,$504.02 ,$277.95 ,$293.00 ,$293.00 ,$216.92 ,$293.00 ,$216.68 ,$606.10 ,$523.16 ,$523.16 ,$510.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000204,P9073,HC PLATELETS PHERESIS PATH REDUCED EA UN,390,1 ,"$1,139.00 ",$569.50 ,$253.09 ,"$1,341.29 ",$658.97 ,$963.48 ,$963.48 ,$387.26 ,$911.20 ,$968.15 ,$711.88 ,"$1,025.10 ",$658.97 ,"$1,082.05 ","$1,025.10 ",$968.15 ,$968.15 ,$387.26 ,$968.15 ,$968.15 ,"$1,025.10 ",$658.97 ,$454.83 ,"$1,025.10 ","$1,341.29 ","$1,047.88 ","$1,025.10 ",$759.03 ,$759.03 ,$693.65 ,$759.03 ,$740.35 ,$793.31 ,$253.09 ,$899.81 ,$698.51 ,$293.00 ,$293.00 ,$387.26 ,$293.00 ,$596.13 ,"$1,082.05 ",$933.98 ,$933.98 ,$911.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000211,P9059,HC COVID CONVALESCENT PLASMA,390,1 ,"$1,594.00 ",$797.00 ,$72.64 ,"$1,594.00 ",$262.22 ,"$1,348.36 ","$1,348.36 ",$541.96 ,"$1,275.20 ","$1,354.90 ",$996.25 ,"$1,434.60 ",$262.22 ,"$1,514.30 ","$1,434.60 ","$1,354.90 ","$1,354.90 ",$541.96 ,"$1,354.90 ","$1,354.90 ","$1,434.60 ",$262.22 ,$454.83 ,"$1,434.60 ",$163.44 ,"$1,466.48 ","$1,434.60 ","$1,062.24 ","$1,062.24 ",$970.75 ,"$1,062.24 ","$1,036.10 ","$1,110.22 ",$354.19 ,"$1,259.26 ",$277.95 ,$293.00 ,$293.00 ,$541.96 ,$293.00 ,$72.64 ,"$1,514.30 ","$1,307.08 ","$1,307.08 ","$1,275.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$937.00 ,$468.50 ,$208.20 ,$937.00 ,$811.44 ,$792.61 ,$792.61 ,$318.58 ,$749.60 ,$796.45 ,$585.63 ,$843.30 ,$811.44 ,$890.15 ,$843.30 ,$796.45 ,$796.45 ,$318.58 ,$796.45 ,$796.45 ,$843.30 ,$811.44 ,$454.83 ,$843.30 ,$912.08 ,$862.04 ,$843.30 ,$624.42 ,$624.42 ,$570.63 ,$624.42 ,$609.05 ,$652.62 ,$208.20 ,$740.23 ,$860.13 ,$293.00 ,$293.00 ,$318.58 ,$293.00 ,$405.37 ,$890.15 ,$768.34 ,$768.34 ,$749.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$325.00 ,$162.50 ,$72.22 ,$325.00 ,$89.25 ,$309.00 ,$206.00 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$89.25 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$89.25 ,$158.40 ,$292.50 ,$244.49 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$94.61 ,$179.00 ,$179.00 ,$110.50 ,$201.00 ,$108.66 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$325.00 ,$162.50 ,$72.22 ,$325.00 ,$89.25 ,$309.00 ,$206.00 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$89.25 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$89.25 ,$158.40 ,$292.50 ,$244.49 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$94.61 ,$179.00 ,$179.00 ,$110.50 ,$201.00 ,$108.66 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100005,77066,HC MAMMOGRAM DIAG BILAT W/CAD IMPLANT,401,1 ,$325.00 ,$162.50 ,$72.22 ,$325.00 ,$89.25 ,$309.00 ,$206.00 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$89.25 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$89.25 ,$158.40 ,$292.50 ,$244.49 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$94.61 ,$179.00 ,$179.00 ,$110.50 ,$201.00 ,$108.66 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100006,77066,HC MAMMOGRAM DIAG W/CAD UPGRADE BIL,401,1 ,$325.00 ,$162.50 ,$72.22 ,$325.00 ,$89.25 ,$309.00 ,$206.00 ,$110.50 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$89.25 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$110.50 ,$276.25 ,$276.25 ,$292.50 ,$89.25 ,$158.40 ,$292.50 ,$244.49 ,$299.00 ,$292.50 ,$216.58 ,$216.58 ,$197.93 ,$216.58 ,$211.25 ,$226.36 ,$72.22 ,$256.75 ,$94.61 ,$179.00 ,$179.00 ,$110.50 ,$201.00 ,$108.66 ,$308.75 ,$266.50 ,$266.50 ,$260.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$300.00 ,$150.00 ,$66.66 ,$300.00 ,$89.25 ,$300.00 ,$206.00 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$89.25 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 ,$89.25 ,$158.40 ,$270.00 ,$191.68 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,$94.61 ,$179.00 ,$179.00 ,$102.00 ,$201.00 ,$85.19 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD  ADDNT VIEW,401,1 ,$300.00 ,$150.00 ,$66.66 ,$300.00 ,$89.25 ,$300.00 ,$206.00 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$89.25 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 ,$89.25 ,$158.40 ,$270.00 ,$191.68 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,$94.61 ,$179.00 ,$179.00 ,$102.00 ,$201.00 ,$85.19 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$300.00 ,$150.00 ,$66.66 ,$300.00 ,$89.25 ,$300.00 ,$206.00 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$89.25 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 ,$89.25 ,$158.40 ,$270.00 ,$191.68 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,$94.61 ,$179.00 ,$179.00 ,$102.00 ,$201.00 ,$85.19 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100010,77065,HC MAMMOGRAM DIAG UNIL W/CAD UPGRADE,401,1 ,$300.00 ,$150.00 ,$66.66 ,$300.00 ,$89.25 ,$300.00 ,$206.00 ,$102.00 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$89.25 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$102.00 ,$255.00 ,$255.00 ,$270.00 ,$89.25 ,$158.40 ,$270.00 ,$191.68 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,$94.61 ,$179.00 ,$179.00 ,$102.00 ,$201.00 ,$85.19 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200007,51798,HC US BLADDER SCAN,402,1 ,$183.00 ,$91.50 ,$40.66 ,$183.00 ,$126.99 ,$183.00 ,$183.00 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$126.99 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$126.99 ,$183.00 ,$164.70 ,$127.91 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$134.61 ,$183.00 ,$183.00 ,$62.22 ,$183.00 ,$56.85 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,$790.00 ,$395.00 ,$111.19 ,$790.00 ,$194.98 ,$567.00 ,$530.00 ,$268.60 ,$632.00 ,$671.50 ,$493.75 ,$711.00 ,$194.98 ,$750.50 ,$711.00 ,$671.50 ,$671.50 ,$268.60 ,$671.50 ,$671.50 ,$711.00 ,$194.98 ,$305.48 ,$711.00 ,$250.18 ,$726.80 ,$711.00 ,$526.46 ,$526.46 ,$481.11 ,$526.46 ,$513.50 ,$550.24 ,$175.54 ,$624.10 ,$206.68 ,$446.00 ,$446.00 ,$268.60 ,$505.00 ,$111.19 ,$750.50 ,$647.80 ,$647.80 ,$632.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200014,76604,HC US CHEST,402,1 ,$580.00 ,$290.00 ,$111.19 ,$580.00 ,$194.98 ,$567.00 ,$530.00 ,$197.20 ,$464.00 ,$493.00 ,$362.50 ,$522.00 ,$194.98 ,$551.00 ,$522.00 ,$493.00 ,$493.00 ,$197.20 ,$493.00 ,$493.00 ,$522.00 ,$194.98 ,$305.48 ,$522.00 ,$250.18 ,$533.60 ,$522.00 ,$386.51 ,$386.51 ,$353.22 ,$386.51 ,$377.00 ,$403.97 ,$128.88 ,$458.20 ,$206.68 ,$446.00 ,$446.00 ,$197.20 ,$505.00 ,$111.19 ,$551.00 ,$475.60 ,$475.60 ,$464.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$340.00 ,$111.19 ,$680.00 ,$292.47 ,$567.00 ,$530.00 ,$231.20 ,$544.00 ,$578.00 ,$425.00 ,$612.00 ,$292.47 ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$231.20 ,$578.00 ,$578.00 ,$612.00 ,$292.47 ,$305.48 ,$612.00 ,$250.18 ,$625.60 ,$612.00 ,$453.15 ,$453.15 ,$414.12 ,$453.15 ,$442.00 ,$473.62 ,$151.10 ,$537.20 ,$310.02 ,$446.00 ,$446.00 ,$231.20 ,$505.00 ,$111.19 ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$340.00 ,$111.19 ,$680.00 ,$292.47 ,$567.00 ,$530.00 ,$231.20 ,$544.00 ,$578.00 ,$425.00 ,$612.00 ,$292.47 ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$231.20 ,$578.00 ,$578.00 ,$612.00 ,$292.47 ,$305.48 ,$612.00 ,$250.18 ,$625.60 ,$612.00 ,$453.15 ,$453.15 ,$414.12 ,$453.15 ,$442.00 ,$473.62 ,$151.10 ,$537.20 ,$310.02 ,$446.00 ,$446.00 ,$231.20 ,$505.00 ,$111.19 ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$275.00 ,$82.61 ,$550.00 ,$292.47 ,$550.00 ,$530.00 ,$187.00 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$292.47 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$187.00 ,$467.50 ,$467.50 ,$495.00 ,$292.47 ,$305.48 ,$495.00 ,$185.87 ,$506.00 ,$495.00 ,$366.52 ,$366.52 ,$334.95 ,$366.52 ,$357.50 ,$383.08 ,$122.21 ,$434.50 ,$310.02 ,$446.00 ,$446.00 ,$187.00 ,$505.00 ,$82.61 ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$275.00 ,$82.61 ,$550.00 ,$292.47 ,$550.00 ,$530.00 ,$187.00 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$292.47 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$187.00 ,$467.50 ,$467.50 ,$495.00 ,$292.47 ,$305.48 ,$495.00 ,$185.87 ,$506.00 ,$495.00 ,$366.52 ,$366.52 ,$334.95 ,$366.52 ,$357.50 ,$383.08 ,$122.21 ,$434.50 ,$310.02 ,$446.00 ,$446.00 ,$187.00 ,$505.00 ,$82.61 ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,100.00 ",$550.00 ,$111.19 ,"$1,100.00 ",$295.99 ,$567.00 ,$530.00 ,$374.00 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$295.99 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$374.00 ,$935.00 ,$935.00 ,$990.00 ,$295.99 ,$305.48 ,$990.00 ,$250.18 ,"$1,012.00 ",$990.00 ,$733.04 ,$733.04 ,$669.90 ,$733.04 ,$715.00 ,$766.15 ,$244.42 ,$869.00 ,$313.75 ,$446.00 ,$446.00 ,$374.00 ,$505.00 ,$111.19 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200018,76705,HC US ABDOMEN LTD,402,1 ,$820.00 ,$410.00 ,$111.19 ,$820.00 ,$194.98 ,$567.00 ,$530.00 ,$278.80 ,$656.00 ,$697.00 ,$512.50 ,$738.00 ,$194.98 ,$779.00 ,$738.00 ,$697.00 ,$697.00 ,$278.80 ,$697.00 ,$697.00 ,$738.00 ,$194.98 ,$305.48 ,$738.00 ,$250.18 ,$754.40 ,$738.00 ,$546.45 ,$546.45 ,$499.38 ,$546.45 ,$533.00 ,$571.13 ,$182.20 ,$647.80 ,$206.68 ,$446.00 ,$446.00 ,$278.80 ,$505.00 ,$111.19 ,$779.00 ,$672.40 ,$672.40 ,$656.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200019,76770,HC US RETROPERITIONEAL,402,1 ,$810.00 ,$405.00 ,$111.19 ,$810.00 ,$295.99 ,$567.00 ,$530.00 ,$275.40 ,$648.00 ,$688.50 ,$506.25 ,$729.00 ,$295.99 ,$769.50 ,$729.00 ,$688.50 ,$688.50 ,$275.40 ,$688.50 ,$688.50 ,$729.00 ,$295.99 ,$305.48 ,$729.00 ,$250.18 ,$745.20 ,$729.00 ,$539.78 ,$539.78 ,$493.29 ,$539.78 ,$526.50 ,$564.17 ,$179.98 ,$639.90 ,$313.75 ,$446.00 ,$446.00 ,$275.40 ,$505.00 ,$111.19 ,$769.50 ,$664.20 ,$664.20 ,$648.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$740.00 ,$370.00 ,$111.19 ,$740.00 ,$194.98 ,$567.00 ,$530.00 ,$251.60 ,$592.00 ,$629.00 ,$462.50 ,$666.00 ,$194.98 ,$703.00 ,$666.00 ,$629.00 ,$629.00 ,$251.60 ,$629.00 ,$629.00 ,$666.00 ,$194.98 ,$305.48 ,$666.00 ,$250.18 ,$680.80 ,$666.00 ,$493.14 ,$493.14 ,$450.66 ,$493.14 ,$481.00 ,$515.41 ,$164.43 ,$584.60 ,$206.68 ,$446.00 ,$446.00 ,$251.60 ,$505.00 ,$111.19 ,$703.00 ,$606.80 ,$606.80 ,$592.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200022,76800,HC US SPINAL CANAL  AND  CONTENTS,402,1 ,$500.00 ,$250.00 ,$111.10 ,$500.00 ,$194.98 ,$500.00 ,$500.00 ,$170.00 ,$400.00 ,$425.00 ,$312.50 ,$450.00 ,$194.98 ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$170.00 ,$425.00 ,$425.00 ,$450.00 ,$194.98 ,$305.48 ,$450.00 ,$250.18 ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$111.10 ,$395.00 ,$206.68 ,$446.00 ,$446.00 ,$170.00 ,$500.00 ,$111.19 ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,$650.00 ,$325.00 ,$111.19 ,$650.00 ,$179.25 ,$567.00 ,$530.00 ,$221.00 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$179.25 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$221.00 ,$552.50 ,$552.50 ,$585.00 ,$179.25 ,$305.48 ,$585.00 ,$250.18 ,$598.00 ,$585.00 ,$433.16 ,$433.16 ,$395.85 ,$433.16 ,$422.50 ,$452.73 ,$144.43 ,$513.50 ,$190.01 ,$446.00 ,$446.00 ,$221.00 ,$505.00 ,$111.19 ,$617.50 ,$533.00 ,$533.00 ,$520.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$360.00 ,$180.00 ,$79.99 ,$360.00 ,$179.25 ,$360.00 ,$360.00 ,$122.40 ,$288.00 ,$306.00 ,$225.00 ,$324.00 ,$179.25 ,$342.00 ,$324.00 ,$306.00 ,$306.00 ,$122.40 ,$306.00 ,$306.00 ,$324.00 ,$179.25 ,$305.48 ,$324.00 , N/A ,$331.20 ,$324.00 ,$239.90 ,$239.90 ,$219.24 ,$239.90 ,$234.00 ,$250.74 ,$79.99 ,$284.40 ,$190.01 ,$360.00 ,$360.00 ,$122.40 ,$360.00 , N/A ,$342.00 ,$295.20 ,$295.20 ,$288.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,$820.00 ,$410.00 ,$111.19 ,$820.00 ,$179.25 ,$567.00 ,$530.00 ,$278.80 ,$656.00 ,$697.00 ,$512.50 ,$738.00 ,$179.25 ,$779.00 ,$738.00 ,$697.00 ,$697.00 ,$278.80 ,$697.00 ,$697.00 ,$738.00 ,$179.25 ,$305.48 ,$738.00 ,$250.18 ,$754.40 ,$738.00 ,$546.45 ,$546.45 ,$499.38 ,$546.45 ,$533.00 ,$571.13 ,$182.20 ,$647.80 ,$190.01 ,$446.00 ,$446.00 ,$278.80 ,$505.00 ,$111.19 ,$779.00 ,$672.40 ,$672.40 ,$656.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,$440.00 ,$220.00 ,$97.77 ,$440.00 ,$179.25 ,$440.00 ,$440.00 ,$149.60 ,$352.00 ,$374.00 ,$275.00 ,$396.00 ,$179.25 ,$418.00 ,$396.00 ,$374.00 ,$374.00 ,$149.60 ,$374.00 ,$374.00 ,$396.00 ,$179.25 ,$305.48 ,$396.00 , N/A ,$404.80 ,$396.00 ,$293.22 ,$293.22 ,$267.96 ,$293.22 ,$286.00 ,$306.46 ,$97.77 ,$347.60 ,$190.01 ,$440.00 ,$440.00 ,$149.60 ,$440.00 , N/A ,$418.00 ,$360.80 ,$360.80 ,$352.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,$930.00 ,$465.00 ,$179.25 ,$930.00 ,$179.25 ,$567.00 ,$530.00 ,$316.20 ,$744.00 ,$790.50 ,$581.25 ,$837.00 ,$179.25 ,$883.50 ,$837.00 ,$790.50 ,$790.50 ,$316.20 ,$790.50 ,$790.50 ,$837.00 ,$179.25 ,$305.48 ,$837.00 ,$528.75 ,$855.60 ,$837.00 ,$619.75 ,$619.75 ,$566.37 ,$619.75 ,$604.50 ,$647.75 ,$206.65 ,$734.70 ,$190.01 ,$446.00 ,$446.00 ,$316.20 ,$505.00 ,$235.00 ,$883.50 ,$762.60 ,$762.60 ,$744.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$460.00 ,$230.00 ,$102.21 ,$460.00 ,$179.25 ,$460.00 ,$460.00 ,$156.40 ,$368.00 ,$391.00 ,$287.50 ,$414.00 ,$179.25 ,$437.00 ,$414.00 ,$391.00 ,$391.00 ,$156.40 ,$391.00 ,$391.00 ,$414.00 ,$179.25 ,$305.48 ,$414.00 ,$250.18 ,$423.20 ,$414.00 ,$306.54 ,$306.54 ,$280.14 ,$306.54 ,$299.00 ,$320.39 ,$102.21 ,$363.40 ,$190.01 ,$446.00 ,$446.00 ,$156.40 ,$460.00 ,$111.19 ,$437.00 ,$377.20 ,$377.20 ,$368.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200031,76815,HC US FETAL HEART BEAT,402,1 ,$480.00 ,$240.00 ,$106.66 ,$480.00 ,$179.25 ,$480.00 ,$480.00 ,$163.20 ,$384.00 ,$408.00 ,$300.00 ,$432.00 ,$179.25 ,$456.00 ,$432.00 ,$408.00 ,$408.00 ,$163.20 ,$408.00 ,$408.00 ,$432.00 ,$179.25 ,$305.48 ,$432.00 ,$250.18 ,$441.60 ,$432.00 ,$319.87 ,$319.87 ,$292.32 ,$319.87 ,$312.00 ,$334.32 ,$106.66 ,$379.20 ,$190.01 ,$446.00 ,$446.00 ,$163.20 ,$480.00 ,$111.19 ,$456.00 ,$393.60 ,$393.60 ,$384.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$630.00 ,$315.00 ,$111.19 ,$630.00 ,$179.25 ,$567.00 ,$530.00 ,$214.20 ,$504.00 ,$535.50 ,$393.75 ,$567.00 ,$179.25 ,$598.50 ,$567.00 ,$535.50 ,$535.50 ,$214.20 ,$535.50 ,$535.50 ,$567.00 ,$179.25 ,$305.48 ,$567.00 ,$250.18 ,$579.60 ,$567.00 ,$419.83 ,$419.83 ,$383.67 ,$419.83 ,$409.50 ,$438.80 ,$139.99 ,$497.70 ,$190.01 ,$446.00 ,$446.00 ,$214.20 ,$505.00 ,$111.19 ,$598.50 ,$516.60 ,$516.60 ,$504.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200033,76818,HC US FETAL BIO PROFILE W/NST,402,1 ,$700.00 ,$350.00 ,$111.19 ,$700.00 ,$179.25 ,$567.00 ,$530.00 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$179.25 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$179.25 ,$305.48 ,$630.00 ,$250.18 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$190.01 ,$446.00 ,$446.00 ,$238.00 ,$505.00 ,$111.19 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200038,76830,HC US TRANSVAGINAL,402,1 ,$760.00 ,$380.00 ,$111.19 ,$760.00 ,$194.98 ,$567.00 ,$530.00 ,$258.40 ,$608.00 ,$646.00 ,$475.00 ,$684.00 ,$194.98 ,$722.00 ,$684.00 ,$646.00 ,$646.00 ,$258.40 ,$646.00 ,$646.00 ,$684.00 ,$194.98 ,$305.48 ,$684.00 ,$250.18 ,$699.20 ,$684.00 ,$506.46 ,$506.46 ,$462.84 ,$506.46 ,$494.00 ,$529.34 ,$168.87 ,$600.40 ,$206.68 ,$446.00 ,$446.00 ,$258.40 ,$505.00 ,$111.19 ,$722.00 ,$623.20 ,$623.20 ,$608.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200040,76856,HC US PELVIS NON OB,402,1 ,$880.00 ,$440.00 ,$111.19 ,$880.00 ,$295.99 ,$567.00 ,$530.00 ,$299.20 ,$704.00 ,$748.00 ,$550.00 ,$792.00 ,$295.99 ,$836.00 ,$792.00 ,$748.00 ,$748.00 ,$299.20 ,$748.00 ,$748.00 ,$792.00 ,$295.99 ,$305.48 ,$792.00 ,$250.18 ,$809.60 ,$792.00 ,$586.43 ,$586.43 ,$535.92 ,$586.43 ,$572.00 ,$612.92 ,$195.54 ,$695.20 ,$313.75 ,$446.00 ,$446.00 ,$299.20 ,$505.00 ,$111.19 ,$836.00 ,$721.60 ,$721.60 ,$704.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$690.00 ,$345.00 ,$111.19 ,$690.00 ,$194.98 ,$567.00 ,$530.00 ,$234.60 ,$552.00 ,$586.50 ,$431.25 ,$621.00 ,$194.98 ,$655.50 ,$621.00 ,$586.50 ,$586.50 ,$234.60 ,$586.50 ,$586.50 ,$621.00 ,$194.98 ,$305.48 ,$621.00 ,$250.18 ,$634.80 ,$621.00 ,$459.82 ,$459.82 ,$420.21 ,$459.82 ,$448.50 ,$480.59 ,$153.32 ,$545.10 ,$206.68 ,$446.00 ,$446.00 ,$234.60 ,$505.00 ,$111.19 ,$655.50 ,$565.80 ,$565.80 ,$552.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200042,76870,HC US SCROTUM,402,1 ,$740.00 ,$370.00 ,$111.19 ,$740.00 ,$194.98 ,$567.00 ,$530.00 ,$251.60 ,$592.00 ,$629.00 ,$462.50 ,$666.00 ,$194.98 ,$703.00 ,$666.00 ,$629.00 ,$629.00 ,$251.60 ,$629.00 ,$629.00 ,$666.00 ,$194.98 ,$305.48 ,$666.00 ,$250.18 ,$680.80 ,$666.00 ,$493.14 ,$493.14 ,$450.66 ,$493.14 ,$481.00 ,$515.41 ,$164.43 ,$584.60 ,$206.68 ,$446.00 ,$446.00 ,$251.60 ,$505.00 ,$111.19 ,$703.00 ,$606.80 ,$606.80 ,$592.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$810.00 ,$405.00 ,$111.19 ,$810.00 ,$194.98 ,$567.00 ,$530.00 ,$275.40 ,$648.00 ,$688.50 ,$506.25 ,$729.00 ,$194.98 ,$769.50 ,$729.00 ,$688.50 ,$688.50 ,$275.40 ,$688.50 ,$688.50 ,$729.00 ,$194.98 ,$305.48 ,$729.00 ,$250.18 ,$745.20 ,$729.00 ,$539.78 ,$539.78 ,$493.29 ,$539.78 ,$526.50 ,$564.17 ,$179.98 ,$639.90 ,$206.68 ,$446.00 ,$446.00 ,$275.40 ,$505.00 ,$111.19 ,$769.50 ,$664.20 ,$664.20 ,$648.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$550.00 ,$275.00 ,$111.19 ,$550.00 ,$194.98 ,$550.00 ,$530.00 ,$187.00 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$194.98 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$187.00 ,$467.50 ,$467.50 ,$495.00 ,$194.98 ,$305.48 ,$495.00 ,$250.18 ,$506.00 ,$495.00 ,$366.52 ,$366.52 ,$334.95 ,$366.52 ,$357.50 ,$383.08 ,$122.21 ,$434.50 ,$206.68 ,$446.00 ,$446.00 ,$187.00 ,$505.00 ,$111.19 ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$530.00 ,$265.00 ,$117.77 ,$530.00 ,$199.50 ,$530.00 ,$530.00 ,$180.20 ,$424.00 ,$450.50 ,$331.25 ,$477.00 ,$199.50 ,$503.50 ,$477.00 ,$450.50 ,$450.50 ,$180.20 ,$450.50 ,$450.50 ,$477.00 ,$199.50 ,$305.48 ,$477.00 , N/A ,$487.60 ,$477.00 ,$353.19 ,$353.19 ,$322.77 ,$353.19 ,$344.50 ,$369.15 ,$117.77 ,$418.70 ,$211.47 ,$446.00 ,$446.00 ,$180.20 ,$505.00 , N/A ,$503.50 ,$434.60 ,$434.60 ,$424.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,$890.00 ,$445.00 ,$197.76 ,$890.00 ,$199.50 ,$567.00 ,$530.00 ,$302.60 ,$712.00 ,$756.50 ,$556.25 ,$801.00 ,$199.50 ,$845.50 ,$801.00 ,$756.50 ,$756.50 ,$302.60 ,$756.50 ,$756.50 ,$801.00 ,$199.50 ,$305.48 ,$801.00 , N/A ,$818.80 ,$801.00 ,$593.10 ,$593.10 ,$542.01 ,$593.10 ,$578.50 ,$619.89 ,$197.76 ,$703.10 ,$211.47 ,$446.00 ,$446.00 ,$302.60 ,$505.00 , N/A ,$845.50 ,$729.80 ,$729.80 ,$712.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200062,76998,HC US INTRAOPERATIVE,402,1 ,"$1,200.00 ",$600.00 ,$199.50 ,"$1,200.00 ",$199.50 ,$567.00 ,$530.00 ,$408.00 ,$960.00 ,"$1,020.00 ",$750.00 ,"$1,080.00 ",$199.50 ,"$1,140.00 ","$1,080.00 ","$1,020.00 ","$1,020.00 ",$408.00 ,"$1,020.00 ","$1,020.00 ","$1,080.00 ",$199.50 ,$305.48 ,"$1,080.00 ", N/A ,"$1,104.00 ","$1,080.00 ",$799.68 ,$799.68 ,$730.80 ,$799.68 ,$780.00 ,$835.80 ,$266.64 ,$948.00 ,$211.47 ,$446.00 ,$446.00 ,$408.00 ,$505.00 , N/A ,"$1,140.00 ",$984.00 ,$984.00 ,$960.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$1,100.00 ",$550.00 ,$235.00 ,"$1,100.00 ",$295.99 ,$567.00 ,$530.00 ,$374.00 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$295.99 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$374.00 ,$935.00 ,$935.00 ,$990.00 ,$295.99 ,$305.48 ,$990.00 ,$528.75 ,"$1,012.00 ",$990.00 ,$733.04 ,$733.04 ,$669.90 ,$733.04 ,$715.00 ,$766.15 ,$244.42 ,$869.00 ,$313.75 ,$446.00 ,$446.00 ,$374.00 ,$505.00 ,$235.00 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200068,93976,HC DUPLEX ABD/PEL/RETRO LTD,402,1 ,"$1,000.00 ",$500.00 ,$111.19 ,"$1,000.00 ",$295.99 ,$567.00 ,$530.00 ,$340.00 ,$800.00 ,$850.00 ,$625.00 ,$900.00 ,$295.99 ,$950.00 ,$900.00 ,$850.00 ,$850.00 ,$340.00 ,$850.00 ,$850.00 ,$900.00 ,$295.99 ,$305.48 ,$900.00 ,$250.18 ,$920.00 ,$900.00 ,$666.40 ,$666.40 ,$609.00 ,$666.40 ,$650.00 ,$696.50 ,$222.20 ,$790.00 ,$313.75 ,$446.00 ,$446.00 ,$340.00 ,$505.00 ,$111.19 ,$950.00 ,$820.00 ,$820.00 ,$800.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,000.00 ",$500.00 ,$111.19 ,"$1,000.00 ",$295.99 ,$567.00 ,$530.00 ,$340.00 ,$800.00 ,$850.00 ,$625.00 ,$900.00 ,$295.99 ,$950.00 ,$900.00 ,$850.00 ,$850.00 ,$340.00 ,$850.00 ,$850.00 ,$900.00 ,$295.99 ,$305.48 ,$900.00 ,$250.18 ,$920.00 ,$900.00 ,$666.40 ,$666.40 ,$609.00 ,$666.40 ,$650.00 ,$696.50 ,$222.20 ,$790.00 ,$313.75 ,$446.00 ,$446.00 ,$340.00 ,$505.00 ,$111.19 ,$950.00 ,$820.00 ,$820.00 ,$800.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200075,76706,HC US AORTA (SCREENING),402,1 ,$500.00 ,$250.00 ,$111.10 ,$500.00 ,$194.98 ,$500.00 ,$500.00 ,$170.00 ,$400.00 ,$425.00 ,$312.50 ,$450.00 ,$194.98 ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$170.00 ,$425.00 ,$425.00 ,$450.00 ,$194.98 ,$305.48 ,$450.00 ,$250.18 ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$111.10 ,$395.00 ,$206.68 ,$446.00 ,$446.00 ,$170.00 ,$500.00 ,$111.19 ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$300.00 ,$150.00 ,$89.25 ,$300.00 ,$89.25 ,$300.00 ,$206.00 ,$89.75 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$89.25 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$89.75 ,$255.00 ,$255.00 ,$270.00 ,$89.25 ,$158.40 ,$270.00 ,$201.94 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$90.65 ,$237.00 ,$94.61 ,$179.00 ,$179.00 ,$89.75 ,$201.00 ,$89.75 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$300.00 ,$150.00 ,$89.25 ,$300.00 ,$89.25 ,$300.00 ,$206.00 ,$89.75 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$89.25 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$89.75 ,$255.00 ,$255.00 ,$270.00 ,$89.25 ,$158.40 ,$270.00 ,$201.94 ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$90.65 ,$237.00 ,$94.61 ,$179.00 ,$179.00 ,$89.75 ,$201.00 ,$89.75 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000002,31502,HC CHG TUBE TRACHEOTOMY,410,1 ,$485.00 ,$242.50 ,$89.38 ,$486.16 ,$195.84 ,$410.26 ,$410.26 ,$164.90 ,$388.00 ,$412.25 ,$303.13 ,$436.50 ,$195.84 ,$460.75 ,$436.50 ,$412.25 ,$412.25 ,$164.90 ,$412.25 ,$412.25 ,$436.50 ,$195.84 ,$89.38 ,$436.50 ,$486.16 ,$446.20 ,$436.50 ,$323.20 ,$323.20 ,$295.37 ,$323.20 ,$315.25 ,$337.80 ,$107.77 ,$383.15 ,$207.59 ,$163.00 ,$163.00 ,$164.90 ,$183.00 ,$216.07 ,$460.75 ,$397.70 ,$397.70 ,$388.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000005,92950,HC CPR,480,1 ,$749.00 ,$374.50 ,$166.43 ,"$1,697.76 ","$1,601.66 ",$633.58 ,$633.58 ,$254.66 ,$599.20 ,$636.65 ,$468.13 ,$674.10 ,"$1,601.66 ",$711.55 ,$674.10 ,$636.65 ,$636.65 ,$254.66 ,$636.65 ,$636.65 ,$674.10 ,"$1,601.66 ",$749.00 ,$674.10 ,$608.15 ,$689.08 ,$674.10 ,$499.13 ,$499.13 ,$456.14 ,$499.13 ,$486.85 ,$521.68 ,$166.43 ,$591.71 ,"$1,697.76 ",$749.00 ,$749.00 ,$254.66 ,$749.00 ,$270.29 ,$711.55 ,$614.18 ,$614.18 ,$599.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000008,N/A,HC HIGH FLOW OXYGEN CANNULA,410,1 ,$84.00 ,$42.00 ,$18.66 ,$84.00 , N/A ,$71.06 ,$71.06 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 , N/A ,$84.00 ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 , N/A ,$84.00 ,$84.00 ,$28.56 ,$84.00 , N/A ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,202.69 ","$1,134.61 ",$837.44 ,$837.44 ,$336.60 ,$792.00 ,$841.50 ,$618.75 ,$891.00 ,"$1,134.61 ",$940.50 ,$891.00 ,$841.50 ,$841.50 ,$336.60 ,$841.50 ,$841.50 ,$891.00 ,"$1,134.61 ",$89.38 ,$891.00 ,"$1,119.47 ",$910.80 ,$891.00 ,$659.74 ,$659.74 ,$602.91 ,$659.74 ,$643.50 ,$689.54 ,$219.98 ,$782.10 ,"$1,202.69 ",$163.00 ,$163.00 ,$336.60 ,$183.00 ,$497.54 ,$940.50 ,$811.80 ,$811.80 ,$792.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000012,94002,HC VENT SEDATED INTL DAY,410,1 ,$990.00 ,$495.00 ,$89.38 ,"$1,202.69 ","$1,134.61 ",$837.44 ,$837.44 ,$336.60 ,$792.00 ,$841.50 ,$618.75 ,$891.00 ,"$1,134.61 ",$940.50 ,$891.00 ,$841.50 ,$841.50 ,$336.60 ,$841.50 ,$841.50 ,$891.00 ,"$1,134.61 ",$89.38 ,$891.00 ,"$1,119.47 ",$910.80 ,$891.00 ,$659.74 ,$659.74 ,$602.91 ,$659.74 ,$643.50 ,$689.54 ,$219.98 ,$782.10 ,"$1,202.69 ",$163.00 ,$163.00 ,$336.60 ,$183.00 ,$497.54 ,$940.50 ,$811.80 ,$811.80 ,$792.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$280.00 ,$140.00 ,$62.22 ,$431.93 ,$218.70 ,$236.85 ,$236.85 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$218.70 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$218.70 ,$89.38 ,$252.00 ,$431.93 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$231.82 ,$163.00 ,$163.00 ,$95.20 ,$183.00 ,$191.97 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$760.00 ,$380.00 ,$89.38 ,"$1,202.69 ","$1,134.61 ",$642.88 ,$642.88 ,$258.40 ,$608.00 ,$646.00 ,$475.00 ,$684.00 ,"$1,134.61 ",$722.00 ,$684.00 ,$646.00 ,$646.00 ,$258.40 ,$646.00 ,$646.00 ,$684.00 ,"$1,134.61 ",$89.38 ,$684.00 ,"$1,119.47 ",$699.20 ,$684.00 ,$506.46 ,$506.46 ,$462.84 ,$506.46 ,$494.00 ,$529.34 ,$168.87 ,$600.40 ,"$1,202.69 ",$163.00 ,$163.00 ,$258.40 ,$183.00 ,$497.54 ,$722.00 ,$623.20 ,$623.20 ,$608.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$280.00 ,$140.00 ,$62.22 ,$431.93 ,$218.70 ,$236.85 ,$236.85 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$218.70 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$218.70 ,$89.38 ,$252.00 ,$431.93 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$231.82 ,$163.00 ,$163.00 ,$95.20 ,$183.00 ,$191.97 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$75.00 ,$37.50 ,$16.67 ,$431.93 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$431.93 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$191.97 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000040,94640,HC EZ PAP TREATMENT,410,1 ,$75.00 ,$37.50 ,$16.67 ,$431.93 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$431.93 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$191.97 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$75.00 ,$37.50 ,$16.67 ,$431.93 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$431.93 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$191.97 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000042,94640,HC SPUTUM SPECIMEN INDUCTION,410,1 ,$75.00 ,$37.50 ,$16.67 ,$431.93 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$431.93 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$191.97 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000044,94640,HC UPDRAFT W/INSTRUCT AND EVAL,410,1 ,$75.00 ,$37.50 ,$16.67 ,$431.93 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$431.93 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$191.97 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000045,94640,HC AEROSOL GENERATOR CONT,410,1 ,$72.00 ,$36.00 ,$16.00 ,$431.93 ,$91.76 ,$60.90 ,$60.90 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 ,$91.76 ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 ,$91.76 ,$72.00 ,$64.80 ,$431.93 ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 ,$97.27 ,$72.00 ,$72.00 ,$24.48 ,$72.00 ,$191.97 ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000049,94642,HC AEROSOL INHALATION PENTAMIDINE,410,1 ,$183.00 ,$91.50 ,$40.66 ,$431.93 ,$91.76 ,$154.80 ,$154.80 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$91.76 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$91.76 ,$89.38 ,$164.70 ,$431.93 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$97.27 ,$163.00 ,$163.00 ,$62.22 ,$183.00 ,$191.97 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$246.00 ,$123.00 ,$54.66 ,$259.11 ,$91.76 ,$208.09 ,$208.09 ,$83.64 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$91.76 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$83.64 ,$209.10 ,$209.10 ,$221.40 ,$91.76 ,$89.38 ,$221.40 ,$259.11 ,$226.32 ,$221.40 ,$163.93 ,$163.93 ,$149.81 ,$163.93 ,$159.90 ,$171.34 ,$54.66 ,$194.34 ,$97.27 ,$163.00 ,$163.00 ,$83.64 ,$183.00 ,$115.16 ,$233.70 ,$201.72 ,$201.72 ,$196.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$46.00 ,$23.00 ,$10.22 ,$97.27 ,$91.76 ,$38.91 ,$38.91 ,$15.64 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$91.76 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$15.64 ,$39.10 ,$39.10 ,$41.40 ,$91.76 ,$46.00 ,$41.40 , N/A ,$42.32 ,$41.40 ,$30.65 ,$30.65 ,$28.01 ,$30.65 ,$29.90 ,$32.04 ,$10.22 ,$36.34 ,$97.27 ,$46.00 ,$46.00 ,$15.64 ,$46.00 , N/A ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000052,94660,HC CPAP,410,1 ,$280.00 ,$140.00 ,$62.22 ,$431.93 ,$218.70 ,$236.85 ,$236.85 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$218.70 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$218.70 ,$89.38 ,$252.00 ,$431.93 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$231.82 ,$163.00 ,$163.00 ,$95.20 ,$183.00 ,$191.97 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000053,94660,HC CPAP DAILY EST PT,410,1 ,$280.00 ,$140.00 ,$62.22 ,$431.93 ,$218.70 ,$236.85 ,$236.85 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$218.70 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$218.70 ,$89.38 ,$252.00 ,$431.93 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$231.82 ,$163.00 ,$163.00 ,$95.20 ,$183.00 ,$191.97 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$183.00 ,$91.50 ,$40.66 ,$431.93 ,$91.76 ,$154.80 ,$154.80 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$91.76 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$91.76 ,$89.38 ,$164.70 ,$431.93 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$97.27 ,$163.00 ,$163.00 ,$62.22 ,$183.00 ,$191.97 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$97.00 ,$48.50 ,$21.55 ,$259.11 ,$91.76 ,$82.05 ,$82.05 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$91.76 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$91.76 ,$89.38 ,$87.30 ,$259.11 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$97.27 ,$97.00 ,$97.00 ,$32.98 ,$97.00 ,$115.16 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$348.00 ,$174.00 ,$77.33 ,$348.00 ,$91.76 ,$294.37 ,$294.37 ,$118.32 ,$278.40 ,$295.80 ,$217.50 ,$313.20 ,$91.76 ,$330.60 ,$313.20 ,$295.80 ,$295.80 ,$118.32 ,$295.80 ,$295.80 ,$313.20 ,$91.76 ,$89.38 ,$313.20 ,$259.11 ,$320.16 ,$313.20 ,$231.91 ,$231.91 ,$211.93 ,$231.91 ,$226.20 ,$242.38 ,$77.33 ,$274.92 ,$97.27 ,$163.00 ,$163.00 ,$118.32 ,$183.00 ,$115.16 ,$330.60 ,$285.36 ,$285.36 ,$278.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$75.00 ,$37.50 ,$16.67 ,$259.11 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$259.11 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$115.16 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$75.00 ,$37.50 ,$16.67 ,$259.11 ,$91.76 ,$63.44 ,$63.44 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$91.76 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$91.76 ,$75.00 ,$67.50 ,$259.11 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$97.27 ,$75.00 ,$75.00 ,$25.50 ,$75.00 ,$115.16 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$86.00 ,$43.00 ,$19.11 ,$86.00 ,$62.72 ,$72.75 ,$72.75 ,$29.24 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$62.72 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$29.24 ,$73.10 ,$73.10 ,$77.40 ,$62.72 ,$86.00 ,$77.40 ,$56.77 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$19.11 ,$67.94 ,$66.48 ,$86.00 ,$86.00 ,$29.24 ,$86.00 ,$25.23 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000072,G0238,HC RESP THRP FUNC-59,410,1 ,$92.00 ,$46.00 ,$20.44 ,$92.00 ,$62.72 ,$77.82 ,$77.82 ,$31.28 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$62.72 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$31.28 ,$78.20 ,$78.20 ,$82.80 ,$62.72 ,$89.38 ,$82.80 ,$56.77 ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 ,$66.48 ,$92.00 ,$92.00 ,$31.28 ,$92.00 ,$25.23 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000087,94669,HC MECHANICAL CHEST WALL OSCILLATION INITIAL,410,1 ,$567.00 ,$283.50 ,$89.38 ,$567.00 ,$91.76 ,$479.63 ,$479.63 ,$192.78 ,$453.60 ,$481.95 ,$354.38 ,$510.30 ,$91.76 ,$538.65 ,$510.30 ,$481.95 ,$481.95 ,$192.78 ,$481.95 ,$481.95 ,$510.30 ,$91.76 ,$89.38 ,$510.30 ,$431.93 ,$521.64 ,$510.30 ,$377.85 ,$377.85 ,$345.30 ,$377.85 ,$368.55 ,$394.92 ,$125.99 ,$447.93 ,$97.27 ,$163.00 ,$163.00 ,$192.78 ,$183.00 ,$191.97 ,$538.65 ,$464.94 ,$464.94 ,$453.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000008,95992,HC CANNALITH REPOSITIONING,420,1 ,$134.00 ,$67.00 ,$29.77 ,$134.00 , N/A ,$134.00 ,$134.00 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 , N/A ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 , N/A ,$109.75 ,$120.60 ,$95.27 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 , N/A ,$134.00 ,$134.00 ,$45.56 ,$134.00 ,$42.34 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000009,97012,HC TRACTION MECH APP,420,1 ,$100.00 ,$50.00 ,$13.97 ,$100.00 ,$25.78 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$25.78 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$25.78 ,$100.00 ,$90.00 ,$31.43 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$27.33 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$13.97 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000010,97016,HC APPLY VASOPNEUMATIC DEVICE,420,1 ,$90.00 ,$45.00 ,$11.55 ,$90.00 ,$25.19 ,$90.00 ,$90.00 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$25.19 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$25.19 ,$90.00 ,$81.00 ,$25.99 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$26.70 ,$90.00 ,$90.00 ,$30.60 ,$90.00 ,$11.55 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000015,97022,HC WHIRLPOOL BATH,420,1 ,$110.00 ,$55.00 ,$16.74 ,$110.00 ,$25.78 ,$110.00 ,$110.00 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$25.78 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$25.78 ,$109.75 ,$99.00 ,$37.67 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$27.33 ,$110.00 ,$110.00 ,$37.40 ,$110.00 ,$16.74 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000020,97022,HC FLUIDOTHERAPY,420,1 ,$110.00 ,$55.00 ,$16.74 ,$110.00 ,$25.78 ,$110.00 ,$110.00 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$25.78 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$25.78 ,$109.75 ,$99.00 ,$37.67 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$27.33 ,$110.00 ,$110.00 ,$37.40 ,$110.00 ,$16.74 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$90.00 ,$45.00 ,$14.30 ,$90.00 ,$22.38 ,$90.00 ,$90.00 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$22.38 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$22.38 ,$90.00 ,$81.00 ,$32.18 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$23.72 ,$90.00 ,$90.00 ,$30.60 ,$90.00 ,$14.30 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$110.00 ,$55.00 ,$19.21 ,$110.00 ,$23.51 ,$110.00 ,$110.00 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$23.51 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$23.51 ,$109.75 ,$99.00 ,$43.22 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$24.92 ,$110.00 ,$110.00 ,$37.40 ,$110.00 ,$19.21 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$90.00 ,$45.00 ,$13.89 ,$90.00 ,$18.49 ,$90.00 ,$90.00 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$18.49 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 ,$18.49 ,$90.00 ,$81.00 ,$31.25 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$19.60 ,$90.00 ,$90.00 ,$30.60 ,$90.00 ,$13.89 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$19.63 ,$100.00 ,$19.63 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$19.63 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$19.63 ,$100.00 ,$90.00 ,$64.85 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$20.81 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$28.82 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$130.00 ,$65.00 ,$19.32 ,$130.00 ,$19.32 ,$130.00 ,$130.00 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$19.32 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$19.32 ,$109.75 ,$117.00 ,$75.33 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$20.48 ,$130.00 ,$130.00 ,$44.20 ,$130.00 ,$33.48 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$16.47 ,$100.00 ,$16.47 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$16.47 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$16.47 ,$100.00 ,$90.00 ,$64.85 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$17.46 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$28.82 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 ,$23.41 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$23.41 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$23.41 ,$100.00 ,$90.00 ,$65.63 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$24.81 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$29.17 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 ,$25.53 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$25.53 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$25.53 ,$100.00 ,$90.00 ,$59.63 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$27.06 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$26.50 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000063,97150,HC GROUP TREATMENT 15MIN,420,1 ,$100.00 ,$50.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$6.08 ,$100.00 ,$90.00 ,$38.95 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$17.31 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$120.00 ,$60.00 ,$18.05 ,$120.00 ,$18.05 ,$120.00 ,$120.00 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$18.05 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 ,$18.05 ,$109.75 ,$108.00 ,$81.65 ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 ,$19.13 ,$120.00 ,$120.00 ,$40.80 ,$120.00 ,$36.29 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000068,97597,HC DEBR SKIN PART THICKNESS <20CM,420,1 ,$388.00 ,$194.00 ,$42.35 ,$388.00 ,$42.35 ,$268.00 ,$216.00 ,$131.92 ,$310.40 ,$329.80 ,$242.50 ,$349.20 ,$42.35 ,$368.60 ,$349.20 ,$329.80 ,$329.80 ,$131.92 ,$329.80 ,$329.80 ,$349.20 ,$42.35 ,$109.75 ,$349.20 ,$222.21 ,$356.96 ,$349.20 ,$258.56 ,$258.56 ,$236.29 ,$258.56 ,$252.20 ,$270.24 ,$86.21 ,$306.52 ,$44.89 ,$202.00 ,$202.00 ,$131.92 ,$224.00 ,$98.76 ,$368.60 ,$318.16 ,$318.16 ,$310.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000083,97598,HC DEBR SKIN PART THICKNESS EA ADDN>20CM FACIL,420,1 ,$172.00 ,$86.00 ,$35.14 ,$172.00 ,$35.14 ,$172.00 ,$172.00 ,$58.48 ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$35.14 ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$58.48 ,$146.20 ,$146.20 ,$154.80 ,$35.14 ,$109.75 ,$154.80 , N/A ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 ,$37.25 ,$172.00 ,$172.00 ,$58.48 ,$172.00 , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$215.00 ,$107.50 ,$41.41 ,$215.00 , N/A ,$215.00 ,$215.00 ,$73.10 ,$172.00 ,$182.75 ,$134.38 ,$193.50 , N/A ,$204.25 ,$193.50 ,$182.75 ,$182.75 ,$73.10 ,$182.75 ,$182.75 ,$193.50 , N/A ,$109.75 ,$193.50 ,$93.17 ,$197.80 ,$193.50 ,$143.28 ,$143.28 ,$130.94 ,$143.28 ,$139.75 ,$149.75 ,$47.77 ,$169.85 , N/A ,$202.00 ,$202.00 ,$73.10 ,$215.00 ,$41.41 ,$204.25 ,$176.30 ,$176.30 ,$172.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$280.00 ,$140.00 ,$49.00 ,$280.00 , N/A ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 , N/A ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 , N/A ,$109.75 ,$252.00 ,$110.25 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 , N/A ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$49.00 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 , N/A ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 , N/A ,$100.00 ,$90.00 ,$73.64 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 , N/A ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$32.73 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000120,97150,HC GROUP TREATMENT 30MIN,420,1 ,$100.00 ,$50.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$6.08 ,$100.00 ,$90.00 ,$38.95 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$17.31 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000121,97150,HC GROUP TREATMENT 45MIN,420,1 ,$100.00 ,$50.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$6.08 ,$100.00 ,$90.00 ,$38.95 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$17.31 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000122,97150,HC GROUP TREATMENT 60MIN,420,1 ,$100.00 ,$50.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$6.08 ,$100.00 ,$90.00 ,$38.95 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$34.00 ,$100.00 ,$17.31 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$220.55 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.02 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$158.00 ,$79.00 ,$35.11 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$53.72 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$53.72 ,$134.30 ,$134.30 ,$142.20 ,$62.66 ,$109.75 ,$142.20 ,$151.94 ,$145.36 ,$142.20 ,$105.29 ,$105.29 ,$96.22 ,$105.29 ,$102.70 ,$110.05 ,$35.11 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$53.72 ,$158.00 ,$67.53 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$158.00 ,$79.00 ,$35.11 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$53.72 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$53.72 ,$134.30 ,$134.30 ,$142.20 ,$62.66 ,$109.75 ,$142.20 ,$151.94 ,$145.36 ,$142.20 ,$105.29 ,$105.29 ,$96.22 ,$105.29 ,$102.70 ,$110.05 ,$35.11 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$53.72 ,$158.00 ,$67.53 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$158.00 ,$79.00 ,$35.11 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$53.72 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$53.72 ,$134.30 ,$134.30 ,$142.20 ,$62.66 ,$109.75 ,$142.20 ,$151.94 ,$145.36 ,$142.20 ,$105.29 ,$105.29 ,$96.22 ,$105.29 ,$102.70 ,$110.05 ,$35.11 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$53.72 ,$158.00 ,$67.53 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$158.00 ,$79.00 ,$35.11 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$53.72 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$53.72 ,$134.30 ,$134.30 ,$142.20 ,$62.66 ,$109.75 ,$142.20 ,$151.94 ,$145.36 ,$142.20 ,$105.29 ,$105.29 ,$96.22 ,$105.29 ,$102.70 ,$110.05 ,$35.11 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$53.72 ,$158.00 ,$67.53 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$110.00 ,$55.00 ,$20.93 ,$110.00 ,$20.93 ,$110.00 ,$110.00 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$20.93 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 ,$20.93 ,$109.75 ,$99.00 ,$72.18 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 ,$22.19 ,$110.00 ,$110.00 ,$37.40 ,$110.00 ,$32.08 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43000024,97542,HC SEATING CLINIC EA 15 MIN,430,1 ,$134.24 ,$67.12 ,$18.94 ,$134.24 ,$18.94 ,$134.24 ,$134.24 ,$45.64 ,$107.39 ,$114.10 ,$83.90 ,$120.82 ,$18.94 ,$127.53 ,$120.82 ,$114.10 ,$114.10 ,$45.64 ,$114.10 ,$114.10 ,$120.82 ,$18.94 ,$109.75 ,$120.82 ,$70.11 ,$123.50 ,$120.82 ,$89.46 ,$89.46 ,$81.75 ,$89.46 ,$87.26 ,$93.50 ,$29.83 ,$106.05 ,$20.08 ,$134.24 ,$134.24 ,$45.64 ,$134.24 ,$31.16 ,$127.53 ,$110.08 ,$110.08 ,$107.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$110.00 ,$55.00 ,$24.44 ,$110.00 , N/A ,$110.00 ,$110.00 ,$37.40 ,$88.00 ,$93.50 ,$68.75 ,$99.00 , N/A ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$37.40 ,$93.50 ,$93.50 ,$99.00 , N/A ,$109.75 ,$99.00 ,$106.88 ,$101.20 ,$99.00 ,$73.30 ,$73.30 ,$66.99 ,$73.30 ,$71.50 ,$76.62 ,$24.44 ,$86.90 , N/A ,$110.00 ,$110.00 ,$37.40 ,$110.00 ,$47.50 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 , N/A ,$90.00 ,$90.00 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 , N/A ,$90.00 ,$81.00 ,$50.40 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 , N/A ,$90.00 ,$90.00 ,$30.60 ,$90.00 ,$22.40 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 , N/A ,$90.00 ,$90.00 ,$30.60 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$30.60 ,$76.50 ,$76.50 ,$81.00 , N/A ,$90.00 ,$81.00 ,$48.85 ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 , N/A ,$90.00 ,$90.00 ,$30.60 ,$90.00 ,$21.71 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43235072,43235,HC EGD DX W/WO SPECIMEN COLLECTION,975,1 ,"$1,416.00 ",$708.00 ,$129.52 ,"$1,859.38 ","$1,686.14 ","$1,197.79 ","$1,197.79 ",$129.52 ,"$1,132.80 ","$1,203.60 ",$885.00 ,"$1,274.40 ","$1,686.14 ","$1,345.20 ","$1,274.40 ","$1,203.60 ","$1,203.60 ",$129.52 ,"$1,203.60 ","$1,203.60 ","$1,274.40 ","$1,686.14 ",$594.72 ,"$1,274.40 ","$1,859.38 ","$1,302.72 ","$1,274.40 ",$943.62 ,$943.62 ,$862.34 ,$943.62 ,$920.40 ,$986.24 ,$314.64 ,"$1,118.64 ","$1,787.31 ", N/A , N/A ,$129.52 , N/A ,$826.39 ,"$1,345.20 ","$1,161.12 ","$1,161.12 ","$1,132.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),43239072,43239,HC EGC W/BX SINGLE,975,1 ,"$1,641.00 ",$820.50 ,$146.12 ,"$1,859.38 ","$1,686.14 ","$1,388.12 ","$1,388.12 ",$146.12 ,"$1,312.80 ","$1,394.85 ","$1,025.63 ","$1,476.90 ","$1,686.14 ","$1,558.95 ","$1,476.90 ","$1,394.85 ","$1,394.85 ",$146.12 ,"$1,394.85 ","$1,394.85 ","$1,476.90 ","$1,686.14 ",$689.22 ,"$1,476.90 ","$1,859.38 ","$1,509.72 ","$1,476.90 ","$1,093.56 ","$1,093.56 ",$999.37 ,"$1,093.56 ","$1,066.65 ","$1,142.96 ",$364.63 ,"$1,296.39 ","$1,787.31 ", N/A , N/A ,$146.12 , N/A ,$826.39 ,"$1,558.95 ","$1,345.62 ","$1,345.62 ","$1,312.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$263.00 ,$131.50 ,$58.44 ,$263.00 ,$62.66 ,$263.00 ,$216.00 ,$89.42 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$89.42 ,$223.55 ,$223.55 ,$236.70 ,$62.66 ,$109.75 ,$236.70 ,$222.01 ,$241.96 ,$236.70 ,$175.26 ,$175.26 ,$160.17 ,$175.26 ,$170.95 ,$183.18 ,$58.44 ,$207.77 ,$66.42 ,$202.00 ,$202.00 ,$89.42 ,$224.00 ,$98.67 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$130.00 ,$65.00 ,$28.89 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$62.66 ,$109.75 ,$117.00 ,$152.69 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$44.20 ,$130.00 ,$67.86 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$130.00 ,$65.00 ,$28.89 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$62.66 ,$109.75 ,$117.00 ,$152.69 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$44.20 ,$130.00 ,$67.86 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$130.00 ,$65.00 ,$28.89 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$62.66 ,$109.75 ,$117.00 ,$152.69 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$44.20 ,$130.00 ,$67.86 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$130.00 ,$65.00 ,$28.89 ,$152.69 ,$62.66 ,$130.00 ,$130.00 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$62.66 ,$109.75 ,$117.00 ,$152.69 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$44.20 ,$130.00 ,$67.86 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$47.91 ,$109.75 ,$252.00 ,$169.13 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$50.78 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$75.17 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$47.91 ,$109.75 ,$252.00 ,$169.13 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$50.78 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$75.17 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$47.91 ,$109.75 ,$252.00 ,$169.13 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$50.78 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$75.17 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$280.00 ,$140.00 ,$47.91 ,$280.00 ,$47.91 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$47.91 ,$109.75 ,$252.00 ,$169.13 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$50.78 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$75.17 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000008,92520,HC LARYNGEAL FUNCTION STUDY,440,1 ,$314.00 ,$157.00 ,$31.07 ,$314.00 ,$31.07 ,$268.00 ,$216.00 ,$106.76 ,$251.20 ,$266.90 ,$196.25 ,$282.60 ,$31.07 ,$298.30 ,$282.60 ,$266.90 ,$266.90 ,$106.76 ,$266.90 ,$266.90 ,$282.60 ,$31.07 ,$109.75 ,$282.60 ,$179.62 ,$288.88 ,$282.60 ,$209.25 ,$209.25 ,$191.23 ,$209.25 ,$204.10 ,$218.70 ,$69.77 ,$248.06 ,$32.93 ,$202.00 ,$202.00 ,$106.76 ,$224.00 ,$79.83 ,$298.30 ,$257.48 ,$257.48 ,$251.