ST. CLARE MEMORIAL HOSPITAL - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hospital_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 , CONTINUUS MEDICAID MANAGED , FIRST HEALTH NETWORK , HEALTHEOS , HUMANA , HUMANA CHOICE CARE PPO , HUMANA MEDICARE ADVANTAGE , HUMANA NATIIONAL POS HMO , HUMANA PREFERRED BHCG , INTERPLAN HEALTH GROUP , LIVE360 HSHS HEALTHY PLAN , MANAGED HEALTH SERVICES MCD , MOLINA MARKETPLACE , MOLINA MEDICAID , 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 ","$39,941.68 ","$8,250.00 ","$84,123.39 ","$30,860.56 ","$60,517.70 ","$60,517.70 ","$35,485.21 ","$48,414.16 ","$51,440.05 ","$37,823.56 ","$54,465.93 ","$79,361.69 ","$30,397.65 ","$57,491.82 ","$54,465.93 ","$51,440.05 ","$51,440.05 ","$35,485.21 ","$51,440.05 ","$51,440.05 ","$54,465.93 ","$36,855.28 ","$30,397.65 ","$77,271.60 ", N/A ,"$54,465.93 ", N/A ,"$55,676.28 ","$54,465.93 ","$60,517.70 ","$60,517.70 ","$36,855.28 ","$60,517.70 ","$39,336.51 ","$41,345.69 ","$29,610.56 ","$47,808.98 ","$84,123.39 ","$60,517.70 ","$60,517.70 ","$35,485.21 ","$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 ","$10,101.76 ","$1,100.00 ","$18,854.72 ","$7,580.91 ","$15,305.70 ","$15,305.70 ","$4,731.36 ","$12,244.56 ","$13,009.85 ","$9,566.06 ","$13,775.13 ","$17,787.47 ","$7,467.20 ","$14,540.42 ","$13,775.13 ","$13,009.85 ","$13,009.85 ","$4,731.36 ","$13,009.85 ","$13,009.85 ","$13,775.13 ","$9,321.17 ","$7,467.20 ","$10,302.88 ", N/A ,"$13,775.13 ", N/A ,"$14,081.24 ","$13,775.13 ","$15,305.70 ","$15,305.70 ","$9,321.17 ","$15,305.70 ","$9,948.71 ","$10,456.85 ","$3,948.08 ","$12,091.50 ","$18,854.72 ","$15,305.70 ","$15,305.70 ","$4,731.36 ","$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 ","$7,560.41 ","$1,100.00 ","$19,354.88 ","$6,873.52 ","$11,455.16 ","$11,455.16 ","$4,731.36 ","$9,164.13 ","$9,736.89 ","$7,159.48 ","$10,309.64 ","$18,259.32 ","$6,770.42 ","$10,882.40 ","$10,309.64 ","$9,736.89 ","$9,736.89 ","$4,731.36 ","$9,736.89 ","$9,736.89 ","$10,309.64 ","$6,976.19 ","$6,770.42 ","$10,302.88 ", N/A ,"$10,309.64 ", N/A ,"$10,538.75 ","$10,309.64 ","$11,455.16 ","$11,455.16 ","$6,976.19 ","$11,455.16 ","$7,445.85 ","$7,826.17 ","$3,948.08 ","$9,049.58 ","$19,354.88 ","$11,455.16 ","$11,455.16 ","$4,731.36 ","$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 ","$15,638.42 ","$2,200.00 ","$32,962.97 ","$11,900.33 ","$23,694.57 ","$23,694.57 ","$9,462.72 ","$18,955.66 ","$20,140.38 ","$14,809.11 ","$21,325.11 ","$31,097.14 ","$11,721.83 ","$22,509.84 ","$21,325.11 ","$20,140.38 ","$20,140.38 ","$9,462.72 ","$20,140.38 ","$20,140.38 ","$21,325.11 ","$14,429.99 ","$11,721.83 ","$20,605.76 ", N/A ,"$21,325.11 ", N/A ,"$21,799.00 ","$21,325.11 ","$23,694.57 ","$23,694.57 ","$14,429.99 ","$23,694.57 ","$15,401.47 ","$16,188.13 ","$7,896.15 ","$18,718.71 ","$32,962.97 ","$23,694.57 ","$23,694.57 ","$9,462.72 ","$23,694.57 ","$2,200.00 ","$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 ","$4,506.88 ","$1,100.00 ","$10,302.88 ","$6,873.52 ","$6,828.61 ","$6,828.61 ","$4,731.36 ","$5,462.89 ","$5,804.32 ","$4,267.88 ","$6,145.75 ","$9,632.79 ","$6,770.42 ","$6,487.18 ","$6,145.75 ","$5,804.32 ","$5,804.32 ","$4,731.36 ","$5,804.32 ","$5,804.32 ","$6,145.75 ","$4,158.62 ","$6,770.42 ","$10,302.88 ", N/A ,"$6,145.75 ", N/A ,"$6,282.32 ","$6,145.75 ","$6,828.61 ","$6,828.61 ","$4,158.62 ","$6,828.61 ","$4,438.60 ","$4,665.31 ","$3,948.08 ","$5,394.60 ","$10,210.76 ","$6,828.61 ","$6,828.61 ","$4,731.36 ","$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 ,$494.50 ,$326.37 ,$111.00 ,"$1,367.54 ","$1,290.13 ",$139.00 ,$111.00 ,$130.85 ,$395.60 ,$420.33 ,$309.06 ,$445.05 ,"$1,290.13 ",$494.50 ,$469.78 ,$445.05 ,$420.33 ,$420.33 ,$130.85 ,$420.33 ,$420.33 ,$445.05 ,$301.15 ,"$1,290.13 ",$306.60 ,$524.17 ,$445.05 ,$839.41 ,$454.94 ,$445.05 ,$326.42 ,$326.42 ,$301.15 ,$326.42 ,$321.43 ,$337.84 ,$112.58 ,$390.66 ,"$1,367.54 ",$242.31 ,$242.31 ,$130.85 ,$242.31 ,$373.07 ,$469.78 ,$405.49 ,$405.49 ,$395.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),10060072,10060,HC I AND D SKIN ABSCESS,510,1 ,$514.05 ,$339.27 ,$111.00 ,$514.05 ,$318.12 ,$139.00 ,$111.00 ,$136.01 ,$411.24 ,$436.94 ,$321.28 ,$462.65 ,$318.12 ,$318.12 ,$488.35 ,$462.65 ,$436.94 ,$436.94 ,$136.01 ,$436.94 ,$436.94 ,$462.65 ,$313.06 ,$318.12 ,$318.72 ,$337.21 ,$462.65 ,$406.31 ,$472.93 ,$462.65 ,$339.32 ,$339.32 ,$313.06 ,$339.32 ,$334.13 ,$351.20 ,$117.02 ,$406.10 ,$337.21 ,$251.88 ,$251.88 ,$136.01 ,$251.88 ,$180.58 ,$488.35 ,$421.52 ,$421.52 ,$411.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),10080072,10080,HC DRAIN PILONIDAL CYST SIMPLE-PREV 72 HR,510,1 ,$798.10 ,$526.75 ,$111.00 ,"$1,460.18 ",$318.12 ,$139.00 ,$111.00 ,$211.18 ,$638.48 ,$678.39 ,$498.81 ,$718.29 ,$318.12 ,$318.12 ,$758.20 ,$718.29 ,$678.39 ,$678.39 ,$211.18 ,$678.39 ,$678.39 ,$718.29 ,$486.04 ,$318.12 ,$494.82 ,$337.21 ,$718.29 ,"$1,460.18 ",$734.25 ,$718.29 ,$526.83 ,$526.83 ,$486.04 ,$526.83 ,$518.77 ,$545.26 ,$181.69 ,$630.50 ,$337.21 ,$391.07 ,$391.07 ,$211.18 ,$391.07 ,$648.97 ,$758.20 ,$654.44 ,$654.44 ,$638.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),10140072,10140,HC I AND D HEMATOMA,975,1 ,$469.00 ,$309.54 ,$106.77 ,"$3,373.99 ","$2,101.03 ",$420.32 ,$420.32 ,$125.50 ,$375.20 ,$398.65 ,$293.13 ,$422.10 ,"$2,101.03 ",$469.00 ,$445.55 ,$422.10 ,$398.65 ,$398.65 ,$125.50 ,$398.65 ,$398.65 ,$422.10 ,$285.62 ,"$2,101.03 ",$256.12 ,$497.14 ,$422.10 ,"$3,373.99 ",$431.48 ,$422.10 ,$309.59 ,$309.59 ,$285.62 ,$309.59 ,$304.85 ,$320.42 ,$106.77 ,$370.51 ,"$2,227.09 ", N/A , N/A ,$125.50 , N/A ,"$1,499.55 ",$445.55 ,$384.58 ,$384.58 ,$375.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),11042072,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM,510,1 ,$487.60 ,$321.82 ,$111.00 ,$839.41 ,$717.24 ,$139.00 ,$111.00 ,$129.02 ,$390.08 ,$414.46 ,$304.75 ,$438.84 ,$717.24 ,$487.60 ,$463.22 ,$438.84 ,$414.46 ,$414.46 ,$129.02 ,$414.46 ,$414.46 ,$438.84 ,$296.95 ,$717.24 ,$302.32 ,$516.86 ,$438.84 ,$839.41 ,$448.59 ,$438.84 ,$321.86 ,$321.86 ,$296.95 ,$321.86 ,$316.94 ,$333.13 ,$111.00 ,$385.20 ,$760.27 ,$238.92 ,$238.92 ,$129.02 ,$238.92 ,$373.07 ,$463.22 ,$399.83 ,$399.83 ,$390.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),11100010,N/A,HC DAILY SERVICE W/TELEMETRY,111,1 ,"$1,761.80 ","$1,162.79 ","$1,072.94 ","$1,761.80 ", Inpatient Medicaid ,"$9,900.00 ","$9,900.00 ", Inpatient Medicare ,"$1,409.44 ","$1,497.53 ","$1,101.13 ","$1,585.62 ", Inpatient Medicaid , Inpatient Medicaid ,"$1,673.71 ","$1,585.62 ","$1,497.53 ","$1,497.53 ", Inpatient Medicare ,"$1,497.53 ","$1,497.53 ","$1,585.62 ","$1,072.94 ", Inpatient Medicaid +104% , Inpatient Medicaid +100% , Inpatient Medicaid +6% ,"$1,585.62 ", Inpatient Medicare +100% ,"$1,620.86 ","$1,585.62 ","$8,848.37 ","$8,848.37 ","$1,072.94 ","$8,848.37 ","$1,145.17 ","$1,203.66 ", Inpatient Medicare +1% ,"$1,391.82 ", Inpatient Medicaid +6% ,"$9,216.00 ","$9,216.00 ", Inpatient Medicare ,"$10,535.00 ",$550.00 ,"$1,673.71 ","$1,444.68 ","$1,444.68 ","$1,409.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),11200072,11200,HC RM SKIN TAG LESION <15-PRV 72 HR,975,1 ,$313.00 ,$206.58 ,$71.26 ,$406.31 ,$318.12 ,$280.51 ,$280.51 ,$81.85 ,$250.40 ,$266.05 ,$195.63 ,$281.70 ,$318.12 ,$313.00 ,$297.35 ,$281.70 ,$266.05 ,$266.05 ,$81.85 ,$266.05 ,$266.05 ,$281.70 ,$190.62 ,$318.12 ,$167.04 ,$331.78 ,$281.70 ,$406.31 ,$287.96 ,$281.70 ,$206.61 ,$206.61 ,$190.62 ,$206.61 ,$203.45 ,$213.84 ,$71.26 ,$247.27 ,$337.21 , N/A , N/A ,$81.85 , N/A ,$180.58 ,$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 ,$399.96 ,$137.95 ,"$3,669.37 ","$3,461.67 ",$543.10 ,$543.10 ,$259.05 ,$484.80 ,$515.10 ,$378.75 ,$545.40 ,"$3,461.67 ",$606.00 ,$575.70 ,$545.40 ,$515.10 ,$515.10 ,$259.05 ,$515.10 ,$515.10 ,$545.40 ,$369.05 ,"$3,461.67 ",$528.68 ,$642.36 ,$545.40 ,"$3,373.99 ",$557.52 ,$545.40 ,$400.02 ,$400.02 ,$369.05 ,$400.02 ,$393.90 ,$414.02 ,$137.95 ,$478.74 ,"$3,669.37 ", N/A , N/A ,$259.05 , N/A ,"$1,499.55 ",$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 ,$492.36 ,$144.80 ,"$3,373.99 ","$2,299.87 ",$668.57 ,$668.57 ,$144.80 ,$596.80 ,$634.10 ,$466.25 ,$671.40 ,"$2,299.87 ",$746.00 ,$708.70 ,$671.40 ,$634.10 ,$634.10 ,$144.80 ,$634.10 ,$634.10 ,$671.40 ,$454.31 ,"$2,299.87 ",$295.52 ,$790.76 ,$671.40 ,"$3,373.99 ",$686.32 ,$671.40 ,$492.43 ,$492.43 ,$454.31 ,$492.43 ,$484.90 ,$509.67 ,$169.83 ,$589.34 ,"$2,437.86 ", N/A , N/A ,$144.80 , N/A ,"$1,499.55 ",$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 ",$867.90 ,$283.72 ,"$5,812.31 ","$3,461.67 ","$1,178.50 ","$1,178.50 ",$283.72 ,"$1,052.00 ","$1,117.75 ",$821.88 ,"$1,183.50 ","$3,461.67 ","$1,315.00 ","$1,249.25 ","$1,183.50 ","$1,117.75 ","$1,117.75 ",$283.72 ,"$1,117.75 ","$1,117.75 ","$1,183.50 ",$800.84 ,"$3,461.67 ",$579.02 ,"$1,393.90 ","$1,183.50 ","$5,812.31 ","$1,209.80 ","$1,183.50 ",$868.03 ,$868.03 ,$800.84 ,$868.03 ,$854.75 ,$898.41 ,$299.36 ,"$1,038.85 ","$3,669.37 ", N/A , N/A ,$283.72 , N/A ,"$2,583.25 ","$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 ,$405.95 ,$267.93 ,$92.41 ,"$1,460.18 ",$832.76 ,$139.00 ,$111.00 ,$107.42 ,$324.76 ,$345.06 ,$253.72 ,$365.36 ,$832.76 ,$405.95 ,$385.65 ,$365.36 ,$345.06 ,$345.06 ,$107.42 ,$345.06 ,$345.06 ,$365.36 ,$247.22 ,$832.76 ,$251.68 ,$430.31 ,$365.36 ,"$1,460.18 ",$373.47 ,$365.36 ,$267.97 ,$267.97 ,$247.22 ,$267.97 ,$263.87 ,$277.35 ,$92.41 ,$320.70 ,$882.73 ,$198.92 ,$198.92 ,$107.42 ,$198.92 ,$648.97 ,$385.65 ,$332.88 ,$332.88 ,$324.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),11450072,11450,HC EXC SKIN SUBQ TISSUE,975,1 ,"$1,554.00 ","$1,025.64 ",$272.98 ,"$5,812.31 ","$3,461.67 ","$1,392.69 ","$1,392.69 ",$272.98 ,"$1,243.20 ","$1,320.90 ",$971.25 ,"$1,398.60 ","$3,461.67 ","$1,554.00 ","$1,476.30 ","$1,398.60 ","$1,320.90 ","$1,320.90 ",$272.98 ,"$1,320.90 ","$1,320.90 ","$1,398.60 ",$946.39 ,"$3,461.67 ",$557.10 ,"$1,647.24 ","$1,398.60 ","$5,812.31 ","$1,429.68 ","$1,398.60 ","$1,025.80 ","$1,025.80 ",$946.39 ,"$1,025.80 ","$1,010.10 ","$1,061.69 ",$353.77 ,"$1,227.66 ","$3,669.37 ", N/A , N/A ,$272.98 , N/A ,"$2,583.25 ","$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 ,$465.75 ,$307.40 ,$106.03 ,$882.73 ,$832.76 ,$139.00 ,$111.00 ,$123.23 ,$372.60 ,$395.89 ,$291.09 ,$419.18 ,$832.76 ,$465.75 ,$442.46 ,$419.18 ,$395.89 ,$395.89 ,$123.23 ,$395.89 ,$395.89 ,$419.18 ,$283.64 ,$832.76 ,$288.76 ,$493.70 ,$419.18 ,$839.41 ,$428.49 ,$419.18 ,$307.44 ,$307.44 ,$283.64 ,$307.44 ,$302.74 ,$318.20 ,$106.03 ,$367.94 ,$882.73 ,$228.22 ,$228.22 ,$123.23 ,$228.22 ,$373.07 ,$442.46 ,$381.92 ,$381.92 ,$372.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),11603072,11603,HC EXC SKIN MALIG 2.1-3CM TAL 72 HR,510,1 ,$434.70 ,$286.90 ,$98.96 ,"$1,460.18 ",$832.76 ,$139.00 ,$111.00 ,$115.02 ,$347.76 ,$369.50 ,$271.69 ,$391.23 ,$832.76 ,$434.70 ,$412.97 ,$391.23 ,$369.50 ,$369.50 ,$115.02 ,$369.50 ,$369.50 ,$391.23 ,$264.73 ,$832.76 ,$269.52 ,$460.78 ,$391.23 ,"$1,460.18 ",$399.92 ,$391.23 ,$286.95 ,$286.95 ,$264.73 ,$286.95 ,$282.56 ,$296.99 ,$98.96 ,$343.41 ,$882.73 ,$213.00 ,$213.00 ,$115.02 ,$213.00 ,$648.97 ,$412.97 ,$356.45 ,$356.45 ,$347.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),11606072,11606,HC EXC MAL LES MRG>4CM,983,1 ,"$1,594.00 ","$1,052.04 ",$330.11 ,"$3,669.37 ","$3,461.67 ","$1,428.54 ","$1,428.54 ",$330.11 ,"$1,275.20 ","$1,354.90 ",$996.25 ,"$1,434.60 ","$3,461.67 ","$1,594.00 ","$1,514.30 ","$1,434.60 ","$1,354.90 ","$1,354.90 ",$330.11 ,"$1,354.90 ","$1,354.90 ","$1,434.60 ",$970.75 ,"$3,461.67 ",$673.70 ,"$1,689.64 ","$1,434.60 ","$3,373.99 ","$1,466.48 ","$1,434.60 ","$1,052.20 ","$1,052.20 ",$970.75 ,"$1,052.20 ","$1,036.10 ","$1,089.02 ",$362.88 ,"$1,259.26 ","$3,669.37 ", N/A , N/A ,$330.11 , N/A ,"$1,499.55 ","$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 ,$754.40 ,$497.90 ,$111.00 ,"$1,460.18 ",$832.76 ,$139.00 ,$111.00 ,$199.62 ,$603.52 ,$641.24 ,$471.50 ,$678.96 ,$832.76 ,$754.40 ,$716.68 ,$678.96 ,$641.24 ,$641.24 ,$199.62 ,$641.24 ,$641.24 ,$678.96 ,$459.43 ,$832.76 ,$467.72 ,$799.66 ,$678.96 ,"$1,460.18 ",$694.05 ,$678.96 ,$497.98 ,$497.98 ,$459.43 ,$497.98 ,$490.36 ,$515.41 ,$171.74 ,$595.98 ,$882.73 ,$369.66 ,$369.66 ,$199.62 ,$369.66 ,$648.97 ,$716.68 ,$618.61 ,$618.61 ,$603.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),11623072,11623,HC EXC SKIN MALIG 2.1-3CM REMAINDER BODY,975,1 ,"$1,044.00 ",$689.04 ,$221.89 ,"$3,373.99 ","$2,299.87 ",$935.63 ,$935.63 ,$221.89 ,$835.20 ,$887.40 ,$652.50 ,$939.60 ,"$2,299.87 ","$1,044.00 ",$991.80 ,$939.60 ,$887.40 ,$887.40 ,$221.89 ,$887.40 ,$887.40 ,$939.60 ,$635.80 ,"$2,299.87 ",$452.84 ,"$1,106.64 ",$939.60 ,"$3,373.99 ",$960.48 ,$939.60 ,$689.14 ,$689.14 ,$635.80 ,$689.14 ,$678.60 ,$713.26 ,$237.67 ,$824.76 ,"$2,437.86 ", N/A , N/A ,$221.89 , N/A ,"$1,499.55 ",$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 ,$929.20 ,$613.27 ,$111.00 ,"$3,373.99 ","$2,299.87 ",$139.00 ,$111.00 ,$245.86 ,$743.36 ,$789.82 ,$580.75 ,$836.28 ,"$2,299.87 ",$929.20 ,$882.74 ,$836.28 ,$789.82 ,$789.82 ,$245.86 ,$789.82 ,$789.82 ,$836.28 ,$565.88 ,"$2,299.87 ",$576.10 ,$984.95 ,$836.28 ,"$3,373.99 ",$854.86 ,$836.28 ,$613.36 ,$613.36 ,$565.88 ,$613.36 ,$603.98 ,$634.83 ,$211.54 ,$734.07 ,"$2,437.86 ",$455.31 ,$455.31 ,$245.86 ,$455.31 ,"$1,499.55 ",$882.74 ,$761.94 ,$761.94 ,$743.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),11730072,11730,HC AVULSION PLATE SINGLE-72HR,975,1 ,$250.00 ,$165.00 ,$56.92 ,$406.31 ,$123.43 ,$224.05 ,$224.05 ,$57.26 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$123.43 ,$123.43 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$57.26 ,$212.50 ,$212.50 ,$225.00 ,$152.25 ,$123.43 ,$116.86 ,$130.84 ,$225.00 ,$406.31 ,$230.00 ,$225.00 ,$165.03 ,$165.03 ,$152.25 ,$165.03 ,$162.50 ,$170.80 ,$56.92 ,$197.50 ,$130.84 , N/A , N/A ,$57.26 , N/A ,$180.58 ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),11750072,11750,HC REMOVAL NAIL BED PRV 72 HR,510,1 ,$351.90 ,$232.25 ,$80.11 ,$882.73 ,$832.76 ,$139.00 ,$111.00 ,$93.11 ,$281.52 ,$299.12 ,$219.94 ,$316.71 ,$832.76 ,$351.90 ,$334.31 ,$316.71 ,$299.12 ,$299.12 ,$93.11 ,$299.12 ,$299.12 ,$316.71 ,$214.31 ,$832.76 ,$218.18 ,$373.01 ,$316.71 ,$839.41 ,$323.75 ,$316.71 ,$232.29 ,$232.29 ,$214.31 ,$232.29 ,$228.74 ,$240.42 ,$80.11 ,$278.00 ,$882.73 ,$172.43 ,$172.43 ,$93.11 ,$172.43 ,$373.07 ,$334.31 ,$288.56 ,$288.56 ,$281.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),11981072,11981,HC INSERT DRUG IMPLANT DEVICE,983,1 ,$265.00 ,$174.90 ,$60.33 ,$337.21 ,$318.12 ,$237.49 ,$237.49 ,$64.81 ,$212.00 ,$225.25 ,$165.63 ,$238.50 ,$318.12 ,$265.00 ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$64.81 ,$225.25 ,$225.25 ,$238.50 ,$161.39 ,$318.12 ,$132.26 ,$280.90 ,$238.50 ,$261.25 ,$243.80 ,$238.50 ,$174.93 ,$174.93 ,$161.39 ,$174.93 ,$172.25 ,$181.05 ,$60.33 ,$209.35 ,$337.21 , N/A , N/A ,$64.81 , N/A ,$116.11 ,$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 ,$342.54 ,$116.97 ,$839.41 ,$351.11 ,$465.13 ,$465.13 ,$118.92 ,$415.20 ,$441.15 ,$324.38 ,$467.10 ,$351.11 ,$351.11 ,$493.05 ,$467.10 ,$441.15 ,$441.15 ,$118.92 ,$441.15 ,$441.15 ,$467.10 ,$316.07 ,$351.11 ,$242.70 ,$372.18 ,$467.10 ,$839.41 ,$477.48 ,$467.10 ,$342.59 ,$342.59 ,$316.07 ,$342.59 ,$337.35 ,$354.58 ,$116.97 ,$410.01 ,$372.18 , N/A , N/A ,$118.92 , N/A ,$373.07 ,$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 ,$306.24 ,$56.69 ,$464.00 ,$351.11 ,$415.84 ,$415.84 ,$56.69 ,$371.20 ,$394.40 ,$290.00 ,$417.60 ,$351.11 ,$351.11 ,$440.80 ,$417.60 ,$394.40 ,$394.40 ,$56.69 ,$394.40 ,$394.40 ,$417.60 ,$282.58 ,$351.11 ,$115.70 ,$372.18 ,$417.60 ,$406.31 ,$426.88 ,$417.60 ,$306.29 ,$306.29 ,$282.58 ,$306.29 ,$301.60 ,$317.00 ,$105.63 ,$366.56 ,$372.18 , N/A , N/A ,$56.69 , N/A ,$180.58 ,$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 ,$607.20 ,$209.45 ,$920.00 ,$717.24 ,$824.50 ,$824.50 ,$251.63 ,$736.00 ,$782.00 ,$575.00 ,$828.00 ,$717.24 ,$717.24 ,$874.00 ,$828.00 ,$782.00 ,$782.00 ,$251.63 ,$782.00 ,$782.00 ,$828.00 ,$560.28 ,$717.24 ,$513.54 ,$760.27 ,$828.00 ,$839.41 ,$846.40 ,$828.00 ,$607.29 ,$607.29 ,$560.28 ,$607.29 ,$598.00 ,$628.54 ,$209.45 ,$726.80 ,$760.27 , N/A , N/A ,$251.63 , N/A ,$373.07 ,$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 ,$523.38 ,$180.53 ,"$1,307.14 ",$717.24 ,$710.69 ,$710.69 ,$225.79 ,$634.40 ,$674.05 ,$495.63 ,$713.70 ,$717.24 ,$717.24 ,$753.35 ,$713.70 ,$674.05 ,$674.05 ,$225.79 ,$674.05 ,$674.05 ,$713.70 ,$482.94 ,$717.24 ,$460.80 ,$760.27 ,$713.70 ,"$1,307.14 ",$729.56 ,$713.70 ,$523.46 ,$523.46 ,$482.94 ,$523.46 ,$515.45 ,$541.78 ,$180.53 ,$626.47 ,$760.27 , N/A , N/A ,$225.79 , N/A ,$580.95 ,$753.35 ,$650.26 ,$650.26 ,$634.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),12052072,12052,HC LAYR CLOS WND FACE,975,1 ,$764.00 ,$504.24 ,$173.93 ,$839.41 ,$717.24 ,$684.70 ,$684.70 ,$212.12 ,$611.20 ,$649.40 ,$477.50 ,$687.60 ,$717.24 ,$717.24 ,$725.80 ,$687.60 ,$649.40 ,$649.40 ,$212.12 ,$649.40 ,$649.40 ,$687.60 ,$465.28 ,$717.24 ,$432.90 ,$760.27 ,$687.60 ,$839.41 ,$702.88 ,$687.60 ,$504.32 ,$504.32 ,$465.28 ,$504.32 ,$496.60 ,$521.96 ,$173.93 ,$603.56 ,$760.27 , N/A , N/A ,$212.12 , N/A ,$373.07 ,$725.80 ,$626.48 ,$626.48 ,$611.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),12100001,N/A,HC DAILY SERVICE,121,1 ,"$1,761.80 ","$1,162.79 ","$1,072.94 ","$1,761.80 ", Inpatient Medicaid ,"$9,900.00 ","$9,900.00 ", Inpatient Medicare ,"$1,409.44 ","$1,497.53 ","$1,101.13 ","$1,585.62 ", Inpatient Medicaid , Inpatient Medicaid ,"$1,673.71 ","$1,585.62 ","$1,497.53 ","$1,497.53 ", Inpatient Medicare ,"$1,497.53 ","$1,497.53 ","$1,585.62 ","$1,072.94 ", Inpatient Medicaid +104% , Inpatient Medicaid +100% , Inpatient Medicaid +6% ,"$1,585.62 ", Inpatient Medicare +100% ,"$1,620.86 ","$1,585.62 ","$8,848.37 ","$8,848.37 ","$1,072.94 ","$8,848.37 ","$1,145.17 ","$1,203.66 ", Inpatient Medicare +1% ,"$1,391.82 ", Inpatient Medicaid +6% ,"$9,216.00 ","$9,216.00 ", Inpatient Medicare ,"$10,535.00 ",$550.00 ,"$1,673.71 ","$1,444.68 ","$1,444.68 ","$1,409.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),12800001,N/A,HC DAILY REHAB SERVICE,128,1 ,$535.90 ,$353.69 ,$326.36 ,$535.90 , Inpatient Medicaid ,"$9,900.00 ","$9,900.00 ", Inpatient Medicare ,$428.72 ,$455.52 ,$334.94 ,$482.31 , Inpatient Medicaid , Inpatient Medicaid ,$509.11 ,$482.31 ,$455.52 ,$455.52 , Inpatient Medicare ,$455.52 ,$455.52 ,$482.31 ,$326.36 , Inpatient Medicaid +104% , Inpatient Medicaid +100% , Inpatient Medicaid +6% ,$482.31 , Inpatient Medicare +100% ,$493.03 ,$482.31 ,"$8,848.37 ","$8,848.37 ",$326.36 ,"$8,848.37 ",$348.34 ,$366.13 , Inpatient Medicare +1% ,$423.36 , Inpatient Medicaid +6% ,"$1,456.00 ","$1,456.00 ", Inpatient Medicare ,"$1,630.00 ",$550.00 ,$509.11 ,$439.44 ,$439.44 ,$428.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),15120072,15120,HC AUTOGRPH F F DG 100SQCM-72 HR,975,1 ,"$3,387.00 ","$2,235.42 ",$725.73 ,"$7,319.34 ","$3,766.97 ","$3,035.43 ","$3,035.43 ",$725.73 ,"$2,709.60 ","$2,878.95 ","$2,116.88 ","$3,048.30 ","$3,766.97 ","$3,387.00 ","$3,217.65 ","$3,048.30 ","$2,878.95 ","$2,878.95 ",$725.73 ,"$2,878.95 ","$2,878.95 ","$3,048.30 ","$2,062.68 ","$3,766.97 ","$1,481.08 ","$3,590.22 ","$3,048.30 ","$7,319.34 ","$3,116.04 ","$3,048.30 ","$2,235.76 ","$2,235.76 ","$2,062.68 ","$2,235.76 ","$2,201.55 ","$2,314.00 ",$771.06 ,"$2,675.73 ","$3,992.99 ", N/A , N/A ,$725.73 , N/A ,"$3,253.04 ","$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 ,$535.90 ,$353.69 ,$326.36 ,$535.90 , Inpatient Medicaid ,"$9,900.00 ","$9,900.00 ", Inpatient Medicare ,$428.72 ,$455.52 ,$334.94 ,$482.31 , Inpatient Medicaid , Inpatient Medicaid ,$509.11 ,$482.31 ,$455.52 ,$455.52 , Inpatient Medicare ,$455.52 ,$455.52 ,$482.31 ,$326.36 , Inpatient Medicaid +104% , Inpatient Medicaid +100% , Inpatient Medicaid +6% ,$482.31 , Inpatient Medicare +100% ,$493.03 ,$482.31 ,"$8,848.37 ","$8,848.37 ",$326.36 ,"$8,848.37 ",$348.34 ,$366.13 , Inpatient Medicare +1% ,$423.36 , Inpatient Medicaid +6% ,"$9,216.00 ","$9,216.00 ", Inpatient Medicare ,"$10,535.00 ",$550.00 ,$509.11 ,$439.44 ,$439.44 ,$428.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),17110072,17110,HC DESTRUCT BENIGN LESION <15 FACIL-PRV 72HR,983,1 ,$281.00 ,$185.46 ,$63.97 ,$406.31 ,$318.12 ,$251.83 ,$251.83 ,$72.20 ,$224.80 ,$238.85 ,$175.63 ,$252.90 ,$318.12 ,$281.00 ,$266.95 ,$252.90 ,$238.85 ,$238.85 ,$72.20 ,$238.85 ,$238.85 ,$252.90 ,$171.13 ,$318.12 ,$147.34 ,$297.86 ,$252.90 ,$406.31 ,$258.52 ,$252.90 ,$185.49 ,$185.49 ,$171.13 ,$185.49 ,$182.65 ,$191.98 ,$63.97 ,$221.99 ,$337.21 , N/A , N/A ,$72.20 , N/A ,$180.58 ,$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 ","$1,329.90 ",$431.29 ,"$7,735.05 ","$2,533.69 ","$1,805.84 ","$1,805.84 ",$431.29 ,"$1,612.00 ","$1,712.75 ","$1,259.38 ","$1,813.50 ","$2,533.69 ","$2,015.00 ","$1,914.25 ","$1,813.50 ","$1,712.75 ","$1,712.75 ",$431.29 ,"$1,712.75 ","$1,712.75 ","$1,813.50 ","$1,227.14 ","$2,533.69 ",$880.18 ,"$2,135.90 ","$1,813.50 ","$7,735.05 ","$1,853.80 ","$1,813.50 ","$1,330.10 ","$1,330.10 ","$1,227.14 ","$1,330.10 ","$1,309.75 ","$1,376.65 ",$458.72 ,"$1,591.85 ","$2,685.71 ", N/A , N/A ,$431.29 , N/A ,"$3,437.80 ","$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 ","$1,597.20 ",$475.67 ,"$7,735.05 ","$2,533.69 ","$2,168.80 ","$2,168.80 ",$475.67 ,"$1,936.00 ","$2,057.00 ","$1,512.50 ","$2,178.00 ","$2,533.69 ","$2,420.00 ","$2,299.00 ","$2,178.00 ","$2,057.00 ","$2,057.00 ",$475.67 ,"$2,057.00 ","$2,057.00 ","$2,178.00 ","$1,473.78 ","$2,533.69 ",$970.76 ,"$2,565.20 ","$2,178.00 ","$7,735.05 ","$2,226.40 ","$2,178.00 ","$1,597.44 ","$1,597.44 ","$1,473.78 ","$1,597.44 ","$1,573.00 ","$1,653.34 ",$550.93 ,"$1,911.80 ","$2,685.71 ", N/A , N/A ,$475.67 , N/A ,"$3,437.80 ","$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 ","$1,277.10 ",$440.51 ,"$7,735.05 ","$6,250.93 ","$1,734.15 ","$1,734.15 ",$677.11 ,"$1,548.00 ","$1,644.75 ","$1,209.38 ","$1,741.50 ","$6,250.93 ","$1,935.00 ","$1,838.25 ","$1,741.50 ","$1,644.75 ","$1,644.75 ",$677.11 ,"$1,644.75 ","$1,644.75 ","$1,741.50 ","$1,178.42 ","$6,250.93 ","$1,381.86 ","$2,051.10 ","$1,741.50 ","$7,735.05 ","$1,780.20 ","$1,741.50 ","$1,277.29 ","$1,277.29 ","$1,178.42 ","$1,277.29 ","$1,257.75 ","$1,321.99 ",$440.51 ,"$1,528.65 ","$6,625.99 ", N/A , N/A ,$677.11 , N/A ,"$3,437.80 ","$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 ,"$3,570.75 ","$2,356.70 ","$2,174.59 ","$3,570.75 ", Inpatient Medicaid ,"$9,900.00 ","$9,900.00 ", Inpatient Medicare ,"$2,856.60 ","$3,035.14 ","$2,231.72 ","$3,213.68 ", Inpatient Medicaid , Inpatient Medicaid ,"$3,392.21 ","$3,213.68 ","$3,035.14 ","$3,035.14 ", Inpatient Medicare ,"$3,035.14 ","$3,035.14 ","$3,213.68 ","$2,174.59 ", Inpatient Medicaid +104% , Inpatient Medicaid +100% , Inpatient Medicaid +6% ,"$3,213.68 ", Inpatient Medicare +100% ,"$3,285.09 ","$3,213.68 ","$8,848.37 ","$8,848.37 ","$2,174.59 ","$8,848.37 ","$2,320.99 ","$2,439.54 ", Inpatient Medicare +1% ,"$2,820.89 ", Inpatient Medicaid +6% ,"$9,216.00 ","$9,216.00 ", Inpatient Medicare ,"$10,535.00 ",$550.00 ,"$3,392.21 ","$2,928.02 ","$2,928.02 ","$2,856.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ACETYLCYSTEINE 20 % SOLN,250,1 ,$52.20 ,$34.45 ,$11.89 ,$52.20 , N/A ,$46.78 ,$46.78 ,$13.81 ,$41.76 ,$44.37 ,$32.63 ,$46.98 , N/A , N/A ,$49.59 ,$46.98 ,$44.37 ,$44.37 ,$13.81 ,$44.37 ,$44.37 ,$46.98 ,$31.79 , N/A ,$32.36 , N/A ,$46.98 , N/A ,$48.02 ,$46.98 ,$34.46 ,$34.46 ,$31.79 ,$34.46 ,$33.93 ,$35.66 ,$11.89 ,$41.24 , N/A ,$25.58 ,$25.58 ,$13.81 ,$25.58 , N/A ,$49.59 ,$42.80 ,$42.80 ,$41.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ALCOHOL 98 % SOLN,250,1 ,$875.61 ,$577.90 ,$199.33 ,$875.61 , N/A ,$784.72 ,$784.72 ,$231.68 ,$700.49 ,$744.27 ,$547.26 ,$788.05 , N/A , N/A ,$831.83 ,$788.05 ,$744.27 ,$744.27 ,$231.68 ,$744.27 ,$744.27 ,$788.05 ,$533.25 , N/A ,$542.88 , N/A ,$788.05 , N/A ,$805.56 ,$788.05 ,$577.99 ,$577.99 ,$533.25 ,$577.99 ,$569.15 ,$598.22 ,$199.33 ,$691.73 , N/A ,$429.05 ,$429.05 ,$231.68 ,$429.05 , N/A ,$831.83 ,$718.00 ,$718.00 ,$700.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ARFORMOTEROL 15 MCG/2ML NEBU,250,1 ,$76.55 ,$50.52 ,$17.43 ,$76.55 , N/A ,$68.60 ,$68.60 ,$20.26 ,$61.24 ,$65.07 ,$47.84 ,$68.90 , N/A , N/A ,$72.72 ,$68.90 ,$65.07 ,$65.07 ,$20.26 ,$65.07 ,$65.07 ,$68.90 ,$46.62 , N/A ,$47.46 , N/A ,$68.90 , N/A ,$70.43 ,$68.90 ,$50.53 ,$50.53 ,$46.62 ,$50.53 ,$49.76 ,$52.30 ,$17.43 ,$60.47 , N/A ,$37.51 ,$37.51 ,$20.26 ,$37.51 , N/A ,$72.72 ,$62.77 ,$62.77 ,$61.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ATROPINE 1 % SOLN 5 ML BOTTLE,250,1 ,$207.10 ,$136.69 ,$47.15 ,$207.10 , N/A ,$185.60 ,$185.60 ,$54.80 ,$165.68 ,$176.04 ,$129.44 ,$186.39 , N/A , N/A ,$196.75 ,$186.39 ,$176.04 ,$176.04 ,$54.80 ,$176.04 ,$176.04 ,$186.39 ,$126.12 , N/A ,$128.40 , N/A ,$186.39 , N/A ,$190.53 ,$186.39 ,$136.71 ,$136.71 ,$126.12 ,$136.71 ,$134.62 ,$141.49 ,$47.15 ,$163.61 , N/A ,$101.48 ,$101.48 ,$54.80 ,$101.48 , N/A ,$196.75 ,$169.82 ,$169.82 ,$165.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,AZTREONAM 1 G SOLR 1 EACH VIAL,250,1 ,$214.05 ,$141.27 ,$48.73 ,$214.05 , N/A ,$191.83 ,$191.83 ,$56.63 ,$171.24 ,$181.94 ,$133.78 ,$192.65 , N/A , N/A ,$203.35 ,$192.65 ,$181.94 ,$181.94 ,$56.63 ,$181.94 ,$181.94 ,$192.65 ,$130.36 , N/A ,$132.72 , N/A ,$192.65 , N/A ,$196.93 ,$192.65 ,$141.29 ,$141.29 ,$130.36 ,$141.29 ,$139.13 ,$146.24 ,$48.73 ,$169.10 , N/A ,$104.88 ,$104.88 ,$56.63 ,$104.88 , N/A ,$203.35 ,$175.52 ,$175.52 ,$171.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,AZTREONAM 2 G SOLR 1 EACH VIAL,250,1 ,$541.05 ,$357.09 ,$123.17 ,$541.05 , N/A ,$484.89 ,$484.89 ,$143.16 ,$432.84 ,$459.89 ,$338.16 ,$486.95 , N/A , N/A ,$514.00 ,$486.95 ,$459.89 ,$459.89 ,$143.16 ,$459.89 ,$459.89 ,$486.95 ,$329.50 , N/A ,$335.46 , N/A ,$486.95 , N/A ,$497.77 ,$486.95 ,$357.15 ,$357.15 ,$329.50 ,$357.15 ,$351.68 ,$369.65 ,$123.17 ,$427.43 , N/A ,$265.11 ,$265.11 ,$143.16 ,$265.11 , N/A ,$514.00 ,$443.66 ,$443.66 ,$432.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BALANCED SALTS SOLN 15 ML BOTTLE,250,1 ,$43.76 ,$28.88 ,$9.96 ,$43.76 , N/A ,$39.22 ,$39.22 ,$11.58 ,$35.01 ,$37.20 ,$27.35 ,$39.38 , N/A , N/A ,$41.57 ,$39.38 ,$37.20 ,$37.20 ,$11.58 ,$37.20 ,$37.20 ,$39.38 ,$26.65 , N/A ,$27.14 , N/A ,$39.38 , N/A ,$40.26 ,$39.38 ,$28.89 ,$28.89 ,$26.65 ,$28.89 ,$28.44 ,$29.90 ,$9.96 ,$34.57 , N/A ,$21.44 ,$21.44 ,$11.58 ,$21.44 , N/A ,$41.57 ,$35.88 ,$35.88 ,$35.01 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BALANCED SALTS SOLN 30 ML BOTTLE,250,1 ,$76.95 ,$50.79 ,$17.52 ,$76.95 , N/A ,$68.96 ,$68.96 ,$20.36 ,$61.56 ,$65.41 ,$48.09 ,$69.26 , N/A , N/A ,$73.10 ,$69.26 ,$65.41 ,$65.41 ,$20.36 ,$65.41 ,$65.41 ,$69.26 ,$46.86 , N/A ,$47.70 , N/A ,$69.26 , N/A ,$70.79 ,$69.26 ,$50.79 ,$50.79 ,$46.86 ,$50.79 ,$50.02 ,$52.57 ,$17.52 ,$60.79 , N/A ,$37.71 ,$37.71 ,$20.36 ,$37.71 , N/A ,$73.10 ,$63.10 ,$63.10 ,$61.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BALANCED SALTS SOLN 500 ML FLEX CONT,250,1 ,$120.70 ,$79.66 ,$27.48 ,$120.70 , N/A ,$108.17 ,$108.17 ,$31.94 ,$96.56 ,$102.60 ,$75.44 ,$108.63 , N/A , N/A ,$114.67 ,$108.63 ,$102.60 ,$102.60 ,$31.94 ,$102.60 ,$102.60 ,$108.63 ,$73.51 , N/A ,$74.84 , N/A ,$108.63 , N/A ,$111.04 ,$108.63 ,$79.67 ,$79.67 ,$73.51 ,$79.67 ,$78.46 ,$82.46 ,$27.48 ,$95.35 , N/A ,$59.14 ,$59.14 ,$31.94 ,$59.14 , N/A ,$114.67 ,$98.97 ,$98.97 ,$96.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BALANCED SALTS SOLN 500 ML GLASS CONT,250,1 ,$127.50 ,$84.15 ,$29.03 ,$127.50 , N/A ,$114.27 ,$114.27 ,$33.74 ,$102.00 ,$108.38 ,$79.69 ,$114.75 , N/A , N/A ,$121.13 ,$114.75 ,$108.38 ,$108.38 ,$33.74 ,$108.38 ,$108.38 ,$114.75 ,$77.65 , N/A ,$79.06 , N/A ,$114.75 , N/A ,$117.30 ,$114.75 ,$84.16 ,$84.16 ,$77.65 ,$84.16 ,$82.88 ,$87.11 ,$29.03 ,$100.73 , N/A ,$62.48 ,$62.48 ,$33.74 ,$62.48 , N/A ,$121.13 ,$104.55 ,$104.55 ,$102.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BENZOCAINE 20 % 20 % SOLN,250,1 ,$37.30 ,$24.62 ,$8.50 ,$37.30 , N/A ,$33.43 ,$33.43 ,$9.87 ,$29.84 ,$31.71 ,$23.31 ,$33.57 , N/A , N/A ,$35.44 ,$33.57 ,$31.71 ,$31.71 ,$9.87 ,$31.71 ,$31.71 ,$33.57 ,$22.72 , N/A ,$23.12 , N/A ,$33.57 , N/A ,$34.32 ,$33.57 ,$24.62 ,$24.62 ,$22.72 ,$24.62 ,$24.25 ,$25.48 ,$8.50 ,$29.47 , N/A ,$18.28 ,$18.28 ,$9.87 ,$18.28 , N/A ,$35.44 ,$30.59 ,$30.59 ,$29.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BENZOCAINE-MENTHOL 20-0.5 % AERO 85 G CAN,250,1 ,$22.55 ,$14.88 ,$5.14 ,$22.55 , N/A ,$20.21 ,$20.21 ,$5.97 ,$18.04 ,$19.17 ,$14.09 ,$20.30 , N/A , N/A ,$21.42 ,$20.30 ,$19.17 ,$19.17 ,$5.97 ,$19.17 ,$19.17 ,$20.30 ,$13.73 , N/A ,$13.98 , N/A ,$20.30 , N/A ,$20.75 ,$20.30 ,$14.89 ,$14.89 ,$13.73 ,$14.89 ,$14.66 ,$15.41 ,$5.14 ,$17.81 , N/A ,$11.05 ,$11.05 ,$5.97 ,$11.05 , N/A ,$21.42 ,$18.49 ,$18.49 ,$18.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BRIMONIDINE 0.2 % SOLN,250,1 ,$115.85 ,$76.46 ,$26.38 ,$115.85 , N/A ,$103.82 ,$103.82 ,$30.65 ,$92.68 ,$98.47 ,$72.41 ,$104.27 , N/A , N/A ,$110.06 ,$104.27 ,$98.47 ,$98.47 ,$30.65 ,$98.47 ,$98.47 ,$104.27 ,$70.55 , N/A ,$71.82 , N/A ,$104.27 , N/A ,$106.58 ,$104.27 ,$76.47 ,$76.47 ,$70.55 ,$76.47 ,$75.30 ,$79.15 ,$26.38 ,$91.52 , N/A ,$56.77 ,$56.77 ,$30.65 ,$56.77 , N/A ,$110.06 ,$95.00 ,$95.00 ,$92.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BRIMONIDINE 0.2 % SOLN 5 ML BOTTLE,250,1 ,$42.50 ,$28.05 ,$9.68 ,$42.50 , N/A ,$38.09 ,$38.09 ,$11.25 ,$34.00 ,$36.13 ,$26.56 ,$38.25 , N/A , N/A ,$40.38 ,$38.25 ,$36.13 ,$36.13 ,$11.25 ,$36.13 ,$36.13 ,$38.25 ,$25.88 , N/A ,$26.36 , N/A ,$38.25 , N/A ,$39.10 ,$38.25 ,$28.05 ,$28.05 ,$25.88 ,$28.05 ,$27.63 ,$29.04 ,$9.68 ,$33.58 , N/A ,$20.83 ,$20.83 ,$11.25 ,$20.83 , N/A ,$40.38 ,$34.85 ,$34.85 ,$34.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUDESONIDE 0.25 MG/2ML SUSP,250,1 ,$32.30 ,$21.32 ,$7.35 ,$32.30 , N/A ,$28.95 ,$28.95 ,$8.55 ,$25.84 ,$27.46 ,$20.19 ,$29.07 , N/A , N/A ,$30.69 ,$29.07 ,$27.46 ,$27.46 ,$8.55 ,$27.46 ,$27.46 ,$29.07 ,$19.67 , N/A ,$20.02 , N/A ,$29.07 , N/A ,$29.72 ,$29.07 ,$21.32 ,$21.32 ,$19.67 ,$21.32 ,$21.00 ,$22.07 ,$7.35 ,$25.52 , N/A ,$15.83 ,$15.83 ,$8.55 ,$15.83 , N/A ,$30.69 ,$26.49 ,$26.49 ,$25.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUDESONIDE 0.5 MG/2ML SUSP,250,1 ,$38.00 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 SOLN,250,1 ,$67.90 ,$44.81 ,$15.46 ,$67.90 , N/A ,$60.85 ,$60.85 ,$17.96 ,$54.32 ,$57.72 ,$42.44 ,$61.11 , N/A , N/A ,$64.51 ,$61.11 ,$57.72 ,$57.72 ,$17.96 ,$57.72 ,$57.72 ,$61.11 ,$41.35 , N/A ,$42.10 , N/A ,$61.11 , N/A ,$62.47 ,$61.11 ,$44.82 ,$44.82 ,$41.35 ,$44.82 ,$44.14 ,$46.39 ,$15.46 ,$53.64 , N/A ,$33.27 ,$33.27 ,$17.96 ,$33.27 , N/A ,$64.51 ,$55.68 ,$55.68 ,$54.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 SOLN 50 ML VIAL,250,1 ,$74.75 ,$49.34 ,$17.01 ,$74.75 , N/A ,$66.99 ,$66.99 ,$19.78 ,$59.80 ,$63.54 ,$46.72 ,$67.28 , N/A , N/A ,$71.01 ,$67.28 ,$63.54 ,$63.54 ,$19.78 ,$63.54 ,$63.54 ,$67.28 ,$45.52 , N/A ,$46.34 , N/A ,$67.28 , N/A ,$68.77 ,$67.28 ,$49.34 ,$49.34 ,$45.52 ,$49.34 ,$48.59 ,$51.07 ,$17.01 ,$59.05 , N/A ,$36.63 ,$36.63 ,$19.78 ,$36.63 , N/A ,$71.01 ,$61.30 ,$61.30 ,$59.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CADEXOMER IODINE 0.9 % GEL 10 G TUBE,250,1 ,$62.05 ,$40.95 ,$14.12 ,$62.05 , N/A ,$55.61 ,$55.61 ,$16.41 ,$49.64 ,$52.74 ,$38.78 ,$55.85 , N/A , N/A ,$58.95 ,$55.85 ,$52.74 ,$52.74 ,$16.41 ,$52.74 ,$52.74 ,$55.85 ,$37.79 , N/A ,$38.48 , N/A ,$55.85 , N/A ,$57.09 ,$55.85 ,$40.96 ,$40.96 ,$37.79 ,$40.96 ,$40.33 ,$42.39 ,$14.12 ,$49.02 , N/A ,$30.40 ,$30.40 ,$16.41 ,$30.40 , N/A ,$58.95 ,$50.88 ,$50.88 ,$49.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CADEXOMER IODINE 0.9 % GEL 40 G TUBE,250,1 ,$221.28 ,$146.04 ,$50.37 ,$221.28 , N/A ,$198.31 ,$198.31 ,$58.55 ,$177.02 ,$188.09 ,$138.30 ,$199.15 , N/A , N/A ,$210.22 ,$199.15 ,$188.09 ,$188.09 ,$58.55 ,$188.09 ,$188.09 ,$199.15 ,$134.76 , N/A ,$137.20 , N/A ,$199.15 , N/A ,$203.58 ,$199.15 ,$146.07 ,$146.07 ,$134.76 ,$146.07 ,$143.83 ,$151.18 ,$50.37 ,$174.81 , N/A ,$108.43 ,$108.43 ,$58.55 ,$108.43 , N/A ,$210.22 ,$181.45 ,$181.45 ,$177.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CALCIUM CHLORIDE 10 % SOLN,250,1 ,$63.60 ,$41.98 ,$14.48 ,$63.60 , N/A ,$57.00 ,$57.00 ,$16.83 ,$50.88 ,$54.06 ,$39.75 ,$57.24 , N/A , N/A ,$60.42 ,$57.24 ,$54.06 ,$54.06 ,$16.83 ,$54.06 ,$54.06 ,$57.24 ,$38.73 , N/A ,$39.44 , N/A ,$57.24 , N/A ,$58.51 ,$57.24 ,$41.98 ,$41.98 ,$38.73 ,$41.98 ,$41.34 ,$43.45 ,$14.48 ,$50.24 , N/A ,$31.16 ,$31.16 ,$16.83 ,$31.16 , N/A ,$60.42 ,$52.15 ,$52.15 ,$50.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CALCIUM CHLORIDE 10 % SOLN 10 ML SYRINGE,250,1 ,$55.35 ,$36.53 ,$12.60 ,$55.35 , N/A ,$49.60 ,$49.60 ,$14.64 ,$44.28 ,$47.05 ,$34.59 ,$49.82 , N/A , N/A ,$52.58 ,$49.82 ,$47.05 ,$47.05 ,$14.64 ,$47.05 ,$47.05 ,$49.82 ,$33.71 , N/A ,$34.32 , N/A ,$49.82 , N/A ,$50.92 ,$49.82 ,$36.54 ,$36.54 ,$33.71 ,$36.54 ,$35.98 ,$37.82 ,$12.60 ,$43.73 , N/A ,$27.12 ,$27.12 ,$14.64 ,$27.12 , N/A ,$52.58 ,$45.39 ,$45.39 ,$44.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CARBACHOL 0.01 % SOLN 1.5 ML VIAL,250,1 ,$160.75 ,$106.10 ,$36.59 ,$160.75 , N/A ,$144.06 ,$144.06 ,$42.53 ,$128.60 ,$136.64 ,$100.47 ,$144.68 , N/A , N/A ,$152.71 ,$144.68 ,$136.64 ,$136.64 ,$42.53 ,$136.64 ,$136.64 ,$144.68 ,$97.90 , N/A ,$99.66 , N/A ,$144.68 , N/A ,$147.89 ,$144.68 ,$106.11 ,$106.11 ,$97.90 ,$106.11 ,$104.49 ,$109.82 ,$36.59 ,$126.99 , N/A ,$78.77 ,$78.77 ,$42.53 ,$78.77 , N/A ,$152.71 ,$131.82 ,$131.82 ,$128.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CEFOTETAN 1 G SOLR 1 EACH VIAL,250,1 ,$155.45 ,$102.60 ,$35.39 ,$155.45 , N/A ,$139.31 ,$139.31 ,$41.13 ,$124.36 ,$132.13 ,$97.16 ,$139.91 , N/A , N/A ,$147.68 ,$139.91 ,$132.13 ,$132.13 ,$41.13 ,$132.13 ,$132.13 ,$139.91 ,$94.67 , N/A ,$96.38 , N/A ,$139.91 , N/A ,$143.01 ,$139.91 ,$102.61 ,$102.61 ,$94.67 ,$102.61 ,$101.04 ,$106.20 ,$35.39 ,$122.81 , N/A ,$76.17 ,$76.17 ,$41.13 ,$76.17 , N/A ,$147.68 ,$127.47 ,$127.47 ,$124.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CEFOTETAN 2 G SOLR 1 EACH VIAL,250,1 ,$310.85 ,$205.16 ,$70.78 ,$310.85 , N/A ,$278.58 ,$278.58 ,$82.25 ,$248.68 ,$264.22 ,$194.28 ,$279.77 , N/A , N/A ,$295.31 ,$279.77 ,$264.22 ,$264.22 ,$82.25 ,$264.22 ,$264.22 ,$279.77 ,$189.31 , N/A ,$192.72 , N/A ,$279.77 , N/A ,$285.98 ,$279.77 ,$205.19 ,$205.19 ,$189.31 ,$205.19 ,$202.05 ,$212.37 ,$70.78 ,$245.57 , N/A ,$152.32 ,$152.32 ,$82.25 ,$152.32 , N/A ,$295.31 ,$254.90 ,$254.90 ,$248.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CHARCOAL ACTIVATED LIQD 120 ML BOTTLE,250,1 ,$56.72 ,$37.44 ,$12.92 ,$56.72 , N/A ,$50.83 ,$50.83 ,$15.00 ,$45.38 ,$48.21 ,$35.45 ,$51.05 , N/A , N/A ,$53.88 ,$51.05 ,$48.21 ,$48.21 ,$15.00 ,$48.21 ,$48.21 ,$51.05 ,$34.54 , N/A ,$35.16 , N/A ,$51.05 , N/A ,$52.18 ,$51.05 ,$37.44 ,$37.44 ,$34.54 ,$37.44 ,$36.87 ,$38.75 ,$12.92 ,$44.81 , N/A ,$27.79 ,$27.79 ,$15.00 ,$27.79 , N/A ,$53.88 ,$46.51 ,$46.51 ,$45.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CHARCOAL ACTIVATED LIQD 240 ML BOTTLE,250,1 ,$137.95 ,$91.05 ,$31.41 ,$137.95 , N/A ,$123.63 ,$123.63 ,$36.50 ,$110.36 ,$117.26 ,$86.22 ,$124.16 , N/A , N/A ,$131.05 ,$124.16 ,$117.26 ,$117.26 ,$36.50 ,$117.26 ,$117.26 ,$124.16 ,$84.01 , N/A ,$85.52 , N/A ,$124.16 , N/A ,$126.91 ,$124.16 ,$91.06 ,$91.06 ,$84.01 ,$91.06 ,$89.67 ,$94.25 ,$31.41 ,$108.98 , N/A ,$67.60 ,$67.60 ,$36.50 ,$67.60 , N/A ,$131.05 ,$113.12 ,$113.12 ,$110.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CHARCOAL ACTIVATED LIQD 240 ML TUBE,250,1 ,$80.80 ,$53.33 ,$18.39 ,$80.80 , N/A ,$72.41 ,$72.41 ,$21.38 ,$64.64 ,$68.68 ,$50.50 ,$72.72 , N/A , N/A ,$76.76 ,$72.72 ,$68.68 ,$68.68 ,$21.38 ,$68.68 ,$68.68 ,$72.72 ,$49.21 , N/A ,$50.10 , N/A ,$72.72 , N/A ,$74.34 ,$72.72 ,$53.34 ,$53.34 ,$49.21 ,$53.34 ,$52.52 ,$55.20 ,$18.39 ,$63.83 , N/A ,$39.59 ,$39.59 ,$21.38 ,$39.59 , N/A ,$76.76 ,$66.26 ,$66.26 ,$64.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CIPROFLOXACIN 0.3 % SOLN 2.5 ML BOTTLE,250,1 ,$42.85 ,$28.28 ,$9.76 ,$42.85 , N/A ,$38.40 ,$38.40 ,$11.34 ,$34.28 ,$36.42 ,$26.78 ,$38.57 , N/A , N/A ,$40.71 ,$38.57 ,$36.42 ,$36.42 ,$11.34 ,$36.42 ,$36.42 ,$38.57 ,$26.10 , N/A ,$26.56 , N/A ,$38.57 , N/A ,$39.42 ,$38.57 ,$28.29 ,$28.29 ,$26.10 ,$28.29 ,$27.85 ,$29.28 ,$9.76 ,$33.85 , N/A ,$21.00 ,$21.00 ,$11.34 ,$21.00 , N/A ,$40.71 ,$35.14 ,$35.14 ,$34.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CIPROFLOXACIN 0.3 % SOLN 5 ML BOTTLE,250,1 ,$160.90 ,$106.19 ,$36.63 ,$160.90 , N/A ,$144.20 ,$144.20 ,$42.57 ,$128.72 ,$136.77 ,$100.56 ,$144.81 , N/A , N/A ,$152.86 ,$144.81 ,$136.77 ,$136.77 ,$42.57 ,$136.77 ,$136.77 ,$144.81 ,$97.99 , N/A ,$99.76 , N/A ,$144.81 , N/A ,$148.03 ,$144.81 ,$106.21 ,$106.21 ,$97.99 ,$106.21 ,$104.59 ,$109.93 ,$36.63 ,$127.11 , N/A ,$78.84 ,$78.84 ,$42.57 ,$78.84 , N/A ,$152.86 ,$131.94 ,$131.94 ,$128.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % SUSP 7.5 ML BOTTLE,250,1 ,$914.70 ,$603.70 ,$208.23 ,$914.70 , N/A ,$819.75 ,$819.75 ,$242.03 ,$731.76 ,$777.50 ,$571.69 ,$823.23 , N/A , N/A ,$868.97 ,$823.23 ,$777.50 ,$777.50 ,$242.03 ,$777.50 ,$777.50 ,$823.23 ,$557.05 , N/A ,$567.12 , N/A ,$823.23 , N/A ,$841.52 ,$823.23 ,$603.79 ,$603.79 ,$557.05 ,$603.79 ,$594.56 ,$624.92 ,$208.23 ,$722.61 , N/A ,$448.20 ,$448.20 ,$242.03 ,$448.20 , N/A ,$868.97 ,$750.05 ,$750.05 ,$731.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CISATRACURIUM 20 MG/10ML SOLN,250,1 ,$115.71 ,$76.37 ,$26.34 ,$115.71 , N/A ,$103.70 ,$103.70 ,$30.62 ,$92.57 ,$98.35 ,$72.32 ,$104.14 , N/A , N/A ,$109.92 ,$104.14 ,$98.35 ,$98.35 ,$30.62 ,$98.35 ,$98.35 ,$104.14 ,$70.47 , N/A ,$71.74 , N/A ,$104.14 , N/A ,$106.45 ,$104.14 ,$76.38 ,$76.38 ,$70.47 ,$76.38 ,$75.21 ,$79.05 ,$26.34 ,$91.41 , N/A ,$56.70 ,$56.70 ,$30.62 ,$56.70 , N/A ,$109.92 ,$94.88 ,$94.88 ,$92.57 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CISATRACURIUM 20 MG/10ML SOLN 10 ML VIAL,250,1 ,$155.00 ,$102.30 ,$35.29 ,$155.00 , N/A ,$138.91 ,$138.91 ,$41.01 ,$124.00 ,$131.75 ,$96.88 ,$139.50 , N/A , N/A ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$41.01 ,$131.75 ,$131.75 ,$139.50 ,$94.40 , N/A ,$96.10 , N/A ,$139.50 , N/A ,$142.60 ,$139.50 ,$102.32 ,$102.32 ,$94.40 ,$102.32 ,$100.75 ,$105.90 ,$35.29 ,$122.45 , N/A ,$75.95 ,$75.95 ,$41.01 ,$75.95 , N/A ,$147.25 ,$127.10 ,$127.10 ,$124.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CLINDAMYCIN 600 MG/50ML SOLN 50 ML FLEX CONT,250,1 ,$122.25 ,$80.69 ,$27.83 ,$122.25 , N/A ,$109.56 ,$109.56 ,$32.35 ,$97.80 ,$103.91 ,$76.41 ,$110.03 , N/A , N/A ,$116.14 ,$110.03 ,$103.91 ,$103.91 ,$32.35 ,$103.91 ,$103.91 ,$110.03 ,$74.45 , N/A ,$75.80 , N/A ,$110.03 , N/A ,$112.47 ,$110.03 ,$80.70 ,$80.70 ,$74.45 ,$80.70 ,$79.46 ,$83.52 ,$27.83 ,$96.58 , N/A ,$59.90 ,$59.90 ,$32.35 ,$59.90 , N/A ,$116.14 ,$100.25 ,$100.25 ,$97.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CLINDAMYCIN 600 MG/50ML SOLN,250,1 ,$122.25 ,$80.69 ,$27.83 ,$122.25 , N/A ,$109.56 ,$109.56 ,$32.35 ,$97.80 ,$103.91 ,$76.41 ,$110.03 , N/A , N/A ,$116.14 ,$110.03 ,$103.91 ,$103.91 ,$32.35 ,$103.91 ,$103.91 ,$110.03 ,$74.45 , N/A ,$75.80 , N/A ,$110.03 , N/A ,$112.47 ,$110.03 ,$80.70 ,$80.70 ,$74.45 ,$80.70 ,$79.46 ,$83.52 ,$27.83 ,$96.58 , N/A ,$59.90 ,$59.90 ,$32.35 ,$59.90 , N/A ,$116.14 ,$100.25 ,$100.25 ,$97.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CLINDAMYCIN 600-0.9 MG/50ML-% SOLN,250,1 ,$109.65 ,$72.37 ,$24.96 ,$109.65 , N/A ,$98.27 ,$98.27 ,$29.02 ,$87.72 ,$93.20 ,$68.53 ,$98.69 , N/A , N/A ,$104.17 ,$98.69 ,$93.20 ,$93.20 ,$29.02 ,$93.20 ,$93.20 ,$98.69 ,$66.78 , N/A ,$67.98 , N/A ,$98.69 , N/A ,$100.88 ,$98.69 ,$72.38 ,$72.38 ,$66.78 ,$72.38 ,$71.27 ,$74.91 ,$24.96 ,$86.62 , N/A ,$53.73 ,$53.73 ,$29.02 ,$53.73 , N/A ,$104.17 ,$89.91 ,$89.91 ,$87.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CLINDAMYCIN 900 MG/50ML SOLN,250,1 ,$127.15 ,$83.92 ,$28.94 ,$127.15 , N/A ,$113.95 ,$113.95 ,$33.64 ,$101.72 ,$108.08 ,$79.47 ,$114.44 , N/A , N/A ,$120.79 ,$114.44 ,$108.08 ,$108.08 ,$33.64 ,$108.08 ,$108.08 ,$114.44 ,$77.43 , N/A ,$78.84 , N/A ,$114.44 , N/A ,$116.98 ,$114.44 ,$83.93 ,$83.93 ,$77.43 ,$83.93 ,$82.65 ,$86.87 ,$28.94 ,$100.45 , N/A ,$62.30 ,$62.30 ,$33.64 ,$62.30 , N/A ,$120.79 ,$104.26 ,$104.26 ,$101.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,COLLAGENASE 250 UNIT/GM OINT 30 G TUBE,250,1 ,"$1,118.95 ",$738.51 ,$254.73 ,"$1,118.95 ", N/A ,"$1,002.80 ","$1,002.80 ",$296.08 ,$895.16 ,$951.11 ,$699.34 ,"$1,007.06 ", N/A , N/A ,"$1,063.00 ","$1,007.06 ",$951.11 ,$951.11 ,$296.08 ,$951.11 ,$951.11 ,"$1,007.06 ",$681.44 , N/A ,$693.74 , N/A ,"$1,007.06 ", N/A ,"$1,029.43 ","$1,007.06 ",$738.62 ,$738.62 ,$681.44 ,$738.62 ,$727.32 ,$764.47 ,$254.73 ,$883.97 , N/A ,$548.29 ,$548.29 ,$296.08 ,$548.29 , N/A ,"$1,063.00 ",$917.54 ,$917.54 ,$895.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXMEDETOMIDINE 200 MCG/2ML SOLN 2 ML VIAL,250,1 ,$140.90 ,$92.99 ,$32.08 ,$140.90 , N/A ,$126.27 ,$126.27 ,$37.28 ,$112.72 ,$119.77 ,$88.06 ,$126.81 , N/A , N/A ,$133.86 ,$126.81 ,$119.77 ,$119.77 ,$37.28 ,$119.77 ,$119.77 ,$126.81 ,$85.81 , N/A ,$87.36 , N/A ,$126.81 , N/A ,$129.63 ,$126.81 ,$93.01 ,$93.01 ,$85.81 ,$93.01 ,$91.59 ,$96.26 ,$32.08 ,$111.31 , N/A ,$69.04 ,$69.04 ,$37.28 ,$69.04 , N/A ,$133.86 ,$115.54 ,$115.54 ,$112.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXMEDETOMIDINE 200 MCG/2ML SOLN,250,1 ,$140.90 ,$92.99 ,$32.08 ,$140.90 , N/A ,$126.27 ,$126.27 ,$37.28 ,$112.72 ,$119.77 ,$88.06 ,$126.81 , N/A , N/A ,$133.86 ,$126.81 ,$119.77 ,$119.77 ,$37.28 ,$119.77 ,$119.77 ,$126.81 ,$85.81 , N/A ,$87.36 , N/A ,$126.81 , N/A ,$129.63 ,$126.81 ,$93.01 ,$93.01 ,$85.81 ,$93.01 ,$91.59 ,$96.26 ,$32.08 ,$111.31 , N/A ,$69.04 ,$69.04 ,$37.28 ,$69.04 , N/A ,$133.86 ,$115.54 ,$115.54 ,$112.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXMEDETOMIDINE 400 MCG/100ML SOLN,250,1 ,$621.30 ,$410.06 ,$141.44 ,$621.30 , N/A ,$556.81 ,$556.81 ,$164.39 ,$497.04 ,$528.11 ,$388.31 ,$559.17 , N/A , N/A ,$590.24 ,$559.17 ,$528.11 ,$528.11 ,$164.39 ,$528.11 ,$528.11 ,$559.17 ,$378.37 , N/A ,$385.20 , N/A ,$559.17 , N/A ,$571.60 ,$559.17 ,$410.12 ,$410.12 ,$378.37 ,$410.12 ,$403.85 ,$424.47 ,$141.44 ,$490.83 , N/A ,$304.44 ,$304.44 ,$164.39 ,$304.44 , N/A ,$590.24 ,$509.47 ,$509.47 ,$497.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXMEDETOMIDINE 400 MCG/4ML SOLN 10 ML VIAL,250,1 ,$983.28 ,$648.96 ,$223.84 ,$983.28 , N/A ,$881.22 ,$881.22 ,$260.18 ,$786.62 ,$835.79 ,$614.55 ,$884.95 , N/A , N/A ,$934.12 ,$884.95 ,$835.79 ,$835.79 ,$260.18 ,$835.79 ,$835.79 ,$884.95 ,$598.82 , N/A ,$609.64 , N/A ,$884.95 , N/A ,$904.62 ,$884.95 ,$649.06 ,$649.06 ,$598.82 ,$649.06 ,$639.13 ,$671.78 ,$223.84 ,$776.79 , N/A ,$481.81 ,$481.81 ,$260.18 ,$481.81 , N/A ,$934.12 ,$806.29 ,$806.29 ,$786.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXMEDETOMIDINE 400 MCG/4ML SOLN 4 ML VIAL,250,1 ,$582.70 ,$384.58 ,$132.65 ,$582.70 , N/A ,$522.22 ,$522.22 ,$154.18 ,$466.16 ,$495.30 ,$364.19 ,$524.43 , N/A , N/A ,$553.57 ,$524.43 ,$495.30 ,$495.30 ,$154.18 ,$495.30 ,$495.30 ,$524.43 ,$354.86 , N/A ,$361.28 , N/A ,$524.43 , N/A ,$536.08 ,$524.43 ,$384.64 ,$384.64 ,$354.86 ,$384.64 ,$378.76 ,$398.10 ,$132.65 ,$460.33 , N/A ,$285.52 ,$285.52 ,$154.18 ,$285.52 , N/A ,$553.57 ,$477.81 ,$477.81 ,$466.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXMEDETOMIDINE 400MCG/100ML -5% SOLN,250,1 ,$296.60 ,$195.76 ,$67.52 ,$296.60 , N/A ,$265.81 ,$265.81 ,$78.48 ,$237.28 ,$252.11 ,$185.38 ,$266.94 , N/A , N/A ,$281.77 ,$266.94 ,$252.11 ,$252.11 ,$78.48 ,$252.11 ,$252.11 ,$266.94 ,$180.63 , N/A ,$183.90 , N/A ,$266.94 , N/A ,$272.87 ,$266.94 ,$195.79 ,$195.79 ,$180.63 ,$195.79 ,$192.79 ,$202.64 ,$67.52 ,$234.31 , N/A ,$145.33 ,$145.33 ,$78.48 ,$145.33 , N/A ,$281.77 ,$243.21 ,$243.21 ,$237.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXTROSE 10 % BOLUS,250,1 ,$40.00 ,$26.40 ,$9.10 ,$40.00 , N/A ,$35.85 ,$35.85 ,$10.58 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$10.58 ,$34.00 ,$34.00 ,$36.00 ,$24.36 , N/A ,$24.80 , N/A ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.40 ,$26.40 ,$24.36 ,$26.40 ,$26.00 ,$27.33 ,$9.10 ,$31.60 , N/A ,$19.60 ,$19.60 ,$10.58 ,$19.60 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DILTIAZEM 1 MG/ML SOLN,250,1 ,$141.60 ,$93.46 ,$32.24 ,$141.60 , N/A ,$126.90 ,$126.90 ,$37.47 ,$113.28 ,$120.36 ,$88.50 ,$127.44 , N/A , N/A ,$134.52 ,$127.44 ,$120.36 ,$120.36 ,$37.47 ,$120.36 ,$120.36 ,$127.44 ,$86.23 , N/A ,$87.80 , N/A ,$127.44 , N/A ,$130.27 ,$127.44 ,$93.47 ,$93.47 ,$86.23 ,$93.47 ,$92.04 ,$96.74 ,$32.24 ,$111.86 , N/A ,$69.38 ,$69.38 ,$37.47 ,$69.38 , N/A ,$134.52 ,$116.11 ,$116.11 ,$113.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DORNASE ALFA 2.5 MG/2.5ML SOLN 2.5 ML PLAS CONT,250,1 ,$890.53 ,$587.75 ,$202.73 ,$890.53 , N/A ,$798.09 ,$798.09 ,$235.63 ,$712.42 ,$756.95 ,$556.58 ,$801.48 , N/A , N/A ,$846.00 ,$801.48 ,$756.95 ,$756.95 ,$235.63 ,$756.95 ,$756.95 ,$801.48 ,$542.33 , N/A ,$552.12 , N/A ,$801.48 , N/A ,$819.29 ,$801.48 ,$587.84 ,$587.84 ,$542.33 ,$587.84 ,$578.84 ,$608.41 ,$202.73 ,$703.52 , N/A ,$436.36 ,$436.36 ,$235.63 ,$436.36 , N/A ,$846.00 ,$730.23 ,$730.23 ,$712.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DOXYCYCLINE HYCLATE 100 MG SOLR 1 EACH VIAL,250,1 ,$194.35 ,$128.27 ,$44.25 ,$194.35 , N/A ,$174.18 ,$174.18 ,$51.42 ,$155.48 ,$165.20 ,$121.47 ,$174.92 , N/A , N/A ,$184.63 ,$174.92 ,$165.20 ,$165.20 ,$51.42 ,$165.20 ,$165.20 ,$174.92 ,$118.36 , N/A ,$120.50 , N/A ,$174.92 , N/A ,$178.80 ,$174.92 ,$128.29 ,$128.29 ,$118.36 ,$128.29 ,$126.33 ,$132.78 ,$44.25 ,$153.54 , N/A ,$95.23 ,$95.23 ,$51.42 ,$95.23 , N/A ,$184.63 ,$159.37 ,$159.37 ,$155.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ENTERAL FEEDING TUBE DECLOGGING,250,1 ,$74.15 ,$48.94 ,$16.88 ,$74.15 , N/A ,$66.45 ,$66.45 ,$19.62 ,$59.32 ,$63.03 ,$46.34 ,$66.74 , N/A , N/A ,$70.44 ,$66.74 ,$63.03 ,$63.03 ,$19.62 ,$63.03 ,$63.03 ,$66.74 ,$45.16 , N/A ,$45.98 , N/A ,$66.74 , N/A ,$68.22 ,$66.74 ,$48.95 ,$48.95 ,$45.16 ,$48.95 ,$48.20 ,$50.66 ,$16.88 ,$58.58 , N/A ,$36.33 ,$36.33 ,$19.62 ,$36.33 , N/A ,$70.44 ,$60.80 ,$60.80 ,$59.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,EPHEDRINE 50 MG/ML SOLN,250,1 ,$214.35 ,$141.47 ,$48.79 ,$214.35 , N/A ,$192.10 ,$192.10 ,$56.71 ,$171.48 ,$182.20 ,$133.97 ,$192.92 , N/A , N/A ,$203.63 ,$192.92 ,$182.20 ,$182.20 ,$56.71 ,$182.20 ,$182.20 ,$192.92 ,$130.54 , N/A ,$132.90 , N/A ,$192.92 , N/A ,$197.20 ,$192.92 ,$141.49 ,$141.49 ,$130.54 ,$141.49 ,$139.33 ,$146.44 ,$48.79 ,$169.34 , N/A ,$105.03 ,$105.03 ,$56.71 ,$105.03 , N/A ,$203.63 ,$175.77 ,$175.77 ,$171.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,EPINEPHRINE 1 MG/10 ML SOSY,250,1 ,$20.40 ,$13.46 ,$4.65 ,$20.40 , N/A ,$18.28 ,$18.28 ,$5.40 ,$16.32 ,$17.34 ,$12.75 ,$18.36 , N/A , N/A ,$19.38 ,$18.36 ,$17.34 ,$17.34 ,$5.40 ,$17.34 ,$17.34 ,$18.36 ,$12.42 , N/A ,$12.64 , N/A ,$18.36 , N/A ,$18.77 ,$18.36 ,$13.47 ,$13.47 ,$12.42 ,$13.47 ,$13.26 ,$13.94 ,$4.65 ,$16.12 , N/A ,$10.00 ,$10.00 ,$5.40 ,$10.00 , N/A ,$19.38 ,$16.73 ,$16.73 ,$16.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ESMOLOL 100 MG/10ML SOLN,250,1 ,$54.15 ,$35.74 ,$12.32 ,$54.15 , N/A ,$48.53 ,$48.53 ,$14.33 ,$43.32 ,$46.03 ,$33.84 ,$48.74 , N/A , N/A ,$51.44 ,$48.74 ,$46.03 ,$46.03 ,$14.33 ,$46.03 ,$46.03 ,$48.74 ,$32.98 , N/A ,$33.58 , N/A ,$48.74 , N/A ,$49.82 ,$48.74 ,$35.74 ,$35.74 ,$32.98 ,$35.74 ,$35.20 ,$37.00 ,$12.32 ,$42.78 , N/A ,$26.53 ,$26.53 ,$14.33 ,$26.53 , N/A ,$51.44 ,$44.40 ,$44.40 ,$43.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ESMOLOL 2500 MG/250ML SOLN,250,1 ,"$3,482.60 ","$2,298.52 ",$792.83 ,"$3,482.60 ", N/A ,"$3,121.11 ","$3,121.11 ",$921.49 ,"$2,786.08 ","$2,960.21 ","$2,176.63 ","$3,134.34 ", N/A , N/A ,"$3,308.47 ","$3,134.34 ","$2,960.21 ","$2,960.21 ",$921.49 ,"$2,960.21 ","$2,960.21 ","$3,134.34 ","$2,120.90 ", N/A ,"$2,159.22 ", N/A ,"$3,134.34 ", N/A ,"$3,203.99 ","$3,134.34 ","$2,298.86 ","$2,298.86 ","$2,120.90 ","$2,298.86 ","$2,263.69 ","$2,379.31 ",$792.83 ,"$2,751.25 ", N/A ,"$1,706.47 ","$1,706.47 ",$921.49 ,"$1,706.47 ", N/A ,"$3,308.47 ","$2,855.73 ","$2,855.73 ","$2,786.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FLUMAZENIL 0.5 MG/5ML SOLN,250,1 ,$50.05 ,$33.03 ,$11.40 ,$50.05 , N/A ,$44.85 ,$44.85 ,$13.24 ,$40.04 ,$42.54 ,$31.28 ,$45.05 , N/A , N/A ,$47.55 ,$45.05 ,$42.54 ,$42.54 ,$13.24 ,$42.54 ,$42.54 ,$45.05 ,$30.48 , N/A ,$31.04 , N/A ,$45.05 , N/A ,$46.05 ,$45.05 ,$33.04 ,$33.04 ,$30.48 ,$33.04 ,$32.53 ,$34.19 ,$11.40 ,$39.54 , N/A ,$24.52 ,$24.52 ,$13.24 ,$24.52 , N/A ,$47.55 ,$41.04 ,$41.04 ,$40.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FORMOTEROL 20 MCG/2ML NEBU,250,1 ,$75.85 ,$50.06 ,$17.27 ,$75.85 , N/A ,$67.98 ,$67.98 ,$20.07 ,$60.68 ,$64.47 ,$47.41 ,$68.27 , N/A , N/A ,$72.06 ,$68.27 ,$64.47 ,$64.47 ,$20.07 ,$64.47 ,$64.47 ,$68.27 ,$46.19 , N/A ,$47.02 , N/A ,$68.27 , N/A ,$69.78 ,$68.27 ,$50.07 ,$50.07 ,$46.19 ,$50.07 ,$49.30 ,$51.82 ,$17.27 ,$59.92 , N/A ,$37.17 ,$37.17 ,$20.07 ,$37.17 , N/A ,$72.06 ,$62.20 ,$62.20 ,$60.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,GENTIAN VIOLET 1 % SOLN 59 ML BOTTLE,250,1 ,$28.30 ,$18.68 ,$6.45 ,$28.30 , N/A ,$25.36 ,$25.36 ,$7.49 ,$22.64 ,$24.06 ,$17.69 ,$25.47 , N/A , N/A ,$26.89 ,$25.47 ,$24.06 ,$24.06 ,$7.49 ,$24.06 ,$24.06 ,$25.47 ,$17.23 , N/A ,$17.54 , N/A ,$25.47 , N/A ,$26.04 ,$25.47 ,$18.68 ,$18.68 ,$17.23 ,$18.68 ,$18.40 ,$19.33 ,$6.45 ,$22.36 , N/A ,$13.87 ,$13.87 ,$7.49 ,$13.87 , N/A ,$26.89 ,$23.21 ,$23.21 ,$22.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,GLYCERIN LIQD,250,1 ,$57.15 ,$37.72 ,$13.00 ,$57.15 , N/A ,$51.22 ,$51.22 ,$15.12 ,$45.72 ,$48.58 ,$35.72 ,$51.44 , N/A , N/A ,$54.29 ,$51.44 ,$48.58 ,$48.58 ,$15.12 ,$48.58 ,$48.58 ,$51.44 ,$34.80 , N/A ,$35.44 , N/A ,$51.44 , N/A ,$52.58 ,$51.44 ,$37.72 ,$37.72 ,$34.80 ,$37.72 ,$37.15 ,$39.04 ,$13.00 ,$45.15 , N/A ,$28.00 ,$28.00 ,$15.12 ,$28.00 , N/A ,$54.29 ,$46.86 ,$46.86 ,$45.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CYCLOPENTOLATE 1 % SOLN 2 ML BOTTLE,250,1 ,$57.15 ,$37.72 ,$13.00 ,$57.15 , N/A ,$51.22 ,$51.22 ,$15.12 ,$45.72 ,$48.58 ,$35.72 ,$51.44 , N/A , N/A ,$54.29 ,$51.44 ,$48.58 ,$48.58 ,$15.12 ,$48.58 ,$48.58 ,$51.44 ,$34.80 , N/A ,$35.44 , N/A ,$51.44 , N/A ,$52.58 ,$51.44 ,$37.72 ,$37.72 ,$34.80 ,$37.72 ,$37.15 ,$39.04 ,$13.00 ,$45.15 , N/A ,$28.00 ,$28.00 ,$15.12 ,$28.00 , N/A ,$54.29 ,$46.86 ,$46.86 ,$45.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,GLYCOPYRROLATE 0.4 MG/2ML SOLN,250,1 ,$99.95 ,$65.97 ,$22.76 ,$99.95 , N/A ,$89.58 ,$89.58 ,$26.45 ,$79.96 ,$84.96 ,$62.47 ,$89.96 , N/A , N/A ,$94.95 ,$89.96 ,$84.96 ,$84.96 ,$26.45 ,$84.96 ,$84.96 ,$89.96 ,$60.87 , N/A ,$61.96 , N/A ,$89.96 , N/A ,$91.95 ,$89.96 ,$65.98 ,$65.98 ,$60.87 ,$65.98 ,$64.97 ,$68.29 ,$22.76 ,$78.96 , N/A ,$48.98 ,$48.98 ,$26.45 ,$48.98 , N/A ,$94.95 ,$81.96 ,$81.96 ,$79.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,GLYCOPYRROLATE 0.2 MG/ML SOLN,250,1 ,$99.95 ,$65.97 ,$22.76 ,$99.95 , N/A ,$89.58 ,$89.58 ,$26.45 ,$79.96 ,$84.96 ,$62.47 ,$89.96 , N/A , N/A ,$94.95 ,$89.96 ,$84.96 ,$84.96 ,$26.45 ,$84.96 ,$84.96 ,$89.96 ,$60.87 , N/A ,$61.96 , N/A ,$89.96 , N/A ,$91.95 ,$89.96 ,$65.98 ,$65.98 ,$60.87 ,$65.98 ,$64.97 ,$68.29 ,$22.76 ,$78.96 , N/A ,$48.98 ,$48.98 ,$26.45 ,$48.98 , N/A ,$94.95 ,$81.96 ,$81.96 ,$79.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,GLYCOPYRROLATE 1 MG/5ML SOLN,250,1 ,$197.95 ,$130.65 ,$45.07 ,$197.95 , N/A ,$177.40 ,$177.40 ,$52.38 ,$158.36 ,$168.26 ,$123.72 ,$178.16 , N/A , N/A ,$188.05 ,$178.16 ,$168.26 ,$168.26 ,$52.38 ,$168.26 ,$168.26 ,$178.16 ,$120.55 , N/A ,$122.72 , N/A ,$178.16 , N/A ,$182.11 ,$178.16 ,$130.67 ,$130.67 ,$120.55 ,$130.67 ,$128.67 ,$135.24 ,$45.07 ,$156.38 , N/A ,$97.00 ,$97.00 ,$52.38 ,$97.00 , N/A ,$188.05 ,$162.32 ,$162.32 ,$158.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ILOPROST 10 MCG/ML SOLN 1 ML GLASS CONT,250,1 ,$335.45 ,$221.40 ,$76.36 ,$335.45 , N/A ,$300.63 ,$300.63 ,$88.76 ,$268.36 ,$285.13 ,$209.66 ,$301.91 , N/A , N/A ,$318.68 ,$301.91 ,$285.13 ,$285.13 ,$88.76 ,$285.13 ,$285.13 ,$301.91 ,$204.29 , N/A ,$207.98 , N/A ,$301.91 , N/A ,$308.61 ,$301.91 ,$221.43 ,$221.43 ,$204.29 ,$221.43 ,$218.04 ,$229.18 ,$76.36 ,$265.01 , N/A ,$164.37 ,$164.37 ,$88.76 ,$164.37 , N/A ,$318.68 ,$275.07 ,$275.07 ,$268.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ILOPROST 10 MCG/ML SOLN,250,1 ,$335.45 ,$221.40 ,$76.36 ,$335.45 , N/A ,$300.63 ,$300.63 ,$88.76 ,$268.36 ,$285.13 ,$209.66 ,$301.91 , N/A , N/A ,$318.68 ,$301.91 ,$285.13 ,$285.13 ,$88.76 ,$285.13 ,$285.13 ,$301.91 ,$204.29 , N/A ,$207.98 , N/A ,$301.91 , N/A ,$308.61 ,$301.91 ,$221.43 ,$221.43 ,$204.29 ,$221.43 ,$218.04 ,$229.18 ,$76.36 ,$265.01 , N/A ,$164.37 ,$164.37 ,$88.76 ,$164.37 , N/A ,$318.68 ,$275.07 ,$275.07 ,$268.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ILOPROST 20 MCG/ML SOLN 1 ML GLASS CONT,250,1 ,$670.85 ,$442.76 ,$152.72 ,$670.85 , N/A ,$601.22 ,$601.22 ,$177.51 ,$536.68 ,$570.22 ,$419.28 ,$603.77 , N/A , N/A ,$637.31 ,$603.77 ,$570.22 ,$570.22 ,$177.51 ,$570.22 ,$570.22 ,$603.77 ,$408.55 , N/A ,$415.92 , N/A ,$603.77 , N/A ,$617.18 ,$603.77 ,$442.83 ,$442.83 ,$408.55 ,$442.83 ,$436.05 ,$458.32 ,$152.72 ,$529.97 , N/A ,$328.72 ,$328.72 ,$177.51 ,$328.72 , N/A ,$637.31 ,$550.10 ,$550.10 ,$536.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ILOPROST 20 MCG/ML SOLN,250,1 ,$670.85 ,$442.76 ,$152.72 ,$670.85 , N/A ,$601.22 ,$601.22 ,$177.51 ,$536.68 ,$570.22 ,$419.28 ,$603.77 , N/A , N/A ,$637.31 ,$603.77 ,$570.22 ,$570.22 ,$177.51 ,$570.22 ,$570.22 ,$603.77 ,$408.55 , N/A ,$415.92 , N/A ,$603.77 , N/A ,$617.18 ,$603.77 ,$442.83 ,$442.83 ,$408.55 ,$442.83 ,$436.05 ,$458.32 ,$152.72 ,$529.97 , N/A ,$328.72 ,$328.72 ,$177.51 ,$328.72 , N/A ,$637.31 ,$550.10 ,$550.10 ,$536.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,INSULIN REGULAR 100 UNITS/100 ML NS SOLN,250,1 ,$289.20 ,$190.87 ,$65.85 ,$289.20 , N/A ,$259.18 ,$259.18 ,$76.52 ,$231.36 ,$245.82 ,$180.75 ,$260.28 , N/A , N/A ,$274.74 ,$260.28 ,$245.82 ,$245.82 ,$76.52 ,$245.82 ,$245.82 ,$260.28 ,$176.12 , N/A ,$179.30 , N/A ,$260.28 , N/A ,$266.06 ,$260.28 ,$190.90 ,$190.90 ,$176.12 ,$190.90 ,$187.98 ,$197.58 ,$65.85 ,$228.47 , N/A ,$141.71 ,$141.71 ,$76.52 ,$141.71 , N/A ,$274.74 ,$237.14 ,$237.14 ,$231.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,IPRATROPIUM 0.03 % SOLN 30 ML BOTTLE,250,1 ,$379.65 ,$250.57 ,$86.43 ,$379.65 , N/A ,$340.24 ,$340.24 ,$100.46 ,$303.72 ,$322.70 ,$237.28 ,$341.69 , N/A , N/A ,$360.67 ,$341.69 ,$322.70 ,$322.70 ,$100.46 ,$322.70 ,$322.70 ,$341.69 ,$231.21 , N/A ,$235.38 , N/A ,$341.69 , N/A ,$349.28 ,$341.69 ,$250.61 ,$250.61 ,$231.21 ,$250.61 ,$246.77 ,$259.38 ,$86.43 ,$299.92 , N/A ,$186.03 ,$186.03 ,$100.46 ,$186.03 , N/A ,$360.67 ,$311.31 ,$311.31 ,$303.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,IPRATROPIUM 0.06 % SOLN 15 ML BOTTLE,250,1 ,$325.45 ,$214.80 ,$74.09 ,$325.45 , N/A ,$291.67 ,$291.67 ,$86.11 ,$260.36 ,$276.63 ,$203.41 ,$292.91 , N/A , N/A ,$309.18 ,$292.91 ,$276.63 ,$276.63 ,$86.11 ,$276.63 ,$276.63 ,$292.91 ,$198.20 , N/A ,$201.78 , N/A ,$292.91 , N/A ,$299.41 ,$292.91 ,$214.83 ,$214.83 ,$198.20 ,$214.83 ,$211.54 ,$222.35 ,$74.09 ,$257.11 , N/A ,$159.47 ,$159.47 ,$86.11 ,$159.47 , N/A ,$309.18 ,$266.87 ,$266.87 ,$260.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ISOPROPYL ALCOHOL 70 % 70 % SOLN 473 ML BOTTLE,250,1 ,$9.65 ,$6.37 ,$2.20 ,$9.65 , N/A ,$8.65 ,$8.65 ,$2.56 ,$7.72 ,$8.20 ,$6.03 ,$8.69 , N/A , N/A ,$9.17 ,$8.69 ,$8.20 ,$8.20 ,$2.56 ,$8.20 ,$8.20 ,$8.69 ,$5.88 , N/A ,$5.98 , N/A ,$8.69 , N/A ,$8.88 ,$8.69 ,$6.37 ,$6.37 ,$5.88 ,$6.37 ,$6.27 ,$6.59 ,$2.20 ,$7.62 , N/A ,$4.73 ,$4.73 ,$2.56 ,$4.73 , N/A ,$9.17 ,$7.91 ,$7.91 ,$7.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETOROLAC 0.4 % SOLN 5 ML BOTTLE,250,1 ,$227.40 ,$150.08 ,$51.76 ,$227.40 , N/A ,$203.80 ,$203.80 ,$60.17 ,$181.92 ,$193.29 ,$142.13 ,$204.66 , N/A , N/A ,$216.03 ,$204.66 ,$193.29 ,$193.29 ,$60.17 ,$193.29 ,$193.29 ,$204.66 ,$138.49 , N/A ,$140.98 , N/A ,$204.66 , N/A ,$209.21 ,$204.66 ,$150.11 ,$150.11 ,$138.49 ,$150.11 ,$147.81 ,$155.36 ,$51.76 ,$179.65 , N/A ,$111.43 ,$111.43 ,$60.17 ,$111.43 , N/A ,$216.03 ,$186.47 ,$186.47 ,$181.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LEVOTHYROXINE 100 MCG SOLR,250,1 ,$525.85 ,$347.06 ,$119.72 ,$525.85 , N/A ,$471.27 ,$471.27 ,$139.14 ,$420.68 ,$446.97 ,$328.66 ,$473.27 , N/A , N/A ,$499.56 ,$473.27 ,$446.97 ,$446.97 ,$139.14 ,$446.97 ,$446.97 ,$473.27 ,$320.24 , N/A ,$326.02 , N/A ,$473.27 , N/A ,$483.78 ,$473.27 ,$347.11 ,$347.11 ,$320.24 ,$347.11 ,$341.80 ,$359.26 ,$119.72 ,$415.42 , N/A ,$257.67 ,$257.67 ,$139.14 ,$257.67 , N/A ,$499.56 ,$431.20 ,$431.20 ,$420.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LEVOTHYROXINE 100 MCG/5ML SOLN,250,1 ,$572.70 ,$377.98 ,$130.38 ,$572.70 , N/A ,$513.25 ,$513.25 ,$151.54 ,$458.16 ,$486.80 ,$357.94 ,$515.43 , N/A , N/A ,$544.07 ,$515.43 ,$486.80 ,$486.80 ,$151.54 ,$486.80 ,$486.80 ,$515.43 ,$348.77 , N/A ,$355.08 , N/A ,$515.43 , N/A ,$526.88 ,$515.43 ,$378.04 ,$378.04 ,$348.77 ,$378.04 ,$372.26 ,$391.27 ,$130.38 ,$452.43 , N/A ,$280.62 ,$280.62 ,$151.54 ,$280.62 , N/A ,$544.07 ,$469.61 ,$469.61 ,$458.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE (PF) 1 % SOLN 2 ML VIAL,250,1 ,$24.50 ,$16.17 ,$5.59 ,$24.50 , N/A ,$21.96 ,$21.96 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FAMOTIDINE (PF) 20 MG/2ML SOLN,250,1 ,$24.50 ,$16.17 ,$5.59 ,$24.50 , N/A ,$21.96 ,$21.96 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUMETANIDE 0.25 MG/ML SOLN,250,1 ,$24.50 ,$16.17 ,$5.59 ,$24.50 , N/A ,$21.96 ,$21.96 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE (PF) 4 % SOLN,250,1 ,$18.00 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , N/A ,$17.10 ,$14.76 ,$14.76 ,$14.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 0.5 % SOLN,250,1 ,$92.90 ,$61.31 ,$21.15 ,$92.90 , N/A ,$83.26 ,$83.26 ,$24.58 ,$74.32 ,$78.97 ,$58.06 ,$83.61 , N/A , N/A ,$88.26 ,$83.61 ,$78.97 ,$78.97 ,$24.58 ,$78.97 ,$78.97 ,$83.61 ,$56.58 , N/A ,$57.60 , N/A ,$83.61 , N/A ,$85.47 ,$83.61 ,$61.32 ,$61.32 ,$56.58 ,$61.32 ,$60.39 ,$63.47 ,$21.15 ,$73.39 , N/A ,$45.52 ,$45.52 ,$24.58 ,$45.52 , N/A ,$88.26 ,$76.18 ,$76.18 ,$74.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % GEL 30 ML TUBE,250,1 ,$436.40 ,$288.02 ,$99.34 ,$436.40 , N/A ,$391.10 ,$391.10 ,$115.47 ,$349.12 ,$370.94 ,$272.75 ,$392.76 , N/A , N/A ,$414.58 ,$392.76 ,$370.94 ,$370.94 ,$115.47 ,$370.94 ,$370.94 ,$392.76 ,$265.77 , N/A ,$270.56 , N/A ,$392.76 , N/A ,$401.49 ,$392.76 ,$288.07 ,$288.07 ,$265.77 ,$288.07 ,$283.66 ,$298.15 ,$99.34 ,$344.76 , N/A ,$213.84 ,$213.84 ,$115.47 ,$213.84 , N/A ,$414.58 ,$357.85 ,$357.85 ,$349.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % PRSY 10 ML SYRINGE,250,1 ,$26.15 ,$17.26 ,$5.95 ,$26.15 , N/A ,$23.44 ,$23.44 ,$6.92 ,$20.92 ,$22.23 ,$16.34 ,$23.54 , N/A , N/A ,$24.84 ,$23.54 ,$22.23 ,$22.23 ,$6.92 ,$22.23 ,$22.23 ,$23.54 ,$15.93 , N/A ,$16.22 , N/A ,$23.54 , N/A ,$24.06 ,$23.54 ,$17.26 ,$17.26 ,$15.93 ,$17.26 ,$17.00 ,$17.87 ,$5.95 ,$20.66 , N/A ,$12.81 ,$12.81 ,$6.92 ,$12.81 , N/A ,$24.84 ,$21.44 ,$21.44 ,$20.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % PRSY 6 ML SYRINGE,250,1 ,$24.30 ,$16.04 ,$5.54 ,$24.30 , N/A ,$21.78 ,$21.78 ,$6.43 ,$19.44 ,$20.66 ,$15.19 ,$21.87 , N/A , N/A ,$23.09 ,$21.87 ,$20.66 ,$20.66 ,$6.43 ,$20.66 ,$20.66 ,$21.87 ,$14.80 , N/A ,$15.06 , N/A ,$21.87 , N/A ,$22.36 ,$21.87 ,$16.04 ,$16.04 ,$14.80 ,$16.04 ,$15.80 ,$16.60 ,$5.54 ,$19.20 , N/A ,$11.91 ,$11.91 ,$6.43 ,$11.91 , N/A ,$23.09 ,$19.93 ,$19.93 ,$19.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 4 % CREA 5 G TUBE,250,1 ,$28.60 ,$18.88 ,$6.52 ,$28.60 , N/A ,$25.63 ,$25.63 ,$7.57 ,$22.88 ,$24.31 ,$17.88 ,$25.74 , N/A , N/A ,$27.17 ,$25.74 ,$24.31 ,$24.31 ,$7.57 ,$24.31 ,$24.31 ,$25.74 ,$17.42 , N/A ,$17.74 , N/A ,$25.74 , N/A ,$26.31 ,$25.74 ,$18.88 ,$18.88 ,$17.42 ,$18.88 ,$18.59 ,$19.54 ,$6.52 ,$22.59 , N/A ,$14.01 ,$14.01 ,$7.57 ,$14.01 , N/A ,$27.17 ,$23.45 ,$23.45 ,$22.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % GEL 5 ML TUBE,250,1 ,$28.60 ,$18.88 ,$6.52 ,$28.60 , N/A ,$25.63 ,$25.63 ,$7.57 ,$22.88 ,$24.31 ,$17.88 ,$25.74 , N/A , N/A ,$27.17 ,$25.74 ,$24.31 ,$24.31 ,$7.57 ,$24.31 ,$24.31 ,$25.74 ,$17.42 , N/A ,$17.74 , N/A ,$25.74 , N/A ,$26.31 ,$25.74 ,$18.88 ,$18.88 ,$17.42 ,$18.88 ,$18.59 ,$19.54 ,$6.52 ,$22.59 , N/A ,$14.01 ,$14.01 ,$7.57 ,$14.01 , N/A ,$27.17 ,$23.45 ,$23.45 ,$22.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 4 % PTCH,250,1 ,$8.95 ,$5.91 ,$2.04 ,$8.95 , N/A ,$8.02 ,$8.02 ,$2.37 ,$7.16 ,$7.61 ,$5.59 ,$8.06 , N/A , N/A ,$8.50 ,$8.06 ,$7.61 ,$7.61 ,$2.37 ,$7.61 ,$7.61 ,$8.06 ,$5.45 , N/A ,$5.54 , N/A ,$8.06 , N/A ,$8.23 ,$8.06 ,$5.91 ,$5.91 ,$5.45 ,$5.91 ,$5.82 ,$6.11 ,$2.04 ,$7.07 , N/A ,$4.39 ,$4.39 ,$2.37 ,$4.39 , N/A ,$8.50 ,$7.34 ,$7.34 ,$7.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 4 % SOLN 50 ML BOTTLE,250,1 ,$163.20 ,$107.71 ,$37.16 ,$163.20 , N/A ,$146.26 ,$146.26 ,$43.18 ,$130.56 ,$138.72 ,$102.00 ,$146.88 , N/A , N/A ,$155.04 ,$146.88 ,$138.72 ,$138.72 ,$43.18 ,$138.72 ,$138.72 ,$146.88 ,$99.39 , N/A ,$101.18 , N/A ,$146.88 , N/A ,$150.14 ,$146.88 ,$107.73 ,$107.73 ,$99.39 ,$107.73 ,$106.08 ,$111.50 ,$37.16 ,$128.93 , N/A ,$79.97 ,$79.97 ,$43.18 ,$79.97 , N/A ,$155.04 ,$133.82 ,$133.82 ,$130.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 4%-EPINEPHRINE 0.05%-TETRACAINE 0.5% 4-0.05-0.5 % SOLN,250,1 ,$60.60 ,$40.00 ,$13.80 ,$60.60 , N/A ,$54.31 ,$54.31 ,$16.03 ,$48.48 ,$51.51 ,$37.88 ,$54.54 , N/A , N/A ,$57.57 ,$54.54 ,$51.51 ,$51.51 ,$16.03 ,$51.51 ,$51.51 ,$54.54 ,$36.91 , N/A ,$37.58 , N/A ,$54.54 , N/A ,$55.75 ,$54.54 ,$40.00 ,$40.00 ,$36.91 ,$40.00 ,$39.39 ,$41.40 ,$13.80 ,$47.87 , N/A ,$29.69 ,$29.69 ,$16.03 ,$29.69 , N/A ,$57.57 ,$49.69 ,$49.69 ,$48.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 5 % OINT 35.44 G TUBE,250,1 ,"$1,076.65 ",$710.59 ,$245.11 ,"$1,076.65 ", N/A ,$964.89 ,$964.89 ,$284.89 ,$861.32 ,$915.15 ,$672.91 ,$968.99 , N/A , N/A ,"$1,022.82 ",$968.99 ,$915.15 ,$915.15 ,$284.89 ,$915.15 ,$915.15 ,$968.99 ,$655.68 , N/A ,$667.52 , N/A ,$968.99 , N/A ,$990.52 ,$968.99 ,$710.70 ,$710.70 ,$655.68 ,$710.70 ,$699.82 ,$735.57 ,$245.11 ,$850.55 , N/A ,$527.56 ,$527.56 ,$284.89 ,$527.56 , N/A ,"$1,022.82 ",$882.85 ,$882.85 ,$861.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE CREAM 4 % KIT,250,1 ,$14.30 ,$9.44 ,$3.25 ,$14.30 , N/A ,$12.82 ,$12.82 ,$3.78 ,$11.44 ,$12.16 ,$8.94 ,$12.87 , N/A , N/A ,$13.59 ,$12.87 ,$12.16 ,$12.16 ,$3.78 ,$12.16 ,$12.16 ,$12.87 ,$8.71 , N/A ,$8.86 , N/A ,$12.87 , N/A ,$13.16 ,$12.87 ,$9.44 ,$9.44 ,$8.71 ,$9.44 ,$9.30 ,$9.77 ,$3.25 ,$11.30 , N/A ,$7.01 ,$7.01 ,$3.78 ,$7.01 , N/A ,$13.59 ,$11.73 ,$11.73 ,$11.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:100000 SOLN 30 ML VIAL,250,1 ,$75.65 ,$49.93 ,$17.22 ,$75.65 , N/A ,$67.80 ,$67.80 ,$20.02 ,$60.52 ,$64.30 ,$47.28 ,$68.09 , N/A , N/A ,$71.87 ,$68.09 ,$64.30 ,$64.30 ,$20.02 ,$64.30 ,$64.30 ,$68.09 ,$46.07 , N/A ,$46.90 , N/A ,$68.09 , N/A ,$69.60 ,$68.09 ,$49.94 ,$49.94 ,$46.07 ,$49.94 ,$49.17 ,$51.68 ,$17.22 ,$59.76 , N/A ,$37.07 ,$37.07 ,$20.02 ,$37.07 , N/A ,$71.87 ,$62.03 ,$62.03 ,$60.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE (PF) 1 % SOLN,250,1 ,$75.65 ,$49.93 ,$17.22 ,$75.65 , N/A ,$67.80 ,$67.80 ,$20.02 ,$60.52 ,$64.30 ,$47.28 ,$68.09 , N/A , N/A ,$71.87 ,$68.09 ,$64.30 ,$64.30 ,$20.02 ,$64.30 ,$64.30 ,$68.09 ,$46.07 , N/A ,$46.90 , N/A ,$68.09 , N/A ,$69.60 ,$68.09 ,$49.94 ,$49.94 ,$46.07 ,$49.94 ,$49.17 ,$51.68 ,$17.22 ,$59.76 , N/A ,$37.07 ,$37.07 ,$20.02 ,$37.07 , N/A ,$71.87 ,$62.03 ,$62.03 ,$60.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 2 %-1:200000 SOLN,250,1 ,$52.75 ,$34.82 ,$12.00 ,$52.75 , N/A ,$47.27 ,$47.27 ,$13.96 ,$42.20 ,$44.84 ,$32.97 ,$47.48 , N/A , N/A ,$50.11 ,$47.48 ,$44.84 ,$44.84 ,$13.96 ,$44.84 ,$44.84 ,$47.48 ,$32.12 , N/A ,$32.70 , N/A ,$47.48 , N/A ,$48.53 ,$47.48 ,$34.82 ,$34.82 ,$32.12 ,$34.82 ,$34.29 ,$36.04 ,$12.00 ,$41.67 , N/A ,$25.85 ,$25.85 ,$13.96 ,$25.85 , N/A ,$50.11 ,$43.26 ,$43.26 ,$42.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-PRILOCAINE 2.5-2.5 % CREA 30 G TUBE,250,1 ,$180.65 ,$119.23 ,$41.13 ,$180.65 , N/A ,$161.90 ,$161.90 ,$47.80 ,$144.52 ,$153.55 ,$112.91 ,$162.59 , N/A , N/A ,$171.62 ,$162.59 ,$153.55 ,$153.55 ,$47.80 ,$153.55 ,$153.55 ,$162.59 ,$110.02 , N/A ,$112.00 , N/A ,$162.59 , N/A ,$166.20 ,$162.59 ,$119.25 ,$119.25 ,$110.02 ,$119.25 ,$117.42 ,$123.42 ,$41.13 ,$142.71 , N/A ,$88.52 ,$88.52 ,$47.80 ,$88.52 , N/A ,$171.62 ,$148.13 ,$148.13 ,$144.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-PRILOCAINE 2.5-2.5 % CREA 5 G TUBE,250,1 ,$33.75 ,$22.28 ,$7.68 ,$33.75 , N/A ,$30.25 ,$30.25 ,$8.93 ,$27.00 ,$28.69 ,$21.09 ,$30.38 , N/A , N/A ,$32.06 ,$30.38 ,$28.69 ,$28.69 ,$8.93 ,$28.69 ,$28.69 ,$30.38 ,$20.55 , N/A ,$20.92 , N/A ,$30.38 , N/A ,$31.05 ,$30.38 ,$22.28 ,$22.28 ,$20.55 ,$22.28 ,$21.94 ,$23.06 ,$7.68 ,$26.66 , N/A ,$16.54 ,$16.54 ,$8.93 ,$16.54 , N/A ,$32.06 ,$27.68 ,$27.68 ,$27.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,MANNITOL 20 % SOLN,250,1 ,$464.35 ,$306.47 ,$105.71 ,$464.35 , N/A ,$416.15 ,$416.15 ,$122.86 ,$371.48 ,$394.70 ,$290.22 ,$417.92 , N/A , N/A ,$441.13 ,$417.92 ,$394.70 ,$394.70 ,$122.86 ,$394.70 ,$394.70 ,$417.92 ,$282.79 , N/A ,$287.90 , N/A ,$417.92 , N/A ,$427.20 ,$417.92 ,$306.52 ,$306.52 ,$282.79 ,$306.52 ,$301.83 ,$317.24 ,$105.71 ,$366.84 , N/A ,$227.53 ,$227.53 ,$122.86 ,$227.53 , N/A ,$441.13 ,$380.77 ,$380.77 ,$371.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,METRONIDAZOLE 500 MG/100ML SOLN,250,1 ,$53.05 ,$35.01 ,$12.07 ,$53.05 , N/A ,$47.54 ,$47.54 ,$14.03 ,$42.44 ,$45.09 ,$33.16 ,$47.75 , N/A , N/A ,$50.40 ,$47.75 ,$45.09 ,$45.09 ,$14.03 ,$45.09 ,$45.09 ,$47.75 ,$32.31 , N/A ,$32.90 , N/A ,$47.75 , N/A ,$48.81 ,$47.75 ,$35.02 ,$35.02 ,$32.31 ,$35.02 ,$34.48 ,$36.24 ,$12.07 ,$41.91 , N/A ,$25.99 ,$25.99 ,$14.03 ,$25.99 , N/A ,$50.40 ,$43.50 ,$43.50 ,$42.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 4%-EPINEPHRINE 0.18%-TETRACAINE 0.5% TOPICAL GEL 4-0.18-0.5 % GEL,250,1 ,$53.05 ,$35.01 ,$12.07 ,$53.05 , N/A ,$47.54 ,$47.54 ,$14.03 ,$42.44 ,$45.09 ,$33.16 ,$47.75 , N/A , N/A ,$50.40 ,$47.75 ,$45.09 ,$45.09 ,$14.03 ,$45.09 ,$45.09 ,$47.75 ,$32.31 , N/A ,$32.90 , N/A ,$47.75 , N/A ,$48.81 ,$47.75 ,$35.02 ,$35.02 ,$32.31 ,$35.02 ,$34.48 ,$36.24 ,$12.07 ,$41.91 , N/A ,$25.99 ,$25.99 ,$14.03 ,$25.99 , N/A ,$50.40 ,$43.50 ,$43.50 ,$42.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,METRONIDAZOLE 500 MG/100 ML SOLN,250,1 ,$53.05 ,$35.01 ,$12.07 ,$53.05 , N/A ,$47.54 ,$47.54 ,$14.03 ,$42.44 ,$45.09 ,$33.16 ,$47.75 , N/A , N/A ,$50.40 ,$47.75 ,$45.09 ,$45.09 ,$14.03 ,$45.09 ,$45.09 ,$47.75 ,$32.31 , N/A ,$32.90 , N/A ,$47.75 , N/A ,$48.81 ,$47.75 ,$35.02 ,$35.02 ,$32.31 ,$35.02 ,$34.48 ,$36.24 ,$12.07 ,$41.91 , N/A ,$25.99 ,$25.99 ,$14.03 ,$25.99 , N/A ,$50.40 ,$43.50 ,$43.50 ,$42.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,MOXIFLOXACIN 0.5 % SOLN 3 ML BOTTLE,250,1 ,$592.75 ,$391.22 ,$134.94 ,$592.75 , N/A ,$531.22 ,$531.22 ,$156.84 ,$474.20 ,$503.84 ,$370.47 ,$533.48 , N/A , N/A ,$563.11 ,$533.48 ,$503.84 ,$503.84 ,$156.84 ,$503.84 ,$503.84 ,$533.48 ,$360.98 , N/A ,$367.50 , N/A ,$533.48 , N/A ,$545.33 ,$533.48 ,$391.27 ,$391.27 ,$360.98 ,$391.27 ,$385.29 ,$404.97 ,$134.94 ,$468.27 , N/A ,$290.45 ,$290.45 ,$156.84 ,$290.45 , N/A ,$563.11 ,$486.06 ,$486.06 ,$474.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,MOXIFLOXACIN 5 MG/ML SOLN,250,1 ,$121.80 ,$80.39 ,$27.72 ,$121.80 , N/A ,$109.16 ,$109.16 ,$32.23 ,$97.44 ,$103.53 ,$76.13 ,$109.62 , N/A , N/A ,$115.71 ,$109.62 ,$103.53 ,$103.53 ,$32.23 ,$103.53 ,$103.53 ,$109.62 ,$74.18 , N/A ,$75.52 , N/A ,$109.62 , N/A ,$112.06 ,$109.62 ,$80.40 ,$80.40 ,$74.18 ,$80.40 ,$79.17 ,$83.21 ,$27.72 ,$96.22 , N/A ,$59.68 ,$59.68 ,$32.23 ,$59.68 , N/A ,$115.71 ,$99.88 ,$99.88 ,$97.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,MULTIVITAMIN (ADULT MVI) INJ 10 ML VIAL,250,1 ,$85.90 ,$56.69 ,$19.56 ,$85.90 , N/A ,$76.98 ,$76.98 ,$22.73 ,$68.72 ,$73.02 ,$53.69 ,$77.31 , N/A , N/A ,$81.61 ,$77.31 ,$73.02 ,$73.02 ,$22.73 ,$73.02 ,$73.02 ,$77.31 ,$52.31 , N/A ,$53.26 , N/A ,$77.31 , N/A ,$79.03 ,$77.31 ,$56.70 ,$56.70 ,$52.31 ,$56.70 ,$55.84 ,$58.69 ,$19.56 ,$67.86 , N/A ,$42.09 ,$42.09 ,$22.73 ,$42.09 , N/A ,$81.61 ,$70.44 ,$70.44 ,$68.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NAFCILLIN 2 GM SOLR 1 EACH VIAL,250,1 ,$173.90 ,$114.77 ,$39.59 ,$173.90 , N/A ,$155.85 ,$155.85 ,$46.01 ,$139.12 ,$147.82 ,$108.69 ,$156.51 , N/A , N/A ,$165.21 ,$156.51 ,$147.82 ,$147.82 ,$46.01 ,$147.82 ,$147.82 ,$156.51 ,$105.91 , N/A ,$107.82 , N/A ,$156.51 , N/A ,$159.99 ,$156.51 ,$114.79 ,$114.79 ,$105.91 ,$114.79 ,$113.04 ,$118.81 ,$39.59 ,$137.38 , N/A ,$85.21 ,$85.21 ,$46.01 ,$85.21 , N/A ,$165.21 ,$142.60 ,$142.60 ,$139.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NICARDIPINE 40-0.83 MG/200ML-% SOLN,250,1 ,"$1,231.40 ",$812.72 ,$280.33 ,"$1,231.40 ", N/A ,"$1,103.58 ","$1,103.58 ",$325.83 ,$985.12 ,"$1,046.69 ",$769.63 ,"$1,108.26 ", N/A , N/A ,"$1,169.83 ","$1,108.26 ","$1,046.69 ","$1,046.69 ",$325.83 ,"$1,046.69 ","$1,046.69 ","$1,108.26 ",$749.92 , N/A ,$763.46 , N/A ,"$1,108.26 ", N/A ,"$1,132.89 ","$1,108.26 ",$812.85 ,$812.85 ,$749.92 ,$812.85 ,$800.41 ,$841.29 ,$280.33 ,$972.81 , N/A ,$603.39 ,$603.39 ,$325.83 ,$603.39 , N/A ,"$1,169.83 ","$1,009.75 ","$1,009.75 ",$985.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NICARDIPINE 40 MG/200 ML IN NS SOLN,250,1 ,"$1,231.40 ",$812.72 ,$280.33 ,"$1,231.40 ", N/A ,"$1,103.58 ","$1,103.58 ",$325.83 ,$985.12 ,"$1,046.69 ",$769.63 ,"$1,108.26 ", N/A , N/A ,"$1,169.83 ","$1,108.26 ","$1,046.69 ","$1,046.69 ",$325.83 ,"$1,046.69 ","$1,046.69 ","$1,108.26 ",$749.92 , N/A ,$763.46 , N/A ,"$1,108.26 ", N/A ,"$1,132.89 ","$1,108.26 ",$812.85 ,$812.85 ,$749.92 ,$812.85 ,$800.41 ,$841.29 ,$280.33 ,$972.81 , N/A ,$603.39 ,$603.39 ,$325.83 ,$603.39 , N/A ,"$1,169.83 ","$1,009.75 ","$1,009.75 ",$985.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NICARDIPINE HCL IN NACL 20-0.9 MG/200ML-% SOLN,250,1 ,$631.15 ,$416.56 ,$143.68 ,$631.15 , N/A ,$565.64 ,$565.64 ,$167.00 ,$504.92 ,$536.48 ,$394.47 ,$568.04 , N/A , N/A ,$599.59 ,$568.04 ,$536.48 ,$536.48 ,$167.00 ,$536.48 ,$536.48 ,$568.04 ,$384.37 , N/A ,$391.32 , N/A ,$568.04 , N/A ,$580.66 ,$568.04 ,$416.62 ,$416.62 ,$384.37 ,$416.62 ,$410.25 ,$431.20 ,$143.68 ,$498.61 , N/A ,$309.26 ,$309.26 ,$167.00 ,$309.26 , N/A ,$599.59 ,$517.54 ,$517.54 ,$504.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NITROGLYCERIN 200-5 MCG/ML-% SOLN,250,1 ,$44.20 ,$29.17 ,$10.06 ,$44.20 , N/A ,$39.61 ,$39.61 ,$11.69 ,$35.36 ,$37.57 ,$27.63 ,$39.78 , N/A , N/A ,$41.99 ,$39.78 ,$37.57 ,$37.57 ,$11.69 ,$37.57 ,$37.57 ,$39.78 ,$26.92 , N/A ,$27.40 , N/A ,$39.78 , N/A ,$40.66 ,$39.78 ,$29.18 ,$29.18 ,$26.92 ,$29.18 ,$28.73 ,$30.20 ,$10.06 ,$34.92 , N/A ,$21.66 ,$21.66 ,$11.69 ,$21.66 , N/A ,$41.99 ,$36.24 ,$36.24 ,$35.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NITROPRUSSIDE 25 MG/ML SOLN,250,1 ,$590.40 ,$389.66 ,$134.41 ,$590.40 , N/A ,$529.12 ,$529.12 ,$156.22 ,$472.32 ,$501.84 ,$369.00 ,$531.36 , N/A , N/A ,$560.88 ,$531.36 ,$501.84 ,$501.84 ,$156.22 ,$501.84 ,$501.84 ,$531.36 ,$359.55 , N/A ,$366.04 , N/A ,$531.36 , N/A ,$543.17 ,$531.36 ,$389.72 ,$389.72 ,$359.55 ,$389.72 ,$383.76 ,$403.36 ,$134.41 ,$466.42 , N/A ,$289.30 ,$289.30 ,$156.22 ,$289.30 , N/A ,$560.88 ,$484.13 ,$484.13 ,$472.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NITROPRUSSIDE 25 MG/ML SOLN 2 ML VIAL,250,1 ,$153.75 ,$101.48 ,$35.00 ,$153.75 , N/A ,$137.79 ,$137.79 ,$40.68 ,$123.00 ,$130.69 ,$96.09 ,$138.38 , N/A , N/A ,$146.06 ,$138.38 ,$130.69 ,$130.69 ,$40.68 ,$130.69 ,$130.69 ,$138.38 ,$93.63 , N/A ,$95.32 , N/A ,$138.38 , N/A ,$141.45 ,$138.38 ,$101.49 ,$101.49 ,$93.63 ,$101.49 ,$99.94 ,$105.04 ,$35.00 ,$121.46 , N/A ,$75.34 ,$75.34 ,$40.68 ,$75.34 , N/A ,$146.06 ,$126.08 ,$126.08 ,$123.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NOREPINEPHRINE 1 MG/ML SOLN 4 ML VIAL,250,1 ,$150.80 ,$99.53 ,$34.33 ,$150.80 , N/A ,$135.15 ,$135.15 ,$39.91 ,$120.64 ,$128.18 ,$94.25 ,$135.72 , N/A , N/A ,$143.26 ,$135.72 ,$128.18 ,$128.18 ,$39.91 ,$128.18 ,$128.18 ,$135.72 ,$91.84 , N/A ,$93.50 , N/A ,$135.72 , N/A ,$138.74 ,$135.72 ,$99.54 ,$99.54 ,$91.84 ,$99.54 ,$98.02 ,$103.03 ,$34.33 ,$119.13 , N/A ,$73.89 ,$73.89 ,$39.91 ,$73.89 , N/A ,$143.26 ,$123.66 ,$123.66 ,$120.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NOREPINEPHRINE 16-0.9 MG/250ML-% SOLN,250,1 ,$236.95 ,$156.39 ,$53.95 ,$236.95 , N/A ,$212.35 ,$212.35 ,$62.70 ,$189.56 ,$201.41 ,$148.09 ,$213.26 , N/A , N/A ,$225.10 ,$213.26 ,$201.41 ,$201.41 ,$62.70 ,$201.41 ,$201.41 ,$213.26 ,$144.30 , N/A ,$146.90 , N/A ,$213.26 , N/A ,$217.99 ,$213.26 ,$156.41 ,$156.41 ,$144.30 ,$156.41 ,$154.02 ,$161.88 ,$53.95 ,$187.19 , N/A ,$116.11 ,$116.11 ,$62.70 ,$116.11 , N/A ,$225.10 ,$194.30 ,$194.30 ,$189.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NOREPINEPHRINE 4-0.9 MG/250ML-% SOLN,250,1 ,$157.00 ,$103.62 ,$35.74 ,$157.00 , N/A ,$140.70 ,$140.70 ,$41.54 ,$125.60 ,$133.45 ,$98.13 ,$141.30 , N/A , N/A ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$41.54 ,$133.45 ,$133.45 ,$141.30 ,$95.61 , N/A ,$97.34 , N/A ,$141.30 , N/A ,$144.44 ,$141.30 ,$103.64 ,$103.64 ,$95.61 ,$103.64 ,$102.05 ,$107.26 ,$35.74 ,$124.03 , N/A ,$76.93 ,$76.93 ,$41.54 ,$76.93 , N/A ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,OFLOXACIN 0.3 % SOLN 10 ML BOTTLE,250,1 ,$137.30 ,$90.62 ,$31.26 ,$137.30 , N/A ,$123.05 ,$123.05 ,$36.33 ,$109.84 ,$116.71 ,$85.81 ,$123.57 , N/A , N/A ,$130.44 ,$123.57 ,$116.71 ,$116.71 ,$36.33 ,$116.71 ,$116.71 ,$123.57 ,$83.62 , N/A ,$85.12 , N/A ,$123.57 , N/A ,$126.32 ,$123.57 ,$90.63 ,$90.63 ,$83.62 ,$90.63 ,$89.25 ,$93.80 ,$31.26 ,$108.47 , N/A ,$67.28 ,$67.28 ,$36.33 ,$67.28 , N/A ,$130.44 ,$112.59 ,$112.59 ,$109.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,OFLOXACIN 0.3 % SOLN 5 ML BOTTLE,250,1 ,$239.20 ,$157.87 ,$54.46 ,$239.20 , N/A ,$214.37 ,$214.37 ,$63.29 ,$191.36 ,$203.32 ,$149.50 ,$215.28 , N/A , N/A ,$227.24 ,$215.28 ,$203.32 ,$203.32 ,$63.29 ,$203.32 ,$203.32 ,$215.28 ,$145.67 , N/A ,$148.30 , N/A ,$215.28 , N/A ,$220.06 ,$215.28 ,$157.90 ,$157.90 ,$145.67 ,$157.90 ,$155.48 ,$163.42 ,$54.46 ,$188.97 , N/A ,$117.21 ,$117.21 ,$63.29 ,$117.21 , N/A ,$227.24 ,$196.14 ,$196.14 ,$191.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,OLANZAPINE 10 MG SOLR,250,1 ,$199.15 ,$131.44 ,$45.33 ,$199.15 , N/A ,$178.48 ,$178.48 ,$52.69 ,$159.32 ,$169.28 ,$124.47 ,$179.24 , N/A , N/A ,$189.19 ,$179.24 ,$169.28 ,$169.28 ,$52.69 ,$169.28 ,$169.28 ,$179.24 ,$121.28 , N/A ,$123.48 , N/A ,$179.24 , N/A ,$183.22 ,$179.24 ,$131.46 ,$131.46 ,$121.28 ,$131.46 ,$129.45 ,$136.06 ,$45.33 ,$157.33 , N/A ,$97.58 ,$97.58 ,$52.69 ,$97.58 , N/A ,$189.19 ,$163.30 ,$163.30 ,$159.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,OPHTHALMIC IRRIGATION SOLN 118 ML BOTTLE,250,1 ,$12.45 ,$8.22 ,$2.83 ,$12.45 , N/A ,$11.16 ,$11.16 ,$3.29 ,$9.96 ,$10.58 ,$7.78 ,$11.21 , N/A , N/A ,$11.83 ,$11.21 ,$10.58 ,$10.58 ,$3.29 ,$10.58 ,$10.58 ,$11.21 ,$7.58 , N/A ,$7.72 , N/A ,$11.21 , N/A ,$11.45 ,$11.21 ,$8.22 ,$8.22 ,$7.58 ,$8.22 ,$8.09 ,$8.51 ,$2.83 ,$9.84 , N/A ,$6.10 ,$6.10 ,$3.29 ,$6.10 , N/A ,$11.83 ,$10.21 ,$10.21 ,$9.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,OXYCHLOROSENE POWD 2 G BOX,250,1 ,$21.10 ,$13.93 ,$4.80 ,$21.10 , N/A ,$18.91 ,$18.91 ,$5.59 ,$16.88 ,$17.94 ,$13.19 ,$18.99 , N/A , N/A ,$20.05 ,$18.99 ,$17.94 ,$17.94 ,$5.59 ,$17.94 ,$17.94 ,$18.99 ,$12.85 , N/A ,$13.08 , N/A ,$18.99 , N/A ,$19.41 ,$18.99 ,$13.93 ,$13.93 ,$12.85 ,$13.93 ,$13.72 ,$14.42 ,$4.80 ,$16.67 , N/A ,$10.34 ,$10.34 ,$5.59 ,$10.34 , N/A ,$20.05 ,$17.30 ,$17.30 ,$16.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PENTAMIDINE 300 MG SOLR 1 EACH VIAL,250,1 ,$831.15 ,$548.56 ,$189.21 ,$831.15 , N/A ,$744.88 ,$744.88 ,$219.92 ,$664.92 ,$706.48 ,$519.47 ,$748.04 , N/A , N/A ,$789.59 ,$748.04 ,$706.48 ,$706.48 ,$219.92 ,$706.48 ,$706.48 ,$748.04 ,$506.17 , N/A ,$515.32 , N/A ,$748.04 , N/A ,$764.66 ,$748.04 ,$548.64 ,$548.64 ,$506.17 ,$548.64 ,$540.25 ,$567.84 ,$189.21 ,$656.61 , N/A ,$407.26 ,$407.26 ,$219.92 ,$407.26 , N/A ,$789.59 ,$681.54 ,$681.54 ,$664.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PHENYLEPHRINE 10 % SOLN 5 ML BOTTLE,250,1 ,$170.00 ,$112.20 ,$38.70 ,$170.00 , N/A ,$152.35 ,$152.35 ,$44.98 ,$136.00 ,$144.50 ,$106.25 ,$153.00 , N/A , N/A ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$44.98 ,$144.50 ,$144.50 ,$153.00 ,$103.53 , N/A ,$105.40 , N/A ,$153.00 , N/A ,$156.40 ,$153.00 ,$112.22 ,$112.22 ,$103.53 ,$112.22 ,$110.50 ,$116.14 ,$38.70 ,$134.30 , N/A ,$83.30 ,$83.30 ,$44.98 ,$83.30 , N/A ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PHENYLEPHRINE 2.5 % SOLN 15 ML BOTTLE,250,1 ,$382.50 ,$252.45 ,$87.08 ,$382.50 , N/A ,$342.80 ,$342.80 ,$101.21 ,$306.00 ,$325.13 ,$239.06 ,$344.25 , N/A , N/A ,$363.38 ,$344.25 ,$325.13 ,$325.13 ,$101.21 ,$325.13 ,$325.13 ,$344.25 ,$232.94 , N/A ,$237.16 , N/A ,$344.25 , N/A ,$351.90 ,$344.25 ,$252.49 ,$252.49 ,$232.94 ,$252.49 ,$248.63 ,$261.32 ,$87.08 ,$302.18 , N/A ,$187.43 ,$187.43 ,$101.21 ,$187.43 , N/A ,$363.38 ,$313.65 ,$313.65 ,$306.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PHENYLEPHRINE 2.5 % SOLN 2 ML BOTTLE,250,1 ,$138.15 ,$91.18 ,$31.45 ,$138.15 , N/A ,$123.81 ,$123.81 ,$36.55 ,$110.52 ,$117.43 ,$86.34 ,$124.34 , N/A , N/A ,$131.24 ,$124.34 ,$117.43 ,$117.43 ,$36.55 ,$117.43 ,$117.43 ,$124.34 ,$84.13 , N/A ,$85.66 , N/A ,$124.34 , N/A ,$127.10 ,$124.34 ,$91.19 ,$91.19 ,$84.13 ,$91.19 ,$89.80 ,$94.38 ,$31.45 ,$109.14 , N/A ,$67.69 ,$67.69 ,$36.55 ,$67.69 , N/A ,$131.24 ,$113.28 ,$113.28 ,$110.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PHENYLEPHRINE HCL POWD,250,1 ,$10.70 ,$7.06 ,$2.43 ,$10.70 , N/A ,$9.59 ,$9.59 ,$2.83 ,$8.56 ,$9.10 ,$6.69 ,$9.63 , N/A , N/A ,$10.17 ,$9.63 ,$9.10 ,$9.10 ,$2.83 ,$9.10 ,$9.10 ,$9.63 ,$6.52 , N/A ,$6.64 , N/A ,$9.63 , N/A ,$9.84 ,$9.63 ,$7.06 ,$7.06 ,$6.52 ,$7.06 ,$6.96 ,$7.31 ,$2.43 ,$8.45 , N/A ,$5.24 ,$5.24 ,$2.83 ,$5.24 , N/A ,$10.17 ,$8.77 ,$8.77 ,$8.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PILOCARPINE 2 % SOLN 15 ML BOTTLE,250,1 ,$342.80 ,$226.25 ,$78.04 ,$342.80 , N/A ,$307.22 ,$307.22 ,$90.71 ,$274.24 ,$291.38 ,$214.25 ,$308.52 , N/A , N/A ,$325.66 ,$308.52 ,$291.38 ,$291.38 ,$90.71 ,$291.38 ,$291.38 ,$308.52 ,$208.77 , N/A ,$212.54 , N/A ,$308.52 , N/A ,$315.38 ,$308.52 ,$226.28 ,$226.28 ,$208.77 ,$226.28 ,$222.82 ,$234.20 ,$78.04 ,$270.81 , N/A ,$167.97 ,$167.97 ,$90.71 ,$167.97 , N/A ,$325.66 ,$281.10 ,$281.10 ,$274.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"POLYETHYLENE GLYCOL 236 G SOLR 4,000 ML BOTTLE",250,1 ,$95.20 ,$62.83 ,$21.68 ,$95.20 , N/A ,$85.32 ,$85.32 ,$25.19 ,$76.16 ,$80.92 ,$59.50 ,$85.68 , N/A , N/A ,$90.44 ,$85.68 ,$80.92 ,$80.92 ,$25.19 ,$80.92 ,$80.92 ,$85.68 ,$57.98 , N/A ,$59.02 , N/A ,$85.68 , N/A ,$87.58 ,$85.68 ,$62.84 ,$62.84 ,$57.98 ,$62.84 ,$61.88 ,$65.04 ,$21.68 ,$75.21 , N/A ,$46.65 ,$46.65 ,$25.19 ,$46.65 , N/A ,$90.44 ,$78.06 ,$78.06 ,$76.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,POTASSIUM IODIDE 1 G/ML 1 GM/ML SOLN,250,1 ,$13.40 ,$8.84 ,$3.05 ,$13.40 , N/A ,$12.01 ,$12.01 ,$3.55 ,$10.72 ,$11.39 ,$8.38 ,$12.06 , N/A , N/A ,$12.73 ,$12.06 ,$11.39 ,$11.39 ,$3.55 ,$11.39 ,$11.39 ,$12.06 ,$8.16 , N/A ,$8.30 , N/A ,$12.06 , N/A ,$12.33 ,$12.06 ,$8.85 ,$8.85 ,$8.16 ,$8.85 ,$8.71 ,$9.15 ,$3.05 ,$10.59 , N/A ,$6.57 ,$6.57 ,$3.55 ,$6.57 , N/A ,$12.73 ,$10.99 ,$10.99 ,$10.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,POTASSIUM PHOSPHATE 45 MMOLE/15ML SOLN 15 ML VIAL,250,1 ,$109.15 ,$72.04 ,$24.84 ,$109.15 , N/A ,$97.82 ,$97.82 ,$28.88 ,$87.32 ,$92.78 ,$68.22 ,$98.24 , N/A , N/A ,$103.69 ,$98.24 ,$92.78 ,$92.78 ,$28.88 ,$92.78 ,$92.78 ,$98.24 ,$66.47 , N/A ,$67.68 , N/A ,$98.24 , N/A ,$100.42 ,$98.24 ,$72.05 ,$72.05 ,$66.47 ,$72.05 ,$70.95 ,$74.57 ,$24.84 ,$86.23 , N/A ,$53.48 ,$53.48 ,$28.88 ,$53.48 , N/A ,$103.69 ,$89.50 ,$89.50 ,$87.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,POVIDONE-IODINE 10 % OINT 28.35 G TUBE,250,1 ,$10.65 ,$7.03 ,$2.42 ,$10.65 , N/A ,$9.54 ,$9.54 ,$2.82 ,$8.52 ,$9.05 ,$6.66 ,$9.59 , N/A , N/A ,$10.12 ,$9.59 ,$9.05 ,$9.05 ,$2.82 ,$9.05 ,$9.05 ,$9.59 ,$6.49 , N/A ,$6.60 , N/A ,$9.59 , N/A ,$9.80 ,$9.59 ,$7.03 ,$7.03 ,$6.49 ,$7.03 ,$6.92 ,$7.28 ,$2.42 ,$8.41 , N/A ,$5.22 ,$5.22 ,$2.82 ,$5.22 , N/A ,$10.12 ,$8.73 ,$8.73 ,$8.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,POVIDONE-IODINE 5 % SOLN 30 ML BOTTLE,250,1 ,$61.45 ,$40.56 ,$13.98 ,$61.45 , N/A ,$55.07 ,$55.07 ,$16.26 ,$49.16 ,$52.23 ,$38.41 ,$55.31 , N/A , N/A ,$58.38 ,$55.31 ,$52.23 ,$52.23 ,$16.26 ,$52.23 ,$52.23 ,$55.31 ,$37.42 , N/A ,$38.10 , N/A ,$55.31 , N/A ,$56.53 ,$55.31 ,$40.56 ,$40.56 ,$37.42 ,$40.56 ,$39.94 ,$41.98 ,$13.98 ,$48.55 , N/A ,$30.11 ,$30.11 ,$16.26 ,$30.11 , N/A ,$58.38 ,$50.39 ,$50.39 ,$49.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PREDNISOLONE ACETATE 1 % SUSP 5 ML BOTTLE,250,1 ,$188.10 ,$124.15 ,$42.82 ,$188.10 , N/A ,$168.58 ,$168.58 ,$49.77 ,$150.48 ,$159.89 ,$117.56 ,$169.29 , N/A , N/A ,$178.70 ,$169.29 ,$159.89 ,$159.89 ,$49.77 ,$159.89 ,$159.89 ,$169.29 ,$114.55 , N/A ,$116.62 , N/A ,$169.29 , N/A ,$173.05 ,$169.29 ,$124.16 ,$124.16 ,$114.55 ,$124.16 ,$122.27 ,$128.51 ,$42.82 ,$148.60 , N/A ,$92.17 ,$92.17 ,$49.77 ,$92.17 , N/A ,$178.70 ,$154.24 ,$154.24 ,$150.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PROPARACAINE 0.5 % SOLN 15 ML BOTTLE,250,1 ,$149.20 ,$98.47 ,$33.97 ,$149.20 , N/A ,$133.71 ,$133.71 ,$39.47 ,$119.36 ,$126.82 ,$93.25 ,$134.28 , N/A , N/A ,$141.74 ,$134.28 ,$126.82 ,$126.82 ,$39.47 ,$126.82 ,$126.82 ,$134.28 ,$90.86 , N/A ,$92.50 , N/A ,$134.28 , N/A ,$137.26 ,$134.28 ,$98.49 ,$98.49 ,$90.86 ,$98.49 ,$96.98 ,$101.93 ,$33.97 ,$117.87 , N/A ,$73.11 ,$73.11 ,$39.47 ,$73.11 , N/A ,$141.74 ,$122.34 ,$122.34 ,$119.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,J0248,REMDESIVIR 100 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$15.29 ,$10.09 ,$3.49 ,$15.29 ,$5.51 ,$12.40 ,$8.27 ,$4.05 ,$12.23 ,$13.00 ,$9.56 ,$13.76 ,$5.51 ,$5.51 ,$14.53 ,$13.76 ,$13.00 ,$13.00 ,$4.05 ,$13.00 ,$13.00 ,$13.76 ,$9.31 ,$5.51 ,$9.48 ,$5.84 ,$13.76 ,$12.40 ,$14.07 ,$13.76 ,$10.09 ,$10.09 ,$9.31 ,$10.09 ,$9.94 ,$10.45 ,$3.49 ,$12.08 ,$5.84 ,$7.49 ,$7.49 ,$4.05 ,$7.49 ,$5.51 ,$14.53 ,$12.54 ,$12.54 ,$12.23 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,REMIFENTANIL 2 MG SOLR 1 EACH VIAL,250,1 ,$640.53 ,$422.75 ,$145.81 ,$640.53 , N/A ,$574.04 ,$574.04 ,$169.48 ,$512.42 ,$544.45 ,$400.33 ,$576.48 , N/A , N/A ,$608.50 ,$576.48 ,$544.45 ,$544.45 ,$169.48 ,$544.45 ,$544.45 ,$576.48 ,$390.08 , N/A ,$397.12 , N/A ,$576.48 , N/A ,$589.29 ,$576.48 ,$422.81 ,$422.81 ,$390.08 ,$422.81 ,$416.34 ,$437.61 ,$145.81 ,$506.02 , N/A ,$313.86 ,$313.86 ,$169.48 ,$313.86 , N/A ,$608.50 ,$525.23 ,$525.23 ,$512.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ROCURONIUM 10 MG/ML SOLN,250,1 ,$103.03 ,$68.00 ,$23.46 ,$103.03 , N/A ,$92.34 ,$92.34 ,$27.26 ,$82.42 ,$87.58 ,$64.39 ,$92.73 , N/A , N/A ,$97.88 ,$92.73 ,$87.58 ,$87.58 ,$27.26 ,$87.58 ,$87.58 ,$92.73 ,$62.75 , N/A ,$63.88 , N/A ,$92.73 , N/A ,$94.79 ,$92.73 ,$68.01 ,$68.01 ,$62.75 ,$68.01 ,$66.97 ,$70.39 ,$23.46 ,$81.39 , N/A ,$50.48 ,$50.48 ,$27.26 ,$50.48 , N/A ,$97.88 ,$84.48 ,$84.48 ,$82.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ROCURONIUM 100 MG/10ML SOLN,250,1 ,$126.71 ,$83.63 ,$28.84 ,$126.71 , N/A ,$113.56 ,$113.56 ,$33.53 ,$101.37 ,$107.70 ,$79.19 ,$114.04 , N/A , N/A ,$120.37 ,$114.04 ,$107.70 ,$107.70 ,$33.53 ,$107.70 ,$107.70 ,$114.04 ,$77.17 , N/A ,$78.56 , N/A ,$114.04 , N/A ,$116.57 ,$114.04 ,$83.64 ,$83.64 ,$77.17 ,$83.64 ,$82.36 ,$86.57 ,$28.84 ,$100.10 , N/A ,$62.09 ,$62.09 ,$33.53 ,$62.09 , N/A ,$120.37 ,$103.90 ,$103.90 ,$101.37 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ROCURONIUM 50 MG/5ML SOLN,250,1 ,$50.00 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ROCURONIUM 50 MG/5ML SOSY,250,1 ,$73.10 ,$48.25 ,$16.64 ,$73.10 , N/A ,$65.51 ,$65.51 ,$19.35 ,$58.48 ,$62.14 ,$45.69 ,$65.79 , N/A , N/A ,$69.45 ,$65.79 ,$62.14 ,$62.14 ,$19.35 ,$62.14 ,$62.14 ,$65.79 ,$44.52 , N/A ,$45.32 , N/A ,$65.79 , N/A ,$67.25 ,$65.79 ,$48.25 ,$48.25 ,$44.52 ,$48.25 ,$47.52 ,$49.94 ,$16.64 ,$57.75 , N/A ,$35.82 ,$35.82 ,$19.35 ,$35.82 , N/A ,$69.45 ,$59.94 ,$59.94 ,$58.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE-EPINEPHRINE PF 0.5% -1:200000 SOLN,250,1 ,$73.10 ,$48.25 ,$16.64 ,$73.10 , N/A ,$65.51 ,$65.51 ,$19.35 ,$58.48 ,$62.14 ,$45.69 ,$65.79 , N/A , N/A ,$69.45 ,$65.79 ,$62.14 ,$62.14 ,$19.35 ,$62.14 ,$62.14 ,$65.79 ,$44.52 , N/A ,$45.32 , N/A ,$65.79 , N/A ,$67.25 ,$65.79 ,$48.25 ,$48.25 ,$44.52 ,$48.25 ,$47.52 ,$49.94 ,$16.64 ,$57.75 , N/A ,$35.82 ,$35.82 ,$19.35 ,$35.82 , N/A ,$69.45 ,$59.94 ,$59.94 ,$58.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SCOPOLAMINE 1 MG/3DAYS PT72,250,1 ,$86.90 ,$57.35 ,$19.79 ,$86.90 , N/A ,$77.88 ,$77.88 ,$22.99 ,$69.52 ,$73.87 ,$54.31 ,$78.21 , N/A , N/A ,$82.56 ,$78.21 ,$73.87 ,$73.87 ,$22.99 ,$73.87 ,$73.87 ,$78.21 ,$52.92 , N/A ,$53.88 , N/A ,$78.21 , N/A ,$79.95 ,$78.21 ,$57.36 ,$57.36 ,$52.92 ,$57.36 ,$56.49 ,$59.37 ,$19.79 ,$68.65 , N/A ,$42.58 ,$42.58 ,$22.99 ,$42.58 , N/A ,$82.56 ,$71.26 ,$71.26 ,$69.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SIMETHICONE 40 MG/0.6ML SUSP 30 ML BOTTLE,250,1 ,$34.00 ,$22.44 ,$7.74 ,$34.00 , N/A ,$30.47 ,$30.47 ,$9.00 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$9.00 ,$28.90 ,$28.90 ,$30.60 ,$20.71 , N/A ,$21.08 , N/A ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.44 ,$22.44 ,$20.71 ,$22.44 ,$22.10 ,$23.23 ,$7.74 ,$26.86 , N/A ,$16.66 ,$16.66 ,$9.00 ,$16.66 , N/A ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SIMETHICONE 40 MG/0.6ML SUSP,250,1 ,$34.00 ,$22.44 ,$7.74 ,$34.00 , N/A ,$30.47 ,$30.47 ,$9.00 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$9.00 ,$28.90 ,$28.90 ,$30.60 ,$20.71 , N/A ,$21.08 , N/A ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.44 ,$22.44 ,$20.71 ,$22.44 ,$22.10 ,$23.23 ,$7.74 ,$26.86 , N/A ,$16.66 ,$16.66 ,$9.00 ,$16.66 , N/A ,$32.30 ,$27.88 ,$27.88 ,$27.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN,250,1 ,$109.50 ,$72.27 ,$24.93 ,$109.50 , N/A ,$98.13 ,$98.13 ,$28.98 ,$87.60 ,$93.08 ,$68.44 ,$98.55 , N/A , N/A ,$104.03 ,$98.55 ,$93.08 ,$93.08 ,$28.98 ,$93.08 ,$93.08 ,$98.55 ,$66.69 , N/A ,$67.90 , N/A ,$98.55 , N/A ,$100.74 ,$98.55 ,$72.28 ,$72.28 ,$66.69 ,$72.28 ,$71.18 ,$74.81 ,$24.93 ,$86.51 , N/A ,$53.66 ,$53.66 ,$28.98 ,$53.66 , N/A ,$104.03 ,$89.79 ,$89.79 ,$87.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN 10 ML SYRINGE,250,1 ,$111.63 ,$73.68 ,$25.41 ,$111.63 , N/A ,$100.04 ,$100.04 ,$29.54 ,$89.30 ,$94.89 ,$69.77 ,$100.47 , N/A , N/A ,$106.05 ,$100.47 ,$94.89 ,$94.89 ,$29.54 ,$94.89 ,$94.89 ,$100.47 ,$67.98 , N/A ,$69.22 , N/A ,$100.47 , N/A ,$102.70 ,$100.47 ,$73.69 ,$73.69 ,$67.98 ,$73.69 ,$72.56 ,$76.27 ,$25.41 ,$88.19 , N/A ,$54.70 ,$54.70 ,$29.54 ,$54.70 , N/A ,$106.05 ,$91.54 ,$91.54 ,$89.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN 50 ML SYRINGE,250,1 ,$96.60 ,$63.76 ,$21.99 ,$96.60 , N/A ,$86.57 ,$86.57 ,$25.56 ,$77.28 ,$82.11 ,$60.38 ,$86.94 , N/A , N/A ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 , N/A ,$59.90 , N/A ,$86.94 , N/A ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 , N/A ,$47.33 ,$47.33 ,$25.56 ,$47.33 , N/A ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM BICARBONATE 8.4 % SOLN 50 ML VIAL,250,1 ,$72.58 ,$47.90 ,$16.52 ,$72.58 , N/A ,$65.05 ,$65.05 ,$19.21 ,$58.06 ,$61.69 ,$45.36 ,$65.32 , N/A , N/A ,$68.95 ,$65.32 ,$61.69 ,$61.69 ,$19.21 ,$61.69 ,$61.69 ,$65.32 ,$44.20 , N/A ,$45.00 , N/A ,$65.32 , N/A ,$66.77 ,$65.32 ,$47.91 ,$47.91 ,$44.20 ,$47.91 ,$47.18 ,$49.59 ,$16.52 ,$57.34 , N/A ,$35.56 ,$35.56 ,$19.21 ,$35.56 , N/A ,$68.95 ,$59.52 ,$59.52 ,$58.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE (EXTERNAL) 0.9 % SOLN 210 ML BOTTLE,250,1 ,$20.75 ,$13.70 ,$4.72 ,$20.75 , N/A ,$18.60 ,$18.60 ,$5.49 ,$16.60 ,$17.64 ,$12.97 ,$18.68 , N/A , N/A ,$19.71 ,$18.68 ,$17.64 ,$17.64 ,$5.49 ,$17.64 ,$17.64 ,$18.68 ,$12.64 , N/A ,$12.86 , N/A ,$18.68 , N/A ,$19.09 ,$18.68 ,$13.70 ,$13.70 ,$12.64 ,$13.70 ,$13.49 ,$14.18 ,$4.72 ,$16.39 , N/A ,$10.17 ,$10.17 ,$5.49 ,$10.17 , N/A ,$19.71 ,$17.02 ,$17.02 ,$16.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE (EXTERNAL) 0.9 % SOLN 210 ML CAN,250,1 ,$19.30 ,$12.74 ,$4.39 ,$19.30 , N/A ,$17.30 ,$17.30 ,$5.11 ,$15.44 ,$16.41 ,$12.06 ,$17.37 , N/A , N/A ,$18.34 ,$17.37 ,$16.41 ,$16.41 ,$5.11 ,$16.41 ,$16.41 ,$17.37 ,$11.75 , N/A ,$11.96 , N/A ,$17.37 , N/A ,$17.76 ,$17.37 ,$12.74 ,$12.74 ,$11.75 ,$12.74 ,$12.55 ,$13.19 ,$4.39 ,$15.25 , N/A ,$9.46 ,$9.46 ,$5.11 ,$9.46 , N/A ,$18.34 ,$15.83 ,$15.83 ,$15.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE (PF) 0.9 % SOLN 10 ML BOX,250,1 ,$11.00 ,$7.26 ,$2.51 ,$11.00 , N/A ,$9.86 ,$9.86 ,$2.91 ,$8.80 ,$9.35 ,$6.88 ,$9.90 , N/A , N/A ,$10.45 ,$9.90 ,$9.35 ,$9.35 ,$2.91 ,$9.35 ,$9.35 ,$9.90 ,$6.70 , N/A ,$6.82 , N/A ,$9.90 , N/A ,$10.12 ,$9.90 ,$7.26 ,$7.26 ,$6.70 ,$7.26 ,$7.15 ,$7.52 ,$2.51 ,$8.69 , N/A ,$5.39 ,$5.39 ,$2.91 ,$5.39 , N/A ,$10.45 ,$9.02 ,$9.02 ,$8.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NORMAL SALINE 0.9 % SOLN,250,1 ,$11.00 ,$7.26 ,$2.51 ,$11.00 , N/A ,$9.86 ,$9.86 ,$2.91 ,$8.80 ,$9.35 ,$6.88 ,$9.90 , N/A , N/A ,$10.45 ,$9.90 ,$9.35 ,$9.35 ,$2.91 ,$9.35 ,$9.35 ,$9.90 ,$6.70 , N/A ,$6.82 , N/A ,$9.90 , N/A ,$10.12 ,$9.90 ,$7.26 ,$7.26 ,$6.70 ,$7.26 ,$7.15 ,$7.52 ,$2.51 ,$8.69 , N/A ,$5.39 ,$5.39 ,$2.91 ,$5.39 , N/A ,$10.45 ,$9.02 ,$9.02 ,$8.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"SODIUM CHLORIDE 0.45 % SOLN 1,000 ML FLEX CONT",250,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DEXTROSE 5 % LACTATED RINGERS BOLUS,250,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"ACETIC ACID 0.25 % SOLN 1,000 ML PLAS CONT",250,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 0.45 %,250,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 0.45 % SOLN,250,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 0.9 % NEBU,250,1 ,$76.50 ,$50.49 ,$17.42 ,$76.50 , N/A ,$68.56 ,$68.56 ,$20.25 ,$61.20 ,$65.03 ,$47.81 ,$68.85 , N/A , N/A ,$72.68 ,$68.85 ,$65.03 ,$65.03 ,$20.25 ,$65.03 ,$65.03 ,$68.85 ,$46.59 , N/A ,$47.44 , N/A ,$68.85 , N/A ,$70.38 ,$68.85 ,$50.50 ,$50.50 ,$46.59 ,$50.50 ,$49.73 ,$52.26 ,$17.42 ,$60.44 , N/A ,$37.49 ,$37.49 ,$20.25 ,$37.49 , N/A ,$72.68 ,$62.73 ,$62.73 ,$61.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"SODIUM CHLORIDE 0.9 % SOLN 1,000 ML FLEX CONT",250,1 ,$18.40 ,$12.14 ,$4.18 ,$18.40 , N/A ,$16.49 ,$16.49 ,$4.87 ,$14.72 ,$15.64 ,$11.50 ,$16.56 , N/A , N/A ,$17.48 ,$16.56 ,$15.64 ,$15.64 ,$4.87 ,$15.64 ,$15.64 ,$16.56 ,$11.21 , N/A ,$11.40 , N/A ,$16.56 , N/A ,$16.93 ,$16.56 ,$12.15 ,$12.15 ,$11.21 ,$12.15 ,$11.96 ,$12.57 ,$4.18 ,$14.54 , N/A ,$9.02 ,$9.02 ,$4.87 ,$9.02 , N/A ,$17.48 ,$15.09 ,$15.09 ,$14.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"SODIUM CHLORIDE 0.9 % SOLN 1,000 ML PLAS CONT",250,1 ,$17.00 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 0.9 % SOLN,250,1 ,$17.00 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 0.9 % SOLN 250 ML PLAS CONT,250,1 ,$15.60 ,$10.30 ,$3.56 ,$15.60 , N/A ,$13.98 ,$13.98 ,$4.13 ,$12.48 ,$13.26 ,$9.75 ,$14.04 , N/A , N/A ,$14.82 ,$14.04 ,$13.26 ,$13.26 ,$4.13 ,$13.26 ,$13.26 ,$14.04 ,$9.50 , N/A ,$9.68 , N/A ,$14.04 , N/A ,$14.35 ,$14.04 ,$10.30 ,$10.30 ,$9.50 ,$10.30 ,$10.14 ,$10.66 ,$3.56 ,$12.32 , N/A ,$7.64 ,$7.64 ,$4.13 ,$7.64 , N/A ,$14.82 ,$12.79 ,$12.79 ,$12.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE BACTERIOSTATIC 0.9 % SOLN,250,1 ,$16.33 ,$10.78 ,$3.72 ,$16.33 , N/A ,$14.63 ,$14.63 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM HYALURONATE 12.8 MG/0.8ML SOSY,250,1 ,$757.00 ,$499.62 ,$172.33 ,$757.00 , N/A ,$678.42 ,$678.42 ,$200.30 ,$605.60 ,$643.45 ,$473.13 ,$681.30 , N/A , N/A ,$719.15 ,$681.30 ,$643.45 ,$643.45 ,$200.30 ,$643.45 ,$643.45 ,$681.30 ,$461.01 , N/A ,$469.34 , N/A ,$681.30 , N/A ,$696.44 ,$681.30 ,$499.70 ,$499.70 ,$461.01 ,$499.70 ,$492.05 ,$517.18 ,$172.33 ,$598.03 , N/A ,$370.93 ,$370.93 ,$200.30 ,$370.93 , N/A ,$719.15 ,$620.74 ,$620.74 ,$605.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM HYALURONATE 9.6 MG/0.8 ML SOSY,250,1 ,$627.50 ,$414.15 ,$142.85 ,$627.50 , N/A ,$562.37 ,$562.37 ,$166.04 ,$502.00 ,$533.38 ,$392.19 ,$564.75 , N/A , N/A ,$596.13 ,$564.75 ,$533.38 ,$533.38 ,$166.04 ,$533.38 ,$533.38 ,$564.75 ,$382.15 , N/A ,$389.06 , N/A ,$564.75 , N/A ,$577.30 ,$564.75 ,$414.21 ,$414.21 ,$382.15 ,$414.21 ,$407.88 ,$428.71 ,$142.85 ,$495.73 , N/A ,$307.48 ,$307.48 ,$166.04 ,$307.48 , N/A ,$596.13 ,$514.55 ,$514.55 ,$502.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM HYPOCHLORITE 0.5 % SOLN 473 ML BOTTLE,250,1 ,$46.65 ,$30.79 ,$10.62 ,$46.65 , N/A ,$41.81 ,$41.81 ,$12.35 ,$37.32 ,$39.65 ,$29.16 ,$41.99 , N/A , N/A ,$44.32 ,$41.99 ,$39.65 ,$39.65 ,$12.35 ,$39.65 ,$39.65 ,$41.99 ,$28.41 , N/A ,$28.92 , N/A ,$41.99 , N/A ,$42.92 ,$41.99 ,$30.79 ,$30.79 ,$28.41 ,$30.79 ,$30.32 ,$31.87 ,$10.62 ,$36.85 , N/A ,$22.86 ,$22.86 ,$12.35 ,$22.86 , N/A ,$44.32 ,$38.25 ,$38.25 ,$37.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM HYPOCHLORITE 0.25 % SOLN 473 ML BOTTLE,250,1 ,$46.65 ,$30.79 ,$10.62 ,$46.65 , N/A ,$41.81 ,$41.81 ,$12.35 ,$37.32 ,$39.65 ,$29.16 ,$41.99 , N/A , N/A ,$44.32 ,$41.99 ,$39.65 ,$39.65 ,$12.35 ,$39.65 ,$39.65 ,$41.99 ,$28.41 , N/A ,$28.92 , N/A ,$41.99 , N/A ,$42.92 ,$41.99 ,$30.79 ,$30.79 ,$28.41 ,$30.79 ,$30.32 ,$31.87 ,$10.62 ,$36.85 , N/A ,$22.86 ,$22.86 ,$12.35 ,$22.86 , N/A ,$44.32 ,$38.25 ,$38.25 ,$37.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM PHOSPHATE 45 MMOLE/15ML SOLN 5 ML VIAL,250,1 ,$119.15 ,$78.64 ,$27.12 ,$119.15 , N/A ,$106.78 ,$106.78 ,$31.53 ,$95.32 ,$101.28 ,$74.47 ,$107.24 , N/A , N/A ,$113.19 ,$107.24 ,$101.28 ,$101.28 ,$31.53 ,$101.28 ,$101.28 ,$107.24 ,$72.56 , N/A ,$73.88 , N/A ,$107.24 , N/A ,$109.62 ,$107.24 ,$78.65 ,$78.65 ,$72.56 ,$78.65 ,$77.45 ,$81.40 ,$27.12 ,$94.13 , N/A ,$58.38 ,$58.38 ,$31.53 ,$58.38 , N/A ,$113.19 ,$97.70 ,$97.70 ,$95.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM TETRADECYL SULFATE 3 % SOLN,250,1 ,$576.60 ,$380.56 ,$131.27 ,$576.60 , N/A ,$516.75 ,$516.75 ,$152.57 ,$461.28 ,$490.11 ,$360.38 ,$518.94 , N/A , N/A ,$547.77 ,$518.94 ,$490.11 ,$490.11 ,$152.57 ,$490.11 ,$490.11 ,$518.94 ,$351.15 , N/A ,$357.50 , N/A ,$518.94 , N/A ,$530.47 ,$518.94 ,$380.61 ,$380.61 ,$351.15 ,$380.61 ,$374.79 ,$393.93 ,$131.27 ,$455.51 , N/A ,$282.53 ,$282.53 ,$152.57 ,$282.53 , N/A ,$547.77 ,$472.81 ,$472.81 ,$461.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SORBITOL-MANNITOL 2.7-0.54 GM/100ML SOLN,250,1 ,$61.20 ,$40.39 ,$13.94 ,$61.20 , N/A ,$54.85 ,$54.85 ,$16.19 ,$48.96 ,$52.02 ,$38.25 ,$55.08 , N/A , N/A ,$58.14 ,$55.08 ,$52.02 ,$52.02 ,$16.19 ,$52.02 ,$52.02 ,$55.08 ,$37.27 , N/A ,$37.94 , N/A ,$55.08 , N/A ,$56.30 ,$55.08 ,$40.40 ,$40.40 ,$37.27 ,$40.40 ,$39.78 ,$41.81 ,$13.94 ,$48.35 , N/A ,$29.99 ,$29.99 ,$16.19 ,$29.99 , N/A ,$58.14 ,$50.18 ,$50.18 ,$48.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"SODIUM CHLORIDE 0.9 % SOLN 3,000 ML PLAS CONT",250,1 ,$61.20 ,$40.39 ,$13.94 ,$61.20 , N/A ,$54.85 ,$54.85 ,$16.19 ,$48.96 ,$52.02 ,$38.25 ,$55.08 , N/A , N/A ,$58.14 ,$55.08 ,$52.02 ,$52.02 ,$16.19 ,$52.02 ,$52.02 ,$55.08 ,$37.27 , N/A ,$37.94 , N/A ,$55.08 , N/A ,$56.30 ,$55.08 ,$40.40 ,$40.40 ,$37.27 ,$40.40 ,$39.78 ,$41.81 ,$13.94 ,$48.35 , N/A ,$29.99 ,$29.99 ,$16.19 ,$29.99 , N/A ,$58.14 ,$50.18 ,$50.18 ,$48.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER (BOTTLE) SOLN 500 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CHLORHEXIDINE 0.12 % SOLN,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FLUORESCEIN 1 MG STRP,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,HYDROGEN PEROXIDE 3 % SOLN 473 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ALBUTEROL (2.5 MG/3ML) 0.083% NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ALBUTEROL (5 MG/ML) 0.5% NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BENZOCAINE 20 % 20 % AERO,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BRIMONIDINE 0.2 % SOLN 10 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SILVER-POTASSIUM NITRATE 75-25 % MISC,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 10 % NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 3 % NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM CHLORIDE 7 % NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,IPRATROPIUM 0.02 % SOLN,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML SOLN,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LEVALBUTEROL 1.25 MG/3ML NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE HCL POWD,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE VISCOUS 2 % SOLN 100 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE VISCOUS 2 % SOLN 15 ML CUP,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,MIDAZOLAM 2 MG/2ML SOLN,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 400-5-5000 OINT 1 EACH BOX,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 400-5-5000 OINT 1 EACH PACKET,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PENTAFLUOROPROP-TETRAFLUOROETH AERO,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,PHENOL 89 % LIQD 1 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,POVIDONE-IODINE 10 % SOLN 237 ML BOTTLE,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,RACEPINEPHRINE 2.25 % 2.25 % NEBU,250,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"STERILE WATER SOLN 1,000 ML BOTTLE",250,1 ,$9.55 ,$6.30 ,$2.18 ,$9.55 , N/A ,$8.56 ,$8.56 ,$2.53 ,$7.64 ,$8.12 ,$5.97 ,$8.60 , N/A , N/A ,$9.07 ,$8.60 ,$8.12 ,$8.12 ,$2.53 ,$8.12 ,$8.12 ,$8.60 ,$5.82 , N/A ,$5.92 , N/A ,$8.60 , N/A ,$8.79 ,$8.60 ,$6.30 ,$6.30 ,$5.82 ,$6.30 ,$6.21 ,$6.52 ,$2.18 ,$7.54 , N/A ,$4.68 ,$4.68 ,$2.53 ,$4.68 , N/A ,$9.07 ,$7.83 ,$7.83 ,$7.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,"STERILE WATER SOLN 1,000 ML FLEX CONT",250,1 ,$67.65 ,$44.65 ,$15.41 ,$67.65 , N/A ,$60.63 ,$60.63 ,$17.90 ,$54.12 ,$57.50 ,$42.28 ,$60.89 , N/A , N/A ,$64.27 ,$60.89 ,$57.50 ,$57.50 ,$17.90 ,$57.50 ,$57.50 ,$60.89 ,$41.20 , N/A ,$41.94 , N/A ,$60.89 , N/A ,$62.24 ,$60.89 ,$44.66 ,$44.66 ,$41.20 ,$44.66 ,$43.97 ,$46.22 ,$15.41 ,$53.44 , N/A ,$33.15 ,$33.15 ,$17.90 ,$33.15 , N/A ,$64.27 ,$55.47 ,$55.47 ,$54.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN,250,1 ,$67.65 ,$44.65 ,$15.41 ,$67.65 , N/A ,$60.63 ,$60.63 ,$17.90 ,$54.12 ,$57.50 ,$42.28 ,$60.89 , N/A , N/A ,$64.27 ,$60.89 ,$57.50 ,$57.50 ,$17.90 ,$57.50 ,$57.50 ,$60.89 ,$41.20 , N/A ,$41.94 , N/A ,$60.89 , N/A ,$62.24 ,$60.89 ,$44.66 ,$44.66 ,$41.20 ,$44.66 ,$43.97 ,$46.22 ,$15.41 ,$53.44 , N/A ,$33.15 ,$33.15 ,$17.90 ,$33.15 , N/A ,$64.27 ,$55.47 ,$55.47 ,$54.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SUGAMMADEX 200 MG/2ML SOLN,250,1 ,$851.80 ,$562.19 ,$193.91 ,$851.80 , N/A ,$763.38 ,$763.38 ,$225.39 ,$681.44 ,$724.03 ,$532.38 ,$766.62 , N/A , N/A ,$809.21 ,$766.62 ,$724.03 ,$724.03 ,$225.39 ,$724.03 ,$724.03 ,$766.62 ,$518.75 , N/A ,$528.12 , N/A ,$766.62 , N/A ,$783.66 ,$766.62 ,$562.27 ,$562.27 ,$518.75 ,$562.27 ,$553.67 ,$581.95 ,$193.91 ,$672.92 , N/A ,$417.38 ,$417.38 ,$225.39 ,$417.38 , N/A ,$809.21 ,$698.48 ,$698.48 ,$681.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SUGAMMADEX 500 MG/5ML SOLN,250,1 ,"$1,560.15 ","$1,029.70 ",$355.17 ,"$1,560.15 ", N/A ,"$1,398.21 ","$1,398.21 ",$412.82 ,"$1,248.12 ","$1,326.13 ",$975.09 ,"$1,404.14 ", N/A , N/A ,"$1,482.14 ","$1,404.14 ","$1,326.13 ","$1,326.13 ",$412.82 ,"$1,326.13 ","$1,326.13 ","$1,404.14 ",$950.13 , N/A ,$967.30 , N/A ,"$1,404.14 ", N/A ,"$1,435.34 ","$1,404.14 ","$1,029.86 ","$1,029.86 ",$950.13 ,"$1,029.86 ","$1,014.10 ","$1,065.89 ",$355.17 ,"$1,232.52 ", N/A ,$764.47 ,$764.47 ,$412.82 ,$764.47 , N/A ,"$1,482.14 ","$1,279.32 ","$1,279.32 ","$1,248.12 "
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SULFACETAMIDE-PREDNISOLONE 10-0.23 % SOLN 5 ML BOTTLE,250,1 ,$63.75 ,$42.08 ,$14.51 ,$63.75 , N/A ,$57.13 ,$57.13 ,$16.87 ,$51.00 ,$54.19 ,$39.84 ,$57.38 , N/A , N/A ,$60.56 ,$57.38 ,$54.19 ,$54.19 ,$16.87 ,$54.19 ,$54.19 ,$57.38 ,$38.82 , N/A ,$39.52 , N/A ,$57.38 , N/A ,$58.65 ,$57.38 ,$42.08 ,$42.08 ,$38.82 ,$42.08 ,$41.44 ,$43.55 ,$14.51 ,$50.36 , N/A ,$31.24 ,$31.24 ,$16.87 ,$31.24 , N/A ,$60.56 ,$52.28 ,$52.28 ,$51.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML SOLN 10 ML VIAL,250,1 ,$80.53 ,$53.15 ,$18.34 ,$80.53 , N/A ,$72.17 ,$72.17 ,$21.31 ,$64.42 ,$68.45 ,$50.33 ,$72.48 , N/A , N/A ,$76.50 ,$72.48 ,$68.45 ,$68.45 ,$21.31 ,$68.45 ,$68.45 ,$72.48 ,$49.04 , N/A ,$49.92 , N/A ,$72.48 , N/A ,$74.09 ,$72.48 ,$53.16 ,$53.16 ,$49.04 ,$53.16 ,$52.34 ,$55.02 ,$18.34 ,$63.62 , N/A ,$39.46 ,$39.46 ,$21.31 ,$39.46 , N/A ,$76.50 ,$66.03 ,$66.03 ,$64.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TETRACAINE 0.5 % SOLN 15 ML BOTTLE,250,1 ,$367.20 ,$242.35 ,$83.59 ,$367.20 , N/A ,$329.08 ,$329.08 ,$97.16 ,$293.76 ,$312.12 ,$229.50 ,$330.48 , N/A , N/A ,$348.84 ,$330.48 ,$312.12 ,$312.12 ,$97.16 ,$312.12 ,$312.12 ,$330.48 ,$223.62 , N/A ,$227.66 , N/A ,$330.48 , N/A ,$337.82 ,$330.48 ,$242.39 ,$242.39 ,$223.62 ,$242.39 ,$238.68 ,$250.87 ,$83.59 ,$290.09 , N/A ,$179.93 ,$179.93 ,$97.16 ,$179.93 , N/A ,$348.84 ,$301.10 ,$301.10 ,$293.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TETRACAINE 0.5 % SOLN 4 ML PLAS CONT,250,1 ,$47.55 ,$31.38 ,$10.83 ,$47.55 , N/A ,$42.61 ,$42.61 ,$12.58 ,$38.04 ,$40.42 ,$29.72 ,$42.80 , N/A , N/A ,$45.17 ,$42.80 ,$40.42 ,$40.42 ,$12.58 ,$40.42 ,$40.42 ,$42.80 ,$28.96 , N/A ,$29.48 , N/A ,$42.80 , N/A ,$43.75 ,$42.80 ,$31.39 ,$31.39 ,$28.96 ,$31.39 ,$30.91 ,$32.49 ,$10.83 ,$37.56 , N/A ,$23.30 ,$23.30 ,$12.58 ,$23.30 , N/A ,$45.17 ,$38.99 ,$38.99 ,$38.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TETRACAINE 0.5 % SOLN 5 ML BOTTLE,250,1 ,$122.40 ,$80.78 ,$27.86 ,$122.40 , N/A ,$109.69 ,$109.69 ,$32.39 ,$97.92 ,$104.04 ,$76.50 ,$110.16 , N/A , N/A ,$116.28 ,$110.16 ,$104.04 ,$104.04 ,$32.39 ,$104.04 ,$104.04 ,$110.16 ,$74.54 , N/A ,$75.88 , N/A ,$110.16 , N/A ,$112.61 ,$110.16 ,$80.80 ,$80.80 ,$74.54 ,$80.80 ,$79.56 ,$83.62 ,$27.86 ,$96.70 , N/A ,$59.98 ,$59.98 ,$32.39 ,$59.98 , N/A ,$116.28 ,$100.37 ,$100.37 ,$97.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,THROMBIN 20000 UNIT SOLR 1 EACH VIAL,250,1 ,"$1,348.35 ",$889.91 ,$306.96 ,"$1,348.35 ", N/A ,"$1,208.39 ","$1,208.39 ",$356.77 ,"$1,078.68 ","$1,146.10 ",$842.72 ,"$1,213.52 ", N/A , N/A ,"$1,280.93 ","$1,213.52 ","$1,146.10 ","$1,146.10 ",$356.77 ,"$1,146.10 ","$1,146.10 ","$1,213.52 ",$821.15 , N/A ,$835.98 , N/A ,"$1,213.52 ", N/A ,"$1,240.48 ","$1,213.52 ",$890.05 ,$890.05 ,$821.15 ,$890.05 ,$876.43 ,$921.19 ,$306.96 ,"$1,065.20 ", N/A ,$660.69 ,$660.69 ,$356.77 ,$660.69 , N/A ,"$1,280.93 ","$1,105.65 ","$1,105.65 ","$1,078.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,THROMBIN 20000 UNIT SOLR,250,1 ,"$1,348.35 ",$889.91 ,$306.96 ,"$1,348.35 ", N/A ,"$1,208.39 ","$1,208.39 ",$356.77 ,"$1,078.68 ","$1,146.10 ",$842.72 ,"$1,213.52 ", N/A , N/A ,"$1,280.93 ","$1,213.52 ","$1,146.10 ","$1,146.10 ",$356.77 ,"$1,146.10 ","$1,146.10 ","$1,213.52 ",$821.15 , N/A ,$835.98 , N/A ,"$1,213.52 ", N/A ,"$1,240.48 ","$1,213.52 ",$890.05 ,$890.05 ,$821.15 ,$890.05 ,$876.43 ,$921.19 ,$306.96 ,"$1,065.20 ", N/A ,$660.69 ,$660.69 ,$356.77 ,$660.69 , N/A ,"$1,280.93 ","$1,105.65 ","$1,105.65 ","$1,078.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TOBRAMYCIN 300 MG/5ML NEBU,250,1 ,$534.65 ,$352.87 ,$121.72 ,$534.65 , N/A ,$479.15 ,$479.15 ,$141.47 ,$427.72 ,$454.45 ,$334.16 ,$481.19 , N/A , N/A ,$507.92 ,$481.19 ,$454.45 ,$454.45 ,$141.47 ,$454.45 ,$454.45 ,$481.19 ,$325.60 , N/A ,$331.48 , N/A ,$481.19 , N/A ,$491.88 ,$481.19 ,$352.92 ,$352.92 ,$325.60 ,$352.92 ,$347.52 ,$365.27 ,$121.72 ,$422.37 , N/A ,$261.98 ,$261.98 ,$141.47 ,$261.98 , N/A ,$507.92 ,$438.41 ,$438.41 ,$427.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OINT,250,1 ,$977.65 ,$645.25 ,$222.57 ,$977.65 , N/A ,$876.17 ,$876.17 ,$258.69 ,$782.12 ,$831.00 ,$611.03 ,$879.89 , N/A , N/A ,$928.77 ,$879.89 ,$831.00 ,$831.00 ,$258.69 ,$831.00 ,$831.00 ,$879.89 ,$595.39 , N/A ,$606.14 , N/A ,$879.89 , N/A ,$899.44 ,$879.89 ,$645.35 ,$645.35 ,$595.39 ,$645.35 ,$635.47 ,$667.93 ,$222.57 ,$772.34 , N/A ,$479.05 ,$479.05 ,$258.69 ,$479.05 , N/A ,$928.77 ,$801.67 ,$801.67 ,$782.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TRACE ELEMENTS (TRALEMENT) CU-MN-SE-ZN 300-55-60-3000 MCG/ML SOLN 1 ML VIAL,250,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TPN CUSTOM (ADULT),250,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TPN-CLINIMIX 4.25/5 (STANDARD ELECTROLYTES),250,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TPN-CLINIMIX 5/20 (CUSTOM ELECTROLYTES),250,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TPN-CLINIMIX 5/20 (STANDARD ELECTROLYTES),250,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TPN-CLINIMIX E 4.25/5 (STANDARD ELECTROLYTES),250,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TRANEXAMIC ACID 1000 MG/10ML SOLN,250,1 ,$153.45 ,$101.28 ,$34.93 ,$153.45 , N/A ,$137.52 ,$137.52 ,$40.60 ,$122.76 ,$130.43 ,$95.91 ,$138.11 , N/A , N/A ,$145.78 ,$138.11 ,$130.43 ,$130.43 ,$40.60 ,$130.43 ,$130.43 ,$138.11 ,$93.45 , N/A ,$95.14 , N/A ,$138.11 , N/A ,$141.17 ,$138.11 ,$101.29 ,$101.29 ,$93.45 ,$101.29 ,$99.74 ,$104.84 ,$34.93 ,$121.23 , N/A ,$75.19 ,$75.19 ,$40.60 ,$75.19 , N/A ,$145.78 ,$125.83 ,$125.83 ,$122.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TRANEXAMIC ACID 1000 MG/10ML SOLN 10 ML VIAL,250,1 ,$369.00 ,$243.54 ,$84.01 ,$369.00 , N/A ,$330.70 ,$330.70 ,$97.64 ,$295.20 ,$313.65 ,$230.63 ,$332.10 , N/A , N/A ,$350.55 ,$332.10 ,$313.65 ,$313.65 ,$97.64 ,$313.65 ,$313.65 ,$332.10 ,$224.72 , N/A ,$228.78 , N/A ,$332.10 , N/A ,$339.48 ,$332.10 ,$243.58 ,$243.58 ,$224.72 ,$243.58 ,$239.85 ,$252.10 ,$84.01 ,$291.51 , N/A ,$180.81 ,$180.81 ,$97.64 ,$180.81 , N/A ,$350.55 ,$302.58 ,$302.58 ,$295.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TROPICAMIDE 1 % SOLN,250,1 ,$36.25 ,$23.93 ,$8.25 ,$36.25 , N/A ,$32.49 ,$32.49 ,$9.59 ,$29.00 ,$30.81 ,$22.66 ,$32.63 , N/A , N/A ,$34.44 ,$32.63 ,$30.81 ,$30.81 ,$9.59 ,$30.81 ,$30.81 ,$32.63 ,$22.08 , N/A ,$22.48 , N/A ,$32.63 , N/A ,$33.35 ,$32.63 ,$23.93 ,$23.93 ,$22.08 ,$23.93 ,$23.56 ,$24.77 ,$8.25 ,$28.64 , N/A ,$17.76 ,$17.76 ,$9.59 ,$17.76 , N/A ,$34.44 ,$29.73 ,$29.73 ,$29.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TROPICAMIDE 1%-PROPARACAINE 0.5%-PHENYLEPHRINE 2.5%-KETOROLAC 0.5% 1-0.5-2.5-0.5 % SOLN 5 ML BOTTLE,250,1 ,$285.60 ,$188.50 ,$65.02 ,$285.60 , N/A ,$255.95 ,$255.95 ,$75.57 ,$228.48 ,$242.76 ,$178.50 ,$257.04 , N/A , N/A ,$271.32 ,$257.04 ,$242.76 ,$242.76 ,$75.57 ,$242.76 ,$242.76 ,$257.04 ,$173.93 , N/A ,$177.08 , N/A ,$257.04 , N/A ,$262.75 ,$257.04 ,$188.52 ,$188.52 ,$173.93 ,$188.52 ,$185.64 ,$195.12 ,$65.02 ,$225.62 , N/A ,$139.94 ,$139.94 ,$75.57 ,$139.94 , N/A ,$271.32 ,$234.19 ,$234.19 ,$228.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TRYPAN BLUE 0.06 % SOLN 0.5 ML SYRINGE,250,1 ,$284.55 ,$187.80 ,$64.78 ,$284.55 , N/A ,$255.01 ,$255.01 ,$75.29 ,$227.64 ,$241.87 ,$177.84 ,$256.10 , N/A , N/A ,$270.32 ,$256.10 ,$241.87 ,$241.87 ,$75.29 ,$241.87 ,$241.87 ,$256.10 ,$173.29 , N/A ,$176.42 , N/A ,$256.10 , N/A ,$261.79 ,$256.10 ,$187.83 ,$187.83 ,$173.29 ,$187.83 ,$184.96 ,$194.40 ,$64.78 ,$224.79 , N/A ,$139.43 ,$139.43 ,$75.29 ,$139.43 , N/A ,$270.32 ,$233.33 ,$233.33 ,$227.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,TUBERCULIN 5 UNIT/0.1ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE 0.5 % 0.5 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE 0.75% IN DEXTROSE 8.25% (INTRATHECAL) 0.75-8.25 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,CLINDAMYCIN 600 MG/4ML SOLN 4 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DILTIAZEM 125 MG/25ML SOLN 25 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DILTIAZEM 25 MG/5ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,DILTIAZEM 50 MG/10ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ENALAPRILAT 1.25 MG/ML INJ,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,ETOMIDATE 2 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FAMOTIDINE 20 MG/2ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FAMOTIDINE 40 MG/4ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FAT EMULSION 20 % EMUL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FOLIC ACID 5 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,FOLIC ACID 5 MG/ML SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUMETANIDE 25 MG/100 ML 25 MG/100 ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE (PF) 0.25 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE (PF) 0.5 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE (PF) 0.5 % SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE (PF) 0.5 % SOLN 30 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE 0.25 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,BUPIVACAINE 0.25 % SOLN 30 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,SODIUM PHOSPHATE 45 MMOLE/15ML SOLN 15 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN 100 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN 250 ML FLEX CONT,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN 50 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,STERILE WATER SOLN 500 ML FLEX CONT,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETAMINE 10 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETAMINE 100 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETAMINE 100 MG/ML SOLN 5 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETAMINE 50 MG/5ML SOSY,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETAMINE 50 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,KETAMINE 50 MG/ML SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LABETALOL 5 MG/ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LABETALOL 5 MG/ML SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LEVOCARNITINE 200 MG/ML SOLN 5 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE (PF) 2 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE (PF) 2 % SOLN 2 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE (PF) 2 % SOLN 5 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 1 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 1 % SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 1 % SOLN 2 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 1 % SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 1 % SOLN 5 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 2 % SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE 4 % 4 % SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:100000 SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:100000 SOLN 10 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 1 %-1:100000 SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 2 %-1:100000 SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LIDOCAINE-EPINEPHRINE 2 %-1:200000 SOLN 20 ML VIAL,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,METOPROLOL TARTRATE 5 MG/5ML SOLN,250,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,VALPROATE 100 MG/ML SOLN 5 ML VIAL,250,1 ,$49.45 ,$32.64 ,$11.25 ,$49.45 , N/A ,$44.32 ,$44.32 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 , N/A , N/A ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 , N/A ,$30.66 , N/A ,$44.51 , N/A ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$11.25 ,$39.07 , N/A ,$24.23 ,$24.23 ,$13.08 ,$24.23 , N/A ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,VANCOMYCIN 50 MG/ML SOLR,250,1 ,$40.40 ,$26.66 ,$9.19 ,$40.40 , N/A ,$36.21 ,$36.21 ,$10.69 ,$32.32 ,$34.34 ,$25.25 ,$36.36 , N/A , N/A ,$38.38 ,$36.36 ,$34.34 ,$34.34 ,$10.69 ,$34.34 ,$34.34 ,$36.36 ,$24.60 , N/A ,$25.04 , N/A ,$36.36 , N/A ,$37.17 ,$36.36 ,$26.67 ,$26.67 ,$24.60 ,$26.67 ,$26.26 ,$27.60 ,$9.19 ,$31.92 , N/A ,$19.80 ,$19.80 ,$10.69 ,$19.80 , N/A ,$38.38 ,$33.13 ,$33.13 ,$32.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,VECURONIUM 10 MG SOLR,250,1 ,$62.75 ,$41.42 ,$14.28 ,$62.75 , N/A ,$56.24 ,$56.24 ,$16.60 ,$50.20 ,$53.34 ,$39.22 ,$56.48 , N/A , N/A ,$59.61 ,$56.48 ,$53.34 ,$53.34 ,$16.60 ,$53.34 ,$53.34 ,$56.48 ,$38.21 , N/A ,$38.90 , N/A ,$56.48 , N/A ,$57.73 ,$56.48 ,$41.42 ,$41.42 ,$38.21 ,$41.42 ,$40.79 ,$42.87 ,$14.28 ,$49.57 , N/A ,$30.75 ,$30.75 ,$16.60 ,$30.75 , N/A ,$59.61 ,$51.46 ,$51.46 ,$50.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,VERAPAMIL 2.5 MG/ML SOLN,250,1 ,$216.85 ,$143.12 ,$49.37 ,$216.85 , N/A ,$194.34 ,$194.34 ,$57.38 ,$173.48 ,$184.32 ,$135.53 ,$195.17 , N/A , N/A ,$206.01 ,$195.17 ,$184.32 ,$184.32 ,$57.38 ,$184.32 ,$184.32 ,$195.17 ,$132.06 , N/A ,$134.44 , N/A ,$195.17 , N/A ,$199.50 ,$195.17 ,$143.14 ,$143.14 ,$132.06 ,$143.14 ,$140.95 ,$148.15 ,$49.37 ,$171.31 , N/A ,$106.26 ,$106.26 ,$57.38 ,$106.26 , N/A ,$206.01 ,$177.82 ,$177.82 ,$173.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,WOUND DRESSING GEL 85 G TUBE,250,1 ,$22.80 ,$15.05 ,$5.18 ,$22.80 , N/A ,$20.43 ,$20.43 ,$6.04 ,$18.24 ,$19.38 ,$14.25 ,$20.52 , N/A , N/A ,$21.66 ,$20.52 ,$19.38 ,$19.38 ,$6.04 ,$19.38 ,$19.38 ,$20.52 ,$13.89 , N/A ,$14.14 , N/A ,$20.52 , N/A ,$20.98 ,$20.52 ,$15.05 ,$15.05 ,$13.89 ,$15.05 ,$14.82 ,$15.58 ,$5.18 ,$18.01 , N/A ,$11.17 ,$11.17 ,$6.04 ,$11.17 , N/A ,$21.66 ,$18.70 ,$18.70 ,$18.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000003,N/A,LEVALBUTEROL 1.25 MG/0.5ML NEBU,250,1 ,$22.80 ,$15.05 ,$5.18 ,$22.80 , N/A ,$20.43 ,$20.43 ,$6.04 ,$18.24 ,$19.38 ,$14.25 ,$20.52 , N/A , N/A ,$21.66 ,$20.52 ,$19.38 ,$19.38 ,$6.04 ,$19.38 ,$19.38 ,$20.52 ,$13.89 , N/A ,$14.14 , N/A ,$20.52 , N/A ,$20.98 ,$20.52 ,$15.05 ,$15.05 ,$13.89 ,$15.05 ,$14.82 ,$15.58 ,$5.18 ,$18.01 , N/A ,$11.17 ,$11.17 ,$6.04 ,$11.17 , N/A ,$21.66 ,$18.70 ,$18.70 ,$18.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),25000275,N/A,HC VISCOAT 0.5ML,250,1 ,$72.00 ,$47.52 ,$16.40 ,$72.00 , N/A ,$64.53 ,$64.53 ,$19.05 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$19.05 ,$61.20 ,$61.20 ,$64.80 ,$43.85 , N/A ,$44.64 , N/A ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.53 ,$47.53 ,$43.85 ,$47.53 ,$46.80 ,$49.19 ,$16.40 ,$56.88 , N/A ,$35.28 ,$35.28 ,$19.05 ,$35.28 , N/A ,$68.40 ,$59.04 ,$59.04 ,$57.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),25800000,N/A,"CLINIMIX E/DEXTROSE (4.25/5) 4.25 % SOLN 1,000 ML PLAS CONT",258,1 ,$295.20 ,$194.83 ,$67.21 ,$295.20 , N/A ,$264.56 ,$264.56 ,$78.11 ,$236.16 ,$250.92 ,$184.50 ,$265.68 , N/A , N/A ,$280.44 ,$265.68 ,$250.92 ,$250.92 ,$78.11 ,$250.92 ,$250.92 ,$265.68 ,$179.78 , N/A ,$183.02 , N/A ,$265.68 , N/A ,$271.58 ,$265.68 ,$194.86 ,$194.86 ,$179.78 ,$194.86 ,$191.88 ,$201.68 ,$67.21 ,$233.21 , N/A ,$144.65 ,$144.65 ,$78.11 ,$144.65 , N/A ,$280.44 ,$242.06 ,$242.06 ,$236.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),25800000,N/A,CLINIMIX/DEXTROSE (5/20) 5 % SOLN,258,1 ,$332.10 ,$219.19 ,$75.60 ,$332.10 , N/A ,$297.63 ,$297.63 ,$87.88 ,$265.68 ,$282.29 ,$207.56 ,$298.89 , N/A , N/A ,$315.50 ,$298.89 ,$282.29 ,$282.29 ,$87.88 ,$282.29 ,$282.29 ,$298.89 ,$202.25 , N/A ,$205.90 , N/A ,$298.89 , N/A ,$305.53 ,$298.89 ,$219.22 ,$219.22 ,$202.25 ,$219.22 ,$215.87 ,$226.89 ,$75.60 ,$262.36 , N/A ,$162.73 ,$162.73 ,$87.88 ,$162.73 , N/A ,$315.50 ,$272.32 ,$272.32 ,$265.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),25800000,N/A,DEXTROSE 10 % SOLN,258,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),25800000,N/A,DEXTROSE 50 % SOLN,258,1 ,$97.80 ,$64.55 ,$22.26 ,$97.80 , N/A ,$87.65 ,$87.65 ,$25.88 ,$78.24 ,$83.13 ,$61.13 ,$88.02 , N/A , N/A ,$92.91 ,$88.02 ,$83.13 ,$83.13 ,$25.88 ,$83.13 ,$83.13 ,$88.02 ,$59.56 , N/A ,$60.64 , N/A ,$88.02 , N/A ,$89.98 ,$88.02 ,$64.56 ,$64.56 ,$59.56 ,$64.56 ,$63.57 ,$66.82 ,$22.26 ,$77.26 , N/A ,$47.92 ,$47.92 ,$25.88 ,$47.92 , N/A ,$92.91 ,$80.20 ,$80.20 ,$78.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),25800000,N/A,TPN-CLINIMIX E 5/15 (STANDARD ELECTROLYTES),258,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),25800000,N/A,TPN-CLINIMIX 5/15 (STANDARD ELECTROLYTES),258,1 ,$996.15 ,$657.46 ,$226.77 ,$996.15 , N/A ,$892.75 ,$892.75 ,$263.58 ,$796.92 ,$846.73 ,$622.59 ,$896.54 , N/A , N/A ,$946.34 ,$896.54 ,$846.73 ,$846.73 ,$263.58 ,$846.73 ,$846.73 ,$896.54 ,$606.66 , N/A ,$617.62 , N/A ,$896.54 , N/A ,$916.46 ,$896.54 ,$657.56 ,$657.56 ,$606.66 ,$657.56 ,$647.50 ,$680.57 ,$226.77 ,$786.96 , N/A ,$488.11 ,$488.11 ,$263.58 ,$488.11 , N/A ,$946.34 ,$816.84 ,$816.84 ,$796.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$515.20 ,$340.03 ,$117.30 ,$583.18 ,$550.17 ,$461.72 ,$461.72 ,$136.32 ,$412.16 ,$437.92 , N/A ,$463.68 ,$550.17 ,$515.20 ,$489.44 ,$463.68 ,$437.92 ,$437.92 ,$136.32 ,$437.92 ,$437.92 ,$463.68 ,$313.76 ,$550.17 ,$319.42 ,$546.11 ,$463.68 ,$464.78 ,$473.98 ,$463.68 ,$340.08 ,$340.08 ,$313.76 ,$340.08 ,$334.88 ,$351.98 ,$117.30 ,$407.01 ,$583.18 ,$434.00 ,$434.00 ,$136.32 ,$481.00 ,$206.57 ,$489.44 ,$422.46 ,$422.46 ,$412.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$205.85 ,$135.86 ,$42.37 ,"$1,019.60 ",$961.89 ,$184.48 ,$184.48 ,$54.47 ,$164.68 ,$174.97 , N/A ,$185.27 ,$961.89 ,$205.85 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$961.89 ,$127.62 ,$218.20 ,$185.27 ,$95.33 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,"$1,019.60 ",$205.85 ,$205.85 ,$54.47 ,$205.85 ,$42.37 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$618.70 ,$408.34 ,$140.85 ,$618.70 ,$550.17 ,$554.48 ,$554.48 ,$163.71 ,$494.96 ,$525.90 , N/A ,$556.83 ,$550.17 ,$550.17 ,$587.77 ,$556.83 ,$525.90 ,$525.90 ,$163.71 ,$525.90 ,$525.90 ,$556.83 ,$376.79 ,$550.17 ,$383.60 ,$583.18 ,$556.83 ,$464.78 ,$569.20 ,$556.83 ,$408.40 ,$408.40 ,$376.79 ,$408.40 ,$402.16 ,$422.70 ,$140.85 ,$488.77 ,$583.18 ,$434.00 ,$434.00 ,$163.71 ,$481.00 ,$206.57 ,$587.77 ,$507.33 ,$507.33 ,$494.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$205.85 ,$135.86 ,$42.37 ,"$1,019.60 ",$961.89 ,$184.48 ,$184.48 ,$54.47 ,$164.68 ,$174.97 , N/A ,$185.27 ,$961.89 ,$205.85 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$961.89 ,$127.62 ,$218.20 ,$185.27 ,$95.33 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,"$1,019.60 ",$205.85 ,$205.85 ,$54.47 ,$205.85 ,$42.37 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$193.20 ,$127.51 ,$43.98 ,$583.18 ,$550.17 ,$173.15 ,$173.15 ,$51.12 ,$154.56 ,$164.22 , N/A ,$173.88 ,$550.17 ,$193.20 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$550.17 ,$119.78 ,$204.79 ,$173.88 ,$151.81 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$583.18 ,$193.20 ,$193.20 ,$51.12 ,$193.20 ,$67.47 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000005,96368,HC INFUS CONCURRENT,260,1 ,$296.70 ,$195.82 ,$67.54 ,$583.18 ,$550.17 ,$265.90 ,$265.90 ,$78.51 ,$237.36 ,$252.20 , N/A ,$267.03 ,$550.17 ,$296.70 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,$550.17 ,$183.96 ,$314.50 ,$267.03 , N/A ,$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,$583.18 ,$296.70 ,$296.70 ,$78.51 ,$296.70 , N/A ,$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000014,M0239,"HC INTRAVENOUS INFUSION, BAMLANIVIMAB",260,1 ,$697.00 ,$460.02 ,$158.67 ,$697.00 ,$309.60 ,$624.65 ,$624.65 ,$184.43 ,$557.60 ,$592.45 ,$435.63 ,$627.30 ,$309.60 ,$309.60 ,$662.15 ,$627.30 ,$592.45 ,$592.45 ,$184.43 ,$592.45 ,$592.45 ,$627.30 ,$424.47 ,$309.60 ,$432.14 ,$328.18 ,$627.30 , N/A ,$641.24 ,$627.30 ,$460.09 ,$460.09 ,$424.47 ,$460.09 ,$453.05 ,$476.19 ,$158.67 ,$550.63 ,$328.18 ,$434.00 ,$434.00 ,$184.43 ,$481.00 , 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 ,$615.12 ,$212.17 ,"$1,013.63 ",$450.00 ,$835.26 ,$835.26 ,$246.61 ,$745.60 ,$792.20 ,$582.50 ,$838.80 ,$450.00 ,$450.00 ,$885.40 ,$838.80 ,$792.20 ,$792.20 ,$246.61 ,$792.20 ,$792.20 ,$838.80 ,$567.59 ,$450.00 ,$577.84 ,$477.00 ,$838.80 ,"$1,013.63 ",$857.44 ,$838.80 ,$615.21 ,$615.21 ,$567.59 ,$615.21 ,$605.80 ,$636.74 ,$212.17 ,$736.28 ,$477.00 ,$434.00 ,$434.00 ,$246.61 ,$481.00 ,$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 ,$924.60 ,$610.24 ,$210.49 ,"$1,013.63 ",$450.00 ,$828.63 ,$828.63 ,$244.65 ,$739.68 ,$785.91 ,$577.88 ,$832.14 ,$450.00 ,$450.00 ,$878.37 ,$832.14 ,$785.91 ,$785.91 ,$244.65 ,$785.91 ,$785.91 ,$832.14 ,$563.08 ,$450.00 ,$573.26 ,$477.00 ,$832.14 ,"$1,013.63 ",$850.63 ,$832.14 ,$610.33 ,$610.33 ,$563.08 ,$610.33 ,$600.99 ,$631.69 ,$210.49 ,$730.43 ,$477.00 ,$434.00 ,$434.00 ,$244.65 ,$481.00 ,$450.50 ,$878.37 ,$758.17 ,$758.17 ,$739.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),26000017,M0247,"HC INTRAVENOUS INFUSION, SOTROVIMAB ADMINISTRATION",260,1 ,"$1,338.60 ",$883.48 ,$304.74 ,"$1,338.60 ",$450.00 ,"$1,199.65 ","$1,199.65 ",$354.19 ,"$1,070.88 ","$1,137.81 ",$836.63 ,"$1,204.74 ",$450.00 ,$450.00 ,"$1,271.67 ","$1,204.74 ","$1,137.81 ","$1,137.81 ",$354.19 ,"$1,137.81 ","$1,137.81 ","$1,204.74 ",$815.21 ,$450.00 ,$829.94 ,$477.00 ,"$1,204.74 ","$1,013.63 ","$1,231.51 ","$1,204.74 ",$883.61 ,$883.61 ,$815.21 ,$883.61 ,$870.09 ,$914.53 ,$304.74 ,"$1,057.49 ",$477.00 ,$434.00 ,$434.00 ,$354.19 ,$481.00 ,$450.50 ,"$1,271.67 ","$1,097.65 ","$1,097.65 ","$1,070.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27000126,N/A,HC DISPOSABLE LINER,270,1 ,$42.00 ,$27.72 ,$9.56 ,$42.00 , N/A ,$37.64 ,$37.64 ,$11.11 ,$33.60 ,$35.70 ,$26.25 ,$37.80 , N/A , N/A ,$39.90 ,$37.80 ,$35.70 ,$35.70 ,$11.11 ,$35.70 ,$35.70 ,$37.80 ,$25.58 , N/A ,$26.04 , N/A ,$37.80 , N/A ,$38.64 ,$37.80 ,$27.72 ,$27.72 ,$25.58 ,$27.72 ,$27.30 ,$28.69 ,$9.56 ,$33.18 , N/A ,$20.58 ,$20.58 ,$11.11 ,$20.58 , N/A ,$39.90 ,$34.44 ,$34.44 ,$33.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100032,N/A,HC CEMENT MIXER,272,1 ,$182.00 ,$120.12 ,$41.43 ,$182.00 , N/A ,$163.11 ,$163.11 ,$48.16 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$48.16 ,$154.70 ,$154.70 ,$163.80 ,$110.84 , N/A ,$112.84 , N/A ,$163.80 , N/A ,$167.44 ,$163.80 ,$120.14 ,$120.14 ,$110.84 ,$120.14 ,$118.30 ,$124.34 ,$41.43 ,$143.78 , N/A ,$89.18 ,$89.18 ,$48.16 ,$89.18 , 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 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , N/A ,$5.89 ,$5.08 ,$5.08 ,$4.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100107,N/A,HC OXYGEN HOURLY,271,1 ,$22.62 ,$14.93 ,$5.14 ,$22.62 , N/A ,$20.27 ,$20.27 ,$5.99 ,$18.10 ,$19.23 ,$14.14 ,$20.36 , N/A , N/A ,$21.49 ,$20.36 ,$19.23 ,$19.23 ,$5.99 ,$19.23 ,$19.23 ,$20.36 ,$13.78 , N/A ,$14.02 , N/A ,$20.36 , N/A ,$20.81 ,$20.36 ,$14.93 ,$14.93 ,$13.78 ,$14.93 ,$14.70 ,$15.45 ,$5.14 ,$17.87 , N/A ,$11.08 ,$11.08 ,$5.99 ,$11.08 , N/A ,$21.49 ,$18.55 ,$18.55 ,$18.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100111,N/A,HC PAD WEBRIL 2IN,271,1 ,$4.10 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100118,N/A,HC POST OP SHOE,271,1 ,$17.56 ,$11.59 ,$4.00 ,$17.56 , N/A ,$15.74 ,$15.74 ,$4.65 ,$14.05 ,$14.93 ,$10.98 ,$15.80 , N/A , N/A ,$16.68 ,$15.80 ,$14.93 ,$14.93 ,$4.65 ,$14.93 ,$14.93 ,$15.80 ,$10.69 , N/A ,$10.88 , N/A ,$15.80 , N/A ,$16.16 ,$15.80 ,$11.59 ,$11.59 ,$10.69 ,$11.59 ,$11.41 ,$12.00 ,$4.00 ,$13.87 , N/A ,$8.60 ,$8.60 ,$4.65 ,$8.60 , N/A ,$16.68 ,$14.40 ,$14.40 ,$14.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100148,L3908,HC SPLINT THUMB SPICA FIT AND ADJUST,274,1 ,$129.89 ,$85.73 ,$29.57 ,$196.19 , N/A ,$76.52 ,$76.52 ,$34.37 ,$103.91 ,$110.41 ,$81.18 ,$116.90 , N/A , N/A ,$123.40 ,$116.90 ,$110.41 ,$110.41 ,$34.37 ,$110.41 ,$110.41 ,$116.90 ,$79.10 , N/A ,$80.54 , N/A ,$116.90 ,$196.19 ,$119.50 ,$116.90 ,$85.74 ,$85.74 ,$79.10 ,$85.74 ,$84.43 ,$88.74 ,$29.57 ,$102.61 , N/A , N/A , N/A ,$34.37 , N/A ,$87.19 ,$123.40 ,$106.51 ,$106.51 ,$103.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100150,N/A,HC WRIST/FOREARM SPLINT,271,1 ,$76.00 ,$50.16 ,$17.30 ,$76.00 , N/A ,$68.11 ,$68.11 ,$20.11 ,$60.80 ,$64.60 ,$47.50 ,$68.40 , N/A , N/A ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$20.11 ,$64.60 ,$64.60 ,$68.40 ,$46.28 , N/A ,$47.12 , N/A ,$68.40 , N/A ,$69.92 ,$68.40 ,$50.17 ,$50.17 ,$46.28 ,$50.17 ,$49.40 ,$51.92 ,$17.30 ,$60.04 , N/A ,$37.24 ,$37.24 ,$20.11 ,$37.24 , 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 ,$62.09 ,$40.98 ,$14.13 ,$62.09 , N/A ,$55.65 ,$55.65 ,$16.42 ,$49.67 ,$52.78 ,$38.81 ,$55.88 , N/A , N/A ,$58.99 ,$55.88 ,$52.78 ,$52.78 ,$16.42 ,$52.78 ,$52.78 ,$55.88 ,$37.81 , N/A ,$38.50 , N/A ,$55.88 , N/A ,$57.12 ,$55.88 ,$40.99 ,$40.99 ,$37.81 ,$40.99 ,$40.36 ,$42.42 ,$14.13 ,$49.05 , N/A ,$30.42 ,$30.42 ,$16.42 ,$30.42 , N/A ,$58.99 ,$50.91 ,$50.91 ,$49.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100157,N/A,"HC TOURNIQUET  AND  TUBING 24 """,271,1 ,$69.50 ,$45.87 ,$15.83 ,$69.50 , N/A ,$62.29 ,$62.29 ,$18.39 ,$55.60 ,$59.08 ,$43.44 ,$62.55 , N/A , N/A ,$66.03 ,$62.55 ,$59.08 ,$59.08 ,$18.39 ,$59.08 ,$59.08 ,$62.55 ,$42.33 , N/A ,$43.10 , N/A ,$62.55 , N/A ,$63.94 ,$62.55 ,$45.88 ,$45.88 ,$42.33 ,$45.88 ,$45.18 ,$47.48 ,$15.83 ,$54.91 , N/A ,$34.06 ,$34.06 ,$18.39 ,$34.06 , N/A ,$66.03 ,$56.99 ,$56.99 ,$55.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100158,N/A,HC TOURNIQUET\TUBING 34-44,271,1 ,$80.93 ,$53.41 ,$18.42 ,$80.93 , N/A ,$72.53 ,$72.53 ,$21.41 ,$64.74 ,$68.79 ,$50.58 ,$72.84 , N/A , N/A ,$76.88 ,$72.84 ,$68.79 ,$68.79 ,$21.41 ,$68.79 ,$68.79 ,$72.84 ,$49.29 , N/A ,$50.18 , N/A ,$72.84 , N/A ,$74.46 ,$72.84 ,$53.42 ,$53.42 ,$49.29 ,$53.42 ,$52.60 ,$55.29 ,$18.42 ,$63.93 , N/A ,$39.66 ,$39.66 ,$21.41 ,$39.66 , N/A ,$76.88 ,$66.36 ,$66.36 ,$64.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27100174,N/A,HC RIB BELT UNIVERSAL,271,1 ,$12.40 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$3.43 ,$1.19 ,$5.20 , N/A ,$4.66 ,$4.66 ,$1.37 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.37 ,$4.42 ,$4.42 ,$4.68 ,$3.17 , N/A ,$3.22 , N/A ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.43 ,$3.43 ,$3.17 ,$3.43 ,$3.38 ,$3.55 ,$1.19 ,$4.11 , N/A ,$2.55 ,$2.55 ,$1.37 ,$2.55 , 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 ,$41.58 ,$14.34 ,$63.00 , N/A ,$56.46 ,$56.46 ,$16.67 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$16.67 ,$53.55 ,$53.55 ,$56.70 ,$38.37 , N/A ,$39.06 , N/A ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.59 ,$41.59 ,$38.37 ,$41.59 ,$40.95 ,$43.04 ,$14.34 ,$49.77 , N/A ,$30.87 ,$30.87 ,$16.67 ,$30.87 , 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 ,$67.56 ,$44.59 ,$15.39 ,$67.56 , N/A ,$60.55 ,$60.55 ,$17.88 ,$54.05 ,$57.43 ,$42.23 ,$60.80 , N/A , N/A ,$64.18 ,$60.80 ,$57.43 ,$57.43 ,$17.88 ,$57.43 ,$57.43 ,$60.80 ,$41.14 , N/A ,$41.88 , N/A ,$60.80 , N/A ,$62.16 ,$60.80 ,$44.60 ,$44.60 ,$41.14 ,$44.60 ,$43.91 ,$46.16 ,$15.39 ,$53.37 , N/A ,$33.10 ,$33.10 ,$17.88 ,$33.10 , N/A ,$64.18 ,$55.40 ,$55.40 ,$54.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),27180000,N/A,HC CASTING,271,1 ,$40.74 ,$26.89 ,$9.27 ,$40.74 , N/A ,$36.51 ,$36.51 ,$10.78 ,$32.59 ,$34.63 ,$25.46 ,$36.67 , N/A , N/A ,$38.70 ,$36.67 ,$34.63 ,$34.63 ,$10.78 ,$34.63 ,$34.63 ,$36.67 ,$24.81 , N/A ,$25.26 , N/A ,$36.67 , N/A ,$37.48 ,$36.67 ,$26.89 ,$26.89 ,$24.81 ,$26.89 ,$26.48 ,$27.83 ,$9.27 ,$32.18 , N/A ,$19.96 ,$19.96 ,$10.78 ,$19.96 , N/A ,$38.70 ,$33.41 ,$33.41 ,$32.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200005,B4087,HC MAGNA PORT G-TUBE SET,272,1 ,$55.00 ,$36.30 ,$14.55 ,$55.00 , N/A ,$34.10 ,$34.10 ,$14.55 ,$44.00 ,$46.75 , N/A ,$49.50 , N/A , N/A ,$52.25 ,$49.50 ,$46.75 ,$46.75 ,$14.55 ,$46.75 ,$46.75 ,$49.50 ,$33.50 , N/A ,$34.10 , N/A ,$49.50 ,$33.00 ,$50.60 ,$49.50 ,$36.31 ,$36.31 ,$33.50 ,$36.31 ,$35.75 ,$37.58 , N/A ,$43.45 , N/A ,$26.95 ,$26.95 ,$14.55 ,$26.95 , 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 ","$1,607.10 ",$554.34 ,"$2,435.00 ", N/A ,"$2,182.25 ","$2,182.25 ",$644.30 ,"$1,948.00 ","$2,069.75 ", N/A ,"$2,191.50 ", N/A , N/A ,"$2,313.25 ","$2,191.50 ","$2,069.75 ","$2,069.75 ",$644.30 ,"$2,069.75 ","$2,069.75 ","$2,191.50 ","$1,482.92 ", N/A ,"$1,509.70 ", N/A ,"$2,191.50 ", N/A ,"$2,240.20 ","$2,191.50 ","$1,607.34 ","$1,607.34 ","$1,482.92 ","$1,607.34 ","$1,582.75 ","$1,663.59 ",$554.34 ,"$1,923.65 ", N/A ,"$1,193.15 ","$1,193.15 ",$644.30 ,"$1,193.15 ", 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 ","$2,505.36 ",$864.17 ,"$3,796.00 ", N/A ,"$3,401.98 ","$3,401.98 ","$1,004.42 ","$3,036.80 ","$3,226.60 ", N/A ,"$3,416.40 ", N/A , N/A ,"$3,606.20 ","$3,416.40 ","$3,226.60 ","$3,226.60 ","$1,004.42 ","$3,226.60 ","$3,226.60 ","$3,416.40 ","$2,311.76 ", N/A ,"$2,353.52 ", N/A ,"$3,416.40 ", N/A ,"$3,492.32 ","$3,416.40 ","$2,505.74 ","$2,505.74 ","$2,311.76 ","$2,505.74 ","$2,467.40 ","$2,593.43 ",$864.17 ,"$2,998.84 ", N/A ,"$1,860.04 ","$1,860.04 ","$1,004.42 ","$1,860.04 ", 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 ",$674.52 ,$232.66 ,"$1,022.00 ", N/A ,$915.92 ,$915.92 ,$270.42 ,$817.60 ,$868.70 , N/A ,$919.80 , N/A , N/A ,$970.90 ,$919.80 ,$868.70 ,$868.70 ,$270.42 ,$868.70 ,$868.70 ,$919.80 ,$622.40 , N/A ,$633.64 , N/A ,$919.80 , N/A ,$940.24 ,$919.80 ,$674.62 ,$674.62 ,$622.40 ,$674.62 ,$664.30 ,$698.23 ,$232.66 ,$807.38 , N/A ,$500.78 ,$500.78 ,$270.42 ,$500.78 , 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 ,$392.04 ,$135.23 ,$594.00 , N/A ,$532.34 ,$532.34 ,$157.17 ,$475.20 ,$504.90 , N/A ,$534.60 , N/A , N/A ,$564.30 ,$534.60 ,$504.90 ,$504.90 ,$157.17 ,$504.90 ,$504.90 ,$534.60 ,$361.75 , N/A ,$368.28 , N/A ,$534.60 , N/A ,$546.48 ,$534.60 ,$392.10 ,$392.10 ,$361.75 ,$392.10 ,$386.10 ,$405.82 ,$135.23 ,$469.26 , N/A ,$291.06 ,$291.06 ,$157.17 ,$291.06 , N/A ,$564.30 ,$487.08 ,$487.08 ,$475.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200034,C1729,HC CATHETER DRAINAGE,272,1 ,$537.00 ,$354.42 ,$122.25 ,$537.00 , N/A ,$481.26 ,$481.26 ,$142.09 ,$429.60 ,$456.45 , N/A ,$483.30 , N/A , N/A ,$510.15 ,$483.30 ,$456.45 ,$456.45 ,$142.09 ,$456.45 ,$456.45 ,$483.30 ,$327.03 , N/A ,$332.94 , N/A ,$483.30 , N/A ,$494.04 ,$483.30 ,$354.47 ,$354.47 ,$327.03 ,$354.47 ,$349.05 ,$366.88 ,$122.25 ,$424.23 , N/A ,$263.13 ,$263.13 ,$142.09 ,$263.13 , 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 ,$34.98 ,$12.06 ,$53.00 , N/A ,$47.50 ,$47.50 ,$14.02 ,$42.40 ,$45.05 , N/A ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A ,$25.97 ,$25.97 ,$14.02 ,$25.97 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200067,C1757,HC CATH EMBOLECTOMY,272,1 ,$350.00 ,$231.00 ,$79.68 ,$350.00 , N/A ,$313.67 ,$313.67 ,$92.61 ,$280.00 ,$297.50 , N/A ,$315.00 , N/A , N/A ,$332.50 ,$315.00 ,$297.50 ,$297.50 ,$92.61 ,$297.50 ,$297.50 ,$315.00 ,$213.15 , N/A ,$217.00 , N/A ,$315.00 , N/A ,$322.00 ,$315.00 ,$231.04 ,$231.04 ,$213.15 ,$231.04 ,$227.50 ,$239.12 ,$79.68 ,$276.50 , N/A ,$171.50 ,$171.50 ,$92.61 ,$171.50 , 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 ",$972.18 ,$335.34 ,"$1,473.00 ", N/A ,"$1,320.10 ","$1,320.10 ",$389.76 ,"$1,178.40 ","$1,252.05 ", N/A ,"$1,325.70 ", N/A , N/A ,"$1,399.35 ","$1,325.70 ","$1,252.05 ","$1,252.05 ",$389.76 ,"$1,252.05 ","$1,252.05 ","$1,325.70 ",$897.06 , N/A ,$913.26 , N/A ,"$1,325.70 ", N/A ,"$1,355.16 ","$1,325.70 ",$972.33 ,$972.33 ,$897.06 ,$972.33 ,$957.45 ,"$1,006.35 ",$335.34 ,"$1,163.67 ", N/A ,$721.77 ,$721.77 ,$389.76 ,$721.77 , 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 ,$182.82 ,$63.06 ,$277.00 , N/A ,$248.25 ,$248.25 ,$73.29 ,$221.60 ,$235.45 , N/A ,$249.30 , N/A , N/A ,$263.15 ,$249.30 ,$235.45 ,$235.45 ,$73.29 ,$235.45 ,$235.45 ,$249.30 ,$168.69 , N/A ,$171.74 , N/A ,$249.30 , N/A ,$254.84 ,$249.30 ,$182.85 ,$182.85 ,$168.69 ,$182.85 ,$180.05 ,$189.25 ,$63.06 ,$218.83 , N/A ,$135.73 ,$135.73 ,$73.29 ,$135.73 , 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 ,$21.78 ,$7.52 ,$33.00 , N/A ,$29.57 ,$29.57 ,$8.73 ,$26.40 ,$28.05 , N/A ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , N/A ,$31.35 ,$27.06 ,$27.06 ,$26.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200098,C1769,SVG HC GUIDEWIRE,272,1 ,$36.00 ,$23.76 ,$8.19 ,$36.00 , N/A ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 , N/A ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A ,$22.32 , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 , N/A ,$17.64 ,$17.64 ,$9.53 ,$17.64 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200100,C1769,HC GUIDEWIRE - STIFF,272,1 ,$178.00 ,$117.48 ,$40.52 ,$178.00 , N/A ,$159.52 ,$159.52 ,$47.10 ,$142.40 ,$151.30 , N/A ,$160.20 , N/A , N/A ,$169.10 ,$160.20 ,$151.30 ,$151.30 ,$47.10 ,$151.30 ,$151.30 ,$160.20 ,$108.40 , N/A ,$110.36 , N/A ,$160.20 , N/A ,$163.76 ,$160.20 ,$117.50 ,$117.50 ,$108.40 ,$117.50 ,$115.70 ,$121.61 ,$40.52 ,$140.62 , N/A ,$87.22 ,$87.22 ,$47.10 ,$87.22 , 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 ,$92.40 ,$31.87 ,$140.00 , N/A ,$125.47 ,$125.47 ,$37.04 ,$112.00 ,$119.00 , N/A ,$126.00 , N/A , N/A ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$37.04 ,$119.00 ,$119.00 ,$126.00 ,$85.26 , N/A ,$86.80 , N/A ,$126.00 , N/A ,$128.80 ,$126.00 ,$92.41 ,$92.41 ,$85.26 ,$92.41 ,$91.00 ,$95.65 ,$31.87 ,$110.60 , N/A ,$68.60 ,$68.60 ,$37.04 ,$68.60 , 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 ,$23.76 ,$8.19 ,$36.00 , N/A ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 , N/A ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A ,$22.32 , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 , N/A ,$17.64 ,$17.64 ,$9.53 ,$17.64 , 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 ,$97.02 ,$33.47 ,$147.00 , N/A ,$131.74 ,$131.74 ,$38.90 ,$117.60 ,$124.95 , N/A ,$132.30 , N/A , N/A ,$139.65 ,$132.30 ,$124.95 ,$124.95 ,$38.90 ,$124.95 ,$124.95 ,$132.30 ,$89.52 , N/A ,$91.14 , N/A ,$132.30 , N/A ,$135.24 ,$132.30 ,$97.03 ,$97.03 ,$89.52 ,$97.03 ,$95.55 ,$100.43 ,$33.47 ,$116.13 , N/A ,$72.03 ,$72.03 ,$38.90 ,$72.03 , 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 ,$55.44 ,$19.12 ,$84.00 , N/A ,$75.28 ,$75.28 ,$22.23 ,$67.20 ,$71.40 , N/A ,$75.60 , N/A , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$22.23 ,$71.40 ,$71.40 ,$75.60 ,$51.16 , N/A ,$52.08 , N/A ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.45 ,$55.45 ,$51.16 ,$55.45 ,$54.60 ,$57.39 ,$19.12 ,$66.36 , N/A ,$41.16 ,$41.16 ,$22.23 ,$41.16 , 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 ,$283.00 ,$186.78 ,$64.43 ,$283.00 , N/A ,$253.62 ,$253.62 ,$74.88 ,$226.40 ,$240.55 , N/A ,$254.70 , N/A , N/A ,$268.85 ,$254.70 ,$240.55 ,$240.55 ,$74.88 ,$240.55 ,$240.55 ,$254.70 ,$172.35 , N/A ,$175.46 , N/A ,$254.70 , N/A ,$260.36 ,$254.70 ,$186.81 ,$186.81 ,$172.35 ,$186.81 ,$183.95 ,$193.35 ,$64.43 ,$223.57 , N/A ,$138.67 ,$138.67 ,$74.88 ,$138.67 , N/A ,$268.85 ,$232.06 ,$232.06 ,$226.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200134,C1769,HC WIRE SYNTHES 1.25 THRDED GUIDE,272,1 ,$96.00 ,$63.36 ,$21.85 ,$96.00 , N/A ,$86.04 ,$86.04 ,$25.40 ,$76.80 ,$81.60 , N/A ,$86.40 , N/A , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$25.40 ,$81.60 ,$81.60 ,$86.40 ,$58.46 , N/A ,$59.52 , N/A ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.37 ,$63.37 ,$58.46 ,$63.37 ,$62.40 ,$65.59 ,$21.85 ,$75.84 , N/A ,$47.04 ,$47.04 ,$25.40 ,$47.04 , 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 ",$761.64 ,$262.71 ,"$1,154.00 ", N/A ,"$1,034.21 ","$1,034.21 ",$305.35 ,$923.20 ,$980.90 , N/A ,"$1,038.60 ", N/A , N/A ,"$1,096.30 ","$1,038.60 ",$980.90 ,$980.90 ,$305.35 ,$980.90 ,$980.90 ,"$1,038.60 ",$702.79 , N/A ,$715.48 , N/A ,"$1,038.60 ", N/A ,"$1,061.68 ","$1,038.60 ",$761.76 ,$761.76 ,$702.79 ,$761.76 ,$750.10 ,$788.41 ,$262.71 ,$911.66 , N/A ,$565.46 ,$565.46 ,$305.35 ,$565.46 , 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 ",$761.64 ,$262.71 ,"$1,154.00 ", N/A ,"$1,034.21 ","$1,034.21 ",$305.35 ,$923.20 ,$980.90 , N/A ,"$1,038.60 ", N/A , N/A ,"$1,096.30 ","$1,038.60 ",$980.90 ,$980.90 ,$305.35 ,$980.90 ,$980.90 ,"$1,038.60 ",$702.79 , N/A ,$715.48 , N/A ,"$1,038.60 ", N/A ,"$1,061.68 ","$1,038.60 ",$761.76 ,$761.76 ,$702.79 ,$761.76 ,$750.10 ,$788.41 ,$262.71 ,$911.66 , N/A ,$565.46 ,$565.46 ,$305.35 ,$565.46 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200200,N/A,HC ABDOMINAL BINDERS,272,1 ,$17.00 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200210,N/A,HC RETRACTOR RING,272,1 ,$143.00 ,$94.38 ,$32.56 ,$143.00 , N/A ,$128.16 ,$128.16 ,$37.84 ,$114.40 ,$121.55 ,$89.38 ,$128.70 , N/A , N/A ,$135.85 ,$128.70 ,$121.55 ,$121.55 ,$37.84 ,$121.55 ,$121.55 ,$128.70 ,$87.09 , N/A ,$88.66 , N/A ,$128.70 , N/A ,$131.56 ,$128.70 ,$94.39 ,$94.39 ,$87.09 ,$94.39 ,$92.95 ,$97.70 ,$32.56 ,$112.97 , N/A ,$70.07 ,$70.07 ,$37.84 ,$70.07 , 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 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$3.43 ,$1.19 ,$5.20 , N/A ,$4.66 ,$4.66 ,$1.37 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.37 ,$4.42 ,$4.42 ,$4.68 ,$3.17 , N/A ,$3.22 , N/A ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.43 ,$3.43 ,$3.17 ,$3.43 ,$3.38 ,$3.55 ,$1.19 ,$4.11 , N/A ,$2.55 ,$2.55 ,$1.37 ,$2.55 , N/A ,$4.94 ,$4.26 ,$4.26 ,$4.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$72.11 ,$47.59 ,$16.42 ,$72.11 , N/A ,$64.63 ,$64.63 ,$19.08 ,$57.69 ,$61.29 ,$45.07 ,$64.90 , N/A , N/A ,$68.50 ,$64.90 ,$61.29 ,$61.29 ,$19.08 ,$61.29 ,$61.29 ,$64.90 ,$43.92 , N/A ,$44.70 , N/A ,$64.90 , N/A ,$66.34 ,$64.90 ,$47.60 ,$47.60 ,$43.92 ,$47.60 ,$46.87 ,$49.27 ,$16.42 ,$56.97 , N/A ,$35.33 ,$35.33 ,$19.08 ,$35.33 , N/A ,$68.50 ,$59.13 ,$59.13 ,$57.69 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200251,N/A,HC ANTI FOG FRED,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , N/A ,$6.84 ,$5.90 ,$5.90 ,$5.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200257,N/A,HC AQUACEL DRESSINGS,272,1 ,$53.00 ,$34.98 ,$12.06 ,$53.00 , N/A ,$47.50 ,$47.50 ,$14.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A ,$25.97 ,$25.97 ,$14.02 ,$25.97 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200266,N/A,HC CANNULA GEMINI 8.25 X 9CM,272,1 ,$12.80 ,$8.45 ,$2.91 ,$12.80 , N/A ,$11.47 ,$11.47 ,$3.39 ,$10.24 ,$10.88 ,$8.00 ,$11.52 , N/A , N/A ,$12.16 ,$11.52 ,$10.88 ,$10.88 ,$3.39 ,$10.88 ,$10.88 ,$11.52 ,$7.80 , N/A ,$7.94 , N/A ,$11.52 , N/A ,$11.78 ,$11.52 ,$8.45 ,$8.45 ,$7.80 ,$8.45 ,$8.32 ,$8.75 ,$2.91 ,$10.11 , N/A ,$6.27 ,$6.27 ,$3.39 ,$6.27 , N/A ,$12.16 ,$10.50 ,$10.50 ,$10.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200275,N/A,HC ARTHROSCOPY CUTTER,272,1 ,$399.93 ,$263.95 ,$91.04 ,$399.93 , N/A ,$358.42 ,$358.42 ,$105.82 ,$319.94 ,$339.94 ,$249.96 ,$359.94 , N/A , N/A ,$379.93 ,$359.94 ,$339.94 ,$339.94 ,$105.82 ,$339.94 ,$339.94 ,$359.94 ,$243.56 , N/A ,$247.96 , N/A ,$359.94 , N/A ,$367.94 ,$359.94 ,$263.99 ,$263.99 ,$243.56 ,$263.99 ,$259.95 ,$273.23 ,$91.04 ,$315.94 , N/A ,$195.97 ,$195.97 ,$105.82 ,$195.97 , N/A ,$379.93 ,$327.94 ,$327.94 ,$319.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200277,N/A,HC ARTHROSCOPY TUBE SET,272,1 ,$317.86 ,$209.79 ,$72.36 ,$317.86 , N/A ,$284.87 ,$284.87 ,$84.10 ,$254.29 ,$270.18 ,$198.66 ,$286.07 , N/A , N/A ,$301.97 ,$286.07 ,$270.18 ,$270.18 ,$84.10 ,$270.18 ,$270.18 ,$286.07 ,$193.58 , N/A ,$197.08 , N/A ,$286.07 , N/A ,$292.43 ,$286.07 ,$209.82 ,$209.82 ,$193.58 ,$209.82 ,$206.61 ,$217.16 ,$72.36 ,$251.11 , N/A ,$155.75 ,$155.75 ,$84.10 ,$155.75 , N/A ,$301.97 ,$260.65 ,$260.65 ,$254.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200283,N/A,HC ATRIUM CHEST DRAINAGE,272,1 ,$208.00 ,$137.28 ,$47.35 ,$208.00 , N/A ,$186.41 ,$186.41 ,$55.04 ,$166.40 ,$176.80 ,$130.00 ,$187.20 , N/A , N/A ,$197.60 ,$187.20 ,$176.80 ,$176.80 ,$55.04 ,$176.80 ,$176.80 ,$187.20 ,$126.67 , N/A ,$128.96 , N/A ,$187.20 , N/A ,$191.36 ,$187.20 ,$137.30 ,$137.30 ,$126.67 ,$137.30 ,$135.20 ,$142.11 ,$47.35 ,$164.32 , N/A ,$101.92 ,$101.92 ,$55.04 ,$101.92 , 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 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$43.56 ,$15.02 ,$66.00 , N/A ,$59.15 ,$59.15 ,$17.46 ,$52.80 ,$56.10 ,$41.25 ,$59.40 , N/A , N/A ,$62.70 ,$59.40 ,$56.10 ,$56.10 ,$17.46 ,$56.10 ,$56.10 ,$59.40 ,$40.19 , N/A ,$40.92 , N/A ,$59.40 , N/A ,$60.72 ,$59.40 ,$43.57 ,$43.57 ,$40.19 ,$43.57 ,$42.90 ,$45.09 ,$15.02 ,$52.14 , N/A ,$32.34 ,$32.34 ,$17.46 ,$32.34 , 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 ,$18.44 ,$12.17 ,$4.19 ,$18.44 , N/A ,$16.53 ,$16.53 ,$4.88 ,$14.75 ,$15.67 ,$11.53 ,$16.60 , N/A , N/A ,$17.52 ,$16.60 ,$15.67 ,$15.67 ,$4.88 ,$15.67 ,$15.67 ,$16.60 ,$11.23 , N/A ,$11.44 , N/A ,$16.60 , N/A ,$16.96 ,$16.60 ,$12.17 ,$12.17 ,$11.23 ,$12.17 ,$11.99 ,$12.60 ,$4.19 ,$14.57 , N/A ,$9.04 ,$9.04 ,$4.88 ,$9.04 , N/A ,$17.52 ,$15.12 ,$15.12 ,$14.75 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200302,N/A,HC BAG URINE LEG STD,272,1 ,$4.10 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , 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 ,$16.00 ,$10.56 ,$3.65 ,$16.00 , N/A ,$14.34 ,$14.34 ,$4.23 ,$12.80 ,$13.60 ,$10.00 ,$14.40 , N/A , N/A ,$15.20 ,$14.40 ,$13.60 ,$13.60 ,$4.23 ,$13.60 ,$13.60 ,$14.40 ,$9.74 , N/A ,$9.92 , N/A ,$14.40 , N/A ,$14.72 ,$14.40 ,$10.56 ,$10.56 ,$9.74 ,$10.56 ,$10.40 ,$10.93 ,$3.65 ,$12.64 , N/A ,$7.84 ,$7.84 ,$4.23 ,$7.84 , N/A ,$15.20 ,$13.12 ,$13.12 ,$12.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200318,N/A,HC BANDAGE ESMARK 4IN,272,1 ,$8.30 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$246.18 ,$84.92 ,$373.00 , N/A ,$334.28 ,$334.28 ,$98.70 ,$298.40 ,$317.05 ,$233.13 ,$335.70 , N/A , N/A ,$354.35 ,$335.70 ,$317.05 ,$317.05 ,$98.70 ,$317.05 ,$317.05 ,$335.70 ,$227.16 , N/A ,$231.26 , N/A ,$335.70 , N/A ,$343.16 ,$335.70 ,$246.22 ,$246.22 ,$227.16 ,$246.22 ,$242.45 ,$254.83 ,$84.92 ,$294.67 , N/A ,$182.77 ,$182.77 ,$98.70 ,$182.77 , 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 ,$435.60 ,$150.25 ,$660.00 , N/A ,$591.49 ,$591.49 ,$174.64 ,$528.00 ,$561.00 ,$412.50 ,$594.00 , N/A , N/A ,$627.00 ,$594.00 ,$561.00 ,$561.00 ,$174.64 ,$561.00 ,$561.00 ,$594.00 ,$401.94 , N/A ,$409.20 , N/A ,$594.00 , N/A ,$607.20 ,$594.00 ,$435.67 ,$435.67 ,$401.94 ,$435.67 ,$429.00 ,$450.91 ,$150.25 ,$521.40 , N/A ,$323.40 ,$323.40 ,$174.64 ,$323.40 , 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 ,$203.28 ,$70.12 ,$308.00 , N/A ,$276.03 ,$276.03 ,$81.50 ,$246.40 ,$261.80 ,$192.50 ,$277.20 , N/A , N/A ,$292.60 ,$277.20 ,$261.80 ,$261.80 ,$81.50 ,$261.80 ,$261.80 ,$277.20 ,$187.57 , N/A ,$190.96 , N/A ,$277.20 , N/A ,$283.36 ,$277.20 ,$203.31 ,$203.31 ,$187.57 ,$203.31 ,$200.20 ,$210.43 ,$70.12 ,$243.32 , N/A ,$150.92 ,$150.92 ,$81.50 ,$150.92 , 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 ,$156.42 ,$53.96 ,$237.00 , N/A ,$212.40 ,$212.40 ,$62.71 ,$189.60 ,$201.45 ,$148.13 ,$213.30 , N/A , N/A ,$225.15 ,$213.30 ,$201.45 ,$201.45 ,$62.71 ,$201.45 ,$201.45 ,$213.30 ,$144.33 , N/A ,$146.94 , N/A ,$213.30 , N/A ,$218.04 ,$213.30 ,$156.44 ,$156.44 ,$144.33 ,$156.44 ,$154.05 ,$161.92 ,$53.96 ,$187.23 , N/A ,$116.13 ,$116.13 ,$62.71 ,$116.13 , 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 ,$168.30 ,$58.06 ,$255.00 , N/A ,$228.53 ,$228.53 ,$67.47 ,$204.00 ,$216.75 ,$159.38 ,$229.50 , N/A , N/A ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$67.47 ,$216.75 ,$216.75 ,$229.50 ,$155.30 , N/A ,$158.10 , N/A ,$229.50 , N/A ,$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 , N/A ,$124.95 ,$124.95 ,$67.47 ,$124.95 , 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 ,$163.02 ,$56.23 ,$247.00 , N/A ,$221.36 ,$221.36 ,$65.36 ,$197.60 ,$209.95 ,$154.38 ,$222.30 , N/A , N/A ,$234.65 ,$222.30 ,$209.95 ,$209.95 ,$65.36 ,$209.95 ,$209.95 ,$222.30 ,$150.42 , N/A ,$153.14 , N/A ,$222.30 , N/A ,$227.24 ,$222.30 ,$163.04 ,$163.04 ,$150.42 ,$163.04 ,$160.55 ,$168.75 ,$56.23 ,$195.13 , N/A ,$121.03 ,$121.03 ,$65.36 ,$121.03 , 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 ,$88.88 ,$58.66 ,$20.23 ,$88.88 , N/A ,$79.65 ,$79.65 ,$23.52 ,$71.10 ,$75.55 ,$55.55 ,$79.99 , N/A , N/A ,$84.44 ,$79.99 ,$75.55 ,$75.55 ,$23.52 ,$75.55 ,$75.55 ,$79.99 ,$54.13 , N/A ,$55.10 , N/A ,$79.99 , N/A ,$81.77 ,$79.99 ,$58.67 ,$58.67 ,$54.13 ,$58.67 ,$57.77 ,$60.72 ,$20.23 ,$70.22 , N/A ,$43.55 ,$43.55 ,$23.52 ,$43.55 , N/A ,$84.44 ,$72.88 ,$72.88 ,$71.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200376,N/A,HC DRILL BIT SYNTHES 2.0,272,1 ,$222.33 ,$146.74 ,$50.62 ,$222.33 , N/A ,$199.25 ,$199.25 ,$58.83 ,$177.86 ,$188.98 ,$138.96 ,$200.10 , N/A , N/A ,$211.21 ,$200.10 ,$188.98 ,$188.98 ,$58.83 ,$188.98 ,$188.98 ,$200.10 ,$135.40 , N/A ,$137.84 , N/A ,$200.10 , N/A ,$204.54 ,$200.10 ,$146.76 ,$146.76 ,$135.40 ,$146.76 ,$144.51 ,$151.90 ,$50.62 ,$175.64 , N/A ,$108.94 ,$108.94 ,$58.83 ,$108.94 , N/A ,$211.21 ,$182.31 ,$182.31 ,$177.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200394,N/A,HC BIT DRILL SYNTHES 3.5,272,1 ,$222.33 ,$146.74 ,$50.62 ,$222.33 , N/A ,$199.25 ,$199.25 ,$58.83 ,$177.86 ,$188.98 ,$138.96 ,$200.10 , N/A , N/A ,$211.21 ,$200.10 ,$188.98 ,$188.98 ,$58.83 ,$188.98 ,$188.98 ,$200.10 ,$135.40 , N/A ,$137.84 , N/A ,$200.10 , N/A ,$204.54 ,$200.10 ,$146.76 ,$146.76 ,$135.40 ,$146.76 ,$144.51 ,$151.90 ,$50.62 ,$175.64 , N/A ,$108.94 ,$108.94 ,$58.83 ,$108.94 , N/A ,$211.21 ,$182.31 ,$182.31 ,$177.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200409,N/A,HC BIT SYN 4.0MM 3FLUTE 195MM,272,1 ,$425.00 ,$280.50 ,$96.76 ,$425.00 , N/A ,$380.89 ,$380.89 ,$112.45 ,$340.00 ,$361.25 ,$265.63 ,$382.50 , N/A , N/A ,$403.75 ,$382.50 ,$361.25 ,$361.25 ,$112.45 ,$361.25 ,$361.25 ,$382.50 ,$258.83 , N/A ,$263.50 , N/A ,$382.50 , N/A ,$391.00 ,$382.50 ,$280.54 ,$280.54 ,$258.83 ,$280.54 ,$276.25 ,$290.36 ,$96.76 ,$335.75 , N/A ,$208.25 ,$208.25 ,$112.45 ,$208.25 , 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 ,$495.00 ,$170.75 ,$750.00 , N/A ,$672.15 ,$672.15 ,$198.45 ,$600.00 ,$637.50 ,$468.75 ,$675.00 , N/A , N/A ,$712.50 ,$675.00 ,$637.50 ,$637.50 ,$198.45 ,$637.50 ,$637.50 ,$675.00 ,$456.75 , N/A ,$465.00 , N/A ,$675.00 , N/A ,$690.00 ,$675.00 ,$495.08 ,$495.08 ,$456.75 ,$495.08 ,$487.50 ,$512.40 ,$170.75 ,$592.50 , N/A ,$367.50 ,$367.50 ,$198.45 ,$367.50 , 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 ,$294.36 ,$101.54 ,$446.00 , N/A ,$399.71 ,$399.71 ,$118.01 ,$356.80 ,$379.10 ,$278.75 ,$401.40 , N/A , N/A ,$423.70 ,$401.40 ,$379.10 ,$379.10 ,$118.01 ,$379.10 ,$379.10 ,$401.40 ,$271.61 , N/A ,$276.52 , N/A ,$401.40 , N/A ,$410.32 ,$401.40 ,$294.40 ,$294.40 ,$271.61 ,$294.40 ,$289.90 ,$304.71 ,$101.54 ,$352.34 , N/A ,$218.54 ,$218.54 ,$118.01 ,$218.54 , 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 ",$943.14 ,$325.32 ,"$1,429.00 ", N/A ,"$1,280.67 ","$1,280.67 ",$378.11 ,"$1,143.20 ","$1,214.65 ",$893.13 ,"$1,286.10 ", N/A , N/A ,"$1,357.55 ","$1,286.10 ","$1,214.65 ","$1,214.65 ",$378.11 ,"$1,214.65 ","$1,214.65 ","$1,286.10 ",$870.26 , N/A ,$885.98 , N/A ,"$1,286.10 ", N/A ,"$1,314.68 ","$1,286.10 ",$943.28 ,$943.28 ,$870.26 ,$943.28 ,$928.85 ,$976.29 ,$325.32 ,"$1,128.91 ", N/A ,$700.21 ,$700.21 ,$378.11 ,$700.21 , 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 ,$294.00 ,$194.04 ,$66.93 ,$294.00 , N/A ,$263.48 ,$263.48 ,$77.79 ,$235.20 ,$249.90 ,$183.75 ,$264.60 , N/A , N/A ,$279.30 ,$264.60 ,$249.90 ,$249.90 ,$77.79 ,$249.90 ,$249.90 ,$264.60 ,$179.05 , N/A ,$182.28 , N/A ,$264.60 , N/A ,$270.48 ,$264.60 ,$194.07 ,$194.07 ,$179.05 ,$194.07 ,$191.10 ,$200.86 ,$66.93 ,$232.26 , N/A ,$144.06 ,$144.06 ,$77.79 ,$144.06 , N/A ,$279.30 ,$241.08 ,$241.08 ,$235.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200425,N/A,HC BIT SYNTHES 3.2 DRILL,272,1 ,$217.00 ,$143.22 ,$49.40 ,$217.00 , N/A ,$194.48 ,$194.48 ,$57.42 ,$173.60 ,$184.45 ,$135.63 ,$195.30 , N/A , N/A ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$57.42 ,$184.45 ,$184.45 ,$195.30 ,$132.15 , N/A ,$134.54 , N/A ,$195.30 , N/A ,$199.64 ,$195.30 ,$143.24 ,$143.24 ,$132.15 ,$143.24 ,$141.05 ,$148.25 ,$49.40 ,$171.43 , N/A ,$106.33 ,$106.33 ,$57.42 ,$106.33 , 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 ,$246.18 ,$84.92 ,$373.00 , N/A ,$334.28 ,$334.28 ,$98.70 ,$298.40 ,$317.05 ,$233.13 ,$335.70 , N/A , N/A ,$354.35 ,$335.70 ,$317.05 ,$317.05 ,$98.70 ,$317.05 ,$317.05 ,$335.70 ,$227.16 , N/A ,$231.26 , N/A ,$335.70 , N/A ,$343.16 ,$335.70 ,$246.22 ,$246.22 ,$227.16 ,$246.22 ,$242.45 ,$254.83 ,$84.92 ,$294.67 , N/A ,$182.77 ,$182.77 ,$98.70 ,$182.77 , 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 ,$238.26 ,$82.18 ,$361.00 , N/A ,$323.53 ,$323.53 ,$95.52 ,$288.80 ,$306.85 ,$225.63 ,$324.90 , N/A , N/A ,$342.95 ,$324.90 ,$306.85 ,$306.85 ,$95.52 ,$306.85 ,$306.85 ,$324.90 ,$219.85 , N/A ,$223.82 , N/A ,$324.90 , N/A ,$332.12 ,$324.90 ,$238.30 ,$238.30 ,$219.85 ,$238.30 ,$234.65 ,$246.64 ,$82.18 ,$285.19 , N/A ,$176.89 ,$176.89 ,$95.52 ,$176.89 , 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 ",$889.68 ,$306.88 ,"$1,348.00 ", N/A ,"$1,208.08 ","$1,208.08 ",$356.68 ,"$1,078.40 ","$1,145.80 ",$842.50 ,"$1,213.20 ", N/A , N/A ,"$1,280.60 ","$1,213.20 ","$1,145.80 ","$1,145.80 ",$356.68 ,"$1,145.80 ","$1,145.80 ","$1,213.20 ",$820.93 , N/A ,$835.76 , N/A ,"$1,213.20 ", N/A ,"$1,240.16 ","$1,213.20 ",$889.81 ,$889.81 ,$820.93 ,$889.81 ,$876.20 ,$920.95 ,$306.88 ,"$1,064.92 ", N/A ,$660.52 ,$660.52 ,$356.68 ,$660.52 , 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 ,$124.08 ,$42.80 ,$188.00 , N/A ,$168.49 ,$168.49 ,$49.74 ,$150.40 ,$159.80 ,$117.50 ,$169.20 , N/A , N/A ,$178.60 ,$169.20 ,$159.80 ,$159.80 ,$49.74 ,$159.80 ,$159.80 ,$169.20 ,$114.49 , N/A ,$116.56 , N/A ,$169.20 , N/A ,$172.96 ,$169.20 ,$124.10 ,$124.10 ,$114.49 ,$124.10 ,$122.20 ,$128.44 ,$42.80 ,$148.52 , N/A ,$92.12 ,$92.12 ,$49.74 ,$92.12 , 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 ,$9.00 ,$5.94 ,$2.05 ,$9.00 , N/A ,$8.07 ,$8.07 ,$2.38 ,$7.20 ,$7.65 ,$5.63 ,$8.10 , N/A , N/A ,$8.55 ,$8.10 ,$7.65 ,$7.65 ,$2.38 ,$7.65 ,$7.65 ,$8.10 ,$5.48 , N/A ,$5.58 , N/A ,$8.10 , N/A ,$8.28 ,$8.10 ,$5.94 ,$5.94 ,$5.48 ,$5.94 ,$5.85 ,$6.15 ,$2.05 ,$7.11 , N/A ,$4.41 ,$4.41 ,$2.38 ,$4.41 , N/A ,$8.55 ,$7.38 ,$7.38 ,$7.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200435,N/A,HC BLADE,272,1 ,$437.00 ,$288.42 ,$99.49 ,$437.00 , N/A ,$391.64 ,$391.64 ,$115.63 ,$349.60 ,$371.45 ,$273.13 ,$393.30 , N/A , N/A ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$115.63 ,$371.45 ,$371.45 ,$393.30 ,$266.13 , N/A ,$270.94 , N/A ,$393.30 , N/A ,$402.04 ,$393.30 ,$288.46 ,$288.46 ,$266.13 ,$288.46 ,$284.05 ,$298.56 ,$99.49 ,$345.23 , N/A ,$214.13 ,$214.13 ,$115.63 ,$214.13 , 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 ,$100.98 ,$34.83 ,$153.00 , N/A ,$137.12 ,$137.12 ,$40.48 ,$122.40 ,$130.05 ,$95.63 ,$137.70 , N/A , N/A ,$145.35 ,$137.70 ,$130.05 ,$130.05 ,$40.48 ,$130.05 ,$130.05 ,$137.70 ,$93.18 , N/A ,$94.86 , N/A ,$137.70 , N/A ,$140.76 ,$137.70 ,$101.00 ,$101.00 ,$93.18 ,$101.00 ,$99.45 ,$104.53 ,$34.83 ,$120.87 , N/A ,$74.97 ,$74.97 ,$40.48 ,$74.97 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$27.06 ,$9.33 ,$41.00 , N/A ,$36.74 ,$36.74 ,$10.85 ,$32.80 ,$34.85 ,$25.63 ,$36.90 , N/A , N/A ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$10.85 ,$34.85 ,$34.85 ,$36.90 ,$24.97 , N/A ,$25.42 , N/A ,$36.90 , N/A ,$37.72 ,$36.90 ,$27.06 ,$27.06 ,$24.97 ,$27.06 ,$26.65 ,$28.01 ,$9.33 ,$32.39 , N/A ,$20.09 ,$20.09 ,$10.85 ,$20.09 , 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 ","$1,264.56 ",$436.19 ,"$1,916.00 ", N/A ,"$1,717.12 ","$1,717.12 ",$506.97 ,"$1,532.80 ","$1,628.60 ","$1,197.50 ","$1,724.40 ", N/A , N/A ,"$1,820.20 ","$1,724.40 ","$1,628.60 ","$1,628.60 ",$506.97 ,"$1,628.60 ","$1,628.60 ","$1,724.40 ","$1,166.84 ", N/A ,"$1,187.92 ", N/A ,"$1,724.40 ", N/A ,"$1,762.72 ","$1,724.40 ","$1,264.75 ","$1,264.75 ","$1,166.84 ","$1,264.75 ","$1,245.40 ","$1,309.01 ",$436.19 ,"$1,513.64 ", N/A ,$938.84 ,$938.84 ,$506.97 ,$938.84 , 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 ,$77.22 ,$26.64 ,$117.00 , N/A ,$104.86 ,$104.86 ,$30.96 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$30.96 ,$99.45 ,$99.45 ,$105.30 ,$71.25 , N/A ,$72.54 , N/A ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.23 ,$77.23 ,$71.25 ,$77.23 ,$76.05 ,$79.93 ,$26.64 ,$92.43 , N/A ,$57.33 ,$57.33 ,$30.96 ,$57.33 , 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 ,$26.40 ,$9.10 ,$40.00 , N/A ,$35.85 ,$35.85 ,$10.58 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$10.58 ,$34.00 ,$34.00 ,$36.00 ,$24.36 , N/A ,$24.80 , N/A ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.40 ,$26.40 ,$24.36 ,$26.40 ,$26.00 ,$27.33 ,$9.10 ,$31.60 , N/A ,$19.60 ,$19.60 ,$10.58 ,$19.60 , 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 ,$39.58 ,$26.12 ,$9.01 ,$39.58 , N/A ,$35.47 ,$35.47 ,$10.48 ,$31.66 ,$33.64 ,$24.74 ,$35.62 , N/A , N/A ,$37.60 ,$35.62 ,$33.64 ,$33.64 ,$10.48 ,$33.64 ,$33.64 ,$35.62 ,$24.10 , N/A ,$24.54 , N/A ,$35.62 , N/A ,$36.41 ,$35.62 ,$26.13 ,$26.13 ,$24.10 ,$26.13 ,$25.73 ,$27.04 ,$9.01 ,$31.27 , N/A ,$19.39 ,$19.39 ,$10.48 ,$19.39 , N/A ,$37.60 ,$32.46 ,$32.46 ,$31.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200485,N/A,HC BLADE REG LEN 3.5MM OR 4.3,272,1 ,$404.00 ,$266.64 ,$91.97 ,$404.00 , N/A ,$362.06 ,$362.06 ,$106.90 ,$323.20 ,$343.40 ,$252.50 ,$363.60 , N/A , N/A ,$383.80 ,$363.60 ,$343.40 ,$343.40 ,$106.90 ,$343.40 ,$343.40 ,$363.60 ,$246.04 , N/A ,$250.48 , N/A ,$363.60 , N/A ,$371.68 ,$363.60 ,$266.68 ,$266.68 ,$246.04 ,$266.68 ,$262.60 ,$276.01 ,$91.97 ,$319.16 , N/A ,$197.96 ,$197.96 ,$106.90 ,$197.96 , 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 ,$366.30 ,$126.35 ,$555.00 , N/A ,$497.39 ,$497.39 ,$146.85 ,$444.00 ,$471.75 ,$346.88 ,$499.50 , N/A , N/A ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$146.85 ,$471.75 ,$471.75 ,$499.50 ,$338.00 , N/A ,$344.10 , N/A ,$499.50 , N/A ,$510.60 ,$499.50 ,$366.36 ,$366.36 ,$338.00 ,$366.36 ,$360.75 ,$379.18 ,$126.35 ,$438.45 , N/A ,$271.95 ,$271.95 ,$146.85 ,$271.95 , 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 ,$409.86 ,$141.37 ,$621.00 , N/A ,$556.54 ,$556.54 ,$164.32 ,$496.80 ,$527.85 ,$388.13 ,$558.90 , N/A , N/A ,$589.95 ,$558.90 ,$527.85 ,$527.85 ,$164.32 ,$527.85 ,$527.85 ,$558.90 ,$378.19 , N/A ,$385.02 , N/A ,$558.90 , N/A ,$571.32 ,$558.90 ,$409.92 ,$409.92 ,$378.19 ,$409.92 ,$403.65 ,$424.27 ,$141.37 ,$490.59 , N/A ,$304.29 ,$304.29 ,$164.32 ,$304.29 , 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 ,$118.00 ,$77.88 ,$26.86 ,$118.00 , N/A ,$105.75 ,$105.75 ,$31.22 ,$94.40 ,$100.30 ,$73.75 ,$106.20 , N/A , N/A ,$112.10 ,$106.20 ,$100.30 ,$100.30 ,$31.22 ,$100.30 ,$100.30 ,$106.20 ,$71.86 , N/A ,$73.16 , N/A ,$106.20 , N/A ,$108.56 ,$106.20 ,$77.89 ,$77.89 ,$71.86 ,$77.89 ,$76.70 ,$80.62 ,$26.86 ,$93.22 , N/A ,$57.82 ,$57.82 ,$31.22 ,$57.82 , N/A ,$112.10 ,$96.76 ,$96.76 ,$94.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200525,N/A,HC BLADE STRYKER TPS,272,1 ,$38.50 ,$25.41 ,$8.77 ,$38.50 , N/A ,$34.50 ,$34.50 ,$10.19 ,$30.80 ,$32.73 ,$24.06 ,$34.65 , N/A , N/A ,$36.58 ,$34.65 ,$32.73 ,$32.73 ,$10.19 ,$32.73 ,$32.73 ,$34.65 ,$23.45 , N/A ,$23.88 , N/A ,$34.65 , N/A ,$35.42 ,$34.65 ,$25.41 ,$25.41 ,$23.45 ,$25.41 ,$25.03 ,$26.30 ,$8.77 ,$30.42 , N/A ,$18.87 ,$18.87 ,$10.19 ,$18.87 , N/A ,$36.58 ,$31.57 ,$31.57 ,$30.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200526,N/A,HC BLADE STRYKR SAG 13MM X 1.37 X 90,272,1 ,$246.00 ,$162.36 ,$56.01 ,$246.00 , N/A ,$220.47 ,$220.47 ,$65.09 ,$196.80 ,$209.10 ,$153.75 ,$221.40 , N/A , N/A ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$65.09 ,$209.10 ,$209.10 ,$221.40 ,$149.81 , N/A ,$152.52 , N/A ,$221.40 , N/A ,$226.32 ,$221.40 ,$162.38 ,$162.38 ,$149.81 ,$162.38 ,$159.90 ,$168.07 ,$56.01 ,$194.34 , N/A ,$120.54 ,$120.54 ,$65.09 ,$120.54 , 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 ,$140.70 ,$92.86 ,$32.03 ,$140.70 , N/A ,$126.10 ,$126.10 ,$37.23 ,$112.56 ,$119.60 ,$87.94 ,$126.63 , N/A , N/A ,$133.67 ,$126.63 ,$119.60 ,$119.60 ,$37.23 ,$119.60 ,$119.60 ,$126.63 ,$85.69 , N/A ,$87.24 , N/A ,$126.63 , N/A ,$129.44 ,$126.63 ,$92.88 ,$92.88 ,$85.69 ,$92.88 ,$91.46 ,$96.13 ,$32.03 ,$111.15 , N/A ,$68.94 ,$68.94 ,$37.23 ,$68.94 , N/A ,$133.67 ,$115.37 ,$115.37 ,$112.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200538,N/A,HC KNIFE BEAVER 45DEG 33MM,272,1 ,$57.00 ,$37.62 ,$12.98 ,$57.00 , N/A ,$51.08 ,$51.08 ,$15.08 ,$45.60 ,$48.45 ,$35.63 ,$51.30 , N/A , N/A ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$15.08 ,$48.45 ,$48.45 ,$51.30 ,$34.71 , N/A ,$35.34 , N/A ,$51.30 , N/A ,$52.44 ,$51.30 ,$37.63 ,$37.63 ,$34.71 ,$37.63 ,$37.05 ,$38.94 ,$12.98 ,$45.03 , N/A ,$27.93 ,$27.93 ,$15.08 ,$27.93 , 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 ,$112.20 ,$38.70 ,$170.00 , N/A ,$152.35 ,$152.35 ,$44.98 ,$136.00 ,$144.50 ,$106.25 ,$153.00 , N/A , N/A ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$44.98 ,$144.50 ,$144.50 ,$153.00 ,$103.53 , N/A ,$105.40 , N/A ,$153.00 , N/A ,$156.40 ,$153.00 ,$112.22 ,$112.22 ,$103.53 ,$112.22 ,$110.50 ,$116.14 ,$38.70 ,$134.30 , N/A ,$83.30 ,$83.30 ,$44.98 ,$83.30 , 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 ,$268.62 ,$92.66 ,$407.00 , N/A ,$364.75 ,$364.75 ,$107.69 ,$325.60 ,$345.95 ,$254.38 ,$366.30 , N/A , N/A ,$386.65 ,$366.30 ,$345.95 ,$345.95 ,$107.69 ,$345.95 ,$345.95 ,$366.30 ,$247.86 , N/A ,$252.34 , N/A ,$366.30 , N/A ,$374.44 ,$366.30 ,$268.66 ,$268.66 ,$247.86 ,$268.66 ,$264.55 ,$278.06 ,$92.66 ,$321.53 , N/A ,$199.43 ,$199.43 ,$107.69 ,$199.43 , 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 ,$75.24 ,$25.95 ,$114.00 , N/A ,$102.17 ,$102.17 ,$30.16 ,$91.20 ,$96.90 ,$71.25 ,$102.60 , N/A , N/A ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$30.16 ,$96.90 ,$96.90 ,$102.60 ,$69.43 , N/A ,$70.68 , N/A ,$102.60 , N/A ,$104.88 ,$102.60 ,$75.25 ,$75.25 ,$69.43 ,$75.25 ,$74.10 ,$77.88 ,$25.95 ,$90.06 , N/A ,$55.86 ,$55.86 ,$30.16 ,$55.86 , 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 ,$54.12 ,$18.67 ,$82.00 , N/A ,$73.49 ,$73.49 ,$21.70 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$21.70 ,$69.70 ,$69.70 ,$73.80 ,$49.94 , N/A ,$50.84 , N/A ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.13 ,$54.13 ,$49.94 ,$54.13 ,$53.30 ,$56.02 ,$18.67 ,$64.78 , N/A ,$40.18 ,$40.18 ,$21.70 ,$40.18 , 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 ,"$1,472.00 ",$971.52 ,$335.11 ,"$1,472.00 ", N/A ,"$1,319.21 ","$1,319.21 ",$389.49 ,"$1,177.60 ","$1,251.20 ",$920.00 ,"$1,324.80 ", N/A , N/A ,"$1,398.40 ","$1,324.80 ","$1,251.20 ","$1,251.20 ",$389.49 ,"$1,251.20 ","$1,251.20 ","$1,324.80 ",$896.45 , N/A ,$912.64 , N/A ,"$1,324.80 ", N/A ,"$1,354.24 ","$1,324.80 ",$971.67 ,$971.67 ,$896.45 ,$971.67 ,$956.80 ,"$1,005.67 ",$335.11 ,"$1,162.88 ", N/A ,$721.28 ,$721.28 ,$389.49 ,$721.28 , N/A ,"$1,398.40 ","$1,207.04 ","$1,207.04 ","$1,177.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200579,N/A,HC BRUSH CYTOLOGY,272,1 ,$37.00 ,$24.42 ,$8.43 ,$37.00 , N/A ,$33.16 ,$33.16 ,$9.79 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$9.79 ,$31.45 ,$31.45 ,$33.30 ,$22.53 , N/A ,$22.94 , N/A ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.42 ,$24.42 ,$22.53 ,$24.42 ,$24.05 ,$25.28 ,$8.43 ,$29.23 , N/A ,$18.13 ,$18.13 ,$9.79 ,$18.13 , 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 ,$30.20 ,$19.93 ,$6.88 ,$30.20 , N/A ,$27.07 ,$27.07 ,$7.99 ,$24.16 ,$25.67 ,$18.88 ,$27.18 , N/A , N/A ,$28.69 ,$27.18 ,$25.67 ,$25.67 ,$7.99 ,$25.67 ,$25.67 ,$27.18 ,$18.39 , N/A ,$18.72 , N/A ,$27.18 , N/A ,$27.78 ,$27.18 ,$19.94 ,$19.94 ,$18.39 ,$19.94 ,$19.63 ,$20.63 ,$6.88 ,$23.86 , N/A ,$14.80 ,$14.80 ,$7.99 ,$14.80 , N/A ,$28.69 ,$24.76 ,$24.76 ,$24.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200597,N/A,HC BUR STRYKER,272,1 ,$113.00 ,$74.58 ,$25.72 ,$113.00 , N/A ,$101.27 ,$101.27 ,$29.90 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$29.90 ,$96.05 ,$96.05 ,$101.70 ,$68.82 , N/A ,$70.06 , N/A ,$101.70 , N/A ,$103.96 ,$101.70 ,$74.59 ,$74.59 ,$68.82 ,$74.59 ,$73.45 ,$77.20 ,$25.72 ,$89.27 , N/A ,$55.37 ,$55.37 ,$29.90 ,$55.37 , N/A ,$107.35 ,$92.66 ,$92.66 ,$90.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200634,N/A,HC BURR STRYKER BARREL LONG HIP,272,1 ,$574.15 ,$378.94 ,$130.70 ,$574.15 , N/A ,$514.55 ,$514.55 ,$151.92 ,$459.32 ,$488.03 ,$358.84 ,$516.74 , N/A , N/A ,$545.44 ,$516.74 ,$488.03 ,$488.03 ,$151.92 ,$488.03 ,$488.03 ,$516.74 ,$349.66 , N/A ,$355.98 , N/A ,$516.74 , N/A ,$528.22 ,$516.74 ,$379.00 ,$379.00 ,$349.66 ,$379.00 ,$373.20 ,$392.26 ,$130.70 ,$453.58 , N/A ,$281.33 ,$281.33 ,$151.92 ,$281.33 , N/A ,$545.44 ,$470.80 ,$470.80 ,$459.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200640,N/A,HC BURR STRYKER ROUND,272,1 ,$160.00 ,$105.60 ,$36.43 ,$160.00 , N/A ,$143.39 ,$143.39 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 , N/A , N/A ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 , N/A ,$99.20 , N/A ,$144.00 , N/A ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 , N/A ,$78.40 ,$78.40 ,$42.34 ,$78.40 , N/A ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200656,N/A,"HC BX NEEDLE TRU-CUT 4 1/2 """,272,1 ,$50.00 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , 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 ,$53.00 ,$34.98 ,$12.06 ,$53.00 , N/A ,$47.50 ,$47.50 ,$14.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A ,$25.97 ,$25.97 ,$14.02 ,$25.97 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200659,N/A,HC CABLE FOR LEADS,272,1 ,$624.00 ,$411.84 ,$142.06 ,$624.00 , N/A ,$559.23 ,$559.23 ,$165.11 ,$499.20 ,$530.40 ,$390.00 ,$561.60 , N/A , N/A ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$165.11 ,$530.40 ,$530.40 ,$561.60 ,$380.02 , N/A ,$386.88 , N/A ,$561.60 , N/A ,$574.08 ,$561.60 ,$411.90 ,$411.90 ,$380.02 ,$411.90 ,$405.60 ,$426.32 ,$142.06 ,$492.96 , N/A ,$305.76 ,$305.76 ,$165.11 ,$305.76 , 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 ,$50.00 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200687,N/A,HC CANNULA ARTHREX NOTCHED,272,1 ,$10.40 ,$6.86 ,$2.36 ,$10.40 , N/A ,$9.32 ,$9.32 ,$2.75 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$2.75 ,$8.84 ,$8.84 ,$9.36 ,$6.33 , N/A ,$6.44 , N/A ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.87 ,$6.87 ,$6.33 ,$6.87 ,$6.76 ,$7.11 ,$2.36 ,$8.22 , N/A ,$5.10 ,$5.10 ,$2.75 ,$5.10 , N/A ,$9.88 ,$8.53 ,$8.53 ,$8.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200689,N/A,HC CANNULA ARTHROSCOPIC DYN,272,1 ,$47.40 ,$31.28 ,$10.79 ,$47.40 , N/A ,$42.48 ,$42.48 ,$12.54 ,$37.92 ,$40.29 ,$29.63 ,$42.66 , N/A , N/A ,$45.03 ,$42.66 ,$40.29 ,$40.29 ,$12.54 ,$40.29 ,$40.29 ,$42.66 ,$28.87 , N/A ,$29.38 , N/A ,$42.66 , N/A ,$43.61 ,$42.66 ,$31.29 ,$31.29 ,$28.87 ,$31.29 ,$30.81 ,$32.38 ,$10.79 ,$37.45 , N/A ,$23.23 ,$23.23 ,$12.54 ,$23.23 , N/A ,$45.03 ,$38.87 ,$38.87 ,$37.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200709,N/A,HC CANNULA PASSPORT BUTTON,272,1 ,$69.00 ,$45.54 ,$15.71 ,$69.00 , N/A ,$61.84 ,$61.84 ,$18.26 ,$55.20 ,$58.65 ,$43.13 ,$62.10 , N/A , N/A ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$18.26 ,$58.65 ,$58.65 ,$62.10 ,$42.02 , N/A ,$42.78 , N/A ,$62.10 , N/A ,$63.48 ,$62.10 ,$45.55 ,$45.55 ,$42.02 ,$45.55 ,$44.85 ,$47.14 ,$15.71 ,$54.51 , N/A ,$33.81 ,$33.81 ,$18.26 ,$33.81 , 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 ","$1,807.74 ",$623.54 ,"$2,739.00 ", N/A ,"$2,454.69 ","$2,454.69 ",$724.74 ,"$2,191.20 ","$2,328.15 ","$1,711.88 ","$2,465.10 ", N/A , N/A ,"$2,602.05 ","$2,465.10 ","$2,328.15 ","$2,328.15 ",$724.74 ,"$2,328.15 ","$2,328.15 ","$2,465.10 ","$1,668.05 ", N/A ,"$1,698.18 ", N/A ,"$2,465.10 ", N/A ,"$2,519.88 ","$2,465.10 ","$1,808.01 ","$1,808.01 ","$1,668.05 ","$1,808.01 ","$1,780.35 ","$1,871.28 ",$623.54 ,"$2,163.81 ", N/A ,"$1,342.11 ","$1,342.11 ",$724.74 ,"$1,342.11 ", 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 ,$29.33 ,$19.36 ,$6.68 ,$29.33 , N/A ,$26.29 ,$26.29 ,$7.76 ,$23.46 ,$24.93 ,$18.33 ,$26.40 , N/A , N/A ,$27.86 ,$26.40 ,$24.93 ,$24.93 ,$7.76 ,$24.93 ,$24.93 ,$26.40 ,$17.86 , N/A ,$18.18 , N/A ,$26.40 , N/A ,$26.98 ,$26.40 ,$19.36 ,$19.36 ,$17.86 ,$19.36 ,$19.06 ,$20.04 ,$6.68 ,$23.17 , N/A ,$14.37 ,$14.37 ,$7.76 ,$14.37 , N/A ,$27.86 ,$24.05 ,$24.05 ,$23.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200779,N/A,HC CATH COUDE 18FR 5CC,272,1 ,$30.00 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$25.74 ,$8.88 ,$39.00 , N/A ,$34.95 ,$34.95 ,$10.32 ,$31.20 ,$33.15 ,$24.38 ,$35.10 , N/A , N/A ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$10.32 ,$33.15 ,$33.15 ,$35.10 ,$23.75 , N/A ,$24.18 , N/A ,$35.10 , N/A ,$35.88 ,$35.10 ,$25.74 ,$25.74 ,$23.75 ,$25.74 ,$25.35 ,$26.64 ,$8.88 ,$30.81 , N/A ,$19.11 ,$19.11 ,$10.32 ,$19.11 , 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 ,$411.84 ,$142.06 ,$624.00 , N/A ,$559.23 ,$559.23 ,$165.11 ,$499.20 ,$530.40 ,$390.00 ,$561.60 , N/A , N/A ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$165.11 ,$530.40 ,$530.40 ,$561.60 ,$380.02 , N/A ,$386.88 , N/A ,$561.60 , N/A ,$574.08 ,$561.60 ,$411.90 ,$411.90 ,$380.02 ,$411.90 ,$405.60 ,$426.32 ,$142.06 ,$492.96 , N/A ,$305.76 ,$305.76 ,$165.11 ,$305.76 , 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 ,$208.56 ,$71.94 ,$316.00 , N/A ,$283.20 ,$283.20 ,$83.61 ,$252.80 ,$268.60 ,$197.50 ,$284.40 , N/A , N/A ,$300.20 ,$284.40 ,$268.60 ,$268.60 ,$83.61 ,$268.60 ,$268.60 ,$284.40 ,$192.44 , N/A ,$195.92 , N/A ,$284.40 , N/A ,$290.72 ,$284.40 ,$208.59 ,$208.59 ,$192.44 ,$208.59 ,$205.40 ,$215.89 ,$71.94 ,$249.64 , N/A ,$154.84 ,$154.84 ,$83.61 ,$154.84 , 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 ,$208.56 ,$71.94 ,$316.00 , N/A ,$283.20 ,$283.20 ,$83.61 ,$252.80 ,$268.60 ,$197.50 ,$284.40 , N/A , N/A ,$300.20 ,$284.40 ,$268.60 ,$268.60 ,$83.61 ,$268.60 ,$268.60 ,$284.40 ,$192.44 , N/A ,$195.92 , N/A ,$284.40 , N/A ,$290.72 ,$284.40 ,$208.59 ,$208.59 ,$192.44 ,$208.59 ,$205.40 ,$215.89 ,$71.94 ,$249.64 , N/A ,$154.84 ,$154.84 ,$83.61 ,$154.84 , 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 ,$208.56 ,$71.94 ,$316.00 , N/A ,$283.20 ,$283.20 ,$83.61 ,$252.80 ,$268.60 ,$197.50 ,$284.40 , N/A , N/A ,$300.20 ,$284.40 ,$268.60 ,$268.60 ,$83.61 ,$268.60 ,$268.60 ,$284.40 ,$192.44 , N/A ,$195.92 , N/A ,$284.40 , N/A ,$290.72 ,$284.40 ,$208.59 ,$208.59 ,$192.44 ,$208.59 ,$205.40 ,$215.89 ,$71.94 ,$249.64 , N/A ,$154.84 ,$154.84 ,$83.61 ,$154.84 , 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 ,$32.00 ,$21.12 ,$7.28 ,$32.00 , N/A ,$28.68 ,$28.68 ,$8.47 ,$25.60 ,$27.20 ,$20.00 ,$28.80 , N/A , N/A ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$8.47 ,$27.20 ,$27.20 ,$28.80 ,$19.49 , N/A ,$19.84 , N/A ,$28.80 , N/A ,$29.44 ,$28.80 ,$21.12 ,$21.12 ,$19.49 ,$21.12 ,$20.80 ,$21.86 ,$7.28 ,$25.28 , N/A ,$15.68 ,$15.68 ,$8.47 ,$15.68 , N/A ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200793,N/A,HC CATH FOLEY 22FR 30CC 2WAY EMMET,272,1 ,$33.00 ,$21.78 ,$7.52 ,$33.00 , N/A ,$29.57 ,$29.57 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , 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 ,$99.00 ,$34.15 ,$150.00 , N/A ,$134.43 ,$134.43 ,$39.69 ,$120.00 ,$127.50 ,$93.75 ,$135.00 , N/A , N/A ,$142.50 ,$135.00 ,$127.50 ,$127.50 ,$39.69 ,$127.50 ,$127.50 ,$135.00 ,$91.35 , N/A ,$93.00 , N/A ,$135.00 , N/A ,$138.00 ,$135.00 ,$99.02 ,$99.02 ,$91.35 ,$99.02 ,$97.50 ,$102.48 ,$34.15 ,$118.50 , N/A ,$73.50 ,$73.50 ,$39.69 ,$73.50 , 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 ,$338.58 ,$116.79 ,$513.00 , N/A ,$459.75 ,$459.75 ,$135.74 ,$410.40 ,$436.05 ,$320.63 ,$461.70 , N/A , N/A ,$487.35 ,$461.70 ,$436.05 ,$436.05 ,$135.74 ,$436.05 ,$436.05 ,$461.70 ,$312.42 , N/A ,$318.06 , N/A ,$461.70 , N/A ,$471.96 ,$461.70 ,$338.63 ,$338.63 ,$312.42 ,$338.63 ,$333.45 ,$350.48 ,$116.79 ,$405.27 , N/A ,$251.37 ,$251.37 ,$135.74 ,$251.37 , 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 ,$54.12 ,$18.67 ,$82.00 , N/A ,$73.49 ,$73.49 ,$21.70 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$21.70 ,$69.70 ,$69.70 ,$73.80 ,$49.94 , N/A ,$50.84 , N/A ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.13 ,$54.13 ,$49.94 ,$54.13 ,$53.30 ,$56.02 ,$18.67 ,$64.78 , N/A ,$40.18 ,$40.18 ,$21.70 ,$40.18 , 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 ,$60.72 ,$20.94 ,$92.00 , N/A ,$82.45 ,$82.45 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 , N/A , N/A ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 , N/A ,$57.04 , N/A ,$82.80 , N/A ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 , N/A ,$45.08 ,$45.08 ,$24.34 ,$45.08 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$63.36 ,$21.85 ,$96.00 , N/A ,$86.04 ,$86.04 ,$25.40 ,$76.80 ,$81.60 ,$60.00 ,$86.40 , N/A , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$25.40 ,$81.60 ,$81.60 ,$86.40 ,$58.46 , N/A ,$59.52 , N/A ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.37 ,$63.37 ,$58.46 ,$63.37 ,$62.40 ,$65.59 ,$21.85 ,$75.84 , N/A ,$47.04 ,$47.04 ,$25.40 ,$47.04 , 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 ,$118.00 ,$77.88 ,$26.86 ,$118.00 , N/A ,$105.75 ,$105.75 ,$31.22 ,$94.40 ,$100.30 ,$73.75 ,$106.20 , N/A , N/A ,$112.10 ,$106.20 ,$100.30 ,$100.30 ,$31.22 ,$100.30 ,$100.30 ,$106.20 ,$71.86 , N/A ,$73.16 , N/A ,$106.20 , N/A ,$108.56 ,$106.20 ,$77.89 ,$77.89 ,$71.86 ,$77.89 ,$76.70 ,$80.62 ,$26.86 ,$93.22 , N/A ,$57.82 ,$57.82 ,$31.22 ,$57.82 , N/A ,$112.10 ,$96.76 ,$96.76 ,$94.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200829,N/A,HC CATH THORACIC 16FR TO 36FR,272,1 ,$53.00 ,$34.98 ,$12.06 ,$53.00 , N/A ,$47.50 ,$47.50 ,$14.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A ,$25.97 ,$25.97 ,$14.02 ,$25.97 , 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 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$182.16 ,$62.83 ,$276.00 , N/A ,$247.35 ,$247.35 ,$73.03 ,$220.80 ,$234.60 ,$172.50 ,$248.40 , N/A , N/A ,$262.20 ,$248.40 ,$234.60 ,$234.60 ,$73.03 ,$234.60 ,$234.60 ,$248.40 ,$168.08 , N/A ,$171.12 , N/A ,$248.40 , N/A ,$253.92 ,$248.40 ,$182.19 ,$182.19 ,$168.08 ,$182.19 ,$179.40 ,$188.56 ,$62.83 ,$218.04 , N/A ,$135.24 ,$135.24 ,$73.03 ,$135.24 , 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 ,"$2,604.33 ","$1,718.86 ",$592.89 ,"$2,604.33 ", N/A ,"$2,334.00 ","$2,334.00 ",$689.11 ,"$2,083.46 ","$2,213.68 ","$1,627.71 ","$2,343.90 ", N/A , N/A ,"$2,474.11 ","$2,343.90 ","$2,213.68 ","$2,213.68 ",$689.11 ,"$2,213.68 ","$2,213.68 ","$2,343.90 ","$1,586.04 ", N/A ,"$1,614.68 ", N/A ,"$2,343.90 ", N/A ,"$2,395.98 ","$2,343.90 ","$1,719.12 ","$1,719.12 ","$1,586.04 ","$1,719.12 ","$1,692.81 ","$1,779.28 ",$592.89 ,"$2,057.42 ", N/A ,"$1,276.12 ","$1,276.12 ",$689.11 ,"$1,276.12 ", N/A ,"$2,474.11 ","$2,135.55 ","$2,135.55 ","$2,083.46 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27200849,N/A,HC CATHETER - FOLEY,272,1 ,$30.00 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$228.36 ,$78.77 ,$346.00 , N/A ,$310.09 ,$310.09 ,$91.55 ,$276.80 ,$294.10 ,$216.25 ,$311.40 , N/A , N/A ,$328.70 ,$311.40 ,$294.10 ,$294.10 ,$91.55 ,$294.10 ,$294.10 ,$311.40 ,$210.71 , N/A ,$214.52 , N/A ,$311.40 , N/A ,$318.32 ,$311.40 ,$228.39 ,$228.39 ,$210.71 ,$228.39 ,$224.90 ,$236.39 ,$78.77 ,$273.34 , N/A ,$169.54 ,$169.54 ,$91.55 ,$169.54 , 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 ,$550.44 ,$189.87 ,$834.00 , N/A ,$747.43 ,$747.43 ,$220.68 ,$667.20 ,$708.90 ,$521.25 ,$750.60 , N/A , N/A ,$792.30 ,$750.60 ,$708.90 ,$708.90 ,$220.68 ,$708.90 ,$708.90 ,$750.60 ,$507.91 , N/A ,$517.08 , N/A ,$750.60 , N/A ,$767.28 ,$750.60 ,$550.52 ,$550.52 ,$507.91 ,$550.52 ,$542.10 ,$569.79 ,$189.87 ,$658.86 , N/A ,$408.66 ,$408.66 ,$220.68 ,$408.66 , 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 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , N/A ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200871,N/A,HC CAUT ELLMAN TIP,272,1 ,$22.00 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200875,N/A,HC CAUT KNIFE CLEANER CARD,272,1 ,$3.10 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$360.36 ,$124.30 ,$546.00 , N/A ,$489.33 ,$489.33 ,$144.47 ,$436.80 ,$464.10 ,$341.25 ,$491.40 , N/A , N/A ,$518.70 ,$491.40 ,$464.10 ,$464.10 ,$144.47 ,$464.10 ,$464.10 ,$491.40 ,$332.51 , N/A ,$338.52 , N/A ,$491.40 , N/A ,$502.32 ,$491.40 ,$360.41 ,$360.41 ,$332.51 ,$360.41 ,$354.90 ,$373.03 ,$124.30 ,$431.34 , N/A ,$267.54 ,$267.54 ,$144.47 ,$267.54 , 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 ","$3,065.70 ","$1,057.45 ","$4,645.00 ", N/A ,"$4,162.85 ","$4,162.85 ","$1,229.07 ","$3,716.00 ","$3,948.25 ","$2,903.13 ","$4,180.50 ", N/A , N/A ,"$4,412.75 ","$4,180.50 ","$3,948.25 ","$3,948.25 ","$1,229.07 ","$3,948.25 ","$3,948.25 ","$4,180.50 ","$2,828.81 ", N/A ,"$2,879.90 ", N/A ,"$4,180.50 ", N/A ,"$4,273.40 ","$4,180.50 ","$3,066.16 ","$3,066.16 ","$2,828.81 ","$3,066.16 ","$3,019.25 ","$3,173.46 ","$1,057.45 ","$3,669.55 ", N/A ,"$2,276.05 ","$2,276.05 ","$1,229.07 ","$2,276.05 ", 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 ,$64.02 ,$22.08 ,$97.00 , N/A ,$86.93 ,$86.93 ,$25.67 ,$77.60 ,$82.45 ,$60.63 ,$87.30 , N/A , N/A ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$25.67 ,$82.45 ,$82.45 ,$87.30 ,$59.07 , N/A ,$60.14 , N/A ,$87.30 , N/A ,$89.24 ,$87.30 ,$64.03 ,$64.03 ,$59.07 ,$64.03 ,$63.05 ,$66.27 ,$22.08 ,$76.63 , N/A ,$47.53 ,$47.53 ,$25.67 ,$47.53 , 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 ,$102.96 ,$35.52 ,$156.00 , N/A ,$139.81 ,$139.81 ,$41.28 ,$124.80 ,$132.60 ,$97.50 ,$140.40 , N/A , N/A ,$148.20 ,$140.40 ,$132.60 ,$132.60 ,$41.28 ,$132.60 ,$132.60 ,$140.40 ,$95.00 , N/A ,$96.72 , N/A ,$140.40 , N/A ,$143.52 ,$140.40 ,$102.98 ,$102.98 ,$95.00 ,$102.98 ,$101.40 ,$106.58 ,$35.52 ,$123.24 , N/A ,$76.44 ,$76.44 ,$41.28 ,$76.44 , 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 ","$1,537.14 ",$530.21 ,"$2,329.00 ", N/A ,"$2,087.25 ","$2,087.25 ",$616.25 ,"$1,863.20 ","$1,979.65 ","$1,455.63 ","$2,096.10 ", N/A , N/A ,"$2,212.55 ","$2,096.10 ","$1,979.65 ","$1,979.65 ",$616.25 ,"$1,979.65 ","$1,979.65 ","$2,096.10 ","$1,418.36 ", N/A ,"$1,443.98 ", N/A ,"$2,096.10 ", N/A ,"$2,142.68 ","$2,096.10 ","$1,537.37 ","$1,537.37 ","$1,418.36 ","$1,537.37 ","$1,513.85 ","$1,591.17 ",$530.21 ,"$1,839.91 ", N/A ,"$1,141.21 ","$1,141.21 ",$616.25 ,"$1,141.21 ", 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 ","$1,728.54 ",$596.22 ,"$2,619.00 ", N/A ,"$2,347.15 ","$2,347.15 ",$692.99 ,"$2,095.20 ","$2,226.15 ","$1,636.88 ","$2,357.10 ", N/A , N/A ,"$2,488.05 ","$2,357.10 ","$2,226.15 ","$2,226.15 ",$692.99 ,"$2,226.15 ","$2,226.15 ","$2,357.10 ","$1,594.97 ", N/A ,"$1,623.78 ", N/A ,"$2,357.10 ", N/A ,"$2,409.48 ","$2,357.10 ","$1,728.80 ","$1,728.80 ","$1,594.97 ","$1,728.80 ","$1,702.35 ","$1,789.30 ",$596.22 ,"$2,069.01 ", N/A ,"$1,283.31 ","$1,283.31 ",$692.99 ,"$1,283.31 ", 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 ","$1,701.48 ",$586.89 ,"$2,578.00 ", N/A ,"$2,310.40 ","$2,310.40 ",$682.14 ,"$2,062.40 ","$2,191.30 ","$1,611.25 ","$2,320.20 ", N/A , N/A ,"$2,449.10 ","$2,320.20 ","$2,191.30 ","$2,191.30 ",$682.14 ,"$2,191.30 ","$2,191.30 ","$2,320.20 ","$1,570.00 ", N/A ,"$1,598.36 ", N/A ,"$2,320.20 ", N/A ,"$2,371.76 ","$2,320.20 ","$1,701.74 ","$1,701.74 ","$1,570.00 ","$1,701.74 ","$1,675.70 ","$1,761.29 ",$586.89 ,"$2,036.62 ", N/A ,"$1,263.22 ","$1,263.22 ",$682.14 ,"$1,263.22 ", 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 ",$967.56 ,$333.74 ,"$1,466.00 ", N/A ,"$1,313.83 ","$1,313.83 ",$387.90 ,"$1,172.80 ","$1,246.10 ",$916.25 ,"$1,319.40 ", N/A , N/A ,"$1,392.70 ","$1,319.40 ","$1,246.10 ","$1,246.10 ",$387.90 ,"$1,246.10 ","$1,246.10 ","$1,319.40 ",$892.79 , N/A ,$908.92 , N/A ,"$1,319.40 ", N/A ,"$1,348.72 ","$1,319.40 ",$967.71 ,$967.71 ,$892.79 ,$967.71 ,$952.90 ,"$1,001.57 ",$333.74 ,"$1,158.14 ", N/A ,$718.34 ,$718.34 ,$387.90 ,$718.34 , 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 ","$1,486.32 ",$512.68 ,"$2,252.00 ", N/A ,"$2,018.24 ","$2,018.24 ",$595.88 ,"$1,801.60 ","$1,914.20 ","$1,407.50 ","$2,026.80 ", N/A , N/A ,"$2,139.40 ","$2,026.80 ","$1,914.20 ","$1,914.20 ",$595.88 ,"$1,914.20 ","$1,914.20 ","$2,026.80 ","$1,371.47 ", N/A ,"$1,396.24 ", N/A ,"$2,026.80 ", N/A ,"$2,071.84 ","$2,026.80 ","$1,486.55 ","$1,486.55 ","$1,371.47 ","$1,486.55 ","$1,463.80 ","$1,538.57 ",$512.68 ,"$1,779.08 ", N/A ,"$1,103.48 ","$1,103.48 ",$595.88 ,"$1,103.48 ", 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 ","$1,192.62 ",$411.37 ,"$1,807.00 ", N/A ,"$1,619.43 ","$1,619.43 ",$478.13 ,"$1,445.60 ","$1,535.95 ","$1,129.38 ","$1,626.30 ", N/A , N/A ,"$1,716.65 ","$1,626.30 ","$1,535.95 ","$1,535.95 ",$478.13 ,"$1,535.95 ","$1,535.95 ","$1,626.30 ","$1,100.46 ", N/A ,"$1,120.34 ", N/A ,"$1,626.30 ", N/A ,"$1,662.44 ","$1,626.30 ","$1,192.80 ","$1,192.80 ","$1,100.46 ","$1,192.80 ","$1,174.55 ","$1,234.54 ",$411.37 ,"$1,427.53 ", N/A ,$885.43 ,$885.43 ,$478.13 ,$885.43 , 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 ","$1,519.32 ",$524.05 ,"$2,302.00 ", N/A ,"$2,063.05 ","$2,063.05 ",$609.11 ,"$1,841.60 ","$1,956.70 ","$1,438.75 ","$2,071.80 ", N/A , N/A ,"$2,186.90 ","$2,071.80 ","$1,956.70 ","$1,956.70 ",$609.11 ,"$1,956.70 ","$1,956.70 ","$2,071.80 ","$1,401.92 ", N/A ,"$1,427.24 ", N/A ,"$2,071.80 ", N/A ,"$2,117.84 ","$2,071.80 ","$1,519.55 ","$1,519.55 ","$1,401.92 ","$1,519.55 ","$1,496.30 ","$1,572.73 ",$524.05 ,"$1,818.58 ", N/A ,"$1,127.98 ","$1,127.98 ",$609.11 ,"$1,127.98 ", 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 ,$452.56 ,$298.69 ,$103.03 ,$452.56 , N/A ,$405.58 ,$405.58 ,$119.75 ,$362.05 ,$384.68 ,$282.85 ,$407.30 , N/A , N/A ,$429.93 ,$407.30 ,$384.68 ,$384.68 ,$119.75 ,$384.68 ,$384.68 ,$407.30 ,$275.61 , N/A ,$280.58 , N/A ,$407.30 , N/A ,$416.36 ,$407.30 ,$298.73 ,$298.73 ,$275.61 ,$298.73 ,$294.16 ,$309.19 ,$103.03 ,$357.52 , N/A ,$221.75 ,$221.75 ,$119.75 ,$221.75 , N/A ,$429.93 ,$371.10 ,$371.10 ,$362.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200928,N/A,"HC CLIP APPLIER SM,MED,LRG",272,1 ,$177.50 ,$117.15 ,$40.42 ,$177.50 , N/A ,$159.08 ,$159.08 ,$46.97 ,$142.00 ,$150.88 ,$110.94 ,$159.75 , N/A , N/A ,$168.63 ,$159.75 ,$150.88 ,$150.88 ,$46.97 ,$150.88 ,$150.88 ,$159.75 ,$108.10 , N/A ,$110.06 , N/A ,$159.75 , N/A ,$163.30 ,$159.75 ,$117.17 ,$117.17 ,$108.10 ,$117.17 ,$115.38 ,$121.27 ,$40.42 ,$140.23 , N/A ,$86.98 ,$86.98 ,$46.97 ,$86.98 , N/A ,$168.63 ,$145.55 ,$145.55 ,$142.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200933,N/A,HC CLIP HEMOSTASIS,272,1 ,$485.57 ,$320.48 ,$110.54 ,$485.57 , N/A ,$435.17 ,$435.17 ,$128.48 ,$388.46 ,$412.73 ,$303.48 ,$437.01 , N/A , N/A ,$461.29 ,$437.01 ,$412.73 ,$412.73 ,$128.48 ,$412.73 ,$412.73 ,$437.01 ,$295.71 , N/A ,$301.06 , N/A ,$437.01 , N/A ,$446.72 ,$437.01 ,$320.52 ,$320.52 ,$295.71 ,$320.52 ,$315.62 ,$331.74 ,$110.54 ,$383.60 , N/A ,$237.93 ,$237.93 ,$128.48 ,$237.93 , N/A ,$461.29 ,$398.17 ,$398.17 ,$388.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200943,N/A,"HC COBAN 1 PER ROLL """,272,1 ,$4.10 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , 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 ,$3.43 ,$1.19 ,$5.20 , N/A ,$4.66 ,$4.66 ,$1.37 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.37 ,$4.42 ,$4.42 ,$4.68 ,$3.17 , N/A ,$3.22 , N/A ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.43 ,$3.43 ,$3.17 ,$3.43 ,$3.38 ,$3.55 ,$1.19 ,$4.11 , N/A ,$2.55 ,$2.55 ,$1.37 ,$2.55 , 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 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$9.57 ,$3.30 ,$14.50 , N/A ,$12.99 ,$12.99 ,$3.84 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$3.84 ,$12.33 ,$12.33 ,$13.05 ,$8.83 , N/A ,$9.00 , N/A ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.57 ,$9.57 ,$8.83 ,$9.57 ,$9.43 ,$9.91 ,$3.30 ,$11.46 , N/A ,$7.11 ,$7.11 ,$3.84 ,$7.11 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$9.57 ,$3.30 ,$14.50 , N/A ,$12.99 ,$12.99 ,$3.84 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$3.84 ,$12.33 ,$12.33 ,$13.05 ,$8.83 , N/A ,$9.00 , N/A ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.57 ,$9.57 ,$8.83 ,$9.57 ,$9.43 ,$9.91 ,$3.30 ,$11.46 , N/A ,$7.11 ,$7.11 ,$3.84 ,$7.11 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200987,N/A,HC CORD BIPOLAR DISP,272,1 ,$17.67 ,$11.66 ,$4.02 ,$17.67 , N/A ,$15.84 ,$15.84 ,$4.67 ,$14.14 ,$15.02 ,$11.04 ,$15.90 , N/A , N/A ,$16.79 ,$15.90 ,$15.02 ,$15.02 ,$4.67 ,$15.02 ,$15.02 ,$15.90 ,$10.76 , N/A ,$10.96 , N/A ,$15.90 , N/A ,$16.26 ,$15.90 ,$11.66 ,$11.66 ,$10.76 ,$11.66 ,$11.49 ,$12.07 ,$4.02 ,$13.96 , N/A ,$8.66 ,$8.66 ,$4.67 ,$8.66 , N/A ,$16.79 ,$14.49 ,$14.49 ,$14.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27200998,N/A,HC COTTONOIDS 1X3 10PK,272,1 ,$26.00 ,$17.16 ,$5.92 ,$26.00 , N/A ,$23.30 ,$23.30 ,$6.88 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$6.88 ,$22.10 ,$22.10 ,$23.40 ,$15.83 , N/A ,$16.12 , N/A ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.16 ,$17.16 ,$15.83 ,$17.16 ,$16.90 ,$17.76 ,$5.92 ,$20.54 , N/A ,$12.74 ,$12.74 ,$6.88 ,$12.74 , 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 ,$332.64 ,$114.74 ,$504.00 , N/A ,$451.68 ,$451.68 ,$133.36 ,$403.20 ,$428.40 ,$315.00 ,$453.60 , N/A , N/A ,$478.80 ,$453.60 ,$428.40 ,$428.40 ,$133.36 ,$428.40 ,$428.40 ,$453.60 ,$306.94 , N/A ,$312.48 , N/A ,$453.60 , N/A ,$463.68 ,$453.60 ,$332.69 ,$332.69 ,$306.94 ,$332.69 ,$327.60 ,$344.33 ,$114.74 ,$398.16 , N/A ,$246.96 ,$246.96 ,$133.36 ,$246.96 , 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 ,$586.08 ,$202.15 ,$888.00 , N/A ,$795.83 ,$795.83 ,$234.96 ,$710.40 ,$754.80 ,$555.00 ,$799.20 , N/A , N/A ,$843.60 ,$799.20 ,$754.80 ,$754.80 ,$234.96 ,$754.80 ,$754.80 ,$799.20 ,$540.79 , N/A ,$550.56 , N/A ,$799.20 , N/A ,$816.96 ,$799.20 ,$586.17 ,$586.17 ,$540.79 ,$586.17 ,$577.20 ,$606.68 ,$202.15 ,$701.52 , N/A ,$435.12 ,$435.12 ,$234.96 ,$435.12 , 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 ,$54.78 ,$18.89 ,$83.00 , N/A ,$74.38 ,$74.38 ,$21.96 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$21.96 ,$70.55 ,$70.55 ,$74.70 ,$50.55 , N/A ,$51.46 , N/A ,$74.70 , N/A ,$76.36 ,$74.70 ,$54.79 ,$54.79 ,$50.55 ,$54.79 ,$53.95 ,$56.71 ,$18.89 ,$65.57 , N/A ,$40.67 ,$40.67 ,$21.96 ,$40.67 , 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 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , 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 ,$86.00 ,$56.76 ,$19.58 ,$86.00 , N/A ,$77.07 ,$77.07 ,$22.76 ,$68.80 ,$73.10 ,$53.75 ,$77.40 , N/A , N/A ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$22.76 ,$73.10 ,$73.10 ,$77.40 ,$52.37 , N/A ,$53.32 , N/A ,$77.40 , N/A ,$79.12 ,$77.40 ,$56.77 ,$56.77 ,$52.37 ,$56.77 ,$55.90 ,$58.76 ,$19.58 ,$67.94 , N/A ,$42.14 ,$42.14 ,$22.76 ,$42.14 , N/A ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201024,N/A,HC CUFF TOURNIQUET 8IN,272,1 ,$51.00 ,$33.66 ,$11.61 ,$51.00 , N/A ,$45.71 ,$45.71 ,$13.49 ,$40.80 ,$43.35 ,$31.88 ,$45.90 , N/A , N/A ,$48.45 ,$45.90 ,$43.35 ,$43.35 ,$13.49 ,$43.35 ,$43.35 ,$45.90 ,$31.06 , N/A ,$31.62 , N/A ,$45.90 , N/A ,$46.92 ,$45.90 ,$33.67 ,$33.67 ,$31.06 ,$33.67 ,$33.15 ,$34.84 ,$11.61 ,$40.29 , N/A ,$24.99 ,$24.99 ,$13.49 ,$24.99 , N/A ,$48.45 ,$41.82 ,$41.82 ,$40.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201025,N/A,HC CUFF TOURNIQUET PEDIATRIC,272,1 ,$79.33 ,$52.36 ,$18.06 ,$79.33 , N/A ,$71.10 ,$71.10 ,$20.99 ,$63.46 ,$67.43 ,$49.58 ,$71.40 , N/A , N/A ,$75.36 ,$71.40 ,$67.43 ,$67.43 ,$20.99 ,$67.43 ,$67.43 ,$71.40 ,$48.31 , N/A ,$49.18 , N/A ,$71.40 , N/A ,$72.98 ,$71.40 ,$52.37 ,$52.37 ,$48.31 ,$52.37 ,$51.56 ,$54.20 ,$18.06 ,$62.67 , N/A ,$38.87 ,$38.87 ,$20.99 ,$38.87 , N/A ,$75.36 ,$65.05 ,$65.05 ,$63.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201042,N/A,HC DERMABOND,272,1 ,$73.00 ,$48.18 ,$16.62 ,$73.00 , N/A ,$65.42 ,$65.42 ,$19.32 ,$58.40 ,$62.05 ,$45.63 ,$65.70 , N/A , N/A ,$69.35 ,$65.70 ,$62.05 ,$62.05 ,$19.32 ,$62.05 ,$62.05 ,$65.70 ,$44.46 , N/A ,$45.26 , N/A ,$65.70 , N/A ,$67.16 ,$65.70 ,$48.19 ,$48.19 ,$44.46 ,$48.19 ,$47.45 ,$49.87 ,$16.62 ,$57.67 , N/A ,$35.77 ,$35.77 ,$19.32 ,$35.77 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$227.70 ,$78.54 ,$345.00 , N/A ,$309.19 ,$309.19 ,$91.29 ,$276.00 ,$293.25 ,$215.63 ,$310.50 , N/A , N/A ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$91.29 ,$293.25 ,$293.25 ,$310.50 ,$210.11 , N/A ,$213.90 , N/A ,$310.50 , N/A ,$317.40 ,$310.50 ,$227.73 ,$227.73 ,$210.11 ,$227.73 ,$224.25 ,$235.70 ,$78.54 ,$272.55 , N/A ,$169.05 ,$169.05 ,$91.29 ,$169.05 , 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 ,$154.44 ,$53.27 ,$234.00 , N/A ,$209.71 ,$209.71 ,$61.92 ,$187.20 ,$198.90 ,$146.25 ,$210.60 , N/A , N/A ,$222.30 ,$210.60 ,$198.90 ,$198.90 ,$61.92 ,$198.90 ,$198.90 ,$210.60 ,$142.51 , N/A ,$145.08 , N/A ,$210.60 , N/A ,$215.28 ,$210.60 ,$154.46 ,$154.46 ,$142.51 ,$154.46 ,$152.10 ,$159.87 ,$53.27 ,$184.86 , N/A ,$114.66 ,$114.66 ,$61.92 ,$114.66 , 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 ","$1,151.70 ",$397.25 ,"$1,745.00 ", N/A ,"$1,563.87 ","$1,563.87 ",$461.73 ,"$1,396.00 ","$1,483.25 ","$1,090.63 ","$1,570.50 ", N/A , N/A ,"$1,657.75 ","$1,570.50 ","$1,483.25 ","$1,483.25 ",$461.73 ,"$1,483.25 ","$1,483.25 ","$1,570.50 ","$1,062.71 ", N/A ,"$1,081.90 ", N/A ,"$1,570.50 ", N/A ,"$1,605.40 ","$1,570.50 ","$1,151.87 ","$1,151.87 ","$1,062.71 ","$1,151.87 ","$1,134.25 ","$1,192.18 ",$397.25 ,"$1,378.55 ", N/A ,$855.05 ,$855.05 ,$461.73 ,$855.05 , 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 ,$430.32 ,$148.43 ,$652.00 , N/A ,$584.32 ,$584.32 ,$172.52 ,$521.60 ,$554.20 ,$407.50 ,$586.80 , N/A , N/A ,$619.40 ,$586.80 ,$554.20 ,$554.20 ,$172.52 ,$554.20 ,$554.20 ,$586.80 ,$397.07 , N/A ,$404.24 , N/A ,$586.80 , N/A ,$599.84 ,$586.80 ,$430.39 ,$430.39 ,$397.07 ,$430.39 ,$423.80 ,$445.45 ,$148.43 ,$515.08 , N/A ,$319.48 ,$319.48 ,$172.52 ,$319.48 , 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 ,$56.10 ,$19.35 ,$85.00 , N/A ,$76.18 ,$76.18 ,$22.49 ,$68.00 ,$72.25 ,$53.13 ,$76.50 , N/A , N/A ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$22.49 ,$72.25 ,$72.25 ,$76.50 ,$51.77 , N/A ,$52.70 , N/A ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.11 ,$56.11 ,$51.77 ,$56.11 ,$55.25 ,$58.07 ,$19.35 ,$67.15 , N/A ,$41.65 ,$41.65 ,$22.49 ,$41.65 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ,$13.29 ,$8.77 ,$3.03 ,$13.29 , N/A ,$11.91 ,$11.91 ,$3.52 ,$10.63 ,$11.30 ,$8.31 ,$11.96 , N/A , N/A ,$12.63 ,$11.96 ,$11.30 ,$11.30 ,$3.52 ,$11.30 ,$11.30 ,$11.96 ,$8.09 , N/A ,$8.24 , N/A ,$11.96 , N/A ,$12.23 ,$11.96 ,$8.77 ,$8.77 ,$8.09 ,$8.77 ,$8.64 ,$9.08 ,$3.03 ,$10.50 , N/A ,$6.51 ,$6.51 ,$3.52 ,$6.51 , N/A ,$12.63 ,$10.90 ,$10.90 ,$10.63 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201110,N/A,HC DRAIN 10MM FLAT,272,1 ,$11.40 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$3.43 ,$1.19 ,$5.20 , N/A ,$4.66 ,$4.66 ,$1.37 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.37 ,$4.42 ,$4.42 ,$4.68 ,$3.17 , N/A ,$3.22 , N/A ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.43 ,$3.43 ,$3.17 ,$3.43 ,$3.38 ,$3.55 ,$1.19 ,$4.11 , N/A ,$2.55 ,$2.55 ,$1.37 ,$2.55 , 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 ,$18.48 ,$6.37 ,$28.00 , N/A ,$25.09 ,$25.09 ,$7.41 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$7.41 ,$23.80 ,$23.80 ,$25.20 ,$17.05 , N/A ,$17.36 , N/A ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.48 ,$18.48 ,$17.05 ,$18.48 ,$18.20 ,$19.13 ,$6.37 ,$22.12 , N/A ,$13.72 ,$13.72 ,$7.41 ,$13.72 , 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 ,$143.22 ,$49.40 ,$217.00 , N/A ,$194.48 ,$194.48 ,$57.42 ,$173.60 ,$184.45 ,$135.63 ,$195.30 , N/A , N/A ,$206.15 ,$195.30 ,$184.45 ,$184.45 ,$57.42 ,$184.45 ,$184.45 ,$195.30 ,$132.15 , N/A ,$134.54 , N/A ,$195.30 , N/A ,$199.64 ,$195.30 ,$143.24 ,$143.24 ,$132.15 ,$143.24 ,$141.05 ,$148.25 ,$49.40 ,$171.43 , N/A ,$106.33 ,$106.33 ,$57.42 ,$106.33 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , N/A ,$2.95 ,$2.54 ,$2.54 ,$2.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201158,N/A,HC DRSG BIO PATCH,272,1 ,$22.70 ,$14.98 ,$5.16 ,$22.70 , N/A ,$20.34 ,$20.34 ,$6.01 ,$18.16 ,$19.30 ,$14.19 ,$20.43 , N/A , N/A ,$21.57 ,$20.43 ,$19.30 ,$19.30 ,$6.01 ,$19.30 ,$19.30 ,$20.43 ,$13.82 , N/A ,$14.08 , N/A ,$20.43 , N/A ,$20.88 ,$20.43 ,$14.98 ,$14.98 ,$13.82 ,$14.98 ,$14.76 ,$15.51 ,$5.16 ,$17.93 , N/A ,$11.12 ,$11.12 ,$6.01 ,$11.12 , N/A ,$21.57 ,$18.61 ,$18.61 ,$18.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201161,N/A,HC DRSG DUO DERM 6X6,272,1 ,$9.30 ,$6.14 ,$2.12 ,$9.30 , N/A ,$8.33 ,$8.33 ,$2.46 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.37 ,$5.66 , N/A ,$5.76 , N/A ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.14 ,$6.14 ,$5.66 ,$6.14 ,$6.05 ,$6.35 ,$2.12 ,$7.35 , N/A ,$4.56 ,$4.56 ,$2.46 ,$4.56 , 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 ,$243.54 ,$84.01 ,$369.00 , N/A ,$330.70 ,$330.70 ,$97.64 ,$295.20 ,$313.65 ,$230.63 ,$332.10 , N/A , N/A ,$350.55 ,$332.10 ,$313.65 ,$313.65 ,$97.64 ,$313.65 ,$313.65 ,$332.10 ,$224.72 , N/A ,$228.78 , N/A ,$332.10 , N/A ,$339.48 ,$332.10 ,$243.58 ,$243.58 ,$224.72 ,$243.58 ,$239.85 ,$252.10 ,$84.01 ,$291.51 , N/A ,$180.81 ,$180.81 ,$97.64 ,$180.81 , 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 ,$38.94 ,$13.44 ,$59.00 , N/A ,$52.88 ,$52.88 ,$15.61 ,$47.20 ,$50.15 ,$36.88 ,$53.10 , N/A , N/A ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$15.61 ,$50.15 ,$50.15 ,$53.10 ,$35.93 , N/A ,$36.58 , N/A ,$53.10 , N/A ,$54.28 ,$53.10 ,$38.95 ,$38.95 ,$35.93 ,$38.95 ,$38.35 ,$40.31 ,$13.44 ,$46.61 , N/A ,$28.91 ,$28.91 ,$15.61 ,$28.91 , 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 ,$168.30 ,$58.06 ,$255.00 , N/A ,$228.53 ,$228.53 ,$67.47 ,$204.00 ,$216.75 ,$159.38 ,$229.50 , N/A , N/A ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$67.47 ,$216.75 ,$216.75 ,$229.50 ,$155.30 , N/A ,$158.10 , N/A ,$229.50 , N/A ,$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 , N/A ,$124.95 ,$124.95 ,$67.47 ,$124.95 , 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 ,$168.30 ,$58.06 ,$255.00 , N/A ,$228.53 ,$228.53 ,$67.47 ,$204.00 ,$216.75 ,$159.38 ,$229.50 , N/A , N/A ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$67.47 ,$216.75 ,$216.75 ,$229.50 ,$155.30 , N/A ,$158.10 , N/A ,$229.50 , N/A ,$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 , N/A ,$124.95 ,$124.95 ,$67.47 ,$124.95 , 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 ,$131.34 ,$45.31 ,$199.00 , N/A ,$178.34 ,$178.34 ,$52.66 ,$159.20 ,$169.15 ,$124.38 ,$179.10 , N/A , N/A ,$189.05 ,$179.10 ,$169.15 ,$169.15 ,$52.66 ,$169.15 ,$169.15 ,$179.10 ,$121.19 , N/A ,$123.38 , N/A ,$179.10 , N/A ,$183.08 ,$179.10 ,$131.36 ,$131.36 ,$121.19 ,$131.36 ,$129.35 ,$135.96 ,$45.31 ,$157.21 , N/A ,$97.51 ,$97.51 ,$52.66 ,$97.51 , 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 ,$40.92 ,$14.11 ,$62.00 , N/A ,$55.56 ,$55.56 ,$16.41 ,$49.60 ,$52.70 ,$38.75 ,$55.80 , N/A , N/A ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$16.41 ,$52.70 ,$52.70 ,$55.80 ,$37.76 , N/A ,$38.44 , N/A ,$55.80 , N/A ,$57.04 ,$55.80 ,$40.93 ,$40.93 ,$37.76 ,$40.93 ,$40.30 ,$42.36 ,$14.11 ,$48.98 , N/A ,$30.38 ,$30.38 ,$16.41 ,$30.38 , 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 ,$566.94 ,$195.56 ,$859.00 , N/A ,$769.84 ,$769.84 ,$227.29 ,$687.20 ,$730.15 ,$536.88 ,$773.10 , N/A , N/A ,$816.05 ,$773.10 ,$730.15 ,$730.15 ,$227.29 ,$730.15 ,$730.15 ,$773.10 ,$523.13 , N/A ,$532.58 , N/A ,$773.10 , N/A ,$790.28 ,$773.10 ,$567.03 ,$567.03 ,$523.13 ,$567.03 ,$558.35 ,$586.87 ,$195.56 ,$678.61 , N/A ,$420.91 ,$420.91 ,$227.29 ,$420.91 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , N/A ,$28.50 ,$24.60 ,$24.60 ,$24.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201220,N/A,HC ENDIPOUCH/ENDOCATCH,272,1 ,$226.47 ,$149.47 ,$51.56 ,$226.47 , N/A ,$202.96 ,$202.96 ,$59.93 ,$181.18 ,$192.50 ,$141.54 ,$203.82 , N/A , N/A ,$215.15 ,$203.82 ,$192.50 ,$192.50 ,$59.93 ,$192.50 ,$192.50 ,$203.82 ,$137.92 , N/A ,$140.42 , N/A ,$203.82 , N/A ,$208.35 ,$203.82 ,$149.49 ,$149.49 ,$137.92 ,$149.49 ,$147.21 ,$154.72 ,$51.56 ,$178.91 , N/A ,$110.97 ,$110.97 ,$59.93 ,$110.97 , N/A ,$215.15 ,$185.71 ,$185.71 ,$181.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201225,N/A,HC ENDO CLIP APPLIER,272,1 ,"$1,002.00 ",$661.32 ,$228.10 ,"$1,002.00 ", N/A ,$897.99 ,$897.99 ,$265.13 ,$801.60 ,$851.70 ,$626.25 ,$901.80 , N/A , N/A ,$951.90 ,$901.80 ,$851.70 ,$851.70 ,$265.13 ,$851.70 ,$851.70 ,$901.80 ,$610.22 , N/A ,$621.24 , N/A ,$901.80 , N/A ,$921.84 ,$901.80 ,$661.42 ,$661.42 ,$610.22 ,$661.42 ,$651.30 ,$684.57 ,$228.10 ,$791.58 , N/A ,$490.98 ,$490.98 ,$265.13 ,$490.98 , 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 ,$243.54 ,$84.01 ,$369.00 , N/A ,$330.70 ,$330.70 ,$97.64 ,$295.20 ,$313.65 ,$230.63 ,$332.10 , N/A , N/A ,$350.55 ,$332.10 ,$313.65 ,$313.65 ,$97.64 ,$313.65 ,$313.65 ,$332.10 ,$224.72 , N/A ,$228.78 , N/A ,$332.10 , N/A ,$339.48 ,$332.10 ,$243.58 ,$243.58 ,$224.72 ,$243.58 ,$239.85 ,$252.10 ,$84.01 ,$291.51 , N/A ,$180.81 ,$180.81 ,$97.64 ,$180.81 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ",$670.56 ,$231.30 ,"$1,016.00 ", N/A ,$910.54 ,$910.54 ,$268.83 ,$812.80 ,$863.60 ,$635.00 ,$914.40 , N/A , N/A ,$965.20 ,$914.40 ,$863.60 ,$863.60 ,$268.83 ,$863.60 ,$863.60 ,$914.40 ,$618.74 , N/A ,$629.92 , N/A ,$914.40 , N/A ,$934.72 ,$914.40 ,$670.66 ,$670.66 ,$618.74 ,$670.66 ,$660.40 ,$694.13 ,$231.30 ,$802.64 , N/A ,$497.84 ,$497.84 ,$268.83 ,$497.84 , N/A ,$965.20 ,$833.12 ,$833.12 ,$812.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201242,N/A,HC ENDOSCOPIC LIGATOR,272,1 ,$113.00 ,$74.58 ,$25.72 ,$113.00 , N/A ,$101.27 ,$101.27 ,$29.90 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$29.90 ,$96.05 ,$96.05 ,$101.70 ,$68.82 , N/A ,$70.06 , N/A ,$101.70 , N/A ,$103.96 ,$101.70 ,$74.59 ,$74.59 ,$68.82 ,$74.59 ,$73.45 ,$77.20 ,$25.72 ,$89.27 , N/A ,$55.37 ,$55.37 ,$29.90 ,$55.37 , N/A ,$107.35 ,$92.66 ,$92.66 ,$90.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201243,N/A,HC ENDOSTITCH 0/2-0 BRALON,272,1 ,$193.00 ,$127.38 ,$43.93 ,$193.00 , N/A ,$172.97 ,$172.97 ,$51.07 ,$154.40 ,$164.05 ,$120.63 ,$173.70 , N/A , N/A ,$183.35 ,$173.70 ,$164.05 ,$164.05 ,$51.07 ,$164.05 ,$164.05 ,$173.70 ,$117.54 , N/A ,$119.66 , N/A ,$173.70 , N/A ,$177.56 ,$173.70 ,$127.40 ,$127.40 ,$117.54 ,$127.40 ,$125.45 ,$131.86 ,$43.93 ,$152.47 , N/A ,$94.57 ,$94.57 ,$51.07 ,$94.57 , 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 ,$590.04 ,$203.53 ,$894.00 , N/A ,$801.20 ,$801.20 ,$236.55 ,$715.20 ,$759.90 ,$558.75 ,$804.60 , N/A , N/A ,$849.30 ,$804.60 ,$759.90 ,$759.90 ,$236.55 ,$759.90 ,$759.90 ,$804.60 ,$544.45 , N/A ,$554.28 , N/A ,$804.60 , N/A ,$822.48 ,$804.60 ,$590.13 ,$590.13 ,$544.45 ,$590.13 ,$581.10 ,$610.78 ,$203.53 ,$706.26 , N/A ,$438.06 ,$438.06 ,$236.55 ,$438.06 , 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 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$27.06 ,$9.33 ,$41.00 , N/A ,$36.74 ,$36.74 ,$10.85 ,$32.80 ,$34.85 ,$25.63 ,$36.90 , N/A , N/A ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$10.85 ,$34.85 ,$34.85 ,$36.90 ,$24.97 , N/A ,$25.42 , N/A ,$36.90 , N/A ,$37.72 ,$36.90 ,$27.06 ,$27.06 ,$24.97 ,$27.06 ,$26.65 ,$28.01 ,$9.33 ,$32.39 , N/A ,$20.09 ,$20.09 ,$10.85 ,$20.09 , 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 ,$40.26 ,$13.89 ,$61.00 , N/A ,$54.67 ,$54.67 ,$16.14 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$16.14 ,$51.85 ,$51.85 ,$54.90 ,$37.15 , N/A ,$37.82 , N/A ,$54.90 , N/A ,$56.12 ,$54.90 ,$40.27 ,$40.27 ,$37.15 ,$40.27 ,$39.65 ,$41.68 ,$13.89 ,$48.19 , N/A ,$29.89 ,$29.89 ,$16.14 ,$29.89 , N/A ,$57.95 ,$50.02 ,$50.02 ,$48.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201274,N/A,HC EYE PACK,272,1 ,$63.35 ,$41.81 ,$14.43 ,$63.35 , N/A ,$56.77 ,$56.77 ,$16.76 ,$50.68 ,$53.85 ,$39.59 ,$57.02 , N/A , N/A ,$60.18 ,$57.02 ,$53.85 ,$53.85 ,$16.76 ,$53.85 ,$53.85 ,$57.02 ,$38.58 , N/A ,$39.28 , N/A ,$57.02 , N/A ,$58.28 ,$57.02 ,$41.82 ,$41.82 ,$38.58 ,$41.82 ,$41.18 ,$43.28 ,$14.43 ,$50.05 , N/A ,$31.04 ,$31.04 ,$16.76 ,$31.04 , N/A ,$60.18 ,$51.95 ,$51.95 ,$50.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201282,N/A,HC FEEDING TUBE,272,1 ,$21.00 ,$13.86 ,$4.78 ,$21.00 , N/A ,$18.82 ,$18.82 ,$5.56 ,$16.80 ,$17.85 ,$13.13 ,$18.90 , N/A , N/A ,$19.95 ,$18.90 ,$17.85 ,$17.85 ,$5.56 ,$17.85 ,$17.85 ,$18.90 ,$12.79 , N/A ,$13.02 , N/A ,$18.90 , N/A ,$19.32 ,$18.90 ,$13.86 ,$13.86 ,$12.79 ,$13.86 ,$13.65 ,$14.35 ,$4.78 ,$16.59 , N/A ,$10.29 ,$10.29 ,$5.56 ,$10.29 , N/A ,$19.95 ,$17.22 ,$17.22 ,$16.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201287,N/A,HC FIBER WIRE SUTURE,272,1 ,$58.25 ,$38.45 ,$13.26 ,$58.25 , N/A ,$52.20 ,$52.20 ,$15.42 ,$46.60 ,$49.51 ,$36.41 ,$52.43 , N/A , N/A ,$55.34 ,$52.43 ,$49.51 ,$49.51 ,$15.42 ,$49.51 ,$49.51 ,$52.43 ,$35.47 , N/A ,$36.12 , N/A ,$52.43 , N/A ,$53.59 ,$52.43 ,$38.45 ,$38.45 ,$35.47 ,$38.45 ,$37.86 ,$39.80 ,$13.26 ,$46.02 , N/A ,$28.54 ,$28.54 ,$15.42 ,$28.54 , N/A ,$55.34 ,$47.77 ,$47.77 ,$46.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201288,N/A,HC FIBERLOOP #2 W/SUTURE NEEDLE,272,1 ,$127.00 ,$83.82 ,$28.91 ,$127.00 , N/A ,$113.82 ,$113.82 ,$33.60 ,$101.60 ,$107.95 ,$79.38 ,$114.30 , N/A , N/A ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$33.60 ,$107.95 ,$107.95 ,$114.30 ,$77.34 , N/A ,$78.74 , N/A ,$114.30 , N/A ,$116.84 ,$114.30 ,$83.83 ,$83.83 ,$77.34 ,$83.83 ,$82.55 ,$86.77 ,$28.91 ,$100.33 , N/A ,$62.23 ,$62.23 ,$33.60 ,$62.23 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$54.00 ,$35.64 ,$12.29 ,$54.00 , N/A ,$48.39 ,$48.39 ,$14.29 ,$43.20 ,$45.90 ,$33.75 ,$48.60 , N/A , N/A ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$14.29 ,$45.90 ,$45.90 ,$48.60 ,$32.89 , N/A ,$33.48 , N/A ,$48.60 , N/A ,$49.68 ,$48.60 ,$35.65 ,$35.65 ,$32.89 ,$35.65 ,$35.10 ,$36.89 ,$12.29 ,$42.66 , N/A ,$26.46 ,$26.46 ,$14.29 ,$26.46 , N/A ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201323,N/A,HC FOREIGN BODY RETRIEVAL NET,272,1 ,$304.00 ,$200.64 ,$69.21 ,$304.00 , N/A ,$272.44 ,$272.44 ,$80.44 ,$243.20 ,$258.40 ,$190.00 ,$273.60 , N/A , N/A ,$288.80 ,$273.60 ,$258.40 ,$258.40 ,$80.44 ,$258.40 ,$258.40 ,$273.60 ,$185.14 , N/A ,$188.48 , N/A ,$273.60 , N/A ,$279.68 ,$273.60 ,$200.67 ,$200.67 ,$185.14 ,$200.67 ,$197.60 ,$207.69 ,$69.21 ,$240.16 , N/A ,$148.96 ,$148.96 ,$80.44 ,$148.96 , 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 ,$106.92 ,$36.88 ,$162.00 , N/A ,$145.18 ,$145.18 ,$42.87 ,$129.60 ,$137.70 ,$101.25 ,$145.80 , N/A , N/A ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$42.87 ,$137.70 ,$137.70 ,$145.80 ,$98.66 , N/A ,$100.44 , N/A ,$145.80 , N/A ,$149.04 ,$145.80 ,$106.94 ,$106.94 ,$98.66 ,$106.94 ,$105.30 ,$110.68 ,$36.88 ,$127.98 , N/A ,$79.38 ,$79.38 ,$42.87 ,$79.38 , 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 ,$40.26 ,$13.89 ,$61.00 , N/A ,$54.67 ,$54.67 ,$16.14 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$16.14 ,$51.85 ,$51.85 ,$54.90 ,$37.15 , N/A ,$37.82 , N/A ,$54.90 , N/A ,$56.12 ,$54.90 ,$40.27 ,$40.27 ,$37.15 ,$40.27 ,$39.65 ,$41.68 ,$13.89 ,$48.19 , N/A ,$29.89 ,$29.89 ,$16.14 ,$29.89 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$278.52 ,$96.07 ,$422.00 , N/A ,$378.20 ,$378.20 ,$111.66 ,$337.60 ,$358.70 ,$263.75 ,$379.80 , N/A , N/A ,$400.90 ,$379.80 ,$358.70 ,$358.70 ,$111.66 ,$358.70 ,$358.70 ,$379.80 ,$257.00 , N/A ,$261.64 , N/A ,$379.80 , N/A ,$388.24 ,$379.80 ,$278.56 ,$278.56 ,$257.00 ,$278.56 ,$274.30 ,$288.31 ,$96.07 ,$333.38 , N/A ,$206.78 ,$206.78 ,$111.66 ,$206.78 , 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 ,$113.52 ,$39.16 ,$172.00 , N/A ,$154.15 ,$154.15 ,$45.51 ,$137.60 ,$146.20 ,$107.50 ,$154.80 , N/A , N/A ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$45.51 ,$146.20 ,$146.20 ,$154.80 ,$104.75 , N/A ,$106.64 , N/A ,$154.80 , N/A ,$158.24 ,$154.80 ,$113.54 ,$113.54 ,$104.75 ,$113.54 ,$111.80 ,$117.51 ,$39.16 ,$135.88 , N/A ,$84.28 ,$84.28 ,$45.51 ,$84.28 , 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 ","$1,114.08 ",$384.28 ,"$1,688.00 ", N/A ,"$1,512.79 ","$1,512.79 ",$446.64 ,"$1,350.40 ","$1,434.80 ","$1,055.00 ","$1,519.20 ", N/A , N/A ,"$1,603.60 ","$1,519.20 ","$1,434.80 ","$1,434.80 ",$446.64 ,"$1,434.80 ","$1,434.80 ","$1,519.20 ","$1,027.99 ", N/A ,"$1,046.56 ", N/A ,"$1,519.20 ", N/A ,"$1,552.96 ","$1,519.20 ","$1,114.25 ","$1,114.25 ","$1,027.99 ","$1,114.25 ","$1,097.20 ","$1,153.24 ",$384.28 ,"$1,333.52 ", N/A ,$827.12 ,$827.12 ,$446.64 ,$827.12 , 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 ,$84.00 ,$55.44 ,$19.12 ,$84.00 , N/A ,$75.28 ,$75.28 ,$22.23 ,$67.20 ,$71.40 ,$52.50 ,$75.60 , N/A , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$22.23 ,$71.40 ,$71.40 ,$75.60 ,$51.16 , N/A ,$52.08 , N/A ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.45 ,$55.45 ,$51.16 ,$55.45 ,$54.60 ,$57.39 ,$19.12 ,$66.36 , N/A ,$41.16 ,$41.16 ,$22.23 ,$41.16 , N/A ,$79.80 ,$68.88 ,$68.88 ,$67.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201390,N/A,HC HEADREST/DAY,272,1 ,$24.50 ,$16.17 ,$5.59 ,$24.50 , N/A ,$21.96 ,$21.96 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201419,N/A,HC HUBER NEEDLE,272,1 ,$16.32 ,$10.77 ,$3.71 ,$16.32 , N/A ,$14.63 ,$14.63 ,$4.32 ,$13.06 ,$13.87 ,$10.20 ,$14.69 , N/A , N/A ,$15.50 ,$14.69 ,$13.87 ,$13.87 ,$4.32 ,$13.87 ,$13.87 ,$14.69 ,$9.94 , N/A ,$10.12 , N/A ,$14.69 , N/A ,$15.01 ,$14.69 ,$10.77 ,$10.77 ,$9.94 ,$10.77 ,$10.61 ,$11.15 ,$3.71 ,$12.89 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.50 ,$13.38 ,$13.38 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201429,N/A,HC ILLUMINATOR RELIEVA SINUS,272,1 ,"$1,337.00 ",$882.42 ,$304.38 ,"$1,337.00 ", N/A ,"$1,198.22 ","$1,198.22 ",$353.77 ,"$1,069.60 ","$1,136.45 ",$835.63 ,"$1,203.30 ", N/A , N/A ,"$1,270.15 ","$1,203.30 ","$1,136.45 ","$1,136.45 ",$353.77 ,"$1,136.45 ","$1,136.45 ","$1,203.30 ",$814.23 , N/A ,$828.94 , N/A ,"$1,203.30 ", N/A ,"$1,230.04 ","$1,203.30 ",$882.55 ,$882.55 ,$814.23 ,$882.55 ,$869.05 ,$913.44 ,$304.38 ,"$1,056.23 ", N/A ,$655.13 ,$655.13 ,$353.77 ,$655.13 , 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 ,$89.10 ,$30.73 ,$135.00 , N/A ,$120.99 ,$120.99 ,$35.72 ,$108.00 ,$114.75 ,$84.38 ,$121.50 , N/A , N/A ,$128.25 ,$121.50 ,$114.75 ,$114.75 ,$35.72 ,$114.75 ,$114.75 ,$121.50 ,$82.22 , N/A ,$83.70 , N/A ,$121.50 , N/A ,$124.20 ,$121.50 ,$89.11 ,$89.11 ,$82.22 ,$89.11 ,$87.75 ,$92.23 ,$30.73 ,$106.65 , N/A ,$66.15 ,$66.15 ,$35.72 ,$66.15 , 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 ,$234.96 ,$81.05 ,$356.00 , N/A ,$319.05 ,$319.05 ,$94.20 ,$284.80 ,$302.60 ,$222.50 ,$320.40 , N/A , N/A ,$338.20 ,$320.40 ,$302.60 ,$302.60 ,$94.20 ,$302.60 ,$302.60 ,$320.40 ,$216.80 , N/A ,$220.72 , N/A ,$320.40 , N/A ,$327.52 ,$320.40 ,$235.00 ,$235.00 ,$216.80 ,$235.00 ,$231.40 ,$243.22 ,$81.05 ,$281.24 , N/A ,$174.44 ,$174.44 ,$94.20 ,$174.44 , N/A ,$338.20 ,$291.92 ,$291.92 ,$284.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201463,N/A,HC IRRIGATION CATH,272,1 ,$36.00 ,$23.76 ,$8.19 ,$36.00 , N/A ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A ,$22.32 , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 , N/A ,$17.64 ,$17.64 ,$9.53 ,$17.64 , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201478,N/A,HC JURGAN BALLS,272,1 ,$16.63 ,$10.98 ,$3.78 ,$16.63 , N/A ,$14.90 ,$14.90 ,$4.40 ,$13.30 ,$14.14 ,$10.39 ,$14.97 , N/A , N/A ,$15.80 ,$14.97 ,$14.14 ,$14.14 ,$4.40 ,$14.14 ,$14.14 ,$14.97 ,$10.13 , N/A ,$10.32 , N/A ,$14.97 , N/A ,$15.30 ,$14.97 ,$10.98 ,$10.98 ,$10.13 ,$10.98 ,$10.81 ,$11.36 ,$3.78 ,$13.14 , N/A ,$8.15 ,$8.15 ,$4.40 ,$8.15 , N/A ,$15.80 ,$13.64 ,$13.64 ,$13.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201483,N/A,HC KERLIX,272,1 ,$3.10 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$342.54 ,$118.15 ,$519.00 , N/A ,$465.13 ,$465.13 ,$137.33 ,$415.20 ,$441.15 ,$324.38 ,$467.10 , N/A , N/A ,$493.05 ,$467.10 ,$441.15 ,$441.15 ,$137.33 ,$441.15 ,$441.15 ,$467.10 ,$316.07 , N/A ,$321.78 , N/A ,$467.10 , N/A ,$477.48 ,$467.10 ,$342.59 ,$342.59 ,$316.07 ,$342.59 ,$337.35 ,$354.58 ,$118.15 ,$410.01 , N/A ,$254.31 ,$254.31 ,$137.33 ,$254.31 , 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 ,$41.58 ,$14.34 ,$63.00 , N/A ,$56.46 ,$56.46 ,$16.67 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$16.67 ,$53.55 ,$53.55 ,$56.70 ,$38.37 , N/A ,$39.06 , N/A ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.59 ,$41.59 ,$38.37 ,$41.59 ,$40.95 ,$43.04 ,$14.34 ,$49.77 , N/A ,$30.87 ,$30.87 ,$16.67 ,$30.87 , 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 ,$175.88 ,$116.08 ,$40.03 ,$175.88 , N/A ,$157.62 ,$157.62 ,$46.54 ,$140.70 ,$149.50 ,$109.93 ,$158.29 , N/A , N/A ,$167.09 ,$158.29 ,$149.50 ,$149.50 ,$46.54 ,$149.50 ,$149.50 ,$158.29 ,$107.11 , N/A ,$109.04 , N/A ,$158.29 , N/A ,$161.81 ,$158.29 ,$116.10 ,$116.10 ,$107.11 ,$116.10 ,$114.32 ,$120.16 ,$40.03 ,$138.95 , N/A ,$86.18 ,$86.18 ,$46.54 ,$86.18 , N/A ,$167.09 ,$144.22 ,$144.22 ,$140.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201519,N/A,HC KIT INLET CLOSE SURE PROC,272,1 ,$355.62 ,$234.71 ,$80.96 ,$355.62 , N/A ,$318.71 ,$318.71 ,$94.10 ,$284.50 ,$302.28 ,$222.26 ,$320.06 , N/A , N/A ,$337.84 ,$320.06 ,$302.28 ,$302.28 ,$94.10 ,$302.28 ,$302.28 ,$320.06 ,$216.57 , N/A ,$220.48 , N/A ,$320.06 , N/A ,$327.17 ,$320.06 ,$234.74 ,$234.74 ,$216.57 ,$234.74 ,$231.15 ,$242.96 ,$80.96 ,$280.94 , N/A ,$174.25 ,$174.25 ,$94.10 ,$174.25 , N/A ,$337.84 ,$291.61 ,$291.61 ,$284.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201521,N/A,HC KIT INTRODUCER,272,1 ,$85.18 ,$56.22 ,$19.39 ,$85.18 , N/A ,$76.34 ,$76.34 ,$22.54 ,$68.14 ,$72.40 ,$53.24 ,$76.66 , N/A , N/A ,$80.92 ,$76.66 ,$72.40 ,$72.40 ,$22.54 ,$72.40 ,$72.40 ,$76.66 ,$51.87 , N/A ,$52.82 , N/A ,$76.66 , N/A ,$78.37 ,$76.66 ,$56.23 ,$56.23 ,$51.87 ,$56.23 ,$55.37 ,$58.20 ,$19.39 ,$67.29 , N/A ,$41.74 ,$41.74 ,$22.54 ,$41.74 , N/A ,$80.92 ,$69.85 ,$69.85 ,$68.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201523,N/A,HC KIT MEDTRONIC ACCESSORY,272,1 ,$624.00 ,$411.84 ,$142.06 ,$624.00 , N/A ,$559.23 ,$559.23 ,$165.11 ,$499.20 ,$530.40 ,$390.00 ,$561.60 , N/A , N/A ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$165.11 ,$530.40 ,$530.40 ,$561.60 ,$380.02 , N/A ,$386.88 , N/A ,$561.60 , N/A ,$574.08 ,$561.60 ,$411.90 ,$411.90 ,$380.02 ,$411.90 ,$405.60 ,$426.32 ,$142.06 ,$492.96 , N/A ,$305.76 ,$305.76 ,$165.11 ,$305.76 , 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 ,$85.20 ,$56.23 ,$19.40 ,$85.20 , N/A ,$76.36 ,$76.36 ,$22.54 ,$68.16 ,$72.42 ,$53.25 ,$76.68 , N/A , N/A ,$80.94 ,$76.68 ,$72.42 ,$72.42 ,$22.54 ,$72.42 ,$72.42 ,$76.68 ,$51.89 , N/A ,$52.82 , N/A ,$76.68 , N/A ,$78.38 ,$76.68 ,$56.24 ,$56.24 ,$51.89 ,$56.24 ,$55.38 ,$58.21 ,$19.40 ,$67.31 , N/A ,$41.75 ,$41.75 ,$22.54 ,$41.75 , N/A ,$80.94 ,$69.86 ,$69.86 ,$68.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201529,N/A,HC KIT NOVASURE ABLATION,272,1 ,"$3,802.00 ","$2,509.32 ",$865.54 ,"$3,802.00 ", N/A ,"$3,407.35 ","$3,407.35 ","$1,006.01 ","$3,041.60 ","$3,231.70 ","$2,376.25 ","$3,421.80 ", N/A , N/A ,"$3,611.90 ","$3,421.80 ","$3,231.70 ","$3,231.70 ","$1,006.01 ","$3,231.70 ","$3,231.70 ","$3,421.80 ","$2,315.42 ", N/A ,"$2,357.24 ", N/A ,"$3,421.80 ", N/A ,"$3,497.84 ","$3,421.80 ","$2,509.70 ","$2,509.70 ","$2,315.42 ","$2,509.70 ","$2,471.30 ","$2,597.53 ",$865.54 ,"$3,003.58 ", N/A ,"$1,862.98 ","$1,862.98 ","$1,006.01 ","$1,862.98 ", 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 ,$177.54 ,$61.24 ,$269.00 , N/A ,$241.08 ,$241.08 ,$71.18 ,$215.20 ,$228.65 ,$168.13 ,$242.10 , N/A , N/A ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$71.18 ,$228.65 ,$228.65 ,$242.10 ,$163.82 , N/A ,$166.78 , N/A ,$242.10 , N/A ,$247.48 ,$242.10 ,$177.57 ,$177.57 ,$163.82 ,$177.57 ,$174.85 ,$183.78 ,$61.24 ,$212.51 , N/A ,$131.81 ,$131.81 ,$71.18 ,$131.81 , N/A ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201534,N/A,HC KIT PREP BONE,272,1 ,$182.50 ,$120.45 ,$41.55 ,$182.50 , N/A ,$163.56 ,$163.56 ,$48.29 ,$146.00 ,$155.13 ,$114.06 ,$164.25 , N/A , N/A ,$173.38 ,$164.25 ,$155.13 ,$155.13 ,$48.29 ,$155.13 ,$155.13 ,$164.25 ,$111.14 , N/A ,$113.16 , N/A ,$164.25 , N/A ,$167.90 ,$164.25 ,$120.47 ,$120.47 ,$111.14 ,$120.47 ,$118.63 ,$124.68 ,$41.55 ,$144.18 , N/A ,$89.43 ,$89.43 ,$48.29 ,$89.43 , N/A ,$173.38 ,$149.65 ,$149.65 ,$146.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201540,N/A,HC KIT SHOULDER SUSPENSION,272,1 ,$232.00 ,$153.12 ,$52.81 ,$232.00 , N/A ,$207.92 ,$207.92 ,$61.39 ,$185.60 ,$197.20 ,$145.00 ,$208.80 , N/A , N/A ,$220.40 ,$208.80 ,$197.20 ,$197.20 ,$61.39 ,$197.20 ,$197.20 ,$208.80 ,$141.29 , N/A ,$143.84 , N/A ,$208.80 , N/A ,$213.44 ,$208.80 ,$153.14 ,$153.14 ,$141.29 ,$153.14 ,$150.80 ,$158.50 ,$52.81 ,$183.28 , N/A ,$113.68 ,$113.68 ,$61.39 ,$113.68 , N/A ,$220.40 ,$190.24 ,$190.24 ,$185.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201572,N/A,HC LAP ENDO SHEARS,272,1 ,$197.72 ,$130.50 ,$45.01 ,$197.72 , N/A ,$177.20 ,$177.20 ,$52.31 ,$158.18 ,$168.06 ,$123.58 ,$177.95 , N/A , N/A ,$187.83 ,$177.95 ,$168.06 ,$168.06 ,$52.31 ,$168.06 ,$168.06 ,$177.95 ,$120.41 , N/A ,$122.58 , N/A ,$177.95 , N/A ,$181.90 ,$177.95 ,$130.52 ,$130.52 ,$120.41 ,$130.52 ,$128.52 ,$135.08 ,$45.01 ,$156.20 , N/A ,$96.88 ,$96.88 ,$52.31 ,$96.88 , N/A ,$187.83 ,$162.13 ,$162.13 ,$158.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201590,N/A,HC LAPAROSCOPY PK,272,1 ,$63.04 ,$41.61 ,$14.36 ,$63.04 , N/A ,$56.50 ,$56.50 ,$16.68 ,$50.43 ,$53.58 ,$39.40 ,$56.74 , N/A , N/A ,$59.89 ,$56.74 ,$53.58 ,$53.58 ,$16.68 ,$53.58 ,$53.58 ,$56.74 ,$38.39 , N/A ,$39.08 , N/A ,$56.74 , N/A ,$58.00 ,$56.74 ,$41.61 ,$41.61 ,$38.39 ,$41.61 ,$40.98 ,$43.07 ,$14.36 ,$49.80 , N/A ,$30.89 ,$30.89 ,$16.68 ,$30.89 , N/A ,$59.89 ,$51.69 ,$51.69 ,$50.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201604,N/A,HC LG CEMENT,272,1 ,$285.00 ,$188.10 ,$64.89 ,$285.00 , N/A ,$255.42 ,$255.42 ,$75.41 ,$228.00 ,$242.25 ,$178.13 ,$256.50 , N/A , N/A ,$270.75 ,$256.50 ,$242.25 ,$242.25 ,$75.41 ,$242.25 ,$242.25 ,$256.50 ,$173.57 , N/A ,$176.70 , N/A ,$256.50 , N/A ,$262.20 ,$256.50 ,$188.13 ,$188.13 ,$173.57 ,$188.13 ,$185.25 ,$194.71 ,$64.89 ,$225.15 , N/A ,$139.65 ,$139.65 ,$75.41 ,$139.65 , 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 ,$44.88 ,$15.48 ,$68.00 , N/A ,$60.94 ,$60.94 ,$17.99 ,$54.40 ,$57.80 ,$42.50 ,$61.20 , N/A , N/A ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$17.99 ,$57.80 ,$57.80 ,$61.20 ,$41.41 , N/A ,$42.16 , N/A ,$61.20 , N/A ,$62.56 ,$61.20 ,$44.89 ,$44.89 ,$41.41 ,$44.89 ,$44.20 ,$46.46 ,$15.48 ,$53.72 , N/A ,$33.32 ,$33.32 ,$17.99 ,$33.32 , N/A ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201626,N/A,HC LOOPS VESSEL,272,1 ,$7.00 ,$4.62 ,$1.60 ,$7.00 , N/A ,$6.27 ,$6.27 ,$1.85 ,$5.60 ,$5.95 ,$4.38 ,$6.30 , N/A , N/A ,$6.65 ,$6.30 ,$5.95 ,$5.95 ,$1.85 ,$5.95 ,$5.95 ,$6.30 ,$4.26 , N/A ,$4.34 , N/A ,$6.30 , N/A ,$6.44 ,$6.30 ,$4.62 ,$4.62 ,$4.26 ,$4.62 ,$4.55 ,$4.78 ,$1.60 ,$5.53 , N/A ,$3.43 ,$3.43 ,$1.85 ,$3.43 , N/A ,$6.65 ,$5.74 ,$5.74 ,$5.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201645,N/A,HC MENISCAL APPLIER,272,1 ,$421.00 ,$277.86 ,$95.84 ,$421.00 , N/A ,$377.30 ,$377.30 ,$111.40 ,$336.80 ,$357.85 ,$263.13 ,$378.90 , N/A , N/A ,$399.95 ,$378.90 ,$357.85 ,$357.85 ,$111.40 ,$357.85 ,$357.85 ,$378.90 ,$256.39 , N/A ,$261.02 , N/A ,$378.90 , N/A ,$387.32 ,$378.90 ,$277.90 ,$277.90 ,$256.39 ,$277.90 ,$273.65 ,$287.63 ,$95.84 ,$332.59 , N/A ,$206.29 ,$206.29 ,$111.40 ,$206.29 , 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 ,$13.86 ,$4.78 ,$21.00 , N/A ,$18.82 ,$18.82 ,$5.56 ,$16.80 ,$17.85 ,$13.13 ,$18.90 , N/A , N/A ,$19.95 ,$18.90 ,$17.85 ,$17.85 ,$5.56 ,$17.85 ,$17.85 ,$18.90 ,$12.79 , N/A ,$13.02 , N/A ,$18.90 , N/A ,$19.32 ,$18.90 ,$13.86 ,$13.86 ,$12.79 ,$13.86 ,$13.65 ,$14.35 ,$4.78 ,$16.59 , N/A ,$10.29 ,$10.29 ,$5.56 ,$10.29 , 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 ,$182.82 ,$63.06 ,$277.00 , N/A ,$248.25 ,$248.25 ,$73.29 ,$221.60 ,$235.45 ,$173.13 ,$249.30 , N/A , N/A ,$263.15 ,$249.30 ,$235.45 ,$235.45 ,$73.29 ,$235.45 ,$235.45 ,$249.30 ,$168.69 , N/A ,$171.74 , N/A ,$249.30 , N/A ,$254.84 ,$249.30 ,$182.85 ,$182.85 ,$168.69 ,$182.85 ,$180.05 ,$189.25 ,$63.06 ,$218.83 , N/A ,$135.73 ,$135.73 ,$73.29 ,$135.73 , 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 ,$16.50 ,$5.69 ,$25.00 , N/A ,$22.41 ,$22.41 ,$6.61 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$6.61 ,$21.25 ,$21.25 ,$22.50 ,$15.23 , N/A ,$15.50 , N/A ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.50 ,$16.50 ,$15.23 ,$16.50 ,$16.25 ,$17.08 ,$5.69 ,$19.75 , N/A ,$12.25 ,$12.25 ,$6.61 ,$12.25 , N/A ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201675,N/A,HC DRSG TEGADERM 1629,272,1 ,$6.00 ,$3.96 ,$1.36 ,$6.00 , N/A ,$5.38 ,$5.38 ,$1.59 ,$4.80 ,$5.10 ,$3.75 ,$5.40 , N/A , N/A ,$5.70 ,$5.40 ,$5.10 ,$5.10 ,$1.59 ,$5.10 ,$5.10 ,$5.40 ,$3.65 , N/A ,$3.72 , N/A ,$5.40 , N/A ,$5.52 ,$5.40 ,$3.96 ,$3.96 ,$3.65 ,$3.96 ,$3.90 ,$4.10 ,$1.36 ,$4.74 , N/A ,$2.94 ,$2.94 ,$1.59 ,$2.94 , N/A ,$5.70 ,$4.92 ,$4.92 ,$4.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201676,N/A,HC DRSG TEGADERM 2X3,272,1 ,$3.05 ,$2.01 ,$0.70 ,$3.05 , N/A ,$2.73 ,$2.73 ,$0.80 ,$2.44 ,$2.59 ,$1.91 ,$2.75 , N/A , N/A ,$2.90 ,$2.75 ,$2.59 ,$2.59 ,$0.80 ,$2.59 ,$2.59 ,$2.75 ,$1.86 , N/A ,$1.90 , N/A ,$2.75 , N/A ,$2.81 ,$2.75 ,$2.01 ,$2.01 ,$1.86 ,$2.01 ,$1.98 ,$2.08 ,$0.70 ,$2.41 , N/A ,$1.49 ,$1.49 ,$0.80 ,$1.49 , N/A ,$2.90 ,$2.50 ,$2.50 ,$2.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201677,N/A,HC DRSG VASELINE GAUZE 1X8,272,1 ,$3.10 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$25.74 ,$8.88 ,$39.00 , N/A ,$34.95 ,$34.95 ,$10.32 ,$31.20 ,$33.15 ,$24.38 ,$35.10 , N/A , N/A ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$10.32 ,$33.15 ,$33.15 ,$35.10 ,$23.75 , N/A ,$24.18 , N/A ,$35.10 , N/A ,$35.88 ,$35.10 ,$25.74 ,$25.74 ,$23.75 ,$25.74 ,$25.35 ,$26.64 ,$8.88 ,$30.81 , N/A ,$19.11 ,$19.11 ,$10.32 ,$19.11 , 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 ,$6.86 ,$2.36 ,$10.40 , N/A ,$9.32 ,$9.32 ,$2.75 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$2.75 ,$8.84 ,$8.84 ,$9.36 ,$6.33 , N/A ,$6.44 , N/A ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.87 ,$6.87 ,$6.33 ,$6.87 ,$6.76 ,$7.11 ,$2.36 ,$8.22 , N/A ,$5.10 ,$5.10 ,$2.75 ,$5.10 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$82.50 ,$28.46 ,$125.00 , N/A ,$112.03 ,$112.03 ,$33.07 ,$100.00 ,$106.25 ,$78.13 ,$112.50 , N/A , N/A ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$33.07 ,$106.25 ,$106.25 ,$112.50 ,$76.13 , N/A ,$77.50 , N/A ,$112.50 , N/A ,$115.00 ,$112.50 ,$82.51 ,$82.51 ,$76.13 ,$82.51 ,$81.25 ,$85.40 ,$28.46 ,$98.75 , N/A ,$61.25 ,$61.25 ,$33.07 ,$61.25 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$46.20 ,$15.93 ,$70.00 , N/A ,$62.73 ,$62.73 ,$18.52 ,$56.00 ,$59.50 ,$43.75 ,$63.00 , N/A , N/A ,$66.50 ,$63.00 ,$59.50 ,$59.50 ,$18.52 ,$59.50 ,$59.50 ,$63.00 ,$42.63 , N/A ,$43.40 , N/A ,$63.00 , N/A ,$64.40 ,$63.00 ,$46.21 ,$46.21 ,$42.63 ,$46.21 ,$45.50 ,$47.82 ,$15.93 ,$55.30 , N/A ,$34.30 ,$34.30 ,$18.52 ,$34.30 , 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 ,$5.00 ,$3.30 ,$1.14 ,$5.00 , N/A ,$4.48 ,$4.48 ,$1.32 ,$4.00 ,$4.25 ,$3.13 ,$4.50 , N/A , N/A ,$4.75 ,$4.50 ,$4.25 ,$4.25 ,$1.32 ,$4.25 ,$4.25 ,$4.50 ,$3.05 , N/A ,$3.10 , N/A ,$4.50 , N/A ,$4.60 ,$4.50 ,$3.30 ,$3.30 ,$3.05 ,$3.30 ,$3.25 ,$3.42 ,$1.14 ,$3.95 , N/A ,$2.45 ,$2.45 ,$1.32 ,$2.45 , N/A ,$4.75 ,$4.10 ,$4.10 ,$4.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201716,N/A,HC NEEDLE SUTURE DISPOSABLE,272,1 ,$15.32 ,$10.11 ,$3.49 ,$15.32 , N/A ,$13.73 ,$13.73 ,$4.06 ,$12.26 ,$13.02 ,$9.58 ,$13.79 , N/A , N/A ,$14.55 ,$13.79 ,$13.02 ,$13.02 ,$4.06 ,$13.02 ,$13.02 ,$13.79 ,$9.33 , N/A ,$9.50 , N/A ,$13.79 , N/A ,$14.09 ,$13.79 ,$10.11 ,$10.11 ,$9.33 ,$10.11 ,$9.96 ,$10.47 ,$3.49 ,$12.10 , N/A ,$7.51 ,$7.51 ,$4.06 ,$7.51 , N/A ,$14.55 ,$12.56 ,$12.56 ,$12.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201731,N/A,HC HF NEEDLE,272,1 ,$123.00 ,$81.18 ,$28.00 ,$123.00 , N/A ,$110.23 ,$110.23 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 , N/A ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A ,$60.27 ,$60.27 ,$32.55 ,$60.27 , 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 ,$31.68 ,$10.93 ,$48.00 , N/A ,$43.02 ,$43.02 ,$12.70 ,$38.40 ,$40.80 ,$30.00 ,$43.20 , N/A , N/A ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$12.70 ,$40.80 ,$40.80 ,$43.20 ,$29.23 , N/A ,$29.76 , N/A ,$43.20 , N/A ,$44.16 ,$43.20 ,$31.68 ,$31.68 ,$29.23 ,$31.68 ,$31.20 ,$32.79 ,$10.93 ,$37.92 , N/A ,$23.52 ,$23.52 ,$12.70 ,$23.52 , N/A ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201779,N/A,HC PACK CUSTOM BASIC,272,1 ,$53.04 ,$35.01 ,$12.07 ,$53.04 , N/A ,$47.53 ,$47.53 ,$14.03 ,$42.43 ,$45.08 ,$33.15 ,$47.74 , N/A , N/A ,$50.39 ,$47.74 ,$45.08 ,$45.08 ,$14.03 ,$45.08 ,$45.08 ,$47.74 ,$32.30 , N/A ,$32.88 , N/A ,$47.74 , N/A ,$48.80 ,$47.74 ,$35.01 ,$35.01 ,$32.30 ,$35.01 ,$34.48 ,$36.24 ,$12.07 ,$41.90 , N/A ,$25.99 ,$25.99 ,$14.03 ,$25.99 , N/A ,$50.39 ,$43.49 ,$43.49 ,$42.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201780,N/A,HC PACK CYSTO III,272,1 ,$17.43 ,$11.50 ,$3.97 ,$17.43 , N/A ,$15.62 ,$15.62 ,$4.62 ,$13.94 ,$14.82 ,$10.89 ,$15.69 , N/A , N/A ,$16.56 ,$15.69 ,$14.82 ,$14.82 ,$4.62 ,$14.82 ,$14.82 ,$15.69 ,$10.61 , N/A ,$10.80 , N/A ,$15.69 , N/A ,$16.04 ,$15.69 ,$11.51 ,$11.51 ,$10.61 ,$11.51 ,$11.33 ,$11.91 ,$3.97 ,$13.77 , N/A ,$8.54 ,$8.54 ,$4.62 ,$8.54 , N/A ,$16.56 ,$14.29 ,$14.29 ,$13.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201784,N/A,HC PACK MEROCEL NASL 400402,272,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , 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 ,$93.00 ,$61.38 ,$21.17 ,$93.00 , N/A ,$83.35 ,$83.35 ,$24.61 ,$74.40 ,$79.05 ,$58.13 ,$83.70 , N/A , N/A ,$88.35 ,$83.70 ,$79.05 ,$79.05 ,$24.61 ,$79.05 ,$79.05 ,$83.70 ,$56.64 , N/A ,$57.66 , N/A ,$83.70 , N/A ,$85.56 ,$83.70 ,$61.39 ,$61.39 ,$56.64 ,$61.39 ,$60.45 ,$63.54 ,$21.17 ,$73.47 , N/A ,$45.57 ,$45.57 ,$24.61 ,$45.57 , N/A ,$88.35 ,$76.26 ,$76.26 ,$74.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201798,N/A,HC PACK VNUS CLOSURE,272,1 ,$251.00 ,$165.66 ,$57.14 ,$251.00 , N/A ,$224.95 ,$224.95 ,$66.41 ,$200.80 ,$213.35 ,$156.88 ,$225.90 , N/A , N/A ,$238.45 ,$225.90 ,$213.35 ,$213.35 ,$66.41 ,$213.35 ,$213.35 ,$225.90 ,$152.86 , N/A ,$155.62 , N/A ,$225.90 , N/A ,$230.92 ,$225.90 ,$165.69 ,$165.69 ,$152.86 ,$165.69 ,$163.15 ,$171.48 ,$57.14 ,$198.29 , N/A ,$122.99 ,$122.99 ,$66.41 ,$122.99 , N/A ,$238.45 ,$205.82 ,$205.82 ,$200.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201804,N/A,HC PAD GROUND BOVIE,272,1 ,$17.00 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , 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 ,$52.14 ,$17.98 ,$79.00 , N/A ,$70.80 ,$70.80 ,$20.90 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$20.90 ,$67.15 ,$67.15 ,$71.10 ,$48.11 , N/A ,$48.98 , N/A ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.15 ,$52.15 ,$48.11 ,$52.15 ,$51.35 ,$53.97 ,$17.98 ,$62.41 , N/A ,$38.71 ,$38.71 ,$20.90 ,$38.71 , 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 ","$2,046.00 ",$705.73 ,"$3,100.00 ", N/A ,"$2,778.22 ","$2,778.22 ",$820.26 ,"$2,480.00 ","$2,635.00 ","$1,937.50 ","$2,790.00 ", N/A , N/A ,"$2,945.00 ","$2,790.00 ","$2,635.00 ","$2,635.00 ",$820.26 ,"$2,635.00 ","$2,635.00 ","$2,790.00 ","$1,887.90 ", N/A ,"$1,922.00 ", N/A ,"$2,790.00 ", N/A ,"$2,852.00 ","$2,790.00 ","$2,046.31 ","$2,046.31 ","$1,887.90 ","$2,046.31 ","$2,015.00 ","$2,117.92 ",$705.73 ,"$2,449.00 ", N/A ,"$1,519.00 ","$1,519.00 ",$820.26 ,"$1,519.00 ", 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 ,$38.28 ,$13.20 ,$58.00 , N/A ,$51.98 ,$51.98 ,$15.35 ,$46.40 ,$49.30 , N/A ,$52.20 , N/A , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$15.35 ,$49.30 ,$49.30 ,$52.20 ,$35.32 , N/A ,$35.96 , N/A ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.29 ,$38.29 ,$35.32 ,$38.29 ,$37.70 ,$39.63 ,$13.20 ,$45.82 , N/A ,$28.42 ,$28.42 ,$15.35 ,$28.42 , 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 ","$1,131.90 ",$390.42 ,"$1,715.00 ", N/A ,"$1,536.98 ","$1,536.98 ",$453.79 ,"$1,372.00 ","$1,457.75 ","$1,071.88 ","$1,543.50 ", N/A , N/A ,"$1,629.25 ","$1,543.50 ","$1,457.75 ","$1,457.75 ",$453.79 ,"$1,457.75 ","$1,457.75 ","$1,543.50 ","$1,044.44 ", N/A ,"$1,063.30 ", N/A ,"$1,543.50 ", N/A ,"$1,577.80 ","$1,543.50 ","$1,132.07 ","$1,132.07 ","$1,044.44 ","$1,132.07 ","$1,114.75 ","$1,171.69 ",$390.42 ,"$1,354.85 ", N/A ,$840.35 ,$840.35 ,$453.79 ,$840.35 , 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 ,$51.48 ,$17.76 ,$78.00 , N/A ,$69.90 ,$69.90 ,$20.64 ,$62.40 ,$66.30 ,$48.75 ,$70.20 , N/A , N/A ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$20.64 ,$66.30 ,$66.30 ,$70.20 ,$47.50 , N/A ,$48.36 , N/A ,$70.20 , N/A ,$71.76 ,$70.20 ,$51.49 ,$51.49 ,$47.50 ,$51.49 ,$50.70 ,$53.29 ,$17.76 ,$61.62 , N/A ,$38.22 ,$38.22 ,$20.64 ,$38.22 , 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 ,$36.96 ,$12.75 ,$56.00 , N/A ,$50.19 ,$50.19 ,$14.82 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$14.82 ,$47.60 ,$47.60 ,$50.40 ,$34.10 , N/A ,$34.72 , N/A ,$50.40 , N/A ,$51.52 ,$50.40 ,$36.97 ,$36.97 ,$34.10 ,$36.97 ,$36.40 ,$38.26 ,$12.75 ,$44.24 , N/A ,$27.44 ,$27.44 ,$14.82 ,$27.44 , 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 ,$51.48 ,$17.76 ,$78.00 , N/A ,$69.90 ,$69.90 ,$20.64 ,$62.40 ,$66.30 ,$48.75 ,$70.20 , N/A , N/A ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$20.64 ,$66.30 ,$66.30 ,$70.20 ,$47.50 , N/A ,$48.36 , N/A ,$70.20 , N/A ,$71.76 ,$70.20 ,$51.49 ,$51.49 ,$47.50 ,$51.49 ,$50.70 ,$53.29 ,$17.76 ,$61.62 , N/A ,$38.22 ,$38.22 ,$20.64 ,$38.22 , 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 ,$63.36 ,$21.85 ,$96.00 , N/A ,$86.04 ,$86.04 ,$25.40 ,$76.80 ,$81.60 ,$60.00 ,$86.40 , N/A , N/A ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$25.40 ,$81.60 ,$81.60 ,$86.40 ,$58.46 , N/A ,$59.52 , N/A ,$86.40 , N/A ,$88.32 ,$86.40 ,$63.37 ,$63.37 ,$58.46 ,$63.37 ,$62.40 ,$65.59 ,$21.85 ,$75.84 , N/A ,$47.04 ,$47.04 ,$25.40 ,$47.04 , 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 ,$47.52 ,$16.40 ,$72.00 , N/A ,$64.53 ,$64.53 ,$19.05 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$19.05 ,$61.20 ,$61.20 ,$64.80 ,$43.85 , N/A ,$44.64 , N/A ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.53 ,$47.53 ,$43.85 ,$47.53 ,$46.80 ,$49.19 ,$16.40 ,$56.88 , N/A ,$35.28 ,$35.28 ,$19.05 ,$35.28 , 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 ,$545.82 ,$188.27 ,$827.00 , N/A ,$741.16 ,$741.16 ,$218.82 ,$661.60 ,$702.95 ,$516.88 ,$744.30 , N/A , N/A ,$785.65 ,$744.30 ,$702.95 ,$702.95 ,$218.82 ,$702.95 ,$702.95 ,$744.30 ,$503.64 , N/A ,$512.74 , N/A ,$744.30 , N/A ,$760.84 ,$744.30 ,$545.90 ,$545.90 ,$503.64 ,$545.90 ,$537.55 ,$565.01 ,$188.27 ,$653.33 , N/A ,$405.23 ,$405.23 ,$218.82 ,$405.23 , 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 ,$142.56 ,$49.18 ,$216.00 , N/A ,$193.58 ,$193.58 ,$57.15 ,$172.80 ,$183.60 ,$135.00 ,$194.40 , N/A , N/A ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$57.15 ,$183.60 ,$183.60 ,$194.40 ,$131.54 , N/A ,$133.92 , N/A ,$194.40 , N/A ,$198.72 ,$194.40 ,$142.58 ,$142.58 ,$131.54 ,$142.58 ,$140.40 ,$147.57 ,$49.18 ,$170.64 , N/A ,$105.84 ,$105.84 ,$57.15 ,$105.84 , 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 ,$38.28 ,$13.20 ,$58.00 , N/A ,$51.98 ,$51.98 ,$15.35 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$15.35 ,$49.30 ,$49.30 ,$52.20 ,$35.32 , N/A ,$35.96 , N/A ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.29 ,$38.29 ,$35.32 ,$38.29 ,$37.70 ,$39.63 ,$13.20 ,$45.82 , N/A ,$28.42 ,$28.42 ,$15.35 ,$28.42 , N/A ,$55.10 ,$47.56 ,$47.56 ,$46.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201887,N/A,HC POWDER GELFOAM,272,1 ,$140.00 ,$92.40 ,$31.87 ,$140.00 , N/A ,$125.47 ,$125.47 ,$37.04 ,$112.00 ,$119.00 ,$87.50 ,$126.00 , N/A , N/A ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$37.04 ,$119.00 ,$119.00 ,$126.00 ,$85.26 , N/A ,$86.80 , N/A ,$126.00 , N/A ,$128.80 ,$126.00 ,$92.41 ,$92.41 ,$85.26 ,$92.41 ,$91.00 ,$95.65 ,$31.87 ,$110.60 , N/A ,$68.60 ,$68.60 ,$37.04 ,$68.60 , N/A ,$133.00 ,$114.80 ,$114.80 ,$112.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201895,N/A,HC DILATION SYRINGE,272,1 ,$50.00 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201920,N/A,HC PROBE SURFACE 90 S,272,1 ,$324.11 ,$213.91 ,$73.79 ,$324.11 , N/A ,$290.47 ,$290.47 ,$85.76 ,$259.29 ,$275.49 ,$202.57 ,$291.70 , N/A , N/A ,$307.90 ,$291.70 ,$275.49 ,$275.49 ,$85.76 ,$275.49 ,$275.49 ,$291.70 ,$197.38 , N/A ,$200.94 , N/A ,$291.70 , N/A ,$298.18 ,$291.70 ,$213.95 ,$213.95 ,$197.38 ,$213.95 ,$210.67 ,$221.43 ,$73.79 ,$256.05 , N/A ,$158.81 ,$158.81 ,$85.76 ,$158.81 , N/A ,$307.90 ,$265.77 ,$265.77 ,$259.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201921,N/A,HC PROBES ARTH 90% ABLATION,272,1 ,$372.00 ,$245.52 ,$84.69 ,$372.00 , N/A ,$333.39 ,$333.39 ,$98.43 ,$297.60 ,$316.20 ,$232.50 ,$334.80 , N/A , N/A ,$353.40 ,$334.80 ,$316.20 ,$316.20 ,$98.43 ,$316.20 ,$316.20 ,$334.80 ,$226.55 , N/A ,$230.64 , N/A ,$334.80 , N/A ,$342.24 ,$334.80 ,$245.56 ,$245.56 ,$226.55 ,$245.56 ,$241.80 ,$254.15 ,$84.69 ,$293.88 , N/A ,$182.28 ,$182.28 ,$98.43 ,$182.28 , 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 ,$12.54 ,$4.32 ,$19.00 , N/A ,$17.03 ,$17.03 ,$5.03 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$5.03 ,$16.15 ,$16.15 ,$17.10 ,$11.57 , N/A ,$11.78 , N/A ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.54 ,$12.54 ,$11.57 ,$12.54 ,$12.35 ,$12.98 ,$4.32 ,$15.01 , N/A ,$9.31 ,$9.31 ,$5.03 ,$9.31 , 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 ,$124.63 ,$82.26 ,$28.37 ,$124.63 , N/A ,$111.69 ,$111.69 ,$32.98 ,$99.70 ,$105.94 ,$77.89 ,$112.17 , N/A , N/A ,$118.40 ,$112.17 ,$105.94 ,$105.94 ,$32.98 ,$105.94 ,$105.94 ,$112.17 ,$75.90 , N/A ,$77.28 , N/A ,$112.17 , N/A ,$114.66 ,$112.17 ,$82.27 ,$82.27 ,$75.90 ,$82.27 ,$81.01 ,$85.15 ,$28.37 ,$98.46 , N/A ,$61.07 ,$61.07 ,$32.98 ,$61.07 , N/A ,$118.40 ,$102.20 ,$102.20 ,$99.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27201980,N/A,HC RETRACTOR V-CARE VAG/CERV,272,1 ,$104.00 ,$68.64 ,$23.68 ,$104.00 , N/A ,$93.20 ,$93.20 ,$27.52 ,$83.20 ,$88.40 ,$65.00 ,$93.60 , N/A , N/A ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$27.52 ,$88.40 ,$88.40 ,$93.60 ,$63.34 , N/A ,$64.48 , N/A ,$93.60 , N/A ,$95.68 ,$93.60 ,$68.65 ,$68.65 ,$63.34 ,$68.65 ,$67.60 ,$71.05 ,$23.68 ,$82.16 , N/A ,$50.96 ,$50.96 ,$27.52 ,$50.96 , N/A ,$98.80 ,$85.28 ,$85.28 ,$83.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$172.80 ,$114.05 ,$39.34 ,$172.80 , N/A ,$154.86 ,$154.86 ,$45.73 ,$138.24 ,$146.88 ,$108.00 ,$155.52 , N/A , N/A ,$164.16 ,$155.52 ,$146.88 ,$146.88 ,$45.73 ,$146.88 ,$146.88 ,$155.52 ,$105.24 , N/A ,$107.14 , N/A ,$155.52 , N/A ,$158.98 ,$155.52 ,$114.07 ,$114.07 ,$105.24 ,$114.07 ,$112.32 ,$118.06 ,$39.34 ,$136.51 , N/A ,$84.67 ,$84.67 ,$45.73 ,$84.67 , N/A ,$164.16 ,$141.70 ,$141.70 ,$138.