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$280.00 ,$140.00 ,$48.82 ,$280.00 ,$48.82 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$48.82 ,$109.75 ,$252.00 ,$187.65 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$51.75 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$83.40 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$280.00 ,$140.00 ,$48.82 ,$280.00 ,$48.82 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$48.82 ,$109.75 ,$252.00 ,$187.65 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$51.75 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$83.40 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$280.00 ,$140.00 ,$48.82 ,$280.00 ,$48.82 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$48.82 ,$109.75 ,$252.00 ,$187.65 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$51.75 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$83.40 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$280.00 ,$140.00 ,$48.82 ,$280.00 ,$48.82 ,$268.00 ,$216.00 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$48.82 ,$109.75 ,$252.00 ,$187.65 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$51.75 ,$202.00 ,$202.00 ,$95.20 ,$224.00 ,$83.40 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400021,92610,HC DYSPHAGIA REEVALUATION 15MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400022,92610,HC DYSPHAGIA REEVALUATION 30MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400023,92610,HC DYSPHAGIA REEVALUATION 45MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400029,92611,HC DYSPHAGIA EVAL-VIDEO 15MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400030,92611,HC DYSPHAGIA EVAL-VIDEO 30MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400031,92611,HC DYSPHAGIA EVAL-VIDEO 45MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400032,92611,HC DYSPHAGIA EVAL-VIDEO 60MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400040,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$30.27 ,$109.75 ,$234.00 ,$293.11 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$32.09 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$130.27 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400041,92522,HC EVALUATE SPEECH PRODUCTION 15MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$24.58 ,$109.75 ,$234.00 ,$245.45 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$26.05 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$109.09 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400042,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 15MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$268.00 ,$216.00 ,$146.20 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$146.20 ,$365.50 ,$365.50 ,$387.00 ,$48.63 ,$109.75 ,$387.00 ,$502.00 ,$395.60 ,$387.00 ,$286.55 ,$286.55 ,$261.87 ,$286.55 ,$279.50 ,$299.50 ,$95.55 ,$339.70 ,$51.55 ,$202.00 ,$202.00 ,$146.20 ,$224.00 ,$223.11 ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400043,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 15MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$216.00 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 ,$25.62 ,$109.75 ,$207.00 ,$241.79 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 ,$27.16 ,$202.00 ,$202.00 ,$78.20 ,$224.00 ,$107.46 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400048,92610,HC DYSPHAGIA REEVALUATION 60MIN,444,1 ,$340.00 ,$170.00 ,$72.23 ,$340.00 ,$72.23 ,$268.00 ,$216.00 ,$115.60 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$115.60 ,$289.00 ,$289.00 ,$306.00 ,$72.23 ,$109.75 ,$306.00 ,$187.18 ,$312.80 ,$306.00 ,$226.58 ,$226.58 ,$207.06 ,$226.58 ,$221.00 ,$236.81 ,$75.55 ,$268.60 ,$76.56 ,$202.00 ,$202.00 ,$115.60 ,$224.00 ,$83.19 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400049,92611,HC DYSPHAGIA RE-EVAL VIDEO 30MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400050,92611,HC DYSPHAGIA RE-EVAL VIDEO 45MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400051,92611,HC DYSPHAGIA RE-EVAL VIDEO 60MIN,444,1 ,$390.00 ,$195.00 ,$86.66 ,$390.00 ,$116.92 ,$268.00 ,$216.00 ,$132.60 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$132.60 ,$331.50 ,$331.50 ,$351.00 ,$116.92 ,$109.75 ,$351.00 ,$200.30 ,$358.80 ,$351.00 ,$259.90 ,$259.90 ,$237.51 ,$259.90 ,$253.50 ,$271.64 ,$86.66 ,$308.10 ,$123.94 ,$202.00 ,$202.00 ,$132.60 ,$224.00 ,$89.02 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$30.27 ,$109.75 ,$234.00 ,$293.11 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$32.09 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$130.27 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$30.27 ,$109.75 ,$234.00 ,$293.11 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$32.09 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$130.27 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400054,92521,HC EVALUATION OF SPEECH FLUENCY 60MIN,444,1 ,$260.00 ,$130.00 ,$30.27 ,$293.11 ,$30.27 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$30.27 ,$109.75 ,$234.00 ,$293.11 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$32.09 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$130.27 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400055,92522,HC EVALUATE SPEECH PRODUCTION 30MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$24.58 ,$109.75 ,$234.00 ,$245.45 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$26.05 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$109.09 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400056,92522,HC EVALUATE SPEECH PRODUCTION 45MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$24.58 ,$109.75 ,$234.00 ,$245.45 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$26.05 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$109.09 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400057,92522,HC EVALUATE SPEECH PRODUCTION 60MIN,444,1 ,$260.00 ,$130.00 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$216.00 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$24.58 ,$109.75 ,$234.00 ,$245.45 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$26.05 ,$202.00 ,$202.00 ,$88.40 ,$224.00 ,$109.09 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$268.00 ,$216.00 ,$146.20 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$146.20 ,$365.50 ,$365.50 ,$387.00 ,$48.63 ,$109.75 ,$387.00 ,$502.00 ,$395.60 ,$387.00 ,$286.55 ,$286.55 ,$261.87 ,$286.55 ,$279.50 ,$299.50 ,$95.55 ,$339.70 ,$51.55 ,$202.00 ,$202.00 ,$146.20 ,$224.00 ,$223.11 ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$268.00 ,$216.00 ,$146.20 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$146.20 ,$365.50 ,$365.50 ,$387.00 ,$48.63 ,$109.75 ,$387.00 ,$502.00 ,$395.60 ,$387.00 ,$286.55 ,$286.55 ,$261.87 ,$286.55 ,$279.50 ,$299.50 ,$95.55 ,$339.70 ,$51.55 ,$202.00 ,$202.00 ,$146.20 ,$224.00 ,$223.11 ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$430.00 ,$215.00 ,$48.63 ,$502.00 ,$48.63 ,$268.00 ,$216.00 ,$146.20 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$146.20 ,$365.50 ,$365.50 ,$387.00 ,$48.63 ,$109.75 ,$387.00 ,$502.00 ,$395.60 ,$387.00 ,$286.55 ,$286.55 ,$261.87 ,$286.55 ,$279.50 ,$299.50 ,$95.55 ,$339.70 ,$51.55 ,$202.00 ,$202.00 ,$146.20 ,$224.00 ,$223.11 ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$216.00 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 ,$25.62 ,$109.75 ,$207.00 ,$241.79 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 ,$27.16 ,$202.00 ,$202.00 ,$78.20 ,$224.00 ,$107.46 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$216.00 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 ,$25.62 ,$109.75 ,$207.00 ,$241.79 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 ,$27.16 ,$202.00 ,$202.00 ,$78.20 ,$224.00 ,$107.46 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$230.00 ,$115.00 ,$25.62 ,$241.79 ,$25.62 ,$230.00 ,$216.00 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 ,$25.62 ,$109.75 ,$207.00 ,$241.79 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 ,$27.16 ,$202.00 ,$202.00 ,$78.20 ,$224.00 ,$107.46 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$840.00 ,$420.00 ,$186.65 ,$840.00 ,$288.25 ,$710.56 ,$710.56 ,$285.60 ,$672.00 ,$714.00 ,$525.00 ,$756.00 ,$288.25 ,$798.00 ,$756.00 ,$714.00 ,$714.00 ,$285.60 ,$714.00 ,$714.00 ,$756.00 ,$288.25 ,$571.36 ,$756.00 ,$794.25 ,$772.80 ,$756.00 ,$559.78 ,$559.78 ,$511.56 ,$559.78 ,$546.00 ,$585.06 ,$186.65 ,$663.60 ,$305.55 ,$575.00 ,$575.00 ,$285.60 ,$650.00 ,$353.00 ,$798.00 ,$688.80 ,$688.80 ,$672.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$474.00 ,$237.00 ,$105.32 ,"$1,429.97 ",$288.25 ,$400.96 ,$400.96 ,$161.16 ,$379.20 ,$402.90 ,$296.25 ,$426.60 ,$288.25 ,$450.30 ,$426.60 ,$402.90 ,$402.90 ,$161.16 ,$402.90 ,$402.90 ,$426.60 ,$288.25 ,$474.00 ,$426.60 ,"$1,429.97 ",$436.08 ,$426.60 ,$315.87 ,$315.87 ,$288.67 ,$315.87 ,$308.10 ,$330.14 ,$105.32 ,$374.46 ,$305.55 ,$474.00 ,$474.00 ,$161.16 ,$474.00 ,$635.54 ,$450.30 ,$388.68 ,$388.68 ,$379.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$388.00 ,$194.00 ,$86.21 ,$794.25 ,$288.25 ,$328.21 ,$328.21 ,$131.92 ,$310.40 ,$329.80 ,$242.50 ,$349.20 ,$288.25 ,$368.60 ,$349.20 ,$329.80 ,$329.80 ,$131.92 ,$329.80 ,$329.80 ,$349.20 ,$288.25 ,$388.00 ,$349.20 ,$794.25 ,$356.96 ,$349.20 ,$258.56 ,$258.56 ,$236.29 ,$258.56 ,$252.20 ,$270.24 ,$86.21 ,$306.52 ,$305.55 ,$388.00 ,$388.00 ,$131.92 ,$388.00 ,$353.00 ,$368.60 ,$318.16 ,$318.16 ,$310.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$291.00 ,$145.50 ,$64.66 ,$412.65 ,$115.63 ,$246.16 ,$246.16 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$115.63 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$115.63 ,$291.00 ,$261.90 ,$412.65 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$122.57 ,$291.00 ,$291.00 ,$98.94 ,$291.00 ,$183.40 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$151.00 ,$75.50 ,$33.55 ,$259.11 ,$115.63 ,$127.73 ,$127.73 ,$51.34 ,$120.80 ,$128.35 ,$94.38 ,$135.90 ,$115.63 ,$143.45 ,$135.90 ,$128.35 ,$128.35 ,$51.34 ,$128.35 ,$128.35 ,$135.90 ,$115.63 ,$151.00 ,$135.90 ,$259.11 ,$138.92 ,$135.90 ,$100.63 ,$100.63 ,$91.96 ,$100.63 ,$98.15 ,$105.17 ,$33.55 ,$119.29 ,$122.57 ,$151.00 ,$151.00 ,$51.34 ,$151.00 ,$115.16 ,$143.45 ,$123.82 ,$123.82 ,$120.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000012,11760,HC REPAIR NAIL BED,450,1 ,$463.00 ,$231.50 ,$102.88 ,"$1,203.50 ",$115.63 ,$391.65 ,$391.65 ,$157.42 ,$370.40 ,$393.55 ,$289.38 ,$416.70 ,$115.63 ,$439.85 ,$416.70 ,$393.55 ,$393.55 ,$157.42 ,$393.55 ,$393.55 ,$416.70 ,$115.63 ,$463.00 ,$416.70 ,"$1,203.50 ",$425.96 ,$416.70 ,$308.54 ,$308.54 ,$281.97 ,$308.54 ,$300.95 ,$322.48 ,$102.88 ,$365.77 ,$122.57 ,$463.00 ,$463.00 ,$157.42 ,$463.00 ,$534.89 ,$439.85 ,$379.66 ,$379.66 ,$370.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,"$1,038.00 ",$519.00 ,$115.63 ,"$1,038.00 ",$115.63 ,$878.04 ,$878.04 ,$352.92 ,$830.40 ,$882.30 ,$648.75 ,$934.20 ,$115.63 ,$986.10 ,$934.20 ,$882.30 ,$882.30 ,$352.92 ,$882.30 ,$882.30 ,$934.20 ,$115.63 ,$571.36 ,$934.20 ,$794.25 ,$954.96 ,$934.20 ,$691.72 ,$691.72 ,$632.14 ,$691.72 ,$674.70 ,$722.97 ,$230.64 ,$820.02 ,$122.57 ,$575.00 ,$575.00 ,$352.92 ,$650.00 ,$353.00 ,$986.10 ,$851.16 ,$851.16 ,$830.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$549.00 ,$274.50 ,$121.99 ,$549.00 ,$329.51 ,$464.40 ,$464.40 ,$186.66 ,$439.20 ,$466.65 ,$343.13 ,$494.10 ,$329.51 ,$521.55 ,$494.10 ,$466.65 ,$466.65 ,$186.66 ,$466.65 ,$466.65 ,$494.10 ,$329.51 ,$549.00 ,$494.10 ,$412.65 ,$505.08 ,$494.10 ,$365.85 ,$365.85 ,$334.34 ,$365.85 ,$356.85 ,$382.38 ,$121.99 ,$433.71 ,$349.28 ,$549.00 ,$549.00 ,$186.66 ,$549.00 ,$183.40 ,$521.55 ,$450.18 ,$450.18 ,$439.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$603.00 ,$301.50 ,$133.99 ,$603.00 ,$329.51 ,$510.08 ,$510.08 ,$205.02 ,$482.40 ,$512.55 ,$376.88 ,$542.70 ,$329.51 ,$572.85 ,$542.70 ,$512.55 ,$512.55 ,$205.02 ,$512.55 ,$512.55 ,$542.70 ,$329.51 ,$571.36 ,$542.70 ,$412.65 ,$554.76 ,$542.70 ,$401.84 ,$401.84 ,$367.23 ,$401.84 ,$391.95 ,$419.99 ,$133.99 ,$476.37 ,$349.28 ,$575.00 ,$575.00 ,$205.02 ,$603.00 ,$183.40 ,$572.85 ,$494.46 ,$494.46 ,$482.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$657.00 ,$328.50 ,$145.99 ,$657.00 ,$329.51 ,$555.76 ,$555.76 ,$223.38 ,$525.60 ,$558.45 ,$410.63 ,$591.30 ,$329.51 ,$624.15 ,$591.30 ,$558.45 ,$558.45 ,$223.38 ,$558.45 ,$558.45 ,$591.30 ,$329.51 ,$571.36 ,$591.30 ,$412.65 ,$604.44 ,$591.30 ,$437.82 ,$437.82 ,$400.11 ,$437.82 ,$427.05 ,$457.60 ,$145.99 ,$519.03 ,$349.28 ,$575.00 ,$575.00 ,$223.38 ,$650.00 ,$183.40 ,$624.15 ,$538.74 ,$538.74 ,$525.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$711.00 ,$355.50 ,$157.98 ,$794.25 ,$329.51 ,$601.43 ,$601.43 ,$241.74 ,$568.80 ,$604.35 ,$444.38 ,$639.90 ,$329.51 ,$675.45 ,$639.90 ,$604.35 ,$604.35 ,$241.74 ,$604.35 ,$604.35 ,$639.90 ,$329.51 ,$571.36 ,$639.90 ,$794.25 ,$654.12 ,$639.90 ,$473.81 ,$473.81 ,$433.00 ,$473.81 ,$462.15 ,$495.21 ,$157.98 ,$561.69 ,$349.28 ,$575.00 ,$575.00 ,$241.74 ,$650.00 ,$353.00 ,$675.45 ,$583.02 ,$583.02 ,$568.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$765.00 ,$382.50 ,$169.98 ,$794.25 ,$329.51 ,$647.11 ,$647.11 ,$260.10 ,$612.00 ,$650.25 ,$478.13 ,$688.50 ,$329.51 ,$726.75 ,$688.50 ,$650.25 ,$650.25 ,$260.10 ,$650.25 ,$650.25 ,$688.50 ,$329.51 ,$571.36 ,$688.50 ,$794.25 ,$703.80 ,$688.50 ,$509.80 ,$509.80 ,$465.89 ,$509.80 ,$497.25 ,$532.82 ,$169.98 ,$604.35 ,$349.28 ,$575.00 ,$575.00 ,$260.10 ,$650.00 ,$353.00 ,$726.75 ,$627.30 ,$627.30 ,$612.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$539.00 ,$269.50 ,$119.77 ,$539.00 ,$329.51 ,$455.94 ,$455.94 ,$183.26 ,$431.20 ,$458.15 ,$336.88 ,$485.10 ,$329.51 ,$512.05 ,$485.10 ,$458.15 ,$458.15 ,$183.26 ,$458.15 ,$458.15 ,$485.10 ,$329.51 ,$539.00 ,$485.10 ,$412.65 ,$495.88 ,$485.10 ,$359.19 ,$359.19 ,$328.25 ,$359.19 ,$350.35 ,$375.41 ,$119.77 ,$425.81 ,$349.28 ,$539.00 ,$539.00 ,$183.26 ,$539.00 ,$183.40 ,$512.05 ,$441.98 ,$441.98 ,$431.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$679.00 ,$339.50 ,$150.87 ,$679.00 ,$329.51 ,$574.37 ,$574.37 ,$230.86 ,$543.20 ,$577.15 ,$424.38 ,$611.10 ,$329.51 ,$645.05 ,$611.10 ,$577.15 ,$577.15 ,$230.86 ,$577.15 ,$577.15 ,$611.10 ,$329.51 ,$571.36 ,$611.10 ,$412.65 ,$624.68 ,$611.10 ,$452.49 ,$452.49 ,$413.51 ,$452.49 ,$441.35 ,$472.92 ,$150.87 ,$536.41 ,$349.28 ,$575.00 ,$575.00 ,$230.86 ,$650.00 ,$183.40 ,$645.05 ,$556.78 ,$556.78 ,$543.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$743.00 ,$371.50 ,$165.09 ,$743.00 ,$329.51 ,$628.50 ,$628.50 ,$252.62 ,$594.40 ,$631.55 ,$464.38 ,$668.70 ,$329.51 ,$705.85 ,$668.70 ,$631.55 ,$631.55 ,$252.62 ,$631.55 ,$631.55 ,$668.70 ,$329.51 ,$571.36 ,$668.70 ,$412.65 ,$683.56 ,$668.70 ,$495.14 ,$495.14 ,$452.49 ,$495.14 ,$482.95 ,$517.50 ,$165.09 ,$586.97 ,$349.28 ,$575.00 ,$575.00 ,$252.62 ,$650.00 ,$183.40 ,$705.85 ,$609.26 ,$609.26 ,$594.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$765.00 ,$382.50 ,$169.98 ,$765.00 ,$329.51 ,$647.11 ,$647.11 ,$260.10 ,$612.00 ,$650.25 ,$478.13 ,$688.50 ,$329.51 ,$726.75 ,$688.50 ,$650.25 ,$650.25 ,$260.10 ,$650.25 ,$650.25 ,$688.50 ,$329.51 ,$571.36 ,$688.50 ,$412.65 ,$703.80 ,$688.50 ,$509.80 ,$509.80 ,$465.89 ,$509.80 ,$497.25 ,$532.82 ,$169.98 ,$604.35 ,$349.28 ,$575.00 ,$575.00 ,$260.10 ,$650.00 ,$183.40 ,$726.75 ,$627.30 ,$627.30 ,$612.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$786.00 ,$393.00 ,$174.65 ,$786.00 ,$329.51 ,$664.88 ,$664.88 ,$267.24 ,$628.80 ,$668.10 ,$491.25 ,$707.40 ,$329.51 ,$746.70 ,$707.40 ,$668.10 ,$668.10 ,$267.24 ,$668.10 ,$668.10 ,$707.40 ,$329.51 ,$571.36 ,$707.40 ,$412.65 ,$723.12 ,$707.40 ,$523.79 ,$523.79 ,$478.67 ,$523.79 ,$510.90 ,$547.45 ,$174.65 ,$620.94 ,$349.28 ,$575.00 ,$575.00 ,$267.24 ,$650.00 ,$183.40 ,$746.70 ,$644.52 ,$644.52 ,$628.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$797.00 ,$398.50 ,$177.09 ,$797.00 ,$329.51 ,$674.18 ,$674.18 ,$270.98 ,$637.60 ,$677.45 ,$498.13 ,$717.30 ,$329.51 ,$757.15 ,$717.30 ,$677.45 ,$677.45 ,$270.98 ,$677.45 ,$677.45 ,$717.30 ,$329.51 ,$571.36 ,$717.30 ,$794.25 ,$733.24 ,$717.30 ,$531.12 ,$531.12 ,$485.37 ,$531.12 ,$518.05 ,$555.11 ,$177.09 ,$629.63 ,$349.28 ,$575.00 ,$575.00 ,$270.98 ,$650.00 ,$353.00 ,$757.15 ,$653.54 ,$653.54 ,$637.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$819.00 ,$409.50 ,$181.98 ,$819.00 ,$329.51 ,$692.79 ,$692.79 ,$278.46 ,$655.20 ,$696.15 ,$511.88 ,$737.10 ,$329.51 ,$778.05 ,$737.10 ,$696.15 ,$696.15 ,$278.46 ,$696.15 ,$696.15 ,$737.10 ,$329.51 ,$571.36 ,$737.10 ,$794.25 ,$753.48 ,$737.10 ,$545.78 ,$545.78 ,$498.77 ,$545.78 ,$532.35 ,$570.43 ,$181.98 ,$647.01 ,$349.28 ,$575.00 ,$575.00 ,$278.46 ,$650.00 ,$353.00 ,$778.05 ,$671.58 ,$671.58 ,$655.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,293.00 ",$662.74 ,"$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ",$662.74 ,"$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ",$662.74 ,$571.36 ,"$1,163.70 ","$1,203.50 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ",$702.50 ,$575.00 ,$575.00 ,$439.62 ,$650.00 ,$534.89 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$700.00 ,$350.00 ,$155.54 ,$794.25 ,$662.74 ,$592.13 ,$592.13 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$662.74 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$662.74 ,$571.36 ,$630.00 ,$794.25 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$702.50 ,$575.00 ,$575.00 ,$238.00 ,$650.00 ,$353.00 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$776.00 ,$388.00 ,$172.43 ,$794.25 ,$662.74 ,$656.42 ,$656.42 ,$263.84 ,$620.80 ,$659.60 ,$485.00 ,$698.40 ,$662.74 ,$737.20 ,$698.40 ,$659.60 ,$659.60 ,$263.84 ,$659.60 ,$659.60 ,$698.40 ,$662.74 ,$571.36 ,$698.40 ,$794.25 ,$713.92 ,$698.40 ,$517.13 ,$517.13 ,$472.58 ,$517.13 ,$504.40 ,$540.48 ,$172.43 ,$613.04 ,$702.50 ,$575.00 ,$575.00 ,$263.84 ,$650.00 ,$353.00 ,$737.20 ,$636.32 ,$636.32 ,$620.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$840.00 ,$420.00 ,$186.65 ,$840.00 ,$662.74 ,$710.56 ,$710.56 ,$285.60 ,$672.00 ,$714.00 ,$525.00 ,$756.00 ,$662.74 ,$798.00 ,$756.00 ,$714.00 ,$714.00 ,$285.60 ,$714.00 ,$714.00 ,$756.00 ,$662.74 ,$571.36 ,$756.00 ,$794.25 ,$772.80 ,$756.00 ,$559.78 ,$559.78 ,$511.56 ,$559.78 ,$546.00 ,$585.06 ,$186.65 ,$663.60 ,$702.50 ,$575.00 ,$575.00 ,$285.60 ,$650.00 ,$353.00 ,$798.00 ,$688.80 ,$688.80 ,$672.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,$916.00 ,$458.00 ,$203.54 ,$916.00 ,$662.74 ,$774.84 ,$774.84 ,$311.44 ,$732.80 ,$778.60 ,$572.50 ,$824.40 ,$662.74 ,$870.20 ,$824.40 ,$778.60 ,$778.60 ,$311.44 ,$778.60 ,$778.60 ,$824.40 ,$662.74 ,$571.36 ,$824.40 ,$794.25 ,$842.72 ,$824.40 ,$610.42 ,$610.42 ,$557.84 ,$610.42 ,$595.40 ,$637.99 ,$203.54 ,$723.64 ,$702.50 ,$575.00 ,$575.00 ,$311.44 ,$650.00 ,$353.00 ,$870.20 ,$751.12 ,$751.12 ,$732.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,$980.00 ,$490.00 ,$217.76 ,"$1,203.50 ",$662.74 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$662.74 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$662.74 ,$571.36 ,$882.00 ,"$1,203.50 ",$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$702.50 ,$575.00 ,$575.00 ,$333.20 ,$650.00 ,$534.89 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$636.00 ,$318.00 ,$141.32 ,$794.25 ,$662.74 ,$537.99 ,$537.99 ,$216.24 ,$508.80 ,$540.60 ,$397.50 ,$572.40 ,$662.74 ,$604.20 ,$572.40 ,$540.60 ,$540.60 ,$216.24 ,$540.60 ,$540.60 ,$572.40 ,$662.74 ,$571.36 ,$572.40 ,$794.25 ,$585.12 ,$572.40 ,$423.83 ,$423.83 ,$387.32 ,$423.83 ,$413.40 ,$442.97 ,$141.32 ,$502.44 ,$702.50 ,$575.00 ,$575.00 ,$216.24 ,$636.00 ,$353.00 ,$604.20 ,$521.52 ,$521.52 ,$508.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$700.00 ,$350.00 ,$155.54 ,$794.25 ,$662.74 ,$592.13 ,$592.13 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$662.74 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$662.74 ,$571.36 ,$630.00 ,$794.25 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$702.50 ,$575.00 ,$575.00 ,$238.00 ,$650.00 ,$353.00 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$776.00 ,$388.00 ,$172.43 ,"$1,203.50 ",$662.74 ,$656.42 ,$656.42 ,$263.84 ,$620.80 ,$659.60 ,$485.00 ,$698.40 ,$662.74 ,$737.20 ,$698.40 ,$659.60 ,$659.60 ,$263.84 ,$659.60 ,$659.60 ,$698.40 ,$662.74 ,$571.36 ,$698.40 ,"$1,203.50 ",$713.92 ,$698.40 ,$517.13 ,$517.13 ,$472.58 ,$517.13 ,$504.40 ,$540.48 ,$172.43 ,$613.04 ,$702.50 ,$575.00 ,$575.00 ,$263.84 ,$650.00 ,$534.89 ,$737.20 ,$636.32 ,$636.32 ,$620.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,$916.00 ,$458.00 ,$203.54 ,"$1,203.50 ",$662.74 ,$774.84 ,$774.84 ,$311.44 ,$732.80 ,$778.60 ,$572.50 ,$824.40 ,$662.74 ,$870.20 ,$824.40 ,$778.60 ,$778.60 ,$311.44 ,$778.60 ,$778.60 ,$824.40 ,$662.74 ,$571.36 ,$824.40 ,"$1,203.50 ",$842.72 ,$824.40 ,$610.42 ,$610.42 ,$557.84 ,$610.42 ,$595.40 ,$637.99 ,$203.54 ,$723.64 ,$702.50 ,$575.00 ,$575.00 ,$311.44 ,$650.00 ,$534.89 ,$870.20 ,$751.12 ,$751.12 ,$732.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,$980.00 ,$490.00 ,$217.76 ,"$1,203.50 ",$662.74 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$662.74 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$662.74 ,$571.36 ,$882.00 ,"$1,203.50 ",$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$702.50 ,$575.00 ,$575.00 ,$333.20 ,$650.00 ,$534.89 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$679.00 ,$339.50 ,$150.87 ,$794.25 ,$662.74 ,$574.37 ,$574.37 ,$230.86 ,$543.20 ,$577.15 ,$424.38 ,$611.10 ,$662.74 ,$645.05 ,$611.10 ,$577.15 ,$577.15 ,$230.86 ,$577.15 ,$577.15 ,$611.10 ,$662.74 ,$571.36 ,$611.10 ,$794.25 ,$624.68 ,$611.10 ,$452.49 ,$452.49 ,$413.51 ,$452.49 ,$441.35 ,$472.92 ,$150.87 ,$536.41 ,$702.50 ,$575.00 ,$575.00 ,$230.86 ,$650.00 ,$353.00 ,$645.05 ,$556.78 ,$556.78 ,$543.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$743.00 ,$371.50 ,$165.09 ,$794.25 ,$662.74 ,$628.50 ,$628.50 ,$252.62 ,$594.40 ,$631.55 ,$464.38 ,$668.70 ,$662.74 ,$705.85 ,$668.70 ,$631.55 ,$631.55 ,$252.62 ,$631.55 ,$631.55 ,$668.70 ,$662.74 ,$571.36 ,$668.70 ,$794.25 ,$683.56 ,$668.70 ,$495.14 ,$495.14 ,$452.49 ,$495.14 ,$482.95 ,$517.50 ,$165.09 ,$586.97 ,$702.50 ,$575.00 ,$575.00 ,$252.62 ,$650.00 ,$353.00 ,$705.85 ,$609.26 ,$609.26 ,$594.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$808.00 ,$404.00 ,$179.54 ,$808.00 ,$662.74 ,$683.49 ,$683.49 ,$274.72 ,$646.40 ,$686.80 ,$505.00 ,$727.20 ,$662.74 ,$767.60 ,$727.20 ,$686.80 ,$686.80 ,$274.72 ,$686.80 ,$686.80 ,$727.20 ,$662.74 ,$571.36 ,$727.20 ,$794.25 ,$743.36 ,$727.20 ,$538.45 ,$538.45 ,$492.07 ,$538.45 ,$525.20 ,$562.77 ,$179.54 ,$638.32 ,$702.50 ,$575.00 ,$575.00 ,$274.72 ,$650.00 ,$353.00 ,$767.60 ,$662.56 ,$662.56 ,$646.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,$883.00 ,$441.50 ,$196.20 ,$883.00 ,$662.74 ,$746.93 ,$746.93 ,$300.22 ,$706.40 ,$750.55 ,$551.88 ,$794.70 ,$662.74 ,$838.85 ,$794.70 ,$750.55 ,$750.55 ,$300.22 ,$750.55 ,$750.55 ,$794.70 ,$662.74 ,$571.36 ,$794.70 ,$794.25 ,$812.36 ,$794.70 ,$588.43 ,$588.43 ,$537.75 ,$588.43 ,$573.95 ,$615.01 ,$196.20 ,$697.57 ,$702.50 ,$575.00 ,$575.00 ,$300.22 ,$650.00 ,$353.00 ,$838.85 ,$724.06 ,$724.06 ,$706.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$943.00 ,$471.50 ,$209.53 ,$943.00 ,$662.74 ,$797.68 ,$797.68 ,$320.62 ,$754.40 ,$801.55 ,$589.38 ,$848.70 ,$662.74 ,$895.85 ,$848.70 ,$801.55 ,$801.55 ,$320.62 ,$801.55 ,$801.55 ,$848.70 ,$662.74 ,$571.36 ,$848.70 ,$794.25 ,$867.56 ,$848.70 ,$628.42 ,$628.42 ,$574.29 ,$628.42 ,$612.95 ,$656.80 ,$209.53 ,$744.97 ,$702.50 ,$575.00 ,$575.00 ,$320.62 ,$650.00 ,$353.00 ,$895.85 ,$773.26 ,$773.26 ,$754.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$980.00 ,$490.00 ,$217.76 ,$980.00 ,$662.74 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$662.74 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$662.74 ,$571.36 ,$882.00 ,$794.25 ,$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$702.50 ,$575.00 ,$575.00 ,$333.20 ,$650.00 ,$353.00 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,$980.00 ,$490.00 ,$217.76 ,"$1,203.50 ",$785.45 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$785.45 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$785.45 ,$571.36 ,$882.00 ,"$1,203.50 ",$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$832.58 ,$575.00 ,$575.00 ,$333.20 ,$650.00 ,$534.89 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,$980.00 ,$490.00 ,$217.76 ,"$1,203.50 ",$785.45 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$785.45 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$785.45 ,$571.36 ,$882.00 ,"$1,203.50 ",$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$832.58 ,$575.00 ,$575.00 ,$333.20 ,$650.00 ,$534.89 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,$980.00 ,$490.00 ,$217.76 ,"$1,203.50 ",$785.45 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$785.45 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$785.45 ,$571.36 ,$882.00 ,"$1,203.50 ",$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$832.58 ,$575.00 ,$575.00 ,$333.20 ,$650.00 ,$534.89 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,293.00 ",$785.45 ,"$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ",$785.45 ,"$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ",$785.45 ,$571.36 ,"$1,163.70 ","$1,203.50 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ",$832.58 ,$575.00 ,$575.00 ,$439.62 ,$650.00 ,$534.89 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,$539.00 ,$269.50 ,$119.77 ,$832.58 ,$785.45 ,$455.94 ,$455.94 ,$183.26 ,$431.20 ,$458.15 ,$336.88 ,$485.10 ,$785.45 ,$512.05 ,$485.10 ,$458.15 ,$458.15 ,$183.26 ,$458.15 ,$458.15 ,$485.10 ,$785.45 ,$539.00 ,$485.10 , N/A ,$495.88 ,$485.10 ,$359.19 ,$359.19 ,$328.25 ,$359.19 ,$350.35 ,$375.41 ,$119.77 ,$425.81 ,$832.58 ,$539.00 ,$539.00 ,$183.26 ,$539.00 , N/A ,$512.05 ,$441.98 ,$441.98 ,$431.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$287.30 ,"$1,293.00 ",$785.45 ,"$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ",$785.45 ,"$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ",$785.45 ,$571.36 ,"$1,163.70 ",$794.25 ,"$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ",$832.58 ,$575.00 ,$575.00 ,$439.62 ,$650.00 ,$353.00 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$311.30 ,"$1,401.00 ",$785.45 ,"$1,185.11 ","$1,185.11 ",$476.34 ,"$1,120.80 ","$1,190.85 ",$875.63 ,"$1,260.90 ",$785.45 ,"$1,330.95 ","$1,260.90 ","$1,190.85 ","$1,190.85 ",$476.34 ,"$1,190.85 ","$1,190.85 ","$1,260.90 ",$785.45 ,$571.36 ,"$1,260.90 ","$1,203.50 ","$1,288.92 ","$1,260.90 ",$933.63 ,$933.63 ,$853.21 ,$933.63 ,$910.65 ,$975.80 ,$311.30 ,"$1,106.79 ",$832.58 ,$575.00 ,$575.00 ,$476.34 ,$650.00 ,$534.89 ,"$1,330.95 ","$1,148.82 ","$1,148.82 ","$1,120.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),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 ,$119.77 ,$832.58 ,$785.45 ,$455.94 ,$455.94 ,$183.26 ,$431.20 ,$458.15 ,$336.88 ,$485.10 ,$785.45 ,$512.05 ,$485.10 ,$458.15 ,$458.15 ,$183.26 ,$458.15 ,$458.15 ,$485.10 ,$785.45 ,$539.00 ,$485.10 , N/A ,$495.88 ,$485.10 ,$359.19 ,$359.19 ,$328.25 ,$359.19 ,$350.35 ,$375.41 ,$119.77 ,$425.81 ,$832.58 ,$539.00 ,$539.00 ,$183.26 ,$539.00 , N/A ,$512.05 ,$441.98 ,$441.98 ,$431.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,"$1,293.00 ",$646.50 ,$287.30 ,"$1,293.00 ",$785.45 ,"$1,093.75 ","$1,093.75 ",$439.62 ,"$1,034.40 ","$1,099.05 ",$808.13 ,"$1,163.70 ",$785.45 ,"$1,228.35 ","$1,163.70 ","$1,099.05 ","$1,099.05 ",$439.62 ,"$1,099.05 ","$1,099.05 ","$1,163.70 ",$785.45 ,$571.36 ,"$1,163.70 ","$1,203.50 ","$1,189.56 ","$1,163.70 ",$861.66 ,$861.66 ,$787.44 ,$861.66 ,$840.45 ,$900.57 ,$287.30 ,"$1,021.47 ",$832.58 ,$575.00 ,$575.00 ,$439.62 ,$650.00 ,$534.89 ,"$1,228.35 ","$1,060.26 ","$1,060.26 ","$1,034.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,"$1,401.00 ",$700.50 ,$311.30 ,"$1,401.00 ",$785.45 ,"$1,185.11 ","$1,185.11 ",$476.34 ,"$1,120.80 ","$1,190.85 ",$875.63 ,"$1,260.90 ",$785.45 ,"$1,330.95 ","$1,260.90 ","$1,190.85 ","$1,190.85 ",$476.34 ,"$1,190.85 ","$1,190.85 ","$1,260.90 ",$785.45 ,$571.36 ,"$1,260.90 ","$1,203.50 ","$1,288.92 ","$1,260.90 ",$933.63 ,$933.63 ,$853.21 ,$933.63 ,$910.65 ,$975.80 ,$311.30 ,"$1,106.79 ",$832.58 ,$575.00 ,$575.00 ,$476.34 ,$650.00 ,$534.89 ,"$1,330.95 ","$1,148.82 ","$1,148.82 ","$1,120.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,$812.00 ,$406.00 ,$180.43 ,"$2,146.92 ","$2,025.40 ",$686.87 ,$686.87 ,$276.08 ,$649.60 ,$690.20 ,$507.50 ,$730.80 ,"$2,025.40 ",$771.40 ,$730.80 ,$690.20 ,$690.20 ,$276.08 ,$690.20 ,$690.20 ,$730.80 ,"$2,025.40 ",$571.36 ,$730.80 , N/A ,$747.04 ,$730.80 ,$541.12 ,$541.12 ,$494.51 ,$541.12 ,$527.80 ,$565.56 ,$180.43 ,$641.48 ,"$2,146.92 ",$575.00 ,$575.00 ,$276.08 ,$650.00 , N/A ,$771.40 ,$665.84 ,$665.84 ,$649.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$183.00 ,$91.50 ,$40.66 ,$412.65 ,$329.51 ,$154.80 ,$154.80 ,$62.22 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$329.51 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$62.22 ,$155.55 ,$155.55 ,$164.70 ,$329.51 ,$183.00 ,$164.70 ,$412.65 ,$168.36 ,$164.70 ,$121.95 ,$121.95 ,$111.45 ,$121.95 ,$118.95 ,$127.46 ,$40.66 ,$144.57 ,$349.28 ,$183.00 ,$183.00 ,$62.22 ,$183.00 ,$183.40 ,$173.85 ,$150.06 ,$150.06 ,$146.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$442.00 ,$221.00 ,$98.21 ,$442.00 ,$329.51 ,$373.89 ,$373.89 ,$150.28 ,$353.60 ,$375.70 ,$276.25 ,$397.80 ,$329.51 ,$419.90 ,$397.80 ,$375.70 ,$375.70 ,$150.28 ,$375.70 ,$375.70 ,$397.80 ,$329.51 ,$442.00 ,$397.80 ,$412.65 ,$406.64 ,$397.80 ,$294.55 ,$294.55 ,$269.18 ,$294.55 ,$287.30 ,$307.85 ,$98.21 ,$349.18 ,$349.28 ,$442.00 ,$442.00 ,$150.28 ,$442.00 ,$183.40 ,$419.90 ,$362.44 ,$362.44 ,$353.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$474.00 ,$237.00 ,$105.32 ,$474.00 ,$329.51 ,$400.96 ,$400.96 ,$161.16 ,$379.20 ,$402.90 ,$296.25 ,$426.60 ,$329.51 ,$450.30 ,$426.60 ,$402.90 ,$402.90 ,$161.16 ,$402.90 ,$402.90 ,$426.60 ,$329.51 ,$474.00 ,$426.60 ,$412.65 ,$436.08 ,$426.60 ,$315.87 ,$315.87 ,$288.67 ,$315.87 ,$308.10 ,$330.14 ,$105.32 ,$374.46 ,$349.28 ,$474.00 ,$474.00 ,$161.16 ,$474.00 ,$183.40 ,$450.30 ,$388.68 ,$388.68 ,$379.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$571.00 ,$285.50 ,$126.88 ,$794.25 ,$662.74 ,$483.01 ,$483.01 ,$194.14 ,$456.80 ,$485.35 ,$356.88 ,$513.90 ,$662.74 ,$542.45 ,$513.90 ,$485.35 ,$485.35 ,$194.14 ,$485.35 ,$485.35 ,$513.90 ,$662.74 ,$571.00 ,$513.90 ,$794.25 ,$525.32 ,$513.90 ,$380.51 ,$380.51 ,$347.74 ,$380.51 ,$371.15 ,$397.70 ,$126.88 ,$451.09 ,$702.50 ,$571.00 ,$571.00 ,$194.14 ,$571.00 ,$353.00 ,$542.45 ,$468.22 ,$468.22 ,$456.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000068,20103,HC EXPL PENTR WOUND EXTREMITY,450,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$1,429.97 ",$662.74 ,"$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ",$662.74 ,"$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ",$662.74 ,$571.36 ,"$1,066.50 ","$1,429.97 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,$702.50 ,$575.00 ,$575.00 ,$402.90 ,$650.00 ,$635.54 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$474.00 ,$237.00 ,$105.32 ,$600.37 ,$424.03 ,$400.96 ,$400.96 ,$161.16 ,$379.20 ,$402.90 ,$296.25 ,$426.60 ,$424.03 ,$450.30 ,$426.60 ,$402.90 ,$402.90 ,$161.16 ,$402.90 ,$402.90 ,$426.60 ,$424.03 ,$474.00 ,$426.60 ,$600.37 ,$436.08 ,$426.60 ,$315.87 ,$315.87 ,$288.67 ,$315.87 ,$308.10 ,$330.14 ,$105.32 ,$374.46 ,$449.47 ,$474.00 ,$474.00 ,$161.16 ,$474.00 ,$266.83 ,$450.30 ,$388.68 ,$388.68 ,$379.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$700.00 ,$350.00 ,$155.54 ,$700.00 ,$424.03 ,$592.13 ,$592.13 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$424.03 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$424.03 ,$571.36 ,$630.00 ,$600.37 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$449.47 ,$575.00 ,$575.00 ,$238.00 ,$650.00 ,$266.83 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$700.00 ,$350.00 ,$155.54 ,$900.55 ,$636.05 ,$592.13 ,$592.13 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$636.05 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$636.05 ,$571.36 ,$630.00 ,$900.55 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$674.21 ,$575.00 ,$575.00 ,$238.00 ,$650.00 ,$400.25 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$700.00 ,$350.00 ,$155.54 ,$900.55 ,$636.05 ,$592.13 ,$592.13 ,$238.00 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$636.05 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$238.00 ,$595.00 ,$595.00 ,$630.00 ,$636.05 ,$571.36 ,$630.00 ,$900.55 ,$644.00 ,$630.00 ,$466.48 ,$466.48 ,$426.30 ,$466.48 ,$455.00 ,$487.55 ,$155.54 ,$553.00 ,$674.21 ,$575.00 ,$575.00 ,$238.00 ,$650.00 ,$400.25 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$894.00 ,$447.00 ,$198.65 ,$894.00 ,$783.09 ,$756.23 ,$756.23 ,$303.96 ,$715.20 ,$759.90 ,$558.75 ,$804.60 ,$783.09 ,$849.30 ,$804.60 ,$759.90 ,$759.90 ,$303.96 ,$759.90 ,$759.90 ,$804.60 ,$783.09 ,$571.36 ,$804.60 ,$473.63 ,$822.48 ,$804.60 ,$595.76 ,$595.76 ,$544.45 ,$595.76 ,$581.10 ,$622.67 ,$198.65 ,$706.26 ,$830.08 ,$575.00 ,$575.00 ,$303.96 ,$650.00 ,$210.50 ,$849.30 ,$733.08 ,$733.08 ,$715.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$528.00 ,$264.00 ,$117.32 ,$830.08 ,$783.09 ,$446.64 ,$446.64 ,$179.52 ,$422.40 ,$448.80 ,$330.00 ,$475.20 ,$783.09 ,$501.60 ,$475.20 ,$448.80 ,$448.80 ,$179.52 ,$448.80 ,$448.80 ,$475.20 ,$783.09 ,$528.00 ,$475.20 ,$473.63 ,$485.76 ,$475.20 ,$351.86 ,$351.86 ,$321.55 ,$351.86 ,$343.20 ,$367.75 ,$117.32 ,$417.12 ,$830.08 ,$528.00 ,$528.00 ,$179.52 ,$528.00 ,$210.50 ,$501.60 ,$432.96 ,$432.96 ,$422.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$830.00 ,$415.00 ,$184.43 ,"$3,200.65 ",$783.09 ,$702.10 ,$702.10 ,$282.20 ,$664.00 ,$705.50 ,$518.75 ,$747.00 ,$783.09 ,$788.50 ,$747.00 ,$705.50 ,$705.50 ,$282.20 ,$705.50 ,$705.50 ,$747.00 ,$783.09 ,$571.36 ,$747.00 ,"$3,200.65 ",$763.60 ,$747.00 ,$553.11 ,$553.11 ,$505.47 ,$553.11 ,$539.50 ,$578.10 ,$184.43 ,$655.70 ,$830.08 ,$575.00 ,$575.00 ,$282.20 ,$650.00 ,"$1,422.51 ",$788.50 ,$680.60 ,$680.60 ,$664.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,221.00 ","$2,110.50 ",$571.36 ,"$4,221.00 ","$1,935.34 ","$3,570.54 ","$3,570.54 ","$1,435.14 ","$3,376.80 ","$3,587.85 ","$2,638.13 ","$3,798.90 ","$1,935.34 ","$4,009.95 ","$3,798.90 ","$3,587.85 ","$3,587.85 ","$1,435.14 ","$3,587.85 ","$3,587.85 ","$3,798.90 ","$1,935.34 ",$571.36 ,"$3,798.90 ","$3,233.23 ","$3,883.32 ","$3,798.90 ","$2,812.87 ","$2,812.87 ","$2,570.59 ","$2,812.87 ","$2,743.65 ","$2,939.93 ",$937.91 ,"$3,334.59 ","$2,051.46 ",$575.00 ,$575.00 ,"$1,435.14 ",$650.00 ,"$1,436.99 ","$4,009.95 ","$3,461.22 ","$3,461.22 ","$3,376.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000086,26418,HC RPR EXTEN TENDON FNGR W/O FREE,450,1 ,"$1,967.00 ",$983.50 ,$437.07 ,"$3,200.65 ","$2,334.70 ","$1,663.89 ","$1,663.89 ",$668.78 ,"$1,573.60 ","$1,671.95 ","$1,229.38 ","$1,770.30 ","$2,334.70 ","$1,868.65 ","$1,770.30 ","$1,671.95 ","$1,671.95 ",$668.78 ,"$1,671.95 ","$1,671.95 ","$1,770.30 ","$2,334.70 ",$571.36 ,"$1,770.30 ","$3,200.65 ","$1,809.64 ","$1,770.30 ","$1,310.81 ","$1,310.81 ","$1,197.90 ","$1,310.81 ","$1,278.55 ","$1,370.02 ",$437.07 ,"$1,553.93 ","$2,474.78 ",$575.00 ,$575.00 ,$668.78 ,$650.00 ,"$1,422.51 ","$1,868.65 ","$1,612.94 ","$1,612.94 ","$1,573.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$851.00 ,$425.50 ,$189.09 ,$851.00 ,$783.09 ,$719.86 ,$719.86 ,$289.34 ,$680.80 ,$723.35 ,$531.88 ,$765.90 ,$783.09 ,$808.45 ,$765.90 ,$723.35 ,$723.35 ,$289.34 ,$723.35 ,$723.35 ,$765.90 ,$783.09 ,$571.36 ,$765.90 ,$473.63 ,$782.92 ,$765.90 ,$567.11 ,$567.11 ,$518.26 ,$567.11 ,$553.15 ,$592.72 ,$189.09 ,$672.29 ,$830.08 ,$575.00 ,$575.00 ,$289.34 ,$650.00 ,$210.50 ,$808.45 ,$697.82 ,$697.82 ,$680.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$851.00 ,$425.50 ,$189.09 ,$851.00 ,$783.09 ,$719.86 ,$719.86 ,$289.34 ,$680.80 ,$723.35 ,$531.88 ,$765.90 ,$783.09 ,$808.45 ,$765.90 ,$723.35 ,$723.35 ,$289.34 ,$723.35 ,$723.35 ,$765.90 ,$783.09 ,$571.36 ,$765.90 ,$473.63 ,$782.92 ,$765.90 ,$567.11 ,$567.11 ,$518.26 ,$567.11 ,$553.15 ,$592.72 ,$189.09 ,$672.29 ,$830.08 ,$575.00 ,$575.00 ,$289.34 ,$650.00 ,$210.50 ,$808.45 ,$697.82 ,$697.82 ,$680.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000095,27266,HC CL TX POST HIP ARTHROPLASTY DISLOCAT W ANESTH,450,1 ,"$1,831.00 ",$915.50 ,$406.85 ,"$3,200.65 ","$1,740.21 ","$1,548.84 ","$1,548.84 ",$622.54 ,"$1,464.80 ","$1,556.35 ","$1,144.38 ","$1,647.90 ","$1,740.21 ","$1,739.45 ","$1,647.90 ","$1,556.35 ","$1,556.35 ",$622.54 ,"$1,556.35 ","$1,556.35 ","$1,647.90 ","$1,740.21 ",$571.36 ,"$1,647.90 ","$3,200.65 ","$1,684.52 ","$1,647.90 ","$1,220.18 ","$1,220.18 ","$1,115.08 ","$1,220.18 ","$1,190.15 ","$1,275.29 ",$406.85 ,"$1,446.49 ","$1,844.62 ",$575.00 ,$575.00 ,$622.54 ,$650.00 ,"$1,422.51 ","$1,739.45 ","$1,501.42 ","$1,501.42 ","$1,464.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$722.00 ,$361.00 ,$160.43 ,$830.08 ,$783.09 ,$610.74 ,$610.74 ,$245.48 ,$577.60 ,$613.70 ,$451.25 ,$649.80 ,$783.09 ,$685.90 ,$649.80 ,$613.70 ,$613.70 ,$245.48 ,$613.70 ,$613.70 ,$649.80 ,$783.09 ,$571.36 ,$649.80 ,$473.63 ,$664.24 ,$649.80 ,$481.14 ,$481.14 ,$439.70 ,$481.14 ,$469.30 ,$502.87 ,$160.43 ,$570.38 ,$830.08 ,$575.00 ,$575.00 ,$245.48 ,$650.00 ,$210.50 ,$685.90 ,$592.04 ,$592.04 ,$577.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000097,28190,HC REM FB FOOT SUBQ,450,1 ,$905.00 ,$452.50 ,$201.09 ,"$1,429.97 ",$785.45 ,$765.54 ,$765.54 ,$307.70 ,$724.00 ,$769.25 ,$565.63 ,$814.50 ,$785.45 ,$859.75 ,$814.50 ,$769.25 ,$769.25 ,$307.70 ,$769.25 ,$769.25 ,$814.50 ,$785.45 ,$571.36 ,$814.50 ,"$1,429.97 ",$832.60 ,$814.50 ,$603.09 ,$603.09 ,$551.15 ,$603.09 ,$588.25 ,$630.33 ,$201.09 ,$714.95 ,$832.58 ,$575.00 ,$575.00 ,$307.70 ,$650.00 ,$635.54 ,$859.75 ,$742.10 ,$742.10 ,$724.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$420.00 ,$210.00 ,$76.64 ,$420.00 ,$76.64 ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$76.64 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$76.64 ,$420.00 ,$378.00 ,$324.65 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 ,$81.24 ,$420.00 ,$420.00 ,$142.80 ,$420.00 ,$144.29 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$302.00 ,$151.00 ,$67.10 ,$302.00 ,$76.64 ,$255.46 ,$255.46 ,$102.68 ,$241.60 ,$256.70 ,$188.75 ,$271.80 ,$76.64 ,$286.90 ,$271.80 ,$256.70 ,$256.70 ,$102.68 ,$256.70 ,$256.70 ,$271.80 ,$76.64 ,$302.00 ,$271.80 ,$259.11 ,$277.84 ,$271.80 ,$201.25 ,$201.25 ,$183.92 ,$201.25 ,$196.30 ,$210.34 ,$67.10 ,$238.58 ,$81.24 ,$302.00 ,$302.00 ,$102.68 ,$302.00 ,$115.16 ,$286.90 ,$247.64 ,$247.64 ,$241.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$345.00 ,$172.50 ,$76.64 ,$345.00 ,$76.64 ,$291.84 ,$291.84 ,$117.30 ,$276.00 ,$293.25 ,$215.63 ,$310.50 ,$76.64 ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$117.30 ,$293.25 ,$293.25 ,$310.50 ,$76.64 ,$345.00 ,$310.50 ,$259.11 ,$317.40 ,$310.50 ,$229.91 ,$229.91 ,$210.11 ,$229.91 ,$224.25 ,$240.29 ,$76.66 ,$272.55 ,$81.24 ,$345.00 ,$345.00 ,$117.30 ,$345.00 ,$115.16 ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000104,29131,HC APPL FINGER SPLINT DYNAMIC,450,1 ,$269.00 ,$134.50 ,$56.85 ,$269.00 ,$76.64 ,$227.55 ,$227.55 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$76.64 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$76.64 ,$269.00 ,$242.10 ,$127.91 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$81.24 ,$269.00 ,$269.00 ,$91.46 ,$269.00 ,$56.85 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000105,29240,HC STRAPPING SHLDR,450,1 ,$269.00 ,$134.50 ,$59.77 ,$269.00 ,$76.64 ,$227.55 ,$227.55 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$76.64 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$76.64 ,$269.00 ,$242.10 ,$259.11 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$81.24 ,$269.00 ,$269.00 ,$91.46 ,$269.00 ,$115.16 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$420.00 ,$210.00 ,$93.32 ,$554.36 ,$331.97 ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$331.97 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$331.97 ,$420.00 ,$378.00 ,$554.36 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 ,$351.89 ,$420.00 ,$420.00 ,$142.80 ,$420.00 ,$246.38 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$420.00 ,$210.00 ,$76.64 ,$420.00 ,$76.64 ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$76.64 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$76.64 ,$420.00 ,$378.00 ,$324.65 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 ,$81.24 ,$420.00 ,$420.00 ,$142.80 ,$420.00 ,$144.29 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$420.00 ,$210.00 ,$76.64 ,$420.00 ,$76.64 ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$76.64 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$76.64 ,$420.00 ,$378.00 ,$324.65 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 ,$81.24 ,$420.00 ,$420.00 ,$142.80 ,$420.00 ,$144.29 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000109,29705,HC REM/BIV CAST ARM/LEG,450,1 ,$748.00 ,$374.00 ,$166.21 ,$748.00 ,$331.97 ,$632.73 ,$632.73 ,$254.32 ,$598.40 ,$635.80 ,$467.50 ,$673.20 ,$331.97 ,$710.60 ,$673.20 ,$635.80 ,$635.80 ,$254.32 ,$635.80 ,$635.80 ,$673.20 ,$331.97 ,$571.36 ,$673.20 ,$554.36 ,$688.16 ,$673.20 ,$498.47 ,$498.47 ,$455.53 ,$498.47 ,$486.20 ,$520.98 ,$166.21 ,$590.92 ,$351.89 ,$575.00 ,$575.00 ,$254.32 ,$650.00 ,$246.38 ,$710.60 ,$613.36 ,$613.36 ,$598.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000110,30300,HC REM FB INTRANASAL,450,1 ,$377.00 ,$188.50 ,$83.77 ,$377.00 ,$195.84 ,$318.90 ,$318.90 ,$128.18 ,$301.60 ,$320.45 ,$235.63 ,$339.30 ,$195.84 ,$358.15 ,$339.30 ,$320.45 ,$320.45 ,$128.18 ,$320.45 ,$320.45 ,$339.30 ,$195.84 ,$377.00 ,$339.30 ,$259.11 ,$346.84 ,$339.30 ,$251.23 ,$251.23 ,$229.59 ,$251.23 ,$245.05 ,$262.58 ,$83.77 ,$297.83 ,$207.59 ,$377.00 ,$377.00 ,$128.18 ,$377.00 ,$115.16 ,$358.15 ,$309.14 ,$309.14 ,$301.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$388.00 ,$194.00 ,$86.21 ,$388.00 ,$195.84 ,$328.21 ,$328.21 ,$131.92 ,$310.40 ,$329.80 ,$242.50 ,$349.20 ,$195.84 ,$368.60 ,$349.20 ,$329.80 ,$329.80 ,$131.92 ,$329.80 ,$329.80 ,$349.20 ,$195.84 ,$388.00 ,$349.20 ,$259.11 ,$356.96 ,$349.20 ,$258.56 ,$258.56 ,$236.29 ,$258.56 ,$252.20 ,$270.24 ,$86.21 ,$306.52 ,$207.59 ,$388.00 ,$388.00 ,$131.92 ,$388.00 ,$115.16 ,$368.60 ,$318.16 ,$318.16 ,$310.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$474.00 ,$237.00 ,$105.32 ,$474.00 ,$195.84 ,$400.96 ,$400.96 ,$161.16 ,$379.20 ,$402.90 ,$296.25 ,$426.60 ,$195.84 ,$450.30 ,$426.60 ,$402.90 ,$402.90 ,$161.16 ,$402.90 ,$402.90 ,$426.60 ,$195.84 ,$474.00 ,$426.60 ,$259.11 ,$436.08 ,$426.60 ,$315.87 ,$315.87 ,$288.67 ,$315.87 ,$308.10 ,$330.14 ,$105.32 ,$374.46 ,$207.59 ,$474.00 ,$474.00 ,$161.16 ,$474.00 ,$115.16 ,$450.30 ,$388.68 ,$388.68 ,$379.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$431.00 ,$215.50 ,$95.77 ,$431.00 ,$195.84 ,$364.58 ,$364.58 ,$146.54 ,$344.80 ,$366.35 ,$269.38 ,$387.90 ,$195.84 ,$409.45 ,$387.90 ,$366.35 ,$366.35 ,$146.54 ,$366.35 ,$366.35 ,$387.90 ,$195.84 ,$431.00 ,$387.90 ,$259.11 ,$396.52 ,$387.90 ,$287.22 ,$287.22 ,$262.48 ,$287.22 ,$280.15 ,$300.19 ,$95.77 ,$340.49 ,$207.59 ,$431.00 ,$431.00 ,$146.54 ,$431.00 ,$115.16 ,$409.45 ,$353.42 ,$353.42 ,$344.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000114,31238,HC NASAL ENDO W EPISTAX CONTROL,450,1 ,"$3,100.00 ","$1,550.00 ",$571.36 ,"$3,636.93 ","$3,431.07 ","$2,622.29 ","$2,622.29 ","$1,054.00 ","$2,480.00 ","$2,635.00 ","$1,937.50 ","$2,790.00 ","$3,431.07 ","$2,945.00 ","$2,790.00 ","$2,635.00 ","$2,635.00 ","$1,054.00 ","$2,635.00 ","$2,635.00 ","$2,790.00 ","$3,431.07 ",$571.36 ,"$2,790.00 ","$3,438.00 ","$2,852.00 ","$2,790.00 ","$2,065.84 ","$2,065.84 ","$1,887.90 ","$2,065.84 ","$2,015.00 ","$2,159.15 ",$688.82 ,"$2,449.00 ","$3,636.93 ",$575.00 ,$575.00 ,"$1,054.00 ",$650.00 ,"$1,528.00 ","$2,945.00 ","$2,542.00 ","$2,542.00 ","$2,480.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000116,31720,HC ASP CATH NASOTRACHEAL,450,1 ,$248.00 ,$124.00 ,$55.11 ,$431.93 ,$91.76 ,$209.78 ,$209.78 ,$84.32 ,$198.40 ,$210.80 ,$155.00 ,$223.20 ,$91.76 ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$84.32 ,$210.80 ,$210.80 ,$223.20 ,$91.76 ,$248.00 ,$223.20 ,$431.93 ,$228.16 ,$223.20 ,$165.27 ,$165.27 ,$151.03 ,$165.27 ,$161.20 ,$172.73 ,$55.11 ,$195.92 ,$97.27 ,$248.00 ,$248.00 ,$84.32 ,$248.00 ,$191.97 ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000123,36400,HC IV START < 3 YEARS OLD (MD),450,1 ,$172.00 ,$86.00 ,$4.12 ,$172.00 ,$4.12 ,$145.49 ,$145.49 ,$58.48 ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$4.12 ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$58.48 ,$146.20 ,$146.20 ,$154.80 ,$4.12 ,$172.00 ,$154.80 , N/A ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 ,$4.37 ,$172.00 ,$172.00 ,$58.48 ,$172.00 , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000124,36406,HC VENIPUNCTURE <3YR VEIN OTHR,450,1 ,$30.00 ,$15.00 ,$4.12 ,$30.00 ,$4.12 ,$25.38 ,$25.38 ,$10.20 ,$24.00 ,$25.50 ,$18.75 ,$27.00 ,$4.12 ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$10.20 ,$25.50 ,$25.50 ,$27.00 ,$4.12 ,$30.00 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.99 ,$19.99 ,$18.27 ,$19.99 ,$19.50 ,$20.90 ,$6.67 ,$23.70 ,$4.37 ,$30.00 ,$30.00 ,$10.20 ,$30.00 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$582.00 ,$291.00 ,$129.32 ,$623.66 ,$424.03 ,$492.31 ,$492.31 ,$197.88 ,$465.60 ,$494.70 ,$363.75 ,$523.80 ,$424.03 ,$552.90 ,$523.80 ,$494.70 ,$494.70 ,$197.88 ,$494.70 ,$494.70 ,$523.80 ,$424.03 ,$571.36 ,$523.80 ,$623.66 ,$535.44 ,$523.80 ,$387.84 ,$387.84 ,$354.44 ,$387.84 ,$378.30 ,$405.36 ,$129.32 ,$459.78 ,$449.47 ,$575.00 ,$575.00 ,$197.88 ,$582.00 ,$277.18 ,$552.90 ,$477.24 ,$477.24 ,$465.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000134,40652,HC RPR LIP UP 1/2 VERTICAL,450,1 ,"$1,404.00 ",$702.00 ,$311.97 ,"$1,716.62 ","$1,619.45 ","$1,187.64 ","$1,187.64 ",$477.36 ,"$1,123.20 ","$1,193.40 ",$877.50 ,"$1,263.60 ","$1,619.45 ","$1,333.80 ","$1,263.60 ","$1,193.40 ","$1,193.40 ",$477.36 ,"$1,193.40 ","$1,193.40 ","$1,263.60 ","$1,619.45 ",$571.36 ,"$1,263.60 ","$1,039.28 ","$1,291.68 ","$1,263.60 ",$935.63 ,$935.63 ,$855.04 ,$935.63 ,$912.60 ,$977.89 ,$311.97 ,"$1,109.16 ","$1,716.62 ",$575.00 ,$575.00 ,$477.36 ,$650.00 ,$461.90 ,"$1,333.80 ","$1,151.28 ","$1,151.28 ","$1,123.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$560.00 ,$280.00 ,$124.43 ,$623.66 ,$195.84 ,$473.70 ,$473.70 ,$190.40 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,$195.84 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$190.40 ,$476.00 ,$476.00 ,$504.00 ,$195.84 ,$560.00 ,$504.00 ,$623.66 ,$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,$207.59 ,$560.00 ,$560.00 ,$190.40 ,$560.00 ,$277.18 ,$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$420.00 ,$210.00 ,$93.32 ,$420.00 ,$195.84 ,$355.28 ,$355.28 ,$142.80 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$195.84 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$142.80 ,$357.00 ,$357.00 ,$378.00 ,$195.84 ,$420.00 ,$378.00 ,$259.11 ,$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$93.32 ,$331.80 ,$207.59 ,$420.00 ,$420.00 ,$142.80 ,$420.00 ,$115.16 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000140,42700,HC I AND D ABSC PERITONSILLAR,450,1 ,$636.00 ,$318.00 ,$141.32 ,$636.00 ,$195.84 ,$537.99 ,$537.99 ,$216.24 ,$508.80 ,$540.60 ,$397.50 ,$572.40 ,$195.84 ,$604.20 ,$572.40 ,$540.60 ,$540.60 ,$216.24 ,$540.60 ,$540.60 ,$572.40 ,$195.84 ,$571.36 ,$572.40 ,$486.16 ,$585.12 ,$572.40 ,$423.83 ,$423.83 ,$387.32 ,$423.83 ,$413.40 ,$442.97 ,$141.32 ,$502.44 ,$207.59 ,$575.00 ,$575.00 ,$216.24 ,$636.00 ,$216.07 ,$604.20 ,$521.52 ,$521.52 ,$508.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000141,42809,HC REMOVE PHARYNX FOREIGN BODY,450,1 ,$215.00 ,$107.50 ,$47.77 ,$623.66 ,$195.84 ,$181.87 ,$181.87 ,$73.10 ,$172.00 ,$182.75 ,$134.38 ,$193.50 ,$195.84 ,$204.25 ,$193.50 ,$182.75 ,$182.75 ,$73.10 ,$182.75 ,$182.75 ,$193.50 ,$195.84 ,$215.00 ,$193.50 ,$623.66 ,$197.80 ,$193.50 ,$143.28 ,$143.28 ,$130.94 ,$143.28 ,$139.75 ,$149.75 ,$47.77 ,$169.85 ,$207.59 ,$215.00 ,$215.00 ,$73.10 ,$215.00 ,$277.18 ,$204.25 ,$176.30 ,$176.30 ,$172.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$2,752.52 ","$2,596.72 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$2,596.72 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$2,596.72 ",$571.36 ,"$1,066.50 ","$1,823.58 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$2,752.52 ",$575.00 ,$575.00 ,$402.90 ,$650.00 ,$810.48 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$474.00 ,$237.00 ,$105.32 ,"$2,752.52 ","$2,596.72 ",$400.96 ,$400.96 ,$161.16 ,$379.20 ,$402.90 ,$296.25 ,$426.60 ,"$2,596.72 ",$450.30 ,$426.60 ,$402.90 ,$402.90 ,$161.16 ,$402.90 ,$402.90 ,$426.60 ,"$2,596.72 ",$474.00 ,$426.60 ,$611.48 ,$436.08 ,$426.60 ,$315.87 ,$315.87 ,$288.67 ,$315.87 ,$308.10 ,$330.14 ,$105.32 ,$374.46 ,"$2,752.52 ",$474.00 ,$474.00 ,$161.16 ,$474.00 ,$271.77 ,$450.30 ,$388.68 ,$388.68 ,$379.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000150,46600,HC ANOSCOPY,450,1 ,$230.00 ,$115.00 ,$51.11 ,$335.91 ,$316.90 ,$194.56 ,$194.56 ,$78.20 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$316.90 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$78.20 ,$195.50 ,$195.50 ,$207.00 ,$316.90 ,$230.00 ,$207.00 ,$259.11 ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 ,$335.91 ,$230.00 ,$230.00 ,$78.20 ,$230.00 ,$115.16 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$517.00 ,$258.50 ,$114.88 ,$611.48 ,$126.99 ,$437.33 ,$437.33 ,$175.78 ,$413.60 ,$439.45 ,$323.13 ,$465.30 ,$126.99 ,$491.15 ,$465.30 ,$439.45 ,$439.45 ,$175.78 ,$439.45 ,$439.45 ,$465.30 ,$126.99 ,$517.00 ,$465.30 ,$611.48 ,$475.64 ,$465.30 ,$344.53 ,$344.53 ,$314.85 ,$344.53 ,$336.05 ,$360.09 ,$114.88 ,$408.43 ,$134.61 ,$517.00 ,$517.00 ,$175.78 ,$517.00 ,$271.77 ,$491.15 ,$423.94 ,$423.94 ,$413.