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202008,N/A,HC SCREW SYN 5.0 LOCKING STARDRV,272,1 ,$442.00 ,$291.72 ,$100.63 ,$442.00 , N/A ,$396.12 ,$396.12 ,$116.95 ,$353.60 ,$375.70 ,$276.25 ,$397.80 , N/A , N/A ,$419.90 ,$397.80 ,$375.70 ,$375.70 ,$116.95 ,$375.70 ,$375.70 ,$397.80 ,$269.18 , N/A ,$274.04 , N/A ,$397.80 , N/A ,$406.64 ,$397.80 ,$291.76 ,$291.76 ,$269.18 ,$291.76 ,$287.30 ,$301.97 ,$100.63 ,$349.18 , N/A ,$216.58 ,$216.58 ,$116.95 ,$216.58 , 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 ,$194.04 ,$66.93 ,$294.00 , N/A ,$263.48 ,$263.48 ,$77.79 ,$235.20 ,$249.90 ,$183.75 ,$264.60 , N/A , N/A ,$279.30 ,$264.60 ,$249.90 ,$249.90 ,$77.79 ,$249.90 ,$249.90 ,$264.60 ,$179.05 , N/A ,$182.28 , N/A ,$264.60 , N/A ,$270.48 ,$264.60 ,$194.07 ,$194.07 ,$179.05 ,$194.07 ,$191.10 ,$200.86 ,$66.93 ,$232.26 , N/A ,$144.06 ,$144.06 ,$77.79 ,$144.06 , N/A ,$279.30 ,$241.08 ,$241.08 ,$235.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202016,N/A,HC SEALS SCOPE WARMER,272,1 ,$37.45 ,$24.72 ,$8.53 ,$37.45 , N/A ,$33.56 ,$33.56 ,$9.91 ,$29.96 ,$31.83 ,$23.41 ,$33.71 , N/A , N/A ,$35.58 ,$33.71 ,$31.83 ,$31.83 ,$9.91 ,$31.83 ,$31.83 ,$33.71 ,$22.81 , N/A ,$23.22 , N/A ,$33.71 , N/A ,$34.45 ,$33.71 ,$24.72 ,$24.72 ,$22.81 ,$24.72 ,$24.34 ,$25.59 ,$8.53 ,$29.59 , N/A ,$18.35 ,$18.35 ,$9.91 ,$18.35 , N/A ,$35.58 ,$30.71 ,$30.71 ,$29.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202020,N/A,HC SHOULDER PACK,272,1 ,$345.00 ,$227.70 ,$78.54 ,$345.00 , N/A ,$309.19 ,$309.19 ,$91.29 ,$276.00 ,$293.25 ,$215.63 ,$310.50 , N/A , N/A ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$91.29 ,$293.25 ,$293.25 ,$310.50 ,$210.11 , N/A ,$213.90 , N/A ,$310.50 , N/A ,$317.40 ,$310.50 ,$227.73 ,$227.73 ,$210.11 ,$227.73 ,$224.25 ,$235.70 ,$78.54 ,$272.55 , N/A ,$169.05 ,$169.05 ,$91.29 ,$169.05 , 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 ","$1,021.02 ",$352.18 ,"$1,547.00 ", N/A ,"$1,386.42 ","$1,386.42 ",$409.34 ,"$1,237.60 ","$1,314.95 ",$966.88 ,"$1,392.30 ", N/A , N/A ,"$1,469.65 ","$1,392.30 ","$1,314.95 ","$1,314.95 ",$409.34 ,"$1,314.95 ","$1,314.95 ","$1,392.30 ",$942.12 , N/A ,$959.14 , N/A ,"$1,392.30 ", N/A ,"$1,423.24 ","$1,392.30 ","$1,021.17 ","$1,021.17 ",$942.12 ,"$1,021.17 ","$1,005.55 ","$1,056.91 ",$352.18 ,"$1,222.13 ", N/A ,$758.03 ,$758.03 ,$409.34 ,$758.03 , 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 ,$6.14 ,$2.12 ,$9.30 , N/A ,$8.33 ,$8.33 ,$2.46 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.37 ,$5.66 , N/A ,$5.76 , N/A ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.14 ,$6.14 ,$5.66 ,$6.14 ,$6.05 ,$6.35 ,$2.12 ,$7.35 , N/A ,$4.56 ,$4.56 ,$2.46 ,$4.56 , 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 ,$5.00 ,$3.30 ,$1.14 ,$5.00 , N/A ,$4.48 ,$4.48 ,$1.32 ,$4.00 ,$4.25 ,$3.13 ,$4.50 , N/A , N/A ,$4.75 ,$4.50 ,$4.25 ,$4.25 ,$1.32 ,$4.25 ,$4.25 ,$4.50 ,$3.05 , N/A ,$3.10 , N/A ,$4.50 , N/A ,$4.60 ,$4.50 ,$3.30 ,$3.30 ,$3.05 ,$3.30 ,$3.25 ,$3.42 ,$1.14 ,$3.95 , N/A ,$2.45 ,$2.45 ,$1.32 ,$2.45 , N/A ,$4.75 ,$4.10 ,$4.10 ,$4.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202072,N/A,HC SPONGE MEROCEL 440406,272,1 ,$248.00 ,$163.68 ,$56.46 ,$248.00 , N/A ,$222.26 ,$222.26 ,$65.62 ,$198.40 ,$210.80 ,$155.00 ,$223.20 , N/A , N/A ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$65.62 ,$210.80 ,$210.80 ,$223.20 ,$151.03 , N/A ,$153.76 , N/A ,$223.20 , N/A ,$228.16 ,$223.20 ,$163.70 ,$163.70 ,$151.03 ,$163.70 ,$161.20 ,$169.43 ,$56.46 ,$195.92 , N/A ,$121.52 ,$121.52 ,$65.62 ,$121.52 , 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 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , N/A ,$3.90 ,$3.36 ,$3.36 ,$3.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202075,N/A,HC SPONGE RAYTEC 3X3,272,1 ,$3.00 ,$1.98 ,$0.69 ,$3.00 , N/A ,$2.69 ,$2.69 ,$0.79 ,$2.40 ,$2.55 ,$1.88 ,$2.70 , N/A , N/A ,$2.85 ,$2.70 ,$2.55 ,$2.55 ,$0.79 ,$2.55 ,$2.55 ,$2.70 ,$1.83 , N/A ,$1.86 , N/A ,$2.70 , N/A ,$2.76 ,$2.70 ,$1.98 ,$1.98 ,$1.83 ,$1.98 ,$1.95 ,$2.05 ,$0.69 ,$2.37 , N/A ,$1.47 ,$1.47 ,$0.79 ,$1.47 , N/A ,$2.85 ,$2.46 ,$2.46 ,$2.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202078,N/A,HC SPONGE TONSIL,272,1 ,$8.30 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$63.02 ,$41.59 ,$14.34 ,$63.02 , N/A ,$56.48 ,$56.48 ,$16.68 ,$50.42 ,$53.57 ,$39.39 ,$56.72 , N/A , N/A ,$59.87 ,$56.72 ,$53.57 ,$53.57 ,$16.68 ,$53.57 ,$53.57 ,$56.72 ,$38.38 , N/A ,$39.08 , N/A ,$56.72 , N/A ,$57.98 ,$56.72 ,$41.60 ,$41.60 ,$38.38 ,$41.60 ,$40.96 ,$43.06 ,$14.34 ,$49.79 , N/A ,$30.88 ,$30.88 ,$16.68 ,$30.88 , N/A ,$59.87 ,$51.68 ,$51.68 ,$50.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202087,N/A,HC STAPLER CEEA 29,272,1 ,$806.00 ,$531.96 ,$183.49 ,$806.00 , N/A ,$722.34 ,$722.34 ,$213.27 ,$644.80 ,$685.10 ,$503.75 ,$725.40 , N/A , N/A ,$765.70 ,$725.40 ,$685.10 ,$685.10 ,$213.27 ,$685.10 ,$685.10 ,$725.40 ,$490.85 , N/A ,$499.72 , N/A ,$725.40 , N/A ,$741.52 ,$725.40 ,$532.04 ,$532.04 ,$490.85 ,$532.04 ,$523.90 ,$550.66 ,$183.49 ,$636.74 , N/A ,$394.94 ,$394.94 ,$213.27 ,$394.94 , 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 ,$531.96 ,$183.49 ,$806.00 , N/A ,$722.34 ,$722.34 ,$213.27 ,$644.80 ,$685.10 ,$503.75 ,$725.40 , N/A , N/A ,$765.70 ,$725.40 ,$685.10 ,$685.10 ,$213.27 ,$685.10 ,$685.10 ,$725.40 ,$490.85 , N/A ,$499.72 , N/A ,$725.40 , N/A ,$741.52 ,$725.40 ,$532.04 ,$532.04 ,$490.85 ,$532.04 ,$523.90 ,$550.66 ,$183.49 ,$636.74 , N/A ,$394.94 ,$394.94 ,$213.27 ,$394.94 , 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 ,$531.96 ,$183.49 ,$806.00 , N/A ,$722.34 ,$722.34 ,$213.27 ,$644.80 ,$685.10 ,$503.75 ,$725.40 , N/A , N/A ,$765.70 ,$725.40 ,$685.10 ,$685.10 ,$213.27 ,$685.10 ,$685.10 ,$725.40 ,$490.85 , N/A ,$499.72 , N/A ,$725.40 , N/A ,$741.52 ,$725.40 ,$532.04 ,$532.04 ,$490.85 ,$532.04 ,$523.90 ,$550.66 ,$183.49 ,$636.74 , N/A ,$394.94 ,$394.94 ,$213.27 ,$394.94 , 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 ,$656.70 ,$226.52 ,$995.00 , N/A ,$891.72 ,$891.72 ,$263.28 ,$796.00 ,$845.75 ,$621.88 ,$895.50 , N/A , N/A ,$945.25 ,$895.50 ,$845.75 ,$845.75 ,$263.28 ,$845.75 ,$845.75 ,$895.50 ,$605.96 , N/A ,$616.90 , N/A ,$895.50 , N/A ,$915.40 ,$895.50 ,$656.80 ,$656.80 ,$605.96 ,$656.80 ,$646.75 ,$679.78 ,$226.52 ,$786.05 , N/A ,$487.55 ,$487.55 ,$263.28 ,$487.55 , 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 ,$538.56 ,$185.77 ,$816.00 , N/A ,$731.30 ,$731.30 ,$215.91 ,$652.80 ,$693.60 ,$510.00 ,$734.40 , N/A , N/A ,$775.20 ,$734.40 ,$693.60 ,$693.60 ,$215.91 ,$693.60 ,$693.60 ,$734.40 ,$496.94 , N/A ,$505.92 , N/A ,$734.40 , N/A ,$750.72 ,$734.40 ,$538.64 ,$538.64 ,$496.94 ,$538.64 ,$530.40 ,$557.49 ,$185.77 ,$644.64 , N/A ,$399.84 ,$399.84 ,$215.91 ,$399.84 , 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 ,$570.90 ,$196.92 ,$865.00 , N/A ,$775.21 ,$775.21 ,$228.88 ,$692.00 ,$735.25 ,$540.63 ,$778.50 , N/A , N/A ,$821.75 ,$778.50 ,$735.25 ,$735.25 ,$228.88 ,$735.25 ,$735.25 ,$778.50 ,$526.79 , N/A ,$536.30 , N/A ,$778.50 , N/A ,$795.80 ,$778.50 ,$570.99 ,$570.99 ,$526.79 ,$570.99 ,$562.25 ,$590.97 ,$196.92 ,$683.35 , N/A ,$423.85 ,$423.85 ,$228.88 ,$423.85 , 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 ","$1,802.46 ",$621.72 ,"$2,731.00 ", N/A ,"$2,447.52 ","$2,447.52 ",$722.62 ,"$2,184.80 ","$2,321.35 ","$1,706.88 ","$2,457.90 ", N/A , N/A ,"$2,594.45 ","$2,457.90 ","$2,321.35 ","$2,321.35 ",$722.62 ,"$2,321.35 ","$2,321.35 ","$2,457.90 ","$1,663.18 ", N/A ,"$1,693.22 ", N/A ,"$2,457.90 ", N/A ,"$2,512.52 ","$2,457.90 ","$1,802.73 ","$1,802.73 ","$1,663.18 ","$1,802.73 ","$1,775.15 ","$1,865.82 ",$621.72 ,"$2,157.49 ", N/A ,"$1,338.19 ","$1,338.19 ",$722.62 ,"$1,338.19 ", 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 ,$194.70 ,$67.16 ,$295.00 , N/A ,$264.38 ,$264.38 ,$78.06 ,$236.00 ,$250.75 ,$184.38 ,$265.50 , N/A , N/A ,$280.25 ,$265.50 ,$250.75 ,$250.75 ,$78.06 ,$250.75 ,$250.75 ,$265.50 ,$179.66 , N/A ,$182.90 , N/A ,$265.50 , N/A ,$271.40 ,$265.50 ,$194.73 ,$194.73 ,$179.66 ,$194.73 ,$191.75 ,$201.54 ,$67.16 ,$233.05 , N/A ,$144.55 ,$144.55 ,$78.06 ,$144.55 , 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 ","$1,559.58 ",$537.94 ,"$2,363.00 ", N/A ,"$2,117.72 ","$2,117.72 ",$625.25 ,"$1,890.40 ","$2,008.55 ","$1,476.88 ","$2,126.70 ", N/A , N/A ,"$2,244.85 ","$2,126.70 ","$2,008.55 ","$2,008.55 ",$625.25 ,"$2,008.55 ","$2,008.55 ","$2,126.70 ","$1,439.07 ", N/A ,"$1,465.06 ", N/A ,"$2,126.70 ", N/A ,"$2,173.96 ","$2,126.70 ","$1,559.82 ","$1,559.82 ","$1,439.07 ","$1,559.82 ","$1,535.95 ","$1,614.40 ",$537.94 ,"$1,866.77 ", N/A ,"$1,157.87 ","$1,157.87 ",$625.25 ,"$1,157.87 ", 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 ,$190.08 ,$65.56 ,$288.00 , N/A ,$258.11 ,$258.11 ,$76.20 ,$230.40 ,$244.80 ,$180.00 ,$259.20 , N/A , N/A ,$273.60 ,$259.20 ,$244.80 ,$244.80 ,$76.20 ,$244.80 ,$244.80 ,$259.20 ,$175.39 , N/A ,$178.56 , N/A ,$259.20 , N/A ,$264.96 ,$259.20 ,$190.11 ,$190.11 ,$175.39 ,$190.11 ,$187.20 ,$196.76 ,$65.56 ,$227.52 , N/A ,$141.12 ,$141.12 ,$76.20 ,$141.12 , 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 ,$43.00 ,$28.38 ,$9.79 ,$43.00 , N/A ,$38.54 ,$38.54 ,$11.38 ,$34.40 ,$36.55 ,$26.88 ,$38.70 , N/A , N/A ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$11.38 ,$36.55 ,$36.55 ,$38.70 ,$26.19 , N/A ,$26.66 , N/A ,$38.70 , N/A ,$39.56 ,$38.70 ,$28.38 ,$28.38 ,$26.19 ,$28.38 ,$27.95 ,$29.38 ,$9.79 ,$33.97 , N/A ,$21.07 ,$21.07 ,$11.38 ,$21.07 , N/A ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202117,N/A,HC STAPLE RELOAD,272,1 ,$409.00 ,$269.94 ,$93.11 ,$409.00 , N/A ,$366.55 ,$366.55 ,$108.22 ,$327.20 ,$347.65 ,$255.63 ,$368.10 , N/A , N/A ,$388.55 ,$368.10 ,$347.65 ,$347.65 ,$108.22 ,$347.65 ,$347.65 ,$368.10 ,$249.08 , N/A ,$253.58 , N/A ,$368.10 , N/A ,$376.28 ,$368.10 ,$269.98 ,$269.98 ,$249.08 ,$269.98 ,$265.85 ,$279.43 ,$93.11 ,$323.11 , N/A ,$200.41 ,$200.41 ,$108.22 ,$200.41 , 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 ,$392.70 ,$135.46 ,$595.00 , N/A ,$533.24 ,$533.24 ,$157.44 ,$476.00 ,$505.75 ,$371.88 ,$535.50 , N/A , N/A ,$565.25 ,$535.50 ,$505.75 ,$505.75 ,$157.44 ,$505.75 ,$505.75 ,$535.50 ,$362.36 , N/A ,$368.90 , N/A ,$535.50 , N/A ,$547.40 ,$535.50 ,$392.76 ,$392.76 ,$362.36 ,$392.76 ,$386.75 ,$406.50 ,$135.46 ,$470.05 , N/A ,$291.55 ,$291.55 ,$157.44 ,$291.55 , 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 ,$392.70 ,$135.46 ,$595.00 , N/A ,$533.24 ,$533.24 ,$157.44 ,$476.00 ,$505.75 ,$371.88 ,$535.50 , N/A , N/A ,$565.25 ,$535.50 ,$505.75 ,$505.75 ,$157.44 ,$505.75 ,$505.75 ,$535.50 ,$362.36 , N/A ,$368.90 , N/A ,$535.50 , N/A ,$547.40 ,$535.50 ,$392.76 ,$392.76 ,$362.36 ,$392.76 ,$386.75 ,$406.50 ,$135.46 ,$470.05 , N/A ,$291.55 ,$291.55 ,$157.44 ,$291.55 , 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 ,$15.18 ,$5.23 ,$23.00 , N/A ,$20.61 ,$20.61 ,$6.09 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$6.09 ,$19.55 ,$19.55 ,$20.70 ,$14.01 , N/A ,$14.26 , N/A ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.18 ,$15.18 ,$14.01 ,$15.18 ,$14.95 ,$15.71 ,$5.23 ,$18.17 , N/A ,$11.27 ,$11.27 ,$6.09 ,$11.27 , 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 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$598.62 ,$206.49 ,$907.00 , N/A ,$812.85 ,$812.85 ,$239.99 ,$725.60 ,$770.95 ,$566.88 ,$816.30 , N/A , N/A ,$861.65 ,$816.30 ,$770.95 ,$770.95 ,$239.99 ,$770.95 ,$770.95 ,$816.30 ,$552.36 , N/A ,$562.34 , N/A ,$816.30 , N/A ,$834.44 ,$816.30 ,$598.71 ,$598.71 ,$552.36 ,$598.71 ,$589.55 ,$619.66 ,$206.49 ,$716.53 , N/A ,$444.43 ,$444.43 ,$239.99 ,$444.43 , 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 ,$347.82 ,$119.97 ,$527.00 , N/A ,$472.30 ,$472.30 ,$139.44 ,$421.60 ,$447.95 ,$329.38 ,$474.30 , N/A , N/A ,$500.65 ,$474.30 ,$447.95 ,$447.95 ,$139.44 ,$447.95 ,$447.95 ,$474.30 ,$320.94 , N/A ,$326.74 , N/A ,$474.30 , N/A ,$484.84 ,$474.30 ,$347.87 ,$347.87 ,$320.94 ,$347.87 ,$342.55 ,$360.05 ,$119.97 ,$416.33 , N/A ,$258.23 ,$258.23 ,$139.44 ,$258.23 , 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 ,$93.72 ,$32.33 ,$142.00 , N/A ,$127.26 ,$127.26 ,$37.57 ,$113.60 ,$120.70 ,$88.75 ,$127.80 , N/A , N/A ,$134.90 ,$127.80 ,$120.70 ,$120.70 ,$37.57 ,$120.70 ,$120.70 ,$127.80 ,$86.48 , N/A ,$88.04 , N/A ,$127.80 , N/A ,$130.64 ,$127.80 ,$93.73 ,$93.73 ,$86.48 ,$93.73 ,$92.30 ,$97.01 ,$32.33 ,$112.18 , N/A ,$69.58 ,$69.58 ,$37.57 ,$69.58 , N/A ,$134.90 ,$116.44 ,$116.44 ,$113.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202149,N/A,HC STOCKINETTE DOUBLE LG,272,1 ,$15.35 ,$10.13 ,$3.50 ,$15.35 , N/A ,$13.76 ,$13.76 ,$4.06 ,$12.28 ,$13.05 ,$9.59 ,$13.82 , N/A , N/A ,$14.58 ,$13.82 ,$13.05 ,$13.05 ,$4.06 ,$13.05 ,$13.05 ,$13.82 ,$9.35 , N/A ,$9.52 , N/A ,$13.82 , N/A ,$14.12 ,$13.82 ,$10.13 ,$10.13 ,$9.35 ,$10.13 ,$9.98 ,$10.49 ,$3.50 ,$12.13 , N/A ,$7.52 ,$7.52 ,$4.06 ,$7.52 , N/A ,$14.58 ,$12.59 ,$12.59 ,$12.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202150,N/A,HC STOCKINETTE DOUBLE MD,272,1 ,$15.25 ,$10.07 ,$3.48 ,$15.25 , N/A ,$13.67 ,$13.67 ,$4.04 ,$12.20 ,$12.96 ,$9.53 ,$13.73 , N/A , N/A ,$14.49 ,$13.73 ,$12.96 ,$12.96 ,$4.04 ,$12.96 ,$12.96 ,$13.73 ,$9.29 , N/A ,$9.46 , N/A ,$13.73 , N/A ,$14.03 ,$13.73 ,$10.07 ,$10.07 ,$9.29 ,$10.07 ,$9.91 ,$10.42 ,$3.48 ,$12.05 , N/A ,$7.47 ,$7.47 ,$4.04 ,$7.47 , N/A ,$14.49 ,$12.51 ,$12.51 ,$12.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202151,N/A,HC STOCKING TED KNEE HIGH,272,1 ,$16.22 ,$10.71 ,$3.69 ,$16.22 , N/A ,$14.54 ,$14.54 ,$4.29 ,$12.98 ,$13.79 ,$10.14 ,$14.60 , N/A , N/A ,$15.41 ,$14.60 ,$13.79 ,$13.79 ,$4.29 ,$13.79 ,$13.79 ,$14.60 ,$9.88 , N/A ,$10.06 , N/A ,$14.60 , N/A ,$14.92 ,$14.60 ,$10.71 ,$10.71 ,$9.88 ,$10.71 ,$10.54 ,$11.08 ,$3.69 ,$12.81 , N/A ,$7.95 ,$7.95 ,$4.29 ,$7.95 , N/A ,$15.41 ,$13.30 ,$13.30 ,$12.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202152,N/A,HC STOCKING TED THIGH HIGH,272,1 ,$17.00 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$394.02 ,$135.91 ,$597.00 , N/A ,$535.03 ,$535.03 ,$157.97 ,$477.60 ,$507.45 ,$373.13 ,$537.30 , N/A , N/A ,$567.15 ,$537.30 ,$507.45 ,$507.45 ,$157.97 ,$507.45 ,$507.45 ,$537.30 ,$363.57 , N/A ,$370.14 , N/A ,$537.30 , N/A ,$549.24 ,$537.30 ,$394.08 ,$394.08 ,$363.57 ,$394.08 ,$388.05 ,$407.87 ,$135.91 ,$471.63 , N/A ,$292.53 ,$292.53 ,$157.97 ,$292.53 , 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 ,$20.46 ,$7.06 ,$31.00 , N/A ,$27.78 ,$27.78 ,$8.20 ,$24.80 ,$26.35 ,$19.38 ,$27.90 , N/A , N/A ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$8.20 ,$26.35 ,$26.35 ,$27.90 ,$18.88 , N/A ,$19.22 , N/A ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.46 ,$20.46 ,$18.88 ,$20.46 ,$20.15 ,$21.18 ,$7.06 ,$24.49 , N/A ,$15.19 ,$15.19 ,$8.20 ,$15.19 , 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 ","$1,234.20 ",$425.71 ,"$1,870.00 ", N/A ,"$1,675.89 ","$1,675.89 ",$494.80 ,"$1,496.00 ","$1,589.50 ","$1,168.75 ","$1,683.00 ", N/A , N/A ,"$1,776.50 ","$1,683.00 ","$1,589.50 ","$1,589.50 ",$494.80 ,"$1,589.50 ","$1,589.50 ","$1,683.00 ","$1,138.83 ", N/A ,"$1,159.40 ", N/A ,"$1,683.00 ", N/A ,"$1,720.40 ","$1,683.00 ","$1,234.39 ","$1,234.39 ","$1,138.83 ","$1,234.39 ","$1,215.50 ","$1,277.58 ",$425.71 ,"$1,477.30 ", N/A ,$916.30 ,$916.30 ,$494.80 ,$916.30 , 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 ,$10.23 ,$3.54 ,$15.50 , N/A ,$13.89 ,$13.89 ,$4.11 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$4.11 ,$13.18 ,$13.18 ,$13.95 ,$9.44 , N/A ,$9.62 , N/A ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.23 ,$10.23 ,$9.44 ,$10.23 ,$10.08 ,$10.59 ,$3.54 ,$12.25 , N/A ,$7.60 ,$7.60 ,$4.11 ,$7.60 , N/A ,$14.73 ,$12.71 ,$12.71 ,$12.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202182,N/A,HC SUPPORTER ADULT,272,1 ,$17.67 ,$11.66 ,$4.02 ,$17.67 , N/A ,$15.84 ,$15.84 ,$4.67 ,$14.14 ,$15.02 ,$11.04 ,$15.90 , N/A , N/A ,$16.79 ,$15.90 ,$15.02 ,$15.02 ,$4.67 ,$15.02 ,$15.02 ,$15.90 ,$10.76 , N/A ,$10.96 , N/A ,$15.90 , N/A ,$16.26 ,$15.90 ,$11.66 ,$11.66 ,$10.76 ,$11.66 ,$11.49 ,$12.07 ,$4.02 ,$13.96 , N/A ,$8.66 ,$8.66 ,$4.67 ,$8.66 , N/A ,$16.79 ,$14.49 ,$14.49 ,$14.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202187,N/A,HC SUT 2-0 ETHIBOND 30IN,272,1 ,$7.08 ,$4.67 ,$1.62 ,$7.08 , N/A ,$6.35 ,$6.35 ,$1.87 ,$5.66 ,$6.02 ,$4.43 ,$6.37 , N/A , N/A ,$6.73 ,$6.37 ,$6.02 ,$6.02 ,$1.87 ,$6.02 ,$6.02 ,$6.37 ,$4.31 , N/A ,$4.38 , N/A ,$6.37 , N/A ,$6.51 ,$6.37 ,$4.67 ,$4.67 ,$4.31 ,$4.67 ,$4.60 ,$4.84 ,$1.62 ,$5.59 , N/A ,$3.47 ,$3.47 ,$1.87 ,$3.47 , N/A ,$6.73 ,$5.81 ,$5.81 ,$5.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202195,N/A,HC SUT BUTTONS 520G,272,1 ,$10.40 ,$6.86 ,$2.36 ,$10.40 , N/A ,$9.32 ,$9.32 ,$2.75 ,$8.32 ,$8.84 ,$6.50 ,$9.36 , N/A , N/A ,$9.88 ,$9.36 ,$8.84 ,$8.84 ,$2.75 ,$8.84 ,$8.84 ,$9.36 ,$6.33 , N/A ,$6.44 , N/A ,$9.36 , N/A ,$9.57 ,$9.36 ,$6.87 ,$6.87 ,$6.33 ,$6.87 ,$6.76 ,$7.11 ,$2.36 ,$8.22 , N/A ,$5.10 ,$5.10 ,$2.75 ,$5.10 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$12.20 ,$8.05 ,$2.78 ,$12.20 , N/A ,$10.93 ,$10.93 ,$3.22 ,$9.76 ,$10.37 ,$7.63 ,$10.98 , N/A , N/A ,$11.59 ,$10.98 ,$10.37 ,$10.37 ,$3.22 ,$10.37 ,$10.37 ,$10.98 ,$7.43 , N/A ,$7.56 , N/A ,$10.98 , N/A ,$11.22 ,$10.98 ,$8.05 ,$8.05 ,$7.43 ,$8.05 ,$7.93 ,$8.34 ,$2.78 ,$9.64 , N/A ,$5.98 ,$5.98 ,$3.22 ,$5.98 , N/A ,$11.59 ,$10.00 ,$10.00 ,$9.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202210,N/A,HC SUT CHROMIC 2-0 L113G/LG113,272,1 ,$12.40 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$12.27 ,$8.10 ,$2.79 ,$12.27 , N/A ,$11.00 ,$11.00 ,$3.24 ,$9.82 ,$10.43 ,$7.67 ,$11.04 , N/A , N/A ,$11.66 ,$11.04 ,$10.43 ,$10.43 ,$3.24 ,$10.43 ,$10.43 ,$11.04 ,$7.47 , N/A ,$7.60 , N/A ,$11.04 , N/A ,$11.29 ,$11.04 ,$8.10 ,$8.10 ,$7.47 ,$8.10 ,$7.98 ,$8.38 ,$2.79 ,$9.69 , N/A ,$6.01 ,$6.01 ,$3.24 ,$6.01 , N/A ,$11.66 ,$10.06 ,$10.06 ,$9.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202216,N/A,HC SUT CHROMIC 3-0 L112G/LG112,272,1 ,$12.40 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$119.46 ,$41.21 ,$181.00 , N/A ,$162.21 ,$162.21 ,$47.89 ,$144.80 ,$153.85 ,$113.13 ,$162.90 , N/A , N/A ,$171.95 ,$162.90 ,$153.85 ,$153.85 ,$47.89 ,$153.85 ,$153.85 ,$162.90 ,$110.23 , N/A ,$112.22 , N/A ,$162.90 , N/A ,$166.52 ,$162.90 ,$119.48 ,$119.48 ,$110.23 ,$119.48 ,$117.65 ,$123.66 ,$41.21 ,$142.99 , N/A ,$88.69 ,$88.69 ,$47.89 ,$88.69 , 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 ,$33.66 ,$11.61 ,$51.00 , N/A ,$45.71 ,$45.71 ,$13.49 ,$40.80 ,$43.35 ,$31.88 ,$45.90 , N/A , N/A ,$48.45 ,$45.90 ,$43.35 ,$43.35 ,$13.49 ,$43.35 ,$43.35 ,$45.90 ,$31.06 , N/A ,$31.62 , N/A ,$45.90 , N/A ,$46.92 ,$45.90 ,$33.67 ,$33.67 ,$31.06 ,$33.67 ,$33.15 ,$34.84 ,$11.61 ,$40.29 , N/A ,$24.99 ,$24.99 ,$13.49 ,$24.99 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$4.22 ,$1.45 ,$6.40 , N/A ,$5.74 ,$5.74 ,$1.70 ,$5.12 ,$5.44 ,$4.00 ,$5.76 , N/A , N/A ,$6.08 ,$5.76 ,$5.44 ,$5.44 ,$1.70 ,$5.44 ,$5.44 ,$5.76 ,$3.90 , N/A ,$3.96 , N/A ,$5.76 , N/A ,$5.89 ,$5.76 ,$4.22 ,$4.22 ,$3.90 ,$4.22 ,$4.16 ,$4.37 ,$1.45 ,$5.06 , N/A ,$3.14 ,$3.14 ,$1.70 ,$3.14 , 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 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$36.96 ,$12.75 ,$56.00 , N/A ,$50.19 ,$50.19 ,$14.82 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$14.82 ,$47.60 ,$47.60 ,$50.40 ,$34.10 , N/A ,$34.72 , N/A ,$50.40 , N/A ,$51.52 ,$50.40 ,$36.97 ,$36.97 ,$34.10 ,$36.97 ,$36.40 ,$38.26 ,$12.75 ,$44.24 , N/A ,$27.44 ,$27.44 ,$14.82 ,$27.44 , 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 ,$7.06 ,$4.66 ,$1.61 ,$7.06 , N/A ,$6.33 ,$6.33 ,$1.87 ,$5.65 ,$6.00 ,$4.41 ,$6.35 , N/A , N/A ,$6.71 ,$6.35 ,$6.00 ,$6.00 ,$1.87 ,$6.00 ,$6.00 ,$6.35 ,$4.30 , N/A ,$4.38 , N/A ,$6.35 , N/A ,$6.50 ,$6.35 ,$4.66 ,$4.66 ,$4.30 ,$4.66 ,$4.59 ,$4.82 ,$1.61 ,$5.58 , N/A ,$3.46 ,$3.46 ,$1.87 ,$3.46 , N/A ,$6.71 ,$5.79 ,$5.79 ,$5.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202267,N/A,HC SUT ETHILON 3-0 FSLX 30IN,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$13.17 ,$8.69 ,$3.00 ,$13.17 , N/A ,$11.80 ,$11.80 ,$3.49 ,$10.54 ,$11.19 ,$8.23 ,$11.85 , N/A , N/A ,$12.51 ,$11.85 ,$11.19 ,$11.19 ,$3.49 ,$11.19 ,$11.19 ,$11.85 ,$8.02 , N/A ,$8.16 , N/A ,$11.85 , N/A ,$12.12 ,$11.85 ,$8.69 ,$8.69 ,$8.02 ,$8.69 ,$8.56 ,$9.00 ,$3.00 ,$10.40 , N/A ,$6.45 ,$6.45 ,$3.49 ,$6.45 , N/A ,$12.51 ,$10.80 ,$10.80 ,$10.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202269,N/A,HC SUT ETHILON 4-0 PS-2 18 1667H,272,1 ,$13.30 ,$8.78 ,$3.03 ,$13.30 , N/A ,$11.92 ,$11.92 ,$3.52 ,$10.64 ,$11.31 ,$8.31 ,$11.97 , N/A , N/A ,$12.64 ,$11.97 ,$11.31 ,$11.31 ,$3.52 ,$11.31 ,$11.31 ,$11.97 ,$8.10 , N/A ,$8.24 , N/A ,$11.97 , N/A ,$12.24 ,$11.97 ,$8.78 ,$8.78 ,$8.10 ,$8.78 ,$8.65 ,$9.09 ,$3.03 ,$10.51 , N/A ,$6.52 ,$6.52 ,$3.52 ,$6.52 , N/A ,$12.64 ,$10.91 ,$10.91 ,$10.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202270,N/A,HC SUT ETHILON 6-0 697G,272,1 ,$13.00 ,$8.58 ,$2.96 ,$13.00 , N/A ,$11.65 ,$11.65 ,$3.44 ,$10.40 ,$11.05 ,$8.13 ,$11.70 , N/A , N/A ,$12.35 ,$11.70 ,$11.05 ,$11.05 ,$3.44 ,$11.05 ,$11.05 ,$11.70 ,$7.92 , N/A ,$8.06 , N/A ,$11.70 , N/A ,$11.96 ,$11.70 ,$8.58 ,$8.58 ,$7.92 ,$8.58 ,$8.45 ,$8.88 ,$2.96 ,$10.27 , N/A ,$6.37 ,$6.37 ,$3.44 ,$6.37 , N/A ,$12.35 ,$10.66 ,$10.66 ,$10.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202293,N/A,HC SUT MONOCRYL 2-0 Y375H/UM345 AU,272,1 ,$8.19 ,$5.41 ,$1.86 ,$8.19 , N/A ,$7.34 ,$7.34 ,$2.17 ,$6.55 ,$6.96 ,$5.12 ,$7.37 , N/A , N/A ,$7.78 ,$7.37 ,$6.96 ,$6.96 ,$2.17 ,$6.96 ,$6.96 ,$7.37 ,$4.99 , N/A ,$5.08 , N/A ,$7.37 , N/A ,$7.53 ,$7.37 ,$5.41 ,$5.41 ,$4.99 ,$5.41 ,$5.32 ,$5.60 ,$1.86 ,$6.47 , N/A ,$4.01 ,$4.01 ,$2.17 ,$4.01 , N/A ,$7.78 ,$6.72 ,$6.72 ,$6.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202299,N/A,HC SUT MONOCRYL 3-0 Y416H,272,1 ,$17.68 ,$11.67 ,$4.03 ,$17.68 , N/A ,$15.84 ,$15.84 ,$4.67 ,$14.14 ,$15.03 ,$11.05 ,$15.91 , N/A , N/A ,$16.80 ,$15.91 ,$15.03 ,$15.03 ,$4.67 ,$15.03 ,$15.03 ,$15.91 ,$10.77 , N/A ,$10.96 , N/A ,$15.91 , N/A ,$16.27 ,$15.91 ,$11.67 ,$11.67 ,$10.77 ,$11.67 ,$11.49 ,$12.08 ,$4.03 ,$13.97 , N/A ,$8.66 ,$8.66 ,$4.67 ,$8.66 , N/A ,$16.80 ,$14.50 ,$14.50 ,$14.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202300,N/A,HC SUT MONOCRYL 3-0 Y936H/SC1780G,272,1 ,$17.81 ,$11.75 ,$4.06 ,$17.81 , N/A ,$15.96 ,$15.96 ,$4.71 ,$14.25 ,$15.14 ,$11.13 ,$16.03 , N/A , N/A ,$16.92 ,$16.03 ,$15.14 ,$15.14 ,$4.71 ,$15.14 ,$15.14 ,$16.03 ,$10.85 , N/A ,$11.04 , N/A ,$16.03 , N/A ,$16.39 ,$16.03 ,$11.76 ,$11.76 ,$10.85 ,$11.76 ,$11.58 ,$12.17 ,$4.06 ,$14.07 , N/A ,$8.73 ,$8.73 ,$4.71 ,$8.73 , N/A ,$16.92 ,$14.60 ,$14.60 ,$14.25 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202304,N/A,HC SUT MONOCRYL 5-0 Y213H,272,1 ,$18.00 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$26.40 ,$9.10 ,$40.00 , N/A ,$35.85 ,$35.85 ,$10.58 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$10.58 ,$34.00 ,$34.00 ,$36.00 ,$24.36 , N/A ,$24.80 , N/A ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.40 ,$26.40 ,$24.36 ,$26.40 ,$26.00 ,$27.33 ,$9.10 ,$31.60 , N/A ,$19.60 ,$19.60 ,$10.58 ,$19.60 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$37.27 ,$24.60 ,$8.49 ,$37.27 , N/A ,$33.40 ,$33.40 ,$9.86 ,$29.82 ,$31.68 ,$23.29 ,$33.54 , N/A , N/A ,$35.41 ,$33.54 ,$31.68 ,$31.68 ,$9.86 ,$31.68 ,$31.68 ,$33.54 ,$22.70 , N/A ,$23.10 , N/A ,$33.54 , N/A ,$34.29 ,$33.54 ,$24.60 ,$24.60 ,$22.70 ,$24.60 ,$24.23 ,$25.46 ,$8.49 ,$29.44 , N/A ,$18.26 ,$18.26 ,$9.86 ,$18.26 , N/A ,$35.41 ,$30.56 ,$30.56 ,$29.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202319,N/A,HC SUT NYLON 10-0 9000G/CS160-6,272,1 ,$62.00 ,$40.92 ,$14.11 ,$62.00 , N/A ,$55.56 ,$55.56 ,$16.41 ,$49.60 ,$52.70 ,$38.75 ,$55.80 , N/A , N/A ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$16.41 ,$52.70 ,$52.70 ,$55.80 ,$37.76 , N/A ,$38.44 , N/A ,$55.80 , N/A ,$57.04 ,$55.80 ,$40.93 ,$40.93 ,$37.76 ,$40.93 ,$40.30 ,$42.36 ,$14.11 ,$48.98 , N/A ,$30.38 ,$30.38 ,$16.41 ,$30.38 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$21.50 ,$14.19 ,$4.90 ,$21.50 , N/A ,$19.27 ,$19.27 ,$5.69 ,$17.20 ,$18.28 ,$13.44 ,$19.35 , N/A , N/A ,$20.43 ,$19.35 ,$18.28 ,$18.28 ,$5.69 ,$18.28 ,$18.28 ,$19.35 ,$13.09 , N/A ,$13.34 , N/A ,$19.35 , N/A ,$19.78 ,$19.35 ,$14.19 ,$14.19 ,$13.09 ,$14.19 ,$13.98 ,$14.69 ,$4.90 ,$16.99 , N/A ,$10.54 ,$10.54 ,$5.69 ,$10.54 , N/A ,$20.43 ,$17.63 ,$17.63 ,$17.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202356,N/A,HC SUT PLAIN 5-0 686G/SG2686,272,1 ,$22.00 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$9.17 ,$6.05 ,$2.09 ,$9.17 , N/A ,$8.22 ,$8.22 ,$2.43 ,$7.34 ,$7.79 ,$5.73 ,$8.25 , N/A , N/A ,$8.71 ,$8.25 ,$7.79 ,$7.79 ,$2.43 ,$7.79 ,$7.79 ,$8.25 ,$5.58 , N/A ,$5.68 , N/A ,$8.25 , N/A ,$8.44 ,$8.25 ,$6.05 ,$6.05 ,$5.58 ,$6.05 ,$5.96 ,$6.26 ,$2.09 ,$7.24 , N/A ,$4.49 ,$4.49 ,$2.43 ,$4.49 , N/A ,$8.71 ,$7.52 ,$7.52 ,$7.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202369,N/A,HC SUT PROLENE 0 8434H/CP434,272,1 ,$9.10 ,$6.01 ,$2.07 ,$9.10 , N/A ,$8.16 ,$8.16 ,$2.41 ,$7.28 ,$7.74 ,$5.69 ,$8.19 , N/A , N/A ,$8.65 ,$8.19 ,$7.74 ,$7.74 ,$2.41 ,$7.74 ,$7.74 ,$8.19 ,$5.54 , N/A ,$5.64 , N/A ,$8.19 , N/A ,$8.37 ,$8.19 ,$6.01 ,$6.01 ,$5.54 ,$6.01 ,$5.92 ,$6.22 ,$2.07 ,$7.19 , N/A ,$4.46 ,$4.46 ,$2.41 ,$4.46 , N/A ,$8.65 ,$7.46 ,$7.46 ,$7.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202370,N/A,HC SUT PROLENE 0 8834H/VP834,272,1 ,$11.40 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$6.14 ,$2.12 ,$9.30 , N/A ,$8.33 ,$8.33 ,$2.46 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.37 ,$5.66 , N/A ,$5.76 , N/A ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.14 ,$6.14 ,$5.66 ,$6.14 ,$6.05 ,$6.35 ,$2.12 ,$7.35 , N/A ,$4.56 ,$4.56 ,$2.46 ,$4.56 , 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 ,$50.16 ,$17.30 ,$76.00 , N/A ,$68.11 ,$68.11 ,$20.11 ,$60.80 ,$64.60 ,$47.50 ,$68.40 , N/A , N/A ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$20.11 ,$64.60 ,$64.60 ,$68.40 ,$46.28 , N/A ,$47.12 , N/A ,$68.40 , N/A ,$69.92 ,$68.40 ,$50.17 ,$50.17 ,$46.28 ,$50.17 ,$49.40 ,$51.92 ,$17.30 ,$60.04 , N/A ,$37.24 ,$37.24 ,$20.11 ,$37.24 , 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 ,$50.16 ,$17.30 ,$76.00 , N/A ,$68.11 ,$68.11 ,$20.11 ,$60.80 ,$64.60 ,$47.50 ,$68.40 , N/A , N/A ,$72.20 ,$68.40 ,$64.60 ,$64.60 ,$20.11 ,$64.60 ,$64.60 ,$68.40 ,$46.28 , N/A ,$47.12 , N/A ,$68.40 , N/A ,$69.92 ,$68.40 ,$50.17 ,$50.17 ,$46.28 ,$50.17 ,$49.40 ,$51.92 ,$17.30 ,$60.04 , N/A ,$37.24 ,$37.24 ,$20.11 ,$37.24 , 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 ,$8.12 ,$5.36 ,$1.85 ,$8.12 , N/A ,$7.28 ,$7.28 ,$2.15 ,$6.50 ,$6.90 ,$5.08 ,$7.31 , N/A , N/A ,$7.71 ,$7.31 ,$6.90 ,$6.90 ,$2.15 ,$6.90 ,$6.90 ,$7.31 ,$4.95 , N/A ,$5.04 , N/A ,$7.31 , N/A ,$7.47 ,$7.31 ,$5.36 ,$5.36 ,$4.95 ,$5.36 ,$5.28 ,$5.55 ,$1.85 ,$6.41 , N/A ,$3.98 ,$3.98 ,$2.15 ,$3.98 , N/A ,$7.71 ,$6.66 ,$6.66 ,$6.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202383,N/A,HC SUT PROLENE 3-0 8522H ET,272,1 ,$19.00 ,$12.54 ,$4.32 ,$19.00 , N/A ,$17.03 ,$17.03 ,$5.03 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$5.03 ,$16.15 ,$16.15 ,$17.10 ,$11.57 , N/A ,$11.78 , N/A ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.54 ,$12.54 ,$11.57 ,$12.54 ,$12.35 ,$12.98 ,$4.32 ,$15.01 , N/A ,$9.31 ,$9.31 ,$5.03 ,$9.31 , 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 ,$11.28 ,$7.44 ,$2.57 ,$11.28 , N/A ,$10.11 ,$10.11 ,$2.99 ,$9.02 ,$9.59 ,$7.05 ,$10.15 , N/A , N/A ,$10.72 ,$10.15 ,$9.59 ,$9.59 ,$2.99 ,$9.59 ,$9.59 ,$10.15 ,$6.87 , N/A ,$7.00 , N/A ,$10.15 , N/A ,$10.38 ,$10.15 ,$7.45 ,$7.45 ,$6.87 ,$7.45 ,$7.33 ,$7.71 ,$2.57 ,$8.91 , N/A ,$5.53 ,$5.53 ,$2.99 ,$5.53 , N/A ,$10.72 ,$9.25 ,$9.25 ,$9.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202395,N/A,HC SUT PROLENE 4-0 PS2 8682H,272,1 ,$16.53 ,$10.91 ,$3.76 ,$16.53 , N/A ,$14.81 ,$14.81 ,$4.37 ,$13.22 ,$14.05 ,$10.33 ,$14.88 , N/A , N/A ,$15.70 ,$14.88 ,$14.05 ,$14.05 ,$4.37 ,$14.05 ,$14.05 ,$14.88 ,$10.07 , N/A ,$10.24 , N/A ,$14.88 , N/A ,$15.21 ,$14.88 ,$10.91 ,$10.91 ,$10.07 ,$10.91 ,$10.74 ,$11.29 ,$3.76 ,$13.06 , N/A ,$8.10 ,$8.10 ,$4.37 ,$8.10 , N/A ,$15.70 ,$13.55 ,$13.55 ,$13.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202402,N/A,HC SUT PROLENE 5-0 8686,272,1 ,$9.30 ,$6.14 ,$2.12 ,$9.30 , N/A ,$8.33 ,$8.33 ,$2.46 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.37 ,$5.66 , N/A ,$5.76 , N/A ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.14 ,$6.14 ,$5.66 ,$6.14 ,$6.05 ,$6.35 ,$2.12 ,$7.35 , N/A ,$4.56 ,$4.56 ,$2.46 ,$4.56 , 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 ,$11.22 ,$3.87 ,$17.00 , N/A ,$15.24 ,$15.24 ,$4.50 ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 ,$4.50 ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A ,$10.54 , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$3.87 ,$13.43 , N/A ,$8.33 ,$8.33 ,$4.50 ,$8.33 , 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 ,$164.00 ,$108.24 ,$37.34 ,$164.00 , N/A ,$146.98 ,$146.98 ,$43.39 ,$131.20 ,$139.40 ,$102.50 ,$147.60 , N/A , N/A ,$155.80 ,$147.60 ,$139.40 ,$139.40 ,$43.39 ,$139.40 ,$139.40 ,$147.60 ,$99.88 , N/A ,$101.68 , N/A ,$147.60 , N/A ,$150.88 ,$147.60 ,$108.26 ,$108.26 ,$99.88 ,$108.26 ,$106.60 ,$112.04 ,$37.34 ,$129.56 , N/A ,$80.36 ,$80.36 ,$43.39 ,$80.36 , N/A ,$155.80 ,$134.48 ,$134.48 ,$131.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202415,N/A,HC SUT PROLENE 7-0 8648G/SP1647G,272,1 ,$11.40 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$28.38 ,$9.79 ,$43.00 , N/A ,$38.54 ,$38.54 ,$11.38 ,$34.40 ,$36.55 ,$26.88 ,$38.70 , N/A , N/A ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$11.38 ,$36.55 ,$36.55 ,$38.70 ,$26.19 , N/A ,$26.66 , N/A ,$38.70 , N/A ,$39.56 ,$38.70 ,$28.38 ,$28.38 ,$26.19 ,$28.38 ,$27.95 ,$29.38 ,$9.79 ,$33.97 , N/A ,$21.07 ,$21.07 ,$11.38 ,$21.07 , 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 ,$29.70 ,$10.24 ,$45.00 , N/A ,$40.33 ,$40.33 ,$11.91 ,$36.00 ,$38.25 ,$28.13 ,$40.50 , N/A , N/A ,$42.75 ,$40.50 ,$38.25 ,$38.25 ,$11.91 ,$38.25 ,$38.25 ,$40.50 ,$27.41 , N/A ,$27.90 , N/A ,$40.50 , N/A ,$41.40 ,$40.50 ,$29.70 ,$29.70 ,$27.41 ,$29.70 ,$29.25 ,$30.74 ,$10.24 ,$35.55 , N/A ,$22.05 ,$22.05 ,$11.91 ,$22.05 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$15.18 ,$5.23 ,$23.00 , N/A ,$20.61 ,$20.61 ,$6.09 ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$6.09 ,$19.55 ,$19.55 ,$20.70 ,$14.01 , N/A ,$14.26 , N/A ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.18 ,$15.18 ,$14.01 ,$15.18 ,$14.95 ,$15.71 ,$5.23 ,$18.17 , N/A ,$11.27 ,$11.27 ,$6.09 ,$11.27 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , 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 ,$6.11 ,$4.03 ,$1.39 ,$6.11 , N/A ,$5.48 ,$5.48 ,$1.62 ,$4.89 ,$5.19 ,$3.82 ,$5.50 , N/A , N/A ,$5.80 ,$5.50 ,$5.19 ,$5.19 ,$1.62 ,$5.19 ,$5.19 ,$5.50 ,$3.72 , N/A ,$3.78 , N/A ,$5.50 , N/A ,$5.62 ,$5.50 ,$4.03 ,$4.03 ,$3.72 ,$4.03 ,$3.97 ,$4.17 ,$1.39 ,$4.83 , N/A ,$2.99 ,$2.99 ,$1.62 ,$2.99 , N/A ,$5.80 ,$5.01 ,$5.01 ,$4.89 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202431,N/A,HC SUT SILK 0 A186H/S196,272,1 ,$5.05 ,$3.33 ,$1.15 ,$5.05 , N/A ,$4.53 ,$4.53 ,$1.33 ,$4.04 ,$4.29 ,$3.16 ,$4.55 , N/A , N/A ,$4.80 ,$4.55 ,$4.29 ,$4.29 ,$1.33 ,$4.29 ,$4.29 ,$4.55 ,$3.08 , N/A ,$3.14 , N/A ,$4.55 , N/A ,$4.65 ,$4.55 ,$3.33 ,$3.33 ,$3.08 ,$3.33 ,$3.28 ,$3.45 ,$1.15 ,$3.99 , N/A ,$2.47 ,$2.47 ,$1.33 ,$2.47 , N/A ,$4.80 ,$4.14 ,$4.14 ,$4.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202432,N/A,HC SUT SILK 0 A306H/S316,272,1 ,$6.20 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$7.09 ,$4.68 ,$1.62 ,$7.09 , N/A ,$6.35 ,$6.35 ,$1.87 ,$5.67 ,$6.03 ,$4.43 ,$6.38 , N/A , N/A ,$6.74 ,$6.38 ,$6.03 ,$6.03 ,$1.87 ,$6.03 ,$6.03 ,$6.38 ,$4.32 , N/A ,$4.40 , N/A ,$6.38 , N/A ,$6.52 ,$6.38 ,$4.68 ,$4.68 ,$4.32 ,$4.68 ,$4.61 ,$4.84 ,$1.62 ,$5.60 , N/A ,$3.47 ,$3.47 ,$1.87 ,$3.47 , N/A ,$6.74 ,$5.81 ,$5.81 ,$5.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202445,N/A,HC SUT SILK 2-0 C012D/GS62M/CS10M,272,1 ,$33.25 ,$21.95 ,$7.58 ,$33.25 , N/A ,$29.80 ,$29.80 ,$8.80 ,$26.60 ,$28.26 ,$20.78 ,$29.93 , N/A , N/A ,$31.59 ,$29.93 ,$28.26 ,$28.26 ,$8.80 ,$28.26 ,$28.26 ,$29.93 ,$20.25 , N/A ,$20.62 , N/A ,$29.93 , N/A ,$30.59 ,$29.93 ,$21.95 ,$21.95 ,$20.25 ,$21.95 ,$21.61 ,$22.72 ,$7.58 ,$26.27 , N/A ,$16.29 ,$16.29 ,$8.80 ,$16.29 , N/A ,$31.59 ,$27.27 ,$27.27 ,$26.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202446,N/A,HC SUT SILK 2-0 C016/GS66M,272,1 ,$32.00 ,$21.12 ,$7.28 ,$32.00 , N/A ,$28.68 ,$28.68 ,$8.47 ,$25.60 ,$27.20 ,$20.00 ,$28.80 , N/A , N/A ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$8.47 ,$27.20 ,$27.20 ,$28.80 ,$19.49 , N/A ,$19.84 , N/A ,$28.80 , N/A ,$29.44 ,$28.80 ,$21.12 ,$21.12 ,$19.49 ,$21.12 ,$20.80 ,$21.86 ,$7.28 ,$25.28 , N/A ,$15.68 ,$15.68 ,$8.47 ,$15.68 , N/A ,$30.40 ,$26.24 ,$26.24 ,$25.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202448,N/A,HC SUT SILK 2-0 K833H/GS833,272,1 ,$6.20 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$7.08 ,$4.67 ,$1.62 ,$7.08 , N/A ,$6.35 ,$6.35 ,$1.87 ,$5.66 ,$6.02 ,$4.43 ,$6.37 , N/A , N/A ,$6.73 ,$6.37 ,$6.02 ,$6.02 ,$1.87 ,$6.02 ,$6.02 ,$6.37 ,$4.31 , N/A ,$4.38 , N/A ,$6.37 , N/A ,$6.51 ,$6.37 ,$4.67 ,$4.67 ,$4.31 ,$4.67 ,$4.60 ,$4.84 ,$1.62 ,$5.59 , N/A ,$3.47 ,$3.47 ,$1.87 ,$3.47 , N/A ,$6.73 ,$5.81 ,$5.81 ,$5.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202458,N/A,HC SUT SILK 3-0 632G/SS732,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$7.10 ,$4.69 ,$1.62 ,$7.10 , N/A ,$6.36 ,$6.36 ,$1.88 ,$5.68 ,$6.04 ,$4.44 ,$6.39 , N/A , N/A ,$6.75 ,$6.39 ,$6.04 ,$6.04 ,$1.88 ,$6.04 ,$6.04 ,$6.39 ,$4.32 , N/A ,$4.40 , N/A ,$6.39 , N/A ,$6.53 ,$6.39 ,$4.69 ,$4.69 ,$4.32 ,$4.69 ,$4.62 ,$4.85 ,$1.62 ,$5.61 , N/A ,$3.48 ,$3.48 ,$1.88 ,$3.48 , N/A ,$6.75 ,$5.82 ,$5.82 ,$5.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202461,N/A,HC SUT SILK 3-0 C013D/GS63M,272,1 ,$29.17 ,$19.25 ,$6.64 ,$29.17 , N/A ,$26.14 ,$26.14 ,$7.72 ,$23.34 ,$24.79 ,$18.23 ,$26.25 , N/A , N/A ,$27.71 ,$26.25 ,$24.79 ,$24.79 ,$7.72 ,$24.79 ,$24.79 ,$26.25 ,$17.76 , N/A ,$18.08 , N/A ,$26.25 , N/A ,$26.84 ,$26.25 ,$19.26 ,$19.26 ,$17.76 ,$19.26 ,$18.96 ,$19.93 ,$6.64 ,$23.04 , N/A ,$14.29 ,$14.29 ,$7.72 ,$14.29 , N/A ,$27.71 ,$23.92 ,$23.92 ,$23.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202462,N/A,HC SUT SILK 3-0 C017T/GS67M,272,1 ,$32.50 ,$21.45 ,$7.40 ,$32.50 , N/A ,$29.13 ,$29.13 ,$8.60 ,$26.00 ,$27.63 ,$20.31 ,$29.25 , N/A , N/A ,$30.88 ,$29.25 ,$27.63 ,$27.63 ,$8.60 ,$27.63 ,$27.63 ,$29.25 ,$19.79 , N/A ,$20.16 , N/A ,$29.25 , N/A ,$29.90 ,$29.25 ,$21.45 ,$21.45 ,$19.79 ,$21.45 ,$21.13 ,$22.20 ,$7.40 ,$25.68 , N/A ,$15.93 ,$15.93 ,$8.60 ,$15.93 , N/A ,$30.88 ,$26.65 ,$26.65 ,$26.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202464,N/A,HC SUT SILK 3-0 K832H/GS832,272,1 ,$6.08 ,$4.01 ,$1.38 ,$6.08 , N/A ,$5.45 ,$5.45 ,$1.61 ,$4.86 ,$5.17 ,$3.80 ,$5.47 , N/A , N/A ,$5.78 ,$5.47 ,$5.17 ,$5.17 ,$1.61 ,$5.17 ,$5.17 ,$5.47 ,$3.70 , N/A ,$3.76 , N/A ,$5.47 , N/A ,$5.59 ,$5.47 ,$4.01 ,$4.01 ,$3.70 ,$4.01 ,$3.95 ,$4.15 ,$1.38 ,$4.80 , N/A ,$2.98 ,$2.98 ,$1.61 ,$2.98 , N/A ,$5.78 ,$4.99 ,$4.99 ,$4.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202469,N/A,HC SUT SILK 4-0 A183H/S183,272,1 ,$8.20 ,$5.41 ,$1.87 ,$8.20 , N/A ,$7.35 ,$7.35 ,$2.17 ,$6.56 ,$6.97 ,$5.13 ,$7.38 , N/A , N/A ,$7.79 ,$7.38 ,$6.97 ,$6.97 ,$2.17 ,$6.97 ,$6.97 ,$7.38 ,$4.99 , N/A ,$5.08 , N/A ,$7.38 , N/A ,$7.54 ,$7.38 ,$5.41 ,$5.41 ,$4.99 ,$5.41 ,$5.33 ,$5.60 ,$1.87 ,$6.48 , N/A ,$4.02 ,$4.02 ,$2.17 ,$4.02 , N/A ,$7.79 ,$6.72 ,$6.72 ,$6.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202470,N/A,HC SUT SILK 4-0 C014D/GS64M,272,1 ,$30.00 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$8.19 ,$5.41 ,$1.86 ,$8.19 , N/A ,$7.34 ,$7.34 ,$2.17 ,$6.55 ,$6.96 ,$5.12 ,$7.37 , N/A , N/A ,$7.78 ,$7.37 ,$6.96 ,$6.96 ,$2.17 ,$6.96 ,$6.96 ,$7.37 ,$4.99 , N/A ,$5.08 , N/A ,$7.37 , N/A ,$7.53 ,$7.37 ,$5.41 ,$5.41 ,$4.99 ,$5.41 ,$5.32 ,$5.60 ,$1.86 ,$6.47 , N/A ,$4.01 ,$4.01 ,$2.17 ,$4.01 , N/A ,$7.78 ,$6.72 ,$6.72 ,$6.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202502,N/A,HC SUT VICRYL 0 CT-1 36IN,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$1.78 ,$0.62 ,$2.70 , N/A ,$2.42 ,$2.42 ,$0.72 ,$2.16 ,$2.30 ,$1.69 ,$2.43 , N/A , N/A ,$2.57 ,$2.43 ,$2.30 ,$2.30 ,$0.72 ,$2.30 ,$2.30 ,$2.43 ,$1.64 , N/A ,$1.68 , N/A ,$2.43 , N/A ,$2.48 ,$2.43 ,$1.78 ,$1.78 ,$1.64 ,$1.78 ,$1.76 ,$1.84 ,$0.62 ,$2.13 , N/A ,$1.32 ,$1.32 ,$0.72 ,$1.32 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$7.06 ,$4.66 ,$1.61 ,$7.06 , N/A ,$6.33 ,$6.33 ,$1.87 ,$5.65 ,$6.00 ,$4.41 ,$6.35 , N/A , N/A ,$6.71 ,$6.35 ,$6.00 ,$6.00 ,$1.87 ,$6.00 ,$6.00 ,$6.35 ,$4.30 , N/A ,$4.38 , N/A ,$6.35 , N/A ,$6.50 ,$6.35 ,$4.66 ,$4.66 ,$4.30 ,$4.66 ,$4.59 ,$4.82 ,$1.61 ,$5.58 , N/A ,$3.46 ,$3.46 ,$1.87 ,$3.46 , N/A ,$6.71 ,$5.79 ,$5.79 ,$5.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202515,N/A,HC SUT VICRYL 0 JJ41G,272,1 ,$38.00 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$24.42 ,$8.43 ,$37.00 , N/A ,$33.16 ,$33.16 ,$9.79 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$9.79 ,$31.45 ,$31.45 ,$33.30 ,$22.53 , N/A ,$22.94 , N/A ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.42 ,$24.42 ,$22.53 ,$24.42 ,$24.05 ,$25.28 ,$8.43 ,$29.23 , N/A ,$18.13 ,$18.13 ,$9.79 ,$18.13 , 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 ,$7.12 ,$4.70 ,$1.63 ,$7.12 , N/A ,$6.38 ,$6.38 ,$1.88 ,$5.70 ,$6.05 ,$4.45 ,$6.41 , N/A , N/A ,$6.76 ,$6.41 ,$6.05 ,$6.05 ,$1.88 ,$6.05 ,$6.05 ,$6.41 ,$4.34 , N/A ,$4.42 , N/A ,$6.41 , N/A ,$6.55 ,$6.41 ,$4.70 ,$4.70 ,$4.34 ,$4.70 ,$4.63 ,$4.86 ,$1.63 ,$5.62 , N/A ,$3.49 ,$3.49 ,$1.88 ,$3.49 , N/A ,$6.76 ,$5.84 ,$5.84 ,$5.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202527,N/A,HC SUT VICRYL 1-0 J268H/CL545LN,272,1 ,$7.14 ,$4.71 ,$1.63 ,$7.14 , N/A ,$6.40 ,$6.40 ,$1.89 ,$5.71 ,$6.07 ,$4.46 ,$6.43 , N/A , N/A ,$6.78 ,$6.43 ,$6.07 ,$6.07 ,$1.89 ,$6.07 ,$6.07 ,$6.43 ,$4.35 , N/A ,$4.42 , N/A ,$6.43 , N/A ,$6.57 ,$6.43 ,$4.71 ,$4.71 ,$4.35 ,$4.71 ,$4.64 ,$4.88 ,$1.63 ,$5.64 , N/A ,$3.50 ,$3.50 ,$1.89 ,$3.50 , N/A ,$6.78 ,$5.85 ,$5.85 ,$5.71 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202528,N/A,HC SUT VICRYL 1-0 J947H/CL955,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$11.00 ,$7.26 ,$2.51 ,$11.00 , N/A ,$9.86 ,$9.86 ,$2.91 ,$8.80 ,$9.35 ,$6.88 ,$9.90 , N/A , N/A ,$10.45 ,$9.90 ,$9.35 ,$9.35 ,$2.91 ,$9.35 ,$9.35 ,$9.90 ,$6.70 , N/A ,$6.82 , N/A ,$9.90 , N/A ,$10.12 ,$9.90 ,$7.26 ,$7.26 ,$6.70 ,$7.26 ,$7.15 ,$7.52 ,$2.51 ,$8.69 , N/A ,$5.39 ,$5.39 ,$2.91 ,$5.39 , N/A ,$10.45 ,$9.02 ,$9.02 ,$8.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202532,N/A,HC SUT VICRYL 2-0,272,1 ,$2.69 ,$1.78 ,$0.62 ,$2.69 , N/A ,$2.41 ,$2.41 ,$0.72 ,$2.15 ,$2.29 ,$1.68 ,$2.42 , N/A , N/A ,$2.56 ,$2.42 ,$2.29 ,$2.29 ,$0.72 ,$2.29 ,$2.29 ,$2.42 ,$1.64 , N/A ,$1.66 , N/A ,$2.42 , N/A ,$2.47 ,$2.42 ,$1.78 ,$1.78 ,$1.64 ,$1.78 ,$1.75 ,$1.84 ,$0.62 ,$2.13 , N/A ,$1.32 ,$1.32 ,$0.72 ,$1.32 , N/A ,$2.56 ,$2.21 ,$2.21 ,$2.15 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202533,N/A,HC SUT VICRYL 2-0 CT-1 36IN,272,1 ,$7.07 ,$4.67 ,$1.62 ,$7.07 , N/A ,$6.34 ,$6.34 ,$1.87 ,$5.66 ,$6.01 ,$4.42 ,$6.36 , N/A , N/A ,$6.72 ,$6.36 ,$6.01 ,$6.01 ,$1.87 ,$6.01 ,$6.01 ,$6.36 ,$4.31 , N/A ,$4.38 , N/A ,$6.36 , N/A ,$6.50 ,$6.36 ,$4.67 ,$4.67 ,$4.31 ,$4.67 ,$4.60 ,$4.83 ,$1.62 ,$5.59 , N/A ,$3.46 ,$3.46 ,$1.87 ,$3.46 , N/A ,$6.72 ,$5.80 ,$5.80 ,$5.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202535,N/A,HC SUT VICRYL 2-0 J266H/CL543LN,272,1 ,$38.00 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$17.82 ,$6.14 ,$27.00 , N/A ,$24.20 ,$24.20 ,$7.14 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$7.14 ,$22.95 ,$22.95 ,$24.30 ,$16.44 , N/A ,$16.74 , N/A ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.82 ,$17.82 ,$16.44 ,$17.82 ,$17.55 ,$18.45 ,$6.14 ,$21.33 , N/A ,$13.23 ,$13.23 ,$7.14 ,$13.23 , 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 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , 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 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$7.15 ,$4.72 ,$1.63 ,$7.15 , N/A ,$6.41 ,$6.41 ,$1.89 ,$5.72 ,$6.08 ,$4.47 ,$6.44 , N/A , N/A ,$6.79 ,$6.44 ,$6.08 ,$6.08 ,$1.89 ,$6.08 ,$6.08 ,$6.44 ,$4.35 , N/A ,$4.44 , N/A ,$6.44 , N/A ,$6.58 ,$6.44 ,$4.72 ,$4.72 ,$4.35 ,$4.72 ,$4.65 ,$4.88 ,$1.63 ,$5.65 , N/A ,$3.50 ,$3.50 ,$1.89 ,$3.50 , N/A ,$6.79 ,$5.86 ,$5.86 ,$5.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202544,N/A,HC SUT VICRYL 2-0 SH 27 J417H,272,1 ,$7.06 ,$4.66 ,$1.61 ,$7.06 , N/A ,$6.33 ,$6.33 ,$1.87 ,$5.65 ,$6.00 ,$4.41 ,$6.35 , N/A , N/A ,$6.71 ,$6.35 ,$6.00 ,$6.00 ,$1.87 ,$6.00 ,$6.00 ,$6.35 ,$4.30 , N/A ,$4.38 , N/A ,$6.35 , N/A ,$6.50 ,$6.35 ,$4.66 ,$4.66 ,$4.30 ,$4.66 ,$4.59 ,$4.82 ,$1.61 ,$5.58 , N/A ,$3.46 ,$3.46 ,$1.87 ,$3.46 , N/A ,$6.71 ,$5.79 ,$5.79 ,$5.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202547,N/A,HC SUT VICRYL 2-0 TIES 18 J111T,272,1 ,$26.67 ,$17.60 ,$6.07 ,$26.67 , N/A ,$23.90 ,$23.90 ,$7.06 ,$21.34 ,$22.67 ,$16.67 ,$24.00 , N/A , N/A ,$25.34 ,$24.00 ,$22.67 ,$22.67 ,$7.06 ,$22.67 ,$22.67 ,$24.00 ,$16.24 , N/A ,$16.54 , N/A ,$24.00 , N/A ,$24.54 ,$24.00 ,$17.60 ,$17.60 ,$16.24 ,$17.60 ,$17.34 ,$18.22 ,$6.07 ,$21.07 , N/A ,$13.07 ,$13.07 ,$7.06 ,$13.07 , N/A ,$25.34 ,$21.87 ,$21.87 ,$21.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202550,N/A,HC SUT VICRYL 3-0 CT 36IN J956H,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$7.03 ,$4.64 ,$1.61 ,$7.03 , N/A ,$6.30 ,$6.30 ,$1.86 ,$5.62 ,$5.98 ,$4.39 ,$6.33 , N/A , N/A ,$6.68 ,$6.33 ,$5.98 ,$5.98 ,$1.86 ,$5.98 ,$5.98 ,$6.33 ,$4.28 , N/A ,$4.36 , N/A ,$6.33 , N/A ,$6.47 ,$6.33 ,$4.64 ,$4.64 ,$4.28 ,$4.64 ,$4.57 ,$4.80 ,$1.61 ,$5.55 , N/A ,$3.44 ,$3.44 ,$1.86 ,$3.44 , N/A ,$6.68 ,$5.76 ,$5.76 ,$5.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202556,N/A,HC SUT VICRYL 3-0 J416 ET,272,1 ,$7.10 ,$4.69 ,$1.62 ,$7.10 , N/A ,$6.36 ,$6.36 ,$1.88 ,$5.68 ,$6.04 ,$4.44 ,$6.39 , N/A , N/A ,$6.75 ,$6.39 ,$6.04 ,$6.04 ,$1.88 ,$6.04 ,$6.04 ,$6.39 ,$4.32 , N/A ,$4.40 , N/A ,$6.39 , N/A ,$6.53 ,$6.39 ,$4.69 ,$4.69 ,$4.32 ,$4.69 ,$4.62 ,$4.85 ,$1.62 ,$5.61 , N/A ,$3.48 ,$3.48 ,$1.88 ,$3.48 , N/A ,$6.75 ,$5.82 ,$5.82 ,$5.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202557,N/A,HC SUT VICRYL 3-0 J427H/SL1638LN,272,1 ,$13.38 ,$8.83 ,$3.05 ,$13.38 , N/A ,$11.99 ,$11.99 ,$3.54 ,$10.70 ,$11.37 ,$8.36 ,$12.04 , N/A , N/A ,$12.71 ,$12.04 ,$11.37 ,$11.37 ,$3.54 ,$11.37 ,$11.37 ,$12.04 ,$8.15 , N/A ,$8.30 , N/A ,$12.04 , N/A ,$12.31 ,$12.04 ,$8.83 ,$8.83 ,$8.15 ,$8.83 ,$8.70 ,$9.14 ,$3.05 ,$10.57 , N/A ,$6.56 ,$6.56 ,$3.54 ,$6.56 , N/A ,$12.71 ,$10.97 ,$10.97 ,$10.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202559,N/A,HC SUT VICRYL 3-0 J864G/GL69MG,272,1 ,$38.00 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$26.75 ,$17.66 ,$6.09 ,$26.75 , N/A ,$23.97 ,$23.97 ,$7.08 ,$21.40 ,$22.74 ,$16.72 ,$24.08 , N/A , N/A ,$25.41 ,$24.08 ,$22.74 ,$22.74 ,$7.08 ,$22.74 ,$22.74 ,$24.08 ,$16.29 , N/A ,$16.58 , N/A ,$24.08 , N/A ,$24.61 ,$24.08 ,$17.66 ,$17.66 ,$16.29 ,$17.66 ,$17.39 ,$18.28 ,$6.09 ,$21.13 , N/A ,$13.11 ,$13.11 ,$7.08 ,$13.11 , N/A ,$25.41 ,$21.94 ,$21.94 ,$21.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202567,N/A,HC SUT VICRYL 4-0 J494G/SL1690,272,1 ,$13.21 ,$8.72 ,$3.01 ,$13.21 , N/A ,$11.84 ,$11.84 ,$3.50 ,$10.57 ,$11.23 ,$8.26 ,$11.89 , N/A , N/A ,$12.55 ,$11.89 ,$11.23 ,$11.23 ,$3.50 ,$11.23 ,$11.23 ,$11.89 ,$8.04 , N/A ,$8.20 , N/A ,$11.89 , N/A ,$12.15 ,$11.89 ,$8.72 ,$8.72 ,$8.04 ,$8.72 ,$8.59 ,$9.03 ,$3.01 ,$10.44 , N/A ,$6.47 ,$6.47 ,$3.50 ,$6.47 , N/A ,$12.55 ,$10.83 ,$10.83 ,$10.57 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202569,N/A,HC SUT VICRYL 4-0 J936H,272,1 ,$14.50 ,$9.57 ,$3.30 ,$14.50 , N/A ,$12.99 ,$12.99 ,$3.84 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$3.84 ,$12.33 ,$12.33 ,$13.05 ,$8.83 , N/A ,$9.00 , N/A ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.57 ,$9.57 ,$8.83 ,$9.57 ,$9.43 ,$9.91 ,$3.30 ,$11.46 , N/A ,$7.11 ,$7.11 ,$3.84 ,$7.11 , 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 ,$13.25 ,$8.75 ,$3.02 ,$13.25 , N/A ,$11.87 ,$11.87 ,$3.51 ,$10.60 ,$11.26 ,$8.28 ,$11.93 , N/A , N/A ,$12.59 ,$11.93 ,$11.26 ,$11.26 ,$3.51 ,$11.26 ,$11.26 ,$11.93 ,$8.07 , N/A ,$8.22 , N/A ,$11.93 , N/A ,$12.19 ,$11.93 ,$8.75 ,$8.75 ,$8.07 ,$8.75 ,$8.61 ,$9.05 ,$3.02 ,$10.47 , N/A ,$6.49 ,$6.49 ,$3.51 ,$6.49 , N/A ,$12.59 ,$10.87 ,$10.87 ,$10.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202573,N/A,HC SUT VICRYL 4-0 RB-1 27 J214H,272,1 ,$7.17 ,$4.73 ,$1.64 ,$7.17 , N/A ,$6.43 ,$6.43 ,$1.90 ,$5.74 ,$6.09 ,$4.48 ,$6.45 , N/A , N/A ,$6.81 ,$6.45 ,$6.09 ,$6.09 ,$1.90 ,$6.09 ,$6.09 ,$6.45 ,$4.37 , N/A ,$4.44 , N/A ,$6.45 , N/A ,$6.60 ,$6.45 ,$4.73 ,$4.73 ,$4.37 ,$4.73 ,$4.66 ,$4.90 ,$1.64 ,$5.66 , N/A ,$3.51 ,$3.51 ,$1.90 ,$3.51 , N/A ,$6.81 ,$5.88 ,$5.88 ,$5.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202575,N/A,HC SUT VICRYL 4-0 SH 18IN J415,272,1 ,$7.20 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$13.25 ,$8.75 ,$3.02 ,$13.25 , N/A ,$11.87 ,$11.87 ,$3.51 ,$10.60 ,$11.26 ,$8.28 ,$11.93 , N/A , N/A ,$12.59 ,$11.93 ,$11.26 ,$11.26 ,$3.51 ,$11.26 ,$11.26 ,$11.93 ,$8.07 , N/A ,$8.22 , N/A ,$11.93 , N/A ,$12.19 ,$11.93 ,$8.75 ,$8.75 ,$8.07 ,$8.75 ,$8.61 ,$9.05 ,$3.02 ,$10.47 , N/A ,$6.49 ,$6.49 ,$3.51 ,$6.49 , N/A ,$12.59 ,$10.87 ,$10.87 ,$10.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202578,N/A,HC SUT VICRYL 5-0 J493/SL1687/SL3687,272,1 ,$13.50 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$99.08 ,$65.39 ,$22.56 ,$99.08 , N/A ,$88.80 ,$88.80 ,$26.21 ,$79.26 ,$84.22 ,$61.93 ,$89.17 , N/A , N/A ,$94.13 ,$89.17 ,$84.22 ,$84.22 ,$26.21 ,$84.22 ,$84.22 ,$89.17 ,$60.34 , N/A ,$61.42 , N/A ,$89.17 , N/A ,$91.15 ,$89.17 ,$65.40 ,$65.40 ,$60.34 ,$65.40 ,$64.40 ,$67.69 ,$22.56 ,$78.27 , N/A ,$48.55 ,$48.55 ,$26.21 ,$48.55 , N/A ,$94.13 ,$81.25 ,$81.25 ,$79.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202637,N/A,HC SYRINGE INFLATION,272,1 ,$104.00 ,$68.64 ,$23.68 ,$104.00 , N/A ,$93.20 ,$93.20 ,$27.52 ,$83.20 ,$88.40 ,$65.00 ,$93.60 , N/A , N/A ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$27.52 ,$88.40 ,$88.40 ,$93.60 ,$63.34 , N/A ,$64.48 , N/A ,$93.60 , N/A ,$95.68 ,$93.60 ,$68.65 ,$68.65 ,$63.34 ,$68.65 ,$67.60 ,$71.05 ,$23.68 ,$82.16 , N/A ,$50.96 ,$50.96 ,$27.52 ,$50.96 , 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 ",$813.12 ,$280.47 ,"$1,232.00 ", N/A ,"$1,104.12 ","$1,104.12 ",$325.99 ,$985.60 ,"$1,047.20 ",$770.00 ,"$1,108.80 ", N/A , N/A ,"$1,170.40 ","$1,108.80 ","$1,047.20 ","$1,047.20 ",$325.99 ,"$1,047.20 ","$1,047.20 ","$1,108.80 ",$750.29 , N/A ,$763.84 , N/A ,"$1,108.80 ", N/A ,"$1,133.44 ","$1,108.80 ",$813.24 ,$813.24 ,$750.29 ,$813.24 ,$800.80 ,$841.70 ,$280.47 ,$973.28 , N/A ,$603.68 ,$603.68 ,$325.99 ,$603.68 , 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 ,$85.80 ,$29.60 ,$130.00 , N/A ,$116.51 ,$116.51 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 , N/A ,$80.60 , N/A ,$117.00 , N/A ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 , N/A ,$63.70 ,$63.70 ,$34.40 ,$63.70 , 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 ,$2.05 ,$0.71 ,$3.10 , N/A ,$2.78 ,$2.78 ,$0.82 ,$2.48 ,$2.64 ,$1.94 ,$2.79 , N/A , N/A ,$2.95 ,$2.79 ,$2.64 ,$2.64 ,$0.82 ,$2.64 ,$2.64 ,$2.79 ,$1.89 , N/A ,$1.92 , N/A ,$2.79 , N/A ,$2.85 ,$2.79 ,$2.05 ,$2.05 ,$1.89 ,$2.05 ,$2.02 ,$2.12 ,$0.71 ,$2.45 , N/A ,$1.52 ,$1.52 ,$0.82 ,$1.52 , 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 ,$305.58 ,$105.40 ,$463.00 , N/A ,$414.94 ,$414.94 ,$122.51 ,$370.40 ,$393.55 ,$289.38 ,$416.70 , N/A , N/A ,$439.85 ,$416.70 ,$393.55 ,$393.55 ,$122.51 ,$393.55 ,$393.55 ,$416.70 ,$281.97 , N/A ,$287.06 , N/A ,$416.70 , N/A ,$425.96 ,$416.70 ,$305.63 ,$305.63 ,$281.97 ,$305.63 ,$300.95 ,$316.32 ,$105.40 ,$365.77 , N/A ,$226.87 ,$226.87 ,$122.51 ,$226.87 , 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 ,$64.02 ,$22.08 ,$97.00 , N/A ,$86.93 ,$86.93 ,$25.67 ,$77.60 ,$82.45 ,$60.63 ,$87.30 , N/A , N/A ,$92.15 ,$87.30 ,$82.45 ,$82.45 ,$25.67 ,$82.45 ,$82.45 ,$87.30 ,$59.07 , N/A ,$60.14 , N/A ,$87.30 , N/A ,$89.24 ,$87.30 ,$64.03 ,$64.03 ,$59.07 ,$64.03 ,$63.05 ,$66.27 ,$22.08 ,$76.63 , N/A ,$47.53 ,$47.53 ,$25.67 ,$47.53 , 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 ,$66.66 ,$22.99 ,$101.00 , N/A ,$90.52 ,$90.52 ,$26.72 ,$80.80 ,$85.85 ,$63.13 ,$90.90 , N/A , N/A ,$95.95 ,$90.90 ,$85.85 ,$85.85 ,$26.72 ,$85.85 ,$85.85 ,$90.90 ,$61.51 , N/A ,$62.62 , N/A ,$90.90 , N/A ,$92.92 ,$90.90 ,$66.67 ,$66.67 ,$61.51 ,$66.67 ,$65.65 ,$69.00 ,$22.99 ,$79.79 , N/A ,$49.49 ,$49.49 ,$26.72 ,$49.49 , 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 ,$25.08 ,$8.65 ,$38.00 , N/A ,$34.06 ,$34.06 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$18.62 ,$18.62 ,$10.05 ,$18.62 , 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 ,$39.60 ,$13.66 ,$60.00 , N/A ,$53.77 ,$53.77 ,$15.88 ,$48.00 ,$51.00 ,$37.50 ,$54.00 , N/A , N/A ,$57.00 ,$54.00 ,$51.00 ,$51.00 ,$15.88 ,$51.00 ,$51.00 ,$54.00 ,$36.54 , N/A ,$37.20 , N/A ,$54.00 , N/A ,$55.20 ,$54.00 ,$39.61 ,$39.61 ,$36.54 ,$39.61 ,$39.00 ,$40.99 ,$13.66 ,$47.40 , N/A ,$29.40 ,$29.40 ,$15.88 ,$29.40 , 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 ,$169.62 ,$58.51 ,$257.00 , N/A ,$230.32 ,$230.32 ,$68.00 ,$205.60 ,$218.45 ,$160.63 ,$231.30 , N/A , N/A ,$244.15 ,$231.30 ,$218.45 ,$218.45 ,$68.00 ,$218.45 ,$218.45 ,$231.30 ,$156.51 , N/A ,$159.34 , N/A ,$231.30 , N/A ,$236.44 ,$231.30 ,$169.65 ,$169.65 ,$156.51 ,$169.65 ,$167.05 ,$175.58 ,$58.51 ,$203.03 , N/A ,$125.93 ,$125.93 ,$68.00 ,$125.93 , 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 ,$47.52 ,$16.40 ,$72.00 , N/A ,$64.53 ,$64.53 ,$19.05 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$19.05 ,$61.20 ,$61.20 ,$64.80 ,$43.85 , N/A ,$44.64 , N/A ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.53 ,$47.53 ,$43.85 ,$47.53 ,$46.80 ,$49.19 ,$16.40 ,$56.88 , N/A ,$35.28 ,$35.28 ,$19.05 ,$35.28 , 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 ","$7,100.94 ","$2,449.33 ","$10,759.00 ", N/A ,"$9,642.22 ","$9,642.22 ","$2,846.83 ","$8,607.20 ","$9,145.15 ","$6,724.38 ","$9,683.10 ", N/A , N/A ,"$10,221.05 ","$9,683.10 ","$9,145.15 ","$9,145.15 ","$2,846.83 ","$9,145.15 ","$9,145.15 ","$9,683.10 ","$6,552.23 ", N/A ,"$6,670.58 ", N/A ,"$9,683.10 ", N/A ,"$9,898.28 ","$9,683.10 ","$7,102.02 ","$7,102.02 ","$6,552.23 ","$7,102.02 ","$6,993.35 ","$7,350.55 ","$2,449.33 ","$8,499.61 ", N/A ,"$5,271.91 ","$5,271.91 ","$2,846.83 ","$5,271.91 ", 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 ,$48.00 ,$31.68 ,$10.93 ,$48.00 , N/A ,$43.02 ,$43.02 ,$12.70 ,$38.40 ,$40.80 ,$30.00 ,$43.20 , N/A , N/A ,$45.60 ,$43.20 ,$40.80 ,$40.80 ,$12.70 ,$40.80 ,$40.80 ,$43.20 ,$29.23 , N/A ,$29.76 , N/A ,$43.20 , N/A ,$44.16 ,$43.20 ,$31.68 ,$31.68 ,$29.23 ,$31.68 ,$31.20 ,$32.79 ,$10.93 ,$37.92 , N/A ,$23.52 ,$23.52 ,$12.70 ,$23.52 , N/A ,$45.60 ,$39.36 ,$39.36 ,$38.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202807,N/A,HC TRAY SPINAL,272,1 ,$266.00 ,$175.56 ,$60.55 ,$266.00 , N/A ,$238.39 ,$238.39 ,$70.38 ,$212.80 ,$226.10 ,$166.25 ,$239.40 , N/A , N/A ,$252.70 ,$239.40 ,$226.10 ,$226.10 ,$70.38 ,$226.10 ,$226.10 ,$239.40 ,$161.99 , N/A ,$164.92 , N/A ,$239.40 , N/A ,$244.72 ,$239.40 ,$175.59 ,$175.59 ,$161.99 ,$175.59 ,$172.90 ,$181.73 ,$60.55 ,$210.14 , N/A ,$130.34 ,$130.34 ,$70.38 ,$130.34 , 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 ,$198.00 ,$68.30 ,$300.00 , N/A ,$268.86 ,$268.86 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 , N/A , N/A ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 , N/A ,$186.00 , N/A ,$270.00 , N/A ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 , N/A ,$147.00 ,$147.00 ,$79.38 ,$147.00 , 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 ,$308.88 ,$106.55 ,$468.00 , N/A ,$419.42 ,$419.42 ,$123.83 ,$374.40 ,$397.80 ,$292.50 ,$421.20 , N/A , N/A ,$444.60 ,$421.20 ,$397.80 ,$397.80 ,$123.83 ,$397.80 ,$397.80 ,$421.20 ,$285.01 , N/A ,$290.16 , N/A ,$421.20 , N/A ,$430.56 ,$421.20 ,$308.93 ,$308.93 ,$285.01 ,$308.93 ,$304.20 ,$319.74 ,$106.55 ,$369.72 , N/A ,$229.32 ,$229.32 ,$123.83 ,$229.32 , 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 ,$13.20 ,$4.56 ,$20.00 , N/A ,$17.92 ,$17.92 ,$5.29 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$5.29 ,$17.00 ,$17.00 ,$18.00 ,$12.18 , N/A ,$12.40 , N/A ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.20 ,$13.20 ,$12.18 ,$13.20 ,$13.00 ,$13.66 ,$4.56 ,$15.80 , N/A ,$9.80 ,$9.80 ,$5.29 ,$9.80 , 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 ,$68.64 ,$23.68 ,$104.00 , N/A ,$93.20 ,$93.20 ,$27.52 ,$83.20 ,$88.40 ,$65.00 ,$93.60 , N/A , N/A ,$98.80 ,$93.60 ,$88.40 ,$88.40 ,$27.52 ,$88.40 ,$88.40 ,$93.60 ,$63.34 , N/A ,$64.48 , N/A ,$93.60 , N/A ,$95.68 ,$93.60 ,$68.65 ,$68.65 ,$63.34 ,$68.65 ,$67.60 ,$71.05 ,$23.68 ,$82.16 , N/A ,$50.96 ,$50.96 ,$27.52 ,$50.96 , 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 ,$2.71 ,$0.93 ,$4.10 , N/A ,$3.67 ,$3.67 ,$1.09 ,$3.28 ,$3.49 ,$2.56 ,$3.69 , N/A , N/A ,$3.90 ,$3.69 ,$3.49 ,$3.49 ,$1.09 ,$3.49 ,$3.49 ,$3.69 ,$2.50 , N/A ,$2.54 , N/A ,$3.69 , N/A ,$3.77 ,$3.69 ,$2.71 ,$2.71 ,$2.50 ,$2.71 ,$2.67 ,$2.80 ,$0.93 ,$3.24 , N/A ,$2.01 ,$2.01 ,$1.09 ,$2.01 , 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 ,$389.40 ,$134.32 ,$590.00 , N/A ,$528.76 ,$528.76 ,$156.11 ,$472.00 ,$501.50 ,$368.75 ,$531.00 , N/A , N/A ,$560.50 ,$531.00 ,$501.50 ,$501.50 ,$156.11 ,$501.50 ,$501.50 ,$531.00 ,$359.31 , N/A ,$365.80 , N/A ,$531.00 , N/A ,$542.80 ,$531.00 ,$389.46 ,$389.46 ,$359.31 ,$389.46 ,$383.50 ,$403.09 ,$134.32 ,$466.10 , N/A ,$289.10 ,$289.10 ,$156.11 ,$289.10 , 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 ,$192.06 ,$66.25 ,$291.00 , N/A ,$260.79 ,$260.79 ,$77.00 ,$232.80 ,$247.35 ,$181.88 ,$261.90 , N/A , N/A ,$276.45 ,$261.90 ,$247.35 ,$247.35 ,$77.00 ,$247.35 ,$247.35 ,$261.90 ,$177.22 , N/A ,$180.42 , N/A ,$261.90 , N/A ,$267.72 ,$261.90 ,$192.09 ,$192.09 ,$177.22 ,$192.09 ,$189.15 ,$198.81 ,$66.25 ,$229.89 , N/A ,$142.59 ,$142.59 ,$77.00 ,$142.59 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ,$185.81 ,$122.63 ,$42.31 ,$185.81 , N/A ,$166.52 ,$166.52 ,$49.17 ,$148.65 ,$157.94 ,$116.13 ,$167.23 , N/A , N/A ,$176.52 ,$167.23 ,$157.94 ,$157.94 ,$49.17 ,$157.94 ,$157.94 ,$167.23 ,$113.16 , N/A ,$115.20 , N/A ,$167.23 , N/A ,$170.95 ,$167.23 ,$122.65 ,$122.65 ,$113.16 ,$122.65 ,$120.78 ,$126.95 ,$42.31 ,$146.79 , N/A ,$91.05 ,$91.05 ,$49.17 ,$91.05 , N/A ,$176.52 ,$152.36 ,$152.36 ,$148.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202947,N/A,HC TUOHY NEEDLE,272,1 ,$22.00 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , N/A ,$20.90 ,$18.04 ,$18.04 ,$17.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202951,N/A,HC ULTRA SLING,272,1 ,$148.50 ,$98.01 ,$33.81 ,$148.50 , N/A ,$133.09 ,$133.09 ,$39.30 ,$118.80 ,$126.23 ,$92.81 ,$133.65 , N/A , N/A ,$141.08 ,$133.65 ,$126.23 ,$126.23 ,$39.30 ,$126.23 ,$126.23 ,$133.65 ,$90.44 , N/A ,$92.08 , N/A ,$133.65 , N/A ,$136.62 ,$133.65 ,$98.02 ,$98.02 ,$90.44 ,$98.02 ,$96.53 ,$101.46 ,$33.81 ,$117.32 , N/A ,$72.77 ,$72.77 ,$39.30 ,$72.77 , N/A ,$141.08 ,$121.77 ,$121.77 ,$118.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27202979,N/A,HC VEIN STRIPPER,272,1 ,$102.00 ,$67.32 ,$23.22 ,$102.00 , N/A ,$91.41 ,$91.41 ,$26.99 ,$81.60 ,$86.70 ,$63.75 ,$91.80 , N/A , N/A ,$96.90 ,$91.80 ,$86.70 ,$86.70 ,$26.99 ,$86.70 ,$86.70 ,$91.80 ,$62.12 , N/A ,$63.24 , N/A ,$91.80 , N/A ,$93.84 ,$91.80 ,$67.33 ,$67.33 ,$62.12 ,$67.33 ,$66.30 ,$69.69 ,$23.22 ,$80.58 , N/A ,$49.98 ,$49.98 ,$26.99 ,$49.98 , 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 ,$74.58 ,$25.72 ,$113.00 , N/A ,$101.27 ,$101.27 ,$29.90 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$29.90 ,$96.05 ,$96.05 ,$101.70 ,$68.82 , N/A ,$70.06 , N/A ,$101.70 , N/A ,$103.96 ,$101.70 ,$74.59 ,$74.59 ,$68.82 ,$74.59 ,$73.45 ,$77.20 ,$25.72 ,$89.27 , N/A ,$55.37 ,$55.37 ,$29.90 ,$55.37 , 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 ,$484.44 ,$167.10 ,$734.00 , N/A ,$657.81 ,$657.81 ,$194.22 ,$587.20 ,$623.90 ,$458.75 ,$660.60 , N/A , N/A ,$697.30 ,$660.60 ,$623.90 ,$623.90 ,$194.22 ,$623.90 ,$623.90 ,$660.60 ,$447.01 , N/A ,$455.08 , N/A ,$660.60 , N/A ,$675.28 ,$660.60 ,$484.51 ,$484.51 ,$447.01 ,$484.51 ,$477.10 ,$501.47 ,$167.10 ,$579.86 , N/A ,$359.66 ,$359.66 ,$194.22 ,$359.66 , 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 ,$524.04 ,$180.76 ,$794.00 , N/A ,$711.58 ,$711.58 ,$210.09 ,$635.20 ,$674.90 ,$496.25 ,$714.60 , N/A , N/A ,$754.30 ,$714.60 ,$674.90 ,$674.90 ,$210.09 ,$674.90 ,$674.90 ,$714.60 ,$483.55 , N/A ,$492.28 , N/A ,$714.60 , N/A ,$730.48 ,$714.60 ,$524.12 ,$524.12 ,$483.55 ,$524.12 ,$516.10 ,$542.46 ,$180.76 ,$627.26 , N/A ,$389.06 ,$389.06 ,$210.09 ,$389.06 , 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 ,$52.14 ,$17.98 ,$79.00 , N/A ,$70.80 ,$70.80 ,$20.90 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$20.90 ,$67.15 ,$67.15 ,$71.10 ,$48.11 , N/A ,$48.98 , N/A ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.15 ,$52.15 ,$48.11 ,$52.15 ,$51.35 ,$53.97 ,$17.98 ,$62.41 , N/A ,$38.71 ,$38.71 ,$20.90 ,$38.71 , 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 ,$37.67 ,$24.86 ,$8.57 ,$37.67 , N/A ,$33.76 ,$33.76 ,$9.97 ,$30.14 ,$32.02 ,$23.54 ,$33.90 , N/A , N/A ,$35.79 ,$33.90 ,$32.02 ,$32.02 ,$9.97 ,$32.02 ,$32.02 ,$33.90 ,$22.94 , N/A ,$23.36 , N/A ,$33.90 , N/A ,$34.66 ,$33.90 ,$24.87 ,$24.87 ,$22.94 ,$24.87 ,$24.49 ,$25.74 ,$8.57 ,$29.76 , N/A ,$18.46 ,$18.46 ,$9.97 ,$18.46 , N/A ,$35.79 ,$30.89 ,$30.89 ,$30.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203050,N/A,HC NASAL BALLOON,272,1 ,"$3,796.00 ","$2,505.36 ",$864.17 ,"$3,796.00 ", N/A ,"$3,401.98 ","$3,401.98 ","$1,004.42 ","$3,036.80 ","$3,226.60 ","$2,372.50 ","$3,416.40 ", N/A , N/A ,"$3,606.20 ","$3,416.40 ","$3,226.60 ","$3,226.60 ","$1,004.42 ","$3,226.60 ","$3,226.60 ","$3,416.40 ","$2,311.76 ", N/A ,"$2,353.52 ", N/A ,"$3,416.40 ", N/A ,"$3,492.32 ","$3,416.40 ","$2,505.74 ","$2,505.74 ","$2,311.76 ","$2,505.74 ","$2,467.40 ","$2,593.43 ",$864.17 ,"$2,998.84 ", N/A ,"$1,860.04 ","$1,860.04 ","$1,004.42 ","$1,860.04 ", 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 ,$124.74 ,$43.02 ,$189.00 , N/A ,$169.38 ,$169.38 ,$50.01 ,$151.20 ,$160.65 ,$118.13 ,$170.10 , N/A , N/A ,$179.55 ,$170.10 ,$160.65 ,$160.65 ,$50.01 ,$160.65 ,$160.65 ,$170.10 ,$115.10 , N/A ,$117.18 , N/A ,$170.10 , N/A ,$173.88 ,$170.10 ,$124.76 ,$124.76 ,$115.10 ,$124.76 ,$122.85 ,$129.12 ,$43.02 ,$149.31 , N/A ,$92.61 ,$92.61 ,$50.01 ,$92.61 , 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 ,$401.94 ,$138.64 ,$609.00 , N/A ,$545.79 ,$545.79 ,$161.14 ,$487.20 ,$517.65 ,$380.63 ,$548.10 , N/A , N/A ,$578.55 ,$548.10 ,$517.65 ,$517.65 ,$161.14 ,$517.65 ,$517.65 ,$548.10 ,$370.88 , N/A ,$377.58 , N/A ,$548.10 , N/A ,$560.28 ,$548.10 ,$402.00 ,$402.00 ,$370.88 ,$402.00 ,$395.85 ,$416.07 ,$138.64 ,$481.11 , N/A ,$298.41 ,$298.41 ,$161.14 ,$298.41 , 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 ,$98.34 ,$33.92 ,$149.00 , N/A ,$133.53 ,$133.53 ,$39.43 ,$119.20 ,$126.65 ,$93.13 ,$134.10 , N/A , N/A ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$39.43 ,$126.65 ,$126.65 ,$134.10 ,$90.74 , N/A ,$92.38 , N/A ,$134.10 , N/A ,$137.08 ,$134.10 ,$98.35 ,$98.35 ,$90.74 ,$98.35 ,$96.85 ,$101.80 ,$33.92 ,$117.71 , N/A ,$73.01 ,$73.01 ,$39.43 ,$73.01 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ,$4.09 ,$1.41 ,$6.20 , N/A ,$5.56 ,$5.56 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$50.86 ,$33.57 ,$11.58 ,$50.86 , N/A ,$45.58 ,$45.58 ,$13.46 ,$40.69 ,$43.23 ,$31.79 ,$45.77 , N/A , N/A ,$48.32 ,$45.77 ,$43.23 ,$43.23 ,$13.46 ,$43.23 ,$43.23 ,$45.77 ,$30.97 , N/A ,$31.54 , N/A ,$45.77 , N/A ,$46.79 ,$45.77 ,$33.57 ,$33.57 ,$30.97 ,$33.57 ,$33.06 ,$34.75 ,$11.58 ,$40.18 , N/A ,$24.92 ,$24.92 ,$13.46 ,$24.92 , N/A ,$48.32 ,$41.71 ,$41.71 ,$40.69 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203218,N/A,HC SWIVELOCK BIO 5.5MM,272,1 ,$828.00 ,$546.48 ,$188.49 ,$828.00 , N/A ,$742.05 ,$742.05 ,$219.09 ,$662.40 ,$703.80 ,$517.50 ,$745.20 , N/A , N/A ,$786.60 ,$745.20 ,$703.80 ,$703.80 ,$219.09 ,$703.80 ,$703.80 ,$745.20 ,$504.25 , N/A ,$513.36 , N/A ,$745.20 , N/A ,$761.76 ,$745.20 ,$546.56 ,$546.56 ,$504.25 ,$546.56 ,$538.20 ,$565.69 ,$188.49 ,$654.12 , N/A ,$405.72 ,$405.72 ,$219.09 ,$405.72 , 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 ,$24.42 ,$8.43 ,$37.00 , N/A ,$33.16 ,$33.16 ,$9.79 ,$29.60 ,$31.45 ,$23.13 ,$33.30 , N/A , N/A ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$9.79 ,$31.45 ,$31.45 ,$33.30 ,$22.53 , N/A ,$22.94 , N/A ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.42 ,$24.42 ,$22.53 ,$24.42 ,$24.05 ,$25.28 ,$8.43 ,$29.23 , N/A ,$18.13 ,$18.13 ,$9.79 ,$18.13 , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203265,N/A,HC ELECTRODES,272,1 ,$94.00 ,$62.04 ,$21.40 ,$94.00 , N/A ,$84.24 ,$84.24 ,$24.87 ,$75.20 ,$79.90 ,$58.75 ,$84.60 , N/A , N/A ,$89.30 ,$84.60 ,$79.90 ,$79.90 ,$24.87 ,$79.90 ,$79.90 ,$84.60 ,$57.25 , N/A ,$58.28 , N/A ,$84.60 , N/A ,$86.48 ,$84.60 ,$62.05 ,$62.05 ,$57.25 ,$62.05 ,$61.10 ,$64.22 ,$21.40 ,$74.26 , N/A ,$46.06 ,$46.06 ,$24.87 ,$46.06 , 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 ,$290.40 ,$100.17 ,$440.00 , N/A ,$394.33 ,$394.33 ,$116.42 ,$352.00 ,$374.00 ,$275.00 ,$396.00 , N/A , N/A ,$418.00 ,$396.00 ,$374.00 ,$374.00 ,$116.42 ,$374.00 ,$374.00 ,$396.00 ,$267.96 , N/A ,$272.80 , N/A ,$396.00 , N/A ,$404.80 ,$396.00 ,$290.44 ,$290.44 ,$267.96 ,$290.44 ,$286.00 ,$300.61 ,$100.17 ,$347.60 , N/A ,$215.60 ,$215.60 ,$116.42 ,$215.60 , 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 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , N/A ,$7.89 ,$6.81 ,$6.81 ,$6.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203298,N/A,HC HEMOSTATIC PARTICLES,272,1 ,$428.00 ,$282.48 ,$97.43 ,$428.00 , N/A ,$383.57 ,$383.57 ,$113.25 ,$342.40 ,$363.80 ,$267.50 ,$385.20 , N/A , N/A ,$406.60 ,$385.20 ,$363.80 ,$363.80 ,$113.25 ,$363.80 ,$363.80 ,$385.20 ,$260.65 , N/A ,$265.36 , N/A ,$385.20 , N/A ,$393.76 ,$385.20 ,$282.52 ,$282.52 ,$260.65 ,$282.52 ,$278.20 ,$292.41 ,$97.43 ,$338.12 , N/A ,$209.72 ,$209.72 ,$113.25 ,$209.72 , N/A ,$406.60 ,$350.96 ,$350.96 ,$342.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203301,N/A,HC MENISCAL DEPLOYMENT GUN,272,1 ,"$1,368.00 ",$902.88 ,$311.43 ,"$1,368.00 ", N/A ,"$1,226.00 ","$1,226.00 ",$361.97 ,"$1,094.40 ","$1,162.80 ",$855.00 ,"$1,231.20 ", N/A , N/A ,"$1,299.60 ","$1,231.20 ","$1,162.80 ","$1,162.80 ",$361.97 ,"$1,162.80 ","$1,162.80 ","$1,231.20 ",$833.11 , N/A ,$848.16 , N/A ,"$1,231.20 ", N/A ,"$1,258.56 ","$1,231.20 ",$903.02 ,$903.02 ,$833.11 ,$903.02 ,$889.20 ,$934.62 ,$311.43 ,"$1,080.72 ", N/A ,$670.32 ,$670.32 ,$361.97 ,$670.32 , 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 ,$139.92 ,$48.26 ,$212.00 , N/A ,$189.99 ,$189.99 ,$56.10 ,$169.60 ,$180.20 ,$132.50 ,$190.80 , N/A , N/A ,$201.40 ,$190.80 ,$180.20 ,$180.20 ,$56.10 ,$180.20 ,$180.20 ,$190.80 ,$129.11 , N/A ,$131.44 , N/A ,$190.80 , N/A ,$195.04 ,$190.80 ,$139.94 ,$139.94 ,$129.11 ,$139.94 ,$137.80 ,$144.84 ,$48.26 ,$167.48 , N/A ,$103.88 ,$103.88 ,$56.10 ,$103.88 , 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 ,"$3,873.60 ","$2,556.58 ",$881.84 ,"$3,873.60 ", N/A ,"$3,471.52 ","$3,471.52 ","$1,024.95 ","$3,098.88 ","$3,292.56 ","$2,421.00 ","$3,486.24 ", N/A , N/A ,"$3,679.92 ","$3,486.24 ","$3,292.56 ","$3,292.56 ","$1,024.95 ","$3,292.56 ","$3,292.56 ","$3,486.24 ","$2,359.02 ", N/A ,"$2,401.64 ", N/A ,"$3,486.24 ", N/A ,"$3,563.71 ","$3,486.24 ","$2,556.96 ","$2,556.96 ","$2,359.02 ","$2,556.96 ","$2,517.84 ","$2,646.44 ",$881.84 ,"$3,060.14 ", N/A ,"$1,898.06 ","$1,898.06 ","$1,024.95 ","$1,898.06 ", N/A ,"$3,679.92 ","$3,176.35 ","$3,176.35 ","$3,098.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27203318,N/A,HC TOPAZ HANDPIECE,272,1 ,$883.00 ,$582.78 ,$201.02 ,$883.00 , N/A ,$791.34 ,$791.34 ,$233.64 ,$706.40 ,$750.55 ,$551.88 ,$794.70 , N/A , N/A ,$838.85 ,$794.70 ,$750.55 ,$750.55 ,$233.64 ,$750.55 ,$750.55 ,$794.70 ,$537.75 , N/A ,$547.46 , N/A ,$794.70 , N/A ,$812.36 ,$794.70 ,$582.87 ,$582.87 ,$537.75 ,$582.87 ,$573.95 ,$603.27 ,$201.02 ,$697.57 , N/A ,$432.67 ,$432.67 ,$233.64 ,$432.67 , 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 ","$1,125.96 ",$388.37 ,"$1,706.00 ", N/A ,"$1,528.92 ","$1,528.92 ",$451.41 ,"$1,364.80 ","$1,450.10 ","$1,066.25 ","$1,535.40 ", N/A , N/A ,"$1,620.70 ","$1,535.40 ","$1,450.10 ","$1,450.10 ",$451.41 ,"$1,450.10 ","$1,450.10 ","$1,535.40 ","$1,038.95 ", N/A ,"$1,057.72 ", N/A ,"$1,535.40 ", N/A ,"$1,569.52 ","$1,535.40 ","$1,126.13 ","$1,126.13 ","$1,038.95 ","$1,126.13 ","$1,108.90 ","$1,165.54 ",$388.37 ,"$1,347.74 ", N/A ,$835.94 ,$835.94 ,$451.41 ,$835.94 , 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 ,$27.48 ,$18.14 ,$6.25 ,$27.48 , N/A ,$24.63 ,$24.63 ,$7.27 ,$21.98 ,$23.36 ,$17.18 ,$24.73 , N/A , N/A ,$26.11 ,$24.73 ,$23.36 ,$23.36 ,$7.27 ,$23.36 ,$23.36 ,$24.73 ,$16.74 , N/A ,$17.04 , N/A ,$24.73 , N/A ,$25.28 ,$24.73 ,$18.14 ,$18.14 ,$16.74 ,$18.14 ,$17.86 ,$18.77 ,$6.25 ,$21.71 , N/A ,$13.47 ,$13.47 ,$7.27 ,$13.47 , N/A ,$26.11 ,$22.53 ,$22.53 ,$21.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203649,C1725,HC BALLOON CATHETER,272,1 ,$149.00 ,$98.34 ,$33.92 ,$149.00 , N/A ,$133.53 ,$133.53 ,$39.43 ,$119.20 ,$126.65 , N/A ,$134.10 , N/A , N/A ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$39.43 ,$126.65 ,$126.65 ,$134.10 ,$90.74 , N/A ,$92.38 , N/A ,$134.10 , N/A ,$137.08 ,$134.10 ,$98.35 ,$98.35 ,$90.74 ,$98.35 ,$96.85 ,$101.80 ,$33.92 ,$117.71 , N/A ,$73.01 ,$73.01 ,$39.43 ,$73.01 , N/A ,$141.55 ,$122.18 ,$122.18 ,$119.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27203657,C1769,HC GUIDEWIRE,272,1 ,$135.00 ,$89.10 ,$30.73 ,$135.00 , N/A ,$120.99 ,$120.99 ,$35.72 ,$108.00 ,$114.75 , N/A ,$121.50 , N/A , N/A ,$128.25 ,$121.50 ,$114.75 ,$114.75 ,$35.72 ,$114.75 ,$114.75 ,$121.50 ,$82.22 , N/A ,$83.70 , N/A ,$121.50 , N/A ,$124.20 ,$121.50 ,$89.11 ,$89.11 ,$82.22 ,$89.11 ,$87.75 ,$92.23 ,$30.73 ,$106.65 , N/A ,$66.15 ,$66.15 ,$35.72 ,$66.15 , 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 ,$194.04 ,$66.93 ,$294.00 , N/A ,$263.48 ,$263.48 ,$77.79 ,$235.20 ,$249.90 ,$183.75 ,$264.60 , N/A , N/A ,$279.30 ,$264.60 ,$249.90 ,$249.90 ,$77.79 ,$249.90 ,$249.90 ,$264.60 ,$179.05 , N/A ,$182.28 , N/A ,$264.60 , N/A ,$270.48 ,$264.60 ,$194.07 ,$194.07 ,$179.05 ,$194.07 ,$191.10 ,$200.86 ,$66.93 ,$232.26 , N/A ,$144.06 ,$144.06 ,$77.79 ,$144.06 , 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 ,$388.08 ,$133.86 ,$588.00 , N/A ,$526.97 ,$526.97 ,$155.58 ,$470.40 ,$499.80 ,$367.50 ,$529.20 , N/A , N/A ,$558.60 ,$529.20 ,$499.80 ,$499.80 ,$155.58 ,$499.80 ,$499.80 ,$529.20 ,$358.09 , N/A ,$364.56 , N/A ,$529.20 , N/A ,$540.96 ,$529.20 ,$388.14 ,$388.14 ,$358.09 ,$388.14 ,$382.20 ,$401.72 ,$133.86 ,$464.52 , N/A ,$288.12 ,$288.12 ,$155.58 ,$288.12 , N/A ,$558.60 ,$482.16 ,$482.16 ,$470.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27204598,N/A,HC SUTURE MONOCRYL,272,1 ,$35.44 ,$23.39 ,$8.07 ,$35.44 , N/A ,$31.76 ,$31.76 ,$9.38 ,$28.35 ,$30.12 ,$22.15 ,$31.90 , N/A , N/A ,$33.67 ,$31.90 ,$30.12 ,$30.12 ,$9.38 ,$30.12 ,$30.12 ,$31.90 ,$21.58 , N/A ,$21.98 , N/A ,$31.90 , N/A ,$32.60 ,$31.90 ,$23.39 ,$23.39 ,$21.58 ,$23.39 ,$23.04 ,$24.21 ,$8.07 ,$28.00 , N/A ,$17.37 ,$17.37 ,$9.38 ,$17.37 , N/A ,$33.67 ,$29.06 ,$29.06 ,$28.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),27204600,N/A,HC SUTURE VICRYL,272,1 ,$25.00 ,$16.50 ,$5.69 ,$25.00 , N/A ,$22.41 ,$22.41 ,$6.61 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$6.61 ,$21.25 ,$21.25 ,$22.50 ,$15.23 , N/A ,$15.50 , N/A ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.50 ,$16.50 ,$15.23 ,$16.50 ,$16.25 ,$17.08 ,$5.69 ,$19.75 , N/A ,$12.25 ,$12.25 ,$6.61 ,$12.25 , 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 ,$36.96 ,$12.75 ,$56.00 , N/A ,$50.19 ,$50.19 ,$14.82 ,$44.80 ,$47.60 ,$35.00 ,$50.40 , N/A , N/A ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$14.82 ,$47.60 ,$47.60 ,$50.40 ,$34.10 , N/A ,$34.72 , N/A ,$50.40 , N/A ,$51.52 ,$50.40 ,$36.97 ,$36.97 ,$34.10 ,$36.97 ,$36.40 ,$38.26 ,$12.75 ,$44.24 , N/A ,$27.44 ,$27.44 ,$14.82 ,$27.44 , 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 ,$18.48 ,$6.37 ,$28.00 , N/A ,$25.09 ,$25.09 ,$7.41 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$7.41 ,$23.80 ,$23.80 ,$25.20 ,$17.05 , N/A ,$17.36 , N/A ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.48 ,$18.48 ,$17.05 ,$18.48 ,$18.20 ,$19.13 ,$6.37 ,$22.12 , N/A ,$13.72 ,$13.72 ,$7.41 ,$13.72 , 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 ,$1.72 ,$0.60 ,$2.60 , N/A ,$2.33 ,$2.33 ,$0.69 ,$2.08 ,$2.21 ,$1.63 ,$2.34 , N/A , N/A ,$2.47 ,$2.34 ,$2.21 ,$2.21 ,$0.69 ,$2.21 ,$2.21 ,$2.34 ,$1.58 , N/A ,$1.62 , N/A ,$2.34 , N/A ,$2.39 ,$2.34 ,$1.72 ,$1.72 ,$1.58 ,$1.72 ,$1.69 ,$1.78 ,$0.60 ,$2.05 , N/A ,$1.27 ,$1.27 ,$0.69 ,$1.27 , 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 ,$188.10 ,$64.89 ,$285.00 , N/A ,$255.42 ,$255.42 ,$75.41 ,$228.00 ,$242.25 ,$178.13 ,$256.50 , N/A , N/A ,$270.75 ,$256.50 ,$242.25 ,$242.25 ,$75.41 ,$242.25 ,$242.25 ,$256.50 ,$173.57 , N/A ,$176.70 , N/A ,$256.50 , N/A ,$262.20 ,$256.50 ,$188.13 ,$188.13 ,$173.57 ,$188.13 ,$185.25 ,$194.71 ,$64.89 ,$225.15 , N/A ,$139.65 ,$139.65 ,$75.41 ,$139.65 , 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 ,$232.32 ,$80.13 ,$352.00 , N/A ,$315.46 ,$315.46 ,$93.14 ,$281.60 ,$299.20 ,$220.00 ,$316.80 , N/A , N/A ,$334.40 ,$316.80 ,$299.20 ,$299.20 ,$93.14 ,$299.20 ,$299.20 ,$316.80 ,$214.37 , N/A ,$218.24 , N/A ,$316.80 , N/A ,$323.84 ,$316.80 ,$232.36 ,$232.36 ,$214.37 ,$232.36 ,$228.80 ,$240.49 ,$80.13 ,$278.08 , N/A ,$172.48 ,$172.48 ,$93.14 ,$172.48 , N/A ,$334.40 ,$288.64 ,$288.64 ,$281.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205357,N/A,HC BLADE SCOPE MOUNTED,272,1 ,"$1,124.00 ",$741.84 ,$255.89 ,"$1,124.00 ", N/A ,"$1,007.33 ","$1,007.33 ",$297.41 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ", N/A , N/A ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$297.41 ,$955.40 ,$955.40 ,"$1,011.60 ",$684.52 , N/A ,$696.88 , N/A ,"$1,011.60 ", N/A ,"$1,034.08 ","$1,011.60 ",$741.95 ,$741.95 ,$684.52 ,$741.95 ,$730.60 ,$767.92 ,$255.89 ,$887.96 , N/A ,$550.76 ,$550.76 ,$297.41 ,$550.76 , N/A ,"$1,067.80 ",$921.68 ,$921.68 ,$899.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205411,N/A,HC DRESSING ELASTIC NET,272,1 ,$36.00 ,$23.76 ,$8.19 ,$36.00 , N/A ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A ,$22.32 , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 , N/A ,$17.64 ,$17.64 ,$9.53 ,$17.64 , 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 ,$10.23 ,$3.54 ,$15.50 , N/A ,$13.89 ,$13.89 ,$4.11 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$4.11 ,$13.18 ,$13.18 ,$13.95 ,$9.44 , N/A ,$9.62 , N/A ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.23 ,$10.23 ,$9.44 ,$10.23 ,$10.08 ,$10.59 ,$3.54 ,$12.25 , N/A ,$7.60 ,$7.60 ,$4.11 ,$7.60 , 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 ,$4.36 ,$2.88 ,$0.99 ,$4.36 , N/A ,$3.91 ,$3.91 ,$1.16 ,$3.49 ,$3.71 ,$2.73 ,$3.92 , N/A , N/A ,$4.14 ,$3.92 ,$3.71 ,$3.71 ,$1.16 ,$3.71 ,$3.71 ,$3.92 ,$2.66 , N/A ,$2.70 , N/A ,$3.92 , N/A ,$4.01 ,$3.92 ,$2.88 ,$2.88 ,$2.66 ,$2.88 ,$2.83 ,$2.98 ,$0.99 ,$3.44 , N/A ,$2.14 ,$2.14 ,$1.16 ,$2.14 , N/A ,$4.14 ,$3.58 ,$3.58 ,$3.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205476,N/A,HC NOSEBLEED TRAY,272,1 ,$44.33 ,$29.26 ,$10.09 ,$44.33 , N/A ,$39.73 ,$39.73 ,$11.73 ,$35.46 ,$37.68 ,$27.71 ,$39.90 , N/A , N/A ,$42.11 ,$39.90 ,$37.68 ,$37.68 ,$11.73 ,$37.68 ,$37.68 ,$39.90 ,$27.00 , N/A ,$27.48 , N/A ,$39.90 , N/A ,$40.78 ,$39.90 ,$29.26 ,$29.26 ,$27.00 ,$29.26 ,$28.81 ,$30.29 ,$10.09 ,$35.02 , N/A ,$21.72 ,$21.72 ,$11.73 ,$21.72 , N/A ,$42.11 ,$36.35 ,$36.35 ,$35.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205477,N/A,HC WALKER AIR SM-XL,272,1 ,$66.00 ,$43.56 ,$15.02 ,$66.00 , N/A ,$59.15 ,$59.15 ,$17.46 ,$52.80 ,$56.10 ,$41.25 ,$59.40 , N/A , N/A ,$62.70 ,$59.40 ,$56.10 ,$56.10 ,$17.46 ,$56.10 ,$56.10 ,$59.40 ,$40.19 , N/A ,$40.92 , N/A ,$59.40 , N/A ,$60.72 ,$59.40 ,$43.57 ,$43.57 ,$40.19 ,$43.57 ,$42.90 ,$45.09 ,$15.02 ,$52.14 , N/A ,$32.34 ,$32.34 ,$17.46 ,$32.34 , N/A ,$62.70 ,$54.12 ,$54.12 ,$52.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205478,N/A,HC 11MM/130 DEG TI CANN 320-440MM,272,1 ,"$2,332.00 ","$1,539.12 ",$530.89 ,"$2,332.00 ", N/A ,"$2,089.94 ","$2,089.94 ",$617.05 ,"$1,865.60 ","$1,982.20 ","$1,457.50 ","$2,098.80 ", N/A , N/A ,"$2,215.40 ","$2,098.80 ","$1,982.20 ","$1,982.20 ",$617.05 ,"$1,982.20 ","$1,982.20 ","$2,098.80 ","$1,420.19 ", N/A ,"$1,445.84 ", N/A ,"$2,098.80 ", N/A ,"$2,145.44 ","$2,098.80 ","$1,539.35 ","$1,539.35 ","$1,420.19 ","$1,539.35 ","$1,515.80 ","$1,593.22 ",$530.89 ,"$1,842.28 ", N/A ,"$1,142.68 ","$1,142.68 ",$617.05 ,"$1,142.68 ", 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 ,$458.04 ,$158.00 ,$694.00 , N/A ,$621.96 ,$621.96 ,$183.63 ,$555.20 ,$589.90 ,$433.75 ,$624.60 , N/A , N/A ,$659.30 ,$624.60 ,$589.90 ,$589.90 ,$183.63 ,$589.90 ,$589.90 ,$624.60 ,$422.65 , N/A ,$430.28 , N/A ,$624.60 , N/A ,$638.48 ,$624.60 ,$458.11 ,$458.11 ,$422.65 ,$458.11 ,$451.10 ,$474.14 ,$158.00 ,$548.26 , N/A ,$340.06 ,$340.06 ,$183.63 ,$340.06 , 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 ,$482.46 ,$166.41 ,$731.00 , N/A ,$655.12 ,$655.12 ,$193.42 ,$584.80 ,$621.35 ,$456.88 ,$657.90 , N/A , N/A ,$694.45 ,$657.90 ,$621.35 ,$621.35 ,$193.42 ,$621.35 ,$621.35 ,$657.90 ,$445.18 , N/A ,$453.22 , N/A ,$657.90 , N/A ,$672.52 ,$657.90 ,$482.53 ,$482.53 ,$445.18 ,$482.53 ,$475.15 ,$499.42 ,$166.41 ,$577.49 , N/A ,$358.19 ,$358.19 ,$193.42 ,$358.19 , 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 ,$145.86 ,$50.31 ,$221.00 , N/A ,$198.06 ,$198.06 ,$58.48 ,$176.80 ,$187.85 ,$138.13 ,$198.90 , N/A , N/A ,$209.95 ,$198.90 ,$187.85 ,$187.85 ,$58.48 ,$187.85 ,$187.85 ,$198.90 ,$134.59 , N/A ,$137.02 , N/A ,$198.90 , N/A ,$203.32 ,$198.90 ,$145.88 ,$145.88 ,$134.59 ,$145.88 ,$143.65 ,$150.99 ,$50.31 ,$174.59 , N/A ,$108.29 ,$108.29 ,$58.48 ,$108.29 , 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 ,$19.00 ,$12.54 ,$4.32 ,$19.00 , N/A ,$17.03 ,$17.03 ,$5.03 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$5.03 ,$16.15 ,$16.15 ,$17.10 ,$11.57 , N/A ,$11.78 , N/A ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.54 ,$12.54 ,$11.57 ,$12.54 ,$12.35 ,$12.98 ,$4.32 ,$15.01 , N/A ,$9.31 ,$9.31 ,$5.03 ,$9.31 , N/A ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205483,N/A,HC SUT TI-CRON 2 T-56 HGS-21 30,272,1 ,$23.50 ,$15.51 ,$5.35 ,$23.50 , N/A ,$21.06 ,$21.06 ,$6.22 ,$18.80 ,$19.98 ,$14.69 ,$21.15 , N/A , N/A ,$22.33 ,$21.15 ,$19.98 ,$19.98 ,$6.22 ,$19.98 ,$19.98 ,$21.15 ,$14.31 , N/A ,$14.58 , N/A ,$21.15 , N/A ,$21.62 ,$21.15 ,$15.51 ,$15.51 ,$14.31 ,$15.51 ,$15.28 ,$16.06 ,$5.35 ,$18.57 , N/A ,$11.52 ,$11.52 ,$6.22 ,$11.52 , N/A ,$22.33 ,$19.27 ,$19.27 ,$18.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27205520,N/A,HC BONE ALLOSYNC DEMINERALIZED,272,1 ,$630.00 ,$415.80 ,$143.42 ,$630.00 , N/A ,$564.61 ,$564.61 ,$166.70 ,$504.00 ,$535.50 ,$393.75 ,$567.00 , N/A , N/A ,$598.50 ,$567.00 ,$535.50 ,$535.50 ,$166.70 ,$535.50 ,$535.50 ,$567.00 ,$383.67 , N/A ,$390.60 , N/A ,$567.00 , N/A ,$579.60 ,$567.00 ,$415.86 ,$415.86 ,$383.67 ,$415.86 ,$409.50 ,$430.42 ,$143.42 ,$497.70 , N/A ,$308.70 ,$308.70 ,$166.70 ,$308.70 , N/A ,$598.50 ,$516.60 ,$516.60 ,$504.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,APPLICATOR COTTON TIP 6,272,1 ,$0.05 ,$0.03 ,$0.01 ,$0.05 , N/A ,$0.04 ,$0.04 ,$0.01 ,$0.04 ,$0.04 ,$0.03 ,$0.05 , N/A , N/A ,$0.05 ,$0.05 ,$0.04 ,$0.04 ,$0.01 ,$0.04 ,$0.04 ,$0.05 ,$0.03 , N/A ,$0.04 , N/A ,$0.05 , N/A ,$0.05 ,$0.05 ,$0.03 ,$0.03 ,$0.03 ,$0.03 ,$0.03 ,$0.03 ,$0.01 ,$0.04 , N/A ,$0.02 ,$0.02 ,$0.01 ,$0.02 , N/A ,$0.05 ,$0.04 ,$0.04 ,$0.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,BARRIER ADHESION INTERCEED,272,1 ,$495.17 ,$326.81 ,$112.73 ,$495.17 , N/A ,$443.77 ,$443.77 ,$131.03 ,$396.14 ,$420.89 ,$309.48 ,$445.65 , N/A , N/A ,$470.41 ,$445.65 ,$420.89 ,$420.89 ,$131.03 ,$420.89 ,$420.89 ,$445.65 ,$301.56 , N/A ,$307.00 , N/A ,$445.65 , N/A ,$455.56 ,$445.65 ,$326.86 ,$326.86 ,$301.56 ,$326.86 ,$321.86 ,$338.30 ,$112.73 ,$391.18 , N/A ,$242.63 ,$242.63 ,$131.03 ,$242.63 , N/A ,$470.41 ,$406.04 ,$406.04 ,$396.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,BLADE ARTHROSCOPY TOMCAT 5.5MM,272,1 ,$83.25 ,$54.95 ,$18.95 ,$83.25 , N/A ,$74.61 ,$74.61 ,$22.03 ,$66.60 ,$70.76 ,$52.03 ,$74.93 , N/A , N/A ,$79.09 ,$74.93 ,$70.76 ,$70.76 ,$22.03 ,$70.76 ,$70.76 ,$74.93 ,$50.70 , N/A ,$51.62 , N/A ,$74.93 , N/A ,$76.59 ,$74.93 ,$54.95 ,$54.95 ,$50.70 ,$54.95 ,$54.11 ,$56.88 ,$18.95 ,$65.77 , N/A ,$40.79 ,$40.79 ,$22.03 ,$40.79 , N/A ,$79.09 ,$68.27 ,$68.27 ,$66.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,BLADE ARTHROSCOPY TOMCAT 4.0MM,272,1 ,$83.25 ,$54.95 ,$18.95 ,$83.25 , N/A ,$74.61 ,$74.61 ,$22.03 ,$66.60 ,$70.76 ,$52.03 ,$74.93 , N/A , N/A ,$79.09 ,$74.93 ,$70.76 ,$70.76 ,$22.03 ,$70.76 ,$70.76 ,$74.93 ,$50.70 , N/A ,$51.62 , N/A ,$74.93 , N/A ,$76.59 ,$74.93 ,$54.95 ,$54.95 ,$50.70 ,$54.95 ,$54.11 ,$56.88 ,$18.95 ,$65.77 , N/A ,$40.79 ,$40.79 ,$22.03 ,$40.79 , N/A ,$79.09 ,$68.27 ,$68.27 ,$66.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,CLIP DURACLIP 2.8MM 235CM 16MM,272,1 ,$222.75 ,$147.02 ,$50.71 ,$222.75 , N/A ,$199.63 ,$199.63 ,$58.94 ,$178.20 ,$189.34 ,$139.22 ,$200.48 , N/A , N/A ,$211.61 ,$200.48 ,$189.34 ,$189.34 ,$58.94 ,$189.34 ,$189.34 ,$200.48 ,$135.65 , N/A ,$138.10 , N/A ,$200.48 , N/A ,$204.93 ,$200.48 ,$147.04 ,$147.04 ,$135.65 ,$147.04 ,$144.79 ,$152.18 ,$50.71 ,$175.97 , N/A ,$109.15 ,$109.15 ,$58.94 ,$109.15 , N/A ,$211.61 ,$182.66 ,$182.66 ,$178.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,CONNECTOR TUBING LUER LOCK STERILE LATEX FREE MICROCLAVE CLEAR .05ML INTRAVENOUS,272,1 ,$2.06 ,$1.36 ,$0.46 ,$2.06 , N/A ,$1.85 ,$1.85 ,$0.55 ,$1.65 ,$1.75 ,$1.29 ,$1.85 , N/A , N/A ,$1.96 ,$1.85 ,$1.75 ,$1.75 ,$0.55 ,$1.75 ,$1.75 ,$1.85 ,$1.25 , N/A ,$1.28 , N/A ,$1.85 , N/A ,$1.90 ,$1.85 ,$1.36 ,$1.36 ,$1.25 ,$1.36 ,$1.34 ,$1.41 ,$0.46 ,$1.63 , N/A ,$1.01 ,$1.01 ,$0.55 ,$1.01 , N/A ,$1.96 ,$1.69 ,$1.69 ,$1.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,CONTRAST RAD ISOVUE 300 15ML,272,1 ,$30.49 ,$20.12 ,$6.94 ,$30.49 , N/A ,$27.33 ,$27.33 ,$8.07 ,$24.39 ,$25.92 ,$19.06 ,$27.44 , N/A , N/A ,$28.97 ,$27.44 ,$25.92 ,$25.92 ,$8.07 ,$25.92 ,$25.92 ,$27.44 ,$18.57 , N/A ,$18.90 , N/A ,$27.44 , N/A ,$28.05 ,$27.44 ,$20.13 ,$20.13 ,$18.57 ,$20.13 ,$19.82 ,$20.83 ,$6.94 ,$24.09 , N/A ,$14.94 ,$14.94 ,$8.07 ,$14.94 , N/A ,$28.97 ,$25.00 ,$25.00 ,$24.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,DRESSING BIOPATCH 2.5CM X 4.0MM,272,1 ,$12.78 ,$8.43 ,$2.91 ,$12.78 , N/A ,$11.45 ,$11.45 ,$3.38 ,$10.22 ,$10.86 ,$7.99 ,$11.50 , N/A , N/A ,$12.14 ,$11.50 ,$10.86 ,$10.86 ,$3.38 ,$10.86 ,$10.86 ,$11.50 ,$7.78 , N/A ,$7.92 , N/A ,$11.50 , N/A ,$11.76 ,$11.50 ,$8.44 ,$8.44 ,$7.78 ,$8.44 ,$8.31 ,$8.73 ,$2.91 ,$10.10 , N/A ,$6.26 ,$6.26 ,$3.38 ,$6.26 , N/A ,$12.14 ,$10.48 ,$10.48 ,$10.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,DRESSING OPSITE 2.5 X 2 INCHES 6.5 X 5CM,272,1 ,$0.45 ,$0.30 ,$0.10 ,$0.45 , N/A ,$0.40 ,$0.40 ,$0.12 ,$0.36 ,$0.38 ,$0.28 ,$0.41 , N/A , N/A ,$0.43 ,$0.41 ,$0.38 ,$0.38 ,$0.12 ,$0.38 ,$0.38 ,$0.41 ,$0.27 , N/A ,$0.28 , N/A ,$0.41 , N/A ,$0.41 ,$0.41 ,$0.30 ,$0.30 ,$0.27 ,$0.30 ,$0.29 ,$0.31 ,$0.10 ,$0.36 , N/A ,$0.22 ,$0.22 ,$0.12 ,$0.22 , N/A ,$0.43 ,$0.37 ,$0.37 ,$0.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,DRESSING PRIMAPORE 4X 3,272,1 ,$0.94 ,$0.62 ,$0.22 ,$0.94 , N/A ,$0.84 ,$0.84 ,$0.24 ,$0.75 ,$0.80 ,$0.59 ,$0.85 , N/A , N/A ,$0.89 ,$0.85 ,$0.80 ,$0.80 ,$0.24 ,$0.80 ,$0.80 ,$0.85 ,$0.57 , N/A ,$0.58 , N/A ,$0.85 , N/A ,$0.86 ,$0.85 ,$0.62 ,$0.62 ,$0.57 ,$0.62 ,$0.61 ,$0.64 ,$0.22 ,$0.74 , N/A ,$0.46 ,$0.46 ,$0.24 ,$0.46 , N/A ,$0.89 ,$0.77 ,$0.77 ,$0.75 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,DRESSING PRIMAPORE 8X4,272,1 ,$1.57 ,$1.04 ,$0.35 ,$1.57 , N/A ,$1.41 ,$1.41 ,$0.41 ,$1.26 ,$1.33 ,$0.98 ,$1.41 , N/A , N/A ,$1.49 ,$1.41 ,$1.33 ,$1.33 ,$0.41 ,$1.33 ,$1.33 ,$1.41 ,$0.96 , N/A ,$0.98 , N/A ,$1.41 , N/A ,$1.44 ,$1.41 ,$1.04 ,$1.04 ,$0.96 ,$1.04 ,$1.02 ,$1.07 ,$0.35 ,$1.24 , N/A ,$0.77 ,$0.77 ,$0.41 ,$0.77 , N/A ,$1.49 ,$1.29 ,$1.29 ,$1.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,DRUG ANTIFLTLNT EZGS2 SMETHC NAHCO3 EFRVSCNT GRNL PKT   4GM,272,1 ,$2.09 ,$1.38 ,$0.47 ,$2.09 , N/A ,$1.87 ,$1.87 ,$0.55 ,$1.67 ,$1.78 ,$1.31 ,$1.88 , N/A , N/A ,$1.99 ,$1.88 ,$1.78 ,$1.78 ,$0.55 ,$1.78 ,$1.78 ,$1.88 ,$1.27 , N/A ,$1.30 , N/A ,$1.88 , N/A ,$1.92 ,$1.88 ,$1.38 ,$1.38 ,$1.27 ,$1.38 ,$1.36 ,$1.43 ,$0.47 ,$1.65 , N/A ,$1.02 ,$1.02 ,$0.55 ,$1.02 , N/A ,$1.99 ,$1.71 ,$1.71 ,$1.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,HANPIECE INTERPULSE HIGH FLOW,272,1 ,$61.37 ,$40.50 ,$13.97 ,$61.37 , N/A ,$55.00 ,$55.00 ,$16.24 ,$49.10 ,$52.16 ,$38.36 ,$55.23 , N/A , N/A ,$58.30 ,$55.23 ,$52.16 ,$52.16 ,$16.24 ,$52.16 ,$52.16 ,$55.23 ,$37.37 , N/A ,$38.04 , N/A ,$55.23 , N/A ,$56.46 ,$55.23 ,$40.51 ,$40.51 ,$37.37 ,$40.51 ,$39.89 ,$41.93 ,$13.97 ,$48.48 , N/A ,$30.07 ,$30.07 ,$16.24 ,$30.07 , N/A ,$58.30 ,$50.32 ,$50.32 ,$49.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,KIT INFUSION PORT WITHOUT Y SITE ACCESS 20GA POWERLOC .75IN STERILE LATEX FREE,272,1 ,$25.97 ,$17.14 ,$5.91 ,$25.97 , N/A ,$23.27 ,$23.27 ,$6.87 ,$20.78 ,$22.07 ,$16.23 ,$23.37 , N/A , N/A ,$24.67 ,$23.37 ,$22.07 ,$22.07 ,$6.87 ,$22.07 ,$22.07 ,$23.37 ,$15.82 , N/A ,$16.10 , N/A ,$23.37 , N/A ,$23.89 ,$23.37 ,$17.14 ,$17.14 ,$15.82 ,$17.14 ,$16.88 ,$17.74 ,$5.91 ,$20.52 , N/A ,$12.73 ,$12.73 ,$6.87 ,$12.73 , N/A ,$24.67 ,$21.30 ,$21.30 ,$20.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,KIT SAFETY PEG TUBE 20FR,272,1 ,$286.80 ,$189.29 ,$65.29 ,$286.80 , N/A ,$257.03 ,$257.03 ,$75.89 ,$229.44 ,$243.78 ,$179.25 ,$258.12 , N/A , N/A ,$272.46 ,$258.12 ,$243.78 ,$243.78 ,$75.89 ,$243.78 ,$243.78 ,$258.12 ,$174.66 , N/A ,$177.82 , N/A ,$258.12 , N/A ,$263.86 ,$258.12 ,$189.32 ,$189.32 ,$174.66 ,$189.32 ,$186.42 ,$195.94 ,$65.29 ,$226.57 , N/A ,$140.53 ,$140.53 ,$75.89 ,$140.53 , N/A ,$272.46 ,$235.18 ,$235.18 ,$229.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,PARTICLES ARISTA HEMOSTATIC 3GM  (SM0002-USA),272,1 ,$390.60 ,$257.80 ,$88.93 ,$390.60 , N/A ,$350.06 ,$350.06 ,$103.35 ,$312.48 ,$332.01 ,$244.13 ,$351.54 , N/A , N/A ,$371.07 ,$351.54 ,$332.01 ,$332.01 ,$103.35 ,$332.01 ,$332.01 ,$351.54 ,$237.88 , N/A ,$242.18 , N/A ,$351.54 , N/A ,$359.35 ,$351.54 ,$257.84 ,$257.84 ,$237.88 ,$257.84 ,$253.89 ,$266.86 ,$88.93 ,$308.57 , N/A ,$191.39 ,$191.39 ,$103.35 ,$191.39 , N/A ,$371.07 ,$320.29 ,$320.29 ,$312.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,PASSER FIRSTPASS ST SELF CAPTURE PRELOAD ROUND PRECURVE NEEDLE DEEP BITE SUTURE NITINOL STERILE DISPOSABLE,272,1 ,$388.87 ,$256.65 ,$88.52 ,$388.87 , N/A ,$348.51 ,$348.51 ,$102.89 ,$311.10 ,$330.54 ,$243.04 ,$349.98 , N/A , N/A ,$369.43 ,$349.98 ,$330.54 ,$330.54 ,$102.89 ,$330.54 ,$330.54 ,$349.98 ,$236.82 , N/A ,$241.10 , N/A ,$349.98 , N/A ,$357.76 ,$349.98 ,$256.69 ,$256.69 ,$236.82 ,$256.69 ,$252.77 ,$265.68 ,$88.52 ,$307.21 , N/A ,$190.55 ,$190.55 ,$102.89 ,$190.55 , N/A ,$369.43 ,$318.87 ,$318.87 ,$311.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SET BLOOD WARMING ADMINISTRATION FLUID INJECTION PORT LEVEL 1 HOTLINE INTRAVENOUS HL-390 DISPOSABLE 8FT STERILE LATEX FREE,272,1 ,$18.88 ,$12.46 ,$4.29 ,$18.88 , N/A ,$16.92 ,$16.92 ,$5.00 ,$15.10 ,$16.05 ,$11.80 ,$16.99 , N/A , N/A ,$17.94 ,$16.99 ,$16.05 ,$16.05 ,$5.00 ,$16.05 ,$16.05 ,$16.99 ,$11.50 , N/A ,$11.70 , N/A ,$16.99 , N/A ,$17.37 ,$16.99 ,$12.46 ,$12.46 ,$11.50 ,$12.46 ,$12.27 ,$12.90 ,$4.29 ,$14.92 , N/A ,$9.25 ,$9.25 ,$5.00 ,$9.25 , N/A ,$17.94 ,$15.48 ,$15.48 ,$15.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SINUPLASTY  SINUS BALLOON INFLATION SYRINGE DEVICE,272,1 ,$167.74 ,$110.71 ,$38.19 ,$167.74 , N/A ,$150.33 ,$150.33 ,$44.38 ,$134.19 ,$142.58 ,$104.84 ,$150.97 , N/A , N/A ,$159.35 ,$150.97 ,$142.58 ,$142.58 ,$44.38 ,$142.58 ,$142.58 ,$150.97 ,$102.15 , N/A ,$104.00 , N/A ,$150.97 , N/A ,$154.32 ,$150.97 ,$110.73 ,$110.73 ,$102.15 ,$110.73 ,$109.03 ,$114.60 ,$38.19 ,$132.51 , N/A ,$82.19 ,$82.19 ,$44.38 ,$82.19 , N/A ,$159.35 ,$137.55 ,$137.55 ,$134.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE ARTHREX FIBERWIRE 2-0 T-5 18IN BRAID TIES,272,1 ,$54.45 ,$35.94 ,$12.40 ,$54.45 , N/A ,$48.80 ,$48.80 ,$14.41 ,$43.56 ,$46.28 ,$34.03 ,$49.01 , N/A , N/A ,$51.73 ,$49.01 ,$46.28 ,$46.28 ,$14.41 ,$46.28 ,$46.28 ,$49.01 ,$33.16 , N/A ,$33.76 , N/A ,$49.01 , N/A ,$50.09 ,$49.01 ,$35.94 ,$35.94 ,$33.16 ,$35.94 ,$35.39 ,$37.20 ,$12.40 ,$43.02 , N/A ,$26.68 ,$26.68 ,$14.41 ,$26.68 , N/A ,$51.73 ,$44.65 ,$44.65 ,$43.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE CHROMIC 0 GS-21 36IN ABSORBABLE,272,1 ,$14.65 ,$9.67 ,$3.33 ,$14.65 , N/A ,$13.13 ,$13.13 ,$3.88 ,$11.72 ,$12.45 ,$9.16 ,$13.19 , N/A , N/A ,$13.92 ,$13.19 ,$12.45 ,$12.45 ,$3.88 ,$12.45 ,$12.45 ,$13.19 ,$8.92 , N/A ,$9.08 , N/A ,$13.19 , N/A ,$13.48 ,$13.19 ,$9.67 ,$9.67 ,$8.92 ,$9.67 ,$9.52 ,$10.01 ,$3.33 ,$11.57 , N/A ,$7.18 ,$7.18 ,$3.88 ,$7.18 , N/A ,$13.92 ,$12.01 ,$12.01 ,$11.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE FORCE FIBER #2,272,1 ,$58.55 ,$38.64 ,$13.33 ,$58.55 , N/A ,$52.47 ,$52.47 ,$15.49 ,$46.84 ,$49.77 ,$36.59 ,$52.70 , N/A , N/A ,$55.62 ,$52.70 ,$49.77 ,$49.77 ,$15.49 ,$49.77 ,$49.77 ,$52.70 ,$35.66 , N/A ,$36.30 , N/A ,$52.70 , N/A ,$53.87 ,$52.70 ,$38.65 ,$38.65 ,$35.66 ,$38.65 ,$38.06 ,$40.00 ,$13.33 ,$46.25 , N/A ,$28.69 ,$28.69 ,$15.49 ,$28.69 , N/A ,$55.62 ,$48.01 ,$48.01 ,$46.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE PDS 0 CT-2 Z334H,272,1 ,$4.31 ,$2.84 ,$0.98 ,$4.31 , N/A ,$3.86 ,$3.86 ,$1.14 ,$3.45 ,$3.66 ,$2.69 ,$3.88 , N/A , N/A ,$4.09 ,$3.88 ,$3.66 ,$3.66 ,$1.14 ,$3.66 ,$3.66 ,$3.88 ,$2.62 , N/A ,$2.68 , N/A ,$3.88 , N/A ,$3.97 ,$3.88 ,$2.85 ,$2.85 ,$2.62 ,$2.85 ,$2.80 ,$2.94 ,$0.98 ,$3.40 , N/A ,$2.11 ,$2.11 ,$1.14 ,$2.11 , N/A ,$4.09 ,$3.53 ,$3.53 ,$3.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE PDS 2-0 SH CR Z775D,272,1 ,$30.69 ,$20.26 ,$6.99 ,$30.69 , N/A ,$27.50 ,$27.50 ,$8.12 ,$24.55 ,$26.09 ,$19.18 ,$27.62 , N/A , N/A ,$29.16 ,$27.62 ,$26.09 ,$26.09 ,$8.12 ,$26.09 ,$26.09 ,$27.62 ,$18.69 , N/A ,$19.02 , N/A ,$27.62 , N/A ,$28.23 ,$27.62 ,$20.26 ,$20.26 ,$18.69 ,$20.26 ,$19.95 ,$20.97 ,$6.99 ,$24.25 , N/A ,$15.04 ,$15.04 ,$8.12 ,$15.04 , N/A ,$29.16 ,$25.17 ,$25.17 ,$24.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE PDS 3-0  SH 27 Z316H,272,1 ,$4.18 ,$2.76 ,$0.95 ,$4.18 , N/A ,$3.75 ,$3.75 ,$1.11 ,$3.34 ,$3.55 ,$2.61 ,$3.76 , N/A , N/A ,$3.97 ,$3.76 ,$3.55 ,$3.55 ,$1.11 ,$3.55 ,$3.55 ,$3.76 ,$2.55 , N/A ,$2.60 , N/A ,$3.76 , N/A ,$3.85 ,$3.76 ,$2.76 ,$2.76 ,$2.55 ,$2.76 ,$2.72 ,$2.86 ,$0.95 ,$3.30 , N/A ,$2.05 ,$2.05 ,$1.11 ,$2.05 , N/A ,$3.97 ,$3.43 ,$3.43 ,$3.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SUTURE VLOC 90 2-0 GS-22 9IN VIOLET,272,1 ,$62.56 ,$41.29 ,$14.24 ,$62.56 , N/A ,$56.07 ,$56.07 ,$16.55 ,$50.05 ,$53.18 ,$39.10 ,$56.30 , N/A , N/A ,$59.43 ,$56.30 ,$53.18 ,$53.18 ,$16.55 ,$53.18 ,$53.18 ,$56.30 ,$38.10 , N/A ,$38.78 , N/A ,$56.30 , N/A ,$57.56 ,$56.30 ,$41.30 ,$41.30 ,$38.10 ,$41.30 ,$40.66 ,$42.74 ,$14.24 ,$49.42 , N/A ,$30.65 ,$30.65 ,$16.55 ,$30.65 , N/A ,$59.43 ,$51.30 ,$51.30 ,$50.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,SYRINGE 1ML LATEX FREE STERILE LUER SLIP MEDICAL,272,1 ,$21.80 ,$14.39 ,$4.96 ,$21.80 , N/A ,$19.54 ,$19.54 ,$5.77 ,$17.44 ,$18.53 ,$13.63 ,$19.62 , N/A , N/A ,$20.71 ,$19.62 ,$18.53 ,$18.53 ,$5.77 ,$18.53 ,$18.53 ,$19.62 ,$13.28 , N/A ,$13.52 , N/A ,$19.62 , N/A ,$20.06 ,$19.62 ,$14.39 ,$14.39 ,$13.28 ,$14.39 ,$14.17 ,$14.89 ,$4.96 ,$17.22 , N/A ,$10.68 ,$10.68 ,$5.77 ,$10.68 , N/A ,$20.71 ,$17.88 ,$17.88 ,$17.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TIP COLONOSCOPE GREEN 11.2MM ENDOCUFF VISION LARGE 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP ADULT STERILE LATEX FREE DISPOSABLE,272,1 ,$54.00 ,$35.64 ,$12.29 ,$54.00 , N/A ,$48.39 ,$48.39 ,$14.29 ,$43.20 ,$45.90 ,$33.75 ,$48.60 , N/A , N/A ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$14.29 ,$45.90 ,$45.90 ,$48.60 ,$32.89 , N/A ,$33.48 , N/A ,$48.60 , N/A ,$49.68 ,$48.60 ,$35.65 ,$35.65 ,$32.89 ,$35.65 ,$35.10 ,$36.89 ,$12.29 ,$42.66 , N/A ,$26.46 ,$26.46 ,$14.29 ,$26.46 , N/A ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TIP COLONOSCOPE BLUE 11MM ENDOCUFF VISION MEDIUM PLASTIC 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE,272,1 ,$54.00 ,$35.64 ,$12.29 ,$54.00 , N/A ,$48.39 ,$48.39 ,$14.29 ,$43.20 ,$45.90 ,$33.75 ,$48.60 , N/A , N/A ,$51.30 ,$48.60 ,$45.90 ,$45.90 ,$14.29 ,$45.90 ,$45.90 ,$48.60 ,$32.89 , N/A ,$33.48 , N/A ,$48.60 , N/A ,$49.68 ,$48.60 ,$35.65 ,$35.65 ,$32.89 ,$35.65 ,$35.10 ,$36.89 ,$12.29 ,$42.66 , N/A ,$26.46 ,$26.46 ,$14.29 ,$26.46 , N/A ,$51.30 ,$44.28 ,$44.28 ,$43.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TRACH SHILEY CUFFED SZ 4,272,1 ,$62.51 ,$41.26 ,$14.23 ,$62.51 , N/A ,$56.02 ,$56.02 ,$16.54 ,$50.01 ,$53.13 ,$39.07 ,$56.26 , N/A , N/A ,$59.38 ,$56.26 ,$53.13 ,$53.13 ,$16.54 ,$53.13 ,$53.13 ,$56.26 ,$38.07 , N/A ,$38.76 , N/A ,$56.26 , N/A ,$57.51 ,$56.26 ,$41.26 ,$41.26 ,$38.07 ,$41.26 ,$40.63 ,$42.71 ,$14.23 ,$49.38 , N/A ,$30.63 ,$30.63 ,$16.54 ,$30.63 , N/A ,$59.38 ,$51.26 ,$51.26 ,$50.01 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TRACH SHILEY CUFFLESS SZ 6,272,1 ,$62.17 ,$41.03 ,$14.15 ,$62.17 , N/A ,$55.72 ,$55.72 ,$16.45 ,$49.74 ,$52.84 ,$38.86 ,$55.95 , N/A , N/A ,$59.06 ,$55.95 ,$52.84 ,$52.84 ,$16.45 ,$52.84 ,$52.84 ,$55.95 ,$37.86 , N/A ,$38.54 , N/A ,$55.95 , N/A ,$57.20 ,$55.95 ,$41.04 ,$41.04 ,$37.86 ,$41.04 ,$40.41 ,$42.47 ,$14.15 ,$49.11 , N/A ,$30.46 ,$30.46 ,$16.45 ,$30.46 , N/A ,$59.06 ,$50.98 ,$50.98 ,$49.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TRACH TUBE CUFFED 3MM HI-LO ORAL/NASAL,272,1 ,$3.03 ,$2.00 ,$0.70 ,$3.03 , N/A ,$2.72 ,$2.72 ,$0.80 ,$2.42 ,$2.58 ,$1.89 ,$2.73 , N/A , N/A ,$2.88 ,$2.73 ,$2.58 ,$2.58 ,$0.80 ,$2.58 ,$2.58 ,$2.73 ,$1.85 , N/A ,$1.88 , N/A ,$2.73 , N/A ,$2.79 ,$2.73 ,$2.00 ,$2.00 ,$1.85 ,$2.00 ,$1.97 ,$2.07 ,$0.70 ,$2.39 , N/A ,$1.48 ,$1.48 ,$0.80 ,$1.48 , N/A ,$2.88 ,$2.48 ,$2.48 ,$2.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TRACH TUBE CUFFED 3.5MM HI-LO ORAL/NASAL,272,1 ,$3.03 ,$2.00 ,$0.70 ,$3.03 , N/A ,$2.72 ,$2.72 ,$0.80 ,$2.42 ,$2.58 ,$1.89 ,$2.73 , N/A , N/A ,$2.88 ,$2.73 ,$2.58 ,$2.58 ,$0.80 ,$2.58 ,$2.58 ,$2.73 ,$1.85 , N/A ,$1.88 , N/A ,$2.73 , N/A ,$2.79 ,$2.73 ,$2.00 ,$2.00 ,$1.85 ,$2.00 ,$1.97 ,$2.07 ,$0.70 ,$2.39 , N/A ,$1.48 ,$1.48 ,$0.80 ,$1.48 , N/A ,$2.88 ,$2.48 ,$2.48 ,$2.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TRACH TUBE CUFFED 4MM HI-LO ORAL/NASAL,272,1 ,$3.04 ,$2.01 ,$0.70 ,$3.04 , N/A ,$2.72 ,$2.72 ,$0.80 ,$2.43 ,$2.58 ,$1.90 ,$2.74 , N/A , N/A ,$2.89 ,$2.74 ,$2.58 ,$2.58 ,$0.80 ,$2.58 ,$2.58 ,$2.74 ,$1.85 , N/A ,$1.88 , N/A ,$2.74 , N/A ,$2.80 ,$2.74 ,$2.01 ,$2.01 ,$1.85 ,$2.01 ,$1.98 ,$2.08 ,$0.70 ,$2.40 , N/A ,$1.49 ,$1.49 ,$0.80 ,$1.49 , N/A ,$2.89 ,$2.49 ,$2.49 ,$2.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TRACH TUBE CUFFED 4.5MM HI-LO ORAL/NASAL,272,1 ,$3.04 ,$2.01 ,$0.70 ,$3.04 , N/A ,$2.72 ,$2.72 ,$0.80 ,$2.43 ,$2.58 ,$1.90 ,$2.74 , N/A , N/A ,$2.89 ,$2.74 ,$2.58 ,$2.58 ,$0.80 ,$2.58 ,$2.58 ,$2.74 ,$1.85 , N/A ,$1.88 , N/A ,$2.74 , N/A ,$2.80 ,$2.74 ,$2.01 ,$2.01 ,$1.85 ,$2.01 ,$1.98 ,$2.08 ,$0.70 ,$2.40 , N/A ,$1.49 ,$1.49 ,$0.80 ,$1.49 , N/A ,$2.89 ,$2.49 ,$2.49 ,$2.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TROCAR SLEEVE XCEL UNIVERSAL 5MM X 100MM,272,1 ,$27.16 ,$17.93 ,$6.18 ,$27.16 , N/A ,$24.34 ,$24.34 ,$7.18 ,$21.73 ,$23.09 ,$16.98 ,$24.44 , N/A , N/A ,$25.80 ,$24.44 ,$23.09 ,$23.09 ,$7.18 ,$23.09 ,$23.09 ,$24.44 ,$16.54 , N/A ,$16.84 , N/A ,$24.44 , N/A ,$24.99 ,$24.44 ,$17.93 ,$17.93 ,$16.54 ,$17.93 ,$17.65 ,$18.56 ,$6.18 ,$21.46 , N/A ,$13.31 ,$13.31 ,$7.18 ,$13.31 , N/A ,$25.80 ,$22.27 ,$22.27 ,$21.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TROCAR XCEL 11MM 100MM BLADELESS,272,1 ,$38.80 ,$25.61 ,$8.83 ,$38.80 , N/A ,$34.77 ,$34.77 ,$10.27 ,$31.04 ,$32.98 ,$24.25 ,$34.92 , N/A , N/A ,$36.86 ,$34.92 ,$32.98 ,$32.98 ,$10.27 ,$32.98 ,$32.98 ,$34.92 ,$23.63 , N/A ,$24.06 , N/A ,$34.92 , N/A ,$35.70 ,$34.92 ,$25.61 ,$25.61 ,$23.63 ,$25.61 ,$25.22 ,$26.51 ,$8.83 ,$30.65 , N/A ,$19.01 ,$19.01 ,$10.27 ,$19.01 , N/A ,$36.86 ,$31.82 ,$31.82 ,$31.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TUBE FEEDING 5FR X 15IN,272,1 ,$1.17 ,$0.77 ,$0.26 ,$1.17 , N/A ,$1.05 ,$1.05 ,$0.31 ,$0.94 ,$0.99 ,$0.73 ,$1.05 , N/A , N/A ,$1.11 ,$1.05 ,$0.99 ,$0.99 ,$0.31 ,$0.99 ,$0.99 ,$1.05 ,$0.71 , N/A ,$0.72 , N/A ,$1.05 , N/A ,$1.08 ,$1.05 ,$0.77 ,$0.77 ,$0.71 ,$0.77 ,$0.76 ,$0.80 ,$0.26 ,$0.92 , N/A ,$0.57 ,$0.57 ,$0.31 ,$0.57 , N/A ,$1.11 ,$0.96 ,$0.96 ,$0.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TUBE FEEDING 8FR X 16,272,1 ,$1.24 ,$0.82 ,$0.28 ,$1.24 , N/A ,$1.11 ,$1.11 ,$0.32 ,$0.99 ,$1.05 ,$0.78 ,$1.12 , N/A , N/A ,$1.18 ,$1.12 ,$1.05 ,$1.05 ,$0.32 ,$1.05 ,$1.05 ,$1.12 ,$0.76 , N/A ,$0.76 , N/A ,$1.12 , N/A ,$1.14 ,$1.12 ,$0.82 ,$0.82 ,$0.76 ,$0.82 ,$0.81 ,$0.85 ,$0.28 ,$0.98 , N/A ,$0.61 ,$0.61 ,$0.32 ,$0.61 , N/A ,$1.18 ,$1.02 ,$1.02 ,$0.99 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TUBE TRACHEOSTOMY 10 81MM 13.8MM 8.9MM SHILEY CUFF REUSABLE INNER CANNULA CONNECTOR STERILE LATEX FREE GREEN WHITE,272,1 ,$85.88 ,$56.68 ,$19.55 ,$85.88 , N/A ,$76.97 ,$76.97 ,$22.73 ,$68.70 ,$73.00 ,$53.68 ,$77.29 , N/A , N/A ,$81.59 ,$77.29 ,$73.00 ,$73.00 ,$22.73 ,$73.00 ,$73.00 ,$77.29 ,$52.30 , N/A ,$53.24 , N/A ,$77.29 , N/A ,$79.01 ,$77.29 ,$56.69 ,$56.69 ,$52.30 ,$56.69 ,$55.82 ,$58.67 ,$19.55 ,$67.85 , N/A ,$42.08 ,$42.08 ,$22.73 ,$42.08 , N/A ,$81.59 ,$70.42 ,$70.42 ,$68.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TUBE VENTILATION 1MM 1.14MM 3.6MM POPE EAR H/C-FLEX,272,1 ,$23.18 ,$15.30 ,$5.27 ,$23.18 , N/A ,$20.77 ,$20.77 ,$6.13 ,$18.54 ,$19.70 ,$14.49 ,$20.86 , N/A , N/A ,$22.02 ,$20.86 ,$19.70 ,$19.70 ,$6.13 ,$19.70 ,$19.70 ,$20.86 ,$14.12 , N/A ,$14.38 , N/A ,$20.86 , N/A ,$21.33 ,$20.86 ,$15.30 ,$15.30 ,$14.12 ,$15.30 ,$15.07 ,$15.84 ,$5.27 ,$18.31 , N/A ,$11.36 ,$11.36 ,$6.13 ,$11.36 , N/A ,$22.02 ,$19.01 ,$19.01 ,$18.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TUBE VENTILATION 6.7MM 1.27MM 5.8MM GOODE T-TUBE SHORT EAR SILICONE MODIFIED MYRINGOTOMY,272,1 ,$53.56 ,$35.35 ,$12.19 ,$53.56 , N/A ,$48.00 ,$48.00 ,$14.17 ,$42.85 ,$45.53 ,$33.48 ,$48.20 , N/A , N/A ,$50.88 ,$48.20 ,$45.53 ,$45.53 ,$14.17 ,$45.53 ,$45.53 ,$48.20 ,$32.62 , N/A ,$33.20 , N/A ,$48.20 , N/A ,$49.28 ,$48.20 ,$35.36 ,$35.36 ,$32.62 ,$35.36 ,$34.81 ,$36.59 ,$12.19 ,$42.31 , N/A ,$26.24 ,$26.24 ,$14.17 ,$26.24 , N/A ,$50.88 ,$43.92 ,$43.92 ,$42.85 
ST. CLARE MEMORIAL HOSPITAL (ACU),27270000,N/A,TUBING COLLECTION SET D  AND  C BEREKLEY,272,1 ,$12.96 ,$8.55 ,$2.95 ,$12.96 , N/A ,$11.61 ,$11.61 ,$3.43 ,$10.37 ,$11.02 ,$8.10 ,$11.66 , N/A , N/A ,$12.31 ,$11.66 ,$11.02 ,$11.02 ,$3.43 ,$11.02 ,$11.02 ,$11.66 ,$7.89 , N/A ,$8.04 , N/A ,$11.66 , N/A ,$11.92 ,$11.66 ,$8.55 ,$8.55 ,$7.89 ,$8.55 ,$8.42 ,$8.85 ,$2.95 ,$10.24 , N/A ,$6.35 ,$6.35 ,$3.43 ,$6.35 , N/A ,$12.31 ,$10.63 ,$10.63 ,$10.37 
ST. CLARE MEMORIAL HOSPITAL (ACU),27271751,C1751,KIT CATHETER 7FR 6IN ARROWG+ARD BLUE PLUS 3 LUMEN ANTIMICROBIAL PRESSURE INJECTABLE CENTRAL VENOUS LATEX FREE,272,1 ,$228.68 ,$150.93 ,$52.07 ,$228.68 , N/A ,$204.94 ,$204.94 ,$60.51 ,$182.94 ,$194.38 , N/A ,$205.81 , N/A , N/A ,$217.25 ,$205.81 ,$194.38 ,$194.38 ,$60.51 ,$194.38 ,$194.38 ,$205.81 ,$139.27 , N/A ,$141.78 , N/A ,$205.81 , N/A ,$210.39 ,$205.81 ,$150.95 ,$150.95 ,$139.27 ,$150.95 ,$148.64 ,$156.23 ,$52.07 ,$180.66 , N/A ,$112.05 ,$112.05 ,$60.51 ,$112.05 , N/A ,$217.25 ,$187.52 ,$187.52 ,$182.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27271769,C1769,WIRE K RICHARDS SGL END SMOOTH .045,272,1 ,$141.75 ,$93.56 ,$32.27 ,$141.75 , N/A ,$127.04 ,$127.04 ,$37.50 ,$113.40 ,$120.49 , N/A ,$127.58 , N/A , N/A ,$134.66 ,$127.58 ,$120.49 ,$120.49 ,$37.50 ,$120.49 ,$120.49 ,$127.58 ,$86.33 , N/A ,$87.88 , N/A ,$127.58 , N/A ,$130.41 ,$127.58 ,$93.57 ,$93.57 ,$86.33 ,$93.57 ,$92.14 ,$96.84 ,$32.27 ,$111.98 , N/A ,$69.46 ,$69.46 ,$37.50 ,$69.46 , N/A ,$134.66 ,$116.24 ,$116.24 ,$113.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280000,N/A,HC APPLIER LIGACLIP 10MM,272,1 ,$274.63 ,$181.26 ,$62.51 ,$274.63 , N/A ,$246.12 ,$246.12 ,$72.67 ,$219.70 ,$233.44 ,$171.64 ,$247.17 , N/A , N/A ,$260.90 ,$247.17 ,$233.44 ,$233.44 ,$72.67 ,$233.44 ,$233.44 ,$247.17 ,$167.25 , N/A ,$170.28 , N/A ,$247.17 , N/A ,$252.66 ,$247.17 ,$181.28 ,$181.28 ,$167.25 ,$181.28 ,$178.51 ,$187.63 ,$62.51 ,$216.96 , N/A ,$134.57 ,$134.57 ,$72.67 ,$134.57 , N/A ,$260.90 ,$225.20 ,$225.20 ,$219.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280001,N/A,HC AQUACELL AG SILVER 8X12,272,1 ,$109.00 ,$71.94 ,$24.81 ,$109.00 , N/A ,$97.69 ,$97.69 ,$28.84 ,$87.20 ,$92.65 ,$68.13 ,$98.10 , N/A , N/A ,$103.55 ,$98.10 ,$92.65 ,$92.65 ,$28.84 ,$92.65 ,$92.65 ,$98.10 ,$66.38 , N/A ,$67.58 , N/A ,$98.10 , N/A ,$100.28 ,$98.10 ,$71.95 ,$71.95 ,$66.38 ,$71.95 ,$70.85 ,$74.47 ,$24.81 ,$86.11 , N/A ,$53.41 ,$53.41 ,$28.84 ,$53.41 , N/A ,$103.55 ,$89.38 ,$89.38 ,$87.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280002,N/A,HC ASPIRATORS,272,1 ,$244.00 ,$161.04 ,$55.55 ,$244.00 , N/A ,$218.67 ,$218.67 ,$64.56 ,$195.20 ,$207.40 ,$152.50 ,$219.60 , N/A , N/A ,$231.80 ,$219.60 ,$207.40 ,$207.40 ,$64.56 ,$207.40 ,$207.40 ,$219.60 ,$148.60 , N/A ,$151.28 , N/A ,$219.60 , N/A ,$224.48 ,$219.60 ,$161.06 ,$161.06 ,$148.60 ,$161.06 ,$158.60 ,$166.70 ,$55.55 ,$192.76 , N/A ,$119.56 ,$119.56 ,$64.56 ,$119.56 , 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 ,$33.45 ,$22.08 ,$7.61 ,$33.45 , N/A ,$29.98 ,$29.98 ,$8.85 ,$26.76 ,$28.43 ,$20.91 ,$30.11 , N/A , N/A ,$31.78 ,$30.11 ,$28.43 ,$28.43 ,$8.85 ,$28.43 ,$28.43 ,$30.11 ,$20.37 , N/A ,$20.74 , N/A ,$30.11 , N/A ,$30.77 ,$30.11 ,$22.08 ,$22.08 ,$20.37 ,$22.08 ,$21.74 ,$22.85 ,$7.61 ,$26.43 , N/A ,$16.39 ,$16.39 ,$8.85 ,$16.39 , N/A ,$31.78 ,$27.43 ,$27.43 ,$26.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280004,N/A,HC BLADE STRYKER AGG,272,1 ,$106.50 ,$70.29 ,$24.25 ,$106.50 , N/A ,$95.45 ,$95.45 ,$28.18 ,$85.20 ,$90.53 ,$66.56 ,$95.85 , N/A , N/A ,$101.18 ,$95.85 ,$90.53 ,$90.53 ,$28.18 ,$90.53 ,$90.53 ,$95.85 ,$64.86 , N/A ,$66.04 , N/A ,$95.85 , N/A ,$97.98 ,$95.85 ,$70.30 ,$70.30 ,$64.86 ,$70.30 ,$69.23 ,$72.76 ,$24.25 ,$84.14 , N/A ,$52.19 ,$52.19 ,$28.18 ,$52.19 , N/A ,$101.18 ,$87.33 ,$87.33 ,$85.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280005,N/A,HC BLADE BARREL BURR 5.0MM,272,1 ,$161.00 ,$106.26 ,$36.65 ,$161.00 , N/A ,$144.29 ,$144.29 ,$42.60 ,$128.80 ,$136.85 ,$100.63 ,$144.90 , N/A , N/A ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$42.60 ,$136.85 ,$136.85 ,$144.90 ,$98.05 , N/A ,$99.82 , N/A ,$144.90 , N/A ,$148.12 ,$144.90 ,$106.28 ,$106.28 ,$98.05 ,$106.28 ,$104.65 ,$110.00 ,$36.65 ,$127.19 , N/A ,$78.89 ,$78.89 ,$42.60 ,$78.89 , 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 ,$139.36 ,$91.98 ,$31.72 ,$139.36 , N/A ,$124.89 ,$124.89 ,$36.88 ,$111.49 ,$118.46 ,$87.10 ,$125.42 , N/A , N/A ,$132.39 ,$125.42 ,$118.46 ,$118.46 ,$36.88 ,$118.46 ,$118.46 ,$125.42 ,$84.87 , N/A ,$86.40 , N/A ,$125.42 , N/A ,$128.21 ,$125.42 ,$91.99 ,$91.99 ,$84.87 ,$91.99 ,$90.58 ,$95.21 ,$31.72 ,$110.09 , N/A ,$68.29 ,$68.29 ,$36.88 ,$68.29 , N/A ,$132.39 ,$114.28 ,$114.28 ,$111.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280007,N/A,HC BLADE RESECTOR 4.0MM,272,1 ,$153.00 ,$100.98 ,$34.83 ,$153.00 , N/A ,$137.12 ,$137.12 ,$40.48 ,$122.40 ,$130.05 ,$95.63 ,$137.70 , N/A , N/A ,$145.35 ,$137.70 ,$130.05 ,$130.05 ,$40.48 ,$130.05 ,$130.05 ,$137.70 ,$93.18 , N/A ,$94.86 , N/A ,$137.70 , N/A ,$140.76 ,$137.70 ,$101.00 ,$101.00 ,$93.18 ,$101.00 ,$99.45 ,$104.53 ,$34.83 ,$120.87 , N/A ,$74.97 ,$74.97 ,$40.48 ,$74.97 , 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 ,$103.00 ,$67.98 ,$23.45 ,$103.00 , N/A ,$92.31 ,$92.31 ,$27.25 ,$82.40 ,$87.55 ,$64.38 ,$92.70 , N/A , N/A ,$97.85 ,$92.70 ,$87.55 ,$87.55 ,$27.25 ,$87.55 ,$87.55 ,$92.70 ,$62.73 , N/A ,$63.86 , N/A ,$92.70 , N/A ,$94.76 ,$92.70 ,$67.99 ,$67.99 ,$62.73 ,$67.99 ,$66.95 ,$70.37 ,$23.45 ,$81.37 , N/A ,$50.47 ,$50.47 ,$27.25 ,$50.47 , N/A ,$97.85 ,$84.46 ,$84.46 ,$82.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280009,N/A,HC BLADE SAG SAW NARROW/THIC,272,1 ,$104.28 ,$68.82 ,$23.74 ,$104.28 , N/A ,$93.46 ,$93.46 ,$27.60 ,$83.42 ,$88.64 ,$65.18 ,$93.85 , N/A , N/A ,$99.07 ,$93.85 ,$88.64 ,$88.64 ,$27.60 ,$88.64 ,$88.64 ,$93.85 ,$63.51 , N/A ,$64.66 , N/A ,$93.85 , N/A ,$95.94 ,$93.85 ,$68.84 ,$68.84 ,$63.51 ,$68.84 ,$67.78 ,$71.24 ,$23.74 ,$82.38 , N/A ,$51.10 ,$51.10 ,$27.60 ,$51.10 , N/A ,$99.07 ,$85.51 ,$85.51 ,$83.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280010,N/A,HC BLADE SURG STAINLESS,272,1 ,$5.20 ,$3.43 ,$1.19 ,$5.20 , N/A ,$4.66 ,$4.66 ,$1.37 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.37 ,$4.42 ,$4.42 ,$4.68 ,$3.17 , N/A ,$3.22 , N/A ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.43 ,$3.43 ,$3.17 ,$3.43 ,$3.38 ,$3.55 ,$1.19 ,$4.11 , N/A ,$2.55 ,$2.55 ,$1.37 ,$2.55 , 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 ,$150.00 ,$99.00 ,$34.15 ,$150.00 , N/A ,$134.43 ,$134.43 ,$39.69 ,$120.00 ,$127.50 ,$93.75 ,$135.00 , N/A , N/A ,$142.50 ,$135.00 ,$127.50 ,$127.50 ,$39.69 ,$127.50 ,$127.50 ,$135.00 ,$91.35 , N/A ,$93.00 , N/A ,$135.00 , N/A ,$138.00 ,$135.00 ,$99.02 ,$99.02 ,$91.35 ,$99.02 ,$97.50 ,$102.48 ,$34.15 ,$118.50 , N/A ,$73.50 ,$73.50 ,$39.69 ,$73.50 , N/A ,$142.50 ,$123.00 ,$123.00 ,$120.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280012,N/A,"HC BLADE, ELECTRODE MOD 6.5",272,1 ,$13.25 ,$8.75 ,$3.02 ,$13.25 , N/A ,$11.87 ,$11.87 ,$3.51 ,$10.60 ,$11.26 ,$8.28 ,$11.93 , N/A , N/A ,$12.59 ,$11.93 ,$11.26 ,$11.26 ,$3.51 ,$11.26 ,$11.26 ,$11.93 ,$8.07 , N/A ,$8.22 , N/A ,$11.93 , N/A ,$12.19 ,$11.93 ,$8.75 ,$8.75 ,$8.07 ,$8.75 ,$8.61 ,$9.05 ,$3.02 ,$10.47 , N/A ,$6.49 ,$6.49 ,$3.51 ,$6.49 , N/A ,$12.59 ,$10.87 ,$10.87 ,$10.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280013,N/A,HC CANNISTER BERKELEY D AND C,272,1 ,$28.00 ,$18.48 ,$6.37 ,$28.00 , N/A ,$25.09 ,$25.09 ,$7.41 ,$22.40 ,$23.80 ,$17.50 ,$25.20 , N/A , N/A ,$26.60 ,$25.20 ,$23.80 ,$23.80 ,$7.41 ,$23.80 ,$23.80 ,$25.20 ,$17.05 , N/A ,$17.36 , N/A ,$25.20 , N/A ,$25.76 ,$25.20 ,$18.48 ,$18.48 ,$17.05 ,$18.48 ,$18.20 ,$19.13 ,$6.37 ,$22.12 , N/A ,$13.72 ,$13.72 ,$7.41 ,$13.72 , 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 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$49.50 ,$17.07 ,$75.00 , N/A ,$67.22 ,$67.22 ,$19.84 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$19.84 ,$63.75 ,$63.75 ,$67.50 ,$45.68 , N/A ,$46.50 , N/A ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.51 ,$49.51 ,$45.68 ,$49.51 ,$48.75 ,$51.24 ,$17.07 ,$59.25 , N/A ,$36.75 ,$36.75 ,$19.84 ,$36.75 , 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 ,$8.18 ,$2.82 ,$12.40 , N/A ,$11.11 ,$11.11 ,$3.28 ,$9.92 ,$10.54 ,$7.75 ,$11.16 , N/A , N/A ,$11.78 ,$11.16 ,$10.54 ,$10.54 ,$3.28 ,$10.54 ,$10.54 ,$11.16 ,$7.55 , N/A ,$7.68 , N/A ,$11.16 , N/A ,$11.41 ,$11.16 ,$8.19 ,$8.19 ,$7.55 ,$8.19 ,$8.06 ,$8.47 ,$2.82 ,$9.80 , N/A ,$6.08 ,$6.08 ,$3.28 ,$6.08 , 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 ,$19.80 ,$6.83 ,$30.00 , N/A ,$26.89 ,$26.89 ,$7.94 ,$24.00 ,$25.50 ,$18.75 ,$27.00 , N/A , N/A ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 , N/A ,$18.60 , N/A ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 , N/A ,$14.70 ,$14.70 ,$7.94 ,$14.70 , 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 ,$21.78 ,$7.52 ,$33.00 , N/A ,$29.57 ,$29.57 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , 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 ,$4.75 ,$1.65 ,$7.20 , N/A ,$6.45 ,$6.45 ,$1.90 ,$5.76 ,$6.12 ,$4.50 ,$6.48 , N/A , N/A ,$6.84 ,$6.48 ,$6.12 ,$6.12 ,$1.90 ,$6.12 ,$6.12 ,$6.48 ,$4.38 , N/A ,$4.46 , N/A ,$6.48 , N/A ,$6.62 ,$6.48 ,$4.75 ,$4.75 ,$4.38 ,$4.75 ,$4.68 ,$4.92 ,$1.65 ,$5.69 , N/A ,$3.53 ,$3.53 ,$1.90 ,$3.53 , 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 ,$642.84 ,$221.73 ,$974.00 , N/A ,$872.90 ,$872.90 ,$257.72 ,$779.20 ,$827.90 ,$608.75 ,$876.60 , N/A , N/A ,$925.30 ,$876.60 ,$827.90 ,$827.90 ,$257.72 ,$827.90 ,$827.90 ,$876.60 ,$593.17 , N/A ,$603.88 , N/A ,$876.60 , N/A ,$896.08 ,$876.60 ,$642.94 ,$642.94 ,$593.17 ,$642.94 ,$633.10 ,$665.44 ,$221.73 ,$769.46 , N/A ,$477.26 ,$477.26 ,$257.72 ,$477.26 , 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 ,$318.78 ,$109.96 ,$483.00 , N/A ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 , N/A , N/A ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 , N/A ,$299.46 , N/A ,$434.70 , N/A ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 , N/A ,$236.67 ,$236.67 ,$127.80 ,$236.67 , 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 ,$13.20 ,$4.56 ,$20.00 , N/A ,$17.92 ,$17.92 ,$5.29 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$5.29 ,$17.00 ,$17.00 ,$18.00 ,$12.18 , N/A ,$12.40 , N/A ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.20 ,$13.20 ,$12.18 ,$13.20 ,$13.00 ,$13.66 ,$4.56 ,$15.80 , N/A ,$9.80 ,$9.80 ,$5.29 ,$9.80 , 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 ,$198.00 ,$68.30 ,$300.00 , N/A ,$268.86 ,$268.86 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 , N/A , N/A ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 , N/A ,$186.00 , N/A ,$270.00 , N/A ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 , N/A ,$147.00 ,$147.00 ,$79.38 ,$147.00 , 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 ,$392.04 ,$135.23 ,$594.00 , N/A ,$532.34 ,$532.34 ,$157.17 ,$475.20 ,$504.90 ,$371.25 ,$534.60 , N/A , N/A ,$564.30 ,$534.60 ,$504.90 ,$504.90 ,$157.17 ,$504.90 ,$504.90 ,$534.60 ,$361.75 , N/A ,$368.28 , N/A ,$534.60 , N/A ,$546.48 ,$534.60 ,$392.10 ,$392.10 ,$361.75 ,$392.10 ,$386.10 ,$405.82 ,$135.23 ,$469.26 , N/A ,$291.06 ,$291.06 ,$157.17 ,$291.06 , 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 ,$34.32 ,$11.84 ,$52.00 , N/A ,$46.60 ,$46.60 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ,$253.44 ,$87.42 ,$384.00 , N/A ,$344.14 ,$344.14 ,$101.61 ,$307.20 ,$326.40 ,$240.00 ,$345.60 , N/A , N/A ,$364.80 ,$345.60 ,$326.40 ,$326.40 ,$101.61 ,$326.40 ,$326.40 ,$345.60 ,$233.86 , N/A ,$238.08 , N/A ,$345.60 , N/A ,$353.28 ,$345.60 ,$253.48 ,$253.48 ,$233.86 ,$253.48 ,$249.60 ,$262.35 ,$87.42 ,$303.36 , N/A ,$188.16 ,$188.16 ,$101.61 ,$188.16 , 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 ,$224.33 ,$148.06 ,$51.08 ,$224.33 , N/A ,$201.04 ,$201.04 ,$59.36 ,$179.46 ,$190.68 ,$140.21 ,$201.90 , N/A , N/A ,$213.11 ,$201.90 ,$190.68 ,$190.68 ,$59.36 ,$190.68 ,$190.68 ,$201.90 ,$136.62 , N/A ,$139.08 , N/A ,$201.90 , N/A ,$206.38 ,$201.90 ,$148.08 ,$148.08 ,$136.62 ,$148.08 ,$145.81 ,$153.26 ,$51.08 ,$177.22 , N/A ,$109.92 ,$109.92 ,$59.36 ,$109.92 , N/A ,$213.11 ,$183.95 ,$183.95 ,$179.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280029,N/A,HC DRILL BIT QC 2/125 MM,272,1 ,$219.00 ,$144.54 ,$49.85 ,$219.00 , N/A ,$196.27 ,$196.27 ,$57.95 ,$175.20 ,$186.15 ,$136.88 ,$197.10 , N/A , N/A ,$208.05 ,$197.10 ,$186.15 ,$186.15 ,$57.95 ,$186.15 ,$186.15 ,$197.10 ,$133.37 , N/A ,$135.78 , N/A ,$197.10 , N/A ,$201.48 ,$197.10 ,$144.56 ,$144.56 ,$133.37 ,$144.56 ,$142.35 ,$149.62 ,$49.85 ,$173.01 , N/A ,$107.31 ,$107.31 ,$57.95 ,$107.31 , 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 ,$483.33 ,$319.00 ,$110.03 ,$483.33 , N/A ,$433.16 ,$433.16 ,$127.89 ,$386.66 ,$410.83 ,$302.08 ,$435.00 , N/A , N/A ,$459.16 ,$435.00 ,$410.83 ,$410.83 ,$127.89 ,$410.83 ,$410.83 ,$435.00 ,$294.35 , N/A ,$299.66 , N/A ,$435.00 , N/A ,$444.66 ,$435.00 ,$319.05 ,$319.05 ,$294.35 ,$319.05 ,$314.16 ,$330.21 ,$110.03 ,$381.83 , N/A ,$236.83 ,$236.83 ,$127.89 ,$236.83 , N/A ,$459.16 ,$396.33 ,$396.33 ,$386.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280031,N/A,"HC DRILL BIT,LGND 14CM 3MM",272,1 ,$434.00 ,$286.44 ,$98.80 ,$434.00 , N/A ,$388.95 ,$388.95 ,$114.84 ,$347.20 ,$368.90 ,$271.25 ,$390.60 , N/A , N/A ,$412.30 ,$390.60 ,$368.90 ,$368.90 ,$114.84 ,$368.90 ,$368.90 ,$390.60 ,$264.31 , N/A ,$269.08 , N/A ,$390.60 , N/A ,$399.28 ,$390.60 ,$286.48 ,$286.48 ,$264.31 ,$286.48 ,$282.10 ,$296.51 ,$98.80 ,$342.86 , N/A ,$212.66 ,$212.66 ,$114.84 ,$212.66 , 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 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$295.68 ,$101.99 ,$448.00 , N/A ,$401.50 ,$401.50 ,$118.54 ,$358.40 ,$380.80 ,$280.00 ,$403.20 , N/A , N/A ,$425.60 ,$403.20 ,$380.80 ,$380.80 ,$118.54 ,$380.80 ,$380.80 ,$403.20 ,$272.83 , N/A ,$277.76 , N/A ,$403.20 , N/A ,$412.16 ,$403.20 ,$295.72 ,$295.72 ,$272.83 ,$295.72 ,$291.20 ,$306.07 ,$101.99 ,$353.92 , N/A ,$219.52 ,$219.52 ,$118.54 ,$219.52 , 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 ,$11.25 ,$7.43 ,$2.57 ,$11.25 , N/A ,$10.08 ,$10.08 ,$2.98 ,$9.00 ,$9.56 ,$7.03 ,$10.13 , N/A , N/A ,$10.69 ,$10.13 ,$9.56 ,$9.56 ,$2.98 ,$9.56 ,$9.56 ,$10.13 ,$6.85 , N/A ,$6.98 , N/A ,$10.13 , N/A ,$10.35 ,$10.13 ,$7.43 ,$7.43 ,$6.85 ,$7.43 ,$7.31 ,$7.69 ,$2.57 ,$8.89 , N/A ,$5.51 ,$5.51 ,$2.98 ,$5.51 , N/A ,$10.69 ,$9.23 ,$9.23 ,$9.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280035,N/A,"HC ELECTRODE BALL EZ CLN 5""",272,1 ,$22.00 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$13.30 ,$8.78 ,$3.03 ,$13.30 , N/A ,$11.92 ,$11.92 ,$3.52 ,$10.64 ,$11.31 ,$8.31 ,$11.97 , N/A , N/A ,$12.64 ,$11.97 ,$11.31 ,$11.31 ,$3.52 ,$11.31 ,$11.31 ,$11.97 ,$8.10 , N/A ,$8.24 , N/A ,$11.97 , N/A ,$12.24 ,$11.97 ,$8.78 ,$8.78 ,$8.10 ,$8.78 ,$8.65 ,$9.09 ,$3.03 ,$10.51 , N/A ,$6.52 ,$6.52 ,$3.52 ,$6.52 , N/A ,$12.64 ,$10.91 ,$10.91 ,$10.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280037,N/A,HC ELECTRODE BLADE MOD 2.5,272,1 ,$12.27 ,$8.10 ,$2.79 ,$12.27 , N/A ,$11.00 ,$11.00 ,$3.24 ,$9.82 ,$10.43 ,$7.67 ,$11.04 , N/A , N/A ,$11.66 ,$11.04 ,$10.43 ,$10.43 ,$3.24 ,$10.43 ,$10.43 ,$11.04 ,$7.47 , N/A ,$7.60 , N/A ,$11.04 , N/A ,$11.29 ,$11.04 ,$8.10 ,$8.10 ,$7.47 ,$8.10 ,$7.98 ,$8.38 ,$2.79 ,$9.69 , N/A ,$6.01 ,$6.01 ,$3.24 ,$6.01 , N/A ,$11.66 ,$10.06 ,$10.06 ,$9.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280038,N/A,HC ELECTRODE LAP L-HOOK 27,272,1 ,$75.00 ,$49.50 ,$17.07 ,$75.00 , N/A ,$67.22 ,$67.22 ,$19.84 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$19.84 ,$63.75 ,$63.75 ,$67.50 ,$45.68 , N/A ,$46.50 , N/A ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.51 ,$49.51 ,$45.68 ,$49.51 ,$48.75 ,$51.24 ,$17.07 ,$59.25 , N/A ,$36.75 ,$36.75 ,$19.84 ,$36.75 , 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 ,$12.22 ,$8.07 ,$2.78 ,$12.22 , N/A ,$10.95 ,$10.95 ,$3.23 ,$9.78 ,$10.39 ,$7.64 ,$11.00 , N/A , N/A ,$11.61 ,$11.00 ,$10.39 ,$10.39 ,$3.23 ,$10.39 ,$10.39 ,$11.00 ,$7.44 , N/A ,$7.58 , N/A ,$11.00 , N/A ,$11.24 ,$11.00 ,$8.07 ,$8.07 ,$7.44 ,$8.07 ,$7.94 ,$8.35 ,$2.78 ,$9.65 , N/A ,$5.99 ,$5.99 ,$3.23 ,$5.99 , N/A ,$11.61 ,$10.02 ,$10.02 ,$9.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280040,N/A,HC ELECTRODE PED D DISPERSIV,272,1 ,$11.40 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$49.50 ,$17.07 ,$75.00 , N/A ,$67.22 ,$67.22 ,$19.84 ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 ,$19.84 ,$63.75 ,$63.75 ,$67.50 ,$45.68 , N/A ,$46.50 , N/A ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.51 ,$49.51 ,$45.68 ,$49.51 ,$48.75 ,$51.24 ,$17.07 ,$59.25 , N/A ,$36.75 ,$36.75 ,$19.84 ,$36.75 , 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 ,$62.04 ,$21.40 ,$94.00 , N/A ,$84.24 ,$84.24 ,$24.87 ,$75.20 ,$79.90 ,$58.75 ,$84.60 , N/A , N/A ,$89.30 ,$84.60 ,$79.90 ,$79.90 ,$24.87 ,$79.90 ,$79.90 ,$84.60 ,$57.25 , N/A ,$58.28 , N/A ,$84.60 , N/A ,$86.48 ,$84.60 ,$62.05 ,$62.05 ,$57.25 ,$62.05 ,$61.10 ,$64.22 ,$21.40 ,$74.26 , N/A ,$46.06 ,$46.06 ,$24.87 ,$46.06 , N/A ,$89.30 ,$77.08 ,$77.08 ,$75.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280043,N/A,HC EVAC RESERVOIR WOUND,272,1 ,$14.00 ,$9.24 ,$3.18 ,$14.00 , N/A ,$12.55 ,$12.55 ,$3.70 ,$11.20 ,$11.90 ,$8.75 ,$12.60 , N/A , N/A ,$13.30 ,$12.60 ,$11.90 ,$11.90 ,$3.70 ,$11.90 ,$11.90 ,$12.60 ,$8.53 , N/A ,$8.68 , N/A ,$12.60 , N/A ,$12.88 ,$12.60 ,$9.24 ,$9.24 ,$8.53 ,$9.24 ,$9.10 ,$9.56 ,$3.18 ,$11.06 , N/A ,$6.86 ,$6.86 ,$3.70 ,$6.86 , N/A ,$13.30 ,$11.48 ,$11.48 ,$11.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280044,N/A,HC FORCEPS BX YELLOW JAW 4,272,1 ,$51.15 ,$33.76 ,$11.64 ,$51.15 , N/A ,$45.84 ,$45.84 ,$13.53 ,$40.92 ,$43.48 ,$31.97 ,$46.04 , N/A , N/A ,$48.59 ,$46.04 ,$43.48 ,$43.48 ,$13.53 ,$43.48 ,$43.48 ,$46.04 ,$31.15 , N/A ,$31.72 , N/A ,$46.04 , N/A ,$47.06 ,$46.04 ,$33.76 ,$33.76 ,$31.15 ,$33.76 ,$33.25 ,$34.95 ,$11.64 ,$40.41 , N/A ,$25.06 ,$25.06 ,$13.53 ,$25.06 , N/A ,$48.59 ,$41.94 ,$41.94 ,$40.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280045,N/A,HC FORCEPS BX JUMBO JAW 4,272,1 ,$116.94 ,$77.18 ,$26.63 ,$116.94 , N/A ,$104.80 ,$104.80 ,$30.94 ,$93.55 ,$99.40 ,$73.09 ,$105.25 , N/A , N/A ,$111.09 ,$105.25 ,$99.40 ,$99.40 ,$30.94 ,$99.40 ,$99.40 ,$105.25 ,$71.22 , N/A ,$72.50 , N/A ,$105.25 , N/A ,$107.58 ,$105.25 ,$77.19 ,$77.19 ,$71.22 ,$77.19 ,$76.01 ,$79.89 ,$26.63 ,$92.38 , N/A ,$57.30 ,$57.30 ,$30.94 ,$57.30 , N/A ,$111.09 ,$95.89 ,$95.89 ,$93.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280047,N/A,HC GELFOAM PLAIN SPONGE,272,1 ,$57.60 ,$38.02 ,$13.11 ,$57.60 , N/A ,$51.62 ,$51.62 ,$15.24 ,$46.08 ,$48.96 ,$36.00 ,$51.84 , N/A , N/A ,$54.72 ,$51.84 ,$48.96 ,$48.96 ,$15.24 ,$48.96 ,$48.96 ,$51.84 ,$35.08 , N/A ,$35.72 , N/A ,$51.84 , N/A ,$52.99 ,$51.84 ,$38.02 ,$38.02 ,$35.08 ,$38.02 ,$37.44 ,$39.35 ,$13.11 ,$45.50 , N/A ,$28.22 ,$28.22 ,$15.24 ,$28.22 , N/A ,$54.72 ,$47.23 ,$47.23 ,$46.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280048,N/A,HC GENESYS HTA PROCEDURE KIT,272,1 ,"$3,172.00 ","$2,093.52 ",$722.12 ,"$3,172.00 ", N/A ,"$2,842.75 ","$2,842.75 ",$839.31 ,"$2,537.60 ","$2,696.20 ","$1,982.50 ","$2,854.80 ", N/A , N/A ,"$3,013.40 ","$2,854.80 ","$2,696.20 ","$2,696.20 ",$839.31 ,"$2,696.20 ","$2,696.20 ","$2,854.80 ","$1,931.75 ", N/A ,"$1,966.64 ", N/A ,"$2,854.80 ", N/A ,"$2,918.24 ","$2,854.80 ","$2,093.84 ","$2,093.84 ","$1,931.75 ","$2,093.84 ","$2,061.80 ","$2,167.11 ",$722.12 ,"$2,505.88 ", N/A ,"$1,554.28 ","$1,554.28 ",$839.31 ,"$1,554.28 ", 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 ,$120.12 ,$41.43 ,$182.00 , N/A ,$163.11 ,$163.11 ,$48.16 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$48.16 ,$154.70 ,$154.70 ,$163.80 ,$110.84 , N/A ,$112.84 , N/A ,$163.80 , N/A ,$167.44 ,$163.80 ,$120.14 ,$120.14 ,$110.84 ,$120.14 ,$118.30 ,$124.34 ,$41.43 ,$143.78 , N/A ,$89.18 ,$89.18 ,$48.16 ,$89.18 , 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 ,$3.43 ,$1.19 ,$5.20 , N/A ,$4.66 ,$4.66 ,$1.37 ,$4.16 ,$4.42 ,$3.25 ,$4.68 , N/A , N/A ,$4.94 ,$4.68 ,$4.42 ,$4.42 ,$1.37 ,$4.42 ,$4.42 ,$4.68 ,$3.17 , N/A ,$3.22 , N/A ,$4.68 , N/A ,$4.78 ,$4.68 ,$3.43 ,$3.43 ,$3.17 ,$3.43 ,$3.38 ,$3.55 ,$1.19 ,$4.11 , N/A ,$2.55 ,$2.55 ,$1.37 ,$2.55 , 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 ,$13.20 ,$4.56 ,$20.00 , N/A ,$17.92 ,$17.92 ,$5.29 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$5.29 ,$17.00 ,$17.00 ,$18.00 ,$12.18 , N/A ,$12.40 , N/A ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.20 ,$13.20 ,$12.18 ,$13.20 ,$13.00 ,$13.66 ,$4.56 ,$15.80 , N/A ,$9.80 ,$9.80 ,$5.29 ,$9.80 , 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 ","$1,664.52 ",$574.14 ,"$2,522.00 ", N/A ,"$2,260.22 ","$2,260.22 ",$667.32 ,"$2,017.60 ","$2,143.70 ","$1,576.25 ","$2,269.80 ", N/A , N/A ,"$2,395.90 ","$2,269.80 ","$2,143.70 ","$2,143.70 ",$667.32 ,"$2,143.70 ","$2,143.70 ","$2,269.80 ","$1,535.90 ", N/A ,"$1,563.64 ", N/A ,"$2,269.80 ", N/A ,"$2,320.24 ","$2,269.80 ","$1,664.77 ","$1,664.77 ","$1,535.90 ","$1,664.77 ","$1,639.30 ","$1,723.03 ",$574.14 ,"$1,992.38 ", N/A ,"$1,235.78 ","$1,235.78 ",$667.32 ,"$1,235.78 ", 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 ,$248.00 ,$163.68 ,$56.46 ,$248.00 , N/A ,$222.26 ,$222.26 ,$65.62 ,$198.40 ,$210.80 ,$155.00 ,$223.20 , N/A , N/A ,$235.60 ,$223.20 ,$210.80 ,$210.80 ,$65.62 ,$210.80 ,$210.80 ,$223.20 ,$151.03 , N/A ,$153.76 , N/A ,$223.20 , N/A ,$228.16 ,$223.20 ,$163.70 ,$163.70 ,$151.03 ,$163.70 ,$161.20 ,$169.43 ,$56.46 ,$195.92 , N/A ,$121.52 ,$121.52 ,$65.62 ,$121.52 , N/A ,$235.60 ,$203.36 ,$203.36 ,$198.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280054,N/A,HC KIT CVC BUNDLE,272,1 ,$177.00 ,$116.82 ,$40.30 ,$177.00 , N/A ,$158.63 ,$158.63 ,$46.83 ,$141.60 ,$150.45 ,$110.63 ,$159.30 , N/A , N/A ,$168.15 ,$159.30 ,$150.45 ,$150.45 ,$46.83 ,$150.45 ,$150.45 ,$159.30 ,$107.79 , N/A ,$109.74 , N/A ,$159.30 , N/A ,$162.84 ,$159.30 ,$116.84 ,$116.84 ,$107.79 ,$116.84 ,$115.05 ,$120.93 ,$40.30 ,$139.83 , N/A ,$86.73 ,$86.73 ,$46.83 ,$86.73 , 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 ,$85.80 ,$29.60 ,$130.00 , N/A ,$116.51 ,$116.51 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 , N/A ,$80.60 , N/A ,$117.00 , N/A ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 , N/A ,$63.70 ,$63.70 ,$34.40 ,$63.70 , 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 ,$55.44 ,$19.12 ,$84.00 , N/A ,$75.28 ,$75.28 ,$22.23 ,$67.20 ,$71.40 ,$52.50 ,$75.60 , N/A , N/A ,$79.80 ,$75.60 ,$71.40 ,$71.40 ,$22.23 ,$71.40 ,$71.40 ,$75.60 ,$51.16 , N/A ,$52.08 , N/A ,$75.60 , N/A ,$77.28 ,$75.60 ,$55.45 ,$55.45 ,$51.16 ,$55.45 ,$54.60 ,$57.39 ,$19.12 ,$66.36 , N/A ,$41.16 ,$41.16 ,$22.23 ,$41.16 , 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 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$27.72 ,$9.56 ,$42.00 , N/A ,$37.64 ,$37.64 ,$11.11 ,$33.60 ,$35.70 ,$26.25 ,$37.80 , N/A , N/A ,$39.90 ,$37.80 ,$35.70 ,$35.70 ,$11.11 ,$35.70 ,$35.70 ,$37.80 ,$25.58 , N/A ,$26.04 , N/A ,$37.80 , N/A ,$38.64 ,$37.80 ,$27.72 ,$27.72 ,$25.58 ,$27.72 ,$27.30 ,$28.69 ,$9.56 ,$33.18 , N/A ,$20.58 ,$20.58 ,$11.11 ,$20.58 , 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 ,$21.78 ,$7.52 ,$33.00 , N/A ,$29.57 ,$29.57 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , 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 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$74.58 ,$25.72 ,$113.00 , N/A ,$101.27 ,$101.27 ,$29.90 ,$90.40 ,$96.05 ,$70.63 ,$101.70 , N/A , N/A ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$29.90 ,$96.05 ,$96.05 ,$101.70 ,$68.82 , N/A ,$70.06 , N/A ,$101.70 , N/A ,$103.96 ,$101.70 ,$74.59 ,$74.59 ,$68.82 ,$74.59 ,$73.45 ,$77.20 ,$25.72 ,$89.27 , N/A ,$55.37 ,$55.37 ,$29.90 ,$55.37 , 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 ,$114.18 ,$39.39 ,$173.00 , N/A ,$155.04 ,$155.04 ,$45.78 ,$138.40 ,$147.05 ,$108.13 ,$155.70 , N/A , N/A ,$164.35 ,$155.70 ,$147.05 ,$147.05 ,$45.78 ,$147.05 ,$147.05 ,$155.70 ,$105.36 , N/A ,$107.26 , N/A ,$155.70 , N/A ,$159.16 ,$155.70 ,$114.20 ,$114.20 ,$105.36 ,$114.20 ,$112.45 ,$118.19 ,$39.39 ,$136.67 , N/A ,$84.77 ,$84.77 ,$45.78 ,$84.77 , 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 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , 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 ,$145.20 ,$50.09 ,$220.00 , N/A ,$197.16 ,$197.16 ,$58.21 ,$176.00 ,$187.00 ,$137.50 ,$198.00 , N/A , N/A ,$209.00 ,$198.00 ,$187.00 ,$187.00 ,$58.21 ,$187.00 ,$187.00 ,$198.00 ,$133.98 , N/A ,$136.40 , N/A ,$198.00 , N/A ,$202.40 ,$198.00 ,$145.22 ,$145.22 ,$133.98 ,$145.22 ,$143.00 ,$150.30 ,$50.09 ,$173.80 , N/A ,$107.80 ,$107.80 ,$58.21 ,$107.80 , 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 ,$145.20 ,$50.09 ,$220.00 , N/A ,$197.16 ,$197.16 ,$58.21 ,$176.00 ,$187.00 ,$137.50 ,$198.00 , N/A , N/A ,$209.00 ,$198.00 ,$187.00 ,$187.00 ,$58.21 ,$187.00 ,$187.00 ,$198.00 ,$133.98 , N/A ,$136.40 , N/A ,$198.00 , N/A ,$202.40 ,$198.00 ,$145.22 ,$145.22 ,$133.98 ,$145.22 ,$143.00 ,$150.30 ,$50.09 ,$173.80 , N/A ,$107.80 ,$107.80 ,$58.21 ,$107.80 , N/A ,$209.00 ,$180.40 ,$180.40 ,$176.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280069,N/A,HC PACK LAPAROTOMY VI,272,1 ,$48.44 ,$31.97 ,$11.02 ,$48.44 , N/A ,$43.41 ,$43.41 ,$12.82 ,$38.75 ,$41.17 ,$30.28 ,$43.60 , N/A , N/A ,$46.02 ,$43.60 ,$41.17 ,$41.17 ,$12.82 ,$41.17 ,$41.17 ,$43.60 ,$29.50 , N/A ,$30.04 , N/A ,$43.60 , N/A ,$44.56 ,$43.60 ,$31.98 ,$31.98 ,$29.50 ,$31.98 ,$31.49 ,$33.09 ,$11.02 ,$38.27 , N/A ,$23.74 ,$23.74 ,$12.82 ,$23.74 , N/A ,$46.02 ,$39.72 ,$39.72 ,$38.75 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280070,N/A,HC PROBE,272,1 ,$454.00 ,$299.64 ,$103.35 ,$454.00 , N/A ,$406.87 ,$406.87 ,$120.13 ,$363.20 ,$385.90 ,$283.75 ,$408.60 , N/A , N/A ,$431.30 ,$408.60 ,$385.90 ,$385.90 ,$120.13 ,$385.90 ,$385.90 ,$408.60 ,$276.49 , N/A ,$281.48 , N/A ,$408.60 , N/A ,$417.68 ,$408.60 ,$299.69 ,$299.69 ,$276.49 ,$299.69 ,$295.10 ,$310.17 ,$103.35 ,$358.66 , N/A ,$222.46 ,$222.46 ,$120.13 ,$222.46 , N/A ,$431.30 ,$372.28 ,$372.28 ,$363.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280071,N/A,HC RASP TPS CROSSCUT LG,272,1 ,$340.20 ,$224.53 ,$77.45 ,$340.20 , N/A ,$304.89 ,$304.89 ,$90.01 ,$272.16 ,$289.17 ,$212.63 ,$306.18 , N/A , N/A ,$323.19 ,$306.18 ,$289.17 ,$289.17 ,$90.01 ,$289.17 ,$289.17 ,$306.18 ,$207.18 , N/A ,$210.92 , N/A ,$306.18 , N/A ,$312.98 ,$306.18 ,$224.57 ,$224.57 ,$207.18 ,$224.57 ,$221.13 ,$232.42 ,$77.45 ,$268.76 , N/A ,$166.70 ,$166.70 ,$90.01 ,$166.70 , N/A ,$323.19 ,$278.96 ,$278.96 ,$272.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280072,N/A,HC RASP TPS CROSSCUT,272,1 ,$324.67 ,$214.28 ,$73.91 ,$324.67 , N/A ,$290.97 ,$290.97 ,$85.91 ,$259.74 ,$275.97 ,$202.92 ,$292.20 , N/A , N/A ,$308.44 ,$292.20 ,$275.97 ,$275.97 ,$85.91 ,$275.97 ,$275.97 ,$292.20 ,$197.72 , N/A ,$201.30 , N/A ,$292.20 , N/A ,$298.70 ,$292.20 ,$214.31 ,$214.31 ,$197.72 ,$214.31 ,$211.04 ,$221.81 ,$73.91 ,$256.49 , N/A ,$159.09 ,$159.09 ,$85.91 ,$159.09 , N/A ,$308.44 ,$266.23 ,$266.23 ,$259.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280073,N/A,HC REAMG ROD 2.5MM BALL 950M,272,1 ,$361.00 ,$238.26 ,$82.18 ,$361.00 , N/A ,$323.53 ,$323.53 ,$95.52 ,$288.80 ,$306.85 ,$225.63 ,$324.90 , N/A , N/A ,$342.95 ,$324.90 ,$306.85 ,$306.85 ,$95.52 ,$306.85 ,$306.85 ,$324.90 ,$219.85 , N/A ,$223.82 , N/A ,$324.90 , N/A ,$332.12 ,$324.90 ,$238.30 ,$238.30 ,$219.85 ,$238.30 ,$234.65 ,$246.64 ,$82.18 ,$285.19 , N/A ,$176.89 ,$176.89 ,$95.52 ,$176.89 , N/A ,$342.95 ,$296.02 ,$296.02 ,$288.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280074,N/A,HC REDUCER CAP ENDOPATH SEAL,272,1 ,$14.50 ,$9.57 ,$3.30 ,$14.50 , N/A ,$12.99 ,$12.99 ,$3.84 ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 ,$3.84 ,$12.33 ,$12.33 ,$13.05 ,$8.83 , N/A ,$9.00 , N/A ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.57 ,$9.57 ,$8.83 ,$9.57 ,$9.43 ,$9.91 ,$3.30 ,$11.46 , N/A ,$7.11 ,$7.11 ,$3.84 ,$7.11 , 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 ",$718.74 ,$247.91 ,"$1,089.00 ", N/A ,$975.96 ,$975.96 ,$288.15 ,$871.20 ,$925.65 ,$680.63 ,$980.10 , N/A , N/A ,"$1,034.55 ",$980.10 ,$925.65 ,$925.65 ,$288.15 ,$925.65 ,$925.65 ,$980.10 ,$663.20 , N/A ,$675.18 , N/A ,$980.10 , N/A ,"$1,001.88 ",$980.10 ,$718.85 ,$718.85 ,$663.20 ,$718.85 ,$707.85 ,$744.00 ,$247.91 ,$860.31 , N/A ,$533.61 ,$533.61 ,$288.15 ,$533.61 , 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 ","$1,635.48 ",$564.13 ,"$2,478.00 ", N/A ,"$2,220.78 ","$2,220.78 ",$655.68 ,"$1,982.40 ","$2,106.30 ","$1,548.75 ","$2,230.20 ", N/A , N/A ,"$2,354.10 ","$2,230.20 ","$2,106.30 ","$2,106.30 ",$655.68 ,"$2,106.30 ","$2,106.30 ","$2,230.20 ","$1,509.10 ", N/A ,"$1,536.36 ", N/A ,"$2,230.20 ", N/A ,"$2,279.76 ","$2,230.20 ","$1,635.73 ","$1,635.73 ","$1,509.10 ","$1,635.73 ","$1,610.70 ","$1,692.97 ",$564.13 ,"$1,957.62 ", N/A ,"$1,214.22 ","$1,214.22 ",$655.68 ,"$1,214.22 ", 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 ,$258.06 ,$89.01 ,$391.00 , N/A ,$350.41 ,$350.41 ,$103.46 ,$312.80 ,$332.35 ,$244.38 ,$351.90 , N/A , N/A ,$371.45 ,$351.90 ,$332.35 ,$332.35 ,$103.46 ,$332.35 ,$332.35 ,$351.90 ,$238.12 , N/A ,$242.42 , N/A ,$351.90 , N/A ,$359.72 ,$351.90 ,$258.10 ,$258.10 ,$238.12 ,$258.10 ,$254.15 ,$267.13 ,$89.01 ,$308.89 , N/A ,$191.59 ,$191.59 ,$103.46 ,$191.59 , 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 ,$60.72 ,$20.94 ,$92.00 , N/A ,$82.45 ,$82.45 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 , N/A , N/A ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 , N/A ,$57.04 , N/A ,$82.80 , N/A ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 , N/A ,$45.08 ,$45.08 ,$24.34 ,$45.08 , 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 ,$62.70 ,$21.63 ,$95.00 , N/A ,$85.14 ,$85.14 ,$25.14 ,$76.00 ,$80.75 ,$59.38 ,$85.50 , N/A , N/A ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$25.14 ,$80.75 ,$80.75 ,$85.50 ,$57.86 , N/A ,$58.90 , N/A ,$85.50 , N/A ,$87.40 ,$85.50 ,$62.71 ,$62.71 ,$57.86 ,$62.71 ,$61.75 ,$64.90 ,$21.63 ,$75.05 , N/A ,$46.55 ,$46.55 ,$25.14 ,$46.55 , 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 ",$740.52 ,$255.43 ,"$1,122.00 ", N/A ,"$1,005.54 ","$1,005.54 ",$296.88 ,$897.60 ,$953.70 ,$701.25 ,"$1,009.80 ", N/A , N/A ,"$1,065.90 ","$1,009.80 ",$953.70 ,$953.70 ,$296.88 ,$953.70 ,$953.70 ,"$1,009.80 ",$683.30 , N/A ,$695.64 , N/A ,"$1,009.80 ", N/A ,"$1,032.24 ","$1,009.80 ",$740.63 ,$740.63 ,$683.30 ,$740.63 ,$729.30 ,$766.55 ,$255.43 ,$886.38 , N/A ,$549.78 ,$549.78 ,$296.88 ,$549.78 , 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 ,$115.50 ,$39.84 ,$175.00 , N/A ,$156.84 ,$156.84 ,$46.30 ,$140.00 ,$148.75 ,$109.38 ,$157.50 , N/A , N/A ,$166.25 ,$157.50 ,$148.75 ,$148.75 ,$46.30 ,$148.75 ,$148.75 ,$157.50 ,$106.58 , N/A ,$108.50 , N/A ,$157.50 , N/A ,$161.00 ,$157.50 ,$115.52 ,$115.52 ,$106.58 ,$115.52 ,$113.75 ,$119.56 ,$39.84 ,$138.25 , N/A ,$85.75 ,$85.75 ,$46.30 ,$85.75 , 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 ,$91.74 ,$31.64 ,$139.00 , N/A ,$124.57 ,$124.57 ,$36.78 ,$111.20 ,$118.15 ,$86.88 ,$125.10 , N/A , N/A ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$36.78 ,$118.15 ,$118.15 ,$125.10 ,$84.65 , N/A ,$86.18 , N/A ,$125.10 , N/A ,$127.88 ,$125.10 ,$91.75 ,$91.75 ,$84.65 ,$91.75 ,$90.35 ,$94.96 ,$31.64 ,$109.81 , N/A ,$68.11 ,$68.11 ,$36.78 ,$68.11 , 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 ,$53.46 ,$18.44 ,$81.00 , N/A ,$72.59 ,$72.59 ,$21.43 ,$64.80 ,$68.85 ,$50.63 ,$72.90 , N/A , N/A ,$76.95 ,$72.90 ,$68.85 ,$68.85 ,$21.43 ,$68.85 ,$68.85 ,$72.90 ,$49.33 , N/A ,$50.22 , N/A ,$72.90 , N/A ,$74.52 ,$72.90 ,$53.47 ,$53.47 ,$49.33 ,$53.47 ,$52.65 ,$55.34 ,$18.44 ,$63.99 , N/A ,$39.69 ,$39.69 ,$21.43 ,$39.69 , 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 ,$101.64 ,$35.05 ,$154.00 , N/A ,$138.01 ,$138.01 ,$40.75 ,$123.20 ,$130.90 ,$96.25 ,$138.60 , N/A , N/A ,$146.30 ,$138.60 ,$130.90 ,$130.90 ,$40.75 ,$130.90 ,$130.90 ,$138.60 ,$93.79 , N/A ,$95.48 , N/A ,$138.60 , N/A ,$141.68 ,$138.60 ,$101.66 ,$101.66 ,$93.79 ,$101.66 ,$100.10 ,$105.21 ,$35.05 ,$121.66 , N/A ,$75.46 ,$75.46 ,$40.75 ,$75.46 , N/A ,$146.30 ,$126.28 ,$126.28 ,$123.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280090,N/A,HC SET INFUSSLATOR TUBE,272,1 ,$25.53 ,$16.85 ,$5.81 ,$25.53 , N/A ,$22.88 ,$22.88 ,$6.75 ,$20.42 ,$21.70 ,$15.96 ,$22.98 , N/A , N/A ,$24.25 ,$22.98 ,$21.70 ,$21.70 ,$6.75 ,$21.70 ,$21.70 ,$22.98 ,$15.55 , N/A ,$15.82 , N/A ,$22.98 , N/A ,$23.49 ,$22.98 ,$16.85 ,$16.85 ,$15.55 ,$16.85 ,$16.59 ,$17.44 ,$5.81 ,$20.17 , N/A ,$12.51 ,$12.51 ,$6.75 ,$12.51 , N/A ,$24.25 ,$20.93 ,$20.93 ,$20.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280091,N/A,HC SHEATH TUBE ENDO2 4MM,272,1 ,$172.00 ,$113.52 ,$39.16 ,$172.00 , N/A ,$154.15 ,$154.15 ,$45.51 ,$137.60 ,$146.20 ,$107.50 ,$154.80 , N/A , N/A ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$45.51 ,$146.20 ,$146.20 ,$154.80 ,$104.75 , N/A ,$106.64 , N/A ,$154.80 , N/A ,$158.24 ,$154.80 ,$113.54 ,$113.54 ,$104.75 ,$113.54 ,$111.80 ,$117.51 ,$39.16 ,$135.88 , N/A ,$84.28 ,$84.28 ,$45.51 ,$84.28 , 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 ,$658.68 ,$227.20 ,$998.00 , N/A ,$894.41 ,$894.41 ,$264.07 ,$798.40 ,$848.30 ,$623.75 ,$898.20 , N/A , N/A ,$948.10 ,$898.20 ,$848.30 ,$848.30 ,$264.07 ,$848.30 ,$848.30 ,$898.20 ,$607.78 , N/A ,$618.76 , N/A ,$898.20 , N/A ,$918.16 ,$898.20 ,$658.78 ,$658.78 ,$607.78 ,$658.78 ,$648.70 ,$681.83 ,$227.20 ,$788.42 , N/A ,$489.02 ,$489.02 ,$264.07 ,$489.02 , 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 ,$26.40 ,$9.10 ,$40.00 , N/A ,$35.85 ,$35.85 ,$10.58 ,$32.00 ,$34.00 ,$25.00 ,$36.00 , N/A , N/A ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$10.58 ,$34.00 ,$34.00 ,$36.00 ,$24.36 , N/A ,$24.80 , N/A ,$36.00 , N/A ,$36.80 ,$36.00 ,$26.40 ,$26.40 ,$24.36 ,$26.40 ,$26.00 ,$27.33 ,$9.10 ,$31.60 , N/A ,$19.60 ,$19.60 ,$10.58 ,$19.60 , N/A ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280094,N/A,HC SNARE GASTRO,272,1 ,$30.68 ,$20.25 ,$6.99 ,$30.68 , N/A ,$27.50 ,$27.50 ,$8.11 ,$24.54 ,$26.08 ,$19.18 ,$27.61 , N/A , N/A ,$29.15 ,$27.61 ,$26.08 ,$26.08 ,$8.11 ,$26.08 ,$26.08 ,$27.61 ,$18.68 , N/A ,$19.02 , N/A ,$27.61 , N/A ,$28.23 ,$27.61 ,$20.25 ,$20.25 ,$18.68 ,$20.25 ,$19.94 ,$20.96 ,$6.99 ,$24.24 , N/A ,$15.03 ,$15.03 ,$8.11 ,$15.03 , N/A ,$29.15 ,$25.16 ,$25.16 ,$24.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280095,N/A,"HC SNARE, ROTATABLE OVAL",272,1 ,$71.00 ,$46.86 ,$16.16 ,$71.00 , N/A ,$63.63 ,$63.63 ,$18.79 ,$56.80 ,$60.35 ,$44.38 ,$63.90 , N/A , N/A ,$67.45 ,$63.90 ,$60.35 ,$60.35 ,$18.79 ,$60.35 ,$60.35 ,$63.90 ,$43.24 , N/A ,$44.02 , N/A ,$63.90 , N/A ,$65.32 ,$63.90 ,$46.87 ,$46.87 ,$43.24 ,$46.87 ,$46.15 ,$48.51 ,$16.16 ,$56.09 , N/A ,$34.79 ,$34.79 ,$18.79 ,$34.79 , 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 ,"$2,821.28 ","$1,862.04 ",$642.27 ,"$2,821.28 ", N/A ,"$2,528.43 ","$2,528.43 ",$746.51 ,"$2,257.02 ","$2,398.09 ","$1,763.30 ","$2,539.15 ", N/A , N/A ,"$2,680.22 ","$2,539.15 ","$2,398.09 ","$2,398.09 ",$746.51 ,"$2,398.09 ","$2,398.09 ","$2,539.15 ","$1,718.16 ", N/A ,"$1,749.20 ", N/A ,"$2,539.15 ", N/A ,"$2,595.58 ","$2,539.15 ","$1,862.33 ","$1,862.33 ","$1,718.16 ","$1,862.33 ","$1,833.83 ","$1,927.50 ",$642.27 ,"$2,228.81 ", N/A ,"$1,382.43 ","$1,382.43 ",$746.51 ,"$1,382.43 ", N/A ,"$2,680.22 ","$2,313.45 ","$2,313.45 ","$2,257.02 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27280097,N/A,"HC STOCKINETTE STERILE 6""",272,1 ,$3.07 ,$2.03 ,$0.71 ,$3.07 , N/A ,$2.75 ,$2.75 ,$0.81 ,$2.46 ,$2.61 ,$1.92 ,$2.76 , N/A , N/A ,$2.92 ,$2.76 ,$2.61 ,$2.61 ,$0.81 ,$2.61 ,$2.61 ,$2.76 ,$1.87 , N/A ,$1.90 , N/A ,$2.76 , N/A ,$2.82 ,$2.76 ,$2.03 ,$2.03 ,$1.87 ,$2.03 ,$2.00 ,$2.10 ,$0.71 ,$2.43 , N/A ,$1.50 ,$1.50 ,$0.81 ,$1.50 , N/A ,$2.92 ,$2.52 ,$2.52 ,$2.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280098,N/A,HC SURGICEL ABS HEMOSTAT 2X3,272,1 ,$122.00 ,$80.52 ,$27.77 ,$122.00 , N/A ,$109.34 ,$109.34 ,$32.28 ,$97.60 ,$103.70 ,$76.25 ,$109.80 , N/A , N/A ,$115.90 ,$109.80 ,$103.70 ,$103.70 ,$32.28 ,$103.70 ,$103.70 ,$109.80 ,$74.30 , N/A ,$75.64 , N/A ,$109.80 , N/A ,$112.24 ,$109.80 ,$80.53 ,$80.53 ,$74.30 ,$80.53 ,$79.30 ,$83.35 ,$27.77 ,$96.38 , N/A ,$59.78 ,$59.78 ,$32.28 ,$59.78 , N/A ,$115.90 ,$100.04 ,$100.04 ,$97.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280100,N/A,HC SUTURE ETH 4.0 BLK MONO,272,1 ,$13.50 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$13.17 ,$8.69 ,$3.00 ,$13.17 , N/A ,$11.80 ,$11.80 ,$3.49 ,$10.54 ,$11.19 ,$8.23 ,$11.85 , N/A , N/A ,$12.51 ,$11.85 ,$11.19 ,$11.19 ,$3.49 ,$11.19 ,$11.19 ,$11.85 ,$8.02 , N/A ,$8.16 , N/A ,$11.85 , N/A ,$12.12 ,$11.85 ,$8.69 ,$8.69 ,$8.02 ,$8.69 ,$8.56 ,$9.00 ,$3.00 ,$10.40 , N/A ,$6.45 ,$6.45 ,$3.49 ,$6.45 , N/A ,$12.51 ,$10.80 ,$10.80 ,$10.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280103,N/A,HC SUTURE MONOCRYL 0 Y398H,272,1 ,$13.50 ,$8.91 ,$3.08 ,$13.50 , N/A ,$12.10 ,$12.10 ,$3.58 ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 ,$3.58 ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A ,$8.38 , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$3.08 ,$10.67 , N/A ,$6.62 ,$6.62 ,$3.58 ,$6.62 , 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 ,$7.08 ,$4.67 ,$1.62 ,$7.08 , N/A ,$6.35 ,$6.35 ,$1.87 ,$5.66 ,$6.02 ,$4.43 ,$6.37 , N/A , N/A ,$6.73 ,$6.37 ,$6.02 ,$6.02 ,$1.87 ,$6.02 ,$6.02 ,$6.37 ,$4.31 , N/A ,$4.38 , N/A ,$6.37 , N/A ,$6.51 ,$6.37 ,$4.67 ,$4.67 ,$4.31 ,$4.67 ,$4.60 ,$4.84 ,$1.62 ,$5.59 , N/A ,$3.47 ,$3.47 ,$1.87 ,$3.47 , N/A ,$6.73 ,$5.81 ,$5.81 ,$5.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280105,N/A,HC SUTURE SILK 2-0 SA65H,272,1 ,$8.30 ,$5.48 ,$1.89 ,$8.30 , N/A ,$7.44 ,$7.44 ,$2.20 ,$6.64 ,$7.06 ,$5.19 ,$7.47 , N/A , N/A ,$7.89 ,$7.47 ,$7.06 ,$7.06 ,$2.20 ,$7.06 ,$7.06 ,$7.47 ,$5.05 , N/A ,$5.14 , N/A ,$7.47 , N/A ,$7.64 ,$7.47 ,$5.48 ,$5.48 ,$5.05 ,$5.48 ,$5.40 ,$5.67 ,$1.89 ,$6.56 , N/A ,$4.07 ,$4.07 ,$2.20 ,$4.07 , 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 ,$20.46 ,$7.06 ,$31.00 , N/A ,$27.78 ,$27.78 ,$8.20 ,$24.80 ,$26.35 ,$19.38 ,$27.90 , N/A , N/A ,$29.45 ,$27.90 ,$26.35 ,$26.35 ,$8.20 ,$26.35 ,$26.35 ,$27.90 ,$18.88 , N/A ,$19.22 , N/A ,$27.90 , N/A ,$28.52 ,$27.90 ,$20.46 ,$20.46 ,$18.88 ,$20.46 ,$20.15 ,$21.18 ,$7.06 ,$24.49 , N/A ,$15.19 ,$15.19 ,$8.20 ,$15.19 , 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 ,$10.26 ,$6.77 ,$2.33 ,$10.26 , N/A ,$9.20 ,$9.20 ,$2.71 ,$8.21 ,$8.72 ,$6.41 ,$9.23 , N/A , N/A ,$9.75 ,$9.23 ,$8.72 ,$8.72 ,$2.71 ,$8.72 ,$8.72 ,$9.23 ,$6.25 , N/A ,$6.36 , N/A ,$9.23 , N/A ,$9.44 ,$9.23 ,$6.77 ,$6.77 ,$6.25 ,$6.77 ,$6.67 ,$7.01 ,$2.33 ,$8.11 , N/A ,$5.03 ,$5.03 ,$2.71 ,$5.03 , N/A ,$9.75 ,$8.41 ,$8.41 ,$8.21 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280108,N/A,HC TROCAR 11MM D11LT,272,1 ,$177.00 ,$116.82 ,$40.30 ,$177.00 , N/A ,$158.63 ,$158.63 ,$46.83 ,$141.60 ,$150.45 ,$110.63 ,$159.30 , N/A , N/A ,$168.15 ,$159.30 ,$150.45 ,$150.45 ,$46.83 ,$150.45 ,$150.45 ,$159.30 ,$107.79 , N/A ,$109.74 , N/A ,$159.30 , N/A ,$162.84 ,$159.30 ,$116.84 ,$116.84 ,$107.79 ,$116.84 ,$115.05 ,$120.93 ,$40.30 ,$139.83 , N/A ,$86.73 ,$86.73 ,$46.83 ,$86.73 , 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 ,$91.74 ,$31.64 ,$139.00 , N/A ,$124.57 ,$124.57 ,$36.78 ,$111.20 ,$118.15 ,$86.88 ,$125.10 , N/A , N/A ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$36.78 ,$118.15 ,$118.15 ,$125.10 ,$84.65 , N/A ,$86.18 , N/A ,$125.10 , N/A ,$127.88 ,$125.10 ,$91.75 ,$91.75 ,$84.65 ,$91.75 ,$90.35 ,$94.96 ,$31.64 ,$109.81 , N/A ,$68.11 ,$68.11 ,$36.78 ,$68.11 , 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 ,$132.66 ,$45.76 ,$201.00 , N/A ,$180.14 ,$180.14 ,$53.18 ,$160.80 ,$170.85 ,$125.63 ,$180.90 , N/A , N/A ,$190.95 ,$180.90 ,$170.85 ,$170.85 ,$53.18 ,$170.85 ,$170.85 ,$180.90 ,$122.41 , N/A ,$124.62 , N/A ,$180.90 , N/A ,$184.92 ,$180.90 ,$132.68 ,$132.68 ,$122.41 ,$132.68 ,$130.65 ,$137.32 ,$45.76 ,$158.79 , N/A ,$98.49 ,$98.49 ,$53.18 ,$98.49 , 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 ,$120.12 ,$41.43 ,$182.00 , N/A ,$163.11 ,$163.11 ,$48.16 ,$145.60 ,$154.70 ,$113.75 ,$163.80 , N/A , N/A ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$48.16 ,$154.70 ,$154.70 ,$163.80 ,$110.84 , N/A ,$112.84 , N/A ,$163.80 , N/A ,$167.44 ,$163.80 ,$120.14 ,$120.14 ,$110.84 ,$120.14 ,$118.30 ,$124.34 ,$41.43 ,$143.78 , N/A ,$89.18 ,$89.18 ,$48.16 ,$89.18 , 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 ,"$1,174.57 ",$775.22 ,$267.39 ,"$1,174.57 ", N/A ,"$1,052.65 ","$1,052.65 ",$310.79 ,$939.66 ,$998.38 ,$734.11 ,"$1,057.11 ", N/A , N/A ,"$1,115.84 ","$1,057.11 ",$998.38 ,$998.38 ,$310.79 ,$998.38 ,$998.38 ,"$1,057.11 ",$715.31 , N/A ,$728.24 , N/A ,"$1,057.11 ", N/A ,"$1,080.60 ","$1,057.11 ",$775.33 ,$775.33 ,$715.31 ,$775.33 ,$763.47 ,$802.47 ,$267.39 ,$927.91 , N/A ,$575.54 ,$575.54 ,$310.79 ,$575.54 , N/A ,"$1,115.84 ",$963.15 ,$963.15 ,$939.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280113,N/A,HC TROCAR SPACE BALLOON STRU,272,1 ,$727.07 ,$479.87 ,$165.52 ,$727.07 , N/A ,$651.60 ,$651.60 ,$192.38 ,$581.66 ,$618.01 ,$454.42 ,$654.36 , N/A , N/A ,$690.72 ,$654.36 ,$618.01 ,$618.01 ,$192.38 ,$618.01 ,$618.01 ,$654.36 ,$442.79 , N/A ,$450.78 , N/A ,$654.36 , N/A ,$668.90 ,$654.36 ,$479.94 ,$479.94 ,$442.79 ,$479.94 ,$472.60 ,$496.73 ,$165.52 ,$574.39 , N/A ,$356.26 ,$356.26 ,$192.38 ,$356.26 , N/A ,$690.72 ,$596.20 ,$596.20 ,$581.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280114,N/A,"HC TROCAR, BLUNT 10-11 MM",272,1 ,$110.00 ,$72.60 ,$25.04 ,$110.00 , N/A ,$98.58 ,$98.58 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 , N/A , N/A ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 , N/A ,$68.20 , N/A ,$99.00 , N/A ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 , N/A ,$53.90 ,$53.90 ,$29.11 ,$53.90 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$5.00 ,$3.30 ,$1.14 ,$5.00 , N/A ,$4.48 ,$4.48 ,$1.32 ,$4.00 ,$4.25 ,$3.13 ,$4.50 , N/A , N/A ,$4.75 ,$4.50 ,$4.25 ,$4.25 ,$1.32 ,$4.25 ,$4.25 ,$4.50 ,$3.05 , N/A ,$3.10 , N/A ,$4.50 , N/A ,$4.60 ,$4.50 ,$3.30 ,$3.30 ,$3.05 ,$3.30 ,$3.25 ,$3.42 ,$1.14 ,$3.95 , N/A ,$2.45 ,$2.45 ,$1.32 ,$2.45 , N/A ,$4.75 ,$4.10 ,$4.10 ,$4.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280117,N/A,"HC TUBE RECTAL 25 FR 20""",272,1 ,$22.00 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$54.12 ,$18.67 ,$82.00 , N/A ,$73.49 ,$73.49 ,$21.70 ,$65.60 ,$69.70 ,$51.25 ,$73.80 , N/A , N/A ,$77.90 ,$73.80 ,$69.70 ,$69.70 ,$21.70 ,$69.70 ,$69.70 ,$73.80 ,$49.94 , N/A ,$50.84 , N/A ,$73.80 , N/A ,$75.44 ,$73.80 ,$54.13 ,$54.13 ,$49.94 ,$54.13 ,$53.30 ,$56.02 ,$18.67 ,$64.78 , N/A ,$40.18 ,$40.18 ,$21.70 ,$40.18 , 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 ,$181.50 ,$62.60 ,$275.00 , N/A ,$246.46 ,$246.46 ,$72.76 ,$220.00 ,$233.75 ,$171.88 ,$247.50 , N/A , N/A ,$261.25 ,$247.50 ,$233.75 ,$233.75 ,$72.76 ,$233.75 ,$233.75 ,$247.50 ,$167.48 , N/A ,$170.50 , N/A ,$247.50 , N/A ,$253.00 ,$247.50 ,$181.53 ,$181.53 ,$167.48 ,$181.53 ,$178.75 ,$187.88 ,$62.60 ,$217.25 , N/A ,$134.75 ,$134.75 ,$72.76 ,$134.75 , 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 ,$93.06 ,$32.09 ,$141.00 , N/A ,$126.36 ,$126.36 ,$37.31 ,$112.80 ,$119.85 ,$88.13 ,$126.90 , N/A , N/A ,$133.95 ,$126.90 ,$119.85 ,$119.85 ,$37.31 ,$119.85 ,$119.85 ,$126.90 ,$85.87 , N/A ,$87.42 , N/A ,$126.90 , N/A ,$129.72 ,$126.90 ,$93.07 ,$93.07 ,$85.87 ,$93.07 ,$91.65 ,$96.33 ,$32.09 ,$111.39 , N/A ,$69.09 ,$69.09 ,$37.31 ,$69.09 , 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 ,$108.24 ,$37.34 ,$164.00 , N/A ,$146.98 ,$146.98 ,$43.39 ,$131.20 ,$139.40 ,$102.50 ,$147.60 , N/A , N/A ,$155.80 ,$147.60 ,$139.40 ,$139.40 ,$43.39 ,$139.40 ,$139.40 ,$147.60 ,$99.88 , N/A ,$101.68 , N/A ,$147.60 , N/A ,$150.88 ,$147.60 ,$108.26 ,$108.26 ,$99.88 ,$108.26 ,$106.60 ,$112.04 ,$37.34 ,$129.56 , N/A ,$80.36 ,$80.36 ,$43.39 ,$80.36 , 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 ,$4.06 ,$2.68 ,$0.92 ,$4.06 , N/A ,$3.64 ,$3.64 ,$1.08 ,$3.25 ,$3.45 ,$2.54 ,$3.65 , N/A , N/A ,$3.86 ,$3.65 ,$3.45 ,$3.45 ,$1.08 ,$3.45 ,$3.45 ,$3.65 ,$2.47 , N/A ,$2.52 , N/A ,$3.65 , N/A ,$3.74 ,$3.65 ,$2.68 ,$2.68 ,$2.47 ,$2.68 ,$2.64 ,$2.77 ,$0.92 ,$3.21 , N/A ,$1.99 ,$1.99 ,$1.08 ,$1.99 , N/A ,$3.86 ,$3.33 ,$3.33 ,$3.25 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280123,N/A,"HC TUBING,IRRIG. (CYSTO)",272,1 ,$9.30 ,$6.14 ,$2.12 ,$9.30 , N/A ,$8.33 ,$8.33 ,$2.46 ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.37 ,$5.66 , N/A ,$5.76 , N/A ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.14 ,$6.14 ,$5.66 ,$6.14 ,$6.05 ,$6.35 ,$2.12 ,$7.35 , N/A ,$4.56 ,$4.56 ,$2.46 ,$4.56 , 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 ,$7.52 ,$2.60 ,$11.40 , N/A ,$10.22 ,$10.22 ,$3.02 ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 ,$3.02 ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A ,$7.06 , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$2.60 ,$9.01 , N/A ,$5.59 ,$5.59 ,$3.02 ,$5.59 , 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 ,$17.16 ,$5.92 ,$26.00 , N/A ,$23.30 ,$23.30 ,$6.88 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$6.88 ,$22.10 ,$22.10 ,$23.40 ,$15.83 , N/A ,$16.12 , N/A ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.16 ,$17.16 ,$15.83 ,$17.16 ,$16.90 ,$17.76 ,$5.92 ,$20.54 , N/A ,$12.74 ,$12.74 ,$6.88 ,$12.74 , 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 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A ,$8.82 ,$8.82 ,$4.76 ,$8.82 , 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 ,$31.02 ,$10.70 ,$47.00 , N/A ,$42.12 ,$42.12 ,$12.44 ,$37.60 ,$39.95 ,$29.38 ,$42.30 , N/A , N/A ,$44.65 ,$42.30 ,$39.95 ,$39.95 ,$12.44 ,$39.95 ,$39.95 ,$42.30 ,$28.62 , N/A ,$29.14 , N/A ,$42.30 , N/A ,$43.24 ,$42.30 ,$31.02 ,$31.02 ,$28.62 ,$31.02 ,$30.55 ,$32.11 ,$10.70 ,$37.13 , N/A ,$23.03 ,$23.03 ,$12.44 ,$23.03 , 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 ,$16.11 ,$10.63 ,$3.67 ,$16.11 , N/A ,$14.44 ,$14.44 ,$4.26 ,$12.89 ,$13.69 ,$10.07 ,$14.50 , N/A , N/A ,$15.30 ,$14.50 ,$13.69 ,$13.69 ,$4.26 ,$13.69 ,$13.69 ,$14.50 ,$9.81 , N/A ,$9.98 , N/A ,$14.50 , N/A ,$14.82 ,$14.50 ,$10.63 ,$10.63 ,$9.81 ,$10.63 ,$10.47 ,$11.01 ,$3.67 ,$12.73 , N/A ,$7.89 ,$7.89 ,$4.26 ,$7.89 , N/A ,$15.30 ,$13.21 ,$13.21 ,$12.89 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280129,N/A,HC VIAL DECANTER II,272,1 ,$6.06 ,$4.00 ,$1.37 ,$6.06 , N/A ,$5.43 ,$5.43 ,$1.61 ,$4.85 ,$5.15 ,$3.79 ,$5.45 , N/A , N/A ,$5.76 ,$5.45 ,$5.15 ,$5.15 ,$1.61 ,$5.15 ,$5.15 ,$5.45 ,$3.69 , N/A ,$3.76 , N/A ,$5.45 , N/A ,$5.58 ,$5.45 ,$4.00 ,$4.00 ,$3.69 ,$4.00 ,$3.94 ,$4.14 ,$1.37 ,$4.79 , N/A ,$2.97 ,$2.97 ,$1.61 ,$2.97 , N/A ,$5.76 ,$4.97 ,$4.97 ,$4.85 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280130,N/A,HC WRAP KNEE DYN PULL UNIV,272,1 ,$50.00 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , N/A ,$47.50 ,$41.00 ,$41.00 ,$40.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280131,N/A,HC LIGATING LOOP,272,1 ,$86.57 ,$57.14 ,$19.71 ,$86.57 , N/A ,$77.58 ,$77.58 ,$22.90 ,$69.26 ,$73.58 ,$54.11 ,$77.91 , N/A , N/A ,$82.24 ,$77.91 ,$73.58 ,$73.58 ,$22.90 ,$73.58 ,$73.58 ,$77.91 ,$52.72 , N/A ,$53.68 , N/A ,$77.91 , N/A ,$79.64 ,$77.91 ,$57.14 ,$57.14 ,$52.72 ,$57.14 ,$56.27 ,$59.14 ,$19.71 ,$68.39 , N/A ,$42.42 ,$42.42 ,$22.90 ,$42.42 , N/A ,$82.24 ,$70.99 ,$70.99 ,$69.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280132,N/A,HC SYSTEM MALYUGIN RING 6.25,272,1 ,$385.80 ,$254.63 ,$87.83 ,$385.80 , N/A ,$345.75 ,$345.75 ,$102.09 ,$308.64 ,$327.93 ,$241.13 ,$347.22 , N/A , N/A ,$366.51 ,$347.22 ,$327.93 ,$327.93 ,$102.09 ,$327.93 ,$327.93 ,$347.22 ,$234.95 , N/A ,$239.20 , N/A ,$347.22 , N/A ,$354.94 ,$347.22 ,$254.67 ,$254.67 ,$234.95 ,$254.67 ,$250.77 ,$263.58 ,$87.83 ,$304.78 , N/A ,$189.04 ,$189.04 ,$102.09 ,$189.04 , N/A ,$366.51 ,$316.36 ,$316.36 ,$308.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280133,N/A,HC CANNULA CEMENT VERTEPORT 10G,272,1 ,$261.00 ,$172.26 ,$59.42 ,$261.00 , N/A ,$233.91 ,$233.91 ,$69.06 ,$208.80 ,$221.85 ,$163.13 ,$234.90 , N/A , N/A ,$247.95 ,$234.90 ,$221.85 ,$221.85 ,$69.06 ,$221.85 ,$221.85 ,$234.90 ,$158.95 , N/A ,$161.82 , N/A ,$234.90 , N/A ,$240.12 ,$234.90 ,$172.29 ,$172.29 ,$158.95 ,$172.29 ,$169.65 ,$178.32 ,$59.42 ,$206.19 , N/A ,$127.89 ,$127.89 ,$69.06 ,$127.89 , 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 ,$278.52 ,$96.07 ,$422.00 , N/A ,$378.20 ,$378.20 ,$111.66 ,$337.60 ,$358.70 ,$263.75 ,$379.80 , N/A , N/A ,$400.90 ,$379.80 ,$358.70 ,$358.70 ,$111.66 ,$358.70 ,$358.70 ,$379.80 ,$257.00 , N/A ,$261.64 , N/A ,$379.80 , N/A ,$388.24 ,$379.80 ,$278.56 ,$278.56 ,$257.00 ,$278.56 ,$274.30 ,$288.31 ,$96.07 ,$333.38 , N/A ,$206.78 ,$206.78 ,$111.66 ,$206.78 , 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 ","$2,589.18 ",$893.08 ,"$3,923.00 ", N/A ,"$3,515.79 ","$3,515.79 ","$1,038.03 ","$3,138.40 ","$3,334.55 ","$2,451.88 ","$3,530.70 ", N/A , N/A ,"$3,726.85 ","$3,530.70 ","$3,334.55 ","$3,334.55 ","$1,038.03 ","$3,334.55 ","$3,334.55 ","$3,530.70 ","$2,389.11 ", N/A ,"$2,432.26 ", N/A ,"$3,530.70 ", N/A ,"$3,609.16 ","$3,530.70 ","$2,589.57 ","$2,589.57 ","$2,389.11 ","$2,589.57 ","$2,549.95 ","$2,680.19 ",$893.08 ,"$3,099.17 ", N/A ,"$1,922.27 ","$1,922.27 ","$1,038.03 ","$1,922.27 ", 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 ,$52.14 ,$17.98 ,$79.00 , N/A ,$70.80 ,$70.80 ,$20.90 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$20.90 ,$67.15 ,$67.15 ,$71.10 ,$48.11 , N/A ,$48.98 , N/A ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.15 ,$52.15 ,$48.11 ,$52.15 ,$51.35 ,$53.97 ,$17.98 ,$62.41 , N/A ,$38.71 ,$38.71 ,$20.90 ,$38.71 , 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 ,$82.50 ,$28.46 ,$125.00 , N/A ,$112.03 ,$112.03 ,$33.07 ,$100.00 ,$106.25 ,$78.13 ,$112.50 , N/A , N/A ,$118.75 ,$112.50 ,$106.25 ,$106.25 ,$33.07 ,$106.25 ,$106.25 ,$112.50 ,$76.13 , N/A ,$77.50 , N/A ,$112.50 , N/A ,$115.00 ,$112.50 ,$82.51 ,$82.51 ,$76.13 ,$82.51 ,$81.25 ,$85.40 ,$28.46 ,$98.75 , N/A ,$61.25 ,$61.25 ,$33.07 ,$61.25 , 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 ,$78.54 ,$27.09 ,$119.00 , N/A ,$106.65 ,$106.65 ,$31.49 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$31.49 ,$101.15 ,$101.15 ,$107.10 ,$72.47 , N/A ,$73.78 , N/A ,$107.10 , N/A ,$109.48 ,$107.10 ,$78.55 ,$78.55 ,$72.47 ,$78.55 ,$77.35 ,$81.30 ,$27.09 ,$94.01 , N/A ,$58.31 ,$58.31 ,$31.49 ,$58.31 , 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 ,$23.10 ,$7.97 ,$35.00 , N/A ,$31.37 ,$31.37 ,$9.26 ,$28.00 ,$29.75 ,$21.88 ,$31.50 , N/A , N/A ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$9.26 ,$29.75 ,$29.75 ,$31.50 ,$21.32 , N/A ,$21.70 , N/A ,$31.50 , N/A ,$32.20 ,$31.50 ,$23.10 ,$23.10 ,$21.32 ,$23.10 ,$22.75 ,$23.91 ,$7.97 ,$27.65 , N/A ,$17.15 ,$17.15 ,$9.26 ,$17.15 , 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 ,$62.38 ,$41.17 ,$14.20 ,$62.38 , N/A ,$55.91 ,$55.91 ,$16.50 ,$49.90 ,$53.02 ,$38.99 ,$56.14 , N/A , N/A ,$59.26 ,$56.14 ,$53.02 ,$53.02 ,$16.50 ,$53.02 ,$53.02 ,$56.14 ,$37.99 , N/A ,$38.68 , N/A ,$56.14 , N/A ,$57.39 ,$56.14 ,$41.18 ,$41.18 ,$37.99 ,$41.18 ,$40.55 ,$42.62 ,$14.20 ,$49.28 , N/A ,$30.57 ,$30.57 ,$16.50 ,$30.57 , N/A ,$59.26 ,$51.15 ,$51.15 ,$49.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280142,N/A,HC MANIPULATOR UTERINE,272,1 ,$276.00 ,$182.16 ,$62.83 ,$276.00 , N/A ,$247.35 ,$247.35 ,$73.03 ,$220.80 ,$234.60 ,$172.50 ,$248.40 , N/A , N/A ,$262.20 ,$248.40 ,$234.60 ,$234.60 ,$73.03 ,$234.60 ,$234.60 ,$248.40 ,$168.08 , N/A ,$171.12 , N/A ,$248.40 , N/A ,$253.92 ,$248.40 ,$182.19 ,$182.19 ,$168.08 ,$182.19 ,$179.40 ,$188.56 ,$62.83 ,$218.04 , N/A ,$135.24 ,$135.24 ,$73.03 ,$135.24 , 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 ,$535.26 ,$184.63 ,$811.00 , N/A ,$726.82 ,$726.82 ,$214.59 ,$648.80 ,$689.35 ,$506.88 ,$729.90 , N/A , N/A ,$770.45 ,$729.90 ,$689.35 ,$689.35 ,$214.59 ,$689.35 ,$689.35 ,$729.90 ,$493.90 , N/A ,$502.82 , N/A ,$729.90 , N/A ,$746.12 ,$729.90 ,$535.34 ,$535.34 ,$493.90 ,$535.34 ,$527.15 ,$554.08 ,$184.63 ,$640.69 , N/A ,$397.39 ,$397.39 ,$214.59 ,$397.39 , 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 ","$1,162.92 ",$401.12 ,"$1,762.00 ", N/A ,"$1,579.10 ","$1,579.10 ",$466.23 ,"$1,409.60 ","$1,497.70 ","$1,101.25 ","$1,585.80 ", N/A , N/A ,"$1,673.90 ","$1,585.80 ","$1,497.70 ","$1,497.70 ",$466.23 ,"$1,497.70 ","$1,497.70 ","$1,585.80 ","$1,073.06 ", N/A ,"$1,092.44 ", N/A ,"$1,585.80 ", N/A ,"$1,621.04 ","$1,585.80 ","$1,163.10 ","$1,163.10 ","$1,073.06 ","$1,163.10 ","$1,145.30 ","$1,203.80 ",$401.12 ,"$1,391.98 ", N/A ,$863.38 ,$863.38 ,$466.23 ,$863.38 , 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 ,$415.14 ,$143.20 ,$629.00 , N/A ,$563.71 ,$563.71 ,$166.43 ,$503.20 ,$534.65 ,$393.13 ,$566.10 , N/A , N/A ,$597.55 ,$566.10 ,$534.65 ,$534.65 ,$166.43 ,$534.65 ,$534.65 ,$566.10 ,$383.06 , N/A ,$389.98 , N/A ,$566.10 , N/A ,$578.68 ,$566.10 ,$415.20 ,$415.20 ,$383.06 ,$415.20 ,$408.85 ,$429.73 ,$143.20 ,$496.91 , N/A ,$308.21 ,$308.21 ,$166.43 ,$308.21 , 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 ,$546.48 ,$188.49 ,$828.00 , N/A ,$742.05 ,$742.05 ,$219.09 ,$662.40 ,$703.80 ,$517.50 ,$745.20 , N/A , N/A ,$786.60 ,$745.20 ,$703.80 ,$703.80 ,$219.09 ,$703.80 ,$703.80 ,$745.20 ,$504.25 , N/A ,$513.36 , N/A ,$745.20 , N/A ,$761.76 ,$745.20 ,$546.56 ,$546.56 ,$504.25 ,$546.56 ,$538.20 ,$565.69 ,$188.49 ,$654.12 , N/A ,$405.72 ,$405.72 ,$219.09 ,$405.72 , 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 ,$59.40 ,$20.49 ,$90.00 , N/A ,$80.66 ,$80.66 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 , N/A ,$55.80 , N/A ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 , N/A ,$44.10 ,$44.10 ,$23.81 ,$44.10 , 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 ,$62.70 ,$21.63 ,$95.00 , N/A ,$85.14 ,$85.14 ,$25.14 ,$76.00 ,$80.75 ,$59.38 ,$85.50 , N/A , N/A ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$25.14 ,$80.75 ,$80.75 ,$85.50 ,$57.86 , N/A ,$58.90 , N/A ,$85.50 , N/A ,$87.40 ,$85.50 ,$62.71 ,$62.71 ,$57.86 ,$62.71 ,$61.75 ,$64.90 ,$21.63 ,$75.05 , N/A ,$46.55 ,$46.55 ,$25.14 ,$46.55 , 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 ,$77.22 ,$26.64 ,$117.00 , N/A ,$104.86 ,$104.86 ,$30.96 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$30.96 ,$99.45 ,$99.45 ,$105.30 ,$71.25 , N/A ,$72.54 , N/A ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.23 ,$77.23 ,$71.25 ,$77.23 ,$76.05 ,$79.93 ,$26.64 ,$92.43 , N/A ,$57.33 ,$57.33 ,$30.96 ,$57.33 , 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 ,$201.30 ,$69.43 ,$305.00 , N/A ,$273.34 ,$273.34 ,$80.70 ,$244.00 ,$259.25 ,$190.63 ,$274.50 , N/A , N/A ,$289.75 ,$274.50 ,$259.25 ,$259.25 ,$80.70 ,$259.25 ,$259.25 ,$274.50 ,$185.75 , N/A ,$189.10 , N/A ,$274.50 , N/A ,$280.60 ,$274.50 ,$201.33 ,$201.33 ,$185.75 ,$201.33 ,$198.25 ,$208.38 ,$69.43 ,$240.95 , N/A ,$149.45 ,$149.45 ,$80.70 ,$149.45 , 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 ,$64.68 ,$22.31 ,$98.00 , N/A ,$87.83 ,$87.83 ,$25.93 ,$78.40 ,$83.30 ,$61.25 ,$88.20 , N/A , N/A ,$93.10 ,$88.20 ,$83.30 ,$83.30 ,$25.93 ,$83.30 ,$83.30 ,$88.20 ,$59.68 , N/A ,$60.76 , N/A ,$88.20 , N/A ,$90.16 ,$88.20 ,$64.69 ,$64.69 ,$59.68 ,$64.69 ,$63.70 ,$66.95 ,$22.31 ,$77.42 , N/A ,$48.02 ,$48.02 ,$25.93 ,$48.02 , N/A ,$93.10 ,$80.36 ,$80.36 ,$78.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280158,N/A,HC DILATOR,270,1 ,$15.50 ,$10.23 ,$3.54 ,$15.50 , N/A ,$13.89 ,$13.89 ,$4.11 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$4.11 ,$13.18 ,$13.18 ,$13.95 ,$9.44 , N/A ,$9.62 , N/A ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.23 ,$10.23 ,$9.44 ,$10.23 ,$10.08 ,$10.59 ,$3.54 ,$12.25 , N/A ,$7.60 ,$7.60 ,$4.11 ,$7.60 , 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 ,$201.96 ,$69.66 ,$306.00 , N/A ,$274.24 ,$274.24 ,$80.97 ,$244.80 ,$260.10 ,$191.25 ,$275.40 , N/A , N/A ,$290.70 ,$275.40 ,$260.10 ,$260.10 ,$80.97 ,$260.10 ,$260.10 ,$275.40 ,$186.35 , N/A ,$189.72 , N/A ,$275.40 , N/A ,$281.52 ,$275.40 ,$201.99 ,$201.99 ,$186.35 ,$201.99 ,$198.90 ,$209.06 ,$69.66 ,$241.74 , N/A ,$149.94 ,$149.94 ,$80.97 ,$149.94 , N/A ,$290.70 ,$250.92 ,$250.92 ,$244.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280160,N/A,HC DETECTOR CO2,272,1 ,$42.17 ,$27.83 ,$9.60 ,$42.17 , N/A ,$37.79 ,$37.79 ,$11.16 ,$33.74 ,$35.84 ,$26.36 ,$37.95 , N/A , N/A ,$40.06 ,$37.95 ,$35.84 ,$35.84 ,$11.16 ,$35.84 ,$35.84 ,$37.95 ,$25.68 , N/A ,$26.14 , N/A ,$37.95 , N/A ,$38.80 ,$37.95 ,$27.84 ,$27.84 ,$25.68 ,$27.84 ,$27.41 ,$28.81 ,$9.60 ,$33.31 , N/A ,$20.66 ,$20.66 ,$11.16 ,$20.66 , N/A ,$40.06 ,$34.58 ,$34.58 ,$33.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280161,N/A,HC DRESS KIT FOAM W/SOFT PORT,272,1 ,$95.00 ,$62.70 ,$21.63 ,$95.00 , N/A ,$85.14 ,$85.14 ,$25.14 ,$76.00 ,$80.75 ,$59.38 ,$85.50 , N/A , N/A ,$90.25 ,$85.50 ,$80.75 ,$80.75 ,$25.14 ,$80.75 ,$80.75 ,$85.50 ,$57.86 , N/A ,$58.90 , N/A ,$85.50 , N/A ,$87.40 ,$85.50 ,$62.71 ,$62.71 ,$57.86 ,$62.71 ,$61.75 ,$64.90 ,$21.63 ,$75.05 , N/A ,$46.55 ,$46.55 ,$25.14 ,$46.55 , 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 ,$202.62 ,$69.89 ,$307.00 , N/A ,$275.13 ,$275.13 ,$81.23 ,$245.60 ,$260.95 ,$191.88 ,$276.30 , N/A , N/A ,$291.65 ,$276.30 ,$260.95 ,$260.95 ,$81.23 ,$260.95 ,$260.95 ,$276.30 ,$186.96 , N/A ,$190.34 , N/A ,$276.30 , N/A ,$282.44 ,$276.30 ,$202.65 ,$202.65 ,$186.96 ,$202.65 ,$199.55 ,$209.74 ,$69.89 ,$242.53 , N/A ,$150.43 ,$150.43 ,$81.23 ,$150.43 , 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 ,$13.20 ,$4.56 ,$20.00 , N/A ,$17.92 ,$17.92 ,$5.29 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$5.29 ,$17.00 ,$17.00 ,$18.00 ,$12.18 , N/A ,$12.40 , N/A ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.20 ,$13.20 ,$12.18 ,$13.20 ,$13.00 ,$13.66 ,$4.56 ,$15.80 , N/A ,$9.80 ,$9.80 ,$5.29 ,$9.80 , 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 ,$164.34 ,$56.68 ,$249.00 , N/A ,$223.15 ,$223.15 ,$65.89 ,$199.20 ,$211.65 ,$155.63 ,$224.10 , N/A , N/A ,$236.55 ,$224.10 ,$211.65 ,$211.65 ,$65.89 ,$211.65 ,$211.65 ,$224.10 ,$151.64 , N/A ,$154.38 , N/A ,$224.10 , N/A ,$229.08 ,$224.10 ,$164.36 ,$164.36 ,$151.64 ,$164.36 ,$161.85 ,$170.12 ,$56.68 ,$196.71 , N/A ,$122.01 ,$122.01 ,$65.89 ,$122.01 , 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 ,$78.54 ,$27.09 ,$119.00 , N/A ,$106.65 ,$106.65 ,$31.49 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$31.49 ,$101.15 ,$101.15 ,$107.10 ,$72.47 , N/A ,$73.78 , N/A ,$107.10 , N/A ,$109.48 ,$107.10 ,$78.55 ,$78.55 ,$72.47 ,$78.55 ,$77.35 ,$81.30 ,$27.09 ,$94.01 , N/A ,$58.31 ,$58.31 ,$31.49 ,$58.31 , 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 ,$50.82 ,$17.53 ,$77.00 , N/A ,$69.01 ,$69.01 ,$20.37 ,$61.60 ,$65.45 ,$48.13 ,$69.30 , N/A , N/A ,$73.15 ,$69.30 ,$65.45 ,$65.45 ,$20.37 ,$65.45 ,$65.45 ,$69.30 ,$46.89 , N/A ,$47.74 , N/A ,$69.30 , N/A ,$70.84 ,$69.30 ,$50.83 ,$50.83 ,$46.89 ,$50.83 ,$50.05 ,$52.61 ,$17.53 ,$60.83 , N/A ,$37.73 ,$37.73 ,$20.37 ,$37.73 , 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 ,$112.86 ,$38.93 ,$171.00 , N/A ,$153.25 ,$153.25 ,$45.25 ,$136.80 ,$145.35 , N/A ,$153.90 , N/A , N/A ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$45.25 ,$145.35 ,$145.35 ,$153.90 ,$104.14 , N/A ,$106.02 , N/A ,$153.90 , N/A ,$157.32 ,$153.90 ,$112.88 ,$112.88 ,$104.14 ,$112.88 ,$111.15 ,$116.83 ,$38.93 ,$135.09 , N/A ,$83.79 ,$83.79 ,$45.25 ,$83.79 , 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 ,$16.50 ,$5.69 ,$25.00 , N/A ,$22.41 ,$22.41 ,$6.61 ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 ,$6.61 ,$21.25 ,$21.25 ,$22.50 ,$15.23 , N/A ,$15.50 , N/A ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.50 ,$16.50 ,$15.23 ,$16.50 ,$16.25 ,$17.08 ,$5.69 ,$19.75 , N/A ,$12.25 ,$12.25 ,$6.61 ,$12.25 , 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 ,$23.10 ,$7.97 ,$35.00 , N/A ,$31.37 ,$31.37 ,$9.26 ,$28.00 ,$29.75 ,$21.88 ,$31.50 , N/A , N/A ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$9.26 ,$29.75 ,$29.75 ,$31.50 ,$21.32 , N/A ,$21.70 , N/A ,$31.50 , N/A ,$32.20 ,$31.50 ,$23.10 ,$23.10 ,$21.32 ,$23.10 ,$22.75 ,$23.91 ,$7.97 ,$27.65 , N/A ,$17.15 ,$17.15 ,$9.26 ,$17.15 , 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 ,$38.28 ,$13.20 ,$58.00 , N/A ,$51.98 ,$51.98 ,$15.35 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$15.35 ,$49.30 ,$49.30 ,$52.20 ,$35.32 , N/A ,$35.96 , N/A ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.29 ,$38.29 ,$35.32 ,$38.29 ,$37.70 ,$39.63 ,$13.20 ,$45.82 , N/A ,$28.42 ,$28.42 ,$15.35 ,$28.42 , 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 ,$68.00 ,$44.88 ,$15.48 ,$68.00 , N/A ,$60.94 ,$60.94 ,$17.99 ,$54.40 ,$57.80 ,$42.50 ,$61.20 , N/A , N/A ,$64.60 ,$61.20 ,$57.80 ,$57.80 ,$17.99 ,$57.80 ,$57.80 ,$61.20 ,$41.41 , N/A ,$42.16 , N/A ,$61.20 , N/A ,$62.56 ,$61.20 ,$44.89 ,$44.89 ,$41.41 ,$44.89 ,$44.20 ,$46.46 ,$15.48 ,$53.72 , N/A ,$33.32 ,$33.32 ,$17.99 ,$33.32 , N/A ,$64.60 ,$55.76 ,$55.76 ,$54.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280172,N/A,HC NEEDLE 1/2 CIRC REV CUT MART UTE,272,1 ,$15.50 ,$10.23 ,$3.54 ,$15.50 , N/A ,$13.89 ,$13.89 ,$4.11 ,$12.40 ,$13.18 ,$9.69 ,$13.95 , N/A , N/A ,$14.73 ,$13.95 ,$13.18 ,$13.18 ,$4.11 ,$13.18 ,$13.18 ,$13.95 ,$9.44 , N/A ,$9.62 , N/A ,$13.95 , N/A ,$14.26 ,$13.95 ,$10.23 ,$10.23 ,$9.44 ,$10.23 ,$10.08 ,$10.59 ,$3.54 ,$12.25 , N/A ,$7.60 ,$7.60 ,$4.11 ,$7.60 , 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 ,$69.30 ,$23.90 ,$105.00 , N/A ,$94.10 ,$94.10 ,$27.78 ,$84.00 ,$89.25 ,$65.63 ,$94.50 , N/A , N/A ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$27.78 ,$89.25 ,$89.25 ,$94.50 ,$63.95 , N/A ,$65.10 , N/A ,$94.50 , N/A ,$96.60 ,$94.50 ,$69.31 ,$69.31 ,$63.95 ,$69.31 ,$68.25 ,$71.74 ,$23.90 ,$82.95 , N/A ,$51.45 ,$51.45 ,$27.78 ,$51.45 , 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 ,$148.83 ,$98.23 ,$33.88 ,$148.83 , N/A ,$133.38 ,$133.38 ,$39.38 ,$119.06 ,$126.51 ,$93.02 ,$133.95 , N/A , N/A ,$141.39 ,$133.95 ,$126.51 ,$126.51 ,$39.38 ,$126.51 ,$126.51 ,$133.95 ,$90.64 , N/A ,$92.28 , N/A ,$133.95 , N/A ,$136.92 ,$133.95 ,$98.24 ,$98.24 ,$90.64 ,$98.24 ,$96.74 ,$101.68 ,$33.88 ,$117.58 , N/A ,$72.93 ,$72.93 ,$39.38 ,$72.93 , N/A ,$141.39 ,$122.04 ,$122.04 ,$119.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280175,N/A,HC PKS SEAL OPEN FORCEPS CURV JAW,272,1 ,$973.00 ,$642.18 ,$221.51 ,$973.00 , N/A ,$872.00 ,$872.00 ,$257.46 ,$778.40 ,$827.05 ,$608.13 ,$875.70 , N/A , N/A ,$924.35 ,$875.70 ,$827.05 ,$827.05 ,$257.46 ,$827.05 ,$827.05 ,$875.70 ,$592.56 , N/A ,$603.26 , N/A ,$875.70 , N/A ,$895.16 ,$875.70 ,$642.28 ,$642.28 ,$592.56 ,$642.28 ,$632.45 ,$664.75 ,$221.51 ,$768.67 , N/A ,$476.77 ,$476.77 ,$257.46 ,$476.77 , 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 ,$38.28 ,$13.20 ,$58.00 , N/A ,$51.98 ,$51.98 ,$15.35 ,$46.40 ,$49.30 ,$36.25 ,$52.20 , N/A , N/A ,$55.10 ,$52.20 ,$49.30 ,$49.30 ,$15.35 ,$49.30 ,$49.30 ,$52.20 ,$35.32 , N/A ,$35.96 , N/A ,$52.20 , N/A ,$53.36 ,$52.20 ,$38.29 ,$38.29 ,$35.32 ,$38.29 ,$37.70 ,$39.63 ,$13.20 ,$45.82 , N/A ,$28.42 ,$28.42 ,$15.35 ,$28.42 , 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 ,$82.25 ,$54.29 ,$18.73 ,$82.25 , N/A ,$73.71 ,$73.71 ,$21.77 ,$65.80 ,$69.91 ,$51.41 ,$74.03 , N/A , N/A ,$78.14 ,$74.03 ,$69.91 ,$69.91 ,$21.77 ,$69.91 ,$69.91 ,$74.03 ,$50.09 , N/A ,$51.00 , N/A ,$74.03 , N/A ,$75.67 ,$74.03 ,$54.29 ,$54.29 ,$50.09 ,$54.29 ,$53.46 ,$56.19 ,$18.73 ,$64.98 , N/A ,$40.30 ,$40.30 ,$21.77 ,$40.30 , N/A ,$78.14 ,$67.45 ,$67.45 ,$65.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280178,N/A,HC ORTHOCORD W DOUBL MENISCAL NEEDLE,272,1 ,$321.00 ,$211.86 ,$73.08 ,$321.00 , N/A ,$287.68 ,$287.68 ,$84.94 ,$256.80 ,$272.85 ,$200.63 ,$288.90 , N/A , N/A ,$304.95 ,$288.90 ,$272.85 ,$272.85 ,$84.94 ,$272.85 ,$272.85 ,$288.90 ,$195.49 , N/A ,$199.02 , N/A ,$288.90 , N/A ,$295.32 ,$288.90 ,$211.89 ,$211.89 ,$195.49 ,$211.89 ,$208.65 ,$219.31 ,$73.08 ,$253.59 , N/A ,$157.29 ,$157.29 ,$84.94 ,$157.29 , 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 ,$85.14 ,$29.37 ,$129.00 , N/A ,$115.61 ,$115.61 ,$34.13 ,$103.20 ,$109.65 ,$80.63 ,$116.10 , N/A , N/A ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$34.13 ,$109.65 ,$109.65 ,$116.10 ,$78.56 , N/A ,$79.98 , N/A ,$116.10 , N/A ,$118.68 ,$116.10 ,$85.15 ,$85.15 ,$78.56 ,$85.15 ,$83.85 ,$88.13 ,$29.37 ,$101.91 , N/A ,$63.21 ,$63.21 ,$34.13 ,$63.21 , 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 ,$363.00 ,$125.21 ,$550.00 , N/A ,$492.91 ,$492.91 ,$145.53 ,$440.00 ,$467.50 ,$343.75 ,$495.00 , N/A , N/A ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$145.53 ,$467.50 ,$467.50 ,$495.00 ,$334.95 , N/A ,$341.00 , N/A ,$495.00 , N/A ,$506.00 ,$495.00 ,$363.06 ,$363.06 ,$334.95 ,$363.06 ,$357.50 ,$375.76 ,$125.21 ,$434.50 , N/A ,$269.50 ,$269.50 ,$145.53 ,$269.50 , 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 ,$235.62 ,$81.27 ,$357.00 , N/A ,$319.94 ,$319.94 ,$94.46 ,$285.60 ,$303.45 ,$223.13 ,$321.30 , N/A , N/A ,$339.15 ,$321.30 ,$303.45 ,$303.45 ,$94.46 ,$303.45 ,$303.45 ,$321.30 ,$217.41 , N/A ,$221.34 , N/A ,$321.30 , N/A ,$328.44 ,$321.30 ,$235.66 ,$235.66 ,$217.41 ,$235.66 ,$232.05 ,$243.90 ,$81.27 ,$282.03 , N/A ,$174.93 ,$174.93 ,$94.46 ,$174.93 , 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 ,$269.94 ,$93.11 ,$409.00 , N/A ,$366.55 ,$366.55 ,$108.22 ,$327.20 ,$347.65 ,$255.63 ,$368.10 , N/A , N/A ,$388.55 ,$368.10 ,$347.65 ,$347.65 ,$108.22 ,$347.65 ,$347.65 ,$368.10 ,$249.08 , N/A ,$253.58 , N/A ,$368.10 , N/A ,$376.28 ,$368.10 ,$269.98 ,$269.98 ,$249.08 ,$269.98 ,$265.85 ,$279.43 ,$93.11 ,$323.11 , N/A ,$200.41 ,$200.41 ,$108.22 ,$200.41 , 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 ,$190.74 ,$65.79 ,$289.00 , N/A ,$259.00 ,$259.00 ,$76.47 ,$231.20 ,$245.65 ,$180.63 ,$260.10 , N/A , N/A ,$274.55 ,$260.10 ,$245.65 ,$245.65 ,$76.47 ,$245.65 ,$245.65 ,$260.10 ,$176.00 , N/A ,$179.18 , N/A ,$260.10 , N/A ,$265.88 ,$260.10 ,$190.77 ,$190.77 ,$176.00 ,$190.77 ,$187.85 ,$197.44 ,$65.79 ,$228.31 , N/A ,$141.61 ,$141.61 ,$76.47 ,$141.61 , 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 ,$308.88 ,$106.55 ,$468.00 , N/A ,$419.42 ,$419.42 ,$123.83 ,$374.40 ,$397.80 ,$292.50 ,$421.20 , N/A , N/A ,$444.60 ,$421.20 ,$397.80 ,$397.80 ,$123.83 ,$397.80 ,$397.80 ,$421.20 ,$285.01 , N/A ,$290.16 , N/A ,$421.20 , N/A ,$430.56 ,$421.20 ,$308.93 ,$308.93 ,$285.01 ,$308.93 ,$304.20 ,$319.74 ,$106.55 ,$369.72 , N/A ,$229.32 ,$229.32 ,$123.83 ,$229.32 , 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 ,$155.10 ,$53.50 ,$235.00 , N/A ,$210.61 ,$210.61 ,$62.18 ,$188.00 ,$199.75 ,$146.88 ,$211.50 , N/A , N/A ,$223.25 ,$211.50 ,$199.75 ,$199.75 ,$62.18 ,$199.75 ,$199.75 ,$211.50 ,$143.12 , N/A ,$145.70 , N/A ,$211.50 , N/A ,$216.20 ,$211.50 ,$155.12 ,$155.12 ,$143.12 ,$155.12 ,$152.75 ,$160.55 ,$53.50 ,$185.65 , N/A ,$115.15 ,$115.15 ,$62.18 ,$115.15 , 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 ,$75.24 ,$25.95 ,$114.00 , N/A ,$102.17 ,$102.17 ,$30.16 ,$91.20 ,$96.90 ,$71.25 ,$102.60 , N/A , N/A ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$30.16 ,$96.90 ,$96.90 ,$102.60 ,$69.43 , N/A ,$70.68 , N/A ,$102.60 , N/A ,$104.88 ,$102.60 ,$75.25 ,$75.25 ,$69.43 ,$75.25 ,$74.10 ,$77.88 ,$25.95 ,$90.06 , N/A ,$55.86 ,$55.86 ,$30.16 ,$55.86 , 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 ,$85.14 ,$29.37 ,$129.00 , N/A ,$115.61 ,$115.61 ,$34.13 ,$103.20 ,$109.65 ,$80.63 ,$116.10 , N/A , N/A ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$34.13 ,$109.65 ,$109.65 ,$116.10 ,$78.56 , N/A ,$79.98 , N/A ,$116.10 , N/A ,$118.68 ,$116.10 ,$85.15 ,$85.15 ,$78.56 ,$85.15 ,$83.85 ,$88.13 ,$29.37 ,$101.91 , N/A ,$63.21 ,$63.21 ,$34.13 ,$63.21 , 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 ,$98.34 ,$33.92 ,$149.00 , N/A ,$133.53 ,$133.53 ,$39.43 ,$119.20 ,$126.65 ,$93.13 ,$134.10 , N/A , N/A ,$141.55 ,$134.10 ,$126.65 ,$126.65 ,$39.43 ,$126.65 ,$126.65 ,$134.10 ,$90.74 , N/A ,$92.38 , N/A ,$134.10 , N/A ,$137.08 ,$134.10 ,$98.35 ,$98.35 ,$90.74 ,$98.35 ,$96.85 ,$101.80 ,$33.92 ,$117.71 , N/A ,$73.01 ,$73.01 ,$39.43 ,$73.01 , 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 ,$153.78 ,$53.05 ,$233.00 , N/A ,$208.81 ,$208.81 ,$61.65 ,$186.40 ,$198.05 ,$145.63 ,$209.70 , N/A , N/A ,$221.35 ,$209.70 ,$198.05 ,$198.05 ,$61.65 ,$198.05 ,$198.05 ,$209.70 ,$141.90 , N/A ,$144.46 , N/A ,$209.70 , N/A ,$214.36 ,$209.70 ,$153.80 ,$153.80 ,$141.90 ,$153.80 ,$151.45 ,$159.19 ,$53.05 ,$184.07 , N/A ,$114.17 ,$114.17 ,$61.65 ,$114.17 , 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 ,$314.16 ,$108.36 ,$476.00 , N/A ,$426.59 ,$426.59 ,$125.95 ,$380.80 ,$404.60 ,$297.50 ,$428.40 , N/A , N/A ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$125.95 ,$404.60 ,$404.60 ,$428.40 ,$289.88 , N/A ,$295.12 , N/A ,$428.40 , N/A ,$437.92 ,$428.40 ,$314.21 ,$314.21 ,$289.88 ,$314.21 ,$309.40 ,$325.20 ,$108.36 ,$376.04 , N/A ,$233.24 ,$233.24 ,$125.95 ,$233.24 , 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 ,$23.76 ,$8.19 ,$36.00 , N/A ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A ,$22.32 , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 , N/A ,$17.64 ,$17.64 ,$9.53 ,$17.64 , 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 ,$62.04 ,$21.40 ,$94.00 , N/A ,$84.24 ,$84.24 ,$24.87 ,$75.20 ,$79.90 ,$58.75 ,$84.60 , N/A , N/A ,$89.30 ,$84.60 ,$79.90 ,$79.90 ,$24.87 ,$79.90 ,$79.90 ,$84.60 ,$57.25 , N/A ,$58.28 , N/A ,$84.60 , N/A ,$86.48 ,$84.60 ,$62.05 ,$62.05 ,$57.25 ,$62.05 ,$61.10 ,$64.22 ,$21.40 ,$74.26 , N/A ,$46.06 ,$46.06 ,$24.87 ,$46.06 , 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 ,$200.00 ,$132.00 ,$45.53 ,$200.00 , N/A ,$179.24 ,$179.24 ,$52.92 ,$160.00 ,$170.00 ,$125.00 ,$180.00 , N/A , N/A ,$190.00 ,$180.00 ,$170.00 ,$170.00 ,$52.92 ,$170.00 ,$170.00 ,$180.00 ,$121.80 , N/A ,$124.00 , N/A ,$180.00 , N/A ,$184.00 ,$180.00 ,$132.02 ,$132.02 ,$121.80 ,$132.02 ,$130.00 ,$136.64 ,$45.53 ,$158.00 , N/A ,$98.00 ,$98.00 ,$52.92 ,$98.00 , N/A ,$190.00 ,$164.00 ,$164.00 ,$160.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280195,N/A,HC CUTTER LINEAR ETS FLEX 45MM,272,1 ,$670.42 ,$442.48 ,$152.63 ,$670.42 , N/A ,$600.83 ,$600.83 ,$177.39 ,$536.34 ,$569.86 ,$419.01 ,$603.38 , N/A , N/A ,$636.90 ,$603.38 ,$569.86 ,$569.86 ,$177.39 ,$569.86 ,$569.86 ,$603.38 ,$408.29 , N/A ,$415.66 , N/A ,$603.38 , N/A ,$616.79 ,$603.38 ,$442.54 ,$442.54 ,$408.29 ,$442.54 ,$435.77 ,$458.03 ,$152.63 ,$529.63 , N/A ,$328.51 ,$328.51 ,$177.39 ,$328.51 , N/A ,$636.90 ,$549.74 ,$549.74 ,$536.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280197,N/A,HC NEEDLE VERRES,272,1 ,$27.49 ,$18.14 ,$6.25 ,$27.49 , N/A ,$24.64 ,$24.64 ,$7.27 ,$21.99 ,$23.37 ,$17.18 ,$24.74 , N/A , N/A ,$26.12 ,$24.74 ,$23.37 ,$23.37 ,$7.27 ,$23.37 ,$23.37 ,$24.74 ,$16.74 , N/A ,$17.04 , N/A ,$24.74 , N/A ,$25.29 ,$24.74 ,$18.15 ,$18.15 ,$16.74 ,$18.15 ,$17.87 ,$18.78 ,$6.25 ,$21.72 , N/A ,$13.47 ,$13.47 ,$7.27 ,$13.47 , N/A ,$26.12 ,$22.54 ,$22.54 ,$21.99 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280198,N/A,HC SLEEVE TROCAR,272,1 ,$17.56 ,$11.59 ,$4.00 ,$17.56 , N/A ,$15.74 ,$15.74 ,$4.65 ,$14.05 ,$14.93 ,$10.98 ,$15.80 , N/A , N/A ,$16.68 ,$15.80 ,$14.93 ,$14.93 ,$4.65 ,$14.93 ,$14.93 ,$15.80 ,$10.69 , N/A ,$10.88 , N/A ,$15.80 , N/A ,$16.16 ,$15.80 ,$11.59 ,$11.59 ,$10.69 ,$11.59 ,$11.41 ,$12.00 ,$4.00 ,$13.87 , N/A ,$8.60 ,$8.60 ,$4.65 ,$8.60 , N/A ,$16.68 ,$14.40 ,$14.40 ,$14.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280199,N/A,HC TROCAR 11 12,272,1 ,$58.10 ,$38.35 ,$13.22 ,$58.10 , N/A ,$52.07 ,$52.07 ,$15.38 ,$46.48 ,$49.39 ,$36.31 ,$52.29 , N/A , N/A ,$55.20 ,$52.29 ,$49.39 ,$49.39 ,$15.38 ,$49.39 ,$49.39 ,$52.29 ,$35.38 , N/A ,$36.02 , N/A ,$52.29 , N/A ,$53.45 ,$52.29 ,$38.35 ,$38.35 ,$35.38 ,$38.35 ,$37.77 ,$39.69 ,$13.22 ,$45.90 , N/A ,$28.47 ,$28.47 ,$15.38 ,$28.47 , N/A ,$55.20 ,$47.64 ,$47.64 ,$46.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280200,N/A,HC TROCAR 5,272,1 ,$36.52 ,$24.10 ,$8.31 ,$36.52 , N/A ,$32.73 ,$32.73 ,$9.66 ,$29.22 ,$31.04 ,$22.83 ,$32.87 , N/A , N/A ,$34.69 ,$32.87 ,$31.04 ,$31.04 ,$9.66 ,$31.04 ,$31.04 ,$32.87 ,$22.24 , N/A ,$22.64 , N/A ,$32.87 , N/A ,$33.60 ,$32.87 ,$24.11 ,$24.11 ,$22.24 ,$24.11 ,$23.74 ,$24.95 ,$8.31 ,$28.85 , N/A ,$17.89 ,$17.89 ,$9.66 ,$17.89 , N/A ,$34.69 ,$29.95 ,$29.95 ,$29.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27280201,N/A,HC SUTURE LIGATURE,272,1 ,$50.00 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A ,$31.00 , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 , N/A ,$24.50 ,$24.50 ,$13.23 ,$24.50 , 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 ,$0.99 ,$0.34 ,$1.50 , N/A ,$1.34 ,$1.34 ,$0.40 ,$1.20 ,$1.28 ,$0.94 ,$1.35 , N/A , N/A ,$1.43 ,$1.35 ,$1.28 ,$1.28 ,$0.40 ,$1.28 ,$1.28 ,$1.35 ,$0.91 , N/A ,$0.94 , N/A ,$1.35 , N/A ,$1.38 ,$1.35 ,$0.99 ,$0.99 ,$0.91 ,$0.99 ,$0.98 ,$1.02 ,$0.34 ,$1.19 , N/A ,$0.74 ,$0.74 ,$0.40 ,$0.74 , 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 ,$42.24 ,$14.57 ,$64.00 , N/A ,$57.36 ,$57.36 ,$16.93 ,$51.20 ,$54.40 ,$40.00 ,$57.60 , N/A , N/A ,$60.80 ,$57.60 ,$54.40 ,$54.40 ,$16.93 ,$54.40 ,$54.40 ,$57.60 ,$38.98 , N/A ,$39.68 , N/A ,$57.60 , N/A ,$58.88 ,$57.60 ,$42.25 ,$42.25 ,$38.98 ,$42.25 ,$41.60 ,$43.72 ,$14.57 ,$50.56 , N/A , N/A , N/A ,$16.93 , 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 ,$45.54 ,$15.71 ,$85.64 , N/A ,$30.33 ,$30.33 ,$18.26 ,$55.20 ,$58.65 ,$43.13 ,$62.10 , N/A , N/A ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$18.26 ,$58.65 ,$58.65 ,$62.10 ,$42.02 , N/A ,$42.78 , N/A ,$62.10 ,$85.64 ,$63.48 ,$62.10 ,$45.55 ,$45.55 ,$42.02 ,$45.55 ,$44.85 ,$47.14 ,$15.71 ,$54.51 , N/A , N/A , N/A ,$18.26 , N/A ,$38.06 ,$65.55 ,$56.58 ,$56.58 ,$55.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400004,L0140,HC CERVICAL COLLAR ADJUSTABLE,274,1 ,$194.92 ,$128.65 ,$44.37 ,$211.28 , N/A ,$68.65 ,$68.65 ,$51.58 ,$155.94 ,$165.68 ,$121.83 ,$175.43 , N/A , N/A ,$185.17 ,$175.43 ,$165.68 ,$165.68 ,$51.58 ,$165.68 ,$165.68 ,$175.43 ,$118.71 , N/A ,$120.86 , N/A ,$175.43 ,$211.28 ,$179.33 ,$175.43 ,$128.67 ,$128.67 ,$118.71 ,$128.67 ,$126.70 ,$133.17 ,$44.37 ,$153.99 , N/A , N/A , N/A ,$51.58 , N/A ,$93.90 ,$185.17 ,$159.83 ,$159.83 ,$155.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400006,L0150,HC PHILADELPHA COLLAR,274,1 ,$127.00 ,$83.82 ,$28.91 ,$278.10 , N/A ,$122.75 ,$122.75 ,$33.60 ,$101.60 ,$107.95 ,$79.38 ,$114.30 , N/A , N/A ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$33.60 ,$107.95 ,$107.95 ,$114.30 ,$77.34 , N/A ,$78.74 , N/A ,$114.30 ,$278.10 ,$116.84 ,$114.30 ,$83.83 ,$83.83 ,$77.34 ,$83.83 ,$82.55 ,$86.77 ,$28.91 ,$100.33 , N/A , N/A , N/A ,$33.60 , N/A ,$123.60 ,$120.65 ,$104.14 ,$104.14 ,$101.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400010,L0172,HC CERVICAL COLLAR TWO PIECE,274,1 ,$282.67 ,$186.56 ,$64.35 ,$419.56 , N/A ,$162.42 ,$162.42 ,$74.79 ,$226.14 ,$240.27 ,$176.67 ,$254.40 , N/A , N/A ,$268.54 ,$254.40 ,$240.27 ,$240.27 ,$74.79 ,$240.27 ,$240.27 ,$254.40 ,$172.15 , N/A ,$175.26 , N/A ,$254.40 ,$419.56 ,$260.06 ,$254.40 ,$186.59 ,$186.59 ,$172.15 ,$186.59 ,$183.74 ,$193.12 ,$64.35 ,$223.31 , N/A , N/A , N/A ,$74.79 , N/A ,$186.47 ,$268.54 ,$231.79 ,$231.79 ,$226.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400014,L1830,HC IMMOB KNEE REG 20 LARGE,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400018,L1830,HC KNEE BRACE - HINGED,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400019,L1830,HC KNEE IMMOBILIZER,274,1 ,$120.14 ,$79.29 ,$27.35 ,$187.28 , N/A ,$74.01 ,$74.01 ,$31.79 ,$96.11 ,$102.12 ,$75.09 ,$108.13 , N/A , N/A ,$114.13 ,$108.13 ,$102.12 ,$102.12 ,$31.79 ,$102.12 ,$102.12 ,$108.13 ,$73.17 , N/A ,$74.48 , N/A ,$108.13 ,$187.28 ,$110.53 ,$108.13 ,$79.30 ,$79.30 ,$73.17 ,$79.30 ,$78.09 ,$82.08 ,$27.35 ,$94.91 , N/A , N/A , N/A ,$31.79 , N/A ,$83.24 ,$114.13 ,$98.51 ,$98.51 ,$96.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400020,L1830,HC KNEE IMMOBILIZER 16 IN,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400021,L1830,HC KNEE IMMOBILIZER 26 IN,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400023,L1830,HC KNEE IMMOBILIZER 22IN,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400028,L1830,HC KNEE IMMOBILIZER FIT  AND  ADJ,274,1 ,$158.78 ,$104.79 ,$36.15 ,$204.67 , N/A ,$74.01 ,$74.01 ,$42.01 ,$127.02 ,$134.96 ,$99.24 ,$142.90 , N/A , N/A ,$150.84 ,$142.90 ,$134.96 ,$134.96 ,$42.01 ,$134.96 ,$134.96 ,$142.90 ,$96.70 , N/A ,$98.44 , N/A ,$142.90 ,$204.67 ,$146.08 ,$142.90 ,$104.81 ,$104.81 ,$96.70 ,$104.81 ,$103.21 ,$108.48 ,$36.15 ,$125.44 , N/A , N/A , N/A ,$42.01 , N/A ,$90.96 ,$150.84 ,$130.20 ,$130.20 ,$127.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400029,L1830,HC KNEE IMMOBILIZER ZIMMER 24INCH,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400031,L1832,HC BRACE KNEE EZ,274,1 ,$186.00 ,$122.76 ,$42.35 ,"$1,505.56 ", N/A ,$186.00 ,$186.00 ,$49.22 ,$148.80 ,$158.10 ,$116.25 ,$167.40 , N/A , N/A ,$176.70 ,$167.40 ,$158.10 ,$158.10 ,$49.22 ,$158.10 ,$158.10 ,$167.40 ,$113.27 , N/A ,$115.32 , N/A ,$167.40 ,"$1,505.56 ",$171.12 ,$167.40 ,$122.78 ,$122.78 ,$113.27 ,$122.78 ,$120.90 ,$127.08 ,$42.35 ,$146.94 , N/A , N/A , N/A ,$49.22 , N/A ,$669.14 ,$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 ,$91.74 ,$31.64 ,$139.00 , N/A ,$124.57 ,$124.57 ,$36.78 ,$111.20 ,$118.15 ,$86.88 ,$125.10 , N/A , N/A ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$36.78 ,$118.15 ,$118.15 ,$125.10 ,$84.65 , N/A ,$86.18 , N/A ,$125.10 , N/A ,$127.88 ,$125.10 ,$91.75 ,$91.75 ,$84.65 ,$91.75 ,$90.35 ,$94.96 ,$31.64 ,$109.81 , N/A ,$68.11 ,$68.11 ,$36.78 ,$68.11 , 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 ,$151.80 ,$52.36 ,$573.25 , N/A ,$230.00 ,$230.00 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 , N/A ,$142.60 , N/A ,$207.00 ,$573.25 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 , N/A , N/A , N/A ,$60.86 , N/A ,$254.78 ,$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 ,$102.30 ,$35.29 ,$207.49 , N/A ,$76.52 ,$76.52 ,$41.01 ,$124.00 ,$131.75 ,$96.88 ,$139.50 , N/A , N/A ,$147.25 ,$139.50 ,$131.75 ,$131.75 ,$41.01 ,$131.75 ,$131.75 ,$139.50 ,$94.40 , N/A ,$96.10 , N/A ,$139.50 ,$207.49 ,$142.60 ,$139.50 ,$102.32 ,$102.32 ,$94.40 ,$102.32 ,$100.75 ,$105.90 ,$35.29 ,$122.45 , N/A , N/A , N/A ,$41.01 , N/A ,$92.22 ,$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 ,$334.62 ,$115.42 ,$736.92 , N/A ,$282.65 ,$282.65 ,$134.15 ,$405.60 ,$430.95 ,$316.88 ,$456.30 , N/A , N/A ,$481.65 ,$456.30 ,$430.95 ,$430.95 ,$134.15 ,$430.95 ,$430.95 ,$456.30 ,$308.76 , N/A ,$314.34 , N/A ,$456.30 ,$736.92 ,$466.44 ,$456.30 ,$334.67 ,$334.67 ,$308.76 ,$334.67 ,$329.55 ,$346.38 ,$115.42 ,$400.53 , N/A , N/A , N/A ,$134.15 , N/A ,$327.52 ,$481.65 ,$415.74 ,$415.74 ,$405.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400063,L4350,HC AIR CAST/FIT  AND  ADJ,274,1 ,$194.06 ,$128.08 ,$44.18 ,$287.06 , N/A ,$110.96 ,$110.96 ,$51.35 ,$155.25 ,$164.95 ,$121.29 ,$174.65 , N/A , N/A ,$184.36 ,$174.65 ,$164.95 ,$164.95 ,$51.35 ,$164.95 ,$164.95 ,$174.65 ,$118.18 , N/A ,$120.32 , N/A ,$174.65 ,$287.06 ,$178.54 ,$174.65 ,$128.10 ,$128.10 ,$118.18 ,$128.10 ,$126.14 ,$132.58 ,$44.18 ,$153.31 , N/A , N/A , N/A ,$51.35 , N/A ,$127.58 ,$184.36 ,$159.13 ,$159.13 ,$155.25 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400064,L4360,HC AIRWALKER SPLINT INCL FITTING,274,1 ,$522.00 ,$344.52 ,$118.83 ,$769.34 , N/A ,$296.91 ,$296.91 ,$138.12 ,$417.60 ,$443.70 ,$326.25 ,$469.80 , N/A , N/A ,$495.90 ,$469.80 ,$443.70 ,$443.70 ,$138.12 ,$443.70 ,$443.70 ,$469.80 ,$317.90 , N/A ,$323.64 , N/A ,$469.80 ,$769.34 ,$480.24 ,$469.80 ,$344.57 ,$344.57 ,$317.90 ,$344.57 ,$339.30 ,$356.63 ,$118.83 ,$412.38 , N/A , N/A , N/A ,$138.12 , N/A ,$341.93 ,$495.90 ,$428.04 ,$428.04 ,$417.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400065,L4386,HC ROM WALKER BOOT FIT  AND  ADJ,274,1 ,$318.30 ,$210.08 ,$72.46 ,$470.53 , N/A ,$181.83 ,$181.83 ,$84.22 ,$254.64 ,$270.56 ,$198.94 ,$286.47 , N/A , N/A ,$302.39 ,$286.47 ,$270.56 ,$270.56 ,$84.22 ,$270.56 ,$270.56 ,$286.47 ,$193.84 , N/A ,$197.34 , N/A ,$286.47 ,$470.53 ,$292.84 ,$286.47 ,$210.11 ,$210.11 ,$193.84 ,$210.11 ,$206.90 ,$217.46 ,$72.46 ,$251.46 , N/A , N/A , N/A ,$84.22 , N/A ,$209.12 ,$302.39 ,$261.01 ,$261.01 ,$254.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400069,L8501,HC PASSEY MUIR VALVE,274,1 ,$269.00 ,$177.54 ,$61.24 ,$369.45 , N/A ,$138.00 ,$138.00 ,$71.18 ,$215.20 ,$228.65 ,$168.13 ,$242.10 , N/A , N/A ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$71.18 ,$228.65 ,$228.65 ,$242.10 ,$163.82 , N/A ,$166.78 , N/A ,$242.10 ,$369.45 ,$247.48 ,$242.10 ,$177.57 ,$177.57 ,$163.82 ,$177.57 ,$174.85 ,$183.78 ,$61.24 ,$212.51 , N/A , N/A , N/A ,$71.18 , N/A ,$164.20 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400080,L3935,HC THUMB SPLINT FIT AND ADJUST,274,1 ,$232.00 ,$153.12 ,$52.81 ,$519.41 , N/A ,$230.56 ,$230.56 ,$61.39 ,$185.60 ,$197.20 ,$145.00 ,$208.80 , N/A , N/A ,$220.40 ,$208.80 ,$197.20 ,$197.20 ,$61.39 ,$197.20 ,$197.20 ,$208.80 ,$141.29 , N/A ,$143.84 , N/A ,$208.80 ,$519.41 ,$213.44 ,$208.80 ,$153.14 ,$153.14 ,$141.29 ,$153.14 ,$150.80 ,$158.50 ,$52.81 ,$183.28 , N/A , N/A , N/A ,$61.39 , N/A ,$230.85 ,$220.40 ,$190.24 ,$190.24 ,$185.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400109,L3702,HC ORTHOSIS ELBOW W/O JOINTS CUSTOM,274,1 ,$476.00 ,$314.16 ,$108.36 ,$756.68 , N/A ,$301.38 ,$301.38 ,$125.95 ,$380.80 ,$404.60 ,$297.50 ,$428.40 , N/A , N/A ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$125.95 ,$404.60 ,$404.60 ,$428.40 ,$289.88 , N/A ,$295.12 , N/A ,$428.40 ,$756.68 ,$437.92 ,$428.40 ,$314.21 ,$314.21 ,$289.88 ,$314.21 ,$309.40 ,$325.20 ,$108.36 ,$376.04 , N/A , N/A , N/A ,$125.95 , N/A ,$336.30 ,$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 ,$436.92 ,$150.70 ,$967.12 , N/A ,$371.79 ,$371.79 ,$175.17 ,$529.60 ,$562.70 ,$413.75 ,$595.80 , N/A , N/A ,$628.90 ,$595.80 ,$562.70 ,$562.70 ,$175.17 ,$562.70 ,$562.70 ,$595.80 ,$403.16 , N/A ,$410.44 , N/A ,$595.80 ,$967.12 ,$609.04 ,$595.80 ,$436.99 ,$436.99 ,$403.16 ,$436.99 ,$430.30 ,$452.28 ,$150.70 ,$522.98 , N/A , N/A , N/A ,$175.17 , N/A ,$429.83 ,$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 ,$615.12 ,$212.17 ,"$1,371.44 ", N/A ,$528.91 ,$528.91 ,$246.61 ,$745.60 ,$792.20 ,$582.50 ,$838.80 , N/A , N/A ,$885.40 ,$838.80 ,$792.20 ,$792.20 ,$246.61 ,$792.20 ,$792.20 ,$838.80 ,$567.59 , N/A ,$577.84 , N/A ,$838.80 ,"$1,371.44 ",$857.44 ,$838.80 ,$615.21 ,$615.21 ,$567.59 ,$615.21 ,$605.80 ,$636.74 ,$212.17 ,$736.28 , N/A , N/A , N/A ,$246.61 , N/A ,$609.53 ,$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 ,$553.08 ,$190.78 ,"$1,230.43 ", N/A ,$474.07 ,$474.07 ,$221.73 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$221.73 ,$712.30 ,$712.30 ,$754.20 ,$510.34 , N/A ,$519.56 , N/A ,$754.20 ,"$1,230.43 ",$770.96 ,$754.20 ,$553.16 ,$553.16 ,$510.34 ,$553.16 ,$544.70 ,$572.52 ,$190.78 ,$662.02 , N/A , N/A , N/A ,$221.73 , N/A ,$546.86 ,$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 ,$314.16 ,$108.36 ,$683.95 , N/A ,$260.97 ,$260.97 ,$125.95 ,$380.80 ,$404.60 ,$297.50 ,$428.40 , N/A , N/A ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$125.95 ,$404.60 ,$404.60 ,$428.40 ,$289.88 , N/A ,$295.12 , N/A ,$428.40 ,$683.95 ,$437.92 ,$428.40 ,$314.21 ,$314.21 ,$289.88 ,$314.21 ,$309.40 ,$325.20 ,$108.36 ,$376.04 , N/A , N/A , N/A ,$125.95 , N/A ,$303.98 ,$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 ,$266.64 ,$91.97 ,$582.64 , N/A ,$222.69 ,$222.69 ,$106.90 ,$323.20 ,$343.40 ,$252.50 ,$363.60 , N/A , N/A ,$383.80 ,$363.60 ,$343.40 ,$343.40 ,$106.90 ,$343.40 ,$343.40 ,$363.60 ,$246.04 , N/A ,$250.48 , N/A ,$363.60 ,$582.64 ,$371.68 ,$363.60 ,$266.68 ,$266.68 ,$246.04 ,$266.68 ,$262.60 ,$276.01 ,$91.97 ,$319.16 , N/A , N/A , N/A ,$106.90 , N/A ,$258.95 ,$383.80 ,$331.28 ,$331.28 ,$323.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27400223,L3807,HC RADIAL NERVE PALSY SPLINT,274,1 ,$230.00 ,$151.80 ,$52.36 ,$573.25 , N/A ,$230.00 ,$230.00 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 , N/A ,$142.60 , N/A ,$207.00 ,$573.25 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 , N/A , N/A , N/A ,$60.86 , N/A ,$254.78 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480001,L3000,HC FOOT INSERT UCB LT,274,1 ,$184.00 ,$121.44 ,$41.89 ,$731.25 , N/A ,$184.00 ,$184.00 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 , N/A , N/A ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 , N/A ,$114.08 , N/A ,$165.60 ,$731.25 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 , N/A , N/A , N/A ,$48.69 , N/A ,$325.00 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480002,L3000,HC FOOT INSERT UCB RT,274,1 ,$184.00 ,$121.44 ,$41.89 ,$731.25 , N/A ,$184.00 ,$184.00 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 , N/A , N/A ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 , N/A ,$114.08 , N/A ,$165.60 ,$731.25 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 , N/A , N/A , N/A ,$48.69 , N/A ,$325.00 ,$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 ,$110.22 ,$38.01 ,$744.37 , N/A ,$167.00 ,$167.00 ,$44.19 ,$133.60 ,$141.95 ,$104.38 ,$150.30 , N/A , N/A ,$158.65 ,$150.30 ,$141.95 ,$141.95 ,$44.19 ,$141.95 ,$141.95 ,$150.30 ,$101.70 , N/A ,$103.54 , N/A ,$150.30 ,$744.37 ,$153.64 ,$150.30 ,$110.24 ,$110.24 ,$101.70 ,$110.24 ,$108.55 ,$114.09 ,$38.01 ,$131.93 , N/A , N/A , N/A ,$44.19 , N/A ,$330.83 ,$158.65 ,$136.94 ,$136.94 ,$133.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27480004,L1830,HC KNEE IMMOBILIZER 28 IN,274,1 ,$123.00 ,$81.18 ,$28.00 ,$188.57 , N/A ,$74.01 ,$74.01 ,$32.55 ,$98.40 ,$104.55 ,$76.88 ,$110.70 , N/A , N/A ,$116.85 ,$110.70 ,$104.55 ,$104.55 ,$32.55 ,$104.55 ,$104.55 ,$110.70 ,$74.91 , N/A ,$76.26 , N/A ,$110.70 ,$188.57 ,$113.16 ,$110.70 ,$81.19 ,$81.19 ,$74.91 ,$81.19 ,$79.95 ,$84.03 ,$28.00 ,$97.17 , N/A , N/A , N/A ,$32.55 , N/A ,$83.81 ,$116.85 ,$100.86 ,$100.86 ,$98.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27500004,C1778,HC NEURO STIMULATOR LEAD,275,1 ,"$2,493.00 ","$1,645.38 ",$567.54 ,"$2,493.00 ", N/A ,"$2,234.23 ","$2,234.23 ",$659.65 ,"$1,994.40 ","$2,119.05 ","$1,558.13 ","$2,243.70 ", N/A , N/A ,"$2,368.35 ","$2,243.70 ","$2,119.05 ","$2,119.05 ",$659.65 ,"$2,119.05 ","$2,119.05 ","$2,243.70 ","$1,518.24 ", N/A ,"$1,545.66 ", N/A ,"$2,243.70 ", N/A ,"$2,293.56 ","$2,243.70 ","$1,645.63 ","$1,645.63 ","$1,518.24 ","$1,645.63 ","$1,620.45 ","$1,703.22 ",$567.54 ,"$1,969.47 ", N/A , N/A , N/A ,$659.65 , 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 ,$238.92 ,$82.41 ,$362.00 , N/A ,$324.42 ,$324.42 ,$95.79 ,$289.60 ,$307.70 ,$226.25 ,$325.80 , N/A , N/A ,$343.90 ,$325.80 ,$307.70 ,$307.70 ,$95.79 ,$307.70 ,$307.70 ,$325.80 ,$220.46 , N/A ,$224.44 , N/A ,$325.80 , N/A ,$333.04 ,$325.80 ,$238.96 ,$238.96 ,$220.46 ,$238.96 ,$235.30 ,$247.32 ,$82.41 ,$285.98 , N/A , N/A , N/A ,$95.79 , 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 ,$451.14 ,$297.75 ,$102.70 ,$451.14 , N/A ,$135.98 ,$135.98 ,$119.37 ,$360.91 ,$383.47 ,$281.96 ,$406.03 , N/A , N/A ,$428.58 ,$406.03 ,$383.47 ,$383.47 ,$119.37 ,$383.47 ,$383.47 ,$406.03 ,$274.74 , N/A ,$279.70 , N/A ,$406.03 , N/A ,$415.05 ,$406.03 ,$297.80 ,$297.80 ,$274.74 ,$297.80 ,$293.24 ,$308.22 ,$102.70 ,$356.40 , N/A , N/A , N/A ,$119.37 , N/A , N/A ,$428.58 ,$369.93 ,$369.93 ,$360.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),27671780,C1780,IOL PRECISION AR40E,276,1 ,$450.00 ,$297.00 ,$102.45 ,$450.00 , N/A ,$403.29 ,$403.29 ,$119.07 ,$360.00 ,$382.50 ,$281.25 ,$405.00 , N/A , N/A ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$119.07 ,$382.50 ,$382.50 ,$405.00 ,$274.05 , N/A ,$279.00 , N/A ,$405.00 , N/A ,$414.00 ,$405.00 ,$297.05 ,$297.05 ,$274.05 ,$297.05 ,$292.50 ,$307.44 ,$102.45 ,$355.50 , N/A , N/A , N/A ,$119.07 , N/A , N/A ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27672632,V2632,IOL PRECISION ZA9003,276,1 ,$337.50 ,$222.75 ,$76.84 ,$337.50 , N/A ,$135.98 ,$135.98 ,$89.31 ,$270.00 ,$286.88 ,$210.94 ,$303.75 , N/A , N/A ,$320.63 ,$303.75 ,$286.88 ,$286.88 ,$89.31 ,$286.88 ,$286.88 ,$303.75 ,$205.54 , N/A ,$209.26 , N/A ,$303.75 , N/A ,$310.50 ,$303.75 ,$222.78 ,$222.78 ,$205.54 ,$222.78 ,$219.38 ,$230.58 ,$76.84 ,$266.63 , N/A , N/A , N/A ,$89.31 , N/A , N/A ,$320.63 ,$276.75 ,$276.75 ,$270.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27672632,V2632,IOL TECNIS SIMPLICITY DCB00,276,1 ,$281.25 ,$185.63 ,$64.03 ,$281.25 , N/A ,$135.98 ,$135.98 ,$74.42 ,$225.00 ,$239.06 ,$175.78 ,$253.13 , N/A , N/A ,$267.19 ,$253.13 ,$239.06 ,$239.06 ,$74.42 ,$239.06 ,$239.06 ,$253.13 ,$171.28 , N/A ,$174.38 , N/A ,$253.13 , N/A ,$258.75 ,$253.13 ,$185.65 ,$185.65 ,$171.28 ,$185.65 ,$182.81 ,$192.15 ,$64.03 ,$222.19 , N/A , N/A , N/A ,$74.42 , N/A , N/A ,$267.19 ,$230.63 ,$230.63 ,$225.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800001,C1713,HC 1.3MM TI EXTENDED H PLT R/L,278,1 ,$874.00 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ,$601.92 ,$207.62 ,$912.00 , N/A ,$817.33 ,$817.33 ,$241.32 ,$729.60 ,$775.20 ,$570.00 ,$820.80 , N/A , N/A ,$866.40 ,$820.80 ,$775.20 ,$775.20 ,$241.32 ,$775.20 ,$775.20 ,$820.80 ,$555.41 , N/A ,$565.44 , N/A ,$820.80 , N/A ,$839.04 ,$820.80 ,$602.01 ,$602.01 ,$555.41 ,$602.01 ,$592.80 ,$623.08 ,$207.62 ,$720.48 , N/A , N/A , N/A ,$241.32 , 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 ,$478.50 ,$165.05 ,$725.00 , N/A ,$649.75 ,$649.75 ,$191.83 ,$580.00 ,$616.25 ,$453.13 ,$652.50 , N/A , N/A ,$688.75 ,$652.50 ,$616.25 ,$616.25 ,$191.83 ,$616.25 ,$616.25 ,$652.50 ,$441.53 , N/A ,$449.50 , N/A ,$652.50 , N/A ,$667.00 ,$652.50 ,$478.57 ,$478.57 ,$441.53 ,$478.57 ,$471.25 ,$495.32 ,$165.05 ,$572.75 , N/A , N/A , N/A ,$191.83 , 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 ,$552.42 ,$190.55 ,$837.00 , N/A ,$750.12 ,$750.12 ,$221.47 ,$669.60 ,$711.45 ,$523.13 ,$753.30 , N/A , N/A ,$795.15 ,$753.30 ,$711.45 ,$711.45 ,$221.47 ,$711.45 ,$711.45 ,$753.30 ,$509.73 , N/A ,$518.94 , N/A ,$753.30 , N/A ,$770.04 ,$753.30 ,$552.50 ,$552.50 ,$509.73 ,$552.50 ,$544.05 ,$571.84 ,$190.55 ,$661.23 , N/A , N/A , N/A ,$221.47 , 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 ",$716.76 ,$247.23 ,"$1,086.00 ", N/A ,$973.27 ,$973.27 ,$287.36 ,$868.80 ,$923.10 ,$678.75 ,$977.40 , N/A , N/A ,"$1,031.70 ",$977.40 ,$923.10 ,$923.10 ,$287.36 ,$923.10 ,$923.10 ,$977.40 ,$661.37 , N/A ,$673.32 , N/A ,$977.40 , N/A ,$999.12 ,$977.40 ,$716.87 ,$716.87 ,$661.37 ,$716.87 ,$705.90 ,$741.96 ,$247.23 ,$857.94 , N/A , N/A , N/A ,$287.36 , 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 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ,$601.92 ,$207.62 ,$912.00 , N/A ,$817.33 ,$817.33 ,$241.32 ,$729.60 ,$775.20 ,$570.00 ,$820.80 , N/A , N/A ,$866.40 ,$820.80 ,$775.20 ,$775.20 ,$241.32 ,$775.20 ,$775.20 ,$820.80 ,$555.41 , N/A ,$565.44 , N/A ,$820.80 , N/A ,$839.04 ,$820.80 ,$602.01 ,$602.01 ,$555.41 ,$602.01 ,$592.80 ,$623.08 ,$207.62 ,$720.48 , N/A , N/A , N/A ,$241.32 , 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 ,$478.50 ,$165.05 ,$725.00 , N/A ,$649.75 ,$649.75 ,$191.83 ,$580.00 ,$616.25 ,$453.13 ,$652.50 , N/A , N/A ,$688.75 ,$652.50 ,$616.25 ,$616.25 ,$191.83 ,$616.25 ,$616.25 ,$652.50 ,$441.53 , N/A ,$449.50 , N/A ,$652.50 , N/A ,$667.00 ,$652.50 ,$478.57 ,$478.57 ,$441.53 ,$478.57 ,$471.25 ,$495.32 ,$165.05 ,$572.75 , N/A , N/A , N/A ,$191.83 , 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 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ,$553.08 ,$190.78 ,$838.00 , N/A ,$751.02 ,$751.02 ,$221.73 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$221.73 ,$712.30 ,$712.30 ,$754.20 ,$510.34 , N/A ,$519.56 , N/A ,$754.20 , N/A ,$770.96 ,$754.20 ,$553.16 ,$553.16 ,$510.34 ,$553.16 ,$544.70 ,$572.52 ,$190.78 ,$662.02 , N/A , N/A , N/A ,$221.73 , 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 ,$553.08 ,$190.78 ,$838.00 , N/A ,$751.02 ,$751.02 ,$221.73 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$221.73 ,$712.30 ,$712.30 ,$754.20 ,$510.34 , N/A ,$519.56 , N/A ,$754.20 , N/A ,$770.96 ,$754.20 ,$553.16 ,$553.16 ,$510.34 ,$553.16 ,$544.70 ,$572.52 ,$190.78 ,$662.02 , N/A , N/A , N/A ,$221.73 , 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 ",$744.48 ,$256.79 ,"$1,128.00 ", N/A ,"$1,010.91 ","$1,010.91 ",$298.47 ,$902.40 ,$958.80 ,$705.00 ,"$1,015.20 ", N/A , N/A ,"$1,071.60 ","$1,015.20 ",$958.80 ,$958.80 ,$298.47 ,$958.80 ,$958.80 ,"$1,015.20 ",$686.95 , N/A ,$699.36 , N/A ,"$1,015.20 ", N/A ,"$1,037.76 ","$1,015.20 ",$744.59 ,$744.59 ,$686.95 ,$744.59 ,$733.20 ,$770.65 ,$256.79 ,$891.12 , N/A , N/A , N/A ,$298.47 , 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 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ",$681.12 ,$234.94 ,"$1,032.00 ", N/A ,$924.88 ,$924.88 ,$273.07 ,$825.60 ,$877.20 ,$645.00 ,$928.80 , N/A , N/A ,$980.40 ,$928.80 ,$877.20 ,$877.20 ,$273.07 ,$877.20 ,$877.20 ,$928.80 ,$628.49 , N/A ,$639.84 , N/A ,$928.80 , N/A ,$949.44 ,$928.80 ,$681.22 ,$681.22 ,$628.49 ,$681.22 ,$670.80 ,$705.06 ,$234.94 ,$815.28 , N/A , N/A , N/A ,$273.07 , 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 ",$771.54 ,$266.13 ,"$1,169.00 ", N/A ,"$1,047.66 ","$1,047.66 ",$309.32 ,$935.20 ,$993.65 ,$730.63 ,"$1,052.10 ", N/A , N/A ,"$1,110.55 ","$1,052.10 ",$993.65 ,$993.65 ,$309.32 ,$993.65 ,$993.65 ,"$1,052.10 ",$711.92 , N/A ,$724.78 , N/A ,"$1,052.10 ", N/A ,"$1,075.48 ","$1,052.10 ",$771.66 ,$771.66 ,$711.92 ,$771.66 ,$759.85 ,$798.66 ,$266.13 ,$923.51 , N/A , N/A , N/A ,$309.32 , 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 ,$526.68 ,$181.67 ,$798.00 , N/A ,$715.17 ,$715.17 ,$211.15 ,$638.40 ,$678.30 ,$498.75 ,$718.20 , N/A , N/A ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$211.15 ,$678.30 ,$678.30 ,$718.20 ,$485.98 , N/A ,$494.76 , N/A ,$718.20 , N/A ,$734.16 ,$718.20 ,$526.76 ,$526.76 ,$485.98 ,$526.76 ,$518.70 ,$545.19 ,$181.67 ,$630.42 , N/A , N/A , N/A ,$211.15 , 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 ,$628.32 ,$216.73 ,$952.00 , N/A ,$853.18 ,$853.18 ,$251.90 ,$761.60 ,$809.20 ,$595.00 ,$856.80 , N/A , N/A ,$904.40 ,$856.80 ,$809.20 ,$809.20 ,$251.90 ,$809.20 ,$809.20 ,$856.80 ,$579.77 , N/A ,$590.24 , N/A ,$856.80 , N/A ,$875.84 ,$856.80 ,$628.42 ,$628.42 ,$579.77 ,$628.42 ,$618.80 ,$650.41 ,$216.73 ,$752.08 , N/A , N/A , N/A ,$251.90 , 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 ,$124.08 ,$42.80 ,$188.00 , N/A ,$168.49 ,$168.49 ,$49.74 ,$150.40 ,$159.80 ,$117.50 ,$169.20 , N/A , N/A ,$178.60 ,$169.20 ,$159.80 ,$159.80 ,$49.74 ,$159.80 ,$159.80 ,$169.20 ,$114.49 , N/A ,$116.56 , N/A ,$169.20 , N/A ,$172.96 ,$169.20 ,$124.10 ,$124.10 ,$114.49 ,$124.10 ,$122.20 ,$128.44 ,$42.80 ,$148.52 , N/A , N/A , N/A ,$49.74 , 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 ",$756.36 ,$260.90 ,"$1,146.00 ", N/A ,"$1,027.05 ","$1,027.05 ",$303.23 ,$916.80 ,$974.10 ,$716.25 ,"$1,031.40 ", N/A , N/A ,"$1,088.70 ","$1,031.40 ",$974.10 ,$974.10 ,$303.23 ,$974.10 ,$974.10 ,"$1,031.40 ",$697.91 , N/A ,$710.52 , N/A ,"$1,031.40 ", N/A ,"$1,054.32 ","$1,031.40 ",$756.47 ,$756.47 ,$697.91 ,$756.47 ,$744.90 ,$782.95 ,$260.90 ,$905.34 , N/A , N/A , N/A ,$303.23 , 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 ,$141.24 ,$48.72 ,$214.00 , N/A ,$191.79 ,$191.79 ,$56.62 ,$171.20 ,$181.90 ,$133.75 ,$192.60 , N/A , N/A ,$203.30 ,$192.60 ,$181.90 ,$181.90 ,$56.62 ,$181.90 ,$181.90 ,$192.60 ,$130.33 , N/A ,$132.68 , N/A ,$192.60 , N/A ,$196.88 ,$192.60 ,$141.26 ,$141.26 ,$130.33 ,$141.26 ,$139.10 ,$146.20 ,$48.72 ,$169.06 , N/A , N/A , N/A ,$56.62 , 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 ,$166.32 ,$57.37 ,$252.00 , N/A ,$225.84 ,$225.84 ,$66.68 ,$201.60 ,$214.20 ,$157.50 ,$226.80 , N/A , N/A ,$239.40 ,$226.80 ,$214.20 ,$214.20 ,$66.68 ,$214.20 ,$214.20 ,$226.80 ,$153.47 , N/A ,$156.24 , N/A ,$226.80 , N/A ,$231.84 ,$226.80 ,$166.35 ,$166.35 ,$153.47 ,$166.35 ,$163.80 ,$172.17 ,$57.37 ,$199.08 , N/A , N/A , N/A ,$66.68 , 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 ",$976.14 ,$336.70 ,"$1,479.00 ", N/A ,"$1,325.48 ","$1,325.48 ",$391.34 ,"$1,183.20 ","$1,257.15 ",$924.38 ,"$1,331.10 ", N/A , N/A ,"$1,405.05 ","$1,331.10 ","$1,257.15 ","$1,257.15 ",$391.34 ,"$1,257.15 ","$1,257.15 ","$1,331.10 ",$900.71 , N/A ,$916.98 , N/A ,"$1,331.10 ", N/A ,"$1,360.68 ","$1,331.10 ",$976.29 ,$976.29 ,$900.71 ,$976.29 ,$961.35 ,"$1,010.45 ",$336.70 ,"$1,168.41 ", N/A , N/A , N/A ,$391.34 , 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 ,$186.78 ,$64.43 ,$283.00 , N/A ,$253.62 ,$253.62 ,$74.88 ,$226.40 ,$240.55 ,$176.88 ,$254.70 , N/A , N/A ,$268.85 ,$254.70 ,$240.55 ,$240.55 ,$74.88 ,$240.55 ,$240.55 ,$254.70 ,$172.35 , N/A ,$175.46 , N/A ,$254.70 , N/A ,$260.36 ,$254.70 ,$186.81 ,$186.81 ,$172.35 ,$186.81 ,$183.95 ,$193.35 ,$64.43 ,$223.57 , N/A , N/A , N/A ,$74.88 , 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 ",$690.36 ,$238.13 ,"$1,046.00 ", N/A ,$937.43 ,$937.43 ,$276.77 ,$836.80 ,$889.10 ,$653.75 ,$941.40 , N/A , N/A ,$993.70 ,$941.40 ,$889.10 ,$889.10 ,$276.77 ,$889.10 ,$889.10 ,$941.40 ,$637.01 , N/A ,$648.52 , N/A ,$941.40 , N/A ,$962.32 ,$941.40 ,$690.46 ,$690.46 ,$637.01 ,$690.46 ,$679.90 ,$714.63 ,$238.13 ,$826.34 , N/A , N/A , N/A ,$276.77 , 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 ",$666.60 ,$229.93 ,"$1,010.00 ", N/A ,$905.16 ,$905.16 ,$267.25 ,$808.00 ,$858.50 ,$631.25 ,$909.00 , N/A , N/A ,$959.50 ,$909.00 ,$858.50 ,$858.50 ,$267.25 ,$858.50 ,$858.50 ,$909.00 ,$615.09 , N/A ,$626.20 , N/A ,$909.00 , N/A ,$929.20 ,$909.00 ,$666.70 ,$666.70 ,$615.09 ,$666.70 ,$656.50 ,$690.03 ,$229.93 ,$797.90 , N/A , N/A , N/A ,$267.25 , 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 ","$1,264.56 ",$436.19 ,"$1,916.00 ", N/A ,"$1,717.12 ","$1,717.12 ",$506.97 ,"$1,532.80 ","$1,628.60 ","$1,197.50 ","$1,724.40 ", N/A , N/A ,"$1,820.20 ","$1,724.40 ","$1,628.60 ","$1,628.60 ",$506.97 ,"$1,628.60 ","$1,628.60 ","$1,724.40 ","$1,166.84 ", N/A ,"$1,187.92 ", N/A ,"$1,724.40 ", N/A ,"$1,762.72 ","$1,724.40 ","$1,264.75 ","$1,264.75 ","$1,166.84 ","$1,264.75 ","$1,245.40 ","$1,309.01 ",$436.19 ,"$1,513.64 ", N/A , N/A , N/A ,$506.97 , 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 ","$1,503.48 ",$518.60 ,"$2,278.00 ", N/A ,"$2,041.54 ","$2,041.54 ",$602.76 ,"$1,822.40 ","$1,936.30 ","$1,423.75 ","$2,050.20 ", N/A , N/A ,"$2,164.10 ","$2,050.20 ","$1,936.30 ","$1,936.30 ",$602.76 ,"$1,936.30 ","$1,936.30 ","$2,050.20 ","$1,387.30 ", N/A ,"$1,412.36 ", N/A ,"$2,050.20 ", N/A ,"$2,095.76 ","$2,050.20 ","$1,503.71 ","$1,503.71 ","$1,387.30 ","$1,503.71 ","$1,480.70 ","$1,556.33 ",$518.60 ,"$1,799.62 ", N/A , N/A , N/A ,$602.76 , 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 ,$161.04 ,$55.55 ,$244.00 , N/A ,$218.67 ,$218.67 ,$64.56 ,$195.20 ,$207.40 ,$152.50 ,$219.60 , N/A , N/A ,$231.80 ,$219.60 ,$207.40 ,$207.40 ,$64.56 ,$207.40 ,$207.40 ,$219.60 ,$148.60 , N/A ,$151.28 , N/A ,$219.60 , N/A ,$224.48 ,$219.60 ,$161.06 ,$161.06 ,$148.60 ,$161.06 ,$158.60 ,$166.70 ,$55.55 ,$192.76 , N/A , N/A , N/A ,$64.56 , 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 ,"$1,134.04 ",$748.47 ,$258.17 ,"$1,134.04 ", N/A ,"$1,016.33 ","$1,016.33 ",$300.07 ,$907.23 ,$963.93 ,$708.78 ,"$1,020.64 ", N/A , N/A ,"$1,077.34 ","$1,020.64 ",$963.93 ,$963.93 ,$300.07 ,$963.93 ,$963.93 ,"$1,020.64 ",$690.63 , N/A ,$703.10 , N/A ,"$1,020.64 ", N/A ,"$1,043.32 ","$1,020.64 ",$748.58 ,$748.58 ,$690.63 ,$748.58 ,$737.13 ,$774.78 ,$258.17 ,$895.89 , N/A , N/A , N/A ,$300.07 , N/A , N/A ,"$1,077.34 ",$929.91 ,$929.91 ,$907.23 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800061,C1713,HC PIN SYN TRANSFIXATION,278,1 ,$415.00 ,$273.90 ,$94.47 ,$415.00 , N/A ,$371.92 ,$371.92 ,$109.81 ,$332.00 ,$352.75 ,$259.38 ,$373.50 , N/A , N/A ,$394.25 ,$373.50 ,$352.75 ,$352.75 ,$109.81 ,$352.75 ,$352.75 ,$373.50 ,$252.74 , N/A ,$257.30 , N/A ,$373.50 , N/A ,$381.80 ,$373.50 ,$273.94 ,$273.94 ,$252.74 ,$273.94 ,$269.75 ,$283.53 ,$94.47 ,$327.85 , N/A , N/A , N/A ,$109.81 , 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 ","$1,270.50 ",$438.24 ,"$1,925.00 ", N/A ,"$1,725.19 ","$1,725.19 ",$509.35 ,"$1,540.00 ","$1,636.25 ","$1,203.13 ","$1,732.50 ", N/A , N/A ,"$1,828.75 ","$1,732.50 ","$1,636.25 ","$1,636.25 ",$509.35 ,"$1,636.25 ","$1,636.25 ","$1,732.50 ","$1,172.33 ", N/A ,"$1,193.50 ", N/A ,"$1,732.50 ", N/A ,"$1,771.00 ","$1,732.50 ","$1,270.69 ","$1,270.69 ","$1,172.33 ","$1,270.69 ","$1,251.25 ","$1,315.16 ",$438.24 ,"$1,520.75 ", N/A , N/A , N/A ,$509.35 , 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 ","$1,431.54 ",$493.78 ,"$2,169.00 ", N/A ,"$1,943.86 ","$1,943.86 ",$573.92 ,"$1,735.20 ","$1,843.65 ","$1,355.63 ","$1,952.10 ", N/A , N/A ,"$2,060.55 ","$1,952.10 ","$1,843.65 ","$1,843.65 ",$573.92 ,"$1,843.65 ","$1,843.65 ","$1,952.10 ","$1,320.92 ", N/A ,"$1,344.78 ", N/A ,"$1,952.10 ", N/A ,"$1,995.48 ","$1,952.10 ","$1,431.76 ","$1,431.76 ","$1,320.92 ","$1,431.76 ","$1,409.85 ","$1,481.86 ",$493.78 ,"$1,713.51 ", N/A , N/A , N/A ,$573.92 , 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 ","$1,605.12 ",$553.65 ,"$2,432.00 ", N/A ,"$2,179.56 ","$2,179.56 ",$643.51 ,"$1,945.60 ","$2,067.20 ","$1,520.00 ","$2,188.80 ", N/A , N/A ,"$2,310.40 ","$2,188.80 ","$2,067.20 ","$2,067.20 ",$643.51 ,"$2,067.20 ","$2,067.20 ","$2,188.80 ","$1,481.09 ", N/A ,"$1,507.84 ", N/A ,"$2,188.80 ", N/A ,"$2,237.44 ","$2,188.80 ","$1,605.36 ","$1,605.36 ","$1,481.09 ","$1,605.36 ","$1,580.80 ","$1,661.54 ",$553.65 ,"$1,921.28 ", N/A , N/A , N/A ,$643.51 , 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 ",$735.90 ,$253.83 ,"$1,115.00 ", N/A ,$999.26 ,$999.26 ,$295.03 ,$892.00 ,$947.75 ,$696.88 ,"$1,003.50 ", N/A , N/A ,"$1,059.25 ","$1,003.50 ",$947.75 ,$947.75 ,$295.03 ,$947.75 ,$947.75 ,"$1,003.50 ",$679.04 , N/A ,$691.30 , N/A ,"$1,003.50 ", N/A ,"$1,025.80 ","$1,003.50 ",$736.01 ,$736.01 ,$679.04 ,$736.01 ,$724.75 ,$761.77 ,$253.83 ,$880.85 , N/A , N/A , N/A ,$295.03 , 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 ","$1,698.18 ",$585.76 ,"$2,573.00 ", N/A ,"$2,305.92 ","$2,305.92 ",$680.82 ,"$2,058.40 ","$2,187.05 ","$1,608.13 ","$2,315.70 ", N/A , N/A ,"$2,444.35 ","$2,315.70 ","$2,187.05 ","$2,187.05 ",$680.82 ,"$2,187.05 ","$2,187.05 ","$2,315.70 ","$1,566.96 ", N/A ,"$1,595.26 ", N/A ,"$2,315.70 ", N/A ,"$2,367.16 ","$2,315.70 ","$1,698.44 ","$1,698.44 ","$1,566.96 ","$1,698.44 ","$1,672.45 ","$1,757.87 ",$585.76 ,"$2,032.67 ", N/A , N/A , N/A ,$680.82 , 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 ","$1,624.26 ",$560.26 ,"$2,461.00 ", N/A ,"$2,205.55 ","$2,205.55 ",$651.18 ,"$1,968.80 ","$2,091.85 ","$1,538.13 ","$2,214.90 ", N/A , N/A ,"$2,337.95 ","$2,214.90 ","$2,091.85 ","$2,091.85 ",$651.18 ,"$2,091.85 ","$2,091.85 ","$2,214.90 ","$1,498.75 ", N/A ,"$1,525.82 ", N/A ,"$2,214.90 ", N/A ,"$2,264.12 ","$2,214.90 ","$1,624.51 ","$1,624.51 ","$1,498.75 ","$1,624.51 ","$1,599.65 ","$1,681.36 ",$560.26 ,"$1,944.19 ", N/A , N/A , N/A ,$651.18 , 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 ","$1,722.60 ",$594.17 ,"$2,610.00 ", N/A ,"$2,339.08 ","$2,339.08 ",$690.61 ,"$2,088.00 ","$2,218.50 ","$1,631.25 ","$2,349.00 ", N/A , N/A ,"$2,479.50 ","$2,349.00 ","$2,218.50 ","$2,218.50 ",$690.61 ,"$2,218.50 ","$2,218.50 ","$2,349.00 ","$1,589.49 ", N/A ,"$1,618.20 ", N/A ,"$2,349.00 ", N/A ,"$2,401.20 ","$2,349.00 ","$1,722.86 ","$1,722.86 ","$1,589.49 ","$1,722.86 ","$1,696.50 ","$1,783.15 ",$594.17 ,"$2,061.90 ", N/A , N/A , N/A ,$690.61 , 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 ","$1,624.26 ",$560.26 ,"$2,461.00 ", N/A ,"$2,205.55 ","$2,205.55 ",$651.18 ,"$1,968.80 ","$2,091.85 ","$1,538.13 ","$2,214.90 ", N/A , N/A ,"$2,337.95 ","$2,214.90 ","$2,091.85 ","$2,091.85 ",$651.18 ,"$2,091.85 ","$2,091.85 ","$2,214.90 ","$1,498.75 ", N/A ,"$1,525.82 ", N/A ,"$2,214.90 ", N/A ,"$2,264.12 ","$2,214.90 ","$1,624.51 ","$1,624.51 ","$1,498.75 ","$1,624.51 ","$1,599.65 ","$1,681.36 ",$560.26 ,"$1,944.19 ", N/A , N/A , N/A ,$651.18 , 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 ","$1,722.60 ",$594.17 ,"$2,610.00 ", N/A ,"$2,339.08 ","$2,339.08 ",$690.61 ,"$2,088.00 ","$2,218.50 ","$1,631.25 ","$2,349.00 ", N/A , N/A ,"$2,479.50 ","$2,349.00 ","$2,218.50 ","$2,218.50 ",$690.61 ,"$2,218.50 ","$2,218.50 ","$2,349.00 ","$1,589.49 ", N/A ,"$1,618.20 ", N/A ,"$2,349.00 ", N/A ,"$2,401.20 ","$2,349.00 ","$1,722.86 ","$1,722.86 ","$1,589.49 ","$1,722.86 ","$1,696.50 ","$1,783.15 ",$594.17 ,"$2,061.90 ", N/A , N/A , N/A ,$690.61 , 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 ,$200.64 ,$69.21 ,$304.00 , N/A ,$272.44 ,$272.44 ,$80.44 ,$243.20 ,$258.40 ,$190.00 ,$273.60 , N/A , N/A ,$288.80 ,$273.60 ,$258.40 ,$258.40 ,$80.44 ,$258.40 ,$258.40 ,$273.60 ,$185.14 , N/A ,$188.48 , N/A ,$273.60 , N/A ,$279.68 ,$273.60 ,$200.67 ,$200.67 ,$185.14 ,$200.67 ,$197.60 ,$207.69 ,$69.21 ,$240.16 , N/A , N/A , N/A ,$80.44 , 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 ,$226.38 ,$78.09 ,$343.00 , N/A ,$307.40 ,$307.40 ,$90.76 ,$274.40 ,$291.55 ,$214.38 ,$308.70 , N/A , N/A ,$325.85 ,$308.70 ,$291.55 ,$291.55 ,$90.76 ,$291.55 ,$291.55 ,$308.70 ,$208.89 , N/A ,$212.66 , N/A ,$308.70 , N/A ,$315.56 ,$308.70 ,$226.41 ,$226.41 ,$208.89 ,$226.41 ,$222.95 ,$234.34 ,$78.09 ,$270.97 , N/A , N/A , N/A ,$90.76 , 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 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A , N/A , N/A ,$21.17 , 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 ,$85.80 ,$29.60 ,$130.00 , N/A ,$116.51 ,$116.51 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 , N/A ,$80.60 , N/A ,$117.00 , N/A ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 , N/A , N/A , N/A ,$34.40 , N/A , N/A ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800121,C1713,HC VITOSS FOAM,278,1 ,$884.00 ,$583.44 ,$201.24 ,$884.00 , N/A ,$792.24 ,$792.24 ,$233.91 ,$707.20 ,$751.40 ,$552.50 ,$795.60 , N/A , N/A ,$839.80 ,$795.60 ,$751.40 ,$751.40 ,$233.91 ,$751.40 ,$751.40 ,$795.60 ,$538.36 , N/A ,$548.08 , N/A ,$795.60 , N/A ,$813.28 ,$795.60 ,$583.53 ,$583.53 ,$538.36 ,$583.53 ,$574.60 ,$603.95 ,$201.24 ,$698.36 , N/A , N/A , N/A ,$233.91 , N/A , N/A ,$839.80 ,$724.88 ,$724.88 ,$707.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800129,C1751,HC POWER PICC DUAL,278,1 ,$465.00 ,$306.90 ,$105.86 ,$465.00 , N/A ,$416.73 ,$416.73 ,$123.04 ,$372.00 ,$395.25 , N/A ,$418.50 , N/A , N/A ,$441.75 ,$418.50 ,$395.25 ,$395.25 ,$123.04 ,$395.25 ,$395.25 ,$418.50 ,$283.19 , N/A ,$288.30 , N/A ,$418.50 , N/A ,$427.80 ,$418.50 ,$306.95 ,$306.95 ,$283.19 ,$306.95 ,$302.25 ,$317.69 ,$105.86 ,$367.35 , N/A , N/A , N/A ,$123.04 , N/A , N/A ,$441.75 ,$381.30 ,$381.30 ,$372.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800148,C1751,HC CATH GROSHONG SNG,278,1 ,$360.00 ,$237.60 ,$81.96 ,$360.00 , N/A ,$322.63 ,$322.63 ,$95.26 ,$288.00 ,$306.00 , N/A ,$324.00 , N/A , N/A ,$342.00 ,$324.00 ,$306.00 ,$306.00 ,$95.26 ,$306.00 ,$306.00 ,$324.00 ,$219.24 , N/A ,$223.20 , N/A ,$324.00 , N/A ,$331.20 ,$324.00 ,$237.64 ,$237.64 ,$219.24 ,$237.64 ,$234.00 ,$245.95 ,$81.96 ,$284.40 , N/A , N/A , N/A ,$95.26 , 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 ,$318.78 ,$109.96 ,$483.00 , N/A ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 , N/A ,$434.70 , N/A , N/A ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 , N/A ,$299.46 , N/A ,$434.70 , N/A ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 , N/A , N/A , N/A ,$127.80 , 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 ","$1,420.98 ",$490.14 ,"$2,153.00 ", N/A ,"$1,929.52 ","$1,929.52 ",$569.68 ,"$1,722.40 ","$1,830.05 ", N/A ,"$1,937.70 ", N/A , N/A ,"$2,045.35 ","$1,937.70 ","$1,830.05 ","$1,830.05 ",$569.68 ,"$1,830.05 ","$1,830.05 ","$1,937.70 ","$1,311.18 ", N/A ,"$1,334.86 ", N/A ,"$1,937.70 ", N/A ,"$1,980.76 ","$1,937.70 ","$1,421.20 ","$1,421.20 ","$1,311.18 ","$1,421.20 ","$1,399.45 ","$1,470.93 ",$490.14 ,"$1,700.87 ", N/A , N/A , N/A ,$569.68 , N/A , N/A ,"$2,045.35 ","$1,765.46 ","$1,765.46 ","$1,722.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800174,C1762,HC CONNECTIVE TISSUE HUMAN,278,1 ,"$2,919.85 ","$1,927.10 ",$664.72 ,"$2,919.85 ", N/A ,"$2,616.77 ","$2,616.77 ",$772.59 ,"$2,335.88 ","$2,481.87 ","$1,824.91 ","$2,627.87 ", N/A , N/A ,"$2,773.86 ","$2,627.87 ","$2,481.87 ","$2,481.87 ",$772.59 ,"$2,481.87 ","$2,481.87 ","$2,627.87 ","$1,778.19 ", N/A ,"$1,810.30 ", N/A ,"$2,627.87 ", N/A ,"$2,686.26 ","$2,627.87 ","$1,927.39 ","$1,927.39 ","$1,778.19 ","$1,927.39 ","$1,897.90 ","$1,994.84 ",$664.72 ,"$2,306.68 ", N/A , N/A , N/A ,$772.59 , N/A , N/A ,"$2,773.86 ","$2,394.28 ","$2,394.28 ","$2,335.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800184,C1713,HC STIMULAN 5CC,278,1 ,"$1,553.00 ","$1,024.98 ",$353.54 ,"$1,553.00 ", N/A ,"$1,391.80 ","$1,391.80 ",$410.92 ,"$1,242.40 ","$1,320.05 ",$970.63 ,"$1,397.70 ", N/A , N/A ,"$1,475.35 ","$1,397.70 ","$1,320.05 ","$1,320.05 ",$410.92 ,"$1,320.05 ","$1,320.05 ","$1,397.70 ",$945.78 , N/A ,$962.86 , N/A ,"$1,397.70 ", N/A ,"$1,428.76 ","$1,397.70 ","$1,025.14 ","$1,025.14 ",$945.78 ,"$1,025.14 ","$1,009.45 ","$1,061.01 ",$353.54 ,"$1,226.87 ", N/A , N/A , N/A ,$410.92 , 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 ",$879.78 ,$303.47 ,"$1,333.00 ", N/A ,"$1,194.63 ","$1,194.63 ",$352.71 ,"$1,066.40 ","$1,133.05 ",$833.13 ,"$1,199.70 ", N/A , N/A ,"$1,266.35 ","$1,199.70 ","$1,133.05 ","$1,133.05 ",$352.71 ,"$1,133.05 ","$1,133.05 ","$1,199.70 ",$811.80 , N/A ,$826.46 , N/A ,"$1,199.70 ", N/A ,"$1,226.36 ","$1,199.70 ",$879.91 ,$879.91 ,$811.80 ,$879.91 ,$866.45 ,$910.71 ,$303.47 ,"$1,053.07 ", N/A , N/A , N/A ,$352.71 , 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 ,$440.88 ,$152.08 ,$668.00 , N/A ,$598.66 ,$598.66 ,$176.75 ,$534.40 ,$567.80 ,$417.50 ,$601.20 , N/A , N/A ,$634.60 ,$601.20 ,$567.80 ,$567.80 ,$176.75 ,$567.80 ,$567.80 ,$601.20 ,$406.81 , N/A ,$414.16 , N/A ,$601.20 , N/A ,$614.56 ,$601.20 ,$440.95 ,$440.95 ,$406.81 ,$440.95 ,$434.20 ,$456.38 ,$152.08 ,$527.72 , N/A , N/A , N/A ,$176.75 , 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 ","$1,943.70 ",$670.44 ,"$2,945.00 ", N/A ,"$2,639.31 ","$2,639.31 ",$779.25 ,"$2,356.00 ","$2,503.25 ","$1,840.63 ","$2,650.50 ", N/A , N/A ,"$2,797.75 ","$2,650.50 ","$2,503.25 ","$2,503.25 ",$779.25 ,"$2,503.25 ","$2,503.25 ","$2,650.50 ","$1,793.51 ", N/A ,"$1,825.90 ", N/A ,"$2,650.50 ", N/A ,"$2,709.40 ","$2,650.50 ","$1,943.99 ","$1,943.99 ","$1,793.51 ","$1,943.99 ","$1,914.25 ","$2,012.02 ",$670.44 ,"$2,326.55 ", N/A , N/A , N/A ,$779.25 , 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 ","$1,429.56 ",$493.10 ,"$2,166.00 ", N/A ,"$1,941.17 ","$1,941.17 ",$573.12 ,"$1,732.80 ","$1,841.10 ","$1,353.75 ","$1,949.40 ", N/A , N/A ,"$2,057.70 ","$1,949.40 ","$1,841.10 ","$1,841.10 ",$573.12 ,"$1,841.10 ","$1,841.10 ","$1,949.40 ","$1,319.09 ", N/A ,"$1,342.92 ", N/A ,"$1,949.40 ", N/A ,"$1,992.72 ","$1,949.40 ","$1,429.78 ","$1,429.78 ","$1,319.09 ","$1,429.78 ","$1,407.90 ","$1,479.81 ",$493.10 ,"$1,711.14 ", N/A , N/A , N/A ,$573.12 , 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 ","$1,959.54 ",$675.91 ,"$2,969.00 ", N/A ,"$2,660.82 ","$2,660.82 ",$785.60 ,"$2,375.20 ","$2,523.65 ","$1,855.63 ","$2,672.10 ", N/A , N/A ,"$2,820.55 ","$2,672.10 ","$2,523.65 ","$2,523.65 ",$785.60 ,"$2,523.65 ","$2,523.65 ","$2,672.10 ","$1,808.12 ", N/A ,"$1,840.78 ", N/A ,"$2,672.10 ", N/A ,"$2,731.48 ","$2,672.10 ","$1,959.84 ","$1,959.84 ","$1,808.12 ","$1,959.84 ","$1,929.85 ","$2,028.42 ",$675.91 ,"$2,345.51 ", N/A , N/A , N/A ,$785.60 , 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 ,$330.00 ,$113.83 ,$500.00 , N/A ,$448.10 ,$448.10 ,$132.30 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$132.30 ,$425.00 ,$425.00 ,$450.00 ,$304.50 , N/A ,$310.00 , N/A ,$450.00 , N/A ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$113.83 ,$395.00 , N/A , N/A , N/A ,$132.30 , 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 ","$16,326.42 ","$5,631.48 ","$24,737.00 ", N/A ,"$22,169.30 ","$22,169.30 ","$6,545.41 ","$19,789.60 ","$21,026.45 ","$15,460.63 ","$22,263.30 ", N/A , N/A ,"$23,500.15 ","$22,263.30 ","$21,026.45 ","$21,026.45 ","$6,545.41 ","$21,026.45 ","$21,026.45 ","$22,263.30 ","$15,064.83 ", N/A ,"$15,336.94 ", N/A ,"$22,263.30 ", N/A ,"$22,758.04 ","$22,263.30 ","$16,328.89 ","$16,328.89 ","$15,064.83 ","$16,328.89 ","$16,079.05 ","$16,900.32 ","$5,631.48 ","$19,542.23 ", N/A ,"$12,121.13 ","$12,121.13 ","$6,545.41 ","$12,121.13 ", 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 ","$1,158.30 ",$399.54 ,"$1,755.00 ", N/A ,"$1,572.83 ","$1,572.83 ",$464.37 ,"$1,404.00 ","$1,491.75 ","$1,096.88 ","$1,579.50 ", N/A , N/A ,"$1,667.25 ","$1,579.50 ","$1,491.75 ","$1,491.75 ",$464.37 ,"$1,491.75 ","$1,491.75 ","$1,579.50 ","$1,068.80 ", N/A ,"$1,088.10 ", N/A ,"$1,579.50 ", N/A ,"$1,614.60 ","$1,579.50 ","$1,158.48 ","$1,158.48 ","$1,068.80 ","$1,158.48 ","$1,140.75 ","$1,199.02 ",$399.54 ,"$1,386.45 ", N/A , N/A , N/A ,$464.37 , 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 ","$3,963.30 ","$1,367.06 ","$6,005.00 ", N/A ,"$5,381.68 ","$5,381.68 ","$1,588.92 ","$4,804.00 ","$5,104.25 ","$3,753.13 ","$5,404.50 ", N/A , N/A ,"$5,704.75 ","$5,404.50 ","$5,104.25 ","$5,104.25 ","$1,588.92 ","$5,104.25 ","$5,104.25 ","$5,404.50 ","$3,657.05 ", N/A ,"$3,723.10 ", N/A ,"$5,404.50 ", N/A ,"$5,524.60 ","$5,404.50 ","$3,963.90 ","$3,963.90 ","$3,657.05 ","$3,963.90 ","$3,903.25 ","$4,102.62 ","$1,367.06 ","$4,743.95 ", N/A ,"$2,942.45 ","$2,942.45 ","$1,588.92 ","$2,942.45 ", 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 ,$720.38 ,$475.45 ,$164.00 ,$720.38 , N/A ,$645.60 ,$645.60 ,$190.61 ,$576.30 ,$612.32 ,$450.24 ,$648.34 , N/A , N/A ,$684.36 ,$648.34 ,$612.32 ,$612.32 ,$190.61 ,$612.32 ,$612.32 ,$648.34 ,$438.71 , N/A ,$446.64 , N/A ,$648.34 , N/A ,$662.75 ,$648.34 ,$475.52 ,$475.52 ,$438.71 ,$475.52 ,$468.25 ,$492.16 ,$164.00 ,$569.10 , N/A , N/A , N/A ,$190.61 , N/A , N/A ,$684.36 ,$590.71 ,$590.71 ,$576.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800441,C1781,HC MESH KUGEL HERNIA MED OV,278,1 ,"$2,377.00 ","$1,568.82 ",$541.14 ,"$2,377.00 ", N/A ,"$2,130.27 ","$2,130.27 ",$628.95 ,"$1,901.60 ","$2,020.45 ","$1,485.63 ","$2,139.30 ", N/A , N/A ,"$2,258.15 ","$2,139.30 ","$2,020.45 ","$2,020.45 ",$628.95 ,"$2,020.45 ","$2,020.45 ","$2,139.30 ","$1,447.59 ", N/A ,"$1,473.74 ", N/A ,"$2,139.30 ", N/A ,"$2,186.84 ","$2,139.30 ","$1,569.06 ","$1,569.06 ","$1,447.59 ","$1,569.06 ","$1,545.05 ","$1,623.97 ",$541.14 ,"$1,877.83 ", N/A , N/A , N/A ,$628.95 , 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 ,$473.22 ,$163.23 ,$717.00 , N/A ,$642.58 ,$642.58 ,$189.72 ,$573.60 ,$609.45 ,$448.13 ,$645.30 , N/A , N/A ,$681.15 ,$645.30 ,$609.45 ,$609.45 ,$189.72 ,$609.45 ,$609.45 ,$645.30 ,$436.65 , N/A ,$444.54 , N/A ,$645.30 , N/A ,$659.64 ,$645.30 ,$473.29 ,$473.29 ,$436.65 ,$473.29 ,$466.05 ,$489.85 ,$163.23 ,$566.43 , N/A , N/A , N/A ,$189.72 , 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 ,$211.20 ,$72.85 ,$320.00 , N/A ,$286.78 ,$286.78 ,$84.67 ,$256.00 ,$272.00 ,$200.00 ,$288.00 , N/A , N/A ,$304.00 ,$288.00 ,$272.00 ,$272.00 ,$84.67 ,$272.00 ,$272.00 ,$288.00 ,$194.88 , N/A ,$198.40 , N/A ,$288.00 , N/A ,$294.40 ,$288.00 ,$211.23 ,$211.23 ,$194.88 ,$211.23 ,$208.00 ,$218.62 ,$72.85 ,$252.80 , N/A , N/A , N/A ,$84.67 , 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 ,$104.94 ,$36.20 ,$159.00 , N/A ,$142.50 ,$142.50 ,$42.07 ,$127.20 ,$135.15 ,$99.38 ,$143.10 , N/A , N/A ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$42.07 ,$135.15 ,$135.15 ,$143.10 ,$96.83 , N/A ,$98.58 , N/A ,$143.10 , N/A ,$146.28 ,$143.10 ,$104.96 ,$104.96 ,$96.83 ,$104.96 ,$103.35 ,$108.63 ,$36.20 ,$125.61 , N/A , N/A , N/A ,$42.07 , 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 ,$163.00 ,$107.58 ,$37.10 ,$163.00 , N/A ,$146.08 ,$146.08 ,$43.13 ,$130.40 ,$138.55 ,$101.88 ,$146.70 , N/A , N/A ,$154.85 ,$146.70 ,$138.55 ,$138.55 ,$43.13 ,$138.55 ,$138.55 ,$146.70 ,$99.27 , N/A ,$101.06 , N/A ,$146.70 , N/A ,$149.96 ,$146.70 ,$107.60 ,$107.60 ,$99.27 ,$107.60 ,$105.95 ,$111.36 ,$37.10 ,$128.77 , N/A , N/A , N/A ,$43.13 , N/A , N/A ,$154.85 ,$133.66 ,$133.66 ,$130.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800450,C1781,HC MESH MARLEX 6X6,278,1 ,$401.00 ,$264.66 ,$91.29 ,$401.00 , N/A ,$359.38 ,$359.38 ,$106.10 ,$320.80 ,$340.85 ,$250.63 ,$360.90 , N/A , N/A ,$380.95 ,$360.90 ,$340.85 ,$340.85 ,$106.10 ,$340.85 ,$340.85 ,$360.90 ,$244.21 , N/A ,$248.62 , N/A ,$360.90 , N/A ,$368.92 ,$360.90 ,$264.70 ,$264.70 ,$244.21 ,$264.70 ,$260.65 ,$273.96 ,$91.29 ,$316.79 , N/A , N/A , N/A ,$106.10 , 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 ,$301.62 ,$104.04 ,$457.00 , N/A ,$409.56 ,$409.56 ,$120.92 ,$365.60 ,$388.45 ,$285.63 ,$411.30 , N/A , N/A ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$120.92 ,$388.45 ,$388.45 ,$411.30 ,$278.31 , N/A ,$283.34 , N/A ,$411.30 , N/A ,$420.44 ,$411.30 ,$301.67 ,$301.67 ,$278.31 ,$301.67 ,$297.05 ,$312.22 ,$104.04 ,$361.03 , N/A , N/A , N/A ,$120.92 , 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 ,$301.62 ,$104.04 ,$457.00 , N/A ,$409.56 ,$409.56 ,$120.92 ,$365.60 ,$388.45 ,$285.63 ,$411.30 , N/A , N/A ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$120.92 ,$388.45 ,$388.45 ,$411.30 ,$278.31 , N/A ,$283.34 , N/A ,$411.30 , N/A ,$420.44 ,$411.30 ,$301.67 ,$301.67 ,$278.31 ,$301.67 ,$297.05 ,$312.22 ,$104.04 ,$361.03 , N/A , N/A , N/A ,$120.92 , 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 ,$301.62 ,$104.04 ,$457.00 , N/A ,$409.56 ,$409.56 ,$120.92 ,$365.60 ,$388.45 ,$285.63 ,$411.30 , N/A , N/A ,$434.15 ,$411.30 ,$388.45 ,$388.45 ,$120.92 ,$388.45 ,$388.45 ,$411.30 ,$278.31 , N/A ,$283.34 , N/A ,$411.30 , N/A ,$420.44 ,$411.30 ,$301.67 ,$301.67 ,$278.31 ,$301.67 ,$297.05 ,$312.22 ,$104.04 ,$361.03 , N/A , N/A , N/A ,$120.92 , 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 ,$331.98 ,$114.51 ,$503.00 , N/A ,$450.79 ,$450.79 ,$133.09 ,$402.40 ,$427.55 ,$314.38 ,$452.70 , N/A , N/A ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$133.09 ,$427.55 ,$427.55 ,$452.70 ,$306.33 , N/A ,$311.86 , N/A ,$452.70 , N/A ,$462.76 ,$452.70 ,$332.03 ,$332.03 ,$306.33 ,$332.03 ,$326.95 ,$343.65 ,$114.51 ,$397.37 , N/A , N/A , N/A ,$133.09 , 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 ,$353.76 ,$122.02 ,$536.00 , N/A ,$480.36 ,$480.36 ,$141.83 ,$428.80 ,$455.60 ,$335.00 ,$482.40 , N/A , N/A ,$509.20 ,$482.40 ,$455.60 ,$455.60 ,$141.83 ,$455.60 ,$455.60 ,$482.40 ,$326.42 , N/A ,$332.32 , N/A ,$482.40 , N/A ,$493.12 ,$482.40 ,$353.81 ,$353.81 ,$326.42 ,$353.81 ,$348.40 ,$366.20 ,$122.02 ,$423.44 , N/A , N/A , N/A ,$141.83 , 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 ,$537.90 ,$185.53 ,$815.00 , N/A ,$730.40 ,$730.40 ,$215.65 ,$652.00 ,$692.75 ,$509.38 ,$733.50 , N/A , N/A ,$774.25 ,$733.50 ,$692.75 ,$692.75 ,$215.65 ,$692.75 ,$692.75 ,$733.50 ,$496.34 , N/A ,$505.30 , N/A ,$733.50 , N/A ,$749.80 ,$733.50 ,$537.98 ,$537.98 ,$496.34 ,$537.98 ,$529.75 ,$556.81 ,$185.53 ,$643.85 , N/A , N/A , N/A ,$215.65 , 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 ",$924.00 ,$318.72 ,"$1,400.00 ", N/A ,"$1,254.68 ","$1,254.68 ",$370.44 ,"$1,120.00 ","$1,190.00 ",$875.00 ,"$1,260.00 ", N/A , N/A ,"$1,330.00 ","$1,260.00 ","$1,190.00 ","$1,190.00 ",$370.44 ,"$1,190.00 ","$1,190.00 ","$1,260.00 ",$852.60 , N/A ,$868.00 , N/A ,"$1,260.00 ", N/A ,"$1,288.00 ","$1,260.00 ",$924.14 ,$924.14 ,$852.60 ,$924.14 ,$910.00 ,$956.48 ,$318.72 ,"$1,106.00 ", N/A , N/A , N/A ,$370.44 , 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 ,$510.84 ,$176.20 ,$774.00 , N/A ,$693.66 ,$693.66 ,$204.80 ,$619.20 ,$657.90 ,$483.75 ,$696.60 , N/A , N/A ,$735.30 ,$696.60 ,$657.90 ,$657.90 ,$204.80 ,$657.90 ,$657.90 ,$696.60 ,$471.37 , N/A ,$479.88 , N/A ,$696.60 , N/A ,$712.08 ,$696.60 ,$510.92 ,$510.92 ,$471.37 ,$510.92 ,$503.10 ,$528.80 ,$176.20 ,$611.46 , N/A , N/A , N/A ,$204.80 , 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 ,"$1,701.83 ","$1,123.21 ",$387.42 ,"$1,701.83 ", N/A ,"$1,525.18 ","$1,525.18 ",$450.30 ,"$1,361.46 ","$1,446.56 ","$1,063.64 ","$1,531.65 ", N/A , N/A ,"$1,616.74 ","$1,531.65 ","$1,446.56 ","$1,446.56 ",$450.30 ,"$1,446.56 ","$1,446.56 ","$1,531.65 ","$1,036.41 ", N/A ,"$1,055.14 ", N/A ,"$1,531.65 ", N/A ,"$1,565.68 ","$1,531.65 ","$1,123.38 ","$1,123.38 ","$1,036.41 ","$1,123.38 ","$1,106.19 ","$1,162.69 ",$387.42 ,"$1,344.45 ", N/A , N/A , N/A ,$450.30 , N/A , N/A ,"$1,616.74 ","$1,395.50 ","$1,395.50 ","$1,361.46 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27800480,C1781,HC MESH VENTRALEX SMALL (0010301),278,1 ,"$1,169.00 ",$771.54 ,$266.13 ,"$1,169.00 ", N/A ,"$1,047.66 ","$1,047.66 ",$309.32 ,$935.20 ,$993.65 ,$730.63 ,"$1,052.10 ", N/A , N/A ,"$1,110.55 ","$1,052.10 ",$993.65 ,$993.65 ,$309.32 ,$993.65 ,$993.65 ,"$1,052.10 ",$711.92 , N/A ,$724.78 , N/A ,"$1,052.10 ", N/A ,"$1,075.48 ","$1,052.10 ",$771.66 ,$771.66 ,$711.92 ,$771.66 ,$759.85 ,$798.66 ,$266.13 ,$923.51 , N/A , N/A , N/A ,$309.32 , 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 ",$847.44 ,$292.30 ,"$1,284.00 ", N/A ,"$1,150.72 ","$1,150.72 ",$339.75 ,"$1,027.20 ","$1,091.40 ",$802.50 ,"$1,155.60 ", N/A , N/A ,"$1,219.80 ","$1,155.60 ","$1,091.40 ","$1,091.40 ",$339.75 ,"$1,091.40 ","$1,091.40 ","$1,155.60 ",$781.96 , N/A ,$796.08 , N/A ,"$1,155.60 ", N/A ,"$1,181.28 ","$1,155.60 ",$847.57 ,$847.57 ,$781.96 ,$847.57 ,$834.60 ,$877.23 ,$292.30 ,"$1,014.36 ", N/A , N/A , N/A ,$339.75 , 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 ,$52.14 ,$17.98 ,$79.00 , N/A ,$70.80 ,$70.80 ,$20.90 ,$63.20 ,$67.15 , N/A ,$71.10 , N/A , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$20.90 ,$67.15 ,$67.15 ,$71.10 ,$48.11 , N/A ,$48.98 , N/A ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.15 ,$52.15 ,$48.11 ,$52.15 ,$51.35 ,$53.97 ,$17.98 ,$62.41 , N/A , N/A , N/A ,$20.90 , 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 ,$405.00 ,$267.30 ,$92.20 ,$405.00 , N/A ,$362.96 ,$362.96 ,$107.16 ,$324.00 ,$344.25 ,$253.13 ,$364.50 , N/A , N/A ,$384.75 ,$364.50 ,$344.25 ,$344.25 ,$107.16 ,$344.25 ,$344.25 ,$364.50 ,$246.65 , N/A ,$251.10 , N/A ,$364.50 , N/A ,$372.60 ,$364.50 ,$267.34 ,$267.34 ,$246.65 ,$267.34 ,$263.25 ,$276.70 ,$92.20 ,$319.95 , N/A , N/A , N/A ,$107.16 , N/A , N/A ,$384.75 ,$332.10 ,$332.10 ,$324.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800586,C1713,HC 30CC CANC CHIPS,278,1 ,$838.00 ,$553.08 ,$190.78 ,$838.00 , N/A ,$751.02 ,$751.02 ,$221.73 ,$670.40 ,$712.30 ,$523.75 ,$754.20 , N/A , N/A ,$796.10 ,$754.20 ,$712.30 ,$712.30 ,$221.73 ,$712.30 ,$712.30 ,$754.20 ,$510.34 , N/A ,$519.56 , N/A ,$754.20 , N/A ,$770.96 ,$754.20 ,$553.16 ,$553.16 ,$510.34 ,$553.16 ,$544.70 ,$572.52 ,$190.78 ,$662.02 , N/A , N/A , N/A ,$221.73 , 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 ","$1,008.48 ",$347.85 ,"$1,528.00 ", N/A ,"$1,369.39 ","$1,369.39 ",$404.31 ,"$1,222.40 ","$1,298.80 ",$955.00 ,"$1,375.20 ", N/A , N/A ,"$1,451.60 ","$1,375.20 ","$1,298.80 ","$1,298.80 ",$404.31 ,"$1,298.80 ","$1,298.80 ","$1,375.20 ",$930.55 , N/A ,$947.36 , N/A ,"$1,375.20 ", N/A ,"$1,405.76 ","$1,375.20 ","$1,008.63 ","$1,008.63 ",$930.55 ,"$1,008.63 ",$993.20 ,"$1,043.93 ",$347.85 ,"$1,207.12 ", N/A , N/A , N/A ,$404.31 , 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 ,$330.00 ,$113.83 ,$500.00 , N/A ,$448.10 ,$448.10 ,$132.30 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$132.30 ,$425.00 ,$425.00 ,$450.00 ,$304.50 , N/A ,$310.00 , N/A ,$450.00 , N/A ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$113.83 ,$395.00 , N/A , N/A , N/A ,$132.30 , 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 ,$330.00 ,$113.83 ,$500.00 , N/A ,$448.10 ,$448.10 ,$132.30 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$132.30 ,$425.00 ,$425.00 ,$450.00 ,$304.50 , N/A ,$310.00 , N/A ,$450.00 , N/A ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$113.83 ,$395.00 , N/A , N/A , N/A ,$132.30 , 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 ,$330.00 ,$113.83 ,$500.00 , N/A ,$448.10 ,$448.10 ,$132.30 ,$400.00 ,$425.00 ,$312.50 ,$450.00 , N/A , N/A ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$132.30 ,$425.00 ,$425.00 ,$450.00 ,$304.50 , N/A ,$310.00 , N/A ,$450.00 , N/A ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$113.83 ,$395.00 , N/A , N/A , N/A ,$132.30 , 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 ","$2,102.76 ",$725.31 ,"$3,186.00 ", N/A ,"$2,855.29 ","$2,855.29 ",$843.02 ,"$2,548.80 ","$2,708.10 ","$1,991.25 ","$2,867.40 ", N/A , N/A ,"$3,026.70 ","$2,867.40 ","$2,708.10 ","$2,708.10 ",$843.02 ,"$2,708.10 ","$2,708.10 ","$2,867.40 ","$1,940.27 ", N/A ,"$1,975.32 ", N/A ,"$2,867.40 ", N/A ,"$2,931.12 ","$2,867.40 ","$2,103.08 ","$2,103.08 ","$1,940.27 ","$2,103.08 ","$2,070.90 ","$2,176.68 ",$725.31 ,"$2,516.94 ", N/A , N/A , N/A ,$843.02 , 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 ,$355.08 ,$122.48 ,$538.00 , N/A ,$482.16 ,$482.16 ,$142.35 ,$430.40 ,$457.30 ,$336.25 ,$484.20 , N/A , N/A ,$511.10 ,$484.20 ,$457.30 ,$457.30 ,$142.35 ,$457.30 ,$457.30 ,$484.20 ,$327.64 , N/A ,$333.56 , N/A ,$484.20 , N/A ,$494.96 ,$484.20 ,$355.13 ,$355.13 ,$327.64 ,$355.13 ,$349.70 ,$367.56 ,$122.48 ,$425.02 , N/A , N/A , N/A ,$142.35 , 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 ",$671.88 ,$231.75 ,"$1,018.00 ", N/A ,$912.33 ,$912.33 ,$269.36 ,$814.40 ,$865.30 ,$636.25 ,$916.20 , N/A , N/A ,$967.10 ,$916.20 ,$865.30 ,$865.30 ,$269.36 ,$865.30 ,$865.30 ,$916.20 ,$619.96 , N/A ,$631.16 , N/A ,$916.20 , N/A ,$936.56 ,$916.20 ,$671.98 ,$671.98 ,$619.96 ,$671.98 ,$661.70 ,$695.50 ,$231.75 ,$804.22 , N/A , N/A , N/A ,$269.36 , 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 ,$118.80 ,$78.41 ,$27.04 ,$118.80 , N/A ,$106.47 ,$106.47 ,$31.44 ,$95.04 ,$100.98 ,$74.25 ,$106.92 , N/A , N/A ,$112.86 ,$106.92 ,$100.98 ,$100.98 ,$31.44 ,$100.98 ,$100.98 ,$106.92 ,$72.35 , N/A ,$73.66 , N/A ,$106.92 , N/A ,$109.30 ,$106.92 ,$78.42 ,$78.42 ,$72.35 ,$78.42 ,$77.22 ,$81.16 ,$27.04 ,$93.85 , N/A , N/A , N/A ,$31.44 , N/A , N/A ,$112.86 ,$97.42 ,$97.42 ,$95.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800629,N/A,HC CEMENT W/MIXER KYPHON,278,1 ,$218.88 ,$144.46 ,$49.82 ,$218.88 , N/A ,$196.16 ,$196.16 ,$57.92 ,$175.10 ,$186.05 ,$136.80 ,$196.99 , N/A , N/A ,$207.94 ,$196.99 ,$186.05 ,$186.05 ,$57.92 ,$186.05 ,$186.05 ,$196.99 ,$133.30 , N/A ,$135.70 , N/A ,$196.99 , N/A ,$201.37 ,$196.99 ,$144.48 ,$144.48 ,$133.30 ,$144.48 ,$142.27 ,$149.54 ,$49.82 ,$172.92 , N/A , N/A , N/A ,$57.92 , N/A , N/A ,$207.94 ,$179.48 ,$179.48 ,$175.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800644,N/A,HC EAR VENT,278,1 ,$65.00 ,$42.90 ,$14.80 ,$65.00 , N/A ,$58.25 ,$58.25 ,$17.20 ,$52.00 ,$55.25 ,$40.63 ,$58.50 , N/A , N/A ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$17.20 ,$55.25 ,$55.25 ,$58.50 ,$39.59 , N/A ,$40.30 , N/A ,$58.50 , N/A ,$59.80 ,$58.50 ,$42.91 ,$42.91 ,$39.59 ,$42.91 ,$42.25 ,$44.41 ,$14.80 ,$51.35 , N/A , N/A , N/A ,$17.20 , 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 ,$52.14 ,$17.98 ,$79.00 , N/A ,$70.80 ,$70.80 ,$20.90 ,$63.20 ,$67.15 ,$49.38 ,$71.10 , N/A , N/A ,$75.05 ,$71.10 ,$67.15 ,$67.15 ,$20.90 ,$67.15 ,$67.15 ,$71.10 ,$48.11 , N/A ,$48.98 , N/A ,$71.10 , N/A ,$72.68 ,$71.10 ,$52.15 ,$52.15 ,$48.11 ,$52.15 ,$51.35 ,$53.97 ,$17.98 ,$62.41 , N/A , N/A , N/A ,$20.90 , 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 ,$54.78 ,$18.89 ,$83.00 , N/A ,$74.38 ,$74.38 ,$21.96 ,$66.40 ,$70.55 , N/A ,$74.70 , N/A , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$21.96 ,$70.55 ,$70.55 ,$74.70 ,$50.55 , N/A ,$51.46 , N/A ,$74.70 , N/A ,$76.36 ,$74.70 ,$54.79 ,$54.79 ,$50.55 ,$54.79 ,$53.95 ,$56.71 ,$18.89 ,$65.57 , N/A , N/A , N/A ,$21.96 , 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 ,$27.80 ,$18.35 ,$6.32 ,$27.80 , N/A ,$24.91 ,$24.91 ,$7.36 ,$22.24 ,$23.63 ,$17.38 ,$25.02 , N/A , N/A ,$26.41 ,$25.02 ,$23.63 ,$23.63 ,$7.36 ,$23.63 ,$23.63 ,$25.02 ,$16.93 , N/A ,$17.24 , N/A ,$25.02 , N/A ,$25.58 ,$25.02 ,$18.35 ,$18.35 ,$16.93 ,$18.35 ,$18.07 ,$18.99 ,$6.32 ,$21.96 , N/A , N/A , N/A ,$7.36 , N/A , N/A ,$26.41 ,$22.80 ,$22.80 ,$22.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800743,N/A,HC K-WIRE ALL SIZES,278,1 ,$19.00 ,$12.54 ,$4.32 ,$19.00 , N/A ,$17.03 ,$17.03 ,$5.03 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$5.03 ,$16.15 ,$16.15 ,$17.10 ,$11.57 , N/A ,$11.78 , N/A ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.54 ,$12.54 ,$11.57 ,$12.54 ,$12.35 ,$12.98 ,$4.32 ,$15.01 , N/A , N/A , N/A ,$5.03 , 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 ","$3,023.46 ","$1,042.89 ","$4,581.00 ", N/A ,"$4,105.49 ","$4,105.49 ","$1,212.13 ","$3,664.80 ","$3,893.85 ","$2,863.13 ","$4,122.90 ", N/A , N/A ,"$4,351.95 ","$4,122.90 ","$3,893.85 ","$3,893.85 ","$1,212.13 ","$3,893.85 ","$3,893.85 ","$4,122.90 ","$2,789.83 ", N/A ,"$2,840.22 ", N/A ,"$4,122.90 ", N/A ,"$4,214.52 ","$4,122.90 ","$3,023.92 ","$3,023.92 ","$2,789.83 ","$3,023.92 ","$2,977.65 ","$3,129.74 ","$1,042.89 ","$3,618.99 ", N/A , N/A , N/A ,"$1,212.13 ", 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 ,$258.72 ,$89.24 ,$392.00 , N/A ,$351.31 ,$351.31 ,$103.72 ,$313.60 ,$333.20 ,$245.00 ,$352.80 , N/A , N/A ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$103.72 ,$333.20 ,$333.20 ,$352.80 ,$238.73 , N/A ,$243.04 , N/A ,$352.80 , N/A ,$360.64 ,$352.80 ,$258.76 ,$258.76 ,$238.73 ,$258.76 ,$254.80 ,$267.81 ,$89.24 ,$309.68 , N/A , N/A , N/A ,$103.72 , 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 ","$1,363.56 ",$470.33 ,"$2,066.00 ", N/A ,"$1,851.55 ","$1,851.55 ",$546.66 ,"$1,652.80 ","$1,756.10 ","$1,291.25 ","$1,859.40 ", N/A , N/A ,"$1,962.70 ","$1,859.40 ","$1,756.10 ","$1,756.10 ",$546.66 ,"$1,756.10 ","$1,756.10 ","$1,859.40 ","$1,258.19 ", N/A ,"$1,280.92 ", N/A ,"$1,859.40 ", N/A ,"$1,900.72 ","$1,859.40 ","$1,363.77 ","$1,363.77 ","$1,258.19 ","$1,363.77 ","$1,342.90 ","$1,411.49 ",$470.33 ,"$1,632.14 ", N/A , N/A , N/A ,$546.66 , 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 ,$373.56 ,$128.85 ,$566.00 , N/A ,$507.25 ,$507.25 ,$149.76 ,$452.80 ,$481.10 ,$353.75 ,$509.40 , N/A , N/A ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$149.76 ,$481.10 ,$481.10 ,$509.40 ,$344.69 , N/A ,$350.92 , N/A ,$509.40 , N/A ,$520.72 ,$509.40 ,$373.62 ,$373.62 ,$344.69 ,$373.62 ,$367.90 ,$386.69 ,$128.85 ,$447.14 , N/A , N/A , N/A ,$149.76 , 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 ,$597.00 ,$394.02 ,$135.91 ,$597.00 , N/A ,$535.03 ,$535.03 ,$157.97 ,$477.60 ,$507.45 ,$373.13 ,$537.30 , N/A , N/A ,$567.15 ,$537.30 ,$507.45 ,$507.45 ,$157.97 ,$507.45 ,$507.45 ,$537.30 ,$363.57 , N/A ,$370.14 , N/A ,$537.30 , N/A ,$549.24 ,$537.30 ,$394.08 ,$394.08 ,$363.57 ,$394.08 ,$388.05 ,$407.87 ,$135.91 ,$471.63 , N/A , N/A , N/A ,$157.97 , N/A , N/A ,$567.15 ,$489.54 ,$489.54 ,$477.