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$798.00 ,$399.00 ,$177.32 ,$798.00 ,$352.07 ,$675.03 ,$675.03 ,$271.32 ,$638.40 ,$678.30 ,$498.75 ,$718.20 ,$352.07 ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$271.32 ,$678.30 ,$678.30 ,$718.20 ,$352.07 ,$571.36 ,$718.20 ,$611.48 ,$734.16 ,$718.20 ,$531.79 ,$531.79 ,$485.98 ,$531.79 ,$518.70 ,$555.81 ,$177.32 ,$630.42 ,$373.19 ,$575.00 ,$575.00 ,$271.32 ,$650.00 ,$271.77 ,$758.10 ,$654.36 ,$654.36 ,$638.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$593.00 ,$296.50 ,$131.76 ,$648.09 ,$347.75 ,$501.62 ,$501.62 ,$201.62 ,$474.40 ,$504.05 ,$370.63 ,$533.70 ,$347.75 ,$563.35 ,$533.70 ,$504.05 ,$504.05 ,$201.62 ,$504.05 ,$504.05 ,$533.70 ,$347.75 ,$571.36 ,$533.70 ,$648.09 ,$545.56 ,$533.70 ,$395.18 ,$395.18 ,$361.14 ,$395.18 ,$385.45 ,$413.02 ,$131.76 ,$468.47 ,$368.62 ,$575.00 ,$575.00 ,$201.62 ,$593.00 ,$288.04 ,$563.35 ,$486.26 ,$486.26 ,$474.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000168,64400,HC DENTAL BLOCK,450,1 ,$765.00 ,$382.50 ,$169.98 ,$813.40 ,$767.36 ,$647.11 ,$647.11 ,$260.10 ,$612.00 ,$650.25 ,$478.13 ,$688.50 ,$767.36 ,$726.75 ,$688.50 ,$650.25 ,$650.25 ,$260.10 ,$650.25 ,$650.25 ,$688.50 ,$767.36 ,$571.36 ,$688.50 ,$600.37 ,$703.80 ,$688.50 ,$509.80 ,$509.80 ,$465.89 ,$509.80 ,$497.25 ,$532.82 ,$169.98 ,$604.35 ,$813.40 ,$575.00 ,$575.00 ,$260.10 ,$650.00 ,$266.83 ,$726.75 ,$627.30 ,$627.30 ,$612.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$380.00 ,$190.00 ,$84.44 ,$813.40 ,$767.36 ,$321.44 ,$321.44 ,$129.20 ,$304.00 ,$323.00 ,$237.50 ,$342.00 ,$767.36 ,$361.00 ,$342.00 ,$323.00 ,$323.00 ,$129.20 ,$323.00 ,$323.00 ,$342.00 ,$767.36 ,$380.00 ,$342.00 ,$600.37 ,$349.60 ,$342.00 ,$253.23 ,$253.23 ,$231.42 ,$253.23 ,$247.00 ,$264.67 ,$84.44 ,$300.20 ,$813.40 ,$380.00 ,$380.00 ,$129.20 ,$380.00 ,$266.83 ,$361.00 ,$311.60 ,$311.60 ,$304.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,$830.00 ,$415.00 ,$184.43 ,"$1,459.17 ",$767.36 ,$702.10 ,$702.10 ,$282.20 ,$664.00 ,$705.50 ,$518.75 ,$747.00 ,$767.36 ,$788.50 ,$747.00 ,$705.50 ,$705.50 ,$282.20 ,$705.50 ,$705.50 ,$747.00 ,$767.36 ,$571.36 ,$747.00 ,"$1,459.17 ",$763.60 ,$747.00 ,$553.11 ,$553.11 ,$505.47 ,$553.11 ,$539.50 ,$578.10 ,$184.43 ,$655.70 ,$813.40 ,$575.00 ,$575.00 ,$282.20 ,$650.00 ,$648.52 ,$788.50 ,$680.60 ,$680.60 ,$664.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$381.00 ,$190.50 ,$84.66 ,$381.00 ,$128.25 ,$322.29 ,$322.29 ,$129.54 ,$304.80 ,$323.85 ,$238.13 ,$342.90 ,$128.25 ,$361.95 ,$342.90 ,$323.85 ,$323.85 ,$129.54 ,$323.85 ,$323.85 ,$342.90 ,$128.25 ,$381.00 ,$342.90 ,$259.11 ,$350.52 ,$342.90 ,$253.90 ,$253.90 ,$232.03 ,$253.90 ,$247.65 ,$265.37 ,$84.66 ,$300.99 ,$135.95 ,$381.00 ,$381.00 ,$129.54 ,$381.00 ,$115.16 ,$361.95 ,$312.42 ,$312.42 ,$304.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$381.00 ,$190.50 ,$84.66 ,$623.66 ,$128.25 ,$322.29 ,$322.29 ,$129.54 ,$304.80 ,$323.85 ,$238.13 ,$342.90 ,$128.25 ,$361.95 ,$342.90 ,$323.85 ,$323.85 ,$129.54 ,$323.85 ,$323.85 ,$342.90 ,$128.25 ,$381.00 ,$342.90 ,$623.66 ,$350.52 ,$342.90 ,$253.90 ,$253.90 ,$232.03 ,$253.90 ,$247.65 ,$265.37 ,$84.66 ,$300.99 ,$135.95 ,$381.00 ,$381.00 ,$129.54 ,$381.00 ,$277.18 ,$361.95 ,$312.42 ,$312.42 ,$304.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$381.00 ,$190.50 ,$84.66 ,$381.00 ,$128.25 ,$322.29 ,$322.29 ,$129.54 ,$304.80 ,$323.85 ,$238.13 ,$342.90 ,$128.25 ,$361.95 ,$342.90 ,$323.85 ,$323.85 ,$129.54 ,$323.85 ,$323.85 ,$342.90 ,$128.25 ,$381.00 ,$342.90 ,$259.11 ,$350.52 ,$342.90 ,$253.90 ,$253.90 ,$232.03 ,$253.90 ,$247.65 ,$265.37 ,$84.66 ,$300.99 ,$135.95 ,$381.00 ,$381.00 ,$129.54 ,$381.00 ,$115.16 ,$361.95 ,$312.42 ,$312.42 ,$304.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$486.00 ,$243.00 ,$107.99 ,$601.11 ,$555.55 ,$411.11 ,$411.11 ,$165.24 ,$388.80 ,$413.10 ,$303.75 ,$437.40 ,$555.55 ,$461.70 ,$437.40 ,$413.10 ,$413.10 ,$165.24 ,$413.10 ,$413.10 ,$437.40 ,$555.55 ,$486.00 ,$437.40 ,$601.11 ,$447.12 ,$437.40 ,$323.87 ,$323.87 ,$295.97 ,$323.87 ,$315.90 ,$338.50 ,$107.99 ,$383.94 ,$588.88 ,$486.00 ,$486.00 ,$165.24 ,$486.00 ,$267.16 ,$461.70 ,$398.52 ,$398.52 ,$388.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000181,69200,HC FB REMOVAL EAR,450,1 ,$215.00 ,$107.50 ,$47.77 ,$259.11 ,$195.84 ,$181.87 ,$181.87 ,$73.10 ,$172.00 ,$182.75 ,$134.38 ,$193.50 ,$195.84 ,$204.25 ,$193.50 ,$182.75 ,$182.75 ,$73.10 ,$182.75 ,$182.75 ,$193.50 ,$195.84 ,$215.00 ,$193.50 ,$259.11 ,$197.80 ,$193.50 ,$143.28 ,$143.28 ,$130.94 ,$143.28 ,$139.75 ,$149.75 ,$47.77 ,$169.85 ,$207.59 ,$215.00 ,$215.00 ,$73.10 ,$215.00 ,$115.16 ,$204.25 ,$176.30 ,$176.30 ,$172.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$108.00 ,$54.00 ,$24.00 ,$207.59 ,$195.84 ,$91.36 ,$91.36 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$195.84 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$195.84 ,$108.00 ,$97.20 ,$127.91 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$207.59 ,$108.00 ,$108.00 ,$36.72 ,$108.00 ,$56.85 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000188,99281,HC ER LEVEL 1,450,1 ,$175.00 ,$87.50 ,$38.89 ,$227.45 ,$214.58 ,$148.03 ,$148.03 ,$59.50 ,$140.00 ,$148.75 ,$109.38 ,$157.50 ,$214.58 ,$166.25 ,$157.50 ,$148.75 ,$148.75 ,$59.50 ,$148.75 ,$148.75 ,$157.50 ,$214.58 ,$175.00 ,$157.50 ,$166.68 ,$161.00 ,$157.50 ,$116.62 ,$116.62 ,$106.58 ,$116.62 ,$113.75 ,$121.89 ,$38.89 ,$138.25 ,$227.45 ,$175.00 ,$175.00 ,$59.50 ,$175.00 ,$74.08 ,$166.25 ,$143.50 ,$143.50 ,$140.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000189,99282,HC ER LEVEL 2,450,1 ,$260.00 ,$130.00 ,$57.77 ,$301.84 ,$214.58 ,$219.93 ,$219.93 ,$88.40 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$214.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$88.40 ,$221.00 ,$221.00 ,$234.00 ,$214.58 ,$260.00 ,$234.00 ,$301.84 ,$239.20 ,$234.00 ,$173.26 ,$173.26 ,$158.34 ,$173.26 ,$169.00 ,$181.09 ,$57.77 ,$205.40 ,$227.45 ,$260.00 ,$260.00 ,$88.40 ,$260.00 ,$134.15 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000190,99283,HC ER LEVEL 3,450,1 ,$410.00 ,$205.00 ,$91.10 ,$531.79 ,$214.58 ,$346.82 ,$346.82 ,$139.40 ,$328.00 ,$348.50 ,$256.25 ,$369.00 ,$214.58 ,$389.50 ,$369.00 ,$348.50 ,$348.50 ,$139.40 ,$348.50 ,$348.50 ,$369.00 ,$214.58 ,$410.00 ,$369.00 ,$531.79 ,$377.20 ,$369.00 ,$273.22 ,$273.22 ,$249.69 ,$273.22 ,$266.50 ,$285.57 ,$91.10 ,$323.90 ,$227.45 ,$410.00 ,$410.00 ,$139.40 ,$410.00 ,$236.35 ,$389.50 ,$336.20 ,$336.20 ,$328.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000191,99284,HC ER LEVEL 4,450,1 ,$670.00 ,$335.00 ,$148.87 ,$835.92 ,$214.58 ,$566.75 ,$566.75 ,$227.80 ,$536.00 ,$569.50 ,$418.75 ,$603.00 ,$214.58 ,$636.50 ,$603.00 ,$569.50 ,$569.50 ,$227.80 ,$569.50 ,$569.50 ,$603.00 ,$214.58 ,$670.00 ,$603.00 ,$835.92 ,$616.40 ,$603.00 ,$446.49 ,$446.49 ,$408.03 ,$446.49 ,$435.50 ,$466.66 ,$148.87 ,$529.30 ,$227.45 ,$670.00 ,$670.00 ,$227.80 ,$670.00 ,$371.52 ,$636.50 ,$549.40 ,$549.40 ,$536.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000192,99285,HC ER LEVEL 5,450,1 ,$980.00 ,$490.00 ,$214.58 ,"$1,199.86 ",$214.58 ,$828.98 ,$828.98 ,$333.20 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$214.58 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$333.20 ,$833.00 ,$833.00 ,$882.00 ,$214.58 ,$980.00 ,$882.00 ,"$1,199.86 ",$901.60 ,$882.00 ,$653.07 ,$653.07 ,$596.82 ,$653.07 ,$637.00 ,$682.57 ,$217.76 ,$774.20 ,$227.45 ,$980.00 ,$980.00 ,$333.20 ,$980.00 ,$533.27 ,$931.00 ,$803.60 ,$803.60 ,$784.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$1,800.00 ",$900.00 ,$214.58 ,"$1,800.00 ",$214.58 ,"$1,522.62 ","$1,522.62 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$214.58 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ",$214.58 ,"$1,800.00 ","$1,620.00 ","$1,711.67 ","$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ",$227.45 ,"$1,800.00 ","$1,800.00 ",$612.00 ,"$1,800.00 ",$760.74 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$510.00 ,$255.00 ,$113.32 ,$510.00 ,$214.58 ,$431.41 ,$431.41 ,$173.40 ,$408.00 ,$433.50 ,$318.75 ,$459.00 ,$214.58 ,$484.50 ,$459.00 ,$433.50 ,$433.50 ,$173.40 ,$433.50 ,$433.50 ,$459.00 ,$214.58 ,$510.00 ,$459.00 , N/A ,$469.20 ,$459.00 ,$339.86 ,$339.86 ,$310.59 ,$339.86 ,$331.50 ,$355.22 ,$113.32 ,$402.90 ,$227.45 ,$510.00 ,$510.00 ,$173.40 ,$510.00 , N/A ,$484.50 ,$418.20 ,$418.20 ,$408.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,$830.00 ,$415.00 ,$184.43 ,"$3,200.65 ",$783.09 ,$702.10 ,$702.10 ,$282.20 ,$664.00 ,$705.50 ,$518.75 ,$747.00 ,$783.09 ,$788.50 ,$747.00 ,$705.50 ,$705.50 ,$282.20 ,$705.50 ,$705.50 ,$747.00 ,$783.09 ,$571.36 ,$747.00 ,"$3,200.65 ",$763.60 ,$747.00 ,$553.11 ,$553.11 ,$505.47 ,$553.11 ,$539.50 ,$578.10 ,$184.43 ,$655.70 ,$830.08 ,$575.00 ,$575.00 ,$282.20 ,$650.00 ,"$1,422.51 ",$788.50 ,$680.60 ,$680.60 ,$664.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,$593.00 ,$296.50 ,$131.76 ,$830.08 ,$783.09 ,$501.62 ,$501.62 ,$201.62 ,$474.40 ,$504.05 ,$370.63 ,$533.70 ,$783.09 ,$563.35 ,$533.70 ,$504.05 ,$504.05 ,$201.62 ,$504.05 ,$504.05 ,$533.70 ,$783.09 ,$571.36 ,$533.70 ,$473.63 ,$545.56 ,$533.70 ,$395.18 ,$395.18 ,$361.14 ,$395.18 ,$385.45 ,$413.02 ,$131.76 ,$468.47 ,$830.08 ,$575.00 ,$575.00 ,$201.62 ,$593.00 ,$210.50 ,$563.35 ,$486.26 ,$486.26 ,$474.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$4,221.00 ","$2,110.50 ",$571.36 ,"$4,221.00 ","$3,075.33 ","$3,570.54 ","$3,570.54 ","$1,435.14 ","$3,376.80 ","$3,587.85 ","$2,638.13 ","$3,798.90 ","$3,075.33 ","$4,009.95 ","$3,798.90 ","$3,587.85 ","$3,587.85 ","$1,435.14 ","$3,587.85 ","$3,587.85 ","$3,798.90 ","$3,075.33 ",$571.36 ,"$3,798.90 ","$3,233.23 ","$3,883.32 ","$3,798.90 ","$2,812.87 ","$2,812.87 ","$2,570.59 ","$2,812.87 ","$2,743.65 ","$2,939.93 ",$937.91 ,"$3,334.59 ","$3,259.85 ",$575.00 ,$575.00 ,"$1,435.14 ",$650.00 ,"$1,436.99 ","$4,009.95 ","$3,461.22 ","$3,461.22 ","$3,376.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000211,26641,HC CLSD DISCL THUMB W/MANIP,450,1 ,$697.00 ,$348.50 ,$154.87 ,$830.08 ,$783.09 ,$589.59 ,$589.59 ,$236.98 ,$557.60 ,$592.45 ,$435.63 ,$627.30 ,$783.09 ,$662.15 ,$627.30 ,$592.45 ,$592.45 ,$236.98 ,$592.45 ,$592.45 ,$627.30 ,$783.09 ,$571.36 ,$627.30 ,$473.63 ,$641.24 ,$627.30 ,$464.48 ,$464.48 ,$424.47 ,$464.48 ,$453.05 ,$485.46 ,$154.87 ,$550.63 ,$830.08 ,$575.00 ,$575.00 ,$236.98 ,$650.00 ,$210.50 ,$662.15 ,$571.54 ,$571.54 ,$557.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$4,177.05 ","$2,088.53 ",$571.36 ,"$4,177.05 ",$783.09 ,"$3,533.37 ","$3,533.37 ","$1,420.20 ","$3,341.64 ","$3,550.49 ","$2,610.66 ","$3,759.35 ",$783.09 ,"$3,968.20 ","$3,759.35 ","$3,550.49 ","$3,550.49 ","$1,420.20 ","$3,550.49 ","$3,550.49 ","$3,759.35 ",$783.09 ,$571.36 ,"$3,759.35 ","$3,200.65 ","$3,842.89 ","$3,759.35 ","$2,783.59 ","$2,783.59 ","$2,543.82 ","$2,783.59 ","$2,715.08 ","$2,909.32 ",$928.14 ,"$3,299.87 ",$830.08 ,$575.00 ,$575.00 ,"$1,420.20 ",$650.00 ,"$1,422.51 ","$3,968.20 ","$3,425.18 ","$3,425.18 ","$3,341.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$755.00 ,$377.50 ,$167.76 ,$755.00 ,$534.14 ,$638.65 ,$638.65 ,$256.70 ,$604.00 ,$641.75 ,$471.88 ,$679.50 ,$534.14 ,$717.25 ,$679.50 ,$641.75 ,$641.75 ,$256.70 ,$641.75 ,$641.75 ,$679.50 ,$534.14 ,$571.36 ,$679.50 ,$732.69 ,$694.60 ,$679.50 ,$503.13 ,$503.13 ,$459.80 ,$503.13 ,$490.75 ,$525.86 ,$167.76 ,$596.45 ,$566.19 ,$575.00 ,$575.00 ,$256.70 ,$650.00 ,$325.64 ,$717.25 ,$619.10 ,$619.10 ,$604.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000216,41899,HC DENTOALVEOLAR STRUCT PROC,450,1 ,$587.00 ,$293.50 ,$130.43 ,"$3,592.77 ","$3,389.41 ",$496.54 ,$496.54 ,$199.58 ,$469.60 ,$498.95 ,$366.88 ,$528.30 ,"$3,389.41 ",$557.65 ,$528.30 ,$498.95 ,$498.95 ,$199.58 ,$498.95 ,$498.95 ,$528.30 ,"$3,389.41 ",$571.36 ,$528.30 ,$486.16 ,$540.04 ,$528.30 ,$391.18 ,$391.18 ,$357.48 ,$391.18 ,$381.55 ,$408.85 ,$130.43 ,$463.73 ,"$3,592.77 ",$575.00 ,$575.00 ,$199.58 ,$587.00 ,$216.07 ,$557.65 ,$481.34 ,$481.34 ,$469.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$1,394.00 ",$697.00 ,$309.75 ,"$3,200.65 ",$783.09 ,"$1,179.18 ","$1,179.18 ",$473.96 ,"$1,115.20 ","$1,184.90 ",$871.25 ,"$1,254.60 ",$783.09 ,"$1,324.30 ","$1,254.60 ","$1,184.90 ","$1,184.90 ",$473.96 ,"$1,184.90 ","$1,184.90 ","$1,254.60 ",$783.09 ,$571.36 ,"$1,254.60 ","$3,200.65 ","$1,282.48 ","$1,254.60 ",$928.96 ,$928.96 ,$848.95 ,$928.96 ,$906.10 ,$970.92 ,$309.75 ,"$1,101.26 ",$830.08 ,$575.00 ,$575.00 ,$473.96 ,$650.00 ,"$1,422.51 ","$1,324.30 ","$1,143.08 ","$1,143.08 ","$1,115.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,$641.00 ,$320.50 ,$142.43 ,$830.08 ,$783.09 ,$542.22 ,$542.22 ,$217.94 ,$512.80 ,$544.85 ,$400.63 ,$576.90 ,$783.09 ,$608.95 ,$576.90 ,$544.85 ,$544.85 ,$217.94 ,$544.85 ,$544.85 ,$576.90 ,$783.09 ,$571.36 ,$576.90 ,$473.63 ,$589.72 ,$576.90 ,$427.16 ,$427.16 ,$390.37 ,$427.16 ,$416.65 ,$446.46 ,$142.43 ,$506.39 ,$830.08 ,$575.00 ,$575.00 ,$217.94 ,$641.00 ,$210.50 ,$608.95 ,$525.62 ,$525.62 ,$512.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000232,26600,HC CLSD METACARPAL W/O MANIP,450,1 ,$491.00 ,$245.50 ,$109.10 ,$830.08 ,$783.09 ,$415.34 ,$415.34 ,$166.94 ,$392.80 ,$417.35 ,$306.88 ,$441.90 ,$783.09 ,$466.45 ,$441.90 ,$417.35 ,$417.35 ,$166.94 ,$417.35 ,$417.35 ,$441.90 ,$783.09 ,$491.00 ,$441.90 ,$473.63 ,$451.72 ,$441.90 ,$327.20 ,$327.20 ,$299.02 ,$327.20 ,$319.15 ,$341.98 ,$109.10 ,$387.89 ,$830.08 ,$491.00 ,$491.00 ,$166.94 ,$491.00 ,$210.50 ,$466.45 ,$402.62 ,$402.62 ,$392.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,$845.00 ,$422.50 ,$187.76 ,$920.31 ,$868.22 ,$714.79 ,$714.79 ,$287.30 ,$676.00 ,$718.25 ,$528.13 ,$760.50 ,$868.22 ,$802.75 ,$760.50 ,$718.25 ,$718.25 ,$287.30 ,$718.25 ,$718.25 ,$760.50 ,$868.22 ,$571.36 ,$760.50 ,$600.37 ,$777.40 ,$760.50 ,$563.11 ,$563.11 ,$514.61 ,$563.11 ,$549.25 ,$588.54 ,$187.76 ,$667.55 ,$920.31 ,$575.00 ,$575.00 ,$287.30 ,$650.00 ,$266.83 ,$802.75 ,$692.90 ,$692.90 ,$676.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$180.00 ,$90.00 ,$40.00 ,$207.59 ,$195.84 ,$152.26 ,$152.26 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$195.84 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$195.84 ,$180.00 ,$162.00 ,$127.91 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$207.59 ,$180.00 ,$180.00 ,$61.20 ,$180.00 ,$56.85 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000281,N/A,HC ED PROC LEVEL 1,450,1 ,$315.00 ,$157.50 ,$69.99 ,$315.00 , N/A ,$266.46 ,$266.46 ,$107.10 ,$252.00 ,$267.75 ,$196.88 ,$283.50 , N/A ,$299.25 ,$283.50 ,$267.75 ,$267.75 ,$107.10 ,$267.75 ,$267.75 ,$283.50 , N/A ,$315.00 ,$283.50 , N/A ,$289.80 ,$283.50 ,$209.92 ,$209.92 ,$191.84 ,$209.92 ,$204.75 ,$219.40 ,$69.99 ,$248.85 , N/A ,$315.00 ,$315.00 ,$107.10 ,$315.00 , N/A ,$299.25 ,$258.30 ,$258.30 ,$252.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000282,N/A,HC ED PROC LEVEL 2,450,1 ,$525.00 ,$262.50 ,$116.66 ,$525.00 , N/A ,$444.10 ,$444.10 ,$178.50 ,$420.00 ,$446.25 ,$328.13 ,$472.50 , N/A ,$498.75 ,$472.50 ,$446.25 ,$446.25 ,$178.50 ,$446.25 ,$446.25 ,$472.50 , N/A ,$525.00 ,$472.50 , N/A ,$483.00 ,$472.50 ,$349.86 ,$349.86 ,$319.73 ,$349.86 ,$341.25 ,$365.66 ,$116.66 ,$414.75 , N/A ,$525.00 ,$525.00 ,$178.50 ,$525.00 , N/A ,$498.75 ,$430.50 ,$430.50 ,$420.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000283,N/A,HC ED PROC LEVEL 3,450,1 ,"$1,050.00 ",$525.00 ,$233.31 ,"$1,050.00 ", N/A ,$888.20 ,$888.20 ,$357.00 ,$840.00 ,$892.50 ,$656.25 ,$945.00 , N/A ,$997.50 ,$945.00 ,$892.50 ,$892.50 ,$357.00 ,$892.50 ,$892.50 ,$945.00 , N/A ,$571.36 ,$945.00 , N/A ,$966.00 ,$945.00 ,$699.72 ,$699.72 ,$639.45 ,$699.72 ,$682.50 ,$731.33 ,$233.31 ,$829.50 , N/A ,$575.00 ,$575.00 ,$357.00 ,$650.00 , N/A ,$997.50 ,$861.00 ,$861.00 ,$840.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000284,N/A,HC ED PROC LEVEL 4,450,1 ,"$2,100.00 ","$1,050.00 ",$466.62 ,"$2,100.00 ", N/A ,"$1,776.39 ","$1,776.39 ",$714.00 ,"$1,680.00 ","$1,785.00 ","$1,312.50 ","$1,890.00 ", N/A ,"$1,995.00 ","$1,890.00 ","$1,785.00 ","$1,785.00 ",$714.00 ,"$1,785.00 ","$1,785.00 ","$1,890.00 ", N/A ,$571.36 ,"$1,890.00 ", N/A ,"$1,932.00 ","$1,890.00 ","$1,399.44 ","$1,399.44 ","$1,278.90 ","$1,399.44 ","$1,365.00 ","$1,462.65 ",$466.62 ,"$1,659.00 ", N/A ,$575.00 ,$575.00 ,$714.00 ,$650.00 , N/A ,"$1,995.00 ","$1,722.00 ","$1,722.00 ","$1,680.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000285,N/A,HC ED PROC LEVEL 5,450,1 ,"$3,150.00 ","$1,575.00 ",$571.36 ,"$3,150.00 ", N/A ,"$2,664.59 ","$2,664.59 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ", N/A ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ", N/A ,$571.36 ,"$2,835.00 ", N/A ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ", N/A ,$575.00 ,$575.00 ,"$1,071.00 ",$650.00 , N/A ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$697.00 ,$348.50 ,$154.87 ,$830.08 ,$783.09 ,$589.59 ,$589.59 ,$236.98 ,$557.60 ,$592.45 ,$435.63 ,$627.30 ,$783.09 ,$662.15 ,$627.30 ,$592.45 ,$592.45 ,$236.98 ,$592.45 ,$592.45 ,$627.30 ,$783.09 ,$571.36 ,$627.30 ,$473.63 ,$641.24 ,$627.30 ,$464.48 ,$464.48 ,$424.47 ,$464.48 ,$453.05 ,$485.46 ,$154.87 ,$550.63 ,$830.08 ,$575.00 ,$575.00 ,$236.98 ,$650.00 ,$210.50 ,$662.15 ,$571.54 ,$571.54 ,$557.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$493.00 ,$246.50 ,$109.54 ,$493.00 ,$195.84 ,$417.03 ,$417.03 ,$167.62 ,$394.40 ,$419.05 ,$308.13 ,$443.70 ,$195.84 ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$167.62 ,$419.05 ,$419.05 ,$443.70 ,$195.84 ,$493.00 ,$443.70 ,$378.27 ,$453.56 ,$443.70 ,$328.54 ,$328.54 ,$300.24 ,$328.54 ,$320.45 ,$343.37 ,$109.54 ,$389.47 ,$207.59 ,$493.00 ,$493.00 ,$167.62 ,$493.00 ,$168.12 ,$468.35 ,$404.26 ,$404.26 ,$394.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000328,27550,HC CLSD TX KNEE DISLOC W/O ANESTH,450,1 ,$618.57 ,$309.29 ,$137.45 ,$830.08 ,$783.09 ,$523.25 ,$523.25 ,$210.31 ,$494.86 ,$525.78 ,$386.61 ,$556.71 ,$783.09 ,$587.64 ,$556.71 ,$525.78 ,$525.78 ,$210.31 ,$525.78 ,$525.78 ,$556.71 ,$783.09 ,$571.36 ,$556.71 ,$473.63 ,$569.08 ,$556.71 ,$412.22 ,$412.22 ,$376.71 ,$412.22 ,$402.07 ,$430.83 ,$137.45 ,$488.67 ,$830.08 ,$575.00 ,$575.00 ,$210.31 ,$618.57 ,$210.50 ,$587.64 ,$507.23 ,$507.23 ,$494.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000443,65220,HC REMOVE FB CORNL W/O SLIT LAMP-LT,450,1 ,"$1,222.00 ",$611.00 ,$128.25 ,"$1,222.00 ",$128.25 ,"$1,033.69 ","$1,033.69 ",$415.48 ,$977.60 ,"$1,038.70 ",$763.75 ,"$1,099.80 ",$128.25 ,"$1,160.90 ","$1,099.80 ","$1,038.70 ","$1,038.70 ",$415.48 ,"$1,038.70 ","$1,038.70 ","$1,099.80 ",$128.25 ,$571.36 ,"$1,099.80 ",$623.66 ,"$1,124.24 ","$1,099.80 ",$814.34 ,$814.34 ,$744.20 ,$814.34 ,$794.30 ,$851.12 ,$271.53 ,$965.38 ,$135.95 ,$575.00 ,$575.00 ,$415.48 ,$650.00 ,$277.18 ,"$1,160.90 ","$1,002.04 ","$1,002.04 ",$977.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,"$4,499.00 ","$2,249.50 ",$571.36 ,"$4,499.00 ",$783.09 ,"$3,805.70 ","$3,805.70 ","$1,529.66 ","$3,599.20 ","$3,824.15 ","$2,811.88 ","$4,049.10 ",$783.09 ,"$4,274.05 ","$4,049.10 ","$3,824.15 ","$3,824.15 ","$1,529.66 ","$3,824.15 ","$3,824.15 ","$4,049.10 ",$783.09 ,$571.36 ,"$4,049.10 ","$3,200.65 ","$4,139.08 ","$4,049.10 ","$2,998.13 ","$2,998.13 ","$2,739.89 ","$2,998.13 ","$2,924.35 ","$3,133.55 ",$999.68 ,"$3,554.21 ",$830.08 ,$575.00 ,$575.00 ,"$1,529.66 ",$650.00 ,"$1,422.51 ","$4,274.05 ","$3,689.18 ","$3,689.18 ","$3,599.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,177.05 ","$2,088.53 ",$571.36 ,"$4,177.05 ",$783.09 ,"$3,533.37 ","$3,533.37 ","$1,420.20 ","$3,341.64 ","$3,550.49 ","$2,610.66 ","$3,759.35 ",$783.09 ,"$3,968.20 ","$3,759.35 ","$3,550.49 ","$3,550.49 ","$1,420.20 ","$3,550.49 ","$3,550.49 ","$3,759.35 ",$783.09 ,$571.36 ,"$3,759.35 ","$3,200.65 ","$3,842.89 ","$3,759.35 ","$2,783.59 ","$2,783.59 ","$2,543.82 ","$2,783.59 ","$2,715.08 ","$2,909.32 ",$928.14 ,"$3,299.87 ",$830.08 ,$575.00 ,$575.00 ,"$1,420.20 ",$650.00 ,"$1,422.51 ","$3,968.20 ","$3,425.18 ","$3,425.18 ","$3,341.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$765.00 ,$382.50 ,$169.98 ,$765.00 ,$352.07 ,$647.11 ,$647.11 ,$260.10 ,$612.00 ,$650.25 ,$478.13 ,$688.50 ,$352.07 ,$726.75 ,$688.50 ,$650.25 ,$650.25 ,$260.10 ,$650.25 ,$650.25 ,$688.50 ,$352.07 ,$571.36 ,$688.50 ,$611.48 ,$703.80 ,$688.50 ,$509.80 ,$509.80 ,$465.89 ,$509.80 ,$497.25 ,$532.82 ,$169.98 ,$604.35 ,$373.19 ,$575.00 ,$575.00 ,$260.10 ,$650.00 ,$271.77 ,$726.75 ,$627.30 ,$627.30 ,$612.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,"$1,008.00 ",$504.00 ,$223.98 ,"$1,008.00 ",$352.07 ,$852.67 ,$852.67 ,$342.72 ,$806.40 ,$856.80 ,$630.00 ,$907.20 ,$352.07 ,$957.60 ,$907.20 ,$856.80 ,$856.80 ,$342.72 ,$856.80 ,$856.80 ,$907.20 ,$352.07 ,$571.36 ,$907.20 ,$611.48 ,$927.36 ,$907.20 ,$671.73 ,$671.73 ,$613.87 ,$671.73 ,$655.20 ,$702.07 ,$223.98 ,$796.32 ,$373.19 ,$575.00 ,$575.00 ,$342.72 ,$650.00 ,$271.77 ,$957.60 ,$826.56 ,$826.56 ,$806.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45378072,45378,HC COLONOSCOPY DX,975,1 ,"$1,914.00 ",$957.00 ,$194.48 ,"$1,914.00 ","$1,711.37 ","$1,619.05 ","$1,619.05 ",$194.48 ,"$1,531.20 ","$1,626.90 ","$1,196.25 ","$1,722.60 ","$1,711.37 ","$1,818.30 ","$1,722.60 ","$1,626.90 ","$1,626.90 ",$194.48 ,"$1,626.90 ","$1,626.90 ","$1,722.60 ","$1,711.37 ",$803.88 ,"$1,722.60 ","$1,823.58 ","$1,760.88 ","$1,722.60 ","$1,275.49 ","$1,275.49 ","$1,165.63 ","$1,275.49 ","$1,244.10 ","$1,333.10 ",$425.29 ,"$1,512.06 ","$1,814.05 ", N/A , N/A ,$194.48 , N/A ,$810.48 ,"$1,818.30 ","$1,569.48 ","$1,569.48 ","$1,531.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45380072,45380,HC COLONOSCOPY W/BX,975,1 ,"$2,105.00 ","$1,052.50 ",$211.69 ,"$2,382.89 ","$1,711.37 ","$1,780.62 ","$1,780.62 ",$211.69 ,"$1,684.00 ","$1,789.25 ","$1,315.63 ","$1,894.50 ","$1,711.37 ","$1,999.75 ","$1,894.50 ","$1,789.25 ","$1,789.25 ",$211.69 ,"$1,789.25 ","$1,789.25 ","$1,894.50 ","$1,711.37 ",$884.10 ,"$1,894.50 ","$2,382.89 ","$1,936.60 ","$1,894.50 ","$1,402.77 ","$1,402.77 ","$1,281.95 ","$1,402.77 ","$1,368.25 ","$1,466.13 ",$467.73 ,"$1,662.95 ","$1,814.05 ", N/A , N/A ,$211.69 , N/A ,"$1,059.06 ","$1,999.75 ","$1,726.10 ","$1,726.10 ","$1,684.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45384072,45384,HC COLONOSCOPY W TUMOR REMOVAL,975,1 ,"$2,711.00 ","$1,355.50 ",$238.75 ,"$2,711.00 ","$1,711.37 ","$2,293.23 ","$2,293.23 ",$238.75 ,"$2,168.80 ","$2,304.35 ","$1,694.38 ","$2,439.90 ","$1,711.37 ","$2,575.45 ","$2,439.90 ","$2,304.35 ","$2,304.35 ",$238.75 ,"$2,304.35 ","$2,304.35 ","$2,439.90 ","$1,711.37 ","$1,138.62 ","$2,439.90 ","$2,382.89 ","$2,494.12 ","$2,439.90 ","$1,806.61 ","$1,806.61 ","$1,651.00 ","$1,806.61 ","$1,762.15 ","$1,888.21 ",$602.38 ,"$2,141.69 ","$1,814.05 ", N/A , N/A ,$238.75 , N/A ,"$1,059.06 ","$2,575.45 ","$2,223.02 ","$2,223.02 ","$2,168.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45385072,45385,"HC COLONOSCOPY,REVM LESN,SNARE-PRV 72 HR",975,1 ,"$2,711.00 ","$1,355.50 ",$268.76 ,"$2,711.00 ","$1,711.37 ","$2,293.23 ","$2,293.23 ",$268.76 ,"$2,168.80 ","$2,304.35 ","$1,694.38 ","$2,439.90 ","$1,711.37 ","$2,575.45 ","$2,439.90 ","$2,304.35 ","$2,304.35 ",$268.76 ,"$2,304.35 ","$2,304.35 ","$2,439.90 ","$1,711.37 ","$1,138.62 ","$2,439.90 ","$2,382.89 ","$2,494.12 ","$2,439.90 ","$1,806.61 ","$1,806.61 ","$1,651.00 ","$1,806.61 ","$1,762.15 ","$1,888.21 ",$602.38 ,"$2,141.69 ","$1,814.05 ", N/A , N/A ,$268.76 , N/A ,"$1,059.06 ","$2,575.45 ","$2,223.02 ","$2,223.02 ","$2,168.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$426.00 ,$213.00 ,$91.76 ,$426.00 ,$91.76 ,$360.35 ,$360.35 ,$144.84 ,$340.80 ,$362.10 ,$266.25 ,$383.40 ,$91.76 ,$404.70 ,$383.40 ,$362.10 ,$362.10 ,$144.84 ,$362.10 ,$362.10 ,$383.40 ,$91.76 ,$348.47 ,$383.40 ,$320.83 ,$391.92 ,$383.40 ,$283.89 ,$283.89 ,$259.43 ,$283.89 ,$276.90 ,$296.71 ,$94.66 ,$336.54 ,$97.27 ,$426.00 ,$426.00 ,$144.84 ,$426.00 ,$142.59 ,$404.70 ,$349.32 ,$349.32 ,$340.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$706.00 ,$353.00 ,$156.87 ,$706.00 ,$180.36 ,$597.21 ,$597.21 ,$240.04 ,$564.80 ,$600.10 ,$441.25 ,$635.40 ,$180.36 ,$670.70 ,$635.40 ,$600.10 ,$600.10 ,$240.04 ,$600.10 ,$600.10 ,$635.40 ,$180.36 ,$348.47 ,$635.40 ,$608.15 ,$649.52 ,$635.40 ,$470.48 ,$470.48 ,$429.95 ,$470.48 ,$458.90 ,$491.73 ,$156.87 ,$557.74 ,$191.18 ,$449.00 ,$449.00 ,$240.04 ,$477.00 ,$270.29 ,$670.70 ,$578.92 ,$578.92 ,$564.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000005,94060,HC SPIROMETRY/PFT PRE  AND  POST UPDRAFT,460,1 ,$706.00 ,$353.00 ,$156.87 ,$706.00 ,$180.36 ,$597.21 ,$597.21 ,$240.04 ,$564.80 ,$600.10 ,$441.25 ,$635.40 ,$180.36 ,$670.70 ,$635.40 ,$600.10 ,$600.10 ,$240.04 ,$600.10 ,$600.10 ,$635.40 ,$180.36 ,$348.47 ,$635.40 ,$608.15 ,$649.52 ,$635.40 ,$470.48 ,$470.48 ,$429.95 ,$470.48 ,$458.90 ,$491.73 ,$156.87 ,$557.74 ,$191.18 ,$449.00 ,$449.00 ,$240.04 ,$477.00 ,$270.29 ,$670.70 ,$578.92 ,$578.92 ,$564.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,086.00 ",$543.00 ,$180.36 ,"$1,086.00 ",$180.36 ,$918.65 ,$918.65 ,$369.24 ,$868.80 ,$923.10 ,$678.75 ,$977.40 ,$180.36 ,"$1,031.70 ",$977.40 ,$923.10 ,$923.10 ,$369.24 ,$923.10 ,$923.10 ,$977.40 ,$180.36 ,$348.47 ,$977.40 ,$608.15 ,$999.12 ,$977.40 ,$723.71 ,$723.71 ,$661.37 ,$723.71 ,$705.90 ,$756.40 ,$241.31 ,$857.94 ,$191.18 ,$449.00 ,$449.00 ,$369.24 ,$477.00 ,$270.29 ,"$1,031.70 ",$890.52 ,$890.52 ,$868.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000014,94618,HC WALK TEST 6 MIN,460,1 ,$526.00 ,$263.00 ,$91.76 ,$526.00 ,$91.76 ,$444.94 ,$444.94 ,$178.84 ,$420.80 ,$447.10 ,$328.75 ,$473.40 ,$91.76 ,$499.70 ,$473.40 ,$447.10 ,$447.10 ,$178.84 ,$447.10 ,$447.10 ,$473.40 ,$91.76 ,$348.47 ,$473.40 ,$259.11 ,$483.92 ,$473.40 ,$350.53 ,$350.53 ,$320.33 ,$350.53 ,$341.90 ,$366.36 ,$116.88 ,$415.54 ,$97.27 ,$449.00 ,$449.00 ,$178.84 ,$477.00 ,$115.16 ,$499.70 ,$431.32 ,$431.32 ,$420.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000018,94762,HC OXIMETRY OVERNIGHT,460,1 ,$269.00 ,$134.50 ,$59.77 ,$320.83 ,$91.76 ,$227.55 ,$227.55 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$91.76 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$91.76 ,$269.00 ,$242.10 ,$320.83 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$97.27 ,$269.00 ,$269.00 ,$91.46 ,$269.00 ,$142.59 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000021,94760,HC PULSE OX SINGLE,460,1 ,$174.00 ,$87.00 ,$38.66 ,$174.00 , N/A ,$147.19 ,$147.19 ,$59.16 ,$139.20 ,$147.90 ,$108.75 ,$156.60 , N/A ,$165.30 ,$156.60 ,$147.90 ,$147.90 ,$59.16 ,$147.90 ,$147.90 ,$156.60 , N/A ,$174.00 ,$156.60 , N/A ,$160.08 ,$156.60 ,$115.95 ,$115.95 ,$105.97 ,$115.95 ,$113.10 ,$121.19 ,$38.66 ,$137.46 , N/A ,$174.00 ,$174.00 ,$59.16 ,$174.00 , N/A ,$165.30 ,$142.68 ,$142.68 ,$139.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000023,94761,HC PULSE OX MULTI DETERMIN,360,1 ,$235.00 ,$117.50 ,$52.22 ,$235.00 , N/A ,$198.79 ,$198.79 ,$79.90 ,$188.00 ,$199.75 ,$146.88 ,$211.50 , N/A ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$79.90 ,$199.75 ,$199.75 ,$211.50 , N/A , N/A ,$211.50 , N/A ,$216.20 ,$211.50 ,$156.60 ,$156.60 ,$143.12 ,$156.60 ,$152.75 ,$163.68 ,$52.22 ,$185.65 , N/A , N/A , N/A ,$79.90 , N/A , N/A ,$223.25 ,$192.70 ,$192.70 ,$188.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000031,94681,HC CO2/O2 UPTAKE EXPIRED GAS,460,1 ,$795.00 ,$397.50 ,$176.65 ,$795.00 ,$180.36 ,$672.49 ,$672.49 ,$270.30 ,$636.00 ,$675.75 ,$496.88 ,$715.50 ,$180.36 ,$755.25 ,$715.50 ,$675.75 ,$675.75 ,$270.30 ,$675.75 ,$675.75 ,$715.50 ,$180.36 ,$348.47 ,$715.50 ,$608.15 ,$731.40 ,$715.50 ,$529.79 ,$529.79 ,$484.16 ,$529.79 ,$516.75 ,$553.72 ,$176.65 ,$628.05 ,$191.18 ,$449.00 ,$449.00 ,$270.30 ,$477.00 ,$270.29 ,$755.25 ,$651.90 ,$651.90 ,$636.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000034,95070,HC INHALATION BRONCHIAL CHALLENGE TEST W/HISTAMINE/METHACHOLINE,460,1 ,$709.00 ,$354.50 ,$75.03 ,"$1,121.69 ",$75.03 ,$599.74 ,$599.74 ,$241.06 ,$567.20 ,$602.65 ,$443.13 ,$638.10 ,$75.03 ,$673.55 ,$638.10 ,$602.65 ,$602.65 ,$241.06 ,$602.65 ,$602.65 ,$638.10 ,$75.03 ,$348.47 ,$638.10 ,"$1,121.69 ",$652.28 ,$638.10 ,$472.48 ,$472.48 ,$431.78 ,$472.48 ,$460.85 ,$493.82 ,$157.54 ,$560.11 ,$79.53 ,$449.00 ,$449.00 ,$241.06 ,$477.00 ,$498.53 ,$673.55 ,$581.38 ,$581.38 ,$567.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),47562072,47562,HC LAPROSCOPIC CHOLECYSTECTOMY,975,1 ,"$4,711.00 ","$2,355.50 ",$679.64 ,"$11,627.30 ","$6,079.91 ","$3,985.03 ","$3,985.03 ",$679.64 ,"$3,768.80 ","$4,004.35 ","$2,944.38 ","$4,239.90 ","$6,079.91 ","$4,475.45 ","$4,239.90 ","$4,004.35 ","$4,004.35 ",$679.64 ,"$4,004.35 ","$4,004.35 ","$4,239.90 ","$6,079.91 ","$1,978.62 ","$4,239.90 ","$11,627.30 ","$4,334.12 ","$4,239.90 ","$3,139.41 ","$3,139.41 ","$2,869.00 ","$3,139.41 ","$3,062.15 ","$3,281.21 ","$1,046.78 ","$3,721.69 ","$6,444.70 ", N/A , N/A ,$679.64 , N/A ,"$5,167.69 ","$4,475.45 ","$3,863.02 ","$3,863.02 ","$3,768.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,616.00 ",$808.00 ,$359.08 ,"$1,616.00 ","$1,138.88 ","$1,366.97 ","$1,366.97 ",$549.44 ,"$1,292.80 ","$1,373.60 ","$1,010.00 ","$1,454.40 ","$1,138.88 ","$1,535.20 ","$1,454.40 ","$1,373.60 ","$1,373.60 ",$549.44 ,"$1,373.60 ","$1,373.60 ","$1,454.40 ","$1,138.88 ",$930.02 ,"$1,454.40 ","$1,290.89 ","$1,486.72 ","$1,454.40 ","$1,076.90 ","$1,076.90 ",$984.14 ,"$1,076.90 ","$1,050.40 ","$1,125.54 ",$359.08 ,"$1,276.64 ","$1,207.21 ",$868.00 ,$868.00 ,$549.44 ,$914.00 ,$573.73 ,"$1,535.20 ","$1,325.12 ","$1,325.12 ","$1,292.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$109.00 ,$54.50 ,$24.22 ,$313.17 ,$295.44 ,$92.20 ,$92.20 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$295.44 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$295.44 ,$109.00 ,$98.10 ,$127.91 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$313.17 ,$109.00 ,$109.00 ,$37.06 ,$109.00 ,$56.85 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),48100277,93288,HC INTERROG DEVICE EVAL PACEMAKER SYSTEM,481,1 ,$134.00 ,$67.00 ,$29.77 ,$134.00 ,$67.89 ,$113.35 ,$113.35 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$67.89 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$67.89 , N/A ,$120.60 ,$85.57 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$71.96 , N/A , N/A ,$45.56 , N/A ,$38.03 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,232.00 ",$616.00 ,$270.29 ,"$1,232.00 ",$295.44 ,"$1,042.15 ","$1,042.15 ",$418.88 ,$985.60 ,"$1,047.20 ",$770.00 ,"$1,108.80 ",$295.44 ,"$1,170.40 ","$1,108.80 ","$1,047.20 ","$1,047.20 ",$418.88 ,"$1,047.20 ","$1,047.20 ","$1,108.80 ",$295.44 ,$633.59 ,"$1,108.80 ",$608.15 ,"$1,133.44 ","$1,108.80 ",$821.00 ,$821.00 ,$750.29 ,$821.00 ,$800.80 ,$858.09 ,$273.75 ,$973.28 ,$313.17 ,$564.00 ,$564.00 ,$418.88 ,$611.00 ,$270.29 ,"$1,170.40 ","$1,010.24 ","$1,010.24 ",$985.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$2,000.00 ","$1,000.00 ",$305.48 ,"$2,000.00 ",$818.02 ,"$1,691.80 ","$1,691.80 ",$680.00 ,"$1,600.00 ","$1,700.00 ","$1,250.00 ","$1,800.00 ",$818.02 ,"$1,900.00 ","$1,800.00 ","$1,700.00 ","$1,700.00 ",$680.00 ,"$1,700.00 ","$1,700.00 ","$1,800.00 ",$818.02 ,$305.48 ,"$1,800.00 ","$1,110.33 ","$1,840.00 ","$1,800.00 ","$1,332.80 ","$1,332.80 ","$1,218.00 ","$1,332.80 ","$1,300.00 ","$1,393.00 ",$444.40 ,"$1,580.00 ",$867.10 ,$421.00 ,$421.00 ,$680.00 ,$477.00 ,$493.48 ,"$1,900.00 ","$1,640.00 ","$1,640.00 ","$1,600.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$880.00 ,$440.00 ,$195.54 ,$880.00 ,$818.02 ,$744.39 ,$744.39 ,$299.20 ,$704.00 ,$748.00 ,$550.00 ,$792.00 ,$818.02 ,$836.00 ,$792.00 ,$748.00 ,$748.00 ,$299.20 ,$748.00 ,$748.00 ,$792.00 ,$818.02 ,$305.48 ,$792.00 ,$528.75 ,$809.60 ,$792.00 ,$586.43 ,$586.43 ,$535.92 ,$586.43 ,$572.00 ,$612.92 ,$195.54 ,$695.20 ,$867.10 ,$421.00 ,$421.00 ,$299.20 ,$477.00 ,$235.00 ,$836.00 ,$721.60 ,$721.60 ,$704.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$788.00 ,$394.00 ,$175.09 ,$788.00 ,$194.98 ,$666.57 ,$666.57 ,$267.92 ,$630.40 ,$669.80 ,$492.50 ,$709.20 ,$194.98 ,$748.60 ,$709.20 ,$669.80 ,$669.80 ,$267.92 ,$669.80 ,$669.80 ,$709.20 ,$194.98 ,$305.48 ,$709.20 , N/A ,$724.96 ,$709.20 ,$525.12 ,$525.12 ,$479.89 ,$525.12 ,$512.20 ,$548.84 ,$175.09 ,$622.52 ,$206.68 ,$421.00 ,$421.00 ,$267.92 ,$477.00 , N/A ,$748.60 ,$646.16 ,$646.16 ,$630.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$1,900.00 ",$950.00 ,$305.48 ,"$1,900.00 ",$818.02 ,"$1,607.21 ","$1,607.21 ",$646.00 ,"$1,520.00 ","$1,615.00 ","$1,187.50 ","$1,710.00 ",$818.02 ,"$1,805.00 ","$1,710.00 ","$1,615.00 ","$1,615.00 ",$646.00 ,"$1,615.00 ","$1,615.00 ","$1,710.00 ",$818.02 ,$305.48 ,"$1,710.00 ","$1,110.33 ","$1,748.00 ","$1,710.00 ","$1,266.16 ","$1,266.16 ","$1,157.10 ","$1,266.16 ","$1,235.00 ","$1,323.35 ",$422.18 ,"$1,501.00 ",$867.10 ,$421.00 ,$421.00 ,$646.00 ,$477.00 ,$493.48 ,"$1,805.00 ","$1,558.00 ","$1,558.00 ","$1,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$471.00 ,$235.50 ,$104.66 ,$867.10 ,$818.02 ,$398.42 ,$398.42 ,$160.14 ,$376.80 ,$400.35 ,$294.38 ,$423.90 ,$818.02 ,$447.45 ,$423.90 ,$400.35 ,$400.35 ,$160.14 ,$400.35 ,$400.35 ,$423.90 ,$818.02 ,$305.48 ,$423.90 , N/A ,$433.32 ,$423.90 ,$313.87 ,$313.87 ,$286.84 ,$313.87 ,$306.15 ,$328.05 ,$104.66 ,$372.09 ,$867.10 ,$421.00 ,$421.00 ,$160.14 ,$471.00 , N/A ,$447.45 ,$386.22 ,$386.22 ,$376.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,139.00 ",$569.50 ,$253.09 ,"$1,139.00 ",$818.02 ,$963.48 ,$963.48 ,$387.26 ,$911.20 ,$968.15 ,$711.88 ,"$1,025.10 ",$818.02 ,"$1,082.05 ","$1,025.10 ",$968.15 ,$968.15 ,$387.26 ,$968.15 ,$968.15 ,"$1,025.10 ",$818.02 ,$305.48 ,"$1,025.10 ",$846.20 ,"$1,047.88 ","$1,025.10 ",$759.03 ,$759.03 ,$693.65 ,$759.03 ,$740.35 ,$793.31 ,$253.09 ,$899.81 ,$867.10 ,$421.00 ,$421.00 ,$387.26 ,$477.00 ,$376.09 ,"$1,082.05 ",$933.98 ,$933.98 ,$911.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$1,961.00 ",$980.50 ,$305.48 ,"$1,961.00 ",$818.02 ,"$1,658.81 ","$1,658.81 ",$666.74 ,"$1,568.80 ","$1,666.85 ","$1,225.63 ","$1,764.90 ",$818.02 ,"$1,862.95 ","$1,764.90 ","$1,666.85 ","$1,666.85 ",$666.74 ,"$1,666.85 ","$1,666.85 ","$1,764.90 ",$818.02 ,$305.48 ,"$1,764.90 ","$1,644.01 ","$1,804.12 ","$1,764.90 ","$1,306.81 ","$1,306.81 ","$1,194.25 ","$1,306.81 ","$1,274.65 ","$1,365.84 ",$435.73 ,"$1,549.19 ",$867.10 ,$421.00 ,$421.00 ,$666.74 ,$477.00 ,$730.67 ,"$1,862.95 ","$1,608.02 ","$1,608.02 ","$1,568.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$506.00 ,$253.00 ,$64.61 ,$794.25 ,$662.74 ,$129.00 ,$103.00 ,$172.04 ,$404.80 ,$430.10 ,$316.25 ,$455.40 ,$662.74 ,$480.70 ,$455.40 ,$430.10 ,$430.10 ,$172.04 ,$430.10 ,$430.10 ,$455.40 ,$662.74 ,$64.61 ,$455.40 ,$794.25 ,$465.52 ,$455.40 ,$337.20 ,$337.20 ,$308.15 ,$337.20 ,$328.90 ,$352.43 ,$112.43 ,$399.74 ,$702.50 ,$253.00 ,$253.00 ,$172.04 ,$253.00 ,$353.00 ,$480.70 ,$414.92 ,$414.92 ,$404.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000009,11045,HC DEBR SKIN/SUBQ TIS EA ADL 20CM FAC,510,1 ,$108.00 ,$54.00 ,$24.00 ,"$1,874.50 ","$1,768.40 ",$108.00 ,$103.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,"$1,768.40 ",$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,"$1,768.40 ",$64.61 ,$97.20 , N/A ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,"$1,874.50 ",$54.00 ,$54.00 ,$36.72 ,$54.00 , N/A ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$636.00 ,$318.00 ,$64.61 ,$732.69 ,$534.14 ,$129.00 ,$103.00 ,$216.24 ,$508.80 ,$540.60 ,$397.50 ,$572.40 ,$534.14 ,$604.20 ,$572.40 ,$540.60 ,$540.60 ,$216.24 ,$540.60 ,$540.60 ,$572.40 ,$534.14 ,$64.61 ,$572.40 ,$732.69 ,$585.12 ,$572.40 ,$423.83 ,$423.83 ,$387.32 ,$423.83 ,$413.40 ,$442.97 ,$141.32 ,$502.44 ,$566.19 ,$318.00 ,$318.00 ,$216.24 ,$318.00 ,$325.64 ,$604.20 ,$521.52 ,$521.52 ,$508.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000053,29580,HC APPLY UNNA BOOT,510,1 ,$334.00 ,$167.00 ,$64.61 ,$351.89 ,$331.97 ,$129.00 ,$103.00 ,$113.56 ,$267.20 ,$283.90 ,$208.75 ,$300.60 ,$331.97 ,$317.30 ,$300.60 ,$283.90 ,$283.90 ,$113.56 ,$283.90 ,$283.90 ,$300.60 ,$331.97 ,$64.61 ,$300.60 ,$324.65 ,$307.28 ,$300.60 ,$222.58 ,$222.58 ,$203.41 ,$222.58 ,$217.10 ,$232.63 ,$74.21 ,$263.86 ,$351.89 ,$167.00 ,$167.00 ,$113.56 ,$167.00 ,$144.29 ,$317.30 ,$273.88 ,$273.88 ,$267.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000055,29581,HC APPLY MULTI COMP LOWER LEG FAC,510,1 ,$345.00 ,$172.50 ,$64.61 ,$351.89 ,$331.97 ,$129.00 ,$103.00 ,$117.30 ,$276.00 ,$293.25 ,$215.63 ,$310.50 ,$331.97 ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$117.30 ,$293.25 ,$293.25 ,$310.50 ,$331.97 ,$64.61 ,$310.50 ,$324.65 ,$317.40 ,$310.50 ,$229.91 ,$229.91 ,$210.11 ,$229.91 ,$224.25 ,$240.29 ,$76.66 ,$272.55 ,$351.89 ,$172.50 ,$172.50 ,$117.30 ,$172.50 ,$144.29 ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$112.00 ,$56.00 ,$24.89 ,$142.47 ,$77.89 ,$94.74 ,$94.74 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$77.89 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$77.89 ,$47.04 ,$100.80 ,$142.47 ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$82.56 ,$112.00 ,$112.00 ,$38.08 ,$112.00 ,$63.32 ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$224.00 ,$112.00 ,$49.77 ,$470.09 ,$77.89 ,$189.48 ,$189.48 ,$76.16 ,$179.20 ,$190.40 ,$140.00 ,$201.60 ,$77.89 ,$212.80 ,$201.60 ,$190.40 ,$190.40 ,$76.16 ,$190.40 ,$190.40 ,$201.60 ,$77.89 ,$94.08 ,$201.60 ,$470.09 ,$206.08 ,$201.60 ,$149.27 ,$149.27 ,$136.42 ,$149.27 ,$145.60 ,$156.02 ,$49.77 ,$176.96 ,$82.56 ,$224.00 ,$224.00 ,$76.16 ,$224.00 ,$208.93 ,$212.80 ,$183.68 ,$183.68 ,$179.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$179.00 ,$89.50 ,$39.77 ,$179.00 ,$77.89 ,$151.42 ,$151.42 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$77.89 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$77.89 ,$75.18 ,$161.10 ,$91.96 ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$82.56 ,$179.00 ,$179.00 ,$60.86 ,$179.00 ,$40.87 ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$179.00 ,$89.50 ,$39.77 ,$179.00 ,$77.89 ,$151.42 ,$151.42 ,$60.86 ,$143.20 ,$152.15 ,$111.88 ,$161.10 ,$77.89 ,$170.05 ,$161.10 ,$152.15 ,$152.15 ,$60.86 ,$152.15 ,$152.15 ,$161.10 ,$77.89 ,$75.18 ,$161.10 , N/A ,$164.68 ,$161.10 ,$119.29 ,$119.29 ,$109.01 ,$119.29 ,$116.35 ,$124.67 ,$39.77 ,$141.41 ,$82.56 ,$179.00 ,$179.00 ,$60.86 ,$179.00 , N/A ,$170.05 ,$146.78 ,$146.78 ,$143.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$134.00 ,$67.00 ,$29.77 ,$134.00 ,$77.89 ,$129.00 ,$103.00 ,$45.56 ,$107.20 ,$113.90 ,$83.75 ,$120.60 ,$77.89 ,$127.30 ,$120.60 ,$113.90 ,$113.90 ,$45.56 ,$113.90 ,$113.90 ,$120.60 ,$77.89 ,$64.61 ,$120.60 ,$127.91 ,$123.28 ,$120.60 ,$89.30 ,$89.30 ,$81.61 ,$89.30 ,$87.10 ,$93.33 ,$29.77 ,$105.86 ,$82.56 ,$67.00 ,$67.00 ,$45.56 ,$67.00 ,$56.85 ,$127.30 ,$109.88 ,$109.88 ,$107.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$227.00 ,$113.50 ,$50.44 ,$227.45 ,$214.58 ,$129.00 ,$103.00 ,$77.18 ,$181.60 ,$192.95 ,$141.88 ,$204.30 ,$214.58 ,$215.65 ,$204.30 ,$192.95 ,$192.95 ,$77.18 ,$192.95 ,$192.95 ,$204.30 ,$214.58 ,$64.61 ,$204.30 , N/A ,$208.84 ,$204.30 ,$151.27 ,$151.27 ,$138.24 ,$151.27 ,$147.55 ,$158.11 ,$50.44 ,$179.33 ,$227.45 ,$113.50 ,$113.50 ,$77.18 ,$113.50 , N/A ,$215.65 ,$186.14 ,$186.14 ,$181.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$237.00 ,$118.50 ,$52.66 ,$237.00 ,$214.58 ,$129.00 ,$103.00 ,$80.58 ,$189.60 ,$201.45 ,$148.13 ,$213.30 ,$214.58 ,$225.15 ,$213.30 ,$201.45 ,$201.45 ,$80.58 ,$201.45 ,$201.45 ,$213.30 ,$214.58 ,$64.61 ,$213.30 , N/A ,$218.04 ,$213.30 ,$157.94 ,$157.94 ,$144.33 ,$157.94 ,$154.05 ,$165.07 ,$52.66 ,$187.23 ,$227.45 ,$118.50 ,$118.50 ,$80.58 ,$118.50 , N/A ,$225.15 ,$194.34 ,$194.34 ,$189.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$288.00 ,$144.00 ,$63.99 ,$288.00 ,$214.58 ,$129.00 ,$103.00 ,$97.92 ,$230.40 ,$244.80 ,$180.00 ,$259.20 ,$214.58 ,$273.60 ,$259.20 ,$244.80 ,$244.80 ,$97.92 ,$244.80 ,$244.80 ,$259.20 ,$214.58 ,$64.61 ,$259.20 , N/A ,$264.96 ,$259.20 ,$191.92 ,$191.92 ,$175.39 ,$191.92 ,$187.20 ,$200.59 ,$63.99 ,$227.52 ,$227.45 ,$144.00 ,$144.00 ,$97.92 ,$144.00 , N/A ,$273.60 ,$236.16 ,$236.16 ,$230.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$319.00 ,$159.50 ,$64.61 ,$319.00 ,$214.58 ,$129.00 ,$103.00 ,$108.46 ,$255.20 ,$271.15 ,$199.38 ,$287.10 ,$214.58 ,$303.05 ,$287.10 ,$271.15 ,$271.15 ,$108.46 ,$271.15 ,$271.15 ,$287.10 ,$214.58 ,$64.61 ,$287.10 , N/A ,$293.48 ,$287.10 ,$212.58 ,$212.58 ,$194.27 ,$212.58 ,$207.35 ,$222.18 ,$70.88 ,$252.01 ,$227.45 ,$159.50 ,$159.50 ,$108.46 ,$159.50 , N/A ,$303.05 ,$261.58 ,$261.58 ,$255.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$402.00 ,$201.00 ,$64.61 ,$402.00 ,$214.58 ,$129.00 ,$103.00 ,$136.68 ,$321.60 ,$341.70 ,$251.25 ,$361.80 ,$214.58 ,$381.90 ,$361.80 ,$341.70 ,$341.70 ,$136.68 ,$341.70 ,$341.70 ,$361.80 ,$214.58 ,$64.61 ,$361.80 , N/A ,$369.84 ,$361.80 ,$267.89 ,$267.89 ,$244.82 ,$267.89 ,$261.30 ,$279.99 ,$89.32 ,$317.58 ,$227.45 ,$201.00 ,$201.00 ,$136.68 ,$201.00 , N/A ,$381.90 ,$329.64 ,$329.64 ,$321.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$47.00 ,$23.50 ,$3.00 ,$47.00 ,$4.12 ,$10.50 ,$9.00 ,$15.98 ,$37.60 ,$39.95 ,$29.38 ,$42.30 ,$4.12 ,$44.65 ,$42.30 ,$39.95 ,$39.95 ,$15.98 ,$39.95 ,$39.95 ,$42.30 ,$4.12 ,$3.40 ,$42.30 ,$6.75 ,$43.24 ,$42.30 ,$31.32 ,$31.32 ,$28.62 ,$31.32 ,$30.55 ,$32.74 ,$10.44 ,$37.13 ,$4.37 ,$3.60 ,$3.60 ,$15.98 ,$3.60 ,$3.00 ,$44.65 ,$38.54 ,$38.54 ,$37.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$205.00 ,$102.50 ,$45.55 ,$259.11 ,$126.99 ,$129.00 ,$103.00 ,$69.70 ,$164.00 ,$174.25 ,$128.13 ,$184.50 ,$126.99 ,$194.75 ,$184.50 ,$174.25 ,$174.25 ,$69.70 ,$174.25 ,$174.25 ,$184.50 ,$126.99 ,$64.61 ,$184.50 ,$259.11 ,$188.60 ,$184.50 ,$136.61 ,$136.61 ,$124.85 ,$136.61 ,$133.25 ,$142.78 ,$45.55 ,$161.95 ,$134.61 ,$102.50 ,$102.50 ,$69.70 ,$102.50 ,$115.16 ,$194.75 ,$168.10 ,$168.10 ,$164.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000172,51702,HC CATH BLADDER SMP,510,1 ,$205.00 ,$102.50 ,$45.55 ,$259.11 ,$126.99 ,$129.00 ,$103.00 ,$69.70 ,$164.00 ,$174.25 ,$128.13 ,$184.50 ,$126.99 ,$194.75 ,$184.50 ,$174.25 ,$174.25 ,$69.70 ,$174.25 ,$174.25 ,$184.50 ,$126.99 ,$64.61 ,$184.50 ,$259.11 ,$188.60 ,$184.50 ,$136.61 ,$136.61 ,$124.85 ,$136.61 ,$133.25 ,$142.78 ,$45.55 ,$161.95 ,$134.61 ,$102.50 ,$102.50 ,$69.70 ,$102.50 ,$115.16 ,$194.75 ,$168.10 ,$168.10 ,$164.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000201,29799,HC REMOVAL REVISION LEGCAST FACILITY,510,1 ,$438.00 ,$219.00 ,$64.61 ,$438.00 ,$76.64 ,$129.00 ,$103.00 ,$148.92 ,$350.40 ,$372.30 ,$273.75 ,$394.20 ,$76.64 ,$416.10 ,$394.20 ,$372.30 ,$372.30 ,$148.92 ,$372.30 ,$372.30 ,$394.20 ,$76.64 ,$64.61 ,$394.20 ,$324.65 ,$402.96 ,$394.20 ,$291.88 ,$291.88 ,$266.74 ,$291.88 ,$284.70 ,$305.07 ,$97.32 ,$346.02 ,$81.24 ,$219.00 ,$219.00 ,$148.92 ,$219.00 ,$144.29 ,$416.10 ,$359.16 ,$359.16 ,$350.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,724.00 ",$862.00 ,$64.61 ,"$2,915.85 ","$2,750.80 ",$129.00 ,$103.00 ,$586.16 ,"$1,379.20 ","$1,465.40 ","$1,077.50 ","$1,551.60 ","$2,750.80 ","$1,637.80 ","$1,551.60 ","$1,465.40 ","$1,465.40 ",$586.16 ,"$1,465.40 ","$1,465.40 ","$1,551.60 ","$2,750.80 ",$64.61 ,"$1,551.60 ","$1,322.01 ","$1,586.08 ","$1,551.60 ","$1,148.87 ","$1,148.87 ","$1,049.92 ","$1,148.87 ","$1,120.60 ","$1,200.77 ",$383.07 ,"$1,361.96 ","$2,915.85 ",$862.00 ,$862.00 ,$586.16 ,$862.00 ,$587.56 ,"$1,637.80 ","$1,413.68 ","$1,413.68 ","$1,379.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),51000315,38222,HC BM ASPIRATION (BX/ASP SAME SITE),360,1 ,"$1,401.00 ",$700.50 ,$311.30 ,"$5,448.49 ","$2,094.24 ","$1,185.11 ","$1,185.11 ",$476.34 ,"$1,120.80 ","$1,190.85 ",$875.63 ,"$1,260.90 ","$2,094.24 ","$1,330.95 ","$1,260.90 ","$1,190.85 ","$1,190.85 ",$476.34 ,"$1,190.85 ","$1,190.85 ","$1,260.90 ","$2,094.24 ","$1,401.00 ","$1,260.90 ","$5,448.49 ","$1,288.92 ","$1,260.90 ",$933.63 ,$933.63 ,$853.21 ,$933.63 ,$910.65 ,$975.80 ,$311.30 ,"$1,106.79 ","$2,219.89 ","$1,401.00 ","$1,401.00 ",$476.34 ,"$1,401.00 ","$2,421.55 ","$1,330.95 ","$1,148.82 ","$1,148.82 ","$1,120.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),51000400,29580,HC APPLY UNNA BOOT BILAT FAC,510,1 ,$496.00 ,$248.00 ,$64.61 ,$527.84 ,$497.96 ,$129.00 ,$103.00 ,$168.64 ,$396.80 ,$421.60 ,$310.00 ,$446.40 ,$497.96 ,$471.20 ,$446.40 ,$421.60 ,$421.60 ,$168.64 ,$421.60 ,$421.60 ,$446.40 ,$497.96 ,$64.61 ,$446.40 ,$486.98 ,$456.32 ,$446.40 ,$330.53 ,$330.53 ,$302.06 ,$330.53 ,$322.40 ,$345.46 ,$110.21 ,$391.84 ,$527.84 ,$248.00 ,$248.00 ,$168.64 ,$248.00 ,$216.44 ,$471.20 ,$406.72 ,$406.72 ,$396.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000401,29581,HC APPLY MULTI COMP LWR LEG BIL FAC,510,1 ,$517.00 ,$258.50 ,$64.61 ,$527.84 ,$497.96 ,$129.00 ,$103.00 ,$175.78 ,$413.60 ,$439.45 ,$323.13 ,$465.30 ,$497.96 ,$491.15 ,$465.30 ,$439.45 ,$439.45 ,$175.78 ,$439.45 ,$439.45 ,$465.30 ,$497.96 ,$64.61 ,$465.30 ,$486.98 ,$475.64 ,$465.30 ,$344.53 ,$344.53 ,$314.85 ,$344.53 ,$336.05 ,$360.09 ,$114.88 ,$408.43 ,$527.84 ,$258.50 ,$258.50 ,$175.78 ,$258.50 ,$216.44 ,$491.15 ,$423.94 ,$423.94 ,$413.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,$269.00 ,$134.50 ,$59.77 ,$412.65 ,$288.25 ,$129.00 ,$103.00 ,$91.46 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$288.25 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$91.46 ,$228.65 ,$228.65 ,$242.10 ,$288.25 ,$64.61 ,$242.10 ,$412.65 ,$247.48 ,$242.10 ,$179.26 ,$179.26 ,$163.82 ,$179.26 ,$174.85 ,$187.36 ,$59.77 ,$212.51 ,$305.55 ,$134.50 ,$134.50 ,$91.46 ,$134.50 ,$183.40 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000444,11982,HC REMOVAL DRUG IMPLANT DEVICE,510,1 ,$812.00 ,$406.00 ,$64.61 ,$812.00 ,$288.25 ,$129.00 ,$103.00 ,$276.08 ,$649.60 ,$690.20 ,$507.50 ,$730.80 ,$288.25 ,$771.40 ,$730.80 ,$690.20 ,$690.20 ,$276.08 ,$690.20 ,$690.20 ,$730.80 ,$288.25 ,$64.61 ,$730.80 ,$623.66 ,$747.04 ,$730.80 ,$541.12 ,$541.12 ,$494.51 ,$541.12 ,$527.80 ,$565.56 ,$180.43 ,$641.48 ,$305.55 ,$406.00 ,$406.00 ,$276.08 ,$406.00 ,$277.18 ,$771.40 ,$665.84 ,$665.84 ,$649.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$235.00 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ",$528.75 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$235.00 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$880.08 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$880.08 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$932.88 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$880.08 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$880.08 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$932.88 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$880.08 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$880.08 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$932.88 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$235.00 ,"$3,150.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$448.91 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$448.91 ,"$1,422.18 ","$2,835.00 ",$528.75 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$475.84 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$235.00 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$536.61 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ","$1,644.01 ","$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$730.67 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$235.00 ,"$2,415.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$448.91 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$448.91 ,"$1,422.18 ","$2,173.50 ",$528.75 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$475.84 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$235.00 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$536.61 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ","$1,644.01 ","$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$730.67 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,415.00 ","$1,207.50 ",$376.09 ,"$2,415.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ",$821.10 ,"$1,932.00 ","$2,052.75 ","$1,509.38 ","$2,173.50 ",$786.56 ,"$2,294.25 ","$2,173.50 ","$2,052.75 ","$2,052.75 ",$821.10 ,"$2,052.75 ","$2,052.75 ","$2,173.50 ",$786.56 ,"$1,422.18 ","$2,173.50 ",$846.20 ,"$2,221.80 ","$2,173.50 ","$1,609.36 ","$1,609.36 ","$1,470.74 ","$1,609.36 ","$1,569.75 ","$1,682.05 ",$536.61 ,"$1,907.85 ",$833.75 ,"$2,415.00 ","$2,415.00 ",$821.10 ,"$2,415.00 ",$376.09 ,"$2,294.25 ","$1,980.30 ","$1,980.30 ","$1,932.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$235.00 ,"$3,150.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$448.91 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$448.91 ,"$1,422.18 ","$2,835.00 ",$528.75 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$475.84 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$235.00 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000041,75557,HC MRI CARDIAC W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$235.00 ,"$3,150.00 ",$448.91 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$448.91 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$448.91 ,"$1,422.18 ","$2,835.00 ",$528.75 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$475.84 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$235.00 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000042,75561,HC MRI CARD W/O AND W CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$3,150.00 ","$1,575.00 ",$376.09 ,"$3,150.00 ",$786.56 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$786.56 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$786.56 ,"$1,422.18 ","$2,835.00 ",$846.20 ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$833.75 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ",$376.09 ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000100,74185,HC MRA ABDOMEN RENAL W/WO CON,610,1 ,"$3,150.00 ","$1,575.00 ",$699.93 ,"$3,150.00 ",$880.08 ,"$1,313.00 ","$1,313.00 ","$1,071.00 ","$2,520.00 ","$2,677.50 ","$1,968.75 ","$2,835.00 ",$880.08 ,"$2,992.50 ","$2,835.00 ","$2,677.50 ","$2,677.50 ","$1,071.00 ","$2,677.50 ","$2,677.50 ","$2,835.00 ",$880.08 ,"$1,422.18 ","$2,835.00 ", N/A ,"$2,898.00 ","$2,835.00 ","$2,099.16 ","$2,099.16 ","$1,918.35 ","$2,099.16 ","$2,047.50 ","$2,193.98 ",$699.93 ,"$2,488.50 ",$932.88 ,"$2,681.00 ","$2,681.00 ","$1,071.00 ","$3,017.00 ", N/A ,"$2,992.50 ","$2,583.00 ","$2,583.00 ","$2,520.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),62100030,N/A,SVG HC ACCUGRID,621,1 ,$80.00 ,$40.00 ,$17.78 ,$80.00 , N/A ,$67.67 ,$67.67 ,$27.20 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$27.20 ,$68.00 ,$68.00 ,$72.00 , N/A ,$33.60 ,$72.00 , N/A ,$73.60 ,$72.00 ,$53.31 ,$53.31 ,$48.72 ,$53.31 ,$52.00 ,$55.72 ,$17.78 ,$63.20 , N/A ,$40.00 ,$40.00 ,$27.20 ,$40.00 , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),62200006,C1726,HC BALLOON DILATOR,622,1 ,$455.00 ,$227.50 ,$101.10 ,$455.00 , N/A ,$384.88 ,$384.88 ,$154.70 ,$364.00 ,$386.75 ,$284.38 ,$409.50 , N/A ,$432.25 ,$409.50 ,$386.75 ,$386.75 ,$154.70 ,$386.75 ,$386.75 ,$409.50 , N/A ,$191.10 ,$409.50 , N/A ,$418.60 ,$409.50 ,$303.21 ,$303.21 ,$277.10 ,$303.21 ,$295.75 ,$316.91 ,$101.10 ,$359.45 , N/A ,$227.50 ,$227.50 ,$154.70 ,$227.50 , N/A ,$432.25 ,$373.10 ,$373.10 ,$364.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),62200026,N/A,HC HOT BIOPSY FORCEPS,621,1 ,$78.00 ,$39.00 ,$17.33 ,$78.00 , N/A ,$65.98 ,$65.98 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 , N/A ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 , N/A ,$32.76 ,$70.20 , N/A ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 , N/A ,$39.00 ,$39.00 ,$26.52 ,$39.00 , N/A ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600009,Q4186,HC EPIFIX PER SQ CM,636,1 ,$857.86 ,$428.93 ,$174.65 ,$857.86 , N/A ,$347.20 ,$231.47 ,$291.67 ,$686.29 ,$729.18 ,$536.16 ,$772.07 , N/A ,$814.97 ,$772.07 ,$729.18 ,$729.18 ,$291.67 ,$729.18 ,$729.18 ,$772.07 , N/A ,$174.65 ,$772.07 , N/A ,$789.23 ,$772.07 ,$571.68 ,$571.68 ,$522.44 ,$571.68 ,$557.61 ,$597.50 ,$190.62 ,$677.71 , N/A ,$428.93 ,$428.93 ,$291.67 ,$428.93 , N/A ,$814.97 ,$703.45 ,$703.45 ,$686.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600127,Q4114,HC FLOWABLE WOUND MATRIX PER 1CC,636,1 ,"$12,949.00 ","$6,474.50 ","$2,877.27 ","$12,949.00 ", N/A ,"$10,953.56 ","$10,953.56 ","$4,402.66 ","$10,359.20 ","$11,006.65 ","$8,093.13 ","$11,654.10 ", N/A ,"$12,301.55 ","$11,654.10 ","$11,006.65 ","$11,006.65 ","$4,402.66 ","$11,006.65 ","$11,006.65 ","$11,654.10 ", N/A ,"$5,438.58 ","$11,654.10 ", N/A ,"$11,913.08 ","$11,654.10 ","$8,629.21 ","$8,629.21 ","$7,885.94 ","$8,629.21 ","$8,416.85 ","$9,018.98 ","$2,877.27 ","$10,229.71 ", N/A ,"$6,474.50 ","$6,474.50 ","$4,402.66 ","$6,474.50 ", N/A ,"$12,301.55 ","$10,618.18 ","$10,618.18 ","$10,359.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600190,Q4160,HC NUSHIELD PER SQ CM,636,1 ,$693.00 ,$346.50 ,$108.58 ,$693.00 , N/A ,$215.87 ,$143.91 ,$235.62 ,$554.40 ,$589.05 ,$433.13 ,$623.70 , N/A ,$658.35 ,$623.70 ,$589.05 ,$589.05 ,$235.62 ,$589.05 ,$589.05 ,$623.70 , N/A ,$108.58 ,$623.70 , N/A ,$637.56 ,$623.70 ,$461.82 ,$461.82 ,$422.04 ,$461.82 ,$450.45 ,$482.67 ,$153.98 ,$547.47 , N/A ,$346.50 ,$346.50 ,$235.62 ,$346.50 , N/A ,$658.35 ,$568.26 ,$568.26 ,$554.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),68200002,N/A,HC LEVEL 2 TRAUMA ACTIVATION <30 MINS,682,1 ,"$2,912.00 ","$1,456.00 ",$647.05 ,"$2,912.00 ", N/A ,"$2,463.26 ","$2,463.26 ",$990.08 ,"$2,329.60 ","$2,475.20 ","$1,820.00 ","$2,620.80 ", N/A ,"$2,766.40 ","$2,620.80 ","$2,475.20 ","$2,475.20 ",$990.08 ,"$2,475.20 ","$2,475.20 ","$2,620.80 ", N/A ,"$1,223.04 ","$2,620.80 ", N/A ,"$2,679.04 ","$2,620.80 ","$1,940.56 ","$1,940.56 ","$1,773.41 ","$1,940.56 ","$1,892.80 ","$2,028.21 ",$647.05 ,"$2,300.48 ", N/A ,"$1,456.00 ","$1,456.00 ",$990.08 ,"$1,456.00 ", N/A ,"$2,766.40 ","$2,387.84 ","$2,387.84 ","$2,329.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),68400002,G0390,HC LEVEL 2 TRAUMA  ACTIVATION,684,1 ,"$2,912.00 ","$1,456.00 ",$214.58 ,"$2,912.00 ",$214.58 ,"$2,463.26 ","$2,463.26 ",$990.08 ,"$2,329.60 ","$2,475.20 ","$1,820.00 ","$2,620.80 ",$214.58 ,"$2,766.40 ","$2,620.80 ","$2,475.20 ","$2,475.20 ",$990.08 ,"$2,475.20 ","$2,475.20 ","$2,620.80 ",$214.58 ,"$1,223.04 ","$2,620.80 ", N/A ,"$2,679.04 ","$2,620.80 ","$1,940.56 ","$1,940.56 ","$1,773.41 ","$1,940.56 ","$1,892.80 ","$2,028.21 ",$647.05 ,"$2,300.48 ",$227.45 ,"$1,456.00 ","$1,456.00 ",$990.08 ,"$1,456.00 ", N/A ,"$2,766.40 ","$2,387.84 ","$2,387.84 ","$2,329.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),71000006,N/A,HC SHORT STAY EXTENDED,710,1 ,$662.00 ,$331.00 ,$147.10 ,$662.00 , N/A ,$559.99 ,$559.99 ,$225.08 ,$529.60 ,$562.70 ,$413.75 ,$595.80 , N/A ,$628.90 ,$595.80 ,$562.70 ,$562.70 ,$225.08 ,$562.70 ,$562.70 ,$595.80 , N/A ,$278.04 ,$595.80 , N/A ,$609.04 ,$595.80 ,$441.16 ,$441.16 ,$403.16 ,$441.16 ,$430.30 ,$461.08 ,$147.10 ,$522.98 , N/A ,$331.00 ,$331.00 ,$225.08 ,$331.00 , N/A ,$628.90 ,$542.84 ,$542.84 ,$529.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),73000002,93005,HC EKG,730,1 ,$202.00 ,$101.00 ,$44.88 ,$202.00 ,$46.48 ,$170.87 ,$170.87 ,$68.68 ,$161.60 ,$171.70 ,$126.25 ,$181.80 ,$46.48 ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$68.68 ,$171.70 ,$171.70 ,$181.80 ,$46.48 ,$140.29 ,$181.80 ,$127.91 ,$185.84 ,$181.80 ,$134.61 ,$134.61 ,$123.02 ,$134.61 ,$131.30 ,$140.69 ,$44.88 ,$159.58 ,$49.27 ,$106.00 ,$106.00 ,$68.68 ,$112.00 ,$56.85 ,$191.90 ,$165.64 ,$165.64 ,$161.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$493.00 ,$246.50 ,$109.54 ,$493.00 ,$120.41 ,$417.03 ,$417.03 ,$167.62 ,$394.40 ,$419.05 ,$308.13 ,$443.70 ,$120.41 ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$167.62 ,$419.05 ,$419.05 ,$443.70 ,$120.41 ,$211.57 ,$443.70 ,$259.11 ,$453.56 ,$443.70 ,$328.54 ,$328.54 ,$300.24 ,$328.54 ,$320.45 ,$343.37 ,$109.54 ,$389.47 ,$127.63 ,$453.00 ,$453.00 ,$167.62 ,$489.00 ,$115.16 ,$468.35 ,$404.26 ,$404.26 ,$394.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100001,93226,HC HOLTER SCAN  AND  REPORT 24 HR,731,1 ,$627.00 ,$313.50 ,$115.16 ,$627.00 ,$120.41 ,$530.38 ,$530.38 ,$213.18 ,$501.60 ,$532.95 ,$391.88 ,$564.30 ,$120.41 ,$595.65 ,$564.30 ,$532.95 ,$532.95 ,$213.18 ,$532.95 ,$532.95 ,$564.30 ,$120.41 ,$211.57 ,$564.30 ,$259.11 ,$576.84 ,$564.30 ,$417.83 ,$417.83 ,$381.84 ,$417.83 ,$407.55 ,$436.71 ,$139.32 ,$495.33 ,$127.63 ,$453.00 ,$453.00 ,$213.18 ,$489.00 ,$115.16 ,$595.65 ,$514.14 ,$514.14 ,$501.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$717.00 ,$358.50 ,$115.16 ,$717.00 ,$120.41 ,$606.51 ,$606.51 ,$243.78 ,$573.60 ,$609.45 ,$448.13 ,$645.30 ,$120.41 ,$681.15 ,$645.30 ,$609.45 ,$609.45 ,$243.78 ,$609.45 ,$609.45 ,$645.30 ,$120.41 ,$211.57 ,$645.30 ,$259.11 ,$659.64 ,$645.30 ,$477.81 ,$477.81 ,$436.65 ,$477.81 ,$466.05 ,$499.39 ,$159.32 ,$566.43 ,$127.63 ,$453.00 ,$453.00 ,$243.78 ,$489.00 ,$115.16 ,$681.15 ,$587.94 ,$587.94 ,$573.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$280.00 ,$140.00 ,$38.03 ,$280.00 ,$120.41 ,$236.85 ,$236.85 ,$95.20 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$120.41 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$95.20 ,$238.00 ,$238.00 ,$252.00 ,$120.41 ,$211.57 ,$252.00 ,$85.57 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$62.22 ,$221.20 ,$127.63 ,$280.00 ,$280.00 ,$95.20 ,$280.00 ,$38.03 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100005,93271,HC CARDIAC EVENT MONITOR,731,1 ,$840.00 ,$420.00 ,$102.53 ,$840.00 ,$120.41 ,$710.56 ,$710.56 ,$285.60 ,$672.00 ,$714.00 ,$525.00 ,$756.00 ,$120.41 ,$798.00 ,$756.00 ,$714.00 ,$714.00 ,$285.60 ,$714.00 ,$714.00 ,$756.00 ,$120.41 ,$211.57 ,$756.00 ,$230.69 ,$772.80 ,$756.00 ,$559.78 ,$559.78 ,$511.56 ,$559.78 ,$546.00 ,$585.06 ,$186.65 ,$663.60 ,$127.63 ,$453.00 ,$453.00 ,$285.60 ,$489.00 ,$102.53 ,$798.00 ,$688.80 ,$688.80 ,$672.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),73130072,73130,HC HAND 3 VIEW-PRV 72 HR,320,1 ,$347.00 ,$173.50 ,$77.10 ,$347.00 ,$100.91 ,$106.10 ,$94.31 ,$117.98 ,$277.60 ,$294.95 ,$216.88 ,$312.30 ,$100.91 ,$329.65 ,$312.30 ,$294.95 ,$294.95 ,$117.98 ,$294.95 ,$294.95 ,$312.30 ,$100.91 ,$145.74 ,$312.30 ,$185.87 ,$319.24 ,$312.30 ,$231.24 ,$231.24 ,$211.32 ,$231.24 ,$225.55 ,$241.69 ,$77.10 ,$274.13 ,$106.96 ,$347.00 ,$347.00 ,$117.98 ,$347.00 ,$82.61 ,$329.65 ,$284.54 ,$284.54 ,$277.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),74000006,95810,HC SLEEP STUDY,740,1 ,"$4,600.00 ","$2,300.00 ",$939.61 ,"$4,600.00 ","$1,343.21 ","$3,090.00 ","$2,678.00 ","$1,564.00 ","$3,680.00 ","$3,910.00 ","$2,875.00 ","$4,140.00 ","$1,343.21 ","$4,370.00 ","$4,140.00 ","$3,910.00 ","$3,910.00 ","$1,564.00 ","$3,910.00 ","$3,910.00 ","$4,140.00 ","$1,343.21 ","$2,262.82 ","$4,140.00 ","$2,114.12 ","$4,232.00 ","$4,140.00 ","$3,065.44 ","$3,065.44 ","$2,801.40 ","$3,065.44 ","$2,990.00 ","$3,203.90 ","$1,022.12 ","$3,634.00 ","$1,423.80 ","$1,232.00 ","$1,232.00 ","$1,564.00 ","$1,355.00 ",$939.61 ,"$4,370.00 ","$3,772.00 ","$3,772.00 ","$3,680.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$4,900.00 ","$2,450.00 ",$939.61 ,"$4,900.00 ","$1,343.21 ","$3,090.00 ","$2,678.00 ","$1,666.00 ","$3,920.00 ","$4,165.00 ","$3,062.50 ","$4,410.00 ","$1,343.21 ","$4,655.00 ","$4,410.00 ","$4,165.00 ","$4,165.00 ","$1,666.00 ","$4,165.00 ","$4,165.00 ","$4,410.00 ","$1,343.21 ","$2,262.82 ","$4,410.00 ","$2,114.12 ","$4,508.00 ","$4,410.00 ","$3,265.36 ","$3,265.36 ","$2,984.10 ","$3,265.36 ","$3,185.00 ","$3,412.85 ","$1,088.78 ","$3,871.00 ","$1,423.80 ","$1,232.00 ","$1,232.00 ","$1,666.00 ","$1,355.00 ",$939.61 ,"$4,655.00 ","$4,018.00 ","$4,018.00 ","$3,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000015,N/A,HC EGD/BIOPSY,750,1 ,"$3,675.00 ","$1,837.50 ",$816.59 ,"$3,675.00 ", N/A ,"$3,108.68 ","$3,108.68 ","$1,249.50 ","$2,940.00 ","$3,123.75 ","$2,296.88 ","$3,307.50 ", N/A ,"$3,491.25 ","$3,307.50 ","$3,123.75 ","$3,123.75 ","$1,249.50 ","$3,123.75 ","$3,123.75 ","$3,307.50 ", N/A , N/A ,"$3,307.50 ", N/A ,"$3,381.00 ","$3,307.50 ","$2,449.02 ","$2,449.02 ","$2,238.08 ","$2,449.02 ","$2,388.75 ","$2,559.64 ",$816.59 ,"$2,903.25 ", N/A , N/A , N/A ,"$1,249.50 ", N/A , N/A ,"$3,491.25 ","$3,013.50 ","$3,013.50 ","$2,940.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000025,N/A,HC EGD/SCLEROTHERAPY,750,1 ,"$3,675.00 ","$1,837.50 ",$816.59 ,"$3,675.00 ", N/A ,"$3,108.68 ","$3,108.68 ","$1,249.50 ","$2,940.00 ","$3,123.75 ","$2,296.88 ","$3,307.50 ", N/A ,"$3,491.25 ","$3,307.50 ","$3,123.75 ","$3,123.75 ","$1,249.50 ","$3,123.75 ","$3,123.75 ","$3,307.50 ", N/A , N/A ,"$3,307.50 ", N/A ,"$3,381.00 ","$3,307.50 ","$2,449.02 ","$2,449.02 ","$2,238.08 ","$2,449.02 ","$2,388.75 ","$2,559.64 ",$816.59 ,"$2,903.25 ", N/A , N/A , N/A ,"$1,249.50 ", N/A , N/A ,"$3,491.25 ","$3,013.50 ","$3,013.50 ","$2,940.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000032,N/A,HC HEMORRHOID BAND WITH SCOPE,750,1 ,"$2,310.00 ","$1,155.00 ",$513.28 ,"$2,310.00 ", N/A ,"$1,954.03 ","$1,954.03 ",$785.40 ,"$1,848.00 ","$1,963.50 ","$1,443.75 ","$2,079.00 ", N/A ,"$2,194.50 ","$2,079.00 ","$1,963.50 ","$1,963.50 ",$785.40 ,"$1,963.50 ","$1,963.50 ","$2,079.00 ", N/A , N/A ,"$2,079.00 ", N/A ,"$2,125.20 ","$2,079.00 ","$1,539.38 ","$1,539.38 ","$1,406.79 ","$1,539.38 ","$1,501.50 ","$1,608.92 ",$513.28 ,"$1,824.90 ", N/A , N/A , N/A ,$785.40 , N/A , N/A ,"$2,194.50 ","$1,894.20 ","$1,894.20 ","$1,848.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$1,800.00 ",$900.00 ,$399.96 ,"$1,859.38 ","$1,302.81 ","$1,522.62 ","$1,522.62 ",$612.00 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ","$1,302.81 ","$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$612.00 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,302.81 ","$1,697.11 ","$1,620.00 ","$1,859.38 ","$1,656.00 ","$1,620.00 ","$1,199.52 ","$1,199.52 ","$1,096.20 ","$1,199.52 ","$1,170.00 ","$1,253.70 ",$399.96 ,"$1,422.00 ","$1,380.98 ","$1,800.00 ","$1,800.00 ",$612.00 ,"$1,800.00 ",$826.39 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,"$2,429.00 ","$1,214.50 ",$539.72 ,"$2,429.00 ","$1,302.81 ","$2,054.69 ","$2,054.69 ",$825.86 ,"$1,943.20 ","$2,064.65 ","$1,518.13 ","$2,186.10 ","$1,302.81 ","$2,307.55 ","$2,186.10 ","$2,064.65 ","$2,064.65 ",$825.86 ,"$2,064.65 ","$2,064.65 ","$2,186.10 ","$1,302.81 ","$1,697.11 ","$2,186.10 ","$1,859.38 ","$2,234.68 ","$2,186.10 ","$1,618.69 ","$1,618.69 ","$1,479.26 ","$1,618.69 ","$1,578.85 ","$1,691.80 ",$539.72 ,"$1,918.91 ","$1,380.98 ","$2,368.00 ","$2,368.00 ",$825.86 ,"$2,429.00 ",$826.39 ,"$2,307.55 ","$1,991.78 ","$1,991.78 ","$1,943.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$9,242.00 ","$4,621.00 ","$2,053.57 ","$9,242.00 ", N/A ,"$7,817.81 ","$7,817.81 ","$3,142.28 ","$7,393.60 ","$7,855.70 ","$5,776.25 ","$8,317.80 ", N/A ,"$8,779.90 ","$8,317.80 ","$7,855.70 ","$7,855.70 ","$3,142.28 ","$7,855.70 ","$7,855.70 ","$8,317.80 ", N/A , N/A ,"$8,317.80 ", N/A ,"$8,502.64 ","$8,317.80 ","$6,158.87 ","$6,158.87 ","$5,628.38 ","$6,158.87 ","$6,007.30 ","$6,437.05 ","$2,053.57 ","$7,301.18 ", N/A , N/A , N/A ,"$3,142.28 ", N/A , N/A ,"$8,779.90 ","$7,578.44 ","$7,578.44 ","$7,393.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001176,N/A,HC ANOSCOPY W/BIOPSY SGL/MULT - 46606,750,1 ,"$3,111.00 ","$1,555.50 ",$691.26 ,"$3,111.00 ", N/A ,"$2,631.59 ","$2,631.59 ","$1,057.74 ","$2,488.80 ","$2,644.35 ","$1,944.38 ","$2,799.90 ", N/A ,"$2,955.45 ","$2,799.90 ","$2,644.35 ","$2,644.35 ","$1,057.74 ","$2,644.35 ","$2,644.35 ","$2,799.90 ", N/A , N/A ,"$2,799.90 ", N/A ,"$2,862.12 ","$2,799.90 ","$2,073.17 ","$2,073.17 ","$1,894.60 ","$2,073.17 ","$2,022.15 ","$2,166.81 ",$691.26 ,"$2,457.69 ", N/A , N/A , N/A ,"$1,057.74 ", N/A , N/A ,"$2,955.45 ","$2,551.02 ","$2,551.02 ","$2,488.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$2,070.00 ","$1,035.00 ",$459.95 ,"$2,070.00 ", N/A ,"$1,751.01 ","$1,751.01 ",$703.80 ,"$1,656.00 ","$1,759.50 ","$1,293.75 ","$1,863.00 ", N/A ,"$1,966.50 ","$1,863.00 ","$1,759.50 ","$1,759.50 ",$703.80 ,"$1,759.50 ","$1,759.50 ","$1,863.00 ", N/A , N/A ,"$1,863.00 ", N/A ,"$1,904.40 ","$1,863.00 ","$1,379.45 ","$1,379.45 ","$1,260.63 ","$1,379.45 ","$1,345.50 ","$1,441.76 ",$459.95 ,"$1,635.30 ", N/A , N/A , N/A ,$703.80 , N/A , N/A ,"$1,966.50 ","$1,697.40 ","$1,697.40 ","$1,656.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,185.00 ",$592.50 ,$263.31 ,"$1,598.31 ","$1,507.84 ","$1,002.39 ","$1,002.39 ",$402.90 ,$948.00 ,"$1,007.25 ",$740.63 ,"$1,066.50 ","$1,507.84 ","$1,125.75 ","$1,066.50 ","$1,007.25 ","$1,007.25 ",$402.90 ,"$1,007.25 ","$1,007.25 ","$1,066.50 ","$1,507.84 ",$497.70 ,"$1,066.50 ","$1,459.17 ","$1,090.20 ","$1,066.50 ",$789.68 ,$789.68 ,$721.67 ,$789.68 ,$770.25 ,$825.35 ,$263.31 ,$936.15 ,"$1,598.31 ",$592.50 ,$592.50 ,$402.90 ,$592.50 ,$648.52 ,"$1,125.75 ",$971.70 ,$971.70 ,$948.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),76200004,G0378,HC CDTU LV I PER HOUR,762,1 ,$166.00 ,$83.00 ,$36.89 ,$166.00 , N/A ,$140.42 ,$140.42 ,$56.44 ,$132.80 ,$141.10 ,$103.75 ,$149.40 , N/A ,$157.70 ,$149.40 ,$141.10 ,$141.10 ,$56.44 ,$141.10 ,$141.10 ,$149.40 , N/A ,$166.00 ,$149.40 , N/A ,$152.72 ,$149.40 ,$110.62 ,$110.62 ,$101.09 ,$110.62 ,$107.90 ,$115.62 ,$36.89 ,$131.14 , N/A ,$166.00 ,$166.00 ,$56.44 ,$166.00 , N/A ,$157.70 ,$136.12 ,$136.12 ,$132.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),76200005,G0378,HC CDTU LV II PER HOUR,762,1 ,$207.00 ,$103.50 ,$46.00 ,$207.00 , N/A ,$175.10 ,$175.10 ,$70.38 ,$165.60 ,$175.95 ,$129.38 ,$186.30 , N/A ,$196.65 ,$186.30 ,$175.95 ,$175.95 ,$70.38 ,$175.95 ,$175.95 ,$186.30 , N/A ,$207.00 ,$186.30 , N/A ,$190.44 ,$186.30 ,$137.94 ,$137.94 ,$126.06 ,$137.94 ,$134.55 ,$144.18 ,$46.00 ,$163.53 , N/A ,$207.00 ,$207.00 ,$70.38 ,$207.00 , N/A ,$196.65 ,$169.74 ,$169.74 ,$165.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$383.00 ,$191.50 ,$85.10 ,$383.00 ,$214.58 ,$323.98 ,$323.98 ,$130.22 ,$306.40 ,$325.55 ,$239.38 ,$344.70 ,$214.58 ,$363.85 ,$344.70 ,$325.55 ,$325.55 ,$130.22 ,$325.55 ,$325.55 ,$344.70 ,$214.58 ,$383.00 ,$344.70 , N/A ,$352.36 ,$344.70 ,$255.23 ,$255.23 ,$233.25 ,$255.23 ,$248.95 ,$266.76 ,$85.10 ,$302.57 ,$227.45 ,$383.00 ,$383.00 ,$130.22 ,$383.00 , N/A ,$363.85 ,$314.06 ,$314.06 ,$306.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),76831072,76831,HC SONOHYSTEROGRAM,972,1 ,$285.00 ,$142.50 ,$63.33 ,$528.75 ,$295.99 ,$241.08 ,$241.08 ,$128.52 ,$228.00 ,$242.25 ,$178.13 ,$256.50 ,$295.99 ,$270.75 ,$256.50 ,$242.25 ,$242.25 ,$128.52 ,$242.25 ,$242.25 ,$256.50 ,$295.99 ,$119.70 ,$256.50 ,$528.75 ,$262.20 ,$256.50 ,$189.92 ,$189.92 ,$173.57 ,$189.92 ,$185.25 ,$198.50 ,$63.33 ,$225.15 ,$313.75 , N/A , N/A ,$128.52 , N/A ,$235.00 ,$270.75 ,$233.70 ,$233.70 ,$228.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$56.00 ,$28.00 ,$12.44 ,$142.47 ,$67.79 ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$67.79 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$67.79 ,$23.52 ,$50.40 ,$142.47 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$71.86 ,$42.00 ,$42.00 ,$19.04 ,$42.00 ,$63.32 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100001,90471,HC RABIES VACC ADMIN IM,771,1 ,$155.00 ,$77.50 ,$34.44 ,$155.00 ,$67.79 ,$131.11 ,$131.11 ,$52.70 ,$124.00 ,$131.75 ,$96.88 ,$139.50 ,$67.79 ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$52.70 ,$131.75 ,$131.75 ,$139.50 ,$67.79 ,$65.10 ,$139.50 ,$142.47 ,$142.60 ,$139.50 ,$103.29 ,$103.29 ,$94.40 ,$103.29 ,$100.75 ,$107.96 ,$34.44 ,$122.45 ,$71.86 ,$42.00 ,$42.00 ,$52.70 ,$42.00 ,$63.32 ,$147.25 ,$127.10 ,$127.10 ,$124.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$56.00 ,$28.00 ,$12.44 ,$71.86 ,$67.79 ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$67.79 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$67.79 ,$23.52 ,$50.40 , N/A ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$71.86 ,$42.00 ,$42.00 ,$19.04 ,$42.00 , N/A ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$56.00 ,$28.00 ,$19.04 ,$91.96 ,$67.79 ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$67.79 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$67.79 ,$23.52 ,$50.40 ,$91.96 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 , N/A ,$44.24 ,$71.86 ,$42.00 ,$42.00 ,$19.04 ,$42.00 ,$40.87 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$56.00 ,$28.00 ,$19.04 ,$91.96 ,$67.79 ,$47.37 ,$47.37 ,$19.04 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$67.79 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$19.04 ,$47.60 ,$47.60 ,$50.40 ,$67.79 ,$23.52 ,$50.40 ,$91.96 ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 , N/A ,$44.24 ,$71.86 ,$42.00 ,$42.00 ,$19.04 ,$42.00 ,$40.87 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$34.00 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$34.00 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 , N/A ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100014,0022A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 , N/A ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100015,0031A,HC ADMINISTRATION SARS-COV-2 VACCINE AD26 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100016,0041A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML FIRST DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 , N/A ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100017,0042A,HC ADMIN SARS-COV-2 VACCINE 5 MCG/0.5ML SECOND DOSE,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 , N/A ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100018,0003A,HC ADM SARSCOV2 30MCG/0.3ML 3RD - PFIZER,771,1 ,$100.00 ,$50.00 ,$22.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$34.00 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100019,0013A,HC ADM SARSCOV2 100MCG/0.5ML 3RD - MODERNA,771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100020,0051A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, FIRST DOSE",771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100021,0052A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, SECOND DOSE",771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100022,0053A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, THIRD DOSE",771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100024,0054A,"HC ADMIN SARS-COV-2 VACCINE 30MCG/0.3ML, TRIS-SUCROSE, BOOSTER DOSE",771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100025,0064A,"HC ADMIN SARS-COV-2 VACCINE 50MCG/0.25ML, BOOSTER DOSE",771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100028,0034A,"HC ADMIN SARS-COV-2 VACCINE JOHNSON  AND  JOHNSON, BOOSTER DOSE",771,1 ,$100.00 ,$50.00 ,$2.22 ,$100.00 ,$67.79 ,$84.59 ,$84.59 ,$2.22 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$67.79 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.22 ,$85.00 ,$85.00 ,$90.00 ,$67.79 ,$42.00 ,$90.00 ,$90.00 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$2.51 ,$79.00 ,$71.86 ,$42.00 ,$42.00 ,$2.22 ,$42.00 ,$40.00 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$250.00 ,$125.00 ,$14.42 ,$250.00 ,$14.42 ,$211.48 ,$211.48 ,$85.00 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$14.42 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$85.00 ,$212.50 ,$212.50 ,$225.00 ,$14.42 ,$105.00 ,$225.00 ,$62.08 ,$230.00 ,$225.00 ,$166.60 ,$166.60 ,$152.25 ,$166.60 ,$162.50 ,$174.13 ,$55.55 ,$197.50 ,$15.29 ,$26.00 ,$26.00 ,$85.00 ,$26.00 ,$27.59 ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),80048072,80048,HC BASIC METABOLIC PANEL-PRV 72 HR,301,1 ,$142.00 ,$71.00 ,$8.46 ,$142.00 ,$8.74 ,$32.90 ,$28.20 ,$48.28 ,$113.60 ,$120.70 ,$88.75 ,$127.80 ,$8.74 ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$48.28 ,$120.70 ,$120.70 ,$127.80 ,$8.74 ,$9.58 ,$127.80 ,$19.04 ,$130.64 ,$127.80 ,$94.63 ,$94.63 ,$86.48 ,$94.63 ,$92.30 ,$98.90 ,$31.55 ,$112.18 ,$9.26 ,$10.15 ,$10.15 ,$48.28 ,$10.15 ,$8.46 ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),80050072,80050,HC GENERAL HEALTH PANEL-72HR,301,1 ,$334.00 ,$167.00 ,$14.57 ,$334.00 ,$14.57 ,$158.13 ,$135.54 ,$113.56 ,$267.20 ,$283.90 ,$208.75 ,$300.60 ,$14.57 ,$317.30 ,$300.60 ,$283.90 ,$283.90 ,$113.56 ,$283.90 ,$283.90 ,$300.60 ,$14.57 ,$140.28 ,$300.60 , N/A ,$307.28 ,$300.60 ,$222.58 ,$222.58 ,$203.41 ,$222.58 ,$217.10 ,$232.63 ,$74.21 ,$263.86 ,$15.44 ,$56.74 ,$56.74 ,$113.56 ,$56.74 , N/A ,$317.30 ,$273.88 ,$273.88 ,$267.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),80053072,80053,HC COMPREHENSIVE METABOL PANEL-PRV 72 HR,301,1 ,$119.00 ,$59.50 ,$10.56 ,$119.00 ,$10.91 ,$41.09 ,$35.22 ,$40.46 ,$95.20 ,$101.15 ,$74.38 ,$107.10 ,$10.91 ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$40.46 ,$101.15 ,$101.15 ,$107.10 ,$10.91 ,$11.95 ,$107.10 ,$23.76 ,$109.48 ,$107.10 ,$79.30 ,$79.30 ,$72.47 ,$79.30 ,$77.35 ,$82.88 ,$26.44 ,$94.01 ,$11.56 ,$12.67 ,$12.67 ,$40.46 ,$12.67 ,$10.56 ,$113.05 ,$97.58 ,$97.58 ,$95.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),80061072,80061,HC LIPID PANEL-PRV 72 HR,301,1 ,$169.00 ,$84.50 ,$13.39 ,$169.00 ,$13.84 ,$52.08 ,$44.64 ,$57.46 ,$135.20 ,$143.65 ,$105.63 ,$152.10 ,$13.84 ,$160.55 ,$152.10 ,$143.65 ,$143.65 ,$57.46 ,$143.65 ,$143.65 ,$152.10 ,$13.84 ,$15.15 ,$152.10 ,$30.13 ,$155.48 ,$152.10 ,$112.62 ,$112.62 ,$102.92 ,$112.62 ,$109.85 ,$117.71 ,$37.55 ,$133.51 ,$14.67 ,$16.07 ,$16.07 ,$57.46 ,$16.07 ,$13.39 ,$160.55 ,$138.58 ,$138.58 ,$135.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),80076072,80076,HC HEPATIC FUNCTION PANEL-PRV 72 HR,301,1 ,$149.00 ,$74.50 ,$8.17 ,$149.00 ,$8.44 ,$31.78 ,$27.24 ,$50.66 ,$119.20 ,$126.65 ,$93.13 ,$134.10 ,$8.44 ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$50.66 ,$126.65 ,$126.65 ,$134.10 ,$8.44 ,$9.25 ,$134.10 ,$18.38 ,$137.08 ,$134.10 ,$99.29 ,$99.29 ,$90.74 ,$99.29 ,$96.85 ,$103.78 ,$33.11 ,$117.71 ,$8.95 ,$9.80 ,$9.80 ,$50.66 ,$9.80 ,$8.17 ,$141.55 ,$122.18 ,$122.18 ,$119.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),80156072,80156,HC CARABAMIZIPINE,301,1 ,$190.00 ,$95.00 ,$14.57 ,$190.00 ,$15.06 ,$56.63 ,$48.54 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$15.06 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$15.06 ,$16.49 ,$171.00 ,$32.78 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$15.96 ,$17.48 ,$17.48 ,$64.60 ,$17.48 ,$14.57 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),80162072,80162,HC DIGOXIN LEVELS-PRV 72 HR,301,1 ,$175.00 ,$87.50 ,$13.28 ,$175.00 ,$13.72 ,$51.63 ,$44.25 ,$59.50 ,$140.00 ,$148.75 ,$109.38 ,$157.50 ,$13.72 ,$166.25 ,$157.50 ,$148.75 ,$148.75 ,$59.50 ,$148.75 ,$148.75 ,$157.50 ,$13.72 ,$15.03 ,$157.50 ,$29.88 ,$161.00 ,$157.50 ,$116.62 ,$116.62 ,$106.58 ,$116.62 ,$113.75 ,$121.89 ,$38.89 ,$138.25 ,$14.54 ,$15.94 ,$15.94 ,$59.50 ,$15.94 ,$13.28 ,$166.25 ,$143.50 ,$143.50 ,$140.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),80188072,80188,HC PRIMADONE,301,1 ,$217.00 ,$108.50 ,$16.59 ,$217.00 ,$17.14 ,$64.54 ,$55.32 ,$73.78 ,$173.60 ,$184.45 ,$135.63 ,$195.30 ,$17.14 ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$73.78 ,$184.45 ,$184.45 ,$195.30 ,$17.14 ,$18.78 ,$195.30 ,$37.33 ,$199.64 ,$195.30 ,$144.61 ,$144.61 ,$132.15 ,$144.61 ,$141.05 ,$151.14 ,$48.22 ,$171.43 ,$18.17 ,$19.91 ,$19.91 ,$73.78 ,$19.91 ,$16.59 ,$206.15 ,$177.94 ,$177.94 ,$173.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),80198072,80198,HC THEOPHYLINE,301,1 ,$120.00 ,$60.00 ,$14.14 ,$120.00 ,$14.61 ,$54.99 ,$47.13 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$14.61 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 ,$14.61 ,$16.00 ,$108.00 ,$31.82 ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 ,$15.49 ,$16.97 ,$16.97 ,$40.80 ,$16.97 ,$14.14 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),80299072,80299,HC QT OF DRUG ASSAY-PRV 72 HR,301,1 ,$128.00 ,$64.00 ,$18.64 ,$128.00 ,$19.26 ,$65.24 ,$55.92 ,$43.52 ,$102.40 ,$108.80 ,$80.00 ,$115.20 ,$19.26 ,$121.60 ,$115.20 ,$108.80 ,$108.80 ,$43.52 ,$108.80 ,$108.80 ,$115.20 ,$19.26 ,$21.10 ,$115.20 ,$41.94 ,$117.76 ,$115.20 ,$85.30 ,$85.30 ,$77.95 ,$85.30 ,$83.20 ,$89.15 ,$28.44 ,$101.12 ,$20.42 ,$22.37 ,$22.37 ,$43.52 ,$22.37 ,$18.64 ,$121.60 ,$104.96 ,$104.96 ,$102.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),81001072,81001,HC URINALYSIS AUTO W/MICRO-PRV 72 HR,307,1 ,$95.00 ,$47.50 ,$3.17 ,$95.00 ,$3.28 ,$12.32 ,$10.56 ,$32.30 ,$76.00 ,$80.75 ,$59.38 ,$85.50 ,$3.28 ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$32.30 ,$80.75 ,$80.75 ,$85.50 ,$3.28 ,$3.59 ,$85.50 ,$7.13 ,$87.40 ,$85.50 ,$63.31 ,$63.31 ,$57.86 ,$63.31 ,$61.75 ,$66.17 ,$21.11 ,$75.05 ,$3.48 ,$3.80 ,$3.80 ,$32.30 ,$3.80 ,$3.17 ,$90.25 ,$77.90 ,$77.90 ,$76.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),81003072,81003,HC URINALYSIS SPECIFIC GRAVITY-PRV 72 HR,307,1 ,$37.00 ,$18.50 ,$2.25 ,$37.00 ,$2.32 ,$8.72 ,$7.47 ,$12.58 ,$29.60 ,$31.45 ,$23.13 ,$33.30 ,$2.32 ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$12.58 ,$31.45 ,$31.45 ,$33.30 ,$2.32 ,$2.55 ,$33.30 ,$5.06 ,$34.04 ,$33.30 ,$24.66 ,$24.66 ,$22.53 ,$24.66 ,$24.05 ,$25.77 ,$8.22 ,$29.23 ,$2.46 ,$2.70 ,$2.70 ,$12.58 ,$2.70 ,$2.25 ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),81025072,81025,HC URINE PREGNANCY TEST-PRV 72 HR,300,1 ,$83.00 ,$41.50 ,$8.61 ,$83.00 ,$8.90 ,$30.14 ,$25.83 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 ,$8.90 ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 ,$8.90 ,$9.74 ,$74.70 ,$19.37 ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 ,$9.43 ,$10.33 ,$10.33 ,$28.22 ,$10.33 ,$8.61 ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),82009072,82009,HC ACETONE KETO,301,1 ,$58.00 ,$29.00 ,$4.52 ,$58.00 ,$4.67 ,$17.57 ,$15.06 ,$19.72 ,$46.40 ,$49.30 ,$36.25 ,$52.20 ,$4.67 ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$19.72 ,$49.30 ,$49.30 ,$52.20 ,$4.67 ,$5.12 ,$52.20 ,$10.17 ,$53.36 ,$52.20 ,$38.65 ,$38.65 ,$35.32 ,$38.65 ,$37.70 ,$40.40 ,$12.89 ,$45.82 ,$4.95 ,$5.42 ,$5.42 ,$19.72 ,$5.42 ,$4.52 ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),82043072,82043,HC MICROALBUMIN URINE,301,1 ,$180.00 ,$90.00 ,$5.78 ,$180.00 ,$5.97 ,$22.47 ,$19.26 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$5.97 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$5.97 ,$6.54 ,$162.00 ,$13.01 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$6.33 ,$6.94 ,$6.94 ,$61.20 ,$6.94 ,$5.78 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),82150072,82150,HC ASSAY OF AMYLASE-PRV 72HR,301,1 ,$88.00 ,$44.00 ,$6.48 ,$88.00 ,$6.70 ,$25.20 ,$21.60 ,$29.92 ,$70.40 ,$74.80 ,$55.00 ,$79.20 ,$6.70 ,$83.60 ,$79.20 ,$74.80 ,$74.80 ,$29.92 ,$74.80 ,$74.80 ,$79.20 ,$6.70 ,$7.33 ,$79.20 ,$14.58 ,$80.96 ,$79.20 ,$58.64 ,$58.64 ,$53.59 ,$58.64 ,$57.20 ,$61.29 ,$19.55 ,$69.52 ,$7.10 ,$7.78 ,$7.78 ,$29.92 ,$7.78 ,$6.48 ,$83.60 ,$72.16 ,$72.16 ,$70.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),82164072,82164,HC ANGIOTENSIN,301,1 ,$196.00 ,$98.00 ,$14.60 ,$196.00 ,$15.09 ,$56.77 ,$48.66 ,$66.64 ,$156.80 ,$166.60 ,$122.50 ,$176.40 ,$15.09 ,$186.20 ,$176.40 ,$166.60 ,$166.60 ,$66.64 ,$166.60 ,$166.60 ,$176.40 ,$15.09 ,$16.52 ,$176.40 ,$32.85 ,$180.32 ,$176.40 ,$130.61 ,$130.61 ,$119.36 ,$130.61 ,$127.40 ,$136.51 ,$43.55 ,$154.84 ,$16.00 ,$17.52 ,$17.52 ,$66.64 ,$17.52 ,$14.60 ,$186.20 ,$160.72 ,$160.72 ,$156.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),82248072,82248,HC BILIRUBIN DIRECT-PRV 72 HR,300,1 ,$67.00 ,$33.50 ,$4.70 ,$67.00 ,$4.70 ,$19.50 ,$16.71 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$4.70 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$4.70 ,$5.68 ,$60.30 ,$11.30 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$4.98 ,$6.02 ,$6.02 ,$22.78 ,$6.02 ,$5.02 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),82270072,82270,HC BLOOD OCCULT-PRV 72 HR,300,1 ,$65.00 ,$32.50 ,$3.66 ,$65.00 ,$3.66 ,$15.33 ,$13.14 ,$22.10 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$3.66 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$22.10 ,$55.25 ,$55.25 ,$58.50 ,$3.66 ,$4.96 ,$58.50 ,$9.86 ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 ,$3.88 ,$5.26 ,$5.26 ,$22.10 ,$5.26 ,$4.38 ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),82272072,82272,HC BLOOD OCCULT FECES-PRV 72 HR,300,1 ,$38.00 ,$19.00 ,$4.23 ,$38.00 ,$4.26 ,$14.81 ,$12.69 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$4.26 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$4.26 ,$4.79 ,$34.20 ,$9.52 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$4.52 ,$5.08 ,$5.08 ,$12.92 ,$5.08 ,$4.23 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),82306072,82306,HC VITAMIN D 25 HYDROX-PRV 72 HR,305,1 ,$291.00 ,$145.50 ,$29.60 ,$291.00 ,$30.59 ,$115.12 ,$98.67 ,$98.94 ,$232.80 ,$247.35 ,$181.88 ,$261.90 ,$30.59 ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$98.94 ,$247.35 ,$247.35 ,$261.90 ,$30.59 ,$33.50 ,$261.90 ,$66.60 ,$267.72 ,$261.90 ,$193.92 ,$193.92 ,$177.22 ,$193.92 ,$189.15 ,$202.68 ,$64.66 ,$229.89 ,$32.43 ,$35.52 ,$35.52 ,$98.94 ,$35.52 ,$29.60 ,$276.45 ,$238.62 ,$238.62 ,$232.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),82365072,82365,HC CALCULUS INFRARED SPEC,300,1 ,$139.00 ,$69.50 ,$12.90 ,$139.00 ,$13.33 ,$50.16 ,$42.99 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 ,$13.33 ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 ,$13.33 ,$14.60 ,$125.10 ,$29.03 ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 ,$14.13 ,$15.48 ,$15.48 ,$47.26 ,$15.48 ,$12.90 ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),82565072,82565,HC CREATININE-PRV 72HR,301,1 ,$77.00 ,$38.50 ,$5.12 ,$77.00 ,$5.29 ,$19.92 ,$17.07 ,$26.18 ,$61.60 ,$65.45 ,$48.13 ,$69.30 ,$5.29 ,$73.15 ,$69.30 ,$65.45 ,$65.45 ,$26.18 ,$65.45 ,$65.45 ,$69.30 ,$5.29 ,$5.79 ,$69.30 ,$11.52 ,$70.84 ,$69.30 ,$51.31 ,$51.31 ,$46.89 ,$51.31 ,$50.05 ,$53.63 ,$17.11 ,$60.83 ,$5.61 ,$6.14 ,$6.14 ,$26.18 ,$6.14 ,$5.12 ,$73.15 ,$63.14 ,$63.14 ,$61.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),82570072,82570,HC CREATININE OTHER SOURCE-PRV 72 HR,300,1 ,$78.00 ,$39.00 ,$5.18 ,$78.00 ,$5.35 ,$20.13 ,$17.25 ,$26.52 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$5.35 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$26.52 ,$66.30 ,$66.30 ,$70.20 ,$5.35 ,$5.86 ,$70.20 ,$11.66 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$5.67 ,$6.22 ,$6.22 ,$26.52 ,$6.22 ,$5.18 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),82607072,82607,HC VITAMIN B12-PRV 72 HR,301,1 ,$234.00 ,$117.00 ,$15.08 ,$234.00 ,$15.58 ,$58.63 ,$50.25 ,$79.56 ,$187.20 ,$198.90 ,$146.25 ,$210.60 ,$15.58 ,$222.30 ,$210.60 ,$198.90 ,$198.90 ,$79.56 ,$198.90 ,$198.90 ,$210.60 ,$15.58 ,$17.07 ,$210.60 ,$33.93 ,$215.28 ,$210.60 ,$155.94 ,$155.94 ,$142.51 ,$155.94 ,$152.10 ,$162.98 ,$51.99 ,$184.86 ,$16.51 ,$18.10 ,$18.10 ,$79.56 ,$18.10 ,$15.08 ,$222.30 ,$191.88 ,$191.88 ,$187.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),82728072,82728,HC FERRITIN-PRV 72 HR,301,1 ,$142.00 ,$71.00 ,$13.63 ,$142.00 ,$14.08 ,$53.03 ,$45.45 ,$48.28 ,$113.60 ,$120.70 ,$88.75 ,$127.80 ,$14.08 ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$48.28 ,$120.70 ,$120.70 ,$127.80 ,$14.08 ,$15.43 ,$127.80 ,$30.67 ,$130.64 ,$127.80 ,$94.63 ,$94.63 ,$86.48 ,$94.63 ,$92.30 ,$98.90 ,$31.55 ,$112.18 ,$14.92 ,$16.36 ,$16.36 ,$48.28 ,$16.36 ,$13.63 ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),82784072,82784,HC IG A D G M,301,1 ,$100.00 ,$50.00 ,$9.30 ,$100.00 ,$9.61 ,$36.19 ,$31.02 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$9.61 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$9.61 ,$10.53 ,$90.00 ,$20.93 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$10.19 ,$11.16 ,$11.16 ,$34.00 ,$11.16 ,$9.30 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),82948072,82948,HC GLUCOSE REAGENT STRIP-PRV 72 HR,300,1 ,$34.00 ,$17.00 ,$4.45 ,$34.00 ,$4.45 ,$17.64 ,$15.12 ,$11.56 ,$27.20 ,$28.90 ,$21.25 ,$30.60 ,$4.45 ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$11.56 ,$28.90 ,$28.90 ,$30.60 ,$4.45 ,$5.70 ,$30.60 ,$11.34 ,$31.28 ,$30.60 ,$22.66 ,$22.66 ,$20.71 ,$22.66 ,$22.10 ,$23.68 ,$7.55 ,$26.86 ,$4.72 ,$6.05 ,$6.05 ,$11.56 ,$6.05 ,$5.04 ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),83036072,83036,HC GLYCOSYLATED HGB-PRV 72 HR,301,1 ,$129.00 ,$64.50 ,$9.71 ,$129.00 ,$10.03 ,$37.77 ,$32.37 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 ,$10.03 ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 ,$10.03 ,$10.99 ,$116.10 ,$21.85 ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 ,$10.63 ,$11.65 ,$11.65 ,$43.86 ,$11.65 ,$9.71 ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),83090072,83090,HC HOMOCYSTINE-PREVEA 72HR,301,1 ,$147.00 ,$73.50 ,$17.92 ,$147.00 ,$18.52 ,$65.59 ,$56.22 ,$49.98 ,$117.60 ,$124.95 ,$91.88 ,$132.30 ,$18.52 ,$139.65 ,$132.30 ,$124.95 ,$124.95 ,$49.98 ,$124.95 ,$124.95 ,$132.30 ,$18.52 ,$20.28 ,$132.30 ,$40.32 ,$135.24 ,$132.30 ,$97.96 ,$97.96 ,$89.52 ,$97.96 ,$95.55 ,$102.39 ,$32.66 ,$116.13 ,$19.63 ,$21.50 ,$21.50 ,$49.98 ,$21.50 ,$17.92 ,$139.65 ,$120.54 ,$120.54 ,$117.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),83540072,83540,HC IRON TOTAL-PRV 72 HR,301,1 ,$84.00 ,$42.00 ,$6.47 ,$84.00 ,$6.69 ,$25.17 ,$21.57 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 ,$6.69 ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 ,$6.69 ,$7.32 ,$75.60 ,$14.56 ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 ,$7.09 ,$7.76 ,$7.76 ,$28.56 ,$7.76 ,$6.47 ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),83550072,83550,HC IRON BINDING CAPACITY-PRV 72 HR,301,1 ,$111.00 ,$55.50 ,$8.74 ,$111.00 ,$9.03 ,$33.99 ,$29.13 ,$37.74 ,$88.80 ,$94.35 ,$69.38 ,$99.90 ,$9.03 ,$105.45 ,$99.90 ,$94.35 ,$94.35 ,$37.74 ,$94.35 ,$94.35 ,$99.90 ,$9.03 ,$9.89 ,$99.90 ,$19.67 ,$102.12 ,$99.90 ,$73.97 ,$73.97 ,$67.60 ,$73.97 ,$72.15 ,$77.31 ,$24.66 ,$87.69 ,$9.57 ,$10.49 ,$10.49 ,$37.74 ,$10.49 ,$8.74 ,$105.45 ,$91.02 ,$91.02 ,$88.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),83615072,83615,HC LACTATE DEHYDRO (LDH)-PRV 72 HR,301,1 ,$74.00 ,$37.00 ,$6.04 ,$74.00 ,$6.24 ,$23.49 ,$20.13 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$6.24 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$6.24 ,$6.84 ,$66.60 ,$13.59 ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$6.61 ,$7.25 ,$7.25 ,$25.16 ,$7.25 ,$6.04 ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),83690072,83690,HC LIPASE-PRV 72 HR,300,1 ,$127.00 ,$63.50 ,$6.89 ,$127.00 ,$7.12 ,$26.78 ,$22.95 ,$43.18 ,$101.60 ,$107.95 ,$79.38 ,$114.30 ,$7.12 ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$43.18 ,$107.95 ,$107.95 ,$114.30 ,$7.12 ,$7.80 ,$114.30 ,$15.50 ,$116.84 ,$114.30 ,$84.63 ,$84.63 ,$77.34 ,$84.63 ,$82.55 ,$88.46 ,$28.22 ,$100.33 ,$7.55 ,$8.27 ,$8.27 ,$43.18 ,$8.27 ,$6.89 ,$120.65 ,$104.14 ,$104.14 ,$101.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),83721072,83721,HC CHOLESTEROL LDL,301,1 ,$87.00 ,$43.50 ,$10.50 ,$87.00 ,$10.85 ,$37.10 ,$31.80 ,$29.58 ,$69.60 ,$73.95 ,$54.38 ,$78.30 ,$10.85 ,$82.65 ,$78.30 ,$73.95 ,$73.95 ,$29.58 ,$73.95 ,$73.95 ,$78.30 ,$10.85 ,$11.88 ,$78.30 ,$23.63 ,$80.04 ,$78.30 ,$57.98 ,$57.98 ,$52.98 ,$57.98 ,$56.55 ,$60.60 ,$19.33 ,$68.73 ,$11.50 ,$12.60 ,$12.60 ,$29.58 ,$12.60 ,$10.50 ,$82.65 ,$71.34 ,$71.34 ,$69.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),83735072,83735,HC MAGNESIUM-PRV 72 HR,301,1 ,$77.00 ,$38.50 ,$6.70 ,$77.00 ,$6.92 ,$26.04 ,$22.32 ,$26.18 ,$61.60 ,$65.45 ,$48.13 ,$69.30 ,$6.92 ,$73.15 ,$69.30 ,$65.45 ,$65.45 ,$26.18 ,$65.45 ,$65.45 ,$69.30 ,$6.92 ,$7.58 ,$69.30 ,$15.08 ,$70.84 ,$69.30 ,$51.31 ,$51.31 ,$46.89 ,$51.31 ,$50.05 ,$53.63 ,$17.11 ,$60.83 ,$7.34 ,$8.04 ,$8.04 ,$26.18 ,$8.04 ,$6.70 ,$73.15 ,$63.14 ,$63.14 ,$61.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),83789072,83789,HC MASS SPEC QT-PRV 72 HR,301,1 ,$170.00 ,$85.00 ,$24.11 ,$170.00 ,$24.91 ,$84.39 ,$72.33 ,$57.80 ,$136.00 ,$144.50 ,$106.25 ,$153.00 ,$24.91 ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$57.80 ,$144.50 ,$144.50 ,$153.00 ,$24.91 ,$27.29 ,$153.00 ,$54.25 ,$156.40 ,$153.00 ,$113.29 ,$113.29 ,$103.53 ,$113.29 ,$110.50 ,$118.41 ,$37.77 ,$134.30 ,$26.40 ,$28.93 ,$28.93 ,$57.80 ,$28.93 ,$24.11 ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),83880072,83880,HC BNP NATRIURETIC PEPTIDE-PRV 72 HR,301,1 ,$217.00 ,$108.50 ,$39.26 ,$217.00 ,$40.57 ,$137.41 ,$117.78 ,$73.78 ,$173.60 ,$184.45 ,$135.63 ,$195.30 ,$40.57 ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$73.78 ,$184.45 ,$184.45 ,$195.30 ,$40.57 ,$44.43 ,$195.30 ,$88.34 ,$199.64 ,$195.30 ,$144.61 ,$144.61 ,$132.15 ,$144.61 ,$141.05 ,$151.14 ,$48.22 ,$171.43 ,$43.00 ,$47.11 ,$47.11 ,$73.78 ,$47.11 ,$39.26 ,$206.15 ,$177.94 ,$177.94 ,$173.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),83883072,83883,HC NEPHELOMETRY,301,1 ,$140.00 ,$70.00 ,$13.60 ,$140.00 ,$14.05 ,$52.89 ,$45.33 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 ,$14.05 ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 ,$14.05 ,$15.39 ,$126.00 ,$30.60 ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 ,$14.89 ,$16.32 ,$16.32 ,$47.60 ,$16.32 ,$13.60 ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),83921072,83921,HC ORGANIC ACID,301,1 ,$190.00 ,$95.00 ,$21.21 ,$190.00 ,$21.92 ,$74.24 ,$63.63 ,$64.60 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$21.92 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$64.60 ,$161.50 ,$161.50 ,$171.00 ,$21.92 ,$24.01 ,$171.00 ,$47.72 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$42.22 ,$150.10 ,$23.24 ,$25.45 ,$25.45 ,$64.60 ,$25.45 ,$21.21 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),83970072,83970,HC PARATHORMONE PTH-PREV 72HR,301,1 ,$309.00 ,$154.50 ,$41.28 ,$309.00 ,$42.65 ,$160.51 ,$137.58 ,$105.06 ,$247.20 ,$262.65 ,$193.13 ,$278.10 ,$42.65 ,$293.55 ,$278.10 ,$262.65 ,$262.65 ,$105.06 ,$262.65 ,$262.65 ,$278.10 ,$42.65 ,$46.72 ,$278.10 ,$92.88 ,$284.28 ,$278.10 ,$205.92 ,$205.92 ,$188.18 ,$205.92 ,$200.85 ,$215.22 ,$68.66 ,$244.11 ,$45.21 ,$49.54 ,$49.54 ,$105.06 ,$49.54 ,$41.28 ,$293.55 ,$253.38 ,$253.38 ,$247.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),84132072,84132,HC POTASSIUM SERUM-PRV 72 HR,300,1 ,$74.00 ,$37.00 ,$4.76 ,$74.00 ,$4.92 ,$17.89 ,$15.33 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$4.92 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$4.92 ,$5.39 ,$66.60 ,$10.71 ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$5.22 ,$5.71 ,$5.71 ,$25.16 ,$5.71 ,$4.76 ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),84156072,84156,HC URINE PROTEIN-PRV 72 HR,301,1 ,$101.00 ,$50.50 ,$3.67 ,$101.00 ,$3.79 ,$14.25 ,$12.21 ,$34.34 ,$80.80 ,$85.85 ,$63.13 ,$90.90 ,$3.79 ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$34.34 ,$85.85 ,$85.85 ,$90.90 ,$3.79 ,$4.15 ,$90.90 ,$8.26 ,$92.92 ,$90.90 ,$67.31 ,$67.31 ,$61.51 ,$67.31 ,$65.65 ,$70.35 ,$22.44 ,$79.79 ,$4.02 ,$4.40 ,$4.40 ,$34.34 ,$4.40 ,$3.67 ,$95.95 ,$82.82 ,$82.82 ,$80.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),84165072,84165,HC PROTEIN ELECTOPHORESUS,300,1 ,$130.00 ,$65.00 ,$10.74 ,$130.00 ,$11.10 ,$41.76 ,$35.79 ,$44.20 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$11.10 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$44.20 ,$110.50 ,$110.50 ,$117.00 ,$11.10 ,$12.16 ,$117.00 ,$24.17 ,$119.60 ,$117.00 ,$86.63 ,$86.63 ,$79.17 ,$86.63 ,$84.50 ,$90.55 ,$28.89 ,$102.70 ,$11.77 ,$12.89 ,$12.89 ,$44.20 ,$12.89 ,$10.74 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),84403072,84403,HC TESTERONE TOTAL-PRV 72HR,301,1 ,$213.00 ,$106.50 ,$25.81 ,$213.00 ,$26.67 ,$100.38 ,$86.04 ,$72.42 ,$170.40 ,$181.05 ,$133.13 ,$191.70 ,$26.67 ,$202.35 ,$191.70 ,$181.05 ,$181.05 ,$72.42 ,$181.05 ,$181.05 ,$191.70 ,$26.67 ,$29.21 ,$191.70 ,$58.07 ,$195.96 ,$191.70 ,$141.94 ,$141.94 ,$129.72 ,$141.94 ,$138.45 ,$148.35 ,$47.33 ,$168.27 ,$28.27 ,$30.97 ,$30.97 ,$72.42 ,$30.97 ,$25.81 ,$202.35 ,$174.66 ,$174.66 ,$170.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),84439072,84439,HC T4 FREE-PRV 72 HR,301,1 ,$162.00 ,$81.00 ,$9.02 ,$162.00 ,$9.32 ,$35.07 ,$30.06 ,$55.08 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$9.32 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$55.08 ,$137.70 ,$137.70 ,$145.80 ,$9.32 ,$10.21 ,$145.80 ,$20.30 ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$36.00 ,$127.98 ,$9.88 ,$10.82 ,$10.82 ,$55.08 ,$10.82 ,$9.02 ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),84443072,84443,HC THYROID STIMULATING HORM-PRV 72 HR,301,1 ,$143.00 ,$71.50 ,$16.80 ,$143.00 ,$17.36 ,$65.35 ,$56.01 ,$48.62 ,$114.40 ,$121.55 ,$89.38 ,$128.70 ,$17.36 ,$135.85 ,$128.70 ,$121.55 ,$121.55 ,$48.62 ,$121.55 ,$121.55 ,$128.70 ,$17.36 ,$19.01 ,$128.70 ,$37.80 ,$131.56 ,$128.70 ,$95.30 ,$95.30 ,$87.09 ,$95.30 ,$92.95 ,$99.60 ,$31.77 ,$112.97 ,$18.40 ,$20.16 ,$20.16 ,$48.62 ,$20.16 ,$16.80 ,$135.85 ,$117.26 ,$117.26 ,$114.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),84450072,84450,HC AST/SGOT-PRV 72 HR,301,1 ,$75.00 ,$37.50 ,$5.18 ,$75.00 ,$5.35 ,$20.13 ,$17.25 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$5.35 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$5.35 ,$5.86 ,$67.50 ,$11.66 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$5.67 ,$6.22 ,$6.22 ,$25.50 ,$6.22 ,$5.18 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),84460072,84460,HC ALT/SGPT-PRV 72 HR,301,1 ,$75.00 ,$37.50 ,$5.30 ,$75.00 ,$5.48 ,$20.62 ,$17.67 ,$25.50 ,$60.00 ,$63.75 ,$46.88 ,$67.50 ,$5.48 ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$25.50 ,$63.75 ,$63.75 ,$67.50 ,$5.48 ,$6.00 ,$67.50 ,$11.93 ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 ,$5.81 ,$6.36 ,$6.36 ,$25.50 ,$6.36 ,$5.30 ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),84550072,84550,HC URIC ACID-PRV 72 HR,301,1 ,$84.00 ,$42.00 ,$4.52 ,$84.00 ,$4.67 ,$17.57 ,$15.06 ,$28.56 ,$67.20 ,$71.40 ,$52.50 ,$75.60 ,$4.67 ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$28.56 ,$71.40 ,$71.40 ,$75.60 ,$4.67 ,$5.12 ,$75.60 ,$10.17 ,$77.28 ,$75.60 ,$55.98 ,$55.98 ,$51.16 ,$55.98 ,$54.60 ,$58.51 ,$18.66 ,$66.36 ,$4.95 ,$5.42 ,$5.42 ,$28.56 ,$5.42 ,$4.52 ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),85014072,85014,HC HEMATOCRIT-PRV 72 HR,305,1 ,$62.00 ,$31.00 ,$2.37 ,$62.00 ,$2.45 ,$9.21 ,$7.89 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$2.45 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$2.45 ,$2.68 ,$55.80 ,$5.33 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$2.60 ,$2.84 ,$2.84 ,$21.08 ,$2.84 ,$2.37 ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),85018072,85018,HC HEMOGLOBIN-PRV 72 HR,305,1 ,$62.00 ,$31.00 ,$2.37 ,$62.00 ,$2.45 ,$9.21 ,$7.89 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$2.45 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$2.45 ,$2.68 ,$55.80 ,$5.33 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$2.60 ,$2.84 ,$2.84 ,$21.08 ,$2.84 ,$2.37 ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),85025072,85025,HC CBC AUTO W/AUTO DIFF-PRV 72 HR,305,1 ,$72.00 ,$36.00 ,$7.77 ,$72.00 ,$8.03 ,$30.21 ,$25.89 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 ,$8.03 ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 ,$8.03 ,$8.79 ,$64.80 ,$17.48 ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 ,$8.51 ,$9.32 ,$9.32 ,$24.48 ,$9.32 ,$7.77 ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),85027072,85027,HC CBC W/O DIFF-PRV 72 HR,305,1 ,$122.00 ,$61.00 ,$6.47 ,$122.00 ,$6.69 ,$25.13 ,$21.54 ,$41.48 ,$97.60 ,$103.70 ,$76.25 ,$109.80 ,$6.69 ,$115.90 ,$109.80 ,$103.70 ,$103.70 ,$41.48 ,$103.70 ,$103.70 ,$109.80 ,$6.69 ,$7.32 ,$109.80 ,$14.56 ,$112.24 ,$109.80 ,$81.30 ,$81.30 ,$74.30 ,$81.30 ,$79.30 ,$84.97 ,$27.11 ,$96.38 ,$7.09 ,$7.76 ,$7.76 ,$41.48 ,$7.76 ,$6.47 ,$115.90 ,$100.04 ,$100.04 ,$97.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),85379072,85379,HC D-DIMMER QUAN-PRV 72 HR,305,1 ,$148.00 ,$74.00 ,$10.18 ,$148.00 ,$10.52 ,$39.59 ,$33.93 ,$50.32 ,$118.40 ,$125.80 ,$92.50 ,$133.20 ,$10.52 ,$140.60 ,$133.20 ,$125.80 ,$125.80 ,$50.32 ,$125.80 ,$125.80 ,$133.20 ,$10.52 ,$11.52 ,$133.20 ,$22.91 ,$136.16 ,$133.20 ,$98.63 ,$98.63 ,$90.13 ,$98.63 ,$96.20 ,$103.08 ,$32.89 ,$116.92 ,$11.15 ,$12.22 ,$12.22 ,$50.32 ,$12.22 ,$10.18 ,$140.60 ,$121.36 ,$121.36 ,$118.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),85610072,85610,HC PROTHROMBIN TIME (PT)-PRV 72 HR,305,1 ,$74.00 ,$37.00 ,$4.29 ,$74.00 ,$4.43 ,$15.30 ,$13.11 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$4.43 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$4.43 ,$4.86 ,$66.60 ,$9.65 ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$4.70 ,$5.15 ,$5.15 ,$25.16 ,$5.15 ,$4.29 ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),85652072,85652,HC ESR AUTO- PRV 72 HR,305,1 ,$67.00 ,$33.50 ,$2.70 ,$67.00 ,$2.79 ,$10.50 ,$9.00 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$2.79 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$2.79 ,$3.06 ,$60.30 ,$6.08 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$2.96 ,$3.24 ,$3.24 ,$22.78 ,$3.24 ,$2.70 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),85730072,85730,HC PTT-PRV 72 HR,305,1 ,$63.00 ,$31.50 ,$6.01 ,$63.00 ,$6.21 ,$23.35 ,$20.01 ,$21.42 ,$50.40 ,$53.55 ,$39.38 ,$56.70 ,$6.21 ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$21.42 ,$53.55 ,$53.55 ,$56.70 ,$6.21 ,$6.80 ,$56.70 ,$13.52 ,$57.96 ,$56.70 ,$41.98 ,$41.98 ,$38.37 ,$41.98 ,$40.95 ,$43.88 ,$14.00 ,$49.77 ,$6.58 ,$7.21 ,$7.21 ,$21.42 ,$7.21 ,$6.01 ,$59.85 ,$51.66 ,$51.66 ,$50.