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27800804,C1713,HC PLATE 1/3 TUBULAR 5 HOLE 57,278,1 ,$555.00 ,$366.30 ,$126.35 ,$555.00 , N/A ,$497.39 ,$497.39 ,$146.85 ,$444.00 ,$471.75 ,$346.88 ,$499.50 , N/A , N/A ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$146.85 ,$471.75 ,$471.75 ,$499.50 ,$338.00 , N/A ,$344.10 , N/A ,$499.50 , N/A ,$510.60 ,$499.50 ,$366.36 ,$366.36 ,$338.00 ,$366.36 ,$360.75 ,$379.18 ,$126.35 ,$438.45 , N/A , N/A , N/A ,$146.85 , 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 ,$366.30 ,$126.35 ,$555.00 , N/A ,$497.39 ,$497.39 ,$146.85 ,$444.00 ,$471.75 ,$346.88 ,$499.50 , N/A , N/A ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$146.85 ,$471.75 ,$471.75 ,$499.50 ,$338.00 , N/A ,$344.10 , N/A ,$499.50 , N/A ,$510.60 ,$499.50 ,$366.36 ,$366.36 ,$338.00 ,$366.36 ,$360.75 ,$379.18 ,$126.35 ,$438.45 , N/A , N/A , N/A ,$146.85 , 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 ,$373.56 ,$128.85 ,$566.00 , N/A ,$507.25 ,$507.25 ,$149.76 ,$452.80 ,$481.10 ,$353.75 ,$509.40 , N/A , N/A ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$149.76 ,$481.10 ,$481.10 ,$509.40 ,$344.69 , N/A ,$350.92 , N/A ,$509.40 , N/A ,$520.72 ,$509.40 ,$373.62 ,$373.62 ,$344.69 ,$373.62 ,$367.90 ,$386.69 ,$128.85 ,$447.14 , N/A , N/A , N/A ,$149.76 , 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 ,$373.56 ,$128.85 ,$566.00 , N/A ,$507.25 ,$507.25 ,$149.76 ,$452.80 ,$481.10 ,$353.75 ,$509.40 , N/A , N/A ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$149.76 ,$481.10 ,$481.10 ,$509.40 ,$344.69 , N/A ,$350.92 , N/A ,$509.40 , N/A ,$520.72 ,$509.40 ,$373.62 ,$373.62 ,$344.69 ,$373.62 ,$367.90 ,$386.69 ,$128.85 ,$447.14 , N/A , N/A , N/A ,$149.76 , 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 ","$1,170.18 ",$403.63 ,"$1,773.00 ", N/A ,"$1,588.96 ","$1,588.96 ",$469.14 ,"$1,418.40 ","$1,507.05 ","$1,108.13 ","$1,595.70 ", N/A , N/A ,"$1,684.35 ","$1,595.70 ","$1,507.05 ","$1,507.05 ",$469.14 ,"$1,507.05 ","$1,507.05 ","$1,595.70 ","$1,079.76 ", N/A ,"$1,099.26 ", N/A ,"$1,595.70 ", N/A ,"$1,631.16 ","$1,595.70 ","$1,170.36 ","$1,170.36 ","$1,079.76 ","$1,170.36 ","$1,152.45 ","$1,211.31 ",$403.63 ,"$1,400.67 ", N/A , N/A , N/A ,$469.14 , 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 ",$893.64 ,$308.24 ,"$1,354.00 ", N/A ,"$1,213.45 ","$1,213.45 ",$358.27 ,"$1,083.20 ","$1,150.90 ",$846.25 ,"$1,218.60 ", N/A , N/A ,"$1,286.30 ","$1,218.60 ","$1,150.90 ","$1,150.90 ",$358.27 ,"$1,150.90 ","$1,150.90 ","$1,218.60 ",$824.59 , N/A ,$839.48 , N/A ,"$1,218.60 ", N/A ,"$1,245.68 ","$1,218.60 ",$893.78 ,$893.78 ,$824.59 ,$893.78 ,$880.10 ,$925.05 ,$308.24 ,"$1,069.66 ", N/A , N/A , N/A ,$358.27 , 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 ","$1,033.56 ",$356.50 ,"$1,566.00 ", N/A ,"$1,403.45 ","$1,403.45 ",$414.36 ,"$1,252.80 ","$1,331.10 ",$978.75 ,"$1,409.40 ", N/A , N/A ,"$1,487.70 ","$1,409.40 ","$1,331.10 ","$1,331.10 ",$414.36 ,"$1,331.10 ","$1,331.10 ","$1,409.40 ",$953.69 , N/A ,$970.92 , N/A ,"$1,409.40 ", N/A ,"$1,440.72 ","$1,409.40 ","$1,033.72 ","$1,033.72 ",$953.69 ,"$1,033.72 ","$1,017.90 ","$1,069.89 ",$356.50 ,"$1,237.14 ", N/A , N/A , N/A ,$414.36 , 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 ","$1,085.70 ",$374.49 ,"$1,645.00 ", N/A ,"$1,474.25 ","$1,474.25 ",$435.27 ,"$1,316.00 ","$1,398.25 ","$1,028.13 ","$1,480.50 ", N/A , N/A ,"$1,562.75 ","$1,480.50 ","$1,398.25 ","$1,398.25 ",$435.27 ,"$1,398.25 ","$1,398.25 ","$1,480.50 ","$1,001.81 ", N/A ,"$1,019.90 ", N/A ,"$1,480.50 ", N/A ,"$1,513.40 ","$1,480.50 ","$1,085.86 ","$1,085.86 ","$1,001.81 ","$1,085.86 ","$1,069.25 ","$1,123.86 ",$374.49 ,"$1,299.55 ", N/A , N/A , N/A ,$435.27 , 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 ","$1,132.56 ",$390.66 ,"$1,716.00 ", N/A ,"$1,537.88 ","$1,537.88 ",$454.05 ,"$1,372.80 ","$1,458.60 ","$1,072.50 ","$1,544.40 ", N/A , N/A ,"$1,630.20 ","$1,544.40 ","$1,458.60 ","$1,458.60 ",$454.05 ,"$1,458.60 ","$1,458.60 ","$1,544.40 ","$1,045.04 ", N/A ,"$1,063.92 ", N/A ,"$1,544.40 ", N/A ,"$1,578.72 ","$1,544.40 ","$1,132.73 ","$1,132.73 ","$1,045.04 ","$1,132.73 ","$1,115.40 ","$1,172.37 ",$390.66 ,"$1,355.64 ", N/A , N/A , N/A ,$454.05 , 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 ",$839.52 ,$289.58 ,"$1,272.00 ", N/A ,"$1,139.97 ","$1,139.97 ",$336.57 ,"$1,017.60 ","$1,081.20 ",$795.00 ,"$1,144.80 ", N/A , N/A ,"$1,208.40 ","$1,144.80 ","$1,081.20 ","$1,081.20 ",$336.57 ,"$1,081.20 ","$1,081.20 ","$1,144.80 ",$774.65 , N/A ,$788.64 , N/A ,"$1,144.80 ", N/A ,"$1,170.24 ","$1,144.80 ",$839.65 ,$839.65 ,$774.65 ,$839.65 ,$826.80 ,$869.03 ,$289.58 ,"$1,004.88 ", N/A , N/A , N/A ,$336.57 , 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 ","$1,089.00 ",$375.63 ,"$1,650.00 ", N/A ,"$1,478.73 ","$1,478.73 ",$436.59 ,"$1,320.00 ","$1,402.50 ","$1,031.25 ","$1,485.00 ", N/A , N/A ,"$1,567.50 ","$1,485.00 ","$1,402.50 ","$1,402.50 ",$436.59 ,"$1,402.50 ","$1,402.50 ","$1,485.00 ","$1,004.85 ", N/A ,"$1,023.00 ", N/A ,"$1,485.00 ", N/A ,"$1,518.00 ","$1,485.00 ","$1,089.17 ","$1,089.17 ","$1,004.85 ","$1,089.17 ","$1,072.50 ","$1,127.28 ",$375.63 ,"$1,303.50 ", N/A , N/A , N/A ,$436.59 , 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 ",$805.86 ,$277.97 ,"$1,221.00 ", N/A ,"$1,094.26 ","$1,094.26 ",$323.08 ,$976.80 ,"$1,037.85 ",$763.13 ,"$1,098.90 ", N/A , N/A ,"$1,159.95 ","$1,098.90 ","$1,037.85 ","$1,037.85 ",$323.08 ,"$1,037.85 ","$1,037.85 ","$1,098.90 ",$743.59 , N/A ,$757.02 , N/A ,"$1,098.90 ", N/A ,"$1,123.32 ","$1,098.90 ",$805.98 ,$805.98 ,$743.59 ,$805.98 ,$793.65 ,$834.19 ,$277.97 ,$964.59 , N/A , N/A , N/A ,$323.08 , 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 ",$903.54 ,$311.66 ,"$1,369.00 ", N/A ,"$1,226.90 ","$1,226.90 ",$362.24 ,"$1,095.20 ","$1,163.65 ",$855.63 ,"$1,232.10 ", N/A , N/A ,"$1,300.55 ","$1,232.10 ","$1,163.65 ","$1,163.65 ",$362.24 ,"$1,163.65 ","$1,163.65 ","$1,232.10 ",$833.72 , N/A ,$848.78 , N/A ,"$1,232.10 ", N/A ,"$1,259.48 ","$1,232.10 ",$903.68 ,$903.68 ,$833.72 ,$903.68 ,$889.85 ,$935.30 ,$311.66 ,"$1,081.51 ", N/A , N/A , N/A ,$362.24 , 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 ",$694.98 ,$239.72 ,"$1,053.00 ", N/A ,$943.70 ,$943.70 ,$278.62 ,$842.40 ,$895.05 ,$658.13 ,$947.70 , N/A , N/A ,"$1,000.35 ",$947.70 ,$895.05 ,$895.05 ,$278.62 ,$895.05 ,$895.05 ,$947.70 ,$641.28 , N/A ,$652.86 , N/A ,$947.70 , N/A ,$968.76 ,$947.70 ,$695.09 ,$695.09 ,$641.28 ,$695.09 ,$684.45 ,$719.41 ,$239.72 ,$831.87 , N/A , N/A , N/A ,$278.62 , 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 ",$786.06 ,$271.14 ,"$1,191.00 ", N/A ,"$1,067.37 ","$1,067.37 ",$315.14 ,$952.80 ,"$1,012.35 ",$744.38 ,"$1,071.90 ", N/A , N/A ,"$1,131.45 ","$1,071.90 ","$1,012.35 ","$1,012.35 ",$315.14 ,"$1,012.35 ","$1,012.35 ","$1,071.90 ",$725.32 , N/A ,$738.42 , N/A ,"$1,071.90 ", N/A ,"$1,095.72 ","$1,071.90 ",$786.18 ,$786.18 ,$725.32 ,$786.18 ,$774.15 ,$813.69 ,$271.14 ,$940.89 , N/A , N/A , N/A ,$315.14 , 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 ",$757.02 ,$261.12 ,"$1,147.00 ", N/A ,"$1,027.94 ","$1,027.94 ",$303.50 ,$917.60 ,$974.95 ,$716.88 ,"$1,032.30 ", N/A , N/A ,"$1,089.65 ","$1,032.30 ",$974.95 ,$974.95 ,$303.50 ,$974.95 ,$974.95 ,"$1,032.30 ",$698.52 , N/A ,$711.14 , N/A ,"$1,032.30 ", N/A ,"$1,055.24 ","$1,032.30 ",$757.13 ,$757.13 ,$698.52 ,$757.13 ,$745.55 ,$783.63 ,$261.12 ,$906.13 , N/A , N/A , N/A ,$303.50 , 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 ,$607.20 ,$209.45 ,$920.00 , N/A ,$824.50 ,$824.50 ,$243.43 ,$736.00 ,$782.00 ,$575.00 ,$828.00 , N/A , N/A ,$874.00 ,$828.00 ,$782.00 ,$782.00 ,$243.43 ,$782.00 ,$782.00 ,$828.00 ,$560.28 , N/A ,$570.40 , N/A ,$828.00 , N/A ,$846.40 ,$828.00 ,$607.29 ,$607.29 ,$560.28 ,$607.29 ,$598.00 ,$628.54 ,$209.45 ,$726.80 , N/A , N/A , N/A ,$243.43 , 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 ",$708.84 ,$244.50 ,"$1,074.00 ", N/A ,$962.52 ,$962.52 ,$284.18 ,$859.20 ,$912.90 ,$671.25 ,$966.60 , N/A , N/A ,"$1,020.30 ",$966.60 ,$912.90 ,$912.90 ,$284.18 ,$912.90 ,$912.90 ,$966.60 ,$654.07 , N/A ,$665.88 , N/A ,$966.60 , N/A ,$988.08 ,$966.60 ,$708.95 ,$708.95 ,$654.07 ,$708.95 ,$698.10 ,$733.76 ,$244.50 ,$848.46 , N/A , N/A , N/A ,$284.18 , 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 ",$837.54 ,$288.89 ,"$1,269.00 ", N/A ,"$1,137.28 ","$1,137.28 ",$335.78 ,"$1,015.20 ","$1,078.65 ",$793.13 ,"$1,142.10 ", N/A , N/A ,"$1,205.55 ","$1,142.10 ","$1,078.65 ","$1,078.65 ",$335.78 ,"$1,078.65 ","$1,078.65 ","$1,142.10 ",$772.82 , N/A ,$786.78 , N/A ,"$1,142.10 ", N/A ,"$1,167.48 ","$1,142.10 ",$837.67 ,$837.67 ,$772.82 ,$837.67 ,$824.85 ,$866.98 ,$288.89 ,"$1,002.51 ", N/A , N/A , N/A ,$335.78 , 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 ,$648.12 ,$223.56 ,$982.00 , N/A ,$880.07 ,$880.07 ,$259.84 ,$785.60 ,$834.70 ,$613.75 ,$883.80 , N/A , N/A ,$932.90 ,$883.80 ,$834.70 ,$834.70 ,$259.84 ,$834.70 ,$834.70 ,$883.80 ,$598.04 , N/A ,$608.84 , N/A ,$883.80 , N/A ,$903.44 ,$883.80 ,$648.22 ,$648.22 ,$598.04 ,$648.22 ,$638.30 ,$670.90 ,$223.56 ,$775.78 , N/A , N/A , N/A ,$259.84 , 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 ","$2,896.74 ",$999.17 ,"$4,389.00 ", N/A ,"$3,933.42 ","$3,933.42 ","$1,161.33 ","$3,511.20 ","$3,730.65 ","$2,743.13 ","$3,950.10 ", N/A , N/A ,"$4,169.55 ","$3,950.10 ","$3,730.65 ","$3,730.65 ","$1,161.33 ","$3,730.65 ","$3,730.65 ","$3,950.10 ","$2,672.90 ", N/A ,"$2,721.18 ", N/A ,"$3,950.10 ", N/A ,"$4,037.88 ","$3,950.10 ","$2,897.18 ","$2,897.18 ","$2,672.90 ","$2,897.18 ","$2,852.85 ","$2,998.56 ",$999.17 ,"$3,467.31 ", N/A , N/A , N/A ,"$1,161.33 ", 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 ","$1,214.40 ",$418.88 ,"$1,840.00 ", N/A ,"$1,649.01 ","$1,649.01 ",$486.86 ,"$1,472.00 ","$1,564.00 ","$1,150.00 ","$1,656.00 ", N/A , N/A ,"$1,748.00 ","$1,656.00 ","$1,564.00 ","$1,564.00 ",$486.86 ,"$1,564.00 ","$1,564.00 ","$1,656.00 ","$1,120.56 ", N/A ,"$1,140.80 ", N/A ,"$1,656.00 ", N/A ,"$1,692.80 ","$1,656.00 ","$1,214.58 ","$1,214.58 ","$1,120.56 ","$1,214.58 ","$1,196.00 ","$1,257.09 ",$418.88 ,"$1,453.60 ", N/A , N/A , N/A ,$486.86 , 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 ","$1,397.22 ",$481.94 ,"$2,117.00 ", N/A ,"$1,897.26 ","$1,897.26 ",$560.16 ,"$1,693.60 ","$1,799.45 ","$1,323.13 ","$1,905.30 ", N/A , N/A ,"$2,011.15 ","$1,905.30 ","$1,799.45 ","$1,799.45 ",$560.16 ,"$1,799.45 ","$1,799.45 ","$1,905.30 ","$1,289.25 ", N/A ,"$1,312.54 ", N/A ,"$1,905.30 ", N/A ,"$1,947.64 ","$1,905.30 ","$1,397.43 ","$1,397.43 ","$1,289.25 ","$1,397.43 ","$1,376.05 ","$1,446.33 ",$481.94 ,"$1,672.43 ", N/A , N/A , N/A ,$560.16 , 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 ","$1,903.44 ",$656.55 ,"$2,884.00 ", N/A ,"$2,584.64 ","$2,584.64 ",$763.11 ,"$2,307.20 ","$2,451.40 ","$1,802.50 ","$2,595.60 ", N/A , N/A ,"$2,739.80 ","$2,595.60 ","$2,451.40 ","$2,451.40 ",$763.11 ,"$2,451.40 ","$2,451.40 ","$2,595.60 ","$1,756.36 ", N/A ,"$1,788.08 ", N/A ,"$2,595.60 ", N/A ,"$2,653.28 ","$2,595.60 ","$1,903.73 ","$1,903.73 ","$1,756.36 ","$1,903.73 ","$1,874.60 ","$1,970.35 ",$656.55 ,"$2,278.36 ", N/A , N/A , N/A ,$763.11 , 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 ","$2,470.38 ",$852.11 ,"$3,743.00 ", N/A ,"$3,354.48 ","$3,354.48 ",$990.40 ,"$2,994.40 ","$3,181.55 ","$2,339.38 ","$3,368.70 ", N/A , N/A ,"$3,555.85 ","$3,368.70 ","$3,181.55 ","$3,181.55 ",$990.40 ,"$3,181.55 ","$3,181.55 ","$3,368.70 ","$2,279.49 ", N/A ,"$2,320.66 ", N/A ,"$3,368.70 ", N/A ,"$3,443.56 ","$3,368.70 ","$2,470.75 ","$2,470.75 ","$2,279.49 ","$2,470.75 ","$2,432.95 ","$2,557.22 ",$852.11 ,"$2,956.97 ", N/A , N/A , N/A ,$990.40 , 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 ,$491.04 ,$169.37 ,$744.00 , N/A ,$666.77 ,$666.77 ,$196.86 ,$595.20 ,$632.40 ,$465.00 ,$669.60 , N/A , N/A ,$706.80 ,$669.60 ,$632.40 ,$632.40 ,$196.86 ,$632.40 ,$632.40 ,$669.60 ,$453.10 , N/A ,$461.28 , N/A ,$669.60 , N/A ,$684.48 ,$669.60 ,$491.11 ,$491.11 ,$453.10 ,$491.11 ,$483.60 ,$508.30 ,$169.37 ,$587.76 , N/A , N/A , N/A ,$196.86 , 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 ,$526.68 ,$181.67 ,$798.00 , N/A ,$715.17 ,$715.17 ,$211.15 ,$638.40 ,$678.30 ,$498.75 ,$718.20 , N/A , N/A ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$211.15 ,$678.30 ,$678.30 ,$718.20 ,$485.98 , N/A ,$494.76 , N/A ,$718.20 , N/A ,$734.16 ,$718.20 ,$526.76 ,$526.76 ,$485.98 ,$526.76 ,$518.70 ,$545.19 ,$181.67 ,$630.42 , N/A , N/A , N/A ,$211.15 , 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 ,$526.68 ,$181.67 ,$798.00 , N/A ,$715.17 ,$715.17 ,$211.15 ,$638.40 ,$678.30 ,$498.75 ,$718.20 , N/A , N/A ,$758.10 ,$718.20 ,$678.30 ,$678.30 ,$211.15 ,$678.30 ,$678.30 ,$718.20 ,$485.98 , N/A ,$494.76 , N/A ,$718.20 , N/A ,$734.16 ,$718.20 ,$526.76 ,$526.76 ,$485.98 ,$526.76 ,$518.70 ,$545.19 ,$181.67 ,$630.42 , N/A , N/A , N/A ,$211.15 , 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 ,$551.76 ,$190.32 ,$836.00 , N/A ,$749.22 ,$749.22 ,$221.21 ,$668.80 ,$710.60 ,$522.50 ,$752.40 , N/A , N/A ,$794.20 ,$752.40 ,$710.60 ,$710.60 ,$221.21 ,$710.60 ,$710.60 ,$752.40 ,$509.12 , N/A ,$518.32 , N/A ,$752.40 , N/A ,$769.12 ,$752.40 ,$551.84 ,$551.84 ,$509.12 ,$551.84 ,$543.40 ,$571.16 ,$190.32 ,$660.44 , N/A , N/A , N/A ,$221.21 , 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 ,$578.82 ,$199.66 ,$877.00 , N/A ,$785.97 ,$785.97 ,$232.05 ,$701.60 ,$745.45 ,$548.13 ,$789.30 , N/A , N/A ,$833.15 ,$789.30 ,$745.45 ,$745.45 ,$232.05 ,$745.45 ,$745.45 ,$789.30 ,$534.09 , N/A ,$543.74 , N/A ,$789.30 , N/A ,$806.84 ,$789.30 ,$578.91 ,$578.91 ,$534.09 ,$578.91 ,$570.05 ,$599.17 ,$199.66 ,$692.83 , N/A , N/A , N/A ,$232.05 , 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 ,$124.86 ,$82.41 ,$28.43 ,$124.86 , N/A ,$111.90 ,$111.90 ,$33.04 ,$99.89 ,$106.13 ,$78.04 ,$112.37 , N/A , N/A ,$118.62 ,$112.37 ,$106.13 ,$106.13 ,$33.04 ,$106.13 ,$106.13 ,$112.37 ,$76.04 , N/A ,$77.42 , N/A ,$112.37 , N/A ,$114.87 ,$112.37 ,$82.42 ,$82.42 ,$76.04 ,$82.42 ,$81.16 ,$85.30 ,$28.43 ,$98.64 , N/A , N/A , N/A ,$33.04 , N/A , N/A ,$118.62 ,$102.39 ,$102.39 ,$99.89 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801038,C1713,HC SCREW 3.5 CORTEX,278,1 ,$82.56 ,$54.49 ,$18.80 ,$82.56 , N/A ,$73.99 ,$73.99 ,$21.84 ,$66.05 ,$70.18 ,$51.60 ,$74.30 , N/A , N/A ,$78.43 ,$74.30 ,$70.18 ,$70.18 ,$21.84 ,$70.18 ,$70.18 ,$74.30 ,$50.28 , N/A ,$51.18 , N/A ,$74.30 , N/A ,$75.96 ,$74.30 ,$54.50 ,$54.50 ,$50.28 ,$54.50 ,$53.66 ,$56.41 ,$18.80 ,$65.22 , N/A , N/A , N/A ,$21.84 , N/A , N/A ,$78.43 ,$67.70 ,$67.70 ,$66.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801071,C1713,HC SCREW LOCKING,278,1 ,$446.00 ,$294.36 ,$101.54 ,$446.00 , N/A ,$399.71 ,$399.71 ,$118.01 ,$356.80 ,$379.10 ,$278.75 ,$401.40 , N/A , N/A ,$423.70 ,$401.40 ,$379.10 ,$379.10 ,$118.01 ,$379.10 ,$379.10 ,$401.40 ,$271.61 , N/A ,$276.52 , N/A ,$401.40 , N/A ,$410.32 ,$401.40 ,$294.40 ,$294.40 ,$271.61 ,$294.40 ,$289.90 ,$304.71 ,$101.54 ,$352.34 , N/A , N/A , N/A ,$118.01 , 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 ,$291.06 ,$100.39 ,$441.00 , N/A ,$395.22 ,$395.22 ,$116.69 ,$352.80 ,$374.85 ,$275.63 ,$396.90 , N/A , N/A ,$418.95 ,$396.90 ,$374.85 ,$374.85 ,$116.69 ,$374.85 ,$374.85 ,$396.90 ,$268.57 , N/A ,$273.42 , N/A ,$396.90 , N/A ,$405.72 ,$396.90 ,$291.10 ,$291.10 ,$268.57 ,$291.10 ,$286.65 ,$301.29 ,$100.39 ,$348.39 , N/A , N/A , N/A ,$116.69 , 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 ,$394.02 ,$135.91 ,$597.00 , N/A ,$535.03 ,$535.03 ,$157.97 ,$477.60 ,$507.45 ,$373.13 ,$537.30 , N/A , N/A ,$567.15 ,$537.30 ,$507.45 ,$507.45 ,$157.97 ,$507.45 ,$507.45 ,$537.30 ,$363.57 , N/A ,$370.14 , N/A ,$537.30 , N/A ,$549.24 ,$537.30 ,$394.08 ,$394.08 ,$363.57 ,$394.08 ,$388.05 ,$407.87 ,$135.91 ,$471.63 , N/A , N/A , N/A ,$157.97 , 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 ,$375.54 ,$129.54 ,$569.00 , N/A ,$509.94 ,$509.94 ,$150.56 ,$455.20 ,$483.65 ,$355.63 ,$512.10 , N/A , N/A ,$540.55 ,$512.10 ,$483.65 ,$483.65 ,$150.56 ,$483.65 ,$483.65 ,$512.10 ,$346.52 , N/A ,$352.78 , N/A ,$512.10 , N/A ,$523.48 ,$512.10 ,$375.60 ,$375.60 ,$346.52 ,$375.60 ,$369.85 ,$388.74 ,$129.54 ,$449.51 , N/A , N/A , N/A ,$150.56 , 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 ,$418.00 ,$275.88 ,$95.16 ,$418.00 , N/A ,$374.61 ,$374.61 ,$110.60 ,$334.40 ,$355.30 ,$261.25 ,$376.20 , N/A , N/A ,$397.10 ,$376.20 ,$355.30 ,$355.30 ,$110.60 ,$355.30 ,$355.30 ,$376.20 ,$254.56 , N/A ,$259.16 , N/A ,$376.20 , N/A ,$384.56 ,$376.20 ,$275.92 ,$275.92 ,$254.56 ,$275.92 ,$271.70 ,$285.58 ,$95.16 ,$330.22 , N/A , N/A , N/A ,$110.60 , N/A , N/A ,$397.10 ,$342.76 ,$342.76 ,$334.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801101,C1713,HC SCREW SYN CAN 4.0 10-60,278,1 ,$63.00 ,$41.58 ,$14.34 ,$63.00 , N/A ,$56.46 ,$56.46 ,$16.67 ,$50.40 ,$53.55 ,$39.38 ,$56.70 , N/A , N/A ,$59.85 ,$56.70 ,$53.55 ,$53.55 ,$16.67 ,$53.55 ,$53.55 ,$56.70 ,$38.37 , N/A ,$39.06 , N/A ,$56.70 , N/A ,$57.96 ,$56.70 ,$41.59 ,$41.59 ,$38.37 ,$41.59 ,$40.95 ,$43.04 ,$14.34 ,$49.77 , N/A , N/A , N/A ,$16.67 , 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 ,$417.78 ,$144.11 ,$633.00 , N/A ,$567.29 ,$567.29 ,$167.49 ,$506.40 ,$538.05 ,$395.63 ,$569.70 , N/A , N/A ,$601.35 ,$569.70 ,$538.05 ,$538.05 ,$167.49 ,$538.05 ,$538.05 ,$569.70 ,$385.50 , N/A ,$392.46 , N/A ,$569.70 , N/A ,$582.36 ,$569.70 ,$417.84 ,$417.84 ,$385.50 ,$417.84 ,$411.45 ,$432.47 ,$144.11 ,$500.07 , N/A , N/A , N/A ,$167.49 , 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 ,$545.16 ,$188.04 ,$826.00 , N/A ,$740.26 ,$740.26 ,$218.56 ,$660.80 ,$702.10 ,$516.25 ,$743.40 , N/A , N/A ,$784.70 ,$743.40 ,$702.10 ,$702.10 ,$218.56 ,$702.10 ,$702.10 ,$743.40 ,$503.03 , N/A ,$512.12 , N/A ,$743.40 , N/A ,$759.92 ,$743.40 ,$545.24 ,$545.24 ,$503.03 ,$545.24 ,$536.90 ,$564.32 ,$188.04 ,$652.54 , N/A , N/A , N/A ,$218.56 , 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 ,$320.76 ,$110.64 ,$486.00 , N/A ,$435.55 ,$435.55 ,$128.60 ,$388.80 ,$413.10 ,$303.75 ,$437.40 , N/A , N/A ,$461.70 ,$437.40 ,$413.10 ,$413.10 ,$128.60 ,$413.10 ,$413.10 ,$437.40 ,$295.97 , N/A ,$301.32 , N/A ,$437.40 , N/A ,$447.12 ,$437.40 ,$320.81 ,$320.81 ,$295.97 ,$320.81 ,$315.90 ,$332.04 ,$110.64 ,$383.94 , N/A , N/A , N/A ,$128.60 , 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 ,$333.65 ,$220.21 ,$75.96 ,$333.65 , N/A ,$299.02 ,$299.02 ,$88.29 ,$266.92 ,$283.60 ,$208.53 ,$300.29 , N/A , N/A ,$316.97 ,$300.29 ,$283.60 ,$283.60 ,$88.29 ,$283.60 ,$283.60 ,$300.29 ,$203.19 , N/A ,$206.86 , N/A ,$300.29 , N/A ,$306.96 ,$300.29 ,$220.24 ,$220.24 ,$203.19 ,$220.24 ,$216.87 ,$227.95 ,$75.96 ,$263.58 , N/A , N/A , N/A ,$88.29 , N/A , N/A ,$316.97 ,$273.59 ,$273.59 ,$266.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801177,N/A,HC STAPLE ENDO GIA 60,278,1 ,$144.00 ,$95.04 ,$32.78 ,$144.00 , N/A ,$129.05 ,$129.05 ,$38.10 ,$115.20 ,$122.40 ,$90.00 ,$129.60 , N/A , N/A ,$136.80 ,$129.60 ,$122.40 ,$122.40 ,$38.10 ,$122.40 ,$122.40 ,$129.60 ,$87.70 , N/A ,$89.28 , N/A ,$129.60 , N/A ,$132.48 ,$129.60 ,$95.05 ,$95.05 ,$87.70 ,$95.05 ,$93.60 ,$98.38 ,$32.78 ,$113.76 , N/A , N/A , N/A ,$38.10 , 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 ",$737.22 ,$254.29 ,"$1,117.00 ", N/A ,"$1,001.06 ","$1,001.06 ",$295.56 ,$893.60 ,$949.45 ,$698.13 ,"$1,005.30 ", N/A , N/A ,"$1,061.15 ","$1,005.30 ",$949.45 ,$949.45 ,$295.56 ,$949.45 ,$949.45 ,"$1,005.30 ",$680.25 , N/A ,$692.54 , N/A ,"$1,005.30 ", N/A ,"$1,027.64 ","$1,005.30 ",$737.33 ,$737.33 ,$680.25 ,$737.33 ,$726.05 ,$763.13 ,$254.29 ,$882.43 , N/A , N/A , N/A ,$295.56 , 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 ,$104.28 ,$35.97 ,$158.00 , N/A ,$141.60 ,$141.60 ,$41.81 ,$126.40 ,$134.30 ,$98.75 ,$142.20 , N/A , N/A ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$41.81 ,$134.30 ,$134.30 ,$142.20 ,$96.22 , N/A ,$97.96 , N/A ,$142.20 , N/A ,$145.36 ,$142.20 ,$104.30 ,$104.30 ,$96.22 ,$104.30 ,$102.70 ,$107.95 ,$35.97 ,$124.82 , N/A , N/A , N/A ,$41.81 , 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 ,$228.00 ,$150.48 ,$51.90 ,$228.00 , N/A ,$204.33 ,$204.33 ,$60.33 ,$182.40 ,$193.80 ,$142.50 ,$205.20 , N/A , N/A ,$216.60 ,$205.20 ,$193.80 ,$193.80 ,$60.33 ,$193.80 ,$193.80 ,$205.20 ,$138.85 , N/A ,$141.36 , N/A ,$205.20 , N/A ,$209.76 ,$205.20 ,$150.50 ,$150.50 ,$138.85 ,$150.50 ,$148.20 ,$155.77 ,$51.90 ,$180.12 , N/A , N/A , N/A ,$60.33 , N/A , N/A ,$216.60 ,$186.96 ,$186.96 ,$182.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801204,N/A,HC STAPLE TA90B,278,1 ,$654.00 ,$431.64 ,$148.88 ,$654.00 , N/A ,$586.11 ,$586.11 ,$173.05 ,$523.20 ,$555.90 ,$408.75 ,$588.60 , N/A , N/A ,$621.30 ,$588.60 ,$555.90 ,$555.90 ,$173.05 ,$555.90 ,$555.90 ,$588.60 ,$398.29 , N/A ,$405.48 , N/A ,$588.60 , N/A ,$601.68 ,$588.60 ,$431.71 ,$431.71 ,$398.29 ,$431.71 ,$425.10 ,$446.81 ,$148.88 ,$516.66 , N/A , N/A , N/A ,$173.05 , N/A , N/A ,$621.30 ,$536.28 ,$536.28 ,$523.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801217,N/A,HC STENT RAINS FRONTL SINUS,278,1 ,$176.00 ,$116.16 ,$40.06 ,$176.00 , N/A ,$157.73 ,$157.73 ,$46.57 ,$140.80 ,$149.60 ,$110.00 ,$158.40 , N/A , N/A ,$167.20 ,$158.40 ,$149.60 ,$149.60 ,$46.57 ,$149.60 ,$149.60 ,$158.40 ,$107.18 , N/A ,$109.12 , N/A ,$158.40 , N/A ,$161.92 ,$158.40 ,$116.18 ,$116.18 ,$107.18 ,$116.18 ,$114.40 ,$120.24 ,$40.06 ,$139.04 , N/A , N/A , N/A ,$46.57 , 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 ,$171.76 ,$113.36 ,$39.10 ,$171.76 , N/A ,$153.93 ,$153.93 ,$45.45 ,$137.41 ,$146.00 ,$107.35 ,$154.58 , N/A , N/A ,$163.17 ,$154.58 ,$146.00 ,$146.00 ,$45.45 ,$146.00 ,$146.00 ,$154.58 ,$104.60 , N/A ,$106.50 , N/A ,$154.58 , N/A ,$158.02 ,$154.58 ,$113.38 ,$113.38 ,$104.60 ,$113.38 ,$111.64 ,$117.35 ,$39.10 ,$135.69 , N/A , N/A , N/A ,$45.45 , N/A , N/A ,$163.17 ,$140.84 ,$140.84 ,$137.41 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801230,N/A,HC SUT BONE WAX W31G,278,1 ,$18.00 ,$11.88 ,$4.10 ,$18.00 , N/A ,$16.13 ,$16.13 ,$4.76 ,$14.40 ,$15.30 ,$11.25 ,$16.20 , N/A , N/A ,$17.10 ,$16.20 ,$15.30 ,$15.30 ,$4.76 ,$15.30 ,$15.30 ,$16.20 ,$10.96 , N/A ,$11.16 , N/A ,$16.20 , N/A ,$16.56 ,$16.20 ,$11.88 ,$11.88 ,$10.96 ,$11.88 ,$11.70 ,$12.30 ,$4.10 ,$14.22 , N/A , N/A , N/A ,$4.76 , 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 ,$23.76 ,$8.19 ,$36.00 , N/A ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A ,$22.32 , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 , N/A , N/A , N/A ,$9.53 , 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 ,$14.52 ,$5.01 ,$22.00 , N/A ,$19.72 ,$19.72 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A , N/A , N/A ,$5.82 , 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 ,$43.56 ,$15.02 ,$66.00 , N/A ,$59.15 ,$59.15 ,$17.46 ,$52.80 ,$56.10 ,$41.25 ,$59.40 , N/A , N/A ,$62.70 ,$59.40 ,$56.10 ,$56.10 ,$17.46 ,$56.10 ,$56.10 ,$59.40 ,$40.19 , N/A ,$40.92 , N/A ,$59.40 , N/A ,$60.72 ,$59.40 ,$43.57 ,$43.57 ,$40.19 ,$43.57 ,$42.90 ,$45.09 ,$15.02 ,$52.14 , N/A , N/A , N/A ,$17.46 , 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 ,$22.44 ,$7.74 ,$34.00 , N/A ,$30.47 ,$30.47 ,$9.00 ,$27.20 ,$28.90 ,$21.25 ,$30.60 , N/A , N/A ,$32.30 ,$30.60 ,$28.90 ,$28.90 ,$9.00 ,$28.90 ,$28.90 ,$30.60 ,$20.71 , N/A ,$21.08 , N/A ,$30.60 , N/A ,$31.28 ,$30.60 ,$22.44 ,$22.44 ,$20.71 ,$22.44 ,$22.10 ,$23.23 ,$7.74 ,$26.86 , N/A , N/A , N/A ,$9.00 , 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 ,$54.78 ,$18.89 ,$83.00 , N/A ,$74.38 ,$74.38 ,$21.96 ,$66.40 ,$70.55 ,$51.88 ,$74.70 , N/A , N/A ,$78.85 ,$74.70 ,$70.55 ,$70.55 ,$21.96 ,$70.55 ,$70.55 ,$74.70 ,$50.55 , N/A ,$51.46 , N/A ,$74.70 , N/A ,$76.36 ,$74.70 ,$54.79 ,$54.79 ,$50.55 ,$54.79 ,$53.95 ,$56.71 ,$18.89 ,$65.57 , N/A , N/A , N/A ,$21.96 , 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 ,$34.98 ,$12.06 ,$53.00 , N/A ,$47.50 ,$47.50 ,$14.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A , N/A , N/A ,$14.02 , 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 ,$27.78 ,$18.33 ,$6.32 ,$27.78 , N/A ,$24.90 ,$24.90 ,$7.35 ,$22.22 ,$23.61 ,$17.36 ,$25.00 , N/A , N/A ,$26.39 ,$25.00 ,$23.61 ,$23.61 ,$7.35 ,$23.61 ,$23.61 ,$25.00 ,$16.92 , N/A ,$17.22 , N/A ,$25.00 , N/A ,$25.56 ,$25.00 ,$18.34 ,$18.34 ,$16.92 ,$18.34 ,$18.06 ,$18.98 ,$6.32 ,$21.95 , N/A , N/A , N/A ,$7.35 , N/A , N/A ,$26.39 ,$22.78 ,$22.78 ,$22.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801344,N/A,HC MEMBRANE SEPRAFILM,278,1 ,$600.00 ,$396.00 ,$136.59 ,$600.00 , N/A ,$537.72 ,$537.72 ,$158.76 ,$480.00 ,$510.00 ,$375.00 ,$540.00 , N/A , N/A ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$158.76 ,$510.00 ,$510.00 ,$540.00 ,$365.40 , N/A ,$372.00 , N/A ,$540.00 , N/A ,$552.00 ,$540.00 ,$396.06 ,$396.06 ,$365.40 ,$396.06 ,$390.00 ,$409.92 ,$136.59 ,$474.00 , N/A , N/A , N/A ,$158.76 , 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 ,$186.12 ,$64.20 ,$282.00 , N/A ,$252.73 ,$252.73 ,$74.62 ,$225.60 ,$239.70 ,$176.25 ,$253.80 , N/A , N/A ,$267.90 ,$253.80 ,$239.70 ,$239.70 ,$74.62 ,$239.70 ,$239.70 ,$253.80 ,$171.74 , N/A ,$174.84 , N/A ,$253.80 , N/A ,$259.44 ,$253.80 ,$186.15 ,$186.15 ,$171.74 ,$186.15 ,$183.30 ,$192.66 ,$64.20 ,$222.78 , N/A , N/A , N/A ,$74.62 , 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 ,"$2,409.00 ","$1,589.94 ",$548.42 ,"$2,409.00 ", N/A ,"$2,158.95 ","$2,158.95 ",$637.42 ,"$1,927.20 ","$2,047.65 ","$1,505.63 ","$2,168.10 ", N/A , N/A ,"$2,288.55 ","$2,168.10 ","$2,047.65 ","$2,047.65 ",$637.42 ,"$2,047.65 ","$2,047.65 ","$2,168.10 ","$1,467.08 ", N/A ,"$1,493.58 ", N/A ,"$2,168.10 ", N/A ,"$2,216.28 ","$2,168.10 ","$1,590.18 ","$1,590.18 ","$1,467.08 ","$1,590.18 ","$1,565.85 ","$1,645.83 ",$548.42 ,"$1,903.11 ", N/A , N/A , N/A ,$637.42 , N/A , N/A ,"$2,288.55 ","$1,975.38 ","$1,975.38 ","$1,927.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27801383,C1781,HC MESH VENTRALIGHT ST ECHO 7X9,278,1 ,"$3,389.00 ","$2,236.74 ",$771.51 ,"$3,389.00 ", N/A ,"$3,037.22 ","$3,037.22 ",$896.73 ,"$2,711.20 ","$2,880.65 ","$2,118.13 ","$3,050.10 ", N/A , N/A ,"$3,219.55 ","$3,050.10 ","$2,880.65 ","$2,880.65 ",$896.73 ,"$2,880.65 ","$2,880.65 ","$3,050.10 ","$2,063.90 ", N/A ,"$2,101.18 ", N/A ,"$3,050.10 ", N/A ,"$3,117.88 ","$3,050.10 ","$2,237.08 ","$2,237.08 ","$2,063.90 ","$2,237.08 ","$2,202.85 ","$2,315.36 ",$771.51 ,"$2,677.31 ", N/A , N/A , N/A ,$896.73 , 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 ","$2,601.72 ",$897.42 ,"$3,942.00 ", N/A ,"$3,532.82 ","$3,532.82 ","$1,043.05 ","$3,153.60 ","$3,350.70 ","$2,463.75 ","$3,547.80 ", N/A , N/A ,"$3,744.90 ","$3,547.80 ","$3,350.70 ","$3,350.70 ","$1,043.05 ","$3,350.70 ","$3,350.70 ","$3,547.80 ","$2,400.68 ", N/A ,"$2,444.04 ", N/A ,"$3,547.80 ", N/A ,"$3,626.64 ","$3,547.80 ","$2,602.11 ","$2,602.11 ","$2,400.68 ","$2,602.11 ","$2,562.30 ","$2,693.17 ",$897.42 ,"$3,114.18 ", N/A , N/A , N/A ,"$1,043.05 ", 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 ,$118.80 ,$40.97 ,$180.00 , N/A ,$161.32 ,$161.32 ,$47.63 ,$144.00 ,$153.00 ,$112.50 ,$162.00 , N/A , N/A ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$47.63 ,$153.00 ,$153.00 ,$162.00 ,$109.62 , N/A ,$111.60 , N/A ,$162.00 , N/A ,$165.60 ,$162.00 ,$118.82 ,$118.82 ,$109.62 ,$118.82 ,$117.00 ,$122.98 ,$40.97 ,$142.20 , N/A , N/A , N/A ,$47.63 , 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 ,"$1,121.00 ",$739.86 ,$255.20 ,"$1,121.00 ", N/A ,"$1,004.64 ","$1,004.64 ",$296.62 ,$896.80 ,$952.85 ,$700.63 ,"$1,008.90 ", N/A , N/A ,"$1,064.95 ","$1,008.90 ",$952.85 ,$952.85 ,$296.62 ,$952.85 ,$952.85 ,"$1,008.90 ",$682.69 , N/A ,$695.02 , N/A ,"$1,008.90 ", N/A ,"$1,031.32 ","$1,008.90 ",$739.97 ,$739.97 ,$682.69 ,$739.97 ,$728.65 ,$765.87 ,$255.20 ,$885.59 , N/A , N/A , N/A ,$296.62 , N/A , N/A ,"$1,064.95 ",$919.22 ,$919.22 ,$896.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27801492,C1781,HC MESH VENTRALIGHT ST ECHO 12X14,278,1 ,"$4,806.00 ","$3,171.96 ","$1,094.10 ","$4,806.00 ", N/A ,"$4,307.14 ","$4,307.14 ","$1,271.67 ","$3,844.80 ","$4,085.10 ","$3,003.75 ","$4,325.40 ", N/A , N/A ,"$4,565.70 ","$4,325.40 ","$4,085.10 ","$4,085.10 ","$1,271.67 ","$4,085.10 ","$4,085.10 ","$4,325.40 ","$2,926.85 ", N/A ,"$2,979.72 ", N/A ,"$4,325.40 ", N/A ,"$4,421.52 ","$4,325.40 ","$3,172.44 ","$3,172.44 ","$2,926.85 ","$3,172.44 ","$3,123.90 ","$3,283.46 ","$1,094.10 ","$3,796.74 ", N/A , N/A , N/A ,"$1,271.67 ", 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 ,$80.00 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A , N/A , N/A ,$21.17 , N/A , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27802174,C1713,HC SUTURE TAPE 1.3MM BLUE,278,1 ,$6.10 ,$4.03 ,$1.38 ,$6.10 , N/A ,$5.47 ,$5.47 ,$1.62 ,$4.88 ,$5.19 ,$3.81 ,$5.49 , N/A , N/A ,$5.80 ,$5.49 ,$5.19 ,$5.19 ,$1.62 ,$5.19 ,$5.19 ,$5.49 ,$3.71 , N/A ,$3.78 , N/A ,$5.49 , N/A ,$5.61 ,$5.49 ,$4.03 ,$4.03 ,$3.71 ,$4.03 ,$3.97 ,$4.17 ,$1.38 ,$4.82 , N/A , N/A , N/A ,$1.62 , 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 ,$9.64 ,$3.32 ,$14.60 , N/A ,$13.08 ,$13.08 ,$3.86 ,$11.68 ,$12.41 ,$9.13 ,$13.14 , N/A , N/A ,$13.87 ,$13.14 ,$12.41 ,$12.41 ,$3.86 ,$12.41 ,$12.41 ,$13.14 ,$8.89 , N/A ,$9.06 , N/A ,$13.14 , N/A ,$13.43 ,$13.14 ,$9.64 ,$9.64 ,$8.89 ,$9.64 ,$9.49 ,$9.97 ,$3.32 ,$11.53 , N/A , N/A , N/A ,$3.86 , 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 ,$16.65 ,$10.99 ,$3.79 ,$16.65 , N/A ,$14.92 ,$14.92 ,$4.41 ,$13.32 ,$14.15 ,$10.41 ,$14.99 , N/A , N/A ,$15.82 ,$14.99 ,$14.15 ,$14.15 ,$4.41 ,$14.15 ,$14.15 ,$14.99 ,$10.14 , N/A ,$10.32 , N/A ,$14.99 , N/A ,$15.32 ,$14.99 ,$10.99 ,$10.99 ,$10.14 ,$10.99 ,$10.82 ,$11.38 ,$3.79 ,$13.15 , N/A , N/A , N/A ,$4.41 , N/A , N/A ,$15.82 ,$13.65 ,$13.65 ,$13.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,AGENT HEMOSTATIC FLOSEAL MATRIX 5 ML,278,1 ,$321.32 ,$212.07 ,$73.15 ,$321.32 , N/A ,$287.97 ,$287.97 ,$85.02 ,$257.06 ,$273.12 ,$200.83 ,$289.19 , N/A , N/A ,$305.25 ,$289.19 ,$273.12 ,$273.12 ,$85.02 ,$273.12 ,$273.12 ,$289.19 ,$195.68 , N/A ,$199.22 , N/A ,$289.19 , N/A ,$295.61 ,$289.19 ,$212.10 ,$212.10 ,$195.68 ,$212.10 ,$208.86 ,$219.53 ,$73.15 ,$253.84 , N/A , N/A , N/A ,$85.02 , N/A , N/A ,$305.25 ,$263.48 ,$263.48 ,$257.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ALLOGRAFT THERASKIN 1 X 1IN 6SQ CM MATRIX,278,1 ,"$1,703.55 ","$1,124.34 ",$387.83 ,"$1,703.55 ", N/A ,"$1,526.72 ","$1,526.72 ",$450.76 ,"$1,362.84 ","$1,448.02 ","$1,064.72 ","$1,533.20 ", N/A , N/A ,"$1,618.37 ","$1,533.20 ","$1,448.02 ","$1,448.02 ",$450.76 ,"$1,448.02 ","$1,448.02 ","$1,533.20 ","$1,037.46 ", N/A ,"$1,056.20 ", N/A ,"$1,533.20 ", N/A ,"$1,567.27 ","$1,533.20 ","$1,124.51 ","$1,124.51 ","$1,037.46 ","$1,124.51 ","$1,107.31 ","$1,163.87 ",$387.83 ,"$1,345.80 ", N/A , N/A , N/A ,$450.76 , N/A , N/A ,"$1,618.37 ","$1,396.91 ","$1,396.91 ","$1,362.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ALLOGRAFT THERASKIN 2 X 1IN 13SQ CM CRYOPRESSURE MESH,278,1 ,"$1,898.30 ","$1,252.88 ",$432.16 ,"$1,898.30 ", N/A ,"$1,701.26 ","$1,701.26 ",$502.29 ,"$1,518.64 ","$1,613.56 ","$1,186.44 ","$1,708.47 ", N/A , N/A ,"$1,803.39 ","$1,708.47 ","$1,613.56 ","$1,613.56 ",$502.29 ,"$1,613.56 ","$1,613.56 ","$1,708.47 ","$1,156.06 ", N/A ,"$1,176.94 ", N/A ,"$1,708.47 ", N/A ,"$1,746.44 ","$1,708.47 ","$1,253.07 ","$1,253.07 ","$1,156.06 ","$1,253.07 ","$1,233.90 ","$1,296.92 ",$432.16 ,"$1,499.66 ", N/A , N/A , N/A ,$502.29 , N/A , N/A ,"$1,803.39 ","$1,556.61 ","$1,556.61 ","$1,518.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ALLOGRAFT THERASKIN 3 X 2IN CRYOPRESSURE MESH,278,1 ,"$2,300.90 ","$1,518.59 ",$523.81 ,"$2,300.90 ", N/A ,"$2,062.07 ","$2,062.07 ",$608.82 ,"$1,840.72 ","$1,955.77 ","$1,438.06 ","$2,070.81 ", N/A , N/A ,"$2,185.86 ","$2,070.81 ","$1,955.77 ","$1,955.77 ",$608.82 ,"$1,955.77 ","$1,955.77 ","$2,070.81 ","$1,401.25 ", N/A ,"$1,426.56 ", N/A ,"$2,070.81 ", N/A ,"$2,116.83 ","$2,070.81 ","$1,518.82 ","$1,518.82 ","$1,401.25 ","$1,518.82 ","$1,495.59 ","$1,571.97 ",$523.81 ,"$1,817.71 ", N/A , N/A , N/A ,$608.82 , N/A , N/A ,"$2,185.86 ","$1,886.74 ","$1,886.74 ","$1,840.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,FILLER BONE 5CC 12.5CC CALCIUM SULFATE STIMULAN RAPID CURE,278,1 ,"$1,537.50 ","$1,014.75 ",$350.03 ,"$1,537.50 ", N/A ,"$1,377.91 ","$1,377.91 ",$406.83 ,"$1,230.00 ","$1,306.88 ",$960.94 ,"$1,383.75 ", N/A , N/A ,"$1,460.63 ","$1,383.75 ","$1,306.88 ","$1,306.88 ",$406.83 ,"$1,306.88 ","$1,306.88 ","$1,383.75 ",$936.34 , N/A ,$953.26 , N/A ,"$1,383.75 ", N/A ,"$1,414.50 ","$1,383.75 ","$1,014.90 ","$1,014.90 ",$936.34 ,"$1,014.90 ",$999.38 ,"$1,050.42 ",$350.03 ,"$1,214.63 ", N/A , N/A , N/A ,$406.83 , N/A , N/A ,"$1,460.63 ","$1,260.75 ","$1,260.75 ","$1,230.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT BONE READIGRAFT CANCELLOUS 30ML 4-10MM PRESERVON CHIP CRUSHED,278,1 ,$896.87 ,$591.93 ,$204.17 ,$896.87 , N/A ,$803.77 ,$803.77 ,$237.31 ,$717.50 ,$762.34 ,$560.54 ,$807.18 , N/A , N/A ,$852.03 ,$807.18 ,$762.34 ,$762.34 ,$237.31 ,$762.34 ,$762.34 ,$807.18 ,$546.19 , N/A ,$556.06 , N/A ,$807.18 , N/A ,$825.12 ,$807.18 ,$592.02 ,$592.02 ,$546.19 ,$592.02 ,$582.97 ,$612.74 ,$204.17 ,$708.53 , N/A , N/A , N/A ,$237.31 , N/A , N/A ,$852.03 ,$735.43 ,$735.43 ,$717.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 16MM GRAFIXPL PRIME 2SQ CM AMNIOTIC MEMBRANE ALLOGRAFT DISC LYOPRESERVE,278,1 ,$903.00 ,$595.98 ,$205.57 ,$903.00 , N/A ,$809.27 ,$809.27 ,$238.93 ,$722.40 ,$767.55 ,$564.38 ,$812.70 , N/A , N/A ,$857.85 ,$812.70 ,$767.55 ,$767.55 ,$238.93 ,$767.55 ,$767.55 ,$812.70 ,$549.93 , N/A ,$559.86 , N/A ,$812.70 , N/A ,$830.76 ,$812.70 ,$596.07 ,$596.07 ,$549.93 ,$596.07 ,$586.95 ,$616.93 ,$205.57 ,$713.37 , N/A , N/A , N/A ,$238.93 , N/A , N/A ,$857.85 ,$740.46 ,$740.46 ,$722.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT BONE 16MM CORE ALLOGRAFT CM2,278,1 ,$903.00 ,$595.98 ,$205.57 ,$903.00 , N/A ,$809.27 ,$809.27 ,$238.93 ,$722.40 ,$767.55 ,$564.38 ,$812.70 , N/A , N/A ,$857.85 ,$812.70 ,$767.55 ,$767.55 ,$238.93 ,$767.55 ,$767.55 ,$812.70 ,$549.93 , N/A ,$559.86 , N/A ,$812.70 , N/A ,$830.76 ,$812.70 ,$596.07 ,$596.07 ,$549.93 ,$596.07 ,$586.95 ,$616.93 ,$205.57 ,$713.37 , N/A , N/A , N/A ,$238.93 , N/A , N/A ,$857.85 ,$740.46 ,$740.46 ,$722.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 2X1.5CM GRAFIXPL PRIME PLACENTAL MEMBRANE ALLOGRAFT,278,1 ,"$1,527.25 ","$1,007.99 ",$347.68 ,"$1,527.25 ", N/A ,"$1,368.72 ","$1,368.72 ",$404.11 ,"$1,221.80 ","$1,298.16 ",$954.53 ,"$1,374.53 ", N/A , N/A ,"$1,450.89 ","$1,374.53 ","$1,298.16 ","$1,298.16 ",$404.11 ,"$1,298.16 ","$1,298.16 ","$1,374.53 ",$930.10 , N/A ,$946.90 , N/A ,"$1,374.53 ", N/A ,"$1,405.07 ","$1,374.53 ","$1,008.14 ","$1,008.14 ",$930.10 ,"$1,008.14 ",$992.71 ,"$1,043.42 ",$347.68 ,"$1,206.53 ", N/A , N/A , N/A ,$404.11 , N/A , N/A ,"$1,450.89 ","$1,252.35 ","$1,252.35 ","$1,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 2X1.5CM GRAFIX CORE 3SQ CM PLACENTAL MEMBRANE ALLOGRAFT,278,1 ,"$1,527.25 ","$1,007.99 ",$347.68 ,"$1,527.25 ", N/A ,"$1,368.72 ","$1,368.72 ",$404.11 ,"$1,221.80 ","$1,298.16 ",$954.53 ,"$1,374.53 ", N/A , N/A ,"$1,450.89 ","$1,374.53 ","$1,298.16 ","$1,298.16 ",$404.11 ,"$1,298.16 ","$1,298.16 ","$1,374.53 ",$930.10 , N/A ,$946.90 , N/A ,"$1,374.53 ", N/A ,"$1,405.07 ","$1,374.53 ","$1,008.14 ","$1,008.14 ",$930.10 ,"$1,008.14 ",$992.71 ,"$1,043.42 ",$347.68 ,"$1,206.53 ", N/A , N/A , N/A ,$404.11 , N/A , N/A ,"$1,450.89 ","$1,252.35 ","$1,252.35 ","$1,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 2X3CM GRAFIX CORE,278,1 ,"$1,947.50 ","$1,285.35 ",$443.36 ,"$1,947.50 ", N/A ,"$1,745.35 ","$1,745.35 ",$515.31 ,"$1,558.00 ","$1,655.38 ","$1,217.19 ","$1,752.75 ", N/A , N/A ,"$1,850.13 ","$1,752.75 ","$1,655.38 ","$1,655.38 ",$515.31 ,"$1,655.38 ","$1,655.38 ","$1,752.75 ","$1,186.03 ", N/A ,"$1,207.46 ", N/A ,"$1,752.75 ", N/A ,"$1,791.70 ","$1,752.75 ","$1,285.54 ","$1,285.54 ","$1,186.03 ","$1,285.54 ","$1,265.88 ","$1,330.53 ",$443.36 ,"$1,538.53 ", N/A , N/A , N/A ,$515.31 , N/A , N/A ,"$1,850.13 ","$1,596.95 ","$1,596.95 ","$1,558.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 2X2CM GRAFIX CORE,278,1 ,"$1,947.50 ","$1,285.35 ",$443.36 ,"$1,947.50 ", N/A ,"$1,745.35 ","$1,745.35 ",$515.31 ,"$1,558.00 ","$1,655.38 ","$1,217.19 ","$1,752.75 ", N/A , N/A ,"$1,850.13 ","$1,752.75 ","$1,655.38 ","$1,655.38 ",$515.31 ,"$1,655.38 ","$1,655.38 ","$1,752.75 ","$1,186.03 ", N/A ,"$1,207.46 ", N/A ,"$1,752.75 ", N/A ,"$1,791.70 ","$1,752.75 ","$1,285.54 ","$1,285.54 ","$1,186.03 ","$1,285.54 ","$1,265.88 ","$1,330.53 ",$443.36 ,"$1,538.53 ", N/A , N/A , N/A ,$515.31 , N/A , N/A ,"$1,850.13 ","$1,596.95 ","$1,596.95 ","$1,558.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 4X3CM GRAFIX CORE ALLOGRAFT,278,1 ,"$2,384.50 ","$1,573.77 ",$542.84 ,"$2,384.50 ", N/A ,"$2,136.99 ","$2,136.99 ",$630.94 ,"$1,907.60 ","$2,026.83 ","$1,490.31 ","$2,146.05 ", N/A , N/A ,"$2,265.28 ","$2,146.05 ","$2,026.83 ","$2,026.83 ",$630.94 ,"$2,026.83 ","$2,026.83 ","$2,146.05 ","$1,452.16 ", N/A ,"$1,478.40 ", N/A ,"$2,146.05 ", N/A ,"$2,193.74 ","$2,146.05 ","$1,574.01 ","$1,574.01 ","$1,452.16 ","$1,574.01 ","$1,549.93 ","$1,629.09 ",$542.84 ,"$1,883.76 ", N/A , N/A , N/A ,$630.94 , N/A , N/A ,"$2,265.28 ","$1,955.29 ","$1,955.29 ","$1,907.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 3X4CM GRAFIX CORE,278,1 ,"$2,384.50 ","$1,573.77 ",$542.84 ,"$2,384.50 ", N/A ,"$2,136.99 ","$2,136.99 ",$630.94 ,"$1,907.60 ","$2,026.83 ","$1,490.31 ","$2,146.05 ", N/A , N/A ,"$2,265.28 ","$2,146.05 ","$2,026.83 ","$2,026.83 ",$630.94 ,"$2,026.83 ","$2,026.83 ","$2,146.05 ","$1,452.16 ", N/A ,"$1,478.40 ", N/A ,"$2,146.05 ", N/A ,"$2,193.74 ","$2,146.05 ","$1,574.01 ","$1,574.01 ","$1,452.16 ","$1,574.01 ","$1,549.93 ","$1,629.09 ",$542.84 ,"$1,883.76 ", N/A , N/A , N/A ,$630.94 , N/A , N/A ,"$2,265.28 ","$1,955.29 ","$1,955.29 ","$1,907.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,GRAFT SOFT TISSUE 5x5CM GRAFIX CORE,278,1 ,"$4,437.00 ","$2,928.42 ","$1,010.11 ","$4,437.00 ", N/A ,"$3,976.44 ","$3,976.44 ","$1,174.03 ","$3,549.60 ","$3,771.45 ","$2,773.13 ","$3,993.30 ", N/A , N/A ,"$4,215.15 ","$3,993.30 ","$3,771.45 ","$3,771.45 ","$1,174.03 ","$3,771.45 ","$3,771.45 ","$3,993.30 ","$2,702.13 ", N/A ,"$2,750.94 ", N/A ,"$3,993.30 ", N/A ,"$4,082.04 ","$3,993.30 ","$2,928.86 ","$2,928.86 ","$2,702.13 ","$2,928.86 ","$2,884.05 ","$3,031.36 ","$1,010.11 ","$3,505.23 ", N/A , N/A , N/A ,"$1,174.03 ", N/A , N/A ,"$4,215.15 ","$3,638.34 ","$3,638.34 ","$3,549.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,MATRIX TISSUE 4X4CM PRIMATRIX FETAL BOVINE DERMIS DERMAL REPAIR SCAFFOLD MESH STERILE LATEX FREE,278,1 ,"$1,910.41 ","$1,260.87 ",$434.90 ,"$1,910.41 ", N/A ,"$1,712.11 ","$1,712.11 ",$505.49 ,"$1,528.33 ","$1,623.85 ","$1,194.01 ","$1,719.37 ", N/A , N/A ,"$1,814.89 ","$1,719.37 ","$1,623.85 ","$1,623.85 ",$505.49 ,"$1,623.85 ","$1,623.85 ","$1,719.37 ","$1,163.44 ", N/A ,"$1,184.46 ", N/A ,"$1,719.37 ", N/A ,"$1,757.58 ","$1,719.37 ","$1,261.06 ","$1,261.06 ","$1,163.44 ","$1,261.06 ","$1,241.77 ","$1,305.19 ",$434.90 ,"$1,509.22 ", N/A , N/A , N/A ,$505.49 , N/A , N/A ,"$1,814.89 ","$1,566.54 ","$1,566.54 ","$1,528.33 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,MATRIX TISSUE 6X6CM PRIMATRIX FETAL BOVINE DERMIS DERMAL REPAIR SCAFFOLD MESH STERILE LATEX FREE,278,1 ,"$3,646.46 ","$2,406.66 ",$830.14 ,"$3,646.46 ", N/A ,"$3,267.96 ","$3,267.96 ",$964.85 ,"$2,917.17 ","$3,099.49 ","$2,279.04 ","$3,281.81 ", N/A , N/A ,"$3,464.14 ","$3,281.81 ","$3,099.49 ","$3,099.49 ",$964.85 ,"$3,099.49 ","$3,099.49 ","$3,281.81 ","$2,220.69 ", N/A ,"$2,260.80 ", N/A ,"$3,281.81 ", N/A ,"$3,354.74 ","$3,281.81 ","$2,407.03 ","$2,407.03 ","$2,220.69 ","$2,407.03 ","$2,370.20 ","$2,491.26 ",$830.14 ,"$2,880.70 ", N/A , N/A , N/A ,$964.85 , N/A , N/A ,"$3,464.14 ","$2,990.10 ","$2,990.10 ","$2,917.17 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 200MM,278,1 ,$475.15 ,$313.60 ,$108.16 ,$475.15 , N/A ,$425.83 ,$425.83 ,$125.72 ,$380.12 ,$403.88 ,$296.97 ,$427.64 , N/A , N/A ,$451.39 ,$427.64 ,$403.88 ,$403.88 ,$125.72 ,$403.88 ,$403.88 ,$427.64 ,$289.37 , N/A ,$294.60 , N/A ,$427.64 , N/A ,$437.14 ,$427.64 ,$313.65 ,$313.65 ,$289.37 ,$313.65 ,$308.85 ,$324.62 ,$108.16 ,$375.37 , N/A , N/A , N/A ,$125.72 , N/A , N/A ,$451.39 ,$389.62 ,$389.62 ,$380.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 100MM,278,1 ,$475.15 ,$313.60 ,$108.16 ,$475.15 , N/A ,$425.83 ,$425.83 ,$125.72 ,$380.12 ,$403.88 ,$296.97 ,$427.64 , N/A , N/A ,$451.39 ,$427.64 ,$403.88 ,$403.88 ,$125.72 ,$403.88 ,$403.88 ,$427.64 ,$289.37 , N/A ,$294.60 , N/A ,$427.64 , N/A ,$437.14 ,$427.64 ,$313.65 ,$313.65 ,$289.37 ,$313.65 ,$308.85 ,$324.62 ,$108.16 ,$375.37 , N/A , N/A , N/A ,$125.72 , N/A , N/A ,$451.39 ,$389.62 ,$389.62 ,$380.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 150MM,278,1 ,$475.15 ,$313.60 ,$108.16 ,$475.15 , N/A ,$425.83 ,$425.83 ,$125.72 ,$380.12 ,$403.88 ,$296.97 ,$427.64 , N/A , N/A ,$451.39 ,$427.64 ,$403.88 ,$403.88 ,$125.72 ,$403.88 ,$403.88 ,$427.64 ,$289.37 , N/A ,$294.60 , N/A ,$427.64 , N/A ,$437.14 ,$427.64 ,$313.65 ,$313.65 ,$289.37 ,$313.65 ,$308.85 ,$324.62 ,$108.16 ,$375.37 , N/A , N/A , N/A ,$125.72 , N/A , N/A ,$451.39 ,$389.62 ,$389.62 ,$380.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 350MM,278,1 ,$509.55 ,$336.30 ,$116.00 ,$509.55 , N/A ,$456.66 ,$456.66 ,$134.83 ,$407.64 ,$433.12 ,$318.47 ,$458.60 , N/A , N/A ,$484.07 ,$458.60 ,$433.12 ,$433.12 ,$134.83 ,$433.12 ,$433.12 ,$458.60 ,$310.32 , N/A ,$315.92 , N/A ,$458.60 , N/A ,$468.79 ,$458.60 ,$336.35 ,$336.35 ,$310.32 ,$336.35 ,$331.21 ,$348.12 ,$116.00 ,$402.54 , N/A , N/A , N/A ,$134.83 , N/A , N/A ,$484.07 ,$417.83 ,$417.83 ,$407.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 250MM,278,1 ,$509.55 ,$336.30 ,$116.00 ,$509.55 , N/A ,$456.66 ,$456.66 ,$134.83 ,$407.64 ,$433.12 ,$318.47 ,$458.60 , N/A , N/A ,$484.07 ,$458.60 ,$433.12 ,$433.12 ,$134.83 ,$433.12 ,$433.12 ,$458.60 ,$310.32 , N/A ,$315.92 , N/A ,$458.60 , N/A ,$468.79 ,$458.60 ,$336.35 ,$336.35 ,$310.32 ,$336.35 ,$331.21 ,$348.12 ,$116.00 ,$402.54 , N/A , N/A , N/A ,$134.83 , N/A , N/A ,$484.07 ,$417.83 ,$417.83 ,$407.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 300MM,278,1 ,$509.55 ,$336.30 ,$116.00 ,$509.55 , N/A ,$456.66 ,$456.66 ,$134.83 ,$407.64 ,$433.12 ,$318.47 ,$458.60 , N/A , N/A ,$484.07 ,$458.60 ,$433.12 ,$433.12 ,$134.83 ,$433.12 ,$433.12 ,$458.60 ,$310.32 , N/A ,$315.92 , N/A ,$458.60 , N/A ,$468.79 ,$458.60 ,$336.35 ,$336.35 ,$310.32 ,$336.35 ,$331.21 ,$348.12 ,$116.00 ,$402.54 , N/A , N/A , N/A ,$134.83 , N/A , N/A ,$484.07 ,$417.83 ,$417.83 ,$407.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 11.0 CARBON FIBER 400MM,278,1 ,$559.00 ,$368.94 ,$127.26 ,$559.00 , N/A ,$500.98 ,$500.98 ,$147.91 ,$447.20 ,$475.15 ,$349.38 ,$503.10 , N/A , N/A ,$531.05 ,$503.10 ,$475.15 ,$475.15 ,$147.91 ,$475.15 ,$475.15 ,$503.10 ,$340.43 , N/A ,$346.58 , N/A ,$503.10 , N/A ,$514.28 ,$503.10 ,$369.00 ,$369.00 ,$340.43 ,$369.00 ,$363.35 ,$381.91 ,$127.26 ,$441.61 , N/A , N/A , N/A ,$147.91 , N/A , N/A ,$531.05 ,$458.38 ,$458.38 ,$447.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES 2.5 REAMING WITH BALL TIP,278,1 ,$269.10 ,$177.61 ,$61.26 ,$269.10 , N/A ,$241.17 ,$241.17 ,$71.21 ,$215.28 ,$228.74 ,$168.19 ,$242.19 , N/A , N/A ,$255.65 ,$242.19 ,$228.74 ,$228.74 ,$71.21 ,$228.74 ,$228.74 ,$242.19 ,$163.88 , N/A ,$166.84 , N/A ,$242.19 , N/A ,$247.57 ,$242.19 ,$177.63 ,$177.63 ,$163.88 ,$177.63 ,$174.92 ,$183.85 ,$61.26 ,$212.59 , N/A , N/A , N/A ,$71.21 , N/A , N/A ,$255.65 ,$220.66 ,$220.66 ,$215.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES CARBON FIBER 8.0 X 240MM,278,1 ,$333.00 ,$219.78 ,$75.81 ,$333.00 , N/A ,$298.43 ,$298.43 ,$88.11 ,$266.40 ,$283.05 ,$208.13 ,$299.70 , N/A , N/A ,$316.35 ,$299.70 ,$283.05 ,$283.05 ,$88.11 ,$283.05 ,$283.05 ,$299.70 ,$202.80 , N/A ,$206.46 , N/A ,$299.70 , N/A ,$306.36 ,$299.70 ,$219.81 ,$219.81 ,$202.80 ,$219.81 ,$216.45 ,$227.51 ,$75.81 ,$263.07 , N/A , N/A , N/A ,$88.11 , N/A , N/A ,$316.35 ,$273.06 ,$273.06 ,$266.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES CARBON FIBER 8.0 X 200MM,278,1 ,$333.00 ,$219.78 ,$75.81 ,$333.00 , N/A ,$298.43 ,$298.43 ,$88.11 ,$266.40 ,$283.05 ,$208.13 ,$299.70 , N/A , N/A ,$316.35 ,$299.70 ,$283.05 ,$283.05 ,$88.11 ,$283.05 ,$283.05 ,$299.70 ,$202.80 , N/A ,$206.46 , N/A ,$299.70 , N/A ,$306.36 ,$299.70 ,$219.81 ,$219.81 ,$202.80 ,$219.81 ,$216.45 ,$227.51 ,$75.81 ,$263.07 , N/A , N/A , N/A ,$88.11 , N/A , N/A ,$316.35 ,$273.06 ,$273.06 ,$266.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,ROD SYNTHES CARBON FIBER 8.0 X 220MM,278,1 ,$333.00 ,$219.78 ,$75.81 ,$333.00 , N/A ,$298.43 ,$298.43 ,$88.11 ,$266.40 ,$283.05 ,$208.13 ,$299.70 , N/A , N/A ,$316.35 ,$299.70 ,$283.05 ,$283.05 ,$88.11 ,$283.05 ,$283.05 ,$299.70 ,$202.80 , N/A ,$206.46 , N/A ,$299.70 , N/A ,$306.36 ,$299.70 ,$219.81 ,$219.81 ,$202.80 ,$219.81 ,$216.45 ,$227.51 ,$75.81 ,$263.07 , N/A , N/A , N/A ,$88.11 , N/A , N/A ,$316.35 ,$273.06 ,$273.06 ,$266.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,TUBE EAR COLLAR BUTTON,278,1 ,$23.61 ,$15.58 ,$5.37 ,$23.61 , N/A ,$21.16 ,$21.16 ,$6.24 ,$18.89 ,$20.07 ,$14.76 ,$21.25 , N/A , N/A ,$22.43 ,$21.25 ,$20.07 ,$20.07 ,$6.24 ,$20.07 ,$20.07 ,$21.25 ,$14.38 , N/A ,$14.64 , N/A ,$21.25 , N/A ,$21.72 ,$21.25 ,$15.59 ,$15.59 ,$14.38 ,$15.59 ,$15.35 ,$16.13 ,$5.37 ,$18.65 , N/A , N/A , N/A ,$6.24 , N/A , N/A ,$22.43 ,$19.36 ,$19.36 ,$18.89 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,TUBE TRACH 4.0 CUFF D,278,1 ,$8.77 ,$5.79 ,$2.00 ,$8.77 , N/A ,$7.86 ,$7.86 ,$2.32 ,$7.02 ,$7.45 ,$5.48 ,$7.89 , N/A , N/A ,$8.33 ,$7.89 ,$7.45 ,$7.45 ,$2.32 ,$7.45 ,$7.45 ,$7.89 ,$5.34 , N/A ,$5.44 , N/A ,$7.89 , N/A ,$8.07 ,$7.89 ,$5.79 ,$5.79 ,$5.34 ,$5.79 ,$5.70 ,$5.99 ,$2.00 ,$6.93 , N/A , N/A , N/A ,$2.32 , N/A , N/A ,$8.33 ,$7.19 ,$7.19 ,$7.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,TUBE TRACH 5.0 CUFF D,278,1 ,$0.88 ,$0.58 ,$0.20 ,$0.88 , N/A ,$0.79 ,$0.79 ,$0.24 ,$0.70 ,$0.75 ,$0.55 ,$0.79 , N/A , N/A ,$0.84 ,$0.79 ,$0.75 ,$0.75 ,$0.24 ,$0.75 ,$0.75 ,$0.79 ,$0.54 , N/A ,$0.54 , N/A ,$0.79 , N/A ,$0.81 ,$0.79 ,$0.58 ,$0.58 ,$0.54 ,$0.58 ,$0.57 ,$0.60 ,$0.20 ,$0.70 , N/A , N/A , N/A ,$0.24 , N/A , N/A ,$0.84 ,$0.72 ,$0.72 ,$0.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,TUBE TRACH SIZE 8 CUFFLESS,278,1 ,$62.17 ,$41.03 ,$14.15 ,$62.17 , N/A ,$55.72 ,$55.72 ,$16.45 ,$49.74 ,$52.84 ,$38.86 ,$55.95 , N/A , N/A ,$59.06 ,$55.95 ,$52.84 ,$52.84 ,$16.45 ,$52.84 ,$52.84 ,$55.95 ,$37.86 , N/A ,$38.54 , N/A ,$55.95 , N/A ,$57.20 ,$55.95 ,$41.04 ,$41.04 ,$37.86 ,$41.04 ,$40.41 ,$42.47 ,$14.15 ,$49.11 , N/A , N/A , N/A ,$16.45 , N/A , N/A ,$59.06 ,$50.98 ,$50.98 ,$49.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,TUBE TRACHEOSTOMY LOW PRESSURE,278,1 ,$255.02 ,$168.31 ,$58.06 ,$255.02 , N/A ,$228.55 ,$228.55 ,$67.48 ,$204.02 ,$216.77 ,$159.39 ,$229.52 , N/A , N/A ,$242.27 ,$229.52 ,$216.77 ,$216.77 ,$67.48 ,$216.77 ,$216.77 ,$229.52 ,$155.31 , N/A ,$158.12 , N/A ,$229.52 , N/A ,$234.62 ,$229.52 ,$168.34 ,$168.34 ,$155.31 ,$168.34 ,$165.76 ,$174.23 ,$58.06 ,$201.47 , N/A , N/A , N/A ,$67.48 , N/A , N/A ,$242.27 ,$209.12 ,$209.12 ,$204.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27870000,N/A,TUBE TRACHEOSTOMY 6 76MM 10.8MM 6.4MM SHILEY CUFF REUSABLE INNER CANNULA CONNECTOR STERILE LATEX FREE GREEN WHITE,278,1 ,$255.02 ,$168.31 ,$58.06 ,$255.02 , N/A ,$228.55 ,$228.55 ,$67.48 ,$204.02 ,$216.77 ,$159.39 ,$229.52 , N/A , N/A ,$242.27 ,$229.52 ,$216.77 ,$216.77 ,$67.48 ,$216.77 ,$216.77 ,$229.52 ,$155.31 , N/A ,$158.12 , N/A ,$229.52 , N/A ,$234.62 ,$229.52 ,$168.34 ,$168.34 ,$155.31 ,$168.34 ,$165.76 ,$174.23 ,$58.06 ,$201.47 , N/A , N/A , N/A ,$67.48 , N/A , N/A ,$242.27 ,$209.12 ,$209.12 ,$204.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ANCHOR SUTURE 24D 2-0 TRUESPAN ORTHOCORD NONABSORBABLE 2 BACKSTOP BRAID PEEK STERILE LATEX FREE,278,1 ,"$1,219.75 ",$805.04 ,$277.68 ,"$1,219.75 ", N/A ,"$1,093.14 ","$1,093.14 ",$322.74 ,$975.80 ,"$1,036.79 ",$762.34 ,"$1,097.78 ", N/A , N/A ,"$1,158.76 ","$1,097.78 ","$1,036.79 ","$1,036.79 ",$322.74 ,"$1,036.79 ","$1,036.79 ","$1,097.78 ",$742.83 , N/A ,$756.24 , N/A ,"$1,097.78 ", N/A ,"$1,122.17 ","$1,097.78 ",$805.16 ,$805.16 ,$742.83 ,$805.16 ,$792.84 ,$833.33 ,$277.68 ,$963.60 , N/A , N/A , N/A ,$322.74 , N/A , N/A ,"$1,158.76 ","$1,000.20 ","$1,000.20 ",$975.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ANCHOR SUTURE 12D 2-0 TRUESPAN ORTHOCORD NONABSORBABLE 2 BACKSTOP BRAID NEEDLE PEEK STERILE LATEX FREE VIOLET MENISCAL REPAIR SYSTEM,278,1 ,"$1,219.75 ",$805.04 ,$277.68 ,"$1,219.75 ", N/A ,"$1,093.14 ","$1,093.14 ",$322.74 ,$975.80 ,"$1,036.79 ",$762.34 ,"$1,097.78 ", N/A , N/A ,"$1,158.76 ","$1,097.78 ","$1,036.79 ","$1,036.79 ",$322.74 ,"$1,036.79 ","$1,036.79 ","$1,097.78 ",$742.83 , N/A ,$756.24 , N/A ,"$1,097.78 ", N/A ,"$1,122.17 ","$1,097.78 ",$805.16 ,$805.16 ,$742.83 ,$805.16 ,$792.84 ,$833.33 ,$277.68 ,$963.60 , N/A , N/A , N/A ,$322.74 , N/A , N/A ,"$1,158.76 ","$1,000.20 ","$1,000.20 ",$975.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ANCHOR SUTURE ARTHREX BIO SWIVELOCK 5.5MM,278,1 ,$946.00 ,$624.36 ,$215.36 ,$946.00 , N/A ,$847.81 ,$847.81 ,$250.31 ,$756.80 ,$804.10 ,$591.25 ,$851.40 , N/A , N/A ,$898.70 ,$851.40 ,$804.10 ,$804.10 ,$250.31 ,$804.10 ,$804.10 ,$851.40 ,$576.11 , N/A ,$586.52 , N/A ,$851.40 , N/A ,$870.32 ,$851.40 ,$624.45 ,$624.45 ,$576.11 ,$624.45 ,$614.90 ,$646.31 ,$215.36 ,$747.34 , N/A , N/A , N/A ,$250.31 , N/A , N/A ,$898.70 ,$775.72 ,$775.72 ,$756.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ANCHOR SUTURE ARTHREX FORKED BIO SWIVELOCK 19.5MM,278,1 ,"$1,028.78 ",$678.99 ,$234.21 ,"$1,028.78 ", N/A ,$921.99 ,$921.99 ,$272.21 ,$823.02 ,$874.46 ,$642.99 ,$925.90 , N/A , N/A ,$977.34 ,$925.90 ,$874.46 ,$874.46 ,$272.21 ,$874.46 ,$874.46 ,$925.90 ,$626.53 , N/A ,$637.84 , N/A ,$925.90 , N/A ,$946.48 ,$925.90 ,$679.10 ,$679.10 ,$626.53 ,$679.10 ,$668.71 ,$702.86 ,$234.21 ,$812.74 , N/A , N/A , N/A ,$272.21 , N/A , N/A ,$977.34 ,$843.60 ,$843.60 ,$823.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ANCHOR ARTHREX FORKED SWIVELOCK 8MM,278,1 ,"$1,028.78 ",$678.99 ,$234.21 ,"$1,028.78 ", N/A ,$921.99 ,$921.99 ,$272.21 ,$823.02 ,$874.46 ,$642.99 ,$925.90 , N/A , N/A ,$977.34 ,$925.90 ,$874.46 ,$874.46 ,$272.21 ,$874.46 ,$874.46 ,$925.90 ,$626.53 , N/A ,$637.84 , N/A ,$925.90 , N/A ,$946.48 ,$925.90 ,$679.10 ,$679.10 ,$626.53 ,$679.10 ,$668.71 ,$702.86 ,$234.21 ,$812.74 , N/A , N/A , N/A ,$272.21 , N/A , N/A ,$977.34 ,$843.60 ,$843.60 ,$823.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ANCHOR SUTURE ARTHREX SWIVELOCK TIGERWIRE 4.75MM,278,1 ,$986.21 ,$650.90 ,$224.52 ,$986.21 , N/A ,$883.84 ,$883.84 ,$260.95 ,$788.97 ,$838.28 ,$616.38 ,$887.59 , N/A , N/A ,$936.90 ,$887.59 ,$838.28 ,$838.28 ,$260.95 ,$838.28 ,$838.28 ,$887.59 ,$600.60 , N/A ,$611.46 , N/A ,$887.59 , N/A ,$907.31 ,$887.59 ,$651.00 ,$651.00 ,$600.60 ,$651.00 ,$641.04 ,$673.78 ,$224.52 ,$779.11 , N/A , N/A , N/A ,$260.95 , N/A , N/A ,$936.90 ,$808.69 ,$808.69 ,$788.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,BONE SCREW ARTHREX QUICKFIX TITANIUM 2MMx13MM,278,1 ,$567.60 ,$374.62 ,$129.22 ,$567.60 , N/A ,$508.68 ,$508.68 ,$150.18 ,$454.08 ,$482.46 ,$354.75 ,$510.84 , N/A , N/A ,$539.22 ,$510.84 ,$482.46 ,$482.46 ,$150.18 ,$482.46 ,$482.46 ,$510.84 ,$345.67 , N/A ,$351.92 , N/A ,$510.84 , N/A ,$522.19 ,$510.84 ,$374.67 ,$374.67 ,$345.67 ,$374.67 ,$368.94 ,$387.78 ,$129.22 ,$448.40 , N/A , N/A , N/A ,$150.18 , N/A , N/A ,$539.22 ,$465.43 ,$465.43 ,$454.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CABLE ORTHOPEDIC TITANIUM COCR 1.7MM 750MM CRIMP STERILE CERVICAL CERCLAGE,278,1 ,$970.73 ,$640.68 ,$220.99 ,$970.73 , N/A ,$869.97 ,$869.97 ,$256.86 ,$776.58 ,$825.12 ,$606.71 ,$873.66 , N/A , N/A ,$922.19 ,$873.66 ,$825.12 ,$825.12 ,$256.86 ,$825.12 ,$825.12 ,$873.66 ,$591.17 , N/A ,$601.86 , N/A ,$873.66 , N/A ,$893.07 ,$873.66 ,$640.78 ,$640.78 ,$591.17 ,$640.78 ,$630.97 ,$663.20 ,$220.99 ,$766.88 , N/A , N/A , N/A ,$256.86 , N/A , N/A ,$922.19 ,$796.00 ,$796.00 ,$776.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CABLE SYNTHES 1.7 X 750MM W/ CRIMP,278,1 ,$969.65 ,$639.97 ,$220.74 ,$969.65 , N/A ,$869.00 ,$869.00 ,$256.57 ,$775.72 ,$824.20 ,$606.03 ,$872.69 , N/A , N/A ,$921.17 ,$872.69 ,$824.20 ,$824.20 ,$256.57 ,$824.20 ,$824.20 ,$872.69 ,$590.52 , N/A ,$601.18 , N/A ,$872.69 , N/A ,$892.08 ,$872.69 ,$640.07 ,$640.07 ,$590.52 ,$640.07 ,$630.27 ,$662.46 ,$220.74 ,$766.02 , N/A , N/A , N/A ,$256.57 , N/A , N/A ,$921.17 ,$795.11 ,$795.11 ,$775.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CEMENT BONE TOBRAMYCIN SIMPLEX,278,1 ,$537.50 ,$354.75 ,$122.37 ,$537.50 , N/A ,$481.71 ,$481.71 ,$142.23 ,$430.00 ,$456.88 ,$335.94 ,$483.75 , N/A , N/A ,$510.63 ,$483.75 ,$456.88 ,$456.88 ,$142.23 ,$456.88 ,$456.88 ,$483.75 ,$327.34 , N/A ,$333.26 , N/A ,$483.75 , N/A ,$494.50 ,$483.75 ,$354.80 ,$354.80 ,$327.34 ,$354.80 ,$349.38 ,$367.22 ,$122.37 ,$424.63 , N/A , N/A , N/A ,$142.23 , N/A , N/A ,$510.63 ,$440.75 ,$440.75 ,$430.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CEMENT HALF DOSE,278,1 ,$101.25 ,$66.83 ,$23.05 ,$101.25 , N/A ,$90.74 ,$90.74 ,$26.79 ,$81.00 ,$86.06 ,$63.28 ,$91.13 , N/A , N/A ,$96.19 ,$91.13 ,$86.06 ,$86.06 ,$26.79 ,$86.06 ,$86.06 ,$91.13 ,$61.66 , N/A ,$62.78 , N/A ,$91.13 , N/A ,$93.15 ,$91.13 ,$66.84 ,$66.84 ,$61.66 ,$66.84 ,$65.81 ,$69.17 ,$23.05 ,$79.99 , N/A , N/A , N/A ,$26.79 , N/A , N/A ,$96.19 ,$83.03 ,$83.03 ,$81.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CEMENT SIMPLEX HV FULL DOSE,278,1 ,$117.00 ,$77.22 ,$26.64 ,$117.00 , N/A ,$104.86 ,$104.86 ,$30.96 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$30.96 ,$99.45 ,$99.45 ,$105.30 ,$71.25 , N/A ,$72.54 , N/A ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.23 ,$77.23 ,$71.25 ,$77.23 ,$76.05 ,$79.93 ,$26.64 ,$92.43 , N/A , N/A , N/A ,$30.96 , N/A , N/A ,$111.15 ,$95.94 ,$95.94 ,$93.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CEMENT FULL DOSE,278,1 ,$117.00 ,$77.22 ,$26.64 ,$117.00 , N/A ,$104.86 ,$104.86 ,$30.96 ,$93.60 ,$99.45 ,$73.13 ,$105.30 , N/A , N/A ,$111.15 ,$105.30 ,$99.45 ,$99.45 ,$30.96 ,$99.45 ,$99.45 ,$105.30 ,$71.25 , N/A ,$72.54 , N/A ,$105.30 , N/A ,$107.64 ,$105.30 ,$77.23 ,$77.23 ,$71.25 ,$77.23 ,$76.05 ,$79.93 ,$26.64 ,$92.43 , N/A , N/A , N/A ,$30.96 , N/A , N/A ,$111.15 ,$95.94 ,$95.94 ,$93.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,CEMENT SIMPLEX HV W/GENTAMICIN,278,1 ,$348.75 ,$230.18 ,$79.39 ,$348.75 , N/A ,$312.55 ,$312.55 ,$92.28 ,$279.00 ,$296.44 ,$217.97 ,$313.88 , N/A , N/A ,$331.31 ,$313.88 ,$296.44 ,$296.44 ,$92.28 ,$296.44 ,$296.44 ,$313.88 ,$212.39 , N/A ,$216.22 , N/A ,$313.88 , N/A ,$320.85 ,$313.88 ,$230.21 ,$230.21 ,$212.39 ,$230.21 ,$226.69 ,$238.27 ,$79.39 ,$275.51 , N/A , N/A , N/A ,$92.28 , N/A , N/A ,$331.31 ,$285.98 ,$285.98 ,$279.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,END CAP SYNTHES TI FOR TROCHANTERIC FIXATION NAILS 5MM EXT,278,1 ,$400.14 ,$264.09 ,$91.09 ,$400.14 , N/A ,$358.61 ,$358.61 ,$105.88 ,$320.11 ,$340.12 ,$250.09 ,$360.13 , N/A , N/A ,$380.13 ,$360.13 ,$340.12 ,$340.12 ,$105.88 ,$340.12 ,$340.12 ,$360.13 ,$243.69 , N/A ,$248.08 , N/A ,$360.13 , N/A ,$368.13 ,$360.13 ,$264.13 ,$264.13 ,$243.69 ,$264.13 ,$260.09 ,$273.38 ,$91.09 ,$316.11 , N/A , N/A , N/A ,$105.88 , N/A , N/A ,$380.13 ,$328.11 ,$328.11 ,$320.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,END CAP SYNTHES TI FOR TROCHANTERIC FIXATION NAILS 0MM EXT,278,1 ,$400.14 ,$264.09 ,$91.09 ,$400.14 , N/A ,$358.61 ,$358.61 ,$105.88 ,$320.11 ,$340.12 ,$250.09 ,$360.13 , N/A , N/A ,$380.13 ,$360.13 ,$340.12 ,$340.12 ,$105.88 ,$340.12 ,$340.12 ,$360.13 ,$243.69 , N/A ,$248.08 , N/A ,$360.13 , N/A ,$368.13 ,$360.13 ,$264.13 ,$264.13 ,$243.69 ,$264.13 ,$260.09 ,$273.38 ,$91.09 ,$316.11 , N/A , N/A , N/A ,$105.88 , N/A , N/A ,$380.13 ,$328.11 ,$328.11 ,$320.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,END CAP SYNTHES TI FOR TROCHANTERIC FIXATION NAILS 10MM EXT,278,1 ,$400.14 ,$264.09 ,$91.09 ,$400.14 , N/A ,$358.61 ,$358.61 ,$105.88 ,$320.11 ,$340.12 ,$250.09 ,$360.13 , N/A , N/A ,$380.13 ,$360.13 ,$340.12 ,$340.12 ,$105.88 ,$340.12 ,$340.12 ,$360.13 ,$243.69 , N/A ,$248.08 , N/A ,$360.13 , N/A ,$368.13 ,$360.13 ,$264.13 ,$264.13 ,$243.69 ,$264.13 ,$260.09 ,$273.38 ,$91.09 ,$316.11 , N/A , N/A , N/A ,$105.88 , N/A , N/A ,$380.13 ,$328.11 ,$328.11 ,$320.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,GRAFT BONE ALLOSYNC DEMINERALIZE BONE MATRIX 1 CC GEL,278,1 ,$430.00 ,$283.80 ,$97.89 ,$430.00 , N/A ,$385.37 ,$385.37 ,$113.78 ,$344.00 ,$365.50 ,$268.75 ,$387.00 , N/A , N/A ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$113.78 ,$365.50 ,$365.50 ,$387.00 ,$261.87 , N/A ,$266.60 , N/A ,$387.00 , N/A ,$395.60 ,$387.00 ,$283.84 ,$283.84 ,$261.87 ,$283.84 ,$279.50 ,$293.78 ,$97.89 ,$339.70 , N/A , N/A , N/A ,$113.78 , N/A , N/A ,$408.50 ,$352.60 ,$352.60 ,$344.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,GRAFT BONE SUBSTITUTE VITOSS,278,1 ,"$1,590.82 ","$1,049.94 ",$362.16 ,"$1,590.82 ", N/A ,"$1,425.69 ","$1,425.69 ",$420.93 ,"$1,272.66 ","$1,352.20 ",$994.26 ,"$1,431.74 ", N/A , N/A ,"$1,511.28 ","$1,431.74 ","$1,352.20 ","$1,352.20 ",$420.93 ,"$1,352.20 ","$1,352.20 ","$1,431.74 ",$968.81 , N/A ,$986.30 , N/A ,"$1,431.74 ", N/A ,"$1,463.55 ","$1,431.74 ","$1,050.10 ","$1,050.10 ",$968.81 ,"$1,050.10 ","$1,034.03 ","$1,086.85 ",$362.16 ,"$1,256.75 ", N/A , N/A , N/A ,$420.93 , N/A , N/A ,"$1,511.28 ","$1,304.47 ","$1,304.47 ","$1,272.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 440MM 130 DEG RT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 320MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 320MM 130 DEG RT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 340MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 360MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 360MM 130 DEG RT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 380MM 130 DEG RT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 400MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 400MM 130 DEG RT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 420MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 420MM 130 DEG RT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TFNA TI CANN 11 X 440MM 130 DEG LT,278,1 ,"$4,055.04 ","$2,676.33 ",$923.15 ,"$4,055.04 ", N/A ,"$3,634.13 ","$3,634.13 ","$1,072.96 ","$3,244.03 ","$3,446.78 ","$2,534.40 ","$3,649.54 ", N/A , N/A ,"$3,852.29 ","$3,649.54 ","$3,446.78 ","$3,446.78 ","$1,072.96 ","$3,446.78 ","$3,446.78 ","$3,649.54 ","$2,469.52 ", N/A ,"$2,514.12 ", N/A ,"$3,649.54 ", N/A ,"$3,730.64 ","$3,649.54 ","$2,676.73 ","$2,676.73 ","$2,469.52 ","$2,676.73 ","$2,635.78 ","$2,770.40 ",$923.15 ,"$3,203.48 ", N/A , N/A , N/A ,"$1,072.96 ", N/A , N/A ,"$3,852.29 ","$3,325.13 ","$3,325.13 ","$3,244.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 10MM X 235MM 130 DEG,278,1 ,"$2,507.54 ","$1,654.98 ",$570.85 ,"$2,507.54 ", N/A ,"$2,247.26 ","$2,247.26 ",$663.50 ,"$2,006.03 ","$2,131.41 ","$1,567.21 ","$2,256.79 ", N/A , N/A ,"$2,382.16 ","$2,256.79 ","$2,131.41 ","$2,131.41 ",$663.50 ,"$2,131.41 ","$2,131.41 ","$2,256.79 ","$1,527.09 ", N/A ,"$1,554.68 ", N/A ,"$2,256.79 ", N/A ,"$2,306.94 ","$2,256.79 ","$1,655.23 ","$1,655.23 ","$1,527.09 ","$1,655.23 ","$1,629.90 ","$1,713.15 ",$570.85 ,"$1,980.96 ", N/A , N/A , N/A ,$663.50 , N/A , N/A ,"$2,382.16 ","$2,056.18 ","$2,056.18 ","$2,006.03 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 420MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 300MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 300MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 320MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 320MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 340MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 340MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 360MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 360MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 380MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 380MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 400MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 400MM 130 DEG RT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 420MM 130 DEG LT,278,1 ,"$3,427.37 ","$2,262.06 ",$780.26 ,"$3,427.37 ", N/A ,"$3,071.61 ","$3,071.61 ",$906.88 ,"$2,741.90 ","$2,913.26 ","$2,142.11 ","$3,084.63 ", N/A , N/A ,"$3,256.00 ","$3,084.63 ","$2,913.26 ","$2,913.26 ",$906.88 ,"$2,913.26 ","$2,913.26 ","$3,084.63 ","$2,087.27 ", N/A ,"$2,124.96 ", N/A ,"$3,084.63 ", N/A ,"$3,153.18 ","$3,084.63 ","$2,262.41 ","$2,262.41 ","$2,087.27 ","$2,262.41 ","$2,227.79 ","$2,341.58 ",$780.26 ,"$2,707.62 ", N/A , N/A , N/A ,$906.88 , N/A , N/A ,"$3,256.00 ","$2,810.44 ","$2,810.44 ","$2,741.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 12MM X 170MM 135 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL 10MM 170MM TROCHANTERIC INTRAMEDULLARY 130D CANNULATED TITANIUM STERILE GREEN,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 10MM X 170MM 125 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 10MM X 170MM 135 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 170MM 125 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 170MM 130 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 170MM 135 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 11MM X 235MM 130 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 12MM X 170MM 125 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 12MM X 170MM 130 DEG,278,1 ,"$2,428.50 ","$1,602.81 ",$552.87 ,"$2,428.50 ", N/A ,"$2,176.42 ","$2,176.42 ",$642.59 ,"$1,942.80 ","$2,064.23 ","$1,517.81 ","$2,185.65 ", N/A , N/A ,"$2,307.08 ","$2,185.65 ","$2,064.23 ","$2,064.23 ",$642.59 ,"$2,064.23 ","$2,064.23 ","$2,185.65 ","$1,478.96 ", N/A ,"$1,505.68 ", N/A ,"$2,185.65 ", N/A ,"$2,234.22 ","$2,185.65 ","$1,603.05 ","$1,603.05 ","$1,478.96 ","$1,603.05 ","$1,578.53 ","$1,659.15 ",$552.87 ,"$1,918.52 ", N/A , N/A , N/A ,$642.59 , N/A , N/A ,"$2,307.08 ","$1,991.37 ","$1,991.37 ","$1,942.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,NAIL SYNTHES TI FIX 12MM X 235MM 130 DEG,278,1 ,"$2,604.37 ","$1,718.88 ",$592.90 ,"$2,604.37 ", N/A ,"$2,334.04 ","$2,334.04 ",$689.12 ,"$2,083.50 ","$2,213.71 ","$1,627.73 ","$2,343.93 ", N/A , N/A ,"$2,474.15 ","$2,343.93 ","$2,213.71 ","$2,213.71 ",$689.12 ,"$2,213.71 ","$2,213.71 ","$2,343.93 ","$1,586.06 ", N/A ,"$1,614.70 ", N/A ,"$2,343.93 ", N/A ,"$2,396.02 ","$2,343.93 ","$1,719.14 ","$1,719.14 ","$1,586.06 ","$1,719.14 ","$1,692.84 ","$1,779.31 ",$592.90 ,"$2,057.45 ", N/A , N/A , N/A ,$689.12 , N/A , N/A ,"$2,474.15 ","$2,135.58 ","$2,135.58 ","$2,083.50 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PIN RICHARDS STEINMAN SGL END SM 7/64,278,1 ,$116.51 ,$76.90 ,$26.53 ,$116.51 , N/A ,$104.42 ,$104.42 ,$30.83 ,$93.21 ,$99.03 ,$72.82 ,$104.86 , N/A , N/A ,$110.68 ,$104.86 ,$99.03 ,$99.03 ,$30.83 ,$99.03 ,$99.03 ,$104.86 ,$70.95 , N/A ,$72.24 , N/A ,$104.86 , N/A ,$107.19 ,$104.86 ,$76.91 ,$76.91 ,$70.95 ,$76.91 ,$75.73 ,$79.60 ,$26.53 ,$92.04 , N/A , N/A , N/A ,$30.83 , N/A , N/A ,$110.68 ,$95.54 ,$95.54 ,$93.21 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PIN STEINMANN SYNTHES 2.0,278,1 ,$35.28 ,$23.28 ,$8.03 ,$35.28 , N/A ,$31.62 ,$31.62 ,$9.34 ,$28.22 ,$29.99 ,$22.05 ,$31.75 , N/A , N/A ,$33.52 ,$31.75 ,$29.99 ,$29.99 ,$9.34 ,$29.99 ,$29.99 ,$31.75 ,$21.49 , N/A ,$21.88 , N/A ,$31.75 , N/A ,$32.46 ,$31.75 ,$23.29 ,$23.29 ,$21.49 ,$23.29 ,$22.93 ,$24.10 ,$8.03 ,$27.87 , N/A , N/A , N/A ,$9.34 , N/A , N/A ,$33.52 ,$28.93 ,$28.93 ,$28.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PIN SYNTHES 1.8 TI BUTTRESS 18MM,278,1 ,$146.63 ,$96.78 ,$33.38 ,$146.63 , N/A ,$131.41 ,$131.41 ,$38.80 ,$117.30 ,$124.64 ,$91.64 ,$131.97 , N/A , N/A ,$139.30 ,$131.97 ,$124.64 ,$124.64 ,$38.80 ,$124.64 ,$124.64 ,$131.97 ,$89.30 , N/A ,$90.92 , N/A ,$131.97 , N/A ,$134.90 ,$131.97 ,$96.79 ,$96.79 ,$89.30 ,$96.79 ,$95.31 ,$100.18 ,$33.38 ,$115.84 , N/A , N/A , N/A ,$38.80 , N/A , N/A ,$139.30 ,$120.24 ,$120.24 ,$117.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PIN SYNTHES 4.5 THRD CERCLAGE POSITIONING,278,1 ,$379.13 ,$250.23 ,$86.31 ,$379.13 , N/A ,$339.78 ,$339.78 ,$100.32 ,$303.30 ,$322.26 ,$236.96 ,$341.22 , N/A , N/A ,$360.17 ,$341.22 ,$322.26 ,$322.26 ,$100.32 ,$322.26 ,$322.26 ,$341.22 ,$230.89 , N/A ,$235.06 , N/A ,$341.22 , N/A ,$348.80 ,$341.22 ,$250.26 ,$250.26 ,$230.89 ,$250.26 ,$246.43 ,$259.02 ,$86.31 ,$299.51 , N/A , N/A , N/A ,$100.32 , N/A , N/A ,$360.17 ,$310.89 ,$310.89 ,$303.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PIN SYNTHES 6.0 TRANSFIXATION 225MM,278,1 ,$293.63 ,$193.80 ,$66.85 ,$293.63 , N/A ,$263.15 ,$263.15 ,$77.69 ,$234.90 ,$249.59 ,$183.52 ,$264.27 , N/A , N/A ,$278.95 ,$264.27 ,$249.59 ,$249.59 ,$77.69 ,$249.59 ,$249.59 ,$264.27 ,$178.82 , N/A ,$182.06 , N/A ,$264.27 , N/A ,$270.14 ,$264.27 ,$193.83 ,$193.83 ,$178.82 ,$193.83 ,$190.86 ,$200.61 ,$66.85 ,$231.97 , N/A , N/A , N/A ,$77.69 , N/A , N/A ,$278.95 ,$240.78 ,$240.78 ,$234.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE CONTOUR 116X13.5X3.7MM STAINLESS STEEL 3.5MM SCREW 4 HOLE ROUND EDGE LOW PROFILE HEAD LCP COMBI BONE TIBIAL RIGHT DISTAL MEDIAL NONSTERILE,278,1 ,"$3,664.15 ","$2,418.34 ",$834.16 ,"$3,664.15 ", N/A ,"$3,283.81 ","$3,283.81 ",$969.53 ,"$2,931.32 ","$3,114.53 ","$2,290.09 ","$3,297.74 ", N/A , N/A ,"$3,480.94 ","$3,297.74 ","$3,114.53 ","$3,114.53 ",$969.53 ,"$3,114.53 ","$3,114.53 ","$3,297.74 ","$2,231.47 ", N/A ,"$2,271.78 ", N/A ,"$3,297.74 ", N/A ,"$3,371.02 ","$3,297.74 ","$2,418.71 ","$2,418.71 ","$2,231.47 ","$2,418.71 ","$2,381.70 ","$2,503.35 ",$834.16 ,"$2,894.68 ", N/A , N/A , N/A ,$969.53 , N/A , N/A ,"$3,480.94 ","$3,004.60 ","$3,004.60 ","$2,931.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE CONTOUR 142X13.5X3.7MM STAINLESS STEEL 3.5MM SCREW 6 HOLE ROUND EDGE LOW PROFILE HEAD LCP COMBI BONE TIBIAL RIGHT DISTAL MEDIAL NONSTERILE,278,1 ,"$2,314.20 ","$1,527.37 ",$526.84 ,"$2,314.20 ", N/A ,"$2,073.99 ","$2,073.99 ",$612.33 ,"$1,851.36 ","$1,967.07 ","$1,446.38 ","$2,082.78 ", N/A , N/A ,"$2,198.49 ","$2,082.78 ","$1,967.07 ","$1,967.07 ",$612.33 ,"$1,967.07 ","$1,967.07 ","$2,082.78 ","$1,409.35 ", N/A ,"$1,434.80 ", N/A ,"$2,082.78 ", N/A ,"$2,129.06 ","$2,082.78 ","$1,527.60 ","$1,527.60 ","$1,409.35 ","$1,527.60 ","$1,504.23 ","$1,581.06 ",$526.84 ,"$1,828.22 ", N/A , N/A , N/A ,$612.33 , N/A , N/A ,"$2,198.49 ","$1,897.64 ","$1,897.64 ","$1,851.36 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3 TI H EXTENDED / LEFT,278,1 ,$883.89 ,$583.37 ,$201.21 ,$883.89 , N/A ,$792.14 ,$792.14 ,$233.88 ,$707.11 ,$751.31 ,$552.43 ,$795.50 , N/A , N/A ,$839.70 ,$795.50 ,$751.31 ,$751.31 ,$233.88 ,$751.31 ,$751.31 ,$795.50 ,$538.29 , N/A ,$548.02 , N/A ,$795.50 , N/A ,$813.18 ,$795.50 ,$583.46 ,$583.46 ,$538.29 ,$583.46 ,$574.53 ,$603.87 ,$201.21 ,$698.27 , N/A , N/A , N/A ,$233.88 , N/A , N/A ,$839.70 ,$724.79 ,$724.79 ,$707.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3 TI T 4 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$817.52 ,$539.56 ,$186.11 ,$817.52 , N/A ,$732.66 ,$732.66 ,$216.32 ,$654.02 ,$694.89 ,$510.95 ,$735.77 , N/A , N/A ,$776.64 ,$735.77 ,$694.89 ,$694.89 ,$216.32 ,$694.89 ,$694.89 ,$735.77 ,$497.87 , N/A ,$506.86 , N/A ,$735.77 , N/A ,$752.12 ,$735.77 ,$539.65 ,$539.65 ,$497.87 ,$539.65 ,$531.39 ,$558.53 ,$186.11 ,$645.84 , N/A , N/A , N/A ,$216.32 , N/A , N/A ,$776.64 ,$670.37 ,$670.37 ,$654.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3 TI EXTENDED / RIGHT,278,1 ,$817.52 ,$539.56 ,$186.11 ,$817.52 , N/A ,$732.66 ,$732.66 ,$216.32 ,$654.02 ,$694.89 ,$510.95 ,$735.77 , N/A , N/A ,$776.64 ,$735.77 ,$694.89 ,$694.89 ,$216.32 ,$694.89 ,$694.89 ,$735.77 ,$497.87 , N/A ,$506.86 , N/A ,$735.77 , N/A ,$752.12 ,$735.77 ,$539.65 ,$539.65 ,$497.87 ,$539.65 ,$531.39 ,$558.53 ,$186.11 ,$645.84 , N/A , N/A , N/A ,$216.32 , N/A , N/A ,$776.64 ,$670.37 ,$670.37 ,$654.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3 TI Y 3 HOLES HEAD/ 8 HOLES SHAFT/32MM,278,1 ,$795.39 ,$524.96 ,$181.07 ,$795.39 , N/A ,$712.83 ,$712.83 ,$210.46 ,$636.31 ,$676.08 ,$497.12 ,$715.85 , N/A , N/A ,$755.62 ,$715.85 ,$676.08 ,$676.08 ,$210.46 ,$676.08 ,$676.08 ,$715.85 ,$484.39 , N/A ,$493.14 , N/A ,$715.85 , N/A ,$731.76 ,$715.85 ,$525.04 ,$525.04 ,$484.39 ,$525.04 ,$517.00 ,$543.41 ,$181.07 ,$628.36 , N/A , N/A , N/A ,$210.46 , N/A , N/A ,$755.62 ,$652.22 ,$652.22 ,$636.31 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3 TI T 3 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$795.39 ,$524.96 ,$181.07 ,$795.39 , N/A ,$712.83 ,$712.83 ,$210.46 ,$636.31 ,$676.08 ,$497.12 ,$715.85 , N/A , N/A ,$755.62 ,$715.85 ,$676.08 ,$676.08 ,$210.46 ,$676.08 ,$676.08 ,$715.85 ,$484.39 , N/A ,$493.14 , N/A ,$715.85 , N/A ,$731.76 ,$715.85 ,$525.04 ,$525.04 ,$484.39 ,$525.04 ,$517.00 ,$543.41 ,$181.07 ,$628.36 , N/A , N/A , N/A ,$210.46 , N/A , N/A ,$755.62 ,$652.22 ,$652.22 ,$636.31 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3MM TI STRAIGHT 6 HOLES/23MM,278,1 ,$725.86 ,$479.07 ,$165.25 ,$725.86 , N/A ,$650.52 ,$650.52 ,$192.06 ,$580.69 ,$616.98 ,$453.66 ,$653.27 , N/A , N/A ,$689.57 ,$653.27 ,$616.98 ,$616.98 ,$192.06 ,$616.98 ,$616.98 ,$653.27 ,$442.05 , N/A ,$450.04 , N/A ,$653.27 , N/A ,$667.79 ,$653.27 ,$479.14 ,$479.14 ,$442.05 ,$479.14 ,$471.81 ,$495.91 ,$165.25 ,$573.43 , N/A , N/A , N/A ,$192.06 , N/A , N/A ,$689.57 ,$595.21 ,$595.21 ,$580.69 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI CONDYLAR 7 HOLES/36MM-RIGHT,278,1 ,"$1,039.66 ",$686.18 ,$236.68 ,"$1,039.66 ", N/A ,$931.74 ,$931.74 ,$275.10 ,$831.73 ,$883.71 ,$649.79 ,$935.69 , N/A , N/A ,$987.68 ,$935.69 ,$883.71 ,$883.71 ,$275.10 ,$883.71 ,$883.71 ,$935.69 ,$633.15 , N/A ,$644.58 , N/A ,$935.69 , N/A ,$956.49 ,$935.69 ,$686.28 ,$686.28 ,$633.15 ,$686.28 ,$675.78 ,$710.30 ,$236.68 ,$821.33 , N/A , N/A , N/A ,$275.10 , N/A , N/A ,$987.68 ,$852.52 ,$852.52 ,$831.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI CONDYLAR 7 HOLES/36MM-LEFT,278,1 ,"$1,039.66 ",$686.18 ,$236.68 ,"$1,039.66 ", N/A ,$931.74 ,$931.74 ,$275.10 ,$831.73 ,$883.71 ,$649.79 ,$935.69 , N/A , N/A ,$987.68 ,$935.69 ,$883.71 ,$883.71 ,$275.10 ,$883.71 ,$883.71 ,$935.69 ,$633.15 , N/A ,$644.58 , N/A ,$935.69 , N/A ,$956.49 ,$935.69 ,$686.28 ,$686.28 ,$633.15 ,$686.28 ,$675.78 ,$710.30 ,$236.68 ,$821.33 , N/A , N/A , N/A ,$275.10 , N/A , N/A ,$987.68 ,$852.52 ,$852.52 ,$831.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI H EXT 8 HOLE RT,278,1 ,$878.62 ,$579.89 ,$200.02 ,$878.62 , N/A ,$787.42 ,$787.42 ,$232.49 ,$702.90 ,$746.83 ,$549.14 ,$790.76 , N/A , N/A ,$834.69 ,$790.76 ,$746.83 ,$746.83 ,$232.49 ,$746.83 ,$746.83 ,$790.76 ,$535.08 , N/A ,$544.74 , N/A ,$790.76 , N/A ,$808.33 ,$790.76 ,$579.98 ,$579.98 ,$535.08 ,$579.98 ,$571.10 ,$600.27 ,$200.02 ,$694.11 , N/A , N/A , N/A ,$232.49 , N/A , N/A ,$834.69 ,$720.47 ,$720.47 ,$702.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI H EXT 8 HOLE LT,278,1 ,$878.62 ,$579.89 ,$200.02 ,$878.62 , N/A ,$787.42 ,$787.42 ,$232.49 ,$702.90 ,$746.83 ,$549.14 ,$790.76 , N/A , N/A ,$834.69 ,$790.76 ,$746.83 ,$746.83 ,$232.49 ,$746.83 ,$746.83 ,$790.76 ,$535.08 , N/A ,$544.74 , N/A ,$790.76 , N/A ,$808.33 ,$790.76 ,$579.98 ,$579.98 ,$535.08 ,$579.98 ,$571.10 ,$600.27 ,$200.02 ,$694.11 , N/A , N/A , N/A ,$232.49 , N/A , N/A ,$834.69 ,$720.47 ,$720.47 ,$702.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI STRAIGHT  12 HOLES/59MM,278,1 ,$790.13 ,$521.49 ,$179.88 ,$790.13 , N/A ,$708.11 ,$708.11 ,$209.07 ,$632.10 ,$671.61 ,$493.83 ,$711.12 , N/A , N/A ,$750.62 ,$711.12 ,$671.61 ,$671.61 ,$209.07 ,$671.61 ,$671.61 ,$711.12 ,$481.19 , N/A ,$489.88 , N/A ,$711.12 , N/A ,$726.92 ,$711.12 ,$521.56 ,$521.56 ,$481.19 ,$521.56 ,$513.58 ,$539.82 ,$179.88 ,$624.20 , N/A , N/A , N/A ,$209.07 , N/A , N/A ,$750.62 ,$647.91 ,$647.91 ,$632.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI STRAIGHT  6 HOLES/29MM,278,1 ,$930.24 ,$613.96 ,$211.78 ,$930.24 , N/A ,$833.68 ,$833.68 ,$246.14 ,$744.19 ,$790.70 ,$581.40 ,$837.22 , N/A , N/A ,$883.73 ,$837.22 ,$790.70 ,$790.70 ,$246.14 ,$790.70 ,$790.70 ,$837.22 ,$566.52 , N/A ,$576.74 , N/A ,$837.22 , N/A ,$855.82 ,$837.22 ,$614.05 ,$614.05 ,$566.52 ,$614.05 ,$604.66 ,$635.54 ,$211.78 ,$734.89 , N/A , N/A , N/A ,$246.14 , N/A , N/A ,$883.73 ,$762.80 ,$762.80 ,$744.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI T 4 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$912.33 ,$602.14 ,$207.70 ,$912.33 , N/A ,$817.63 ,$817.63 ,$241.40 ,$729.86 ,$775.48 ,$570.21 ,$821.10 , N/A , N/A ,$866.71 ,$821.10 ,$775.48 ,$775.48 ,$241.40 ,$775.48 ,$775.48 ,$821.10 ,$555.61 , N/A ,$565.64 , N/A ,$821.10 , N/A ,$839.34 ,$821.10 ,$602.23 ,$602.23 ,$555.61 ,$602.23 ,$593.01 ,$623.30 ,$207.70 ,$720.74 , N/A , N/A , N/A ,$241.40 , N/A , N/A ,$866.71 ,$748.11 ,$748.11 ,$729.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.5MM TI Y 3 X 8 HOLES,278,1 ,$877.57 ,$579.20 ,$199.78 ,$877.57 , N/A ,$786.48 ,$786.48 ,$232.20 ,$702.06 ,$745.93 ,$548.48 ,$789.81 , N/A , N/A ,$833.69 ,$789.81 ,$745.93 ,$745.93 ,$232.20 ,$745.93 ,$745.93 ,$789.81 ,$534.44 , N/A ,$544.10 , N/A ,$789.81 , N/A ,$807.36 ,$789.81 ,$579.28 ,$579.28 ,$534.44 ,$579.28 ,$570.42 ,$599.56 ,$199.78 ,$693.28 , N/A , N/A , N/A ,$232.20 , N/A , N/A ,$833.69 ,$719.61 ,$719.61 ,$702.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI CONDYLAR 7H/39MM RT,278,1 ,"$1,544.92 ","$1,019.65 ",$351.70 ,"$1,544.92 ", N/A ,"$1,384.56 ","$1,384.56 ",$408.79 ,"$1,235.94 ","$1,313.18 ",$965.58 ,"$1,390.43 ", N/A , N/A ,"$1,467.67 ","$1,390.43 ","$1,313.18 ","$1,313.18 ",$408.79 ,"$1,313.18 ","$1,313.18 ","$1,390.43 ",$940.86 , N/A ,$957.86 , N/A ,"$1,390.43 ", N/A ,"$1,421.33 ","$1,390.43 ","$1,019.80 ","$1,019.80 ",$940.86 ,"$1,019.80 ","$1,004.20 ","$1,055.49 ",$351.70 ,"$1,220.49 ", N/A , N/A , N/A ,$408.79 , N/A , N/A ,"$1,467.67 ","$1,266.83 ","$1,266.83 ","$1,235.94 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI CONDYLAR 7H/39MM LT,278,1 ,"$1,544.92 ","$1,019.65 ",$351.70 ,"$1,544.92 ", N/A ,"$1,384.56 ","$1,384.56 ",$408.79 ,"$1,235.94 ","$1,313.18 ",$965.58 ,"$1,390.43 ", N/A , N/A ,"$1,467.67 ","$1,390.43 ","$1,313.18 ","$1,313.18 ",$408.79 ,"$1,313.18 ","$1,313.18 ","$1,390.43 ",$940.86 , N/A ,$957.86 , N/A ,"$1,390.43 ", N/A ,"$1,421.33 ","$1,390.43 ","$1,019.80 ","$1,019.80 ",$940.86 ,"$1,019.80 ","$1,004.20 ","$1,055.49 ",$351.70 ,"$1,220.49 ", N/A , N/A , N/A ,$408.79 , N/A , N/A ,"$1,467.67 ","$1,266.83 ","$1,266.83 ","$1,235.94 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI LC-DCP 4 HOLES/24MM,278,1 ,$724.81 ,$478.37 ,$165.01 ,$724.81 , N/A ,$649.57 ,$649.57 ,$191.79 ,$579.85 ,$616.09 ,$453.01 ,$652.33 , N/A , N/A ,$688.57 ,$652.33 ,$616.09 ,$616.09 ,$191.79 ,$616.09 ,$616.09 ,$652.33 ,$441.41 , N/A ,$449.38 , N/A ,$652.33 , N/A ,$666.83 ,$652.33 ,$478.45 ,$478.45 ,$441.41 ,$478.45 ,$471.13 ,$495.19 ,$165.01 ,$572.60 , N/A , N/A , N/A ,$191.79 , N/A , N/A ,$688.57 ,$594.34 ,$594.34 ,$579.85 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI LC-DCP 6 HOLES/36MM,278,1 ,$854.39 ,$563.90 ,$194.51 ,$854.39 , N/A ,$765.70 ,$765.70 ,$226.08 ,$683.51 ,$726.23 ,$533.99 ,$768.95 , N/A , N/A ,$811.67 ,$768.95 ,$726.23 ,$726.23 ,$226.08 ,$726.23 ,$726.23 ,$768.95 ,$520.32 , N/A ,$529.72 , N/A ,$768.95 , N/A ,$786.04 ,$768.95 ,$563.98 ,$563.98 ,$520.32 ,$563.98 ,$555.35 ,$583.72 ,$194.51 ,$674.97 , N/A , N/A , N/A ,$226.08 , N/A , N/A ,$811.67 ,$700.60 ,$700.60 ,$683.51 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI LC-DCP 8 HOLES/48MM,278,1 ,$967.11 ,$638.29 ,$220.17 ,$967.11 , N/A ,$866.72 ,$866.72 ,$255.90 ,$773.69 ,$822.04 ,$604.44 ,$870.40 , N/A , N/A ,$918.75 ,$870.40 ,$822.04 ,$822.04 ,$255.90 ,$822.04 ,$822.04 ,$870.40 ,$588.97 , N/A ,$599.60 , N/A ,$870.40 , N/A ,$889.74 ,$870.40 ,$638.39 ,$638.39 ,$588.97 ,$638.39 ,$628.62 ,$660.73 ,$220.17 ,$764.02 , N/A , N/A , N/A ,$255.90 , N/A , N/A ,$918.75 ,$793.03 ,$793.03 ,$773.69 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI STRAIGHT 12 HOLES/71MM,278,1 ,$782.75 ,$516.62 ,$178.19 ,$782.75 , N/A ,$701.50 ,$701.50 ,$207.11 ,$626.20 ,$665.34 ,$489.22 ,$704.48 , N/A , N/A ,$743.61 ,$704.48 ,$665.34 ,$665.34 ,$207.11 ,$665.34 ,$665.34 ,$704.48 ,$476.69 , N/A ,$485.30 , N/A ,$704.48 , N/A ,$720.13 ,$704.48 ,$516.69 ,$516.69 ,$476.69 ,$516.69 ,$508.79 ,$534.77 ,$178.19 ,$618.37 , N/A , N/A , N/A ,$207.11 , N/A , N/A ,$743.61 ,$641.86 ,$641.86 ,$626.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI STRAIGHT 6 HOLES/35MM,278,1 ,$950.26 ,$627.17 ,$216.33 ,$950.26 , N/A ,$851.62 ,$851.62 ,$251.44 ,$760.21 ,$807.72 ,$593.91 ,$855.23 , N/A , N/A ,$902.75 ,$855.23 ,$807.72 ,$807.72 ,$251.44 ,$807.72 ,$807.72 ,$855.23 ,$578.71 , N/A ,$589.16 , N/A ,$855.23 , N/A ,$874.24 ,$855.23 ,$627.27 ,$627.27 ,$578.71 ,$627.27 ,$617.67 ,$649.22 ,$216.33 ,$750.71 , N/A , N/A , N/A ,$251.44 , N/A , N/A ,$902.75 ,$779.21 ,$779.21 ,$760.21 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI T 2 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$819.62 ,$540.95 ,$186.59 ,$819.62 , N/A ,$734.54 ,$734.54 ,$216.87 ,$655.70 ,$696.68 ,$512.26 ,$737.66 , N/A , N/A ,$778.64 ,$737.66 ,$696.68 ,$696.68 ,$216.87 ,$696.68 ,$696.68 ,$737.66 ,$499.15 , N/A ,$508.16 , N/A ,$737.66 , N/A ,$754.05 ,$737.66 ,$541.03 ,$541.03 ,$499.15 ,$541.03 ,$532.75 ,$559.96 ,$186.59 ,$647.50 , N/A , N/A , N/A ,$216.87 , N/A , N/A ,$778.64 ,$672.09 ,$672.09 ,$655.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI T 3 HOLES HEAD/ 8 HOLES SHAFT,278,1 ,$832.27 ,$549.30 ,$189.46 ,$832.27 , N/A ,$745.88 ,$745.88 ,$220.22 ,$665.82 ,$707.43 ,$520.17 ,$749.04 , N/A , N/A ,$790.66 ,$749.04 ,$707.43 ,$707.43 ,$220.22 ,$707.43 ,$707.43 ,$749.04 ,$506.85 , N/A ,$516.00 , N/A ,$749.04 , N/A ,$765.69 ,$749.04 ,$549.38 ,$549.38 ,$506.85 ,$549.38 ,$540.98 ,$568.61 ,$189.46 ,$657.49 , N/A , N/A , N/A ,$220.22 , N/A , N/A ,$790.66 ,$682.46 ,$682.46 ,$665.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0MM TI Y 3 HOLES HEAD 8 HOLES SHAFT/48MM,278,1 ,"$1,080.84 ",$713.35 ,$246.06 ,"$1,080.84 ", N/A ,$968.65 ,$968.65 ,$285.99 ,$864.67 ,$918.71 ,$675.53 ,$972.76 , N/A , N/A ,"$1,026.80 ",$972.76 ,$918.71 ,$918.71 ,$285.99 ,$918.71 ,$918.71 ,$972.76 ,$658.23 , N/A ,$670.12 , N/A ,$972.76 , N/A ,$994.37 ,$972.76 ,$713.46 ,$713.46 ,$658.23 ,$713.46 ,$702.55 ,$738.43 ,$246.06 ,$853.86 , N/A , N/A , N/A ,$285.99 , N/A , N/A ,"$1,026.80 ",$886.29 ,$886.29 ,$864.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/2H SHAFT RIGHT,278,1 ,"$1,671.75 ","$1,103.36 ",$380.58 ,"$1,671.75 ", N/A ,"$1,498.22 ","$1,498.22 ",$442.34 ,"$1,337.40 ","$1,420.99 ","$1,044.84 ","$1,504.58 ", N/A , N/A ,"$1,588.16 ","$1,504.58 ","$1,420.99 ","$1,420.99 ",$442.34 ,"$1,420.99 ","$1,420.99 ","$1,504.58 ","$1,018.10 ", N/A ,"$1,036.48 ", N/A ,"$1,504.58 ", N/A ,"$1,538.01 ","$1,504.58 ","$1,103.52 ","$1,103.52 ","$1,018.10 ","$1,103.52 ","$1,086.64 ","$1,142.14 ",$380.58 ,"$1,320.68 ", N/A , N/A , N/A ,$442.34 , N/A , N/A ,"$1,588.16 ","$1,370.84 ","$1,370.84 ","$1,337.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/2H SHAFT LEFT,278,1 ,"$1,671.75 ","$1,103.36 ",$380.58 ,"$1,671.75 ", N/A ,"$1,498.22 ","$1,498.22 ",$442.34 ,"$1,337.40 ","$1,420.99 ","$1,044.84 ","$1,504.58 ", N/A , N/A ,"$1,588.16 ","$1,504.58 ","$1,420.99 ","$1,420.99 ",$442.34 ,"$1,420.99 ","$1,420.99 ","$1,504.58 ","$1,018.10 ", N/A ,"$1,036.48 ", N/A ,"$1,504.58 ", N/A ,"$1,538.01 ","$1,504.58 ","$1,103.52 ","$1,103.52 ","$1,018.10 ","$1,103.52 ","$1,086.64 ","$1,142.14 ",$380.58 ,"$1,320.68 ", N/A , N/A , N/A ,$442.34 , N/A , N/A ,"$1,588.16 ","$1,370.84 ","$1,370.84 ","$1,337.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/3H SHAFT RIGHT,278,1 ,"$1,738.67 ","$1,147.52 ",$395.81 ,"$1,738.67 ", N/A ,"$1,558.20 ","$1,558.20 ",$460.05 ,"$1,390.94 ","$1,477.87 ","$1,086.67 ","$1,564.80 ", N/A , N/A ,"$1,651.74 ","$1,564.80 ","$1,477.87 ","$1,477.87 ",$460.05 ,"$1,477.87 ","$1,477.87 ","$1,564.80 ","$1,058.85 ", N/A ,"$1,077.98 ", N/A ,"$1,564.80 ", N/A ,"$1,599.58 ","$1,564.80 ","$1,147.70 ","$1,147.70 ","$1,058.85 ","$1,147.70 ","$1,130.14 ","$1,187.86 ",$395.81 ,"$1,373.55 ", N/A , N/A , N/A ,$460.05 , N/A , N/A ,"$1,651.74 ","$1,425.71 ","$1,425.71 ","$1,390.94 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/3H SHAFT LEFT,278,1 ,"$1,738.67 ","$1,147.52 ",$395.81 ,"$1,738.67 ", N/A ,"$1,558.20 ","$1,558.20 ",$460.05 ,"$1,390.94 ","$1,477.87 ","$1,086.67 ","$1,564.80 ", N/A , N/A ,"$1,651.74 ","$1,564.80 ","$1,477.87 ","$1,477.87 ",$460.05 ,"$1,477.87 ","$1,477.87 ","$1,564.80 ","$1,058.85 ", N/A ,"$1,077.98 ", N/A ,"$1,564.80 ", N/A ,"$1,599.58 ","$1,564.80 ","$1,147.70 ","$1,147.70 ","$1,058.85 ","$1,147.70 ","$1,130.14 ","$1,187.86 ",$395.81 ,"$1,373.55 ", N/A , N/A , N/A ,$460.05 , N/A , N/A ,"$1,651.74 ","$1,425.71 ","$1,425.71 ","$1,390.94 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/4H SHAFT RIGHT,278,1 ,"$1,803.49 ","$1,190.30 ",$410.57 ,"$1,803.49 ", N/A ,"$1,616.29 ","$1,616.29 ",$477.20 ,"$1,442.79 ","$1,532.97 ","$1,127.18 ","$1,623.14 ", N/A , N/A ,"$1,713.32 ","$1,623.14 ","$1,532.97 ","$1,532.97 ",$477.20 ,"$1,532.97 ","$1,532.97 ","$1,623.14 ","$1,098.33 ", N/A ,"$1,118.16 ", N/A ,"$1,623.14 ", N/A ,"$1,659.21 ","$1,623.14 ","$1,190.48 ","$1,190.48 ","$1,098.33 ","$1,190.48 ","$1,172.27 ","$1,232.14 ",$410.57 ,"$1,424.76 ", N/A , N/A , N/A ,$477.20 , N/A , N/A ,"$1,713.32 ","$1,478.86 ","$1,478.86 ","$1,442.79 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 VA-LCP VLR DIST RADIUS 6H HD/4H SHAFT LEFT,278,1 ,"$1,803.49 ","$1,190.30 ",$410.57 ,"$1,803.49 ", N/A ,"$1,616.29 ","$1,616.29 ",$477.20 ,"$1,442.79 ","$1,532.97 ","$1,127.18 ","$1,623.14 ", N/A , N/A ,"$1,713.32 ","$1,623.14 ","$1,532.97 ","$1,532.97 ",$477.20 ,"$1,532.97 ","$1,532.97 ","$1,623.14 ","$1,098.33 ", N/A ,"$1,118.16 ", N/A ,"$1,623.14 ", N/A ,"$1,659.21 ","$1,623.14 ","$1,190.48 ","$1,190.48 ","$1,098.33 ","$1,190.48 ","$1,172.27 ","$1,232.14 ",$410.57 ,"$1,424.76 ", N/A , N/A , N/A ,$477.20 , N/A , N/A ,"$1,713.32 ","$1,478.86 ","$1,478.86 ","$1,442.79 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI CONDYLAR 8 HOLES/57MM - RIGHT,278,1 ,"$1,178.28 ",$777.66 ,$268.24 ,"$1,178.28 ", N/A ,"$1,055.97 ","$1,055.97 ",$311.78 ,$942.62 ,"$1,001.54 ",$736.43 ,"$1,060.45 ", N/A , N/A ,"$1,119.37 ","$1,060.45 ","$1,001.54 ","$1,001.54 ",$311.78 ,"$1,001.54 ","$1,001.54 ","$1,060.45 ",$717.57 , N/A ,$730.54 , N/A ,"$1,060.45 ", N/A ,"$1,084.02 ","$1,060.45 ",$777.78 ,$777.78 ,$717.57 ,$777.78 ,$765.88 ,$805.00 ,$268.24 ,$930.84 , N/A , N/A , N/A ,$311.78 , N/A , N/A ,"$1,119.37 ",$966.19 ,$966.19 ,$942.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI CONDYLAR 8 HOLES/57MM - LEFT,278,1 ,"$1,178.28 ",$777.66 ,$268.24 ,"$1,178.28 ", N/A ,"$1,055.97 ","$1,055.97 ",$311.78 ,$942.62 ,"$1,001.54 ",$736.43 ,"$1,060.45 ", N/A , N/A ,"$1,119.37 ","$1,060.45 ","$1,001.54 ","$1,001.54 ",$311.78 ,"$1,001.54 ","$1,001.54 ","$1,060.45 ",$717.57 , N/A ,$730.54 , N/A ,"$1,060.45 ", N/A ,"$1,084.02 ","$1,060.45 ",$777.78 ,$777.78 ,$717.57 ,$777.78 ,$765.88 ,$805.00 ,$268.24 ,$930.84 , N/A , N/A , N/A ,$311.78 , N/A , N/A ,"$1,119.37 ",$966.19 ,$966.19 ,$942.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI LC-DCP 4 HOLES/31MM,278,1 ,"$1,110.98 ",$733.25 ,$252.93 ,"$1,110.98 ", N/A ,$995.66 ,$995.66 ,$293.96 ,$888.78 ,$944.33 ,$694.36 ,$999.88 , N/A , N/A ,"$1,055.43 ",$999.88 ,$944.33 ,$944.33 ,$293.96 ,$944.33 ,$944.33 ,$999.88 ,$676.59 , N/A ,$688.80 , N/A ,$999.88 , N/A ,"$1,022.10 ",$999.88 ,$733.36 ,$733.36 ,$676.59 ,$733.36 ,$722.14 ,$759.02 ,$252.93 ,$877.67 , N/A , N/A , N/A ,$293.96 , N/A , N/A ,"$1,055.43 ",$911.00 ,$911.00 ,$888.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI LC-DCP 6 HOLES/47MM,278,1 ,"$1,253.62 ",$827.39 ,$285.39 ,"$1,253.62 ", N/A ,"$1,123.49 ","$1,123.49 ",$331.71 ,"$1,002.90 ","$1,065.58 ",$783.51 ,"$1,128.26 ", N/A , N/A ,"$1,190.94 ","$1,128.26 ","$1,065.58 ","$1,065.58 ",$331.71 ,"$1,065.58 ","$1,065.58 ","$1,128.26 ",$763.45 , N/A ,$777.24 , N/A ,"$1,128.26 ", N/A ,"$1,153.33 ","$1,128.26 ",$827.51 ,$827.51 ,$763.45 ,$827.51 ,$814.85 ,$856.47 ,$285.39 ,$990.36 , N/A , N/A , N/A ,$331.71 , N/A , N/A ,"$1,190.94 ","$1,027.97 ","$1,027.97 ","$1,002.90 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI LC-DCP 8 HOLES/63MM,278,1 ,"$1,355.07 ",$894.35 ,$308.49 ,"$1,355.07 ", N/A ,"$1,214.41 ","$1,214.41 ",$358.55 ,"$1,084.06 ","$1,151.81 ",$846.92 ,"$1,219.56 ", N/A , N/A ,"$1,287.32 ","$1,219.56 ","$1,151.81 ","$1,151.81 ",$358.55 ,"$1,151.81 ","$1,151.81 ","$1,219.56 ",$825.24 , N/A ,$840.14 , N/A ,"$1,219.56 ", N/A ,"$1,246.66 ","$1,219.56 ",$894.48 ,$894.48 ,$825.24 ,$894.48 ,$880.80 ,$925.78 ,$308.49 ,"$1,070.51 ", N/A , N/A , N/A ,$358.55 , N/A , N/A ,"$1,287.32 ","$1,111.16 ","$1,111.16 ","$1,084.06 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI STRAIGHT 12 HOLES/72MM,278,1 ,$954.47 ,$629.95 ,$217.30 ,$954.47 , N/A ,$855.40 ,$855.40 ,$252.56 ,$763.58 ,$811.30 ,$596.54 ,$859.02 , N/A , N/A ,$906.75 ,$859.02 ,$811.30 ,$811.30 ,$252.56 ,$811.30 ,$811.30 ,$859.02 ,$581.27 , N/A ,$591.78 , N/A ,$859.02 , N/A ,$878.11 ,$859.02 ,$630.05 ,$630.05 ,$581.27 ,$630.05 ,$620.41 ,$652.09 ,$217.30 ,$754.03 , N/A , N/A , N/A ,$252.56 , N/A , N/A ,$906.75 ,$782.67 ,$782.67 ,$763.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI STRAIGHT 6 HOLES/36MM,278,1 ,$863.87 ,$570.15 ,$196.67 ,$863.87 , N/A ,$774.20 ,$774.20 ,$228.58 ,$691.10 ,$734.29 ,$539.92 ,$777.48 , N/A , N/A ,$820.68 ,$777.48 ,$734.29 ,$734.29 ,$228.58 ,$734.29 ,$734.29 ,$777.48 ,$526.10 , N/A ,$535.60 , N/A ,$777.48 , N/A ,$794.76 ,$777.48 ,$570.24 ,$570.24 ,$526.10 ,$570.24 ,$561.52 ,$590.20 ,$196.67 ,$682.46 , N/A , N/A , N/A ,$228.58 , N/A , N/A ,$820.68 ,$708.37 ,$708.37 ,$691.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI Y PLATE,278,1 ,"$1,297.81 ",$856.55 ,$295.46 ,"$1,297.81 ", N/A ,"$1,163.10 ","$1,163.10 ",$343.40 ,"$1,038.25 ","$1,103.14 ",$811.13 ,"$1,168.03 ", N/A , N/A ,"$1,232.92 ","$1,168.03 ","$1,103.14 ","$1,103.14 ",$343.40 ,"$1,103.14 ","$1,103.14 ","$1,168.03 ",$790.37 , N/A ,$804.64 , N/A ,"$1,168.03 ", N/A ,"$1,193.99 ","$1,168.03 ",$856.68 ,$856.68 ,$790.37 ,$856.68 ,$843.58 ,$886.66 ,$295.46 ,"$1,025.27 ", N/A , N/A , N/A ,$343.40 , N/A , N/A ,"$1,232.92 ","$1,064.20 ","$1,064.20 ","$1,038.25 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI T 2 HOLES HEAD/ 8 HOLES SHAFT/54MM,278,1 ,"$1,297.81 ",$856.55 ,$295.46 ,"$1,297.81 ", N/A ,"$1,163.10 ","$1,163.10 ",$343.40 ,"$1,038.25 ","$1,103.14 ",$811.13 ,"$1,168.03 ", N/A , N/A ,"$1,232.92 ","$1,168.03 ","$1,103.14 ","$1,103.14 ",$343.40 ,"$1,103.14 ","$1,103.14 ","$1,168.03 ",$790.37 , N/A ,$804.64 , N/A ,"$1,168.03 ", N/A ,"$1,193.99 ","$1,168.03 ",$856.68 ,$856.68 ,$790.37 ,$856.68 ,$843.58 ,$886.66 ,$295.46 ,"$1,025.27 ", N/A , N/A , N/A ,$343.40 , N/A , N/A ,"$1,232.92 ","$1,064.20 ","$1,064.20 ","$1,038.25 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4MM TI T 3 HOLES HEAD/ 8 HOLES SHAFT/54MM,278,1 ,"$1,297.81 ",$856.55 ,$295.46 ,"$1,297.81 ", N/A ,"$1,163.10 ","$1,163.10 ",$343.40 ,"$1,038.25 ","$1,103.14 ",$811.13 ,"$1,168.03 ", N/A , N/A ,"$1,232.92 ","$1,168.03 ","$1,103.14 ","$1,103.14 ",$343.40 ,"$1,103.14 ","$1,103.14 ","$1,168.03 ",$790.37 , N/A ,$804.64 , N/A ,"$1,168.03 ", N/A ,"$1,193.99 ","$1,168.03 ",$856.68 ,$856.68 ,$790.37 ,$856.68 ,$843.58 ,$886.66 ,$295.46 ,"$1,025.27 ", N/A , N/A , N/A ,$343.40 , N/A , N/A ,"$1,232.92 ","$1,064.20 ","$1,064.20 ","$1,038.25 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  3 HOLE 23MM,278,1 ,$303.19 ,$200.11 ,$69.02 ,$303.19 , N/A ,$271.72 ,$271.72 ,$80.22 ,$242.55 ,$257.71 ,$189.49 ,$272.87 , N/A , N/A ,$288.03 ,$272.87 ,$257.71 ,$257.71 ,$80.22 ,$257.71 ,$257.71 ,$272.87 ,$184.64 , N/A ,$187.98 , N/A ,$272.87 , N/A ,$278.93 ,$272.87 ,$200.14 ,$200.14 ,$184.64 ,$200.14 ,$197.07 ,$207.14 ,$69.02 ,$239.52 , N/A , N/A , N/A ,$80.22 , N/A , N/A ,$288.03 ,$248.62 ,$248.62 ,$242.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  4 HOLE 31MM,278,1 ,$348.39 ,$229.94 ,$79.31 ,$348.39 , N/A ,$312.23 ,$312.23 ,$92.19 ,$278.71 ,$296.13 ,$217.74 ,$313.55 , N/A , N/A ,$330.97 ,$313.55 ,$296.13 ,$296.13 ,$92.19 ,$296.13 ,$296.13 ,$313.55 ,$212.17 , N/A ,$216.00 , N/A ,$313.55 , N/A ,$320.52 ,$313.55 ,$229.97 ,$229.97 ,$212.17 ,$229.97 ,$226.45 ,$238.02 ,$79.31 ,$275.23 , N/A , N/A , N/A ,$92.19 , N/A , N/A ,$330.97 ,$285.68 ,$285.68 ,$278.71 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 T  3 HOLE 32MM,278,1 ,$758.52 ,$500.62 ,$172.68 ,$758.52 , N/A ,$679.79 ,$679.79 ,$200.70 ,$606.82 ,$644.74 ,$474.08 ,$682.67 , N/A , N/A ,$720.59 ,$682.67 ,$644.74 ,$644.74 ,$200.70 ,$644.74 ,$644.74 ,$682.67 ,$461.94 , N/A ,$470.28 , N/A ,$682.67 , N/A ,$697.84 ,$682.67 ,$500.70 ,$500.70 ,$461.94 ,$500.70 ,$493.04 ,$518.22 ,$172.68 ,$599.23 , N/A , N/A , N/A ,$200.70 , N/A , N/A ,$720.59 ,$621.99 ,$621.99 ,$606.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP MEDIAL DISTAL TIBIA W/O TAB 10H RIGHT,278,1 ,"$2,434.19 ","$1,606.57 ",$554.15 ,"$2,434.19 ", N/A ,"$2,181.52 ","$2,181.52 ",$644.09 ,"$1,947.35 ","$2,069.06 ","$1,521.37 ","$2,190.77 ", N/A , N/A ,"$2,312.48 ","$2,190.77 ","$2,069.06 ","$2,069.06 ",$644.09 ,"$2,069.06 ","$2,069.06 ","$2,190.77 ","$1,482.42 ", N/A ,"$1,509.20 ", N/A ,"$2,190.77 ", N/A ,"$2,239.45 ","$2,190.77 ","$1,606.81 ","$1,606.81 ","$1,482.42 ","$1,606.81 ","$1,582.22 ","$1,663.04 ",$554.15 ,"$1,923.01 ", N/A , N/A , N/A ,$644.09 , N/A , N/A ,"$2,312.48 ","$1,996.04 ","$1,996.04 ","$1,947.35 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP MEDIAL DISTAL TIBIA W/O TAB 10H LEFT,278,1 ,"$2,434.19 ","$1,606.57 ",$554.15 ,"$2,434.19 ", N/A ,"$2,181.52 ","$2,181.52 ",$644.09 ,"$1,947.35 ","$2,069.06 ","$1,521.37 ","$2,190.77 ", N/A , N/A ,"$2,312.48 ","$2,190.77 ","$2,069.06 ","$2,069.06 ",$644.09 ,"$2,069.06 ","$2,069.06 ","$2,190.77 ","$1,482.42 ", N/A ,"$1,509.20 ", N/A ,"$2,190.77 ", N/A ,"$2,239.45 ","$2,190.77 ","$1,606.81 ","$1,606.81 ","$1,482.42 ","$1,606.81 ","$1,582.22 ","$1,663.04 ",$554.15 ,"$1,923.01 ", N/A , N/A , N/A ,$644.09 , N/A , N/A ,"$2,312.48 ","$1,996.04 ","$1,996.04 ","$1,947.35 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP MEDIAL DISTAL TIBIA W/O TAB 4H LEFT,278,1 ,"$2,358.85 ","$1,556.84 ",$537.01 ,"$2,358.85 ", N/A ,"$2,114.00 ","$2,114.00 ",$624.15 ,"$1,887.08 ","$2,005.02 ","$1,474.28 ","$2,122.97 ", N/A , N/A ,"$2,240.91 ","$2,122.97 ","$2,005.02 ","$2,005.02 ",$624.15 ,"$2,005.02 ","$2,005.02 ","$2,122.97 ","$1,436.54 ", N/A ,"$1,462.48 ", N/A ,"$2,122.97 ", N/A ,"$2,170.14 ","$2,122.97 ","$1,557.08 ","$1,557.08 ","$1,436.54 ","$1,557.08 ","$1,533.25 ","$1,611.57 ",$537.01 ,"$1,863.49 ", N/A , N/A , N/A ,$624.15 , N/A , N/A ,"$2,240.91 ","$1,934.26 ","$1,934.26 ","$1,887.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP MEDIAL DISTAL TIBIA W/O TAB 6H LEFT,278,1 ,"$2,386.02 ","$1,574.77 ",$543.18 ,"$2,386.02 ", N/A ,"$2,138.35 ","$2,138.35 ",$631.35 ,"$1,908.82 ","$2,028.12 ","$1,491.26 ","$2,147.42 ", N/A , N/A ,"$2,266.72 ","$2,147.42 ","$2,028.12 ","$2,028.12 ",$631.35 ,"$2,028.12 ","$2,028.12 ","$2,147.42 ","$1,453.09 ", N/A ,"$1,479.34 ", N/A ,"$2,147.42 ", N/A ,"$2,195.14 ","$2,147.42 ","$1,575.01 ","$1,575.01 ","$1,453.09 ","$1,575.01 ","$1,550.91 ","$1,630.13 ",$543.18 ,"$1,884.96 ", N/A , N/A , N/A ,$631.35 , N/A , N/A ,"$2,266.72 ","$1,956.54 ","$1,956.54 ","$1,908.82 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP PROX HUMERUS 6H  HEAD 3H SHAFT,278,1 ,"$2,644.97 ","$1,745.68 ",$602.13 ,"$2,644.97 ", N/A ,"$2,370.42 ","$2,370.42 ",$699.86 ,"$2,115.98 ","$2,248.22 ","$1,653.11 ","$2,380.47 ", N/A , N/A ,"$2,512.72 ","$2,380.47 ","$2,248.22 ","$2,248.22 ",$699.86 ,"$2,248.22 ","$2,248.22 ","$2,380.47 ","$1,610.79 ", N/A ,"$1,639.88 ", N/A ,"$2,380.47 ", N/A ,"$2,433.37 ","$2,380.47 ","$1,745.94 ","$1,745.94 ","$1,610.79 ","$1,745.94 ","$1,719.23 ","$1,807.04 ",$602.13 ,"$2,089.53 ", N/A , N/A , N/A ,$699.86 , N/A , N/A ,"$2,512.72 ","$2,168.88 ","$2,168.88 ","$2,115.98 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP PROX HUMERUS 6H HEAD 5H SHAFT,278,1 ,"$2,727.83 ","$1,800.37 ",$621.00 ,"$2,727.83 ", N/A ,"$2,444.68 ","$2,444.68 ",$721.78 ,"$2,182.26 ","$2,318.66 ","$1,704.89 ","$2,455.05 ", N/A , N/A ,"$2,591.44 ","$2,455.05 ","$2,318.66 ","$2,318.66 ",$721.78 ,"$2,318.66 ","$2,318.66 ","$2,455.05 ","$1,661.25 ", N/A ,"$1,691.26 ", N/A ,"$2,455.05 ", N/A ,"$2,509.60 ","$2,455.05 ","$1,800.64 ","$1,800.64 ","$1,661.25 ","$1,800.64 ","$1,773.09 ","$1,863.65 ",$621.00 ,"$2,154.99 ", N/A , N/A , N/A ,$721.78 , N/A , N/A ,"$2,591.44 ","$2,236.82 ","$2,236.82 ","$2,182.26 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  5 HOLE,278,1 ,$824.89 ,$544.43 ,$187.79 ,$824.89 , N/A ,$739.27 ,$739.27 ,$218.27 ,$659.91 ,$701.16 ,$515.56 ,$742.40 , N/A , N/A ,$783.65 ,$742.40 ,$701.16 ,$701.16 ,$218.27 ,$701.16 ,$701.16 ,$742.40 ,$502.36 , N/A ,$511.44 , N/A ,$742.40 , N/A ,$758.90 ,$742.40 ,$544.51 ,$544.51 ,$502.36 ,$544.51 ,$536.18 ,$563.56 ,$187.79 ,$651.66 , N/A , N/A , N/A ,$218.27 , N/A , N/A ,$783.65 ,$676.41 ,$676.41 ,$659.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  6 HOLE,278,1 ,$953.42 ,$629.26 ,$217.05 ,$953.42 , N/A ,$854.46 ,$854.46 ,$252.27 ,$762.74 ,$810.41 ,$595.89 ,$858.08 , N/A , N/A ,$905.75 ,$858.08 ,$810.41 ,$810.41 ,$252.27 ,$810.41 ,$810.41 ,$858.08 ,$580.63 , N/A ,$591.12 , N/A ,$858.08 , N/A ,$877.15 ,$858.08 ,$629.35 ,$629.35 ,$580.63 ,$629.35 ,$619.72 ,$651.38 ,$217.05 ,$753.20 , N/A , N/A , N/A ,$252.27 , N/A , N/A ,$905.75 ,$781.80 ,$781.80 ,$762.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  7 HOLE,278,1 ,$999.77 ,$659.85 ,$227.60 ,$999.77 , N/A ,$895.99 ,$895.99 ,$264.54 ,$799.82 ,$849.80 ,$624.86 ,$899.79 , N/A , N/A ,$949.78 ,$899.79 ,$849.80 ,$849.80 ,$264.54 ,$849.80 ,$849.80 ,$899.79 ,$608.86 , N/A ,$619.86 , N/A ,$899.79 , N/A ,$919.79 ,$899.79 ,$659.95 ,$659.95 ,$608.86 ,$659.95 ,$649.85 ,$683.04 ,$227.60 ,$789.82 , N/A , N/A , N/A ,$264.54 , N/A , N/A ,$949.78 ,$819.81 ,$819.81 ,$799.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP RECON  8 HOLE,278,1 ,"$1,044.02 ",$689.05 ,$237.67 ,"$1,044.02 ", N/A ,$935.65 ,$935.65 ,$276.25 ,$835.22 ,$887.42 ,$652.51 ,$939.62 , N/A , N/A ,$991.82 ,$939.62 ,$887.42 ,$887.42 ,$276.25 ,$887.42 ,$887.42 ,$939.62 ,$635.81 , N/A ,$647.30 , N/A ,$939.62 , N/A ,$960.50 ,$939.62 ,$689.16 ,$689.16 ,$635.81 ,$689.16 ,$678.61 ,$713.27 ,$237.67 ,$824.78 , N/A , N/A , N/A ,$276.25 , N/A , N/A ,$991.82 ,$856.10 ,$856.10 ,$835.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP RECON 10 HOLE,278,1 ,"$1,031.62 ",$680.87 ,$234.85 ,"$1,031.62 ", N/A ,$924.54 ,$924.54 ,$272.97 ,$825.30 ,$876.88 ,$644.76 ,$928.46 , N/A , N/A ,$980.04 ,$928.46 ,$876.88 ,$876.88 ,$272.97 ,$876.88 ,$876.88 ,$928.46 ,$628.26 , N/A ,$639.60 , N/A ,$928.46 , N/A ,$949.09 ,$928.46 ,$680.97 ,$680.97 ,$628.26 ,$680.97 ,$670.55 ,$704.80 ,$234.85 ,$814.98 , N/A , N/A , N/A ,$272.97 , N/A , N/A ,$980.04 ,$845.93 ,$845.93 ,$825.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP RECON 12 HOLE,278,1 ,"$1,142.12 ",$753.80 ,$260.01 ,"$1,142.12 ", N/A ,"$1,023.57 ","$1,023.57 ",$302.20 ,$913.70 ,$970.80 ,$713.83 ,"$1,027.91 ", N/A , N/A ,"$1,085.01 ","$1,027.91 ",$970.80 ,$970.80 ,$302.20 ,$970.80 ,$970.80 ,"$1,027.91 ",$695.55 , N/A ,$708.12 , N/A ,"$1,027.91 ", N/A ,"$1,050.75 ","$1,027.91 ",$753.91 ,$753.91 ,$695.55 ,$753.91 ,$742.38 ,$780.30 ,$260.01 ,$902.27 , N/A , N/A , N/A ,$302.20 , N/A , N/A ,"$1,085.01 ",$936.54 ,$936.54 ,$913.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 10 HOLE,278,1 ,$698.47 ,$460.99 ,$159.01 ,$698.47 , N/A ,$625.97 ,$625.97 ,$184.82 ,$558.78 ,$593.70 ,$436.54 ,$628.62 , N/A , N/A ,$663.55 ,$628.62 ,$593.70 ,$593.70 ,$184.82 ,$593.70 ,$593.70 ,$628.62 ,$425.37 , N/A ,$433.06 , N/A ,$628.62 , N/A ,$642.59 ,$628.62 ,$461.06 ,$461.06 ,$425.37 ,$461.06 ,$454.01 ,$477.19 ,$159.01 ,$551.79 , N/A , N/A , N/A ,$184.82 , N/A , N/A ,$663.55 ,$572.75 ,$572.75 ,$558.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 12 HOLE,278,1 ,$771.16 ,$508.97 ,$175.56 ,$771.16 , N/A ,$691.11 ,$691.11 ,$204.05 ,$616.93 ,$655.49 ,$481.98 ,$694.04 , N/A , N/A ,$732.60 ,$694.04 ,$655.49 ,$655.49 ,$204.05 ,$655.49 ,$655.49 ,$694.04 ,$469.64 , N/A ,$478.12 , N/A ,$694.04 , N/A ,$709.47 ,$694.04 ,$509.04 ,$509.04 ,$469.64 ,$509.04 ,$501.25 ,$526.86 ,$175.56 ,$609.22 , N/A , N/A , N/A ,$204.05 , N/A , N/A ,$732.60 ,$632.35 ,$632.35 ,$616.93 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 14 HOLE,278,1 ,"$1,102.94 ",$727.94 ,$251.10 ,"$1,102.94 ", N/A ,$988.45 ,$988.45 ,$291.83 ,$882.35 ,$937.50 ,$689.34 ,$992.65 , N/A , N/A ,"$1,047.79 ",$992.65 ,$937.50 ,$937.50 ,$291.83 ,$937.50 ,$937.50 ,$992.65 ,$671.69 , N/A ,$683.82 , N/A ,$992.65 , N/A ,"$1,014.70 ",$992.65 ,$728.05 ,$728.05 ,$671.69 ,$728.05 ,$716.91 ,$753.53 ,$251.10 ,$871.32 , N/A , N/A , N/A ,$291.83 , N/A , N/A ,"$1,047.79 ",$904.41 ,$904.41 ,$882.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 5 HOLE,278,1 ,$561.52 ,$370.60 ,$127.83 ,$561.52 , N/A ,$503.23 ,$503.23 ,$148.58 ,$449.22 ,$477.29 ,$350.95 ,$505.37 , N/A , N/A ,$533.44 ,$505.37 ,$477.29 ,$477.29 ,$148.58 ,$477.29 ,$477.29 ,$505.37 ,$341.97 , N/A ,$348.14 , N/A ,$505.37 , N/A ,$516.60 ,$505.37 ,$370.66 ,$370.66 ,$341.97 ,$370.66 ,$364.99 ,$383.63 ,$127.83 ,$443.60 , N/A , N/A , N/A ,$148.58 , N/A , N/A ,$533.44 ,$460.45 ,$460.45 ,$449.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 6 HOLE,278,1 ,$597.33 ,$394.24 ,$135.98 ,$597.33 , N/A ,$535.33 ,$535.33 ,$158.05 ,$477.86 ,$507.73 ,$373.33 ,$537.60 , N/A , N/A ,$567.46 ,$537.60 ,$507.73 ,$507.73 ,$158.05 ,$507.73 ,$507.73 ,$537.60 ,$363.77 , N/A ,$370.34 , N/A ,$537.60 , N/A ,$549.54 ,$537.60 ,$394.30 ,$394.30 ,$363.77 ,$394.30 ,$388.26 ,$408.10 ,$135.98 ,$471.89 , N/A , N/A , N/A ,$158.05 , N/A , N/A ,$567.46 ,$489.81 ,$489.81 ,$477.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 8 HOLE,278,1 ,$651.06 ,$429.70 ,$148.22 ,$651.06 , N/A ,$583.48 ,$583.48 ,$172.27 ,$520.85 ,$553.40 ,$406.91 ,$585.95 , N/A , N/A ,$618.51 ,$585.95 ,$553.40 ,$553.40 ,$172.27 ,$553.40 ,$553.40 ,$585.95 ,$396.50 , N/A ,$403.66 , N/A ,$585.95 , N/A ,$598.98 ,$585.95 ,$429.76 ,$429.76 ,$396.50 ,$429.76 ,$423.19 ,$444.80 ,$148.22 ,$514.34 , N/A , N/A , N/A ,$172.27 , N/A , N/A ,$618.51 ,$533.87 ,$533.87 ,$520.85 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP-COMBI 9 HOLE,278,1 ,$678.45 ,$447.78 ,$154.45 ,$678.45 , N/A ,$608.03 ,$608.03 ,$179.52 ,$542.76 ,$576.68 ,$424.03 ,$610.61 , N/A , N/A ,$644.53 ,$610.61 ,$576.68 ,$576.68 ,$179.52 ,$576.68 ,$576.68 ,$610.61 ,$413.18 , N/A ,$420.64 , N/A ,$610.61 , N/A ,$624.17 ,$610.61 ,$447.84 ,$447.84 ,$413.18 ,$447.84 ,$440.99 ,$463.52 ,$154.45 ,$535.98 , N/A , N/A , N/A ,$179.52 , N/A , N/A ,$644.53 ,$556.33 ,$556.33 ,$542.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 12H 224MM,278,1 ,"$1,299.82 ",$857.88 ,$295.91 ,"$1,299.82 ", N/A ,"$1,164.90 ","$1,164.90 ",$343.93 ,"$1,039.86 ","$1,104.85 ",$812.39 ,"$1,169.84 ", N/A , N/A ,"$1,234.83 ","$1,169.84 ","$1,104.85 ","$1,104.85 ",$343.93 ,"$1,104.85 ","$1,104.85 ","$1,169.84 ",$791.59 , N/A ,$805.88 , N/A ,"$1,169.84 ", N/A ,"$1,195.83 ","$1,169.84 ",$858.01 ,$858.01 ,$791.59 ,$858.01 ,$844.88 ,$888.04 ,$295.91 ,"$1,026.86 ", N/A , N/A , N/A ,$343.93 , N/A , N/A ,"$1,234.83 ","$1,065.85 ","$1,065.85 ","$1,039.86 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 14H 260MM,278,1 ,"$1,446.48 ",$954.68 ,$329.30 ,"$1,446.48 ", N/A ,"$1,296.34 ","$1,296.34 ",$382.74 ,"$1,157.18 ","$1,229.51 ",$904.05 ,"$1,301.83 ", N/A , N/A ,"$1,374.16 ","$1,301.83 ","$1,229.51 ","$1,229.51 ",$382.74 ,"$1,229.51 ","$1,229.51 ","$1,301.83 ",$880.91 , N/A ,$896.82 , N/A ,"$1,301.83 ", N/A ,"$1,330.76 ","$1,301.83 ",$954.82 ,$954.82 ,$880.91 ,$954.82 ,$940.21 ,$988.24 ,$329.30 ,"$1,142.72 ", N/A , N/A , N/A ,$382.74 , N/A , N/A ,"$1,374.16 ","$1,186.11 ","$1,186.11 ","$1,157.18 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 16H 296MM,278,1 ,"$1,756.87 ","$1,159.53 ",$399.96 ,"$1,756.87 ", N/A ,"$1,574.51 ","$1,574.51 ",$464.86 ,"$1,405.50 ","$1,493.34 ","$1,098.04 ","$1,581.18 ", N/A , N/A ,"$1,669.03 ","$1,581.18 ","$1,493.34 ","$1,493.34 ",$464.86 ,"$1,493.34 ","$1,493.34 ","$1,581.18 ","$1,069.93 ", N/A ,"$1,089.26 ", N/A ,"$1,581.18 ", N/A ,"$1,616.32 ","$1,581.18 ","$1,159.71 ","$1,159.71 ","$1,069.93 ","$1,159.71 ","$1,141.97 ","$1,200.29 ",$399.96 ,"$1,387.93 ", N/A , N/A , N/A ,$464.86 , N/A , N/A ,"$1,669.03 ","$1,440.63 ","$1,440.63 ","$1,405.50 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 6H 116MM,278,1 ,$800.66 ,$528.44 ,$182.27 ,$800.66 , N/A ,$717.55 ,$717.55 ,$211.86 ,$640.53 ,$680.56 ,$500.41 ,$720.59 , N/A , N/A ,$760.63 ,$720.59 ,$680.56 ,$680.56 ,$211.86 ,$680.56 ,$680.56 ,$720.59 ,$487.60 , N/A ,$496.40 , N/A ,$720.59 , N/A ,$736.61 ,$720.59 ,$528.52 ,$528.52 ,$487.60 ,$528.52 ,$520.43 ,$547.01 ,$182.27 ,$632.52 , N/A , N/A , N/A ,$211.86 , N/A , N/A ,$760.63 ,$656.54 ,$656.54 ,$640.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1.3 12H STRAIGHT 47MM,278,1 ,$800.66 ,$528.44 ,$182.27 ,$800.66 , N/A ,$717.55 ,$717.55 ,$211.86 ,$640.53 ,$680.56 ,$500.41 ,$720.59 , N/A , N/A ,$760.63 ,$720.59 ,$680.56 ,$680.56 ,$211.86 ,$680.56 ,$680.56 ,$720.59 ,$487.60 , N/A ,$496.40 , N/A ,$720.59 , N/A ,$736.61 ,$720.59 ,$528.52 ,$528.52 ,$487.60 ,$528.52 ,$520.43 ,$547.01 ,$182.27 ,$632.52 , N/A , N/A , N/A ,$211.86 , N/A , N/A ,$760.63 ,$656.54 ,$656.54 ,$640.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 8H 152MM,278,1 ,"$1,036.64 ",$684.18 ,$235.99 ,"$1,036.64 ", N/A ,$929.04 ,$929.04 ,$274.29 ,$829.31 ,$881.14 ,$647.90 ,$932.98 , N/A , N/A ,$984.81 ,$932.98 ,$881.14 ,$881.14 ,$274.29 ,$881.14 ,$881.14 ,$932.98 ,$631.31 , N/A ,$642.72 , N/A ,$932.98 , N/A ,$953.71 ,$932.98 ,$684.29 ,$684.29 ,$631.31 ,$684.29 ,$673.82 ,$708.23 ,$235.99 ,$818.95 , N/A , N/A , N/A ,$274.29 , N/A , N/A ,$984.81 ,$850.04 ,$850.04 ,$829.31 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 LCP T PLATE 4 HOLE 83MM,278,1 ,"$1,104.95 ",$729.27 ,$251.55 ,"$1,104.95 ", N/A ,$990.26 ,$990.26 ,$292.37 ,$883.96 ,$939.21 ,$690.59 ,$994.46 , N/A , N/A ,"$1,049.70 ",$994.46 ,$939.21 ,$939.21 ,$292.37 ,$939.21 ,$939.21 ,$994.46 ,$672.91 , N/A ,$685.06 , N/A ,$994.46 , N/A ,"$1,016.55 ",$994.46 ,$729.38 ,$729.38 ,$672.91 ,$729.38 ,$718.22 ,$754.90 ,$251.55 ,$872.91 , N/A , N/A , N/A ,$292.37 , N/A , N/A ,"$1,049.70 ",$906.06 ,$906.06 ,$883.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 LCP T PLATE 6 HOLE 115MM,278,1 ,"$1,264.67 ",$834.68 ,$287.90 ,"$1,264.67 ", N/A ,"$1,133.40 ","$1,133.40 ",$334.63 ,"$1,011.74 ","$1,074.97 ",$790.42 ,"$1,138.20 ", N/A , N/A ,"$1,201.44 ","$1,138.20 ","$1,074.97 ","$1,074.97 ",$334.63 ,"$1,074.97 ","$1,074.97 ","$1,138.20 ",$770.18 , N/A ,$784.10 , N/A ,"$1,138.20 ", N/A ,"$1,163.50 ","$1,138.20 ",$834.81 ,$834.81 ,$770.18 ,$834.81 ,$822.04 ,$864.02 ,$287.90 ,$999.09 , N/A , N/A , N/A ,$334.63 , N/A , N/A ,"$1,201.44 ","$1,037.03 ","$1,037.03 ","$1,011.74 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 LCP T PLATE 8 HOLE 147MM,278,1 ,"$1,461.55 ",$964.62 ,$332.73 ,"$1,461.55 ", N/A ,"$1,309.84 ","$1,309.84 ",$386.73 ,"$1,169.24 ","$1,242.32 ",$913.47 ,"$1,315.40 ", N/A , N/A ,"$1,388.47 ","$1,315.40 ","$1,242.32 ","$1,242.32 ",$386.73 ,"$1,242.32 ","$1,242.32 ","$1,315.40 ",$890.08 , N/A ,$906.16 , N/A ,"$1,315.40 ", N/A ,"$1,344.63 ","$1,315.40 ",$964.77 ,$964.77 ,$890.08 ,$964.77 ,$950.01 ,$998.53 ,$332.73 ,"$1,154.62 ", N/A , N/A , N/A ,$386.73 , N/A , N/A ,"$1,388.47 ","$1,198.47 ","$1,198.47 ","$1,169.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 10H 188MM,278,1 ,"$1,042.97 ",$688.36 ,$237.43 ,"$1,042.97 ", N/A ,$934.71 ,$934.71 ,$275.97 ,$834.38 ,$886.52 ,$651.86 ,$938.67 , N/A , N/A ,$990.82 ,$938.67 ,$886.52 ,$886.52 ,$275.97 ,$886.52 ,$886.52 ,$938.67 ,$635.17 , N/A ,$646.64 , N/A ,$938.67 , N/A ,$959.53 ,$938.67 ,$688.46 ,$688.46 ,$635.17 ,$688.46 ,$677.93 ,$712.56 ,$237.43 ,$823.95 , N/A , N/A , N/A ,$275.97 , N/A , N/A ,$990.82 ,$855.24 ,$855.24 ,$834.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 12H 224MM,278,1 ,"$1,151.16 ",$759.77 ,$262.07 ,"$1,151.16 ", N/A ,"$1,031.67 ","$1,031.67 ",$304.59 ,$920.93 ,$978.49 ,$719.48 ,"$1,036.04 ", N/A , N/A ,"$1,093.60 ","$1,036.04 ",$978.49 ,$978.49 ,$304.59 ,$978.49 ,$978.49 ,"$1,036.04 ",$701.06 , N/A ,$713.72 , N/A ,"$1,036.04 ", N/A ,"$1,059.07 ","$1,036.04 ",$759.88 ,$759.88 ,$701.06 ,$759.88 ,$748.25 ,$786.47 ,$262.07 ,$909.42 , N/A , N/A , N/A ,$304.59 , N/A , N/A ,"$1,093.60 ",$943.95 ,$943.95 ,$920.93 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 BROAD LCP 10H 188MM,278,1 ,"$1,151.16 ",$759.77 ,$262.07 ,"$1,151.16 ", N/A ,"$1,031.67 ","$1,031.67 ",$304.59 ,$920.93 ,$978.49 ,$719.48 ,"$1,036.04 ", N/A , N/A ,"$1,093.60 ","$1,036.04 ",$978.49 ,$978.49 ,$304.59 ,$978.49 ,$978.49 ,"$1,036.04 ",$701.06 , N/A ,$713.72 , N/A ,"$1,036.04 ", N/A ,"$1,059.07 ","$1,036.04 ",$759.88 ,$759.88 ,$701.06 ,$759.88 ,$748.25 ,$786.47 ,$262.07 ,$909.42 , N/A , N/A , N/A ,$304.59 , N/A , N/A ,"$1,093.60 ",$943.95 ,$943.95 ,$920.93 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 14H 260MM,278,1 ,"$1,290.78 ",$851.91 ,$293.85 ,"$1,290.78 ", N/A ,"$1,156.80 ","$1,156.80 ",$341.54 ,"$1,032.62 ","$1,097.16 ",$806.74 ,"$1,161.70 ", N/A , N/A ,"$1,226.24 ","$1,161.70 ","$1,097.16 ","$1,097.16 ",$341.54 ,"$1,097.16 ","$1,097.16 ","$1,161.70 ",$786.09 , N/A ,$800.28 , N/A ,"$1,161.70 ", N/A ,"$1,187.52 ","$1,161.70 ",$852.04 ,$852.04 ,$786.09 ,$852.04 ,$839.01 ,$881.86 ,$293.85 ,"$1,019.72 ", N/A , N/A , N/A ,$341.54 , N/A , N/A ,"$1,226.24 ","$1,058.44 ","$1,058.44 ","$1,032.62 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 16H 296MM,278,1 ,"$1,507.75 ",$995.12 ,$343.24 ,"$1,507.75 ", N/A ,"$1,351.25 ","$1,351.25 ",$398.95 ,"$1,206.20 ","$1,281.59 ",$942.34 ,"$1,356.98 ", N/A , N/A ,"$1,432.36 ","$1,356.98 ","$1,281.59 ","$1,281.59 ",$398.95 ,"$1,281.59 ","$1,281.59 ","$1,356.98 ",$918.22 , N/A ,$934.80 , N/A ,"$1,356.98 ", N/A ,"$1,387.13 ","$1,356.98 ",$995.27 ,$995.27 ,$918.22 ,$995.27 ,$980.04 ,"$1,030.09 ",$343.24 ,"$1,191.12 ", N/A , N/A , N/A ,$398.95 , N/A , N/A ,"$1,432.36 ","$1,236.36 ","$1,236.36 ","$1,206.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 4 HOLE 80MM,278,1 ,$661.60 ,$436.66 ,$150.62 ,$661.60 , N/A ,$592.93 ,$592.93 ,$175.06 ,$529.28 ,$562.36 ,$413.50 ,$595.44 , N/A , N/A ,$628.52 ,$595.44 ,$562.36 ,$562.36 ,$175.06 ,$562.36 ,$562.36 ,$595.44 ,$402.91 , N/A ,$410.20 , N/A ,$595.44 , N/A ,$608.67 ,$595.44 ,$436.72 ,$436.72 ,$402.91 ,$436.72 ,$430.04 ,$452.01 ,$150.62 ,$522.66 , N/A , N/A , N/A ,$175.06 , N/A , N/A ,$628.52 ,$542.51 ,$542.51 ,$529.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 6 HOLE 116MM,278,1 ,$747.99 ,$493.67 ,$170.28 ,$747.99 , N/A ,$670.35 ,$670.35 ,$197.92 ,$598.39 ,$635.79 ,$467.49 ,$673.19 , N/A , N/A ,$710.59 ,$673.19 ,$635.79 ,$635.79 ,$197.92 ,$635.79 ,$635.79 ,$673.19 ,$455.53 , N/A ,$463.76 , N/A ,$673.19 , N/A ,$688.15 ,$673.19 ,$493.75 ,$493.75 ,$455.53 ,$493.75 ,$486.19 ,$511.03 ,$170.28 ,$590.91 , N/A , N/A , N/A ,$197.92 , N/A , N/A ,$710.59 ,$613.35 ,$613.35 ,$598.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 4.5 NARROW LCP 8H 152MM,278,1 ,$917.60 ,$605.62 ,$208.90 ,$917.60 , N/A ,$822.35 ,$822.35 ,$242.79 ,$734.08 ,$779.96 ,$573.50 ,$825.84 , N/A , N/A ,$871.72 ,$825.84 ,$779.96 ,$779.96 ,$242.79 ,$779.96 ,$779.96 ,$825.84 ,$558.82 , N/A ,$568.92 , N/A ,$825.84 , N/A ,$844.19 ,$825.84 ,$605.71 ,$605.71 ,$558.82 ,$605.71 ,$596.44 ,$626.90 ,$208.90 ,$724.90 , N/A , N/A , N/A ,$242.79 , N/A , N/A ,$871.72 ,$752.43 ,$752.43 ,$734.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP DISTAL RADIUS VOLAR EXTRA ARTICULAR LEFT LONG,278,1 ,"$1,649.39 ","$1,088.60 ",$375.49 ,"$1,649.39 ", N/A ,"$1,478.18 ","$1,478.18 ",$436.43 ,"$1,319.51 ","$1,401.98 ","$1,030.87 ","$1,484.45 ", N/A , N/A ,"$1,566.92 ","$1,484.45 ","$1,401.98 ","$1,401.98 ",$436.43 ,"$1,401.98 ","$1,401.98 ","$1,484.45 ","$1,004.48 ", N/A ,"$1,022.62 ", N/A ,"$1,484.45 ", N/A ,"$1,517.44 ","$1,484.45 ","$1,088.76 ","$1,088.76 ","$1,004.48 ","$1,088.76 ","$1,072.10 ","$1,126.86 ",$375.49 ,"$1,303.02 ", N/A , N/A , N/A ,$436.43 , N/A , N/A ,"$1,566.92 ","$1,352.50 ","$1,352.50 ","$1,319.51 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 4H LFT,278,1 ,"$1,649.39 ","$1,088.60 ",$375.49 ,"$1,649.39 ", N/A ,"$1,478.18 ","$1,478.18 ",$436.43 ,"$1,319.51 ","$1,401.98 ","$1,030.87 ","$1,484.45 ", N/A , N/A ,"$1,566.92 ","$1,484.45 ","$1,401.98 ","$1,401.98 ",$436.43 ,"$1,401.98 ","$1,401.98 ","$1,484.45 ","$1,004.48 ", N/A ,"$1,022.62 ", N/A ,"$1,484.45 ", N/A ,"$1,517.44 ","$1,484.45 ","$1,088.76 ","$1,088.76 ","$1,004.48 ","$1,088.76 ","$1,072.10 ","$1,126.86 ",$375.49 ,"$1,303.02 ", N/A , N/A , N/A ,$436.43 , N/A , N/A ,"$1,566.92 ","$1,352.50 ","$1,352.50 ","$1,319.51 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 4H RGT,278,1 ,"$1,649.39 ","$1,088.60 ",$375.49 ,"$1,649.39 ", N/A ,"$1,478.18 ","$1,478.18 ",$436.43 ,"$1,319.51 ","$1,401.98 ","$1,030.87 ","$1,484.45 ", N/A , N/A ,"$1,566.92 ","$1,484.45 ","$1,401.98 ","$1,401.98 ",$436.43 ,"$1,401.98 ","$1,401.98 ","$1,484.45 ","$1,004.48 ", N/A ,"$1,022.62 ", N/A ,"$1,484.45 ", N/A ,"$1,517.44 ","$1,484.45 ","$1,088.76 ","$1,088.76 ","$1,004.48 ","$1,088.76 ","$1,072.10 ","$1,126.86 ",$375.49 ,"$1,303.02 ", N/A , N/A , N/A ,$436.43 , N/A , N/A ,"$1,566.92 ","$1,352.50 ","$1,352.50 ","$1,319.51 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 61MM LFT,278,1 ,"$1,649.39 ","$1,088.60 ",$375.49 ,"$1,649.39 ", N/A ,"$1,478.18 ","$1,478.18 ",$436.43 ,"$1,319.51 ","$1,401.98 ","$1,030.87 ","$1,484.45 ", N/A , N/A ,"$1,566.92 ","$1,484.45 ","$1,401.98 ","$1,401.98 ",$436.43 ,"$1,401.98 ","$1,401.98 ","$1,484.45 ","$1,004.48 ", N/A ,"$1,022.62 ", N/A ,"$1,484.45 ", N/A ,"$1,517.44 ","$1,484.45 ","$1,088.76 ","$1,088.76 ","$1,004.48 ","$1,088.76 ","$1,072.10 ","$1,126.86 ",$375.49 ,"$1,303.02 ", N/A , N/A , N/A ,$436.43 , N/A , N/A ,"$1,566.92 ","$1,352.50 ","$1,352.50 ","$1,319.51 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 61MM RHT,278,1 ,"$1,649.39 ","$1,088.60 ",$375.49 ,"$1,649.39 ", N/A ,"$1,478.18 ","$1,478.18 ",$436.43 ,"$1,319.51 ","$1,401.98 ","$1,030.87 ","$1,484.45 ", N/A , N/A ,"$1,566.92 ","$1,484.45 ","$1,401.98 ","$1,401.98 ",$436.43 ,"$1,401.98 ","$1,401.98 ","$1,484.45 ","$1,004.48 ", N/A ,"$1,022.62 ", N/A ,"$1,484.45 ", N/A ,"$1,517.44 ","$1,484.45 ","$1,088.76 ","$1,088.76 ","$1,004.48 ","$1,088.76 ","$1,072.10 ","$1,126.86 ",$375.49 ,"$1,303.02 ", N/A , N/A , N/A ,$436.43 , N/A , N/A ,"$1,566.92 ","$1,352.50 ","$1,352.50 ","$1,319.51 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H RGT,278,1 ,"$1,649.39 ","$1,088.60 ",$375.49 ,"$1,649.39 ", N/A ,"$1,478.18 ","$1,478.18 ",$436.43 ,"$1,319.51 ","$1,401.98 ","$1,030.87 ","$1,484.45 ", N/A , N/A ,"$1,566.92 ","$1,484.45 ","$1,401.98 ","$1,401.98 ",$436.43 ,"$1,401.98 ","$1,401.98 ","$1,484.45 ","$1,004.48 ", N/A ,"$1,022.62 ", N/A ,"$1,484.45 ", N/A ,"$1,517.44 ","$1,484.45 ","$1,088.76 ","$1,088.76 ","$1,004.48 ","$1,088.76 ","$1,072.10 ","$1,126.86 ",$375.49 ,"$1,303.02 ", N/A , N/A , N/A ,$436.43 , N/A , N/A ,"$1,566.92 ","$1,352.50 ","$1,352.50 ","$1,319.51 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/3H SHAFT RIGHT,278,1 ,"$1,592.13 ","$1,050.81 ",$362.45 ,"$1,592.13 ", N/A ,"$1,426.87 ","$1,426.87 ",$421.28 ,"$1,273.70 ","$1,353.31 ",$995.08 ,"$1,432.92 ", N/A , N/A ,"$1,512.52 ","$1,432.92 ","$1,353.31 ","$1,353.31 ",$421.28 ,"$1,353.31 ","$1,353.31 ","$1,432.92 ",$969.61 , N/A ,$987.12 , N/A ,"$1,432.92 ", N/A ,"$1,464.76 ","$1,432.92 ","$1,050.97 ","$1,050.97 ",$969.61 ,"$1,050.97 ","$1,034.88 ","$1,087.74 ",$362.45 ,"$1,257.78 ", N/A , N/A , N/A ,$421.28 , N/A , N/A ,"$1,512.52 ","$1,305.55 ","$1,305.55 ","$1,273.70 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/3H SHAFT LEFT,278,1 ,"$1,592.13 ","$1,050.81 ",$362.45 ,"$1,592.13 ", N/A ,"$1,426.87 ","$1,426.87 ",$421.28 ,"$1,273.70 ","$1,353.31 ",$995.08 ,"$1,432.92 ", N/A , N/A ,"$1,512.52 ","$1,432.92 ","$1,353.31 ","$1,353.31 ",$421.28 ,"$1,353.31 ","$1,353.31 ","$1,432.92 ",$969.61 , N/A ,$987.12 , N/A ,"$1,432.92 ", N/A ,"$1,464.76 ","$1,432.92 ","$1,050.97 ","$1,050.97 ",$969.61 ,"$1,050.97 ","$1,034.88 ","$1,087.74 ",$362.45 ,"$1,257.78 ", N/A , N/A , N/A ,$421.28 , N/A , N/A ,"$1,512.52 ","$1,305.55 ","$1,305.55 ","$1,273.70 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/3H SHAFT RIGHT,278,1 ,"$1,592.13 ","$1,050.81 ",$362.45 ,"$1,592.13 ", N/A ,"$1,426.87 ","$1,426.87 ",$421.28 ,"$1,273.70 ","$1,353.31 ",$995.08 ,"$1,432.92 ", N/A , N/A ,"$1,512.52 ","$1,432.92 ","$1,353.31 ","$1,353.31 ",$421.28 ,"$1,353.31 ","$1,353.31 ","$1,432.92 ",$969.61 , N/A ,$987.12 , N/A ,"$1,432.92 ", N/A ,"$1,464.76 ","$1,432.92 ","$1,050.97 ","$1,050.97 ",$969.61 ,"$1,050.97 ","$1,034.88 ","$1,087.74 ",$362.45 ,"$1,257.78 ", N/A , N/A , N/A ,$421.28 , N/A , N/A ,"$1,512.52 ","$1,305.55 ","$1,305.55 ","$1,273.70 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/3H SHAFT LEFT,278,1 ,"$1,592.13 ","$1,050.81 ",$362.45 ,"$1,592.13 ", N/A ,"$1,426.87 ","$1,426.87 ",$421.28 ,"$1,273.70 ","$1,353.31 ",$995.08 ,"$1,432.92 ", N/A , N/A ,"$1,512.52 ","$1,432.92 ","$1,353.31 ","$1,353.31 ",$421.28 ,"$1,353.31 ","$1,353.31 ","$1,432.92 ",$969.61 , N/A ,$987.12 , N/A ,"$1,432.92 ", N/A ,"$1,464.76 ","$1,432.92 ","$1,050.97 ","$1,050.97 ",$969.61 ,"$1,050.97 ","$1,034.88 ","$1,087.74 ",$362.45 ,"$1,257.78 ", N/A , N/A , N/A ,$421.28 , N/A , N/A ,"$1,512.52 ","$1,305.55 ","$1,305.55 ","$1,273.70 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/4H SHAFT LEFT,278,1 ,"$1,641.35 ","$1,083.29 ",$373.66 ,"$1,641.35 ", N/A ,"$1,470.98 ","$1,470.98 ",$434.30 ,"$1,313.08 ","$1,395.15 ","$1,025.84 ","$1,477.22 ", N/A , N/A ,"$1,559.28 ","$1,477.22 ","$1,395.15 ","$1,395.15 ",$434.30 ,"$1,395.15 ","$1,395.15 ","$1,477.22 ",$999.58 , N/A ,"$1,017.64 ", N/A ,"$1,477.22 ", N/A ,"$1,510.04 ","$1,477.22 ","$1,083.46 ","$1,083.46 ",$999.58 ,"$1,083.46 ","$1,066.88 ","$1,121.37 ",$373.66 ,"$1,296.67 ", N/A , N/A , N/A ,$434.30 , N/A , N/A ,"$1,559.28 ","$1,345.91 ","$1,345.91 ","$1,313.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/4H SHAFT LEFT,278,1 ,"$1,641.35 ","$1,083.29 ",$373.66 ,"$1,641.35 ", N/A ,"$1,470.98 ","$1,470.98 ",$434.30 ,"$1,313.08 ","$1,395.15 ","$1,025.84 ","$1,477.22 ", N/A , N/A ,"$1,559.28 ","$1,477.22 ","$1,395.15 ","$1,395.15 ",$434.30 ,"$1,395.15 ","$1,395.15 ","$1,477.22 ",$999.58 , N/A ,"$1,017.64 ", N/A ,"$1,477.22 ", N/A ,"$1,510.04 ","$1,477.22 ","$1,083.46 ","$1,083.46 ",$999.58 ,"$1,083.46 ","$1,066.88 ","$1,121.37 ",$373.66 ,"$1,296.67 ", N/A , N/A , N/A ,$434.30 , N/A , N/A ,"$1,559.28 ","$1,345.91 ","$1,345.91 ","$1,313.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 8H HEAD/4H SHAFT RIGHT,278,1 ,"$1,641.35 ","$1,083.29 ",$373.66 ,"$1,641.35 ", N/A ,"$1,470.98 ","$1,470.98 ",$434.30 ,"$1,313.08 ","$1,395.15 ","$1,025.84 ","$1,477.22 ", N/A , N/A ,"$1,559.28 ","$1,477.22 ","$1,395.15 ","$1,395.15 ",$434.30 ,"$1,395.15 ","$1,395.15 ","$1,477.22 ",$999.58 , N/A ,"$1,017.64 ", N/A ,"$1,477.22 ", N/A ,"$1,510.04 ","$1,477.22 ","$1,083.46 ","$1,083.46 ",$999.58 ,"$1,083.46 ","$1,066.88 ","$1,121.37 ",$373.66 ,"$1,296.67 ", N/A , N/A , N/A ,$434.30 , N/A , N/A ,"$1,559.28 ","$1,345.91 ","$1,345.91 ","$1,313.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/4H SHAFT  RIGHT,278,1 ,"$1,641.35 ","$1,083.29 ",$373.66 ,"$1,641.35 ", N/A ,"$1,470.98 ","$1,470.98 ",$434.30 ,"$1,313.08 ","$1,395.15 ","$1,025.84 ","$1,477.22 ", N/A , N/A ,"$1,559.28 ","$1,477.22 ","$1,395.15 ","$1,395.15 ",$434.30 ,"$1,395.15 ","$1,395.15 ","$1,477.22 ",$999.58 , N/A ,"$1,017.64 ", N/A ,"$1,477.22 ", N/A ,"$1,510.04 ","$1,477.22 ","$1,083.46 ","$1,083.46 ",$999.58 ,"$1,083.46 ","$1,066.88 ","$1,121.37 ",$373.66 ,"$1,296.67 ", N/A , N/A , N/A ,$434.30 , N/A , N/A ,"$1,559.28 ","$1,345.91 ","$1,345.91 ","$1,313.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR COLUMN DIST RAD 9H HEAD/5H SHAFT LEFT,278,1 ,"$1,689.57 ","$1,115.12 ",$384.64 ,"$1,689.57 ", N/A ,"$1,514.19 ","$1,514.19 ",$447.06 ,"$1,351.66 ","$1,436.13 ","$1,055.98 ","$1,520.61 ", N/A , N/A ,"$1,605.09 ","$1,520.61 ","$1,436.13 ","$1,436.13 ",$447.06 ,"$1,436.13 ","$1,436.13 ","$1,520.61 ","$1,028.95 ", N/A ,"$1,047.54 ", N/A ,"$1,520.61 ", N/A ,"$1,554.40 ","$1,520.61 ","$1,115.29 ","$1,115.29 ","$1,028.95 ","$1,115.29 ","$1,098.22 ","$1,154.31 ",$384.64 ,"$1,334.76 ", N/A , N/A , N/A ,$447.06 , N/A , N/A ,"$1,605.09 ","$1,385.45 ","$1,385.45 ","$1,351.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE 68.5MM STAINLESS STEEL 2.4MM SCREW 8 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE LCP COMBI BONE RADIUS LEFT DISTAL VOLAR NONSTERILE,278,1 ,"$1,689.57 ","$1,115.12 ",$384.64 ,"$1,689.57 ", N/A ,"$1,514.19 ","$1,514.19 ",$447.06 ,"$1,351.66 ","$1,436.13 ","$1,055.98 ","$1,520.61 ", N/A , N/A ,"$1,605.09 ","$1,520.61 ","$1,436.13 ","$1,436.13 ",$447.06 ,"$1,436.13 ","$1,436.13 ","$1,520.61 ","$1,028.95 ", N/A ,"$1,047.54 ", N/A ,"$1,520.61 ", N/A ,"$1,554.40 ","$1,520.61 ","$1,115.29 ","$1,115.29 ","$1,028.95 ","$1,115.29 ","$1,098.22 ","$1,154.31 ",$384.64 ,"$1,334.76 ", N/A , N/A , N/A ,$447.06 , N/A , N/A ,"$1,605.09 ","$1,385.45 ","$1,385.45 ","$1,351.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE 68.5MM STAINLESS STEEL 2.4MM SCREW 8 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE LCP COMBI BONE RADIUS RIGHT DISTAL VOLAR NONSTERILE,278,1 ,"$1,689.57 ","$1,115.12 ",$384.64 ,"$1,689.57 ", N/A ,"$1,514.19 ","$1,514.19 ",$447.06 ,"$1,351.66 ","$1,436.13 ","$1,055.98 ","$1,520.61 ", N/A , N/A ,"$1,605.09 ","$1,520.61 ","$1,436.13 ","$1,436.13 ",$447.06 ,"$1,436.13 ","$1,436.13 ","$1,520.61 ","$1,028.95 ", N/A ,"$1,047.54 ", N/A ,"$1,520.61 ", N/A ,"$1,554.40 ","$1,520.61 ","$1,115.29 ","$1,115.29 ","$1,028.95 ","$1,115.29 ","$1,098.22 ","$1,154.31 ",$384.64 ,"$1,334.76 ", N/A , N/A , N/A ,$447.06 , N/A , N/A ,"$1,605.09 ","$1,385.45 ","$1,385.45 ","$1,351.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE 68.5MM STAINLESS STEEL 2.4MM SCREW 9 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE LCP COMBI BONE RADIUS RIGHT DISTAL VOLAR NONSTERILE,278,1 ,"$1,689.57 ","$1,115.12 ",$384.64 ,"$1,689.57 ", N/A ,"$1,514.19 ","$1,514.19 ",$447.06 ,"$1,351.66 ","$1,436.13 ","$1,055.98 ","$1,520.61 ", N/A , N/A ,"$1,605.09 ","$1,520.61 ","$1,436.13 ","$1,436.13 ",$447.06 ,"$1,436.13 ","$1,436.13 ","$1,520.61 ","$1,028.95 ", N/A ,"$1,047.54 ", N/A ,"$1,520.61 ", N/A ,"$1,554.40 ","$1,520.61 ","$1,115.29 ","$1,115.29 ","$1,028.95 ","$1,115.29 ","$1,098.22 ","$1,154.31 ",$384.64 ,"$1,334.76 ", N/A , N/A , N/A ,$447.06 , N/A , N/A ,"$1,605.09 ","$1,385.45 ","$1,385.45 ","$1,351.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR DISTAL RADIUS EXTRA ARTICULAR RIGHT,278,1 ,"$1,556.98 ","$1,027.61 ",$354.46 ,"$1,556.98 ", N/A ,"$1,395.37 ","$1,395.37 ",$411.97 ,"$1,245.58 ","$1,323.43 ",$973.11 ,"$1,401.28 ", N/A , N/A ,"$1,479.13 ","$1,401.28 ","$1,323.43 ","$1,323.43 ",$411.97 ,"$1,323.43 ","$1,323.43 ","$1,401.28 ",$948.20 , N/A ,$965.32 , N/A ,"$1,401.28 ", N/A ,"$1,432.42 ","$1,401.28 ","$1,027.76 ","$1,027.76 ",$948.20 ,"$1,027.76 ","$1,012.04 ","$1,063.73 ",$354.46 ,"$1,230.01 ", N/A , N/A , N/A ,$411.97 , N/A , N/A ,"$1,479.13 ","$1,276.72 ","$1,276.72 ","$1,245.58 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR DISTAL RADIUS EXTRA ARTICULAR 4H LEFT,278,1 ,"$1,556.98 ","$1,027.61 ",$354.46 ,"$1,556.98 ", N/A ,"$1,395.37 ","$1,395.37 ",$411.97 ,"$1,245.58 ","$1,323.43 ",$973.11 ,"$1,401.28 ", N/A , N/A ,"$1,479.13 ","$1,401.28 ","$1,323.43 ","$1,323.43 ",$411.97 ,"$1,323.43 ","$1,323.43 ","$1,401.28 ",$948.20 , N/A ,$965.32 , N/A ,"$1,401.28 ", N/A ,"$1,432.42 ","$1,401.28 ","$1,027.76 ","$1,027.76 ",$948.20 ,"$1,027.76 ","$1,012.04 ","$1,063.73 ",$354.46 ,"$1,230.01 ", N/A , N/A , N/A ,$411.97 , N/A , N/A ,"$1,479.13 ","$1,276.72 ","$1,276.72 ","$1,245.58 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP VOLAR DISTAL RADIUS EXTRA ARTICULAR LEFT,278,1 ,"$1,556.98 ","$1,027.61 ",$354.46 ,"$1,556.98 ", N/A ,"$1,395.37 ","$1,395.37 ",$411.97 ,"$1,245.58 ","$1,323.43 ",$973.11 ,"$1,401.28 ", N/A , N/A ,"$1,479.13 ","$1,401.28 ","$1,323.43 ","$1,323.43 ",$411.97 ,"$1,323.43 ","$1,323.43 ","$1,401.28 ",$948.20 , N/A ,$965.32 , N/A ,"$1,401.28 ", N/A ,"$1,432.42 ","$1,401.28 ","$1,027.76 ","$1,027.76 ",$948.20 ,"$1,027.76 ","$1,012.04 ","$1,063.73 ",$354.46 ,"$1,230.01 ", N/A , N/A , N/A ,$411.97 , N/A , N/A ,"$1,479.13 ","$1,276.72 ","$1,276.72 ","$1,245.58 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 43MM LFT,278,1 ,"$1,556.98 ","$1,027.61 ",$354.46 ,"$1,556.98 ", N/A ,"$1,395.37 ","$1,395.37 ",$411.97 ,"$1,245.58 ","$1,323.43 ",$973.11 ,"$1,401.28 ", N/A , N/A ,"$1,479.13 ","$1,401.28 ","$1,323.43 ","$1,323.43 ",$411.97 ,"$1,323.43 ","$1,323.43 ","$1,401.28 ",$948.20 , N/A ,$965.32 , N/A ,"$1,401.28 ", N/A ,"$1,432.42 ","$1,401.28 ","$1,027.76 ","$1,027.76 ",$948.20 ,"$1,027.76 ","$1,012.04 ","$1,063.73 ",$354.46 ,"$1,230.01 ", N/A , N/A , N/A ,$411.97 , N/A , N/A ,"$1,479.13 ","$1,276.72 ","$1,276.72 ","$1,245.58 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.4 LCP VOLAR DIST RAD 5H 43MM RHT,278,1 ,"$1,556.98 ","$1,027.61 ",$354.46 ,"$1,556.98 ", N/A ,"$1,395.37 ","$1,395.37 ",$411.97 ,"$1,245.58 ","$1,323.43 ",$973.11 ,"$1,401.28 ", N/A , N/A ,"$1,479.13 ","$1,401.28 ","$1,323.43 ","$1,323.43 ",$411.97 ,"$1,323.43 ","$1,323.43 ","$1,401.28 ",$948.20 , N/A ,$965.32 , N/A ,"$1,401.28 ", N/A ,"$1,432.42 ","$1,401.28 ","$1,027.76 ","$1,027.76 ",$948.20 ,"$1,027.76 ","$1,012.04 ","$1,063.73 ",$354.46 ,"$1,230.01 ", N/A , N/A , N/A ,$411.97 , N/A , N/A ,"$1,479.13 ","$1,276.72 ","$1,276.72 ","$1,245.58 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES LCP DISTAL RADIUS VOLAR EXTRA ARTICULAR 4H RIGHT,278,1 ,"$1,556.98 ","$1,027.61 ",$354.46 ,"$1,556.98 ", N/A ,"$1,395.37 ","$1,395.37 ",$411.97 ,"$1,245.58 ","$1,323.43 ",$973.11 ,"$1,401.28 ", N/A , N/A ,"$1,479.13 ","$1,401.28 ","$1,323.43 ","$1,323.43 ",$411.97 ,"$1,323.43 ","$1,323.43 ","$1,401.28 ",$948.20 , N/A ,$965.32 , N/A ,"$1,401.28 ", N/A ,"$1,432.42 ","$1,401.28 ","$1,027.76 ","$1,027.76 ",$948.20 ,"$1,027.76 ","$1,012.04 ","$1,063.73 ",$354.46 ,"$1,230.01 ", N/A , N/A , N/A ,$411.97 , N/A , N/A ,"$1,479.13 ","$1,276.72 ","$1,276.72 ","$1,245.58 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES MINI 5 HOLE 2.0MM,278,1 ,$569.94 ,$376.16 ,$129.75 ,$569.94 , N/A ,$510.78 ,$510.78 ,$150.80 ,$455.95 ,$484.45 ,$356.21 ,$512.95 , N/A , N/A ,$541.44 ,$512.95 ,$484.45 ,$484.45 ,$150.80 ,$484.45 ,$484.45 ,$512.95 ,$347.09 , N/A ,$353.36 , N/A ,$512.95 , N/A ,$524.34 ,$512.95 ,$376.22 ,$376.22 ,$347.09 ,$376.22 ,$370.46 ,$389.38 ,$129.75 ,$450.25 , N/A , N/A , N/A ,$150.80 , N/A , N/A ,$541.44 ,$467.35 ,$467.35 ,$455.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES MINI 3 HOLE 2.0MM,278,1 ,$569.94 ,$376.16 ,$129.75 ,$569.94 , N/A ,$510.78 ,$510.78 ,$150.80 ,$455.95 ,$484.45 ,$356.21 ,$512.95 , N/A , N/A ,$541.44 ,$512.95 ,$484.45 ,$484.45 ,$150.80 ,$484.45 ,$484.45 ,$512.95 ,$347.09 , N/A ,$353.36 , N/A ,$512.95 , N/A ,$524.34 ,$512.95 ,$376.22 ,$376.22 ,$347.09 ,$376.22 ,$370.46 ,$389.38 ,$129.75 ,$450.25 , N/A , N/A , N/A ,$150.80 , N/A , N/A ,$541.44 ,$467.35 ,$467.35 ,$455.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES MINI 4 HOLE 2.0MM,278,1 ,$569.94 ,$376.16 ,$129.75 ,$569.94 , N/A ,$510.78 ,$510.78 ,$150.80 ,$455.95 ,$484.45 ,$356.21 ,$512.95 , N/A , N/A ,$541.44 ,$512.95 ,$484.45 ,$484.45 ,$150.80 ,$484.45 ,$484.45 ,$512.95 ,$347.09 , N/A ,$353.36 , N/A ,$512.95 , N/A ,$524.34 ,$512.95 ,$376.22 ,$376.22 ,$347.09 ,$376.22 ,$370.46 ,$389.38 ,$129.75 ,$450.25 , N/A , N/A , N/A ,$150.80 , N/A , N/A ,$541.44 ,$467.35 ,$467.35 ,$455.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES MINI T 2 HOLE 2.0MM,278,1 ,$131.20 ,$86.59 ,$29.87 ,$131.20 , N/A ,$117.58 ,$117.58 ,$34.71 ,$104.96 ,$111.52 ,$82.00 ,$118.08 , N/A , N/A ,$124.64 ,$118.08 ,$111.52 ,$111.52 ,$34.71 ,$111.52 ,$111.52 ,$118.08 ,$79.90 , N/A ,$81.34 , N/A ,$118.08 , N/A ,$120.70 ,$118.08 ,$86.61 ,$86.61 ,$79.90 ,$86.61 ,$85.28 ,$89.64 ,$29.87 ,$103.65 , N/A , N/A , N/A ,$34.71 , N/A , N/A ,$124.64 ,$107.58 ,$107.58 ,$104.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES OBL SM R,278,1 ,$674.24 ,$445.00 ,$153.50 ,$674.24 , N/A ,$604.25 ,$604.25 ,$178.40 ,$539.39 ,$573.10 ,$421.40 ,$606.82 , N/A , N/A ,$640.53 ,$606.82 ,$573.10 ,$573.10 ,$178.40 ,$573.10 ,$573.10 ,$606.82 ,$410.61 , N/A ,$418.02 , N/A ,$606.82 , N/A ,$620.30 ,$606.82 ,$445.07 ,$445.07 ,$410.61 ,$445.07 ,$438.26 ,$460.64 ,$153.50 ,$532.65 , N/A , N/A , N/A ,$178.40 , N/A , N/A ,$640.53 ,$552.88 ,$552.88 ,$539.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES OBL SM L,278,1 ,$674.24 ,$445.00 ,$153.50 ,$674.24 , N/A ,$604.25 ,$604.25 ,$178.40 ,$539.39 ,$573.10 ,$421.40 ,$606.82 , N/A , N/A ,$640.53 ,$606.82 ,$573.10 ,$573.10 ,$178.40 ,$573.10 ,$573.10 ,$606.82 ,$410.61 , N/A ,$418.02 , N/A ,$606.82 , N/A ,$620.30 ,$606.82 ,$445.07 ,$445.07 ,$410.61 ,$445.07 ,$438.26 ,$460.64 ,$153.50 ,$532.65 , N/A , N/A , N/A ,$178.40 , N/A , N/A ,$640.53 ,$552.88 ,$552.88 ,$539.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES OBLIQUE 2H 19MM RIGHT,278,1 ,$315.32 ,$208.11 ,$71.78 ,$315.32 , N/A ,$282.59 ,$282.59 ,$83.44 ,$252.26 ,$268.02 ,$197.08 ,$283.79 , N/A , N/A ,$299.55 ,$283.79 ,$268.02 ,$268.02 ,$83.44 ,$268.02 ,$268.02 ,$283.79 ,$192.03 , N/A ,$195.50 , N/A ,$283.79 , N/A ,$290.09 ,$283.79 ,$208.14 ,$208.14 ,$192.03 ,$208.14 ,$204.96 ,$215.43 ,$71.78 ,$249.10 , N/A , N/A , N/A ,$83.44 , N/A , N/A ,$299.55 ,$258.56 ,$258.56 ,$252.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.0 MINI OBLIQUE 2H LT,278,1 ,$315.32 ,$208.11 ,$71.78 ,$315.32 , N/A ,$282.59 ,$282.59 ,$83.44 ,$252.26 ,$268.02 ,$197.08 ,$283.79 , N/A , N/A ,$299.55 ,$283.79 ,$268.02 ,$268.02 ,$83.44 ,$268.02 ,$268.02 ,$283.79 ,$192.03 , N/A ,$195.50 , N/A ,$283.79 , N/A ,$290.09 ,$283.79 ,$208.14 ,$208.14 ,$192.03 ,$208.14 ,$204.96 ,$215.43 ,$71.78 ,$249.10 , N/A , N/A , N/A ,$83.44 , N/A , N/A ,$299.55 ,$258.56 ,$258.56 ,$252.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 12 HOLE,278,1 ,$375.95 ,$248.13 ,$85.58 ,$375.95 , N/A ,$336.93 ,$336.93 ,$99.48 ,$300.76 ,$319.56 ,$234.97 ,$338.36 , N/A , N/A ,$357.15 ,$338.36 ,$319.56 ,$319.56 ,$99.48 ,$319.56 ,$319.56 ,$338.36 ,$228.95 , N/A ,$233.08 , N/A ,$338.36 , N/A ,$345.87 ,$338.36 ,$248.16 ,$248.16 ,$228.95 ,$248.16 ,$244.37 ,$256.85 ,$85.58 ,$297.00 , N/A , N/A , N/A ,$99.48 , N/A , N/A ,$357.15 ,$308.28 ,$308.28 ,$300.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 5 HOLE,278,1 ,$338.47 ,$223.39 ,$77.06 ,$338.47 , N/A ,$303.34 ,$303.34 ,$89.56 ,$270.78 ,$287.70 ,$211.54 ,$304.62 , N/A , N/A ,$321.55 ,$304.62 ,$287.70 ,$287.70 ,$89.56 ,$287.70 ,$287.70 ,$304.62 ,$206.13 , N/A ,$209.86 , N/A ,$304.62 , N/A ,$311.39 ,$304.62 ,$223.42 ,$223.42 ,$206.13 ,$223.42 ,$220.01 ,$231.24 ,$77.06 ,$267.39 , N/A , N/A , N/A ,$89.56 , N/A , N/A ,$321.55 ,$277.55 ,$277.55 ,$270.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 1/3 TUBULAR LCP W/COLLAR 6 HOLE,278,1 ,$338.47 ,$223.39 ,$77.06 ,$338.47 , N/A ,$303.34 ,$303.34 ,$89.56 ,$270.78 ,$287.70 ,$211.54 ,$304.62 , N/A , N/A ,$321.55 ,$304.62 ,$287.70 ,$287.70 ,$89.56 ,$287.70 ,$287.70 ,$304.62 ,$206.13 , N/A ,$209.86 , N/A ,$304.62 , N/A ,$311.39 ,$304.62 ,$223.42 ,$223.42 ,$206.13 ,$223.42 ,$220.01 ,$231.24 ,$77.06 ,$267.39 , N/A , N/A , N/A ,$89.56 , N/A , N/A ,$321.55 ,$277.55 ,$277.55 ,$270.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  5 HOLE 39MM,278,1 ,$338.47 ,$223.39 ,$77.06 ,$338.47 , N/A ,$303.34 ,$303.34 ,$89.56 ,$270.78 ,$287.70 ,$211.54 ,$304.62 , N/A , N/A ,$321.55 ,$304.62 ,$287.70 ,$287.70 ,$89.56 ,$287.70 ,$287.70 ,$304.62 ,$206.13 , N/A ,$209.86 , N/A ,$304.62 , N/A ,$311.39 ,$304.62 ,$223.42 ,$223.42 ,$206.13 ,$223.42 ,$220.01 ,$231.24 ,$77.06 ,$267.39 , N/A , N/A , N/A ,$89.56 , N/A , N/A ,$321.55 ,$277.55 ,$277.55 ,$270.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  6 HOLE 47MM,278,1 ,$338.47 ,$223.39 ,$77.06 ,$338.47 , N/A ,$303.34 ,$303.34 ,$89.56 ,$270.78 ,$287.70 ,$211.54 ,$304.62 , N/A , N/A ,$321.55 ,$304.62 ,$287.70 ,$287.70 ,$89.56 ,$287.70 ,$287.70 ,$304.62 ,$206.13 , N/A ,$209.86 , N/A ,$304.62 , N/A ,$311.39 ,$304.62 ,$223.42 ,$223.42 ,$206.13 ,$223.42 ,$220.01 ,$231.24 ,$77.06 ,$267.39 , N/A , N/A , N/A ,$89.56 , N/A , N/A ,$321.55 ,$277.55 ,$277.55 ,$270.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 7 HOLE,278,1 ,$343.98 ,$227.03 ,$78.31 ,$343.98 , N/A ,$308.27 ,$308.27 ,$91.01 ,$275.18 ,$292.38 ,$214.99 ,$309.58 , N/A , N/A ,$326.78 ,$309.58 ,$292.38 ,$292.38 ,$91.01 ,$292.38 ,$292.38 ,$309.58 ,$209.48 , N/A ,$213.26 , N/A ,$309.58 , N/A ,$316.46 ,$309.58 ,$227.06 ,$227.06 ,$209.48 ,$227.06 ,$223.59 ,$235.01 ,$78.31 ,$271.74 , N/A , N/A , N/A ,$91.01 , N/A , N/A ,$326.78 ,$282.06 ,$282.06 ,$275.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  7 HOLE 55MM,278,1 ,$343.98 ,$227.03 ,$78.31 ,$343.98 , N/A ,$308.27 ,$308.27 ,$91.01 ,$275.18 ,$292.38 ,$214.99 ,$309.58 , N/A , N/A ,$326.78 ,$309.58 ,$292.38 ,$292.38 ,$91.01 ,$292.38 ,$292.38 ,$309.58 ,$209.48 , N/A ,$213.26 , N/A ,$309.58 , N/A ,$316.46 ,$309.58 ,$227.06 ,$227.06 ,$209.48 ,$227.06 ,$223.59 ,$235.01 ,$78.31 ,$271.74 , N/A , N/A , N/A ,$91.01 , N/A , N/A ,$326.78 ,$282.06 ,$282.06 ,$275.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 4MM 6MM 20MM 8MM PERI-LOC STAINLESS STEEL 2.5MM FLUTE HIP SELF TAP CANNULATED TROCAR STERILE,278,1 ,$468.70 ,$309.34 ,$106.70 ,$468.70 , N/A ,$420.05 ,$420.05 ,$124.02 ,$374.96 ,$398.40 ,$292.94 ,$421.83 , N/A , N/A ,$445.27 ,$421.83 ,$398.40 ,$398.40 ,$124.02 ,$398.40 ,$398.40 ,$421.83 ,$285.44 , N/A ,$290.60 , N/A ,$421.83 , N/A ,$431.20 ,$421.83 ,$309.39 ,$309.39 ,$285.44 ,$309.39 ,$304.66 ,$320.22 ,$106.70 ,$370.27 , N/A , N/A , N/A ,$124.02 , N/A , N/A ,$445.27 ,$384.33 ,$384.33 ,$374.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 4MM 16MM CANNULATED,278,1 ,$468.70 ,$309.34 ,$106.70 ,$468.70 , N/A ,$420.05 ,$420.05 ,$124.02 ,$374.96 ,$398.40 ,$292.94 ,$421.83 , N/A , N/A ,$445.27 ,$421.83 ,$398.40 ,$398.40 ,$124.02 ,$398.40 ,$398.40 ,$421.83 ,$285.44 , N/A ,$290.60 , N/A ,$421.83 , N/A ,$431.20 ,$421.83 ,$309.39 ,$309.39 ,$285.44 ,$309.39 ,$304.66 ,$320.22 ,$106.70 ,$370.27 , N/A , N/A , N/A ,$124.02 , N/A , N/A ,$445.27 ,$384.33 ,$384.33 ,$374.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW LOCKING ARTHREX 3.5 X 24MM,278,1 ,$371.25 ,$245.03 ,$84.52 ,$371.25 , N/A ,$332.71 ,$332.71 ,$98.24 ,$297.00 ,$315.56 ,$232.03 ,$334.13 , N/A , N/A ,$352.69 ,$334.13 ,$315.56 ,$315.56 ,$98.24 ,$315.56 ,$315.56 ,$334.13 ,$226.09 , N/A ,$230.18 , N/A ,$334.13 , N/A ,$341.55 ,$334.13 ,$245.06 ,$245.06 ,$226.09 ,$245.06 ,$241.31 ,$253.64 ,$84.52 ,$293.29 , N/A , N/A , N/A ,$98.24 , N/A , N/A ,$352.69 ,$304.43 ,$304.43 ,$297.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,BONE SCREW ARTHREX LOW PROFILE HEXALOBE LOCK 3.5MMx18MM,278,1 ,$371.25 ,$245.03 ,$84.52 ,$371.25 , N/A ,$332.71 ,$332.71 ,$98.24 ,$297.00 ,$315.56 ,$232.03 ,$334.13 , N/A , N/A ,$352.69 ,$334.13 ,$315.56 ,$315.56 ,$98.24 ,$315.56 ,$315.56 ,$334.13 ,$226.09 , N/A ,$230.18 , N/A ,$334.13 , N/A ,$341.55 ,$334.13 ,$245.06 ,$245.06 ,$226.09 ,$245.06 ,$241.31 ,$253.64 ,$84.52 ,$293.29 , N/A , N/A , N/A ,$98.24 , N/A , N/A ,$352.69 ,$304.43 ,$304.43 ,$297.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 14MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  6MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  7MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  8MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP  9MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 10MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 11MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 12MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.0 TI CORTEX SELF TAP 13MM,278,1 ,$163.17 ,$107.69 ,$37.15 ,$163.17 , N/A ,$146.23 ,$146.23 ,$43.18 ,$130.54 ,$138.69 ,$101.98 ,$146.85 , N/A , N/A ,$155.01 ,$146.85 ,$138.69 ,$138.69 ,$43.18 ,$138.69 ,$138.69 ,$146.85 ,$99.37 , N/A ,$101.16 , N/A ,$146.85 , N/A ,$150.12 ,$146.85 ,$107.71 ,$107.71 ,$99.37 ,$107.71 ,$106.06 ,$111.48 ,$37.15 ,$128.90 , N/A , N/A , N/A ,$43.18 , N/A , N/A ,$155.01 ,$133.80 ,$133.80 ,$130.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 18MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  6MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  7MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  8MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP  9MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 10MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 11MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 12MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 13MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 14MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.3 TI CORTEX SELF TAP 16MM,278,1 ,$169.79 ,$112.06 ,$38.65 ,$169.79 , N/A ,$152.17 ,$152.17 ,$44.92 ,$135.83 ,$144.32 ,$106.12 ,$152.81 , N/A , N/A ,$161.30 ,$152.81 ,$144.32 ,$144.32 ,$44.92 ,$144.32 ,$144.32 ,$152.81 ,$103.40 , N/A ,$105.26 , N/A ,$152.81 , N/A ,$156.21 ,$152.81 ,$112.08 ,$112.08 ,$103.40 ,$112.08 ,$110.36 ,$116.00 ,$38.65 ,$134.13 , N/A , N/A , N/A ,$44.92 , N/A , N/A ,$161.30 ,$139.23 ,$139.23 ,$135.83 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 32MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  6MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  7MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  8MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP  9MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 10MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 11MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 12MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 13MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 14MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 16MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 18MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 20MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 22MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 TI CORTEX SELF TAP 24MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  6MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  7MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  8MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP  9MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 10MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 11MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 12MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 13MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 14MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 16MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 18MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 20MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 22MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 24MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 26MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 28MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 TI CORTEX SELF TAP 30MM,278,1 ,$72.77 ,$48.03 ,$16.57 ,$72.77 , N/A ,$65.22 ,$65.22 ,$19.26 ,$58.22 ,$61.85 ,$45.48 ,$65.49 , N/A , N/A ,$69.13 ,$65.49 ,$61.85 ,$61.85 ,$19.26 ,$61.85 ,$61.85 ,$65.49 ,$44.32 , N/A ,$45.12 , N/A ,$65.49 , N/A ,$66.95 ,$65.49 ,$48.04 ,$48.04 ,$44.32 ,$48.04 ,$47.30 ,$49.72 ,$16.57 ,$57.49 , N/A , N/A , N/A ,$19.26 , N/A , N/A ,$69.13 ,$59.67 ,$59.67 ,$58.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 30MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE  6MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE  8MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 10MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 12MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 14MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 16MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 18MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 20MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 22MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 24MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 26MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 LOCKING STARDRIVE 28MM,278,1 ,$234.83 ,$154.99 ,$53.46 ,$234.83 , N/A ,$210.45 ,$210.45 ,$62.13 ,$187.86 ,$199.61 ,$146.77 ,$211.35 , N/A , N/A ,$223.09 ,$211.35 ,$199.61 ,$199.61 ,$62.13 ,$199.61 ,$199.61 ,$211.35 ,$143.01 , N/A ,$145.60 , N/A ,$211.35 , N/A ,$216.04 ,$211.35 ,$155.01 ,$155.01 ,$143.01 ,$155.01 ,$152.64 ,$160.44 ,$53.46 ,$185.52 , N/A , N/A , N/A ,$62.13 , N/A , N/A ,$223.09 ,$192.56 ,$192.56 ,$187.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 32MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  6MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  7MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  8MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP  9MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 10MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 11MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 12MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 13MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 14MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 16MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 18MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 20MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 22MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 24MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 26MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 28MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.4 TI CORTEX SELF TAP 30MM,278,1 ,$168.68 ,$111.33 ,$38.41 ,$168.68 , N/A ,$151.17 ,$151.17 ,$44.63 ,$134.94 ,$143.38 ,$105.43 ,$151.81 , N/A , N/A ,$160.25 ,$151.81 ,$143.38 ,$143.38 ,$44.63 ,$143.38 ,$143.38 ,$151.81 ,$102.73 , N/A ,$104.58 , N/A ,$151.81 , N/A ,$155.19 ,$151.81 ,$111.35 ,$111.35 ,$102.73 ,$111.35 ,$109.64 ,$115.24 ,$38.41 ,$133.26 , N/A , N/A , N/A ,$44.63 , N/A , N/A ,$160.25 ,$138.32 ,$138.32 ,$134.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 30MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 10MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 12MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 14MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 16MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 18MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 20MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 22MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 24MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 26MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAP 28MM,278,1 ,$77.18 ,$50.94 ,$17.57 ,$77.18 , N/A ,$69.17 ,$69.17 ,$20.42 ,$61.74 ,$65.60 ,$48.24 ,$69.46 , N/A , N/A ,$73.32 ,$69.46 ,$65.60 ,$65.60 ,$20.42 ,$65.60 ,$65.60 ,$69.46 ,$47.00 , N/A ,$47.86 , N/A ,$69.46 , N/A ,$71.01 ,$69.46 ,$50.95 ,$50.95 ,$47.00 ,$50.95 ,$50.17 ,$52.73 ,$17.57 ,$60.97 , N/A , N/A , N/A ,$20.42 , N/A , N/A ,$73.32 ,$63.29 ,$63.29 ,$61.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 50,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP  6MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP  7MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP  8MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP  9MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 10MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 11MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 12MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 14MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 1.5 CORTEX SELF TAP 16MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 10MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 12MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 14MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 16MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 18MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 20MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 6MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.0 CORTEX SELF TAP 8MM,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING  6,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING  8,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 10,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 12,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 14,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 16,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 18,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 20,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 22,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 24,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 26,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 28,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 30,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 32,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 34,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 36,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 38,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 40,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 45,278,1 ,$76.77 ,$50.67 ,$17.48 ,$76.77 , N/A ,$68.80 ,$68.80 ,$20.32 ,$61.42 ,$65.25 ,$47.98 ,$69.09 , N/A , N/A ,$72.93 ,$69.09 ,$65.25 ,$65.25 ,$20.32 ,$65.25 ,$65.25 ,$69.09 ,$46.75 , N/A ,$47.60 , N/A ,$69.09 , N/A ,$70.63 ,$69.09 ,$50.68 ,$50.68 ,$46.75 ,$50.68 ,$49.90 ,$52.45 ,$17.48 ,$60.65 , N/A , N/A , N/A ,$20.32 , N/A , N/A ,$72.93 ,$62.95 ,$62.95 ,$61.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 2.7 CORTICAL SELF TAPPING 55,278,1 ,$90.00 ,$59.40 ,$20.49 ,$90.00 , N/A ,$80.66 ,$80.66 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 , N/A ,$55.80 , N/A ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 , N/A , N/A , N/A ,$23.81 , N/A , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CANNULATED TFN 90MM,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 100MM TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5MM CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 105MM TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5MM FEMORAL PROXIMAL CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 110MM TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5MM FEMORAL PROXIMAL CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 115MM TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5MM CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 120MM TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5MM CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 125MM TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5MM CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 75MM TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5MM FEMORAL PROXIMAL CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 80MM TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5MM FEMORAL PROXIMAL CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 85MM TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5MM CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 10.35MM 95MM TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5MM CANNULATED STERILE TAN,278,1 ,"$1,375.55 ",$907.86 ,$313.15 ,"$1,375.55 ", N/A ,"$1,232.77 ","$1,232.77 ",$363.97 ,"$1,100.44 ","$1,169.22 ",$859.72 ,"$1,238.00 ", N/A , N/A ,"$1,306.77 ","$1,238.00 ","$1,169.22 ","$1,169.22 ",$363.97 ,"$1,169.22 ","$1,169.22 ","$1,238.00 ",$837.71 , N/A ,$852.84 , N/A ,"$1,238.00 ", N/A ,"$1,265.51 ","$1,238.00 ",$908.00 ,$908.00 ,$837.71 ,$908.00 ,$894.11 ,$939.78 ,$313.15 ,"$1,086.68 ", N/A , N/A , N/A ,$363.97 , N/A , N/A ,"$1,306.77 ","$1,127.95 ","$1,127.95 ","$1,100.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 60MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 10MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 12MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 14MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 16MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 18MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 20MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 22MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 24MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 26MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 28MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 30MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 32MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 34MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 36MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 38MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 40MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 45MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 50MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 CORTEX S/TAP 55MM,278,1 ,$42.53 ,$28.07 ,$9.68 ,$42.53 , N/A ,$38.12 ,$38.12 ,$11.25 ,$34.02 ,$36.15 ,$26.58 ,$38.28 , N/A , N/A ,$40.40 ,$38.28 ,$36.15 ,$36.15 ,$11.25 ,$36.15 ,$36.15 ,$38.28 ,$25.90 , N/A ,$26.36 , N/A ,$38.28 , N/A ,$39.13 ,$38.28 ,$28.07 ,$28.07 ,$25.90 ,$28.07 ,$27.64 ,$29.06 ,$9.68 ,$33.60 , N/A , N/A , N/A ,$11.25 , N/A , N/A ,$40.40 ,$34.87 ,$34.87 ,$34.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  60MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  10MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  12MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  14MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  16MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  18MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  20MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  22MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  24MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  26MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  28MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  30MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  32MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  34MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  36MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  38MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  40MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  45MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  50MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 3.5 LOCKING STARDRIVE  55MM,278,1 ,$252.47 ,$166.63 ,$57.48 ,$252.47 , N/A ,$226.26 ,$226.26 ,$66.81 ,$201.98 ,$214.60 ,$157.79 ,$227.22 , N/A , N/A ,$239.85 ,$227.22 ,$214.60 ,$214.60 ,$66.81 ,$214.60 ,$214.60 ,$227.22 ,$153.75 , N/A ,$156.54 , N/A ,$227.22 , N/A ,$232.27 ,$227.22 ,$166.66 ,$166.66 ,$153.75 ,$166.66 ,$164.11 ,$172.49 ,$57.48 ,$199.45 , N/A , N/A , N/A ,$66.81 , N/A , N/A ,$239.85 ,$207.03 ,$207.03 ,$201.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 60,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 10,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 12,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 14,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 16,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 18,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 20,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 22,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 24,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 26,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 28,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 30,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 35,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 40,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 45,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 50,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS FULL THREAD 55,278,1 ,$34.97 ,$23.08 ,$7.96 ,$34.97 , N/A ,$31.34 ,$31.34 ,$9.25 ,$27.98 ,$29.72 ,$21.86 ,$31.47 , N/A , N/A ,$33.22 ,$31.47 ,$29.72 ,$29.72 ,$9.25 ,$29.72 ,$29.72 ,$31.47 ,$21.30 , N/A ,$21.68 , N/A ,$31.47 , N/A ,$32.17 ,$31.47 ,$23.08 ,$23.08 ,$21.30 ,$23.08 ,$22.73 ,$23.89 ,$7.96 ,$27.63 , N/A , N/A , N/A ,$9.25 , N/A , N/A ,$33.22 ,$28.68 ,$28.68 ,$27.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT 50,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  10,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  12,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  14,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  16,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  18,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  20,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  22,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  24,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  26,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  28,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  30,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  35,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  40,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANCELLOUS PT  45,278,1 ,$32.63 ,$21.54 ,$7.43 ,$32.63 , N/A ,$29.24 ,$29.24 ,$8.63 ,$26.10 ,$27.74 ,$20.39 ,$29.37 , N/A , N/A ,$31.00 ,$29.37 ,$27.74 ,$27.74 ,$8.63 ,$27.74 ,$27.74 ,$29.37 ,$19.87 , N/A ,$20.24 , N/A ,$29.37 , N/A ,$30.02 ,$29.37 ,$21.54 ,$21.54 ,$19.87 ,$21.54 ,$21.21 ,$22.29 ,$7.43 ,$25.78 , N/A , N/A , N/A ,$8.63 , N/A , N/A ,$31.00 ,$26.76 ,$26.76 ,$26.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 72MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 30MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 32MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 34MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 36MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 38MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 40MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 42MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 44MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 46MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 48MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 50MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 52MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 54MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 56MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 58MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 60MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 64MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 68MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 10MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 12MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 14MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 16MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 18MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 20MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 22MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 24MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 26MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 CANN SHORT THREAD 28MM,278,1 ,$402.44 ,$265.61 ,$91.62 ,$402.44 , N/A ,$360.67 ,$360.67 ,$106.49 ,$321.95 ,$342.07 ,$251.53 ,$362.20 , N/A , N/A ,$382.32 ,$362.20 ,$342.07 ,$342.07 ,$106.49 ,$342.07 ,$342.07 ,$362.20 ,$245.09 , N/A ,$249.52 , N/A ,$362.20 , N/A ,$370.24 ,$362.20 ,$265.65 ,$265.65 ,$245.09 ,$265.65 ,$261.59 ,$274.95 ,$91.62 ,$317.93 , N/A , N/A , N/A ,$106.49 , N/A , N/A ,$382.32 ,$330.00 ,$330.00 ,$321.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 SCHANZ SELF DRILL 3MM,278,1 ,$382.50 ,$252.45 ,$87.08 ,$382.50 , N/A ,$342.80 ,$342.80 ,$101.21 ,$306.00 ,$325.13 ,$239.06 ,$344.25 , N/A , N/A ,$363.38 ,$344.25 ,$325.13 ,$325.13 ,$101.21 ,$325.13 ,$325.13 ,$344.25 ,$232.94 , N/A ,$237.16 , N/A ,$344.25 , N/A ,$351.90 ,$344.25 ,$252.49 ,$252.49 ,$232.94 ,$252.49 ,$248.63 ,$261.32 ,$87.08 ,$302.18 , N/A , N/A , N/A ,$101.21 , N/A , N/A ,$363.38 ,$313.65 ,$313.65 ,$306.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.0 SCHANZ 20MM THREAD/ 80MM,278,1 ,$382.50 ,$252.45 ,$87.08 ,$382.50 , N/A ,$342.80 ,$342.80 ,$101.21 ,$306.00 ,$325.13 ,$239.06 ,$344.25 , N/A , N/A ,$363.38 ,$344.25 ,$325.13 ,$325.13 ,$101.21 ,$325.13 ,$325.13 ,$344.25 ,$232.94 , N/A ,$237.16 , N/A ,$344.25 , N/A ,$351.90 ,$344.25 ,$252.49 ,$252.49 ,$232.94 ,$252.49 ,$248.63 ,$261.32 ,$87.08 ,$302.18 , N/A , N/A , N/A ,$101.21 , N/A , N/A ,$363.38 ,$313.65 ,$313.65 ,$306.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 70MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 14MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 16MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 18MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 20MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 22MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 24MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 26MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 28MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 30MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 32MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 34MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 36MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 38MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 40MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 42MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 44MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 46MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 48MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 50MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 52MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 54MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 56MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 58MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 60MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 62MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 64MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 66MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 4.5 CORTEX SELF TAPPING 68MM,278,1 ,$43.79 ,$28.90 ,$9.97 ,$43.79 , N/A ,$39.24 ,$39.24 ,$11.58 ,$35.03 ,$37.22 ,$27.37 ,$39.41 , N/A , N/A ,$41.60 ,$39.41 ,$37.22 ,$37.22 ,$11.58 ,$37.22 ,$37.22 ,$39.41 ,$26.67 , N/A ,$27.14 , N/A ,$39.41 , N/A ,$40.29 ,$39.41 ,$28.91 ,$28.91 ,$26.67 ,$28.91 ,$28.46 ,$29.92 ,$9.97 ,$34.59 , N/A , N/A , N/A ,$11.58 , N/A , N/A ,$41.60 ,$35.91 ,$35.91 ,$35.03 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 90MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 14MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 16MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 18MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 20MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 22MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 24MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 26MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 28MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 30MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 32MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 34MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 36MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 38MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 40MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 42MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 44MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 46MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 48MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 50MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 55MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 60MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 65MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 70MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 75MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 80MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 LOCKING STARDRIVE 85MM,278,1 ,$292.16 ,$192.83 ,$66.51 ,$292.16 , N/A ,$261.83 ,$261.83 ,$77.30 ,$233.73 ,$248.34 ,$182.60 ,$262.94 , N/A , N/A ,$277.55 ,$262.94 ,$248.34 ,$248.34 ,$77.30 ,$248.34 ,$248.34 ,$262.94 ,$177.93 , N/A ,$181.14 , N/A ,$262.94 , N/A ,$268.79 ,$262.94 ,$192.85 ,$192.85 ,$177.93 ,$192.85 ,$189.90 ,$199.60 ,$66.51 ,$230.81 , N/A , N/A , N/A ,$77.30 , N/A , N/A ,$277.55 ,$239.57 ,$239.57 ,$233.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 95MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 100MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 26MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 28MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 30MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 32MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 34MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 36MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 38MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 40MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 42MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 44MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 46MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 48MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 50MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 52MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 54MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 56MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 58MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 60MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 64MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 68MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 72MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 76MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 80MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 85MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING 90MM,278,1 ,$381.42 ,$251.74 ,$86.84 ,$381.42 , N/A ,$341.83 ,$341.83 ,$100.92 ,$305.14 ,$324.21 ,$238.39 ,$343.28 , N/A , N/A ,$362.35 ,$343.28 ,$324.21 ,$324.21 ,$100.92 ,$324.21 ,$324.21 ,$343.28 ,$232.28 , N/A ,$236.48 , N/A ,$343.28 , N/A ,$350.91 ,$343.28 ,$251.78 ,$251.78 ,$232.28 ,$251.78 ,$247.92 ,$260.59 ,$86.84 ,$301.32 , N/A , N/A , N/A ,$100.92 , N/A , N/A ,$362.35 ,$312.76 ,$312.76 ,$305.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 80MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 30MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 34MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 36MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 38MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 44MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 46MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 48MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 50MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 52MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 54MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 56MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 58MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 60MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 64MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 68MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 72MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 TI LOCKING W/T25 STAR 76MM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 5MM 4.3MM 32MM TITANIUM T25 FULL THREAD SELF TAP LOCK STARDRIVE BLUNT TIP STERILE LIGHT GREEN EXPERT CANNULATED NAIL SYSTEM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 5MM 4.3MM 40MM TITANIUM T25 FULL THREAD SELF TAP LOCK STARDRIVE BLUNT TIP STERILE LIGHT GREEN EXPERT CANNULATED NAIL SYSTEM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW BONE 5MM 4.3MM 42MM TITANIUM T25 FULL THREAD SELF TAP LOCK STARDRIVE BLUNT TIP STERILE LIGHT GREEN EXPERT CANNULATED NAIL SYSTEM,278,1 ,$459.50 ,$303.27 ,$104.61 ,$459.50 , N/A ,$411.80 ,$411.80 ,$121.59 ,$367.60 ,$390.58 ,$287.19 ,$413.55 , N/A , N/A ,$436.53 ,$413.55 ,$390.58 ,$390.58 ,$121.59 ,$390.58 ,$390.58 ,$413.55 ,$279.84 , N/A ,$284.90 , N/A ,$413.55 , N/A ,$422.74 ,$413.55 ,$303.32 ,$303.32 ,$279.84 ,$303.32 ,$298.68 ,$313.93 ,$104.61 ,$363.01 , N/A , N/A , N/A ,$121.59 , N/A , N/A ,$436.53 ,$376.79 ,$376.79 ,$367.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0SCHANZ SELF DRILL 200MM,278,1 ,$439.88 ,$290.32 ,$100.14 ,$439.88 , N/A ,$394.22 ,$394.22 ,$116.39 ,$351.90 ,$373.90 ,$274.93 ,$395.89 , N/A , N/A ,$417.89 ,$395.89 ,$373.90 ,$373.90 ,$116.39 ,$373.90 ,$373.90 ,$395.89 ,$267.89 , N/A ,$272.72 , N/A ,$395.89 , N/A ,$404.69 ,$395.89 ,$290.36 ,$290.36 ,$267.89 ,$290.36 ,$285.92 ,$300.53 ,$100.14 ,$347.51 , N/A , N/A , N/A ,$116.39 , N/A , N/A ,$417.89 ,$360.70 ,$360.70 ,$351.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 5.0 SCHANZ SELF DRILL150,278,1 ,$439.88 ,$290.32 ,$100.14 ,$439.88 , N/A ,$394.22 ,$394.22 ,$116.39 ,$351.90 ,$373.90 ,$274.93 ,$395.89 , N/A , N/A ,$417.89 ,$395.89 ,$373.90 ,$373.90 ,$116.39 ,$373.90 ,$373.90 ,$395.89 ,$267.89 , N/A ,$272.72 , N/A ,$395.89 , N/A ,$404.69 ,$395.89 ,$290.36 ,$290.36 ,$267.89 ,$290.36 ,$285.92 ,$300.53 ,$100.14 ,$347.51 , N/A , N/A , N/A ,$116.39 , N/A , N/A ,$417.89 ,$360.70 ,$360.70 ,$351.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT 110MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 100MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 105MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 110MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 85MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 90MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 95MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  85MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  90MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  95MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT 100MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT 105MM,278,1 ,$70.74 ,$46.69 ,$16.10 ,$70.74 , N/A ,$63.40 ,$63.40 ,$18.72 ,$56.59 ,$60.13 ,$44.21 ,$63.67 , N/A , N/A ,$67.20 ,$63.67 ,$60.13 ,$60.13 ,$18.72 ,$60.13 ,$60.13 ,$63.67 ,$43.08 , N/A ,$43.86 , N/A ,$63.67 , N/A ,$65.08 ,$63.67 ,$46.70 ,$46.70 ,$43.08 ,$46.70 ,$45.98 ,$48.33 ,$16.10 ,$55.88 , N/A , N/A , N/A ,$18.72 , N/A , N/A ,$67.20 ,$58.01 ,$58.01 ,$56.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  60MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 30MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 35MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 40MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 45MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 50MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 55MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 60MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 65MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 70MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 75MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 16MM PT 80MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  45MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  50MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  55MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  60MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  65MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  70MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  75MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS 32MM PT  80MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  25MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  30MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  35MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  40MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  45MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  50MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANCELLOUS F/THRD  55MM,278,1 ,$65.23 ,$43.05 ,$14.85 ,$65.23 , N/A ,$58.46 ,$58.46 ,$17.26 ,$52.18 ,$55.45 ,$40.77 ,$58.71 , N/A , N/A ,$61.97 ,$58.71 ,$55.45 ,$55.45 ,$17.26 ,$55.45 ,$55.45 ,$58.71 ,$39.73 , N/A ,$40.44 , N/A ,$58.71 , N/A ,$60.01 ,$58.71 ,$43.06 ,$43.06 ,$39.73 ,$43.06 ,$42.40 ,$44.57 ,$14.85 ,$51.53 , N/A , N/A , N/A ,$17.26 , N/A , N/A ,$61.97 ,$53.49 ,$53.49 ,$52.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 150,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  30,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  35,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  40,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  45,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  50,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  55,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  60,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  65,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  70,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  75,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  80,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  85,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  90,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT  95,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 100,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 105,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 110,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 115,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 120,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 125,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 130,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 135,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 140,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 145,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 16MM PT 150,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  45,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  50,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  55,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  60,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  65,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  70,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  75,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  80,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  85,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  90,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT  95,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 100,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 105,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 110,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 115,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 120,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 125,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 130,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 135,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 140,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SCREW SYNTHES 6.5 CANN SELF TAP 32MM PT 145,278,1 ,$505.92 ,$333.91 ,$115.17 ,$505.92 , N/A ,$453.41 ,$453.41 ,$133.87 ,$404.74 ,$430.03 ,$316.20 ,$455.33 , N/A , N/A ,$480.62 ,$455.33 ,$430.03 ,$430.03 ,$133.87 ,$430.03 ,$430.03 ,$455.33 ,$308.11 , N/A ,$313.68 , N/A ,$455.33 , N/A ,$465.45 ,$455.33 ,$333.96 ,$333.96 ,$308.11 ,$333.96 ,$328.85 ,$345.64 ,$115.17 ,$399.68 , N/A , N/A , N/A ,$133.87 , N/A , N/A ,$480.62 ,$414.85 ,$414.85 ,$404.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,SUTURE ARTHREX FIBERWARE 2 C-13 38IN BRAID TIES,278,1 ,$54.45 ,$35.94 ,$12.40 ,$54.45 , N/A ,$48.80 ,$48.80 ,$14.41 ,$43.56 ,$46.28 ,$34.03 ,$49.01 , N/A , N/A ,$51.73 ,$49.01 ,$46.28 ,$46.28 ,$14.41 ,$46.28 ,$46.28 ,$49.01 ,$33.16 , N/A ,$33.76 , N/A ,$49.01 , N/A ,$50.09 ,$49.01 ,$35.94 ,$35.94 ,$33.16 ,$35.94 ,$35.39 ,$37.20 ,$12.40 ,$43.02 , N/A , N/A , N/A ,$14.41 , N/A , N/A ,$51.73 ,$44.65 ,$44.65 ,$43.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 2.0MM CORTEX SCREWS 54MM,278,1 ,$364.93 ,$240.85 ,$83.07 ,$364.93 , N/A ,$327.05 ,$327.05 ,$96.56 ,$291.94 ,$310.19 ,$228.08 ,$328.44 , N/A , N/A ,$346.68 ,$328.44 ,$310.19 ,$310.19 ,$96.56 ,$310.19 ,$310.19 ,$328.44 ,$222.24 , N/A ,$226.26 , N/A ,$328.44 , N/A ,$335.74 ,$328.44 ,$240.89 ,$240.89 ,$222.24 ,$240.89 ,$237.20 ,$249.32 ,$83.07 ,$288.29 , N/A , N/A , N/A ,$96.56 , N/A , N/A ,$346.68 ,$299.24 ,$299.24 ,$291.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 1.5MM CORTEX SCREWS 50MM,278,1 ,$364.93 ,$240.85 ,$83.07 ,$364.93 , N/A ,$327.05 ,$327.05 ,$96.56 ,$291.94 ,$310.19 ,$228.08 ,$328.44 , N/A , N/A ,$346.68 ,$328.44 ,$310.19 ,$310.19 ,$96.56 ,$310.19 ,$310.19 ,$328.44 ,$222.24 , N/A ,$226.26 , N/A ,$328.44 , N/A ,$335.74 ,$328.44 ,$240.89 ,$240.89 ,$222.24 ,$240.89 ,$237.20 ,$249.32 ,$83.07 ,$288.29 , N/A , N/A , N/A ,$96.56 , N/A , N/A ,$346.68 ,$299.24 ,$299.24 ,$291.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 2.7 QRTR-TUBE  8 HOLE 63MM,278,1 ,$364.93 ,$240.85 ,$83.07 ,$364.93 , N/A ,$327.05 ,$327.05 ,$96.56 ,$291.94 ,$310.19 ,$228.08 ,$328.44 , N/A , N/A ,$346.68 ,$328.44 ,$310.19 ,$310.19 ,$96.56 ,$310.19 ,$310.19 ,$328.44 ,$222.24 , N/A ,$226.26 , N/A ,$328.44 , N/A ,$335.74 ,$328.44 ,$240.89 ,$240.89 ,$222.24 ,$240.89 ,$237.20 ,$249.32 ,$83.07 ,$288.29 , N/A , N/A , N/A ,$96.56 , N/A , N/A ,$346.68 ,$299.24 ,$299.24 ,$291.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 10 HOLE,278,1 ,$364.93 ,$240.85 ,$83.07 ,$364.93 , N/A ,$327.05 ,$327.05 ,$96.56 ,$291.94 ,$310.19 ,$228.08 ,$328.44 , N/A , N/A ,$346.68 ,$328.44 ,$310.19 ,$310.19 ,$96.56 ,$310.19 ,$310.19 ,$328.44 ,$222.24 , N/A ,$226.26 , N/A ,$328.44 , N/A ,$335.74 ,$328.44 ,$240.89 ,$240.89 ,$222.24 ,$240.89 ,$237.20 ,$249.32 ,$83.07 ,$288.29 , N/A , N/A , N/A ,$96.56 , N/A , N/A ,$346.68 ,$299.24 ,$299.24 ,$291.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES ONE-THIRD TUBULAR LCP W/COLLAR 8 HOLE,278,1 ,$364.93 ,$240.85 ,$83.07 ,$364.93 , N/A ,$327.05 ,$327.05 ,$96.56 ,$291.94 ,$310.19 ,$228.08 ,$328.44 , N/A , N/A ,$346.68 ,$328.44 ,$310.19 ,$310.19 ,$96.56 ,$310.19 ,$310.19 ,$328.44 ,$222.24 , N/A ,$226.26 , N/A ,$328.44 , N/A ,$335.74 ,$328.44 ,$240.89 ,$240.89 ,$222.24 ,$240.89 ,$237.20 ,$249.32 ,$83.07 ,$288.29 , N/A , N/A , N/A ,$96.56 , N/A , N/A ,$346.68 ,$299.24 ,$299.24 ,$291.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 4.0 F/CANNULATED SCREWS,278,1 ,"$1,566.20 ","$1,033.69 ",$356.55 ,"$1,566.20 ", N/A ,"$1,403.63 ","$1,403.63 ",$414.41 ,"$1,252.96 ","$1,331.27 ",$978.88 ,"$1,409.58 ", N/A , N/A ,"$1,487.89 ","$1,409.58 ","$1,331.27 ","$1,331.27 ",$414.41 ,"$1,331.27 ","$1,331.27 ","$1,409.58 ",$953.82 , N/A ,$971.04 , N/A ,"$1,409.58 ", N/A ,"$1,440.90 ","$1,409.58 ","$1,033.85 ","$1,033.85 ",$953.82 ,"$1,033.85 ","$1,018.03 ","$1,070.03 ",$356.55 ,"$1,237.30 ", N/A , N/A , N/A ,$414.41 , N/A , N/A ,"$1,487.89 ","$1,284.28 ","$1,284.28 ","$1,252.96 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 4.0MM CANCELLOUS BONE SCREWS/110MM,278,1 ,$428.87 ,$283.05 ,$97.64 ,$428.87 , N/A ,$384.35 ,$384.35 ,$113.47 ,$343.10 ,$364.54 ,$268.04 ,$385.98 , N/A , N/A ,$407.43 ,$385.98 ,$364.54 ,$364.54 ,$113.47 ,$364.54 ,$364.54 ,$385.98 ,$261.18 , N/A ,$265.90 , N/A ,$385.98 , N/A ,$394.56 ,$385.98 ,$283.10 ,$283.10 ,$261.18 ,$283.10 ,$278.77 ,$293.00 ,$97.64 ,$338.81 , N/A , N/A , N/A ,$113.47 , N/A , N/A ,$407.43 ,$351.67 ,$351.67 ,$343.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 2.7MM CORTEX SCREWS 100MM,278,1 ,$428.87 ,$283.05 ,$97.64 ,$428.87 , N/A ,$384.35 ,$384.35 ,$113.47 ,$343.10 ,$364.54 ,$268.04 ,$385.98 , N/A , N/A ,$407.43 ,$385.98 ,$364.54 ,$364.54 ,$113.47 ,$364.54 ,$364.54 ,$385.98 ,$261.18 , N/A ,$265.90 , N/A ,$385.98 , N/A ,$394.56 ,$385.98 ,$283.10 ,$283.10 ,$261.18 ,$283.10 ,$278.77 ,$293.00 ,$97.64 ,$338.81 , N/A , N/A , N/A ,$113.47 , N/A , N/A ,$407.43 ,$351.67 ,$351.67 ,$343.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 3.5MM CORTEX SCREWS GOLD/110MM,278,1 ,$428.87 ,$283.05 ,$97.64 ,$428.87 , N/A ,$384.35 ,$384.35 ,$113.47 ,$343.10 ,$364.54 ,$268.04 ,$385.98 , N/A , N/A ,$407.43 ,$385.98 ,$364.54 ,$364.54 ,$113.47 ,$364.54 ,$364.54 ,$385.98 ,$261.18 , N/A ,$265.90 , N/A ,$385.98 , N/A ,$394.56 ,$385.98 ,$283.10 ,$283.10 ,$261.18 ,$283.10 ,$278.77 ,$293.00 ,$97.64 ,$338.81 , N/A , N/A , N/A ,$113.47 , N/A , N/A ,$407.43 ,$351.67 ,$351.67 ,$343.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 4.5 CANNULATED SCREW 180MM,278,1 ,"$1,703.55 ","$1,124.34 ",$387.83 ,"$1,703.55 ", N/A ,"$1,526.72 ","$1,526.72 ",$450.76 ,"$1,362.84 ","$1,448.02 ","$1,064.72 ","$1,533.20 ", N/A , N/A ,"$1,618.37 ","$1,533.20 ","$1,448.02 ","$1,448.02 ",$450.76 ,"$1,448.02 ","$1,448.02 ","$1,533.20 ","$1,037.46 ", N/A ,"$1,056.20 ", N/A ,"$1,533.20 ", N/A ,"$1,567.27 ","$1,533.20 ","$1,124.51 ","$1,124.51 ","$1,037.46 ","$1,124.51 ","$1,107.31 ","$1,163.87 ",$387.83 ,"$1,345.80 ", N/A , N/A , N/A ,$450.76 , N/A , N/A ,"$1,618.37 ","$1,396.91 ","$1,396.91 ","$1,362.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 4.5MM CORTEX/SHAFT SCREWS 130MM/57MM TAP DEPTH,278,1 ,$435.49 ,$287.42 ,$99.14 ,$435.49 , N/A ,$390.29 ,$390.29 ,$115.23 ,$348.39 ,$370.17 ,$272.18 ,$391.94 , N/A , N/A ,$413.72 ,$391.94 ,$370.17 ,$370.17 ,$115.23 ,$370.17 ,$370.17 ,$391.94 ,$265.21 , N/A ,$270.00 , N/A ,$391.94 , N/A ,$400.65 ,$391.94 ,$287.47 ,$287.47 ,$265.21 ,$287.47 ,$283.07 ,$297.53 ,$99.14 ,$344.04 , N/A , N/A , N/A ,$115.23 , N/A , N/A ,$413.72 ,$357.10 ,$357.10 ,$348.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,TAP SYNTHES 6.5,278,1 ,$909.17 ,$600.05 ,$206.98 ,$909.17 , N/A ,$814.80 ,$814.80 ,$240.57 ,$727.34 ,$772.79 ,$568.23 ,$818.25 , N/A , N/A ,$863.71 ,$818.25 ,$772.79 ,$772.79 ,$240.57 ,$772.79 ,$772.79 ,$818.25 ,$553.68 , N/A ,$563.68 , N/A ,$818.25 , N/A ,$836.44 ,$818.25 ,$600.14 ,$600.14 ,$553.68 ,$600.14 ,$590.96 ,$621.14 ,$206.98 ,$718.24 , N/A , N/A , N/A ,$240.57 , N/A , N/A ,$863.71 ,$745.52 ,$745.52 ,$727.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WASHER SYNTHES 13.0MM,278,1 ,$56.23 ,$37.11 ,$12.80 ,$56.23 , N/A ,$50.39 ,$50.39 ,$14.88 ,$44.98 ,$47.80 ,$35.14 ,$50.61 , N/A , N/A ,$53.42 ,$50.61 ,$47.80 ,$47.80 ,$14.88 ,$47.80 ,$47.80 ,$50.61 ,$34.24 , N/A ,$34.86 , N/A ,$50.61 , N/A ,$51.73 ,$50.61 ,$37.12 ,$37.12 ,$34.24 ,$37.12 ,$36.55 ,$38.42 ,$12.80 ,$44.42 , N/A , N/A , N/A ,$14.88 , N/A , N/A ,$53.42 ,$46.11 ,$46.11 ,$44.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WASHER SYNTHES 7.0MM,278,1 ,$50.72 ,$33.48 ,$11.55 ,$50.72 , N/A ,$45.46 ,$45.46 ,$13.42 ,$40.58 ,$43.11 ,$31.70 ,$45.65 , N/A , N/A ,$48.18 ,$45.65 ,$43.11 ,$43.11 ,$13.42 ,$43.11 ,$43.11 ,$45.65 ,$30.89 , N/A ,$31.44 , N/A ,$45.65 , N/A ,$46.66 ,$45.65 ,$33.48 ,$33.48 ,$30.89 ,$33.48 ,$32.97 ,$34.65 ,$11.55 ,$40.07 , N/A , N/A , N/A ,$13.42 , N/A , N/A ,$48.18 ,$41.59 ,$41.59 ,$40.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE FIXATION 1MM 150MM KIRSCHNER STAINLESS STEEL 2 END TROCAR POINT NONSTERILE,278,1 ,$28.86 ,$19.05 ,$6.58 ,$28.86 , N/A ,$25.86 ,$25.86 ,$7.63 ,$23.09 ,$24.53 ,$18.04 ,$25.97 , N/A , N/A ,$27.42 ,$25.97 ,$24.53 ,$24.53 ,$7.63 ,$24.53 ,$24.53 ,$25.97 ,$17.58 , N/A ,$17.90 , N/A ,$25.97 , N/A ,$26.55 ,$25.97 ,$19.05 ,$19.05 ,$17.58 ,$19.05 ,$18.76 ,$19.72 ,$6.58 ,$22.80 , N/A , N/A , N/A ,$7.63 , N/A , N/A ,$27.42 ,$23.67 ,$23.67 ,$23.09 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 0.8 KIRSCHNER  W/TROCAR POINT 70MM,278,1 ,$15.88 ,$10.48 ,$3.62 ,$15.88 , N/A ,$14.23 ,$14.23 ,$4.20 ,$12.70 ,$13.50 ,$9.93 ,$14.29 , N/A , N/A ,$15.09 ,$14.29 ,$13.50 ,$13.50 ,$4.20 ,$13.50 ,$13.50 ,$14.29 ,$9.67 , N/A ,$9.84 , N/A ,$14.29 , N/A ,$14.61 ,$14.29 ,$10.48 ,$10.48 ,$9.67 ,$10.48 ,$10.32 ,$10.85 ,$3.62 ,$12.55 , N/A , N/A , N/A ,$4.20 , N/A , N/A ,$15.09 ,$13.02 ,$13.02 ,$12.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 0.6 KIRSCHNER,278,1 ,$15.88 ,$10.48 ,$3.62 ,$15.88 , N/A ,$14.23 ,$14.23 ,$4.20 ,$12.70 ,$13.50 ,$9.93 ,$14.29 , N/A , N/A ,$15.09 ,$14.29 ,$13.50 ,$13.50 ,$4.20 ,$13.50 ,$13.50 ,$14.29 ,$9.67 , N/A ,$9.84 , N/A ,$14.29 , N/A ,$14.61 ,$14.29 ,$10.48 ,$10.48 ,$9.67 ,$10.48 ,$10.32 ,$10.85 ,$3.62 ,$12.55 , N/A , N/A , N/A ,$4.20 , N/A , N/A ,$15.09 ,$13.02 ,$13.02 ,$12.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 15MM X 150MM,278,1 ,$98.69 ,$65.14 ,$22.47 ,$98.69 , N/A ,$88.45 ,$88.45 ,$26.12 ,$78.95 ,$83.89 ,$61.68 ,$88.82 , N/A , N/A ,$93.76 ,$88.82 ,$83.89 ,$83.89 ,$26.12 ,$83.89 ,$83.89 ,$88.82 ,$60.10 , N/A ,$61.18 , N/A ,$88.82 , N/A ,$90.79 ,$88.82 ,$65.15 ,$65.15 ,$60.10 ,$65.15 ,$64.15 ,$67.43 ,$22.47 ,$77.97 , N/A , N/A , N/A ,$26.12 , N/A , N/A ,$93.76 ,$80.93 ,$80.93 ,$78.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.6 COMPRESSION 10MM X 150MM,278,1 ,$98.69 ,$65.14 ,$22.47 ,$98.69 , N/A ,$88.45 ,$88.45 ,$26.12 ,$78.95 ,$83.89 ,$61.68 ,$88.82 , N/A , N/A ,$93.76 ,$88.82 ,$83.89 ,$83.89 ,$26.12 ,$83.89 ,$83.89 ,$88.82 ,$60.10 , N/A ,$61.18 , N/A ,$88.82 , N/A ,$90.79 ,$88.82 ,$65.15 ,$65.15 ,$60.10 ,$65.15 ,$64.15 ,$67.43 ,$22.47 ,$77.97 , N/A , N/A , N/A ,$26.12 , N/A , N/A ,$93.76 ,$80.93 ,$80.93 ,$78.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.6 KIRSCHNER W/5MM THREAD TROCAR 150MM,278,1 ,$34.07 ,$22.49 ,$7.76 ,$34.07 , N/A ,$30.53 ,$30.53 ,$9.02 ,$27.26 ,$28.96 ,$21.29 ,$30.66 , N/A , N/A ,$32.37 ,$30.66 ,$28.96 ,$28.96 ,$9.02 ,$28.96 ,$28.96 ,$30.66 ,$20.75 , N/A ,$21.12 , N/A ,$30.66 , N/A ,$31.34 ,$30.66 ,$22.49 ,$22.49 ,$20.75 ,$22.49 ,$22.15 ,$23.28 ,$7.76 ,$26.92 , N/A , N/A , N/A ,$9.02 , N/A , N/A ,$32.37 ,$27.94 ,$27.94 ,$27.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE FIXATION 1.6MM 150MM 15MM KIRSCHNER STAINLESS STEEL TROCAR POINT THREAD NONSTERILE,278,1 ,$34.07 ,$22.49 ,$7.76 ,$34.07 , N/A ,$30.53 ,$30.53 ,$9.02 ,$27.26 ,$28.96 ,$21.29 ,$30.66 , N/A , N/A ,$32.37 ,$30.66 ,$28.96 ,$28.96 ,$9.02 ,$28.96 ,$28.96 ,$30.66 ,$20.75 , N/A ,$21.12 , N/A ,$30.66 , N/A ,$31.34 ,$30.66 ,$22.49 ,$22.49 ,$20.75 ,$22.49 ,$22.15 ,$23.28 ,$7.76 ,$26.92 , N/A , N/A , N/A ,$9.02 , N/A , N/A ,$32.37 ,$27.94 ,$27.94 ,$27.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.6 KIRSCHNER W/TROCAR 150MM,278,1 ,$21.61 ,$14.26 ,$4.92 ,$21.61 , N/A ,$19.37 ,$19.37 ,$5.71 ,$17.29 ,$18.37 ,$13.51 ,$19.45 , N/A , N/A ,$20.53 ,$19.45 ,$18.37 ,$18.37 ,$5.71 ,$18.37 ,$18.37 ,$19.45 ,$13.16 , N/A ,$13.40 , N/A ,$19.45 , N/A ,$19.88 ,$19.45 ,$14.26 ,$14.26 ,$13.16 ,$14.26 ,$14.05 ,$14.76 ,$4.92 ,$17.07 , N/A , N/A , N/A ,$5.71 , N/A , N/A ,$20.53 ,$17.72 ,$17.72 ,$17.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE FIXATION 2MM 150MM KIRSCHNER STAINLESS STEEL 2 END TROCAR POINT NONSTERILE,278,1 ,$21.61 ,$14.26 ,$4.92 ,$21.61 , N/A ,$19.37 ,$19.37 ,$5.71 ,$17.29 ,$18.37 ,$13.51 ,$19.45 , N/A , N/A ,$20.53 ,$19.45 ,$18.37 ,$18.37 ,$5.71 ,$18.37 ,$18.37 ,$19.45 ,$13.16 , N/A ,$13.40 , N/A ,$19.45 , N/A ,$19.88 ,$19.45 ,$14.26 ,$14.26 ,$13.16 ,$14.26 ,$14.05 ,$14.76 ,$4.92 ,$17.07 , N/A , N/A , N/A ,$5.71 , N/A , N/A ,$20.53 ,$17.72 ,$17.72 ,$17.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE KIRSCHNER 1.25MM 150MM 2 END TROCAR POINT,278,1 ,$21.61 ,$14.26 ,$4.92 ,$21.61 , N/A ,$19.37 ,$19.37 ,$5.71 ,$17.29 ,$18.37 ,$13.51 ,$19.45 , N/A , N/A ,$20.53 ,$19.45 ,$18.37 ,$18.37 ,$5.71 ,$18.37 ,$18.37 ,$19.45 ,$13.16 , N/A ,$13.40 , N/A ,$19.45 , N/A ,$19.88 ,$19.45 ,$14.26 ,$14.26 ,$13.16 ,$14.26 ,$14.05 ,$14.76 ,$4.92 ,$17.07 , N/A , N/A , N/A ,$5.71 , N/A , N/A ,$20.53 ,$17.72 ,$17.72 ,$17.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.6MM KIRSCHNER 150MM W/TROCAR POINT,278,1 ,$18.30 ,$12.08 ,$4.16 ,$18.30 , N/A ,$16.40 ,$16.40 ,$4.84 ,$14.64 ,$15.56 ,$11.44 ,$16.47 , N/A , N/A ,$17.39 ,$16.47 ,$15.56 ,$15.56 ,$4.84 ,$15.56 ,$15.56 ,$16.47 ,$11.14 , N/A ,$11.34 , N/A ,$16.47 , N/A ,$16.84 ,$16.47 ,$12.08 ,$12.08 ,$11.14 ,$12.08 ,$11.90 ,$12.50 ,$4.16 ,$14.46 , N/A , N/A , N/A ,$4.84 , N/A , N/A ,$17.39 ,$15.01 ,$15.01 ,$14.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.25MM KIRSCHNER  W/TROCAR POINT 150MM,278,1 ,$18.30 ,$12.08 ,$4.16 ,$18.30 , N/A ,$16.40 ,$16.40 ,$4.84 ,$14.64 ,$15.56 ,$11.44 ,$16.47 , N/A , N/A ,$17.39 ,$16.47 ,$15.56 ,$15.56 ,$4.84 ,$15.56 ,$15.56 ,$16.47 ,$11.14 , N/A ,$11.34 , N/A ,$16.47 , N/A ,$16.84 ,$16.47 ,$12.08 ,$12.08 ,$11.14 ,$12.08 ,$11.90 ,$12.50 ,$4.16 ,$14.46 , N/A , N/A , N/A ,$4.84 , N/A , N/A ,$17.39 ,$15.01 ,$15.01 ,$14.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 2.0 KIRSCHNER,278,1 ,$24.47 ,$16.15 ,$5.58 ,$24.47 , N/A ,$21.93 ,$21.93 ,$6.48 ,$19.58 ,$20.80 ,$15.29 ,$22.02 , N/A , N/A ,$23.25 ,$22.02 ,$20.80 ,$20.80 ,$6.48 ,$20.80 ,$20.80 ,$22.02 ,$14.90 , N/A ,$15.18 , N/A ,$22.02 , N/A ,$22.51 ,$22.02 ,$16.15 ,$16.15 ,$14.90 ,$16.15 ,$15.91 ,$16.72 ,$5.58 ,$19.33 , N/A , N/A , N/A ,$6.48 , N/A , N/A ,$23.25 ,$20.07 ,$20.07 ,$19.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,WIRE SYNTHES 1.0MM KIRSCHNER  W/TROCAR POINT 150MM,278,1 ,$24.47 ,$16.15 ,$5.58 ,$24.47 , N/A ,$21.93 ,$21.93 ,$6.48 ,$19.58 ,$20.80 ,$15.29 ,$22.02 , N/A , N/A ,$23.25 ,$22.02 ,$20.80 ,$20.80 ,$6.48 ,$20.80 ,$20.80 ,$22.02 ,$14.90 , N/A ,$15.18 , N/A ,$22.02 , N/A ,$22.51 ,$22.02 ,$16.15 ,$16.15 ,$14.90 ,$16.15 ,$15.91 ,$16.72 ,$5.58 ,$19.33 , N/A , N/A , N/A ,$6.48 , N/A , N/A ,$23.25 ,$20.07 ,$20.07 ,$19.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,ZPLATE SYNTHES 3.5 LCP MEDIAL DISTAL TIBIA W/O TAB 8H LEFT,278,1 ,"$2,409.49 ","$1,590.26 ",$548.53 ,"$2,409.49 ", N/A ,"$2,159.38 ","$2,159.38 ",$637.55 ,"$1,927.59 ","$2,048.07 ","$1,505.93 ","$2,168.54 ", N/A , N/A ,"$2,289.02 ","$2,168.54 ","$2,048.07 ","$2,048.07 ",$637.55 ,"$2,048.07 ","$2,048.07 ","$2,168.54 ","$1,467.38 ", N/A ,"$1,493.88 ", N/A ,"$2,168.54 ", N/A ,"$2,216.73 ","$2,168.54 ","$1,590.50 ","$1,590.50 ","$1,467.38 ","$1,590.50 ","$1,566.17 ","$1,646.16 ",$548.53 ,"$1,903.50 ", N/A , N/A , N/A ,$637.55 , N/A , N/A ,"$2,289.02 ","$1,975.78 ","$1,975.78 ","$1,927.59 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871713,C1713,PLATE SYNTHES 3.5 LCP MEDIAL DISTAL TIBIA W/O TAB 8H RIGHT,278,1 ,"$2,409.49 ","$1,590.26 ",$548.53 ,"$2,409.49 ", N/A ,"$2,159.38 ","$2,159.38 ",$637.55 ,"$1,927.59 ","$2,048.07 ","$1,505.93 ","$2,168.54 ", N/A , N/A ,"$2,289.02 ","$2,168.54 ","$2,048.07 ","$2,048.07 ",$637.55 ,"$2,048.07 ","$2,048.07 ","$2,168.54 ","$1,467.38 ", N/A ,"$1,493.88 ", N/A ,"$2,168.54 ", N/A ,"$2,216.73 ","$2,168.54 ","$1,590.50 ","$1,590.50 ","$1,467.38 ","$1,590.50 ","$1,566.17 ","$1,646.16 ",$548.53 ,"$1,903.50 ", N/A , N/A , N/A ,$637.55 , N/A , N/A ,"$2,289.02 ","$1,975.78 ","$1,975.78 ","$1,927.59 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871762,C1762,GRAFT SOFT TISSUE 35X35MM MATRACELL ARTHROFLEX THK2MM DERMIS DECELLULARIZE STERILE,278,1 ,"$4,672.08 ","$3,083.57 ","$1,063.62 ","$4,672.08 ", N/A ,"$4,187.12 ","$4,187.12 ","$1,236.23 ","$3,737.66 ","$3,971.27 ","$2,920.05 ","$4,204.87 ", N/A , N/A ,"$4,438.48 ","$4,204.87 ","$3,971.27 ","$3,971.27 ","$1,236.23 ","$3,971.27 ","$3,971.27 ","$4,204.87 ","$2,845.30 ", N/A ,"$2,896.68 ", N/A ,"$4,204.87 ", N/A ,"$4,298.31 ","$4,204.87 ","$3,084.04 ","$3,084.04 ","$2,845.30 ","$3,084.04 ","$3,036.85 ","$3,191.97 ","$1,063.62 ","$3,690.94 ", N/A , N/A , N/A ,"$1,236.23 ", N/A , N/A ,"$4,438.48 ","$3,831.11 ","$3,831.11 ","$3,737.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871768,C1768,GRAFT GORTEX 6 X 50CM,278,1 ,"$1,320.20 ",$871.33 ,$300.56 ,"$1,320.20 ", N/A ,"$1,183.16 ","$1,183.16 ",$349.32 ,"$1,056.16 ","$1,122.17 ",$825.13 ,"$1,188.18 ", N/A , N/A ,"$1,254.19 ","$1,188.18 ","$1,122.17 ","$1,122.17 ",$349.32 ,"$1,122.17 ","$1,122.17 ","$1,188.18 ",$804.00 , N/A ,$818.52 , N/A ,"$1,188.18 ", N/A ,"$1,214.58 ","$1,188.18 ",$871.46 ,$871.46 ,$804.00 ,$871.46 ,$858.13 ,$901.96 ,$300.56 ,"$1,042.96 ", N/A , N/A , N/A ,$349.32 , N/A , N/A ,"$1,254.19 ","$1,082.56 ","$1,082.56 ","$1,056.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871772,C1772,PUMP PAIN ON-Q 400ML,278,1 ,$438.75 ,$289.58 ,$99.88 ,$438.75 , N/A ,$393.21 ,$393.21 ,$116.09 ,$351.00 ,$372.94 ,$274.22 ,$394.88 , N/A , N/A ,$416.81 ,$394.88 ,$372.94 ,$372.94 ,$116.09 ,$372.94 ,$372.94 ,$394.88 ,$267.20 , N/A ,$272.02 , N/A ,$394.88 , N/A ,$403.65 ,$394.88 ,$289.62 ,$289.62 ,$267.20 ,$289.62 ,$285.19 ,$299.75 ,$99.88 ,$346.61 , N/A , N/A , N/A ,$116.09 , N/A , N/A ,$416.81 ,$359.78 ,$359.78 ,$351.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871776,C1776,COMPONENT PTLR 38MM MEDIALIZE DOME ATTUNE KN,278,1 ,"$1,025.00 ",$676.50 ,$233.35 ,"$1,025.00 ", N/A ,$918.61 ,$918.61 ,$271.21 ,$820.00 ,$871.25 ,$640.63 ,$922.50 , N/A , N/A ,$973.75 ,$922.50 ,$871.25 ,$871.25 ,$271.21 ,$871.25 ,$871.25 ,$922.50 ,$624.23 , N/A ,$635.50 , N/A ,$922.50 , N/A ,$943.00 ,$922.50 ,$676.60 ,$676.60 ,$624.23 ,$676.60 ,$666.25 ,$700.28 ,$233.35 ,$809.75 , N/A , N/A , N/A ,$271.21 , N/A , N/A ,$973.75 ,$840.50 ,$840.50 ,$820.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871776,C1776,STEINMANN PIN SYNTHES WITH CENTRAL THREAD 5.0MM X 200MM,278,1 ,$292.50 ,$193.05 ,$66.59 ,$292.50 , N/A ,$262.14 ,$262.14 ,$77.40 ,$234.00 ,$248.63 ,$182.81 ,$263.25 , N/A , N/A ,$277.88 ,$263.25 ,$248.63 ,$248.63 ,$77.40 ,$248.63 ,$248.63 ,$263.25 ,$178.13 , N/A ,$181.36 , N/A ,$263.25 , N/A ,$269.10 ,$263.25 ,$193.08 ,$193.08 ,$178.13 ,$193.08 ,$190.13 ,$199.84 ,$66.59 ,$231.08 , N/A , N/A , N/A ,$77.40 , N/A , N/A ,$277.88 ,$239.85 ,$239.85 ,$234.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH 3DMAX RIGHT MID MEDIUM 8CMX13CM INGUINAL,278,1 ,$496.44 ,$327.65 ,$113.01 ,$496.44 , N/A ,$444.91 ,$444.91 ,$131.36 ,$397.15 ,$421.97 ,$310.28 ,$446.80 , N/A , N/A ,$471.62 ,$446.80 ,$421.97 ,$421.97 ,$131.36 ,$421.97 ,$421.97 ,$446.80 ,$302.33 , N/A ,$307.80 , N/A ,$446.80 , N/A ,$456.72 ,$446.80 ,$327.70 ,$327.70 ,$302.33 ,$327.70 ,$322.69 ,$339.17 ,$113.01 ,$392.19 , N/A , N/A , N/A ,$131.36 , N/A , N/A ,$471.62 ,$407.08 ,$407.08 ,$397.15 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH 3DMAX LEFT MID MEDIUM 8CMX13CM INGUINAL,278,1 ,$496.44 ,$327.65 ,$113.01 ,$496.44 , N/A ,$444.91 ,$444.91 ,$131.36 ,$397.15 ,$421.97 ,$310.28 ,$446.80 , N/A , N/A ,$471.62 ,$446.80 ,$421.97 ,$421.97 ,$131.36 ,$421.97 ,$421.97 ,$446.80 ,$302.33 , N/A ,$307.80 , N/A ,$446.80 , N/A ,$456.72 ,$446.80 ,$327.70 ,$327.70 ,$302.33 ,$327.70 ,$322.69 ,$339.17 ,$113.01 ,$392.19 , N/A , N/A , N/A ,$131.36 , N/A , N/A ,$471.62 ,$407.08 ,$407.08 ,$397.15 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 10 X 14 011266,278,1 ,$382.50 ,$252.45 ,$87.08 ,$382.50 , N/A ,$342.80 ,$342.80 ,$101.21 ,$306.00 ,$325.13 ,$239.06 ,$344.25 , N/A , N/A ,$363.38 ,$344.25 ,$325.13 ,$325.13 ,$101.21 ,$325.13 ,$325.13 ,$344.25 ,$232.94 , N/A ,$237.16 , N/A ,$344.25 , N/A ,$351.90 ,$344.25 ,$252.49 ,$252.49 ,$232.94 ,$252.49 ,$248.63 ,$261.32 ,$87.08 ,$302.18 , N/A , N/A , N/A ,$101.21 , N/A , N/A ,$363.38 ,$313.65 ,$313.65 ,$306.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 3D MAX INGUINAL 16CM X 10CM RIGHT,278,1 ,$526.32 ,$347.37 ,$119.81 ,$526.32 , N/A ,$471.69 ,$471.69 ,$139.27 ,$421.06 ,$447.37 ,$328.95 ,$473.69 , N/A , N/A ,$500.00 ,$473.69 ,$447.37 ,$447.37 ,$139.27 ,$447.37 ,$447.37 ,$473.69 ,$320.53 , N/A ,$326.32 , N/A ,$473.69 , N/A ,$484.21 ,$473.69 ,$347.42 ,$347.42 ,$320.53 ,$347.42 ,$342.11 ,$359.58 ,$119.81 ,$415.79 , N/A , N/A , N/A ,$139.27 , N/A , N/A ,$500.00 ,$431.58 ,$431.58 ,$421.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 3D MAX INGUINAL 16CM X 10CM LEFT,278,1 ,$526.32 ,$347.37 ,$119.81 ,$526.32 , N/A ,$471.69 ,$471.69 ,$139.27 ,$421.06 ,$447.37 ,$328.95 ,$473.69 , N/A , N/A ,$500.00 ,$473.69 ,$447.37 ,$447.37 ,$139.27 ,$447.37 ,$447.37 ,$473.69 ,$320.53 , N/A ,$326.32 , N/A ,$473.69 , N/A ,$484.21 ,$473.69 ,$347.42 ,$347.42 ,$320.53 ,$347.42 ,$342.11 ,$359.58 ,$119.81 ,$415.79 , N/A , N/A , N/A ,$139.27 , N/A , N/A ,$500.00 ,$431.58 ,$431.58 ,$421.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 3D MAX LARGE RIGHT 0117321,278,1 ,$487.41 ,$321.69 ,$110.96 ,$487.41 , N/A ,$436.82 ,$436.82 ,$128.97 ,$389.93 ,$414.30 ,$304.63 ,$438.67 , N/A , N/A ,$463.04 ,$438.67 ,$414.30 ,$414.30 ,$128.97 ,$414.30 ,$414.30 ,$438.67 ,$296.83 , N/A ,$302.20 , N/A ,$438.67 , N/A ,$448.42 ,$438.67 ,$321.74 ,$321.74 ,$296.83 ,$321.74 ,$316.82 ,$333.00 ,$110.96 ,$385.05 , N/A , N/A , N/A ,$128.97 , N/A , N/A ,$463.04 ,$399.68 ,$399.68 ,$389.93 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 3D MAX LARGE LEFT 0117311,278,1 ,$487.41 ,$321.69 ,$110.96 ,$487.41 , N/A ,$436.82 ,$436.82 ,$128.97 ,$389.93 ,$414.30 ,$304.63 ,$438.67 , N/A , N/A ,$463.04 ,$438.67 ,$414.30 ,$414.30 ,$128.97 ,$414.30 ,$414.30 ,$438.67 ,$296.83 , N/A ,$302.20 , N/A ,$438.67 , N/A ,$448.42 ,$438.67 ,$321.74 ,$321.74 ,$296.83 ,$321.74 ,$316.82 ,$333.00 ,$110.96 ,$385.05 , N/A , N/A , N/A ,$128.97 , N/A , N/A ,$463.04 ,$399.68 ,$399.68 ,$389.93 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 3D MAX MEDIUM RIGHT 3.1 X 5.3 0117320,278,1 ,$459.89 ,$303.53 ,$104.69 ,$459.89 , N/A ,$412.15 ,$412.15 ,$121.69 ,$367.91 ,$390.91 ,$287.43 ,$413.90 , N/A , N/A ,$436.90 ,$413.90 ,$390.91 ,$390.91 ,$121.69 ,$390.91 ,$390.91 ,$413.90 ,$280.07 , N/A ,$285.14 , N/A ,$413.90 , N/A ,$423.10 ,$413.90 ,$303.57 ,$303.57 ,$280.07 ,$303.57 ,$298.93 ,$314.20 ,$104.69 ,$363.31 , N/A , N/A , N/A ,$121.69 , N/A , N/A ,$436.90 ,$377.11 ,$377.11 ,$367.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD 3D MAX MEDIUM LEFT 3.1 X 5.3 0117310,278,1 ,$459.89 ,$303.53 ,$104.69 ,$459.89 , N/A ,$412.15 ,$412.15 ,$121.69 ,$367.91 ,$390.91 ,$287.43 ,$413.90 , N/A , N/A ,$436.90 ,$413.90 ,$390.91 ,$390.91 ,$121.69 ,$390.91 ,$390.91 ,$413.90 ,$280.07 , N/A ,$285.14 , N/A ,$413.90 , N/A ,$423.10 ,$413.90 ,$303.57 ,$303.57 ,$280.07 ,$303.57 ,$298.93 ,$314.20 ,$104.69 ,$363.31 , N/A , N/A , N/A ,$121.69 , N/A , N/A ,$436.90 ,$377.11 ,$377.11 ,$367.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH BARD MARLEX 2 X 4 0112650,278,1 ,$90.90 ,$59.99 ,$20.70 ,$90.90 , N/A ,$81.46 ,$81.46 ,$24.05 ,$72.72 ,$77.27 ,$56.81 ,$81.81 , N/A , N/A ,$86.36 ,$81.81 ,$77.27 ,$77.27 ,$24.05 ,$77.27 ,$77.27 ,$81.81 ,$55.36 , N/A ,$56.36 , N/A ,$81.81 , N/A ,$83.63 ,$81.81 ,$60.00 ,$60.00 ,$55.36 ,$60.00 ,$59.09 ,$62.10 ,$20.70 ,$71.81 , N/A , N/A , N/A ,$24.05 , N/A , N/A ,$86.36 ,$74.54 ,$74.54 ,$72.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH PARIETEX POLYESTER 6X6 TET1515,278,1 ,$318.24 ,$210.04 ,$72.45 ,$318.24 , N/A ,$285.21 ,$285.21 ,$84.20 ,$254.59 ,$270.50 ,$198.90 ,$286.42 , N/A , N/A ,$302.33 ,$286.42 ,$270.50 ,$270.50 ,$84.20 ,$270.50 ,$270.50 ,$286.42 ,$193.81 , N/A ,$197.30 , N/A ,$286.42 , N/A ,$292.78 ,$286.42 ,$210.07 ,$210.07 ,$193.81 ,$210.07 ,$206.86 ,$217.42 ,$72.45 ,$251.41 , N/A , N/A , N/A ,$84.20 , N/A , N/A ,$302.33 ,$260.96 ,$260.96 ,$254.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH SURGICAL GORE BIO-A TISSUE REINFORCEMENT 10X7CM TISSUE REINFORCEMENT SYNTHETIC HIATAL HERNIA REPAIR,278,1 ,"$1,117.25 ",$737.39 ,$254.35 ,"$1,117.25 ", N/A ,"$1,001.28 ","$1,001.28 ",$295.63 ,$893.80 ,$949.66 ,$698.28 ,"$1,005.53 ", N/A , N/A ,"$1,061.39 ","$1,005.53 ",$949.66 ,$949.66 ,$295.63 ,$949.66 ,$949.66 ,"$1,005.53 ",$680.41 , N/A ,$692.70 , N/A ,"$1,005.53 ", N/A ,"$1,027.87 ","$1,005.53 ",$737.50 ,$737.50 ,$680.41 ,$737.50 ,$726.21 ,$763.31 ,$254.35 ,$882.63 , N/A , N/A , N/A ,$295.63 , N/A , N/A ,"$1,061.39 ",$916.15 ,$916.15 ,$893.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH SURGICAL PROLENE 6X3IN CUSTOMIZABLE KNIT NONABSORBABLE MONOFILAMENT STERILE POLYPROPYLENE FLAT RECTANGLE LATEX FREE HERNIA REPAIR,278,1 ,$147.92 ,$97.63 ,$33.67 ,$147.92 , N/A ,$132.57 ,$132.57 ,$39.14 ,$118.34 ,$125.73 ,$92.45 ,$133.13 , N/A , N/A ,$140.52 ,$133.13 ,$125.73 ,$125.73 ,$39.14 ,$125.73 ,$125.73 ,$133.13 ,$90.08 , N/A ,$91.72 , N/A ,$133.13 , N/A ,$136.09 ,$133.13 ,$97.64 ,$97.64 ,$90.08 ,$97.64 ,$96.15 ,$101.06 ,$33.67 ,$116.86 , N/A , N/A , N/A ,$39.14 , N/A , N/A ,$140.52 ,$121.29 ,$121.29 ,$118.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH VENTRALEX LARGE 5950009,278,1 ,"$1,292.32 ",$852.93 ,$294.20 ,"$1,292.32 ", N/A ,"$1,158.18 ","$1,158.18 ",$341.95 ,"$1,033.86 ","$1,098.47 ",$807.70 ,"$1,163.09 ", N/A , N/A ,"$1,227.70 ","$1,163.09 ","$1,098.47 ","$1,098.47 ",$341.95 ,"$1,098.47 ","$1,098.47 ","$1,163.09 ",$787.02 , N/A ,$801.24 , N/A ,"$1,163.09 ", N/A ,"$1,188.93 ","$1,163.09 ",$853.06 ,$853.06 ,$787.02 ,$853.06 ,$840.01 ,$882.91 ,$294.20 ,"$1,020.93 ", N/A , N/A , N/A ,$341.95 , N/A , N/A ,"$1,227.70 ","$1,059.70 ","$1,059.70 ","$1,033.86 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH VENTRALIGHT 4 X 6 5954460,278,1 ,$801.09 ,$528.72 ,$182.37 ,$801.09 , N/A ,$717.94 ,$717.94 ,$211.96 ,$640.87 ,$680.93 ,$500.68 ,$720.98 , N/A , N/A ,$761.04 ,$720.98 ,$680.93 ,$680.93 ,$211.96 ,$680.93 ,$680.93 ,$720.98 ,$487.86 , N/A ,$496.68 , N/A ,$720.98 , N/A ,$737.00 ,$720.98 ,$528.80 ,$528.80 ,$487.86 ,$528.80 ,$520.71 ,$547.30 ,$182.37 ,$632.86 , N/A , N/A , N/A ,$211.96 , N/A , N/A ,$761.04 ,$656.89 ,$656.89 ,$640.87 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH VENTRALIGHT 6 X 8 5954680,278,1 ,"$1,517.00 ","$1,001.22 ",$345.35 ,"$1,517.00 ", N/A ,"$1,359.54 ","$1,359.54 ",$401.40 ,"$1,213.60 ","$1,289.45 ",$948.13 ,"$1,365.30 ", N/A , N/A ,"$1,441.15 ","$1,365.30 ","$1,289.45 ","$1,289.45 ",$401.40 ,"$1,289.45 ","$1,289.45 ","$1,365.30 ",$923.85 , N/A ,$940.54 , N/A ,"$1,365.30 ", N/A ,"$1,395.64 ","$1,365.30 ","$1,001.37 ","$1,001.37 ",$923.85 ,"$1,001.37 ",$986.05 ,"$1,036.41 ",$345.35 ,"$1,198.43 ", N/A , N/A , N/A ,$401.40 , N/A , N/A ,"$1,441.15 ","$1,243.94 ","$1,243.94 ","$1,213.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH VENTRALIGHT ST ECHO ELLIPTICAL 6X4IN,278,1 ,"$1,087.32 ",$717.63 ,$247.53 ,"$1,087.32 ", N/A ,$974.46 ,$974.46 ,$287.71 ,$869.86 ,$924.22 ,$679.58 ,$978.59 , N/A , N/A ,"$1,032.95 ",$978.59 ,$924.22 ,$924.22 ,$287.71 ,$924.22 ,$924.22 ,$978.59 ,$662.18 , N/A ,$674.14 , N/A ,$978.59 , N/A ,"$1,000.33 ",$978.59 ,$717.74 ,$717.74 ,$662.18 ,$717.74 ,$706.76 ,$742.86 ,$247.53 ,$858.98 , N/A , N/A , N/A ,$287.71 , N/A , N/A ,"$1,032.95 ",$891.60 ,$891.60 ,$869.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH VENTRALIGHT ST ECHO OVAL 6 X 8 5955680,278,1 ,"$2,104.44 ","$1,388.93 ",$479.08 ,"$2,104.44 ", N/A ,"$1,886.00 ","$1,886.00 ",$556.84 ,"$1,683.55 ","$1,788.77 ","$1,315.28 ","$1,894.00 ", N/A , N/A ,"$1,999.22 ","$1,894.00 ","$1,788.77 ","$1,788.77 ",$556.84 ,"$1,788.77 ","$1,788.77 ","$1,894.00 ","$1,281.60 ", N/A ,"$1,304.76 ", N/A ,"$1,894.00 ", N/A ,"$1,936.08 ","$1,894.00 ","$1,389.14 ","$1,389.14 ","$1,281.60 ","$1,389.14 ","$1,367.89 ","$1,437.75 ",$479.08 ,"$1,662.51 ", N/A , N/A , N/A ,$556.84 , N/A , N/A ,"$1,999.22 ","$1,725.64 ","$1,725.64 ","$1,683.55 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871781,C1781,MESH VENTRALIGHT ST ECHO OVAL 8X10IN,278,1 ,"$3,388.84 ","$2,236.63 ",$771.48 ,"$3,388.84 ", N/A ,"$3,037.08 ","$3,037.08 ",$896.69 ,"$2,711.07 ","$2,880.51 ","$2,118.03 ","$3,049.96 ", N/A , N/A ,"$3,219.40 ","$3,049.96 ","$2,880.51 ","$2,880.51 ",$896.69 ,"$2,880.51 ","$2,880.51 ","$3,049.96 ","$2,063.80 ", N/A ,"$2,101.08 ", N/A ,"$3,049.96 ", N/A ,"$3,117.73 ","$3,049.96 ","$2,236.97 ","$2,236.97 ","$2,063.80 ","$2,236.97 ","$2,202.75 ","$2,315.26 ",$771.48 ,"$2,677.18 ", N/A , N/A , N/A ,$896.69 , N/A , N/A ,"$3,219.40 ","$2,778.85 ","$2,778.85 ","$2,711.07 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27871788,C1788,CATHETER POWER PORT MRI IMPLANTED 8FR,278,1 ,$537.50 ,$354.75 ,$122.37 ,$537.50 , N/A ,$481.71 ,$481.71 ,$142.23 ,$430.00 ,$456.88 ,$335.94 ,$483.75 , N/A , N/A ,$510.63 ,$483.75 ,$456.88 ,$456.88 ,$142.23 ,$456.88 ,$456.88 ,$483.75 ,$327.34 , N/A ,$333.26 , N/A ,$483.75 , N/A ,$494.50 ,$483.75 ,$354.80 ,$354.80 ,$327.34 ,$354.80 ,$349.38 ,$367.22 ,$122.37 ,$424.63 , N/A , N/A , N/A ,$142.23 , N/A , N/A ,$510.63 ,$440.75 ,$440.75 ,$430.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27871788,C1788,POWERPORT CLEARVUE AIRGUARD 8FR,278,1 ,$688.00 ,$454.08 ,$156.62 ,$688.00 , N/A ,$616.59 ,$616.59 ,$182.04 ,$550.40 ,$584.80 ,$430.00 ,$619.20 , N/A , N/A ,$653.60 ,$619.20 ,$584.80 ,$584.80 ,$182.04 ,$584.80 ,$584.80 ,$619.20 ,$418.99 , N/A ,$426.56 , N/A ,$619.20 , N/A ,$632.96 ,$619.20 ,$454.15 ,$454.15 ,$418.99 ,$454.15 ,$447.20 ,$470.04 ,$156.62 ,$543.52 , N/A , N/A , N/A ,$182.04 , N/A , N/A ,$653.60 ,$564.16 ,$564.16 ,$550.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),27872625,C2625,HC STENT NON-CORONARY TEMPORARY WITH DELIVERY SYSTEM(PROPEL),278,1 ,"$1,853.00 ","$1,222.98 ",$421.84 ,"$1,853.00 ", N/A ,"$1,660.66 ","$1,660.66 ",$490.30 ,"$1,482.40 ","$1,575.05 ","$1,158.13 ","$1,667.70 ", N/A , N/A ,"$1,760.35 ","$1,667.70 ","$1,575.05 ","$1,575.05 ",$490.30 ,"$1,575.05 ","$1,575.05 ","$1,667.70 ","$1,128.48 ", N/A ,"$1,148.86 ", N/A ,"$1,667.70 ", N/A ,"$1,704.76 ","$1,667.70 ","$1,223.17 ","$1,223.17 ","$1,128.48 ","$1,223.17 ","$1,204.45 ","$1,265.97 ",$421.84 ,"$1,463.87 ", N/A , N/A , N/A ,$490.30 , N/A , N/A ,"$1,760.35 ","$1,519.46 ","$1,519.46 ","$1,482.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27874104,Q4104,MESH INTEGRA BOVINE COLLAGEN 2 X 2IN,636,1 ,"$6,303.35 ","$4,160.21 ",$71.45 ,"$6,303.35 ", N/A ,$107.17 ,$71.45 ,"$1,667.86 ","$5,042.68 ","$5,357.85 ","$3,939.59 ","$5,673.02 ", N/A , N/A ,"$5,988.18 ","$5,673.02 ","$5,357.85 ","$5,357.85 ","$1,667.86 ","$5,357.85 ","$5,357.85 ","$5,673.02 ","$3,838.74 ", N/A ,"$3,908.08 ", N/A ,"$5,673.02 ", N/A ,"$5,799.08 ","$5,673.02 ","$4,160.84 ","$4,160.84 ","$3,838.74 ","$4,160.84 ","$4,097.18 ","$4,306.45 ","$1,434.98 ","$4,979.65 ", N/A ,"$3,088.64 ","$3,088.64 ","$1,667.86 ","$3,088.64 ", N/A ,"$5,988.18 ","$5,168.75 ","$5,168.75 ","$5,042.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27874112,Q4112,MATRIX TISSUE 3X6CM AMNION CORD,278,1 ,"$7,326.00 ","$4,835.16 ","$1,667.79 ","$7,326.00 ", N/A ,"$6,565.56 ","$6,565.56 ","$1,938.46 ","$5,860.80 ","$6,227.10 ","$4,578.75 ","$6,593.40 ", N/A , N/A ,"$6,959.70 ","$6,593.40 ","$6,227.10 ","$6,227.10 ","$1,938.46 ","$6,227.10 ","$6,227.10 ","$6,593.40 ","$4,461.53 ", N/A ,"$4,542.12 ", N/A ,"$6,593.40 ", N/A ,"$6,739.92 ","$6,593.40 ","$4,835.89 ","$4,835.89 ","$4,461.53 ","$4,835.89 ","$4,761.90 ","$5,005.12 ","$1,667.79 ","$5,787.54 ", N/A ,"$3,589.74 ","$3,589.74 ","$1,938.46 ","$3,589.74 ", N/A ,"$6,959.70 ","$6,007.32 ","$6,007.32 ","$5,860.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27878699,L8699,HC PROSTHETIC IMPLANTS NOS,278,1 ,"$1,946.44 ","$1,284.65 ",$443.12 ,"$1,946.44 ", N/A ,"$1,744.40 ","$1,744.40 ",$515.03 ,"$1,557.15 ","$1,654.47 ","$1,216.53 ","$1,751.80 ", N/A , N/A ,"$1,849.12 ","$1,751.80 ","$1,654.47 ","$1,654.47 ",$515.03 ,"$1,654.47 ","$1,654.47 ","$1,751.80 ","$1,185.38 ", N/A ,"$1,206.80 ", N/A ,"$1,751.80 ", N/A ,"$1,790.72 ","$1,751.80 ","$1,284.85 ","$1,284.85 ","$1,185.38 ","$1,284.85 ","$1,265.19 ","$1,329.81 ",$443.12 ,"$1,537.69 ", N/A , N/A , N/A ,$515.03 , N/A , N/A ,"$1,849.12 ","$1,596.08 ","$1,596.08 ","$1,557.15 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27878699,L8699,UROLIFT,278,1 ,"$1,896.25 ","$1,251.53 ",$431.69 ,"$1,896.25 ", N/A ,"$1,699.42 ","$1,699.42 ",$501.75 ,"$1,517.00 ","$1,611.81 ","$1,185.16 ","$1,706.63 ", N/A , N/A ,"$1,801.44 ","$1,706.63 ","$1,611.81 ","$1,611.81 ",$501.75 ,"$1,611.81 ","$1,611.81 ","$1,706.63 ","$1,154.82 ", N/A ,"$1,175.68 ", N/A ,"$1,706.63 ", N/A ,"$1,744.55 ","$1,706.63 ","$1,251.71 ","$1,251.71 ","$1,154.82 ","$1,251.71 ","$1,232.56 ","$1,295.52 ",$431.69 ,"$1,498.04 ", N/A , N/A , N/A ,$501.75 , N/A , N/A ,"$1,801.44 ","$1,554.93 ","$1,554.93 ","$1,517.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880000,C1713,HC ANCHOR SUTURE FTPRNT 4.5/5.5,278,1 ,"$1,067.00 ",$704.22 ,$242.90 ,"$1,067.00 ", N/A ,$956.25 ,$956.25 ,$282.33 ,$853.60 ,$906.95 ,$666.88 ,$960.30 , N/A , N/A ,"$1,013.65 ",$960.30 ,$906.95 ,$906.95 ,$282.33 ,$906.95 ,$906.95 ,$960.30 ,$649.80 , N/A ,$661.54 , N/A ,$960.30 , N/A ,$981.64 ,$960.30 ,$704.33 ,$704.33 ,$649.80 ,$704.33 ,$693.55 ,$728.97 ,$242.90 ,$842.93 , N/A , N/A , N/A ,$282.33 , 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 ,$648.12 ,$223.56 ,$982.00 , N/A ,$880.07 ,$880.07 ,$259.84 ,$785.60 ,$834.70 ,$613.75 ,$883.80 , N/A , N/A ,$932.90 ,$883.80 ,$834.70 ,$834.70 ,$259.84 ,$834.70 ,$834.70 ,$883.80 ,$598.04 , N/A ,$608.84 , N/A ,$883.80 , N/A ,$903.44 ,$883.80 ,$648.22 ,$648.22 ,$598.04 ,$648.22 ,$638.30 ,$670.90 ,$223.56 ,$775.78 , N/A , N/A , N/A ,$259.84 , 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 ","$2,636.70 ",$909.48 ,"$3,995.00 ", N/A ,"$3,580.32 ","$3,580.32 ","$1,057.08 ","$3,196.00 ","$3,395.75 ","$2,496.88 ","$3,595.50 ", N/A , N/A ,"$3,795.25 ","$3,595.50 ","$3,395.75 ","$3,395.75 ","$1,057.08 ","$3,395.75 ","$3,395.75 ","$3,595.50 ","$2,432.96 ", N/A ,"$2,476.90 ", N/A ,"$3,595.50 ", N/A ,"$3,675.40 ","$3,595.50 ","$2,637.10 ","$2,637.10 ","$2,432.96 ","$2,637.10 ","$2,596.75 ","$2,729.38 ",$909.48 ,"$3,156.05 ", N/A , N/A , N/A ,"$1,057.08 ", 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 ","$2,859.78 ",$986.43 ,"$4,333.00 ", N/A ,"$3,883.23 ","$3,883.23 ","$1,146.51 ","$3,466.40 ","$3,683.05 ","$2,708.13 ","$3,899.70 ", N/A , N/A ,"$4,116.35 ","$3,899.70 ","$3,683.05 ","$3,683.05 ","$1,146.51 ","$3,683.05 ","$3,683.05 ","$3,899.70 ","$2,638.80 ", N/A ,"$2,686.46 ", N/A ,"$3,899.70 ", N/A ,"$3,986.36 ","$3,899.70 ","$2,860.21 ","$2,860.21 ","$2,638.80 ","$2,860.21 ","$2,816.45 ","$2,960.31 ",$986.43 ,"$3,423.07 ", N/A , N/A , N/A ,"$1,146.51 ", 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 ","$2,054.58 ",$708.69 ,"$3,113.00 ", N/A ,"$2,789.87 ","$2,789.87 ",$823.70 ,"$2,490.40 ","$2,646.05 ","$1,945.63 ","$2,801.70 ", N/A , N/A ,"$2,957.35 ","$2,801.70 ","$2,646.05 ","$2,646.05 ",$823.70 ,"$2,646.05 ","$2,646.05 ","$2,801.70 ","$1,895.82 ", N/A ,"$1,930.06 ", N/A ,"$2,801.70 ", N/A ,"$2,863.96 ","$2,801.70 ","$2,054.89 ","$2,054.89 ","$1,895.82 ","$2,054.89 ","$2,023.45 ","$2,126.80 ",$708.69 ,"$2,459.27 ", N/A , N/A , N/A ,$823.70 , 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 ","$3,290.10 ","$1,134.86 ","$4,985.00 ", N/A ,"$4,467.56 ","$4,467.56 ","$1,319.03 ","$3,988.00 ","$4,237.25 ","$3,115.63 ","$4,486.50 ", N/A , N/A ,"$4,735.75 ","$4,486.50 ","$4,237.25 ","$4,237.25 ","$1,319.03 ","$4,237.25 ","$4,237.25 ","$4,486.50 ","$3,035.87 ", N/A ,"$3,090.70 ", N/A ,"$4,486.50 ", N/A ,"$4,586.20 ","$4,486.50 ","$3,290.60 ","$3,290.60 ","$3,035.87 ","$3,290.60 ","$3,240.25 ","$3,405.75 ","$1,134.86 ","$3,938.15 ", N/A , N/A , N/A ,"$1,319.03 ", 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 ","$3,525.06 ","$1,215.90 ","$5,341.00 ", N/A ,"$4,786.60 ","$4,786.60 ","$1,413.23 ","$4,272.80 ","$4,539.85 ","$3,338.13 ","$4,806.90 ", N/A , N/A ,"$5,073.95 ","$4,806.90 ","$4,539.85 ","$4,539.85 ","$1,413.23 ","$4,539.85 ","$4,539.85 ","$4,806.90 ","$3,252.67 ", N/A ,"$3,311.42 ", N/A ,"$4,806.90 ", N/A ,"$4,913.72 ","$4,806.90 ","$3,525.59 ","$3,525.59 ","$3,252.67 ","$3,525.59 ","$3,471.65 ","$3,648.97 ","$1,215.90 ","$4,219.39 ", N/A , N/A , N/A ,"$1,413.23 ", 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 ","$3,948.12 ","$1,361.83 ","$5,982.00 ", N/A ,"$5,361.07 ","$5,361.07 ","$1,582.84 ","$4,785.60 ","$5,084.70 ","$3,738.75 ","$5,383.80 ", N/A , N/A ,"$5,682.90 ","$5,383.80 ","$5,084.70 ","$5,084.70 ","$1,582.84 ","$5,084.70 ","$5,084.70 ","$5,383.80 ","$3,643.04 ", N/A ,"$3,708.84 ", N/A ,"$5,383.80 ", N/A ,"$5,503.44 ","$5,383.80 ","$3,948.72 ","$3,948.72 ","$3,643.04 ","$3,948.72 ","$3,888.30 ","$4,086.90 ","$1,361.83 ","$4,725.78 ", N/A ,"$2,931.18 ","$2,931.18 ","$1,582.84 ","$2,931.18 ", 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 ","$5,879.28 ","$2,027.94 ","$8,908.00 ", N/A ,"$7,983.35 ","$7,983.35 ","$2,357.06 ","$7,126.40 ","$7,571.80 ","$5,567.50 ","$8,017.20 ", N/A , N/A ,"$8,462.60 ","$8,017.20 ","$7,571.80 ","$7,571.80 ","$2,357.06 ","$7,571.80 ","$7,571.80 ","$8,017.20 ","$5,424.97 ", N/A ,"$5,522.96 ", N/A ,"$8,017.20 ", N/A ,"$8,195.36 ","$8,017.20 ","$5,880.17 ","$5,880.17 ","$5,424.97 ","$5,880.17 ","$5,790.20 ","$6,085.95 ","$2,027.94 ","$7,037.32 ", N/A ,"$4,364.92 ","$4,364.92 ","$2,357.06 ","$4,364.92 ", 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 ","$2,711.94 ",$935.43 ,"$4,109.00 ", N/A ,"$3,682.49 ","$3,682.49 ","$1,087.24 ","$3,287.20 ","$3,492.65 ","$2,568.13 ","$3,698.10 ", N/A , N/A ,"$3,903.55 ","$3,698.10 ","$3,492.65 ","$3,492.65 ","$1,087.24 ","$3,492.65 ","$3,492.65 ","$3,698.10 ","$2,502.38 ", N/A ,"$2,547.58 ", N/A ,"$3,698.10 ", N/A ,"$3,780.28 ","$3,698.10 ","$2,712.35 ","$2,712.35 ","$2,502.38 ","$2,712.35 ","$2,670.85 ","$2,807.27 ",$935.43 ,"$3,246.11 ", N/A , N/A , N/A ,"$1,087.24 ", 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 ","$2,847.24 ",$982.10 ,"$4,314.00 ", N/A ,"$3,866.21 ","$3,866.21 ","$1,141.48 ","$3,451.20 ","$3,666.90 ","$2,696.25 ","$3,882.60 ", N/A , N/A ,"$4,098.30 ","$3,882.60 ","$3,666.90 ","$3,666.90 ","$1,141.48 ","$3,666.90 ","$3,666.90 ","$3,882.60 ","$2,627.23 ", N/A ,"$2,674.68 ", N/A ,"$3,882.60 ", N/A ,"$3,968.88 ","$3,882.60 ","$2,847.67 ","$2,847.67 ","$2,627.23 ","$2,847.67 ","$2,804.10 ","$2,947.32 ",$982.10 ,"$3,408.06 ", N/A , N/A , N/A ,"$1,141.48 ", 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 ","$3,568.62 ","$1,230.93 ","$5,407.00 ", N/A ,"$4,845.75 ","$4,845.75 ","$1,430.69 ","$4,325.60 ","$4,595.95 ","$3,379.38 ","$4,866.30 ", N/A , N/A ,"$5,136.65 ","$4,866.30 ","$4,595.95 ","$4,595.95 ","$1,430.69 ","$4,595.95 ","$4,595.95 ","$4,866.30 ","$3,292.86 ", N/A ,"$3,352.34 ", N/A ,"$4,866.30 ", N/A ,"$4,974.44 ","$4,866.30 ","$3,569.16 ","$3,569.16 ","$3,292.86 ","$3,569.16 ","$3,514.55 ","$3,694.06 ","$1,230.93 ","$4,271.53 ", N/A , N/A , N/A ,"$1,430.69 ", 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 ","$3,747.48 ","$1,292.62 ","$5,678.00 ", N/A ,"$5,088.62 ","$5,088.62 ","$1,502.40 ","$4,542.40 ","$4,826.30 ","$3,548.75 ","$5,110.20 ", N/A , N/A ,"$5,394.10 ","$5,110.20 ","$4,826.30 ","$4,826.30 ","$1,502.40 ","$4,826.30 ","$4,826.30 ","$5,110.20 ","$3,457.90 ", N/A ,"$3,520.36 ", N/A ,"$5,110.20 ", N/A ,"$5,223.76 ","$5,110.20 ","$3,748.05 ","$3,748.05 ","$3,457.90 ","$3,748.05 ","$3,690.70 ","$3,879.21 ","$1,292.62 ","$4,485.62 ", N/A , N/A , N/A ,"$1,502.40 ", 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 ,$321.42 ,$110.87 ,$487.00 , N/A ,$436.45 ,$436.45 ,$128.86 ,$389.60 ,$413.95 ,$304.38 ,$438.30 , N/A , N/A ,$462.65 ,$438.30 ,$413.95 ,$413.95 ,$128.86 ,$413.95 ,$413.95 ,$438.30 ,$296.58 , N/A ,$301.94 , N/A ,$438.30 , N/A ,$448.04 ,$438.30 ,$321.47 ,$321.47 ,$296.58 ,$321.47 ,$316.55 ,$332.72 ,$110.87 ,$384.73 , N/A , N/A , N/A ,$128.86 , 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 ","$2,927.10 ","$1,009.64 ","$4,435.00 ", N/A ,"$3,974.65 ","$3,974.65 ","$1,173.50 ","$3,548.00 ","$3,769.75 ","$2,771.88 ","$3,991.50 ", N/A , N/A ,"$4,213.25 ","$3,991.50 ","$3,769.75 ","$3,769.75 ","$1,173.50 ","$3,769.75 ","$3,769.75 ","$3,991.50 ","$2,700.92 ", N/A ,"$2,749.70 ", N/A ,"$3,991.50 ", N/A ,"$4,080.20 ","$3,991.50 ","$2,927.54 ","$2,927.54 ","$2,700.92 ","$2,927.54 ","$2,882.75 ","$3,029.99 ","$1,009.64 ","$3,503.65 ", N/A , N/A , N/A ,"$1,173.50 ", 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 ","$1,286.34 ",$443.69 ,"$1,949.00 ", N/A ,"$1,746.69 ","$1,746.69 ",$515.71 ,"$1,559.20 ","$1,656.65 ","$1,218.13 ","$1,754.10 ", N/A , N/A ,"$1,851.55 ","$1,754.10 ","$1,656.65 ","$1,656.65 ",$515.71 ,"$1,656.65 ","$1,656.65 ","$1,754.10 ","$1,186.94 ", N/A ,"$1,208.38 ", N/A ,"$1,754.10 ", N/A ,"$1,793.08 ","$1,754.10 ","$1,286.53 ","$1,286.53 ","$1,186.94 ","$1,286.53 ","$1,266.85 ","$1,331.56 ",$443.69 ,"$1,539.71 ", N/A , N/A , N/A ,$515.71 , 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 ,$112.86 ,$38.93 ,$171.00 , N/A ,$153.25 ,$153.25 ,$45.25 ,$136.80 ,$145.35 ,$106.88 ,$153.90 , N/A , N/A ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$45.25 ,$145.35 ,$145.35 ,$153.90 ,$104.14 , N/A ,$106.02 , N/A ,$153.90 , N/A ,$157.32 ,$153.90 ,$112.88 ,$112.88 ,$104.14 ,$112.88 ,$111.15 ,$116.83 ,$38.93 ,$135.09 , N/A , N/A , N/A ,$45.25 , 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 ","$1,787.94 ",$616.71 ,"$2,709.00 ", N/A ,"$2,427.81 ","$2,427.81 ",$716.80 ,"$2,167.20 ","$2,302.65 ","$1,693.13 ","$2,438.10 ", N/A , N/A ,"$2,573.55 ","$2,438.10 ","$2,302.65 ","$2,302.65 ",$716.80 ,"$2,302.65 ","$2,302.65 ","$2,438.10 ","$1,649.78 ", N/A ,"$1,679.58 ", N/A ,"$2,438.10 ", N/A ,"$2,492.28 ","$2,438.10 ","$1,788.21 ","$1,788.21 ","$1,649.78 ","$1,788.21 ","$1,760.85 ","$1,850.79 ",$616.71 ,"$2,140.11 ", N/A , N/A , N/A ,$716.80 , 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 ,$112.86 ,$38.93 ,$171.00 , N/A ,$153.25 ,$153.25 ,$45.25 ,$136.80 ,$145.35 ,$106.88 ,$153.90 , N/A , N/A ,$162.45 ,$153.90 ,$145.35 ,$145.35 ,$45.25 ,$145.35 ,$145.35 ,$153.90 ,$104.14 , N/A ,$106.02 , N/A ,$153.90 , N/A ,$157.32 ,$153.90 ,$112.88 ,$112.88 ,$104.14 ,$112.88 ,$111.15 ,$116.83 ,$38.93 ,$135.09 , N/A , N/A , N/A ,$45.25 , 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 ","$2,927.10 ","$1,009.64 ","$4,435.00 ", N/A ,"$3,974.65 ","$3,974.65 ","$1,173.50 ","$3,548.00 ","$3,769.75 ","$2,771.88 ","$3,991.50 ", N/A , N/A ,"$4,213.25 ","$3,991.50 ","$3,769.75 ","$3,769.75 ","$1,173.50 ","$3,769.75 ","$3,769.75 ","$3,991.50 ","$2,700.92 ", N/A ,"$2,749.70 ", N/A ,"$3,991.50 ", N/A ,"$4,080.20 ","$3,991.50 ","$2,927.54 ","$2,927.54 ","$2,700.92 ","$2,927.54 ","$2,882.75 ","$3,029.99 ","$1,009.64 ","$3,503.65 ", N/A , N/A , N/A ,"$1,173.50 ", 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 ","$2,836.68 ",$978.46 ,"$4,298.00 ", N/A ,"$3,851.87 ","$3,851.87 ","$1,137.25 ","$3,438.40 ","$3,653.30 ","$2,686.25 ","$3,868.20 ", N/A , N/A ,"$4,083.10 ","$3,868.20 ","$3,653.30 ","$3,653.30 ","$1,137.25 ","$3,653.30 ","$3,653.30 ","$3,868.20 ","$2,617.48 ", N/A ,"$2,664.76 ", N/A ,"$3,868.20 ", N/A ,"$3,954.16 ","$3,868.20 ","$2,837.11 ","$2,837.11 ","$2,617.48 ","$2,837.11 ","$2,793.70 ","$2,936.39 ",$978.46 ,"$3,395.42 ", N/A , N/A , N/A ,"$1,137.25 ", 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 ","$2,868.36 ",$989.39 ,"$4,346.00 ", N/A ,"$3,894.89 ","$3,894.89 ","$1,149.95 ","$3,476.80 ","$3,694.10 ","$2,716.25 ","$3,911.40 ", N/A , N/A ,"$4,128.70 ","$3,911.40 ","$3,694.10 ","$3,694.10 ","$1,149.95 ","$3,694.10 ","$3,694.10 ","$3,911.40 ","$2,646.71 ", N/A ,"$2,694.52 ", N/A ,"$3,911.40 ", N/A ,"$3,998.32 ","$3,911.40 ","$2,868.79 ","$2,868.79 ","$2,646.71 ","$2,868.79 ","$2,824.90 ","$2,969.19 ",$989.39 ,"$3,433.34 ", N/A , N/A , N/A ,"$1,149.95 ", 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 ","$1,094.94 ",$377.68 ,"$1,659.00 ", N/A ,"$1,486.80 ","$1,486.80 ",$438.97 ,"$1,327.20 ","$1,410.15 ","$1,036.88 ","$1,493.10 ", N/A , N/A ,"$1,576.05 ","$1,493.10 ","$1,410.15 ","$1,410.15 ",$438.97 ,"$1,410.15 ","$1,410.15 ","$1,493.10 ","$1,010.33 ", N/A ,"$1,028.58 ", N/A ,"$1,493.10 ", N/A ,"$1,526.28 ","$1,493.10 ","$1,095.11 ","$1,095.11 ","$1,010.33 ","$1,095.11 ","$1,078.35 ","$1,133.43 ",$377.68 ,"$1,310.61 ", N/A , N/A , N/A ,$438.97 , 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 ","$1,265.88 ",$436.64 ,"$1,918.00 ", N/A ,"$1,718.91 ","$1,718.91 ",$507.50 ,"$1,534.40 ","$1,630.30 ","$1,198.75 ","$1,726.20 ", N/A , N/A ,"$1,822.10 ","$1,726.20 ","$1,630.30 ","$1,630.30 ",$507.50 ,"$1,630.30 ","$1,630.30 ","$1,726.20 ","$1,168.06 ", N/A ,"$1,189.16 ", N/A ,"$1,726.20 ", N/A ,"$1,764.56 ","$1,726.20 ","$1,266.07 ","$1,266.07 ","$1,168.06 ","$1,266.07 ","$1,246.70 ","$1,310.38 ",$436.64 ,"$1,515.22 ", N/A , N/A , N/A ,$507.50 , 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 ","$1,435.50 ",$495.14 ,"$2,175.00 ", N/A ,"$1,949.24 ","$1,949.24 ",$575.50 ,"$1,740.00 ","$1,848.75 ","$1,359.38 ","$1,957.50 ", N/A , N/A ,"$2,066.25 ","$1,957.50 ","$1,848.75 ","$1,848.75 ",$575.50 ,"$1,848.75 ","$1,848.75 ","$1,957.50 ","$1,324.58 ", N/A ,"$1,348.50 ", N/A ,"$1,957.50 ", N/A ,"$2,001.00 ","$1,957.50 ","$1,435.72 ","$1,435.72 ","$1,324.58 ","$1,435.72 ","$1,413.75 ","$1,485.96 ",$495.14 ,"$1,718.25 ", N/A , N/A , N/A ,$575.50 , 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 ","$1,132.56 ",$390.66 ,"$1,716.00 ", N/A ,"$1,537.88 ","$1,537.88 ",$454.05 ,"$1,372.80 ","$1,458.60 ","$1,072.50 ","$1,544.40 ", N/A , N/A ,"$1,630.20 ","$1,544.40 ","$1,458.60 ","$1,458.60 ",$454.05 ,"$1,458.60 ","$1,458.60 ","$1,544.40 ","$1,045.04 ", N/A ,"$1,063.92 ", N/A ,"$1,544.40 ", N/A ,"$1,578.72 ","$1,544.40 ","$1,132.73 ","$1,132.73 ","$1,045.04 ","$1,132.73 ","$1,115.40 ","$1,172.37 ",$390.66 ,"$1,355.64 ", N/A , N/A , N/A ,$454.05 , 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 ",$960.96 ,$331.47 ,"$1,456.00 ", N/A ,"$1,304.87 ","$1,304.87 ",$385.26 ,"$1,164.80 ","$1,237.60 ",$910.00 ,"$1,310.40 ", N/A , N/A ,"$1,383.20 ","$1,310.40 ","$1,237.60 ","$1,237.60 ",$385.26 ,"$1,237.60 ","$1,237.60 ","$1,310.40 ",$886.70 , N/A ,$902.72 , N/A ,"$1,310.40 ", N/A ,"$1,339.52 ","$1,310.40 ",$961.11 ,$961.11 ,$886.70 ,$961.11 ,$946.40 ,$994.74 ,$331.47 ,"$1,150.24 ", N/A , N/A , N/A ,$385.26 , 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 ","$3,176.58 ","$1,095.70 ","$4,813.00 ", N/A ,"$4,313.41 ","$4,313.41 ","$1,273.52 ","$3,850.40 ","$4,091.05 ","$3,008.13 ","$4,331.70 ", N/A , N/A ,"$4,572.35 ","$4,331.70 ","$4,091.05 ","$4,091.05 ","$1,273.52 ","$4,091.05 ","$4,091.05 ","$4,331.70 ","$2,931.12 ", N/A ,"$2,984.06 ", N/A ,"$4,331.70 ", N/A ,"$4,427.96 ","$4,331.70 ","$3,177.06 ","$3,177.06 ","$2,931.12 ","$3,177.06 ","$3,128.45 ","$3,288.24 ","$1,095.70 ","$3,802.27 ", N/A , N/A , N/A ,"$1,273.52 ", 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 ","$3,232.68 ","$1,115.05 ","$4,898.00 ", N/A ,"$4,389.59 ","$4,389.59 ","$1,296.01 ","$3,918.40 ","$4,163.30 ","$3,061.25 ","$4,408.20 ", N/A , N/A ,"$4,653.10 ","$4,408.20 ","$4,163.30 ","$4,163.30 ","$1,296.01 ","$4,163.30 ","$4,163.30 ","$4,408.20 ","$2,982.88 ", N/A ,"$3,036.76 ", N/A ,"$4,408.20 ", N/A ,"$4,506.16 ","$4,408.20 ","$3,233.17 ","$3,233.17 ","$2,982.88 ","$3,233.17 ","$3,183.70 ","$3,346.31 ","$1,115.05 ","$3,869.42 ", N/A , N/A , N/A ,"$1,296.01 ", 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 ,$133.32 ,$45.98 ,$202.00 , N/A ,$181.03 ,$181.03 ,$53.45 ,$161.60 ,$171.70 ,$126.25 ,$181.80 , N/A , N/A ,$191.90 ,$181.80 ,$171.70 ,$171.70 ,$53.45 ,$171.70 ,$171.70 ,$181.80 ,$123.02 , N/A ,$125.24 , N/A ,$181.80 , N/A ,$185.84 ,$181.80 ,$133.34 ,$133.34 ,$123.02 ,$133.34 ,$131.30 ,$138.01 ,$45.98 ,$159.58 , N/A , N/A , N/A ,$53.45 , 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 ,$151.80 ,$52.36 ,$230.00 , N/A ,$206.13 ,$206.13 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 , N/A , N/A ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 , N/A ,$142.60 , N/A ,$207.00 , N/A ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 , N/A , N/A , N/A ,$60.86 , 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 ,$174.90 ,$60.33 ,$265.00 , N/A ,$237.49 ,$237.49 ,$70.12 ,$212.00 ,$225.25 ,$165.63 ,$238.50 , N/A , N/A ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$70.12 ,$225.25 ,$225.25 ,$238.50 ,$161.39 , N/A ,$164.30 , N/A ,$238.50 , N/A ,$243.80 ,$238.50 ,$174.93 ,$174.93 ,$161.39 ,$174.93 ,$172.25 ,$181.05 ,$60.33 ,$209.35 , N/A , N/A , N/A ,$70.12 , 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 ,"$1,441.00 ",$951.06 ,$328.05 ,"$1,441.00 ", N/A ,"$1,291.42 ","$1,291.42 ",$381.29 ,"$1,152.80 ","$1,224.85 ",$900.63 ,"$1,296.90 ", N/A , N/A ,"$1,368.95 ","$1,296.90 ","$1,224.85 ","$1,224.85 ",$381.29 ,"$1,224.85 ","$1,224.85 ","$1,296.90 ",$877.57 , N/A ,$893.42 , N/A ,"$1,296.90 ", N/A ,"$1,325.72 ","$1,296.90 ",$951.20 ,$951.20 ,$877.57 ,$951.20 ,$936.65 ,$984.49 ,$328.05 ,"$1,138.39 ", N/A , N/A , N/A ,$381.29 , N/A , N/A ,"$1,368.95 ","$1,181.62 ","$1,181.62 ","$1,152.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880033,C1713,HC RAPIDLOC MENISCAL,278,1 ,$793.00 ,$523.38 ,$180.53 ,$793.00 , N/A ,$710.69 ,$710.69 ,$209.83 ,$634.40 ,$674.05 ,$495.63 ,$713.70 , N/A , N/A ,$753.35 ,$713.70 ,$674.05 ,$674.05 ,$209.83 ,$674.05 ,$674.05 ,$713.70 ,$482.94 , N/A ,$491.66 , N/A ,$713.70 , N/A ,$729.56 ,$713.70 ,$523.46 ,$523.46 ,$482.94 ,$523.46 ,$515.45 ,$541.78 ,$180.53 ,$626.47 , N/A , N/A , N/A ,$209.83 , 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 ,$399.69 ,$263.80 ,$90.99 ,$399.69 , N/A ,$358.20 ,$358.20 ,$105.76 ,$319.75 ,$339.74 ,$249.81 ,$359.72 , N/A , N/A ,$379.71 ,$359.72 ,$339.74 ,$339.74 ,$105.76 ,$339.74 ,$339.74 ,$359.72 ,$243.41 , N/A ,$247.80 , N/A ,$359.72 , N/A ,$367.71 ,$359.72 ,$263.84 ,$263.84 ,$243.41 ,$263.84 ,$259.80 ,$273.07 ,$90.99 ,$315.76 , N/A , N/A , N/A ,$105.76 , N/A , N/A ,$379.71 ,$327.75 ,$327.75 ,$319.75 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880035,C1713,HC SCREW CORTEX 2.0 SLF TAP,278,1 ,$80.00 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A , N/A , N/A ,$21.17 , 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 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A , N/A , N/A ,$21.17 , 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 ,$176.22 ,$60.78 ,$267.00 , N/A ,$239.29 ,$239.29 ,$70.65 ,$213.60 ,$226.95 ,$166.88 ,$240.30 , N/A , N/A ,$253.65 ,$240.30 ,$226.95 ,$226.95 ,$70.65 ,$226.95 ,$226.95 ,$240.30 ,$162.60 , N/A ,$165.54 , N/A ,$240.30 , N/A ,$245.64 ,$240.30 ,$176.25 ,$176.25 ,$162.60 ,$176.25 ,$173.55 ,$182.41 ,$60.78 ,$210.93 , N/A , N/A , N/A ,$70.65 , 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 ,$367.62 ,$126.80 ,$557.00 , N/A ,$499.18 ,$499.18 ,$147.38 ,$445.60 ,$473.45 ,$348.13 ,$501.30 , N/A , N/A ,$529.15 ,$501.30 ,$473.45 ,$473.45 ,$147.38 ,$473.45 ,$473.45 ,$501.30 ,$339.21 , N/A ,$345.34 , N/A ,$501.30 , N/A ,$512.44 ,$501.30 ,$367.68 ,$367.68 ,$339.21 ,$367.68 ,$362.05 ,$380.54 ,$126.80 ,$440.03 , N/A , N/A , N/A ,$147.38 , 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 ,$385.44 ,$132.95 ,$584.00 , N/A ,$523.38 ,$523.38 ,$154.53 ,$467.20 ,$496.40 ,$365.00 ,$525.60 , N/A , N/A ,$554.80 ,$525.60 ,$496.40 ,$496.40 ,$154.53 ,$496.40 ,$496.40 ,$525.60 ,$355.66 , N/A ,$362.08 , N/A ,$525.60 , N/A ,$537.28 ,$525.60 ,$385.50 ,$385.50 ,$355.66 ,$385.50 ,$379.60 ,$398.99 ,$132.95 ,$461.36 , N/A , N/A , N/A ,$154.53 , 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 ,$484.44 ,$167.10 ,$734.00 , N/A ,$657.81 ,$657.81 ,$194.22 ,$587.20 ,$623.90 ,$458.75 ,$660.60 , N/A , N/A ,$697.30 ,$660.60 ,$623.90 ,$623.90 ,$194.22 ,$623.90 ,$623.90 ,$660.60 ,$447.01 , N/A ,$455.08 , N/A ,$660.60 , N/A ,$675.28 ,$660.60 ,$484.51 ,$484.51 ,$447.01 ,$484.51 ,$477.10 ,$501.47 ,$167.10 ,$579.86 , N/A , N/A , N/A ,$194.22 , 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 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A , N/A , N/A ,$21.17 , 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 ,$85.14 ,$29.37 ,$129.00 , N/A ,$115.61 ,$115.61 ,$34.13 ,$103.20 ,$109.65 ,$80.63 ,$116.10 , N/A , N/A ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$34.13 ,$109.65 ,$109.65 ,$116.10 ,$78.56 , N/A ,$79.98 , N/A ,$116.10 , N/A ,$118.68 ,$116.10 ,$85.15 ,$85.15 ,$78.56 ,$85.15 ,$83.85 ,$88.13 ,$29.37 ,$101.91 , N/A , N/A , N/A ,$34.13 , 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 ,$78.54 ,$27.09 ,$119.00 , N/A ,$106.65 ,$106.65 ,$31.49 ,$95.20 ,$101.15 ,$74.38 ,$107.10 , N/A , N/A ,$113.05 ,$107.10 ,$101.15 ,$101.15 ,$31.49 ,$101.15 ,$101.15 ,$107.10 ,$72.47 , N/A ,$73.78 , N/A ,$107.10 , N/A ,$109.48 ,$107.10 ,$78.55 ,$78.55 ,$72.47 ,$78.55 ,$77.35 ,$81.30 ,$27.09 ,$94.01 , N/A , N/A , N/A ,$31.49 , 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 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A , N/A , N/A ,$21.17 , 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 ,$277.20 ,$95.62 ,$420.00 , N/A ,$376.40 ,$376.40 ,$111.13 ,$336.00 ,$357.00 ,$262.50 ,$378.00 , N/A , N/A ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$111.13 ,$357.00 ,$357.00 ,$378.00 ,$255.78 , N/A ,$260.40 , N/A ,$378.00 , N/A ,$386.40 ,$378.00 ,$277.24 ,$277.24 ,$255.78 ,$277.24 ,$273.00 ,$286.94 ,$95.62 ,$331.80 , N/A , N/A , N/A ,$111.13 , 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 ","$1,267.20 ",$437.10 ,"$1,920.00 ", N/A ,"$1,720.70 ","$1,720.70 ",$508.03 ,"$1,536.00 ","$1,632.00 ","$1,200.00 ","$1,728.00 ", N/A , N/A ,"$1,824.00 ","$1,728.00 ","$1,632.00 ","$1,632.00 ",$508.03 ,"$1,632.00 ","$1,632.00 ","$1,728.00 ","$1,169.28 ", N/A ,"$1,190.40 ", N/A ,"$1,728.00 ", N/A ,"$1,766.40 ","$1,728.00 ","$1,267.39 ","$1,267.39 ","$1,169.28 ","$1,267.39 ","$1,248.00 ","$1,311.74 ",$437.10 ,"$1,516.80 ", N/A , N/A , N/A ,$508.03 , 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 ","$5,655.54 ","$1,950.77 ","$8,569.00 ", N/A ,"$7,679.54 ","$7,679.54 ","$2,267.36 ","$6,855.20 ","$7,283.65 ", N/A ,"$7,712.10 ", N/A , N/A ,"$8,140.55 ","$7,712.10 ","$7,283.65 ","$7,283.65 ","$2,267.36 ","$7,283.65 ","$7,283.65 ","$7,712.10 ","$5,218.52 ", N/A ,"$5,312.78 ", N/A ,"$7,712.10 ", N/A ,"$7,883.48 ","$7,712.10 ","$5,656.40 ","$5,656.40 ","$5,218.52 ","$5,656.40 ","$5,569.85 ","$5,854.34 ","$1,950.77 ","$6,769.51 ", N/A ,"$4,198.81 ","$4,198.81 ","$2,267.36 ","$4,198.81 ", 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 ,$175.56 ,$60.55 ,$266.00 , N/A ,$238.39 ,$238.39 ,$70.38 ,$212.80 ,$226.10 ,$166.25 ,$239.40 , N/A , N/A ,$252.70 ,$239.40 ,$226.10 ,$226.10 ,$70.38 ,$226.10 ,$226.10 ,$239.40 ,$161.99 , N/A ,$164.92 , N/A ,$239.40 , N/A ,$244.72 ,$239.40 ,$175.59 ,$175.59 ,$161.99 ,$175.59 ,$172.90 ,$181.73 ,$60.55 ,$210.14 , N/A , N/A , N/A ,$70.38 , 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 ","$1,402.50 ",$483.77 ,"$2,125.00 ", N/A ,"$1,904.43 ","$1,904.43 ",$562.27 ,"$1,700.00 ","$1,806.25 ","$1,328.13 ","$1,912.50 ", N/A , N/A ,"$2,018.75 ","$1,912.50 ","$1,806.25 ","$1,806.25 ",$562.27 ,"$1,806.25 ","$1,806.25 ","$1,912.50 ","$1,294.13 ", N/A ,"$1,317.50 ", N/A ,"$1,912.50 ", N/A ,"$1,955.00 ","$1,912.50 ","$1,402.71 ","$1,402.71 ","$1,294.13 ","$1,402.71 ","$1,381.25 ","$1,451.80 ",$483.77 ,"$1,678.75 ", N/A , N/A , N/A ,$562.27 , 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 ","$2,834.04 ",$977.55 ,"$4,294.00 ", N/A ,"$3,848.28 ","$3,848.28 ","$1,136.19 ","$3,435.20 ","$3,649.90 ","$2,683.75 ","$3,864.60 ", N/A , N/A ,"$4,079.30 ","$3,864.60 ","$3,649.90 ","$3,649.90 ","$1,136.19 ","$3,649.90 ","$3,649.90 ","$3,864.60 ","$2,615.05 ", N/A ,"$2,662.28 ", N/A ,"$3,864.60 ", N/A ,"$3,950.48 ","$3,864.60 ","$2,834.47 ","$2,834.47 ","$2,615.05 ","$2,834.47 ","$2,791.10 ","$2,933.66 ",$977.55 ,"$3,392.26 ", N/A , N/A , N/A ,"$1,136.19 ", 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 ,$566.28 ,$195.32 ,$858.00 , N/A ,$768.94 ,$768.94 ,$227.03 ,$686.40 ,$729.30 ,$536.25 ,$772.20 , N/A , N/A ,$815.10 ,$772.20 ,$729.30 ,$729.30 ,$227.03 ,$729.30 ,$729.30 ,$772.20 ,$522.52 , N/A ,$531.96 , N/A ,$772.20 , N/A ,$789.36 ,$772.20 ,$566.37 ,$566.37 ,$522.52 ,$566.37 ,$557.70 ,$586.19 ,$195.32 ,$677.82 , N/A , N/A , N/A ,$227.03 , 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 ","$31,328.22 ","$10,806.05 ","$47,467.00 ", N/A ,"$42,539.93 ","$42,539.93 ","$12,559.77 ","$37,973.60 ","$40,346.95 ","$29,666.88 ","$42,720.30 ", N/A , N/A ,"$45,093.65 ","$42,720.30 ","$40,346.95 ","$40,346.95 ","$12,559.77 ","$40,346.95 ","$40,346.95 ","$42,720.30 ","$28,907.40 ", N/A ,"$29,429.54 ", N/A ,"$42,720.30 ", N/A ,"$43,669.64 ","$42,720.30 ","$31,332.97 ","$31,332.97 ","$28,907.40 ","$31,332.97 ","$30,853.55 ","$32,429.45 ","$10,806.05 ","$37,498.93 ", N/A ,"$23,258.83 ","$23,258.83 ","$12,559.77 ","$23,258.83 ", 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 ,$56.10 ,$19.35 ,$85.00 , N/A ,$76.18 ,$76.18 ,$22.49 ,$68.00 ,$72.25 , N/A ,$76.50 , N/A , N/A ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$22.49 ,$72.25 ,$72.25 ,$76.50 ,$51.77 , N/A ,$52.70 , N/A ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.11 ,$56.11 ,$51.77 ,$56.11 ,$55.25 ,$58.07 ,$19.35 ,$67.15 , N/A , N/A , N/A ,$22.49 , 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 ,$111.77 ,$73.77 ,$25.45 ,$111.77 , N/A ,$100.17 ,$100.17 ,$29.58 ,$89.42 ,$95.00 , N/A ,$100.59 , N/A , N/A ,$106.18 ,$100.59 ,$95.00 ,$95.00 ,$29.58 ,$95.00 ,$95.00 ,$100.59 ,$68.07 , N/A ,$69.30 , N/A ,$100.59 , N/A ,$102.83 ,$100.59 ,$73.78 ,$73.78 ,$68.07 ,$73.78 ,$72.65 ,$76.36 ,$25.45 ,$88.30 , N/A , N/A , N/A ,$29.58 , N/A , N/A ,$106.18 ,$91.65 ,$91.65 ,$89.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880057,C1729,HC CATH DRAINAGE FLEXIMA REGULAR,278,1 ,$252.00 ,$166.32 ,$57.37 ,$252.00 , N/A ,$225.84 ,$225.84 ,$66.68 ,$201.60 ,$214.20 , N/A ,$226.80 , N/A , N/A ,$239.40 ,$226.80 ,$214.20 ,$214.20 ,$66.68 ,$214.20 ,$214.20 ,$226.80 ,$153.47 , N/A ,$156.24 , N/A ,$226.80 , N/A ,$231.84 ,$226.80 ,$166.35 ,$166.35 ,$153.47 ,$166.35 ,$163.80 ,$172.17 ,$57.37 ,$199.08 , N/A , N/A , N/A ,$66.68 , 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 ","$1,747.68 ",$602.83 ,"$2,648.00 ", N/A ,"$2,373.14 ","$2,373.14 ",$700.66 ,"$2,118.40 ","$2,250.80 ","$1,655.00 ","$2,383.20 ", N/A , N/A ,"$2,515.60 ","$2,383.20 ","$2,250.80 ","$2,250.80 ",$700.66 ,"$2,250.80 ","$2,250.80 ","$2,383.20 ","$1,612.63 ", N/A ,"$1,641.76 ", N/A ,"$2,383.20 ", N/A ,"$2,436.16 ","$2,383.20 ","$1,747.94 ","$1,747.94 ","$1,612.63 ","$1,747.94 ","$1,721.20 ","$1,809.11 ",$602.83 ,"$2,091.92 ", N/A , N/A , N/A ,$700.66 , 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 ","$1,869.12 ",$644.71 ,"$2,832.00 ", N/A ,"$2,538.04 ","$2,538.04 ",$749.35 ,"$2,265.60 ","$2,407.20 ","$1,770.00 ","$2,548.80 ", N/A , N/A ,"$2,690.40 ","$2,548.80 ","$2,407.20 ","$2,407.20 ",$749.35 ,"$2,407.20 ","$2,407.20 ","$2,548.80 ","$1,724.69 ", N/A ,"$1,755.84 ", N/A ,"$2,548.80 ", N/A ,"$2,605.44 ","$2,548.80 ","$1,869.40 ","$1,869.40 ","$1,724.69 ","$1,869.40 ","$1,840.80 ","$1,934.82 ",$644.71 ,"$2,237.28 ", N/A , N/A , N/A ,$749.35 , 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 ","$2,467.74 ",$851.20 ,"$3,739.00 ", N/A ,"$3,350.89 ","$3,350.89 ",$989.34 ,"$2,991.20 ","$3,178.15 ","$2,336.88 ","$3,365.10 ", N/A , N/A ,"$3,552.05 ","$3,365.10 ","$3,178.15 ","$3,178.15 ",$989.34 ,"$3,178.15 ","$3,178.15 ","$3,365.10 ","$2,277.05 ", N/A ,"$2,318.18 ", N/A ,"$3,365.10 ", N/A ,"$3,439.88 ","$3,365.10 ","$2,468.11 ","$2,468.11 ","$2,277.05 ","$2,468.11 ","$2,430.35 ","$2,554.48 ",$851.20 ,"$2,953.81 ", N/A , N/A , N/A ,$989.34 , 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 ","$4,261.62 ","$1,469.96 ","$6,457.00 ", N/A ,"$5,786.76 ","$5,786.76 ","$1,708.52 ","$5,165.60 ","$5,488.45 ","$4,035.63 ","$5,811.30 ", N/A , N/A ,"$6,134.15 ","$5,811.30 ","$5,488.45 ","$5,488.45 ","$1,708.52 ","$5,488.45 ","$5,488.45 ","$5,811.30 ","$3,932.31 ", N/A ,"$4,003.34 ", N/A ,"$5,811.30 ", N/A ,"$5,940.44 ","$5,811.30 ","$4,262.27 ","$4,262.27 ","$3,932.31 ","$4,262.27 ","$4,197.05 ","$4,411.42 ","$1,469.96 ","$5,101.03 ", N/A ,"$3,163.93 ","$3,163.93 ","$1,708.52 ","$3,163.93 ", 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 ",$771.54 ,$266.13 ,"$1,169.00 ", N/A ,"$1,047.66 ","$1,047.66 ",$309.32 ,$935.20 ,$993.65 ,$730.63 ,"$1,052.10 ", N/A , N/A ,"$1,110.55 ","$1,052.10 ",$993.65 ,$993.65 ,$309.32 ,$993.65 ,$993.65 ,"$1,052.10 ",$711.92 , N/A ,$724.78 , N/A ,"$1,052.10 ", N/A ,"$1,075.48 ","$1,052.10 ",$771.66 ,$771.66 ,$711.92 ,$771.66 ,$759.85 ,$798.66 ,$266.13 ,$923.51 , N/A , N/A , N/A ,$309.32 , 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 ","$1,799.82 ",$620.81 ,"$2,727.00 ", N/A ,"$2,443.94 ","$2,443.94 ",$721.56 ,"$2,181.60 ","$2,317.95 ","$1,704.38 ","$2,454.30 ", N/A , N/A ,"$2,590.65 ","$2,454.30 ","$2,317.95 ","$2,317.95 ",$721.56 ,"$2,317.95 ","$2,317.95 ","$2,454.30 ","$1,660.74 ", N/A ,"$1,690.74 ", N/A ,"$2,454.30 ", N/A ,"$2,508.84 ","$2,454.30 ","$1,800.09 ","$1,800.09 ","$1,660.74 ","$1,800.09 ","$1,772.55 ","$1,863.09 ",$620.81 ,"$2,154.33 ", N/A , N/A , N/A ,$721.56 , 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 ,$283.80 ,$97.89 ,$430.00 , N/A ,$385.37 ,$385.37 ,$113.78 ,$344.00 ,$365.50 ,$268.75 ,$387.00 , N/A , N/A ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$113.78 ,$365.50 ,$365.50 ,$387.00 ,$261.87 , N/A ,$266.60 , N/A ,$387.00 , N/A ,$395.60 ,$387.00 ,$283.84 ,$283.84 ,$261.87 ,$283.84 ,$279.50 ,$293.78 ,$97.89 ,$339.70 , N/A , N/A , N/A ,$113.78 , 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 ,$570.00 ,$376.20 ,$129.76 ,$570.00 , N/A ,$510.83 ,$510.83 ,$150.82 ,$456.00 ,$484.50 ,$356.25 ,$513.00 , N/A , N/A ,$541.50 ,$513.00 ,$484.50 ,$484.50 ,$150.82 ,$484.50 ,$484.50 ,$513.00 ,$347.13 , N/A ,$353.40 , N/A ,$513.00 , N/A ,$524.40 ,$513.00 ,$376.26 ,$376.26 ,$347.13 ,$376.26 ,$370.50 ,$389.42 ,$129.76 ,$450.30 , N/A , N/A , N/A ,$150.82 , N/A , N/A ,$541.50 ,$467.40 ,$467.40 ,$456.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),27880066,C1781,HC MESH PARIETEX PLUT PATCH 6CM 5X10,278,1 ,$781.00 ,$515.46 ,$177.80 ,$781.00 , N/A ,$699.93 ,$699.93 ,$206.65 ,$624.80 ,$663.85 ,$488.13 ,$702.90 , N/A , N/A ,$741.95 ,$702.90 ,$663.85 ,$663.85 ,$206.65 ,$663.85 ,$663.85 ,$702.90 ,$475.63 , N/A ,$484.22 , N/A ,$702.90 , N/A ,$718.52 ,$702.90 ,$515.54 ,$515.54 ,$475.63 ,$515.54 ,$507.65 ,$533.58 ,$177.80 ,$616.99 , N/A , N/A , N/A ,$206.65 , 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 ","$1,690.26 ",$583.02 ,"$2,561.00 ", N/A ,"$2,295.17 ","$2,295.17 ",$677.64 ,"$2,048.80 ","$2,176.85 ","$1,600.63 ","$2,304.90 ", N/A , N/A ,"$2,432.95 ","$2,304.90 ","$2,176.85 ","$2,176.85 ",$677.64 ,"$2,176.85 ","$2,176.85 ","$2,304.90 ","$1,559.65 ", N/A ,"$1,587.82 ", N/A ,"$2,304.90 ", N/A ,"$2,356.12 ","$2,304.90 ","$1,690.52 ","$1,690.52 ","$1,559.65 ","$1,690.52 ","$1,664.65 ","$1,749.68 ",$583.02 ,"$2,023.19 ", N/A , N/A , N/A ,$677.64 , 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 ","$3,131.04 ","$1,079.99 ","$4,744.00 ", N/A ,"$4,251.57 ","$4,251.57 ","$1,255.26 ","$3,795.20 ","$4,032.40 ","$2,965.00 ","$4,269.60 ", N/A , N/A ,"$4,506.80 ","$4,269.60 ","$4,032.40 ","$4,032.40 ","$1,255.26 ","$4,032.40 ","$4,032.40 ","$4,269.60 ","$2,889.10 ", N/A ,"$2,941.28 ", N/A ,"$4,269.60 ", N/A ,"$4,364.48 ","$4,269.60 ","$3,131.51 ","$3,131.51 ","$2,889.10 ","$3,131.51 ","$3,083.60 ","$3,241.10 ","$1,079.99 ","$3,747.76 ", N/A , N/A , N/A ,"$1,255.26 ", 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 ","$1,291.62 ",$445.52 ,"$1,957.00 ", N/A ,"$1,753.86 ","$1,753.86 ",$517.82 ,"$1,565.60 ","$1,663.45 ","$1,223.13 ","$1,761.30 ", N/A , N/A ,"$1,859.15 ","$1,761.30 ","$1,663.45 ","$1,663.45 ",$517.82 ,"$1,663.45 ","$1,663.45 ","$1,761.30 ","$1,191.81 ", N/A ,"$1,213.34 ", N/A ,"$1,761.30 ", N/A ,"$1,800.44 ","$1,761.30 ","$1,291.82 ","$1,291.82 ","$1,191.81 ","$1,291.82 ","$1,272.05 ","$1,337.02 ",$445.52 ,"$1,546.03 ", N/A , N/A , N/A ,$517.82 , 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 ","$1,506.78 ",$519.73 ,"$2,283.00 ", N/A ,"$2,046.02 ","$2,046.02 ",$604.08 ,"$1,826.40 ","$1,940.55 ","$1,426.88 ","$2,054.70 ", N/A , N/A ,"$2,168.85 ","$2,054.70 ","$1,940.55 ","$1,940.55 ",$604.08 ,"$1,940.55 ","$1,940.55 ","$2,054.70 ","$1,390.35 ", N/A ,"$1,415.46 ", N/A ,"$2,054.70 ", N/A ,"$2,100.36 ","$2,054.70 ","$1,507.01 ","$1,507.01 ","$1,390.35 ","$1,507.01 ","$1,483.95 ","$1,559.75 ",$519.73 ,"$1,803.57 ", N/A , N/A , N/A ,$604.08 , 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 ","$2,158.20 ",$744.43 ,"$3,270.00 ", N/A ,"$2,930.57 ","$2,930.57 ",$865.24 ,"$2,616.00 ","$2,779.50 ","$2,043.75 ","$2,943.00 ", N/A , N/A ,"$3,106.50 ","$2,943.00 ","$2,779.50 ","$2,779.50 ",$865.24 ,"$2,779.50 ","$2,779.50 ","$2,943.00 ","$1,991.43 ", N/A ,"$2,027.40 ", N/A ,"$2,943.00 ", N/A ,"$3,008.40 ","$2,943.00 ","$2,158.53 ","$2,158.53 ","$1,991.43 ","$2,158.53 ","$2,125.50 ","$2,234.06 ",$744.43 ,"$2,583.30 ", N/A , N/A , N/A ,$865.24 , 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 ,$325.38 ,$112.23 ,$493.00 , N/A ,$441.83 ,$441.83 ,$130.45 ,$394.40 ,$419.05 ,$308.13 ,$443.70 , N/A , N/A ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$130.45 ,$419.05 ,$419.05 ,$443.70 ,$300.24 , N/A ,$305.66 , N/A ,$443.70 , N/A ,$453.56 ,$443.70 ,$325.43 ,$325.43 ,$300.24 ,$325.43 ,$320.45 ,$336.82 ,$112.23 ,$389.47 , N/A , N/A , N/A ,$130.45 , 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 ,$25.74 ,$8.88 ,$39.00 , N/A ,$34.95 ,$34.95 ,$10.32 ,$31.20 ,$33.15 , N/A ,$35.10 , N/A , N/A ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$10.32 ,$33.15 ,$33.15 ,$35.10 ,$23.75 , N/A ,$24.18 , N/A ,$35.10 , N/A ,$35.88 ,$35.10 ,$25.74 ,$25.74 ,$23.75 ,$25.74 ,$25.35 ,$26.64 ,$8.88 ,$30.81 , N/A , N/A , N/A ,$10.32 , 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 ,$40.92 ,$14.11 ,$62.00 , N/A ,$55.56 ,$55.56 ,$16.41 ,$49.60 ,$52.70 , N/A ,$55.80 , N/A , N/A ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$16.41 ,$52.70 ,$52.70 ,$55.80 ,$37.76 , N/A ,$38.44 , N/A ,$55.80 , N/A ,$57.04 ,$55.80 ,$40.93 ,$40.93 ,$37.76 ,$40.93 ,$40.30 ,$42.36 ,$14.11 ,$48.98 , N/A , N/A , N/A ,$16.41 , 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 ",$864.60 ,$298.22 ,"$1,310.00 ", N/A ,"$1,174.02 ","$1,174.02 ",$346.63 ,"$1,048.00 ","$1,113.50 ", N/A ,"$1,179.00 ", N/A , N/A ,"$1,244.50 ","$1,179.00 ","$1,113.50 ","$1,113.50 ",$346.63 ,"$1,113.50 ","$1,113.50 ","$1,179.00 ",$797.79 , N/A ,$812.20 , N/A ,"$1,179.00 ", N/A ,"$1,205.20 ","$1,179.00 ",$864.73 ,$864.73 ,$797.79 ,$864.73 ,$851.50 ,$894.99 ,$298.22 ,"$1,034.90 ", N/A , N/A , N/A ,$346.63 , 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 ,$180.18 ,$62.15 ,$273.00 , N/A ,$244.66 ,$244.66 ,$72.24 ,$218.40 ,$232.05 ,$170.63 ,$245.70 , N/A , N/A ,$259.35 ,$245.70 ,$232.05 ,$232.05 ,$72.24 ,$232.05 ,$232.05 ,$245.70 ,$166.26 , N/A ,$169.26 , N/A ,$245.70 , N/A ,$251.16 ,$245.70 ,$180.21 ,$180.21 ,$166.26 ,$180.21 ,$177.45 ,$186.51 ,$62.15 ,$215.67 , N/A , N/A , N/A ,$72.24 , 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 ,$189.42 ,$65.34 ,$287.00 , N/A ,$257.21 ,$257.21 ,$75.94 ,$229.60 ,$243.95 ,$179.38 ,$258.30 , N/A , N/A ,$272.65 ,$258.30 ,$243.95 ,$243.95 ,$75.94 ,$243.95 ,$243.95 ,$258.30 ,$174.78 , N/A ,$177.94 , N/A ,$258.30 , N/A ,$264.04 ,$258.30 ,$189.45 ,$189.45 ,$174.78 ,$189.45 ,$186.55 ,$196.08 ,$65.34 ,$226.73 , N/A , N/A , N/A ,$75.94 , 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 ,$85.80 ,$29.60 ,$130.00 , N/A ,$116.51 ,$116.51 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 , N/A , N/A ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 , N/A ,$80.60 , N/A ,$117.00 , N/A ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 , N/A , N/A , N/A ,$34.40 , 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 ,$152.46 ,$52.59 ,$231.00 , N/A ,$207.02 ,$207.02 ,$61.12 ,$184.80 ,$196.35 ,$144.38 ,$207.90 , N/A , N/A ,$219.45 ,$207.90 ,$196.35 ,$196.35 ,$61.12 ,$196.35 ,$196.35 ,$207.90 ,$140.68 , N/A ,$143.22 , N/A ,$207.90 , N/A ,$212.52 ,$207.90 ,$152.48 ,$152.48 ,$140.68 ,$152.48 ,$150.15 ,$157.82 ,$52.59 ,$182.49 , N/A , N/A , N/A ,$61.12 , 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 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ,$628.32 ,$216.73 ,$952.00 , N/A ,$853.18 ,$853.18 ,$251.90 ,$761.60 ,$809.20 ,$595.00 ,$856.80 , N/A , N/A ,$904.40 ,$856.80 ,$809.20 ,$809.20 ,$251.90 ,$809.20 ,$809.20 ,$856.80 ,$579.77 , N/A ,$590.24 , N/A ,$856.80 , N/A ,$875.84 ,$856.80 ,$628.42 ,$628.42 ,$579.77 ,$628.42 ,$618.80 ,$650.41 ,$216.73 ,$752.08 , N/A , N/A , N/A ,$251.90 , 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 ,$576.84 ,$198.97 ,$874.00 , N/A ,$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 , N/A , N/A ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 , N/A ,$541.88 , N/A ,$786.60 , N/A ,$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 , N/A , N/A , N/A ,$231.26 , 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 ",$680.46 ,$234.71 ,"$1,031.00 ", N/A ,$923.98 ,$923.98 ,$272.80 ,$824.80 ,$876.35 ,$644.38 ,$927.90 , N/A , N/A ,$979.45 ,$927.90 ,$876.35 ,$876.35 ,$272.80 ,$876.35 ,$876.35 ,$927.90 ,$627.88 , N/A ,$639.22 , N/A ,$927.90 , N/A ,$948.52 ,$927.90 ,$680.56 ,$680.56 ,$627.88 ,$680.56 ,$670.15 ,$704.38 ,$234.71 ,$814.49 , N/A , N/A , N/A ,$272.80 , 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 ,$646.80 ,$223.10 ,$980.00 , N/A ,$878.28 ,$878.28 ,$259.31 ,$784.00 ,$833.00 ,$612.50 ,$882.00 , N/A , N/A ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$259.31 ,$833.00 ,$833.00 ,$882.00 ,$596.82 , N/A ,$607.60 , N/A ,$882.00 , N/A ,$901.60 ,$882.00 ,$646.90 ,$646.90 ,$596.82 ,$646.90 ,$637.00 ,$669.54 ,$223.10 ,$774.20 , N/A , N/A , N/A ,$259.31 , 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 ","$3,208.26 ","$1,106.63 ","$4,861.00 ", N/A ,"$4,356.43 ","$4,356.43 ","$1,286.22 ","$3,888.80 ","$4,131.85 ","$3,038.13 ","$4,374.90 ", N/A , N/A ,"$4,617.95 ","$4,374.90 ","$4,131.85 ","$4,131.85 ","$1,286.22 ","$4,131.85 ","$4,131.85 ","$4,374.90 ","$2,960.35 ", N/A ,"$3,013.82 ", N/A ,"$4,374.90 ", N/A ,"$4,472.12 ","$4,374.90 ","$3,208.75 ","$3,208.75 ","$2,960.35 ","$3,208.75 ","$3,159.65 ","$3,321.04 ","$1,106.63 ","$3,840.19 ", N/A , N/A , N/A ,"$1,286.22 ", 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 ,$566.28 ,$195.32 ,$858.00 , N/A ,$768.94 ,$768.94 ,$227.03 ,$686.40 ,$729.30 ,$536.25 ,$772.20 , N/A , N/A ,$815.10 ,$772.20 ,$729.30 ,$729.30 ,$227.03 ,$729.30 ,$729.30 ,$772.20 ,$522.52 , N/A ,$531.96 , N/A ,$772.20 , N/A ,$789.36 ,$772.20 ,$566.37 ,$566.37 ,$522.52 ,$566.37 ,$557.70 ,$586.19 ,$195.32 ,$677.82 , N/A , N/A , N/A ,$227.03 , 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 ","$1,671.12 ",$576.42 ,"$2,532.00 ", N/A ,"$2,269.18 ","$2,269.18 ",$669.97 ,"$2,025.60 ","$2,152.20 ","$1,582.50 ","$2,278.80 ", N/A , N/A ,"$2,405.40 ","$2,278.80 ","$2,152.20 ","$2,152.20 ",$669.97 ,"$2,152.20 ","$2,152.20 ","$2,278.80 ","$1,541.99 ", N/A ,"$1,569.84 ", N/A ,"$2,278.80 ", N/A ,"$2,329.44 ","$2,278.80 ","$1,671.37 ","$1,671.37 ","$1,541.99 ","$1,671.37 ","$1,645.80 ","$1,729.86 ",$576.42 ,"$2,000.28 ", N/A , N/A , N/A ,$669.97 , 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 ,"$2,588.50 ","$1,708.41 ",$589.28 ,"$2,588.50 ", N/A ,"$2,319.81 ","$2,319.81 ",$684.92 ,"$2,070.80 ","$2,200.23 ","$1,617.81 ","$2,329.65 ", N/A , N/A ,"$2,459.08 ","$2,329.65 ","$2,200.23 ","$2,200.23 ",$684.92 ,"$2,200.23 ","$2,200.23 ","$2,329.65 ","$1,576.40 ", N/A ,"$1,604.88 ", N/A ,"$2,329.65 ", N/A ,"$2,381.42 ","$2,329.65 ","$1,708.67 ","$1,708.67 ","$1,576.40 ","$1,708.67 ","$1,682.53 ","$1,768.46 ",$589.28 ,"$2,044.92 ", N/A , N/A , N/A ,$684.92 , N/A , N/A ,"$2,459.08 ","$2,122.57 ","$2,122.57 ","$2,070.80 "