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),86038072,86038,HC ANA SCREEN-PRV 72 HR,302,1 ,$132.00 ,$66.00 ,$12.09 ,$132.00 ,$12.49 ,$47.01 ,$40.29 ,$44.88 ,$105.60 ,$112.20 ,$82.50 ,$118.80 ,$12.49 ,$125.40 ,$118.80 ,$112.20 ,$112.20 ,$44.88 ,$112.20 ,$112.20 ,$118.80 ,$12.49 ,$13.68 ,$118.80 ,$27.20 ,$121.44 ,$118.80 ,$87.96 ,$87.96 ,$80.39 ,$87.96 ,$85.80 ,$91.94 ,$29.33 ,$104.28 ,$13.24 ,$14.51 ,$14.51 ,$44.88 ,$14.51 ,$12.09 ,$125.40 ,$108.24 ,$108.24 ,$105.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86140072,86140,HC C-REACTIVE PROTEIN-PRV 72 HR,302,1 ,$142.00 ,$71.00 ,$5.18 ,$142.00 ,$5.35 ,$20.13 ,$17.25 ,$48.28 ,$113.60 ,$120.70 ,$88.75 ,$127.80 ,$5.35 ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$48.28 ,$120.70 ,$120.70 ,$127.80 ,$5.35 ,$5.86 ,$127.80 ,$11.66 ,$130.64 ,$127.80 ,$94.63 ,$94.63 ,$86.48 ,$94.63 ,$92.30 ,$98.90 ,$31.55 ,$112.18 ,$5.67 ,$6.22 ,$6.22 ,$48.28 ,$6.22 ,$5.18 ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86255072,86255,HC FLUOR AB SC,302,1 ,$158.00 ,$79.00 ,$12.05 ,$158.00 ,$12.45 ,$46.87 ,$40.17 ,$53.72 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$12.45 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$53.72 ,$134.30 ,$134.30 ,$142.20 ,$12.45 ,$13.64 ,$142.20 ,$27.11 ,$145.36 ,$142.20 ,$105.29 ,$105.29 ,$96.22 ,$105.29 ,$102.70 ,$110.05 ,$35.11 ,$124.82 ,$13.20 ,$14.46 ,$14.46 ,$53.72 ,$14.46 ,$12.05 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),86304072,86304,HC TUMOR AG CA 125-PRV 72 HR,302,1 ,$172.00 ,$86.00 ,$20.81 ,$172.00 ,$21.50 ,$80.96 ,$69.39 ,$58.48 ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$21.50 ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$58.48 ,$146.20 ,$146.20 ,$154.80 ,$21.50 ,$23.55 ,$154.80 ,$46.82 ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 ,$22.79 ,$24.97 ,$24.97 ,$58.48 ,$24.97 ,$20.81 ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86308072,86308,HC HETEROPHILE SCRN-PRV 72 HR,300,1 ,$91.00 ,$45.50 ,$5.18 ,$91.00 ,$5.35 ,$20.13 ,$17.25 ,$30.94 ,$72.80 ,$77.35 ,$56.88 ,$81.90 ,$5.35 ,$86.45 ,$81.90 ,$77.35 ,$77.35 ,$30.94 ,$77.35 ,$77.35 ,$81.90 ,$5.35 ,$5.86 ,$81.90 ,$11.66 ,$83.72 ,$81.90 ,$60.64 ,$60.64 ,$55.42 ,$60.64 ,$59.15 ,$63.38 ,$20.22 ,$71.89 ,$5.67 ,$6.22 ,$6.22 ,$30.94 ,$6.22 ,$5.18 ,$86.45 ,$74.62 ,$74.62 ,$72.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),86331072,86331,HC IMMUNODIFF EL EA AB-PRV 72 HR,302,1 ,$132.00 ,$66.00 ,$11.98 ,$132.00 ,$12.38 ,$46.59 ,$39.93 ,$44.88 ,$105.60 ,$112.20 ,$82.50 ,$118.80 ,$12.38 ,$125.40 ,$118.80 ,$112.20 ,$112.20 ,$44.88 ,$112.20 ,$112.20 ,$118.80 ,$12.38 ,$13.56 ,$118.80 ,$26.96 ,$121.44 ,$118.80 ,$87.96 ,$87.96 ,$80.39 ,$87.96 ,$85.80 ,$91.94 ,$29.33 ,$104.28 ,$13.12 ,$14.38 ,$14.38 ,$44.88 ,$14.38 ,$11.98 ,$125.40 ,$108.24 ,$108.24 ,$105.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86332072,86332,HC IMMUNE COMPLEX ASSAY-PRV 72 HR,300,1 ,$177.00 ,$88.50 ,$24.37 ,$177.00 ,$25.18 ,$94.78 ,$81.24 ,$60.18 ,$141.60 ,$150.45 ,$110.63 ,$159.30 ,$25.18 ,$168.15 ,$159.30 ,$150.45 ,$150.45 ,$60.18 ,$150.45 ,$150.45 ,$159.30 ,$25.18 ,$27.58 ,$159.30 ,$54.83 ,$162.84 ,$159.30 ,$117.95 ,$117.95 ,$107.79 ,$117.95 ,$115.05 ,$123.28 ,$39.33 ,$139.83 ,$26.69 ,$29.24 ,$29.24 ,$60.18 ,$29.24 ,$24.37 ,$168.15 ,$145.14 ,$145.14 ,$141.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86334072,86334,HC IMMUNOFIXATION SERUM,300,1 ,$180.00 ,$90.00 ,$22.34 ,$180.00 ,$23.08 ,$86.91 ,$74.49 ,$61.20 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$23.08 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$61.20 ,$153.00 ,$153.00 ,$162.00 ,$23.08 ,$25.28 ,$162.00 ,$50.27 ,$165.60 ,$162.00 ,$119.95 ,$119.95 ,$109.62 ,$119.95 ,$117.00 ,$125.37 ,$40.00 ,$142.20 ,$24.46 ,$26.81 ,$26.81 ,$61.20 ,$26.81 ,$22.34 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),86430072,86430,HC RHEUMATOID FACTOR-PRV 72 HR,302,1 ,$71.00 ,$35.50 ,$6.14 ,$71.00 ,$6.34 ,$22.05 ,$18.90 ,$24.14 ,$56.80 ,$60.35 ,$44.38 ,$63.90 ,$6.34 ,$67.45 ,$63.90 ,$60.35 ,$60.35 ,$24.14 ,$60.35 ,$60.35 ,$63.90 ,$6.34 ,$6.95 ,$63.90 ,$13.82 ,$65.32 ,$63.90 ,$47.31 ,$47.31 ,$43.24 ,$47.31 ,$46.15 ,$49.45 ,$15.78 ,$56.09 ,$6.72 ,$7.37 ,$7.37 ,$24.14 ,$7.37 ,$6.14 ,$67.45 ,$58.22 ,$58.22 ,$56.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),86580072,86580,HC TB SCREEN-PRV 72 HR,300,1 ,$104.00 ,$52.00 ,$18.39 ,$104.00 ,$18.39 ,$28.20 ,$24.17 ,$35.36 ,$83.20 ,$88.40 ,$65.00 ,$93.60 ,$18.39 ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$35.36 ,$88.40 ,$88.40 ,$93.60 ,$18.39 ,$43.68 ,$93.60 ,$56.77 ,$95.68 ,$93.60 ,$69.31 ,$69.31 ,$63.34 ,$69.31 ,$67.60 ,$72.44 ,$23.11 ,$82.16 ,$19.49 ,$27.59 ,$27.59 ,$35.36 ,$27.59 ,$25.23 ,$98.80 ,$85.28 ,$85.28 ,$83.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),86618072,86618,HC LYMES DISEASE-PRV 72 HR,302,1 ,$157.00 ,$78.50 ,$17.03 ,$157.00 ,$17.60 ,$66.22 ,$56.76 ,$53.38 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$17.60 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$53.38 ,$133.45 ,$133.45 ,$141.30 ,$17.60 ,$19.27 ,$141.30 ,$38.32 ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$18.66 ,$20.44 ,$20.44 ,$53.38 ,$20.44 ,$17.03 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86695072,86695,HC HERPES SIMPLEX AB-PRV 72 HR,302,1 ,$139.00 ,$69.50 ,$13.19 ,$139.00 ,$13.63 ,$51.28 ,$43.95 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 ,$13.63 ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 ,$13.63 ,$14.93 ,$125.10 ,$29.68 ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 ,$14.45 ,$15.83 ,$15.83 ,$47.26 ,$15.83 ,$13.19 ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),86696072,86696,HC HERPES SIMPLEX AB II-PRV 72 HR,302,1 ,$139.00 ,$69.50 ,$19.35 ,$139.00 ,$19.99 ,$75.29 ,$64.53 ,$47.26 ,$111.20 ,$118.15 ,$86.88 ,$125.10 ,$19.99 ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$47.26 ,$118.15 ,$118.15 ,$125.10 ,$19.99 ,$21.90 ,$125.10 ,$43.54 ,$127.88 ,$125.10 ,$92.63 ,$92.63 ,$84.65 ,$92.63 ,$90.35 ,$96.81 ,$30.89 ,$109.81 ,$21.19 ,$23.22 ,$23.22 ,$47.26 ,$23.22 ,$19.35 ,$132.05 ,$113.98 ,$113.98 ,$111.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),86705072,86705,HC HEP B CORE IGM AB PRV 72 HR,300,1 ,$109.00 ,$54.50 ,$11.77 ,$109.00 ,$12.16 ,$45.78 ,$39.24 ,$37.06 ,$87.20 ,$92.65 ,$68.13 ,$98.10 ,$12.16 ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$37.06 ,$92.65 ,$92.65 ,$98.10 ,$12.16 ,$13.32 ,$98.10 ,$26.48 ,$100.28 ,$98.10 ,$72.64 ,$72.64 ,$66.38 ,$72.64 ,$70.85 ,$75.92 ,$24.22 ,$86.11 ,$12.89 ,$14.12 ,$14.12 ,$37.06 ,$14.12 ,$11.77 ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),87040072,87040,HC BLOOD CULTURE-72HR PRV,306,1 ,$141.00 ,$70.50 ,$10.32 ,$141.00 ,$10.66 ,$40.15 ,$34.41 ,$47.94 ,$112.80 ,$119.85 ,$88.13 ,$126.90 ,$10.66 ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$47.94 ,$119.85 ,$119.85 ,$126.90 ,$10.66 ,$11.68 ,$126.90 ,$23.22 ,$129.72 ,$126.90 ,$93.96 ,$93.96 ,$85.87 ,$93.96 ,$91.65 ,$98.21 ,$31.33 ,$111.39 ,$11.30 ,$12.38 ,$12.38 ,$47.94 ,$12.38 ,$10.32 ,$133.95 ,$115.62 ,$115.62 ,$112.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),87045072,87045,HC CULTURE FECES-PRV 72HR,300,1 ,$120.00 ,$60.00 ,$9.44 ,$120.00 ,$9.75 ,$36.72 ,$31.47 ,$40.80 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$9.75 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$40.80 ,$102.00 ,$102.00 ,$108.00 ,$9.75 ,$10.68 ,$108.00 ,$21.24 ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$26.66 ,$94.80 ,$10.34 ,$11.33 ,$11.33 ,$40.80 ,$11.33 ,$9.44 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),87046072,87046,HC CX FECES ADDNL-PRV 72 HR,306,1 ,$231.00 ,$115.50 ,$3.40 ,$231.00 ,$3.40 ,$36.72 ,$31.47 ,$78.54 ,$184.80 ,$196.35 ,$144.38 ,$207.90 ,$3.40 ,$219.45 ,$207.90 ,$196.35 ,$196.35 ,$78.54 ,$196.35 ,$196.35 ,$207.90 ,$3.40 ,$10.68 ,$207.90 ,$21.24 ,$212.52 ,$207.90 ,$153.94 ,$153.94 ,$140.68 ,$153.94 ,$150.15 ,$160.89 ,$51.33 ,$182.49 ,$3.60 ,$11.33 ,$11.33 ,$78.54 ,$11.33 ,$9.44 ,$219.45 ,$189.42 ,$189.42 ,$184.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),87077072,87077,HC CULTURE AEROBIC ID ADDL-PRV 72 HR,306,1 ,$123.00 ,$61.50 ,$8.08 ,$123.00 ,$8.35 ,$31.40 ,$26.91 ,$41.82 ,$98.40 ,$104.55 ,$76.88 ,$110.70 ,$8.35 ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$41.82 ,$104.55 ,$104.55 ,$110.70 ,$8.35 ,$9.14 ,$110.70 ,$18.18 ,$113.16 ,$110.70 ,$81.97 ,$81.97 ,$74.91 ,$81.97 ,$79.95 ,$85.67 ,$27.33 ,$97.17 ,$8.85 ,$9.70 ,$9.70 ,$41.82 ,$9.70 ,$8.08 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87081072,87081,HC CULTURE SCREEN ONLY-PRV 72 HR,306,1 ,$62.00 ,$31.00 ,$6.63 ,$62.00 ,$6.85 ,$25.76 ,$22.08 ,$21.08 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$6.85 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$21.08 ,$52.70 ,$52.70 ,$55.80 ,$6.85 ,$7.50 ,$55.80 ,$14.92 ,$57.04 ,$55.80 ,$41.32 ,$41.32 ,$37.76 ,$41.32 ,$40.30 ,$43.18 ,$13.78 ,$48.98 ,$7.26 ,$7.96 ,$7.96 ,$21.08 ,$7.96 ,$6.63 ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),87086072,87086,HC CULTURE URINE W/COLONY CT-PRV 72 HR,306,1 ,$103.00 ,$51.50 ,$8.07 ,$103.00 ,$8.34 ,$31.40 ,$26.91 ,$35.02 ,$82.40 ,$87.55 ,$64.38 ,$92.70 ,$8.34 ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$35.02 ,$87.55 ,$87.55 ,$92.70 ,$8.34 ,$9.13 ,$92.70 ,$18.16 ,$94.76 ,$92.70 ,$68.64 ,$68.64 ,$62.73 ,$68.64 ,$66.95 ,$71.74 ,$22.89 ,$81.37 ,$8.84 ,$9.68 ,$9.68 ,$35.02 ,$9.68 ,$8.07 ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87088072,87088,HC CULTURE URINE ID EA ISOL-PRV 72 HR,306,1 ,$97.00 ,$48.50 ,$8.09 ,$97.00 ,$8.36 ,$31.47 ,$26.97 ,$32.98 ,$77.60 ,$82.45 ,$60.63 ,$87.30 ,$8.36 ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$32.98 ,$82.45 ,$82.45 ,$87.30 ,$8.36 ,$9.16 ,$87.30 ,$18.20 ,$89.24 ,$87.30 ,$64.64 ,$64.64 ,$59.07 ,$64.64 ,$63.05 ,$67.56 ,$21.55 ,$76.63 ,$8.86 ,$9.71 ,$9.71 ,$32.98 ,$9.71 ,$8.09 ,$92.15 ,$79.54 ,$79.54 ,$77.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),87186072,87186,HC SENSITIVITY MIC-PRV 72 HR,306,1 ,$108.00 ,$54.00 ,$8.65 ,$108.00 ,$8.94 ,$33.64 ,$28.83 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$8.94 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$8.94 ,$9.79 ,$97.20 ,$19.46 ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$9.48 ,$10.38 ,$10.38 ,$36.72 ,$10.38 ,$8.65 ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87220072,87220,HC FUNGAL SMEAR-PRV 72 HR,300,1 ,$69.00 ,$34.50 ,$4.27 ,$69.00 ,$4.41 ,$16.63 ,$14.25 ,$23.46 ,$55.20 ,$58.65 ,$43.13 ,$62.10 ,$4.41 ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$23.46 ,$58.65 ,$58.65 ,$62.10 ,$4.41 ,$4.83 ,$62.10 ,$9.61 ,$63.48 ,$62.10 ,$45.98 ,$45.98 ,$42.02 ,$45.98 ,$44.85 ,$48.06 ,$15.33 ,$54.51 ,$4.67 ,$5.12 ,$5.12 ,$23.46 ,$5.12 ,$4.27 ,$65.55 ,$56.58 ,$56.58 ,$55.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),87324072,87324,HC C DIFF TOXIN,300,1 ,$95.00 ,$47.50 ,$11.98 ,$95.00 ,$12.38 ,$46.62 ,$39.96 ,$32.30 ,$76.00 ,$80.75 ,$59.38 ,$85.50 ,$12.38 ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$32.30 ,$80.75 ,$80.75 ,$85.50 ,$12.38 ,$13.56 ,$85.50 ,$26.96 ,$87.40 ,$85.50 ,$63.31 ,$63.31 ,$57.86 ,$63.31 ,$61.75 ,$66.17 ,$21.11 ,$75.05 ,$13.12 ,$14.38 ,$14.38 ,$32.30 ,$14.38 ,$11.98 ,$90.25 ,$77.90 ,$77.90 ,$76.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),87328072,87328,HC CRYPTO GIAR-PRV 72 HR,306,1 ,$83.00 ,$41.50 ,$13.82 ,$83.00 ,$14.28 ,$48.37 ,$41.46 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 ,$14.28 ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 ,$14.28 ,$15.64 ,$74.70 ,$31.10 ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 ,$15.14 ,$16.58 ,$16.58 ,$28.22 ,$16.58 ,$13.82 ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87329072,87329,HC ENZYME IMMUN-PRV 72 HR,306,1 ,$83.00 ,$41.50 ,$11.98 ,$83.00 ,$12.38 ,$46.62 ,$39.96 ,$28.22 ,$66.40 ,$70.55 ,$51.88 ,$74.70 ,$12.38 ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$28.22 ,$70.55 ,$70.55 ,$74.70 ,$12.38 ,$13.56 ,$74.70 ,$26.96 ,$76.36 ,$74.70 ,$55.31 ,$55.31 ,$50.55 ,$55.31 ,$53.95 ,$57.81 ,$18.44 ,$65.57 ,$13.12 ,$14.38 ,$14.38 ,$28.22 ,$14.38 ,$11.98 ,$78.85 ,$68.06 ,$68.06 ,$66.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87338072,87338,HC H PYLORI AG STOOL,306,1 ,$118.00 ,$59.00 ,$14.38 ,$118.00 ,$14.86 ,$55.93 ,$47.94 ,$40.12 ,$94.40 ,$100.30 ,$73.75 ,$106.20 ,$14.86 ,$112.10 ,$106.20 ,$100.30 ,$100.30 ,$40.12 ,$100.30 ,$100.30 ,$106.20 ,$14.86 ,$16.28 ,$106.20 ,$32.36 ,$108.56 ,$106.20 ,$78.64 ,$78.64 ,$71.86 ,$78.64 ,$76.70 ,$82.19 ,$26.22 ,$93.22 ,$15.75 ,$17.26 ,$17.26 ,$40.12 ,$17.26 ,$14.38 ,$112.10 ,$96.76 ,$96.76 ,$94.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87804072,87804,HC FLU-PRV 72 HR,300,1 ,$100.00 ,$50.00 ,$16.55 ,$100.00 ,$16.86 ,$57.93 ,$49.65 ,$34.00 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$16.86 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$34.00 ,$85.00 ,$85.00 ,$90.00 ,$16.86 ,$18.73 ,$90.00 ,$37.24 ,$92.00 ,$90.00 ,$66.64 ,$66.64 ,$60.90 ,$66.64 ,$65.00 ,$69.65 ,$22.22 ,$79.00 ,$17.87 ,$19.86 ,$19.86 ,$34.00 ,$19.86 ,$16.55 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),87880072,87880,HC STREP-PRV 72 HR,300,1 ,$91.00 ,$45.50 ,$16.53 ,$91.00 ,$16.86 ,$57.86 ,$49.59 ,$30.94 ,$72.80 ,$77.35 ,$56.88 ,$81.90 ,$16.86 ,$86.45 ,$81.90 ,$77.35 ,$77.35 ,$30.94 ,$77.35 ,$77.35 ,$81.90 ,$16.86 ,$18.71 ,$81.90 ,$37.19 ,$83.72 ,$81.90 ,$60.64 ,$60.64 ,$55.42 ,$60.64 ,$59.15 ,$63.38 ,$20.22 ,$71.89 ,$17.87 ,$19.84 ,$19.84 ,$30.94 ,$19.84 ,$16.53 ,$86.45 ,$74.62 ,$74.62 ,$72.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),88142072,88142,HC CYTOPATH CERVICAL,311,1 ,$144.00 ,$72.00 ,$20.26 ,$144.00 ,$20.93 ,$78.79 ,$67.53 ,$48.96 ,$115.20 ,$122.40 ,$90.00 ,$129.60 ,$20.93 ,$136.80 ,$129.60 ,$122.40 ,$122.40 ,$48.96 ,$122.40 ,$122.40 ,$129.60 ,$20.93 ,$22.93 ,$129.60 ,$45.59 ,$132.48 ,$129.60 ,$95.96 ,$95.96 ,$87.70 ,$95.96 ,$93.60 ,$100.30 ,$32.00 ,$113.76 ,$22.19 ,$24.31 ,$24.31 ,$48.96 ,$24.31 ,$20.26 ,$136.80 ,$118.08 ,$118.08 ,$115.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),89055072,89055,HC LUEKO ACCESS STOLL QN/SEMI,300,1 ,$68.00 ,$34.00 ,$4.27 ,$68.00 ,$4.41 ,$16.63 ,$14.25 ,$23.12 ,$54.40 ,$57.80 ,$42.50 ,$61.20 ,$4.41 ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$23.12 ,$57.80 ,$57.80 ,$61.20 ,$4.41 ,$4.83 ,$61.20 ,$9.61 ,$62.56 ,$61.20 ,$45.32 ,$45.32 ,$41.41 ,$45.32 ,$44.20 ,$47.36 ,$15.11 ,$53.72 ,$4.67 ,$5.12 ,$5.12 ,$23.12 ,$5.12 ,$4.27 ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),90471072,90471,HC IMMUN ADMIN ONE VACCINE-PRV 72 HR,771,1 ,$38.00 ,$19.00 ,$8.44 ,$142.47 ,$67.79 ,$32.14 ,$32.14 ,$12.92 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$67.79 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$12.92 ,$32.30 ,$32.30 ,$34.20 ,$67.79 ,$15.96 ,$34.20 ,$142.47 ,$34.96 ,$34.20 ,$25.32 ,$25.32 ,$23.14 ,$25.32 ,$24.70 ,$26.47 ,$8.44 ,$30.02 ,$71.86 ,$38.00 ,$38.00 ,$12.92 ,$38.00 ,$63.32 ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),90632072,90632,HC HEPA VACCINE ADULT IM,983,1 ,$172.00 ,$86.00 ,$38.22 ,$172.00 ,$47.69 ,$145.49 ,$145.49 , N/A ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$47.69 ,$163.40 ,$154.80 ,$146.20 ,$146.20 , N/A ,$146.20 ,$146.20 ,$154.80 ,$47.69 ,$72.24 ,$154.80 , N/A ,$158.24 ,$154.80 ,$114.62 ,$114.62 ,$104.75 ,$114.62 ,$111.80 ,$119.80 ,$38.22 ,$135.88 ,$50.55 , N/A , N/A , N/A , N/A , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),90655072,90655,HC FLU VACCINE 6-35 MONTH PRES FREE,636,1 ,$39.00 ,$19.50 ,$8.67 ,$50.55 ,$47.69 ,$32.99 ,$32.99 ,$13.26 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$47.69 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$13.26 ,$33.15 ,$33.15 ,$35.10 ,$47.69 ,$16.38 ,$35.10 ,$27.20 ,$35.88 ,$35.10 ,$25.99 ,$25.99 ,$23.75 ,$25.99 ,$25.35 ,$27.16 ,$8.67 ,$30.81 ,$50.55 ,$19.50 ,$19.50 ,$13.26 ,$19.50 ,$12.09 ,$37.05 ,$31.98 ,$31.98 ,$31.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),90656072,G0008,HC FLU VACCINE 3  AND  > IM-PRV 72 HR,636,1 ,$35.00 ,$17.50 ,$11.90 ,$91.96 ,$67.79 ,$29.61 ,$29.61 ,$11.90 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$67.79 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$11.90 ,$29.75 ,$29.75 ,$31.50 ,$67.79 ,$14.70 ,$31.50 ,$91.96 ,$32.20 ,$31.50 ,$23.32 ,$23.32 ,$21.32 ,$23.32 ,$22.75 ,$24.38 , N/A ,$27.65 ,$71.86 ,$17.50 ,$17.50 ,$11.90 ,$17.50 ,$40.87 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),90715072,90715,HC DTAP VACCINE >7 YEARS,636,1 ,$59.00 ,$29.50 ,$13.11 ,$59.00 ,$47.69 ,$59.00 ,$54.24 ,$20.06 ,$47.20 ,$50.15 ,$36.88 ,$53.10 ,$47.69 ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$20.06 ,$50.15 ,$50.15 ,$53.10 ,$47.69 ,$40.93 ,$53.10 , N/A ,$54.28 ,$53.10 ,$39.32 ,$39.32 ,$35.93 ,$39.32 ,$38.35 ,$41.09 ,$13.11 ,$46.61 ,$50.55 ,$29.50 ,$29.50 ,$20.06 ,$29.50 , N/A ,$56.05 ,$48.38 ,$48.38 ,$47.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),90732072,90732,HC PNEUMOVAX POLY 24 VALENT,636,1 ,$85.00 ,$42.50 ,$18.89 ,$85.00 ,$47.69 ,$85.00 ,$85.00 ,$28.90 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$47.69 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$28.90 ,$72.25 ,$72.25 ,$76.50 ,$47.69 ,$85.00 ,$76.50 ,$59.29 ,$78.20 ,$76.50 ,$56.64 ,$56.64 ,$51.77 ,$56.64 ,$55.25 ,$59.20 ,$18.89 ,$67.15 ,$50.55 ,$42.50 ,$42.50 ,$28.90 ,$42.50 ,$26.35 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$2,220.00 ","$1,110.00 ",$235.00 ,"$2,220.00 ",$295.99 ,"$1,877.90 ","$1,877.90 ",$754.80 ,"$1,776.00 ","$1,887.00 ","$1,387.50 ","$1,998.00 ",$295.99 ,"$2,109.00 ","$1,998.00 ","$1,887.00 ","$1,887.00 ",$754.80 ,"$1,887.00 ","$1,887.00 ","$1,998.00 ",$295.99 ,$305.48 ,"$1,998.00 ",$528.75 ,"$2,042.40 ","$1,998.00 ","$1,479.41 ","$1,479.41 ","$1,351.98 ","$1,479.41 ","$1,443.00 ","$1,546.23 ",$493.28 ,"$1,753.80 ",$313.75 ,$381.00 ,$381.00 ,$754.80 ,$409.00 ,$235.00 ,"$2,109.00 ","$1,820.40 ","$1,820.40 ","$1,776.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,"$1,390.00 ",$695.00 ,$111.19 ,"$1,390.00 ",$194.98 ,"$1,175.80 ","$1,175.80 ",$472.60 ,"$1,112.00 ","$1,181.50 ",$868.75 ,"$1,251.00 ",$194.98 ,"$1,320.50 ","$1,251.00 ","$1,181.50 ","$1,181.50 ",$472.60 ,"$1,181.50 ","$1,181.50 ","$1,251.00 ",$194.98 ,$305.48 ,"$1,251.00 ",$250.18 ,"$1,278.80 ","$1,251.00 ",$926.30 ,$926.30 ,$846.51 ,$926.30 ,$903.50 ,$968.14 ,$308.86 ,"$1,098.10 ",$206.68 ,$381.00 ,$381.00 ,$472.60 ,$409.00 ,$111.19 ,"$1,320.50 ","$1,139.80 ","$1,139.80 ","$1,112.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,"$1,310.00 ",$655.00 ,$115.16 ,"$1,310.00 ",$194.98 ,"$1,108.13 ","$1,108.13 ",$445.40 ,"$1,048.00 ","$1,113.50 ",$818.75 ,"$1,179.00 ",$194.98 ,"$1,244.50 ","$1,179.00 ","$1,113.50 ","$1,113.50 ",$445.40 ,"$1,113.50 ","$1,113.50 ","$1,179.00 ",$194.98 ,$305.48 ,"$1,179.00 ",$259.11 ,"$1,205.20 ","$1,179.00 ",$872.98 ,$872.98 ,$797.79 ,$872.98 ,$851.50 ,$912.42 ,$291.08 ,"$1,034.90 ",$206.68 ,$381.00 ,$381.00 ,$445.40 ,$409.00 ,$115.16 ,"$1,244.50 ","$1,074.20 ","$1,074.20 ","$1,048.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,882.00 ",$941.00 ,$142.59 ,"$1,882.00 ",$295.44 ,"$1,591.98 ","$1,591.98 ",$639.88 ,"$1,505.60 ","$1,599.70 ","$1,176.25 ","$1,693.80 ",$295.44 ,"$1,787.90 ","$1,693.80 ","$1,599.70 ","$1,599.70 ",$639.88 ,"$1,599.70 ","$1,599.70 ","$1,693.80 ",$295.44 ,$305.48 ,"$1,693.80 ",$320.83 ,"$1,731.44 ","$1,693.80 ","$1,254.16 ","$1,254.16 ","$1,146.14 ","$1,254.16 ","$1,223.30 ","$1,310.81 ",$418.18 ,"$1,486.78 ",$313.17 ,$381.00 ,$381.00 ,$639.88 ,$409.00 ,$142.59 ,"$1,787.90 ","$1,543.24 ","$1,543.24 ","$1,505.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,"$1,882.00 ",$941.00 ,$142.59 ,"$1,882.00 ",$295.44 ,"$1,591.98 ","$1,591.98 ",$639.88 ,"$1,505.60 ","$1,599.70 ","$1,176.25 ","$1,693.80 ",$295.44 ,"$1,787.90 ","$1,693.80 ","$1,599.70 ","$1,599.70 ",$639.88 ,"$1,599.70 ","$1,599.70 ","$1,693.80 ",$295.44 ,$305.48 ,"$1,693.80 ",$320.83 ,"$1,731.44 ","$1,693.80 ","$1,254.16 ","$1,254.16 ","$1,146.14 ","$1,254.16 ","$1,223.30 ","$1,310.81 ",$418.18 ,"$1,486.78 ",$313.17 ,$381.00 ,$381.00 ,$639.88 ,$409.00 ,$142.59 ,"$1,787.90 ","$1,543.24 ","$1,543.24 ","$1,505.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$2,212.00 ","$1,106.00 ",$194.98 ,"$2,212.00 ",$194.98 ,"$1,871.13 ","$1,871.13 ",$752.08 ,"$1,769.60 ","$1,880.20 ","$1,382.50 ","$1,990.80 ",$194.98 ,"$2,101.40 ","$1,990.80 ","$1,880.20 ","$1,880.20 ",$752.08 ,"$1,880.20 ","$1,880.20 ","$1,990.80 ",$194.98 ,$305.48 ,"$1,990.80 ",$608.15 ,"$2,035.04 ","$1,990.80 ","$1,474.08 ","$1,474.08 ","$1,347.11 ","$1,474.08 ","$1,437.80 ","$1,540.66 ",$491.51 ,"$1,747.48 ",$206.68 ,$381.00 ,$381.00 ,$752.08 ,$409.00 ,$270.29 ,"$2,101.40 ","$1,813.84 ","$1,813.84 ","$1,769.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$2,790.00 ","$1,395.00 ",$235.00 ,"$2,790.00 ",$295.99 ,"$2,360.06 ","$2,360.06 ",$948.60 ,"$2,232.00 ","$2,371.50 ","$1,743.75 ","$2,511.00 ",$295.99 ,"$2,650.50 ","$2,511.00 ","$2,371.50 ","$2,371.50 ",$948.60 ,"$2,371.50 ","$2,371.50 ","$2,511.00 ",$295.99 ,$305.48 ,"$2,511.00 ",$528.75 ,"$2,566.80 ","$2,511.00 ","$1,859.26 ","$1,859.26 ","$1,699.11 ","$1,859.26 ","$1,813.50 ","$1,943.24 ",$619.94 ,"$2,204.10 ",$313.75 ,$381.00 ,$381.00 ,$948.60 ,$409.00 ,$235.00 ,"$2,650.50 ","$2,287.80 ","$2,287.80 ","$2,232.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,"$1,595.00 ",$797.50 ,$111.19 ,"$1,595.00 ",$194.98 ,"$1,349.21 ","$1,349.21 ",$542.30 ,"$1,276.00 ","$1,355.75 ",$996.88 ,"$1,435.50 ",$194.98 ,"$1,515.25 ","$1,435.50 ","$1,355.75 ","$1,355.75 ",$542.30 ,"$1,355.75 ","$1,355.75 ","$1,435.50 ",$194.98 ,$305.48 ,"$1,435.50 ",$250.18 ,"$1,467.40 ","$1,435.50 ","$1,062.91 ","$1,062.91 ",$971.36 ,"$1,062.91 ","$1,036.75 ","$1,110.92 ",$354.41 ,"$1,260.05 ",$206.68 ,$381.00 ,$381.00 ,$542.30 ,$409.00 ,$111.19 ,"$1,515.25 ","$1,307.90 ","$1,307.90 ","$1,276.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,$760.00 ,$380.00 ,$111.19 ,$760.00 ,$194.98 ,$642.88 ,$642.88 ,$258.40 ,$608.00 ,$646.00 ,$475.00 ,$684.00 ,$194.98 ,$722.00 ,$684.00 ,$646.00 ,$646.00 ,$258.40 ,$646.00 ,$646.00 ,$684.00 ,$194.98 ,$305.48 ,$684.00 ,$250.18 ,$699.20 ,$684.00 ,$506.46 ,$506.46 ,$462.84 ,$506.46 ,$494.00 ,$529.34 ,$168.87 ,$600.40 ,$206.68 ,$381.00 ,$381.00 ,$258.40 ,$409.00 ,$111.19 ,$722.00 ,$623.20 ,$623.20 ,$608.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,835.00 ",$917.50 ,$235.00 ,"$1,835.00 ",$295.99 ,"$1,552.23 ","$1,552.23 ",$623.90 ,"$1,468.00 ","$1,559.75 ","$1,146.88 ","$1,651.50 ",$295.99 ,"$1,743.25 ","$1,651.50 ","$1,559.75 ","$1,559.75 ",$623.90 ,"$1,559.75 ","$1,559.75 ","$1,651.50 ",$295.99 ,$305.48 ,"$1,651.50 ",$528.75 ,"$1,688.20 ","$1,651.50 ","$1,222.84 ","$1,222.84 ","$1,117.52 ","$1,222.84 ","$1,192.75 ","$1,278.08 ",$407.74 ,"$1,449.65 ",$313.75 ,$381.00 ,$381.00 ,$623.90 ,$409.00 ,$235.00 ,"$1,743.25 ","$1,504.70 ","$1,504.70 ","$1,468.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100042,93970,HC DUPLEX VENOUS EXT BI UPPER,921,1 ,"$1,835.00 ",$917.50 ,$235.00 ,"$1,835.00 ",$295.99 ,"$1,552.23 ","$1,552.23 ",$623.90 ,"$1,468.00 ","$1,559.75 ","$1,146.88 ","$1,651.50 ",$295.99 ,"$1,743.25 ","$1,651.50 ","$1,559.75 ","$1,559.75 ",$623.90 ,"$1,559.75 ","$1,559.75 ","$1,651.50 ",$295.99 ,$305.48 ,"$1,651.50 ",$528.75 ,"$1,688.20 ","$1,651.50 ","$1,222.84 ","$1,222.84 ","$1,117.52 ","$1,222.84 ","$1,192.75 ","$1,278.08 ",$407.74 ,"$1,449.65 ",$313.75 ,$381.00 ,$381.00 ,$623.90 ,$409.00 ,$235.00 ,"$1,743.25 ","$1,504.70 ","$1,504.70 ","$1,468.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,"$1,260.00 ",$630.00 ,$111.19 ,"$1,260.00 ",$194.98 ,"$1,065.83 ","$1,065.83 ",$428.40 ,"$1,008.00 ","$1,071.00 ",$787.50 ,"$1,134.00 ",$194.98 ,"$1,197.00 ","$1,134.00 ","$1,071.00 ","$1,071.00 ",$428.40 ,"$1,071.00 ","$1,071.00 ","$1,134.00 ",$194.98 ,$305.48 ,"$1,134.00 ",$250.18 ,"$1,159.20 ","$1,134.00 ",$839.66 ,$839.66 ,$767.34 ,$839.66 ,$819.00 ,$877.59 ,$279.97 ,$995.40 ,$206.68 ,$381.00 ,$381.00 ,$428.40 ,$409.00 ,$111.19 ,"$1,197.00 ","$1,033.20 ","$1,033.20 ","$1,008.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),93000072,93000,HC EKG COMPLETE,730,1 ,$241.00 ,$120.50 ,$46.48 ,$241.00 ,$46.48 ,$203.86 ,$203.86 ,$81.94 ,$192.80 ,$204.85 ,$150.63 ,$216.90 ,$46.48 ,$228.95 ,$216.90 ,$204.85 ,$204.85 ,$81.94 ,$204.85 ,$204.85 ,$216.90 ,$46.48 ,$140.29 ,$216.90 , N/A ,$221.72 ,$216.90 ,$160.60 ,$160.60 ,$146.77 ,$160.60 ,$156.65 ,$167.86 ,$53.55 ,$190.39 ,$49.27 ,$106.00 ,$106.00 ,$81.94 ,$112.00 , N/A ,$228.95 ,$197.62 ,$197.62 ,$192.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),93005072,93005,HC EKG-PRV 72 HR,730,1 ,$168.00 ,$84.00 ,$37.33 ,$168.00 ,$46.48 ,$142.11 ,$142.11 ,$57.12 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$46.48 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$57.12 ,$142.80 ,$142.80 ,$151.20 ,$46.48 ,$140.29 ,$151.20 ,$127.91 ,$154.56 ,$151.20 ,$111.96 ,$111.96 ,$102.31 ,$111.96 ,$109.20 ,$117.01 ,$37.33 ,$132.72 ,$49.27 ,$106.00 ,$106.00 ,$57.12 ,$112.00 ,$56.85 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),93010072,93010,HC EKG INTER AND REPORT PRO,985,1 ,$90.00 ,$45.00 ,$8.89 ,$90.00 ,$46.48 ,$76.13 ,$76.13 ,$8.89 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$46.48 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$8.89 ,$76.50 ,$76.50 ,$81.00 ,$46.48 ,$37.80 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$49.27 , N/A , N/A ,$8.89 , N/A , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),93016072,93016,"HC CARDIAC STRESS TST, DR SUPERV ONLY",985,1 ,$214.00 ,$107.00 ,$23.51 ,$313.17 ,$295.44 ,$181.02 ,$181.02 ,$23.51 ,$171.20 ,$181.90 ,$133.75 ,$192.60 ,$295.44 ,$203.30 ,$192.60 ,$181.90 ,$181.90 ,$23.51 ,$181.90 ,$181.90 ,$192.60 ,$295.44 ,$89.88 ,$192.60 , N/A ,$196.88 ,$192.60 ,$142.61 ,$142.61 ,$130.33 ,$142.61 ,$139.10 ,$149.05 ,$47.55 ,$169.06 ,$313.17 , N/A , N/A ,$23.51 , N/A , N/A ,$203.30 ,$175.48 ,$175.48 ,$171.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),93018072,93018,HC CARDIOVASCULAR STRESS TEST,983,1 ,$225.00 ,$112.50 ,$15.76 ,$313.17 ,$295.44 ,$190.33 ,$190.33 ,$15.76 ,$180.00 ,$191.25 ,$140.63 ,$202.50 ,$295.44 ,$213.75 ,$202.50 ,$191.25 ,$191.25 ,$15.76 ,$191.25 ,$191.25 ,$202.50 ,$295.44 ,$94.50 ,$202.50 , N/A ,$207.00 ,$202.50 ,$149.94 ,$149.94 ,$137.03 ,$149.94 ,$146.25 ,$156.71 ,$50.00 ,$177.75 ,$313.17 , N/A , N/A ,$15.76 , N/A , N/A ,$213.75 ,$184.50 ,$184.50 ,$180.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),93280072,93280,HC PRGM DEVICE EVAL DUAL PREVEA 72HR,480,1 ,$116.00 ,$58.00 ,$25.78 ,$116.00 ,$67.89 ,$98.12 ,$98.12 ,$39.44 ,$92.80 ,$98.60 ,$72.50 ,$104.40 ,$67.89 ,$110.20 ,$104.40 ,$98.60 ,$98.60 ,$39.44 ,$98.60 ,$98.60 ,$104.40 ,$67.89 ,$116.00 ,$104.40 ,$85.57 ,$106.72 ,$104.40 ,$77.30 ,$77.30 ,$70.64 ,$77.30 ,$75.40 ,$80.79 ,$25.78 ,$91.64 ,$71.96 ,$116.00 ,$116.00 ,$39.44 ,$116.00 ,$38.03 ,$110.20 ,$95.12 ,$95.12 ,$92.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$248.00 ,$124.00 ,$55.11 ,$259.11 ,$103.42 ,$209.78 ,$209.78 ,$84.32 ,$198.40 ,$210.80 ,$155.00 ,$223.20 ,$103.42 ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$84.32 ,$210.80 ,$210.80 ,$223.20 ,$103.42 ,$216.10 ,$223.20 ,$259.11 ,$228.16 ,$223.20 ,$165.27 ,$165.27 ,$151.03 ,$165.27 ,$161.20 ,$172.73 ,$55.11 ,$195.92 ,$109.63 ,$122.00 ,$122.00 ,$84.32 ,$128.00 ,$115.16 ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),94010072,94010,HC BREATHING CAPACITY TEST-PRV 72 HR,983,1 ,$78.00 ,$39.00 ,$17.33 ,$320.83 ,$91.76 ,$65.98 ,$65.98 ,$28.73 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$91.76 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$28.73 ,$66.30 ,$66.30 ,$70.20 ,$91.76 ,$32.76 ,$70.20 ,$320.83 ,$71.76 ,$70.20 ,$51.98 ,$51.98 ,$47.50 ,$51.98 ,$50.70 ,$54.33 ,$17.33 ,$61.62 ,$97.27 , N/A , N/A ,$28.73 , N/A ,$142.59 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),94060072,94060,HC EVAL OF BRONCHOSPASM-PRV 72 HR,410,1 ,$159.00 ,$79.50 ,$35.33 ,$608.15 ,$180.36 ,$134.50 ,$134.50 ,$54.06 ,$127.20 ,$135.15 ,$99.38 ,$143.10 ,$180.36 ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$54.06 ,$135.15 ,$135.15 ,$143.10 ,$180.36 ,$89.38 ,$143.10 ,$608.15 ,$146.28 ,$143.10 ,$105.96 ,$105.96 ,$96.83 ,$105.96 ,$103.35 ,$110.74 ,$35.33 ,$125.61 ,$191.18 ,$159.00 ,$159.00 ,$54.06 ,$159.00 ,$270.29 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),94200008,99406,HC SMOKING CESSATION PULM 3-10MIN,942,1 ,$78.69 ,$39.35 ,$17.48 ,$78.69 ,$42.46 ,$66.56 ,$66.56 ,$26.75 ,$62.95 ,$66.89 ,$49.18 ,$70.82 ,$42.46 ,$74.76 ,$70.82 ,$66.89 ,$66.89 ,$26.75 ,$66.89 ,$66.89 ,$70.82 ,$42.46 ,$78.69 ,$70.82 ,$60.39 ,$72.39 ,$70.82 ,$52.44 ,$52.44 ,$47.92 ,$52.44 ,$51.15 ,$54.81 ,$17.48 ,$62.17 ,$45.01 ,$78.69 ,$78.69 ,$26.75 ,$78.69 ,$26.84 ,$74.76 ,$64.53 ,$64.53 ,$62.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$72.00 ,$36.00 ,$16.00 ,$280.30 ,$264.43 ,$72.00 ,$72.00 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 ,$264.43 ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 ,$264.43 ,$72.00 ,$64.80 ,$266.74 ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 ,$280.30 ,$72.00 ,$72.00 ,$24.48 ,$72.00 ,$118.55 ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300005,93798,HC CARDIAC REHAB W/EKG SESSION (PH2),943,1 ,$484.00 ,$242.00 ,$107.54 ,$484.00 ,$264.43 ,$484.00 ,$438.00 ,$164.56 ,$387.20 ,$411.40 ,$302.50 ,$435.60 ,$264.43 ,$459.80 ,$435.60 ,$411.40 ,$411.40 ,$164.56 ,$411.40 ,$411.40 ,$435.60 ,$264.43 ,$130.11 ,$435.60 ,$266.74 ,$445.28 ,$435.60 ,$322.54 ,$322.54 ,$294.76 ,$322.54 ,$314.60 ,$337.11 ,$107.54 ,$382.36 ,$280.30 ,$447.00 ,$447.00 ,$164.56 ,$484.00 ,$118.55 ,$459.80 ,$396.88 ,$396.88 ,$387.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$484.00 ,$242.00 ,$107.54 ,$484.00 ,$264.43 ,$484.00 ,$438.00 ,$164.56 ,$387.20 ,$411.40 ,$302.50 ,$435.60 ,$264.43 ,$459.80 ,$435.60 ,$411.40 ,$411.40 ,$164.56 ,$411.40 ,$411.40 ,$435.60 ,$264.43 ,$130.11 ,$435.60 ,$266.74 ,$445.28 ,$435.60 ,$322.54 ,$322.54 ,$294.76 ,$322.54 ,$314.60 ,$337.11 ,$107.54 ,$382.36 ,$280.30 ,$447.00 ,$447.00 ,$164.56 ,$484.00 ,$118.55 ,$459.80 ,$396.88 ,$396.88 ,$387.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$484.00 ,$242.00 ,$107.54 ,$484.00 ,$264.43 ,$484.00 ,$438.00 ,$164.56 ,$387.20 ,$411.40 ,$302.50 ,$435.60 ,$264.43 ,$459.80 ,$435.60 ,$411.40 ,$411.40 ,$164.56 ,$411.40 ,$411.40 ,$435.60 ,$264.43 ,$130.11 ,$435.60 ,$266.74 ,$445.28 ,$435.60 ,$322.54 ,$322.54 ,$294.76 ,$322.54 ,$314.60 ,$337.11 ,$107.54 ,$382.36 ,$280.30 ,$447.00 ,$447.00 ,$164.56 ,$484.00 ,$118.55 ,$459.80 ,$396.88 ,$396.88 ,$387.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),94640072,94640,HC AIRWAY INHALATION TREATMENT-PRV 72 HR,410,1 ,$266.00 ,$133.00 ,$59.11 ,$431.93 ,$91.76 ,$225.01 ,$225.01 ,$90.44 ,$212.80 ,$226.10 ,$166.25 ,$239.40 ,$91.76 ,$252.70 ,$239.40 ,$226.10 ,$226.10 ,$90.44 ,$226.10 ,$226.10 ,$239.40 ,$91.76 ,$89.38 ,$239.40 ,$431.93 ,$244.72 ,$239.40 ,$177.26 ,$177.26 ,$161.99 ,$177.26 ,$172.90 ,$185.27 ,$59.11 ,$210.14 ,$97.27 ,$163.00 ,$163.00 ,$90.44 ,$183.00 ,$191.97 ,$252.70 ,$218.12 ,$218.12 ,$212.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),94726072,94726,HC SPIROMETRY W/BRONCHOD-PREV 72HR,976,1 ,$116.00 ,$58.00 ,$25.78 ,$608.15 ,$180.36 ,$98.12 ,$98.12 ,$58.62 ,$92.80 ,$98.60 ,$72.50 ,$104.40 ,$180.36 ,$110.20 ,$104.40 ,$98.60 ,$98.60 ,$58.62 ,$98.60 ,$98.60 ,$104.40 ,$180.36 ,$48.72 ,$104.40 ,$608.15 ,$106.72 ,$104.40 ,$77.30 ,$77.30 ,$70.64 ,$77.30 ,$75.40 ,$80.79 ,$25.78 ,$91.64 ,$191.18 , N/A , N/A ,$58.62 , N/A ,$270.29 ,$110.20 ,$95.12 ,$95.12 ,$92.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),94800001,94625,HC PHY/QHP OP PULM RHB W/O MNTR,948,1 ,$171.00 ,$85.50 ,$38.00 ,$171.00 ,$62.72 ,$144.65 ,$144.65 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 ,$62.72 ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 ,$62.72 ,$71.82 ,$153.90 ,$127.91 ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 ,$66.48 ,$158.00 ,$158.00 ,$58.14 ,$171.00 ,$56.85 ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),94800002,94626,HC PHY/QHP OP PULM RHB W/MNTR,948,1 ,$171.00 ,$85.50 ,$38.00 ,$171.00 ,$62.72 ,$144.65 ,$144.65 ,$58.14 ,$136.80 ,$145.35 ,$106.88 ,$153.90 ,$62.72 ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$58.14 ,$145.35 ,$145.35 ,$153.90 ,$62.72 ,$71.82 ,$153.90 ,$127.91 ,$157.32 ,$153.90 ,$113.95 ,$113.95 ,$104.14 ,$113.95 ,$111.15 ,$119.10 ,$38.00 ,$135.09 ,$66.48 ,$158.00 ,$158.00 ,$58.14 ,$171.00 ,$56.85 ,$162.45 ,$140.22 ,$140.22 ,$136.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$25.00 ,$12.50 ,$5.56 ,$25.00 , N/A ,$21.15 ,$21.15 , N/A ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 , N/A ,$21.25 ,$21.25 ,$22.50 , N/A ,$10.50 ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.66 ,$16.66 ,$15.23 ,$16.66 ,$16.25 ,$17.41 ,$5.56 ,$19.75 , N/A , N/A , N/A , N/A , N/A , N/A ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$50.00 ,$25.00 ,$11.11 ,$50.00 , N/A ,$42.30 ,$42.30 , N/A ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 , N/A ,$42.50 ,$42.50 ,$45.00 , N/A ,$21.00 ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.32 ,$33.32 ,$30.45 ,$33.32 ,$32.50 ,$34.83 ,$11.11 ,$39.50 , N/A , N/A , N/A , N/A , N/A , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$75.00 ,$37.50 ,$16.67 ,$75.00 , N/A ,$63.44 ,$63.44 , N/A ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 , N/A ,$63.75 ,$63.75 ,$67.50 , N/A ,$31.50 ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.98 ,$49.98 ,$45.68 ,$49.98 ,$48.75 ,$52.24 ,$16.67 ,$59.25 , N/A , N/A , N/A , N/A , N/A , N/A ,$71.25 ,$61.50 ,$61.50 ,$60.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96000052,M0239,"PC INTRAVENOUS INFUSION, BAMLANIVIMAB",960,1 ,$697.00 ,$348.50 ,$154.87 ,$697.00 ,$309.60 ,$589.59 ,$589.59 , N/A ,$557.60 ,$592.45 ,$435.63 ,$627.30 ,$309.60 ,$662.15 ,$627.30 ,$592.45 ,$592.45 , N/A ,$592.45 ,$592.45 ,$627.30 ,$309.60 ,$292.74 ,$627.30 , N/A ,$641.24 ,$627.30 ,$464.48 ,$464.48 ,$424.47 ,$464.48 ,$453.05 ,$485.46 ,$154.87 ,$550.63 ,$328.18 , N/A , N/A , N/A , N/A , N/A ,$662.15 ,$571.54 ,$571.54 ,$557.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),96100003,90792,PC EVAL PSYCH DIAG W/MED SERVICE MD,961,1 ,$150.00 ,$75.00 ,$33.33 ,$490.97 ,$463.18 ,$126.89 ,$126.89 ,$150.00 ,$120.00 ,$127.50 ,$93.75 ,$135.00 ,$463.18 ,$142.50 ,$135.00 ,$127.50 ,$127.50 ,$150.00 ,$127.50 ,$127.50 ,$135.00 ,$463.18 ,$63.00 ,$135.00 ,$307.46 ,$138.00 ,$135.00 ,$99.96 ,$99.96 ,$91.35 ,$99.96 ,$97.50 ,$104.48 ,$33.33 ,$118.50 ,$490.97 , N/A , N/A ,$150.00 , N/A ,$136.65 ,$142.50 ,$123.00 ,$123.00 ,$120.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400001,100,PC ANESTH SALIVARY GLAND,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400002,102,PC ANESTH REPAIR OF CLEFT LIP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400003,103,PC ANESTH BLEPHAROPLASTY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400004,104,PC ANESTH ELECTROSHOCK,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400005,120,PC ANESTH EAR SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400006,124,PC ANESTH EAR EXAM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400007,126,PC ANESTH TYMPANOTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400008,140,PC ANESTH PROCEDURES ON EYE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400009,142,PC ANESTH LENS SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400010,144,PC ANESTH CORNEAL TRANSPLANT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400011,145,PC ANESTH VITREORETINAL SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400012,147,PC ANESTH IRIDECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400013,148,PC ANESTH EYE EXAM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400014,160,PC ANESTH NOSE/SINUS SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400015,162,PC ANESTH NOSE/SINUS RADICAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400016,164,PC ANESTH BIOPSY OF NOSE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400017,170,PC ANESTH PROCEDURE ON MOUTH,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400018,172,PC ANESTH CLEFT PALATE REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400019,174,PC ANESTH RETROPHARYNGEAL TUMOR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400020,176,PC ANESTH RADICAL PHARYNGEAL SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400021,190,PC ANESTH FACE/SKULL BONE SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400022,192,PC ANESTH FACIAL BONE SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400023,210,PC ANESTH CRANIAL SURG NOS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400024,211,PC ANESTH CRAN SURG HEMOTOMA,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400025,212,PC ANESTH SUBDURAL TAPS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400026,214,PC ANESTH BURR HOLES,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400027,215,PC ANESTH SKULL REPAIR/FRACT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400028,216,PC ANESTH HEAD VESSEL SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400029,218,PC ANESTH SPECIAL HEAD SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400030,220,PC ANESTH INTRCRN NERVE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400031,222,PC ANESTH HEAD NERVE SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400032,300,PC ANESTH HEAD/NECK/PTRUNK,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400033,320,PC ANESTH NECK ORGAN 1  AND  OVER,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400034,322,PC ANESTH BIOPSY OF THYROID,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400035,326,PC ANESTH LARYNX/TRACH < 1 YR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400036,350,PC ANESTH NECK VESSEL SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400037,352,PC ANESTH SIMPLE LIGATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400038,400,PC ANESTH SKIN EXT/PER/ATRUNK,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400039,402,PC ANESTH RECONST BREAST,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400040,404,PC ANESTH RADICAL BREAST,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400041,406,PC ANESTH RADICAL BREAST W/NODE DISECT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400042,410,PC ANESTH CORRECT HEART RHYTHM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400043,450,PC ANESTH CLAVICLE/SCAPULA,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400045,454,PC ANESTH COLLAR BONE BIOPSY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400046,470,PC ANESTH REMOVAL OF RIB,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400047,472,PC ANESTH CHEST WALL REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400048,474,PC ANESTH SURGERY OF RIB(S),964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400049,500,PC ANESTH ESOPHAGEAL SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400050,520,PC ANESTH CHEST PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400051,522,PC ANESTH CHEST LINING BIOPSY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400052,524,PC ANESTH CHEST DRAINAGE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400053,528,PC ANESTH CHEST PARTITION VIEW,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400054,529,PC ANESTH CHEST PART VIEW W LUNG VENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400055,530,PC ANESTH PACEMAKER INSERTION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400056,532,PC ANESTH VASCULAR ACCESS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400057,534,PC ANESTH CARDIOVERTER/DEFIB,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400058,537,PC ANESTH CARDIAC ELECTROPHYS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400059,539,PC ANESTH TRACH-BRONCH RECONST,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400060,540,PC ANESTH CHEST SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400061,541,PC ANESTH ONE LUNG VENTILATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400062,542,PC ANESTH RELEASE OF LUNG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400063,546,PC ANESTH LUNG CHEST WALL SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400064,548,PC ANESTH TRACHEA BRONCHI SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400065,550,PC ANESTH STERNAL DEBRIDEMENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400066,560,PC ANESTH HEART SURG W/O PUMP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400067,561,PC ANESTH HEART SURG < 1 YR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400068,562,PC ANESTH HRT SURG W/PMP AGE 1+,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400069,563,PC ANESTH HEART SURG W/ARREST,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400070,566,PC ANESTH CABG W/O PUMP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400071,567,PC ANESTH CABG W/PUMP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400072,580,PC ANESTH HEART/LUNG TRANSPLNT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400073,600,PC ANESTH CERVICAL SPINE/CORD,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400074,604,PC ANESTH SITTING PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400075,620,PC ANESTH THORACIC SPINE/CORD,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400077,625,PC ANES SPINE TRANTHOR W/O VENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400078,626,PC ANES SPINE TRANSTHOR W/VENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400079,630,PC ANESTH LUMBAR SPINE/CORD,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400080,632,PC ANESTH LUMBAR SYMPH,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400082,635,PC ANESTH LUMBAR PUNCTURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400083,640,PC ANESTH SPINE MANIPULATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400084,670,PC ANESTH EXTENSIVE SPINE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400085,700,PC ANESTH UPPER ANT ABD WALL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400086,702,PC ANESTH FOR LIVER BIOPSY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400087,730,PC ANESTH UPPER POST ABD WALL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400089,750,PC ANESTH HERNIA UPPER ABD,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400090,752,PC ANESTH HERNIA LUMBAR/VENTRAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400091,754,PC ANESTH OMPHALOCELE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400092,756,PC ANESTH HERNIA DIAPHRAGM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400093,770,PC ANESTH BLOOD VESSEL REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400094,790,PC ANESTH SURG UPPER ABDOMEN,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400095,792,PC ANESTH HEMORR/EXCISE LIVER,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400096,794,PC ANESTH PANCREAS REMOVAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400097,796,PC ANESTH FOR LIVER TRANSPLANT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400098,797,PC ANESTH SURGERY FOR OBESITY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400099,800,PC ANESTH LOWER ANT ABD WALL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400100,802,PC ANESTH FAT LAYER REMOVAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400102,820,PC ANESTH LOWER POST ABD WALL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400103,830,PC ANESTH HERNIA LOWER ABD,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400104,832,PC ANESTH HERNIA VENTRAL/INCISION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400105,834,PC ANESTH HERNIA REPAIR < 1 YR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400106,836,PC ANESTH HERNIA REPAIR PREEMIE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400107,840,PC ANESTH SURG LOWER ABDOMEN,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400108,842,PC ANESTH AMNIOCENTESIS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400109,844,PC ANESTH ABDOMINOPERINEAL RESECT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400110,846,PC ANESTH HYSTERECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400111,848,PC ANESTH PELVIC ORGAN SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400112,851,PC ANESTH TUBAL LIGATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400113,860,PC ANESTH SURGERY OF ABDOMEN,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400114,862,PC ANESTH KIDNEY/URETER SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400115,864,PC ANESTH REMOVAL OF BLADDER,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400116,865,PC ANESTH RADICAL PROSTATECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400117,866,PC ANESTH REMOVAL OF ADRENAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400118,868,PC ANESTH KIDNEY TRANSPLANT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400119,870,PC ANESTH BLADDER STONE SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400120,872,PC ANESTH ESWL W/WATERBATH,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400121,873,PC ANESTH ESWL W/O WATERBATH,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400122,880,PC ANESTH ABDOMEN VESSEL SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400123,882,PC ANESTH MAJOR VEIN LIGATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400124,902,PC ANESTH ANORECTAL SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400125,904,PC ANESTH PERINEAL SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400126,906,PC ANESTH REMOVAL OF VULVA,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400127,908,PC ANESTH PERINEAL PROSTATECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400128,910,PC ANESTH BLADDER SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400129,912,PC ANESTH BLADDER TUMOR SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400130,914,PC ANESTH TURP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400131,916,PC ANESTH BLEEDING CONTROL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400132,918,PC ANESTH STONE REMOVAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400133,920,PC ANESTH GENITALIA SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400134,921,PC ANESTH VASECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400135,922,PC ANESTH SPERM DUCT SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400136,924,PC ANESTH TESTIS EXPLORATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400137,926,PC ANESTH RADICAL ORCHIECTOMY ING,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400138,928,PC ANESTH RADICAL ORCHIECTOMY ABD,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400139,930,PC ANESTH TESTIS SUSPENSION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400140,932,PC ANESTH AMPUTATION OF PENIS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400141,934,PC ANESTH PENIS ING NODES REMOVAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400142,936,PC ANESTH PENIS ING/ILIAC NODES REMOVAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400143,938,PC ANESTH INSERT PENIS DEVICE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400144,940,PC ANESTH VAGINAL PROCEDURES,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400145,942,PC ANESTH SURG ON VAG/URETHRAL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400146,944,PC ANESTH VAGINAL HYSTERECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400147,948,PC ANESTH REPAIR OF CERVIX,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400148,950,PC ANESTH VAGINAL ENDOSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400149,952,PC ANESTH HYSTEROSCOPE/GRAPH,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400150,1112,PC ANESTH BONE ASPIRATE/BX,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400151,1120,PC ANESTH BONY PELVIS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400152,1130,PC ANESTH BODY CAST PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400153,1140,PC ANESTH AMPUTATION AT PELVIS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400154,1150,PC ANESTH PELVIC TUMOR SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400155,1160,PC ANESTH PELVIS PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400156,1170,PC ANESTH SYMPHYSIS PUBIS OR SI JOINT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400157,1173,PC ANESTH FX REPAIR PELVIS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400160,1200,PC ANESTH HIP JOINT PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400161,1202,PC ANESTH ARTHROSCOPY OF HIP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400162,1210,PC ANESTH HIP JOINT SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400163,1212,PC ANESTH HIP DISARTICULATION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400164,1214,PC ANESTH HIP ARTHROPLASTY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400165,1215,PC ANESTH REVISE HIP REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400166,1220,PC ANESTH PROCEDURE ON FEMUR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400167,1230,PC ANESTH SURGERY OF FEMUR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400168,1232,PC ANESTH AMPUTATION OF FEMUR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400169,1234,PC ANESTH RADICAL FEMUR SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400170,1250,PC ANESTH UPPER LEG SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400171,1260,PC ANESTH UPPER LEG VEINS SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400172,1270,PC ANESTH THIGH ARTERIES SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400173,1272,PC ANESTH FEMORAL ARTERY SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400174,1274,PC ANESTH FEMORAL EMBOLECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400175,1320,"PC ANESTH KNEE (NERVES, MUSCLE)",964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400176,1340,PC ANESTH LOWER FEMUR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400177,1360,PC ANESTH OPEN LOWER FEMUR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400178,1380,PC ANESTH KNEE JOINT PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400179,1382,PC ANESTH DX KNEE ARTHROSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400180,1390,PC ANESTH UPPER TIB/FIB/PATELLA,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400181,1392,PC ANESTH OPEN UPPER TIB/FIB/PATELLA,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400182,1400,PC ANESTH KNEE JOINT SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400183,1402,PC ANESTH KNEE ARTHROPLASTY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400184,1404,PC ANESTH AMPUTATION AT KNEE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400185,1420,PC ANESTH KNEE JOINT CASTING,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400186,1430,PC ANESTH KNEE VEINS SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400187,1432,PC ANESTH KNEE VESSEL SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400188,1440,PC ANESTH KNEE ARTERIES SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400189,1442,PC ANESTH KNEE ARTERY SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400190,1444,PC ANESTH KNEE ARTERY REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400191,1462,PC ANESTH LOWER LEG PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400192,1464,PC ANESTH ANKLE/FT ARTHROSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400193,1470,"PC ANESTH LOWER LEG (NERVES, MUSCLE)",964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400194,1472,PC ANESTH ACHILLES TENDON SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400195,1474,PC ANESTH GASTROCNEMIUS RECESSION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400196,1480,PC ANESTH LOWER LEG BONE SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400197,1482,PC ANESTH RADICAL LEG SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400198,1484,PC ANESTH LOWER LEG REVISION,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400199,1486,PC ANESTH ANKLE REPLACEMENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400200,1490,PC ANESTH LOWER LEG CASTING,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400201,1500,PC ANESTH LEG ARTERIES SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400202,1502,PC ANESTH LWR LEG EMBOLECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400203,1520,PC ANESTH LOWER LEG VEIN SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400204,1522,PC ANESTH VENOUS THROMBECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400205,1610,"PC ANESTH SHOULDER (NERVES, MUSCLE)",964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400206,1620,PC ANESTH SHOULDER PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400207,1622,PC ANES DX SHOULDER ARTHROSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400208,1630,PC ANESTH SURGERY OF SHOULDER,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400209,1634,PC ANESTH SHOULDER JOINT AMPUT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400210,1636,PC ANESTH FOREQUARTER AMPUT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400211,1638,PC ANESTH SHOULDER REPLACEMENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400212,1650,PC ANESTH SHOULDER ARTERY SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400213,1652,PC ANESTH AXIL/BRACH ANEURYSM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400214,1654,PC ANESTH SHOULDER BYPASS GRAFT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400215,1656,PC ANESTH ARM-LEG VESSEL SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400216,1670,PC ANESTH SHOULDER VEIN SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400217,1680,PC ANESTH SHOULDER CASTING,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400219,1710,PC ANESTH ELBOW AREA SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400220,1712,PC ANESTH TENOTOMY UPPR ARM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400221,1714,PC ANESTH TENOPLASTY UPPR ARM,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400222,1716,PC ANESTH BICEPS TENDON REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400223,1730,PC ANESTH UPPR ARM PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400224,1732,PC ANESTH DX ELBOW ARTHROSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400225,1740,PC ANESTH UPPER ARM SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400226,1742,PC ANESTH HUMERUS SURGERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400227,1744,PC ANESTH HUMERUS REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400228,1756,PC ANESTH RADICAL HUMERUS SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400229,1758,PC ANESTH HUMERAL LESION SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400230,1760,PC ANESTH ELBOW REPLACEMENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400231,1770,PC ANESTH UPPR ARM ARTERY SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400232,1772,PC ANESTH UPPR ARM EMBOLECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400233,1780,PC ANESTH UPPER ARM VEIN SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400234,1782,PC ANESTH UPPR ARM VEIN REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400235,1810,"PC ANESTH LOWER ARM (NERVES, MUSCLES)",964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400236,1820,PC ANESTH LOWER ARM PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400237,1829,PC ANESTH DX WRIST ARTHROSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400238,1830,"PC ANESTH LOWER ARM (ARTHRO, ENDO)",964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400239,1832,PC ANESTH WRIST REPLACEMENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400240,1840,PC ANESTH LWR ARM ARTERY SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400241,1842,PC ANESTH LWR ARM EMBOLECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400242,1844,PC ANESTH VASCULAR SHUNT SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400243,1850,PC ANESTH LOWER ARM VEIN SURG,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400244,1852,PC ANESTH LWR ARM VEIN REPAIR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400245,1860,PC ANESTH LOWER ARM CASTING,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400246,1916,PC ANESTH DX ARTERIOGRAPHY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400247,1920,PC ANESTH CATHETERIZE HEART,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400248,1922,PC ANESTH CAT OR MRI SCAN,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400249,1924,PC ANES THER INTERVEN RAD ART,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400250,1925,PC ANES THER INTERVEN RAD CAR,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400251,1926,PC ANES TX INTERV RAD HRT/CRAN,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400252,1930,PC ANES THER INTERVEN RAD VEI,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400253,1931,PC ANES THER INTERVEN RAD TIP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400254,1932,PC ANES TX INTERV RAD TH VEIN,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400255,1933,PC ANES TX INTERV RAD CRAN V,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400256,1935,PC ANESTH PERC IMG DX SP PROC,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400257,1936,PC ANESTH PERC IMG TX SP PROC,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400258,1951,PC ANESTH BURN LESS 4 PERCENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400259,1952,PC ANESTH BURN 4-9 PERCENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400260,1953,PC ANESTH BURN EACH 9 PERCENT,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400261,1958,PC ANESTH ANTEPARTUM MANIPUL,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400262,1960,PC ANESTH VAGINAL DELIVERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400263,1961,PC ANESTH CS DELIVERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400264,1962,PC ANESTH EMER HYSTERECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400265,1963,PC ANESTH CS HYSTERECTOMY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400266,1965,PC ANESTH INC/MISSED AB PROC,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400267,1966,PC ANESTH INDUCED AB PROCEDURE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400268,1967,PC ANESTH/ANALG VAG DELIVERY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400269,1968,PC ANES/ANALG CS DELIVER ADD-ON,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400270,1969,PC ANESTH/ANALG CS HYST ADD-ON,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400271,1991,PC ANESTH NERVE BLOCK/INJ,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400272,1992,PC ANESTH N BLOCK/INJ PRONE,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400278,99135,HC ANES-CONTROLLED HYPOTENSION,964,1 ,$160.00 ,$80.00 ,$35.55 ,$160.00 ,$42.16 ,$135.34 ,$135.34 , N/A ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$42.16 ,$152.00 ,$144.00 ,$136.00 ,$136.00 , N/A ,$136.00 ,$136.00 ,$144.00 ,$42.16 ,$67.20 ,$144.00 , N/A ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$44.69 , N/A , N/A , N/A , N/A , N/A ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400279,99140,HC ANES-EMERGENY CONDITION,964,1 ,$160.00 ,$80.00 ,$35.55 ,$160.00 ,$42.16 ,$135.34 ,$135.34 , N/A ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$42.16 ,$152.00 ,$144.00 ,$136.00 ,$136.00 , N/A ,$136.00 ,$136.00 ,$144.00 ,$42.16 ,$67.20 ,$144.00 , N/A ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 ,$44.69 , N/A , N/A , N/A , N/A , N/A ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400280,1990,PC ANESTH ORGAN HARVEST,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400281,36405,PC VENIPUNCTURE SCALP <3 YRS,963,1 ,$60.00 ,$30.00 ,$4.12 ,$60.00 ,$4.12 ,$50.75 ,$50.75 ,$16.26 ,$48.00 ,$51.00 ,$37.50 ,$54.00 ,$4.12 ,$57.00 ,$54.00 ,$51.00 ,$51.00 ,$16.26 ,$51.00 ,$51.00 ,$54.00 ,$4.12 ,$25.20 ,$54.00 , N/A ,$55.20 ,$54.00 ,$39.98 ,$39.98 ,$36.54 ,$39.98 ,$39.00 ,$41.79 ,$13.33 ,$47.40 ,$4.37 , N/A , N/A ,$16.26 , N/A , N/A ,$57.00 ,$49.20 ,$49.20 ,$48.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400285,1996,PC ANESTH EPID/SUBAR DRUG ADMIN DAILY MGMT-QZ,964,1 ,$160.00 ,$80.00 ,$35.55 ,$160.00 , N/A ,$135.34 ,$135.34 , N/A ,$128.00 ,$136.00 ,$100.00 ,$144.00 , N/A ,$152.00 ,$144.00 ,$136.00 ,$136.00 , N/A ,$136.00 ,$136.00 ,$144.00 , N/A ,$67.20 ,$144.00 , N/A ,$147.20 ,$144.00 ,$106.62 ,$106.62 ,$97.44 ,$106.62 ,$104.00 ,$111.44 ,$35.55 ,$126.40 , N/A , N/A , N/A , N/A , N/A , N/A ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400392,64486,PC ANESTH TAP BLOCK W/INJ UNILT,964,1 ,$640.00 ,$320.00 ,$59.62 ,$813.40 ,$767.36 ,$541.38 ,$541.38 ,$59.62 ,$512.00 ,$544.00 ,$400.00 ,$576.00 ,$767.36 ,$608.00 ,$576.00 ,$544.00 ,$544.00 ,$59.62 ,$544.00 ,$544.00 ,$576.00 ,$767.36 ,$268.80 ,$576.00 , N/A ,$588.80 ,$576.00 ,$426.50 ,$426.50 ,$389.76 ,$426.50 ,$416.00 ,$445.76 ,$142.21 ,$505.60 ,$813.40 , N/A , N/A ,$59.62 , N/A , N/A ,$608.00 ,$524.80 ,$524.80 ,$512.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400393,64415,PC ANESTH INJ NERVE BRACHIAL PLEXUS SINGLE,964,1 ,$660.00 ,$330.00 ,$67.46 ,"$2,167.48 ","$2,044.79 ",$558.29 ,$558.29 ,$67.46 ,$528.00 ,$561.00 ,$412.50 ,$594.00 ,"$2,044.79 ",$627.00 ,$594.00 ,$561.00 ,$561.00 ,$67.46 ,$561.00 ,$561.00 ,$594.00 ,"$2,044.79 ",$277.20 ,$594.00 ,"$1,891.64 ",$607.20 ,$594.00 ,$439.82 ,$439.82 ,$401.94 ,$439.82 ,$429.00 ,$459.69 ,$146.65 ,$521.40 ,"$2,167.48 ", N/A , N/A ,$67.46 , N/A ,$840.73 ,$627.00 ,$541.20 ,$541.20 ,$528.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400394,62320,PC INJ INTRLAMNR CERV/THOR W/O GUIDE,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,598.31 ","$1,507.84 ",$215.70 ,$215.70 ,$105.01 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,507.84 ",$242.25 ,$229.50 ,$216.75 ,$216.75 ,$105.01 ,$216.75 ,$216.75 ,$229.50 ,"$1,507.84 ",$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,"$1,598.31 ", N/A , N/A ,$105.01 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400395,62321,PC INJ INTRLAMNR CERV/THOR W/GUIDE,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,598.31 ","$1,507.84 ",$215.70 ,$215.70 ,$114.02 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,507.84 ",$242.25 ,$229.50 ,$216.75 ,$216.75 ,$114.02 ,$216.75 ,$216.75 ,$229.50 ,"$1,507.84 ",$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,"$1,598.31 ", N/A , N/A ,$114.02 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400396,62322,PC INJ INTRLAMNR LUM/SAC W/O GUIDE,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,598.31 ","$1,507.84 ",$215.70 ,$215.70 ,$85.62 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,507.84 ",$242.25 ,$229.50 ,$216.75 ,$216.75 ,$85.62 ,$216.75 ,$216.75 ,$229.50 ,"$1,507.84 ",$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,"$1,598.31 ", N/A , N/A ,$85.62 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400397,62323,PC INJ INTRLAMNR LUM/SAC W/GUIDE,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,598.31 ","$1,507.84 ",$215.70 ,$215.70 ,$105.54 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,507.84 ",$242.25 ,$229.50 ,$216.75 ,$216.75 ,$105.54 ,$216.75 ,$216.75 ,$229.50 ,"$1,507.84 ",$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,"$1,598.31 ", N/A , N/A ,$105.54 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400398,64425,PC INJ ANESTH ILIOINGUINAL NERVE,964,1 ,$410.00 ,$205.00 ,$58.53 ,"$1,459.17 ",$767.36 ,$346.82 ,$346.82 ,$58.53 ,$328.00 ,$348.50 ,$256.25 ,$369.00 ,$767.36 ,$389.50 ,$369.00 ,$348.50 ,$348.50 ,$58.53 ,$348.50 ,$348.50 ,$369.00 ,$767.36 ,$172.20 ,$369.00 ,"$1,459.17 ",$377.20 ,$369.00 ,$273.22 ,$273.22 ,$249.69 ,$273.22 ,$266.50 ,$285.57 ,$91.10 ,$323.90 ,$813.40 , N/A , N/A ,$58.53 , N/A ,$648.52 ,$389.50 ,$336.20 ,$336.20 ,$328.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400399,64450,PC INJ ANES OTHER THAN PERIPHERAL,964,1 ,$255.00 ,$127.50 ,$44.71 ,"$1,459.17 ",$767.36 ,$215.70 ,$215.70 ,$44.71 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$767.36 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$44.71 ,$216.75 ,$216.75 ,$229.50 ,$767.36 ,$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,$813.40 , N/A , N/A ,$44.71 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400400,64418,PC NERVE BLOCK SUPRACAPULAR,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,459.17 ",$767.36 ,$215.70 ,$215.70 ,$59.71 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$767.36 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$59.71 ,$216.75 ,$216.75 ,$229.50 ,$767.36 ,$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,$813.40 , N/A , N/A ,$59.71 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400401,64417,PC NERVE BLOCK AXILLARY NERVE,964,1 ,$410.00 ,$205.00 ,$65.09 ,"$2,167.48 ","$2,044.79 ",$346.82 ,$346.82 ,$65.09 ,$328.00 ,$348.50 ,$256.25 ,$369.00 ,"$2,044.79 ",$389.50 ,$369.00 ,$348.50 ,$348.50 ,$65.09 ,$348.50 ,$348.50 ,$369.00 ,"$2,044.79 ",$172.20 ,$369.00 ,"$1,891.64 ",$377.20 ,$369.00 ,$273.22 ,$273.22 ,$249.69 ,$273.22 ,$266.50 ,$285.57 ,$91.10 ,$323.90 ,"$2,167.48 ", N/A , N/A ,$65.09 , N/A ,$840.73 ,$389.50 ,$336.20 ,$336.20 ,$328.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400402,64488,PC INJ TAP BLOCK W/GUIDE- BIL,964,1 ,$215.00 ,$107.50 ,$47.77 ,$813.40 ,$767.36 ,$181.87 ,$181.87 ,$73.98 ,$172.00 ,$182.75 ,$134.38 ,$193.50 ,$767.36 ,$204.25 ,$193.50 ,$182.75 ,$182.75 ,$73.98 ,$182.75 ,$182.75 ,$193.50 ,$767.36 ,$90.30 ,$193.50 , N/A ,$197.80 ,$193.50 ,$143.28 ,$143.28 ,$130.94 ,$143.28 ,$139.75 ,$149.75 ,$47.77 ,$169.85 ,$813.40 , N/A , N/A ,$73.98 , N/A , N/A ,$204.25 ,$176.30 ,$176.30 ,$172.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400405,62326,PC INJ W/CATH PLACE LUMBAR/SACRAL W/O GUIDANCE,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,891.64 ","$1,507.84 ",$215.70 ,$215.70 ,$91.75 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,507.84 ",$242.25 ,$229.50 ,$216.75 ,$216.75 ,$91.75 ,$216.75 ,$216.75 ,$229.50 ,"$1,507.84 ",$107.10 ,$229.50 ,"$1,891.64 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,"$1,598.31 ", N/A , N/A ,$91.75 , N/A ,$840.73 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400406,62324,PC INJ W/CATH CERV/THOR W/O GUIDE,964,1 ,$255.00 ,$127.50 ,$56.66 ,"$1,891.64 ","$1,507.84 ",$215.70 ,$215.70 ,$95.65 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,507.84 ",$242.25 ,$229.50 ,$216.75 ,$216.75 ,$95.65 ,$216.75 ,$216.75 ,$229.50 ,"$1,507.84 ",$107.10 ,$229.50 ,"$1,891.64 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$56.66 ,$201.45 ,"$1,598.31 ", N/A , N/A ,$95.65 , N/A ,$840.73 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400407,64445,PC NERVE BLOCK SCIATIC SINGLE,964,1 ,$555.00 ,$277.50 ,$57.06 ,"$1,459.17 ",$767.36 ,$469.47 ,$469.47 ,$57.06 ,$444.00 ,$471.75 ,$346.88 ,$499.50 ,$767.36 ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$57.06 ,$471.75 ,$471.75 ,$499.50 ,$767.36 ,$233.10 ,$499.50 ,"$1,459.17 ",$510.60 ,$499.50 ,$369.85 ,$369.85 ,$338.00 ,$369.85 ,$360.75 ,$386.56 ,$123.32 ,$438.45 ,$813.40 , N/A , N/A ,$57.06 , N/A ,$648.52 ,$527.25 ,$455.10 ,$455.10 ,$444.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400478,731,PC ANESTH UPPER GI ENDO PROC NOS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400479,732,PC ANESTH UPPER GI ERCP,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400480,811,PC ANESTH LOWER ENDO PROCS NOS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400481,812,PC ANESTH SCREENING COLONOSCOPY,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400482,813,PC ANESTH UPPER/LOWER GI ENDO PROCS,964,1 ,$10.90 ,$5.45 ,$2.42 ,$10.90 , N/A ,$9.22 ,$9.22 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 , N/A ,$4.58 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.26 ,$7.26 ,$6.64 ,$7.26 ,$7.09 ,$7.59 ,$2.42 ,$8.61 , N/A , N/A , N/A , N/A , N/A , N/A ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400632,64416,PC ANESTH INTRASCALENE BLOCK CONTINUOUS,964,1 ,$660.00 ,$330.00 ,$68.49 ,"$2,167.48 ","$2,044.79 ",$558.29 ,$558.29 ,$68.49 ,$528.00 ,$561.00 ,$412.50 ,$594.00 ,"$2,044.79 ",$627.00 ,$594.00 ,$561.00 ,$561.00 ,$68.49 ,$561.00 ,$561.00 ,$594.00 ,"$2,044.79 ",$277.20 ,$594.00 ,"$1,891.64 ",$607.20 ,$594.00 ,$439.82 ,$439.82 ,$401.94 ,$439.82 ,$429.00 ,$459.69 ,$146.65 ,$521.40 ,"$2,167.48 ", N/A , N/A ,$68.49 , N/A ,$840.73 ,$627.00 ,$541.20 ,$541.20 ,$528.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400633,64461,PC PARAVERTEBRAL PARASPINE BLOCK THORACIC SINGLE,964,1 ,$450.00 ,$225.00 ,$83.65 ,"$1,598.31 ","$1,507.84 ",$380.66 ,$380.66 ,$83.65 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,"$1,507.84 ",$427.50 ,$405.00 ,$382.50 ,$382.50 ,$83.65 ,$382.50 ,$382.50 ,$405.00 ,"$1,507.84 ",$189.00 ,$405.00 ,"$1,459.17 ",$414.00 ,$405.00 ,$299.88 ,$299.88 ,$274.05 ,$299.88 ,$292.50 ,$313.43 ,$99.99 ,$355.50 ,"$1,598.31 ", N/A , N/A ,$83.65 , N/A ,$648.52 ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400634,64462,PC PARAVERTEBRAL PARASPINE BLOCK THORACIC 2ND AND ADDN ADD ON,964,1 ,$300.00 ,$150.00 ,$52.43 ,"$1,598.31 ","$1,507.84 ",$253.77 ,$253.77 ,$52.43 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,"$1,507.84 ",$285.00 ,$270.00 ,$255.00 ,$255.00 ,$52.43 ,$255.00 ,$255.00 ,$270.00 ,"$1,507.84 ",$126.00 ,$270.00 , N/A ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$66.66 ,$237.00 ,"$1,598.31 ", N/A , N/A ,$52.43 , N/A , N/A ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400635,64463,PC PARAVERTEBRAL PARASPINE BLOCK THORACIC CATH CONTINUOUS,964,1 ,$450.00 ,$225.00 ,$88.37 ,"$1,598.31 ","$1,507.84 ",$380.66 ,$380.66 ,$88.37 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,"$1,507.84 ",$427.50 ,$405.00 ,$382.50 ,$382.50 ,$88.37 ,$382.50 ,$382.50 ,$405.00 ,"$1,507.84 ",$189.00 ,$405.00 ,"$1,459.17 ",$414.00 ,$405.00 ,$299.88 ,$299.88 ,$274.05 ,$299.88 ,$292.50 ,$313.43 ,$99.99 ,$355.50 ,"$1,598.31 ", N/A , N/A ,$88.37 , N/A ,$648.52 ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400638,64448,PC FEMORAL NERVE BLOCK CONTINUOUS,964,1 ,$210.00 ,$105.00 ,$46.66 ,"$2,167.48 ","$2,044.79 ",$177.64 ,$177.64 ,$65.04 ,$168.00 ,$178.50 ,$131.25 ,$189.00 ,"$2,044.79 ",$199.50 ,$189.00 ,$178.50 ,$178.50 ,$65.04 ,$178.50 ,$178.50 ,$189.00 ,"$2,044.79 ",$88.20 ,$189.00 ,"$1,891.64 ",$193.20 ,$189.00 ,$139.94 ,$139.94 ,$127.89 ,$139.94 ,$136.50 ,$146.27 ,$46.66 ,$165.90 ,"$2,167.48 ", N/A , N/A ,$65.04 , N/A ,$840.73 ,$199.50 ,$172.20 ,$172.20 ,$168.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400639,64449,PC NERVE BLOCK INJ LUMBAR PLEXUS CONTINUOUS,964,1 ,$245.00 ,$122.50 ,$54.44 ,"$2,167.48 ","$2,044.79 ",$207.25 ,$207.25 ,$65.82 ,$196.00 ,$208.25 ,$153.13 ,$220.50 ,"$2,044.79 ",$232.75 ,$220.50 ,$208.25 ,$208.25 ,$65.82 ,$208.25 ,$208.25 ,$220.50 ,"$2,044.79 ",$102.90 ,$220.50 ,"$1,891.64 ",$225.40 ,$220.50 ,$163.27 ,$163.27 ,$149.21 ,$163.27 ,$159.25 ,$170.64 ,$54.44 ,$193.55 ,"$2,167.48 ", N/A , N/A ,$65.82 , N/A ,$840.73 ,$232.75 ,$200.90 ,$200.90 ,$196.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400651,64489,PC TAP BLOCK BIL BY INFUSION,964,1 ,$237.54 ,$118.77 ,$52.78 ,$813.40 ,$767.36 ,$200.94 ,$200.94 ,$83.06 ,$190.03 ,$201.91 ,$148.46 ,$213.79 ,$767.36 ,$225.66 ,$213.79 ,$201.91 ,$201.91 ,$83.06 ,$201.91 ,$201.91 ,$213.79 ,$767.36 ,$99.77 ,$213.79 , N/A ,$218.54 ,$213.79 ,$158.30 ,$158.30 ,$144.66 ,$158.30 ,$154.40 ,$165.45 ,$52.78 ,$187.66 ,$813.40 , N/A , N/A ,$83.06 , N/A , N/A ,$225.66 ,$194.78 ,$194.78 ,$190.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400652,64446,PC NERVE BLOCK SCIATIC CONTINUOUS INFUSION,964,1 ,$170.00 ,$85.00 ,$37.77 ,"$2,167.48 ","$2,044.79 ",$143.80 ,$143.80 ,$63.10 ,$136.00 ,$144.50 ,$106.25 ,$153.00 ,"$2,044.79 ",$161.50 ,$153.00 ,$144.50 ,$144.50 ,$63.10 ,$144.50 ,$144.50 ,$153.00 ,"$2,044.79 ",$71.40 ,$153.00 ,"$1,891.64 ",$156.40 ,$153.00 ,$113.29 ,$113.29 ,$103.53 ,$113.29 ,$110.50 ,$118.41 ,$37.77 ,$134.30 ,"$2,167.48 ", N/A , N/A ,$63.10 , N/A ,$840.73 ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),97500072,49321,HC LAPAROSCOPY BIOPSY,975,1 ,"$2,297.00 ","$1,148.50 ",$356.79 ,"$11,627.30 ","$6,564.90 ","$1,943.03 ","$1,943.03 ",$356.79 ,"$1,837.60 ","$1,952.45 ","$1,435.63 ","$2,067.30 ","$6,564.90 ","$2,182.15 ","$2,067.30 ","$1,952.45 ","$1,952.45 ",$356.79 ,"$1,952.45 ","$1,952.45 ","$2,067.30 ","$6,564.90 ",$964.74 ,"$2,067.30 ","$11,627.30 ","$2,113.24 ","$2,067.30 ","$1,530.72 ","$1,530.72 ","$1,398.87 ","$1,530.72 ","$1,493.05 ","$1,599.86 ",$510.39 ,"$1,814.63 ","$6,958.79 ", N/A , N/A ,$356.79 , N/A ,"$5,167.69 ","$2,182.15 ","$1,883.54 ","$1,883.54 ","$1,837.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),97520072,20206,HC CT GUIDED MUSCLE BX-PRV 72HR,975,1 ,$741.00 ,$370.50 ,$60.95 ,"$3,233.23 ","$1,113.15 ",$626.81 ,$626.81 ,$60.95 ,$592.80 ,$629.85 ,$463.13 ,$666.90 ,"$1,113.15 ",$703.95 ,$666.90 ,$629.85 ,$629.85 ,$60.95 ,$629.85 ,$629.85 ,$666.90 ,"$1,113.15 ",$311.22 ,$666.90 ,"$3,233.23 ",$681.72 ,$666.90 ,$493.80 ,$493.80 ,$451.27 ,$493.80 ,$481.65 ,$516.11 ,$164.65 ,$585.39 ,"$1,179.94 ", N/A , N/A ,$60.95 , N/A ,"$1,436.99 ",$703.95 ,$607.62 ,$607.62 ,$592.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),97521072,10021,PC ASP FINE NDL W/O IMAGING GUIDE PRO,975,1 ,$613.00 ,$306.50 ,$57.72 ,"$1,179.94 ","$1,113.15 ",$518.54 ,$518.54 ,$57.72 ,$490.40 ,$521.05 ,$383.13 ,$551.70 ,"$1,113.15 ",$582.35 ,$551.70 ,$521.05 ,$521.05 ,$57.72 ,$521.05 ,$521.05 ,$551.70 ,"$1,113.15 ",$257.46 ,$551.70 ,$794.25 ,$563.96 ,$551.70 ,$408.50 ,$408.50 ,$373.32 ,$408.50 ,$398.45 ,$426.95 ,$136.21 ,$484.27 ,"$1,179.94 ", N/A , N/A ,$57.72 , N/A ,$353.00 ,$582.35 ,$502.66 ,$502.66 ,$490.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180002,10060,PC DRAIN SKIN ABSCESS SIMPLE,981,1 ,$354.00 ,$177.00 ,$112.19 ,$412.65 ,$288.25 ,$299.45 ,$299.45 ,$112.19 ,$283.20 ,$300.90 ,$221.25 ,$318.60 ,$288.25 ,$336.30 ,$318.60 ,$300.90 ,$300.90 ,$112.19 ,$300.90 ,$300.90 ,$318.60 ,$288.25 ,$148.68 ,$318.60 ,$412.65 ,$325.68 ,$318.60 ,$235.91 ,$235.91 ,$215.59 ,$235.91 ,$230.10 ,$246.56 ,$113.31 ,$279.66 ,$305.55 , N/A , N/A ,$112.19 , N/A ,$183.40 ,$336.30 ,$290.28 ,$290.28 ,$283.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180003,10061,PC DRAIN SKIN ABSCESS COMPLIC,981,1 ,$546.00 ,$273.00 ,$194.66 ,$794.25 ,$288.25 ,$461.86 ,$461.86 ,$194.66 ,$436.80 ,$464.10 ,$341.25 ,$491.40 ,$288.25 ,$518.70 ,$491.40 ,$464.10 ,$464.10 ,$194.66 ,$464.10 ,$464.10 ,$491.40 ,$288.25 ,$229.32 ,$491.40 ,$794.25 ,$502.32 ,$491.40 ,$363.85 ,$363.85 ,$332.51 ,$363.85 ,$354.90 ,$380.29 ,$196.61 ,$431.34 ,$305.55 , N/A , N/A ,$194.66 , N/A ,$353.00 ,$518.70 ,$447.72 ,$447.72 ,$436.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180004,10080,PC DRAIN PILONIDAL CYST SIMPL,981,1 ,$503.00 ,$251.50 ,$110.56 ,"$1,429.97 ",$288.25 ,$425.49 ,$425.49 ,$110.56 ,$402.40 ,$427.55 ,$314.38 ,$452.70 ,$288.25 ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$110.56 ,$427.55 ,$427.55 ,$452.70 ,$288.25 ,$211.26 ,$452.70 ,"$1,429.97 ",$462.76 ,$452.70 ,$335.20 ,$335.20 ,$306.33 ,$335.20 ,$326.95 ,$350.34 ,$111.67 ,$397.37 ,$305.55 , N/A , N/A ,$110.56 , N/A ,$635.54 ,$477.85 ,$412.46 ,$412.46 ,$402.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180005,10081,PC DRAIN PILONIDAL CYST COMPLIC,981,1 ,$503.00 ,$251.50 ,$179.74 ,"$2,051.46 ","$1,935.34 ",$425.49 ,$425.49 ,$179.74 ,$402.40 ,$427.55 ,$314.38 ,$452.70 ,"$1,935.34 ",$477.85 ,$452.70 ,$427.55 ,$427.55 ,$179.74 ,$427.55 ,$427.55 ,$452.70 ,"$1,935.34 ",$211.26 ,$452.70 ,"$1,429.97 ",$462.76 ,$452.70 ,$335.20 ,$335.20 ,$306.33 ,$335.20 ,$326.95 ,$350.34 ,$181.54 ,$397.37 ,"$2,051.46 ", N/A , N/A ,$179.74 , N/A ,$635.54 ,$477.85 ,$412.46 ,$412.46 ,$402.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180006,10120,PC REMOVE FOREIGN BODY SIMPLE,981,1 ,$423.00 ,$211.50 ,$110.73 ,$794.25 ,$288.25 ,$357.82 ,$357.82 ,$110.73 ,$338.40 ,$359.55 ,$264.38 ,$380.70 ,$288.25 ,$401.85 ,$380.70 ,$359.55 ,$359.55 ,$110.73 ,$359.55 ,$359.55 ,$380.70 ,$288.25 ,$177.66 ,$380.70 ,$794.25 ,$389.16 ,$380.70 ,$281.89 ,$281.89 ,$257.61 ,$281.89 ,$274.95 ,$294.62 ,$111.84 ,$334.17 ,$305.55 , N/A , N/A ,$110.73 , N/A ,$353.00 ,$401.85 ,$346.86 ,$346.86 ,$338.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180007,10121,PC REMOVE FOREIGN BODY COMPLIC,981,1 ,$768.00 ,$384.00 ,$193.92 ,"$3,233.23 ","$2,025.40 ",$649.65 ,$649.65 ,$193.92 ,$614.40 ,$652.80 ,$480.00 ,$691.20 ,"$2,025.40 ",$729.60 ,$691.20 ,$652.80 ,$652.80 ,$193.92 ,$652.80 ,$652.80 ,$691.20 ,"$2,025.40 ",$322.56 ,$691.20 ,"$3,233.23 ",$706.56 ,$691.20 ,$511.80 ,$511.80 ,$467.71 ,$511.80 ,$499.20 ,$534.91 ,$195.86 ,$606.72 ,"$2,146.92 ", N/A , N/A ,$193.92 , N/A ,"$1,436.99 ",$729.60 ,$629.76 ,$629.76 ,$614.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180008,10140,PC DRAINAGE OF HEMATOMA/FLUID,981,1 ,$530.00 ,$265.00 ,$124.99 ,"$3,233.23 ","$1,935.34 ",$448.33 ,$448.33 ,$124.99 ,$424.00 ,$450.50 ,$331.25 ,$477.00 ,"$1,935.34 ",$503.50 ,$477.00 ,$450.50 ,$450.50 ,$124.99 ,$450.50 ,$450.50 ,$477.00 ,"$1,935.34 ",$222.60 ,$477.00 ,"$3,233.23 ",$487.60 ,$477.00 ,$353.19 ,$353.19 ,$322.77 ,$353.19 ,$344.50 ,$369.15 ,$126.24 ,$418.70 ,"$2,051.46 ", N/A , N/A ,$124.99 , N/A ,"$1,436.99 ",$503.50 ,$434.60 ,$434.60 ,$424.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180009,10160,PC PUNCTURE DRAINAGE OF LESION,981,1 ,$371.00 ,$185.50 ,$101.17 ,$794.25 ,$288.25 ,$313.83 ,$313.83 ,$101.17 ,$296.80 ,$315.35 ,$231.88 ,$333.90 ,$288.25 ,$352.45 ,$333.90 ,$315.35 ,$315.35 ,$101.17 ,$315.35 ,$315.35 ,$333.90 ,$288.25 ,$155.82 ,$333.90 ,$794.25 ,$341.32 ,$333.90 ,$247.23 ,$247.23 ,$225.94 ,$247.23 ,$241.15 ,$258.40 ,$102.18 ,$293.09 ,$305.55 , N/A , N/A ,$101.17 , N/A ,$353.00 ,$352.45 ,$304.22 ,$304.22 ,$296.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180021,11042,PC CLEANSING OF SKIN/TISSUE,981,1 ,$435.00 ,$217.50 ,$63.53 ,$794.25 ,$662.74 ,$367.97 ,$367.97 ,$63.53 ,$348.00 ,$369.75 ,$271.88 ,$391.50 ,$662.74 ,$413.25 ,$391.50 ,$369.75 ,$369.75 ,$63.53 ,$369.75 ,$369.75 ,$391.50 ,$662.74 ,$182.70 ,$391.50 ,$794.25 ,$400.20 ,$391.50 ,$289.88 ,$289.88 ,$264.92 ,$289.88 ,$282.75 ,$302.98 ,$64.17 ,$343.65 ,$702.50 , N/A , N/A ,$63.53 , N/A ,$353.00 ,$413.25 ,$356.70 ,$356.70 ,$348.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180028,11740,PC DRAIN BLOOD FROM UNDER NAIL,981,1 ,$192.00 ,$96.00 ,$33.42 ,$259.11 ,$115.63 ,$162.41 ,$162.41 ,$33.42 ,$153.60 ,$163.20 ,$120.00 ,$172.80 ,$115.63 ,$182.40 ,$172.80 ,$163.20 ,$163.20 ,$33.42 ,$163.20 ,$163.20 ,$172.80 ,$115.63 ,$80.64 ,$172.80 ,$259.11 ,$176.64 ,$172.80 ,$127.95 ,$127.95 ,$116.93 ,$127.95 ,$124.80 ,$133.73 ,$33.75 ,$151.68 ,$122.57 , N/A , N/A ,$33.42 , N/A ,$115.16 ,$182.40 ,$157.44 ,$157.44 ,$153.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180029,11750,PC REMOVAL OF NAIL BED,981,1 ,$953.00 ,$476.50 ,$108.99 ,$953.00 ,$785.45 ,$806.14 ,$806.14 ,$108.99 ,$762.40 ,$810.05 ,$595.63 ,$857.70 ,$785.45 ,$905.35 ,$857.70 ,$810.05 ,$810.05 ,$108.99 ,$810.05 ,$810.05 ,$857.70 ,$785.45 ,$400.26 ,$857.70 ,$794.25 ,$876.76 ,$857.70 ,$635.08 ,$635.08 ,$580.38 ,$635.08 ,$619.45 ,$663.76 ,$110.08 ,$752.87 ,$832.58 , N/A , N/A ,$108.99 , N/A ,$353.00 ,$905.35 ,$781.46 ,$781.46 ,$762.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180031,11765,PC EXC WEDGE SKIN NAIL FOLD,981,1 ,$280.00 ,$140.00 ,$98.45 ,$794.25 ,$115.63 ,$236.85 ,$236.85 ,$98.45 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$115.63 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$98.45 ,$238.00 ,$238.00 ,$252.00 ,$115.63 ,$117.60 ,$252.00 ,$794.25 ,$257.60 ,$252.00 ,$186.59 ,$186.59 ,$170.52 ,$186.59 ,$182.00 ,$195.02 ,$99.43 ,$221.20 ,$122.57 , N/A , N/A ,$98.45 , N/A ,$353.00 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180032,12001,PC REPR SUPERF WND BODY <2.5CM,981,1 ,$476.00 ,$238.00 ,$46.19 ,$476.00 ,$329.51 ,$402.65 ,$402.65 ,$46.19 ,$380.80 ,$404.60 ,$297.50 ,$428.40 ,$329.51 ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$46.19 ,$404.60 ,$404.60 ,$428.40 ,$329.51 ,$199.92 ,$428.40 ,$412.65 ,$437.92 ,$428.40 ,$317.21 ,$317.21 ,$289.88 ,$317.21 ,$309.40 ,$331.53 ,$46.65 ,$376.04 ,$349.28 , N/A , N/A ,$46.19 , N/A ,$183.40 ,$452.20 ,$390.32 ,$390.32 ,$380.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180033,12002,PC REPR SUP NPTERF WND BODY 2.6-7.5,981,1 ,$488.00 ,$244.00 ,$60.58 ,$488.00 ,$329.51 ,$412.80 ,$412.80 ,$60.58 ,$390.40 ,$414.80 ,$305.00 ,$439.20 ,$329.51 ,$463.60 ,$439.20 ,$414.80 ,$414.80 ,$60.58 ,$414.80 ,$414.80 ,$439.20 ,$329.51 ,$204.96 ,$439.20 ,$412.65 ,$448.96 ,$439.20 ,$325.20 ,$325.20 ,$297.19 ,$325.20 ,$317.20 ,$339.89 ,$61.19 ,$385.52 ,$349.28 , N/A , N/A ,$60.58 , N/A ,$183.40 ,$463.60 ,$400.16 ,$400.16 ,$390.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180034,12004,PC REPR SUPERF WND BODY 7.6-12.5,981,1 ,$508.00 ,$254.00 ,$74.97 ,$508.00 ,$329.51 ,$429.72 ,$429.72 ,$74.97 ,$406.40 ,$431.80 ,$317.50 ,$457.20 ,$329.51 ,$482.60 ,$457.20 ,$431.80 ,$431.80 ,$74.97 ,$431.80 ,$431.80 ,$457.20 ,$329.51 ,$213.36 ,$457.20 ,$412.65 ,$467.36 ,$457.20 ,$338.53 ,$338.53 ,$309.37 ,$338.53 ,$330.20 ,$353.82 ,$75.72 ,$401.32 ,$349.28 , N/A , N/A ,$74.97 , N/A ,$183.40 ,$482.60 ,$416.56 ,$416.56 ,$406.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180035,12005,PC REPR SUPERF WND BODY 12.6-20,981,1 ,$865.00 ,$432.50 ,$97.26 ,$865.00 ,$329.51 ,$731.70 ,$731.70 ,$97.26 ,$692.00 ,$735.25 ,$540.63 ,$778.50 ,$329.51 ,$821.75 ,$778.50 ,$735.25 ,$735.25 ,$97.26 ,$735.25 ,$735.25 ,$778.50 ,$329.51 ,$363.30 ,$778.50 ,$794.25 ,$795.80 ,$778.50 ,$576.44 ,$576.44 ,$526.79 ,$576.44 ,$562.25 ,$602.47 ,$98.23 ,$683.35 ,$349.28 , N/A , N/A ,$97.26 , N/A ,$353.00 ,$821.75 ,$709.30 ,$709.30 ,$692.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180036,12006,PC REPR SUPERF WND BODY 20.1-30,981,1 ,"$1,184.00 ",$592.00 ,$119.57 ,"$1,184.00 ",$329.51 ,"$1,001.55 ","$1,001.55 ",$119.57 ,$947.20 ,"$1,006.40 ",$740.00 ,"$1,065.60 ",$329.51 ,"$1,124.80 ","$1,065.60 ","$1,006.40 ","$1,006.40 ",$119.57 ,"$1,006.40 ","$1,006.40 ","$1,065.60 ",$329.51 ,$497.28 ,"$1,065.60 ",$794.25 ,"$1,089.28 ","$1,065.60 ",$789.02 ,$789.02 ,$721.06 ,$789.02 ,$769.60 ,$824.66 ,$120.77 ,$935.36 ,$349.28 , N/A , N/A ,$119.57 , N/A ,$353.00 ,"$1,124.80 ",$970.88 ,$970.88 ,$947.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180037,12007,PC REPR SUPERF WND BODY >30CM,981,1 ,"$1,337.00 ",$668.50 ,$149.50 ,"$1,337.00 ",$329.51 ,"$1,130.97 ","$1,130.97 ",$149.50 ,"$1,069.60 ","$1,136.45 ",$835.63 ,"$1,203.30 ",$329.51 ,"$1,270.15 ","$1,203.30 ","$1,136.45 ","$1,136.45 ",$149.50 ,"$1,136.45 ","$1,136.45 ","$1,203.30 ",$329.51 ,$561.54 ,"$1,203.30 ",$412.65 ,"$1,230.04 ","$1,203.30 ",$890.98 ,$890.98 ,$814.23 ,$890.98 ,$869.05 ,$931.22 ,$151.00 ,"$1,056.23 ",$349.28 , N/A , N/A ,$149.50 , N/A ,$183.40 ,"$1,270.15 ","$1,096.34 ","$1,096.34 ","$1,069.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180038,12011,PC REPR SUPERF WND FACE <2.5CM,981,1 ,$503.00 ,$251.50 ,$56.66 ,$503.00 ,$329.51 ,$425.49 ,$425.49 ,$56.66 ,$402.40 ,$427.55 ,$314.38 ,$452.70 ,$329.51 ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$56.66 ,$427.55 ,$427.55 ,$452.70 ,$329.51 ,$211.26 ,$452.70 ,$412.65 ,$462.76 ,$452.70 ,$335.20 ,$335.20 ,$306.33 ,$335.20 ,$326.95 ,$350.34 ,$57.23 ,$397.37 ,$349.28 , N/A , N/A ,$56.66 , N/A ,$183.40 ,$477.85 ,$412.46 ,$412.46 ,$402.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180039,12013,PC REPR SUPERF WND FACE 2.6-5,981,1 ,$529.00 ,$264.50 ,$59.53 ,$529.00 ,$329.51 ,$447.48 ,$447.48 ,$59.53 ,$423.20 ,$449.65 ,$330.63 ,$476.10 ,$329.51 ,$502.55 ,$476.10 ,$449.65 ,$449.65 ,$59.53 ,$449.65 ,$449.65 ,$476.10 ,$329.51 ,$222.18 ,$476.10 ,$412.65 ,$486.68 ,$476.10 ,$352.53 ,$352.53 ,$322.16 ,$352.53 ,$343.85 ,$368.45 ,$60.13 ,$417.91 ,$349.28 , N/A , N/A ,$59.53 , N/A ,$183.40 ,$502.55 ,$433.78 ,$433.78 ,$423.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180040,12014,PC REPR SUPERF WND FACE 5.1-7.5,981,1 ,$586.00 ,$293.00 ,$76.45 ,$586.00 ,$329.51 ,$495.70 ,$495.70 ,$76.45 ,$468.80 ,$498.10 ,$366.25 ,$527.40 ,$329.51 ,$556.70 ,$527.40 ,$498.10 ,$498.10 ,$76.45 ,$498.10 ,$498.10 ,$527.40 ,$329.51 ,$246.12 ,$527.40 ,$412.65 ,$539.12 ,$527.40 ,$390.51 ,$390.51 ,$356.87 ,$390.51 ,$380.90 ,$408.15 ,$77.21 ,$462.94 ,$349.28 , N/A , N/A ,$76.45 , N/A ,$183.40 ,$556.70 ,$480.52 ,$480.52 ,$468.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180041,12015,PC REPR SUPERF WND FACE 7.6-12.5,981,1 ,$773.00 ,$386.50 ,$96.56 ,$773.00 ,$329.51 ,$653.88 ,$653.88 ,$96.56 ,$618.40 ,$657.05 ,$483.13 ,$695.70 ,$329.51 ,$734.35 ,$695.70 ,$657.05 ,$657.05 ,$96.56 ,$657.05 ,$657.05 ,$695.70 ,$329.51 ,$324.66 ,$695.70 ,$412.65 ,$711.16 ,$695.70 ,$515.13 ,$515.13 ,$470.76 ,$515.13 ,$502.45 ,$538.39 ,$97.53 ,$610.67 ,$349.28 , N/A , N/A ,$96.56 , N/A ,$183.40 ,$734.35 ,$633.86 ,$633.86 ,$618.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180042,12016,PC REPR SUPERF WND FACE 12.6-20,981,1 ,$953.00 ,$476.50 ,$132.12 ,$953.00 ,$329.51 ,$806.14 ,$806.14 ,$132.12 ,$762.40 ,$810.05 ,$595.63 ,$857.70 ,$329.51 ,$905.35 ,$857.70 ,$810.05 ,$810.05 ,$132.12 ,$810.05 ,$810.05 ,$857.70 ,$329.51 ,$400.26 ,$857.70 ,$794.25 ,$876.76 ,$857.70 ,$635.08 ,$635.08 ,$580.38 ,$635.08 ,$619.45 ,$663.76 ,$133.44 ,$752.87 ,$349.28 , N/A , N/A ,$132.12 , N/A ,$353.00 ,$905.35 ,$781.46 ,$781.46 ,$762.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180045,12020,PC CLOSURE SUPERF WND DEHIS SIMPLE,981,1 ,$662.00 ,$331.00 ,$197.28 ,"$1,203.50 ",$662.74 ,$559.99 ,$559.99 ,$197.28 ,$529.60 ,$562.70 ,$413.75 ,$595.80 ,$662.74 ,$628.90 ,$595.80 ,$562.70 ,$562.70 ,$197.28 ,$562.70 ,$562.70 ,$595.80 ,$662.74 ,$278.04 ,$595.80 ,"$1,203.50 ",$609.04 ,$595.80 ,$441.16 ,$441.16 ,$403.16 ,$441.16 ,$430.30 ,$461.08 ,$199.25 ,$522.98 ,$702.50 , N/A , N/A ,$197.28 , N/A ,$534.89 ,$628.90 ,$542.84 ,$542.84 ,$529.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180047,12031,"PC LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",981,1 ,$715.00 ,$357.50 ,$159.61 ,$794.25 ,$662.74 ,$604.82 ,$604.82 ,$159.61 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,$662.74 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$159.61 ,$607.75 ,$607.75 ,$643.50 ,$662.74 ,$300.30 ,$643.50 ,$794.25 ,$657.80 ,$643.50 ,$476.48 ,$476.48 ,$435.44 ,$476.48 ,$464.75 ,$498.00 ,$161.21 ,$564.85 ,$702.50 , N/A , N/A ,$159.61 , N/A ,$353.00 ,$679.25 ,$586.30 ,$586.30 ,$572.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180048,12032,"PC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5",981,1 ,$885.00 ,$442.50 ,$200.45 ,$885.00 ,$662.74 ,$748.62 ,$748.62 ,$200.45 ,$708.00 ,$752.25 ,$553.13 ,$796.50 ,$662.74 ,$840.75 ,$796.50 ,$752.25 ,$752.25 ,$200.45 ,$752.25 ,$752.25 ,$796.50 ,$662.74 ,$371.70 ,$796.50 ,$794.25 ,$814.20 ,$796.50 ,$589.76 ,$589.76 ,$538.97 ,$589.76 ,$575.25 ,$616.40 ,$202.45 ,$699.15 ,$702.50 , N/A , N/A ,$200.45 , N/A ,$353.00 ,$840.75 ,$725.70 ,$725.70 ,$708.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180049,12034,"PC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5",981,1 ,$680.00 ,$340.00 ,$215.72 ,$794.25 ,$662.74 ,$575.21 ,$575.21 ,$215.72 ,$544.00 ,$578.00 ,$425.00 ,$612.00 ,$662.74 ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$215.72 ,$578.00 ,$578.00 ,$612.00 ,$662.74 ,$285.60 ,$612.00 ,$794.25 ,$625.60 ,$612.00 ,$453.15 ,$453.15 ,$414.12 ,$453.15 ,$442.00 ,$473.62 ,$217.88 ,$537.20 ,$702.50 , N/A , N/A ,$215.72 , N/A ,$353.00 ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180053,12041,PC LAYR CLOS WND REST BODY <2.5CM,981,1 ,$731.00 ,$365.50 ,$152.17 ,$794.25 ,$662.74 ,$618.35 ,$618.35 ,$152.17 ,$584.80 ,$621.35 ,$456.88 ,$657.90 ,$662.74 ,$694.45 ,$657.90 ,$621.35 ,$621.35 ,$152.17 ,$621.35 ,$621.35 ,$657.90 ,$662.74 ,$307.02 ,$657.90 ,$794.25 ,$672.52 ,$657.90 ,$487.14 ,$487.14 ,$445.18 ,$487.14 ,$475.15 ,$509.14 ,$153.69 ,$577.49 ,$702.50 , N/A , N/A ,$152.17 , N/A ,$353.00 ,$694.45 ,$599.42 ,$599.42 ,$584.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180054,12042,PC LAYR CLOS WND REST BODY 2.6-7.5,981,1 ,$768.00 ,$384.00 ,$206.74 ,$794.25 ,$662.74 ,$649.65 ,$649.65 ,$206.74 ,$614.40 ,$652.80 ,$480.00 ,$691.20 ,$662.74 ,$729.60 ,$691.20 ,$652.80 ,$652.80 ,$206.74 ,$652.80 ,$652.80 ,$691.20 ,$662.74 ,$322.56 ,$691.20 ,$794.25 ,$706.56 ,$691.20 ,$511.80 ,$511.80 ,$467.71 ,$511.80 ,$499.20 ,$534.91 ,$208.81 ,$606.72 ,$702.50 , N/A , N/A ,$206.74 , N/A ,$353.00 ,$729.60 ,$629.76 ,$629.76 ,$614.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180055,12044,PC LAYR CLOS WND REST BODY 7.6-12.5,981,1 ,$764.00 ,$382.00 ,$224.24 ,"$1,203.50 ",$662.74 ,$646.27 ,$646.27 ,$224.24 ,$611.20 ,$649.40 ,$477.50 ,$687.60 ,$662.74 ,$725.80 ,$687.60 ,$649.40 ,$649.40 ,$224.24 ,$649.40 ,$649.40 ,$687.60 ,$662.74 ,$320.88 ,$687.60 ,"$1,203.50 ",$702.88 ,$687.60 ,$509.13 ,$509.13 ,$465.28 ,$509.13 ,$496.60 ,$532.13 ,$226.48 ,$603.56 ,$702.50 , N/A , N/A ,$224.24 , N/A ,$534.89 ,$725.80 ,$626.48 ,$626.48 ,$611.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180056,12045,PC LAYR CLOS WND REST BODY 12.6-20,981,1 ,"$1,239.00 ",$619.50 ,$283.52 ,"$1,239.00 ",$662.74 ,"$1,048.07 ","$1,048.07 ",$283.52 ,$991.20 ,"$1,053.15 ",$774.38 ,"$1,115.10 ",$662.74 ,"$1,177.05 ","$1,115.10 ","$1,053.15 ","$1,053.15 ",$283.52 ,"$1,053.15 ","$1,053.15 ","$1,115.10 ",$662.74 ,$520.38 ,"$1,115.10 ","$1,203.50 ","$1,139.88 ","$1,115.10 ",$825.67 ,$825.67 ,$754.55 ,$825.67 ,$805.35 ,$862.96 ,$286.36 ,$978.81 ,$702.50 , N/A , N/A ,$283.52 , N/A ,$534.89 ,"$1,177.05 ","$1,015.98 ","$1,015.98 ",$991.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180059,12051,"PC LAYR CLOS WND FACE,FACIAL <2.5CM",981,1 ,$794.00 ,$397.00 ,$178.34 ,$794.25 ,$662.74 ,$671.64 ,$671.64 ,$178.34 ,$635.20 ,$674.90 ,$496.25 ,$714.60 ,$662.74 ,$754.30 ,$714.60 ,$674.90 ,$674.90 ,$178.34 ,$674.90 ,$674.90 ,$714.60 ,$662.74 ,$333.48 ,$714.60 ,$794.25 ,$730.48 ,$714.60 ,$529.12 ,$529.12 ,$483.55 ,$529.12 ,$516.10 ,$553.02 ,$180.12 ,$627.26 ,$702.50 , N/A , N/A ,$178.34 , N/A ,$353.00 ,$754.30 ,$651.08 ,$651.08 ,$635.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180060,12052,"PC LAYR CLOS WND FACE,FACIAL 2.5-5",981,1 ,$900.00 ,$450.00 ,$210.07 ,$900.00 ,$662.74 ,$761.31 ,$761.31 ,$210.07 ,$720.00 ,$765.00 ,$562.50 ,$810.00 ,$662.74 ,$855.00 ,$810.00 ,$765.00 ,$765.00 ,$210.07 ,$765.00 ,$765.00 ,$810.00 ,$662.74 ,$378.00 ,$810.00 ,$794.25 ,$828.00 ,$810.00 ,$599.76 ,$599.76 ,$548.10 ,$599.76 ,$585.00 ,$626.85 ,$212.17 ,$711.00 ,$702.50 , N/A , N/A ,$210.07 , N/A ,$353.00 ,$855.00 ,$738.00 ,$738.00 ,$720.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180061,12053,"PC LAYR CLOS WND FACE,FACIAL 5.1-7.5",981,1 ,$847.00 ,$423.50 ,$225.67 ,$847.00 ,$662.74 ,$716.48 ,$716.48 ,$225.67 ,$677.60 ,$719.95 ,$529.38 ,$762.30 ,$662.74 ,$804.65 ,$762.30 ,$719.95 ,$719.95 ,$225.67 ,$719.95 ,$719.95 ,$762.30 ,$662.74 ,$355.74 ,$762.30 ,$794.25 ,$779.24 ,$762.30 ,$564.44 ,$564.44 ,$515.82 ,$564.44 ,$550.55 ,$589.94 ,$227.93 ,$669.13 ,$702.50 , N/A , N/A ,$225.67 , N/A ,$353.00 ,$804.65 ,$694.54 ,$694.54 ,$677.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180062,12054,"PC LAYR CLOS WND FACE,FACIAL 7.6-12.5",981,1 ,"$1,239.00 ",$619.50 ,$227.89 ,"$1,239.00 ",$662.74 ,"$1,048.07 ","$1,048.07 ",$227.89 ,$991.20 ,"$1,053.15 ",$774.38 ,"$1,115.10 ",$662.74 ,"$1,177.05 ","$1,115.10 ","$1,053.15 ","$1,053.15 ",$227.89 ,"$1,053.15 ","$1,053.15 ","$1,115.10 ",$662.74 ,$520.38 ,"$1,115.10 ",$794.25 ,"$1,139.88 ","$1,115.10 ",$825.67 ,$825.67 ,$754.55 ,$825.67 ,$805.35 ,$862.96 ,$230.17 ,$978.81 ,$702.50 , N/A , N/A ,$227.89 , N/A ,$353.00 ,"$1,177.05 ","$1,015.98 ","$1,015.98 ",$991.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180069,13121,"PC REPR CMPL WND SCALP,EXTR 2.6-7.5",981,1 ,"$1,297.00 ",$648.50 ,$272.31 ,"$1,297.00 ",$785.45 ,"$1,097.13 ","$1,097.13 ",$272.31 ,"$1,037.60 ","$1,102.45 ",$810.63 ,"$1,167.30 ",$785.45 ,"$1,232.15 ","$1,167.30 ","$1,102.45 ","$1,102.45 ",$272.31 ,"$1,102.45 ","$1,102.45 ","$1,167.30 ",$785.45 ,$544.74 ,"$1,167.30 ","$1,203.50 ","$1,193.24 ","$1,167.30 ",$864.32 ,$864.32 ,$789.87 ,$864.32 ,$843.05 ,$903.36 ,$275.03 ,"$1,024.63 ",$832.58 , N/A , N/A ,$272.31 , N/A ,$534.89 ,"$1,232.15 ","$1,063.54 ","$1,063.54 ","$1,037.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180070,13122,"PC REP,SKIN,SCALP/EXTREM+5CM/<",981,1 ,$545.00 ,$272.50 ,$86.22 ,$832.58 ,$785.45 ,$461.02 ,$461.02 ,$86.22 ,$436.00 ,$463.25 ,$340.63 ,$490.50 ,$785.45 ,$517.75 ,$490.50 ,$463.25 ,$463.25 ,$86.22 ,$463.25 ,$463.25 ,$490.50 ,$785.45 ,$228.90 ,$490.50 , N/A ,$501.40 ,$490.50 ,$363.19 ,$363.19 ,$331.91 ,$363.19 ,$354.25 ,$379.59 ,$87.08 ,$430.55 ,$832.58 , N/A , N/A ,$86.22 , N/A , N/A ,$517.75 ,$446.90 ,$446.90 ,$436.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180071,13131,"PC REPR CMPL WND HEAD,FAC,HAND 1.1-2.5",981,1 ,"$1,059.00 ",$529.50 ,$255.64 ,"$1,059.00 ",$785.45 ,$895.81 ,$895.81 ,$255.64 ,$847.20 ,$900.15 ,$661.88 ,$953.10 ,$785.45 ,"$1,006.05 ",$953.10 ,$900.15 ,$900.15 ,$255.64 ,$900.15 ,$900.15 ,$953.10 ,$785.45 ,$444.78 ,$953.10 ,$794.25 ,$974.28 ,$953.10 ,$705.72 ,$705.72 ,$644.93 ,$705.72 ,$688.35 ,$737.59 ,$258.20 ,$836.61 ,$832.58 , N/A , N/A ,$255.64 , N/A ,$353.00 ,"$1,006.05 ",$868.38 ,$868.38 ,$847.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180072,13132,"PC REPR CMPL WND HEAD,FAC,HAND 2.6-7.5",981,1 ,"$1,624.00 ",$812.00 ,$320.12 ,"$1,624.00 ",$785.45 ,"$1,373.74 ","$1,373.74 ",$320.12 ,"$1,299.20 ","$1,380.40 ","$1,015.00 ","$1,461.60 ",$785.45 ,"$1,542.80 ","$1,461.60 ","$1,380.40 ","$1,380.40 ",$320.12 ,"$1,380.40 ","$1,380.40 ","$1,461.60 ",$785.45 ,$682.08 ,"$1,461.60 ","$1,203.50 ","$1,494.08 ","$1,461.60 ","$1,082.23 ","$1,082.23 ",$989.02 ,"$1,082.23 ","$1,055.60 ","$1,131.12 ",$323.32 ,"$1,282.96 ",$832.58 , N/A , N/A ,$320.12 , N/A ,$534.89 ,"$1,542.80 ","$1,331.68 ","$1,331.68 ","$1,299.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180077,13153,"PC REP,EYELID,NOSE,EAR,LIP+5CM",981,1 ,$497.00 ,$248.50 ,$142.88 ,"$2,146.92 ","$2,025.40 ",$420.41 ,$420.41 ,$142.88 ,$397.60 ,$422.45 ,$310.63 ,$447.30 ,"$2,025.40 ",$472.15 ,$447.30 ,$422.45 ,$422.45 ,$142.88 ,$422.45 ,$422.45 ,$447.30 ,"$2,025.40 ",$208.74 ,$447.30 , N/A ,$457.24 ,$447.30 ,$331.20 ,$331.20 ,$302.67 ,$331.20 ,$323.05 ,$346.16 ,$144.31 ,$392.63 ,"$2,146.92 ", N/A , N/A ,$142.88 , N/A , N/A ,$472.15 ,$407.54 ,$407.54 ,$397.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180079,15852,"PC DRESSING CHANGE,NOT FOR BURN",981,1 ,$250.00 ,$125.00 ,$48.06 ,"$1,203.50 ",$329.51 ,$211.48 ,$211.48 ,$48.06 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$329.51 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$48.06 ,$212.50 ,$212.50 ,$225.00 ,$329.51 ,$105.00 ,$225.00 ,"$1,203.50 ",$230.00 ,$225.00 ,$166.60 ,$166.60 ,$152.25 ,$166.60 ,$162.50 ,$174.13 ,$48.54 ,$197.50 ,$349.28 , N/A , N/A ,$48.06 , N/A ,$534.89 ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180081,16020,PC DRESS/DEBRID SMALL BURN NO ANES,981,1 ,$265.00 ,$132.50 ,$57.25 ,$412.65 ,$329.51 ,$224.16 ,$224.16 ,$57.25 ,$212.00 ,$225.25 ,$165.63 ,$238.50 ,$329.51 ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$57.25 ,$225.25 ,$225.25 ,$238.50 ,$329.51 ,$111.30 ,$238.50 ,$412.65 ,$243.80 ,$238.50 ,$176.60 ,$176.60 ,$161.39 ,$176.60 ,$172.25 ,$184.57 ,$57.82 ,$209.35 ,$349.28 , N/A , N/A ,$57.25 , N/A ,$183.40 ,$251.75 ,$217.30 ,$217.30 ,$212.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180082,16025,PC DRESS/DEBRID MED BURN NO ANESTH,981,1 ,$450.00 ,$225.00 ,$116.55 ,$450.00 ,$329.51 ,$380.66 ,$380.66 ,$116.55 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,$329.51 ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$116.55 ,$382.50 ,$382.50 ,$405.00 ,$329.51 ,$189.00 ,$405.00 ,$412.65 ,$414.00 ,$405.00 ,$299.88 ,$299.88 ,$274.05 ,$299.88 ,$292.50 ,$313.43 ,$117.72 ,$355.50 ,$349.28 , N/A , N/A ,$116.55 , N/A ,$183.40 ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180089,20103,"PC EXPLORE WOUND,EXTREMITY",981,1 ,"$1,807.00 ",$903.50 ,$359.63 ,"$1,807.00 ",$662.74 ,"$1,528.54 ","$1,528.54 ",$359.63 ,"$1,445.60 ","$1,535.95 ","$1,129.38 ","$1,626.30 ",$662.74 ,"$1,716.65 ","$1,626.30 ","$1,535.95 ","$1,535.95 ",$359.63 ,"$1,535.95 ","$1,535.95 ","$1,626.30 ",$662.74 ,$758.94 ,"$1,626.30 ","$1,429.97 ","$1,662.44 ","$1,626.30 ","$1,204.18 ","$1,204.18 ","$1,100.46 ","$1,204.18 ","$1,174.55 ","$1,258.58 ",$363.23 ,"$1,427.53 ",$702.50 , N/A , N/A ,$359.63 , N/A ,$635.54 ,"$1,716.65 ","$1,481.74 ","$1,481.74 ","$1,445.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180090,20520,PC REMOVAL OF FOREIGN BODY,981,1 ,$476.00 ,$238.00 ,$156.33 ,"$3,259.85 ","$3,075.33 ",$402.65 ,$402.65 ,$156.33 ,$380.80 ,$404.60 ,$297.50 ,$428.40 ,"$3,075.33 ",$452.20 ,$428.40 ,$404.60 ,$404.60 ,$156.33 ,$404.60 ,$404.60 ,$428.40 ,"$3,075.33 ",$199.92 ,$428.40 ,"$3,233.23 ",$437.92 ,$428.40 ,$317.21 ,$317.21 ,$289.88 ,$317.21 ,$309.40 ,$331.53 ,$157.89 ,$376.04 ,"$3,259.85 ", N/A , N/A ,$156.33 , N/A ,"$1,436.99 ",$452.20 ,$390.32 ,$390.32 ,$380.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180091,20525,PC REMOVAL OF FOREIGN BODY DEEP/COMPLIC,981,1 ,"$1,322.00 ",$661.00 ,$258.46 ,"$5,448.49 ","$3,075.33 ","$1,118.28 ","$1,118.28 ",$258.46 ,"$1,057.60 ","$1,123.70 ",$826.25 ,"$1,189.80 ","$3,075.33 ","$1,255.90 ","$1,189.80 ","$1,123.70 ","$1,123.70 ",$258.46 ,"$1,123.70 ","$1,123.70 ","$1,189.80 ","$3,075.33 ",$555.24 ,"$1,189.80 ","$5,448.49 ","$1,216.24 ","$1,189.80 ",$880.98 ,$880.98 ,$805.10 ,$880.98 ,$859.30 ,$920.77 ,$261.04 ,"$1,044.38 ","$3,259.85 ", N/A , N/A ,$258.46 , N/A ,"$2,421.55 ","$1,255.90 ","$1,084.04 ","$1,084.04 ","$1,057.