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 ","$1,803.12 ",$621.95 ,"$2,732.00 ", N/A ,"$2,448.42 ","$2,448.42 ",$722.89 ,"$2,185.60 ","$2,322.20 ","$1,707.50 ","$2,458.80 ", N/A , N/A ,"$2,595.40 ","$2,458.80 ","$2,322.20 ","$2,322.20 ",$722.89 ,"$2,322.20 ","$2,322.20 ","$2,458.80 ","$1,663.79 ", N/A ,"$1,693.84 ", N/A ,"$2,458.80 ", N/A ,"$2,513.44 ","$2,458.80 ","$1,803.39 ","$1,803.39 ","$1,663.79 ","$1,803.39 ","$1,775.80 ","$1,866.50 ",$621.95 ,"$2,158.28 ", N/A , N/A , N/A ,$722.89 , 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 ","$2,397.78 ",$827.07 ,"$3,633.00 ", N/A ,"$3,255.89 ","$3,255.89 ",$961.29 ,"$2,906.40 ","$3,088.05 ","$2,270.63 ","$3,269.70 ", N/A , N/A ,"$3,451.35 ","$3,269.70 ","$3,088.05 ","$3,088.05 ",$961.29 ,"$3,088.05 ","$3,088.05 ","$3,269.70 ","$2,212.50 ", N/A ,"$2,252.46 ", N/A ,"$3,269.70 ", N/A ,"$3,342.36 ","$3,269.70 ","$2,398.14 ","$2,398.14 ","$2,212.50 ","$2,398.14 ","$2,361.45 ","$2,482.07 ",$827.07 ,"$2,870.07 ", N/A , N/A , N/A ,$961.29 , 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 ","$3,818.76 ","$1,317.21 ","$5,786.00 ", N/A ,"$5,185.41 ","$5,185.41 ","$1,530.98 ","$4,628.80 ","$4,918.10 ","$3,616.25 ","$5,207.40 ", N/A , N/A ,"$5,496.70 ","$5,207.40 ","$4,918.10 ","$4,918.10 ","$1,530.98 ","$4,918.10 ","$4,918.10 ","$5,207.40 ","$3,523.67 ", N/A ,"$3,587.32 ", N/A ,"$5,207.40 ", N/A ,"$5,323.12 ","$5,207.40 ","$3,819.34 ","$3,819.34 ","$3,523.67 ","$3,819.34 ","$3,760.90 ","$3,953.00 ","$1,317.21 ","$4,570.94 ", N/A ,"$2,835.14 ","$2,835.14 ","$1,530.98 ","$2,835.14 ", 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 ",$850.74 ,$293.44 ,"$1,289.00 ", N/A ,"$1,155.20 ","$1,155.20 ",$341.07 ,"$1,031.20 ","$1,095.65 ",$805.63 ,"$1,160.10 ", N/A , N/A ,"$1,224.55 ","$1,160.10 ","$1,095.65 ","$1,095.65 ",$341.07 ,"$1,095.65 ","$1,095.65 ","$1,160.10 ",$785.00 , N/A ,$799.18 , N/A ,"$1,160.10 ", N/A ,"$1,185.88 ","$1,160.10 ",$850.87 ,$850.87 ,$785.00 ,$850.87 ,$837.85 ,$880.64 ,$293.44 ,"$1,018.31 ", N/A , N/A , N/A ,$341.07 , 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 ,"$3,646.93 ","$2,406.97 ",$830.24 ,"$3,646.93 ", N/A ,"$3,268.38 ","$3,268.38 ",$964.98 ,"$2,917.54 ","$3,099.89 ","$2,279.33 ","$3,282.24 ", N/A , N/A ,"$3,464.58 ","$3,282.24 ","$3,099.89 ","$3,099.89 ",$964.98 ,"$3,099.89 ","$3,099.89 ","$3,282.24 ","$2,220.98 ", N/A ,"$2,261.10 ", N/A ,"$3,282.24 ", N/A ,"$3,355.18 ","$3,282.24 ","$2,407.34 ","$2,407.34 ","$2,220.98 ","$2,407.34 ","$2,370.50 ","$2,491.58 ",$830.24 ,"$2,881.07 ", N/A , N/A , N/A ,$964.98 , N/A , N/A ,"$3,464.58 ","$2,990.48 ","$2,990.48 ","$2,917.54 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880095,Q4104,HC INTEGRA BILAYER MTRX WND 4X5 PER SQ CM,278,1 ,"$12,212.74 ","$8,060.41 ","$2,780.28 ","$12,212.74 ", N/A ,"$10,945.06 ","$10,945.06 ","$3,231.49 ","$9,770.19 ","$10,380.83 ","$7,632.96 ","$10,991.47 ", N/A , N/A ,"$11,602.10 ","$10,991.47 ","$10,380.83 ","$10,380.83 ","$3,231.49 ","$10,380.83 ","$10,380.83 ","$10,991.47 ","$7,437.56 ", N/A ,"$7,571.90 ", N/A ,"$10,991.47 ", N/A ,"$11,235.72 ","$10,991.47 ","$8,061.63 ","$8,061.63 ","$7,437.56 ","$8,061.63 ","$7,938.28 ","$8,343.74 ","$2,780.28 ","$9,648.06 ", N/A ,"$5,984.24 ","$5,984.24 ","$3,231.49 ","$5,984.24 ", N/A ,"$11,602.10 ","$10,014.45 ","$10,014.45 ","$9,770.19 "
ST. CLARE MEMORIAL HOSPITAL (ACU),27880162,C1781,HC MESH SURGIMESH,278,1 ,"$1,326.00 ",$875.16 ,$301.87 ,"$1,326.00 ", N/A ,"$1,188.36 ","$1,188.36 ",$350.86 ,"$1,060.80 ","$1,127.10 ",$828.75 ,"$1,193.40 ", N/A , N/A ,"$1,259.70 ","$1,193.40 ","$1,127.10 ","$1,127.10 ",$350.86 ,"$1,127.10 ","$1,127.10 ","$1,193.40 ",$807.53 , N/A ,$822.12 , N/A ,"$1,193.40 ", N/A ,"$1,219.92 ","$1,193.40 ",$875.29 ,$875.29 ,$807.53 ,$875.29 ,$861.90 ,$905.92 ,$301.87 ,"$1,047.54 ", N/A , N/A , N/A ,$350.86 , 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 ",$984.06 ,$339.43 ,"$10,826.95 ","$10,214.10 ","$1,336.23 ","$1,336.23 ",$613.79 ,"$1,192.80 ","$1,267.35 ",$931.88 ,"$1,341.90 ","$10,214.10 ","$1,491.00 ","$1,416.45 ","$1,341.90 ","$1,267.35 ","$1,267.35 ",$613.79 ,"$1,267.35 ","$1,267.35 ","$1,341.90 ",$908.02 ,"$10,214.10 ","$1,252.64 ","$1,580.46 ","$1,341.90 ","$6,697.49 ","$1,371.72 ","$1,341.90 ",$984.21 ,$984.21 ,$908.02 ,$984.21 ,$969.15 ,"$1,018.65 ",$339.43 ,"$1,177.89 ","$10,826.95 ", N/A , N/A ,$613.79 , N/A ,"$2,976.66 ","$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 ,$852.15 ,$562.42 ,$111.00 ,"$5,812.31 ","$4,132.62 ",$139.00 ,$111.00 ,$225.48 ,$681.72 ,$724.33 ,$532.59 ,$766.94 ,"$4,132.62 ",$852.15 ,$809.54 ,$766.94 ,$724.33 ,$724.33 ,$225.48 ,$724.33 ,$724.33 ,$766.94 ,$518.96 ,"$4,132.62 ",$528.34 ,$903.28 ,$766.94 ,"$5,812.31 ",$783.98 ,$766.94 ,$562.50 ,$562.50 ,$518.96 ,$562.50 ,$553.90 ,$582.19 ,$193.99 ,$673.20 ,"$4,380.58 ",$417.55 ,$417.55 ,$225.48 ,$417.55 ,"$2,583.25 ",$809.54 ,$698.76 ,$698.76 ,$681.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),28285072,28285,HC CORRECT HAMMERTOE,975,1 ,"$1,864.00 ","$1,230.24 ",$413.16 ,"$6,697.49 ","$4,132.62 ","$1,670.52 ","$1,670.52 ",$413.16 ,"$1,491.20 ","$1,584.40 ","$1,165.00 ","$1,677.60 ","$4,132.62 ","$1,864.00 ","$1,770.80 ","$1,677.60 ","$1,584.40 ","$1,584.40 ",$413.16 ,"$1,584.40 ","$1,584.40 ","$1,677.60 ","$1,135.18 ","$4,132.62 ",$843.18 ,"$1,975.84 ","$1,677.60 ","$6,697.49 ","$1,714.88 ","$1,677.60 ","$1,230.43 ","$1,230.43 ","$1,135.18 ","$1,230.43 ","$1,211.60 ","$1,273.48 ",$424.35 ,"$1,472.56 ","$4,380.58 ", N/A , N/A ,$413.16 , N/A ,"$2,976.66 ","$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 ","$1,405.80 ",$445.66 ,"$10,826.95 ","$10,214.10 ","$1,908.91 ","$1,908.91 ",$445.66 ,"$1,704.00 ","$1,810.50 ","$1,331.25 ","$1,917.00 ","$10,214.10 ","$2,130.00 ","$2,023.50 ","$1,917.00 ","$1,810.50 ","$1,810.50 ",$445.66 ,"$1,810.50 ","$1,810.50 ","$1,917.00 ","$1,297.17 ","$10,214.10 ",$909.52 ,"$2,257.80 ","$1,917.00 ","$6,697.49 ","$1,959.60 ","$1,917.00 ","$1,406.01 ","$1,406.01 ","$1,297.17 ","$1,406.01 ","$1,384.50 ","$1,455.22 ",$484.90 ,"$1,682.70 ","$10,826.95 ", N/A , N/A ,$445.66 , N/A ,"$2,976.66 ","$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 ,$39.10 ,$25.81 ,$8.90 ,$39.10 , N/A ,$35.04 ,$35.04 ,$10.35 ,$31.28 ,$33.24 ,$24.44 ,$35.19 , N/A , N/A ,$37.15 ,$35.19 ,$33.24 ,$33.24 ,$10.35 ,$33.24 ,$33.24 ,$35.19 ,$23.81 , N/A ,$24.24 , N/A ,$35.19 , N/A ,$35.97 ,$35.19 ,$25.81 ,$25.81 ,$23.81 ,$25.81 ,$25.42 ,$26.71 ,$8.90 ,$30.89 , N/A ,$19.16 ,$19.16 ,$10.35 ,$19.16 , N/A ,$37.15 ,$32.06 ,$32.06 ,$31.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$30.00 ,$19.80 ,$3.47 ,$30.00 ,$4.31 ,$9.00 ,$9.00 ,$7.94 ,$24.00 ,$25.50 , N/A ,$27.00 ,$4.31 ,$4.31 ,$28.50 ,$27.00 ,$25.50 ,$25.50 ,$7.94 ,$25.50 ,$25.50 ,$27.00 ,$18.27 ,$4.31 ,$18.60 ,$4.57 ,$27.00 , N/A ,$27.60 ,$27.00 ,$19.80 ,$19.80 ,$18.27 ,$19.80 ,$19.50 ,$20.50 ,$6.83 ,$23.70 ,$4.57 ,$3.47 ,$3.47 ,$7.94 ,$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 ,$9.90 ,$3.41 ,$19.28 , N/A ,$9.00 ,$9.00 ,$3.97 ,$12.00 ,$12.75 , N/A ,$13.50 , N/A , N/A ,$14.25 ,$13.50 ,$12.75 ,$12.75 ,$3.97 ,$12.75 ,$12.75 ,$13.50 ,$9.14 , N/A ,$9.30 , N/A ,$13.50 ,$19.28 ,$13.80 ,$13.50 ,$9.90 ,$9.90 ,$9.14 ,$9.90 ,$9.75 ,$10.25 ,$3.41 ,$11.85 , N/A ,$3.60 ,$3.60 ,$3.97 ,$3.60 ,$8.57 ,$14.25 ,$12.30 ,$12.30 ,$12.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000011,36415,HC CATHETER COLLECTION,300,1 ,$15.00 ,$9.90 ,$3.41 ,$19.28 , N/A ,$9.00 ,$9.00 ,$3.97 ,$12.00 ,$12.75 , N/A ,$13.50 , N/A , N/A ,$14.25 ,$13.50 ,$12.75 ,$12.75 ,$3.97 ,$12.75 ,$12.75 ,$13.50 ,$9.14 , N/A ,$9.30 , N/A ,$13.50 ,$19.28 ,$13.80 ,$13.50 ,$9.90 ,$9.90 ,$9.14 ,$9.90 ,$9.75 ,$10.25 ,$3.41 ,$11.85 , N/A ,$3.60 ,$3.60 ,$3.97 ,$3.60 ,$8.57 ,$14.25 ,$12.30 ,$12.30 ,$12.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000014,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$136.85 ,$90.32 ,$31.15 ,$261.25 ,$127.41 ,$122.65 ,$122.65 ,$36.21 ,$109.48 ,$116.32 , N/A ,$123.17 ,$127.41 ,$127.41 ,$130.01 ,$123.17 ,$116.32 ,$116.32 ,$36.21 ,$116.32 ,$116.32 ,$123.17 ,$83.34 ,$127.41 ,$84.84 ,$135.05 ,$123.17 ,$261.25 ,$125.90 ,$123.17 ,$90.33 ,$90.33 ,$83.34 ,$90.33 ,$88.95 ,$93.50 ,$31.15 ,$108.11 ,$135.05 , N/A , N/A ,$36.21 , N/A ,$116.11 ,$130.01 ,$112.22 ,$112.22 ,$109.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000015,36600,HC ARTERIAL PUNCTURE,300,1 ,$74.75 ,$49.34 ,$17.01 ,$261.25 ,$127.41 ,$66.99 ,$66.99 ,$19.78 ,$59.80 ,$63.54 ,$46.72 ,$67.28 ,$127.41 ,$74.75 ,$71.01 ,$67.28 ,$63.54 ,$63.54 ,$19.78 ,$63.54 ,$63.54 ,$67.28 ,$45.52 ,$127.41 ,$46.34 ,$79.24 ,$67.28 ,$261.25 ,$68.77 ,$67.28 ,$49.34 ,$49.34 ,$45.52 ,$49.34 ,$48.59 ,$51.07 ,$17.01 ,$59.05 ,$135.05 , N/A , N/A ,$19.78 , N/A ,$116.11 ,$71.01 ,$61.30 ,$61.30 ,$59.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$148.35 ,$97.91 ,$33.77 ,$261.25 ,$127.41 ,$132.95 ,$132.95 ,$39.25 ,$118.68 ,$126.10 , N/A ,$133.52 ,$127.41 ,$127.41 ,$140.93 ,$133.52 ,$126.10 ,$126.10 ,$39.25 ,$126.10 ,$126.10 ,$133.52 ,$90.35 ,$127.41 ,$91.98 ,$135.05 ,$133.52 ,$261.25 ,$136.48 ,$133.52 ,$97.93 ,$97.93 ,$90.35 ,$97.93 ,$96.43 ,$101.35 ,$33.77 ,$117.20 ,$135.05 , N/A , N/A ,$39.25 , N/A ,$116.11 ,$140.93 ,$121.65 ,$121.65 ,$118.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000101,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$74.75 ,$49.34 ,$5.60 ,$74.75 ,$5.79 ,$19.60 ,$19.60 ,$19.78 ,$59.80 ,$63.54 ,$46.72 ,$67.28 ,$5.79 ,$5.79 ,$71.01 ,$67.28 ,$63.54 ,$63.54 ,$19.78 ,$63.54 ,$63.54 ,$67.28 ,$45.52 ,$5.79 ,$46.34 ,$6.14 ,$67.28 ,$12.60 ,$68.77 ,$67.28 ,$49.34 ,$49.34 ,$45.52 ,$49.34 ,$48.59 ,$51.07 ,$17.01 ,$59.05 ,$6.14 ,$6.72 ,$6.72 ,$19.78 ,$6.72 ,$5.60 ,$71.01 ,$61.30 ,$61.30 ,$59.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000102,89051,HC CELL CT BODY FLUID W/DIFF (SYN),300,1 ,$113.85 ,$75.14 ,$5.60 ,$113.85 ,$5.79 ,$19.60 ,$19.60 ,$30.13 ,$91.08 ,$96.77 ,$71.16 ,$102.47 ,$5.79 ,$5.79 ,$108.16 ,$102.47 ,$96.77 ,$96.77 ,$30.13 ,$96.77 ,$96.77 ,$102.47 ,$69.33 ,$5.79 ,$70.58 ,$6.14 ,$102.47 ,$12.60 ,$104.74 ,$102.47 ,$75.15 ,$75.15 ,$69.33 ,$75.15 ,$74.00 ,$77.78 ,$25.92 ,$89.94 ,$6.14 ,$6.72 ,$6.72 ,$30.13 ,$6.72 ,$5.60 ,$108.16 ,$93.36 ,$93.36 ,$91.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000104,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$47.15 ,$31.12 ,$4.27 ,$47.15 ,$4.41 ,$14.95 ,$14.95 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$4.41 ,$4.41 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$4.41 ,$29.24 ,$4.67 ,$42.44 ,$9.61 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$4.67 ,$5.12 ,$5.12 ,$12.48 ,$5.12 ,$4.27 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000105,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$60.95 ,$40.23 ,$7.33 ,$60.95 ,$7.57 ,$25.66 ,$25.66 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$7.57 ,$7.57 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$7.57 ,$37.78 ,$8.02 ,$54.86 ,$16.49 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$8.02 ,$8.80 ,$8.80 ,$16.13 ,$8.80 ,$7.33 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000106,89125,HC FAT STAIN,300,1 ,$44.85 ,$29.60 ,$5.88 ,$44.85 ,$6.08 ,$20.58 ,$20.58 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$6.08 ,$6.08 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$6.08 ,$27.80 ,$6.44 ,$40.37 ,$13.23 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$6.44 ,$7.06 ,$7.06 ,$11.87 ,$7.06 ,$5.88 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000107,89190,HC SMEAR NASAL EOSINOPHILS,300,1 ,$47.15 ,$31.12 ,$5.79 ,$47.15 ,$5.98 ,$20.27 ,$20.27 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$5.98 ,$5.98 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$5.98 ,$29.24 ,$6.34 ,$42.44 ,$13.03 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$6.34 ,$6.95 ,$6.95 ,$12.48 ,$6.95 ,$5.79 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000120,80306,HC DRUG SCREEN URINE,300,1 ,$300.00 ,$198.00 ,$17.14 ,$300.00 ,$17.71 ,$59.99 ,$59.99 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$17.71 ,$17.71 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$17.71 ,$186.00 ,$18.77 ,$270.00 ,$38.57 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 ,$18.77 ,$20.57 ,$20.57 ,$79.38 ,$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 ,$40.26 ,$13.89 ,$61.00 ,$17.71 ,$59.99 ,$59.99 ,$16.14 ,$48.80 ,$51.85 ,$38.13 ,$54.90 ,$17.71 ,$17.71 ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$16.14 ,$51.85 ,$51.85 ,$54.90 ,$37.15 ,$17.71 ,$37.82 ,$18.77 ,$54.90 ,$38.57 ,$56.12 ,$54.90 ,$40.27 ,$40.27 ,$37.15 ,$40.27 ,$39.65 ,$41.68 ,$13.89 ,$48.19 ,$18.77 ,$20.57 ,$20.57 ,$16.14 ,$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 ,$120.78 ,$17.14 ,$183.00 ,$17.71 ,$59.99 ,$59.99 ,$48.42 ,$146.40 ,$155.55 ,$114.38 ,$164.70 ,$17.71 ,$17.71 ,$173.85 ,$164.70 ,$155.55 ,$155.55 ,$48.42 ,$155.55 ,$155.55 ,$164.70 ,$111.45 ,$17.71 ,$113.46 ,$18.77 ,$164.70 ,$38.57 ,$168.36 ,$164.70 ,$120.80 ,$120.80 ,$111.45 ,$120.80 ,$118.95 ,$125.03 ,$41.66 ,$144.57 ,$18.77 ,$20.57 ,$20.57 ,$48.42 ,$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 ,$103.50 ,$68.31 ,$13.40 ,$103.50 ,$13.40 ,$68.50 ,$68.50 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$13.40 ,$13.40 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$13.40 ,$64.18 ,$14.20 ,$93.15 ,$44.03 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$14.20 ,$23.48 ,$23.48 ,$27.39 ,$23.48 ,$19.57 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000200,80307,HC MECONIUM SCREEN MAYO,300,1 ,$370.00 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$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 ,$118.45 ,$78.18 ,$8.10 ,$118.45 ,$8.37 ,$28.35 ,$28.35 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$8.37 ,$8.37 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$8.37 ,$73.44 ,$8.87 ,$106.61 ,$18.23 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$8.87 ,$9.72 ,$9.72 ,$31.34 ,$9.72 ,$8.10 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000206,80307,HC DRUG SCREEN PANEL 9,300,1 ,$370.00 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$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 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$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 ,$116.15 ,$76.66 ,$14.72 ,$116.15 ,$15.21 ,$51.52 ,$51.52 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$15.21 ,$15.21 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$15.21 ,$72.02 ,$16.12 ,$104.54 ,$33.12 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$16.12 ,$17.66 ,$17.66 ,$30.73 ,$17.66 ,$14.72 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000227,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$297.85 ,$196.58 ,$12.05 ,$297.85 ,$12.45 ,$42.18 ,$42.18 ,$78.81 ,$238.28 ,$253.17 ,$186.16 ,$268.07 ,$12.45 ,$12.45 ,$282.96 ,$268.07 ,$253.17 ,$253.17 ,$78.81 ,$253.17 ,$253.17 ,$268.07 ,$181.39 ,$12.45 ,$184.66 ,$13.20 ,$268.07 ,$27.11 ,$274.02 ,$268.07 ,$196.61 ,$196.61 ,$181.39 ,$196.61 ,$193.60 ,$203.49 ,$67.82 ,$235.30 ,$13.20 ,$14.46 ,$14.46 ,$78.81 ,$14.46 ,$12.05 ,$282.96 ,$244.24 ,$244.24 ,$238.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30000236,80307,HC DRUG SCREEN PANEL 4,301,1 ,$370.00 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$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 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30002044,0346U,HC BETA AMYLOID AB40/AB42 LC-MS/MS RATIO PLASMA,300,1 ,$412.50 ,$272.25 ,$93.91 ,$412.50 , N/A ,$369.68 ,$369.68 ,$109.15 ,$330.00 ,$350.63 ,$257.81 ,$371.25 , N/A , N/A ,$391.88 ,$371.25 ,$350.63 ,$350.63 ,$109.15 ,$350.63 ,$350.63 ,$371.25 ,$251.21 , N/A ,$255.76 , N/A ,$371.25 , N/A ,$379.50 ,$371.25 ,$272.29 ,$272.29 ,$251.21 ,$272.29 ,$268.13 ,$281.82 ,$93.91 ,$325.88 , N/A ,$202.13 ,$202.13 ,$109.15 ,$202.13 , N/A ,$391.88 ,$338.25 ,$338.25 ,$330.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30010201,86332,HC IMMUNE COMPLEX ASSAY,300,1 ,$212.75 ,$140.42 ,$24.37 ,$212.75 ,$25.18 ,$85.30 ,$85.30 ,$56.29 ,$170.20 ,$180.84 ,$132.97 ,$191.48 ,$25.18 ,$25.18 ,$202.11 ,$191.48 ,$180.84 ,$180.84 ,$56.29 ,$180.84 ,$180.84 ,$191.48 ,$129.56 ,$25.18 ,$131.90 ,$26.69 ,$191.48 ,$54.83 ,$195.73 ,$191.48 ,$140.44 ,$140.44 ,$129.56 ,$140.44 ,$138.29 ,$145.35 ,$48.43 ,$168.07 ,$26.69 ,$29.24 ,$29.24 ,$56.29 ,$29.24 ,$24.37 ,$202.11 ,$174.46 ,$174.46 ,$170.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30080001,87804,HC FLU PRV 72HR,300,1 ,$115.00 ,$75.90 ,$16.55 ,$115.00 ,$16.86 ,$57.93 ,$57.93 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$16.86 ,$16.86 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 ,$16.86 ,$71.30 ,$17.87 ,$103.50 ,$37.24 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 ,$17.87 ,$19.86 ,$19.86 ,$30.43 ,$19.86 ,$16.55 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100101,80048,HC BASIC METABOLIC PANEL,301,1 ,$111.55 ,$73.62 ,$8.46 ,$111.55 ,$8.74 ,$29.61 ,$29.61 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$8.74 ,$8.74 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$8.74 ,$69.16 ,$9.26 ,$100.40 ,$19.04 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$9.26 ,$10.15 ,$10.15 ,$29.52 ,$10.15 ,$8.46 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100102,80050,HC GENERAL HEALTH PANEL,301,1 ,$391.00 ,$258.06 ,$15.23 ,$391.00 ,$15.23 ,$135.78 ,$135.78 ,$103.46 ,$312.80 ,$332.35 ,$244.38 ,$351.90 ,$15.23 ,$15.23 ,$371.45 ,$351.90 ,$332.35 ,$332.35 ,$103.46 ,$332.35 ,$332.35 ,$351.90 ,$238.12 ,$15.23 ,$242.42 ,$16.14 ,$351.90 , N/A ,$359.72 ,$351.90 ,$258.10 ,$258.10 ,$238.12 ,$258.10 ,$254.15 ,$267.13 ,$89.01 ,$308.89 ,$16.14 ,$56.74 ,$56.74 ,$103.46 ,$56.74 , N/A ,$371.45 ,$320.62 ,$320.62 ,$312.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100103,80051,HC ELECTROLYTE PANEL,301,1 ,$63.25 ,$41.75 ,$7.01 ,$63.25 ,$7.24 ,$24.54 ,$24.54 ,$16.74 ,$50.60 ,$53.76 ,$39.53 ,$56.93 ,$7.24 ,$7.24 ,$60.09 ,$56.93 ,$53.76 ,$53.76 ,$16.74 ,$53.76 ,$53.76 ,$56.93 ,$38.52 ,$7.24 ,$39.22 ,$7.67 ,$56.93 ,$15.77 ,$58.19 ,$56.93 ,$41.75 ,$41.75 ,$38.52 ,$41.75 ,$41.11 ,$43.21 ,$14.41 ,$49.97 ,$7.67 ,$8.41 ,$8.41 ,$16.74 ,$8.41 ,$7.01 ,$60.09 ,$51.87 ,$51.87 ,$50.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$154.10 ,$101.71 ,$10.56 ,$154.10 ,$10.91 ,$36.96 ,$36.96 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$10.91 ,$10.91 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$10.91 ,$95.54 ,$11.56 ,$138.69 ,$23.76 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$11.56 ,$12.67 ,$12.67 ,$40.78 ,$12.67 ,$10.56 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100107,80061,HC LIPID PANEL,301,1 ,$116.15 ,$76.66 ,$13.39 ,$116.15 ,$13.84 ,$46.87 ,$46.87 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.84 ,$13.84 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.84 ,$72.02 ,$14.67 ,$104.54 ,$30.13 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.67 ,$16.07 ,$16.07 ,$30.73 ,$16.07 ,$13.39 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100108,80069,HC RENAL PANEL,301,1 ,$128.80 ,$85.01 ,$8.68 ,$128.80 ,$8.97 ,$30.38 ,$30.38 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$8.97 ,$8.97 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$8.97 ,$79.86 ,$9.51 ,$115.92 ,$19.53 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$9.51 ,$10.42 ,$10.42 ,$34.08 ,$10.42 ,$8.68 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100109,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$411.70 ,$271.72 ,$47.63 ,$411.70 ,$49.22 ,$166.71 ,$166.71 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$49.22 ,$49.22 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$49.22 ,$255.26 ,$52.17 ,$370.53 ,$107.17 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$52.17 ,$57.16 ,$57.16 ,$108.94 ,$57.16 ,$47.63 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100110,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.44 ,$28.60 ,$28.60 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.44 ,$8.44 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.44 ,$55.62 ,$8.95 ,$80.73 ,$18.38 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$8.95 ,$9.80 ,$9.80 ,$23.74 ,$9.80 ,$8.17 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100111,80150,HC AMIKACIN,301,1 ,$136.85 ,$90.32 ,$15.08 ,$136.85 ,$15.58 ,$52.78 ,$52.78 ,$36.21 ,$109.48 ,$116.32 ,$85.53 ,$123.17 ,$15.58 ,$15.58 ,$130.01 ,$123.17 ,$116.32 ,$116.32 ,$36.21 ,$116.32 ,$116.32 ,$123.17 ,$83.34 ,$15.58 ,$84.84 ,$16.51 ,$123.17 ,$33.93 ,$125.90 ,$123.17 ,$90.33 ,$90.33 ,$83.34 ,$90.33 ,$88.95 ,$93.50 ,$31.15 ,$108.11 ,$16.51 ,$18.10 ,$18.10 ,$36.21 ,$18.10 ,$15.08 ,$130.01 ,$112.22 ,$112.22 ,$109.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100112,80335,HC AMITRIPTYLINE,301,1 ,$90.00 ,$59.40 ,$20.49 ,$90.00 ,$21.05 ,$79.87 ,$79.87 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$21.05 ,$21.05 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$21.05 ,$55.80 ,$22.31 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$22.31 , N/A , N/A ,$23.81 , 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 ,$69.96 ,$21.05 ,$106.00 ,$21.05 ,$79.87 ,$79.87 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 ,$21.05 ,$21.05 ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 ,$21.05 ,$65.72 ,$22.31 ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 ,$22.31 , N/A , N/A ,$28.05 , 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 ,$25.08 ,$8.65 ,$38.00 ,$21.05 ,$38.00 ,$38.00 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$21.05 ,$21.05 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 ,$21.05 ,$23.56 ,$22.31 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 ,$22.31 , N/A , N/A ,$10.05 , 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 ,$25.08 ,$8.65 ,$38.00 ,$21.05 ,$38.00 ,$38.00 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$21.05 ,$21.05 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 ,$21.05 ,$23.56 ,$22.31 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 ,$22.31 , N/A , N/A ,$10.05 , N/A , N/A ,$36.10 ,$31.16 ,$31.16 ,$30.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100116,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$124.20 ,$81.97 ,$14.57 ,$124.20 ,$15.06 ,$51.00 ,$51.00 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$15.06 ,$15.06 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$15.06 ,$77.00 ,$15.96 ,$111.78 ,$32.78 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$15.96 ,$17.48 ,$17.48 ,$32.86 ,$17.48 ,$14.57 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100117,80157,HC CARBAMAZEPINE FREE,301,1 ,$142.60 ,$94.12 ,$13.25 ,$142.60 ,$13.69 ,$46.38 ,$46.38 ,$37.73 ,$114.08 ,$121.21 ,$89.13 ,$128.34 ,$13.69 ,$13.69 ,$135.47 ,$128.34 ,$121.21 ,$121.21 ,$37.73 ,$121.21 ,$121.21 ,$128.34 ,$86.84 ,$13.69 ,$88.42 ,$14.51 ,$128.34 ,$29.81 ,$131.19 ,$128.34 ,$94.13 ,$94.13 ,$86.84 ,$94.13 ,$92.69 ,$97.42 ,$32.47 ,$112.65 ,$14.51 ,$15.90 ,$15.90 ,$37.73 ,$15.90 ,$13.25 ,$135.47 ,$116.93 ,$116.93 ,$114.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100118,80158,HC CYCLOSPORINE,301,1 ,$90.00 ,$59.40 ,$18.05 ,$90.00 ,$18.65 ,$63.18 ,$63.18 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$18.65 ,$18.65 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$18.65 ,$55.80 ,$19.77 ,$81.00 ,$40.61 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$19.77 ,$21.66 ,$21.66 ,$23.81 ,$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 ,$27.72 ,$9.56 ,$42.00 ,$21.05 ,$42.00 ,$42.00 ,$11.11 ,$33.60 ,$35.70 ,$26.25 ,$37.80 ,$21.05 ,$21.05 ,$39.90 ,$37.80 ,$35.70 ,$35.70 ,$11.11 ,$35.70 ,$35.70 ,$37.80 ,$25.58 ,$21.05 ,$26.04 ,$22.31 ,$37.80 , N/A ,$38.64 ,$37.80 ,$27.72 ,$27.72 ,$25.58 ,$27.72 ,$27.30 ,$28.69 ,$9.56 ,$33.18 ,$22.31 , N/A , N/A ,$11.11 , N/A , N/A ,$39.90 ,$34.44 ,$34.44 ,$33.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100120,80162,HC DIGOXIN LEVELS,301,1 ,$87.40 ,$57.68 ,$13.28 ,$87.40 ,$13.72 ,$46.48 ,$46.48 ,$23.13 ,$69.92 ,$74.29 ,$54.63 ,$78.66 ,$13.72 ,$13.72 ,$83.03 ,$78.66 ,$74.29 ,$74.29 ,$23.13 ,$74.29 ,$74.29 ,$78.66 ,$53.23 ,$13.72 ,$54.18 ,$14.54 ,$78.66 ,$29.88 ,$80.41 ,$78.66 ,$57.69 ,$57.69 ,$53.23 ,$57.69 ,$56.81 ,$59.71 ,$19.89 ,$69.05 ,$14.54 ,$15.94 ,$15.94 ,$23.13 ,$15.94 ,$13.28 ,$83.03 ,$71.67 ,$71.67 ,$69.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100121,80164,HC VALPROIC ACID,301,1 ,$111.55 ,$73.62 ,$13.54 ,$111.55 ,$13.99 ,$47.39 ,$47.39 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$13.99 ,$13.99 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$13.99 ,$69.16 ,$14.83 ,$100.40 ,$30.47 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$14.83 ,$16.25 ,$16.25 ,$29.52 ,$16.25 ,$13.54 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100122,80335,HC DOXEPIN,301,1 ,$62.00 ,$40.92 ,$14.11 ,$62.00 ,$21.05 ,$62.00 ,$62.00 ,$16.41 ,$49.60 ,$52.70 ,$38.75 ,$55.80 ,$21.05 ,$21.05 ,$58.90 ,$55.80 ,$52.70 ,$52.70 ,$16.41 ,$52.70 ,$52.70 ,$55.80 ,$37.76 ,$21.05 ,$38.44 ,$22.31 ,$55.80 , N/A ,$57.04 ,$55.80 ,$40.93 ,$40.93 ,$37.76 ,$40.93 ,$40.30 ,$42.36 ,$14.11 ,$48.98 ,$22.31 , N/A , N/A ,$16.41 , N/A , N/A ,$58.90 ,$50.84 ,$50.84 ,$49.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100123,80168,HC ZARONTIN,301,1 ,$136.85 ,$90.32 ,$16.34 ,$136.85 ,$16.88 ,$57.19 ,$57.19 ,$36.21 ,$109.48 ,$116.32 ,$85.53 ,$123.17 ,$16.88 ,$16.88 ,$130.01 ,$123.17 ,$116.32 ,$116.32 ,$36.21 ,$116.32 ,$116.32 ,$123.17 ,$83.34 ,$16.88 ,$84.84 ,$17.89 ,$123.17 ,$36.77 ,$125.90 ,$123.17 ,$90.33 ,$90.33 ,$83.34 ,$90.33 ,$88.95 ,$93.50 ,$31.15 ,$108.11 ,$17.89 ,$19.61 ,$19.61 ,$36.21 ,$19.61 ,$16.34 ,$130.01 ,$112.22 ,$112.22 ,$109.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100124,80170,HC GENTAMICIN,301,1 ,$198.95 ,$131.31 ,$16.38 ,$198.95 ,$16.93 ,$57.33 ,$57.33 ,$52.65 ,$159.16 ,$169.11 ,$124.34 ,$179.06 ,$16.93 ,$16.93 ,$189.00 ,$179.06 ,$169.11 ,$169.11 ,$52.65 ,$169.11 ,$169.11 ,$179.06 ,$121.16 ,$16.93 ,$123.34 ,$17.95 ,$179.06 ,$36.86 ,$183.03 ,$179.06 ,$131.33 ,$131.33 ,$121.16 ,$131.33 ,$129.32 ,$135.92 ,$45.30 ,$157.17 ,$17.95 ,$19.66 ,$19.66 ,$52.65 ,$19.66 ,$16.38 ,$189.00 ,$163.14 ,$163.14 ,$159.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100125,80335,HC IMIPRAMINE,301,1 ,$65.00 ,$42.90 ,$14.80 ,$65.00 ,$21.05 ,$65.00 ,$65.00 ,$17.20 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$21.05 ,$21.05 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$17.20 ,$55.25 ,$55.25 ,$58.50 ,$39.59 ,$21.05 ,$40.30 ,$22.31 ,$58.50 , N/A ,$59.80 ,$58.50 ,$42.91 ,$42.91 ,$39.59 ,$42.91 ,$42.25 ,$44.41 ,$14.80 ,$51.35 ,$22.31 , N/A , N/A ,$17.20 , N/A , N/A ,$61.75 ,$53.30 ,$53.30 ,$52.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100126,80176,HC LIDOCAINE,301,1 ,$223.10 ,$147.25 ,$14.69 ,$223.10 ,$15.18 ,$51.42 ,$51.42 ,$59.04 ,$178.48 ,$189.64 ,$139.44 ,$200.79 ,$15.18 ,$15.18 ,$211.95 ,$200.79 ,$189.64 ,$189.64 ,$59.04 ,$189.64 ,$189.64 ,$200.79 ,$135.87 ,$15.18 ,$138.32 ,$16.09 ,$200.79 ,$33.05 ,$205.25 ,$200.79 ,$147.27 ,$147.27 ,$135.87 ,$147.27 ,$145.02 ,$152.42 ,$50.78 ,$176.25 ,$16.09 ,$17.63 ,$17.63 ,$59.04 ,$17.63 ,$14.69 ,$211.95 ,$182.94 ,$182.94 ,$178.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100127,80178,HC LITHIUM,301,1 ,$56.35 ,$37.19 ,$6.61 ,$56.35 ,$6.83 ,$23.14 ,$23.14 ,$14.91 ,$45.08 ,$47.90 ,$35.22 ,$50.72 ,$6.83 ,$6.83 ,$53.53 ,$50.72 ,$47.90 ,$47.90 ,$14.91 ,$47.90 ,$47.90 ,$50.72 ,$34.32 ,$6.83 ,$34.94 ,$7.24 ,$50.72 ,$14.87 ,$51.84 ,$50.72 ,$37.20 ,$37.20 ,$34.32 ,$37.20 ,$36.63 ,$38.50 ,$12.83 ,$44.52 ,$7.24 ,$7.93 ,$7.93 ,$14.91 ,$7.93 ,$6.61 ,$53.53 ,$46.21 ,$46.21 ,$45.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100128,80335,HC NORTRIPTYLINE,301,1 ,$85.00 ,$56.10 ,$19.35 ,$85.00 ,$21.05 ,$79.87 ,$79.87 ,$22.49 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$21.05 ,$21.05 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$22.49 ,$72.25 ,$72.25 ,$76.50 ,$51.77 ,$21.05 ,$52.70 ,$22.31 ,$76.50 , N/A ,$78.20 ,$76.50 ,$56.11 ,$56.11 ,$51.77 ,$56.11 ,$55.25 ,$58.07 ,$19.35 ,$67.15 ,$22.31 , N/A , N/A ,$22.49 , N/A , N/A ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100129,80184,HC PHENOBARBITAL,301,1 ,$111.55 ,$73.62 ,$15.30 ,$111.55 ,$15.81 ,$53.55 ,$53.55 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$15.81 ,$15.81 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$15.81 ,$69.16 ,$16.76 ,$100.40 ,$34.43 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$16.76 ,$18.36 ,$18.36 ,$29.52 ,$18.36 ,$15.30 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100130,80185,HC PHENYTOIN TOTAL,301,1 ,$111.55 ,$73.62 ,$13.25 ,$111.55 ,$13.69 ,$46.38 ,$46.38 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$13.69 ,$13.69 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$13.69 ,$69.16 ,$14.51 ,$100.40 ,$29.81 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$14.51 ,$15.90 ,$15.90 ,$29.52 ,$15.90 ,$13.25 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100131,80186,HC PHENYTOIN FREE,301,1 ,$87.40 ,$57.68 ,$13.76 ,$87.40 ,$14.22 ,$48.16 ,$48.16 ,$23.13 ,$69.92 ,$74.29 ,$54.63 ,$78.66 ,$14.22 ,$14.22 ,$83.03 ,$78.66 ,$74.29 ,$74.29 ,$23.13 ,$74.29 ,$74.29 ,$78.66 ,$53.23 ,$14.22 ,$54.18 ,$15.07 ,$78.66 ,$30.96 ,$80.41 ,$78.66 ,$57.69 ,$57.69 ,$53.23 ,$57.69 ,$56.81 ,$59.71 ,$19.89 ,$69.05 ,$15.07 ,$16.51 ,$16.51 ,$23.13 ,$16.51 ,$13.76 ,$83.03 ,$71.67 ,$71.67 ,$69.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100132,80188,HC PRIMIDONE,301,1 ,$111.55 ,$73.62 ,$16.59 ,$111.55 ,$17.14 ,$58.07 ,$58.07 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$17.14 ,$17.14 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$17.14 ,$69.16 ,$18.17 ,$100.40 ,$37.33 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$18.17 ,$19.91 ,$19.91 ,$29.52 ,$19.91 ,$16.59 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100133,80192,HC PROCAINEAMIDE,301,1 ,$132.25 ,$87.29 ,$16.75 ,$132.25 ,$17.31 ,$58.63 ,$58.63 ,$35.00 ,$105.80 ,$112.41 ,$82.66 ,$119.03 ,$17.31 ,$17.31 ,$125.64 ,$119.03 ,$112.41 ,$112.41 ,$35.00 ,$112.41 ,$112.41 ,$119.03 ,$80.54 ,$17.31 ,$82.00 ,$18.35 ,$119.03 ,$37.69 ,$121.67 ,$119.03 ,$87.30 ,$87.30 ,$80.54 ,$87.30 ,$85.96 ,$90.35 ,$30.11 ,$104.48 ,$18.35 ,$20.10 ,$20.10 ,$35.00 ,$20.10 ,$16.75 ,$125.64 ,$108.45 ,$108.45 ,$105.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100134,80194,HC QUINIDINE,301,1 ,$126.50 ,$83.49 ,$14.60 ,$126.50 ,$15.09 ,$51.10 ,$51.10 ,$33.48 ,$101.20 ,$107.53 ,$79.06 ,$113.85 ,$15.09 ,$15.09 ,$120.18 ,$113.85 ,$107.53 ,$107.53 ,$33.48 ,$107.53 ,$107.53 ,$113.85 ,$77.04 ,$15.09 ,$78.44 ,$16.00 ,$113.85 ,$32.85 ,$116.38 ,$113.85 ,$83.50 ,$83.50 ,$77.04 ,$83.50 ,$82.23 ,$86.42 ,$28.80 ,$99.94 ,$16.00 ,$17.52 ,$17.52 ,$33.48 ,$17.52 ,$14.60 ,$120.18 ,$103.73 ,$103.73 ,$101.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100135,80195,HC RAPAMYCIN (SIROLIMUS),301,1 ,$98.90 ,$65.27 ,$13.73 ,$98.90 ,$14.19 ,$48.06 ,$48.06 ,$26.17 ,$79.12 ,$84.07 ,$61.81 ,$89.01 ,$14.19 ,$14.19 ,$93.96 ,$89.01 ,$84.07 ,$84.07 ,$26.17 ,$84.07 ,$84.07 ,$89.01 ,$60.23 ,$14.19 ,$61.32 ,$15.04 ,$89.01 ,$30.89 ,$90.99 ,$89.01 ,$65.28 ,$65.28 ,$60.23 ,$65.28 ,$64.29 ,$67.57 ,$22.52 ,$78.13 ,$15.04 ,$16.48 ,$16.48 ,$26.17 ,$16.48 ,$13.73 ,$93.96 ,$81.10 ,$81.10 ,$79.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100136,G0480,HC SALICYLATE,301,1 ,$180.00 ,$118.80 ,$40.97 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$47.63 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$47.63 ,$153.00 ,$153.00 ,$162.00 ,$109.62 ,$63.95 ,$111.60 ,$67.79 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$118.82 ,$118.82 ,$109.62 ,$118.82 ,$117.00 ,$122.98 ,$40.97 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$47.63 ,$137.32 ,$114.43 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100137,80197,HC TACROLIMUS,301,1 ,$111.55 ,$73.62 ,$13.73 ,$111.55 ,$14.19 ,$48.06 ,$48.06 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$14.19 ,$14.19 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$14.19 ,$69.16 ,$15.04 ,$100.40 ,$30.89 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$15.04 ,$16.48 ,$16.48 ,$29.52 ,$16.48 ,$13.73 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100138,80198,HC THEOPHYLLINE,301,1 ,$98.90 ,$65.27 ,$14.14 ,$98.90 ,$14.61 ,$49.49 ,$49.49 ,$26.17 ,$79.12 ,$84.07 ,$61.81 ,$89.01 ,$14.61 ,$14.61 ,$93.96 ,$89.01 ,$84.07 ,$84.07 ,$26.17 ,$84.07 ,$84.07 ,$89.01 ,$60.23 ,$14.61 ,$61.32 ,$15.49 ,$89.01 ,$31.82 ,$90.99 ,$89.01 ,$65.28 ,$65.28 ,$60.23 ,$65.28 ,$64.29 ,$67.57 ,$22.52 ,$78.13 ,$15.49 ,$16.97 ,$16.97 ,$26.17 ,$16.97 ,$14.14 ,$93.96 ,$81.10 ,$81.10 ,$79.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100139,80200,HC TOBRAMYCIN,301,1 ,$111.55 ,$73.62 ,$16.13 ,$111.55 ,$16.67 ,$56.46 ,$56.46 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$16.67 ,$16.67 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$16.67 ,$69.16 ,$17.67 ,$100.40 ,$36.29 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$17.67 ,$19.36 ,$19.36 ,$29.52 ,$19.36 ,$16.13 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100140,80201,HC TOPIRAMATE,301,1 ,$111.55 ,$73.62 ,$11.92 ,$111.55 ,$12.32 ,$41.72 ,$41.72 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$12.32 ,$12.32 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$12.32 ,$69.16 ,$13.06 ,$100.40 ,$26.82 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$13.06 ,$14.30 ,$14.30 ,$29.52 ,$14.30 ,$11.92 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100141,80202,HC VANCOMYCIN,301,1 ,$136.85 ,$90.32 ,$13.54 ,$136.85 ,$13.99 ,$47.39 ,$47.39 ,$36.21 ,$109.48 ,$116.32 ,$85.53 ,$123.17 ,$13.99 ,$13.99 ,$130.01 ,$123.17 ,$116.32 ,$116.32 ,$36.21 ,$116.32 ,$116.32 ,$123.17 ,$83.34 ,$13.99 ,$84.84 ,$14.83 ,$123.17 ,$30.47 ,$125.90 ,$123.17 ,$90.33 ,$90.33 ,$83.34 ,$90.33 ,$88.95 ,$93.50 ,$31.15 ,$108.11 ,$14.83 ,$16.25 ,$16.25 ,$36.21 ,$16.25 ,$13.54 ,$130.01 ,$112.22 ,$112.22 ,$109.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100142,80299,HC WARFARIN,301,1 ,$179.40 ,$118.40 ,$18.64 ,$179.40 ,$19.26 ,$65.24 ,$65.24 ,$47.47 ,$143.52 ,$152.49 ,$112.13 ,$161.46 ,$19.26 ,$19.26 ,$170.43 ,$161.46 ,$152.49 ,$152.49 ,$47.47 ,$152.49 ,$152.49 ,$161.46 ,$109.25 ,$19.26 ,$111.22 ,$20.42 ,$161.46 ,$41.94 ,$165.05 ,$161.46 ,$118.42 ,$118.42 ,$109.25 ,$118.42 ,$116.61 ,$122.57 ,$40.84 ,$141.73 ,$20.42 ,$22.37 ,$22.37 ,$47.47 ,$22.37 ,$18.64 ,$170.43 ,$147.11 ,$147.11 ,$143.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100143,80299,HC FELBAMATE,301,1 ,$186.30 ,$122.96 ,$18.64 ,$186.30 ,$19.26 ,$65.24 ,$65.24 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$19.26 ,$19.26 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$19.26 ,$115.50 ,$20.42 ,$167.67 ,$41.94 ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$20.42 ,$22.37 ,$22.37 ,$49.29 ,$22.37 ,$18.64 ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100144,80299,HC IBUPROFEN,301,1 ,$141.45 ,$93.36 ,$18.64 ,$141.45 ,$19.26 ,$65.24 ,$65.24 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$19.26 ,$19.26 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$19.26 ,$87.70 ,$20.42 ,$127.31 ,$41.94 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$20.42 ,$22.37 ,$22.37 ,$37.43 ,$22.37 ,$18.64 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100145,80187,HC FLECAINAIDE,301,1 ,$50.00 ,$33.00 ,$11.39 ,$61.00 ,$21.69 ,$50.00 ,$50.00 ,$13.23 ,$40.00 ,$42.50 ,$31.25 ,$45.00 ,$21.69 ,$21.69 ,$47.50 ,$45.00 ,$42.50 ,$42.50 ,$13.23 ,$42.50 ,$42.50 ,$45.00 ,$30.45 ,$21.69 ,$31.00 ,$22.99 ,$45.00 ,$61.00 ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$39.50 ,$22.99 ,$32.53 ,$32.53 ,$13.23 ,$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 ,$72.60 ,$14.48 ,$110.00 ,$14.48 ,$75.85 ,$75.85 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$14.48 ,$14.48 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$14.48 ,$68.20 ,$15.35 ,$99.00 ,$48.76 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$15.35 ,$26.00 ,$26.00 ,$29.11 ,$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 ,$59.40 ,$13.25 ,$90.00 ,$13.69 ,$46.38 ,$46.38 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$13.69 ,$13.69 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$13.69 ,$55.80 ,$14.51 ,$81.00 ,$29.81 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$14.51 ,$15.90 ,$15.90 ,$23.81 ,$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 ,$66.00 ,$13.25 ,$100.00 ,$13.69 ,$46.38 ,$46.38 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$13.69 ,$13.69 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$13.69 ,$62.00 ,$14.51 ,$90.00 ,$29.81 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$26.46 ,$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 ,$72.60 ,$13.25 ,$110.00 ,$13.69 ,$46.38 ,$46.38 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$13.69 ,$13.69 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$13.69 ,$68.20 ,$14.51 ,$99.00 ,$29.81 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$14.51 ,$15.90 ,$15.90 ,$29.11 ,$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 ,$66.00 ,$13.25 ,$100.00 ,$13.69 ,$46.38 ,$46.38 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$13.69 ,$13.69 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$13.69 ,$62.00 ,$14.51 ,$90.00 ,$29.81 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$26.46 ,$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 ,$79.20 ,$19.70 ,$120.00 ,$19.70 ,$94.89 ,$94.89 ,$31.75 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$19.70 ,$19.70 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$31.75 ,$102.00 ,$102.00 ,$108.00 ,$73.08 ,$19.70 ,$74.40 ,$20.88 ,$108.00 ,$61.00 ,$110.40 ,$108.00 ,$79.21 ,$79.21 ,$73.08 ,$79.21 ,$78.00 ,$81.98 ,$27.32 ,$94.80 ,$20.88 ,$32.53 ,$32.53 ,$31.75 ,$32.53 ,$27.11 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100152,80299,HC TRAZODONE,301,1 ,$186.30 ,$122.96 ,$18.64 ,$186.30 ,$19.26 ,$65.24 ,$65.24 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$19.26 ,$19.26 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$19.26 ,$115.50 ,$20.42 ,$167.67 ,$41.94 ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$20.42 ,$22.37 ,$22.37 ,$49.29 ,$22.37 ,$18.64 ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100153,80299,HC RITALIN,301,1 ,$104.65 ,$69.07 ,$18.64 ,$104.65 ,$19.26 ,$65.24 ,$65.24 ,$27.69 ,$83.72 ,$88.95 ,$65.41 ,$94.19 ,$19.26 ,$19.26 ,$99.42 ,$94.19 ,$88.95 ,$88.95 ,$27.69 ,$88.95 ,$88.95 ,$94.19 ,$63.73 ,$19.26 ,$64.88 ,$20.42 ,$94.19 ,$41.94 ,$96.28 ,$94.19 ,$69.08 ,$69.08 ,$63.73 ,$69.08 ,$68.02 ,$71.50 ,$23.82 ,$82.67 ,$20.42 ,$22.37 ,$22.37 ,$27.69 ,$22.37 ,$18.64 ,$99.42 ,$85.81 ,$85.81 ,$83.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100155,81099,HC INBORN ERR METABOLISM,301,1 ,$760.15 ,$501.70 ,$5.11 ,$760.15 ,$5.11 ,$681.25 ,$681.25 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$5.11 ,$5.11 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$5.11 ,$471.30 ,$5.42 ,$684.14 ,$456.09 ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 , N/A ,$600.52 ,$5.42 ,$372.47 ,$372.47 ,$201.14 ,$372.47 , N/A ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100156,G0480,HC ACETAMINOPHEN,301,1 ,$200.00 ,$132.00 ,$45.53 ,$257.47 ,$63.95 ,$200.00 ,$200.00 ,$52.92 ,$160.00 ,$170.00 ,$125.00 ,$180.00 ,$63.95 ,$63.95 ,$190.00 ,$180.00 ,$170.00 ,$170.00 ,$52.92 ,$170.00 ,$170.00 ,$180.00 ,$121.80 ,$63.95 ,$124.00 ,$67.79 ,$180.00 ,$257.47 ,$184.00 ,$180.00 ,$132.02 ,$132.02 ,$121.80 ,$132.02 ,$130.00 ,$136.64 ,$45.53 ,$158.00 ,$67.79 ,$137.32 ,$137.32 ,$52.92 ,$137.32 ,$114.43 ,$190.00 ,$164.00 ,$164.00 ,$160.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100157,82009,HC ACETONE SERUM,301,1 ,$55.20 ,$36.43 ,$4.52 ,$55.20 ,$4.67 ,$15.82 ,$15.82 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$4.67 ,$4.67 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$4.67 ,$34.22 ,$4.95 ,$49.68 ,$10.17 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$4.95 ,$5.42 ,$5.42 ,$14.60 ,$5.42 ,$4.52 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100158,82010,HC ACETONE KETONES SERUM QN,301,1 ,$63.25 ,$41.75 ,$8.17 ,$63.25 ,$8.44 ,$28.60 ,$28.60 ,$16.74 ,$50.60 ,$53.76 ,$39.53 ,$56.93 ,$8.44 ,$8.44 ,$60.09 ,$56.93 ,$53.76 ,$53.76 ,$16.74 ,$53.76 ,$53.76 ,$56.93 ,$38.52 ,$8.44 ,$39.22 ,$8.95 ,$56.93 ,$18.38 ,$58.19 ,$56.93 ,$41.75 ,$41.75 ,$38.52 ,$41.75 ,$41.11 ,$43.21 ,$14.41 ,$49.97 ,$8.95 ,$9.80 ,$9.80 ,$16.74 ,$9.80 ,$8.17 ,$60.09 ,$51.87 ,$51.87 ,$50.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100159,82017,HC ACYLCARNITINES QN EA SPEC,301,1 ,$554.30 ,$365.84 ,$16.87 ,$554.30 ,$17.43 ,$59.05 ,$59.05 ,$146.67 ,$443.44 ,$471.16 ,$346.44 ,$498.87 ,$17.43 ,$17.43 ,$526.59 ,$498.87 ,$471.16 ,$471.16 ,$146.67 ,$471.16 ,$471.16 ,$498.87 ,$337.57 ,$17.43 ,$343.66 ,$18.48 ,$498.87 ,$37.96 ,$509.96 ,$498.87 ,$365.89 ,$365.89 ,$337.57 ,$365.89 ,$360.30 ,$378.70 ,$126.18 ,$437.90 ,$18.48 ,$20.24 ,$20.24 ,$146.67 ,$20.24 ,$16.87 ,$526.59 ,$454.53 ,$454.53 ,$443.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100162,82017,HC ACYLCARNITINES QN PLASMA MAYO,301,1 ,$497.95 ,$328.65 ,$16.87 ,$497.95 ,$17.43 ,$59.05 ,$59.05 ,$131.76 ,$398.36 ,$423.26 ,$311.22 ,$448.16 ,$17.43 ,$17.43 ,$473.05 ,$448.16 ,$423.26 ,$423.26 ,$131.76 ,$423.26 ,$423.26 ,$448.16 ,$303.25 ,$17.43 ,$308.72 ,$18.48 ,$448.16 ,$37.96 ,$458.11 ,$448.16 ,$328.70 ,$328.70 ,$303.25 ,$328.70 ,$323.67 ,$340.20 ,$113.37 ,$393.38 ,$18.48 ,$20.24 ,$20.24 ,$131.76 ,$20.24 ,$16.87 ,$473.05 ,$408.32 ,$408.32 ,$398.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100163,82024,HC ACTH,301,1 ,$334.65 ,$220.87 ,$38.62 ,$334.65 ,$39.91 ,$135.17 ,$135.17 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$39.91 ,$39.91 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$39.91 ,$207.48 ,$42.30 ,$301.19 ,$86.90 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$42.30 ,$46.34 ,$46.34 ,$88.55 ,$46.34 ,$38.62 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100164,82040,HC ALBUMIN,301,1 ,$43.70 ,$28.84 ,$4.95 ,$43.70 ,$5.11 ,$17.33 ,$17.33 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$5.11 ,$5.11 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$5.11 ,$27.10 ,$5.42 ,$39.33 ,$11.14 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$5.42 ,$5.94 ,$5.94 ,$11.56 ,$5.94 ,$4.95 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100165,82040,HC ALBUMIN SERUM,301,1 ,$40.25 ,$26.57 ,$4.95 ,$40.25 ,$5.11 ,$17.33 ,$17.33 ,$10.65 ,$32.20 ,$34.21 ,$25.16 ,$36.23 ,$5.11 ,$5.11 ,$38.24 ,$36.23 ,$34.21 ,$34.21 ,$10.65 ,$34.21 ,$34.21 ,$36.23 ,$24.51 ,$5.11 ,$24.96 ,$5.42 ,$36.23 ,$11.14 ,$37.03 ,$36.23 ,$26.57 ,$26.57 ,$24.51 ,$26.57 ,$26.16 ,$27.50 ,$9.16 ,$31.80 ,$5.42 ,$5.94 ,$5.94 ,$10.65 ,$5.94 ,$4.95 ,$38.24 ,$33.01 ,$33.01 ,$32.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100166,82042,HC ALBUMIN BODY FLUID,301,1 ,$77.05 ,$50.85 ,$7.27 ,$77.05 ,$7.27 ,$27.23 ,$27.23 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$7.27 ,$7.27 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$7.27 ,$47.78 ,$7.71 ,$69.35 ,$17.51 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$7.71 ,$9.34 ,$9.34 ,$20.38 ,$9.34 ,$7.78 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100167,82042,HC ALBUMIN CSF,301,1 ,$77.05 ,$50.85 ,$7.27 ,$77.05 ,$7.27 ,$27.23 ,$27.23 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$7.27 ,$7.27 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$7.27 ,$47.78 ,$7.71 ,$69.35 ,$17.51 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$7.71 ,$9.34 ,$9.34 ,$20.38 ,$9.34 ,$7.78 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$62.10 ,$40.99 ,$5.78 ,$62.10 ,$5.97 ,$20.23 ,$20.23 ,$16.43 ,$49.68 ,$52.79 ,$38.81 ,$55.89 ,$5.97 ,$5.97 ,$59.00 ,$55.89 ,$52.79 ,$52.79 ,$16.43 ,$52.79 ,$52.79 ,$55.89 ,$37.82 ,$5.97 ,$38.50 ,$6.33 ,$55.89 ,$13.01 ,$57.13 ,$55.89 ,$40.99 ,$40.99 ,$37.82 ,$40.99 ,$40.37 ,$42.43 ,$14.13 ,$49.06 ,$6.33 ,$6.94 ,$6.94 ,$16.43 ,$6.94 ,$5.78 ,$59.00 ,$50.92 ,$50.92 ,$49.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100169,G0480,HC ALCOHOL (ETOH),301,1 ,$180.00 ,$118.80 ,$40.97 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$47.63 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$47.63 ,$153.00 ,$153.00 ,$162.00 ,$109.62 ,$63.95 ,$111.60 ,$67.79 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$118.82 ,$118.82 ,$109.62 ,$118.82 ,$117.00 ,$122.98 ,$40.97 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$47.63 ,$137.32 ,$114.43 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100170,82085,HC ALDOLASE,301,1 ,$77.05 ,$50.85 ,$9.71 ,$77.05 ,$10.03 ,$33.99 ,$33.99 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$10.03 ,$10.03 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$10.03 ,$47.78 ,$10.63 ,$69.35 ,$21.85 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$10.63 ,$11.65 ,$11.65 ,$20.38 ,$11.65 ,$9.71 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100171,82088,HC ALDOSTERONE,301,1 ,$361.10 ,$238.33 ,$40.75 ,$361.10 ,$42.11 ,$142.63 ,$142.63 ,$95.55 ,$288.88 ,$306.94 ,$225.69 ,$324.99 ,$42.11 ,$42.11 ,$343.05 ,$324.99 ,$306.94 ,$306.94 ,$95.55 ,$306.94 ,$306.94 ,$324.99 ,$219.91 ,$42.11 ,$223.88 ,$44.64 ,$324.99 ,$91.69 ,$332.21 ,$324.99 ,$238.36 ,$238.36 ,$219.91 ,$238.36 ,$234.72 ,$246.70 ,$82.20 ,$285.27 ,$44.64 ,$48.90 ,$48.90 ,$95.55 ,$48.90 ,$40.75 ,$343.05 ,$296.10 ,$296.10 ,$288.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100172,82103,HC ALPHA-1 ANTITRYPSIN TOTAL,301,1 ,$118.45 ,$78.18 ,$13.44 ,$118.45 ,$13.89 ,$47.04 ,$47.04 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$13.89 ,$13.89 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$13.89 ,$73.44 ,$14.72 ,$106.61 ,$30.24 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$14.72 ,$16.13 ,$16.13 ,$31.34 ,$16.13 ,$13.44 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100174,82104,HC ANTITRYPSIN PHENO,301,1 ,$170.20 ,$112.33 ,$14.46 ,$170.20 ,$14.94 ,$50.61 ,$50.61 ,$45.03 ,$136.16 ,$144.67 ,$106.38 ,$153.18 ,$14.94 ,$14.94 ,$161.69 ,$153.18 ,$144.67 ,$144.67 ,$45.03 ,$144.67 ,$144.67 ,$153.18 ,$103.65 ,$14.94 ,$105.52 ,$15.84 ,$153.18 ,$32.54 ,$156.58 ,$153.18 ,$112.35 ,$112.35 ,$103.65 ,$112.35 ,$110.63 ,$116.28 ,$38.75 ,$134.46 ,$15.84 ,$17.35 ,$17.35 ,$45.03 ,$17.35 ,$14.46 ,$161.69 ,$139.56 ,$139.56 ,$136.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100175,82105,HC ALPHA FETOPROTEIN SERUM,301,1 ,$141.45 ,$93.36 ,$16.77 ,$141.45 ,$17.33 ,$58.70 ,$58.70 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$17.33 ,$17.33 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$17.33 ,$87.70 ,$18.37 ,$127.31 ,$37.73 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$18.37 ,$20.12 ,$20.12 ,$37.43 ,$20.12 ,$16.77 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100178,82105,HC AFP MATERNAL,301,1 ,$141.45 ,$93.36 ,$16.77 ,$141.45 ,$17.33 ,$58.70 ,$58.70 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$17.33 ,$17.33 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$17.33 ,$87.70 ,$18.37 ,$127.31 ,$37.73 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$18.37 ,$20.12 ,$20.12 ,$37.43 ,$20.12 ,$16.77 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100179,82108,HC ALUMINUM,301,1 ,$180.55 ,$119.16 ,$25.48 ,$180.55 ,$26.33 ,$89.18 ,$89.18 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$26.33 ,$26.33 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$26.33 ,$111.94 ,$27.91 ,$162.50 ,$57.33 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$27.91 ,$30.58 ,$30.58 ,$47.77 ,$30.58 ,$25.48 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100180,82131,HC AMINO ACID QN SINGLE,301,1 ,$195.50 ,$129.03 ,$21.01 ,$195.50 ,$21.01 ,$80.43 ,$80.43 ,$51.73 ,$156.40 ,$166.18 ,$122.19 ,$175.95 ,$21.01 ,$21.01 ,$185.73 ,$175.95 ,$166.18 ,$166.18 ,$51.73 ,$166.18 ,$166.18 ,$175.95 ,$119.06 ,$21.01 ,$121.22 ,$22.27 ,$175.95 ,$51.71 ,$179.86 ,$175.95 ,$129.05 ,$129.05 ,$119.06 ,$129.05 ,$127.08 ,$133.57 ,$44.51 ,$154.45 ,$22.27 ,$27.58 ,$27.58 ,$51.73 ,$27.58 ,$22.98 ,$185.73 ,$160.31 ,$160.31 ,$156.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100182,82139,HC AMINO ACID 6+ QN PLASMA,301,1 ,"$1,288.00 ",$850.08 ,$16.87 ,"$1,288.00 ",$17.43 ,$59.05 ,$59.05 ,$340.80 ,"$1,030.40 ","$1,094.80 ",$805.00 ,"$1,159.20 ",$17.43 ,$17.43 ,"$1,223.60 ","$1,159.20 ","$1,094.80 ","$1,094.80 ",$340.80 ,"$1,094.80 ","$1,094.80 ","$1,159.20 ",$784.39 ,$17.43 ,$798.56 ,$18.48 ,"$1,159.20 ",$37.96 ,"$1,184.96 ","$1,159.20 ",$850.21 ,$850.21 ,$784.39 ,$850.21 ,$837.20 ,$879.96 ,$293.22 ,"$1,017.52 ",$18.48 ,$20.24 ,$20.24 ,$340.80 ,$20.24 ,$16.87 ,"$1,223.60 ","$1,056.16 ","$1,056.16 ","$1,030.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30100186,82140,HC AMMONIA,301,1 ,$128.80 ,$85.01 ,$14.57 ,$128.80 ,$15.06 ,$51.00 ,$51.00 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.06 ,$15.06 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.06 ,$79.86 ,$15.96 ,$115.92 ,$32.78 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.96 ,$17.48 ,$17.48 ,$34.08 ,$17.48 ,$14.57 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100187,80324,HC AMPHETAMINE,301,1 ,$46.00 ,$30.36 ,$10.48 ,$46.00 ,$21.05 ,$46.00 ,$46.00 ,$12.17 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$21.05 ,$21.05 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$12.17 ,$39.10 ,$39.10 ,$41.40 ,$28.01 ,$21.05 ,$28.52 ,$22.31 ,$41.40 , N/A ,$42.32 ,$41.40 ,$30.36 ,$30.36 ,$28.01 ,$30.36 ,$29.90 ,$31.43 ,$10.48 ,$36.34 ,$22.31 , N/A , N/A ,$12.17 , N/A , N/A ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100188,82150,HC AMYLASE,301,1 ,$77.05 ,$50.85 ,$6.48 ,$77.05 ,$6.70 ,$22.68 ,$22.68 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$6.70 ,$6.70 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$6.70 ,$47.78 ,$7.10 ,$69.35 ,$14.58 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$7.10 ,$7.78 ,$7.78 ,$20.38 ,$7.78 ,$6.48 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100189,82157,HC ANDROSTENEDIONE,301,1 ,$257.60 ,$170.02 ,$29.28 ,$257.60 ,$30.26 ,$102.48 ,$102.48 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$30.26 ,$30.26 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$30.26 ,$159.72 ,$32.08 ,$231.84 ,$65.88 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$32.08 ,$35.14 ,$35.14 ,$68.16 ,$35.14 ,$29.28 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100190,82164,"HC ACE, CSF",301,1 ,$128.80 ,$85.01 ,$14.60 ,$128.80 ,$15.09 ,$51.10 ,$51.10 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.09 ,$15.09 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.09 ,$79.86 ,$16.00 ,$115.92 ,$32.85 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.00 ,$17.52 ,$17.52 ,$34.08 ,$17.52 ,$14.60 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100191,82164,HC ANGIOTENSIN 1 ENZYME (ACE),301,1 ,$128.80 ,$85.01 ,$14.60 ,$128.80 ,$15.09 ,$51.10 ,$51.10 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.09 ,$15.09 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.09 ,$79.86 ,$16.00 ,$115.92 ,$32.85 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.00 ,$17.52 ,$17.52 ,$34.08 ,$17.52 ,$14.60 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100192,82172,HC APOLIPOPROTEIN SERUM,301,1 ,$116.15 ,$76.66 ,$21.09 ,$116.15 ,$21.79 ,$73.82 ,$73.82 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$21.79 ,$21.79 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$21.79 ,$72.02 ,$23.10 ,$104.54 ,$47.45 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$23.10 ,$25.31 ,$25.31 ,$30.73 ,$25.31 ,$21.09 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100193,82175,HC ARSENIC,301,1 ,$60.95 ,$40.23 ,$13.88 ,$60.95 ,$19.60 ,$60.95 ,$60.95 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$19.60 ,$19.60 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$19.60 ,$37.78 ,$20.78 ,$54.86 ,$42.68 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$20.78 ,$22.76 ,$22.76 ,$16.13 ,$22.76 ,$18.97 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100194,82175,HC ARSENIC BLOOD,301,1 ,$103.50 ,$68.31 ,$18.97 ,$103.50 ,$19.60 ,$66.40 ,$66.40 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$19.60 ,$19.60 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$19.60 ,$64.18 ,$20.78 ,$93.15 ,$42.68 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$20.78 ,$22.76 ,$22.76 ,$27.39 ,$22.76 ,$18.97 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100195,82175,HC ARSENIC URINE,301,1 ,$103.50 ,$68.31 ,$18.97 ,$103.50 ,$19.60 ,$66.40 ,$66.40 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$19.60 ,$19.60 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$19.60 ,$64.18 ,$20.78 ,$93.15 ,$42.68 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$20.78 ,$22.76 ,$22.76 ,$27.39 ,$22.76 ,$18.97 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100196,82175,HC ARESNIC 24 HR URINE,301,1 ,$103.50 ,$68.31 ,$18.97 ,$103.50 ,$19.60 ,$66.40 ,$66.40 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$19.60 ,$19.60 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$19.60 ,$64.18 ,$20.78 ,$93.15 ,$42.68 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$20.78 ,$22.76 ,$22.76 ,$27.39 ,$22.76 ,$18.97 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100197,82180,HC VITAMIN C (ASCORBIC ACID),301,1 ,$89.70 ,$59.20 ,$9.89 ,$89.70 ,$10.22 ,$34.62 ,$34.62 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.22 ,$10.22 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.22 ,$55.62 ,$10.83 ,$80.73 ,$22.25 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.83 ,$11.87 ,$11.87 ,$23.74 ,$11.87 ,$9.89 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100199,80345,HC BARBITURATE,301,1 ,$38.00 ,$25.08 ,$8.65 ,$38.00 ,$21.05 ,$38.00 ,$38.00 ,$10.05 ,$30.40 ,$32.30 ,$23.75 ,$34.20 ,$21.05 ,$21.05 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 ,$21.05 ,$23.56 ,$22.31 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 ,$22.31 , N/A , N/A ,$10.05 , 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 ,$141.45 ,$93.36 ,$16.18 ,$141.45 ,$16.72 ,$56.63 ,$56.63 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.72 ,$16.72 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.72 ,$87.70 ,$17.72 ,$127.31 ,$36.41 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$17.72 ,$19.42 ,$19.42 ,$37.43 ,$19.42 ,$16.18 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$43.70 ,$28.84 ,$4.24 ,$43.70 ,$4.24 ,$17.57 ,$17.57 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$4.24 ,$4.24 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$4.24 ,$27.10 ,$4.49 ,$39.33 ,$11.30 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$4.49 ,$6.02 ,$6.02 ,$11.56 ,$6.02 ,$5.02 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$43.70 ,$28.84 ,$4.70 ,$43.70 ,$4.70 ,$17.57 ,$17.57 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$4.70 ,$4.70 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$4.70 ,$27.10 ,$4.98 ,$39.33 ,$11.30 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$4.98 ,$6.02 ,$6.02 ,$11.56 ,$6.02 ,$5.02 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100205,82270,HC OCCULT BLOOD FECAL SCRN,301,1 ,$29.90 ,$19.73 ,$3.66 ,$29.90 ,$3.66 ,$15.33 ,$15.33 ,$7.91 ,$23.92 ,$25.42 ,$18.69 ,$26.91 ,$3.66 ,$3.66 ,$28.41 ,$26.91 ,$25.42 ,$25.42 ,$7.91 ,$25.42 ,$25.42 ,$26.91 ,$18.21 ,$3.66 ,$18.54 ,$3.88 ,$26.91 ,$9.86 ,$27.51 ,$26.91 ,$19.74 ,$19.74 ,$18.21 ,$19.74 ,$19.44 ,$20.43 ,$6.81 ,$23.62 ,$3.88 ,$5.26 ,$5.26 ,$7.91 ,$5.26 ,$4.38 ,$28.41 ,$24.52 ,$24.52 ,$23.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100206,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$29.90 ,$19.73 ,$4.26 ,$29.90 ,$4.26 ,$18.62 ,$18.62 ,$7.91 ,$23.92 ,$25.42 ,$18.69 ,$26.91 ,$4.26 ,$4.26 ,$28.41 ,$26.91 ,$25.42 ,$25.42 ,$7.91 ,$25.42 ,$25.42 ,$26.91 ,$18.21 ,$4.26 ,$18.54 ,$4.52 ,$26.91 ,$11.97 ,$27.51 ,$26.91 ,$19.74 ,$19.74 ,$18.21 ,$19.74 ,$19.44 ,$20.43 ,$6.81 ,$23.62 ,$4.52 ,$6.38 ,$6.38 ,$7.91 ,$6.38 ,$5.32 ,$28.41 ,$24.52 ,$24.52 ,$23.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100207,82272,HC OCCULT BLOOD FECAL DIAG,301,1 ,$28.75 ,$18.98 ,$4.23 ,$28.75 ,$4.26 ,$14.81 ,$14.81 ,$7.60 ,$23.00 ,$24.44 ,$17.97 ,$25.88 ,$4.26 ,$4.26 ,$27.31 ,$25.88 ,$24.44 ,$24.44 ,$7.60 ,$24.44 ,$24.44 ,$25.88 ,$17.51 ,$4.26 ,$17.82 ,$4.52 ,$25.88 ,$9.52 ,$26.45 ,$25.88 ,$18.98 ,$18.98 ,$17.51 ,$18.98 ,$18.69 ,$19.64 ,$6.55 ,$22.71 ,$4.52 ,$5.08 ,$5.08 ,$7.60 ,$5.08 ,$4.23 ,$27.31 ,$23.58 ,$23.58 ,$23.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100208,82274,HC OCCULT BLOOD FECAL HGB,301,1 ,$131.10 ,$86.53 ,$15.92 ,$131.10 ,$16.45 ,$55.72 ,$55.72 ,$34.69 ,$104.88 ,$111.44 ,$81.94 ,$117.99 ,$16.45 ,$16.45 ,$124.55 ,$117.99 ,$111.44 ,$111.44 ,$34.69 ,$111.44 ,$111.44 ,$117.99 ,$79.84 ,$16.45 ,$81.28 ,$17.44 ,$117.99 ,$35.82 ,$120.61 ,$117.99 ,$86.54 ,$86.54 ,$79.84 ,$86.54 ,$85.22 ,$89.57 ,$29.84 ,$103.57 ,$17.44 ,$19.10 ,$19.10 ,$34.69 ,$19.10 ,$15.92 ,$124.55 ,$107.50 ,$107.50 ,$104.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100209,82300,HC CADMIUM,301,1 ,$103.50 ,$68.31 ,$23.57 ,$103.50 ,$24.43 ,$82.74 ,$82.74 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$24.43 ,$24.43 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$24.43 ,$64.18 ,$25.90 ,$93.15 ,$53.19 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$25.90 ,$28.37 ,$28.37 ,$27.39 ,$28.37 ,$23.64 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100210,82300,HC CADMIUM URINE,301,1 ,$103.50 ,$68.31 ,$23.57 ,$103.50 ,$24.43 ,$82.74 ,$82.74 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$24.43 ,$24.43 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$24.43 ,$64.18 ,$25.90 ,$93.15 ,$53.19 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$25.90 ,$28.37 ,$28.37 ,$27.39 ,$28.37 ,$23.64 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100211,82300,HC CADMIUM 24 HR URINE,301,1 ,$103.50 ,$68.31 ,$23.57 ,$103.50 ,$24.43 ,$82.74 ,$82.74 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$24.43 ,$24.43 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$24.43 ,$64.18 ,$25.90 ,$93.15 ,$53.19 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$25.90 ,$28.37 ,$28.37 ,$27.39 ,$28.37 ,$23.64 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100212,82306,HC VITAMIN D 25 OH,301,1 ,$257.60 ,$170.02 ,$29.60 ,$257.60 ,$30.59 ,$103.60 ,$103.60 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$30.59 ,$30.59 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$30.59 ,$159.72 ,$32.43 ,$231.84 ,$66.60 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$32.43 ,$35.52 ,$35.52 ,$68.16 ,$35.52 ,$29.60 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100213,82308,HC CALCITONIN,301,1 ,$180.55 ,$119.16 ,$26.79 ,$180.55 ,$27.68 ,$93.77 ,$93.77 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$27.68 ,$27.68 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$27.68 ,$111.94 ,$29.34 ,$162.50 ,$60.28 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$29.34 ,$32.15 ,$32.15 ,$47.77 ,$32.15 ,$26.79 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100214,82310,HC CALCIUM,301,1 ,$43.70 ,$28.84 ,$5.16 ,$43.70 ,$5.33 ,$18.06 ,$18.06 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$5.33 ,$5.33 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$5.33 ,$27.10 ,$5.65 ,$39.33 ,$11.61 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$5.65 ,$6.19 ,$6.19 ,$11.56 ,$6.19 ,$5.16 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100215,82330,HC CALCIUM IONIZED,301,1 ,$116.15 ,$76.66 ,$13.68 ,$116.15 ,$14.14 ,$47.88 ,$47.88 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$14.14 ,$14.14 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$14.14 ,$72.02 ,$14.99 ,$104.54 ,$30.78 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.99 ,$16.42 ,$16.42 ,$30.73 ,$16.42 ,$13.68 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$52.90 ,$34.91 ,$6.03 ,$52.90 ,$6.23 ,$21.11 ,$21.11 ,$13.99 ,$42.32 ,$44.97 ,$33.06 ,$47.61 ,$6.23 ,$6.23 ,$50.26 ,$47.61 ,$44.97 ,$44.97 ,$13.99 ,$44.97 ,$44.97 ,$47.61 ,$32.22 ,$6.23 ,$32.80 ,$6.60 ,$47.61 ,$13.57 ,$48.67 ,$47.61 ,$34.92 ,$34.92 ,$32.22 ,$34.92 ,$34.39 ,$36.14 ,$12.04 ,$41.79 ,$6.60 ,$7.24 ,$7.24 ,$13.99 ,$7.24 ,$6.03 ,$50.26 ,$43.38 ,$43.38 ,$42.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100217,82360,HC CALCULUS ANALYSIS QN,301,1 ,$126.50 ,$83.49 ,$12.87 ,$126.50 ,$13.30 ,$45.05 ,$45.05 ,$33.48 ,$101.20 ,$107.53 ,$79.06 ,$113.85 ,$13.30 ,$13.30 ,$120.18 ,$113.85 ,$107.53 ,$107.53 ,$33.48 ,$107.53 ,$107.53 ,$113.85 ,$77.04 ,$13.30 ,$78.44 ,$14.10 ,$113.85 ,$28.96 ,$116.38 ,$113.85 ,$83.50 ,$83.50 ,$77.04 ,$83.50 ,$82.23 ,$86.42 ,$28.80 ,$99.94 ,$14.10 ,$15.44 ,$15.44 ,$33.48 ,$15.44 ,$12.87 ,$120.18 ,$103.73 ,$103.73 ,$101.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100218,82365,HC CALCULUS ANLYS (SA) INFRARED,301,1 ,$135.70 ,$89.56 ,$12.90 ,$135.70 ,$13.33 ,$45.15 ,$45.15 ,$35.91 ,$108.56 ,$115.35 ,$84.81 ,$122.13 ,$13.33 ,$13.33 ,$128.92 ,$122.13 ,$115.35 ,$115.35 ,$35.91 ,$115.35 ,$115.35 ,$122.13 ,$82.64 ,$13.33 ,$84.14 ,$14.13 ,$122.13 ,$29.03 ,$124.84 ,$122.13 ,$89.58 ,$89.58 ,$82.64 ,$89.58 ,$88.21 ,$92.71 ,$30.89 ,$107.20 ,$14.13 ,$15.48 ,$15.48 ,$35.91 ,$15.48 ,$12.90 ,$128.92 ,$111.27 ,$111.27 ,$108.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100221,82373,HC CARBOHY DEFICIENT TRANSFER,301,1 ,$594.55 ,$392.40 ,$10.38 ,$594.55 ,$10.38 ,$63.21 ,$63.21 ,$157.32 ,$475.64 ,$505.37 ,$371.59 ,$535.10 ,$10.38 ,$10.38 ,$564.82 ,$535.10 ,$505.37 ,$505.37 ,$157.32 ,$505.37 ,$505.37 ,$535.10 ,$362.08 ,$10.38 ,$368.62 ,$11.00 ,$535.10 ,$40.64 ,$546.99 ,$535.10 ,$392.46 ,$392.46 ,$362.08 ,$392.46 ,$386.46 ,$406.20 ,$135.36 ,$469.69 ,$11.00 ,$21.67 ,$21.67 ,$157.32 ,$21.67 ,$18.06 ,$564.82 ,$487.53 ,$487.53 ,$475.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100222,82374,HC BICARBONATE,301,1 ,$116.15 ,$76.66 ,$4.88 ,$116.15 ,$5.04 ,$17.08 ,$17.08 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$5.04 ,$5.04 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$5.04 ,$72.02 ,$5.34 ,$104.54 ,$10.98 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$5.34 ,$5.86 ,$5.86 ,$30.73 ,$5.86 ,$4.88 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100223,82374,HC CO2,301,1 ,$49.45 ,$32.64 ,$4.88 ,$49.45 ,$5.04 ,$17.08 ,$17.08 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 ,$5.04 ,$5.04 ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 ,$5.04 ,$30.66 ,$5.34 ,$44.51 ,$10.98 ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$11.25 ,$39.07 ,$5.34 ,$5.86 ,$5.86 ,$13.08 ,$5.86 ,$4.88 ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100224,82375,HC CARBON MONOXIDE,301,1 ,$193.20 ,$127.51 ,$12.32 ,$193.20 ,$12.73 ,$43.12 ,$43.12 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$12.73 ,$12.73 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$12.73 ,$119.78 ,$13.49 ,$173.88 ,$27.72 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$13.49 ,$14.78 ,$14.78 ,$51.12 ,$14.78 ,$12.32 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100225,82375,HC CARBOXYHEMOGLOBIN,301,1 ,$193.20 ,$127.51 ,$12.32 ,$193.20 ,$12.73 ,$43.12 ,$43.12 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$12.73 ,$12.73 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$12.73 ,$119.78 ,$13.49 ,$173.88 ,$27.72 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$13.49 ,$14.78 ,$14.78 ,$51.12 ,$14.78 ,$12.32 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100226,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$167.90 ,$110.81 ,$18.96 ,$167.90 ,$19.59 ,$66.36 ,$66.36 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.59 ,$19.59 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.59 ,$104.10 ,$20.77 ,$151.11 ,$42.66 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$20.77 ,$22.75 ,$22.75 ,$44.42 ,$22.75 ,$18.96 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100227,82378,HC CEA BODY FLUID,301,1 ,$270.25 ,$178.37 ,$18.96 ,$270.25 ,$19.59 ,$66.36 ,$66.36 ,$71.51 ,$216.20 ,$229.71 ,$168.91 ,$243.23 ,$19.59 ,$19.59 ,$256.74 ,$243.23 ,$229.71 ,$229.71 ,$71.51 ,$229.71 ,$229.71 ,$243.23 ,$164.58 ,$19.59 ,$167.56 ,$20.77 ,$243.23 ,$42.66 ,$248.63 ,$243.23 ,$178.39 ,$178.39 ,$164.58 ,$178.39 ,$175.66 ,$184.63 ,$61.52 ,$213.50 ,$20.77 ,$22.75 ,$22.75 ,$71.51 ,$22.75 ,$18.96 ,$256.74 ,$221.61 ,$221.61 ,$216.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100230,82379,HC CARNITINE,301,1 ,$489.90 ,$323.33 ,$16.87 ,$489.90 ,$17.43 ,$59.05 ,$59.05 ,$129.62 ,$391.92 ,$416.42 ,$306.19 ,$440.91 ,$17.43 ,$17.43 ,$465.41 ,$440.91 ,$416.42 ,$416.42 ,$129.62 ,$416.42 ,$416.42 ,$440.91 ,$298.35 ,$17.43 ,$303.74 ,$18.48 ,$440.91 ,$37.96 ,$450.71 ,$440.91 ,$323.38 ,$323.38 ,$298.35 ,$323.38 ,$318.44 ,$334.70 ,$111.53 ,$387.02 ,$18.48 ,$20.24 ,$20.24 ,$129.62 ,$20.24 ,$16.87 ,$465.41 ,$401.72 ,$401.72 ,$391.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100231,82380,HC CAROTENE,301,1 ,$65.55 ,$43.26 ,$9.22 ,$65.55 ,$9.53 ,$32.27 ,$32.27 ,$17.35 ,$52.44 ,$55.72 ,$40.97 ,$59.00 ,$9.53 ,$9.53 ,$62.27 ,$59.00 ,$55.72 ,$55.72 ,$17.35 ,$55.72 ,$55.72 ,$59.00 ,$39.92 ,$9.53 ,$40.64 ,$10.10 ,$59.00 ,$20.75 ,$60.31 ,$59.00 ,$43.27 ,$43.27 ,$39.92 ,$43.27 ,$42.61 ,$44.78 ,$14.93 ,$51.78 ,$10.10 ,$11.06 ,$11.06 ,$17.35 ,$11.06 ,$9.22 ,$62.27 ,$53.75 ,$53.75 ,$52.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100232,82384,HC CATECHOLAMINE FRACTION,301,1 ,$218.50 ,$144.21 ,$25.25 ,$218.50 ,$26.09 ,$88.38 ,$88.38 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$26.09 ,$26.09 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$26.09 ,$135.48 ,$27.66 ,$196.65 ,$56.81 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$27.66 ,$30.30 ,$30.30 ,$57.82 ,$30.30 ,$25.25 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100234,82384,HC CATECHOLAMINE PLASMA,301,1 ,$96.60 ,$63.76 ,$21.99 ,$96.60 ,$26.09 ,$88.38 ,$88.38 ,$25.56 ,$77.28 ,$82.11 ,$60.38 ,$86.94 ,$26.09 ,$26.09 ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 ,$26.09 ,$59.90 ,$27.66 ,$86.94 ,$56.81 ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 ,$27.66 ,$30.30 ,$30.30 ,$25.56 ,$30.30 ,$25.25 ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100235,82390,HC CERULOPLASMIN,301,1 ,$89.70 ,$59.20 ,$10.74 ,$89.70 ,$11.10 ,$37.59 ,$37.59 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$11.10 ,$11.10 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$11.10 ,$55.62 ,$11.77 ,$80.73 ,$24.17 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.77 ,$12.89 ,$12.89 ,$23.74 ,$12.89 ,$10.74 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100236,82397,HC CHEMILUMINESCENT ASSAY,301,1 ,$128.80 ,$85.01 ,$14.12 ,$128.80 ,$14.59 ,$49.42 ,$49.42 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.59 ,$14.59 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.59 ,$79.86 ,$15.47 ,$115.92 ,$31.77 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.47 ,$16.94 ,$16.94 ,$34.08 ,$16.94 ,$14.12 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100237,82435,HC CHLORIDE,301,1 ,$77.05 ,$50.85 ,$4.60 ,$77.05 ,$4.75 ,$16.10 ,$16.10 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$4.75 ,$4.75 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$4.75 ,$47.78 ,$5.04 ,$69.35 ,$10.35 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$5.04 ,$5.52 ,$5.52 ,$20.38 ,$5.52 ,$4.60 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100238,82436,HC CHLORIDE URINE,301,1 ,$55.20 ,$36.43 ,$5.75 ,$55.20 ,$5.94 ,$20.13 ,$20.13 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$5.94 ,$5.94 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$5.94 ,$34.22 ,$6.30 ,$49.68 ,$12.94 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$6.30 ,$6.90 ,$6.90 ,$14.60 ,$6.90 ,$5.75 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100240,82438,HC CHLORIDE OTHER SOURCE,301,1 ,$87.40 ,$57.68 ,$5.00 ,$87.40 ,$5.17 ,$17.50 ,$17.50 ,$23.13 ,$69.92 ,$74.29 ,$54.63 ,$78.66 ,$5.17 ,$5.17 ,$83.03 ,$78.66 ,$74.29 ,$74.29 ,$23.13 ,$74.29 ,$74.29 ,$78.66 ,$53.23 ,$5.17 ,$54.18 ,$5.48 ,$78.66 ,$11.25 ,$80.41 ,$78.66 ,$57.69 ,$57.69 ,$53.23 ,$57.69 ,$56.81 ,$59.71 ,$19.89 ,$69.05 ,$5.48 ,$6.00 ,$6.00 ,$23.13 ,$6.00 ,$5.00 ,$83.03 ,$71.67 ,$71.67 ,$69.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100241,82465,HC CHOLESTEROL,301,1 ,$64.40 ,$42.50 ,$4.35 ,$64.40 ,$4.49 ,$15.23 ,$15.23 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$4.49 ,$4.49 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$4.49 ,$39.92 ,$4.76 ,$57.96 ,$9.79 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$4.76 ,$5.22 ,$5.22 ,$17.04 ,$5.22 ,$4.35 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100242,82542,HC CHROMATO QN SGL COLUMN,301,1 ,$180.55 ,$119.16 ,$24.09 ,$180.55 ,$24.89 ,$84.32 ,$84.32 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$24.89 ,$24.89 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$24.89 ,$111.94 ,$26.38 ,$162.50 ,$54.20 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$26.38 ,$28.91 ,$28.91 ,$47.77 ,$28.91 ,$24.09 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100243,80299,HC CHROMATO QN MLT COLUMN,301,1 ,$210.45 ,$138.90 ,$18.64 ,$210.45 ,$19.26 ,$65.24 ,$65.24 ,$55.68 ,$168.36 ,$178.88 ,$131.53 ,$189.41 ,$19.26 ,$19.26 ,$199.93 ,$189.41 ,$178.88 ,$178.88 ,$55.68 ,$178.88 ,$178.88 ,$189.41 ,$128.16 ,$19.26 ,$130.48 ,$20.42 ,$189.41 ,$41.94 ,$193.61 ,$189.41 ,$138.92 ,$138.92 ,$128.16 ,$138.92 ,$136.79 ,$143.78 ,$47.90 ,$166.26 ,$20.42 ,$22.37 ,$22.37 ,$55.68 ,$22.37 ,$18.64 ,$199.93 ,$172.57 ,$172.57 ,$168.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100245,82495,HC CHROMIUM SERUM,301,1 ,$141.45 ,$93.36 ,$10.23 ,$141.45 ,$10.23 ,$70.98 ,$70.98 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$10.23 ,$10.23 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$10.23 ,$87.70 ,$10.84 ,$127.31 ,$45.63 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$10.84 ,$24.34 ,$24.34 ,$37.43 ,$24.34 ,$20.28 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100246,82507,HC CITRATE,301,1 ,$236.90 ,$156.35 ,$27.80 ,$236.90 ,$28.73 ,$97.30 ,$97.30 ,$62.68 ,$189.52 ,$201.37 ,$148.06 ,$213.21 ,$28.73 ,$28.73 ,$225.06 ,$213.21 ,$201.37 ,$201.37 ,$62.68 ,$201.37 ,$201.37 ,$213.21 ,$144.27 ,$28.73 ,$146.88 ,$30.45 ,$213.21 ,$62.55 ,$217.95 ,$213.21 ,$156.38 ,$156.38 ,$144.27 ,$156.38 ,$153.99 ,$161.85 ,$53.93 ,$187.15 ,$30.45 ,$33.36 ,$33.36 ,$62.68 ,$33.36 ,$27.80 ,$225.06 ,$194.26 ,$194.26 ,$189.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100247,80343,HC COCAINE QN,301,1 ,$36.00 ,$23.76 ,$8.19 ,$36.00 ,$21.05 ,$32.26 ,$32.26 ,$9.53 ,$28.80 ,$30.60 ,$22.50 ,$32.40 ,$21.05 ,$21.05 ,$34.20 ,$32.40 ,$30.60 ,$30.60 ,$9.53 ,$30.60 ,$30.60 ,$32.40 ,$21.92 ,$21.05 ,$22.32 ,$22.31 ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$8.19 ,$28.44 ,$22.31 , N/A , N/A ,$9.53 , N/A , N/A ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100252,82525,HC COPPER,301,1 ,$77.05 ,$50.85 ,$12.41 ,$77.05 ,$12.82 ,$43.44 ,$43.44 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.82 ,$12.82 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.82 ,$47.78 ,$13.59 ,$69.35 ,$27.92 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.59 ,$14.89 ,$14.89 ,$20.38 ,$14.89 ,$12.41 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100253,82530,HC CORTISOL FREE,301,1 ,$141.45 ,$93.36 ,$16.71 ,$141.45 ,$17.27 ,$58.49 ,$58.49 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$17.27 ,$17.27 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$17.27 ,$87.70 ,$18.31 ,$127.31 ,$37.60 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$18.31 ,$20.05 ,$20.05 ,$37.43 ,$20.05 ,$16.71 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100254,82533,HC CORTISOL TOTAL,301,1 ,$141.45 ,$93.36 ,$16.30 ,$141.45 ,$16.84 ,$57.05 ,$57.05 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.84 ,$16.84 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.84 ,$87.70 ,$17.85 ,$127.31 ,$36.68 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$17.85 ,$19.56 ,$19.56 ,$37.43 ,$19.56 ,$16.30 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100255,G0480,HC RISPERIDONE,301,1 ,$128.00 ,$84.48 ,$29.14 ,$257.47 ,$63.95 ,$128.00 ,$128.00 ,$33.87 ,$102.40 ,$108.80 ,$80.00 ,$115.20 ,$63.95 ,$63.95 ,$121.60 ,$115.20 ,$108.80 ,$108.80 ,$33.87 ,$108.80 ,$108.80 ,$115.20 ,$77.95 ,$63.95 ,$79.36 ,$67.79 ,$115.20 ,$257.47 ,$117.76 ,$115.20 ,$84.49 ,$84.49 ,$77.95 ,$84.49 ,$83.20 ,$87.45 ,$29.14 ,$101.12 ,$67.79 ,$128.00 ,$128.00 ,$33.87 ,$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 ,$66.00 ,$22.77 ,$225.00 ,$63.95 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$63.95 ,$63.95 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$63.95 ,$62.00 ,$67.79 ,$90.00 ,$225.00 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$67.79 ,$100.00 ,$100.00 ,$26.46 ,$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 ,$59.80 ,$39.47 ,$6.51 ,$59.80 ,$6.73 ,$22.79 ,$22.79 ,$15.83 ,$47.84 ,$50.83 ,$37.38 ,$53.82 ,$6.73 ,$6.73 ,$56.81 ,$53.82 ,$50.83 ,$50.83 ,$15.83 ,$50.83 ,$50.83 ,$53.82 ,$36.42 ,$6.73 ,$37.08 ,$7.13 ,$53.82 ,$14.65 ,$55.02 ,$53.82 ,$39.47 ,$39.47 ,$36.42 ,$39.47 ,$38.87 ,$40.86 ,$13.61 ,$47.24 ,$7.13 ,$7.81 ,$7.81 ,$15.83 ,$7.81 ,$6.51 ,$56.81 ,$49.04 ,$49.04 ,$47.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100260,82552,HC CREATINE KINASE (CPK) ISO,301,1 ,$105.80 ,$69.83 ,$13.39 ,$105.80 ,$13.84 ,$46.87 ,$46.87 ,$28.00 ,$84.64 ,$89.93 ,$66.13 ,$95.22 ,$13.84 ,$13.84 ,$100.51 ,$95.22 ,$89.93 ,$89.93 ,$28.00 ,$89.93 ,$89.93 ,$95.22 ,$64.43 ,$13.84 ,$65.60 ,$14.67 ,$95.22 ,$30.13 ,$97.34 ,$95.22 ,$69.84 ,$69.84 ,$64.43 ,$69.84 ,$68.77 ,$72.28 ,$24.08 ,$83.58 ,$14.67 ,$16.07 ,$16.07 ,$28.00 ,$16.07 ,$13.39 ,$100.51 ,$86.76 ,$86.76 ,$84.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$77.05 ,$50.85 ,$8.66 ,$77.05 ,$8.66 ,$40.43 ,$40.43 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.66 ,$8.66 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.66 ,$47.78 ,$9.18 ,$69.35 ,$25.99 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.18 ,$13.86 ,$13.86 ,$20.38 ,$13.86 ,$11.55 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100262,82565,HC CREATININE,301,1 ,$44.85 ,$29.60 ,$5.12 ,$44.85 ,$5.29 ,$17.92 ,$17.92 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$5.29 ,$5.29 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$5.29 ,$27.80 ,$5.61 ,$40.37 ,$11.52 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$5.61 ,$6.14 ,$6.14 ,$11.87 ,$6.14 ,$5.12 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$44.85 ,$29.60 ,$5.18 ,$44.85 ,$5.35 ,$18.13 ,$18.13 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$5.35 ,$5.35 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$5.35 ,$27.80 ,$5.67 ,$40.37 ,$11.66 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$5.67 ,$6.22 ,$6.22 ,$11.87 ,$6.22 ,$5.18 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100266,82575,HC CREATININE CLEARANCE,301,1 ,$103.50 ,$68.31 ,$9.46 ,$103.50 ,$9.78 ,$33.11 ,$33.11 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$9.78 ,$9.78 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$9.78 ,$64.18 ,$10.37 ,$93.15 ,$21.29 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$10.37 ,$11.35 ,$11.35 ,$27.39 ,$11.35 ,$9.46 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100267,82585,HC CRYOFIBRINOGEN,301,1 ,$59.80 ,$39.47 ,$9.02 ,$59.80 ,$9.02 ,$49.49 ,$49.49 ,$15.83 ,$47.84 ,$50.83 ,$37.38 ,$53.82 ,$9.02 ,$9.02 ,$56.81 ,$53.82 ,$50.83 ,$50.83 ,$15.83 ,$50.83 ,$50.83 ,$53.82 ,$36.42 ,$9.02 ,$37.08 ,$9.56 ,$53.82 ,$31.82 ,$55.02 ,$53.82 ,$39.47 ,$39.47 ,$36.42 ,$39.47 ,$38.87 ,$40.86 ,$13.61 ,$47.24 ,$9.56 ,$16.97 ,$16.97 ,$15.83 ,$16.97 ,$14.14 ,$56.81 ,$49.04 ,$49.04 ,$47.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100268,82595,HC CRYOGLOBULIN,301,1 ,$193.20 ,$127.51 ,$6.47 ,$193.20 ,$6.69 ,$22.65 ,$22.65 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$6.69 ,$6.69 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$6.69 ,$119.78 ,$7.09 ,$173.88 ,$14.56 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$7.09 ,$7.76 ,$7.76 ,$51.12 ,$7.76 ,$6.47 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100269,82607,HC VITAMIN B12,301,1 ,$128.80 ,$85.01 ,$15.08 ,$128.80 ,$15.58 ,$52.78 ,$52.78 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.58 ,$15.58 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.58 ,$79.86 ,$16.51 ,$115.92 ,$33.93 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.51 ,$18.10 ,$18.10 ,$34.08 ,$18.10 ,$15.08 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100270,82626,HC DHEA,301,1 ,$218.50 ,$144.21 ,$25.27 ,$218.50 ,$26.11 ,$88.45 ,$88.45 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$26.11 ,$26.11 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$26.11 ,$135.48 ,$27.68 ,$196.65 ,$56.86 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$27.68 ,$30.32 ,$30.32 ,$57.82 ,$30.32 ,$25.27 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100271,82627,HC DHEA SULFATE,301,1 ,$193.20 ,$127.51 ,$22.23 ,$193.20 ,$22.97 ,$77.81 ,$77.81 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$22.97 ,$22.97 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$22.97 ,$119.78 ,$24.35 ,$173.88 ,$50.02 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$24.35 ,$26.68 ,$26.68 ,$51.12 ,$26.68 ,$22.23 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100272,82652,HC VITAMIN D (1 25 DIHYDROXY),301,1 ,$334.65 ,$220.87 ,$38.50 ,$334.65 ,$39.78 ,$134.75 ,$134.75 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$39.78 ,$39.78 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$39.78 ,$207.48 ,$42.17 ,$301.19 ,$86.63 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$42.17 ,$46.20 ,$46.20 ,$88.55 ,$46.20 ,$38.50 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100274,82664,HC ELECTROPHORETIC TEST,301,1 ,$257.60 ,$170.02 ,$48.31 ,$257.60 ,$48.31 ,$215.25 ,$215.25 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$48.31 ,$48.31 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$48.31 ,$159.72 ,$51.21 ,$231.84 ,$138.38 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$51.21 ,$73.80 ,$73.80 ,$68.16 ,$73.80 ,$61.50 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100275,82668,HC ERYTHROPOIETIN,301,1 ,$116.15 ,$76.66 ,$18.79 ,$116.15 ,$19.42 ,$65.77 ,$65.77 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.42 ,$19.42 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.42 ,$72.02 ,$20.59 ,$104.54 ,$42.28 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.59 ,$22.55 ,$22.55 ,$30.73 ,$22.55 ,$18.79 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100276,82670,HC ESTRADIOL,301,1 ,$244.95 ,$161.67 ,$27.94 ,$244.95 ,$28.87 ,$97.79 ,$97.79 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$28.87 ,$28.87 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$28.87 ,$151.86 ,$30.60 ,$220.46 ,$62.87 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$30.60 ,$33.53 ,$33.53 ,$64.82 ,$33.53 ,$27.94 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100278,82672,HC ESTROGEN TOTAL,301,1 ,$193.20 ,$127.51 ,$21.70 ,$193.20 ,$22.42 ,$75.95 ,$75.95 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$22.42 ,$22.42 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$22.42 ,$119.78 ,$23.77 ,$173.88 ,$48.83 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$23.77 ,$26.04 ,$26.04 ,$51.12 ,$26.04 ,$21.70 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100280,82677,HC ESTRIOL,301,1 ,$232.30 ,$153.32 ,$24.18 ,$232.30 ,$24.99 ,$84.63 ,$84.63 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$24.99 ,$24.99 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$24.99 ,$144.02 ,$26.49 ,$209.07 ,$54.41 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$26.49 ,$29.02 ,$29.02 ,$61.47 ,$29.02 ,$24.18 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100285,82679,HC ESTRONE,301,1 ,$210.45 ,$138.90 ,$24.95 ,$210.45 ,$25.78 ,$87.33 ,$87.33 ,$55.68 ,$168.36 ,$178.88 ,$131.53 ,$189.41 ,$25.78 ,$25.78 ,$199.93 ,$189.41 ,$178.88 ,$178.88 ,$55.68 ,$178.88 ,$178.88 ,$189.41 ,$128.16 ,$25.78 ,$130.48 ,$27.33 ,$189.41 ,$56.14 ,$193.61 ,$189.41 ,$138.92 ,$138.92 ,$128.16 ,$138.92 ,$136.79 ,$143.78 ,$47.90 ,$166.26 ,$27.33 ,$29.94 ,$29.94 ,$55.68 ,$29.94 ,$24.95 ,$199.93 ,$172.57 ,$172.57 ,$168.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100287,82710,HC FECAL FAT QN,301,1 ,$322.00 ,$212.52 ,$16.80 ,$322.00 ,$17.36 ,$58.80 ,$58.80 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$17.36 ,$17.36 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$17.36 ,$199.64 ,$18.40 ,$289.80 ,$37.80 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$18.40 ,$20.16 ,$20.16 ,$85.20 ,$20.16 ,$16.80 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100288,82725,HC FATTY ACIDS NONESTERIFIED,301,1 ,$180.55 ,$119.16 ,$18.72 ,$180.55 ,$18.72 ,$65.70 ,$65.70 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$18.72 ,$18.72 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$18.72 ,$111.94 ,$19.84 ,$162.50 ,$42.23 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$19.84 ,$22.52 ,$22.52 ,$47.77 ,$22.52 ,$18.77 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100289,82726,HC VLFC FATTY ACIDS,301,1 ,$322.00 ,$212.52 ,$19.75 ,$322.00 ,$20.41 ,$69.13 ,$69.13 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$20.41 ,$20.41 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$20.41 ,$199.64 ,$21.63 ,$289.80 ,$44.44 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$21.63 ,$23.70 ,$23.70 ,$85.20 ,$23.70 ,$19.75 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100290,82728,HC FERRITIN,301,1 ,$116.15 ,$76.66 ,$13.63 ,$116.15 ,$14.08 ,$47.71 ,$47.71 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$14.08 ,$14.08 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$14.08 ,$72.02 ,$14.92 ,$104.54 ,$30.67 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.92 ,$16.36 ,$16.36 ,$30.73 ,$16.36 ,$13.63 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$566.95 ,$374.19 ,$64.41 ,$566.95 ,$66.55 ,$225.44 ,$225.44 ,$150.02 ,$453.56 ,$481.91 ,$354.34 ,$510.26 ,$66.55 ,$66.55 ,$538.60 ,$510.26 ,$481.91 ,$481.91 ,$150.02 ,$481.91 ,$481.91 ,$510.26 ,$345.27 ,$66.55 ,$351.50 ,$70.54 ,$510.26 ,$144.92 ,$521.59 ,$510.26 ,$374.24 ,$374.24 ,$345.27 ,$374.24 ,$368.52 ,$387.34 ,$129.07 ,$447.89 ,$70.54 ,$77.29 ,$77.29 ,$150.02 ,$77.29 ,$64.41 ,$538.60 ,$464.90 ,$464.90 ,$453.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100292,82746,HC FOLIC ACID SERUM,301,1 ,$128.80 ,$85.01 ,$14.70 ,$128.80 ,$15.19 ,$51.45 ,$51.45 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.19 ,$15.19 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.19 ,$79.86 ,$16.10 ,$115.92 ,$33.08 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.10 ,$17.64 ,$17.64 ,$34.08 ,$17.64 ,$14.70 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100293,82747,HC FOLIC ACID RBC,301,1 ,$103.50 ,$68.31 ,$16.37 ,$103.50 ,$16.37 ,$61.78 ,$61.78 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$16.37 ,$16.37 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$16.37 ,$64.18 ,$17.35 ,$93.15 ,$39.71 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$17.35 ,$21.18 ,$21.18 ,$27.39 ,$21.18 ,$17.65 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100294,82775,HC GALACTOSE TRANSFERASE QN,301,1 ,$141.45 ,$93.36 ,$21.07 ,$141.45 ,$21.77 ,$73.75 ,$73.75 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$21.77 ,$21.77 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$21.77 ,$87.70 ,$23.08 ,$127.31 ,$47.41 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$23.08 ,$25.28 ,$25.28 ,$37.43 ,$25.28 ,$21.07 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100295,82784,HC GAMMAGLOBULIN,301,1 ,$77.05 ,$50.85 ,$9.30 ,$77.05 ,$9.61 ,$32.55 ,$32.55 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$9.61 ,$9.61 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$9.61 ,$47.78 ,$10.19 ,$69.35 ,$20.93 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$10.19 ,$11.16 ,$11.16 ,$20.38 ,$11.16 ,$9.30 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100298,82784,HC GAMMAGLOBULIN TOTAL,301,1 ,$77.05 ,$50.85 ,$9.30 ,$77.05 ,$9.61 ,$32.55 ,$32.55 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$9.61 ,$9.61 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$9.61 ,$47.78 ,$10.19 ,$69.35 ,$20.93 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$10.19 ,$11.16 ,$11.16 ,$20.38 ,$11.16 ,$9.30 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100300,82784,HC IGD SERUM,301,1 ,$81.65 ,$53.89 ,$9.30 ,$81.65 ,$9.61 ,$32.55 ,$32.55 ,$21.61 ,$65.32 ,$69.40 ,$51.03 ,$73.49 ,$9.61 ,$9.61 ,$77.57 ,$73.49 ,$69.40 ,$69.40 ,$21.61 ,$69.40 ,$69.40 ,$73.49 ,$49.72 ,$9.61 ,$50.62 ,$10.19 ,$73.49 ,$20.93 ,$75.12 ,$73.49 ,$53.90 ,$53.90 ,$49.72 ,$53.90 ,$53.07 ,$55.78 ,$18.59 ,$64.50 ,$10.19 ,$11.16 ,$11.16 ,$21.61 ,$11.16 ,$9.30 ,$77.57 ,$66.95 ,$66.95 ,$65.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100302,82785,HC GAMMAGLOBULIN IGE,301,1 ,$141.45 ,$93.36 ,$16.46 ,$141.45 ,$17.01 ,$57.61 ,$57.61 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$17.01 ,$17.01 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$17.01 ,$87.70 ,$18.03 ,$127.31 ,$37.04 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$18.03 ,$19.75 ,$19.75 ,$37.43 ,$19.75 ,$16.46 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100303,82787,HC IGG SUBCLASS1-3,301,1 ,$47.15 ,$31.12 ,$5.90 ,$47.15 ,$5.90 ,$28.07 ,$28.07 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$5.90 ,$5.90 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$5.90 ,$29.24 ,$6.25 ,$42.44 ,$18.05 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$6.25 ,$9.62 ,$9.62 ,$12.48 ,$9.62 ,$8.02 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100304,82787,HC IGG SUBCLASS 4,301,1 ,$47.15 ,$31.12 ,$5.90 ,$47.15 ,$5.90 ,$28.07 ,$28.07 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$5.90 ,$5.90 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$5.90 ,$29.24 ,$6.25 ,$42.44 ,$18.05 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$6.25 ,$9.62 ,$9.62 ,$12.48 ,$9.62 ,$8.02 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100306,82803,HC BLOOD GAS PH PO2  AND /OR PCO2,301,1 ,$167.90 ,$110.81 ,$26.07 ,$167.90 ,$26.94 ,$91.25 ,$91.25 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$26.94 ,$26.94 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$26.94 ,$104.10 ,$28.56 ,$151.11 ,$58.66 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$28.56 ,$31.28 ,$31.28 ,$44.42 ,$31.28 ,$26.07 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100307,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$244.95 ,$161.67 ,$39.91 ,$244.95 ,$39.91 ,$244.95 ,$244.95 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$39.91 ,$39.91 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$39.91 ,$151.86 ,$42.30 ,$220.46 ,$177.23 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$42.30 ,$94.52 ,$94.52 ,$64.82 ,$94.52 ,$78.77 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100308,82810,HC BLOOD GAS O2 SAT ONLY,301,1 ,$173.65 ,$114.61 ,$9.77 ,$173.65 ,$10.10 ,$34.20 ,$34.20 ,$45.95 ,$138.92 ,$147.60 ,$108.53 ,$156.29 ,$10.10 ,$10.10 ,$164.97 ,$156.29 ,$147.60 ,$147.60 ,$45.95 ,$147.60 ,$147.60 ,$156.29 ,$105.75 ,$10.10 ,$107.66 ,$10.71 ,$156.29 ,$21.98 ,$159.76 ,$156.29 ,$114.63 ,$114.63 ,$105.75 ,$114.63 ,$112.87 ,$118.64 ,$39.53 ,$137.18 ,$10.71 ,$11.72 ,$11.72 ,$45.95 ,$11.72 ,$9.77 ,$164.97 ,$142.39 ,$142.39 ,$138.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100309,82941,HC GASTRIN,301,1 ,$116.15 ,$76.66 ,$17.63 ,$116.15 ,$18.22 ,$61.71 ,$61.71 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$18.22 ,$18.22 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$18.22 ,$72.02 ,$19.31 ,$104.54 ,$39.67 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$19.31 ,$21.16 ,$21.16 ,$30.73 ,$21.16 ,$17.63 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100310,82943,HC GLUCAGON PLASMA,301,1 ,$71.30 ,$47.06 ,$13.88 ,$71.30 ,$13.88 ,$50.02 ,$50.02 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$13.88 ,$13.88 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$13.88 ,$44.20 ,$14.71 ,$64.17 ,$32.15 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 ,$16.23 ,$56.33 ,$14.71 ,$17.15 ,$17.15 ,$18.86 ,$17.15 ,$14.29 ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$62.10 ,$40.99 ,$3.93 ,$62.10 ,$4.06 ,$13.76 ,$13.76 ,$16.43 ,$49.68 ,$52.79 ,$38.81 ,$55.89 ,$4.06 ,$4.06 ,$59.00 ,$55.89 ,$52.79 ,$52.79 ,$16.43 ,$52.79 ,$52.79 ,$55.89 ,$37.82 ,$4.06 ,$38.50 ,$4.30 ,$55.89 ,$8.84 ,$57.13 ,$55.89 ,$40.99 ,$40.99 ,$37.82 ,$40.99 ,$40.37 ,$42.43 ,$14.13 ,$49.06 ,$4.30 ,$4.72 ,$4.72 ,$16.43 ,$4.72 ,$3.93 ,$59.00 ,$50.92 ,$50.92 ,$49.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100312,82947,HC GLUCOSE,301,1 ,$34.50 ,$22.77 ,$3.93 ,$34.50 ,$4.06 ,$13.76 ,$13.76 ,$9.13 ,$27.60 ,$29.33 ,$21.56 ,$31.05 ,$4.06 ,$4.06 ,$32.78 ,$31.05 ,$29.33 ,$29.33 ,$9.13 ,$29.33 ,$29.33 ,$31.05 ,$21.01 ,$4.06 ,$21.40 ,$4.30 ,$31.05 ,$8.84 ,$31.74 ,$31.05 ,$22.77 ,$22.77 ,$21.01 ,$22.77 ,$22.43 ,$23.57 ,$7.86 ,$27.26 ,$4.30 ,$4.72 ,$4.72 ,$9.13 ,$4.72 ,$3.93 ,$32.78 ,$28.29 ,$28.29 ,$27.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100313,82950,HC GLUCOSE SCREEN,301,1 ,$103.50 ,$68.31 ,$4.75 ,$103.50 ,$4.91 ,$16.63 ,$16.63 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$4.91 ,$4.91 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$4.91 ,$64.18 ,$5.20 ,$93.15 ,$10.69 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$5.20 ,$5.70 ,$5.70 ,$27.39 ,$5.70 ,$4.75 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$128.80 ,$85.01 ,$12.87 ,$128.80 ,$13.30 ,$45.05 ,$45.05 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$13.30 ,$13.30 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$13.30 ,$79.86 ,$14.10 ,$115.92 ,$28.96 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$14.10 ,$15.44 ,$15.44 ,$34.08 ,$15.44 ,$12.87 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$35.65 ,$23.53 ,$3.92 ,$35.65 ,$4.05 ,$13.72 ,$13.72 ,$9.44 ,$28.52 ,$30.30 ,$22.28 ,$32.09 ,$4.05 ,$4.05 ,$33.87 ,$32.09 ,$30.30 ,$30.30 ,$9.44 ,$30.30 ,$30.30 ,$32.09 ,$21.71 ,$4.05 ,$22.10 ,$4.29 ,$32.09 ,$8.82 ,$32.80 ,$32.09 ,$23.53 ,$23.53 ,$21.71 ,$23.53 ,$23.17 ,$24.36 ,$8.11 ,$28.16 ,$4.29 ,$4.70 ,$4.70 ,$9.44 ,$4.70 ,$3.92 ,$33.87 ,$29.23 ,$29.23 ,$28.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100316,82955,HC G6PD ENZYME QN,301,1 ,$495.65 ,$327.13 ,$9.70 ,$495.65 ,$10.02 ,$33.95 ,$33.95 ,$131.15 ,$396.52 ,$421.30 ,$309.78 ,$446.09 ,$10.02 ,$10.02 ,$470.87 ,$446.09 ,$421.30 ,$421.30 ,$131.15 ,$421.30 ,$421.30 ,$446.09 ,$301.85 ,$10.02 ,$307.30 ,$10.62 ,$446.09 ,$21.83 ,$456.00 ,$446.09 ,$327.18 ,$327.18 ,$301.85 ,$327.18 ,$322.17 ,$338.63 ,$112.84 ,$391.56 ,$10.62 ,$11.64 ,$11.64 ,$131.15 ,$11.64 ,$9.70 ,$470.87 ,$406.43 ,$406.43 ,$396.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100317,82955,HC GLUCOSE 6 PHOS DEHYDROGN,301,1 ,$89.70 ,$59.20 ,$9.70 ,$89.70 ,$10.02 ,$33.95 ,$33.95 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.02 ,$10.02 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.02 ,$55.62 ,$10.62 ,$80.73 ,$21.83 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.62 ,$11.64 ,$11.64 ,$23.74 ,$11.64 ,$9.70 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100318,82962,HC GLUCOSE BY DEVICE,301,1 ,$21.85 ,$14.42 ,$3.28 ,$21.85 ,$3.30 ,$11.48 ,$11.48 ,$5.78 ,$17.48 ,$18.57 ,$13.66 ,$19.67 ,$3.30 ,$3.30 ,$20.76 ,$19.67 ,$18.57 ,$18.57 ,$5.78 ,$18.57 ,$18.57 ,$19.67 ,$13.31 ,$3.30 ,$13.54 ,$3.50 ,$19.67 ,$7.38 ,$20.10 ,$19.67 ,$14.42 ,$14.42 ,$13.31 ,$14.42 ,$14.20 ,$14.93 ,$4.98 ,$17.26 ,$3.50 ,$3.94 ,$3.94 ,$5.78 ,$3.94 ,$3.28 ,$20.76 ,$17.92 ,$17.92 ,$17.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100319,82977,HC GGT/GGTP,301,1 ,$63.25 ,$41.75 ,$7.20 ,$63.25 ,$7.44 ,$25.20 ,$25.20 ,$16.74 ,$50.60 ,$53.76 ,$39.53 ,$56.93 ,$7.44 ,$7.44 ,$60.09 ,$56.93 ,$53.76 ,$53.76 ,$16.74 ,$53.76 ,$53.76 ,$56.93 ,$38.52 ,$7.44 ,$39.22 ,$7.89 ,$56.93 ,$16.20 ,$58.19 ,$56.93 ,$41.75 ,$41.75 ,$38.52 ,$41.75 ,$41.11 ,$43.21 ,$14.41 ,$49.97 ,$7.89 ,$8.64 ,$8.64 ,$16.74 ,$8.64 ,$7.20 ,$60.09 ,$51.87 ,$51.87 ,$50.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100321,82985,HC FRUCTOSAMINE,301,1 ,$103.50 ,$68.31 ,$16.62 ,$103.50 ,$16.62 ,$58.66 ,$58.66 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$16.62 ,$16.62 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$16.62 ,$64.18 ,$17.62 ,$93.15 ,$37.71 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$17.62 ,$20.11 ,$20.11 ,$27.39 ,$20.11 ,$16.76 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100323,83001,HC FSH,301,1 ,$167.90 ,$110.81 ,$18.58 ,$167.90 ,$19.20 ,$65.03 ,$65.03 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.20 ,$19.20 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.20 ,$104.10 ,$20.35 ,$151.11 ,$41.81 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$20.35 ,$22.30 ,$22.30 ,$44.42 ,$22.30 ,$18.58 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100325,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$167.90 ,$110.81 ,$18.52 ,$167.90 ,$19.14 ,$64.82 ,$64.82 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.14 ,$19.14 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.14 ,$104.10 ,$20.29 ,$151.11 ,$41.67 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$20.29 ,$22.22 ,$22.22 ,$44.42 ,$22.22 ,$18.52 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100326,83003,HC GROWTH HORMONE,301,1 ,$116.15 ,$76.66 ,$16.67 ,$116.15 ,$17.23 ,$58.35 ,$58.35 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.23 ,$17.23 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.23 ,$72.02 ,$18.26 ,$104.54 ,$37.51 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.26 ,$20.00 ,$20.00 ,$30.73 ,$20.00 ,$16.67 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100327,83010,HC HAPTOGLOBIN,301,1 ,$116.15 ,$76.66 ,$12.58 ,$116.15 ,$13.00 ,$44.03 ,$44.03 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.00 ,$13.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.00 ,$72.02 ,$13.78 ,$104.54 ,$28.31 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$13.78 ,$15.10 ,$15.10 ,$30.73 ,$15.10 ,$12.58 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100328,83018,HC HEAVY METAL EACH,301,1 ,$141.45 ,$93.36 ,$21.96 ,$141.45 ,$22.69 ,$76.86 ,$76.86 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$22.69 ,$22.69 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$22.69 ,$87.70 ,$24.05 ,$127.31 ,$49.41 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$24.05 ,$26.35 ,$26.35 ,$37.43 ,$26.35 ,$21.96 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100329,83018,HC HEAVY METAL 24HR EACH,301,1 ,$141.45 ,$93.36 ,$21.96 ,$141.45 ,$22.69 ,$76.86 ,$76.86 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$22.69 ,$22.69 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$22.69 ,$87.70 ,$24.05 ,$127.31 ,$49.41 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$24.05 ,$26.35 ,$26.35 ,$37.43 ,$26.35 ,$21.96 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100331,83020,HC HGB ELECTROPHORESIS (MAYO),301,1 ,$113.85 ,$75.14 ,$6.41 ,$113.85 ,$6.41 ,$45.05 ,$45.05 ,$30.13 ,$91.08 ,$96.77 ,$71.16 ,$102.47 ,$6.41 ,$6.41 ,$108.16 ,$102.47 ,$96.77 ,$96.77 ,$30.13 ,$96.77 ,$96.77 ,$102.47 ,$69.33 ,$6.41 ,$70.58 ,$6.79 ,$102.47 ,$28.96 ,$104.74 ,$102.47 ,$75.15 ,$75.15 ,$69.33 ,$75.15 ,$74.00 ,$77.78 ,$25.92 ,$89.94 ,$6.79 ,$15.44 ,$15.44 ,$30.13 ,$15.44 ,$12.87 ,$108.16 ,$93.36 ,$93.36 ,$91.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100334,83021,HC HEMOGLOBIN FRACT QN,301,1 ,$218.50 ,$144.21 ,$18.06 ,$218.50 ,$18.66 ,$63.21 ,$63.21 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$18.66 ,$18.66 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$18.66 ,$135.48 ,$19.78 ,$196.65 ,$40.64 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$19.78 ,$21.67 ,$21.67 ,$57.82 ,$21.67 ,$18.06 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$89.70 ,$59.20 ,$9.71 ,$89.70 ,$10.03 ,$33.99 ,$33.99 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.03 ,$10.03 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.03 ,$55.62 ,$10.63 ,$80.73 ,$21.85 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.63 ,$11.65 ,$11.65 ,$23.74 ,$11.65 ,$9.71 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100338,83050,HC METHEMOGLOBIN,301,1 ,$77.05 ,$50.85 ,$4.12 ,$77.05 ,$4.12 ,$28.70 ,$28.70 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$4.12 ,$4.12 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$4.12 ,$47.78 ,$4.37 ,$69.35 ,$18.45 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$4.37 ,$9.84 ,$9.84 ,$20.38 ,$9.84 ,$8.20 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100340,83051,HC HEMOGLOBIN PLASMA (MAYO),301,1 ,$66.70 ,$44.02 ,$4.90 ,$66.70 ,$4.90 ,$25.59 ,$25.59 ,$17.65 ,$53.36 ,$56.70 ,$41.69 ,$60.03 ,$4.90 ,$4.90 ,$63.37 ,$60.03 ,$56.70 ,$56.70 ,$17.65 ,$56.70 ,$56.70 ,$60.03 ,$40.62 ,$4.90 ,$41.36 ,$5.19 ,$60.03 ,$16.45 ,$61.36 ,$60.03 ,$44.03 ,$44.03 ,$40.62 ,$44.03 ,$43.36 ,$45.57 ,$15.18 ,$52.69 ,$5.19 ,$8.77 ,$8.77 ,$17.65 ,$8.77 ,$7.31 ,$63.37 ,$54.69 ,$54.69 ,$53.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100343,83068,HC HEMOGLOBIN UNSTABLE,301,1 ,$139.15 ,$91.84 ,$9.47 ,$139.15 ,$9.79 ,$33.15 ,$33.15 ,$36.82 ,$111.32 ,$118.28 ,$86.97 ,$125.24 ,$9.79 ,$9.79 ,$132.19 ,$125.24 ,$118.28 ,$118.28 ,$36.82 ,$118.28 ,$118.28 ,$125.24 ,$84.74 ,$9.79 ,$86.28 ,$10.38 ,$125.24 ,$21.31 ,$128.02 ,$125.24 ,$91.85 ,$91.85 ,$84.74 ,$91.85 ,$90.45 ,$95.07 ,$31.67 ,$109.93 ,$10.38 ,$11.36 ,$11.36 ,$36.82 ,$11.36 ,$9.47 ,$132.19 ,$114.10 ,$114.10 ,$111.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100344,83070,HC HEMOSIDERIN,301,1 ,$64.40 ,$42.50 ,$4.75 ,$64.40 ,$4.91 ,$16.63 ,$16.63 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$4.91 ,$4.91 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$4.91 ,$39.92 ,$5.20 ,$57.96 ,$10.69 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$5.20 ,$5.70 ,$5.70 ,$17.04 ,$5.70 ,$4.75 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100345,83088,HC HISTAMINE,301,1 ,$244.95 ,$161.67 ,$29.53 ,$244.95 ,$30.51 ,$103.36 ,$103.36 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$30.51 ,$30.51 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$30.51 ,$151.86 ,$32.34 ,$220.46 ,$66.44 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$32.34 ,$35.44 ,$35.44 ,$64.82 ,$35.44 ,$29.53 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100346,83090,HC HOMOCYSTEINE,301,1 ,$154.10 ,$101.71 ,$17.92 ,$154.10 ,$18.52 ,$62.72 ,$62.72 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.52 ,$18.52 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.52 ,$95.54 ,$19.63 ,$138.69 ,$40.32 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.63 ,$21.50 ,$21.50 ,$40.78 ,$21.50 ,$17.92 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100347,83150,HC HOMOVANILLIC ACID (HVA24),301,1 ,$128.80 ,$85.01 ,$19.62 ,$128.80 ,$19.62 ,$78.44 ,$78.44 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$19.62 ,$19.62 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$19.62 ,$79.86 ,$20.80 ,$115.92 ,$50.42 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$20.80 ,$26.89 ,$26.89 ,$34.08 ,$26.89 ,$22.41 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100349,83491,HC CORTICOSTEROIDS 17D,301,1 ,$143.75 ,$94.88 ,$17.90 ,$143.75 ,$18.50 ,$62.65 ,$62.65 ,$38.03 ,$115.00 ,$122.19 ,$89.84 ,$129.38 ,$18.50 ,$18.50 ,$136.56 ,$129.38 ,$122.19 ,$122.19 ,$38.03 ,$122.19 ,$122.19 ,$129.38 ,$87.54 ,$18.50 ,$89.12 ,$19.61 ,$129.38 ,$40.28 ,$132.25 ,$129.38 ,$94.89 ,$94.89 ,$87.54 ,$94.89 ,$93.44 ,$98.21 ,$32.72 ,$113.56 ,$19.61 ,$21.48 ,$21.48 ,$38.03 ,$21.48 ,$17.90 ,$136.56 ,$117.88 ,$117.88 ,$115.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100350,83497,HC HYDROXYINDOLACET 5 (HIAA),301,1 ,$116.15 ,$76.66 ,$12.90 ,$116.15 ,$13.33 ,$45.15 ,$45.15 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.33 ,$13.33 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.33 ,$72.02 ,$14.13 ,$104.54 ,$29.03 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.13 ,$15.48 ,$15.48 ,$30.73 ,$15.48 ,$12.90 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100352,83498,HC HYDROXYPROGESTERONE 17D,301,1 ,$244.95 ,$161.67 ,$27.17 ,$244.95 ,$28.07 ,$95.10 ,$95.10 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$28.07 ,$28.07 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$28.07 ,$151.86 ,$29.75 ,$220.46 ,$61.13 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$29.75 ,$32.60 ,$32.60 ,$64.82 ,$32.60 ,$27.17 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100354,83505,HC HYDROXYPROLIN,301,1 ,$207.00 ,$136.62 ,$24.30 ,$207.00 ,$25.11 ,$85.05 ,$85.05 ,$54.77 ,$165.60 ,$175.95 ,$129.38 ,$186.30 ,$25.11 ,$25.11 ,$196.65 ,$186.30 ,$175.95 ,$175.95 ,$54.77 ,$175.95 ,$175.95 ,$186.30 ,$126.06 ,$25.11 ,$128.34 ,$26.62 ,$186.30 ,$54.68 ,$190.44 ,$186.30 ,$136.64 ,$136.64 ,$126.06 ,$136.64 ,$134.55 ,$141.42 ,$47.13 ,$163.53 ,$26.62 ,$29.16 ,$29.16 ,$54.77 ,$29.16 ,$24.30 ,$196.65 ,$169.74 ,$169.74 ,$165.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100355,83516,HC IMMUNO QL/SQ MLT,301,1 ,$103.50 ,$68.31 ,$11.53 ,$103.50 ,$11.91 ,$40.36 ,$40.36 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$11.91 ,$11.91 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$11.91 ,$64.18 ,$12.62 ,$93.15 ,$25.94 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$12.62 ,$13.84 ,$13.84 ,$27.39 ,$13.84 ,$11.53 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100357,83516,HC HISTONE ANTIBODY,301,1 ,$116.15 ,$76.66 ,$11.53 ,$116.15 ,$11.91 ,$40.36 ,$40.36 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$11.91 ,$11.91 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$11.91 ,$72.02 ,$12.62 ,$104.54 ,$25.94 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$12.62 ,$13.84 ,$13.84 ,$30.73 ,$13.84 ,$11.53 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100358,83516,HC ACTIN AB,301,1 ,$92.00 ,$60.72 ,$11.53 ,$92.00 ,$11.91 ,$40.36 ,$40.36 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$11.91 ,$11.91 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 ,$11.91 ,$57.04 ,$12.62 ,$82.80 ,$25.94 ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 ,$12.62 ,$13.84 ,$13.84 ,$24.34 ,$13.84 ,$11.53 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100359,83516,HC IMMUNO QL/SQ MLT (2),301,1 ,$95.45 ,$63.00 ,$11.53 ,$95.45 ,$11.91 ,$40.36 ,$40.36 ,$25.25 ,$76.36 ,$81.13 ,$59.66 ,$85.91 ,$11.91 ,$11.91 ,$90.68 ,$85.91 ,$81.13 ,$81.13 ,$25.25 ,$81.13 ,$81.13 ,$85.91 ,$58.13 ,$11.91 ,$59.18 ,$12.62 ,$85.91 ,$25.94 ,$87.81 ,$85.91 ,$63.01 ,$63.01 ,$58.13 ,$63.01 ,$62.04 ,$65.21 ,$21.73 ,$75.41 ,$12.62 ,$13.84 ,$13.84 ,$25.25 ,$13.84 ,$11.53 ,$90.68 ,$78.27 ,$78.27 ,$76.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100363,83519,HC ACETYLCHOLINE RECEPTR AB,301,1 ,$116.15 ,$76.66 ,$18.40 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.00 ,$19.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.00 ,$72.02 ,$20.14 ,$104.54 ,$41.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$30.73 ,$22.08 ,$18.40 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100365,83519,HC GAD 65 AB,301,1 ,$118.45 ,$78.18 ,$18.40 ,$118.45 ,$19.00 ,$64.40 ,$64.40 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$19.00 ,$19.00 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$19.00 ,$73.44 ,$20.14 ,$106.61 ,$41.40 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$20.14 ,$22.08 ,$22.08 ,$31.34 ,$22.08 ,$18.40 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100367,83519,HC PTH RELATED PROTEIN,301,1 ,$116.15 ,$76.66 ,$18.40 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.00 ,$19.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.00 ,$72.02 ,$20.14 ,$104.54 ,$41.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$30.73 ,$22.08 ,$18.40 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100368,83519,HC NEOPTERIN,301,1 ,$116.15 ,$76.66 ,$18.40 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.00 ,$19.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.00 ,$72.02 ,$20.14 ,$104.54 ,$41.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$30.73 ,$22.08 ,$18.40 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100369,83519,HC IGF BINDING PROTEIN,301,1 ,$116.15 ,$76.66 ,$18.40 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.00 ,$19.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.00 ,$72.02 ,$20.14 ,$104.54 ,$41.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$30.73 ,$22.08 ,$18.40 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100370,83519,HC ACHR BINDING AB,301,1 ,$194.35 ,$128.27 ,$18.40 ,$194.35 ,$19.00 ,$64.40 ,$64.40 ,$51.42 ,$155.48 ,$165.20 ,$121.47 ,$174.92 ,$19.00 ,$19.00 ,$184.63 ,$174.92 ,$165.20 ,$165.20 ,$51.42 ,$165.20 ,$165.20 ,$174.92 ,$118.36 ,$19.00 ,$120.50 ,$20.14 ,$174.92 ,$41.40 ,$178.80 ,$174.92 ,$128.29 ,$128.29 ,$118.36 ,$128.29 ,$126.33 ,$132.78 ,$44.25 ,$153.54 ,$20.14 ,$22.08 ,$22.08 ,$51.42 ,$22.08 ,$18.40 ,$184.63 ,$159.37 ,$159.37 ,$155.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100371,83519,HC MUSK ANTIBODY,301,1 ,$644.00 ,$425.04 ,$18.40 ,$644.00 ,$19.00 ,$64.40 ,$64.40 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$19.00 ,$19.00 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$19.00 ,$399.28 ,$20.14 ,$579.60 ,$41.40 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$20.14 ,$22.08 ,$22.08 ,$170.40 ,$22.08 ,$18.40 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100372,83519,HC ACEYTLCHOLINE RECPT AB (BK),301,1 ,$106.95 ,$70.59 ,$18.40 ,$106.95 ,$19.00 ,$64.40 ,$64.40 ,$28.30 ,$85.56 ,$90.91 ,$66.84 ,$96.26 ,$19.00 ,$19.00 ,$101.60 ,$96.26 ,$90.91 ,$90.91 ,$28.30 ,$90.91 ,$90.91 ,$96.26 ,$65.13 ,$19.00 ,$66.30 ,$20.14 ,$96.26 ,$41.40 ,$98.39 ,$96.26 ,$70.60 ,$70.60 ,$65.13 ,$70.60 ,$69.52 ,$73.07 ,$24.35 ,$84.49 ,$20.14 ,$22.08 ,$22.08 ,$28.30 ,$22.08 ,$18.40 ,$101.60 ,$87.70 ,$87.70 ,$85.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100373,83519,HC ACEYTLCHOLINE RECPT AB (MD),301,1 ,$116.15 ,$76.66 ,$18.40 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.00 ,$19.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.00 ,$72.02 ,$20.14 ,$104.54 ,$41.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$30.73 ,$22.08 ,$18.40 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100375,80155,HC CAFFEINE,301,1 ,$180.00 ,$118.80 ,$15.44 ,$180.00 ,$15.44 ,$135.00 ,$135.00 ,$47.63 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$15.44 ,$15.44 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$47.63 ,$153.00 ,$153.00 ,$162.00 ,$109.62 ,$15.44 ,$111.60 ,$16.37 ,$162.00 ,$86.78 ,$165.60 ,$162.00 ,$118.82 ,$118.82 ,$109.62 ,$118.82 ,$117.00 ,$122.98 ,$40.97 ,$142.20 ,$16.37 ,$46.28 ,$46.28 ,$47.63 ,$46.28 ,$38.57 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100376,83520,HC METHOTREXATE,301,1 ,$386.40 ,$255.02 ,$17.27 ,$386.40 ,$17.85 ,$60.45 ,$60.45 ,$102.24 ,$309.12 ,$328.44 ,$241.50 ,$347.76 ,$17.85 ,$17.85 ,$367.08 ,$347.76 ,$328.44 ,$328.44 ,$102.24 ,$328.44 ,$328.44 ,$347.76 ,$235.32 ,$17.85 ,$239.56 ,$18.92 ,$347.76 ,$38.86 ,$355.49 ,$347.76 ,$255.06 ,$255.06 ,$235.32 ,$255.06 ,$251.16 ,$263.99 ,$87.96 ,$305.26 ,$18.92 ,$20.72 ,$20.72 ,$102.24 ,$20.72 ,$17.27 ,$367.08 ,$316.85 ,$316.85 ,$309.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100378,83520,HC C1 ESTERASE IHHIB FUNCTN,301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.85 ,$17.85 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.85 ,$72.02 ,$18.92 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$30.73 ,$20.72 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100379,83520,HC IMMUNOASSAY QN PROTEIN,301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.85 ,$17.85 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.85 ,$72.02 ,$18.92 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$30.73 ,$20.72 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100381,83520,HC C3 A,301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.85 ,$17.85 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.85 ,$72.02 ,$18.92 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$30.73 ,$20.72 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100384,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.85 ,$17.85 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.85 ,$72.02 ,$18.92 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$30.73 ,$20.72 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100385,83520,HC CD ANTI GLIADIN,301,1 ,$113.85 ,$75.14 ,$17.27 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$30.13 ,$91.08 ,$96.77 ,$71.16 ,$102.47 ,$17.85 ,$17.85 ,$108.16 ,$102.47 ,$96.77 ,$96.77 ,$30.13 ,$96.77 ,$96.77 ,$102.47 ,$69.33 ,$17.85 ,$70.58 ,$18.92 ,$102.47 ,$38.86 ,$104.74 ,$102.47 ,$75.15 ,$75.15 ,$69.33 ,$75.15 ,$74.00 ,$77.78 ,$25.92 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$30.13 ,$20.72 ,$17.27 ,$108.16 ,$93.36 ,$93.36 ,$91.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100386,83520,HC FIBROSPECT TIMP 1,301,1 ,$113.85 ,$75.14 ,$17.27 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$30.13 ,$91.08 ,$96.77 ,$71.16 ,$102.47 ,$17.85 ,$17.85 ,$108.16 ,$102.47 ,$96.77 ,$96.77 ,$30.13 ,$96.77 ,$96.77 ,$102.47 ,$69.33 ,$17.85 ,$70.58 ,$18.92 ,$102.47 ,$38.86 ,$104.74 ,$102.47 ,$75.15 ,$75.15 ,$69.33 ,$75.15 ,$74.00 ,$77.78 ,$25.92 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$30.13 ,$20.72 ,$17.27 ,$108.16 ,$93.36 ,$93.36 ,$91.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100389,83520,HC TRYPTASE,301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.85 ,$17.85 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.85 ,$72.02 ,$18.92 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$30.73 ,$20.72 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100390,82397,HC INHIBIN B,301,1 ,$257.60 ,$170.02 ,$14.12 ,$257.60 ,$14.59 ,$49.42 ,$49.42 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$14.59 ,$14.59 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$14.59 ,$159.72 ,$15.47 ,$231.84 ,$31.77 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$15.47 ,$16.94 ,$16.94 ,$68.16 ,$16.94 ,$14.12 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100392,83525,HC INSULIN TOTAL,301,1 ,$89.70 ,$59.20 ,$11.43 ,$89.70 ,$11.81 ,$40.01 ,$40.01 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$11.81 ,$11.81 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$11.81 ,$55.62 ,$12.52 ,$80.73 ,$25.72 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$12.52 ,$13.72 ,$13.72 ,$23.74 ,$13.72 ,$11.43 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100393,83540,HC IRON TOTAL,301,1 ,$56.35 ,$37.19 ,$6.47 ,$56.35 ,$6.69 ,$22.65 ,$22.65 ,$14.91 ,$45.08 ,$47.90 ,$35.22 ,$50.72 ,$6.69 ,$6.69 ,$53.53 ,$50.72 ,$47.90 ,$47.90 ,$14.91 ,$47.90 ,$47.90 ,$50.72 ,$34.32 ,$6.69 ,$34.94 ,$7.09 ,$50.72 ,$14.56 ,$51.84 ,$50.72 ,$37.20 ,$37.20 ,$34.32 ,$37.20 ,$36.63 ,$38.50 ,$12.83 ,$44.52 ,$7.09 ,$7.76 ,$7.76 ,$14.91 ,$7.76 ,$6.47 ,$53.53 ,$46.21 ,$46.21 ,$45.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$77.05 ,$50.85 ,$8.74 ,$77.05 ,$9.03 ,$30.59 ,$30.59 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$9.03 ,$9.03 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$9.03 ,$47.78 ,$9.57 ,$69.35 ,$19.67 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.57 ,$10.49 ,$10.49 ,$20.38 ,$10.49 ,$8.74 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100395,83586,HC KETOSTEROIDS (17-KS),301,1 ,$105.80 ,$69.83 ,$12.80 ,$105.80 ,$13.23 ,$44.80 ,$44.80 ,$28.00 ,$84.64 ,$89.93 ,$66.13 ,$95.22 ,$13.23 ,$13.23 ,$100.51 ,$95.22 ,$89.93 ,$89.93 ,$28.00 ,$89.93 ,$89.93 ,$95.22 ,$64.43 ,$13.23 ,$65.60 ,$14.02 ,$95.22 ,$28.80 ,$97.34 ,$95.22 ,$69.84 ,$69.84 ,$64.43 ,$69.84 ,$68.77 ,$72.28 ,$24.08 ,$83.58 ,$14.02 ,$15.36 ,$15.36 ,$28.00 ,$15.36 ,$12.80 ,$100.51 ,$86.76 ,$86.76 ,$84.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$103.50 ,$68.31 ,$11.57 ,$103.50 ,$11.96 ,$40.50 ,$40.50 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$11.96 ,$11.96 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$11.96 ,$64.18 ,$12.68 ,$93.15 ,$26.03 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$12.68 ,$13.88 ,$13.88 ,$27.39 ,$13.88 ,$11.57 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$56.35 ,$37.19 ,$6.04 ,$56.35 ,$6.24 ,$21.14 ,$21.14 ,$14.91 ,$45.08 ,$47.90 ,$35.22 ,$50.72 ,$6.24 ,$6.24 ,$53.53 ,$50.72 ,$47.90 ,$47.90 ,$14.91 ,$47.90 ,$47.90 ,$50.72 ,$34.32 ,$6.24 ,$34.94 ,$6.61 ,$50.72 ,$13.59 ,$51.84 ,$50.72 ,$37.20 ,$37.20 ,$34.32 ,$37.20 ,$36.63 ,$38.50 ,$12.83 ,$44.52 ,$6.61 ,$7.25 ,$7.25 ,$14.91 ,$7.25 ,$6.04 ,$53.53 ,$46.21 ,$46.21 ,$45.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100399,83625,HC LDH ISOENZYMES,301,1 ,$89.70 ,$59.20 ,$12.79 ,$89.70 ,$13.22 ,$44.77 ,$44.77 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$13.22 ,$13.22 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$13.22 ,$55.62 ,$14.01 ,$80.73 ,$28.78 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$14.01 ,$15.35 ,$15.35 ,$23.74 ,$15.35 ,$12.79 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100401,83655,HC LEAD,301,1 ,$103.50 ,$68.31 ,$12.11 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.51 ,$12.51 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.51 ,$64.18 ,$13.26 ,$93.15 ,$27.25 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$27.39 ,$14.53 ,$12.11 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100402,83655,HC LEAD BLOOD HMP,301,1 ,$103.50 ,$68.31 ,$12.11 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.51 ,$12.51 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.51 ,$64.18 ,$13.26 ,$93.15 ,$27.25 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$27.39 ,$14.53 ,$12.11 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100404,83655,HC LEAD URINE,301,1 ,$103.50 ,$68.31 ,$12.11 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.51 ,$12.51 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.51 ,$64.18 ,$13.26 ,$93.15 ,$27.25 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$27.39 ,$14.53 ,$12.11 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100406,83655,HC LEAD 24HR URINE,301,1 ,$103.50 ,$68.31 ,$12.11 ,$103.50 ,$12.51 ,$42.39 ,$42.39 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.51 ,$12.51 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.51 ,$64.18 ,$13.26 ,$93.15 ,$27.25 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.26 ,$14.53 ,$14.53 ,$27.39 ,$14.53 ,$12.11 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100408,83663,HC FETAL LUNG MATURITY,301,1 ,$622.15 ,$410.62 ,$13.65 ,$622.15 ,$13.65 ,$66.19 ,$66.19 ,$164.62 ,$497.72 ,$528.83 ,$388.84 ,$559.94 ,$13.65 ,$13.65 ,$591.04 ,$559.94 ,$528.83 ,$528.83 ,$164.62 ,$528.83 ,$528.83 ,$559.94 ,$378.89 ,$13.65 ,$385.74 ,$14.47 ,$559.94 ,$42.55 ,$572.38 ,$559.94 ,$410.68 ,$410.68 ,$378.89 ,$410.68 ,$404.40 ,$425.05 ,$141.63 ,$491.50 ,$14.47 ,$22.69 ,$22.69 ,$164.62 ,$22.69 ,$18.91 ,$591.04 ,$510.16 ,$510.16 ,$497.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100409,83690,HC LIPASE,301,1 ,$89.70 ,$59.20 ,$6.89 ,$89.70 ,$7.12 ,$24.12 ,$24.12 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$7.12 ,$7.12 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$7.12 ,$55.62 ,$7.55 ,$80.73 ,$15.50 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$7.55 ,$8.27 ,$8.27 ,$23.74 ,$8.27 ,$6.89 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100410,83695,HC LIPOPROTEIN,301,1 ,$89.70 ,$59.20 ,$14.32 ,$89.70 ,$14.80 ,$50.12 ,$50.12 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$14.80 ,$14.80 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$14.80 ,$55.62 ,$15.69 ,$80.73 ,$32.22 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$15.69 ,$17.18 ,$17.18 ,$23.74 ,$17.18 ,$14.32 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100413,83704,HC LP FRACTN ION MOBILITY,301,1 ,$282.90 ,$186.71 ,$34.19 ,$282.90 ,$35.33 ,$119.67 ,$119.67 ,$74.85 ,$226.32 ,$240.47 ,$176.81 ,$254.61 ,$35.33 ,$35.33 ,$268.76 ,$254.61 ,$240.47 ,$240.47 ,$74.85 ,$240.47 ,$240.47 ,$254.61 ,$172.29 ,$35.33 ,$175.40 ,$37.45 ,$254.61 ,$76.93 ,$260.27 ,$254.61 ,$186.74 ,$186.74 ,$172.29 ,$186.74 ,$183.89 ,$193.28 ,$64.41 ,$223.49 ,$37.45 ,$41.03 ,$41.03 ,$74.85 ,$41.03 ,$34.19 ,$268.76 ,$231.98 ,$231.98 ,$226.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100414,83704,HC NMR LIPOPROFILE LIP,301,1 ,$148.35 ,$97.91 ,$33.77 ,$148.35 ,$35.33 ,$119.67 ,$119.67 ,$39.25 ,$118.68 ,$126.10 ,$92.72 ,$133.52 ,$35.33 ,$35.33 ,$140.93 ,$133.52 ,$126.10 ,$126.10 ,$39.25 ,$126.10 ,$126.10 ,$133.52 ,$90.35 ,$35.33 ,$91.98 ,$37.45 ,$133.52 ,$76.93 ,$136.48 ,$133.52 ,$97.93 ,$97.93 ,$90.35 ,$97.93 ,$96.43 ,$101.35 ,$33.77 ,$117.20 ,$37.45 ,$41.03 ,$41.03 ,$39.25 ,$41.03 ,$34.19 ,$140.93 ,$121.65 ,$121.65 ,$118.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100415,83718,HC CHOLESTEROL HDL,301,1 ,$77.05 ,$50.85 ,$8.19 ,$77.05 ,$8.46 ,$28.67 ,$28.67 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.46 ,$8.46 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.46 ,$47.78 ,$8.97 ,$69.35 ,$18.43 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.97 ,$9.83 ,$9.83 ,$20.38 ,$9.83 ,$8.19 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100416,83721,HC CHOLESTEROL LDL,301,1 ,$89.70 ,$59.20 ,$10.50 ,$89.70 ,$10.85 ,$36.75 ,$36.75 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.85 ,$10.85 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.85 ,$55.62 ,$11.50 ,$80.73 ,$23.63 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.50 ,$12.60 ,$12.60 ,$23.74 ,$12.60 ,$10.50 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100417,83735,HC MAGNESIUM,301,1 ,$59.80 ,$39.47 ,$6.70 ,$59.80 ,$6.92 ,$23.45 ,$23.45 ,$15.83 ,$47.84 ,$50.83 ,$37.38 ,$53.82 ,$6.92 ,$6.92 ,$56.81 ,$53.82 ,$50.83 ,$50.83 ,$15.83 ,$50.83 ,$50.83 ,$53.82 ,$36.42 ,$6.92 ,$37.08 ,$7.34 ,$53.82 ,$15.08 ,$55.02 ,$53.82 ,$39.47 ,$39.47 ,$36.42 ,$39.47 ,$38.87 ,$40.86 ,$13.61 ,$47.24 ,$7.34 ,$8.04 ,$8.04 ,$15.83 ,$8.04 ,$6.70 ,$56.81 ,$49.04 ,$49.04 ,$47.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100418,83785,HC MANGANESE (MAYO),301,1 ,$180.55 ,$119.16 ,$26.65 ,$180.55 ,$27.54 ,$93.28 ,$93.28 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$27.54 ,$27.54 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$27.54 ,$111.94 ,$29.19 ,$162.50 ,$59.96 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$29.19 ,$31.98 ,$31.98 ,$47.77 ,$31.98 ,$26.65 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100419,83785,HC MANGANESE,301,1 ,$180.55 ,$119.16 ,$26.65 ,$180.55 ,$27.54 ,$93.28 ,$93.28 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$27.54 ,$27.54 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$27.54 ,$111.94 ,$29.19 ,$162.50 ,$59.96 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$29.19 ,$31.98 ,$31.98 ,$47.77 ,$31.98 ,$26.65 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100421,82542,HC BILE ACIDS,301,1 ,$361.10 ,$238.33 ,$24.09 ,$361.10 ,$24.89 ,$84.32 ,$84.32 ,$95.55 ,$288.88 ,$306.94 ,$225.69 ,$324.99 ,$24.89 ,$24.89 ,$343.05 ,$324.99 ,$306.94 ,$306.94 ,$95.55 ,$306.94 ,$306.94 ,$324.99 ,$219.91 ,$24.89 ,$223.88 ,$26.38 ,$324.99 ,$54.20 ,$332.21 ,$324.99 ,$238.36 ,$238.36 ,$219.91 ,$238.36 ,$234.72 ,$246.70 ,$82.20 ,$285.27 ,$26.38 ,$28.91 ,$28.91 ,$95.55 ,$28.91 ,$24.09 ,$343.05 ,$296.10 ,$296.10 ,$288.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100423,G0480,HC ETHYL GLUCUR/SULFATE,301,1 ,$180.00 ,$118.80 ,$40.97 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$47.63 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$47.63 ,$153.00 ,$153.00 ,$162.00 ,$109.62 ,$63.95 ,$111.60 ,$67.79 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$118.82 ,$118.82 ,$109.62 ,$118.82 ,$117.00 ,$122.98 ,$40.97 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$47.63 ,$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 ,$66.00 ,$13.25 ,$100.00 ,$13.69 ,$46.38 ,$46.38 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$13.69 ,$13.69 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$13.69 ,$62.00 ,$14.51 ,$90.00 ,$29.81 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$14.51 ,$15.90 ,$15.90 ,$26.46 ,$15.90 ,$13.25 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100428,83825,HC MERCURY BLOOD,301,1 ,$116.15 ,$76.66 ,$16.26 ,$116.15 ,$16.80 ,$56.91 ,$56.91 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$16.80 ,$16.80 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$16.80 ,$72.02 ,$17.81 ,$104.54 ,$36.59 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$17.81 ,$19.51 ,$19.51 ,$30.73 ,$19.51 ,$16.26 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100429,83825,HC MERCURY 24HR URINE,301,1 ,$116.15 ,$76.66 ,$16.26 ,$116.15 ,$16.80 ,$56.91 ,$56.91 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$16.80 ,$16.80 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$16.80 ,$72.02 ,$17.81 ,$104.54 ,$36.59 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$17.81 ,$19.51 ,$19.51 ,$30.73 ,$19.51 ,$16.26 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100430,83835,HC METANEPHRINES,301,1 ,$154.10 ,$101.71 ,$16.94 ,$154.10 ,$17.50 ,$59.29 ,$59.29 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$17.50 ,$17.50 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$17.50 ,$95.54 ,$18.55 ,$138.69 ,$38.12 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$18.55 ,$20.33 ,$20.33 ,$40.78 ,$20.33 ,$16.94 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100431,83835,HC METANEPHRINES PLASMA,301,1 ,$154.10 ,$101.71 ,$16.94 ,$154.10 ,$17.50 ,$59.29 ,$59.29 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$17.50 ,$17.50 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$17.50 ,$95.54 ,$18.55 ,$138.69 ,$38.12 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$18.55 ,$20.33 ,$20.33 ,$40.78 ,$20.33 ,$16.94 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100432,83835,HC METANEPHRINES RANDM URINE,301,1 ,$154.10 ,$101.71 ,$16.94 ,$154.10 ,$17.50 ,$59.29 ,$59.29 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$17.50 ,$17.50 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$17.50 ,$95.54 ,$18.55 ,$138.69 ,$38.12 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$18.55 ,$20.33 ,$20.33 ,$40.78 ,$20.33 ,$16.94 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100433,80358,HC METHADONE,301,1 ,$210.00 ,$138.60 ,$21.05 ,$210.00 ,$21.05 ,$79.87 ,$79.87 ,$55.57 ,$168.00 ,$178.50 ,$131.25 ,$189.00 ,$21.05 ,$21.05 ,$199.50 ,$189.00 ,$178.50 ,$178.50 ,$55.57 ,$178.50 ,$178.50 ,$189.00 ,$127.89 ,$21.05 ,$130.20 ,$22.31 ,$189.00 , N/A ,$193.20 ,$189.00 ,$138.62 ,$138.62 ,$127.89 ,$138.62 ,$136.50 ,$143.47 ,$47.80 ,$165.90 ,$22.31 , N/A , N/A ,$55.57 , 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 ,$128.80 ,$85.01 ,$17.20 ,$128.80 ,$17.77 ,$60.20 ,$60.20 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$17.77 ,$17.77 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$17.77 ,$79.86 ,$18.84 ,$115.92 ,$38.70 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$18.84 ,$20.64 ,$20.64 ,$34.08 ,$20.64 ,$17.20 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100435,83874,HC MYOGLOBIN,301,1 ,$128.80 ,$85.01 ,$12.92 ,$128.80 ,$13.35 ,$45.22 ,$45.22 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$13.35 ,$13.35 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$13.35 ,$79.86 ,$14.15 ,$115.92 ,$29.07 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$14.15 ,$15.50 ,$15.50 ,$34.08 ,$15.50 ,$12.92 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100436,83874,HC MYOGLOBIN URINE,301,1 ,$128.80 ,$85.01 ,$12.92 ,$128.80 ,$13.35 ,$45.22 ,$45.22 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$13.35 ,$13.35 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$13.35 ,$79.86 ,$14.15 ,$115.92 ,$29.07 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$14.15 ,$15.50 ,$15.50 ,$34.08 ,$15.50 ,$12.92 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$296.70 ,$195.82 ,$39.26 ,$296.70 ,$40.57 ,$137.41 ,$137.41 ,$78.51 ,$237.36 ,$252.20 ,$185.44 ,$267.03 ,$40.57 ,$40.57 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,$40.57 ,$183.96 ,$43.00 ,$267.03 ,$88.34 ,$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,$43.00 ,$47.11 ,$47.11 ,$78.51 ,$47.11 ,$39.26 ,$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100439,83521,HC NEPHELOMETRY EA ANALYTE,301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.27 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.27 ,$17.27 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.27 ,$72.02 ,$18.31 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.31 ,$56.91 ,$56.91 ,$30.73 ,$56.91 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100440,83521,HC NEPHELOMETRY EA AN (MAYO),301,1 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.27 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.27 ,$17.27 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.27 ,$72.02 ,$18.31 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.31 ,$56.91 ,$56.91 ,$30.73 ,$56.91 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100445,G0480,HC NICOTINE W/METABOLITE,301,1 ,$120.00 ,$79.20 ,$27.32 ,$257.47 ,$63.95 ,$120.00 ,$120.00 ,$31.75 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$63.95 ,$63.95 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$31.75 ,$102.00 ,$102.00 ,$108.00 ,$73.08 ,$63.95 ,$74.40 ,$67.79 ,$108.00 ,$257.47 ,$110.40 ,$108.00 ,$79.21 ,$79.21 ,$73.08 ,$79.21 ,$78.00 ,$81.98 ,$27.32 ,$94.80 ,$67.79 ,$120.00 ,$120.00 ,$31.75 ,$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 ,$27.60 ,$18.22 ,$6.28 ,$27.60 ,$8.37 ,$27.60 ,$27.60 ,$7.30 ,$22.08 ,$23.46 ,$17.25 ,$24.84 ,$8.37 ,$8.37 ,$26.22 ,$24.84 ,$23.46 ,$23.46 ,$7.30 ,$23.46 ,$23.46 ,$24.84 ,$16.81 ,$8.37 ,$17.12 ,$8.87 ,$24.84 ,$18.23 ,$25.39 ,$24.84 ,$18.22 ,$18.22 ,$16.81 ,$18.22 ,$17.94 ,$18.86 ,$6.28 ,$21.80 ,$8.87 ,$9.72 ,$9.72 ,$7.30 ,$9.72 ,$8.10 ,$26.22 ,$22.63 ,$22.63 ,$22.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100486,80165,HC VALPROIC ACID FREE,301,1 ,$82.80 ,$54.65 ,$13.54 ,$82.80 ,$13.99 ,$47.39 ,$47.39 ,$21.91 ,$66.24 ,$70.38 ,$51.75 ,$74.52 ,$13.99 ,$13.99 ,$78.66 ,$74.52 ,$70.38 ,$70.38 ,$21.91 ,$70.38 ,$70.38 ,$74.52 ,$50.43 ,$13.99 ,$51.34 ,$14.83 ,$74.52 ,$30.47 ,$76.18 ,$74.52 ,$54.66 ,$54.66 ,$50.43 ,$54.66 ,$53.82 ,$56.57 ,$18.85 ,$65.41 ,$14.83 ,$16.25 ,$16.25 ,$21.91 ,$16.25 ,$13.54 ,$78.66 ,$67.90 ,$67.90 ,$66.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100660,83915,HC NUCLEOTIDASE,301,1 ,$167.90 ,$110.81 ,$11.15 ,$167.90 ,$11.52 ,$39.03 ,$39.03 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$11.52 ,$11.52 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$11.52 ,$104.10 ,$12.21 ,$151.11 ,$25.09 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$12.21 ,$13.38 ,$13.38 ,$44.42 ,$13.38 ,$11.15 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100661,83916,HC OLIGOCLONAL BANDS,301,1 ,$167.90 ,$110.81 ,$27.39 ,$167.90 ,$28.28 ,$95.87 ,$95.87 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$28.28 ,$28.28 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$28.28 ,$104.10 ,$29.98 ,$151.11 ,$61.63 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$29.98 ,$32.87 ,$32.87 ,$44.42 ,$32.87 ,$27.39 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100662,83918,HC ORGANIC ACIDS QD,301,1 ,$760.15 ,$501.70 ,$23.14 ,$760.15 ,$23.14 ,$82.60 ,$82.60 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$23.14 ,$23.14 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$23.14 ,$471.30 ,$24.53 ,$684.14 ,$53.10 ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 ,$173.05 ,$600.52 ,$24.53 ,$28.32 ,$28.32 ,$201.14 ,$28.32 ,$23.60 ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100664,83918,HC ORGANIC ACIDS URINE,301,1 ,"$1,362.75 ",$899.42 ,$23.14 ,"$1,362.75 ",$23.14 ,$82.60 ,$82.60 ,$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ",$23.14 ,$23.14 ,"$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,$23.14 ,$844.90 ,$24.53 ,"$1,226.48 ",$53.10 ,"$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ",$24.53 ,$28.32 ,$28.32 ,$360.58 ,$28.32 ,$23.60 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30100666,83921,HC ORGANIC ACID SNG QN (MEHTYL),301,1 ,$141.45 ,$93.36 ,$21.21 ,$141.45 ,$21.92 ,$74.24 ,$74.24 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$21.92 ,$21.92 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$21.92 ,$87.70 ,$23.24 ,$127.31 ,$47.72 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$23.24 ,$25.45 ,$25.45 ,$37.43 ,$25.45 ,$21.21 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100667,80364,HC OPIATES EXP,301,1 ,$37.00 ,$24.42 ,$8.43 ,$37.00 ,$21.05 ,$33.16 ,$33.16 ,$9.79 ,$29.60 ,$31.45 ,$23.13 ,$33.30 ,$21.05 ,$21.05 ,$35.15 ,$33.30 ,$31.45 ,$31.45 ,$9.79 ,$31.45 ,$31.45 ,$33.30 ,$22.53 ,$21.05 ,$22.94 ,$22.31 ,$33.30 , N/A ,$34.04 ,$33.30 ,$24.42 ,$24.42 ,$22.53 ,$24.42 ,$24.05 ,$25.28 ,$8.43 ,$29.23 ,$22.31 , N/A , N/A ,$9.79 , N/A , N/A ,$35.15 ,$30.34 ,$30.34 ,$29.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100668,83930,HC OSMOLALITY BLOOD,301,1 ,$57.50 ,$37.95 ,$6.61 ,$57.50 ,$6.83 ,$23.14 ,$23.14 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$6.83 ,$6.83 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$6.83 ,$35.66 ,$7.24 ,$51.75 ,$14.87 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$7.24 ,$7.93 ,$7.93 ,$15.22 ,$7.93 ,$6.61 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100669,83935,HC OSMOLALITY URINE,301,1 ,$60.95 ,$40.23 ,$6.82 ,$60.95 ,$7.05 ,$23.87 ,$23.87 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$7.05 ,$7.05 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$7.05 ,$37.78 ,$7.47 ,$54.86 ,$15.35 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$7.47 ,$8.18 ,$8.18 ,$16.13 ,$8.18 ,$6.82 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$361.10 ,$238.33 ,$41.28 ,$361.10 ,$42.65 ,$144.48 ,$144.48 ,$95.55 ,$288.88 ,$306.94 ,$225.69 ,$324.99 ,$42.65 ,$42.65 ,$343.05 ,$324.99 ,$306.94 ,$306.94 ,$95.55 ,$306.94 ,$306.94 ,$324.99 ,$219.91 ,$42.65 ,$223.88 ,$45.21 ,$324.99 ,$92.88 ,$332.21 ,$324.99 ,$238.36 ,$238.36 ,$219.91 ,$238.36 ,$234.72 ,$246.70 ,$82.20 ,$285.27 ,$45.21 ,$49.54 ,$49.54 ,$95.55 ,$49.54 ,$41.28 ,$343.05 ,$296.10 ,$296.10 ,$288.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100673,83986,HC PH BODY FLUID,301,1 ,$31.05 ,$20.49 ,$3.58 ,$31.05 ,$3.70 ,$12.53 ,$12.53 ,$8.21 ,$24.84 ,$26.39 ,$19.41 ,$27.95 ,$3.70 ,$3.70 ,$29.50 ,$27.95 ,$26.39 ,$26.39 ,$8.21 ,$26.39 ,$26.39 ,$27.95 ,$18.91 ,$3.70 ,$19.26 ,$3.92 ,$27.95 ,$8.06 ,$28.57 ,$27.95 ,$20.50 ,$20.50 ,$18.91 ,$20.50 ,$20.18 ,$21.21 ,$7.07 ,$24.53 ,$3.92 ,$4.30 ,$4.30 ,$8.21 ,$4.30 ,$3.58 ,$29.50 ,$25.46 ,$25.46 ,$24.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100674,83986,HC PH BODY FLUID (FECES),301,1 ,$31.05 ,$20.49 ,$3.58 ,$31.05 ,$3.70 ,$12.53 ,$12.53 ,$8.21 ,$24.84 ,$26.39 ,$19.41 ,$27.95 ,$3.70 ,$3.70 ,$29.50 ,$27.95 ,$26.39 ,$26.39 ,$8.21 ,$26.39 ,$26.39 ,$27.95 ,$18.91 ,$3.70 ,$19.26 ,$3.92 ,$27.95 ,$8.06 ,$28.57 ,$27.95 ,$20.50 ,$20.50 ,$18.91 ,$20.50 ,$20.18 ,$21.21 ,$7.07 ,$24.53 ,$3.92 ,$4.30 ,$4.30 ,$8.21 ,$4.30 ,$3.58 ,$29.50 ,$25.46 ,$25.46 ,$24.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100675,83992,HC PHENCYCLIDINE (PCP),301,1 ,$128.80 ,$85.01 ,$20.67 ,$128.80 ,$20.67 ,$123.22 ,$123.22 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$20.67 ,$20.67 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$20.67 ,$79.86 ,$21.91 ,$115.92 , N/A ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$21.91 ,$51.97 ,$51.97 ,$34.08 ,$51.97 , N/A ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100677,84060,HC ACID PHOSPHATASE,301,1 ,$119.60 ,$78.94 ,$7.64 ,$119.60 ,$7.89 ,$26.74 ,$26.74 ,$31.64 ,$95.68 ,$101.66 ,$74.75 ,$107.64 ,$7.89 ,$7.89 ,$113.62 ,$107.64 ,$101.66 ,$101.66 ,$31.64 ,$101.66 ,$101.66 ,$107.64 ,$72.84 ,$7.89 ,$74.16 ,$8.36 ,$107.64 ,$17.19 ,$110.03 ,$107.64 ,$78.95 ,$78.95 ,$72.84 ,$78.95 ,$77.74 ,$81.71 ,$27.23 ,$94.48 ,$8.36 ,$9.17 ,$9.17 ,$31.64 ,$9.17 ,$7.64 ,$113.62 ,$98.07 ,$98.07 ,$95.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$32.20 ,$21.25 ,$5.18 ,$32.20 ,$5.35 ,$18.13 ,$18.13 ,$8.52 ,$25.76 ,$27.37 ,$20.13 ,$28.98 ,$5.35 ,$5.35 ,$30.59 ,$28.98 ,$27.37 ,$27.37 ,$8.52 ,$27.37 ,$27.37 ,$28.98 ,$19.61 ,$5.35 ,$19.96 ,$5.67 ,$28.98 ,$11.66 ,$29.62 ,$28.98 ,$21.26 ,$21.26 ,$19.61 ,$21.26 ,$20.93 ,$22.00 ,$7.33 ,$25.44 ,$5.67 ,$6.22 ,$6.22 ,$8.52 ,$6.22 ,$5.18 ,$30.59 ,$26.40 ,$26.40 ,$25.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100681,84080,HC ALK PHOS ISOENZ,301,1 ,$128.80 ,$85.01 ,$14.78 ,$128.80 ,$15.27 ,$51.73 ,$51.73 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.27 ,$15.27 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.27 ,$79.86 ,$16.19 ,$115.92 ,$33.26 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.19 ,$17.74 ,$17.74 ,$34.08 ,$17.74 ,$14.78 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100682,84081,HC PHOSPHATIDYLYCEROL (PG),301,1 ,$501.40 ,$330.92 ,$16.52 ,$501.40 ,$17.07 ,$57.82 ,$57.82 ,$132.67 ,$401.12 ,$426.19 ,$313.38 ,$451.26 ,$17.07 ,$17.07 ,$476.33 ,$451.26 ,$426.19 ,$426.19 ,$132.67 ,$426.19 ,$426.19 ,$451.26 ,$305.35 ,$17.07 ,$310.86 ,$18.09 ,$451.26 ,$37.17 ,$461.29 ,$451.26 ,$330.97 ,$330.97 ,$305.35 ,$330.97 ,$325.91 ,$342.56 ,$114.14 ,$396.11 ,$18.09 ,$19.82 ,$19.82 ,$132.67 ,$19.82 ,$16.52 ,$476.33 ,$411.15 ,$411.15 ,$401.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100684,84100,HC PHOSPHORUS,301,1 ,$41.40 ,$27.32 ,$4.74 ,$41.40 ,$4.90 ,$16.59 ,$16.59 ,$10.96 ,$33.12 ,$35.19 ,$25.88 ,$37.26 ,$4.90 ,$4.90 ,$39.33 ,$37.26 ,$35.19 ,$35.19 ,$10.96 ,$35.19 ,$35.19 ,$37.26 ,$25.21 ,$4.90 ,$25.66 ,$5.19 ,$37.26 ,$10.67 ,$38.09 ,$37.26 ,$27.33 ,$27.33 ,$25.21 ,$27.33 ,$26.91 ,$28.28 ,$9.43 ,$32.71 ,$5.19 ,$5.69 ,$5.69 ,$10.96 ,$5.69 ,$4.74 ,$39.33 ,$33.95 ,$33.95 ,$33.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100685,84105,HC PHOSPHORUS URINE,301,1 ,$44.85 ,$29.60 ,$5.78 ,$44.85 ,$5.97 ,$20.23 ,$20.23 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$5.97 ,$5.97 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$5.97 ,$27.80 ,$6.33 ,$40.37 ,$13.01 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$6.33 ,$6.94 ,$6.94 ,$11.87 ,$6.94 ,$5.78 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100687,84110,HC PORPHOBILINOGEN QN (24),301,1 ,$77.05 ,$50.85 ,$8.44 ,$77.05 ,$8.72 ,$29.54 ,$29.54 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.72 ,$8.72 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.72 ,$47.78 ,$9.24 ,$69.35 ,$18.99 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.24 ,$10.13 ,$10.13 ,$20.38 ,$10.13 ,$8.44 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100689,84120,HC PORPHYRINS QN FRACT,301,1 ,$154.10 ,$101.71 ,$14.71 ,$154.10 ,$15.20 ,$51.49 ,$51.49 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$15.20 ,$15.20 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$15.20 ,$95.54 ,$16.11 ,$138.69 ,$33.10 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$16.11 ,$17.65 ,$17.65 ,$40.78 ,$17.65 ,$14.71 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100690,84120,HC PORPHYRINS QN FRACT RNDM,301,1 ,$193.20 ,$127.51 ,$14.71 ,$193.20 ,$15.20 ,$51.49 ,$51.49 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$15.20 ,$15.20 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$15.20 ,$119.78 ,$16.11 ,$173.88 ,$33.10 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$16.11 ,$17.65 ,$17.65 ,$51.12 ,$17.65 ,$14.71 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100691,84132,HC POTASSIUM,301,1 ,$40.25 ,$26.57 ,$4.76 ,$40.25 ,$4.92 ,$16.66 ,$16.66 ,$10.65 ,$32.20 ,$34.21 ,$25.16 ,$36.23 ,$4.92 ,$4.92 ,$38.24 ,$36.23 ,$34.21 ,$34.21 ,$10.65 ,$34.21 ,$34.21 ,$36.23 ,$24.51 ,$4.92 ,$24.96 ,$5.22 ,$36.23 ,$10.71 ,$37.03 ,$36.23 ,$26.57 ,$26.57 ,$24.51 ,$26.57 ,$26.16 ,$27.50 ,$9.16 ,$31.80 ,$5.22 ,$5.71 ,$5.71 ,$10.65 ,$5.71 ,$4.76 ,$38.24 ,$33.01 ,$33.01 ,$32.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100694,84133,HC POTASSIUM URINE,301,1 ,$36.80 ,$24.29 ,$4.73 ,$36.80 ,$4.89 ,$16.56 ,$16.56 ,$9.74 ,$29.44 ,$31.28 ,$23.00 ,$33.12 ,$4.89 ,$4.89 ,$34.96 ,$33.12 ,$31.28 ,$31.28 ,$9.74 ,$31.28 ,$31.28 ,$33.12 ,$22.41 ,$4.89 ,$22.82 ,$5.18 ,$33.12 ,$10.64 ,$33.86 ,$33.12 ,$24.29 ,$24.29 ,$22.41 ,$24.29 ,$23.92 ,$25.14 ,$8.37 ,$29.07 ,$5.18 ,$5.68 ,$5.68 ,$9.74 ,$5.68 ,$4.73 ,$34.96 ,$30.18 ,$30.18 ,$29.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100695,84134,HC PREALBUMIN,301,1 ,$57.50 ,$37.95 ,$7.85 ,$57.50 ,$7.85 ,$51.07 ,$51.07 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$7.85 ,$7.85 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$7.85 ,$35.66 ,$8.32 ,$51.75 ,$32.83 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$8.32 ,$17.51 ,$17.51 ,$15.22 ,$17.51 ,$14.59 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100696,84144,HC PROGESTERONE,301,1 ,$167.90 ,$110.81 ,$20.86 ,$167.90 ,$21.55 ,$73.01 ,$73.01 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$21.55 ,$21.55 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$21.55 ,$104.10 ,$22.84 ,$151.11 ,$46.94 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$22.84 ,$25.03 ,$25.03 ,$44.42 ,$25.03 ,$20.86 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100697,84146,HC PROLACTIN,301,1 ,$167.90 ,$110.81 ,$19.38 ,$167.90 ,$20.03 ,$67.83 ,$67.83 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$20.03 ,$20.03 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$20.03 ,$104.10 ,$21.23 ,$151.11 ,$43.61 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$21.23 ,$23.26 ,$23.26 ,$44.42 ,$23.26 ,$19.38 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100698,84153,HC PSA TOTAL,301,1 ,$167.90 ,$110.81 ,$18.39 ,$167.90 ,$19.00 ,$64.37 ,$64.37 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.00 ,$19.00 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.00 ,$104.10 ,$20.14 ,$151.11 ,$41.38 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$20.14 ,$22.07 ,$22.07 ,$44.42 ,$22.07 ,$18.39 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100699,84154,HC PSA FREE,301,1 ,$167.90 ,$110.81 ,$18.39 ,$167.90 ,$19.00 ,$64.37 ,$64.37 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.00 ,$19.00 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.00 ,$104.10 ,$20.14 ,$151.11 ,$41.38 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$20.14 ,$22.07 ,$22.07 ,$44.42 ,$22.07 ,$18.39 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100700,84155,HC PROTEIN TOTAL,301,1 ,$33.35 ,$22.01 ,$3.67 ,$33.35 ,$3.79 ,$12.85 ,$12.85 ,$8.82 ,$26.68 ,$28.35 ,$20.84 ,$30.02 ,$3.79 ,$3.79 ,$31.68 ,$30.02 ,$28.35 ,$28.35 ,$8.82 ,$28.35 ,$28.35 ,$30.02 ,$20.31 ,$3.79 ,$20.68 ,$4.02 ,$30.02 ,$8.26 ,$30.68 ,$30.02 ,$22.01 ,$22.01 ,$20.31 ,$22.01 ,$21.68 ,$22.78 ,$7.59 ,$26.35 ,$4.02 ,$4.40 ,$4.40 ,$8.82 ,$4.40 ,$3.67 ,$31.68 ,$27.35 ,$27.35 ,$26.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$40.25 ,$26.57 ,$3.67 ,$40.25 ,$3.79 ,$12.85 ,$12.85 ,$10.65 ,$32.20 ,$34.21 ,$25.16 ,$36.23 ,$3.79 ,$3.79 ,$38.24 ,$36.23 ,$34.21 ,$34.21 ,$10.65 ,$34.21 ,$34.21 ,$36.23 ,$24.51 ,$3.79 ,$24.96 ,$4.02 ,$36.23 ,$8.26 ,$37.03 ,$36.23 ,$26.57 ,$26.57 ,$24.51 ,$26.57 ,$26.16 ,$27.50 ,$9.16 ,$31.80 ,$4.02 ,$4.40 ,$4.40 ,$10.65 ,$4.40 ,$3.67 ,$38.24 ,$33.01 ,$33.01 ,$32.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100702,84156,HC PROTEIN TOTAL 24HR URINE,301,1 ,$32.20 ,$21.25 ,$3.67 ,$32.20 ,$3.79 ,$12.85 ,$12.85 ,$8.52 ,$25.76 ,$27.37 ,$20.13 ,$28.98 ,$3.79 ,$3.79 ,$30.59 ,$28.98 ,$27.37 ,$27.37 ,$8.52 ,$27.37 ,$27.37 ,$28.98 ,$19.61 ,$3.79 ,$19.96 ,$4.02 ,$28.98 ,$8.26 ,$29.62 ,$28.98 ,$21.26 ,$21.26 ,$19.61 ,$21.26 ,$20.93 ,$22.00 ,$7.33 ,$25.44 ,$4.02 ,$4.40 ,$4.40 ,$8.52 ,$4.40 ,$3.67 ,$30.59 ,$26.40 ,$26.40 ,$25.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$60.95 ,$40.23 ,$4.00 ,$60.95 ,$4.13 ,$14.00 ,$14.00 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$4.13 ,$4.13 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$4.13 ,$37.78 ,$4.38 ,$54.86 ,$9.00 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$4.38 ,$4.80 ,$4.80 ,$16.13 ,$4.80 ,$4.00 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100704,84157,HC PROTEIN TOTAL SPINAL FLUID,301,1 ,$60.95 ,$40.23 ,$4.00 ,$60.95 ,$4.13 ,$14.00 ,$14.00 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$4.13 ,$4.13 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$4.13 ,$37.78 ,$4.38 ,$54.86 ,$9.00 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$4.38 ,$4.80 ,$4.80 ,$16.13 ,$4.80 ,$4.00 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100705,84165,HC PROTEIN ELECTROPHORESIS,301,1 ,$89.70 ,$59.20 ,$10.74 ,$89.70 ,$11.10 ,$37.59 ,$37.59 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$11.10 ,$11.10 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$11.10 ,$55.62 ,$11.77 ,$80.73 ,$24.17 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.77 ,$12.89 ,$12.89 ,$23.74 ,$12.89 ,$10.74 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100706,84166,HC PROTEIN EP OTH FLUID,301,1 ,$154.10 ,$101.71 ,$17.83 ,$154.10 ,$18.42 ,$62.41 ,$62.41 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.42 ,$18.42 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.42 ,$95.54 ,$19.53 ,$138.69 ,$40.12 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.53 ,$21.40 ,$21.40 ,$40.78 ,$21.40 ,$17.83 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100709,84202,HC PROTOPORPHYRIN,301,1 ,$103.50 ,$68.31 ,$14.35 ,$103.50 ,$14.83 ,$50.23 ,$50.23 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$14.83 ,$14.83 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$14.83 ,$64.18 ,$15.72 ,$93.15 ,$32.29 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$15.72 ,$17.22 ,$17.22 ,$27.39 ,$17.22 ,$14.35 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100710,84206,HC PROINSULIN,301,1 ,$334.65 ,$220.87 ,$25.05 ,$334.65 ,$25.05 ,$93.42 ,$93.42 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$25.05 ,$25.05 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$25.05 ,$207.48 ,$26.55 ,$301.19 ,$60.05 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$26.55 ,$32.03 ,$32.03 ,$88.55 ,$32.03 ,$26.69 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100711,84207,HC VITAMIN B6,301,1 ,$244.95 ,$161.67 ,$28.10 ,$244.95 ,$29.04 ,$98.35 ,$98.35 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$29.04 ,$29.04 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$29.04 ,$151.86 ,$30.78 ,$220.46 ,$63.23 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$30.78 ,$33.72 ,$33.72 ,$64.82 ,$33.72 ,$28.10 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100712,84210,HC PYRUVATE,301,1 ,$128.80 ,$85.01 ,$14.48 ,$128.80 ,$14.96 ,$50.68 ,$50.68 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.96 ,$14.96 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.96 ,$79.86 ,$15.86 ,$115.92 ,$32.58 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.86 ,$17.38 ,$17.38 ,$34.08 ,$17.38 ,$14.48 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100713,84220,HC PYRUVATE KINASE,301,1 ,$261.05 ,$172.29 ,$9.44 ,$261.05 ,$9.75 ,$33.04 ,$33.04 ,$69.07 ,$208.84 ,$221.89 ,$163.16 ,$234.95 ,$9.75 ,$9.75 ,$248.00 ,$234.95 ,$221.89 ,$221.89 ,$69.07 ,$221.89 ,$221.89 ,$234.95 ,$158.98 ,$9.75 ,$161.86 ,$10.34 ,$234.95 ,$21.24 ,$240.17 ,$234.95 ,$172.32 ,$172.32 ,$158.98 ,$172.32 ,$169.68 ,$178.35 ,$59.43 ,$206.23 ,$10.34 ,$11.33 ,$11.33 ,$69.07 ,$11.33 ,$9.44 ,$248.00 ,$214.06 ,$214.06 ,$208.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100715,84244,HC RENIN,301,1 ,$193.20 ,$127.51 ,$21.99 ,$193.20 ,$22.72 ,$76.97 ,$76.97 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$22.72 ,$22.72 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$22.72 ,$119.78 ,$24.08 ,$173.88 ,$49.48 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$24.08 ,$26.39 ,$26.39 ,$51.12 ,$26.39 ,$21.99 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100717,84255,HC SELENIUM,301,1 ,$218.50 ,$144.21 ,$25.53 ,$218.50 ,$26.38 ,$89.36 ,$89.36 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$26.38 ,$26.38 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$26.38 ,$135.48 ,$27.96 ,$196.65 ,$57.44 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$27.96 ,$30.64 ,$30.64 ,$57.82 ,$30.64 ,$25.53 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100718,84260,HC SEROTONIN,301,1 ,$218.50 ,$144.21 ,$30.98 ,$218.50 ,$32.01 ,$108.43 ,$108.43 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$32.01 ,$32.01 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$32.01 ,$135.48 ,$33.93 ,$196.65 ,$69.71 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$33.93 ,$37.18 ,$37.18 ,$57.82 ,$37.18 ,$30.98 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100719,84260,HC SEROTONIN WHOLE BLOOD,301,1 ,$262.20 ,$173.05 ,$30.98 ,$262.20 ,$32.01 ,$108.43 ,$108.43 ,$69.37 ,$209.76 ,$222.87 ,$163.88 ,$235.98 ,$32.01 ,$32.01 ,$249.09 ,$235.98 ,$222.87 ,$222.87 ,$69.37 ,$222.87 ,$222.87 ,$235.98 ,$159.68 ,$32.01 ,$162.56 ,$33.93 ,$235.98 ,$69.71 ,$241.22 ,$235.98 ,$173.08 ,$173.08 ,$159.68 ,$173.08 ,$170.43 ,$179.14 ,$59.69 ,$207.14 ,$33.93 ,$37.18 ,$37.18 ,$69.37 ,$37.18 ,$30.98 ,$249.09 ,$215.00 ,$215.00 ,$209.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100720,84270,HC SEX HORMONE BIND GLOB,301,1 ,$193.20 ,$127.51 ,$21.73 ,$193.20 ,$22.45 ,$76.06 ,$76.06 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$22.45 ,$22.45 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$22.45 ,$119.78 ,$23.80 ,$173.88 ,$48.89 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$23.80 ,$26.08 ,$26.08 ,$51.12 ,$26.08 ,$21.73 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100721,84295,HC SODIUM,301,1 ,$27.60 ,$18.22 ,$4.81 ,$27.60 ,$4.97 ,$16.84 ,$16.84 ,$7.30 ,$22.08 ,$23.46 ,$17.25 ,$24.84 ,$4.97 ,$4.97 ,$26.22 ,$24.84 ,$23.46 ,$23.46 ,$7.30 ,$23.46 ,$23.46 ,$24.84 ,$16.81 ,$4.97 ,$17.12 ,$5.27 ,$24.84 ,$10.82 ,$25.39 ,$24.84 ,$18.22 ,$18.22 ,$16.81 ,$18.22 ,$17.94 ,$18.86 ,$6.28 ,$21.80 ,$5.27 ,$5.77 ,$5.77 ,$7.30 ,$5.77 ,$4.81 ,$26.22 ,$22.63 ,$22.63 ,$22.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100724,84300,HC SODIUM URINE,301,1 ,$42.55 ,$28.08 ,$5.06 ,$42.55 ,$5.23 ,$17.71 ,$17.71 ,$11.26 ,$34.04 ,$36.17 ,$26.59 ,$38.30 ,$5.23 ,$5.23 ,$40.42 ,$38.30 ,$36.17 ,$36.17 ,$11.26 ,$36.17 ,$36.17 ,$38.30 ,$25.91 ,$5.23 ,$26.38 ,$5.54 ,$38.30 ,$11.39 ,$39.15 ,$38.30 ,$28.09 ,$28.09 ,$25.91 ,$28.09 ,$27.66 ,$29.07 ,$9.69 ,$33.61 ,$5.54 ,$6.07 ,$6.07 ,$11.26 ,$6.07 ,$5.06 ,$40.42 ,$34.89 ,$34.89 ,$34.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100725,84302,HC SODIUM OTHER FLUID,301,1 ,$42.55 ,$28.08 ,$4.86 ,$42.55 ,$5.02 ,$17.01 ,$17.01 ,$11.26 ,$34.04 ,$36.17 ,$26.59 ,$38.30 ,$5.02 ,$5.02 ,$40.42 ,$38.30 ,$36.17 ,$36.17 ,$11.26 ,$36.17 ,$36.17 ,$38.30 ,$25.91 ,$5.02 ,$26.38 ,$5.32 ,$38.30 ,$10.94 ,$39.15 ,$38.30 ,$28.09 ,$28.09 ,$25.91 ,$28.09 ,$27.66 ,$29.07 ,$9.69 ,$33.61 ,$5.32 ,$5.83 ,$5.83 ,$11.26 ,$5.83 ,$4.86 ,$40.42 ,$34.89 ,$34.89 ,$34.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100726,84305,HC SOMATOMEDINC,301,1 ,$193.20 ,$127.51 ,$21.26 ,$193.20 ,$21.97 ,$74.41 ,$74.41 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$21.97 ,$21.97 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$21.97 ,$119.78 ,$23.29 ,$173.88 ,$47.84 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$23.29 ,$25.51 ,$25.51 ,$51.12 ,$25.51 ,$21.26 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100727,84311,HC SPECTROPHOTOMETRY,301,1 ,$244.95 ,$161.67 ,$8.10 ,$244.95 ,$8.37 ,$28.35 ,$28.35 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$8.37 ,$8.37 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$8.37 ,$151.86 ,$8.87 ,$220.46 ,$18.23 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$8.87 ,$9.72 ,$9.72 ,$64.82 ,$9.72 ,$8.10 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100728,84376,HC SUGARS SINGLE QL,301,1 ,$77.05 ,$50.85 ,$5.50 ,$77.05 ,$5.68 ,$19.25 ,$19.25 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$5.68 ,$5.68 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$5.68 ,$47.78 ,$6.02 ,$69.35 ,$12.38 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$6.02 ,$6.60 ,$6.60 ,$20.38 ,$6.60 ,$5.50 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100730,84315,HC SPEC GRAVITY NON UR,301,1 ,$18.06 ,$11.92 ,$3.28 ,$18.06 ,$3.39 ,$11.48 ,$11.48 ,$4.78 ,$14.45 ,$15.35 ,$11.29 ,$16.25 ,$3.39 ,$3.39 ,$17.16 ,$16.25 ,$15.35 ,$15.35 ,$4.78 ,$15.35 ,$15.35 ,$16.25 ,$11.00 ,$3.39 ,$11.20 ,$3.59 ,$16.25 ,$7.38 ,$16.62 ,$16.25 ,$11.92 ,$11.92 ,$11.00 ,$11.92 ,$11.74 ,$12.34 ,$4.11 ,$14.27 ,$3.59 ,$3.94 ,$3.94 ,$4.78 ,$3.94 ,$3.28 ,$17.16 ,$14.81 ,$14.81 ,$14.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100732,84402,HC TESTOSTERONE FREE,301,1 ,$218.50 ,$144.21 ,$25.47 ,$218.50 ,$26.32 ,$89.15 ,$89.15 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$26.32 ,$26.32 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$26.32 ,$135.48 ,$27.90 ,$196.65 ,$57.31 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$27.90 ,$30.56 ,$30.56 ,$57.82 ,$30.56 ,$25.47 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100733,84403,HC TESTOSTERONE TOTAL,301,1 ,$218.50 ,$144.21 ,$25.81 ,$218.50 ,$26.67 ,$90.34 ,$90.34 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$26.67 ,$26.67 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$26.67 ,$135.48 ,$28.27 ,$196.65 ,$58.07 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$28.27 ,$30.97 ,$30.97 ,$57.82 ,$30.97 ,$25.81 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100735,84425,HC VITAMIN B1,301,1 ,$154.10 ,$101.71 ,$21.23 ,$154.10 ,$21.94 ,$74.31 ,$74.31 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$21.94 ,$21.94 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$21.94 ,$95.54 ,$23.26 ,$138.69 ,$47.77 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$23.26 ,$25.48 ,$25.48 ,$40.78 ,$25.48 ,$21.23 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100737,84432,HC THYROGLOBULIN,301,1 ,$141.45 ,$93.36 ,$16.06 ,$141.45 ,$16.59 ,$56.21 ,$56.21 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.59 ,$16.59 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.59 ,$87.70 ,$17.59 ,$127.31 ,$36.14 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$17.59 ,$19.27 ,$19.27 ,$37.43 ,$19.27 ,$16.06 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100738,84432,HC THYROGLOBULIN 2,301,1 ,$411.70 ,$271.72 ,$16.06 ,$411.70 ,$16.59 ,$56.21 ,$56.21 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$16.59 ,$16.59 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$16.59 ,$255.26 ,$17.59 ,$370.53 ,$36.14 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$17.59 ,$19.27 ,$19.27 ,$108.94 ,$19.27 ,$16.06 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100739,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$44.85 ,$29.60 ,$6.87 ,$44.85 ,$7.10 ,$24.05 ,$24.05 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$7.10 ,$7.10 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$7.10 ,$27.80 ,$7.53 ,$40.37 ,$15.46 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$7.53 ,$8.24 ,$8.24 ,$11.87 ,$8.24 ,$6.87 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100740,84439,HC T4 FREE,301,1 ,$77.05 ,$50.85 ,$9.02 ,$77.05 ,$9.32 ,$31.57 ,$31.57 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$9.32 ,$9.32 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$9.32 ,$47.78 ,$9.88 ,$69.35 ,$20.30 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.88 ,$10.82 ,$10.82 ,$20.38 ,$10.82 ,$9.02 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100742,84442,HC THYROXINE BIND GLOB,301,1 ,$93.15 ,$61.48 ,$14.78 ,$93.15 ,$15.27 ,$51.73 ,$51.73 ,$24.65 ,$74.52 ,$79.18 ,$58.22 ,$83.84 ,$15.27 ,$15.27 ,$88.49 ,$83.84 ,$79.18 ,$79.18 ,$24.65 ,$79.18 ,$79.18 ,$83.84 ,$56.73 ,$15.27 ,$57.76 ,$16.19 ,$83.84 ,$33.26 ,$85.70 ,$83.84 ,$61.49 ,$61.49 ,$56.73 ,$61.49 ,$60.55 ,$63.64 ,$21.20 ,$73.59 ,$16.19 ,$17.74 ,$17.74 ,$24.65 ,$17.74 ,$14.78 ,$88.49 ,$76.38 ,$76.38 ,$74.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$141.45 ,$93.36 ,$16.80 ,$141.45 ,$17.36 ,$58.80 ,$58.80 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$17.36 ,$17.36 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$17.36 ,$87.70 ,$18.40 ,$127.31 ,$37.80 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$18.40 ,$20.16 ,$20.16 ,$37.43 ,$20.16 ,$16.80 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100744,84445,HC THYROID STIM IMMUNO GLOB,301,1 ,$334.65 ,$220.87 ,$32.70 ,$334.65 ,$32.70 ,$178.01 ,$178.01 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$32.70 ,$32.70 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$32.70 ,$207.48 ,$34.66 ,$301.19 ,$114.44 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$34.66 ,$61.03 ,$61.03 ,$88.55 ,$61.03 ,$50.86 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100745,84446,HC VITAMIN E,301,1 ,$128.80 ,$85.01 ,$14.18 ,$128.80 ,$14.65 ,$49.63 ,$49.63 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.65 ,$14.65 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.65 ,$79.86 ,$15.53 ,$115.92 ,$31.91 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.53 ,$17.02 ,$17.02 ,$34.08 ,$17.02 ,$14.18 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100746,84450,HC AST,301,1 ,$44.85 ,$29.60 ,$5.18 ,$44.85 ,$5.35 ,$18.13 ,$18.13 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$5.35 ,$5.35 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$5.35 ,$27.80 ,$5.67 ,$40.37 ,$11.66 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$5.67 ,$6.22 ,$6.22 ,$11.87 ,$6.22 ,$5.18 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100747,84460,HC ALT,301,1 ,$46.00 ,$30.36 ,$5.30 ,$46.00 ,$5.48 ,$18.55 ,$18.55 ,$12.17 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$5.48 ,$5.48 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$12.17 ,$39.10 ,$39.10 ,$41.40 ,$28.01 ,$5.48 ,$28.52 ,$5.81 ,$41.40 ,$11.93 ,$42.32 ,$41.40 ,$30.36 ,$30.36 ,$28.01 ,$30.36 ,$29.90 ,$31.43 ,$10.48 ,$36.34 ,$5.81 ,$6.36 ,$6.36 ,$12.17 ,$6.36 ,$5.30 ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100748,84466,HC TRANSFERRIN,301,1 ,$62.10 ,$40.99 ,$12.76 ,$62.10 ,$13.18 ,$44.66 ,$44.66 ,$16.43 ,$49.68 ,$52.79 ,$38.81 ,$55.89 ,$13.18 ,$13.18 ,$59.00 ,$55.89 ,$52.79 ,$52.79 ,$16.43 ,$52.79 ,$52.79 ,$55.89 ,$37.82 ,$13.18 ,$38.50 ,$13.97 ,$55.89 ,$28.71 ,$57.13 ,$55.89 ,$40.99 ,$40.99 ,$37.82 ,$40.99 ,$40.37 ,$42.43 ,$14.13 ,$49.06 ,$13.97 ,$15.31 ,$15.31 ,$16.43 ,$15.31 ,$12.76 ,$59.00 ,$50.92 ,$50.92 ,$49.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100750,84478,HC TRIGLYCERIDES,301,1 ,$50.60 ,$33.40 ,$5.74 ,$50.60 ,$5.93 ,$20.09 ,$20.09 ,$13.39 ,$40.48 ,$43.01 ,$31.63 ,$45.54 ,$5.93 ,$5.93 ,$48.07 ,$45.54 ,$43.01 ,$43.01 ,$13.39 ,$43.01 ,$43.01 ,$45.54 ,$30.82 ,$5.93 ,$31.38 ,$6.29 ,$45.54 ,$12.92 ,$46.55 ,$45.54 ,$33.40 ,$33.40 ,$30.82 ,$33.40 ,$32.89 ,$34.57 ,$11.52 ,$39.97 ,$6.29 ,$6.89 ,$6.89 ,$13.39 ,$6.89 ,$5.74 ,$48.07 ,$41.49 ,$41.49 ,$40.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100752,84478,HC TRICGLYCERIDES BODY FLUID,301,1 ,$50.60 ,$33.40 ,$5.74 ,$50.60 ,$5.93 ,$20.09 ,$20.09 ,$13.39 ,$40.48 ,$43.01 ,$31.63 ,$45.54 ,$5.93 ,$5.93 ,$48.07 ,$45.54 ,$43.01 ,$43.01 ,$13.39 ,$43.01 ,$43.01 ,$45.54 ,$30.82 ,$5.93 ,$31.38 ,$6.29 ,$45.54 ,$12.92 ,$46.55 ,$45.54 ,$33.40 ,$33.40 ,$30.82 ,$33.40 ,$32.89 ,$34.57 ,$11.52 ,$39.97 ,$6.29 ,$6.89 ,$6.89 ,$13.39 ,$6.89 ,$5.74 ,$48.07 ,$41.49 ,$41.49 ,$40.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100753,84479,HC T3 UPTAKE,301,1 ,$77.05 ,$50.85 ,$6.47 ,$77.05 ,$6.69 ,$22.65 ,$22.65 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$6.69 ,$6.69 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$6.69 ,$47.78 ,$7.09 ,$69.35 ,$14.56 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$7.09 ,$7.76 ,$7.76 ,$20.38 ,$7.76 ,$6.47 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100754,84480,HC T3 TOTAL,301,1 ,$128.80 ,$85.01 ,$14.18 ,$128.80 ,$14.65 ,$49.63 ,$49.63 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.65 ,$14.65 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.65 ,$79.86 ,$15.53 ,$115.92 ,$31.91 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.53 ,$17.02 ,$17.02 ,$34.08 ,$17.02 ,$14.18 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100755,84481,HC T3 FREE,301,1 ,$103.50 ,$68.31 ,$16.62 ,$103.50 ,$16.62 ,$59.29 ,$59.29 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$16.62 ,$16.62 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$16.62 ,$64.18 ,$17.62 ,$93.15 ,$38.12 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$17.62 ,$20.33 ,$20.33 ,$27.39 ,$20.33 ,$16.94 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100757,84482,HC T3 REVERSE,301,1 ,$77.05 ,$50.85 ,$10.82 ,$77.05 ,$10.82 ,$55.16 ,$55.16 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$10.82 ,$10.82 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$10.82 ,$47.78 ,$11.47 ,$69.35 ,$35.46 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$11.47 ,$18.91 ,$18.91 ,$20.38 ,$18.91 ,$15.76 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100758,84484,HC TROPONIN QN,301,1 ,$116.15 ,$76.66 ,$12.47 ,$116.15 ,$12.89 ,$43.65 ,$43.65 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$12.89 ,$12.89 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$12.89 ,$72.02 ,$13.66 ,$104.54 ,$28.06 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$13.66 ,$14.96 ,$14.96 ,$30.73 ,$14.96 ,$12.47 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100760,84510,HC TYROSINE,301,1 ,$163.30 ,$107.78 ,$10.63 ,$163.30 ,$10.98 ,$37.21 ,$37.21 ,$43.21 ,$130.64 ,$138.81 ,$102.06 ,$146.97 ,$10.98 ,$10.98 ,$155.14 ,$146.97 ,$138.81 ,$138.81 ,$43.21 ,$138.81 ,$138.81 ,$146.97 ,$99.45 ,$10.98 ,$101.24 ,$11.64 ,$146.97 ,$23.92 ,$150.24 ,$146.97 ,$107.79 ,$107.79 ,$99.45 ,$107.79 ,$106.15 ,$111.57 ,$37.18 ,$129.01 ,$11.64 ,$12.76 ,$12.76 ,$43.21 ,$12.76 ,$10.63 ,$155.14 ,$133.91 ,$133.91 ,$130.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100761,84520,HC BUN,301,1 ,$34.50 ,$22.77 ,$3.95 ,$34.50 ,$4.08 ,$13.83 ,$13.83 ,$9.13 ,$27.60 ,$29.33 ,$21.56 ,$31.05 ,$4.08 ,$4.08 ,$32.78 ,$31.05 ,$29.33 ,$29.33 ,$9.13 ,$29.33 ,$29.33 ,$31.05 ,$21.01 ,$4.08 ,$21.40 ,$4.32 ,$31.05 ,$8.89 ,$31.74 ,$31.05 ,$22.77 ,$22.77 ,$21.01 ,$22.77 ,$22.43 ,$23.57 ,$7.86 ,$27.26 ,$4.32 ,$4.74 ,$4.74 ,$9.13 ,$4.74 ,$3.95 ,$32.78 ,$28.29 ,$28.29 ,$27.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100762,84520,HC BUN BODY FLUID,301,1 ,$43.70 ,$28.84 ,$3.95 ,$43.70 ,$4.08 ,$13.83 ,$13.83 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$4.08 ,$4.08 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$4.08 ,$27.10 ,$4.32 ,$39.33 ,$8.89 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$4.32 ,$4.74 ,$4.74 ,$11.56 ,$4.74 ,$3.95 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100764,84540,HC UREA URINE,301,1 ,$77.05 ,$50.85 ,$5.56 ,$77.05 ,$5.75 ,$19.46 ,$19.46 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$5.75 ,$5.75 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$5.75 ,$47.78 ,$6.10 ,$69.35 ,$12.51 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$6.10 ,$6.67 ,$6.67 ,$20.38 ,$6.67 ,$5.56 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100765,84550,HC URIC ACID,301,1 ,$43.70 ,$28.84 ,$4.52 ,$43.70 ,$4.67 ,$15.82 ,$15.82 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$4.67 ,$4.67 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$4.67 ,$27.10 ,$4.95 ,$39.33 ,$10.17 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$4.95 ,$5.42 ,$5.42 ,$11.56 ,$5.42 ,$4.52 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100766,84560,HC URIC ACID OTH SRC,301,1 ,$41.40 ,$27.32 ,$5.08 ,$41.40 ,$5.25 ,$17.78 ,$17.78 ,$10.96 ,$33.12 ,$35.19 ,$25.88 ,$37.26 ,$5.25 ,$5.25 ,$39.33 ,$37.26 ,$35.19 ,$35.19 ,$10.96 ,$35.19 ,$35.19 ,$37.26 ,$25.21 ,$5.25 ,$25.66 ,$5.57 ,$37.26 ,$11.43 ,$38.09 ,$37.26 ,$27.33 ,$27.33 ,$25.21 ,$27.33 ,$26.91 ,$28.28 ,$9.43 ,$32.71 ,$5.57 ,$6.10 ,$6.10 ,$10.96 ,$6.10 ,$5.08 ,$39.33 ,$33.95 ,$33.95 ,$33.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100768,84585,HC VANILLYLMAND AC (VMA),301,1 ,$128.80 ,$85.01 ,$15.50 ,$128.80 ,$16.02 ,$54.25 ,$54.25 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$16.02 ,$16.02 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$16.02 ,$79.86 ,$16.98 ,$115.92 ,$34.88 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.98 ,$18.60 ,$18.60 ,$34.08 ,$18.60 ,$15.50 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100769,84586,HC VASOACTIVE INTEST PEPTIDE,301,1 ,$218.50 ,$144.21 ,$17.93 ,$218.50 ,$17.93 ,$123.66 ,$123.66 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$17.93 ,$17.93 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$17.93 ,$135.48 ,$19.01 ,$196.65 ,$79.49 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$19.01 ,$42.40 ,$42.40 ,$57.82 ,$42.40 ,$35.33 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100770,84588,HC VASOPRESSIN (ADH),301,1 ,$296.70 ,$195.82 ,$33.94 ,$296.70 ,$35.07 ,$118.79 ,$118.79 ,$78.51 ,$237.36 ,$252.20 ,$185.44 ,$267.03 ,$35.07 ,$35.07 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,$35.07 ,$183.96 ,$37.17 ,$267.03 ,$76.37 ,$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,$37.17 ,$40.73 ,$40.73 ,$78.51 ,$40.73 ,$33.94 ,$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100771,84590,HC VITAMIN A,301,1 ,$103.50 ,$68.31 ,$11.61 ,$103.50 ,$12.00 ,$40.64 ,$40.64 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.00 ,$12.00 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.00 ,$64.18 ,$12.72 ,$93.15 ,$26.12 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$12.72 ,$13.93 ,$13.93 ,$27.39 ,$13.93 ,$11.61 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100772,84597,HC VITAMIN K,301,1 ,$450.80 ,$297.53 ,$13.72 ,$450.80 ,$14.18 ,$48.02 ,$48.02 ,$119.29 ,$360.64 ,$383.18 ,$281.75 ,$405.72 ,$14.18 ,$14.18 ,$428.26 ,$405.72 ,$383.18 ,$383.18 ,$119.29 ,$383.18 ,$383.18 ,$405.72 ,$274.54 ,$14.18 ,$279.50 ,$15.03 ,$405.72 ,$30.87 ,$414.74 ,$405.72 ,$297.57 ,$297.57 ,$274.54 ,$297.57 ,$293.02 ,$307.99 ,$102.63 ,$356.13 ,$15.03 ,$16.46 ,$16.46 ,$119.29 ,$16.46 ,$13.72 ,$428.26 ,$369.66 ,$369.66 ,$360.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100773,80320,HC VOLATILES,301,1 ,$250.00 ,$165.00 ,$56.92 ,$250.00 ,$118.42 ,$79.87 ,$79.87 ,$66.15 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$118.42 ,$118.42 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$66.15 ,$212.50 ,$212.50 ,$225.00 ,$152.25 ,$118.42 ,$155.00 ,$125.53 ,$225.00 , N/A ,$230.00 ,$225.00 ,$165.03 ,$165.03 ,$152.25 ,$165.03 ,$162.50 ,$170.80 ,$56.92 ,$197.50 ,$125.53 , N/A , N/A ,$66.15 , N/A , N/A ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100776,84630,HC ZINC,301,1 ,$89.70 ,$59.20 ,$11.39 ,$89.70 ,$11.77 ,$39.87 ,$39.87 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$11.77 ,$11.77 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$11.77 ,$55.62 ,$12.48 ,$80.73 ,$25.63 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$12.48 ,$13.67 ,$13.67 ,$23.74 ,$13.67 ,$11.39 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100778,84630,HC ZINC PLASMA,301,1 ,$39.10 ,$25.81 ,$8.90 ,$39.10 ,$11.77 ,$39.10 ,$39.10 ,$10.35 ,$31.28 ,$33.24 ,$24.44 ,$35.19 ,$11.77 ,$11.77 ,$37.15 ,$35.19 ,$33.24 ,$33.24 ,$10.35 ,$33.24 ,$33.24 ,$35.19 ,$23.81 ,$11.77 ,$24.24 ,$12.48 ,$35.19 ,$25.63 ,$35.97 ,$35.19 ,$25.81 ,$25.81 ,$23.81 ,$25.81 ,$25.42 ,$26.71 ,$8.90 ,$30.89 ,$12.48 ,$13.67 ,$13.67 ,$10.35 ,$13.67 ,$11.39 ,$37.15 ,$32.06 ,$32.06 ,$31.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100801,84681,HC C PEPTIDE,301,1 ,$116.15 ,$76.66 ,$7.34 ,$116.15 ,$7.34 ,$72.84 ,$72.84 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$7.34 ,$7.34 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$7.34 ,$72.02 ,$7.78 ,$104.54 ,$46.82 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$7.78 ,$24.97 ,$24.97 ,$30.73 ,$24.97 ,$20.81 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100802,84702,HC HCG QN,301,1 ,$128.80 ,$85.01 ,$15.05 ,$128.80 ,$15.55 ,$52.68 ,$52.68 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.55 ,$15.55 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.55 ,$79.86 ,$16.48 ,$115.92 ,$33.86 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.48 ,$18.06 ,$18.06 ,$34.08 ,$18.06 ,$15.05 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100808,84703,HC HCG QL,301,1 ,$77.05 ,$50.85 ,$7.52 ,$77.05 ,$7.77 ,$26.32 ,$26.32 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$7.77 ,$7.77 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$7.77 ,$47.78 ,$8.24 ,$69.35 ,$16.92 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.24 ,$9.02 ,$9.02 ,$20.38 ,$9.02 ,$7.52 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100813,G0103,HC PSA ANNUAL SCREENING,301,1 ,$167.90 ,$110.81 ,$19.31 ,$167.90 ,$19.95 ,$67.59 ,$67.59 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.95 ,$19.95 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.95 ,$104.10 ,$21.15 ,$151.11 ,$43.45 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$21.15 ,$23.17 ,$23.17 ,$44.42 ,$23.17 ,$19.31 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100814,G0123,HC PAP SMEAR THIN PREP SCREEN (CMH),301,1 ,$173.65 ,$114.61 ,$20.26 ,$173.65 ,$20.93 ,$70.91 ,$70.91 ,$45.95 ,$138.92 ,$147.60 ,$108.53 ,$156.29 ,$20.93 ,$20.93 ,$164.97 ,$156.29 ,$147.60 ,$147.60 ,$45.95 ,$147.60 ,$147.60 ,$156.29 ,$105.75 ,$20.93 ,$107.66 ,$22.19 ,$156.29 ,$45.59 ,$159.76 ,$156.29 ,$114.63 ,$114.63 ,$105.75 ,$114.63 ,$112.87 ,$118.64 ,$39.53 ,$137.18 ,$22.19 ,$24.31 ,$24.31 ,$45.95 ,$24.31 ,$20.26 ,$164.97 ,$142.39 ,$142.39 ,$138.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100815,G0123,HC PAP SMEAR THIN PREP SCREEN,311,1 ,$173.65 ,$114.61 ,$20.26 ,$173.65 ,$20.93 ,$70.91 ,$70.91 ,$45.95 ,$138.92 ,$147.60 ,$108.53 ,$156.29 ,$20.93 ,$20.93 ,$164.97 ,$156.29 ,$147.60 ,$147.60 ,$45.95 ,$147.60 ,$147.60 ,$156.29 ,$105.75 ,$20.93 ,$107.66 ,$22.19 ,$156.29 ,$45.59 ,$159.76 ,$156.29 ,$114.63 ,$114.63 ,$105.75 ,$114.63 ,$112.87 ,$118.64 ,$39.53 ,$137.18 ,$22.19 ,$24.31 ,$24.31 ,$45.95 ,$24.31 ,$20.26 ,$164.97 ,$142.39 ,$142.39 ,$138.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100820,83664,HC LAMELLAR BODY CT,301,1 ,$188.60 ,$124.48 ,$6.82 ,$188.60 ,$6.82 ,$67.62 ,$67.62 ,$49.90 ,$150.88 ,$160.31 ,$117.88 ,$169.74 ,$6.82 ,$6.82 ,$179.17 ,$169.74 ,$160.31 ,$160.31 ,$49.90 ,$160.31 ,$160.31 ,$169.74 ,$114.86 ,$6.82 ,$116.94 ,$7.23 ,$169.74 ,$43.47 ,$173.51 ,$169.74 ,$124.49 ,$124.49 ,$114.86 ,$124.49 ,$122.59 ,$128.85 ,$42.93 ,$148.99 ,$7.23 ,$23.18 ,$23.18 ,$49.90 ,$23.18 ,$19.32 ,$179.17 ,$154.65 ,$154.65 ,$150.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100821,80159,HC CLOZAPINE,301,1 ,$100.00 ,$66.00 ,$20.15 ,$100.00 ,$20.18 ,$70.53 ,$70.53 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$20.18 ,$20.18 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$20.18 ,$62.00 ,$21.39 ,$90.00 ,$45.34 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$21.39 ,$24.18 ,$24.18 ,$26.46 ,$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 ,$63.25 ,$41.75 ,$8.00 ,$63.25 ,$8.27 ,$28.00 ,$28.00 ,$16.74 ,$50.60 ,$53.76 ,$39.53 ,$56.93 ,$8.27 ,$8.27 ,$60.09 ,$56.93 ,$53.76 ,$53.76 ,$16.74 ,$53.76 ,$53.76 ,$56.93 ,$38.52 ,$8.27 ,$39.22 ,$8.77 ,$56.93 ,$18.00 ,$58.19 ,$56.93 ,$41.75 ,$41.75 ,$38.52 ,$41.75 ,$41.11 ,$43.21 ,$14.41 ,$49.97 ,$8.77 ,$9.60 ,$9.60 ,$16.74 ,$9.60 ,$8.00 ,$60.09 ,$51.87 ,$51.87 ,$50.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100845,82948,HC GLUCOSE BLOOD REAGENT STRIP,301,1 ,$20.70 ,$13.66 ,$4.45 ,$20.70 ,$4.45 ,$17.64 ,$17.64 ,$5.48 ,$16.56 ,$17.60 ,$12.94 ,$18.63 ,$4.45 ,$4.45 ,$19.67 ,$18.63 ,$17.60 ,$17.60 ,$5.48 ,$17.60 ,$17.60 ,$18.63 ,$12.61 ,$4.45 ,$12.84 ,$4.72 ,$18.63 ,$11.34 ,$19.04 ,$18.63 ,$13.66 ,$13.66 ,$12.61 ,$13.66 ,$13.46 ,$14.14 ,$4.71 ,$16.35 ,$4.72 ,$6.05 ,$6.05 ,$5.48 ,$6.05 ,$5.04 ,$19.67 ,$16.97 ,$16.97 ,$16.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100860,84145,HC PROCALCITONIN,301,1 ,$232.30 ,$153.32 ,$27.22 ,$232.30 ,$28.13 ,$95.27 ,$95.27 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$28.13 ,$28.13 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$28.13 ,$144.02 ,$29.82 ,$209.07 ,$61.25 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$29.82 ,$32.66 ,$32.66 ,$61.47 ,$32.66 ,$27.22 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100950,G0328,HC OCCULT BLOOD FECAL SCRN - AMB,301,1 ,$143.75 ,$94.88 ,$18.05 ,$143.75 ,$18.68 ,$63.18 ,$63.18 ,$38.03 ,$115.00 ,$122.19 ,$89.84 ,$129.38 ,$18.68 ,$18.68 ,$136.56 ,$129.38 ,$122.19 ,$122.19 ,$38.03 ,$122.19 ,$122.19 ,$129.38 ,$87.54 ,$18.68 ,$89.12 ,$19.80 ,$129.38 ,$40.61 ,$132.25 ,$129.38 ,$94.89 ,$94.89 ,$87.54 ,$94.89 ,$93.44 ,$98.21 ,$32.72 ,$113.56 ,$19.80 ,$21.66 ,$21.66 ,$38.03 ,$21.66 ,$18.05 ,$136.56 ,$117.88 ,$117.88 ,$115.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100961,83993,HC CALPROTECTIN STOOL,301,1 ,$180.55 ,$119.16 ,$19.63 ,$180.55 ,$20.28 ,$68.71 ,$68.71 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$20.28 ,$20.28 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$20.28 ,$111.94 ,$21.50 ,$162.50 ,$44.17 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$21.50 ,$23.56 ,$23.56 ,$47.77 ,$23.56 ,$19.63 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100962,82656,"HC ELASTASE,PANCREATIC EL1 FECAL QT",301,1 ,$244.95 ,$161.67 ,$11.53 ,$244.95 ,$11.91 ,$40.36 ,$40.36 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$11.91 ,$11.91 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$11.91 ,$151.86 ,$12.62 ,$220.46 ,$25.94 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$12.62 ,$13.84 ,$13.84 ,$64.82 ,$13.84 ,$11.53 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100965,80361,HC DIHYDROCODEINONE,301,1 ,$172.00 ,$113.52 ,$21.05 ,$172.00 ,$21.05 ,$79.87 ,$79.87 ,$45.51 ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$21.05 ,$21.05 ,$163.40 ,$154.80 ,$146.20 ,$146.20 ,$45.51 ,$146.20 ,$146.20 ,$154.80 ,$104.75 ,$21.05 ,$106.64 ,$22.31 ,$154.80 , N/A ,$158.24 ,$154.80 ,$113.54 ,$113.54 ,$104.75 ,$113.54 ,$111.80 ,$117.51 ,$39.16 ,$135.88 ,$22.31 , N/A , N/A ,$45.51 , N/A , N/A ,$163.40 ,$141.04 ,$141.04 ,$137.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100968,83018,HC COBALT BLOOD,301,1 ,$141.45 ,$93.36 ,$21.96 ,$141.45 ,$22.69 ,$76.86 ,$76.86 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$22.69 ,$22.69 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$22.69 ,$87.70 ,$24.05 ,$127.31 ,$49.41 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$24.05 ,$26.35 ,$26.35 ,$37.43 ,$26.35 ,$21.96 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30100979,G0480,HC TRAMADOL,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$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 ,$131.10 ,$86.53 ,$16.71 ,$131.10 ,$17.27 ,$58.49 ,$58.49 ,$34.69 ,$104.88 ,$111.44 ,$81.94 ,$117.99 ,$17.27 ,$17.27 ,$124.55 ,$117.99 ,$111.44 ,$111.44 ,$34.69 ,$111.44 ,$111.44 ,$117.99 ,$79.84 ,$17.27 ,$81.28 ,$18.31 ,$117.99 ,$37.60 ,$120.61 ,$117.99 ,$86.54 ,$86.54 ,$79.84 ,$86.54 ,$85.22 ,$89.57 ,$29.84 ,$103.57 ,$18.31 ,$20.05 ,$20.05 ,$34.69 ,$20.05 ,$16.71 ,$124.55 ,$107.50 ,$107.50 ,$104.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101006,82787,HC IMMUNOGLOBULIN SUBCLASSES,301,1 ,$72.45 ,$47.82 ,$5.90 ,$72.45 ,$5.90 ,$28.07 ,$28.07 ,$19.17 ,$57.96 ,$61.58 ,$45.28 ,$65.21 ,$5.90 ,$5.90 ,$68.83 ,$65.21 ,$61.58 ,$61.58 ,$19.17 ,$61.58 ,$61.58 ,$65.21 ,$44.12 ,$5.90 ,$44.92 ,$6.25 ,$65.21 ,$18.05 ,$66.65 ,$65.21 ,$47.82 ,$47.82 ,$44.12 ,$47.82 ,$47.09 ,$49.50 ,$16.49 ,$57.24 ,$6.25 ,$9.62 ,$9.62 ,$19.17 ,$9.62 ,$8.02 ,$68.83 ,$59.41 ,$59.41 ,$57.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101010,83520,HC IMMUNOASSAY QN OTHER,301,1 ,$180.55 ,$119.16 ,$17.27 ,$180.55 ,$17.85 ,$60.45 ,$60.45 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$17.85 ,$17.85 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$17.85 ,$111.94 ,$18.92 ,$162.50 ,$38.86 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$18.92 ,$20.72 ,$20.72 ,$47.77 ,$20.72 ,$17.27 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101024,G0480,HC DRUG CONFIRMATION EA PROC 1-7 CLASSES,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101050,82610,HC CYSTATIN C,301,1 ,$141.45 ,$93.36 ,$18.52 ,$141.45 ,$19.00 ,$64.82 ,$64.82 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$19.00 ,$19.00 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$19.00 ,$87.70 ,$20.14 ,$127.31 ,$41.67 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$20.14 ,$22.22 ,$22.22 ,$37.43 ,$22.22 ,$18.52 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101051,83789,HC MASS/TANDEM SPEC TPMT ACTIVITY EACH SPECIMEN,301,1 ,$399.05 ,$263.37 ,$24.11 ,$399.05 ,$24.91 ,$84.39 ,$84.39 ,$105.59 ,$319.24 ,$339.19 ,$249.41 ,$359.15 ,$24.91 ,$24.91 ,$379.10 ,$359.15 ,$339.19 ,$339.19 ,$105.59 ,$339.19 ,$339.19 ,$359.15 ,$243.02 ,$24.91 ,$247.42 ,$26.40 ,$359.15 ,$54.25 ,$367.13 ,$359.15 ,$263.41 ,$263.41 ,$243.02 ,$263.41 ,$259.38 ,$272.63 ,$90.85 ,$315.25 ,$26.40 ,$28.93 ,$28.93 ,$105.59 ,$28.93 ,$24.11 ,$379.10 ,$327.22 ,$327.22 ,$319.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101052,82642,HC DRUG CONFIRMATION DIHYDROTESTOSTERONE LC/MS/MS,301,1 ,$205.85 ,$135.86 ,$29.28 ,$205.85 ,$30.26 ,$102.48 ,$102.48 ,$54.47 ,$164.68 ,$174.97 ,$128.66 ,$185.27 ,$30.26 ,$30.26 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$30.26 ,$127.62 ,$32.08 ,$185.27 ,$65.88 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,$32.08 ,$35.14 ,$35.14 ,$54.47 ,$35.14 ,$29.28 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101053,80235,HC LACOSAMIDE LC/MS/MS,301,1 ,$110.00 ,$72.60 ,$21.69 ,$110.00 ,$21.69 ,$94.89 ,$94.89 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$21.69 ,$21.69 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$21.69 ,$68.20 ,$22.99 ,$99.00 ,$61.00 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$22.99 ,$32.53 ,$32.53 ,$29.11 ,$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 ,$116.15 ,$76.66 ,$17.27 ,$116.15 ,$17.85 ,$60.45 ,$60.45 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$17.85 ,$17.85 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$17.85 ,$72.02 ,$18.92 ,$104.54 ,$38.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$18.92 ,$20.72 ,$20.72 ,$30.73 ,$20.72 ,$17.27 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101055,83519,HC CALCIUM CHAN AB VOLTAGE-GATED,301,1 ,$116.15 ,$76.66 ,$18.40 ,$116.15 ,$19.00 ,$64.40 ,$64.40 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$19.00 ,$19.00 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$19.00 ,$72.02 ,$20.14 ,$104.54 ,$41.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$20.14 ,$22.08 ,$22.08 ,$30.73 ,$22.08 ,$18.40 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101057,84140,HC PREGNENOLONE,301,1 ,$121.90 ,$80.45 ,$20.67 ,$121.90 ,$21.36 ,$72.35 ,$72.35 ,$32.25 ,$97.52 ,$103.62 ,$76.19 ,$109.71 ,$21.36 ,$21.36 ,$115.81 ,$109.71 ,$103.62 ,$103.62 ,$32.25 ,$103.62 ,$103.62 ,$109.71 ,$74.24 ,$21.36 ,$75.58 ,$22.64 ,$109.71 ,$46.51 ,$112.15 ,$109.71 ,$80.47 ,$80.47 ,$74.24 ,$80.47 ,$79.24 ,$83.28 ,$27.75 ,$96.30 ,$22.64 ,$24.80 ,$24.80 ,$32.25 ,$24.80 ,$20.67 ,$115.81 ,$99.96 ,$99.96 ,$97.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101058,82679,HC ESTRONE LC/MS/MS,301,1 ,$115.00 ,$75.90 ,$24.95 ,$115.00 ,$25.78 ,$87.33 ,$87.33 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$25.78 ,$25.78 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 ,$25.78 ,$71.30 ,$27.33 ,$103.50 ,$56.14 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 ,$27.33 ,$29.94 ,$29.94 ,$30.43 ,$29.94 ,$24.95 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101066,G0480,HC IF PREGABALIN,301,1 ,$282.00 ,$186.12 ,$63.95 ,$282.00 ,$63.95 ,$282.00 ,$282.00 ,$74.62 ,$225.60 ,$239.70 ,$176.25 ,$253.80 ,$63.95 ,$63.95 ,$267.90 ,$253.80 ,$239.70 ,$239.70 ,$74.62 ,$239.70 ,$239.70 ,$253.80 ,$171.74 ,$63.95 ,$174.84 ,$67.79 ,$253.80 ,$257.47 ,$259.44 ,$253.80 ,$186.15 ,$186.15 ,$171.74 ,$186.15 ,$183.30 ,$192.66 ,$64.20 ,$222.78 ,$67.79 ,$137.32 ,$137.32 ,$74.62 ,$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 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101068,84630,HC ZINC RBC,301,1 ,$92.00 ,$60.72 ,$11.39 ,$92.00 ,$11.77 ,$39.87 ,$39.87 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$11.77 ,$11.77 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 ,$11.77 ,$57.04 ,$12.48 ,$82.80 ,$25.63 ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 ,$12.48 ,$13.67 ,$13.67 ,$24.34 ,$13.67 ,$11.39 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101071,84432,HC THYROGLOBULIN MASS SPEC,301,1 ,$373.75 ,$246.68 ,$16.06 ,$373.75 ,$16.59 ,$56.21 ,$56.21 ,$98.89 ,$299.00 ,$317.69 ,$233.59 ,$336.38 ,$16.59 ,$16.59 ,$355.06 ,$336.38 ,$317.69 ,$317.69 ,$98.89 ,$317.69 ,$317.69 ,$336.38 ,$227.61 ,$16.59 ,$231.72 ,$17.59 ,$336.38 ,$36.14 ,$343.85 ,$336.38 ,$246.71 ,$246.71 ,$227.61 ,$246.71 ,$242.94 ,$255.35 ,$85.08 ,$295.26 ,$17.59 ,$19.27 ,$19.27 ,$98.89 ,$19.27 ,$16.06 ,$355.06 ,$306.48 ,$306.48 ,$299.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101127,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$189.75 ,$125.24 ,$18.64 ,$189.75 ,$19.26 ,$65.24 ,$65.24 ,$50.21 ,$151.80 ,$161.29 ,$118.59 ,$170.78 ,$19.26 ,$19.26 ,$180.26 ,$170.78 ,$161.29 ,$161.29 ,$50.21 ,$161.29 ,$161.29 ,$170.78 ,$115.56 ,$19.26 ,$117.64 ,$20.42 ,$170.78 ,$41.94 ,$174.57 ,$170.78 ,$125.25 ,$125.25 ,$115.56 ,$125.25 ,$123.34 ,$129.64 ,$43.20 ,$149.90 ,$20.42 ,$22.37 ,$22.37 ,$50.21 ,$22.37 ,$18.64 ,$180.26 ,$155.60 ,$155.60 ,$151.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101466,82600,HC CYANIDE BLOOD,301,1 ,$167.90 ,$110.81 ,$19.40 ,$167.90 ,$20.05 ,$67.90 ,$67.90 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$20.05 ,$20.05 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$20.05 ,$104.10 ,$21.25 ,$151.11 ,$43.65 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$21.25 ,$23.28 ,$23.28 ,$44.42 ,$23.28 ,$19.40 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101467,84238,HC RECEPTOR ASSAY TRASFERRIN,301,1 ,$257.60 ,$170.02 ,$36.57 ,$257.60 ,$37.79 ,$128.00 ,$128.00 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$37.79 ,$37.79 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$37.79 ,$159.72 ,$40.06 ,$231.84 ,$82.28 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$40.06 ,$43.88 ,$43.88 ,$68.16 ,$43.88 ,$36.57 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101468,83013,HC H PYLORI BREATH TEST,301,1 ,$315.10 ,$207.97 ,$67.36 ,$315.10 ,$69.60 ,$235.76 ,$235.76 ,$83.38 ,$252.08 ,$267.84 ,$196.94 ,$283.59 ,$69.60 ,$69.60 ,$299.35 ,$283.59 ,$267.84 ,$267.84 ,$83.38 ,$267.84 ,$267.84 ,$283.59 ,$191.90 ,$69.60 ,$195.36 ,$73.78 ,$283.59 ,$151.56 ,$289.89 ,$283.59 ,$208.00 ,$208.00 ,$191.90 ,$208.00 ,$204.82 ,$215.28 ,$71.73 ,$248.93 ,$73.78 ,$80.83 ,$80.83 ,$83.38 ,$80.83 ,$67.36 ,$299.35 ,$258.38 ,$258.38 ,$252.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101501,84999,HC OSMOLALITY FECAL,301,1 ,$148.35 ,$97.91 ,$19.92 ,$148.35 ,$19.92 ,$132.95 ,$132.95 ,$39.25 ,$118.68 ,$126.10 ,$92.72 ,$133.52 ,$19.92 ,$19.92 ,$140.93 ,$133.52 ,$126.10 ,$126.10 ,$39.25 ,$126.10 ,$126.10 ,$133.52 ,$90.35 ,$19.92 ,$91.98 ,$21.12 ,$133.52 ,$89.01 ,$136.48 ,$133.52 ,$97.93 ,$97.93 ,$90.35 ,$97.93 ,$96.43 ,$101.35 , N/A ,$117.20 ,$21.12 ,$72.69 ,$72.69 ,$39.25 ,$72.69 , N/A ,$140.93 ,$121.65 ,$121.65 ,$118.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101502,83520,HC IMMUNOASSAY QN MYELIN ASSOC GLYCOPROTEIN,301,1 ,$178.25 ,$117.65 ,$17.27 ,$178.25 ,$17.85 ,$60.45 ,$60.45 ,$47.17 ,$142.60 ,$151.51 ,$111.41 ,$160.43 ,$17.85 ,$17.85 ,$169.34 ,$160.43 ,$151.51 ,$151.51 ,$47.17 ,$151.51 ,$151.51 ,$160.43 ,$108.55 ,$17.85 ,$110.52 ,$18.92 ,$160.43 ,$38.86 ,$163.99 ,$160.43 ,$117.66 ,$117.66 ,$108.55 ,$117.66 ,$115.86 ,$121.78 ,$40.58 ,$140.82 ,$18.92 ,$20.72 ,$20.72 ,$47.17 ,$20.72 ,$17.27 ,$169.34 ,$146.17 ,$146.17 ,$142.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101504,80285,HC VORICONAZOLE,301,1 ,$140.00 ,$92.40 ,$21.69 ,$140.00 ,$21.69 ,$94.89 ,$94.89 ,$37.04 ,$112.00 ,$119.00 ,$87.50 ,$126.00 ,$21.69 ,$21.69 ,$133.00 ,$126.00 ,$119.00 ,$119.00 ,$37.04 ,$119.00 ,$119.00 ,$126.00 ,$85.26 ,$21.69 ,$86.80 ,$22.99 ,$126.00 ,$61.00 ,$128.80 ,$126.00 ,$92.41 ,$92.41 ,$85.26 ,$92.41 ,$91.00 ,$95.65 ,$31.87 ,$110.60 ,$22.99 ,$32.53 ,$32.53 ,$37.04 ,$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 ",$660.00 ,$172.18 ,"$1,000.00 ",$172.18 ,$864.22 ,$864.22 ,$264.60 ,$800.00 ,$850.00 ,$625.00 ,$900.00 ,$172.18 ,$172.18 ,$950.00 ,$900.00 ,$850.00 ,$850.00 ,$264.60 ,$850.00 ,$850.00 ,$900.00 ,$609.00 ,$172.18 ,$620.00 ,$182.51 ,$900.00 ,$555.57 ,$920.00 ,$900.00 ,$660.10 ,$660.10 ,$609.00 ,$660.10 ,$650.00 ,$683.20 ,$227.65 ,$790.00 ,$182.51 ,$296.30 ,$296.30 ,$264.60 ,$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 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$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 ,$65.34 ,$22.54 ,$222.75 ,$63.95 ,$99.00 ,$99.00 ,$26.20 ,$79.20 ,$84.15 ,$61.88 ,$89.10 ,$63.95 ,$63.95 ,$94.05 ,$89.10 ,$84.15 ,$84.15 ,$26.20 ,$84.15 ,$84.15 ,$89.10 ,$60.29 ,$63.95 ,$61.38 ,$67.79 ,$89.10 ,$222.75 ,$91.08 ,$89.10 ,$65.35 ,$65.35 ,$60.29 ,$65.35 ,$64.35 ,$67.64 ,$22.54 ,$78.21 ,$67.79 ,$99.00 ,$99.00 ,$26.20 ,$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 ,$113.85 ,$75.14 ,$17.27 ,$113.85 ,$17.85 ,$60.45 ,$60.45 ,$30.13 ,$91.08 ,$96.77 ,$71.16 ,$102.47 ,$17.85 ,$17.85 ,$108.16 ,$102.47 ,$96.77 ,$96.77 ,$30.13 ,$96.77 ,$96.77 ,$102.47 ,$69.33 ,$17.85 ,$70.58 ,$18.92 ,$102.47 ,$38.86 ,$104.74 ,$102.47 ,$75.15 ,$75.15 ,$69.33 ,$75.15 ,$74.00 ,$77.78 ,$25.92 ,$89.94 ,$18.92 ,$20.72 ,$20.72 ,$30.13 ,$20.72 ,$17.27 ,$108.16 ,$93.36 ,$93.36 ,$91.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101523,84181,HC NEURONAL NUCLEAR AB/WB,301,1 ,$226.55 ,$149.52 ,$17.03 ,$226.55 ,$17.60 ,$59.61 ,$59.61 ,$59.95 ,$181.24 ,$192.57 ,$141.59 ,$203.90 ,$17.60 ,$17.60 ,$215.22 ,$203.90 ,$192.57 ,$192.57 ,$59.95 ,$192.57 ,$192.57 ,$203.90 ,$137.97 ,$17.60 ,$140.46 ,$18.66 ,$203.90 ,$38.32 ,$208.43 ,$203.90 ,$149.55 ,$149.55 ,$137.97 ,$149.55 ,$147.26 ,$154.78 ,$51.58 ,$178.97 ,$18.66 ,$20.44 ,$20.44 ,$59.95 ,$20.44 ,$17.03 ,$215.22 ,$185.77 ,$185.77 ,$181.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101594,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$96.60 ,$63.76 ,$6.04 ,$96.60 ,$6.24 ,$21.14 ,$21.14 ,$25.56 ,$77.28 ,$82.11 ,$60.38 ,$86.94 ,$6.24 ,$6.24 ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 ,$6.24 ,$59.90 ,$6.61 ,$86.94 ,$13.59 ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 ,$6.61 ,$7.25 ,$7.25 ,$25.56 ,$7.25 ,$6.04 ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101595,83690,HC LIPASE,301,1 ,$205.85 ,$135.86 ,$6.89 ,$205.85 ,$7.12 ,$24.12 ,$24.12 ,$54.47 ,$164.68 ,$174.97 ,$128.66 ,$185.27 ,$7.12 ,$7.12 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$7.12 ,$127.62 ,$7.55 ,$185.27 ,$15.50 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,$7.55 ,$8.27 ,$8.27 ,$54.47 ,$8.27 ,$6.89 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101683,83519,HC IMMUNOASSAY QN CHANNEL/NEURONAL AB,301,1 ,$242.65 ,$160.15 ,$18.40 ,$242.65 ,$19.00 ,$64.40 ,$64.40 ,$64.21 ,$194.12 ,$206.25 ,$151.66 ,$218.39 ,$19.00 ,$19.00 ,$230.52 ,$218.39 ,$206.25 ,$206.25 ,$64.21 ,$206.25 ,$206.25 ,$218.39 ,$147.77 ,$19.00 ,$150.44 ,$20.14 ,$218.39 ,$41.40 ,$223.24 ,$218.39 ,$160.17 ,$160.17 ,$147.77 ,$160.17 ,$157.72 ,$165.78 ,$55.24 ,$191.69 ,$20.14 ,$22.08 ,$22.08 ,$64.21 ,$22.08 ,$18.40 ,$230.52 ,$198.97 ,$198.97 ,$194.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101684,83520,HC IMMUNOASSAY QN STRIATIONAL AB,301,1 ,$194.35 ,$128.27 ,$17.27 ,$194.35 ,$17.85 ,$60.45 ,$60.45 ,$51.42 ,$155.48 ,$165.20 ,$121.47 ,$174.92 ,$17.85 ,$17.85 ,$184.63 ,$174.92 ,$165.20 ,$165.20 ,$51.42 ,$165.20 ,$165.20 ,$174.92 ,$118.36 ,$17.85 ,$120.50 ,$18.92 ,$174.92 ,$38.86 ,$178.80 ,$174.92 ,$128.29 ,$128.29 ,$118.36 ,$128.29 ,$126.33 ,$132.78 ,$44.25 ,$153.54 ,$18.92 ,$20.72 ,$20.72 ,$51.42 ,$20.72 ,$17.27 ,$184.63 ,$159.37 ,$159.37 ,$155.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101721,83520,HC TSH RECEPTOR BINDING AB,301,1 ,$194.35 ,$128.27 ,$17.27 ,$194.35 ,$17.85 ,$60.45 ,$60.45 ,$51.42 ,$155.48 ,$165.20 ,$121.47 ,$174.92 ,$17.85 ,$17.85 ,$184.63 ,$174.92 ,$165.20 ,$165.20 ,$51.42 ,$165.20 ,$165.20 ,$174.92 ,$118.36 ,$17.85 ,$120.50 ,$18.92 ,$174.92 ,$38.86 ,$178.80 ,$174.92 ,$128.29 ,$128.29 ,$118.36 ,$128.29 ,$126.33 ,$132.78 ,$44.25 ,$153.54 ,$18.92 ,$20.72 ,$20.72 ,$51.42 ,$20.72 ,$17.27 ,$184.63 ,$159.37 ,$159.37 ,$155.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101737,82784,HC IMMUNOGLOBIN G,301,1 ,$44.85 ,$29.60 ,$9.30 ,$44.85 ,$9.61 ,$32.55 ,$32.55 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$9.61 ,$9.61 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$9.61 ,$27.80 ,$10.19 ,$40.37 ,$20.93 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$10.19 ,$11.16 ,$11.16 ,$11.87 ,$11.16 ,$9.30 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101741,84545,"HC UREA NITROGEN, CLEARANCE",301,1 ,$310.50 ,$204.93 ,$7.20 ,$310.50 ,$7.44 ,$25.20 ,$25.20 ,$82.16 ,$248.40 ,$263.93 ,$194.06 ,$279.45 ,$7.44 ,$7.44 ,$294.98 ,$279.45 ,$263.93 ,$263.93 ,$82.16 ,$263.93 ,$263.93 ,$279.45 ,$189.09 ,$7.44 ,$192.52 ,$7.89 ,$279.45 ,$16.20 ,$285.66 ,$279.45 ,$204.96 ,$204.96 ,$189.09 ,$204.96 ,$201.83 ,$212.13 ,$70.69 ,$245.30 ,$7.89 ,$8.64 ,$8.64 ,$82.16 ,$8.64 ,$7.20 ,$294.98 ,$254.61 ,$254.61 ,$248.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101746,G0480,HC DRUG SCRN DEFINT 1-7 CLASS T1,301,1 ,$52.00 ,$34.32 ,$11.84 ,$117.00 ,$52.00 ,$52.00 ,$52.00 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$52.00 ,$52.00 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 ,$52.00 ,$32.24 ,$55.12 ,$46.80 ,$117.00 ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 ,$55.12 ,$52.00 ,$52.00 ,$13.76 ,$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 ,$34.32 ,$11.84 ,$52.00 ,$21.05 ,$52.00 ,$52.00 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$21.05 ,$21.05 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 ,$21.05 ,$32.24 ,$22.31 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 ,$22.31 , N/A , N/A ,$13.76 , 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 ,$34.32 ,$11.84 ,$52.00 ,$21.05 ,$52.00 ,$52.00 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$21.05 ,$21.05 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 ,$21.05 ,$32.24 ,$22.31 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 ,$22.31 , N/A , N/A ,$13.76 , 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 ,$34.32 ,$11.84 ,$52.00 ,$21.05 ,$52.00 ,$52.00 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$21.05 ,$21.05 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 ,$21.05 ,$32.24 ,$22.31 ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 ,$22.31 , N/A , N/A ,$13.76 , N/A , N/A ,$49.40 ,$42.64 ,$42.64 ,$41.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101761,83520,HC PHOSPHOLIPASE A2 RECPT ANTIBODY,301,1 ,$296.80 ,$195.89 ,$17.27 ,$296.80 ,$17.85 ,$60.45 ,$60.45 ,$78.54 ,$237.44 ,$252.28 ,$185.50 ,$267.12 ,$17.85 ,$17.85 ,$281.96 ,$267.12 ,$252.28 ,$252.28 ,$78.54 ,$252.28 ,$252.28 ,$267.12 ,$180.75 ,$17.85 ,$184.02 ,$18.92 ,$267.12 ,$38.86 ,$273.06 ,$267.12 ,$195.92 ,$195.92 ,$180.75 ,$195.92 ,$192.92 ,$202.77 ,$67.56 ,$234.47 ,$18.92 ,$20.72 ,$20.72 ,$78.54 ,$20.72 ,$17.27 ,$281.96 ,$243.38 ,$243.38 ,$237.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101828,84433,HC ASSAY THIOPURINE S-METHYLTRANSFERASE,301,1 ,$399.05 ,$263.37 ,$19.92 ,$399.05 ,$19.92 ,$77.60 ,$77.60 ,$105.59 ,$319.24 ,$339.19 ,$249.41 ,$359.15 ,$19.92 ,$19.92 ,$379.10 ,$359.15 ,$339.19 ,$339.19 ,$105.59 ,$339.19 ,$339.19 ,$359.15 ,$243.02 ,$19.92 ,$247.42 ,$21.12 ,$359.15 ,$49.88 ,$367.13 ,$359.15 ,$263.41 ,$263.41 ,$243.02 ,$263.41 ,$259.38 ,$272.63 ,$90.85 ,$315.25 ,$21.12 ,$195.53 ,$195.53 ,$105.59 ,$195.53 ,$22.17 ,$379.10 ,$327.22 ,$327.22 ,$319.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101829,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$189.75 ,$125.24 ,$18.64 ,$189.75 ,$19.26 ,$65.24 ,$65.24 ,$50.21 ,$151.80 ,$161.29 ,$118.59 ,$170.78 ,$19.26 ,$19.26 ,$180.26 ,$170.78 ,$161.29 ,$161.29 ,$50.21 ,$161.29 ,$161.29 ,$170.78 ,$115.56 ,$19.26 ,$117.64 ,$20.42 ,$170.78 ,$41.94 ,$174.57 ,$170.78 ,$125.25 ,$125.25 ,$115.56 ,$125.25 ,$123.34 ,$129.64 ,$43.20 ,$149.90 ,$20.42 ,$22.37 ,$22.37 ,$50.21 ,$22.37 ,$18.64 ,$180.26 ,$155.60 ,$155.60 ,$151.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101830,G0480,HC DRUG WARFARIN,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101831,81596,HC CHRONIC HEP C VIRUS ASSAYS,301,1 ,$303.67 ,$200.42 ,$69.13 ,$303.67 , N/A ,$252.67 ,$252.67 ,$80.35 ,$242.94 ,$258.12 ,$189.79 ,$273.30 , N/A , N/A ,$288.49 ,$273.30 ,$258.12 ,$258.12 ,$80.35 ,$258.12 ,$258.12 ,$273.30 ,$184.94 , N/A ,$188.28 , N/A ,$273.30 ,$162.43 ,$279.38 ,$273.30 ,$200.45 ,$200.45 ,$184.94 ,$200.45 ,$197.39 ,$207.47 ,$69.13 ,$239.90 , N/A ,$86.63 ,$86.63 ,$80.35 ,$86.63 ,$72.19 ,$288.49 ,$249.01 ,$249.01 ,$242.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101832,80189,HC ITRACONAZOLE,301,1 ,$69.19 ,$45.67 ,$15.75 ,$69.19 ,$27.11 ,$69.19 ,$69.19 ,$18.31 ,$55.35 ,$58.81 ,$43.24 ,$62.27 ,$27.11 ,$27.11 ,$65.73 ,$62.27 ,$58.81 ,$58.81 ,$18.31 ,$58.81 ,$58.81 ,$62.27 ,$42.14 ,$27.11 ,$42.90 ,$28.74 ,$62.27 ,$61.00 ,$63.65 ,$62.27 ,$45.67 ,$45.67 ,$42.14 ,$45.67 ,$44.97 ,$47.27 ,$15.75 ,$54.66 ,$28.74 ,$32.53 ,$32.53 ,$18.31 ,$32.53 ,$27.11 ,$65.73 ,$56.74 ,$56.74 ,$55.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101833,G0480,HC DRUG SCREEN (FLUNITRAZEPAM),301,1 ,$330.00 ,$217.80 ,$63.95 ,$330.00 ,$63.95 ,$330.00 ,$330.00 ,$87.32 ,$264.00 ,$280.50 ,$206.25 ,$297.00 ,$63.95 ,$63.95 ,$313.50 ,$297.00 ,$280.50 ,$280.50 ,$87.32 ,$280.50 ,$280.50 ,$297.00 ,$200.97 ,$63.95 ,$204.60 ,$67.79 ,$297.00 ,$257.47 ,$303.60 ,$297.00 ,$217.83 ,$217.83 ,$200.97 ,$217.83 ,$214.50 ,$225.46 ,$75.13 ,$260.70 ,$67.79 ,$137.32 ,$137.32 ,$87.32 ,$137.32 ,$114.43 ,$313.50 ,$270.60 ,$270.60 ,$264.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101834,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT,301,1 ,$370.00 ,$244.20 ,$62.14 ,$370.00 ,$63.40 ,$217.49 ,$217.49 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$63.40 ,$63.40 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$63.40 ,$229.40 ,$67.20 ,$333.00 ,$139.82 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$67.20 ,$74.57 ,$74.57 ,$97.90 ,$74.57 ,$62.14 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101835,80181,HC FLECAINIDE,301,1 ,$15.98 ,$10.55 ,$3.65 ,$35.96 ,$14.91 ,$15.98 ,$15.98 ,$4.22 ,$12.78 ,$13.58 ,$9.99 ,$14.38 ,$14.91 ,$14.91 ,$15.18 ,$14.38 ,$13.58 ,$13.58 ,$4.22 ,$13.58 ,$13.58 ,$14.38 ,$9.73 ,$14.91 ,$9.90 ,$15.80 ,$14.38 ,$35.96 ,$14.70 ,$14.38 ,$10.55 ,$10.55 ,$9.73 ,$10.55 ,$10.39 ,$10.92 ,$3.65 ,$12.62 ,$15.80 ,$15.98 ,$15.98 ,$4.22 ,$15.98 ,$15.98 ,$15.18 ,$13.10 ,$13.10 ,$12.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101836,G0480,HC PHOSPHATIDYLETHANOL BLOOD TEST,301,1 ,$180.00 ,$118.80 ,$40.97 ,$257.47 ,$63.95 ,$180.00 ,$180.00 ,$47.63 ,$144.00 ,$153.00 ,$112.50 ,$162.00 ,$63.95 ,$63.95 ,$171.00 ,$162.00 ,$153.00 ,$153.00 ,$47.63 ,$153.00 ,$153.00 ,$162.00 ,$109.62 ,$63.95 ,$111.60 ,$67.79 ,$162.00 ,$257.47 ,$165.60 ,$162.00 ,$118.82 ,$118.82 ,$109.62 ,$118.82 ,$117.00 ,$122.98 ,$40.97 ,$142.20 ,$67.79 ,$137.32 ,$137.32 ,$47.63 ,$137.32 ,$114.43 ,$171.00 ,$147.60 ,$147.60 ,$144.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101837,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$296.70 ,$195.82 ,$39.26 ,$296.70 ,$40.57 ,$137.41 ,$137.41 ,$78.51 ,$237.36 ,$252.20 ,$185.44 ,$267.03 ,$40.57 ,$40.57 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,$40.57 ,$183.96 ,$43.00 ,$267.03 ,$88.34 ,$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,$43.00 ,$47.11 ,$47.11 ,$78.51 ,$47.11 ,$39.26 ,$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101838,G0480,HC DRUG MONITORING AMPHETAMINES QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101839,83527,HC INSULIN FREE,301,1 ,$15.24 ,$10.06 ,$3.48 ,$29.14 ,$13.38 ,$15.24 ,$15.24 ,$4.03 ,$12.19 ,$12.95 ,$9.53 ,$13.72 ,$13.38 ,$13.38 ,$14.48 ,$13.72 ,$12.95 ,$12.95 ,$4.03 ,$12.95 ,$12.95 ,$13.72 ,$9.28 ,$13.38 ,$9.44 ,$14.18 ,$13.72 ,$29.14 ,$14.02 ,$13.72 ,$10.06 ,$10.06 ,$9.28 ,$10.06 ,$9.91 ,$10.41 ,$3.48 ,$12.04 ,$14.18 ,$15.24 ,$15.24 ,$4.03 ,$15.24 ,$12.95 ,$14.48 ,$12.50 ,$12.50 ,$12.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101840,G0480,HC DRUG MONITORING BARBITURATES QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101841,G0480,HC DRUG MONITORING MARIJUANA METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101842,G0480,HC DRUG MONITORING COCAINE METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101843,G0480,HC DRUG MONITORING METHADONE METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101844,G0480,HC DRUG MONITORING PROPOXYPHENE METABOLITE QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101845,G0480,HC DRUG MONITORING ZOLPHIDEM QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101846,G0480,HC DRUG MONITORING PHENCYCLIDINE QN URINE,301,1 ,$160.00 ,$105.60 ,$36.43 ,$257.47 ,$63.95 ,$160.00 ,$160.00 ,$42.34 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$63.95 ,$63.95 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$42.34 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$63.95 ,$99.20 ,$67.79 ,$144.00 ,$257.47 ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$67.79 ,$137.32 ,$137.32 ,$42.34 ,$137.32 ,$114.43 ,$152.00 ,$131.20 ,$131.20 ,$128.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101847,G0480,HC IMMUNOASSAY QN OTHER,301,1 ,$180.55 ,$119.16 ,$41.11 ,$257.47 ,$63.95 ,$180.55 ,$180.55 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$63.95 ,$63.95 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$63.95 ,$111.94 ,$67.79 ,$162.50 ,$257.47 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$67.79 ,$137.32 ,$137.32 ,$47.77 ,$137.32 ,$114.43 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101848,82978,HC GLUTATHIONE,301,1 ,$299.00 ,$197.34 ,$15.45 ,$299.00 ,$15.96 ,$54.08 ,$54.08 ,$79.12 ,$239.20 ,$254.15 ,$186.88 ,$269.10 ,$15.96 ,$15.96 ,$284.05 ,$269.10 ,$254.15 ,$254.15 ,$79.12 ,$254.15 ,$254.15 ,$269.10 ,$182.09 ,$15.96 ,$185.38 ,$16.92 ,$269.10 ,$34.76 ,$275.08 ,$269.10 ,$197.37 ,$197.37 ,$182.09 ,$197.37 ,$194.35 ,$204.28 ,$68.07 ,$236.21 ,$16.92 ,$18.54 ,$18.54 ,$79.12 ,$18.54 ,$15.45 ,$284.05 ,$245.18 ,$245.18 ,$239.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30101850,80151,HC DRUG ASSAY AMIODARONE,301,1 ,$16.76 ,$11.06 ,$3.81 ,$37.71 ,$14.91 ,$16.76 ,$16.76 ,$4.44 ,$13.41 ,$14.25 ,$10.48 ,$15.08 ,$14.91 ,$14.91 ,$15.92 ,$15.08 ,$14.25 ,$14.25 ,$4.44 ,$14.25 ,$14.25 ,$15.08 ,$10.21 ,$14.91 ,$10.40 ,$15.80 ,$15.08 ,$37.71 ,$15.42 ,$15.08 ,$11.06 ,$11.06 ,$10.21 ,$11.06 ,$10.89 ,$11.45 ,$3.81 ,$13.24 ,$15.80 ,$16.76 ,$16.76 ,$4.44 ,$16.76 ,$16.76 ,$15.92 ,$13.74 ,$13.74 ,$13.41 