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180092,20600,PC DRAIN/INJECT SMALL JOINT/BURSA,981,1 ,$296.00 ,$148.00 ,$37.56 ,$600.37 ,$424.03 ,$250.39 ,$250.39 ,$37.56 ,$236.80 ,$251.60 ,$185.00 ,$266.40 ,$424.03 ,$281.20 ,$266.40 ,$251.60 ,$251.60 ,$37.56 ,$251.60 ,$251.60 ,$266.40 ,$424.03 ,$124.32 ,$266.40 ,$600.37 ,$272.32 ,$266.40 ,$197.25 ,$197.25 ,$180.26 ,$197.25 ,$192.40 ,$206.16 ,$37.94 ,$233.84 ,$449.47 , N/A , N/A ,$37.56 , N/A ,$266.83 ,$281.20 ,$242.72 ,$242.72 ,$236.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180093,20605,PC DRAIN/INJECT MEDIUM JOINT/BURSA,981,1 ,$318.00 ,$159.00 ,$39.08 ,$600.37 ,$424.03 ,$269.00 ,$269.00 ,$39.08 ,$254.40 ,$270.30 ,$198.75 ,$286.20 ,$424.03 ,$302.10 ,$286.20 ,$270.30 ,$270.30 ,$39.08 ,$270.30 ,$270.30 ,$286.20 ,$424.03 ,$133.56 ,$286.20 ,$600.37 ,$292.56 ,$286.20 ,$211.92 ,$211.92 ,$193.66 ,$211.92 ,$206.70 ,$221.49 ,$39.47 ,$251.22 ,$449.47 , N/A , N/A ,$39.08 , N/A ,$266.83 ,$302.10 ,$260.76 ,$260.76 ,$254.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180094,20610,PC DRAIN/INJECT LARGE JOINT/BURSA,981,1 ,$418.00 ,$209.00 ,$47.33 ,$600.37 ,$424.03 ,$353.59 ,$353.59 ,$47.33 ,$334.40 ,$355.30 ,$261.25 ,$376.20 ,$424.03 ,$397.10 ,$376.20 ,$355.30 ,$355.30 ,$47.33 ,$355.30 ,$355.30 ,$376.20 ,$424.03 ,$175.56 ,$376.20 ,$600.37 ,$384.56 ,$376.20 ,$278.56 ,$278.56 ,$254.56 ,$278.56 ,$271.70 ,$291.14 ,$47.80 ,$330.22 ,$449.47 , N/A , N/A ,$47.33 , N/A ,$266.83 ,$397.10 ,$342.76 ,$342.76 ,$334.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180095,21310,PC CLOSED RX NOSE FRACTURE W/O MANIPULATION,981,1 ,$266.00 ,$133.00 ,$111.72 ,$266.00 , N/A ,$225.01 ,$225.01 , N/A ,$212.80 ,$226.10 ,$166.25 ,$239.40 , N/A ,$252.70 ,$239.40 ,$226.10 ,$226.10 , N/A ,$226.10 ,$226.10 ,$239.40 , N/A ,$111.72 ,$239.40 , N/A ,$244.72 ,$239.40 ,$177.26 ,$177.26 ,$161.99 ,$177.26 ,$172.90 ,$185.27 , N/A ,$210.14 , N/A , N/A , N/A , N/A , N/A , N/A ,$252.70 ,$218.12 ,$218.12 ,$212.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180096,21315,PC CLOSED RX NOSE FRACTURE W/O STABILIZATION,981,1 ,"$1,003.00 ",$501.50 ,$62.18 ,"$3,108.47 ","$1,619.45 ",$848.44 ,$848.44 ,$62.18 ,$802.40 ,$852.55 ,$626.88 ,$902.70 ,"$1,619.45 ",$952.85 ,$902.70 ,$852.55 ,$852.55 ,$62.18 ,$852.55 ,$852.55 ,$902.70 ,"$1,619.45 ",$421.26 ,$902.70 ,"$3,108.47 ",$922.76 ,$902.70 ,$668.40 ,$668.40 ,$610.83 ,$668.40 ,$651.95 ,$698.59 ,$62.80 ,$792.37 ,"$1,716.62 ", N/A , N/A ,$62.18 , N/A ,"$1,381.54 ",$952.85 ,$822.46 ,$822.46 ,$802.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180097,21320,PC CLOSED RX NOSE FX W STABILIZATN.,981,1 ,"$1,469.00 ",$734.50 ,$100.16 ,"$6,286.46 ","$1,619.45 ","$1,242.63 ","$1,242.63 ",$100.16 ,"$1,175.20 ","$1,248.65 ",$918.13 ,"$1,322.10 ","$1,619.45 ","$1,395.55 ","$1,322.10 ","$1,248.65 ","$1,248.65 ",$100.16 ,"$1,248.65 ","$1,248.65 ","$1,322.10 ","$1,619.45 ",$616.98 ,"$1,322.10 ","$6,286.46 ","$1,351.48 ","$1,322.10 ",$978.94 ,$978.94 ,$894.62 ,$978.94 ,$954.85 ,"$1,023.16 ",$101.16 ,"$1,160.51 ","$1,716.62 ", N/A , N/A ,$100.16 , N/A ,"$2,793.98 ","$1,395.55 ","$1,204.58 ","$1,204.58 ","$1,175.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180098,21337,PC CLOSED RX NASAL SEPTAL FRACTURE,981,1 ,$523.00 ,$261.50 ,$219.66 ,"$6,286.46 ","$1,619.45 ",$442.41 ,$442.41 ,$318.82 ,$418.40 ,$444.55 ,$326.88 ,$470.70 ,"$1,619.45 ",$496.85 ,$470.70 ,$444.55 ,$444.55 ,$318.82 ,$444.55 ,$444.55 ,$470.70 ,"$1,619.45 ",$219.66 ,$470.70 ,"$6,286.46 ",$481.16 ,$470.70 ,$348.53 ,$348.53 ,$318.51 ,$348.53 ,$339.95 ,$364.27 ,$322.01 ,$413.17 ,"$1,716.62 ", N/A , N/A ,$318.82 , N/A ,"$2,793.98 ",$496.85 ,$428.86 ,$428.86 ,$418.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180099,21355,PC CLOSED REPAIR CHEEK BONE FRAC,981,1 ,"$2,441.00 ","$1,220.50 ",$348.63 ,"$6,286.46 ","$5,278.73 ","$2,064.84 ","$2,064.84 ",$348.63 ,"$1,952.80 ","$2,074.85 ","$1,525.63 ","$2,196.90 ","$5,278.73 ","$2,318.95 ","$2,196.90 ","$2,074.85 ","$2,074.85 ",$348.63 ,"$2,074.85 ","$2,074.85 ","$2,196.90 ","$5,278.73 ","$1,025.22 ","$2,196.90 ","$6,286.46 ","$2,245.72 ","$2,196.90 ","$1,626.68 ","$1,626.68 ","$1,486.57 ","$1,626.68 ","$1,586.65 ","$1,700.16 ",$352.12 ,"$1,928.39 ","$5,595.45 ", N/A , N/A ,$348.63 , N/A ,"$2,793.98 ","$2,318.95 ","$2,001.62 ","$2,001.62 ","$1,952.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180100,21450,PC CLOSED RX MANDIBLE FX,981,1 ,"$2,149.00 ","$1,074.50 ",$461.90 ,"$3,592.77 ","$3,389.41 ","$1,817.84 ","$1,817.84 ",$529.49 ,"$1,719.20 ","$1,826.65 ","$1,343.13 ","$1,934.10 ","$3,389.41 ","$2,041.55 ","$1,934.10 ","$1,826.65 ","$1,826.65 ",$529.49 ,"$1,826.65 ","$1,826.65 ","$1,934.10 ","$3,389.41 ",$902.58 ,"$1,934.10 ","$1,039.28 ","$1,977.08 ","$1,934.10 ","$1,432.09 ","$1,432.09 ","$1,308.74 ","$1,432.09 ","$1,396.85 ","$1,496.78 ",$534.78 ,"$1,697.71 ","$3,592.77 ", N/A , N/A ,$529.49 , N/A ,$461.90 ,"$2,041.55 ","$1,762.18 ","$1,762.18 ","$1,719.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180101,21480,PC REDUCE TEMPOROMANDIBL DISLOC,981,1 ,$566.00 ,$283.00 ,$31.84 ,$566.00 ,$195.84 ,$478.78 ,$478.78 ,$31.84 ,$452.80 ,$481.10 ,$353.75 ,$509.40 ,$195.84 ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$31.84 ,$481.10 ,$481.10 ,$509.40 ,$195.84 ,$237.72 ,$509.40 ,$473.63 ,$520.72 ,$509.40 ,$377.18 ,$377.18 ,$344.69 ,$377.18 ,$367.90 ,$394.22 ,$32.16 ,$447.14 ,$207.59 , N/A , N/A ,$31.84 , N/A ,$210.50 ,$537.70 ,$464.12 ,$464.12 ,$452.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180119,23650,PC CLOSED RX SHLDR DISLOCATION,981,1 ,"$1,124.00 ",$562.00 ,$210.50 ,"$1,124.00 ",$783.09 ,$950.79 ,$950.79 ,$314.24 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ",$783.09 ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$314.24 ,$955.40 ,$955.40 ,"$1,011.60 ",$783.09 ,$472.08 ,"$1,011.60 ",$473.63 ,"$1,034.08 ","$1,011.60 ",$749.03 ,$749.03 ,$684.52 ,$749.03 ,$730.60 ,$782.87 ,$317.38 ,$887.96 ,$830.08 , N/A , N/A ,$314.24 , N/A ,$210.50 ,"$1,067.80 ",$921.68 ,$921.68 ,$899.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180120,23655,"PC CLOSED RX SHLDR DISLOC,ANESTHESIA",981,1 ,"$1,429.00 ",$714.50 ,$434.91 ,"$3,200.65 ","$1,740.21 ","$1,208.79 ","$1,208.79 ",$434.91 ,"$1,143.20 ","$1,214.65 ",$893.13 ,"$1,286.10 ","$1,740.21 ","$1,357.55 ","$1,286.10 ","$1,214.65 ","$1,214.65 ",$434.91 ,"$1,214.65 ","$1,214.65 ","$1,286.10 ","$1,740.21 ",$600.18 ,"$1,286.10 ","$3,200.65 ","$1,314.68 ","$1,286.10 ",$952.29 ,$952.29 ,$870.26 ,$952.29 ,$928.85 ,$995.30 ,$439.26 ,"$1,128.91 ","$1,844.62 ", N/A , N/A ,$434.91 , N/A ,"$1,422.51 ","$1,357.55 ","$1,171.78 ","$1,171.78 ","$1,143.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180121,23665,"PC CLOSED RX SHLDR DISLOC,GR TUB FX",981,1 ,"$1,194.00 ",$597.00 ,$425.19 ,"$3,200.65 ",$783.09 ,"$1,010.00 ","$1,010.00 ",$425.19 ,$955.20 ,"$1,014.90 ",$746.25 ,"$1,074.60 ",$783.09 ,"$1,134.30 ","$1,074.60 ","$1,014.90 ","$1,014.90 ",$425.19 ,"$1,014.90 ","$1,014.90 ","$1,074.60 ",$783.09 ,$501.48 ,"$1,074.60 ","$3,200.65 ","$1,098.48 ","$1,074.60 ",$795.68 ,$795.68 ,$727.15 ,$795.68 ,$776.10 ,$831.62 ,$429.44 ,$943.26 ,$830.08 , N/A , N/A ,$425.19 , N/A ,"$1,422.51 ","$1,134.30 ",$979.08 ,$979.08 ,$955.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180124,23930,"PC INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA",981,1 ,"$1,162.00 ",$581.00 ,$224.86 ,"$5,448.49 ","$3,075.33 ",$982.94 ,$982.94 ,$224.86 ,$929.60 ,$987.70 ,$726.25 ,"$1,045.80 ","$3,075.33 ","$1,103.90 ","$1,045.80 ",$987.70 ,$987.70 ,$224.86 ,$987.70 ,$987.70 ,"$1,045.80 ","$3,075.33 ",$488.04 ,"$1,045.80 ","$5,448.49 ","$1,069.04 ","$1,045.80 ",$774.36 ,$774.36 ,$707.66 ,$774.36 ,$755.30 ,$809.33 ,$227.11 ,$917.98 ,"$3,259.85 ", N/A , N/A ,$224.86 , N/A ,"$2,421.55 ","$1,103.90 ",$952.84 ,$952.84 ,$929.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180125,23931,PC INCIS/DRAIN ARM/ELBOW INFECT BURSA,981,1 ,$866.00 ,$433.00 ,$169.41 ,"$3,259.85 ","$3,075.33 ",$732.55 ,$732.55 ,$169.41 ,$692.80 ,$736.10 ,$541.25 ,$779.40 ,"$3,075.33 ",$822.70 ,$779.40 ,$736.10 ,$736.10 ,$169.41 ,$736.10 ,$736.10 ,$779.40 ,"$3,075.33 ",$363.72 ,$779.40 ,"$3,233.23 ",$796.72 ,$779.40 ,$577.10 ,$577.10 ,$527.39 ,$577.10 ,$562.90 ,$603.17 ,$171.10 ,$684.14 ,"$3,259.85 ", N/A , N/A ,$169.41 , N/A ,"$1,436.99 ",$822.70 ,$710.12 ,$710.12 ,$692.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180126,23935,PC INCIS DEEP ARM/ELBOW BONE LESION,981,1 ,"$1,843.00 ",$921.50 ,$538.37 ,"$10,606.29 ","$10,005.93 ","$1,558.99 ","$1,558.99 ",$538.37 ,"$1,474.40 ","$1,566.55 ","$1,151.88 ","$1,658.70 ","$10,005.93 ","$1,750.85 ","$1,658.70 ","$1,566.55 ","$1,566.55 ",$538.37 ,"$1,566.55 ","$1,566.55 ","$1,658.70 ","$10,005.93 ",$774.06 ,"$1,658.70 ","$6,507.63 ","$1,695.56 ","$1,658.70 ","$1,228.18 ","$1,228.18 ","$1,122.39 ","$1,228.18 ","$1,197.95 ","$1,283.65 ",$543.75 ,"$1,455.97 ","$10,606.29 ", N/A , N/A ,$538.37 , N/A ,"$2,892.28 ","$1,750.85 ","$1,511.26 ","$1,511.26 ","$1,474.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180135,24600,PC CLOSED RX ELBOW DISLOCATION,981,1 ,"$1,469.00 ",$734.50 ,$210.50 ,"$1,469.00 ",$783.09 ,"$1,242.63 ","$1,242.63 ",$359.70 ,"$1,175.20 ","$1,248.65 ",$918.13 ,"$1,322.10 ",$783.09 ,"$1,395.55 ","$1,322.10 ","$1,248.65 ","$1,248.65 ",$359.70 ,"$1,248.65 ","$1,248.65 ","$1,322.10 ",$783.09 ,$616.98 ,"$1,322.10 ",$473.63 ,"$1,351.48 ","$1,322.10 ",$978.94 ,$978.94 ,$894.62 ,$978.94 ,$954.85 ,"$1,023.16 ",$363.30 ,"$1,160.51 ",$830.08 , N/A , N/A ,$359.70 , N/A ,$210.50 ,"$1,395.55 ","$1,204.58 ","$1,204.58 ","$1,175.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180138,24640,"PC CLOSED RX RADIAL HEAD DISLOC,CHILD",981,1 ,$495.00 ,$247.50 ,$87.45 ,$830.08 ,$783.09 ,$418.72 ,$418.72 ,$87.45 ,$396.00 ,$420.75 ,$309.38 ,$445.50 ,$783.09 ,$470.25 ,$445.50 ,$420.75 ,$420.75 ,$87.45 ,$420.75 ,$420.75 ,$445.50 ,$783.09 ,$207.90 ,$445.50 ,$473.63 ,$455.40 ,$445.50 ,$329.87 ,$329.87 ,$301.46 ,$329.87 ,$321.75 ,$344.77 ,$88.32 ,$391.05 ,$830.08 , N/A , N/A ,$87.45 , N/A ,$210.50 ,$470.25 ,$405.90 ,$405.90 ,$396.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180139,24650,PC CLOSED RX RADIAL HEAD/NECK FX,981,1 ,"$1,060.00 ",$530.00 ,$210.50 ,"$1,060.00 ",$783.09 ,$896.65 ,$896.65 ,$263.51 ,$848.00 ,$901.00 ,$662.50 ,$954.00 ,$783.09 ,"$1,007.00 ",$954.00 ,$901.00 ,$901.00 ,$263.51 ,$901.00 ,$901.00 ,$954.00 ,$783.09 ,$445.20 ,$954.00 ,$473.63 ,$975.20 ,$954.00 ,$706.38 ,$706.38 ,$645.54 ,$706.38 ,$689.00 ,$738.29 ,$266.15 ,$837.40 ,$830.08 , N/A , N/A ,$263.51 , N/A ,$210.50 ,"$1,007.00 ",$869.20 ,$869.20 ,$848.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180151,25560,PC CLOSED RX RAD/ULNA SHAFT FX,981,1 ,$619.00 ,$309.50 ,$210.50 ,$830.08 ,$783.09 ,$523.61 ,$523.61 ,$277.47 ,$495.20 ,$526.15 ,$386.88 ,$557.10 ,$783.09 ,$588.05 ,$557.10 ,$526.15 ,$526.15 ,$277.47 ,$526.15 ,$526.15 ,$557.10 ,$783.09 ,$259.98 ,$557.10 ,$473.63 ,$569.48 ,$557.10 ,$412.50 ,$412.50 ,$376.97 ,$412.50 ,$402.35 ,$431.13 ,$280.24 ,$489.01 ,$830.08 , N/A , N/A ,$277.47 , N/A ,$210.50 ,$588.05 ,$507.58 ,$507.58 ,$495.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180154,25605,"PC CLOSED RX DIST RAD/ULNA FX,MANIPUL",981,1 ,"$3,517.00 ","$1,758.50 ",$542.33 ,"$3,517.00 ",$783.09 ,"$2,975.03 ","$2,975.03 ",$542.33 ,"$2,813.60 ","$2,989.45 ","$2,198.13 ","$3,165.30 ",$783.09 ,"$3,341.15 ","$3,165.30 ","$2,989.45 ","$2,989.45 ",$542.33 ,"$2,989.45 ","$2,989.45 ","$3,165.30 ",$783.09 ,"$1,477.14 ","$3,165.30 ","$3,200.65 ","$3,235.64 ","$3,165.30 ","$2,343.73 ","$2,343.73 ","$2,141.85 ","$2,343.73 ","$2,286.05 ","$2,449.59 ",$547.75 ,"$2,778.43 ",$830.08 , N/A , N/A ,$542.33 , N/A ,"$1,422.51 ","$3,341.15 ","$2,883.94 ","$2,883.94 ","$2,813.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180165,25660,PC CLOSED TREAT WRIST DISLOCATION,981,1 ,"$1,548.00 ",$774.00 ,$210.50 ,"$1,548.00 ",$783.09 ,"$1,309.45 ","$1,309.45 ",$477.10 ,"$1,238.40 ","$1,315.80 ",$967.50 ,"$1,393.20 ",$783.09 ,"$1,470.60 ","$1,393.20 ","$1,315.80 ","$1,315.80 ",$477.10 ,"$1,315.80 ","$1,315.80 ","$1,393.20 ",$783.09 ,$650.16 ,"$1,393.20 ",$473.63 ,"$1,424.16 ","$1,393.20 ","$1,031.59 ","$1,031.59 ",$942.73 ,"$1,031.59 ","$1,006.20 ","$1,078.18 ",$481.87 ,"$1,222.92 ",$830.08 , N/A , N/A ,$477.10 , N/A ,$210.50 ,"$1,470.60 ","$1,269.36 ","$1,269.36 ","$1,238.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180169,26010,"PC DRAIN FINGER ABSCESS,SIMPLE",981,1 ,$715.00 ,$357.50 ,$149.43 ,$715.00 ,$288.25 ,$604.82 ,$604.82 ,$149.43 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,$288.25 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$149.43 ,$607.75 ,$607.75 ,$643.50 ,$288.25 ,$300.30 ,$643.50 ,$412.65 ,$657.80 ,$643.50 ,$476.48 ,$476.48 ,$435.44 ,$476.48 ,$464.75 ,$498.00 ,$150.92 ,$564.85 ,$305.55 , N/A , N/A ,$149.43 , N/A ,$183.40 ,$679.25 ,$586.30 ,$586.30 ,$572.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180180,26641,"PC TREAT THUMB DISLOC,MANIPULATN",981,1 ,$615.00 ,$307.50 ,$210.50 ,$830.08 ,$783.09 ,$520.23 ,$520.23 ,$407.99 ,$492.00 ,$522.75 ,$384.38 ,$553.50 ,$783.09 ,$584.25 ,$553.50 ,$522.75 ,$522.75 ,$407.99 ,$522.75 ,$522.75 ,$553.50 ,$783.09 ,$258.30 ,$553.50 ,$473.63 ,$565.80 ,$553.50 ,$409.84 ,$409.84 ,$374.54 ,$409.84 ,$399.75 ,$428.35 ,$412.07 ,$485.85 ,$830.08 , N/A , N/A ,$407.99 , N/A ,$210.50 ,$584.25 ,$504.30 ,$504.30 ,$492.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180181,26645,"PC TREAT THUMB FX/DISLOC,MANIP",981,1 ,"$1,133.00 ",$566.50 ,$420.63 ,"$3,200.65 ",$783.09 ,$958.40 ,$958.40 ,$420.63 ,$906.40 ,$963.05 ,$708.13 ,"$1,019.70 ",$783.09 ,"$1,076.35 ","$1,019.70 ",$963.05 ,$963.05 ,$420.63 ,$963.05 ,$963.05 ,"$1,019.70 ",$783.09 ,$475.86 ,"$1,019.70 ","$3,200.65 ","$1,042.36 ","$1,019.70 ",$755.03 ,$755.03 ,$690.00 ,$755.03 ,$736.45 ,$789.13 ,$424.84 ,$895.07 ,$830.08 , N/A , N/A ,$420.63 , N/A ,"$1,422.51 ","$1,076.35 ",$929.06 ,$929.06 ,$906.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180182,26650,PC PERCUT FIX THUMB FX/DISLOC,981,1 ,"$2,303.00 ","$1,151.50 ",$512.86 ,"$9,925.99 ","$9,364.14 ","$1,948.11 ","$1,948.11 ",$512.86 ,"$1,842.40 ","$1,957.55 ","$1,439.38 ","$2,072.70 ","$9,364.14 ","$2,187.85 ","$2,072.70 ","$1,957.55 ","$1,957.55 ",$512.86 ,"$1,957.55 ","$1,957.55 ","$2,072.70 ","$9,364.14 ",$967.26 ,"$2,072.70 ","$6,507.63 ","$2,118.76 ","$2,072.70 ","$1,534.72 ","$1,534.72 ","$1,402.53 ","$1,534.72 ","$1,496.95 ","$1,604.04 ",$517.99 ,"$1,819.37 ","$9,925.99 ", N/A , N/A ,$512.86 , N/A ,"$2,892.28 ","$2,187.85 ","$1,888.46 ","$1,888.46 ","$1,842.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180183,26670,PC TREAT HAND DISLOCATION CLOSED W/O ANESTHESIA,981,1 ,$736.00 ,$368.00 ,$210.50 ,$830.08 ,$783.09 ,$622.58 ,$622.58 ,$332.90 ,$588.80 ,$625.60 ,$460.00 ,$662.40 ,$783.09 ,$699.20 ,$662.40 ,$625.60 ,$625.60 ,$332.90 ,$625.60 ,$625.60 ,$662.40 ,$783.09 ,$309.12 ,$662.40 ,$473.63 ,$677.12 ,$662.40 ,$490.47 ,$490.47 ,$448.22 ,$490.47 ,$478.40 ,$512.62 ,$336.23 ,$581.44 ,$830.08 , N/A , N/A ,$332.90 , N/A ,$210.50 ,$699.20 ,$603.52 ,$603.52 ,$588.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180185,26685,PC TREAT HAND DISLOCATION OPEN FIXATION,981,1 ,"$2,588.00 ","$1,294.00 ",$609.60 ,"$9,925.99 ","$9,364.14 ","$2,189.19 ","$2,189.19 ",$609.60 ,"$2,070.40 ","$2,199.80 ","$1,617.50 ","$2,329.20 ","$9,364.14 ","$2,458.60 ","$2,329.20 ","$2,199.80 ","$2,199.80 ",$609.60 ,"$2,199.80 ","$2,199.80 ","$2,329.20 ","$9,364.14 ","$1,086.96 ","$2,329.20 ","$6,507.63 ","$2,380.96 ","$2,329.20 ","$1,724.64 ","$1,724.64 ","$1,576.09 ","$1,724.64 ","$1,682.20 ","$1,802.54 ",$615.70 ,"$2,044.52 ","$9,925.99 ", N/A , N/A ,$609.60 , N/A ,"$2,892.28 ","$2,458.60 ","$2,122.16 ","$2,122.16 ","$2,070.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180194,26750,PC CLOSE RX DIST FINGR FX,981,1 ,$378.00 ,$189.00 ,$158.76 ,$830.08 ,$783.09 ,$319.75 ,$319.75 ,$202.55 ,$302.40 ,$321.30 ,$236.25 ,$340.20 ,$783.09 ,$359.10 ,$340.20 ,$321.30 ,$321.30 ,$202.55 ,$321.30 ,$321.30 ,$340.20 ,$783.09 ,$158.76 ,$340.20 ,$473.63 ,$347.76 ,$340.20 ,$251.90 ,$251.90 ,$230.20 ,$251.90 ,$245.70 ,$263.28 ,$204.58 ,$298.62 ,$830.08 , N/A , N/A ,$202.55 , N/A ,$210.50 ,$359.10 ,$309.96 ,$309.96 ,$302.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180195,26755,"PC CLOSE RX DIST FINGR FX,MANIPULATN",981,1 ,$736.00 ,$368.00 ,$210.50 ,$830.08 ,$783.09 ,$622.58 ,$622.58 ,$293.18 ,$588.80 ,$625.60 ,$460.00 ,$662.40 ,$783.09 ,$699.20 ,$662.40 ,$625.60 ,$625.60 ,$293.18 ,$625.60 ,$625.60 ,$662.40 ,$783.09 ,$309.12 ,$662.40 ,$473.63 ,$677.12 ,$662.40 ,$490.47 ,$490.47 ,$448.22 ,$490.47 ,$478.40 ,$512.62 ,$296.11 ,$581.44 ,$830.08 , N/A , N/A ,$293.18 , N/A ,$210.50 ,$699.20 ,$603.52 ,$603.52 ,$588.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180196,26756,PC PERCUT RX DIST FINGR FX,981,1 ,"$1,562.00 ",$781.00 ,$453.30 ,"$9,925.99 ","$9,364.14 ","$1,321.30 ","$1,321.30 ",$453.30 ,"$1,249.60 ","$1,327.70 ",$976.25 ,"$1,405.80 ","$9,364.14 ","$1,483.90 ","$1,405.80 ","$1,327.70 ","$1,327.70 ",$453.30 ,"$1,327.70 ","$1,327.70 ","$1,405.80 ","$9,364.14 ",$656.04 ,"$1,405.80 ","$6,507.63 ","$1,437.04 ","$1,405.80 ","$1,040.92 ","$1,040.92 ",$951.26 ,"$1,040.92 ","$1,015.30 ","$1,087.93 ",$457.83 ,"$1,233.98 ","$9,925.99 ", N/A , N/A ,$453.30 , N/A ,"$2,892.28 ","$1,483.90 ","$1,280.84 ","$1,280.84 ","$1,249.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180197,26770,PC CLOSED RX IP JT DISLOCATION,981,1 ,$384.00 ,$192.00 ,$161.28 ,$830.08 ,$783.09 ,$324.83 ,$324.83 ,$277.32 ,$307.20 ,$326.40 ,$240.00 ,$345.60 ,$783.09 ,$364.80 ,$345.60 ,$326.40 ,$326.40 ,$277.32 ,$326.40 ,$326.40 ,$345.60 ,$783.09 ,$161.28 ,$345.60 ,$473.63 ,$353.28 ,$345.60 ,$255.90 ,$255.90 ,$233.86 ,$255.90 ,$249.60 ,$267.46 ,$280.09 ,$303.36 ,$830.08 , N/A , N/A ,$277.32 , N/A ,$210.50 ,$364.80 ,$314.88 ,$314.88 ,$307.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180213,27265,PC CLOSED RX POST HIP ARTHRPLAS DISLOC,981,1 ,"$1,117.00 ",$558.50 ,$210.50 ,"$1,117.00 ",$783.09 ,$944.87 ,$944.87 ,$433.34 ,$893.60 ,$949.45 ,$698.13 ,"$1,005.30 ",$783.09 ,"$1,061.15 ","$1,005.30 ",$949.45 ,$949.45 ,$433.34 ,$949.45 ,$949.45 ,"$1,005.30 ",$783.09 ,$469.14 ,"$1,005.30 ",$473.63 ,"$1,027.64 ","$1,005.30 ",$744.37 ,$744.37 ,$680.25 ,$744.37 ,$726.05 ,$777.99 ,$437.67 ,$882.43 ,$830.08 , N/A , N/A ,$433.34 , N/A ,$210.50 ,"$1,061.15 ",$915.94 ,$915.94 ,$893.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180229,27550,PC CLOSED RX KNEE DISLOCATN,981,1 ,"$1,483.00 ",$741.50 ,$210.50 ,"$1,483.00 ",$783.09 ,"$1,254.47 ","$1,254.47 ",$500.85 ,"$1,186.40 ","$1,260.55 ",$926.88 ,"$1,334.70 ",$783.09 ,"$1,408.85 ","$1,334.70 ","$1,260.55 ","$1,260.55 ",$500.85 ,"$1,260.55 ","$1,260.55 ","$1,334.70 ",$783.09 ,$622.86 ,"$1,334.70 ",$473.63 ,"$1,364.36 ","$1,334.70 ",$988.27 ,$988.27 ,$903.15 ,$988.27 ,$963.95 ,"$1,032.91 ",$505.86 ,"$1,171.57 ",$830.08 , N/A , N/A ,$500.85 , N/A ,$210.50 ,"$1,408.85 ","$1,216.06 ","$1,216.06 ","$1,186.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180231,27560,PC CLOSED RX KNEECAP DISLOCATN,981,1 ,"$1,227.00 ",$613.50 ,$210.50 ,"$1,227.00 ",$783.09 ,"$1,037.92 ","$1,037.92 ",$358.68 ,$981.60 ,"$1,042.95 ",$766.88 ,"$1,104.30 ",$783.09 ,"$1,165.65 ","$1,104.30 ","$1,042.95 ","$1,042.95 ",$358.68 ,"$1,042.95 ","$1,042.95 ","$1,104.30 ",$783.09 ,$515.34 ,"$1,104.30 ",$473.63 ,"$1,128.84 ","$1,104.30 ",$817.67 ,$817.67 ,$747.24 ,$817.67 ,$797.55 ,$854.61 ,$362.27 ,$969.33 ,$830.08 , N/A , N/A ,$358.68 , N/A ,$210.50 ,"$1,165.65 ","$1,006.14 ","$1,006.14 ",$981.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180237,27760,PC CLOSED RX MED MALLEOLUS FX,981,1 ,"$1,306.00 ",$653.00 ,$210.50 ,"$1,306.00 ",$783.09 ,"$1,104.75 ","$1,104.75 ",$330.31 ,"$1,044.80 ","$1,110.10 ",$816.25 ,"$1,175.40 ",$783.09 ,"$1,240.70 ","$1,175.40 ","$1,110.10 ","$1,110.10 ",$330.31 ,"$1,110.10 ","$1,110.10 ","$1,175.40 ",$783.09 ,$548.52 ,"$1,175.40 ",$473.63 ,"$1,201.52 ","$1,175.40 ",$870.32 ,$870.32 ,$795.35 ,$870.32 ,$848.90 ,$909.63 ,$333.61 ,"$1,031.74 ",$830.08 , N/A , N/A ,$330.31 , N/A ,$210.50 ,"$1,240.70 ","$1,070.92 ","$1,070.92 ","$1,044.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180238,27762,"PC CLOSED RX MED MALLEOLUS FX,MANIP",981,1 ,"$1,985.00 ",$992.50 ,$464.03 ,"$3,200.65 ",$783.09 ,"$1,679.11 ","$1,679.11 ",$464.03 ,"$1,588.00 ","$1,687.25 ","$1,240.63 ","$1,786.50 ",$783.09 ,"$1,885.75 ","$1,786.50 ","$1,687.25 ","$1,687.25 ",$464.03 ,"$1,687.25 ","$1,687.25 ","$1,786.50 ",$783.09 ,$833.70 ,"$1,786.50 ","$3,200.65 ","$1,826.20 ","$1,786.50 ","$1,322.80 ","$1,322.80 ","$1,208.87 ","$1,322.80 ","$1,290.25 ","$1,382.55 ",$468.67 ,"$1,568.15 ",$830.08 , N/A , N/A ,$464.03 , N/A ,"$1,422.51 ","$1,885.75 ","$1,627.70 ","$1,627.70 ","$1,588.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180245,27810,"PC CLOSED RX BIMALLEOLAR FX,MANIP",981,1 ,"$4,045.00 ","$2,022.50 ",$451.66 ,"$4,045.00 ",$783.09 ,"$3,421.67 ","$3,421.67 ",$451.66 ,"$3,236.00 ","$3,438.25 ","$2,528.13 ","$3,640.50 ",$783.09 ,"$3,842.75 ","$3,640.50 ","$3,438.25 ","$3,438.25 ",$451.66 ,"$3,438.25 ","$3,438.25 ","$3,640.50 ",$783.09 ,"$1,698.90 ","$3,640.50 ","$3,200.65 ","$3,721.40 ","$3,640.50 ","$2,695.59 ","$2,695.59 ","$2,463.41 ","$2,695.59 ","$2,629.25 ","$2,817.34 ",$456.18 ,"$3,195.55 ",$830.08 , N/A , N/A ,$451.66 , N/A ,"$1,422.51 ","$3,842.75 ","$3,316.90 ","$3,316.90 ","$3,236.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180247,27818,"PC CLOSED RX TRIMALLEOLAR FX,MANIP",981,1 ,"$3,182.00 ","$1,591.00 ",$463.41 ,"$3,200.65 ",$783.09 ,"$2,691.65 ","$2,691.65 ",$463.41 ,"$2,545.60 ","$2,704.70 ","$1,988.75 ","$2,863.80 ",$783.09 ,"$3,022.90 ","$2,863.80 ","$2,704.70 ","$2,704.70 ",$463.41 ,"$2,704.70 ","$2,704.70 ","$2,863.80 ",$783.09 ,"$1,336.44 ","$2,863.80 ","$3,200.65 ","$2,927.44 ","$2,863.80 ","$2,120.48 ","$2,120.48 ","$1,937.84 ","$2,120.48 ","$2,068.30 ","$2,216.26 ",$468.04 ,"$2,513.78 ",$830.08 , N/A , N/A ,$463.41 , N/A ,"$1,422.51 ","$3,022.90 ","$2,609.24 ","$2,609.24 ","$2,545.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180250,27840,PC CLOSED RX ANKLE DISLOCATN,981,1 ,"$1,124.00 ",$562.00 ,$210.50 ,"$1,124.00 ",$783.09 ,$950.79 ,$950.79 ,$405.35 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ",$783.09 ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$405.35 ,$955.40 ,$955.40 ,"$1,011.60 ",$783.09 ,$472.08 ,"$1,011.60 ",$473.63 ,"$1,034.08 ","$1,011.60 ",$749.03 ,$749.03 ,$684.52 ,$749.03 ,$730.60 ,$782.87 ,$409.40 ,$887.96 ,$830.08 , N/A , N/A ,$405.35 , N/A ,$210.50 ,"$1,067.80 ",$921.68 ,$921.68 ,$899.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180253,28400,PC CLOSED RX HEEL FX,981,1 ,"$1,124.00 ",$562.00 ,$210.50 ,"$1,124.00 ",$783.09 ,$950.79 ,$950.79 ,$246.03 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ",$783.09 ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$246.03 ,$955.40 ,$955.40 ,"$1,011.60 ",$783.09 ,$472.08 ,"$1,011.60 ",$473.63 ,"$1,034.08 ","$1,011.60 ",$749.03 ,$749.03 ,$684.52 ,$749.03 ,$730.60 ,$782.87 ,$248.49 ,$887.96 ,$830.08 , N/A , N/A ,$246.03 , N/A ,$210.50 ,"$1,067.80 ",$921.68 ,$921.68 ,$899.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180254,28405,"PC CLOSED RX HEEL FX,MANIPULATN",981,1 ,"$2,023.00 ","$1,011.50 ",$210.50 ,"$2,023.00 ",$783.09 ,"$1,711.26 ","$1,711.26 ",$376.15 ,"$1,618.40 ","$1,719.55 ","$1,264.38 ","$1,820.70 ",$783.09 ,"$1,921.85 ","$1,820.70 ","$1,719.55 ","$1,719.55 ",$376.15 ,"$1,719.55 ","$1,719.55 ","$1,820.70 ",$783.09 ,$849.66 ,"$1,820.70 ",$473.63 ,"$1,861.16 ","$1,820.70 ","$1,348.13 ","$1,348.13 ","$1,232.01 ","$1,348.13 ","$1,314.95 ","$1,409.02 ",$379.91 ,"$1,598.17 ",$830.08 , N/A , N/A ,$376.15 , N/A ,$210.50 ,"$1,921.85 ","$1,658.86 ","$1,658.86 ","$1,618.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180255,28406,PC PERCUT RX HEEL FX,981,1 ,"$2,958.00 ","$1,479.00 ",$599.91 ,"$14,393.36 ","$9,364.14 ","$2,502.17 ","$2,502.17 ",$599.91 ,"$2,366.40 ","$2,514.30 ","$1,848.75 ","$2,662.20 ","$9,364.14 ","$2,810.10 ","$2,662.20 ","$2,514.30 ","$2,514.30 ",$599.91 ,"$2,514.30 ","$2,514.30 ","$2,662.20 ","$9,364.14 ","$1,242.36 ","$2,662.20 ","$14,393.36 ","$2,721.36 ","$2,662.20 ","$1,971.21 ","$1,971.21 ","$1,801.42 ","$1,971.21 ","$1,922.70 ","$2,060.25 ",$605.91 ,"$2,336.82 ","$9,925.99 ", N/A , N/A ,$599.91 , N/A ,"$6,397.05 ","$2,810.10 ","$2,425.56 ","$2,425.56 ","$2,366.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180264,28490,PC CLOSED RX BIG TOE FRACTURE,981,1 ,$467.00 ,$233.50 ,$133.10 ,$830.08 ,$783.09 ,$395.04 ,$395.04 ,$133.10 ,$373.60 ,$396.95 ,$291.88 ,$420.30 ,$783.09 ,$443.65 ,$420.30 ,$396.95 ,$396.95 ,$133.10 ,$396.95 ,$396.95 ,$420.30 ,$783.09 ,$196.14 ,$420.30 ,$473.63 ,$429.64 ,$420.30 ,$311.21 ,$311.21 ,$284.40 ,$311.21 ,$303.55 ,$325.27 ,$134.43 ,$368.93 ,$830.08 , N/A , N/A ,$133.10 , N/A ,$210.50 ,$443.65 ,$382.94 ,$382.94 ,$373.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180265,28495,"PC CLOSED RX BIG TOE FX,MANIP",981,1 ,$373.00 ,$186.50 ,$156.66 ,$830.08 ,$783.09 ,$315.52 ,$315.52 ,$159.78 ,$298.40 ,$317.05 ,$233.13 ,$335.70 ,$783.09 ,$354.35 ,$335.70 ,$317.05 ,$317.05 ,$159.78 ,$317.05 ,$317.05 ,$335.70 ,$783.09 ,$156.66 ,$335.70 ,$473.63 ,$343.16 ,$335.70 ,$248.57 ,$248.57 ,$227.16 ,$248.57 ,$242.45 ,$259.79 ,$161.38 ,$294.67 ,$830.08 , N/A , N/A ,$159.78 , N/A ,$210.50 ,$354.35 ,$305.86 ,$305.86 ,$298.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180266,28496,PC PERCUT BIG TOE FX,981,1 ,$847.00 ,$423.50 ,$260.27 ,"$9,925.99 ","$9,364.14 ",$716.48 ,$716.48 ,$260.27 ,$677.60 ,$719.95 ,$529.38 ,$762.30 ,"$9,364.14 ",$804.65 ,$762.30 ,$719.95 ,$719.95 ,$260.27 ,$719.95 ,$719.95 ,$762.30 ,"$9,364.14 ",$355.74 ,$762.30 ,"$6,507.63 ",$779.24 ,$762.30 ,$564.44 ,$564.44 ,$515.82 ,$564.44 ,$550.55 ,$589.94 ,$262.87 ,$669.13 ,"$9,925.99 ", N/A , N/A ,$260.27 , N/A ,"$2,892.28 ",$804.65 ,$694.54 ,$694.54 ,$677.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180267,28510,PC CLOSED RX TOE FX,981,1 ,$216.00 ,$108.00 ,$90.72 ,$830.08 ,$783.09 ,$182.71 ,$182.71 ,$128.14 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$783.09 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$128.14 ,$183.60 ,$183.60 ,$194.40 ,$783.09 ,$90.72 ,$194.40 ,$473.63 ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$129.42 ,$170.64 ,$830.08 , N/A , N/A ,$128.14 , N/A ,$210.50 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180268,28515,"PC CLOSED RX TOE FX,MANIPULATN",981,1 ,$622.00 ,$311.00 ,$153.08 ,$830.08 ,$783.09 ,$526.15 ,$526.15 ,$153.08 ,$497.60 ,$528.70 ,$388.75 ,$559.80 ,$783.09 ,$590.90 ,$559.80 ,$528.70 ,$528.70 ,$153.08 ,$528.70 ,$528.70 ,$559.80 ,$783.09 ,$261.24 ,$559.80 ,$473.63 ,$572.24 ,$559.80 ,$414.50 ,$414.50 ,$378.80 ,$414.50 ,$404.30 ,$433.22 ,$154.61 ,$491.38 ,$830.08 , N/A , N/A ,$153.08 , N/A ,$210.50 ,$590.90 ,$510.04 ,$510.04 ,$497.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180279,28660,"PC CLOSED RX I-P JT,TOE DISLOCATION",981,1 ,$508.00 ,$254.00 ,$97.52 ,$830.08 ,$783.09 ,$429.72 ,$429.72 ,$97.52 ,$406.40 ,$431.80 ,$317.50 ,$457.20 ,$783.09 ,$482.60 ,$457.20 ,$431.80 ,$431.80 ,$97.52 ,$431.80 ,$431.80 ,$457.20 ,$783.09 ,$213.36 ,$457.20 ,$473.63 ,$467.36 ,$457.20 ,$338.53 ,$338.53 ,$309.37 ,$338.53 ,$330.20 ,$353.82 ,$98.50 ,$401.32 ,$830.08 , N/A , N/A ,$97.52 , N/A ,$210.50 ,$482.60 ,$416.56 ,$416.56 ,$406.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180286,29105,PC APPLY LONG ARM SPLINT,981,1 ,$344.00 ,$172.00 ,$42.84 ,$344.00 ,$76.64 ,$290.99 ,$290.99 ,$42.84 ,$275.20 ,$292.40 ,$215.00 ,$309.60 ,$76.64 ,$326.80 ,$309.60 ,$292.40 ,$292.40 ,$42.84 ,$292.40 ,$292.40 ,$309.60 ,$76.64 ,$144.48 ,$309.60 ,$324.65 ,$316.48 ,$309.60 ,$229.24 ,$229.24 ,$209.50 ,$229.24 ,$223.60 ,$239.60 ,$43.27 ,$271.76 ,$81.24 , N/A , N/A ,$42.84 , N/A ,$144.29 ,$326.80 ,$282.08 ,$282.08 ,$275.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180287,29125,"PC APPLY FOREARM SPLINT,STATIC",981,1 ,$265.00 ,$132.50 ,$41.59 ,$265.00 ,$76.64 ,$224.16 ,$224.16 ,$41.59 ,$212.00 ,$225.25 ,$165.63 ,$238.50 ,$76.64 ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$41.59 ,$225.25 ,$225.25 ,$238.50 ,$76.64 ,$111.30 ,$238.50 ,$259.11 ,$243.80 ,$238.50 ,$176.60 ,$176.60 ,$161.39 ,$176.60 ,$172.25 ,$184.57 ,$42.01 ,$209.35 ,$81.24 , N/A , N/A ,$41.59 , N/A ,$115.16 ,$251.75 ,$217.30 ,$217.30 ,$212.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180288,29126,"PC APPLY FOREARM SPLINT,DYNAMIC",981,1 ,$352.00 ,$176.00 ,$51.60 ,$352.00 ,$76.64 ,$297.76 ,$297.76 ,$51.60 ,$281.60 ,$299.20 ,$220.00 ,$316.80 ,$76.64 ,$334.40 ,$316.80 ,$299.20 ,$299.20 ,$51.60 ,$299.20 ,$299.20 ,$316.80 ,$76.64 ,$147.84 ,$316.80 ,$259.11 ,$323.84 ,$316.80 ,$234.57 ,$234.57 ,$214.37 ,$234.57 ,$228.80 ,$245.17 ,$52.12 ,$278.08 ,$81.24 , N/A , N/A ,$51.60 , N/A ,$115.16 ,$334.40 ,$288.64 ,$288.64 ,$281.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180289,29130,"PC APPLY FINGER SPLINT,STATIC",981,1 ,$156.00 ,$78.00 ,$30.27 ,$259.11 ,$76.64 ,$131.96 ,$131.96 ,$30.27 ,$124.80 ,$132.60 ,$97.50 ,$140.40 ,$76.64 ,$148.20 ,$140.40 ,$132.60 ,$132.60 ,$30.27 ,$132.60 ,$132.60 ,$140.40 ,$76.64 ,$65.52 ,$140.40 ,$259.11 ,$143.52 ,$140.40 ,$103.96 ,$103.96 ,$95.00 ,$103.96 ,$101.40 ,$108.65 ,$30.57 ,$123.24 ,$81.24 , N/A , N/A ,$30.27 , N/A ,$115.16 ,$148.20 ,$127.92 ,$127.92 ,$124.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180290,29131,"PC APPLY FINGER SPLINT,DYNAMIC",981,1 ,$182.00 ,$91.00 ,$35.86 ,$182.00 ,$76.64 ,$153.95 ,$153.95 ,$35.86 ,$145.60 ,$154.70 ,$113.75 ,$163.80 ,$76.64 ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$35.86 ,$154.70 ,$154.70 ,$163.80 ,$76.64 ,$76.44 ,$163.80 ,$127.91 ,$167.44 ,$163.80 ,$121.28 ,$121.28 ,$110.84 ,$121.28 ,$118.30 ,$126.76 ,$36.22 ,$143.78 ,$81.24 , N/A , N/A ,$35.86 , N/A ,$56.85 ,$172.90 ,$149.24 ,$149.24 ,$145.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180291,29240,PC STRAPPING OF SHOULDER,981,1 ,$189.00 ,$94.50 ,$20.09 ,$259.11 ,$76.64 ,$159.88 ,$159.88 ,$20.09 ,$151.20 ,$160.65 ,$118.13 ,$170.10 ,$76.64 ,$179.55 ,$170.10 ,$160.65 ,$160.65 ,$20.09 ,$160.65 ,$160.65 ,$170.10 ,$76.64 ,$79.38 ,$170.10 ,$259.11 ,$173.88 ,$170.10 ,$125.95 ,$125.95 ,$115.10 ,$125.95 ,$122.85 ,$131.64 ,$20.29 ,$149.31 ,$81.24 , N/A , N/A ,$20.09 , N/A ,$115.16 ,$179.55 ,$154.98 ,$154.98 ,$151.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180292,29260,PC STRAPPING OF ELBOW OR WRIST,981,1 ,$86.00 ,$43.00 ,$20.69 ,$127.91 ,$76.64 ,$72.75 ,$72.75 ,$20.69 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$76.64 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$20.69 ,$73.10 ,$73.10 ,$77.40 ,$76.64 ,$36.12 ,$77.40 ,$127.91 ,$79.12 ,$77.40 ,$57.31 ,$57.31 ,$52.37 ,$57.31 ,$55.90 ,$59.90 ,$20.90 ,$67.94 ,$81.24 , N/A , N/A ,$20.69 , N/A ,$56.85 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180304,29505,PC APPLY LONG LEG SPLINT,981,1 ,$216.00 ,$108.00 ,$53.56 ,$324.65 ,$76.64 ,$182.71 ,$182.71 ,$53.56 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$76.64 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$53.56 ,$183.60 ,$183.60 ,$194.40 ,$76.64 ,$90.72 ,$194.40 ,$324.65 ,$198.72 ,$194.40 ,$143.94 ,$143.94 ,$131.54 ,$143.94 ,$140.40 ,$150.44 ,$54.10 ,$170.64 ,$81.24 , N/A , N/A ,$53.56 , N/A ,$144.29 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180305,29515,PC APPLY LOWER LEG SPLINT,981,1 ,$255.00 ,$127.50 ,$51.46 ,$324.65 ,$76.64 ,$215.70 ,$215.70 ,$51.46 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$76.64 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$51.46 ,$216.75 ,$216.75 ,$229.50 ,$76.64 ,$107.10 ,$229.50 ,$324.65 ,$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$51.97 ,$201.45 ,$81.24 , N/A , N/A ,$51.46 , N/A ,$144.29 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180321,30300,PC REMOVE NASAL FOREIGN BODY,981,1 ,$715.00 ,$357.50 ,$115.16 ,$715.00 ,$195.84 ,$604.82 ,$604.82 ,$134.03 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,$195.84 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$134.03 ,$607.75 ,$607.75 ,$643.50 ,$195.84 ,$300.30 ,$643.50 ,$259.11 ,$657.80 ,$643.50 ,$476.48 ,$476.48 ,$435.44 ,$476.48 ,$464.75 ,$498.00 ,$135.37 ,$564.85 ,$207.59 , N/A , N/A ,$134.03 , N/A ,$115.16 ,$679.25 ,$586.30 ,$586.30 ,$572.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180323,30801,"PC CAUTERIZATION, INNER NOSE",981,1 ,$715.00 ,$357.50 ,$166.62 ,"$3,108.47 ","$1,619.45 ",$604.82 ,$604.82 ,$166.62 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,"$1,619.45 ",$679.25 ,$643.50 ,$607.75 ,$607.75 ,$166.62 ,$607.75 ,$607.75 ,$643.50 ,"$1,619.45 ",$300.30 ,$643.50 ,"$3,108.47 ",$657.80 ,$643.50 ,$476.48 ,$476.48 ,$435.44 ,$476.48 ,$464.75 ,$498.00 ,$168.29 ,$564.85 ,"$1,716.62 ", N/A , N/A ,$166.62 , N/A ,"$1,381.54 ",$679.25 ,$586.30 ,$586.30 ,$572.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180324,30802,"PC CAUTER TURBINATE MUCOSA,INTRAMURAL",981,1 ,"$1,041.00 ",$520.50 ,$220.49 ,"$3,108.47 ","$1,619.45 ",$880.58 ,$880.58 ,$220.49 ,$832.80 ,$884.85 ,$650.63 ,$936.90 ,"$1,619.45 ",$988.95 ,$936.90 ,$884.85 ,$884.85 ,$220.49 ,$884.85 ,$884.85 ,$936.90 ,"$1,619.45 ",$437.22 ,$936.90 ,"$3,108.47 ",$957.72 ,$936.90 ,$693.72 ,$693.72 ,$633.97 ,$693.72 ,$676.65 ,$725.06 ,$222.69 ,$822.39 ,"$1,716.62 ", N/A , N/A ,$220.49 , N/A ,"$1,381.54 ",$988.95 ,$853.62 ,$853.62 ,$832.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180325,30901,"PC CTRL NOSEBLEED,ANTER,SIMPLE",981,1 ,$384.00 ,$192.00 ,$58.69 ,$384.00 ,$195.84 ,$324.83 ,$324.83 ,$58.69 ,$307.20 ,$326.40 ,$240.00 ,$345.60 ,$195.84 ,$364.80 ,$345.60 ,$326.40 ,$326.40 ,$58.69 ,$326.40 ,$326.40 ,$345.60 ,$195.84 ,$161.28 ,$345.60 ,$259.11 ,$353.28 ,$345.60 ,$255.90 ,$255.90 ,$233.86 ,$255.90 ,$249.60 ,$267.46 ,$59.28 ,$303.36 ,$207.59 , N/A , N/A ,$58.69 , N/A ,$115.16 ,$364.80 ,$314.88 ,$314.88 ,$307.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180326,30903,"PC CTRL NOSEBLEED,ANTER,COMPLEX",981,1 ,$635.00 ,$317.50 ,$80.08 ,$635.00 ,$195.84 ,$537.15 ,$537.15 ,$80.08 ,$508.00 ,$539.75 ,$396.88 ,$571.50 ,$195.84 ,$603.25 ,$571.50 ,$539.75 ,$539.75 ,$80.08 ,$539.75 ,$539.75 ,$571.50 ,$195.84 ,$266.70 ,$571.50 ,$259.11 ,$584.20 ,$571.50 ,$423.16 ,$423.16 ,$386.72 ,$423.16 ,$412.75 ,$442.28 ,$80.88 ,$501.65 ,$207.59 , N/A , N/A ,$80.08 , N/A ,$115.16 ,$603.25 ,$520.70 ,$520.70 ,$508.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180327,30905,PC CONTROL OF NOSEBLEED,981,1 ,"$1,105.00 ",$552.50 ,$109.47 ,"$1,105.00 ",$195.84 ,$934.72 ,$934.72 ,$109.47 ,$884.00 ,$939.25 ,$690.63 ,$994.50 ,$195.84 ,"$1,049.75 ",$994.50 ,$939.25 ,$939.25 ,$109.47 ,$939.25 ,$939.25 ,$994.50 ,$195.84 ,$464.10 ,$994.50 ,$259.11 ,"$1,016.60 ",$994.50 ,$736.37 ,$736.37 ,$672.95 ,$736.37 ,$718.25 ,$769.63 ,$110.56 ,$872.95 ,$207.59 , N/A , N/A ,$109.47 , N/A ,$115.16 ,"$1,049.75 ",$906.10 ,$906.10 ,$884.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180328,30906,PC REPEAT CONTROL OF NOSEBLEED,981,1 ,$780.00 ,$390.00 ,$141.79 ,$780.00 ,$195.84 ,$659.80 ,$659.80 ,$141.79 ,$624.00 ,$663.00 ,$487.50 ,$702.00 ,$195.84 ,$741.00 ,$702.00 ,$663.00 ,$663.00 ,$141.79 ,$663.00 ,$663.00 ,$702.00 ,$195.84 ,$327.60 ,$702.00 ,$486.16 ,$717.60 ,$702.00 ,$519.79 ,$519.79 ,$475.02 ,$519.79 ,$507.00 ,$543.27 ,$143.21 ,$616.20 ,$207.59 , N/A , N/A ,$141.79 , N/A ,$216.07 ,$741.00 ,$639.60 ,$639.60 ,$624.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180329,31500,PC INSERT EMERGENCY ENDOTRACH AIRWAY,981,1 ,$624.00 ,$312.00 ,$147.75 ,"$1,697.76 ","$1,601.66 ",$527.84 ,$527.84 ,$147.75 ,$499.20 ,$530.40 ,$390.00 ,$561.60 ,"$1,601.66 ",$592.80 ,$561.60 ,$530.40 ,$530.40 ,$147.75 ,$530.40 ,$530.40 ,$561.60 ,"$1,601.66 ",$262.08 ,$561.60 ,$486.16 ,$574.08 ,$561.60 ,$415.83 ,$415.83 ,$380.02 ,$415.83 ,$405.60 ,$434.62 ,$149.23 ,$492.96 ,"$1,697.76 ", N/A , N/A ,$147.75 , N/A ,$216.07 ,$592.80 ,$511.68 ,$511.68 ,$499.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180330,31502,PC TRACH TUBE CHANGE,981,1 ,$342.00 ,$171.00 ,$36.81 ,$486.16 ,$195.84 ,$289.30 ,$289.30 ,$36.81 ,$273.60 ,$290.70 ,$213.75 ,$307.80 ,$195.84 ,$324.90 ,$307.80 ,$290.70 ,$290.70 ,$36.81 ,$290.70 ,$290.70 ,$307.80 ,$195.84 ,$143.64 ,$307.80 ,$486.16 ,$314.64 ,$307.80 ,$227.91 ,$227.91 ,$208.28 ,$227.91 ,$222.30 ,$238.20 ,$37.18 ,$270.18 ,$207.59 , N/A , N/A ,$36.81 , N/A ,$216.07 ,$324.90 ,$280.44 ,$280.44 ,$273.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180345,32551,PC CHEST TUBE INSERTION,981,1 ,$660.00 ,$330.00 ,$161.38 ,"$3,231.36 ","$1,679.20 ",$558.29 ,$558.29 ,$161.38 ,$528.00 ,$561.00 ,$412.50 ,$594.00 ,"$1,679.20 ",$627.00 ,$594.00 ,$561.00 ,$561.00 ,$161.38 ,$561.00 ,$561.00 ,$594.00 ,"$1,679.20 ",$277.20 ,$594.00 ,"$3,231.36 ",$607.20 ,$594.00 ,$439.82 ,$439.82 ,$401.94 ,$439.82 ,$429.00 ,$459.69 ,$162.99 ,$521.40 ,"$1,779.95 ", N/A , N/A ,$161.38 , N/A ,"$1,436.16 ",$627.00 ,$541.20 ,$541.20 ,$528.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180349,43752,PC PLACEMENT NG/OG TUBE BY PHYSICIAN,981,1 ,$244.00 ,$122.00 ,$42.65 ,"$1,256.44 ","$1,185.32 ",$206.40 ,$206.40 ,$42.65 ,$195.20 ,$207.40 ,$152.50 ,$219.60 ,"$1,185.32 ",$231.80 ,$219.60 ,$207.40 ,$207.40 ,$42.65 ,$207.40 ,$207.40 ,$219.60 ,"$1,185.32 ",$102.48 ,$219.60 ,$623.66 ,$224.48 ,$219.60 ,$162.60 ,$162.60 ,$148.60 ,$162.60 ,$158.60 ,$169.95 ,$43.08 ,$192.76 ,"$1,256.44 ", N/A , N/A ,$42.65 , N/A ,$277.18 ,$231.80 ,$200.08 ,$200.08 ,$195.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180351,43761,PC REPOSITION GASTROSTOMY TUBE,981,1 ,$607.00 ,$303.50 ,$108.23 ,$611.48 ,$352.07 ,$513.46 ,$513.46 ,$108.23 ,$485.60 ,$515.95 ,$379.38 ,$546.30 ,$352.07 ,$576.65 ,$546.30 ,$515.95 ,$515.95 ,$108.23 ,$515.95 ,$515.95 ,$546.30 ,$352.07 ,$254.94 ,$546.30 ,$611.48 ,$558.44 ,$546.30 ,$404.50 ,$404.50 ,$369.66 ,$404.50 ,$394.55 ,$422.78 ,$109.31 ,$479.53 ,$373.19 , N/A , N/A ,$108.23 , N/A ,$271.77 ,$576.65 ,$497.74 ,$497.74 ,$485.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180354,59430,PC CARE AFTER DELIVERY ONLY,981,1 ,$590.00 ,$295.00 ,$180.20 ,$590.00 ,$434.39 ,$499.08 ,$499.08 ,$180.20 ,$472.00 ,$501.50 ,$368.75 ,$531.00 ,$434.39 ,$560.50 ,$531.00 ,$501.50 ,$501.50 ,$180.20 ,$501.50 ,$501.50 ,$531.00 ,$434.39 ,$247.80 ,$531.00 , N/A ,$542.80 ,$531.00 ,$393.18 ,$393.18 ,$359.31 ,$393.18 ,$383.50 ,$410.94 ,$182.00 ,$466.10 ,$460.45 , N/A , N/A ,$180.20 , N/A , N/A ,$560.50 ,$483.80 ,$483.80 ,$472.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180355,62270,"PC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC",981,1 ,$694.00 ,$347.00 ,$64.19 ,"$1,598.31 ","$1,507.84 ",$587.05 ,$587.05 ,$64.19 ,$555.20 ,$589.90 ,$433.75 ,$624.60 ,"$1,507.84 ",$659.30 ,$624.60 ,$589.90 ,$589.90 ,$64.19 ,$589.90 ,$589.90 ,$624.60 ,"$1,507.84 ",$291.48 ,$624.60 ,"$1,459.17 ",$638.48 ,$624.60 ,$462.48 ,$462.48 ,$422.65 ,$462.48 ,$451.10 ,$483.37 ,$64.83 ,$548.26 ,"$1,598.31 ", N/A , N/A ,$64.19 , N/A ,$648.52 ,$659.30 ,$569.08 ,$569.08 ,$555.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180356,67930,"PC SUTURE EYELID WOUND,PARTIAL THICK",981,1 ,"$1,340.00 ",$670.00 ,$250.31 ,"$4,598.33 ","$2,363.55 ","$1,133.51 ","$1,133.51 ",$250.31 ,"$1,072.00 ","$1,139.00 ",$837.50 ,"$1,206.00 ","$2,363.55 ","$1,273.00 ","$1,206.00 ","$1,139.00 ","$1,139.00 ",$250.31 ,"$1,139.00 ","$1,139.00 ","$1,206.00 ","$2,363.55 ",$562.80 ,"$1,206.00 ","$4,598.33 ","$1,232.80 ","$1,206.00 ",$892.98 ,$892.98 ,$816.06 ,$892.98 ,$871.00 ,$933.31 ,$252.81 ,"$1,058.60 ","$2,505.36 ", N/A , N/A ,$250.31 , N/A ,"$2,043.70 ","$1,273.00 ","$1,098.80 ","$1,098.80 ","$1,072.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180358,67938,"PC REMOVE EYELID FOREIGN BODY,EMBEDDED",981,1 ,"$1,050.00 ",$525.00 ,$124.98 ,"$1,050.00 ",$555.55 ,$888.20 ,$888.20 ,$124.98 ,$840.00 ,$892.50 ,$656.25 ,$945.00 ,$555.55 ,$997.50 ,$945.00 ,$892.50 ,$892.50 ,$124.98 ,$892.50 ,$892.50 ,$945.00 ,$555.55 ,$441.00 ,$945.00 ,$601.11 ,$966.00 ,$945.00 ,$699.72 ,$699.72 ,$639.45 ,$699.72 ,$682.50 ,$731.33 ,$126.23 ,$829.50 ,$588.88 , N/A , N/A ,$124.98 , N/A ,$267.16 ,$997.50 ,$861.00 ,$861.00 ,$840.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180370,90474,PC IMMUNE ADMIN ORAL/NASAL ADDL,981,1 ,$32.00 ,$16.00 ,$13.44 ,$71.86 ,$67.79 ,$27.07 ,$27.07 ,$13.60 ,$25.60 ,$27.20 ,$20.00 ,$28.80 ,$67.79 ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$13.60 ,$27.20 ,$27.20 ,$28.80 ,$67.79 ,$13.44 ,$28.80 , N/A ,$29.44 ,$28.80 ,$21.32 ,$21.32 ,$19.49 ,$21.32 ,$20.80 ,$22.29 ,$13.74 ,$25.28 ,$71.86 , N/A , N/A ,$13.60 , N/A , N/A ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180437,92950,PC HEART/LUNG RESUSCITATION (CPR),981,1 ,$930.00 ,$465.00 ,$195.78 ,"$1,697.76 ","$1,601.66 ",$786.69 ,$786.69 ,$195.78 ,$744.00 ,$790.50 ,$581.25 ,$837.00 ,"$1,601.66 ",$883.50 ,$837.00 ,$790.50 ,$790.50 ,$195.78 ,$790.50 ,$790.50 ,$837.00 ,"$1,601.66 ",$390.60 ,$837.00 ,$608.15 ,$855.60 ,$837.00 ,$619.75 ,$619.75 ,$566.37 ,$619.75 ,$604.50 ,$647.75 ,$197.74 ,$734.70 ,"$1,697.76 ", N/A , N/A ,$195.78 , N/A ,$270.29 ,$883.50 ,$762.60 ,$762.60 ,$744.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180438,92960,"PC CARDIOVERSION, ELECTIVE;EXTERN",981,1 ,$979.00 ,$489.50 ,$116.37 ,"$1,290.89 ","$1,138.88 ",$828.14 ,$828.14 ,$116.37 ,$783.20 ,$832.15 ,$611.88 ,$881.10 ,"$1,138.88 ",$930.05 ,$881.10 ,$832.15 ,$832.15 ,$116.37 ,$832.15 ,$832.15 ,$881.10 ,"$1,138.88 ",$411.18 ,$881.10 ,"$1,290.89 ",$900.68 ,$881.10 ,$652.41 ,$652.41 ,$596.21 ,$652.41 ,$636.35 ,$681.87 ,$117.53 ,$773.41 ,"$1,207.21 ", N/A , N/A ,$116.37 , N/A ,$573.73 ,$930.05 ,$802.78 ,$802.78 ,$783.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180454,96361,PC INTRAVENOUS INFUSION,981,1 ,$53.00 ,$26.50 ,$13.82 ,$958.24 ,$904.00 ,$44.83 ,$44.83 ,$13.82 ,$42.40 ,$45.05 ,$33.13 ,$47.70 ,$904.00 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$13.82 ,$45.05 ,$45.05 ,$47.70 ,$904.00 ,$22.26 ,$47.70 ,$91.96 ,$48.76 ,$47.70 ,$35.32 ,$35.32 ,$32.28 ,$35.32 ,$34.45 ,$36.91 ,$13.96 ,$41.87 ,$958.24 , N/A , N/A ,$13.82 , N/A ,$40.87 ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180460,96374,"PC INTRAVENOUS PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG",981,1 ,$169.00 ,$84.50 ,$42.26 ,$470.09 ,$77.89 ,$142.96 ,$142.96 ,$42.26 ,$135.20 ,$143.65 ,$105.63 ,$152.10 ,$77.89 ,$160.55 ,$152.10 ,$143.65 ,$143.65 ,$42.26 ,$143.65 ,$143.65 ,$152.10 ,$77.89 ,$70.98 ,$152.10 ,$470.09 ,$155.48 ,$152.10 ,$112.62 ,$112.62 ,$102.92 ,$112.62 ,$109.85 ,$117.71 ,$42.68 ,$133.51 ,$82.56 , N/A , N/A ,$42.26 , N/A ,$208.93 ,$160.55 ,$138.58 ,$138.58 ,$135.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180462,99175,PC INDUCTION OF VOMITING,981,1 ,$120.00 ,$60.00 ,$30.79 ,"$1,256.44 ","$1,185.32 ",$101.51 ,$101.51 ,$30.79 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,"$1,185.32 ",$114.00 ,$108.00 ,$102.00 ,$102.00 ,$30.79 ,$102.00 ,$102.00 ,$108.00 ,"$1,185.32 ",$50.40 ,$108.00 , N/A ,$110.40 ,$108.00 ,$79.97 ,$79.97 ,$73.08 ,$79.97 ,$78.00 ,$83.58 ,$31.10 ,$94.80 ,"$1,256.44 ", N/A , N/A ,$30.79 , N/A , N/A ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180463,99195,PC PHLEBOTOMY,981,1 ,$233.00 ,$116.50 ,$97.86 ,$259.11 ,$103.42 ,$197.09 ,$197.09 ,$108.15 ,$186.40 ,$198.05 ,$145.63 ,$209.70 ,$103.42 ,$221.35 ,$209.70 ,$198.05 ,$198.05 ,$108.15 ,$198.05 ,$198.05 ,$209.70 ,$103.42 ,$97.86 ,$209.70 ,$259.11 ,$214.36 ,$209.70 ,$155.27 ,$155.27 ,$141.90 ,$155.27 ,$151.45 ,$162.28 ,$109.23 ,$184.07 ,$109.63 , N/A , N/A ,$108.15 , N/A ,$115.16 ,$221.35 ,$191.06 ,$191.06 ,$186.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180464,99281,"PC EMERGENCY DEPT VISIT,LEVEL I",981,1 ,$137.00 ,$68.50 ,$23.20 ,$227.45 ,$214.58 ,$115.89 ,$115.89 ,$23.20 ,$109.60 ,$116.45 ,$85.63 ,$123.30 ,$214.58 ,$130.15 ,$123.30 ,$116.45 ,$116.45 ,$23.20 ,$116.45 ,$116.45 ,$123.30 ,$214.58 ,$57.54 ,$123.30 ,$166.68 ,$126.04 ,$123.30 ,$91.30 ,$91.30 ,$83.43 ,$91.30 ,$89.05 ,$95.42 ,$23.43 ,$108.23 ,$227.45 , N/A , N/A ,$23.20 , N/A ,$74.08 ,$130.15 ,$112.34 ,$112.34 ,$109.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180465,99282,"PC EMERGENCY DEPT VISIT,LEVEL II",981,1 ,$190.00 ,$95.00 ,$44.86 ,$301.84 ,$214.58 ,$160.72 ,$160.72 ,$44.86 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$214.58 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$44.86 ,$161.50 ,$161.50 ,$171.00 ,$214.58 ,$79.80 ,$171.00 ,$301.84 ,$174.80 ,$171.00 ,$126.62 ,$126.62 ,$115.71 ,$126.62 ,$123.50 ,$132.34 ,$45.31 ,$150.10 ,$227.45 , N/A , N/A ,$44.86 , N/A ,$134.15 ,$180.50 ,$155.80 ,$155.80 ,$152.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180466,99283,"PC EMERGENCY DEPT VISIT,LEVEL III",981,1 ,$290.00 ,$145.00 ,$76.13 ,$531.79 ,$214.58 ,$245.31 ,$245.31 ,$76.13 ,$232.00 ,$246.50 ,$181.25 ,$261.00 ,$214.58 ,$275.50 ,$261.00 ,$246.50 ,$246.50 ,$76.13 ,$246.50 ,$246.50 ,$261.00 ,$214.58 ,$121.80 ,$261.00 ,$531.79 ,$266.80 ,$261.00 ,$193.26 ,$193.26 ,$176.61 ,$193.26 ,$188.50 ,$201.99 ,$76.89 ,$229.10 ,$227.45 , N/A , N/A ,$76.13 , N/A ,$236.35 ,$275.50 ,$237.80 ,$237.80 ,$232.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180467,99284,"PC EMERGENCY DEPT VISIT,LEVEL IV",981,1 ,$400.00 ,$200.00 ,$129.12 ,$835.92 ,$214.58 ,$338.36 ,$338.36 ,$129.12 ,$320.00 ,$340.00 ,$250.00 ,$360.00 ,$214.58 ,$380.00 ,$360.00 ,$340.00 ,$340.00 ,$129.12 ,$340.00 ,$340.00 ,$360.00 ,$214.58 ,$168.00 ,$360.00 ,$835.92 ,$368.00 ,$360.00 ,$266.56 ,$266.56 ,$243.60 ,$266.56 ,$260.00 ,$278.60 ,$130.41 ,$316.00 ,$227.45 , N/A , N/A ,$129.12 , N/A ,$371.52 ,$380.00 ,$328.00 ,$328.00 ,$320.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180468,99285,"PC EMERGENCY DEPT VISIT,LEVEL V",981,1 ,$600.00 ,$300.00 ,$187.24 ,"$1,199.86 ",$214.58 ,$507.54 ,$507.54 ,$187.24 ,$480.00 ,$510.00 ,$375.00 ,$540.00 ,$214.58 ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$187.24 ,$510.00 ,$510.00 ,$540.00 ,$214.58 ,$252.00 ,$540.00 ,"$1,199.86 ",$552.00 ,$540.00 ,$399.84 ,$399.84 ,$365.40 ,$399.84 ,$390.00 ,$417.90 ,$189.11 ,$474.00 ,$227.45 , N/A , N/A ,$187.24 , N/A ,$533.27 ,$570.00 ,$492.00 ,$492.00 ,$480.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180469,99291,"PC CRITICAL CARE, E/M 30-74 MINUTES",981,1 ,$879.00 ,$439.50 ,$214.58 ,"$1,711.67 ",$214.58 ,$743.55 ,$743.55 ,$230.97 ,$703.20 ,$747.15 ,$549.38 ,$791.10 ,$214.58 ,$835.05 ,$791.10 ,$747.15 ,$747.15 ,$230.97 ,$747.15 ,$747.15 ,$791.10 ,$214.58 ,$369.18 ,$791.10 ,"$1,711.67 ",$808.68 ,$791.10 ,$585.77 ,$585.77 ,$535.31 ,$585.77 ,$571.35 ,$612.22 ,$233.28 ,$694.41 ,$227.45 , N/A , N/A ,$230.97 , N/A ,$760.74 ,$835.05 ,$720.78 ,$720.78 ,$703.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180470,99292,"PC CRITICAL CARE, ADDL 30 MIN",981,1 ,$416.00 ,$208.00 ,$115.91 ,$416.00 ,$214.58 ,$351.89 ,$351.89 ,$115.91 ,$332.80 ,$353.60 ,$260.00 ,$374.40 ,$214.58 ,$395.20 ,$374.40 ,$353.60 ,$353.60 ,$115.91 ,$353.60 ,$353.60 ,$374.40 ,$214.58 ,$174.72 ,$374.40 , N/A ,$382.72 ,$374.40 ,$277.22 ,$277.22 ,$253.34 ,$277.22 ,$270.40 ,$289.74 ,$117.07 ,$328.64 ,$227.45 , N/A , N/A ,$115.91 , N/A , N/A ,$395.20 ,$341.12 ,$341.12 ,$332.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180471,99471,PC INIT.PEDIATRIC CRITICAL CARE,981,1 ,"$2,720.00 ","$1,360.00 ",$846.94 ,"$2,720.00 ", N/A ,"$2,300.85 ","$2,300.85 ",$846.94 ,"$2,176.00 ","$2,312.00 ","$1,700.00 ","$2,448.00 ", N/A ,"$2,584.00 ","$2,448.00 ","$2,312.00 ","$2,312.00 ",$846.94 ,"$2,312.00 ","$2,312.00 ","$2,448.00 ", N/A ,"$1,142.40 ","$2,448.00 ", N/A ,"$2,502.40 ","$2,448.00 ","$1,812.61 ","$1,812.61 ","$1,656.48 ","$1,812.61 ","$1,768.00 ","$1,894.48 ",$855.41 ,"$2,148.80 ", N/A , N/A , N/A ,$846.94 , N/A , N/A ,"$2,584.00 ","$2,230.40 ","$2,230.40 ","$2,176.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180477,28190,PC REMOVE FB FOOT,981,1 ,$873.00 ,$436.50 ,$141.53 ,"$1,429.97 ",$785.45 ,$738.47 ,$738.47 ,$141.53 ,$698.40 ,$742.05 ,$545.63 ,$785.70 ,$785.45 ,$829.35 ,$785.70 ,$742.05 ,$742.05 ,$141.53 ,$742.05 ,$742.05 ,$785.70 ,$785.45 ,$366.66 ,$785.70 ,"$1,429.97 ",$803.16 ,$785.70 ,$581.77 ,$581.77 ,$531.66 ,$581.77 ,$567.45 ,$608.04 ,$142.95 ,$689.67 ,$832.58 , N/A , N/A ,$141.53 , N/A ,$635.54 ,$829.35 ,$715.86 ,$715.86 ,$698.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180478,65222,PC REMOVE FB EYE CORNEAL SLIT LAMP,981,1 ,$345.00 ,$172.50 ,$53.94 ,$345.00 ,$128.25 ,$291.84 ,$291.84 ,$53.94 ,$276.00 ,$293.25 ,$215.63 ,$310.50 ,$128.25 ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$53.94 ,$293.25 ,$293.25 ,$310.50 ,$128.25 ,$144.90 ,$310.50 ,$259.11 ,$317.40 ,$310.50 ,$229.91 ,$229.91 ,$210.11 ,$229.91 ,$224.25 ,$240.29 ,$54.48 ,$272.55 ,$135.95 , N/A , N/A ,$53.94 , N/A ,$115.16 ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180479,69209,"PC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL",981,1 ,$43.00 ,$21.50 ,$16.18 ,$207.59 ,$195.84 ,$36.37 ,$36.37 ,$16.18 ,$34.40 ,$36.55 ,$26.88 ,$38.70 ,$195.84 ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$16.18 ,$36.55 ,$36.55 ,$38.70 ,$195.84 ,$18.06 ,$38.70 ,$127.91 ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 ,$16.34 ,$33.97 ,$207.59 , N/A , N/A ,$16.18 , N/A ,$56.85 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180498,11760,PC REPAIR NAIL BED,981,1 ,$353.07 ,$176.54 ,$115.63 ,"$1,203.50 ",$115.63 ,$298.66 ,$298.66 ,$118.05 ,$282.46 ,$300.11 ,$220.67 ,$317.76 ,$115.63 ,$335.42 ,$317.76 ,$300.11 ,$300.11 ,$118.05 ,$300.11 ,$300.11 ,$317.76 ,$115.63 ,$148.29 ,$317.76 ,"$1,203.50 ",$324.82 ,$317.76 ,$235.29 ,$235.29 ,$215.02 ,$235.29 ,$229.50 ,$245.91 ,$119.23 ,$278.93 ,$122.57 , N/A , N/A ,$118.05 , N/A ,$534.89 ,$335.42 ,$289.52 ,$289.52 ,$282.