ST. CLARE MEMORIAL HOSPITAL (ACU),30108000,84620,HC XYLOSE TOLERANCE TEST,301,1 ,$178.25 ,$117.65 ,$12.91 ,$178.25 ,$13.34 ,$45.19 ,$45.19 ,$47.17 ,$142.60 ,$151.51 ,$111.41 ,$160.43 ,$13.34 ,$13.34 ,$169.34 ,$160.43 ,$151.51 ,$151.51 ,$47.17 ,$151.51 ,$151.51 ,$160.43 ,$108.55 ,$13.34 ,$110.52 ,$14.14 ,$160.43 ,$29.05 ,$163.99 ,$160.43 ,$117.66 ,$117.66 ,$108.55 ,$117.66 ,$115.86 ,$121.78 ,$40.58 ,$140.82 ,$14.14 ,$15.49 ,$15.49 ,$47.17 ,$15.49 ,$12.91 ,$169.34 ,$146.17 ,$146.17 ,$142.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30110162,82017,HC ACYLCARNITINES QN PLASMA MAYO-CMH,301,1 ,$211.60 ,$139.66 ,$16.87 ,$211.60 ,$17.43 ,$59.05 ,$59.05 ,$55.99 ,$169.28 ,$179.86 ,$132.25 ,$190.44 ,$17.43 ,$17.43 ,$201.02 ,$190.44 ,$179.86 ,$179.86 ,$55.99 ,$179.86 ,$179.86 ,$190.44 ,$128.86 ,$17.43 ,$131.20 ,$18.48 ,$190.44 ,$37.96 ,$194.67 ,$190.44 ,$139.68 ,$139.68 ,$128.86 ,$139.68 ,$137.54 ,$144.57 ,$48.18 ,$167.16 ,$18.48 ,$20.24 ,$20.24 ,$55.99 ,$20.24 ,$16.87 ,$201.02 ,$173.51 ,$173.51 ,$169.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30120750,84478,HC TRIGLYCERIDES-CLIN,301,1 ,$66.70 ,$44.02 ,$5.74 ,$66.70 ,$5.93 ,$20.09 ,$20.09 ,$17.65 ,$53.36 ,$56.70 ,$41.69 ,$60.03 ,$5.93 ,$5.93 ,$63.37 ,$60.03 ,$56.70 ,$56.70 ,$17.65 ,$56.70 ,$56.70 ,$60.03 ,$40.62 ,$5.93 ,$41.36 ,$6.29 ,$60.03 ,$12.92 ,$61.36 ,$60.03 ,$44.03 ,$44.03 ,$40.62 ,$44.03 ,$43.36 ,$45.57 ,$15.18 ,$52.69 ,$6.29 ,$6.89 ,$6.89 ,$17.65 ,$6.89 ,$5.74 ,$63.37 ,$54.69 ,$54.69 ,$53.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30140757,84482,HC T3 REVERSE-REF,301,1 ,$377.20 ,$248.95 ,$10.82 ,$377.20 ,$10.82 ,$55.16 ,$55.16 ,$99.80 ,$301.76 ,$320.62 ,$235.75 ,$339.48 ,$10.82 ,$10.82 ,$358.34 ,$339.48 ,$320.62 ,$320.62 ,$99.80 ,$320.62 ,$320.62 ,$339.48 ,$229.71 ,$10.82 ,$233.86 ,$11.47 ,$339.48 ,$35.46 ,$347.02 ,$339.48 ,$248.99 ,$248.99 ,$229.71 ,$248.99 ,$245.18 ,$257.70 ,$85.88 ,$297.99 ,$11.47 ,$18.91 ,$18.91 ,$99.80 ,$18.91 ,$15.76 ,$358.34 ,$309.30 ,$309.30 ,$301.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200103,86021,HC LEUKO AB ID,302,1 ,$141.45 ,$93.36 ,$15.05 ,$141.45 ,$15.55 ,$52.68 ,$52.68 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$15.55 ,$15.55 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$15.55 ,$87.70 ,$16.48 ,$127.31 ,$33.86 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$16.48 ,$18.06 ,$18.06 ,$37.43 ,$18.06 ,$15.05 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200105,86021,HC LEUKO AB ID (ANCA),302,1 ,$89.70 ,$59.20 ,$15.05 ,$89.70 ,$15.55 ,$52.68 ,$52.68 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$15.55 ,$15.55 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$15.55 ,$55.62 ,$16.48 ,$80.73 ,$33.86 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$16.48 ,$18.06 ,$18.06 ,$23.74 ,$18.06 ,$15.05 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200106,86021,HC LEUKO AB ID (MYELO),302,1 ,$116.15 ,$76.66 ,$15.05 ,$116.15 ,$15.55 ,$52.68 ,$52.68 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$15.55 ,$15.55 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$15.55 ,$72.02 ,$16.48 ,$104.54 ,$33.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$16.48 ,$18.06 ,$18.06 ,$30.73 ,$18.06 ,$15.05 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200107,86021,HC LEUKO AB ID (PROTEIN),302,1 ,$116.15 ,$76.66 ,$15.05 ,$116.15 ,$15.55 ,$52.68 ,$52.68 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$15.55 ,$15.55 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$15.55 ,$72.02 ,$16.48 ,$104.54 ,$33.86 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$16.48 ,$18.06 ,$18.06 ,$30.73 ,$18.06 ,$15.05 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200108,86022,HC PLATELET AB ID (HIT),302,1 ,$232.30 ,$153.32 ,$18.37 ,$232.30 ,$18.98 ,$64.30 ,$64.30 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$18.98 ,$18.98 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$18.98 ,$144.02 ,$20.12 ,$209.07 ,$41.33 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$20.12 ,$22.04 ,$22.04 ,$61.47 ,$22.04 ,$18.37 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200113,86022,HC PLATELET AB-ID,302,1 ,$232.30 ,$153.32 ,$18.37 ,$232.30 ,$18.98 ,$64.30 ,$64.30 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$18.98 ,$18.98 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$18.98 ,$144.02 ,$20.12 ,$209.07 ,$41.33 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$20.12 ,$22.04 ,$22.04 ,$61.47 ,$22.04 ,$18.37 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200118,86023,HC PLATELET ASSOC AB ID IGG,302,1 ,$116.15 ,$76.66 ,$12.46 ,$116.15 ,$12.87 ,$43.61 ,$43.61 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$12.87 ,$12.87 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$12.87 ,$72.02 ,$13.64 ,$104.54 ,$28.04 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$13.64 ,$14.95 ,$14.95 ,$30.73 ,$14.95 ,$12.46 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200119,86038,HC ANA SCREEN,302,1 ,$89.70 ,$59.20 ,$12.09 ,$89.70 ,$12.49 ,$42.32 ,$42.32 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$12.49 ,$12.49 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$12.49 ,$55.62 ,$13.24 ,$80.73 ,$27.20 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$13.24 ,$14.51 ,$14.51 ,$23.74 ,$14.51 ,$12.09 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200120,86039,HC ANA TITER,302,1 ,$103.50 ,$68.31 ,$11.16 ,$103.50 ,$11.53 ,$39.06 ,$39.06 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$11.53 ,$11.53 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$11.53 ,$64.18 ,$12.22 ,$93.15 ,$25.11 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$12.22 ,$13.39 ,$13.39 ,$27.39 ,$13.39 ,$11.16 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200121,86060,HC ASO,302,1 ,$141.45 ,$93.36 ,$7.30 ,$141.45 ,$7.54 ,$25.55 ,$25.55 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$7.54 ,$7.54 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$7.54 ,$87.70 ,$7.99 ,$127.31 ,$16.43 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$7.99 ,$8.76 ,$8.76 ,$37.43 ,$8.76 ,$7.30 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200122,86063,HC ASO SCREEN,302,1 ,$120.75 ,$79.70 ,$5.77 ,$120.75 ,$5.96 ,$20.20 ,$20.20 ,$31.95 ,$96.60 ,$102.64 ,$75.47 ,$108.68 ,$5.96 ,$5.96 ,$114.71 ,$108.68 ,$102.64 ,$102.64 ,$31.95 ,$102.64 ,$102.64 ,$108.68 ,$73.54 ,$5.96 ,$74.86 ,$6.32 ,$108.68 ,$12.98 ,$111.09 ,$108.68 ,$79.71 ,$79.71 ,$73.54 ,$79.71 ,$78.49 ,$82.50 ,$27.49 ,$95.39 ,$6.32 ,$6.92 ,$6.92 ,$31.95 ,$6.92 ,$5.77 ,$114.71 ,$99.02 ,$99.02 ,$96.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200123,86140,HC C-REACTIVE PROTEIN,302,1 ,$51.75 ,$34.16 ,$5.18 ,$51.75 ,$5.35 ,$18.13 ,$18.13 ,$13.69 ,$41.40 ,$43.99 ,$32.34 ,$46.58 ,$5.35 ,$5.35 ,$49.16 ,$46.58 ,$43.99 ,$43.99 ,$13.69 ,$43.99 ,$43.99 ,$46.58 ,$31.52 ,$5.35 ,$32.08 ,$5.67 ,$46.58 ,$11.66 ,$47.61 ,$46.58 ,$34.16 ,$34.16 ,$31.52 ,$34.16 ,$33.64 ,$35.36 ,$11.78 ,$40.88 ,$5.67 ,$6.22 ,$6.22 ,$13.69 ,$6.22 ,$5.18 ,$49.16 ,$42.44 ,$42.44 ,$41.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200124,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$193.20 ,$127.51 ,$12.95 ,$193.20 ,$13.38 ,$45.33 ,$45.33 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$13.38 ,$13.38 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$13.38 ,$119.78 ,$14.18 ,$173.88 ,$29.14 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$14.18 ,$15.54 ,$15.54 ,$51.12 ,$15.54 ,$12.95 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200125,86146,HC BETA 2 GLYCO AB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$89.08 ,$89.08 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.17 ,$8.17 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.17 ,$55.62 ,$8.66 ,$80.73 ,$57.26 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$8.66 ,$30.54 ,$30.54 ,$23.74 ,$30.54 ,$25.45 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200126,86147,HC CARDIOLIPIN AB EA,302,1 ,$77.05 ,$50.85 ,$8.17 ,$77.05 ,$8.17 ,$77.05 ,$77.05 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.17 ,$8.17 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.17 ,$47.78 ,$8.66 ,$69.35 ,$57.26 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.66 ,$30.54 ,$30.54 ,$20.38 ,$30.54 ,$25.45 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200128,86147,HC CARDIOLIPIN AB EA (PHOSPH),302,1 ,$87.40 ,$57.68 ,$8.17 ,$87.40 ,$8.17 ,$87.40 ,$87.40 ,$23.13 ,$69.92 ,$74.29 ,$54.63 ,$78.66 ,$8.17 ,$8.17 ,$83.03 ,$78.66 ,$74.29 ,$74.29 ,$23.13 ,$74.29 ,$74.29 ,$78.66 ,$53.23 ,$8.17 ,$54.18 ,$8.66 ,$78.66 ,$57.26 ,$80.41 ,$78.66 ,$57.69 ,$57.69 ,$53.23 ,$57.69 ,$56.81 ,$59.71 ,$19.89 ,$69.05 ,$8.66 ,$30.54 ,$30.54 ,$23.13 ,$30.54 ,$25.45 ,$83.03 ,$71.67 ,$71.67 ,$69.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200130,86160,HC COMPLEMENT AG EA (C3),302,1 ,$103.50 ,$68.31 ,$12.00 ,$103.50 ,$12.40 ,$42.00 ,$42.00 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.40 ,$12.40 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.40 ,$64.18 ,$13.14 ,$93.15 ,$27.00 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.14 ,$14.40 ,$14.40 ,$27.39 ,$14.40 ,$12.00 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200131,86160,HC COMPLEMENT AG EA (C4),302,1 ,$103.50 ,$68.31 ,$12.00 ,$103.50 ,$12.40 ,$42.00 ,$42.00 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.40 ,$12.40 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.40 ,$64.18 ,$13.14 ,$93.15 ,$27.00 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.14 ,$14.40 ,$14.40 ,$27.39 ,$14.40 ,$12.00 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200133,86161,HC C1 ESTERASE INHIBITOR,302,1 ,$98.90 ,$65.27 ,$12.00 ,$98.90 ,$12.40 ,$42.00 ,$42.00 ,$26.17 ,$79.12 ,$84.07 ,$61.81 ,$89.01 ,$12.40 ,$12.40 ,$93.96 ,$89.01 ,$84.07 ,$84.07 ,$26.17 ,$84.07 ,$84.07 ,$89.01 ,$60.23 ,$12.40 ,$61.32 ,$13.14 ,$89.01 ,$27.00 ,$90.99 ,$89.01 ,$65.28 ,$65.28 ,$60.23 ,$65.28 ,$64.29 ,$67.57 ,$22.52 ,$78.13 ,$13.14 ,$14.40 ,$14.40 ,$26.17 ,$14.40 ,$12.00 ,$93.96 ,$81.10 ,$81.10 ,$79.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200134,86162,HC COMPLEMENT TOTAL,302,1 ,$167.90 ,$110.81 ,$20.32 ,$167.90 ,$21.00 ,$71.12 ,$71.12 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$21.00 ,$21.00 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$21.00 ,$104.10 ,$22.26 ,$151.11 ,$45.72 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$22.26 ,$24.38 ,$24.38 ,$44.42 ,$24.38 ,$20.32 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200135,86200,HC CCP AB,302,1 ,$116.15 ,$76.66 ,$12.95 ,$116.15 ,$13.38 ,$45.33 ,$45.33 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.38 ,$13.38 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.38 ,$72.02 ,$14.18 ,$104.54 ,$29.14 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.18 ,$15.54 ,$15.54 ,$30.73 ,$15.54 ,$12.95 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200136,86215,HC DEOXYRIBONUCLEASE AB,302,1 ,$89.70 ,$59.20 ,$13.25 ,$89.70 ,$13.69 ,$46.38 ,$46.38 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$13.69 ,$13.69 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$13.69 ,$55.62 ,$14.51 ,$80.73 ,$29.81 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$14.51 ,$15.90 ,$15.90 ,$23.74 ,$15.90 ,$13.25 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200137,86225,HC DNA DOUBLE STRAND AB,302,1 ,$116.15 ,$76.66 ,$13.74 ,$116.15 ,$14.20 ,$48.09 ,$48.09 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$14.20 ,$14.20 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$14.20 ,$72.02 ,$15.05 ,$104.54 ,$30.92 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$15.05 ,$16.49 ,$16.49 ,$30.73 ,$16.49 ,$13.74 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200138,86235,HC ENA AB,302,1 ,$154.10 ,$101.71 ,$17.93 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.53 ,$18.53 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.53 ,$95.54 ,$19.64 ,$138.69 ,$40.34 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$40.78 ,$21.52 ,$17.93 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200139,86235,HC ENA AB (SCL70),302,1 ,$154.10 ,$101.71 ,$17.93 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.53 ,$18.53 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.53 ,$95.54 ,$19.64 ,$138.69 ,$40.34 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$40.78 ,$21.52 ,$17.93 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200140,86235,HC ENA AB (JO1),302,1 ,$154.10 ,$101.71 ,$17.93 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.53 ,$18.53 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.53 ,$95.54 ,$19.64 ,$138.69 ,$40.34 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$40.78 ,$21.52 ,$17.93 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200141,86235,HC ENA AB (SSA/SSB),302,1 ,$154.10 ,$101.71 ,$17.93 ,$154.10 ,$18.53 ,$62.76 ,$62.76 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.53 ,$18.53 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.53 ,$95.54 ,$19.64 ,$138.69 ,$40.34 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.64 ,$21.52 ,$21.52 ,$40.78 ,$21.52 ,$17.93 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200142,86255,HC FLUOR AB SCR (MITOCHONDRIAL),302,1 ,$64.40 ,$42.50 ,$12.05 ,$64.40 ,$12.45 ,$42.18 ,$42.18 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$12.45 ,$12.45 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$12.45 ,$39.92 ,$13.20 ,$57.96 ,$27.11 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$13.20 ,$14.46 ,$14.46 ,$17.04 ,$14.46 ,$12.05 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200143,86255,HC FLUOR AB SCR (MUSCLE),302,1 ,$47.15 ,$31.12 ,$10.73 ,$47.15 ,$12.45 ,$42.18 ,$42.18 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$12.45 ,$12.45 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$12.45 ,$29.24 ,$13.20 ,$42.44 ,$27.11 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$13.20 ,$14.46 ,$14.46 ,$12.48 ,$14.46 ,$12.05 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200144,86255,HC FLUOR AB SCR (RETICULIN),302,1 ,$149.50 ,$98.67 ,$12.05 ,$149.50 ,$12.45 ,$42.18 ,$42.18 ,$39.56 ,$119.60 ,$127.08 ,$93.44 ,$134.55 ,$12.45 ,$12.45 ,$142.03 ,$134.55 ,$127.08 ,$127.08 ,$39.56 ,$127.08 ,$127.08 ,$134.55 ,$91.05 ,$12.45 ,$92.70 ,$13.20 ,$134.55 ,$27.11 ,$137.54 ,$134.55 ,$98.69 ,$98.69 ,$91.05 ,$98.69 ,$97.18 ,$102.14 ,$34.04 ,$118.11 ,$13.20 ,$14.46 ,$14.46 ,$39.56 ,$14.46 ,$12.05 ,$142.03 ,$122.59 ,$122.59 ,$119.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200146,86255,HC FLUOR AB SCR (ENDOMYSIAL),302,1 ,$128.80 ,$85.01 ,$12.05 ,$128.80 ,$12.45 ,$42.18 ,$42.18 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$12.45 ,$12.45 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$12.45 ,$79.86 ,$13.20 ,$115.92 ,$27.11 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$13.20 ,$14.46 ,$14.46 ,$34.08 ,$14.46 ,$12.05 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200147,86255,HC FLUOR AB SCR (HU AB IFA),302,1 ,$180.55 ,$119.16 ,$12.05 ,$180.55 ,$12.45 ,$42.18 ,$42.18 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$12.45 ,$12.45 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$12.45 ,$111.94 ,$13.20 ,$162.50 ,$27.11 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$13.20 ,$14.46 ,$14.46 ,$47.77 ,$14.46 ,$12.05 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200148,86255,HC FLUOR AB SCR (PURKINJE),302,1 ,$180.55 ,$119.16 ,$12.05 ,$180.55 ,$12.45 ,$42.18 ,$42.18 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$12.45 ,$12.45 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$12.45 ,$111.94 ,$13.20 ,$162.50 ,$27.11 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$13.20 ,$14.46 ,$14.46 ,$47.77 ,$14.46 ,$12.05 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200149,86225,HC YO AB IFA,302,1 ,$116.15 ,$76.66 ,$13.74 ,$116.15 ,$14.20 ,$48.09 ,$48.09 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$14.20 ,$14.20 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$14.20 ,$72.02 ,$15.05 ,$104.54 ,$30.92 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$15.05 ,$16.49 ,$16.49 ,$30.73 ,$16.49 ,$13.74 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200150,86256,HC FLUOR AB TITER (C ANCA),302,1 ,$103.50 ,$68.31 ,$12.05 ,$103.50 ,$12.45 ,$42.18 ,$42.18 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.45 ,$12.45 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.45 ,$64.18 ,$13.20 ,$93.15 ,$27.11 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.20 ,$14.46 ,$14.46 ,$27.39 ,$14.46 ,$12.05 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200151,86256,HC FLUOR AB TITER (P ANCA),302,1 ,$103.50 ,$68.31 ,$12.05 ,$103.50 ,$12.45 ,$42.18 ,$42.18 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.45 ,$12.45 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.45 ,$64.18 ,$13.20 ,$93.15 ,$27.11 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.20 ,$14.46 ,$14.46 ,$27.39 ,$14.46 ,$12.05 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200156,86256,HC FLUOR AB TITER (MUSCLE),302,1 ,$118.45 ,$78.18 ,$12.05 ,$118.45 ,$12.45 ,$42.18 ,$42.18 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$12.45 ,$12.45 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$12.45 ,$73.44 ,$13.20 ,$106.61 ,$27.11 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$13.20 ,$14.46 ,$14.46 ,$31.34 ,$14.46 ,$12.05 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200157,82677,HC ESTRIOL SERUM,302,1 ,$131.10 ,$86.53 ,$24.18 ,$131.10 ,$24.99 ,$84.63 ,$84.63 ,$34.69 ,$104.88 ,$111.44 ,$81.94 ,$117.99 ,$24.99 ,$24.99 ,$124.55 ,$117.99 ,$111.44 ,$111.44 ,$34.69 ,$111.44 ,$111.44 ,$117.99 ,$79.84 ,$24.99 ,$81.28 ,$26.49 ,$117.99 ,$54.41 ,$120.61 ,$117.99 ,$86.54 ,$86.54 ,$79.84 ,$86.54 ,$85.22 ,$89.57 ,$29.84 ,$103.57 ,$26.49 ,$29.02 ,$29.02 ,$34.69 ,$29.02 ,$24.18 ,$124.55 ,$107.50 ,$107.50 ,$104.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200158,86300,HC TUMOR AG CA 15-3 (27.29),302,1 ,$180.55 ,$119.16 ,$20.81 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$21.50 ,$21.50 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$21.50 ,$111.94 ,$22.79 ,$162.50 ,$46.82 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$47.77 ,$24.97 ,$20.81 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200160,86301,HC TUMOR AG CA 19-9,302,1 ,$180.55 ,$119.16 ,$20.81 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$21.50 ,$21.50 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$21.50 ,$111.94 ,$22.79 ,$162.50 ,$46.82 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$47.77 ,$24.97 ,$20.81 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200162,86304,HC TUMOR AG CA 125,302,1 ,$180.55 ,$119.16 ,$20.81 ,$180.55 ,$21.50 ,$72.84 ,$72.84 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$21.50 ,$21.50 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$21.50 ,$111.94 ,$22.79 ,$162.50 ,$46.82 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$22.79 ,$24.97 ,$24.97 ,$47.77 ,$24.97 ,$20.81 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$89.70 ,$59.20 ,$5.18 ,$89.70 ,$5.35 ,$18.13 ,$18.13 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$5.35 ,$5.35 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$5.35 ,$55.62 ,$5.67 ,$80.73 ,$11.66 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$5.67 ,$6.22 ,$6.22 ,$23.74 ,$6.22 ,$5.18 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200164,86316,HC TUMOR AG OTHER AG QN,302,1 ,$193.20 ,$127.51 ,$20.81 ,$193.20 ,$21.50 ,$72.84 ,$72.84 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$21.50 ,$21.50 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$21.50 ,$119.78 ,$22.79 ,$173.88 ,$46.82 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$22.79 ,$24.97 ,$24.97 ,$51.12 ,$24.97 ,$20.81 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200165,86317,HC INFECTIOUS AB QN,302,1 ,$128.80 ,$85.01 ,$14.99 ,$128.80 ,$15.49 ,$52.47 ,$52.47 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.49 ,$15.49 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.49 ,$79.86 ,$16.42 ,$115.92 ,$33.73 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.42 ,$17.99 ,$17.99 ,$34.08 ,$17.99 ,$14.99 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200167,86331,HC IMMUNODIFF EL EA AG AB QL,302,1 ,$55.20 ,$36.43 ,$11.98 ,$55.20 ,$12.38 ,$41.93 ,$41.93 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$12.38 ,$12.38 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$12.38 ,$34.22 ,$13.12 ,$49.68 ,$26.96 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$13.12 ,$14.38 ,$14.38 ,$14.60 ,$14.38 ,$11.98 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200168,86331,HC IMMUNODIFF EL EA AG AB QL (TEICH),302,1 ,$55.20 ,$36.43 ,$11.98 ,$55.20 ,$12.38 ,$41.93 ,$41.93 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$12.38 ,$12.38 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$12.38 ,$34.22 ,$13.12 ,$49.68 ,$26.96 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$13.12 ,$14.38 ,$14.38 ,$14.60 ,$14.38 ,$11.98 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200169,86334,HC IMMUNOFIX ELECTRO SERUM,302,1 ,$193.20 ,$127.51 ,$22.34 ,$193.20 ,$23.08 ,$78.19 ,$78.19 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$23.08 ,$23.08 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$23.08 ,$119.78 ,$24.46 ,$173.88 ,$50.27 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$24.46 ,$26.81 ,$26.81 ,$51.12 ,$26.81 ,$22.34 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200170,86334,HC IMMUNOFIX ELECTRO REFLEX,302,1 ,$270.25 ,$178.37 ,$22.34 ,$270.25 ,$23.08 ,$78.19 ,$78.19 ,$71.51 ,$216.20 ,$229.71 ,$168.91 ,$243.23 ,$23.08 ,$23.08 ,$256.74 ,$243.23 ,$229.71 ,$229.71 ,$71.51 ,$229.71 ,$229.71 ,$243.23 ,$164.58 ,$23.08 ,$167.56 ,$24.46 ,$243.23 ,$50.27 ,$248.63 ,$243.23 ,$178.39 ,$178.39 ,$164.58 ,$178.39 ,$175.66 ,$184.63 ,$61.52 ,$213.50 ,$24.46 ,$26.81 ,$26.81 ,$71.51 ,$26.81 ,$22.34 ,$256.74 ,$221.61 ,$221.61 ,$216.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200171,86335,HC IMMUNOFIX ELECTRO OTH,302,1 ,$257.60 ,$170.02 ,$29.35 ,$257.60 ,$30.33 ,$102.73 ,$102.73 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$30.33 ,$30.33 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$30.33 ,$159.72 ,$32.15 ,$231.84 ,$66.04 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$32.15 ,$35.22 ,$35.22 ,$68.16 ,$35.22 ,$29.35 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200172,86335,HC IMMUNOFIX ELECTRO OTH (TRANS),302,1 ,$257.60 ,$170.02 ,$29.35 ,$257.60 ,$30.33 ,$102.73 ,$102.73 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$30.33 ,$30.33 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$30.33 ,$159.72 ,$32.15 ,$231.84 ,$66.04 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$32.15 ,$35.22 ,$35.22 ,$68.16 ,$35.22 ,$29.35 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200173,86336,HC INHIBIN A,302,1 ,$141.45 ,$93.36 ,$15.59 ,$141.45 ,$16.11 ,$54.57 ,$54.57 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.11 ,$16.11 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.11 ,$87.70 ,$17.08 ,$127.31 ,$35.08 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$17.08 ,$18.71 ,$18.71 ,$37.43 ,$18.71 ,$15.59 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200175,86337,HC INSULIN AB (HS),302,1 ,$293.25 ,$193.55 ,$21.41 ,$293.25 ,$22.12 ,$74.94 ,$74.94 ,$77.60 ,$234.60 ,$249.26 ,$183.28 ,$263.93 ,$22.12 ,$22.12 ,$278.59 ,$263.93 ,$249.26 ,$249.26 ,$77.60 ,$249.26 ,$249.26 ,$263.93 ,$178.59 ,$22.12 ,$181.82 ,$23.45 ,$263.93 ,$48.17 ,$269.79 ,$263.93 ,$193.57 ,$193.57 ,$178.59 ,$193.57 ,$190.61 ,$200.35 ,$66.76 ,$231.67 ,$23.45 ,$25.69 ,$25.69 ,$77.60 ,$25.69 ,$21.41 ,$278.59 ,$240.47 ,$240.47 ,$234.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200177,86340,HC INTRINSIC FACTOR AB,302,1 ,$128.80 ,$85.01 ,$14.28 ,$128.80 ,$14.28 ,$52.78 ,$52.78 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.28 ,$14.28 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.28 ,$79.86 ,$15.14 ,$115.92 ,$33.93 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.14 ,$18.10 ,$18.10 ,$34.08 ,$18.10 ,$15.08 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200179,86355,HC B CELLS TOTAL COUNT (CD19),302,1 ,$289.80 ,$191.27 ,$37.73 ,$289.80 ,$38.99 ,$132.06 ,$132.06 ,$76.68 ,$231.84 ,$246.33 ,$181.13 ,$260.82 ,$38.99 ,$38.99 ,$275.31 ,$260.82 ,$246.33 ,$246.33 ,$76.68 ,$246.33 ,$246.33 ,$260.82 ,$176.49 ,$38.99 ,$179.68 ,$41.33 ,$260.82 ,$84.89 ,$266.62 ,$260.82 ,$191.30 ,$191.30 ,$176.49 ,$191.30 ,$188.37 ,$197.99 ,$65.97 ,$228.94 ,$41.33 ,$45.28 ,$45.28 ,$76.68 ,$45.28 ,$37.73 ,$275.31 ,$237.64 ,$237.64 ,$231.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200180,86355,HC B CELLS TOTAL COUNT (CD20),302,1 ,$289.80 ,$191.27 ,$37.73 ,$289.80 ,$38.99 ,$132.06 ,$132.06 ,$76.68 ,$231.84 ,$246.33 ,$181.13 ,$260.82 ,$38.99 ,$38.99 ,$275.31 ,$260.82 ,$246.33 ,$246.33 ,$76.68 ,$246.33 ,$246.33 ,$260.82 ,$176.49 ,$38.99 ,$179.68 ,$41.33 ,$260.82 ,$84.89 ,$266.62 ,$260.82 ,$191.30 ,$191.30 ,$176.49 ,$191.30 ,$188.37 ,$197.99 ,$65.97 ,$228.94 ,$41.33 ,$45.28 ,$45.28 ,$76.68 ,$45.28 ,$37.73 ,$275.31 ,$237.64 ,$237.64 ,$231.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200181,86355,HC B CELLS TOTAL COUNT,302,1 ,$334.65 ,$220.87 ,$37.73 ,$334.65 ,$38.99 ,$132.06 ,$132.06 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$38.99 ,$38.99 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$38.99 ,$207.48 ,$41.33 ,$301.19 ,$84.89 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$41.33 ,$45.28 ,$45.28 ,$88.55 ,$45.28 ,$37.73 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200182,86357,HC CD8 TOTAL COUNT,302,1 ,$334.65 ,$220.87 ,$37.73 ,$334.65 ,$38.99 ,$132.06 ,$132.06 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$38.99 ,$38.99 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$38.99 ,$207.48 ,$41.33 ,$301.19 ,$84.89 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$41.33 ,$45.28 ,$45.28 ,$88.55 ,$45.28 ,$37.73 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200184,86360,HC ABS T CELLS CD4 CD8 RATIO,302,1 ,$411.70 ,$271.72 ,$46.98 ,$411.70 ,$48.54 ,$164.43 ,$164.43 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$48.54 ,$48.54 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$48.54 ,$255.26 ,$51.45 ,$370.53 ,$105.71 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$51.45 ,$56.38 ,$56.38 ,$108.94 ,$56.38 ,$46.98 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200185,86360,HC ABS T CELLS CD4 CD8 RATIO (MARKER),302,1 ,$411.70 ,$271.72 ,$46.98 ,$411.70 ,$48.54 ,$164.43 ,$164.43 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$48.54 ,$48.54 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$48.54 ,$255.26 ,$51.45 ,$370.53 ,$105.71 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$51.45 ,$56.38 ,$56.38 ,$108.94 ,$56.38 ,$46.98 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200187,86361,HC T CELLS CD4 COUNT,302,1 ,$225.40 ,$148.76 ,$26.78 ,$225.40 ,$27.67 ,$93.73 ,$93.73 ,$59.64 ,$180.32 ,$191.59 ,$140.88 ,$202.86 ,$27.67 ,$27.67 ,$214.13 ,$202.86 ,$191.59 ,$191.59 ,$59.64 ,$191.59 ,$191.59 ,$202.86 ,$137.27 ,$27.67 ,$139.74 ,$29.33 ,$202.86 ,$60.26 ,$207.37 ,$202.86 ,$148.79 ,$148.79 ,$137.27 ,$148.79 ,$146.51 ,$153.99 ,$51.31 ,$178.07 ,$29.33 ,$32.14 ,$32.14 ,$59.64 ,$32.14 ,$26.78 ,$214.13 ,$184.83 ,$184.83 ,$180.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200189,86376,HC MICROSOMAL AB,302,1 ,$128.80 ,$85.01 ,$14.55 ,$128.80 ,$15.03 ,$50.93 ,$50.93 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.03 ,$15.03 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.03 ,$79.86 ,$15.93 ,$115.92 ,$32.74 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.93 ,$17.46 ,$17.46 ,$34.08 ,$17.46 ,$14.55 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200191,86403,HC PARTICLE AGG SCREEN,302,1 ,$118.45 ,$78.18 ,$11.54 ,$118.45 ,$11.92 ,$40.39 ,$40.39 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$11.92 ,$11.92 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$11.92 ,$73.44 ,$12.64 ,$106.61 ,$25.97 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$12.64 ,$13.85 ,$13.85 ,$31.34 ,$13.85 ,$11.54 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200193,86403,HC STREPTOZYME,302,1 ,$65.55 ,$43.26 ,$11.54 ,$65.55 ,$11.92 ,$40.39 ,$40.39 ,$17.35 ,$52.44 ,$55.72 ,$40.97 ,$59.00 ,$11.92 ,$11.92 ,$62.27 ,$59.00 ,$55.72 ,$55.72 ,$17.35 ,$55.72 ,$55.72 ,$59.00 ,$39.92 ,$11.92 ,$40.64 ,$12.64 ,$59.00 ,$25.97 ,$60.31 ,$59.00 ,$43.27 ,$43.27 ,$39.92 ,$43.27 ,$42.61 ,$44.78 ,$14.93 ,$51.78 ,$12.64 ,$13.85 ,$13.85 ,$17.35 ,$13.85 ,$11.54 ,$62.27 ,$53.75 ,$53.75 ,$52.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200194,86403,HC CRYPTOCOCCUS AB,302,1 ,$104.65 ,$69.07 ,$11.54 ,$104.65 ,$11.92 ,$40.39 ,$40.39 ,$27.69 ,$83.72 ,$88.95 ,$65.41 ,$94.19 ,$11.92 ,$11.92 ,$99.42 ,$94.19 ,$88.95 ,$88.95 ,$27.69 ,$88.95 ,$88.95 ,$94.19 ,$63.73 ,$11.92 ,$64.88 ,$12.64 ,$94.19 ,$25.97 ,$96.28 ,$94.19 ,$69.08 ,$69.08 ,$63.73 ,$69.08 ,$68.02 ,$71.50 ,$23.82 ,$82.67 ,$12.64 ,$13.85 ,$13.85 ,$27.69 ,$13.85 ,$11.54 ,$99.42 ,$85.81 ,$85.81 ,$83.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200196,86406,HC PARTICLE AGGLUT TITER,302,1 ,$92.00 ,$60.72 ,$9.85 ,$92.00 ,$9.85 ,$37.24 ,$37.24 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$9.85 ,$9.85 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 ,$9.85 ,$57.04 ,$10.44 ,$82.80 ,$23.94 ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 ,$10.44 ,$12.77 ,$12.77 ,$24.34 ,$12.77 ,$10.64 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200197,86430,HC RHEUMATOID FACTOR,302,1 ,$54.05 ,$35.67 ,$6.14 ,$54.05 ,$6.34 ,$21.49 ,$21.49 ,$14.30 ,$43.24 ,$45.94 ,$33.78 ,$48.65 ,$6.34 ,$6.34 ,$51.35 ,$48.65 ,$45.94 ,$45.94 ,$14.30 ,$45.94 ,$45.94 ,$48.65 ,$32.92 ,$6.34 ,$33.52 ,$6.72 ,$48.65 ,$13.82 ,$49.73 ,$48.65 ,$35.68 ,$35.68 ,$32.92 ,$35.68 ,$35.13 ,$36.93 ,$12.30 ,$42.70 ,$6.72 ,$7.37 ,$7.37 ,$14.30 ,$7.37 ,$6.14 ,$51.35 ,$44.32 ,$44.32 ,$43.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200198,86431,HC RHEUMATOID FACTOR QN,302,1 ,$50.60 ,$33.40 ,$5.67 ,$50.60 ,$5.86 ,$19.85 ,$19.85 ,$13.39 ,$40.48 ,$43.01 ,$31.63 ,$45.54 ,$5.86 ,$5.86 ,$48.07 ,$45.54 ,$43.01 ,$43.01 ,$13.39 ,$43.01 ,$43.01 ,$45.54 ,$30.82 ,$5.86 ,$31.38 ,$6.21 ,$45.54 ,$12.76 ,$46.55 ,$45.54 ,$33.40 ,$33.40 ,$30.82 ,$33.40 ,$32.89 ,$34.57 ,$11.52 ,$39.97 ,$6.21 ,$6.80 ,$6.80 ,$13.39 ,$6.80 ,$5.67 ,$48.07 ,$41.49 ,$41.49 ,$40.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200199,86480,HC TB QUANTIFERON GOLD,302,1 ,$500.25 ,$330.17 ,$61.98 ,$500.25 ,$64.04 ,$216.93 ,$216.93 ,$132.37 ,$400.20 ,$425.21 ,$312.66 ,$450.23 ,$64.04 ,$64.04 ,$475.24 ,$450.23 ,$425.21 ,$425.21 ,$132.37 ,$425.21 ,$425.21 ,$450.23 ,$304.65 ,$64.04 ,$310.16 ,$67.88 ,$450.23 ,$139.46 ,$460.23 ,$450.23 ,$330.22 ,$330.22 ,$304.65 ,$330.22 ,$325.16 ,$341.77 ,$113.89 ,$395.20 ,$67.88 ,$74.38 ,$74.38 ,$132.37 ,$74.38 ,$61.98 ,$475.24 ,$410.21 ,$410.21 ,$400.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200200,86580,HC SKIN TEST TB INTRADERMAL,302,1 ,$77.05 ,$50.85 ,$17.54 ,$77.05 ,$18.68 ,$34.59 ,$34.59 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$18.68 ,$18.68 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$18.68 ,$47.78 ,$19.80 ,$69.35 ,$56.16 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$19.80 ,$27.59 ,$27.59 ,$20.38 ,$27.59 ,$24.96 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200201,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$36.80 ,$24.29 ,$4.27 ,$36.80 ,$4.41 ,$14.95 ,$14.95 ,$9.74 ,$29.44 ,$31.28 ,$23.00 ,$33.12 ,$4.41 ,$4.41 ,$34.96 ,$33.12 ,$31.28 ,$31.28 ,$9.74 ,$31.28 ,$31.28 ,$33.12 ,$22.41 ,$4.41 ,$22.82 ,$4.67 ,$33.12 ,$9.61 ,$33.86 ,$33.12 ,$24.29 ,$24.29 ,$22.41 ,$24.29 ,$23.92 ,$25.14 ,$8.37 ,$29.07 ,$4.67 ,$5.12 ,$5.12 ,$9.74 ,$5.12 ,$4.27 ,$34.96 ,$30.18 ,$30.18 ,$29.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200204,86593,HC SYPHILIS VDRL RPR QN,302,1 ,$54.05 ,$35.67 ,$4.40 ,$54.05 ,$4.55 ,$15.40 ,$15.40 ,$14.30 ,$43.24 ,$45.94 ,$33.78 ,$48.65 ,$4.55 ,$4.55 ,$51.35 ,$48.65 ,$45.94 ,$45.94 ,$14.30 ,$45.94 ,$45.94 ,$48.65 ,$32.92 ,$4.55 ,$33.52 ,$4.82 ,$48.65 ,$9.90 ,$49.73 ,$48.65 ,$35.68 ,$35.68 ,$32.92 ,$35.68 ,$35.13 ,$36.93 ,$12.30 ,$42.70 ,$4.82 ,$5.28 ,$5.28 ,$14.30 ,$5.28 ,$4.40 ,$51.35 ,$44.32 ,$44.32 ,$43.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200207,86606,HC ASPERGILLUS AB,302,1 ,$78.20 ,$51.61 ,$8.17 ,$78.20 ,$8.17 ,$52.68 ,$52.68 ,$20.69 ,$62.56 ,$66.47 ,$48.88 ,$70.38 ,$8.17 ,$8.17 ,$74.29 ,$70.38 ,$66.47 ,$66.47 ,$20.69 ,$66.47 ,$66.47 ,$70.38 ,$47.62 ,$8.17 ,$48.48 ,$8.66 ,$70.38 ,$33.86 ,$71.94 ,$70.38 ,$51.62 ,$51.62 ,$47.62 ,$51.62 ,$50.83 ,$53.43 ,$17.81 ,$61.78 ,$8.66 ,$18.06 ,$18.06 ,$20.69 ,$18.06 ,$15.05 ,$74.29 ,$64.12 ,$64.12 ,$62.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200208,86606,HC ASPERGILLUS AB (ASPER),302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$52.68 ,$52.68 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$8.17 ,$8.17 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$8.17 ,$39.92 ,$8.66 ,$57.96 ,$33.86 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$8.66 ,$18.06 ,$18.06 ,$17.04 ,$18.06 ,$15.05 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200211,86609,HC BACTERIUM AB NOS,302,1 ,$40.25 ,$26.57 ,$8.17 ,$40.25 ,$8.17 ,$40.25 ,$40.25 ,$10.65 ,$32.20 ,$34.21 ,$25.16 ,$36.23 ,$8.17 ,$8.17 ,$38.24 ,$36.23 ,$34.21 ,$34.21 ,$10.65 ,$34.21 ,$34.21 ,$36.23 ,$24.51 ,$8.17 ,$24.96 ,$8.66 ,$36.23 ,$28.98 ,$37.03 ,$36.23 ,$26.57 ,$26.57 ,$24.51 ,$26.57 ,$26.16 ,$27.50 ,$9.16 ,$31.80 ,$8.66 ,$15.46 ,$15.46 ,$10.65 ,$15.46 ,$12.88 ,$38.24 ,$33.01 ,$33.01 ,$32.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200212,86611,HC BARTONELLA SCREEN AB,302,1 ,$65.55 ,$43.26 ,$8.17 ,$65.55 ,$8.17 ,$35.63 ,$35.63 ,$17.35 ,$52.44 ,$55.72 ,$40.97 ,$59.00 ,$8.17 ,$8.17 ,$62.27 ,$59.00 ,$55.72 ,$55.72 ,$17.35 ,$55.72 ,$55.72 ,$59.00 ,$39.92 ,$8.17 ,$40.64 ,$8.66 ,$59.00 ,$22.91 ,$60.31 ,$59.00 ,$43.27 ,$43.27 ,$39.92 ,$43.27 ,$42.61 ,$44.78 ,$14.93 ,$51.78 ,$8.66 ,$12.22 ,$12.22 ,$17.35 ,$12.22 ,$10.18 ,$62.27 ,$53.75 ,$53.75 ,$52.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200213,86612,HC BLASTOMYCES AB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.15 ,$45.15 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.17 ,$8.17 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.17 ,$55.62 ,$8.66 ,$80.73 ,$29.03 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$8.66 ,$15.48 ,$15.48 ,$23.74 ,$15.48 ,$12.90 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200214,86612,HC BLASTOMYCES AB (CF/ID),302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.15 ,$45.15 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.17 ,$8.17 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.17 ,$55.62 ,$8.66 ,$80.73 ,$29.03 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$8.66 ,$15.48 ,$15.48 ,$23.74 ,$15.48 ,$12.90 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200217,86617,HC LYME DISEASE AB CONFIRM (IGG),302,1 ,$141.45 ,$93.36 ,$15.49 ,$141.45 ,$16.01 ,$54.22 ,$54.22 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.01 ,$16.01 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.01 ,$87.70 ,$16.97 ,$127.31 ,$34.85 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$16.97 ,$18.59 ,$18.59 ,$37.43 ,$18.59 ,$15.49 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200218,86617,HC LYME DISEASE AB CONFIRM (IGM),302,1 ,$141.45 ,$93.36 ,$15.49 ,$141.45 ,$16.01 ,$54.22 ,$54.22 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.01 ,$16.01 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.01 ,$87.70 ,$16.97 ,$127.31 ,$34.85 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$16.97 ,$18.59 ,$18.59 ,$37.43 ,$18.59 ,$15.49 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200219,86618,HC LYME AB,302,1 ,$154.10 ,$101.71 ,$17.03 ,$154.10 ,$17.60 ,$59.61 ,$59.61 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$17.60 ,$17.60 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$17.60 ,$95.54 ,$18.66 ,$138.69 ,$38.32 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$18.66 ,$20.44 ,$20.44 ,$40.78 ,$20.44 ,$17.03 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200220,86622,HC BRUCELLA AB (IGG/IGM),302,1 ,$77.05 ,$50.85 ,$8.17 ,$77.05 ,$8.17 ,$31.26 ,$31.26 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.17 ,$8.17 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.17 ,$47.78 ,$8.66 ,$69.35 ,$20.09 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.66 ,$10.72 ,$10.72 ,$20.38 ,$10.72 ,$8.93 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200221,86622,HC BRUCELLA AB,302,1 ,$69.00 ,$45.54 ,$8.17 ,$69.00 ,$8.17 ,$31.26 ,$31.26 ,$18.26 ,$55.20 ,$58.65 ,$43.13 ,$62.10 ,$8.17 ,$8.17 ,$65.55 ,$62.10 ,$58.65 ,$58.65 ,$18.26 ,$58.65 ,$58.65 ,$62.10 ,$42.02 ,$8.17 ,$42.78 ,$8.66 ,$62.10 ,$20.09 ,$63.48 ,$62.10 ,$45.55 ,$45.55 ,$42.02 ,$45.55 ,$44.85 ,$47.14 ,$15.71 ,$54.51 ,$8.66 ,$10.72 ,$10.72 ,$18.26 ,$10.72 ,$8.93 ,$65.55 ,$56.58 ,$56.58 ,$55.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200222,86628,HC CANDIDA AB,302,1 ,$71.30 ,$47.06 ,$8.17 ,$71.30 ,$8.17 ,$42.04 ,$42.04 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$8.17 ,$8.17 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$8.17 ,$44.20 ,$8.66 ,$64.17 ,$27.02 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 ,$16.23 ,$56.33 ,$8.66 ,$14.41 ,$14.41 ,$18.86 ,$14.41 ,$12.01 ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200224,86631,HC CHLAMYDIA AB IGG,302,1 ,$55.20 ,$36.43 ,$8.17 ,$55.20 ,$8.17 ,$41.37 ,$41.37 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$8.17 ,$8.17 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$8.17 ,$34.22 ,$8.66 ,$49.68 ,$26.60 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$8.66 ,$14.18 ,$14.18 ,$14.60 ,$14.18 ,$11.82 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200225,86631,HC CHLAMYDIA AB (GRP AB),302,1 ,$167.90 ,$110.81 ,$8.17 ,$167.90 ,$8.17 ,$41.37 ,$41.37 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$8.17 ,$8.17 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$8.17 ,$104.10 ,$8.66 ,$151.11 ,$26.60 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$8.66 ,$14.18 ,$14.18 ,$44.42 ,$14.18 ,$11.82 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200226,86631,HC CHLAMYDIA AB (PSITT IGG/IGA),302,1 ,$19.55 ,$12.90 ,$4.46 ,$26.60 ,$8.17 ,$19.55 ,$19.55 ,$5.17 ,$15.64 ,$16.62 ,$12.22 ,$17.60 ,$8.17 ,$8.17 ,$18.57 ,$17.60 ,$16.62 ,$16.62 ,$5.17 ,$16.62 ,$16.62 ,$17.60 ,$11.91 ,$8.17 ,$12.12 ,$8.66 ,$17.60 ,$26.60 ,$17.99 ,$17.60 ,$12.91 ,$12.91 ,$11.91 ,$12.91 ,$12.71 ,$13.36 ,$4.46 ,$15.44 ,$8.66 ,$14.18 ,$14.18 ,$5.17 ,$14.18 ,$11.82 ,$18.57 ,$16.03 ,$16.03 ,$15.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200227,86631,HC CHLAMYDIA AB IGG 2,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$41.37 ,$41.37 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$8.17 ,$8.17 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$8.17 ,$39.92 ,$8.66 ,$57.96 ,$26.60 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$8.66 ,$14.18 ,$14.18 ,$17.04 ,$14.18 ,$11.82 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200229,86632,HC CHLAMYDIA AB IGM PSITTACI,302,1 ,$19.55 ,$12.90 ,$4.46 ,$28.53 ,$8.17 ,$19.55 ,$19.55 ,$5.17 ,$15.64 ,$16.62 ,$12.22 ,$17.60 ,$8.17 ,$8.17 ,$18.57 ,$17.60 ,$16.62 ,$16.62 ,$5.17 ,$16.62 ,$16.62 ,$17.60 ,$11.91 ,$8.17 ,$12.12 ,$8.66 ,$17.60 ,$28.53 ,$17.99 ,$17.60 ,$12.91 ,$12.91 ,$11.91 ,$12.91 ,$12.71 ,$13.36 ,$4.46 ,$15.44 ,$8.66 ,$15.22 ,$15.22 ,$5.17 ,$15.22 ,$12.68 ,$18.57 ,$16.03 ,$16.03 ,$15.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200230,86632,HC CHLAMYDIA AB IGM,302,1 ,$63.25 ,$41.75 ,$8.17 ,$63.25 ,$8.17 ,$44.38 ,$44.38 ,$16.74 ,$50.60 ,$53.76 ,$39.53 ,$56.93 ,$8.17 ,$8.17 ,$60.09 ,$56.93 ,$53.76 ,$53.76 ,$16.74 ,$53.76 ,$53.76 ,$56.93 ,$38.52 ,$8.17 ,$39.22 ,$8.66 ,$56.93 ,$28.53 ,$58.19 ,$56.93 ,$41.75 ,$41.75 ,$38.52 ,$41.75 ,$41.11 ,$43.21 ,$14.41 ,$49.97 ,$8.66 ,$15.22 ,$15.22 ,$16.74 ,$15.22 ,$12.68 ,$60.09 ,$51.87 ,$51.87 ,$50.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200231,86635,HC COCCIDIOIDES AB,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$40.15 ,$40.15 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$8.17 ,$8.17 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$8.17 ,$39.92 ,$8.66 ,$57.96 ,$25.81 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$8.66 ,$13.76 ,$13.76 ,$17.04 ,$13.76 ,$11.47 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200233,86638,HC Q FEVER AB IGG,302,1 ,$82.80 ,$54.65 ,$8.17 ,$82.80 ,$8.17 ,$42.42 ,$42.42 ,$21.91 ,$66.24 ,$70.38 ,$51.75 ,$74.52 ,$8.17 ,$8.17 ,$78.66 ,$74.52 ,$70.38 ,$70.38 ,$21.91 ,$70.38 ,$70.38 ,$74.52 ,$50.43 ,$8.17 ,$51.34 ,$8.66 ,$74.52 ,$27.27 ,$76.18 ,$74.52 ,$54.66 ,$54.66 ,$50.43 ,$54.66 ,$53.82 ,$56.57 ,$18.85 ,$65.41 ,$8.66 ,$14.54 ,$14.54 ,$21.91 ,$14.54 ,$12.12 ,$78.66 ,$67.90 ,$67.90 ,$66.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200234,86638,HC Q FEVER AB IGM,302,1 ,$82.80 ,$54.65 ,$8.17 ,$82.80 ,$8.17 ,$42.42 ,$42.42 ,$21.91 ,$66.24 ,$70.38 ,$51.75 ,$74.52 ,$8.17 ,$8.17 ,$78.66 ,$74.52 ,$70.38 ,$70.38 ,$21.91 ,$70.38 ,$70.38 ,$74.52 ,$50.43 ,$8.17 ,$51.34 ,$8.66 ,$74.52 ,$27.27 ,$76.18 ,$74.52 ,$54.66 ,$54.66 ,$50.43 ,$54.66 ,$53.82 ,$56.57 ,$18.85 ,$65.41 ,$8.66 ,$14.54 ,$14.54 ,$21.91 ,$14.54 ,$12.12 ,$78.66 ,$67.90 ,$67.90 ,$66.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200235,86645,HC CMV AB IGM,302,1 ,$116.15 ,$76.66 ,$8.17 ,$116.15 ,$8.17 ,$58.98 ,$58.98 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$8.17 ,$8.17 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$8.17 ,$72.02 ,$8.66 ,$104.54 ,$37.91 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$8.66 ,$20.22 ,$20.22 ,$30.73 ,$20.22 ,$16.85 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200236,86651,HC ENCEPHALITIS CALIFORNIA AB,302,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$46.17 ,$46.17 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$8.17 ,$8.17 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$8.17 ,$39.92 ,$8.66 ,$57.96 ,$29.68 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$8.66 ,$15.83 ,$15.83 ,$17.04 ,$15.83 ,$13.19 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200237,86652,HC ENCEPHALITIS EQUINE AB,302,1 ,$78.20 ,$51.61 ,$8.17 ,$78.20 ,$8.17 ,$46.17 ,$46.17 ,$20.69 ,$62.56 ,$66.47 ,$48.88 ,$70.38 ,$8.17 ,$8.17 ,$74.29 ,$70.38 ,$66.47 ,$66.47 ,$20.69 ,$66.47 ,$66.47 ,$70.38 ,$47.62 ,$8.17 ,$48.48 ,$8.66 ,$70.38 ,$29.68 ,$71.94 ,$70.38 ,$51.62 ,$51.62 ,$47.62 ,$51.62 ,$50.83 ,$53.43 ,$17.81 ,$61.78 ,$8.66 ,$15.83 ,$15.83 ,$20.69 ,$15.83 ,$13.19 ,$74.29 ,$64.12 ,$64.12 ,$62.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200238,86653,HC ENCEPHALITIS ST LOUIS AB,302,1 ,$79.35 ,$52.37 ,$8.17 ,$79.35 ,$8.17 ,$46.17 ,$46.17 ,$20.99 ,$63.48 ,$67.45 ,$49.59 ,$71.42 ,$8.17 ,$8.17 ,$75.38 ,$71.42 ,$67.45 ,$67.45 ,$20.99 ,$67.45 ,$67.45 ,$71.42 ,$48.32 ,$8.17 ,$49.20 ,$8.66 ,$71.42 ,$29.68 ,$73.00 ,$71.42 ,$52.38 ,$52.38 ,$48.32 ,$52.38 ,$51.58 ,$54.21 ,$18.06 ,$62.69 ,$8.66 ,$15.83 ,$15.83 ,$20.99 ,$15.83 ,$13.19 ,$75.38 ,$65.07 ,$65.07 ,$63.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200239,86654,HC ENCEPHALITIS WEST EQUINE AB,302,1 ,$78.20 ,$51.61 ,$8.17 ,$78.20 ,$8.17 ,$46.17 ,$46.17 ,$20.69 ,$62.56 ,$66.47 ,$48.88 ,$70.38 ,$8.17 ,$8.17 ,$74.29 ,$70.38 ,$66.47 ,$66.47 ,$20.69 ,$66.47 ,$66.47 ,$70.38 ,$47.62 ,$8.17 ,$48.48 ,$8.66 ,$70.38 ,$29.68 ,$71.94 ,$70.38 ,$51.62 ,$51.62 ,$47.62 ,$51.62 ,$50.83 ,$53.43 ,$17.81 ,$61.78 ,$8.66 ,$15.83 ,$15.83 ,$20.69 ,$15.83 ,$13.19 ,$74.29 ,$64.12 ,$64.12 ,$62.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200240,86658,HC ENTEROVIRUS A COXSACKIE,302,1 ,$77.05 ,$50.85 ,$8.17 ,$77.05 ,$8.17 ,$45.61 ,$45.61 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.17 ,$8.17 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.17 ,$47.78 ,$8.66 ,$69.35 ,$29.32 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.66 ,$15.64 ,$15.64 ,$20.38 ,$15.64 ,$13.03 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200244,86663,HC EBV EARLY AG,302,1 ,$116.15 ,$76.66 ,$13.12 ,$116.15 ,$13.56 ,$45.92 ,$45.92 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.56 ,$13.56 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.56 ,$72.02 ,$14.37 ,$104.54 ,$29.52 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.37 ,$15.74 ,$15.74 ,$30.73 ,$15.74 ,$13.12 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200245,86664,HC EBV NUCLEAR AG,302,1 ,$128.80 ,$85.01 ,$15.29 ,$128.80 ,$15.80 ,$53.52 ,$53.52 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.80 ,$15.80 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.80 ,$79.86 ,$16.75 ,$115.92 ,$34.40 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.75 ,$18.35 ,$18.35 ,$34.08 ,$18.35 ,$15.29 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200246,86665,HC EBV VIRAL CAP,302,1 ,$154.10 ,$101.71 ,$18.14 ,$154.10 ,$18.74 ,$63.49 ,$63.49 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$18.74 ,$18.74 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$18.74 ,$95.54 ,$19.86 ,$138.69 ,$40.82 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$19.86 ,$21.77 ,$21.77 ,$40.78 ,$21.77 ,$18.14 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200247,86666,HC EHRICHIA AB,302,1 ,$44.85 ,$29.60 ,$8.17 ,$44.85 ,$8.17 ,$35.63 ,$35.63 ,$11.87 ,$35.88 ,$38.12 ,$28.03 ,$40.37 ,$8.17 ,$8.17 ,$42.61 ,$40.37 ,$38.12 ,$38.12 ,$11.87 ,$38.12 ,$38.12 ,$40.37 ,$27.31 ,$8.17 ,$27.80 ,$8.66 ,$40.37 ,$22.91 ,$41.26 ,$40.37 ,$29.61 ,$29.61 ,$27.31 ,$29.61 ,$29.15 ,$30.64 ,$10.21 ,$35.43 ,$8.66 ,$12.22 ,$12.22 ,$11.87 ,$12.22 ,$10.18 ,$42.61 ,$36.78 ,$36.78 ,$35.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200248,86666,HC EHRICHIA AB (ANAPLASMA),302,1 ,$57.50 ,$37.95 ,$8.17 ,$57.50 ,$8.17 ,$35.63 ,$35.63 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$8.17 ,$8.17 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$8.17 ,$35.66 ,$8.66 ,$51.75 ,$22.91 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$8.66 ,$12.22 ,$12.22 ,$15.22 ,$12.22 ,$10.18 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200250,86671,HC FUNGUS AB NOS,302,1 ,$59.80 ,$39.47 ,$7.15 ,$59.80 ,$7.15 ,$42.88 ,$42.88 ,$15.83 ,$47.84 ,$50.83 ,$37.38 ,$53.82 ,$7.15 ,$7.15 ,$56.81 ,$53.82 ,$50.83 ,$50.83 ,$15.83 ,$50.83 ,$50.83 ,$53.82 ,$36.42 ,$7.15 ,$37.08 ,$7.58 ,$53.82 ,$27.56 ,$55.02 ,$53.82 ,$39.47 ,$39.47 ,$36.42 ,$39.47 ,$38.87 ,$40.86 ,$13.61 ,$47.24 ,$7.58 ,$14.70 ,$14.70 ,$15.83 ,$14.70 ,$12.25 ,$56.81 ,$49.04 ,$49.04 ,$47.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200251,86677,HC H PYLORI AB,302,1 ,$103.50 ,$68.31 ,$8.17 ,$103.50 ,$8.17 ,$58.98 ,$58.98 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$8.17 ,$8.17 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$8.17 ,$64.18 ,$8.66 ,$93.15 ,$37.91 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$8.66 ,$20.22 ,$20.22 ,$27.39 ,$20.22 ,$16.85 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200252,86684,HC HAEMOPHILUS INFLUENZA AB,302,1 ,$180.55 ,$119.16 ,$15.84 ,$180.55 ,$16.37 ,$55.44 ,$55.44 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$16.37 ,$16.37 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$16.37 ,$111.94 ,$17.35 ,$162.50 ,$35.64 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$17.35 ,$19.01 ,$19.01 ,$47.77 ,$19.01 ,$15.84 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200253,86689,HC HIV WESTERN BLOT,302,1 ,$405.95 ,$267.93 ,$19.35 ,$405.95 ,$19.99 ,$67.73 ,$67.73 ,$107.42 ,$324.76 ,$345.06 ,$253.72 ,$365.36 ,$19.99 ,$19.99 ,$385.65 ,$365.36 ,$345.06 ,$345.06 ,$107.42 ,$345.06 ,$345.06 ,$365.36 ,$247.22 ,$19.99 ,$251.68 ,$21.19 ,$365.36 ,$43.54 ,$373.47 ,$365.36 ,$267.97 ,$267.97 ,$247.22 ,$267.97 ,$263.87 ,$277.35 ,$92.41 ,$320.70 ,$21.19 ,$23.22 ,$23.22 ,$107.42 ,$23.22 ,$19.35 ,$385.65 ,$332.88 ,$332.88 ,$324.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200256,86689,HC HIV1 WESTERN BLOT,302,1 ,$162.15 ,$107.02 ,$19.35 ,$162.15 ,$19.99 ,$67.73 ,$67.73 ,$42.90 ,$129.72 ,$137.83 ,$101.34 ,$145.94 ,$19.99 ,$19.99 ,$154.04 ,$145.94 ,$137.83 ,$137.83 ,$42.90 ,$137.83 ,$137.83 ,$145.94 ,$98.75 ,$19.99 ,$100.54 ,$21.19 ,$145.94 ,$43.54 ,$149.18 ,$145.94 ,$107.04 ,$107.04 ,$98.75 ,$107.04 ,$105.40 ,$110.78 ,$36.91 ,$128.10 ,$21.19 ,$23.22 ,$23.22 ,$42.90 ,$23.22 ,$19.35 ,$154.04 ,$132.96 ,$132.96 ,$129.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200257,86689,HC HIV2 WESTERN BLOT,302,1 ,$162.15 ,$107.02 ,$19.35 ,$162.15 ,$19.99 ,$67.73 ,$67.73 ,$42.90 ,$129.72 ,$137.83 ,$101.34 ,$145.94 ,$19.99 ,$19.99 ,$154.04 ,$145.94 ,$137.83 ,$137.83 ,$42.90 ,$137.83 ,$137.83 ,$145.94 ,$98.75 ,$19.99 ,$100.54 ,$21.19 ,$145.94 ,$43.54 ,$149.18 ,$145.94 ,$107.04 ,$107.04 ,$98.75 ,$107.04 ,$105.40 ,$110.78 ,$36.91 ,$128.10 ,$21.19 ,$23.22 ,$23.22 ,$42.90 ,$23.22 ,$19.35 ,$154.04 ,$132.96 ,$132.96 ,$129.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200258,86692,HC HEPATITIS D AB,302,1 ,$151.80 ,$100.19 ,$17.16 ,$151.80 ,$17.73 ,$60.06 ,$60.06 ,$40.17 ,$121.44 ,$129.03 ,$94.88 ,$136.62 ,$17.73 ,$17.73 ,$144.21 ,$136.62 ,$129.03 ,$129.03 ,$40.17 ,$129.03 ,$129.03 ,$136.62 ,$92.45 ,$17.73 ,$94.12 ,$18.79 ,$136.62 ,$38.61 ,$139.66 ,$136.62 ,$100.20 ,$100.20 ,$92.45 ,$100.20 ,$98.67 ,$103.71 ,$34.55 ,$119.92 ,$18.79 ,$20.59 ,$20.59 ,$40.17 ,$20.59 ,$17.16 ,$144.21 ,$124.48 ,$124.48 ,$121.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200259,86694,HC HERPES SIMPLEX AB,302,1 ,$127.65 ,$84.25 ,$14.39 ,$127.65 ,$14.87 ,$50.37 ,$50.37 ,$33.78 ,$102.12 ,$108.50 ,$79.78 ,$114.89 ,$14.87 ,$14.87 ,$121.27 ,$114.89 ,$108.50 ,$108.50 ,$33.78 ,$108.50 ,$108.50 ,$114.89 ,$77.74 ,$14.87 ,$79.14 ,$15.76 ,$114.89 ,$32.38 ,$117.44 ,$114.89 ,$84.26 ,$84.26 ,$77.74 ,$84.26 ,$82.97 ,$87.21 ,$29.06 ,$100.84 ,$15.76 ,$17.27 ,$17.27 ,$33.78 ,$17.27 ,$14.39 ,$121.27 ,$104.67 ,$104.67 ,$102.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200261,86695,HC HERPES SIMPLEX AB I,302,1 ,$116.15 ,$76.66 ,$13.19 ,$116.15 ,$13.63 ,$46.17 ,$46.17 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.63 ,$13.63 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.63 ,$72.02 ,$14.45 ,$104.54 ,$29.68 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.45 ,$15.83 ,$15.83 ,$30.73 ,$15.83 ,$13.19 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200262,86695,HC HERPES SIMPLEX IGG I,302,1 ,$110.40 ,$72.86 ,$13.19 ,$110.40 ,$13.63 ,$46.17 ,$46.17 ,$29.21 ,$88.32 ,$93.84 ,$69.00 ,$99.36 ,$13.63 ,$13.63 ,$104.88 ,$99.36 ,$93.84 ,$93.84 ,$29.21 ,$93.84 ,$93.84 ,$99.36 ,$67.23 ,$13.63 ,$68.44 ,$14.45 ,$99.36 ,$29.68 ,$101.57 ,$99.36 ,$72.88 ,$72.88 ,$67.23 ,$72.88 ,$71.76 ,$75.43 ,$25.13 ,$87.22 ,$14.45 ,$15.83 ,$15.83 ,$29.21 ,$15.83 ,$13.19 ,$104.88 ,$90.53 ,$90.53 ,$88.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200263,86696,HC HERPES SIMPLEX AB II,302,1 ,$167.90 ,$110.81 ,$19.35 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.99 ,$19.99 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.99 ,$104.10 ,$21.19 ,$151.11 ,$43.54 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$44.42 ,$23.22 ,$19.35 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200264,86696,HC HERPES SIMPLEX IGG II,302,1 ,$167.90 ,$110.81 ,$19.35 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.99 ,$19.99 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.99 ,$104.10 ,$21.19 ,$151.11 ,$43.54 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$44.42 ,$23.22 ,$19.35 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200265,86698,HC HISTOPLASMA AB,302,1 ,$89.70 ,$59.20 ,$13.79 ,$89.70 ,$14.25 ,$48.27 ,$48.27 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$14.25 ,$14.25 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$14.25 ,$55.62 ,$15.11 ,$80.73 ,$31.03 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$15.11 ,$16.55 ,$16.55 ,$23.74 ,$16.55 ,$13.79 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200270,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$116.15 ,$76.66 ,$13.71 ,$116.15 ,$14.17 ,$47.99 ,$47.99 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$14.17 ,$14.17 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$14.17 ,$72.02 ,$15.02 ,$104.54 ,$30.85 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$15.02 ,$16.45 ,$16.45 ,$30.73 ,$16.45 ,$13.71 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200271,86704,HC HEP CORE AB,302,1 ,$103.50 ,$68.31 ,$12.05 ,$103.50 ,$12.45 ,$42.18 ,$42.18 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$12.45 ,$12.45 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$12.45 ,$64.18 ,$13.20 ,$93.15 ,$27.11 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$13.20 ,$14.46 ,$14.46 ,$27.39 ,$14.46 ,$12.05 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200272,86704,HC HEP CORE AB (ATB),302,1 ,$124.20 ,$81.97 ,$12.05 ,$124.20 ,$12.45 ,$42.18 ,$42.18 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$12.45 ,$12.45 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$12.45 ,$77.00 ,$13.20 ,$111.78 ,$27.11 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$13.20 ,$14.46 ,$14.46 ,$32.86 ,$14.46 ,$12.05 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200273,86706,HC HEP B SURFACE AB,302,1 ,$89.70 ,$59.20 ,$10.74 ,$89.70 ,$11.10 ,$37.59 ,$37.59 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$11.10 ,$11.10 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$11.10 ,$55.62 ,$11.77 ,$80.73 ,$24.17 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.77 ,$12.89 ,$12.89 ,$23.74 ,$12.89 ,$10.74 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200274,86706,HC HEP B SURFACE AB (ATB),302,1 ,$67.85 ,$44.78 ,$10.74 ,$67.85 ,$11.10 ,$37.59 ,$37.59 ,$17.95 ,$54.28 ,$57.67 ,$42.41 ,$61.07 ,$11.10 ,$11.10 ,$64.46 ,$61.07 ,$57.67 ,$57.67 ,$17.95 ,$57.67 ,$57.67 ,$61.07 ,$41.32 ,$11.10 ,$42.06 ,$11.77 ,$61.07 ,$24.17 ,$62.42 ,$61.07 ,$44.79 ,$44.79 ,$41.32 ,$44.79 ,$44.10 ,$46.36 ,$15.45 ,$53.60 ,$11.77 ,$12.89 ,$12.89 ,$17.95 ,$12.89 ,$10.74 ,$64.46 ,$55.64 ,$55.64 ,$54.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200275,86707,HC HEP B E AB,302,1 ,$77.05 ,$50.85 ,$11.57 ,$77.05 ,$11.96 ,$40.50 ,$40.50 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$11.96 ,$11.96 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$11.96 ,$47.78 ,$12.68 ,$69.35 ,$26.03 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$12.68 ,$13.88 ,$13.88 ,$20.38 ,$13.88 ,$11.57 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200276,86708,HC HEP A AB TOTAL,302,1 ,$89.70 ,$59.20 ,$12.39 ,$89.70 ,$12.80 ,$43.37 ,$43.37 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$12.80 ,$12.80 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$12.80 ,$55.62 ,$13.57 ,$80.73 ,$27.88 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$13.57 ,$14.87 ,$14.87 ,$23.74 ,$14.87 ,$12.39 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200277,86709,HC HEP A AB IGM,302,1 ,$180.55 ,$119.16 ,$11.26 ,$180.55 ,$11.63 ,$39.41 ,$39.41 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$11.63 ,$11.63 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$11.63 ,$111.94 ,$12.33 ,$162.50 ,$25.34 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$12.33 ,$13.51 ,$13.51 ,$47.77 ,$13.51 ,$11.26 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200278,86709,HC HEP ABC AB IGM,302,1 ,$116.15 ,$76.66 ,$11.26 ,$116.15 ,$11.63 ,$39.41 ,$39.41 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$11.63 ,$11.63 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$11.63 ,$72.02 ,$12.33 ,$104.54 ,$25.34 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$12.33 ,$13.51 ,$13.51 ,$30.73 ,$13.51 ,$11.26 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200279,86713,HC LEGIONELLA AB (PNEUM),302,1 ,$116.15 ,$76.66 ,$15.30 ,$116.15 ,$15.81 ,$53.55 ,$53.55 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$15.81 ,$15.81 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$15.81 ,$72.02 ,$16.76 ,$104.54 ,$34.43 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$16.76 ,$18.36 ,$18.36 ,$30.73 ,$18.36 ,$15.30 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200280,86713,HC LEGIONELLA AB (IGM),302,1 ,$116.15 ,$76.66 ,$15.30 ,$116.15 ,$15.81 ,$53.55 ,$53.55 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$15.81 ,$15.81 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$15.81 ,$72.02 ,$16.76 ,$104.54 ,$34.43 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$16.76 ,$18.36 ,$18.36 ,$30.73 ,$18.36 ,$15.30 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200281,86720,HC LEPTOSPIRA AB,302,1 ,$113.85 ,$75.14 ,$8.17 ,$113.85 ,$8.17 ,$56.70 ,$56.70 ,$30.13 ,$91.08 ,$96.77 ,$71.16 ,$102.47 ,$8.17 ,$8.17 ,$108.16 ,$102.47 ,$96.77 ,$96.77 ,$30.13 ,$96.77 ,$96.77 ,$102.47 ,$69.33 ,$8.17 ,$70.58 ,$8.66 ,$102.47 ,$36.45 ,$104.74 ,$102.47 ,$75.15 ,$75.15 ,$69.33 ,$75.15 ,$74.00 ,$77.78 ,$25.92 ,$89.94 ,$8.66 ,$19.44 ,$19.44 ,$30.13 ,$19.44 ,$16.20 ,$108.16 ,$93.36 ,$93.36 ,$91.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200282,86735,HC MUMPS AB,302,1 ,$141.45 ,$93.36 ,$13.05 ,$141.45 ,$13.48 ,$45.68 ,$45.68 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$13.48 ,$13.48 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$13.48 ,$87.70 ,$14.29 ,$127.31 ,$29.36 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$14.29 ,$15.66 ,$15.66 ,$37.43 ,$15.66 ,$13.05 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200283,86735,HC MUMPS QN,302,1 ,$51.75 ,$34.16 ,$11.78 ,$51.75 ,$13.48 ,$45.68 ,$45.68 ,$13.69 ,$41.40 ,$43.99 ,$32.34 ,$46.58 ,$13.48 ,$13.48 ,$49.16 ,$46.58 ,$43.99 ,$43.99 ,$13.69 ,$43.99 ,$43.99 ,$46.58 ,$31.52 ,$13.48 ,$32.08 ,$14.29 ,$46.58 ,$29.36 ,$47.61 ,$46.58 ,$34.16 ,$34.16 ,$31.52 ,$34.16 ,$33.64 ,$35.36 ,$11.78 ,$40.88 ,$14.29 ,$15.66 ,$15.66 ,$13.69 ,$15.66 ,$13.05 ,$49.16 ,$42.44 ,$42.44 ,$41.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200284,86738,HC MYCOPLASMA AB,302,1 ,$89.70 ,$59.20 ,$13.24 ,$89.70 ,$13.68 ,$46.34 ,$46.34 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$13.68 ,$13.68 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$13.68 ,$55.62 ,$14.50 ,$80.73 ,$29.79 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$14.50 ,$15.89 ,$15.89 ,$23.74 ,$15.89 ,$13.24 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200285,86744,HC NOCARDIA AB,302,1 ,$47.15 ,$31.12 ,$8.17 ,$47.15 ,$8.17 ,$47.15 ,$47.15 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$8.17 ,$8.17 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$8.17 ,$29.24 ,$8.66 ,$42.44 ,$35.98 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$8.66 ,$19.19 ,$19.19 ,$12.48 ,$19.19 ,$15.99 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200286,86747,HC PARVOVIRUS AB,302,1 ,$103.50 ,$68.31 ,$15.03 ,$103.50 ,$15.53 ,$52.61 ,$52.61 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$15.53 ,$15.53 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$15.53 ,$64.18 ,$16.46 ,$93.15 ,$33.82 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$16.46 ,$18.04 ,$18.04 ,$27.39 ,$18.04 ,$15.03 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200287,86753,HC PROTOZOA AB,302,1 ,$55.20 ,$36.43 ,$8.17 ,$55.20 ,$8.17 ,$43.37 ,$43.37 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$8.17 ,$8.17 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$8.17 ,$34.22 ,$8.66 ,$49.68 ,$27.88 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$8.66 ,$14.87 ,$14.87 ,$14.60 ,$14.87 ,$12.39 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200288,86762,HC RUBELLA AB,302,1 ,$128.80 ,$85.01 ,$14.39 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.87 ,$14.87 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.87 ,$79.86 ,$15.76 ,$115.92 ,$32.38 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$34.08 ,$17.27 ,$14.39 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200289,86762,HC RUBELLA AB QN,302,1 ,$128.80 ,$85.01 ,$14.39 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.87 ,$14.87 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.87 ,$79.86 ,$15.76 ,$115.92 ,$32.38 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$34.08 ,$17.27 ,$14.39 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200290,86762,HC RUBELLA AB IGG/IGM,302,1 ,$133.40 ,$88.04 ,$14.39 ,$133.40 ,$14.87 ,$50.37 ,$50.37 ,$35.30 ,$106.72 ,$113.39 ,$83.38 ,$120.06 ,$14.87 ,$14.87 ,$126.73 ,$120.06 ,$113.39 ,$113.39 ,$35.30 ,$113.39 ,$113.39 ,$120.06 ,$81.24 ,$14.87 ,$82.70 ,$15.76 ,$120.06 ,$32.38 ,$122.73 ,$120.06 ,$88.06 ,$88.06 ,$81.24 ,$88.06 ,$86.71 ,$91.14 ,$30.37 ,$105.39 ,$15.76 ,$17.27 ,$17.27 ,$35.30 ,$17.27 ,$14.39 ,$126.73 ,$109.39 ,$109.39 ,$106.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200291,86765,HC RUBEOLA AB,302,1 ,$116.15 ,$76.66 ,$12.88 ,$116.15 ,$13.31 ,$45.08 ,$45.08 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.31 ,$13.31 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.31 ,$72.02 ,$14.11 ,$104.54 ,$28.98 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.11 ,$15.46 ,$15.46 ,$30.73 ,$15.46 ,$12.88 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200292,86765,HC RUBEOLA AB QN,302,1 ,$116.15 ,$76.66 ,$12.88 ,$116.15 ,$13.31 ,$45.08 ,$45.08 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.31 ,$13.31 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.31 ,$72.02 ,$14.11 ,$104.54 ,$28.98 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.11 ,$15.46 ,$15.46 ,$30.73 ,$15.46 ,$12.88 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200294,86768,HC SALMONELLA,302,1 ,$86.25 ,$56.93 ,$11.50 ,$86.25 ,$11.50 ,$46.17 ,$46.17 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$11.50 ,$11.50 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$11.50 ,$53.48 ,$12.19 ,$77.63 ,$29.68 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$12.19 ,$15.83 ,$15.83 ,$22.82 ,$15.83 ,$13.19 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200295,86774,HC TETANUS AB,302,1 ,$128.80 ,$85.01 ,$14.80 ,$128.80 ,$15.29 ,$51.80 ,$51.80 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.29 ,$15.29 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.29 ,$79.86 ,$16.21 ,$115.92 ,$33.30 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.21 ,$17.76 ,$17.76 ,$34.08 ,$17.76 ,$14.80 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200296,86777,HC TOXOPLASMA AB,302,1 ,$128.80 ,$85.01 ,$14.39 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.87 ,$14.87 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.87 ,$79.86 ,$15.76 ,$115.92 ,$32.38 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$34.08 ,$17.27 ,$14.39 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200297,86778,HC TOXOPLASMA AB IGM,302,1 ,$116.15 ,$76.66 ,$14.41 ,$116.15 ,$14.89 ,$50.44 ,$50.44 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$14.89 ,$14.89 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$14.89 ,$72.02 ,$15.78 ,$104.54 ,$32.42 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$15.78 ,$17.29 ,$17.29 ,$30.73 ,$17.29 ,$14.41 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200298,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$49.45 ,$32.64 ,$11.13 ,$49.45 ,$11.13 ,$46.34 ,$46.34 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 ,$11.13 ,$11.13 ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 ,$11.13 ,$30.66 ,$11.80 ,$44.51 ,$29.79 ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$11.25 ,$39.07 ,$11.80 ,$15.89 ,$15.89 ,$13.08 ,$15.89 ,$13.24 ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200299,86787,HC VARICELLA ZOSTER ATB,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$45.08 ,$45.08 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.17 ,$8.17 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.17 ,$55.62 ,$8.66 ,$80.73 ,$28.98 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$8.66 ,$15.46 ,$15.46 ,$23.74 ,$15.46 ,$12.88 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200301,86787,HC VARICELLA ZOSTER QN,302,1 ,$51.75 ,$34.16 ,$8.17 ,$51.75 ,$8.17 ,$45.08 ,$45.08 ,$13.69 ,$41.40 ,$43.99 ,$32.34 ,$46.58 ,$8.17 ,$8.17 ,$49.16 ,$46.58 ,$43.99 ,$43.99 ,$13.69 ,$43.99 ,$43.99 ,$46.58 ,$31.52 ,$8.17 ,$32.08 ,$8.66 ,$46.58 ,$28.98 ,$47.61 ,$46.58 ,$34.16 ,$34.16 ,$31.52 ,$34.16 ,$33.64 ,$35.36 ,$11.78 ,$40.88 ,$8.66 ,$15.46 ,$15.46 ,$13.69 ,$15.46 ,$12.88 ,$49.16 ,$42.44 ,$42.44 ,$41.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200303,86788,HC WEST NILE VIRUS AB IGM,302,1 ,$89.70 ,$59.20 ,$8.17 ,$89.70 ,$8.17 ,$58.98 ,$58.98 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.17 ,$8.17 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.17 ,$55.62 ,$8.66 ,$80.73 ,$37.91 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$8.66 ,$20.22 ,$20.22 ,$23.74 ,$20.22 ,$16.85 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200304,86789,HC WEST NILE AB,302,1 ,$103.50 ,$68.31 ,$14.39 ,$103.50 ,$14.87 ,$50.37 ,$50.37 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$14.87 ,$14.87 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$14.87 ,$64.18 ,$15.76 ,$93.15 ,$32.38 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$15.76 ,$17.27 ,$17.27 ,$27.39 ,$17.27 ,$14.39 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200305,86790,HC HTLV I/II AB,302,1 ,$89.70 ,$59.20 ,$12.88 ,$89.70 ,$18.68 ,$45.08 ,$45.08 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$18.68 ,$18.68 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$18.68 ,$55.62 ,$19.80 ,$80.73 ,$28.98 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$19.80 ,$15.46 ,$15.46 ,$23.74 ,$15.46 ,$12.88 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200306,86790,HC HHV6 IGM/IGG,302,1 ,$89.70 ,$59.20 ,$12.88 ,$89.70 ,$18.68 ,$45.08 ,$45.08 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$18.68 ,$18.68 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$18.68 ,$55.62 ,$19.80 ,$80.73 ,$28.98 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$19.80 ,$15.46 ,$15.46 ,$23.74 ,$15.46 ,$12.88 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200307,86790,HC HERPES VIRUS 7 IGM/IGG,302,1 ,$89.70 ,$59.20 ,$12.88 ,$89.70 ,$18.68 ,$45.08 ,$45.08 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$18.68 ,$18.68 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$18.68 ,$55.62 ,$19.80 ,$80.73 ,$28.98 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$19.80 ,$15.46 ,$15.46 ,$23.74 ,$15.46 ,$12.88 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200308,86790,HC HERPES VIRUS 8 IGM,302,1 ,$149.50 ,$98.67 ,$12.88 ,$149.50 ,$18.68 ,$45.08 ,$45.08 ,$39.56 ,$119.60 ,$127.08 ,$93.44 ,$134.55 ,$18.68 ,$18.68 ,$142.03 ,$134.55 ,$127.08 ,$127.08 ,$39.56 ,$127.08 ,$127.08 ,$134.55 ,$91.05 ,$18.68 ,$92.70 ,$19.80 ,$134.55 ,$28.98 ,$137.54 ,$134.55 ,$98.69 ,$98.69 ,$91.05 ,$98.69 ,$97.18 ,$102.14 ,$34.04 ,$118.11 ,$19.80 ,$15.46 ,$15.46 ,$39.56 ,$15.46 ,$12.88 ,$142.03 ,$122.59 ,$122.59 ,$119.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200310,86694,HC HSV IGM,302,1 ,$128.80 ,$85.01 ,$14.39 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.87 ,$14.87 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.87 ,$79.86 ,$15.76 ,$115.92 ,$32.38 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$34.08 ,$17.27 ,$14.39 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200312,86800,HC THYROGLOBULIN AB,302,1 ,$141.45 ,$93.36 ,$15.91 ,$141.45 ,$16.44 ,$55.69 ,$55.69 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$16.44 ,$16.44 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$16.44 ,$87.70 ,$17.43 ,$127.31 ,$35.80 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$17.43 ,$19.09 ,$19.09 ,$37.43 ,$19.09 ,$15.91 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200314,86803,HC HEP C AB,302,1 ,$128.80 ,$85.01 ,$14.27 ,$128.80 ,$14.75 ,$49.95 ,$49.95 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.75 ,$14.75 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.75 ,$79.86 ,$15.64 ,$115.92 ,$32.11 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.64 ,$17.12 ,$17.12 ,$34.08 ,$17.12 ,$14.27 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200316,86804,HC HEP C AB CONFIRM,302,1 ,$188.60 ,$124.48 ,$15.49 ,$188.60 ,$16.01 ,$54.22 ,$54.22 ,$49.90 ,$150.88 ,$160.31 ,$117.88 ,$169.74 ,$16.01 ,$16.01 ,$179.17 ,$169.74 ,$160.31 ,$160.31 ,$49.90 ,$160.31 ,$160.31 ,$169.74 ,$114.86 ,$16.01 ,$116.94 ,$16.97 ,$169.74 ,$34.85 ,$173.51 ,$169.74 ,$124.49 ,$124.49 ,$114.86 ,$124.49 ,$122.59 ,$128.85 ,$42.93 ,$148.99 ,$16.97 ,$18.59 ,$18.59 ,$49.90 ,$18.59 ,$15.49 ,$179.17 ,$154.65 ,$154.65 ,$150.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200319,86808,HC CYTOTOXIC PRA QUICK SCR,302,1 ,$71.30 ,$47.06 ,$16.23 ,$71.30 ,$30.67 ,$71.30 ,$71.30 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$30.67 ,$30.67 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$30.67 ,$44.20 ,$32.51 ,$64.17 ,$66.78 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 ,$16.23 ,$56.33 ,$32.51 ,$35.62 ,$35.62 ,$18.86 ,$35.62 ,$29.68 ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200322,86812,HC HLA TYPING SINGLE A/B/C,302,1 ,$270.25 ,$178.37 ,$25.81 ,$270.25 ,$26.67 ,$90.34 ,$90.34 ,$71.51 ,$216.20 ,$229.71 ,$168.91 ,$243.23 ,$26.67 ,$26.67 ,$256.74 ,$243.23 ,$229.71 ,$229.71 ,$71.51 ,$229.71 ,$229.71 ,$243.23 ,$164.58 ,$26.67 ,$167.56 ,$28.27 ,$243.23 ,$58.07 ,$248.63 ,$243.23 ,$178.39 ,$178.39 ,$164.58 ,$178.39 ,$175.66 ,$184.63 ,$61.52 ,$213.50 ,$28.27 ,$30.97 ,$30.97 ,$71.51 ,$30.97 ,$25.81 ,$256.74 ,$221.61 ,$221.61 ,$216.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200323,86813,HC HLA TYPING MULTI A/B/C,302,1 ,$678.50 ,$447.81 ,$58.00 ,$678.50 ,$59.93 ,$203.00 ,$203.00 ,$179.54 ,$542.80 ,$576.73 ,$424.06 ,$610.65 ,$59.93 ,$59.93 ,$644.58 ,$610.65 ,$576.73 ,$576.73 ,$179.54 ,$576.73 ,$576.73 ,$610.65 ,$413.21 ,$59.93 ,$420.68 ,$63.53 ,$610.65 ,$130.50 ,$624.22 ,$610.65 ,$447.88 ,$447.88 ,$413.21 ,$447.88 ,$441.03 ,$463.55 ,$154.47 ,$536.02 ,$63.53 ,$69.60 ,$69.60 ,$179.54 ,$69.60 ,$58.00 ,$644.58 ,$556.37 ,$556.37 ,$542.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200324,86849,HC IMMUNOASSAY UNLISTED (LEUKO),302,1 ,$71.30 ,$47.06 ,$18.68 ,$71.30 ,$18.68 ,$63.90 ,$63.90 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$18.68 ,$18.68 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$18.68 ,$44.20 ,$19.80 ,$64.17 ,$42.78 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 , N/A ,$56.33 ,$19.80 ,$34.94 ,$34.94 ,$18.86 ,$34.94 , N/A ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200327,86850,HC AB SCREEN,302,1 ,$90.00 ,$59.40 ,$5.38 ,$112.82 ,$5.38 ,$34.20 ,$34.20 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$5.38 ,$5.38 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$5.38 ,$55.80 ,$5.70 ,$81.00 ,$112.82 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$5.70 ,$11.72 ,$11.72 ,$23.81 ,$11.72 ,$50.14 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200329,86860,HC ELUTION,302,1 ,$146.00 ,$96.36 ,$33.24 ,$353.81 ,$260.58 ,$104.97 ,$104.97 ,$38.63 ,$116.80 ,$124.10 ,$91.25 ,$131.40 ,$260.58 ,$146.00 ,$138.70 ,$131.40 ,$124.10 ,$124.10 ,$38.63 ,$124.10 ,$124.10 ,$131.40 ,$88.91 ,$260.58 ,$90.52 ,$154.76 ,$131.40 ,$353.81 ,$134.32 ,$131.40 ,$96.37 ,$96.37 ,$88.91 ,$96.37 ,$94.90 ,$99.75 ,$33.24 ,$115.34 ,$276.21 ,$146.00 ,$146.00 ,$38.63 ,$146.00 ,$157.25 ,$138.70 ,$119.72 ,$119.72 ,$116.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200331,86870,HC RBC AB ID PANEL,302,1 ,$269.00 ,$177.54 ,$61.24 ,$729.25 ,$260.58 ,$143.76 ,$143.76 ,$71.18 ,$215.20 ,$228.65 ,$168.13 ,$242.10 ,$260.58 ,$260.58 ,$255.55 ,$242.10 ,$228.65 ,$228.65 ,$71.18 ,$228.65 ,$228.65 ,$242.10 ,$163.82 ,$260.58 ,$166.78 ,$276.21 ,$242.10 ,$729.25 ,$247.48 ,$242.10 ,$177.57 ,$177.57 ,$163.82 ,$177.57 ,$174.85 ,$183.78 ,$61.24 ,$212.51 ,$276.21 ,$269.00 ,$269.00 ,$71.18 ,$269.00 ,$324.11 ,$255.55 ,$220.58 ,$220.58 ,$215.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200334,86880,HC COOMBS DIRECT,302,1 ,$56.00 ,$36.96 ,$5.57 ,$129.33 ,$5.57 ,$18.87 ,$18.87 ,$14.82 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$5.57 ,$5.57 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$14.82 ,$47.60 ,$47.60 ,$50.40 ,$34.10 ,$5.57 ,$34.72 ,$5.90 ,$50.40 ,$129.33 ,$51.52 ,$50.40 ,$36.97 ,$36.97 ,$34.10 ,$36.97 ,$36.40 ,$38.26 ,$12.75 ,$44.24 ,$5.90 ,$6.47 ,$6.47 ,$14.82 ,$6.47 ,$57.48 ,$53.20 ,$45.92 ,$45.92 ,$44.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200338,86885,HC INDIRECT COOMBS,302,1 ,$80.00 ,$52.80 ,$5.91 ,$353.81 ,$5.91 ,$20.02 ,$20.02 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 ,$5.91 ,$5.91 ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 ,$5.91 ,$49.60 ,$6.26 ,$72.00 ,$353.81 ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 ,$6.26 ,$6.86 ,$6.86 ,$21.17 ,$6.86 ,$157.25 ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200340,86886,HC INDIRECT TITER,302,1 ,$67.00 ,$44.22 ,$5.35 ,$353.81 ,$5.35 ,$18.13 ,$18.13 ,$17.73 ,$53.60 ,$56.95 ,$41.88 ,$60.30 ,$5.35 ,$5.35 ,$63.65 ,$60.30 ,$56.95 ,$56.95 ,$17.73 ,$56.95 ,$56.95 ,$60.30 ,$40.80 ,$5.35 ,$41.54 ,$5.67 ,$60.30 ,$353.81 ,$61.64 ,$60.30 ,$44.23 ,$44.23 ,$40.80 ,$44.23 ,$43.55 ,$45.77 ,$15.25 ,$52.93 ,$5.67 ,$6.22 ,$6.22 ,$17.73 ,$6.22 ,$157.25 ,$63.65 ,$54.94 ,$54.94 ,$53.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200342,86890,HC AUTOLOGOUS PROCESSING FEE,302,1 ,$381.00 ,$251.46 ,$86.74 ,$381.00 ,$128.97 ,$330.88 ,$330.88 ,$100.81 ,$304.80 ,$323.85 ,$238.13 ,$342.90 ,$128.97 ,$128.97 ,$361.95 ,$342.90 ,$323.85 ,$323.85 ,$100.81 ,$323.85 ,$323.85 ,$342.90 ,$232.03 ,$128.97 ,$236.22 ,$136.71 ,$342.90 ,$353.81 ,$350.52 ,$342.90 ,$251.50 ,$251.50 ,$232.03 ,$251.50 ,$247.65 ,$260.30 ,$86.74 ,$300.99 ,$136.71 ,$172.20 ,$172.20 ,$100.81 ,$172.20 ,$157.25 ,$361.95 ,$312.42 ,$312.42 ,$304.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200344,86900,HC BLOOD TYPING ABO,302,1 ,$40.00 ,$26.40 ,$3.09 ,$261.25 ,$3.09 ,$10.47 ,$10.47 ,$10.58 ,$32.00 ,$34.00 ,$25.00 ,$36.00 ,$3.09 ,$3.09 ,$38.00 ,$36.00 ,$34.00 ,$34.00 ,$10.58 ,$34.00 ,$34.00 ,$36.00 ,$24.36 ,$3.09 ,$24.80 ,$3.28 ,$36.00 ,$261.25 ,$36.80 ,$36.00 ,$26.40 ,$26.40 ,$24.36 ,$26.40 ,$26.00 ,$27.33 ,$9.10 ,$31.60 ,$3.28 ,$3.59 ,$3.59 ,$10.58 ,$3.59 ,$116.11 ,$38.00 ,$32.80 ,$32.80 ,$32.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200346,86901,HC BLOOD TYPING RH,302,1 ,$44.00 ,$29.04 ,$3.09 ,$76.41 ,$3.09 ,$10.47 ,$10.47 ,$11.64 ,$35.20 ,$37.40 ,$27.50 ,$39.60 ,$3.09 ,$3.09 ,$41.80 ,$39.60 ,$37.40 ,$37.40 ,$11.64 ,$37.40 ,$37.40 ,$39.60 ,$26.80 ,$3.09 ,$27.28 ,$3.28 ,$39.60 ,$76.41 ,$40.48 ,$39.60 ,$29.04 ,$29.04 ,$26.80 ,$29.04 ,$28.60 ,$30.06 ,$10.02 ,$34.76 ,$3.28 ,$3.59 ,$3.59 ,$11.64 ,$3.59 ,$33.96 ,$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 ,$51.48 ,$5.37 ,$729.25 ,$5.37 ,$22.23 ,$22.23 ,$20.64 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$5.37 ,$5.37 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$20.64 ,$66.30 ,$66.30 ,$70.20 ,$47.50 ,$5.37 ,$48.36 ,$5.69 ,$70.20 ,$729.25 ,$71.76 ,$70.20 ,$51.49 ,$51.49 ,$47.50 ,$51.49 ,$50.70 ,$53.29 ,$17.76 ,$61.62 ,$5.69 ,$7.62 ,$7.62 ,$20.64 ,$7.62 ,$324.11 ,$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 ,$75.24 ,$5.37 ,$729.25 ,$5.37 ,$22.23 ,$22.23 ,$30.16 ,$91.20 ,$96.90 ,$71.25 ,$102.60 ,$5.37 ,$5.37 ,$108.30 ,$102.60 ,$96.90 ,$96.90 ,$30.16 ,$96.90 ,$96.90 ,$102.60 ,$69.43 ,$5.37 ,$70.68 ,$5.69 ,$102.60 ,$729.25 ,$104.88 ,$102.60 ,$75.25 ,$75.25 ,$69.43 ,$75.25 ,$74.10 ,$77.88 ,$25.95 ,$90.06 ,$5.69 ,$7.62 ,$7.62 ,$30.16 ,$7.62 ,$324.11 ,$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 ,$56.76 ,$13.37 ,$86.00 ,$13.37 ,$57.19 ,$57.19 ,$22.76 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$13.37 ,$13.37 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$22.76 ,$73.10 ,$73.10 ,$77.40 ,$52.37 ,$13.37 ,$53.32 ,$14.17 ,$77.40 ,$76.41 ,$79.12 ,$77.40 ,$56.77 ,$56.77 ,$52.37 ,$56.77 ,$55.90 ,$58.76 ,$19.58 ,$67.94 ,$14.17 ,$19.61 ,$19.61 ,$22.76 ,$19.61 ,$33.96 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200356,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$157.00 ,$103.62 ,$35.74 ,$353.81 ,$260.58 ,$116.38 ,$116.38 ,$41.54 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$260.58 ,$157.00 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$41.54 ,$133.45 ,$133.45 ,$141.30 ,$95.61 ,$260.58 ,$97.34 ,$166.42 ,$141.30 ,$353.81 ,$144.44 ,$141.30 ,$103.64 ,$103.64 ,$95.61 ,$103.64 ,$102.05 ,$107.26 ,$35.74 ,$124.03 ,$276.21 ,$157.00 ,$157.00 ,$41.54 ,$157.00 ,$157.25 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200360,86922,HC CROSSMATCH AHG,302,1 ,$157.00 ,$103.62 ,$35.74 ,$353.81 ,$260.58 ,$124.37 ,$124.37 ,$41.54 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$260.58 ,$157.00 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$41.54 ,$133.45 ,$133.45 ,$141.30 ,$95.61 ,$260.58 ,$97.34 ,$166.42 ,$141.30 ,$353.81 ,$144.44 ,$141.30 ,$103.64 ,$103.64 ,$95.61 ,$103.64 ,$102.05 ,$107.26 ,$35.74 ,$124.03 ,$276.21 ,$157.00 ,$157.00 ,$41.54 ,$157.00 ,$157.25 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200362,86923,HC CROSSMATCH ELECTRONIC,302,1 ,$157.00 ,$103.62 ,$35.74 ,$353.81 ,$260.58 ,$93.56 ,$93.56 ,$41.54 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$260.58 ,$157.00 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$41.54 ,$133.45 ,$133.45 ,$141.30 ,$95.61 ,$260.58 ,$97.34 ,$166.42 ,$141.30 ,$353.81 ,$144.44 ,$141.30 ,$103.64 ,$103.64 ,$95.61 ,$103.64 ,$102.05 ,$107.26 ,$35.74 ,$124.03 ,$276.21 ,$157.00 ,$157.00 ,$41.54 ,$157.00 ,$157.25 ,$149.15 ,$128.74 ,$128.74 ,$125.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200363,86927,HC FFP THAWING EACH UNIT,302,1 ,$168.00 ,$110.88 ,$38.25 ,$353.81 ,$128.97 ,$66.18 ,$66.18 ,$44.45 ,$134.40 ,$142.80 ,$105.00 ,$151.20 ,$128.97 ,$128.97 ,$159.60 ,$151.20 ,$142.80 ,$142.80 ,$44.45 ,$142.80 ,$142.80 ,$151.20 ,$102.31 ,$128.97 ,$104.16 ,$136.71 ,$151.20 ,$353.81 ,$154.56 ,$151.20 ,$110.90 ,$110.90 ,$102.31 ,$110.90 ,$109.20 ,$114.78 ,$38.25 ,$132.72 ,$136.71 ,$168.00 ,$168.00 ,$44.45 ,$168.00 ,$157.25 ,$159.60 ,$137.76 ,$137.76 ,$134.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200364,86940,HC HEOLYSIN AGG AUTO SCREEN,302,1 ,$96.00 ,$63.36 ,$8.77 ,$96.00 ,$9.06 ,$30.70 ,$30.70 ,$25.40 ,$76.80 ,$81.60 ,$60.00 ,$86.40 ,$9.06 ,$9.06 ,$91.20 ,$86.40 ,$81.60 ,$81.60 ,$25.40 ,$81.60 ,$81.60 ,$86.40 ,$58.46 ,$9.06 ,$59.52 ,$9.60 ,$86.40 ,$19.73 ,$88.32 ,$86.40 ,$63.37 ,$63.37 ,$58.46 ,$63.37 ,$62.40 ,$65.59 ,$21.85 ,$75.84 ,$9.60 ,$10.52 ,$10.52 ,$25.40 ,$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 ,$75.90 ,$26.18 ,$136.71 ,$128.97 ,$96.98 ,$96.98 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$128.97 ,$115.00 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 ,$128.97 ,$71.30 ,$121.90 ,$103.50 ,$76.41 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 ,$136.71 ,$40.12 ,$40.12 ,$30.43 ,$40.12 ,$33.96 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200368,86965,HC BLOOD PRODUCT POOL,302,1 ,$127.00 ,$83.82 ,$28.91 ,$353.81 ,$128.97 ,$108.39 ,$108.39 ,$33.60 ,$101.60 ,$107.95 ,$79.38 ,$114.30 ,$128.97 ,$127.00 ,$120.65 ,$114.30 ,$107.95 ,$107.95 ,$33.60 ,$107.95 ,$107.95 ,$114.30 ,$77.34 ,$128.97 ,$78.74 ,$134.62 ,$114.30 ,$353.81 ,$116.84 ,$114.30 ,$83.83 ,$83.83 ,$77.34 ,$83.83 ,$82.55 ,$86.77 ,$28.91 ,$100.33 ,$136.71 ,$127.00 ,$127.00 ,$33.60 ,$127.00 ,$157.25 ,$120.65 ,$104.14 ,$104.14 ,$101.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200373,86403,HC PARTICLE AGG SCREEN (HAEMOPHILUS OR NEISSERIA),302,1 ,$132.25 ,$87.29 ,$11.54 ,$132.25 ,$11.92 ,$40.39 ,$40.39 ,$35.00 ,$105.80 ,$112.41 ,$82.66 ,$119.03 ,$11.92 ,$11.92 ,$125.64 ,$119.03 ,$112.41 ,$112.41 ,$35.00 ,$112.41 ,$112.41 ,$119.03 ,$80.54 ,$11.92 ,$82.00 ,$12.64 ,$119.03 ,$25.97 ,$121.67 ,$119.03 ,$87.30 ,$87.30 ,$80.54 ,$87.30 ,$85.96 ,$90.35 ,$30.11 ,$104.48 ,$12.64 ,$13.85 ,$13.85 ,$35.00 ,$13.85 ,$11.54 ,$125.64 ,$108.45 ,$108.45 ,$105.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200375,86880,HC C3 DIRECT COOMBS,302,1 ,$52.00 ,$34.32 ,$5.57 ,$129.33 ,$5.57 ,$18.87 ,$18.87 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 ,$5.57 ,$5.57 ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 ,$5.57 ,$32.24 ,$5.90 ,$46.80 ,$129.33 ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 ,$5.90 ,$6.47 ,$6.47 ,$13.76 ,$6.47 ,$57.48 ,$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 ,"$1,043.05 ",$688.41 ,$139.23 ,"$1,043.05 ",$139.23 ,"$1,043.05 ","$1,043.05 ",$275.99 ,$834.44 ,$886.59 ,$651.91 ,$938.75 ,$139.23 ,$139.23 ,$990.90 ,$938.75 ,$886.59 ,$886.59 ,$275.99 ,$886.59 ,$886.59 ,$938.75 ,$635.22 ,$139.23 ,$646.70 ,$147.58 ,$938.75 ,$728.44 ,$959.61 ,$938.75 ,$688.52 ,$688.52 ,$635.22 ,$688.52 ,$677.98 ,$712.61 ,$237.45 ,$824.01 ,$147.58 ,$388.50 ,$388.50 ,$275.99 ,$388.50 ,$323.75 ,$990.90 ,$855.30 ,$855.30 ,$834.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200448,86757,HC RICKETTSIA IGG,302,1 ,$128.80 ,$85.01 ,$19.35 ,$128.80 ,$19.99 ,$67.73 ,$67.73 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$19.99 ,$19.99 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$19.99 ,$79.86 ,$21.19 ,$115.92 ,$43.54 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$21.19 ,$23.22 ,$23.22 ,$34.08 ,$23.22 ,$19.35 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200449,86757,HC RICKETTSIA IGM,302,1 ,$128.80 ,$85.01 ,$19.35 ,$128.80 ,$19.99 ,$67.73 ,$67.73 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$19.99 ,$19.99 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$19.99 ,$79.86 ,$21.19 ,$115.92 ,$43.54 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$21.19 ,$23.22 ,$23.22 ,$34.08 ,$23.22 ,$19.35 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200450,86635,HC COCCID AB IGG/IGM,302,1 ,$157.55 ,$103.98 ,$8.17 ,$157.55 ,$8.17 ,$40.15 ,$40.15 ,$41.69 ,$126.04 ,$133.92 ,$98.47 ,$141.80 ,$8.17 ,$8.17 ,$149.67 ,$141.80 ,$133.92 ,$133.92 ,$41.69 ,$133.92 ,$133.92 ,$141.80 ,$95.95 ,$8.17 ,$97.68 ,$8.66 ,$141.80 ,$25.81 ,$144.95 ,$141.80 ,$104.00 ,$104.00 ,$95.95 ,$104.00 ,$102.41 ,$107.64 ,$35.87 ,$124.46 ,$8.66 ,$13.76 ,$13.76 ,$41.69 ,$13.76 ,$11.47 ,$149.67 ,$129.19 ,$129.19 ,$126.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200460,86038,HC ANA CENTROMERE B AB,302,1 ,$89.70 ,$59.20 ,$12.09 ,$89.70 ,$12.49 ,$42.32 ,$42.32 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$12.49 ,$12.49 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$12.49 ,$55.62 ,$13.24 ,$80.73 ,$27.20 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$13.24 ,$14.51 ,$14.51 ,$23.74 ,$14.51 ,$12.09 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200500,87804,HC INFLUENZA ASSAY W/OPTIC,302,1 ,$116.15 ,$76.66 ,$16.55 ,$116.15 ,$16.86 ,$57.93 ,$57.93 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$16.86 ,$16.86 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$16.86 ,$72.02 ,$17.87 ,$104.54 ,$37.24 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$17.87 ,$19.86 ,$19.86 ,$30.73 ,$19.86 ,$16.55 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200501,86682,HC HELMINTH ANTIBODY,302,1 ,$184.00 ,$121.44 ,$8.17 ,$184.00 ,$8.17 ,$45.54 ,$45.54 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 ,$8.17 ,$8.17 ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 ,$8.17 ,$114.08 ,$8.66 ,$165.60 ,$29.27 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 ,$8.66 ,$15.61 ,$15.61 ,$48.69 ,$15.61 ,$13.01 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200502,87272,HC CRYPTOSPORIDIUM,302,1 ,$116.15 ,$76.66 ,$11.98 ,$116.15 ,$12.38 ,$41.93 ,$41.93 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$12.38 ,$12.38 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$12.38 ,$72.02 ,$13.12 ,$104.54 ,$26.96 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$13.12 ,$14.38 ,$14.38 ,$30.73 ,$14.38 ,$11.98 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200511,86226,HC DNA SINGLE STRAND AB,302,1 ,$132.25 ,$87.29 ,$12.11 ,$132.25 ,$12.51 ,$42.39 ,$42.39 ,$35.00 ,$105.80 ,$112.41 ,$82.66 ,$119.03 ,$12.51 ,$12.51 ,$125.64 ,$119.03 ,$112.41 ,$112.41 ,$35.00 ,$112.41 ,$112.41 ,$119.03 ,$80.54 ,$12.51 ,$82.00 ,$13.26 ,$119.03 ,$27.25 ,$121.67 ,$119.03 ,$87.30 ,$87.30 ,$80.54 ,$87.30 ,$85.96 ,$90.35 ,$30.11 ,$104.48 ,$13.26 ,$14.53 ,$14.53 ,$35.00 ,$14.53 ,$12.11 ,$125.64 ,$108.45 ,$108.45 ,$105.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200513,86256,HC FLUOR AB TITER,302,1 ,$98.90 ,$65.27 ,$12.05 ,$98.90 ,$12.45 ,$42.18 ,$42.18 ,$26.17 ,$79.12 ,$84.07 ,$61.81 ,$89.01 ,$12.45 ,$12.45 ,$93.96 ,$89.01 ,$84.07 ,$84.07 ,$26.17 ,$84.07 ,$84.07 ,$89.01 ,$60.23 ,$12.45 ,$61.32 ,$13.20 ,$89.01 ,$27.11 ,$90.99 ,$89.01 ,$65.28 ,$65.28 ,$60.23 ,$65.28 ,$64.29 ,$67.57 ,$22.52 ,$78.13 ,$13.20 ,$14.46 ,$14.46 ,$26.17 ,$14.46 ,$12.05 ,$93.96 ,$81.10 ,$81.10 ,$79.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200540,86701,HC HIV-1 AB,302,1 ,$103.50 ,$68.31 ,$8.89 ,$103.50 ,$9.19 ,$31.12 ,$31.12 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$9.19 ,$9.19 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$9.19 ,$64.18 ,$9.74 ,$93.15 ,$20.00 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$9.74 ,$10.67 ,$10.67 ,$27.39 ,$10.67 ,$8.89 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200541,86702,HC HIV-2 AB,302,1 ,$103.50 ,$68.31 ,$13.52 ,$103.50 ,$13.97 ,$47.32 ,$47.32 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$13.97 ,$13.97 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$13.97 ,$64.18 ,$14.81 ,$93.15 ,$30.42 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$14.81 ,$16.22 ,$16.22 ,$27.39 ,$16.22 ,$13.52 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200577,86481,HC TB ANTIGEN RESPONSE GAMMA INTER T-CELL SUSP,302,1 ,$540.50 ,$356.73 ,$90.12 ,$540.50 ,$90.12 ,$350.00 ,$350.00 ,$143.02 ,$432.40 ,$459.43 ,$337.81 ,$486.45 ,$90.12 ,$90.12 ,$513.48 ,$486.45 ,$459.43 ,$459.43 ,$143.02 ,$459.43 ,$459.43 ,$486.45 ,$329.16 ,$90.12 ,$335.12 ,$95.53 ,$486.45 ,$225.00 ,$497.26 ,$486.45 ,$356.78 ,$356.78 ,$329.16 ,$356.78 ,$351.33 ,$369.27 ,$123.05 ,$427.00 ,$95.53 ,$120.00 ,$120.00 ,$143.02 ,$120.00 ,$100.00 ,$513.48 ,$443.21 ,$443.21 ,$432.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200582,86382,HC RABIES VACCINE RESPONSE TTR,302,1 ,$180.55 ,$119.16 ,$16.91 ,$180.55 ,$17.47 ,$59.19 ,$59.19 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$17.47 ,$17.47 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$17.47 ,$111.94 ,$18.52 ,$162.50 ,$38.05 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$18.52 ,$20.29 ,$20.29 ,$47.77 ,$20.29 ,$16.91 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200583,86382,HC POLIOVIRUS AB NEUTRALIZATION,302,1 ,$50.60 ,$33.40 ,$11.52 ,$50.60 ,$17.47 ,$50.60 ,$50.60 ,$13.39 ,$40.48 ,$43.01 ,$31.63 ,$45.54 ,$17.47 ,$17.47 ,$48.07 ,$45.54 ,$43.01 ,$43.01 ,$13.39 ,$43.01 ,$43.01 ,$45.54 ,$30.82 ,$17.47 ,$31.38 ,$18.52 ,$45.54 ,$38.05 ,$46.55 ,$45.54 ,$33.40 ,$33.40 ,$30.82 ,$33.40 ,$32.89 ,$34.57 ,$11.52 ,$39.97 ,$18.52 ,$20.29 ,$20.29 ,$13.39 ,$20.29 ,$16.91 ,$48.07 ,$41.49 ,$41.49 ,$40.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200584,86658,HC ENTEROVIRUS PANEL CF SERUM,302,1 ,$167.90 ,$110.81 ,$8.17 ,$167.90 ,$8.17 ,$45.61 ,$45.61 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$8.17 ,$8.17 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$8.17 ,$104.10 ,$8.66 ,$151.11 ,$29.32 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$8.66 ,$15.64 ,$15.64 ,$44.42 ,$15.64 ,$13.03 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200585,86800,HC THYROGLOBULIN AB CANCER MONITORING,302,1 ,$57.50 ,$37.95 ,$13.09 ,$57.50 ,$16.44 ,$55.69 ,$55.69 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$16.44 ,$16.44 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$16.44 ,$35.66 ,$17.43 ,$51.75 ,$35.80 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$17.43 ,$19.09 ,$19.09 ,$15.22 ,$19.09 ,$15.91 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200586,86790,HC VIRUS AB DENGUE FEVER IGG/IGMA,302,1 ,$128.80 ,$85.01 ,$12.88 ,$128.80 ,$18.68 ,$45.08 ,$45.08 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$18.68 ,$18.68 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$18.68 ,$79.86 ,$19.80 ,$115.92 ,$28.98 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$19.80 ,$15.46 ,$15.46 ,$34.08 ,$15.46 ,$12.88 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200587,86753,HC PROTOZOA AB ENTAMOEBA HISTOLYTICA IGG,302,1 ,$109.25 ,$72.11 ,$8.17 ,$109.25 ,$8.17 ,$43.37 ,$43.37 ,$28.91 ,$87.40 ,$92.86 ,$68.28 ,$98.33 ,$8.17 ,$8.17 ,$103.79 ,$98.33 ,$92.86 ,$92.86 ,$28.91 ,$92.86 ,$92.86 ,$98.33 ,$66.53 ,$8.17 ,$67.74 ,$8.66 ,$98.33 ,$27.88 ,$100.51 ,$98.33 ,$72.12 ,$72.12 ,$66.53 ,$72.12 ,$71.01 ,$74.64 ,$24.87 ,$86.31 ,$8.66 ,$14.87 ,$14.87 ,$28.91 ,$14.87 ,$12.39 ,$103.79 ,$89.59 ,$89.59 ,$87.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200822,86705,HC HEP B CORE IGM,302,1 ,$193.20 ,$127.51 ,$11.77 ,$193.20 ,$12.16 ,$41.20 ,$41.20 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$12.16 ,$12.16 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$12.16 ,$119.78 ,$12.89 ,$173.88 ,$26.48 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$12.89 ,$14.12 ,$14.12 ,$51.12 ,$14.12 ,$11.77 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200824,86644,HC CMV AB,302,1 ,$128.80 ,$85.01 ,$14.39 ,$128.80 ,$14.87 ,$50.37 ,$50.37 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.87 ,$14.87 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.87 ,$79.86 ,$15.76 ,$115.92 ,$32.38 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.76 ,$17.27 ,$17.27 ,$34.08 ,$17.27 ,$14.39 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200825,86671,HC FUNGUS AB NOS 2-REF,302,1 ,$59.80 ,$39.47 ,$7.15 ,$59.80 ,$7.15 ,$42.88 ,$42.88 ,$15.83 ,$47.84 ,$50.83 ,$37.38 ,$53.82 ,$7.15 ,$7.15 ,$56.81 ,$53.82 ,$50.83 ,$50.83 ,$15.83 ,$50.83 ,$50.83 ,$53.82 ,$36.42 ,$7.15 ,$37.08 ,$7.58 ,$53.82 ,$27.56 ,$55.02 ,$53.82 ,$39.47 ,$39.47 ,$36.42 ,$39.47 ,$38.87 ,$40.86 ,$13.61 ,$47.24 ,$7.58 ,$14.70 ,$14.70 ,$15.83 ,$14.70 ,$12.25 ,$56.81 ,$49.04 ,$49.04 ,$47.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200830,87801,HC INFECT MLT  ORG AMP,302,1 ,$618.70 ,$408.34 ,$50.62 ,$618.70 ,$50.62 ,$245.70 ,$245.70 ,$163.71 ,$494.96 ,$525.90 ,$386.69 ,$556.83 ,$50.62 ,$50.62 ,$587.77 ,$556.83 ,$525.90 ,$525.90 ,$163.71 ,$525.90 ,$525.90 ,$556.83 ,$376.79 ,$50.62 ,$383.60 ,$53.66 ,$556.83 ,$157.95 ,$569.20 ,$556.83 ,$408.40 ,$408.40 ,$376.79 ,$408.40 ,$402.16 ,$422.70 ,$140.85 ,$488.77 ,$53.66 ,$84.24 ,$84.24 ,$163.71 ,$84.24 ,$70.20 ,$587.77 ,$507.33 ,$507.33 ,$494.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200833,86406,HC STREPTOZYME TITER,302,1 ,$88.55 ,$58.44 ,$9.85 ,$88.55 ,$9.85 ,$37.24 ,$37.24 ,$23.43 ,$70.84 ,$75.27 ,$55.34 ,$79.70 ,$9.85 ,$9.85 ,$84.12 ,$79.70 ,$75.27 ,$75.27 ,$23.43 ,$75.27 ,$75.27 ,$79.70 ,$53.93 ,$9.85 ,$54.90 ,$10.44 ,$79.70 ,$23.94 ,$81.47 ,$79.70 ,$58.45 ,$58.45 ,$53.93 ,$58.45 ,$57.56 ,$60.50 ,$20.16 ,$69.95 ,$10.44 ,$12.77 ,$12.77 ,$23.43 ,$12.77 ,$10.64 ,$84.12 ,$72.61 ,$72.61 ,$70.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200835,86790,HC HANTAVIRUS (SIN NOMBRE) ELISA,302,1 ,$78.20 ,$51.61 ,$12.88 ,$78.20 ,$18.68 ,$45.08 ,$45.08 ,$20.69 ,$62.56 ,$66.47 ,$48.88 ,$70.38 ,$18.68 ,$18.68 ,$74.29 ,$70.38 ,$66.47 ,$66.47 ,$20.69 ,$66.47 ,$66.47 ,$70.38 ,$47.62 ,$18.68 ,$48.48 ,$19.80 ,$70.38 ,$28.98 ,$71.94 ,$70.38 ,$51.62 ,$51.62 ,$47.62 ,$51.62 ,$50.83 ,$53.43 ,$17.81 ,$61.78 ,$19.80 ,$15.46 ,$15.46 ,$20.69 ,$15.46 ,$12.88 ,$74.29 ,$64.12 ,$64.12 ,$62.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200836,86790,HC HANTAVIRUS (SIN NOMBRE) IGG,302,1 ,$138.00 ,$91.08 ,$12.88 ,$138.00 ,$18.68 ,$45.08 ,$45.08 ,$36.51 ,$110.40 ,$117.30 ,$86.25 ,$124.20 ,$18.68 ,$18.68 ,$131.10 ,$124.20 ,$117.30 ,$117.30 ,$36.51 ,$117.30 ,$117.30 ,$124.20 ,$84.04 ,$18.68 ,$85.56 ,$19.80 ,$124.20 ,$28.98 ,$126.96 ,$124.20 ,$91.09 ,$91.09 ,$84.04 ,$91.09 ,$89.70 ,$94.28 ,$31.42 ,$109.02 ,$19.80 ,$15.46 ,$15.46 ,$36.51 ,$15.46 ,$12.88 ,$131.10 ,$113.16 ,$113.16 ,$110.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200837,86790,HC HANTAVIRUS (SIN NOMBRE) IGM,302,1 ,$78.20 ,$51.61 ,$12.88 ,$78.20 ,$18.68 ,$45.08 ,$45.08 ,$20.69 ,$62.56 ,$66.47 ,$48.88 ,$70.38 ,$18.68 ,$18.68 ,$74.29 ,$70.38 ,$66.47 ,$66.47 ,$20.69 ,$66.47 ,$66.47 ,$70.38 ,$47.62 ,$18.68 ,$48.48 ,$19.80 ,$70.38 ,$28.98 ,$71.94 ,$70.38 ,$51.62 ,$51.62 ,$47.62 ,$51.62 ,$50.83 ,$53.43 ,$17.81 ,$61.78 ,$19.80 ,$15.46 ,$15.46 ,$20.69 ,$15.46 ,$12.88 ,$74.29 ,$64.12 ,$64.12 ,$62.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30200841,86671,HC FUNGUS AB SACC CEREVISIAE,302,1 ,$169.05 ,$111.57 ,$7.15 ,$169.05 ,$7.15 ,$42.88 ,$42.88 ,$44.73 ,$135.24 ,$143.69 ,$105.66 ,$152.15 ,$7.15 ,$7.15 ,$160.60 ,$152.15 ,$143.69 ,$143.69 ,$44.73 ,$143.69 ,$143.69 ,$152.15 ,$102.95 ,$7.15 ,$104.82 ,$7.58 ,$152.15 ,$27.56 ,$155.53 ,$152.15 ,$111.59 ,$111.59 ,$102.95 ,$111.59 ,$109.88 ,$115.50 ,$38.48 ,$133.55 ,$7.58 ,$14.70 ,$14.70 ,$44.73 ,$14.70 ,$12.25 ,$160.60 ,$138.62 ,$138.62 ,$135.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201069,86711,HC AB JOHN CUNNINGHAM VIRUS,302,1 ,"$2,060.80 ","$1,360.13 ",$15.79 ,"$2,060.80 ",$15.79 ,$59.12 ,$59.12 ,$545.29 ,"$1,648.64 ","$1,751.68 ","$1,288.00 ","$1,854.72 ",$15.79 ,$15.79 ,"$1,957.76 ","$1,854.72 ","$1,751.68 ","$1,751.68 ",$545.29 ,"$1,751.68 ","$1,751.68 ","$1,854.72 ","$1,255.03 ",$15.79 ,"$1,277.70 ",$16.74 ,"$1,854.72 ",$38.00 ,"$1,895.94 ","$1,854.72 ","$1,360.33 ","$1,360.33 ","$1,255.03 ","$1,360.33 ","$1,339.52 ","$1,407.94 ",$469.15 ,"$1,628.03 ",$16.74 ,$20.27 ,$20.27 ,$545.29 ,$20.27 ,$16.89 ,"$1,957.76 ","$1,689.86 ","$1,689.86 ","$1,648.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30201070,86711,HC AB JOHN CUNNINGHAM VIRUS INHIBITION ASSAY,302,1 ,$807.30 ,$532.82 ,$15.79 ,$807.30 ,$15.79 ,$59.12 ,$59.12 ,$213.61 ,$645.84 ,$686.21 ,$504.56 ,$726.57 ,$15.79 ,$15.79 ,$766.94 ,$726.57 ,$686.21 ,$686.21 ,$213.61 ,$686.21 ,$686.21 ,$726.57 ,$491.65 ,$15.79 ,$500.52 ,$16.74 ,$726.57 ,$38.00 ,$742.72 ,$726.57 ,$532.90 ,$532.90 ,$491.65 ,$532.90 ,$524.75 ,$551.55 ,$183.79 ,$637.77 ,$16.74 ,$20.27 ,$20.27 ,$213.61 ,$20.27 ,$16.89 ,$766.94 ,$661.99 ,$661.99 ,$645.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201080,G0472,HC HEPATITIS C SCREEN HIGH RISK,302,1 ,$124.20 ,$81.97 ,$28.28 ,$124.20 ,$62.01 ,$124.20 ,$124.20 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$62.01 ,$62.01 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$62.01 ,$77.00 ,$65.73 ,$111.78 ,$104.29 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$65.73 ,$55.62 ,$55.62 ,$32.86 ,$55.62 ,$46.35 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201081,86695,HC HERPES SIMPLEX IGM I,302,1 ,$116.15 ,$76.66 ,$13.19 ,$116.15 ,$13.63 ,$46.17 ,$46.17 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$13.63 ,$13.63 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$13.63 ,$72.02 ,$14.45 ,$104.54 ,$29.68 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$14.45 ,$15.83 ,$15.83 ,$30.73 ,$15.83 ,$13.19 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201082,86696,HC HERPES SIMPLEX IGM II,302,1 ,$167.90 ,$110.81 ,$19.35 ,$167.90 ,$19.99 ,$67.73 ,$67.73 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$19.99 ,$19.99 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$19.99 ,$104.10 ,$21.19 ,$151.11 ,$43.54 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$21.19 ,$23.22 ,$23.22 ,$44.42 ,$23.22 ,$19.35 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201085,86481,HC TSPOT TB AG RESPONSE GAMMA INTER T-CELL SUSP,302,1 ,$334.65 ,$220.87 ,$76.19 ,$334.65 ,$90.12 ,$334.65 ,$334.65 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$90.12 ,$90.12 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$90.12 ,$207.48 ,$95.53 ,$301.19 ,$225.00 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$95.53 ,$120.00 ,$120.00 ,$88.55 ,$120.00 ,$100.00 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201087,86317,HC INFECTIOUS STREPTOCOCCUS PNEUMONIAE EA AB,302,1 ,$103.50 ,$68.31 ,$14.99 ,$103.50 ,$15.49 ,$52.47 ,$52.47 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$15.49 ,$15.49 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$15.49 ,$64.18 ,$16.42 ,$93.15 ,$33.73 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$16.42 ,$17.99 ,$17.99 ,$27.39 ,$17.99 ,$14.99 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201090,86780,HC TREPONEMA P AB SCREEN,302,1 ,$49.45 ,$32.64 ,$11.13 ,$49.45 ,$11.13 ,$46.34 ,$46.34 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 ,$11.13 ,$11.13 ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 ,$11.13 ,$30.66 ,$11.80 ,$44.51 ,$29.79 ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$11.25 ,$39.07 ,$11.80 ,$15.89 ,$15.89 ,$13.08 ,$15.89 ,$13.24 ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201158,86255,HC FLUOR AB SCR CYTOP/NEURONAL AB,302,1 ,$161.00 ,$106.26 ,$12.05 ,$161.00 ,$12.45 ,$42.18 ,$42.18 ,$42.60 ,$128.80 ,$136.85 ,$100.63 ,$144.90 ,$12.45 ,$12.45 ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$42.60 ,$136.85 ,$136.85 ,$144.90 ,$98.05 ,$12.45 ,$99.82 ,$13.20 ,$144.90 ,$27.11 ,$148.12 ,$144.90 ,$106.28 ,$106.28 ,$98.05 ,$106.28 ,$104.65 ,$110.00 ,$36.65 ,$127.19 ,$13.20 ,$14.46 ,$14.46 ,$42.60 ,$14.46 ,$12.05 ,$152.95 ,$132.02 ,$132.02 ,$128.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201182,86255,HC FLUOR AB SCR (CRITHIDIA TITER W/REFLEX)-REF,302,1 ,$20.70 ,$13.66 ,$4.71 ,$27.11 ,$12.45 ,$20.70 ,$20.70 ,$5.48 ,$16.56 ,$17.60 ,$12.94 ,$18.63 ,$12.45 ,$12.45 ,$19.67 ,$18.63 ,$17.60 ,$17.60 ,$5.48 ,$17.60 ,$17.60 ,$18.63 ,$12.61 ,$12.45 ,$12.84 ,$13.20 ,$18.63 ,$27.11 ,$19.04 ,$18.63 ,$13.66 ,$13.66 ,$12.61 ,$13.66 ,$13.46 ,$14.14 ,$4.71 ,$16.35 ,$13.20 ,$14.46 ,$14.46 ,$5.48 ,$14.46 ,$12.05 ,$19.67 ,$16.97 ,$16.97 ,$16.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201183,86015,HC ACTIN SMOOTH MUSCLE ANTIBODY EACH-REF,302,1 ,$76.03 ,$50.18 ,$11.91 ,$76.03 ,$11.91 ,$40.36 ,$40.36 ,$20.12 ,$60.82 ,$64.63 ,$47.52 ,$68.43 ,$11.91 ,$11.91 ,$72.23 ,$68.43 ,$64.63 ,$64.63 ,$20.12 ,$64.63 ,$64.63 ,$68.43 ,$46.30 ,$11.91 ,$47.14 ,$12.62 ,$68.43 ,$27.11 ,$69.95 ,$68.43 ,$50.19 ,$50.19 ,$46.30 ,$50.19 ,$49.42 ,$51.94 ,$17.31 ,$60.06 ,$12.62 ,$37.25 ,$37.25 ,$20.12 ,$37.25 ,$12.05 ,$72.23 ,$62.34 ,$62.34 ,$60.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201236,86596,HC VOLTAGE GTG CALC CHNL- REF,302,1 ,$57.75 ,$38.12 ,$12.05 ,$57.75 ,$12.05 ,$57.75 ,$57.75 ,$15.28 ,$46.20 ,$49.09 ,$36.09 ,$51.98 ,$12.05 ,$12.05 ,$54.86 ,$51.98 ,$49.09 ,$49.09 ,$15.28 ,$49.09 ,$49.09 ,$51.98 ,$35.17 ,$12.05 ,$35.80 ,$12.77 ,$51.98 ,$27.11 ,$53.13 ,$51.98 ,$38.12 ,$38.12 ,$35.17 ,$38.12 ,$37.54 ,$39.45 ,$13.14 ,$45.62 ,$12.77 ,$28.30 ,$28.30 ,$15.28 ,$28.30 ,$12.05 ,$54.86 ,$47.36 ,$47.36 ,$46.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201239,86596,HC VOLTAGE-GTD CA CHNL ANTB EA-REF,302,1 ,$283.50 ,$187.11 ,$12.05 ,$283.50 ,$12.05 ,$64.40 ,$64.40 ,$75.02 ,$226.80 ,$240.98 ,$177.19 ,$255.15 ,$12.05 ,$12.05 ,$269.33 ,$255.15 ,$240.98 ,$240.98 ,$75.02 ,$240.98 ,$240.98 ,$255.15 ,$172.65 ,$12.05 ,$175.78 ,$12.77 ,$255.15 ,$27.11 ,$260.82 ,$255.15 ,$187.14 ,$187.14 ,$172.65 ,$187.14 ,$184.28 ,$193.69 ,$64.54 ,$223.97 ,$12.77 ,$138.92 ,$138.92 ,$75.02 ,$138.92 ,$12.05 ,$269.33 ,$232.47 ,$232.47 ,$226.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201243,86317,HC INFECTIOUS AB QN,302,1 ,$128.80 ,$85.01 ,$14.99 ,$128.80 ,$15.49 ,$52.47 ,$52.47 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$15.49 ,$15.49 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$15.49 ,$79.86 ,$16.42 ,$115.92 ,$33.73 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$16.42 ,$17.99 ,$17.99 ,$34.08 ,$17.99 ,$14.99 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201244,86052,HC AQUAPORIN 4,302,1 ,$385.00 ,$254.10 ,$12.05 ,$385.00 ,$12.05 ,$42.18 ,$42.18 ,$101.87 ,$308.00 ,$327.25 ,$240.63 ,$346.50 ,$12.05 ,$12.05 ,$365.75 ,$346.50 ,$327.25 ,$327.25 ,$101.87 ,$327.25 ,$327.25 ,$346.50 ,$234.47 ,$12.05 ,$238.70 ,$12.77 ,$346.50 ,$27.11 ,$354.20 ,$346.50 ,$254.14 ,$254.14 ,$234.47 ,$254.14 ,$250.25 ,$263.03 ,$87.65 ,$304.15 ,$12.77 ,$188.65 ,$188.65 ,$101.87 ,$188.65 ,$12.05 ,$365.75 ,$315.70 ,$315.70 ,$308.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201247,86231,HC EMA EACH IG CLASS,302,1 ,$38.08 ,$25.13 ,$8.67 ,$38.08 ,$12.05 ,$38.08 ,$38.08 ,$10.07 ,$30.46 ,$32.37 ,$23.80 ,$34.27 ,$12.05 ,$12.05 ,$36.18 ,$34.27 ,$32.37 ,$32.37 ,$10.07 ,$32.37 ,$32.37 ,$34.27 ,$23.19 ,$12.05 ,$23.60 ,$12.77 ,$34.27 ,$27.20 ,$35.03 ,$34.27 ,$25.14 ,$25.14 ,$23.19 ,$25.14 ,$24.75 ,$26.02 ,$8.67 ,$30.08 ,$12.77 ,$18.66 ,$18.66 ,$10.07 ,$18.66 ,$12.09 ,$36.18 ,$31.23 ,$31.23 ,$30.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201248,86364,HC TISS TRNSGLTMNASE EA IG CLAS,302,1 ,$36.32 ,$23.97 ,$8.26 ,$36.32 ,$11.91 ,$36.32 ,$36.32 ,$9.61 ,$29.06 ,$30.87 ,$22.70 ,$32.69 ,$11.91 ,$11.91 ,$34.50 ,$32.69 ,$30.87 ,$30.87 ,$9.61 ,$30.87 ,$30.87 ,$32.69 ,$22.12 ,$11.91 ,$22.52 ,$12.62 ,$32.69 ,$25.94 ,$33.41 ,$32.69 ,$23.97 ,$23.97 ,$22.12 ,$23.97 ,$23.61 ,$24.81 ,$8.26 ,$28.69 ,$12.62 ,$17.80 ,$17.80 ,$9.61 ,$17.80 ,$11.53 ,$34.50 ,$29.78 ,$29.78 ,$29.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),30201249,86593,HC SYPHILIS VDRL RPR QN,302,1 ,$54.05 ,$35.67 ,$4.40 ,$54.05 ,$4.55 ,$15.40 ,$15.40 ,$14.30 ,$43.24 ,$45.94 ,$33.78 ,$48.65 ,$4.55 ,$4.55 ,$51.35 ,$48.65 ,$45.94 ,$45.94 ,$14.30 ,$45.94 ,$45.94 ,$48.65 ,$32.92 ,$4.55 ,$33.52 ,$4.82 ,$48.65 ,$9.90 ,$49.73 ,$48.65 ,$35.68 ,$35.68 ,$32.92 ,$35.68 ,$35.13 ,$36.93 ,$12.30 ,$42.70 ,$4.82 ,$5.28 ,$5.28 ,$14.30 ,$5.28 ,$4.40 ,$51.35 ,$44.32 ,$44.32 ,$43.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30240102,86003,HC ALLERGEN IGE QN EA-REF,302,1 ,$11.62 ,$7.67 ,$2.65 ,$11.75 ,$4.57 ,$11.62 ,$11.62 ,$3.08 ,$9.30 ,$9.88 ,$7.26 ,$10.46 ,$4.57 ,$4.57 ,$11.04 ,$10.46 ,$9.88 ,$9.88 ,$3.08 ,$9.88 ,$9.88 ,$10.46 ,$7.08 ,$4.57 ,$7.20 ,$4.84 ,$10.46 ,$11.75 ,$10.69 ,$10.46 ,$7.67 ,$7.67 ,$7.08 ,$7.67 ,$7.55 ,$7.94 ,$2.65 ,$9.18 ,$4.84 ,$6.26 ,$6.26 ,$3.08 ,$6.26 ,$5.22 ,$11.04 ,$9.53 ,$9.53 ,$9.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),30240129,86157,HC COLD AGGLUTININ TITER-REF,302,1 ,$11.50 ,$7.59 ,$2.63 ,$18.14 ,$8.17 ,$11.50 ,$11.50 ,$3.05 ,$9.20 ,$9.78 ,$7.19 ,$10.35 ,$8.17 ,$8.17 ,$10.93 ,$10.35 ,$9.78 ,$9.78 ,$3.05 ,$9.78 ,$9.78 ,$10.35 ,$7.00 ,$8.17 ,$7.14 ,$8.66 ,$10.35 ,$18.14 ,$10.58 ,$10.35 ,$7.59 ,$7.59 ,$7.00 ,$7.59 ,$7.48 ,$7.86 ,$2.63 ,$9.09 ,$8.66 ,$9.67 ,$9.67 ,$3.05 ,$9.67 ,$8.06 ,$10.93 ,$9.43 ,$9.43 ,$9.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30240192,86403,HC CRYPTOCOCAL ANTIGEN-REF,302,1 ,$23.00 ,$15.18 ,$5.23 ,$25.97 ,$11.92 ,$23.00 ,$23.00 ,$6.09 ,$18.40 ,$19.55 ,$14.38 ,$20.70 ,$11.92 ,$11.92 ,$21.85 ,$20.70 ,$19.55 ,$19.55 ,$6.09 ,$19.55 ,$19.55 ,$20.70 ,$14.01 ,$11.92 ,$14.26 ,$12.64 ,$20.70 ,$25.97 ,$21.16 ,$20.70 ,$15.18 ,$15.18 ,$14.01 ,$15.18 ,$14.95 ,$15.71 ,$5.23 ,$18.17 ,$12.64 ,$13.85 ,$13.85 ,$6.09 ,$13.85 ,$11.54 ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500098,85421,HC PLASMINOGEN ANTIGENIC,305,1 ,$164.45 ,$108.54 ,$10.18 ,$164.45 ,$10.52 ,$35.63 ,$35.63 ,$43.51 ,$131.56 ,$139.78 ,$102.78 ,$148.01 ,$10.52 ,$10.52 ,$156.23 ,$148.01 ,$139.78 ,$139.78 ,$43.51 ,$139.78 ,$139.78 ,$148.01 ,$100.15 ,$10.52 ,$101.96 ,$11.15 ,$148.01 ,$22.91 ,$151.29 ,$148.01 ,$108.55 ,$108.55 ,$100.15 ,$108.55 ,$106.89 ,$112.35 ,$37.44 ,$129.92 ,$11.15 ,$12.22 ,$12.22 ,$43.51 ,$12.22 ,$10.18 ,$156.23 ,$134.85 ,$134.85 ,$131.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$40.25 ,$26.57 ,$3.80 ,$40.25 ,$3.93 ,$13.30 ,$13.30 ,$10.65 ,$32.20 ,$34.21 ,$25.16 ,$36.23 ,$3.93 ,$3.93 ,$38.24 ,$36.23 ,$34.21 ,$34.21 ,$10.65 ,$34.21 ,$34.21 ,$36.23 ,$24.51 ,$3.93 ,$24.96 ,$4.17 ,$36.23 ,$8.55 ,$37.03 ,$36.23 ,$26.57 ,$26.57 ,$24.51 ,$26.57 ,$26.16 ,$27.50 ,$9.16 ,$31.80 ,$4.17 ,$4.56 ,$4.56 ,$10.65 ,$4.56 ,$3.80 ,$38.24 ,$33.01 ,$33.01 ,$32.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500104,85014,HC HEMATOCRIT,305,1 ,$20.70 ,$13.66 ,$2.37 ,$20.70 ,$2.45 ,$8.30 ,$8.30 ,$5.48 ,$16.56 ,$17.60 ,$12.94 ,$18.63 ,$2.45 ,$2.45 ,$19.67 ,$18.63 ,$17.60 ,$17.60 ,$5.48 ,$17.60 ,$17.60 ,$18.63 ,$12.61 ,$2.45 ,$12.84 ,$2.60 ,$18.63 ,$5.33 ,$19.04 ,$18.63 ,$13.66 ,$13.66 ,$12.61 ,$13.66 ,$13.46 ,$14.14 ,$4.71 ,$16.35 ,$2.60 ,$2.84 ,$2.84 ,$5.48 ,$2.84 ,$2.37 ,$19.67 ,$16.97 ,$16.97 ,$16.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500106,85018,HC HGB,305,1 ,$21.85 ,$14.42 ,$2.37 ,$21.85 ,$2.45 ,$8.30 ,$8.30 ,$5.78 ,$17.48 ,$18.57 ,$13.66 ,$19.67 ,$2.45 ,$2.45 ,$20.76 ,$19.67 ,$18.57 ,$18.57 ,$5.78 ,$18.57 ,$18.57 ,$19.67 ,$13.31 ,$2.45 ,$13.54 ,$2.60 ,$19.67 ,$5.33 ,$20.10 ,$19.67 ,$14.42 ,$14.42 ,$13.31 ,$14.42 ,$14.20 ,$14.93 ,$4.98 ,$17.26 ,$2.60 ,$2.84 ,$2.84 ,$5.78 ,$2.84 ,$2.37 ,$20.76 ,$17.92 ,$17.92 ,$17.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$77.05 ,$50.85 ,$7.77 ,$77.05 ,$8.03 ,$27.20 ,$27.20 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.03 ,$8.03 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.03 ,$47.78 ,$8.51 ,$69.35 ,$17.48 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.51 ,$9.32 ,$9.32 ,$20.38 ,$9.32 ,$7.77 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500108,85027,HC CBC W/O DIFF,305,1 ,$56.35 ,$37.19 ,$6.47 ,$56.35 ,$6.69 ,$22.65 ,$22.65 ,$14.91 ,$45.08 ,$47.90 ,$35.22 ,$50.72 ,$6.69 ,$6.69 ,$53.53 ,$50.72 ,$47.90 ,$47.90 ,$14.91 ,$47.90 ,$47.90 ,$50.72 ,$34.32 ,$6.69 ,$34.94 ,$7.09 ,$50.72 ,$14.56 ,$51.84 ,$50.72 ,$37.20 ,$37.20 ,$34.32 ,$37.20 ,$36.63 ,$38.50 ,$12.83 ,$44.52 ,$7.09 ,$7.76 ,$7.76 ,$14.91 ,$7.76 ,$6.47 ,$53.53 ,$46.21 ,$46.21 ,$45.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500109,85027,HC HISTOGRAM,305,1 ,$56.35 ,$37.19 ,$6.47 ,$56.35 ,$6.69 ,$22.65 ,$22.65 ,$14.91 ,$45.08 ,$47.90 ,$35.22 ,$50.72 ,$6.69 ,$6.69 ,$53.53 ,$50.72 ,$47.90 ,$47.90 ,$14.91 ,$47.90 ,$47.90 ,$50.72 ,$34.32 ,$6.69 ,$34.94 ,$7.09 ,$50.72 ,$14.56 ,$51.84 ,$50.72 ,$37.20 ,$37.20 ,$34.32 ,$37.20 ,$36.63 ,$38.50 ,$12.83 ,$44.52 ,$7.09 ,$7.76 ,$7.76 ,$14.91 ,$7.76 ,$6.47 ,$53.53 ,$46.21 ,$46.21 ,$45.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500110,85044,HC RETIC COUNT MANUAL,305,1 ,$167.90 ,$110.81 ,$4.31 ,$167.90 ,$4.45 ,$15.09 ,$15.09 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$4.45 ,$4.45 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$4.45 ,$104.10 ,$4.72 ,$151.11 ,$9.70 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$4.72 ,$5.17 ,$5.17 ,$44.42 ,$5.17 ,$4.31 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500111,85045,HC RETIC COUNT AUTO,305,1 ,$39.10 ,$25.81 ,$3.99 ,$39.10 ,$4.12 ,$13.97 ,$13.97 ,$10.35 ,$31.28 ,$33.24 ,$24.44 ,$35.19 ,$4.12 ,$4.12 ,$37.15 ,$35.19 ,$33.24 ,$33.24 ,$10.35 ,$33.24 ,$33.24 ,$35.19 ,$23.81 ,$4.12 ,$24.24 ,$4.37 ,$35.19 ,$8.98 ,$35.97 ,$35.19 ,$25.81 ,$25.81 ,$23.81 ,$25.81 ,$25.42 ,$26.71 ,$8.90 ,$30.89 ,$4.37 ,$4.79 ,$4.79 ,$10.35 ,$4.79 ,$3.99 ,$37.15 ,$32.06 ,$32.06 ,$31.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$21.85 ,$14.42 ,$2.54 ,$21.85 ,$2.62 ,$8.89 ,$8.89 ,$5.78 ,$17.48 ,$18.57 ,$13.66 ,$19.67 ,$2.62 ,$2.62 ,$20.76 ,$19.67 ,$18.57 ,$18.57 ,$5.78 ,$18.57 ,$18.57 ,$19.67 ,$13.31 ,$2.62 ,$13.54 ,$2.78 ,$19.67 ,$5.72 ,$20.10 ,$19.67 ,$14.42 ,$14.42 ,$13.31 ,$14.42 ,$14.20 ,$14.93 ,$4.98 ,$17.26 ,$2.78 ,$3.05 ,$3.05 ,$5.78 ,$3.05 ,$2.54 ,$20.76 ,$17.92 ,$17.92 ,$17.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$43.70 ,$28.84 ,$4.48 ,$43.70 ,$4.63 ,$15.68 ,$15.68 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$4.63 ,$4.63 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$4.63 ,$27.10 ,$4.91 ,$39.33 ,$10.08 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$4.91 ,$5.38 ,$5.38 ,$11.56 ,$5.38 ,$4.48 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500117,85097,HC BONE MARROW SMEAR INTERP (MAYO),305,1 ,$525.55 ,$346.86 ,$119.65 ,"$1,747.15 ",$979.60 ,$162.43 ,$162.43 ,$139.06 ,$420.44 ,$446.72 ,$328.47 ,$473.00 ,$979.60 ,$525.55 ,$499.27 ,$473.00 ,$446.72 ,$446.72 ,$139.06 ,$446.72 ,$446.72 ,$473.00 ,$320.06 ,$979.60 ,$325.84 ,$557.08 ,$473.00 ,"$1,747.15 ",$483.51 ,$473.00 ,$346.92 ,$346.92 ,$320.06 ,$346.92 ,$341.61 ,$359.06 ,$119.65 ,$415.18 ,"$1,038.38 ",$525.55 ,$525.55 ,$139.06 ,$525.55 ,$776.51 ,$499.27 ,$430.95 ,$430.95 ,$420.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500119,85175,HC CLOT LYSIS TIME,305,1 ,$89.70 ,$59.20 ,$6.40 ,$89.70 ,$6.40 ,$71.30 ,$71.30 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$6.40 ,$6.40 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$6.40 ,$55.62 ,$6.78 ,$80.73 ,$45.83 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$6.78 ,$24.44 ,$24.44 ,$23.74 ,$24.44 ,$20.37 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500121,85210,HC FACTOR II PROTHROM SPEC,305,1 ,$116.15 ,$76.66 ,$8.17 ,$116.15 ,$8.17 ,$45.43 ,$45.43 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$8.17 ,$8.17 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$8.17 ,$72.02 ,$8.66 ,$104.54 ,$29.21 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$8.66 ,$15.58 ,$15.58 ,$30.73 ,$15.58 ,$12.98 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500123,85220,HC FACTOR V CLOTTING FACTOR,305,1 ,$193.20 ,$127.51 ,$17.65 ,$193.20 ,$18.24 ,$61.78 ,$61.78 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$18.24 ,$18.24 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$18.24 ,$119.78 ,$19.33 ,$173.88 ,$39.71 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$19.33 ,$21.18 ,$21.18 ,$51.12 ,$21.18 ,$17.65 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500125,85230,HC FACTOR VII PROCONVERTIN,305,1 ,$193.20 ,$127.51 ,$17.90 ,$193.20 ,$18.50 ,$62.65 ,$62.65 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$18.50 ,$18.50 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$18.50 ,$119.78 ,$19.61 ,$173.88 ,$40.28 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$19.61 ,$21.48 ,$21.48 ,$51.12 ,$21.48 ,$17.90 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500126,85240,HC FACTOR VIII AHG 1 STAGE,305,1 ,$116.15 ,$76.66 ,$9.84 ,$116.15 ,$9.84 ,$62.65 ,$62.65 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$9.84 ,$9.84 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$9.84 ,$72.02 ,$10.43 ,$104.54 ,$40.28 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$10.43 ,$21.48 ,$21.48 ,$30.73 ,$21.48 ,$17.90 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500131,85245,HC FACTOR VIII VW RISTOCTN,305,1 ,$205.85 ,$135.86 ,$22.94 ,$205.85 ,$23.70 ,$80.29 ,$80.29 ,$54.47 ,$164.68 ,$174.97 ,$128.66 ,$185.27 ,$23.70 ,$23.70 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$23.70 ,$127.62 ,$25.12 ,$185.27 ,$51.62 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,$25.12 ,$27.53 ,$27.53 ,$54.47 ,$27.53 ,$22.94 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500132,85246,HC FACTOR VIII VW ANTIGEN,305,1 ,$180.55 ,$119.16 ,$22.94 ,$180.55 ,$23.70 ,$80.29 ,$80.29 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$23.70 ,$23.70 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$23.70 ,$111.94 ,$25.12 ,$162.50 ,$51.62 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$25.12 ,$27.53 ,$27.53 ,$47.77 ,$27.53 ,$22.94 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500136,85247,HC FACTOR VIII VW MULTIM ANALY,305,1 ,$244.95 ,$161.67 ,$22.94 ,$244.95 ,$23.70 ,$80.29 ,$80.29 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$23.70 ,$23.70 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$23.70 ,$151.86 ,$25.12 ,$220.46 ,$51.62 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$25.12 ,$27.53 ,$27.53 ,$64.82 ,$27.53 ,$22.94 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500138,85250,HC FACTOR IX PTC OR CHRISTMAS,305,1 ,$257.60 ,$170.02 ,$19.04 ,$257.60 ,$19.67 ,$66.64 ,$66.64 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$19.67 ,$19.67 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$19.67 ,$159.72 ,$20.85 ,$231.84 ,$42.84 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$20.85 ,$22.85 ,$22.85 ,$68.16 ,$22.85 ,$19.04 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500142,85260,HC FACTOR X (STUART-POWER),305,1 ,$180.55 ,$119.16 ,$17.90 ,$180.55 ,$18.50 ,$62.65 ,$62.65 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$18.50 ,$18.50 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$18.50 ,$111.94 ,$19.61 ,$162.50 ,$40.28 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$19.61 ,$21.48 ,$21.48 ,$47.77 ,$21.48 ,$17.90 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500144,85270,HC FACTOR XI PTA,305,1 ,$193.20 ,$127.51 ,$17.90 ,$193.20 ,$18.50 ,$62.65 ,$62.65 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$18.50 ,$18.50 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$18.50 ,$119.78 ,$19.61 ,$173.88 ,$40.28 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$19.61 ,$21.48 ,$21.48 ,$51.12 ,$21.48 ,$17.90 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500146,85280,HC FACTOR XII HAGEMAN,305,1 ,$141.45 ,$93.36 ,$19.35 ,$141.45 ,$19.99 ,$67.73 ,$67.73 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$19.99 ,$19.99 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$19.99 ,$87.70 ,$21.19 ,$127.31 ,$43.54 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$21.19 ,$23.22 ,$23.22 ,$37.43 ,$23.22 ,$19.35 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500147,85291,HC FACTOR XIII FIBRIN SCRN,305,1 ,$64.40 ,$42.50 ,$9.11 ,$64.40 ,$9.41 ,$31.89 ,$31.89 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$9.41 ,$9.41 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$9.41 ,$39.92 ,$9.97 ,$57.96 ,$20.50 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$9.97 ,$10.93 ,$10.93 ,$17.04 ,$10.93 ,$9.11 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500149,85300,HC ANTITHROMBIN III ACT,305,1 ,$167.90 ,$110.81 ,$11.85 ,$167.90 ,$12.24 ,$41.48 ,$41.48 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$12.24 ,$12.24 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$12.24 ,$104.10 ,$12.97 ,$151.11 ,$26.66 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$12.97 ,$14.22 ,$14.22 ,$44.42 ,$14.22 ,$11.85 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500150,85300,HC ANTITHROMBIN III,305,1 ,$167.90 ,$110.81 ,$11.85 ,$167.90 ,$12.24 ,$41.48 ,$41.48 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$12.24 ,$12.24 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$12.24 ,$104.10 ,$12.97 ,$151.11 ,$26.66 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$12.97 ,$14.22 ,$14.22 ,$44.42 ,$14.22 ,$11.85 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500151,85301,HC ANTITHROMBIN III AG,305,1 ,$116.15 ,$76.66 ,$10.81 ,$116.15 ,$11.17 ,$37.84 ,$37.84 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$11.17 ,$11.17 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$11.17 ,$72.02 ,$11.84 ,$104.54 ,$24.32 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$11.84 ,$12.97 ,$12.97 ,$30.73 ,$12.97 ,$10.81 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500153,85302,HC PROTEIN C AG,305,1 ,$167.90 ,$110.81 ,$12.01 ,$167.90 ,$12.41 ,$42.04 ,$42.04 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$12.41 ,$12.41 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$12.41 ,$104.10 ,$13.15 ,$151.11 ,$27.02 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$13.15 ,$14.41 ,$14.41 ,$44.42 ,$14.41 ,$12.01 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500154,85303,HC PROTEIN C ACTIVITY,305,1 ,$141.45 ,$93.36 ,$13.84 ,$141.45 ,$14.30 ,$48.44 ,$48.44 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$14.30 ,$14.30 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$14.30 ,$87.70 ,$15.16 ,$127.31 ,$31.14 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$15.16 ,$16.61 ,$16.61 ,$37.43 ,$16.61 ,$13.84 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500156,85305,HC PROTEIN S TOTAL,305,1 ,$167.90 ,$110.81 ,$11.61 ,$167.90 ,$12.00 ,$40.64 ,$40.64 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$12.00 ,$12.00 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$12.00 ,$104.10 ,$12.72 ,$151.11 ,$26.12 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$12.72 ,$13.93 ,$13.93 ,$44.42 ,$13.93 ,$11.61 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500158,85306,HC PROTEIN S FREE (2),305,1 ,$282.90 ,$186.71 ,$15.32 ,$282.90 ,$15.83 ,$53.62 ,$53.62 ,$74.85 ,$226.32 ,$240.47 ,$176.81 ,$254.61 ,$15.83 ,$15.83 ,$268.76 ,$254.61 ,$240.47 ,$240.47 ,$74.85 ,$240.47 ,$240.47 ,$254.61 ,$172.29 ,$15.83 ,$175.40 ,$16.78 ,$254.61 ,$34.47 ,$260.27 ,$254.61 ,$186.74 ,$186.74 ,$172.29 ,$186.74 ,$183.89 ,$193.28 ,$64.41 ,$223.49 ,$16.78 ,$18.38 ,$18.38 ,$74.85 ,$18.38 ,$15.32 ,$268.76 ,$231.98 ,$231.98 ,$226.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500159,85306,HC PROTEIN S FREE,305,1 ,$167.90 ,$110.81 ,$15.32 ,$167.90 ,$15.83 ,$53.62 ,$53.62 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$15.83 ,$15.83 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$15.83 ,$104.10 ,$16.78 ,$151.11 ,$34.47 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$16.78 ,$18.38 ,$18.38 ,$44.42 ,$18.38 ,$15.32 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500164,85307,HC ACTIV PROTEIN C RESIST,305,1 ,$154.10 ,$101.71 ,$15.32 ,$154.10 ,$15.83 ,$53.62 ,$53.62 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$15.83 ,$15.83 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$15.83 ,$95.54 ,$16.78 ,$138.69 ,$34.47 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$16.78 ,$18.38 ,$18.38 ,$40.78 ,$18.38 ,$15.32 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500165,85335,HC FACTOR VIII INHIB,305,1 ,$257.60 ,$170.02 ,$12.87 ,$257.60 ,$13.30 ,$45.05 ,$45.05 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$13.30 ,$13.30 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$13.30 ,$159.72 ,$14.10 ,$231.84 ,$28.96 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$14.10 ,$15.44 ,$15.44 ,$68.16 ,$15.44 ,$12.87 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500166,85335,HC FACTOR IX INHIB,305,1 ,$262.20 ,$173.05 ,$12.87 ,$262.20 ,$13.30 ,$45.05 ,$45.05 ,$69.37 ,$209.76 ,$222.87 ,$163.88 ,$235.98 ,$13.30 ,$13.30 ,$249.09 ,$235.98 ,$222.87 ,$222.87 ,$69.37 ,$222.87 ,$222.87 ,$235.98 ,$159.68 ,$13.30 ,$162.56 ,$14.10 ,$235.98 ,$28.96 ,$241.22 ,$235.98 ,$173.08 ,$173.08 ,$159.68 ,$173.08 ,$170.43 ,$179.14 ,$59.69 ,$207.14 ,$14.10 ,$15.44 ,$15.44 ,$69.37 ,$15.44 ,$12.87 ,$249.09 ,$215.00 ,$215.00 ,$209.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500168,85347,HC ACTIVATED CLOTTING TIME,305,1 ,$120.75 ,$79.70 ,$4.28 ,$120.75 ,$4.42 ,$14.98 ,$14.98 ,$31.95 ,$96.60 ,$102.64 ,$75.47 ,$108.68 ,$4.42 ,$4.42 ,$114.71 ,$108.68 ,$102.64 ,$102.64 ,$31.95 ,$102.64 ,$102.64 ,$108.68 ,$73.54 ,$4.42 ,$74.86 ,$4.69 ,$108.68 ,$9.63 ,$111.09 ,$108.68 ,$79.71 ,$79.71 ,$73.54 ,$79.71 ,$78.49 ,$82.50 ,$27.49 ,$95.39 ,$4.69 ,$5.14 ,$5.14 ,$31.95 ,$5.14 ,$4.28 ,$114.71 ,$99.02 ,$99.02 ,$96.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500174,85362,HC FDP/FSP AGGLUT SQ,305,1 ,$60.95 ,$40.23 ,$6.89 ,$60.95 ,$7.12 ,$24.12 ,$24.12 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$7.12 ,$7.12 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$7.12 ,$37.78 ,$7.55 ,$54.86 ,$15.50 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$7.55 ,$8.27 ,$8.27 ,$16.13 ,$8.27 ,$6.89 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500175,85379,HC D DIMER QN,305,1 ,$89.70 ,$59.20 ,$10.18 ,$89.70 ,$10.52 ,$35.63 ,$35.63 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.52 ,$10.52 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.52 ,$55.62 ,$11.15 ,$80.73 ,$22.91 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.15 ,$12.22 ,$12.22 ,$23.74 ,$12.22 ,$10.18 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500176,85384,HC FIBRINOGEN,305,1 ,$89.70 ,$59.20 ,$9.72 ,$89.70 ,$10.04 ,$34.02 ,$34.02 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.04 ,$10.04 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.04 ,$55.62 ,$10.64 ,$80.73 ,$21.87 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.64 ,$11.66 ,$11.66 ,$23.74 ,$11.66 ,$9.72 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500179,85385,HC FIBRINOGEN AG,305,1 ,$77.05 ,$50.85 ,$11.94 ,$77.05 ,$11.94 ,$50.61 ,$50.61 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$11.94 ,$11.94 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$11.94 ,$47.78 ,$12.66 ,$69.35 ,$32.54 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$12.66 ,$17.35 ,$17.35 ,$20.38 ,$17.35 ,$14.46 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500181,85410,HC ALPHA 2 ANTIPLASMIN,305,1 ,$232.30 ,$153.32 ,$7.71 ,$232.30 ,$7.97 ,$26.99 ,$26.99 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$7.97 ,$7.97 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$7.97 ,$144.02 ,$8.45 ,$209.07 ,$17.35 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$8.45 ,$9.25 ,$9.25 ,$61.47 ,$9.25 ,$7.71 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500185,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$193.20 ,$127.51 ,$7.73 ,$193.20 ,$7.99 ,$27.06 ,$27.06 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$7.99 ,$7.99 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$7.99 ,$119.78 ,$8.47 ,$173.88 ,$17.39 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$8.47 ,$9.28 ,$9.28 ,$51.12 ,$9.28 ,$7.73 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500186,85461,HC FETAL HGB ROSETTE,305,1 ,$77.05 ,$50.85 ,$9.33 ,$77.05 ,$9.33 ,$32.76 ,$32.76 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$9.33 ,$9.33 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$9.33 ,$47.78 ,$9.89 ,$69.35 ,$21.06 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.89 ,$11.23 ,$11.23 ,$20.38 ,$11.23 ,$9.36 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500187,85520,HC HEPARIN ASSAY,305,1 ,$218.50 ,$144.21 ,$13.09 ,$218.50 ,$13.53 ,$45.82 ,$45.82 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$13.53 ,$13.53 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$13.53 ,$135.48 ,$14.34 ,$196.65 ,$29.45 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$14.34 ,$15.71 ,$15.71 ,$57.82 ,$15.71 ,$13.09 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500190,85540,HC LEUKOCYTE ALK PHOS,305,1 ,$161.00 ,$106.26 ,$8.60 ,$161.00 ,$8.89 ,$30.10 ,$30.10 ,$42.60 ,$128.80 ,$136.85 ,$100.63 ,$144.90 ,$8.89 ,$8.89 ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$42.60 ,$136.85 ,$136.85 ,$144.90 ,$98.05 ,$8.89 ,$99.82 ,$9.42 ,$144.90 ,$19.35 ,$148.12 ,$144.90 ,$106.28 ,$106.28 ,$98.05 ,$106.28 ,$104.65 ,$110.00 ,$36.65 ,$127.19 ,$9.42 ,$10.32 ,$10.32 ,$42.60 ,$10.32 ,$8.60 ,$152.95 ,$132.02 ,$132.02 ,$128.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500191,85557,HC OSMOTIC FRAG RBC INCUB,305,1 ,$297.85 ,$196.58 ,$13.36 ,$297.85 ,$13.80 ,$46.76 ,$46.76 ,$78.81 ,$238.28 ,$253.17 ,$186.16 ,$268.07 ,$13.80 ,$13.80 ,$282.96 ,$268.07 ,$253.17 ,$253.17 ,$78.81 ,$253.17 ,$253.17 ,$268.07 ,$181.39 ,$13.80 ,$184.66 ,$14.63 ,$268.07 ,$30.06 ,$274.02 ,$268.07 ,$196.61 ,$196.61 ,$181.39 ,$196.61 ,$193.60 ,$203.49 ,$67.82 ,$235.30 ,$14.63 ,$16.03 ,$16.03 ,$78.81 ,$16.03 ,$13.36 ,$282.96 ,$244.24 ,$244.24 ,$238.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500192,85576,HC PLATELET AGGREGATION EA,305,1 ,$244.95 ,$161.67 ,$24.91 ,$244.95 ,$25.74 ,$87.19 ,$87.19 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$25.74 ,$25.74 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$25.74 ,$151.86 ,$27.28 ,$220.46 ,$56.05 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$27.28 ,$29.89 ,$29.89 ,$64.82 ,$29.89 ,$24.91 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$41.40 ,$27.32 ,$4.29 ,$41.40 ,$4.43 ,$15.02 ,$15.02 ,$10.96 ,$33.12 ,$35.19 ,$25.88 ,$37.26 ,$4.43 ,$4.43 ,$39.33 ,$37.26 ,$35.19 ,$35.19 ,$10.96 ,$35.19 ,$35.19 ,$37.26 ,$25.21 ,$4.43 ,$25.66 ,$4.70 ,$37.26 ,$9.65 ,$38.09 ,$37.26 ,$27.33 ,$27.33 ,$25.21 ,$27.33 ,$26.91 ,$28.28 ,$9.43 ,$32.71 ,$4.70 ,$5.15 ,$5.15 ,$10.96 ,$5.15 ,$4.29 ,$39.33 ,$33.95 ,$33.95 ,$33.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500197,85611,HC PT MIX STUDY,305,1 ,$55.20 ,$36.43 ,$3.94 ,$55.20 ,$4.07 ,$13.79 ,$13.79 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$4.07 ,$4.07 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$4.07 ,$34.22 ,$4.31 ,$49.68 ,$8.87 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$4.31 ,$4.73 ,$4.73 ,$14.60 ,$4.73 ,$3.94 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500198,85613,HC RUSSELL VIPER VENOM SCR,305,1 ,$89.70 ,$59.20 ,$9.58 ,$89.70 ,$9.90 ,$33.53 ,$33.53 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$9.90 ,$9.90 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$9.90 ,$55.62 ,$10.49 ,$80.73 ,$21.56 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.49 ,$11.50 ,$11.50 ,$23.74 ,$11.50 ,$9.58 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500200,85613,HC RUSSELL VIPER VENOM CONF,305,1 ,$89.70 ,$59.20 ,$9.58 ,$89.70 ,$9.90 ,$33.53 ,$33.53 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$9.90 ,$9.90 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$9.90 ,$55.62 ,$10.49 ,$80.73 ,$21.56 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.49 ,$11.50 ,$11.50 ,$23.74 ,$11.50 ,$9.58 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500201,85613,HC RUSSELL VIPER VENOM DIL (DRVVT),305,1 ,$89.70 ,$59.20 ,$9.58 ,$89.70 ,$9.90 ,$33.53 ,$33.53 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$9.90 ,$9.90 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$9.90 ,$55.62 ,$10.49 ,$80.73 ,$21.56 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.49 ,$11.50 ,$11.50 ,$23.74 ,$11.50 ,$9.58 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500205,85652,HC SED RATE AUTO,305,1 ,$46.00 ,$30.36 ,$2.70 ,$46.00 ,$2.79 ,$9.45 ,$9.45 ,$12.17 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$2.79 ,$2.79 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$12.17 ,$39.10 ,$39.10 ,$41.40 ,$28.01 ,$2.79 ,$28.52 ,$2.96 ,$41.40 ,$6.08 ,$42.32 ,$41.40 ,$30.36 ,$30.36 ,$28.01 ,$30.36 ,$29.90 ,$31.43 ,$10.48 ,$36.34 ,$2.96 ,$3.24 ,$3.24 ,$12.17 ,$3.24 ,$2.70 ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500206,85660,HC SICKLE CELL RBC,305,1 ,$77.05 ,$50.85 ,$5.51 ,$77.05 ,$5.69 ,$19.29 ,$19.29 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$5.69 ,$5.69 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$5.69 ,$47.78 ,$6.03 ,$69.35 ,$12.40 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$6.03 ,$6.61 ,$6.61 ,$20.38 ,$6.61 ,$5.51 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500207,85670,HC THROMBIN TIME PLASMA,305,1 ,$116.15 ,$76.66 ,$5.77 ,$116.15 ,$6.84 ,$20.20 ,$20.20 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$6.84 ,$6.84 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$6.84 ,$72.02 ,$7.25 ,$104.54 ,$12.98 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$7.25 ,$6.92 ,$6.92 ,$30.73 ,$6.92 ,$5.77 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500208,85705,HC HEX PHOSPHOLIPID NEUT,305,1 ,$64.40 ,$42.50 ,$8.17 ,$64.40 ,$8.17 ,$33.71 ,$33.71 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$8.17 ,$8.17 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$8.17 ,$39.92 ,$8.66 ,$57.96 ,$21.67 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$8.66 ,$11.56 ,$11.56 ,$17.04 ,$11.56 ,$9.63 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500209,85730,HC PTT (LUPUS),305,1 ,$59.80 ,$39.47 ,$6.01 ,$59.80 ,$6.21 ,$21.04 ,$21.04 ,$15.83 ,$47.84 ,$50.83 ,$37.38 ,$53.82 ,$6.21 ,$6.21 ,$56.81 ,$53.82 ,$50.83 ,$50.83 ,$15.83 ,$50.83 ,$50.83 ,$53.82 ,$36.42 ,$6.21 ,$37.08 ,$6.58 ,$53.82 ,$13.52 ,$55.02 ,$53.82 ,$39.47 ,$39.47 ,$36.42 ,$39.47 ,$38.87 ,$40.86 ,$13.61 ,$47.24 ,$6.58 ,$7.21 ,$7.21 ,$15.83 ,$7.21 ,$6.01 ,$56.81 ,$49.04 ,$49.04 ,$47.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500211,85730,HC PTT,305,1 ,$64.40 ,$42.50 ,$6.01 ,$64.40 ,$6.21 ,$21.04 ,$21.04 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$6.21 ,$6.21 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$6.21 ,$39.92 ,$6.58 ,$57.96 ,$13.52 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$6.58 ,$7.21 ,$7.21 ,$17.04 ,$7.21 ,$6.01 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500212,85730,HC APTT,305,1 ,$118.45 ,$78.18 ,$6.01 ,$118.45 ,$6.21 ,$21.04 ,$21.04 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$6.21 ,$6.21 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$6.21 ,$73.44 ,$6.58 ,$106.61 ,$13.52 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$6.58 ,$7.21 ,$7.21 ,$31.34 ,$7.21 ,$6.01 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500213,85732,HC PTT MIXING STUDY,305,1 ,$89.70 ,$59.20 ,$6.47 ,$89.70 ,$6.69 ,$22.65 ,$22.65 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$6.69 ,$6.69 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$6.69 ,$55.62 ,$7.09 ,$80.73 ,$14.56 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$7.09 ,$7.76 ,$7.76 ,$23.74 ,$7.76 ,$6.47 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500216,85732,HC PTT MIXING STUDY (PLASMA),305,1 ,$180.55 ,$119.16 ,$6.47 ,$180.55 ,$6.69 ,$22.65 ,$22.65 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$6.69 ,$6.69 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$6.69 ,$111.94 ,$7.09 ,$162.50 ,$14.56 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$7.09 ,$7.76 ,$7.76 ,$47.77 ,$7.76 ,$6.47 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500228,85397,HC VW FACTOR ACTIVITY MAYO,305,1 ,$331.20 ,$218.59 ,$30.86 ,$331.20 ,$31.89 ,$108.01 ,$108.01 ,$87.63 ,$264.96 ,$281.52 ,$207.00 ,$298.08 ,$31.89 ,$31.89 ,$314.64 ,$298.08 ,$281.52 ,$281.52 ,$87.63 ,$281.52 ,$281.52 ,$298.08 ,$201.70 ,$31.89 ,$205.34 ,$33.80 ,$298.08 ,$69.44 ,$304.70 ,$298.08 ,$218.63 ,$218.63 ,$201.70 ,$218.63 ,$215.28 ,$226.28 ,$75.40 ,$261.65 ,$33.80 ,$37.03 ,$37.03 ,$87.63 ,$37.03 ,$30.86 ,$314.64 ,$271.58 ,$271.58 ,$264.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500231,85260,HC FACTOR X CHROMOGENIC,305,1 ,$218.50 ,$144.21 ,$17.90 ,$218.50 ,$18.50 ,$62.65 ,$62.65 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$18.50 ,$18.50 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$18.50 ,$135.48 ,$19.61 ,$196.65 ,$40.28 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$19.61 ,$21.48 ,$21.48 ,$57.82 ,$21.48 ,$17.90 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30500343,85549,HC MURAMIDASE,305,1 ,$101.20 ,$66.79 ,$18.75 ,$101.20 ,$19.37 ,$65.63 ,$65.63 ,$26.77 ,$80.96 ,$86.02 ,$63.25 ,$91.08 ,$19.37 ,$19.37 ,$96.14 ,$91.08 ,$86.02 ,$86.02 ,$26.77 ,$86.02 ,$86.02 ,$91.08 ,$61.63 ,$19.37 ,$62.74 ,$20.53 ,$91.08 ,$42.19 ,$93.10 ,$91.08 ,$66.80 ,$66.80 ,$61.63 ,$66.80 ,$65.78 ,$69.14 ,$23.04 ,$79.95 ,$20.53 ,$22.50 ,$22.50 ,$26.77 ,$22.50 ,$18.75 ,$96.14 ,$82.98 ,$82.98 ,$80.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30540180,85397,HC MBC ADAMTS13 ACTIVITY-REF,305,1 ,$287.50 ,$189.75 ,$30.86 ,$287.50 ,$31.89 ,$108.01 ,$108.01 ,$76.08 ,$230.00 ,$244.38 ,$179.69 ,$258.75 ,$31.89 ,$31.89 ,$273.13 ,$258.75 ,$244.38 ,$244.38 ,$76.08 ,$244.38 ,$244.38 ,$258.75 ,$175.09 ,$31.89 ,$178.26 ,$33.80 ,$258.75 ,$69.44 ,$264.50 ,$258.75 ,$189.78 ,$189.78 ,$175.09 ,$189.78 ,$186.88 ,$196.42 ,$65.45 ,$227.13 ,$33.80 ,$37.03 ,$37.03 ,$76.08 ,$37.03 ,$30.86 ,$273.13 ,$235.75 ,$235.75 ,$230.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600096,87480,HC CANDIDA SPECIES DNA SCREEN,306,1 ,$180.55 ,$119.16 ,$20.05 ,$180.55 ,$20.72 ,$70.18 ,$70.18 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$20.72 ,$20.72 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$20.72 ,$111.94 ,$21.96 ,$162.50 ,$45.11 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$21.96 ,$24.06 ,$24.06 ,$47.77 ,$24.06 ,$20.05 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600097,87660,HC TRICHOMONAS DNA SCREEN,306,1 ,$180.55 ,$119.16 ,$20.05 ,$180.55 ,$20.72 ,$70.18 ,$70.18 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$20.72 ,$20.72 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$20.72 ,$111.94 ,$21.96 ,$162.50 ,$45.11 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$21.96 ,$24.06 ,$24.06 ,$47.77 ,$24.06 ,$20.05 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600098,87510,HC G VAGINALIS DNA SCREEN,306,1 ,$180.55 ,$119.16 ,$20.05 ,$180.55 ,$20.72 ,$70.18 ,$70.18 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$20.72 ,$20.72 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$20.72 ,$111.94 ,$21.96 ,$162.50 ,$45.11 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$21.96 ,$24.06 ,$24.06 ,$47.77 ,$24.06 ,$20.05 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600099,87496,HC CMV DNA QUAL PCR,306,1 ,$334.65 ,$220.87 ,$35.09 ,$334.65 ,$36.26 ,$122.82 ,$122.82 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$36.26 ,$36.26 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$36.26 ,$207.48 ,$38.44 ,$301.19 ,$78.95 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$38.44 ,$42.11 ,$42.11 ,$88.55 ,$42.11 ,$35.09 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600101,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$46.00 ,$30.36 ,$5.25 ,$46.00 ,$5.25 ,$23.38 ,$23.38 ,$12.17 ,$36.80 ,$39.10 ,$28.75 ,$41.40 ,$5.25 ,$5.25 ,$43.70 ,$41.40 ,$39.10 ,$39.10 ,$12.17 ,$39.10 ,$39.10 ,$41.40 ,$28.01 ,$5.25 ,$28.52 ,$5.57 ,$41.40 ,$15.03 ,$42.32 ,$41.40 ,$30.36 ,$30.36 ,$28.01 ,$30.36 ,$29.90 ,$31.43 ,$10.48 ,$36.34 ,$5.57 ,$8.02 ,$8.02 ,$12.17 ,$8.02 ,$6.68 ,$43.70 ,$37.72 ,$37.72 ,$36.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600102,87040,HC BLOOD CULTURE,306,1 ,$128.80 ,$85.01 ,$10.32 ,$128.80 ,$10.66 ,$36.12 ,$36.12 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$10.66 ,$10.66 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$10.66 ,$79.86 ,$11.30 ,$115.92 ,$23.22 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$11.30 ,$12.38 ,$12.38 ,$34.08 ,$12.38 ,$10.32 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600103,87045,HC STOOL CULTURE,306,1 ,$89.70 ,$59.20 ,$9.44 ,$89.70 ,$9.75 ,$33.04 ,$33.04 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$9.75 ,$9.75 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$9.75 ,$55.62 ,$10.34 ,$80.73 ,$21.24 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$10.34 ,$11.33 ,$11.33 ,$23.74 ,$11.33 ,$9.44 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600104,87046,HC STOOL CULTURE ADD ISO,306,1 ,$77.05 ,$50.85 ,$3.40 ,$77.05 ,$3.40 ,$33.04 ,$33.04 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$3.40 ,$3.40 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$3.40 ,$47.78 ,$3.60 ,$69.35 ,$21.24 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$3.60 ,$11.33 ,$11.33 ,$20.38 ,$11.33 ,$9.44 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600108,87081,HC BODY FLUID CULTURE (MRSA),306,1 ,$124.20 ,$81.97 ,$6.63 ,$124.20 ,$6.85 ,$23.21 ,$23.21 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$6.85 ,$6.85 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$6.85 ,$77.00 ,$7.26 ,$111.78 ,$14.92 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$7.26 ,$7.96 ,$7.96 ,$32.86 ,$7.96 ,$6.63 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600109,87070,HC BODY FLUID CULTURE,306,1 ,$116.15 ,$76.66 ,$8.62 ,$116.15 ,$8.91 ,$30.17 ,$30.17 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$8.91 ,$8.91 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$8.91 ,$72.02 ,$9.44 ,$104.54 ,$19.40 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$9.44 ,$10.34 ,$10.34 ,$30.73 ,$10.34 ,$8.62 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600111,87070,"HC BODY FLUID CULTURE (CSF, WOUND,MISC)",306,1 ,$196.65 ,$129.79 ,$8.62 ,$196.65 ,$8.91 ,$30.17 ,$30.17 ,$52.04 ,$157.32 ,$167.15 ,$122.91 ,$176.99 ,$8.91 ,$8.91 ,$186.82 ,$176.99 ,$167.15 ,$167.15 ,$52.04 ,$167.15 ,$167.15 ,$176.99 ,$119.76 ,$8.91 ,$121.92 ,$9.44 ,$176.99 ,$19.40 ,$180.92 ,$176.99 ,$129.81 ,$129.81 ,$119.76 ,$129.81 ,$127.82 ,$134.35 ,$44.77 ,$155.35 ,$9.44 ,$10.34 ,$10.34 ,$52.04 ,$10.34 ,$8.62 ,$186.82 ,$161.25 ,$161.25 ,$157.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600112,87070,HC BODY FLUID CULTURE (WOUND),306,1 ,$196.65 ,$129.79 ,$8.62 ,$196.65 ,$8.91 ,$30.17 ,$30.17 ,$52.04 ,$157.32 ,$167.15 ,$122.91 ,$176.99 ,$8.91 ,$8.91 ,$186.82 ,$176.99 ,$167.15 ,$167.15 ,$52.04 ,$167.15 ,$167.15 ,$176.99 ,$119.76 ,$8.91 ,$121.92 ,$9.44 ,$176.99 ,$19.40 ,$180.92 ,$176.99 ,$129.81 ,$129.81 ,$119.76 ,$129.81 ,$127.82 ,$134.35 ,$44.77 ,$155.35 ,$9.44 ,$10.34 ,$10.34 ,$52.04 ,$10.34 ,$8.62 ,$186.82 ,$161.25 ,$161.25 ,$157.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600120,87075,HC CULTURE ANAEROBIC,306,1 ,$116.15 ,$76.66 ,$9.47 ,$116.15 ,$9.79 ,$33.15 ,$33.15 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$9.79 ,$9.79 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$9.79 ,$72.02 ,$10.38 ,$104.54 ,$21.31 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$10.38 ,$11.36 ,$11.36 ,$30.73 ,$11.36 ,$9.47 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600121,87076,HC CULTURE ANAEROBIC ID,306,1 ,$77.05 ,$50.85 ,$8.08 ,$77.05 ,$8.35 ,$28.28 ,$28.28 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.35 ,$8.35 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.35 ,$47.78 ,$8.85 ,$69.35 ,$18.18 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.85 ,$9.70 ,$9.70 ,$20.38 ,$9.70 ,$8.08 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600122,87076,HC CULTURE ANAEROBIC ID (ORGANISM),306,1 ,$77.05 ,$50.85 ,$8.08 ,$77.05 ,$8.35 ,$28.28 ,$28.28 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.35 ,$8.35 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.35 ,$47.78 ,$8.85 ,$69.35 ,$18.18 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.85 ,$9.70 ,$9.70 ,$20.38 ,$9.70 ,$8.08 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600123,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$77.05 ,$50.85 ,$8.08 ,$77.05 ,$8.35 ,$28.28 ,$28.28 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.35 ,$8.35 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.35 ,$47.78 ,$8.85 ,$69.35 ,$18.18 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.85 ,$9.70 ,$9.70 ,$20.38 ,$9.70 ,$8.08 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600124,87081,HC CULTURE SCR (MRSA),306,1 ,$64.40 ,$42.50 ,$6.63 ,$64.40 ,$6.85 ,$23.21 ,$23.21 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$6.85 ,$6.85 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$6.85 ,$39.92 ,$7.26 ,$57.96 ,$14.92 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$7.26 ,$7.96 ,$7.96 ,$17.04 ,$7.96 ,$6.63 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600125,87081,HC CULTURE SCR (GRP B STREP),306,1 ,$85.10 ,$56.17 ,$6.63 ,$85.10 ,$6.85 ,$23.21 ,$23.21 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$6.85 ,$6.85 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$6.85 ,$52.76 ,$7.26 ,$76.59 ,$14.92 ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$7.26 ,$7.96 ,$7.96 ,$22.52 ,$7.96 ,$6.63 ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600126,87081,HC CULTURE SCR (GC ONLY),306,1 ,$57.50 ,$37.95 ,$6.63 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$6.85 ,$6.85 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$6.85 ,$35.66 ,$7.26 ,$51.75 ,$14.92 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$15.22 ,$7.96 ,$6.63 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600127,87081,HC CULTURE SCR (LEGIONELLA),306,1 ,$57.50 ,$37.95 ,$6.63 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$6.85 ,$6.85 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$6.85 ,$35.66 ,$7.26 ,$51.75 ,$14.92 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$15.22 ,$7.96 ,$6.63 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600129,87081,HC CULTURE SCR (GRP A STREP),306,1 ,$57.50 ,$37.95 ,$6.63 ,$57.50 ,$6.85 ,$23.21 ,$23.21 ,$15.22 ,$46.00 ,$48.88 ,$35.94 ,$51.75 ,$6.85 ,$6.85 ,$54.63 ,$51.75 ,$48.88 ,$48.88 ,$15.22 ,$48.88 ,$48.88 ,$51.75 ,$35.02 ,$6.85 ,$35.66 ,$7.26 ,$51.75 ,$14.92 ,$52.90 ,$51.75 ,$37.96 ,$37.96 ,$35.02 ,$37.96 ,$37.38 ,$39.28 ,$13.09 ,$45.43 ,$7.26 ,$7.96 ,$7.96 ,$15.22 ,$7.96 ,$6.63 ,$54.63 ,$47.15 ,$47.15 ,$46.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600130,87081,HC CULTURE SCR (VRE),306,1 ,$133.40 ,$88.04 ,$6.63 ,$133.40 ,$6.85 ,$23.21 ,$23.21 ,$35.30 ,$106.72 ,$113.39 ,$83.38 ,$120.06 ,$6.85 ,$6.85 ,$126.73 ,$120.06 ,$113.39 ,$113.39 ,$35.30 ,$113.39 ,$113.39 ,$120.06 ,$81.24 ,$6.85 ,$82.70 ,$7.26 ,$120.06 ,$14.92 ,$122.73 ,$120.06 ,$88.06 ,$88.06 ,$81.24 ,$88.06 ,$86.71 ,$91.14 ,$30.37 ,$105.39 ,$7.26 ,$7.96 ,$7.96 ,$35.30 ,$7.96 ,$6.63 ,$126.73 ,$109.39 ,$109.39 ,$106.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600131,87081,HC CULTURE (MRSA),306,1 ,$64.40 ,$42.50 ,$6.63 ,$64.40 ,$6.85 ,$23.21 ,$23.21 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$6.85 ,$6.85 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$6.85 ,$39.92 ,$7.26 ,$57.96 ,$14.92 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$7.26 ,$7.96 ,$7.96 ,$17.04 ,$7.96 ,$6.63 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600132,87081,HC CULTURE (CLO TEST),306,1 ,$83.95 ,$55.41 ,$6.63 ,$83.95 ,$6.85 ,$23.21 ,$23.21 ,$22.22 ,$67.16 ,$71.36 ,$52.47 ,$75.56 ,$6.85 ,$6.85 ,$79.75 ,$75.56 ,$71.36 ,$71.36 ,$22.22 ,$71.36 ,$71.36 ,$75.56 ,$51.13 ,$6.85 ,$52.04 ,$7.26 ,$75.56 ,$14.92 ,$77.23 ,$75.56 ,$55.42 ,$55.42 ,$51.13 ,$55.42 ,$54.57 ,$57.35 ,$19.11 ,$66.32 ,$7.26 ,$7.96 ,$7.96 ,$22.22 ,$7.96 ,$6.63 ,$79.75 ,$68.84 ,$68.84 ,$67.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600133,87081,HC CULTURE SCR (BRUCELLA),306,1 ,$73.60 ,$48.58 ,$6.63 ,$73.60 ,$6.85 ,$23.21 ,$23.21 ,$19.47 ,$58.88 ,$62.56 ,$46.00 ,$66.24 ,$6.85 ,$6.85 ,$69.92 ,$66.24 ,$62.56 ,$62.56 ,$19.47 ,$62.56 ,$62.56 ,$66.24 ,$44.82 ,$6.85 ,$45.64 ,$7.26 ,$66.24 ,$14.92 ,$67.71 ,$66.24 ,$48.58 ,$48.58 ,$44.82 ,$48.58 ,$47.84 ,$50.28 ,$16.76 ,$58.14 ,$7.26 ,$7.96 ,$7.96 ,$19.47 ,$7.96 ,$6.63 ,$69.92 ,$60.35 ,$60.35 ,$58.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600134,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$77.05 ,$50.85 ,$8.07 ,$77.05 ,$8.34 ,$28.25 ,$28.25 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.34 ,$8.34 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.34 ,$47.78 ,$8.84 ,$69.35 ,$18.16 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.84 ,$9.68 ,$9.68 ,$20.38 ,$9.68 ,$8.07 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600135,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$77.05 ,$50.85 ,$8.09 ,$77.05 ,$8.36 ,$28.32 ,$28.32 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.36 ,$8.36 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.36 ,$47.78 ,$8.86 ,$69.35 ,$18.20 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$8.86 ,$9.71 ,$9.71 ,$20.38 ,$9.71 ,$8.09 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600136,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$154.10 ,$101.71 ,$7.71 ,$154.10 ,$7.97 ,$26.99 ,$26.99 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$7.97 ,$7.97 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$7.97 ,$95.54 ,$8.45 ,$138.69 ,$17.35 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$8.45 ,$9.25 ,$9.25 ,$40.78 ,$9.25 ,$7.71 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600138,87102,HC CULTURE FUNGUS OTHER,306,1 ,$89.70 ,$59.20 ,$8.41 ,$89.70 ,$8.69 ,$29.44 ,$29.44 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$8.69 ,$8.69 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$8.69 ,$55.62 ,$9.21 ,$80.73 ,$18.92 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$9.21 ,$10.09 ,$10.09 ,$23.74 ,$10.09 ,$8.41 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600140,87103,HC CULTURE FUNGUS BLOOD,306,1 ,$193.20 ,$127.51 ,$12.68 ,$193.20 ,$12.68 ,$71.61 ,$71.61 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$12.68 ,$12.68 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$12.68 ,$119.78 ,$13.44 ,$173.88 ,$46.04 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$13.44 ,$24.55 ,$24.55 ,$51.12 ,$24.55 ,$20.46 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600142,87106,HC CULTURE FUNGUS ID,306,1 ,$110.40 ,$72.86 ,$10.32 ,$110.40 ,$10.66 ,$36.12 ,$36.12 ,$29.21 ,$88.32 ,$93.84 ,$69.00 ,$99.36 ,$10.66 ,$10.66 ,$104.88 ,$99.36 ,$93.84 ,$93.84 ,$29.21 ,$93.84 ,$93.84 ,$99.36 ,$67.23 ,$10.66 ,$68.44 ,$11.30 ,$99.36 ,$23.22 ,$101.57 ,$99.36 ,$72.88 ,$72.88 ,$67.23 ,$72.88 ,$71.76 ,$75.43 ,$25.13 ,$87.22 ,$11.30 ,$12.38 ,$12.38 ,$29.21 ,$12.38 ,$10.32 ,$104.88 ,$90.53 ,$90.53 ,$88.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600145,87107,HC CULTURE FUNGUS ID MOLD,306,1 ,$89.70 ,$59.20 ,$10.32 ,$89.70 ,$10.66 ,$36.12 ,$36.12 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.66 ,$10.66 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.66 ,$55.62 ,$11.30 ,$80.73 ,$23.22 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.30 ,$12.38 ,$12.38 ,$23.74 ,$12.38 ,$10.32 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600146,87109,HC CULTURE MYCOPLASMA,306,1 ,$103.50 ,$68.31 ,$14.01 ,$103.50 ,$14.01 ,$53.87 ,$53.87 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$14.01 ,$14.01 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$14.01 ,$64.18 ,$14.85 ,$93.15 ,$34.63 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$14.85 ,$18.47 ,$18.47 ,$27.39 ,$18.47 ,$15.39 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600148,87116,HC CULTURE AFB/TB/MYCOBACT,306,1 ,$89.70 ,$59.20 ,$10.80 ,$89.70 ,$11.16 ,$37.80 ,$37.80 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$11.16 ,$11.16 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$11.16 ,$55.62 ,$11.83 ,$80.73 ,$24.30 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.83 ,$12.96 ,$12.96 ,$23.74 ,$12.96 ,$10.80 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600149,87116,HC CULTURE AFB/TB/MYCOBACT (BLOOD),306,1 ,$186.30 ,$122.96 ,$10.80 ,$186.30 ,$11.16 ,$37.80 ,$37.80 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$11.16 ,$11.16 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$11.16 ,$115.50 ,$11.83 ,$167.67 ,$24.30 ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$11.83 ,$12.96 ,$12.96 ,$49.29 ,$12.96 ,$10.80 ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600151,87118,HC MYCOBACTERIA ID BY HPLC,306,1 ,$180.55 ,$119.16 ,$14.61 ,$180.55 ,$15.10 ,$51.14 ,$51.14 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$15.10 ,$15.10 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$15.10 ,$111.94 ,$16.01 ,$162.50 ,$32.87 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$16.01 ,$17.53 ,$17.53 ,$47.77 ,$17.53 ,$14.61 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600152,87140,HC CLT TYP IF EA ANTISER (RESP),306,1 ,$21.85 ,$14.42 ,$4.98 ,$21.85 ,$5.76 ,$19.50 ,$19.50 ,$5.78 ,$17.48 ,$18.57 ,$13.66 ,$19.67 ,$5.76 ,$5.76 ,$20.76 ,$19.67 ,$18.57 ,$18.57 ,$5.78 ,$18.57 ,$18.57 ,$19.67 ,$13.31 ,$5.76 ,$13.54 ,$6.11 ,$19.67 ,$12.53 ,$20.10 ,$19.67 ,$14.42 ,$14.42 ,$13.31 ,$14.42 ,$14.20 ,$14.93 ,$4.98 ,$17.26 ,$6.11 ,$6.68 ,$6.68 ,$5.78 ,$6.68 ,$5.57 ,$20.76 ,$17.92 ,$17.92 ,$17.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600153,87140,HC CLT TYP IF EA ANTISER (CHLAM PNEUMO 1),306,1 ,$43.70 ,$28.84 ,$5.57 ,$43.70 ,$5.76 ,$19.50 ,$19.50 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$5.76 ,$5.76 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$5.76 ,$27.10 ,$6.11 ,$39.33 ,$12.53 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$6.11 ,$6.68 ,$6.68 ,$11.56 ,$6.68 ,$5.57 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600154,87140,HC CLT TYP IF EA ANTISER (CHLAM PNEUMO 2),306,1 ,$43.70 ,$28.84 ,$5.57 ,$43.70 ,$5.76 ,$19.50 ,$19.50 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$5.76 ,$5.76 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$5.76 ,$27.10 ,$6.11 ,$39.33 ,$12.53 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$6.11 ,$6.68 ,$6.68 ,$11.56 ,$6.68 ,$5.57 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600157,87140,HC CLT TYP IF EA ANTISER (ADENO/ENTERO),306,1 ,$24.15 ,$15.94 ,$5.50 ,$24.15 ,$5.76 ,$19.50 ,$19.50 ,$6.39 ,$19.32 ,$20.53 ,$15.09 ,$21.74 ,$5.76 ,$5.76 ,$22.94 ,$21.74 ,$20.53 ,$20.53 ,$6.39 ,$20.53 ,$20.53 ,$21.74 ,$14.71 ,$5.76 ,$14.98 ,$6.11 ,$21.74 ,$12.53 ,$22.22 ,$21.74 ,$15.94 ,$15.94 ,$14.71 ,$15.94 ,$15.70 ,$16.50 ,$5.50 ,$19.08 ,$6.11 ,$6.68 ,$6.68 ,$6.39 ,$6.68 ,$5.57 ,$22.94 ,$19.80 ,$19.80 ,$19.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600159,87147,HC CULTURE TYPE SEROLOGIC,306,1 ,$152.95 ,$100.95 ,$5.18 ,$152.95 ,$5.35 ,$18.13 ,$18.13 ,$40.47 ,$122.36 ,$130.01 ,$95.59 ,$137.66 ,$5.35 ,$5.35 ,$145.30 ,$137.66 ,$130.01 ,$130.01 ,$40.47 ,$130.01 ,$130.01 ,$137.66 ,$93.15 ,$5.35 ,$94.82 ,$5.67 ,$137.66 ,$11.66 ,$140.71 ,$137.66 ,$100.96 ,$100.96 ,$93.15 ,$100.96 ,$99.42 ,$104.50 ,$34.82 ,$120.83 ,$5.67 ,$6.22 ,$6.22 ,$40.47 ,$6.22 ,$5.18 ,$145.30 ,$125.42 ,$125.42 ,$122.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600161,87168,HC EXAM ARTHROPOD,306,1 ,$89.70 ,$59.20 ,$4.27 ,$89.70 ,$4.41 ,$14.95 ,$14.95 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$4.41 ,$4.41 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$4.41 ,$55.62 ,$4.67 ,$80.73 ,$9.61 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$4.67 ,$5.12 ,$5.12 ,$23.74 ,$5.12 ,$4.27 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600162,87169,HC PARASITE ID,306,1 ,$89.70 ,$59.20 ,$4.31 ,$89.70 ,$4.45 ,$15.09 ,$15.09 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$4.45 ,$4.45 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$4.45 ,$55.62 ,$4.72 ,$80.73 ,$9.70 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$4.72 ,$5.17 ,$5.17 ,$23.74 ,$5.17 ,$4.31 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600163,87172,HC PINWORM EXAM,306,1 ,$31.05 ,$20.49 ,$4.27 ,$31.05 ,$4.41 ,$14.95 ,$14.95 ,$8.21 ,$24.84 ,$26.39 ,$19.41 ,$27.95 ,$4.41 ,$4.41 ,$29.50 ,$27.95 ,$26.39 ,$26.39 ,$8.21 ,$26.39 ,$26.39 ,$27.95 ,$18.91 ,$4.41 ,$19.26 ,$4.67 ,$27.95 ,$9.61 ,$28.57 ,$27.95 ,$20.50 ,$20.50 ,$18.91 ,$20.50 ,$20.18 ,$21.21 ,$7.07 ,$24.53 ,$4.67 ,$5.12 ,$5.12 ,$8.21 ,$5.12 ,$4.27 ,$29.50 ,$25.46 ,$25.46 ,$24.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600164,87177,HC SMEAR OVA PARASITE CONC/ID,306,1 ,$77.05 ,$50.85 ,$8.90 ,$77.05 ,$9.20 ,$31.15 ,$31.15 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$9.20 ,$9.20 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$9.20 ,$47.78 ,$9.75 ,$69.35 ,$20.03 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.75 ,$10.68 ,$10.68 ,$20.38 ,$10.68 ,$8.90 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600166,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$89.70 ,$59.20 ,$4.75 ,$89.70 ,$4.91 ,$16.63 ,$16.63 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$4.91 ,$4.91 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$4.91 ,$55.62 ,$5.20 ,$80.73 ,$10.69 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$5.20 ,$5.70 ,$5.70 ,$23.74 ,$5.70 ,$4.75 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600168,87184,HC SENSITIVITY DISK KB (HAEMOPHILUS),306,1 ,$64.40 ,$42.50 ,$7.48 ,$64.40 ,$7.73 ,$26.18 ,$26.18 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$7.73 ,$7.73 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$7.73 ,$39.92 ,$8.19 ,$57.96 ,$16.83 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$8.19 ,$8.98 ,$8.98 ,$17.04 ,$8.98 ,$7.48 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600172,87186,HC SENSITIVITY MIC,306,1 ,$77.05 ,$50.85 ,$8.65 ,$77.05 ,$8.94 ,$30.28 ,$30.28 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.94 ,$8.94 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.94 ,$47.78 ,$9.48 ,$69.35 ,$19.46 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.48 ,$10.38 ,$10.38 ,$20.38 ,$10.38 ,$8.65 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$51.75 ,$34.16 ,$4.27 ,$51.75 ,$4.41 ,$14.95 ,$14.95 ,$13.69 ,$41.40 ,$43.99 ,$32.34 ,$46.58 ,$4.41 ,$4.41 ,$49.16 ,$46.58 ,$43.99 ,$43.99 ,$13.69 ,$43.99 ,$43.99 ,$46.58 ,$31.52 ,$4.41 ,$32.08 ,$4.67 ,$46.58 ,$9.61 ,$47.61 ,$46.58 ,$34.16 ,$34.16 ,$31.52 ,$34.16 ,$33.64 ,$35.36 ,$11.78 ,$40.88 ,$4.67 ,$5.12 ,$5.12 ,$13.69 ,$5.12 ,$4.27 ,$49.16 ,$42.44 ,$42.44 ,$41.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600176,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$52.90 ,$34.91 ,$5.39 ,$52.90 ,$5.57 ,$18.87 ,$18.87 ,$13.99 ,$42.32 ,$44.97 ,$33.06 ,$47.61 ,$5.57 ,$5.57 ,$50.26 ,$47.61 ,$44.97 ,$44.97 ,$13.99 ,$44.97 ,$44.97 ,$47.61 ,$32.22 ,$5.57 ,$32.80 ,$5.90 ,$47.61 ,$12.13 ,$48.67 ,$47.61 ,$34.92 ,$34.92 ,$32.22 ,$34.92 ,$34.39 ,$36.14 ,$12.04 ,$41.79 ,$5.90 ,$6.47 ,$6.47 ,$13.99 ,$6.47 ,$5.39 ,$50.26 ,$43.38 ,$43.38 ,$42.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600177,87206,HC SMEAR ACID FAST/FLUOR (FUNGUS),306,1 ,$154.10 ,$101.71 ,$5.39 ,$154.10 ,$5.57 ,$18.87 ,$18.87 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$5.57 ,$5.57 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$5.57 ,$95.54 ,$5.90 ,$138.69 ,$12.13 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$5.90 ,$6.47 ,$6.47 ,$40.78 ,$6.47 ,$5.39 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600179,87207,HC SPECIAL STAIN (MALARIA),306,1 ,$167.90 ,$110.81 ,$5.99 ,$167.90 ,$6.19 ,$20.97 ,$20.97 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$6.19 ,$6.19 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$6.19 ,$104.10 ,$6.56 ,$151.11 ,$13.48 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$6.56 ,$7.19 ,$7.19 ,$44.42 ,$7.19 ,$5.99 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600180,87207,HC SPECIAL STAIN (TZANCK EVAL),306,1 ,$85.10 ,$56.17 ,$5.99 ,$85.10 ,$6.19 ,$20.97 ,$20.97 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$6.19 ,$6.19 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$6.19 ,$52.76 ,$6.56 ,$76.59 ,$13.48 ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$6.56 ,$7.19 ,$7.19 ,$22.52 ,$7.19 ,$5.99 ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600182,87209,HC OVA  AND  PARASITE W/STAIN,306,1 ,$103.50 ,$68.31 ,$17.98 ,$103.50 ,$18.58 ,$62.93 ,$62.93 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$18.58 ,$18.58 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$18.58 ,$64.18 ,$19.69 ,$93.15 ,$40.46 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$19.69 ,$21.58 ,$21.58 ,$27.39 ,$21.58 ,$17.98 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600183,87210,HC SMEAR WET MOUNT,306,1 ,$36.80 ,$24.29 ,$5.82 ,$36.80 ,$6.00 ,$20.37 ,$20.37 ,$9.74 ,$29.44 ,$31.28 ,$23.00 ,$33.12 ,$6.00 ,$6.00 ,$34.96 ,$33.12 ,$31.28 ,$31.28 ,$9.74 ,$31.28 ,$31.28 ,$33.12 ,$22.41 ,$6.00 ,$22.82 ,$6.36 ,$33.12 ,$13.10 ,$33.86 ,$33.12 ,$24.29 ,$24.29 ,$22.41 ,$24.29 ,$23.92 ,$25.14 ,$8.37 ,$29.07 ,$6.36 ,$6.98 ,$6.98 ,$9.74 ,$6.98 ,$5.82 ,$34.96 ,$30.18 ,$30.18 ,$29.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600184,87210,HC SMEAR WET MOUNT (FUNGUS),306,1 ,$51.75 ,$34.16 ,$5.82 ,$51.75 ,$6.00 ,$20.37 ,$20.37 ,$13.69 ,$41.40 ,$43.99 ,$32.34 ,$46.58 ,$6.00 ,$6.00 ,$49.16 ,$46.58 ,$43.99 ,$43.99 ,$13.69 ,$43.99 ,$43.99 ,$46.58 ,$31.52 ,$6.00 ,$32.08 ,$6.36 ,$46.58 ,$13.10 ,$47.61 ,$46.58 ,$34.16 ,$34.16 ,$31.52 ,$34.16 ,$33.64 ,$35.36 ,$11.78 ,$40.88 ,$6.36 ,$6.98 ,$6.98 ,$13.69 ,$6.98 ,$5.82 ,$49.16 ,$42.44 ,$42.44 ,$41.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600185,87220,HC TISSUE KOH PREP,306,1 ,$60.95 ,$40.23 ,$4.27 ,$60.95 ,$4.41 ,$14.95 ,$14.95 ,$16.13 ,$48.76 ,$51.81 ,$38.09 ,$54.86 ,$4.41 ,$4.41 ,$57.90 ,$54.86 ,$51.81 ,$51.81 ,$16.13 ,$51.81 ,$51.81 ,$54.86 ,$37.12 ,$4.41 ,$37.78 ,$4.67 ,$54.86 ,$9.61 ,$56.07 ,$54.86 ,$40.23 ,$40.23 ,$37.12 ,$40.23 ,$39.62 ,$41.64 ,$13.88 ,$48.15 ,$4.67 ,$5.12 ,$5.12 ,$16.13 ,$5.12 ,$4.27 ,$57.90 ,$49.98 ,$49.98 ,$48.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600186,87230,HC TOXIN ANTITOXIN ASSAY,306,1 ,$150.65 ,$99.43 ,$19.74 ,$150.65 ,$20.40 ,$69.09 ,$69.09 ,$39.87 ,$120.52 ,$128.05 ,$94.16 ,$135.59 ,$20.40 ,$20.40 ,$143.12 ,$135.59 ,$128.05 ,$128.05 ,$39.87 ,$128.05 ,$128.05 ,$135.59 ,$91.75 ,$20.40 ,$93.40 ,$21.62 ,$135.59 ,$44.42 ,$138.60 ,$135.59 ,$99.44 ,$99.44 ,$91.75 ,$99.44 ,$97.92 ,$102.92 ,$34.30 ,$119.01 ,$21.62 ,$23.69 ,$23.69 ,$39.87 ,$23.69 ,$19.74 ,$143.12 ,$123.53 ,$123.53 ,$120.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600187,87252,HC CULTURE VIRUS ID TISS (CMV),306,1 ,$232.30 ,$153.32 ,$26.07 ,$232.30 ,$26.94 ,$91.25 ,$91.25 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$26.94 ,$26.94 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$26.94 ,$144.02 ,$28.56 ,$209.07 ,$58.66 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$28.56 ,$31.28 ,$31.28 ,$61.47 ,$31.28 ,$26.07 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600188,87252,HC CULTURE VIRUS ID TISS (HERPES),306,1 ,$232.30 ,$153.32 ,$26.07 ,$232.30 ,$26.94 ,$91.25 ,$91.25 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$26.94 ,$26.94 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$26.94 ,$144.02 ,$28.56 ,$209.07 ,$58.66 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$28.56 ,$31.28 ,$31.28 ,$61.47 ,$31.28 ,$26.07 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600189,87252,HC CULTURE VIRUS ID TISS (RESP),306,1 ,$131.10 ,$86.53 ,$26.07 ,$131.10 ,$26.94 ,$91.25 ,$91.25 ,$34.69 ,$104.88 ,$111.44 ,$81.94 ,$117.99 ,$26.94 ,$26.94 ,$124.55 ,$117.99 ,$111.44 ,$111.44 ,$34.69 ,$111.44 ,$111.44 ,$117.99 ,$79.84 ,$26.94 ,$81.28 ,$28.56 ,$117.99 ,$58.66 ,$120.61 ,$117.99 ,$86.54 ,$86.54 ,$79.84 ,$86.54 ,$85.22 ,$89.57 ,$29.84 ,$103.57 ,$28.56 ,$31.28 ,$31.28 ,$34.69 ,$31.28 ,$26.07 ,$124.55 ,$107.50 ,$107.50 ,$104.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600193,87254,HC VIRUS ISOL SHELL ID (CMV),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$7.06 ,$7.06 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$7.06 ,$104.10 ,$7.48 ,$151.11 ,$44.01 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$44.42 ,$23.47 ,$19.56 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600194,87254,HC VIRUS ISOL SHELL ID (RESP),306,1 ,$105.80 ,$69.83 ,$7.06 ,$105.80 ,$7.06 ,$68.46 ,$68.46 ,$28.00 ,$84.64 ,$89.93 ,$66.13 ,$95.22 ,$7.06 ,$7.06 ,$100.51 ,$95.22 ,$89.93 ,$89.93 ,$28.00 ,$89.93 ,$89.93 ,$95.22 ,$64.43 ,$7.06 ,$65.60 ,$7.48 ,$95.22 ,$44.01 ,$97.34 ,$95.22 ,$69.84 ,$69.84 ,$64.43 ,$69.84 ,$68.77 ,$72.28 ,$24.08 ,$83.58 ,$7.48 ,$23.47 ,$23.47 ,$28.00 ,$23.47 ,$19.56 ,$100.51 ,$86.76 ,$86.76 ,$84.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600195,87254,HC VIRUS ISOL SHELL ID (VARI),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$7.06 ,$7.06 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$7.06 ,$104.10 ,$7.48 ,$151.11 ,$44.01 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$44.42 ,$23.47 ,$19.56 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600196,87254,HC VIRUS ISOL SHELL ID (CHLAM PNEUMO 1),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$7.06 ,$7.06 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$7.06 ,$104.10 ,$7.48 ,$151.11 ,$44.01 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$44.42 ,$23.47 ,$19.56 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600197,87254,HC VIRUS ISOL SHELL ID (CHLAM PNEUMO 2),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$7.06 ,$7.06 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$7.06 ,$104.10 ,$7.48 ,$151.11 ,$44.01 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$44.42 ,$23.47 ,$19.56 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600198,87254,HC VIRUS ISOL SHELL ID (CHLAM TRACH),306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$7.06 ,$7.06 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$7.06 ,$104.10 ,$7.48 ,$151.11 ,$44.01 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$44.42 ,$23.47 ,$19.56 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600200,87260,HC IF ADENOVIRUS AG,306,1 ,$97.75 ,$64.52 ,$14.43 ,$97.75 ,$14.91 ,$50.51 ,$50.51 ,$25.86 ,$78.20 ,$83.09 ,$61.09 ,$87.98 ,$14.91 ,$14.91 ,$92.86 ,$87.98 ,$83.09 ,$83.09 ,$25.86 ,$83.09 ,$83.09 ,$87.98 ,$59.53 ,$14.91 ,$60.60 ,$15.80 ,$87.98 ,$32.47 ,$89.93 ,$87.98 ,$64.52 ,$64.52 ,$59.53 ,$64.52 ,$63.54 ,$66.78 ,$22.25 ,$77.22 ,$15.80 ,$17.32 ,$17.32 ,$25.86 ,$17.32 ,$14.43 ,$92.86 ,$80.16 ,$80.16 ,$78.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600202,87273,HC IF HERPES SIMPLEX 2 AG,306,1 ,$97.75 ,$64.52 ,$11.98 ,$97.75 ,$12.38 ,$41.93 ,$41.93 ,$25.86 ,$78.20 ,$83.09 ,$61.09 ,$87.98 ,$12.38 ,$12.38 ,$92.86 ,$87.98 ,$83.09 ,$83.09 ,$25.86 ,$83.09 ,$83.09 ,$87.98 ,$59.53 ,$12.38 ,$60.60 ,$13.12 ,$87.98 ,$26.96 ,$89.93 ,$87.98 ,$64.52 ,$64.52 ,$59.53 ,$64.52 ,$63.54 ,$66.78 ,$22.25 ,$77.22 ,$13.12 ,$14.38 ,$14.38 ,$25.86 ,$14.38 ,$11.98 ,$92.86 ,$80.16 ,$80.16 ,$78.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600203,87274,HC IF HERPES SIMPLEX 1 AG,306,1 ,$97.75 ,$64.52 ,$11.98 ,$97.75 ,$12.38 ,$41.93 ,$41.93 ,$25.86 ,$78.20 ,$83.09 ,$61.09 ,$87.98 ,$12.38 ,$12.38 ,$92.86 ,$87.98 ,$83.09 ,$83.09 ,$25.86 ,$83.09 ,$83.09 ,$87.98 ,$59.53 ,$12.38 ,$60.60 ,$13.12 ,$87.98 ,$26.96 ,$89.93 ,$87.98 ,$64.52 ,$64.52 ,$59.53 ,$64.52 ,$63.54 ,$66.78 ,$22.25 ,$77.22 ,$13.12 ,$14.38 ,$14.38 ,$25.86 ,$14.38 ,$11.98 ,$92.86 ,$80.16 ,$80.16 ,$78.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600204,87275,HC IF INFLUENZA B AG,306,1 ,$125.35 ,$82.73 ,$12.25 ,$125.35 ,$12.66 ,$42.88 ,$42.88 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$12.66 ,$12.66 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$12.66 ,$77.72 ,$13.42 ,$112.82 ,$27.56 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$13.42 ,$14.70 ,$14.70 ,$33.16 ,$14.70 ,$12.25 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600205,87276,HC IF INFLUENZA A AG,306,1 ,$125.35 ,$82.73 ,$16.07 ,$125.35 ,$16.61 ,$56.25 ,$56.25 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$16.61 ,$16.61 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$16.61 ,$77.72 ,$17.61 ,$112.82 ,$36.16 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$17.61 ,$19.28 ,$19.28 ,$33.16 ,$19.28 ,$16.07 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600206,87278,HC IF LEGIONELLA AG,306,1 ,$77.05 ,$50.85 ,$15.60 ,$77.05 ,$16.12 ,$54.60 ,$54.60 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$16.12 ,$16.12 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$16.12 ,$47.78 ,$17.09 ,$69.35 ,$35.10 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$17.09 ,$18.72 ,$18.72 ,$20.38 ,$18.72 ,$15.60 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600207,87279,HC IF PARAFLUENZA AG,306,1 ,$97.75 ,$64.52 ,$16.43 ,$97.75 ,$16.86 ,$57.51 ,$57.51 ,$25.86 ,$78.20 ,$83.09 ,$61.09 ,$87.98 ,$16.86 ,$16.86 ,$92.86 ,$87.98 ,$83.09 ,$83.09 ,$25.86 ,$83.09 ,$83.09 ,$87.98 ,$59.53 ,$16.86 ,$60.60 ,$17.87 ,$87.98 ,$36.97 ,$89.93 ,$87.98 ,$64.52 ,$64.52 ,$59.53 ,$64.52 ,$63.54 ,$66.78 ,$22.25 ,$77.22 ,$17.87 ,$19.72 ,$19.72 ,$25.86 ,$19.72 ,$16.43 ,$92.86 ,$80.16 ,$80.16 ,$78.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600208,87280,HC IF RSV AG,306,1 ,$128.80 ,$85.01 ,$13.42 ,$128.80 ,$13.87 ,$46.97 ,$46.97 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$13.87 ,$13.87 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$13.87 ,$79.86 ,$14.70 ,$115.92 ,$30.20 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$14.70 ,$16.10 ,$16.10 ,$34.08 ,$16.10 ,$13.42 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600209,87281,HC IF PNEUMOCYST CARINII AG,306,1 ,$128.80 ,$85.01 ,$11.98 ,$128.80 ,$12.38 ,$41.93 ,$41.93 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$12.38 ,$12.38 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$12.38 ,$79.86 ,$13.12 ,$115.92 ,$26.96 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$13.12 ,$14.38 ,$14.38 ,$34.08 ,$14.38 ,$11.98 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600210,87290,HC IF VARICELLA ZOETER AG,306,1 ,$125.35 ,$82.73 ,$13.42 ,$125.35 ,$13.87 ,$46.97 ,$46.97 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$13.87 ,$13.87 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$13.87 ,$77.72 ,$14.70 ,$112.82 ,$30.20 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$14.70 ,$16.10 ,$16.10 ,$33.16 ,$16.10 ,$13.42 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600211,87300,HC IF POLYVALENT MLT ORG AG,306,1 ,$97.75 ,$64.52 ,$8.66 ,$97.75 ,$8.66 ,$41.93 ,$41.93 ,$25.86 ,$78.20 ,$83.09 ,$61.09 ,$87.98 ,$8.66 ,$8.66 ,$92.86 ,$87.98 ,$83.09 ,$83.09 ,$25.86 ,$83.09 ,$83.09 ,$87.98 ,$59.53 ,$8.66 ,$60.60 ,$9.18 ,$87.98 ,$26.96 ,$89.93 ,$87.98 ,$64.52 ,$64.52 ,$59.53 ,$64.52 ,$63.54 ,$66.78 ,$22.25 ,$77.22 ,$9.18 ,$14.38 ,$14.38 ,$25.86 ,$14.38 ,$11.98 ,$92.86 ,$80.16 ,$80.16 ,$78.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600212,87305,HC EIA QL ASPERGILLUS AG,306,1 ,$154.10 ,$101.71 ,$11.98 ,$154.10 ,$12.38 ,$41.93 ,$41.93 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$12.38 ,$12.38 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$12.38 ,$95.54 ,$13.12 ,$138.69 ,$26.96 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$13.12 ,$14.38 ,$14.38 ,$40.78 ,$14.38 ,$11.98 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$125.35 ,$82.73 ,$11.98 ,$125.35 ,$12.38 ,$41.93 ,$41.93 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$12.38 ,$12.38 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$12.38 ,$77.72 ,$13.12 ,$112.82 ,$26.96 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$13.12 ,$14.38 ,$14.38 ,$33.16 ,$14.38 ,$11.98 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600214,87327,HC EIA QL CRYPTOCOCCUS AG,306,1 ,$125.35 ,$82.73 ,$13.42 ,$125.35 ,$13.87 ,$46.97 ,$46.97 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$13.87 ,$13.87 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$13.87 ,$77.72 ,$14.70 ,$112.82 ,$30.20 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$14.70 ,$16.10 ,$16.10 ,$33.16 ,$16.10 ,$13.42 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600215,87328,HC EIA QL CRYPTOSPORIDIUM AG,306,1 ,$55.20 ,$36.43 ,$12.57 ,$55.20 ,$14.28 ,$48.37 ,$48.37 ,$14.60 ,$44.16 ,$46.92 ,$34.50 ,$49.68 ,$14.28 ,$14.28 ,$52.44 ,$49.68 ,$46.92 ,$46.92 ,$14.60 ,$46.92 ,$46.92 ,$49.68 ,$33.62 ,$14.28 ,$34.22 ,$15.14 ,$49.68 ,$31.10 ,$50.78 ,$49.68 ,$36.44 ,$36.44 ,$33.62 ,$36.44 ,$35.88 ,$37.71 ,$12.57 ,$43.61 ,$15.14 ,$16.58 ,$16.58 ,$14.60 ,$16.58 ,$13.82 ,$52.44 ,$45.26 ,$45.26 ,$44.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600216,87329,HC EIA QL GIARDIA AG,306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600217,87338,HC EIA QL H PYLORI AG STOOL,306,1 ,$154.10 ,$101.71 ,$14.38 ,$154.10 ,$14.86 ,$50.33 ,$50.33 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 ,$14.86 ,$14.86 ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 ,$14.86 ,$95.54 ,$15.75 ,$138.69 ,$32.36 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 ,$15.75 ,$17.26 ,$17.26 ,$40.78 ,$17.26 ,$14.38 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600218,87340,HC EIA QL HEPATITIS B AG,306,1 ,$89.70 ,$59.20 ,$10.33 ,$89.70 ,$10.67 ,$36.16 ,$36.16 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.67 ,$10.67 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.67 ,$55.62 ,$11.31 ,$80.73 ,$23.24 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.31 ,$12.40 ,$12.40 ,$23.74 ,$12.40 ,$10.33 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600219,87340,HC EIA QL HEPATITIS ABC B AG,306,1 ,$89.70 ,$59.20 ,$10.33 ,$89.70 ,$10.67 ,$36.16 ,$36.16 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.67 ,$10.67 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.67 ,$55.62 ,$11.31 ,$80.73 ,$23.24 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.31 ,$12.40 ,$12.40 ,$23.74 ,$12.40 ,$10.33 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600220,87341,HC EIA QL HEPATITIS B AG NEUT,306,1 ,$89.70 ,$59.20 ,$10.33 ,$89.70 ,$10.67 ,$36.16 ,$36.16 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$10.67 ,$10.67 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$10.67 ,$55.62 ,$11.31 ,$80.73 ,$23.24 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$11.31 ,$12.40 ,$12.40 ,$23.74 ,$12.40 ,$10.33 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600221,87350,HC HEPATITIS BE AG QL,306,1 ,$77.05 ,$50.85 ,$11.53 ,$77.05 ,$11.91 ,$40.36 ,$40.36 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$11.91 ,$11.91 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$11.91 ,$47.78 ,$12.62 ,$69.35 ,$25.94 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$12.62 ,$13.84 ,$13.84 ,$20.38 ,$13.84 ,$11.53 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600222,87385,HC EIA QL HISTOPLASMA AG,306,1 ,$180.55 ,$119.16 ,$13.25 ,$180.55 ,$13.69 ,$46.38 ,$46.38 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$13.69 ,$13.69 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$13.69 ,$111.94 ,$14.51 ,$162.50 ,$29.81 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$14.51 ,$15.90 ,$15.90 ,$47.77 ,$15.90 ,$13.25 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600223,87385,HC EIA QL HISTOPLASMA AG (URINE),306,1 ,$167.90 ,$110.81 ,$13.25 ,$167.90 ,$13.69 ,$46.38 ,$46.38 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$13.69 ,$13.69 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$13.69 ,$104.10 ,$14.51 ,$151.11 ,$29.81 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$14.51 ,$15.90 ,$15.90 ,$44.42 ,$15.90 ,$13.25 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600225,87400,HC EIA QL INFLUENZA A/B AG,306,1 ,$93.15 ,$61.48 ,$8.66 ,$93.15 ,$8.66 ,$49.46 ,$49.46 ,$24.65 ,$74.52 ,$79.18 ,$58.22 ,$83.84 ,$8.66 ,$8.66 ,$88.49 ,$83.84 ,$79.18 ,$79.18 ,$24.65 ,$79.18 ,$79.18 ,$83.84 ,$56.73 ,$8.66 ,$57.76 ,$9.18 ,$83.84 ,$31.79 ,$85.70 ,$83.84 ,$61.49 ,$61.49 ,$56.73 ,$61.49 ,$60.55 ,$63.64 ,$21.20 ,$73.59 ,$9.18 ,$16.96 ,$16.96 ,$24.65 ,$16.96 ,$14.13 ,$88.49 ,$76.38 ,$76.38 ,$74.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600226,87420,HC RSV AG QL,306,1 ,$128.80 ,$85.01 ,$13.91 ,$128.80 ,$14.37 ,$48.69 ,$48.69 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$14.37 ,$14.37 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$14.37 ,$79.86 ,$15.23 ,$115.92 ,$31.30 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$15.23 ,$16.69 ,$16.69 ,$34.08 ,$16.69 ,$13.91 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600227,87425,HC EIA QL ROTAVIRUS AG,306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600230,87449,HC EIA QL MLT AG INF (LEGION),306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600231,87449,HC EIA QL MLT AG INF (S. PNEUMO),306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600232,87449,HC EIA QL MLT AG INF (NOROVIRUS),306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600233,87449,HC EIA QL MLT AG INF (BLASTO),306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600235,87476,HC LYMES DNA DETECT PCR,306,1 ,$407.10 ,$268.69 ,$35.09 ,$407.10 ,$36.26 ,$122.82 ,$122.82 ,$107.72 ,$325.68 ,$346.04 ,$254.44 ,$366.39 ,$36.26 ,$36.26 ,$386.75 ,$366.39 ,$346.04 ,$346.04 ,$107.72 ,$346.04 ,$346.04 ,$366.39 ,$247.92 ,$36.26 ,$252.40 ,$38.44 ,$366.39 ,$78.95 ,$374.53 ,$366.39 ,$268.73 ,$268.73 ,$247.92 ,$268.73 ,$264.62 ,$278.13 ,$92.68 ,$321.61 ,$38.44 ,$42.11 ,$42.11 ,$107.72 ,$42.11 ,$35.09 ,$386.75 ,$333.82 ,$333.82 ,$325.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600236,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600237,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$309.35 ,$204.17 ,$37.27 ,$309.35 ,$38.51 ,$130.45 ,$130.45 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$38.51 ,$38.51 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$38.51 ,$191.80 ,$40.82 ,$278.42 ,$83.86 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$40.82 ,$44.72 ,$44.72 ,$81.85 ,$44.72 ,$37.27 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600238,87497,HC CMV QN,306,1 ,$296.70 ,$195.82 ,$42.84 ,$296.70 ,$44.27 ,$149.94 ,$149.94 ,$78.51 ,$237.36 ,$252.20 ,$185.44 ,$267.03 ,$44.27 ,$44.27 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,$44.27 ,$183.96 ,$46.93 ,$267.03 ,$96.39 ,$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,$46.93 ,$51.41 ,$51.41 ,$78.51 ,$51.41 ,$42.84 ,$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600239,87498,HC ENTEROVIRUS AMP PROBE,306,1 ,$285.20 ,$188.23 ,$35.09 ,$285.20 ,$36.26 ,$122.82 ,$122.82 ,$75.46 ,$228.16 ,$242.42 ,$178.25 ,$256.68 ,$36.26 ,$36.26 ,$270.94 ,$256.68 ,$242.42 ,$242.42 ,$75.46 ,$242.42 ,$242.42 ,$256.68 ,$173.69 ,$36.26 ,$176.82 ,$38.44 ,$256.68 ,$78.95 ,$262.38 ,$256.68 ,$188.26 ,$188.26 ,$173.69 ,$188.26 ,$185.38 ,$194.85 ,$64.93 ,$225.31 ,$38.44 ,$42.11 ,$42.11 ,$75.46 ,$42.11 ,$35.09 ,$270.94 ,$233.86 ,$233.86 ,$228.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600241,87517,HC HEPATITIS B QN (PCR),306,1 ,$425.50 ,$280.83 ,$42.84 ,$425.50 ,$44.27 ,$149.94 ,$149.94 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$44.27 ,$44.27 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$44.27 ,$263.82 ,$46.93 ,$382.95 ,$96.39 ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$46.93 ,$51.41 ,$51.41 ,$112.59 ,$51.41 ,$42.84 ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600242,87522,HC HEPATITIS C QN,306,1 ,$373.75 ,$246.68 ,$42.84 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$98.89 ,$299.00 ,$317.69 ,$233.59 ,$336.38 ,$44.27 ,$44.27 ,$355.06 ,$336.38 ,$317.69 ,$317.69 ,$98.89 ,$317.69 ,$317.69 ,$336.38 ,$227.61 ,$44.27 ,$231.72 ,$46.93 ,$336.38 ,$96.39 ,$343.85 ,$336.38 ,$246.71 ,$246.71 ,$227.61 ,$246.71 ,$242.94 ,$255.35 ,$85.08 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$98.89 ,$51.41 ,$42.84 ,$355.06 ,$306.48 ,$306.48 ,$299.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600244,87529,HC HERPES SIMPLEX AMP,306,1 ,$205.85 ,$135.86 ,$35.09 ,$205.85 ,$36.26 ,$122.82 ,$122.82 ,$54.47 ,$164.68 ,$174.97 ,$128.66 ,$185.27 ,$36.26 ,$36.26 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$36.26 ,$127.62 ,$38.44 ,$185.27 ,$78.95 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,$38.44 ,$42.11 ,$42.11 ,$54.47 ,$42.11 ,$35.09 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600245,87535,HC PROBE HIV-1 AMP,306,1 ,$373.75 ,$246.68 ,$35.09 ,$373.75 ,$36.26 ,$122.82 ,$122.82 ,$98.89 ,$299.00 ,$317.69 ,$233.59 ,$336.38 ,$36.26 ,$36.26 ,$355.06 ,$336.38 ,$317.69 ,$317.69 ,$98.89 ,$317.69 ,$317.69 ,$336.38 ,$227.61 ,$36.26 ,$231.72 ,$38.44 ,$336.38 ,$78.95 ,$343.85 ,$336.38 ,$246.71 ,$246.71 ,$227.61 ,$246.71 ,$242.94 ,$255.35 ,$85.08 ,$295.26 ,$38.44 ,$42.11 ,$42.11 ,$98.89 ,$42.11 ,$35.09 ,$355.06 ,$306.48 ,$306.48 ,$299.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600246,87536,HC HIV-1 QN,306,1 ,$373.75 ,$246.68 ,$85.08 ,$373.75 ,$87.93 ,$297.85 ,$297.85 ,$98.89 ,$299.00 ,$317.69 ,$233.59 ,$336.38 ,$87.93 ,$87.93 ,$355.06 ,$336.38 ,$317.69 ,$317.69 ,$98.89 ,$317.69 ,$317.69 ,$336.38 ,$227.61 ,$87.93 ,$231.72 ,$93.21 ,$336.38 ,$191.48 ,$343.85 ,$336.38 ,$246.71 ,$246.71 ,$227.61 ,$246.71 ,$242.94 ,$255.35 ,$85.08 ,$295.26 ,$93.21 ,$102.12 ,$102.12 ,$98.89 ,$102.12 ,$85.10 ,$355.06 ,$306.48 ,$306.48 ,$299.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600248,87556,HC MTB COMPLEX PCR,306,1 ,$257.60 ,$170.02 ,$41.68 ,$257.60 ,$43.07 ,$145.88 ,$145.88 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$43.07 ,$43.07 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$43.07 ,$159.72 ,$45.65 ,$231.84 ,$93.78 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$45.65 ,$50.02 ,$50.02 ,$68.16 ,$50.02 ,$41.68 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600249,87591,HC NEISSERIA AMP,306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600250,87624,HC HPV AMP,306,1 ,$162.15 ,$107.02 ,$35.09 ,$162.15 ,$36.26 ,$122.82 ,$122.82 ,$42.90 ,$129.72 ,$137.83 ,$101.34 ,$145.94 ,$36.26 ,$36.26 ,$154.04 ,$145.94 ,$137.83 ,$137.83 ,$42.90 ,$137.83 ,$137.83 ,$145.94 ,$98.75 ,$36.26 ,$100.54 ,$38.44 ,$145.94 ,$78.95 ,$149.18 ,$145.94 ,$107.04 ,$107.04 ,$98.75 ,$107.04 ,$105.40 ,$110.78 ,$36.91 ,$128.10 ,$38.44 ,$42.11 ,$42.11 ,$42.90 ,$42.11 ,$35.09 ,$154.04 ,$132.96 ,$132.96 ,$129.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600254,87640,HC STAPH AURE AMP PROBE,306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600255,87641,HC MRSA AMP,306,1 ,$141.45 ,$93.36 ,$32.20 ,$141.45 ,$36.26 ,$122.82 ,$122.82 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$36.26 ,$36.26 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$36.26 ,$87.70 ,$38.44 ,$127.31 ,$78.95 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$38.44 ,$42.11 ,$42.11 ,$37.43 ,$42.11 ,$35.09 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600256,87798,HC INFECT AMP (BORDETELLA),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600257,87653,HC INFECT AMP (GRP B STREP),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600258,87798,HC INFECT AMP (PNEUMO),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600259,87798,HC INFECT AMP (WEST NILE),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600260,87798,HC INFECT AMP (PARVOVIRUS),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600262,87798,HC INFECT AMP (A PHAGO),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600263,87798,HC INFECT AMP (RSV),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600267,87799,HC INFECT AGENT QN,306,1 ,$373.75 ,$246.68 ,$42.84 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$98.89 ,$299.00 ,$317.69 ,$233.59 ,$336.38 ,$44.27 ,$44.27 ,$355.06 ,$336.38 ,$317.69 ,$317.69 ,$98.89 ,$317.69 ,$317.69 ,$336.38 ,$227.61 ,$44.27 ,$231.72 ,$46.93 ,$336.38 ,$96.39 ,$343.85 ,$336.38 ,$246.71 ,$246.71 ,$227.61 ,$246.71 ,$242.94 ,$255.35 ,$85.08 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$98.89 ,$51.41 ,$42.84 ,$355.06 ,$306.48 ,$306.48 ,$299.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600270,87880,HC OPTICAL STREP,306,1 ,$103.50 ,$68.31 ,$16.53 ,$103.50 ,$16.86 ,$57.86 ,$57.86 ,$27.39 ,$82.80 ,$87.98 ,$64.69 ,$93.15 ,$16.86 ,$16.86 ,$98.33 ,$93.15 ,$87.98 ,$87.98 ,$27.39 ,$87.98 ,$87.98 ,$93.15 ,$63.03 ,$16.86 ,$64.18 ,$17.87 ,$93.15 ,$37.19 ,$95.22 ,$93.15 ,$68.32 ,$68.32 ,$63.03 ,$68.32 ,$67.28 ,$70.71 ,$23.57 ,$81.77 ,$17.87 ,$19.84 ,$19.84 ,$27.39 ,$19.84 ,$16.53 ,$98.33 ,$84.87 ,$84.87 ,$82.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600271,87899,HC INFECT AGENT DETECT OPTICAL,306,1 ,$77.05 ,$50.85 ,$16.07 ,$77.05 ,$16.61 ,$56.25 ,$56.25 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$16.61 ,$16.61 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$16.61 ,$47.78 ,$17.61 ,$69.35 ,$36.16 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$17.61 ,$19.28 ,$19.28 ,$20.38 ,$19.28 ,$16.07 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600272,87902,HC GENTOYPE HEP C,306,1 ,"$1,803.20 ","$1,190.11 ",$257.45 ,"$1,803.20 ",$266.02 ,$901.08 ,$901.08 ,$477.12 ,"$1,442.56 ","$1,532.72 ","$1,127.00 ","$1,622.88 ",$266.02 ,$266.02 ,"$1,713.04 ","$1,622.88 ","$1,532.72 ","$1,532.72 ",$477.12 ,"$1,532.72 ","$1,532.72 ","$1,622.88 ","$1,098.15 ",$266.02 ,"$1,117.98 ",$281.98 ,"$1,622.88 ",$579.26 ,"$1,658.94 ","$1,622.88 ","$1,190.29 ","$1,190.29 ","$1,098.15 ","$1,190.29 ","$1,172.08 ","$1,231.95 ",$410.51 ,"$1,424.53 ",$281.98 ,$308.94 ,$308.94 ,$477.12 ,$308.94 ,$257.45 ,"$1,713.04 ","$1,478.62 ","$1,478.62 ","$1,442.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30600273,87801,HC INFECT MLT ORG AMP STAPH,306,1 ,$416.30 ,$274.76 ,$50.62 ,$416.30 ,$50.62 ,$245.70 ,$245.70 ,$110.15 ,$333.04 ,$353.86 ,$260.19 ,$374.67 ,$50.62 ,$50.62 ,$395.49 ,$374.67 ,$353.86 ,$353.86 ,$110.15 ,$353.86 ,$353.86 ,$374.67 ,$253.53 ,$50.62 ,$258.10 ,$53.66 ,$374.67 ,$157.95 ,$383.00 ,$374.67 ,$274.80 ,$274.80 ,$253.53 ,$274.80 ,$270.60 ,$284.42 ,$94.78 ,$328.88 ,$53.66 ,$84.24 ,$84.24 ,$110.15 ,$84.24 ,$70.20 ,$395.49 ,$341.37 ,$341.37 ,$333.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600275,87153,HC MYCOBACTERIA ID BY DNA SEQUENCING,306,1 ,$772.80 ,$510.05 ,$115.36 ,$772.80 ,$119.20 ,$403.76 ,$403.76 ,$204.49 ,$618.24 ,$656.88 ,$483.00 ,$695.52 ,$119.20 ,$119.20 ,$734.16 ,$695.52 ,$656.88 ,$656.88 ,$204.49 ,$656.88 ,$656.88 ,$695.52 ,$470.64 ,$119.20 ,$479.14 ,$126.35 ,$695.52 ,$259.56 ,$710.98 ,$695.52 ,$510.13 ,$510.13 ,$470.64 ,$510.13 ,$502.32 ,$527.98 ,$175.93 ,$610.51 ,$126.35 ,$138.43 ,$138.43 ,$204.49 ,$138.43 ,$115.36 ,$734.16 ,$633.70 ,$633.70 ,$618.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600280,87491,HC C TACH RNA TMA,306,1 ,$282.90 ,$186.71 ,$35.09 ,$282.90 ,$36.26 ,$122.82 ,$122.82 ,$74.85 ,$226.32 ,$240.47 ,$176.81 ,$254.61 ,$36.26 ,$36.26 ,$268.76 ,$254.61 ,$240.47 ,$240.47 ,$74.85 ,$240.47 ,$240.47 ,$254.61 ,$172.29 ,$36.26 ,$175.40 ,$38.44 ,$254.61 ,$78.95 ,$260.27 ,$254.61 ,$186.74 ,$186.74 ,$172.29 ,$186.74 ,$183.89 ,$193.28 ,$64.41 ,$223.49 ,$38.44 ,$42.11 ,$42.11 ,$74.85 ,$42.11 ,$35.09 ,$268.76 ,$231.98 ,$231.98 ,$226.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600281,87591,HC N GONOR RNA TMA,306,1 ,$282.90 ,$186.71 ,$35.09 ,$282.90 ,$36.26 ,$122.82 ,$122.82 ,$74.85 ,$226.32 ,$240.47 ,$176.81 ,$254.61 ,$36.26 ,$36.26 ,$268.76 ,$254.61 ,$240.47 ,$240.47 ,$74.85 ,$240.47 ,$240.47 ,$254.61 ,$172.29 ,$36.26 ,$175.40 ,$38.44 ,$254.61 ,$78.95 ,$260.27 ,$254.61 ,$186.74 ,$186.74 ,$172.29 ,$186.74 ,$183.89 ,$193.28 ,$64.41 ,$223.49 ,$38.44 ,$42.11 ,$42.11 ,$74.85 ,$42.11 ,$35.09 ,$268.76 ,$231.98 ,$231.98 ,$226.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600282,87899,HC INFECT AGENT DETECT OPT (SHIGA),306,1 ,$77.05 ,$50.85 ,$16.07 ,$77.05 ,$16.61 ,$56.25 ,$56.25 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$16.61 ,$16.61 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$16.61 ,$47.78 ,$17.61 ,$69.35 ,$36.16 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$17.61 ,$19.28 ,$19.28 ,$20.38 ,$19.28 ,$16.07 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600285,87624,HC HPV HR GENOTYPES,306,1 ,$180.55 ,$119.16 ,$35.09 ,$180.55 ,$36.26 ,$122.82 ,$122.82 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$36.26 ,$36.26 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$36.26 ,$111.94 ,$38.44 ,$162.50 ,$78.95 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$38.44 ,$42.11 ,$42.11 ,$47.77 ,$42.11 ,$35.09 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600286,87625,HC HPV GENOTYPE 16 18/45,306,1 ,$180.55 ,$119.16 ,$38.30 ,$180.55 ,$38.30 ,$141.93 ,$141.93 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$38.30 ,$38.30 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$38.30 ,$111.94 ,$40.60 ,$162.50 ,$91.24 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$40.60 ,$48.66 ,$48.66 ,$47.77 ,$48.66 ,$40.55 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600288,87633,HC RESP VIRUS MAP-TECH 17 TARGETS,306,1 ,"$1,030.40 ",$680.06 ,$234.57 ,"$1,030.40 ",$430.66 ,"$1,030.40 ","$1,030.40 ",$272.65 ,$824.32 ,$875.84 ,$644.00 ,$927.36 ,$430.66 ,$430.66 ,$978.88 ,$927.36 ,$875.84 ,$875.84 ,$272.65 ,$875.84 ,$875.84 ,$927.36 ,$627.51 ,$430.66 ,$638.84 ,$456.50 ,$927.36 ,$937.76 ,$947.97 ,$927.36 ,$680.17 ,$680.17 ,$627.51 ,$680.17 ,$669.76 ,$703.97 ,$234.57 ,$814.02 ,$456.50 ,$500.14 ,$500.14 ,$272.65 ,$500.14 ,$416.78 ,$978.88 ,$844.93 ,$844.93 ,$824.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600289,87798,HC B. PERTUSSIS AP-TECH,306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600290,87486,HC C PNEUMONIAE AP-TECH,306,1 ,$257.60 ,$170.02 ,$35.09 ,$257.60 ,$36.26 ,$122.82 ,$122.82 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$36.26 ,$36.26 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$36.26 ,$159.72 ,$38.44 ,$231.84 ,$78.95 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$38.44 ,$42.11 ,$42.11 ,$68.16 ,$42.11 ,$35.09 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600291,87581,HC M PNEUMONIAS AP-TECH,306,1 ,$257.60 ,$170.02 ,$35.09 ,$257.60 ,$36.26 ,$122.82 ,$122.82 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$36.26 ,$36.26 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$36.26 ,$159.72 ,$38.44 ,$231.84 ,$78.95 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$38.44 ,$42.11 ,$42.11 ,$68.16 ,$42.11 ,$35.09 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600292,87798,HC INFECT AMP (EA ORG) MENI,306,1 ,$236.90 ,$156.35 ,$35.09 ,$236.90 ,$36.26 ,$122.82 ,$122.82 ,$62.68 ,$189.52 ,$201.37 ,$148.06 ,$213.21 ,$36.26 ,$36.26 ,$225.06 ,$213.21 ,$201.37 ,$201.37 ,$62.68 ,$201.37 ,$201.37 ,$213.21 ,$144.27 ,$36.26 ,$146.88 ,$38.44 ,$213.21 ,$78.95 ,$217.95 ,$213.21 ,$156.38 ,$156.38 ,$144.27 ,$156.38 ,$153.99 ,$161.85 ,$53.93 ,$187.15 ,$38.44 ,$42.11 ,$42.11 ,$62.68 ,$42.11 ,$35.09 ,$225.06 ,$194.26 ,$194.26 ,$189.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600293,87653,HC INFECT AMP (STREP B) MENI,306,1 ,$236.90 ,$156.35 ,$35.09 ,$236.90 ,$36.26 ,$122.82 ,$122.82 ,$62.68 ,$189.52 ,$201.37 ,$148.06 ,$213.21 ,$36.26 ,$36.26 ,$225.06 ,$213.21 ,$201.37 ,$201.37 ,$62.68 ,$201.37 ,$201.37 ,$213.21 ,$144.27 ,$36.26 ,$146.88 ,$38.44 ,$213.21 ,$78.95 ,$217.95 ,$213.21 ,$156.38 ,$156.38 ,$144.27 ,$156.38 ,$153.99 ,$161.85 ,$53.93 ,$187.15 ,$38.44 ,$42.11 ,$42.11 ,$62.68 ,$42.11 ,$35.09 ,$225.06 ,$194.26 ,$194.26 ,$189.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600294,87496,HC INFECT AMP (CMV) MENI,306,1 ,$182.85 ,$120.68 ,$35.09 ,$182.85 ,$36.26 ,$122.82 ,$122.82 ,$48.38 ,$146.28 ,$155.42 ,$114.28 ,$164.57 ,$36.26 ,$36.26 ,$173.71 ,$164.57 ,$155.42 ,$155.42 ,$48.38 ,$155.42 ,$155.42 ,$164.57 ,$111.36 ,$36.26 ,$113.36 ,$38.44 ,$164.57 ,$78.95 ,$168.22 ,$164.57 ,$120.70 ,$120.70 ,$111.36 ,$120.70 ,$118.85 ,$124.92 ,$41.63 ,$144.45 ,$38.44 ,$42.11 ,$42.11 ,$48.38 ,$42.11 ,$35.09 ,$173.71 ,$149.94 ,$149.94 ,$146.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600295,87532,HC INFECT AMP (HHSV6) MENI,306,1 ,$182.85 ,$120.68 ,$35.09 ,$182.85 ,$36.26 ,$122.82 ,$122.82 ,$48.38 ,$146.28 ,$155.42 ,$114.28 ,$164.57 ,$36.26 ,$36.26 ,$173.71 ,$164.57 ,$155.42 ,$155.42 ,$48.38 ,$155.42 ,$155.42 ,$164.57 ,$111.36 ,$36.26 ,$113.36 ,$38.44 ,$164.57 ,$78.95 ,$168.22 ,$164.57 ,$120.70 ,$120.70 ,$111.36 ,$120.70 ,$118.85 ,$124.92 ,$41.63 ,$144.45 ,$38.44 ,$42.11 ,$42.11 ,$48.38 ,$42.11 ,$35.09 ,$173.71 ,$149.94 ,$149.94 ,$146.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600296,87529,HC INFECT AMP (HSV 1 OR 2) MENI,306,1 ,$182.85 ,$120.68 ,$35.09 ,$182.85 ,$36.26 ,$122.82 ,$122.82 ,$48.38 ,$146.28 ,$155.42 ,$114.28 ,$164.57 ,$36.26 ,$36.26 ,$173.71 ,$164.57 ,$155.42 ,$155.42 ,$48.38 ,$155.42 ,$155.42 ,$164.57 ,$111.36 ,$36.26 ,$113.36 ,$38.44 ,$164.57 ,$78.95 ,$168.22 ,$164.57 ,$120.70 ,$120.70 ,$111.36 ,$120.70 ,$118.85 ,$124.92 ,$41.63 ,$144.45 ,$38.44 ,$42.11 ,$42.11 ,$48.38 ,$42.11 ,$35.09 ,$173.71 ,$149.94 ,$149.94 ,$146.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600297,87798,HC BABESIA SPECIES PCR B,306,1 ,$89.70 ,$59.20 ,$20.42 ,$89.70 ,$36.26 ,$89.70 ,$89.70 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$36.26 ,$36.26 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$36.26 ,$55.62 ,$38.44 ,$80.73 ,$78.95 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$38.44 ,$42.11 ,$42.11 ,$23.74 ,$42.11 ,$35.09 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600298,87798,HC DETECT AGENT NOS DNA AMP,306,1 ,$89.70 ,$59.20 ,$20.42 ,$89.70 ,$36.26 ,$89.70 ,$89.70 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$36.26 ,$36.26 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$36.26 ,$55.62 ,$38.44 ,$80.73 ,$78.95 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$38.44 ,$42.11 ,$42.11 ,$23.74 ,$42.11 ,$35.09 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600306,87207,HC SPECIAL STAIN INCL BODIES/PARASITES,306,1 ,$77.05 ,$50.85 ,$5.99 ,$77.05 ,$6.19 ,$20.97 ,$20.97 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$6.19 ,$6.19 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$6.19 ,$47.78 ,$6.56 ,$69.35 ,$13.48 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$6.56 ,$7.19 ,$7.19 ,$20.38 ,$7.19 ,$5.99 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600316,87389,HC HIV-1 AG W/HIV-1  AND  HIV-2 AB,306,1 ,$128.80 ,$85.01 ,$24.08 ,$128.80 ,$24.88 ,$84.28 ,$84.28 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$24.88 ,$24.88 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$24.88 ,$79.86 ,$26.37 ,$115.92 ,$54.18 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$26.37 ,$28.90 ,$28.90 ,$34.08 ,$28.90 ,$24.08 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600318,87449,HC EIA QL MLT AG INF,306,1 ,$77.05 ,$50.85 ,$11.98 ,$77.05 ,$12.38 ,$41.93 ,$41.93 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$12.38 ,$12.38 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$12.38 ,$47.78 ,$13.12 ,$69.35 ,$26.96 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$13.12 ,$14.38 ,$14.38 ,$20.38 ,$14.38 ,$11.98 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600332,87651,HC INFECT AMP (GRP A STREP),306,1 ,$285.20 ,$188.23 ,$35.09 ,$285.20 ,$36.26 ,$122.82 ,$122.82 ,$75.46 ,$228.16 ,$242.42 ,$178.25 ,$256.68 ,$36.26 ,$36.26 ,$270.94 ,$256.68 ,$242.42 ,$242.42 ,$75.46 ,$242.42 ,$242.42 ,$256.68 ,$173.69 ,$36.26 ,$176.82 ,$38.44 ,$256.68 ,$78.95 ,$262.38 ,$256.68 ,$188.26 ,$188.26 ,$173.69 ,$188.26 ,$185.38 ,$194.85 ,$64.93 ,$225.31 ,$38.44 ,$42.11 ,$42.11 ,$75.46 ,$42.11 ,$35.09 ,$270.94 ,$233.86 ,$233.86 ,$228.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600335,87799,HC INFECT AGENT QN BK VIRUS DNA,306,1 ,$345.00 ,$227.70 ,$42.84 ,$345.00 ,$44.27 ,$149.94 ,$149.94 ,$91.29 ,$276.00 ,$293.25 ,$215.63 ,$310.50 ,$44.27 ,$44.27 ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$91.29 ,$293.25 ,$293.25 ,$310.50 ,$210.11 ,$44.27 ,$213.90 ,$46.93 ,$310.50 ,$96.39 ,$317.40 ,$310.50 ,$227.73 ,$227.73 ,$210.11 ,$227.73 ,$224.25 ,$235.70 ,$78.54 ,$272.55 ,$46.93 ,$51.41 ,$51.41 ,$91.29 ,$51.41 ,$42.84 ,$327.75 ,$282.90 ,$282.90 ,$276.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600339,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,"$1,030.40 ",$680.06 ,$234.57 ,"$1,030.40 ",$430.66 ,"$1,030.40 ","$1,030.40 ",$272.65 ,$824.32 ,$875.84 ,$644.00 ,$927.36 ,$430.66 ,$430.66 ,$978.88 ,$927.36 ,$875.84 ,$875.84 ,$272.65 ,$875.84 ,$875.84 ,$927.36 ,$627.51 ,$430.66 ,$638.84 ,$456.50 ,$927.36 ,$937.76 ,$947.97 ,$927.36 ,$680.17 ,$680.17 ,$627.51 ,$680.17 ,$669.76 ,$703.97 ,$234.57 ,$814.02 ,$456.50 ,$500.14 ,$500.14 ,$272.65 ,$500.14 ,$416.78 ,$978.88 ,$844.93 ,$844.93 ,$824.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600341,87798,HC INFECT AMP (VZV VIRUS DNA QL RT PCR),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600343,87798,HC INFECT AMP (NOROVIRUS RNA QL RT PCR),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600344,87530,HC HSV QUANT  TYPE 1  AND  2 DNA QN RT PCR,306,1 ,$232.30 ,$153.32 ,$42.84 ,$232.30 ,$44.27 ,$149.94 ,$149.94 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$44.27 ,$44.27 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$44.27 ,$144.02 ,$46.93 ,$209.07 ,$96.39 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$46.93 ,$51.41 ,$51.41 ,$61.47 ,$51.41 ,$42.84 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600345,87799,HC INFECT AGENT QN BK VIRUS DNA RT PCR URINE,306,1 ,$373.75 ,$246.68 ,$42.84 ,$373.75 ,$44.27 ,$149.94 ,$149.94 ,$98.89 ,$299.00 ,$317.69 ,$233.59 ,$336.38 ,$44.27 ,$44.27 ,$355.06 ,$336.38 ,$317.69 ,$317.69 ,$98.89 ,$317.69 ,$317.69 ,$336.38 ,$227.61 ,$44.27 ,$231.72 ,$46.93 ,$336.38 ,$96.39 ,$343.85 ,$336.38 ,$246.71 ,$246.71 ,$227.61 ,$246.71 ,$242.94 ,$255.35 ,$85.08 ,$295.26 ,$46.93 ,$51.41 ,$51.41 ,$98.89 ,$51.41 ,$42.84 ,$355.06 ,$306.48 ,$306.48 ,$299.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600346,87798,HC INFECT AMP (B PERTUSSIS/PARA DNA QL RTPCR),306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$36.26 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$36.26 ,$36.26 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$36.26 ,$191.80 ,$38.44 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$38.44 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600347,87505,HC GI ENTERIC PATHOGEN PANEL 3-5 TARGETS,306,1 ,$502.55 ,$331.68 ,$114.41 ,$502.55 ,$132.56 ,$449.02 ,$449.02 ,$132.98 ,$402.04 ,$427.17 ,$314.09 ,$452.30 ,$132.56 ,$132.56 ,$477.42 ,$452.30 ,$427.17 ,$427.17 ,$132.98 ,$427.17 ,$427.17 ,$452.30 ,$306.05 ,$132.56 ,$311.58 ,$140.51 ,$452.30 ,$288.65 ,$462.35 ,$452.30 ,$331.73 ,$331.73 ,$306.05 ,$331.73 ,$326.66 ,$343.34 ,$114.41 ,$397.01 ,$140.51 ,$153.95 ,$153.95 ,$132.98 ,$153.95 ,$128.29 ,$477.42 ,$412.09 ,$412.09 ,$402.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600348,87483,HC INFECT AMP CNS DNA/RNA 14 TARGETS,306,1 ,"$2,189.60 ","$1,445.14 ",$333.42 ,"$2,189.60 ",$333.42 ,"$1,458.73 ","$1,458.73 ",$579.37 ,"$1,751.68 ","$1,861.16 ","$1,368.50 ","$1,970.64 ",$333.42 ,$333.42 ,"$2,080.12 ","$1,970.64 ","$1,861.16 ","$1,861.16 ",$579.37 ,"$1,861.16 ","$1,861.16 ","$1,970.64 ","$1,333.47 ",$333.42 ,"$1,357.56 ",$353.43 ,"$1,970.64 ",$937.76 ,"$2,014.43 ","$1,970.64 ","$1,445.36 ","$1,445.36 ","$1,333.47 ","$1,445.36 ","$1,423.24 ","$1,495.93 ",$498.48 ,"$1,729.78 ",$353.43 ,$500.14 ,$500.14 ,$579.37 ,$500.14 ,$416.78 ,"$2,080.12 ","$1,795.47 ","$1,795.47 ","$1,751.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),30600349,87798,HC INFECT AMP (ZIKA PCR SERUM),306,1 ,$376.05 ,$248.19 ,$35.09 ,$376.05 ,$36.26 ,$122.82 ,$122.82 ,$99.50 ,$300.84 ,$319.64 ,$235.03 ,$338.45 ,$36.26 ,$36.26 ,$357.25 ,$338.45 ,$319.64 ,$319.64 ,$99.50 ,$319.64 ,$319.64 ,$338.45 ,$229.01 ,$36.26 ,$233.16 ,$38.44 ,$338.45 ,$78.95 ,$345.97 ,$338.45 ,$248.23 ,$248.23 ,$229.01 ,$248.23 ,$244.43 ,$256.92 ,$85.60 ,$297.08 ,$38.44 ,$42.11 ,$42.11 ,$99.50 ,$42.11 ,$35.09 ,$357.25 ,$308.36 ,$308.36 ,$300.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600350,87798,HC INFECT AMP (ZIKA VIRUS REAL TIME PCR RNA QL),306,1 ,$644.00 ,$425.04 ,$35.09 ,$644.00 ,$36.26 ,$122.82 ,$122.82 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$36.26 ,$36.26 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$36.26 ,$399.28 ,$38.44 ,$579.60 ,$78.95 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$38.44 ,$42.11 ,$42.11 ,$170.40 ,$42.11 ,$35.09 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600351,86628,HC CANDIDA AB  IGA IGG IBM,306,1 ,$47.15 ,$31.12 ,$8.17 ,$47.15 ,$8.17 ,$42.04 ,$42.04 ,$12.48 ,$37.72 ,$40.08 ,$29.47 ,$42.44 ,$8.17 ,$8.17 ,$44.79 ,$42.44 ,$40.08 ,$40.08 ,$12.48 ,$40.08 ,$40.08 ,$42.44 ,$28.71 ,$8.17 ,$29.24 ,$8.66 ,$42.44 ,$27.02 ,$43.38 ,$42.44 ,$31.12 ,$31.12 ,$28.71 ,$31.12 ,$30.65 ,$32.21 ,$10.73 ,$37.25 ,$8.66 ,$14.41 ,$14.41 ,$12.48 ,$14.41 ,$12.01 ,$44.79 ,$38.66 ,$38.66 ,$37.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600352,87563,"HC INFECT AMP (MYCOPLASMA/UREAPLASMA PNL, PCR)",306,1 ,$309.35 ,$204.17 ,$28.07 ,$309.35 ,$28.07 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$28.07 ,$28.07 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$28.07 ,$191.80 ,$29.75 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$29.75 ,$42.11 ,$42.11 ,$81.85 ,$42.11 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600406,87254,HC VIRUS ISOL SHELL ID,306,1 ,$143.75 ,$94.88 ,$7.06 ,$143.75 ,$7.06 ,$68.46 ,$68.46 ,$38.03 ,$115.00 ,$122.19 ,$89.84 ,$129.38 ,$7.06 ,$7.06 ,$136.56 ,$129.38 ,$122.19 ,$122.19 ,$38.03 ,$122.19 ,$122.19 ,$129.38 ,$87.54 ,$7.06 ,$89.12 ,$7.48 ,$129.38 ,$44.01 ,$132.25 ,$129.38 ,$94.89 ,$94.89 ,$87.54 ,$94.89 ,$93.44 ,$98.21 ,$32.72 ,$113.56 ,$7.48 ,$23.47 ,$23.47 ,$38.03 ,$23.47 ,$19.56 ,$136.56 ,$117.88 ,$117.88 ,$115.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600498,87506,HC GI ENTERIC PATHOGEN PANEL 6-8 TARGETS,306,1 ,$604.90 ,$399.23 ,$137.71 ,$604.90 ,$232.94 ,$604.90 ,$604.90 ,$160.05 ,$483.92 ,$514.17 ,$378.06 ,$544.41 ,$232.94 ,$232.94 ,$574.66 ,$544.41 ,$514.17 ,$514.17 ,$160.05 ,$514.17 ,$514.17 ,$544.41 ,$368.38 ,$232.94 ,$375.04 ,$246.92 ,$544.41 ,$591.73 ,$556.51 ,$544.41 ,$399.29 ,$399.29 ,$368.38 ,$399.29 ,$393.19 ,$413.27 ,$137.71 ,$477.87 ,$246.92 ,$315.59 ,$315.59 ,$160.05 ,$315.59 ,$262.99 ,$574.66 ,$496.02 ,$496.02 ,$483.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600499,87506,HC GI ENTERIC PATHOGEN PANEL 9-11 TARGETS,306,1 ,$695.75 ,$459.20 ,$158.39 ,$695.75 ,$232.94 ,$695.75 ,$695.75 ,$184.09 ,$556.60 ,$591.39 ,$434.84 ,$626.18 ,$232.94 ,$232.94 ,$660.96 ,$626.18 ,$591.39 ,$591.39 ,$184.09 ,$591.39 ,$591.39 ,$626.18 ,$423.71 ,$232.94 ,$431.36 ,$246.92 ,$626.18 ,$591.73 ,$640.09 ,$626.18 ,$459.26 ,$459.26 ,$423.71 ,$459.26 ,$452.24 ,$475.34 ,$158.39 ,$549.64 ,$246.92 ,$315.59 ,$315.59 ,$184.09 ,$315.59 ,$262.99 ,$660.96 ,$570.52 ,$570.52 ,$556.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600500,87254,HC VIRUS ISOL SHELL RESP RAPID CULTURE W/REFLEX,306,1 ,$167.90 ,$110.81 ,$7.06 ,$167.90 ,$7.06 ,$68.46 ,$68.46 ,$44.42 ,$134.32 ,$142.72 ,$104.94 ,$151.11 ,$7.06 ,$7.06 ,$159.51 ,$151.11 ,$142.72 ,$142.72 ,$44.42 ,$142.72 ,$142.72 ,$151.11 ,$102.25 ,$7.06 ,$104.10 ,$7.48 ,$151.11 ,$44.01 ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$38.23 ,$132.64 ,$7.48 ,$23.47 ,$23.47 ,$44.42 ,$23.47 ,$19.56 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600501,87140,HC CLT TYP IF EA VIRAL RESP RAPID CULTURE REFLEX,306,1 ,$81.65 ,$53.89 ,$5.57 ,$81.65 ,$5.76 ,$19.50 ,$19.50 ,$21.61 ,$65.32 ,$69.40 ,$51.03 ,$73.49 ,$5.76 ,$5.76 ,$77.57 ,$73.49 ,$69.40 ,$69.40 ,$21.61 ,$69.40 ,$69.40 ,$73.49 ,$49.72 ,$5.76 ,$50.62 ,$6.11 ,$73.49 ,$12.53 ,$75.12 ,$73.49 ,$53.90 ,$53.90 ,$49.72 ,$53.90 ,$53.07 ,$55.78 ,$18.59 ,$64.50 ,$6.11 ,$6.68 ,$6.68 ,$21.61 ,$6.68 ,$5.57 ,$77.57 ,$66.95 ,$66.95 ,$65.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600540,87798,HC IF AGENT PARAPERTUSSIS DNA DETECTION METHOD,306,1 ,$411.70 ,$271.72 ,$35.09 ,$411.70 ,$36.26 ,$122.82 ,$122.82 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$36.26 ,$36.26 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$36.26 ,$255.26 ,$38.44 ,$370.53 ,$78.95 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$38.44 ,$42.11 ,$42.11 ,$108.94 ,$42.11 ,$35.09 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600594,87150,HC CULTURE TYPING ID AMP PROBE TECH,306,1 ,$77.05 ,$50.85 ,$17.54 ,$78.95 ,$36.26 ,$77.05 ,$77.05 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$36.26 ,$36.26 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$36.26 ,$47.78 ,$38.44 ,$69.35 ,$78.95 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$38.44 ,$42.11 ,$42.11 ,$20.38 ,$42.11 ,$35.09 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600595,87798,HC INFECT AMP (TICK BORNE PCR PNL CHAIN REACTION),306,1 ,$228.85 ,$151.04 ,$35.09 ,$228.85 ,$36.26 ,$122.82 ,$122.82 ,$60.55 ,$183.08 ,$194.52 ,$143.03 ,$205.97 ,$36.26 ,$36.26 ,$217.41 ,$205.97 ,$194.52 ,$194.52 ,$60.55 ,$194.52 ,$194.52 ,$205.97 ,$139.37 ,$36.26 ,$141.88 ,$38.44 ,$205.97 ,$78.95 ,$210.54 ,$205.97 ,$151.06 ,$151.06 ,$139.37 ,$151.06 ,$148.75 ,$156.35 ,$52.11 ,$180.79 ,$38.44 ,$42.11 ,$42.11 ,$60.55 ,$42.11 ,$35.09 ,$217.41 ,$187.66 ,$187.66 ,$183.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600596,87801,HC INFECT MLT ORG AMP TICK,306,1 ,$446.20 ,$294.49 ,$50.62 ,$446.20 ,$50.62 ,$245.70 ,$245.70 ,$118.06 ,$356.96 ,$379.27 ,$278.88 ,$401.58 ,$50.62 ,$50.62 ,$423.89 ,$401.58 ,$379.27 ,$379.27 ,$118.06 ,$379.27 ,$379.27 ,$401.58 ,$271.74 ,$50.62 ,$276.64 ,$53.66 ,$401.58 ,$157.95 ,$410.50 ,$401.58 ,$294.54 ,$294.54 ,$271.74 ,$294.54 ,$290.03 ,$304.84 ,$101.59 ,$352.50 ,$53.66 ,$84.24 ,$84.24 ,$118.06 ,$84.24 ,$70.20 ,$423.89 ,$365.88 ,$365.88 ,$356.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600597,87186,HC SENSITIVITY MIC FUNGUS,306,1 ,$463.45 ,$305.88 ,$8.65 ,$463.45 ,$8.94 ,$30.28 ,$30.28 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$8.94 ,$8.94 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$8.94 ,$287.34 ,$9.48 ,$417.11 ,$19.46 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$9.48 ,$10.38 ,$10.38 ,$122.63 ,$10.38 ,$8.65 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600636,87811,HC COVID ANTIGEN TEST,306,1 ,$109.20 ,$72.07 ,$24.86 ,$109.20 ,$41.38 ,$109.20 ,$109.20 ,$28.89 ,$87.36 ,$92.82 ,$68.25 ,$98.28 ,$41.38 ,$41.38 ,$103.74 ,$98.28 ,$92.82 ,$92.82 ,$28.89 ,$92.82 ,$92.82 ,$98.28 ,$66.50 ,$41.38 ,$67.70 ,$43.86 ,$98.28 ,$93.11 ,$100.46 ,$98.28 ,$72.08 ,$72.08 ,$66.50 ,$72.08 ,$70.98 ,$74.61 ,$24.86 ,$86.27 ,$43.86 ,$49.78 ,$49.78 ,$28.89 ,$49.78 ,$41.38 ,$103.74 ,$89.54 ,$89.54 ,$87.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600663,87593,HC INFECT AMP ORTHOPOXVIRUS/MONKEYPOX DNA,306,1 ,$113.00 ,$74.58 ,$25.72 ,$113.00 ,$49.14 ,$113.00 ,$113.00 ,$29.90 ,$90.40 ,$96.05 ,$70.63 ,$101.70 ,$49.14 ,$49.14 ,$107.35 ,$101.70 ,$96.05 ,$96.05 ,$29.90 ,$96.05 ,$96.05 ,$101.70 ,$68.82 ,$49.14 ,$70.06 ,$52.09 ,$101.70 , N/A ,$103.96 ,$101.70 ,$74.59 ,$74.59 ,$68.82 ,$74.59 ,$73.45 ,$77.20 ,$25.72 ,$89.27 ,$52.09 ,$55.37 ,$55.37 ,$29.90 ,$55.37 , N/A ,$107.35 ,$92.66 ,$92.66 ,$90.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600665,87188,HC MACROTUBE DIL METH 5DRG PNL,306,1 ,$187.67 ,$123.86 ,$6.64 ,$187.67 ,$6.86 ,$23.24 ,$23.24 ,$49.66 ,$150.14 ,$159.52 ,$117.29 ,$168.90 ,$6.86 ,$6.86 ,$178.29 ,$168.90 ,$159.52 ,$159.52 ,$49.66 ,$159.52 ,$159.52 ,$168.90 ,$114.29 ,$6.86 ,$116.36 ,$7.27 ,$168.90 ,$14.94 ,$172.66 ,$168.90 ,$123.88 ,$123.88 ,$114.29 ,$123.88 ,$121.99 ,$128.22 ,$42.72 ,$148.26 ,$7.27 ,$7.97 ,$7.97 ,$49.66 ,$7.97 ,$6.64 ,$178.29 ,$153.89 ,$153.89 ,$150.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600666,87449,HC EIA QL MLT AG INF (FUNGITELL),306,1 ,$411.70 ,$271.72 ,$11.98 ,$411.70 ,$12.38 ,$41.93 ,$41.93 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$12.38 ,$12.38 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$12.38 ,$255.26 ,$13.12 ,$370.53 ,$26.96 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$13.12 ,$14.38 ,$14.38 ,$108.94 ,$14.38 ,$11.98 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600667,87468,HC ANAPLSMA PHGCYTOPHLM AMP PRB,306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$49.14 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$49.14 ,$49.14 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$49.14 ,$191.80 ,$52.09 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$52.09 ,$151.58 ,$151.58 ,$81.85 ,$151.58 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600668,87469,HC BABESIA MICROTI AMP PRB,306,1 ,$129.60 ,$85.54 ,$29.51 ,$129.60 ,$49.14 ,$122.82 ,$122.82 ,$34.29 ,$103.68 ,$110.16 ,$81.00 ,$116.64 ,$49.14 ,$49.14 ,$123.12 ,$116.64 ,$110.16 ,$110.16 ,$34.29 ,$110.16 ,$110.16 ,$116.64 ,$78.93 ,$49.14 ,$80.36 ,$52.09 ,$116.64 ,$78.95 ,$119.23 ,$116.64 ,$85.55 ,$85.55 ,$78.93 ,$85.55 ,$84.24 ,$88.54 ,$29.51 ,$102.38 ,$52.09 ,$63.50 ,$63.50 ,$34.29 ,$63.50 ,$35.09 ,$123.12 ,$106.27 ,$106.27 ,$103.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600669,87478,HC BORRELIA MIYAMOTOI AMP PRB,306,1 ,$129.60 ,$85.54 ,$29.51 ,$129.60 ,$49.14 ,$122.82 ,$122.82 ,$34.29 ,$103.68 ,$110.16 ,$81.00 ,$116.64 ,$49.14 ,$49.14 ,$123.12 ,$116.64 ,$110.16 ,$110.16 ,$34.29 ,$110.16 ,$110.16 ,$116.64 ,$78.93 ,$49.14 ,$80.36 ,$52.09 ,$116.64 ,$78.95 ,$119.23 ,$116.64 ,$85.55 ,$85.55 ,$78.93 ,$85.55 ,$84.24 ,$88.54 ,$29.51 ,$102.38 ,$52.09 ,$63.50 ,$63.50 ,$34.29 ,$63.50 ,$35.09 ,$123.12 ,$106.27 ,$106.27 ,$103.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600670,87484,HC EHRLICHA CHAFFEENSIS AMP PRB,306,1 ,$309.35 ,$204.17 ,$35.09 ,$309.35 ,$49.14 ,$122.82 ,$122.82 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$49.14 ,$49.14 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$49.14 ,$191.80 ,$52.09 ,$278.42 ,$78.95 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$52.09 ,$151.58 ,$151.58 ,$81.85 ,$151.58 ,$35.09 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),30600671,87662,HC ZIKA VIRUS DNA/RNA AMP PROBE,306,1 ,$644.00 ,$425.04 ,$50.68 ,$644.00 ,$50.68 ,$179.59 ,$179.59 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$50.68 ,$50.68 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$50.68 ,$399.28 ,$53.72 ,$579.60 ,$115.45 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$53.72 ,$61.57 ,$61.57 ,$170.40 ,$61.57 ,$51.31 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682011,87635,HC COVID-19 LAB TEST NON-CDC,306,1 ,$139.15 ,$91.84 ,$31.67 ,$139.15 ,$51.31 ,$139.15 ,$139.15 ,$36.82 ,$111.32 ,$118.28 ,$86.97 ,$125.24 ,$51.31 ,$51.31 ,$132.19 ,$125.24 ,$118.28 ,$118.28 ,$36.82 ,$118.28 ,$118.28 ,$125.24 ,$84.74 ,$51.31 ,$86.28 ,$54.39 ,$125.24 ,$115.45 ,$128.02 ,$125.24 ,$91.85 ,$91.85 ,$84.74 ,$91.85 ,$90.45 ,$95.07 ,$31.67 ,$109.93 ,$54.39 ,$61.60 ,$61.60 ,$36.82 ,$51.33 ,$51.31 ,$132.19 ,$114.10 ,$114.10 ,$111.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682013,87635,HC COVID-19 LAB TEST,306,1 ,$139.15 ,$91.84 ,$31.67 ,$139.15 ,$51.31 ,$139.15 ,$139.15 ,$36.82 ,$111.32 ,$118.28 ,$86.97 ,$125.24 ,$51.31 ,$51.31 ,$132.19 ,$125.24 ,$118.28 ,$118.28 ,$36.82 ,$118.28 ,$118.28 ,$125.24 ,$84.74 ,$51.31 ,$86.28 ,$54.39 ,$125.24 ,$115.45 ,$128.02 ,$125.24 ,$91.85 ,$91.85 ,$84.74 ,$91.85 ,$90.45 ,$95.07 ,$31.67 ,$109.93 ,$54.39 ,$61.60 ,$61.60 ,$36.82 ,$51.33 ,$51.31 ,$132.19 ,$114.10 ,$114.10 ,$111.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682014,86769,HC SARS-COV-2 COVID-19 ANTIBODY,306,1 ,$100.05 ,$66.03 ,$22.78 ,$100.05 ,$42.13 ,$100.05 ,$100.05 ,$26.47 ,$80.04 ,$85.04 ,$62.53 ,$90.05 ,$42.13 ,$42.13 ,$95.05 ,$90.05 ,$85.04 ,$85.04 ,$26.47 ,$85.04 ,$85.04 ,$90.05 ,$60.93 ,$42.13 ,$62.04 ,$44.66 ,$90.05 ,$94.79 ,$92.05 ,$90.05 ,$66.04 ,$66.04 ,$60.93 ,$66.04 ,$65.03 ,$68.35 ,$22.78 ,$79.04 ,$44.66 ,$50.56 ,$50.56 ,$26.47 ,$42.13 ,$42.13 ,$95.05 ,$82.04 ,$82.04 ,$80.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682021,86769,HC SARS-COV-2 COVID-19 ANTIBODY IN-HOUSE,306,1 ,$100.05 ,$66.03 ,$22.78 ,$100.05 ,$42.13 ,$100.05 ,$100.05 ,$26.47 ,$80.04 ,$85.04 ,$62.53 ,$90.05 ,$42.13 ,$42.13 ,$95.05 ,$90.05 ,$85.04 ,$85.04 ,$26.47 ,$85.04 ,$85.04 ,$90.05 ,$60.93 ,$42.13 ,$62.04 ,$44.66 ,$90.05 ,$94.79 ,$92.05 ,$90.05 ,$66.04 ,$66.04 ,$60.93 ,$66.04 ,$65.03 ,$68.35 ,$22.78 ,$79.04 ,$44.66 ,$50.56 ,$50.56 ,$26.47 ,$42.13 ,$42.13 ,$95.05 ,$82.04 ,$82.04 ,$80.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682023,87426,HC SARS COVID ANTIGEN TEST,306,1 ,$96.60 ,$63.76 ,$21.99 ,$96.60 ,$35.33 ,$96.60 ,$96.60 ,$25.56 ,$77.28 ,$82.11 ,$60.38 ,$86.94 ,$35.33 ,$35.33 ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 ,$35.33 ,$59.90 ,$37.45 ,$86.94 ,$79.49 ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 ,$37.45 ,$54.44 ,$54.44 ,$25.56 ,$54.44 ,$35.33 ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),30682024,87635,HC SARS-COV-2 COVID-19 TEST,306,1 ,$139.15 ,$91.84 ,$31.67 ,$139.15 ,$51.31 ,$139.15 ,$139.15 ,$36.82 ,$111.32 ,$118.28 ,$86.97 ,$125.24 ,$51.31 ,$51.31 ,$132.19 ,$125.24 ,$118.28 ,$118.28 ,$36.82 ,$118.28 ,$118.28 ,$125.24 ,$84.74 ,$51.31 ,$86.28 ,$54.39 ,$125.24 ,$115.45 ,$128.02 ,$125.24 ,$91.85 ,$91.85 ,$84.74 ,$91.85 ,$90.45 ,$95.07 ,$31.67 ,$109.93 ,$54.39 ,$61.60 ,$61.60 ,$36.82 ,$51.33 ,$51.31 ,$132.19 ,$114.10 ,$114.10 ,$111.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700101,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$49.45 ,$32.64 ,$3.17 ,$49.45 ,$3.28 ,$11.10 ,$11.10 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 ,$3.28 ,$3.28 ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 ,$3.28 ,$30.66 ,$3.48 ,$44.51 ,$7.13 ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$11.25 ,$39.07 ,$3.48 ,$3.80 ,$3.80 ,$13.08 ,$3.80 ,$3.17 ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700104,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$35.65 ,$23.53 ,$2.25 ,$35.65 ,$2.32 ,$7.88 ,$7.88 ,$9.44 ,$28.52 ,$30.30 ,$22.28 ,$32.09 ,$2.32 ,$2.32 ,$33.87 ,$32.09 ,$30.30 ,$30.30 ,$9.44 ,$30.30 ,$30.30 ,$32.09 ,$21.71 ,$2.32 ,$22.10 ,$2.46 ,$32.09 ,$5.06 ,$32.80 ,$32.09 ,$23.53 ,$23.53 ,$21.71 ,$23.53 ,$23.17 ,$24.36 ,$8.11 ,$28.16 ,$2.46 ,$2.70 ,$2.70 ,$9.44 ,$2.70 ,$2.25 ,$33.87 ,$29.23 ,$29.23 ,$28.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700115,81015,HC URINALYSIS MICRO ONLY,307,1 ,$27.60 ,$18.22 ,$3.05 ,$27.60 ,$3.15 ,$10.68 ,$10.68 ,$7.30 ,$22.08 ,$23.46 ,$17.25 ,$24.84 ,$3.15 ,$3.15 ,$26.22 ,$24.84 ,$23.46 ,$23.46 ,$7.30 ,$23.46 ,$23.46 ,$24.84 ,$16.81 ,$3.15 ,$17.12 ,$3.34 ,$24.84 ,$6.86 ,$25.39 ,$24.84 ,$18.22 ,$18.22 ,$16.81 ,$18.22 ,$17.94 ,$18.86 ,$6.28 ,$21.80 ,$3.34 ,$3.66 ,$3.66 ,$7.30 ,$3.66 ,$3.05 ,$26.22 ,$22.63 ,$22.63 ,$22.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),30700116,81025,HC URINE PREGNANCY TEST,307,1 ,$77.05 ,$50.85 ,$8.61 ,$77.05 ,$8.90 ,$30.14 ,$30.14 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$8.90 ,$8.90 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$8.90 ,$47.78 ,$9.43 ,$69.35 ,$19.37 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$9.43 ,$10.33 ,$10.33 ,$20.38 ,$10.33 ,$8.61 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),30900002,89300,HC POST VASECTOMY SEMEN ANALYSIS,309,1 ,$95.45 ,$63.00 ,$9.84 ,$95.45 ,$10.17 ,$34.44 ,$34.44 ,$25.25 ,$76.36 ,$81.13 ,$59.66 ,$85.91 ,$10.17 ,$10.17 ,$90.68 ,$85.91 ,$81.13 ,$81.13 ,$25.25 ,$81.13 ,$81.13 ,$85.91 ,$58.13 ,$10.17 ,$59.18 ,$10.78 ,$85.91 ,$22.14 ,$87.81 ,$85.91 ,$63.01 ,$63.01 ,$58.13 ,$63.01 ,$62.04 ,$65.21 ,$21.73 ,$75.41 ,$10.78 ,$11.81 ,$11.81 ,$25.25 ,$11.81 ,$9.84 ,$90.68 ,$78.27 ,$78.27 ,$76.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),30900200,81168,HC CCND1/IGH TRANSLOCATION ANALYSIS,309,1 ,$621.93 ,$410.47 ,$141.58 ,$621.93 ,$165.85 ,$621.93 ,$621.93 ,$164.56 ,$497.54 ,$528.64 ,$388.71 ,$559.74 ,$165.85 ,$165.85 ,$590.83 ,$559.74 ,$528.64 ,$528.64 ,$164.56 ,$528.64 ,$528.64 ,$559.74 ,$378.76 ,$165.85 ,$385.60 ,$175.80 ,$559.74 ,$466.45 ,$572.18 ,$559.74 ,$410.54 ,$410.54 ,$378.76 ,$410.54 ,$404.25 ,$424.90 ,$141.58 ,$491.32 ,$175.80 ,$248.77 ,$248.77 ,$164.56 ,$248.77 ,$207.31 ,$590.83 ,$509.98 ,$509.98 ,$497.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),30900201,81278,HC IGH@/BCL2 TRANSLOCATION ALYS,309,1 ,$370.00 ,$244.20 ,$84.23 ,$466.45 ,$165.85 ,$370.00 ,$370.00 ,$97.90 ,$296.00 ,$314.50 ,$231.25 ,$333.00 ,$165.85 ,$165.85 ,$351.50 ,$333.00 ,$314.50 ,$314.50 ,$97.90 ,$314.50 ,$314.50 ,$333.00 ,$225.33 ,$165.85 ,$229.40 ,$175.80 ,$333.00 ,$466.45 ,$340.40 ,$333.00 ,$244.24 ,$244.24 ,$225.33 ,$244.24 ,$240.50 ,$252.78 ,$84.23 ,$292.30 ,$175.80 ,$248.77 ,$248.77 ,$97.90 ,$248.77 ,$207.31 ,$351.50 ,$303.40 ,$303.40 ,$296.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000010,81206,HC BCR/ABL1 GENE MAJOR BP,310,1 ,$978.65 ,$645.91 ,$163.96 ,$978.65 ,$169.42 ,$573.86 ,$573.86 ,$258.96 ,$782.92 ,$831.85 ,$611.66 ,$880.79 ,$169.42 ,$169.42 ,$929.72 ,$880.79 ,$831.85 ,$831.85 ,$258.96 ,$831.85 ,$831.85 ,$880.79 ,$596.00 ,$169.42 ,$606.76 ,$179.59 ,$880.79 ,$368.91 ,$900.36 ,$880.79 ,$646.01 ,$646.01 ,$596.00 ,$646.01 ,$636.12 ,$668.61 ,$222.79 ,$773.13 ,$179.59 ,$196.75 ,$196.75 ,$258.96 ,$196.75 ,$163.96 ,$929.72 ,$802.49 ,$802.49 ,$782.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000011,81206,HC BCR/ABL1 GENE MAJOR BP QUEST,310,1 ,$540.50 ,$356.73 ,$123.05 ,$540.50 ,$169.42 ,$540.50 ,$540.50 ,$143.02 ,$432.40 ,$459.43 ,$337.81 ,$486.45 ,$169.42 ,$169.42 ,$513.48 ,$486.45 ,$459.43 ,$459.43 ,$143.02 ,$459.43 ,$459.43 ,$486.45 ,$329.16 ,$169.42 ,$335.12 ,$179.59 ,$486.45 ,$368.91 ,$497.26 ,$486.45 ,$356.78 ,$356.78 ,$329.16 ,$356.78 ,$351.33 ,$369.27 ,$123.05 ,$427.00 ,$179.59 ,$196.75 ,$196.75 ,$143.02 ,$196.75 ,$163.96 ,$513.48 ,$443.21 ,$443.21 ,$432.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000012,81207,HC BCR/ABL1 GENE MINOR BP,310,1 ,"$1,184.50 ",$781.77 ,$144.84 ,"$1,184.50 ",$149.66 ,$506.94 ,$506.94 ,$313.42 ,$947.60 ,"$1,006.83 ",$740.31 ,"$1,066.05 ",$149.66 ,$149.66 ,"$1,125.28 ","$1,066.05 ","$1,006.83 ","$1,006.83 ",$313.42 ,"$1,006.83 ","$1,006.83 ","$1,066.05 ",$721.36 ,$149.66 ,$734.40 ,$158.64 ,"$1,066.05 ",$325.89 ,"$1,089.74 ","$1,066.05 ",$781.89 ,$781.89 ,$721.36 ,$781.89 ,$769.93 ,$809.25 ,$269.66 ,$935.76 ,$158.64 ,$173.81 ,$173.81 ,$313.42 ,$173.81 ,$144.84 ,"$1,125.28 ",$971.29 ,$971.29 ,$947.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000013,81226,HC CYP2D6 GENE COM VARIANTS,310,1 ,"$2,060.80 ","$1,360.13 ",$450.91 ,"$2,060.80 ",$615.67 ,"$1,578.19 ","$1,578.19 ",$545.29 ,"$1,648.64 ","$1,751.68 ","$1,288.00 ","$1,854.72 ",$615.67 ,$615.67 ,"$1,957.76 ","$1,854.72 ","$1,751.68 ","$1,751.68 ",$545.29 ,"$1,751.68 ","$1,751.68 ","$1,854.72 ","$1,255.03 ",$615.67 ,"$1,277.70 ",$652.61 ,"$1,854.72 ","$1,014.55 ","$1,895.94 ","$1,854.72 ","$1,360.33 ","$1,360.33 ","$1,255.03 ","$1,360.33 ","$1,339.52 ","$1,407.94 ",$469.15 ,"$1,628.03 ",$652.61 ,$541.09 ,$541.09 ,$545.29 ,$541.09 ,$450.91 ,"$1,957.76 ","$1,689.86 ","$1,689.86 ","$1,648.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31000015,81240,HC F2 GENE ANAL 20210G A VAR,310,1 ,$309.35 ,$204.17 ,$53.70 ,$309.35 ,$53.70 ,$229.92 ,$229.92 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$53.70 ,$53.70 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$53.70 ,$191.80 ,$56.92 ,$278.42 ,$147.80 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$56.92 ,$78.83 ,$78.83 ,$81.85 ,$78.83 ,$65.69 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000016,81241,HC F5 GENE ANAL LEIDEN VAR,310,1 ,$309.35 ,$204.17 ,$66.70 ,$309.35 ,$66.70 ,$256.80 ,$256.80 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$66.70 ,$66.70 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$66.70 ,$191.80 ,$70.70 ,$278.42 ,$165.08 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$70.70 ,$88.04 ,$88.04 ,$81.85 ,$88.04 ,$73.37 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000017,81243,HC FMR1 GENE CHARACTERZTN,310,1 ,$309.35 ,$204.17 ,$54.46 ,$309.35 ,$54.46 ,$199.64 ,$199.64 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$54.46 ,$54.46 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$54.46 ,$191.80 ,$57.73 ,$278.42 ,$185.61 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 , N/A ,$244.39 ,$57.73 ,$68.45 ,$68.45 ,$81.85 ,$68.45 , N/A ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000018,81256,HC HFE GENE,310,1 ,$554.30 ,$365.84 ,$65.36 ,$554.30 ,$67.54 ,$228.76 ,$228.76 ,$146.67 ,$443.44 ,$471.16 ,$346.44 ,$498.87 ,$67.54 ,$67.54 ,$526.59 ,$498.87 ,$471.16 ,$471.16 ,$146.67 ,$471.16 ,$471.16 ,$498.87 ,$337.57 ,$67.54 ,$343.66 ,$71.59 ,$498.87 ,$147.06 ,$509.96 ,$498.87 ,$365.89 ,$365.89 ,$337.57 ,$365.89 ,$360.30 ,$378.70 ,$126.18 ,$437.90 ,$71.59 ,$78.43 ,$78.43 ,$146.67 ,$78.43 ,$65.36 ,$526.59 ,$454.53 ,$454.53 ,$443.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000019,81261,HC IGH GENE REARRNG AMP METH,310,1 ,"$2,084.95 ","$1,376.07 ",$197.99 ,"$2,084.95 ",$204.58 ,$692.97 ,$692.97 ,$551.68 ,"$1,667.96 ","$1,772.21 ","$1,303.09 ","$1,876.46 ",$204.58 ,$204.58 ,"$1,980.70 ","$1,876.46 ","$1,772.21 ","$1,772.21 ",$551.68 ,"$1,772.21 ","$1,772.21 ","$1,876.46 ","$1,269.73 ",$204.58 ,"$1,292.66 ",$216.85 ,"$1,876.46 ",$445.48 ,"$1,918.15 ","$1,876.46 ","$1,376.28 ","$1,376.28 ","$1,269.73 ","$1,376.28 ","$1,355.22 ","$1,424.44 ",$474.65 ,"$1,647.11 ",$216.85 ,$237.59 ,$237.59 ,$551.68 ,$237.59 ,$197.99 ,"$1,980.70 ","$1,709.66 ","$1,709.66 ","$1,667.96 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31000021,81275,HC KRAS GENE,310,1 ,"$1,210.95 ",$799.23 ,$157.98 ,"$1,210.95 ",$157.98 ,$676.38 ,$676.38 ,$320.42 ,$968.76 ,"$1,029.31 ",$756.84 ,"$1,089.86 ",$157.98 ,$157.98 ,"$1,150.40 ","$1,089.86 ","$1,029.31 ","$1,029.31 ",$320.42 ,"$1,029.31 ","$1,029.31 ","$1,089.86 ",$737.47 ,$157.98 ,$750.78 ,$167.46 ,"$1,089.86 ",$434.81 ,"$1,114.07 ","$1,089.86 ",$799.35 ,$799.35 ,$737.47 ,$799.35 ,$787.12 ,$827.32 ,$275.68 ,$956.65 ,$167.46 ,$231.90 ,$231.90 ,$320.42 ,$231.90 ,$193.25 ,"$1,150.40 ",$992.98 ,$992.98 ,$968.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000022,81291,HC MTHFR ISOLATION,310,1 ,$361.10 ,$238.33 ,$65.34 ,$361.10 ,$80.20 ,$228.69 ,$228.69 ,$95.55 ,$288.88 ,$306.94 ,$225.69 ,$324.99 ,$80.20 ,$80.20 ,$343.05 ,$324.99 ,$306.94 ,$306.94 ,$95.55 ,$306.94 ,$306.94 ,$324.99 ,$219.91 ,$80.20 ,$223.88 ,$85.01 ,$324.99 ,$147.02 ,$332.21 ,$324.99 ,$238.36 ,$238.36 ,$219.91 ,$238.36 ,$234.72 ,$246.70 ,$82.20 ,$285.27 ,$85.01 ,$78.41 ,$78.41 ,$95.55 ,$78.41 ,$65.34 ,$343.05 ,$296.10 ,$296.10 ,$288.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000023,81301,HC MSI MICROSAT INSTAB,310,1 ,"$1,404.15 ",$926.74 ,$316.03 ,"$1,404.15 ",$316.03 ,"$1,219.96 ","$1,219.96 ",$371.54 ,"$1,123.32 ","$1,193.53 ",$877.59 ,"$1,263.74 ",$316.03 ,$316.03 ,"$1,333.94 ","$1,263.74 ","$1,193.53 ","$1,193.53 ",$371.54 ,"$1,193.53 ","$1,193.53 ","$1,263.74 ",$855.13 ,$316.03 ,$870.58 ,$334.99 ,"$1,263.74 ",$784.26 ,"$1,291.82 ","$1,263.74 ",$926.88 ,$926.88 ,$855.13 ,$926.88 ,$912.70 ,$959.32 ,$319.66 ,"$1,109.28 ",$334.99 ,$418.27 ,$418.27 ,$371.54 ,$418.27 ,$348.56 ,"$1,333.94 ","$1,151.40 ","$1,151.40 ","$1,123.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31000025,81301,HC HNCP MICROSATL INSTABLTY,310,1 ,$672.75 ,$444.02 ,$153.15 ,$784.26 ,$316.03 ,$672.75 ,$672.75 ,$178.01 ,$538.20 ,$571.84 ,$420.47 ,$605.48 ,$316.03 ,$316.03 ,$639.11 ,$605.48 ,$571.84 ,$571.84 ,$178.01 ,$571.84 ,$571.84 ,$605.48 ,$409.70 ,$316.03 ,$417.10 ,$334.99 ,$605.48 ,$784.26 ,$618.93 ,$605.48 ,$444.08 ,$444.08 ,$409.70 ,$444.08 ,$437.29 ,$459.62 ,$153.15 ,$531.47 ,$334.99 ,$418.27 ,$418.27 ,$178.01 ,$418.27 ,$348.56 ,$639.11 ,$551.66 ,$551.66 ,$538.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000026,81315,HC PML/RARAL COM BRKPNTS,310,1 ,"$1,120.10 ",$739.27 ,$207.31 ,"$1,120.10 ",$214.21 ,$725.59 ,$725.59 ,$296.38 ,$896.08 ,$952.09 ,$700.06 ,"$1,008.09 ",$214.21 ,$214.21 ,"$1,064.10 ","$1,008.09 ",$952.09 ,$952.09 ,$296.38 ,$952.09 ,$952.09 ,"$1,008.09 ",$682.14 ,$214.21 ,$694.46 ,$227.06 ,"$1,008.09 ",$466.45 ,"$1,030.49 ","$1,008.09 ",$739.38 ,$739.38 ,$682.14 ,$739.38 ,$728.07 ,$765.25 ,$255.00 ,$884.88 ,$227.06 ,$248.77 ,$248.77 ,$296.38 ,$248.77 ,$207.31 ,"$1,064.10 ",$918.48 ,$918.48 ,$896.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000027,81331,HC SNRPN/UBE3A GENE,310,1 ,$425.50 ,$280.83 ,$51.07 ,$425.50 ,$52.77 ,$178.75 ,$178.75 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$52.77 ,$52.77 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$52.77 ,$263.82 ,$55.94 ,$382.95 ,$114.91 ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$55.94 ,$61.28 ,$61.28 ,$112.59 ,$61.28 ,$51.07 ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000028,81332,HC SERPINA1 GENE,310,1 ,"$1,221.30 ",$806.06 ,$43.65 ,"$1,221.30 ",$80.20 ,$152.78 ,$152.78 ,$323.15 ,$977.04 ,"$1,038.11 ",$763.31 ,"$1,099.17 ",$80.20 ,$80.20 ,"$1,160.24 ","$1,099.17 ","$1,038.11 ","$1,038.11 ",$323.15 ,"$1,038.11 ","$1,038.11 ","$1,099.17 ",$743.77 ,$80.20 ,$757.20 ,$85.01 ,"$1,099.17 ",$98.21 ,"$1,123.60 ","$1,099.17 ",$806.18 ,$806.18 ,$743.77 ,$806.18 ,$793.85 ,$834.39 ,$278.04 ,$964.83 ,$85.01 ,$52.38 ,$52.38 ,$323.15 ,$52.38 ,$43.65 ,"$1,160.24 ","$1,001.47 ","$1,001.47 ",$977.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000029,81383,HC HLA II TYPING ALLELE HR,310,1 ,$818.80 ,$540.41 ,$109.13 ,$818.80 ,$112.76 ,$381.96 ,$381.96 ,$216.66 ,$655.04 ,$695.98 ,$511.75 ,$736.92 ,$112.76 ,$112.76 ,$777.86 ,$736.92 ,$695.98 ,$695.98 ,$216.66 ,$695.98 ,$695.98 ,$736.92 ,$498.65 ,$112.76 ,$507.66 ,$119.53 ,$736.92 ,$245.54 ,$753.30 ,$736.92 ,$540.49 ,$540.49 ,$498.65 ,$540.49 ,$532.22 ,$559.40 ,$186.40 ,$646.85 ,$119.53 ,$130.96 ,$130.96 ,$216.66 ,$130.96 ,$109.13 ,$777.86 ,$671.42 ,$671.42 ,$655.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000030,81400,HC DPD MOPATH PROCEDURE L1,310,1 ,$483.00 ,$318.78 ,$51.17 ,$483.00 ,$51.17 ,$223.86 ,$223.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$51.17 ,$51.17 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$51.17 ,$299.46 ,$54.24 ,$434.70 ,$143.91 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 ,$54.24 ,$76.75 ,$76.75 ,$127.80 ,$76.75 ,$63.96 ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000032,81402,HC TCR MOPATH PROCED L3,310,1 ,$676.20 ,$446.29 ,$120.26 ,$676.20 ,$120.26 ,$526.16 ,$526.16 ,$178.92 ,$540.96 ,$574.77 ,$422.63 ,$608.58 ,$120.26 ,$120.26 ,$642.39 ,$608.58 ,$574.77 ,$574.77 ,$178.92 ,$574.77 ,$574.77 ,$608.58 ,$411.81 ,$120.26 ,$419.24 ,$127.48 ,$608.58 ,$405.72 ,$622.10 ,$608.58 ,$446.36 ,$446.36 ,$411.81 ,$446.36 ,$439.53 ,$461.98 , N/A ,$534.20 ,$127.48 ,$180.40 ,$180.40 ,$178.92 ,$180.40 , N/A ,$642.39 ,$554.48 ,$554.48 ,$540.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000033,81270,HC JAK2 GENE,310,1 ,$644.00 ,$425.04 ,$91.66 ,$644.00 ,$94.71 ,$320.81 ,$320.81 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$94.71 ,$94.71 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$94.71 ,$399.28 ,$100.39 ,$579.60 ,$206.24 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$100.39 ,$109.99 ,$109.99 ,$170.40 ,$109.99 ,$91.66 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000054,81261,HC AMPLIFIED METH IG GRA,310,1 ,$566.95 ,$374.19 ,$129.07 ,$566.95 ,$204.58 ,$566.95 ,$566.95 ,$150.02 ,$453.56 ,$481.91 ,$354.34 ,$510.26 ,$204.58 ,$204.58 ,$538.60 ,$510.26 ,$481.91 ,$481.91 ,$150.02 ,$481.91 ,$481.91 ,$510.26 ,$345.27 ,$204.58 ,$351.50 ,$216.85 ,$510.26 ,$445.48 ,$521.59 ,$510.26 ,$374.24 ,$374.24 ,$345.27 ,$374.24 ,$368.52 ,$387.34 ,$129.07 ,$447.89 ,$216.85 ,$237.59 ,$237.59 ,$150.02 ,$237.59 ,$197.99 ,$538.60 ,$464.90 ,$464.90 ,$453.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000056,81403,HC MO PATH LEVEL 4,310,1 ,"$1,124.70 ",$742.30 ,$148.16 ,"$1,124.70 ",$148.16 ,$648.20 ,$648.20 ,$297.60 ,$899.76 ,$956.00 ,$702.94 ,"$1,012.23 ",$148.16 ,$148.16 ,"$1,068.47 ","$1,012.23 ",$956.00 ,$956.00 ,$297.60 ,$956.00 ,$956.00 ,"$1,012.23 ",$684.94 ,$148.16 ,$697.32 ,$157.05 ,"$1,012.23 ",$674.82 ,"$1,034.72 ","$1,012.23 ",$742.41 ,$742.41 ,$684.94 ,$742.41 ,$731.06 ,$768.40 , N/A ,$888.51 ,$157.05 ,$222.24 ,$222.24 ,$297.60 ,$222.24 , N/A ,"$1,068.47 ",$922.25 ,$922.25 ,$899.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000073,81207,HC BCR/ABL1 GENE MINOR BP QUEST,310,1 ,$386.40 ,$255.02 ,$87.96 ,$386.40 ,$149.66 ,$386.40 ,$386.40 ,$102.24 ,$309.12 ,$328.44 ,$241.50 ,$347.76 ,$149.66 ,$149.66 ,$367.08 ,$347.76 ,$328.44 ,$328.44 ,$102.24 ,$328.44 ,$328.44 ,$347.76 ,$235.32 ,$149.66 ,$239.56 ,$158.64 ,$347.76 ,$325.89 ,$355.49 ,$347.76 ,$255.06 ,$255.06 ,$235.32 ,$255.06 ,$251.16 ,$263.99 ,$87.96 ,$305.26 ,$158.64 ,$173.81 ,$173.81 ,$102.24 ,$173.81 ,$144.84 ,$367.08 ,$316.85 ,$316.85 ,$309.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000101,83540,HC IRON LIVER TISSUE,310,1 ,$128.80 ,$85.01 ,$6.47 ,$128.80 ,$6.69 ,$22.65 ,$22.65 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$6.69 ,$6.69 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$6.69 ,$79.86 ,$7.09 ,$115.92 ,$14.56 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$7.09 ,$7.76 ,$7.76 ,$34.08 ,$7.76 ,$6.47 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000107,81235,HC EGFR GENE COM VARIANTS,310,1 ,$884.35 ,$583.67 ,$201.32 ,$884.35 ,$264.01 ,$884.35 ,$884.35 ,$233.99 ,$707.48 ,$751.70 ,$552.72 ,$795.92 ,$264.01 ,$264.01 ,$840.13 ,$795.92 ,$751.70 ,$751.70 ,$233.99 ,$751.70 ,$751.70 ,$795.92 ,$538.57 ,$264.01 ,$548.30 ,$279.85 ,$795.92 ,$730.31 ,$813.60 ,$795.92 ,$583.76 ,$583.76 ,$538.57 ,$583.76 ,$574.83 ,$604.19 ,$201.32 ,$698.64 ,$279.85 ,$389.50 ,$389.50 ,$233.99 ,$389.50 ,$324.58 ,$840.13 ,$725.17 ,$725.17 ,$707.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000109,81170,HC ABL1 GENE ANALYSIS KINASE DOMAIN,310,1 ,$540.50 ,$356.73 ,$123.05 ,$675.00 ,$195.07 ,$540.50 ,$540.50 ,$143.02 ,$432.40 ,$459.43 ,$337.81 ,$486.45 ,$195.07 ,$195.07 ,$513.48 ,$486.45 ,$459.43 ,$459.43 ,$143.02 ,$459.43 ,$459.43 ,$486.45 ,$329.16 ,$195.07 ,$335.12 ,$206.77 ,$486.45 ,$675.00 ,$497.26 ,$486.45 ,$356.78 ,$356.78 ,$329.16 ,$356.78 ,$351.33 ,$369.27 ,$123.05 ,$427.00 ,$206.77 ,$360.00 ,$360.00 ,$143.02 ,$360.00 ,$300.00 ,$513.48 ,$443.21 ,$443.21 ,$432.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000110,81218,HC CEBPA GENE ANALYSIS FULL SEQUENCE,310,1 ,$540.50 ,$356.73 ,$123.05 ,$544.28 ,$195.07 ,$540.50 ,$540.50 ,$143.02 ,$432.40 ,$459.43 ,$337.81 ,$486.45 ,$195.07 ,$195.07 ,$513.48 ,$486.45 ,$459.43 ,$459.43 ,$143.02 ,$459.43 ,$459.43 ,$486.45 ,$329.16 ,$195.07 ,$335.12 ,$206.77 ,$486.45 ,$544.28 ,$497.26 ,$486.45 ,$356.78 ,$356.78 ,$329.16 ,$356.78 ,$351.33 ,$369.27 ,$123.05 ,$427.00 ,$206.77 ,$290.28 ,$290.28 ,$143.02 ,$290.28 ,$241.90 ,$513.48 ,$443.21 ,$443.21 ,$432.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000111,81219,HC CALR GENE ANALYSIS EXON 9,310,1 ,$540.50 ,$356.73 ,$98.08 ,$540.50 ,$98.08 ,$425.71 ,$425.71 ,$143.02 ,$432.40 ,$459.43 ,$337.81 ,$486.45 ,$98.08 ,$98.08 ,$513.48 ,$486.45 ,$459.43 ,$459.43 ,$143.02 ,$459.43 ,$459.43 ,$486.45 ,$329.16 ,$98.08 ,$335.12 ,$103.96 ,$486.45 ,$273.67 ,$497.26 ,$486.45 ,$356.78 ,$356.78 ,$329.16 ,$356.78 ,$351.33 ,$369.27 ,$123.05 ,$427.00 ,$103.96 ,$145.96 ,$145.96 ,$143.02 ,$145.96 ,$121.63 ,$513.48 ,$443.21 ,$443.21 ,$432.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000112,81226,HC CYP2D6 GENE ANALYSIS COMMON VARIANTS,310,1 ,$695.75 ,$459.20 ,$158.39 ,"$1,014.55 ",$615.67 ,$695.75 ,$695.75 ,$184.09 ,$556.60 ,$591.39 ,$434.84 ,$626.18 ,$615.67 ,$615.67 ,$660.96 ,$626.18 ,$591.39 ,$591.39 ,$184.09 ,$591.39 ,$591.39 ,$626.18 ,$423.71 ,$615.67 ,$431.36 ,$652.61 ,$626.18 ,"$1,014.55 ",$640.09 ,$626.18 ,$459.26 ,$459.26 ,$423.71 ,$459.26 ,$452.24 ,$475.34 ,$158.39 ,$549.64 ,$652.61 ,$541.09 ,$541.09 ,$184.09 ,$541.09 ,$450.91 ,$660.96 ,$570.52 ,$570.52 ,$556.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000113,81245,HC FLT3 GENE ANALYSIS INT TANDEM DUP VARIANTS,310,1 ,$322.00 ,$212.52 ,$73.30 ,$372.40 ,$132.74 ,$322.00 ,$322.00 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$132.74 ,$132.74 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$132.74 ,$199.64 ,$140.70 ,$289.80 ,$372.40 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$140.70 ,$198.61 ,$198.61 ,$85.20 ,$198.61 ,$165.51 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000114,81246,HC FL53 GENE ANALYSIS TYROSINE KINASE VARIANTS,310,1 ,$270.25 ,$178.37 ,$61.52 ,$270.25 ,$85.76 ,$270.25 ,$270.25 ,$71.51 ,$216.20 ,$229.71 ,$168.91 ,$243.23 ,$85.76 ,$85.76 ,$256.74 ,$243.23 ,$229.71 ,$229.71 ,$71.51 ,$229.71 ,$229.71 ,$243.23 ,$164.58 ,$85.76 ,$167.56 ,$90.91 ,$243.23 ,$186.75 ,$248.63 ,$243.23 ,$178.39 ,$178.39 ,$164.58 ,$178.39 ,$175.66 ,$184.63 ,$61.52 ,$213.50 ,$90.91 ,$99.60 ,$99.60 ,$71.51 ,$99.60 ,$83.00 ,$256.74 ,$221.61 ,$221.61 ,$216.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000115,81257,HC HBA1/HBA2 GENE ANALYSIS COM DELETE OR VARIANTS,310,1 ,$721.05 ,$475.89 ,$105.67 ,$721.05 ,$105.67 ,$357.91 ,$357.91 ,$190.79 ,$576.84 ,$612.89 ,$450.66 ,$648.95 ,$105.67 ,$105.67 ,$685.00 ,$648.95 ,$612.89 ,$612.89 ,$190.79 ,$612.89 ,$612.89 ,$648.95 ,$439.12 ,$105.67 ,$447.06 ,$112.01 ,$648.95 ,$432.63 ,$663.37 ,$648.95 ,$475.97 ,$475.97 ,$439.12 ,$475.97 ,$468.68 ,$492.62 , N/A ,$569.63 ,$112.01 ,$122.71 ,$122.71 ,$190.79 ,$122.71 , N/A ,$685.00 ,$591.26 ,$591.26 ,$576.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000116,81261,HC IGH GENE ANALYSIS REARRANGEMENT AMP,310,1 ,$684.25 ,$451.61 ,$155.77 ,$684.25 ,$204.58 ,$684.25 ,$684.25 ,$181.05 ,$547.40 ,$581.61 ,$427.66 ,$615.83 ,$204.58 ,$204.58 ,$650.04 ,$615.83 ,$581.61 ,$581.61 ,$181.05 ,$581.61 ,$581.61 ,$615.83 ,$416.71 ,$204.58 ,$424.24 ,$216.85 ,$615.83 ,$445.48 ,$629.51 ,$615.83 ,$451.67 ,$451.67 ,$416.71 ,$451.67 ,$444.76 ,$467.48 ,$155.77 ,$540.56 ,$216.85 ,$237.59 ,$237.59 ,$181.05 ,$237.59 ,$197.99 ,$650.04 ,$561.09 ,$561.09 ,$547.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000117,81263,HC IGH VAR REG SOMATIC MUTATION ANALYSIS,310,1 ,$888.95 ,$586.71 ,$202.37 ,$888.95 ,$304.33 ,$888.95 ,$888.95 ,$235.22 ,$711.16 ,$755.61 ,$555.59 ,$800.06 ,$304.33 ,$304.33 ,$844.50 ,$800.06 ,$755.61 ,$755.61 ,$235.22 ,$755.61 ,$755.61 ,$800.06 ,$541.37 ,$304.33 ,$551.14 ,$322.59 ,$800.06 ,$662.67 ,$817.83 ,$800.06 ,$586.80 ,$586.80 ,$541.37 ,$586.80 ,$577.82 ,$607.33 ,$202.37 ,$702.27 ,$322.59 ,$353.42 ,$353.42 ,$235.22 ,$353.42 ,$294.52 ,$844.50 ,$728.94 ,$728.94 ,$711.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000118,81272,HC V KIT GENE ANALYSIS TARGETED SEQ,310,1 ,$644.00 ,$425.04 ,$146.61 ,$741.40 ,$195.07 ,$644.00 ,$644.00 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$195.07 ,$195.07 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$195.07 ,$399.28 ,$206.77 ,$579.60 ,$741.40 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$206.77 ,$395.41 ,$395.41 ,$170.40 ,$395.41 ,$329.51 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000119,81315,HC PML/RARALPHA ANALYSIS COMMON BRKPNTS QL/QN,310,1 ,$656.65 ,$433.39 ,$149.49 ,$656.65 ,$214.21 ,$656.65 ,$656.65 ,$173.75 ,$525.32 ,$558.15 ,$410.41 ,$590.99 ,$214.21 ,$214.21 ,$623.82 ,$590.99 ,$558.15 ,$558.15 ,$173.75 ,$558.15 ,$558.15 ,$590.99 ,$399.90 ,$214.21 ,$407.12 ,$227.06 ,$590.99 ,$466.45 ,$604.12 ,$590.99 ,$433.45 ,$433.45 ,$399.90 ,$433.45 ,$426.82 ,$448.62 ,$149.49 ,$518.75 ,$227.06 ,$248.77 ,$248.77 ,$173.75 ,$248.77 ,$207.31 ,$623.82 ,$538.45 ,$538.45 ,$525.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000120,81350,HC UGT1A1 GENE ANALYSIS COM VARIANTS,310,1 ,$805.00 ,$531.30 ,$183.26 ,$805.00 , N/A ,$805.00 ,$805.00 ,$213.00 ,$644.00 ,$684.25 ,$503.13 ,$724.50 , N/A , N/A ,$764.75 ,$724.50 ,$684.25 ,$684.25 ,$213.00 ,$684.25 ,$684.25 ,$724.50 ,$490.25 , N/A ,$499.10 , N/A ,$724.50 ,$526.50 ,$740.60 ,$724.50 ,$531.38 ,$531.38 ,$490.25 ,$531.38 ,$523.25 ,$549.98 ,$183.26 ,$635.95 , N/A ,$280.80 ,$280.80 ,$213.00 ,$280.80 ,$234.00 ,$764.75 ,$660.10 ,$660.10 ,$644.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000121,81401,HC MOPATH PROC (ABL),310,1 ,$644.00 ,$425.04 ,$109.60 ,$644.00 ,$109.60 ,$479.50 ,$479.50 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$109.60 ,$109.60 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$109.60 ,$399.28 ,$116.18 ,$579.60 ,$386.40 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 , N/A ,$508.76 ,$116.18 ,$164.40 ,$164.40 ,$170.40 ,$164.40 , N/A ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000123,81401,HC MOPATH PROC (CBFB),310,1 ,$644.00 ,$425.04 ,$109.60 ,$644.00 ,$109.60 ,$479.50 ,$479.50 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$109.60 ,$109.60 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$109.60 ,$399.28 ,$116.18 ,$579.60 ,$386.40 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 , N/A ,$508.76 ,$116.18 ,$164.40 ,$164.40 ,$170.40 ,$164.40 , N/A ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000124,81402,HC MOPATH PROC (BCL2) L3,310,1 ,$644.00 ,$425.04 ,$120.26 ,$644.00 ,$120.26 ,$526.16 ,$526.16 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$120.26 ,$120.26 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$120.26 ,$399.28 ,$127.48 ,$579.60 ,$386.40 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 , N/A ,$508.76 ,$127.48 ,$180.40 ,$180.40 ,$170.40 ,$180.40 , N/A ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000202,81229,HC CYTOGENOMIC MICROARRAY ASSAY,310,1 ,"$2,447.20 ","$1,615.15 ",$557.12 ,"$2,610.00 ",$608.00 ,"$2,447.20 ","$2,447.20 ",$647.53 ,"$1,957.76 ","$2,080.12 ","$1,529.50 ","$2,202.48 ",$608.00 ,$608.00 ,"$2,324.84 ","$2,202.48 ","$2,080.12 ","$2,080.12 ",$647.53 ,"$2,080.12 ","$2,080.12 ","$2,202.48 ","$1,490.34 ",$608.00 ,"$1,517.26 ",$644.48 ,"$2,202.48 ","$2,610.00 ","$2,251.42 ","$2,202.48 ","$1,615.40 ","$1,615.40 ","$1,490.34 ","$1,615.40 ","$1,590.68 ","$1,671.93 ",$557.12 ,"$1,933.29 ",$644.48 ,"$1,392.00 ","$1,392.00 ",$647.53 ,"$1,392.00 ","$1,160.00 ","$2,324.84 ","$2,006.70 ","$2,006.70 ","$1,957.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31000235,81219,HC MUTATION ANALYSIS CALRETICULIN,310,1 ,$676.20 ,$446.29 ,$98.08 ,$676.20 ,$98.08 ,$425.71 ,$425.71 ,$178.92 ,$540.96 ,$574.77 ,$422.63 ,$608.58 ,$98.08 ,$98.08 ,$642.39 ,$608.58 ,$574.77 ,$574.77 ,$178.92 ,$574.77 ,$574.77 ,$608.58 ,$411.81 ,$98.08 ,$419.24 ,$103.96 ,$608.58 ,$273.67 ,$622.10 ,$608.58 ,$446.36 ,$446.36 ,$411.81 ,$446.36 ,$439.53 ,$461.98 ,$153.95 ,$534.20 ,$103.96 ,$145.96 ,$145.96 ,$178.92 ,$145.96 ,$121.63 ,$642.39 ,$554.48 ,$554.48 ,$540.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000236,81403,HC MOLECULAR PATH MUTATION ANALYSIS EXON 12,310,1 ,$515.20 ,$340.03 ,$136.32 ,$515.20 ,$148.16 ,$515.20 ,$515.20 ,$136.32 ,$412.16 ,$437.92 ,$322.00 ,$463.68 ,$148.16 ,$148.16 ,$489.44 ,$463.68 ,$437.92 ,$437.92 ,$136.32 ,$437.92 ,$437.92 ,$463.68 ,$313.76 ,$148.16 ,$319.42 ,$157.05 ,$463.68 ,$309.12 ,$473.98 ,$463.68 ,$340.08 ,$340.08 ,$313.76 ,$340.08 ,$334.88 ,$351.98 , N/A ,$407.01 ,$157.05 ,$222.24 ,$222.24 ,$136.32 ,$222.24 , N/A ,$489.44 ,$422.46 ,$422.46 ,$412.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000237,81402,HC MOLECULAR PATH MUTATION ANALYSIS MPL,310,1 ,$483.00 ,$318.78 ,$120.26 ,$483.00 ,$120.26 ,$483.00 ,$483.00 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$120.26 ,$120.26 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$120.26 ,$299.46 ,$127.48 ,$434.70 ,$289.80 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 , N/A ,$381.57 ,$127.48 ,$180.40 ,$180.40 ,$127.80 ,$180.40 , N/A ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000238,81479,HC MUTATION ANALYSIS CSF3R,310,1 ,$386.40 ,$255.02 ,$80.20 ,$386.40 ,$80.20 ,$346.29 ,$346.29 ,$102.24 ,$309.12 ,$328.44 ,$241.50 ,$347.76 ,$80.20 ,$80.20 ,$367.08 ,$347.76 ,$328.44 ,$328.44 ,$102.24 ,$328.44 ,$328.44 ,$347.76 ,$235.32 ,$80.20 ,$239.56 ,$85.01 ,$347.76 ,$231.84 ,$355.49 ,$347.76 ,$255.06 ,$255.06 ,$235.32 ,$255.06 ,$251.16 ,$263.99 , N/A ,$305.26 ,$85.01 ,$189.34 ,$189.34 ,$102.24 ,$189.34 , N/A ,$367.08 ,$316.85 ,$316.85 ,$309.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000239,81270,HC JAK2 MUTATION ANALYSIS,310,1 ,$463.45 ,$305.88 ,$91.66 ,$463.45 ,$94.71 ,$320.81 ,$320.81 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$94.71 ,$94.71 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$94.71 ,$287.34 ,$100.39 ,$417.11 ,$206.24 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$100.39 ,$109.99 ,$109.99 ,$122.63 ,$109.99 ,$91.66 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000308,81208,HC BCR/ABL1 GENE OTH BP QL/QN,310,1 ,$355.97 ,$234.94 ,$81.04 ,$482.90 ,$175.54 ,$355.97 ,$355.97 ,$94.19 ,$284.78 ,$302.57 ,$222.48 ,$320.37 ,$175.54 ,$175.54 ,$338.17 ,$320.37 ,$302.57 ,$302.57 ,$94.19 ,$302.57 ,$302.57 ,$320.37 ,$216.79 ,$175.54 ,$220.70 ,$186.07 ,$320.37 ,$482.90 ,$327.49 ,$320.37 ,$234.98 ,$234.98 ,$216.79 ,$234.98 ,$231.38 ,$243.20 ,$81.04 ,$281.22 ,$186.07 ,$257.54 ,$257.54 ,$94.19 ,$257.54 ,$214.62 ,$338.17 ,$291.90 ,$291.90 ,$284.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),31000313,81405,HC MOLECULAR PATH PROC LEVEL 6,310,1 ,$205.85 ,$135.86 ,$54.47 ,$218.20 ,$205.85 ,$205.85 ,$205.85 ,$54.47 ,$164.68 ,$174.97 ,$128.66 ,$185.27 ,$205.85 ,$205.85 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$205.85 ,$127.62 ,$218.20 ,$185.27 ,$123.51 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 , N/A ,$162.62 ,$218.20 ,$205.85 ,$205.85 ,$54.47 ,$205.85 , N/A ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$193.20 ,$127.51 ,$33.96 ,$193.20 ,$65.18 ,$133.85 ,$133.85 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$65.18 ,$65.18 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$65.18 ,$119.78 ,$69.09 ,$173.88 ,$76.41 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$69.09 ,$40.12 ,$40.12 ,$51.12 ,$40.12 ,$33.96 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$270.25 ,$178.37 ,$33.96 ,$270.25 ,$65.18 ,$140.70 ,$140.70 ,$71.51 ,$216.20 ,$229.71 ,$168.91 ,$243.23 ,$65.18 ,$65.18 ,$256.74 ,$243.23 ,$229.71 ,$229.71 ,$71.51 ,$229.71 ,$229.71 ,$243.23 ,$164.58 ,$65.18 ,$167.56 ,$69.09 ,$243.23 ,$76.41 ,$248.63 ,$243.23 ,$178.39 ,$178.39 ,$164.58 ,$178.39 ,$175.66 ,$184.63 ,$61.52 ,$213.50 ,$69.09 ,$40.12 ,$40.12 ,$71.51 ,$40.12 ,$33.96 ,$256.74 ,$221.61 ,$221.61 ,$216.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$218.50 ,$144.21 ,$49.74 ,$218.50 ,$65.18 ,$130.43 ,$130.43 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$65.18 ,$65.18 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$65.18 ,$135.48 ,$69.09 ,$196.65 ,$112.82 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$69.09 ,$59.36 ,$59.36 ,$57.82 ,$59.36 ,$50.14 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100106,88142,HC THINPREP PAP (CMH),311,1 ,$180.55 ,$119.16 ,$20.26 ,$180.55 ,$20.93 ,$70.91 ,$70.91 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$20.93 ,$20.93 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$20.93 ,$111.94 ,$22.19 ,$162.50 ,$45.59 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$22.19 ,$24.31 ,$24.31 ,$47.77 ,$24.31 ,$20.26 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100107,88142,HC THINPREP PAP,311,1 ,$180.55 ,$119.16 ,$20.26 ,$180.55 ,$20.93 ,$70.91 ,$70.91 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$20.93 ,$20.93 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$20.93 ,$111.94 ,$22.19 ,$162.50 ,$45.59 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$22.19 ,$24.31 ,$24.31 ,$47.77 ,$24.31 ,$20.26 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$218.50 ,$144.21 ,$24.96 ,$218.50 ,$65.18 ,$154.39 ,$154.39 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$65.18 ,$65.18 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$65.18 ,$135.48 ,$69.09 ,$196.65 ,$56.16 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$69.09 ,$27.59 ,$27.59 ,$57.82 ,$27.59 ,$24.96 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100114,88172,HC FINE NEEDLE EVAL,311,1 ,$162.15 ,$107.02 ,$36.91 ,$353.81 ,$143.18 ,$64.25 ,$64.25 ,$42.90 ,$129.72 ,$137.83 ,$101.34 ,$145.94 ,$143.18 ,$143.18 ,$154.04 ,$145.94 ,$137.83 ,$137.83 ,$42.90 ,$137.83 ,$137.83 ,$145.94 ,$98.75 ,$143.18 ,$100.54 ,$151.77 ,$145.94 ,$353.81 ,$149.18 ,$145.94 ,$107.04 ,$107.04 ,$98.75 ,$107.04 ,$105.40 ,$110.78 ,$36.91 ,$128.10 ,$151.77 ,$162.15 ,$162.15 ,$42.90 ,$162.15 ,$157.25 ,$154.04 ,$132.96 ,$132.96 ,$129.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$463.45 ,$305.88 ,$50.14 ,$463.45 ,$131.50 ,$291.24 ,$291.24 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$131.50 ,$131.50 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$131.50 ,$287.34 ,$139.39 ,$417.11 ,$112.82 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$139.39 ,$59.36 ,$59.36 ,$122.63 ,$59.36 ,$50.14 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100117,88182,HC T AND B CELL QN FLOWCYT,311,1 ,$173.65 ,$114.61 ,$39.53 ,$173.65 ,$65.18 ,$173.65 ,$173.65 ,$45.95 ,$138.92 ,$147.60 ,$108.53 ,$156.29 ,$65.18 ,$65.18 ,$164.97 ,$156.29 ,$147.60 ,$147.60 ,$45.95 ,$147.60 ,$147.60 ,$156.29 ,$105.75 ,$65.18 ,$107.66 ,$69.09 ,$156.29 ,$112.82 ,$159.76 ,$156.29 ,$114.63 ,$114.63 ,$105.75 ,$114.63 ,$112.87 ,$118.64 ,$39.53 ,$137.18 ,$69.09 ,$59.36 ,$59.36 ,$45.95 ,$59.36 ,$50.14 ,$164.97 ,$142.39 ,$142.39 ,$138.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100121,88184,HC FLOW CYTO 1ST MARKER,311,1 ,$540.50 ,$356.73 ,$123.05 ,$729.25 ,$143.18 ,$226.63 ,$226.63 ,$143.02 ,$432.40 ,$459.43 ,$337.81 ,$486.45 ,$143.18 ,$143.18 ,$513.48 ,$486.45 ,$459.43 ,$459.43 ,$143.02 ,$459.43 ,$459.43 ,$486.45 ,$329.16 ,$143.18 ,$335.12 ,$151.77 ,$486.45 ,$729.25 ,$497.26 ,$486.45 ,$356.78 ,$356.78 ,$329.16 ,$356.78 ,$351.33 ,$369.27 ,$123.05 ,$427.00 ,$151.77 ,$340.09 ,$340.09 ,$143.02 ,$340.09 ,$324.11 ,$513.48 ,$443.21 ,$443.21 ,$432.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100126,88185,HC FLOW CYTO EA ADD MARKER,311,1 ,$334.65 ,$220.87 ,$26.86 ,$334.65 ,$65.18 ,$73.02 ,$73.02 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$65.18 ,$65.18 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$65.18 ,$207.48 ,$69.09 ,$301.19 , N/A ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$69.09 ,$26.86 ,$26.86 ,$88.55 ,$26.86 , N/A ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100128,88185,HC T AND B MAKERS ADDL,311,1 ,$88.55 ,$58.44 ,$20.16 ,$88.55 ,$65.18 ,$73.02 ,$73.02 ,$23.43 ,$70.84 ,$75.27 ,$55.34 ,$79.70 ,$65.18 ,$65.18 ,$84.12 ,$79.70 ,$75.27 ,$75.27 ,$23.43 ,$75.27 ,$75.27 ,$79.70 ,$53.93 ,$65.18 ,$54.90 ,$69.09 ,$79.70 , N/A ,$81.47 ,$79.70 ,$58.45 ,$58.45 ,$53.93 ,$58.45 ,$57.56 ,$60.50 ,$20.16 ,$69.95 ,$69.09 ,$26.86 ,$26.86 ,$23.43 ,$26.86 , N/A ,$84.12 ,$72.61 ,$72.61 ,$70.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100131,88230,HC TISSUE CLT NONNEO (CHROMO),311,1 ,$645.15 ,$425.80 ,$70.04 ,$645.15 ,$70.04 ,$407.72 ,$407.72 ,$170.71 ,$516.12 ,$548.38 ,$403.22 ,$580.64 ,$70.04 ,$70.04 ,$612.89 ,$580.64 ,$548.38 ,$548.38 ,$170.71 ,$548.38 ,$548.38 ,$580.64 ,$392.90 ,$70.04 ,$400.00 ,$74.24 ,$580.64 ,$262.10 ,$593.54 ,$580.64 ,$425.86 ,$425.86 ,$392.90 ,$425.86 ,$419.35 ,$440.77 ,$146.86 ,$509.67 ,$74.24 ,$139.79 ,$139.79 ,$170.71 ,$139.79 ,$116.49 ,$612.89 ,$529.02 ,$529.02 ,$516.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100137,88233,HC TISSUE CULT SKIN/OTH SOLID,311,1 ,$458.85 ,$302.84 ,$70.04 ,$458.85 ,$70.04 ,$458.85 ,$458.85 ,$121.41 ,$367.08 ,$390.02 ,$286.78 ,$412.97 ,$70.04 ,$70.04 ,$435.91 ,$412.97 ,$390.02 ,$390.02 ,$121.41 ,$390.02 ,$390.02 ,$412.97 ,$279.44 ,$70.04 ,$284.48 ,$74.24 ,$412.97 ,$316.64 ,$422.14 ,$412.97 ,$302.89 ,$302.89 ,$279.44 ,$302.89 ,$298.25 ,$313.49 ,$104.47 ,$362.49 ,$74.24 ,$168.88 ,$168.88 ,$121.41 ,$168.88 ,$140.73 ,$435.91 ,$376.26 ,$376.26 ,$367.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100139,88235,HC TISSUE CULT AMNIO/CHORION,311,1 ,$692.30 ,$456.92 ,$70.04 ,$692.30 ,$70.04 ,$526.05 ,$526.05 ,$183.18 ,$553.84 ,$588.46 ,$432.69 ,$623.07 ,$70.04 ,$70.04 ,$657.69 ,$623.07 ,$588.46 ,$588.46 ,$183.18 ,$588.46 ,$588.46 ,$623.07 ,$421.61 ,$70.04 ,$429.22 ,$74.24 ,$623.07 ,$338.18 ,$636.92 ,$623.07 ,$456.99 ,$456.99 ,$421.61 ,$456.99 ,$450.00 ,$472.98 ,$157.60 ,$546.92 ,$74.24 ,$180.36 ,$180.36 ,$183.18 ,$180.36 ,$150.30 ,$657.69 ,$567.69 ,$567.69 ,$553.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100140,88237,HC TISSUE CULT BONE/BLD (CHROMO QD),311,1 ,$504.85 ,$333.20 ,$70.04 ,$504.85 ,$70.04 ,$503.13 ,$503.13 ,$133.58 ,$403.88 ,$429.12 ,$315.53 ,$454.37 ,$70.04 ,$70.04 ,$479.61 ,$454.37 ,$429.12 ,$429.12 ,$133.58 ,$429.12 ,$429.12 ,$454.37 ,$307.45 ,$70.04 ,$313.00 ,$74.24 ,$454.37 ,$323.44 ,$464.46 ,$454.37 ,$333.25 ,$333.25 ,$307.45 ,$333.25 ,$328.15 ,$344.91 ,$114.93 ,$398.83 ,$74.24 ,$172.50 ,$172.50 ,$133.58 ,$172.50 ,$143.75 ,$479.61 ,$413.98 ,$413.98 ,$403.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100143,88237,HC TISSUE CULT BONE/BLD (CHROMO),311,1 ,$422.05 ,$278.55 ,$70.04 ,$422.05 ,$70.04 ,$422.05 ,$422.05 ,$111.67 ,$337.64 ,$358.74 ,$263.78 ,$379.85 ,$70.04 ,$70.04 ,$400.95 ,$379.85 ,$358.74 ,$358.74 ,$111.67 ,$358.74 ,$358.74 ,$379.85 ,$257.03 ,$70.04 ,$261.68 ,$74.24 ,$379.85 ,$323.44 ,$388.29 ,$379.85 ,$278.60 ,$278.60 ,$257.03 ,$278.60 ,$274.33 ,$288.34 ,$96.08 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$111.67 ,$172.50 ,$143.75 ,$400.95 ,$346.08 ,$346.08 ,$337.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100144,88237,HC TISSUE CULT BONE/BLD,311,1 ,$422.05 ,$278.55 ,$70.04 ,$422.05 ,$70.04 ,$422.05 ,$422.05 ,$111.67 ,$337.64 ,$358.74 ,$263.78 ,$379.85 ,$70.04 ,$70.04 ,$400.95 ,$379.85 ,$358.74 ,$358.74 ,$111.67 ,$358.74 ,$358.74 ,$379.85 ,$257.03 ,$70.04 ,$261.68 ,$74.24 ,$379.85 ,$323.44 ,$388.29 ,$379.85 ,$278.60 ,$278.60 ,$257.03 ,$278.60 ,$274.33 ,$288.34 ,$96.08 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$111.67 ,$172.50 ,$143.75 ,$400.95 ,$346.08 ,$346.08 ,$337.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100145,88237,HC TISSUE CULT BONE/BLD (CHROMO 1),311,1 ,$422.05 ,$278.55 ,$70.04 ,$422.05 ,$70.04 ,$422.05 ,$422.05 ,$111.67 ,$337.64 ,$358.74 ,$263.78 ,$379.85 ,$70.04 ,$70.04 ,$400.95 ,$379.85 ,$358.74 ,$358.74 ,$111.67 ,$358.74 ,$358.74 ,$379.85 ,$257.03 ,$70.04 ,$261.68 ,$74.24 ,$379.85 ,$323.44 ,$388.29 ,$379.85 ,$278.60 ,$278.60 ,$257.03 ,$278.60 ,$274.33 ,$288.34 ,$96.08 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$111.67 ,$172.50 ,$143.75 ,$400.95 ,$346.08 ,$346.08 ,$337.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100146,88237,HC TISSUE CULT BONE/BLD (CHROMO 2),311,1 ,$422.05 ,$278.55 ,$70.04 ,$422.05 ,$70.04 ,$422.05 ,$422.05 ,$111.67 ,$337.64 ,$358.74 ,$263.78 ,$379.85 ,$70.04 ,$70.04 ,$400.95 ,$379.85 ,$358.74 ,$358.74 ,$111.67 ,$358.74 ,$358.74 ,$379.85 ,$257.03 ,$70.04 ,$261.68 ,$74.24 ,$379.85 ,$323.44 ,$388.29 ,$379.85 ,$278.60 ,$278.60 ,$257.03 ,$278.60 ,$274.33 ,$288.34 ,$96.08 ,$333.42 ,$74.24 ,$172.50 ,$172.50 ,$111.67 ,$172.50 ,$143.75 ,$400.95 ,$346.08 ,$346.08 ,$337.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100148,88239,HC TISSUE CULT TUMOR,311,1 ,$570.40 ,$376.46 ,$70.04 ,$570.40 ,$70.04 ,$516.32 ,$516.32 ,$150.93 ,$456.32 ,$484.84 ,$356.50 ,$513.36 ,$70.04 ,$70.04 ,$541.88 ,$513.36 ,$484.84 ,$484.84 ,$150.93 ,$484.84 ,$484.84 ,$513.36 ,$347.37 ,$70.04 ,$353.64 ,$74.24 ,$513.36 ,$331.92 ,$524.77 ,$513.36 ,$376.52 ,$376.52 ,$347.37 ,$376.52 ,$370.76 ,$389.70 ,$129.85 ,$450.62 ,$74.24 ,$177.02 ,$177.02 ,$150.93 ,$177.02 ,$147.52 ,$541.88 ,$467.73 ,$467.73 ,$456.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100150,88239,HC TISSUE CULT TUMOR (LYM),311,1 ,$745.20 ,$491.83 ,$70.04 ,$745.20 ,$70.04 ,$516.32 ,$516.32 ,$197.18 ,$596.16 ,$633.42 ,$465.75 ,$670.68 ,$70.04 ,$70.04 ,$707.94 ,$670.68 ,$633.42 ,$633.42 ,$197.18 ,$633.42 ,$633.42 ,$670.68 ,$453.83 ,$70.04 ,$462.02 ,$74.24 ,$670.68 ,$331.92 ,$685.58 ,$670.68 ,$491.91 ,$491.91 ,$453.83 ,$491.91 ,$484.38 ,$509.12 ,$169.65 ,$588.71 ,$74.24 ,$177.02 ,$177.02 ,$197.18 ,$177.02 ,$147.52 ,$707.94 ,$611.06 ,$611.06 ,$596.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100151,88240,HC CRYOPRESERVATION,311,1 ,$56.35 ,$37.19 ,$9.83 ,$56.35 ,$9.83 ,$45.75 ,$45.75 ,$14.91 ,$45.08 ,$47.90 ,$35.22 ,$50.72 ,$9.83 ,$9.83 ,$53.53 ,$50.72 ,$47.90 ,$47.90 ,$14.91 ,$47.90 ,$47.90 ,$50.72 ,$34.32 ,$9.83 ,$34.94 ,$10.42 ,$50.72 ,$29.41 ,$51.84 ,$50.72 ,$37.20 ,$37.20 ,$34.32 ,$37.20 ,$36.63 ,$38.50 ,$12.83 ,$44.52 ,$10.42 ,$15.68 ,$15.68 ,$14.91 ,$15.68 ,$13.07 ,$53.53 ,$46.21 ,$46.21 ,$45.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100155,88299,HC CYTOGENIC STUDY (LYMPH),311,1 ,$533.60 ,$352.18 ,$50.14 ,$533.60 ,$80.20 ,$478.21 ,$478.21 ,$141.19 ,$426.88 ,$453.56 ,$333.50 ,$480.24 ,$80.20 ,$80.20 ,$506.92 ,$480.24 ,$453.56 ,$453.56 ,$141.19 ,$453.56 ,$453.56 ,$480.24 ,$324.96 ,$80.20 ,$330.84 ,$85.01 ,$480.24 ,$112.82 ,$490.91 ,$480.24 ,$352.23 ,$352.23 ,$324.96 ,$352.23 ,$346.84 ,$364.56 ,$121.48 ,$421.54 ,$85.01 ,$59.36 ,$59.36 ,$141.19 ,$59.36 ,$50.14 ,$506.92 ,$437.55 ,$437.55 ,$426.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100161,88262,HC CHROM COUNT 15-20/2,311,1 ,$558.90 ,$368.87 ,$125.49 ,$558.90 ,$129.67 ,$439.22 ,$439.22 ,$147.88 ,$447.12 ,$475.07 ,$349.31 ,$503.01 ,$129.67 ,$129.67 ,$530.96 ,$503.01 ,$475.07 ,$475.07 ,$147.88 ,$475.07 ,$475.07 ,$503.01 ,$340.37 ,$129.67 ,$346.52 ,$137.45 ,$503.01 ,$282.35 ,$514.19 ,$503.01 ,$368.93 ,$368.93 ,$340.37 ,$368.93 ,$363.29 ,$381.84 ,$127.24 ,$441.53 ,$137.45 ,$150.59 ,$150.59 ,$147.88 ,$150.59 ,$125.49 ,$530.96 ,$458.30 ,$458.30 ,$447.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100165,88264,HC CYTOGENIC STUDY (HEMA BLD),311,1 ,"$1,054.55 ",$696.00 ,$144.61 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$279.04 ,$843.64 ,$896.37 ,$659.09 ,$949.10 ,$149.43 ,$149.43 ,"$1,001.82 ",$949.10 ,$896.37 ,$896.37 ,$279.04 ,$896.37 ,$896.37 ,$949.10 ,$642.22 ,$149.43 ,$653.82 ,$158.40 ,$949.10 ,$325.37 ,$970.19 ,$949.10 ,$696.11 ,$696.11 ,$642.22 ,$696.11 ,$685.46 ,$720.47 ,$240.08 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$279.04 ,$173.53 ,$144.61 ,"$1,001.82 ",$864.73 ,$864.73 ,$843.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100166,88264,HC CHROM ANLYS ANALYZE 20,311,1 ,"$1,054.55 ",$696.00 ,$144.61 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$279.04 ,$843.64 ,$896.37 ,$659.09 ,$949.10 ,$149.43 ,$149.43 ,"$1,001.82 ",$949.10 ,$896.37 ,$896.37 ,$279.04 ,$896.37 ,$896.37 ,$949.10 ,$642.22 ,$149.43 ,$653.82 ,$158.40 ,$949.10 ,$325.37 ,$970.19 ,$949.10 ,$696.11 ,$696.11 ,$642.22 ,$696.11 ,$685.46 ,$720.47 ,$240.08 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$279.04 ,$173.53 ,$144.61 ,"$1,001.82 ",$864.73 ,$864.73 ,$843.