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180507,20552,PC INJ TRIGGER PT 1-2 MUSCLE,981,1 ,$107.37 ,$53.69 ,$39.76 ,$600.37 ,$424.03 ,$90.82 ,$90.82 ,$39.76 ,$85.90 ,$91.26 ,$67.11 ,$96.63 ,$424.03 ,$102.00 ,$96.63 ,$91.26 ,$91.26 ,$39.76 ,$91.26 ,$91.26 ,$96.63 ,$424.03 ,$45.10 ,$96.63 ,$600.37 ,$98.78 ,$96.63 ,$71.55 ,$71.55 ,$65.39 ,$71.55 ,$69.79 ,$74.78 ,$40.16 ,$84.82 ,$449.47 , N/A , N/A ,$39.76 , N/A ,$266.83 ,$102.00 ,$88.04 ,$88.04 ,$85.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180512,26418,PC RPR EXTEN TENDON FNGR W/O FREE,981,1 ,"$1,847.00 ",$923.50 ,$681.37 ,"$3,200.65 ","$2,334.70 ","$1,562.38 ","$1,562.38 ",$681.37 ,"$1,477.60 ","$1,569.95 ","$1,154.38 ","$1,662.30 ","$2,334.70 ","$1,754.65 ","$1,662.30 ","$1,569.95 ","$1,569.95 ",$681.37 ,"$1,569.95 ","$1,569.95 ","$1,662.30 ","$2,334.70 ",$775.74 ,"$1,662.30 ","$3,200.65 ","$1,699.24 ","$1,662.30 ","$1,230.84 ","$1,230.84 ","$1,124.82 ","$1,230.84 ","$1,200.55 ","$1,286.44 ",$688.18 ,"$1,459.13 ","$2,474.78 ", N/A , N/A ,$681.37 , N/A ,"$1,422.51 ","$1,754.65 ","$1,514.54 ","$1,514.54 ","$1,477.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180524,36400,PC IV START < 3 YEARS OLD,981,1 ,$274.00 ,$137.00 ,$4.12 ,$274.00 ,$4.12 ,$231.78 ,$231.78 ,$20.29 ,$219.20 ,$232.90 ,$171.25 ,$246.60 ,$4.12 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$20.29 ,$232.90 ,$232.90 ,$246.60 ,$4.12 ,$115.08 ,$246.60 , N/A ,$252.08 ,$246.60 ,$182.59 ,$182.59 ,$166.87 ,$182.59 ,$178.10 ,$190.84 ,$20.49 ,$216.46 ,$4.37 , N/A , N/A ,$20.29 , N/A , N/A ,$260.30 ,$224.68 ,$224.68 ,$219.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180527,36410,PC VENIPUNCTURE > AGE 3,981,1 ,$107.00 ,$53.50 ,$9.77 ,$109.63 ,$103.42 ,$90.51 ,$90.51 ,$9.77 ,$85.60 ,$90.95 ,$66.88 ,$96.30 ,$103.42 ,$101.65 ,$96.30 ,$90.95 ,$90.95 ,$9.77 ,$90.95 ,$90.95 ,$96.30 ,$103.42 ,$44.94 ,$96.30 , N/A ,$98.44 ,$96.30 ,$71.30 ,$71.30 ,$65.16 ,$71.30 ,$69.55 ,$74.53 ,$9.87 ,$84.53 ,$109.63 , N/A , N/A ,$9.77 , N/A , N/A ,$101.65 ,$87.74 ,$87.74 ,$85.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180532,36680,PC PLACE NDL INFS INTRAOSSEOUS,981,1 ,$541.00 ,$270.50 ,$60.72 ,$623.66 ,$424.03 ,$457.63 ,$457.63 ,$60.72 ,$432.80 ,$459.85 ,$338.13 ,$486.90 ,$424.03 ,$513.95 ,$486.90 ,$459.85 ,$459.85 ,$60.72 ,$459.85 ,$459.85 ,$486.90 ,$424.03 ,$227.22 ,$486.90 ,$623.66 ,$497.72 ,$486.90 ,$360.52 ,$360.52 ,$329.47 ,$360.52 ,$351.65 ,$376.81 ,$61.33 ,$427.39 ,$449.47 , N/A , N/A ,$60.72 , N/A ,$277.18 ,$513.95 ,$443.62 ,$443.62 ,$432.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180539,41250,PC RPR LAC MOUTH/TONGUE <2.5CM,981,1 ,"$1,120.50 ",$560.25 ,$160.17 ,"$1,120.50 ",$195.84 ,$947.83 ,$947.83 ,$160.17 ,$896.40 ,$952.43 ,$700.31 ,"$1,008.45 ",$195.84 ,"$1,064.48 ","$1,008.45 ",$952.43 ,$952.43 ,$160.17 ,$952.43 ,$952.43 ,"$1,008.45 ",$195.84 ,$470.61 ,"$1,008.45 ",$623.66 ,"$1,030.86 ","$1,008.45 ",$746.70 ,$746.70 ,$682.38 ,$746.70 ,$728.33 ,$780.43 ,$161.77 ,$885.20 ,$207.59 , N/A , N/A ,$160.17 , N/A ,$277.18 ,"$1,064.48 ",$918.81 ,$918.81 ,$896.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180542,41800,PC DRAIN ABSC/CYST/HEMAT DENTOALVLR,981,1 ,$803.00 ,$401.50 ,$115.16 ,$803.00 ,$195.84 ,$679.26 ,$679.26 ,$163.61 ,$642.40 ,$682.55 ,$501.88 ,$722.70 ,$195.84 ,$762.85 ,$722.70 ,$682.55 ,$682.55 ,$163.61 ,$682.55 ,$682.55 ,$722.70 ,$195.84 ,$337.26 ,$722.70 ,$259.11 ,$738.76 ,$722.70 ,$535.12 ,$535.12 ,$489.03 ,$535.12 ,$521.95 ,$559.29 ,$165.25 ,$634.37 ,$207.59 , N/A , N/A ,$163.61 , N/A ,$115.16 ,$762.85 ,$658.46 ,$658.46 ,$642.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180555,46050,PC I AND D PERIANAL ABSCESS SUPFIC,981,1 ,"$2,381.00 ","$1,190.50 ",$105.58 ,"$2,752.52 ","$2,596.72 ","$2,014.09 ","$2,014.09 ",$105.58 ,"$1,904.80 ","$2,023.85 ","$1,488.13 ","$2,142.90 ","$2,596.72 ","$2,261.95 ","$2,142.90 ","$2,023.85 ","$2,023.85 ",$105.58 ,"$2,023.85 ","$2,023.85 ","$2,142.90 ","$2,596.72 ","$1,000.02 ","$2,142.90 ","$1,823.58 ","$2,190.52 ","$2,142.90 ","$1,586.70 ","$1,586.70 ","$1,450.03 ","$1,586.70 ","$1,547.65 ","$1,658.37 ",$106.64 ,"$1,880.99 ","$2,752.52 ", N/A , N/A ,$105.58 , N/A ,$810.48 ,"$2,261.95 ","$1,952.42 ","$1,952.42 ","$1,904.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180577,56405,PC I AND D ABSCESS VULVA/PERINEAL,981,1 ,$650.00 ,$325.00 ,$135.83 ,$650.00 ,$347.75 ,$549.84 ,$549.84 ,$135.83 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$347.75 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$135.83 ,$552.50 ,$552.50 ,$585.00 ,$347.75 ,$273.00 ,$585.00 ,$648.09 ,$598.00 ,$585.00 ,$433.16 ,$433.16 ,$395.85 ,$433.16 ,$422.50 ,$452.73 ,$137.19 ,$513.50 ,$368.62 , N/A , N/A ,$135.83 , N/A ,$288.04 ,$617.50 ,$533.00 ,$533.00 ,$520.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180578,56420,PC I AND D ABSCESS GLAND BARTHOLINS,981,1 ,$496.00 ,$248.00 ,$118.56 ,$496.00 ,$347.75 ,$419.57 ,$419.57 ,$118.56 ,$396.80 ,$421.60 ,$310.00 ,$446.40 ,$347.75 ,$471.20 ,$446.40 ,$421.60 ,$421.60 ,$118.56 ,$421.60 ,$421.60 ,$446.40 ,$347.75 ,$208.32 ,$446.40 ,$391.48 ,$456.32 ,$446.40 ,$330.53 ,$330.53 ,$302.06 ,$330.53 ,$322.40 ,$345.46 ,$119.75 ,$391.84 ,$368.62 , N/A , N/A ,$118.56 , N/A ,$173.99 ,$471.20 ,$406.72 ,$406.72 ,$396.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180590,64400,PC INJ ANES NERVE TRIGEMINAL,981,1 ,$363.00 ,$181.50 ,$51.08 ,$813.40 ,$767.36 ,$307.06 ,$307.06 ,$51.08 ,$290.40 ,$308.55 ,$226.88 ,$326.70 ,$767.36 ,$344.85 ,$326.70 ,$308.55 ,$308.55 ,$51.08 ,$308.55 ,$308.55 ,$326.70 ,$767.36 ,$152.46 ,$326.70 ,$600.37 ,$333.96 ,$326.70 ,$241.90 ,$241.90 ,$221.07 ,$241.90 ,$235.95 ,$252.83 ,$51.59 ,$286.77 ,$813.40 , N/A , N/A ,$51.08 , N/A ,$266.83 ,$344.85 ,$297.66 ,$297.66 ,$290.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180592,64405,PC INJ ANES NERVE OCCIPITAL,981,1 ,$286.00 ,$143.00 ,$53.82 ,$813.40 ,$767.36 ,$241.93 ,$241.93 ,$53.82 ,$228.80 ,$243.10 ,$178.75 ,$257.40 ,$767.36 ,$271.70 ,$257.40 ,$243.10 ,$243.10 ,$53.82 ,$243.10 ,$243.10 ,$257.40 ,$767.36 ,$120.12 ,$257.40 ,$600.37 ,$263.12 ,$257.40 ,$190.59 ,$190.59 ,$174.17 ,$190.59 ,$185.90 ,$199.20 ,$54.36 ,$225.94 ,$813.40 , N/A , N/A ,$53.82 , N/A ,$266.83 ,$271.70 ,$234.52 ,$234.52 ,$228.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180593,64420,PC INJ ANES NERVE INTERCOSTAL SINGLE,981,1 ,$420.00 ,$210.00 ,$62.83 ,"$1,459.17 ",$767.36 ,$355.28 ,$355.28 ,$62.83 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$767.36 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$62.83 ,$357.00 ,$357.00 ,$378.00 ,$767.36 ,$176.40 ,$378.00 ,"$1,459.17 ",$386.40 ,$378.00 ,$279.89 ,$279.89 ,$255.78 ,$279.89 ,$273.00 ,$292.53 ,$63.46 ,$331.80 ,$813.40 , N/A , N/A ,$62.83 , N/A ,$648.52 ,$399.00 ,$344.40 ,$344.40 ,$336.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180594,64421,PC INJ ANES NERVE INTERCOSTAL MULTIPLE,981,1 ,$533.00 ,$266.50 ,$26.52 ,"$2,167.48 ","$2,044.79 ",$450.86 ,$450.86 ,$26.52 ,$426.40 ,$453.05 ,$333.13 ,$479.70 ,"$2,044.79 ",$506.35 ,$479.70 ,$453.05 ,$453.05 ,$26.52 ,$453.05 ,$453.05 ,$479.70 ,"$2,044.79 ",$223.86 ,$479.70 ,"$1,891.64 ",$490.36 ,$479.70 ,$355.19 ,$355.19 ,$324.60 ,$355.19 ,$346.45 ,$371.23 ,$26.79 ,$421.07 ,"$2,167.48 ", N/A , N/A ,$26.52 , N/A ,$840.73 ,$506.35 ,$437.06 ,$437.06 ,$426.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180596,64447,PC INJ ANES NERVE FEMORAL SGL,981,1 ,$255.00 ,$127.50 ,$56.45 ,"$1,459.17 ",$767.36 ,$215.70 ,$215.70 ,$56.45 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$767.36 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$56.45 ,$216.75 ,$216.75 ,$229.50 ,$767.36 ,$107.10 ,$229.50 ,"$1,459.17 ",$234.60 ,$229.50 ,$169.93 ,$169.93 ,$155.30 ,$169.93 ,$165.75 ,$177.61 ,$57.01 ,$201.45 ,$813.40 , N/A , N/A ,$56.45 , N/A ,$648.52 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180600,69000,PC DRAIN ABSC/HEMA EAR EXT SMP,981,1 ,"$1,140.00 ",$570.00 ,$131.61 ,"$1,429.97 ",$195.84 ,$964.33 ,$964.33 ,$131.61 ,$912.00 ,$969.00 ,$712.50 ,"$1,026.00 ",$195.84 ,"$1,083.00 ","$1,026.00 ",$969.00 ,$969.00 ,$131.61 ,$969.00 ,$969.00 ,"$1,026.00 ",$195.84 ,$478.80 ,"$1,026.00 ","$1,429.97 ","$1,048.80 ","$1,026.00 ",$759.70 ,$759.70 ,$694.26 ,$759.70 ,$741.00 ,$794.01 ,$132.93 ,$900.60 ,$207.59 , N/A , N/A ,$131.61 , N/A ,$635.54 ,"$1,083.00 ",$934.80 ,$934.80 ,$912.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180602,69200,PC REM FOREIGN BODY CANAL AUD EXT,981,1 ,$417.00 ,$208.50 ,$49.73 ,$417.00 ,$195.84 ,$352.74 ,$352.74 ,$49.73 ,$333.60 ,$354.45 ,$260.63 ,$375.30 ,$195.84 ,$396.15 ,$375.30 ,$354.45 ,$354.45 ,$49.73 ,$354.45 ,$354.45 ,$375.30 ,$195.84 ,$175.14 ,$375.30 ,$259.11 ,$383.64 ,$375.30 ,$277.89 ,$277.89 ,$253.95 ,$277.89 ,$271.05 ,$290.44 ,$50.23 ,$329.43 ,$207.59 , N/A , N/A ,$49.73 , N/A ,$115.16 ,$396.15 ,$341.94 ,$341.94 ,$333.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180607,99151,PC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,981,1 ,$262.00 ,$131.00 ,$26.78 ,$262.00 ,$42.16 ,$221.63 ,$221.63 ,$26.78 ,$209.60 ,$222.70 ,$163.75 ,$235.80 ,$42.16 ,$248.90 ,$235.80 ,$222.70 ,$222.70 ,$26.78 ,$222.70 ,$222.70 ,$235.80 ,$42.16 ,$110.04 ,$235.80 , N/A ,$241.04 ,$235.80 ,$174.60 ,$174.60 ,$159.56 ,$174.60 ,$170.30 ,$182.48 ,$27.05 ,$206.98 ,$44.69 , N/A , N/A ,$26.78 , N/A , N/A ,$248.90 ,$214.84 ,$214.84 ,$209.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180608,99152,PC MODERATE SEDATION SAME PHY >5HY 1ST 15MIN,981,1 ,$165.00 ,$82.50 ,$13.07 ,$165.00 ,$42.16 ,$139.57 ,$139.57 ,$13.07 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$42.16 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$13.07 ,$140.25 ,$140.25 ,$148.50 ,$42.16 ,$69.30 ,$148.50 , N/A ,$151.80 ,$148.50 ,$109.96 ,$109.96 ,$100.49 ,$109.96 ,$107.25 ,$114.92 ,$13.20 ,$130.35 ,$44.69 , N/A , N/A ,$13.07 , N/A , N/A ,$156.75 ,$135.30 ,$135.30 ,$132.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180609,99153,PC MODERATE SEDATION SAME PHY EA ADDL 15MIN,981,1 ,$57.00 ,$28.50 ,$11.18 ,$57.00 ,$42.16 ,$48.22 ,$48.22 ,$11.18 ,$45.60 ,$48.45 ,$35.63 ,$51.30 ,$42.16 ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$11.18 ,$48.45 ,$48.45 ,$51.30 ,$42.16 ,$23.94 ,$51.30 , N/A ,$52.44 ,$51.30 ,$37.98 ,$37.98 ,$34.71 ,$37.98 ,$37.05 ,$39.70 ,$11.29 ,$45.03 ,$44.69 , N/A , N/A ,$11.18 , N/A , N/A ,$54.15 ,$46.74 ,$46.74 ,$45.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180858,11730,PC AVULSION NAIL PLATE SINGLE,981,1 ,$165.00 ,$82.50 ,$57.43 ,$412.65 ,$115.63 ,$139.57 ,$139.57 ,$57.43 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$115.63 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$57.43 ,$140.25 ,$140.25 ,$148.50 ,$115.63 ,$69.30 ,$148.50 ,$412.65 ,$151.80 ,$148.50 ,$109.96 ,$109.96 ,$100.49 ,$109.96 ,$107.25 ,$114.92 ,$58.00 ,$130.35 ,$122.57 , N/A , N/A ,$57.43 , N/A ,$183.40 ,$156.75 ,$135.30 ,$135.30 ,$132.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180947,G0425,PC TELEHEALTH CONSULT 30 MIN,981,1 ,$300.00 ,$150.00 ,$106.35 ,$300.00 ,$214.58 ,$253.77 ,$253.77 , N/A ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$214.58 ,$285.00 ,$270.00 ,$255.00 ,$255.00 , N/A ,$255.00 ,$255.00 ,$270.00 ,$214.58 ,$126.00 ,$270.00 , N/A ,$276.00 ,$270.00 ,$199.92 ,$199.92 ,$182.70 ,$199.92 ,$195.00 ,$208.95 ,$106.35 ,$237.00 ,$227.45 , N/A , N/A , N/A , N/A , N/A ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180948,G0426,PC TELEHEALTH CONSULT 50 MIN,981,1 ,$400.00 ,$200.00 ,$144.54 ,$400.00 ,$214.58 ,$338.36 ,$338.36 , N/A ,$320.00 ,$340.00 ,$250.00 ,$360.00 ,$214.58 ,$380.00 ,$360.00 ,$340.00 ,$340.00 , N/A ,$340.00 ,$340.00 ,$360.00 ,$214.58 ,$168.00 ,$360.00 , N/A ,$368.00 ,$360.00 ,$266.56 ,$266.56 ,$243.60 ,$266.56 ,$260.00 ,$278.60 ,$144.54 ,$316.00 ,$227.45 , N/A , N/A , N/A , N/A , N/A ,$380.00 ,$328.00 ,$328.00 ,$320.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180949,G0427,PC TELEHEALTH CONSULT 70 MIN,981,1 ,$500.00 ,$250.00 ,$210.00 ,$500.00 ,$214.58 ,$422.95 ,$422.95 , N/A ,$400.00 ,$425.00 ,$312.50 ,$450.00 ,$214.58 ,$475.00 ,$450.00 ,$425.00 ,$425.00 , N/A ,$425.00 ,$425.00 ,$450.00 ,$214.58 ,$210.00 ,$450.00 , N/A ,$460.00 ,$450.00 ,$333.20 ,$333.20 ,$304.50 ,$333.20 ,$325.00 ,$348.25 ,$212.74 ,$395.00 ,$227.45 , N/A , N/A , N/A , N/A , N/A ,$475.00 ,$410.00 ,$410.00 ,$400.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180952,64450,PC INJ ANES OTHER THAN PERIPHERAL,981,1 ,$637.00 ,$318.50 ,$44.71 ,"$1,459.17 ",$767.36 ,$538.84 ,$538.84 ,$44.71 ,$509.60 ,$541.45 ,$398.13 ,$573.30 ,$767.36 ,$605.15 ,$573.30 ,$541.45 ,$541.45 ,$44.71 ,$541.45 ,$541.45 ,$573.30 ,$767.36 ,$267.54 ,$573.30 ,"$1,459.17 ",$586.04 ,$573.30 ,$424.50 ,$424.50 ,$387.93 ,$424.50 ,$414.05 ,$443.67 ,$45.16 ,$503.23 ,$813.40 , N/A , N/A ,$44.71 , N/A ,$648.52 ,$605.15 ,$522.34 ,$522.34 ,$509.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180953,65205,PC REMOVE EYE FB CONJUCT SUPER,981,1 ,$228.00 ,$114.00 ,$31.14 ,$259.11 ,$128.25 ,$192.87 ,$192.87 ,$31.14 ,$182.40 ,$193.80 ,$142.50 ,$205.20 ,$128.25 ,$216.60 ,$205.20 ,$193.80 ,$193.80 ,$31.14 ,$193.80 ,$193.80 ,$205.20 ,$128.25 ,$95.76 ,$205.20 ,$259.11 ,$209.76 ,$205.20 ,$151.94 ,$151.94 ,$138.85 ,$151.94 ,$148.20 ,$158.80 ,$31.45 ,$180.12 ,$135.95 , N/A , N/A ,$31.14 , N/A ,$115.16 ,$216.60 ,$186.96 ,$186.96 ,$182.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180955,65220,PC REMOVE FB CORNL W/O SLIT LAMP,981,1 ,$811.00 ,$405.50 ,$43.15 ,$811.00 ,$128.25 ,$686.02 ,$686.02 ,$43.15 ,$648.80 ,$689.35 ,$506.88 ,$729.90 ,$128.25 ,$770.45 ,$729.90 ,$689.35 ,$689.35 ,$43.15 ,$689.35 ,$689.35 ,$729.90 ,$128.25 ,$340.62 ,$729.90 ,$623.66 ,$746.12 ,$729.90 ,$540.45 ,$540.45 ,$493.90 ,$540.45 ,$527.15 ,$564.86 ,$43.58 ,$640.69 ,$135.95 , N/A , N/A ,$43.15 , N/A ,$277.18 ,$770.45 ,$665.02 ,$665.02 ,$648.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180957,43762,PC REPLACE GASTRO TUBE PERC,981,1 ,$416.00 ,$208.00 ,$38.48 ,$611.48 ,$352.07 ,$351.89 ,$351.89 ,$38.48 ,$332.80 ,$353.60 ,$260.00 ,$374.40 ,$352.07 ,$395.20 ,$374.40 ,$353.60 ,$353.60 ,$38.48 ,$353.60 ,$353.60 ,$374.40 ,$352.07 ,$174.72 ,$374.40 ,$611.48 ,$382.72 ,$374.40 ,$277.22 ,$277.22 ,$253.34 ,$277.22 ,$270.40 ,$289.74 ,$38.86 ,$328.64 ,$373.19 , N/A , N/A ,$38.48 , N/A ,$271.77 ,$395.20 ,$341.12 ,$341.12 ,$332.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180958,43763,PC REPLACE GASTRO TUBE PERC W/REVISE TRACT,981,1 ,$438.00 ,$219.00 ,$88.19 ,$611.48 ,$352.07 ,$370.50 ,$370.50 ,$88.19 ,$350.40 ,$372.30 ,$273.75 ,$394.20 ,$352.07 ,$416.10 ,$394.20 ,$372.30 ,$372.30 ,$88.19 ,$372.30 ,$372.30 ,$394.20 ,$352.07 ,$183.96 ,$394.20 ,$611.48 ,$402.96 ,$394.20 ,$291.88 ,$291.88 ,$266.74 ,$291.88 ,$284.70 ,$305.07 ,$89.07 ,$346.02 ,$373.19 , N/A , N/A ,$88.19 , N/A ,$271.77 ,$416.10 ,$359.16 ,$359.16 ,$350.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180959,11103,PC BIOPSY SKIN TANGENTIAL ADDL LESN,981,1 ,$162.00 ,$81.00 ,$23.22 ,$832.58 ,$785.45 ,$137.04 ,$137.04 ,$23.22 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$785.45 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$23.22 ,$137.70 ,$137.70 ,$145.80 ,$785.45 ,$68.04 ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$23.45 ,$127.98 ,$832.58 , N/A , N/A ,$23.22 , N/A , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180960,11105,PC BIOPSY SKIN PUNCH ADDL LESN,981,1 ,$162.00 ,$81.00 ,$27.14 ,$832.58 ,$785.45 ,$137.04 ,$137.04 ,$27.14 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$785.45 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$27.14 ,$137.70 ,$137.70 ,$145.80 ,$785.45 ,$68.04 ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$27.41 ,$127.98 ,$832.58 , N/A , N/A ,$27.14 , N/A , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180961,11107,PC BIOPSY SKIN INCISIONAL ADDL LESN,981,1 ,$162.00 ,$81.00 ,$32.68 ,$832.58 ,$785.45 ,$137.04 ,$137.04 ,$32.68 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$785.45 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$32.68 ,$137.70 ,$137.70 ,$145.80 ,$785.45 ,$68.04 ,$145.80 , N/A ,$149.04 ,$145.80 ,$107.96 ,$107.96 ,$98.66 ,$107.96 ,$105.30 ,$112.83 ,$33.01 ,$127.98 ,$832.58 , N/A , N/A ,$32.68 , N/A , N/A ,$153.90 ,$132.84 ,$132.84 ,$129.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180963,11104,PC BIOPSY SKIN PUNCH INIT LESN,981,1 ,$324.00 ,$162.00 ,$49.63 ,$832.58 ,$785.45 ,$274.07 ,$274.07 ,$49.63 ,$259.20 ,$275.40 ,$202.50 ,$291.60 ,$785.45 ,$307.80 ,$291.60 ,$275.40 ,$275.40 ,$49.63 ,$275.40 ,$275.40 ,$291.60 ,$785.45 ,$136.08 ,$291.60 ,$794.25 ,$298.08 ,$291.60 ,$215.91 ,$215.91 ,$197.32 ,$215.91 ,$210.60 ,$225.67 ,$50.13 ,$255.96 ,$832.58 , N/A , N/A ,$49.63 , N/A ,$353.00 ,$307.80 ,$265.68 ,$265.68 ,$259.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180964,11106,PC BIOPSY SKIN INCISIONAL INIT LESN,981,1 ,$324.00 ,$162.00 ,$60.12 ,"$1,203.50 ",$785.45 ,$274.07 ,$274.07 ,$60.12 ,$259.20 ,$275.40 ,$202.50 ,$291.60 ,$785.45 ,$307.80 ,$291.60 ,$275.40 ,$275.40 ,$60.12 ,$275.40 ,$275.40 ,$291.60 ,$785.45 ,$136.08 ,$291.60 ,"$1,203.50 ",$298.08 ,$291.60 ,$215.91 ,$215.91 ,$197.32 ,$215.91 ,$210.60 ,$225.67 ,$60.72 ,$255.96 ,$832.58 , N/A , N/A ,$60.12 , N/A ,$534.89 ,$307.80 ,$265.68 ,$265.68 ,$259.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180978,G0508,PC TELEHEALTH CRITICAL CARE CONSULT 60 MIN,981,1 ,$600.00 ,$300.00 ,$214.58 ,$600.00 ,$214.58 ,$507.54 ,$507.54 , N/A ,$480.00 ,$510.00 ,$375.00 ,$540.00 ,$214.58 ,$570.00 ,$540.00 ,$510.00 ,$510.00 , N/A ,$510.00 ,$510.00 ,$540.00 ,$214.58 ,$252.00 ,$540.00 , N/A ,$552.00 ,$540.00 ,$399.84 ,$399.84 ,$365.40 ,$399.84 ,$390.00 ,$417.90 ,$224.69 ,$474.00 ,$227.45 , N/A , N/A , N/A , N/A , N/A ,$570.00 ,$492.00 ,$492.00 ,$480.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180979,40652,"PC RRR LIP FULL THICKNESS, UP TO 1/2 VERT HEIGHT",981,1 ,"$1,325.00 ",$662.50 ,$377.94 ,"$1,716.62 ","$1,619.45 ","$1,120.82 ","$1,120.82 ",$377.94 ,"$1,060.00 ","$1,126.25 ",$828.13 ,"$1,192.50 ","$1,619.45 ","$1,258.75 ","$1,192.50 ","$1,126.25 ","$1,126.25 ",$377.94 ,"$1,126.25 ","$1,126.25 ","$1,192.50 ","$1,619.45 ",$556.50 ,"$1,192.50 ","$1,039.28 ","$1,219.00 ","$1,192.50 ",$882.98 ,$882.98 ,$806.93 ,$882.98 ,$861.25 ,$922.86 ,$381.72 ,"$1,046.75 ","$1,716.62 ", N/A , N/A ,$377.94 , N/A ,$461.90 ,"$1,258.75 ","$1,086.50 ","$1,086.50 ","$1,060.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180980,76882,PC US EXTREMITY NON VASCULAR KNEE,981,1 ,$93.09 ,$46.55 ,$39.10 ,$250.18 ,$194.98 ,$78.74 ,$78.74 ,$61.32 ,$74.47 ,$79.13 ,$58.18 ,$83.78 ,$194.98 ,$88.44 ,$83.78 ,$79.13 ,$79.13 ,$61.32 ,$79.13 ,$79.13 ,$83.78 ,$194.98 ,$39.10 ,$83.78 ,$250.18 ,$85.64 ,$83.78 ,$62.04 ,$62.04 ,$56.69 ,$62.04 ,$60.51 ,$64.84 ,$61.93 ,$73.54 ,$206.68 , N/A , N/A ,$61.32 , N/A ,$111.19 ,$88.44 ,$76.33 ,$76.33 ,$74.47 
ST. CLARE MEMORIAL HOSPITAL (ACU),98300005,11042,PC DEBR SKIN/SUBQ TISS/PROC INIT 20CM PRO,983,1 ,$460.00 ,$230.00 ,$63.53 ,$794.25 ,$662.74 ,$389.11 ,$389.11 ,$63.53 ,$368.00 ,$391.00 ,$287.50 ,$414.00 ,$662.74 ,$437.00 ,$414.00 ,$391.00 ,$391.00 ,$63.53 ,$391.00 ,$391.00 ,$414.00 ,$662.74 ,$193.20 ,$414.00 ,$794.25 ,$423.20 ,$414.00 ,$306.54 ,$306.54 ,$280.14 ,$306.54 ,$299.00 ,$320.39 ,$102.21 ,$363.40 ,$702.50 , N/A , N/A ,$63.53 , N/A ,$353.00 ,$437.00 ,$377.20 ,$377.20 ,$368.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98300039,29581,PC APPL BIL MULT COMP LOWLEG PRO,983,1 ,$600.00 ,$300.00 ,$30.06 ,$600.00 ,$331.97 ,$507.54 ,$507.54 ,$30.06 ,$480.00 ,$510.00 ,$375.00 ,$540.00 ,$331.97 ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$30.06 ,$510.00 ,$510.00 ,$540.00 ,$331.97 ,$252.00 ,$540.00 ,$324.65 ,$552.00 ,$540.00 ,$399.84 ,$399.84 ,$365.40 ,$399.84 ,$390.00 ,$417.90 ,$133.32 ,$474.00 ,$351.89 , N/A , N/A ,$30.06 , N/A ,$144.29 ,$570.00 ,$492.00 ,$492.00 ,$480.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98300092,10140,PC I AND D HEMATOMA/SEROMA/FLUID PRO,983,1 ,$560.00 ,$280.00 ,$124.43 ,"$3,233.23 ","$1,935.34 ",$473.70 ,$473.70 ,$124.99 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,"$1,935.34 ",$532.00 ,$504.00 ,$476.00 ,$476.00 ,$124.99 ,$476.00 ,$476.00 ,$504.00 ,"$1,935.34 ",$235.20 ,$504.00 ,"$3,233.23 ",$515.20 ,$504.00 ,$373.18 ,$373.18 ,$341.04 ,$373.18 ,$364.00 ,$390.04 ,$124.43 ,$442.40 ,"$2,051.46 ", N/A , N/A ,$124.99 , N/A ,"$1,436.99 ",$532.00 ,$459.20 ,$459.20 ,$448.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98302072,99202,PC CLINIC VISIT LIMITED NEW PRO,983,1 ,$115.00 ,$57.50 ,$25.55 ,$227.45 ,$214.58 ,$97.28 ,$97.28 ,$52.05 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$214.58 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$52.05 ,$97.75 ,$97.75 ,$103.50 ,$214.58 ,$48.30 ,$103.50 , N/A ,$105.80 ,$103.50 ,$76.64 ,$76.64 ,$70.04 ,$76.64 ,$74.75 ,$80.10 ,$25.55 ,$90.85 ,$227.45 , N/A , N/A ,$52.05 , N/A , N/A ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98303072,99203,PC CLINIC VISIT INTERM NEW PRO,983,1 ,$157.00 ,$78.50 ,$34.89 ,$227.45 ,$214.58 ,$132.81 ,$132.81 ,$88.42 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$214.58 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$88.42 ,$133.45 ,$133.45 ,$141.30 ,$214.58 ,$65.94 ,$141.30 , N/A ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$227.45 , N/A , N/A ,$88.42 , N/A , N/A ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98304072,99204,PC CLINIC VISIT COMPLEX NEW PRO,983,1 ,$268.00 ,$134.00 ,$59.55 ,$268.00 ,$214.58 ,$226.70 ,$226.70 ,$144.05 ,$214.40 ,$227.80 ,$167.50 ,$241.20 ,$214.58 ,$254.60 ,$241.20 ,$227.80 ,$227.80 ,$144.05 ,$227.80 ,$227.80 ,$241.20 ,$214.58 ,$112.56 ,$241.20 , N/A ,$246.56 ,$241.20 ,$178.60 ,$178.60 ,$163.21 ,$178.60 ,$174.20 ,$186.66 ,$59.55 ,$211.72 ,$227.45 , N/A , N/A ,$144.05 , N/A , N/A ,$254.60 ,$219.76 ,$219.76 ,$214.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98305072,99205,PC CLINIC VISIT COMPREH NEW PRO,983,1 ,$350.00 ,$175.00 ,$77.77 ,$350.00 ,$214.58 ,$296.07 ,$296.07 ,$195.55 ,$280.00 ,$297.50 ,$218.75 ,$315.00 ,$214.58 ,$332.50 ,$315.00 ,$297.50 ,$297.50 ,$195.55 ,$297.50 ,$297.50 ,$315.00 ,$214.58 ,$147.00 ,$315.00 , N/A ,$322.00 ,$315.00 ,$233.24 ,$233.24 ,$213.15 ,$233.24 ,$227.50 ,$243.78 ,$77.77 ,$276.50 ,$227.45 , N/A , N/A ,$195.55 , N/A , N/A ,$332.50 ,$287.00 ,$287.00 ,$280.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98311072,99211,PC CLINIC VISIT BRIEF EST PRO,983,1 ,$56.00 ,$28.00 ,$9.64 ,$227.45 ,$214.58 ,$47.37 ,$47.37 ,$9.64 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$214.58 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$9.64 ,$47.60 ,$47.60 ,$50.40 ,$214.58 ,$23.52 ,$50.40 , N/A ,$51.52 ,$50.40 ,$37.32 ,$37.32 ,$34.10 ,$37.32 ,$36.40 ,$39.00 ,$12.44 ,$44.24 ,$227.45 , N/A , N/A ,$9.64 , N/A , N/A ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98312072,99212,PC CLINIC VISIT LIMIT EST PRO,983,1 ,$65.00 ,$32.50 ,$14.44 ,$227.45 ,$214.58 ,$54.98 ,$54.98 ,$38.53 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$214.58 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$38.53 ,$55.25 ,$55.25 ,$58.50 ,$214.58 ,$27.30 ,$58.50 , N/A ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 ,$227.45 , N/A , N/A ,$38.53 , N/A , N/A ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98313072,99213,PC CLINIC VISIT INTERM EST PRO,983,1 ,$108.00 ,$54.00 ,$24.00 ,$227.45 ,$214.58 ,$91.36 ,$91.36 ,$71.61 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$214.58 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$71.61 ,$91.80 ,$91.80 ,$97.20 ,$214.58 ,$45.36 ,$97.20 , N/A ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$227.45 , N/A , N/A ,$71.61 , N/A , N/A ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98314072,99214,PC CLINIC VISIT COMPLX EST PRO,983,1 ,$165.00 ,$82.50 ,$36.66 ,$227.45 ,$214.58 ,$139.57 ,$139.57 ,$105.73 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$214.58 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$105.73 ,$140.25 ,$140.25 ,$148.50 ,$214.58 ,$69.30 ,$148.50 , N/A ,$151.80 ,$148.50 ,$109.96 ,$109.96 ,$100.49 ,$109.96 ,$107.25 ,$114.92 ,$36.66 ,$130.35 ,$227.45 , N/A , N/A ,$105.73 , N/A , N/A ,$156.75 ,$135.30 ,$135.30 ,$132.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98315072,99215,PC CLINIC VISIT COMPHR EST PRO,983,1 ,$234.00 ,$117.00 ,$51.99 ,$234.00 ,$214.58 ,$197.94 ,$197.94 ,$156.21 ,$187.20 ,$198.90 ,$146.25 ,$210.60 ,$214.58 ,$222.30 ,$210.60 ,$198.90 ,$198.90 ,$156.21 ,$198.90 ,$198.90 ,$210.60 ,$214.58 ,$98.28 ,$210.60 , N/A ,$215.28 ,$210.60 ,$155.94 ,$155.94 ,$142.51 ,$155.94 ,$152.10 ,$162.98 ,$51.99 ,$184.86 ,$227.45 , N/A , N/A ,$156.21 , N/A , N/A ,$222.30 ,$191.88 ,$191.88 ,$187.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98500002,93016,PC CARDIAC STRESS TEST SUPERVISION,985,1 ,$70.00 ,$35.00 ,$15.55 ,$313.17 ,$295.44 ,$59.21 ,$59.21 ,$23.51 ,$56.00 ,$59.50 ,$43.75 ,$63.00 ,$295.44 ,$66.50 ,$63.00 ,$59.50 ,$59.50 ,$23.51 ,$59.50 ,$59.50 ,$63.00 ,$295.44 ,$29.40 ,$63.00 , N/A ,$64.40 ,$63.00 ,$46.65 ,$46.65 ,$42.63 ,$46.65 ,$45.50 ,$48.76 ,$15.55 ,$55.30 ,$313.17 , N/A , N/A ,$23.51 , N/A , N/A ,$66.50 ,$57.40 ,$57.40 ,$56.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),99202072,99202,HC CLINIC VISIT LIMITED NEW-PRV 72 HR,510,1 ,$70.00 ,$35.00 ,$15.55 ,$227.45 ,$214.58 ,$70.00 ,$70.00 ,$23.80 ,$56.00 ,$59.50 ,$43.75 ,$63.00 ,$214.58 ,$66.50 ,$63.00 ,$59.50 ,$59.50 ,$23.80 ,$59.50 ,$59.50 ,$63.00 ,$214.58 ,$64.61 ,$63.00 , N/A ,$64.40 ,$63.00 ,$46.65 ,$46.65 ,$42.63 ,$46.65 ,$45.50 ,$48.76 ,$15.55 ,$55.30 ,$227.45 ,$35.00 ,$35.00 ,$23.80 ,$35.00 , N/A ,$66.50 ,$57.40 ,$57.40 ,$56.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),99203072,99203,HC CLINIC VISIT INTERM NEW-PRV 72 HR,510,1 ,$112.00 ,$56.00 ,$24.89 ,$227.45 ,$214.58 ,$112.00 ,$103.00 ,$38.08 ,$89.60 ,$95.20 ,$70.00 ,$100.80 ,$214.58 ,$106.40 ,$100.80 ,$95.20 ,$95.20 ,$38.08 ,$95.20 ,$95.20 ,$100.80 ,$214.58 ,$64.61 ,$100.80 , N/A ,$103.04 ,$100.80 ,$74.64 ,$74.64 ,$68.21 ,$74.64 ,$72.80 ,$78.01 ,$24.89 ,$88.48 ,$227.45 ,$56.00 ,$56.00 ,$38.08 ,$56.00 , N/A ,$106.40 ,$91.84 ,$91.84 ,$89.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),99204072,99204,HC CLINIC VISIT COMPLEX NEW-PRV 72 HR,510,1 ,$156.00 ,$78.00 ,$34.66 ,$227.45 ,$214.58 ,$129.00 ,$103.00 ,$53.04 ,$124.80 ,$132.60 ,$97.50 ,$140.40 ,$214.58 ,$148.20 ,$140.40 ,$132.60 ,$132.60 ,$53.04 ,$132.60 ,$132.60 ,$140.40 ,$214.58 ,$64.61 ,$140.40 , N/A ,$143.52 ,$140.40 ,$103.96 ,$103.96 ,$95.00 ,$103.96 ,$101.40 ,$108.65 ,$34.66 ,$123.24 ,$227.45 ,$78.00 ,$78.00 ,$53.04 ,$78.00 , N/A ,$148.20 ,$127.92 ,$127.92 ,$124.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),99205072,99205,HC CLINIC VISIT COMPREH NEW-PRV 72 HR,510,1 ,$185.00 ,$92.50 ,$41.11 ,$227.45 ,$214.58 ,$129.00 ,$103.00 ,$62.90 ,$148.00 ,$157.25 ,$115.63 ,$166.50 ,$214.58 ,$175.75 ,$166.50 ,$157.25 ,$157.25 ,$62.90 ,$157.25 ,$157.25 ,$166.50 ,$214.58 ,$64.61 ,$166.50 , N/A ,$170.20 ,$166.50 ,$123.28 ,$123.28 ,$112.67 ,$123.28 ,$120.25 ,$128.85 ,$41.11 ,$146.15 ,$227.45 ,$92.50 ,$92.50 ,$62.90 ,$92.50 , N/A ,$175.75 ,$151.70 ,$151.70 ,$148.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),99211072,99211,HC CLINIC VISIT BRIEF EST-PRV 72 HR,510,1 ,$31.00 ,$15.50 ,$6.89 ,$227.45 ,$214.58 ,$31.00 ,$31.00 ,$10.54 ,$24.80 ,$26.35 ,$19.38 ,$27.90 ,$214.58 ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$10.54 ,$26.35 ,$26.35 ,$27.90 ,$214.58 ,$31.00 ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.66 ,$20.66 ,$18.88 ,$20.66 ,$20.15 ,$21.59 ,$6.89 ,$24.49 ,$227.45 ,$15.50 ,$15.50 ,$10.54 ,$15.50 , N/A ,$29.45 ,$25.42 ,$25.42 ,$24.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),99212072,99212,HC CLINIC VISIT LIMIT EST-PRV 72 HR,510,1 ,$54.00 ,$27.00 ,$12.00 ,$227.45 ,$214.58 ,$54.00 ,$54.00 ,$18.36 ,$43.20 ,$45.90 ,$33.75 ,$48.60 ,$214.58 ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$18.36 ,$45.90 ,$45.90 ,$48.60 ,$214.58 ,$54.00 ,$48.60 , N/A ,$49.68 ,$48.60 ,$35.99 ,$35.99 ,$32.89 ,$35.99 ,$35.10 ,$37.61 ,$12.00 ,$42.66 ,$227.45 ,$27.00 ,$27.00 ,$18.36 ,$27.00 , N/A ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),99213072,99213,HC CLINIC VISIT INTERM EST-PRV 72 HR,510,1 ,$74.00 ,$37.00 ,$16.44 ,$227.45 ,$214.58 ,$74.00 ,$74.00 ,$25.16 ,$59.20 ,$62.90 ,$46.25 ,$66.60 ,$214.58 ,$70.30 ,$66.60 ,$62.90 ,$62.90 ,$25.16 ,$62.90 ,$62.90 ,$66.60 ,$214.58 ,$64.61 ,$66.60 , N/A ,$68.08 ,$66.60 ,$49.31 ,$49.31 ,$45.07 ,$49.31 ,$48.10 ,$51.54 ,$16.44 ,$58.46 ,$227.45 ,$37.00 ,$37.00 ,$25.16 ,$37.00 , N/A ,$70.30 ,$60.68 ,$60.68 ,$59.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),99214072,99214,HC CLINIC VISIT COMPLX EST-PRV 72 HR,510,1 ,$108.00 ,$54.00 ,$24.00 ,$227.45 ,$214.58 ,$108.00 ,$103.00 ,$36.72 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$214.58 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$36.72 ,$91.80 ,$91.80 ,$97.20 ,$214.58 ,$64.61 ,$97.20 , N/A ,$99.36 ,$97.20 ,$71.97 ,$71.97 ,$65.77 ,$71.97 ,$70.20 ,$75.22 ,$24.00 ,$85.32 ,$227.45 ,$54.00 ,$54.00 ,$36.72 ,$54.00 , N/A ,$102.60 ,$88.56 ,$88.56 ,$86.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),99215072,99215,HC CLINIC VISIT COMPRH EST-PRV 72 HR,510,1 ,$137.00 ,$68.50 ,$30.44 ,$227.45 ,$214.58 ,$129.00 ,$103.00 ,$46.58 ,$109.60 ,$116.45 ,$85.63 ,$123.30 ,$214.58 ,$130.15 ,$123.30 ,$116.45 ,$116.45 ,$46.58 ,$116.45 ,$116.45 ,$123.30 ,$214.58 ,$64.61 ,$123.30 , N/A ,$126.04 ,$123.30 ,$91.30 ,$91.30 ,$83.43 ,$91.30 ,$89.05 ,$95.42 ,$30.44 ,$108.23 ,$227.45 ,$68.50 ,$68.50 ,$46.58 ,$68.50 , N/A ,$130.15 ,$112.34 ,$112.34 ,$109.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),99217072,99217,HC OBSERVATION;INITAL HIGH COMP,982,1 ,$233.00 ,$116.50 ,$51.77 ,$233.00 ,$214.58 ,$197.09 ,$197.09 ,$76.20 ,$186.40 ,$198.05 ,$145.63 ,$209.70 ,$214.58 ,$221.35 ,$209.70 ,$198.05 ,$198.05 ,$76.20 ,$198.05 ,$198.05 ,$209.70 ,$214.58 ,$97.86 ,$209.70 , N/A ,$214.36 ,$209.70 ,$155.27 ,$155.27 ,$141.90 ,$155.27 ,$151.45 ,$162.28 ,$51.77 ,$184.07 ,$227.45 , N/A , N/A ,$76.20 , N/A , N/A ,$221.35 ,$191.06 ,$191.06 ,$186.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),99218072,99218,HC OBSV IP SAME DAY;MOD,982,1 ,$281.00 ,$140.50 ,$62.44 ,$281.00 ,$214.58 ,$237.70 ,$237.70 ,$103.14 ,$224.80 ,$238.85 ,$175.63 ,$252.90 ,$214.58 ,$266.95 ,$252.90 ,$238.85 ,$238.85 ,$103.14 ,$238.85 ,$238.85 ,$252.90 ,$214.58 ,$118.02 ,$252.90 , N/A ,$258.52 ,$252.90 ,$187.26 ,$187.26 ,$171.13 ,$187.26 ,$182.65 ,$195.72 ,$62.44 ,$221.99 ,$227.45 , N/A , N/A ,$103.14 , N/A , N/A ,$266.95 ,$230.42 ,$230.42 ,$224.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),99219072,99219,"HC INITIAL OBSERVATION CARE,LEVL II",983,1 ,$395.00 ,$197.50 ,$87.77 ,$395.00 ,$214.58 ,$334.13 ,$334.13 ,$140.67 ,$316.00 ,$335.75 ,$246.88 ,$355.50 ,$214.58 ,$375.25 ,$355.50 ,$335.75 ,$335.75 ,$140.67 ,$335.75 ,$335.75 ,$355.50 ,$214.58 ,$165.90 ,$355.50 , N/A ,$363.40 ,$355.50 ,$263.23 ,$263.23 ,$240.56 ,$263.23 ,$256.75 ,$275.12 ,$87.77 ,$312.05 ,$227.45 , N/A , N/A ,$140.67 , N/A , N/A ,$375.25 ,$323.90 ,$323.90 ,$316.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),99220072,99220,HC INITIAL OBSERVATION CARE LEVEL III-PRV 72HR,983,1 ,$495.00 ,$247.50 ,$109.99 ,$495.00 ,$214.58 ,$418.72 ,$418.72 ,$190.50 ,$396.00 ,$420.75 ,$309.38 ,$445.50 ,$214.58 ,$470.25 ,$445.50 ,$420.75 ,$420.75 ,$190.50 ,$420.75 ,$420.75 ,$445.50 ,$214.58 ,$207.90 ,$445.50 , N/A ,$455.40 ,$445.50 ,$329.87 ,$329.87 ,$301.46 ,$329.87 ,$321.75 ,$344.77 ,$109.99 ,$391.05 ,$227.45 , N/A , N/A ,$190.50 , N/A , N/A ,$470.25 ,$405.90 ,$405.90 ,$396.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),99224072,99224,HC SUBSEQ OBSERVATION PER DAY,987,1 ,$192.00 ,$96.00 ,$41.22 ,$227.45 ,$214.58 ,$162.41 ,$162.41 ,$41.22 ,$153.60 ,$163.20 ,$120.00 ,$172.80 ,$214.58 ,$182.40 ,$172.80 ,$163.20 ,$163.20 ,$41.22 ,$163.20 ,$163.20 ,$172.80 ,$214.58 ,$80.64 ,$172.80 , N/A ,$176.64 ,$172.80 ,$127.95 ,$127.95 ,$116.93 ,$127.95 ,$124.80 ,$133.73 ,$42.66 ,$151.68 ,$227.45 , N/A , N/A ,$41.22 , N/A , N/A ,$182.40 ,$157.44 ,$157.44 ,$153.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),99225072,99225,HC SUBSQ OBSV CARE 15,982,1 ,$276.00 ,$138.00 ,$61.33 ,$276.00 ,$214.58 ,$233.47 ,$233.47 ,$75.47 ,$220.80 ,$234.60 ,$172.50 ,$248.40 ,$214.58 ,$262.20 ,$248.40 ,$234.60 ,$234.60 ,$75.47 ,$234.60 ,$234.60 ,$248.40 ,$214.58 ,$115.92 ,$248.40 , N/A ,$253.92 ,$248.40 ,$183.93 ,$183.93 ,$168.08 ,$183.93 ,$179.40 ,$192.23 ,$61.33 ,$218.04 ,$227.45 , N/A , N/A ,$75.47 , N/A , N/A ,$262.20 ,$226.32 ,$226.32 ,$220.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),99226072,99226,HC SUBSQ OBSV CARE 25,982,1 ,$362.00 ,$181.00 ,$80.44 ,$362.00 ,$214.58 ,$306.22 ,$306.22 ,$108.10 ,$289.60 ,$307.70 ,$226.25 ,$325.80 ,$214.58 ,$343.90 ,$325.80 ,$307.70 ,$307.70 ,$108.10 ,$307.70 ,$307.70 ,$325.80 ,$214.58 ,$152.04 ,$325.80 , N/A ,$333.04 ,$325.80 ,$241.24 ,$241.24 ,$220.46 ,$241.24 ,$235.30 ,$252.13 ,$80.44 ,$285.98 ,$227.45 , N/A , N/A ,$108.10 , N/A , N/A ,$343.90 ,$296.84 ,$296.84 ,$289.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),99231072,99231,HC SUBSQ HOSPITAL CARE LVL 1,987,1 ,$157.00 ,$78.50 ,$34.89 ,$227.45 ,$214.58 ,$132.81 ,$132.81 ,$40.85 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$214.58 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$40.85 ,$133.45 ,$133.45 ,$141.30 ,$214.58 ,$65.94 ,$141.30 , N/A ,$144.44 ,$141.30 ,$104.62 ,$104.62 ,$95.61 ,$104.62 ,$102.05 ,$109.35 ,$34.89 ,$124.03 ,$227.45 , N/A , N/A ,$40.85 , N/A , N/A ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),99232072,99232,SUBQ HOSP CARE LEVEL 2,983,1 ,$230.00 ,$115.00 ,$51.11 ,$230.00 ,$214.58 ,$194.56 ,$194.56 ,$75.84 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$214.58 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$75.84 ,$195.50 ,$195.50 ,$207.00 ,$214.58 ,$96.60 ,$207.00 , N/A ,$211.60 ,$207.00 ,$153.27 ,$153.27 ,$140.07 ,$153.27 ,$149.50 ,$160.20 ,$51.11 ,$181.70 ,$227.45 , N/A , N/A ,$75.84 , N/A , N/A ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),99235072,99235,HC OBSERVATION DISCHARGE,982,1 ,$603.00 ,$301.50 ,$133.99 ,$603.00 ,$214.58 ,$510.08 ,$510.08 ,$175.80 ,$482.40 ,$512.55 ,$376.88 ,$542.70 ,$214.58 ,$572.85 ,$542.70 ,$512.55 ,$512.55 ,$175.80 ,$512.55 ,$512.55 ,$542.70 ,$214.58 ,$253.26 ,$542.70 , N/A ,$554.76 ,$542.70 ,$401.84 ,$401.84 ,$367.23 ,$401.84 ,$391.95 ,$419.99 ,$133.99 ,$476.37 ,$227.45 , N/A , N/A ,$175.80 , N/A , N/A ,$572.85 ,$494.46 ,$494.46 ,$482.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0008072,G0008,HC ADMIN INFLUENZA VACCINE-PRV 72 HR,771,1 ,$43.00 ,$21.50 ,$14.62 ,$91.96 ,$67.79 ,$36.37 ,$36.37 ,$14.62 ,$34.40 ,$36.55 ,$26.88 ,$38.70 ,$67.79 ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$14.62 ,$36.55 ,$36.55 ,$38.70 ,$67.79 ,$18.06 ,$38.70 ,$91.96 ,$39.56 ,$38.70 ,$28.66 ,$28.66 ,$26.19 ,$28.66 ,$27.95 ,$29.95 , N/A ,$33.97 ,$71.86 ,$42.00 ,$42.00 ,$14.62 ,$42.00 ,$40.87 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0101072,G0101,HC PELVIC/BREAST EXAM,983,1 ,$92.00 ,$46.00 ,$20.44 ,$227.45 ,$214.58 ,$77.82 ,$77.82 , N/A ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$214.58 ,$87.40 ,$82.80 ,$78.20 ,$78.20 , N/A ,$78.20 ,$78.20 ,$82.80 ,$214.58 ,$38.64 ,$82.80 ,$171.95 ,$84.64 ,$82.80 ,$61.31 ,$61.31 ,$56.03 ,$61.31 ,$59.80 ,$64.08 ,$20.44 ,$72.68 ,$227.45 , N/A , N/A , N/A , N/A ,$76.42 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0103072,G0103,HC PSA ANNUAL SCREENING,301,1 ,$192.00 ,$96.00 ,$19.31 ,$192.00 ,$19.95 ,$71.54 ,$61.32 ,$65.28 ,$153.60 ,$163.20 ,$120.00 ,$172.80 ,$19.95 ,$182.40 ,$172.80 ,$163.20 ,$163.20 ,$65.28 ,$163.20 ,$163.20 ,$172.80 ,$19.95 ,$21.86 ,$172.80 ,$43.45 ,$176.64 ,$172.80 ,$127.95 ,$127.95 ,$116.93 ,$127.95 ,$124.80 ,$133.73 ,$42.66 ,$151.68 ,$21.15 ,$23.17 ,$23.17 ,$65.28 ,$23.17 ,$19.31 ,$182.40 ,$157.44 ,$157.44 ,$153.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0105072,G0105,HC COLORECTAL CANCER SCREEN-PRV 72 HR,975,1 ,"$1,216.00 ",$608.00 ,$270.20 ,"$1,823.58 ","$1,711.37 ","$1,028.61 ","$1,028.61 ", N/A ,$972.80 ,"$1,033.60 ",$760.00 ,"$1,094.40 ","$1,711.37 ","$1,155.20 ","$1,094.40 ","$1,033.60 ","$1,033.60 ", N/A ,"$1,033.60 ","$1,033.60 ","$1,094.40 ","$1,711.37 ",$510.72 ,"$1,094.40 ","$1,823.58 ","$1,118.72 ","$1,094.40 ",$810.34 ,$810.34 ,$740.54 ,$810.34 ,$790.40 ,$846.94 ,$270.20 ,$960.64 ,"$1,814.05 ", N/A , N/A , N/A , N/A ,$810.48 ,"$1,155.20 ",$997.12 ,$997.12 ,$972.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0108072,G0108,HC DIABETES SELF MGT ED 30 MIN,942,1 ,$129.00 ,$64.50 ,$28.66 ,$129.00 ,$115.73 ,$109.12 ,$109.12 ,$43.86 ,$103.20 ,$109.65 ,$80.63 ,$116.10 ,$115.73 ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$43.86 ,$109.65 ,$109.65 ,$116.10 ,$115.73 ,$129.00 ,$116.10 ,$120.38 ,$118.68 ,$116.10 ,$85.97 ,$85.97 ,$78.56 ,$85.97 ,$83.85 ,$89.85 ,$28.66 ,$101.91 ,$122.67 ,$101.00 ,$101.00 ,$43.86 ,$112.00 ,$53.50 ,$122.55 ,$105.78 ,$105.78 ,$103.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0121072,G0121,HC COLONSCOPY SCRN LOW RISK,975,1 ,"$1,377.00 ",$688.50 ,$305.97 ,"$1,823.58 ","$1,711.37 ","$1,164.80 ","$1,164.80 ", N/A ,"$1,101.60 ","$1,170.45 ",$860.63 ,"$1,239.30 ","$1,711.37 ","$1,308.15 ","$1,239.30 ","$1,170.45 ","$1,170.45 ", N/A ,"$1,170.45 ","$1,170.45 ","$1,239.30 ","$1,711.37 ",$578.34 ,"$1,239.30 ","$1,823.58 ","$1,266.84 ","$1,239.30 ",$917.63 ,$917.63 ,$838.59 ,$917.63 ,$895.05 ,$959.08 ,$305.97 ,"$1,087.83 ","$1,814.05 ", N/A , N/A , N/A , N/A ,$810.48 ,"$1,308.15 ","$1,129.14 ","$1,129.14 ","$1,101.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),G0402072,G0402,HC MEDICARE PHYSICAL,510,1 ,$67.00 ,$33.50 ,$14.89 ,$273.04 ,$214.58 ,$67.00 ,$67.00 ,$22.78 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$214.58 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$22.78 ,$56.95 ,$56.95 ,$60.30 ,$214.58 ,$64.61 ,$60.30 ,$273.04 ,$61.64 ,$60.30 ,$44.65 ,$44.65 ,$40.80 ,$44.65 ,$43.55 ,$46.67 ,$14.89 ,$52.93 ,$227.45 ,$33.50 ,$33.50 ,$22.78 ,$33.50 ,$121.35 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0404072,G0404,HC EKG TRACING INITIAL PHYSICAL-PRV 72HR,730,1 ,$140.00 ,$70.00 ,$25.23 ,$140.00 ,$46.48 ,$118.43 ,$118.43 ,$47.60 ,$112.00 ,$119.00 ,$87.50 ,$126.00 ,$46.48 ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$47.60 ,$119.00 ,$119.00 ,$126.00 ,$46.48 ,$140.00 ,$126.00 ,$56.77 ,$128.80 ,$126.00 ,$93.30 ,$93.30 ,$85.26 ,$93.30 ,$91.00 ,$97.51 ,$31.11 ,$110.60 ,$49.27 ,$106.00 ,$106.00 ,$47.60 ,$112.00 ,$25.23 ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0405072,G0405,HC IPPE EKG INTERPRETATION,985,1 ,$90.00 ,$45.00 ,$20.00 ,$90.00 ,$46.48 ,$76.13 ,$76.13 , N/A ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$46.48 ,$85.50 ,$81.00 ,$76.50 ,$76.50 , N/A ,$76.50 ,$76.50 ,$81.00 ,$46.48 ,$37.80 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.98 ,$59.98 ,$54.81 ,$59.98 ,$58.50 ,$62.69 ,$20.00 ,$71.10 ,$49.27 , N/A , N/A , N/A , N/A , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0438072,G0438,HC ANNUAL WELLNESS,510,1 ,$192.00 ,$96.00 ,$42.66 ,$362.59 ,$214.58 ,$129.00 ,$103.00 ,$65.28 ,$153.60 ,$163.20 ,$120.00 ,$172.80 ,$214.58 ,$182.40 ,$172.80 ,$163.20 ,$163.20 ,$65.28 ,$163.20 ,$163.20 ,$172.80 ,$214.58 ,$64.61 ,$172.80 ,$362.59 ,$176.64 ,$172.80 ,$127.95 ,$127.95 ,$116.93 ,$127.95 ,$124.80 ,$133.73 ,$42.66 ,$151.68 ,$227.45 ,$96.00 ,$96.00 ,$65.28 ,$96.00 ,$161.15 ,$182.40 ,$157.44 ,$157.44 ,$153.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1030072,J1030,HC DEPO-MEDROL 40MG,636,1 ,$33.00 ,$16.50 ,$6.45 ,$33.00 , N/A ,$12.83 ,$8.55 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$6.45 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1040072,J1040,HC DEPO - MEDROL 80MG,636,1 ,$65.00 ,$32.50 ,$13.38 ,$65.00 , N/A ,$26.60 ,$17.73 ,$22.10 ,$52.00 ,$55.25 ,$40.63 ,$58.50 , N/A ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$22.10 ,$55.25 ,$55.25 ,$58.50 , N/A ,$13.38 ,$58.50 , N/A ,$59.80 ,$58.50 ,$43.32 ,$43.32 ,$39.59 ,$43.32 ,$42.25 ,$45.27 ,$14.44 ,$51.35 , N/A ,$32.50 ,$32.50 ,$22.10 ,$32.50 , N/A ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1100072,J1100,HC DEXAMETHASONE 4MG/ML VIAL,636,1 ,$6.20 ,$3.10 ,$0.14 ,$6.20 , N/A ,$0.27 ,$0.18 ,$2.11 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$2.11 ,$5.27 ,$5.27 ,$5.58 , N/A ,$0.14 ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.13 ,$4.13 ,$3.78 ,$4.13 ,$4.03 ,$4.32 ,$1.37 ,$4.90 , N/A ,$3.10 ,$3.10 ,$2.11 ,$3.10 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1170072,J1170,HC DILAUDID INJ TO 4MG,636,1 ,$27.00 ,$13.50 ,$3.11 ,$27.00 , N/A ,$6.19 ,$4.13 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 , N/A ,$3.11 ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 , N/A ,$13.50 ,$13.50 ,$9.18 ,$13.50 , N/A ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1650072,J1650,HC LOVENOX INJ 10MG,636,1 ,$22.00 ,$11.00 ,$0.91 ,$22.00 , N/A ,$1.80 ,$1.20 ,$7.48 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$7.48 ,$18.70 ,$18.70 ,$19.80 , N/A ,$0.91 ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.66 ,$14.66 ,$13.40 ,$14.66 ,$14.30 ,$15.32 ,$4.89 ,$17.38 , N/A ,$11.00 ,$11.00 ,$7.48 ,$11.00 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1885072,J1885,HC KETOROLAC PER 15MG,636,1 ,$52.00 ,$26.00 ,$0.62 ,$52.00 , N/A ,$1.24 ,$0.83 ,$17.68 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$17.68 ,$44.20 ,$44.20 ,$46.80 , N/A ,$0.62 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.65 ,$34.65 ,$31.67 ,$34.65 ,$33.80 ,$36.22 ,$11.55 ,$41.08 , N/A ,$26.00 ,$26.00 ,$17.68 ,$26.00 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),J2175072,J2175,HC DEMEROL HCL UP TO 100MG,636,1 ,$33.00 ,$16.50 ,$7.04 ,$33.00 , N/A ,$14.00 ,$9.33 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$7.04 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),J2360072,J2360,HC PRHENADRINE CITRITE INJ 60MG,636,1 ,$61.00 ,$30.50 ,$5.87 ,$61.00 , N/A ,$11.68 ,$7.79 ,$20.74 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$20.74 ,$51.85 ,$51.85 ,$54.90 , N/A ,$5.87 ,$54.90 , N/A ,$56.12 ,$54.90 ,$40.65 ,$40.65 ,$37.15 ,$40.65 ,$39.65 ,$42.49 ,$13.55 ,$48.19 , N/A ,$30.50 ,$30.50 ,$20.74 ,$30.50 , N/A ,$57.95 ,$50.02 ,$50.02 ,$48.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),J2405072,J2405,HC ZOFRAN INJ 1 MG,636,1 ,$27.00 ,$13.50 ,$0.09 ,$27.00 , N/A ,$0.18 ,$0.12 ,$9.18 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$9.18 ,$22.95 ,$22.95 ,$24.30 , N/A ,$0.09 ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.99 ,$17.99 ,$16.44 ,$17.99 ,$17.55 ,$18.81 ,$6.00 ,$21.33 , N/A ,$13.50 ,$13.50 ,$9.18 ,$13.50 , N/A ,$25.65 ,$22.14 ,$22.14 ,$21.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),J2505072,J2505,HC NEULASTA INJ 6MG,636,1 ,"$8,468.00 ","$4,234.00 ","$1,881.59 ","$8,468.00 ", N/A ,"$4,998.67 ","$3,332.45 ","$2,879.12 ","$6,774.40 ","$7,197.80 ","$5,292.50 ","$7,621.20 ", N/A ,"$8,044.60 ","$7,621.20 ","$7,197.80 ","$7,197.80 ","$2,879.12 ","$7,197.80 ","$7,197.80 ","$7,621.20 ", N/A ,"$2,514.44 ","$7,621.20 ", N/A ,"$7,790.56 ","$7,621.20 ","$5,643.08 ","$5,643.08 ","$5,157.01 ","$5,643.08 ","$5,504.20 ","$5,897.96 ","$1,881.59 ","$6,689.72 ", N/A ,"$4,234.00 ","$4,234.00 ","$2,879.12 ","$4,234.00 ", N/A ,"$8,044.60 ","$6,943.76 ","$6,943.76 ","$6,774.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),J2550072,J2550,HC PROMETHAZINE HCL TO 50 MG,636,1 ,$20.00 ,$10.00 ,$2.67 ,$20.00 , N/A ,$5.31 ,$3.54 ,$6.80 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$6.80 ,$17.00 ,$17.00 ,$18.00 , N/A ,$2.67 ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.33 ,$13.33 ,$12.18 ,$13.33 ,$13.00 ,$13.93 ,$4.44 ,$15.80 , N/A ,$10.00 ,$10.00 ,$6.80 ,$10.00 , N/A ,$19.00 ,$16.40 ,$16.40 ,$16.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),J2930072,J2930,HC METHYLPREDNISOLONE NA 125MG USE TO 1G,636,1 ,$33.00 ,$16.50 ,$6.67 ,$33.00 , N/A ,$13.25 ,$8.84 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 , N/A ,$6.67 ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 , N/A ,$16.50 ,$16.50 ,$11.22 ,$16.50 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),J3030072,J3030,HC SUMATRIPTAN SUC ING 06MG,636,1 ,$128.00 ,$64.00 ,$28.44 ,$128.00 , N/A ,$108.28 ,$108.28 ,$43.52 ,$102.40 ,$108.80 ,$80.00 ,$115.20 , N/A ,$121.60 ,$115.20 ,$108.80 ,$108.80 ,$43.52 ,$108.80 ,$108.80 ,$115.20 , N/A ,$53.76 ,$115.20 , N/A ,$117.76 ,$115.20 ,$85.30 ,$85.30 ,$77.95 ,$85.30 ,$83.20 ,$89.15 ,$28.44 ,$101.12 , N/A ,$64.00 ,$64.00 ,$43.52 ,$64.00 , N/A ,$121.60 ,$104.96 ,$104.96 ,$102.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),J3370072,J3370,HC VANCOMYCIN 500MG VIAL,636,1 ,$72.00 ,$36.00 ,$3.15 ,$72.00 , N/A ,$6.26 ,$4.17 ,$24.48 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$24.48 ,$61.20 ,$61.20 ,$64.80 , N/A ,$3.15 ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.98 ,$47.98 ,$43.85 ,$47.98 ,$46.80 ,$50.15 ,$16.00 ,$56.88 , N/A ,$36.00 ,$36.00 ,$24.48 ,$36.00 , N/A ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),J3420072,J3420,HC VITSMIN B12 IN YO 1000 MCG,636,1 ,$19.00 ,$9.50 ,$2.04 ,$19.00 , N/A ,$4.05 ,$2.70 ,$6.46 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$6.46 ,$16.15 ,$16.15 ,$17.10 , N/A ,$2.04 ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.66 ,$12.66 ,$11.57 ,$12.66 ,$12.35 ,$13.23 ,$4.22 ,$15.01 , N/A ,$9.50 ,$9.50 ,$6.46 ,$9.50 , N/A ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),J3430072,J3430,HC PHYTONADIONE 1MG VIT K,636,1 ,$26.00 ,$13.00 ,$3.87 ,$26.00 , N/A ,$7.70 ,$5.13 ,$8.84 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$8.84 ,$22.10 ,$22.10 ,$23.40 , N/A ,$3.87 ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.33 ,$17.33 ,$15.83 ,$17.33 ,$16.90 ,$18.11 ,$5.78 ,$20.54 , N/A ,$13.00 ,$13.00 ,$8.84 ,$13.00 , N/A ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),J7307072,J7307,HC ETONOGESTREL IMPLANT SYSTEM,636,1 ,"$1,225.00 ",$612.50 ,$272.20 ,"$1,225.00 ",$930.03 ,"$1,036.23 ","$1,036.23 ",$416.50 ,$980.00 ,"$1,041.25 ",$765.63 ,"$1,102.50 ",$930.03 ,"$1,163.75 ","$1,102.50 ","$1,041.25 ","$1,041.25 ",$416.50 ,"$1,041.25 ","$1,041.25 ","$1,102.50 ",$930.03 ,$514.50 ,"$1,102.50 ", N/A ,"$1,127.00 ","$1,102.50 ",$816.34 ,$816.34 ,$746.03 ,$816.34 ,$796.25 ,$853.21 ,$272.20 ,$967.75 ,$985.83 ,$612.50 ,$612.50 ,$416.50 ,$612.50 , N/A ,"$1,163.75 ","$1,004.50 ","$1,004.50 ",$980.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),L3030072,L3030,"HC FOOT INSERT,MOLDED",N/A,1 ,$47.00 , N/A ,$32.74 ,$42.30 , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$42.30 , N/A , N/A ,$42.30 , N/A , N/A , N/A , N/A , N/A ,$42.30 , N/A , N/A ,$42.30 , N/A , N/A ,$42.30 , N/A , N/A , N/A , N/A , N/A ,$32.74 , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A , N/A 
ST. CLARE MEMORIAL HOSPITAL (ACU),P3000072,P3000,HC PAP SMEAR SCREEN (UP TOP 3),311,1 ,$147.00 ,$73.50 ,$14.86 ,$147.00 ,$14.86 ,$52.47 ,$44.97 ,$49.98 ,$117.60 ,$124.95 ,$91.88 ,$132.30 ,$14.86 ,$139.65 ,$132.30 ,$124.95 ,$124.95 ,$49.98 ,$124.95 ,$124.95 ,$132.30 ,$14.86 ,$18.02 ,$132.30 ,$35.82 ,$135.24 ,$132.30 ,$97.96 ,$97.96 ,$89.52 ,$97.96 ,$95.55 ,$102.39 ,$32.66 ,$116.13 ,$15.75 ,$18.14 ,$18.14 ,$49.98 ,$18.14 ,$15.92 ,$139.65 ,$120.54 ,$120.54 ,$117.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),Q0091072,Q0091,HC PAP SMEAR COLLECTION-PRV 72 HR,983,1 ,$73.00 ,$36.50 ,$16.22 ,$73.00 ,$30.45 ,$61.75 ,$61.75 , N/A ,$58.40 ,$62.05 ,$45.63 ,$65.70 ,$30.45 ,$69.35 ,$65.70 ,$62.05 ,$62.05 , N/A ,$62.05 ,$62.05 ,$65.70 ,$30.45 ,$30.66 ,$65.70 ,$56.77 ,$67.16 ,$65.70 ,$48.65 ,$48.65 ,$44.46 ,$48.65 ,$47.45 ,$50.84 ,$16.22 ,$57.67 ,$32.28 , N/A , N/A , N/A , N/A ,$25.23 ,$69.35 ,$59.86 ,$59.86 ,$58.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),Q2038072,Q2038,HC FLU VAX>3YRS FLUZONE,636,1 ,$33.00 ,$16.50 ,$7.33 ,$50.55 ,$47.69 ,$27.91 ,$27.91 ,$11.22 ,$26.40 ,$28.05 ,$20.63 ,$29.70 ,$47.69 ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$11.22 ,$28.05 ,$28.05 ,$29.70 ,$47.69 ,$13.86 ,$29.70 ,$23.02 ,$30.36 ,$29.70 ,$21.99 ,$21.99 ,$20.10 ,$21.99 ,$21.45 ,$22.98 ,$7.33 ,$26.07 ,$50.55 ,$16.50 ,$16.50 ,$11.22 ,$16.50 ,$10.23 ,$31.35 ,$27.06 ,$27.06 ,$26.40