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100169,88264,HC CYTOGENIC STUDY (BM),311,1 ,"$1,054.55 ",$696.00 ,$144.61 ,"$1,054.55 ",$149.43 ,$506.14 ,$506.14 ,$279.04 ,$843.64 ,$896.37 ,$659.09 ,$949.10 ,$149.43 ,$149.43 ,"$1,001.82 ",$949.10 ,$896.37 ,$896.37 ,$279.04 ,$896.37 ,$896.37 ,$949.10 ,$642.22 ,$149.43 ,$653.82 ,$158.40 ,$949.10 ,$325.37 ,$970.19 ,$949.10 ,$696.11 ,$696.11 ,$642.22 ,$696.11 ,$685.46 ,$720.47 ,$240.08 ,$833.09 ,$158.40 ,$173.53 ,$173.53 ,$279.04 ,$173.53 ,$144.61 ,"$1,001.82 ",$864.73 ,$864.73 ,$843.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100170,88299,HC CYTOGENIC STUDY (SOLID),311,1 ,$683.10 ,$450.85 ,$50.14 ,$683.10 ,$80.20 ,$612.19 ,$612.19 ,$180.75 ,$546.48 ,$580.64 ,$426.94 ,$614.79 ,$80.20 ,$80.20 ,$648.95 ,$614.79 ,$580.64 ,$580.64 ,$180.75 ,$580.64 ,$580.64 ,$614.79 ,$416.01 ,$80.20 ,$423.52 ,$85.01 ,$614.79 ,$112.82 ,$628.45 ,$614.79 ,$450.91 ,$450.91 ,$416.01 ,$450.91 ,$444.02 ,$466.69 ,$155.51 ,$539.65 ,$85.01 ,$59.36 ,$59.36 ,$180.75 ,$59.36 ,$50.14 ,$648.95 ,$560.14 ,$560.14 ,$546.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100171,88269,HC CHROM CT AMNIOTIC INSITU,311,1 ,"$1,054.55 ",$696.00 ,$173.66 ,"$1,054.55 ",$179.44 ,$607.81 ,$607.81 ,$279.04 ,$843.64 ,$896.37 ,$659.09 ,$949.10 ,$179.44 ,$179.44 ,"$1,001.82 ",$949.10 ,$896.37 ,$896.37 ,$279.04 ,$896.37 ,$896.37 ,$949.10 ,$642.22 ,$179.44 ,$653.82 ,$190.21 ,$949.10 ,$390.74 ,$970.19 ,$949.10 ,$696.11 ,$696.11 ,$642.22 ,$696.11 ,$685.46 ,$720.47 ,$240.08 ,$833.09 ,$190.21 ,$208.39 ,$208.39 ,$279.04 ,$208.39 ,$173.66 ,"$1,001.82 ",$864.73 ,$864.73 ,$843.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100172,88271,HC MCG DNA PROBE (HER2),311,1 ,$285.20 ,$188.23 ,$20.36 ,$285.20 ,$20.36 ,$74.97 ,$74.97 ,$75.46 ,$228.16 ,$242.42 ,$178.25 ,$256.68 ,$20.36 ,$20.36 ,$270.94 ,$256.68 ,$242.42 ,$242.42 ,$75.46 ,$242.42 ,$242.42 ,$256.68 ,$173.69 ,$20.36 ,$176.82 ,$21.58 ,$256.68 ,$48.20 ,$262.38 ,$256.68 ,$188.26 ,$188.26 ,$173.69 ,$188.26 ,$185.38 ,$194.85 ,$64.93 ,$225.31 ,$21.58 ,$25.70 ,$25.70 ,$75.46 ,$25.70 ,$21.42 ,$270.94 ,$233.86 ,$233.86 ,$228.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100173,88271,HC MCG DNA PROBE (PARDER WILLI),311,1 ,$496.80 ,$327.89 ,$20.36 ,$496.80 ,$20.36 ,$74.97 ,$74.97 ,$131.46 ,$397.44 ,$422.28 ,$310.50 ,$447.12 ,$20.36 ,$20.36 ,$471.96 ,$447.12 ,$422.28 ,$422.28 ,$131.46 ,$422.28 ,$422.28 ,$447.12 ,$302.55 ,$20.36 ,$308.02 ,$21.58 ,$447.12 ,$48.20 ,$457.06 ,$447.12 ,$327.94 ,$327.94 ,$302.55 ,$327.94 ,$322.92 ,$339.41 ,$113.09 ,$392.47 ,$21.58 ,$25.70 ,$25.70 ,$131.46 ,$25.70 ,$21.42 ,$471.96 ,$407.38 ,$407.38 ,$397.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100174,88271,HC MCG DNA PROBE(FISH),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100178,88271,HC MCG DNA PROBE (T CELL),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100179,88271,HC MCG DNA PROBE (B CELL LYMPH),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100180,88271,HC MCG DNA PROBE (AML),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100181,88271,HC MCG DNA PROBE (MYCN),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100182,88271,HC MCG DNA PROBE (MDS),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100183,88271,HC MCG DNA PROBE (EACH),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100185,88271,HC MCG DNA PROBE (CLL),311,1 ,$248.40 ,$163.94 ,$20.36 ,$248.40 ,$20.36 ,$74.97 ,$74.97 ,$65.73 ,$198.72 ,$211.14 ,$155.25 ,$223.56 ,$20.36 ,$20.36 ,$235.98 ,$223.56 ,$211.14 ,$211.14 ,$65.73 ,$211.14 ,$211.14 ,$223.56 ,$151.28 ,$20.36 ,$154.00 ,$21.58 ,$223.56 ,$48.20 ,$228.53 ,$223.56 ,$163.97 ,$163.97 ,$151.28 ,$163.97 ,$161.46 ,$169.71 ,$56.55 ,$196.24 ,$21.58 ,$25.70 ,$25.70 ,$65.73 ,$25.70 ,$21.42 ,$235.98 ,$203.69 ,$203.69 ,$198.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100186,88271,HC MCG DNA PROBE (BCR),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100187,88271,HC MCG DNA PROBE (B CELL ALL),311,1 ,$124.20 ,$81.97 ,$20.36 ,$124.20 ,$20.36 ,$74.97 ,$74.97 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$20.36 ,$20.36 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$20.36 ,$77.00 ,$21.58 ,$111.78 ,$48.20 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$21.58 ,$25.70 ,$25.70 ,$32.86 ,$25.70 ,$21.42 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100191,88273,HC MCG CHROM INSITU 10-30 (PARDER WILLI),311,1 ,$570.40 ,$376.46 ,$34.81 ,$570.40 ,$35.97 ,$121.84 ,$121.84 ,$150.93 ,$456.32 ,$484.84 ,$356.50 ,$513.36 ,$35.97 ,$35.97 ,$541.88 ,$513.36 ,$484.84 ,$484.84 ,$150.93 ,$484.84 ,$484.84 ,$513.36 ,$347.37 ,$35.97 ,$353.64 ,$38.13 ,$513.36 ,$78.32 ,$524.77 ,$513.36 ,$376.52 ,$376.52 ,$347.37 ,$376.52 ,$370.76 ,$389.70 ,$129.85 ,$450.62 ,$38.13 ,$41.77 ,$41.77 ,$150.93 ,$41.77 ,$34.81 ,$541.88 ,$467.73 ,$467.73 ,$456.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100193,88274,HC MCG INTERPHASE INSITU 25 (HER2),311,1 ,$248.40 ,$163.94 ,$42.38 ,$248.40 ,$43.79 ,$148.33 ,$148.33 ,$65.73 ,$198.72 ,$211.14 ,$155.25 ,$223.56 ,$43.79 ,$43.79 ,$235.98 ,$223.56 ,$211.14 ,$211.14 ,$65.73 ,$211.14 ,$211.14 ,$223.56 ,$151.28 ,$43.79 ,$154.00 ,$46.42 ,$223.56 ,$95.36 ,$228.53 ,$223.56 ,$163.97 ,$163.97 ,$151.28 ,$163.97 ,$161.46 ,$169.71 ,$56.55 ,$196.24 ,$46.42 ,$50.86 ,$50.86 ,$65.73 ,$50.86 ,$42.38 ,$235.98 ,$203.69 ,$203.69 ,$198.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100194,88274,HC MCG INTERPHASE INSITU 25 (MYCN),311,1 ,$248.40 ,$163.94 ,$42.38 ,$248.40 ,$43.79 ,$148.33 ,$148.33 ,$65.73 ,$198.72 ,$211.14 ,$155.25 ,$223.56 ,$43.79 ,$43.79 ,$235.98 ,$223.56 ,$211.14 ,$211.14 ,$65.73 ,$211.14 ,$211.14 ,$223.56 ,$151.28 ,$43.79 ,$154.00 ,$46.42 ,$223.56 ,$95.36 ,$228.53 ,$223.56 ,$163.97 ,$163.97 ,$151.28 ,$163.97 ,$161.46 ,$169.71 ,$56.55 ,$196.24 ,$46.42 ,$50.86 ,$50.86 ,$65.73 ,$50.86 ,$42.38 ,$235.98 ,$203.69 ,$203.69 ,$198.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100197,88275,HC MCG INTERPH INSITU 100 ADDITIONAL,311,1 ,$124.20 ,$81.97 ,$28.28 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$52.89 ,$52.89 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$52.89 ,$77.00 ,$56.06 ,$111.78 ,$115.18 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$32.86 ,$61.43 ,$51.19 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100200,88275,HC MCG INTERPH INSITU 100 (AML),311,1 ,$261.05 ,$172.29 ,$51.19 ,$261.05 ,$52.89 ,$179.17 ,$179.17 ,$69.07 ,$208.84 ,$221.89 ,$163.16 ,$234.95 ,$52.89 ,$52.89 ,$248.00 ,$234.95 ,$221.89 ,$221.89 ,$69.07 ,$221.89 ,$221.89 ,$234.95 ,$158.98 ,$52.89 ,$161.86 ,$56.06 ,$234.95 ,$115.18 ,$240.17 ,$234.95 ,$172.32 ,$172.32 ,$158.98 ,$172.32 ,$169.68 ,$178.35 ,$59.43 ,$206.23 ,$56.06 ,$61.43 ,$61.43 ,$69.07 ,$61.43 ,$51.19 ,$248.00 ,$214.06 ,$214.06 ,$208.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100201,88275,HC MCG INTERPH INSITU 100 (MDS),311,1 ,$372.60 ,$245.92 ,$51.19 ,$372.60 ,$52.89 ,$179.17 ,$179.17 ,$98.59 ,$298.08 ,$316.71 ,$232.88 ,$335.34 ,$52.89 ,$52.89 ,$353.97 ,$335.34 ,$316.71 ,$316.71 ,$98.59 ,$316.71 ,$316.71 ,$335.34 ,$226.91 ,$52.89 ,$231.02 ,$56.06 ,$335.34 ,$115.18 ,$342.79 ,$335.34 ,$245.95 ,$245.95 ,$226.91 ,$245.95 ,$242.19 ,$254.56 ,$84.83 ,$294.35 ,$56.06 ,$61.43 ,$61.43 ,$98.59 ,$61.43 ,$51.19 ,$353.97 ,$305.53 ,$305.53 ,$298.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100202,88275,HC MCG INTERPH INSITU 100 (PCPD),311,1 ,$124.20 ,$81.97 ,$28.28 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$52.89 ,$52.89 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$52.89 ,$77.00 ,$56.06 ,$111.78 ,$115.18 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$32.86 ,$61.43 ,$51.19 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100204,88275,HC MCG INTERPH INSITU 100 (CLL),311,1 ,$124.20 ,$81.97 ,$28.28 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$52.89 ,$52.89 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$52.89 ,$77.00 ,$56.06 ,$111.78 ,$115.18 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$32.86 ,$61.43 ,$51.19 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100205,88275,HC MCG INTERPH INSITU 100 (BCR),311,1 ,$248.40 ,$163.94 ,$51.19 ,$248.40 ,$52.89 ,$179.17 ,$179.17 ,$65.73 ,$198.72 ,$211.14 ,$155.25 ,$223.56 ,$52.89 ,$52.89 ,$235.98 ,$223.56 ,$211.14 ,$211.14 ,$65.73 ,$211.14 ,$211.14 ,$223.56 ,$151.28 ,$52.89 ,$154.00 ,$56.06 ,$223.56 ,$115.18 ,$228.53 ,$223.56 ,$163.97 ,$163.97 ,$151.28 ,$163.97 ,$161.46 ,$169.71 ,$56.55 ,$196.24 ,$56.06 ,$61.43 ,$61.43 ,$65.73 ,$61.43 ,$51.19 ,$235.98 ,$203.69 ,$203.69 ,$198.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100207,88275,HC MCG INTERPH INSITU 100 (B CELL ALL),311,1 ,$124.20 ,$81.97 ,$28.28 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$52.89 ,$52.89 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$52.89 ,$77.00 ,$56.06 ,$111.78 ,$115.18 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$32.86 ,$61.43 ,$51.19 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100208,88275,HC MCG INTERPH INSITU 100 (T CELL LYMPH),311,1 ,$124.20 ,$81.97 ,$28.28 ,$124.20 ,$52.89 ,$124.20 ,$124.20 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$52.89 ,$52.89 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$52.89 ,$77.00 ,$56.06 ,$111.78 ,$115.18 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$56.06 ,$61.43 ,$61.43 ,$32.86 ,$61.43 ,$51.19 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100210,88275,HC MCG INTERPH INSITU 100 (B CELL LYMPHOMA),311,1 ,$223.10 ,$147.25 ,$50.78 ,$223.10 ,$52.89 ,$179.17 ,$179.17 ,$59.04 ,$178.48 ,$189.64 ,$139.44 ,$200.79 ,$52.89 ,$52.89 ,$211.95 ,$200.79 ,$189.64 ,$189.64 ,$59.04 ,$189.64 ,$189.64 ,$200.79 ,$135.87 ,$52.89 ,$138.32 ,$56.06 ,$200.79 ,$115.18 ,$205.25 ,$200.79 ,$147.27 ,$147.27 ,$135.87 ,$147.27 ,$145.02 ,$152.42 ,$50.78 ,$176.25 ,$56.06 ,$61.43 ,$61.43 ,$59.04 ,$61.43 ,$51.19 ,$211.95 ,$182.94 ,$182.94 ,$178.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100211,88280,HC CHROM ADDL KARYO,311,1 ,$310.50 ,$204.93 ,$33.47 ,$310.50 ,$34.58 ,$117.15 ,$117.15 ,$82.16 ,$248.40 ,$263.93 ,$194.06 ,$279.45 ,$34.58 ,$34.58 ,$294.98 ,$279.45 ,$263.93 ,$263.93 ,$82.16 ,$263.93 ,$263.93 ,$279.45 ,$189.09 ,$34.58 ,$192.52 ,$36.65 ,$279.45 ,$75.31 ,$285.66 ,$279.45 ,$204.96 ,$204.96 ,$189.09 ,$204.96 ,$201.83 ,$212.13 ,$70.69 ,$245.30 ,$36.65 ,$40.16 ,$40.16 ,$82.16 ,$40.16 ,$33.47 ,$294.98 ,$254.61 ,$254.61 ,$248.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100214,88289,HC CHROM ADDL HIGH RES (HRS),311,1 ,$343.85 ,$226.94 ,$34.43 ,$343.85 ,$35.58 ,$120.51 ,$120.51 ,$90.98 ,$275.08 ,$292.27 ,$214.91 ,$309.47 ,$35.58 ,$35.58 ,$326.66 ,$309.47 ,$292.27 ,$292.27 ,$90.98 ,$292.27 ,$292.27 ,$309.47 ,$209.40 ,$35.58 ,$213.18 ,$37.71 ,$309.47 ,$77.47 ,$316.34 ,$309.47 ,$226.98 ,$226.98 ,$209.40 ,$226.98 ,$223.50 ,$234.92 ,$78.28 ,$271.64 ,$37.71 ,$41.32 ,$41.32 ,$90.98 ,$41.32 ,$34.43 ,$326.66 ,$281.96 ,$281.96 ,$275.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100222,88299,HC CYTOGENIC STUDY,311,1 ,$611.80 ,$403.79 ,$50.14 ,$611.80 ,$80.20 ,$548.30 ,$548.30 ,$161.89 ,$489.44 ,$520.03 ,$382.38 ,$550.62 ,$80.20 ,$80.20 ,$581.21 ,$550.62 ,$520.03 ,$520.03 ,$161.89 ,$520.03 ,$520.03 ,$550.62 ,$372.59 ,$80.20 ,$379.32 ,$85.01 ,$550.62 ,$112.82 ,$562.86 ,$550.62 ,$403.85 ,$403.85 ,$372.59 ,$403.85 ,$397.67 ,$417.98 ,$139.28 ,$483.32 ,$85.01 ,$59.36 ,$59.36 ,$161.89 ,$59.36 ,$50.14 ,$581.21 ,$501.68 ,$501.68 ,$489.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100232,88271,HC MCG DNA PROBE (QST EACH),311,1 ,$186.30 ,$122.96 ,$20.36 ,$186.30 ,$20.36 ,$74.97 ,$74.97 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$20.36 ,$20.36 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$20.36 ,$115.50 ,$21.58 ,$167.67 ,$48.20 ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$21.58 ,$25.70 ,$25.70 ,$49.29 ,$25.70 ,$21.42 ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100233,88275,HC MCG INTERPH INSITU 100 (FISH MDS MY),311,1 ,$278.30 ,$183.68 ,$51.19 ,$278.30 ,$52.89 ,$179.17 ,$179.17 ,$73.64 ,$222.64 ,$236.56 ,$173.94 ,$250.47 ,$52.89 ,$52.89 ,$264.39 ,$250.47 ,$236.56 ,$236.56 ,$73.64 ,$236.56 ,$236.56 ,$250.47 ,$169.48 ,$52.89 ,$172.54 ,$56.06 ,$250.47 ,$115.18 ,$256.04 ,$250.47 ,$183.71 ,$183.71 ,$169.48 ,$183.71 ,$180.90 ,$190.13 ,$63.36 ,$219.86 ,$56.06 ,$61.43 ,$61.43 ,$73.64 ,$61.43 ,$51.19 ,$264.39 ,$228.21 ,$228.21 ,$222.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100234,88275,HC MCG INTERPH INSITU 100 (FISH AMLM3/BURKITT),311,1 ,$278.30 ,$183.68 ,$51.19 ,$278.30 ,$52.89 ,$179.17 ,$179.17 ,$73.64 ,$222.64 ,$236.56 ,$173.94 ,$250.47 ,$52.89 ,$52.89 ,$264.39 ,$250.47 ,$236.56 ,$236.56 ,$73.64 ,$236.56 ,$236.56 ,$250.47 ,$169.48 ,$52.89 ,$172.54 ,$56.06 ,$250.47 ,$115.18 ,$256.04 ,$250.47 ,$183.71 ,$183.71 ,$169.48 ,$183.71 ,$180.90 ,$190.13 ,$63.36 ,$219.86 ,$56.06 ,$61.43 ,$61.43 ,$73.64 ,$61.43 ,$51.19 ,$264.39 ,$228.21 ,$228.21 ,$222.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100235,88275,HC MCG INTERPH INSITU 100 (FISH AML/HES/AMLETO/IGH),311,1 ,$278.30 ,$183.68 ,$51.19 ,$278.30 ,$52.89 ,$179.17 ,$179.17 ,$73.64 ,$222.64 ,$236.56 ,$173.94 ,$250.47 ,$52.89 ,$52.89 ,$264.39 ,$250.47 ,$236.56 ,$236.56 ,$73.64 ,$236.56 ,$236.56 ,$250.47 ,$169.48 ,$52.89 ,$172.54 ,$56.06 ,$250.47 ,$115.18 ,$256.04 ,$250.47 ,$183.71 ,$183.71 ,$169.48 ,$183.71 ,$180.90 ,$190.13 ,$63.36 ,$219.86 ,$56.06 ,$61.43 ,$61.43 ,$73.64 ,$61.43 ,$51.19 ,$264.39 ,$228.21 ,$228.21 ,$222.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100236,88275,HC MCG INTERPH INSITU 100 (FISH ESO),311,1 ,$290.95 ,$192.03 ,$51.19 ,$290.95 ,$52.89 ,$179.17 ,$179.17 ,$76.99 ,$232.76 ,$247.31 ,$181.84 ,$261.86 ,$52.89 ,$52.89 ,$276.40 ,$261.86 ,$247.31 ,$247.31 ,$76.99 ,$247.31 ,$247.31 ,$261.86 ,$177.19 ,$52.89 ,$180.38 ,$56.06 ,$261.86 ,$115.18 ,$267.67 ,$261.86 ,$192.06 ,$192.06 ,$177.19 ,$192.06 ,$189.12 ,$198.78 ,$66.24 ,$229.85 ,$56.06 ,$61.43 ,$61.43 ,$76.99 ,$61.43 ,$51.19 ,$276.40 ,$238.58 ,$238.58 ,$232.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100237,88275,HC MCG INTERPH INSITU 100 (FISH IGHBCL2/MCL),311,1 ,$323.15 ,$213.28 ,$51.19 ,$323.15 ,$52.89 ,$179.17 ,$179.17 ,$85.50 ,$258.52 ,$274.68 ,$201.97 ,$290.84 ,$52.89 ,$52.89 ,$306.99 ,$290.84 ,$274.68 ,$274.68 ,$85.50 ,$274.68 ,$274.68 ,$290.84 ,$196.80 ,$52.89 ,$200.36 ,$56.06 ,$290.84 ,$115.18 ,$297.30 ,$290.84 ,$213.31 ,$213.31 ,$196.80 ,$213.31 ,$210.05 ,$220.78 ,$73.56 ,$255.29 ,$56.06 ,$61.43 ,$61.43 ,$85.50 ,$61.43 ,$51.19 ,$306.99 ,$264.98 ,$264.98 ,$258.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),31100250,81479,HC UNLISTED MOLECULAR PATHOLOGY,311,1 ,$518.65 ,$342.31 ,$80.20 ,$518.65 ,$80.20 ,$464.81 ,$464.81 ,$137.24 ,$414.92 ,$440.85 ,$324.16 ,$466.79 ,$80.20 ,$80.20 ,$492.72 ,$466.79 ,$440.85 ,$440.85 ,$137.24 ,$440.85 ,$440.85 ,$466.79 ,$315.86 ,$80.20 ,$321.56 ,$85.01 ,$466.79 ,$311.19 ,$477.16 ,$466.79 ,$342.36 ,$342.36 ,$315.86 ,$342.36 ,$337.12 ,$354.34 , N/A ,$409.73 ,$85.01 ,$254.14 ,$254.14 ,$137.24 ,$254.14 , N/A ,$492.72 ,$425.29 ,$425.29 ,$414.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$125.35 ,$82.73 ,$24.96 ,$125.35 ,$68.58 ,$35.73 ,$35.73 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$68.58 ,$68.58 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$68.58 ,$77.72 ,$72.69 ,$112.82 ,$56.16 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$72.69 ,$27.59 ,$27.59 ,$33.16 ,$27.59 ,$24.96 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200102,88302,HC GROSS  AND  MICRO LEVEL II,312,1 ,$257.60 ,$170.02 ,$24.96 ,$257.60 ,$68.58 ,$82.51 ,$82.51 ,$68.16 ,$206.08 ,$218.96 ,$161.00 ,$231.84 ,$68.58 ,$68.58 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$68.58 ,$159.72 ,$72.69 ,$231.84 ,$56.16 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$72.69 ,$27.59 ,$27.59 ,$68.16 ,$27.59 ,$24.96 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200103,88304,HC GROSS  AND  MICRO LEVEL III,312,1 ,$322.00 ,$212.52 ,$50.14 ,$322.00 ,$68.58 ,$100.76 ,$100.76 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$68.58 ,$68.58 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$68.58 ,$199.64 ,$72.69 ,$289.80 ,$112.82 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$72.69 ,$59.36 ,$59.36 ,$85.20 ,$59.36 ,$50.14 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200104,88304,HC GROSS  AND  MICRO LEVEL III (CMH),312,1 ,$322.00 ,$212.52 ,$50.14 ,$322.00 ,$68.58 ,$100.76 ,$100.76 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$68.58 ,$68.58 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$68.58 ,$199.64 ,$72.69 ,$289.80 ,$112.82 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$72.69 ,$59.36 ,$59.36 ,$85.20 ,$59.36 ,$50.14 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200107,88305,HC GROSS  AND  MICRO LEVEL IV (CMH),312,1 ,$386.40 ,$255.02 ,$50.14 ,$386.40 ,$68.58 ,$113.31 ,$113.31 ,$102.24 ,$309.12 ,$328.44 ,$241.50 ,$347.76 ,$68.58 ,$68.58 ,$367.08 ,$347.76 ,$328.44 ,$328.44 ,$102.24 ,$328.44 ,$328.44 ,$347.76 ,$235.32 ,$68.58 ,$239.56 ,$72.69 ,$347.76 ,$112.82 ,$355.49 ,$347.76 ,$255.06 ,$255.06 ,$235.32 ,$255.06 ,$251.16 ,$263.99 ,$87.96 ,$305.26 ,$72.69 ,$59.36 ,$59.36 ,$102.24 ,$59.36 ,$50.14 ,$367.08 ,$316.85 ,$316.85 ,$309.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200108,88305,HC GROSS  AND  MICRO LEVEL IV,312,1 ,$386.40 ,$255.02 ,$50.14 ,$386.40 ,$68.58 ,$113.31 ,$113.31 ,$102.24 ,$309.12 ,$328.44 ,$241.50 ,$347.76 ,$68.58 ,$68.58 ,$367.08 ,$347.76 ,$328.44 ,$328.44 ,$102.24 ,$328.44 ,$328.44 ,$347.76 ,$235.32 ,$68.58 ,$239.56 ,$72.69 ,$347.76 ,$112.82 ,$355.49 ,$347.76 ,$255.06 ,$255.06 ,$235.32 ,$255.06 ,$251.16 ,$263.99 ,$87.96 ,$305.26 ,$72.69 ,$59.36 ,$59.36 ,$102.24 ,$59.36 ,$50.14 ,$367.08 ,$316.85 ,$316.85 ,$309.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200109,88305,HC GROSS  AND  MICRO LEVEL IV (BM),312,1 ,$328.90 ,$217.07 ,$50.14 ,$328.90 ,$68.58 ,$113.31 ,$113.31 ,$87.02 ,$263.12 ,$279.57 ,$205.56 ,$296.01 ,$68.58 ,$68.58 ,$312.46 ,$296.01 ,$279.57 ,$279.57 ,$87.02 ,$279.57 ,$279.57 ,$296.01 ,$200.30 ,$68.58 ,$203.92 ,$72.69 ,$296.01 ,$112.82 ,$302.59 ,$296.01 ,$217.11 ,$217.11 ,$200.30 ,$217.11 ,$213.79 ,$224.70 ,$74.88 ,$259.83 ,$72.69 ,$59.36 ,$59.36 ,$87.02 ,$59.36 ,$50.14 ,$312.46 ,$269.70 ,$269.70 ,$263.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200110,88307,HC GROSS  AND  MICRO LEVEL V,312,1 ,"$1,262.70 ",$833.38 ,$197.92 ,"$1,262.70 ",$197.92 ,$683.73 ,$683.73 ,$334.11 ,"$1,010.16 ","$1,073.30 ",$789.19 ,"$1,136.43 ",$197.92 ,$197.92 ,"$1,199.57 ","$1,136.43 ","$1,073.30 ","$1,073.30 ",$334.11 ,"$1,073.30 ","$1,073.30 ","$1,136.43 ",$768.98 ,$197.92 ,$782.88 ,$209.80 ,"$1,136.43 ",$729.25 ,"$1,161.68 ","$1,136.43 ",$833.51 ,$833.51 ,$768.98 ,$833.51 ,$820.76 ,$862.68 ,$287.45 ,$997.53 ,$209.80 ,$340.09 ,$340.09 ,$334.11 ,$340.09 ,$324.11 ,"$1,199.57 ","$1,035.41 ","$1,035.41 ","$1,010.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200111,88307,HC GROSS  AND  MICRO LEVEL V (CMH),312,1 ,"$1,262.70 ",$833.38 ,$197.92 ,"$1,262.70 ",$197.92 ,$683.73 ,$683.73 ,$334.11 ,"$1,010.16 ","$1,073.30 ",$789.19 ,"$1,136.43 ",$197.92 ,$197.92 ,"$1,199.57 ","$1,136.43 ","$1,073.30 ","$1,073.30 ",$334.11 ,"$1,073.30 ","$1,073.30 ","$1,136.43 ",$768.98 ,$197.92 ,$782.88 ,$209.80 ,"$1,136.43 ",$729.25 ,"$1,161.68 ","$1,136.43 ",$833.51 ,$833.51 ,$768.98 ,$833.51 ,$820.76 ,$862.68 ,$287.45 ,$997.53 ,$209.80 ,$340.09 ,$340.09 ,$334.11 ,$340.09 ,$324.11 ,"$1,199.57 ","$1,035.41 ","$1,035.41 ","$1,010.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200113,88309,HC GROSS  AND  MICRO LEVEL VI,312,1 ,"$1,803.20 ","$1,190.11 ",$197.92 ,"$1,803.20 ",$197.92 ,$975.82 ,$975.82 ,$477.12 ,"$1,442.56 ","$1,532.72 ","$1,127.00 ","$1,622.88 ",$197.92 ,$197.92 ,"$1,713.04 ","$1,622.88 ","$1,532.72 ","$1,532.72 ",$477.12 ,"$1,532.72 ","$1,532.72 ","$1,622.88 ","$1,098.15 ",$197.92 ,"$1,117.98 ",$209.80 ,"$1,622.88 ","$1,747.15 ","$1,658.94 ","$1,622.88 ","$1,190.29 ","$1,190.29 ","$1,098.15 ","$1,190.29 ","$1,172.08 ","$1,231.95 ",$410.51 ,"$1,424.53 ",$209.80 ,$753.84 ,$753.84 ,$477.12 ,$753.84 ,$776.51 ,"$1,713.04 ","$1,478.62 ","$1,478.62 ","$1,442.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200114,88309,HC GROSS  AND  MICRO LEVEL VI (CMH),312,1 ,"$1,803.20 ","$1,190.11 ",$197.92 ,"$1,803.20 ",$197.92 ,$975.82 ,$975.82 ,$477.12 ,"$1,442.56 ","$1,532.72 ","$1,127.00 ","$1,622.88 ",$197.92 ,$197.92 ,"$1,713.04 ","$1,622.88 ","$1,532.72 ","$1,532.72 ",$477.12 ,"$1,532.72 ","$1,532.72 ","$1,622.88 ","$1,098.15 ",$197.92 ,"$1,117.98 ",$209.80 ,"$1,622.88 ","$1,747.15 ","$1,658.94 ","$1,622.88 ","$1,190.29 ","$1,190.29 ","$1,098.15 ","$1,190.29 ","$1,172.08 ","$1,231.95 ",$410.51 ,"$1,424.53 ",$209.80 ,$753.84 ,$753.84 ,$477.12 ,$753.84 ,$776.51 ,"$1,713.04 ","$1,478.62 ","$1,478.62 ","$1,442.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200116,88311,HC DECALCIFICATION,312,1 ,$89.70 ,$59.20 ,$10.82 ,$89.70 ,$68.58 ,$27.74 ,$27.74 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$68.58 ,$68.58 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$68.58 ,$55.62 ,$72.69 ,$80.73 , N/A ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$72.69 ,$10.82 ,$10.82 ,$23.74 ,$10.82 , N/A ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200123,88312,HC SPECIAL STAIN I,312,1 ,$411.70 ,$271.72 ,$50.14 ,$411.70 ,$68.58 ,$290.16 ,$290.16 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$68.58 ,$68.58 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$68.58 ,$255.26 ,$72.69 ,$370.53 ,$112.82 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$72.69 ,$59.36 ,$59.36 ,$108.94 ,$59.36 ,$50.14 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200124,88312,HC SPECIAL STAIN I (GIEMSA OR PAS),312,1 ,$411.70 ,$271.72 ,$50.14 ,$411.70 ,$68.58 ,$290.16 ,$290.16 ,$108.94 ,$329.36 ,$349.95 ,$257.31 ,$370.53 ,$68.58 ,$68.58 ,$391.12 ,$370.53 ,$349.95 ,$349.95 ,$108.94 ,$349.95 ,$349.95 ,$370.53 ,$250.73 ,$68.58 ,$255.26 ,$72.69 ,$370.53 ,$112.82 ,$378.76 ,$370.53 ,$271.76 ,$271.76 ,$250.73 ,$271.76 ,$267.61 ,$281.27 ,$93.73 ,$325.24 ,$72.69 ,$59.36 ,$59.36 ,$108.94 ,$59.36 ,$50.14 ,$391.12 ,$337.59 ,$337.59 ,$329.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200125,88313,HC SPECIAL STAIN II,312,1 ,$334.65 ,$220.87 ,$33.96 ,$334.65 ,$68.58 ,$230.83 ,$230.83 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$68.58 ,$68.58 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$68.58 ,$207.48 ,$72.69 ,$301.19 ,$76.41 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$72.69 ,$40.12 ,$40.12 ,$88.55 ,$40.12 ,$33.96 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200127,88313,HC SPECIAL STAIN II (SUDAN BLACK),312,1 ,$334.65 ,$220.87 ,$33.96 ,$334.65 ,$68.58 ,$230.83 ,$230.83 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$68.58 ,$68.58 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$68.58 ,$207.48 ,$72.69 ,$301.19 ,$76.41 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$72.69 ,$40.12 ,$40.12 ,$88.55 ,$40.12 ,$33.96 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200128,88313,HC SPECIAL STAIN II (MISC),312,1 ,$334.65 ,$220.87 ,$33.96 ,$334.65 ,$68.58 ,$230.83 ,$230.83 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$68.58 ,$68.58 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$68.58 ,$207.48 ,$72.69 ,$301.19 ,$76.41 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$72.69 ,$40.12 ,$40.12 ,$88.55 ,$40.12 ,$33.96 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200129,88313,HC SPECIAL STAIN II (MAST CELL),312,1 ,$164.45 ,$108.54 ,$33.96 ,$164.45 ,$68.58 ,$164.45 ,$164.45 ,$43.51 ,$131.56 ,$139.78 ,$102.78 ,$148.01 ,$68.58 ,$68.58 ,$156.23 ,$148.01 ,$139.78 ,$139.78 ,$43.51 ,$139.78 ,$139.78 ,$148.01 ,$100.15 ,$68.58 ,$101.96 ,$72.69 ,$148.01 ,$76.41 ,$151.29 ,$148.01 ,$108.55 ,$108.55 ,$100.15 ,$108.55 ,$106.89 ,$112.35 ,$37.44 ,$129.92 ,$72.69 ,$40.12 ,$40.12 ,$43.51 ,$40.12 ,$33.96 ,$156.23 ,$134.85 ,$134.85 ,$131.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200130,88313,HC SPECIAL STAIN II (CONGO RED),312,1 ,$184.00 ,$121.44 ,$33.96 ,$184.00 ,$68.58 ,$184.00 ,$184.00 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 ,$68.58 ,$68.58 ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 ,$68.58 ,$114.08 ,$72.69 ,$165.60 ,$76.41 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 ,$72.69 ,$40.12 ,$40.12 ,$48.69 ,$40.12 ,$33.96 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200131,88313,HC SPECIAL STAIN II (FE),312,1 ,$184.00 ,$121.44 ,$33.96 ,$184.00 ,$68.58 ,$184.00 ,$184.00 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 ,$68.58 ,$68.58 ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 ,$68.58 ,$114.08 ,$72.69 ,$165.60 ,$76.41 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 ,$72.69 ,$40.12 ,$40.12 ,$48.69 ,$40.12 ,$33.96 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200132,88313,HC SPECIAL STAIN II (PAS),312,1 ,$184.00 ,$121.44 ,$33.96 ,$184.00 ,$68.58 ,$184.00 ,$184.00 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 ,$68.58 ,$68.58 ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 ,$68.58 ,$114.08 ,$72.69 ,$165.60 ,$76.41 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 ,$72.69 ,$40.12 ,$40.12 ,$48.69 ,$40.12 ,$33.96 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200133,88313,HC SPECIAL STAIN II (ALCIAN BLUE/PAS),312,1 ,$315.10 ,$207.97 ,$33.96 ,$315.10 ,$68.58 ,$230.83 ,$230.83 ,$83.38 ,$252.08 ,$267.84 ,$196.94 ,$283.59 ,$68.58 ,$68.58 ,$299.35 ,$283.59 ,$267.84 ,$267.84 ,$83.38 ,$267.84 ,$267.84 ,$283.59 ,$191.90 ,$68.58 ,$195.36 ,$72.69 ,$283.59 ,$76.41 ,$289.89 ,$283.59 ,$208.00 ,$208.00 ,$191.90 ,$208.00 ,$204.82 ,$215.28 ,$71.73 ,$248.93 ,$72.69 ,$40.12 ,$40.12 ,$83.38 ,$40.12 ,$33.96 ,$299.35 ,$258.38 ,$258.38 ,$252.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200134,88313,HC SPECIAL STAIN II (ELASTIC),312,1 ,$288.65 ,$190.51 ,$33.96 ,$288.65 ,$68.58 ,$230.83 ,$230.83 ,$76.38 ,$230.92 ,$245.35 ,$180.41 ,$259.79 ,$68.58 ,$68.58 ,$274.22 ,$259.79 ,$245.35 ,$245.35 ,$76.38 ,$245.35 ,$245.35 ,$259.79 ,$175.79 ,$68.58 ,$178.96 ,$72.69 ,$259.79 ,$76.41 ,$265.56 ,$259.79 ,$190.54 ,$190.54 ,$175.79 ,$190.54 ,$187.62 ,$197.21 ,$65.71 ,$228.03 ,$72.69 ,$40.12 ,$40.12 ,$76.38 ,$40.12 ,$33.96 ,$274.22 ,$236.69 ,$236.69 ,$230.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200136,88313,HC SPECIAL STAIN II (MUCICARMINE),312,1 ,$293.25 ,$193.55 ,$33.96 ,$293.25 ,$68.58 ,$230.83 ,$230.83 ,$77.60 ,$234.60 ,$249.26 ,$183.28 ,$263.93 ,$68.58 ,$68.58 ,$278.59 ,$263.93 ,$249.26 ,$249.26 ,$77.60 ,$249.26 ,$249.26 ,$263.93 ,$178.59 ,$68.58 ,$181.82 ,$72.69 ,$263.93 ,$76.41 ,$269.79 ,$263.93 ,$193.57 ,$193.57 ,$178.59 ,$193.57 ,$190.61 ,$200.35 ,$66.76 ,$231.67 ,$72.69 ,$40.12 ,$40.12 ,$77.60 ,$40.12 ,$33.96 ,$278.59 ,$240.47 ,$240.47 ,$234.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200137,88313,HC SPECIAL STAIN II (ALCIAN BL W/HYALUR),312,1 ,$293.25 ,$193.55 ,$33.96 ,$293.25 ,$68.58 ,$230.83 ,$230.83 ,$77.60 ,$234.60 ,$249.26 ,$183.28 ,$263.93 ,$68.58 ,$68.58 ,$278.59 ,$263.93 ,$249.26 ,$249.26 ,$77.60 ,$249.26 ,$249.26 ,$263.93 ,$178.59 ,$68.58 ,$181.82 ,$72.69 ,$263.93 ,$76.41 ,$269.79 ,$263.93 ,$193.57 ,$193.57 ,$178.59 ,$193.57 ,$190.61 ,$200.35 ,$66.76 ,$231.67 ,$72.69 ,$40.12 ,$40.12 ,$77.60 ,$40.12 ,$33.96 ,$278.59 ,$240.47 ,$240.47 ,$234.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200143,88313,HC SPECIAL STAIN II (TRICHROME),312,1 ,$184.00 ,$121.44 ,$33.96 ,$184.00 ,$68.58 ,$184.00 ,$184.00 ,$48.69 ,$147.20 ,$156.40 ,$115.00 ,$165.60 ,$68.58 ,$68.58 ,$174.80 ,$165.60 ,$156.40 ,$156.40 ,$48.69 ,$156.40 ,$156.40 ,$165.60 ,$112.06 ,$68.58 ,$114.08 ,$72.69 ,$165.60 ,$76.41 ,$169.28 ,$165.60 ,$121.46 ,$121.46 ,$112.06 ,$121.46 ,$119.60 ,$125.71 ,$41.89 ,$145.36 ,$72.69 ,$40.12 ,$40.12 ,$48.69 ,$40.12 ,$33.96 ,$174.80 ,$150.88 ,$150.88 ,$147.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200144,88313,HC SPECIAL STAIN II (RETICULUM),312,1 ,$288.65 ,$190.51 ,$33.96 ,$288.65 ,$68.58 ,$230.83 ,$230.83 ,$76.38 ,$230.92 ,$245.35 ,$180.41 ,$259.79 ,$68.58 ,$68.58 ,$274.22 ,$259.79 ,$245.35 ,$245.35 ,$76.38 ,$245.35 ,$245.35 ,$259.79 ,$175.79 ,$68.58 ,$178.96 ,$72.69 ,$259.79 ,$76.41 ,$265.56 ,$259.79 ,$190.54 ,$190.54 ,$175.79 ,$190.54 ,$187.62 ,$197.21 ,$65.71 ,$228.03 ,$72.69 ,$40.12 ,$40.12 ,$76.38 ,$40.12 ,$33.96 ,$274.22 ,$236.69 ,$236.69 ,$230.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200145,88313,HC SPECIAL STAIN II (ALCIAN BLUE),312,1 ,$315.10 ,$207.97 ,$33.96 ,$315.10 ,$68.58 ,$230.83 ,$230.83 ,$83.38 ,$252.08 ,$267.84 ,$196.94 ,$283.59 ,$68.58 ,$68.58 ,$299.35 ,$283.59 ,$267.84 ,$267.84 ,$83.38 ,$267.84 ,$267.84 ,$283.59 ,$191.90 ,$68.58 ,$195.36 ,$72.69 ,$283.59 ,$76.41 ,$289.89 ,$283.59 ,$208.00 ,$208.00 ,$191.90 ,$208.00 ,$204.82 ,$215.28 ,$71.73 ,$248.93 ,$72.69 ,$40.12 ,$40.12 ,$83.38 ,$40.12 ,$33.96 ,$299.35 ,$258.38 ,$258.38 ,$252.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200146,88313,HC SPECIAL STAIN II (PAS W/DIGEST),312,1 ,$315.10 ,$207.97 ,$33.96 ,$315.10 ,$68.58 ,$230.83 ,$230.83 ,$83.38 ,$252.08 ,$267.84 ,$196.94 ,$283.59 ,$68.58 ,$68.58 ,$299.35 ,$283.59 ,$267.84 ,$267.84 ,$83.38 ,$267.84 ,$267.84 ,$283.59 ,$191.90 ,$68.58 ,$195.36 ,$72.69 ,$283.59 ,$76.41 ,$289.89 ,$283.59 ,$208.00 ,$208.00 ,$191.90 ,$208.00 ,$204.82 ,$215.28 ,$71.73 ,$248.93 ,$72.69 ,$40.12 ,$40.12 ,$83.38 ,$40.12 ,$33.96 ,$299.35 ,$258.38 ,$258.38 ,$252.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200156,88319,HC HISTOCHEM ENZYME STAIN,312,1 ,$282.90 ,$186.71 ,$64.41 ,"$1,747.15 ",$197.92 ,$282.90 ,$282.90 ,$74.85 ,$226.32 ,$240.47 ,$176.81 ,$254.61 ,$197.92 ,$197.92 ,$268.76 ,$254.61 ,$240.47 ,$240.47 ,$74.85 ,$240.47 ,$240.47 ,$254.61 ,$172.29 ,$197.92 ,$175.40 ,$209.80 ,$254.61 ,"$1,747.15 ",$260.27 ,$254.61 ,$186.74 ,$186.74 ,$172.29 ,$186.74 ,$183.89 ,$193.28 ,$64.41 ,$223.49 ,$209.80 ,$282.90 ,$282.90 ,$74.85 ,$282.90 ,$776.51 ,$268.76 ,$231.98 ,$231.98 ,$226.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200158,88321,HC CONSULT SLIDES,312,1 ,$476.10 ,$314.23 ,$33.96 ,$476.10 ,$131.50 ,$281.66 ,$281.66 ,$125.98 ,$380.88 ,$404.69 ,$297.56 ,$428.49 ,$131.50 ,$131.50 ,$452.30 ,$428.49 ,$404.69 ,$404.69 ,$125.98 ,$404.69 ,$404.69 ,$428.49 ,$289.94 ,$131.50 ,$295.18 ,$139.39 ,$428.49 ,$76.41 ,$438.01 ,$428.49 ,$314.27 ,$314.27 ,$289.94 ,$314.27 ,$309.47 ,$325.27 ,$108.39 ,$376.12 ,$139.39 ,$40.12 ,$40.12 ,$125.98 ,$40.12 ,$33.96 ,$452.30 ,$390.40 ,$390.40 ,$380.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200164,88323,HC CONSULT/SLIDE PREP,312,1 ,$476.10 ,$314.23 ,$50.14 ,$476.10 ,$131.50 ,$89.35 ,$89.35 ,$125.98 ,$380.88 ,$404.69 ,$297.56 ,$428.49 ,$131.50 ,$131.50 ,$452.30 ,$428.49 ,$404.69 ,$404.69 ,$125.98 ,$404.69 ,$404.69 ,$428.49 ,$289.94 ,$131.50 ,$295.18 ,$139.39 ,$428.49 ,$112.82 ,$438.01 ,$428.49 ,$314.27 ,$314.27 ,$289.94 ,$314.27 ,$309.47 ,$325.27 ,$108.39 ,$376.12 ,$139.39 ,$59.36 ,$59.36 ,$125.98 ,$59.36 ,$50.14 ,$452.30 ,$390.40 ,$390.40 ,$380.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200165,88323,HC CONSULT/SLIDE PREP (CUTAN),312,1 ,$85.10 ,$56.17 ,$19.37 ,$139.39 ,$131.50 ,$85.10 ,$85.10 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$131.50 ,$85.10 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$131.50 ,$52.76 ,$90.21 ,$76.59 ,$112.82 ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$139.39 ,$59.36 ,$59.36 ,$22.52 ,$59.36 ,$50.14 ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200169,88325,HC CONSULT PATH REV/REP (HEMATOPATH),312,1 ,"$1,288.00 ",$850.08 ,$59.36 ,"$1,288.00 ",$131.50 ,$457.89 ,$457.89 ,$340.80 ,"$1,030.40 ","$1,094.80 ",$805.00 ,"$1,159.20 ",$131.50 ,$131.50 ,"$1,223.60 ","$1,159.20 ","$1,094.80 ","$1,094.80 ",$340.80 ,"$1,094.80 ","$1,094.80 ","$1,159.20 ",$784.39 ,$131.50 ,$798.56 ,$139.39 ,"$1,159.20 ",$353.81 ,"$1,184.96 ","$1,159.20 ",$850.21 ,$850.21 ,$784.39 ,$850.21 ,$837.20 ,$879.96 ,$293.22 ,"$1,017.52 ",$139.39 ,$59.36 ,$59.36 ,$340.80 ,$59.36 ,$157.25 ,"$1,223.60 ","$1,056.16 ","$1,056.16 ","$1,030.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200170,88325,HC CONSULT PATH REV/REP (RENAL PATH),312,1 ,"$1,288.00 ",$850.08 ,$59.36 ,"$1,288.00 ",$131.50 ,$457.89 ,$457.89 ,$340.80 ,"$1,030.40 ","$1,094.80 ",$805.00 ,"$1,159.20 ",$131.50 ,$131.50 ,"$1,223.60 ","$1,159.20 ","$1,094.80 ","$1,094.80 ",$340.80 ,"$1,094.80 ","$1,094.80 ","$1,159.20 ",$784.39 ,$131.50 ,$798.56 ,$139.39 ,"$1,159.20 ",$353.81 ,"$1,184.96 ","$1,159.20 ",$850.21 ,$850.21 ,$784.39 ,$850.21 ,$837.20 ,$879.96 ,$293.22 ,"$1,017.52 ",$139.39 ,$59.36 ,$59.36 ,$340.80 ,$59.36 ,$157.25 ,"$1,223.60 ","$1,056.16 ","$1,056.16 ","$1,030.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200172,88329,HC CONSULT PATH SURGERY,312,1 ,$457.70 ,$302.08 ,$33.96 ,$457.70 ,$131.50 ,$119.10 ,$119.10 ,$121.11 ,$366.16 ,$389.05 ,$286.06 ,$411.93 ,$131.50 ,$131.50 ,$434.82 ,$411.93 ,$389.05 ,$389.05 ,$121.11 ,$389.05 ,$389.05 ,$411.93 ,$278.74 ,$131.50 ,$283.78 ,$139.39 ,$411.93 ,$76.41 ,$421.08 ,$411.93 ,$302.13 ,$302.13 ,$278.74 ,$302.13 ,$297.51 ,$312.70 ,$104.19 ,$361.58 ,$139.39 ,$40.12 ,$40.12 ,$121.11 ,$40.12 ,$33.96 ,$434.82 ,$375.31 ,$375.31 ,$366.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$296.70 ,$195.82 ,$67.54 ,$353.81 ,$131.50 ,$136.13 ,$136.13 ,$78.51 ,$237.36 ,$252.20 ,$185.44 ,$267.03 ,$131.50 ,$131.50 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,$131.50 ,$183.96 ,$139.39 ,$267.03 ,$353.81 ,$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,$139.39 ,$172.20 ,$172.20 ,$78.51 ,$172.20 ,$157.25 ,$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$218.50 ,$144.21 ,$27.72 ,$218.50 ,$131.50 ,$80.23 ,$80.23 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$131.50 ,$131.50 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$131.50 ,$135.48 ,$139.39 ,$196.65 , N/A ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$139.39 ,$27.72 ,$27.72 ,$57.82 ,$27.72 , N/A ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200175,88333,HC CONSULT PATH SURG CYTO INIT,312,1 ,$141.45 ,$93.36 ,$32.20 ,"$1,747.15 ",$131.50 ,$107.61 ,$107.61 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$131.50 ,$131.50 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$131.50 ,$87.70 ,$139.39 ,$127.31 ,"$1,747.15 ",$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$139.39 ,$141.45 ,$141.45 ,$37.43 ,$141.45 ,$776.51 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200176,88334,HC CONSULT PATH SURG EA ADDL,312,1 ,$200.10 ,$132.07 ,$21.65 ,$200.10 ,$131.50 ,$63.89 ,$63.89 ,$52.95 ,$160.08 ,$170.09 ,$125.06 ,$180.09 ,$131.50 ,$131.50 ,$190.10 ,$180.09 ,$170.09 ,$170.09 ,$52.95 ,$170.09 ,$170.09 ,$180.09 ,$121.86 ,$131.50 ,$124.06 ,$139.39 ,$180.09 , N/A ,$184.09 ,$180.09 ,$132.09 ,$132.09 ,$121.86 ,$132.09 ,$130.07 ,$136.71 ,$45.55 ,$158.08 ,$139.39 ,$21.65 ,$21.65 ,$52.95 ,$21.65 , N/A ,$190.10 ,$164.08 ,$164.08 ,$160.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200177,88341,HC IMMUNOHISTOCHEM EA AB,312,1 ,$116.15 ,$76.66 ,$26.44 ,$209.80 ,$197.92 ,$116.15 ,$116.15 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$197.92 ,$116.15 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$197.92 ,$72.02 ,$123.12 ,$104.54 , N/A ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$209.80 ,$77.52 ,$77.52 ,$30.73 ,$77.52 , N/A ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200182,88341,HC IMMUNOHISTOCHEM EA AB T2,312,1 ,$315.10 ,$207.97 ,$71.73 ,$315.10 ,$197.92 ,$203.09 ,$203.09 ,$83.38 ,$252.08 ,$267.84 ,$196.94 ,$283.59 ,$197.92 ,$197.92 ,$299.35 ,$283.59 ,$267.84 ,$267.84 ,$83.38 ,$267.84 ,$267.84 ,$283.59 ,$191.90 ,$197.92 ,$195.36 ,$209.80 ,$283.59 , N/A ,$289.89 ,$283.59 ,$208.00 ,$208.00 ,$191.90 ,$208.00 ,$204.82 ,$215.28 ,$71.73 ,$248.93 ,$209.80 ,$77.52 ,$77.52 ,$83.38 ,$77.52 , N/A ,$299.35 ,$258.38 ,$258.38 ,$252.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200184,88341,HC IMMUNOHISTOCHEM EA AB T4,312,1 ,$312.80 ,$206.45 ,$71.21 ,$312.80 ,$197.92 ,$203.09 ,$203.09 ,$82.77 ,$250.24 ,$265.88 ,$195.50 ,$281.52 ,$197.92 ,$197.92 ,$297.16 ,$281.52 ,$265.88 ,$265.88 ,$82.77 ,$265.88 ,$265.88 ,$281.52 ,$190.50 ,$197.92 ,$193.94 ,$209.80 ,$281.52 , N/A ,$287.78 ,$281.52 ,$206.48 ,$206.48 ,$190.50 ,$206.48 ,$203.32 ,$213.71 ,$71.21 ,$247.11 ,$209.80 ,$77.52 ,$77.52 ,$82.77 ,$77.52 , N/A ,$297.16 ,$256.50 ,$256.50 ,$250.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200187,88346,HC IF DIRECT (RENAL BX),312,1 ,$116.15 ,$76.66 ,$26.44 ,$729.25 ,$197.92 ,$116.15 ,$116.15 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$197.92 ,$116.15 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$197.92 ,$72.02 ,$123.12 ,$104.54 ,$729.25 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$209.80 ,$116.15 ,$116.15 ,$30.73 ,$116.15 ,$324.11 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200188,88346,HC IF DIRECT (CUTANEOUS),312,1 ,$116.15 ,$76.66 ,$26.44 ,$729.25 ,$197.92 ,$116.15 ,$116.15 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$197.92 ,$116.15 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$197.92 ,$72.02 ,$123.12 ,$104.54 ,$729.25 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$209.80 ,$116.15 ,$116.15 ,$30.73 ,$116.15 ,$324.11 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200189,88348,HC ELECTRON MICRO DIAG,312,1 ,"$3,864.00 ","$2,550.24 ",$197.92 ,"$3,864.00 ",$197.92 ,"$1,265.92 ","$1,265.92 ","$1,022.41 ","$3,091.20 ","$3,284.40 ","$2,415.00 ","$3,477.60 ",$197.92 ,$197.92 ,"$3,670.80 ","$3,477.60 ","$3,284.40 ","$3,284.40 ","$1,022.41 ","$3,284.40 ","$3,284.40 ","$3,477.60 ","$2,353.18 ",$197.92 ,"$2,395.68 ",$209.80 ,"$3,477.60 ","$1,747.15 ","$3,554.88 ","$3,477.60 ","$2,550.63 ","$2,550.63 ","$2,353.18 ","$2,550.63 ","$2,511.60 ","$2,639.88 ",$879.66 ,"$3,052.56 ",$209.80 ,$753.84 ,$753.84 ,"$1,022.41 ",$753.84 ,$776.51 ,"$3,670.80 ","$3,168.48 ","$3,168.48 ","$3,091.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200190,88348,HC ELECTRON MICRO DIAG MAYO,312,1 ,"$1,880.25 ","$1,240.97 ",$197.92 ,"$1,880.25 ",$197.92 ,"$1,265.92 ","$1,265.92 ",$497.52 ,"$1,504.20 ","$1,598.21 ","$1,175.16 ","$1,692.23 ",$197.92 ,$197.92 ,"$1,786.24 ","$1,692.23 ","$1,598.21 ","$1,598.21 ",$497.52 ,"$1,598.21 ","$1,598.21 ","$1,692.23 ","$1,145.07 ",$197.92 ,"$1,165.76 ",$209.80 ,"$1,692.23 ","$1,747.15 ","$1,729.83 ","$1,692.23 ","$1,241.15 ","$1,241.15 ","$1,145.07 ","$1,241.15 ","$1,222.16 ","$1,284.59 ",$428.04 ,"$1,485.40 ",$209.80 ,$753.84 ,$753.84 ,$497.52 ,$753.84 ,$776.51 ,"$1,786.24 ","$1,541.81 ","$1,541.81 ","$1,504.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200191,88360,HC MORPHO ANLYS TUMOR MAN (PR),312,1 ,$463.45 ,$305.88 ,$105.51 ,$463.45 ,$197.92 ,$266.20 ,$266.20 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 ,$353.81 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$172.20 ,$172.20 ,$122.63 ,$172.20 ,$157.25 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200192,88360,HC MORPHO ANLYS TUMOR MAN (ER),312,1 ,$463.45 ,$305.88 ,$105.51 ,$463.45 ,$197.92 ,$266.20 ,$266.20 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 ,$353.81 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$172.20 ,$172.20 ,$122.63 ,$172.20 ,$157.25 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200193,88360,HC MORPHO ANLYS TUMOR MAN,312,1 ,$463.45 ,$305.88 ,$105.51 ,$463.45 ,$197.92 ,$266.20 ,$266.20 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 ,$353.81 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$172.20 ,$172.20 ,$122.63 ,$172.20 ,$157.25 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200194,88360,HC MORPHO ANLYS TUMOR MAN (HER2),312,1 ,$463.45 ,$305.88 ,$105.51 ,$463.45 ,$197.92 ,$266.20 ,$266.20 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 ,$353.81 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$172.20 ,$172.20 ,$122.63 ,$172.20 ,$157.25 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200202,88361,HC MORPHO ANLYS COMP ASSIST,312,1 ,$550.85 ,$363.56 ,$125.41 ,$729.25 ,$197.92 ,$258.22 ,$258.22 ,$145.76 ,$440.68 ,$468.22 ,$344.28 ,$495.77 ,$197.92 ,$197.92 ,$523.31 ,$495.77 ,$468.22 ,$468.22 ,$145.76 ,$468.22 ,$468.22 ,$495.77 ,$335.47 ,$197.92 ,$341.52 ,$209.80 ,$495.77 ,$729.25 ,$506.78 ,$495.77 ,$363.62 ,$363.62 ,$335.47 ,$363.62 ,$358.05 ,$376.34 ,$125.41 ,$435.17 ,$209.80 ,$340.09 ,$340.09 ,$145.76 ,$340.09 ,$324.11 ,$523.31 ,$451.70 ,$451.70 ,$440.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200203,88363,HC EXAM ARCHIVE TISS MOL ANLYS,312,1 ,$143.75 ,$94.88 ,$24.96 ,$143.75 ,$65.18 ,$64.93 ,$64.93 ,$38.03 ,$115.00 ,$122.19 ,$89.84 ,$129.38 ,$65.18 ,$65.18 ,$136.56 ,$129.38 ,$122.19 ,$122.19 ,$38.03 ,$122.19 ,$122.19 ,$129.38 ,$87.54 ,$65.18 ,$89.12 ,$69.09 ,$129.38 ,$56.16 ,$132.25 ,$129.38 ,$94.89 ,$94.89 ,$87.54 ,$94.89 ,$93.44 ,$98.21 ,$32.72 ,$113.56 ,$69.09 ,$27.59 ,$27.59 ,$38.03 ,$27.59 ,$24.96 ,$136.56 ,$117.88 ,$117.88 ,$115.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200204,88365,HC IN SITU HYBRID (FISH),312,1 ,$640.55 ,$422.76 ,$145.82 ,$640.55 ,$197.92 ,$457.10 ,$457.10 ,$169.49 ,$512.44 ,$544.47 ,$400.34 ,$576.50 ,$197.92 ,$197.92 ,$608.52 ,$576.50 ,$544.47 ,$544.47 ,$169.49 ,$544.47 ,$544.47 ,$576.50 ,$390.10 ,$197.92 ,$397.14 ,$209.80 ,$576.50 ,$353.81 ,$589.31 ,$576.50 ,$422.83 ,$422.83 ,$390.10 ,$422.83 ,$416.36 ,$437.62 ,$145.82 ,$506.03 ,$209.80 ,$172.20 ,$172.20 ,$169.49 ,$172.20 ,$157.25 ,$608.52 ,$525.25 ,$525.25 ,$512.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200208,88368,HC MORPHO ANLYS IN SITU HYBRID,312,1 ,$476.10 ,$314.23 ,$108.39 ,$729.25 ,$197.92 ,$317.91 ,$317.91 ,$125.98 ,$380.88 ,$404.69 ,$297.56 ,$428.49 ,$197.92 ,$197.92 ,$452.30 ,$428.49 ,$404.69 ,$404.69 ,$125.98 ,$404.69 ,$404.69 ,$428.49 ,$289.94 ,$197.92 ,$295.18 ,$209.80 ,$428.49 ,$729.25 ,$438.01 ,$428.49 ,$314.27 ,$314.27 ,$289.94 ,$314.27 ,$309.47 ,$325.27 ,$108.39 ,$376.12 ,$209.80 ,$340.09 ,$340.09 ,$125.98 ,$340.09 ,$324.11 ,$452.30 ,$390.40 ,$390.40 ,$380.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200210,88399,HC ACGH ARRAY,312,1 ,"$2,363.25 ","$1,559.75 ",$50.14 ,"$2,363.25 ",$65.18 ,"$2,117.94 ","$2,117.94 ",$625.32 ,"$1,890.60 ","$2,008.76 ","$1,477.03 ","$2,126.93 ",$65.18 ,$65.18 ,"$2,245.09 ","$2,126.93 ","$2,008.76 ","$2,008.76 ",$625.32 ,"$2,008.76 ","$2,008.76 ","$2,126.93 ","$1,439.22 ",$65.18 ,"$1,465.22 ",$69.09 ,"$2,126.93 ",$112.82 ,"$2,174.19 ","$2,126.93 ","$1,559.98 ","$1,559.98 ","$1,439.22 ","$1,559.98 ","$1,536.11 ","$1,614.57 ",$538.01 ,"$1,866.97 ",$69.09 ,$59.36 ,$59.36 ,$625.32 ,$59.36 ,$50.14 ,"$2,245.09 ","$1,937.87 ","$1,937.87 ","$1,890.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200212,G0416,HC PROSTATE NEEDLE BX SAMPLING 1-20 SPEC,312,1 ,$599.15 ,$395.44 ,$136.40 ,$729.25 ,$197.92 ,$593.60 ,$593.60 ,$158.53 ,$479.32 ,$509.28 ,$374.47 ,$539.24 ,$197.92 ,$197.92 ,$569.19 ,$539.24 ,$509.28 ,$509.28 ,$158.53 ,$509.28 ,$509.28 ,$539.24 ,$364.88 ,$197.92 ,$371.48 ,$209.80 ,$539.24 ,$729.25 ,$551.22 ,$539.24 ,$395.50 ,$395.50 ,$364.88 ,$395.50 ,$389.45 ,$409.34 ,$136.40 ,$473.33 ,$209.80 ,$340.09 ,$340.09 ,$158.53 ,$340.09 ,$324.11 ,$569.19 ,$491.30 ,$491.30 ,$479.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200213,88313,HC SPECIAL STAIN II (BM CLOT),312,1 ,$249.55 ,$164.70 ,$33.96 ,$249.55 ,$68.58 ,$230.83 ,$230.83 ,$66.03 ,$199.64 ,$212.12 ,$155.97 ,$224.60 ,$68.58 ,$68.58 ,$237.07 ,$224.60 ,$212.12 ,$212.12 ,$66.03 ,$212.12 ,$212.12 ,$224.60 ,$151.98 ,$68.58 ,$154.72 ,$72.69 ,$224.60 ,$76.41 ,$229.59 ,$224.60 ,$164.73 ,$164.73 ,$151.98 ,$164.73 ,$162.21 ,$170.49 ,$56.81 ,$197.14 ,$72.69 ,$40.12 ,$40.12 ,$66.03 ,$40.12 ,$33.96 ,$237.07 ,$204.63 ,$204.63 ,$199.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200214,88348,HC ELECTROMICROSCOPE SCAN,312,1 ,"$1,288.00 ",$850.08 ,$197.92 ,"$1,747.15 ",$197.92 ,"$1,265.92 ","$1,265.92 ",$340.80 ,"$1,030.40 ","$1,094.80 ",$805.00 ,"$1,159.20 ",$197.92 ,$197.92 ,"$1,223.60 ","$1,159.20 ","$1,094.80 ","$1,094.80 ",$340.80 ,"$1,094.80 ","$1,094.80 ","$1,159.20 ",$784.39 ,$197.92 ,$798.56 ,$209.80 ,"$1,159.20 ","$1,747.15 ","$1,184.96 ","$1,159.20 ",$850.21 ,$850.21 ,$784.39 ,$850.21 ,$837.20 ,$879.96 ,$293.22 ,"$1,017.52 ",$209.80 ,$753.84 ,$753.84 ,$340.80 ,$753.84 ,$776.51 ,"$1,223.60 ","$1,056.16 ","$1,056.16 ","$1,030.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),31200215,88341,HC MLH-1 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$77.52 ,$425.50 ,$197.92 ,$203.09 ,$203.09 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$197.92 ,$197.92 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$197.92 ,$263.82 ,$209.80 ,$382.95 , N/A ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$209.80 ,$77.52 ,$77.52 ,$112.59 ,$77.52 , N/A ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200216,88341,HC MSH-2 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$77.52 ,$425.50 ,$197.92 ,$203.09 ,$203.09 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$197.92 ,$197.92 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$197.92 ,$263.82 ,$209.80 ,$382.95 , N/A ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$209.80 ,$77.52 ,$77.52 ,$112.59 ,$77.52 , N/A ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200217,88341,HC MSH-3 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$77.52 ,$425.50 ,$197.92 ,$203.09 ,$203.09 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$197.92 ,$197.92 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$197.92 ,$263.82 ,$209.80 ,$382.95 , N/A ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$209.80 ,$77.52 ,$77.52 ,$112.59 ,$77.52 , N/A ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200218,88341,HC PMS-2 IMMUNOSTAIN,312,1 ,$425.50 ,$280.83 ,$77.52 ,$425.50 ,$197.92 ,$203.09 ,$203.09 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$197.92 ,$197.92 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$197.92 ,$263.82 ,$209.80 ,$382.95 , N/A ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$209.80 ,$77.52 ,$77.52 ,$112.59 ,$77.52 , N/A ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$334.65 ,$220.87 ,$76.19 ,$353.81 ,$197.92 ,$222.85 ,$222.85 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$197.92 ,$197.92 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$197.92 ,$207.48 ,$209.80 ,$301.19 ,$353.81 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$209.80 ,$172.20 ,$172.20 ,$88.55 ,$172.20 ,$157.25 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200221,88341,HC IP STAIN ADDITIONAL,312,1 ,$425.50 ,$280.83 ,$77.52 ,$425.50 ,$197.92 ,$203.09 ,$203.09 ,$112.59 ,$340.40 ,$361.68 ,$265.94 ,$382.95 ,$197.92 ,$197.92 ,$404.23 ,$382.95 ,$361.68 ,$361.68 ,$112.59 ,$361.68 ,$361.68 ,$382.95 ,$259.13 ,$197.92 ,$263.82 ,$209.80 ,$382.95 , N/A ,$391.46 ,$382.95 ,$280.87 ,$280.87 ,$259.13 ,$280.87 ,$276.58 ,$290.70 ,$96.87 ,$336.15 ,$209.80 ,$77.52 ,$77.52 ,$112.59 ,$77.52 , N/A ,$404.23 ,$348.91 ,$348.91 ,$340.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200229,88368,HC I KAPPA ISH,312,1 ,"$1,030.40 ",$680.06 ,$197.92 ,"$1,030.40 ",$197.92 ,$317.91 ,$317.91 ,$272.65 ,$824.32 ,$875.84 ,$644.00 ,$927.36 ,$197.92 ,$197.92 ,$978.88 ,$927.36 ,$875.84 ,$875.84 ,$272.65 ,$875.84 ,$875.84 ,$927.36 ,$627.51 ,$197.92 ,$638.84 ,$209.80 ,$927.36 ,$729.25 ,$947.97 ,$927.36 ,$680.17 ,$680.17 ,$627.51 ,$680.17 ,$669.76 ,$703.97 ,$234.57 ,$814.02 ,$209.80 ,$340.09 ,$340.09 ,$272.65 ,$340.09 ,$324.11 ,$978.88 ,$844.93 ,$844.93 ,$824.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200230,88369,HC I LAMBDA ISH-ADDITIONAL,312,1 ,$463.45 ,$305.88 ,$99.18 ,$463.45 ,$197.92 ,$278.75 ,$278.75 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 , N/A ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$99.18 ,$99.18 ,$122.63 ,$99.18 , N/A ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200231,88313,HC PERIODIC ACID SCHIFF STAIN II,312,1 ,$334.65 ,$220.87 ,$33.96 ,$334.65 ,$68.58 ,$230.83 ,$230.83 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$68.58 ,$68.58 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$68.58 ,$207.48 ,$72.69 ,$301.19 ,$76.41 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$72.69 ,$40.12 ,$40.12 ,$88.55 ,$40.12 ,$33.96 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200232,88313,HC MASSONS TRICHROME STAIN II,312,1 ,$334.65 ,$220.87 ,$33.96 ,$334.65 ,$68.58 ,$230.83 ,$230.83 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$68.58 ,$68.58 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$68.58 ,$207.48 ,$72.69 ,$301.19 ,$76.41 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$72.69 ,$40.12 ,$40.12 ,$88.55 ,$40.12 ,$33.96 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200233,88313,HC JONES METH SILVER STAIN II,312,1 ,$334.65 ,$220.87 ,$33.96 ,$334.65 ,$68.58 ,$230.83 ,$230.83 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$68.58 ,$68.58 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$68.58 ,$207.48 ,$72.69 ,$301.19 ,$76.41 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$72.69 ,$40.12 ,$40.12 ,$88.55 ,$40.12 ,$33.96 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200235,88381,HC MICRODISSECTION MANUAL,312,1 ,$322.00 ,$212.52 ,$68.58 ,$322.00 ,$68.58 ,$322.00 ,$322.00 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$68.58 ,$68.58 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$68.58 ,$199.64 ,$72.69 ,$289.80 , N/A ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$72.69 ,$188.39 ,$188.39 ,$85.20 ,$188.39 , N/A ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200239,88368,HC HER2 DUAL ISH,312,1 ,"$1,030.40 ",$680.06 ,$197.92 ,"$1,030.40 ",$197.92 ,$317.91 ,$317.91 ,$272.65 ,$824.32 ,$875.84 ,$644.00 ,$927.36 ,$197.92 ,$197.92 ,$978.88 ,$927.36 ,$875.84 ,$875.84 ,$272.65 ,$875.84 ,$875.84 ,$927.36 ,$627.51 ,$197.92 ,$638.84 ,$209.80 ,$927.36 ,$729.25 ,$947.97 ,$927.36 ,$680.17 ,$680.17 ,$627.51 ,$680.17 ,$669.76 ,$703.97 ,$234.57 ,$814.02 ,$209.80 ,$340.09 ,$340.09 ,$272.65 ,$340.09 ,$324.11 ,$978.88 ,$844.93 ,$844.93 ,$824.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200240,88365,HC EPSTEIN BARR ISH,312,1 ,$399.05 ,$263.37 ,$90.85 ,$399.05 ,$197.92 ,$399.05 ,$399.05 ,$105.59 ,$319.24 ,$339.19 ,$249.41 ,$359.15 ,$197.92 ,$197.92 ,$379.10 ,$359.15 ,$339.19 ,$339.19 ,$105.59 ,$339.19 ,$339.19 ,$359.15 ,$243.02 ,$197.92 ,$247.42 ,$209.80 ,$359.15 ,$353.81 ,$367.13 ,$359.15 ,$263.41 ,$263.41 ,$243.02 ,$263.41 ,$259.38 ,$272.63 ,$90.85 ,$315.25 ,$209.80 ,$172.20 ,$172.20 ,$105.59 ,$172.20 ,$157.25 ,$379.10 ,$327.22 ,$327.22 ,$319.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200241,88369,HC HER2 DUAL ISH - ADDITIONAL,312,1 ,$463.45 ,$305.88 ,$99.18 ,$463.45 ,$197.92 ,$278.75 ,$278.75 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 , N/A ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$99.18 ,$99.18 ,$122.63 ,$99.18 , N/A ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200242,88368,HC ISH,312,1 ,$357.65 ,$236.05 ,$81.42 ,$729.25 ,$197.92 ,$317.91 ,$317.91 ,$94.64 ,$286.12 ,$304.00 ,$223.53 ,$321.89 ,$197.92 ,$197.92 ,$339.77 ,$321.89 ,$304.00 ,$304.00 ,$94.64 ,$304.00 ,$304.00 ,$321.89 ,$217.81 ,$197.92 ,$221.74 ,$209.80 ,$321.89 ,$729.25 ,$329.04 ,$321.89 ,$236.08 ,$236.08 ,$217.81 ,$236.08 ,$232.47 ,$244.35 ,$81.42 ,$282.54 ,$209.80 ,$340.09 ,$340.09 ,$94.64 ,$340.09 ,$324.11 ,$339.77 ,$293.27 ,$293.27 ,$286.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200243,88369,HC ISH ADDITIONAL,312,1 ,$357.65 ,$236.05 ,$81.42 ,$357.65 ,$197.92 ,$278.75 ,$278.75 ,$94.64 ,$286.12 ,$304.00 ,$223.53 ,$321.89 ,$197.92 ,$197.92 ,$339.77 ,$321.89 ,$304.00 ,$304.00 ,$94.64 ,$304.00 ,$304.00 ,$321.89 ,$217.81 ,$197.92 ,$221.74 ,$209.80 ,$321.89 , N/A ,$329.04 ,$321.89 ,$236.08 ,$236.08 ,$217.81 ,$236.08 ,$232.47 ,$244.35 ,$81.42 ,$282.54 ,$209.80 ,$99.18 ,$99.18 ,$94.64 ,$99.18 , N/A ,$339.77 ,$293.27 ,$293.27 ,$286.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200278,88364,HC IN SITU HYBRID(FISH) EA ADL-90,312,1 ,$640.55 ,$422.76 ,$125.16 ,$640.55 ,$197.92 ,$348.35 ,$348.35 ,$169.49 ,$512.44 ,$544.47 ,$400.34 ,$576.50 ,$197.92 ,$197.92 ,$608.52 ,$576.50 ,$544.47 ,$544.47 ,$169.49 ,$544.47 ,$544.47 ,$576.50 ,$390.10 ,$197.92 ,$397.14 ,$209.80 ,$576.50 , N/A ,$589.31 ,$576.50 ,$422.83 ,$422.83 ,$390.10 ,$422.83 ,$416.36 ,$437.62 ,$145.82 ,$506.03 ,$209.80 ,$125.16 ,$125.16 ,$169.49 ,$125.16 , N/A ,$608.52 ,$525.25 ,$525.25 ,$512.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),31200291,88360,HC MORPHO ANALYSIS TUMOR MANUAL PD-L1,312,1 ,$463.45 ,$305.88 ,$105.51 ,$463.45 ,$197.92 ,$266.20 ,$266.20 ,$122.63 ,$370.76 ,$393.93 ,$289.66 ,$417.11 ,$197.92 ,$197.92 ,$440.28 ,$417.11 ,$393.93 ,$393.93 ,$122.63 ,$393.93 ,$393.93 ,$417.11 ,$282.24 ,$197.92 ,$287.34 ,$209.80 ,$417.11 ,$353.81 ,$426.37 ,$417.11 ,$305.92 ,$305.92 ,$282.24 ,$305.92 ,$301.24 ,$316.63 ,$105.51 ,$366.13 ,$209.80 ,$172.20 ,$172.20 ,$122.63 ,$172.20 ,$157.25 ,$440.28 ,$380.03 ,$380.03 ,$370.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$760.15 ,$501.70 ,$173.05 ,$760.15 ,$590.54 ,$681.25 ,$681.25 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$590.54 ,$590.54 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$590.54 ,$471.30 ,$625.97 ,$684.14 , N/A ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 ,$173.05 ,$600.52 ,$625.97 ,$388.00 ,$388.00 ,$201.14 ,$436.00 , N/A ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$760.15 ,$501.70 ,$173.05 ,$760.15 ,$590.54 ,$681.25 ,$681.25 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$590.54 ,$590.54 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$590.54 ,$471.30 ,$625.97 ,$684.14 , N/A ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 ,$173.05 ,$600.52 ,$625.97 ,$388.00 ,$388.00 ,$201.14 ,$436.00 , N/A ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$760.15 ,$501.70 ,$173.05 ,$760.15 ,$590.54 ,$681.25 ,$681.25 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$590.54 ,$590.54 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$590.54 ,$471.30 ,$625.97 ,$684.14 , N/A ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 ,$173.05 ,$600.52 ,$625.97 ,$388.00 ,$388.00 ,$201.14 ,$436.00 , N/A ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$760.15 ,$501.70 ,$173.05 ,$760.15 ,$590.54 ,$681.25 ,$681.25 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$590.54 ,$590.54 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$590.54 ,$471.30 ,$625.97 ,$684.14 , N/A ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 ,$173.05 ,$600.52 ,$625.97 ,$388.00 ,$388.00 ,$201.14 ,$436.00 , N/A ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$731.40 ,$482.72 ,$166.50 ,$731.40 ,$590.54 ,$655.48 ,$655.48 ,$193.53 ,$585.12 ,$621.69 ,$457.13 ,$658.26 ,$590.54 ,$590.54 ,$694.83 ,$658.26 ,$621.69 ,$621.69 ,$193.53 ,$621.69 ,$621.69 ,$658.26 ,$445.42 ,$590.54 ,$453.46 ,$625.97 ,$658.26 , N/A ,$672.89 ,$658.26 ,$482.80 ,$482.80 ,$445.42 ,$482.80 ,$475.41 ,$499.69 ,$166.50 ,$577.81 ,$625.97 ,$388.00 ,$388.00 ,$193.53 ,$436.00 , N/A ,$694.83 ,$599.75 ,$599.75 ,$585.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$760.15 ,$501.70 ,$173.05 ,$760.15 ,$590.54 ,$681.25 ,$681.25 ,$201.14 ,$608.12 ,$646.13 ,$475.09 ,$684.14 ,$590.54 ,$590.54 ,$722.14 ,$684.14 ,$646.13 ,$646.13 ,$201.14 ,$646.13 ,$646.13 ,$684.14 ,$462.93 ,$590.54 ,$471.30 ,$625.97 ,$684.14 , N/A ,$699.34 ,$684.14 ,$501.78 ,$501.78 ,$462.93 ,$501.78 ,$494.10 ,$519.33 ,$173.05 ,$600.52 ,$625.97 ,$388.00 ,$388.00 ,$201.14 ,$436.00 , N/A ,$722.14 ,$623.32 ,$623.32 ,$608.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$3,347.66 ","$1,845.03 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$1,845.03 ","$1,362.75 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$1,845.03 ",$844.90 ,"$1,444.52 ","$1,226.48 ","$3,347.66 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$1,955.73 ",$388.00 ,$388.00 ,$360.58 ,$436.00 ,"$1,487.85 ","$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000026,36000,HC IV START > 3YR OLD,320,1 ,$139.00 ,$91.74 ,$31.64 ,$139.00 ,$127.41 ,$124.57 ,$124.57 ,$36.78 ,$111.20 ,$118.15 ,$86.88 ,$125.10 ,$127.41 ,$127.41 ,$132.05 ,$125.10 ,$118.15 ,$118.15 ,$36.78 ,$118.15 ,$118.15 ,$125.10 ,$84.65 ,$127.41 ,$86.18 ,$135.05 ,$125.10 , N/A ,$127.88 ,$125.10 ,$91.75 ,$91.75 ,$84.65 ,$91.75 ,$90.35 ,$94.96 ,$31.64 ,$109.81 ,$135.05 ,$139.00 ,$139.00 ,$36.78 ,$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 ,$124.20 ,$81.97 ,$28.28 ,$135.05 ,$127.41 ,$111.31 ,$111.31 ,$32.86 ,$99.36 ,$105.57 , N/A ,$111.78 ,$127.41 ,$124.20 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$127.41 ,$77.00 ,$131.65 ,$111.78 , N/A ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$135.05 , N/A , N/A ,$32.86 , N/A , N/A ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$631.35 ,$416.69 ,$143.73 ,$631.35 ,$590.54 ,$565.82 ,$565.82 ,$167.05 ,$505.08 ,$536.65 ,$394.59 ,$568.22 ,$590.54 ,$590.54 ,$599.78 ,$568.22 ,$536.65 ,$536.65 ,$167.05 ,$536.65 ,$536.65 ,$568.22 ,$384.49 ,$590.54 ,$391.44 ,$625.97 ,$568.22 ,$464.78 ,$580.84 ,$568.22 ,$416.75 ,$416.75 ,$384.49 ,$416.75 ,$410.38 ,$431.34 ,$143.73 ,$498.77 ,$625.97 ,$388.00 ,$388.00 ,$167.05 ,$436.00 ,$206.57 ,$599.78 ,$517.71 ,$517.71 ,$505.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$495.65 ,$327.13 ,$112.84 ,$973.39 ,$918.29 ,$444.20 ,$444.20 ,$131.15 ,$396.52 ,$421.30 ,$309.78 ,$446.09 ,$918.29 ,$495.65 ,$470.87 ,$446.09 ,$421.30 ,$421.30 ,$131.15 ,$421.30 ,$421.30 ,$446.09 ,$301.85 ,$918.29 ,$307.30 ,$525.39 ,$446.09 ,$849.53 ,$456.00 ,$446.09 ,$327.18 ,$327.18 ,$301.85 ,$327.18 ,$322.17 ,$338.63 ,$112.84 ,$391.56 ,$973.39 ,$388.00 ,$388.00 ,$131.15 ,$436.00 ,$377.57 ,$470.87 ,$406.43 ,$406.43 ,$396.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000036,43761,HC REPOSITION G-TUBE,320,1 ,"$1,040.75 ",$686.90 ,$214.87 ,"$1,040.75 ",$918.29 ,$932.72 ,$932.72 ,$275.38 ,$832.60 ,$884.64 ,$650.47 ,$936.68 ,$918.29 ,$918.29 ,$988.71 ,$936.68 ,$884.64 ,$884.64 ,$275.38 ,$884.64 ,$884.64 ,$936.68 ,$633.82 ,$918.29 ,$645.26 ,$973.39 ,$936.68 ,$483.46 ,$957.49 ,$936.68 ,$687.00 ,$687.00 ,$633.82 ,$687.00 ,$676.49 ,$711.04 ,$236.92 ,$822.19 ,$973.39 ,$388.00 ,$388.00 ,$275.38 ,$436.00 ,$214.87 ,$988.71 ,$853.42 ,$853.42 ,$832.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000054,49424,HC INJ CONTRAST ABSC/CYST,320,1 ,$790.81 ,$521.93 ,$180.04 ,$790.81 ,$590.54 ,$708.72 ,$708.72 ,$209.25 ,$632.65 ,$672.19 ,$494.26 ,$711.73 ,$590.54 ,$590.54 ,$751.27 ,$711.73 ,$672.19 ,$672.19 ,$209.25 ,$672.19 ,$672.19 ,$711.73 ,$481.60 ,$590.54 ,$490.30 ,$625.97 ,$711.73 , N/A ,$727.55 ,$711.73 ,$522.01 ,$522.01 ,$481.60 ,$522.01 ,$514.03 ,$540.28 ,$180.04 ,$624.74 ,$625.97 ,$388.00 ,$388.00 ,$209.25 ,$436.00 , N/A ,$751.27 ,$648.46 ,$648.46 ,$632.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000056,49440,HC INSERT GASTRO TUBE FLUORO,320,1 ,"$2,105.65 ","$1,389.73 ",$388.00 ,"$3,918.58 ",$918.29 ,"$1,887.08 ","$1,887.08 ",$557.16 ,"$1,684.52 ","$1,789.80 ","$1,316.03 ","$1,895.09 ",$918.29 ,$918.29 ,"$2,000.37 ","$1,895.09 ","$1,789.80 ","$1,789.80 ",$557.16 ,"$1,789.80 ","$1,789.80 ","$1,895.09 ","$1,282.34 ",$918.29 ,"$1,305.50 ",$973.39 ,"$1,895.09 ","$3,918.58 ","$1,937.20 ","$1,895.09 ","$1,389.94 ","$1,389.94 ","$1,282.34 ","$1,389.94 ","$1,368.67 ","$1,438.58 ",$479.36 ,"$1,663.46 ",$973.39 ,$388.00 ,$388.00 ,$557.16 ,$436.00 ,"$1,741.59 ","$2,000.37 ","$1,726.63 ","$1,726.63 ","$1,684.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$2,793.35 ","$1,843.61 ",$388.00 ,"$2,793.35 ",$918.29 ,"$2,503.40 ","$2,503.40 ",$739.12 ,"$2,234.68 ","$2,374.35 ","$1,745.84 ","$2,514.02 ",$918.29 ,$918.29 ,"$2,653.68 ","$2,514.02 ","$2,374.35 ","$2,374.35 ",$739.12 ,"$2,374.35 ","$2,374.35 ","$2,514.02 ","$1,701.15 ",$918.29 ,"$1,731.88 ",$973.39 ,"$2,514.02 ","$1,857.40 ","$2,569.88 ","$2,514.02 ","$1,843.89 ","$1,843.89 ","$1,701.15 ","$1,843.89 ","$1,815.68 ","$1,908.42 ",$635.91 ,"$2,206.75 ",$973.39 ,$388.00 ,$388.00 ,$739.12 ,$436.00 ,$825.51 ,"$2,653.68 ","$2,290.55 ","$2,290.55 ","$2,234.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000061,49451,HC RPLC DUODEN/JEJUN TB FLUORO,320,1 ,"$2,602.95 ","$1,717.95 ",$388.00 ,"$2,602.95 ",$918.29 ,"$2,332.76 ","$2,332.76 ",$688.74 ,"$2,082.36 ","$2,212.51 ","$1,626.84 ","$2,342.66 ",$918.29 ,$918.29 ,"$2,472.80 ","$2,342.66 ","$2,212.51 ","$2,212.51 ",$688.74 ,"$2,212.51 ","$2,212.51 ","$2,342.66 ","$1,585.20 ",$918.29 ,"$1,613.82 ",$973.39 ,"$2,342.66 ","$1,857.40 ","$2,394.71 ","$2,342.66 ","$1,718.21 ","$1,718.21 ","$1,585.20 ","$1,718.21 ","$1,691.92 ","$1,778.34 ",$592.58 ,"$2,056.33 ",$973.39 ,$388.00 ,$388.00 ,$688.74 ,$436.00 ,$825.51 ,"$2,472.80 ","$2,134.42 ","$2,134.42 ","$2,082.36 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$545.10 ,$359.77 ,$124.09 ,$545.10 ,$227.47 ,$488.52 ,$488.52 ,$144.24 ,$436.08 ,$463.34 ,$340.69 ,$490.59 ,$227.47 ,$227.47 ,$517.85 ,$490.59 ,$463.34 ,$463.34 ,$144.24 ,$463.34 ,$463.34 ,$490.59 ,$331.97 ,$227.47 ,$337.96 ,$241.12 ,$490.59 ,$525.42 ,$501.49 ,$490.59 ,$359.82 ,$359.82 ,$331.97 ,$359.82 ,$354.32 ,$372.41 ,$124.09 ,$430.63 ,$241.12 ,$388.00 ,$388.00 ,$144.24 ,$436.00 ,$233.52 ,$517.85 ,$446.98 ,$446.98 ,$436.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000085,51600,HC INJ CYSTOGRAM,320,1 ,$637.10 ,$420.49 ,$145.04 ,$637.10 ,$590.54 ,$570.97 ,$570.97 ,$168.58 ,$509.68 ,$541.54 ,$398.19 ,$573.39 ,$590.54 ,$590.54 ,$605.25 ,$573.39 ,$541.54 ,$541.54 ,$168.58 ,$541.54 ,$541.54 ,$573.39 ,$387.99 ,$590.54 ,$395.00 ,$625.97 ,$573.39 , N/A ,$586.13 ,$573.39 ,$420.55 ,$420.55 ,$387.99 ,$420.55 ,$414.12 ,$435.27 ,$145.04 ,$503.31 ,$625.97 ,$388.00 ,$388.00 ,$168.58 ,$436.00 , N/A ,$605.25 ,$522.42 ,$522.42 ,$509.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$290.59 ,$191.79 ,$66.16 ,$290.59 ,$105.66 ,$97.42 ,$80.52 ,$76.89 ,$232.47 ,$247.00 ,$181.62 ,$261.53 ,$105.66 ,$105.66 ,$276.06 ,$261.53 ,$247.00 ,$247.00 ,$76.89 ,$247.00 ,$247.00 ,$261.53 ,$176.97 ,$105.66 ,$180.16 ,$112.00 ,$261.53 ,$195.48 ,$267.34 ,$261.53 ,$191.82 ,$191.82 ,$176.97 ,$191.82 ,$188.88 ,$198.53 ,$66.16 ,$229.57 ,$112.00 ,$290.59 ,$290.59 ,$76.89 ,$290.59 ,$86.88 ,$276.06 ,$238.28 ,$238.28 ,$232.47 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$486.91 ,$321.36 ,$105.35 ,$486.91 ,$105.66 ,$132.05 ,$105.35 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$392.50 ,$259.05 ,$77.76 ,$392.50 ,$105.66 ,$91.88 ,$77.76 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$486.91 ,$321.36 ,$105.66 ,$486.91 ,$105.66 ,$144.52 ,$116.38 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$122.36 ,$98.45 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$486.91 ,$321.36 ,$105.66 ,$486.91 ,$105.66 ,$144.52 ,$115.01 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$98.80 ,$87.41 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$486.91 ,$321.36 ,$86.88 ,$486.91 ,$105.66 ,$112.66 ,$101.21 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$195.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$86.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000109,70240,HC SELLA TURCICA,320,1 ,$392.50 ,$259.05 ,$83.27 ,$392.50 ,$105.66 ,$98.80 ,$83.27 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$392.50 ,$259.05 ,$89.36 ,$392.50 ,$105.66 ,$111.27 ,$97.07 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$486.91 ,$321.36 ,$105.66 ,$486.91 ,$105.66 ,$129.28 ,$115.01 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$173.62 ,$142.60 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000114,70336,HC MRI TMJ,320,1 ,"$3,864.00 ","$2,550.24 ",$233.52 ,"$3,864.00 ",$473.03 ,$932.21 ,$932.21 ,"$1,022.41 ","$3,091.20 ","$3,284.40 ","$2,415.00 ","$3,477.60 ",$473.03 ,$473.03 ,"$3,670.80 ","$3,477.60 ","$3,284.40 ","$3,284.40 ","$1,022.41 ","$3,284.40 ","$3,284.40 ","$3,477.60 ","$2,353.18 ",$473.03 ,"$2,395.68 ",$501.41 ,"$3,477.60 ",$525.42 ,"$3,554.88 ","$3,477.60 ","$2,550.63 ","$2,550.63 ","$2,353.18 ","$2,550.63 ","$2,511.60 ","$2,639.88 ",$879.66 ,"$3,052.56 ",$501.41 ,$388.00 ,$388.00 ,"$1,022.41 ",$436.00 ,$233.52 ,"$3,670.80 ","$3,168.48 ","$3,168.48 ","$3,091.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000115,70355,HC XRAY PAN MANDIBLE/MAXLA,320,1 ,$392.50 ,$259.05 ,$32.30 ,$392.50 ,$105.66 ,$32.30 ,$33.61 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$383.99 ,$253.43 ,$83.27 ,$383.99 ,$105.66 ,$93.26 ,$83.27 ,$101.61 ,$307.19 ,$326.39 ,$239.99 ,$345.59 ,$105.66 ,$105.66 ,$364.79 ,$345.59 ,$326.39 ,$326.39 ,$101.61 ,$326.39 ,$326.39 ,$345.59 ,$233.85 ,$105.66 ,$238.08 ,$112.00 ,$345.59 ,$195.48 ,$353.27 ,$345.59 ,$253.47 ,$253.47 ,$233.85 ,$253.47 ,$249.59 ,$262.34 ,$87.42 ,$303.35 ,$112.00 ,$383.99 ,$383.99 ,$101.61 ,$383.99 ,$86.88 ,$364.79 ,$314.87 ,$314.87 ,$307.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000118,74230,HC XRAY SPEECH EVAL W/CINE/VIDEO,320,1 ,$639.29 ,$421.93 ,$145.54 ,$639.29 ,$227.47 ,$434.08 ,$389.54 ,$169.16 ,$511.43 ,$543.40 ,$399.56 ,$575.36 ,$227.47 ,$227.47 ,$607.33 ,$575.36 ,$543.40 ,$543.40 ,$169.16 ,$543.40 ,$543.40 ,$575.36 ,$389.33 ,$227.47 ,$396.36 ,$241.12 ,$575.36 ,$405.77 ,$588.15 ,$575.36 ,$422.00 ,$422.00 ,$389.33 ,$422.00 ,$415.54 ,$436.76 ,$145.54 ,$505.04 ,$241.12 ,$388.00 ,$388.00 ,$169.16 ,$436.00 ,$180.34 ,$607.33 ,$524.22 ,$524.22 ,$511.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000121,71045,HC XR CHEST 1V,320,1 ,$322.90 ,$213.11 ,$59.82 ,$322.90 ,$105.66 ,$69.71 ,$59.82 ,$85.44 ,$258.32 ,$274.47 ,$201.81 ,$290.61 ,$105.66 ,$105.66 ,$306.76 ,$290.61 ,$274.47 ,$274.47 ,$85.44 ,$274.47 ,$274.47 ,$290.61 ,$196.65 ,$105.66 ,$200.20 ,$112.00 ,$290.61 ,$195.48 ,$297.07 ,$290.61 ,$213.15 ,$213.15 ,$196.65 ,$213.15 ,$209.89 ,$220.61 ,$73.51 ,$255.09 ,$112.00 ,$322.90 ,$322.90 ,$85.44 ,$322.90 ,$86.88 ,$306.76 ,$264.78 ,$264.78 ,$258.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000123,71045,HC XR CHEST 1V POST OP,320,1 ,$322.90 ,$213.11 ,$59.82 ,$322.90 ,$105.66 ,$69.71 ,$59.82 ,$85.44 ,$258.32 ,$274.47 ,$201.81 ,$290.61 ,$105.66 ,$105.66 ,$306.76 ,$290.61 ,$274.47 ,$274.47 ,$85.44 ,$274.47 ,$274.47 ,$290.61 ,$196.65 ,$105.66 ,$200.20 ,$112.00 ,$290.61 ,$195.48 ,$297.07 ,$290.61 ,$213.15 ,$213.15 ,$196.65 ,$213.15 ,$209.89 ,$220.61 ,$73.51 ,$255.09 ,$112.00 ,$322.90 ,$322.90 ,$85.44 ,$322.90 ,$86.88 ,$306.76 ,$264.78 ,$264.78 ,$258.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000126,71045,HC XR CHEST 1V INFANT,320,1 ,$322.90 ,$213.11 ,$59.82 ,$322.90 ,$105.66 ,$69.71 ,$59.82 ,$85.44 ,$258.32 ,$274.47 ,$201.81 ,$290.61 ,$105.66 ,$105.66 ,$306.76 ,$290.61 ,$274.47 ,$274.47 ,$85.44 ,$274.47 ,$274.47 ,$290.61 ,$196.65 ,$105.66 ,$200.20 ,$112.00 ,$290.61 ,$195.48 ,$297.07 ,$290.61 ,$213.15 ,$213.15 ,$196.65 ,$213.15 ,$209.89 ,$220.61 ,$73.51 ,$255.09 ,$112.00 ,$322.90 ,$322.90 ,$85.44 ,$322.90 ,$86.88 ,$306.76 ,$264.78 ,$264.78 ,$258.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000127,71046,HC XR CHEST 2V,320,1 ,$322.90 ,$213.11 ,$73.51 ,$322.90 ,$105.66 ,$94.65 ,$79.14 ,$85.44 ,$258.32 ,$274.47 ,$201.81 ,$290.61 ,$105.66 ,$105.66 ,$306.76 ,$290.61 ,$274.47 ,$274.47 ,$85.44 ,$274.47 ,$274.47 ,$290.61 ,$196.65 ,$105.66 ,$200.20 ,$112.00 ,$290.61 ,$195.48 ,$297.07 ,$290.61 ,$213.15 ,$213.15 ,$196.65 ,$213.15 ,$209.89 ,$220.61 ,$73.51 ,$255.09 ,$112.00 ,$322.90 ,$322.90 ,$85.44 ,$322.90 ,$86.88 ,$306.76 ,$264.78 ,$264.78 ,$258.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000131,71048,HC XR CHEST PA/LAT W/OBLIQUES,320,1 ,$441.60 ,$291.46 ,$100.54 ,$441.60 ,$105.66 ,$129.28 ,$102.59 ,$116.85 ,$353.28 ,$375.36 ,$276.00 ,$397.44 ,$105.66 ,$105.66 ,$419.52 ,$397.44 ,$375.36 ,$375.36 ,$116.85 ,$375.36 ,$375.36 ,$397.44 ,$268.93 ,$105.66 ,$273.80 ,$112.00 ,$397.44 ,$240.48 ,$406.27 ,$397.44 ,$291.50 ,$291.50 ,$268.93 ,$291.50 ,$287.04 ,$301.70 ,$100.54 ,$348.86 ,$112.00 ,$388.00 ,$388.00 ,$116.85 ,$436.00 ,$106.88 ,$419.52 ,$362.11 ,$362.11 ,$353.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000133,71048,HC XR CHEST 4+V,320,1 ,$441.60 ,$291.46 ,$100.54 ,$441.60 ,$105.66 ,$129.28 ,$102.59 ,$116.85 ,$353.28 ,$375.36 ,$276.00 ,$397.44 ,$105.66 ,$105.66 ,$419.52 ,$397.44 ,$375.36 ,$375.36 ,$116.85 ,$375.36 ,$375.36 ,$397.44 ,$268.93 ,$105.66 ,$273.80 ,$112.00 ,$397.44 ,$240.48 ,$406.27 ,$397.44 ,$291.50 ,$291.50 ,$268.93 ,$291.50 ,$287.04 ,$301.70 ,$100.54 ,$348.86 ,$112.00 ,$388.00 ,$388.00 ,$116.85 ,$436.00 ,$106.88 ,$419.52 ,$362.11 ,$362.11 ,$353.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$322.90 ,$213.11 ,$73.51 ,$322.90 ,$105.66 ,$94.65 ,$79.14 ,$85.44 ,$258.32 ,$274.47 ,$201.81 ,$290.61 ,$105.66 ,$105.66 ,$306.76 ,$290.61 ,$274.47 ,$274.47 ,$85.44 ,$274.47 ,$274.47 ,$290.61 ,$196.65 ,$105.66 ,$200.20 ,$112.00 ,$290.61 ,$195.48 ,$297.07 ,$290.61 ,$213.15 ,$213.15 ,$196.65 ,$213.15 ,$209.89 ,$220.61 ,$73.51 ,$255.09 ,$112.00 ,$322.90 ,$322.90 ,$85.44 ,$322.90 ,$86.88 ,$306.76 ,$264.78 ,$264.78 ,$258.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000137,71100,HC XR RIBS 2V UNI,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$107.12 ,$88.79 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$594.06 ,$392.08 ,$98.45 ,$594.06 ,$105.66 ,$120.97 ,$98.45 ,$157.19 ,$475.25 ,$504.95 ,$371.29 ,$534.65 ,$105.66 ,$105.66 ,$564.36 ,$534.65 ,$504.95 ,$504.95 ,$157.19 ,$504.95 ,$504.95 ,$534.65 ,$361.78 ,$105.66 ,$368.32 ,$112.00 ,$534.65 ,$240.48 ,$546.54 ,$534.65 ,$392.14 ,$392.14 ,$361.78 ,$392.14 ,$386.14 ,$405.86 ,$135.24 ,$469.31 ,$112.00 ,$388.00 ,$388.00 ,$157.19 ,$436.00 ,$106.88 ,$564.36 ,$487.13 ,$487.13 ,$475.25 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$486.91 ,$321.36 ,$101.21 ,$486.91 ,$105.66 ,$123.74 ,$101.21 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,$594.06 ,$392.08 ,$105.66 ,$594.06 ,$105.66 ,$154.22 ,$124.66 ,$157.19 ,$475.25 ,$504.95 ,$371.29 ,$534.65 ,$105.66 ,$105.66 ,$564.36 ,$534.65 ,$504.95 ,$504.95 ,$157.19 ,$504.95 ,$504.95 ,$534.65 ,$361.78 ,$105.66 ,$368.32 ,$112.00 ,$534.65 ,$240.48 ,$546.54 ,$534.65 ,$392.14 ,$392.14 ,$361.78 ,$392.14 ,$386.14 ,$405.86 ,$135.24 ,$469.31 ,$112.00 ,$388.00 ,$388.00 ,$157.19 ,$436.00 ,$106.88 ,$564.36 ,$487.13 ,$487.13 ,$475.25 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000141,71120,HC XR STERNUM 2+V,320,1 ,$392.50 ,$259.05 ,$80.52 ,$392.50 ,$105.66 ,$100.19 ,$80.52 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ,"$3,622.50 ","$2,390.85 ",$233.52 ,"$3,622.50 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$473.03 ,$473.03 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$473.03 ,"$2,245.96 ",$501.41 ,"$3,260.25 ",$525.42 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$233.52 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$740.75 ,"$3,622.50 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$810.26 ,$810.26 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$810.26 ,"$2,245.96 ",$858.88 ,"$3,260.25 ","$1,666.69 ","$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$740.75 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$810.26 ,$810.26 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$810.26 ,"$2,245.96 ",$858.88 ,"$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$411.60 ,$271.66 ,$58.44 ,$411.60 ,$105.66 ,$68.32 ,$58.44 ,$108.91 ,$329.28 ,$349.86 ,$257.25 ,$370.44 ,$105.66 ,$105.66 ,$391.02 ,$370.44 ,$349.86 ,$349.86 ,$108.91 ,$349.86 ,$349.86 ,$370.44 ,$250.66 ,$105.66 ,$255.20 ,$112.00 ,$370.44 ,$195.48 ,$378.67 ,$370.44 ,$271.70 ,$271.70 ,$250.66 ,$271.70 ,$267.54 ,$281.21 ,$93.71 ,$325.16 ,$112.00 ,$388.00 ,$388.00 ,$108.91 ,$411.60 ,$86.88 ,$391.02 ,$337.51 ,$337.51 ,$329.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000158,72020,HC XR SPINE 1V (C SPINE/L SPINE),320,1 ,$415.84 ,$274.45 ,$58.44 ,$415.84 ,$105.66 ,$68.32 ,$58.44 ,$110.03 ,$332.67 ,$353.46 ,$259.90 ,$374.26 ,$105.66 ,$105.66 ,$395.05 ,$374.26 ,$353.46 ,$353.46 ,$110.03 ,$353.46 ,$353.46 ,$374.26 ,$253.25 ,$105.66 ,$257.82 ,$112.00 ,$374.26 ,$195.48 ,$382.57 ,$374.26 ,$274.50 ,$274.50 ,$253.25 ,$274.50 ,$270.30 ,$284.10 ,$94.67 ,$328.51 ,$112.00 ,$388.00 ,$388.00 ,$110.03 ,$415.84 ,$86.88 ,$395.05 ,$340.99 ,$340.99 ,$332.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000160,72020,HC XR SPINE 1V (T SPINE),320,1 ,$415.84 ,$274.45 ,$58.44 ,$415.84 ,$105.66 ,$68.32 ,$58.44 ,$110.03 ,$332.67 ,$353.46 ,$259.90 ,$374.26 ,$105.66 ,$105.66 ,$395.05 ,$374.26 ,$353.46 ,$353.46 ,$110.03 ,$353.46 ,$353.46 ,$374.26 ,$253.25 ,$105.66 ,$257.82 ,$112.00 ,$374.26 ,$195.48 ,$382.57 ,$374.26 ,$274.50 ,$274.50 ,$253.25 ,$274.50 ,$270.30 ,$284.10 ,$94.67 ,$328.51 ,$112.00 ,$388.00 ,$388.00 ,$110.03 ,$415.84 ,$86.88 ,$395.05 ,$340.99 ,$340.99 ,$332.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000161,72020,HC XR L-SPINE 1V,320,1 ,$415.84 ,$274.45 ,$58.44 ,$415.84 ,$105.66 ,$68.32 ,$58.44 ,$110.03 ,$332.67 ,$353.46 ,$259.90 ,$374.26 ,$105.66 ,$105.66 ,$395.05 ,$374.26 ,$353.46 ,$353.46 ,$110.03 ,$353.46 ,$353.46 ,$374.26 ,$253.25 ,$105.66 ,$257.82 ,$112.00 ,$374.26 ,$195.48 ,$382.57 ,$374.26 ,$274.50 ,$274.50 ,$253.25 ,$274.50 ,$270.30 ,$284.10 ,$94.67 ,$328.51 ,$112.00 ,$388.00 ,$388.00 ,$110.03 ,$415.84 ,$86.88 ,$395.05 ,$340.99 ,$340.99 ,$332.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$522.98 ,$345.17 ,$86.88 ,$522.98 ,$105.66 ,$118.20 ,$97.07 ,$138.38 ,$418.38 ,$444.53 ,$326.86 ,$470.68 ,$105.66 ,$105.66 ,$496.83 ,$470.68 ,$444.53 ,$444.53 ,$138.38 ,$444.53 ,$444.53 ,$470.68 ,$318.49 ,$105.66 ,$324.24 ,$112.00 ,$470.68 ,$195.48 ,$481.14 ,$470.68 ,$345.22 ,$345.22 ,$318.49 ,$345.22 ,$339.94 ,$357.30 ,$119.06 ,$413.15 ,$112.00 ,$388.00 ,$388.00 ,$138.38 ,$436.00 ,$86.88 ,$496.83 ,$428.84 ,$428.84 ,$418.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$557.99 ,$368.27 ,$105.66 ,$557.99 ,$105.66 ,$165.30 ,$132.94 ,$147.65 ,$446.39 ,$474.29 ,$348.74 ,$502.19 ,$105.66 ,$105.66 ,$530.09 ,$502.19 ,$474.29 ,$474.29 ,$147.65 ,$474.29 ,$474.29 ,$502.19 ,$339.82 ,$105.66 ,$345.96 ,$112.00 ,$502.19 ,$240.48 ,$513.35 ,$502.19 ,$368.33 ,$368.33 ,$339.82 ,$368.33 ,$362.69 ,$381.22 ,$127.03 ,$440.81 ,$112.00 ,$388.00 ,$388.00 ,$147.65 ,$436.00 ,$106.88 ,$530.09 ,$457.55 ,$457.55 ,$446.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,$724.54 ,$478.20 ,$105.66 ,$724.54 ,$105.66 ,$197.17 ,$160.53 ,$191.72 ,$579.63 ,$615.86 ,$452.84 ,$652.09 ,$105.66 ,$105.66 ,$688.31 ,$652.09 ,$615.86 ,$615.86 ,$191.72 ,$615.86 ,$615.86 ,$652.09 ,$441.24 ,$105.66 ,$449.22 ,$112.00 ,$652.09 ,$240.48 ,$666.58 ,$652.09 ,$478.27 ,$478.27 ,$441.24 ,$478.27 ,$470.95 ,$495.01 ,$164.94 ,$572.39 ,$112.00 ,$388.00 ,$388.00 ,$191.72 ,$436.00 ,$106.88 ,$688.31 ,$594.12 ,$594.12 ,$579.63 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000172,72070,HC XR T-SPINE 2V,320,1 ,$392.50 ,$259.05 ,$87.41 ,$392.50 ,$105.66 ,$94.65 ,$87.41 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000174,72072,HC XR T-SPINE 3V,320,1 ,$392.50 ,$259.05 ,$89.36 ,$392.50 ,$105.66 ,$116.81 ,$97.07 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$451.91 ,$298.26 ,$97.07 ,$451.91 ,$105.66 ,$119.58 ,$97.07 ,$119.58 ,$361.53 ,$384.12 ,$282.44 ,$406.72 ,$105.66 ,$105.66 ,$429.31 ,$406.72 ,$384.12 ,$384.12 ,$119.58 ,$384.12 ,$384.12 ,$406.72 ,$275.21 ,$105.66 ,$280.18 ,$112.00 ,$406.72 ,$240.48 ,$415.76 ,$406.72 ,$298.31 ,$298.31 ,$275.21 ,$298.31 ,$293.74 ,$308.74 ,$102.88 ,$357.01 ,$112.00 ,$388.00 ,$388.00 ,$119.58 ,$436.00 ,$106.88 ,$429.31 ,$370.57 ,$370.57 ,$361.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000181,72110,HC XR L-SPINE 4+V,320,1 ,$724.54 ,$478.20 ,$105.66 ,$724.54 ,$105.66 ,$159.76 ,$135.70 ,$191.72 ,$579.63 ,$615.86 ,$452.84 ,$652.09 ,$105.66 ,$105.66 ,$688.31 ,$652.09 ,$615.86 ,$615.86 ,$191.72 ,$615.86 ,$615.86 ,$652.09 ,$441.24 ,$105.66 ,$449.22 ,$112.00 ,$652.09 ,$240.48 ,$666.58 ,$652.09 ,$478.27 ,$478.27 ,$441.24 ,$478.27 ,$470.95 ,$495.01 ,$164.94 ,$572.39 ,$112.00 ,$388.00 ,$388.00 ,$191.72 ,$436.00 ,$106.88 ,$688.31 ,$594.12 ,$594.12 ,$579.63 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,$724.54 ,$478.20 ,$105.66 ,$724.54 ,$105.66 ,$195.79 ,$160.53 ,$191.72 ,$579.63 ,$615.86 ,$452.84 ,$652.09 ,$105.66 ,$105.66 ,$688.31 ,$652.09 ,$615.86 ,$615.86 ,$191.72 ,$615.86 ,$615.86 ,$652.09 ,$441.24 ,$105.66 ,$449.22 ,$112.00 ,$652.09 ,$240.48 ,$666.58 ,$652.09 ,$478.27 ,$478.27 ,$441.24 ,$478.27 ,$470.95 ,$495.01 ,$164.94 ,$572.39 ,$112.00 ,$388.00 ,$388.00 ,$191.72 ,$436.00 ,$106.88 ,$688.31 ,$594.12 ,$594.12 ,$579.63 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000186,72170,HC XR PELVIS 1-2V,320,1 ,$392.50 ,$259.05 ,$79.41 ,$392.50 ,$105.66 ,$79.41 ,$92.93 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$388.26 ,$256.25 ,$88.39 ,$388.26 ,$105.66 ,$123.74 ,$110.87 ,$102.73 ,$310.61 ,$330.02 ,$242.66 ,$349.43 ,$105.66 ,$105.66 ,$368.85 ,$349.43 ,$330.02 ,$330.02 ,$102.73 ,$330.02 ,$330.02 ,$349.43 ,$236.45 ,$105.66 ,$240.72 ,$112.00 ,$349.43 ,$240.48 ,$357.20 ,$349.43 ,$256.29 ,$256.29 ,$236.45 ,$256.29 ,$252.37 ,$265.26 ,$88.39 ,$306.73 ,$112.00 ,$388.00 ,$388.00 ,$102.73 ,$388.26 ,$106.88 ,$368.85 ,$318.37 ,$318.37 ,$310.61 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$392.50 ,$259.05 ,$89.36 ,$392.50 ,$105.66 ,$116.81 ,$97.07 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$392.50 ,$259.05 ,$83.27 ,$392.50 ,$105.66 ,$98.80 ,$83.27 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000196,62304,HC XR MYELOGRAM L-SPINE,320,1 ,"$2,105.65 ","$1,389.73 ",$388.00 ,"$2,105.65 ","$1,091.77 ","$1,887.08 ","$1,887.08 ",$557.16 ,"$1,684.52 ","$1,789.80 ","$1,316.03 ","$1,895.09 ","$1,091.77 ","$1,091.77 ","$2,000.37 ","$1,895.09 ","$1,789.80 ","$1,789.80 ",$557.16 ,"$1,789.80 ","$1,789.80 ","$1,895.09 ","$1,282.34 ","$1,091.77 ","$1,305.50 ","$1,157.28 ","$1,895.09 ","$1,666.69 ","$1,937.20 ","$1,895.09 ","$1,389.94 ","$1,389.94 ","$1,282.34 ","$1,389.94 ","$1,368.67 ","$1,438.58 ",$479.36 ,"$1,663.46 ","$1,157.28 ",$388.00 ,$388.00 ,$557.16 ,$436.00 ,$740.75 ,"$2,000.37 ","$1,726.63 ","$1,726.63 ","$1,684.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000201,73000,HC XRAY CLAVICLE,320,1 ,$415.84 ,$274.45 ,$79.14 ,$415.84 ,$105.66 ,$98.80 ,$79.14 ,$110.03 ,$332.67 ,$353.46 ,$259.90 ,$374.26 ,$105.66 ,$105.66 ,$395.05 ,$374.26 ,$353.46 ,$353.46 ,$110.03 ,$353.46 ,$353.46 ,$374.26 ,$253.25 ,$105.66 ,$257.82 ,$112.00 ,$374.26 ,$195.48 ,$382.57 ,$374.26 ,$274.50 ,$274.50 ,$253.25 ,$274.50 ,$270.30 ,$284.10 ,$94.67 ,$328.51 ,$112.00 ,$388.00 ,$388.00 ,$110.03 ,$415.84 ,$86.88 ,$395.05 ,$340.99 ,$340.99 ,$332.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000204,73010,HC XRAY SCAPULA,320,1 ,$439.18 ,$289.86 ,$61.40 ,$439.18 ,$105.66 ,$61.40 ,$87.41 ,$116.21 ,$351.34 ,$373.30 ,$274.49 ,$395.26 ,$105.66 ,$105.66 ,$417.22 ,$395.26 ,$373.30 ,$373.30 ,$116.21 ,$373.30 ,$373.30 ,$395.26 ,$267.46 ,$105.66 ,$272.30 ,$112.00 ,$395.26 ,$240.48 ,$404.05 ,$395.26 ,$289.90 ,$289.90 ,$267.46 ,$289.90 ,$285.47 ,$300.05 ,$99.98 ,$346.95 ,$112.00 ,$388.00 ,$388.00 ,$116.21 ,$436.00 ,$106.88 ,$417.22 ,$360.13 ,$360.13 ,$351.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$392.50 ,$259.05 ,$57.24 ,$392.50 ,$105.66 ,$57.24 ,$59.82 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$392.50 ,$259.05 ,$79.14 ,$392.50 ,$158.49 ,$104.34 ,$79.14 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$392.50 ,$259.05 ,$79.14 ,$392.50 ,$158.49 ,$104.34 ,$79.14 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,"$2,060.80 ","$1,360.13 ",$227.47 ,"$2,060.80 ",$227.47 ,$439.63 ,$321.94 ,$545.29 ,"$1,648.64 ","$1,751.68 ","$1,288.00 ","$1,854.72 ",$227.47 ,$227.47 ,"$1,957.76 ","$1,854.72 ","$1,751.68 ","$1,751.68 ",$545.29 ,"$1,751.68 ","$1,751.68 ","$1,854.72 ","$1,255.03 ",$227.47 ,"$1,277.70 ",$241.12 ,"$1,854.72 ",$828.97 ,"$1,895.94 ","$1,854.72 ","$1,360.33 ","$1,360.33 ","$1,255.03 ","$1,360.33 ","$1,339.52 ","$1,407.94 ",$469.15 ,"$1,628.03 ",$241.12 ,$388.00 ,$388.00 ,$545.29 ,$436.00 ,$368.43 ,"$1,957.76 ","$1,689.86 ","$1,689.86 ","$1,648.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$392.50 ,$259.05 ,$79.41 ,$392.50 ,$105.66 ,$79.41 ,$102.59 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$392.50 ,$259.05 ,$83.27 ,$392.50 ,$105.66 ,$98.80 ,$83.27 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$392.50 ,$259.05 ,$72.24 ,$392.50 ,$105.66 ,$86.33 ,$72.24 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$80.52 ,$392.50 ,$105.66 ,$98.80 ,$80.52 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,"$1,120.10 ",$739.27 ,$227.47 ,"$1,120.10 ",$227.47 ,$357.88 ,$298.49 ,$296.38 ,$896.08 ,$952.09 ,$700.06 ,"$1,008.09 ",$227.47 ,$227.47 ,"$1,064.10 ","$1,008.09 ",$952.09 ,$952.09 ,$296.38 ,$952.09 ,$952.09 ,"$1,008.09 ",$682.14 ,$227.47 ,$694.46 ,$241.12 ,"$1,008.09 ",$828.97 ,"$1,030.49 ","$1,008.09 ",$739.38 ,$739.38 ,$682.14 ,$739.38 ,$728.07 ,$765.25 ,$255.00 ,$884.88 ,$241.12 ,$388.00 ,$388.00 ,$296.38 ,$436.00 ,$368.43 ,"$1,064.10 ",$918.48 ,$918.48 ,$896.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$392.50 ,$259.05 ,$75.00 ,$392.50 ,$158.49 ,$87.72 ,$75.00 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$392.50 ,$259.05 ,$75.00 ,$392.50 ,$158.49 ,$87.72 ,$75.00 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$392.50 ,$259.05 ,$79.14 ,$392.50 ,$105.66 ,$98.80 ,$79.14 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$105.73 ,$90.17 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$105.73 ,$90.17 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$133.44 ,$106.73 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$133.44 ,$106.73 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000235,73110,HC XRAY WRIST COMP MIN 3 V + NAVIC,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$133.44 ,$106.73 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,"$1,033.23 ",$681.93 ,$227.47 ,"$1,033.23 ",$227.47 ,$459.02 ,$346.77 ,$273.39 ,$826.58 ,$878.25 ,$645.77 ,$929.91 ,$227.47 ,$227.47 ,$981.57 ,$929.91 ,$878.25 ,$878.25 ,$273.39 ,$878.25 ,$878.25 ,$929.91 ,$629.24 ,$227.47 ,$640.60 ,$241.12 ,$929.91 ,$828.97 ,$950.57 ,$929.91 ,$682.04 ,$682.04 ,$629.24 ,$682.04 ,$671.60 ,$705.90 ,$235.22 ,$816.25 ,$241.12 ,$388.00 ,$388.00 ,$273.39 ,$436.00 ,$368.43 ,$981.57 ,$847.25 ,$847.25 ,$826.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$392.50 ,$259.05 ,$79.14 ,$392.50 ,$105.66 ,$94.65 ,$79.14 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$115.43 ,$94.31 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$115.43 ,$94.31 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$126.51 ,$102.59 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,"$2,060.80 ","$1,360.13 ",$227.47 ,"$2,060.80 ",$227.47 ,$443.78 ,$323.32 ,$545.29 ,"$1,648.64 ","$1,751.68 ","$1,288.00 ","$1,854.72 ",$227.47 ,$227.47 ,"$1,957.76 ","$1,854.72 ","$1,751.68 ","$1,751.68 ",$545.29 ,"$1,751.68 ","$1,751.68 ","$1,854.72 ","$1,255.03 ",$227.47 ,"$1,277.70 ",$241.12 ,"$1,854.72 ",$828.97 ,"$1,895.94 ","$1,854.72 ","$1,360.33 ","$1,360.33 ","$1,255.03 ","$1,360.33 ","$1,339.52 ","$1,407.94 ",$469.15 ,"$1,628.03 ",$241.12 ,$388.00 ,$388.00 ,$545.29 ,$436.00 ,$368.43 ,"$1,957.76 ","$1,689.86 ","$1,689.86 ","$1,648.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$107.12 ,$91.55 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$107.12 ,$91.55 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$130.67 ,$106.73 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$130.67 ,$106.73 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$392.50 ,$259.05 ,$89.36 ,$392.50 ,$158.49 ,$145.91 ,$116.38 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$392.50 ,$259.05 ,$89.36 ,$392.50 ,$158.49 ,$145.91 ,$116.38 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000267,73565,HC XR KNEE STAND,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$132.05 ,$109.49 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,"$1,188.11 ",$784.15 ,$227.47 ,"$1,188.11 ",$227.47 ,$501.97 ,$381.26 ,$314.37 ,$950.49 ,"$1,009.89 ",$742.57 ,"$1,069.30 ",$227.47 ,$227.47 ,"$1,128.70 ","$1,069.30 ","$1,009.89 ","$1,009.89 ",$314.37 ,"$1,009.89 ","$1,009.89 ","$1,069.30 ",$723.56 ,$227.47 ,$736.62 ,$241.12 ,"$1,069.30 ",$828.97 ,"$1,093.06 ","$1,069.30 ",$784.27 ,$784.27 ,$723.56 ,$784.27 ,$772.27 ,$811.72 ,$270.48 ,$938.61 ,$241.12 ,$388.00 ,$388.00 ,$314.37 ,$436.00 ,$368.43 ,"$1,128.70 ",$974.25 ,$974.25 ,$950.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$392.50 ,$259.05 ,$81.90 ,$392.50 ,$158.49 ,$97.42 ,$81.90 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$392.50 ,$259.05 ,$81.90 ,$392.50 ,$158.49 ,$97.42 ,$81.90 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$392.50 ,$259.05 ,$79.14 ,$392.50 ,$105.66 ,$98.80 ,$79.14 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$392.50 ,$259.05 ,$86.03 ,$392.50 ,$158.49 ,$100.19 ,$86.03 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$392.50 ,$259.05 ,$86.03 ,$392.50 ,$158.49 ,$100.19 ,$86.03 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$116.81 ,$94.31 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$116.81 ,$94.31 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,"$1,311.17 ",$865.37 ,$227.47 ,"$1,311.17 ",$227.47 ,$442.40 ,$345.39 ,$346.94 ,"$1,048.94 ","$1,114.49 ",$819.48 ,"$1,180.05 ",$227.47 ,$227.47 ,"$1,245.61 ","$1,180.05 ","$1,114.49 ","$1,114.49 ",$346.94 ,"$1,114.49 ","$1,114.49 ","$1,180.05 ",$798.50 ,$227.47 ,$812.92 ,$241.12 ,"$1,180.05 ",$828.97 ,"$1,206.28 ","$1,180.05 ",$865.50 ,$865.50 ,$798.50 ,$865.50 ,$852.26 ,$895.79 ,$298.50 ,"$1,035.82 ",$241.12 ,$388.00 ,$388.00 ,$346.94 ,$436.00 ,$368.43 ,"$1,245.61 ","$1,075.16 ","$1,075.16 ","$1,048.94 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$392.50 ,$259.05 ,$73.62 ,$392.50 ,$158.49 ,$84.95 ,$73.62 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$392.50 ,$259.05 ,$73.62 ,$392.50 ,$158.49 ,$84.95 ,$73.62 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$108.50 ,$87.41 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$158.49 ,$108.50 ,$87.41 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$158.49 ,$158.49 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$158.49 ,$243.36 ,$168.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$168.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$392.50 ,$259.05 ,$72.24 ,$392.50 ,$105.66 ,$86.33 ,$72.24 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$392.50 ,$259.05 ,$84.65 ,$392.50 ,$105.66 ,$93.26 ,$84.65 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$383.99 ,$253.43 ,$73.62 ,$383.99 ,$105.66 ,$87.72 ,$73.62 ,$101.61 ,$307.19 ,$326.39 ,$239.99 ,$345.59 ,$105.66 ,$105.66 ,$364.79 ,$345.59 ,$326.39 ,$326.39 ,$101.61 ,$326.39 ,$326.39 ,$345.59 ,$233.85 ,$105.66 ,$238.08 ,$112.00 ,$345.59 ,$195.48 ,$353.27 ,$345.59 ,$253.47 ,$253.47 ,$233.85 ,$253.47 ,$249.59 ,$262.34 ,$87.42 ,$303.35 ,$112.00 ,$383.99 ,$383.99 ,$101.61 ,$383.99 ,$86.88 ,$364.79 ,$314.87 ,$314.87 ,$307.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000294,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V),320,1 ,$383.99 ,$253.43 ,$87.42 ,$383.99 ,$105.66 ,$105.73 ,$88.79 ,$101.61 ,$307.19 ,$326.39 ,$239.99 ,$345.59 ,$105.66 ,$105.66 ,$364.79 ,$345.59 ,$326.39 ,$326.39 ,$101.61 ,$326.39 ,$326.39 ,$345.59 ,$233.85 ,$105.66 ,$238.08 ,$112.00 ,$345.59 ,$240.48 ,$353.27 ,$345.59 ,$253.47 ,$253.47 ,$233.85 ,$253.47 ,$249.59 ,$262.34 ,$87.42 ,$303.35 ,$112.00 ,$383.99 ,$383.99 ,$101.61 ,$383.99 ,$106.88 ,$364.79 ,$314.87 ,$314.87 ,$307.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000297,74019,HC XRAY ABDOMEN AP  AND  LAT (2 V OR 3 V)FLAT,320,1 ,$383.99 ,$253.43 ,$87.42 ,$383.99 ,$105.66 ,$105.73 ,$88.79 ,$101.61 ,$307.19 ,$326.39 ,$239.99 ,$345.59 ,$105.66 ,$105.66 ,$364.79 ,$345.59 ,$326.39 ,$326.39 ,$101.61 ,$326.39 ,$326.39 ,$345.59 ,$233.85 ,$105.66 ,$238.08 ,$112.00 ,$345.59 ,$240.48 ,$353.27 ,$345.59 ,$253.47 ,$253.47 ,$233.85 ,$253.47 ,$249.59 ,$262.34 ,$87.42 ,$303.35 ,$112.00 ,$383.99 ,$383.99 ,$101.61 ,$383.99 ,$106.88 ,$364.79 ,$314.87 ,$314.87 ,$307.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,$545.88 ,$360.28 ,$105.66 ,$545.88 ,$105.66 ,$143.14 ,$116.38 ,$144.44 ,$436.70 ,$464.00 ,$341.18 ,$491.29 ,$105.66 ,$105.66 ,$518.59 ,$491.29 ,$464.00 ,$464.00 ,$144.44 ,$464.00 ,$464.00 ,$491.29 ,$332.44 ,$105.66 ,$338.44 ,$112.00 ,$491.29 ,$240.48 ,$502.21 ,$491.29 ,$360.34 ,$360.34 ,$332.44 ,$360.34 ,$354.82 ,$372.95 ,$124.27 ,$431.25 ,$112.00 ,$388.00 ,$388.00 ,$144.44 ,$436.00 ,$106.88 ,$518.59 ,$447.62 ,$447.62 ,$436.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$627.87 ,$414.39 ,$105.66 ,$627.87 ,$105.66 ,$298.31 ,$243.31 ,$166.13 ,$502.30 ,$533.69 ,$392.42 ,$565.08 ,$105.66 ,$105.66 ,$596.48 ,$565.08 ,$533.69 ,$533.69 ,$166.13 ,$533.69 ,$533.69 ,$565.08 ,$382.37 ,$105.66 ,$389.28 ,$112.00 ,$565.08 ,$405.77 ,$577.64 ,$565.08 ,$414.46 ,$414.46 ,$382.37 ,$414.46 ,$408.12 ,$428.96 ,$142.93 ,$496.02 ,$112.00 ,$388.00 ,$388.00 ,$166.13 ,$436.00 ,$180.34 ,$596.48 ,$514.85 ,$514.85 ,$502.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,$639.29 ,$421.93 ,$145.54 ,$639.29 ,$227.47 ,$434.08 ,$389.54 ,$169.16 ,$511.43 ,$543.40 ,$399.56 ,$575.36 ,$227.47 ,$227.47 ,$607.33 ,$575.36 ,$543.40 ,$543.40 ,$169.16 ,$543.40 ,$543.40 ,$575.36 ,$389.33 ,$227.47 ,$396.36 ,$241.12 ,$575.36 ,$405.77 ,$588.15 ,$575.36 ,$422.00 ,$422.00 ,$389.33 ,$422.00 ,$415.54 ,$436.76 ,$145.54 ,$505.04 ,$241.12 ,$388.00 ,$388.00 ,$169.16 ,$436.00 ,$180.34 ,$607.33 ,$524.22 ,$524.22 ,$511.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,$987.99 ,$652.07 ,$180.34 ,$987.99 ,$227.47 ,$420.23 ,$393.68 ,$261.42 ,$790.39 ,$839.79 ,$617.49 ,$889.19 ,$227.47 ,$227.47 ,$938.59 ,$889.19 ,$839.79 ,$839.79 ,$261.42 ,$839.79 ,$839.79 ,$889.19 ,$601.69 ,$227.47 ,$612.56 ,$241.12 ,$889.19 ,$405.77 ,$908.95 ,$889.19 ,$652.17 ,$652.17 ,$601.69 ,$652.17 ,$642.19 ,$674.99 ,$224.92 ,$780.51 ,$241.12 ,$388.00 ,$388.00 ,$261.42 ,$436.00 ,$180.34 ,$938.59 ,$810.15 ,$810.15 ,$790.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,$987.99 ,$652.07 ,$180.34 ,$987.99 ,$227.47 ,$420.23 ,$393.68 ,$261.42 ,$790.39 ,$839.79 ,$617.49 ,$889.19 ,$227.47 ,$227.47 ,$938.59 ,$889.19 ,$839.79 ,$839.79 ,$261.42 ,$839.79 ,$839.79 ,$889.19 ,$601.69 ,$227.47 ,$612.56 ,$241.12 ,$889.19 ,$405.77 ,$908.95 ,$889.19 ,$652.17 ,$652.17 ,$601.69 ,$652.17 ,$642.19 ,$674.99 ,$224.92 ,$780.51 ,$241.12 ,$388.00 ,$388.00 ,$261.42 ,$436.00 ,$180.34 ,$938.59 ,$810.15 ,$810.15 ,$790.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$744.11 ,$491.11 ,$169.40 ,$744.11 ,$227.47 ,$362.04 ,$345.39 ,$196.89 ,$595.29 ,$632.49 ,$465.07 ,$669.70 ,$227.47 ,$227.47 ,$706.90 ,$669.70 ,$632.49 ,$632.49 ,$196.89 ,$632.49 ,$632.49 ,$669.70 ,$453.16 ,$227.47 ,$461.34 ,$241.12 ,$669.70 ,$405.77 ,$684.58 ,$669.70 ,$491.19 ,$491.19 ,$453.16 ,$491.19 ,$483.67 ,$508.38 ,$169.40 ,$587.85 ,$241.12 ,$388.00 ,$388.00 ,$196.89 ,$436.00 ,$180.34 ,$706.90 ,$610.17 ,$610.17 ,$595.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000315,74270,HC XRAY COLON BARIUM,320,1 ,$790.81 ,$521.93 ,$180.04 ,$790.81 ,$227.47 ,$452.10 ,$490.25 ,$209.25 ,$632.65 ,$672.19 ,$494.26 ,$711.73 ,$227.47 ,$227.47 ,$751.27 ,$711.73 ,$672.19 ,$672.19 ,$209.25 ,$672.19 ,$672.19 ,$711.73 ,$481.60 ,$227.47 ,$490.30 ,$241.12 ,$711.73 ,$405.77 ,$727.55 ,$711.73 ,$522.01 ,$522.01 ,$481.60 ,$522.01 ,$514.03 ,$540.28 ,$180.04 ,$624.74 ,$241.12 ,$388.00 ,$388.00 ,$209.25 ,$436.00 ,$180.34 ,$751.27 ,$648.46 ,$648.46 ,$632.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,$790.81 ,$521.93 ,$180.04 ,$790.81 ,$227.47 ,$452.10 ,$490.25 ,$209.25 ,$632.65 ,$672.19 ,$494.26 ,$711.73 ,$227.47 ,$227.47 ,$751.27 ,$711.73 ,$672.19 ,$672.19 ,$209.25 ,$672.19 ,$672.19 ,$711.73 ,$481.60 ,$227.47 ,$490.30 ,$241.12 ,$711.73 ,$405.77 ,$727.55 ,$711.73 ,$522.01 ,$522.01 ,$481.60 ,$522.01 ,$514.03 ,$540.28 ,$180.04 ,$624.74 ,$241.12 ,$388.00 ,$388.00 ,$209.25 ,$436.00 ,$180.34 ,$751.27 ,$648.46 ,$648.46 ,$632.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,$802.22 ,$529.47 ,$95.95 ,$802.22 ,$374.53 ,$95.95 ,$129.42 ,$212.27 ,$641.78 ,$681.89 ,$501.39 ,$722.00 ,$374.53 ,$374.53 ,$762.11 ,$722.00 ,$681.89 ,$681.89 ,$212.27 ,$681.89 ,$681.89 ,$722.00 ,$488.55 ,$374.53 ,$497.38 ,$397.00 ,$722.00 , N/A ,$738.04 ,$722.00 ,$529.55 ,$529.55 ,$488.55 ,$529.55 ,$521.44 ,$548.08 ,$182.63 ,$633.75 ,$397.00 ,$388.00 ,$388.00 ,$212.27 ,$436.00 , N/A ,$762.11 ,$657.82 ,$657.82 ,$641.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000324,74301,HC CHOLANGIOGRAPHY OPERATIVE ADDL,320,1 ,$471.16 ,$310.97 ,$74.62 ,$471.16 ,$374.53 ,$74.74 ,$74.62 ,$124.67 ,$376.93 ,$400.49 ,$294.48 ,$424.04 ,$374.53 ,$374.53 ,$447.60 ,$424.04 ,$400.49 ,$400.49 ,$124.67 ,$400.49 ,$400.49 ,$424.04 ,$286.94 ,$374.53 ,$292.12 ,$397.00 ,$424.04 , N/A ,$433.47 ,$424.04 ,$311.01 ,$311.01 ,$286.94 ,$311.01 ,$306.25 ,$321.90 ,$107.26 ,$372.22 ,$397.00 ,$388.00 ,$388.00 ,$124.67 ,$436.00 , N/A ,$447.60 ,$386.35 ,$386.35 ,$376.93 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,$766.94 ,$506.18 ,$174.60 ,$828.97 ,$227.47 ,$216.57 ,$177.09 ,$202.93 ,$613.55 ,$651.90 ,$479.34 ,$690.25 ,$227.47 ,$227.47 ,$728.59 ,$690.25 ,$651.90 ,$651.90 ,$202.93 ,$651.90 ,$651.90 ,$690.25 ,$467.07 ,$227.47 ,$475.50 ,$241.12 ,$690.25 ,$828.97 ,$705.58 ,$690.25 ,$506.26 ,$506.26 ,$467.07 ,$506.26 ,$498.51 ,$523.97 ,$174.60 ,$605.88 ,$241.12 ,$388.00 ,$388.00 ,$202.93 ,$436.00 ,$368.43 ,$728.59 ,$628.89 ,$628.89 ,$613.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,$766.94 ,$506.18 ,$174.60 ,$828.97 ,$227.47 ,$478.42 ,$687.33 ,$202.93 ,$613.55 ,$651.90 ,$479.34 ,$690.25 ,$227.47 ,$227.47 ,$728.59 ,$690.25 ,$651.90 ,$651.90 ,$202.93 ,$651.90 ,$651.90 ,$690.25 ,$467.07 ,$227.47 ,$475.50 ,$241.12 ,$690.25 ,$828.97 ,$705.58 ,$690.25 ,$506.26 ,$506.26 ,$467.07 ,$506.26 ,$498.51 ,$523.97 ,$174.60 ,$605.88 ,$241.12 ,$388.00 ,$388.00 ,$202.93 ,$436.00 ,$368.43 ,$728.59 ,$628.89 ,$628.89 ,$613.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000342,74425,HC XR UROGRAM ANTE (LOOPOGRAM SVG),320,1 ,$766.94 ,$506.18 ,$174.60 ,$828.97 ,$227.47 ,$478.42 ,$687.33 ,$202.93 ,$613.55 ,$651.90 ,$479.34 ,$690.25 ,$227.47 ,$227.47 ,$728.59 ,$690.25 ,$651.90 ,$651.90 ,$202.93 ,$651.90 ,$651.90 ,$690.25 ,$467.07 ,$227.47 ,$475.50 ,$241.12 ,$690.25 ,$828.97 ,$705.58 ,$690.25 ,$506.26 ,$506.26 ,$467.07 ,$506.26 ,$498.51 ,$523.97 ,$174.60 ,$605.88 ,$241.12 ,$388.00 ,$388.00 ,$202.93 ,$436.00 ,$368.43 ,$728.59 ,$628.89 ,$628.89 ,$613.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,"$1,186.21 ",$782.90 ,$88.79 ,"$1,186.21 ",$227.47 ,$105.73 ,$88.79 ,$313.87 ,$948.97 ,"$1,008.28 ",$741.38 ,"$1,067.59 ",$227.47 ,$227.47 ,"$1,126.90 ","$1,067.59 ","$1,008.28 ","$1,008.28 ",$313.87 ,"$1,008.28 ","$1,008.28 ","$1,067.59 ",$722.40 ,$227.47 ,$735.46 ,$241.12 ,"$1,067.59 ",$828.97 ,"$1,091.31 ","$1,067.59 ",$783.02 ,$783.02 ,$722.40 ,$783.02 ,$771.04 ,$810.42 ,$270.05 ,$937.11 ,$241.12 ,$388.00 ,$388.00 ,$313.87 ,$436.00 ,$368.43 ,"$1,126.90 ",$972.69 ,$972.69 ,$948.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,$929.87 ,$613.71 ,$211.69 ,$929.87 ,$227.47 ,$377.28 ,$286.07 ,$246.04 ,$743.90 ,$790.39 ,$581.17 ,$836.88 ,$227.47 ,$227.47 ,$883.38 ,$836.88 ,$790.39 ,$790.39 ,$246.04 ,$790.39 ,$790.39 ,$836.88 ,$566.29 ,$227.47 ,$576.52 ,$241.12 ,$836.88 ,$525.42 ,$855.48 ,$836.88 ,$613.81 ,$613.81 ,$566.29 ,$613.81 ,$604.42 ,$635.29 ,$211.69 ,$734.60 ,$241.12 ,$388.00 ,$388.00 ,$246.04 ,$436.00 ,$233.52 ,$883.38 ,$762.49 ,$762.49 ,$743.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,$778.35 ,$513.71 ,$177.19 ,$778.35 ,$227.47 ,$331.56 ,$244.69 ,$205.95 ,$622.68 ,$661.60 ,$486.47 ,$700.52 ,$227.47 ,$227.47 ,$739.43 ,$700.52 ,$661.60 ,$661.60 ,$205.95 ,$661.60 ,$661.60 ,$700.52 ,$474.02 ,$227.47 ,$482.58 ,$241.12 ,$700.52 ,$525.42 ,$716.08 ,$700.52 ,$513.79 ,$513.79 ,$474.02 ,$513.79 ,$505.93 ,$531.77 ,$177.19 ,$614.90 ,$241.12 ,$388.00 ,$388.00 ,$205.95 ,$436.00 ,$233.52 ,$739.43 ,$638.25 ,$638.25 ,$622.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$1,495.00 ",$986.70 ,$340.34 ,"$3,373.99 ","$1,387.23 ","$1,339.82 ","$1,339.82 ",$395.58 ,"$1,196.00 ","$1,270.75 ",$934.38 ,"$1,345.50 ","$1,387.23 ","$1,387.23 ","$1,420.25 ","$1,345.50 ","$1,270.75 ","$1,270.75 ",$395.58 ,"$1,270.75 ","$1,270.75 ","$1,345.50 ",$910.46 ,"$1,387.23 ",$926.90 ,"$1,470.46 ","$1,345.50 ","$3,373.99 ","$1,375.40 ","$1,345.50 ",$986.85 ,$986.85 ,$910.46 ,$986.85 ,$971.75 ,"$1,021.38 ",$340.34 ,"$1,181.05 ","$1,470.46 ",$388.00 ,$388.00 ,$395.58 ,$436.00 ,"$1,499.55 ","$1,420.25 ","$1,225.90 ","$1,225.90 ","$1,196.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$1,511.04 ",$997.29 ,$243.31 ,"$1,511.04 ",$374.53 ,$245.66 ,$243.31 ,$399.82 ,"$1,208.83 ","$1,284.38 ",$944.40 ,"$1,359.94 ",$374.53 ,$374.53 ,"$1,435.49 ","$1,359.94 ","$1,284.38 ","$1,284.38 ",$399.82 ,"$1,284.38 ","$1,284.38 ","$1,359.94 ",$920.22 ,$374.53 ,$936.84 ,$397.00 ,"$1,359.94 ", N/A ,"$1,390.16 ","$1,359.94 ",$997.44 ,$997.44 ,$920.22 ,$997.44 ,$982.18 ,"$1,032.34 ",$344.00 ,"$1,193.72 ",$397.00 ,$388.00 ,$388.00 ,$399.82 ,$436.00 , N/A ,"$1,435.49 ","$1,239.05 ","$1,239.05 ","$1,208.83 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$644.00 ,$425.04 ,$114.04 ,$644.00 ,$227.47 ,$114.04 ,$121.90 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$227.47 ,$227.47 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$227.47 ,$399.28 ,$241.12 ,$579.60 ,$525.42 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$241.12 ,$388.00 ,$388.00 ,$170.40 ,$436.00 ,$233.52 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000452,N/A,HC FLUORO  OARM/CARM <1 HR OR,360,1 ,"$1,046.22 ",$690.51 ,$238.18 ,"$1,046.22 ", N/A ,$937.62 ,$937.62 ,$276.83 ,$836.98 ,$889.29 ,$653.89 ,$941.60 , N/A , N/A ,$993.91 ,$941.60 ,$889.29 ,$889.29 ,$276.83 ,$889.29 ,$889.29 ,$941.60 ,$637.15 , N/A ,$648.66 , N/A ,$941.60 , N/A ,$962.52 ,$941.60 ,$690.61 ,$690.61 ,$637.15 ,$690.61 ,$680.04 ,$714.78 ,$238.18 ,$826.51 , N/A , N/A , N/A ,$276.83 , N/A , N/A ,$993.91 ,$857.90 ,$857.90 ,$836.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000456,N/A,HC CARM FLUORO > 1 HR OR,360,1 ,"$1,113.00 ",$734.58 ,$253.38 ,"$1,113.00 ", N/A ,$997.47 ,$997.47 ,$294.50 ,$890.40 ,$946.05 ,$695.63 ,"$1,001.70 ", N/A , N/A ,"$1,057.35 ","$1,001.70 ",$946.05 ,$946.05 ,$294.50 ,$946.05 ,$946.05 ,"$1,001.70 ",$677.82 , N/A ,$690.06 , N/A ,"$1,001.70 ", N/A ,"$1,023.96 ","$1,001.70 ",$734.69 ,$734.69 ,$677.82 ,$734.69 ,$723.45 ,$760.40 ,$253.38 ,$879.27 , N/A , N/A , N/A ,$294.50 , N/A , N/A ,"$1,057.35 ",$912.66 ,$912.66 ,$890.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,$755.52 ,$498.64 ,$119.14 ,"$1,132.04 ",$227.47 ,$147.29 ,$119.14 ,$199.91 ,$604.42 ,$642.19 ,$472.20 ,$679.97 ,$227.47 ,$227.47 ,$717.74 ,$679.97 ,$642.19 ,$642.19 ,$199.91 ,$642.19 ,$642.19 ,$679.97 ,$460.11 ,$227.47 ,$468.42 ,$241.12 ,$679.97 ,"$1,132.04 ",$695.08 ,$679.97 ,$498.72 ,$498.72 ,$460.11 ,$498.72 ,$491.09 ,$516.17 ,$172.00 ,$596.86 ,$241.12 ,$388.00 ,$388.00 ,$199.91 ,$436.00 ,$503.13 ,$717.74 ,$619.53 ,$619.53 ,$604.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000466,76080,HC ABSCESS FISTULA DRAINAGE CATH CHECK,320,1 ,$755.52 ,$498.64 ,$119.14 ,"$1,132.04 ",$227.47 ,$147.29 ,$119.14 ,$199.91 ,$604.42 ,$642.19 ,$472.20 ,$679.97 ,$227.47 ,$227.47 ,$717.74 ,$679.97 ,$642.19 ,$642.19 ,$199.91 ,$642.19 ,$642.19 ,$679.97 ,$460.11 ,$227.47 ,$468.42 ,$241.12 ,$679.97 ,"$1,132.04 ",$695.08 ,$679.97 ,$498.72 ,$498.72 ,$460.11 ,$498.72 ,$491.09 ,$516.17 ,$172.00 ,$596.86 ,$241.12 ,$388.00 ,$388.00 ,$199.91 ,$436.00 ,$503.13 ,$717.74 ,$619.53 ,$619.53 ,$604.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$579.60 ,$382.54 ,$131.95 ,$579.60 ,$374.53 ,$350.96 ,$277.80 ,$153.36 ,$463.68 ,$492.66 ,$362.25 ,$521.64 ,$374.53 ,$374.53 ,$550.62 ,$521.64 ,$492.66 ,$492.66 ,$153.36 ,$492.66 ,$492.66 ,$521.64 ,$352.98 ,$374.53 ,$359.36 ,$397.00 ,$521.64 , N/A ,$533.23 ,$521.64 ,$382.59 ,$382.59 ,$352.98 ,$382.59 ,$376.74 ,$395.98 ,$131.95 ,$457.88 ,$397.00 ,$388.00 ,$388.00 ,$153.36 ,$436.00 , N/A ,$550.62 ,$475.27 ,$475.27 ,$463.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$644.00 ,$425.04 ,$146.61 ,$644.00 ,$374.53 ,$371.74 ,$284.69 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$374.53 ,$374.53 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$374.53 ,$399.28 ,$397.00 ,$579.60 , N/A ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$397.00 ,$388.00 ,$388.00 ,$170.40 ,$436.00 , N/A ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000479,77002,HC FLUORO NEEDLE PLACEMENT HIP,320,1 ,$644.00 ,$425.04 ,$146.61 ,$644.00 ,$374.53 ,$371.74 ,$284.69 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$374.53 ,$374.53 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$374.53 ,$399.28 ,$397.00 ,$579.60 , N/A ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$397.00 ,$388.00 ,$388.00 ,$170.40 ,$436.00 , N/A ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,$708.40 ,$467.54 ,$161.27 ,$708.40 ,$374.53 ,$319.09 ,$262.62 ,$187.44 ,$566.72 ,$602.14 ,$442.75 ,$637.56 ,$374.53 ,$374.53 ,$672.98 ,$637.56 ,$602.14 ,$602.14 ,$187.44 ,$602.14 ,$602.14 ,$637.56 ,$431.42 ,$374.53 ,$439.20 ,$397.00 ,$637.56 , N/A ,$651.73 ,$637.56 ,$467.61 ,$467.61 ,$431.42 ,$467.61 ,$460.46 ,$483.98 ,$161.27 ,$559.64 ,$397.00 ,$388.00 ,$388.00 ,$187.44 ,$436.00 , N/A ,$672.98 ,$580.89 ,$580.89 ,$566.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$851.00 ,$561.66 ,$193.74 ,"$3,373.99 ","$2,533.69 ",$762.67 ,$762.67 ,$225.17 ,$680.80 ,$723.35 ,$531.88 ,$765.90 ,"$2,533.69 ",$851.00 ,$808.45 ,$765.90 ,$723.35 ,$723.35 ,$225.17 ,$723.35 ,$723.35 ,$765.90 ,$518.26 ,"$2,533.69 ",$527.62 ,$902.06 ,$765.90 ,"$3,373.99 ",$782.92 ,$765.90 ,$561.75 ,$561.75 ,$518.26 ,$561.75 ,$553.15 ,$581.40 ,$193.74 ,$672.29 ,"$2,685.71 ",$388.00 ,$388.00 ,$225.17 ,$436.00 ,"$1,499.55 ",$808.45 ,$697.82 ,$697.82 ,$680.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$486.91 ,$321.36 ,$88.79 ,$486.91 ,$105.66 ,$132.05 ,$88.79 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000493,77074,HC BONE SURVEY LIMITED,320,1 ,$486.91 ,$321.36 ,$105.66 ,$486.91 ,$105.66 ,$183.32 ,$172.95 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,$641.79 ,$423.58 ,$106.88 ,$641.79 ,$227.47 ,$302.47 ,$251.58 ,$169.81 ,$513.43 ,$545.52 ,$401.12 ,$577.61 ,$227.47 ,$227.47 ,$609.70 ,$577.61 ,$545.52 ,$545.52 ,$169.81 ,$545.52 ,$545.52 ,$577.61 ,$390.85 ,$227.47 ,$397.90 ,$241.12 ,$577.61 ,$240.48 ,$590.45 ,$577.61 ,$423.65 ,$423.65 ,$390.85 ,$423.65 ,$417.16 ,$438.47 ,$146.11 ,$507.01 ,$241.12 ,$388.00 ,$388.00 ,$169.81 ,$436.00 ,$106.88 ,$609.70 ,$526.27 ,$526.27 ,$513.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000496,77080,HC BONE DENSITY DXA,320,1 ,$736.20 ,$485.89 ,$106.88 ,$736.20 ,$149.42 ,$112.66 ,$116.38 ,$194.79 ,$588.96 ,$625.77 ,$460.13 ,$662.58 ,$149.42 ,$149.42 ,$699.39 ,$662.58 ,$625.77 ,$625.77 ,$194.79 ,$625.77 ,$625.77 ,$662.58 ,$448.35 ,$149.42 ,$456.44 ,$158.39 ,$662.58 ,$240.48 ,$677.30 ,$662.58 ,$485.97 ,$485.97 ,$448.35 ,$485.97 ,$478.53 ,$502.97 ,$167.60 ,$581.60 ,$158.39 ,$388.00 ,$388.00 ,$194.79 ,$436.00 ,$106.88 ,$699.39 ,$603.68 ,$603.68 ,$588.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$676.80 ,$446.69 ,$86.33 ,$676.80 ,$149.42 ,$86.33 ,$88.79 ,$179.09 ,$541.44 ,$575.28 ,$423.00 ,$609.12 ,$149.42 ,$149.42 ,$642.96 ,$609.12 ,$575.28 ,$575.28 ,$179.09 ,$575.28 ,$575.28 ,$609.12 ,$412.17 ,$149.42 ,$419.62 ,$158.39 ,$609.12 ,$195.48 ,$622.66 ,$609.12 ,$446.76 ,$446.76 ,$412.17 ,$446.76 ,$439.92 ,$462.39 ,$154.08 ,$534.67 ,$158.39 ,$388.00 ,$388.00 ,$179.09 ,$436.00 ,$86.88 ,$642.96 ,$554.98 ,$554.98 ,$541.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$644.00 ,$425.04 ,$114.04 ,$644.00 ,$227.47 ,$114.04 ,$121.90 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$227.47 ,$227.47 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$227.47 ,$399.28 ,$241.12 ,$579.60 ,$525.42 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$241.12 ,$388.00 ,$388.00 ,$170.40 ,$436.00 ,$233.52 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$446.20 ,$294.49 ,$101.59 ,$611.75 ,$463.61 ,$399.88 ,$399.88 ,$118.06 ,$356.96 ,$379.27 ,$278.88 ,$401.58 ,$463.61 ,$446.20 ,$423.89 ,$401.58 ,$379.27 ,$379.27 ,$118.06 ,$379.27 ,$379.27 ,$401.58 ,$271.74 ,$463.61 ,$276.64 ,$472.97 ,$401.58 ,$611.75 ,$410.50 ,$401.58 ,$294.54 ,$294.54 ,$271.74 ,$294.54 ,$290.03 ,$304.84 ,$101.59 ,$352.50 ,$491.43 ,$388.00 ,$388.00 ,$118.06 ,$436.00 ,$271.89 ,$423.89 ,$365.88 ,$365.88 ,$356.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000509,77072,HC BONE AGE STUDIES,320,1 ,$630.12 ,$415.88 ,$55.68 ,$630.12 ,$105.66 ,$69.71 ,$55.68 ,$166.73 ,$504.10 ,$535.60 ,$393.83 ,$567.11 ,$105.66 ,$105.66 ,$598.61 ,$567.11 ,$535.60 ,$535.60 ,$166.73 ,$535.60 ,$535.60 ,$567.11 ,$383.74 ,$105.66 ,$390.68 ,$112.00 ,$567.11 ,$240.48 ,$579.71 ,$567.11 ,$415.94 ,$415.94 ,$383.74 ,$415.94 ,$409.58 ,$430.50 ,$143.45 ,$497.79 ,$112.00 ,$388.00 ,$388.00 ,$166.73 ,$436.00 ,$106.88 ,$598.61 ,$516.70 ,$516.70 ,$504.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000523,72020,HC XR SPINE 1V (C SPINE CLEAR LAT),320,1 ,$415.84 ,$274.45 ,$58.44 ,$415.84 ,$105.66 ,$68.32 ,$58.44 ,$110.03 ,$332.67 ,$353.46 ,$259.90 ,$374.26 ,$105.66 ,$105.66 ,$395.05 ,$374.26 ,$353.46 ,$353.46 ,$110.03 ,$353.46 ,$353.46 ,$374.26 ,$253.25 ,$105.66 ,$257.82 ,$112.00 ,$374.26 ,$195.48 ,$382.57 ,$374.26 ,$274.50 ,$274.50 ,$253.25 ,$274.50 ,$270.30 ,$284.10 ,$94.67 ,$328.51 ,$112.00 ,$388.00 ,$388.00 ,$110.03 ,$415.84 ,$86.88 ,$395.05 ,$340.99 ,$340.99 ,$332.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000525,N/A,HC CARM FLUORO <1 HR OR,360,1 ,"$1,046.22 ",$690.51 ,$238.18 ,"$1,046.22 ", N/A ,$937.62 ,$937.62 ,$276.83 ,$836.98 ,$889.29 ,$653.89 ,$941.60 , N/A , N/A ,$993.91 ,$941.60 ,$889.29 ,$889.29 ,$276.83 ,$889.29 ,$889.29 ,$941.60 ,$637.15 , N/A ,$648.66 , N/A ,$941.60 , N/A ,$962.52 ,$941.60 ,$690.61 ,$690.61 ,$637.15 ,$690.61 ,$680.04 ,$714.78 ,$238.18 ,$826.51 , N/A , N/A , N/A ,$276.83 , N/A , N/A ,$993.91 ,$857.90 ,$857.90 ,$836.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$1,955.73 ","$1,845.03 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$1,845.03 ","$1,362.75 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$1,845.03 ",$844.90 ,"$1,444.52 ","$1,226.48 ","$1,301.63 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$1,955.73 ",$388.00 ,$388.00 ,$360.58 ,$436.00 ,$578.50 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,955.73 ","$1,845.03 ","$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ","$1,845.03 ","$1,486.95 ","$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,"$1,845.03 ",$921.90 ,"$1,576.17 ","$1,338.26 ","$1,301.63 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ","$1,955.73 ",$388.00 ,$388.00 ,$393.45 ,$436.00 ,$578.50 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$122.36 ,$97.07 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$102.59 ,$102.59 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$392.50 ,$259.05 ,$89.36 ,$392.50 ,$105.66 ,$188.12 ,$188.12 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$240.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$106.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$392.50 ,$259.05 ,$81.90 ,$392.50 ,$105.66 ,$81.90 ,$81.90 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$439.18 ,$289.86 ,$86.88 ,$439.18 ,$105.66 ,$121.90 ,$121.90 ,$116.21 ,$351.34 ,$373.30 ,$274.49 ,$395.26 ,$105.66 ,$105.66 ,$417.22 ,$395.26 ,$373.30 ,$373.30 ,$116.21 ,$373.30 ,$373.30 ,$395.26 ,$267.46 ,$105.66 ,$272.30 ,$112.00 ,$395.26 ,$195.48 ,$404.05 ,$395.26 ,$289.90 ,$289.90 ,$267.46 ,$289.90 ,$285.47 ,$300.05 ,$99.98 ,$346.95 ,$112.00 ,$388.00 ,$388.00 ,$116.21 ,$436.00 ,$86.88 ,$417.22 ,$360.13 ,$360.13 ,$351.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$486.91 ,$321.36 ,$105.66 ,$486.91 ,$105.66 ,$152.25 ,$152.25 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$486.91 ,$321.36 ,$103.97 ,$486.91 ,$105.66 ,$103.97 ,$103.97 ,$128.84 ,$389.53 ,$413.87 ,$304.32 ,$438.22 ,$105.66 ,$105.66 ,$462.56 ,$438.22 ,$413.87 ,$413.87 ,$128.84 ,$413.87 ,$413.87 ,$438.22 ,$296.53 ,$105.66 ,$301.88 ,$112.00 ,$438.22 ,$240.48 ,$447.96 ,$438.22 ,$321.41 ,$321.41 ,$296.53 ,$321.41 ,$316.49 ,$332.66 ,$110.85 ,$384.66 ,$112.00 ,$388.00 ,$388.00 ,$128.84 ,$436.00 ,$106.88 ,$462.56 ,$399.27 ,$399.27 ,$389.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$534.65 ,$352.87 ,$105.66 ,$534.65 ,$105.66 ,$134.32 ,$134.32 ,$141.47 ,$427.72 ,$454.45 ,$334.16 ,$481.19 ,$105.66 ,$105.66 ,$507.92 ,$481.19 ,$454.45 ,$454.45 ,$141.47 ,$454.45 ,$454.45 ,$481.19 ,$325.60 ,$105.66 ,$331.48 ,$112.00 ,$481.19 ,$240.48 ,$491.88 ,$481.19 ,$352.92 ,$352.92 ,$325.60 ,$352.92 ,$347.52 ,$365.27 ,$121.72 ,$422.37 ,$112.00 ,$388.00 ,$388.00 ,$141.47 ,$436.00 ,$106.88 ,$507.92 ,$438.41 ,$438.41 ,$427.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$582.39 ,$384.38 ,$105.66 ,$582.39 ,$105.66 ,$163.29 ,$163.29 ,$154.10 ,$465.91 ,$495.03 ,$363.99 ,$524.15 ,$105.66 ,$105.66 ,$553.27 ,$524.15 ,$495.03 ,$495.03 ,$154.10 ,$495.03 ,$495.03 ,$524.15 ,$354.68 ,$105.66 ,$361.08 ,$112.00 ,$524.15 ,$240.48 ,$535.80 ,$524.15 ,$384.44 ,$384.44 ,$354.68 ,$384.44 ,$378.55 ,$397.89 ,$132.58 ,$460.09 ,$112.00 ,$388.00 ,$388.00 ,$154.10 ,$436.00 ,$106.88 ,$553.27 ,$477.56 ,$477.56 ,$465.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$392.50 ,$259.05 ,$76.38 ,$392.50 ,$105.66 ,$76.38 ,$76.38 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$392.50 ,$259.05 ,$86.88 ,$392.50 ,$105.66 ,$92.93 ,$92.93 ,$103.86 ,$314.00 ,$333.63 ,$245.31 ,$353.25 ,$105.66 ,$105.66 ,$372.88 ,$353.25 ,$333.63 ,$333.63 ,$103.86 ,$333.63 ,$333.63 ,$353.25 ,$239.03 ,$105.66 ,$243.36 ,$112.00 ,$353.25 ,$195.48 ,$361.10 ,$353.25 ,$259.09 ,$259.09 ,$239.03 ,$259.09 ,$255.13 ,$268.16 ,$89.36 ,$310.08 ,$112.00 ,$388.00 ,$388.00 ,$103.86 ,$392.50 ,$86.88 ,$372.88 ,$321.85 ,$321.85 ,$314.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),32000586,72265,HC XR MYELOGRAPHY L-SPINE,320,1 ,"$2,467.90 ","$1,628.81 ",$218.47 ,"$2,467.90 ","$1,091.77 ",$291.38 ,$218.47 ,$653.00 ,"$1,974.32 ","$2,097.72 ","$1,542.44 ","$2,221.11 ","$1,091.77 ","$1,091.77 ","$2,344.51 ","$2,221.11 ","$2,097.72 ","$2,097.72 ",$653.00 ,"$2,097.72 ","$2,097.72 ","$2,221.11 ","$1,502.95 ","$1,091.77 ","$1,530.10 ","$1,157.28 ","$2,221.11 ","$1,666.69 ","$2,270.47 ","$2,221.11 ","$1,629.06 ","$1,629.06 ","$1,502.95 ","$1,629.06 ","$1,604.14 ","$1,686.07 ",$561.83 ,"$1,949.64 ","$1,157.28 ",$388.00 ,$388.00 ,$653.00 ,$436.00 ,$740.75 ,"$2,344.51 ","$2,023.68 ","$2,023.68 ","$1,974.32 "
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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , 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 ,$662.53 ,$437.27 ,$86.98 ,$662.53 ,$86.98 ,$593.76 ,$593.76 ,$175.30 ,$530.02 ,$563.15 ,$414.08 ,$596.28 ,$86.98 ,$86.98 ,$629.40 ,$596.28 ,$563.15 ,$563.15 ,$175.30 ,$563.15 ,$563.15 ,$596.28 ,$403.48 ,$86.98 ,$410.76 ,$92.20 ,$596.28 ,$464.78 ,$609.53 ,$596.28 ,$437.34 ,$437.34 ,$403.48 ,$437.34 ,$430.64 ,$452.64 ,$150.82 ,$523.40 ,$92.20 ,$589.00 ,$589.00 ,$175.30 ,$662.53 ,$206.57 ,$629.40 ,$543.27 ,$543.27 ,$530.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$380.00 ,$250.80 ,$67.47 ,$380.00 ,$86.98 ,$340.56 ,$340.56 ,$100.55 ,$304.00 ,$323.00 ,$237.50 ,$342.00 ,$86.98 ,$86.98 ,$361.00 ,$342.00 ,$323.00 ,$323.00 ,$100.55 ,$323.00 ,$323.00 ,$342.00 ,$231.42 ,$86.98 ,$235.60 ,$92.20 ,$342.00 ,$151.81 ,$349.60 ,$342.00 ,$250.84 ,$250.84 ,$231.42 ,$250.84 ,$247.00 ,$259.62 ,$86.50 ,$300.20 ,$92.20 ,$380.00 ,$380.00 ,$100.55 ,$380.00 ,$67.47 ,$361.00 ,$311.60 ,$311.60 ,$304.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,"$1,018.44 ",$672.17 ,$231.85 ,"$1,018.44 ",$550.17 ,$912.73 ,$912.73 ,$269.48 ,$814.75 ,$865.67 ,$636.53 ,$916.60 ,$550.17 ,$550.17 ,$967.52 ,$916.60 ,$865.67 ,$865.67 ,$269.48 ,$865.67 ,$865.67 ,$916.60 ,$620.23 ,$550.17 ,$631.44 ,$583.18 ,$916.60 ,$748.40 ,$936.96 ,$916.60 ,$672.27 ,$672.27 ,$620.23 ,$672.27 ,$661.99 ,$695.80 ,$231.85 ,$804.57 ,$583.18 ,$589.00 ,$589.00 ,$269.48 ,$670.00 ,$332.62 ,$967.52 ,$835.12 ,$835.12 ,$814.75 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$257.35 ,$169.85 ,$58.58 ,"$1,019.60 ",$961.89 ,$230.64 ,$230.64 ,$68.09 ,$205.88 ,$218.75 ,$160.84 ,$231.62 ,$961.89 ,$257.35 ,$244.48 ,$231.62 ,$218.75 ,$218.75 ,$68.09 ,$218.75 ,$218.75 ,$231.62 ,$156.73 ,$961.89 ,$159.56 ,$272.79 ,$231.62 ,$151.81 ,$236.76 ,$231.62 ,$169.88 ,$169.88 ,$156.73 ,$169.88 ,$167.28 ,$175.82 ,$58.58 ,$203.31 ,"$1,019.60 ",$257.35 ,$257.35 ,$68.09 ,$257.35 ,$67.47 ,$244.48 ,$211.03 ,$211.03 ,$205.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$367.95 ,$242.85 ,$67.47 ,$583.18 ,$550.17 ,$329.76 ,$329.76 ,$97.36 ,$294.36 ,$312.76 ,$229.97 ,$331.16 ,$550.17 ,$367.95 ,$349.55 ,$331.16 ,$312.76 ,$312.76 ,$97.36 ,$312.76 ,$312.76 ,$331.16 ,$224.08 ,$550.17 ,$228.12 ,$390.03 ,$331.16 ,$151.81 ,$338.51 ,$331.16 ,$242.88 ,$242.88 ,$224.08 ,$242.88 ,$239.17 ,$251.38 ,$83.77 ,$290.68 ,$583.18 ,$367.95 ,$367.95 ,$97.36 ,$367.95 ,$67.47 ,$349.55 ,$301.72 ,$301.72 ,$294.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000002,78012,HC THYROID UPTAKE SGL/MULT 78012,340,1 ,$512.00 ,$337.92 ,$116.56 ,$874.53 ,$710.41 ,$291.30 ,$283.81 ,$135.48 ,$409.60 ,$435.20 ,$320.00 ,$460.80 ,$710.41 ,$512.00 ,$486.40 ,$460.80 ,$435.20 ,$435.20 ,$135.48 ,$435.20 ,$435.20 ,$460.80 ,$311.81 ,$710.41 ,$317.44 ,$542.72 ,$460.80 ,$874.53 ,$471.04 ,$460.80 ,$337.97 ,$337.97 ,$311.81 ,$337.97 ,$332.80 ,$349.80 ,$116.56 ,$404.48 ,$753.03 ,$512.00 ,$512.00 ,$135.48 ,$512.00 ,$388.68 ,$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 ","$1,035.54 ",$357.19 ,"$1,569.00 ",$710.41 ,$835.79 ,$859.60 ,$415.16 ,"$1,255.20 ","$1,333.65 ",$980.63 ,"$1,412.10 ",$710.41 ,$710.41 ,"$1,490.55 ","$1,412.10 ","$1,333.65 ","$1,333.65 ",$415.16 ,"$1,333.65 ","$1,333.65 ","$1,412.10 ",$955.52 ,$710.41 ,$972.78 ,$753.03 ,"$1,412.10 ",$874.53 ,"$1,443.48 ","$1,412.10 ","$1,035.70 ","$1,035.70 ",$955.52 ,"$1,035.70 ","$1,019.85 ","$1,071.94 ",$357.19 ,"$1,239.51 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$415.16 ,"$1,508.00 ",$388.68 ,"$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 ,$656.04 ,$226.29 ,$994.00 ,$710.41 ,$687.54 ,$689.91 ,$263.01 ,$795.20 ,$844.90 ,$621.25 ,$894.60 ,$710.41 ,$710.41 ,$944.30 ,$894.60 ,$844.90 ,$844.90 ,$263.01 ,$844.90 ,$844.90 ,$894.60 ,$605.35 ,$710.41 ,$616.28 ,$753.03 ,$894.60 ,$874.53 ,$914.48 ,$894.60 ,$656.14 ,$656.14 ,$605.35 ,$656.14 ,$646.10 ,$679.10 ,$226.29 ,$785.26 ,$753.03 ,$994.00 ,$994.00 ,$263.01 ,$994.00 ,$388.68 ,$944.30 ,$815.08 ,$815.08 ,$795.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000009,78070,HC PARATHRYOID IMAGING 78070,340,1 ,"$1,673.00 ","$1,104.18 ",$380.87 ,"$1,892.80 ","$1,785.66 ",$992.34 ,"$1,032.04 ",$442.68 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ","$1,785.66 ","$1,673.00 ","$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$442.68 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ","$1,018.86 ","$1,785.66 ","$1,037.26 ","$1,773.38 ","$1,505.70 ",$874.53 ,"$1,539.16 ","$1,505.70 ","$1,104.35 ","$1,104.35 ","$1,018.86 ","$1,104.35 ","$1,087.45 ","$1,142.99 ",$380.87 ,"$1,321.67 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$442.68 ,"$1,508.00 ",$388.68 ,"$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 ","$1,380.72 ",$476.25 ,"$2,092.00 ","$1,785.66 ","$1,156.26 ","$1,182.92 ",$553.54 ,"$1,673.60 ","$1,778.20 ","$1,307.50 ","$1,882.80 ","$1,785.66 ","$1,785.66 ","$1,987.40 ","$1,882.80 ","$1,778.20 ","$1,778.20 ",$553.54 ,"$1,778.20 ","$1,778.20 ","$1,882.80 ","$1,274.03 ","$1,785.66 ","$1,297.04 ","$1,892.80 ","$1,882.80 ","$1,135.13 ","$1,924.64 ","$1,882.80 ","$1,380.93 ","$1,380.93 ","$1,274.03 ","$1,380.93 ","$1,359.80 ","$1,429.25 ",$476.25 ,"$1,652.68 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$553.54 ,"$1,508.00 ",$504.50 ,"$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 ",$759.00 ,$261.81 ,"$1,892.80 ","$1,785.66 ",$662.61 ,$671.97 ,$304.29 ,$920.00 ,$977.50 ,$718.75 ,"$1,035.00 ","$1,785.66 ","$1,150.00 ","$1,092.50 ","$1,035.00 ",$977.50 ,$977.50 ,$304.29 ,$977.50 ,$977.50 ,"$1,035.00 ",$700.35 ,"$1,785.66 ",$713.00 ,"$1,219.00 ","$1,035.00 ","$1,135.13 ","$1,058.00 ","$1,035.00 ",$759.12 ,$759.12 ,$700.35 ,$759.12 ,$747.50 ,$785.68 ,$261.81 ,$908.50 ,"$1,892.80 ","$1,150.00 ","$1,150.00 ",$304.29 ,"$1,150.00 ",$504.50 ,"$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 ",$690.36 ,$238.13 ,"$1,892.80 ","$1,785.66 ",$730.49 ,$707.84 ,$276.77 ,$836.80 ,$889.10 ,$653.75 ,$941.40 ,"$1,785.66 ","$1,046.00 ",$993.70 ,$941.40 ,$889.10 ,$889.10 ,$276.77 ,$889.10 ,$889.10 ,$941.40 ,$637.01 ,"$1,785.66 ",$648.52 ,"$1,108.76 ",$941.40 ,"$1,135.13 ",$962.32 ,$941.40 ,$690.46 ,$690.46 ,$637.01 ,$690.46 ,$679.90 ,$714.63 ,$238.13 ,$826.34 ,"$1,892.80 ","$1,046.00 ","$1,046.00 ",$276.77 ,"$1,046.00 ",$504.50 ,$993.70 ,$857.72 ,$857.72 ,$836.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,"$1,360.00 ",$897.60 ,$309.61 ,"$1,892.80 ","$1,785.66 ",$673.69 ,$676.11 ,$359.86 ,"$1,088.00 ","$1,156.00 ",$850.00 ,"$1,224.00 ","$1,785.66 ","$1,360.00 ","$1,292.00 ","$1,224.00 ","$1,156.00 ","$1,156.00 ",$359.86 ,"$1,156.00 ","$1,156.00 ","$1,224.00 ",$828.24 ,"$1,785.66 ",$843.20 ,"$1,441.60 ","$1,224.00 ",$874.53 ,"$1,251.20 ","$1,224.00 ",$897.74 ,$897.74 ,$828.24 ,$897.74 ,$884.00 ,$929.15 ,$309.61 ,"$1,074.40 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$359.86 ,"$1,360.00 ",$388.68 ,"$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 ","$1,173.48 ",$388.68 ,"$1,892.80 ","$1,785.66 ",$415.99 ,$397.44 ,$470.46 ,"$1,422.40 ","$1,511.30 ","$1,111.25 ","$1,600.20 ","$1,785.66 ","$1,778.00 ","$1,689.10 ","$1,600.20 ","$1,511.30 ","$1,511.30 ",$470.46 ,"$1,511.30 ","$1,511.30 ","$1,600.20 ","$1,082.80 ","$1,785.66 ","$1,102.36 ","$1,884.68 ","$1,600.20 ",$874.53 ,"$1,635.76 ","$1,600.20 ","$1,173.66 ","$1,173.66 ","$1,082.80 ","$1,173.66 ","$1,155.70 ","$1,214.73 ",$404.77 ,"$1,404.62 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$470.46 ,"$1,508.00 ",$388.68 ,"$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 ","$1,173.48 ",$388.68 ,"$1,892.80 ","$1,785.66 ",$415.99 ,$397.44 ,$470.46 ,"$1,422.40 ","$1,511.30 ","$1,111.25 ","$1,600.20 ","$1,785.66 ","$1,778.00 ","$1,689.10 ","$1,600.20 ","$1,511.30 ","$1,511.30 ",$470.46 ,"$1,511.30 ","$1,511.30 ","$1,600.20 ","$1,082.80 ","$1,785.66 ","$1,102.36 ","$1,884.68 ","$1,600.20 ",$874.53 ,"$1,635.76 ","$1,600.20 ","$1,173.66 ","$1,173.66 ","$1,082.80 ","$1,173.66 ","$1,155.70 ","$1,214.73 ",$404.77 ,"$1,404.62 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$470.46 ,"$1,508.00 ",$388.68 ,"$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 ","$1,380.72 ",$388.68 ,"$2,092.00 ",$710.41 ,"$1,128.56 ","$1,166.36 ",$553.54 ,"$1,673.60 ","$1,778.20 ","$1,307.50 ","$1,882.80 ",$710.41 ,$710.41 ,"$1,987.40 ","$1,882.80 ","$1,778.20 ","$1,778.20 ",$553.54 ,"$1,778.20 ","$1,778.20 ","$1,882.80 ","$1,274.03 ",$710.41 ,"$1,297.04 ",$753.03 ,"$1,882.80 ",$874.53 ,"$1,924.64 ","$1,882.80 ","$1,380.93 ","$1,380.93 ","$1,274.03 ","$1,380.93 ","$1,359.80 ","$1,429.25 ",$476.25 ,"$1,652.68 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$553.54 ,"$1,508.00 ",$388.68 ,"$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 ","$1,104.18 ",$380.87 ,"$1,673.00 ",$710.41 ,"$1,139.64 ","$1,176.02 ",$442.68 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ",$710.41 ,$710.41 ,"$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$442.68 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ","$1,018.86 ",$710.41 ,"$1,037.26 ",$753.03 ,"$1,505.70 ",$874.53 ,"$1,539.16 ","$1,505.70 ","$1,104.35 ","$1,104.35 ","$1,018.86 ","$1,104.35 ","$1,087.45 ","$1,142.99 ",$380.87 ,"$1,321.67 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$442.68 ,"$1,508.00 ",$388.68 ,"$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 ","$1,173.48 ",$388.68 ,"$1,778.00 ",$710.41 ,"$1,157.65 ","$1,180.16 ",$470.46 ,"$1,422.40 ","$1,511.30 ","$1,111.25 ","$1,600.20 ",$710.41 ,$710.41 ,"$1,689.10 ","$1,600.20 ","$1,511.30 ","$1,511.30 ",$470.46 ,"$1,511.30 ","$1,511.30 ","$1,600.20 ","$1,082.80 ",$710.41 ,"$1,102.36 ",$753.03 ,"$1,600.20 ",$874.53 ,"$1,635.76 ","$1,600.20 ","$1,173.66 ","$1,173.66 ","$1,082.80 ","$1,173.66 ","$1,155.70 ","$1,214.73 ",$404.77 ,"$1,404.62 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$470.46 ,"$1,508.00 ",$388.68 ,"$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 ","$1,311.42 ",$388.68 ,"$1,987.00 ",$710.41 ,$995.12 ,"$1,033.42 ",$525.76 ,"$1,589.60 ","$1,688.95 ","$1,241.88 ","$1,788.30 ",$710.41 ,$710.41 ,"$1,887.65 ","$1,788.30 ","$1,688.95 ","$1,688.95 ",$525.76 ,"$1,688.95 ","$1,688.95 ","$1,788.30 ","$1,210.08 ",$710.41 ,"$1,231.94 ",$753.03 ,"$1,788.30 ",$874.53 ,"$1,828.04 ","$1,788.30 ","$1,311.62 ","$1,311.62 ","$1,210.08 ","$1,311.62 ","$1,291.55 ","$1,357.52 ",$452.35 ,"$1,569.73 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$525.76 ,"$1,508.00 ",$388.68 ,"$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 ","$1,449.36 ",$388.68 ,"$2,196.00 ",$710.41 ,"$1,157.65 ","$1,177.40 ",$581.06 ,"$1,756.80 ","$1,866.60 ","$1,372.50 ","$1,976.40 ",$710.41 ,$710.41 ,"$2,086.20 ","$1,976.40 ","$1,866.60 ","$1,866.60 ",$581.06 ,"$1,866.60 ","$1,866.60 ","$1,976.40 ","$1,337.36 ",$710.41 ,"$1,361.52 ",$753.03 ,"$1,976.40 ",$874.53 ,"$2,020.32 ","$1,976.40 ","$1,449.58 ","$1,449.58 ","$1,337.36 ","$1,449.58 ","$1,427.40 ","$1,500.31 ",$499.93 ,"$1,734.84 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$581.06 ,"$1,508.00 ",$388.68 ,"$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 ","$2,899.38 ","$1,000.08 ","$4,393.00 ","$1,785.66 ","$1,066.21 ","$1,080.83 ","$1,162.39 ","$3,514.40 ","$3,734.05 ","$2,745.63 ","$3,953.70 ","$1,785.66 ","$1,785.66 ","$4,173.35 ","$3,953.70 ","$3,734.05 ","$3,734.05 ","$1,162.39 ","$3,734.05 ","$3,734.05 ","$3,953.70 ","$2,675.34 ","$1,785.66 ","$2,723.66 ","$1,892.80 ","$3,953.70 ","$2,986.36 ","$4,041.56 ","$3,953.70 ","$2,899.82 ","$2,899.82 ","$2,675.34 ","$2,899.82 ","$2,855.45 ","$3,001.30 ","$1,000.08 ","$3,470.47 ","$1,892.80 ","$1,330.00 ","$1,330.00 ","$1,162.39 ","$1,508.00 ","$1,327.27 ","$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 ","$2,899.38 ","$1,000.08 ","$4,393.00 ","$1,785.66 ","$1,066.21 ","$1,080.83 ","$1,162.39 ","$3,514.40 ","$3,734.05 ","$2,745.63 ","$3,953.70 ","$1,785.66 ","$1,785.66 ","$4,173.35 ","$3,953.70 ","$3,734.05 ","$3,734.05 ","$1,162.39 ","$3,734.05 ","$3,734.05 ","$3,953.70 ","$2,675.34 ","$1,785.66 ","$2,723.66 ","$1,892.80 ","$3,953.70 ","$2,986.36 ","$4,041.56 ","$3,953.70 ","$2,899.82 ","$2,899.82 ","$2,675.34 ","$2,899.82 ","$2,855.45 ","$3,001.30 ","$1,000.08 ","$3,470.47 ","$1,892.80 ","$1,330.00 ","$1,330.00 ","$1,162.39 ","$1,508.00 ","$1,327.27 ","$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 ","$3,175.26 ","$1,095.25 ","$4,811.00 ","$1,785.66 ","$1,539.96 ","$1,561.92 ","$1,272.99 ","$3,848.80 ","$4,089.35 ","$3,006.88 ","$4,329.90 ","$1,785.66 ","$1,785.66 ","$4,570.45 ","$4,329.90 ","$4,089.35 ","$4,089.35 ","$1,272.99 ","$4,089.35 ","$4,089.35 ","$4,329.90 ","$2,929.90 ","$1,785.66 ","$2,982.82 ","$1,892.80 ","$4,329.90 ","$2,986.36 ","$4,426.12 ","$4,329.90 ","$3,175.74 ","$3,175.74 ","$2,929.90 ","$3,175.74 ","$3,127.15 ","$3,286.88 ","$1,095.25 ","$3,800.69 ","$1,892.80 ","$1,330.00 ","$1,330.00 ","$1,272.99 ","$1,508.00 ","$1,327.27 ","$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 ","$3,175.26 ","$1,095.25 ","$4,811.00 ","$1,785.66 ","$1,539.96 ","$1,561.92 ","$1,272.99 ","$3,848.80 ","$4,089.35 ","$3,006.88 ","$4,329.90 ","$1,785.66 ","$1,785.66 ","$4,570.45 ","$4,329.90 ","$4,089.35 ","$4,089.35 ","$1,272.99 ","$4,089.35 ","$4,089.35 ","$4,329.90 ","$2,929.90 ","$1,785.66 ","$2,982.82 ","$1,892.80 ","$4,329.90 ","$2,986.36 ","$4,426.12 ","$4,329.90 ","$3,175.74 ","$3,175.74 ","$2,929.90 ","$3,175.74 ","$3,127.15 ","$3,286.88 ","$1,095.25 ","$3,800.69 ","$1,892.80 ","$1,330.00 ","$1,330.00 ","$1,272.99 ","$1,508.00 ","$1,327.27 ","$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 ","$1,449.36 ",$388.68 ,"$2,196.00 ",$710.41 ,$705.55 ,$717.50 ,$581.06 ,"$1,756.80 ","$1,866.60 ","$1,372.50 ","$1,976.40 ",$710.41 ,$710.41 ,"$2,086.20 ","$1,976.40 ","$1,866.60 ","$1,866.60 ",$581.06 ,"$1,866.60 ","$1,866.60 ","$1,976.40 ","$1,337.36 ",$710.41 ,"$1,361.52 ",$753.03 ,"$1,976.40 ",$874.53 ,"$2,020.32 ","$1,976.40 ","$1,449.58 ","$1,449.58 ","$1,337.36 ","$1,449.58 ","$1,427.40 ","$1,500.31 ",$499.93 ,"$1,734.84 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$581.06 ,"$1,508.00 ",$388.68 ,"$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 ","$1,518.66 ",$388.68 ,"$2,301.00 ",$710.41 ,$855.18 ,$866.50 ,$608.84 ,"$1,840.80 ","$1,955.85 ","$1,438.13 ","$2,070.90 ",$710.41 ,$710.41 ,"$2,185.95 ","$2,070.90 ","$1,955.85 ","$1,955.85 ",$608.84 ,"$1,955.85 ","$1,955.85 ","$2,070.90 ","$1,401.31 ",$710.41 ,"$1,426.62 ",$753.03 ,"$2,070.90 ",$874.53 ,"$2,116.92 ","$2,070.90 ","$1,518.89 ","$1,518.89 ","$1,401.31 ","$1,518.89 ","$1,495.65 ","$1,572.04 ",$523.83 ,"$1,817.79 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$608.84 ,"$1,508.00 ",$388.68 ,"$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 ","$1,035.54 ",$357.19 ,"$1,892.80 ","$1,785.66 ",$781.75 ,$801.66 ,$415.16 ,"$1,255.20 ","$1,333.65 ",$980.63 ,"$1,412.10 ","$1,785.66 ","$1,569.00 ","$1,490.55 ","$1,412.10 ","$1,333.65 ","$1,333.65 ",$415.16 ,"$1,333.65 ","$1,333.65 ","$1,412.10 ",$955.52 ,"$1,785.66 ",$972.78 ,"$1,663.14 ","$1,412.10 ",$874.53 ,"$1,443.48 ","$1,412.10 ","$1,035.70 ","$1,035.70 ",$955.52 ,"$1,035.70 ","$1,019.85 ","$1,071.94 ",$357.19 ,"$1,239.51 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$415.16 ,"$1,508.00 ",$388.68 ,"$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 ","$1,104.18 ",$380.87 ,"$1,892.80 ","$1,785.66 ","$1,095.30 ","$1,119.46 ",$442.68 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ","$1,785.66 ","$1,673.00 ","$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$442.68 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ","$1,018.86 ","$1,785.66 ","$1,037.26 ","$1,773.38 ","$1,505.70 ","$1,135.13 ","$1,539.16 ","$1,505.70 ","$1,104.35 ","$1,104.35 ","$1,018.86 ","$1,104.35 ","$1,087.45 ","$1,142.99 ",$380.87 ,"$1,321.67 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$442.68 ,"$1,508.00 ",$504.50 ,"$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 ","$1,104.18 ",$380.87 ,"$1,673.00 ",$710.41 ,$770.67 ,$765.79 ,$442.68 ,"$1,338.40 ","$1,422.05 ","$1,045.63 ","$1,505.70 ",$710.41 ,$710.41 ,"$1,589.35 ","$1,505.70 ","$1,422.05 ","$1,422.05 ",$442.68 ,"$1,422.05 ","$1,422.05 ","$1,505.70 ","$1,018.86 ",$710.41 ,"$1,037.26 ",$753.03 ,"$1,505.70 ",$874.53 ,"$1,539.16 ","$1,505.70 ","$1,104.35 ","$1,104.35 ","$1,018.86 ","$1,104.35 ","$1,087.45 ","$1,142.99 ",$380.87 ,"$1,321.67 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$442.68 ,"$1,508.00 ",$388.68 ,"$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 ","$1,587.30 ",$504.50 ,"$2,405.00 ",$710.41 ,$727.72 ,$738.19 ,$636.36 ,"$1,924.00 ","$2,044.25 ","$1,503.13 ","$2,164.50 ",$710.41 ,$710.41 ,"$2,284.75 ","$2,164.50 ","$2,044.25 ","$2,044.25 ",$636.36 ,"$2,044.25 ","$2,044.25 ","$2,164.50 ","$1,464.65 ",$710.41 ,"$1,491.10 ",$753.03 ,"$2,164.50 ","$1,135.13 ","$2,212.60 ","$2,164.50 ","$1,587.54 ","$1,587.54 ","$1,464.65 ","$1,587.54 ","$1,563.25 ","$1,643.10 ",$547.51 ,"$1,899.95 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$636.36 ,"$1,508.00 ",$504.50 ,"$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 ","$1,587.30 ",$466.92 ,"$2,405.00 ",$710.41 ,$482.93 ,$466.92 ,$636.36 ,"$1,924.00 ","$2,044.25 ","$1,503.13 ","$2,164.50 ",$710.41 ,$710.41 ,"$2,284.75 ","$2,164.50 ","$2,044.25 ","$2,044.25 ",$636.36 ,"$2,044.25 ","$2,044.25 ","$2,164.50 ","$1,464.65 ",$710.41 ,"$1,491.10 ",$753.03 ,"$2,164.50 ","$1,135.13 ","$2,212.60 ","$2,164.50 ","$1,587.54 ","$1,587.54 ","$1,464.65 ","$1,587.54 ","$1,563.25 ","$1,643.10 ",$547.51 ,"$1,899.95 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$636.36 ,"$1,508.00 ",$504.50 ,"$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 ","$1,587.30 ",$504.50 ,"$2,405.00 ",$710.41 ,"$1,177.05 ","$1,191.20 ",$636.36 ,"$1,924.00 ","$2,044.25 ","$1,503.13 ","$2,164.50 ",$710.41 ,$710.41 ,"$2,284.75 ","$2,164.50 ","$2,044.25 ","$2,044.25 ",$636.36 ,"$2,044.25 ","$2,044.25 ","$2,164.50 ","$1,464.65 ",$710.41 ,"$1,491.10 ",$753.03 ,"$2,164.50 ","$1,135.13 ","$2,212.60 ","$2,164.50 ","$1,587.54 ","$1,587.54 ","$1,464.65 ","$1,587.54 ","$1,563.25 ","$1,643.10 ",$547.51 ,"$1,899.95 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$636.36 ,"$1,508.00 ",$504.50 ,"$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 ","$2,195.16 ",$757.18 ,"$3,326.00 ","$1,785.66 ","$1,296.20 ","$1,145.67 ",$880.06 ,"$2,660.80 ","$2,827.10 ","$2,078.75 ","$2,993.40 ","$1,785.66 ","$1,785.66 ","$3,159.70 ","$2,993.40 ","$2,827.10 ","$2,827.10 ",$880.06 ,"$2,827.10 ","$2,827.10 ","$2,993.40 ","$2,025.53 ","$1,785.66 ","$2,062.12 ","$1,892.80 ","$2,993.40 ","$2,986.36 ","$3,059.92 ","$2,993.40 ","$2,195.49 ","$2,195.49 ","$2,025.53 ","$2,195.49 ","$2,161.90 ","$2,272.32 ",$757.18 ,"$2,627.54 ","$1,892.80 ","$1,330.00 ","$1,330.00 ",$880.06 ,"$1,508.00 ","$1,327.27 ","$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 ","$1,449.36 ",$499.93 ,"$2,196.00 ",$710.41 ,"$1,536.75 ","$1,595.91 ",$581.06 ,"$1,756.80 ","$1,866.60 ","$1,372.50 ","$1,976.40 ",$710.41 ,$710.41 ,"$2,086.20 ","$1,976.40 ","$1,866.60 ","$1,866.60 ",$581.06 ,"$1,866.60 ","$1,866.60 ","$1,976.40 ","$1,337.36 ",$710.41 ,"$1,361.52 ",$753.03 ,"$1,976.40 ","$1,135.13 ","$2,020.32 ","$1,976.40 ","$1,449.58 ","$1,449.58 ","$1,337.36 ","$1,449.58 ","$1,427.40 ","$1,500.31 ",$499.93 ,"$1,734.84 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$581.06 ,"$1,508.00 ",$504.50 ,"$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 ","$1,518.66 ",$388.68 ,"$2,301.00 ",$710.41 ,"$1,139.64 ","$1,182.92 ",$608.84 ,"$1,840.80 ","$1,955.85 ","$1,438.13 ","$2,070.90 ",$710.41 ,$710.41 ,"$2,185.95 ","$2,070.90 ","$1,955.85 ","$1,955.85 ",$608.84 ,"$1,955.85 ","$1,955.85 ","$2,070.90 ","$1,401.31 ",$710.41 ,"$1,426.62 ",$753.03 ,"$2,070.90 ",$874.53 ,"$2,116.92 ","$2,070.90 ","$1,518.89 ","$1,518.89 ","$1,401.31 ","$1,518.89 ","$1,495.65 ","$1,572.04 ",$523.83 ,"$1,817.79 ",$753.03 ,"$1,330.00 ","$1,330.00 ",$608.84 ,"$1,508.00 ",$388.68 ,"$2,185.95 ","$1,886.82 ","$1,886.82 ","$1,840.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34100020,0042T,HC CT CEREBRAL PERFUSION W/BLOOD FLOW,351,1 ,"$2,100.00 ","$1,386.00 ",$2.23 ,"$2,100.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$2.23 ,"$1,680.00 ","$1,785.00 ","$1,312.50 ","$1,890.00 ",$602.32 ,$602.32 ,"$1,995.00 ","$1,890.00 ","$1,785.00 ","$1,785.00 ",$2.23 ,"$1,785.00 ","$1,785.00 ","$1,890.00 ","$1,278.90 ",$602.32 ,$4.47 ,$638.46 ,"$1,890.00 ", N/A ,"$1,932.00 ","$1,890.00 ","$1,386.21 ","$1,386.21 ","$1,278.90 ","$1,386.21 ","$1,365.00 ","$1,434.72 ",$2.46 ,"$1,659.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$2.23 ,"$1,730.00 ", N/A ,"$1,995.00 ","$1,722.00 ","$1,722.00 ","$1,680.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$522.10 ,$344.59 ,$118.85 ,$522.10 , N/A ,$467.91 ,$467.91 ,$138.15 ,$417.68 ,$443.79 , N/A ,$469.89 , N/A , N/A ,$496.00 ,$469.89 ,$443.79 ,$443.79 ,$138.15 ,$443.79 ,$443.79 ,$469.89 ,$317.96 , N/A ,$323.70 , N/A ,$469.89 , N/A ,$480.33 ,$469.89 ,$344.64 ,$344.64 ,$317.96 ,$344.64 ,$339.37 ,$356.70 ,$118.85 ,$412.46 , N/A ,$255.83 ,$255.83 ,$138.15 ,$255.83 , N/A ,$496.00 ,$428.12 ,$428.12 ,$417.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$186.30 ,$122.96 ,$42.41 ,$186.30 , N/A ,$166.96 ,$166.96 ,$49.29 ,$149.04 ,$158.36 , N/A ,$167.67 , N/A , N/A ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 , N/A ,$115.50 , N/A ,$167.67 , N/A ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 , N/A ,$91.29 ,$91.29 ,$49.29 ,$91.29 , N/A ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$96.60 ,$63.76 ,$21.99 ,$96.60 , N/A ,$86.57 ,$86.57 ,$25.56 ,$77.28 ,$82.11 , N/A ,$86.94 , N/A , N/A ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 , N/A ,$59.90 , N/A ,$86.94 , N/A ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 , N/A ,$47.33 ,$47.33 ,$25.56 ,$47.33 , N/A ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$232.30 ,$153.32 ,$52.88 ,$232.30 , N/A ,$208.19 ,$208.19 ,$61.47 ,$185.84 ,$197.46 , N/A ,$209.07 , N/A , N/A ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 , N/A ,$144.02 , N/A ,$209.07 , N/A ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 , N/A ,$113.83 ,$113.83 ,$61.47 ,$113.83 , N/A ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$200.10 ,$132.07 ,$45.55 ,$200.10 , N/A ,$179.33 ,$179.33 ,$52.95 ,$160.08 ,$170.09 , N/A ,$180.09 , N/A , N/A ,$190.10 ,$180.09 ,$170.09 ,$170.09 ,$52.95 ,$170.09 ,$170.09 ,$180.09 ,$121.86 , N/A ,$124.06 , N/A ,$180.09 , N/A ,$184.09 ,$180.09 ,$132.09 ,$132.09 ,$121.86 ,$132.09 ,$130.07 ,$136.71 ,$45.55 ,$158.08 , N/A ,$98.05 ,$98.05 ,$52.95 ,$98.05 , N/A ,$190.10 ,$164.08 ,$164.08 ,$160.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$811.90 ,$535.85 ,$184.84 ,$811.90 , N/A ,$727.62 ,$727.62 ,$214.83 ,$649.52 ,$690.12 , N/A ,$730.71 , N/A , N/A ,$771.31 ,$730.71 ,$690.12 ,$690.12 ,$214.83 ,$690.12 ,$690.12 ,$730.71 ,$494.45 , N/A ,$503.38 , N/A ,$730.71 , N/A ,$746.95 ,$730.71 ,$535.94 ,$535.94 ,$494.45 ,$535.94 ,$527.74 ,$554.69 ,$184.84 ,$641.40 , N/A ,$397.83 ,$397.83 ,$214.83 ,$397.83 , N/A ,$771.31 ,$665.76 ,$665.76 ,$649.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$309.35 ,$204.17 ,$70.42 ,$309.35 , N/A ,$277.24 ,$277.24 ,$81.85 ,$247.48 ,$262.95 , N/A ,$278.42 , N/A , N/A ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 , N/A ,$191.80 , N/A ,$278.42 , N/A ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 , N/A ,$151.58 ,$151.58 ,$81.85 ,$151.58 , N/A ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300024,A9547,HC DIAGNUCLIDE IN OXINE .5 MCI,343,1 ,"$3,348.80 ","$2,210.21 ",$762.36 ,"$3,348.80 ", N/A ,"$3,001.19 ","$3,001.19 ",$886.10 ,"$2,679.04 ","$2,846.48 ", N/A ,"$3,013.92 ", N/A , N/A ,"$3,181.36 ","$3,013.92 ","$2,846.48 ","$2,846.48 ",$886.10 ,"$2,846.48 ","$2,846.48 ","$3,013.92 ","$2,039.42 ", N/A ,"$2,076.26 ", N/A ,"$3,013.92 ", N/A ,"$3,080.90 ","$3,013.92 ","$2,210.54 ","$2,210.54 ","$2,039.42 ","$2,210.54 ","$2,176.72 ","$2,287.90 ",$762.36 ,"$2,645.55 ", N/A ,"$1,640.91 ","$1,640.91 ",$886.10 ,"$1,640.91 ", N/A ,"$3,181.36 ","$2,746.02 ","$2,746.02 ","$2,679.04 "
ST. CLARE MEMORIAL HOSPITAL (ACU),34300035,A9560,HC TC99M GI BLD MUGA UP TO 30MCI,343,1 ,$399.05 ,$263.37 ,$90.85 ,$399.05 , N/A ,$357.63 ,$357.63 ,$105.59 ,$319.24 ,$339.19 , N/A ,$359.15 , N/A , N/A ,$379.10 ,$359.15 ,$339.19 ,$339.19 ,$105.59 ,$339.19 ,$339.19 ,$359.15 ,$243.02 , N/A ,$247.42 , N/A ,$359.15 , N/A ,$367.13 ,$359.15 ,$263.41 ,$263.41 ,$243.02 ,$263.41 ,$259.38 ,$272.63 ,$90.85 ,$315.25 , N/A ,$195.53 ,$195.53 ,$105.59 ,$195.53 , N/A ,$379.10 ,$327.22 ,$327.22 ,$319.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$399.05 ,$263.37 ,$90.85 ,$399.05 , N/A ,$357.63 ,$357.63 ,$105.59 ,$319.24 ,$339.19 , N/A ,$359.15 , N/A , N/A ,$379.10 ,$359.15 ,$339.19 ,$339.19 ,$105.59 ,$339.19 ,$339.19 ,$359.15 ,$243.02 , N/A ,$247.42 , N/A ,$359.15 , N/A ,$367.13 ,$359.15 ,$263.41 ,$263.41 ,$243.02 ,$263.41 ,$259.38 ,$272.63 ,$90.85 ,$315.25 , N/A ,$195.53 ,$195.53 ,$105.59 ,$195.53 , N/A ,$379.10 ,$327.22 ,$327.22 ,$319.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300037,A9562,HC DIAG NUCLDE MAG 3 PER DOSE,343,1 ,"$1,133.90 ",$748.37 ,$258.14 ,"$1,133.90 ", N/A ,"$1,016.20 ","$1,016.20 ",$300.03 ,$907.12 ,$963.82 , N/A ,"$1,020.51 ", N/A , N/A ,"$1,077.21 ","$1,020.51 ",$963.82 ,$963.82 ,$300.03 ,$963.82 ,$963.82 ,"$1,020.51 ",$690.55 , N/A ,$703.02 , N/A ,"$1,020.51 ", N/A ,"$1,043.19 ","$1,020.51 ",$748.49 ,$748.49 ,$690.55 ,$748.49 ,$737.04 ,$774.68 ,$258.14 ,$895.78 , N/A ,$555.61 ,$555.61 ,$300.03 ,$555.61 , N/A ,"$1,077.21 ",$929.80 ,$929.80 ,$907.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$272.00 ,$179.52 ,$61.93 ,$272.00 ,$99.20 ,$261.63 ,$174.42 ,$71.97 ,$217.60 ,$231.20 ,$170.00 ,$244.80 ,$99.20 ,$99.20 ,$258.40 ,$244.80 ,$231.20 ,$231.20 ,$71.97 ,$231.20 ,$231.20 ,$244.80 ,$165.65 ,$99.20 ,$168.64 ,$105.15 ,$244.80 , N/A ,$250.24 ,$244.80 ,$179.55 ,$179.55 ,$165.65 ,$179.55 ,$176.80 ,$185.83 ,$61.93 ,$214.88 ,$105.15 ,$133.28 ,$133.28 ,$71.97 ,$133.28 , N/A ,$258.40 ,$223.04 ,$223.04 ,$217.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300052,A9539,HC DIAGNUCLIDE DTPA AEROSOL,343,1 ,$200.10 ,$132.07 ,$45.55 ,$200.10 , N/A ,$179.33 ,$179.33 ,$52.95 ,$160.08 ,$170.09 , N/A ,$180.09 , N/A , N/A ,$190.10 ,$180.09 ,$170.09 ,$170.09 ,$52.95 ,$170.09 ,$170.09 ,$180.09 ,$121.86 , N/A ,$124.06 , N/A ,$180.09 , N/A ,$184.09 ,$180.09 ,$132.09 ,$132.09 ,$121.86 ,$132.09 ,$130.07 ,$136.71 ,$45.55 ,$158.08 , N/A ,$98.05 ,$98.05 ,$52.95 ,$98.05 , N/A ,$190.10 ,$164.08 ,$164.08 ,$160.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300066,Q9969,HC TC-99M NON-HUE ADD-ON PER STUDY DOSE,343,1 ,$12.88 ,$8.50 ,$2.93 ,$22.50 , N/A ,$11.54 ,$11.54 ,$3.41 ,$10.30 ,$10.95 , N/A ,$11.59 , N/A , N/A ,$12.24 ,$11.59 ,$10.95 ,$10.95 ,$3.41 ,$10.95 ,$10.95 ,$11.59 ,$7.84 , N/A ,$7.98 , N/A ,$11.59 ,$22.50 ,$11.85 ,$11.59 ,$8.50 ,$8.50 ,$7.84 ,$8.50 ,$8.37 ,$8.80 ,$2.93 ,$10.18 , N/A ,$6.31 ,$6.31 ,$3.41 ,$6.31 ,$10.00 ,$12.24 ,$10.56 ,$10.56 ,$10.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),34300071,A9592,HC COPPER CU-64 DOTATATE DIAGNOSTIC 1 MILLICURIE,343,1 ,"$2,850.00 ","$1,881.00 ",$648.82 ,"$2,850.00 ", N/A ,"$2,554.17 ","$2,554.17 ",$754.11 ,"$2,280.00 ","$2,422.50 ","$1,781.25 ","$2,565.00 ", N/A , N/A ,"$2,707.50 ","$2,565.00 ","$2,422.50 ","$2,422.50 ",$754.11 ,"$2,422.50 ","$2,422.50 ","$2,565.00 ","$1,735.65 ", N/A ,"$1,767.00 ", N/A ,"$2,565.00 ","$2,183.89 ","$2,622.00 ","$2,565.00 ","$1,881.29 ","$1,881.29 ","$1,735.65 ","$1,881.29 ","$1,852.50 ","$1,947.12 ",$648.82 ,"$2,251.50 ", N/A ,"$1,396.50 ","$1,396.50 ",$754.11 ,"$1,396.50 ",$970.62 ,"$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 ","$1,042.14 ",$359.46 ,"$1,579.00 ",$850.00 ,"$1,415.10 ","$1,415.10 ",$417.80 ,"$1,263.20 ","$1,342.15 ",$986.88 ,"$1,421.10 ",$850.00 ,$850.00 ,"$1,500.05 ","$1,421.10 ","$1,342.15 ","$1,342.15 ",$417.80 ,"$1,342.15 ","$1,342.15 ","$1,421.10 ",$961.61 ,$850.00 ,$978.98 ,$901.00 ,"$1,421.10 ","$1,305.79 ","$1,452.68 ","$1,421.10 ","$1,042.30 ","$1,042.30 ",$961.61 ,"$1,042.30 ","$1,026.35 ","$1,078.77 ",$359.46 ,"$1,247.41 ",$901.00 ,$773.71 ,$773.71 ,$417.80 ,$773.71 ,$580.35 ,"$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 ,"$1,982.60 ","$1,308.52 ",$451.35 ,"$3,373.99 ","$1,387.23 ","$1,196.00 ","$1,196.00 ",$524.59 ,"$1,586.08 ","$1,685.21 ","$1,239.13 ","$1,784.34 ","$1,387.23 ","$1,387.23 ","$1,883.47 ","$1,784.34 ","$1,685.21 ","$1,685.21 ",$524.59 ,"$1,685.21 ","$1,685.21 ","$1,784.34 ","$1,207.40 ","$1,387.23 ","$1,229.22 ","$1,470.46 ","$1,784.34 ","$3,373.99 ","$1,823.99 ","$1,784.34 ","$1,308.71 ","$1,308.71 ","$1,207.40 ","$1,308.71 ","$1,288.69 ","$1,354.51 ",$451.35 ,"$1,566.25 ","$1,470.46 ","$1,512.00 ","$1,512.00 ",$524.59 ,"$1,730.00 ","$1,499.55 ","$1,883.47 ","$1,625.73 ","$1,625.73 ","$1,586.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$1,734.20 ","$1,144.57 ",$394.80 ,"$3,373.99 ","$1,387.23 ","$1,196.00 ","$1,196.00 ",$458.87 ,"$1,387.36 ","$1,474.07 ","$1,083.88 ","$1,560.78 ","$1,387.23 ","$1,387.23 ","$1,647.49 ","$1,560.78 ","$1,474.07 ","$1,474.07 ",$458.87 ,"$1,474.07 ","$1,474.07 ","$1,560.78 ","$1,056.13 ","$1,387.23 ","$1,075.20 ","$1,470.46 ","$1,560.78 ","$3,373.99 ","$1,595.46 ","$1,560.78 ","$1,144.75 ","$1,144.75 ","$1,056.13 ","$1,144.75 ","$1,127.23 ","$1,184.81 ",$394.80 ,"$1,370.02 ","$1,470.46 ","$1,512.00 ","$1,512.00 ",$458.87 ,"$1,730.00 ","$1,499.55 ","$1,647.49 ","$1,422.04 ","$1,422.04 ","$1,387.36 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,"$1,090.20 ",$719.53 ,$248.19 ,"$1,460.18 ","$1,290.13 ","$1,090.20 ","$1,090.20 ",$288.46 ,$872.16 ,$926.67 ,$681.38 ,$981.18 ,"$1,290.13 ","$1,090.20 ","$1,035.69 ",$981.18 ,$926.67 ,$926.67 ,$288.46 ,$926.67 ,$926.67 ,$981.18 ,$663.93 ,"$1,290.13 ",$675.92 ,"$1,155.61 ",$981.18 ,"$1,460.18 ","$1,002.98 ",$981.18 ,$719.64 ,$719.64 ,$663.93 ,$719.64 ,$708.63 ,$744.82 ,$248.19 ,$861.26 ,"$1,367.54 ","$1,090.20 ","$1,090.20 ",$288.46 ,"$1,090.20 ",$648.97 ,"$1,035.69 ",$893.96 ,$893.96 ,$872.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000031,64425,HC INJ ANESTH; ILIOINGUINAL NERVE,350,1 ,$742.90 ,$490.31 ,$169.13 ,"$1,449.77 ",$766.50 ,$742.90 ,$742.90 ,$196.57 ,$594.32 ,$631.47 ,$464.31 ,$668.61 ,$766.50 ,$742.90 ,$705.76 ,$668.61 ,$631.47 ,$631.47 ,$196.57 ,$631.47 ,$631.47 ,$668.61 ,$452.43 ,$766.50 ,$460.60 ,$787.47 ,$668.61 ,"$1,449.77 ",$683.47 ,$668.61 ,$490.39 ,$490.39 ,$452.43 ,$490.39 ,$482.89 ,$507.55 ,$169.13 ,$586.89 ,$812.49 ,$742.90 ,$742.90 ,$196.57 ,$742.90 ,$644.34 ,$705.76 ,$609.18 ,$609.18 ,$594.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$602.32 ,$602.32 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$602.32 ,"$1,116.00 ",$638.46 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,584.00 ",$180.34 ,"$2,400.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$635.04 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$602.32 ,$602.32 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$635.04 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ","$1,461.60 ",$602.32 ,"$1,488.00 ",$638.46 ,"$2,160.00 ",$405.77 ,"$2,208.00 ","$2,160.00 ","$1,584.24 ","$1,584.24 ","$1,461.60 ","$1,584.24 ","$1,560.00 ","$1,639.68 ",$546.37 ,"$1,896.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$635.04 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ,"$3,362.80 ","$2,219.45 ",$233.52 ,"$3,362.80 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$473.03 ,$473.03 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$473.03 ,"$2,084.94 ",$501.41 ,"$3,026.52 ",$525.42 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$233.52 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$1,800.00 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$368.43 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$828.97 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$368.43 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$368.43 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$828.97 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$368.43 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$2,090.00 ","$1,804.00 ","$1,804.00 ","$1,760.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$2,600.00 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$2,470.00 ","$2,132.00 ","$2,132.00 ","$2,080.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$1,800.00 ","$1,188.00 ",$227.67 ,"$1,800.00 ",$328.94 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$328.94 ,$328.94 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$328.94 ,"$1,116.00 ",$348.68 ,"$1,620.00 ",$512.26 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$348.68 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$227.67 ,"$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 ","$1,188.00 ",$227.67 ,"$1,800.00 ",$328.94 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$328.94 ,$328.94 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$328.94 ,"$1,116.00 ",$348.68 ,"$1,620.00 ",$512.26 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$348.68 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$227.67 ,"$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 ","$1,452.00 ",$434.16 ,"$2,200.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$903.49 ,$903.49 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$903.49 ,"$1,364.00 ",$957.70 ,"$1,980.00 ",$976.86 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$434.16 ,"$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 ","$1,452.00 ",$434.16 ,"$2,200.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$903.49 ,$903.49 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$903.49 ,"$1,364.00 ",$957.70 ,"$1,980.00 ",$976.86 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$434.16 ,"$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 ","$1,584.00 ",$434.16 ,"$2,400.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$635.04 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$903.49 ,$903.49 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$635.04 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ","$1,461.60 ",$903.49 ,"$1,488.00 ",$957.70 ,"$2,160.00 ",$976.86 ,"$2,208.00 ","$2,160.00 ","$1,584.24 ","$1,584.24 ","$1,461.60 ","$1,584.24 ","$1,560.00 ","$1,639.68 ",$546.37 ,"$1,896.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$635.04 ,"$1,730.00 ",$434.16 ,"$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 ","$1,584.00 ",$434.16 ,"$2,400.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$635.04 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$903.49 ,$903.49 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$635.04 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ","$1,461.60 ",$903.49 ,"$1,488.00 ",$957.70 ,"$2,160.00 ",$976.86 ,"$2,208.00 ","$2,160.00 ","$1,584.24 ","$1,584.24 ","$1,461.60 ","$1,584.24 ","$1,560.00 ","$1,639.68 ",$546.37 ,"$1,896.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$635.04 ,"$1,730.00 ",$434.16 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$227.67 ,"$1,800.00 ",$328.94 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$328.94 ,$328.94 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$328.94 ,"$1,116.00 ",$348.68 ,"$1,620.00 ",$512.26 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$348.68 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$227.67 ,"$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 ","$1,188.00 ",$227.67 ,"$1,800.00 ",$328.94 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$328.94 ,$328.94 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$328.94 ,"$1,116.00 ",$348.68 ,"$1,620.00 ",$512.26 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$348.68 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$227.67 ,"$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 ","$1,452.00 ",$434.16 ,"$2,200.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$903.49 ,$903.49 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$903.49 ,"$1,364.00 ",$957.70 ,"$1,980.00 ",$976.86 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$434.16 ,"$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 ","$1,452.00 ",$434.16 ,"$2,200.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$903.49 ,$903.49 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$903.49 ,"$1,364.00 ",$957.70 ,"$1,980.00 ",$976.86 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$434.16 ,"$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 ","$1,716.00 ",$434.16 ,"$2,600.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$903.49 ,$903.49 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$903.49 ,"$1,612.00 ",$957.70 ,"$2,340.00 ",$976.86 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$434.16 ,"$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 ","$1,716.00 ",$434.16 ,"$2,600.00 ",$903.49 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$903.49 ,$903.49 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$903.49 ,"$1,612.00 ",$957.70 ,"$2,340.00 ",$976.86 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$957.70 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$434.16 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,188.00 ",$106.88 ,"$1,800.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$219.29 ,$219.29 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$219.29 ,"$1,116.00 ",$232.45 ,"$1,620.00 ",$240.48 ,"$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$476.28 ,"$1,730.00 ",$106.88 ,"$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 ","$1,452.00 ",$180.34 ,"$2,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$582.12 ,"$1,760.00 ","$1,870.00 ","$1,375.00 ","$1,980.00 ",$602.32 ,$602.32 ,"$2,090.00 ","$1,980.00 ","$1,870.00 ","$1,870.00 ",$582.12 ,"$1,870.00 ","$1,870.00 ","$1,980.00 ","$1,339.80 ",$602.32 ,"$1,364.00 ",$638.46 ,"$1,980.00 ",$405.77 ,"$2,024.00 ","$1,980.00 ","$1,452.22 ","$1,452.22 ","$1,339.80 ","$1,452.22 ","$1,430.00 ","$1,503.04 ",$500.84 ,"$1,738.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$582.12 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$602.32 ,$602.32 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$602.32 ,"$1,612.00 ",$638.46 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ","$2,376.00 ",$233.52 ,"$3,600.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ",$952.56 ,"$2,880.00 ","$3,060.00 ","$2,250.00 ","$3,240.00 ",$602.32 ,$602.32 ,"$3,420.00 ","$3,240.00 ","$3,060.00 ","$3,060.00 ",$952.56 ,"$3,060.00 ","$3,060.00 ","$3,240.00 ","$2,192.40 ",$602.32 ,"$2,232.00 ",$638.46 ,"$3,240.00 ",$525.42 ,"$3,312.00 ","$3,240.00 ","$2,376.36 ","$2,376.36 ","$2,192.40 ","$2,376.36 ","$2,340.00 ","$2,459.52 ",$819.55 ,"$2,844.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ",$952.56 ,"$1,730.00 ",$233.52 ,"$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 ","$2,772.00 ",$368.43 ,"$4,200.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ","$1,111.32 ","$3,360.00 ","$3,570.00 ","$2,625.00 ","$3,780.00 ",$602.32 ,$602.32 ,"$3,990.00 ","$3,780.00 ","$3,570.00 ","$3,570.00 ","$1,111.32 ","$3,570.00 ","$3,570.00 ","$3,780.00 ","$2,557.80 ",$602.32 ,"$2,604.00 ",$638.46 ,"$3,780.00 ",$828.97 ,"$3,864.00 ","$3,780.00 ","$2,772.42 ","$2,772.42 ","$2,557.80 ","$2,772.42 ","$2,730.00 ","$2,869.44 ",$956.15 ,"$3,318.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ","$1,111.32 ","$1,730.00 ",$368.43 ,"$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 ","$3,234.00 ",$368.43 ,"$4,900.00 ",$602.32 ,"$1,196.00 ","$1,196.00 ","$1,296.54 ","$3,920.00 ","$4,165.00 ","$3,062.50 ","$4,410.00 ",$602.32 ,$602.32 ,"$4,655.00 ","$4,410.00 ","$4,165.00 ","$4,165.00 ","$1,296.54 ","$4,165.00 ","$4,165.00 ","$4,410.00 ","$2,984.10 ",$602.32 ,"$3,038.00 ",$638.46 ,"$4,410.00 ",$828.97 ,"$4,508.00 ","$4,410.00 ","$3,234.49 ","$3,234.49 ","$2,984.10 ","$3,234.49 ","$3,185.00 ","$3,347.68 ","$1,115.50 ","$3,871.00 ",$638.46 ,"$1,512.00 ","$1,512.00 ","$1,296.54 ","$1,730.00 ",$368.43 ,"$4,655.00 ","$4,018.00 ","$4,018.00 ","$3,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,"$1,600.00 ","$1,056.00 ",$86.88 ,"$1,600.00 ",$219.29 ,"$1,196.00 ","$1,196.00 ",$423.36 ,"$1,280.00 ","$1,360.00 ","$1,000.00 ","$1,440.00 ",$219.29 ,$219.29 ,"$1,520.00 ","$1,440.00 ","$1,360.00 ","$1,360.00 ",$423.36 ,"$1,360.00 ","$1,360.00 ","$1,440.00 ",$974.40 ,$219.29 ,$992.00 ,$232.45 ,"$1,440.00 ",$195.48 ,"$1,472.00 ","$1,440.00 ","$1,056.16 ","$1,056.16 ",$974.40 ,"$1,056.16 ","$1,040.00 ","$1,093.12 ",$364.25 ,"$1,264.00 ",$232.45 ,"$1,512.00 ","$1,512.00 ",$423.36 ,"$1,600.00 ",$86.88 ,"$1,520.00 ","$1,312.00 ","$1,312.00 ","$1,280.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000088,N/A,HC CT HRT W/O DYE W/CA TEST (PROMO),350,1 ,$100.00 ,$66.00 ,$22.77 ,$100.00 , N/A ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$62.00 , N/A ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 , N/A ,$100.00 ,$100.00 ,$26.46 ,$100.00 , N/A ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$2,600.00 ","$1,716.00 ",$180.34 ,"$2,600.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ",$687.96 ,"$2,080.00 ","$2,210.00 ","$1,625.00 ","$2,340.00 ",$744.43 ,$744.43 ,"$2,470.00 ","$2,340.00 ","$2,210.00 ","$2,210.00 ",$687.96 ,"$2,210.00 ","$2,210.00 ","$2,340.00 ","$1,583.40 ",$744.43 ,"$1,612.00 ",$789.10 ,"$2,340.00 ",$405.77 ,"$2,392.00 ","$2,340.00 ","$1,716.26 ","$1,716.26 ","$1,583.40 ","$1,716.26 ","$1,690.00 ","$1,776.32 ",$591.90 ,"$2,054.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ",$687.96 ,"$1,730.00 ",$180.34 ,"$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 ",$726.00 ,$86.88 ,"$1,100.00 ",$219.29 ,"$1,100.00 ","$1,100.00 ",$291.06 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$219.29 ,$219.29 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$291.06 ,$935.00 ,$935.00 ,$990.00 ,$669.90 ,$219.29 ,$682.00 ,$232.45 ,$990.00 ,$195.48 ,"$1,012.00 ",$990.00 ,$726.11 ,$726.11 ,$669.90 ,$726.11 ,$715.00 ,$751.52 ,$250.42 ,$869.00 ,$232.45 ,"$1,100.00 ","$1,100.00 ",$291.06 ,"$1,100.00 ",$86.88 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),35000103,76497,HC UNLISTED CT PROC,350,1 ,$243.00 ,$160.38 ,$55.32 ,$243.00 ,$219.29 ,$243.00 ,$243.00 ,$64.30 ,$194.40 ,$206.55 ,$151.88 ,$218.70 ,$219.29 ,$219.29 ,$230.85 ,$218.70 ,$206.55 ,$206.55 ,$64.30 ,$206.55 ,$206.55 ,$218.70 ,$147.99 ,$219.29 ,$150.66 ,$232.45 ,$218.70 ,$195.48 ,$223.56 ,$218.70 ,$160.40 ,$160.40 ,$147.99 ,$160.40 ,$157.95 ,$166.02 ,$55.32 ,$191.97 ,$232.45 ,$243.00 ,$243.00 ,$64.30 ,$243.00 ,$86.88 ,$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 ","$2,437.71 ",$168.53 ,"$3,693.50 ",$168.53 ,"$1,196.00 ","$1,196.00 ",$977.30 ,"$2,954.80 ","$3,139.48 ","$2,308.44 ","$3,324.15 ",$168.53 ,$168.53 ,"$3,508.83 ","$3,324.15 ","$3,139.48 ","$3,139.48 ",$977.30 ,"$3,139.48 ","$3,139.48 ","$3,324.15 ","$2,249.34 ",$168.53 ,"$2,289.98 ",$178.64 ,"$3,324.15 ", N/A ,"$3,398.02 ","$3,324.15 ","$2,438.08 ","$2,438.08 ","$2,249.34 ","$2,438.08 ","$2,400.78 ","$2,523.40 ",$840.85 ,"$2,917.87 ",$178.64 ,"$1,512.00 ","$1,512.00 ",$977.30 ,"$1,730.00 ", 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 ","$1,122.00 ",$168.53 ,"$1,700.00 ",$168.53 ,"$1,196.00 ","$1,196.00 ",$449.82 ,"$1,360.00 ","$1,445.00 ","$1,062.50 ","$1,530.00 ",$168.53 ,$168.53 ,"$1,615.00 ","$1,530.00 ","$1,445.00 ","$1,445.00 ",$449.82 ,"$1,445.00 ","$1,445.00 ","$1,530.00 ","$1,035.30 ",$168.53 ,"$1,054.00 ",$178.64 ,"$1,530.00 ", N/A ,"$1,564.00 ","$1,530.00 ","$1,122.17 ","$1,122.17 ","$1,035.30 ","$1,122.17 ","$1,105.00 ","$1,161.44 ",$387.01 ,"$1,343.00 ",$178.64 ,"$1,512.00 ","$1,512.00 ",$449.82 ,"$1,700.00 ", 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 ","$3,168.00 ",$368.43 ,"$4,800.00 ",$744.43 ,"$1,196.00 ","$1,196.00 ","$1,270.08 ","$3,840.00 ","$4,080.00 ","$3,000.00 ","$4,320.00 ",$744.43 ,$744.43 ,"$4,560.00 ","$4,320.00 ","$4,080.00 ","$4,080.00 ","$1,270.08 ","$4,080.00 ","$4,080.00 ","$4,320.00 ","$2,923.20 ",$744.43 ,"$2,976.00 ",$789.10 ,"$4,320.00 ",$828.97 ,"$4,416.00 ","$4,320.00 ","$3,168.48 ","$3,168.48 ","$2,923.20 ","$3,168.48 ","$3,120.00 ","$3,279.36 ","$1,092.74 ","$3,792.00 ",$789.10 ,"$1,512.00 ","$1,512.00 ","$1,270.08 ","$1,730.00 ",$368.43 ,"$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 ,"$2,357.50 ","$1,555.95 ",$536.70 ,"$2,357.50 ",$907.04 ,"$1,196.00 ","$1,196.00 ",$623.80 ,"$1,886.00 ","$2,003.88 ","$1,473.44 ","$2,121.75 ",$907.04 ,$907.04 ,"$2,239.63 ","$2,121.75 ","$2,003.88 ","$2,003.88 ",$623.80 ,"$2,003.88 ","$2,003.88 ","$2,121.75 ","$1,435.72 ",$907.04 ,"$1,461.66 ",$961.46 ,"$2,121.75 ","$1,449.77 ","$2,168.90 ","$2,121.75 ","$1,556.19 ","$1,556.19 ","$1,435.72 ","$1,556.19 ","$1,532.38 ","$1,610.64 ",$536.70 ,"$1,862.43 ",$961.46 ,"$1,512.00 ","$1,512.00 ",$623.80 ,"$1,730.00 ",$644.34 ,"$2,239.63 ","$1,933.15 ","$1,933.15 ","$1,886.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),35000154,71271,HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST,350,1 ,"$1,100.00 ",$726.00 ,$106.88 ,"$1,100.00 ",$219.29 ,"$1,100.00 ","$1,100.00 ",$291.06 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$219.29 ,$219.29 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$291.06 ,$935.00 ,$935.00 ,$990.00 ,$669.90 ,$219.29 ,$682.00 ,$232.45 ,$990.00 ,$240.48 ,"$1,012.00 ",$990.00 ,$726.11 ,$726.11 ,$669.90 ,$726.11 ,$715.00 ,$751.52 ,$250.42 ,$869.00 ,$232.45 ,"$1,100.00 ","$1,100.00 ",$291.06 ,"$1,100.00 ",$106.88 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000003,N/A,HC SCHEDULED PROCEDURE,360,1 ,"$1,780.80 ","$1,175.33 ",$405.41 ,"$1,780.80 ", N/A ,"$1,595.95 ","$1,595.95 ",$471.20 ,"$1,424.64 ","$1,513.68 ","$1,113.00 ","$1,602.72 ", N/A , N/A ,"$1,691.76 ","$1,602.72 ","$1,513.68 ","$1,513.68 ",$471.20 ,"$1,513.68 ","$1,513.68 ","$1,602.72 ","$1,084.51 ", N/A ,"$1,104.10 ", N/A ,"$1,602.72 ", N/A ,"$1,638.34 ","$1,602.72 ","$1,175.51 ","$1,175.51 ","$1,084.51 ","$1,175.51 ","$1,157.52 ","$1,216.64 ",$405.41 ,"$1,406.83 ", N/A , N/A , N/A ,$471.20 , N/A , N/A ,"$1,691.76 ","$1,460.26 ","$1,460.26 ","$1,424.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000004,N/A,HC SCHEDULED PROCEDURE LIMITED,360,1 ,$991.10 ,$654.13 ,$225.63 ,$991.10 , N/A ,$888.22 ,$888.22 ,$262.25 ,$792.88 ,$842.44 ,$619.44 ,$891.99 , N/A , N/A ,$941.55 ,$891.99 ,$842.44 ,$842.44 ,$262.25 ,$842.44 ,$842.44 ,$891.99 ,$603.58 , N/A ,$614.48 , N/A ,$891.99 , N/A ,$911.81 ,$891.99 ,$654.23 ,$654.23 ,$603.58 ,$654.23 ,$644.22 ,$677.12 ,$225.63 ,$782.97 , N/A , N/A , N/A ,$262.25 , N/A , N/A ,$941.55 ,$812.70 ,$812.70 ,$792.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$334.65 ,$220.87 ,$76.19 ,$406.31 ,$318.12 ,$299.91 ,$299.91 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$318.12 ,$318.12 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$318.12 ,$207.48 ,$337.21 ,$301.19 ,$406.31 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$337.21 ,$334.65 ,$334.65 ,$88.55 ,$334.65 ,$180.58 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,"$2,229.85 ","$1,471.70 ",$507.64 ,"$3,373.99 ","$2,101.03 ","$1,998.39 ","$1,998.39 ",$590.02 ,"$1,783.88 ","$1,895.37 ","$1,393.66 ","$2,006.87 ","$2,101.03 ","$2,101.03 ","$2,118.36 ","$2,006.87 ","$1,895.37 ","$1,895.37 ",$590.02 ,"$1,895.37 ","$1,895.37 ","$2,006.87 ","$1,357.98 ","$2,101.03 ","$1,382.50 ","$2,227.09 ","$2,006.87 ","$3,373.99 ","$2,051.46 ","$2,006.87 ","$1,471.92 ","$1,471.92 ","$1,357.98 ","$1,471.92 ","$1,449.40 ","$1,523.43 ",$507.64 ,"$1,761.58 ","$2,227.09 ","$2,229.85 ","$2,229.85 ",$590.02 ,"$2,229.85 ","$1,499.55 ","$2,118.36 ","$1,828.48 ","$1,828.48 ","$1,783.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$532.45 ,$351.42 ,$121.21 ,$839.41 ,$318.12 ,$477.18 ,$477.18 ,$140.88 ,$425.96 ,$452.58 ,$332.78 ,$479.21 ,$318.12 ,$318.12 ,$505.83 ,$479.21 ,$452.58 ,$452.58 ,$140.88 ,$452.58 ,$452.58 ,$479.21 ,$324.26 ,$318.12 ,$330.12 ,$337.21 ,$479.21 ,$839.41 ,$489.85 ,$479.21 ,$351.47 ,$351.47 ,$324.26 ,$351.47 ,$346.09 ,$363.77 ,$121.21 ,$420.64 ,$337.21 ,$532.45 ,$532.45 ,$140.88 ,$532.45 ,$373.07 ,$505.83 ,$436.61 ,$436.61 ,$425.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000078,19000,HC ASP CYST BREAST,360,1 ,$916.55 ,$604.92 ,$208.66 ,"$1,460.18 ","$1,290.13 ",$821.41 ,$821.41 ,$242.52 ,$733.24 ,$779.07 ,$572.84 ,$824.90 ,"$1,290.13 ",$916.55 ,$870.72 ,$824.90 ,$779.07 ,$779.07 ,$242.52 ,$779.07 ,$779.07 ,$824.90 ,$558.18 ,"$1,290.13 ",$568.26 ,$971.54 ,$824.90 ,"$1,460.18 ",$843.23 ,$824.90 ,$605.01 ,$605.01 ,$558.18 ,$605.01 ,$595.76 ,$626.19 ,$208.66 ,$724.07 ,"$1,367.54 ",$916.55 ,$916.55 ,$242.52 ,$916.55 ,$648.97 ,$870.72 ,$751.57 ,$751.57 ,$733.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$769.35 ,$507.77 ,$175.15 ,"$1,367.54 ","$1,290.13 ",$689.49 ,$689.49 ,$203.57 ,$615.48 ,$653.95 ,$480.84 ,$692.42 ,"$1,290.13 ",$769.35 ,$730.88 ,$692.42 ,$653.95 ,$653.95 ,$203.57 ,$653.95 ,$653.95 ,$692.42 ,$468.53 ,"$1,290.13 ",$477.00 ,$815.51 ,$692.42 , N/A ,$707.80 ,$692.42 ,$507.85 ,$507.85 ,$468.53 ,$507.85 ,$500.08 ,$525.62 ,$175.15 ,$607.79 ,"$1,367.54 ",$635.00 ,$635.00 ,$203.57 ,$697.00 , N/A ,$730.88 ,$630.87 ,$630.87 ,$615.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$4,600.00 ","$3,036.00 ","$1,047.21 ","$4,600.00 ","$2,533.69 ","$4,122.52 ","$4,122.52 ","$1,217.16 ","$3,680.00 ","$3,910.00 ","$2,875.00 ","$4,140.00 ","$2,533.69 ","$2,533.69 ","$4,370.00 ","$4,140.00 ","$3,910.00 ","$3,910.00 ","$1,217.16 ","$3,910.00 ","$3,910.00 ","$4,140.00 ","$2,801.40 ","$2,533.69 ","$2,852.00 ","$2,685.71 ","$4,140.00 ","$3,373.99 ","$4,232.00 ","$4,140.00 ","$3,036.46 ","$3,036.46 ","$2,801.40 ","$3,036.46 ","$2,990.00 ","$3,142.72 ","$1,047.21 ","$3,634.00 ","$2,685.71 ","$2,415.00 ","$2,415.00 ","$1,217.16 ","$2,656.00 ","$1,499.55 ","$4,370.00 ","$3,772.00 ","$3,772.00 ","$3,680.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,725.00 ","$1,138.50 ",$392.71 ,"$2,685.71 ","$2,533.69 ","$1,545.95 ","$1,545.95 ",$456.43 ,"$1,380.00 ","$1,466.25 ","$1,078.13 ","$1,552.50 ","$2,533.69 ","$1,725.00 ","$1,638.75 ","$1,552.50 ","$1,466.25 ","$1,466.25 ",$456.43 ,"$1,466.25 ","$1,466.25 ","$1,552.50 ","$1,050.53 ","$2,533.69 ","$1,069.50 ","$1,828.50 ","$1,552.50 ","$1,460.18 ","$1,587.00 ","$1,552.50 ","$1,138.67 ","$1,138.67 ","$1,050.53 ","$1,138.67 ","$1,121.25 ","$1,178.52 ",$392.71 ,"$1,362.75 ","$2,685.71 ","$1,725.00 ","$1,725.00 ",$456.43 ,"$1,725.00 ",$648.97 ,"$1,638.75 ","$1,414.50 ","$1,414.50 ","$1,380.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$3,373.99 ","$1,290.13 ","$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ","$1,290.13 ","$1,290.13 ","$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,"$1,290.13 ",$921.90 ,"$1,367.54 ","$1,338.26 ","$3,373.99 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ","$1,367.54 ","$1,486.95 ","$1,486.95 ",$393.45 ,"$1,486.95 ","$1,499.55 ","$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$1,734.20 ","$1,144.57 ",$394.80 ,"$3,373.99 ","$1,290.13 ","$1,554.19 ","$1,554.19 ",$458.87 ,"$1,387.36 ","$1,474.07 ","$1,083.88 ","$1,560.78 ","$1,290.13 ","$1,290.13 ","$1,647.49 ","$1,560.78 ","$1,474.07 ","$1,474.07 ",$458.87 ,"$1,474.07 ","$1,474.07 ","$1,560.78 ","$1,056.13 ","$1,290.13 ","$1,075.20 ","$1,367.54 ","$1,560.78 ","$3,373.99 ","$1,595.46 ","$1,560.78 ","$1,144.75 ","$1,144.75 ","$1,056.13 ","$1,144.75 ","$1,127.23 ","$1,184.81 ",$394.80 ,"$1,370.02 ","$1,367.54 ","$1,734.20 ","$1,734.20 ",$458.87 ,"$1,734.20 ","$1,499.55 ","$1,647.49 ","$1,422.04 ","$1,422.04 ","$1,387.36 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000114,19282,HC BREAST NDL LOC BX ADDN LESION,360,1 ,$172.50 ,$113.85 ,$39.28 ,"$2,685.71 ","$2,533.69 ",$154.59 ,$154.59 ,$45.65 ,$138.00 ,$146.63 ,$107.81 ,$155.25 ,"$2,533.69 ",$172.50 ,$163.88 ,$155.25 ,$146.63 ,$146.63 ,$45.65 ,$146.63 ,$146.63 ,$155.25 ,$105.05 ,"$2,533.69 ",$106.96 ,$182.85 ,$155.25 , N/A ,$158.70 ,$155.25 ,$113.87 ,$113.87 ,$105.05 ,$113.87 ,$112.13 ,$117.85 ,$39.28 ,$136.28 ,"$2,685.71 ",$172.50 ,$172.50 ,$45.65 ,$172.50 , N/A ,$163.88 ,$141.45 ,$141.45 ,$138.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000118,36470,HC INJ SCLEROSING SOLUTION SINGLE VEIN,360,1 ,$358.80 ,$236.81 ,$81.68 ,"$1,228.89 ","$1,159.33 ",$321.56 ,$321.56 ,$94.94 ,$287.04 ,$304.98 ,$224.25 ,$322.92 ,"$1,159.33 ",$358.80 ,$340.86 ,$322.92 ,$304.98 ,$304.98 ,$94.94 ,$304.98 ,$304.98 ,$322.92 ,$218.51 ,"$1,159.33 ",$222.46 ,$380.33 ,$322.92 ,$839.41 ,$330.10 ,$322.92 ,$236.84 ,$236.84 ,$218.51 ,$236.84 ,$233.22 ,$245.13 ,$81.68 ,$283.45 ,"$1,228.89 ",$358.80 ,$358.80 ,$94.94 ,$358.80 ,$373.07 ,$340.86 ,$294.22 ,$294.22 ,$287.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$3,096.95 ","$2,043.99 ",$705.03 ,"$6,702.68 ","$2,105.50 ","$2,775.49 ","$2,775.49 ",$819.46 ,"$2,477.56 ","$2,632.41 ","$1,935.59 ","$2,787.26 ","$2,105.50 ","$2,105.50 ","$2,942.10 ","$2,787.26 ","$2,632.41 ","$2,632.41 ",$819.46 ,"$2,632.41 ","$2,632.41 ","$2,787.26 ","$1,886.04 ","$2,105.50 ","$1,920.10 ","$2,231.83 ","$2,787.26 ","$6,702.68 ","$2,849.19 ","$2,787.26 ","$2,044.30 ","$2,044.30 ","$1,886.04 ","$2,044.30 ","$2,013.02 ","$2,115.84 ",$705.03 ,"$2,446.59 ","$2,231.83 ","$1,974.00 ","$1,974.00 ",$819.46 ,"$2,047.00 ","$2,978.97 ","$2,942.10 ","$2,539.50 ","$2,539.50 ","$2,477.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$6,813.75 ","$4,497.08 ","$1,551.17 ","$6,813.75 ","$4,105.12 ","$6,106.48 ","$6,106.48 ","$1,802.92 ","$5,451.00 ","$5,791.69 ","$4,258.59 ","$6,132.38 ","$4,105.12 ","$4,105.12 ","$6,473.06 ","$6,132.38 ","$5,791.69 ","$5,791.69 ","$1,802.92 ","$5,791.69 ","$5,791.69 ","$6,132.38 ","$4,149.57 ","$4,105.12 ","$4,224.52 ","$4,351.43 ","$6,132.38 ","$6,702.68 ","$6,268.65 ","$6,132.38 ","$4,497.76 ","$4,497.76 ","$4,149.57 ","$4,497.76 ","$4,428.94 ","$4,655.15 ","$1,551.17 ","$5,382.86 ","$4,351.43 ","$3,950.00 ","$3,950.00 ","$1,802.92 ","$4,209.00 ","$2,978.97 ","$6,473.06 ","$5,587.28 ","$5,587.28 ","$5,451.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$1,858.40 ","$1,226.54 ",$423.07 ,"$3,347.66 ","$2,105.50 ","$1,665.50 ","$1,665.50 ",$491.73 ,"$1,486.72 ","$1,579.64 ","$1,161.50 ","$1,672.56 ","$2,105.50 ","$1,858.40 ","$1,765.48 ","$1,672.56 ","$1,579.64 ","$1,579.64 ",$491.73 ,"$1,579.64 ","$1,579.64 ","$1,672.56 ","$1,131.77 ","$2,105.50 ","$1,152.20 ","$1,969.90 ","$1,672.56 ","$3,347.66 ","$1,709.73 ","$1,672.56 ","$1,226.73 ","$1,226.73 ","$1,131.77 ","$1,226.73 ","$1,207.96 ","$1,269.66 ",$423.07 ,"$1,468.14 ","$2,231.83 ","$1,858.40 ","$1,858.40 ",$491.73 ,"$1,858.40 ","$1,487.85 ","$1,765.48 ","$1,523.89 ","$1,523.89 ","$1,486.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$6,937.95 ","$4,579.05 ","$1,579.46 ","$6,937.95 ","$4,105.12 ","$6,217.79 ","$6,217.79 ","$1,835.78 ","$5,550.36 ","$5,897.26 ","$4,336.22 ","$6,244.16 ","$4,105.12 ","$4,105.12 ","$6,591.05 ","$6,244.16 ","$5,897.26 ","$5,897.26 ","$1,835.78 ","$5,897.26 ","$5,897.26 ","$6,244.16 ","$4,225.21 ","$4,105.12 ","$4,301.52 ","$4,351.43 ","$6,244.16 ","$6,702.68 ","$6,382.91 ","$6,244.16 ","$4,579.74 ","$4,579.74 ","$4,225.21 ","$4,579.74 ","$4,509.67 ","$4,740.01 ","$1,579.46 ","$5,480.98 ","$4,351.43 ","$3,950.00 ","$3,950.00 ","$1,835.78 ","$4,209.00 ","$2,978.97 ","$6,591.05 ","$5,689.12 ","$5,689.12 ","$5,550.36 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$2,725.20 ","$1,798.63 ",$620.41 ,"$3,347.66 ","$2,105.50 ","$2,442.32 ","$2,442.32 ",$721.08 ,"$2,180.16 ","$2,316.42 ","$1,703.25 ","$2,452.68 ","$2,105.50 ","$2,105.50 ","$2,588.94 ","$2,452.68 ","$2,316.42 ","$2,316.42 ",$721.08 ,"$2,316.42 ","$2,316.42 ","$2,452.68 ","$1,659.65 ","$2,105.50 ","$1,689.62 ","$2,231.83 ","$2,452.68 ","$3,347.66 ","$2,507.18 ","$2,452.68 ","$1,798.90 ","$1,798.90 ","$1,659.65 ","$1,798.90 ","$1,771.38 ","$1,861.86 ",$620.41 ,"$2,152.91 ","$2,231.83 ","$1,974.00 ","$1,974.00 ",$721.08 ,"$2,047.00 ","$1,487.85 ","$2,588.94 ","$2,234.66 ","$2,234.66 ","$2,180.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$1,238.55 ",$817.44 ,$281.97 ,"$1,435.14 ","$1,353.91 ","$1,109.99 ","$1,109.99 ",$327.72 ,$990.84 ,"$1,052.77 ",$774.09 ,"$1,114.70 ","$1,353.91 ","$1,238.55 ","$1,176.62 ","$1,114.70 ","$1,052.77 ","$1,052.77 ",$327.72 ,"$1,052.77 ","$1,052.77 ","$1,114.70 ",$754.28 ,"$1,353.91 ",$767.90 ,"$1,312.86 ","$1,114.70 ","$1,301.63 ","$1,139.47 ","$1,114.70 ",$817.57 ,$817.57 ,$754.28 ,$817.57 ,$805.06 ,$846.18 ,$281.97 ,$978.45 ,"$1,435.14 ","$1,238.55 ","$1,238.55 ",$327.72 ,"$1,238.55 ",$578.50 ,"$1,176.62 ","$1,015.61 ","$1,015.61 ",$990.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$2,725.50 ","$1,798.83 ",$620.48 ,"$3,347.66 ","$1,353.91 ","$2,442.59 ","$2,442.59 ",$721.17 ,"$2,180.40 ","$2,316.68 ","$1,703.44 ","$2,452.95 ","$1,353.91 ","$1,353.91 ","$2,589.23 ","$2,452.95 ","$2,316.68 ","$2,316.68 ",$721.17 ,"$2,316.68 ","$2,316.68 ","$2,452.95 ","$1,659.83 ","$1,353.91 ","$1,689.82 ","$1,435.14 ","$2,452.95 ","$3,347.66 ","$2,507.46 ","$2,452.95 ","$1,799.10 ","$1,799.10 ","$1,659.83 ","$1,799.10 ","$1,771.58 ","$1,862.06 ",$620.48 ,"$2,153.15 ","$1,435.14 ","$2,415.00 ","$2,415.00 ",$721.17 ,"$2,656.00 ","$1,487.85 ","$2,589.23 ","$2,234.91 ","$2,234.91 ","$2,180.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,$696.00 ,$459.36 ,$158.45 ,"$1,347.28 ","$1,271.02 ",$623.76 ,$623.76 ,$184.16 ,$556.80 ,$591.60 ,$435.00 ,$626.40 ,"$1,271.02 ",$696.00 ,$661.20 ,$626.40 ,$591.60 ,$591.60 ,$184.16 ,$591.60 ,$591.60 ,$626.40 ,$423.86 ,"$1,271.02 ",$431.52 ,$737.76 ,$626.40 , N/A ,$640.32 ,$626.40 ,$459.43 ,$459.43 ,$423.86 ,$459.43 ,$452.40 ,$475.51 ,$158.45 ,$549.84 ,"$1,347.28 ",$635.00 ,$635.00 ,$184.16 ,$696.00 , N/A ,$661.20 ,$570.72 ,$570.72 ,$556.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000157,38220,HC ASP BONE MARROW ONLY,360,1 ,"$1,238.55 ",$817.44 ,$281.97 ,"$3,373.99 ","$2,811.12 ","$1,109.99 ","$1,109.99 ",$327.72 ,$990.84 ,"$1,052.77 ",$774.09 ,"$1,114.70 ","$2,811.12 ","$1,238.55 ","$1,176.62 ","$1,114.70 ","$1,052.77 ","$1,052.77 ",$327.72 ,"$1,052.77 ","$1,052.77 ","$1,114.70 ",$754.28 ,"$2,811.12 ",$767.90 ,"$1,312.86 ","$1,114.70 ","$3,373.99 ","$1,139.47 ","$1,114.70 ",$817.57 ,$817.57 ,$754.28 ,$817.57 ,$805.06 ,$846.18 ,$281.97 ,$978.45 ,"$2,979.79 ","$1,238.55 ","$1,238.55 ",$327.72 ,"$1,238.55 ","$1,499.55 ","$1,176.62 ","$1,015.61 ","$1,015.61 ",$990.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000158,38221,HC BX BONE MARROW ONLY,360,1 ,$892.40 ,$588.98 ,$203.15 ,"$3,373.99 ","$2,811.12 ",$799.77 ,$799.77 ,$236.13 ,$713.92 ,$758.54 ,$557.75 ,$803.16 ,"$2,811.12 ",$892.40 ,$847.78 ,$803.16 ,$758.54 ,$758.54 ,$236.13 ,$758.54 ,$758.54 ,$803.16 ,$543.47 ,"$2,811.12 ",$553.28 ,$945.94 ,$803.16 ,"$3,373.99 ",$821.01 ,$803.16 ,$589.07 ,$589.07 ,$543.47 ,$589.07 ,$580.06 ,$609.69 ,$203.15 ,$705.00 ,"$2,979.79 ",$892.40 ,$892.40 ,$236.13 ,$892.40 ,"$1,499.55 ",$847.78 ,$731.77 ,$731.77 ,$713.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$2,229.85 ","$1,471.70 ",$507.64 ,"$3,373.99 ","$2,299.87 ","$1,998.39 ","$1,998.39 ",$590.02 ,"$1,783.88 ","$1,895.37 ","$1,393.66 ","$2,006.87 ","$2,299.87 ","$2,229.85 ","$2,118.36 ","$2,006.87 ","$1,895.37 ","$1,895.37 ",$590.02 ,"$1,895.37 ","$1,895.37 ","$2,006.87 ","$1,357.98 ","$2,299.87 ","$1,382.50 ","$2,363.64 ","$2,006.87 ","$3,373.99 ","$2,051.46 ","$2,006.87 ","$1,471.92 ","$1,471.92 ","$1,357.98 ","$1,471.92 ","$1,449.40 ","$1,523.43 ",$507.64 ,"$1,761.58 ","$2,437.86 ","$2,229.85 ","$2,229.85 ",$590.02 ,"$2,229.85 ","$1,499.55 ","$2,118.36 ","$1,828.48 ","$1,828.48 ","$1,783.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,238.55 ",$817.44 ,$281.97 ,"$1,744.74 ","$1,645.98 ","$1,109.99 ","$1,109.99 ",$327.72 ,$990.84 ,"$1,052.77 ",$774.09 ,"$1,114.70 ","$1,645.98 ","$1,238.55 ","$1,176.62 ","$1,114.70 ","$1,052.77 ","$1,052.77 ",$327.72 ,"$1,052.77 ","$1,052.77 ","$1,114.70 ",$754.28 ,"$1,645.98 ",$767.90 ,"$1,312.86 ","$1,114.70 ","$1,449.77 ","$1,139.47 ","$1,114.70 ",$817.57 ,$817.57 ,$754.28 ,$817.57 ,$805.06 ,$846.18 ,$281.97 ,$978.45 ,"$1,744.74 ","$1,238.55 ","$1,238.55 ",$327.72 ,"$1,238.55 ",$644.34 ,"$1,176.62 ","$1,015.61 ","$1,015.61 ",$990.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000305,23700,HC SHOULDER MANIPULATION W/ANESTHESIA,360,1 ,"$2,831.30 ","$1,868.66 ",$644.56 ,"$3,227.67 ","$1,915.43 ","$2,537.41 ","$2,537.41 ",$749.16 ,"$2,265.04 ","$2,406.61 ","$1,769.56 ","$2,548.17 ","$1,915.43 ","$1,915.43 ","$2,689.74 ","$2,548.17 ","$2,406.61 ","$2,406.61 ",$749.16 ,"$2,406.61 ","$2,406.61 ","$2,548.17 ","$1,724.26 ","$1,915.43 ","$1,755.40 ","$2,030.36 ","$2,548.17 ","$3,227.67 ","$2,604.80 ","$2,548.17 ","$1,868.94 ","$1,868.94 ","$1,724.26 ","$1,868.94 ","$1,840.35 ","$1,934.34 ",$644.56 ,"$2,236.73 ","$2,030.36 ","$2,415.00 ","$2,415.00 ",$749.16 ,"$2,656.00 ","$1,434.52 ","$2,689.74 ","$2,321.67 ","$2,321.67 ","$2,265.04 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000309,27096,HC INJECTION SACRAL JOINT,360,1 ,"$1,294.90 ",$854.63 ,$294.79 ,"$1,294.90 ",$907.04 ,"$1,160.49 ","$1,160.49 ",$342.63 ,"$1,035.92 ","$1,100.67 ",$809.31 ,"$1,165.41 ",$907.04 ,$907.04 ,"$1,230.16 ","$1,165.41 ","$1,100.67 ","$1,100.67 ",$342.63 ,"$1,100.67 ","$1,100.67 ","$1,165.41 ",$788.59 ,$907.04 ,$802.84 ,$961.46 ,"$1,165.41 ", N/A ,"$1,191.31 ","$1,165.41 ",$854.76 ,$854.76 ,$788.59 ,$854.76 ,$841.69 ,$884.68 ,$294.79 ,"$1,022.97 ",$961.46 ,$635.00 ,$635.00 ,$342.63 ,$697.00 , N/A ,"$1,230.16 ","$1,061.82 ","$1,061.82 ","$1,035.92 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000310,64421,HC INJ ANES INTERCOSTAL NERVE EA ADDNT LEVEL,360,1 ,"$1,238.55 ",$817.44 ,$281.97 ,"$2,177.69 ","$2,054.42 ","$1,109.99 ","$1,109.99 ",$327.72 ,$990.84 ,"$1,052.77 ",$774.09 ,"$1,114.70 ","$2,054.42 ","$1,238.55 ","$1,176.62 ","$1,114.70 ","$1,052.77 ","$1,052.77 ",$327.72 ,"$1,052.77 ","$1,052.77 ","$1,114.70 ",$754.28 ,"$2,054.42 ",$767.90 ,"$1,312.86 ","$1,114.70 ","$1,917.41 ","$1,139.47 ","$1,114.70 ",$817.57 ,$817.57 ,$754.28 ,$817.57 ,$805.06 ,$846.18 ,$281.97 ,$978.45 ,"$2,177.69 ","$1,238.55 ","$1,238.55 ",$327.72 ,"$1,238.55 ",$852.18 ,"$1,176.62 ","$1,015.61 ","$1,015.61 ",$990.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000311,64420,HC INJ INTERCOSTAL NERVE;SINGLE,360,1 ,$923.45 ,$609.48 ,$210.22 ,"$1,449.77 ",$766.50 ,$827.60 ,$827.60 ,$244.34 ,$738.76 ,$784.93 ,$577.16 ,$831.11 ,$766.50 ,$766.50 ,$877.28 ,$831.11 ,$784.93 ,$784.93 ,$244.34 ,$784.93 ,$784.93 ,$831.11 ,$562.38 ,$766.50 ,$572.54 ,$812.49 ,$831.11 ,"$1,449.77 ",$849.57 ,$831.11 ,$609.57 ,$609.57 ,$562.38 ,$609.57 ,$600.24 ,$630.90 ,$210.22 ,$729.53 ,$812.49 ,$923.45 ,$923.45 ,$244.34 ,$923.45 ,$644.34 ,$877.28 ,$757.23 ,$757.23 ,$738.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000313,64493,HC INJ FACET LUMBO SACRAL;SINGLE,360,1 ,"$2,849.70 ","$1,880.80 ",$648.74 ,"$2,849.70 ","$1,645.98 ","$2,553.90 ","$2,553.90 ",$754.03 ,"$2,279.76 ","$2,422.25 ","$1,781.06 ","$2,564.73 ","$1,645.98 ","$1,645.98 ","$2,707.22 ","$2,564.73 ","$2,422.25 ","$2,422.25 ",$754.03 ,"$2,422.25 ","$2,422.25 ","$2,564.73 ","$1,735.47 ","$1,645.98 ","$1,766.82 ","$1,744.74 ","$2,564.73 ","$1,917.41 ","$2,621.72 ","$2,564.73 ","$1,881.09 ","$1,881.09 ","$1,735.47 ","$1,881.09 ","$1,852.31 ","$1,946.92 ",$648.74 ,"$2,251.26 ","$1,744.74 ","$1,974.00 ","$1,974.00 ",$754.03 ,"$2,047.00 ",$852.18 ,"$2,707.22 ","$2,336.75 ","$2,336.75 ","$2,279.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000314,64494,HC INJ FACET LUMBO/SACRAL;2ND LEVEL,360,1 ,$495.65 ,$327.13 ,$112.84 ,"$1,744.74 ","$1,645.98 ",$444.20 ,$444.20 ,$131.15 ,$396.52 ,$421.30 ,$309.78 ,$446.09 ,"$1,645.98 ",$495.65 ,$470.87 ,$446.09 ,$421.30 ,$421.30 ,$131.15 ,$421.30 ,$421.30 ,$446.09 ,$301.85 ,"$1,645.98 ",$307.30 ,$525.39 ,$446.09 , N/A ,$456.00 ,$446.09 ,$327.18 ,$327.18 ,$301.85 ,$327.18 ,$322.17 ,$338.63 ,$112.84 ,$391.56 ,"$1,744.74 ",$495.65 ,$495.65 ,$131.15 ,$495.65 , N/A ,$470.87 ,$406.43 ,$406.43 ,$396.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000315,64495,HC INJ FACET LUMBO/SACRAL;3RD LEVEL,360,1 ,$495.65 ,$327.13 ,$112.84 ,"$1,744.74 ","$1,645.98 ",$444.20 ,$444.20 ,$131.15 ,$396.52 ,$421.30 ,$309.78 ,$446.09 ,"$1,645.98 ",$495.65 ,$470.87 ,$446.09 ,$421.30 ,$421.30 ,$131.15 ,$421.30 ,$421.30 ,$446.09 ,$301.85 ,"$1,645.98 ",$307.30 ,$525.39 ,$446.09 , N/A ,$456.00 ,$446.09 ,$327.18 ,$327.18 ,$301.85 ,$327.18 ,$322.17 ,$338.63 ,$112.84 ,$391.56 ,"$1,744.74 ",$495.65 ,$495.65 ,$131.15 ,$495.65 , N/A ,$470.87 ,$406.43 ,$406.43 ,$396.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000322,64479,HC INJ TRANSF CERV/THORACIC SINGLE,360,1 ,"$1,772.15 ","$1,169.62 ",$403.44 ,"$1,917.41 ","$1,645.98 ","$1,588.20 ","$1,588.20 ",$468.91 ,"$1,417.72 ","$1,506.33 ","$1,107.59 ","$1,594.94 ","$1,645.98 ","$1,645.98 ","$1,683.54 ","$1,594.94 ","$1,506.33 ","$1,506.33 ",$468.91 ,"$1,506.33 ","$1,506.33 ","$1,594.94 ","$1,079.24 ","$1,645.98 ","$1,098.74 ","$1,744.74 ","$1,594.94 ","$1,917.41 ","$1,630.38 ","$1,594.94 ","$1,169.80 ","$1,169.80 ","$1,079.24 ","$1,169.80 ","$1,151.90 ","$1,210.73 ",$403.44 ,"$1,400.00 ","$1,744.74 ","$1,772.15 ","$1,772.15 ",$468.91 ,"$1,772.15 ",$852.18 ,"$1,683.54 ","$1,453.16 ","$1,453.16 ","$1,417.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000323,64480,HC INJ TRANSF CERV/THORACIC ADDL,360,1 ,$903.90 ,$596.57 ,$205.78 ,"$1,744.74 ","$1,645.98 ",$810.08 ,$810.08 ,$239.17 ,$723.12 ,$768.32 ,$564.94 ,$813.51 ,"$1,645.98 ",$903.90 ,$858.71 ,$813.51 ,$768.32 ,$768.32 ,$239.17 ,$768.32 ,$768.32 ,$813.51 ,$550.48 ,"$1,645.98 ",$560.42 ,$958.13 ,$813.51 , N/A ,$831.59 ,$813.51 ,$596.66 ,$596.66 ,$550.48 ,$596.66 ,$587.54 ,$617.54 ,$205.78 ,$714.08 ,"$1,744.74 ",$635.00 ,$635.00 ,$239.17 ,$697.00 , N/A ,$858.71 ,$741.20 ,$741.20 ,$723.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000324,64483,HC INJ TRANSF LUMBAR SACRAL SINGLE,360,1 ,"$2,229.85 ","$1,471.70 ",$507.64 ,"$2,229.85 ","$1,645.98 ","$1,998.39 ","$1,998.39 ",$590.02 ,"$1,783.88 ","$1,895.37 ","$1,393.66 ","$2,006.87 ","$1,645.98 ","$1,645.98 ","$2,118.36 ","$2,006.87 ","$1,895.37 ","$1,895.37 ",$590.02 ,"$1,895.37 ","$1,895.37 ","$2,006.87 ","$1,357.98 ","$1,645.98 ","$1,382.50 ","$1,744.74 ","$2,006.87 ","$1,917.41 ","$2,051.46 ","$2,006.87 ","$1,471.92 ","$1,471.92 ","$1,357.98 ","$1,471.92 ","$1,449.40 ","$1,523.43 ",$507.64 ,"$1,761.58 ","$1,744.74 ","$1,974.00 ","$1,974.00 ",$590.02 ,"$2,047.00 ",$852.18 ,"$2,118.36 ","$1,828.48 ","$1,828.48 ","$1,783.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000325,64484,HC INJ TRANSF LUMBAR SACRAL ADDL,360,1 ,$903.90 ,$596.57 ,$205.78 ,"$1,744.74 ","$1,645.98 ",$810.08 ,$810.08 ,$239.17 ,$723.12 ,$768.32 ,$564.94 ,$813.51 ,"$1,645.98 ",$903.90 ,$858.71 ,$813.51 ,$768.32 ,$768.32 ,$239.17 ,$768.32 ,$768.32 ,$813.51 ,$550.48 ,"$1,645.98 ",$560.42 ,$958.13 ,$813.51 , N/A ,$831.59 ,$813.51 ,$596.66 ,$596.66 ,$550.48 ,$596.66 ,$587.54 ,$617.54 ,$205.78 ,$714.08 ,"$1,744.74 ",$635.00 ,$635.00 ,$239.17 ,$697.00 , N/A ,$858.71 ,$741.20 ,$741.20 ,$723.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000326,64405,HC NERVE BLOCK; OCCIPITAL,360,1 ,"$1,152.30 ",$760.52 ,$262.33 ,"$1,152.30 ",$766.50 ,"$1,032.69 ","$1,032.69 ",$304.90 ,$921.84 ,$979.46 ,$720.19 ,"$1,037.07 ",$766.50 ,$766.50 ,"$1,094.69 ","$1,037.07 ",$979.46 ,$979.46 ,$304.90 ,$979.46 ,$979.46 ,"$1,037.07 ",$701.75 ,$766.50 ,$714.42 ,$812.49 ,"$1,037.07 ",$611.75 ,"$1,060.12 ","$1,037.07 ",$760.63 ,$760.63 ,$701.75 ,$760.63 ,$749.00 ,$787.25 ,$262.33 ,$910.32 ,$812.49 ,$635.00 ,$635.00 ,$304.90 ,$697.00 ,$271.89 ,"$1,094.69 ",$944.89 ,$944.89 ,$921.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000327,64445,HC NERVE BLOCK;SCIATIC SINGLE,360,1 ,"$1,858.40 ","$1,226.54 ",$423.07 ,"$1,858.40 ",$766.50 ,"$1,665.50 ","$1,665.50 ",$491.73 ,"$1,486.72 ","$1,579.64 ","$1,161.50 ","$1,672.56 ",$766.50 ,$766.50 ,"$1,765.48 ","$1,672.56 ","$1,579.64 ","$1,579.64 ",$491.73 ,"$1,579.64 ","$1,579.64 ","$1,672.56 ","$1,131.77 ",$766.50 ,"$1,152.20 ",$812.49 ,"$1,672.56 ","$1,449.77 ","$1,709.73 ","$1,672.56 ","$1,226.73 ","$1,226.73 ","$1,131.77 ","$1,226.73 ","$1,207.96 ","$1,269.66 ",$423.07 ,"$1,468.14 ",$812.49 ,"$1,858.40 ","$1,858.40 ",$491.73 ,"$1,858.40 ",$644.34 ,"$1,765.48 ","$1,523.89 ","$1,523.89 ","$1,486.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000328,64418,HC NERVE BLOCK;SUPRACAPULAR,360,1 ,$903.90 ,$596.57 ,$205.78 ,"$1,449.77 ",$766.50 ,$810.08 ,$810.08 ,$239.17 ,$723.12 ,$768.32 ,$564.94 ,$813.51 ,$766.50 ,$766.50 ,$858.71 ,$813.51 ,$768.32 ,$768.32 ,$239.17 ,$768.32 ,$768.32 ,$813.51 ,$550.48 ,$766.50 ,$560.42 ,$812.49 ,$813.51 ,"$1,449.77 ",$831.59 ,$813.51 ,$596.66 ,$596.66 ,$550.48 ,$596.66 ,$587.54 ,$617.54 ,$205.78 ,$714.08 ,$812.49 ,$903.90 ,$903.90 ,$239.17 ,$903.90 ,$644.34 ,$858.71 ,$741.20 ,$741.20 ,$723.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000330,N/A,HC GI ROOM PRE-OP CARE,750,1 ,$222.60 ,$146.92 ,$50.68 ,$222.60 , N/A ,$199.49 ,$199.49 ,$58.90 ,$178.08 ,$189.21 ,$139.13 ,$200.34 , N/A , N/A ,$211.47 ,$200.34 ,$189.21 ,$189.21 ,$58.90 ,$189.21 ,$189.21 ,$200.34 ,$135.56 , N/A ,$138.02 , N/A ,$200.34 , N/A ,$204.79 ,$200.34 ,$146.94 ,$146.94 ,$135.56 ,$146.94 ,$144.69 ,$152.08 ,$50.68 ,$175.85 , N/A , N/A , N/A ,$58.90 , N/A , N/A ,$211.47 ,$182.53 ,$182.53 ,$178.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000331,64520,HC NERVE BLOCK;L/S PARAVERTEBAL SYMP,360,1 ,"$1,499.60 ",$989.74 ,$341.39 ,"$1,917.41 ","$1,645.98 ","$1,343.94 ","$1,343.94 ",$396.79 ,"$1,199.68 ","$1,274.66 ",$937.25 ,"$1,349.64 ","$1,645.98 ","$1,499.60 ","$1,424.62 ","$1,349.64 ","$1,274.66 ","$1,274.66 ",$396.79 ,"$1,274.66 ","$1,274.66 ","$1,349.64 ",$913.26 ,"$1,645.98 ",$929.76 ,"$1,589.58 ","$1,349.64 ","$1,917.41 ","$1,379.63 ","$1,349.64 ",$989.89 ,$989.89 ,$913.26 ,$989.89 ,$974.74 ,"$1,024.53 ",$341.39 ,"$1,184.68 ","$1,744.74 ","$1,499.60 ","$1,499.60 ",$396.79 ,"$1,499.60 ",$852.18 ,"$1,424.62 ","$1,229.67 ","$1,229.67 ","$1,199.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000338,N/A,HC EMERGENCY/URGENT,360,1 ,$679.46 ,$448.44 ,$154.68 ,$679.46 , N/A ,$608.93 ,$608.93 ,$179.78 ,$543.57 ,$577.54 ,$424.66 ,$611.51 , N/A , N/A ,$645.49 ,$611.51 ,$577.54 ,$577.54 ,$179.78 ,$577.54 ,$577.54 ,$611.51 ,$413.79 , N/A ,$421.26 , N/A ,$611.51 , N/A ,$625.10 ,$611.51 ,$448.51 ,$448.51 ,$413.79 ,$448.51 ,$441.65 ,$464.21 ,$154.68 ,$536.77 , N/A , N/A , N/A ,$179.78 , N/A , N/A ,$645.49 ,$557.16 ,$557.16 ,$543.57 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000339,64461,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC SINGLE,360,1 ,$954.50 ,$629.97 ,$217.31 ,"$1,744.74 ","$1,645.98 ",$855.42 ,$855.42 ,$252.57 ,$763.60 ,$811.33 ,$596.56 ,$859.05 ,"$1,645.98 ",$954.50 ,$906.78 ,$859.05 ,$811.33 ,$811.33 ,$252.57 ,$811.33 ,$811.33 ,$859.05 ,$581.29 ,"$1,645.98 ",$591.80 ,"$1,011.77 ",$859.05 ,"$1,449.77 ",$878.14 ,$859.05 ,$630.07 ,$630.07 ,$581.29 ,$630.07 ,$620.43 ,$652.11 ,$217.31 ,$754.06 ,"$1,744.74 ",$954.50 ,$954.50 ,$252.57 ,$954.50 ,$644.34 ,$906.78 ,$782.69 ,$782.69 ,$763.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000340,64462,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC 2ND AND ADDN ADD ON,360,1 ,$247.25 ,$163.19 ,$56.29 ,"$1,744.74 ","$1,645.98 ",$221.59 ,$221.59 ,$65.42 ,$197.80 ,$210.16 ,$154.53 ,$222.53 ,"$1,645.98 ",$247.25 ,$234.89 ,$222.53 ,$210.16 ,$210.16 ,$65.42 ,$210.16 ,$210.16 ,$222.53 ,$150.58 ,"$1,645.98 ",$153.30 ,$262.09 ,$222.53 , N/A ,$227.47 ,$222.53 ,$163.21 ,$163.21 ,$150.58 ,$163.21 ,$160.71 ,$168.92 ,$56.29 ,$195.33 ,"$1,744.74 ",$247.25 ,$247.25 ,$65.42 ,$247.25 , N/A ,$234.89 ,$202.75 ,$202.75 ,$197.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000341,64463,HC PARAVERTEBRAL PARASPINE BLOCK THORACIC CATH CONTINUOUS,360,1 ,$910.80 ,$601.13 ,$207.34 ,"$1,744.74 ","$1,645.98 ",$816.26 ,$816.26 ,$241.00 ,$728.64 ,$774.18 ,$569.25 ,$819.72 ,"$1,645.98 ",$910.80 ,$865.26 ,$819.72 ,$774.18 ,$774.18 ,$241.00 ,$774.18 ,$774.18 ,$819.72 ,$554.68 ,"$1,645.98 ",$564.70 ,$965.45 ,$819.72 ,"$1,449.77 ",$837.94 ,$819.72 ,$601.22 ,$601.22 ,$554.68 ,$601.22 ,$592.02 ,$622.26 ,$207.34 ,$719.53 ,"$1,744.74 ",$910.80 ,$910.80 ,$241.00 ,$910.80 ,$644.34 ,$865.26 ,$746.86 ,$746.86 ,$728.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000569,64486,HC TAP BLOCK W/INJ UNILT,360,1 ,"$1,090.20 ",$719.53 ,$248.19 ,"$1,090.20 ",$766.50 ,$977.04 ,$977.04 ,$288.46 ,$872.16 ,$926.67 ,$681.38 ,$981.18 ,$766.50 ,$766.50 ,"$1,035.69 ",$981.18 ,$926.67 ,$926.67 ,$288.46 ,$926.67 ,$926.67 ,$981.18 ,$663.93 ,$766.50 ,$675.92 ,$812.49 ,$981.18 , N/A ,"$1,002.98 ",$981.18 ,$719.64 ,$719.64 ,$663.93 ,$719.64 ,$708.63 ,$744.82 ,$248.19 ,$861.26 ,$812.49 ,$635.00 ,$635.00 ,$288.46 ,$697.00 , N/A ,"$1,035.69 ",$893.96 ,$893.96 ,$872.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000718,64449,HC NERVE BLOCK INJ LUMBAR PLEXUS CONTINUOUS,360,1 ,$941.85 ,$621.62 ,$214.42 ,"$2,177.69 ","$2,054.42 ",$844.09 ,$844.09 ,$249.21 ,$753.48 ,$800.57 ,$588.66 ,$847.67 ,"$2,054.42 ",$941.85 ,$894.76 ,$847.67 ,$800.57 ,$800.57 ,$249.21 ,$800.57 ,$800.57 ,$847.67 ,$573.59 ,"$2,054.42 ",$583.94 ,$998.36 ,$847.67 ,"$1,917.41 ",$866.50 ,$847.67 ,$621.72 ,$621.72 ,$573.59 ,$621.72 ,$612.20 ,$643.47 ,$214.42 ,$744.06 ,"$2,177.69 ",$941.85 ,$941.85 ,$249.21 ,$941.85 ,$852.18 ,$894.76 ,$772.32 ,$772.32 ,$753.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),36000720,64446,HC NERVE BLOCK SCIATIC CONTINUOUS INFUSION,360,1 ,"$2,837.05 ","$1,872.45 ",$645.87 ,"$2,837.05 ","$2,054.42 ","$2,542.56 ","$2,542.56 ",$750.68 ,"$2,269.64 ","$2,411.49 ","$1,773.16 ","$2,553.35 ","$2,054.42 ","$2,054.42 ","$2,695.20 ","$2,553.35 ","$2,411.49 ","$2,411.49 ",$750.68 ,"$2,411.49 ","$2,411.49 ","$2,553.35 ","$1,727.76 ","$2,054.42 ","$1,758.98 ","$2,177.69 ","$2,553.35 ","$1,917.41 ","$2,610.09 ","$2,553.35 ","$1,872.74 ","$1,872.74 ","$1,727.76 ","$1,872.74 ","$1,844.08 ","$1,938.27 ",$645.87 ,"$2,241.27 ","$2,177.69 ","$1,974.00 ","$1,974.00 ",$750.68 ,"$2,047.00 ",$852.18 ,"$2,695.20 ","$2,326.38 ","$2,326.38 ","$2,269.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36000761,54115,HC REMOVAL FOREIGN BODY DEEP PENILE TISSUE,360,1 ,"$8,462.85 ","$5,585.48 ","$1,926.60 ","$8,462.85 ","$3,773.76 ","$7,584.41 ","$7,584.41 ","$2,239.27 ","$6,770.28 ","$7,193.42 ","$5,289.28 ","$7,616.57 ","$3,773.76 ","$3,773.76 ","$8,039.71 ","$7,616.57 ","$7,193.42 ","$7,193.42 ","$2,239.27 ","$7,193.42 ","$7,193.42 ","$7,616.57 ","$5,153.88 ","$3,773.76 ","$5,246.96 ","$4,000.19 ","$7,616.57 ","$5,812.31 ","$7,785.82 ","$7,616.57 ","$5,586.33 ","$5,586.33 ","$5,153.88 ","$5,586.33 ","$5,500.85 ","$5,781.82 ","$1,926.60 ","$6,685.65 ","$4,000.19 ","$2,895.00 ","$2,895.00 ","$2,239.27 ","$3,415.00 ","$2,583.25 ","$8,039.71 ","$6,939.54 ","$6,939.54 ","$6,770.28 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36010060,N/A,HC ENDOSCOPY PROCEDURE LEVEL I,360,1 ,"$3,172.58 ","$2,093.90 ",$722.25 ,"$3,172.58 ", N/A ,"$2,843.27 ","$2,843.27 ",$839.47 ,"$2,538.06 ","$2,696.69 ","$1,982.86 ","$2,855.32 ", N/A , N/A ,"$3,013.95 ","$2,855.32 ","$2,696.69 ","$2,696.69 ",$839.47 ,"$2,696.69 ","$2,696.69 ","$2,855.32 ","$1,932.10 ", N/A ,"$1,967.00 ", N/A ,"$2,855.32 ", N/A ,"$2,918.77 ","$2,855.32 ","$2,094.22 ","$2,094.22 ","$1,932.10 ","$2,094.22 ","$2,062.18 ","$2,167.51 ",$722.25 ,"$2,506.34 ", N/A , N/A , N/A ,$839.47 , N/A , N/A ,"$3,013.95 ","$2,601.52 ","$2,601.52 ","$2,538.06 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36010061,N/A,HC ENDOSCOPY PROCEDURE LEVEL 1 SECONDARY,360,1 ,"$1,357.86 ",$896.19 ,$309.12 ,"$1,357.86 ", N/A ,"$1,216.91 ","$1,216.91 ",$359.29 ,"$1,086.29 ","$1,154.18 ",$848.66 ,"$1,222.07 ", N/A , N/A ,"$1,289.97 ","$1,222.07 ","$1,154.18 ","$1,154.18 ",$359.29 ,"$1,154.18 ","$1,154.18 ","$1,222.07 ",$826.94 , N/A ,$841.88 , N/A ,"$1,222.07 ", N/A ,"$1,249.23 ","$1,222.07 ",$896.32 ,$896.32 ,$826.94 ,$896.32 ,$882.61 ,$927.69 ,$309.12 ,"$1,072.71 ", N/A , N/A , N/A ,$359.29 , N/A , N/A ,"$1,289.97 ","$1,113.45 ","$1,113.45 ","$1,086.29 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36030112,N/A,HC DENTAL 0-90 MIN ASC,360,1 ,"$7,011.90 ","$4,627.85 ","$1,596.29 ","$7,011.90 ", N/A ,"$6,284.06 ","$6,284.06 ","$1,855.35 ","$5,609.52 ","$5,960.12 ","$4,382.44 ","$6,310.71 ", N/A , N/A ,"$6,661.31 ","$6,310.71 ","$5,960.12 ","$5,960.12 ","$1,855.35 ","$5,960.12 ","$5,960.12 ","$6,310.71 ","$4,270.25 ", N/A ,"$4,347.38 ", N/A ,"$6,310.71 ", N/A ,"$6,450.95 ","$6,310.71 ","$4,628.56 ","$4,628.56 ","$4,270.25 ","$4,628.56 ","$4,557.74 ","$4,790.53 ","$1,596.29 ","$5,539.40 ", N/A , N/A , N/A ,"$1,855.35 ", N/A , N/A ,"$6,661.31 ","$5,749.76 ","$5,749.76 ","$5,609.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36030113,N/A,HC DENTAL 91-150 MIN ASC,360,1 ,"$1,335.60 ",$881.50 ,$304.05 ,"$1,335.60 ", N/A ,"$1,196.96 ","$1,196.96 ",$353.40 ,"$1,068.48 ","$1,135.26 ",$834.75 ,"$1,202.04 ", N/A , N/A ,"$1,268.82 ","$1,202.04 ","$1,135.26 ","$1,135.26 ",$353.40 ,"$1,135.26 ","$1,135.26 ","$1,202.04 ",$813.38 , N/A ,$828.08 , N/A ,"$1,202.04 ", N/A ,"$1,228.75 ","$1,202.04 ",$881.63 ,$881.63 ,$813.38 ,$881.63 ,$868.14 ,$912.48 ,$304.05 ,"$1,055.12 ", N/A , N/A , N/A ,$353.40 , N/A , N/A ,"$1,268.82 ","$1,095.19 ","$1,095.19 ","$1,068.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36030114,N/A,HC DENTAL 151 AND GREATER ASC,360,1 ,"$2,003.40 ","$1,322.24 ",$456.08 ,"$2,003.40 ", N/A ,"$1,795.45 ","$1,795.45 ",$530.10 ,"$1,602.72 ","$1,702.89 ","$1,252.13 ","$1,803.06 ", N/A , N/A ,"$1,903.23 ","$1,803.06 ","$1,702.89 ","$1,702.89 ",$530.10 ,"$1,702.89 ","$1,702.89 ","$1,803.06 ","$1,220.07 ", N/A ,"$1,242.10 ", N/A ,"$1,803.06 ", N/A ,"$1,843.13 ","$1,803.06 ","$1,322.44 ","$1,322.44 ","$1,220.07 ","$1,322.44 ","$1,302.21 ","$1,368.72 ",$456.08 ,"$1,582.69 ", N/A , N/A , N/A ,$530.10 , N/A , N/A ,"$1,903.23 ","$1,642.79 ","$1,642.79 ","$1,602.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36040025,N/A,HC SURGICAL SUITE PER 15 MINS,360,1 ,"$1,257.29 ",$829.81 ,$286.23 ,"$1,257.29 ", N/A ,"$1,126.78 ","$1,126.78 ",$332.68 ,"$1,005.83 ","$1,068.70 ",$785.81 ,"$1,131.56 ", N/A , N/A ,"$1,194.43 ","$1,131.56 ","$1,068.70 ","$1,068.70 ",$332.68 ,"$1,068.70 ","$1,068.70 ","$1,131.56 ",$765.69 , N/A ,$779.52 , N/A ,"$1,131.56 ", N/A ,"$1,156.71 ","$1,131.56 ",$829.94 ,$829.94 ,$765.69 ,$829.94 ,$817.24 ,$858.98 ,$286.23 ,$993.26 , N/A , N/A , N/A ,$332.68 , N/A , N/A ,"$1,194.43 ","$1,030.98 ","$1,030.98 ","$1,005.83 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36050017,N/A,HC BANDAGE COBAN 4IN STERILE,272,1 ,$11.00 ,$7.26 ,$2.51 ,$11.00 , N/A ,$9.86 ,$9.86 ,$2.91 ,$8.80 ,$9.35 ,$6.88 ,$9.90 , N/A , N/A ,$10.45 ,$9.90 ,$9.35 ,$9.35 ,$2.91 ,$9.35 ,$9.35 ,$9.90 ,$6.70 , N/A ,$6.82 , N/A ,$9.90 , N/A ,$10.12 ,$9.90 ,$7.26 ,$7.26 ,$6.70 ,$7.26 ,$7.15 ,$7.52 ,$2.51 ,$8.69 , N/A ,$5.39 ,$5.39 ,$2.91 ,$5.39 , N/A ,$10.45 ,$9.02 ,$9.02 ,$8.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050019,N/A,HC BANDAGE COBAN 6IN STERILE,272,1 ,$16.69 ,$11.02 ,$3.80 ,$16.69 , N/A ,$14.96 ,$14.96 ,$4.42 ,$13.35 ,$14.19 ,$10.43 ,$15.02 , N/A , N/A ,$15.86 ,$15.02 ,$14.19 ,$14.19 ,$4.42 ,$14.19 ,$14.19 ,$15.02 ,$10.16 , N/A ,$10.34 , N/A ,$15.02 , N/A ,$15.35 ,$15.02 ,$11.02 ,$11.02 ,$10.16 ,$11.02 ,$10.85 ,$11.40 ,$3.80 ,$13.19 , N/A ,$8.18 ,$8.18 ,$4.42 ,$8.18 , N/A ,$15.86 ,$13.69 ,$13.69 ,$13.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050034,C9363,HC BILAYER MATRIX WOUND DRESS PER SQCM,278,1 ,"$1,811.00 ","$1,195.26 ",$412.29 ,"$1,811.00 ", N/A ,"$1,623.02 ","$1,623.02 ",$479.19 ,"$1,448.80 ","$1,539.35 ","$1,131.88 ","$1,629.90 ", N/A , N/A ,"$1,720.45 ","$1,629.90 ","$1,539.35 ","$1,539.35 ",$479.19 ,"$1,539.35 ","$1,539.35 ","$1,629.90 ","$1,102.90 ", N/A ,"$1,122.82 ", N/A ,"$1,629.90 ", N/A ,"$1,666.12 ","$1,629.90 ","$1,195.44 ","$1,195.44 ","$1,102.90 ","$1,195.44 ","$1,177.15 ","$1,237.28 ",$412.29 ,"$1,430.69 ", N/A , N/A , N/A ,$479.19 , 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 ,$51.42 ,$33.94 ,$11.71 ,$51.42 , N/A ,$46.08 ,$46.08 ,$13.60 ,$41.14 ,$43.71 ,$32.14 ,$46.28 , N/A , N/A ,$48.85 ,$46.28 ,$43.71 ,$43.71 ,$13.60 ,$43.71 ,$43.71 ,$46.28 ,$31.31 , N/A ,$31.88 , N/A ,$46.28 , N/A ,$47.31 ,$46.28 ,$33.94 ,$33.94 ,$31.31 ,$33.94 ,$33.42 ,$35.13 ,$11.71 ,$40.62 , N/A ,$25.20 ,$25.20 ,$13.60 ,$25.20 , N/A ,$48.85 ,$42.16 ,$42.16 ,$41.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050113,N/A,HC DRSG FLAT COTTON,272,1 ,$31.50 ,$20.79 ,$7.17 ,$31.50 , N/A ,$28.23 ,$28.23 ,$8.34 ,$25.20 ,$26.78 ,$19.69 ,$28.35 , N/A , N/A ,$29.93 ,$28.35 ,$26.78 ,$26.78 ,$8.34 ,$26.78 ,$26.78 ,$28.35 ,$19.18 , N/A ,$19.54 , N/A ,$28.35 , N/A ,$28.98 ,$28.35 ,$20.79 ,$20.79 ,$19.18 ,$20.79 ,$20.48 ,$21.52 ,$7.17 ,$24.89 , N/A ,$15.44 ,$15.44 ,$8.34 ,$15.44 , N/A ,$29.93 ,$25.83 ,$25.83 ,$25.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050117,N/A,HC ELECTRODE LIGASURE SEALER/DIV,360,1 ,"$1,747.94 ","$1,153.64 ",$397.93 ,"$1,747.94 ", N/A ,"$1,566.50 ","$1,566.50 ",$462.50 ,"$1,398.35 ","$1,485.75 ","$1,092.46 ","$1,573.15 ", N/A , N/A ,"$1,660.54 ","$1,573.15 ","$1,485.75 ","$1,485.75 ",$462.50 ,"$1,485.75 ","$1,485.75 ","$1,573.15 ","$1,064.50 ", N/A ,"$1,083.72 ", N/A ,"$1,573.15 ", N/A ,"$1,608.10 ","$1,573.15 ","$1,153.82 ","$1,153.82 ","$1,064.50 ","$1,153.82 ","$1,136.16 ","$1,194.19 ",$397.93 ,"$1,380.87 ", N/A , N/A , N/A ,$462.50 , N/A , N/A ,"$1,660.54 ","$1,433.31 ","$1,433.31 ","$1,398.35 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36050199,N/A,HC PACK BASIC,360,1 ,$127.20 ,$83.95 ,$28.96 ,$127.20 , N/A ,$114.00 ,$114.00 ,$33.65 ,$101.76 ,$108.12 ,$79.50 ,$114.48 , N/A , N/A ,$120.84 ,$114.48 ,$108.12 ,$108.12 ,$33.65 ,$108.12 ,$108.12 ,$114.48 ,$77.46 , N/A ,$78.86 , N/A ,$114.48 , N/A ,$117.02 ,$114.48 ,$83.96 ,$83.96 ,$77.46 ,$83.96 ,$82.68 ,$86.90 ,$28.96 ,$100.49 , N/A , N/A , N/A ,$33.65 , N/A , N/A ,$120.84 ,$104.30 ,$104.30 ,$101.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050200,N/A,HC PACK ORTHO,360,1 ,$76.32 ,$50.37 ,$17.38 ,$76.32 , N/A ,$68.40 ,$68.40 ,$20.20 ,$61.06 ,$64.87 ,$47.70 ,$68.69 , N/A , N/A ,$72.50 ,$68.69 ,$64.87 ,$64.87 ,$20.20 ,$64.87 ,$64.87 ,$68.69 ,$46.48 , N/A ,$47.32 , N/A ,$68.69 , N/A ,$70.21 ,$68.69 ,$50.38 ,$50.38 ,$46.48 ,$50.38 ,$49.61 ,$52.14 ,$17.38 ,$60.29 , N/A , N/A , N/A ,$20.20 , N/A , N/A ,$72.50 ,$62.58 ,$62.58 ,$61.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050216,N/A,HC PACK SHOULDER,360,1 ,$79.50 ,$52.47 ,$18.10 ,$79.50 , N/A ,$71.25 ,$71.25 ,$21.04 ,$63.60 ,$67.58 ,$49.69 ,$71.55 , N/A , N/A ,$75.53 ,$71.55 ,$67.58 ,$67.58 ,$21.04 ,$67.58 ,$67.58 ,$71.55 ,$48.42 , N/A ,$49.30 , N/A ,$71.55 , N/A ,$73.14 ,$71.55 ,$52.48 ,$52.48 ,$48.42 ,$52.48 ,$51.68 ,$54.31 ,$18.10 ,$62.81 , N/A , N/A , N/A ,$21.04 , N/A , N/A ,$75.53 ,$65.19 ,$65.19 ,$63.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),36050625,N/A,HC LOCAL ANESTHETIC,360,1 ,$172.78 ,$114.03 ,$39.34 ,$172.78 , N/A ,$154.85 ,$154.85 ,$45.72 ,$138.22 ,$146.86 ,$107.99 ,$155.50 , N/A , N/A ,$164.14 ,$155.50 ,$146.86 ,$146.86 ,$45.72 ,$146.86 ,$146.86 ,$155.50 ,$105.22 , N/A ,$107.12 , N/A ,$155.50 , N/A ,$158.96 ,$155.50 ,$114.05 ,$114.05 ,$105.22 ,$114.05 ,$112.31 ,$118.04 ,$39.34 ,$136.50 , N/A , N/A , N/A ,$45.72 , N/A , N/A ,$164.14 ,$141.68 ,$141.68 ,$138.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),36060001,N/A,HC OR LEVEL 1 BASE,360,1 ,"$4,006.80 ","$2,644.49 ",$912.16 ,"$4,006.80 ", N/A ,"$3,590.89 ","$3,590.89 ","$1,060.20 ","$3,205.44 ","$3,405.78 ","$2,504.25 ","$3,606.12 ", N/A , N/A ,"$3,806.46 ","$3,606.12 ","$3,405.78 ","$3,405.78 ","$1,060.20 ","$3,405.78 ","$3,405.78 ","$3,606.12 ","$2,440.14 ", N/A ,"$2,484.22 ", N/A ,"$3,606.12 ", N/A ,"$3,686.26 ","$3,606.12 ","$2,644.89 ","$2,644.89 ","$2,440.14 ","$2,644.89 ","$2,604.42 ","$2,737.45 ",$912.16 ,"$3,165.37 ", N/A , N/A , N/A ,"$1,060.20 ", N/A , N/A ,"$3,806.46 ","$3,285.58 ","$3,285.58 ","$3,205.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36060002,N/A,HC OR LEVEL 2 BASE,360,1 ,"$5,787.60 ","$3,819.82 ","$1,317.57 ","$5,787.60 ", N/A ,"$5,186.85 ","$5,186.85 ","$1,531.40 ","$4,630.08 ","$4,919.46 ","$3,617.25 ","$5,208.84 ", N/A , N/A ,"$5,498.22 ","$5,208.84 ","$4,919.46 ","$4,919.46 ","$1,531.40 ","$4,919.46 ","$4,919.46 ","$5,208.84 ","$3,524.65 ", N/A ,"$3,588.32 ", N/A ,"$5,208.84 ", N/A ,"$5,324.59 ","$5,208.84 ","$3,820.39 ","$3,820.39 ","$3,524.65 ","$3,820.39 ","$3,761.94 ","$3,954.09 ","$1,317.57 ","$4,572.20 ", N/A , N/A , N/A ,"$1,531.40 ", N/A , N/A ,"$5,498.22 ","$4,745.83 ","$4,745.83 ","$4,630.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36060003,N/A,HC OR LEVEL 3 BASE,360,1 ,"$7,457.10 ","$4,921.69 ","$1,697.63 ","$7,457.10 ", N/A ,"$6,683.05 ","$6,683.05 ","$1,973.15 ","$5,965.68 ","$6,338.54 ","$4,660.69 ","$6,711.39 ", N/A , N/A ,"$7,084.25 ","$6,711.39 ","$6,338.54 ","$6,338.54 ","$1,973.15 ","$6,338.54 ","$6,338.54 ","$6,711.39 ","$4,541.37 ", N/A ,"$4,623.40 ", N/A ,"$6,711.39 ", N/A ,"$6,860.53 ","$6,711.39 ","$4,922.43 ","$4,922.43 ","$4,541.37 ","$4,922.43 ","$4,847.12 ","$5,094.69 ","$1,697.63 ","$5,891.11 ", N/A , N/A , N/A ,"$1,973.15 ", N/A , N/A ,"$7,084.25 ","$6,114.82 ","$6,114.82 ","$5,965.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36060004,N/A,HC OR LEVEL 4 BASE,360,1 ,"$10,350.90 ","$6,831.59 ","$2,356.43 ","$10,350.90 ", N/A ,"$9,276.48 ","$9,276.48 ","$2,738.85 ","$8,280.72 ","$8,798.27 ","$6,469.31 ","$9,315.81 ", N/A , N/A ,"$9,833.36 ","$9,315.81 ","$8,798.27 ","$8,798.27 ","$2,738.85 ","$8,798.27 ","$8,798.27 ","$9,315.81 ","$6,303.70 ", N/A ,"$6,417.56 ", N/A ,"$9,315.81 ", N/A ,"$9,522.83 ","$9,315.81 ","$6,832.63 ","$6,832.63 ","$6,303.70 ","$6,832.63 ","$6,728.09 ","$7,071.73 ","$2,356.43 ","$8,177.21 ", N/A , N/A , N/A ,"$2,738.85 ", N/A , N/A ,"$9,833.36 ","$8,487.74 ","$8,487.74 ","$8,280.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36060005,N/A,HC OR LEVEL 5 BASE,360,1 ,"$12,243.00 ","$8,080.38 ","$2,787.17 ","$12,243.00 ", N/A ,"$10,972.18 ","$10,972.18 ","$3,239.50 ","$9,794.40 ","$10,406.55 ","$7,651.88 ","$11,018.70 ", N/A , N/A ,"$11,630.85 ","$11,018.70 ","$10,406.55 ","$10,406.55 ","$3,239.50 ","$10,406.55 ","$10,406.55 ","$11,018.70 ","$7,455.99 ", N/A ,"$7,590.66 ", N/A ,"$11,018.70 ", N/A ,"$11,263.56 ","$11,018.70 ","$8,081.60 ","$8,081.60 ","$7,455.99 ","$8,081.60 ","$7,957.95 ","$8,364.42 ","$2,787.17 ","$9,671.97 ", N/A , N/A , N/A ,"$3,239.50 ", N/A , N/A ,"$11,630.85 ","$10,039.26 ","$10,039.26 ","$9,794.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36060007,N/A,HC OR LEVEL 1 PER MIN,360,1 ,$16.70 ,$11.02 ,$3.80 ,$16.70 , N/A ,$14.97 ,$14.97 ,$4.42 ,$13.36 ,$14.20 ,$10.44 ,$15.03 , N/A , N/A ,$15.87 ,$15.03 ,$14.20 ,$14.20 ,$4.42 ,$14.20 ,$14.20 ,$15.03 ,$10.17 , N/A ,$10.36 , N/A ,$15.03 , N/A ,$15.36 ,$15.03 ,$11.02 ,$11.02 ,$10.17 ,$11.02 ,$10.86 ,$11.41 ,$3.80 ,$13.19 , N/A , N/A , N/A ,$4.42 , N/A , N/A ,$15.87 ,$13.69 ,$13.69 ,$13.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),36060008,N/A,HC OR LEVEL 2 PER MIN,360,1 ,$40.28 ,$26.58 ,$9.16 ,$40.28 , N/A ,$36.10 ,$36.10 ,$10.66 ,$32.22 ,$34.24 ,$25.18 ,$36.25 , N/A , N/A ,$38.27 ,$36.25 ,$34.24 ,$34.24 ,$10.66 ,$34.24 ,$34.24 ,$36.25 ,$24.53 , N/A ,$24.98 , N/A ,$36.25 , N/A ,$37.06 ,$36.25 ,$26.59 ,$26.59 ,$24.53 ,$26.59 ,$26.18 ,$27.52 ,$9.16 ,$31.82 , N/A , N/A , N/A ,$10.66 , N/A , N/A ,$38.27 ,$33.03 ,$33.03 ,$32.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),36060009,N/A,HC OR LEVEL 3 PER MIN,360,1 ,$56.18 ,$37.08 ,$12.79 ,$56.18 , N/A ,$50.35 ,$50.35 ,$14.87 ,$44.94 ,$47.75 ,$35.11 ,$50.56 , N/A , N/A ,$53.37 ,$50.56 ,$47.75 ,$47.75 ,$14.87 ,$47.75 ,$47.75 ,$50.56 ,$34.21 , N/A ,$34.84 , N/A ,$50.56 , N/A ,$51.69 ,$50.56 ,$37.08 ,$37.08 ,$34.21 ,$37.08 ,$36.52 ,$38.38 ,$12.79 ,$44.38 , N/A , N/A , N/A ,$14.87 , N/A , N/A ,$53.37 ,$46.07 ,$46.07 ,$44.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),36060010,N/A,HC OR LEVEL 4 PER MIN,360,1 ,$89.04 ,$58.77 ,$20.27 ,$89.04 , N/A ,$79.80 ,$79.80 ,$23.56 ,$71.23 ,$75.68 ,$55.65 ,$80.14 , N/A , N/A ,$84.59 ,$80.14 ,$75.68 ,$75.68 ,$23.56 ,$75.68 ,$75.68 ,$80.14 ,$54.23 , N/A ,$55.20 , N/A ,$80.14 , N/A ,$81.92 ,$80.14 ,$58.78 ,$58.78 ,$54.23 ,$58.78 ,$57.88 ,$60.83 ,$20.27 ,$70.34 , N/A , N/A , N/A ,$23.56 , N/A , N/A ,$84.59 ,$73.01 ,$73.01 ,$71.23 
ST. CLARE MEMORIAL HOSPITAL (ACU),36060011,N/A,HC OR LEVEL 5 PER MIN,360,1 ,$100.70 ,$66.46 ,$22.92 ,$100.70 , N/A ,$90.25 ,$90.25 ,$26.65 ,$80.56 ,$85.60 ,$62.94 ,$90.63 , N/A , N/A ,$95.67 ,$90.63 ,$85.60 ,$85.60 ,$26.65 ,$85.60 ,$85.60 ,$90.63 ,$61.33 , N/A ,$62.44 , N/A ,$90.63 , N/A ,$92.64 ,$90.63 ,$66.47 ,$66.47 ,$61.33 ,$66.47 ,$65.46 ,$68.80 ,$22.92 ,$79.55 , N/A , N/A , N/A ,$26.65 , N/A , N/A ,$95.67 ,$82.57 ,$82.57 ,$80.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080000,N/A,HC SURGERY CARE PREOP CMH,360,1 ,$345.56 ,$228.07 ,$78.66 ,$345.56 , N/A ,$309.69 ,$309.69 ,$91.43 ,$276.45 ,$293.73 ,$215.98 ,$311.00 , N/A , N/A ,$328.28 ,$311.00 ,$293.73 ,$293.73 ,$91.43 ,$293.73 ,$293.73 ,$311.00 ,$210.45 , N/A ,$214.24 , N/A ,$311.00 , N/A ,$317.92 ,$311.00 ,$228.10 ,$228.10 ,$210.45 ,$228.10 ,$224.61 ,$236.09 ,$78.66 ,$272.99 , N/A , N/A , N/A ,$91.43 , N/A , N/A ,$328.28 ,$283.36 ,$283.36 ,$276.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080003,N/A,HC GI PRE OP W/O IV,360,1 ,$183.38 ,$121.03 ,$41.75 ,$183.38 , N/A ,$164.35 ,$164.35 ,$48.52 ,$146.70 ,$155.87 ,$114.61 ,$165.04 , N/A , N/A ,$174.21 ,$165.04 ,$155.87 ,$155.87 ,$48.52 ,$155.87 ,$155.87 ,$165.04 ,$111.68 , N/A ,$113.70 , N/A ,$165.04 , N/A ,$168.71 ,$165.04 ,$121.05 ,$121.05 ,$111.68 ,$121.05 ,$119.20 ,$125.29 ,$41.75 ,$144.87 , N/A , N/A , N/A ,$48.52 , N/A , N/A ,$174.21 ,$150.37 ,$150.37 ,$146.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$1,053.40 ",$695.24 ,$239.81 ,"$2,177.69 ","$2,054.42 ",$944.06 ,$944.06 ,$278.73 ,$842.72 ,$895.39 ,$658.38 ,$948.06 ,"$2,054.42 ","$1,053.40 ","$1,000.73 ",$948.06 ,$895.39 ,$895.39 ,$278.73 ,$895.39 ,$895.39 ,$948.06 ,$641.52 ,"$2,054.42 ",$653.10 ,"$1,116.60 ",$948.06 ,"$1,917.41 ",$969.13 ,$948.06 ,$695.35 ,$695.35 ,$641.52 ,$695.35 ,$684.71 ,$719.68 ,$239.81 ,$832.19 ,"$2,177.69 ","$1,053.40 ","$1,053.40 ",$278.73 ,"$1,053.40 ",$852.18 ,"$1,000.73 ",$863.79 ,$863.79 ,$842.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080009,64447,HC NERVE FEMORAL BLOCK CMH PAIN,360,1 ,$768.20 ,$507.01 ,$174.89 ,"$1,449.77 ",$766.50 ,$688.46 ,$688.46 ,$203.26 ,$614.56 ,$652.97 ,$480.13 ,$691.38 ,$766.50 ,$766.50 ,$729.79 ,$691.38 ,$652.97 ,$652.97 ,$203.26 ,$652.97 ,$652.97 ,$691.38 ,$467.83 ,$766.50 ,$476.28 ,$812.49 ,$691.38 ,"$1,449.77 ",$706.74 ,$691.38 ,$507.09 ,$507.09 ,$467.83 ,$507.09 ,$499.33 ,$524.83 ,$174.89 ,$606.88 ,$812.49 ,$768.20 ,$768.20 ,$203.26 ,$768.20 ,$644.34 ,$729.79 ,$629.92 ,$629.92 ,$614.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),36080010,64455,HC INJ ANES AGENT DIGITAL NERVES,360,1 ,$656.65 ,$433.39 ,$149.49 ,$812.49 ,$766.50 ,$588.49 ,$588.49 ,$173.75 ,$525.32 ,$558.15 ,$410.41 ,$590.99 ,$766.50 ,$656.65 ,$623.82 ,$590.99 ,$558.15 ,$558.15 ,$173.75 ,$558.15 ,$558.15 ,$590.99 ,$399.90 ,$766.50 ,$407.12 ,$696.05 ,$590.99 ,$611.75 ,$604.12 ,$590.99 ,$433.45 ,$433.45 ,$399.90 ,$433.45 ,$426.82 ,$448.62 ,$149.49 ,$518.75 ,$812.49 ,$635.00 ,$635.00 ,$173.75 ,$656.65 ,$271.89 ,$623.82 ,$538.45 ,$538.45 ,$525.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,744.74 ","$1,645.98 ","$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ","$1,645.98 ","$1,486.95 ","$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,"$1,645.98 ",$921.90 ,"$1,576.17 ","$1,338.26 ","$1,449.77 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ","$1,744.74 ","$1,486.95 ","$1,486.95 ",$393.45 ,"$1,486.95 ",$644.34 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$2,354.05 ","$1,553.67 ",$535.90 ,"$2,354.05 ","$1,645.98 ","$2,109.70 ","$2,109.70 ",$622.88 ,"$1,883.24 ","$2,000.94 ","$1,471.28 ","$2,118.65 ","$1,645.98 ","$1,645.98 ","$2,236.35 ","$2,118.65 ","$2,000.94 ","$2,000.94 ",$622.88 ,"$2,000.94 ","$2,000.94 ","$2,118.65 ","$1,433.62 ","$1,645.98 ","$1,459.52 ","$1,744.74 ","$2,118.65 ","$1,449.77 ","$2,165.73 ","$2,118.65 ","$1,553.91 ","$1,553.91 ","$1,433.62 ","$1,553.91 ","$1,530.13 ","$1,608.29 ",$535.90 ,"$1,859.70 ","$1,744.74 ","$1,974.00 ","$1,974.00 ",$622.88 ,"$2,047.00 ",$644.34 ,"$2,236.35 ","$1,930.32 ","$1,930.32 ","$1,883.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,917.41 ","$1,645.98 ","$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ","$1,645.98 ","$1,486.95 ","$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,"$1,645.98 ",$921.90 ,"$1,576.17 ","$1,338.26 ","$1,917.41 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ","$1,744.74 ","$1,486.95 ","$1,486.95 ",$393.45 ,"$1,486.95 ",$852.18 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$1,858.40 ","$1,226.54 ",$423.07 ,"$1,858.40 ","$1,645.98 ","$1,665.50 ","$1,665.50 ",$491.73 ,"$1,486.72 ","$1,579.64 ","$1,161.50 ","$1,672.56 ","$1,645.98 ","$1,645.98 ","$1,765.48 ","$1,672.56 ","$1,579.64 ","$1,579.64 ",$491.73 ,"$1,579.64 ","$1,579.64 ","$1,672.56 ","$1,131.77 ","$1,645.98 ","$1,152.20 ","$1,744.74 ","$1,672.56 ","$1,449.77 ","$1,709.73 ","$1,672.56 ","$1,226.73 ","$1,226.73 ","$1,131.77 ","$1,226.73 ","$1,207.96 ","$1,269.66 ",$423.07 ,"$1,468.14 ","$1,744.74 ","$1,858.40 ","$1,858.40 ",$491.73 ,"$1,858.40 ",$644.34 ,"$1,765.48 ","$1,523.89 ","$1,523.89 ","$1,486.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,917.41 ","$1,645.98 ","$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ","$1,645.98 ","$1,486.95 ","$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,"$1,645.98 ",$921.90 ,"$1,576.17 ","$1,338.26 ","$1,917.41 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ","$1,744.74 ","$1,486.95 ","$1,486.95 ",$393.45 ,"$1,486.95 ",$852.18 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100148,64488,HC INJ TAP BLOCK W/GUIDE- BIL,361,1 ,"$1,207.50 ",$796.95 ,$274.90 ,"$1,207.50 ",$766.50 ,"$1,082.16 ","$1,082.16 ",$319.51 ,$966.00 ,"$1,026.38 ",$754.69 ,"$1,086.75 ",$766.50 ,$766.50 ,"$1,147.13 ","$1,086.75 ","$1,026.38 ","$1,026.38 ",$319.51 ,"$1,026.38 ","$1,026.38 ","$1,086.75 ",$735.37 ,$766.50 ,$748.66 ,$812.49 ,"$1,086.75 ", N/A ,"$1,110.90 ","$1,086.75 ",$797.07 ,$797.07 ,$735.37 ,$797.07 ,$784.88 ,$824.96 ,$274.90 ,$953.93 ,$812.49 ,$635.00 ,$635.00 ,$319.51 ,$697.00 , N/A ,"$1,147.13 ",$990.15 ,$990.15 ,$966.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100196,64447,HC FEMORAL NERVE BLOCK SINGLE,361,1 ,$768.20 ,$507.01 ,$174.89 ,"$1,449.77 ",$766.50 ,$688.46 ,$688.46 ,$203.26 ,$614.56 ,$652.97 ,$480.13 ,$691.38 ,$766.50 ,$766.50 ,$729.79 ,$691.38 ,$652.97 ,$652.97 ,$203.26 ,$652.97 ,$652.97 ,$691.38 ,$467.83 ,$766.50 ,$476.28 ,$812.49 ,$691.38 ,"$1,449.77 ",$706.74 ,$691.38 ,$507.09 ,$507.09 ,$467.83 ,$507.09 ,$499.33 ,$524.83 ,$174.89 ,$606.88 ,$812.49 ,$768.20 ,$768.20 ,$203.26 ,$768.20 ,$644.34 ,$729.79 ,$629.92 ,$629.92 ,$614.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100232,11103,HC BIOPSY SKIN TANGENTIAL ADDL LESN,361,1 ,$186.30 ,$122.96 ,$42.41 ,$882.73 ,$832.76 ,$166.96 ,$166.96 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$832.76 ,$186.30 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$832.76 ,$115.50 ,$197.48 ,$167.67 , N/A ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$882.73 ,$186.30 ,$186.30 ,$49.29 ,$186.30 , N/A ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100233,11105,HC BIOPSY SKIN PUNCH ADDL LESN,361,1 ,$186.30 ,$122.96 ,$42.41 ,$882.73 ,$832.76 ,$166.96 ,$166.96 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$832.76 ,$186.30 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$832.76 ,$115.50 ,$197.48 ,$167.67 , N/A ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$882.73 ,$186.30 ,$186.30 ,$49.29 ,$186.30 , N/A ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100234,11107,HC BIOPSY SKIN INCISIONAL ADDL LESN,361,1 ,$186.30 ,$122.96 ,$42.41 ,$882.73 ,$832.76 ,$166.96 ,$166.96 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$832.76 ,$186.30 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$832.76 ,$115.50 ,$197.48 ,$167.67 , N/A ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$882.73 ,$186.30 ,$186.30 ,$49.29 ,$186.30 , N/A ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,$384.10 ,$253.51 ,$87.44 ,$882.73 ,$832.76 ,$344.23 ,$344.23 ,$101.64 ,$307.28 ,$326.49 ,$240.06 ,$345.69 ,$832.76 ,$384.10 ,$364.90 ,$345.69 ,$326.49 ,$326.49 ,$101.64 ,$326.49 ,$326.49 ,$345.69 ,$233.92 ,$832.76 ,$238.14 ,$407.15 ,$345.69 ,$406.31 ,$353.37 ,$345.69 ,$253.54 ,$253.54 ,$233.92 ,$253.54 ,$249.67 ,$262.42 ,$87.44 ,$303.44 ,$882.73 ,$384.10 ,$384.10 ,$101.64 ,$384.10 ,$180.58 ,$364.90 ,$314.96 ,$314.96 ,$307.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,$384.10 ,$253.51 ,$87.44 ,$882.73 ,$832.76 ,$344.23 ,$344.23 ,$101.64 ,$307.28 ,$326.49 ,$240.06 ,$345.69 ,$832.76 ,$384.10 ,$364.90 ,$345.69 ,$326.49 ,$326.49 ,$101.64 ,$326.49 ,$326.49 ,$345.69 ,$233.92 ,$832.76 ,$238.14 ,$407.15 ,$345.69 ,$839.41 ,$353.37 ,$345.69 ,$253.54 ,$253.54 ,$233.92 ,$253.54 ,$249.67 ,$262.42 ,$87.44 ,$303.44 ,$882.73 ,$384.10 ,$384.10 ,$101.64 ,$384.10 ,$373.07 ,$364.90 ,$314.96 ,$314.96 ,$307.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,$384.10 ,$253.51 ,$87.44 ,"$1,307.14 ",$832.76 ,$344.23 ,$344.23 ,$101.64 ,$307.28 ,$326.49 ,$240.06 ,$345.69 ,$832.76 ,$384.10 ,$364.90 ,$345.69 ,$326.49 ,$326.49 ,$101.64 ,$326.49 ,$326.49 ,$345.69 ,$233.92 ,$832.76 ,$238.14 ,$407.15 ,$345.69 ,"$1,307.14 ",$353.37 ,$345.69 ,$253.54 ,$253.54 ,$233.92 ,$253.54 ,$249.67 ,$262.42 ,$87.44 ,$303.44 ,$882.73 ,$384.10 ,$384.10 ,$101.64 ,$384.10 ,$580.95 ,$364.90 ,$314.96 ,$314.96 ,$307.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$1,460.18 ","$1,290.13 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$1,290.13 ","$1,290.13 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$1,290.13 ",$844.90 ,"$1,367.54 ","$1,226.48 ","$1,460.18 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$1,367.54 ","$1,362.75 ","$1,362.75 ",$360.58 ,"$1,362.75 ",$648.97 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$681.95 ,$450.09 ,$155.25 ,"$1,367.54 ","$1,290.13 ",$611.16 ,$611.16 ,$180.45 ,$545.56 ,$579.66 ,$426.22 ,$613.76 ,"$1,290.13 ",$681.95 ,$647.85 ,$613.76 ,$579.66 ,$579.66 ,$180.45 ,$579.66 ,$579.66 ,$613.76 ,$415.31 ,"$1,290.13 ",$422.80 ,$722.87 ,$613.76 , N/A ,$627.39 ,$613.76 ,$450.16 ,$450.16 ,$415.31 ,$450.16 ,$443.27 ,$465.91 ,$155.25 ,$538.74 ,"$1,367.54 ",$635.00 ,$635.00 ,$180.45 ,$681.95 , N/A ,$647.85 ,$559.20 ,$559.20 ,$545.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100240,10007,HC ASP FINE NDL W/FLUORO GUIDE INIT LESN,361,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$1,460.18 ","$1,290.13 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$1,290.13 ","$1,290.13 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$1,290.13 ",$844.90 ,"$1,367.54 ","$1,226.48 ","$1,460.18 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$1,367.54 ","$1,362.75 ","$1,362.75 ",$360.58 ,"$1,362.75 ",$648.97 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100241,10008,HC ASP FINE NDL W/FLUORO GUIDE EA ADDL LESN,361,1 ,$681.95 ,$450.09 ,$155.25 ,"$1,367.54 ","$1,290.13 ",$611.16 ,$611.16 ,$180.45 ,$545.56 ,$579.66 ,$426.22 ,$613.76 ,"$1,290.13 ",$681.95 ,$647.85 ,$613.76 ,$579.66 ,$579.66 ,$180.45 ,$579.66 ,$579.66 ,$613.76 ,$415.31 ,"$1,290.13 ",$422.80 ,$722.87 ,$613.76 , N/A ,$627.39 ,$613.76 ,$450.16 ,$450.16 ,$415.31 ,$450.16 ,$443.27 ,$465.91 ,$155.25 ,$538.74 ,"$1,367.54 ",$635.00 ,$635.00 ,$180.45 ,$681.95 , N/A ,$647.85 ,$559.20 ,$559.20 ,$545.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100242,10009,HC ASP FINE NDL W/CT GUIDE INIT LESN,361,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$1,460.18 ","$1,290.13 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$1,290.13 ","$1,290.13 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$1,290.13 ",$844.90 ,"$1,367.54 ","$1,226.48 ","$1,460.18 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$1,367.54 ","$1,362.75 ","$1,362.75 ",$360.58 ,"$1,362.75 ",$648.97 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100243,10010,HC ASP FINE NDL W/CT GUIDE EA ADDL LESN,361,1 ,$681.95 ,$450.09 ,$155.25 ,"$1,367.54 ","$1,290.13 ",$611.16 ,$611.16 ,$180.45 ,$545.56 ,$579.66 ,$426.22 ,$613.76 ,"$1,290.13 ",$681.95 ,$647.85 ,$613.76 ,$579.66 ,$579.66 ,$180.45 ,$579.66 ,$579.66 ,$613.76 ,$415.31 ,"$1,290.13 ",$422.80 ,$722.87 ,$613.76 , N/A ,$627.39 ,$613.76 ,$450.16 ,$450.16 ,$415.31 ,$450.16 ,$443.27 ,$465.91 ,$155.25 ,$538.74 ,"$1,367.54 ",$635.00 ,$635.00 ,$180.45 ,$681.95 , N/A ,$647.85 ,$559.20 ,$559.20 ,$545.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100246,36572,HC INS CATH PERIPH CV W/O PORT W/GUIDANCE <5,361,1 ,"$3,284.40 ","$2,167.70 ",$578.50 ,"$3,284.40 ","$2,105.50 ","$2,943.48 ","$2,943.48 ",$869.05 ,"$2,627.52 ","$2,791.74 ","$2,052.75 ","$2,955.96 ","$2,105.50 ","$2,105.50 ","$3,120.18 ","$2,955.96 ","$2,791.74 ","$2,791.74 ",$869.05 ,"$2,791.74 ","$2,791.74 ","$2,955.96 ","$2,000.20 ","$2,105.50 ","$2,036.32 ","$2,231.83 ","$2,955.96 ","$1,301.63 ","$3,021.65 ","$2,955.96 ","$2,168.03 ","$2,168.03 ","$2,000.20 ","$2,168.03 ","$2,134.86 ","$2,243.90 ",$747.70 ,"$2,594.68 ","$2,231.83 ","$1,974.00 ","$1,974.00 ",$869.05 ,"$2,047.00 ",$578.50 ,"$3,120.18 ","$2,693.21 ","$2,693.21 ","$2,627.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,"$3,592.60 ","$2,371.12 ",$817.87 ,"$3,592.60 ","$2,105.50 ","$3,219.69 ","$3,219.69 ",$950.60 ,"$2,874.08 ","$3,053.71 ","$2,245.38 ","$3,233.34 ","$2,105.50 ","$2,105.50 ","$3,412.97 ","$3,233.34 ","$3,053.71 ","$3,053.71 ",$950.60 ,"$3,053.71 ","$3,053.71 ","$3,233.34 ","$2,187.89 ","$2,105.50 ","$2,227.42 ","$2,231.83 ","$3,233.34 ","$3,347.66 ","$3,305.19 ","$3,233.34 ","$2,371.48 ","$2,371.48 ","$2,187.89 ","$2,371.48 ","$2,335.19 ","$2,454.46 ",$817.87 ,"$2,838.15 ","$2,231.83 ","$2,415.00 ","$2,415.00 ",$950.60 ,"$2,656.00 ","$1,487.85 ","$3,412.97 ","$2,945.93 ","$2,945.93 ","$2,874.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,744.74 ","$1,645.98 ","$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ","$1,645.98 ","$1,486.95 ","$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,"$1,645.98 ",$921.90 ,"$1,576.17 ","$1,338.26 ","$1,449.77 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ","$1,744.74 ","$1,486.95 ","$1,486.95 ",$393.45 ,"$1,486.95 ",$644.34 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100281,32408,HC CORE NDL BX LUNG/MEDIASTINUM PERQ W IMG,361,1 ,"$5,229.05 ","$3,451.17 ","$1,190.42 ","$5,229.05 ","$1,845.03 ","$4,686.27 ","$4,686.27 ","$1,383.60 ","$4,183.24 ","$4,444.69 ","$3,268.16 ","$4,706.15 ","$1,845.03 ","$1,845.03 ","$4,967.60 ","$4,706.15 ","$4,444.69 ","$4,444.69 ","$1,383.60 ","$4,444.69 ","$4,444.69 ","$4,706.15 ","$3,184.49 ","$1,845.03 ","$3,242.02 ","$1,955.73 ","$4,706.15 ","$3,373.99 ","$4,810.73 ","$4,706.15 ","$3,451.70 ","$3,451.70 ","$3,184.49 ","$3,451.70 ","$3,398.88 ","$3,572.49 ","$1,190.42 ","$4,130.95 ","$1,955.73 ","$2,415.00 ","$2,415.00 ","$1,383.60 ","$2,656.00 ","$1,499.55 ","$4,967.60 ","$4,287.82 ","$4,287.82 ","$4,183.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36100284,53060,HC DRAIN OF SKENE GLAND ABS OR CYST,450,1 ,$296.70 ,$195.82 ,$67.54 ,"$5,845.00 ","$5,514.15 ",$265.90 ,$265.90 ,$78.51 ,$237.36 ,$252.20 ,$185.44 ,$267.03 ,"$5,514.15 ",$296.70 ,$281.87 ,$267.03 ,$252.20 ,$252.20 ,$78.51 ,$252.20 ,$252.20 ,$267.03 ,$180.69 ,"$5,514.15 ",$183.96 ,$314.50 ,$267.03 ,"$4,173.48 ",$272.96 ,$267.03 ,$195.85 ,$195.85 ,$180.69 ,$195.85 ,$192.86 ,$202.71 ,$67.54 ,$234.39 ,"$5,845.00 ",$296.70 ,$296.70 ,$78.51 ,$296.70 ,"$1,854.88 ",$281.87 ,$243.29 ,$243.29 ,$237.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),36100286,64489,HC TAP BLOCK BIL BY INFUSION,361,1 ,"$6,149.46 ","$4,058.64 ",$635.00 ,"$6,149.46 ",$766.50 ,"$5,511.15 ","$5,511.15 ","$1,627.14 ","$4,919.57 ","$5,227.04 ","$3,843.41 ","$5,534.51 ",$766.50 ,$766.50 ,"$5,841.99 ","$5,534.51 ","$5,227.04 ","$5,227.04 ","$1,627.14 ","$5,227.04 ","$5,227.04 ","$5,534.51 ","$3,745.02 ",$766.50 ,"$3,812.66 ",$812.49 ,"$5,534.51 ", N/A ,"$5,657.50 ","$5,534.51 ","$4,059.26 ","$4,059.26 ","$3,745.02 ","$4,059.26 ","$3,997.15 ","$4,201.31 ","$1,399.95 ","$4,858.07 ",$812.49 ,$635.00 ,$635.00 ,"$1,627.14 ",$697.00 , N/A ,"$5,841.99 ","$5,042.56 ","$5,042.56 ","$4,919.57 "
ST. CLARE MEMORIAL HOSPITAL (ACU),36415072,36415,HC VENIPUNCTURE-PRV 72 HR,300,1 ,$38.00 ,$25.08 ,$3.60 ,$38.00 , N/A ,$9.00 ,$9.00 ,$10.05 ,$30.40 ,$32.30 , N/A ,$34.20 , N/A , N/A ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 , N/A ,$23.56 , N/A ,$34.20 ,$19.28 ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 , N/A ,$3.60 ,$3.60 ,$10.05 ,$3.60 ,$8.57 ,$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 ,$25.08 ,$3.47 ,$38.00 ,$4.31 ,$9.00 ,$9.00 ,$10.05 ,$30.40 ,$32.30 , N/A ,$34.20 ,$4.31 ,$4.31 ,$36.10 ,$34.20 ,$32.30 ,$32.30 ,$10.05 ,$32.30 ,$32.30 ,$34.20 ,$23.14 ,$4.31 ,$23.56 ,$4.57 ,$34.20 , N/A ,$34.96 ,$34.20 ,$25.08 ,$25.08 ,$23.14 ,$25.08 ,$24.70 ,$25.96 ,$8.65 ,$30.02 ,$4.57 ,$3.47 ,$3.47 ,$10.05 ,$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 ","$3,200.34 ",$344.14 ,"$6,702.68 ","$4,105.12 ","$4,345.67 ","$4,345.67 ",$344.14 ,"$3,879.20 ","$4,121.65 ","$3,030.63 ","$4,364.10 ","$4,105.12 ","$4,105.12 ","$4,606.55 ","$4,364.10 ","$4,121.65 ","$4,121.65 ",$344.14 ,"$4,121.65 ","$4,121.65 ","$4,364.10 ","$2,953.04 ","$4,105.12 ",$702.32 ,"$4,351.43 ","$4,364.10 ","$6,702.68 ","$4,461.08 ","$4,364.10 ","$3,200.82 ","$3,200.82 ","$2,953.04 ","$3,200.82 ","$3,151.85 ","$3,312.84 ","$1,103.89 ","$3,830.71 ","$4,351.43 ", N/A , N/A ,$344.14 , N/A ,"$2,978.97 ","$4,606.55 ","$3,976.18 ","$3,976.18 ","$3,879.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000003,N/A,HC GENERAL ANESTHESIA PER 15 MINS,370,1 ,$424.10 ,$279.91 ,$96.55 ,$424.10 , N/A ,$380.08 ,$380.08 ,$112.22 ,$339.28 ,$360.49 ,$265.06 ,$381.69 , N/A , N/A ,$402.90 ,$381.69 ,$360.49 ,$360.49 ,$112.22 ,$360.49 ,$360.49 ,$381.69 ,$258.28 , N/A ,$262.94 , N/A ,$381.69 , N/A ,$390.17 ,$381.69 ,$279.95 ,$279.95 ,$258.28 ,$279.95 ,$275.67 ,$289.75 ,$96.55 ,$335.04 , N/A ,$207.81 ,$207.81 ,$112.22 ,$207.81 , N/A ,$402.90 ,$347.76 ,$347.76 ,$339.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,"$1,265.00 ",$834.90 ,$207.83 ,"$1,456.37 ","$1,373.93 ","$1,133.69 ","$1,133.69 ",$334.72 ,"$1,012.00 ","$1,075.25 ",$790.63 ,"$1,138.50 ","$1,373.93 ","$1,265.00 ","$1,201.75 ","$1,138.50 ","$1,075.25 ","$1,075.25 ",$334.72 ,"$1,075.25 ","$1,075.25 ","$1,138.50 ",$770.39 ,"$1,373.93 ",$784.30 ,"$1,340.90 ","$1,138.50 ",$467.62 ,"$1,163.80 ","$1,138.50 ",$835.03 ,$835.03 ,$770.39 ,$835.03 ,$822.25 ,$864.25 ,$287.98 ,$999.35 ,"$1,456.37 ",$635.00 ,$635.00 ,$334.72 ,$697.00 ,$207.83 ,"$1,201.75 ","$1,037.30 ","$1,037.30 ","$1,012.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,$941.85 ,$621.62 ,$214.42 ,"$2,177.69 ","$2,054.42 ",$844.09 ,$844.09 ,$249.21 ,$753.48 ,$800.57 ,$588.66 ,$847.67 ,"$2,054.42 ",$941.85 ,$894.76 ,$847.67 ,$800.57 ,$800.57 ,$249.21 ,$800.57 ,$800.57 ,$847.67 ,$573.59 ,"$2,054.42 ",$583.94 ,$998.36 ,$847.67 ,"$1,917.41 ",$866.50 ,$847.67 ,$621.72 ,$621.72 ,$573.59 ,$621.72 ,$612.20 ,$643.47 ,$214.42 ,$744.06 ,"$2,177.69 ",$461.51 ,$461.51 ,$249.21 ,$461.51 ,$852.18 ,$894.76 ,$772.32 ,$772.32 ,$753.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$92.00 ,$60.72 ,$20.94 ,$92.00 ,$41.88 ,$82.45 ,$82.45 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$41.88 ,$41.88 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 ,$41.88 ,$57.04 ,$44.39 ,$82.80 , N/A ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 ,$44.39 ,$45.08 ,$45.08 ,$24.34 ,$45.08 , N/A ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000020,99157,HC MODERATE SEDATION DIFF PHY EA ADDL 15MIN,370,1 ,$92.00 ,$60.72 ,$20.94 ,$92.00 ,$41.88 ,$82.45 ,$82.45 ,$24.34 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$41.88 ,$41.88 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$24.34 ,$78.20 ,$78.20 ,$82.80 ,$56.03 ,$41.88 ,$57.04 ,$44.39 ,$82.80 , N/A ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 ,$44.39 ,$45.08 ,$45.08 ,$24.34 ,$45.08 , N/A ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000021,64447,HC FEMORAL NERVE BLOCK SINGLE,370,1 ,$768.20 ,$507.01 ,$174.89 ,"$1,449.77 ",$766.50 ,$688.46 ,$688.46 ,$203.26 ,$614.56 ,$652.97 ,$480.13 ,$691.38 ,$766.50 ,$766.50 ,$729.79 ,$691.38 ,$652.97 ,$652.97 ,$203.26 ,$652.97 ,$652.97 ,$691.38 ,$467.83 ,$766.50 ,$476.28 ,$812.49 ,$691.38 ,"$1,449.77 ",$706.74 ,$691.38 ,$507.09 ,$507.09 ,$467.83 ,$507.09 ,$499.33 ,$524.83 ,$174.89 ,$606.88 ,$812.49 ,$376.42 ,$376.42 ,$203.26 ,$376.42 ,$644.34 ,$729.79 ,$629.92 ,$629.92 ,$614.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000022,64415,HC INTRASCALENE BLOCK SINGLE,370,1 ,$768.20 ,$507.01 ,$174.89 ,"$2,177.69 ","$2,054.42 ",$688.46 ,$688.46 ,$203.26 ,$614.56 ,$652.97 ,$480.13 ,$691.38 ,"$2,054.42 ",$768.20 ,$729.79 ,$691.38 ,$652.97 ,$652.97 ,$203.26 ,$652.97 ,$652.97 ,$691.38 ,$467.83 ,"$2,054.42 ",$476.28 ,$814.29 ,$691.38 ,"$1,917.41 ",$706.74 ,$691.38 ,$507.09 ,$507.09 ,$467.83 ,$507.09 ,$499.33 ,$524.83 ,$174.89 ,$606.88 ,"$2,177.69 ",$376.42 ,$376.42 ,$203.26 ,$376.42 ,$852.18 ,$729.79 ,$629.92 ,$629.92 ,$614.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$1,598.50 ","$1,055.01 ",$363.91 ,"$2,177.69 ","$2,054.42 ","$1,432.58 ","$1,432.58 ",$422.97 ,"$1,278.80 ","$1,358.73 ",$999.06 ,"$1,438.65 ","$2,054.42 ","$1,598.50 ","$1,518.58 ","$1,438.65 ","$1,358.73 ","$1,358.73 ",$422.97 ,"$1,358.73 ","$1,358.73 ","$1,438.65 ",$973.49 ,"$2,054.42 ",$991.08 ,"$1,694.41 ","$1,438.65 ","$1,917.41 ","$1,470.62 ","$1,438.65 ","$1,055.17 ","$1,055.17 ",$973.49 ,"$1,055.17 ","$1,039.03 ","$1,092.10 ",$363.91 ,"$1,262.82 ","$2,177.69 ",$783.27 ,$783.27 ,$422.97 ,$783.27 ,$852.18 ,"$1,518.58 ","$1,310.77 ","$1,310.77 ","$1,278.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000050,N/A,HC BIER BLOCK ANES INIT,370,1 ,$868.14 ,$572.97 ,$197.64 ,$868.14 , N/A ,$778.03 ,$778.03 ,$229.71 ,$694.51 ,$737.92 ,$542.59 ,$781.33 , N/A , N/A ,$824.73 ,$781.33 ,$737.92 ,$737.92 ,$229.71 ,$737.92 ,$737.92 ,$781.33 ,$528.70 , N/A ,$538.24 , N/A ,$781.33 , N/A ,$798.69 ,$781.33 ,$573.06 ,$573.06 ,$528.70 ,$573.06 ,$564.29 ,$593.11 ,$197.64 ,$685.83 , N/A ,$425.39 ,$425.39 ,$229.71 ,$425.39 , N/A ,$824.73 ,$711.87 ,$711.87 ,$694.51 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000051,N/A,HC BIER BLOCK ANES ADDL,370,1 ,$178.08 ,$117.53 ,$40.54 ,$178.08 , N/A ,$159.60 ,$159.60 ,$47.12 ,$142.46 ,$151.37 ,$111.30 ,$160.27 , N/A , N/A ,$169.18 ,$160.27 ,$151.37 ,$151.37 ,$47.12 ,$151.37 ,$151.37 ,$160.27 ,$108.45 , N/A ,$110.40 , N/A ,$160.27 , N/A ,$163.83 ,$160.27 ,$117.55 ,$117.55 ,$108.45 ,$117.55 ,$115.75 ,$121.66 ,$40.54 ,$140.68 , N/A ,$87.26 ,$87.26 ,$47.12 ,$87.26 , N/A ,$169.18 ,$146.03 ,$146.03 ,$142.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000052,N/A,HC GENERAL ANES INIT,370,1 ,"$1,558.20 ","$1,028.41 ",$354.73 ,"$1,558.20 ", N/A ,"$1,396.46 ","$1,396.46 ",$412.30 ,"$1,246.56 ","$1,324.47 ",$973.88 ,"$1,402.38 ", N/A , N/A ,"$1,480.29 ","$1,402.38 ","$1,324.47 ","$1,324.47 ",$412.30 ,"$1,324.47 ","$1,324.47 ","$1,402.38 ",$948.94 , N/A ,$966.08 , N/A ,"$1,402.38 ", N/A ,"$1,433.54 ","$1,402.38 ","$1,028.57 ","$1,028.57 ",$948.94 ,"$1,028.57 ","$1,012.83 ","$1,064.56 ",$354.73 ,"$1,230.98 ", N/A ,$763.52 ,$763.52 ,$412.30 ,$763.52 , N/A ,"$1,480.29 ","$1,277.72 ","$1,277.72 ","$1,246.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000053,N/A,HC GENERAL ANES ADDL,370,1 ,$212.00 ,$139.92 ,$48.26 ,$212.00 , N/A ,$189.99 ,$189.99 ,$56.10 ,$169.60 ,$180.20 ,$132.50 ,$190.80 , N/A , N/A ,$201.40 ,$190.80 ,$180.20 ,$180.20 ,$56.10 ,$180.20 ,$180.20 ,$190.80 ,$129.11 , N/A ,$131.44 , N/A ,$190.80 , N/A ,$195.04 ,$190.80 ,$139.94 ,$139.94 ,$129.11 ,$139.94 ,$137.80 ,$144.84 ,$48.26 ,$167.48 , N/A ,$103.88 ,$103.88 ,$56.10 ,$103.88 , N/A ,$201.40 ,$173.84 ,$173.84 ,$169.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000054,N/A,HC MONITORED ANES INIT,370,1 ,$690.06 ,$455.44 ,$157.09 ,$690.06 , N/A ,$618.43 ,$618.43 ,$182.59 ,$552.05 ,$586.55 ,$431.29 ,$621.05 , N/A , N/A ,$655.56 ,$621.05 ,$586.55 ,$586.55 ,$182.59 ,$586.55 ,$586.55 ,$621.05 ,$420.25 , N/A ,$427.84 , N/A ,$621.05 , N/A ,$634.86 ,$621.05 ,$455.51 ,$455.51 ,$420.25 ,$455.51 ,$448.54 ,$471.45 ,$157.09 ,$545.15 , N/A ,$338.13 ,$338.13 ,$182.59 ,$338.13 , N/A ,$655.56 ,$565.85 ,$565.85 ,$552.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000055,N/A,HC MONITORED ANES ADDL,370,1 ,$178.08 ,$117.53 ,$40.54 ,$178.08 , N/A ,$159.60 ,$159.60 ,$47.12 ,$142.46 ,$151.37 ,$111.30 ,$160.27 , N/A , N/A ,$169.18 ,$160.27 ,$151.37 ,$151.37 ,$47.12 ,$151.37 ,$151.37 ,$160.27 ,$108.45 , N/A ,$110.40 , N/A ,$160.27 , N/A ,$163.83 ,$160.27 ,$117.55 ,$117.55 ,$108.45 ,$117.55 ,$115.75 ,$121.66 ,$40.54 ,$140.68 , N/A ,$87.26 ,$87.26 ,$47.12 ,$87.26 , N/A ,$169.18 ,$146.03 ,$146.03 ,$142.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000056,N/A,HC SPINAL ANES INIT,370,1 ,"$1,558.20 ","$1,028.41 ",$354.73 ,"$1,558.20 ", N/A ,"$1,396.46 ","$1,396.46 ",$412.30 ,"$1,246.56 ","$1,324.47 ",$973.88 ,"$1,402.38 ", N/A , N/A ,"$1,480.29 ","$1,402.38 ","$1,324.47 ","$1,324.47 ",$412.30 ,"$1,324.47 ","$1,324.47 ","$1,402.38 ",$948.94 , N/A ,$966.08 , N/A ,"$1,402.38 ", N/A ,"$1,433.54 ","$1,402.38 ","$1,028.57 ","$1,028.57 ",$948.94 ,"$1,028.57 ","$1,012.83 ","$1,064.56 ",$354.73 ,"$1,230.98 ", N/A ,$763.52 ,$763.52 ,$412.30 ,$763.52 , N/A ,"$1,480.29 ","$1,277.72 ","$1,277.72 ","$1,246.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),37000057,N/A,HC SPINAL ANES ADDL,370,1 ,$178.08 ,$117.53 ,$40.54 ,$178.08 , N/A ,$159.60 ,$159.60 ,$47.12 ,$142.46 ,$151.37 ,$111.30 ,$160.27 , N/A , N/A ,$169.18 ,$160.27 ,$151.37 ,$151.37 ,$47.12 ,$151.37 ,$151.37 ,$160.27 ,$108.45 , N/A ,$110.40 , N/A ,$160.27 , N/A ,$163.83 ,$160.27 ,$117.55 ,$117.55 ,$108.45 ,$117.55 ,$115.75 ,$121.66 ,$40.54 ,$140.68 , N/A ,$87.26 ,$87.26 ,$47.12 ,$87.26 , N/A ,$169.18 ,$146.03 ,$146.03 ,$142.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$41.88 ,$437.00 ,$41.88 ,$391.64 ,$391.64 ,$115.63 ,$349.60 ,$371.45 ,$273.13 ,$393.30 ,$41.88 ,$41.88 ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$115.63 ,$371.45 ,$371.45 ,$393.30 ,$266.13 ,$41.88 ,$270.94 ,$44.39 ,$393.30 , N/A ,$402.04 ,$393.30 ,$288.46 ,$288.46 ,$266.13 ,$288.46 ,$284.05 ,$298.56 ,$99.49 ,$345.23 ,$44.39 ,$214.13 ,$214.13 ,$115.63 ,$214.13 , N/A ,$415.15 ,$358.34 ,$358.34 ,$349.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$41.88 ,$437.00 ,$41.88 ,$391.64 ,$391.64 ,$115.63 ,$349.60 ,$371.45 ,$273.13 ,$393.30 ,$41.88 ,$41.88 ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$115.63 ,$371.45 ,$371.45 ,$393.30 ,$266.13 ,$41.88 ,$270.94 ,$44.39 ,$393.30 , N/A ,$402.04 ,$393.30 ,$288.46 ,$288.46 ,$266.13 ,$288.46 ,$284.05 ,$298.56 ,$99.49 ,$345.23 ,$44.39 ,$214.13 ,$214.13 ,$115.63 ,$214.13 , N/A ,$415.15 ,$358.34 ,$358.34 ,$349.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),37000075,99156,HC MODERATE SEDATION DIFF PHY >5YR 1ST 15MIN,370,1 ,$437.00 ,$288.42 ,$41.88 ,$437.00 ,$41.88 ,$391.64 ,$391.64 ,$115.63 ,$349.60 ,$371.45 ,$273.13 ,$393.30 ,$41.88 ,$41.88 ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$115.63 ,$371.45 ,$371.45 ,$393.30 ,$266.13 ,$41.88 ,$270.94 ,$44.39 ,$393.30 , N/A ,$402.04 ,$393.30 ,$288.46 ,$288.46 ,$266.13 ,$288.46 ,$284.05 ,$298.56 ,$99.49 ,$345.23 ,$44.39 ,$214.13 ,$214.13 ,$115.63 ,$214.13 , N/A ,$415.15 ,$358.34 ,$358.34 ,$349.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,$768.20 ,$507.01 ,$174.89 ,"$1,449.77 ",$766.50 ,$688.46 ,$688.46 ,$203.26 ,$614.56 ,$652.97 ,$480.13 ,$691.38 ,$766.50 ,$766.50 ,$729.79 ,$691.38 ,$652.97 ,$652.97 ,$203.26 ,$652.97 ,$652.97 ,$691.38 ,$467.83 ,$766.50 ,$476.28 ,$812.49 ,$691.38 ,"$1,449.77 ",$706.74 ,$691.38 ,$507.09 ,$507.09 ,$467.83 ,$507.09 ,$499.33 ,$524.83 ,$174.89 ,$606.88 ,$812.49 ,$768.20 ,$768.20 ,$203.26 ,$768.20 ,$644.34 ,$729.79 ,$629.92 ,$629.92 ,$614.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),37080001,64415,HC INTRASCALENE BLOCK SINGLE,360,1 ,$768.20 ,$507.01 ,$174.89 ,"$2,177.69 ","$2,054.42 ",$688.46 ,$688.46 ,$203.26 ,$614.56 ,$652.97 ,$480.13 ,$691.38 ,"$2,054.42 ",$768.20 ,$729.79 ,$691.38 ,$652.97 ,$652.97 ,$203.26 ,$652.97 ,$652.97 ,$691.38 ,$467.83 ,"$2,054.42 ",$476.28 ,$814.29 ,$691.38 ,"$1,917.41 ",$706.74 ,$691.38 ,$507.09 ,$507.09 ,$467.83 ,$507.09 ,$499.33 ,$524.83 ,$174.89 ,$606.88 ,"$2,177.69 ",$768.20 ,$768.20 ,$203.26 ,$768.20 ,$852.18 ,$729.79 ,$629.92 ,$629.92 ,$614.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),37609072,37609,"HC LIGAT, BX TEMP ARTERY",975,1 ,"$1,647.00 ","$1,087.02 ",$211.36 ,"$4,345.15 ","$4,099.20 ","$1,476.04 ","$1,476.04 ",$211.36 ,"$1,317.60 ","$1,399.95 ","$1,029.38 ","$1,482.30 ","$4,099.20 ","$1,647.00 ","$1,564.65 ","$1,482.30 ","$1,399.95 ","$1,399.95 ",$211.36 ,"$1,399.95 ","$1,399.95 ","$1,482.30 ","$1,003.02 ","$4,099.20 ",$431.34 ,"$1,745.82 ","$1,482.30 ","$3,373.99 ","$1,515.24 ","$1,482.30 ","$1,087.18 ","$1,087.18 ","$1,003.02 ","$1,087.18 ","$1,070.55 ","$1,125.23 ",$374.95 ,"$1,301.13 ","$4,345.15 ", N/A , N/A ,$211.36 , N/A ,"$1,499.55 ","$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 ","$3,305.94 ","$1,114.66 ","$21,413.35 ","$20,201.27 ","$4,489.07 ","$4,489.07 ","$1,114.66 ","$4,007.20 ","$4,257.65 ","$3,130.63 ","$4,508.10 ","$20,201.27 ","$5,009.00 ","$4,758.55 ","$4,508.10 ","$4,257.65 ","$4,257.65 ","$1,114.66 ","$4,257.65 ","$4,257.65 ","$4,508.10 ","$3,050.48 ","$20,201.27 ","$2,274.82 ","$5,309.54 ","$4,508.10 ", N/A ,"$4,608.28 ","$4,508.10 ","$3,306.44 ","$3,306.44 ","$3,050.48 ","$3,306.44 ","$3,255.85 ","$3,422.15 ","$1,140.32 ","$3,957.11 ","$21,413.35 ", N/A , N/A ,"$1,114.66 ", 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 ,$258.72 ,$89.24 ,$425.72 ,$392.00 ,$351.31 ,$351.31 ,$103.72 ,$313.60 ,$333.20 ,$245.00 ,$352.80 ,$392.00 ,$392.00 ,$372.40 ,$352.80 ,$333.20 ,$333.20 ,$103.72 ,$333.20 ,$333.20 ,$352.80 ,$238.73 ,$392.00 ,$243.04 ,$415.52 ,$352.80 ,$425.72 ,$360.64 ,$352.80 ,$258.76 ,$258.76 ,$238.73 ,$258.76 ,$254.80 ,$267.81 ,$89.24 ,$309.68 ,$415.52 ,$299.00 ,$299.00 ,$103.72 ,$299.00 ,$189.21 ,$372.40 ,$321.44 ,$321.44 ,$313.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),39000110,P9017,HC FRESH FROZEN PLASMA EA,390,1 ,$246.00 ,$162.36 ,$38.65 ,$246.00 ,$38.65 ,$220.47 ,$220.47 ,$65.09 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$38.65 ,$38.65 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$65.09 ,$209.10 ,$209.10 ,$221.40 ,$149.81 ,$38.65 ,$152.52 ,$40.97 ,$221.40 ,$192.31 ,$226.32 ,$221.40 ,$162.38 ,$162.38 ,$149.81 ,$162.38 ,$159.90 ,$168.07 ,$56.01 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$65.09 ,$246.00 ,$85.47 ,$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 ,$162.36 ,$38.65 ,$246.00 ,$38.65 ,$220.47 ,$220.47 ,$65.09 ,$196.80 ,$209.10 ,$153.75 ,$221.40 ,$38.65 ,$38.65 ,$233.70 ,$221.40 ,$209.10 ,$209.10 ,$65.09 ,$209.10 ,$209.10 ,$221.40 ,$149.81 ,$38.65 ,$152.52 ,$40.97 ,$221.40 ,$192.31 ,$226.32 ,$221.40 ,$162.38 ,$162.38 ,$149.81 ,$162.38 ,$159.90 ,$168.07 ,$56.01 ,$194.34 ,$40.97 ,$246.00 ,$246.00 ,$65.09 ,$246.00 ,$85.47 ,$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 ,$232.98 ,$80.36 ,$660.55 ,$623.16 ,$316.36 ,$316.36 ,$93.40 ,$282.40 ,$300.05 ,$220.63 ,$317.70 ,$623.16 ,$353.00 ,$335.35 ,$317.70 ,$300.05 ,$300.05 ,$93.40 ,$300.05 ,$300.05 ,$317.70 ,$214.98 ,$623.16 ,$218.86 ,$374.18 ,$317.70 ,$294.50 ,$324.76 ,$317.70 ,$233.02 ,$233.02 ,$214.98 ,$233.02 ,$229.45 ,$241.17 ,$80.36 ,$278.87 ,$660.55 ,$299.00 ,$299.00 ,$93.40 ,$299.00 ,$130.89 ,$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 ","$1,034.88 ",$299.00 ,"$1,568.00 ",$623.16 ,"$1,405.24 ","$1,405.24 ",$414.89 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$623.16 ,$623.16 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$414.89 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$954.91 ,$623.16 ,$972.16 ,$660.55 ,"$1,411.20 ","$1,092.74 ","$1,442.56 ","$1,411.20 ","$1,035.04 ","$1,035.04 ",$954.91 ,"$1,035.04 ","$1,019.20 ","$1,071.26 ",$356.96 ,"$1,238.72 ",$660.55 ,$299.00 ,$299.00 ,$414.89 ,$299.00 ,$485.66 ,"$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 ","$1,034.88 ",$299.00 ,"$1,568.00 ",$623.16 ,"$1,405.24 ","$1,405.24 ",$414.89 ,"$1,254.40 ","$1,332.80 ",$980.00 ,"$1,411.20 ",$623.16 ,$623.16 ,"$1,489.60 ","$1,411.20 ","$1,332.80 ","$1,332.80 ",$414.89 ,"$1,332.80 ","$1,332.80 ","$1,411.20 ",$954.91 ,$623.16 ,$972.16 ,$660.55 ,"$1,411.20 ","$1,435.93 ","$1,442.56 ","$1,411.20 ","$1,035.04 ","$1,035.04 ",$954.91 ,"$1,035.04 ","$1,019.20 ","$1,071.26 ",$356.96 ,"$1,238.72 ",$660.55 ,$299.00 ,$299.00 ,$414.89 ,$299.00 ,$638.19 ,"$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 ,$568.92 ,$196.24 ,$862.00 ,$274.68 ,$772.52 ,$772.52 ,$228.09 ,$689.60 ,$732.70 ,$538.75 ,$775.80 ,$274.68 ,$274.68 ,$818.90 ,$775.80 ,$732.70 ,$732.70 ,$228.09 ,$732.70 ,$732.70 ,$775.80 ,$524.96 ,$274.68 ,$534.44 ,$291.16 ,$775.80 ,$583.02 ,$793.04 ,$775.80 ,$569.01 ,$569.01 ,$524.96 ,$569.01 ,$560.30 ,$588.92 ,$196.24 ,$680.98 ,$291.16 ,$299.00 ,$299.00 ,$228.09 ,$299.00 ,$259.12 ,$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 ,$421.08 ,$145.25 ,$638.00 ,$274.68 ,$571.78 ,$571.78 ,$168.81 ,$510.40 ,$542.30 ,$398.75 ,$574.20 ,$274.68 ,$274.68 ,$606.10 ,$574.20 ,$542.30 ,$542.30 ,$168.81 ,$542.30 ,$542.30 ,$574.20 ,$388.54 ,$274.68 ,$395.56 ,$291.16 ,$574.20 ,$441.97 ,$586.96 ,$574.20 ,$421.14 ,$421.14 ,$388.54 ,$421.14 ,$414.70 ,$435.88 ,$145.25 ,$504.02 ,$291.16 ,$299.00 ,$299.00 ,$168.81 ,$299.00 ,$196.43 ,$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 ",$751.74 ,$259.30 ,"$1,300.25 ",$623.16 ,"$1,020.77 ","$1,020.77 ",$301.38 ,$911.20 ,$968.15 ,$711.88 ,"$1,025.10 ",$623.16 ,$623.16 ,"$1,082.05 ","$1,025.10 ",$968.15 ,$968.15 ,$301.38 ,$968.15 ,$968.15 ,"$1,025.10 ",$693.65 ,$623.16 ,$706.18 ,$660.55 ,"$1,025.10 ","$1,300.25 ","$1,047.88 ","$1,025.10 ",$751.85 ,$751.85 ,$693.65 ,$751.85 ,$740.35 ,$778.16 ,$259.30 ,$899.81 ,$660.55 ,$299.00 ,$299.00 ,$301.38 ,$299.00 ,$577.89 ,"$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 ","$1,052.04 ",$76.20 ,"$1,594.00 ",$274.68 ,"$1,428.54 ","$1,428.54 ",$421.77 ,"$1,275.20 ","$1,354.90 ",$996.25 ,"$1,434.60 ",$274.68 ,$274.68 ,"$1,514.30 ","$1,434.60 ","$1,354.90 ","$1,354.90 ",$421.77 ,"$1,354.90 ","$1,354.90 ","$1,434.60 ",$970.75 ,$274.68 ,$988.28 ,$291.16 ,"$1,434.60 ",$171.45 ,"$1,466.48 ","$1,434.60 ","$1,052.20 ","$1,052.20 ",$970.75 ,"$1,052.20 ","$1,036.10 ","$1,089.02 ",$362.88 ,"$1,259.26 ",$291.16 ,$299.00 ,$299.00 ,$421.77 ,$299.00 ,$76.20 ,"$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 ,"$1,077.55 ",$711.18 ,$245.31 ,"$1,077.55 ",$801.48 ,$965.70 ,$965.70 ,$285.12 ,$862.04 ,$915.92 ,$673.47 ,$969.80 ,$801.48 ,$801.48 ,"$1,023.67 ",$969.80 ,$915.92 ,$915.92 ,$285.12 ,$915.92 ,$915.92 ,$969.80 ,$656.23 ,$801.48 ,$668.08 ,$849.57 ,$969.80 ,$917.44 ,$991.35 ,$969.80 ,$711.29 ,$711.29 ,$656.23 ,$711.29 ,$700.41 ,$736.18 ,$245.31 ,$851.26 ,$849.57 ,$299.00 ,$299.00 ,$285.12 ,$299.00 ,$407.75 ,"$1,023.67 ",$883.59 ,$883.59 ,$862.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$325.00 ,$214.50 ,$73.99 ,$325.00 ,$92.47 ,$325.00 ,$222.00 ,$85.99 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$92.47 ,$92.47 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$85.99 ,$276.25 ,$276.25 ,$292.50 ,$197.93 ,$92.47 ,$201.50 ,$98.02 ,$292.50 ,$241.45 ,$299.00 ,$292.50 ,$214.53 ,$214.53 ,$197.93 ,$214.53 ,$211.25 ,$222.04 ,$73.99 ,$256.75 ,$98.02 ,$183.00 ,$183.00 ,$85.99 ,$205.00 ,$107.31 ,$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 ,$214.50 ,$73.99 ,$325.00 ,$92.47 ,$325.00 ,$222.00 ,$85.99 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$92.47 ,$92.47 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$85.99 ,$276.25 ,$276.25 ,$292.50 ,$197.93 ,$92.47 ,$201.50 ,$98.02 ,$292.50 ,$241.45 ,$299.00 ,$292.50 ,$214.53 ,$214.53 ,$197.93 ,$214.53 ,$211.25 ,$222.04 ,$73.99 ,$256.75 ,$98.02 ,$183.00 ,$183.00 ,$85.99 ,$205.00 ,$107.31 ,$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 ,$214.50 ,$73.99 ,$325.00 ,$92.47 ,$325.00 ,$222.00 ,$85.99 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$92.47 ,$92.47 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$85.99 ,$276.25 ,$276.25 ,$292.50 ,$197.93 ,$92.47 ,$201.50 ,$98.02 ,$292.50 ,$241.45 ,$299.00 ,$292.50 ,$214.53 ,$214.53 ,$197.93 ,$214.53 ,$211.25 ,$222.04 ,$73.99 ,$256.75 ,$98.02 ,$183.00 ,$183.00 ,$85.99 ,$205.00 ,$107.31 ,$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 ,$214.50 ,$73.99 ,$325.00 ,$92.47 ,$325.00 ,$222.00 ,$85.99 ,$260.00 ,$276.25 ,$203.13 ,$292.50 ,$92.47 ,$92.47 ,$308.75 ,$292.50 ,$276.25 ,$276.25 ,$85.99 ,$276.25 ,$276.25 ,$292.50 ,$197.93 ,$92.47 ,$201.50 ,$98.02 ,$292.50 ,$241.45 ,$299.00 ,$292.50 ,$214.53 ,$214.53 ,$197.93 ,$214.53 ,$211.25 ,$222.04 ,$73.99 ,$256.75 ,$98.02 ,$183.00 ,$183.00 ,$85.99 ,$205.00 ,$107.31 ,$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 ,$198.00 ,$68.30 ,$300.00 ,$92.47 ,$300.00 ,$222.00 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$92.47 ,$92.47 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$92.47 ,$186.00 ,$98.02 ,$270.00 ,$189.29 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 ,$98.02 ,$183.00 ,$183.00 ,$79.38 ,$205.00 ,$84.13 ,$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 ,$198.00 ,$68.30 ,$300.00 ,$92.47 ,$300.00 ,$222.00 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$92.47 ,$92.47 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$92.47 ,$186.00 ,$98.02 ,$270.00 ,$189.29 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 ,$98.02 ,$183.00 ,$183.00 ,$79.38 ,$205.00 ,$84.13 ,$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 ,$198.00 ,$68.30 ,$300.00 ,$92.47 ,$300.00 ,$222.00 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$92.47 ,$92.47 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$92.47 ,$186.00 ,$98.02 ,$270.00 ,$189.29 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 ,$98.02 ,$183.00 ,$183.00 ,$79.38 ,$205.00 ,$84.13 ,$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 ,$198.00 ,$68.30 ,$300.00 ,$92.47 ,$300.00 ,$222.00 ,$79.38 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$92.47 ,$92.47 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$79.38 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$92.47 ,$186.00 ,$98.02 ,$270.00 ,$189.29 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 ,$98.02 ,$183.00 ,$183.00 ,$79.38 ,$205.00 ,$84.13 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200007,51798,HC US BLADDER SCAN,402,1 ,$210.45 ,$138.90 ,$47.90 ,$210.45 ,$150.61 ,$210.45 ,$210.45 ,$55.68 ,$168.36 ,$178.88 ,$131.53 ,$189.41 ,$150.61 ,$150.61 ,$199.93 ,$189.41 ,$178.88 ,$178.88 ,$55.68 ,$178.88 ,$178.88 ,$189.41 ,$128.16 ,$150.61 ,$130.48 ,$159.65 ,$189.41 ,$129.33 ,$193.61 ,$189.41 ,$138.92 ,$138.92 ,$128.16 ,$138.92 ,$136.79 ,$143.78 ,$47.90 ,$166.26 ,$159.65 ,$210.45 ,$210.45 ,$55.68 ,$210.45 ,$57.48 ,$199.93 ,$172.57 ,$172.57 ,$168.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,$790.00 ,$521.40 ,$106.88 ,$790.00 ,$203.25 ,$612.00 ,$572.00 ,$209.03 ,$632.00 ,$671.50 ,$493.75 ,$711.00 ,$203.25 ,$203.25 ,$750.50 ,$711.00 ,$671.50 ,$671.50 ,$209.03 ,$671.50 ,$671.50 ,$711.00 ,$481.11 ,$203.25 ,$489.80 ,$215.45 ,$711.00 ,$240.48 ,$726.80 ,$711.00 ,$521.48 ,$521.48 ,$481.11 ,$521.48 ,$513.50 ,$539.73 ,$179.85 ,$624.10 ,$215.45 ,$455.00 ,$455.00 ,$209.03 ,$515.00 ,$106.88 ,$750.50 ,$647.80 ,$647.80 ,$632.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200014,76604,HC US CHEST,402,1 ,$580.00 ,$382.80 ,$106.88 ,$580.00 ,$203.25 ,$580.00 ,$572.00 ,$153.47 ,$464.00 ,$493.00 ,$362.50 ,$522.00 ,$203.25 ,$203.25 ,$551.00 ,$522.00 ,$493.00 ,$493.00 ,$153.47 ,$493.00 ,$493.00 ,$522.00 ,$353.22 ,$203.25 ,$359.60 ,$215.45 ,$522.00 ,$240.48 ,$533.60 ,$522.00 ,$382.86 ,$382.86 ,$353.22 ,$382.86 ,$377.00 ,$396.26 ,$132.04 ,$458.20 ,$215.45 ,$455.00 ,$455.00 ,$153.47 ,$515.00 ,$106.88 ,$551.00 ,$475.60 ,$475.60 ,$464.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$448.80 ,$106.88 ,$680.00 ,$304.88 ,$612.00 ,$572.00 ,$179.93 ,$544.00 ,$578.00 ,$425.00 ,$612.00 ,$304.88 ,$304.88 ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$179.93 ,$578.00 ,$578.00 ,$612.00 ,$414.12 ,$304.88 ,$421.60 ,$323.17 ,$612.00 ,$240.48 ,$625.60 ,$612.00 ,$448.87 ,$448.87 ,$414.12 ,$448.87 ,$442.00 ,$464.58 ,$154.80 ,$537.20 ,$323.17 ,$455.00 ,$455.00 ,$179.93 ,$515.00 ,$106.88 ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,$680.00 ,$448.80 ,$106.88 ,$680.00 ,$304.88 ,$612.00 ,$572.00 ,$179.93 ,$544.00 ,$578.00 ,$425.00 ,$612.00 ,$304.88 ,$304.88 ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$179.93 ,$578.00 ,$578.00 ,$612.00 ,$414.12 ,$304.88 ,$421.60 ,$323.17 ,$612.00 ,$240.48 ,$625.60 ,$612.00 ,$448.87 ,$448.87 ,$414.12 ,$448.87 ,$442.00 ,$464.58 ,$154.80 ,$537.20 ,$323.17 ,$455.00 ,$455.00 ,$179.93 ,$515.00 ,$106.88 ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$363.00 ,$86.88 ,$550.00 ,$304.88 ,$550.00 ,$550.00 ,$145.53 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$304.88 ,$304.88 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$145.53 ,$467.50 ,$467.50 ,$495.00 ,$334.95 ,$304.88 ,$341.00 ,$323.17 ,$495.00 ,$195.48 ,$506.00 ,$495.00 ,$363.06 ,$363.06 ,$334.95 ,$363.06 ,$357.50 ,$375.76 ,$125.21 ,$434.50 ,$323.17 ,$455.00 ,$455.00 ,$145.53 ,$515.00 ,$86.88 ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200016,76642,HC US BREAST LIMITED,402,1 ,$550.00 ,$363.00 ,$86.88 ,$550.00 ,$304.88 ,$550.00 ,$550.00 ,$145.53 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$304.88 ,$304.88 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$145.53 ,$467.50 ,$467.50 ,$495.00 ,$334.95 ,$304.88 ,$341.00 ,$323.17 ,$495.00 ,$195.48 ,$506.00 ,$495.00 ,$363.06 ,$363.06 ,$334.95 ,$363.06 ,$357.50 ,$375.76 ,$125.21 ,$434.50 ,$323.17 ,$455.00 ,$455.00 ,$145.53 ,$515.00 ,$86.88 ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,100.00 ",$726.00 ,$106.88 ,"$1,100.00 ",$315.37 ,$612.00 ,$572.00 ,$291.06 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$315.37 ,$315.37 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$291.06 ,$935.00 ,$935.00 ,$990.00 ,$669.90 ,$315.37 ,$682.00 ,$334.29 ,$990.00 ,$240.48 ,"$1,012.00 ",$990.00 ,$726.11 ,$726.11 ,$669.90 ,$726.11 ,$715.00 ,$751.52 ,$250.42 ,$869.00 ,$334.29 ,$455.00 ,$455.00 ,$291.06 ,$515.00 ,$106.88 ,"$1,045.00 ",$902.00 ,$902.00 ,$880.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200018,76705,HC US ABDOMEN LTD,402,1 ,$820.00 ,$541.20 ,$106.88 ,$820.00 ,$203.25 ,$612.00 ,$572.00 ,$216.97 ,$656.00 ,$697.00 ,$512.50 ,$738.00 ,$203.25 ,$203.25 ,$779.00 ,$738.00 ,$697.00 ,$697.00 ,$216.97 ,$697.00 ,$697.00 ,$738.00 ,$499.38 ,$203.25 ,$508.40 ,$215.45 ,$738.00 ,$240.48 ,$754.40 ,$738.00 ,$541.28 ,$541.28 ,$499.38 ,$541.28 ,$533.00 ,$560.22 ,$186.68 ,$647.80 ,$215.45 ,$455.00 ,$455.00 ,$216.97 ,$515.00 ,$106.88 ,$779.00 ,$672.40 ,$672.40 ,$656.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200019,76770,HC US RETROPERITIONEAL,402,1 ,$810.00 ,$534.60 ,$106.88 ,$810.00 ,$315.37 ,$612.00 ,$572.00 ,$214.33 ,$648.00 ,$688.50 ,$506.25 ,$729.00 ,$315.37 ,$315.37 ,$769.50 ,$729.00 ,$688.50 ,$688.50 ,$214.33 ,$688.50 ,$688.50 ,$729.00 ,$493.29 ,$315.37 ,$502.20 ,$334.29 ,$729.00 ,$240.48 ,$745.20 ,$729.00 ,$534.68 ,$534.68 ,$493.29 ,$534.68 ,$526.50 ,$553.39 ,$184.40 ,$639.90 ,$334.29 ,$455.00 ,$455.00 ,$214.33 ,$515.00 ,$106.88 ,$769.50 ,$664.20 ,$664.20 ,$648.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$740.00 ,$488.40 ,$106.88 ,$740.00 ,$203.25 ,$612.00 ,$572.00 ,$195.80 ,$592.00 ,$629.00 ,$462.50 ,$666.00 ,$203.25 ,$203.25 ,$703.00 ,$666.00 ,$629.00 ,$629.00 ,$195.80 ,$629.00 ,$629.00 ,$666.00 ,$450.66 ,$203.25 ,$458.80 ,$215.45 ,$666.00 ,$240.48 ,$680.80 ,$666.00 ,$488.47 ,$488.47 ,$450.66 ,$488.47 ,$481.00 ,$505.57 ,$168.46 ,$584.60 ,$215.45 ,$455.00 ,$455.00 ,$195.80 ,$515.00 ,$106.88 ,$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 ,$330.00 ,$106.88 ,$500.00 ,$203.25 ,$500.00 ,$500.00 ,$132.30 ,$400.00 ,$425.00 ,$312.50 ,$450.00 ,$203.25 ,$203.25 ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$132.30 ,$425.00 ,$425.00 ,$450.00 ,$304.50 ,$203.25 ,$310.00 ,$215.45 ,$450.00 ,$240.48 ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$113.83 ,$395.00 ,$215.45 ,$455.00 ,$455.00 ,$132.30 ,$500.00 ,$106.88 ,$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 ,$429.00 ,$106.88 ,$650.00 ,$190.60 ,$612.00 ,$572.00 ,$171.99 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$190.60 ,$190.60 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$171.99 ,$552.50 ,$552.50 ,$585.00 ,$395.85 ,$190.60 ,$403.00 ,$202.04 ,$585.00 ,$240.48 ,$598.00 ,$585.00 ,$429.07 ,$429.07 ,$395.85 ,$429.07 ,$422.50 ,$444.08 ,$147.98 ,$513.50 ,$202.04 ,$455.00 ,$455.00 ,$171.99 ,$515.00 ,$106.88 ,$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 ,$237.60 ,$81.96 ,$360.00 ,$190.60 ,$360.00 ,$360.00 ,$95.26 ,$288.00 ,$306.00 ,$225.00 ,$324.00 ,$190.60 ,$190.60 ,$342.00 ,$324.00 ,$306.00 ,$306.00 ,$95.26 ,$306.00 ,$306.00 ,$324.00 ,$219.24 ,$190.60 ,$223.20 ,$202.04 ,$324.00 , N/A ,$331.20 ,$324.00 ,$237.64 ,$237.64 ,$219.24 ,$237.64 ,$234.00 ,$245.95 ,$81.96 ,$284.40 ,$202.04 ,$360.00 ,$360.00 ,$95.26 ,$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 ,$541.20 ,$106.88 ,$820.00 ,$190.60 ,$612.00 ,$572.00 ,$216.97 ,$656.00 ,$697.00 ,$512.50 ,$738.00 ,$190.60 ,$190.60 ,$779.00 ,$738.00 ,$697.00 ,$697.00 ,$216.97 ,$697.00 ,$697.00 ,$738.00 ,$499.38 ,$190.60 ,$508.40 ,$202.04 ,$738.00 ,$240.48 ,$754.40 ,$738.00 ,$541.28 ,$541.28 ,$499.38 ,$541.28 ,$533.00 ,$560.22 ,$186.68 ,$647.80 ,$202.04 ,$455.00 ,$455.00 ,$216.97 ,$515.00 ,$106.88 ,$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 ,$290.40 ,$100.17 ,$440.00 ,$190.60 ,$440.00 ,$440.00 ,$116.42 ,$352.00 ,$374.00 ,$275.00 ,$396.00 ,$190.60 ,$190.60 ,$418.00 ,$396.00 ,$374.00 ,$374.00 ,$116.42 ,$374.00 ,$374.00 ,$396.00 ,$267.96 ,$190.60 ,$272.80 ,$202.04 ,$396.00 , N/A ,$404.80 ,$396.00 ,$290.44 ,$290.44 ,$267.96 ,$290.44 ,$286.00 ,$300.61 ,$100.17 ,$347.60 ,$202.04 ,$440.00 ,$440.00 ,$116.42 ,$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 ,$613.80 ,$190.60 ,$930.00 ,$190.60 ,$612.00 ,$572.00 ,$246.08 ,$744.00 ,$790.50 ,$581.25 ,$837.00 ,$190.60 ,$190.60 ,$883.50 ,$837.00 ,$790.50 ,$790.50 ,$246.08 ,$790.50 ,$790.50 ,$837.00 ,$566.37 ,$190.60 ,$576.60 ,$202.04 ,$837.00 ,$525.42 ,$855.60 ,$837.00 ,$613.89 ,$613.89 ,$566.37 ,$613.89 ,$604.50 ,$635.38 ,$211.72 ,$734.70 ,$202.04 ,$455.00 ,$455.00 ,$246.08 ,$515.00 ,$233.52 ,$883.50 ,$762.60 ,$762.60 ,$744.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$460.00 ,$303.60 ,$104.72 ,$460.00 ,$190.60 ,$460.00 ,$460.00 ,$121.72 ,$368.00 ,$391.00 ,$287.50 ,$414.00 ,$190.60 ,$190.60 ,$437.00 ,$414.00 ,$391.00 ,$391.00 ,$121.72 ,$391.00 ,$391.00 ,$414.00 ,$280.14 ,$190.60 ,$285.20 ,$202.04 ,$414.00 ,$240.48 ,$423.20 ,$414.00 ,$303.65 ,$303.65 ,$280.14 ,$303.65 ,$299.00 ,$314.27 ,$104.72 ,$363.40 ,$202.04 ,$455.00 ,$455.00 ,$121.72 ,$460.00 ,$106.88 ,$437.00 ,$377.20 ,$377.20 ,$368.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200031,76815,HC US FETAL HEART BEAT,402,1 ,$480.00 ,$316.80 ,$106.88 ,$480.00 ,$190.60 ,$480.00 ,$480.00 ,$127.01 ,$384.00 ,$408.00 ,$300.00 ,$432.00 ,$190.60 ,$190.60 ,$456.00 ,$432.00 ,$408.00 ,$408.00 ,$127.01 ,$408.00 ,$408.00 ,$432.00 ,$292.32 ,$190.60 ,$297.60 ,$202.04 ,$432.00 ,$240.48 ,$441.60 ,$432.00 ,$316.85 ,$316.85 ,$292.32 ,$316.85 ,$312.00 ,$327.94 ,$109.27 ,$379.20 ,$202.04 ,$455.00 ,$455.00 ,$127.01 ,$480.00 ,$106.88 ,$456.00 ,$393.60 ,$393.60 ,$384.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,$630.00 ,$415.80 ,$106.88 ,$630.00 ,$190.60 ,$612.00 ,$572.00 ,$166.70 ,$504.00 ,$535.50 ,$393.75 ,$567.00 ,$190.60 ,$190.60 ,$598.50 ,$567.00 ,$535.50 ,$535.50 ,$166.70 ,$535.50 ,$535.50 ,$567.00 ,$383.67 ,$190.60 ,$390.60 ,$202.04 ,$567.00 ,$240.48 ,$579.60 ,$567.00 ,$415.86 ,$415.86 ,$383.67 ,$415.86 ,$409.50 ,$430.42 ,$143.42 ,$497.70 ,$202.04 ,$455.00 ,$455.00 ,$166.70 ,$515.00 ,$106.88 ,$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 ,$462.00 ,$106.88 ,$700.00 ,$190.60 ,$612.00 ,$572.00 ,$185.22 ,$560.00 ,$595.00 ,$437.50 ,$630.00 ,$190.60 ,$190.60 ,$665.00 ,$630.00 ,$595.00 ,$595.00 ,$185.22 ,$595.00 ,$595.00 ,$630.00 ,$426.30 ,$190.60 ,$434.00 ,$202.04 ,$630.00 ,$240.48 ,$644.00 ,$630.00 ,$462.07 ,$462.07 ,$426.30 ,$462.07 ,$455.00 ,$478.24 ,$159.36 ,$553.00 ,$202.04 ,$455.00 ,$455.00 ,$185.22 ,$515.00 ,$106.88 ,$665.00 ,$574.00 ,$574.00 ,$560.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200038,76830,HC US TRANSVAGINAL,402,1 ,$760.00 ,$501.60 ,$106.88 ,$760.00 ,$203.25 ,$612.00 ,$572.00 ,$201.10 ,$608.00 ,$646.00 ,$475.00 ,$684.00 ,$203.25 ,$203.25 ,$722.00 ,$684.00 ,$646.00 ,$646.00 ,$201.10 ,$646.00 ,$646.00 ,$684.00 ,$462.84 ,$203.25 ,$471.20 ,$215.45 ,$684.00 ,$240.48 ,$699.20 ,$684.00 ,$501.68 ,$501.68 ,$462.84 ,$501.68 ,$494.00 ,$519.23 ,$173.02 ,$600.40 ,$215.45 ,$455.00 ,$455.00 ,$201.10 ,$515.00 ,$106.88 ,$722.00 ,$623.20 ,$623.20 ,$608.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200040,76856,HC US PELVIS NON OB,402,1 ,$880.00 ,$580.80 ,$106.88 ,$880.00 ,$315.37 ,$612.00 ,$572.00 ,$232.85 ,$704.00 ,$748.00 ,$550.00 ,$792.00 ,$315.37 ,$315.37 ,$836.00 ,$792.00 ,$748.00 ,$748.00 ,$232.85 ,$748.00 ,$748.00 ,$792.00 ,$535.92 ,$315.37 ,$545.60 ,$334.29 ,$792.00 ,$240.48 ,$809.60 ,$792.00 ,$580.89 ,$580.89 ,$535.92 ,$580.89 ,$572.00 ,$601.22 ,$200.33 ,$695.20 ,$334.29 ,$455.00 ,$455.00 ,$232.85 ,$515.00 ,$106.88 ,$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 ,$455.40 ,$106.88 ,$690.00 ,$203.25 ,$612.00 ,$572.00 ,$182.57 ,$552.00 ,$586.50 ,$431.25 ,$621.00 ,$203.25 ,$203.25 ,$655.50 ,$621.00 ,$586.50 ,$586.50 ,$182.57 ,$586.50 ,$586.50 ,$621.00 ,$420.21 ,$203.25 ,$427.80 ,$215.45 ,$621.00 ,$240.48 ,$634.80 ,$621.00 ,$455.47 ,$455.47 ,$420.21 ,$455.47 ,$448.50 ,$471.41 ,$157.08 ,$545.10 ,$215.45 ,$455.00 ,$455.00 ,$182.57 ,$515.00 ,$106.88 ,$655.50 ,$565.80 ,$565.80 ,$552.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200042,76870,HC US SCROTUM,402,1 ,$740.00 ,$488.40 ,$106.88 ,$740.00 ,$203.25 ,$612.00 ,$572.00 ,$195.80 ,$592.00 ,$629.00 ,$462.50 ,$666.00 ,$203.25 ,$203.25 ,$703.00 ,$666.00 ,$629.00 ,$629.00 ,$195.80 ,$629.00 ,$629.00 ,$666.00 ,$450.66 ,$203.25 ,$458.80 ,$215.45 ,$666.00 ,$240.48 ,$680.80 ,$666.00 ,$488.47 ,$488.47 ,$450.66 ,$488.47 ,$481.00 ,$505.57 ,$168.46 ,$584.60 ,$215.45 ,$455.00 ,$455.00 ,$195.80 ,$515.00 ,$106.88 ,$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 ,$534.60 ,$106.88 ,$810.00 ,$203.25 ,$612.00 ,$572.00 ,$214.33 ,$648.00 ,$688.50 ,$506.25 ,$729.00 ,$203.25 ,$203.25 ,$769.50 ,$729.00 ,$688.50 ,$688.50 ,$214.33 ,$688.50 ,$688.50 ,$729.00 ,$493.29 ,$203.25 ,$502.20 ,$215.45 ,$729.00 ,$240.48 ,$745.20 ,$729.00 ,$534.68 ,$534.68 ,$493.29 ,$534.68 ,$526.50 ,$553.39 ,$184.40 ,$639.90 ,$215.45 ,$455.00 ,$455.00 ,$214.33 ,$515.00 ,$106.88 ,$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 ,$363.00 ,$106.88 ,$550.00 ,$203.25 ,$550.00 ,$550.00 ,$145.53 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$203.25 ,$203.25 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$145.53 ,$467.50 ,$467.50 ,$495.00 ,$334.95 ,$203.25 ,$341.00 ,$215.45 ,$495.00 ,$240.48 ,$506.00 ,$495.00 ,$363.06 ,$363.06 ,$334.95 ,$363.06 ,$357.50 ,$375.76 ,$125.21 ,$434.50 ,$215.45 ,$455.00 ,$455.00 ,$145.53 ,$515.00 ,$106.88 ,$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 ,$349.80 ,$120.66 ,$530.00 ,$213.15 ,$530.00 ,$530.00 ,$140.24 ,$424.00 ,$450.50 ,$331.25 ,$477.00 ,$213.15 ,$213.15 ,$503.50 ,$477.00 ,$450.50 ,$450.50 ,$140.24 ,$450.50 ,$450.50 ,$477.00 ,$322.77 ,$213.15 ,$328.60 ,$225.94 ,$477.00 , N/A ,$487.60 ,$477.00 ,$349.85 ,$349.85 ,$322.77 ,$349.85 ,$344.50 ,$362.10 ,$120.66 ,$418.70 ,$225.94 ,$455.00 ,$455.00 ,$140.24 ,$515.00 , 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 ,$587.40 ,$202.61 ,$890.00 ,$213.15 ,$612.00 ,$572.00 ,$235.49 ,$712.00 ,$756.50 ,$556.25 ,$801.00 ,$213.15 ,$213.15 ,$845.50 ,$801.00 ,$756.50 ,$756.50 ,$235.49 ,$756.50 ,$756.50 ,$801.00 ,$542.01 ,$213.15 ,$551.80 ,$225.94 ,$801.00 , N/A ,$818.80 ,$801.00 ,$587.49 ,$587.49 ,$542.01 ,$587.49 ,$578.50 ,$608.05 ,$202.61 ,$703.10 ,$225.94 ,$455.00 ,$455.00 ,$235.49 ,$515.00 , 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 ",$792.00 ,$213.15 ,"$1,200.00 ",$213.15 ,$612.00 ,$572.00 ,$317.52 ,$960.00 ,"$1,020.00 ",$750.00 ,"$1,080.00 ",$213.15 ,$213.15 ,"$1,140.00 ","$1,080.00 ","$1,020.00 ","$1,020.00 ",$317.52 ,"$1,020.00 ","$1,020.00 ","$1,080.00 ",$730.80 ,$213.15 ,$744.00 ,$225.94 ,"$1,080.00 ", N/A ,"$1,104.00 ","$1,080.00 ",$792.12 ,$792.12 ,$730.80 ,$792.12 ,$780.00 ,$819.84 ,$273.18 ,$948.00 ,$225.94 ,$455.00 ,$455.00 ,$317.52 ,$515.00 , 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 ",$726.00 ,$233.52 ,"$1,100.00 ",$315.37 ,$612.00 ,$572.00 ,$291.06 ,$880.00 ,$935.00 ,$687.50 ,$990.00 ,$315.37 ,$315.37 ,"$1,045.00 ",$990.00 ,$935.00 ,$935.00 ,$291.06 ,$935.00 ,$935.00 ,$990.00 ,$669.90 ,$315.37 ,$682.00 ,$334.29 ,$990.00 ,$525.42 ,"$1,012.00 ",$990.00 ,$726.11 ,$726.11 ,$669.90 ,$726.11 ,$715.00 ,$751.52 ,$250.42 ,$869.00 ,$334.29 ,$455.00 ,$455.00 ,$291.06 ,$515.00 ,$233.52 ,"$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 ",$660.00 ,$106.88 ,"$1,000.00 ",$315.37 ,$612.00 ,$572.00 ,$264.60 ,$800.00 ,$850.00 ,$625.00 ,$900.00 ,$315.37 ,$315.37 ,$950.00 ,$900.00 ,$850.00 ,$850.00 ,$264.60 ,$850.00 ,$850.00 ,$900.00 ,$609.00 ,$315.37 ,$620.00 ,$334.29 ,$900.00 ,$240.48 ,$920.00 ,$900.00 ,$660.10 ,$660.10 ,$609.00 ,$660.10 ,$650.00 ,$683.20 ,$227.65 ,$790.00 ,$334.29 ,$455.00 ,$455.00 ,$264.60 ,$515.00 ,$106.88 ,$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 ",$660.00 ,$106.88 ,"$1,000.00 ",$315.37 ,$612.00 ,$572.00 ,$264.60 ,$800.00 ,$850.00 ,$625.00 ,$900.00 ,$315.37 ,$315.37 ,$950.00 ,$900.00 ,$850.00 ,$850.00 ,$264.60 ,$850.00 ,$850.00 ,$900.00 ,$609.00 ,$315.37 ,$620.00 ,$334.29 ,$900.00 ,$240.48 ,$920.00 ,$900.00 ,$660.10 ,$660.10 ,$609.00 ,$660.10 ,$650.00 ,$683.20 ,$227.65 ,$790.00 ,$334.29 ,$455.00 ,$455.00 ,$264.60 ,$515.00 ,$106.88 ,$950.00 ,$820.00 ,$820.00 ,$800.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),40200075,76706,HC US AORTA (SCREENING),402,1 ,$500.00 ,$330.00 ,$106.88 ,$500.00 ,$203.25 ,$500.00 ,$500.00 ,$132.30 ,$400.00 ,$425.00 ,$312.50 ,$450.00 ,$203.25 ,$203.25 ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$132.30 ,$425.00 ,$425.00 ,$450.00 ,$304.50 ,$203.25 ,$310.00 ,$215.45 ,$450.00 ,$240.48 ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$113.83 ,$395.00 ,$215.45 ,$455.00 ,$455.00 ,$132.30 ,$500.00 ,$106.88 ,$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 ,$198.00 ,$87.18 ,$300.00 ,$92.47 ,$300.00 ,$222.00 ,$87.18 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$92.47 ,$92.47 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$87.18 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$92.47 ,$177.92 ,$98.02 ,$270.00 ,$200.16 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$88.05 ,$237.00 ,$98.02 ,$183.00 ,$183.00 ,$87.18 ,$205.00 ,$88.96 ,$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 ,$198.00 ,$87.18 ,$300.00 ,$92.47 ,$300.00 ,$222.00 ,$87.18 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$92.47 ,$92.47 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$87.18 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$92.47 ,$177.92 ,$98.02 ,$270.00 ,$200.16 ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$88.05 ,$237.00 ,$98.02 ,$183.00 ,$183.00 ,$87.18 ,$205.00 ,$88.96 ,$285.00 ,$246.00 ,$246.00 ,$240.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000002,31502,HC CHG TUBE TRACHEOTOMY,410,1 ,$557.75 ,$368.12 ,$126.97 ,$557.75 ,$307.08 ,$499.86 ,$499.86 ,$147.58 ,$446.20 ,$474.09 ,$348.59 ,$501.98 ,$307.08 ,$307.08 ,$529.86 ,$501.98 ,$474.09 ,$474.09 ,$147.58 ,$474.09 ,$474.09 ,$501.98 ,$339.67 ,$307.08 ,$345.80 ,$325.50 ,$501.98 ,$467.62 ,$513.13 ,$501.98 ,$368.17 ,$368.17 ,$339.67 ,$368.17 ,$362.54 ,$381.05 ,$126.97 ,$440.62 ,$325.50 ,$166.00 ,$166.00 ,$147.58 ,$187.00 ,$207.83 ,$529.86 ,$457.36 ,$457.36 ,$446.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000005,92950,HC CPR,480,1 ,$749.00 ,$494.34 ,$170.51 ,"$1,456.37 ","$1,373.93 ",$671.25 ,$671.25 ,$198.19 ,$599.20 ,$636.65 ,$468.13 ,$674.10 ,"$1,373.93 ",$749.00 ,$711.55 ,$674.10 ,$636.65 ,$636.65 ,$198.19 ,$636.65 ,$636.65 ,$674.10 ,$456.14 ,"$1,373.93 ",$464.38 ,$793.94 ,$674.10 ,$630.14 ,$689.08 ,$674.10 ,$494.41 ,$494.41 ,$456.14 ,$494.41 ,$486.85 ,$511.72 ,$170.51 ,$591.71 ,"$1,456.37 ",$749.00 ,$749.00 ,$198.19 ,$749.00 ,$280.06 ,$711.55 ,$614.18 ,$614.18 ,$599.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000008,N/A,HC HIGH FLOW OXYGEN CANNULA,410,1 ,$89.04 ,$58.77 ,$20.27 ,$89.04 , N/A ,$79.80 ,$79.80 ,$23.56 ,$71.23 ,$75.68 ,$55.65 ,$80.14 , N/A , N/A ,$84.59 ,$80.14 ,$75.68 ,$75.68 ,$23.56 ,$75.68 ,$75.68 ,$80.14 ,$54.23 , N/A ,$55.20 , N/A ,$80.14 , N/A ,$81.92 ,$80.14 ,$58.78 ,$58.78 ,$54.23 ,$58.78 ,$57.88 ,$60.83 ,$20.27 ,$70.34 , N/A ,$89.04 ,$89.04 ,$23.56 ,$89.04 , N/A ,$84.59 ,$73.01 ,$73.01 ,$71.23 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,"$1,138.50 ",$751.41 ,$166.00 ,"$2,250.49 ","$2,123.10 ","$1,020.32 ","$1,020.32 ",$301.25 ,$910.80 ,$967.73 ,$711.56 ,"$1,024.65 ","$2,123.10 ","$1,138.50 ","$1,081.58 ","$1,024.65 ",$967.73 ,$967.73 ,$301.25 ,$967.73 ,$967.73 ,"$1,024.65 ",$693.35 ,"$2,123.10 ",$705.88 ,"$1,206.81 ","$1,024.65 ","$1,252.62 ","$1,047.42 ","$1,024.65 ",$751.52 ,$751.52 ,$693.35 ,$751.52 ,$740.03 ,$777.82 ,$259.19 ,$899.42 ,"$2,250.49 ",$166.00 ,$166.00 ,$301.25 ,$187.00 ,$556.72 ,"$1,081.58 ",$933.57 ,$933.57 ,$910.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000012,94002,HC VENT SEDATED INTL DAY,410,1 ,"$1,138.50 ",$751.41 ,$166.00 ,"$2,250.49 ","$2,123.10 ","$1,020.32 ","$1,020.32 ",$301.25 ,$910.80 ,$967.73 ,$711.56 ,"$1,024.65 ","$2,123.10 ","$1,138.50 ","$1,081.58 ","$1,024.65 ",$967.73 ,$967.73 ,$301.25 ,$967.73 ,$967.73 ,"$1,024.65 ",$693.35 ,"$2,123.10 ",$705.88 ,"$1,206.81 ","$1,024.65 ","$1,252.62 ","$1,047.42 ","$1,024.65 ",$751.52 ,$751.52 ,$693.35 ,$751.52 ,$740.03 ,$777.82 ,$259.19 ,$899.42 ,"$2,250.49 ",$166.00 ,$166.00 ,$301.25 ,$187.00 ,$556.72 ,"$1,081.58 ",$933.57 ,$933.57 ,$910.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$322.00 ,$212.52 ,$73.30 ,$430.88 ,$240.12 ,$288.58 ,$288.58 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$240.12 ,$240.12 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$240.12 ,$199.64 ,$254.53 ,$289.80 ,$430.88 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$254.53 ,$166.00 ,$166.00 ,$85.20 ,$187.00 ,$191.50 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$874.00 ,$576.84 ,$166.00 ,"$2,250.49 ","$2,123.10 ",$783.28 ,$783.28 ,$231.26 ,$699.20 ,$742.90 ,$546.25 ,$786.60 ,"$2,123.10 ",$874.00 ,$830.30 ,$786.60 ,$742.90 ,$742.90 ,$231.26 ,$742.90 ,$742.90 ,$786.60 ,$532.27 ,"$2,123.10 ",$541.88 ,$926.44 ,$786.60 ,"$1,252.62 ",$804.08 ,$786.60 ,$576.93 ,$576.93 ,$532.27 ,$576.93 ,$568.10 ,$597.12 ,$198.97 ,$690.46 ,"$2,250.49 ",$166.00 ,$166.00 ,$231.26 ,$187.00 ,$556.72 ,$830.30 ,$716.68 ,$716.68 ,$699.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$322.00 ,$212.52 ,$73.30 ,$430.88 ,$240.12 ,$288.58 ,$288.58 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$240.12 ,$240.12 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$240.12 ,$199.64 ,$254.53 ,$289.80 ,$430.88 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$254.53 ,$166.00 ,$166.00 ,$85.20 ,$187.00 ,$191.50 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$86.25 ,$56.93 ,$19.64 ,$430.88 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$430.88 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$191.50 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000040,94640,HC EZ PAP TREATMENT,410,1 ,$86.25 ,$56.93 ,$19.64 ,$430.88 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$430.88 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$191.50 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$86.25 ,$56.93 ,$19.64 ,$430.88 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$430.88 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$191.50 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000042,94640,HC SPUTUM SPECIMEN INDUCTION,410,1 ,$86.25 ,$56.93 ,$19.64 ,$430.88 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$430.88 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$191.50 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000044,94640,HC UPDRAFT W/INSTRUCT AND EVAL,410,1 ,$86.25 ,$56.93 ,$19.64 ,$430.88 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$430.88 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$191.50 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000045,94640,HC AEROSOL GENERATOR CONT,410,1 ,$82.80 ,$54.65 ,$18.85 ,$430.88 ,$103.51 ,$74.21 ,$74.21 ,$21.91 ,$66.24 ,$70.38 ,$51.75 ,$74.52 ,$103.51 ,$82.80 ,$78.66 ,$74.52 ,$70.38 ,$70.38 ,$21.91 ,$70.38 ,$70.38 ,$74.52 ,$50.43 ,$103.51 ,$51.34 ,$87.77 ,$74.52 ,$430.88 ,$76.18 ,$74.52 ,$54.66 ,$54.66 ,$50.43 ,$54.66 ,$53.82 ,$56.57 ,$18.85 ,$65.41 ,$109.72 ,$82.80 ,$82.80 ,$21.91 ,$82.80 ,$191.50 ,$78.66 ,$67.90 ,$67.90 ,$66.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000049,94642,HC AEROSOL INHALATION PENTAMIDINE,410,1 ,$210.45 ,$138.90 ,$47.90 ,$430.88 ,$103.51 ,$188.61 ,$188.61 ,$55.68 ,$168.36 ,$178.88 ,$131.53 ,$189.41 ,$103.51 ,$103.51 ,$199.93 ,$189.41 ,$178.88 ,$178.88 ,$55.68 ,$178.88 ,$178.88 ,$189.41 ,$128.16 ,$103.51 ,$130.48 ,$109.72 ,$189.41 ,$430.88 ,$193.61 ,$189.41 ,$138.92 ,$138.92 ,$128.16 ,$138.92 ,$136.79 ,$143.78 ,$47.90 ,$166.26 ,$109.72 ,$166.00 ,$166.00 ,$55.68 ,$187.00 ,$191.50 ,$199.93 ,$172.57 ,$172.57 ,$168.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$260.63 ,$172.02 ,$59.33 ,$261.25 ,$103.51 ,$233.58 ,$233.58 ,$68.96 ,$208.50 ,$221.54 ,$162.89 ,$234.57 ,$103.51 ,$103.51 ,$247.60 ,$234.57 ,$221.54 ,$221.54 ,$68.96 ,$221.54 ,$221.54 ,$234.57 ,$158.72 ,$103.51 ,$161.60 ,$109.72 ,$234.57 ,$261.25 ,$239.78 ,$234.57 ,$172.04 ,$172.04 ,$158.72 ,$172.04 ,$169.41 ,$178.06 ,$59.33 ,$205.90 ,$109.72 ,$166.00 ,$166.00 ,$68.96 ,$187.00 ,$116.11 ,$247.60 ,$213.72 ,$213.72 ,$208.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$48.73 ,$32.16 ,$11.09 ,$109.72 ,$103.51 ,$43.67 ,$43.67 ,$12.90 ,$38.98 ,$41.42 ,$30.46 ,$43.86 ,$103.51 ,$48.73 ,$46.29 ,$43.86 ,$41.42 ,$41.42 ,$12.90 ,$41.42 ,$41.42 ,$43.86 ,$29.68 ,$103.51 ,$30.22 ,$51.65 ,$43.86 , N/A ,$44.83 ,$43.86 ,$32.17 ,$32.17 ,$29.68 ,$32.17 ,$31.67 ,$33.29 ,$11.09 ,$38.50 ,$109.72 ,$48.73 ,$48.73 ,$12.90 ,$48.73 , N/A ,$46.29 ,$39.96 ,$39.96 ,$38.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000052,94660,HC CPAP,410,1 ,$322.00 ,$212.52 ,$73.30 ,$430.88 ,$240.12 ,$288.58 ,$288.58 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$240.12 ,$240.12 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$240.12 ,$199.64 ,$254.53 ,$289.80 ,$430.88 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$254.53 ,$166.00 ,$166.00 ,$85.20 ,$187.00 ,$191.50 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000053,94660,HC CPAP DAILY EST PT,410,1 ,$322.00 ,$212.52 ,$73.30 ,$430.88 ,$240.12 ,$288.58 ,$288.58 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$240.12 ,$240.12 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$240.12 ,$199.64 ,$254.53 ,$289.80 ,$430.88 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$254.53 ,$166.00 ,$166.00 ,$85.20 ,$187.00 ,$191.50 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$210.45 ,$138.90 ,$47.90 ,$430.88 ,$103.51 ,$188.61 ,$188.61 ,$55.68 ,$168.36 ,$178.88 ,$131.53 ,$189.41 ,$103.51 ,$103.51 ,$199.93 ,$189.41 ,$178.88 ,$178.88 ,$55.68 ,$178.88 ,$178.88 ,$189.41 ,$128.16 ,$103.51 ,$130.48 ,$109.72 ,$189.41 ,$430.88 ,$193.61 ,$189.41 ,$138.92 ,$138.92 ,$128.16 ,$138.92 ,$136.79 ,$143.78 ,$47.90 ,$166.26 ,$109.72 ,$166.00 ,$166.00 ,$55.68 ,$187.00 ,$191.50 ,$199.93 ,$172.57 ,$172.57 ,$168.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$111.55 ,$73.62 ,$25.40 ,$261.25 ,$103.51 ,$99.97 ,$99.97 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$103.51 ,$103.51 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$103.51 ,$69.16 ,$109.72 ,$100.40 ,$261.25 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$109.72 ,$111.55 ,$111.55 ,$29.52 ,$111.55 ,$116.11 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$400.20 ,$264.13 ,$91.11 ,$400.20 ,$103.51 ,$358.66 ,$358.66 ,$105.89 ,$320.16 ,$340.17 ,$250.13 ,$360.18 ,$103.51 ,$103.51 ,$380.19 ,$360.18 ,$340.17 ,$340.17 ,$105.89 ,$340.17 ,$340.17 ,$360.18 ,$243.72 ,$103.51 ,$248.12 ,$109.72 ,$360.18 ,$261.25 ,$368.18 ,$360.18 ,$264.17 ,$264.17 ,$243.72 ,$264.17 ,$260.13 ,$273.42 ,$91.11 ,$316.16 ,$109.72 ,$166.00 ,$166.00 ,$105.89 ,$187.00 ,$116.11 ,$380.19 ,$328.16 ,$328.16 ,$320.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$86.25 ,$56.93 ,$19.64 ,$261.25 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$261.25 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$116.11 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$86.25 ,$56.93 ,$19.64 ,$261.25 ,$103.51 ,$77.30 ,$77.30 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$103.51 ,$86.25 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$103.51 ,$53.48 ,$91.43 ,$77.63 ,$261.25 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$109.72 ,$86.25 ,$86.25 ,$22.82 ,$86.25 ,$116.11 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000068,G0237,HC RESP STRENGTH/ENDURANCE,410,1 ,$98.90 ,$65.27 ,$22.52 ,$98.90 ,$65.29 ,$88.63 ,$88.63 ,$26.17 ,$79.12 ,$84.07 ,$61.81 ,$89.01 ,$65.29 ,$65.29 ,$93.96 ,$89.01 ,$84.07 ,$84.07 ,$26.17 ,$84.07 ,$84.07 ,$89.01 ,$60.23 ,$65.29 ,$61.32 ,$69.21 ,$89.01 ,$56.16 ,$90.99 ,$89.01 ,$65.28 ,$65.28 ,$60.23 ,$65.28 ,$64.29 ,$67.57 ,$22.52 ,$78.13 ,$69.21 ,$98.90 ,$98.90 ,$26.17 ,$98.90 ,$24.96 ,$93.96 ,$81.10 ,$81.10 ,$79.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000072,G0238,HC RESP THRP FUNC-59,410,1 ,$105.80 ,$69.83 ,$24.08 ,$105.80 ,$65.29 ,$94.82 ,$94.82 ,$28.00 ,$84.64 ,$89.93 ,$66.13 ,$95.22 ,$65.29 ,$65.29 ,$100.51 ,$95.22 ,$89.93 ,$89.93 ,$28.00 ,$89.93 ,$89.93 ,$95.22 ,$64.43 ,$65.29 ,$65.60 ,$69.21 ,$95.22 ,$56.16 ,$97.34 ,$95.22 ,$69.84 ,$69.84 ,$64.43 ,$69.84 ,$68.77 ,$72.28 ,$24.08 ,$83.58 ,$69.21 ,$105.80 ,$105.80 ,$28.00 ,$105.80 ,$24.96 ,$100.51 ,$86.76 ,$86.76 ,$84.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),41000087,94669,HC MECHANICAL CHEST WALL OSCILLATION INITIAL,410,1 ,$652.05 ,$430.35 ,$103.51 ,$652.05 ,$103.51 ,$584.37 ,$584.37 ,$172.53 ,$521.64 ,$554.24 ,$407.53 ,$586.85 ,$103.51 ,$103.51 ,$619.45 ,$586.85 ,$554.24 ,$554.24 ,$172.53 ,$554.24 ,$554.24 ,$586.85 ,$397.10 ,$103.51 ,$404.28 ,$109.72 ,$586.85 ,$430.88 ,$599.89 ,$586.85 ,$430.42 ,$430.42 ,$397.10 ,$430.42 ,$423.83 ,$445.48 ,$148.44 ,$515.12 ,$109.72 ,$166.00 ,$166.00 ,$172.53 ,$187.00 ,$191.50 ,$619.45 ,$534.68 ,$534.68 ,$521.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000008,95992,HC CANALITH REPOSITIONING,420,1 ,$154.10 ,$101.71 ,$35.07 ,$154.10 , N/A ,$154.10 ,$154.10 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 , N/A , N/A ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 , N/A ,$95.54 , N/A ,$138.69 ,$94.37 ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 , N/A ,$154.10 ,$154.10 ,$40.78 ,$154.10 ,$41.94 ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000009,97012,HC TRACTION MECH APP,420,1 ,$100.00 ,$66.00 ,$14.05 ,$100.00 ,$25.78 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$25.78 ,$25.78 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$25.78 ,$62.00 ,$27.33 ,$90.00 ,$31.61 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$27.33 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$14.05 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000010,97016,HC APPLY VASOPNEUMATIC DEVICE,420,1 ,$90.00 ,$59.40 ,$11.36 ,$90.00 ,$25.19 ,$90.00 ,$90.00 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$25.19 ,$25.19 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$25.19 ,$55.80 ,$26.70 ,$81.00 ,$25.56 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$26.70 ,$90.00 ,$90.00 ,$23.81 ,$90.00 ,$11.36 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000015,97022,HC WHIRLPOOL BATH,420,1 ,$110.00 ,$72.60 ,$16.49 ,$110.00 ,$25.78 ,$110.00 ,$110.00 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$25.78 ,$25.78 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$25.78 ,$68.20 ,$27.33 ,$99.00 ,$37.10 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$27.33 ,$110.00 ,$110.00 ,$29.11 ,$110.00 ,$16.49 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000020,97022,HC FLUIDOTHERAPY,420,1 ,$110.00 ,$72.60 ,$16.49 ,$110.00 ,$25.78 ,$110.00 ,$110.00 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$25.78 ,$25.78 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$25.78 ,$68.20 ,$27.33 ,$99.00 ,$37.10 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$27.33 ,$110.00 ,$110.00 ,$29.11 ,$110.00 ,$16.49 ,$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 ,$59.40 ,$14.05 ,$90.00 ,$22.38 ,$90.00 ,$90.00 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$22.38 ,$22.38 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$22.38 ,$55.80 ,$23.72 ,$81.00 ,$31.61 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$23.72 ,$90.00 ,$90.00 ,$23.81 ,$90.00 ,$14.05 ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$110.00 ,$72.60 ,$19.22 ,$110.00 ,$23.51 ,$110.00 ,$110.00 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$23.51 ,$23.51 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$23.51 ,$68.20 ,$24.92 ,$99.00 ,$43.25 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$24.92 ,$110.00 ,$110.00 ,$29.11 ,$110.00 ,$19.22 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$90.00 ,$59.40 ,$13.98 ,$90.00 ,$18.49 ,$90.00 ,$90.00 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$18.49 ,$18.49 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$18.49 ,$55.80 ,$19.60 ,$81.00 ,$31.46 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$19.60 ,$90.00 ,$90.00 ,$23.81 ,$90.00 ,$13.98 ,$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 ,$66.00 ,$19.63 ,$100.00 ,$19.63 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$19.63 ,$19.63 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$19.63 ,$62.00 ,$20.81 ,$90.00 ,$64.98 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$20.81 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$28.88 ,$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 ,$85.80 ,$19.32 ,$130.00 ,$19.32 ,$130.00 ,$130.00 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$19.32 ,$19.32 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 ,$19.32 ,$80.60 ,$20.48 ,$117.00 ,$74.59 ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 ,$20.48 ,$130.00 ,$130.00 ,$34.40 ,$130.00 ,$33.15 ,$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 ,$66.00 ,$16.47 ,$100.00 ,$16.47 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$16.47 ,$16.47 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$16.47 ,$62.00 ,$17.46 ,$90.00 ,$64.98 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$17.46 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$28.88 ,$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 ,$66.00 ,$22.77 ,$100.00 ,$23.41 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$23.41 ,$23.41 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$23.41 ,$62.00 ,$24.81 ,$90.00 ,$66.04 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$24.81 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$29.35 ,$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 ,$66.00 ,$22.77 ,$100.00 ,$25.53 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$25.53 ,$25.53 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$25.53 ,$62.00 ,$27.06 ,$90.00 ,$59.83 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$27.06 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$26.59 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000063,97150,HC GROUP TREATMENT 15MIN,420,1 ,$100.00 ,$66.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$6.08 ,$62.00 ,$6.44 ,$90.00 ,$39.02 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$17.34 ,$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 ,$79.20 ,$18.05 ,$120.00 ,$18.05 ,$120.00 ,$120.00 ,$31.75 ,$96.00 ,$102.00 ,$75.00 ,$108.00 ,$18.05 ,$18.05 ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$31.75 ,$102.00 ,$102.00 ,$108.00 ,$73.08 ,$18.05 ,$74.40 ,$19.13 ,$108.00 ,$81.59 ,$110.40 ,$108.00 ,$79.21 ,$79.21 ,$73.08 ,$79.21 ,$78.00 ,$81.98 ,$27.32 ,$94.80 ,$19.13 ,$120.00 ,$120.00 ,$31.75 ,$120.00 ,$36.26 ,$114.00 ,$98.40 ,$98.40 ,$96.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000068,97597,HC DEBR SKIN PART THICKNESS <20CM,420,1 ,$446.20 ,$294.49 ,$42.35 ,$446.20 ,$42.35 ,$289.00 ,$233.00 ,$118.06 ,$356.96 ,$379.27 ,$278.88 ,$401.58 ,$42.35 ,$42.35 ,$423.89 ,$401.58 ,$379.27 ,$379.27 ,$118.06 ,$379.27 ,$379.27 ,$401.58 ,$271.74 ,$42.35 ,$276.64 ,$44.89 ,$401.58 ,$218.05 ,$410.50 ,$401.58 ,$294.54 ,$294.54 ,$271.74 ,$294.54 ,$290.03 ,$304.84 ,$101.59 ,$352.50 ,$44.89 ,$206.00 ,$206.00 ,$118.06 ,$228.00 ,$96.91 ,$423.89 ,$365.88 ,$365.88 ,$356.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000083,97598,HC DEBR SKIN PART THICKNESS EA ADDN>20CM FACIL,420,1 ,$197.80 ,$130.55 ,$35.14 ,$197.80 ,$35.14 ,$197.80 ,$197.80 ,$52.34 ,$158.24 ,$168.13 ,$123.63 ,$178.02 ,$35.14 ,$35.14 ,$187.91 ,$178.02 ,$168.13 ,$168.13 ,$52.34 ,$168.13 ,$168.13 ,$178.02 ,$120.46 ,$35.14 ,$122.64 ,$37.25 ,$178.02 , N/A ,$181.98 ,$178.02 ,$130.57 ,$130.57 ,$120.46 ,$130.57 ,$128.57 ,$135.14 ,$45.02 ,$156.26 ,$37.25 ,$197.80 ,$197.80 ,$52.34 ,$197.80 , N/A ,$187.91 ,$162.20 ,$162.20 ,$158.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$247.25 ,$163.19 ,$41.60 ,$247.25 , N/A ,$247.25 ,$233.00 ,$65.42 ,$197.80 ,$210.16 ,$154.53 ,$222.53 , N/A , N/A ,$234.89 ,$222.53 ,$210.16 ,$210.16 ,$65.42 ,$210.16 ,$210.16 ,$222.53 ,$150.58 , N/A ,$153.30 , N/A ,$222.53 ,$93.60 ,$227.47 ,$222.53 ,$163.21 ,$163.21 ,$150.58 ,$163.21 ,$160.71 ,$168.92 ,$56.29 ,$195.33 , N/A ,$206.00 ,$206.00 ,$65.42 ,$228.00 ,$41.60 ,$234.89 ,$202.75 ,$202.75 ,$197.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$322.00 ,$212.52 ,$49.73 ,$322.00 , N/A ,$289.00 ,$233.00 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 , N/A , N/A ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 , N/A ,$199.64 , N/A ,$289.80 ,$111.89 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 , N/A ,$206.00 ,$206.00 ,$85.20 ,$228.00 ,$49.73 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$100.00 ,$66.00 ,$22.77 ,$100.00 , N/A ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$62.00 , N/A ,$90.00 ,$74.39 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 , N/A ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$33.06 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000103,99368,HC MEDICAL TEAM CONFERENCE W/O PATIENT NON-PHYSICIAN,420,1 ,$154.10 ,$101.71 ,$35.07 ,$154.10 , N/A ,$154.10 ,$154.10 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 , N/A , N/A ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 , N/A ,$95.54 , N/A ,$138.69 , N/A ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 , N/A ,$154.10 ,$154.10 ,$40.78 ,$154.10 , N/A ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000105,G0175,HC FAMILY CONFERENCE,420,1 ,$438.15 ,$289.18 ,$99.74 ,$858.62 , N/A ,$289.00 ,$233.00 ,$115.93 ,$350.52 ,$372.43 ,$273.84 ,$394.34 , N/A , N/A ,$416.24 ,$394.34 ,$372.43 ,$372.43 ,$115.93 ,$372.43 ,$372.43 ,$394.34 ,$266.83 , N/A ,$271.66 , N/A ,$394.34 ,$858.62 ,$403.10 ,$394.34 ,$289.22 ,$289.22 ,$266.83 ,$289.22 ,$284.80 ,$299.34 ,$99.74 ,$346.14 , N/A ,$206.00 ,$206.00 ,$115.93 ,$228.00 ,$381.61 ,$416.24 ,$359.28 ,$359.28 ,$350.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000120,97150,HC GROUP TREATMENT 30MIN,420,1 ,$100.00 ,$66.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$6.08 ,$62.00 ,$6.44 ,$90.00 ,$39.02 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$17.34 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000121,97150,HC GROUP TREATMENT 45MIN,420,1 ,$100.00 ,$66.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$6.08 ,$62.00 ,$6.44 ,$90.00 ,$39.02 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$17.34 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000122,97150,HC GROUP TREATMENT 60MIN,420,1 ,$100.00 ,$66.00 ,$6.08 ,$100.00 ,$6.08 ,$100.00 ,$100.00 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$6.08 ,$6.08 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$6.08 ,$62.00 ,$6.44 ,$90.00 ,$39.02 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$6.44 ,$100.00 ,$100.00 ,$26.46 ,$100.00 ,$17.34 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),42000216,99366,HC MEDICAL TEAM CONFERENCE W/PATIENT NON-PHYSICIAN,420,1 ,$154.10 ,$101.71 ,$35.07 ,$154.10 , N/A ,$154.10 ,$154.10 ,$40.78 ,$123.28 ,$130.99 ,$96.31 ,$138.69 , N/A , N/A ,$146.40 ,$138.69 ,$130.99 ,$130.99 ,$40.78 ,$130.99 ,$130.99 ,$138.69 ,$93.85 , N/A ,$95.54 , N/A ,$138.69 , N/A ,$141.77 ,$138.69 ,$101.72 ,$101.72 ,$93.85 ,$101.72 ,$100.17 ,$105.28 ,$35.07 ,$121.74 , N/A ,$154.10 ,$154.10 ,$40.78 ,$154.10 , N/A ,$146.40 ,$126.36 ,$126.36 ,$123.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$263.00 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$158.00 ,$104.28 ,$35.97 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$41.81 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$41.81 ,$134.30 ,$134.30 ,$142.20 ,$96.22 ,$62.66 ,$97.96 ,$66.42 ,$142.20 ,$152.39 ,$145.36 ,$142.20 ,$104.30 ,$104.30 ,$96.22 ,$104.30 ,$102.70 ,$107.95 ,$35.97 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$41.81 ,$158.00 ,$67.73 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$158.00 ,$104.28 ,$35.97 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$41.81 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$41.81 ,$134.30 ,$134.30 ,$142.20 ,$96.22 ,$62.66 ,$97.96 ,$66.42 ,$142.20 ,$152.39 ,$145.36 ,$142.20 ,$104.30 ,$104.30 ,$96.22 ,$104.30 ,$102.70 ,$107.95 ,$35.97 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$41.81 ,$158.00 ,$67.73 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$158.00 ,$104.28 ,$35.97 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$41.81 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$41.81 ,$134.30 ,$134.30 ,$142.20 ,$96.22 ,$62.66 ,$97.96 ,$66.42 ,$142.20 ,$152.39 ,$145.36 ,$142.20 ,$104.30 ,$104.30 ,$96.22 ,$104.30 ,$102.70 ,$107.95 ,$35.97 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$41.81 ,$158.00 ,$67.73 ,$150.10 ,$129.56 ,$129.56 ,$126.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$158.00 ,$104.28 ,$35.97 ,$158.00 ,$62.66 ,$158.00 ,$158.00 ,$41.81 ,$126.40 ,$134.30 ,$98.75 ,$142.20 ,$62.66 ,$62.66 ,$150.10 ,$142.20 ,$134.30 ,$134.30 ,$41.81 ,$134.30 ,$134.30 ,$142.20 ,$96.22 ,$62.66 ,$97.96 ,$66.42 ,$142.20 ,$152.39 ,$145.36 ,$142.20 ,$104.30 ,$104.30 ,$96.22 ,$104.30 ,$102.70 ,$107.95 ,$35.97 ,$124.82 ,$66.42 ,$158.00 ,$158.00 ,$41.81 ,$158.00 ,$67.73 ,$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 ,$72.60 ,$20.93 ,$110.00 ,$20.93 ,$110.00 ,$110.00 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 ,$20.93 ,$20.93 ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 ,$20.93 ,$68.20 ,$22.19 ,$99.00 ,$72.23 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 ,$22.19 ,$110.00 ,$110.00 ,$29.11 ,$110.00 ,$32.10 ,$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 ,$88.60 ,$18.94 ,$134.24 ,$18.94 ,$134.24 ,$134.24 ,$35.52 ,$107.39 ,$114.10 ,$83.90 ,$120.82 ,$18.94 ,$18.94 ,$127.53 ,$120.82 ,$114.10 ,$114.10 ,$35.52 ,$114.10 ,$114.10 ,$120.82 ,$81.75 ,$18.94 ,$83.22 ,$20.08 ,$120.82 ,$70.16 ,$123.50 ,$120.82 ,$88.61 ,$88.61 ,$81.75 ,$88.61 ,$87.26 ,$91.71 ,$30.57 ,$106.05 ,$20.08 ,$134.24 ,$134.24 ,$35.52 ,$134.24 ,$31.18 ,$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 ,$72.60 ,$25.04 ,$110.00 , N/A ,$110.00 ,$110.00 ,$29.11 ,$88.00 ,$93.50 ,$68.75 ,$99.00 , N/A , N/A ,$104.50 ,$99.00 ,$93.50 ,$93.50 ,$29.11 ,$93.50 ,$93.50 ,$99.00 ,$66.99 , N/A ,$68.20 , N/A ,$99.00 ,$106.45 ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$25.04 ,$86.90 , N/A ,$110.00 ,$110.00 ,$29.11 ,$110.00 ,$47.31 ,$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 ,$59.40 ,$20.49 ,$90.00 , N/A ,$90.00 ,$90.00 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 , N/A ,$55.80 , N/A ,$81.00 ,$49.95 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 , N/A ,$90.00 ,$90.00 ,$23.81 ,$90.00 ,$22.20 ,$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 ,$59.40 ,$20.49 ,$90.00 , N/A ,$90.00 ,$90.00 ,$23.81 ,$72.00 ,$76.50 ,$56.25 ,$81.00 , N/A , N/A ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$23.81 ,$76.50 ,$76.50 ,$81.00 ,$54.81 , N/A ,$55.80 , N/A ,$81.00 ,$47.70 ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 , N/A ,$90.00 ,$90.00 ,$23.81 ,$90.00 ,$21.20 ,$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 ",$934.56 ,$128.28 ,"$1,970.34 ","$1,858.81 ","$1,269.02 ","$1,269.02 ",$128.28 ,"$1,132.80 ","$1,203.60 ",$885.00 ,"$1,274.40 ","$1,858.81 ","$1,416.00 ","$1,345.20 ","$1,274.40 ","$1,203.60 ","$1,203.60 ",$128.28 ,"$1,203.60 ","$1,203.60 ","$1,274.40 ",$862.34 ,"$1,858.81 ",$261.80 ,"$1,500.96 ","$1,274.40 ","$1,857.40 ","$1,302.72 ","$1,274.40 ",$934.70 ,$934.70 ,$862.34 ,$934.70 ,$920.40 ,$967.41 ,$322.36 ,"$1,118.64 ","$1,970.34 ", N/A , N/A ,$128.28 , N/A ,$825.51 ,"$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 ","$1,083.06 ",$144.82 ,"$1,970.34 ","$1,858.81 ","$1,470.66 ","$1,470.66 ",$144.82 ,"$1,312.80 ","$1,394.85 ","$1,025.63 ","$1,476.90 ","$1,858.81 ","$1,641.00 ","$1,558.95 ","$1,476.90 ","$1,394.85 ","$1,394.85 ",$144.82 ,"$1,394.85 ","$1,394.85 ","$1,476.90 ",$999.37 ,"$1,858.81 ",$295.56 ,"$1,739.46 ","$1,476.90 ","$1,857.40 ","$1,509.72 ","$1,476.90 ","$1,083.22 ","$1,083.22 ",$999.37 ,"$1,083.22 ","$1,066.65 ","$1,121.13 ",$373.58 ,"$1,296.39 ","$1,970.34 ", N/A , N/A ,$144.82 , N/A ,$825.51 ,"$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$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 ,$173.58 ,$59.87 ,$263.00 ,$62.66 ,$263.00 ,$233.00 ,$69.59 ,$210.40 ,$223.55 ,$164.38 ,$236.70 ,$62.66 ,$62.66 ,$249.85 ,$236.70 ,$223.55 ,$223.55 ,$69.59 ,$223.55 ,$223.55 ,$236.70 ,$160.17 ,$62.66 ,$163.06 ,$66.42 ,$236.70 ,$221.24 ,$241.96 ,$236.70 ,$173.61 ,$173.61 ,$160.17 ,$173.61 ,$170.95 ,$179.68 ,$59.87 ,$207.77 ,$66.42 ,$206.00 ,$206.00 ,$69.59 ,$228.00 ,$98.33 ,$249.85 ,$215.66 ,$215.66 ,$210.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$130.00 ,$85.80 ,$29.60 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 ,$62.66 ,$80.60 ,$66.42 ,$117.00 ,$151.65 ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$34.40 ,$130.00 ,$67.40 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$130.00 ,$85.80 ,$29.60 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 ,$62.66 ,$80.60 ,$66.42 ,$117.00 ,$151.65 ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$34.40 ,$130.00 ,$67.40 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$130.00 ,$85.80 ,$29.60 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 ,$62.66 ,$80.60 ,$66.42 ,$117.00 ,$151.65 ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$34.40 ,$130.00 ,$67.40 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$130.00 ,$85.80 ,$29.60 ,$151.65 ,$62.66 ,$130.00 ,$130.00 ,$34.40 ,$104.00 ,$110.50 ,$81.25 ,$117.00 ,$62.66 ,$62.66 ,$123.50 ,$117.00 ,$110.50 ,$110.50 ,$34.40 ,$110.50 ,$110.50 ,$117.00 ,$79.17 ,$62.66 ,$80.60 ,$66.42 ,$117.00 ,$151.65 ,$119.60 ,$117.00 ,$85.81 ,$85.81 ,$79.17 ,$85.81 ,$84.50 ,$88.82 ,$29.60 ,$102.70 ,$66.42 ,$130.00 ,$130.00 ,$34.40 ,$130.00 ,$67.40 ,$123.50 ,$106.60 ,$106.60 ,$104.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$280.00 ,$184.80 ,$47.91 ,$280.00 ,$47.91 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$47.91 ,$173.60 ,$50.78 ,$252.00 ,$168.17 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$50.78 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$74.74 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$280.00 ,$184.80 ,$47.91 ,$280.00 ,$47.91 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$47.91 ,$173.60 ,$50.78 ,$252.00 ,$168.17 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$50.78 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$74.74 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$280.00 ,$184.80 ,$47.91 ,$280.00 ,$47.91 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$47.91 ,$173.60 ,$50.78 ,$252.00 ,$168.17 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$50.78 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$74.74 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$280.00 ,$184.80 ,$47.91 ,$280.00 ,$47.91 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$47.91 ,$47.91 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$47.91 ,$173.60 ,$50.78 ,$252.00 ,$168.17 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$50.78 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$74.74 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000008,92520,HC LARYNGEAL FUNCTION STUDY,440,1 ,$332.67 ,$219.56 ,$31.07 ,$332.67 ,$31.07 ,$289.00 ,$233.00 ,$88.02 ,$266.14 ,$282.77 ,$207.92 ,$299.40 ,$31.07 ,$31.07 ,$316.04 ,$299.40 ,$282.77 ,$282.77 ,$88.02 ,$282.77 ,$282.77 ,$299.40 ,$202.60 ,$31.07 ,$206.26 ,$32.93 ,$299.40 ,$184.91 ,$306.06 ,$299.40 ,$219.60 ,$219.60 ,$202.60 ,$219.60 ,$216.24 ,$227.28 ,$75.73 ,$262.81 ,$32.93 ,$206.00 ,$206.00 ,$88.02 ,$228.00 ,$82.18 ,$316.04 ,$272.79 ,$272.79 ,$266.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$280.00 ,$184.80 ,$48.82 ,$280.00 ,$48.82 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$48.82 ,$173.60 ,$51.75 ,$252.00 ,$186.44 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$51.75 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$82.86 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$280.00 ,$184.80 ,$48.82 ,$280.00 ,$48.82 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$48.82 ,$173.60 ,$51.75 ,$252.00 ,$186.44 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$51.75 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$82.86 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$280.00 ,$184.80 ,$48.82 ,$280.00 ,$48.82 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$48.82 ,$173.60 ,$51.75 ,$252.00 ,$186.44 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$51.75 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$82.86 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$280.00 ,$184.80 ,$48.82 ,$280.00 ,$48.82 ,$280.00 ,$233.00 ,$74.09 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$48.82 ,$48.82 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$74.09 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$48.82 ,$173.60 ,$51.75 ,$252.00 ,$186.44 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$63.74 ,$221.20 ,$51.75 ,$206.00 ,$206.00 ,$74.09 ,$228.00 ,$82.86 ,$266.00 ,$229.60 ,$229.60 ,$224.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400018,92610,HC DYSPHAGIA EVALUATION  30MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400021,92610,HC DYSPHAGIA REEVALUATION 15MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400022,92610,HC DYSPHAGIA REEVALUATION 30MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400023,92610,HC DYSPHAGIA REEVALUATION 45MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$323.00 ,$278.80 ,$278.80 ,$272.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400029,92611,HC DYSPHAGIA EVAL-VIDEO 15MIN,444,1 ,$390.00 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400030,92611,HC DYSPHAGIA EVAL-VIDEO 30MIN,444,1 ,$390.00 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400031,92611,HC DYSPHAGIA EVAL-VIDEO 45MIN,444,1 ,$390.00 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$370.50 ,$319.80 ,$319.80 ,$312.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400032,92611,HC DYSPHAGIA EVAL-VIDEO 60MIN,444,1 ,$390.00 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$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 ,$171.60 ,$30.27 ,$292.48 ,$30.27 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$30.27 ,$161.20 ,$32.09 ,$234.00 ,$292.48 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$32.09 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$129.99 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400041,92522,HC EVALUATE SPEECH PRODUCTION 15MIN,444,1 ,$260.00 ,$171.60 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$24.58 ,$161.20 ,$26.05 ,$234.00 ,$243.68 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$26.05 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$108.30 ,$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 ,$283.80 ,$48.63 ,$501.62 ,$48.63 ,$289.00 ,$233.00 ,$113.78 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$113.78 ,$365.50 ,$365.50 ,$387.00 ,$261.87 ,$48.63 ,$266.60 ,$51.55 ,$387.00 ,$501.62 ,$395.60 ,$387.00 ,$283.84 ,$283.84 ,$261.87 ,$283.84 ,$279.50 ,$293.78 ,$97.89 ,$339.70 ,$51.55 ,$206.00 ,$206.00 ,$113.78 ,$228.00 ,$222.94 ,$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 ,$151.80 ,$25.62 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 ,$25.62 ,$142.60 ,$27.16 ,$207.00 ,$240.80 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 ,$27.16 ,$206.00 ,$206.00 ,$60.86 ,$228.00 ,$107.02 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400048,92610,HC DYSPHAGIA REEVALUATION 60MIN,444,1 ,$340.00 ,$224.40 ,$72.23 ,$340.00 ,$72.23 ,$289.00 ,$233.00 ,$89.96 ,$272.00 ,$289.00 ,$212.50 ,$306.00 ,$72.23 ,$72.23 ,$323.00 ,$306.00 ,$289.00 ,$289.00 ,$89.96 ,$289.00 ,$289.00 ,$306.00 ,$207.06 ,$72.23 ,$210.80 ,$76.56 ,$306.00 ,$186.28 ,$312.80 ,$306.00 ,$224.43 ,$224.43 ,$207.06 ,$224.43 ,$221.00 ,$232.29 ,$77.40 ,$268.60 ,$76.56 ,$206.00 ,$206.00 ,$89.96 ,$228.00 ,$82.79 ,$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 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$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 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$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 ,$257.40 ,$88.43 ,$390.00 ,$116.92 ,$289.00 ,$233.00 ,$103.19 ,$312.00 ,$331.50 ,$243.75 ,$351.00 ,$116.92 ,$116.92 ,$370.50 ,$351.00 ,$331.50 ,$331.50 ,$103.19 ,$331.50 ,$331.50 ,$351.00 ,$237.51 ,$116.92 ,$241.80 ,$123.94 ,$351.00 ,$198.97 ,$358.80 ,$351.00 ,$257.44 ,$257.44 ,$237.51 ,$257.44 ,$253.50 ,$266.45 ,$88.79 ,$308.10 ,$123.94 ,$206.00 ,$206.00 ,$103.19 ,$228.00 ,$88.43 ,$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 ,$171.60 ,$30.27 ,$292.48 ,$30.27 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$30.27 ,$161.20 ,$32.09 ,$234.00 ,$292.48 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$32.09 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$129.99 ,$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 ,$171.60 ,$30.27 ,$292.48 ,$30.27 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$30.27 ,$161.20 ,$32.09 ,$234.00 ,$292.48 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$32.09 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$129.99 ,$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 ,$171.60 ,$30.27 ,$292.48 ,$30.27 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$30.27 ,$30.27 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$30.27 ,$161.20 ,$32.09 ,$234.00 ,$292.48 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$32.09 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$129.99 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400055,92522,HC EVALUATE SPEECH PRODUCTION 30MIN,444,1 ,$260.00 ,$171.60 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$24.58 ,$161.20 ,$26.05 ,$234.00 ,$243.68 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$26.05 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$108.30 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400056,92522,HC EVALUATE SPEECH PRODUCTION 45MIN,444,1 ,$260.00 ,$171.60 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$24.58 ,$161.20 ,$26.05 ,$234.00 ,$243.68 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$26.05 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$108.30 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),44400057,92522,HC EVALUATE SPEECH PRODUCTION 60MIN,444,1 ,$260.00 ,$171.60 ,$24.58 ,$260.00 ,$24.58 ,$260.00 ,$233.00 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$24.58 ,$24.58 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$24.58 ,$161.20 ,$26.05 ,$234.00 ,$243.68 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$26.05 ,$206.00 ,$206.00 ,$68.80 ,$228.00 ,$108.30 ,$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 ,$283.80 ,$48.63 ,$501.62 ,$48.63 ,$289.00 ,$233.00 ,$113.78 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$113.78 ,$365.50 ,$365.50 ,$387.00 ,$261.87 ,$48.63 ,$266.60 ,$51.55 ,$387.00 ,$501.62 ,$395.60 ,$387.00 ,$283.84 ,$283.84 ,$261.87 ,$283.84 ,$279.50 ,$293.78 ,$97.89 ,$339.70 ,$51.55 ,$206.00 ,$206.00 ,$113.78 ,$228.00 ,$222.94 ,$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 ,$283.80 ,$48.63 ,$501.62 ,$48.63 ,$289.00 ,$233.00 ,$113.78 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$113.78 ,$365.50 ,$365.50 ,$387.00 ,$261.87 ,$48.63 ,$266.60 ,$51.55 ,$387.00 ,$501.62 ,$395.60 ,$387.00 ,$283.84 ,$283.84 ,$261.87 ,$283.84 ,$279.50 ,$293.78 ,$97.89 ,$339.70 ,$51.55 ,$206.00 ,$206.00 ,$113.78 ,$228.00 ,$222.94 ,$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 ,$283.80 ,$48.63 ,$501.62 ,$48.63 ,$289.00 ,$233.00 ,$113.78 ,$344.00 ,$365.50 ,$268.75 ,$387.00 ,$48.63 ,$48.63 ,$408.50 ,$387.00 ,$365.50 ,$365.50 ,$113.78 ,$365.50 ,$365.50 ,$387.00 ,$261.87 ,$48.63 ,$266.60 ,$51.55 ,$387.00 ,$501.62 ,$395.60 ,$387.00 ,$283.84 ,$283.84 ,$261.87 ,$283.84 ,$279.50 ,$293.78 ,$97.89 ,$339.70 ,$51.55 ,$206.00 ,$206.00 ,$113.78 ,$228.00 ,$222.94 ,$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 ,$151.80 ,$25.62 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 ,$25.62 ,$142.60 ,$27.16 ,$207.00 ,$240.80 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 ,$27.16 ,$206.00 ,$206.00 ,$60.86 ,$228.00 ,$107.02 ,$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 ,$151.80 ,$25.62 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 ,$25.62 ,$142.60 ,$27.16 ,$207.00 ,$240.80 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 ,$27.16 ,$206.00 ,$206.00 ,$60.86 ,$228.00 ,$107.02 ,$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 ,$151.80 ,$25.62 ,$240.80 ,$25.62 ,$230.00 ,$230.00 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$25.62 ,$25.62 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 ,$25.62 ,$142.60 ,$27.16 ,$207.00 ,$240.80 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 ,$27.16 ,$206.00 ,$206.00 ,$60.86 ,$228.00 ,$107.02 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$966.00 ,$637.56 ,$219.91 ,$966.00 ,$318.12 ,$865.73 ,$865.73 ,$255.60 ,$772.80 ,$821.10 ,$603.75 ,$869.40 ,$318.12 ,$318.12 ,$917.70 ,$869.40 ,$821.10 ,$821.10 ,$255.60 ,$821.10 ,$821.10 ,$869.40 ,$588.29 ,$318.12 ,$598.92 ,$337.21 ,$869.40 ,$839.41 ,$888.72 ,$869.40 ,$637.66 ,$637.66 ,$588.29 ,$637.66 ,$627.90 ,$659.97 ,$219.91 ,$763.14 ,$337.21 ,$587.00 ,$587.00 ,$255.60 ,$663.00 ,$373.07 ,$917.70 ,$792.12 ,$792.12 ,$772.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$545.10 ,$359.77 ,$124.09 ,"$1,460.18 ",$318.12 ,$488.52 ,$488.52 ,$144.24 ,$436.08 ,$463.34 ,$340.69 ,$490.59 ,$318.12 ,$318.12 ,$517.85 ,$490.59 ,$463.34 ,$463.34 ,$144.24 ,$463.34 ,$463.34 ,$490.59 ,$331.97 ,$318.12 ,$337.96 ,$337.21 ,$490.59 ,"$1,460.18 ",$501.49 ,$490.59 ,$359.82 ,$359.82 ,$331.97 ,$359.82 ,$354.32 ,$372.41 ,$124.09 ,$430.63 ,$337.21 ,$545.10 ,$545.10 ,$144.24 ,$545.10 ,$648.97 ,$517.85 ,$446.98 ,$446.98 ,$436.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$446.20 ,$294.49 ,$101.59 ,$839.41 ,$318.12 ,$399.88 ,$399.88 ,$118.06 ,$356.96 ,$379.27 ,$278.88 ,$401.58 ,$318.12 ,$318.12 ,$423.89 ,$401.58 ,$379.27 ,$379.27 ,$118.06 ,$379.27 ,$379.27 ,$401.58 ,$271.74 ,$318.12 ,$276.64 ,$337.21 ,$401.58 ,$839.41 ,$410.50 ,$401.58 ,$294.54 ,$294.54 ,$271.74 ,$294.54 ,$290.03 ,$304.84 ,$101.59 ,$352.50 ,$337.21 ,$446.20 ,$446.20 ,$118.06 ,$446.20 ,$373.07 ,$423.89 ,$365.88 ,$365.88 ,$356.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$334.65 ,$220.87 ,$76.19 ,$406.31 ,$123.43 ,$299.91 ,$299.91 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$123.43 ,$123.43 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$123.43 ,$207.48 ,$130.84 ,$301.19 ,$406.31 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$130.84 ,$334.65 ,$334.65 ,$88.55 ,$334.65 ,$180.58 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$173.65 ,$114.61 ,$39.53 ,$261.25 ,$123.43 ,$155.63 ,$155.63 ,$45.95 ,$138.92 ,$147.60 ,$108.53 ,$156.29 ,$123.43 ,$123.43 ,$164.97 ,$156.29 ,$147.60 ,$147.60 ,$45.95 ,$147.60 ,$147.60 ,$156.29 ,$105.75 ,$123.43 ,$107.66 ,$130.84 ,$156.29 ,$261.25 ,$159.76 ,$156.29 ,$114.63 ,$114.63 ,$105.75 ,$114.63 ,$112.87 ,$118.64 ,$39.53 ,$137.18 ,$130.84 ,$173.65 ,$173.65 ,$45.95 ,$173.65 ,$116.11 ,$164.97 ,$142.39 ,$142.39 ,$138.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000012,11760,HC REPAIR NAIL BED,450,1 ,$532.45 ,$351.42 ,$121.21 ,"$1,307.14 ",$123.43 ,$477.18 ,$477.18 ,$140.88 ,$425.96 ,$452.58 ,$332.78 ,$479.21 ,$123.43 ,$123.43 ,$505.83 ,$479.21 ,$452.58 ,$452.58 ,$140.88 ,$452.58 ,$452.58 ,$479.21 ,$324.26 ,$123.43 ,$330.12 ,$130.84 ,$479.21 ,"$1,307.14 ",$489.85 ,$479.21 ,$351.47 ,$351.47 ,$324.26 ,$351.47 ,$346.09 ,$363.77 ,$121.21 ,$420.64 ,$130.84 ,$532.45 ,$532.45 ,$140.88 ,$532.45 ,$580.95 ,$505.83 ,$436.61 ,$436.61 ,$425.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000013,11765,HC EXC WEDGE SKIN NAIL FOLD,450,1 ,"$1,193.70 ",$787.84 ,$123.43 ,"$1,193.70 ",$123.43 ,"$1,069.79 ","$1,069.79 ",$315.85 ,$954.96 ,"$1,014.65 ",$746.06 ,"$1,074.33 ",$123.43 ,$123.43 ,"$1,134.02 ","$1,074.33 ","$1,014.65 ","$1,014.65 ",$315.85 ,"$1,014.65 ","$1,014.65 ","$1,074.33 ",$726.96 ,$123.43 ,$740.10 ,$130.84 ,"$1,074.33 ",$839.41 ,"$1,098.20 ","$1,074.33 ",$787.96 ,$787.96 ,$726.96 ,$787.96 ,$775.91 ,$815.54 ,$271.75 ,$943.02 ,$130.84 ,$587.00 ,$587.00 ,$315.85 ,$663.00 ,$373.07 ,"$1,134.02 ",$978.83 ,$978.83 ,$954.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$631.35 ,$416.69 ,$143.73 ,$631.35 ,$351.11 ,$565.82 ,$565.82 ,$167.05 ,$505.08 ,$536.65 ,$394.59 ,$568.22 ,$351.11 ,$351.11 ,$599.78 ,$568.22 ,$536.65 ,$536.65 ,$167.05 ,$536.65 ,$536.65 ,$568.22 ,$384.49 ,$351.11 ,$391.44 ,$372.18 ,$568.22 ,$406.31 ,$580.84 ,$568.22 ,$416.75 ,$416.75 ,$384.49 ,$416.75 ,$410.38 ,$431.34 ,$143.73 ,$498.77 ,$372.18 ,$587.00 ,$587.00 ,$167.05 ,$631.35 ,$180.58 ,$599.78 ,$517.71 ,$517.71 ,$505.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$693.45 ,$457.68 ,$157.86 ,$693.45 ,$351.11 ,$621.47 ,$621.47 ,$183.49 ,$554.76 ,$589.43 ,$433.41 ,$624.11 ,$351.11 ,$351.11 ,$658.78 ,$624.11 ,$589.43 ,$589.43 ,$183.49 ,$589.43 ,$589.43 ,$624.11 ,$422.31 ,$351.11 ,$429.94 ,$372.18 ,$624.11 ,$406.31 ,$637.97 ,$624.11 ,$457.75 ,$457.75 ,$422.31 ,$457.75 ,$450.74 ,$473.77 ,$157.86 ,$547.83 ,$372.18 ,$587.00 ,$587.00 ,$183.49 ,$663.00 ,$180.58 ,$658.78 ,$568.63 ,$568.63 ,$554.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$755.55 ,$498.66 ,$172.01 ,$755.55 ,$351.11 ,$677.12 ,$677.12 ,$199.92 ,$604.44 ,$642.22 ,$472.22 ,$680.00 ,$351.11 ,$351.11 ,$717.77 ,$680.00 ,$642.22 ,$642.22 ,$199.92 ,$642.22 ,$642.22 ,$680.00 ,$460.13 ,$351.11 ,$468.44 ,$372.18 ,$680.00 ,$406.31 ,$695.11 ,$680.00 ,$498.74 ,$498.74 ,$460.13 ,$498.74 ,$491.11 ,$516.19 ,$172.01 ,$596.88 ,$372.18 ,$587.00 ,$587.00 ,$199.92 ,$663.00 ,$180.58 ,$717.77 ,$619.55 ,$619.55 ,$604.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$817.65 ,$539.65 ,$186.14 ,$839.41 ,$351.11 ,$732.78 ,$732.78 ,$216.35 ,$654.12 ,$695.00 ,$511.03 ,$735.89 ,$351.11 ,$351.11 ,$776.77 ,$735.89 ,$695.00 ,$695.00 ,$216.35 ,$695.00 ,$695.00 ,$735.89 ,$497.95 ,$351.11 ,$506.94 ,$372.18 ,$735.89 ,$839.41 ,$752.24 ,$735.89 ,$539.73 ,$539.73 ,$497.95 ,$539.73 ,$531.47 ,$558.62 ,$186.14 ,$645.94 ,$372.18 ,$587.00 ,$587.00 ,$216.35 ,$663.00 ,$373.07 ,$776.77 ,$670.47 ,$670.47 ,$654.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$879.75 ,$580.64 ,$200.27 ,$879.75 ,$351.11 ,$788.43 ,$788.43 ,$232.78 ,$703.80 ,$747.79 ,$549.84 ,$791.78 ,$351.11 ,$351.11 ,$835.76 ,$791.78 ,$747.79 ,$747.79 ,$232.78 ,$747.79 ,$747.79 ,$791.78 ,$535.77 ,$351.11 ,$545.44 ,$372.18 ,$791.78 ,$839.41 ,$809.37 ,$791.78 ,$580.72 ,$580.72 ,$535.77 ,$580.72 ,$571.84 ,$601.05 ,$200.27 ,$695.00 ,$372.18 ,$587.00 ,$587.00 ,$232.78 ,$663.00 ,$373.07 ,$835.76 ,$721.40 ,$721.40 ,$703.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$619.85 ,$409.10 ,$141.12 ,$619.85 ,$351.11 ,$555.51 ,$555.51 ,$164.01 ,$495.88 ,$526.87 ,$387.41 ,$557.87 ,$351.11 ,$351.11 ,$588.86 ,$557.87 ,$526.87 ,$526.87 ,$164.01 ,$526.87 ,$526.87 ,$557.87 ,$377.49 ,$351.11 ,$384.30 ,$372.18 ,$557.87 ,$406.31 ,$570.26 ,$557.87 ,$409.16 ,$409.16 ,$377.49 ,$409.16 ,$402.90 ,$423.48 ,$141.12 ,$489.68 ,$372.18 ,$587.00 ,$587.00 ,$164.01 ,$619.85 ,$180.58 ,$588.86 ,$508.28 ,$508.28 ,$495.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$780.85 ,$515.36 ,$177.77 ,$780.85 ,$351.11 ,$699.80 ,$699.80 ,$206.61 ,$624.68 ,$663.72 ,$488.03 ,$702.77 ,$351.11 ,$351.11 ,$741.81 ,$702.77 ,$663.72 ,$663.72 ,$206.61 ,$663.72 ,$663.72 ,$702.77 ,$475.54 ,$351.11 ,$484.12 ,$372.18 ,$702.77 ,$406.31 ,$718.38 ,$702.77 ,$515.44 ,$515.44 ,$475.54 ,$515.44 ,$507.55 ,$533.48 ,$177.77 ,$616.87 ,$372.18 ,$587.00 ,$587.00 ,$206.61 ,$663.00 ,$180.58 ,$741.81 ,$640.30 ,$640.30 ,$624.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$854.45 ,$563.94 ,$180.58 ,$854.45 ,$351.11 ,$765.76 ,$765.76 ,$226.09 ,$683.56 ,$726.28 ,$534.03 ,$769.01 ,$351.11 ,$351.11 ,$811.73 ,$769.01 ,$726.28 ,$726.28 ,$226.09 ,$726.28 ,$726.28 ,$769.01 ,$520.36 ,$351.11 ,$529.76 ,$372.18 ,$769.01 ,$406.31 ,$786.09 ,$769.01 ,$564.02 ,$564.02 ,$520.36 ,$564.02 ,$555.39 ,$583.76 ,$194.52 ,$675.02 ,$372.18 ,$587.00 ,$587.00 ,$226.09 ,$663.00 ,$180.58 ,$811.73 ,$700.65 ,$700.65 ,$683.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$879.75 ,$580.64 ,$180.58 ,$879.75 ,$351.11 ,$788.43 ,$788.43 ,$232.78 ,$703.80 ,$747.79 ,$549.84 ,$791.78 ,$351.11 ,$351.11 ,$835.76 ,$791.78 ,$747.79 ,$747.79 ,$232.78 ,$747.79 ,$747.79 ,$791.78 ,$535.77 ,$351.11 ,$545.44 ,$372.18 ,$791.78 ,$406.31 ,$809.37 ,$791.78 ,$580.72 ,$580.72 ,$535.77 ,$580.72 ,$571.84 ,$601.05 ,$200.27 ,$695.00 ,$372.18 ,$587.00 ,$587.00 ,$232.78 ,$663.00 ,$180.58 ,$835.76 ,$721.40 ,$721.40 ,$703.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$903.90 ,$596.57 ,$180.58 ,$903.90 ,$351.11 ,$810.08 ,$810.08 ,$239.17 ,$723.12 ,$768.32 ,$564.94 ,$813.51 ,$351.11 ,$351.11 ,$858.71 ,$813.51 ,$768.32 ,$768.32 ,$239.17 ,$768.32 ,$768.32 ,$813.51 ,$550.48 ,$351.11 ,$560.42 ,$372.18 ,$813.51 ,$406.31 ,$831.59 ,$813.51 ,$596.66 ,$596.66 ,$550.48 ,$596.66 ,$587.54 ,$617.54 ,$205.78 ,$714.08 ,$372.18 ,$587.00 ,$587.00 ,$239.17 ,$663.00 ,$180.58 ,$858.71 ,$741.20 ,$741.20 ,$723.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$916.55 ,$604.92 ,$208.66 ,$916.55 ,$351.11 ,$821.41 ,$821.41 ,$242.52 ,$733.24 ,$779.07 ,$572.84 ,$824.90 ,$351.11 ,$351.11 ,$870.72 ,$824.90 ,$779.07 ,$779.07 ,$242.52 ,$779.07 ,$779.07 ,$824.90 ,$558.18 ,$351.11 ,$568.26 ,$372.18 ,$824.90 ,$839.41 ,$843.23 ,$824.90 ,$605.01 ,$605.01 ,$558.18 ,$605.01 ,$595.76 ,$626.19 ,$208.66 ,$724.07 ,$372.18 ,$587.00 ,$587.00 ,$242.52 ,$663.00 ,$373.07 ,$870.72 ,$751.57 ,$751.57 ,$733.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000025,12017,HC SIMP F/E/E/N/L/MM 20.1-30.0CM,450,1 ,$941.85 ,$621.62 ,$214.42 ,$941.85 ,$351.11 ,$844.09 ,$844.09 ,$249.21 ,$753.48 ,$800.57 ,$588.66 ,$847.67 ,$351.11 ,$351.11 ,$894.76 ,$847.67 ,$800.57 ,$800.57 ,$249.21 ,$800.57 ,$800.57 ,$847.67 ,$573.59 ,$351.11 ,$583.94 ,$372.18 ,$847.67 ,$839.41 ,$866.50 ,$847.67 ,$621.72 ,$621.72 ,$573.59 ,$621.72 ,$612.20 ,$643.47 ,$214.42 ,$744.06 ,$372.18 ,$587.00 ,$587.00 ,$249.21 ,$663.00 ,$373.07 ,$894.76 ,$772.32 ,$772.32 ,$753.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,486.95 ",$717.24 ,"$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ",$717.24 ,$717.24 ,"$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,$717.24 ,$921.90 ,$760.27 ,"$1,338.26 ","$1,307.14 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ",$760.27 ,$587.00 ,$587.00 ,$393.45 ,$663.00 ,$580.95 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$805.00 ,$531.30 ,$183.26 ,$839.41 ,$717.24 ,$721.44 ,$721.44 ,$213.00 ,$644.00 ,$684.25 ,$503.13 ,$724.50 ,$717.24 ,$717.24 ,$764.75 ,$724.50 ,$684.25 ,$684.25 ,$213.00 ,$684.25 ,$684.25 ,$724.50 ,$490.25 ,$717.24 ,$499.10 ,$760.27 ,$724.50 ,$839.41 ,$740.60 ,$724.50 ,$531.38 ,$531.38 ,$490.25 ,$531.38 ,$523.25 ,$549.98 ,$183.26 ,$635.95 ,$760.27 ,$587.00 ,$587.00 ,$213.00 ,$663.00 ,$373.07 ,$764.75 ,$660.10 ,$660.10 ,$644.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$892.40 ,$588.98 ,$203.15 ,$892.40 ,$717.24 ,$799.77 ,$799.77 ,$236.13 ,$713.92 ,$758.54 ,$557.75 ,$803.16 ,$717.24 ,$717.24 ,$847.78 ,$803.16 ,$758.54 ,$758.54 ,$236.13 ,$758.54 ,$758.54 ,$803.16 ,$543.47 ,$717.24 ,$553.28 ,$760.27 ,$803.16 ,$839.41 ,$821.01 ,$803.16 ,$589.07 ,$589.07 ,$543.47 ,$589.07 ,$580.06 ,$609.69 ,$203.15 ,$705.00 ,$760.27 ,$587.00 ,$587.00 ,$236.13 ,$663.00 ,$373.07 ,$847.78 ,$731.77 ,$731.77 ,$713.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$966.00 ,$637.56 ,$219.91 ,$966.00 ,$717.24 ,$865.73 ,$865.73 ,$255.60 ,$772.80 ,$821.10 ,$603.75 ,$869.40 ,$717.24 ,$717.24 ,$917.70 ,$869.40 ,$821.10 ,$821.10 ,$255.60 ,$821.10 ,$821.10 ,$869.40 ,$588.29 ,$717.24 ,$598.92 ,$760.27 ,$869.40 ,$839.41 ,$888.72 ,$869.40 ,$637.66 ,$637.66 ,$588.29 ,$637.66 ,$627.90 ,$659.97 ,$219.91 ,$763.14 ,$760.27 ,$587.00 ,$587.00 ,$255.60 ,$663.00 ,$373.07 ,$917.70 ,$792.12 ,$792.12 ,$772.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,"$1,053.40 ",$695.24 ,$239.81 ,"$1,053.40 ",$717.24 ,$944.06 ,$944.06 ,$278.73 ,$842.72 ,$895.39 ,$658.38 ,$948.06 ,$717.24 ,$717.24 ,"$1,000.73 ",$948.06 ,$895.39 ,$895.39 ,$278.73 ,$895.39 ,$895.39 ,$948.06 ,$641.52 ,$717.24 ,$653.10 ,$760.27 ,$948.06 ,$839.41 ,$969.13 ,$948.06 ,$695.35 ,$695.35 ,$641.52 ,$695.35 ,$684.71 ,$719.68 ,$239.81 ,$832.19 ,$760.27 ,$587.00 ,$587.00 ,$278.73 ,$663.00 ,$373.07 ,"$1,000.73 ",$863.79 ,$863.79 ,$842.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,"$1,127.00 ",$743.82 ,$256.56 ,"$1,307.14 ",$717.24 ,"$1,010.02 ","$1,010.02 ",$298.20 ,$901.60 ,$957.95 ,$704.38 ,"$1,014.30 ",$717.24 ,$717.24 ,"$1,070.65 ","$1,014.30 ",$957.95 ,$957.95 ,$298.20 ,$957.95 ,$957.95 ,"$1,014.30 ",$686.34 ,$717.24 ,$698.74 ,$760.27 ,"$1,014.30 ","$1,307.14 ","$1,036.84 ","$1,014.30 ",$743.93 ,$743.93 ,$686.34 ,$743.93 ,$732.55 ,$769.97 ,$256.56 ,$890.33 ,$760.27 ,$587.00 ,$587.00 ,$298.20 ,$663.00 ,$580.95 ,"$1,070.65 ",$924.14 ,$924.14 ,$901.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$731.40 ,$482.72 ,$166.50 ,$839.41 ,$717.24 ,$655.48 ,$655.48 ,$193.53 ,$585.12 ,$621.69 ,$457.13 ,$658.26 ,$717.24 ,$717.24 ,$694.83 ,$658.26 ,$621.69 ,$621.69 ,$193.53 ,$621.69 ,$621.69 ,$658.26 ,$445.42 ,$717.24 ,$453.46 ,$760.27 ,$658.26 ,$839.41 ,$672.89 ,$658.26 ,$482.80 ,$482.80 ,$445.42 ,$482.80 ,$475.41 ,$499.69 ,$166.50 ,$577.81 ,$760.27 ,$587.00 ,$587.00 ,$193.53 ,$663.00 ,$373.07 ,$694.83 ,$599.75 ,$599.75 ,$585.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$805.00 ,$531.30 ,$183.26 ,$839.41 ,$717.24 ,$721.44 ,$721.44 ,$213.00 ,$644.00 ,$684.25 ,$503.13 ,$724.50 ,$717.24 ,$717.24 ,$764.75 ,$724.50 ,$684.25 ,$684.25 ,$213.00 ,$684.25 ,$684.25 ,$724.50 ,$490.25 ,$717.24 ,$499.10 ,$760.27 ,$724.50 ,$839.41 ,$740.60 ,$724.50 ,$531.38 ,$531.38 ,$490.25 ,$531.38 ,$523.25 ,$549.98 ,$183.26 ,$635.95 ,$760.27 ,$587.00 ,$587.00 ,$213.00 ,$663.00 ,$373.07 ,$764.75 ,$660.10 ,$660.10 ,$644.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000037,12044,HC INTRM N/H/F/GEN 7.6-12.5CM,450,1 ,$892.40 ,$588.98 ,$203.15 ,"$1,307.14 ",$717.24 ,$799.77 ,$799.77 ,$236.13 ,$713.92 ,$758.54 ,$557.75 ,$803.16 ,$717.24 ,$717.24 ,$847.78 ,$803.16 ,$758.54 ,$758.54 ,$236.13 ,$758.54 ,$758.54 ,$803.16 ,$543.47 ,$717.24 ,$553.28 ,$760.27 ,$803.16 ,"$1,307.14 ",$821.01 ,$803.16 ,$589.07 ,$589.07 ,$543.47 ,$589.07 ,$580.06 ,$609.69 ,$203.15 ,$705.00 ,$760.27 ,$587.00 ,$587.00 ,$236.13 ,$663.00 ,$580.95 ,$847.78 ,$731.77 ,$731.77 ,$713.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000038,12045,HC INTRM N/H/F/GEN 12.6-20.0CM,450,1 ,"$1,053.40 ",$695.24 ,$239.81 ,"$1,307.14 ",$717.24 ,$944.06 ,$944.06 ,$278.73 ,$842.72 ,$895.39 ,$658.38 ,$948.06 ,$717.24 ,$717.24 ,"$1,000.73 ",$948.06 ,$895.39 ,$895.39 ,$278.73 ,$895.39 ,$895.39 ,$948.06 ,$641.52 ,$717.24 ,$653.10 ,$760.27 ,$948.06 ,"$1,307.14 ",$969.13 ,$948.06 ,$695.35 ,$695.35 ,$641.52 ,$695.35 ,$684.71 ,$719.68 ,$239.81 ,$832.19 ,$760.27 ,$587.00 ,$587.00 ,$278.73 ,$663.00 ,$580.95 ,"$1,000.73 ",$863.79 ,$863.79 ,$842.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000039,12046,HC INTRM N/H/F/GEN 20.1-30CM,450,1 ,"$1,127.00 ",$743.82 ,$256.56 ,"$1,307.14 ",$717.24 ,"$1,010.02 ","$1,010.02 ",$298.20 ,$901.60 ,$957.95 ,$704.38 ,"$1,014.30 ",$717.24 ,$717.24 ,"$1,070.65 ","$1,014.30 ",$957.95 ,$957.95 ,$298.20 ,$957.95 ,$957.95 ,"$1,014.30 ",$686.34 ,$717.24 ,$698.74 ,$760.27 ,"$1,014.30 ","$1,307.14 ","$1,036.84 ","$1,014.30 ",$743.93 ,$743.93 ,$686.34 ,$743.93 ,$732.55 ,$769.97 ,$256.56 ,$890.33 ,$760.27 ,$587.00 ,$587.00 ,$298.20 ,$663.00 ,$580.95 ,"$1,070.65 ",$924.14 ,$924.14 ,$901.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$780.85 ,$515.36 ,$177.77 ,$839.41 ,$717.24 ,$699.80 ,$699.80 ,$206.61 ,$624.68 ,$663.72 ,$488.03 ,$702.77 ,$717.24 ,$717.24 ,$741.81 ,$702.77 ,$663.72 ,$663.72 ,$206.61 ,$663.72 ,$663.72 ,$702.77 ,$475.54 ,$717.24 ,$484.12 ,$760.27 ,$702.77 ,$839.41 ,$718.38 ,$702.77 ,$515.44 ,$515.44 ,$475.54 ,$515.44 ,$507.55 ,$533.48 ,$177.77 ,$616.87 ,$760.27 ,$587.00 ,$587.00 ,$206.61 ,$663.00 ,$373.07 ,$741.81 ,$640.30 ,$640.30 ,$624.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$854.45 ,$563.94 ,$194.52 ,$854.45 ,$717.24 ,$765.76 ,$765.76 ,$226.09 ,$683.56 ,$726.28 ,$534.03 ,$769.01 ,$717.24 ,$717.24 ,$811.73 ,$769.01 ,$726.28 ,$726.28 ,$226.09 ,$726.28 ,$726.28 ,$769.01 ,$520.36 ,$717.24 ,$529.76 ,$760.27 ,$769.01 ,$839.41 ,$786.09 ,$769.01 ,$564.02 ,$564.02 ,$520.36 ,$564.02 ,$555.39 ,$583.76 ,$194.52 ,$675.02 ,$760.27 ,$587.00 ,$587.00 ,$226.09 ,$663.00 ,$373.07 ,$811.73 ,$700.65 ,$700.65 ,$683.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$929.20 ,$613.27 ,$211.54 ,$929.20 ,$717.24 ,$832.75 ,$832.75 ,$245.86 ,$743.36 ,$789.82 ,$580.75 ,$836.28 ,$717.24 ,$717.24 ,$882.74 ,$836.28 ,$789.82 ,$789.82 ,$245.86 ,$789.82 ,$789.82 ,$836.28 ,$565.88 ,$717.24 ,$576.10 ,$760.27 ,$836.28 ,$839.41 ,$854.86 ,$836.28 ,$613.36 ,$613.36 ,$565.88 ,$613.36 ,$603.98 ,$634.83 ,$211.54 ,$734.07 ,$760.27 ,$587.00 ,$587.00 ,$245.86 ,$663.00 ,$373.07 ,$882.74 ,$761.94 ,$761.94 ,$743.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,"$1,015.45 ",$670.20 ,$231.17 ,"$1,015.45 ",$717.24 ,$910.05 ,$910.05 ,$268.69 ,$812.36 ,$863.13 ,$634.66 ,$913.91 ,$717.24 ,$717.24 ,$964.68 ,$913.91 ,$863.13 ,$863.13 ,$268.69 ,$863.13 ,$863.13 ,$913.91 ,$618.41 ,$717.24 ,$629.58 ,$760.27 ,$913.91 ,$839.41 ,$934.21 ,$913.91 ,$670.30 ,$670.30 ,$618.41 ,$670.30 ,$660.04 ,$693.76 ,$231.17 ,$802.21 ,$760.27 ,$587.00 ,$587.00 ,$268.69 ,$663.00 ,$373.07 ,$964.68 ,$832.67 ,$832.67 ,$812.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000045,12055,HC INTRM F/E/E/N/L/MM 12.6-20.0CM,450,1 ,"$1,084.45 ",$715.74 ,$246.87 ,"$1,084.45 ",$717.24 ,$971.88 ,$971.88 ,$286.94 ,$867.56 ,$921.78 ,$677.78 ,$976.01 ,$717.24 ,$717.24 ,"$1,030.23 ",$976.01 ,$921.78 ,$921.78 ,$286.94 ,$921.78 ,$921.78 ,$976.01 ,$660.43 ,$717.24 ,$672.36 ,$760.27 ,$976.01 ,$839.41 ,$997.69 ,$976.01 ,$715.85 ,$715.85 ,$660.43 ,$715.85 ,$704.89 ,$740.90 ,$246.87 ,$856.72 ,$760.27 ,$587.00 ,$587.00 ,$286.94 ,$663.00 ,$373.07 ,"$1,030.23 ",$889.25 ,$889.25 ,$867.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000046,12056,HC INTRM F/E/E/N/L/MM 20.1-30.0CM,450,1 ,"$1,127.00 ",$743.82 ,$256.56 ,"$1,127.00 ",$717.24 ,"$1,010.02 ","$1,010.02 ",$298.20 ,$901.60 ,$957.95 ,$704.38 ,"$1,014.30 ",$717.24 ,$717.24 ,"$1,070.65 ","$1,014.30 ",$957.95 ,$957.95 ,$298.20 ,$957.95 ,$957.95 ,"$1,014.30 ",$686.34 ,$717.24 ,$698.74 ,$760.27 ,"$1,014.30 ",$839.41 ,"$1,036.84 ","$1,014.30 ",$743.93 ,$743.93 ,$686.34 ,$743.93 ,$732.55 ,$769.97 ,$256.56 ,$890.33 ,$760.27 ,$587.00 ,$587.00 ,$298.20 ,$663.00 ,$373.07 ,"$1,070.65 ",$924.14 ,$924.14 ,$901.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000048,13100,HC CMPLX TRUNK 1.1-2.5 CM,450,1 ,"$1,127.00 ",$743.82 ,$256.56 ,"$1,307.14 ",$832.76 ,"$1,010.02 ","$1,010.02 ",$298.20 ,$901.60 ,$957.95 ,$704.38 ,"$1,014.30 ",$832.76 ,$832.76 ,"$1,070.65 ","$1,014.30 ",$957.95 ,$957.95 ,$298.20 ,$957.95 ,$957.95 ,"$1,014.30 ",$686.34 ,$832.76 ,$698.74 ,$882.73 ,"$1,014.30 ","$1,307.14 ","$1,036.84 ","$1,014.30 ",$743.93 ,$743.93 ,$686.34 ,$743.93 ,$732.55 ,$769.97 ,$256.56 ,$890.33 ,$882.73 ,$587.00 ,$587.00 ,$298.20 ,$663.00 ,$580.95 ,"$1,070.65 ",$924.14 ,$924.14 ,$901.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000049,13101,HC CMPLX TRUNK 2.6-7.5 CM,450,1 ,"$1,127.00 ",$743.82 ,$256.56 ,"$1,307.14 ",$832.76 ,"$1,010.02 ","$1,010.02 ",$298.20 ,$901.60 ,$957.95 ,$704.38 ,"$1,014.30 ",$832.76 ,$832.76 ,"$1,070.65 ","$1,014.30 ",$957.95 ,$957.95 ,$298.20 ,$957.95 ,$957.95 ,"$1,014.30 ",$686.34 ,$832.76 ,$698.74 ,$882.73 ,"$1,014.30 ","$1,307.14 ","$1,036.84 ","$1,014.30 ",$743.93 ,$743.93 ,$686.34 ,$743.93 ,$732.55 ,$769.97 ,$256.56 ,$890.33 ,$882.73 ,$587.00 ,$587.00 ,$298.20 ,$663.00 ,$580.95 ,"$1,070.65 ",$924.14 ,$924.14 ,$901.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000051,13120,HC CMPLX S/A/L 1.1-2.5 CM,450,1 ,"$1,127.00 ",$743.82 ,$256.56 ,"$1,307.14 ",$832.76 ,"$1,010.02 ","$1,010.02 ",$298.20 ,$901.60 ,$957.95 ,$704.38 ,"$1,014.30 ",$832.76 ,$832.76 ,"$1,070.65 ","$1,014.30 ",$957.95 ,$957.95 ,$298.20 ,$957.95 ,$957.95 ,"$1,014.30 ",$686.34 ,$832.76 ,$698.74 ,$882.73 ,"$1,014.30 ","$1,307.14 ","$1,036.84 ","$1,014.30 ",$743.93 ,$743.93 ,$686.34 ,$743.93 ,$732.55 ,$769.97 ,$256.56 ,$890.33 ,$882.73 ,$587.00 ,$587.00 ,$298.20 ,$663.00 ,$580.95 ,"$1,070.65 ",$924.14 ,$924.14 ,$901.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000052,13121,HC CMPLX S/A/L 2.6-7.5 CM,450,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,486.95 ",$832.76 ,"$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ",$832.76 ,$832.76 ,"$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,$832.76 ,$921.90 ,$882.73 ,"$1,338.26 ","$1,307.14 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ",$882.73 ,$587.00 ,$587.00 ,$393.45 ,$663.00 ,$580.95 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000053,13122,HC CMPLX S/A/L EA ADDL 5 CM OR LESS,450,1 ,$619.85 ,$409.10 ,$141.12 ,$882.73 ,$832.76 ,$555.51 ,$555.51 ,$164.01 ,$495.88 ,$526.87 ,$387.41 ,$557.87 ,$832.76 ,$619.85 ,$588.86 ,$557.87 ,$526.87 ,$526.87 ,$164.01 ,$526.87 ,$526.87 ,$557.87 ,$377.49 ,$832.76 ,$384.30 ,$657.04 ,$557.87 , N/A ,$570.26 ,$557.87 ,$409.16 ,$409.16 ,$377.49 ,$409.16 ,$402.90 ,$423.48 ,$141.12 ,$489.68 ,$882.73 ,$587.00 ,$587.00 ,$164.01 ,$619.85 , N/A ,$588.86 ,$508.28 ,$508.28 ,$495.88 
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 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,486.95 ",$832.76 ,"$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ",$832.76 ,$832.76 ,"$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,$832.76 ,$921.90 ,$882.73 ,"$1,338.26 ",$839.41 ,"$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ",$882.73 ,$587.00 ,$587.00 ,$393.45 ,$663.00 ,$373.07 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
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 ,"$1,611.15 ","$1,063.36 ",$366.78 ,"$1,611.15 ",$832.76 ,"$1,443.91 ","$1,443.91 ",$426.31 ,"$1,288.92 ","$1,369.48 ","$1,006.97 ","$1,450.04 ",$832.76 ,$832.76 ,"$1,530.59 ","$1,450.04 ","$1,369.48 ","$1,369.48 ",$426.31 ,"$1,369.48 ","$1,369.48 ","$1,450.04 ",$981.19 ,$832.76 ,$998.92 ,$882.73 ,"$1,450.04 ","$1,307.14 ","$1,482.26 ","$1,450.04 ","$1,063.52 ","$1,063.52 ",$981.19 ,"$1,063.52 ","$1,047.25 ","$1,100.74 ",$366.78 ,"$1,272.81 ",$882.73 ,$587.00 ,$587.00 ,$426.31 ,$663.00 ,$580.95 ,"$1,530.59 ","$1,321.14 ","$1,321.14 ","$1,288.92 "
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 ,$619.85 ,$409.10 ,$141.12 ,$882.73 ,$832.76 ,$555.51 ,$555.51 ,$164.01 ,$495.88 ,$526.87 ,$387.41 ,$557.87 ,$832.76 ,$619.85 ,$588.86 ,$557.87 ,$526.87 ,$526.87 ,$164.01 ,$526.87 ,$526.87 ,$557.87 ,$377.49 ,$832.76 ,$384.30 ,$657.04 ,$557.87 , N/A ,$570.26 ,$557.87 ,$409.16 ,$409.16 ,$377.49 ,$409.16 ,$402.90 ,$423.48 ,$141.12 ,$489.68 ,$882.73 ,$587.00 ,$587.00 ,$164.01 ,$619.85 , N/A ,$588.86 ,$508.28 ,$508.28 ,$495.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000058,13151,HC CMPLX E/N/E/L 1.1-2.5 CM,450,1 ,"$1,486.95 ",$981.39 ,$338.51 ,"$1,486.95 ",$832.76 ,"$1,332.60 ","$1,332.60 ",$393.45 ,"$1,189.56 ","$1,263.91 ",$929.34 ,"$1,338.26 ",$832.76 ,$832.76 ,"$1,412.60 ","$1,338.26 ","$1,263.91 ","$1,263.91 ",$393.45 ,"$1,263.91 ","$1,263.91 ","$1,338.26 ",$905.55 ,$832.76 ,$921.90 ,$882.73 ,"$1,338.26 ","$1,307.14 ","$1,367.99 ","$1,338.26 ",$981.54 ,$981.54 ,$905.55 ,$981.54 ,$966.52 ,"$1,015.88 ",$338.51 ,"$1,174.69 ",$882.73 ,$587.00 ,$587.00 ,$393.45 ,$663.00 ,$580.95 ,"$1,412.60 ","$1,219.30 ","$1,219.30 ","$1,189.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,"$1,611.15 ","$1,063.36 ",$366.78 ,"$1,611.15 ",$832.76 ,"$1,443.91 ","$1,443.91 ",$426.31 ,"$1,288.92 ","$1,369.48 ","$1,006.97 ","$1,450.04 ",$832.76 ,$832.76 ,"$1,530.59 ","$1,450.04 ","$1,369.48 ","$1,369.48 ",$426.31 ,"$1,369.48 ","$1,369.48 ","$1,450.04 ",$981.19 ,$832.76 ,$998.92 ,$882.73 ,"$1,450.04 ","$1,307.14 ","$1,482.26 ","$1,450.04 ","$1,063.52 ","$1,063.52 ",$981.19 ,"$1,063.52 ","$1,047.25 ","$1,100.74 ",$366.78 ,"$1,272.81 ",$882.73 ,$587.00 ,$587.00 ,$426.31 ,$663.00 ,$580.95 ,"$1,530.59 ","$1,321.14 ","$1,321.14 ","$1,288.92 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000060,13153,HC CMPLX E/N/E/L EA ADDL 5 CM OR LESS,450,1 ,$933.80 ,$616.31 ,$212.58 ,"$2,437.86 ","$2,299.87 ",$836.87 ,$836.87 ,$247.09 ,$747.04 ,$793.73 ,$583.63 ,$840.42 ,"$2,299.87 ",$933.80 ,$887.11 ,$840.42 ,$793.73 ,$793.73 ,$247.09 ,$793.73 ,$793.73 ,$840.42 ,$568.68 ,"$2,299.87 ",$578.96 ,$989.83 ,$840.42 , N/A ,$859.10 ,$840.42 ,$616.40 ,$616.40 ,$568.68 ,$616.40 ,$606.97 ,$637.97 ,$212.58 ,$737.70 ,"$2,437.86 ",$587.00 ,$587.00 ,$247.09 ,$663.00 , N/A ,$887.11 ,$765.72 ,$765.72 ,$747.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000061,16000,HC TX BURN 1ST DEGREE INIT,450,1 ,$210.45 ,$138.90 ,$47.90 ,$406.31 ,$351.11 ,$188.61 ,$188.61 ,$55.68 ,$168.36 ,$178.88 ,$131.53 ,$189.41 ,$351.11 ,$210.45 ,$199.93 ,$189.41 ,$178.88 ,$178.88 ,$55.68 ,$178.88 ,$178.88 ,$189.41 ,$128.16 ,$351.11 ,$130.48 ,$223.08 ,$189.41 ,$406.31 ,$193.61 ,$189.41 ,$138.92 ,$138.92 ,$128.16 ,$138.92 ,$136.79 ,$143.78 ,$47.90 ,$166.26 ,$372.18 ,$210.45 ,$210.45 ,$55.68 ,$210.45 ,$180.58 ,$199.93 ,$172.57 ,$172.57 ,$168.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$508.30 ,$335.48 ,$115.72 ,$508.30 ,$351.11 ,$455.54 ,$455.54 ,$134.50 ,$406.64 ,$432.06 ,$317.69 ,$457.47 ,$351.11 ,$351.11 ,$482.89 ,$457.47 ,$432.06 ,$432.06 ,$134.50 ,$432.06 ,$432.06 ,$457.47 ,$309.55 ,$351.11 ,$315.14 ,$372.18 ,$457.47 ,$406.31 ,$467.64 ,$457.47 ,$335.53 ,$335.53 ,$309.55 ,$335.53 ,$330.40 ,$347.27 ,$115.72 ,$401.56 ,$372.18 ,$508.30 ,$508.30 ,$134.50 ,$508.30 ,$180.58 ,$482.89 ,$416.81 ,$416.81 ,$406.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$545.10 ,$359.77 ,$124.09 ,$545.10 ,$351.11 ,$488.52 ,$488.52 ,$144.24 ,$436.08 ,$463.34 ,$340.69 ,$490.59 ,$351.11 ,$351.11 ,$517.85 ,$490.59 ,$463.34 ,$463.34 ,$144.24 ,$463.34 ,$463.34 ,$490.59 ,$331.97 ,$351.11 ,$337.96 ,$372.18 ,$490.59 ,$406.31 ,$501.49 ,$490.59 ,$359.82 ,$359.82 ,$331.97 ,$359.82 ,$354.32 ,$372.41 ,$124.09 ,$430.63 ,$372.18 ,$545.10 ,$545.10 ,$144.24 ,$545.10 ,$180.58 ,$517.85 ,$446.98 ,$446.98 ,$436.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$656.65 ,$433.39 ,$149.49 ,$839.41 ,$717.24 ,$588.49 ,$588.49 ,$173.75 ,$525.32 ,$558.15 ,$410.41 ,$590.99 ,$717.24 ,$656.65 ,$623.82 ,$590.99 ,$558.15 ,$558.15 ,$173.75 ,$558.15 ,$558.15 ,$590.99 ,$399.90 ,$717.24 ,$407.12 ,$696.05 ,$590.99 ,$839.41 ,$604.12 ,$590.99 ,$433.45 ,$433.45 ,$399.90 ,$433.45 ,$426.82 ,$448.62 ,$149.49 ,$518.75 ,$760.27 ,$587.00 ,$587.00 ,$173.75 ,$656.65 ,$373.07 ,$623.82 ,$538.45 ,$538.45 ,$525.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000068,20103,HC EXPL PENTR WOUND EXTREMITY,450,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$3,373.99 ",$717.24 ,"$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ",$717.24 ,$717.24 ,"$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,$717.24 ,$844.90 ,$760.27 ,"$1,226.48 ","$3,373.99 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ",$760.27 ,$587.00 ,$587.00 ,$360.58 ,$663.00 ,"$1,499.55 ","$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000069,20600,HC ARTHROCENT ASP/INJ JT SMALL,450,1 ,$545.10 ,$359.77 ,$124.09 ,$611.75 ,$463.61 ,$488.52 ,$488.52 ,$144.24 ,$436.08 ,$463.34 ,$340.69 ,$490.59 ,$463.61 ,$463.61 ,$517.85 ,$490.59 ,$463.34 ,$463.34 ,$144.24 ,$463.34 ,$463.34 ,$490.59 ,$331.97 ,$463.61 ,$337.96 ,$491.43 ,$490.59 ,$611.75 ,$501.49 ,$490.59 ,$359.82 ,$359.82 ,$331.97 ,$359.82 ,$354.32 ,$372.41 ,$124.09 ,$430.63 ,$491.43 ,$545.10 ,$545.10 ,$144.24 ,$545.10 ,$271.89 ,$517.85 ,$446.98 ,$446.98 ,$436.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$805.00 ,$531.30 ,$183.26 ,$805.00 ,$463.61 ,$721.44 ,$721.44 ,$213.00 ,$644.00 ,$684.25 ,$503.13 ,$724.50 ,$463.61 ,$463.61 ,$764.75 ,$724.50 ,$684.25 ,$684.25 ,$213.00 ,$684.25 ,$684.25 ,$724.50 ,$490.25 ,$463.61 ,$499.10 ,$491.43 ,$724.50 ,$611.75 ,$740.60 ,$724.50 ,$531.38 ,$531.38 ,$490.25 ,$531.38 ,$523.25 ,$549.98 ,$183.26 ,$635.95 ,$491.43 ,$587.00 ,$587.00 ,$213.00 ,$663.00 ,$271.89 ,$764.75 ,$660.10 ,$660.10 ,$644.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$805.00 ,$531.30 ,$183.26 ,$917.63 ,$695.42 ,$721.44 ,$721.44 ,$213.00 ,$644.00 ,$684.25 ,$503.13 ,$724.50 ,$695.42 ,$695.42 ,$764.75 ,$724.50 ,$684.25 ,$684.25 ,$213.00 ,$684.25 ,$684.25 ,$724.50 ,$490.25 ,$695.42 ,$499.10 ,$737.15 ,$724.50 ,$917.63 ,$740.60 ,$724.50 ,$531.38 ,$531.38 ,$490.25 ,$531.38 ,$523.25 ,$549.98 ,$183.26 ,$635.95 ,$737.15 ,$587.00 ,$587.00 ,$213.00 ,$663.00 ,$407.84 ,$764.75 ,$660.10 ,$660.10 ,$644.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$805.00 ,$531.30 ,$183.26 ,$917.63 ,$695.42 ,$721.44 ,$721.44 ,$213.00 ,$644.00 ,$684.25 ,$503.13 ,$724.50 ,$695.42 ,$695.42 ,$764.75 ,$724.50 ,$684.25 ,$684.25 ,$213.00 ,$684.25 ,$684.25 ,$724.50 ,$490.25 ,$695.42 ,$499.10 ,$737.15 ,$724.50 ,$917.63 ,$740.60 ,$724.50 ,$531.38 ,$531.38 ,$490.25 ,$531.38 ,$523.25 ,$549.98 ,$183.26 ,$635.95 ,$737.15 ,$587.00 ,$587.00 ,$213.00 ,$663.00 ,$407.84 ,$764.75 ,$660.10 ,$660.10 ,$644.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,"$1,028.10 ",$678.55 ,$207.01 ,"$1,028.10 ",$859.29 ,$921.38 ,$921.38 ,$272.04 ,$822.48 ,$873.89 ,$642.56 ,$925.29 ,$859.29 ,$859.29 ,$976.70 ,$925.29 ,$873.89 ,$873.89 ,$272.04 ,$873.89 ,$873.89 ,$925.29 ,$626.11 ,$859.29 ,$637.42 ,$910.85 ,$925.29 ,$465.77 ,$945.85 ,$925.29 ,$678.65 ,$678.65 ,$626.11 ,$678.65 ,$668.27 ,$702.40 ,$234.04 ,$812.20 ,$910.85 ,$587.00 ,$587.00 ,$272.04 ,$663.00 ,$207.01 ,$976.70 ,$843.04 ,$843.04 ,$822.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$663.60 ,$437.98 ,$151.08 ,$910.85 ,$859.29 ,$594.72 ,$594.72 ,$175.59 ,$530.88 ,$564.06 ,$414.75 ,$597.24 ,$859.29 ,$663.60 ,$630.42 ,$597.24 ,$564.06 ,$564.06 ,$175.59 ,$564.06 ,$564.06 ,$597.24 ,$404.13 ,$859.29 ,$411.44 ,$703.42 ,$597.24 ,$465.77 ,$610.51 ,$597.24 ,$438.04 ,$438.04 ,$404.13 ,$438.04 ,$431.34 ,$453.37 ,$151.08 ,$524.24 ,$910.85 ,$587.00 ,$587.00 ,$175.59 ,$663.00 ,$207.01 ,$630.42 ,$544.15 ,$544.15 ,$530.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$607.20 ,$400.75 ,$138.24 ,$910.85 ,$859.29 ,$544.17 ,$544.17 ,$160.66 ,$485.76 ,$516.12 ,$379.50 ,$546.48 ,$859.29 ,$607.20 ,$576.84 ,$546.48 ,$516.12 ,$516.12 ,$160.66 ,$516.12 ,$516.12 ,$546.48 ,$369.78 ,$859.29 ,$376.46 ,$643.63 ,$546.48 ,$465.77 ,$558.62 ,$546.48 ,$400.81 ,$400.81 ,$369.78 ,$400.81 ,$394.68 ,$414.84 ,$138.24 ,$479.69 ,$910.85 ,$587.00 ,$587.00 ,$160.66 ,$607.20 ,$207.01 ,$576.84 ,$497.90 ,$497.90 ,$485.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,$954.50 ,$629.97 ,$217.31 ,"$3,227.67 ",$859.29 ,$855.42 ,$855.42 ,$252.57 ,$763.60 ,$811.33 ,$596.56 ,$859.05 ,$859.29 ,$859.29 ,$906.78 ,$859.05 ,$811.33 ,$811.33 ,$252.57 ,$811.33 ,$811.33 ,$859.05 ,$581.29 ,$859.29 ,$591.80 ,$910.85 ,$859.05 ,"$3,227.67 ",$878.14 ,$859.05 ,$630.07 ,$630.07 ,$581.29 ,$630.07 ,$620.43 ,$652.11 ,$217.31 ,$754.06 ,$910.85 ,$587.00 ,$587.00 ,$252.57 ,$663.00 ,"$1,434.52 ",$906.78 ,$782.69 ,$782.69 ,$763.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000083,26010,HC DRAIN ABSC FINGER SIMPLE,450,1 ,$495.65 ,$327.13 ,$112.84 ,$495.65 ,$318.12 ,$444.20 ,$444.20 ,$131.15 ,$396.52 ,$421.30 ,$309.78 ,$446.09 ,$318.12 ,$318.12 ,$470.87 ,$446.09 ,$421.30 ,$421.30 ,$131.15 ,$421.30 ,$421.30 ,$446.09 ,$301.85 ,$318.12 ,$307.30 ,$337.21 ,$446.09 ,$406.31 ,$456.00 ,$446.09 ,$327.18 ,$327.18 ,$301.85 ,$327.18 ,$322.17 ,$338.63 ,$112.84 ,$391.56 ,$337.21 ,$495.65 ,$495.65 ,$131.15 ,$495.65 ,$180.58 ,$470.87 ,$406.43 ,$406.43 ,$396.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000084,26011,HC DRAIN ABSC FINGER COMPLCD,450,1 ,"$4,854.15 ","$3,203.74 ",$587.00 ,"$4,854.15 ","$2,101.03 ","$4,350.29 ","$4,350.29 ","$1,284.41 ","$3,883.32 ","$4,126.03 ","$3,033.84 ","$4,368.74 ","$2,101.03 ","$2,101.03 ","$4,611.44 ","$4,368.74 ","$4,126.03 ","$4,126.03 ","$1,284.41 ","$4,126.03 ","$4,126.03 ","$4,368.74 ","$2,956.18 ","$2,101.03 ","$3,009.58 ","$2,227.09 ","$4,368.74 ","$3,373.99 ","$4,465.82 ","$4,368.74 ","$3,204.22 ","$3,204.22 ","$2,956.18 ","$3,204.22 ","$3,155.20 ","$3,316.36 ","$1,105.06 ","$3,834.78 ","$2,227.09 ",$587.00 ,$587.00 ,"$1,284.41 ",$663.00 ,"$1,499.55 ","$4,611.44 ","$3,980.40 ","$3,980.40 ","$3,883.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000086,26418,HC RPR EXTEN TENDON FNGR W/O FREE,450,1 ,"$2,262.05 ","$1,492.95 ",$514.96 ,"$3,227.67 ","$2,532.02 ","$2,027.25 ","$2,027.25 ",$598.53 ,"$1,809.64 ","$1,922.74 ","$1,413.78 ","$2,035.85 ","$2,532.02 ","$2,262.05 ","$2,148.95 ","$2,035.85 ","$1,922.74 ","$1,922.74 ",$598.53 ,"$1,922.74 ","$1,922.74 ","$2,035.85 ","$1,377.59 ","$2,532.02 ","$1,402.48 ","$2,397.77 ","$2,035.85 ","$3,227.67 ","$2,081.09 ","$2,035.85 ","$1,493.18 ","$1,493.18 ","$1,377.59 ","$1,493.18 ","$1,470.33 ","$1,545.43 ",$514.96 ,"$1,787.02 ","$2,683.94 ",$587.00 ,$587.00 ,$598.53 ,$663.00 ,"$1,434.52 ","$2,148.95 ","$1,854.88 ","$1,854.88 ","$1,809.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$978.65 ,$645.91 ,$207.01 ,$978.65 ,$859.29 ,$877.07 ,$877.07 ,$258.96 ,$782.92 ,$831.85 ,$611.66 ,$880.79 ,$859.29 ,$859.29 ,$929.72 ,$880.79 ,$831.85 ,$831.85 ,$258.96 ,$831.85 ,$831.85 ,$880.79 ,$596.00 ,$859.29 ,$606.76 ,$910.85 ,$880.79 ,$465.77 ,$900.36 ,$880.79 ,$646.01 ,$646.01 ,$596.00 ,$646.01 ,$636.12 ,$668.61 ,$222.79 ,$773.13 ,$910.85 ,$587.00 ,$587.00 ,$258.96 ,$663.00 ,$207.01 ,$929.72 ,$802.49 ,$802.49 ,$782.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$978.65 ,$645.91 ,$207.01 ,$978.65 ,$859.29 ,$877.07 ,$877.07 ,$258.96 ,$782.92 ,$831.85 ,$611.66 ,$880.79 ,$859.29 ,$859.29 ,$929.72 ,$880.79 ,$831.85 ,$831.85 ,$258.96 ,$831.85 ,$831.85 ,$880.79 ,$596.00 ,$859.29 ,$606.76 ,$910.85 ,$880.79 ,$465.77 ,$900.36 ,$880.79 ,$646.01 ,$646.01 ,$596.00 ,$646.01 ,$636.12 ,$668.61 ,$222.79 ,$773.13 ,$910.85 ,$587.00 ,$587.00 ,$258.96 ,$663.00 ,$207.01 ,$929.72 ,$802.49 ,$802.49 ,$782.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000095,27266,HC CL TX POST HIP ARTHROPLASTY DISLOCAT W ANESTH,450,1 ,"$2,105.65 ","$1,389.73 ",$479.36 ,"$3,227.67 ","$1,915.43 ","$1,887.08 ","$1,887.08 ",$557.16 ,"$1,684.52 ","$1,789.80 ","$1,316.03 ","$1,895.09 ","$1,915.43 ","$1,915.43 ","$2,000.37 ","$1,895.09 ","$1,789.80 ","$1,789.80 ",$557.16 ,"$1,789.80 ","$1,789.80 ","$1,895.09 ","$1,282.34 ","$1,915.43 ","$1,305.50 ","$2,030.36 ","$1,895.09 ","$3,227.67 ","$1,937.20 ","$1,895.09 ","$1,389.94 ","$1,389.94 ","$1,282.34 ","$1,389.94 ","$1,368.67 ","$1,438.58 ",$479.36 ,"$1,663.46 ","$2,030.36 ",$587.00 ,$587.00 ,$557.16 ,$663.00 ,"$1,434.52 ","$2,000.37 ","$1,726.63 ","$1,726.63 ","$1,684.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$830.30 ,$548.00 ,$189.02 ,$910.85 ,$859.29 ,$744.11 ,$744.11 ,$219.70 ,$664.24 ,$705.76 ,$518.94 ,$747.27 ,$859.29 ,$830.30 ,$788.79 ,$747.27 ,$705.76 ,$705.76 ,$219.70 ,$705.76 ,$705.76 ,$747.27 ,$505.65 ,$859.29 ,$514.78 ,$880.12 ,$747.27 ,$465.77 ,$763.88 ,$747.27 ,$548.08 ,$548.08 ,$505.65 ,$548.08 ,$539.70 ,$567.26 ,$189.02 ,$655.94 ,$910.85 ,$587.00 ,$587.00 ,$219.70 ,$663.00 ,$207.01 ,$788.79 ,$680.85 ,$680.85 ,$664.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000097,28190,HC REM FB FOOT SUBQ,450,1 ,"$1,040.75 ",$686.90 ,$236.92 ,"$1,460.18 ",$832.76 ,$932.72 ,$932.72 ,$275.38 ,$832.60 ,$884.64 ,$650.47 ,$936.68 ,$832.76 ,$832.76 ,$988.71 ,$936.68 ,$884.64 ,$884.64 ,$275.38 ,$884.64 ,$884.64 ,$936.68 ,$633.82 ,$832.76 ,$645.26 ,$882.73 ,$936.68 ,"$1,460.18 ",$957.49 ,$936.68 ,$687.00 ,$687.00 ,$633.82 ,$687.00 ,$676.49 ,$711.04 ,$236.92 ,$822.19 ,$882.73 ,$587.00 ,$587.00 ,$275.38 ,$663.00 ,$648.97 ,$988.71 ,$853.42 ,$853.42 ,$832.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$483.00 ,$318.78 ,$109.96 ,$483.00 ,$132.85 ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$132.85 ,$132.85 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$132.85 ,$299.46 ,$140.82 ,$434.70 ,$327.96 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 ,$140.82 ,$483.00 ,$483.00 ,$127.80 ,$483.00 ,$145.76 ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$347.30 ,$229.22 ,$79.07 ,$347.30 ,$132.85 ,$311.25 ,$311.25 ,$91.89 ,$277.84 ,$295.21 ,$217.06 ,$312.57 ,$132.85 ,$132.85 ,$329.94 ,$312.57 ,$295.21 ,$295.21 ,$91.89 ,$295.21 ,$295.21 ,$312.57 ,$211.51 ,$132.85 ,$215.32 ,$140.82 ,$312.57 ,$261.25 ,$319.52 ,$312.57 ,$229.25 ,$229.25 ,$211.51 ,$229.25 ,$225.75 ,$237.28 ,$79.07 ,$274.37 ,$140.82 ,$347.30 ,$347.30 ,$91.89 ,$347.30 ,$116.11 ,$329.94 ,$284.79 ,$284.79 ,$277.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$396.75 ,$261.86 ,$90.32 ,$396.75 ,$132.85 ,$355.57 ,$355.57 ,$104.98 ,$317.40 ,$337.24 ,$247.97 ,$357.08 ,$132.85 ,$132.85 ,$376.91 ,$357.08 ,$337.24 ,$337.24 ,$104.98 ,$337.24 ,$337.24 ,$357.08 ,$241.62 ,$132.85 ,$245.98 ,$140.82 ,$357.08 ,$261.25 ,$365.01 ,$357.08 ,$261.89 ,$261.89 ,$241.62 ,$261.89 ,$257.89 ,$271.06 ,$90.32 ,$313.43 ,$140.82 ,$396.75 ,$396.75 ,$104.98 ,$396.75 ,$116.11 ,$376.91 ,$325.34 ,$325.34 ,$317.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000104,29131,HC APPL FINGER SPLINT DYNAMIC,450,1 ,$309.35 ,$204.17 ,$57.48 ,$309.35 ,$132.85 ,$277.24 ,$277.24 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$132.85 ,$132.85 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$132.85 ,$191.80 ,$140.82 ,$278.42 ,$129.33 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$140.82 ,$309.35 ,$309.35 ,$81.85 ,$309.35 ,$57.48 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000105,29240,HC STRAPPING SHLDR,450,1 ,$309.35 ,$204.17 ,$70.42 ,$309.35 ,$132.85 ,$277.24 ,$277.24 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$132.85 ,$132.85 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$132.85 ,$191.80 ,$140.82 ,$278.42 ,$261.25 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$140.82 ,$309.35 ,$309.35 ,$81.85 ,$309.35 ,$116.11 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$483.00 ,$318.78 ,$109.96 ,$539.80 ,$338.14 ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$338.14 ,$338.14 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$338.14 ,$299.46 ,$358.43 ,$434.70 ,$539.80 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 ,$358.43 ,$483.00 ,$483.00 ,$127.80 ,$483.00 ,$239.91 ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$483.00 ,$318.78 ,$109.96 ,$483.00 ,$132.85 ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$132.85 ,$132.85 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$132.85 ,$299.46 ,$140.82 ,$434.70 ,$327.96 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 ,$140.82 ,$483.00 ,$483.00 ,$127.80 ,$483.00 ,$145.76 ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$483.00 ,$318.78 ,$109.96 ,$483.00 ,$132.85 ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$132.85 ,$132.85 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$132.85 ,$299.46 ,$140.82 ,$434.70 ,$327.96 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 ,$140.82 ,$483.00 ,$483.00 ,$127.80 ,$483.00 ,$145.76 ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000109,29705,HC REM/BIV CAST ARM/LEG,450,1 ,$860.20 ,$567.73 ,$195.83 ,$860.20 ,$338.14 ,$770.91 ,$770.91 ,$227.60 ,$688.16 ,$731.17 ,$537.63 ,$774.18 ,$338.14 ,$338.14 ,$817.19 ,$774.18 ,$731.17 ,$731.17 ,$227.60 ,$731.17 ,$731.17 ,$774.18 ,$523.86 ,$338.14 ,$533.32 ,$358.43 ,$774.18 ,$539.80 ,$791.38 ,$774.18 ,$567.82 ,$567.82 ,$523.86 ,$567.82 ,$559.13 ,$587.69 ,$195.83 ,$679.56 ,$358.43 ,$587.00 ,$587.00 ,$227.60 ,$663.00 ,$239.91 ,$817.19 ,$705.36 ,$705.36 ,$688.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000110,30300,HC REM FB INTRANASAL,450,1 ,$433.55 ,$286.14 ,$98.71 ,$433.55 ,$307.08 ,$388.55 ,$388.55 ,$114.72 ,$346.84 ,$368.52 ,$270.97 ,$390.20 ,$307.08 ,$307.08 ,$411.87 ,$390.20 ,$368.52 ,$368.52 ,$114.72 ,$368.52 ,$368.52 ,$390.20 ,$264.03 ,$307.08 ,$268.80 ,$325.50 ,$390.20 ,$261.25 ,$398.87 ,$390.20 ,$286.19 ,$286.19 ,$264.03 ,$286.19 ,$281.81 ,$296.20 ,$98.71 ,$342.50 ,$325.50 ,$433.55 ,$433.55 ,$114.72 ,$433.55 ,$116.11 ,$411.87 ,$355.51 ,$355.51 ,$346.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$446.20 ,$294.49 ,$101.59 ,$446.20 ,$307.08 ,$399.88 ,$399.88 ,$118.06 ,$356.96 ,$379.27 ,$278.88 ,$401.58 ,$307.08 ,$307.08 ,$423.89 ,$401.58 ,$379.27 ,$379.27 ,$118.06 ,$379.27 ,$379.27 ,$401.58 ,$271.74 ,$307.08 ,$276.64 ,$325.50 ,$401.58 ,$261.25 ,$410.50 ,$401.58 ,$294.54 ,$294.54 ,$271.74 ,$294.54 ,$290.03 ,$304.84 ,$101.59 ,$352.50 ,$325.50 ,$446.20 ,$446.20 ,$118.06 ,$446.20 ,$116.11 ,$423.89 ,$365.88 ,$365.88 ,$356.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000112,30903,HC CNTRL NOSEBLEED ANT CPLX,450,1 ,$545.10 ,$359.77 ,$116.11 ,$545.10 ,$307.08 ,$488.52 ,$488.52 ,$144.24 ,$436.08 ,$463.34 ,$340.69 ,$490.59 ,$307.08 ,$307.08 ,$517.85 ,$490.59 ,$463.34 ,$463.34 ,$144.24 ,$463.34 ,$463.34 ,$490.59 ,$331.97 ,$307.08 ,$337.96 ,$325.50 ,$490.59 ,$261.25 ,$501.49 ,$490.59 ,$359.82 ,$359.82 ,$331.97 ,$359.82 ,$354.32 ,$372.41 ,$124.09 ,$430.63 ,$325.50 ,$545.10 ,$545.10 ,$144.24 ,$545.10 ,$116.11 ,$517.85 ,$446.98 ,$446.98 ,$436.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$495.65 ,$327.13 ,$112.84 ,$495.65 ,$307.08 ,$444.20 ,$444.20 ,$131.15 ,$396.52 ,$421.30 ,$309.78 ,$446.09 ,$307.08 ,$307.08 ,$470.87 ,$446.09 ,$421.30 ,$421.30 ,$131.15 ,$421.30 ,$421.30 ,$446.09 ,$301.85 ,$307.08 ,$307.30 ,$325.50 ,$446.09 ,$261.25 ,$456.00 ,$446.09 ,$327.18 ,$327.18 ,$301.85 ,$327.18 ,$322.17 ,$338.63 ,$112.84 ,$391.56 ,$325.50 ,$495.65 ,$495.65 ,$131.15 ,$495.65 ,$116.11 ,$470.87 ,$406.43 ,$406.43 ,$396.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000114,31238,HC NASAL ENDO W EPISTAX CONTROL,450,1 ,"$3,100.00 ","$2,046.00 ",$587.00 ,"$3,840.94 ","$3,623.53 ","$2,778.22 ","$2,778.22 ",$820.26 ,"$2,480.00 ","$2,635.00 ","$1,937.50 ","$2,790.00 ","$3,623.53 ","$3,100.00 ","$2,945.00 ","$2,790.00 ","$2,635.00 ","$2,635.00 ",$820.26 ,"$2,635.00 ","$2,635.00 ","$2,790.00 ","$1,887.90 ","$3,623.53 ","$1,922.00 ","$3,286.00 ","$2,790.00 ","$3,596.76 ","$2,852.00 ","$2,790.00 ","$2,046.31 ","$2,046.31 ","$1,887.90 ","$2,046.31 ","$2,015.00 ","$2,117.92 ",$705.73 ,"$2,449.00 ","$3,840.94 ",$587.00 ,$587.00 ,$820.26 ,$663.00 ,"$1,598.56 ","$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 ,$285.20 ,$188.23 ,$64.93 ,$430.88 ,$103.51 ,$255.60 ,$255.60 ,$75.46 ,$228.16 ,$242.42 ,$178.25 ,$256.68 ,$103.51 ,$103.51 ,$270.94 ,$256.68 ,$242.42 ,$242.42 ,$75.46 ,$242.42 ,$242.42 ,$256.68 ,$173.69 ,$103.51 ,$176.82 ,$109.72 ,$256.68 ,$430.88 ,$262.38 ,$256.68 ,$188.26 ,$188.26 ,$173.69 ,$188.26 ,$185.38 ,$194.85 ,$64.93 ,$225.31 ,$109.72 ,$285.20 ,$285.20 ,$75.46 ,$285.20 ,$191.50 ,$270.94 ,$233.86 ,$233.86 ,$228.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000123,36400,HC IV START < 3 YEARS OLD (MD),450,1 ,$197.80 ,$130.55 ,$4.31 ,$197.80 ,$4.31 ,$177.27 ,$177.27 ,$52.34 ,$158.24 ,$168.13 , N/A ,$178.02 ,$4.31 ,$4.31 ,$187.91 ,$178.02 ,$168.13 ,$168.13 ,$52.34 ,$168.13 ,$168.13 ,$178.02 ,$120.46 ,$4.31 ,$122.64 ,$4.57 ,$178.02 , N/A ,$181.98 ,$178.02 ,$130.57 ,$130.57 ,$120.46 ,$130.57 ,$128.57 ,$135.14 ,$45.02 ,$156.26 ,$4.57 ,$197.80 ,$197.80 ,$52.34 ,$197.80 , N/A ,$187.91 ,$162.20 ,$162.20 ,$158.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000124,36406,HC VENIPUNCTURE <3YR VEIN OTHR,450,1 ,$34.50 ,$22.77 ,$4.31 ,$34.50 ,$4.31 ,$30.92 ,$30.92 ,$9.13 ,$27.60 ,$29.33 ,$21.56 ,$31.05 ,$4.31 ,$4.31 ,$32.78 ,$31.05 ,$29.33 ,$29.33 ,$9.13 ,$29.33 ,$29.33 ,$31.05 ,$21.01 ,$4.31 ,$21.40 ,$4.57 ,$31.05 , N/A ,$31.74 ,$31.05 ,$22.77 ,$22.77 ,$21.01 ,$22.77 ,$22.43 ,$23.57 ,$7.86 ,$27.26 ,$4.57 ,$34.50 ,$34.50 ,$9.13 ,$34.50 , N/A ,$32.78 ,$28.29 ,$28.29 ,$27.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$669.30 ,$441.74 ,$152.37 ,$849.53 ,$463.61 ,$599.83 ,$599.83 ,$177.10 ,$535.44 ,$568.91 ,$418.31 ,$602.37 ,$463.61 ,$463.61 ,$635.84 ,$602.37 ,$568.91 ,$568.91 ,$177.10 ,$568.91 ,$568.91 ,$602.37 ,$407.60 ,$463.61 ,$414.96 ,$491.43 ,$602.37 ,$849.53 ,$615.76 ,$602.37 ,$441.80 ,$441.80 ,$407.60 ,$441.80 ,$435.05 ,$457.27 ,$152.37 ,$528.75 ,$491.43 ,$587.00 ,$587.00 ,$177.10 ,$663.00 ,$377.57 ,$635.84 ,$548.83 ,$548.83 ,$535.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000134,40652,HC RPR LIP UP 1/2 VERTICAL,450,1 ,"$1,614.60 ","$1,065.64 ",$307.08 ,"$1,614.60 ",$307.08 ,"$1,447.00 ","$1,447.00 ",$427.22 ,"$1,291.68 ","$1,372.41 ","$1,009.13 ","$1,453.14 ",$307.08 ,$307.08 ,"$1,533.87 ","$1,453.14 ","$1,372.41 ","$1,372.41 ",$427.22 ,"$1,372.41 ","$1,372.41 ","$1,453.14 ",$983.29 ,$307.08 ,"$1,001.06 ",$325.50 ,"$1,453.14 ","$1,027.85 ","$1,485.43 ","$1,453.14 ","$1,065.80 ","$1,065.80 ",$983.29 ,"$1,065.80 ","$1,049.49 ","$1,103.09 ",$367.57 ,"$1,275.53 ",$325.50 ,$587.00 ,$587.00 ,$427.22 ,$663.00 ,$456.82 ,"$1,533.87 ","$1,323.97 ","$1,323.97 ","$1,291.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$644.00 ,$425.04 ,$146.61 ,$849.53 ,$307.08 ,$577.15 ,$577.15 ,$170.40 ,$515.20 ,$547.40 ,$402.50 ,$579.60 ,$307.08 ,$307.08 ,$611.80 ,$579.60 ,$547.40 ,$547.40 ,$170.40 ,$547.40 ,$547.40 ,$579.60 ,$392.20 ,$307.08 ,$399.28 ,$325.50 ,$579.60 ,$849.53 ,$592.48 ,$579.60 ,$425.10 ,$425.10 ,$392.20 ,$425.10 ,$418.60 ,$439.98 ,$146.61 ,$508.76 ,$325.50 ,$587.00 ,$587.00 ,$170.40 ,$644.00 ,$377.57 ,$611.80 ,$528.08 ,$528.08 ,$515.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$483.00 ,$318.78 ,$109.96 ,$483.00 ,$307.08 ,$432.86 ,$432.86 ,$127.80 ,$386.40 ,$410.55 ,$301.88 ,$434.70 ,$307.08 ,$307.08 ,$458.85 ,$434.70 ,$410.55 ,$410.55 ,$127.80 ,$410.55 ,$410.55 ,$434.70 ,$294.15 ,$307.08 ,$299.46 ,$325.50 ,$434.70 ,$261.25 ,$444.36 ,$434.70 ,$318.83 ,$318.83 ,$294.15 ,$318.83 ,$313.95 ,$329.99 ,$109.96 ,$381.57 ,$325.50 ,$483.00 ,$483.00 ,$127.80 ,$483.00 ,$116.11 ,$458.85 ,$396.06 ,$396.06 ,$386.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000140,42700,HC I AND D ABSC PERITONSILLAR,450,1 ,$731.40 ,$482.72 ,$166.50 ,$731.40 ,$307.08 ,$655.48 ,$655.48 ,$193.53 ,$585.12 ,$621.69 ,$457.13 ,$658.26 ,$307.08 ,$307.08 ,$694.83 ,$658.26 ,$621.69 ,$621.69 ,$193.53 ,$621.69 ,$621.69 ,$658.26 ,$445.42 ,$307.08 ,$453.46 ,$325.50 ,$658.26 ,$467.62 ,$672.89 ,$658.26 ,$482.80 ,$482.80 ,$445.42 ,$482.80 ,$475.41 ,$499.69 ,$166.50 ,$577.81 ,$325.50 ,$587.00 ,$587.00 ,$193.53 ,$663.00 ,$207.83 ,$694.83 ,$599.75 ,$599.75 ,$585.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000141,42809,HC REMOVE PHARYNX FOREIGN BODY,450,1 ,$247.25 ,$163.19 ,$56.29 ,$849.53 ,$307.08 ,$221.59 ,$221.59 ,$65.42 ,$197.80 ,$210.16 ,$154.53 ,$222.53 ,$307.08 ,$247.25 ,$234.89 ,$222.53 ,$210.16 ,$210.16 ,$65.42 ,$210.16 ,$210.16 ,$222.53 ,$150.58 ,$307.08 ,$153.30 ,$262.09 ,$222.53 ,$849.53 ,$227.47 ,$222.53 ,$163.21 ,$163.21 ,$150.58 ,$163.21 ,$160.71 ,$168.92 ,$56.29 ,$195.33 ,$325.50 ,$247.25 ,$247.25 ,$65.42 ,$247.25 ,$377.57 ,$234.89 ,$202.75 ,$202.75 ,$197.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000147,46050,HC I AND D ABSC PERIANAL SUPFIC,450,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$2,983.89 ","$2,814.99 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$2,814.99 ","$1,362.75 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$2,814.99 ",$844.90 ,"$1,444.52 ","$1,226.48 ","$1,869.84 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$2,983.89 ",$587.00 ,$587.00 ,$360.58 ,$663.00 ,$831.04 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$545.10 ,$359.77 ,$124.09 ,"$2,983.89 ","$2,814.99 ",$488.52 ,$488.52 ,$144.24 ,$436.08 ,$463.34 ,$340.69 ,$490.59 ,"$2,814.99 ",$545.10 ,$517.85 ,$490.59 ,$463.34 ,$463.34 ,$144.24 ,$463.34 ,$463.34 ,$490.59 ,$331.97 ,"$2,814.99 ",$337.96 ,$577.81 ,$490.59 ,$483.46 ,$501.49 ,$490.59 ,$359.82 ,$359.82 ,$331.97 ,$359.82 ,$354.32 ,$372.41 ,$124.09 ,$430.63 ,"$2,983.89 ",$545.10 ,$545.10 ,$144.24 ,$545.10 ,$214.87 ,$517.85 ,$446.98 ,$446.98 ,$436.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000150,46600,HC ANOSCOPY,450,1 ,$230.00 ,$151.80 ,$52.36 ,$397.00 ,$374.53 ,$206.13 ,$206.13 ,$60.86 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$374.53 ,$230.00 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$60.86 ,$195.50 ,$195.50 ,$207.00 ,$140.07 ,$374.53 ,$142.60 ,$243.80 ,$207.00 ,$261.25 ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 ,$397.00 ,$230.00 ,$230.00 ,$60.86 ,$230.00 ,$116.11 ,$218.50 ,$188.60 ,$188.60 ,$184.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$594.55 ,$392.40 ,$135.36 ,$594.55 ,$150.61 ,$532.84 ,$532.84 ,$157.32 ,$475.64 ,$505.37 ,$371.59 ,$535.10 ,$150.61 ,$150.61 ,$564.82 ,$535.10 ,$505.37 ,$505.37 ,$157.32 ,$505.37 ,$505.37 ,$535.10 ,$362.08 ,$150.61 ,$368.62 ,$159.65 ,$535.10 ,$483.46 ,$546.99 ,$535.10 ,$392.46 ,$392.46 ,$362.08 ,$392.46 ,$386.46 ,$406.20 ,$135.36 ,$469.69 ,$159.65 ,$587.00 ,$587.00 ,$157.32 ,$594.55 ,$214.87 ,$564.82 ,$487.53 ,$487.53 ,$475.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$917.70 ,$605.68 ,$150.61 ,$917.70 ,$150.61 ,$822.44 ,$822.44 ,$242.82 ,$734.16 ,$780.05 ,$573.56 ,$825.93 ,$150.61 ,$150.61 ,$871.82 ,$825.93 ,$780.05 ,$780.05 ,$242.82 ,$780.05 ,$780.05 ,$825.93 ,$558.88 ,$150.61 ,$568.98 ,$159.65 ,$825.93 ,$483.46 ,$844.28 ,$825.93 ,$605.77 ,$605.77 ,$558.88 ,$605.77 ,$596.51 ,$626.97 ,$208.92 ,$724.98 ,$159.65 ,$587.00 ,$587.00 ,$242.82 ,$663.00 ,$214.87 ,$871.82 ,$752.51 ,$752.51 ,$734.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$681.95 ,$450.09 ,$155.25 ,$681.95 ,$360.32 ,$611.16 ,$611.16 ,$180.45 ,$545.56 ,$579.66 ,$426.22 ,$613.76 ,$360.32 ,$360.32 ,$647.85 ,$613.76 ,$579.66 ,$579.66 ,$180.45 ,$579.66 ,$579.66 ,$613.76 ,$415.31 ,$360.32 ,$422.80 ,$381.94 ,$613.76 ,$656.91 ,$627.39 ,$613.76 ,$450.16 ,$450.16 ,$415.31 ,$450.16 ,$443.27 ,$465.91 ,$155.25 ,$538.74 ,$381.94 ,$587.00 ,$587.00 ,$180.45 ,$663.00 ,$291.96 ,$647.85 ,$559.20 ,$559.20 ,$545.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000168,64400,HC DENTAL BLOCK,450,1 ,$879.75 ,$580.64 ,$200.27 ,$879.75 ,$766.50 ,$788.43 ,$788.43 ,$232.78 ,$703.80 ,$747.79 ,$549.84 ,$791.78 ,$766.50 ,$766.50 ,$835.76 ,$791.78 ,$747.79 ,$747.79 ,$232.78 ,$747.79 ,$747.79 ,$791.78 ,$535.77 ,$766.50 ,$545.44 ,$812.49 ,$791.78 ,$611.75 ,$809.37 ,$791.78 ,$580.72 ,$580.72 ,$535.77 ,$580.72 ,$571.84 ,$601.05 ,$200.27 ,$695.00 ,$812.49 ,$587.00 ,$587.00 ,$232.78 ,$663.00 ,$271.89 ,$835.76 ,$721.40 ,$721.40 ,$703.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$437.00 ,$288.42 ,$99.49 ,$812.49 ,$766.50 ,$391.64 ,$391.64 ,$115.63 ,$349.60 ,$371.45 ,$273.13 ,$393.30 ,$766.50 ,$437.00 ,$415.15 ,$393.30 ,$371.45 ,$371.45 ,$115.63 ,$371.45 ,$371.45 ,$393.30 ,$266.13 ,$766.50 ,$270.94 ,$463.22 ,$393.30 ,$611.75 ,$402.04 ,$393.30 ,$288.46 ,$288.46 ,$266.13 ,$288.46 ,$284.05 ,$298.56 ,$99.49 ,$345.23 ,$812.49 ,$437.00 ,$437.00 ,$115.63 ,$437.00 ,$271.89 ,$415.15 ,$358.34 ,$358.34 ,$349.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,$954.50 ,$629.97 ,$217.31 ,"$1,449.77 ",$766.50 ,$855.42 ,$855.42 ,$252.57 ,$763.60 ,$811.33 ,$596.56 ,$859.05 ,$766.50 ,$766.50 ,$906.78 ,$859.05 ,$811.33 ,$811.33 ,$252.57 ,$811.33 ,$811.33 ,$859.05 ,$581.29 ,$766.50 ,$591.80 ,$812.49 ,$859.05 ,"$1,449.77 ",$878.14 ,$859.05 ,$630.07 ,$630.07 ,$581.29 ,$630.07 ,$620.43 ,$652.11 ,$217.31 ,$754.06 ,$812.49 ,$587.00 ,$587.00 ,$252.57 ,$663.00 ,$644.34 ,$906.78 ,$782.69 ,$782.69 ,$763.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$438.15 ,$289.18 ,$99.74 ,$438.15 ,$139.30 ,$392.67 ,$392.67 ,$115.93 ,$350.52 ,$372.43 ,$273.84 ,$394.34 ,$139.30 ,$139.30 ,$416.24 ,$394.34 ,$372.43 ,$372.43 ,$115.93 ,$372.43 ,$372.43 ,$394.34 ,$266.83 ,$139.30 ,$271.66 ,$147.66 ,$394.34 ,$261.25 ,$403.10 ,$394.34 ,$289.22 ,$289.22 ,$266.83 ,$289.22 ,$284.80 ,$299.34 ,$99.74 ,$346.14 ,$147.66 ,$438.15 ,$438.15 ,$115.93 ,$438.15 ,$116.11 ,$416.24 ,$359.28 ,$359.28 ,$350.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$438.15 ,$289.18 ,$99.74 ,$849.53 ,$139.30 ,$392.67 ,$392.67 ,$115.93 ,$350.52 ,$372.43 ,$273.84 ,$394.34 ,$139.30 ,$139.30 ,$416.24 ,$394.34 ,$372.43 ,$372.43 ,$115.93 ,$372.43 ,$372.43 ,$394.34 ,$266.83 ,$139.30 ,$271.66 ,$147.66 ,$394.34 ,$849.53 ,$403.10 ,$394.34 ,$289.22 ,$289.22 ,$266.83 ,$289.22 ,$284.80 ,$299.34 ,$99.74 ,$346.14 ,$147.66 ,$438.15 ,$438.15 ,$115.93 ,$438.15 ,$377.57 ,$416.24 ,$359.28 ,$359.28 ,$350.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$438.15 ,$289.18 ,$99.74 ,$438.15 ,$139.30 ,$392.67 ,$392.67 ,$115.93 ,$350.52 ,$372.43 ,$273.84 ,$394.34 ,$139.30 ,$139.30 ,$416.24 ,$394.34 ,$372.43 ,$372.43 ,$115.93 ,$372.43 ,$372.43 ,$394.34 ,$266.83 ,$139.30 ,$271.66 ,$147.66 ,$394.34 ,$261.25 ,$403.10 ,$394.34 ,$289.22 ,$289.22 ,$266.83 ,$289.22 ,$284.80 ,$299.34 ,$99.74 ,$346.14 ,$147.66 ,$438.15 ,$438.15 ,$115.93 ,$438.15 ,$116.11 ,$416.24 ,$359.28 ,$359.28 ,$350.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,$558.90 ,$368.87 ,$127.24 ,$595.60 ,$520.24 ,$500.89 ,$500.89 ,$147.88 ,$447.12 ,$475.07 ,$349.31 ,$503.01 ,$520.24 ,$520.24 ,$530.96 ,$503.01 ,$475.07 ,$475.07 ,$147.88 ,$475.07 ,$475.07 ,$503.01 ,$340.37 ,$520.24 ,$346.52 ,$551.45 ,$503.01 ,$595.60 ,$514.19 ,$503.01 ,$368.93 ,$368.93 ,$340.37 ,$368.93 ,$363.29 ,$381.84 ,$127.24 ,$441.53 ,$551.45 ,$558.90 ,$558.90 ,$147.88 ,$558.90 ,$264.71 ,$530.96 ,$458.30 ,$458.30 ,$447.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000181,69200,HC FB REMOVAL EAR,450,1 ,$247.25 ,$163.19 ,$56.29 ,$261.25 , N/A ,$221.59 ,$221.59 ,$65.42 ,$197.80 ,$210.16 ,$154.53 ,$222.53 , N/A , N/A ,$234.89 ,$222.53 ,$210.16 ,$210.16 ,$65.42 ,$210.16 ,$210.16 ,$222.53 ,$150.58 , N/A ,$153.30 , N/A ,$222.53 ,$261.25 ,$227.47 ,$222.53 ,$163.21 ,$163.21 ,$150.58 ,$163.21 ,$160.71 ,$168.92 ,$56.29 ,$195.33 , N/A ,$247.25 ,$247.25 ,$65.42 ,$247.25 ,$116.11 ,$234.89 ,$202.75 ,$202.75 ,$197.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$124.20 ,$81.97 ,$28.28 ,$129.33 , N/A ,$111.31 ,$111.31 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 , N/A , N/A ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 , N/A ,$77.00 , N/A ,$111.78 ,$129.33 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 , N/A ,$124.20 ,$124.20 ,$32.86 ,$124.20 ,$57.48 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000188,99281,HC ER LEVEL 1,450,1 ,$175.00 ,$115.50 ,$39.84 ,$251.62 ,$237.38 ,$156.84 ,$156.84 ,$46.30 ,$140.00 ,$148.75 ,$109.38 ,$157.50 ,$237.38 ,$175.00 ,$166.25 ,$157.50 ,$148.75 ,$148.75 ,$46.30 ,$148.75 ,$148.75 ,$157.50 ,$106.58 ,$237.38 ,$108.50 ,$185.50 ,$157.50 ,$168.95 ,$161.00 ,$157.50 ,$115.52 ,$115.52 ,$106.58 ,$115.52 ,$113.75 ,$119.56 ,$39.84 ,$138.25 ,$251.62 ,$175.00 ,$175.00 ,$46.30 ,$175.00 ,$75.09 ,$166.25 ,$143.50 ,$143.50 ,$140.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000189,99282,HC ER LEVEL 2,450,1 ,$260.00 ,$171.60 ,$59.19 ,$314.30 ,$237.38 ,$233.01 ,$233.01 ,$68.80 ,$208.00 ,$221.00 ,$162.50 ,$234.00 ,$237.38 ,$237.38 ,$247.00 ,$234.00 ,$221.00 ,$221.00 ,$68.80 ,$221.00 ,$221.00 ,$234.00 ,$158.34 ,$237.38 ,$161.20 ,$251.62 ,$234.00 ,$314.30 ,$239.20 ,$234.00 ,$171.63 ,$171.63 ,$158.34 ,$171.63 ,$169.00 ,$177.63 ,$59.19 ,$205.40 ,$251.62 ,$260.00 ,$260.00 ,$68.80 ,$260.00 ,$139.69 ,$247.00 ,$213.20 ,$213.20 ,$208.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000190,99283,HC ER LEVEL 3,450,1 ,$410.00 ,$270.60 ,$93.34 ,$551.32 ,$237.38 ,$367.44 ,$367.44 ,$108.49 ,$328.00 ,$348.50 ,$256.25 ,$369.00 ,$237.38 ,$237.38 ,$389.50 ,$369.00 ,$348.50 ,$348.50 ,$108.49 ,$348.50 ,$348.50 ,$369.00 ,$249.69 ,$237.38 ,$254.20 ,$251.62 ,$369.00 ,$551.32 ,$377.20 ,$369.00 ,$270.64 ,$270.64 ,$249.69 ,$270.64 ,$266.50 ,$280.11 ,$93.34 ,$323.90 ,$251.62 ,$410.00 ,$410.00 ,$108.49 ,$410.00 ,$245.03 ,$389.50 ,$336.20 ,$336.20 ,$328.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000191,99284,HC ER LEVEL 4,450,1 ,$670.00 ,$442.20 ,$152.53 ,$858.62 ,$237.38 ,$600.45 ,$600.45 ,$177.28 ,$536.00 ,$569.50 ,$418.75 ,$603.00 ,$237.38 ,$237.38 ,$636.50 ,$603.00 ,$569.50 ,$569.50 ,$177.28 ,$569.50 ,$569.50 ,$603.00 ,$408.03 ,$237.38 ,$415.40 ,$251.62 ,$603.00 ,$858.62 ,$616.40 ,$603.00 ,$442.27 ,$442.27 ,$408.03 ,$442.27 ,$435.50 ,$457.74 ,$152.53 ,$529.30 ,$251.62 ,$670.00 ,$670.00 ,$177.28 ,$670.00 ,$381.61 ,$636.50 ,$549.40 ,$549.40 ,$536.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000192,99285,HC ER LEVEL 5,450,1 ,$980.00 ,$646.80 ,$223.10 ,"$1,233.25 ",$237.38 ,$878.28 ,$878.28 ,$259.31 ,$784.00 ,$833.00 ,$612.50 ,$882.00 ,$237.38 ,$237.38 ,$931.00 ,$882.00 ,$833.00 ,$833.00 ,$259.31 ,$833.00 ,$833.00 ,$882.00 ,$596.82 ,$237.38 ,$607.60 ,$251.62 ,$882.00 ,"$1,233.25 ",$901.60 ,$882.00 ,$646.90 ,$646.90 ,$596.82 ,$646.90 ,$637.00 ,$669.54 ,$223.10 ,$774.20 ,$251.62 ,$980.00 ,$980.00 ,$259.31 ,$980.00 ,$548.11 ,$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 ","$1,188.00 ",$237.38 ,"$1,800.00 ",$237.38 ,"$1,613.16 ","$1,613.16 ",$476.28 ,"$1,440.00 ","$1,530.00 ","$1,125.00 ","$1,620.00 ",$237.38 ,$237.38 ,"$1,710.00 ","$1,620.00 ","$1,530.00 ","$1,530.00 ",$476.28 ,"$1,530.00 ","$1,530.00 ","$1,620.00 ","$1,096.20 ",$237.38 ,"$1,116.00 ",$251.62 ,"$1,620.00 ","$1,727.37 ","$1,656.00 ","$1,620.00 ","$1,188.18 ","$1,188.18 ","$1,096.20 ","$1,188.18 ","$1,170.00 ","$1,229.76 ",$409.78 ,"$1,422.00 ",$251.62 ,"$1,800.00 ","$1,800.00 ",$476.28 ,"$1,800.00 ",$767.72 ,"$1,710.00 ","$1,476.00 ","$1,476.00 ","$1,440.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000194,99285,HC ER LEVEL 5 SANE,450,1 ,"$2,400.00 ","$1,584.00 ",$237.38 ,"$2,400.00 ",$237.38 ,"$2,150.88 ","$2,150.88 ",$635.04 ,"$1,920.00 ","$2,040.00 ","$1,500.00 ","$2,160.00 ",$237.38 ,$237.38 ,"$2,280.00 ","$2,160.00 ","$2,040.00 ","$2,040.00 ",$635.04 ,"$2,040.00 ","$2,040.00 ","$2,160.00 ","$1,461.60 ",$237.38 ,"$1,488.00 ",$251.62 ,"$2,160.00 ","$1,233.25 ","$2,208.00 ","$2,160.00 ","$1,584.24 ","$1,584.24 ","$1,461.60 ","$1,584.24 ","$1,560.00 ","$1,639.68 ",$546.37 ,"$1,896.00 ",$251.62 ,"$2,043.00 ","$2,043.00 ",$635.04 ,"$2,203.00 ",$548.11 ,"$2,280.00 ","$1,968.00 ","$1,968.00 ","$1,920.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,$510.00 ,$336.60 ,$116.10 ,$510.00 ,$237.38 ,$457.06 ,$457.06 ,$134.95 ,$408.00 ,$433.50 ,$318.75 ,$459.00 ,$237.38 ,$237.38 ,$484.50 ,$459.00 ,$433.50 ,$433.50 ,$134.95 ,$433.50 ,$433.50 ,$459.00 ,$310.59 ,$237.38 ,$316.20 ,$251.62 ,$459.00 , N/A ,$469.20 ,$459.00 ,$336.65 ,$336.65 ,$310.59 ,$336.65 ,$331.50 ,$348.43 ,$116.10 ,$402.90 ,$251.62 ,$510.00 ,$510.00 ,$134.95 ,$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 ,$954.50 ,$629.97 ,$217.31 ,"$3,227.67 ",$859.29 ,$855.42 ,$855.42 ,$252.57 ,$763.60 ,$811.33 ,$596.56 ,$859.05 ,$859.29 ,$859.29 ,$906.78 ,$859.05 ,$811.33 ,$811.33 ,$252.57 ,$811.33 ,$811.33 ,$859.05 ,$581.29 ,$859.29 ,$591.80 ,$910.85 ,$859.05 ,"$3,227.67 ",$878.14 ,$859.05 ,$630.07 ,$630.07 ,$581.29 ,$630.07 ,$620.43 ,$652.11 ,$217.31 ,$754.06 ,$910.85 ,$587.00 ,$587.00 ,$252.57 ,$663.00 ,"$1,434.52 ",$906.78 ,$782.69 ,$782.69 ,$763.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000203,27840,HC TX DISL ANKLE W/O ANES CLS,450,1 ,$681.95 ,$450.09 ,$155.25 ,$910.85 ,$859.29 ,$611.16 ,$611.16 ,$180.45 ,$545.56 ,$579.66 ,$426.22 ,$613.76 ,$859.29 ,$681.95 ,$647.85 ,$613.76 ,$579.66 ,$579.66 ,$180.45 ,$579.66 ,$579.66 ,$613.76 ,$415.31 ,$859.29 ,$422.80 ,$722.87 ,$613.76 ,$465.77 ,$627.39 ,$613.76 ,$450.16 ,$450.16 ,$415.31 ,$450.16 ,$443.27 ,$465.91 ,$155.25 ,$538.74 ,$910.85 ,$587.00 ,$587.00 ,$180.45 ,$663.00 ,$207.01 ,$647.85 ,$559.20 ,$559.20 ,$545.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000204,23931,HC I AND D BURSA ELBOW/ARM,450,1 ,"$4,854.15 ","$3,203.74 ",$587.00 ,"$4,854.15 ","$3,447.67 ","$4,350.29 ","$4,350.29 ","$1,284.41 ","$3,883.32 ","$4,126.03 ","$3,033.84 ","$4,368.74 ","$3,447.67 ","$3,447.67 ","$4,611.44 ","$4,368.74 ","$4,126.03 ","$4,126.03 ","$1,284.41 ","$4,126.03 ","$4,126.03 ","$4,368.74 ","$2,956.18 ","$3,447.67 ","$3,009.58 ","$3,654.53 ","$4,368.74 ","$3,373.99 ","$4,465.82 ","$4,368.74 ","$3,204.22 ","$3,204.22 ","$2,956.18 ","$3,204.22 ","$3,155.20 ","$3,316.36 ","$1,105.06 ","$3,834.78 ","$3,654.53 ",$587.00 ,$587.00 ,"$1,284.41 ",$663.00 ,"$1,499.55 ","$4,611.44 ","$3,980.40 ","$3,980.40 ","$3,883.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000211,26641,HC CLSD DISCL THUMB W/MANIP,450,1 ,$801.55 ,$529.02 ,$182.48 ,$910.85 ,$859.29 ,$718.35 ,$718.35 ,$212.09 ,$641.24 ,$681.32 ,$500.97 ,$721.40 ,$859.29 ,$801.55 ,$761.47 ,$721.40 ,$681.32 ,$681.32 ,$212.09 ,$681.32 ,$681.32 ,$721.40 ,$488.14 ,$859.29 ,$496.96 ,$849.64 ,$721.40 ,$465.77 ,$737.43 ,$721.40 ,$529.10 ,$529.10 ,$488.14 ,$529.10 ,$521.01 ,$547.62 ,$182.48 ,$633.22 ,$910.85 ,$587.00 ,$587.00 ,$212.09 ,$663.00 ,$207.01 ,$761.47 ,$657.27 ,$657.27 ,$641.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000212,25690,HC CLSD WRIST DISLOC,450,1 ,"$4,803.61 ","$3,170.38 ",$587.00 ,"$4,803.61 ",$859.29 ,"$4,305.00 ","$4,305.00 ","$1,271.03 ","$3,842.89 ","$4,083.07 ","$3,002.26 ","$4,323.25 ",$859.29 ,$859.29 ,"$4,563.43 ","$4,323.25 ","$4,083.07 ","$4,083.07 ","$1,271.03 ","$4,083.07 ","$4,083.07 ","$4,323.25 ","$2,925.40 ",$859.29 ,"$2,978.24 ",$910.85 ,"$4,323.25 ","$3,227.67 ","$4,419.32 ","$4,323.25 ","$3,170.86 ","$3,170.86 ","$2,925.40 ","$3,170.86 ","$3,122.35 ","$3,281.83 ","$1,093.56 ","$3,794.85 ",$910.85 ,$587.00 ,$587.00 ,"$1,271.03 ",$663.00 ,"$1,434.52 ","$4,563.43 ","$3,938.96 ","$3,938.96 ","$3,842.89 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$755.00 ,$498.30 ,$171.88 ,$755.00 ,$550.17 ,$676.63 ,$676.63 ,$199.77 ,$604.00 ,$641.75 ,$471.88 ,$679.50 ,$550.17 ,$550.17 ,$717.25 ,$679.50 ,$641.75 ,$641.75 ,$199.77 ,$641.75 ,$641.75 ,$679.50 ,$459.80 ,$550.17 ,$468.10 ,$583.18 ,$679.50 ,$748.40 ,$694.60 ,$679.50 ,$498.38 ,$498.38 ,$459.80 ,$498.38 ,$490.75 ,$515.82 ,$171.88 ,$596.45 ,$583.18 ,$587.00 ,$587.00 ,$199.77 ,$663.00 ,$332.62 ,$717.25 ,$619.10 ,$619.10 ,$604.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000216,41899,HC DENTOALVEOLAR STRUCT PROC,450,1 ,$675.05 ,$445.53 ,$153.67 ,"$2,441.00 ","$2,302.83 ",$604.98 ,$604.98 ,$178.61 ,$540.04 ,$573.79 ,$421.91 ,$607.55 ,"$2,302.83 ",$675.05 ,$641.30 ,$607.55 ,$573.79 ,$573.79 ,$178.61 ,$573.79 ,$573.79 ,$607.55 ,$411.11 ,"$2,302.83 ",$418.54 ,$715.55 ,$607.55 ,$467.62 ,$621.05 ,$607.55 ,$445.60 ,$445.60 ,$411.11 ,$445.60 ,$438.78 ,$461.19 ,$153.67 ,$533.29 ,"$2,441.00 ",$587.00 ,$587.00 ,$178.61 ,$663.00 ,$207.83 ,$641.30 ,$553.54 ,$553.54 ,$540.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$1,603.10 ","$1,058.05 ",$364.95 ,"$3,227.67 ",$859.29 ,"$1,436.70 ","$1,436.70 ",$424.18 ,"$1,282.48 ","$1,362.64 ","$1,001.94 ","$1,442.79 ",$859.29 ,$859.29 ,"$1,522.95 ","$1,442.79 ","$1,362.64 ","$1,362.64 ",$424.18 ,"$1,362.64 ","$1,362.64 ","$1,442.79 ",$976.29 ,$859.29 ,$993.92 ,$910.85 ,"$1,442.79 ","$3,227.67 ","$1,474.85 ","$1,442.79 ","$1,058.21 ","$1,058.21 ",$976.29 ,"$1,058.21 ","$1,042.02 ","$1,095.24 ",$364.95 ,"$1,266.45 ",$910.85 ,$587.00 ,$587.00 ,$424.18 ,$663.00 ,"$1,434.52 ","$1,522.95 ","$1,314.54 ","$1,314.54 ","$1,282.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000221,10121,HC RM FB SUBQ W/INC COMPL,450,1 ,"$4,465.00 ","$2,946.90 ",$587.00 ,"$4,465.00 ","$2,299.87 ","$4,001.53 ","$4,001.53 ","$1,181.44 ","$3,572.00 ","$3,795.25 ","$2,790.63 ","$4,018.50 ","$2,299.87 ","$2,299.87 ","$4,241.75 ","$4,018.50 ","$3,795.25 ","$3,795.25 ","$1,181.44 ","$3,795.25 ","$3,795.25 ","$4,018.50 ","$2,719.19 ","$2,299.87 ","$2,768.30 ","$2,437.86 ","$4,018.50 ","$3,373.99 ","$4,107.80 ","$4,018.50 ","$2,947.35 ","$2,947.35 ","$2,719.19 ","$2,947.35 ","$2,902.25 ","$3,050.49 ","$1,016.48 ","$3,527.35 ","$2,437.86 ",$587.00 ,$587.00 ,"$1,181.44 ",$663.00 ,"$1,499.55 ","$4,241.75 ","$3,661.30 ","$3,661.30 ","$3,572.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000227,25600,HC CLSD DIS.RADIUS W/O MANIP,450,1 ,$737.15 ,$486.52 ,$167.82 ,$910.85 ,$859.29 ,$660.63 ,$660.63 ,$195.05 ,$589.72 ,$626.58 ,$460.72 ,$663.44 ,$859.29 ,$737.15 ,$700.29 ,$663.44 ,$626.58 ,$626.58 ,$195.05 ,$626.58 ,$626.58 ,$663.44 ,$448.92 ,$859.29 ,$457.04 ,$781.38 ,$663.44 ,$465.77 ,$678.18 ,$663.44 ,$486.59 ,$486.59 ,$448.92 ,$486.59 ,$479.15 ,$503.62 ,$167.82 ,$582.35 ,$910.85 ,$587.00 ,$587.00 ,$195.05 ,$663.00 ,$207.01 ,$700.29 ,$604.46 ,$604.46 ,$589.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000232,26600,HC CLSD METACARPAL W/O MANIP,450,1 ,$564.65 ,$372.67 ,$128.55 ,$910.85 ,$859.29 ,$506.04 ,$506.04 ,$149.41 ,$451.72 ,$479.95 ,$352.91 ,$508.19 ,$859.29 ,$564.65 ,$536.42 ,$508.19 ,$479.95 ,$479.95 ,$149.41 ,$479.95 ,$479.95 ,$508.19 ,$343.87 ,$859.29 ,$350.08 ,$598.53 ,$508.19 ,$465.77 ,$519.48 ,$508.19 ,$372.73 ,$372.73 ,$343.87 ,$372.73 ,$367.02 ,$385.77 ,$128.55 ,$446.07 ,$910.85 ,$564.65 ,$564.65 ,$149.41 ,$564.65 ,$207.01 ,$536.42 ,$463.01 ,$463.01 ,$451.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000238,26670,HC HAND DISL W/MANIP W/O ANES,450,1 ,$640.50 ,$422.73 ,$145.81 ,$910.85 ,$859.29 ,$574.02 ,$574.02 ,$169.48 ,$512.40 ,$544.43 ,$400.31 ,$576.45 ,$859.29 ,$640.50 ,$608.48 ,$576.45 ,$544.43 ,$544.43 ,$169.48 ,$544.43 ,$544.43 ,$576.45 ,$390.06 ,$859.29 ,$397.12 ,$678.93 ,$576.45 ,$465.77 ,$589.26 ,$576.45 ,$422.79 ,$422.79 ,$390.06 ,$422.79 ,$416.33 ,$437.59 ,$145.81 ,$506.00 ,$910.85 ,$587.00 ,$587.00 ,$169.48 ,$640.50 ,$207.01 ,$608.48 ,$525.21 ,$525.21 ,$512.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$744.05 ,$491.07 ,$169.38 ,$910.85 ,$859.29 ,$666.82 ,$666.82 ,$196.87 ,$595.24 ,$632.44 ,$465.03 ,$669.65 ,$859.29 ,$744.05 ,$706.85 ,$669.65 ,$632.44 ,$632.44 ,$196.87 ,$632.44 ,$632.44 ,$669.65 ,$453.13 ,$859.29 ,$461.32 ,$788.69 ,$669.65 ,$465.77 ,$684.53 ,$669.65 ,$491.15 ,$491.15 ,$453.13 ,$491.15 ,$483.63 ,$508.34 ,$169.38 ,$587.80 ,$910.85 ,$587.00 ,$587.00 ,$196.87 ,$663.00 ,$207.01 ,$706.85 ,$610.12 ,$610.12 ,$595.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000270,20606,HC ARTHROCNT ASP/INJ JT INTRM W/ULTRA,450,1 ,"$1,102.85 ",$727.88 ,$251.08 ,"$1,449.77 ",$907.04 ,$988.37 ,$988.37 ,$291.81 ,$882.28 ,$937.42 ,$689.28 ,$992.57 ,$907.04 ,$907.04 ,"$1,047.71 ",$992.57 ,$937.42 ,$937.42 ,$291.81 ,$937.42 ,$937.42 ,$992.57 ,$671.64 ,$907.04 ,$683.76 ,$961.46 ,$992.57 ,"$1,449.77 ","$1,014.62 ",$992.57 ,$727.99 ,$727.99 ,$671.64 ,$727.99 ,$716.85 ,$753.47 ,$251.08 ,$871.25 ,$961.46 ,$587.00 ,$587.00 ,$291.81 ,$663.00 ,$644.34 ,"$1,047.71 ",$904.34 ,$904.34 ,$882.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,$971.75 ,$641.36 ,$221.23 ,$971.75 ,$907.04 ,$870.88 ,$870.88 ,$257.12 ,$777.40 ,$825.99 ,$607.34 ,$874.58 ,$907.04 ,$907.04 ,$923.16 ,$874.58 ,$825.99 ,$825.99 ,$257.12 ,$825.99 ,$825.99 ,$874.58 ,$591.80 ,$907.04 ,$602.48 ,$961.46 ,$874.58 ,$611.75 ,$894.01 ,$874.58 ,$641.45 ,$641.45 ,$591.80 ,$641.45 ,$631.64 ,$663.90 ,$221.23 ,$767.68 ,$961.46 ,$587.00 ,$587.00 ,$257.12 ,$663.00 ,$271.89 ,$923.16 ,$796.84 ,$796.84 ,$777.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$207.00 ,$136.62 ,$47.13 ,$207.00 , N/A ,$185.51 ,$185.51 ,$54.77 ,$165.60 ,$175.95 ,$129.38 ,$186.30 , N/A , N/A ,$196.65 ,$186.30 ,$175.95 ,$175.95 ,$54.77 ,$175.95 ,$175.95 ,$186.30 ,$126.06 , N/A ,$128.34 , N/A ,$186.30 ,$129.33 ,$190.44 ,$186.30 ,$136.64 ,$136.64 ,$126.06 ,$136.64 ,$134.55 ,$141.42 ,$47.13 ,$163.53 , N/A ,$207.00 ,$207.00 ,$54.77 ,$207.00 ,$57.48 ,$196.65 ,$169.74 ,$169.74 ,$165.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000281,N/A,HC ED PROC LEVEL 1,450,1 ,$333.90 ,$220.37 ,$76.02 ,$333.90 , N/A ,$299.24 ,$299.24 ,$88.35 ,$267.12 ,$283.82 ,$208.69 ,$300.51 , N/A , N/A ,$317.21 ,$300.51 ,$283.82 ,$283.82 ,$88.35 ,$283.82 ,$283.82 ,$300.51 ,$203.35 , N/A ,$207.02 , N/A ,$300.51 , N/A ,$307.19 ,$300.51 ,$220.41 ,$220.41 ,$203.35 ,$220.41 ,$217.04 ,$228.12 ,$76.02 ,$263.78 , N/A ,$333.90 ,$333.90 ,$88.35 ,$333.90 , N/A ,$317.21 ,$273.80 ,$273.80 ,$267.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000282,N/A,HC ED PROC LEVEL 2,450,1 ,$556.50 ,$367.29 ,$126.69 ,$556.50 , N/A ,$498.74 ,$498.74 ,$147.25 ,$445.20 ,$473.03 ,$347.81 ,$500.85 , N/A , N/A ,$528.68 ,$500.85 ,$473.03 ,$473.03 ,$147.25 ,$473.03 ,$473.03 ,$500.85 ,$338.91 , N/A ,$345.04 , N/A ,$500.85 , N/A ,$511.98 ,$500.85 ,$367.35 ,$367.35 ,$338.91 ,$367.35 ,$361.73 ,$380.20 ,$126.69 ,$439.64 , N/A ,$556.50 ,$556.50 ,$147.25 ,$556.50 , N/A ,$528.68 ,$456.33 ,$456.33 ,$445.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000283,N/A,HC ED PROC LEVEL 3,450,1 ,"$1,113.00 ",$734.58 ,$253.38 ,"$1,113.00 ", N/A ,$997.47 ,$997.47 ,$294.50 ,$890.40 ,$946.05 ,$695.63 ,"$1,001.70 ", N/A , N/A ,"$1,057.35 ","$1,001.70 ",$946.05 ,$946.05 ,$294.50 ,$946.05 ,$946.05 ,"$1,001.70 ",$677.82 , N/A ,$690.06 , N/A ,"$1,001.70 ", N/A ,"$1,023.96 ","$1,001.70 ",$734.69 ,$734.69 ,$677.82 ,$734.69 ,$723.45 ,$760.40 ,$253.38 ,$879.27 , N/A ,$587.00 ,$587.00 ,$294.50 ,$663.00 , N/A ,"$1,057.35 ",$912.66 ,$912.66 ,$890.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000284,N/A,HC ED PROC LEVEL 4,450,1 ,"$2,226.00 ","$1,469.16 ",$506.76 ,"$2,226.00 ", N/A ,"$1,994.94 ","$1,994.94 ",$589.00 ,"$1,780.80 ","$1,892.10 ","$1,391.25 ","$2,003.40 ", N/A , N/A ,"$2,114.70 ","$2,003.40 ","$1,892.10 ","$1,892.10 ",$589.00 ,"$1,892.10 ","$1,892.10 ","$2,003.40 ","$1,355.63 ", N/A ,"$1,380.12 ", N/A ,"$2,003.40 ", N/A ,"$2,047.92 ","$2,003.40 ","$1,469.38 ","$1,469.38 ","$1,355.63 ","$1,469.38 ","$1,446.90 ","$1,520.80 ",$506.76 ,"$1,758.54 ", N/A ,$587.00 ,$587.00 ,$589.00 ,$663.00 , N/A ,"$2,114.70 ","$1,825.32 ","$1,825.32 ","$1,780.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000285,N/A,HC ED PROC LEVEL 5,450,1 ,"$3,339.00 ","$2,203.74 ",$587.00 ,"$3,339.00 ", N/A ,"$2,992.41 ","$2,992.41 ",$883.50 ,"$2,671.20 ","$2,838.15 ","$2,086.88 ","$3,005.10 ", N/A , N/A ,"$3,172.05 ","$3,005.10 ","$2,838.15 ","$2,838.15 ",$883.50 ,"$2,838.15 ","$2,838.15 ","$3,005.10 ","$2,033.45 ", N/A ,"$2,070.18 ", N/A ,"$3,005.10 ", N/A ,"$3,071.88 ","$3,005.10 ","$2,204.07 ","$2,204.07 ","$2,033.45 ","$2,204.07 ","$2,170.35 ","$2,281.20 ",$760.14 ,"$2,637.81 ", N/A ,$587.00 ,$587.00 ,$883.50 ,$663.00 , N/A ,"$3,172.05 ","$2,737.98 ","$2,737.98 ","$2,671.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$801.55 ,$529.02 ,$182.48 ,$910.85 ,$859.29 ,$718.35 ,$718.35 ,$212.09 ,$641.24 ,$681.32 ,$500.97 ,$721.40 ,$859.29 ,$801.55 ,$761.47 ,$721.40 ,$681.32 ,$681.32 ,$212.09 ,$681.32 ,$681.32 ,$721.40 ,$488.14 ,$859.29 ,$496.96 ,$849.64 ,$721.40 ,$465.77 ,$737.43 ,$721.40 ,$529.10 ,$529.10 ,$488.14 ,$529.10 ,$521.01 ,$547.62 ,$182.48 ,$633.22 ,$910.85 ,$587.00 ,$587.00 ,$212.09 ,$663.00 ,$207.01 ,$761.47 ,$657.27 ,$657.27 ,$641.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000310,31505,HC LARYNGOSCOPY INDIRECT,450,1 ,$493.00 ,$325.38 ,$112.23 ,$493.00 ,$307.08 ,$441.83 ,$441.83 ,$130.45 ,$394.40 ,$419.05 ,$308.13 ,$443.70 ,$307.08 ,$307.08 ,$468.35 ,$443.70 ,$419.05 ,$419.05 ,$130.45 ,$419.05 ,$419.05 ,$443.70 ,$300.24 ,$307.08 ,$305.66 ,$325.50 ,$443.70 ,$402.19 ,$453.56 ,$443.70 ,$325.43 ,$325.43 ,$300.24 ,$325.43 ,$320.45 ,$336.82 ,$112.23 ,$389.47 ,$325.50 ,$493.00 ,$493.00 ,$130.45 ,$493.00 ,$178.75 ,$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 ,$711.36 ,$469.50 ,$161.94 ,$910.85 ,$859.29 ,$637.52 ,$637.52 ,$188.23 ,$569.09 ,$604.66 ,$444.60 ,$640.22 ,$859.29 ,$711.36 ,$675.79 ,$640.22 ,$604.66 ,$604.66 ,$188.23 ,$604.66 ,$604.66 ,$640.22 ,$433.22 ,$859.29 ,$441.04 ,$754.04 ,$640.22 ,$465.77 ,$654.45 ,$640.22 ,$469.57 ,$469.57 ,$433.22 ,$469.57 ,$462.38 ,$486.00 ,$161.94 ,$561.97 ,$910.85 ,$587.00 ,$587.00 ,$188.23 ,$663.00 ,$207.01 ,$675.79 ,$583.32 ,$583.32 ,$569.09 
ST. CLARE MEMORIAL HOSPITAL (ACU),45000443,65220,HC REMOVE FB CORNL W/O SLIT LAMP-LT,450,1 ,"$1,405.30 ",$927.50 ,$139.30 ,"$1,405.30 ",$139.30 ,"$1,259.43 ","$1,259.43 ",$371.84 ,"$1,124.24 ","$1,194.51 ",$878.31 ,"$1,264.77 ",$139.30 ,$139.30 ,"$1,335.04 ","$1,264.77 ","$1,194.51 ","$1,194.51 ",$371.84 ,"$1,194.51 ","$1,194.51 ","$1,264.77 ",$855.83 ,$139.30 ,$871.28 ,$147.66 ,"$1,264.77 ",$849.53 ,"$1,292.88 ","$1,264.77 ",$927.64 ,$927.64 ,$855.83 ,$927.64 ,$913.45 ,$960.10 ,$319.92 ,"$1,110.19 ",$147.66 ,$587.00 ,$587.00 ,$371.84 ,$663.00 ,$377.57 ,"$1,335.04 ","$1,152.35 ","$1,152.35 ","$1,124.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45000500,57200,HC REPAIR SUTURE VAGINA COLPORRHAPHY,450,1 ,"$8,440.95 ","$5,571.03 ",$587.00 ,"$8,440.95 ","$4,709.06 ","$7,564.78 ","$7,564.78 ","$2,233.48 ","$6,752.76 ","$7,174.81 ","$5,275.59 ","$7,596.86 ","$4,709.06 ","$4,709.06 ","$8,018.90 ","$7,596.86 ","$7,174.81 ","$7,174.81 ","$2,233.48 ","$7,174.81 ","$7,174.81 ","$7,596.86 ","$5,140.54 ","$4,709.06 ","$5,233.38 ","$4,991.60 ","$7,596.86 ","$6,361.74 ","$7,765.67 ","$7,596.86 ","$5,571.87 ","$5,571.87 ","$5,140.54 ","$5,571.87 ","$5,486.62 ","$5,766.86 ","$1,921.61 ","$6,668.35 ","$4,991.60 ",$587.00 ,$587.00 ,"$2,233.48 ",$663.00 ,"$2,827.44 ","$8,018.90 ","$6,921.58 ","$6,921.58 ","$6,752.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45001159,43754,HC GASTRIC INTUBATION/ASPIRATION DIAG SINGLE,450,1 ,$805.20 ,$531.43 ,$183.31 ,$805.20 , N/A ,$721.62 ,$721.62 ,$213.05 ,$644.16 ,$684.42 ,$503.25 ,$724.68 , N/A , N/A ,$764.94 ,$724.68 ,$684.42 ,$684.42 ,$213.05 ,$684.42 ,$684.42 ,$724.68 ,$490.37 , N/A ,$499.22 , N/A ,$724.68 ,$630.14 ,$740.78 ,$724.68 ,$531.51 ,$531.51 ,$490.37 ,$531.51 ,$523.38 ,$550.11 ,$183.31 ,$636.11 , N/A ,$587.00 ,$587.00 ,$213.05 ,$663.00 ,$280.06 ,$764.94 ,$660.26 ,$660.26 ,$644.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),45001272,23665,HC TX FX DISLOC SHOULDER HUMERW/MANIP,450,1 ,"$5,173.85 ","$3,414.74 ",$587.00 ,"$5,173.85 ",$859.29 ,"$4,636.80 ","$4,636.80 ","$1,369.00 ","$4,139.08 ","$4,397.77 ","$3,233.66 ","$4,656.47 ",$859.29 ,$859.29 ,"$4,915.16 ","$4,656.47 ","$4,397.77 ","$4,397.77 ","$1,369.00 ","$4,397.77 ","$4,397.77 ","$4,656.47 ","$3,150.87 ",$859.29 ,"$3,207.78 ",$910.85 ,"$4,656.47 ","$3,227.67 ","$4,759.94 ","$4,656.47 ","$3,415.26 ","$3,415.26 ","$3,150.87 ","$3,415.26 ","$3,363.00 ","$3,534.77 ","$1,177.85 ","$4,087.34 ",$910.85 ,$587.00 ,$587.00 ,"$1,369.00 ",$663.00 ,"$1,434.52 ","$4,915.16 ","$4,242.56 ","$4,242.56 ","$4,139.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45001281,25520,HC TX FX RADIUS SHAFT W/DISLOC CLOSED,450,1 ,"$4,803.61 ","$3,170.38 ",$587.00 ,"$4,803.61 ",$859.29 ,"$4,305.00 ","$4,305.00 ","$1,271.03 ","$3,842.89 ","$4,083.07 ","$3,002.26 ","$4,323.25 ",$859.29 ,$859.29 ,"$4,563.43 ","$4,323.25 ","$4,083.07 ","$4,083.07 ","$1,271.03 ","$4,083.07 ","$4,083.07 ","$4,323.25 ","$2,925.40 ",$859.29 ,"$2,978.24 ",$910.85 ,"$4,323.25 ","$3,227.67 ","$4,419.32 ","$4,323.25 ","$3,170.86 ","$3,170.86 ","$2,925.40 ","$3,170.86 ","$3,122.35 ","$3,281.83 ","$1,093.56 ","$3,794.85 ",$910.85 ,$587.00 ,$587.00 ,"$1,271.03 ",$663.00 ,"$1,434.52 ","$4,563.43 ","$3,938.96 ","$3,938.96 ","$3,842.89 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45001305,28435,HC TX FX CLOSED TALUS W/MANIP,450,1 ,"$4,481.40 ","$2,957.72 ",$587.00 ,"$4,481.40 ",$859.29 ,"$4,016.23 ","$4,016.23 ","$1,185.78 ","$3,585.12 ","$3,809.19 ","$2,800.88 ","$4,033.26 ",$859.29 ,$859.29 ,"$4,257.33 ","$4,033.26 ","$3,809.19 ","$3,809.19 ","$1,185.78 ","$3,809.19 ","$3,809.19 ","$4,033.26 ","$2,729.17 ",$859.29 ,"$2,778.46 ",$910.85 ,"$4,033.26 ","$3,227.67 ","$4,122.89 ","$4,033.26 ","$2,958.17 ","$2,958.17 ","$2,729.17 ","$2,958.17 ","$2,912.91 ","$3,061.69 ","$1,020.21 ","$3,540.31 ",$910.85 ,$587.00 ,$587.00 ,"$1,185.78 ",$663.00 ,"$1,434.52 ","$4,257.33 ","$3,674.75 ","$3,674.75 ","$3,585.12 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$879.75 ,$580.64 ,$200.27 ,$973.39 ,$918.29 ,$788.43 ,$788.43 ,$232.78 ,$703.80 ,$747.79 ,$549.84 ,$791.78 ,$918.29 ,$879.75 ,$835.76 ,$791.78 ,$747.79 ,$747.79 ,$232.78 ,$747.79 ,$747.79 ,$791.78 ,$535.77 ,$918.29 ,$545.44 ,$932.54 ,$791.78 ,$483.46 ,$809.37 ,$791.78 ,$580.72 ,$580.72 ,$535.77 ,$580.72 ,$571.84 ,$601.05 ,$200.27 ,$695.00 ,$973.39 ,$587.00 ,$587.00 ,$232.78 ,$663.00 ,$214.87 ,$835.76 ,$721.40 ,$721.40 ,$703.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,"$1,159.20 ",$765.07 ,$214.87 ,"$1,159.20 ",$918.29 ,"$1,038.88 ","$1,038.88 ",$306.72 ,$927.36 ,$985.32 ,$724.50 ,"$1,043.28 ",$918.29 ,$918.29 ,"$1,101.24 ","$1,043.28 ",$985.32 ,$985.32 ,$306.72 ,$985.32 ,$985.32 ,"$1,043.28 ",$705.95 ,$918.29 ,$718.70 ,$973.39 ,"$1,043.28 ",$483.46 ,"$1,066.46 ","$1,043.28 ",$765.19 ,$765.19 ,$705.95 ,$765.19 ,$753.48 ,$791.97 ,$263.90 ,$915.77 ,$973.39 ,$587.00 ,$587.00 ,$306.72 ,$663.00 ,$214.87 ,"$1,101.24 ",$950.54 ,$950.54 ,$927.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),45001367,15853,HC REMOVAL SUTURES OR STAPLES NOT REQ ANESTH,450,1 ,$1.00 ,$0.66 ,$0.23 ,$1.00 , N/A ,$0.90 ,$0.90 ,$0.26 ,$0.80 ,$0.85 ,$0.63 ,$0.90 , N/A , N/A ,$0.95 ,$0.90 ,$0.85 ,$0.85 ,$0.26 ,$0.85 ,$0.85 ,$0.90 ,$0.61 , N/A ,$0.62 , N/A ,$0.90 , N/A ,$0.92 ,$0.90 ,$0.66 ,$0.66 ,$0.61 ,$0.66 ,$0.65 ,$0.68 ,$0.23 ,$0.79 , N/A ,$1.00 ,$1.00 ,$0.26 ,$1.00 , N/A ,$0.95 ,$0.82 ,$0.82 ,$0.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45001368,15854,HC REMOVAL SUTURES AND STAPLES NOT REQ ANESTH,450,1 ,$1.00 ,$0.66 ,$0.23 ,$1.00 , N/A ,$0.90 ,$0.90 ,$0.26 ,$0.80 ,$0.85 ,$0.63 ,$0.90 , N/A , N/A ,$0.95 ,$0.90 ,$0.85 ,$0.85 ,$0.26 ,$0.85 ,$0.85 ,$0.90 ,$0.61 , N/A ,$0.62 , N/A ,$0.90 , N/A ,$0.92 ,$0.90 ,$0.66 ,$0.66 ,$0.61 ,$0.66 ,$0.65 ,$0.68 ,$0.23 ,$0.79 , N/A ,$1.00 ,$1.00 ,$0.26 ,$1.00 , N/A ,$0.95 ,$0.82 ,$0.82 ,$0.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),45080004,23605,HC CLOSED RX PROX HUMERUS FX MANIP,450,1 ,"$4,481.40 ","$2,957.72 ",$587.00 ,"$4,481.40 ",$859.29 ,"$4,016.23 ","$4,016.23 ","$1,185.78 ","$3,585.12 ","$3,809.19 ","$2,800.88 ","$4,033.26 ",$859.29 ,$859.29 ,"$4,257.33 ","$4,033.26 ","$3,809.19 ","$3,809.19 ","$1,185.78 ","$3,809.19 ","$3,809.19 ","$4,033.26 ","$2,729.17 ",$859.29 ,"$2,778.46 ",$910.85 ,"$4,033.26 ","$3,227.67 ","$4,122.89 ","$4,033.26 ","$2,958.17 ","$2,958.17 ","$2,729.17 ","$2,958.17 ","$2,912.91 ","$3,061.69 ","$1,020.21 ","$3,540.31 ",$910.85 ,$587.00 ,$587.00 ,"$1,185.78 ",$663.00 ,"$1,434.52 ","$4,257.33 ","$3,674.75 ","$3,674.75 ","$3,585.12 "
ST. CLARE MEMORIAL HOSPITAL (ACU),45378072,45378,HC COLONOSCOPY DX,975,1 ,"$1,914.00 ","$1,263.24 ",$192.67 ,"$2,005.54 ","$1,892.02 ","$1,715.33 ","$1,715.33 ",$192.67 ,"$1,531.20 ","$1,626.90 ","$1,196.25 ","$1,722.60 ","$1,892.02 ","$1,892.02 ","$1,818.30 ","$1,722.60 ","$1,626.90 ","$1,626.90 ",$192.67 ,"$1,626.90 ","$1,626.90 ","$1,722.60 ","$1,165.63 ","$1,892.02 ",$393.20 ,"$2,005.54 ","$1,722.60 ","$1,869.84 ","$1,760.88 ","$1,722.60 ","$1,263.43 ","$1,263.43 ","$1,165.63 ","$1,263.43 ","$1,244.10 ","$1,307.64 ",$435.73 ,"$1,512.06 ","$2,005.54 ", N/A , N/A ,$192.67 , N/A ,$831.04 ,"$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 ","$1,389.30 ",$209.80 ,"$2,436.55 ","$1,892.02 ","$1,886.50 ","$1,886.50 ",$209.80 ,"$1,684.00 ","$1,789.25 ","$1,315.63 ","$1,894.50 ","$1,892.02 ","$1,892.02 ","$1,999.75 ","$1,894.50 ","$1,789.25 ","$1,789.25 ",$209.80 ,"$1,789.25 ","$1,789.25 ","$1,894.50 ","$1,281.95 ","$1,892.02 ",$428.16 ,"$2,005.54 ","$1,894.50 ","$2,436.55 ","$1,936.60 ","$1,894.50 ","$1,389.51 ","$1,389.51 ","$1,281.95 ","$1,389.51 ","$1,368.25 ","$1,438.14 ",$479.21 ,"$1,662.95 ","$2,005.54 ", N/A , N/A ,$209.80 , N/A ,"$1,082.91 ","$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 ","$1,789.26 ",$236.16 ,"$2,711.00 ","$1,892.02 ","$2,429.60 ","$2,429.60 ",$236.16 ,"$2,168.80 ","$2,304.35 ","$1,694.38 ","$2,439.90 ","$1,892.02 ","$1,892.02 ","$2,575.45 ","$2,439.90 ","$2,304.35 ","$2,304.35 ",$236.16 ,"$2,304.35 ","$2,304.35 ","$2,439.90 ","$1,651.00 ","$1,892.02 ",$481.96 ,"$2,005.54 ","$2,439.90 ","$2,436.55 ","$2,494.12 ","$2,439.90 ","$1,789.53 ","$1,789.53 ","$1,651.00 ","$1,789.53 ","$1,762.15 ","$1,852.16 ",$617.17 ,"$2,141.69 ","$2,005.54 ", N/A , N/A ,$236.16 , N/A ,"$1,082.91 ","$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 ","$1,789.26 ",$265.67 ,"$2,711.00 ","$1,892.02 ","$2,429.60 ","$2,429.60 ",$265.67 ,"$2,168.80 ","$2,304.35 ","$1,694.38 ","$2,439.90 ","$1,892.02 ","$1,892.02 ","$2,575.45 ","$2,439.90 ","$2,304.35 ","$2,304.35 ",$265.67 ,"$2,304.35 ","$2,304.35 ","$2,439.90 ","$1,651.00 ","$1,892.02 ",$542.18 ,"$2,005.54 ","$2,439.90 ","$2,436.55 ","$2,494.12 ","$2,439.90 ","$1,789.53 ","$1,789.53 ","$1,651.00 ","$1,789.53 ","$1,762.15 ","$1,852.16 ",$617.17 ,"$2,141.69 ","$2,005.54 ", N/A , N/A ,$265.67 , N/A ,"$1,082.91 ","$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 ,$451.33 ,$297.88 ,$102.75 ,$451.33 ,$103.51 ,$404.48 ,$404.48 ,$119.42 ,$361.06 ,$383.63 ,$282.08 ,$406.20 ,$103.51 ,$103.51 ,$428.76 ,$406.20 ,$383.63 ,$383.63 ,$119.42 ,$383.63 ,$383.63 ,$406.20 ,$274.86 ,$103.51 ,$279.82 ,$109.72 ,$406.20 ,$327.22 ,$415.22 ,$406.20 ,$297.92 ,$297.92 ,$274.86 ,$297.92 ,$293.36 ,$308.35 ,$102.75 ,$356.55 ,$109.72 ,$451.33 ,$451.33 ,$119.42 ,$451.33 ,$145.43 ,$428.76 ,$370.09 ,$370.09 ,$361.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000004,94060,HC SPIROMETRY/PFT PRE  AND  POST,460,1 ,$747.97 ,$493.66 ,$170.27 ,$747.97 ,$191.30 ,$670.33 ,$670.33 ,$197.91 ,$598.38 ,$635.77 ,$467.48 ,$673.17 ,$191.30 ,$191.30 ,$710.57 ,$673.17 ,$635.77 ,$635.77 ,$197.91 ,$635.77 ,$635.77 ,$673.17 ,$455.51 ,$191.30 ,$463.74 ,$202.78 ,$673.17 ,$630.14 ,$688.13 ,$673.17 ,$493.74 ,$493.74 ,$455.51 ,$493.74 ,$486.18 ,$511.01 ,$170.27 ,$590.90 ,$202.78 ,$458.00 ,$458.00 ,$197.91 ,$487.00 ,$280.06 ,$710.57 ,$613.34 ,$613.34 ,$598.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000005,94060,HC SPIROMETRY/PFT PRE  AND  POST UPDRAFT,460,1 ,$747.97 ,$493.66 ,$170.27 ,$747.97 ,$191.30 ,$670.33 ,$670.33 ,$197.91 ,$598.38 ,$635.77 ,$467.48 ,$673.17 ,$191.30 ,$191.30 ,$710.57 ,$673.17 ,$635.77 ,$635.77 ,$197.91 ,$635.77 ,$635.77 ,$673.17 ,$455.51 ,$191.30 ,$463.74 ,$202.78 ,$673.17 ,$630.14 ,$688.13 ,$673.17 ,$493.74 ,$493.74 ,$455.51 ,$493.74 ,$486.18 ,$511.01 ,$170.27 ,$590.90 ,$202.78 ,$458.00 ,$458.00 ,$197.91 ,$487.00 ,$280.06 ,$710.57 ,$613.34 ,$613.34 ,$598.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,150.57 ",$759.38 ,$191.30 ,"$1,150.57 ",$191.30 ,"$1,031.14 ","$1,031.14 ",$304.44 ,$920.46 ,$977.98 ,$719.11 ,"$1,035.51 ",$191.30 ,$191.30 ,"$1,093.04 ","$1,035.51 ",$977.98 ,$977.98 ,$304.44 ,$977.98 ,$977.98 ,"$1,035.51 ",$700.70 ,$191.30 ,$713.36 ,$202.78 ,"$1,035.51 ",$630.14 ,"$1,058.52 ","$1,035.51 ",$759.49 ,$759.49 ,$700.70 ,$759.49 ,$747.87 ,$786.07 ,$261.93 ,$908.95 ,$202.78 ,$458.00 ,$458.00 ,$304.44 ,$487.00 ,$280.06 ,"$1,093.04 ",$943.47 ,$943.47 ,$920.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000014,94618,HC WALK TEST 6 MIN,460,1 ,$557.27 ,$367.80 ,$103.51 ,$557.27 ,$103.51 ,$499.43 ,$499.43 ,$147.45 ,$445.82 ,$473.68 ,$348.29 ,$501.54 ,$103.51 ,$103.51 ,$529.41 ,$501.54 ,$473.68 ,$473.68 ,$147.45 ,$473.68 ,$473.68 ,$501.54 ,$339.38 ,$103.51 ,$345.50 ,$109.72 ,$501.54 ,$261.25 ,$512.69 ,$501.54 ,$367.85 ,$367.85 ,$339.38 ,$367.85 ,$362.23 ,$380.73 ,$126.86 ,$440.24 ,$109.72 ,$458.00 ,$458.00 ,$147.45 ,$487.00 ,$116.11 ,$529.41 ,$456.96 ,$456.96 ,$445.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000018,94762,HC OXIMETRY OVERNIGHT,460,1 ,$284.99 ,$188.09 ,$64.89 ,$327.22 ,$103.51 ,$255.41 ,$255.41 ,$75.41 ,$227.99 ,$242.24 ,$178.12 ,$256.49 ,$103.51 ,$103.51 ,$270.74 ,$256.49 ,$242.24 ,$242.24 ,$75.41 ,$242.24 ,$242.24 ,$256.49 ,$173.56 ,$103.51 ,$176.70 ,$109.72 ,$256.49 ,$327.22 ,$262.19 ,$256.49 ,$188.12 ,$188.12 ,$173.56 ,$188.12 ,$185.24 ,$194.71 ,$64.89 ,$225.14 ,$109.72 ,$284.99 ,$284.99 ,$75.41 ,$284.99 ,$145.43 ,$270.74 ,$233.69 ,$233.69 ,$227.99 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000021,94760,HC PULSE OX SINGLE,460,1 ,$184.34 ,$121.66 ,$41.96 ,$184.34 , N/A ,$165.21 ,$165.21 ,$48.77 ,$147.47 ,$156.69 ,$115.21 ,$165.91 , N/A , N/A ,$175.12 ,$165.91 ,$156.69 ,$156.69 ,$48.77 ,$156.69 ,$156.69 ,$165.91 ,$112.26 , N/A ,$114.30 , N/A ,$165.91 , N/A ,$169.59 ,$165.91 ,$121.68 ,$121.68 ,$112.26 ,$121.68 ,$119.82 ,$125.94 ,$41.96 ,$145.63 , N/A ,$184.34 ,$184.34 ,$48.77 ,$184.34 , N/A ,$175.12 ,$151.16 ,$151.16 ,$147.47 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000023,94761,HC PULSE OX MULTI DETERMIN,360,1 ,$248.97 ,$164.32 ,$56.67 ,$248.97 , N/A ,$223.13 ,$223.13 ,$65.88 ,$199.18 ,$211.62 ,$155.61 ,$224.07 , N/A , N/A ,$236.52 ,$224.07 ,$211.62 ,$211.62 ,$65.88 ,$211.62 ,$211.62 ,$224.07 ,$151.62 , N/A ,$154.36 , N/A ,$224.07 , N/A ,$229.05 ,$224.07 ,$164.35 ,$164.35 ,$151.62 ,$164.35 ,$161.83 ,$170.10 ,$56.67 ,$196.69 , N/A , N/A , N/A ,$65.88 , N/A , N/A ,$236.52 ,$204.16 ,$204.16 ,$199.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000031,94681,HC CO2/O2 UPTAKE EXPIRED GAS,460,1 ,$842.27 ,$555.90 ,$191.30 ,$842.27 ,$191.30 ,$754.84 ,$754.84 ,$222.86 ,$673.82 ,$715.93 ,$526.42 ,$758.04 ,$191.30 ,$191.30 ,$800.16 ,$758.04 ,$715.93 ,$715.93 ,$222.86 ,$715.93 ,$715.93 ,$758.04 ,$512.94 ,$191.30 ,$522.20 ,$202.78 ,$758.04 ,$630.14 ,$774.89 ,$758.04 ,$555.98 ,$555.98 ,$512.94 ,$555.98 ,$547.48 ,$575.44 ,$191.75 ,$665.39 ,$202.78 ,$458.00 ,$458.00 ,$222.86 ,$487.00 ,$280.06 ,$800.16 ,$690.66 ,$690.66 ,$673.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),46000034,95070,HC INHALATION BRONCHIAL CHALLENGE TEST W/HISTAMINE/METHACHOLINE,460,1 ,$751.15 ,$495.76 ,$85.75 ,"$1,087.72 ",$85.75 ,$673.18 ,$673.18 ,$198.75 ,$600.92 ,$638.48 ,$469.47 ,$676.04 ,$85.75 ,$85.75 ,$713.59 ,$676.04 ,$638.48 ,$638.48 ,$198.75 ,$638.48 ,$638.48 ,$676.04 ,$457.45 ,$85.75 ,$465.72 ,$90.90 ,$676.04 ,"$1,087.72 ",$691.06 ,$676.04 ,$495.83 ,$495.83 ,$457.45 ,$495.83 ,$488.25 ,$513.19 ,$171.00 ,$593.41 ,$90.90 ,$458.00 ,$458.00 ,$198.75 ,$487.00 ,$483.43 ,$713.59 ,$615.94 ,$615.94 ,$600.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),47562072,47562,HC LAPROSCOPIC CHOLECYSTECTOMY,975,1 ,"$4,711.00 ","$3,109.26 ",$674.74 ,"$11,727.34 ","$6,612.97 ","$4,222.00 ","$4,222.00 ",$674.74 ,"$3,768.80 ","$4,004.35 ","$2,944.38 ","$4,239.90 ","$6,612.97 ","$4,711.00 ","$4,475.45 ","$4,239.90 ","$4,004.35 ","$4,004.35 ",$674.74 ,"$4,004.35 ","$4,004.35 ","$4,239.90 ","$2,869.00 ","$6,612.97 ","$1,377.02 ","$4,993.66 ","$4,239.90 ","$11,727.34 ","$4,334.12 ","$4,239.90 ","$3,109.73 ","$3,109.73 ","$2,869.00 ","$3,109.73 ","$3,062.15 ","$3,218.56 ","$1,072.48 ","$3,721.69 ","$7,009.75 ", N/A , N/A ,$674.74 , N/A ,"$5,212.15 ","$4,475.45 ","$3,863.02 ","$3,863.02 ","$3,768.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,858.40 ","$1,226.54 ",$423.07 ,"$1,858.40 ","$1,197.97 ","$1,665.50 ","$1,665.50 ",$491.73 ,"$1,486.72 ","$1,579.64 ","$1,161.50 ","$1,672.56 ","$1,197.97 ","$1,197.97 ","$1,765.48 ","$1,672.56 ","$1,579.64 ","$1,579.64 ",$491.73 ,"$1,579.64 ","$1,579.64 ","$1,672.56 ","$1,131.77 ","$1,197.97 ","$1,152.20 ","$1,269.85 ","$1,672.56 ","$1,323.32 ","$1,709.73 ","$1,672.56 ","$1,226.73 ","$1,226.73 ","$1,131.77 ","$1,226.73 ","$1,207.96 ","$1,269.66 ",$423.07 ,"$1,468.14 ","$1,269.85 ",$885.00 ,$885.00 ,$491.73 ,$932.00 ,$588.14 ,"$1,765.48 ","$1,523.89 ","$1,523.89 ","$1,486.72 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$125.35 ,$82.73 ,$28.54 ,$129.33 , N/A ,$112.34 ,$112.34 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 , N/A , N/A ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 , N/A ,$77.72 , N/A ,$112.82 ,$129.33 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 , N/A ,$125.35 ,$125.35 ,$33.16 ,$125.35 ,$57.48 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),48100277,93288,HC INTERROG DEVICE EVAL PACEMAKER SYSTEM,481,1 ,$141.97 ,$93.70 ,$32.32 ,$141.97 ,$69.81 ,$127.23 ,$127.23 ,$37.56 ,$113.58 ,$120.67 ,$88.73 ,$127.77 ,$69.81 ,$69.81 ,$134.87 ,$127.77 ,$120.67 ,$120.67 ,$37.56 ,$120.67 ,$120.67 ,$127.77 ,$86.46 ,$69.81 ,$88.02 ,$74.00 ,$127.77 ,$78.75 ,$130.61 ,$127.77 ,$93.71 ,$93.71 ,$86.46 ,$93.71 ,$92.28 ,$96.99 ,$32.32 ,$112.16 ,$74.00 , N/A , N/A ,$37.56 , N/A ,$35.00 ,$134.87 ,$116.42 ,$116.42 ,$113.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,416.80 ",$935.09 ,$280.06 ,"$1,416.80 ",$317.09 ,"$1,269.74 ","$1,269.74 ",$374.89 ,"$1,133.44 ","$1,204.28 ",$885.50 ,"$1,275.12 ",$317.09 ,$317.09 ,"$1,345.96 ","$1,275.12 ","$1,204.28 ","$1,204.28 ",$374.89 ,"$1,204.28 ","$1,204.28 ","$1,275.12 ",$862.83 ,$317.09 ,$878.42 ,$336.12 ,"$1,275.12 ",$630.14 ,"$1,303.46 ","$1,275.12 ",$935.23 ,$935.23 ,$862.83 ,$935.23 ,$920.92 ,$967.96 ,$322.54 ,"$1,119.27 ",$336.12 ,$575.00 ,$575.00 ,$374.89 ,$623.00 ,$280.06 ,"$1,345.96 ","$1,161.78 ","$1,161.78 ","$1,133.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$2,260.59 ","$1,491.99 ",$429.00 ,"$2,260.59 ",$874.20 ,"$2,025.94 ","$2,025.94 ",$598.15 ,"$1,808.47 ","$1,921.50 ","$1,412.87 ","$2,034.53 ",$874.20 ,$874.20 ,"$2,147.56 ","$2,034.53 ","$1,921.50 ","$1,921.50 ",$598.15 ,"$1,921.50 ","$1,921.50 ","$2,034.53 ","$1,376.70 ",$874.20 ,"$1,401.56 ",$926.65 ,"$2,034.53 ","$1,132.04 ","$2,079.74 ","$2,034.53 ","$1,492.22 ","$1,492.22 ","$1,376.70 ","$1,492.22 ","$1,469.38 ","$1,544.44 ",$514.64 ,"$1,785.87 ",$926.65 ,$429.00 ,$429.00 ,$598.15 ,$487.00 ,$503.13 ,"$2,147.56 ","$1,853.68 ","$1,853.68 ","$1,808.47 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$994.66 ,$656.48 ,$226.44 ,$994.66 ,$874.20 ,$891.41 ,$891.41 ,$263.19 ,$795.73 ,$845.46 ,$621.66 ,$895.19 ,$874.20 ,$874.20 ,$944.93 ,$895.19 ,$845.46 ,$845.46 ,$263.19 ,$845.46 ,$845.46 ,$895.19 ,$605.75 ,$874.20 ,$616.68 ,$926.65 ,$895.19 ,$525.42 ,$915.09 ,$895.19 ,$656.58 ,$656.58 ,$605.75 ,$656.58 ,$646.53 ,$679.55 ,$226.44 ,$785.78 ,$926.65 ,$429.00 ,$429.00 ,$263.19 ,$487.00 ,$233.52 ,$944.93 ,$815.62 ,$815.62 ,$795.73 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$890.67 ,$587.84 ,$202.76 ,$890.67 ,$203.25 ,$798.22 ,$798.22 ,$235.67 ,$712.54 ,$757.07 ,$556.67 ,$801.60 ,$203.25 ,$203.25 ,$846.14 ,$801.60 ,$757.07 ,$757.07 ,$235.67 ,$757.07 ,$757.07 ,$801.60 ,$542.42 ,$203.25 ,$552.22 ,$215.45 ,$801.60 , N/A ,$819.42 ,$801.60 ,$587.93 ,$587.93 ,$542.42 ,$587.93 ,$578.94 ,$608.51 ,$202.76 ,$703.63 ,$215.45 ,$429.00 ,$429.00 ,$235.67 ,$487.00 , N/A ,$846.14 ,$730.35 ,$730.35 ,$712.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300007,93350,HC ECHO REST  AND  STRESS W/PF,483,1 ,"$2,147.56 ","$1,417.39 ",$429.00 ,"$2,147.56 ",$874.20 ,"$1,924.64 ","$1,924.64 ",$568.24 ,"$1,718.05 ","$1,825.43 ","$1,342.23 ","$1,932.80 ",$874.20 ,$874.20 ,"$2,040.18 ","$1,932.80 ","$1,825.43 ","$1,825.43 ",$568.24 ,"$1,825.43 ","$1,825.43 ","$1,932.80 ","$1,307.86 ",$874.20 ,"$1,331.48 ",$926.65 ,"$1,932.80 ","$1,132.04 ","$1,975.76 ","$1,932.80 ","$1,417.60 ","$1,417.60 ","$1,307.86 ","$1,417.60 ","$1,395.91 ","$1,467.21 ",$488.90 ,"$1,696.57 ",$926.65 ,$429.00 ,$429.00 ,$568.24 ,$487.00 ,$503.13 ,"$2,040.18 ","$1,761.00 ","$1,761.00 ","$1,718.05 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$532.37 ,$351.36 ,$121.20 ,$926.65 ,$874.20 ,$477.11 ,$477.11 ,$140.87 ,$425.90 ,$452.51 ,$332.73 ,$479.13 ,$874.20 ,$532.37 ,$505.75 ,$479.13 ,$452.51 ,$452.51 ,$140.87 ,$452.51 ,$452.51 ,$479.13 ,$324.21 ,$874.20 ,$330.06 ,$564.31 ,$479.13 , N/A ,$489.78 ,$479.13 ,$351.42 ,$351.42 ,$324.21 ,$351.42 ,$346.04 ,$363.72 ,$121.20 ,$420.57 ,$926.65 ,$429.00 ,$429.00 ,$140.87 ,$487.00 , N/A ,$505.75 ,$436.54 ,$436.54 ,$425.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),48300016,C8924,HC ECHO TTE W/W/O CONT  AND  W/CONT LIMIT,483,1 ,"$1,287.40 ",$849.68 ,$293.08 ,"$1,287.40 ",$874.20 ,"$1,153.77 ","$1,153.77 ",$340.65 ,"$1,029.92 ","$1,094.29 ",$804.63 ,"$1,158.66 ",$874.20 ,$874.20 ,"$1,223.03 ","$1,158.66 ","$1,094.29 ","$1,094.29 ",$340.65 ,"$1,094.29 ","$1,094.29 ","$1,158.66 ",$784.03 ,$874.20 ,$798.18 ,$926.65 ,"$1,158.66 ",$828.97 ,"$1,184.41 ","$1,158.66 ",$849.81 ,$849.81 ,$784.03 ,$849.81 ,$836.81 ,$879.55 ,$293.08 ,"$1,017.05 ",$926.65 ,$429.00 ,$429.00 ,$340.65 ,$487.00 ,$368.43 ,"$1,223.03 ","$1,055.67 ","$1,055.67 ","$1,029.92 "
ST. CLARE MEMORIAL HOSPITAL (ACU),48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT  AND  W/CONT,483,1 ,"$2,216.50 ","$1,462.89 ",$429.00 ,"$2,216.50 ",$874.20 ,"$1,986.43 ","$1,986.43 ",$586.49 ,"$1,773.20 ","$1,884.03 ","$1,385.31 ","$1,994.85 ",$874.20 ,$874.20 ,"$2,105.68 ","$1,994.85 ","$1,884.03 ","$1,884.03 ",$586.49 ,"$1,884.03 ","$1,884.03 ","$1,994.85 ","$1,349.85 ",$874.20 ,"$1,374.24 ",$926.65 ,"$1,994.85 ","$1,666.69 ","$2,039.18 ","$1,994.85 ","$1,463.11 ","$1,463.11 ","$1,349.85 ","$1,463.11 ","$1,440.73 ","$1,514.31 ",$504.60 ,"$1,751.04 ",$926.65 ,$429.00 ,$429.00 ,$586.49 ,$487.00 ,$740.75 ,"$2,105.68 ","$1,817.53 ","$1,817.53 ","$1,773.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,$581.90 ,$384.05 ,$111.00 ,$839.41 ,$717.24 ,$139.00 ,$111.00 ,$153.97 ,$465.52 ,$494.62 ,$363.69 ,$523.71 ,$717.24 ,$581.90 ,$552.81 ,$523.71 ,$494.62 ,$494.62 ,$153.97 ,$494.62 ,$494.62 ,$523.71 ,$354.38 ,$717.24 ,$360.78 ,$616.81 ,$523.71 ,$839.41 ,$535.35 ,$523.71 ,$384.11 ,$384.11 ,$354.38 ,$384.11 ,$378.24 ,$397.55 ,$132.48 ,$459.70 ,$760.27 ,$285.13 ,$285.13 ,$153.97 ,$285.13 ,$373.07 ,$552.81 ,$477.16 ,$477.16 ,$465.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000009,11045,HC DEBR SKIN/SUBQ TIS EA ADL 20CM FAC,510,1 ,$124.20 ,$81.97 ,$28.28 ,"$2,031.33 ","$1,916.35 ",$124.20 ,$111.00 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,"$1,916.35 ",$124.20 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,"$1,916.35 ",$77.00 ,$131.65 ,$111.78 , N/A ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,"$2,031.33 ",$60.86 ,$60.86 ,$32.86 ,$60.86 , N/A ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,"$1,111.95 ",$733.89 ,$111.00 ,"$1,111.95 ",$832.76 ,$139.00 ,$111.00 ,$294.23 ,$889.56 ,$945.16 ,$694.97 ,"$1,000.76 ",$832.76 ,$832.76 ,"$1,056.35 ","$1,000.76 ",$945.16 ,$945.16 ,$294.23 ,$945.16 ,$945.16 ,"$1,000.76 ",$677.18 ,$832.76 ,$689.40 ,$882.73 ,"$1,000.76 ",$839.41 ,"$1,022.99 ","$1,000.76 ",$734.00 ,$734.00 ,$677.18 ,$734.00 ,$722.77 ,$759.68 ,$253.14 ,$878.44 ,$882.73 ,$544.86 ,$544.86 ,$294.23 ,$544.86 ,$373.07 ,"$1,056.35 ",$911.80 ,$911.80 ,$889.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$731.40 ,$482.72 ,$111.00 ,$748.40 ,$550.17 ,$139.00 ,$111.00 ,$193.53 ,$585.12 ,$621.69 ,$457.13 ,$658.26 ,$550.17 ,$550.17 ,$694.83 ,$658.26 ,$621.69 ,$621.69 ,$193.53 ,$621.69 ,$621.69 ,$658.26 ,$445.42 ,$550.17 ,$453.46 ,$583.18 ,$658.26 ,$748.40 ,$672.89 ,$658.26 ,$482.80 ,$482.80 ,$445.42 ,$482.80 ,$475.41 ,$499.69 ,$166.50 ,$577.81 ,$583.18 ,$358.39 ,$358.39 ,$193.53 ,$358.39 ,$332.62 ,$694.83 ,$599.75 ,$599.75 ,$585.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000053,29580,HC APPLY UNNA BOOT,510,1 ,$384.10 ,$253.51 ,$87.44 ,$384.10 ,$338.14 ,$139.00 ,$111.00 ,$101.64 ,$307.28 ,$326.49 ,$240.06 ,$345.69 ,$338.14 ,$338.14 ,$364.90 ,$345.69 ,$326.49 ,$326.49 ,$101.64 ,$326.49 ,$326.49 ,$345.69 ,$233.92 ,$338.14 ,$238.14 ,$358.43 ,$345.69 ,$327.96 ,$353.37 ,$345.69 ,$253.54 ,$253.54 ,$233.92 ,$253.54 ,$249.67 ,$262.42 ,$87.44 ,$303.44 ,$358.43 ,$188.21 ,$188.21 ,$101.64 ,$188.21 ,$145.76 ,$364.90 ,$314.96 ,$314.96 ,$307.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000055,29581,HC APPLY MULTI COMP LOWER LEG FAC,510,1 ,$396.75 ,$261.86 ,$90.32 ,$396.75 ,$338.14 ,$139.00 ,$111.00 ,$104.98 ,$317.40 ,$337.24 ,$247.97 ,$357.08 ,$338.14 ,$338.14 ,$376.91 ,$357.08 ,$337.24 ,$337.24 ,$104.98 ,$337.24 ,$337.24 ,$357.08 ,$241.62 ,$338.14 ,$245.98 ,$358.43 ,$357.08 ,$327.96 ,$365.01 ,$357.08 ,$261.89 ,$261.89 ,$241.62 ,$261.89 ,$257.89 ,$271.06 ,$90.32 ,$313.43 ,$358.43 ,$194.41 ,$194.41 ,$104.98 ,$194.41 ,$145.76 ,$376.91 ,$325.34 ,$325.34 ,$317.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$128.80 ,$85.01 ,$29.32 ,$151.81 ,$86.98 ,$115.43 ,$115.43 ,$34.08 ,$103.04 ,$109.48 , N/A ,$115.92 ,$86.98 ,$86.98 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$86.98 ,$79.86 ,$92.20 ,$115.92 ,$151.81 ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$92.20 ,$128.80 ,$128.80 ,$34.08 ,$128.80 ,$67.47 ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$257.60 ,$170.02 ,$58.64 ,$464.78 ,$86.98 ,$230.86 ,$230.86 ,$68.16 ,$206.08 ,$218.96 , N/A ,$231.84 ,$86.98 ,$86.98 ,$244.72 ,$231.84 ,$218.96 ,$218.96 ,$68.16 ,$218.96 ,$218.96 ,$231.84 ,$156.88 ,$86.98 ,$159.72 ,$92.20 ,$231.84 ,$464.78 ,$236.99 ,$231.84 ,$170.04 ,$170.04 ,$156.88 ,$170.04 ,$167.44 ,$175.99 ,$58.64 ,$203.50 ,$92.20 ,$257.60 ,$257.60 ,$68.16 ,$257.60 ,$206.57 ,$244.72 ,$211.23 ,$211.23 ,$206.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$205.85 ,$135.86 ,$42.37 ,$205.85 ,$86.98 ,$184.48 ,$184.48 ,$54.47 ,$164.68 ,$174.97 , N/A ,$185.27 ,$86.98 ,$86.98 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$86.98 ,$127.62 ,$92.20 ,$185.27 ,$95.33 ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,$92.20 ,$205.85 ,$205.85 ,$54.47 ,$205.85 ,$42.37 ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$205.85 ,$135.86 ,$46.86 ,$205.85 ,$86.98 ,$184.48 ,$184.48 ,$54.47 ,$164.68 ,$174.97 , N/A ,$185.27 ,$86.98 ,$86.98 ,$195.56 ,$185.27 ,$174.97 ,$174.97 ,$54.47 ,$174.97 ,$174.97 ,$185.27 ,$125.36 ,$86.98 ,$127.62 ,$92.20 ,$185.27 , N/A ,$189.38 ,$185.27 ,$135.88 ,$135.88 ,$125.36 ,$135.88 ,$133.80 ,$140.64 ,$46.86 ,$162.62 ,$92.20 ,$205.85 ,$205.85 ,$54.47 ,$205.85 , N/A ,$195.56 ,$168.80 ,$168.80 ,$164.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$146.74 ,$96.85 ,$33.41 ,$146.74 ,$86.98 ,$139.00 ,$111.00 ,$38.83 ,$117.39 ,$124.73 , N/A ,$132.07 ,$86.98 ,$86.98 ,$139.40 ,$132.07 ,$124.73 ,$124.73 ,$38.83 ,$124.73 ,$124.73 ,$132.07 ,$89.36 ,$86.98 ,$90.98 ,$92.20 ,$132.07 ,$129.33 ,$135.00 ,$132.07 ,$96.86 ,$96.86 ,$89.36 ,$96.86 ,$95.38 ,$100.25 ,$33.41 ,$115.92 ,$92.20 ,$71.90 ,$71.90 ,$38.83 ,$71.90 ,$57.48 ,$139.40 ,$120.33 ,$120.33 ,$117.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$261.05 ,$172.29 ,$59.43 ,$261.05 ,$237.38 ,$139.00 ,$111.00 ,$69.07 ,$208.84 ,$221.89 ,$163.16 ,$234.95 ,$237.38 ,$237.38 ,$248.00 ,$234.95 ,$221.89 ,$221.89 ,$69.07 ,$221.89 ,$221.89 ,$234.95 ,$158.98 ,$237.38 ,$161.86 ,$251.62 ,$234.95 , N/A ,$240.17 ,$234.95 ,$172.32 ,$172.32 ,$158.98 ,$172.32 ,$169.68 ,$178.35 ,$59.43 ,$206.23 ,$251.62 ,$127.91 ,$127.91 ,$69.07 ,$127.91 , N/A ,$248.00 ,$214.06 ,$214.06 ,$208.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$272.55 ,$179.88 ,$62.05 ,$272.55 ,$237.38 ,$139.00 ,$111.00 ,$72.12 ,$218.04 ,$231.67 ,$170.34 ,$245.30 ,$237.38 ,$237.38 ,$258.92 ,$245.30 ,$231.67 ,$231.67 ,$72.12 ,$231.67 ,$231.67 ,$245.30 ,$165.98 ,$237.38 ,$168.98 ,$251.62 ,$245.30 , N/A ,$250.75 ,$245.30 ,$179.91 ,$179.91 ,$165.98 ,$179.91 ,$177.16 ,$186.21 ,$62.05 ,$215.31 ,$251.62 ,$133.55 ,$133.55 ,$72.12 ,$133.55 , N/A ,$258.92 ,$223.49 ,$223.49 ,$218.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$331.20 ,$218.59 ,$75.40 ,$331.20 ,$237.38 ,$139.00 ,$111.00 ,$87.63 ,$264.96 ,$281.52 ,$207.00 ,$298.08 ,$237.38 ,$237.38 ,$314.64 ,$298.08 ,$281.52 ,$281.52 ,$87.63 ,$281.52 ,$281.52 ,$298.08 ,$201.70 ,$237.38 ,$205.34 ,$251.62 ,$298.08 , N/A ,$304.70 ,$298.08 ,$218.63 ,$218.63 ,$201.70 ,$218.63 ,$215.28 ,$226.28 ,$75.40 ,$261.65 ,$251.62 ,$162.29 ,$162.29 ,$87.63 ,$162.29 , N/A ,$314.64 ,$271.58 ,$271.58 ,$264.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$366.85 ,$242.12 ,$83.52 ,$366.85 ,$237.38 ,$139.00 ,$111.00 ,$97.07 ,$293.48 ,$311.82 ,$229.28 ,$330.17 ,$237.38 ,$237.38 ,$348.51 ,$330.17 ,$311.82 ,$311.82 ,$97.07 ,$311.82 ,$311.82 ,$330.17 ,$223.41 ,$237.38 ,$227.44 ,$251.62 ,$330.17 , N/A ,$337.50 ,$330.17 ,$242.16 ,$242.16 ,$223.41 ,$242.16 ,$238.45 ,$250.63 ,$83.52 ,$289.81 ,$251.62 ,$179.76 ,$179.76 ,$97.07 ,$179.76 , N/A ,$348.51 ,$300.82 ,$300.82 ,$293.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$462.30 ,$305.12 ,$105.24 ,$462.30 ,$237.38 ,$139.00 ,$111.00 ,$122.32 ,$369.84 ,$392.96 ,$288.94 ,$416.07 ,$237.38 ,$237.38 ,$439.19 ,$416.07 ,$392.96 ,$392.96 ,$122.32 ,$392.96 ,$392.96 ,$416.07 ,$281.54 ,$237.38 ,$286.62 ,$251.62 ,$416.07 , N/A ,$425.32 ,$416.07 ,$305.16 ,$305.16 ,$281.54 ,$305.16 ,$300.50 ,$315.84 ,$105.24 ,$365.22 ,$251.62 ,$226.53 ,$226.53 ,$122.32 ,$226.53 , N/A ,$439.19 ,$379.09 ,$379.09 ,$369.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000147,P9612,HC CATH FOR SPECIMEN COLLECTION,300,1 ,$54.05 ,$35.67 ,$3.60 ,$54.05 ,$4.31 ,$10.50 ,$10.50 ,$14.30 ,$43.24 ,$45.94 ,$33.78 ,$48.65 ,$4.31 ,$4.31 ,$51.35 ,$48.65 ,$45.94 ,$45.94 ,$14.30 ,$45.94 ,$45.94 ,$48.65 ,$32.92 ,$4.31 ,$33.52 ,$4.57 ,$48.65 ,$19.28 ,$49.73 ,$48.65 ,$35.68 ,$35.68 ,$32.92 ,$35.68 ,$35.13 ,$36.93 ,$12.30 ,$42.70 ,$4.57 ,$3.60 ,$3.60 ,$14.30 ,$3.60 ,$8.57 ,$51.35 ,$44.32 ,$44.32 ,$43.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$235.75 ,$155.60 ,$53.66 ,$261.25 ,$150.61 ,$139.00 ,$111.00 ,$62.38 ,$188.60 ,$200.39 ,$147.34 ,$212.18 ,$150.61 ,$150.61 ,$223.96 ,$212.18 ,$200.39 ,$200.39 ,$62.38 ,$200.39 ,$200.39 ,$212.18 ,$143.57 ,$150.61 ,$146.16 ,$159.65 ,$212.18 ,$261.25 ,$216.89 ,$212.18 ,$155.62 ,$155.62 ,$143.57 ,$155.62 ,$153.24 ,$161.06 ,$53.66 ,$186.24 ,$159.65 ,$115.52 ,$115.52 ,$62.38 ,$115.52 ,$116.11 ,$223.96 ,$193.32 ,$193.32 ,$188.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000172,51702,HC CATH BLADDER SMP,510,1 ,$235.75 ,$155.60 ,$53.66 ,$261.25 ,$150.61 ,$139.00 ,$111.00 ,$62.38 ,$188.60 ,$200.39 ,$147.34 ,$212.18 ,$150.61 ,$150.61 ,$223.96 ,$212.18 ,$200.39 ,$200.39 ,$62.38 ,$200.39 ,$200.39 ,$212.18 ,$143.57 ,$150.61 ,$146.16 ,$159.65 ,$212.18 ,$261.25 ,$216.89 ,$212.18 ,$155.62 ,$155.62 ,$143.57 ,$155.62 ,$153.24 ,$161.06 ,$53.66 ,$186.24 ,$159.65 ,$115.52 ,$115.52 ,$62.38 ,$115.52 ,$116.11 ,$223.96 ,$193.32 ,$193.32 ,$188.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000201,29799,HC REMOVAL REVISION LEGCAST FACILITY,510,1 ,$503.70 ,$332.44 ,$111.00 ,$503.70 ,$132.85 ,$139.00 ,$111.00 ,$133.28 ,$402.96 ,$428.15 ,$314.81 ,$453.33 ,$132.85 ,$132.85 ,$478.52 ,$453.33 ,$428.15 ,$428.15 ,$133.28 ,$428.15 ,$428.15 ,$453.33 ,$306.75 ,$132.85 ,$312.30 ,$140.82 ,$453.33 ,$327.96 ,$463.40 ,$453.33 ,$332.49 ,$332.49 ,$306.75 ,$332.49 ,$327.41 ,$344.13 ,$114.67 ,$397.92 ,$140.82 ,$246.81 ,$246.81 ,$133.28 ,$246.81 ,$145.76 ,$478.52 ,$413.03 ,$413.03 ,$402.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000207,52000,HC CYSTOURETHROSCOPY,510,1 ,"$1,724.00 ","$1,137.84 ",$111.00 ,"$3,152.32 ","$2,973.89 ",$139.00 ,$111.00 ,$456.17 ,"$1,379.20 ","$1,465.40 ","$1,077.50 ","$1,551.60 ","$2,973.89 ","$1,724.00 ","$1,637.80 ","$1,551.60 ","$1,465.40 ","$1,465.40 ",$456.17 ,"$1,465.40 ","$1,465.40 ","$1,551.60 ","$1,049.92 ","$2,973.89 ","$1,068.88 ","$1,827.44 ","$1,551.60 ","$1,407.02 ","$1,586.08 ","$1,551.60 ","$1,138.01 ","$1,138.01 ","$1,049.92 ","$1,138.01 ","$1,120.60 ","$1,177.84 ",$392.48 ,"$1,361.96 ","$3,152.32 ",$844.76 ,$844.76 ,$456.17 ,$844.76 ,$625.34 ,"$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 ,"$1,611.15 ","$1,063.36 ",$366.78 ,"$5,812.31 ","$2,811.12 ","$1,443.91 ","$1,443.91 ",$426.31 ,"$1,288.92 ","$1,369.48 ","$1,006.97 ","$1,450.04 ","$2,811.12 ","$1,611.15 ","$1,530.59 ","$1,450.04 ","$1,369.48 ","$1,369.48 ",$426.31 ,"$1,369.48 ","$1,369.48 ","$1,450.04 ",$981.19 ,"$2,811.12 ",$998.92 ,"$1,707.82 ","$1,450.04 ","$5,812.31 ","$1,482.26 ","$1,450.04 ","$1,063.52 ","$1,063.52 ",$981.19 ,"$1,063.52 ","$1,047.25 ","$1,100.74 ",$366.78 ,"$1,272.81 ","$2,979.79 ","$1,611.15 ","$1,611.15 ",$426.31 ,"$1,611.15 ","$2,583.25 ","$1,530.59 ","$1,321.14 ","$1,321.14 ","$1,288.92 "
ST. CLARE MEMORIAL HOSPITAL (ACU),51000400,29580,HC APPLY UNNA BOOT BILAT FAC,510,1 ,$570.40 ,$376.46 ,$111.00 ,$570.40 ,$507.21 ,$139.00 ,$111.00 ,$150.93 ,$456.32 ,$484.84 ,$356.50 ,$513.36 ,$507.21 ,$507.21 ,$541.88 ,$513.36 ,$484.84 ,$484.84 ,$150.93 ,$484.84 ,$484.84 ,$513.36 ,$347.37 ,$507.21 ,$353.64 ,$537.64 ,$513.36 ,$491.94 ,$524.77 ,$513.36 ,$376.52 ,$376.52 ,$347.37 ,$376.52 ,$370.76 ,$389.70 ,$129.85 ,$450.62 ,$537.64 ,$279.50 ,$279.50 ,$150.93 ,$279.50 ,$218.64 ,$541.88 ,$467.73 ,$467.73 ,$456.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000401,29581,HC APPLY MULTI COMP LWR LEG BIL FAC,510,1 ,$594.55 ,$392.40 ,$111.00 ,$594.55 ,$507.21 ,$139.00 ,$111.00 ,$157.32 ,$475.64 ,$505.37 ,$371.59 ,$535.10 ,$507.21 ,$507.21 ,$564.82 ,$535.10 ,$505.37 ,$505.37 ,$157.32 ,$505.37 ,$505.37 ,$535.10 ,$362.08 ,$507.21 ,$368.62 ,$537.64 ,$535.10 ,$491.94 ,$546.99 ,$535.10 ,$392.46 ,$392.46 ,$362.08 ,$392.46 ,$386.46 ,$406.20 ,$135.36 ,$469.69 ,$537.64 ,$291.33 ,$291.33 ,$157.32 ,$291.33 ,$218.64 ,$564.82 ,$487.53 ,$487.53 ,$475.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,$309.35 ,$204.17 ,$70.42 ,$406.31 ,$318.12 ,$139.00 ,$111.00 ,$81.85 ,$247.48 ,$262.95 ,$193.34 ,$278.42 ,$318.12 ,$309.35 ,$293.88 ,$278.42 ,$262.95 ,$262.95 ,$81.85 ,$262.95 ,$262.95 ,$278.42 ,$188.39 ,$318.12 ,$191.80 ,$327.91 ,$278.42 ,$406.31 ,$284.60 ,$278.42 ,$204.20 ,$204.20 ,$188.39 ,$204.20 ,$201.08 ,$211.35 ,$70.42 ,$244.39 ,$337.21 ,$151.58 ,$151.58 ,$81.85 ,$151.58 ,$180.58 ,$293.88 ,$253.67 ,$253.67 ,$247.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000444,11982,HC REMOVAL DRUG IMPLANT DEVICE,510,1 ,$933.80 ,$616.31 ,$111.00 ,$933.80 ,$318.12 ,$139.00 ,$111.00 ,$247.09 ,$747.04 ,$793.73 ,$583.63 ,$840.42 ,$318.12 ,$318.12 ,$887.11 ,$840.42 ,$793.73 ,$793.73 ,$247.09 ,$793.73 ,$793.73 ,$840.42 ,$568.68 ,$318.12 ,$578.96 ,$337.21 ,$840.42 ,$849.53 ,$859.10 ,$840.42 ,$616.40 ,$616.40 ,$568.68 ,$616.40 ,$606.97 ,$637.97 ,$212.58 ,$737.70 ,$337.21 ,$457.56 ,$457.56 ,$247.09 ,$457.56 ,$377.57 ,$887.11 ,$765.72 ,$765.72 ,$747.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),51000481,98925,HC OSTEOPATHIC MAN 1-2 REGIONS,510,1 ,$86.10 ,$56.83 ,$19.60 ,$86.10 ,$61.52 ,$86.10 ,$86.10 ,$22.78 ,$68.88 ,$73.19 ,$53.81 ,$77.49 ,$61.52 ,$61.52 ,$81.80 ,$77.49 ,$73.19 ,$73.19 ,$22.78 ,$73.19 ,$73.19 ,$77.49 ,$52.43 ,$61.52 ,$53.38 ,$65.21 ,$77.49 ,$56.21 ,$79.21 ,$77.49 ,$56.83 ,$56.83 ,$52.43 ,$56.83 ,$55.97 ,$58.82 ,$19.60 ,$68.02 ,$65.21 ,$42.19 ,$42.19 ,$22.78 ,$42.19 ,$24.98 ,$81.80 ,$70.60 ,$70.60 ,$68.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$3,362.80 ","$2,219.45 ",$368.43 ,"$3,362.80 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$810.26 ,$810.26 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$810.26 ,"$2,084.94 ",$858.88 ,"$3,026.52 ",$828.97 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$368.43 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$233.52 ,"$3,362.80 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$965.49 ,$965.49 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$965.49 ,"$2,084.94 ","$1,023.42 ","$3,026.52 ",$525.42 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$233.52 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$368.43 ,"$3,362.80 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$965.49 ,$965.49 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$965.49 ,"$2,084.94 ","$1,023.42 ","$3,026.52 ",$828.97 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$368.43 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$233.52 ,"$2,578.15 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$682.18 ,"$2,062.52 ","$2,191.43 ","$1,611.34 ","$2,320.34 ",$965.49 ,$965.49 ,"$2,449.24 ","$2,320.34 ","$2,191.43 ","$2,191.43 ",$682.18 ,"$2,191.43 ","$2,191.43 ","$2,320.34 ","$1,570.09 ",$965.49 ,"$1,598.46 ","$1,023.42 ","$2,320.34 ",$525.42 ,"$2,371.90 ","$2,320.34 ","$1,701.84 ","$1,701.84 ","$1,570.09 ","$1,701.84 ","$1,675.80 ","$1,761.39 ",$586.92 ,"$2,036.74 ","$1,023.42 ","$2,578.15 ","$2,578.15 ",$682.18 ,"$2,578.15 ",$233.52 ,"$2,449.24 ","$2,114.08 ","$2,114.08 ","$2,062.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$368.43 ,"$2,578.15 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$682.18 ,"$2,062.52 ","$2,191.43 ","$1,611.34 ","$2,320.34 ",$965.49 ,$965.49 ,"$2,449.24 ","$2,320.34 ","$2,191.43 ","$2,191.43 ",$682.18 ,"$2,191.43 ","$2,191.43 ","$2,320.34 ","$1,570.09 ",$965.49 ,"$1,598.46 ","$1,023.42 ","$2,320.34 ",$828.97 ,"$2,371.90 ","$2,320.34 ","$1,701.84 ","$1,701.84 ","$1,570.09 ","$1,701.84 ","$1,675.80 ","$1,761.39 ",$586.92 ,"$2,036.74 ","$1,023.42 ","$2,578.15 ","$2,578.15 ",$682.18 ,"$2,578.15 ",$368.43 ,"$2,449.24 ","$2,114.08 ","$2,114.08 ","$2,062.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$368.43 ,"$2,578.15 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$682.18 ,"$2,062.52 ","$2,191.43 ","$1,611.34 ","$2,320.34 ",$965.49 ,$965.49 ,"$2,449.24 ","$2,320.34 ","$2,191.43 ","$2,191.43 ",$682.18 ,"$2,191.43 ","$2,191.43 ","$2,320.34 ","$1,570.09 ",$965.49 ,"$1,598.46 ","$1,023.42 ","$2,320.34 ",$828.97 ,"$2,371.90 ","$2,320.34 ","$1,701.84 ","$1,701.84 ","$1,570.09 ","$1,701.84 ","$1,675.80 ","$1,761.39 ",$586.92 ,"$2,036.74 ","$1,023.42 ","$2,578.15 ","$2,578.15 ",$682.18 ,"$2,578.15 ",$368.43 ,"$2,449.24 ","$2,114.08 ","$2,114.08 ","$2,062.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$233.52 ,"$3,362.80 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$473.03 ,$473.03 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$473.03 ,"$2,084.94 ",$501.41 ,"$3,026.52 ",$525.42 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$233.52 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,362.80 ","$2,219.45 ",$368.43 ,"$3,362.80 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$810.26 ,$810.26 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$810.26 ,"$2,084.94 ",$858.88 ,"$3,026.52 ",$828.97 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$368.43 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$3,362.80 ","$2,219.45 ",$368.43 ,"$3,362.80 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$810.26 ,$810.26 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$810.26 ,"$2,084.94 ",$858.88 ,"$3,026.52 ",$828.97 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$368.43 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$2,578.15 ","$1,701.58 ",$233.52 ,"$2,578.15 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$682.18 ,"$2,062.52 ","$2,191.43 ","$1,611.34 ","$2,320.34 ",$473.03 ,$473.03 ,"$2,449.24 ","$2,320.34 ","$2,191.43 ","$2,191.43 ",$682.18 ,"$2,191.43 ","$2,191.43 ","$2,320.34 ","$1,570.09 ",$473.03 ,"$1,598.46 ",$501.41 ,"$2,320.34 ",$525.42 ,"$2,371.90 ","$2,320.34 ","$1,701.84 ","$1,701.84 ","$1,570.09 ","$1,701.84 ","$1,675.80 ","$1,761.39 ",$586.92 ,"$2,036.74 ",$501.41 ,"$2,578.15 ","$2,578.15 ",$682.18 ,"$2,578.15 ",$233.52 ,"$2,449.24 ","$2,114.08 ","$2,114.08 ","$2,062.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$2,578.15 ","$1,701.58 ",$368.43 ,"$2,578.15 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$682.18 ,"$2,062.52 ","$2,191.43 ","$1,611.34 ","$2,320.34 ",$810.26 ,$810.26 ,"$2,449.24 ","$2,320.34 ","$2,191.43 ","$2,191.43 ",$682.18 ,"$2,191.43 ","$2,191.43 ","$2,320.34 ","$1,570.09 ",$810.26 ,"$1,598.46 ",$858.88 ,"$2,320.34 ",$828.97 ,"$2,371.90 ","$2,320.34 ","$1,701.84 ","$1,701.84 ","$1,570.09 ","$1,701.84 ","$1,675.80 ","$1,761.39 ",$586.92 ,"$2,036.74 ",$858.88 ,"$2,578.15 ","$2,578.15 ",$682.18 ,"$2,578.15 ",$368.43 ,"$2,449.24 ","$2,114.08 ","$2,114.08 ","$2,062.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$2,578.15 ","$1,701.58 ",$368.43 ,"$2,578.15 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$682.18 ,"$2,062.52 ","$2,191.43 ","$1,611.34 ","$2,320.34 ",$810.26 ,$810.26 ,"$2,449.24 ","$2,320.34 ","$2,191.43 ","$2,191.43 ",$682.18 ,"$2,191.43 ","$2,191.43 ","$2,320.34 ","$1,570.09 ",$810.26 ,"$1,598.46 ",$858.88 ,"$2,320.34 ",$828.97 ,"$2,371.90 ","$2,320.34 ","$1,701.84 ","$1,701.84 ","$1,570.09 ","$1,701.84 ","$1,675.80 ","$1,761.39 ",$586.92 ,"$2,036.74 ",$858.88 ,"$2,578.15 ","$2,578.15 ",$682.18 ,"$2,578.15 ",$368.43 ,"$2,449.24 ","$2,114.08 ","$2,114.08 ","$2,062.52 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$632.26 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ","$1,666.69 ","$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$740.75 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$233.52 ,"$2,777.25 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$473.03 ,$473.03 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$473.03 ,"$1,721.90 ",$501.41 ,"$2,499.53 ",$525.42 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$233.52 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$632.26 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ","$1,666.69 ","$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$740.75 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$2,777.25 ","$1,832.99 ",$368.43 ,"$2,777.25 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$734.86 ,"$2,221.80 ","$2,360.66 ","$1,735.78 ","$2,499.53 ",$810.26 ,$810.26 ,"$2,638.39 ","$2,499.53 ","$2,360.66 ","$2,360.66 ",$734.86 ,"$2,360.66 ","$2,360.66 ","$2,499.53 ","$1,691.35 ",$810.26 ,"$1,721.90 ",$858.88 ,"$2,499.53 ",$828.97 ,"$2,555.07 ","$2,499.53 ","$1,833.26 ","$1,833.26 ","$1,691.35 ","$1,833.26 ","$1,805.21 ","$1,897.42 ",$632.26 ,"$2,194.03 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$734.86 ,"$2,777.25 ",$368.43 ,"$2,638.39 ","$2,277.35 ","$2,277.35 ","$2,221.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$233.52 ,"$3,622.50 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$473.03 ,$473.03 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$473.03 ,"$2,245.96 ",$501.41 ,"$3,260.25 ",$525.42 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$233.52 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000039,74182,HC MRI ABDOMEN W/CON,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$810.26 ,$810.26 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$810.26 ,"$2,245.96 ",$858.88 ,"$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$810.26 ,$810.26 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$810.26 ,"$2,245.96 ",$858.88 ,"$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000041,75557,HC MRI CARDIAC W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$233.52 ,"$3,622.50 ",$473.03 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$473.03 ,$473.03 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$473.03 ,"$2,245.96 ",$501.41 ,"$3,260.25 ",$525.42 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$501.41 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$233.52 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000042,75561,HC MRI CARD W/O AND W CON,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$810.26 ,$810.26 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$810.26 ,"$2,245.96 ",$858.88 ,"$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$965.49 ,$965.49 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$965.49 ,"$2,245.96 ","$1,023.42 ","$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$810.26 ,$810.26 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$810.26 ,"$2,245.96 ",$858.88 ,"$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$965.49 ,$965.49 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$965.49 ,"$2,245.96 ","$1,023.42 ","$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$965.49 ,$965.49 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$965.49 ,"$2,245.96 ","$1,023.42 ","$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,622.50 ","$2,390.85 ",$368.43 ,"$3,622.50 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$965.49 ,$965.49 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$965.49 ,"$2,245.96 ","$1,023.42 ","$3,260.25 ",$828.97 ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ",$368.43 ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$3,362.80 ","$2,219.45 ",$368.43 ,"$3,362.80 ",$810.26 ,"$1,418.00 ","$1,418.00 ",$889.80 ,"$2,690.24 ","$2,858.38 ","$2,101.75 ","$3,026.52 ",$810.26 ,$810.26 ,"$3,194.66 ","$3,026.52 ","$2,858.38 ","$2,858.38 ",$889.80 ,"$2,858.38 ","$2,858.38 ","$3,026.52 ","$2,047.95 ",$810.26 ,"$2,084.94 ",$858.88 ,"$3,026.52 ",$828.97 ,"$3,093.78 ","$3,026.52 ","$2,219.78 ","$2,219.78 ","$2,047.95 ","$2,219.78 ","$2,185.82 ","$2,297.47 ",$765.55 ,"$2,656.61 ",$858.88 ,"$2,735.00 ","$2,735.00 ",$889.80 ,"$3,077.00 ",$368.43 ,"$3,194.66 ","$2,757.50 ","$2,757.50 ","$2,690.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),61000100,74185,HC MRA ABDOMEN RENAL W/WO CON,610,1 ,"$3,622.50 ","$2,390.85 ",$824.68 ,"$3,622.50 ",$965.49 ,"$1,418.00 ","$1,418.00 ",$958.52 ,"$2,898.00 ","$3,079.13 ","$2,264.06 ","$3,260.25 ",$965.49 ,$965.49 ,"$3,441.38 ","$3,260.25 ","$3,079.13 ","$3,079.13 ",$958.52 ,"$3,079.13 ","$3,079.13 ","$3,260.25 ","$2,206.10 ",$965.49 ,"$2,245.96 ","$1,023.42 ","$3,260.25 ", N/A ,"$3,332.70 ","$3,260.25 ","$2,391.21 ","$2,391.21 ","$2,206.10 ","$2,391.21 ","$2,354.63 ","$2,474.89 ",$824.68 ,"$2,861.78 ","$1,023.42 ","$2,735.00 ","$2,735.00 ",$958.52 ,"$3,077.00 ", N/A ,"$3,441.38 ","$2,970.45 ","$2,970.45 ","$2,898.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),62100030,N/A,SVG HC ACCUGRID,621,1 ,$80.00 ,$52.80 ,$18.21 ,$80.00 , N/A ,$71.70 ,$71.70 ,$21.17 ,$64.00 ,$68.00 ,$50.00 ,$72.00 , N/A , N/A ,$76.00 ,$72.00 ,$68.00 ,$68.00 ,$21.17 ,$68.00 ,$68.00 ,$72.00 ,$48.72 , N/A ,$49.60 , N/A ,$72.00 , N/A ,$73.60 ,$72.00 ,$52.81 ,$52.81 ,$48.72 ,$52.81 ,$52.00 ,$54.66 ,$18.21 ,$63.20 , N/A ,$39.20 ,$39.20 ,$21.17 ,$39.20 , N/A ,$76.00 ,$65.60 ,$65.60 ,$64.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),62200006,C1726,HC BALLOON DILATOR,622,1 ,$455.00 ,$300.30 ,$103.59 ,$455.00 , N/A ,$407.77 ,$407.77 ,$120.39 ,$364.00 ,$386.75 , N/A ,$409.50 , N/A , N/A ,$432.25 ,$409.50 ,$386.75 ,$386.75 ,$120.39 ,$386.75 ,$386.75 ,$409.50 ,$277.10 , N/A ,$282.10 , N/A ,$409.50 , N/A ,$418.60 ,$409.50 ,$300.35 ,$300.35 ,$277.10 ,$300.35 ,$295.75 ,$310.86 ,$103.59 ,$359.45 , N/A ,$222.95 ,$222.95 ,$120.39 ,$222.95 , N/A ,$432.25 ,$373.10 ,$373.10 ,$364.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),62200026,N/A,HC HOT BIOPSY FORCEPS,621,1 ,$76.69 ,$50.62 ,$17.46 ,$76.69 , N/A ,$68.73 ,$68.73 ,$20.30 ,$61.35 ,$65.19 ,$47.93 ,$69.02 , N/A , N/A ,$72.86 ,$69.02 ,$65.19 ,$65.19 ,$20.30 ,$65.19 ,$65.19 ,$69.02 ,$46.70 , N/A ,$47.54 , N/A ,$69.02 , N/A ,$70.55 ,$69.02 ,$50.62 ,$50.62 ,$46.70 ,$50.62 ,$49.85 ,$52.39 ,$17.46 ,$60.59 , N/A ,$37.58 ,$37.58 ,$20.30 ,$37.58 , N/A ,$72.86 ,$62.89 ,$62.89 ,$61.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0131,ACETAMINOPHEN 10 MG/ML SOLN per10 mg,636,1 ,$2.73 ,$1.80 ,$0.15 ,$2.73 , N/A ,$0.23 ,$0.15 ,$0.73 ,$2.18 ,$2.32 ,$1.71 ,$2.46 , N/A , N/A ,$2.59 ,$2.46 ,$2.32 ,$2.32 ,$0.73 ,$2.32 ,$2.32 ,$2.46 ,$1.66 , N/A ,$1.70 , N/A ,$2.46 , N/A ,$2.51 ,$2.46 ,$1.80 ,$1.80 ,$1.66 ,$1.80 ,$1.77 ,$1.87 ,$0.63 ,$2.16 , N/A ,$1.34 ,$1.34 ,$0.73 ,$1.34 , N/A ,$2.59 ,$2.24 ,$2.24 ,$2.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1120,ACETAZOLAMIDE 500 MG SOLR per500 mg,636,1 ,$324.45 ,$214.14 ,$43.52 ,$324.45 , N/A ,$65.27 ,$43.52 ,$85.85 ,$259.56 ,$275.78 ,$202.78 ,$292.01 , N/A , N/A ,$308.23 ,$292.01 ,$275.78 ,$275.78 ,$85.85 ,$275.78 ,$275.78 ,$292.01 ,$197.59 , N/A ,$201.16 , N/A ,$292.01 , N/A ,$298.49 ,$292.01 ,$214.17 ,$214.17 ,$197.59 ,$214.17 ,$210.89 ,$221.66 ,$73.86 ,$256.32 , N/A ,$158.98 ,$158.98 ,$85.85 ,$158.98 , N/A ,$308.23 ,$266.05 ,$266.05 ,$259.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0132,ACETYLCYSTEINE 200 MG/ML SOLN 30 ML VIAL per100 mg,636,1 ,$23.12 ,$15.26 ,$1.14 ,$23.12 , N/A ,$1.71 ,$1.14 ,$6.12 ,$18.50 ,$19.65 ,$14.45 ,$20.81 , N/A , N/A ,$21.96 ,$20.81 ,$19.65 ,$19.65 ,$6.12 ,$19.65 ,$19.65 ,$20.81 ,$14.08 , N/A ,$14.34 , N/A ,$20.81 , N/A ,$21.27 ,$20.81 ,$15.26 ,$15.26 ,$14.08 ,$15.26 ,$15.03 ,$15.80 ,$5.26 ,$18.26 , N/A ,$11.33 ,$11.33 ,$6.12 ,$11.33 , N/A ,$21.96 ,$18.96 ,$18.96 ,$18.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0133,ACYCLOVIR 50 MG/ML SOLN 10 ML VIAL per5 mg,636,1 ,$1.39 ,$0.92 ,$0.06 ,$1.39 , N/A ,$0.09 ,$0.06 ,$0.37 ,$1.11 ,$1.18 ,$0.87 ,$1.25 , N/A , N/A ,$1.32 ,$1.25 ,$1.18 ,$1.18 ,$0.37 ,$1.18 ,$1.18 ,$1.25 ,$0.85 , N/A ,$0.86 , N/A ,$1.25 , N/A ,$1.28 ,$1.25 ,$0.92 ,$0.92 ,$0.85 ,$0.92 ,$0.90 ,$0.95 ,$0.31 ,$1.10 , N/A ,$0.68 ,$0.68 ,$0.37 ,$0.68 , N/A ,$1.32 ,$1.14 ,$1.14 ,$1.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0133,ACYCLOVIR 50 MG/ML SOLN 20 ML VIAL per5 mg,636,1 ,$0.92 ,$0.61 ,$0.06 ,$0.92 , N/A ,$0.09 ,$0.06 ,$0.24 ,$0.74 ,$0.78 ,$0.58 ,$0.83 , N/A , N/A ,$0.87 ,$0.83 ,$0.78 ,$0.78 ,$0.24 ,$0.78 ,$0.78 ,$0.83 ,$0.56 , N/A ,$0.58 , N/A ,$0.83 , N/A ,$0.85 ,$0.83 ,$0.61 ,$0.61 ,$0.56 ,$0.61 ,$0.60 ,$0.63 ,$0.21 ,$0.73 , N/A ,$0.45 ,$0.45 ,$0.24 ,$0.45 , N/A ,$0.87 ,$0.75 ,$0.75 ,$0.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0153,ADENOSINE 12 MG/4ML SOLN per1 mg,636,1 ,$13.47 ,$8.89 ,$0.75 ,$13.47 , N/A ,$1.13 ,$0.75 ,$3.57 ,$10.78 ,$11.45 ,$8.42 ,$12.12 , N/A , N/A ,$12.80 ,$12.12 ,$11.45 ,$11.45 ,$3.57 ,$11.45 ,$11.45 ,$12.12 ,$8.20 , N/A ,$8.36 , N/A ,$12.12 , N/A ,$12.39 ,$12.12 ,$8.89 ,$8.89 ,$8.20 ,$8.89 ,$8.76 ,$9.20 ,$3.07 ,$10.64 , N/A ,$6.60 ,$6.60 ,$3.57 ,$6.60 , N/A ,$12.80 ,$11.05 ,$11.05 ,$10.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0153,ADENOSINE 6 MG/2ML SOLN per1 mg,636,1 ,$19.56 ,$12.91 ,$0.75 ,$19.56 , N/A ,$1.13 ,$0.75 ,$5.17 ,$15.65 ,$16.63 ,$12.23 ,$17.60 , N/A , N/A ,$18.58 ,$17.60 ,$16.63 ,$16.63 ,$5.17 ,$16.63 ,$16.63 ,$17.60 ,$11.91 , N/A ,$12.12 , N/A ,$17.60 , N/A ,$18.00 ,$17.60 ,$12.91 ,$12.91 ,$11.91 ,$12.91 ,$12.71 ,$13.36 ,$4.46 ,$15.45 , N/A ,$9.58 ,$9.58 ,$5.17 ,$9.58 , N/A ,$18.58 ,$16.04 ,$16.04 ,$15.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,P9047,ALBUMIN HUMAN 25 % SOLN per50 mL,636,1 ,$423.75 ,$279.68 ,$53.08 ,$423.75 ,$274.68 ,$119.43 ,$79.62 ,$112.12 ,$339.00 ,$360.19 ,$264.84 ,$381.38 ,$274.68 ,$274.68 ,$402.56 ,$381.38 ,$360.19 ,$360.19 ,$112.12 ,$360.19 ,$360.19 ,$381.38 ,$258.06 ,$274.68 ,$262.72 ,$291.16 ,$381.38 ,$119.42 ,$389.85 ,$381.38 ,$279.72 ,$279.72 ,$258.06 ,$279.72 ,$275.44 ,$289.51 ,$96.46 ,$334.76 ,$291.16 ,$207.64 ,$207.64 ,$112.12 ,$207.64 ,$53.08 ,$402.56 ,$347.48 ,$347.48 ,$339.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,P9045,ALBUMIN HUMAN 5 % SOLN per250 mL,636,1 ,$512.00 ,$337.92 ,$53.08 ,$660.55 ,$623.16 ,$119.43 ,$79.62 ,$135.48 ,$409.60 ,$435.20 ,$320.00 ,$460.80 ,$623.16 ,$512.00 ,$486.40 ,$460.80 ,$435.20 ,$435.20 ,$135.48 ,$435.20 ,$435.20 ,$460.80 ,$311.81 ,$623.16 ,$317.44 ,$542.72 ,$460.80 ,$119.42 ,$471.04 ,$460.80 ,$337.97 ,$337.97 ,$311.81 ,$337.97 ,$332.80 ,$349.80 ,$116.56 ,$404.48 ,$660.55 ,$250.88 ,$250.88 ,$135.48 ,$250.88 ,$53.08 ,$486.40 ,$419.84 ,$419.84 ,$409.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2997,ALTEPLASE 100 MG SOLR per1 mg,636,1 ,$332.65 ,$219.55 ,$75.73 ,$332.65 ,$99.20 ,$197.03 ,$131.36 ,$88.02 ,$266.12 ,$282.75 ,$207.91 ,$299.39 ,$99.20 ,$99.20 ,$316.02 ,$299.39 ,$282.75 ,$282.75 ,$88.02 ,$282.75 ,$282.75 ,$299.39 ,$202.58 ,$99.20 ,$206.24 ,$105.15 ,$299.39 ,$197.02 ,$306.04 ,$299.39 ,$219.58 ,$219.58 ,$202.58 ,$219.58 ,$216.22 ,$227.27 ,$75.73 ,$262.79 ,$105.15 ,$163.00 ,$163.00 ,$88.02 ,$163.00 ,$87.57 ,$316.02 ,$272.77 ,$272.77 ,$266.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2997,ALTEPLASE 2 MG SOLR per1 mg,636,1 ,$400.18 ,$264.12 ,$87.57 ,$400.18 ,$99.20 ,$197.03 ,$131.36 ,$105.89 ,$320.14 ,$340.15 ,$250.11 ,$360.16 ,$99.20 ,$99.20 ,$380.17 ,$360.16 ,$340.15 ,$340.15 ,$105.89 ,$340.15 ,$340.15 ,$360.16 ,$243.71 ,$99.20 ,$248.12 ,$105.15 ,$360.16 ,$197.02 ,$368.17 ,$360.16 ,$264.16 ,$264.16 ,$243.71 ,$264.16 ,$260.12 ,$273.40 ,$91.10 ,$316.14 ,$105.15 ,$196.09 ,$196.09 ,$105.89 ,$196.09 ,$87.57 ,$380.17 ,$328.15 ,$328.15 ,$320.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2997,ALTEPLASE 2 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$400.18 ,$264.12 ,$87.57 ,$400.18 ,$99.20 ,$197.03 ,$131.36 ,$105.89 ,$320.14 ,$340.15 ,$250.11 ,$360.16 ,$99.20 ,$99.20 ,$380.17 ,$360.16 ,$340.15 ,$340.15 ,$105.89 ,$340.15 ,$340.15 ,$360.16 ,$243.71 ,$99.20 ,$248.12 ,$105.15 ,$360.16 ,$197.02 ,$368.17 ,$360.16 ,$264.16 ,$264.16 ,$243.71 ,$264.16 ,$260.12 ,$273.40 ,$91.10 ,$316.14 ,$105.15 ,$196.09 ,$196.09 ,$105.89 ,$196.09 ,$87.57 ,$380.17 ,$328.15 ,$328.15 ,$320.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0280,AMINOPHYLLINE 25 MG/ML SOLN per250 mg,636,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$20.12 ,$13.41 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0282,AMIODARONE 150 MG/3ML SOLN per30 mg,636,1 ,$9.80 ,$6.47 ,$2.22 ,$9.80 , N/A ,$8.78 ,$8.78 ,$2.60 ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 ,$2.60 ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A ,$6.08 , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$2.22 ,$7.74 , N/A ,$4.80 ,$4.80 ,$2.60 ,$4.80 , N/A ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0282,AMIODARONE 150-4.21 MG/100ML-% SOLN per30 mg,636,1 ,$57.35 ,$37.85 ,$13.05 ,$57.35 , N/A ,$51.40 ,$51.40 ,$15.17 ,$45.88 ,$48.75 ,$35.84 ,$51.62 , N/A , N/A ,$54.48 ,$51.62 ,$48.75 ,$48.75 ,$15.17 ,$48.75 ,$48.75 ,$51.62 ,$34.93 , N/A ,$35.56 , N/A ,$51.62 , N/A ,$52.76 ,$51.62 ,$37.86 ,$37.86 ,$34.93 ,$37.86 ,$37.28 ,$39.18 ,$13.05 ,$45.31 , N/A ,$28.10 ,$28.10 ,$15.17 ,$28.10 , N/A ,$54.48 ,$47.03 ,$47.03 ,$45.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0282,AMIODARONE 360-4.14 MG/200ML-% SOLN per30 mg,636,1 ,$30.97 ,$20.44 ,$7.05 ,$30.97 , N/A ,$27.76 ,$27.76 ,$8.19 ,$24.78 ,$26.32 ,$19.36 ,$27.87 , N/A , N/A ,$29.42 ,$27.87 ,$26.32 ,$26.32 ,$8.19 ,$26.32 ,$26.32 ,$27.87 ,$18.86 , N/A ,$19.20 , N/A ,$27.87 , N/A ,$28.49 ,$27.87 ,$20.44 ,$20.44 ,$18.86 ,$20.44 ,$20.13 ,$21.16 ,$7.05 ,$24.47 , N/A ,$15.18 ,$15.18 ,$8.19 ,$15.18 , N/A ,$29.42 ,$25.40 ,$25.40 ,$24.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0289,AMPHOTERICIN B LIPOSOME 50 MG SUSR 1 EACH VIAL per10 mg,636,1 ,$214.68 ,$141.69 ,$26.85 ,"$1,740.39 ","$1,641.88 ",$60.41 ,$40.28 ,$56.80 ,$171.74 ,$182.48 ,$134.18 ,$193.21 ,"$1,641.88 ",$214.68 ,$203.95 ,$193.21 ,$182.48 ,$182.48 ,$56.80 ,$182.48 ,$182.48 ,$193.21 ,$130.74 ,"$1,641.88 ",$133.10 ,$227.56 ,$193.21 ,$60.41 ,$197.51 ,$193.21 ,$141.71 ,$141.71 ,$130.74 ,$141.71 ,$139.54 ,$146.67 ,$48.87 ,$169.60 ,"$1,740.39 ",$105.19 ,$105.19 ,$56.80 ,$105.19 ,$26.85 ,$203.95 ,$176.04 ,$176.04 ,$171.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0290,AMPICILLIN 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$24.50 ,$16.17 ,$1.38 ,$24.50 , N/A ,$2.07 ,$1.38 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0290,AMPICILLIN 2 G SOLR 1 EACH VIAL per500 mg,636,1 ,$24.48 ,$16.16 ,$1.38 ,$24.48 , N/A ,$2.07 ,$1.38 ,$6.48 ,$19.58 ,$20.81 ,$15.30 ,$22.03 , N/A , N/A ,$23.26 ,$22.03 ,$20.81 ,$20.81 ,$6.48 ,$20.81 ,$20.81 ,$22.03 ,$14.91 , N/A ,$15.18 , N/A ,$22.03 , N/A ,$22.52 ,$22.03 ,$16.16 ,$16.16 ,$14.91 ,$16.16 ,$15.91 ,$16.72 ,$5.58 ,$19.34 , N/A ,$12.00 ,$12.00 ,$6.48 ,$12.00 , N/A ,$23.26 ,$20.07 ,$20.07 ,$19.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0295,AMPICILLIN-SULBACTAM 1.5 (1-0.5) G SOLR 1 EACH VIAL per1.5 g,636,1 ,$58.70 ,$38.74 ,$3.26 ,$58.70 , N/A ,$4.88 ,$3.26 ,$15.53 ,$46.96 ,$49.90 ,$36.69 ,$52.83 , N/A , N/A ,$55.77 ,$52.83 ,$49.90 ,$49.90 ,$15.53 ,$49.90 ,$49.90 ,$52.83 ,$35.75 , N/A ,$36.40 , N/A ,$52.83 , N/A ,$54.00 ,$52.83 ,$38.75 ,$38.75 ,$35.75 ,$38.75 ,$38.16 ,$40.10 ,$13.37 ,$46.37 , N/A ,$28.76 ,$28.76 ,$15.53 ,$28.76 , N/A ,$55.77 ,$48.13 ,$48.13 ,$46.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0295,AMPICILLIN-SULBACTAM 3 (2-1) G SOLR 1 EACH VIAL per1.5 g,636,1 ,$58.88 ,$38.86 ,$3.26 ,$58.88 , N/A ,$4.88 ,$3.26 ,$15.58 ,$47.10 ,$50.05 ,$36.80 ,$52.99 , N/A , N/A ,$55.94 ,$52.99 ,$50.05 ,$50.05 ,$15.58 ,$50.05 ,$50.05 ,$52.99 ,$35.86 , N/A ,$36.50 , N/A ,$52.99 , N/A ,$54.17 ,$52.99 ,$38.87 ,$38.87 ,$35.86 ,$38.87 ,$38.27 ,$40.23 ,$13.41 ,$46.52 , N/A ,$28.85 ,$28.85 ,$15.58 ,$28.85 , N/A ,$55.94 ,$48.28 ,$48.28 ,$47.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7187,ANTIHEMOPHILIC FACTOR VIII-VWF 250-600 UNITS SOLR per1 Int'l Units VWF:RCo,636,1 ,$4.09 ,$2.70 ,$0.93 ,"$6,709.17 ","$6,329.41 ",$3.04 ,$2.03 ,$1.08 ,$3.27 ,$3.48 ,$2.56 ,$3.68 ,"$6,329.41 ",$4.09 ,$3.89 ,$3.68 ,$3.48 ,$3.48 ,$1.08 ,$3.48 ,$3.48 ,$3.68 ,$2.49 ,"$6,329.41 ",$2.54 ,$4.34 ,$3.68 ,$3.04 ,$3.76 ,$3.68 ,$2.70 ,$2.70 ,$2.49 ,$2.70 ,$2.66 ,$2.79 ,$0.93 ,$3.23 ,"$6,709.17 ",$2.00 ,$2.00 ,$1.08 ,$2.00 ,$1.35 ,$3.89 ,$3.35 ,$3.35 ,$3.27 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7187,ANTIHEMOPHILIC FACTOR VIII-VWF 1000-2400 UNITS SOLR per1 Int'l Units VWF:RCo,636,1 ,$4.09 ,$2.70 ,$0.93 ,"$6,709.17 ","$6,329.41 ",$3.04 ,$2.03 ,$1.08 ,$3.27 ,$3.48 ,$2.56 ,$3.68 ,"$6,329.41 ",$4.09 ,$3.89 ,$3.68 ,$3.48 ,$3.48 ,$1.08 ,$3.48 ,$3.48 ,$3.68 ,$2.49 ,"$6,329.41 ",$2.54 ,$4.34 ,$3.68 ,$3.04 ,$3.76 ,$3.68 ,$2.70 ,$2.70 ,$2.49 ,$2.70 ,$2.66 ,$2.79 ,$0.93 ,$3.23 ,"$6,709.17 ",$2.00 ,$2.00 ,$1.08 ,$2.00 ,$1.35 ,$3.89 ,$3.35 ,$3.35 ,$3.27 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J8501,APREPITANT 40 MG CAPS per5 mg,636,1 ,$43.98 ,$29.03 ,$4.49 ,$43.98 , N/A ,$6.73 ,$4.49 ,$11.63 ,$35.18 ,$37.38 ,$27.49 ,$39.58 , N/A , N/A ,$41.78 ,$39.58 ,$37.38 ,$37.38 ,$11.63 ,$37.38 ,$37.38 ,$39.58 ,$26.78 , N/A ,$27.26 , N/A ,$39.58 , N/A ,$40.46 ,$39.58 ,$29.03 ,$29.03 ,$26.78 ,$29.03 ,$28.59 ,$30.05 ,$10.02 ,$34.74 , N/A ,$21.55 ,$21.55 ,$11.63 ,$21.55 , N/A ,$41.78 ,$36.06 ,$36.06 ,$35.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0461,ATROPINE 1 MG/10ML SOSY per0.01 mg,636,1 ,$0.98 ,$0.65 ,$0.15 ,$0.98 , N/A ,$0.23 ,$0.15 ,$0.25 ,$0.78 ,$0.83 ,$0.61 ,$0.88 , N/A , N/A ,$0.93 ,$0.88 ,$0.83 ,$0.83 ,$0.25 ,$0.83 ,$0.83 ,$0.88 ,$0.60 , N/A ,$0.60 , N/A ,$0.88 , N/A ,$0.90 ,$0.88 ,$0.65 ,$0.65 ,$0.60 ,$0.65 ,$0.64 ,$0.67 ,$0.23 ,$0.77 , N/A ,$0.48 ,$0.48 ,$0.25 ,$0.48 , N/A ,$0.93 ,$0.80 ,$0.80 ,$0.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0461,ATROPINE 1 MG/ML SOLN per0.01 mg,636,1 ,$0.93 ,$0.61 ,$0.15 ,$0.93 , N/A ,$0.23 ,$0.15 ,$0.24 ,$0.74 ,$0.79 ,$0.58 ,$0.84 , N/A , N/A ,$0.88 ,$0.84 ,$0.79 ,$0.79 ,$0.24 ,$0.79 ,$0.79 ,$0.84 ,$0.57 , N/A ,$0.58 , N/A ,$0.84 , N/A ,$0.86 ,$0.84 ,$0.61 ,$0.61 ,$0.57 ,$0.61 ,$0.60 ,$0.64 ,$0.21 ,$0.73 , N/A ,$0.46 ,$0.46 ,$0.24 ,$0.46 , N/A ,$0.88 ,$0.76 ,$0.76 ,$0.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7500,AZATHIOPRINE 50 MG TABS per50 mg,636,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$8.00 ,$8.00 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0456,AZITHROMYCIN 500 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$106.40 ,$70.22 ,$3.89 ,$106.40 , N/A ,$5.83 ,$3.89 ,$28.16 ,$85.12 ,$90.44 ,$66.50 ,$95.76 , N/A , N/A ,$101.08 ,$95.76 ,$90.44 ,$90.44 ,$28.16 ,$90.44 ,$90.44 ,$95.76 ,$64.80 , N/A ,$65.96 , N/A ,$95.76 , N/A ,$97.89 ,$95.76 ,$70.23 ,$70.23 ,$64.80 ,$70.23 ,$69.16 ,$72.69 ,$24.22 ,$84.06 , N/A ,$52.14 ,$52.14 ,$28.16 ,$52.14 , N/A ,$101.08 ,$87.25 ,$87.25 ,$85.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,BARICITINIB 2 MG TABS per2 mg,636,1 ,$339.63 ,$224.16 ,$89.87 ,$339.63 , N/A ,$304.38 ,$304.38 ,$89.87 ,$271.70 ,$288.69 ,$212.27 ,$305.67 , N/A , N/A ,$322.65 ,$305.67 ,$288.69 ,$288.69 ,$89.87 ,$288.69 ,$288.69 ,$305.67 ,$206.83 , N/A ,$210.58 , N/A ,$305.67 ,$203.78 ,$312.46 ,$305.67 ,$224.19 ,$224.19 ,$206.83 ,$224.19 ,$220.76 ,$232.04 , N/A ,$268.31 , N/A ,$166.42 ,$166.42 ,$89.87 ,$166.42 , N/A ,$322.65 ,$278.50 ,$278.50 ,$271.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0485,BELATACEPT 250 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$14.29 ,$9.43 ,$3.25 ,"$2,294.65 ","$2,164.76 ",$8.53 ,$5.69 ,$3.78 ,$11.43 ,$12.15 ,$8.93 ,$12.86 ,"$2,164.76 ",$14.29 ,$13.58 ,$12.86 ,$12.15 ,$12.15 ,$3.78 ,$12.15 ,$12.15 ,$12.86 ,$8.70 ,"$2,164.76 ",$8.86 ,$15.15 ,$12.86 ,$8.54 ,$13.15 ,$12.86 ,$9.43 ,$9.43 ,$8.70 ,$9.43 ,$9.29 ,$9.76 ,$3.25 ,$11.29 ,"$2,294.65 ",$7.00 ,$7.00 ,$3.78 ,$7.00 ,$3.79 ,$13.58 ,$11.72 ,$11.72 ,$11.43 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0515,BENZTROPINE MESYLATE 1 MG/ML SOLN per1 mg,636,1 ,$230.65 ,$152.23 ,$23.81 ,$230.65 , N/A ,$35.71 ,$23.81 ,$61.03 ,$184.52 ,$196.05 ,$144.16 ,$207.59 , N/A , N/A ,$219.12 ,$207.59 ,$196.05 ,$196.05 ,$61.03 ,$196.05 ,$196.05 ,$207.59 ,$140.47 , N/A ,$143.00 , N/A ,$207.59 , N/A ,$212.20 ,$207.59 ,$152.25 ,$152.25 ,$140.47 ,$152.25 ,$149.92 ,$157.58 ,$52.51 ,$182.21 , N/A ,$113.02 ,$113.02 ,$61.03 ,$113.02 , N/A ,$219.12 ,$189.13 ,$189.13 ,$184.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0583,BIVALIRUDIN 250 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$5.97 ,$3.94 ,$0.29 ,$281.01 ,$265.10 ,$0.43 ,$0.29 ,$1.58 ,$4.78 ,$5.07 ,$3.73 ,$5.37 ,$265.10 ,$5.97 ,$5.67 ,$5.37 ,$5.07 ,$5.07 ,$1.58 ,$5.07 ,$5.07 ,$5.37 ,$3.64 ,$265.10 ,$3.70 ,$6.33 ,$5.37 , N/A ,$5.49 ,$5.37 ,$3.94 ,$3.94 ,$3.64 ,$3.94 ,$3.88 ,$4.08 ,$1.35 ,$4.72 ,$281.01 ,$2.93 ,$2.93 ,$1.58 ,$2.93 , N/A ,$5.67 ,$4.90 ,$4.90 ,$4.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0583,BIVALIRUDIN 250 MG SOLR per1 mg,636,1 ,$11.15 ,$7.36 ,$0.29 ,$281.01 ,$265.10 ,$0.43 ,$0.29 ,$2.95 ,$8.92 ,$9.48 ,$6.97 ,$10.04 ,$265.10 ,$11.15 ,$10.59 ,$10.04 ,$9.48 ,$9.48 ,$2.95 ,$9.48 ,$9.48 ,$10.04 ,$6.79 ,$265.10 ,$6.92 ,$11.82 ,$10.04 , N/A ,$10.26 ,$10.04 ,$7.36 ,$7.36 ,$6.79 ,$7.36 ,$7.25 ,$7.62 ,$2.54 ,$8.81 ,$281.01 ,$5.46 ,$5.46 ,$2.95 ,$5.46 , N/A ,$10.59 ,$9.14 ,$9.14 ,$8.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0585,BOTULINUM TOXIN TYPE A 100 UNITS SOLR per1 Units,636,1 ,$23.97 ,$15.82 ,$5.46 ,"$1,009.67 ",$952.52 ,$14.22 ,$9.48 ,$6.34 ,$19.18 ,$20.37 ,$14.98 ,$21.57 ,$952.52 ,$23.97 ,$22.77 ,$21.57 ,$20.37 ,$20.37 ,$6.34 ,$20.37 ,$20.37 ,$21.57 ,$14.60 ,$952.52 ,$14.86 ,$25.41 ,$21.57 ,$14.22 ,$22.05 ,$21.57 ,$15.82 ,$15.82 ,$14.60 ,$15.82 ,$15.58 ,$16.38 ,$5.46 ,$18.94 ,"$1,009.67 ",$11.75 ,$11.75 ,$6.34 ,$11.75 ,$6.32 ,$22.77 ,$19.66 ,$19.66 ,$19.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0585,ONABOTULINUMTOXINA 100 UNITS SOLR per1 Units,636,1 ,$23.97 ,$15.82 ,$5.46 ,"$1,009.67 ",$952.52 ,$14.22 ,$9.48 ,$6.34 ,$19.18 ,$20.37 ,$14.98 ,$21.57 ,$952.52 ,$23.97 ,$22.77 ,$21.57 ,$20.37 ,$20.37 ,$6.34 ,$20.37 ,$20.37 ,$21.57 ,$14.60 ,$952.52 ,$14.86 ,$25.41 ,$21.57 ,$14.22 ,$22.05 ,$21.57 ,$15.82 ,$15.82 ,$14.60 ,$15.82 ,$15.58 ,$16.38 ,$5.46 ,$18.94 ,"$1,009.67 ",$11.75 ,$11.75 ,$6.34 ,$11.75 ,$6.32 ,$22.77 ,$19.66 ,$19.66 ,$19.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9290,BUPIVACAINE LIPOSOME 1.3 % SUSP per1 mg,636,1 ,$11.03 ,$7.28 ,$2.52 ,$11.03 , N/A ,$9.89 ,$9.89 ,$2.92 ,$8.82 ,$9.38 ,$6.89 ,$9.93 , N/A , N/A ,$10.48 ,$9.93 ,$9.38 ,$9.38 ,$2.92 ,$9.38 ,$9.38 ,$9.93 ,$6.72 , N/A ,$6.84 , N/A ,$9.93 , N/A ,$10.15 ,$9.93 ,$7.28 ,$7.28 ,$6.72 ,$7.28 ,$7.17 ,$7.54 ,$2.52 ,$8.71 , N/A ,$5.40 ,$5.40 ,$2.92 ,$5.40 , N/A ,$10.48 ,$9.04 ,$9.04 ,$8.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0574,BUPRENORPHINE-NALOXONE 8-2 MG FILM per1 Film,636,1 ,$8.00 ,$5.28 ,$1.82 ,$8.00 , N/A ,$7.17 ,$7.17 ,$2.12 ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 ,$2.12 ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A ,$4.96 , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$1.82 ,$6.32 , N/A ,$3.92 ,$3.92 ,$2.12 ,$3.92 , N/A ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0630,CALCITONIN 200 UNIT/ML SOLN per400 Units,636,1 ,"$5,919.70 ","$3,907.00 ","$1,328.00 ","$5,919.70 ","$2,622.99 ","$2,988.00 ","$1,992.00 ","$1,566.35 ","$4,735.76 ","$5,031.75 ","$3,699.81 ","$5,327.73 ","$2,622.99 ","$2,622.99 ","$5,623.72 ","$5,327.73 ","$5,031.75 ","$5,031.75 ","$1,566.35 ","$5,031.75 ","$5,031.75 ","$5,327.73 ","$3,605.10 ","$2,622.99 ","$3,670.22 ","$2,780.37 ","$5,327.73 ","$2,987.99 ","$5,446.12 ","$5,327.73 ","$3,907.59 ","$3,907.59 ","$3,605.10 ","$3,907.59 ","$3,847.81 ","$4,044.34 ","$1,347.65 ","$4,676.56 ","$2,780.37 ","$2,900.65 ","$2,900.65 ","$1,566.35 ","$2,900.65 ","$1,328.00 ","$5,623.72 ","$4,854.15 ","$4,854.15 ","$4,735.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0610,CALCIUM GLUCONATE 1 G 1-0.675 GM/50ML-% SOLN per100 mL,636,1 ,$176.70 ,$116.62 ,$7.76 ,$176.70 , N/A ,$11.63 ,$7.76 ,$46.76 ,$141.36 ,$150.20 ,$110.44 ,$159.03 , N/A , N/A ,$167.87 ,$159.03 ,$150.20 ,$150.20 ,$46.76 ,$150.20 ,$150.20 ,$159.03 ,$107.61 , N/A ,$109.56 , N/A ,$159.03 , N/A ,$162.56 ,$159.03 ,$116.64 ,$116.64 ,$107.61 ,$116.64 ,$114.86 ,$120.72 ,$40.23 ,$139.59 , N/A ,$86.58 ,$86.58 ,$46.76 ,$86.58 , N/A ,$167.87 ,$144.89 ,$144.89 ,$141.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0610,CALCIUM GLUCONATE 10 % SOLN 10 ML VIAL per10 mL,636,1 ,$73.93 ,$48.79 ,$7.76 ,$73.93 , N/A ,$11.63 ,$7.76 ,$19.56 ,$59.14 ,$62.84 ,$46.21 ,$66.54 , N/A , N/A ,$70.23 ,$66.54 ,$62.84 ,$62.84 ,$19.56 ,$62.84 ,$62.84 ,$66.54 ,$45.02 , N/A ,$45.84 , N/A ,$66.54 , N/A ,$68.02 ,$66.54 ,$48.80 ,$48.80 ,$45.02 ,$48.80 ,$48.05 ,$50.51 ,$16.83 ,$58.40 , N/A ,$36.23 ,$36.23 ,$19.56 ,$36.23 , N/A ,$70.23 ,$60.62 ,$60.62 ,$59.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0610,CALCIUM GLUCONATE 2 G 2-0.675 GM/100ML-% SOLN per50 mL,636,1 ,$161.23 ,$106.41 ,$7.76 ,$161.23 , N/A ,$11.63 ,$7.76 ,$42.66 ,$128.98 ,$137.05 ,$100.77 ,$145.11 , N/A , N/A ,$153.17 ,$145.11 ,$137.05 ,$137.05 ,$42.66 ,$137.05 ,$137.05 ,$145.11 ,$98.19 , N/A ,$99.96 , N/A ,$145.11 , N/A ,$148.33 ,$145.11 ,$106.43 ,$106.43 ,$98.19 ,$106.43 ,$104.80 ,$110.15 ,$36.70 ,$127.37 , N/A ,$79.00 ,$79.00 ,$42.66 ,$79.00 , N/A ,$153.17 ,$132.21 ,$132.21 ,$128.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 1-4 GM/50ML-% SOLN per500 mg,636,1 ,$34.83 ,$22.99 ,$1.16 ,$34.83 , N/A ,$1.73 ,$1.16 ,$9.21 ,$27.86 ,$29.61 ,$21.77 ,$31.35 , N/A , N/A ,$33.09 ,$31.35 ,$29.61 ,$29.61 ,$9.21 ,$29.61 ,$29.61 ,$31.35 ,$21.21 , N/A ,$21.60 , N/A ,$31.35 , N/A ,$32.04 ,$31.35 ,$22.99 ,$22.99 ,$21.21 ,$22.99 ,$22.64 ,$23.80 ,$7.93 ,$27.52 , N/A ,$17.07 ,$17.07 ,$9.21 ,$17.07 , N/A ,$33.09 ,$28.56 ,$28.56 ,$27.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 10 G SOLR per500 mg,636,1 ,$12.25 ,$8.09 ,$1.16 ,$12.25 , N/A ,$1.73 ,$1.16 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 1 G SOLR per500 mg,636,1 ,$12.25 ,$8.09 ,$1.16 ,$12.25 , N/A ,$1.73 ,$1.16 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 2 GM/20 ML SOSY per500 mg,636,1 ,$32.45 ,$21.42 ,$1.16 ,$32.45 , N/A ,$1.73 ,$1.16 ,$8.58 ,$25.96 ,$27.58 ,$20.28 ,$29.21 , N/A , N/A ,$30.83 ,$29.21 ,$27.58 ,$27.58 ,$8.58 ,$27.58 ,$27.58 ,$29.21 ,$19.76 , N/A ,$20.12 , N/A ,$29.21 , N/A ,$29.85 ,$29.21 ,$21.42 ,$21.42 ,$19.76 ,$21.42 ,$21.09 ,$22.17 ,$7.38 ,$25.64 , N/A ,$15.90 ,$15.90 ,$8.58 ,$15.90 , N/A ,$30.83 ,$26.61 ,$26.61 ,$25.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 2-4 GM/100ML-% SOLN per500 mg,636,1 ,$24.80 ,$16.37 ,$1.16 ,$24.80 , N/A ,$1.73 ,$1.16 ,$6.57 ,$19.84 ,$21.08 ,$15.50 ,$22.32 , N/A , N/A ,$23.56 ,$22.32 ,$21.08 ,$21.08 ,$6.57 ,$21.08 ,$21.08 ,$22.32 ,$15.10 , N/A ,$15.38 , N/A ,$22.32 , N/A ,$22.82 ,$22.32 ,$16.37 ,$16.37 ,$15.10 ,$16.37 ,$16.12 ,$16.94 ,$5.64 ,$19.59 , N/A ,$12.15 ,$12.15 ,$6.57 ,$12.15 , N/A ,$23.56 ,$20.34 ,$20.34 ,$19.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 2-5 GM/100ML-% SOLN per500 mg,636,1 ,$35.56 ,$23.47 ,$1.16 ,$35.56 , N/A ,$1.73 ,$1.16 ,$9.41 ,$28.45 ,$30.23 ,$22.23 ,$32.00 , N/A , N/A ,$33.78 ,$32.00 ,$30.23 ,$30.23 ,$9.41 ,$30.23 ,$30.23 ,$32.00 ,$21.66 , N/A ,$22.04 , N/A ,$32.00 , N/A ,$32.72 ,$32.00 ,$23.47 ,$23.47 ,$21.66 ,$23.47 ,$23.11 ,$24.29 ,$8.09 ,$28.09 , N/A ,$17.42 ,$17.42 ,$9.41 ,$17.42 , N/A ,$33.78 ,$29.16 ,$29.16 ,$28.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 3 GM/20ML SOSY per500 mg,636,1 ,$24.50 ,$16.17 ,$1.16 ,$24.50 , N/A ,$1.73 ,$1.16 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$24.50 ,$16.17 ,$1.16 ,$24.50 , N/A ,$1.73 ,$1.16 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0690,CEFAZOLIN 500 MG SOLR per500 mg,636,1 ,$59.88 ,$39.52 ,$1.16 ,$59.88 , N/A ,$1.73 ,$1.16 ,$15.85 ,$47.90 ,$50.90 ,$37.43 ,$53.89 , N/A , N/A ,$56.89 ,$53.89 ,$50.90 ,$50.90 ,$15.85 ,$50.90 ,$50.90 ,$53.89 ,$36.47 , N/A ,$37.12 , N/A ,$53.89 , N/A ,$55.09 ,$53.89 ,$39.53 ,$39.53 ,$36.47 ,$39.53 ,$38.92 ,$40.91 ,$13.63 ,$47.31 , N/A ,$29.34 ,$29.34 ,$15.85 ,$29.34 , N/A ,$56.89 ,$49.10 ,$49.10 ,$47.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0692,CEFEPIME 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$62.53 ,$41.27 ,$1.86 ,$62.53 , N/A ,$2.79 ,$1.86 ,$16.54 ,$50.02 ,$53.15 ,$39.08 ,$56.28 , N/A , N/A ,$59.40 ,$56.28 ,$53.15 ,$53.15 ,$16.54 ,$53.15 ,$53.15 ,$56.28 ,$38.08 , N/A ,$38.76 , N/A ,$56.28 , N/A ,$57.53 ,$56.28 ,$41.28 ,$41.28 ,$38.08 ,$41.28 ,$40.64 ,$42.72 ,$14.23 ,$49.40 , N/A ,$30.64 ,$30.64 ,$16.54 ,$30.64 , N/A ,$59.40 ,$51.27 ,$51.27 ,$50.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0692,CEFEPIME 2 G SOLR 1 EACH VIAL per500 mg,636,1 ,$62.06 ,$40.96 ,$1.86 ,$62.06 , N/A ,$2.79 ,$1.86 ,$16.42 ,$49.65 ,$52.75 ,$38.79 ,$55.85 , N/A , N/A ,$58.96 ,$55.85 ,$52.75 ,$52.75 ,$16.42 ,$52.75 ,$52.75 ,$55.85 ,$37.79 , N/A ,$38.48 , N/A ,$55.85 , N/A ,$57.10 ,$55.85 ,$40.97 ,$40.97 ,$37.79 ,$40.97 ,$40.34 ,$42.40 ,$14.12 ,$49.03 , N/A ,$30.41 ,$30.41 ,$16.42 ,$30.41 , N/A ,$58.96 ,$50.89 ,$50.89 ,$49.65 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0712,CEFTAROLINE 600 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$17.57 ,$11.60 ,$3.77 ,$281.01 ,$265.10 ,$8.48 ,$5.66 ,$4.65 ,$14.06 ,$14.93 ,$10.98 ,$15.81 ,$265.10 ,$17.57 ,$16.69 ,$15.81 ,$14.93 ,$14.93 ,$4.65 ,$14.93 ,$14.93 ,$15.81 ,$10.70 ,$265.10 ,$10.90 ,$18.62 ,$15.81 ,$8.47 ,$16.16 ,$15.81 ,$11.60 ,$11.60 ,$10.70 ,$11.60 ,$11.42 ,$12.00 ,$4.00 ,$13.88 ,$281.01 ,$8.61 ,$8.61 ,$4.65 ,$8.61 ,$3.77 ,$16.69 ,$14.41 ,$14.41 ,$14.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0713,CEFTAZIDIME 2 G SOLR 1 EACH VIAL per500 mg,636,1 ,$22.33 ,$14.74 ,$2.79 ,$22.33 , N/A ,$4.19 ,$2.79 ,$5.91 ,$17.86 ,$18.98 ,$13.96 ,$20.10 , N/A , N/A ,$21.21 ,$20.10 ,$18.98 ,$18.98 ,$5.91 ,$18.98 ,$18.98 ,$20.10 ,$13.60 , N/A ,$13.84 , N/A ,$20.10 , N/A ,$20.54 ,$20.10 ,$14.74 ,$14.74 ,$13.60 ,$14.74 ,$14.51 ,$15.26 ,$5.09 ,$17.64 , N/A ,$10.94 ,$10.94 ,$5.91 ,$10.94 , N/A ,$21.21 ,$18.31 ,$18.31 ,$17.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0714,CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G SOLR 1 EACH VIAL per0.625 g,636,1 ,$425.20 ,$280.63 ,$90.84 ,$528.18 ,$498.28 ,$204.39 ,$136.26 ,$112.50 ,$340.16 ,$361.42 ,$265.75 ,$382.68 ,$498.28 ,$425.20 ,$403.94 ,$382.68 ,$361.42 ,$361.42 ,$112.50 ,$361.42 ,$361.42 ,$382.68 ,$258.95 ,$498.28 ,$263.62 ,$450.71 ,$382.68 ,$204.39 ,$391.18 ,$382.68 ,$280.67 ,$280.67 ,$258.95 ,$280.67 ,$276.38 ,$290.50 ,$96.80 ,$335.91 ,$528.18 ,$208.35 ,$208.35 ,$112.50 ,$208.35 ,$90.84 ,$403.94 ,$348.66 ,$348.66 ,$340.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0696,CEFTRIAXONE 1 G SOLR 1 EACH VIAL per250 mg,636,1 ,$70.65 ,$46.63 ,$0.77 ,$70.65 , N/A ,$1.15 ,$0.77 ,$18.70 ,$56.52 ,$60.05 ,$44.16 ,$63.59 , N/A , N/A ,$67.12 ,$63.59 ,$60.05 ,$60.05 ,$18.70 ,$60.05 ,$60.05 ,$63.59 ,$43.03 , N/A ,$43.80 , N/A ,$63.59 , N/A ,$65.00 ,$63.59 ,$46.64 ,$46.64 ,$43.03 ,$46.64 ,$45.92 ,$48.27 ,$16.08 ,$55.81 , N/A ,$34.62 ,$34.62 ,$18.70 ,$34.62 , N/A ,$67.12 ,$57.93 ,$57.93 ,$56.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0696,CEFTRIAXONE 2 G SOLR 1 EACH VIAL per250 mg,636,1 ,$70.20 ,$46.33 ,$0.77 ,$70.20 , N/A ,$1.15 ,$0.77 ,$18.57 ,$56.16 ,$59.67 ,$43.88 ,$63.18 , N/A , N/A ,$66.69 ,$63.18 ,$59.67 ,$59.67 ,$18.57 ,$59.67 ,$59.67 ,$63.18 ,$42.75 , N/A ,$43.52 , N/A ,$63.18 , N/A ,$64.58 ,$63.18 ,$46.34 ,$46.34 ,$42.75 ,$46.34 ,$45.63 ,$47.96 ,$15.98 ,$55.46 , N/A ,$34.40 ,$34.40 ,$18.57 ,$34.40 , N/A ,$66.69 ,$57.56 ,$57.56 ,$56.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0696,CEFTRIAXONE 250 MG SOLR 1 EACH VIAL per250 mg,636,1 ,$49.00 ,$32.34 ,$0.77 ,$49.00 , N/A ,$1.15 ,$0.77 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0696,CEFTRIAXONE 500 MG SOLR 1 EACH VIAL per250 mg,636,1 ,$86.08 ,$56.81 ,$0.77 ,$86.08 , N/A ,$1.15 ,$0.77 ,$22.78 ,$68.86 ,$73.17 ,$53.80 ,$77.47 , N/A , N/A ,$81.78 ,$77.47 ,$73.17 ,$73.17 ,$22.78 ,$73.17 ,$73.17 ,$77.47 ,$52.42 , N/A ,$53.36 , N/A ,$77.47 , N/A ,$79.19 ,$77.47 ,$56.82 ,$56.82 ,$52.42 ,$56.82 ,$55.95 ,$58.81 ,$19.60 ,$68.00 , N/A ,$42.18 ,$42.18 ,$22.78 ,$42.18 , N/A ,$81.78 ,$70.59 ,$70.59 ,$68.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0697,CEFUROXIME 1.5 G SOLR 1 EACH VIAL per750 mg,636,1 ,$24.50 ,$16.17 ,$3.36 ,$24.50 , N/A ,$5.04 ,$3.36 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2400,CHLOROPROCAINE (PF) 2 % SOLN per30 mL,636,1 ,$78.70 ,$51.94 ,$17.91 ,$78.70 , N/A ,$66.51 ,$44.34 ,$20.82 ,$62.96 ,$66.90 ,$49.19 ,$70.83 , N/A , N/A ,$74.77 ,$70.83 ,$66.90 ,$66.90 ,$20.82 ,$66.90 ,$66.90 ,$70.83 ,$47.93 , N/A ,$48.80 , N/A ,$70.83 , N/A ,$72.40 ,$70.83 ,$51.95 ,$51.95 ,$47.93 ,$51.95 ,$51.16 ,$53.77 ,$17.91 ,$62.17 , N/A ,$38.56 ,$38.56 ,$20.82 ,$38.56 , N/A ,$74.77 ,$64.53 ,$64.53 ,$62.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1205,CHLOROTHIAZIDE 500 MG SOLR 1 EACH VIAL per500 mg,636,1 ,"$1,411.10 ",$931.33 ,$115.31 ,"$1,411.10 ", N/A ,$172.96 ,$115.31 ,$373.38 ,"$1,128.88 ","$1,199.44 ",$881.94 ,"$1,269.99 ", N/A , N/A ,"$1,340.55 ","$1,269.99 ","$1,199.44 ","$1,199.44 ",$373.38 ,"$1,199.44 ","$1,199.44 ","$1,269.99 ",$859.36 , N/A ,$874.88 , N/A ,"$1,269.99 ", N/A ,"$1,298.21 ","$1,269.99 ",$931.47 ,$931.47 ,$859.36 ,$931.47 ,$917.22 ,$964.06 ,$321.24 ,"$1,114.77 ", N/A ,$691.44 ,$691.44 ,$373.38 ,$691.44 , N/A ,"$1,340.55 ","$1,157.10 ","$1,157.10 ","$1,128.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,N/A,CINACALCET 30 MG TABS,636,1 ,$109.80 ,$72.47 ,$24.99 ,$109.80 , N/A ,$98.40 ,$98.40 ,$29.06 ,$87.84 ,$93.33 ,$68.63 ,$98.82 , N/A , N/A ,$104.31 ,$98.82 ,$93.33 ,$93.33 ,$29.06 ,$93.33 ,$93.33 ,$98.82 ,$66.87 , N/A ,$68.08 , N/A ,$98.82 , N/A ,$101.02 ,$98.82 ,$72.48 ,$72.48 ,$66.87 ,$72.48 ,$71.37 ,$75.02 ,$24.99 ,$86.74 , N/A ,$53.80 ,$53.80 ,$29.06 ,$53.80 , N/A ,$104.31 ,$90.04 ,$90.04 ,$87.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0744,CIPROFLOXACIN 400 MG/200ML SOLN per200 mg,636,1 ,$28.38 ,$18.73 ,$2.01 ,$28.38 , N/A ,$3.02 ,$2.01 ,$7.51 ,$22.70 ,$24.12 ,$17.74 ,$25.54 , N/A , N/A ,$26.96 ,$25.54 ,$24.12 ,$24.12 ,$7.51 ,$24.12 ,$24.12 ,$25.54 ,$17.28 , N/A ,$17.60 , N/A ,$25.54 , N/A ,$26.11 ,$25.54 ,$18.73 ,$18.73 ,$17.28 ,$18.73 ,$18.45 ,$19.39 ,$6.47 ,$22.42 , N/A ,$13.91 ,$13.91 ,$7.51 ,$13.91 , N/A ,$26.96 ,$23.27 ,$23.27 ,$22.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q2004,CITRIC ACID-GLUCONOLACTONE SOLN per500 mL,636,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0735,CLONIDINE 100 MCG/ML SOLN 10 ML VIAL per1 mg,636,1 ,$324.75 ,$214.34 ,$34.34 ,$324.75 , N/A ,$51.50 ,$34.34 ,$85.93 ,$259.80 ,$276.04 ,$202.97 ,$292.28 , N/A , N/A ,$308.51 ,$292.28 ,$276.04 ,$276.04 ,$85.93 ,$276.04 ,$276.04 ,$292.28 ,$197.77 , N/A ,$201.34 , N/A ,$292.28 , N/A ,$298.77 ,$292.28 ,$214.37 ,$214.37 ,$197.77 ,$214.37 ,$211.09 ,$221.87 ,$73.93 ,$256.55 , N/A ,$159.13 ,$159.13 ,$85.93 ,$159.13 , N/A ,$308.51 ,$266.30 ,$266.30 ,$259.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7189,COAGULATION FACTOR VIIA RECOMB 2 MG SOLR per1 mcg,636,1 ,$6.86 ,$4.53 ,$1.57 ,"$9,931.67 ","$9,369.50 ",$5.27 ,$3.51 ,$1.81 ,$5.49 ,$5.83 ,$4.29 ,$6.17 ,"$9,369.50 ",$6.86 ,$6.52 ,$6.17 ,$5.83 ,$5.83 ,$1.81 ,$5.83 ,$5.83 ,$6.17 ,$4.18 ,"$9,369.50 ",$4.26 ,$7.27 ,$6.17 ,$5.27 ,$6.31 ,$6.17 ,$4.53 ,$4.53 ,$4.18 ,$4.53 ,$4.46 ,$4.69 ,$1.57 ,$5.42 ,"$9,931.67 ",$3.36 ,$3.36 ,$1.81 ,$3.36 ,$2.34 ,$6.52 ,$5.63 ,$5.63 ,$5.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7189,COAGULATION FACTOR VIIA RECOMB 1 MG SOLR per1 mcg,636,1 ,$6.86 ,$4.53 ,$1.57 ,"$9,931.67 ","$9,369.50 ",$5.27 ,$3.51 ,$1.81 ,$5.49 ,$5.83 ,$4.29 ,$6.17 ,"$9,369.50 ",$6.86 ,$6.52 ,$6.17 ,$5.83 ,$5.83 ,$1.81 ,$5.83 ,$5.83 ,$6.17 ,$4.18 ,"$9,369.50 ",$4.26 ,$7.27 ,$6.17 ,$5.27 ,$6.31 ,$6.17 ,$4.53 ,$4.53 ,$4.18 ,$4.53 ,$4.46 ,$4.69 ,$1.57 ,$5.42 ,"$9,931.67 ",$3.36 ,$3.36 ,$1.81 ,$3.36 ,$2.34 ,$6.52 ,$5.63 ,$5.63 ,$5.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1410,CONJUGATED ESTROGENS 25 MG SOLR per25 mg,636,1 ,"$1,613.10 ","$1,064.65 ",$265.10 ,"$1,613.10 ",$265.10 ,$800.51 ,$533.67 ,$426.83 ,"$1,290.48 ","$1,371.14 ","$1,008.19 ","$1,451.79 ",$265.10 ,$265.10 ,"$1,532.45 ","$1,451.79 ","$1,371.14 ","$1,371.14 ",$426.83 ,"$1,371.14 ","$1,371.14 ","$1,451.79 ",$982.38 ,$265.10 ,"$1,000.12 ",$281.01 ,"$1,451.79 ",$800.51 ,"$1,484.05 ","$1,451.79 ","$1,064.81 ","$1,064.81 ",$982.38 ,"$1,064.81 ","$1,048.52 ","$1,102.07 ",$367.23 ,"$1,274.35 ",$281.01 ,$790.42 ,$790.42 ,$426.83 ,$790.42 ,$355.78 ,"$1,532.45 ","$1,322.74 ","$1,322.74 ","$1,290.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0834,COSYNTROPIN 0.25 MG SOLR 1 EACH VIAL per0.25 mg,636,1 ,$530.80 ,$350.33 ,$37.17 ,$530.80 , N/A ,$55.76 ,$37.17 ,$140.45 ,$424.64 ,$451.18 ,$331.75 ,$477.72 , N/A , N/A ,$504.26 ,$477.72 ,$451.18 ,$451.18 ,$140.45 ,$451.18 ,$451.18 ,$477.72 ,$323.26 , N/A ,$329.10 , N/A ,$477.72 , N/A ,$488.34 ,$477.72 ,$350.38 ,$350.38 ,$323.26 ,$350.38 ,$345.02 ,$362.64 ,$120.83 ,$419.33 , N/A ,$260.09 ,$260.09 ,$140.45 ,$260.09 , N/A ,$504.26 ,$435.26 ,$435.26 ,$424.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3420,CYANOCOBALAMIN 1000 MCG/ML SOLN per1000 mcg,636,1 ,$49.00 ,$32.34 ,$2.42 ,$49.00 , N/A ,$3.62 ,$2.42 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0878,DAPTOMYCIN 500 MG SOLR per1 mg,636,1 ,$3.37 ,$2.22 ,$0.06 ,$105.15 ,$99.20 ,$0.09 ,$0.06 ,$0.89 ,$2.70 ,$2.86 ,$2.11 ,$3.03 ,$99.20 ,$3.37 ,$3.20 ,$3.03 ,$2.86 ,$2.86 ,$0.89 ,$2.86 ,$2.86 ,$3.03 ,$2.05 ,$99.20 ,$2.08 ,$3.57 ,$3.03 , N/A ,$3.10 ,$3.03 ,$2.22 ,$2.22 ,$2.05 ,$2.22 ,$2.19 ,$2.30 ,$0.77 ,$2.66 ,$105.15 ,$1.65 ,$1.65 ,$0.89 ,$1.65 , N/A ,$3.20 ,$2.76 ,$2.76 ,$2.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0881,DARBEPOETIN ALFA-POLYSORBATE 40 MCG/0.4ML SOSY per1 mcg,636,1 ,$29.26 ,$19.31 ,$3.09 ,"$1,009.67 ",$952.52 ,$6.95 ,$4.64 ,$7.74 ,$23.41 ,$24.87 ,$18.29 ,$26.33 ,$952.52 ,$29.26 ,$27.80 ,$26.33 ,$24.87 ,$24.87 ,$7.74 ,$24.87 ,$24.87 ,$26.33 ,$17.82 ,$952.52 ,$18.14 ,$31.02 ,$26.33 ,$6.95 ,$26.92 ,$26.33 ,$19.31 ,$19.31 ,$17.82 ,$19.31 ,$19.02 ,$19.99 ,$6.66 ,$23.12 ,"$1,009.67 ",$14.34 ,$14.34 ,$7.74 ,$14.34 ,$3.09 ,$27.80 ,$23.99 ,$23.99 ,$23.41 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0897,DENOSUMAB 60 MG/ML SOSY per1 mg,636,1 ,$72.38 ,$47.77 ,$16.48 ,"$1,856.40 ","$1,751.32 ",$51.80 ,$34.53 ,$19.15 ,$57.90 ,$61.52 ,$45.24 ,$65.14 ,"$1,751.32 ",$72.38 ,$68.76 ,$65.14 ,$61.52 ,$61.52 ,$19.15 ,$61.52 ,$61.52 ,$65.14 ,$44.08 ,"$1,751.32 ",$44.88 ,$76.72 ,$65.14 ,$51.79 ,$66.59 ,$65.14 ,$47.78 ,$47.78 ,$44.08 ,$47.78 ,$47.05 ,$49.45 ,$16.48 ,$57.18 ,"$1,856.40 ",$35.47 ,$35.47 ,$19.15 ,$35.47 ,$23.02 ,$68.76 ,$59.35 ,$59.35 ,$57.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2597,DESMOPRESSIN 4 MCG/ML SOLN 1 ML AMPULE per1 mcg,636,1 ,$148.92 ,$98.29 ,$7.08 ,$281.01 ,$265.10 ,$15.93 ,$10.62 ,$39.41 ,$119.14 ,$126.58 ,$93.08 ,$134.03 ,$265.10 ,$148.92 ,$141.47 ,$134.03 ,$126.58 ,$126.58 ,$39.41 ,$126.58 ,$126.58 ,$134.03 ,$90.69 ,$265.10 ,$92.34 ,$157.86 ,$134.03 ,$15.92 ,$137.01 ,$134.03 ,$98.30 ,$98.30 ,$90.69 ,$98.30 ,$96.80 ,$101.74 ,$33.90 ,$117.65 ,$281.01 ,$72.97 ,$72.97 ,$39.41 ,$72.97 ,$7.08 ,$141.47 ,$122.11 ,$122.11 ,$119.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J8540,DEXAMETHASONE 0.5 MG TABS per0.25 mg,636,1 ,$1.33 ,$0.88 ,$0.17 ,$1.33 , N/A ,$0.25 ,$0.17 ,$0.35 ,$1.06 ,$1.13 ,$0.83 ,$1.20 , N/A , N/A ,$1.26 ,$1.20 ,$1.13 ,$1.13 ,$0.35 ,$1.13 ,$1.13 ,$1.20 ,$0.81 , N/A ,$0.82 , N/A ,$1.20 , N/A ,$1.22 ,$1.20 ,$0.88 ,$0.88 ,$0.81 ,$0.88 ,$0.86 ,$0.91 ,$0.30 ,$1.05 , N/A ,$0.65 ,$0.65 ,$0.35 ,$0.65 , N/A ,$1.26 ,$1.09 ,$1.09 ,$1.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J8540,DEXAMETHASONE 0.5 MG/5ML SOLN per0.25 mg,636,1 ,$4.00 ,$2.64 ,$0.17 ,$4.00 , N/A ,$0.25 ,$0.17 ,$1.06 ,$3.20 ,$3.40 ,$2.50 ,$3.60 , N/A , N/A ,$3.80 ,$3.60 ,$3.40 ,$3.40 ,$1.06 ,$3.40 ,$3.40 ,$3.60 ,$2.44 , N/A ,$2.48 , N/A ,$3.60 , N/A ,$3.68 ,$3.60 ,$2.64 ,$2.64 ,$2.44 ,$2.64 ,$2.60 ,$2.73 ,$0.91 ,$3.16 , N/A ,$1.96 ,$1.96 ,$1.06 ,$1.96 , N/A ,$3.80 ,$3.28 ,$3.28 ,$3.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1100,DEXAMETHASONE 10 MG/ML SOLN per1 mg,636,1 ,$4.90 ,$3.23 ,$0.20 ,$4.90 , N/A ,$0.29 ,$0.20 ,$1.29 ,$3.92 ,$4.17 ,$3.06 ,$4.41 , N/A , N/A ,$4.66 ,$4.41 ,$4.17 ,$4.17 ,$1.29 ,$4.17 ,$4.17 ,$4.41 ,$2.98 , N/A ,$3.04 , N/A ,$4.41 , N/A ,$4.51 ,$4.41 ,$3.23 ,$3.23 ,$2.98 ,$3.23 ,$3.19 ,$3.35 ,$1.12 ,$3.87 , N/A ,$2.40 ,$2.40 ,$1.29 ,$2.40 , N/A ,$4.66 ,$4.02 ,$4.02 ,$3.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J8540,DEXAMETHASONE 2 MG TABS per0.25 mg,636,1 ,$0.50 ,$0.33 ,$0.12 ,$0.50 , N/A ,$0.25 ,$0.17 ,$0.14 ,$0.40 ,$0.43 ,$0.31 ,$0.45 , N/A , N/A ,$0.48 ,$0.45 ,$0.43 ,$0.43 ,$0.14 ,$0.43 ,$0.43 ,$0.45 ,$0.30 , N/A ,$0.32 , N/A ,$0.45 , N/A ,$0.46 ,$0.45 ,$0.33 ,$0.33 ,$0.30 ,$0.33 ,$0.33 ,$0.34 ,$0.12 ,$0.40 , N/A ,$0.25 ,$0.25 ,$0.14 ,$0.25 , N/A ,$0.48 ,$0.41 ,$0.41 ,$0.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1100,DEXAMETHASONE 20 MG/5ML SOLN 5 ML VIAL per1 mg,636,1 ,$6.13 ,$4.05 ,$0.20 ,$6.13 , N/A ,$0.29 ,$0.20 ,$1.63 ,$4.90 ,$5.21 ,$3.83 ,$5.52 , N/A , N/A ,$5.82 ,$5.52 ,$5.21 ,$5.21 ,$1.63 ,$5.21 ,$5.21 ,$5.52 ,$3.73 , N/A ,$3.80 , N/A ,$5.52 , N/A ,$5.64 ,$5.52 ,$4.05 ,$4.05 ,$3.73 ,$4.05 ,$3.98 ,$4.19 ,$1.39 ,$4.84 , N/A ,$3.00 ,$3.00 ,$1.63 ,$3.00 , N/A ,$5.82 ,$5.03 ,$5.03 ,$4.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1100,DEXAMETHASONE 20 MG/5ML SOLN per1 mg,636,1 ,$5.44 ,$3.59 ,$0.20 ,$5.44 , N/A ,$0.29 ,$0.20 ,$1.44 ,$4.35 ,$4.62 ,$3.40 ,$4.90 , N/A , N/A ,$5.17 ,$4.90 ,$4.62 ,$4.62 ,$1.44 ,$4.62 ,$4.62 ,$4.90 ,$3.31 , N/A ,$3.38 , N/A ,$4.90 , N/A ,$5.00 ,$4.90 ,$3.59 ,$3.59 ,$3.31 ,$3.59 ,$3.54 ,$3.72 ,$1.23 ,$4.30 , N/A ,$2.67 ,$2.67 ,$1.44 ,$2.67 , N/A ,$5.17 ,$4.46 ,$4.46 ,$4.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J8540,DEXAMETHASONE 4 MG TABS per0.25 mg,636,1 ,$0.25 ,$0.17 ,$0.06 ,$0.25 , N/A ,$0.25 ,$0.17 ,$0.07 ,$0.20 ,$0.21 ,$0.16 ,$0.23 , N/A , N/A ,$0.24 ,$0.23 ,$0.21 ,$0.21 ,$0.07 ,$0.21 ,$0.21 ,$0.23 ,$0.15 , N/A ,$0.16 , N/A ,$0.23 , N/A ,$0.23 ,$0.23 ,$0.17 ,$0.17 ,$0.15 ,$0.17 ,$0.16 ,$0.17 ,$0.06 ,$0.20 , N/A ,$0.12 ,$0.12 ,$0.07 ,$0.12 , N/A ,$0.24 ,$0.21 ,$0.21 ,$0.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1100,DEXAMETHASONE 4 MG/ML SOLN per1 mg,636,1 ,$12.25 ,$8.09 ,$0.20 ,$12.25 , N/A ,$0.29 ,$0.20 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1100,DEXAMETHASONE 4 MG/ML SOLN 1 ML VIAL per1 mg,636,1 ,$12.25 ,$8.09 ,$0.20 ,$12.25 , N/A ,$0.29 ,$0.20 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1100,DEXAMETHASONE PF 10 MG/ML SOLN per1 mg,636,1 ,$5.06 ,$3.34 ,$0.20 ,$5.06 , N/A ,$0.29 ,$0.20 ,$1.34 ,$4.05 ,$4.30 ,$3.16 ,$4.55 , N/A , N/A ,$4.81 ,$4.55 ,$4.30 ,$4.30 ,$1.34 ,$4.30 ,$4.30 ,$4.55 ,$3.08 , N/A ,$3.14 , N/A ,$4.55 , N/A ,$4.66 ,$4.55 ,$3.34 ,$3.34 ,$3.08 ,$3.34 ,$3.29 ,$3.46 ,$1.15 ,$4.00 , N/A ,$2.48 ,$2.48 ,$1.34 ,$2.48 , N/A ,$4.81 ,$4.15 ,$4.15 ,$4.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,DEXTROSE 5 % AND 0.45 % NACL WITH KCL 10 MEQ 10-5-0.45 MEQ/L-%-% SOLN per2 mEq,636,1 ,$21.20 ,$13.99 ,$0.17 ,$21.20 , N/A ,$0.25 ,$0.17 ,$5.61 ,$16.96 ,$18.02 ,$13.25 ,$19.08 , N/A , N/A ,$20.14 ,$19.08 ,$18.02 ,$18.02 ,$5.61 ,$18.02 ,$18.02 ,$19.08 ,$12.91 , N/A ,$13.14 , N/A ,$19.08 , N/A ,$19.50 ,$19.08 ,$13.99 ,$13.99 ,$12.91 ,$13.99 ,$13.78 ,$14.48 ,$4.83 ,$16.75 , N/A ,$10.39 ,$10.39 ,$5.61 ,$10.39 , N/A ,$20.14 ,$17.38 ,$17.38 ,$16.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,DEXTROSE 5 % AND 0.9 % NACL WITH KCL 20 MEQ 20-5-0.9 MEQ/L-%-% SOLN per2 mEq,636,1 ,$10.60 ,$7.00 ,$0.17 ,$10.60 , N/A ,$0.25 ,$0.17 ,$2.80 ,$8.48 ,$9.01 ,$6.63 ,$9.54 , N/A , N/A ,$10.07 ,$9.54 ,$9.01 ,$9.01 ,$2.80 ,$9.01 ,$9.01 ,$9.54 ,$6.46 , N/A ,$6.58 , N/A ,$9.54 , N/A ,$9.75 ,$9.54 ,$7.00 ,$7.00 ,$6.46 ,$7.00 ,$6.89 ,$7.24 ,$2.41 ,$8.37 , N/A ,$5.19 ,$5.19 ,$2.80 ,$5.19 , N/A ,$10.07 ,$8.69 ,$8.69 ,$8.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,0.45 % NACL WITH KCL 20 MEQ 20-0.45 MEQ/L-% SOLN per2 mEq,636,1 ,$10.60 ,$7.00 ,$0.17 ,$10.60 , N/A ,$0.25 ,$0.17 ,$2.80 ,$8.48 ,$9.01 ,$6.63 ,$9.54 , N/A , N/A ,$10.07 ,$9.54 ,$9.01 ,$9.01 ,$2.80 ,$9.01 ,$9.01 ,$9.54 ,$6.46 , N/A ,$6.58 , N/A ,$9.54 , N/A ,$9.75 ,$9.54 ,$7.00 ,$7.00 ,$6.46 ,$7.00 ,$6.89 ,$7.24 ,$2.41 ,$8.37 , N/A ,$5.19 ,$5.19 ,$2.80 ,$5.19 , N/A ,$10.07 ,$8.69 ,$8.69 ,$8.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,"0.9 % NACL WITH KCL 20 MEQ 20-0.9 MEQ/L-% SOLN 1,000 ML FLEX CONT per2 mEq",636,1 ,$10.60 ,$7.00 ,$0.17 ,$10.60 , N/A ,$0.25 ,$0.17 ,$2.80 ,$8.48 ,$9.01 ,$6.63 ,$9.54 , N/A , N/A ,$10.07 ,$9.54 ,$9.01 ,$9.01 ,$2.80 ,$9.01 ,$9.01 ,$9.54 ,$6.46 , N/A ,$6.58 , N/A ,$9.54 , N/A ,$9.75 ,$9.54 ,$7.00 ,$7.00 ,$6.46 ,$7.00 ,$6.89 ,$7.24 ,$2.41 ,$8.37 , N/A ,$5.19 ,$5.19 ,$2.80 ,$5.19 , N/A ,$10.07 ,$8.69 ,$8.69 ,$8.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,0.9 % NACL WITH KCL 20 MEQ 20-0.9 MEQ/L-% SOLN per2 mEq,636,1 ,$10.60 ,$7.00 ,$0.17 ,$10.60 , N/A ,$0.25 ,$0.17 ,$2.80 ,$8.48 ,$9.01 ,$6.63 ,$9.54 , N/A , N/A ,$10.07 ,$9.54 ,$9.01 ,$9.01 ,$2.80 ,$9.01 ,$9.01 ,$9.54 ,$6.46 , N/A ,$6.58 , N/A ,$9.54 , N/A ,$9.75 ,$9.54 ,$7.00 ,$7.00 ,$6.46 ,$7.00 ,$6.89 ,$7.24 ,$2.41 ,$8.37 , N/A ,$5.19 ,$5.19 ,$2.80 ,$5.19 , N/A ,$10.07 ,$8.69 ,$8.69 ,$8.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,DEXTROSE 5 % AND 0.45 % NACL WITH KCL 20 MEQ 20-5-0.45 MEQ/L-%-% SOLN per2 mEq,636,1 ,$10.60 ,$7.00 ,$0.17 ,$10.60 , N/A ,$0.25 ,$0.17 ,$2.80 ,$8.48 ,$9.01 ,$6.63 ,$9.54 , N/A , N/A ,$10.07 ,$9.54 ,$9.01 ,$9.01 ,$2.80 ,$9.01 ,$9.01 ,$9.54 ,$6.46 , N/A ,$6.58 , N/A ,$9.54 , N/A ,$9.75 ,$9.54 ,$7.00 ,$7.00 ,$6.46 ,$7.00 ,$6.89 ,$7.24 ,$2.41 ,$8.37 , N/A ,$5.19 ,$5.19 ,$2.80 ,$5.19 , N/A ,$10.07 ,$8.69 ,$8.69 ,$8.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,DEXTROSE 5 % AND 0.9 % NACL WITH KCL 40 MEQ 40-5-0.9 MEQ/L-%-% SOLN per2 mEq,636,1 ,$5.30 ,$3.50 ,$0.17 ,$5.30 , N/A ,$0.25 ,$0.17 ,$1.40 ,$4.24 ,$4.51 ,$3.31 ,$4.77 , N/A , N/A ,$5.04 ,$4.77 ,$4.51 ,$4.51 ,$1.40 ,$4.51 ,$4.51 ,$4.77 ,$3.23 , N/A ,$3.28 , N/A ,$4.77 , N/A ,$4.88 ,$4.77 ,$3.50 ,$3.50 ,$3.23 ,$3.50 ,$3.45 ,$3.62 ,$1.21 ,$4.19 , N/A ,$2.60 ,$2.60 ,$1.40 ,$2.60 , N/A ,$5.04 ,$4.35 ,$4.35 ,$4.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,"0.9 % NACL WITH KCL 40 MEQ 40-0.9 MEQ/L-% SOLN 1,000 ML FLEX CONT per2 mEq",636,1 ,$5.30 ,$3.50 ,$0.17 ,$5.30 , N/A ,$0.25 ,$0.17 ,$1.40 ,$4.24 ,$4.51 ,$3.31 ,$4.77 , N/A , N/A ,$5.04 ,$4.77 ,$4.51 ,$4.51 ,$1.40 ,$4.51 ,$4.51 ,$4.77 ,$3.23 , N/A ,$3.28 , N/A ,$4.77 , N/A ,$4.88 ,$4.77 ,$3.50 ,$3.50 ,$3.23 ,$3.50 ,$3.45 ,$3.62 ,$1.21 ,$4.19 , N/A ,$2.60 ,$2.60 ,$1.40 ,$2.60 , N/A ,$5.04 ,$4.35 ,$4.35 ,$4.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,DEXTROSE 5 % AND 0.45 % NACL WITH KCL 40 MEQ 40-5-0.45 MEQ/L-%-% SOLN per2 mEq,636,1 ,$5.30 ,$3.50 ,$0.17 ,$5.30 , N/A ,$0.25 ,$0.17 ,$1.40 ,$4.24 ,$4.51 ,$3.31 ,$4.77 , N/A , N/A ,$5.04 ,$4.77 ,$4.51 ,$4.51 ,$1.40 ,$4.51 ,$4.51 ,$4.77 ,$3.23 , N/A ,$3.28 , N/A ,$4.77 , N/A ,$4.88 ,$4.77 ,$3.50 ,$3.50 ,$3.23 ,$3.50 ,$3.45 ,$3.62 ,$1.21 ,$4.19 , N/A ,$2.60 ,$2.60 ,$1.40 ,$2.60 , N/A ,$5.04 ,$4.35 ,$4.35 ,$4.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7042,DEXTROSE 5 %-SODIUM CHLORIDE 0.9 % 5-0.9 % SOLN per500 mL,636,1 ,$53.00 ,$34.98 ,$1.88 ,$53.00 , N/A ,$2.81 ,$1.88 ,$14.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A ,$25.97 ,$25.97 ,$14.02 ,$25.97 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7042,"DEXTROSE 5 %-SODIUM CHLORIDE 0.9 % 5-0.9 % SOLN 1,000 ML FLEX CONT per500 mL",636,1 ,$53.00 ,$34.98 ,$1.88 ,$53.00 , N/A ,$2.81 ,$1.88 ,$14.02 ,$42.40 ,$45.05 ,$33.13 ,$47.70 , N/A , N/A ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$14.02 ,$45.05 ,$45.05 ,$47.70 ,$32.28 , N/A ,$32.86 , N/A ,$47.70 , N/A ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$12.06 ,$41.87 , N/A ,$25.97 ,$25.97 ,$14.02 ,$25.97 , N/A ,$50.35 ,$43.46 ,$43.46 ,$42.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7121,DEXTROSE 5% LACTATED RINGERS 5 % SOLN per1000 mL,636,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7121,"DEXTROSE 5% LACTATED RINGERS 5 % SOLN 1,000 ML FLEX CONT per1000 mL",636,1 ,$106.00 ,$69.96 ,$24.13 ,$106.00 , N/A ,$95.00 ,$95.00 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3360,DIAZEPAM 5 MG/ML SOLN per5 mg,636,1 ,$102.65 ,$67.75 ,$10.68 ,$102.65 , N/A ,$16.02 ,$10.68 ,$27.17 ,$82.12 ,$87.25 ,$64.16 ,$92.39 , N/A , N/A ,$97.52 ,$92.39 ,$87.25 ,$87.25 ,$27.17 ,$87.25 ,$87.25 ,$92.39 ,$62.51 , N/A ,$63.64 , N/A ,$92.39 , N/A ,$94.44 ,$92.39 ,$67.76 ,$67.76 ,$62.51 ,$67.76 ,$66.72 ,$70.13 ,$23.37 ,$81.09 , N/A ,$50.30 ,$50.30 ,$27.17 ,$50.30 , N/A ,$97.52 ,$84.17 ,$84.17 ,$82.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0500,DICYCLOMINE 10 MG/ML SOLN per20 mg,636,1 ,$620.40 ,$409.46 ,$34.16 ,$620.40 , N/A ,$51.23 ,$34.16 ,$164.16 ,$496.32 ,$527.34 ,$387.75 ,$558.36 , N/A , N/A ,$589.38 ,$558.36 ,$527.34 ,$527.34 ,$164.16 ,$527.34 ,$527.34 ,$558.36 ,$377.82 , N/A ,$384.64 , N/A ,$558.36 , N/A ,$570.77 ,$558.36 ,$409.53 ,$409.53 ,$377.82 ,$409.53 ,$403.26 ,$423.86 ,$141.24 ,$490.12 , N/A ,$304.00 ,$304.00 ,$164.16 ,$304.00 , N/A ,$589.38 ,$508.73 ,$508.73 ,$496.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1160,DIGOXIN 0.25 MG/ML SOLN per0.5 mg,636,1 ,$49.00 ,$32.34 ,$11.04 ,$49.00 , N/A ,$16.56 ,$11.04 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1162,DIGOXIN IMMUNE FAB 40 MG SOLR 1 EACH VIAL per1 vial,636,1 ,"$15,622.75 ","$10,311.02 ","$3,556.58 ","$15,622.75 ","$9,369.50 ","$10,335.53 ","$6,890.36 ","$4,133.78 ","$12,498.20 ","$13,279.34 ","$9,764.22 ","$14,060.48 ","$9,369.50 ","$9,369.50 ","$14,841.61 ","$14,060.48 ","$13,279.34 ","$13,279.34 ","$4,133.78 ","$13,279.34 ","$13,279.34 ","$14,060.48 ","$9,514.25 ","$9,369.50 ","$9,686.10 ","$9,931.67 ","$14,060.48 ","$10,335.54 ","$14,372.93 ","$14,060.48 ","$10,312.58 ","$10,312.58 ","$9,514.25 ","$10,312.58 ","$10,154.79 ","$10,673.46 ","$3,556.58 ","$12,341.97 ","$9,931.67 ","$7,655.15 ","$7,655.15 ","$4,133.78 ","$7,655.15 ","$4,593.57 ","$14,841.61 ","$12,810.66 ","$12,810.66 ","$12,498.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1110,DIHYDROERGOTAMINE 1 MG/ML SOLN per1 mg,636,1 ,$744.55 ,$491.40 ,$86.70 ,$744.55 , N/A ,$130.05 ,$86.70 ,$197.01 ,$595.64 ,$632.87 ,$465.34 ,$670.10 , N/A , N/A ,$707.32 ,$670.10 ,$632.87 ,$632.87 ,$197.01 ,$632.87 ,$632.87 ,$670.10 ,$453.43 , N/A ,$461.62 , N/A ,$670.10 , N/A ,$684.99 ,$670.10 ,$491.48 ,$491.48 ,$453.43 ,$491.48 ,$483.96 ,$508.68 ,$169.50 ,$588.19 , N/A ,$364.83 ,$364.83 ,$197.01 ,$364.83 , N/A ,$707.32 ,$610.53 ,$610.53 ,$595.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1200,DIPHENHYDRAMINE 50 MG/ML SOLN per50 mg,636,1 ,$49.00 ,$32.34 ,$1.70 ,$49.00 , N/A ,$2.54 ,$1.70 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1250,DOBUTAMINE 1 MG/ML SOLN per250 mg,636,1 ,$196.95 ,$129.99 ,$9.80 ,$196.95 , N/A ,$14.69 ,$9.80 ,$52.12 ,$157.56 ,$167.41 ,$123.09 ,$177.26 , N/A , N/A ,$187.10 ,$177.26 ,$167.41 ,$167.41 ,$52.12 ,$167.41 ,$167.41 ,$177.26 ,$119.94 , N/A ,$122.10 , N/A ,$177.26 , N/A ,$181.19 ,$177.26 ,$130.01 ,$130.01 ,$119.94 ,$130.01 ,$128.02 ,$134.56 ,$44.83 ,$155.59 , N/A ,$96.51 ,$96.51 ,$52.12 ,$96.51 , N/A ,$187.10 ,$161.50 ,$161.50 ,$157.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1265,DOPAMINE 1.6-5 MG/ML-% SOLN per40 mg,636,1 ,$13.55 ,$8.94 ,$1.01 ,$13.55 , N/A ,$1.51 ,$1.01 ,$3.59 ,$10.84 ,$11.52 ,$8.47 ,$12.20 , N/A , N/A ,$12.87 ,$12.20 ,$11.52 ,$11.52 ,$3.59 ,$11.52 ,$11.52 ,$12.20 ,$8.25 , N/A ,$8.40 , N/A ,$12.20 , N/A ,$12.47 ,$12.20 ,$8.94 ,$8.94 ,$8.25 ,$8.94 ,$8.81 ,$9.26 ,$3.09 ,$10.70 , N/A ,$6.64 ,$6.64 ,$3.59 ,$6.64 , N/A ,$12.87 ,$11.11 ,$11.11 ,$10.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1265,DOPAMINE 40 MG/ML SOLN 10 ML VIAL per40 mg,636,1 ,$4.90 ,$3.23 ,$1.01 ,$4.90 , N/A ,$1.51 ,$1.01 ,$1.29 ,$3.92 ,$4.17 ,$3.06 ,$4.41 , N/A , N/A ,$4.66 ,$4.41 ,$4.17 ,$4.17 ,$1.29 ,$4.17 ,$4.17 ,$4.41 ,$2.98 , N/A ,$3.04 , N/A ,$4.41 , N/A ,$4.51 ,$4.41 ,$3.23 ,$3.23 ,$2.98 ,$3.23 ,$3.19 ,$3.35 ,$1.12 ,$3.87 , N/A ,$2.40 ,$2.40 ,$1.29 ,$2.40 , N/A ,$4.66 ,$4.02 ,$4.02 ,$3.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1790,DROPERIDOL 2.5 MG/ML SOLN per5 mg,636,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1322,ELOSULFASE ALFA 5 MG/5ML SOLN 5 ML VIAL per1 mg,636,1 ,"$1,035.50 ",$683.43 ,$235.74 ,"$15,846.23 ","$14,949.27 ",$591.10 ,$394.07 ,$274.00 ,$828.40 ,$880.18 ,$647.19 ,$931.95 ,"$14,949.27 ","$1,035.50 ",$983.73 ,$931.95 ,$880.18 ,$880.18 ,$274.00 ,$880.18 ,$880.18 ,$931.95 ,$630.62 ,"$14,949.27 ",$642.02 ,"$1,097.63 ",$931.95 ,$591.10 ,$952.66 ,$931.95 ,$683.53 ,$683.53 ,$630.62 ,$683.53 ,$673.08 ,$707.45 ,$235.74 ,$818.05 ,"$15,846.23 ",$507.40 ,$507.40 ,$274.00 ,$507.40 ,$262.71 ,$983.73 ,$849.11 ,$849.11 ,$828.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7170,EMICIZUMAB-KXWH 60 MG/0.4ML SOLN per0.5 mg,636,1 ,$154.74 ,$102.13 ,$35.23 ,"$47,849.05 ","$45,140.61 ",$112.39 ,$74.93 ,$40.94 ,$123.79 ,$131.53 ,$96.71 ,$139.27 ,"$45,140.61 ",$154.74 ,$147.00 ,$139.27 ,$131.53 ,$131.53 ,$40.94 ,$131.53 ,$131.53 ,$139.27 ,$94.24 ,"$45,140.61 ",$95.94 ,$164.02 ,$139.27 ,$112.38 ,$142.36 ,$139.27 ,$102.14 ,$102.14 ,$94.24 ,$102.14 ,$100.58 ,$105.72 ,$35.23 ,$122.24 ,"$47,849.05 ",$75.82 ,$75.82 ,$40.94 ,$75.82 ,$49.95 ,$147.00 ,$126.89 ,$126.89 ,$123.79 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 100 MG/ML SOLN 1 ML SYRINGE per10 mg,636,1 ,$14.68 ,$9.69 ,$1.14 ,$14.68 , N/A ,$1.71 ,$1.14 ,$3.88 ,$11.74 ,$12.48 ,$9.18 ,$13.21 , N/A , N/A ,$13.95 ,$13.21 ,$12.48 ,$12.48 ,$3.88 ,$12.48 ,$12.48 ,$13.21 ,$8.94 , N/A ,$9.10 , N/A ,$13.21 , N/A ,$13.51 ,$13.21 ,$9.69 ,$9.69 ,$8.94 ,$9.69 ,$9.54 ,$10.03 ,$3.34 ,$11.60 , N/A ,$7.19 ,$7.19 ,$3.88 ,$7.19 , N/A ,$13.95 ,$12.04 ,$12.04 ,$11.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 100 MG/ML SOSY per10 mg,636,1 ,$11.54 ,$7.62 ,$1.14 ,$11.54 , N/A ,$1.71 ,$1.14 ,$3.06 ,$9.23 ,$9.81 ,$7.21 ,$10.39 , N/A , N/A ,$10.96 ,$10.39 ,$9.81 ,$9.81 ,$3.06 ,$9.81 ,$9.81 ,$10.39 ,$7.03 , N/A ,$7.16 , N/A ,$10.39 , N/A ,$10.62 ,$10.39 ,$7.62 ,$7.62 ,$7.03 ,$7.62 ,$7.50 ,$7.88 ,$2.63 ,$9.12 , N/A ,$5.65 ,$5.65 ,$3.06 ,$5.65 , N/A ,$10.96 ,$9.46 ,$9.46 ,$9.23 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 120 MG/0.8ML SOSY per10 mg,636,1 ,$33.75 ,$22.28 ,$1.14 ,$33.75 , N/A ,$1.71 ,$1.14 ,$8.93 ,$27.00 ,$28.69 ,$21.09 ,$30.38 , N/A , N/A ,$32.06 ,$30.38 ,$28.69 ,$28.69 ,$8.93 ,$28.69 ,$28.69 ,$30.38 ,$20.55 , N/A ,$20.92 , N/A ,$30.38 , N/A ,$31.05 ,$30.38 ,$22.28 ,$22.28 ,$20.55 ,$22.28 ,$21.94 ,$23.06 ,$7.68 ,$26.66 , N/A ,$16.54 ,$16.54 ,$8.93 ,$16.54 , N/A ,$32.06 ,$27.68 ,$27.68 ,$27.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 150 MG/ML SOSY per10 mg,636,1 ,$11.07 ,$7.31 ,$1.14 ,$11.07 , N/A ,$1.71 ,$1.14 ,$2.93 ,$8.86 ,$9.41 ,$6.92 ,$9.96 , N/A , N/A ,$10.52 ,$9.96 ,$9.41 ,$9.41 ,$2.93 ,$9.41 ,$9.41 ,$9.96 ,$6.74 , N/A ,$6.86 , N/A ,$9.96 , N/A ,$10.18 ,$9.96 ,$7.31 ,$7.31 ,$6.74 ,$7.31 ,$7.20 ,$7.56 ,$2.53 ,$8.75 , N/A ,$5.42 ,$5.42 ,$2.93 ,$5.42 , N/A ,$10.52 ,$9.08 ,$9.08 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 100 MG/ML SOLN per10 mg,636,1 ,$11.07 ,$7.31 ,$1.14 ,$11.07 , N/A ,$1.71 ,$1.14 ,$2.93 ,$8.86 ,$9.41 ,$6.92 ,$9.96 , N/A , N/A ,$10.52 ,$9.96 ,$9.41 ,$9.41 ,$2.93 ,$9.41 ,$9.41 ,$9.96 ,$6.74 , N/A ,$6.86 , N/A ,$9.96 , N/A ,$10.18 ,$9.96 ,$7.31 ,$7.31 ,$6.74 ,$7.31 ,$7.20 ,$7.56 ,$2.53 ,$8.75 , N/A ,$5.42 ,$5.42 ,$2.93 ,$5.42 , N/A ,$10.52 ,$9.08 ,$9.08 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 100 MG/ML SOSY 1 ML SYRINGE per10 mg,636,1 ,$11.07 ,$7.31 ,$1.14 ,$11.07 , N/A ,$1.71 ,$1.14 ,$2.93 ,$8.86 ,$9.41 ,$6.92 ,$9.96 , N/A , N/A ,$10.52 ,$9.96 ,$9.41 ,$9.41 ,$2.93 ,$9.41 ,$9.41 ,$9.96 ,$6.74 , N/A ,$6.86 , N/A ,$9.96 , N/A ,$10.18 ,$9.96 ,$7.31 ,$7.31 ,$6.74 ,$7.31 ,$7.20 ,$7.56 ,$2.53 ,$8.75 , N/A ,$5.42 ,$5.42 ,$2.93 ,$5.42 , N/A ,$10.52 ,$9.08 ,$9.08 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 40 MG/0.4ML SOSY per10 mg,636,1 ,$12.25 ,$8.09 ,$1.14 ,$12.25 , N/A ,$1.71 ,$1.14 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 40 MG/0.4ML SOSY 0.4 ML SYRINGE per10 mg,636,1 ,$12.25 ,$8.09 ,$1.14 ,$12.25 , N/A ,$1.71 ,$1.14 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 60 MG/0.6ML SOSY per10 mg,636,1 ,$16.33 ,$10.78 ,$1.14 ,$16.33 , N/A ,$1.71 ,$1.14 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 30 MG/0.3ML SOLN per10 mg,636,1 ,$16.33 ,$10.78 ,$1.14 ,$16.33 , N/A ,$1.71 ,$1.14 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 30 MG/0.3ML SOSY per10 mg,636,1 ,$16.33 ,$10.78 ,$1.14 ,$16.33 , N/A ,$1.71 ,$1.14 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 40 MG/0.4ML SOLN per10 mg,636,1 ,$16.33 ,$10.78 ,$1.14 ,$16.33 , N/A ,$1.71 ,$1.14 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 80 MG/0.8ML SOLN 0.8 ML SYRINGE per10 mg,636,1 ,$11.08 ,$7.31 ,$1.14 ,$11.08 , N/A ,$1.71 ,$1.14 ,$2.93 ,$8.86 ,$9.42 ,$6.93 ,$9.97 , N/A , N/A ,$10.53 ,$9.97 ,$9.42 ,$9.42 ,$2.93 ,$9.42 ,$9.42 ,$9.97 ,$6.75 , N/A ,$6.86 , N/A ,$9.97 , N/A ,$10.19 ,$9.97 ,$7.31 ,$7.31 ,$6.75 ,$7.31 ,$7.20 ,$7.57 ,$2.53 ,$8.75 , N/A ,$5.43 ,$5.43 ,$2.93 ,$5.43 , N/A ,$10.53 ,$9.09 ,$9.09 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 60 MG/0.6ML SOSY 0.6 ML SYRINGE per10 mg,636,1 ,$11.08 ,$7.31 ,$1.14 ,$11.08 , N/A ,$1.71 ,$1.14 ,$2.93 ,$8.86 ,$9.42 ,$6.93 ,$9.97 , N/A , N/A ,$10.53 ,$9.97 ,$9.42 ,$9.42 ,$2.93 ,$9.42 ,$9.42 ,$9.97 ,$6.75 , N/A ,$6.86 , N/A ,$9.97 , N/A ,$10.19 ,$9.97 ,$7.31 ,$7.31 ,$6.75 ,$7.31 ,$7.20 ,$7.57 ,$2.53 ,$8.75 , N/A ,$5.43 ,$5.43 ,$2.93 ,$5.43 , N/A ,$10.53 ,$9.09 ,$9.09 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 80 MG/0.8 ML SOSY per10 mg,636,1 ,$11.08 ,$7.31 ,$1.14 ,$11.08 , N/A ,$1.71 ,$1.14 ,$2.93 ,$8.86 ,$9.42 ,$6.93 ,$9.97 , N/A , N/A ,$10.53 ,$9.97 ,$9.42 ,$9.42 ,$2.93 ,$9.42 ,$9.42 ,$9.97 ,$6.75 , N/A ,$6.86 , N/A ,$9.97 , N/A ,$10.19 ,$9.97 ,$7.31 ,$7.31 ,$6.75 ,$7.31 ,$7.20 ,$7.57 ,$2.53 ,$8.75 , N/A ,$5.43 ,$5.43 ,$2.93 ,$5.43 , N/A ,$10.53 ,$9.09 ,$9.09 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1650,ENOXAPARIN 80 MG/0.8ML SOLN per10 mg,636,1 ,$14.67 ,$9.68 ,$1.14 ,$14.67 , N/A ,$1.71 ,$1.14 ,$3.88 ,$11.74 ,$12.47 ,$9.17 ,$13.20 , N/A , N/A ,$13.94 ,$13.20 ,$12.47 ,$12.47 ,$3.88 ,$12.47 ,$12.47 ,$13.20 ,$8.93 , N/A ,$9.10 , N/A ,$13.20 , N/A ,$13.50 ,$13.20 ,$9.68 ,$9.68 ,$8.93 ,$9.68 ,$9.54 ,$10.02 ,$3.33 ,$11.59 , N/A ,$7.19 ,$7.19 ,$3.88 ,$7.19 , N/A ,$13.94 ,$12.03 ,$12.03 ,$11.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3490,EPHEDRINE 50 MG/ML SOLN per50 mg,636,1 ,$349.05 ,$230.37 ,$79.46 ,$349.05 , N/A ,$312.82 ,$312.82 ,$92.36 ,$279.24 ,$296.69 ,$218.16 ,$314.15 , N/A , N/A ,$331.60 ,$314.15 ,$296.69 ,$296.69 ,$92.36 ,$296.69 ,$296.69 ,$314.15 ,$212.57 , N/A ,$216.42 , N/A ,$314.15 , N/A ,$321.13 ,$314.15 ,$230.41 ,$230.41 ,$212.57 ,$230.41 ,$226.88 ,$238.47 ,$79.46 ,$275.75 , N/A ,$171.03 ,$171.03 ,$92.36 ,$171.03 , N/A ,$331.60 ,$286.22 ,$286.22 ,$279.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0171,EPINEPHRINE 1 MG/10ML SOSY per0.1 mg,636,1 ,$7.27 ,$4.80 ,$1.11 ,$7.27 , N/A ,$1.67 ,$1.11 ,$1.92 ,$5.82 ,$6.18 ,$4.54 ,$6.54 , N/A , N/A ,$6.91 ,$6.54 ,$6.18 ,$6.18 ,$1.92 ,$6.18 ,$6.18 ,$6.54 ,$4.43 , N/A ,$4.50 , N/A ,$6.54 , N/A ,$6.69 ,$6.54 ,$4.80 ,$4.80 ,$4.43 ,$4.80 ,$4.73 ,$4.97 ,$1.66 ,$5.74 , N/A ,$3.56 ,$3.56 ,$1.92 ,$3.56 , N/A ,$6.91 ,$5.96 ,$5.96 ,$5.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0171,EPINEPHRINE 30 MG/30ML SOLN 30 ML VIAL per0.1 mg,636,1 ,$16.33 ,$10.78 ,$1.11 ,$16.33 , N/A ,$1.67 ,$1.11 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0171,EPINEPHRINE 30 MG/30ML SOLN 1 ML VIAL per0.1 mg,636,1 ,$16.33 ,$10.78 ,$1.11 ,$16.33 , N/A ,$1.67 ,$1.11 ,$4.32 ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 ,$4.32 ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A ,$10.12 , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$3.72 ,$12.90 , N/A ,$8.00 ,$8.00 ,$4.32 ,$8.00 , N/A ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0171,EPINEPHRINE PF 1 MG/ML SOLN per0.1 mg,636,1 ,$10.77 ,$7.11 ,$1.11 ,$10.77 , N/A ,$1.67 ,$1.11 ,$2.85 ,$8.62 ,$9.15 ,$6.73 ,$9.69 , N/A , N/A ,$10.23 ,$9.69 ,$9.15 ,$9.15 ,$2.85 ,$9.15 ,$9.15 ,$9.69 ,$6.56 , N/A ,$6.68 , N/A ,$9.69 , N/A ,$9.91 ,$9.69 ,$7.11 ,$7.11 ,$6.56 ,$7.11 ,$7.00 ,$7.36 ,$2.45 ,$8.51 , N/A ,$5.28 ,$5.28 ,$2.85 ,$5.28 , N/A ,$10.23 ,$8.83 ,$8.83 ,$8.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0171,EPINEPHRINE 1 MG/ML SOLN 1 ML AMPULE per0.1 mg,636,1 ,$10.77 ,$7.11 ,$1.11 ,$10.77 , N/A ,$1.67 ,$1.11 ,$2.85 ,$8.62 ,$9.15 ,$6.73 ,$9.69 , N/A , N/A ,$10.23 ,$9.69 ,$9.15 ,$9.15 ,$2.85 ,$9.15 ,$9.15 ,$9.69 ,$6.56 , N/A ,$6.68 , N/A ,$9.69 , N/A ,$9.91 ,$9.69 ,$7.11 ,$7.11 ,$6.56 ,$7.11 ,$7.00 ,$7.36 ,$2.45 ,$8.51 , N/A ,$5.28 ,$5.28 ,$2.85 ,$5.28 , N/A ,$10.23 ,$8.83 ,$8.83 ,$8.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0885,EPOETIN ALFA 10000 UNIT/ML SOLN per1000 Units,636,1 ,$126.68 ,$83.61 ,$7.93 ,$281.01 ,$265.10 ,$17.84 ,$11.90 ,$33.52 ,$101.34 ,$107.68 ,$79.18 ,$114.01 ,$265.10 ,$126.68 ,$120.35 ,$114.01 ,$107.68 ,$107.68 ,$33.52 ,$107.68 ,$107.68 ,$114.01 ,$77.15 ,$265.10 ,$78.54 ,$134.28 ,$114.01 ,$17.84 ,$116.55 ,$114.01 ,$83.62 ,$83.62 ,$77.15 ,$83.62 ,$82.34 ,$86.55 ,$28.84 ,$100.08 ,$281.01 ,$62.07 ,$62.07 ,$33.52 ,$62.07 ,$7.93 ,$120.35 ,$103.88 ,$103.88 ,$101.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0885,EPOETIN ALFA 2000 UNIT/ML SOLN per1000 Units,636,1 ,$197.26 ,$130.19 ,$7.93 ,$281.01 ,$265.10 ,$17.84 ,$11.90 ,$52.19 ,$157.81 ,$167.67 ,$123.29 ,$177.53 ,$265.10 ,$197.26 ,$187.40 ,$177.53 ,$167.67 ,$167.67 ,$52.19 ,$167.67 ,$167.67 ,$177.53 ,$120.13 ,$265.10 ,$122.30 ,$209.10 ,$177.53 ,$17.84 ,$181.48 ,$177.53 ,$130.21 ,$130.21 ,$120.13 ,$130.21 ,$128.22 ,$134.77 ,$44.90 ,$155.84 ,$281.01 ,$96.66 ,$96.66 ,$52.19 ,$96.66 ,$7.93 ,$187.40 ,$161.75 ,$161.75 ,$157.81 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0885,EPOETIN ALFA 20000 UNIT/ML SOLN per1000 Units,636,1 ,$101.02 ,$66.67 ,$7.93 ,$281.01 ,$265.10 ,$17.84 ,$11.90 ,$26.73 ,$80.82 ,$85.87 ,$63.14 ,$90.92 ,$265.10 ,$101.02 ,$95.97 ,$90.92 ,$85.87 ,$85.87 ,$26.73 ,$85.87 ,$85.87 ,$90.92 ,$61.52 ,$265.10 ,$62.64 ,$107.08 ,$90.92 ,$17.84 ,$92.94 ,$90.92 ,$66.68 ,$66.68 ,$61.52 ,$66.68 ,$65.66 ,$69.02 ,$22.99 ,$79.81 ,$281.01 ,$49.50 ,$49.50 ,$26.73 ,$49.50 ,$7.93 ,$95.97 ,$82.84 ,$82.84 ,$80.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q5106,EPOETIN ALFA-EPBX 10000 UNITS/ML SOLN per1000 Units,636,1 ,$54.93 ,$36.25 ,$8.51 ,$528.18 ,$498.28 ,$19.15 ,$12.77 ,$14.53 ,$43.94 ,$46.69 ,$34.33 ,$49.44 ,$498.28 ,$54.93 ,$52.18 ,$49.44 ,$46.69 ,$46.69 ,$14.53 ,$46.69 ,$46.69 ,$49.44 ,$33.45 ,$498.28 ,$34.06 ,$58.23 ,$49.44 ,$19.16 ,$50.54 ,$49.44 ,$36.26 ,$36.26 ,$33.45 ,$36.26 ,$35.70 ,$37.53 ,$12.50 ,$43.39 ,$528.18 ,$26.92 ,$26.92 ,$14.53 ,$26.92 ,$8.51 ,$52.18 ,$45.04 ,$45.04 ,$43.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q5106,EPOETIN ALFA-EPBX 4000 UNIT/ML SOLN per1000 Units,636,1 ,$81.40 ,$53.72 ,$8.51 ,$528.18 ,$498.28 ,$19.15 ,$12.77 ,$21.54 ,$65.12 ,$69.19 ,$50.88 ,$73.26 ,$498.28 ,$81.40 ,$77.33 ,$73.26 ,$69.19 ,$69.19 ,$21.54 ,$69.19 ,$69.19 ,$73.26 ,$49.57 ,$498.28 ,$50.46 ,$86.28 ,$73.26 ,$19.16 ,$74.89 ,$73.26 ,$53.73 ,$53.73 ,$49.57 ,$53.73 ,$52.91 ,$55.61 ,$18.53 ,$64.31 ,$528.18 ,$39.89 ,$39.89 ,$21.54 ,$39.89 ,$8.51 ,$77.33 ,$66.75 ,$66.75 ,$65.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1327,EPTIFIBATIDE 20 MG/10ML SOLN per5 mg,636,1 ,$290.59 ,$191.79 ,$6.77 ,$290.59 ,$121.00 ,$10.15 ,$6.77 ,$76.89 ,$232.47 ,$247.00 ,$181.62 ,$261.53 ,$121.00 ,$121.00 ,$276.06 ,$261.53 ,$247.00 ,$247.00 ,$76.89 ,$247.00 ,$247.00 ,$261.53 ,$176.97 ,$121.00 ,$180.16 ,$128.26 ,$261.53 , N/A ,$267.34 ,$261.53 ,$191.82 ,$191.82 ,$176.97 ,$191.82 ,$188.88 ,$198.53 ,$66.16 ,$229.57 ,$128.26 ,$142.39 ,$142.39 ,$76.89 ,$142.39 , N/A ,$276.06 ,$238.28 ,$238.28 ,$232.47 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1327,EPTIFIBATIDE 200 MG/100ML SOLN per5 mg,636,1 ,$112.13 ,$74.01 ,$6.77 ,$128.26 ,$121.00 ,$10.15 ,$6.77 ,$29.67 ,$89.70 ,$95.31 ,$70.08 ,$100.92 ,$121.00 ,$112.13 ,$106.52 ,$100.92 ,$95.31 ,$95.31 ,$29.67 ,$95.31 ,$95.31 ,$100.92 ,$68.29 ,$121.00 ,$69.52 ,$118.86 ,$100.92 , N/A ,$103.16 ,$100.92 ,$74.02 ,$74.02 ,$68.29 ,$74.02 ,$72.88 ,$76.61 ,$25.53 ,$88.58 ,$128.26 ,$54.94 ,$54.94 ,$29.67 ,$54.94 , N/A ,$106.52 ,$91.95 ,$91.95 ,$89.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1335,ERTAPENEM 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$320.38 ,$211.45 ,$19.25 ,$320.38 , N/A ,$28.87 ,$19.25 ,$84.77 ,$256.30 ,$272.32 ,$200.24 ,$288.34 , N/A , N/A ,$304.36 ,$288.34 ,$272.32 ,$272.32 ,$84.77 ,$272.32 ,$272.32 ,$288.34 ,$195.11 , N/A ,$198.64 , N/A ,$288.34 , N/A ,$294.75 ,$288.34 ,$211.48 ,$211.48 ,$195.11 ,$211.48 ,$208.25 ,$218.88 ,$72.94 ,$253.10 , N/A ,$156.99 ,$156.99 ,$84.77 ,$156.99 , N/A ,$304.36 ,$262.71 ,$262.71 ,$256.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1364,ERYTHROMYCIN 500 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$61.00 ,$40.26 ,$13.89 ,$192.46 , N/A ,$61.00 ,$61.00 ,$16.14 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$16.14 ,$51.85 ,$51.85 ,$54.90 ,$37.15 , N/A ,$37.82 , N/A ,$54.90 ,$192.46 ,$56.12 ,$54.90 ,$40.27 ,$40.27 ,$37.15 ,$40.27 ,$39.65 ,$41.68 ,$13.89 ,$48.19 , N/A ,$29.89 ,$29.89 ,$16.14 ,$29.89 ,$85.54 ,$57.95 ,$50.02 ,$50.02 ,$48.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 1000 MCG/20ML SOLN per0.1 mg,636,1 ,$4.74 ,$3.13 ,$1.08 ,$4.74 , N/A ,$2.21 ,$1.47 ,$1.25 ,$3.79 ,$4.03 ,$2.96 ,$4.27 , N/A , N/A ,$4.50 ,$4.27 ,$4.03 ,$4.03 ,$1.25 ,$4.03 ,$4.03 ,$4.27 ,$2.89 , N/A ,$2.94 , N/A ,$4.27 , N/A ,$4.36 ,$4.27 ,$3.13 ,$3.13 ,$2.89 ,$3.13 ,$3.08 ,$3.24 ,$1.08 ,$3.74 , N/A ,$2.32 ,$2.32 ,$1.25 ,$2.32 , N/A ,$4.50 ,$3.89 ,$3.89 ,$3.79 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 2500 MCG/50ML SOLN per0.1 mg,636,1 ,$24.50 ,$16.17 ,$1.47 ,$24.50 , N/A ,$2.21 ,$1.47 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 50 MCG/ML SOLN per0.1 mg,636,1 ,$49.00 ,$32.34 ,$1.47 ,$49.00 , N/A ,$2.21 ,$1.47 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 100 MCG/2ML SOLN 2 ML AMPULE per0.1 mg,636,1 ,$49.00 ,$32.34 ,$1.47 ,$49.00 , N/A ,$2.21 ,$1.47 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 100 MCG/2ML SOLN per0.1 mg,636,1 ,$49.00 ,$32.34 ,$1.47 ,$49.00 , N/A ,$2.21 ,$1.47 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 250 MCG/5ML SOLN per0.1 mg,636,1 ,$49.00 ,$32.34 ,$1.47 ,$49.00 , N/A ,$2.21 ,$1.47 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3010,FENTANYL 50 MCG/ML SOSY per0.1 mg,636,1 ,$17.81 ,$11.75 ,$1.47 ,$17.81 , N/A ,$2.21 ,$1.47 ,$4.71 ,$14.25 ,$15.14 ,$11.13 ,$16.03 , N/A , N/A ,$16.92 ,$16.03 ,$15.14 ,$15.14 ,$4.71 ,$15.14 ,$15.14 ,$16.03 ,$10.85 , N/A ,$11.04 , N/A ,$16.03 , N/A ,$16.39 ,$16.03 ,$11.76 ,$11.76 ,$10.85 ,$11.76 ,$11.58 ,$12.17 ,$4.06 ,$14.07 , N/A ,$8.73 ,$8.73 ,$4.71 ,$8.73 , N/A ,$16.92 ,$14.60 ,$14.60 ,$14.25 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1439,FERRIC CARBOXYMALTOSE 750 MG/15ML SOLN 15 ML VIAL per1 mg,636,1 ,$8.52 ,$5.62 ,$1.13 ,"$1,009.67 ",$952.52 ,$2.54 ,$1.70 ,$2.25 ,$6.82 ,$7.24 ,$5.33 ,$7.67 ,$952.52 ,$8.52 ,$8.09 ,$7.67 ,$7.24 ,$7.24 ,$2.25 ,$7.24 ,$7.24 ,$7.67 ,$5.19 ,$952.52 ,$5.28 ,$9.03 ,$7.67 ,$2.55 ,$7.84 ,$7.67 ,$5.62 ,$5.62 ,$5.19 ,$5.62 ,$5.54 ,$5.82 ,$1.94 ,$6.73 ,"$1,009.67 ",$4.17 ,$4.17 ,$2.25 ,$4.17 ,$1.13 ,$8.09 ,$6.99 ,$6.99 ,$6.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q0138,FERUMOXYTOL 510 MG/17ML SOLN 17 ML VIAL per1 mg,636,1 ,$17.27 ,$11.40 ,$0.48 ,$528.18 ,$498.28 ,$1.08 ,$0.72 ,$4.57 ,$13.82 ,$14.68 ,$10.79 ,$15.54 ,$498.28 ,$17.27 ,$16.41 ,$15.54 ,$14.68 ,$14.68 ,$4.57 ,$14.68 ,$14.68 ,$15.54 ,$10.52 ,$498.28 ,$10.70 ,$18.31 ,$15.54 ,$1.08 ,$15.89 ,$15.54 ,$11.40 ,$11.40 ,$10.52 ,$11.40 ,$11.23 ,$11.80 ,$3.93 ,$13.64 ,$528.18 ,$8.46 ,$8.46 ,$4.57 ,$8.46 ,$0.48 ,$16.41 ,$14.16 ,$14.16 ,$13.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1450,FLUCONAZOLE 200-0.9 MG/100ML-% SOLN per200 mg,636,1 ,$168.70 ,$111.34 ,$3.68 ,$168.70 , N/A ,$5.51 ,$3.68 ,$44.64 ,$134.96 ,$143.40 ,$105.44 ,$151.83 , N/A , N/A ,$160.27 ,$151.83 ,$143.40 ,$143.40 ,$44.64 ,$143.40 ,$143.40 ,$151.83 ,$102.74 , N/A ,$104.60 , N/A ,$151.83 , N/A ,$155.20 ,$151.83 ,$111.36 ,$111.36 ,$102.74 ,$111.36 ,$109.66 ,$115.26 ,$38.41 ,$133.27 , N/A ,$82.66 ,$82.66 ,$44.64 ,$82.66 , N/A ,$160.27 ,$138.33 ,$138.33 ,$134.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1450,FLUCONAZOLE 400-0.9 MG/200ML-% SOLN per200 mg,636,1 ,$41.30 ,$27.26 ,$3.68 ,$41.30 , N/A ,$5.51 ,$3.68 ,$10.93 ,$33.04 ,$35.11 ,$25.81 ,$37.17 , N/A , N/A ,$39.24 ,$37.17 ,$35.11 ,$35.11 ,$10.93 ,$35.11 ,$35.11 ,$37.17 ,$25.15 , N/A ,$25.60 , N/A ,$37.17 , N/A ,$38.00 ,$37.17 ,$27.26 ,$27.26 ,$25.15 ,$27.26 ,$26.85 ,$28.22 ,$9.41 ,$32.63 , N/A ,$20.24 ,$20.24 ,$10.93 ,$20.24 , N/A ,$39.24 ,$33.87 ,$33.87 ,$33.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1451,FOMEPIZOLE 1.5 GM/1.5ML SOLN 1.5 ML VIAL per15 mg,636,1 ,$38.81 ,$25.61 ,$7.25 ,$528.18 ,$498.28 ,$11.99 ,$8.00 ,$10.27 ,$31.05 ,$32.99 ,$24.26 ,$34.93 ,$498.28 ,$38.81 ,$36.87 ,$34.93 ,$32.99 ,$32.99 ,$10.27 ,$32.99 ,$32.99 ,$34.93 ,$23.64 ,$498.28 ,$24.06 ,$41.14 ,$34.93 ,$16.31 ,$35.71 ,$34.93 ,$25.62 ,$25.62 ,$23.64 ,$25.62 ,$25.23 ,$26.52 ,$8.84 ,$30.66 ,$528.18 ,$19.02 ,$19.02 ,$10.27 ,$19.02 ,$7.25 ,$36.87 ,$31.82 ,$31.82 ,$31.05 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1652,FONDAPARINUX 10 MG/0.8ML SOLN per0.5 mg,636,1 ,$26.69 ,$17.62 ,$1.61 ,$26.69 , N/A ,$2.41 ,$1.61 ,$7.07 ,$21.35 ,$22.69 ,$16.68 ,$24.02 , N/A , N/A ,$25.36 ,$24.02 ,$22.69 ,$22.69 ,$7.07 ,$22.69 ,$22.69 ,$24.02 ,$16.25 , N/A ,$16.54 , N/A ,$24.02 , N/A ,$24.55 ,$24.02 ,$17.62 ,$17.62 ,$16.25 ,$17.62 ,$17.35 ,$18.23 ,$6.08 ,$21.09 , N/A ,$13.08 ,$13.08 ,$7.07 ,$13.08 , N/A ,$25.36 ,$21.89 ,$21.89 ,$21.35 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1652,FONDAPARINUX 2.5 MG/0.5ML SOLN 0.5 ML SYRINGE per0.5 mg,636,1 ,$44.28 ,$29.22 ,$1.61 ,$44.28 , N/A ,$2.41 ,$1.61 ,$11.72 ,$35.42 ,$37.64 ,$27.68 ,$39.85 , N/A , N/A ,$42.07 ,$39.85 ,$37.64 ,$37.64 ,$11.72 ,$37.64 ,$37.64 ,$39.85 ,$26.97 , N/A ,$27.46 , N/A ,$39.85 , N/A ,$40.74 ,$39.85 ,$29.23 ,$29.23 ,$26.97 ,$29.23 ,$28.78 ,$30.25 ,$10.07 ,$34.98 , N/A ,$21.70 ,$21.70 ,$11.72 ,$21.70 , N/A ,$42.07 ,$36.31 ,$36.31 ,$35.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1652,FONDAPARINUX 2.5 MG/0.5ML SOLN per0.5 mg,636,1 ,$45.37 ,$29.94 ,$1.61 ,$45.37 , N/A ,$2.41 ,$1.61 ,$12.00 ,$36.30 ,$38.56 ,$28.36 ,$40.83 , N/A , N/A ,$43.10 ,$40.83 ,$38.56 ,$38.56 ,$12.00 ,$38.56 ,$38.56 ,$40.83 ,$27.63 , N/A ,$28.12 , N/A ,$40.83 , N/A ,$41.74 ,$40.83 ,$29.95 ,$29.95 ,$27.63 ,$29.95 ,$29.49 ,$31.00 ,$10.33 ,$35.84 , N/A ,$22.23 ,$22.23 ,$12.00 ,$22.23 , N/A ,$43.10 ,$37.20 ,$37.20 ,$36.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1652,FONDAPARINUX 5 MG/0.4ML SOLN per0.5 mg,636,1 ,$50.80 ,$33.53 ,$1.61 ,$50.80 , N/A ,$2.41 ,$1.61 ,$13.45 ,$40.64 ,$43.18 ,$31.75 ,$45.72 , N/A , N/A ,$48.26 ,$45.72 ,$43.18 ,$43.18 ,$13.45 ,$43.18 ,$43.18 ,$45.72 ,$30.94 , N/A ,$31.50 , N/A ,$45.72 , N/A ,$46.74 ,$45.72 ,$33.53 ,$33.53 ,$30.94 ,$33.53 ,$33.02 ,$34.71 ,$11.56 ,$40.13 , N/A ,$24.89 ,$24.89 ,$13.45 ,$24.89 , N/A ,$48.26 ,$41.66 ,$41.66 ,$40.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1652,FONDAPARINUX 7.5 MG/0.6ML SOLN 0.6 ML SYRINGE per0.5 mg,636,1 ,$35.58 ,$23.48 ,$1.61 ,$35.58 , N/A ,$2.41 ,$1.61 ,$9.42 ,$28.46 ,$30.24 ,$22.24 ,$32.02 , N/A , N/A ,$33.80 ,$32.02 ,$30.24 ,$30.24 ,$9.42 ,$30.24 ,$30.24 ,$32.02 ,$21.67 , N/A ,$22.06 , N/A ,$32.02 , N/A ,$32.73 ,$32.02 ,$23.49 ,$23.49 ,$21.67 ,$23.49 ,$23.13 ,$24.31 ,$8.09 ,$28.11 , N/A ,$17.43 ,$17.43 ,$9.42 ,$17.43 , N/A ,$33.80 ,$29.18 ,$29.18 ,$28.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1652,FONDAPARINUX 7.5 MG/0.6ML SOLN per0.5 mg,636,1 ,$24.07 ,$15.89 ,$1.61 ,$24.07 , N/A ,$2.41 ,$1.61 ,$6.37 ,$19.26 ,$20.46 ,$15.04 ,$21.66 , N/A , N/A ,$22.87 ,$21.66 ,$20.46 ,$20.46 ,$6.37 ,$20.46 ,$20.46 ,$21.66 ,$14.66 , N/A ,$14.92 , N/A ,$21.66 , N/A ,$22.14 ,$21.66 ,$15.89 ,$15.89 ,$14.66 ,$15.89 ,$15.65 ,$16.44 ,$5.49 ,$19.02 , N/A ,$11.79 ,$11.79 ,$6.37 ,$11.79 , N/A ,$22.87 ,$19.74 ,$19.74 ,$19.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1453,FOSAPREPITANT DIMEGLUMINE 150 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$8.46 ,$5.58 ,$0.29 ,$105.15 ,$99.20 ,$0.43 ,$0.29 ,$2.23 ,$6.77 ,$7.19 ,$5.29 ,$7.61 ,$99.20 ,$8.46 ,$8.04 ,$7.61 ,$7.19 ,$7.19 ,$2.23 ,$7.19 ,$7.19 ,$7.61 ,$5.15 ,$99.20 ,$5.24 ,$8.97 ,$7.61 , N/A ,$7.78 ,$7.61 ,$5.58 ,$5.58 ,$5.15 ,$5.58 ,$5.50 ,$5.78 ,$1.93 ,$6.68 ,$105.15 ,$4.15 ,$4.15 ,$2.23 ,$4.15 , N/A ,$8.04 ,$6.94 ,$6.94 ,$6.77 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q2009,FOSPHENYTOIN 100 MG PE/2ML SOLN 2 ML VIAL per50 mg PE,636,1 ,$135.30 ,$89.30 ,$2.42 ,$135.30 , N/A ,$3.62 ,$2.42 ,$35.80 ,$108.24 ,$115.01 ,$84.56 ,$121.77 , N/A , N/A ,$128.54 ,$121.77 ,$115.01 ,$115.01 ,$35.80 ,$115.01 ,$115.01 ,$121.77 ,$82.40 , N/A ,$83.88 , N/A ,$121.77 , N/A ,$124.48 ,$121.77 ,$89.31 ,$89.31 ,$82.40 ,$89.31 ,$87.95 ,$92.44 ,$30.80 ,$106.89 , N/A ,$66.30 ,$66.30 ,$35.80 ,$66.30 , N/A ,$128.54 ,$110.95 ,$110.95 ,$108.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q2009,FOSPHENYTOIN 500 MG PE/10ML SOLN 10 ML VIAL per50 mg PE,636,1 ,$81.19 ,$53.59 ,$2.42 ,$81.19 , N/A ,$3.62 ,$2.42 ,$21.48 ,$64.95 ,$69.01 ,$50.74 ,$73.07 , N/A , N/A ,$77.13 ,$73.07 ,$69.01 ,$69.01 ,$21.48 ,$69.01 ,$69.01 ,$73.07 ,$49.44 , N/A ,$50.34 , N/A ,$73.07 , N/A ,$74.69 ,$73.07 ,$53.59 ,$53.59 ,$49.44 ,$53.59 ,$52.77 ,$55.47 ,$18.48 ,$64.14 , N/A ,$39.78 ,$39.78 ,$21.48 ,$39.78 , N/A ,$77.13 ,$66.58 ,$66.58 ,$64.95 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1940,FUROSEMIDE 10 MG/ML SOLN per20 mg,636,1 ,$49.00 ,$32.34 ,$0.87 ,$49.00 , N/A ,$1.31 ,$0.87 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1940,FUROSEMIDE 1000 MG/100 ML SOLN per20 mg,636,1 ,$4.90 ,$3.23 ,$0.87 ,$4.90 , N/A ,$1.31 ,$0.87 ,$1.29 ,$3.92 ,$4.17 ,$3.06 ,$4.41 , N/A , N/A ,$4.66 ,$4.41 ,$4.17 ,$4.17 ,$1.29 ,$4.17 ,$4.17 ,$4.41 ,$2.98 , N/A ,$3.04 , N/A ,$4.41 , N/A ,$4.51 ,$4.41 ,$3.23 ,$3.23 ,$2.98 ,$3.23 ,$3.19 ,$3.35 ,$1.12 ,$3.87 , N/A ,$2.40 ,$2.40 ,$1.29 ,$2.40 , N/A ,$4.66 ,$4.02 ,$4.02 ,$3.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J9201,GEMCITABINE 1 GM/26.3ML SOLN 26.3 ML VIAL per200 mg,636,1 ,$56.94 ,$37.58 ,$5.00 ,$56.94 , N/A ,$7.49 ,$5.00 ,$15.06 ,$45.55 ,$48.40 ,$35.59 ,$51.25 , N/A , N/A ,$54.09 ,$51.25 ,$48.40 ,$48.40 ,$15.06 ,$48.40 ,$48.40 ,$51.25 ,$34.68 , N/A ,$35.30 , N/A ,$51.25 , N/A ,$52.38 ,$51.25 ,$37.59 ,$37.59 ,$34.68 ,$37.59 ,$37.01 ,$38.90 ,$12.97 ,$44.98 , N/A ,$27.90 ,$27.90 ,$15.06 ,$27.90 , N/A ,$54.09 ,$46.69 ,$46.69 ,$45.55 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1580,GENTAMICIN 1.2-0.9 MG/ML-% SOLN per80 mg,636,1 ,$30.83 ,$20.35 ,$3.81 ,$30.83 , N/A ,$5.72 ,$3.81 ,$8.15 ,$24.66 ,$26.21 ,$19.27 ,$27.75 , N/A , N/A ,$29.29 ,$27.75 ,$26.21 ,$26.21 ,$8.15 ,$26.21 ,$26.21 ,$27.75 ,$18.78 , N/A ,$19.12 , N/A ,$27.75 , N/A ,$28.36 ,$27.75 ,$20.35 ,$20.35 ,$18.78 ,$20.35 ,$20.04 ,$21.06 ,$7.02 ,$24.36 , N/A ,$15.11 ,$15.11 ,$8.15 ,$15.11 , N/A ,$29.29 ,$25.28 ,$25.28 ,$24.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1580,GENTAMICIN 2-0.9 MG/ML-% SOLN per80 mg,636,1 ,$15.38 ,$10.15 ,$3.51 ,$15.38 , N/A ,$5.72 ,$3.81 ,$4.07 ,$12.30 ,$13.07 ,$9.61 ,$13.84 , N/A , N/A ,$14.61 ,$13.84 ,$13.07 ,$13.07 ,$4.07 ,$13.07 ,$13.07 ,$13.84 ,$9.37 , N/A ,$9.54 , N/A ,$13.84 , N/A ,$14.15 ,$13.84 ,$10.15 ,$10.15 ,$9.37 ,$10.15 ,$10.00 ,$10.51 ,$3.51 ,$12.15 , N/A ,$7.54 ,$7.54 ,$4.07 ,$7.54 , N/A ,$14.61 ,$12.61 ,$12.61 ,$12.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1580,GENTAMICIN 40 MG/ML SOLN 2 ML VIAL per80 mg,636,1 ,$24.50 ,$16.17 ,$3.81 ,$24.50 , N/A ,$5.72 ,$3.81 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1580,GENTAMICIN 40 MG/ML SOLN 20 ML VIAL per80 mg,636,1 ,$16.50 ,$10.89 ,$3.76 ,$16.50 , N/A ,$5.72 ,$3.81 ,$4.37 ,$13.20 ,$14.03 ,$10.31 ,$14.85 , N/A , N/A ,$15.68 ,$14.85 ,$14.03 ,$14.03 ,$4.37 ,$14.03 ,$14.03 ,$14.85 ,$10.05 , N/A ,$10.24 , N/A ,$14.85 , N/A ,$15.18 ,$14.85 ,$10.89 ,$10.89 ,$10.05 ,$10.89 ,$10.73 ,$11.27 ,$3.76 ,$13.04 , N/A ,$8.09 ,$8.09 ,$4.37 ,$8.09 , N/A ,$15.68 ,$13.53 ,$13.53 ,$13.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1610,GLUCAGON (DIAGNOSTIC) 1 MG SOLR per1 mg,636,1 ,$849.10 ,$560.41 ,$190.26 ,$849.10 ,$265.10 ,$428.09 ,$285.39 ,$224.67 ,$679.28 ,$721.74 ,$530.69 ,$764.19 ,$265.10 ,$265.10 ,$806.65 ,$764.19 ,$721.74 ,$721.74 ,$224.67 ,$721.74 ,$721.74 ,$764.19 ,$517.10 ,$265.10 ,$526.44 ,$281.01 ,$764.19 ,$428.08 ,$781.17 ,$764.19 ,$560.49 ,$560.49 ,$517.10 ,$560.49 ,$551.92 ,$580.11 ,$193.30 ,$670.79 ,$281.01 ,$416.06 ,$416.06 ,$224.67 ,$416.06 ,$190.26 ,$806.65 ,$696.26 ,$696.26 ,$679.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1610,GLUCAGON 1 MG KIT per1 mg,636,1 ,"$1,331.00 ",$878.46 ,$190.26 ,"$1,331.00 ",$265.10 ,$428.09 ,$285.39 ,$352.18 ,"$1,064.80 ","$1,131.35 ",$831.88 ,"$1,197.90 ",$265.10 ,$265.10 ,"$1,264.45 ","$1,197.90 ","$1,131.35 ","$1,131.35 ",$352.18 ,"$1,131.35 ","$1,131.35 ","$1,197.90 ",$810.58 ,$265.10 ,$825.22 ,$281.01 ,"$1,197.90 ",$428.08 ,"$1,224.52 ","$1,197.90 ",$878.59 ,$878.59 ,$810.58 ,$878.59 ,$865.15 ,$909.34 ,$303.01 ,"$1,051.49 ",$281.01 ,$652.19 ,$652.19 ,$352.18 ,$652.19 ,$190.26 ,"$1,264.45 ","$1,091.42 ","$1,091.42 ","$1,064.80 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1610,GLUCAGON 1 MG SOLR per1 mg,636,1 ,$854.60 ,$564.04 ,$190.26 ,$854.60 ,$265.10 ,$428.09 ,$285.39 ,$226.13 ,$683.68 ,$726.41 ,$534.13 ,$769.14 ,$265.10 ,$265.10 ,$811.87 ,$769.14 ,$726.41 ,$726.41 ,$226.13 ,$726.41 ,$726.41 ,$769.14 ,$520.45 ,$265.10 ,$529.86 ,$281.01 ,$769.14 ,$428.08 ,$786.23 ,$769.14 ,$564.12 ,$564.12 ,$520.45 ,$564.12 ,$555.49 ,$583.86 ,$194.56 ,$675.13 ,$281.01 ,$418.75 ,$418.75 ,$226.13 ,$418.75 ,$190.26 ,$811.87 ,$700.77 ,$700.77 ,$683.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3490,GLYCOPYRROLATE 1 MG/5ML SOSY per1 mg,636,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1630,HALOPERIDOL LACTATE 5 MG/ML SOLN per5 mg,636,1 ,$49.00 ,$32.34 ,$1.73 ,$49.00 , N/A ,$2.59 ,$1.73 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1644,HEPARIN (PORCINE) 100 UNIT/ML SOLN per1000 Units,636,1 ,$4.07 ,$2.69 ,$0.39 ,$4.07 , N/A ,$0.59 ,$0.39 ,$1.08 ,$3.26 ,$3.46 ,$2.54 ,$3.66 , N/A , N/A ,$3.87 ,$3.66 ,$3.46 ,$3.46 ,$1.08 ,$3.46 ,$3.46 ,$3.66 ,$2.48 , N/A ,$2.52 , N/A ,$3.66 , N/A ,$3.74 ,$3.66 ,$2.69 ,$2.69 ,$2.48 ,$2.69 ,$2.65 ,$2.78 ,$0.93 ,$3.22 , N/A ,$1.99 ,$1.99 ,$1.08 ,$1.99 , N/A ,$3.87 ,$3.34 ,$3.34 ,$3.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1644,HEPARIN (PORCINE) 1000 UNIT/ML SOLN 10 ML VIAL per1000 Units,636,1 ,$5.60 ,$3.70 ,$0.39 ,$5.60 , N/A ,$0.59 ,$0.39 ,$1.48 ,$4.48 ,$4.76 ,$3.50 ,$5.04 , N/A , N/A ,$5.32 ,$5.04 ,$4.76 ,$4.76 ,$1.48 ,$4.76 ,$4.76 ,$5.04 ,$3.41 , N/A ,$3.48 , N/A ,$5.04 , N/A ,$5.15 ,$5.04 ,$3.70 ,$3.70 ,$3.41 ,$3.70 ,$3.64 ,$3.83 ,$1.27 ,$4.42 , N/A ,$2.74 ,$2.74 ,$1.48 ,$2.74 , N/A ,$5.32 ,$4.59 ,$4.59 ,$4.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1644,HEPARIN (PORCINE) 1000 UNIT/ML SOLN per1000 Units,636,1 ,$28.56 ,$18.85 ,$0.39 ,$28.56 , N/A ,$0.59 ,$0.39 ,$7.56 ,$22.85 ,$24.28 ,$17.85 ,$25.70 , N/A , N/A ,$27.13 ,$25.70 ,$24.28 ,$24.28 ,$7.56 ,$24.28 ,$24.28 ,$25.70 ,$17.39 , N/A ,$17.70 , N/A ,$25.70 , N/A ,$26.28 ,$25.70 ,$18.85 ,$18.85 ,$17.39 ,$18.85 ,$18.56 ,$19.51 ,$6.51 ,$22.56 , N/A ,$13.99 ,$13.99 ,$7.56 ,$13.99 , N/A ,$27.13 ,$23.42 ,$23.42 ,$22.85 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1644,HEPARIN (PORCINE) 25000-0.45 UT/250ML-% SOLN per1000 Units,636,1 ,$5.36 ,$3.54 ,$0.39 ,$5.36 , N/A ,$0.59 ,$0.39 ,$1.42 ,$4.29 ,$4.56 ,$3.35 ,$4.82 , N/A , N/A ,$5.09 ,$4.82 ,$4.56 ,$4.56 ,$1.42 ,$4.56 ,$4.56 ,$4.82 ,$3.26 , N/A ,$3.32 , N/A ,$4.82 , N/A ,$4.93 ,$4.82 ,$3.54 ,$3.54 ,$3.26 ,$3.54 ,$3.48 ,$3.66 ,$1.22 ,$4.23 , N/A ,$2.63 ,$2.63 ,$1.42 ,$2.63 , N/A ,$5.09 ,$4.40 ,$4.40 ,$4.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1644,HEPARIN (PORCINE) 5000 UNIT/ML SOLN per1000 Units,636,1 ,$9.80 ,$6.47 ,$0.39 ,$9.80 , N/A ,$0.59 ,$0.39 ,$2.60 ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 ,$2.60 ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A ,$6.08 , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$2.22 ,$7.74 , N/A ,$4.80 ,$4.80 ,$2.60 ,$4.80 , N/A ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1642,HEPARIN FLUSH 100 UNIT/ML SOLN per10 Units,636,1 ,$0.66 ,$0.44 ,$0.03 ,$0.66 , N/A ,$0.05 ,$0.03 ,$0.18 ,$0.53 ,$0.56 , N/A ,$0.59 , N/A , N/A ,$0.63 ,$0.59 ,$0.56 ,$0.56 ,$0.18 ,$0.56 ,$0.56 ,$0.59 ,$0.40 , N/A ,$0.40 , N/A ,$0.59 , N/A ,$0.61 ,$0.59 ,$0.44 ,$0.44 ,$0.40 ,$0.44 ,$0.43 ,$0.45 ,$0.15 ,$0.52 , N/A ,$0.32 ,$0.32 ,$0.18 ,$0.32 , N/A ,$0.63 ,$0.54 ,$0.54 ,$0.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90632,HEPATITIS A VACCINE 1440 EL U/ML SUSP per1 mL,636,1 ,$564.95 ,$372.87 ,$52.21 ,$564.95 ,$52.21 ,$157.73 ,$105.15 ,$149.49 ,$451.96 ,$480.21 ,$353.09 ,$508.46 ,$52.21 ,$52.21 ,$536.70 ,$508.46 ,$480.21 ,$480.21 ,$149.49 ,$480.21 ,$480.21 ,$508.46 ,$344.05 ,$52.21 ,$350.26 ,$55.34 ,$508.46 , N/A ,$519.75 ,$508.46 ,$372.92 ,$372.92 ,$344.05 ,$372.92 ,$367.22 ,$385.97 ,$128.62 ,$446.31 ,$55.34 ,$276.83 ,$276.83 ,$149.49 ,$276.83 , N/A ,$536.70 ,$463.26 ,$463.26 ,$451.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90746,HEPATITIS B VACCINE 20 MCG/ML SUSY per1 mL,636,1 ,$473.65 ,$312.61 ,$52.21 ,$473.65 ,$52.21 ,$158.36 ,$105.57 ,$125.33 ,$378.92 ,$402.60 ,$296.03 ,$426.29 ,$52.21 ,$52.21 ,$449.97 ,$426.29 ,$402.60 ,$402.60 ,$125.33 ,$402.60 ,$402.60 ,$426.29 ,$288.45 ,$52.21 ,$293.66 ,$55.34 ,$426.29 ,$330.37 ,$435.76 ,$426.29 ,$312.66 ,$312.66 ,$288.45 ,$312.66 ,$307.87 ,$323.60 ,$107.83 ,$374.18 ,$55.34 ,$232.09 ,$232.09 ,$125.33 ,$232.09 ,$146.83 ,$449.97 ,$388.39 ,$388.39 ,$378.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90746,HEPATITIS B VACCINE 20 MCG/ML SUSP per1 mL,636,1 ,$473.65 ,$312.61 ,$52.21 ,$473.65 ,$52.21 ,$158.36 ,$105.57 ,$125.33 ,$378.92 ,$402.60 ,$296.03 ,$426.29 ,$52.21 ,$52.21 ,$449.97 ,$426.29 ,$402.60 ,$402.60 ,$125.33 ,$402.60 ,$402.60 ,$426.29 ,$288.45 ,$52.21 ,$293.66 ,$55.34 ,$426.29 ,$330.37 ,$435.76 ,$426.29 ,$312.66 ,$312.66 ,$288.45 ,$312.66 ,$307.87 ,$323.60 ,$107.83 ,$374.18 ,$55.34 ,$232.09 ,$232.09 ,$125.33 ,$232.09 ,$146.83 ,$449.97 ,$388.39 ,$388.39 ,$378.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3473,HYALURONIDASE HUMAN 150 UNIT/ML SOLN per1 Units,636,1 ,$2.75 ,$1.82 ,$0.54 ,$2.75 , N/A ,$0.81 ,$0.54 ,$0.73 ,$2.20 ,$2.34 ,$1.72 ,$2.48 , N/A , N/A ,$2.61 ,$2.48 ,$2.34 ,$2.34 ,$0.73 ,$2.34 ,$2.34 ,$2.48 ,$1.67 , N/A ,$1.70 , N/A ,$2.48 , N/A ,$2.53 ,$2.48 ,$1.82 ,$1.82 ,$1.67 ,$1.82 ,$1.79 ,$1.88 ,$0.63 ,$2.17 , N/A ,$1.35 ,$1.35 ,$0.73 ,$1.35 , N/A ,$2.61 ,$2.26 ,$2.26 ,$2.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0360,HYDRALAZINE 20 MG/ML SOLN per20 mg,636,1 ,$326.40 ,$215.42 ,$8.25 ,$326.40 , N/A ,$12.38 ,$8.25 ,$86.37 ,$261.12 ,$277.44 ,$204.00 ,$293.76 , N/A , N/A ,$310.08 ,$293.76 ,$277.44 ,$277.44 ,$86.37 ,$277.44 ,$277.44 ,$293.76 ,$198.78 , N/A ,$202.36 , N/A ,$293.76 , N/A ,$300.29 ,$293.76 ,$215.46 ,$215.46 ,$198.78 ,$215.46 ,$212.16 ,$223.00 ,$74.30 ,$257.86 , N/A ,$159.94 ,$159.94 ,$86.37 ,$159.94 , N/A ,$310.08 ,$267.65 ,$267.65 ,$261.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1720,HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLR per100 mg,636,1 ,$136.60 ,$90.16 ,$26.87 ,$136.60 , N/A ,$40.30 ,$26.87 ,$36.14 ,$109.28 ,$116.11 ,$85.38 ,$122.94 , N/A , N/A ,$129.77 ,$122.94 ,$116.11 ,$116.11 ,$36.14 ,$116.11 ,$116.11 ,$122.94 ,$83.19 , N/A ,$84.70 , N/A ,$122.94 , N/A ,$125.67 ,$122.94 ,$90.17 ,$90.17 ,$83.19 ,$90.17 ,$88.79 ,$93.33 ,$31.10 ,$107.91 , N/A ,$66.93 ,$66.93 ,$36.14 ,$66.93 , N/A ,$129.77 ,$112.01 ,$112.01 ,$109.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1720,HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLR 1 EACH VIAL per100 mg,636,1 ,$136.60 ,$90.16 ,$26.87 ,$136.60 , N/A ,$40.30 ,$26.87 ,$36.14 ,$109.28 ,$116.11 ,$85.38 ,$122.94 , N/A , N/A ,$129.77 ,$122.94 ,$116.11 ,$116.11 ,$36.14 ,$116.11 ,$116.11 ,$122.94 ,$83.19 , N/A ,$84.70 , N/A ,$122.94 , N/A ,$125.67 ,$122.94 ,$90.17 ,$90.17 ,$83.19 ,$90.17 ,$88.79 ,$93.33 ,$31.10 ,$107.91 , N/A ,$66.93 ,$66.93 ,$36.14 ,$66.93 , N/A ,$129.77 ,$112.01 ,$112.01 ,$109.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1170,HYDROMORPHONE 1 MG/ML per4 mg,636,1 ,$21.86 ,$14.43 ,$4.98 ,$21.86 , N/A ,$8.66 ,$5.78 ,$5.78 ,$17.49 ,$18.58 ,$13.66 ,$19.67 , N/A , N/A ,$20.77 ,$19.67 ,$18.58 ,$18.58 ,$5.78 ,$18.58 ,$18.58 ,$19.67 ,$13.31 , N/A ,$13.56 , N/A ,$19.67 , N/A ,$20.11 ,$19.67 ,$14.43 ,$14.43 ,$13.31 ,$14.43 ,$14.21 ,$14.93 ,$4.98 ,$17.27 , N/A ,$10.71 ,$10.71 ,$5.78 ,$10.71 , N/A ,$20.77 ,$17.93 ,$17.93 ,$17.49 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1170,HYDROMORPHONE 10 MG/ML SOLN 1 ML AMPULE per4 mg,636,1 ,$7.27 ,$4.80 ,$1.66 ,$7.27 , N/A ,$7.27 ,$5.78 ,$1.92 ,$5.82 ,$6.18 ,$4.54 ,$6.54 , N/A , N/A ,$6.91 ,$6.54 ,$6.18 ,$6.18 ,$1.92 ,$6.18 ,$6.18 ,$6.54 ,$4.43 , N/A ,$4.50 , N/A ,$6.54 , N/A ,$6.69 ,$6.54 ,$4.80 ,$4.80 ,$4.43 ,$4.80 ,$4.73 ,$4.97 ,$1.66 ,$5.74 , N/A ,$3.56 ,$3.56 ,$1.92 ,$3.56 , N/A ,$6.91 ,$5.96 ,$5.96 ,$5.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1170,HYDROMORPHONE 2 MG/ML SOLN per4 mg,636,1 ,$49.00 ,$32.34 ,$5.78 ,$49.00 , N/A ,$8.66 ,$5.78 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1170,HYDROMORPHONE 1 MG/ML SOLN per4 mg,636,1 ,$49.00 ,$32.34 ,$5.78 ,$49.00 , N/A ,$8.66 ,$5.78 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1170,HYDROMORPHONE 500 MG/50ML SOLN per4 mg,636,1 ,$6.13 ,$4.05 ,$1.39 ,$6.13 , N/A ,$6.13 ,$5.78 ,$1.63 ,$4.90 ,$5.21 ,$3.83 ,$5.52 , N/A , N/A ,$5.82 ,$5.52 ,$5.21 ,$5.21 ,$1.63 ,$5.21 ,$5.21 ,$5.52 ,$3.73 , N/A ,$3.80 , N/A ,$5.52 , N/A ,$5.64 ,$5.52 ,$4.05 ,$4.05 ,$3.73 ,$4.05 ,$3.98 ,$4.19 ,$1.39 ,$4.84 , N/A ,$3.00 ,$3.00 ,$1.63 ,$3.00 , N/A ,$5.82 ,$5.03 ,$5.03 ,$4.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1170,HYDROMORPHONE HCL PF 50 MG/5ML SOLN per4 mg,636,1 ,$24.50 ,$16.17 ,$5.59 ,$24.50 , N/A ,$8.66 ,$5.78 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3410,HYDROXYZINE 50 MG/ML SOLN per25 mg,636,1 ,$94.53 ,$62.39 ,$19.67 ,$94.53 , N/A ,$29.50 ,$19.67 ,$25.01 ,$75.62 ,$80.35 ,$59.08 ,$85.08 , N/A , N/A ,$89.80 ,$85.08 ,$80.35 ,$80.35 ,$25.01 ,$80.35 ,$80.35 ,$85.08 ,$57.57 , N/A ,$58.60 , N/A ,$85.08 , N/A ,$86.97 ,$85.08 ,$62.40 ,$62.40 ,$57.57 ,$62.40 ,$61.44 ,$64.58 ,$21.52 ,$74.68 , N/A ,$46.32 ,$46.32 ,$25.01 ,$46.32 , N/A ,$89.80 ,$77.51 ,$77.51 ,$75.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1742,IBUTILIDE 1 MG/10ML SOLN 10 ML VIAL per1 mg,636,1 ,"$3,354.50 ","$2,213.97 ",$265.10 ,"$3,354.50 ",$265.10 ,$461.39 ,$307.59 ,$887.61 ,"$2,683.60 ","$2,851.33 ","$2,096.56 ","$3,019.05 ",$265.10 ,$265.10 ,"$3,186.78 ","$3,019.05 ","$2,851.33 ","$2,851.33 ",$887.61 ,"$2,851.33 ","$2,851.33 ","$3,019.05 ","$2,042.89 ",$265.10 ,"$2,079.80 ",$281.01 ,"$3,019.05 ",$628.63 ,"$3,086.14 ","$3,019.05 ","$2,214.31 ","$2,214.31 ","$2,042.89 ","$2,214.31 ","$2,180.43 ","$2,291.79 ",$763.67 ,"$2,650.06 ",$281.01 ,"$1,643.71 ","$1,643.71 ",$887.61 ,"$1,643.71 ",$279.39 ,"$3,186.78 ","$2,750.69 ","$2,750.69 ","$2,683.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1568,IMMUNE GLOBULIN 5 GM/50ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$41.82 ,"$2,780.37 ","$2,622.99 ",$94.10 ,$62.73 ,$106.93 ,$323.28 ,$343.49 ,$252.56 ,$363.69 ,"$2,622.99 ",$404.10 ,$383.90 ,$363.69 ,$343.49 ,$343.49 ,$106.93 ,$343.49 ,$343.49 ,$363.69 ,$246.10 ,"$2,622.99 ",$250.54 ,$428.35 ,$363.69 ,$94.10 ,$371.77 ,$363.69 ,$266.75 ,$266.75 ,$246.10 ,$266.75 ,$262.67 ,$276.08 ,$91.99 ,$319.24 ,"$2,780.37 ",$198.01 ,$198.01 ,$106.93 ,$198.01 ,$41.82 ,$383.90 ,$331.36 ,$331.36 ,$323.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1568,IMMUNE GLOBULIN 10 GM/100ML SOLN 100 ML VIAL per500 mg,636,1 ,$404.10 ,$266.71 ,$41.82 ,"$2,780.37 ","$2,622.99 ",$94.10 ,$62.73 ,$106.93 ,$323.28 ,$343.49 ,$252.56 ,$363.69 ,"$2,622.99 ",$404.10 ,$383.90 ,$363.69 ,$343.49 ,$343.49 ,$106.93 ,$343.49 ,$343.49 ,$363.69 ,$246.10 ,"$2,622.99 ",$250.54 ,$428.35 ,$363.69 ,$94.10 ,$371.77 ,$363.69 ,$266.75 ,$266.75 ,$246.10 ,$266.75 ,$262.67 ,$276.08 ,$91.99 ,$319.24 ,"$2,780.37 ",$198.01 ,$198.01 ,$106.93 ,$198.01 ,$41.82 ,$383.90 ,$331.36 ,$331.36 ,$323.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1568,IMMUNE GLOBULIN 10 GM/100ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$41.82 ,"$2,780.37 ","$2,622.99 ",$94.10 ,$62.73 ,$106.93 ,$323.28 ,$343.49 ,$252.56 ,$363.69 ,"$2,622.99 ",$404.10 ,$383.90 ,$363.69 ,$343.49 ,$343.49 ,$106.93 ,$343.49 ,$343.49 ,$363.69 ,$246.10 ,"$2,622.99 ",$250.54 ,$428.35 ,$363.69 ,$94.10 ,$371.77 ,$363.69 ,$266.75 ,$266.75 ,$246.10 ,$266.75 ,$262.67 ,$276.08 ,$91.99 ,$319.24 ,"$2,780.37 ",$198.01 ,$198.01 ,$106.93 ,$198.01 ,$41.82 ,$383.90 ,$331.36 ,$331.36 ,$323.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1568,IMMUNE GLOBULIN 20 GM/200ML SOLN 200 ML VIAL per500 mg,636,1 ,$404.10 ,$266.71 ,$41.82 ,"$2,780.37 ","$2,622.99 ",$94.10 ,$62.73 ,$106.93 ,$323.28 ,$343.49 ,$252.56 ,$363.69 ,"$2,622.99 ",$404.10 ,$383.90 ,$363.69 ,$343.49 ,$343.49 ,$106.93 ,$343.49 ,$343.49 ,$363.69 ,$246.10 ,"$2,622.99 ",$250.54 ,$428.35 ,$363.69 ,$94.10 ,$371.77 ,$363.69 ,$266.75 ,$266.75 ,$246.10 ,$266.75 ,$262.67 ,$276.08 ,$91.99 ,$319.24 ,"$2,780.37 ",$198.01 ,$198.01 ,$106.93 ,$198.01 ,$41.82 ,$383.90 ,$331.36 ,$331.36 ,$323.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1568,IMMUNE GLOBULIN 20 GM/200ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$41.82 ,"$2,780.37 ","$2,622.99 ",$94.10 ,$62.73 ,$106.93 ,$323.28 ,$343.49 ,$252.56 ,$363.69 ,"$2,622.99 ",$404.10 ,$383.90 ,$363.69 ,$343.49 ,$343.49 ,$106.93 ,$343.49 ,$343.49 ,$363.69 ,$246.10 ,"$2,622.99 ",$250.54 ,$428.35 ,$363.69 ,$94.10 ,$371.77 ,$363.69 ,$266.75 ,$266.75 ,$246.10 ,$266.75 ,$262.67 ,$276.08 ,$91.99 ,$319.24 ,"$2,780.37 ",$198.01 ,$198.01 ,$106.93 ,$198.01 ,$41.82 ,$383.90 ,$331.36 ,$331.36 ,$323.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1568,IMMUNE GLOBULIN 30 GM/300ML SOLN per500 mg,636,1 ,$404.10 ,$266.71 ,$41.82 ,"$2,780.37 ","$2,622.99 ",$94.10 ,$62.73 ,$106.93 ,$323.28 ,$343.49 ,$252.56 ,$363.69 ,"$2,622.99 ",$404.10 ,$383.90 ,$363.69 ,$343.49 ,$343.49 ,$106.93 ,$343.49 ,$343.49 ,$363.69 ,$246.10 ,"$2,622.99 ",$250.54 ,$428.35 ,$363.69 ,$94.10 ,$371.77 ,$363.69 ,$266.75 ,$266.75 ,$246.10 ,$266.75 ,$262.67 ,$276.08 ,$91.99 ,$319.24 ,"$2,780.37 ",$198.01 ,$198.01 ,$106.93 ,$198.01 ,$41.82 ,$383.90 ,$331.36 ,$331.36 ,$323.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1745,INFLIXIMAB 100 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$343.34 ,$226.60 ,$34.04 ,"$2,780.37 ","$2,622.99 ",$76.59 ,$51.06 ,$90.85 ,$274.67 ,$291.84 ,$214.59 ,$309.01 ,"$2,622.99 ",$343.34 ,$326.17 ,$309.01 ,$291.84 ,$291.84 ,$90.85 ,$291.84 ,$291.84 ,$309.01 ,$209.09 ,"$2,622.99 ",$212.88 ,$363.94 ,$309.01 ,$76.60 ,$315.87 ,$309.01 ,$226.64 ,$226.64 ,$209.09 ,$226.64 ,$223.17 ,$234.57 ,$78.16 ,$271.24 ,"$2,780.37 ",$168.24 ,$168.24 ,$90.85 ,$168.24 ,$34.04 ,$326.17 ,$281.54 ,$281.54 ,$274.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q5104,INFLIXIMAB-ABDA 100 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$221.50 ,$146.19 ,$36.43 ,"$2,780.37 ","$2,622.99 ",$81.97 ,$54.65 ,$58.61 ,$177.20 ,$188.28 ,$138.44 ,$199.35 ,"$2,622.99 ",$221.50 ,$210.43 ,$199.35 ,$188.28 ,$188.28 ,$58.61 ,$188.28 ,$188.28 ,$199.35 ,$134.89 ,"$2,622.99 ",$137.34 ,$234.79 ,$199.35 ,$81.97 ,$203.78 ,$199.35 ,$146.21 ,$146.21 ,$134.89 ,$146.21 ,$143.98 ,$151.33 ,$50.43 ,$174.99 ,"$2,780.37 ",$108.54 ,$108.54 ,$58.61 ,$108.54 ,$36.43 ,$210.43 ,$181.63 ,$181.63 ,$177.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q5103,INFLIXIMAB-DYYB 100 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$278.21 ,$183.62 ,$20.59 ,"$2,780.37 ","$2,622.99 ",$46.33 ,$30.89 ,$73.62 ,$222.57 ,$236.48 ,$173.88 ,$250.39 ,"$2,622.99 ",$278.21 ,$264.30 ,$250.39 ,$236.48 ,$236.48 ,$73.62 ,$236.48 ,$236.48 ,$250.39 ,$169.43 ,"$2,622.99 ",$172.50 ,$294.90 ,$250.39 ,$46.33 ,$255.95 ,$250.39 ,$183.65 ,$183.65 ,$169.43 ,$183.65 ,$180.84 ,$190.07 ,$63.34 ,$219.79 ,"$2,780.37 ",$136.32 ,$136.32 ,$73.62 ,$136.32 ,$20.59 ,$264.30 ,$228.13 ,$228.13 ,$222.57 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90686,INFLUENZA VIRUS VACCINE (QUAD) 0.5 ML SUSY per0.5 mL,636,1 ,$142.15 ,$93.82 ,$28.55 ,$142.15 ,$52.21 ,$42.82 ,$28.55 ,$37.61 ,$113.72 ,$120.83 ,$88.84 ,$127.94 ,$52.21 ,$52.21 ,$135.04 ,$127.94 ,$120.83 ,$120.83 ,$37.61 ,$120.83 ,$120.83 ,$127.94 ,$86.57 ,$52.21 ,$88.14 ,$55.34 ,$127.94 ,$99.15 ,$130.78 ,$127.94 ,$93.83 ,$93.83 ,$86.57 ,$93.83 ,$92.40 ,$97.12 ,$32.36 ,$112.30 ,$55.34 ,$69.65 ,$69.65 ,$37.61 ,$69.65 ,$44.07 ,$135.04 ,$116.56 ,$116.56 ,$113.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1750,IRON DEXTRAN COMPLEX 50 MG/ML SOLN 2 ML VIAL per50 mg,636,1 ,$115.88 ,$76.48 ,$16.57 ,$115.88 ,$99.20 ,$37.28 ,$24.86 ,$30.66 ,$92.70 ,$98.50 ,$72.43 ,$104.29 ,$99.20 ,$99.20 ,$110.09 ,$104.29 ,$98.50 ,$98.50 ,$30.66 ,$98.50 ,$98.50 ,$104.29 ,$70.57 ,$99.20 ,$71.84 ,$105.15 ,$104.29 ,$37.29 ,$106.61 ,$104.29 ,$76.49 ,$76.49 ,$70.57 ,$76.49 ,$75.32 ,$79.17 ,$26.38 ,$91.55 ,$105.15 ,$56.78 ,$56.78 ,$30.66 ,$56.78 ,$16.57 ,$110.09 ,$95.02 ,$95.02 ,$92.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1756,IRON SUCROSE 20 MG/ML SOLN 5 ML VIAL per1 mg,636,1 ,$4.26 ,$2.81 ,$0.32 ,$4.26 , N/A ,$0.47 ,$0.32 ,$1.13 ,$3.41 ,$3.62 ,$2.66 ,$3.83 , N/A , N/A ,$4.05 ,$3.83 ,$3.62 ,$3.62 ,$1.13 ,$3.62 ,$3.62 ,$3.83 ,$2.59 , N/A ,$2.64 , N/A ,$3.83 , N/A ,$3.92 ,$3.83 ,$2.81 ,$2.81 ,$2.59 ,$2.81 ,$2.77 ,$2.91 ,$0.97 ,$3.37 , N/A ,$2.09 ,$2.09 ,$1.13 ,$2.09 , N/A ,$4.05 ,$3.49 ,$3.49 ,$3.41 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3490,ISOPROTERENOL 0.2 MG/ML SOLN per1 mL,636,1 ,"$2,988.00 ","$1,972.08 ",$680.23 ,"$2,988.00 ", N/A ,"$2,677.85 ","$2,677.85 ",$790.62 ,"$2,390.40 ","$2,539.80 ","$1,867.50 ","$2,689.20 ", N/A , N/A ,"$2,838.60 ","$2,689.20 ","$2,539.80 ","$2,539.80 ",$790.62 ,"$2,539.80 ","$2,539.80 ","$2,689.20 ","$1,819.69 ", N/A ,"$1,852.56 ", N/A ,"$2,689.20 ", N/A ,"$2,748.96 ","$2,689.20 ","$1,972.38 ","$1,972.38 ","$1,819.69 ","$1,972.38 ","$1,942.20 ","$2,041.40 ",$680.23 ,"$2,360.52 ", N/A ,"$1,464.12 ","$1,464.12 ",$790.62 ,"$1,464.12 ", N/A ,"$2,838.60 ","$2,450.16 ","$2,450.16 ","$2,390.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1885,KETOROLAC 15 MG/ML SOLN per15 mg,636,1 ,$49.00 ,$32.34 ,$0.74 ,$49.00 , N/A ,$1.10 ,$0.74 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1885,KETOROLAC 60 MG/2ML SOLN per15 mg,636,1 ,$24.50 ,$16.17 ,$0.74 ,$24.50 , N/A ,$1.10 ,$0.74 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1885,KETOROLAC 30 MG/ML SOLN 1 ML VIAL per15 mg,636,1 ,$24.50 ,$16.17 ,$0.74 ,$24.50 , N/A ,$1.10 ,$0.74 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9254,LACOSAMIDE 200 MG/20ML SOLN 20 ML VIAL per1 mg,636,1 ,$3.22 ,$2.13 ,$0.73 ,$3.22 , N/A ,$2.89 ,$2.89 ,$0.85 ,$2.58 ,$2.74 ,$2.01 ,$2.90 , N/A , N/A ,$3.06 ,$2.90 ,$2.74 ,$2.74 ,$0.85 ,$2.74 ,$2.74 ,$2.90 ,$1.96 , N/A ,$2.00 , N/A ,$2.90 , N/A ,$2.96 ,$2.90 ,$2.13 ,$2.13 ,$1.96 ,$2.13 ,$2.09 ,$2.20 ,$0.73 ,$2.54 , N/A ,$1.58 ,$1.58 ,$0.85 ,$1.58 , N/A ,$3.06 ,$2.64 ,$2.64 ,$2.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7120,LACTATED RINGERS SOLN per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.84 ,$106.00 , N/A ,$5.76 ,$3.84 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7120,LACTATED RINGERS BOLUS per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.84 ,$106.00 , N/A ,$5.76 ,$3.84 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7120,"LACTATED RINGERS SOLN 1,000 ML FLEX CONT per1000 mL",636,1 ,$106.00 ,$69.96 ,$3.84 ,$106.00 , N/A ,$5.76 ,$3.84 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1953,LEVETIRACETAM 1000 MG/100ML SOLN per10 mg,636,1 ,$3.63 ,$2.40 ,$0.14 ,$3.63 , N/A ,$0.20 ,$0.14 ,$0.96 ,$2.90 ,$3.09 ,$2.27 ,$3.27 , N/A , N/A ,$3.45 ,$3.27 ,$3.09 ,$3.09 ,$0.96 ,$3.09 ,$3.09 ,$3.27 ,$2.21 , N/A ,$2.26 , N/A ,$3.27 , N/A ,$3.34 ,$3.27 ,$2.40 ,$2.40 ,$2.21 ,$2.40 ,$2.36 ,$2.48 ,$0.82 ,$2.87 , N/A ,$1.78 ,$1.78 ,$0.96 ,$1.78 , N/A ,$3.45 ,$2.98 ,$2.98 ,$2.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1953,LEVETIRACETAM 1500 MG/100ML SOLN per10 mg,636,1 ,$3.50 ,$2.31 ,$0.14 ,$3.50 , N/A ,$0.20 ,$0.14 ,$0.93 ,$2.80 ,$2.98 ,$2.19 ,$3.15 , N/A , N/A ,$3.33 ,$3.15 ,$2.98 ,$2.98 ,$0.93 ,$2.98 ,$2.98 ,$3.15 ,$2.13 , N/A ,$2.18 , N/A ,$3.15 , N/A ,$3.22 ,$3.15 ,$2.31 ,$2.31 ,$2.13 ,$2.31 ,$2.28 ,$2.39 ,$0.80 ,$2.77 , N/A ,$1.72 ,$1.72 ,$0.93 ,$1.72 , N/A ,$3.33 ,$2.87 ,$2.87 ,$2.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1953,LEVETIRACETAM 500 MG/100ML SOLN per10 mg,636,1 ,$4.71 ,$3.11 ,$0.14 ,$4.71 , N/A ,$0.20 ,$0.14 ,$1.24 ,$3.77 ,$4.00 ,$2.94 ,$4.24 , N/A , N/A ,$4.47 ,$4.24 ,$4.00 ,$4.00 ,$1.24 ,$4.00 ,$4.00 ,$4.24 ,$2.87 , N/A ,$2.92 , N/A ,$4.24 , N/A ,$4.33 ,$4.24 ,$3.11 ,$3.11 ,$2.87 ,$3.11 ,$3.06 ,$3.22 ,$1.07 ,$3.72 , N/A ,$2.31 ,$2.31 ,$1.24 ,$2.31 , N/A ,$4.47 ,$3.86 ,$3.86 ,$3.77 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1953,LEVETIRACETAM 500 MG/5ML SOLN 5 ML VIAL per10 mg,636,1 ,$1.55 ,$1.02 ,$0.14 ,$1.55 , N/A ,$0.20 ,$0.14 ,$0.41 ,$1.24 ,$1.32 ,$0.97 ,$1.40 , N/A , N/A ,$1.47 ,$1.40 ,$1.32 ,$1.32 ,$0.41 ,$1.32 ,$1.32 ,$1.40 ,$0.94 , N/A ,$0.96 , N/A ,$1.40 , N/A ,$1.43 ,$1.40 ,$1.02 ,$1.02 ,$0.94 ,$1.02 ,$1.01 ,$1.06 ,$0.35 ,$1.22 , N/A ,$0.76 ,$0.76 ,$0.41 ,$0.76 , N/A ,$1.47 ,$1.27 ,$1.27 ,$1.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1956,LEVOFLOXACIN 250 MG/50ML SOLN per250 mg,636,1 ,$75.20 ,$49.63 ,$1.26 ,$75.20 , N/A ,$1.89 ,$1.26 ,$19.89 ,$60.16 ,$63.92 ,$47.00 ,$67.68 , N/A , N/A ,$71.44 ,$67.68 ,$63.92 ,$63.92 ,$19.89 ,$63.92 ,$63.92 ,$67.68 ,$45.80 , N/A ,$46.62 , N/A ,$67.68 , N/A ,$69.18 ,$67.68 ,$49.64 ,$49.64 ,$45.80 ,$49.64 ,$48.88 ,$51.38 ,$17.12 ,$59.41 , N/A ,$36.85 ,$36.85 ,$19.89 ,$36.85 , N/A ,$71.44 ,$61.66 ,$61.66 ,$60.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1956,LEVOFLOXACIN 500 MG/100ML SOLN per250 mg,636,1 ,$61.90 ,$40.85 ,$1.26 ,$61.90 , N/A ,$1.89 ,$1.26 ,$16.38 ,$49.52 ,$52.62 ,$38.69 ,$55.71 , N/A , N/A ,$58.81 ,$55.71 ,$52.62 ,$52.62 ,$16.38 ,$52.62 ,$52.62 ,$55.71 ,$37.70 , N/A ,$38.38 , N/A ,$55.71 , N/A ,$56.95 ,$55.71 ,$40.86 ,$40.86 ,$37.70 ,$40.86 ,$40.24 ,$42.29 ,$14.09 ,$48.90 , N/A ,$30.33 ,$30.33 ,$16.38 ,$30.33 , N/A ,$58.81 ,$50.76 ,$50.76 ,$49.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1956,LEVOFLOXACIN 750 MG/150ML SOLN per250 mg,636,1 ,$26.30 ,$17.36 ,$1.26 ,$26.30 , N/A ,$1.89 ,$1.26 ,$6.96 ,$21.04 ,$22.36 ,$16.44 ,$23.67 , N/A , N/A ,$24.99 ,$23.67 ,$22.36 ,$22.36 ,$6.96 ,$22.36 ,$22.36 ,$23.67 ,$16.02 , N/A ,$16.30 , N/A ,$23.67 , N/A ,$24.20 ,$23.67 ,$17.36 ,$17.36 ,$16.02 ,$17.36 ,$17.10 ,$17.97 ,$5.99 ,$20.78 , N/A ,$12.89 ,$12.89 ,$6.96 ,$12.89 , N/A ,$24.99 ,$21.57 ,$21.57 ,$21.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2001,LIDOCAINE (CARDIAC) 20 MG/ML INJ per10 mg,636,1 ,$4.99 ,$3.29 ,$0.05 ,$4.99 , N/A ,$0.07 ,$0.05 ,$1.32 ,$3.99 ,$4.24 ,$3.12 ,$4.49 , N/A , N/A ,$4.74 ,$4.49 ,$4.24 ,$4.24 ,$1.32 ,$4.24 ,$4.24 ,$4.49 ,$3.04 , N/A ,$3.10 , N/A ,$4.49 , N/A ,$4.59 ,$4.49 ,$3.29 ,$3.29 ,$3.04 ,$3.29 ,$3.24 ,$3.41 ,$1.14 ,$3.94 , N/A ,$2.45 ,$2.45 ,$1.32 ,$2.45 , N/A ,$4.74 ,$4.09 ,$4.09 ,$3.99 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2001,LIDOCAINE (CARDIAC) PF 100 MG/5ML SOLN per10 mg,636,1 ,$4.90 ,$3.23 ,$0.05 ,$4.90 , N/A ,$0.07 ,$0.05 ,$1.29 ,$3.92 ,$4.17 ,$3.06 ,$4.41 , N/A , N/A ,$4.66 ,$4.41 ,$4.17 ,$4.17 ,$1.29 ,$4.17 ,$4.17 ,$4.41 ,$2.98 , N/A ,$3.04 , N/A ,$4.41 , N/A ,$4.51 ,$4.41 ,$3.23 ,$3.23 ,$2.98 ,$3.23 ,$3.19 ,$3.35 ,$1.12 ,$3.87 , N/A ,$2.40 ,$2.40 ,$1.29 ,$2.40 , N/A ,$4.66 ,$4.02 ,$4.02 ,$3.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2001,LIDOCAINE 8-5 MG/ML-% SOLN per10 mg,636,1 ,$6.13 ,$4.05 ,$0.05 ,$6.13 , N/A ,$0.07 ,$0.05 ,$1.63 ,$4.90 ,$5.21 ,$3.83 ,$5.52 , N/A , N/A ,$5.82 ,$5.52 ,$5.21 ,$5.21 ,$1.63 ,$5.21 ,$5.21 ,$5.52 ,$3.73 , N/A ,$3.80 , N/A ,$5.52 , N/A ,$5.64 ,$5.52 ,$4.05 ,$4.05 ,$3.73 ,$4.05 ,$3.98 ,$4.19 ,$1.39 ,$4.84 , N/A ,$3.00 ,$3.00 ,$1.63 ,$3.00 , N/A ,$5.82 ,$5.03 ,$5.03 ,$4.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2020,LINEZOLID 600 MG/300ML SOLN per200 mg,636,1 ,$236.02 ,$155.77 ,$5.15 ,$236.02 , N/A ,$7.72 ,$5.15 ,$62.46 ,$188.82 ,$200.62 ,$147.51 ,$212.42 , N/A , N/A ,$224.22 ,$212.42 ,$200.62 ,$200.62 ,$62.46 ,$200.62 ,$200.62 ,$212.42 ,$143.74 , N/A ,$146.34 , N/A ,$212.42 , N/A ,$217.14 ,$212.42 ,$155.80 ,$155.80 ,$143.74 ,$155.80 ,$153.41 ,$161.25 ,$53.72 ,$186.46 , N/A ,$115.65 ,$115.65 ,$62.46 ,$115.65 , N/A ,$224.22 ,$193.54 ,$193.54 ,$188.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2060,LORAZEPAM 2 MG/ML SOLN 10 ML VIAL per2 mg,636,1 ,$7.38 ,$4.87 ,$1.69 ,$7.38 , N/A ,$2.66 ,$1.77 ,$1.95 ,$5.90 ,$6.27 ,$4.61 ,$6.64 , N/A , N/A ,$7.01 ,$6.64 ,$6.27 ,$6.27 ,$1.95 ,$6.27 ,$6.27 ,$6.64 ,$4.49 , N/A ,$4.58 , N/A ,$6.64 , N/A ,$6.79 ,$6.64 ,$4.87 ,$4.87 ,$4.49 ,$4.87 ,$4.80 ,$5.04 ,$1.69 ,$5.83 , N/A ,$3.62 ,$3.62 ,$1.95 ,$3.62 , N/A ,$7.01 ,$6.05 ,$6.05 ,$5.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2060,LORAZEPAM 2 MG/ML SOLN per2 mg,636,1 ,$49.00 ,$32.34 ,$1.77 ,$49.00 , N/A ,$2.66 ,$1.77 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 1-5 GM/100ML-% SOLN per500 mg,636,1 ,$43.13 ,$28.47 ,$1.19 ,$43.13 , N/A ,$1.78 ,$1.19 ,$11.42 ,$34.50 ,$36.66 ,$26.96 ,$38.82 , N/A , N/A ,$40.97 ,$38.82 ,$36.66 ,$36.66 ,$11.42 ,$36.66 ,$36.66 ,$38.82 ,$26.27 , N/A ,$26.74 , N/A ,$38.82 , N/A ,$39.68 ,$38.82 ,$28.47 ,$28.47 ,$26.27 ,$28.47 ,$28.03 ,$29.47 ,$9.82 ,$34.07 , N/A ,$21.13 ,$21.13 ,$11.42 ,$21.13 , N/A ,$40.97 ,$35.37 ,$35.37 ,$34.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 2 GM/50ML SOLN per500 mg,636,1 ,$37.33 ,$24.64 ,$1.19 ,$37.33 , N/A ,$1.78 ,$1.19 ,$9.88 ,$29.86 ,$31.73 ,$23.33 ,$33.60 , N/A , N/A ,$35.46 ,$33.60 ,$31.73 ,$31.73 ,$9.88 ,$31.73 ,$31.73 ,$33.60 ,$22.73 , N/A ,$23.14 , N/A ,$33.60 , N/A ,$34.34 ,$33.60 ,$24.64 ,$24.64 ,$22.73 ,$24.64 ,$24.26 ,$25.50 ,$8.51 ,$29.49 , N/A ,$18.29 ,$18.29 ,$9.88 ,$18.29 , N/A ,$35.46 ,$30.61 ,$30.61 ,$29.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 20 GM/500ML SOLN per500 mg,636,1 ,$1.93 ,$1.27 ,$0.43 ,$1.93 , N/A ,$1.78 ,$1.19 ,$0.51 ,$1.54 ,$1.64 ,$1.21 ,$1.74 , N/A , N/A ,$1.83 ,$1.74 ,$1.64 ,$1.64 ,$0.51 ,$1.64 ,$1.64 ,$1.74 ,$1.18 , N/A ,$1.20 , N/A ,$1.74 , N/A ,$1.78 ,$1.74 ,$1.27 ,$1.27 ,$1.18 ,$1.27 ,$1.25 ,$1.32 ,$0.43 ,$1.52 , N/A ,$0.95 ,$0.95 ,$0.51 ,$0.95 , N/A ,$1.83 ,$1.58 ,$1.58 ,$1.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 4 GM/50ML SOLN per500 mg,636,1 ,$10.78 ,$7.11 ,$1.19 ,$10.78 , N/A ,$1.78 ,$1.19 ,$2.85 ,$8.62 ,$9.16 ,$6.74 ,$9.70 , N/A , N/A ,$10.24 ,$9.70 ,$9.16 ,$9.16 ,$2.85 ,$9.16 ,$9.16 ,$9.70 ,$6.57 , N/A ,$6.68 , N/A ,$9.70 , N/A ,$9.92 ,$9.70 ,$7.12 ,$7.12 ,$6.57 ,$7.12 ,$7.01 ,$7.36 ,$2.45 ,$8.52 , N/A ,$5.28 ,$5.28 ,$2.85 ,$5.28 , N/A ,$10.24 ,$8.84 ,$8.84 ,$8.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 50 % SOLN 20 ML VIAL per500 mg,636,1 ,$4.08 ,$2.69 ,$0.93 ,$4.08 , N/A ,$1.78 ,$1.19 ,$1.08 ,$3.26 ,$3.47 ,$2.55 ,$3.67 , N/A , N/A ,$3.88 ,$3.67 ,$3.47 ,$3.47 ,$1.08 ,$3.47 ,$3.47 ,$3.67 ,$2.48 , N/A ,$2.52 , N/A ,$3.67 , N/A ,$3.75 ,$3.67 ,$2.69 ,$2.69 ,$2.48 ,$2.69 ,$2.65 ,$2.79 ,$0.93 ,$3.22 , N/A ,$2.00 ,$2.00 ,$1.08 ,$2.00 , N/A ,$3.88 ,$3.35 ,$3.35 ,$3.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 50 % SOLN 10 ML VIAL per500 mg,636,1 ,$4.08 ,$2.69 ,$0.93 ,$4.08 , N/A ,$1.78 ,$1.19 ,$1.08 ,$3.26 ,$3.47 ,$2.55 ,$3.67 , N/A , N/A ,$3.88 ,$3.67 ,$3.47 ,$3.47 ,$1.08 ,$3.47 ,$3.47 ,$3.67 ,$2.48 , N/A ,$2.52 , N/A ,$3.67 , N/A ,$3.75 ,$3.67 ,$2.69 ,$2.69 ,$2.48 ,$2.69 ,$2.65 ,$2.79 ,$0.93 ,$3.22 , N/A ,$2.00 ,$2.00 ,$1.08 ,$2.00 , N/A ,$3.88 ,$3.35 ,$3.35 ,$3.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 50 % SOLN per500 mg,636,1 ,$49.00 ,$32.34 ,$1.19 ,$49.00 , N/A ,$1.78 ,$1.19 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3475,MAGNESIUM SULFATE 50 % SOLN 2 ML VIAL per500 mg,636,1 ,$49.00 ,$32.34 ,$1.19 ,$49.00 , N/A ,$1.78 ,$1.19 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2175,MEPERIDINE 50 MG/ML SOLN per100 mg,636,1 ,$49.00 ,$32.34 ,$10.53 ,$49.00 , N/A ,$15.80 ,$10.53 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2175,MEPERIDINE 25 MG/ML SOLN per100 mg,636,1 ,$49.00 ,$32.34 ,$10.53 ,$49.00 , N/A ,$15.80 ,$10.53 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0670,MEPIVACAINE 2 % SOLN per10 mL,636,1 ,$49.00 ,$32.34 ,$5.21 ,$49.00 , N/A ,$7.81 ,$5.21 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2182,MEPOLIZUMAB 100 MG SOLR per1 mg,636,1 ,$123.33 ,$81.40 ,$28.08 ,"$4,139.91 ","$3,905.58 ",$66.08 ,$44.06 ,$32.63 ,$98.66 ,$104.83 ,$77.08 ,$111.00 ,"$3,905.58 ",$123.33 ,$117.16 ,$111.00 ,$104.83 ,$104.83 ,$32.63 ,$104.83 ,$104.83 ,$111.00 ,$75.11 ,"$3,905.58 ",$76.46 ,$130.73 ,$111.00 ,$66.09 ,$113.46 ,$111.00 ,$81.41 ,$81.41 ,$75.11 ,$81.41 ,$80.16 ,$84.26 ,$28.08 ,$97.43 ,"$4,139.91 ",$60.43 ,$60.43 ,$32.63 ,$60.43 ,$29.37 ,$117.16 ,$101.13 ,$101.13 ,$98.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2185,MEROPENEM 1 G SOLR 1 EACH VIAL per100 mg,636,1 ,$22.14 ,$14.61 ,$0.75 ,$22.14 , N/A ,$1.13 ,$0.75 ,$5.86 ,$17.71 ,$18.82 ,$13.84 ,$19.93 , N/A , N/A ,$21.03 ,$19.93 ,$18.82 ,$18.82 ,$5.86 ,$18.82 ,$18.82 ,$19.93 ,$13.48 , N/A ,$13.72 , N/A ,$19.93 , N/A ,$20.37 ,$19.93 ,$14.61 ,$14.61 ,$13.48 ,$14.61 ,$14.39 ,$15.13 ,$5.04 ,$17.49 , N/A ,$10.85 ,$10.85 ,$5.86 ,$10.85 , N/A ,$21.03 ,$18.15 ,$18.15 ,$17.71 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2185,MEROPENEM 500 MG SOLR 1 EACH VIAL per100 mg,636,1 ,$13.53 ,$8.93 ,$0.75 ,$13.53 , N/A ,$1.13 ,$0.75 ,$3.58 ,$10.82 ,$11.50 ,$8.46 ,$12.18 , N/A , N/A ,$12.85 ,$12.18 ,$11.50 ,$11.50 ,$3.58 ,$11.50 ,$11.50 ,$12.18 ,$8.24 , N/A ,$8.38 , N/A ,$12.18 , N/A ,$12.45 ,$12.18 ,$8.93 ,$8.93 ,$8.24 ,$8.93 ,$8.79 ,$9.24 ,$3.08 ,$10.69 , N/A ,$6.63 ,$6.63 ,$3.58 ,$6.63 , N/A ,$12.85 ,$11.09 ,$11.09 ,$10.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7674,METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML IN SODIUM CHLORIDE 0.9 % 0.25 MG/ML SOLR per1 mg,636,1 ,$76.50 ,$50.49 ,$1.25 ,$76.50 , N/A ,$1.87 ,$1.25 ,$20.25 ,$61.20 ,$65.03 ,$47.81 ,$68.85 , N/A , N/A ,$72.68 ,$68.85 ,$65.03 ,$65.03 ,$20.25 ,$65.03 ,$65.03 ,$68.85 ,$46.59 , N/A ,$47.44 , N/A ,$68.85 , N/A ,$70.38 ,$68.85 ,$50.50 ,$50.50 ,$46.59 ,$50.50 ,$49.73 ,$52.26 ,$17.42 ,$60.44 , N/A ,$37.49 ,$37.49 ,$20.25 ,$37.49 , N/A ,$72.68 ,$62.73 ,$62.73 ,$61.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7674,METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML IN SODIUM CHLORIDE 0.9 % 0.0625 MG/ML SOLR per1 mg,636,1 ,$76.50 ,$50.49 ,$1.25 ,$76.50 , N/A ,$1.87 ,$1.25 ,$20.25 ,$61.20 ,$65.03 ,$47.81 ,$68.85 , N/A , N/A ,$72.68 ,$68.85 ,$65.03 ,$65.03 ,$20.25 ,$65.03 ,$65.03 ,$68.85 ,$46.59 , N/A ,$47.44 , N/A ,$68.85 , N/A ,$70.38 ,$68.85 ,$50.50 ,$50.50 ,$46.59 ,$50.50 ,$49.73 ,$52.26 ,$17.42 ,$60.44 , N/A ,$37.49 ,$37.49 ,$20.25 ,$37.49 , N/A ,$72.68 ,$62.73 ,$62.73 ,$61.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7674,METHACHOLINE (PROVOCHOLINE) 1 MG/ML IN SODIUM CHLORIDE 0.9 % 1 MG/ML SOLR per1 mg,636,1 ,$25.50 ,$16.83 ,$1.25 ,$25.50 , N/A ,$1.87 ,$1.25 ,$6.75 ,$20.40 ,$21.68 ,$15.94 ,$22.95 , N/A , N/A ,$24.23 ,$22.95 ,$21.68 ,$21.68 ,$6.75 ,$21.68 ,$21.68 ,$22.95 ,$15.53 , N/A ,$15.82 , N/A ,$22.95 , N/A ,$23.46 ,$22.95 ,$16.83 ,$16.83 ,$15.53 ,$16.83 ,$16.58 ,$17.42 ,$5.81 ,$20.15 , N/A ,$12.50 ,$12.50 ,$6.75 ,$12.50 , N/A ,$24.23 ,$20.91 ,$20.91 ,$20.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7674,METHACHOLINE (PROVOCHOLINE) 16 MG/ML IN SODIUM CHLORIDE 0.9 % 16 MG/ML SOLR per1 mg,636,1 ,$1.59 ,$1.05 ,$0.36 ,$1.59 , N/A ,$1.59 ,$1.25 ,$0.42 ,$1.27 ,$1.35 ,$0.99 ,$1.43 , N/A , N/A ,$1.51 ,$1.43 ,$1.35 ,$1.35 ,$0.42 ,$1.35 ,$1.35 ,$1.43 ,$0.97 , N/A ,$0.98 , N/A ,$1.43 , N/A ,$1.46 ,$1.43 ,$1.05 ,$1.05 ,$0.97 ,$1.05 ,$1.03 ,$1.09 ,$0.36 ,$1.26 , N/A ,$0.78 ,$0.78 ,$0.42 ,$0.78 , N/A ,$1.51 ,$1.30 ,$1.30 ,$1.27 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7674,METHACHOLINE (PROVOCHOLINE) 4 MG/ML IN SODIUM CHLORIDE 0.9 % 4 MG/ML SOLR per1 mg,636,1 ,$6.38 ,$4.21 ,$1.25 ,$6.38 , N/A ,$1.87 ,$1.25 ,$1.69 ,$5.10 ,$5.42 ,$3.99 ,$5.74 , N/A , N/A ,$6.06 ,$5.74 ,$5.42 ,$5.42 ,$1.69 ,$5.42 ,$5.42 ,$5.74 ,$3.89 , N/A ,$3.96 , N/A ,$5.74 , N/A ,$5.87 ,$5.74 ,$4.21 ,$4.21 ,$3.89 ,$4.21 ,$4.15 ,$4.36 ,$1.45 ,$5.04 , N/A ,$3.13 ,$3.13 ,$1.69 ,$3.13 , N/A ,$6.06 ,$5.23 ,$5.23 ,$5.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2800,METHOCARBAMOL 1000 MG/10ML SOLN per10 mL,636,1 ,$66.45 ,$43.86 ,$7.97 ,$66.45 , N/A ,$11.95 ,$7.97 ,$17.58 ,$53.16 ,$56.48 ,$41.53 ,$59.81 , N/A , N/A ,$63.13 ,$59.81 ,$56.48 ,$56.48 ,$17.58 ,$56.48 ,$56.48 ,$59.81 ,$40.47 , N/A ,$41.20 , N/A ,$59.81 , N/A ,$61.13 ,$59.81 ,$43.86 ,$43.86 ,$40.47 ,$43.86 ,$43.19 ,$45.40 ,$15.12 ,$52.50 , N/A ,$32.56 ,$32.56 ,$17.58 ,$32.56 , N/A ,$63.13 ,$54.49 ,$54.49 ,$53.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J9260,METHOTREXATE (PF) 50 MG/2ML SOLN per50 mg,636,1 ,$48.10 ,$31.75 ,$3.68 ,$48.10 , N/A ,$5.51 ,$3.68 ,$12.73 ,$38.48 ,$40.89 ,$30.06 ,$43.29 , N/A , N/A ,$45.70 ,$43.29 ,$40.89 ,$40.89 ,$12.73 ,$40.89 ,$40.89 ,$43.29 ,$29.29 , N/A ,$29.82 , N/A ,$43.29 , N/A ,$44.25 ,$43.29 ,$31.75 ,$31.75 ,$29.29 ,$31.75 ,$31.27 ,$32.86 ,$10.95 ,$38.00 , N/A ,$23.57 ,$23.57 ,$12.73 ,$23.57 , N/A ,$45.70 ,$39.44 ,$39.44 ,$38.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J8610,METHOTREXATE 2.5 MG TABS per2.5 mg,636,1 ,$21.22 ,$14.01 ,$0.60 ,$21.22 , N/A ,$0.90 ,$0.60 ,$5.62 ,$16.98 ,$18.04 ,$13.26 ,$19.10 , N/A , N/A ,$20.16 ,$19.10 ,$18.04 ,$18.04 ,$5.62 ,$18.04 ,$18.04 ,$19.10 ,$12.92 , N/A ,$13.16 , N/A ,$19.10 , N/A ,$19.52 ,$19.10 ,$14.01 ,$14.01 ,$12.92 ,$14.01 ,$13.79 ,$14.50 ,$4.83 ,$16.76 , N/A ,$10.40 ,$10.40 ,$5.62 ,$10.40 , N/A ,$20.16 ,$17.40 ,$17.40 ,$16.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q9968,METHYLENE BLUE 1 % SOLN per1 mg,636,1 ,$12.39 ,$8.18 ,$2.82 ,$16.65 , N/A ,$12.39 ,$11.33 ,$3.28 ,$9.91 ,$10.53 , N/A ,$11.15 , N/A , N/A ,$11.77 ,$11.15 ,$10.53 ,$10.53 ,$3.28 ,$10.53 ,$10.53 ,$11.15 ,$7.55 , N/A ,$7.68 , N/A ,$11.15 ,$16.65 ,$11.40 ,$11.15 ,$8.18 ,$8.18 ,$7.55 ,$8.18 ,$8.05 ,$8.46 ,$2.82 ,$9.79 , N/A ,$6.07 ,$6.07 ,$3.28 ,$6.07 ,$7.40 ,$11.77 ,$10.16 ,$10.16 ,$9.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,METHYLENE BLUE 50 MG/10ML SOLN per1 mL,636,1 ,$192.20 ,$126.85 ,$50.85 ,$192.20 , N/A ,$172.25 ,$172.25 ,$50.85 ,$153.76 ,$163.37 ,$120.13 ,$172.98 , N/A , N/A ,$182.59 ,$172.98 ,$163.37 ,$163.37 ,$50.85 ,$163.37 ,$163.37 ,$172.98 ,$117.05 , N/A ,$119.16 , N/A ,$172.98 ,$115.32 ,$176.82 ,$172.98 ,$126.87 ,$126.87 ,$117.05 ,$126.87 ,$124.93 ,$131.31 , N/A ,$151.84 , N/A ,$94.18 ,$94.18 ,$50.85 ,$94.18 , N/A ,$182.59 ,$157.60 ,$157.60 ,$153.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2210,METHYLERGONOVINE 0.2 MG/ML SOLN per0.2 mg,636,1 ,$145.85 ,$96.26 ,$31.29 ,$145.85 , N/A ,$46.94 ,$31.29 ,$38.59 ,$116.68 ,$123.97 ,$91.16 ,$131.27 , N/A , N/A ,$138.56 ,$131.27 ,$123.97 ,$123.97 ,$38.59 ,$123.97 ,$123.97 ,$131.27 ,$88.82 , N/A ,$90.42 , N/A ,$131.27 , N/A ,$134.18 ,$131.27 ,$96.28 ,$96.28 ,$88.82 ,$96.28 ,$94.80 ,$99.64 ,$33.21 ,$115.22 , N/A ,$71.47 ,$71.47 ,$38.59 ,$71.47 , N/A ,$138.56 ,$119.60 ,$119.60 ,$116.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2212,METHYLNALTREXONE 12 MG/0.6ML SOLN per0.1 mg,636,1 ,$5.73 ,$3.78 ,$1.30 ,$5.73 , N/A ,$5.14 ,$5.14 ,$1.52 ,$4.58 ,$4.87 ,$3.58 ,$5.16 , N/A , N/A ,$5.44 ,$5.16 ,$4.87 ,$4.87 ,$1.52 ,$4.87 ,$4.87 ,$5.16 ,$3.49 , N/A ,$3.56 , N/A ,$5.16 , N/A ,$5.27 ,$5.16 ,$3.78 ,$3.78 ,$3.49 ,$3.78 ,$3.72 ,$3.91 ,$1.30 ,$4.53 , N/A ,$2.81 ,$2.81 ,$1.52 ,$2.81 , N/A ,$5.44 ,$4.70 ,$4.70 ,$4.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7509,METHYLPREDNISOLONE 4 MG TABS per4 mg,636,1 ,$5.65 ,$3.73 ,$0.41 ,$5.65 , N/A ,$0.61 ,$0.41 ,$1.50 ,$4.52 ,$4.80 ,$3.53 ,$5.09 , N/A , N/A ,$5.37 ,$5.09 ,$4.80 ,$4.80 ,$1.50 ,$4.80 ,$4.80 ,$5.09 ,$3.44 , N/A ,$3.50 , N/A ,$5.09 , N/A ,$5.20 ,$5.09 ,$3.73 ,$3.73 ,$3.44 ,$3.73 ,$3.67 ,$3.86 ,$1.28 ,$4.46 , N/A ,$2.77 ,$2.77 ,$1.50 ,$2.77 , N/A ,$5.37 ,$4.63 ,$4.63 ,$4.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1030,METHYLPREDNISOLONE ACETATE 40 MG/ML SUSP per40 mg,636,1 ,$83.83 ,$55.33 ,$12.12 ,$83.83 , N/A ,$18.18 ,$12.12 ,$22.18 ,$67.06 ,$71.26 ,$52.39 ,$75.45 , N/A , N/A ,$79.64 ,$75.45 ,$71.26 ,$71.26 ,$22.18 ,$71.26 ,$71.26 ,$75.45 ,$51.05 , N/A ,$51.98 , N/A ,$75.45 , N/A ,$77.12 ,$75.45 ,$55.34 ,$55.34 ,$51.05 ,$55.34 ,$54.49 ,$57.27 ,$19.08 ,$66.23 , N/A ,$41.08 ,$41.08 ,$22.18 ,$41.08 , N/A ,$79.64 ,$68.74 ,$68.74 ,$67.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1040,METHYLPREDNISOLONE ACETATE 80 MG/ML SUSP per80 mg,636,1 ,$145.55 ,$96.06 ,$19.13 ,$145.55 , N/A ,$28.69 ,$19.13 ,$38.51 ,$116.44 ,$123.72 ,$90.97 ,$131.00 , N/A , N/A ,$138.27 ,$131.00 ,$123.72 ,$123.72 ,$38.51 ,$123.72 ,$123.72 ,$131.00 ,$88.64 , N/A ,$90.24 , N/A ,$131.00 , N/A ,$133.91 ,$131.00 ,$96.08 ,$96.08 ,$88.64 ,$96.08 ,$94.61 ,$99.44 ,$33.13 ,$114.98 , N/A ,$71.32 ,$71.32 ,$38.51 ,$71.32 , N/A ,$138.27 ,$119.35 ,$119.35 ,$116.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2930,METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG SOLR 1 EACH VIAL per125 mg,636,1 ,$40.58 ,$26.78 ,$8.21 ,$40.58 , N/A ,$12.31 ,$8.21 ,$10.74 ,$32.46 ,$34.49 ,$25.36 ,$36.52 , N/A , N/A ,$38.55 ,$36.52 ,$34.49 ,$34.49 ,$10.74 ,$34.49 ,$34.49 ,$36.52 ,$24.71 , N/A ,$25.16 , N/A ,$36.52 , N/A ,$37.33 ,$36.52 ,$26.79 ,$26.79 ,$24.71 ,$26.79 ,$26.38 ,$27.72 ,$9.23 ,$32.06 , N/A ,$19.88 ,$19.88 ,$10.74 ,$19.88 , N/A ,$38.55 ,$33.28 ,$33.28 ,$32.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2930,METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLR per125 mg,636,1 ,$71.90 ,$47.45 ,$8.21 ,$71.90 , N/A ,$12.31 ,$8.21 ,$19.02 ,$57.52 ,$61.12 ,$44.94 ,$64.71 , N/A , N/A ,$68.31 ,$64.71 ,$61.12 ,$61.12 ,$19.02 ,$61.12 ,$61.12 ,$64.71 ,$43.79 , N/A ,$44.58 , N/A ,$64.71 , N/A ,$66.15 ,$64.71 ,$47.46 ,$47.46 ,$43.79 ,$47.46 ,$46.74 ,$49.12 ,$16.38 ,$56.80 , N/A ,$35.23 ,$35.23 ,$19.02 ,$35.23 , N/A ,$68.31 ,$58.96 ,$58.96 ,$57.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2920,METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLR per40 mg,636,1 ,$49.00 ,$32.34 ,$6.20 ,$49.00 , N/A ,$9.29 ,$6.20 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2930,METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG SOLR 1 EACH VIAL per125 mg,636,1 ,$44.83 ,$29.59 ,$8.21 ,$44.83 , N/A ,$12.31 ,$8.21 ,$11.86 ,$35.86 ,$38.11 ,$28.02 ,$40.35 , N/A , N/A ,$42.59 ,$40.35 ,$38.11 ,$38.11 ,$11.86 ,$38.11 ,$38.11 ,$40.35 ,$27.30 , N/A ,$27.80 , N/A ,$40.35 , N/A ,$41.24 ,$40.35 ,$29.59 ,$29.59 ,$27.30 ,$29.59 ,$29.14 ,$30.63 ,$10.20 ,$35.42 , N/A ,$21.97 ,$21.97 ,$11.86 ,$21.97 , N/A ,$42.59 ,$36.76 ,$36.76 ,$35.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2765,METOCLOPRAMIDE 5 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$1.61 ,$49.00 , N/A ,$2.41 ,$1.61 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2248,MICAFUNGIN 100 MG SOLR per1 mg,636,1 ,$9.31 ,$6.14 ,$1.25 ,$105.15 ,$99.20 ,$1.87 ,$1.25 ,$2.46 ,$7.45 ,$7.91 ,$5.82 ,$8.38 ,$99.20 ,$9.31 ,$8.84 ,$8.38 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.38 ,$5.67 ,$99.20 ,$5.78 ,$9.87 ,$8.38 , N/A ,$8.57 ,$8.38 ,$6.15 ,$6.15 ,$5.67 ,$6.15 ,$6.05 ,$6.36 ,$2.12 ,$7.35 ,$105.15 ,$4.56 ,$4.56 ,$2.46 ,$4.56 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2248,MICAFUNGIN 100 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$9.31 ,$6.14 ,$1.25 ,$105.15 ,$99.20 ,$1.87 ,$1.25 ,$2.46 ,$7.45 ,$7.91 ,$5.82 ,$8.38 ,$99.20 ,$9.31 ,$8.84 ,$8.38 ,$7.91 ,$7.91 ,$2.46 ,$7.91 ,$7.91 ,$8.38 ,$5.67 ,$99.20 ,$5.78 ,$9.87 ,$8.38 , N/A ,$8.57 ,$8.38 ,$6.15 ,$6.15 ,$5.67 ,$6.15 ,$6.05 ,$6.36 ,$2.12 ,$7.35 ,$105.15 ,$4.56 ,$4.56 ,$2.46 ,$4.56 , N/A ,$8.84 ,$7.63 ,$7.63 ,$7.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2248,MICAFUNGIN 50 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$9.32 ,$6.15 ,$1.25 ,$105.15 ,$99.20 ,$1.87 ,$1.25 ,$2.47 ,$7.46 ,$7.92 ,$5.83 ,$8.39 ,$99.20 ,$9.32 ,$8.85 ,$8.39 ,$7.92 ,$7.92 ,$2.47 ,$7.92 ,$7.92 ,$8.39 ,$5.68 ,$99.20 ,$5.78 ,$9.88 ,$8.39 , N/A ,$8.57 ,$8.39 ,$6.15 ,$6.15 ,$5.68 ,$6.15 ,$6.06 ,$6.37 ,$2.12 ,$7.36 ,$105.15 ,$4.57 ,$4.57 ,$2.47 ,$4.57 , N/A ,$8.85 ,$7.64 ,$7.64 ,$7.46 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2250,MIDAZOLAM 100 MG/100ML NS SOLN per1 mg,636,1 ,$2.52 ,$1.66 ,$0.26 ,$2.52 , N/A ,$0.38 ,$0.26 ,$0.67 ,$2.02 ,$2.14 ,$1.58 ,$2.27 , N/A , N/A ,$2.39 ,$2.27 ,$2.14 ,$2.14 ,$0.67 ,$2.14 ,$2.14 ,$2.27 ,$1.53 , N/A ,$1.56 , N/A ,$2.27 , N/A ,$2.32 ,$2.27 ,$1.66 ,$1.66 ,$1.53 ,$1.66 ,$1.64 ,$1.72 ,$0.58 ,$1.99 , N/A ,$1.23 ,$1.23 ,$0.67 ,$1.23 , N/A ,$2.39 ,$2.07 ,$2.07 ,$2.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2250,MIDAZOLAM 100 MG/100ML SOLN 100 ML FLEX CONT per1 mL,636,1 ,$1.93 ,$1.27 ,$0.26 ,$1.93 , N/A ,$0.38 ,$0.26 ,$0.51 ,$1.54 ,$1.64 ,$1.21 ,$1.74 , N/A , N/A ,$1.83 ,$1.74 ,$1.64 ,$1.64 ,$0.51 ,$1.64 ,$1.64 ,$1.74 ,$1.18 , N/A ,$1.20 , N/A ,$1.74 , N/A ,$1.78 ,$1.74 ,$1.27 ,$1.27 ,$1.18 ,$1.27 ,$1.25 ,$1.32 ,$0.43 ,$1.52 , N/A ,$0.95 ,$0.95 ,$0.51 ,$0.95 , N/A ,$1.83 ,$1.58 ,$1.58 ,$1.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2250,MIDAZOLAM 2 MG/2ML SOLN per1 mg,636,1 ,$24.50 ,$16.17 ,$0.26 ,$24.50 , N/A ,$0.38 ,$0.26 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2250,MIDAZOLAM 5 MG/5ML SOLN per1 mg,636,1 ,$9.80 ,$6.47 ,$0.26 ,$9.80 , N/A ,$0.38 ,$0.26 ,$2.60 ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 ,$2.60 ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A ,$6.08 , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$2.22 ,$7.74 , N/A ,$4.80 ,$4.80 ,$2.60 ,$4.80 , N/A ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2250,MIDAZOLAM 50 MG/10ML SOLN 10 ML VIAL per1 mg,636,1 ,$0.87 ,$0.57 ,$0.20 ,$0.87 , N/A ,$0.38 ,$0.26 ,$0.23 ,$0.70 ,$0.74 ,$0.54 ,$0.78 , N/A , N/A ,$0.83 ,$0.78 ,$0.74 ,$0.74 ,$0.23 ,$0.74 ,$0.74 ,$0.78 ,$0.53 , N/A ,$0.54 , N/A ,$0.78 , N/A ,$0.80 ,$0.78 ,$0.57 ,$0.57 ,$0.53 ,$0.57 ,$0.57 ,$0.59 ,$0.20 ,$0.69 , N/A ,$0.43 ,$0.43 ,$0.23 ,$0.43 , N/A ,$0.83 ,$0.71 ,$0.71 ,$0.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2260,MILRINONE 10 MG/10ML SOLN per5 mg,636,1 ,$147.60 ,$97.42 ,$3.18 ,$147.60 , N/A ,$4.77 ,$3.18 ,$39.05 ,$118.08 ,$125.46 ,$92.25 ,$132.84 , N/A , N/A ,$140.22 ,$132.84 ,$125.46 ,$125.46 ,$39.05 ,$125.46 ,$125.46 ,$132.84 ,$89.89 , N/A ,$91.52 , N/A ,$132.84 , N/A ,$135.79 ,$132.84 ,$97.43 ,$97.43 ,$89.89 ,$97.43 ,$95.94 ,$100.84 ,$33.60 ,$116.60 , N/A ,$72.32 ,$72.32 ,$39.05 ,$72.32 , N/A ,$140.22 ,$121.03 ,$121.03 ,$118.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2260,MILRINONE 20-5 MG/100ML-% SOLN per5 mg,636,1 ,$35.71 ,$23.57 ,$3.18 ,$35.71 , N/A ,$4.77 ,$3.18 ,$9.45 ,$28.57 ,$30.35 ,$22.32 ,$32.14 , N/A , N/A ,$33.92 ,$32.14 ,$30.35 ,$30.35 ,$9.45 ,$30.35 ,$30.35 ,$32.14 ,$21.75 , N/A ,$22.14 , N/A ,$32.14 , N/A ,$32.85 ,$32.14 ,$23.57 ,$23.57 ,$21.75 ,$23.57 ,$23.21 ,$24.40 ,$8.12 ,$28.21 , N/A ,$17.50 ,$17.50 ,$9.45 ,$17.50 , N/A ,$33.92 ,$29.28 ,$29.28 ,$28.57 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE (PF) 1 MG/ML SOLN per10 mg,636,1 ,$213.75 ,$141.08 ,$5.01 ,$213.75 , N/A ,$7.52 ,$5.01 ,$56.56 ,$171.00 ,$181.69 ,$133.59 ,$192.38 , N/A , N/A ,$203.06 ,$192.38 ,$181.69 ,$181.69 ,$56.56 ,$181.69 ,$181.69 ,$192.38 ,$130.17 , N/A ,$132.52 , N/A ,$192.38 , N/A ,$196.65 ,$192.38 ,$141.10 ,$141.10 ,$130.17 ,$141.10 ,$138.94 ,$146.03 ,$48.66 ,$168.86 , N/A ,$104.74 ,$104.74 ,$56.56 ,$104.74 , N/A ,$203.06 ,$175.28 ,$175.28 ,$171.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE 1 MG/ML SOLN per10 mg,636,1 ,$134.25 ,$88.61 ,$5.01 ,$134.25 , N/A ,$7.52 ,$5.01 ,$35.52 ,$107.40 ,$114.11 ,$83.91 ,$120.83 , N/A , N/A ,$127.54 ,$120.83 ,$114.11 ,$114.11 ,$35.52 ,$114.11 ,$114.11 ,$120.83 ,$81.76 , N/A ,$83.24 , N/A ,$120.83 , N/A ,$123.51 ,$120.83 ,$88.62 ,$88.62 ,$81.76 ,$88.62 ,$87.26 ,$91.72 ,$30.57 ,$106.06 , N/A ,$65.78 ,$65.78 ,$35.52 ,$65.78 , N/A ,$127.54 ,$110.09 ,$110.09 ,$107.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE 4 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$5.01 ,$49.00 , N/A ,$7.52 ,$5.01 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE 10 MG/ML SOLN 1 ML SYRINGE per10 mg,636,1 ,$49.00 ,$32.34 ,$5.01 ,$49.00 , N/A ,$7.52 ,$5.01 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE 10 MG/ML SOLN 1 ML VIAL per10 mg,636,1 ,$49.00 ,$32.34 ,$5.01 ,$49.00 , N/A ,$7.52 ,$5.01 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE 10 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$5.01 ,$49.00 , N/A ,$7.52 ,$5.01 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE 2 MG/ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$5.01 ,$49.00 , N/A ,$7.52 ,$5.01 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2270,MORPHINE SULFATE 25 MG/ML SOLN 10 ML VIAL per10 mg,636,1 ,$2.28 ,$1.50 ,$0.52 ,$2.28 , N/A ,$2.28 ,$2.28 ,$0.61 ,$1.82 ,$1.94 ,$1.43 ,$2.05 , N/A , N/A ,$2.17 ,$2.05 ,$1.94 ,$1.94 ,$0.61 ,$1.94 ,$1.94 ,$2.05 ,$1.39 , N/A ,$1.42 , N/A ,$2.05 , N/A ,$2.10 ,$2.05 ,$1.51 ,$1.51 ,$1.39 ,$1.51 ,$1.48 ,$1.56 ,$0.52 ,$1.80 , N/A ,$1.12 ,$1.12 ,$0.61 ,$1.12 , N/A ,$2.17 ,$1.87 ,$1.87 ,$1.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3490,MULTIVITAMIN (ADULT MVI) INJ 10 ML VIAL per1 mL,636,1 ,$171.75 ,$113.36 ,$39.10 ,$171.75 , N/A ,$153.92 ,$153.92 ,$45.44 ,$137.40 ,$145.99 ,$107.34 ,$154.58 , N/A , N/A ,$163.16 ,$154.58 ,$145.99 ,$145.99 ,$45.44 ,$145.99 ,$145.99 ,$154.58 ,$104.60 , N/A ,$106.48 , N/A ,$154.58 , N/A ,$158.01 ,$154.58 ,$113.37 ,$113.37 ,$104.60 ,$113.37 ,$111.64 ,$117.34 ,$39.10 ,$135.68 , N/A ,$84.16 ,$84.16 ,$45.44 ,$84.16 , N/A ,$163.16 ,$140.84 ,$140.84 ,$137.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7517,MYCOPHENOLATE 250 MG CAPS per250 mg,636,1 ,$13.48 ,$8.90 ,$0.30 ,$13.48 , N/A ,$0.45 ,$0.30 ,$3.57 ,$10.78 ,$11.46 ,$8.43 ,$12.13 , N/A , N/A ,$12.81 ,$12.13 ,$11.46 ,$11.46 ,$3.57 ,$11.46 ,$11.46 ,$12.13 ,$8.21 , N/A ,$8.36 , N/A ,$12.13 , N/A ,$12.40 ,$12.13 ,$8.90 ,$8.90 ,$8.21 ,$8.90 ,$8.76 ,$9.21 ,$3.07 ,$10.65 , N/A ,$6.61 ,$6.61 ,$3.57 ,$6.61 , N/A ,$12.81 ,$11.05 ,$11.05 ,$10.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7518,MYCOPHENOLATE EC 180 MG TBEC per180 mg,636,1 ,$20.98 ,$13.85 ,$0.96 ,$20.98 , N/A ,$1.44 ,$0.96 ,$5.55 ,$16.78 ,$17.83 ,$13.11 ,$18.88 , N/A , N/A ,$19.93 ,$18.88 ,$17.83 ,$17.83 ,$5.55 ,$17.83 ,$17.83 ,$18.88 ,$12.78 , N/A ,$13.00 , N/A ,$18.88 , N/A ,$19.30 ,$18.88 ,$13.85 ,$13.85 ,$12.78 ,$13.85 ,$13.64 ,$14.33 ,$4.78 ,$16.57 , N/A ,$10.28 ,$10.28 ,$5.55 ,$10.28 , N/A ,$19.93 ,$17.20 ,$17.20 ,$16.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7518,MYCOPHENOLATE EC 360 MG TBEC per180 mg,636,1 ,$15.55 ,$10.26 ,$0.96 ,$15.55 , N/A ,$1.44 ,$0.96 ,$4.12 ,$12.44 ,$13.22 ,$9.72 ,$14.00 , N/A , N/A ,$14.77 ,$14.00 ,$13.22 ,$13.22 ,$4.12 ,$13.22 ,$13.22 ,$14.00 ,$9.47 , N/A ,$9.64 , N/A ,$14.00 , N/A ,$14.31 ,$14.00 ,$10.26 ,$10.26 ,$9.47 ,$10.26 ,$10.11 ,$10.62 ,$3.55 ,$12.28 , N/A ,$7.62 ,$7.62 ,$4.12 ,$7.62 , N/A ,$14.77 ,$12.75 ,$12.75 ,$12.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2300,NALBUPHINE SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.29 ,$49.00 , N/A ,$6.44 ,$4.29 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2310,NALOXONE 0.4 MG/ML SOLN 10 ML VIAL per1 mg,636,1 ,$219.10 ,$144.61 ,$12.11 ,$219.10 , N/A ,$18.16 ,$12.11 ,$57.98 ,$175.28 ,$186.24 ,$136.94 ,$197.19 , N/A , N/A ,$208.15 ,$197.19 ,$186.24 ,$186.24 ,$57.98 ,$186.24 ,$186.24 ,$197.19 ,$133.43 , N/A ,$135.84 , N/A ,$197.19 , N/A ,$201.57 ,$197.19 ,$144.63 ,$144.63 ,$133.43 ,$144.63 ,$142.42 ,$149.69 ,$49.87 ,$173.09 , N/A ,$107.36 ,$107.36 ,$57.98 ,$107.36 , N/A ,$208.15 ,$179.66 ,$179.66 ,$175.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2310,NALOXONE 0.4 MG/ML SOLN per1 mg,636,1 ,$116.85 ,$77.12 ,$12.11 ,$116.85 , N/A ,$18.16 ,$12.11 ,$30.92 ,$93.48 ,$99.32 ,$73.03 ,$105.17 , N/A , N/A ,$111.01 ,$105.17 ,$99.32 ,$99.32 ,$30.92 ,$99.32 ,$99.32 ,$105.17 ,$71.16 , N/A ,$72.44 , N/A ,$105.17 , N/A ,$107.50 ,$105.17 ,$77.13 ,$77.13 ,$71.16 ,$77.13 ,$75.95 ,$79.83 ,$26.61 ,$92.31 , N/A ,$57.26 ,$57.26 ,$30.92 ,$57.26 , N/A ,$111.01 ,$95.82 ,$95.82 ,$93.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2310,NALOXONE 0.4 MG/ML SOLN 1 ML VIAL per1 mg,636,1 ,$116.85 ,$77.12 ,$12.11 ,$116.85 , N/A ,$18.16 ,$12.11 ,$30.92 ,$93.48 ,$99.32 ,$73.03 ,$105.17 , N/A , N/A ,$111.01 ,$105.17 ,$99.32 ,$99.32 ,$30.92 ,$99.32 ,$99.32 ,$105.17 ,$71.16 , N/A ,$72.44 , N/A ,$105.17 , N/A ,$107.50 ,$105.17 ,$77.13 ,$77.13 ,$71.16 ,$77.13 ,$75.95 ,$79.83 ,$26.61 ,$92.31 , N/A ,$57.26 ,$57.26 ,$30.92 ,$57.26 , N/A ,$111.01 ,$95.82 ,$95.82 ,$93.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2310,NALOXONE 2 MG/2ML SOSY 2 ML SYRINGE per1 mg,636,1 ,$121.78 ,$80.37 ,$12.11 ,$121.78 , N/A ,$18.16 ,$12.11 ,$32.22 ,$97.42 ,$103.51 ,$76.11 ,$109.60 , N/A , N/A ,$115.69 ,$109.60 ,$103.51 ,$103.51 ,$32.22 ,$103.51 ,$103.51 ,$109.60 ,$74.16 , N/A ,$75.50 , N/A ,$109.60 , N/A ,$112.04 ,$109.60 ,$80.39 ,$80.39 ,$74.16 ,$80.39 ,$79.16 ,$83.20 ,$27.72 ,$96.21 , N/A ,$59.67 ,$59.67 ,$32.22 ,$59.67 , N/A ,$115.69 ,$99.86 ,$99.86 ,$97.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2710,NEOSTIGMINE 5 MG/5ML SOLN per0.5 mg,636,1 ,$8.17 ,$5.39 ,$1.86 ,$8.17 , N/A ,$7.32 ,$7.32 ,$2.17 ,$6.54 ,$6.94 ,$5.11 ,$7.35 , N/A , N/A ,$7.76 ,$7.35 ,$6.94 ,$6.94 ,$2.17 ,$6.94 ,$6.94 ,$7.35 ,$4.98 , N/A ,$5.06 , N/A ,$7.35 , N/A ,$7.52 ,$7.35 ,$5.39 ,$5.39 ,$4.98 ,$5.39 ,$5.31 ,$5.58 ,$1.86 ,$6.45 , N/A ,$4.00 ,$4.00 ,$2.17 ,$4.00 , N/A ,$7.76 ,$6.70 ,$6.70 ,$6.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2710,NEOSTIGMINE 10 MG/10ML SOLN per0.5 mg,636,1 ,$8.17 ,$5.39 ,$1.86 ,$8.17 , N/A ,$7.32 ,$7.32 ,$2.17 ,$6.54 ,$6.94 ,$5.11 ,$7.35 , N/A , N/A ,$7.76 ,$7.35 ,$6.94 ,$6.94 ,$2.17 ,$6.94 ,$6.94 ,$7.35 ,$4.98 , N/A ,$5.06 , N/A ,$7.35 , N/A ,$7.52 ,$7.35 ,$5.39 ,$5.39 ,$4.98 ,$5.39 ,$5.31 ,$5.58 ,$1.86 ,$6.45 , N/A ,$4.00 ,$4.00 ,$2.17 ,$4.00 , N/A ,$7.76 ,$6.70 ,$6.70 ,$6.54 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2710,NEOSTIGMINE 5 MG/5ML SOSY per0.5 mg,636,1 ,$15.13 ,$9.99 ,$3.44 ,$15.13 , N/A ,$13.56 ,$13.56 ,$4.01 ,$12.10 ,$12.86 ,$9.46 ,$13.62 , N/A , N/A ,$14.37 ,$13.62 ,$12.86 ,$12.86 ,$4.01 ,$12.86 ,$12.86 ,$13.62 ,$9.21 , N/A ,$9.38 , N/A ,$13.62 , N/A ,$13.92 ,$13.62 ,$9.99 ,$9.99 ,$9.21 ,$9.99 ,$9.83 ,$10.34 ,$3.44 ,$11.95 , N/A ,$7.41 ,$7.41 ,$4.01 ,$7.41 , N/A ,$14.37 ,$12.41 ,$12.41 ,$12.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2350,OCRELIZUMAB 300 MG/10ML SOLN 10 ML VIAL per1 mg,636,1 ,$174.41 ,$115.11 ,$39.70 ,"$47,849.05 ","$45,140.61 ",$132.68 ,$88.46 ,$46.15 ,$139.53 ,$148.25 ,$109.01 ,$156.97 ,"$45,140.61 ",$174.41 ,$165.69 ,$156.97 ,$148.25 ,$148.25 ,$46.15 ,$148.25 ,$148.25 ,$156.97 ,$106.22 ,"$45,140.61 ",$108.14 ,$184.87 ,$156.97 ,$132.68 ,$160.46 ,$156.97 ,$115.13 ,$115.13 ,$106.22 ,$115.13 ,$113.37 ,$119.16 ,$39.70 ,$137.78 ,"$47,849.05 ",$85.46 ,$85.46 ,$46.15 ,$85.46 ,$58.97 ,$165.69 ,$143.02 ,$143.02 ,$139.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2354,OCTREOTIDE 100 MCG/ML SOLN 1 ML VIAL per25 mcg,636,1 ,$11.99 ,$7.91 ,$1.74 ,$11.99 , N/A ,$2.61 ,$1.74 ,$3.18 ,$9.59 ,$10.19 ,$7.49 ,$10.79 , N/A , N/A ,$11.39 ,$10.79 ,$10.19 ,$10.19 ,$3.18 ,$10.19 ,$10.19 ,$10.79 ,$7.30 , N/A ,$7.44 , N/A ,$10.79 , N/A ,$11.03 ,$10.79 ,$7.91 ,$7.91 ,$7.30 ,$7.91 ,$7.79 ,$8.19 ,$2.73 ,$9.47 , N/A ,$5.88 ,$5.88 ,$3.18 ,$5.88 , N/A ,$11.39 ,$9.83 ,$9.83 ,$9.59 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2354,OCTREOTIDE 100 MCG/ML SOLN per25 mcg,636,1 ,$49.53 ,$32.69 ,$1.74 ,$49.53 , N/A ,$2.61 ,$1.74 ,$13.10 ,$39.62 ,$42.10 ,$30.96 ,$44.58 , N/A , N/A ,$47.05 ,$44.58 ,$42.10 ,$42.10 ,$13.10 ,$42.10 ,$42.10 ,$44.58 ,$30.16 , N/A ,$30.70 , N/A ,$44.58 , N/A ,$45.57 ,$44.58 ,$32.69 ,$32.69 ,$30.16 ,$32.69 ,$32.19 ,$33.84 ,$11.27 ,$39.13 , N/A ,$24.27 ,$24.27 ,$13.10 ,$24.27 , N/A ,$47.05 ,$40.61 ,$40.61 ,$39.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2354,OCTREOTIDE 50 MCG/ML SOLN per25 mcg,636,1 ,$24.50 ,$16.17 ,$1.74 ,$24.50 , N/A ,$2.61 ,$1.74 ,$6.49 ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 ,$6.49 ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A ,$15.20 , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$5.59 ,$19.36 , N/A ,$12.01 ,$12.01 ,$6.49 ,$12.01 , N/A ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2354,OCTREOTIDE 500 MCG/ML SOLN 1 ML VIAL per25 mcg,636,1 ,$18.34 ,$12.10 ,$1.74 ,$18.34 , N/A ,$2.61 ,$1.74 ,$4.85 ,$14.67 ,$15.59 ,$11.46 ,$16.51 , N/A , N/A ,$17.42 ,$16.51 ,$15.59 ,$15.59 ,$4.85 ,$15.59 ,$15.59 ,$16.51 ,$11.17 , N/A ,$11.38 , N/A ,$16.51 , N/A ,$16.87 ,$16.51 ,$12.11 ,$12.11 ,$11.17 ,$12.11 ,$11.92 ,$12.53 ,$4.17 ,$14.49 , N/A ,$8.99 ,$8.99 ,$4.85 ,$8.99 , N/A ,$17.42 ,$15.04 ,$15.04 ,$14.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2354,OCTREOTIDE 500 MCG/ML SOSY per25 mcg,636,1 ,$14.65 ,$9.67 ,$1.74 ,$14.65 , N/A ,$2.61 ,$1.74 ,$3.88 ,$11.72 ,$12.45 ,$9.16 ,$13.19 , N/A , N/A ,$13.92 ,$13.19 ,$12.45 ,$12.45 ,$3.88 ,$12.45 ,$12.45 ,$13.19 ,$8.92 , N/A ,$9.08 , N/A ,$13.19 , N/A ,$13.48 ,$13.19 ,$9.67 ,$9.67 ,$8.92 ,$9.67 ,$9.52 ,$10.01 ,$3.33 ,$11.57 , N/A ,$7.18 ,$7.18 ,$3.88 ,$7.18 , N/A ,$13.92 ,$12.01 ,$12.01 ,$11.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2405,ONDANSETRON 40 MG/20ML SOLN 2 ML VIAL per1 mg,636,1 ,$12.25 ,$8.09 ,$0.14 ,$12.25 , N/A ,$0.20 ,$0.14 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2405,ONDANSETRON 4 MG/2ML SOLN per1 mg,636,1 ,$12.25 ,$8.09 ,$0.14 ,$12.25 , N/A ,$0.20 ,$0.14 ,$3.24 ,$9.80 ,$10.41 ,$7.66 ,$11.03 , N/A , N/A ,$11.64 ,$11.03 ,$10.41 ,$10.41 ,$3.24 ,$10.41 ,$10.41 ,$11.03 ,$7.46 , N/A ,$7.60 , N/A ,$11.03 , N/A ,$11.27 ,$11.03 ,$8.09 ,$8.09 ,$7.46 ,$8.09 ,$7.96 ,$8.37 ,$2.79 ,$9.68 , N/A ,$6.00 ,$6.00 ,$3.24 ,$6.00 , N/A ,$11.64 ,$10.05 ,$10.05 ,$9.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2407,ORITAVANCIN 400 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$80.43 ,$53.08 ,$18.32 ,"$2,780.37 ","$2,622.99 ",$60.01 ,$40.01 ,$21.29 ,$64.34 ,$68.37 ,$50.27 ,$72.39 ,"$2,622.99 ",$80.43 ,$76.41 ,$72.39 ,$68.37 ,$68.37 ,$21.29 ,$68.37 ,$68.37 ,$72.39 ,$48.98 ,"$2,622.99 ",$49.86 ,$85.26 ,$72.39 ,$60.00 ,$74.00 ,$72.39 ,$53.09 ,$53.09 ,$48.98 ,$53.09 ,$52.28 ,$54.95 ,$18.32 ,$63.54 ,"$2,780.37 ",$39.41 ,$39.41 ,$21.29 ,$39.41 ,$26.67 ,$76.41 ,$65.95 ,$65.95 ,$64.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2360,ORPHENADRINE 30 MG/ML SOLN per60 mg,636,1 ,$115.15 ,$76.00 ,$8.07 ,$115.15 , N/A ,$12.11 ,$8.07 ,$30.47 ,$92.12 ,$97.88 ,$71.97 ,$103.64 , N/A , N/A ,$109.39 ,$103.64 ,$97.88 ,$97.88 ,$30.47 ,$97.88 ,$97.88 ,$103.64 ,$70.13 , N/A ,$71.40 , N/A ,$103.64 , N/A ,$105.94 ,$103.64 ,$76.01 ,$76.01 ,$70.13 ,$76.01 ,$74.85 ,$78.67 ,$26.21 ,$90.97 , N/A ,$56.42 ,$56.42 ,$30.47 ,$56.42 , N/A ,$109.39 ,$94.42 ,$94.42 ,$92.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2590,OXYTOCIN 10 UNIT/ML SOLN 1 ML VIAL per10 Units,636,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2590,OXYTOCIN 10 UNIT/ML SOLN per10 Units,636,1 ,$26.58 ,$17.54 ,$6.05 ,$26.58 , N/A ,$23.82 ,$23.82 ,$7.04 ,$21.26 ,$22.59 ,$16.61 ,$23.92 , N/A , N/A ,$25.25 ,$23.92 ,$22.59 ,$22.59 ,$7.04 ,$22.59 ,$22.59 ,$23.92 ,$16.19 , N/A ,$16.48 , N/A ,$23.92 , N/A ,$24.45 ,$23.92 ,$17.55 ,$17.55 ,$16.19 ,$17.55 ,$17.28 ,$18.16 ,$6.05 ,$21.00 , N/A ,$13.02 ,$13.02 ,$7.04 ,$13.02 , N/A ,$25.25 ,$21.80 ,$21.80 ,$21.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2430,PAMIDRONATE 30 MG/10ML SOLN 10 ML VIAL per30 mg,636,1 ,$199.27 ,$131.52 ,$15.86 ,$199.27 , N/A ,$23.78 ,$15.86 ,$52.72 ,$159.42 ,$169.38 ,$124.54 ,$179.34 , N/A , N/A ,$189.31 ,$179.34 ,$169.38 ,$169.38 ,$52.72 ,$169.38 ,$169.38 ,$179.34 ,$121.36 , N/A ,$123.54 , N/A ,$179.34 , N/A ,$183.33 ,$179.34 ,$131.54 ,$131.54 ,$121.36 ,$131.54 ,$129.53 ,$136.14 ,$45.36 ,$157.42 , N/A ,$97.64 ,$97.64 ,$52.72 ,$97.64 , N/A ,$189.31 ,$163.40 ,$163.40 ,$159.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9113,PANTOPRAZOLE 40 MG SOLR 1 EACH VIAL per1 vial,636,1 ,$52.30 ,$34.52 ,$11.91 ,$52.30 , N/A ,$46.87 ,$46.87 ,$13.84 ,$41.84 ,$44.46 ,$32.69 ,$47.07 , N/A , N/A ,$49.69 ,$47.07 ,$44.46 ,$44.46 ,$13.84 ,$44.46 ,$44.46 ,$47.07 ,$31.85 , N/A ,$32.42 , N/A ,$47.07 , N/A ,$48.12 ,$47.07 ,$34.52 ,$34.52 ,$31.85 ,$34.52 ,$34.00 ,$35.73 ,$11.91 ,$41.32 , N/A ,$25.63 ,$25.63 ,$13.84 ,$25.63 , N/A ,$49.69 ,$42.89 ,$42.89 ,$41.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J9271,PEMBROLIZUMAB 100 MG/4ML SOLN 4 ML VIAL per1 mg,636,1 ,$152.55 ,$100.68 ,$34.73 ,"$15,846.23 ","$14,949.27 ",$124.70 ,$83.13 ,$40.37 ,$122.04 ,$129.67 ,$95.34 ,$137.30 ,"$14,949.27 ",$152.55 ,$144.92 ,$137.30 ,$129.67 ,$129.67 ,$40.37 ,$129.67 ,$129.67 ,$137.30 ,$92.90 ,"$14,949.27 ",$94.58 ,$161.70 ,$137.30 ,$124.69 ,$140.35 ,$137.30 ,$100.70 ,$100.70 ,$92.90 ,$100.70 ,$99.16 ,$104.22 ,$34.73 ,$120.51 ,"$15,846.23 ",$74.75 ,$74.75 ,$40.37 ,$74.75 ,$55.42 ,$144.92 ,$125.09 ,$125.09 ,$122.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0561,PENICILLIN G BENZATHINE 600000 UNIT/ML SUSY per100000 Units,636,1 ,$86.45 ,$57.06 ,$18.59 ,$105.15 ,$99.20 ,$41.83 ,$27.89 ,$22.87 ,$69.16 ,$73.48 ,$54.03 ,$77.81 ,$99.20 ,$86.45 ,$82.13 ,$77.81 ,$73.48 ,$73.48 ,$22.87 ,$73.48 ,$73.48 ,$77.81 ,$52.65 ,$99.20 ,$53.60 ,$91.64 ,$77.81 ,$41.83 ,$79.53 ,$77.81 ,$57.07 ,$57.07 ,$52.65 ,$57.07 ,$56.19 ,$59.06 ,$19.68 ,$68.30 ,$105.15 ,$42.36 ,$42.36 ,$22.87 ,$42.36 ,$18.59 ,$82.13 ,$70.89 ,$70.89 ,$69.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0561,PENICILLIN G BENZATHINE 1200000 UNIT/2ML SUSY per100000 Units,636,1 ,$86.45 ,$57.06 ,$18.59 ,$105.15 ,$99.20 ,$41.83 ,$27.89 ,$22.87 ,$69.16 ,$73.48 ,$54.03 ,$77.81 ,$99.20 ,$86.45 ,$82.13 ,$77.81 ,$73.48 ,$73.48 ,$22.87 ,$73.48 ,$73.48 ,$77.81 ,$52.65 ,$99.20 ,$53.60 ,$91.64 ,$77.81 ,$41.83 ,$79.53 ,$77.81 ,$57.07 ,$57.07 ,$52.65 ,$57.07 ,$56.19 ,$59.06 ,$19.68 ,$68.30 ,$105.15 ,$42.36 ,$42.36 ,$22.87 ,$42.36 ,$18.59 ,$82.13 ,$70.89 ,$70.89 ,$69.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2540,PENICILLIN G POTASSIUM 5000000 UNITS SOLR 1 EACH VIAL per600000 Units,636,1 ,$13.86 ,$9.15 ,$1.14 ,$13.86 , N/A ,$1.71 ,$1.14 ,$3.67 ,$11.09 ,$11.78 ,$8.66 ,$12.47 , N/A , N/A ,$13.17 ,$12.47 ,$11.78 ,$11.78 ,$3.67 ,$11.78 ,$11.78 ,$12.47 ,$8.44 , N/A ,$8.60 , N/A ,$12.47 , N/A ,$12.75 ,$12.47 ,$9.15 ,$9.15 ,$8.44 ,$9.15 ,$9.01 ,$9.47 ,$3.16 ,$10.95 , N/A ,$6.79 ,$6.79 ,$3.67 ,$6.79 , N/A ,$13.17 ,$11.37 ,$11.37 ,$11.09 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2560,PHENOBARBITAL 130 MG/ML SOLN per120 mg,636,1 ,$252.40 ,$166.58 ,$39.03 ,$252.40 , N/A ,$87.82 ,$58.55 ,$66.79 ,$201.92 ,$214.54 ,$157.75 ,$227.16 , N/A , N/A ,$239.78 ,$227.16 ,$214.54 ,$214.54 ,$66.79 ,$214.54 ,$214.54 ,$227.16 ,$153.71 , N/A ,$156.48 , N/A ,$227.16 ,$87.82 ,$232.21 ,$227.16 ,$166.61 ,$166.61 ,$153.71 ,$166.61 ,$164.06 ,$172.44 ,$57.46 ,$199.40 , N/A ,$123.68 ,$123.68 ,$66.79 ,$123.68 ,$39.03 ,$239.78 ,$206.97 ,$206.97 ,$201.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2760,PHENTOLAMINE 5 MG SOLR per5 mg,636,1 ,"$1,852.05 ","$1,222.35 ",$99.20 ,"$1,852.05 ",$99.20 ,"$1,017.95 ",$678.63 ,$490.05 ,"$1,481.64 ","$1,574.24 ","$1,157.53 ","$1,666.85 ",$99.20 ,$99.20 ,"$1,759.45 ","$1,666.85 ","$1,574.24 ","$1,574.24 ",$490.05 ,"$1,574.24 ","$1,574.24 ","$1,666.85 ","$1,127.90 ",$99.20 ,"$1,148.28 ",$105.15 ,"$1,666.85 ","$1,017.94 ","$1,703.89 ","$1,666.85 ","$1,222.54 ","$1,222.54 ","$1,127.90 ","$1,222.54 ","$1,203.83 ","$1,265.32 ",$421.63 ,"$1,463.12 ",$105.15 ,$907.50 ,$907.50 ,$490.05 ,$907.50 ,$452.42 ,"$1,759.45 ","$1,518.68 ","$1,518.68 ","$1,481.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2370,PHENYLEPHRINE 10 MG/ML SOLN 1 ML VIAL per1 mL,636,1 ,$23.62 ,$15.59 ,$5.37 ,$23.62 , N/A ,$21.17 ,$21.17 ,$6.25 ,$18.90 ,$20.08 ,$14.76 ,$21.26 , N/A , N/A ,$22.44 ,$21.26 ,$20.08 ,$20.08 ,$6.25 ,$20.08 ,$20.08 ,$21.26 ,$14.38 , N/A ,$14.64 , N/A ,$21.26 , N/A ,$21.73 ,$21.26 ,$15.59 ,$15.59 ,$14.38 ,$15.59 ,$15.35 ,$16.14 ,$5.37 ,$18.66 , N/A ,$11.57 ,$11.57 ,$6.25 ,$11.57 , N/A ,$22.44 ,$19.37 ,$19.37 ,$18.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2370,PHENYLEPHRINE 10 MG/ML SOLN 5 ML VIAL per1 mL,636,1 ,$32.58 ,$21.50 ,$7.41 ,$32.58 , N/A ,$29.20 ,$29.20 ,$8.62 ,$26.06 ,$27.69 ,$20.36 ,$29.32 , N/A , N/A ,$30.95 ,$29.32 ,$27.69 ,$27.69 ,$8.62 ,$27.69 ,$27.69 ,$29.32 ,$19.84 , N/A ,$20.20 , N/A ,$29.32 , N/A ,$29.97 ,$29.32 ,$21.51 ,$21.51 ,$19.84 ,$21.51 ,$21.18 ,$22.26 ,$7.41 ,$25.74 , N/A ,$15.96 ,$15.96 ,$8.62 ,$15.96 , N/A ,$30.95 ,$26.72 ,$26.72 ,$26.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2370,PHENYLEPHRINE SOLN per1 mL,636,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2370,PHENYLEPHRINE 10 MG/ML SOLN per1 mL,636,1 ,$49.00 ,$32.34 ,$11.15 ,$49.00 , N/A ,$43.91 ,$43.91 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3430,PHYTONADIONE (ADULT) 10 MG/ML SOLN 1 ML AMPULE per1 mg,636,1 ,$31.57 ,$20.84 ,$4.50 ,$31.57 , N/A ,$6.75 ,$4.50 ,$8.35 ,$25.26 ,$26.83 ,$19.73 ,$28.41 , N/A , N/A ,$29.99 ,$28.41 ,$26.83 ,$26.83 ,$8.35 ,$26.83 ,$26.83 ,$28.41 ,$19.23 , N/A ,$19.58 , N/A ,$28.41 , N/A ,$29.04 ,$28.41 ,$20.84 ,$20.84 ,$19.23 ,$20.84 ,$20.52 ,$21.57 ,$7.18 ,$24.94 , N/A ,$15.47 ,$15.47 ,$8.35 ,$15.47 , N/A ,$29.99 ,$25.89 ,$25.89 ,$25.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3430,PHYTONADIONE (PEDS) 1 MG/0.5ML SOLN 0.5 ML SYRINGE per1 mg,636,1 ,$182.55 ,$120.48 ,$4.50 ,$182.55 , N/A ,$6.75 ,$4.50 ,$48.30 ,$146.04 ,$155.17 ,$114.09 ,$164.30 , N/A , N/A ,$173.42 ,$164.30 ,$155.17 ,$155.17 ,$48.30 ,$155.17 ,$155.17 ,$164.30 ,$111.17 , N/A ,$113.18 , N/A ,$164.30 , N/A ,$167.95 ,$164.30 ,$120.50 ,$120.50 ,$111.17 ,$120.50 ,$118.66 ,$124.72 ,$41.56 ,$144.21 , N/A ,$89.45 ,$89.45 ,$48.30 ,$89.45 , N/A ,$173.42 ,$149.69 ,$149.69 ,$146.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3430,PHYTONADIONE 10 MG/ML SOLN per1 mg,636,1 ,$36.14 ,$23.85 ,$4.50 ,$36.14 , N/A ,$6.75 ,$4.50 ,$9.56 ,$28.91 ,$30.72 ,$22.59 ,$32.53 , N/A , N/A ,$34.33 ,$32.53 ,$30.72 ,$30.72 ,$9.56 ,$30.72 ,$30.72 ,$32.53 ,$22.01 , N/A ,$22.40 , N/A ,$32.53 , N/A ,$33.25 ,$32.53 ,$23.86 ,$23.86 ,$22.01 ,$23.86 ,$23.49 ,$24.69 ,$8.22 ,$28.55 , N/A ,$17.71 ,$17.71 ,$9.56 ,$17.71 , N/A ,$34.33 ,$29.63 ,$29.63 ,$28.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2543,PIPERACILLIN-TAZOBACTAM 3-0.375 GM/50ML SOLN per1.125 g,636,1 ,$60.23 ,$39.75 ,$2.01 ,$60.23 , N/A ,$3.02 ,$2.01 ,$15.93 ,$48.18 ,$51.20 ,$37.64 ,$54.21 , N/A , N/A ,$57.22 ,$54.21 ,$51.20 ,$51.20 ,$15.93 ,$51.20 ,$51.20 ,$54.21 ,$36.68 , N/A ,$37.34 , N/A ,$54.21 , N/A ,$55.41 ,$54.21 ,$39.76 ,$39.76 ,$36.68 ,$39.76 ,$39.15 ,$41.15 ,$13.71 ,$47.58 , N/A ,$29.51 ,$29.51 ,$15.93 ,$29.51 , N/A ,$57.22 ,$49.39 ,$49.39 ,$48.18 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2543,PIPERACILLIN-TAZOBACTAM 3.375 (3-0.375) G SOLR 1 EACH VIAL per1.125 g,636,1 ,$44.60 ,$29.44 ,$2.01 ,$44.60 , N/A ,$3.02 ,$2.01 ,$11.80 ,$35.68 ,$37.91 ,$27.88 ,$40.14 , N/A , N/A ,$42.37 ,$40.14 ,$37.91 ,$37.91 ,$11.80 ,$37.91 ,$37.91 ,$40.14 ,$27.16 , N/A ,$27.66 , N/A ,$40.14 , N/A ,$41.03 ,$40.14 ,$29.44 ,$29.44 ,$27.16 ,$29.44 ,$28.99 ,$30.47 ,$10.15 ,$35.23 , N/A ,$21.85 ,$21.85 ,$11.80 ,$21.85 , N/A ,$42.37 ,$36.57 ,$36.57 ,$35.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2543,PIPERACILLIN-TAZOBACTAM 4.5 (4-0.5) G SOLR 1 EACH VIAL per1.125 g,636,1 ,$42.36 ,$27.96 ,$2.01 ,$42.36 , N/A ,$3.02 ,$2.01 ,$11.21 ,$33.89 ,$36.01 ,$26.48 ,$38.12 , N/A , N/A ,$40.24 ,$38.12 ,$36.01 ,$36.01 ,$11.21 ,$36.01 ,$36.01 ,$38.12 ,$25.80 , N/A ,$26.26 , N/A ,$38.12 , N/A ,$38.97 ,$38.12 ,$27.96 ,$27.96 ,$25.80 ,$27.96 ,$27.53 ,$28.94 ,$9.64 ,$33.46 , N/A ,$20.76 ,$20.76 ,$11.21 ,$20.76 , N/A ,$40.24 ,$34.74 ,$34.74 ,$33.89 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90677,PNEUMOCOCCAL 0.5 ML SUSY per0.5 mL,636,1 ,$970.25 ,$640.37 ,$211.32 ,$970.25 ,$211.32 ,$649.49 ,$432.99 ,$256.73 ,$776.20 ,$824.71 ,$606.41 ,$873.23 ,$211.32 ,$211.32 ,$921.74 ,$873.23 ,$824.71 ,$824.71 ,$256.73 ,$824.71 ,$824.71 ,$873.23 ,$590.88 ,$211.32 ,$601.56 ,$224.00 ,$873.23 ,$676.75 ,$892.63 ,$873.23 ,$640.46 ,$640.46 ,$590.88 ,$640.46 ,$630.66 ,$662.87 ,$220.88 ,$766.50 ,$224.00 ,$475.42 ,$475.42 ,$256.73 ,$475.42 ,$300.78 ,$921.74 ,$795.61 ,$795.61 ,$776.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90670,PNEUMOCOCCAL SUSP per0.5 mL,636,1 ,$855.45 ,$564.60 ,$194.75 ,$855.45 ,$211.32 ,$580.48 ,$386.99 ,$226.35 ,$684.36 ,$727.13 ,$534.66 ,$769.91 ,$211.32 ,$211.32 ,$812.68 ,$769.91 ,$727.13 ,$727.13 ,$226.35 ,$727.13 ,$727.13 ,$769.91 ,$520.97 ,$211.32 ,$530.38 ,$224.00 ,$769.91 ,$596.68 ,$787.01 ,$769.91 ,$564.68 ,$564.68 ,$520.97 ,$564.68 ,$556.04 ,$584.44 ,$194.75 ,$675.81 ,$224.00 ,$419.17 ,$419.17 ,$226.35 ,$419.17 ,$265.19 ,$812.68 ,$701.47 ,$701.47 ,$684.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90732,PNEUMOCOCCAL VACCINE 25 MCG/0.5ML INJ per0.5 mL,636,1 ,$555.00 ,$366.30 ,$52.21 ,$555.00 ,$52.21 ,$300.31 ,$200.21 ,$146.85 ,$444.00 ,$471.75 ,$346.88 ,$499.50 ,$52.21 ,$52.21 ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$146.85 ,$471.75 ,$471.75 ,$499.50 ,$338.00 ,$52.21 ,$344.10 ,$55.34 ,$499.50 ,$387.11 ,$510.60 ,$499.50 ,$366.36 ,$366.36 ,$338.00 ,$366.36 ,$360.75 ,$379.18 ,$126.35 ,$438.45 ,$55.34 ,$271.95 ,$271.95 ,$146.85 ,$271.95 ,$172.05 ,$527.25 ,$455.10 ,$455.10 ,$444.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 10 MEQ/100ML SOLN per2 mEq,636,1 ,$13.32 ,$8.79 ,$0.17 ,$13.32 , N/A ,$0.25 ,$0.17 ,$3.53 ,$10.66 ,$11.32 ,$8.33 ,$11.99 , N/A , N/A ,$12.65 ,$11.99 ,$11.32 ,$11.32 ,$3.53 ,$11.32 ,$11.32 ,$11.99 ,$8.11 , N/A ,$8.26 , N/A ,$11.99 , N/A ,$12.25 ,$11.99 ,$8.79 ,$8.79 ,$8.11 ,$8.79 ,$8.66 ,$9.10 ,$3.03 ,$10.52 , N/A ,$6.53 ,$6.53 ,$3.53 ,$6.53 , N/A ,$12.65 ,$10.92 ,$10.92 ,$10.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 20 ML VIAL per2 mEq,636,1 ,$2.45 ,$1.62 ,$0.17 ,$2.45 , N/A ,$0.25 ,$0.17 ,$0.65 ,$1.96 ,$2.08 ,$1.53 ,$2.21 , N/A , N/A ,$2.33 ,$2.21 ,$2.08 ,$2.08 ,$0.65 ,$2.08 ,$2.08 ,$2.21 ,$1.49 , N/A ,$1.52 , N/A ,$2.21 , N/A ,$2.25 ,$2.21 ,$1.62 ,$1.62 ,$1.49 ,$1.62 ,$1.59 ,$1.67 ,$0.56 ,$1.94 , N/A ,$1.20 ,$1.20 ,$0.65 ,$1.20 , N/A ,$2.33 ,$2.01 ,$2.01 ,$1.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 250 ML GLASS CONT per2 mEq,636,1 ,$49.00 ,$32.34 ,$0.17 ,$49.00 , N/A ,$0.25 ,$0.17 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 5 ML VIAL per2 mEq,636,1 ,$9.80 ,$6.47 ,$0.17 ,$9.80 , N/A ,$0.25 ,$0.17 ,$2.60 ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 ,$2.60 ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A ,$6.08 , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$2.22 ,$7.74 , N/A ,$4.80 ,$4.80 ,$2.60 ,$4.80 , N/A ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 2 MEQ/ML SOLN 10 ML VIAL per2 mEq,636,1 ,$9.80 ,$6.47 ,$0.17 ,$9.80 , N/A ,$0.25 ,$0.17 ,$2.60 ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 ,$2.60 ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A ,$6.08 , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$2.22 ,$7.74 , N/A ,$4.80 ,$4.80 ,$2.60 ,$4.80 , N/A ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 20 MEQ/100ML SOLN per2 mEq,636,1 ,$6.78 ,$4.47 ,$0.17 ,$6.78 , N/A ,$0.25 ,$0.17 ,$1.79 ,$5.42 ,$5.76 ,$4.24 ,$6.10 , N/A , N/A ,$6.44 ,$6.10 ,$5.76 ,$5.76 ,$1.79 ,$5.76 ,$5.76 ,$6.10 ,$4.13 , N/A ,$4.20 , N/A ,$6.10 , N/A ,$6.24 ,$6.10 ,$4.48 ,$4.48 ,$4.13 ,$4.48 ,$4.41 ,$4.63 ,$1.55 ,$5.36 , N/A ,$3.32 ,$3.32 ,$1.79 ,$3.32 , N/A ,$6.44 ,$5.56 ,$5.56 ,$5.42 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3480,POTASSIUM CHLORIDE 40 MEQ/100ML SOLN per2 mEq,636,1 ,$3.42 ,$2.26 ,$0.17 ,$3.42 , N/A ,$0.25 ,$0.17 ,$0.90 ,$2.74 ,$2.91 ,$2.14 ,$3.08 , N/A , N/A ,$3.25 ,$3.08 ,$2.91 ,$2.91 ,$0.90 ,$2.91 ,$2.91 ,$3.08 ,$2.08 , N/A ,$2.12 , N/A ,$3.08 , N/A ,$3.15 ,$3.08 ,$2.26 ,$2.26 ,$2.08 ,$2.26 ,$2.22 ,$2.34 ,$0.78 ,$2.70 , N/A ,$1.68 ,$1.68 ,$0.90 ,$1.68 , N/A ,$3.25 ,$2.80 ,$2.80 ,$2.74 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7510,PREDNISOLONE 15 MG/5ML SOLN per5 mg,636,1 ,$13.74 ,$9.07 ,$0.39 ,$13.74 , N/A ,$0.59 ,$0.39 ,$3.64 ,$10.99 ,$11.68 ,$8.59 ,$12.37 , N/A , N/A ,$13.05 ,$12.37 ,$11.68 ,$11.68 ,$3.64 ,$11.68 ,$11.68 ,$12.37 ,$8.37 , N/A ,$8.52 , N/A ,$12.37 , N/A ,$12.64 ,$12.37 ,$9.07 ,$9.07 ,$8.37 ,$9.07 ,$8.93 ,$9.39 ,$3.13 ,$10.85 , N/A ,$6.73 ,$6.73 ,$3.64 ,$6.73 , N/A ,$13.05 ,$11.27 ,$11.27 ,$10.99 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7512,PREDNISONE 1 MG TABS per1 mg,636,1 ,$2.00 ,$1.32 ,$0.02 ,$2.00 , N/A ,$0.02 ,$0.02 ,$0.53 ,$1.60 ,$1.70 ,$1.25 ,$1.80 , N/A , N/A ,$1.90 ,$1.80 ,$1.70 ,$1.70 ,$0.53 ,$1.70 ,$1.70 ,$1.80 ,$1.22 , N/A ,$1.24 , N/A ,$1.80 , N/A ,$1.84 ,$1.80 ,$1.32 ,$1.32 ,$1.22 ,$1.32 ,$1.30 ,$1.37 ,$0.45 ,$1.58 , N/A ,$0.98 ,$0.98 ,$0.53 ,$0.98 , N/A ,$1.90 ,$1.64 ,$1.64 ,$1.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7512,PREDNISONE 20 MG TABS per1 mg,636,1 ,$0.40 ,$0.26 ,$0.02 ,$0.40 , N/A ,$0.02 ,$0.02 ,$0.11 ,$0.32 ,$0.34 ,$0.25 ,$0.36 , N/A , N/A ,$0.38 ,$0.36 ,$0.34 ,$0.34 ,$0.11 ,$0.34 ,$0.34 ,$0.36 ,$0.24 , N/A ,$0.24 , N/A ,$0.36 , N/A ,$0.37 ,$0.36 ,$0.26 ,$0.26 ,$0.24 ,$0.26 ,$0.26 ,$0.27 ,$0.09 ,$0.32 , N/A ,$0.20 ,$0.20 ,$0.11 ,$0.20 , N/A ,$0.38 ,$0.33 ,$0.33 ,$0.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7512,PREDNISONE 10 MG TABS per1 mg,636,1 ,$0.40 ,$0.26 ,$0.02 ,$0.40 , N/A ,$0.02 ,$0.02 ,$0.11 ,$0.32 ,$0.34 ,$0.25 ,$0.36 , N/A , N/A ,$0.38 ,$0.36 ,$0.34 ,$0.34 ,$0.11 ,$0.34 ,$0.34 ,$0.36 ,$0.24 , N/A ,$0.24 , N/A ,$0.36 , N/A ,$0.37 ,$0.36 ,$0.26 ,$0.26 ,$0.24 ,$0.26 ,$0.26 ,$0.27 ,$0.09 ,$0.32 , N/A ,$0.20 ,$0.20 ,$0.11 ,$0.20 , N/A ,$0.38 ,$0.33 ,$0.33 ,$0.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7512,PREDNISONE 5 MG TABS per1 mg,636,1 ,$1.60 ,$1.06 ,$0.02 ,$1.60 , N/A ,$0.02 ,$0.02 ,$0.42 ,$1.28 ,$1.36 ,$1.00 ,$1.44 , N/A , N/A ,$1.52 ,$1.44 ,$1.36 ,$1.36 ,$0.42 ,$1.36 ,$1.36 ,$1.44 ,$0.97 , N/A ,$1.00 , N/A ,$1.44 , N/A ,$1.47 ,$1.44 ,$1.06 ,$1.06 ,$0.97 ,$1.06 ,$1.04 ,$1.09 ,$0.36 ,$1.26 , N/A ,$0.78 ,$0.78 ,$0.42 ,$0.78 , N/A ,$1.52 ,$1.31 ,$1.31 ,$1.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2690,PROCAINAMIDE 500 MG/ML SOLN 2 ML VIAL per1 g,636,1 ,$537.00 ,$354.42 ,$122.25 ,$537.00 , N/A ,$369.83 ,$246.56 ,$142.09 ,$429.60 ,$456.45 ,$335.63 ,$483.30 , N/A , N/A ,$510.15 ,$483.30 ,$456.45 ,$456.45 ,$142.09 ,$456.45 ,$456.45 ,$483.30 ,$327.03 , N/A ,$332.94 , N/A ,$483.30 , N/A ,$494.04 ,$483.30 ,$354.47 ,$354.47 ,$327.03 ,$354.47 ,$349.05 ,$366.88 ,$122.25 ,$424.23 , N/A ,$263.13 ,$263.13 ,$142.09 ,$263.13 , N/A ,$510.15 ,$440.34 ,$440.34 ,$429.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0780,PROCHLORPERAZINE 10 MG/2ML SOLN 2 ML VIAL per10 mg,636,1 ,$132.85 ,$87.68 ,$4.47 ,$132.85 , N/A ,$6.71 ,$4.47 ,$35.15 ,$106.28 ,$112.92 ,$83.03 ,$119.57 , N/A , N/A ,$126.21 ,$119.57 ,$112.92 ,$112.92 ,$35.15 ,$112.92 ,$112.92 ,$119.57 ,$80.91 , N/A ,$82.36 , N/A ,$119.57 , N/A ,$122.22 ,$119.57 ,$87.69 ,$87.69 ,$80.91 ,$87.69 ,$86.35 ,$90.76 ,$30.25 ,$104.95 , N/A ,$65.10 ,$65.10 ,$35.15 ,$65.10 , N/A ,$126.21 ,$108.94 ,$108.94 ,$106.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0780,PROCHLORPERAZINE 10 MG/2ML SOLN per10 mg,636,1 ,$49.00 ,$32.34 ,$4.47 ,$49.00 , N/A ,$6.71 ,$4.47 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2550,PROMETHAZINE 25 MG/ML SOLN per50 mg,636,1 ,$49.00 ,$32.34 ,$4.67 ,$49.00 , N/A ,$7.00 ,$4.67 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2550,PROMETHAZINE 25 MG/ML SOLN 1 ML AMPULE per50 mg,636,1 ,$49.00 ,$32.34 ,$4.67 ,$49.00 , N/A ,$7.00 ,$4.67 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2550,PROMETHAZINE 25 MG/ML SOLN 1 ML VIAL per50 mg,636,1 ,$49.00 ,$32.34 ,$4.67 ,$49.00 , N/A ,$7.00 ,$4.67 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2704,PROPOFOL 1000 MG/100ML EMUL per10 mg,636,1 ,$1.90 ,$1.25 ,$0.20 ,$1.90 , N/A ,$0.29 ,$0.20 ,$0.50 ,$1.52 ,$1.62 ,$1.19 ,$1.71 , N/A , N/A ,$1.81 ,$1.71 ,$1.62 ,$1.62 ,$0.50 ,$1.62 ,$1.62 ,$1.71 ,$1.16 , N/A ,$1.18 , N/A ,$1.71 , N/A ,$1.75 ,$1.71 ,$1.25 ,$1.25 ,$1.16 ,$1.25 ,$1.24 ,$1.30 ,$0.43 ,$1.50 , N/A ,$0.93 ,$0.93 ,$0.50 ,$0.93 , N/A ,$1.81 ,$1.56 ,$1.56 ,$1.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2704,PROPOFOL 200 MG/20ML EMUL per10 mg,636,1 ,$6.57 ,$4.34 ,$0.20 ,$6.57 , N/A ,$0.29 ,$0.20 ,$1.73 ,$5.26 ,$5.58 ,$4.11 ,$5.91 , N/A , N/A ,$6.24 ,$5.91 ,$5.58 ,$5.58 ,$1.73 ,$5.58 ,$5.58 ,$5.91 ,$4.00 , N/A ,$4.08 , N/A ,$5.91 , N/A ,$6.04 ,$5.91 ,$4.34 ,$4.34 ,$4.00 ,$4.34 ,$4.27 ,$4.49 ,$1.50 ,$5.19 , N/A ,$3.22 ,$3.22 ,$1.73 ,$3.22 , N/A ,$6.24 ,$5.39 ,$5.39 ,$5.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2704,PROPOFOL 500 MG/50ML EMUL per10 mg,636,1 ,$2.83 ,$1.87 ,$0.20 ,$2.83 , N/A ,$0.29 ,$0.20 ,$0.74 ,$2.26 ,$2.41 ,$1.77 ,$2.55 , N/A , N/A ,$2.69 ,$2.55 ,$2.41 ,$2.41 ,$0.74 ,$2.41 ,$2.41 ,$2.55 ,$1.72 , N/A ,$1.76 , N/A ,$2.55 , N/A ,$2.60 ,$2.55 ,$1.87 ,$1.87 ,$1.72 ,$1.87 ,$1.84 ,$1.93 ,$0.65 ,$2.24 , N/A ,$1.39 ,$1.39 ,$0.74 ,$1.39 , N/A ,$2.69 ,$2.32 ,$2.32 ,$2.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2720,PROTAMINE 10 MG/ML SOLN 5 ML VIAL per10 mg,636,1 ,$19.87 ,$13.11 ,$1.31 ,$19.87 , N/A ,$1.96 ,$1.31 ,$5.25 ,$15.90 ,$16.89 ,$12.42 ,$17.88 , N/A , N/A ,$18.88 ,$17.88 ,$16.89 ,$16.89 ,$5.25 ,$16.89 ,$16.89 ,$17.88 ,$12.10 , N/A ,$12.32 , N/A ,$17.88 , N/A ,$18.28 ,$17.88 ,$13.12 ,$13.12 ,$12.10 ,$13.12 ,$12.92 ,$13.58 ,$4.53 ,$15.70 , N/A ,$9.74 ,$9.74 ,$5.25 ,$9.74 , N/A ,$18.88 ,$16.29 ,$16.29 ,$15.90 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2720,PROTAMINE 10 MG/ML SOLN per10 mg,636,1 ,$11.91 ,$7.86 ,$1.31 ,$11.91 , N/A ,$1.96 ,$1.31 ,$3.16 ,$9.53 ,$10.12 ,$7.44 ,$10.72 , N/A , N/A ,$11.31 ,$10.72 ,$10.12 ,$10.12 ,$3.16 ,$10.12 ,$10.12 ,$10.72 ,$7.25 , N/A ,$7.38 , N/A ,$10.72 , N/A ,$10.96 ,$10.72 ,$7.86 ,$7.86 ,$7.25 ,$7.86 ,$7.74 ,$8.14 ,$2.71 ,$9.41 , N/A ,$5.84 ,$5.84 ,$3.16 ,$5.84 , N/A ,$11.31 ,$9.77 ,$9.77 ,$9.53 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7168,PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) 500 UNITS KIT per1 Int'l Units,636,1 ,$7.84 ,$5.17 ,$1.78 ,"$4,139.91 ","$3,905.58 ",$7.03 ,$7.03 ,$2.08 ,$6.27 ,$6.66 ,$4.90 ,$7.06 ,"$3,905.58 ",$7.84 ,$7.45 ,$7.06 ,$6.66 ,$6.66 ,$2.08 ,$6.66 ,$6.66 ,$7.06 ,$4.77 ,"$3,905.58 ",$4.86 ,$8.31 ,$7.06 ,$4.91 ,$7.21 ,$7.06 ,$5.18 ,$5.18 ,$4.77 ,$5.18 ,$5.10 ,$5.36 ,$1.78 ,$6.19 ,"$4,139.91 ",$3.84 ,$3.84 ,$2.08 ,$3.84 ,$2.18 ,$7.45 ,$6.43 ,$6.43 ,$6.27 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7168,PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) 1000 UNITS KIT per1 Int'l Units,636,1 ,$7.84 ,$5.17 ,$1.78 ,"$4,139.91 ","$3,905.58 ",$7.03 ,$7.03 ,$2.08 ,$6.27 ,$6.66 ,$4.90 ,$7.06 ,"$3,905.58 ",$7.84 ,$7.45 ,$7.06 ,$6.66 ,$6.66 ,$2.08 ,$6.66 ,$6.66 ,$7.06 ,$4.77 ,"$3,905.58 ",$4.86 ,$8.31 ,$7.06 ,$4.91 ,$7.21 ,$7.06 ,$5.18 ,$5.18 ,$4.77 ,$5.18 ,$5.10 ,$5.36 ,$1.78 ,$6.19 ,"$4,139.91 ",$3.84 ,$3.84 ,$2.08 ,$3.84 ,$2.18 ,$7.45 ,$6.43 ,$6.43 ,$6.27 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3415,PYRIDOXINE 100 MG/ML SOLN 1 ML VIAL per100 mg,636,1 ,$61.15 ,$40.36 ,$8.43 ,$61.15 , N/A ,$12.65 ,$8.43 ,$16.18 ,$48.92 ,$51.98 ,$38.22 ,$55.04 , N/A , N/A ,$58.09 ,$55.04 ,$51.98 ,$51.98 ,$16.18 ,$51.98 ,$51.98 ,$55.04 ,$37.24 , N/A ,$37.92 , N/A ,$55.04 , N/A ,$56.26 ,$55.04 ,$40.37 ,$40.37 ,$37.24 ,$40.37 ,$39.75 ,$41.78 ,$13.92 ,$48.31 , N/A ,$29.96 ,$29.96 ,$16.18 ,$29.96 , N/A ,$58.09 ,$50.14 ,$50.14 ,$48.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90375,RABIES IMMUNE GLOBULIN 1500 UNIT/5ML SOLN 5 ML VIAL per150 Units,636,1 ,$985.55 ,$650.46 ,$224.37 ,"$2,780.37 ","$2,622.99 ",$756.45 ,$504.30 ,$260.78 ,$788.44 ,$837.72 ,$615.97 ,$887.00 ,"$2,622.99 ",$985.55 ,$936.27 ,$887.00 ,$837.72 ,$837.72 ,$260.78 ,$837.72 ,$837.72 ,$887.00 ,$600.20 ,"$2,622.99 ",$611.04 ,"$1,044.68 ",$887.00 ,$756.45 ,$906.71 ,$887.00 ,$650.56 ,$650.56 ,$600.20 ,$650.56 ,$640.61 ,$673.33 ,$224.37 ,$778.58 ,"$2,780.37 ",$482.92 ,$482.92 ,$260.78 ,$482.92 ,$336.20 ,$936.27 ,$808.15 ,$808.15 ,$788.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90375,RABIES IMMUNE GLOBULIN 1500 UNIT/5ML SOLN per150 Units,636,1 ,$911.63 ,$601.68 ,$207.53 ,"$2,780.37 ","$2,622.99 ",$756.45 ,$504.30 ,$241.22 ,$729.30 ,$774.89 ,$569.77 ,$820.47 ,"$2,622.99 ",$911.63 ,$866.05 ,$820.47 ,$774.89 ,$774.89 ,$241.22 ,$774.89 ,$774.89 ,$820.47 ,$555.18 ,"$2,622.99 ",$565.22 ,$966.33 ,$820.47 ,$756.45 ,$838.70 ,$820.47 ,$601.77 ,$601.77 ,$555.18 ,$601.77 ,$592.56 ,$622.83 ,$207.53 ,$720.19 ,"$2,780.37 ",$446.70 ,$446.70 ,$241.22 ,$446.70 ,$336.20 ,$866.05 ,$747.54 ,$747.54 ,$729.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90376,RABIES IMMUNE GLOBULIN 300 UNIT/2ML SOLN per1 mL,636,1 ,"$1,267.20 ",$836.35 ,$288.48 ,"$2,780.37 ","$2,622.99 ",$667.67 ,$445.11 ,$335.30 ,"$1,013.76 ","$1,077.12 ",$792.00 ,"$1,140.48 ","$2,622.99 ","$1,267.20 ","$1,203.84 ","$1,140.48 ","$1,077.12 ","$1,077.12 ",$335.30 ,"$1,077.12 ","$1,077.12 ","$1,140.48 ",$771.72 ,"$2,622.99 ",$785.66 ,"$1,343.23 ","$1,140.48 ",$667.67 ,"$1,165.82 ","$1,140.48 ",$836.48 ,$836.48 ,$771.72 ,$836.48 ,$823.68 ,$865.75 ,$288.48 ,"$1,001.09 ","$2,780.37 ",$620.93 ,$620.93 ,$335.30 ,$620.93 ,$296.74 ,"$1,203.84 ","$1,039.10 ","$1,039.10 ","$1,013.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90375,RABIES IMMUNE GLOBULIN 300 UNIT/ML SOLN per150 Units,636,1 ,$854.15 ,$563.74 ,$194.44 ,"$2,780.37 ","$2,622.99 ",$756.45 ,$504.30 ,$226.01 ,$683.32 ,$726.03 ,$533.84 ,$768.74 ,"$2,622.99 ",$854.15 ,$811.44 ,$768.74 ,$726.03 ,$726.03 ,$226.01 ,$726.03 ,$726.03 ,$768.74 ,$520.18 ,"$2,622.99 ",$529.58 ,$905.40 ,$768.74 ,$756.45 ,$785.82 ,$768.74 ,$563.82 ,$563.82 ,$520.18 ,$563.82 ,$555.20 ,$583.56 ,$194.44 ,$674.78 ,"$2,780.37 ",$418.53 ,$418.53 ,$226.01 ,$418.53 ,$336.20 ,$811.44 ,$700.40 ,$700.40 ,$683.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90675,RABIES VACCINE SUSR per1 mL,636,1 ,"$1,796.70 ","$1,185.82 ",$211.32 ,"$1,796.70 ",$211.32 ,$770.00 ,$513.33 ,$475.41 ,"$1,437.36 ","$1,527.20 ","$1,122.94 ","$1,617.03 ",$211.32 ,$211.32 ,"$1,706.87 ","$1,617.03 ","$1,527.20 ","$1,527.20 ",$475.41 ,"$1,527.20 ","$1,527.20 ","$1,617.03 ","$1,094.19 ",$211.32 ,"$1,113.96 ",$224.00 ,"$1,617.03 ",$770.00 ,"$1,652.96 ","$1,617.03 ","$1,186.00 ","$1,186.00 ","$1,094.19 ","$1,186.00 ","$1,167.86 ","$1,227.51 ",$409.02 ,"$1,419.39 ",$224.00 ,$880.38 ,$880.38 ,$475.41 ,$880.38 ,$342.22 ,"$1,706.87 ","$1,473.29 ","$1,473.29 ","$1,437.36 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2783,RASBURICASE 1.5 MG SOLR 1 EACH VIAL per0.5 mg,636,1 ,"$1,275.93 ",$842.11 ,$290.46 ,"$4,139.91 ","$3,905.58 ",$771.46 ,$514.31 ,$337.61 ,"$1,020.74 ","$1,084.54 ",$797.46 ,"$1,148.34 ","$3,905.58 ","$1,275.93 ","$1,212.13 ","$1,148.34 ","$1,084.54 ","$1,084.54 ",$337.61 ,"$1,084.54 ","$1,084.54 ","$1,148.34 ",$777.04 ,"$3,905.58 ",$791.08 ,"$1,352.49 ","$1,148.34 ",$771.45 ,"$1,173.86 ","$1,148.34 ",$842.24 ,$842.24 ,$777.04 ,$842.24 ,$829.35 ,$871.72 ,$290.46 ,"$1,007.98 ","$4,139.91 ",$625.21 ,$625.21 ,$337.61 ,$625.21 ,$342.87 ,"$1,212.13 ","$1,046.26 ","$1,046.26 ","$1,020.74 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2785,REGADENOSON 0.4 MG/5ML SOLN per0.1 mg,636,1 ,$461.71 ,$304.73 ,$92.99 ,$461.71 , N/A ,$139.48 ,$92.99 ,$122.17 ,$369.37 ,$392.45 ,$288.57 ,$415.54 , N/A , N/A ,$438.62 ,$415.54 ,$392.45 ,$392.45 ,$122.17 ,$392.45 ,$392.45 ,$415.54 ,$281.18 , N/A ,$286.26 , N/A ,$415.54 , N/A ,$424.77 ,$415.54 ,$304.77 ,$304.77 ,$281.18 ,$304.77 ,$300.11 ,$315.44 ,$105.10 ,$364.75 , N/A ,$226.24 ,$226.24 ,$122.17 ,$226.24 , N/A ,$438.62 ,$378.60 ,$378.60 ,$369.37 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2791,RHO D IMMUNE GLOBULIN 1500 UNIT/2ML SOSY per100 Units,636,1 ,$78.91 ,$52.08 ,$7.41 ,$105.15 ,$99.20 ,$11.12 ,$7.41 ,$20.88 ,$63.13 ,$67.07 ,$49.32 ,$71.02 ,$99.20 ,$78.91 ,$74.96 ,$71.02 ,$67.07 ,$67.07 ,$20.88 ,$67.07 ,$67.07 ,$71.02 ,$48.06 ,$99.20 ,$48.92 ,$83.64 ,$71.02 , N/A ,$72.60 ,$71.02 ,$52.09 ,$52.09 ,$48.06 ,$52.09 ,$51.29 ,$53.91 ,$17.96 ,$62.34 ,$105.15 ,$38.67 ,$38.67 ,$20.88 ,$38.67 , N/A ,$74.96 ,$64.71 ,$64.71 ,$63.13 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,RISANKIZUMAB 600 MG/10ML SOLN 10 ML VIAL per10 mL,636,1 ,"$26,861.05 ","$17,728.29 ","$7,107.43 ","$26,861.05 ", N/A ,"$24,072.87 ","$24,072.87 ","$7,107.43 ","$21,488.84 ","$22,831.89 ","$16,788.16 ","$24,174.95 ", N/A , N/A ,"$25,518.00 ","$24,174.95 ","$22,831.89 ","$22,831.89 ","$7,107.43 ","$22,831.89 ","$22,831.89 ","$24,174.95 ","$16,358.38 ", N/A ,"$16,653.86 ", N/A ,"$24,174.95 ","$16,116.63 ","$24,712.17 ","$24,174.95 ","$17,730.98 ","$17,730.98 ","$16,358.38 ","$17,730.98 ","$17,459.68 ","$18,351.47 ", N/A ,"$21,220.23 ", N/A ,"$13,161.91 ","$13,161.91 ","$7,107.43 ","$13,161.91 ", N/A ,"$25,518.00 ","$22,026.06 ","$22,026.06 ","$21,488.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2794,RISPERIDONE MICROSPHERES ER 37.5 MG SRER per0.5 mg,636,1 ,$42.26 ,$27.89 ,$9.62 ,"$1,009.67 ",$952.52 ,$26.08 ,$17.39 ,$11.18 ,$33.81 ,$35.92 ,$26.41 ,$38.03 ,$952.52 ,$42.26 ,$40.15 ,$38.03 ,$35.92 ,$35.92 ,$11.18 ,$35.92 ,$35.92 ,$38.03 ,$25.74 ,$952.52 ,$26.20 ,$44.80 ,$38.03 ,$26.07 ,$38.88 ,$38.03 ,$27.90 ,$27.90 ,$25.74 ,$27.90 ,$27.47 ,$28.87 ,$9.62 ,$33.39 ,"$1,009.67 ",$20.71 ,$20.71 ,$11.18 ,$20.71 ,$11.59 ,$40.15 ,$34.65 ,$34.65 ,$33.81 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q5115,RITUXIMAB-ABBS 100 MG/10ML SOLN 10 ML VIAL per10 mg,636,1 ,$392.71 ,$259.19 ,$47.80 ,"$6,709.17 ","$6,329.41 ",$107.55 ,$71.70 ,$103.91 ,$314.17 ,$333.80 ,$245.44 ,$353.44 ,"$6,329.41 ",$392.71 ,$373.07 ,$353.44 ,$333.80 ,$333.80 ,$103.91 ,$333.80 ,$333.80 ,$353.44 ,$239.16 ,"$6,329.41 ",$243.48 ,$416.27 ,$353.44 ,$107.55 ,$361.29 ,$353.44 ,$259.23 ,$259.23 ,$239.16 ,$259.23 ,$255.26 ,$268.30 ,$89.40 ,$310.24 ,"$6,709.17 ",$192.43 ,$192.43 ,$103.91 ,$192.43 ,$47.80 ,$373.07 ,$322.02 ,$322.02 ,$314.17 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,Q5115,RITUXIMAB-ABBS 100 MG/10ML SOLN 50 ML VIAL per10 mg,636,1 ,$390.65 ,$257.83 ,$47.80 ,"$6,709.17 ","$6,329.41 ",$107.55 ,$71.70 ,$103.37 ,$312.52 ,$332.05 ,$244.16 ,$351.59 ,"$6,329.41 ",$390.65 ,$371.12 ,$351.59 ,$332.05 ,$332.05 ,$103.37 ,$332.05 ,$332.05 ,$351.59 ,$237.91 ,"$6,329.41 ",$242.20 ,$414.09 ,$351.59 ,$107.55 ,$359.40 ,$351.59 ,$257.87 ,$257.87 ,$237.91 ,$257.87 ,$253.92 ,$266.89 ,$88.93 ,$308.61 ,"$6,709.17 ",$191.42 ,$191.42 ,$103.37 ,$191.42 ,$47.80 ,$371.12 ,$320.33 ,$320.33 ,$312.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2795,ROPIVACAINE 0.2 % 2 MG/ML SOLN per1 mg,636,1 ,$0.84 ,$0.55 ,$0.12 ,$0.84 , N/A ,$0.18 ,$0.12 ,$0.23 ,$0.67 ,$0.71 ,$0.53 ,$0.76 , N/A , N/A ,$0.80 ,$0.76 ,$0.71 ,$0.71 ,$0.23 ,$0.71 ,$0.71 ,$0.76 ,$0.51 , N/A ,$0.52 , N/A ,$0.76 , N/A ,$0.77 ,$0.76 ,$0.55 ,$0.55 ,$0.51 ,$0.55 ,$0.55 ,$0.57 ,$0.19 ,$0.66 , N/A ,$0.41 ,$0.41 ,$0.23 ,$0.41 , N/A ,$0.80 ,$0.69 ,$0.69 ,$0.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2795,ROPIVACAINE 0.2 % SOLN per1 mg,636,1 ,$1.45 ,$0.96 ,$0.12 ,$1.45 , N/A ,$0.18 ,$0.12 ,$0.38 ,$1.16 ,$1.23 ,$0.91 ,$1.31 , N/A , N/A ,$1.38 ,$1.31 ,$1.23 ,$1.23 ,$0.38 ,$1.23 ,$1.23 ,$1.31 ,$0.88 , N/A ,$0.90 , N/A ,$1.31 , N/A ,$1.33 ,$1.31 ,$0.96 ,$0.96 ,$0.88 ,$0.96 ,$0.94 ,$0.99 ,$0.32 ,$1.15 , N/A ,$0.71 ,$0.71 ,$0.38 ,$0.71 , N/A ,$1.38 ,$1.19 ,$1.19 ,$1.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2795,ROPIVACAINE 5 MG/ML SOLN 20 ML VIAL per1 mg,636,1 ,$1.07 ,$0.71 ,$0.12 ,$1.07 , N/A ,$0.18 ,$0.12 ,$0.28 ,$0.86 ,$0.91 ,$0.67 ,$0.96 , N/A , N/A ,$1.02 ,$0.96 ,$0.91 ,$0.91 ,$0.28 ,$0.91 ,$0.91 ,$0.96 ,$0.65 , N/A ,$0.66 , N/A ,$0.96 , N/A ,$0.98 ,$0.96 ,$0.71 ,$0.71 ,$0.65 ,$0.71 ,$0.70 ,$0.73 ,$0.24 ,$0.85 , N/A ,$0.52 ,$0.52 ,$0.28 ,$0.52 , N/A ,$1.02 ,$0.88 ,$0.88 ,$0.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2795,ROPIVACAINE 5 MG/ML SOLN 20 ML AMPULE per1 mg,636,1 ,$1.07 ,$0.71 ,$0.12 ,$1.07 , N/A ,$0.18 ,$0.12 ,$0.28 ,$0.86 ,$0.91 ,$0.67 ,$0.96 , N/A , N/A ,$1.02 ,$0.96 ,$0.91 ,$0.91 ,$0.28 ,$0.91 ,$0.91 ,$0.96 ,$0.65 , N/A ,$0.66 , N/A ,$0.96 , N/A ,$0.98 ,$0.96 ,$0.71 ,$0.71 ,$0.65 ,$0.71 ,$0.70 ,$0.73 ,$0.24 ,$0.85 , N/A ,$0.52 ,$0.52 ,$0.28 ,$0.52 , N/A ,$1.02 ,$0.88 ,$0.88 ,$0.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2795,ROPIVACAINE 5 MG/ML SOLN 30 ML VIAL per1 mg,636,1 ,$1.39 ,$0.92 ,$0.12 ,$1.39 , N/A ,$0.18 ,$0.12 ,$0.37 ,$1.11 ,$1.18 ,$0.87 ,$1.25 , N/A , N/A ,$1.32 ,$1.25 ,$1.18 ,$1.18 ,$0.37 ,$1.18 ,$1.18 ,$1.25 ,$0.85 , N/A ,$0.86 , N/A ,$1.25 , N/A ,$1.28 ,$1.25 ,$0.92 ,$0.92 ,$0.85 ,$0.92 ,$0.90 ,$0.95 ,$0.31 ,$1.10 , N/A ,$0.68 ,$0.68 ,$0.37 ,$0.68 , N/A ,$1.32 ,$1.14 ,$1.14 ,$1.11 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2795,ROPIVACAINE 5 MG/ML SOLN per1 mg,636,1 ,$0.39 ,$0.26 ,$0.09 ,$0.39 , N/A ,$0.18 ,$0.12 ,$0.11 ,$0.31 ,$0.33 ,$0.24 ,$0.35 , N/A , N/A ,$0.37 ,$0.35 ,$0.33 ,$0.33 ,$0.11 ,$0.33 ,$0.33 ,$0.35 ,$0.24 , N/A ,$0.24 , N/A ,$0.35 , N/A ,$0.36 ,$0.35 ,$0.26 ,$0.26 ,$0.24 ,$0.26 ,$0.25 ,$0.27 ,$0.09 ,$0.31 , N/A ,$0.19 ,$0.19 ,$0.11 ,$0.19 , N/A ,$0.37 ,$0.32 ,$0.32 ,$0.31 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7999,ROPIVACAINE-CLONIDINE-KETOROLAC 123-0.04-15 MG/50 ML SOSY per50 mL,636,1 ,$369.00 ,$243.54 ,$84.01 ,$369.00 , N/A ,$330.70 ,$330.70 ,$97.64 ,$295.20 ,$313.65 ,$230.63 ,$332.10 , N/A , N/A ,$350.55 ,$332.10 ,$313.65 ,$313.65 ,$97.64 ,$313.65 ,$313.65 ,$332.10 ,$224.72 , N/A ,$228.78 , N/A ,$332.10 , N/A ,$339.48 ,$332.10 ,$243.58 ,$243.58 ,$224.72 ,$243.58 ,$239.85 ,$252.10 ,$84.01 ,$291.51 , N/A ,$180.81 ,$180.81 ,$97.64 ,$180.81 , N/A ,$350.55 ,$302.58 ,$302.58 ,$295.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,SARILUMAB 200 MG/1.14ML SOSY 1.14 ML PEN per200 mg,636,1 ,"$5,375.70 ","$3,547.96 ","$1,422.41 ","$5,375.70 ", N/A ,"$4,817.70 ","$4,817.70 ","$1,422.41 ","$4,300.56 ","$4,569.35 ","$3,359.81 ","$4,838.13 ", N/A , N/A ,"$5,106.92 ","$4,838.13 ","$4,569.35 ","$4,569.35 ","$1,422.41 ","$4,569.35 ","$4,569.35 ","$4,838.13 ","$3,273.80 ", N/A ,"$3,332.94 ", N/A ,"$4,838.13 ","$3,225.42 ","$4,945.64 ","$4,838.13 ","$3,548.50 ","$3,548.50 ","$3,273.80 ","$3,548.50 ","$3,494.21 ","$3,672.68 ", N/A ,"$4,246.80 ", N/A ,"$2,634.09 ","$2,634.09 ","$1,422.41 ","$2,634.09 ", N/A ,"$5,106.92 ","$4,408.07 ","$4,408.07 ","$4,300.56 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2805,SINCALIDE 5 MCG SOLR per5 mcg,636,1 ,$503.85 ,$332.54 ,$99.20 ,$503.85 ,$99.20 ,$261.63 ,$174.42 ,$133.32 ,$403.08 ,$428.27 ,$314.91 ,$453.47 ,$99.20 ,$99.20 ,$478.66 ,$453.47 ,$428.27 ,$428.27 ,$133.32 ,$428.27 ,$428.27 ,$453.47 ,$306.84 ,$99.20 ,$312.38 ,$105.15 ,$453.47 , N/A ,$463.54 ,$453.47 ,$332.59 ,$332.59 ,$306.84 ,$332.59 ,$327.50 ,$344.23 ,$114.71 ,$398.04 ,$105.15 ,$246.89 ,$246.89 ,$133.32 ,$246.89 , N/A ,$478.66 ,$413.16 ,$413.16 ,$403.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J2805,SINCALIDE 5 MCG SOLR 1 EACH VIAL per5 mcg,636,1 ,$503.85 ,$332.54 ,$99.20 ,$503.85 ,$99.20 ,$261.63 ,$174.42 ,$133.32 ,$403.08 ,$428.27 ,$314.91 ,$453.47 ,$99.20 ,$99.20 ,$478.66 ,$453.47 ,$428.27 ,$428.27 ,$133.32 ,$428.27 ,$428.27 ,$453.47 ,$306.84 ,$99.20 ,$312.38 ,$105.15 ,$453.47 , N/A ,$463.54 ,$453.47 ,$332.59 ,$332.59 ,$306.84 ,$332.59 ,$327.50 ,$344.23 ,$114.71 ,$398.04 ,$105.15 ,$246.89 ,$246.89 ,$133.32 ,$246.89 , N/A ,$478.66 ,$413.16 ,$413.16 ,$403.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7030,SODIUM CHLORIDE 0.9% SOLN per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.87 ,$106.00 , N/A ,$5.81 ,$3.87 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7030,SODIUM CHLORIDE 0.9 % SOLN 10 ML VIAL per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.87 ,$106.00 , N/A ,$5.81 ,$3.87 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7030,SODIUM CHLORIDE 0.9 % SOLN 20 ML VIAL per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.87 ,$106.00 , N/A ,$5.81 ,$3.87 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7030,SODIUM CHLORIDE 0.9 % SOLN 50 ML VIAL per1000 mL,636,1 ,$106.00 ,$69.96 ,$3.87 ,$106.00 , N/A ,$5.81 ,$3.87 ,$28.05 ,$84.80 ,$90.10 ,$66.25 ,$95.40 , N/A , N/A ,$100.70 ,$95.40 ,$90.10 ,$90.10 ,$28.05 ,$90.10 ,$90.10 ,$95.40 ,$64.55 , N/A ,$65.72 , N/A ,$95.40 , N/A ,$97.52 ,$95.40 ,$69.97 ,$69.97 ,$64.55 ,$69.97 ,$68.90 ,$72.42 ,$24.13 ,$83.74 , N/A ,$51.94 ,$51.94 ,$28.05 ,$51.94 , N/A ,$100.70 ,$86.92 ,$86.92 ,$84.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7131,SODIUM CHLORIDE 3 % SOLN per1 mL,636,1 ,$0.21 ,$0.14 ,$0.05 ,$0.21 , N/A ,$0.19 ,$0.19 ,$0.06 ,$0.17 ,$0.18 ,$0.13 ,$0.19 , N/A , N/A ,$0.20 ,$0.19 ,$0.18 ,$0.18 ,$0.06 ,$0.18 ,$0.18 ,$0.19 ,$0.13 , N/A ,$0.14 , N/A ,$0.19 , N/A ,$0.19 ,$0.19 ,$0.14 ,$0.14 ,$0.13 ,$0.14 ,$0.14 ,$0.14 ,$0.05 ,$0.17 , N/A ,$0.10 ,$0.10 ,$0.06 ,$0.10 , N/A ,$0.20 ,$0.17 ,$0.17 ,$0.17 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7131,SODIUM CHLORIDE 3% per1 mL,636,1 ,$2.12 ,$1.40 ,$0.48 ,$2.12 , N/A ,$1.90 ,$1.90 ,$0.56 ,$1.70 ,$1.80 ,$1.33 ,$1.91 , N/A , N/A ,$2.01 ,$1.91 ,$1.80 ,$1.80 ,$0.56 ,$1.80 ,$1.80 ,$1.91 ,$1.29 , N/A ,$1.32 , N/A ,$1.91 , N/A ,$1.95 ,$1.91 ,$1.40 ,$1.40 ,$1.29 ,$1.40 ,$1.38 ,$1.45 ,$0.48 ,$1.67 , N/A ,$1.04 ,$1.04 ,$0.56 ,$1.04 , N/A ,$2.01 ,$1.74 ,$1.74 ,$1.70 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0330,SUCCINYLCHOLINE 20 MG/ML SOLN per20 mg,636,1 ,$9.80 ,$6.47 ,$2.22 ,$9.80 , N/A ,$8.78 ,$8.78 ,$2.60 ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 ,$2.60 ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A ,$6.08 , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$2.22 ,$7.74 , N/A ,$4.80 ,$4.80 ,$2.60 ,$4.80 , N/A ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J0330,SUCCINYLCHOLINE 200 MG/10ML SOSY per20 mg,636,1 ,$14.58 ,$9.62 ,$3.31 ,$14.58 , N/A ,$13.07 ,$13.07 ,$3.86 ,$11.66 ,$12.39 ,$9.11 ,$13.12 , N/A , N/A ,$13.85 ,$13.12 ,$12.39 ,$12.39 ,$3.86 ,$12.39 ,$12.39 ,$13.12 ,$8.88 , N/A ,$9.04 , N/A ,$13.12 , N/A ,$13.41 ,$13.12 ,$9.62 ,$9.62 ,$8.88 ,$9.62 ,$9.48 ,$9.96 ,$3.31 ,$11.52 , N/A ,$7.14 ,$7.14 ,$3.86 ,$7.14 , N/A ,$13.85 ,$11.96 ,$11.96 ,$11.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3030,SUMATRIPTAN SUCCINATE 6 MG/0.5ML SOLN per6 mg,636,1 ,$352.75 ,$232.82 ,$80.30 ,$352.75 , N/A ,$316.13 ,$316.13 ,$93.34 ,$282.20 ,$299.84 ,$220.47 ,$317.48 , N/A , N/A ,$335.11 ,$317.48 ,$299.84 ,$299.84 ,$93.34 ,$299.84 ,$299.84 ,$317.48 ,$214.82 , N/A ,$218.70 , N/A ,$317.48 , N/A ,$324.53 ,$317.48 ,$232.85 ,$232.85 ,$214.82 ,$232.85 ,$229.29 ,$241.00 ,$80.30 ,$278.67 , N/A ,$172.85 ,$172.85 ,$93.34 ,$172.85 , N/A ,$335.11 ,$289.26 ,$289.26 ,$282.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7507,TACROLIMUS 1 MG CAPS per1 mg,636,1 ,$15.20 ,$10.03 ,$0.53 ,$15.20 , N/A ,$0.79 ,$0.53 ,$4.02 ,$12.16 ,$12.92 ,$9.50 ,$13.68 , N/A , N/A ,$14.44 ,$13.68 ,$12.92 ,$12.92 ,$4.02 ,$12.92 ,$12.92 ,$13.68 ,$9.26 , N/A ,$9.42 , N/A ,$13.68 , N/A ,$13.98 ,$13.68 ,$10.03 ,$10.03 ,$9.26 ,$10.03 ,$9.88 ,$10.38 ,$3.47 ,$12.01 , N/A ,$7.45 ,$7.45 ,$4.02 ,$7.45 , N/A ,$14.44 ,$12.46 ,$12.46 ,$12.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J7507,TACROLIMUS 0.5 MG CAPS per1 mg,636,1 ,$15.20 ,$10.03 ,$0.53 ,$15.20 , N/A ,$0.79 ,$0.53 ,$4.02 ,$12.16 ,$12.92 ,$9.50 ,$13.68 , N/A , N/A ,$14.44 ,$13.68 ,$12.92 ,$12.92 ,$4.02 ,$12.92 ,$12.92 ,$13.68 ,$9.26 , N/A ,$9.42 , N/A ,$13.68 , N/A ,$13.98 ,$13.68 ,$10.03 ,$10.03 ,$9.26 ,$10.03 ,$9.88 ,$10.38 ,$3.47 ,$12.01 , N/A ,$7.45 ,$7.45 ,$4.02 ,$7.45 , N/A ,$14.44 ,$12.46 ,$12.46 ,$12.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1447,TBO-FILGRASTIM 480 MCG/0.8ML SOSY per1 mcg,636,1 ,$3.15 ,$2.08 ,$0.39 ,$528.18 ,$498.28 ,$0.88 ,$0.59 ,$0.83 ,$2.52 ,$2.68 ,$1.97 ,$2.84 ,$498.28 ,$3.15 ,$2.99 ,$2.84 ,$2.68 ,$2.68 ,$0.83 ,$2.68 ,$2.68 ,$2.84 ,$1.92 ,$498.28 ,$1.96 ,$3.34 ,$2.84 ,$0.87 ,$2.90 ,$2.84 ,$2.08 ,$2.08 ,$1.92 ,$2.08 ,$2.05 ,$2.15 ,$0.72 ,$2.49 ,$528.18 ,$1.54 ,$1.54 ,$0.83 ,$1.54 ,$0.39 ,$2.99 ,$2.58 ,$2.58 ,$2.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1447,TBO-FILGRASTIM 300 MCG/0.5ML SOSY per1 mcg,636,1 ,$3.15 ,$2.08 ,$0.39 ,$528.18 ,$498.28 ,$0.88 ,$0.59 ,$0.83 ,$2.52 ,$2.68 ,$1.97 ,$2.84 ,$498.28 ,$3.15 ,$2.99 ,$2.84 ,$2.68 ,$2.68 ,$0.83 ,$2.68 ,$2.68 ,$2.84 ,$1.92 ,$498.28 ,$1.96 ,$3.34 ,$2.84 ,$0.87 ,$2.90 ,$2.84 ,$2.08 ,$2.08 ,$1.92 ,$2.08 ,$2.05 ,$2.15 ,$0.72 ,$2.49 ,$528.18 ,$1.54 ,$1.54 ,$0.83 ,$1.54 ,$0.39 ,$2.99 ,$2.58 ,$2.58 ,$2.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90715,TDAP 5-2.5-18.5 LF-MCG/0.5 SUSY per0.5 mL,636,1 ,$221.25 ,$146.03 ,$50.37 ,$221.25 ,$52.21 ,$84.67 ,$56.45 ,$58.55 ,$177.00 ,$188.06 ,$138.28 ,$199.13 ,$52.21 ,$52.21 ,$210.19 ,$199.13 ,$188.06 ,$188.06 ,$58.55 ,$188.06 ,$188.06 ,$199.13 ,$134.74 ,$52.21 ,$137.18 ,$55.34 ,$199.13 , N/A ,$203.55 ,$199.13 ,$146.05 ,$146.05 ,$134.74 ,$146.05 ,$143.81 ,$151.16 ,$50.37 ,$174.79 ,$55.34 ,$108.41 ,$108.41 ,$58.55 ,$108.41 , N/A ,$210.19 ,$181.43 ,$181.43 ,$177.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3101,TENECTEPLASE 50 MG KIT per1 mg,636,1 ,$407.36 ,$268.86 ,$92.74 ,"$9,931.67 ","$9,369.50 ",$323.30 ,$215.54 ,$107.79 ,$325.89 ,$346.26 ,$254.60 ,$366.62 ,"$9,369.50 ",$407.36 ,$386.99 ,$366.62 ,$346.26 ,$346.26 ,$107.79 ,$346.26 ,$346.26 ,$366.62 ,$248.08 ,"$9,369.50 ",$252.56 ,$431.80 ,$366.62 ,$323.31 ,$374.77 ,$366.62 ,$268.90 ,$268.90 ,$248.08 ,$268.90 ,$264.78 ,$278.31 ,$92.74 ,$321.81 ,"$9,931.67 ",$199.61 ,$199.61 ,$107.79 ,$199.61 ,$143.69 ,$386.99 ,$334.04 ,$334.04 ,$325.89 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90714,TETANUS  AND  DIPHTHERIA TOXOIDS (ADULT) 5-2 LFU INJ per0.5 mL,636,1 ,$278.00 ,$183.48 ,$43.91 ,$278.00 ,$52.21 ,$65.86 ,$43.91 ,$73.56 ,$222.40 ,$236.30 ,$173.75 ,$250.20 ,$52.21 ,$52.21 ,$264.10 ,$250.20 ,$236.30 ,$236.30 ,$73.56 ,$236.30 ,$236.30 ,$250.20 ,$169.30 ,$52.21 ,$172.36 ,$55.34 ,$250.20 , N/A ,$255.76 ,$250.20 ,$183.51 ,$183.51 ,$169.30 ,$183.51 ,$180.70 ,$189.93 ,$63.29 ,$219.62 ,$55.34 ,$136.22 ,$136.22 ,$73.56 ,$136.22 , N/A ,$264.10 ,$227.96 ,$227.96 ,$222.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J1670,TETANUS IMMUNE GLOBULIN 250 UNIT/ML SOSY per250 Units,636,1 ,"$2,313.00 ","$1,526.58 ",$498.28 ,"$2,313.00 ",$498.28 ,"$1,227.65 ",$818.43 ,$612.02 ,"$1,850.40 ","$1,966.05 ","$1,445.63 ","$2,081.70 ",$498.28 ,$498.28 ,"$2,197.35 ","$2,081.70 ","$1,966.05 ","$1,966.05 ",$612.02 ,"$1,966.05 ","$1,966.05 ","$2,081.70 ","$1,408.62 ",$498.28 ,"$1,434.06 ",$528.18 ,"$2,081.70 ","$1,227.64 ","$2,127.96 ","$2,081.70 ","$1,526.81 ","$1,526.81 ","$1,408.62 ","$1,526.81 ","$1,503.45 ","$1,580.24 ",$526.56 ,"$1,827.27 ",$528.18 ,"$1,133.37 ","$1,133.37 ",$612.02 ,"$1,133.37 ",$545.62 ,"$2,197.35 ","$1,896.66 ","$1,896.66 ","$1,850.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,90714,TETANUS-DIPHTHERIA TOXOIDS TD 2-2 LF/0.5ML SUSP per0.5 mL,636,1 ,$200.50 ,$132.33 ,$43.91 ,$200.50 ,$52.21 ,$65.86 ,$43.91 ,$53.06 ,$160.40 ,$170.43 ,$125.31 ,$180.45 ,$52.21 ,$52.21 ,$190.48 ,$180.45 ,$170.43 ,$170.43 ,$53.06 ,$170.43 ,$170.43 ,$180.45 ,$122.10 ,$52.21 ,$124.32 ,$55.34 ,$180.45 , N/A ,$184.46 ,$180.45 ,$132.35 ,$132.35 ,$122.10 ,$132.35 ,$130.33 ,$136.98 ,$45.65 ,$158.40 ,$55.34 ,$98.25 ,$98.25 ,$53.06 ,$98.25 , N/A ,$190.48 ,$164.41 ,$164.41 ,$160.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3411,THIAMINE 100 MG/ML SOLN per100 mg,636,1 ,$49.00 ,$32.34 ,$3.30 ,$49.00 , N/A ,$4.95 ,$3.30 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3411,THIAMINE 100 MG/ML SOLN 2 ML VIAL per100 mg,636,1 ,$49.00 ,$32.34 ,$3.30 ,$49.00 , N/A ,$4.95 ,$3.30 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3590,THROMBIN (RECOMBINANT) 5000 UNIT SOLR per1 Units,636,1 ,$0.09 ,$0.06 ,$0.02 ,$0.09 , N/A ,$0.08 ,$0.08 ,$0.02 ,$0.07 ,$0.08 ,$0.06 ,$0.08 , N/A , N/A ,$0.09 ,$0.08 ,$0.08 ,$0.08 ,$0.02 ,$0.08 ,$0.08 ,$0.08 ,$0.05 , N/A ,$0.06 , N/A ,$0.08 , N/A ,$0.08 ,$0.08 ,$0.06 ,$0.06 ,$0.05 ,$0.06 ,$0.06 ,$0.06 ,$0.02 ,$0.07 , N/A ,$0.04 ,$0.04 ,$0.02 ,$0.04 , N/A ,$0.09 ,$0.07 ,$0.07 ,$0.07 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3590,THROMBIN 5000 UNIT SOLR 1 EACH VIAL per1 Units,636,1 ,$532.35 ,$351.35 ,$121.19 ,$532.35 , N/A ,$477.09 ,$477.09 ,$140.86 ,$425.88 ,$452.50 ,$332.72 ,$479.12 , N/A , N/A ,$505.73 ,$479.12 ,$452.50 ,$452.50 ,$140.86 ,$452.50 ,$452.50 ,$479.12 ,$324.20 , N/A ,$330.06 , N/A ,$479.12 , N/A ,$489.76 ,$479.12 ,$351.40 ,$351.40 ,$324.20 ,$351.40 ,$346.03 ,$363.70 ,$121.19 ,$420.56 , N/A ,$260.85 ,$260.85 ,$140.86 ,$260.85 , N/A ,$505.73 ,$436.53 ,$436.53 ,$425.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3260,TOBRAMYCIN 1.2 G SOLR per80 mg,636,1 ,$41.00 ,$27.06 ,$3.51 ,$41.00 , N/A ,$5.27 ,$3.51 ,$10.85 ,$32.80 ,$34.85 ,$25.63 ,$36.90 , N/A , N/A ,$38.95 ,$36.90 ,$34.85 ,$34.85 ,$10.85 ,$34.85 ,$34.85 ,$36.90 ,$24.97 , N/A ,$25.42 , N/A ,$36.90 , N/A ,$37.72 ,$36.90 ,$27.06 ,$27.06 ,$24.97 ,$27.06 ,$26.65 ,$28.01 ,$9.33 ,$32.39 , N/A ,$20.09 ,$20.09 ,$10.85 ,$20.09 , N/A ,$38.95 ,$33.62 ,$33.62 ,$32.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3260,TOBRAMYCIN 80 MG/2ML SOLN 2 ML VIAL per80 mg,636,1 ,$49.00 ,$32.34 ,$3.51 ,$49.00 , N/A ,$5.27 ,$3.51 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3262,TOCILIZUMAB 162 MG/0.9ML SOSY 0.9 ML SYRINGE per1 mg,636,1 ,$19.53 ,$12.89 ,$4.44 ,"$2,294.65 ","$2,164.76 ",$13.19 ,$8.79 ,$5.16 ,$15.62 ,$16.60 ,$12.21 ,$17.58 ,"$2,164.76 ",$19.53 ,$18.55 ,$17.58 ,$16.60 ,$16.60 ,$5.16 ,$16.60 ,$16.60 ,$17.58 ,$11.89 ,"$2,164.76 ",$12.10 ,$20.70 ,$17.58 ,$13.19 ,$17.97 ,$17.58 ,$12.89 ,$12.89 ,$11.89 ,$12.89 ,$12.69 ,$13.34 ,$4.44 ,$15.43 ,"$2,294.65 ",$9.57 ,$9.57 ,$5.16 ,$9.57 ,$5.86 ,$18.55 ,$16.01 ,$16.01 ,$15.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3262,TOCILIZUMAB 162 MG/0.9ML SOAJ per1 mg,636,1 ,$19.53 ,$12.89 ,$4.44 ,"$2,294.65 ","$2,164.76 ",$13.19 ,$8.79 ,$5.16 ,$15.62 ,$16.60 ,$12.21 ,$17.58 ,"$2,164.76 ",$19.53 ,$18.55 ,$17.58 ,$16.60 ,$16.60 ,$5.16 ,$16.60 ,$16.60 ,$17.58 ,$11.89 ,"$2,164.76 ",$12.10 ,$20.70 ,$17.58 ,$13.19 ,$17.97 ,$17.58 ,$12.89 ,$12.89 ,$11.89 ,$12.89 ,$12.69 ,$13.34 ,$4.44 ,$15.43 ,"$2,294.65 ",$9.57 ,$9.57 ,$5.16 ,$9.57 ,$5.86 ,$18.55 ,$16.01 ,$16.01 ,$15.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3262,TOCILIZUMAB 400 MG/20ML SOLN 20 ML VIAL per1 mg,636,1 ,$25.05 ,$16.53 ,$5.70 ,"$2,294.65 ","$2,164.76 ",$13.19 ,$8.79 ,$6.62 ,$20.04 ,$21.29 ,$15.66 ,$22.55 ,"$2,164.76 ",$25.05 ,$23.80 ,$22.55 ,$21.29 ,$21.29 ,$6.62 ,$21.29 ,$21.29 ,$22.55 ,$15.26 ,"$2,164.76 ",$15.54 ,$26.55 ,$22.55 ,$13.19 ,$23.05 ,$22.55 ,$16.54 ,$16.54 ,$15.26 ,$16.54 ,$16.28 ,$17.11 ,$5.70 ,$19.79 ,"$2,294.65 ",$12.27 ,$12.27 ,$6.62 ,$12.27 ,$5.86 ,$23.80 ,$20.54 ,$20.54 ,$20.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3262,TOCILIZUMAB 400 MG/20ML SOLN 10 ML VIAL per1 mg,636,1 ,$25.05 ,$16.53 ,$5.70 ,"$2,294.65 ","$2,164.76 ",$13.19 ,$8.79 ,$6.62 ,$20.04 ,$21.29 ,$15.66 ,$22.55 ,"$2,164.76 ",$25.05 ,$23.80 ,$22.55 ,$21.29 ,$21.29 ,$6.62 ,$21.29 ,$21.29 ,$22.55 ,$15.26 ,"$2,164.76 ",$15.54 ,$26.55 ,$22.55 ,$13.19 ,$23.05 ,$22.55 ,$16.54 ,$16.54 ,$15.26 ,$16.54 ,$16.28 ,$17.11 ,$5.70 ,$19.79 ,"$2,294.65 ",$12.27 ,$12.27 ,$6.62 ,$12.27 ,$5.86 ,$23.80 ,$20.54 ,$20.54 ,$20.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3301,TRIAMCINOLONE ACETONIDE 10 MG/ML SUSP 5 ML VIAL per10 mg,636,1 ,$49.00 ,$32.34 ,$1.68 ,$49.00 , N/A ,$2.52 ,$1.68 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3301,TRIAMCINOLONE ACETONIDE 40 MG/ML SUSP per10 mg,636,1 ,$17.28 ,$11.40 ,$1.68 ,$17.28 , N/A ,$2.52 ,$1.68 ,$4.58 ,$13.82 ,$14.69 ,$10.80 ,$15.55 , N/A , N/A ,$16.42 ,$15.55 ,$14.69 ,$14.69 ,$4.58 ,$14.69 ,$14.69 ,$15.55 ,$10.52 , N/A ,$10.72 , N/A ,$15.55 , N/A ,$15.90 ,$15.55 ,$11.41 ,$11.41 ,$10.52 ,$11.41 ,$11.23 ,$11.81 ,$3.93 ,$13.65 , N/A ,$8.47 ,$8.47 ,$4.58 ,$8.47 , N/A ,$16.42 ,$14.17 ,$14.17 ,$13.82 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3358,USTEKINUMAB 130 MG/26ML SOLN 26 ML VIAL per1 mg,636,1 ,$64.18 ,$42.36 ,$12.25 ,"$6,709.17 ","$6,329.41 ",$27.56 ,$18.38 ,$16.98 ,$51.34 ,$54.55 ,$40.11 ,$57.76 ,"$6,329.41 ",$64.18 ,$60.97 ,$57.76 ,$54.55 ,$54.55 ,$16.98 ,$54.55 ,$54.55 ,$57.76 ,$39.09 ,"$6,329.41 ",$39.80 ,$68.03 ,$57.76 ,$27.55 ,$59.05 ,$57.76 ,$42.37 ,$42.37 ,$39.09 ,$42.37 ,$41.72 ,$43.85 ,$14.61 ,$50.70 ,"$6,709.17 ",$31.45 ,$31.45 ,$16.98 ,$31.45 ,$12.25 ,$60.97 ,$52.63 ,$52.63 ,$51.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,N/A,VANCOMYCIN 1 G SOLR,636,1 ,$59.20 ,$39.07 ,$13.48 ,$59.20 , N/A ,$53.06 ,$53.06 ,$15.66 ,$47.36 ,$50.32 ,$37.00 ,$53.28 , N/A , N/A ,$56.24 ,$53.28 ,$50.32 ,$50.32 ,$15.66 ,$50.32 ,$50.32 ,$53.28 ,$36.05 , N/A ,$36.70 , N/A ,$53.28 , N/A ,$54.46 ,$53.28 ,$39.08 ,$39.08 ,$36.05 ,$39.08 ,$38.48 ,$40.45 ,$13.48 ,$46.77 , N/A ,$29.01 ,$29.01 ,$15.66 ,$29.01 , N/A ,$56.24 ,$48.54 ,$48.54 ,$47.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1 G SOLR 1 EACH VIAL per500 mg,636,1 ,$59.20 ,$39.07 ,$3.74 ,$59.20 , N/A ,$5.60 ,$3.74 ,$15.66 ,$47.36 ,$50.32 ,$37.00 ,$53.28 , N/A , N/A ,$56.24 ,$53.28 ,$50.32 ,$50.32 ,$15.66 ,$50.32 ,$50.32 ,$53.28 ,$36.05 , N/A ,$36.70 , N/A ,$53.28 , N/A ,$54.46 ,$53.28 ,$39.08 ,$39.08 ,$36.05 ,$39.08 ,$38.48 ,$40.45 ,$13.48 ,$46.77 , N/A ,$29.01 ,$29.01 ,$15.66 ,$29.01 , N/A ,$56.24 ,$48.54 ,$48.54 ,$47.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1 G SOLR per500 mg,636,1 ,$77.35 ,$51.05 ,$3.74 ,$77.35 , N/A ,$5.60 ,$3.74 ,$20.46 ,$61.88 ,$65.75 ,$48.34 ,$69.62 , N/A , N/A ,$73.48 ,$69.62 ,$65.75 ,$65.75 ,$20.46 ,$65.75 ,$65.75 ,$69.62 ,$47.11 , N/A ,$47.96 , N/A ,$69.62 , N/A ,$71.16 ,$69.62 ,$51.06 ,$51.06 ,$47.11 ,$51.06 ,$50.28 ,$52.85 ,$17.61 ,$61.11 , N/A ,$37.90 ,$37.90 ,$20.46 ,$37.90 , N/A ,$73.48 ,$63.43 ,$63.43 ,$61.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1 GM/200ML SOLN per500 mg,636,1 ,$115.10 ,$75.97 ,$3.74 ,$115.10 , N/A ,$5.60 ,$3.74 ,$30.46 ,$92.08 ,$97.84 ,$71.94 ,$103.59 , N/A , N/A ,$109.35 ,$103.59 ,$97.84 ,$97.84 ,$30.46 ,$97.84 ,$97.84 ,$103.59 ,$70.10 , N/A ,$71.36 , N/A ,$103.59 , N/A ,$105.89 ,$103.59 ,$75.98 ,$75.98 ,$70.10 ,$75.98 ,$74.82 ,$78.64 ,$26.20 ,$90.93 , N/A ,$56.40 ,$56.40 ,$30.46 ,$56.40 , N/A ,$109.35 ,$94.38 ,$94.38 ,$92.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1.25 G SOLR 1 EACH VIAL per500 mg,636,1 ,$49.45 ,$32.64 ,$3.74 ,$49.45 , N/A ,$5.60 ,$3.74 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 , N/A , N/A ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 , N/A ,$30.66 , N/A ,$44.51 , N/A ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$11.25 ,$39.07 , N/A ,$24.23 ,$24.23 ,$13.08 ,$24.23 , N/A ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 10 G SOLR per500 mg,636,1 ,$51.49 ,$33.98 ,$3.74 ,$51.49 , N/A ,$5.60 ,$3.74 ,$13.62 ,$41.19 ,$43.77 ,$32.18 ,$46.34 , N/A , N/A ,$48.92 ,$46.34 ,$43.77 ,$43.77 ,$13.62 ,$43.77 ,$43.77 ,$46.34 ,$31.36 , N/A ,$31.92 , N/A ,$46.34 , N/A ,$47.37 ,$46.34 ,$33.99 ,$33.99 ,$31.36 ,$33.99 ,$33.47 ,$35.18 ,$11.72 ,$40.68 , N/A ,$25.23 ,$25.23 ,$13.62 ,$25.23 , N/A ,$48.92 ,$42.22 ,$42.22 ,$41.19 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1250 MG/250ML SOLN per500 mg,636,1 ,$56.95 ,$37.59 ,$3.74 ,$56.95 , N/A ,$5.60 ,$3.74 ,$15.07 ,$45.56 ,$48.41 ,$35.59 ,$51.26 , N/A , N/A ,$54.10 ,$51.26 ,$48.41 ,$48.41 ,$15.07 ,$48.41 ,$48.41 ,$51.26 ,$34.68 , N/A ,$35.30 , N/A ,$51.26 , N/A ,$52.39 ,$51.26 ,$37.59 ,$37.59 ,$34.68 ,$37.59 ,$37.02 ,$38.91 ,$12.97 ,$44.99 , N/A ,$27.91 ,$27.91 ,$15.07 ,$27.91 , N/A ,$54.10 ,$46.70 ,$46.70 ,$45.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1500 MG/300ML SOLN per500 mg,636,1 ,$74.50 ,$49.17 ,$3.74 ,$74.50 , N/A ,$5.60 ,$3.74 ,$19.72 ,$59.60 ,$63.33 ,$46.56 ,$67.05 , N/A , N/A ,$70.78 ,$67.05 ,$63.33 ,$63.33 ,$19.72 ,$63.33 ,$63.33 ,$67.05 ,$45.37 , N/A ,$46.20 , N/A ,$67.05 , N/A ,$68.54 ,$67.05 ,$49.18 ,$49.18 ,$45.37 ,$49.18 ,$48.43 ,$50.90 ,$16.96 ,$58.86 , N/A ,$36.51 ,$36.51 ,$19.72 ,$36.51 , N/A ,$70.78 ,$61.09 ,$61.09 ,$59.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1750 MG/350ML SOLN per500 mg,636,1 ,$55.63 ,$36.72 ,$3.74 ,$55.63 , N/A ,$5.60 ,$3.74 ,$14.72 ,$44.50 ,$47.29 ,$34.77 ,$50.07 , N/A , N/A ,$52.85 ,$50.07 ,$47.29 ,$47.29 ,$14.72 ,$47.29 ,$47.29 ,$50.07 ,$33.88 , N/A ,$34.50 , N/A ,$50.07 , N/A ,$51.18 ,$50.07 ,$36.72 ,$36.72 ,$33.88 ,$36.72 ,$36.16 ,$38.01 ,$12.66 ,$43.95 , N/A ,$27.26 ,$27.26 ,$14.72 ,$27.26 , N/A ,$52.85 ,$45.62 ,$45.62 ,$44.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 2000 MG/400ML SOLN per500 mg,636,1 ,$59.39 ,$39.20 ,$3.74 ,$59.39 , N/A ,$5.60 ,$3.74 ,$15.72 ,$47.51 ,$50.48 ,$37.12 ,$53.45 , N/A , N/A ,$56.42 ,$53.45 ,$50.48 ,$50.48 ,$15.72 ,$50.48 ,$50.48 ,$53.45 ,$36.17 , N/A ,$36.82 , N/A ,$53.45 , N/A ,$54.64 ,$53.45 ,$39.20 ,$39.20 ,$36.17 ,$39.20 ,$38.60 ,$40.58 ,$13.52 ,$46.92 , N/A ,$29.10 ,$29.10 ,$15.72 ,$29.10 , N/A ,$56.42 ,$48.70 ,$48.70 ,$47.51 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 500 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$59.35 ,$39.17 ,$3.74 ,$59.35 , N/A ,$5.60 ,$3.74 ,$15.70 ,$47.48 ,$50.45 ,$37.09 ,$53.42 , N/A , N/A ,$56.38 ,$53.42 ,$50.45 ,$50.45 ,$15.70 ,$50.45 ,$50.45 ,$53.42 ,$36.14 , N/A ,$36.80 , N/A ,$53.42 , N/A ,$54.60 ,$53.42 ,$39.18 ,$39.18 ,$36.14 ,$39.18 ,$38.58 ,$40.55 ,$13.51 ,$46.89 , N/A ,$29.08 ,$29.08 ,$15.70 ,$29.08 , N/A ,$56.38 ,$48.67 ,$48.67 ,$47.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 1.5 G SOLR 1 EACH VIAL per500 mg,636,1 ,$59.35 ,$39.17 ,$3.74 ,$59.35 , N/A ,$5.60 ,$3.74 ,$15.70 ,$47.48 ,$50.45 ,$37.09 ,$53.42 , N/A , N/A ,$56.38 ,$53.42 ,$50.45 ,$50.45 ,$15.70 ,$50.45 ,$50.45 ,$53.42 ,$36.14 , N/A ,$36.80 , N/A ,$53.42 , N/A ,$54.60 ,$53.42 ,$39.18 ,$39.18 ,$36.14 ,$39.18 ,$38.58 ,$40.55 ,$13.51 ,$46.89 , N/A ,$29.08 ,$29.08 ,$15.70 ,$29.08 , N/A ,$56.38 ,$48.67 ,$48.67 ,$47.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 500 MG SOLR per500 mg,636,1 ,$49.00 ,$32.34 ,$3.74 ,$49.00 , N/A ,$5.60 ,$3.74 ,$12.97 ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 ,$12.97 ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A ,$30.38 , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$11.15 ,$38.71 , N/A ,$24.01 ,$24.01 ,$12.97 ,$24.01 , N/A ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 750 MG SOLR 1 EACH VIAL per500 mg,636,1 ,$36.33 ,$23.98 ,$3.74 ,$36.33 , N/A ,$5.60 ,$3.74 ,$9.61 ,$29.06 ,$30.88 ,$22.71 ,$32.70 , N/A , N/A ,$34.51 ,$32.70 ,$30.88 ,$30.88 ,$9.61 ,$30.88 ,$30.88 ,$32.70 ,$22.13 , N/A ,$22.52 , N/A ,$32.70 , N/A ,$33.42 ,$32.70 ,$23.98 ,$23.98 ,$22.13 ,$23.98 ,$23.61 ,$24.82 ,$8.27 ,$28.70 , N/A ,$17.80 ,$17.80 ,$9.61 ,$17.80 , N/A ,$34.51 ,$29.79 ,$29.79 ,$29.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3370,VANCOMYCIN 750-5 MG/150ML-% SOLN per500 mg,636,1 ,$60.20 ,$39.73 ,$3.74 ,$60.20 , N/A ,$5.60 ,$3.74 ,$15.92 ,$48.16 ,$51.17 ,$37.63 ,$54.18 , N/A , N/A ,$57.19 ,$54.18 ,$51.17 ,$51.17 ,$15.92 ,$51.17 ,$51.17 ,$54.18 ,$36.66 , N/A ,$37.32 , N/A ,$54.18 , N/A ,$55.38 ,$54.18 ,$39.74 ,$39.74 ,$36.66 ,$39.74 ,$39.13 ,$41.13 ,$13.71 ,$47.56 , N/A ,$29.50 ,$29.50 ,$15.92 ,$29.50 , N/A ,$57.19 ,$49.36 ,$49.36 ,$48.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,VASOPRESSIN 20 UNIT/ML SOLN per1 mL,636,1 ,"$1,006.70 ",$664.42 ,$266.37 ,"$1,006.70 ", N/A ,$902.20 ,$902.20 ,$266.37 ,$805.36 ,$855.70 ,$629.19 ,$906.03 , N/A , N/A ,$956.37 ,$906.03 ,$855.70 ,$855.70 ,$266.37 ,$855.70 ,$855.70 ,$906.03 ,$613.08 , N/A ,$624.16 , N/A ,$906.03 ,$604.02 ,$926.16 ,$906.03 ,$664.52 ,$664.52 ,$613.08 ,$664.52 ,$654.36 ,$687.78 , N/A ,$795.29 , N/A ,$493.28 ,$493.28 ,$266.37 ,$493.28 , N/A ,$956.37 ,$825.49 ,$825.49 ,$805.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,VASOPRESSIN 20 UNIT/ML SOLN 1 ML VIAL per1 mL,636,1 ,"$1,006.70 ",$664.42 ,$266.37 ,"$1,006.70 ", N/A ,$902.20 ,$902.20 ,$266.37 ,$805.36 ,$855.70 ,$629.19 ,$906.03 , N/A , N/A ,$956.37 ,$906.03 ,$855.70 ,$855.70 ,$266.37 ,$855.70 ,$855.70 ,$906.03 ,$613.08 , N/A ,$624.16 , N/A ,$906.03 ,$604.02 ,$926.16 ,$906.03 ,$664.52 ,$664.52 ,$613.08 ,$664.52 ,$654.36 ,$687.78 , N/A ,$795.29 , N/A ,$493.28 ,$493.28 ,$266.37 ,$493.28 , N/A ,$956.37 ,$825.49 ,$825.49 ,$805.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,C9399,VASOPRESSIN 20 UNITS/ML per20 Units,636,1 ,"$1,598.55 ","$1,055.04 ",$422.98 ,"$1,598.55 ", N/A ,"$1,432.62 ","$1,432.62 ",$422.98 ,"$1,278.84 ","$1,358.77 ",$999.09 ,"$1,438.70 ", N/A , N/A ,"$1,518.62 ","$1,438.70 ","$1,358.77 ","$1,358.77 ",$422.98 ,"$1,358.77 ","$1,358.77 ","$1,438.70 ",$973.52 , N/A ,$991.10 , N/A ,"$1,438.70 ",$959.13 ,"$1,470.67 ","$1,438.70 ","$1,055.20 ","$1,055.20 ",$973.52 ,"$1,055.20 ","$1,039.06 ","$1,092.13 ", N/A ,"$1,262.85 ", N/A ,$783.29 ,$783.29 ,$422.98 ,$783.29 , N/A ,"$1,518.62 ","$1,310.81 ","$1,310.81 ","$1,278.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3380,VEDOLIZUMAB 300 MG SOLR 1 EACH VIAL per1 mg,636,1 ,$75.59 ,$49.89 ,$17.21 ,"$9,931.67 ","$9,369.50 ",$49.14 ,$32.76 ,$20.00 ,$60.47 ,$64.25 ,$47.24 ,$68.03 ,"$9,369.50 ",$75.59 ,$71.81 ,$68.03 ,$64.25 ,$64.25 ,$20.00 ,$64.25 ,$64.25 ,$68.03 ,$46.03 ,"$9,369.50 ",$46.86 ,$80.13 ,$68.03 ,$49.14 ,$69.54 ,$68.03 ,$49.90 ,$49.90 ,$46.03 ,$49.90 ,$49.13 ,$51.64 ,$17.21 ,$59.72 ,"$9,931.67 ",$37.04 ,$37.04 ,$20.00 ,$37.04 ,$21.84 ,$71.81 ,$61.98 ,$61.98 ,$60.47 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3465,VORICONAZOLE 200 MG SOLR 1 EACH VIAL per10 mg,636,1 ,$37.34 ,$24.64 ,$1.41 ,$37.34 , N/A ,$2.12 ,$1.41 ,$9.88 ,$29.87 ,$31.74 ,$23.34 ,$33.61 , N/A , N/A ,$35.47 ,$33.61 ,$31.74 ,$31.74 ,$9.88 ,$31.74 ,$31.74 ,$33.61 ,$22.74 , N/A ,$23.16 , N/A ,$33.61 , N/A ,$34.35 ,$33.61 ,$24.65 ,$24.65 ,$22.74 ,$24.65 ,$24.27 ,$25.51 ,$8.51 ,$29.50 , N/A ,$18.30 ,$18.30 ,$9.88 ,$18.30 , N/A ,$35.47 ,$30.62 ,$30.62 ,$29.87 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3486,ZIPRASIDONE 20 MG SOLR per10 mg,636,1 ,$211.65 ,$139.69 ,$15.18 ,$211.65 , N/A ,$22.77 ,$15.18 ,$56.01 ,$169.32 ,$179.90 ,$132.28 ,$190.49 , N/A , N/A ,$201.07 ,$190.49 ,$179.90 ,$179.90 ,$56.01 ,$179.90 ,$179.90 ,$190.49 ,$128.89 , N/A ,$131.22 , N/A ,$190.49 , N/A ,$194.72 ,$190.49 ,$139.71 ,$139.71 ,$128.89 ,$139.71 ,$137.57 ,$144.60 ,$48.19 ,$167.20 , N/A ,$103.71 ,$103.71 ,$56.01 ,$103.71 , N/A ,$201.07 ,$173.55 ,$173.55 ,$169.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3489,ZOLEDRONIC ACID 4 MG/100ML SOLN per1 mg,636,1 ,$332.10 ,$219.19 ,$12.15 ,$332.10 , N/A ,$18.23 ,$12.15 ,$87.88 ,$265.68 ,$282.29 ,$207.56 ,$298.89 , N/A , N/A ,$315.50 ,$298.89 ,$282.29 ,$282.29 ,$87.88 ,$282.29 ,$282.29 ,$298.89 ,$202.25 , N/A ,$205.90 , N/A ,$298.89 , N/A ,$305.53 ,$298.89 ,$219.22 ,$219.22 ,$202.25 ,$219.22 ,$215.87 ,$226.89 ,$75.60 ,$262.36 , N/A ,$162.73 ,$162.73 ,$87.88 ,$162.73 , N/A ,$315.50 ,$272.32 ,$272.32 ,$265.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3489,ZOLEDRONIC ACID 4 MG/5ML CONC 5 ML VIAL per1 mg,636,1 ,$869.75 ,$574.04 ,$12.15 ,$869.75 , N/A ,$18.23 ,$12.15 ,$230.13 ,$695.80 ,$739.29 ,$543.59 ,$782.78 , N/A , N/A ,$826.26 ,$782.78 ,$739.29 ,$739.29 ,$230.13 ,$739.29 ,$739.29 ,$782.78 ,$529.68 , N/A ,$539.24 , N/A ,$782.78 , N/A ,$800.17 ,$782.78 ,$574.12 ,$574.12 ,$529.68 ,$574.12 ,$565.34 ,$594.21 ,$198.00 ,$687.10 , N/A ,$426.18 ,$426.18 ,$230.13 ,$426.18 , N/A ,$826.26 ,$713.20 ,$713.20 ,$695.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600002,J3489,ZOLEDRONIC ACID 5 MG/100ML SOLN per1 mg,636,1 ,$442.80 ,$292.25 ,$12.15 ,$442.80 , N/A ,$18.23 ,$12.15 ,$117.17 ,$354.24 ,$376.38 ,$276.75 ,$398.52 , N/A , N/A ,$420.66 ,$398.52 ,$376.38 ,$376.38 ,$117.17 ,$376.38 ,$376.38 ,$398.52 ,$269.67 , N/A ,$274.54 , N/A ,$398.52 , N/A ,$407.38 ,$398.52 ,$292.29 ,$292.29 ,$269.67 ,$292.29 ,$287.82 ,$302.52 ,$100.80 ,$349.81 , N/A ,$216.97 ,$216.97 ,$117.17 ,$216.97 , N/A ,$420.66 ,$363.10 ,$363.10 ,$354.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600009,Q4186,HC EPIFIX PER SQ CM,636,1 ,$857.86 ,$566.19 ,$195.29 ,$857.86 , N/A ,$338.33 ,$225.56 ,$226.99 ,$686.29 ,$729.18 ,$536.16 ,$772.07 , N/A , N/A ,$814.97 ,$772.07 ,$729.18 ,$729.18 ,$226.99 ,$729.18 ,$729.18 ,$772.07 ,$522.44 , N/A ,$531.88 , N/A ,$772.07 , N/A ,$789.23 ,$772.07 ,$566.27 ,$566.27 ,$522.44 ,$566.27 ,$557.61 ,$586.09 ,$195.29 ,$677.71 , N/A ,$420.35 ,$420.35 ,$226.99 ,$420.35 , N/A ,$814.97 ,$703.45 ,$703.45 ,$686.29 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9963,DIATRIZOATE MEGLUMINE  AND  SODIUM 66-10 % SOLN per1 mL,636,1 ,$2.08 ,$1.37 ,$0.32 ,$2.08 , N/A ,$0.47 ,$0.32 ,$0.55 ,$1.66 ,$1.77 , N/A ,$1.87 , N/A , N/A ,$1.98 ,$1.87 ,$1.77 ,$1.77 ,$0.55 ,$1.77 ,$1.77 ,$1.87 ,$1.27 , N/A ,$1.28 , N/A ,$1.87 , N/A ,$1.91 ,$1.87 ,$1.37 ,$1.37 ,$1.27 ,$1.37 ,$1.35 ,$1.42 ,$0.47 ,$1.64 , N/A ,$1.02 ,$1.02 ,$0.55 ,$1.02 , N/A ,$1.98 ,$1.71 ,$1.71 ,$1.66 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9958,DIATRIZOATE MEGLUMINE 18 % SOLN per1 mL,636,1 ,$0.28 ,$0.18 ,$0.06 ,$0.28 , N/A ,$0.18 ,$0.12 ,$0.08 ,$0.22 ,$0.24 , N/A ,$0.25 , N/A , N/A ,$0.27 ,$0.25 ,$0.24 ,$0.24 ,$0.08 ,$0.24 ,$0.24 ,$0.25 ,$0.17 , N/A ,$0.18 , N/A ,$0.25 , N/A ,$0.26 ,$0.25 ,$0.18 ,$0.18 ,$0.17 ,$0.18 ,$0.18 ,$0.19 ,$0.06 ,$0.22 , N/A ,$0.14 ,$0.14 ,$0.08 ,$0.14 , N/A ,$0.27 ,$0.23 ,$0.23 ,$0.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9958,DIATRIZOATE MEGLUMINE 30 % SOLN per1 mL,636,1 ,$0.48 ,$0.32 ,$0.11 ,$0.48 , N/A ,$0.18 ,$0.12 ,$0.13 ,$0.38 ,$0.41 , N/A ,$0.43 , N/A , N/A ,$0.46 ,$0.43 ,$0.41 ,$0.41 ,$0.13 ,$0.41 ,$0.41 ,$0.43 ,$0.29 , N/A ,$0.30 , N/A ,$0.43 , N/A ,$0.44 ,$0.43 ,$0.32 ,$0.32 ,$0.29 ,$0.32 ,$0.31 ,$0.33 ,$0.11 ,$0.38 , N/A ,$0.24 ,$0.24 ,$0.13 ,$0.24 , N/A ,$0.46 ,$0.39 ,$0.39 ,$0.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN 10 ML VIAL per1 mL,636,1 ,$15.01 ,$9.91 ,$2.75 ,$15.01 , N/A ,$4.12 ,$2.75 ,$3.97 ,$12.01 ,$12.76 , N/A ,$13.51 , N/A , N/A ,$14.26 ,$13.51 ,$12.76 ,$12.76 ,$3.97 ,$12.76 ,$12.76 ,$13.51 ,$9.14 , N/A ,$9.30 , N/A ,$13.51 , N/A ,$13.81 ,$13.51 ,$9.91 ,$9.91 ,$9.14 ,$9.91 ,$9.76 ,$10.25 ,$3.41 ,$11.86 , N/A ,$7.35 ,$7.35 ,$3.97 ,$7.35 , N/A ,$14.26 ,$12.31 ,$12.31 ,$12.01 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN 15 ML VIAL per1 mL,636,1 ,$14.64 ,$9.66 ,$2.75 ,$14.64 , N/A ,$4.12 ,$2.75 ,$3.87 ,$11.71 ,$12.44 , N/A ,$13.18 , N/A , N/A ,$13.91 ,$13.18 ,$12.44 ,$12.44 ,$3.87 ,$12.44 ,$12.44 ,$13.18 ,$8.92 , N/A ,$9.08 , N/A ,$13.18 , N/A ,$13.47 ,$13.18 ,$9.66 ,$9.66 ,$8.92 ,$9.66 ,$9.52 ,$10.00 ,$3.33 ,$11.57 , N/A ,$7.17 ,$7.17 ,$3.87 ,$7.17 , N/A ,$13.91 ,$12.00 ,$12.00 ,$11.71 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN 5 ML VIAL per1 mL,636,1 ,$15.30 ,$10.10 ,$2.75 ,$15.30 , N/A ,$4.12 ,$2.75 ,$4.05 ,$12.24 ,$13.01 , N/A ,$13.77 , N/A , N/A ,$14.54 ,$13.77 ,$13.01 ,$13.01 ,$4.05 ,$13.01 ,$13.01 ,$13.77 ,$9.32 , N/A ,$9.48 , N/A ,$13.77 , N/A ,$14.08 ,$13.77 ,$10.10 ,$10.10 ,$9.32 ,$10.10 ,$9.95 ,$10.45 ,$3.49 ,$12.09 , N/A ,$7.50 ,$7.50 ,$4.05 ,$7.50 , N/A ,$14.54 ,$12.55 ,$12.55 ,$12.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,A9577,GADOBENATE DIMEGLUMINE 529 MG/ML SOLN per1 mL,636,1 ,$13.56 ,$8.95 ,$2.75 ,$13.56 , N/A ,$4.12 ,$2.75 ,$3.59 ,$10.85 ,$11.53 , N/A ,$12.20 , N/A , N/A ,$12.88 ,$12.20 ,$11.53 ,$11.53 ,$3.59 ,$11.53 ,$11.53 ,$12.20 ,$8.26 , N/A ,$8.40 , N/A ,$12.20 , N/A ,$12.48 ,$12.20 ,$8.95 ,$8.95 ,$8.26 ,$8.95 ,$8.81 ,$9.26 ,$3.09 ,$10.71 , N/A ,$6.64 ,$6.64 ,$3.59 ,$6.64 , N/A ,$12.88 ,$11.12 ,$11.12 ,$10.85 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,A9581,GADOXETATE DISODIUM 0.25 MOL/L SOLN per1 mL,636,1 ,$36.63 ,$24.18 ,$8.33 ,$36.63 , N/A ,$33.10 ,$22.07 ,$9.69 ,$29.30 ,$31.14 , N/A ,$32.97 , N/A , N/A ,$34.80 ,$32.97 ,$31.14 ,$31.14 ,$9.69 ,$31.14 ,$31.14 ,$32.97 ,$22.31 , N/A ,$22.72 , N/A ,$32.97 , N/A ,$33.70 ,$32.97 ,$24.18 ,$24.18 ,$22.31 ,$24.18 ,$23.81 ,$25.03 ,$8.33 ,$28.94 , N/A ,$17.95 ,$17.95 ,$9.69 ,$17.95 , N/A ,$34.80 ,$30.04 ,$30.04 ,$29.30 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9966,IOPAMIDOL 41 % SOLN per1 mL,636,1 ,$11.43 ,$7.54 ,$0.77 ,$11.43 , N/A ,$1.15 ,$0.77 ,$3.03 ,$9.14 ,$9.72 , N/A ,$10.29 , N/A , N/A ,$10.86 ,$10.29 ,$9.72 ,$9.72 ,$3.03 ,$9.72 ,$9.72 ,$10.29 ,$6.96 , N/A ,$7.08 , N/A ,$10.29 , N/A ,$10.52 ,$10.29 ,$7.54 ,$7.54 ,$6.96 ,$7.54 ,$7.43 ,$7.81 ,$2.61 ,$9.03 , N/A ,$5.60 ,$5.60 ,$3.03 ,$5.60 , N/A ,$10.86 ,$9.37 ,$9.37 ,$9.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9967,IOPAMIDOL 61 % SOLN 30 ML VIAL per1 mL,636,1 ,$1.90 ,$1.25 ,$0.26 ,$1.90 , N/A ,$0.38 ,$0.26 ,$0.50 ,$1.52 ,$1.62 , N/A ,$1.71 , N/A , N/A ,$1.81 ,$1.71 ,$1.62 ,$1.62 ,$0.50 ,$1.62 ,$1.62 ,$1.71 ,$1.16 , N/A ,$1.18 , N/A ,$1.71 , N/A ,$1.75 ,$1.71 ,$1.25 ,$1.25 ,$1.16 ,$1.25 ,$1.24 ,$1.30 ,$0.43 ,$1.50 , N/A ,$0.93 ,$0.93 ,$0.50 ,$0.93 , N/A ,$1.81 ,$1.56 ,$1.56 ,$1.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9967,IOPAMIDOL 61 % SOLN 50 ML VIAL per1 mL,636,1 ,$1.21 ,$0.80 ,$0.26 ,$1.21 , N/A ,$0.38 ,$0.26 ,$0.32 ,$0.97 ,$1.03 , N/A ,$1.09 , N/A , N/A ,$1.15 ,$1.09 ,$1.03 ,$1.03 ,$0.32 ,$1.03 ,$1.03 ,$1.09 ,$0.74 , N/A ,$0.76 , N/A ,$1.09 , N/A ,$1.11 ,$1.09 ,$0.80 ,$0.80 ,$0.74 ,$0.80 ,$0.79 ,$0.83 ,$0.27 ,$0.96 , N/A ,$0.59 ,$0.59 ,$0.32 ,$0.59 , N/A ,$1.15 ,$0.99 ,$0.99 ,$0.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9967,IOPAMIDOL 61 % SOLN per1 mL,636,1 ,$1.18 ,$0.78 ,$0.26 ,$1.18 , N/A ,$0.38 ,$0.26 ,$0.31 ,$0.94 ,$1.00 , N/A ,$1.06 , N/A , N/A ,$1.12 ,$1.06 ,$1.00 ,$1.00 ,$0.31 ,$1.00 ,$1.00 ,$1.06 ,$0.72 , N/A ,$0.74 , N/A ,$1.06 , N/A ,$1.09 ,$1.06 ,$0.78 ,$0.78 ,$0.72 ,$0.78 ,$0.77 ,$0.81 ,$0.26 ,$0.93 , N/A ,$0.58 ,$0.58 ,$0.31 ,$0.58 , N/A ,$1.12 ,$0.97 ,$0.97 ,$0.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9967,IOPAMIDOL 76 % SOLN per1 mL,636,1 ,$1.32 ,$0.87 ,$0.26 ,$1.32 , N/A ,$0.38 ,$0.26 ,$0.35 ,$1.06 ,$1.12 , N/A ,$1.19 , N/A , N/A ,$1.25 ,$1.19 ,$1.12 ,$1.12 ,$0.35 ,$1.12 ,$1.12 ,$1.19 ,$0.80 , N/A ,$0.82 , N/A ,$1.19 , N/A ,$1.21 ,$1.19 ,$0.87 ,$0.87 ,$0.80 ,$0.87 ,$0.86 ,$0.90 ,$0.29 ,$1.04 , N/A ,$0.65 ,$0.65 ,$0.35 ,$0.65 , N/A ,$1.25 ,$1.08 ,$1.08 ,$1.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600012,Q9957,PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML SUSP per1 mL,636,1 ,$385.03 ,$254.12 ,$73.59 ,$385.03 , N/A ,$110.39 ,$73.59 ,$101.88 ,$308.02 ,$327.28 , N/A ,$346.53 , N/A , N/A ,$365.78 ,$346.53 ,$327.28 ,$327.28 ,$101.88 ,$327.28 ,$327.28 ,$346.53 ,$234.48 , N/A ,$238.72 , N/A ,$346.53 , N/A ,$354.23 ,$346.53 ,$254.16 ,$254.16 ,$234.48 ,$254.16 ,$250.27 ,$263.05 ,$87.66 ,$304.17 , N/A ,$188.66 ,$188.66 ,$101.88 ,$188.66 , N/A ,$365.78 ,$315.72 ,$315.72 ,$308.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),63600127,Q4114,HC FLOWABLE WOUND MATRIX PER 1CC,636,1 ,"$12,949.00 ","$8,546.34 ","$2,280.20 ","$12,949.00 ", N/A ,"$3,420.29 ","$2,280.20 ","$3,426.31 ","$10,359.20 ","$11,006.65 ","$8,093.13 ","$11,654.10 ", N/A , N/A ,"$12,301.55 ","$11,654.10 ","$11,006.65 ","$11,006.65 ","$3,426.31 ","$11,006.65 ","$11,006.65 ","$11,654.10 ","$7,885.94 ", N/A ,"$8,028.38 ", N/A ,"$11,654.10 ", N/A ,"$11,913.08 ","$11,654.10 ","$8,547.63 ","$8,547.63 ","$7,885.94 ","$8,547.63 ","$8,416.85 ","$8,846.76 ","$2,947.89 ","$10,229.71 ", N/A ,"$6,345.01 ","$6,345.01 ","$3,426.31 ","$6,345.01 ", 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 USED - JC,636,1 ,$693.00 ,$457.38 ,$144.02 ,$693.00 , N/A ,$216.02 ,$144.02 ,$183.37 ,$554.40 ,$589.05 ,$433.13 ,$623.70 , N/A , N/A ,$658.35 ,$623.70 ,$589.05 ,$589.05 ,$183.37 ,$589.05 ,$589.05 ,$623.70 ,$422.04 , N/A ,$429.66 , N/A ,$623.70 , N/A ,$637.56 ,$623.70 ,$457.45 ,$457.45 ,$422.04 ,$457.45 ,$450.45 ,$473.46 ,$157.76 ,$547.47 , N/A ,$339.57 ,$339.57 ,$183.37 ,$339.57 , N/A ,$658.35 ,$568.26 ,$568.26 ,$554.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN-CODEINE 120-12 MG/5ML SOLN,637,1 ,$9.60 ,$6.34 ,$4.70 ,$9.60 , N/A ,$8.60 ,$8.60 , N/A ,$7.68 ,$8.16 ,$6.00 ,$8.64 , N/A , N/A ,$9.12 ,$8.64 ,$8.16 ,$8.16 , N/A ,$8.16 ,$8.16 ,$8.64 ,$5.85 , N/A , N/A , N/A ,$8.64 , N/A ,$8.83 ,$8.64 ,$6.34 ,$6.34 ,$5.85 ,$6.34 ,$6.24 ,$6.56 ,$9.51 ,$7.58 , N/A ,$4.70 ,$4.70 , N/A ,$4.70 ,$9.60 ,$9.12 ,$7.87 ,$7.87 ,$7.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAZOLAMIDE 250 MG TABS,637,1 ,$14.25 ,$9.41 ,$6.98 ,$14.25 , N/A ,$12.77 ,$12.77 , N/A ,$11.40 ,$12.11 ,$8.91 ,$12.83 , N/A , N/A ,$13.54 ,$12.83 ,$12.11 ,$12.11 , N/A ,$12.11 ,$12.11 ,$12.83 ,$8.68 , N/A , N/A , N/A ,$12.83 , N/A ,$13.11 ,$12.83 ,$9.41 ,$9.41 ,$8.68 ,$9.41 ,$9.26 ,$9.74 ,$14.10 ,$11.26 , N/A ,$6.98 ,$6.98 , N/A ,$6.98 ,$14.25 ,$13.54 ,$11.69 ,$11.69 ,$11.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAZOLAMIDE ER 500 MG CP12,637,1 ,$19.45 ,$12.84 ,$9.53 ,$19.45 , N/A ,$17.43 ,$17.43 , N/A ,$15.56 ,$16.53 ,$12.16 ,$17.51 , N/A , N/A ,$18.48 ,$17.51 ,$16.53 ,$16.53 , N/A ,$16.53 ,$16.53 ,$17.51 ,$11.85 , N/A , N/A , N/A ,$17.51 , N/A ,$17.89 ,$17.51 ,$12.84 ,$12.84 ,$11.85 ,$12.84 ,$12.64 ,$13.29 ,$19.25 ,$15.37 , N/A ,$9.53 ,$9.53 , N/A ,$9.53 ,$19.45 ,$18.48 ,$15.95 ,$15.95 ,$15.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACYCLOVIR 5 % OINT 15 G TUBE,637,1 ,"$1,355.95 ",$894.93 ,$664.42 ,"$1,355.95 ", N/A ,"$1,215.20 ","$1,215.20 ", N/A ,"$1,084.76 ","$1,152.56 ",$847.47 ,"$1,220.36 ", N/A , N/A ,"$1,288.15 ","$1,220.36 ","$1,152.56 ","$1,152.56 ", N/A ,"$1,152.56 ","$1,152.56 ","$1,220.36 ",$825.77 , N/A , N/A , N/A ,"$1,220.36 ", N/A ,"$1,247.47 ","$1,220.36 ",$895.06 ,$895.06 ,$825.77 ,$895.06 ,$881.37 ,$926.39 ,"$1,342.12 ","$1,071.20 ", N/A ,$664.42 ,$664.42 , N/A ,$664.42 ,"$1,355.95 ","$1,288.15 ","$1,111.88 ","$1,111.88 ","$1,084.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT AERS,637,1 ,$251.70 ,$166.12 ,$123.33 ,$251.70 , N/A ,$225.57 ,$225.57 , N/A ,$201.36 ,$213.95 ,$157.31 ,$226.53 , N/A , N/A ,$239.12 ,$226.53 ,$213.95 ,$213.95 , N/A ,$213.95 ,$213.95 ,$226.53 ,$153.29 , N/A , N/A , N/A ,$226.53 , N/A ,$231.56 ,$226.53 ,$166.15 ,$166.15 ,$153.29 ,$166.15 ,$163.61 ,$171.96 ,$249.14 ,$198.84 , N/A ,$123.33 ,$123.33 , N/A ,$123.33 ,$251.70 ,$239.12 ,$206.39 ,$206.39 ,$201.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALENDRONATE 70 MG TABS,637,1 ,$69.65 ,$45.97 ,$34.13 ,$69.65 , N/A ,$62.42 ,$62.42 , N/A ,$55.72 ,$59.20 ,$43.53 ,$62.69 , N/A , N/A ,$66.17 ,$62.69 ,$59.20 ,$59.20 , N/A ,$59.20 ,$59.20 ,$62.69 ,$42.42 , N/A , N/A , N/A ,$62.69 , N/A ,$64.08 ,$62.69 ,$45.98 ,$45.98 ,$42.42 ,$45.98 ,$45.27 ,$47.58 ,$68.94 ,$55.02 , N/A ,$34.13 ,$34.13 , N/A ,$34.13 ,$69.65 ,$66.17 ,$57.11 ,$57.11 ,$55.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALOGLIPTIN 25 MG TABS,637,1 ,$26.55 ,$17.52 ,$13.01 ,$26.55 , N/A ,$23.79 ,$23.79 , N/A ,$21.24 ,$22.57 ,$16.59 ,$23.90 , N/A , N/A ,$25.22 ,$23.90 ,$22.57 ,$22.57 , N/A ,$22.57 ,$22.57 ,$23.90 ,$16.17 , N/A , N/A , N/A ,$23.90 , N/A ,$24.43 ,$23.90 ,$17.53 ,$17.53 ,$16.17 ,$17.53 ,$17.26 ,$18.14 ,$26.28 ,$20.97 , N/A ,$13.01 ,$13.01 , N/A ,$13.01 ,$26.55 ,$25.22 ,$21.77 ,$21.77 ,$21.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALOGLIPTIN 12.5 MG TABS,637,1 ,$26.55 ,$17.52 ,$13.01 ,$26.55 , N/A ,$23.79 ,$23.79 , N/A ,$21.24 ,$22.57 ,$16.59 ,$23.90 , N/A , N/A ,$25.22 ,$23.90 ,$22.57 ,$22.57 , N/A ,$22.57 ,$22.57 ,$23.90 ,$16.17 , N/A , N/A , N/A ,$23.90 , N/A ,$24.43 ,$23.90 ,$17.53 ,$17.53 ,$16.17 ,$17.53 ,$17.26 ,$18.14 ,$26.28 ,$20.97 , N/A ,$13.01 ,$13.01 , N/A ,$13.01 ,$26.55 ,$25.22 ,$21.77 ,$21.77 ,$21.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALOGLIPTIN 6.25 MG TABS,637,1 ,$26.53 ,$17.51 ,$13.00 ,$26.53 , N/A ,$23.78 ,$23.78 , N/A ,$21.22 ,$22.55 ,$16.58 ,$23.88 , N/A , N/A ,$25.20 ,$23.88 ,$22.55 ,$22.55 , N/A ,$22.55 ,$22.55 ,$23.88 ,$16.16 , N/A , N/A , N/A ,$23.88 , N/A ,$24.41 ,$23.88 ,$17.51 ,$17.51 ,$16.16 ,$17.51 ,$17.24 ,$18.13 ,$26.26 ,$20.96 , N/A ,$13.00 ,$13.00 , N/A ,$13.00 ,$26.53 ,$25.20 ,$21.75 ,$21.75 ,$21.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALUMINUM POTASSIUM SULFATE POWD 10 G VIAL,637,1 ,$278.80 ,$184.01 ,$136.61 ,$278.80 , N/A ,$249.86 ,$249.86 , N/A ,$223.04 ,$236.98 ,$174.25 ,$250.92 , N/A , N/A ,$264.86 ,$250.92 ,$236.98 ,$236.98 , N/A ,$236.98 ,$236.98 ,$250.92 ,$169.79 , N/A , N/A , N/A ,$250.92 , N/A ,$256.50 ,$250.92 ,$184.04 ,$184.04 ,$169.79 ,$184.04 ,$181.22 ,$190.48 ,$275.96 ,$220.25 , N/A ,$136.61 ,$136.61 , N/A ,$136.61 ,$278.80 ,$264.86 ,$228.62 ,$228.62 ,$223.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMINOCAPROIC ACID 0.25 GM/ML SOLN,637,1 ,$43.40 ,$28.64 ,$21.27 ,$43.40 , N/A ,$38.90 ,$38.90 , N/A ,$34.72 ,$36.89 ,$27.13 ,$39.06 , N/A , N/A ,$41.23 ,$39.06 ,$36.89 ,$36.89 , N/A ,$36.89 ,$36.89 ,$39.06 ,$26.43 , N/A , N/A , N/A ,$39.06 , N/A ,$39.93 ,$39.06 ,$28.65 ,$28.65 ,$26.43 ,$28.65 ,$28.21 ,$29.65 ,$42.95 ,$34.29 , N/A ,$21.27 ,$21.27 , N/A ,$21.27 ,$43.40 ,$41.23 ,$35.59 ,$35.59 ,$34.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMMONIUM LACTATE 12 % LOTN 226 G BOTTLE,637,1 ,$129.90 ,$85.73 ,$63.65 ,$129.90 , N/A ,$116.42 ,$116.42 , N/A ,$103.92 ,$110.42 ,$81.19 ,$116.91 , N/A , N/A ,$123.41 ,$116.91 ,$110.42 ,$110.42 , N/A ,$110.42 ,$110.42 ,$116.91 ,$79.11 , N/A , N/A , N/A ,$116.91 , N/A ,$119.51 ,$116.91 ,$85.75 ,$85.75 ,$79.11 ,$85.75 ,$84.44 ,$88.75 ,$128.58 ,$102.62 , N/A ,$63.65 ,$63.65 , N/A ,$63.65 ,$129.90 ,$123.41 ,$106.52 ,$106.52 ,$103.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN-CLAVULANATE 200-28.5 MG/5ML SUSR,637,1 ,$25.10 ,$16.57 ,$12.30 ,$25.10 , N/A ,$22.49 ,$22.49 , N/A ,$20.08 ,$21.34 ,$15.69 ,$22.59 , N/A , N/A ,$23.85 ,$22.59 ,$21.34 ,$21.34 , N/A ,$21.34 ,$21.34 ,$22.59 ,$15.29 , N/A , N/A , N/A ,$22.59 , N/A ,$23.09 ,$22.59 ,$16.57 ,$16.57 ,$15.29 ,$16.57 ,$16.32 ,$17.15 ,$24.84 ,$19.83 , N/A ,$12.30 ,$12.30 , N/A ,$12.30 ,$25.10 ,$23.85 ,$20.58 ,$20.58 ,$20.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN-CLAVULANATE 400-57 MG/5ML SUSR,637,1 ,$16.30 ,$10.76 ,$7.99 ,$16.30 , N/A ,$14.61 ,$14.61 , N/A ,$13.04 ,$13.86 ,$10.19 ,$14.67 , N/A , N/A ,$15.49 ,$14.67 ,$13.86 ,$13.86 , N/A ,$13.86 ,$13.86 ,$14.67 ,$9.93 , N/A , N/A , N/A ,$14.67 , N/A ,$15.00 ,$14.67 ,$10.76 ,$10.76 ,$9.93 ,$10.76 ,$10.60 ,$11.14 ,$16.13 ,$12.88 , N/A ,$7.99 ,$7.99 , N/A ,$7.99 ,$16.30 ,$15.49 ,$13.37 ,$13.37 ,$13.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN-CLAVULANATE 500-125 MG TABS,637,1 ,$12.90 ,$8.51 ,$6.32 ,$12.90 , N/A ,$11.56 ,$11.56 , N/A ,$10.32 ,$10.97 ,$8.06 ,$11.61 , N/A , N/A ,$12.26 ,$11.61 ,$10.97 ,$10.97 , N/A ,$10.97 ,$10.97 ,$11.61 ,$7.86 , N/A , N/A , N/A ,$11.61 , N/A ,$11.87 ,$11.61 ,$8.52 ,$8.52 ,$7.86 ,$8.52 ,$8.39 ,$8.81 ,$12.77 ,$10.19 , N/A ,$6.32 ,$6.32 , N/A ,$6.32 ,$12.90 ,$12.26 ,$10.58 ,$10.58 ,$10.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN-CLAVULANATE 875-125 MG TABS,637,1 ,$17.25 ,$11.39 ,$8.45 ,$17.25 , N/A ,$15.46 ,$15.46 , N/A ,$13.80 ,$14.66 ,$10.78 ,$15.53 , N/A , N/A ,$16.39 ,$15.53 ,$14.66 ,$14.66 , N/A ,$14.66 ,$14.66 ,$15.53 ,$10.51 , N/A , N/A , N/A ,$15.53 , N/A ,$15.87 ,$15.53 ,$11.39 ,$11.39 ,$10.51 ,$11.39 ,$11.21 ,$11.79 ,$17.07 ,$13.63 , N/A ,$8.45 ,$8.45 , N/A ,$8.45 ,$17.25 ,$16.39 ,$14.15 ,$14.15 ,$13.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ANALGESIC 10-15 % CREA 85 G TUBE,637,1 ,$12.75 ,$8.42 ,$6.25 ,$12.75 , N/A ,$11.43 ,$11.43 , N/A ,$10.20 ,$10.84 ,$7.97 ,$11.48 , N/A , N/A ,$12.11 ,$11.48 ,$10.84 ,$10.84 , N/A ,$10.84 ,$10.84 ,$11.48 ,$7.76 , N/A , N/A , N/A ,$11.48 , N/A ,$11.73 ,$11.48 ,$8.42 ,$8.42 ,$7.76 ,$8.42 ,$8.29 ,$8.71 ,$12.62 ,$10.07 , N/A ,$6.25 ,$6.25 , N/A ,$6.25 ,$12.75 ,$12.11 ,$10.46 ,$10.46 ,$10.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ANASTROZOLE 1 MG TABS,637,1 ,$45.85 ,$30.26 ,$22.47 ,$45.85 , N/A ,$41.09 ,$41.09 , N/A ,$36.68 ,$38.97 ,$28.66 ,$41.27 , N/A , N/A ,$43.56 ,$41.27 ,$38.97 ,$38.97 , N/A ,$38.97 ,$38.97 ,$41.27 ,$27.92 , N/A , N/A , N/A ,$41.27 , N/A ,$42.18 ,$41.27 ,$30.27 ,$30.27 ,$27.92 ,$30.27 ,$29.80 ,$31.32 ,$45.38 ,$36.22 , N/A ,$22.47 ,$22.47 , N/A ,$22.47 ,$45.85 ,$43.56 ,$37.60 ,$37.60 ,$36.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,APIXABAN 5 MG TABS,637,1 ,$36.00 ,$23.76 ,$17.64 ,$36.00 , N/A ,$32.26 ,$32.26 , N/A ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 , N/A ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A , N/A , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$35.63 ,$28.44 , N/A ,$17.64 ,$17.64 , N/A ,$17.64 ,$36.00 ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,APIXABAN 2.5 MG TABS,637,1 ,$36.00 ,$23.76 ,$17.64 ,$36.00 , N/A ,$32.26 ,$32.26 , N/A ,$28.80 ,$30.60 ,$22.50 ,$32.40 , N/A , N/A ,$34.20 ,$32.40 ,$30.60 ,$30.60 , N/A ,$30.60 ,$30.60 ,$32.40 ,$21.92 , N/A , N/A , N/A ,$32.40 , N/A ,$33.12 ,$32.40 ,$23.76 ,$23.76 ,$21.92 ,$23.76 ,$23.40 ,$24.60 ,$35.63 ,$28.44 , N/A ,$17.64 ,$17.64 , N/A ,$17.64 ,$36.00 ,$34.20 ,$29.52 ,$29.52 ,$28.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ARIPIPRAZOLE 2 MG TABS,637,1 ,$109.07 ,$71.99 ,$53.44 ,$109.07 , N/A ,$97.75 ,$97.75 , N/A ,$87.26 ,$92.71 ,$68.17 ,$98.16 , N/A , N/A ,$103.62 ,$98.16 ,$92.71 ,$92.71 , N/A ,$92.71 ,$92.71 ,$98.16 ,$66.42 , N/A , N/A , N/A ,$98.16 , N/A ,$100.34 ,$98.16 ,$72.00 ,$72.00 ,$66.42 ,$72.00 ,$70.90 ,$74.52 ,$107.96 ,$86.17 , N/A ,$53.44 ,$53.44 , N/A ,$53.44 ,$109.07 ,$103.62 ,$89.44 ,$89.44 ,$87.26 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ARIPIPRAZOLE 5 MG TABS,637,1 ,$101.76 ,$67.16 ,$49.86 ,$101.76 , N/A ,$91.20 ,$91.20 , N/A ,$81.41 ,$86.50 ,$63.60 ,$91.58 , N/A , N/A ,$96.67 ,$91.58 ,$86.50 ,$86.50 , N/A ,$86.50 ,$86.50 ,$91.58 ,$61.97 , N/A , N/A , N/A ,$91.58 , N/A ,$93.62 ,$91.58 ,$67.17 ,$67.17 ,$61.97 ,$67.17 ,$66.14 ,$69.52 ,$100.72 ,$80.39 , N/A ,$49.86 ,$49.86 , N/A ,$49.86 ,$101.76 ,$96.67 ,$83.44 ,$83.44 ,$81.41 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATOMOXETINE 25 MG CAPS,637,1 ,$48.40 ,$31.94 ,$23.72 ,$48.40 , N/A ,$43.38 ,$43.38 , N/A ,$38.72 ,$41.14 ,$30.25 ,$43.56 , N/A , N/A ,$45.98 ,$43.56 ,$41.14 ,$41.14 , N/A ,$41.14 ,$41.14 ,$43.56 ,$29.48 , N/A , N/A , N/A ,$43.56 , N/A ,$44.53 ,$43.56 ,$31.95 ,$31.95 ,$29.48 ,$31.95 ,$31.46 ,$33.07 ,$47.90 ,$38.24 , N/A ,$23.72 ,$23.72 , N/A ,$23.72 ,$48.40 ,$45.98 ,$39.69 ,$39.69 ,$38.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATOMOXETINE 10 MG CAPS,637,1 ,$48.40 ,$31.94 ,$23.72 ,$48.40 , N/A ,$43.38 ,$43.38 , N/A ,$38.72 ,$41.14 ,$30.25 ,$43.56 , N/A , N/A ,$45.98 ,$43.56 ,$41.14 ,$41.14 , N/A ,$41.14 ,$41.14 ,$43.56 ,$29.48 , N/A , N/A , N/A ,$43.56 , N/A ,$44.53 ,$43.56 ,$31.95 ,$31.95 ,$29.48 ,$31.95 ,$31.46 ,$33.07 ,$47.90 ,$38.24 , N/A ,$23.72 ,$23.72 , N/A ,$23.72 ,$48.40 ,$45.98 ,$39.69 ,$39.69 ,$38.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATORVASTATIN 40 MG TABS,637,1 ,$19.65 ,$12.97 ,$9.63 ,$19.65 , N/A ,$17.61 ,$17.61 , N/A ,$15.72 ,$16.70 ,$12.28 ,$17.69 , N/A , N/A ,$18.67 ,$17.69 ,$16.70 ,$16.70 , N/A ,$16.70 ,$16.70 ,$17.69 ,$11.97 , N/A , N/A , N/A ,$17.69 , N/A ,$18.08 ,$17.69 ,$12.97 ,$12.97 ,$11.97 ,$12.97 ,$12.77 ,$13.42 ,$19.45 ,$15.52 , N/A ,$9.63 ,$9.63 , N/A ,$9.63 ,$19.65 ,$18.67 ,$16.11 ,$16.11 ,$15.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATOVAQUONE 750 MG/5ML SUSP,637,1 ,$22.32 ,$14.73 ,$10.94 ,$22.32 , N/A ,$20.00 ,$20.00 , N/A ,$17.86 ,$18.97 ,$13.95 ,$20.09 , N/A , N/A ,$21.20 ,$20.09 ,$18.97 ,$18.97 , N/A ,$18.97 ,$18.97 ,$20.09 ,$13.59 , N/A , N/A , N/A ,$20.09 , N/A ,$20.53 ,$20.09 ,$14.73 ,$14.73 ,$13.59 ,$14.73 ,$14.51 ,$15.25 ,$22.09 ,$17.63 , N/A ,$10.94 ,$10.94 , N/A ,$10.94 ,$22.32 ,$21.20 ,$18.30 ,$18.30 ,$17.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AZELASTINE 0.1 % SOLN 30 ML BOTTLE,637,1 ,$494.95 ,$326.67 ,$242.53 ,$494.95 , N/A ,$443.57 ,$443.57 , N/A ,$395.96 ,$420.71 ,$309.34 ,$445.46 , N/A , N/A ,$470.20 ,$445.46 ,$420.71 ,$420.71 , N/A ,$420.71 ,$420.71 ,$445.46 ,$301.42 , N/A , N/A , N/A ,$445.46 , N/A ,$455.35 ,$445.46 ,$326.72 ,$326.72 ,$301.42 ,$326.72 ,$321.72 ,$338.15 ,$489.90 ,$391.01 , N/A ,$242.53 ,$242.53 , N/A ,$242.53 ,$494.95 ,$470.20 ,$405.86 ,$405.86 ,$395.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BACITRACIN 500 UNIT/GM OINT 28 G TUBE,637,1 ,$17.90 ,$11.81 ,$8.77 ,$17.90 , N/A ,$16.04 ,$16.04 , N/A ,$14.32 ,$15.22 ,$11.19 ,$16.11 , N/A , N/A ,$17.01 ,$16.11 ,$15.22 ,$15.22 , N/A ,$15.22 ,$15.22 ,$16.11 ,$10.90 , N/A , N/A , N/A ,$16.11 , N/A ,$16.47 ,$16.11 ,$11.82 ,$11.82 ,$10.90 ,$11.82 ,$11.64 ,$12.23 ,$17.72 ,$14.14 , N/A ,$8.77 ,$8.77 , N/A ,$8.77 ,$17.90 ,$17.01 ,$14.68 ,$14.68 ,$14.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BACITRACIN 500 UNIT/GM OINT 28.4 G TUBE,637,1 ,$11.80 ,$7.79 ,$5.78 ,$11.80 , N/A ,$10.58 ,$10.58 , N/A ,$9.44 ,$10.03 ,$7.38 ,$10.62 , N/A , N/A ,$11.21 ,$10.62 ,$10.03 ,$10.03 , N/A ,$10.03 ,$10.03 ,$10.62 ,$7.19 , N/A , N/A , N/A ,$10.62 , N/A ,$10.86 ,$10.62 ,$7.79 ,$7.79 ,$7.19 ,$7.79 ,$7.67 ,$8.06 ,$11.68 ,$9.32 , N/A ,$5.78 ,$5.78 , N/A ,$5.78 ,$11.80 ,$11.21 ,$9.68 ,$9.68 ,$9.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BACITRACIN 500 UNIT/GM OINT 3.5 G TUBE,637,1 ,$402.70 ,$265.78 ,$197.32 ,$402.70 , N/A ,$360.90 ,$360.90 , N/A ,$322.16 ,$342.30 ,$251.69 ,$362.43 , N/A , N/A ,$382.57 ,$362.43 ,$342.30 ,$342.30 , N/A ,$342.30 ,$342.30 ,$362.43 ,$245.24 , N/A , N/A , N/A ,$362.43 , N/A ,$370.48 ,$362.43 ,$265.82 ,$265.82 ,$245.24 ,$265.82 ,$261.76 ,$275.12 ,$398.60 ,$318.13 , N/A ,$197.32 ,$197.32 , N/A ,$197.32 ,$402.70 ,$382.57 ,$330.21 ,$330.21 ,$322.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BACITRACIN-POLYMYXIN B (OPHTH) OINT 3.5 G TUBE,637,1 ,$97.45 ,$64.32 ,$47.75 ,$97.45 , N/A ,$87.33 ,$87.33 , N/A ,$77.96 ,$82.83 ,$60.91 ,$87.71 , N/A , N/A ,$92.58 ,$87.71 ,$82.83 ,$82.83 , N/A ,$82.83 ,$82.83 ,$87.71 ,$59.35 , N/A , N/A , N/A ,$87.71 , N/A ,$89.65 ,$87.71 ,$64.33 ,$64.33 ,$59.35 ,$64.33 ,$63.34 ,$66.58 ,$96.45 ,$76.99 , N/A ,$47.75 ,$47.75 , N/A ,$47.75 ,$97.45 ,$92.58 ,$79.91 ,$79.91 ,$77.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BENZOCAINE 10 % GEL 9 G TUBE,637,1 ,$16.35 ,$10.79 ,$8.01 ,$16.35 , N/A ,$14.65 ,$14.65 , N/A ,$13.08 ,$13.90 ,$10.22 ,$14.72 , N/A , N/A ,$15.53 ,$14.72 ,$13.90 ,$13.90 , N/A ,$13.90 ,$13.90 ,$14.72 ,$9.96 , N/A , N/A , N/A ,$14.72 , N/A ,$15.04 ,$14.72 ,$10.79 ,$10.79 ,$9.96 ,$10.79 ,$10.63 ,$11.17 ,$16.18 ,$12.92 , N/A ,$8.01 ,$8.01 , N/A ,$8.01 ,$16.35 ,$15.53 ,$13.41 ,$13.41 ,$13.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BENZONATATE 100 MG CAPS,637,1 ,$8.55 ,$5.64 ,$4.19 ,$8.55 , N/A ,$7.66 ,$7.66 , N/A ,$6.84 ,$7.27 ,$5.34 ,$7.70 , N/A , N/A ,$8.12 ,$7.70 ,$7.27 ,$7.27 , N/A ,$7.27 ,$7.27 ,$7.70 ,$5.21 , N/A , N/A , N/A ,$7.70 , N/A ,$7.87 ,$7.70 ,$5.64 ,$5.64 ,$5.21 ,$5.64 ,$5.56 ,$5.84 ,$8.47 ,$6.75 , N/A ,$4.19 ,$4.19 , N/A ,$4.19 ,$8.55 ,$8.12 ,$7.01 ,$7.01 ,$6.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BETAMETHASONE DIPROPIONATE 0.05 % CREA 15 G TUBE,637,1 ,$141.45 ,$93.36 ,$69.31 ,$141.45 , N/A ,$126.77 ,$126.77 , N/A ,$113.16 ,$120.23 ,$88.41 ,$127.31 , N/A , N/A ,$134.38 ,$127.31 ,$120.23 ,$120.23 , N/A ,$120.23 ,$120.23 ,$127.31 ,$86.14 , N/A , N/A , N/A ,$127.31 , N/A ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$140.00 ,$111.75 , N/A ,$69.31 ,$69.31 , N/A ,$69.31 ,$141.45 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BETHANECHOL 25 MG TABS,637,1 ,$9.10 ,$6.01 ,$4.46 ,$9.10 , N/A ,$8.16 ,$8.16 , N/A ,$7.28 ,$7.74 ,$5.69 ,$8.19 , N/A , N/A ,$8.65 ,$8.19 ,$7.74 ,$7.74 , N/A ,$7.74 ,$7.74 ,$8.19 ,$5.54 , N/A , N/A , N/A ,$8.19 , N/A ,$8.37 ,$8.19 ,$6.01 ,$6.01 ,$5.54 ,$6.01 ,$5.92 ,$6.22 ,$9.01 ,$7.19 , N/A ,$4.46 ,$4.46 , N/A ,$4.46 ,$9.10 ,$8.65 ,$7.46 ,$7.46 ,$7.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BICALUTAMIDE 50 MG TABS,637,1 ,$62.45 ,$41.22 ,$30.60 ,$62.45 , N/A ,$55.97 ,$55.97 , N/A ,$49.96 ,$53.08 ,$39.03 ,$56.21 , N/A , N/A ,$59.33 ,$56.21 ,$53.08 ,$53.08 , N/A ,$53.08 ,$53.08 ,$56.21 ,$38.03 , N/A , N/A , N/A ,$56.21 , N/A ,$57.45 ,$56.21 ,$41.22 ,$41.22 ,$38.03 ,$41.22 ,$40.59 ,$42.67 ,$61.81 ,$49.34 , N/A ,$30.60 ,$30.60 , N/A ,$30.60 ,$62.45 ,$59.33 ,$51.21 ,$51.21 ,$49.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BREXPIPRAZOLE 1 MG TABS,637,1 ,$181.23 ,$119.61 ,$88.80 ,$181.23 , N/A ,$162.42 ,$162.42 , N/A ,$144.98 ,$154.05 ,$113.27 ,$163.11 , N/A , N/A ,$172.17 ,$163.11 ,$154.05 ,$154.05 , N/A ,$154.05 ,$154.05 ,$163.11 ,$110.37 , N/A , N/A , N/A ,$163.11 , N/A ,$166.73 ,$163.11 ,$119.63 ,$119.63 ,$110.37 ,$119.63 ,$117.80 ,$123.82 ,$179.38 ,$143.17 , N/A ,$88.80 ,$88.80 , N/A ,$88.80 ,$181.23 ,$172.17 ,$148.61 ,$148.61 ,$144.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BREXPIPRAZOLE 0.5 MG TABS,637,1 ,$181.23 ,$119.61 ,$88.80 ,$181.23 , N/A ,$162.42 ,$162.42 , N/A ,$144.98 ,$154.05 ,$113.27 ,$163.11 , N/A , N/A ,$172.17 ,$163.11 ,$154.05 ,$154.05 , N/A ,$154.05 ,$154.05 ,$163.11 ,$110.37 , N/A , N/A , N/A ,$163.11 , N/A ,$166.73 ,$163.11 ,$119.63 ,$119.63 ,$110.37 ,$119.63 ,$117.80 ,$123.82 ,$179.38 ,$143.17 , N/A ,$88.80 ,$88.80 , N/A ,$88.80 ,$181.23 ,$172.17 ,$148.61 ,$148.61 ,$144.98 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BRIMONIDINE-TIMOLOL 0.2-0.5 % SOLN 5 ML BOTTLE,637,1 ,$832.90 ,$549.71 ,$408.12 ,$832.90 , N/A ,$746.45 ,$746.45 , N/A ,$666.32 ,$707.97 ,$520.56 ,$749.61 , N/A , N/A ,$791.26 ,$749.61 ,$707.97 ,$707.97 , N/A ,$707.97 ,$707.97 ,$749.61 ,$507.24 , N/A , N/A , N/A ,$749.61 , N/A ,$766.27 ,$749.61 ,$549.80 ,$549.80 ,$507.24 ,$549.80 ,$541.39 ,$569.04 ,$824.41 ,$657.99 , N/A ,$408.12 ,$408.12 , N/A ,$408.12 ,$832.90 ,$791.26 ,$682.98 ,$682.98 ,$666.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BRINZOLAMIDE 1 % SUSP 10 ML BOTTLE,637,1 ,"$1,400.40 ",$924.26 ,$686.20 ,"$1,400.40 ", N/A ,"$1,255.04 ","$1,255.04 ", N/A ,"$1,120.32 ","$1,190.34 ",$875.25 ,"$1,260.36 ", N/A , N/A ,"$1,330.38 ","$1,260.36 ","$1,190.34 ","$1,190.34 ", N/A ,"$1,190.34 ","$1,190.34 ","$1,260.36 ",$852.84 , N/A , N/A , N/A ,"$1,260.36 ", N/A ,"$1,288.37 ","$1,260.36 ",$924.40 ,$924.40 ,$852.84 ,$924.40 ,$910.26 ,$956.75 ,"$1,386.11 ","$1,106.32 ", N/A ,$686.20 ,$686.20 , N/A ,$686.20 ,"$1,400.40 ","$1,330.38 ","$1,148.33 ","$1,148.33 ","$1,120.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BRINZOLAMIDE-BRIMONIDINE 1-0.2 % SUSP,637,1 ,$778.15 ,$513.58 ,$381.29 ,$778.15 , N/A ,$697.38 ,$697.38 , N/A ,$622.52 ,$661.43 ,$486.34 ,$700.34 , N/A , N/A ,$739.24 ,$700.34 ,$661.43 ,$661.43 , N/A ,$661.43 ,$661.43 ,$700.34 ,$473.89 , N/A , N/A , N/A ,$700.34 , N/A ,$715.90 ,$700.34 ,$513.66 ,$513.66 ,$473.89 ,$513.66 ,$505.80 ,$531.63 ,$770.21 ,$614.74 , N/A ,$381.29 ,$381.29 , N/A ,$381.29 ,$778.15 ,$739.24 ,$638.08 ,$638.08 ,$622.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUDESONIDE EC 3 MG CPEP,637,1 ,$55.10 ,$36.37 ,$27.00 ,$55.10 , N/A ,$49.38 ,$49.38 , N/A ,$44.08 ,$46.84 ,$34.44 ,$49.59 , N/A , N/A ,$52.35 ,$49.59 ,$46.84 ,$46.84 , N/A ,$46.84 ,$46.84 ,$49.59 ,$33.56 , N/A , N/A , N/A ,$49.59 , N/A ,$50.69 ,$49.59 ,$36.37 ,$36.37 ,$33.56 ,$36.37 ,$35.82 ,$37.64 ,$54.54 ,$43.53 , N/A ,$27.00 ,$27.00 , N/A ,$27.00 ,$55.10 ,$52.35 ,$45.18 ,$45.18 ,$44.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUMETANIDE 0.5 MG TABS,637,1 ,$8.20 ,$5.41 ,$4.02 ,$8.20 , N/A ,$7.35 ,$7.35 , N/A ,$6.56 ,$6.97 ,$5.13 ,$7.38 , N/A , N/A ,$7.79 ,$7.38 ,$6.97 ,$6.97 , N/A ,$6.97 ,$6.97 ,$7.38 ,$4.99 , N/A , N/A , N/A ,$7.38 , N/A ,$7.54 ,$7.38 ,$5.41 ,$5.41 ,$4.99 ,$5.41 ,$5.33 ,$5.60 ,$8.11 ,$6.48 , N/A ,$4.02 ,$4.02 , N/A ,$4.02 ,$8.20 ,$7.79 ,$6.72 ,$6.72 ,$6.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPRENORPHINE 10 MCG/HR PTWK,637,1 ,$367.25 ,$242.39 ,$179.95 ,$367.25 , N/A ,$329.13 ,$329.13 , N/A ,$293.80 ,$312.16 ,$229.53 ,$330.53 , N/A , N/A ,$348.89 ,$330.53 ,$312.16 ,$312.16 , N/A ,$312.16 ,$312.16 ,$330.53 ,$223.66 , N/A , N/A , N/A ,$330.53 , N/A ,$337.87 ,$330.53 ,$242.42 ,$242.42 ,$223.66 ,$242.42 ,$238.71 ,$250.91 ,$363.50 ,$290.13 , N/A ,$179.95 ,$179.95 , N/A ,$179.95 ,$367.25 ,$348.89 ,$301.15 ,$301.15 ,$293.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPRENORPHINE 2 MG SUBL,637,1 ,$8.34 ,$5.50 ,$4.09 ,$8.34 , N/A ,$7.47 ,$7.47 , N/A ,$6.67 ,$7.09 ,$5.21 ,$7.51 , N/A , N/A ,$7.92 ,$7.51 ,$7.09 ,$7.09 , N/A ,$7.09 ,$7.09 ,$7.51 ,$5.08 , N/A , N/A , N/A ,$7.51 , N/A ,$7.67 ,$7.51 ,$5.51 ,$5.51 ,$5.08 ,$5.51 ,$5.42 ,$5.70 ,$8.25 ,$6.59 , N/A ,$4.09 ,$4.09 , N/A ,$4.09 ,$8.34 ,$7.92 ,$6.84 ,$6.84 ,$6.67 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPRENORPHINE 5 MCG/HR PTWK,637,1 ,$283.05 ,$186.81 ,$138.69 ,$283.05 , N/A ,$253.67 ,$253.67 , N/A ,$226.44 ,$240.59 ,$176.91 ,$254.75 , N/A , N/A ,$268.90 ,$254.75 ,$240.59 ,$240.59 , N/A ,$240.59 ,$240.59 ,$254.75 ,$172.38 , N/A , N/A , N/A ,$254.75 , N/A ,$260.41 ,$254.75 ,$186.84 ,$186.84 ,$172.38 ,$186.84 ,$183.98 ,$193.38 ,$280.16 ,$223.61 , N/A ,$138.69 ,$138.69 , N/A ,$138.69 ,$283.05 ,$268.90 ,$232.10 ,$232.10 ,$226.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPROPION XL 150 MG TB24,637,1 ,$15.85 ,$10.46 ,$7.77 ,$15.85 , N/A ,$14.20 ,$14.20 , N/A ,$12.68 ,$13.47 ,$9.91 ,$14.27 , N/A , N/A ,$15.06 ,$14.27 ,$13.47 ,$13.47 , N/A ,$13.47 ,$13.47 ,$14.27 ,$9.65 , N/A , N/A , N/A ,$14.27 , N/A ,$14.58 ,$14.27 ,$10.46 ,$10.46 ,$9.65 ,$10.46 ,$10.30 ,$10.83 ,$15.69 ,$12.52 , N/A ,$7.77 ,$7.77 , N/A ,$7.77 ,$15.85 ,$15.06 ,$13.00 ,$13.00 ,$12.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCITONIN 200 UNIT/ACT SOLN 3.7 ML BOTTLE,637,1 ,$403.05 ,$266.01 ,$197.49 ,$403.05 , N/A ,$361.21 ,$361.21 , N/A ,$322.44 ,$342.59 ,$251.91 ,$362.75 , N/A , N/A ,$382.90 ,$362.75 ,$342.59 ,$342.59 , N/A ,$342.59 ,$342.59 ,$362.75 ,$245.46 , N/A , N/A , N/A ,$362.75 , N/A ,$370.81 ,$362.75 ,$266.05 ,$266.05 ,$245.46 ,$266.05 ,$261.98 ,$275.36 ,$398.94 ,$318.41 , N/A ,$197.49 ,$197.49 , N/A ,$197.49 ,$403.05 ,$382.90 ,$330.50 ,$330.50 ,$322.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CAMPHOR-MENTHOL 0.5-0.5 % LOTN 222 ML BOTTLE,637,1 ,$28.70 ,$18.94 ,$14.06 ,$28.70 , N/A ,$25.72 ,$25.72 , N/A ,$22.96 ,$24.40 ,$17.94 ,$25.83 , N/A , N/A ,$27.27 ,$25.83 ,$24.40 ,$24.40 , N/A ,$24.40 ,$24.40 ,$25.83 ,$17.48 , N/A , N/A , N/A ,$25.83 , N/A ,$26.40 ,$25.83 ,$18.94 ,$18.94 ,$17.48 ,$18.94 ,$18.66 ,$19.61 ,$28.41 ,$22.67 , N/A ,$14.06 ,$14.06 , N/A ,$14.06 ,$28.70 ,$27.27 ,$23.53 ,$23.53 ,$22.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CANAGLIFLOZIN 100 MG TABS,637,1 ,$77.53 ,$51.17 ,$37.99 ,$77.53 , N/A ,$69.48 ,$69.48 , N/A ,$62.02 ,$65.90 ,$48.46 ,$69.78 , N/A , N/A ,$73.65 ,$69.78 ,$65.90 ,$65.90 , N/A ,$65.90 ,$65.90 ,$69.78 ,$47.22 , N/A , N/A , N/A ,$69.78 , N/A ,$71.33 ,$69.78 ,$51.18 ,$51.18 ,$47.22 ,$51.18 ,$50.39 ,$52.97 ,$76.74 ,$61.25 , N/A ,$37.99 ,$37.99 , N/A ,$37.99 ,$77.53 ,$73.65 ,$63.57 ,$63.57 ,$62.02 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CAPSAICIN 0.025 % CREA 60 G TUBE,637,1 ,$33.90 ,$22.37 ,$16.61 ,$33.90 , N/A ,$30.38 ,$30.38 , N/A ,$27.12 ,$28.82 ,$21.19 ,$30.51 , N/A , N/A ,$32.21 ,$30.51 ,$28.82 ,$28.82 , N/A ,$28.82 ,$28.82 ,$30.51 ,$20.65 , N/A , N/A , N/A ,$30.51 , N/A ,$31.19 ,$30.51 ,$22.38 ,$22.38 ,$20.65 ,$22.38 ,$22.04 ,$23.16 ,$33.56 ,$26.78 , N/A ,$16.61 ,$16.61 , N/A ,$16.61 ,$33.90 ,$32.21 ,$27.80 ,$27.80 ,$27.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBAMAZEPINE XR 200 MG TB12,637,1 ,$13.75 ,$9.08 ,$6.74 ,$13.75 , N/A ,$12.32 ,$12.32 , N/A ,$11.00 ,$11.69 ,$8.59 ,$12.38 , N/A , N/A ,$13.06 ,$12.38 ,$11.69 ,$11.69 , N/A ,$11.69 ,$11.69 ,$12.38 ,$8.37 , N/A , N/A , N/A ,$12.38 , N/A ,$12.65 ,$12.38 ,$9.08 ,$9.08 ,$8.37 ,$9.08 ,$8.94 ,$9.39 ,$13.61 ,$10.86 , N/A ,$6.74 ,$6.74 , N/A ,$6.74 ,$13.75 ,$13.06 ,$11.28 ,$11.28 ,$11.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBAMIDE PEROXIDE 6.5 % SOLN 15 ML BOTTLE,637,1 ,$34.15 ,$22.54 ,$16.73 ,$34.15 , N/A ,$30.61 ,$30.61 , N/A ,$27.32 ,$29.03 ,$21.34 ,$30.74 , N/A , N/A ,$32.44 ,$30.74 ,$29.03 ,$29.03 , N/A ,$29.03 ,$29.03 ,$30.74 ,$20.80 , N/A , N/A , N/A ,$30.74 , N/A ,$31.42 ,$30.74 ,$22.54 ,$22.54 ,$20.80 ,$22.54 ,$22.20 ,$23.33 ,$33.80 ,$26.98 , N/A ,$16.73 ,$16.73 , N/A ,$16.73 ,$34.15 ,$32.44 ,$28.00 ,$28.00 ,$27.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CEFDINIR 250 MG/5ML SUSR,637,1 ,$33.85 ,$22.34 ,$16.59 ,$33.85 , N/A ,$30.34 ,$30.34 , N/A ,$27.08 ,$28.77 ,$21.16 ,$30.47 , N/A , N/A ,$32.16 ,$30.47 ,$28.77 ,$28.77 , N/A ,$28.77 ,$28.77 ,$30.47 ,$20.61 , N/A , N/A , N/A ,$30.47 , N/A ,$31.14 ,$30.47 ,$22.34 ,$22.34 ,$20.61 ,$22.34 ,$22.00 ,$23.13 ,$33.51 ,$26.74 , N/A ,$16.59 ,$16.59 , N/A ,$16.59 ,$33.85 ,$32.16 ,$27.76 ,$27.76 ,$27.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CEFDINIR 300 MG CAPS,637,1 ,$17.40 ,$11.48 ,$8.53 ,$17.40 , N/A ,$15.59 ,$15.59 , N/A ,$13.92 ,$14.79 ,$10.88 ,$15.66 , N/A , N/A ,$16.53 ,$15.66 ,$14.79 ,$14.79 , N/A ,$14.79 ,$14.79 ,$15.66 ,$10.60 , N/A , N/A , N/A ,$15.66 , N/A ,$16.01 ,$15.66 ,$11.49 ,$11.49 ,$10.60 ,$11.49 ,$11.31 ,$11.89 ,$17.22 ,$13.75 , N/A ,$8.53 ,$8.53 , N/A ,$8.53 ,$17.40 ,$16.53 ,$14.27 ,$14.27 ,$13.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CEFPROZIL 250 MG TABS,637,1 ,$14.90 ,$9.83 ,$7.30 ,$14.90 , N/A ,$13.35 ,$13.35 , N/A ,$11.92 ,$12.67 ,$9.31 ,$13.41 , N/A , N/A ,$14.16 ,$13.41 ,$12.67 ,$12.67 , N/A ,$12.67 ,$12.67 ,$13.41 ,$9.07 , N/A , N/A , N/A ,$13.41 , N/A ,$13.71 ,$13.41 ,$9.84 ,$9.84 ,$9.07 ,$9.84 ,$9.69 ,$10.18 ,$14.75 ,$11.77 , N/A ,$7.30 ,$7.30 , N/A ,$7.30 ,$14.90 ,$14.16 ,$12.22 ,$12.22 ,$11.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CELECOXIB 100 MG CAPS,637,1 ,$15.75 ,$10.40 ,$7.72 ,$15.75 , N/A ,$14.12 ,$14.12 , N/A ,$12.60 ,$13.39 ,$9.84 ,$14.18 , N/A , N/A ,$14.96 ,$14.18 ,$13.39 ,$13.39 , N/A ,$13.39 ,$13.39 ,$14.18 ,$9.59 , N/A , N/A , N/A ,$14.18 , N/A ,$14.49 ,$14.18 ,$10.40 ,$10.40 ,$9.59 ,$10.40 ,$10.24 ,$10.76 ,$15.59 ,$12.44 , N/A ,$7.72 ,$7.72 , N/A ,$7.72 ,$15.75 ,$14.96 ,$12.92 ,$12.92 ,$12.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CELECOXIB 200 MG CAPS,637,1 ,$25.75 ,$17.00 ,$12.62 ,$25.75 , N/A ,$23.08 ,$23.08 , N/A ,$20.60 ,$21.89 ,$16.09 ,$23.18 , N/A , N/A ,$24.46 ,$23.18 ,$21.89 ,$21.89 , N/A ,$21.89 ,$21.89 ,$23.18 ,$15.68 , N/A , N/A , N/A ,$23.18 , N/A ,$23.69 ,$23.18 ,$17.00 ,$17.00 ,$15.68 ,$17.00 ,$16.74 ,$17.59 ,$25.49 ,$20.34 , N/A ,$12.62 ,$12.62 , N/A ,$12.62 ,$25.75 ,$24.46 ,$21.12 ,$21.12 ,$20.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CETAPHIL LOTN 237 ML BOTTLE,637,1 ,$21.80 ,$14.39 ,$10.68 ,$21.80 , N/A ,$19.54 ,$19.54 , N/A ,$17.44 ,$18.53 ,$13.63 ,$19.62 , N/A , N/A ,$20.71 ,$19.62 ,$18.53 ,$18.53 , N/A ,$18.53 ,$18.53 ,$19.62 ,$13.28 , N/A , N/A , N/A ,$19.62 , N/A ,$20.06 ,$19.62 ,$14.39 ,$14.39 ,$13.28 ,$14.39 ,$14.17 ,$14.89 ,$21.58 ,$17.22 , N/A ,$10.68 ,$10.68 , N/A ,$10.68 ,$21.80 ,$20.71 ,$17.88 ,$17.88 ,$17.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CETIRIZINE 5 MG/5ML SOLN,637,1 ,$9.80 ,$6.47 ,$4.80 ,$9.80 , N/A ,$8.78 ,$8.78 , N/A ,$7.84 ,$8.33 ,$6.13 ,$8.82 , N/A , N/A ,$9.31 ,$8.82 ,$8.33 ,$8.33 , N/A ,$8.33 ,$8.33 ,$8.82 ,$5.97 , N/A , N/A , N/A ,$8.82 , N/A ,$9.02 ,$8.82 ,$6.47 ,$6.47 ,$5.97 ,$6.47 ,$6.37 ,$6.70 ,$9.70 ,$7.74 , N/A ,$4.80 ,$4.80 , N/A ,$4.80 ,$9.80 ,$9.31 ,$8.04 ,$8.04 ,$7.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHLORPROMAZINE 25 MG TABS,637,1 ,$26.00 ,$17.16 ,$12.74 ,$26.00 , N/A ,$23.30 ,$23.30 , N/A ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 , N/A ,$22.10 ,$22.10 ,$23.40 ,$15.83 , N/A , N/A , N/A ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.16 ,$17.16 ,$15.83 ,$17.16 ,$16.90 ,$17.76 ,$25.73 ,$20.54 , N/A ,$12.74 ,$12.74 , N/A ,$12.74 ,$26.00 ,$24.70 ,$21.32 ,$21.32 ,$20.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHOLESTYRAMINE 4 G PACK,637,1 ,$11.50 ,$7.59 ,$5.64 ,$11.50 , N/A ,$10.31 ,$10.31 , N/A ,$9.20 ,$9.78 ,$7.19 ,$10.35 , N/A , N/A ,$10.93 ,$10.35 ,$9.78 ,$9.78 , N/A ,$9.78 ,$9.78 ,$10.35 ,$7.00 , N/A , N/A , N/A ,$10.35 , N/A ,$10.58 ,$10.35 ,$7.59 ,$7.59 ,$7.00 ,$7.59 ,$7.48 ,$7.86 ,$11.39 ,$9.09 , N/A ,$5.64 ,$5.64 , N/A ,$5.64 ,$11.50 ,$10.93 ,$9.43 ,$9.43 ,$9.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHOLESTYRAMINE LIGHT 4 G PACK,637,1 ,$11.40 ,$7.52 ,$5.59 ,$11.40 , N/A ,$10.22 ,$10.22 , N/A ,$9.12 ,$9.69 ,$7.13 ,$10.26 , N/A , N/A ,$10.83 ,$10.26 ,$9.69 ,$9.69 , N/A ,$9.69 ,$9.69 ,$10.26 ,$6.94 , N/A , N/A , N/A ,$10.26 , N/A ,$10.49 ,$10.26 ,$7.53 ,$7.53 ,$6.94 ,$7.53 ,$7.41 ,$7.79 ,$11.28 ,$9.01 , N/A ,$5.59 ,$5.59 , N/A ,$5.59 ,$11.40 ,$10.83 ,$9.35 ,$9.35 ,$9.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CIPROFLOXACIN-HYDROCORTISONE 0.2-1 % SUSP 10 ML BOTTLE,637,1 ,"$1,288.75 ",$850.58 ,$631.49 ,"$1,288.75 ", N/A ,"$1,154.98 ","$1,154.98 ", N/A ,"$1,031.00 ","$1,095.44 ",$805.47 ,"$1,159.88 ", N/A , N/A ,"$1,224.31 ","$1,159.88 ","$1,095.44 ","$1,095.44 ", N/A ,"$1,095.44 ","$1,095.44 ","$1,159.88 ",$784.85 , N/A , N/A , N/A ,"$1,159.88 ", N/A ,"$1,185.65 ","$1,159.88 ",$850.70 ,$850.70 ,$784.85 ,$850.70 ,$837.69 ,$880.47 ,"$1,275.61 ","$1,018.11 ", N/A ,$631.49 ,$631.49 , N/A ,$631.49 ,"$1,288.75 ","$1,224.31 ","$1,056.78 ","$1,056.78 ","$1,031.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CITALOPRAM 10 MG TABS,637,1 ,$8.28 ,$5.46 ,$4.06 ,$8.28 , N/A ,$7.42 ,$7.42 , N/A ,$6.62 ,$7.04 ,$5.18 ,$7.45 , N/A , N/A ,$7.87 ,$7.45 ,$7.04 ,$7.04 , N/A ,$7.04 ,$7.04 ,$7.45 ,$5.04 , N/A , N/A , N/A ,$7.45 , N/A ,$7.62 ,$7.45 ,$5.47 ,$5.47 ,$5.04 ,$5.47 ,$5.38 ,$5.66 ,$8.19 ,$6.54 , N/A ,$4.06 ,$4.06 , N/A ,$4.06 ,$8.28 ,$7.87 ,$6.79 ,$6.79 ,$6.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CITRIC ACID-SODIUM CITRATE 500-334 MG/5ML SOLN,637,1 ,$18.90 ,$12.47 ,$9.26 ,$18.90 , N/A ,$16.94 ,$16.94 , N/A ,$15.12 ,$16.07 ,$11.81 ,$17.01 , N/A , N/A ,$17.96 ,$17.01 ,$16.07 ,$16.07 , N/A ,$16.07 ,$16.07 ,$17.01 ,$11.51 , N/A , N/A , N/A ,$17.01 , N/A ,$17.39 ,$17.01 ,$12.48 ,$12.48 ,$11.51 ,$12.48 ,$12.29 ,$12.91 ,$18.71 ,$14.93 , N/A ,$9.26 ,$9.26 , N/A ,$9.26 ,$18.90 ,$17.96 ,$15.50 ,$15.50 ,$15.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLARITHROMYCIN 250 MG TABS,637,1 ,$20.48 ,$13.52 ,$10.04 ,$20.48 , N/A ,$18.35 ,$18.35 , N/A ,$16.38 ,$17.41 ,$12.80 ,$18.43 , N/A , N/A ,$19.46 ,$18.43 ,$17.41 ,$17.41 , N/A ,$17.41 ,$17.41 ,$18.43 ,$12.47 , N/A , N/A , N/A ,$18.43 , N/A ,$18.84 ,$18.43 ,$13.52 ,$13.52 ,$12.47 ,$13.52 ,$13.31 ,$13.99 ,$20.27 ,$16.18 , N/A ,$10.04 ,$10.04 , N/A ,$10.04 ,$20.48 ,$19.46 ,$16.79 ,$16.79 ,$16.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLINDAMYCIN 1 % LOTN 60 ML BOTTLE,637,1 ,$490.45 ,$323.70 ,$240.32 ,$490.45 , N/A ,$439.54 ,$439.54 , N/A ,$392.36 ,$416.88 ,$306.53 ,$441.41 , N/A , N/A ,$465.93 ,$441.41 ,$416.88 ,$416.88 , N/A ,$416.88 ,$416.88 ,$441.41 ,$298.68 , N/A , N/A , N/A ,$441.41 , N/A ,$451.21 ,$441.41 ,$323.75 ,$323.75 ,$298.68 ,$323.75 ,$318.79 ,$335.08 ,$485.44 ,$387.46 , N/A ,$240.32 ,$240.32 , N/A ,$240.32 ,$490.45 ,$465.93 ,$402.17 ,$402.17 ,$392.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOBAZAM 10 MG TABS,637,1 ,$67.23 ,$44.37 ,$32.94 ,$67.23 , N/A ,$60.25 ,$60.25 , N/A ,$53.78 ,$57.15 ,$42.02 ,$60.51 , N/A , N/A ,$63.87 ,$60.51 ,$57.15 ,$57.15 , N/A ,$57.15 ,$57.15 ,$60.51 ,$40.94 , N/A , N/A , N/A ,$60.51 , N/A ,$61.85 ,$60.51 ,$44.38 ,$44.38 ,$40.94 ,$44.38 ,$43.70 ,$45.93 ,$66.54 ,$53.11 , N/A ,$32.94 ,$32.94 , N/A ,$32.94 ,$67.23 ,$63.87 ,$55.13 ,$55.13 ,$53.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOBETASOL 0.05 % CREA 15 G TUBE,637,1 ,$436.00 ,$287.76 ,$213.64 ,$436.00 , N/A ,$390.74 ,$390.74 , N/A ,$348.80 ,$370.60 ,$272.50 ,$392.40 , N/A , N/A ,$414.20 ,$392.40 ,$370.60 ,$370.60 , N/A ,$370.60 ,$370.60 ,$392.40 ,$265.52 , N/A , N/A , N/A ,$392.40 , N/A ,$401.12 ,$392.40 ,$287.80 ,$287.80 ,$265.52 ,$287.80 ,$283.40 ,$297.88 ,$431.55 ,$344.44 , N/A ,$213.64 ,$213.64 , N/A ,$213.64 ,$436.00 ,$414.20 ,$357.52 ,$357.52 ,$348.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOMIPRAMINE 25 MG CAPS,637,1 ,$38.23 ,$25.23 ,$18.73 ,$38.23 , N/A ,$34.26 ,$34.26 , N/A ,$30.58 ,$32.50 ,$23.89 ,$34.41 , N/A , N/A ,$36.32 ,$34.41 ,$32.50 ,$32.50 , N/A ,$32.50 ,$32.50 ,$34.41 ,$23.28 , N/A , N/A , N/A ,$34.41 , N/A ,$35.17 ,$34.41 ,$25.24 ,$25.24 ,$23.28 ,$25.24 ,$24.85 ,$26.12 ,$37.84 ,$30.20 , N/A ,$18.73 ,$18.73 , N/A ,$18.73 ,$38.23 ,$36.32 ,$31.35 ,$31.35 ,$30.58 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLONIDINE 0.1 MG/24HR PTWK,637,1 ,$112.75 ,$74.42 ,$55.25 ,$112.75 , N/A ,$101.05 ,$101.05 , N/A ,$90.20 ,$95.84 ,$70.47 ,$101.48 , N/A , N/A ,$107.11 ,$101.48 ,$95.84 ,$95.84 , N/A ,$95.84 ,$95.84 ,$101.48 ,$68.66 , N/A , N/A , N/A ,$101.48 , N/A ,$103.73 ,$101.48 ,$74.43 ,$74.43 ,$68.66 ,$74.43 ,$73.29 ,$77.03 ,$111.60 ,$89.07 , N/A ,$55.25 ,$55.25 , N/A ,$55.25 ,$112.75 ,$107.11 ,$92.46 ,$92.46 ,$90.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLONIDINE 0.2 MG/24HR PTWK,637,1 ,$189.65 ,$125.17 ,$92.93 ,$189.65 , N/A ,$169.96 ,$169.96 , N/A ,$151.72 ,$161.20 ,$118.53 ,$170.69 , N/A , N/A ,$180.17 ,$170.69 ,$161.20 ,$161.20 , N/A ,$161.20 ,$161.20 ,$170.69 ,$115.50 , N/A , N/A , N/A ,$170.69 , N/A ,$174.48 ,$170.69 ,$125.19 ,$125.19 ,$115.50 ,$125.19 ,$123.27 ,$129.57 ,$187.72 ,$149.82 , N/A ,$92.93 ,$92.93 , N/A ,$92.93 ,$189.65 ,$180.17 ,$155.51 ,$155.51 ,$151.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLONIDINE 0.3 MG/24HR PTWK,637,1 ,$263.05 ,$173.61 ,$128.89 ,$263.05 , N/A ,$235.75 ,$235.75 , N/A ,$210.44 ,$223.59 ,$164.41 ,$236.75 , N/A , N/A ,$249.90 ,$236.75 ,$223.59 ,$223.59 , N/A ,$223.59 ,$223.59 ,$236.75 ,$160.20 , N/A , N/A , N/A ,$236.75 , N/A ,$242.01 ,$236.75 ,$173.64 ,$173.64 ,$160.20 ,$173.64 ,$170.98 ,$179.72 ,$260.37 ,$207.81 , N/A ,$128.89 ,$128.89 , N/A ,$128.89 ,$263.05 ,$249.90 ,$215.70 ,$215.70 ,$210.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOPIDOGREL 300 MG TABS,637,1 ,$90.60 ,$59.80 ,$44.39 ,$90.60 , N/A ,$81.20 ,$81.20 , N/A ,$72.48 ,$77.01 ,$56.63 ,$81.54 , N/A , N/A ,$86.07 ,$81.54 ,$77.01 ,$77.01 , N/A ,$77.01 ,$77.01 ,$81.54 ,$55.18 , N/A , N/A , N/A ,$81.54 , N/A ,$83.35 ,$81.54 ,$59.81 ,$59.81 ,$55.18 ,$59.81 ,$58.89 ,$61.90 ,$89.68 ,$71.57 , N/A ,$44.39 ,$44.39 , N/A ,$44.39 ,$90.60 ,$86.07 ,$74.29 ,$74.29 ,$72.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOPIDOGREL 75 MG TABS,637,1 ,$23.20 ,$15.31 ,$11.37 ,$23.20 , N/A ,$20.79 ,$20.79 , N/A ,$18.56 ,$19.72 ,$14.50 ,$20.88 , N/A , N/A ,$22.04 ,$20.88 ,$19.72 ,$19.72 , N/A ,$19.72 ,$19.72 ,$20.88 ,$14.13 , N/A , N/A , N/A ,$20.88 , N/A ,$21.34 ,$20.88 ,$15.31 ,$15.31 ,$14.13 ,$15.31 ,$15.08 ,$15.85 ,$22.96 ,$18.33 , N/A ,$11.37 ,$11.37 , N/A ,$11.37 ,$23.20 ,$22.04 ,$19.02 ,$19.02 ,$18.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOTRIMAZOLE 1 % CREA 30 G TUBE,637,1 ,$118.35 ,$78.11 ,$57.99 ,$118.35 , N/A ,$106.07 ,$106.07 , N/A ,$94.68 ,$100.60 ,$73.97 ,$106.52 , N/A , N/A ,$112.43 ,$106.52 ,$100.60 ,$100.60 , N/A ,$100.60 ,$100.60 ,$106.52 ,$72.08 , N/A , N/A , N/A ,$106.52 , N/A ,$108.88 ,$106.52 ,$78.12 ,$78.12 ,$72.08 ,$78.12 ,$76.93 ,$80.86 ,$117.14 ,$93.50 , N/A ,$57.99 ,$57.99 , N/A ,$57.99 ,$118.35 ,$112.43 ,$97.05 ,$97.05 ,$94.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOTRIMAZOLE 1 % CREA 45 G TUBE,637,1 ,$40.90 ,$26.99 ,$20.04 ,$40.90 , N/A ,$36.65 ,$36.65 , N/A ,$32.72 ,$34.77 ,$25.56 ,$36.81 , N/A , N/A ,$38.86 ,$36.81 ,$34.77 ,$34.77 , N/A ,$34.77 ,$34.77 ,$36.81 ,$24.91 , N/A , N/A , N/A ,$36.81 , N/A ,$37.63 ,$36.81 ,$27.00 ,$27.00 ,$24.91 ,$27.00 ,$26.59 ,$27.94 ,$40.48 ,$32.31 , N/A ,$20.04 ,$20.04 , N/A ,$20.04 ,$40.90 ,$38.86 ,$33.54 ,$33.54 ,$32.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % CREA 15 G TUBE,637,1 ,$191.10 ,$126.13 ,$93.64 ,$191.10 , N/A ,$171.26 ,$171.26 , N/A ,$152.88 ,$162.44 ,$119.44 ,$171.99 , N/A , N/A ,$181.55 ,$171.99 ,$162.44 ,$162.44 , N/A ,$162.44 ,$162.44 ,$171.99 ,$116.38 , N/A , N/A , N/A ,$171.99 , N/A ,$175.81 ,$171.99 ,$126.15 ,$126.15 ,$116.38 ,$126.15 ,$124.22 ,$130.56 ,$189.15 ,$150.97 , N/A ,$93.64 ,$93.64 , N/A ,$93.64 ,$191.10 ,$181.55 ,$156.70 ,$156.70 ,$152.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % CREA 45 G TUBE,637,1 ,$411.45 ,$271.56 ,$201.61 ,$411.45 , N/A ,$368.74 ,$368.74 , N/A ,$329.16 ,$349.73 ,$257.16 ,$370.31 , N/A , N/A ,$390.88 ,$370.31 ,$349.73 ,$349.73 , N/A ,$349.73 ,$349.73 ,$370.31 ,$250.57 , N/A , N/A , N/A ,$370.31 , N/A ,$378.53 ,$370.31 ,$271.60 ,$271.60 ,$250.57 ,$271.60 ,$267.44 ,$281.10 ,$407.25 ,$325.05 , N/A ,$201.61 ,$201.61 , N/A ,$201.61 ,$411.45 ,$390.88 ,$337.39 ,$337.39 ,$329.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLOZAPINE 100 MG TABS,637,1 ,$11.68 ,$7.71 ,$5.72 ,$11.68 , N/A ,$10.47 ,$10.47 , N/A ,$9.34 ,$9.93 ,$7.30 ,$10.51 , N/A , N/A ,$11.10 ,$10.51 ,$9.93 ,$9.93 , N/A ,$9.93 ,$9.93 ,$10.51 ,$7.11 , N/A , N/A , N/A ,$10.51 , N/A ,$10.75 ,$10.51 ,$7.71 ,$7.71 ,$7.11 ,$7.71 ,$7.59 ,$7.98 ,$11.56 ,$9.23 , N/A ,$5.72 ,$5.72 , N/A ,$5.72 ,$11.68 ,$11.10 ,$9.58 ,$9.58 ,$9.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,COLCHICINE 0.6 MG CAPS,637,1 ,$27.75 ,$18.32 ,$13.60 ,$27.75 , N/A ,$24.87 ,$24.87 , N/A ,$22.20 ,$23.59 ,$17.34 ,$24.98 , N/A , N/A ,$26.36 ,$24.98 ,$23.59 ,$23.59 , N/A ,$23.59 ,$23.59 ,$24.98 ,$16.90 , N/A , N/A , N/A ,$24.98 , N/A ,$25.53 ,$24.98 ,$18.32 ,$18.32 ,$16.90 ,$18.32 ,$18.04 ,$18.96 ,$27.47 ,$21.92 , N/A ,$13.60 ,$13.60 , N/A ,$13.60 ,$27.75 ,$26.36 ,$22.76 ,$22.76 ,$22.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,COLCHICINE 0.6 MG TABS,637,1 ,$27.90 ,$18.41 ,$13.67 ,$27.90 , N/A ,$25.00 ,$25.00 , N/A ,$22.32 ,$23.72 ,$17.44 ,$25.11 , N/A , N/A ,$26.51 ,$25.11 ,$23.72 ,$23.72 , N/A ,$23.72 ,$23.72 ,$25.11 ,$16.99 , N/A , N/A , N/A ,$25.11 , N/A ,$25.67 ,$25.11 ,$18.42 ,$18.42 ,$16.99 ,$18.42 ,$18.14 ,$19.06 ,$27.62 ,$22.04 , N/A ,$13.67 ,$13.67 , N/A ,$13.67 ,$27.90 ,$26.51 ,$22.88 ,$22.88 ,$22.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CONJUGATED ESTROGENS 0.625 MG/GM CREA 30 G TUBE,637,1 ,"$1,697.80 ","$1,120.55 ",$831.92 ,"$1,697.80 ", N/A ,"$1,521.57 ","$1,521.57 ", N/A ,"$1,358.24 ","$1,443.13 ","$1,061.13 ","$1,528.02 ", N/A , N/A ,"$1,612.91 ","$1,528.02 ","$1,443.13 ","$1,443.13 ", N/A ,"$1,443.13 ","$1,443.13 ","$1,528.02 ","$1,033.96 ", N/A , N/A , N/A ,"$1,528.02 ", N/A ,"$1,561.98 ","$1,528.02 ","$1,120.72 ","$1,120.72 ","$1,033.96 ","$1,120.72 ","$1,103.57 ","$1,159.94 ","$1,680.48 ","$1,341.26 ", N/A ,$831.92 ,$831.92 , N/A ,$831.92 ,"$1,697.80 ","$1,612.91 ","$1,392.20 ","$1,392.20 ","$1,358.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CYCLOSPORINE 0.05 % EMUL 30 EACH PLAS CONT,637,1 ,$41.81 ,$27.59 ,$20.49 ,$41.81 , N/A ,$37.47 ,$37.47 , N/A ,$33.45 ,$35.54 ,$26.13 ,$37.63 , N/A , N/A ,$39.72 ,$37.63 ,$35.54 ,$35.54 , N/A ,$35.54 ,$35.54 ,$37.63 ,$25.46 , N/A , N/A , N/A ,$37.63 , N/A ,$38.47 ,$37.63 ,$27.60 ,$27.60 ,$25.46 ,$27.60 ,$27.18 ,$28.56 ,$41.39 ,$33.03 , N/A ,$20.49 ,$20.49 , N/A ,$20.49 ,$41.81 ,$39.72 ,$34.28 ,$34.28 ,$33.45 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DABIGATRAN 75 MG CAPS,637,1 ,$33.75 ,$22.28 ,$16.54 ,$33.75 , N/A ,$30.25 ,$30.25 , N/A ,$27.00 ,$28.69 ,$21.09 ,$30.38 , N/A , N/A ,$32.06 ,$30.38 ,$28.69 ,$28.69 , N/A ,$28.69 ,$28.69 ,$30.38 ,$20.55 , N/A , N/A , N/A ,$30.38 , N/A ,$31.05 ,$30.38 ,$22.28 ,$22.28 ,$20.55 ,$22.28 ,$21.94 ,$23.06 ,$33.41 ,$26.66 , N/A ,$16.54 ,$16.54 , N/A ,$16.54 ,$33.75 ,$32.06 ,$27.68 ,$27.68 ,$27.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DABIGATRAN 150 MG CAPS,637,1 ,$33.75 ,$22.28 ,$16.54 ,$33.75 , N/A ,$30.25 ,$30.25 , N/A ,$27.00 ,$28.69 ,$21.09 ,$30.38 , N/A , N/A ,$32.06 ,$30.38 ,$28.69 ,$28.69 , N/A ,$28.69 ,$28.69 ,$30.38 ,$20.55 , N/A , N/A , N/A ,$30.38 , N/A ,$31.05 ,$30.38 ,$22.28 ,$22.28 ,$20.55 ,$22.28 ,$21.94 ,$23.06 ,$33.41 ,$26.66 , N/A ,$16.54 ,$16.54 , N/A ,$16.54 ,$33.75 ,$32.06 ,$27.68 ,$27.68 ,$27.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DESMOPRESSIN 0.1 MG TABS,637,1 ,$17.98 ,$11.87 ,$8.81 ,$17.98 , N/A ,$16.11 ,$16.11 , N/A ,$14.38 ,$15.28 ,$11.24 ,$16.18 , N/A , N/A ,$17.08 ,$16.18 ,$15.28 ,$15.28 , N/A ,$15.28 ,$15.28 ,$16.18 ,$10.95 , N/A , N/A , N/A ,$16.18 , N/A ,$16.54 ,$16.18 ,$11.87 ,$11.87 ,$10.95 ,$11.87 ,$11.69 ,$12.28 ,$17.80 ,$14.20 , N/A ,$8.81 ,$8.81 , N/A ,$8.81 ,$17.98 ,$17.08 ,$14.74 ,$14.74 ,$14.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DESVENLAFAXINE ER 50 MG TB24,637,1 ,$40.65 ,$26.83 ,$19.92 ,$40.65 , N/A ,$36.43 ,$36.43 , N/A ,$32.52 ,$34.55 ,$25.41 ,$36.59 , N/A , N/A ,$38.62 ,$36.59 ,$34.55 ,$34.55 , N/A ,$34.55 ,$34.55 ,$36.59 ,$24.76 , N/A , N/A , N/A ,$36.59 , N/A ,$37.40 ,$36.59 ,$26.83 ,$26.83 ,$24.76 ,$26.83 ,$26.42 ,$27.77 ,$40.24 ,$32.11 , N/A ,$19.92 ,$19.92 , N/A ,$19.92 ,$40.65 ,$38.62 ,$33.33 ,$33.33 ,$32.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DEXAMETHASONE 0.1 % SUSP 5 ML BOTTLE,637,1 ,$307.70 ,$203.08 ,$150.77 ,$307.70 , N/A ,$275.76 ,$275.76 , N/A ,$246.16 ,$261.55 ,$192.31 ,$276.93 , N/A , N/A ,$292.32 ,$276.93 ,$261.55 ,$261.55 , N/A ,$261.55 ,$261.55 ,$276.93 ,$187.39 , N/A , N/A , N/A ,$276.93 , N/A ,$283.08 ,$276.93 ,$203.11 ,$203.11 ,$187.39 ,$203.11 ,$200.01 ,$210.22 ,$304.56 ,$243.08 , N/A ,$150.77 ,$150.77 , N/A ,$150.77 ,$307.70 ,$292.32 ,$252.31 ,$252.31 ,$246.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DEXTROSE 40 % GEL 37.5 G TUBE,637,1 ,$13.40 ,$8.84 ,$6.57 ,$13.40 , N/A ,$12.01 ,$12.01 , N/A ,$10.72 ,$11.39 ,$8.38 ,$12.06 , N/A , N/A ,$12.73 ,$12.06 ,$11.39 ,$11.39 , N/A ,$11.39 ,$11.39 ,$12.06 ,$8.16 , N/A , N/A , N/A ,$12.06 , N/A ,$12.33 ,$12.06 ,$8.85 ,$8.85 ,$8.16 ,$8.85 ,$8.71 ,$9.15 ,$13.26 ,$10.59 , N/A ,$6.57 ,$6.57 , N/A ,$6.57 ,$13.40 ,$12.73 ,$10.99 ,$10.99 ,$10.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIBUCAINE (PERIANAL) 1 % OINT 28 G TUBE,637,1 ,$20.40 ,$13.46 ,$10.00 ,$20.40 , N/A ,$18.28 ,$18.28 , N/A ,$16.32 ,$17.34 ,$12.75 ,$18.36 , N/A , N/A ,$19.38 ,$18.36 ,$17.34 ,$17.34 , N/A ,$17.34 ,$17.34 ,$18.36 ,$12.42 , N/A , N/A , N/A ,$18.36 , N/A ,$18.77 ,$18.36 ,$13.47 ,$13.47 ,$12.42 ,$13.47 ,$13.26 ,$13.94 ,$20.19 ,$16.12 , N/A ,$10.00 ,$10.00 , N/A ,$10.00 ,$20.40 ,$19.38 ,$16.73 ,$16.73 ,$16.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DICLOFENAC SODIUM 1 % GEL 100 G TUBE,637,1 ,$178.85 ,$118.04 ,$87.64 ,$178.85 , N/A ,$160.29 ,$160.29 , N/A ,$143.08 ,$152.02 ,$111.78 ,$160.97 , N/A , N/A ,$169.91 ,$160.97 ,$152.02 ,$152.02 , N/A ,$152.02 ,$152.02 ,$160.97 ,$108.92 , N/A , N/A , N/A ,$160.97 , N/A ,$164.54 ,$160.97 ,$118.06 ,$118.06 ,$108.92 ,$118.06 ,$116.25 ,$122.19 ,$177.03 ,$141.29 , N/A ,$87.64 ,$87.64 , N/A ,$87.64 ,$178.85 ,$169.91 ,$146.66 ,$146.66 ,$143.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DILTIAZEM SR 60 MG CP12,637,1 ,$13.50 ,$8.91 ,$6.62 ,$13.50 , N/A ,$12.10 ,$12.10 , N/A ,$10.80 ,$11.48 ,$8.44 ,$12.15 , N/A , N/A ,$12.83 ,$12.15 ,$11.48 ,$11.48 , N/A ,$11.48 ,$11.48 ,$12.15 ,$8.22 , N/A , N/A , N/A ,$12.15 , N/A ,$12.42 ,$12.15 ,$8.91 ,$8.91 ,$8.22 ,$8.91 ,$8.78 ,$9.22 ,$13.37 ,$10.67 , N/A ,$6.62 ,$6.62 , N/A ,$6.62 ,$13.50 ,$12.83 ,$11.07 ,$11.07 ,$10.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DILTIAZEM SR 90 MG CP12,637,1 ,$12.33 ,$8.14 ,$6.04 ,$12.33 , N/A ,$11.05 ,$11.05 , N/A ,$9.86 ,$10.48 ,$7.71 ,$11.10 , N/A , N/A ,$11.71 ,$11.10 ,$10.48 ,$10.48 , N/A ,$10.48 ,$10.48 ,$11.10 ,$7.51 , N/A , N/A , N/A ,$11.10 , N/A ,$11.34 ,$11.10 ,$8.14 ,$8.14 ,$7.51 ,$8.14 ,$8.01 ,$8.42 ,$12.20 ,$9.74 , N/A ,$6.04 ,$6.04 , N/A ,$6.04 ,$12.33 ,$11.71 ,$10.11 ,$10.11 ,$9.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPHENHYDRAMINE-ZINC 2-0.1 % CREA 28 G TUBE,637,1 ,$14.80 ,$9.77 ,$7.25 ,$14.80 , N/A ,$13.26 ,$13.26 , N/A ,$11.84 ,$12.58 ,$9.25 ,$13.32 , N/A , N/A ,$14.06 ,$13.32 ,$12.58 ,$12.58 , N/A ,$12.58 ,$12.58 ,$13.32 ,$9.01 , N/A , N/A , N/A ,$13.32 , N/A ,$13.62 ,$13.32 ,$9.77 ,$9.77 ,$9.01 ,$9.77 ,$9.62 ,$10.11 ,$14.65 ,$11.69 , N/A ,$7.25 ,$7.25 , N/A ,$7.25 ,$14.80 ,$14.06 ,$12.14 ,$12.14 ,$11.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DESMOPRESSIN 0.2 MG TABS,637,1 ,$14.80 ,$9.77 ,$7.25 ,$14.80 , N/A ,$13.26 ,$13.26 , N/A ,$11.84 ,$12.58 ,$9.25 ,$13.32 , N/A , N/A ,$14.06 ,$13.32 ,$12.58 ,$12.58 , N/A ,$12.58 ,$12.58 ,$13.32 ,$9.01 , N/A , N/A , N/A ,$13.32 , N/A ,$13.62 ,$13.32 ,$9.77 ,$9.77 ,$9.01 ,$9.77 ,$9.62 ,$10.11 ,$14.65 ,$11.69 , N/A ,$7.25 ,$7.25 , N/A ,$7.25 ,$14.80 ,$14.06 ,$12.14 ,$12.14 ,$11.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPYRIDAMOLE-ASPIRIN 25-200 MG CP12,637,1 ,$28.45 ,$18.78 ,$13.94 ,$28.45 , N/A ,$25.50 ,$25.50 , N/A ,$22.76 ,$24.18 ,$17.78 ,$25.61 , N/A , N/A ,$27.03 ,$25.61 ,$24.18 ,$24.18 , N/A ,$24.18 ,$24.18 ,$25.61 ,$17.33 , N/A , N/A , N/A ,$25.61 , N/A ,$26.17 ,$25.61 ,$18.78 ,$18.78 ,$17.33 ,$18.78 ,$18.49 ,$19.44 ,$28.16 ,$22.48 , N/A ,$13.94 ,$13.94 , N/A ,$13.94 ,$28.45 ,$27.03 ,$23.33 ,$23.33 ,$22.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIVALPROEX ER 500 MG TB24,637,1 ,$13.90 ,$9.17 ,$6.81 ,$13.90 , N/A ,$12.46 ,$12.46 , N/A ,$11.12 ,$11.82 ,$8.69 ,$12.51 , N/A , N/A ,$13.21 ,$12.51 ,$11.82 ,$11.82 , N/A ,$11.82 ,$11.82 ,$12.51 ,$8.47 , N/A , N/A , N/A ,$12.51 , N/A ,$12.79 ,$12.51 ,$9.18 ,$9.18 ,$8.47 ,$9.18 ,$9.04 ,$9.50 ,$13.76 ,$10.98 , N/A ,$6.81 ,$6.81 , N/A ,$6.81 ,$13.90 ,$13.21 ,$11.40 ,$11.40 ,$11.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOFETILIDE 250 MCG CAPS,637,1 ,$29.15 ,$19.24 ,$14.28 ,$29.15 , N/A ,$26.12 ,$26.12 , N/A ,$23.32 ,$24.78 ,$18.22 ,$26.24 , N/A , N/A ,$27.69 ,$26.24 ,$24.78 ,$24.78 , N/A ,$24.78 ,$24.78 ,$26.24 ,$17.75 , N/A , N/A , N/A ,$26.24 , N/A ,$26.82 ,$26.24 ,$19.24 ,$19.24 ,$17.75 ,$19.24 ,$18.95 ,$19.92 ,$28.85 ,$23.03 , N/A ,$14.28 ,$14.28 , N/A ,$14.28 ,$29.15 ,$27.69 ,$23.90 ,$23.90 ,$23.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOFETILIDE 125 MCG CAPS,637,1 ,$29.15 ,$19.24 ,$14.28 ,$29.15 , N/A ,$26.12 ,$26.12 , N/A ,$23.32 ,$24.78 ,$18.22 ,$26.24 , N/A , N/A ,$27.69 ,$26.24 ,$24.78 ,$24.78 , N/A ,$24.78 ,$24.78 ,$26.24 ,$17.75 , N/A , N/A , N/A ,$26.24 , N/A ,$26.82 ,$26.24 ,$19.24 ,$19.24 ,$17.75 ,$19.24 ,$18.95 ,$19.92 ,$28.85 ,$23.03 , N/A ,$14.28 ,$14.28 , N/A ,$14.28 ,$29.15 ,$27.69 ,$23.90 ,$23.90 ,$23.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DORZOLAMIDE 2 % SOLN 10 ML BOTTLE,637,1 ,$227.15 ,$149.92 ,$111.30 ,$227.15 , N/A ,$203.57 ,$203.57 , N/A ,$181.72 ,$193.08 ,$141.97 ,$204.44 , N/A , N/A ,$215.79 ,$204.44 ,$193.08 ,$193.08 , N/A ,$193.08 ,$193.08 ,$204.44 ,$138.33 , N/A , N/A , N/A ,$204.44 , N/A ,$208.98 ,$204.44 ,$149.94 ,$149.94 ,$138.33 ,$149.94 ,$147.65 ,$155.19 ,$224.83 ,$179.45 , N/A ,$111.30 ,$111.30 , N/A ,$111.30 ,$227.15 ,$215.79 ,$186.26 ,$186.26 ,$181.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML SOLN 10 ML BOTTLE,637,1 ,$416.85 ,$275.12 ,$204.26 ,$416.85 , N/A ,$373.58 ,$373.58 , N/A ,$333.48 ,$354.32 ,$260.53 ,$375.17 , N/A , N/A ,$396.01 ,$375.17 ,$354.32 ,$354.32 , N/A ,$354.32 ,$354.32 ,$375.17 ,$253.86 , N/A , N/A , N/A ,$375.17 , N/A ,$383.50 ,$375.17 ,$275.16 ,$275.16 ,$253.86 ,$275.16 ,$270.95 ,$284.79 ,$412.60 ,$329.31 , N/A ,$204.26 ,$204.26 , N/A ,$204.26 ,$416.85 ,$396.01 ,$341.82 ,$341.82 ,$333.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXYCYCLINE HYCLATE 100 MG CAPS,637,1 ,$32.70 ,$21.58 ,$16.02 ,$32.70 , N/A ,$29.31 ,$29.31 , N/A ,$26.16 ,$27.80 ,$20.44 ,$29.43 , N/A , N/A ,$31.07 ,$29.43 ,$27.80 ,$27.80 , N/A ,$27.80 ,$27.80 ,$29.43 ,$19.91 , N/A , N/A , N/A ,$29.43 , N/A ,$30.08 ,$29.43 ,$21.59 ,$21.59 ,$19.91 ,$21.59 ,$21.26 ,$22.34 ,$32.37 ,$25.83 , N/A ,$16.02 ,$16.02 , N/A ,$16.02 ,$32.70 ,$31.07 ,$26.81 ,$26.81 ,$26.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DRONABINOL 2.5 MG CAPS,637,1 ,$44.55 ,$29.40 ,$21.83 ,$44.55 , N/A ,$39.93 ,$39.93 , N/A ,$35.64 ,$37.87 ,$27.84 ,$40.10 , N/A , N/A ,$42.32 ,$40.10 ,$37.87 ,$37.87 , N/A ,$37.87 ,$37.87 ,$40.10 ,$27.13 , N/A , N/A , N/A ,$40.10 , N/A ,$40.99 ,$40.10 ,$29.41 ,$29.41 ,$27.13 ,$29.41 ,$28.96 ,$30.44 ,$44.10 ,$35.19 , N/A ,$21.83 ,$21.83 , N/A ,$21.83 ,$44.55 ,$42.32 ,$36.53 ,$36.53 ,$35.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DRONEDARONE 400 MG TABS,637,1 ,$49.25 ,$32.51 ,$24.13 ,$49.25 , N/A ,$44.14 ,$44.14 , N/A ,$39.40 ,$41.86 ,$30.78 ,$44.33 , N/A , N/A ,$46.79 ,$44.33 ,$41.86 ,$41.86 , N/A ,$41.86 ,$41.86 ,$44.33 ,$29.99 , N/A , N/A , N/A ,$44.33 , N/A ,$45.31 ,$44.33 ,$32.51 ,$32.51 ,$29.99 ,$32.51 ,$32.01 ,$33.65 ,$48.75 ,$38.91 , N/A ,$24.13 ,$24.13 , N/A ,$24.13 ,$49.25 ,$46.79 ,$40.39 ,$40.39 ,$39.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DULOXETINE 20 MG CPEP,637,1 ,$22.95 ,$15.15 ,$11.25 ,$22.95 , N/A ,$20.57 ,$20.57 , N/A ,$18.36 ,$19.51 ,$14.34 ,$20.66 , N/A , N/A ,$21.80 ,$20.66 ,$19.51 ,$19.51 , N/A ,$19.51 ,$19.51 ,$20.66 ,$13.98 , N/A , N/A , N/A ,$20.66 , N/A ,$21.11 ,$20.66 ,$15.15 ,$15.15 ,$13.98 ,$15.15 ,$14.92 ,$15.68 ,$22.72 ,$18.13 , N/A ,$11.25 ,$11.25 , N/A ,$11.25 ,$22.95 ,$21.80 ,$18.82 ,$18.82 ,$18.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DULOXETINE 30 MG CPEP,637,1 ,$26.70 ,$17.62 ,$13.08 ,$26.70 , N/A ,$23.93 ,$23.93 , N/A ,$21.36 ,$22.70 ,$16.69 ,$24.03 , N/A , N/A ,$25.37 ,$24.03 ,$22.70 ,$22.70 , N/A ,$22.70 ,$22.70 ,$24.03 ,$16.26 , N/A , N/A , N/A ,$24.03 , N/A ,$24.56 ,$24.03 ,$17.62 ,$17.62 ,$16.26 ,$17.62 ,$17.36 ,$18.24 ,$26.43 ,$21.09 , N/A ,$13.08 ,$13.08 , N/A ,$13.08 ,$26.70 ,$25.37 ,$21.89 ,$21.89 ,$21.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DUTASTERIDE 0.5 MG CAPS,637,1 ,$20.60 ,$13.60 ,$10.09 ,$20.60 , N/A ,$18.46 ,$18.46 , N/A ,$16.48 ,$17.51 ,$12.88 ,$18.54 , N/A , N/A ,$19.57 ,$18.54 ,$17.51 ,$17.51 , N/A ,$17.51 ,$17.51 ,$18.54 ,$12.55 , N/A , N/A , N/A ,$18.54 , N/A ,$18.95 ,$18.54 ,$13.60 ,$13.60 ,$12.55 ,$13.60 ,$13.39 ,$14.07 ,$20.39 ,$16.27 , N/A ,$10.09 ,$10.09 , N/A ,$10.09 ,$20.60 ,$19.57 ,$16.89 ,$16.89 ,$16.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EMOLLIENT OINT 85 G TUBE,637,1 ,$32.10 ,$21.19 ,$15.73 ,$32.10 , N/A ,$28.77 ,$28.77 , N/A ,$25.68 ,$27.29 ,$20.06 ,$28.89 , N/A , N/A ,$30.50 ,$28.89 ,$27.29 ,$27.29 , N/A ,$27.29 ,$27.29 ,$28.89 ,$19.55 , N/A , N/A , N/A ,$28.89 , N/A ,$29.53 ,$28.89 ,$21.19 ,$21.19 ,$19.55 ,$21.19 ,$20.87 ,$21.93 ,$31.77 ,$25.36 , N/A ,$15.73 ,$15.73 , N/A ,$15.73 ,$32.10 ,$30.50 ,$26.32 ,$26.32 ,$25.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EMPAGLIFLOZIN 25 MG TABS,637,1 ,$77.60 ,$51.22 ,$38.02 ,$77.60 , N/A ,$69.55 ,$69.55 , N/A ,$62.08 ,$65.96 ,$48.50 ,$69.84 , N/A , N/A ,$73.72 ,$69.84 ,$65.96 ,$65.96 , N/A ,$65.96 ,$65.96 ,$69.84 ,$47.26 , N/A , N/A , N/A ,$69.84 , N/A ,$71.39 ,$69.84 ,$51.22 ,$51.22 ,$47.26 ,$51.22 ,$50.44 ,$53.02 ,$76.81 ,$61.30 , N/A ,$38.02 ,$38.02 , N/A ,$38.02 ,$77.60 ,$73.72 ,$63.63 ,$63.63 ,$62.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EMPAGLIFLOZIN 10 MG TABS,637,1 ,$77.60 ,$51.22 ,$38.02 ,$77.60 , N/A ,$69.55 ,$69.55 , N/A ,$62.08 ,$65.96 ,$48.50 ,$69.84 , N/A , N/A ,$73.72 ,$69.84 ,$65.96 ,$65.96 , N/A ,$65.96 ,$65.96 ,$69.84 ,$47.26 , N/A , N/A , N/A ,$69.84 , N/A ,$71.39 ,$69.84 ,$51.22 ,$51.22 ,$47.26 ,$51.22 ,$50.44 ,$53.02 ,$76.81 ,$61.30 , N/A ,$38.02 ,$38.02 , N/A ,$38.02 ,$77.60 ,$73.72 ,$63.63 ,$63.63 ,$62.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EMTRICITABINE-TENOFOVIR 200-300 MG TABS,637,1 ,$238.05 ,$157.11 ,$116.64 ,$238.05 , N/A ,$213.34 ,$213.34 , N/A ,$190.44 ,$202.34 ,$148.78 ,$214.25 , N/A , N/A ,$226.15 ,$214.25 ,$202.34 ,$202.34 , N/A ,$202.34 ,$202.34 ,$214.25 ,$144.97 , N/A , N/A , N/A ,$214.25 , N/A ,$219.01 ,$214.25 ,$157.14 ,$157.14 ,$144.97 ,$157.14 ,$154.73 ,$162.64 ,$235.62 ,$188.06 , N/A ,$116.64 ,$116.64 , N/A ,$116.64 ,$238.05 ,$226.15 ,$195.20 ,$195.20 ,$190.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EPINEPHRINE 0.3 MG/0.3ML SOAJ,637,1 ,"$1,442.45 ",$952.02 ,$706.80 ,"$1,442.45 ", N/A ,"$1,292.72 ","$1,292.72 ", N/A ,"$1,153.96 ","$1,226.08 ",$901.53 ,"$1,298.21 ", N/A , N/A ,"$1,370.33 ","$1,298.21 ","$1,226.08 ","$1,226.08 ", N/A ,"$1,226.08 ","$1,226.08 ","$1,298.21 ",$878.45 , N/A , N/A , N/A ,"$1,298.21 ", N/A ,"$1,327.05 ","$1,298.21 ",$952.16 ,$952.16 ,$878.45 ,$952.16 ,$937.59 ,$985.48 ,"$1,427.73 ","$1,139.54 ", N/A ,$706.80 ,$706.80 , N/A ,$706.80 ,"$1,442.45 ","$1,370.33 ","$1,182.81 ","$1,182.81 ","$1,153.96 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ERYTHROMYCIN EC 250 MG TBEC,637,1 ,$28.55 ,$18.84 ,$13.99 ,$28.55 , N/A ,$25.59 ,$25.59 , N/A ,$22.84 ,$24.27 ,$17.84 ,$25.70 , N/A , N/A ,$27.12 ,$25.70 ,$24.27 ,$24.27 , N/A ,$24.27 ,$24.27 ,$25.70 ,$17.39 , N/A , N/A , N/A ,$25.70 , N/A ,$26.27 ,$25.70 ,$18.85 ,$18.85 ,$17.39 ,$18.85 ,$18.56 ,$19.51 ,$28.26 ,$22.55 , N/A ,$13.99 ,$13.99 , N/A ,$13.99 ,$28.55 ,$27.12 ,$23.41 ,$23.41 ,$22.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ESCITALOPRAM 5 MG TABS,637,1 ,$15.35 ,$10.13 ,$7.52 ,$15.35 , N/A ,$13.76 ,$13.76 , N/A ,$12.28 ,$13.05 ,$9.59 ,$13.82 , N/A , N/A ,$14.58 ,$13.82 ,$13.05 ,$13.05 , N/A ,$13.05 ,$13.05 ,$13.82 ,$9.35 , N/A , N/A , N/A ,$13.82 , N/A ,$14.12 ,$13.82 ,$10.13 ,$10.13 ,$9.35 ,$10.13 ,$9.98 ,$10.49 ,$15.19 ,$12.13 , N/A ,$7.52 ,$7.52 , N/A ,$7.52 ,$15.35 ,$14.58 ,$12.59 ,$12.59 ,$12.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ESTRADIOL 0.1 MG/24HR PTTW,637,1 ,$38.65 ,$25.51 ,$18.94 ,$38.65 , N/A ,$34.64 ,$34.64 , N/A ,$30.92 ,$32.85 ,$24.16 ,$34.79 , N/A , N/A ,$36.72 ,$34.79 ,$32.85 ,$32.85 , N/A ,$32.85 ,$32.85 ,$34.79 ,$23.54 , N/A , N/A , N/A ,$34.79 , N/A ,$35.56 ,$34.79 ,$25.51 ,$25.51 ,$23.54 ,$25.51 ,$25.12 ,$26.41 ,$38.26 ,$30.53 , N/A ,$18.94 ,$18.94 , N/A ,$18.94 ,$38.65 ,$36.72 ,$31.69 ,$31.69 ,$30.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ESTRADIOL 0.1 MG/GM CREA 42.5 G TUBE,637,1 ,"$1,220.45 ",$805.50 ,$598.02 ,"$1,220.45 ", N/A ,"$1,093.77 ","$1,093.77 ", N/A ,$976.36 ,"$1,037.38 ",$762.78 ,"$1,098.41 ", N/A , N/A ,"$1,159.43 ","$1,098.41 ","$1,037.38 ","$1,037.38 ", N/A ,"$1,037.38 ","$1,037.38 ","$1,098.41 ",$743.25 , N/A , N/A , N/A ,"$1,098.41 ", N/A ,"$1,122.81 ","$1,098.41 ",$805.62 ,$805.62 ,$743.25 ,$805.62 ,$793.29 ,$833.81 ,"$1,208.00 ",$964.16 , N/A ,$598.02 ,$598.02 , N/A ,$598.02 ,"$1,220.45 ","$1,159.43 ","$1,000.77 ","$1,000.77 ",$976.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EZETIMIBE 10 MG TABS,637,1 ,$42.15 ,$27.82 ,$20.65 ,$42.15 , N/A ,$37.77 ,$37.77 , N/A ,$33.72 ,$35.83 ,$26.34 ,$37.94 , N/A , N/A ,$40.04 ,$37.94 ,$35.83 ,$35.83 , N/A ,$35.83 ,$35.83 ,$37.94 ,$25.67 , N/A , N/A , N/A ,$37.94 , N/A ,$38.78 ,$37.94 ,$27.82 ,$27.82 ,$25.67 ,$27.82 ,$27.40 ,$28.80 ,$41.72 ,$33.30 , N/A ,$20.65 ,$20.65 , N/A ,$20.65 ,$42.15 ,$40.04 ,$34.56 ,$34.56 ,$33.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FEBUXOSTAT 40 MG TABS,637,1 ,$44.90 ,$29.63 ,$22.00 ,$44.90 , N/A ,$40.24 ,$40.24 , N/A ,$35.92 ,$38.17 ,$28.06 ,$40.41 , N/A , N/A ,$42.66 ,$40.41 ,$38.17 ,$38.17 , N/A ,$38.17 ,$38.17 ,$40.41 ,$27.34 , N/A , N/A , N/A ,$40.41 , N/A ,$41.31 ,$40.41 ,$29.64 ,$29.64 ,$27.34 ,$29.64 ,$29.19 ,$30.68 ,$44.44 ,$35.47 , N/A ,$22.00 ,$22.00 , N/A ,$22.00 ,$44.90 ,$42.66 ,$36.82 ,$36.82 ,$35.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENOFIBRATE 145 MG TABS,637,1 ,$19.50 ,$12.87 ,$9.56 ,$19.50 , N/A ,$17.48 ,$17.48 , N/A ,$15.60 ,$16.58 ,$12.19 ,$17.55 , N/A , N/A ,$18.53 ,$17.55 ,$16.58 ,$16.58 , N/A ,$16.58 ,$16.58 ,$17.55 ,$11.88 , N/A , N/A , N/A ,$17.55 , N/A ,$17.94 ,$17.55 ,$12.87 ,$12.87 ,$11.88 ,$12.87 ,$12.68 ,$13.32 ,$19.31 ,$15.41 , N/A ,$9.56 ,$9.56 , N/A ,$9.56 ,$19.50 ,$18.53 ,$15.99 ,$15.99 ,$15.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENTANYL 100 MCG/HR PT72,637,1 ,$267.65 ,$176.65 ,$131.15 ,$267.65 , N/A ,$239.87 ,$239.87 , N/A ,$214.12 ,$227.50 ,$167.28 ,$240.89 , N/A , N/A ,$254.27 ,$240.89 ,$227.50 ,$227.50 , N/A ,$227.50 ,$227.50 ,$240.89 ,$163.00 , N/A , N/A , N/A ,$240.89 , N/A ,$246.24 ,$240.89 ,$176.68 ,$176.68 ,$163.00 ,$176.68 ,$173.97 ,$182.86 ,$264.92 ,$211.44 , N/A ,$131.15 ,$131.15 , N/A ,$131.15 ,$267.65 ,$254.27 ,$219.47 ,$219.47 ,$214.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENTANYL 12 MCG/HR PT72,637,1 ,$69.05 ,$45.57 ,$33.83 ,$69.05 , N/A ,$61.88 ,$61.88 , N/A ,$55.24 ,$58.69 ,$43.16 ,$62.15 , N/A , N/A ,$65.60 ,$62.15 ,$58.69 ,$58.69 , N/A ,$58.69 ,$58.69 ,$62.15 ,$42.05 , N/A , N/A , N/A ,$62.15 , N/A ,$63.53 ,$62.15 ,$45.58 ,$45.58 ,$42.05 ,$45.58 ,$44.88 ,$47.18 ,$68.35 ,$54.55 , N/A ,$33.83 ,$33.83 , N/A ,$33.83 ,$69.05 ,$65.60 ,$56.62 ,$56.62 ,$55.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENTANYL 25 MCG/HR PT72,637,1 ,$49.05 ,$32.37 ,$24.03 ,$49.05 , N/A ,$43.96 ,$43.96 , N/A ,$39.24 ,$41.69 ,$30.66 ,$44.15 , N/A , N/A ,$46.60 ,$44.15 ,$41.69 ,$41.69 , N/A ,$41.69 ,$41.69 ,$44.15 ,$29.87 , N/A , N/A , N/A ,$44.15 , N/A ,$45.13 ,$44.15 ,$32.38 ,$32.38 ,$29.87 ,$32.38 ,$31.88 ,$33.51 ,$48.55 ,$38.75 , N/A ,$24.03 ,$24.03 , N/A ,$24.03 ,$49.05 ,$46.60 ,$40.22 ,$40.22 ,$39.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENTANYL 50 MCG/HR PT72,637,1 ,$132.20 ,$87.25 ,$64.78 ,$132.20 , N/A ,$118.48 ,$118.48 , N/A ,$105.76 ,$112.37 ,$82.63 ,$118.98 , N/A , N/A ,$125.59 ,$118.98 ,$112.37 ,$112.37 , N/A ,$112.37 ,$112.37 ,$118.98 ,$80.51 , N/A , N/A , N/A ,$118.98 , N/A ,$121.62 ,$118.98 ,$87.27 ,$87.27 ,$80.51 ,$87.27 ,$85.93 ,$90.32 ,$130.85 ,$104.44 , N/A ,$64.78 ,$64.78 , N/A ,$64.78 ,$132.20 ,$125.59 ,$108.40 ,$108.40 ,$105.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENTANYL 75 MCG/HR PT72,637,1 ,$201.70 ,$133.12 ,$98.83 ,$201.70 , N/A ,$180.76 ,$180.76 , N/A ,$161.36 ,$171.45 ,$126.06 ,$181.53 , N/A , N/A ,$191.62 ,$181.53 ,$171.45 ,$171.45 , N/A ,$171.45 ,$171.45 ,$181.53 ,$122.84 , N/A , N/A , N/A ,$181.53 , N/A ,$185.56 ,$181.53 ,$133.14 ,$133.14 ,$122.84 ,$133.14 ,$131.11 ,$137.80 ,$199.65 ,$159.34 , N/A ,$98.83 ,$98.83 , N/A ,$98.83 ,$201.70 ,$191.62 ,$165.39 ,$165.39 ,$161.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FIDAXOMICIN 200 MG TABS,637,1 ,$819.00 ,$540.54 ,$401.31 ,$819.00 , N/A ,$733.99 ,$733.99 , N/A ,$655.20 ,$696.15 ,$511.88 ,$737.10 , N/A , N/A ,$778.05 ,$737.10 ,$696.15 ,$696.15 , N/A ,$696.15 ,$696.15 ,$737.10 ,$498.77 , N/A , N/A , N/A ,$737.10 , N/A ,$753.48 ,$737.10 ,$540.62 ,$540.62 ,$498.77 ,$540.62 ,$532.35 ,$559.54 ,$810.65 ,$647.01 , N/A ,$401.31 ,$401.31 , N/A ,$401.31 ,$819.00 ,$778.05 ,$671.58 ,$671.58 ,$655.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FINASTERIDE 5 MG TABS,637,1 ,$10.65 ,$7.03 ,$5.22 ,$10.65 , N/A ,$9.54 ,$9.54 , N/A ,$8.52 ,$9.05 ,$6.66 ,$9.59 , N/A , N/A ,$10.12 ,$9.59 ,$9.05 ,$9.05 , N/A ,$9.05 ,$9.05 ,$9.59 ,$6.49 , N/A , N/A , N/A ,$9.59 , N/A ,$9.80 ,$9.59 ,$7.03 ,$7.03 ,$6.49 ,$7.03 ,$6.92 ,$7.28 ,$10.54 ,$8.41 , N/A ,$5.22 ,$5.22 , N/A ,$5.22 ,$10.65 ,$10.12 ,$8.73 ,$8.73 ,$8.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUCONAZOLE 100 MG TABS,637,1 ,$32.45 ,$21.42 ,$15.90 ,$32.45 , N/A ,$29.08 ,$29.08 , N/A ,$25.96 ,$27.58 ,$20.28 ,$29.21 , N/A , N/A ,$30.83 ,$29.21 ,$27.58 ,$27.58 , N/A ,$27.58 ,$27.58 ,$29.21 ,$19.76 , N/A , N/A , N/A ,$29.21 , N/A ,$29.85 ,$29.21 ,$21.42 ,$21.42 ,$19.76 ,$21.42 ,$21.09 ,$22.17 ,$32.11 ,$25.64 , N/A ,$15.90 ,$15.90 , N/A ,$15.90 ,$32.45 ,$30.83 ,$26.61 ,$26.61 ,$25.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUCONAZOLE 40 MG/ML SUSR,637,1 ,$12.67 ,$8.36 ,$6.21 ,$12.67 , N/A ,$11.35 ,$11.35 , N/A ,$10.14 ,$10.77 ,$7.92 ,$11.40 , N/A , N/A ,$12.04 ,$11.40 ,$10.77 ,$10.77 , N/A ,$10.77 ,$10.77 ,$11.40 ,$7.72 , N/A , N/A , N/A ,$11.40 , N/A ,$11.66 ,$11.40 ,$8.36 ,$8.36 ,$7.72 ,$8.36 ,$8.24 ,$8.66 ,$12.54 ,$10.01 , N/A ,$6.21 ,$6.21 , N/A ,$6.21 ,$12.67 ,$12.04 ,$10.39 ,$10.39 ,$10.14 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUOCINOLONE 0.025 % OINT 15 G TUBE,637,1 ,$119.35 ,$78.77 ,$58.48 ,$119.35 , N/A ,$106.96 ,$106.96 , N/A ,$95.48 ,$101.45 ,$74.59 ,$107.42 , N/A , N/A ,$113.38 ,$107.42 ,$101.45 ,$101.45 , N/A ,$101.45 ,$101.45 ,$107.42 ,$72.68 , N/A , N/A , N/A ,$107.42 , N/A ,$109.80 ,$107.42 ,$78.78 ,$78.78 ,$72.68 ,$78.78 ,$77.58 ,$81.54 ,$118.13 ,$94.29 , N/A ,$58.48 ,$58.48 , N/A ,$58.48 ,$119.35 ,$113.38 ,$97.87 ,$97.87 ,$95.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUOROMETHOLONE ACETATE 0.1 % SUSP 5 ML BOTTLE,637,1 ,$367.05 ,$242.25 ,$179.85 ,$367.05 , N/A ,$328.95 ,$328.95 , N/A ,$293.64 ,$311.99 ,$229.41 ,$330.35 , N/A , N/A ,$348.70 ,$330.35 ,$311.99 ,$311.99 , N/A ,$311.99 ,$311.99 ,$330.35 ,$223.53 , N/A , N/A , N/A ,$330.35 , N/A ,$337.69 ,$330.35 ,$242.29 ,$242.29 ,$223.53 ,$242.29 ,$238.58 ,$250.77 ,$363.31 ,$289.97 , N/A ,$179.85 ,$179.85 , N/A ,$179.85 ,$367.05 ,$348.70 ,$300.98 ,$300.98 ,$293.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUOXETINE 10 MG CAPS,637,1 ,$8.25 ,$5.45 ,$4.04 ,$8.25 , N/A ,$7.39 ,$7.39 , N/A ,$6.60 ,$7.01 ,$5.16 ,$7.43 , N/A , N/A ,$7.84 ,$7.43 ,$7.01 ,$7.01 , N/A ,$7.01 ,$7.01 ,$7.43 ,$5.02 , N/A , N/A , N/A ,$7.43 , N/A ,$7.59 ,$7.43 ,$5.45 ,$5.45 ,$5.02 ,$5.45 ,$5.36 ,$5.64 ,$8.16 ,$6.52 , N/A ,$4.04 ,$4.04 , N/A ,$4.04 ,$8.25 ,$7.84 ,$6.77 ,$6.77 ,$6.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FAMOTIDINE 20 MG TABS,637,1 ,$8.25 ,$5.45 ,$4.04 ,$8.25 , N/A ,$7.39 ,$7.39 , N/A ,$6.60 ,$7.01 ,$5.16 ,$7.43 , N/A , N/A ,$7.84 ,$7.43 ,$7.01 ,$7.01 , N/A ,$7.01 ,$7.01 ,$7.43 ,$5.02 , N/A , N/A , N/A ,$7.43 , N/A ,$7.59 ,$7.43 ,$5.45 ,$5.45 ,$5.02 ,$5.45 ,$5.36 ,$5.64 ,$8.16 ,$6.52 , N/A ,$4.04 ,$4.04 , N/A ,$4.04 ,$8.25 ,$7.84 ,$6.77 ,$6.77 ,$6.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE 110 MCG/ACT AERO,637,1 ,$18.65 ,$12.31 ,$9.14 ,$18.65 , N/A ,$16.71 ,$16.71 , N/A ,$14.92 ,$15.85 ,$11.66 ,$16.79 , N/A , N/A ,$17.72 ,$16.79 ,$15.85 ,$15.85 , N/A ,$15.85 ,$15.85 ,$16.79 ,$11.36 , N/A , N/A , N/A ,$16.79 , N/A ,$17.16 ,$16.79 ,$12.31 ,$12.31 ,$11.36 ,$12.31 ,$12.12 ,$12.74 ,$18.46 ,$14.73 , N/A ,$9.14 ,$9.14 , N/A ,$9.14 ,$18.65 ,$17.72 ,$15.29 ,$15.29 ,$14.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE PROPIONATE 220 MCG/ACT AERO,637,1 ,$14.50 ,$9.57 ,$7.11 ,$14.50 , N/A ,$12.99 ,$12.99 , N/A ,$11.60 ,$12.33 ,$9.06 ,$13.05 , N/A , N/A ,$13.78 ,$13.05 ,$12.33 ,$12.33 , N/A ,$12.33 ,$12.33 ,$13.05 ,$8.83 , N/A , N/A , N/A ,$13.05 , N/A ,$13.34 ,$13.05 ,$9.57 ,$9.57 ,$8.83 ,$9.57 ,$9.43 ,$9.91 ,$14.36 ,$11.46 , N/A ,$7.11 ,$7.11 , N/A ,$7.11 ,$14.50 ,$13.78 ,$11.89 ,$11.89 ,$11.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE PROPIONATE 44 MCG/ACT AERO,637,1 ,$13.95 ,$9.21 ,$6.84 ,$13.95 , N/A ,$12.50 ,$12.50 , N/A ,$11.16 ,$11.86 ,$8.72 ,$12.56 , N/A , N/A ,$13.25 ,$12.56 ,$11.86 ,$11.86 , N/A ,$11.86 ,$11.86 ,$12.56 ,$8.50 , N/A , N/A , N/A ,$12.56 , N/A ,$12.83 ,$12.56 ,$9.21 ,$9.21 ,$8.50 ,$9.21 ,$9.07 ,$9.53 ,$13.81 ,$11.02 , N/A ,$6.84 ,$6.84 , N/A ,$6.84 ,$13.95 ,$13.25 ,$11.44 ,$11.44 ,$11.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE PROPIONATE 50 MCG/ACT SUSP 16 G BOTTLE,637,1 ,$289.90 ,$191.33 ,$142.05 ,$289.90 , N/A ,$259.81 ,$259.81 , N/A ,$231.92 ,$246.42 ,$181.19 ,$260.91 , N/A , N/A ,$275.41 ,$260.91 ,$246.42 ,$246.42 , N/A ,$246.42 ,$246.42 ,$260.91 ,$176.55 , N/A , N/A , N/A ,$260.91 , N/A ,$266.71 ,$260.91 ,$191.36 ,$191.36 ,$176.55 ,$191.36 ,$188.44 ,$198.06 ,$286.94 ,$229.02 , N/A ,$142.05 ,$142.05 , N/A ,$142.05 ,$289.90 ,$275.41 ,$237.72 ,$237.72 ,$231.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUOROMETHOLONE 0.1 % SUSP 5 ML BOTTLE,637,1 ,$289.90 ,$191.33 ,$142.05 ,$289.90 , N/A ,$259.81 ,$259.81 , N/A ,$231.92 ,$246.42 ,$181.19 ,$260.91 , N/A , N/A ,$275.41 ,$260.91 ,$246.42 ,$246.42 , N/A ,$246.42 ,$246.42 ,$260.91 ,$176.55 , N/A , N/A , N/A ,$260.91 , N/A ,$266.71 ,$260.91 ,$191.36 ,$191.36 ,$176.55 ,$191.36 ,$188.44 ,$198.06 ,$286.94 ,$229.02 , N/A ,$142.05 ,$142.05 , N/A ,$142.05 ,$289.90 ,$275.41 ,$237.72 ,$237.72 ,$231.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE-SALMETEROL 230-21 MCG/ACT AERO,637,1 ,$44.15 ,$29.14 ,$21.63 ,$44.15 , N/A ,$39.57 ,$39.57 , N/A ,$35.32 ,$37.53 ,$27.59 ,$39.74 , N/A , N/A ,$41.94 ,$39.74 ,$37.53 ,$37.53 , N/A ,$37.53 ,$37.53 ,$39.74 ,$26.89 , N/A , N/A , N/A ,$39.74 , N/A ,$40.62 ,$39.74 ,$29.14 ,$29.14 ,$26.89 ,$29.14 ,$28.70 ,$30.16 ,$43.70 ,$34.88 , N/A ,$21.63 ,$21.63 , N/A ,$21.63 ,$44.15 ,$41.94 ,$36.20 ,$36.20 ,$35.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE-SALMETEROL 45-21 MCG/ACT AERO,637,1 ,$29.65 ,$19.57 ,$14.53 ,$29.65 , N/A ,$26.57 ,$26.57 , N/A ,$23.72 ,$25.20 ,$18.53 ,$26.69 , N/A , N/A ,$28.17 ,$26.69 ,$25.20 ,$25.20 , N/A ,$25.20 ,$25.20 ,$26.69 ,$18.06 , N/A , N/A , N/A ,$26.69 , N/A ,$27.28 ,$26.69 ,$19.57 ,$19.57 ,$18.06 ,$19.57 ,$19.27 ,$20.26 ,$29.35 ,$23.42 , N/A ,$14.53 ,$14.53 , N/A ,$14.53 ,$29.65 ,$28.17 ,$24.31 ,$24.31 ,$23.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUVOXAMINE 100 MG TABS,637,1 ,$8.95 ,$5.91 ,$4.39 ,$8.95 , N/A ,$8.02 ,$8.02 , N/A ,$7.16 ,$7.61 ,$5.59 ,$8.06 , N/A , N/A ,$8.50 ,$8.06 ,$7.61 ,$7.61 , N/A ,$7.61 ,$7.61 ,$8.06 ,$5.45 , N/A , N/A , N/A ,$8.06 , N/A ,$8.23 ,$8.06 ,$5.91 ,$5.91 ,$5.45 ,$5.91 ,$5.82 ,$6.11 ,$8.86 ,$7.07 , N/A ,$4.39 ,$4.39 , N/A ,$4.39 ,$8.95 ,$8.50 ,$7.34 ,$7.34 ,$7.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FOSFOMYCIN 3 G PACK,637,1 ,$321.30 ,$212.06 ,$157.44 ,$321.30 , N/A ,$287.95 ,$287.95 , N/A ,$257.04 ,$273.11 ,$200.81 ,$289.17 , N/A , N/A ,$305.24 ,$289.17 ,$273.11 ,$273.11 , N/A ,$273.11 ,$273.11 ,$289.17 ,$195.67 , N/A , N/A , N/A ,$289.17 , N/A ,$295.60 ,$289.17 ,$212.09 ,$212.09 ,$195.67 ,$212.09 ,$208.85 ,$219.51 ,$318.02 ,$253.83 , N/A ,$157.44 ,$157.44 , N/A ,$157.44 ,$321.30 ,$305.24 ,$263.47 ,$263.47 ,$257.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 600 MG TABS,637,1 ,$8.60 ,$5.68 ,$4.21 ,$8.60 , N/A ,$7.71 ,$7.71 , N/A ,$6.88 ,$7.31 ,$5.38 ,$7.74 , N/A , N/A ,$8.17 ,$7.74 ,$7.31 ,$7.31 , N/A ,$7.31 ,$7.31 ,$7.74 ,$5.24 , N/A , N/A , N/A ,$7.74 , N/A ,$7.91 ,$7.74 ,$5.68 ,$5.68 ,$5.24 ,$5.68 ,$5.59 ,$5.88 ,$8.52 ,$6.79 , N/A ,$4.21 ,$4.21 , N/A ,$4.21 ,$8.60 ,$8.17 ,$7.05 ,$7.05 ,$6.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUOXETINE 20 MG CAPS,637,1 ,$8.60 ,$5.68 ,$4.21 ,$8.60 , N/A ,$7.71 ,$7.71 , N/A ,$6.88 ,$7.31 ,$5.38 ,$7.74 , N/A , N/A ,$8.17 ,$7.74 ,$7.31 ,$7.31 , N/A ,$7.31 ,$7.31 ,$7.74 ,$5.24 , N/A , N/A , N/A ,$7.74 , N/A ,$7.91 ,$7.74 ,$5.68 ,$5.68 ,$5.24 ,$5.68 ,$5.59 ,$5.88 ,$8.52 ,$6.79 , N/A ,$4.21 ,$4.21 , N/A ,$4.21 ,$8.60 ,$8.17 ,$7.05 ,$7.05 ,$6.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GALANTAMINE 4 MG TABS,637,1 ,$10.85 ,$7.16 ,$5.32 ,$10.85 , N/A ,$9.72 ,$9.72 , N/A ,$8.68 ,$9.22 ,$6.78 ,$9.77 , N/A , N/A ,$10.31 ,$9.77 ,$9.22 ,$9.22 , N/A ,$9.22 ,$9.22 ,$9.77 ,$6.61 , N/A , N/A , N/A ,$9.77 , N/A ,$9.98 ,$9.77 ,$7.16 ,$7.16 ,$6.61 ,$7.16 ,$7.05 ,$7.41 ,$10.74 ,$8.57 , N/A ,$5.32 ,$5.32 , N/A ,$5.32 ,$10.85 ,$10.31 ,$8.90 ,$8.90 ,$8.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GENTAMICIN 0.1 % OINT 15 G TUBE,637,1 ,$167.90 ,$110.81 ,$82.27 ,$167.90 , N/A ,$150.47 ,$150.47 , N/A ,$134.32 ,$142.72 ,$104.94 ,$151.11 , N/A , N/A ,$159.51 ,$151.11 ,$142.72 ,$142.72 , N/A ,$142.72 ,$142.72 ,$151.11 ,$102.25 , N/A , N/A , N/A ,$151.11 , N/A ,$154.47 ,$151.11 ,$110.83 ,$110.83 ,$102.25 ,$110.83 ,$109.14 ,$114.71 ,$166.19 ,$132.64 , N/A ,$82.27 ,$82.27 , N/A ,$82.27 ,$167.90 ,$159.51 ,$137.68 ,$137.68 ,$134.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GENTAMICIN 0.3 % SOLN 5 ML BOTTLE,637,1 ,$65.25 ,$43.07 ,$31.97 ,$65.25 , N/A ,$58.48 ,$58.48 , N/A ,$52.20 ,$55.46 ,$40.78 ,$58.73 , N/A , N/A ,$61.99 ,$58.73 ,$55.46 ,$55.46 , N/A ,$55.46 ,$55.46 ,$58.73 ,$39.74 , N/A , N/A , N/A ,$58.73 , N/A ,$60.03 ,$58.73 ,$43.07 ,$43.07 ,$39.74 ,$43.07 ,$42.41 ,$44.58 ,$64.58 ,$51.55 , N/A ,$31.97 ,$31.97 , N/A ,$31.97 ,$65.25 ,$61.99 ,$53.51 ,$53.51 ,$52.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GUANFACINE ER 1 MG TB24,637,1 ,$35.70 ,$23.56 ,$17.49 ,$35.70 , N/A ,$31.99 ,$31.99 , N/A ,$28.56 ,$30.35 ,$22.31 ,$32.13 , N/A , N/A ,$33.92 ,$32.13 ,$30.35 ,$30.35 , N/A ,$30.35 ,$30.35 ,$32.13 ,$21.74 , N/A , N/A , N/A ,$32.13 , N/A ,$32.84 ,$32.13 ,$23.57 ,$23.57 ,$21.74 ,$23.57 ,$23.21 ,$24.39 ,$35.34 ,$28.20 , N/A ,$17.49 ,$17.49 , N/A ,$17.49 ,$35.70 ,$33.92 ,$29.27 ,$29.27 ,$28.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA 25 MG TABS,637,1 ,$35.70 ,$23.56 ,$17.49 ,$35.70 , N/A ,$31.99 ,$31.99 , N/A ,$28.56 ,$30.35 ,$22.31 ,$32.13 , N/A , N/A ,$33.92 ,$32.13 ,$30.35 ,$30.35 , N/A ,$30.35 ,$30.35 ,$32.13 ,$21.74 , N/A , N/A , N/A ,$32.13 , N/A ,$32.84 ,$32.13 ,$23.57 ,$23.57 ,$21.74 ,$23.57 ,$23.21 ,$24.39 ,$35.34 ,$28.20 , N/A ,$17.49 ,$17.49 , N/A ,$17.49 ,$35.70 ,$33.92 ,$29.27 ,$29.27 ,$28.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML SOLN,637,1 ,$16.75 ,$11.06 ,$8.21 ,$16.75 , N/A ,$15.01 ,$15.01 , N/A ,$13.40 ,$14.24 ,$10.47 ,$15.08 , N/A , N/A ,$15.91 ,$15.08 ,$14.24 ,$14.24 , N/A ,$14.24 ,$14.24 ,$15.08 ,$10.20 , N/A , N/A , N/A ,$15.08 , N/A ,$15.41 ,$15.08 ,$11.06 ,$11.06 ,$10.20 ,$11.06 ,$10.89 ,$11.44 ,$16.58 ,$13.23 , N/A ,$8.21 ,$8.21 , N/A ,$8.21 ,$16.75 ,$15.91 ,$13.74 ,$13.74 ,$13.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUOXETINE 20 MG/5ML SOLN,637,1 ,$16.75 ,$11.06 ,$8.21 ,$16.75 , N/A ,$15.01 ,$15.01 , N/A ,$13.40 ,$14.24 ,$10.47 ,$15.08 , N/A , N/A ,$15.91 ,$15.08 ,$14.24 ,$14.24 , N/A ,$14.24 ,$14.24 ,$15.08 ,$10.20 , N/A , N/A , N/A ,$15.08 , N/A ,$15.41 ,$15.08 ,$11.06 ,$11.06 ,$10.20 ,$11.06 ,$10.89 ,$11.44 ,$16.58 ,$13.23 , N/A ,$8.21 ,$8.21 , N/A ,$8.21 ,$16.75 ,$15.91 ,$13.74 ,$13.74 ,$13.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 1 % CREA 28 G TUBE,637,1 ,$13.65 ,$9.01 ,$6.69 ,$13.65 , N/A ,$12.23 ,$12.23 , N/A ,$10.92 ,$11.60 ,$8.53 ,$12.29 , N/A , N/A ,$12.97 ,$12.29 ,$11.60 ,$11.60 , N/A ,$11.60 ,$11.60 ,$12.29 ,$8.31 , N/A , N/A , N/A ,$12.29 , N/A ,$12.56 ,$12.29 ,$9.01 ,$9.01 ,$8.31 ,$9.01 ,$8.87 ,$9.33 ,$13.51 ,$10.78 , N/A ,$6.69 ,$6.69 , N/A ,$6.69 ,$13.65 ,$12.97 ,$11.19 ,$11.19 ,$10.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 1 % CREA 28.4 G TUBE,637,1 ,$22.05 ,$14.55 ,$10.80 ,$22.05 , N/A ,$19.76 ,$19.76 , N/A ,$17.64 ,$18.74 ,$13.78 ,$19.85 , N/A , N/A ,$20.95 ,$19.85 ,$18.74 ,$18.74 , N/A ,$18.74 ,$18.74 ,$19.85 ,$13.43 , N/A , N/A , N/A ,$19.85 , N/A ,$20.29 ,$19.85 ,$14.56 ,$14.56 ,$13.43 ,$14.56 ,$14.33 ,$15.06 ,$21.82 ,$17.42 , N/A ,$10.80 ,$10.80 , N/A ,$10.80 ,$22.05 ,$20.95 ,$18.08 ,$18.08 ,$17.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 1 % CREA 30 G TUBE,637,1 ,$13.60 ,$8.98 ,$6.66 ,$13.60 , N/A ,$12.19 ,$12.19 , N/A ,$10.88 ,$11.56 ,$8.50 ,$12.24 , N/A , N/A ,$12.92 ,$12.24 ,$11.56 ,$11.56 , N/A ,$11.56 ,$11.56 ,$12.24 ,$8.28 , N/A , N/A , N/A ,$12.24 , N/A ,$12.51 ,$12.24 ,$8.98 ,$8.98 ,$8.28 ,$8.98 ,$8.84 ,$9.29 ,$13.47 ,$10.74 , N/A ,$6.66 ,$6.66 , N/A ,$6.66 ,$13.60 ,$12.92 ,$11.15 ,$11.15 ,$10.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 2.5 % CREA 28 G TUBE,637,1 ,$36.75 ,$24.26 ,$18.01 ,$36.75 , N/A ,$32.94 ,$32.94 , N/A ,$29.40 ,$31.24 ,$22.97 ,$33.08 , N/A , N/A ,$34.91 ,$33.08 ,$31.24 ,$31.24 , N/A ,$31.24 ,$31.24 ,$33.08 ,$22.38 , N/A , N/A , N/A ,$33.08 , N/A ,$33.81 ,$33.08 ,$24.26 ,$24.26 ,$22.38 ,$24.26 ,$23.89 ,$25.11 ,$36.38 ,$29.03 , N/A ,$18.01 ,$18.01 , N/A ,$18.01 ,$36.75 ,$34.91 ,$30.14 ,$30.14 ,$29.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 2.5 % CREA 28.35 G TUBE,637,1 ,$296.90 ,$195.95 ,$145.48 ,$296.90 , N/A ,$266.08 ,$266.08 , N/A ,$237.52 ,$252.37 ,$185.56 ,$267.21 , N/A , N/A ,$282.06 ,$267.21 ,$252.37 ,$252.37 , N/A ,$252.37 ,$252.37 ,$267.21 ,$180.81 , N/A , N/A , N/A ,$267.21 , N/A ,$273.15 ,$267.21 ,$195.98 ,$195.98 ,$180.81 ,$195.98 ,$192.99 ,$202.84 ,$293.87 ,$234.55 , N/A ,$145.48 ,$145.48 , N/A ,$145.48 ,$296.90 ,$282.06 ,$243.46 ,$243.46 ,$237.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 2.5 % CREA 30 G TUBE,637,1 ,$296.95 ,$195.99 ,$145.51 ,$296.95 , N/A ,$266.13 ,$266.13 , N/A ,$237.56 ,$252.41 ,$185.59 ,$267.26 , N/A , N/A ,$282.10 ,$267.26 ,$252.41 ,$252.41 , N/A ,$252.41 ,$252.41 ,$267.26 ,$180.84 , N/A , N/A , N/A ,$267.26 , N/A ,$273.19 ,$267.26 ,$196.02 ,$196.02 ,$180.84 ,$196.02 ,$193.02 ,$202.88 ,$293.92 ,$234.59 , N/A ,$145.51 ,$145.51 , N/A ,$145.51 ,$296.95 ,$282.10 ,$243.50 ,$243.50 ,$237.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 2.5 % OINT 20 G TUBE,637,1 ,$16.90 ,$11.15 ,$8.28 ,$16.90 , N/A ,$15.15 ,$15.15 , N/A ,$13.52 ,$14.37 ,$10.56 ,$15.21 , N/A , N/A ,$16.06 ,$15.21 ,$14.37 ,$14.37 , N/A ,$14.37 ,$14.37 ,$15.21 ,$10.29 , N/A , N/A , N/A ,$15.21 , N/A ,$15.55 ,$15.21 ,$11.16 ,$11.16 ,$10.29 ,$11.16 ,$10.99 ,$11.55 ,$16.73 ,$13.35 , N/A ,$8.28 ,$8.28 , N/A ,$8.28 ,$16.90 ,$16.06 ,$13.86 ,$13.86 ,$13.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 2.5 % OINT 28.35 G TUBE,637,1 ,$37.40 ,$24.68 ,$18.33 ,$37.40 , N/A ,$33.52 ,$33.52 , N/A ,$29.92 ,$31.79 ,$23.38 ,$33.66 , N/A , N/A ,$35.53 ,$33.66 ,$31.79 ,$31.79 , N/A ,$31.79 ,$31.79 ,$33.66 ,$22.78 , N/A , N/A , N/A ,$33.66 , N/A ,$34.41 ,$33.66 ,$24.69 ,$24.69 ,$22.78 ,$24.69 ,$24.31 ,$25.55 ,$37.01 ,$29.55 , N/A ,$18.33 ,$18.33 , N/A ,$18.33 ,$37.40 ,$35.53 ,$30.67 ,$30.67 ,$29.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 20 MG TABS,637,1 ,$11.10 ,$7.33 ,$5.44 ,$11.10 , N/A ,$9.95 ,$9.95 , N/A ,$8.88 ,$9.44 ,$6.94 ,$9.99 , N/A , N/A ,$10.55 ,$9.99 ,$9.44 ,$9.44 , N/A ,$9.44 ,$9.44 ,$9.99 ,$6.76 , N/A , N/A , N/A ,$9.99 , N/A ,$10.21 ,$9.99 ,$7.33 ,$7.33 ,$6.76 ,$7.33 ,$7.22 ,$7.58 ,$10.99 ,$8.77 , N/A ,$5.44 ,$5.44 , N/A ,$5.44 ,$11.10 ,$10.55 ,$9.10 ,$9.10 ,$8.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 25 MG SUPP,637,1 ,$77.00 ,$50.82 ,$37.73 ,$77.00 , N/A ,$69.01 ,$69.01 , N/A ,$61.60 ,$65.45 ,$48.13 ,$69.30 , N/A , N/A ,$73.15 ,$69.30 ,$65.45 ,$65.45 , N/A ,$65.45 ,$65.45 ,$69.30 ,$46.89 , N/A , N/A , N/A ,$69.30 , N/A ,$70.84 ,$69.30 ,$50.83 ,$50.83 ,$46.89 ,$50.83 ,$50.05 ,$52.61 ,$76.21 ,$60.83 , N/A ,$37.73 ,$37.73 , N/A ,$37.73 ,$77.00 ,$73.15 ,$63.14 ,$63.14 ,$61.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE-PRAMOXINE 1-1 % CREA 30 G TUBE,637,1 ,$495.05 ,$326.73 ,$242.57 ,$495.05 , N/A ,$443.66 ,$443.66 , N/A ,$396.04 ,$420.79 ,$309.41 ,$445.55 , N/A , N/A ,$470.30 ,$445.55 ,$420.79 ,$420.79 , N/A ,$420.79 ,$420.79 ,$445.55 ,$301.49 , N/A , N/A , N/A ,$445.55 , N/A ,$455.45 ,$445.55 ,$326.78 ,$326.78 ,$301.49 ,$326.78 ,$321.78 ,$338.22 ,$490.00 ,$391.09 , N/A ,$242.57 ,$242.57 , N/A ,$242.57 ,$495.05 ,$470.30 ,$405.94 ,$405.94 ,$396.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,INDOMETHACIN 50 MG SUPP,250,1 ,"$1,262.70 ",$833.38 ,$287.45 ,"$1,262.70 ", N/A ,"$1,131.63 ","$1,131.63 ",$334.11 ,"$1,010.16 ","$1,073.30 ",$789.19 ,"$1,136.43 ", N/A , N/A ,"$1,199.57 ","$1,136.43 ","$1,073.30 ","$1,073.30 ",$334.11 ,"$1,073.30 ","$1,073.30 ","$1,136.43 ",$768.98 , N/A ,$782.88 , N/A ,"$1,136.43 ", N/A ,"$1,161.68 ","$1,136.43 ",$833.51 ,$833.51 ,$768.98 ,$833.51 ,$820.76 ,$862.68 ,$287.45 ,$997.53 , N/A ,$618.72 ,$618.72 ,$334.11 ,$618.72 , N/A ,"$1,199.57 ","$1,035.41 ","$1,035.41 ","$1,010.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN ASPART PROTAMINE-INSULIN ASPART (70-30) 100 UNIT/ML SUSP per5 Units,637,1 ,$11.08 ,$7.31 ,$5.43 ,$11.08 , N/A ,$9.93 ,$9.93 , N/A ,$8.86 ,$9.42 ,$6.93 ,$9.97 , N/A , N/A ,$10.53 ,$9.97 ,$9.42 ,$9.42 , N/A ,$9.42 ,$9.42 ,$9.97 ,$6.75 , N/A , N/A , N/A ,$9.97 , N/A ,$10.19 ,$9.97 ,$7.31 ,$7.31 ,$6.75 ,$7.31 ,$7.20 ,$7.57 ,$10.97 ,$8.75 , N/A ,$5.43 ,$5.43 , N/A ,$5.43 ,$11.08 ,$10.53 ,$9.09 ,$9.09 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN GLARGINE 100 UNIT/ML SOLN per5 Units,637,1 ,$16.33 ,$10.78 ,$8.00 ,$16.33 , N/A ,$14.63 ,$14.63 , N/A ,$13.06 ,$13.88 ,$10.21 ,$14.70 , N/A , N/A ,$15.51 ,$14.70 ,$13.88 ,$13.88 , N/A ,$13.88 ,$13.88 ,$14.70 ,$9.95 , N/A , N/A , N/A ,$14.70 , N/A ,$15.02 ,$14.70 ,$10.78 ,$10.78 ,$9.95 ,$10.78 ,$10.61 ,$11.16 ,$16.16 ,$12.90 , N/A ,$8.00 ,$8.00 , N/A ,$8.00 ,$16.33 ,$15.51 ,$13.39 ,$13.39 ,$13.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN LISPRO PROTAMINE-INSULIN LISPRO (75-25) 100 UNIT/ML SUSP per5 Units,637,1 ,$10.51 ,$6.94 ,$5.15 ,$10.51 , N/A ,$9.42 ,$9.42 , N/A ,$8.41 ,$8.93 ,$6.57 ,$9.46 , N/A , N/A ,$9.98 ,$9.46 ,$8.93 ,$8.93 , N/A ,$8.93 ,$8.93 ,$9.46 ,$6.40 , N/A , N/A , N/A ,$9.46 , N/A ,$9.67 ,$9.46 ,$6.94 ,$6.94 ,$6.40 ,$6.94 ,$6.83 ,$7.18 ,$10.41 ,$8.30 , N/A ,$5.15 ,$5.15 , N/A ,$5.15 ,$10.51 ,$9.98 ,$8.62 ,$8.62 ,$8.41 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN NPH-INSULIN REGULAR (70-30) 100 UNIT/ML SUSP per5 Units,637,1 ,$24.50 ,$16.17 ,$12.01 ,$24.50 , N/A ,$21.96 ,$21.96 , N/A ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 , N/A ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A , N/A , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$24.25 ,$19.36 , N/A ,$12.01 ,$12.01 , N/A ,$12.01 ,$24.50 ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN NPH 100 UNIT/ML SUSP per5 Units,637,1 ,$24.50 ,$16.17 ,$12.01 ,$24.50 , N/A ,$21.96 ,$21.96 , N/A ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 , N/A ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A , N/A , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$24.25 ,$19.36 , N/A ,$12.01 ,$12.01 , N/A ,$12.01 ,$24.50 ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN REGULAR (CONCENTRATED) 500 UNIT/ML SOLN per5 Units,637,1 ,$5.49 ,$3.62 ,$2.69 ,$5.49 , N/A ,$4.92 ,$4.92 , N/A ,$4.39 ,$4.67 ,$3.43 ,$4.94 , N/A , N/A ,$5.22 ,$4.94 ,$4.67 ,$4.67 , N/A ,$4.67 ,$4.67 ,$4.94 ,$3.34 , N/A , N/A , N/A ,$4.94 , N/A ,$5.05 ,$4.94 ,$3.62 ,$3.62 ,$3.34 ,$3.62 ,$3.57 ,$3.75 ,$5.43 ,$4.34 , N/A ,$2.69 ,$2.69 , N/A ,$2.69 ,$5.49 ,$5.22 ,$4.50 ,$4.50 ,$4.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN REGULAR 100 UNIT/ML SOLN per5 Units,637,1 ,$49.00 ,$32.34 ,$24.01 ,$49.00 , N/A ,$43.91 ,$43.91 , N/A ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 , N/A ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A , N/A , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$48.50 ,$38.71 , N/A ,$24.01 ,$24.01 , N/A ,$24.01 ,$49.00 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,J1815,INSULIN LISPRO 100 UNIT/ML SOLN per5 Units,637,1 ,$49.00 ,$32.34 ,$24.01 ,$49.00 , N/A ,$43.91 ,$43.91 , N/A ,$39.20 ,$41.65 ,$30.63 ,$44.10 , N/A , N/A ,$46.55 ,$44.10 ,$41.65 ,$41.65 , N/A ,$41.65 ,$41.65 ,$44.10 ,$29.84 , N/A , N/A , N/A ,$44.10 , N/A ,$45.08 ,$44.10 ,$32.34 ,$32.34 ,$29.84 ,$32.34 ,$31.85 ,$33.48 ,$48.50 ,$38.71 , N/A ,$24.01 ,$24.01 , N/A ,$24.01 ,$49.00 ,$46.55 ,$40.18 ,$40.18 ,$39.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT AERS 4 G INHALER,637,1 ,"$1,771.20 ","$1,168.99 ",$867.89 ,"$1,771.20 ", N/A ,"$1,587.35 ","$1,587.35 ", N/A ,"$1,416.96 ","$1,505.52 ","$1,107.00 ","$1,594.08 ", N/A , N/A ,"$1,682.64 ","$1,594.08 ","$1,505.52 ","$1,505.52 ", N/A ,"$1,505.52 ","$1,505.52 ","$1,594.08 ","$1,078.66 ", N/A , N/A , N/A ,"$1,594.08 ", N/A ,"$1,629.50 ","$1,594.08 ","$1,169.17 ","$1,169.17 ","$1,078.66 ","$1,169.17 ","$1,151.28 ","$1,210.08 ","$1,753.13 ","$1,399.25 ", N/A ,$867.89 ,$867.89 , N/A ,$867.89 ,"$1,771.20 ","$1,682.64 ","$1,452.38 ","$1,452.38 ","$1,416.96 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ITRACONAZOLE 100 MG CAPS,637,1 ,$53.48 ,$35.30 ,$26.21 ,$53.48 , N/A ,$47.93 ,$47.93 , N/A ,$42.78 ,$45.46 ,$33.43 ,$48.13 , N/A , N/A ,$50.81 ,$48.13 ,$45.46 ,$45.46 , N/A ,$45.46 ,$45.46 ,$48.13 ,$32.57 , N/A , N/A , N/A ,$48.13 , N/A ,$49.20 ,$48.13 ,$35.30 ,$35.30 ,$32.57 ,$35.30 ,$34.76 ,$36.54 ,$52.93 ,$42.25 , N/A ,$26.21 ,$26.21 , N/A ,$26.21 ,$53.48 ,$50.81 ,$43.85 ,$43.85 ,$42.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,KETOCONAZOLE 2 % CREA 15 G TUBE,637,1 ,$105.10 ,$69.37 ,$51.50 ,$105.10 , N/A ,$94.19 ,$94.19 , N/A ,$84.08 ,$89.34 ,$65.69 ,$94.59 , N/A , N/A ,$99.85 ,$94.59 ,$89.34 ,$89.34 , N/A ,$89.34 ,$89.34 ,$94.59 ,$64.01 , N/A , N/A , N/A ,$94.59 , N/A ,$96.69 ,$94.59 ,$69.38 ,$69.38 ,$64.01 ,$69.38 ,$68.32 ,$71.80 ,$104.03 ,$83.03 , N/A ,$51.50 ,$51.50 , N/A ,$51.50 ,$105.10 ,$99.85 ,$86.18 ,$86.18 ,$84.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,KETOCONAZOLE 2 % SHAM 120 ML BOTTLE,637,1 ,$102.85 ,$67.88 ,$50.40 ,$102.85 , N/A ,$92.17 ,$92.17 , N/A ,$82.28 ,$87.42 ,$64.28 ,$92.57 , N/A , N/A ,$97.71 ,$92.57 ,$87.42 ,$87.42 , N/A ,$87.42 ,$87.42 ,$92.57 ,$62.64 , N/A , N/A , N/A ,$92.57 , N/A ,$94.62 ,$92.57 ,$67.89 ,$67.89 ,$62.64 ,$67.89 ,$66.85 ,$70.27 ,$101.80 ,$81.25 , N/A ,$50.40 ,$50.40 , N/A ,$50.40 ,$102.85 ,$97.71 ,$84.34 ,$84.34 ,$82.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,KETOROLAC 0.5 % SOLN 10 ML BOTTLE,637,1 ,$714.00 ,$471.24 ,$349.86 ,$714.00 , N/A ,$639.89 ,$639.89 , N/A ,$571.20 ,$606.90 ,$446.25 ,$642.60 , N/A , N/A ,$678.30 ,$642.60 ,$606.90 ,$606.90 , N/A ,$606.90 ,$606.90 ,$642.60 ,$434.83 , N/A , N/A , N/A ,$642.60 , N/A ,$656.88 ,$642.60 ,$471.31 ,$471.31 ,$434.83 ,$471.31 ,$464.10 ,$487.80 ,$706.72 ,$564.06 , N/A ,$349.86 ,$349.86 , N/A ,$349.86 ,$714.00 ,$678.30 ,$585.48 ,$585.48 ,$571.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,KETOROLAC 0.5 % SOLN 5 ML BOTTLE,637,1 ,$358.70 ,$236.74 ,$175.76 ,$358.70 , N/A ,$321.47 ,$321.47 , N/A ,$286.96 ,$304.90 ,$224.19 ,$322.83 , N/A , N/A ,$340.77 ,$322.83 ,$304.90 ,$304.90 , N/A ,$304.90 ,$304.90 ,$322.83 ,$218.45 , N/A , N/A , N/A ,$322.83 , N/A ,$330.00 ,$322.83 ,$236.78 ,$236.78 ,$218.45 ,$236.78 ,$233.16 ,$245.06 ,$355.04 ,$283.37 , N/A ,$175.76 ,$175.76 , N/A ,$175.76 ,$358.70 ,$340.77 ,$294.13 ,$294.13 ,$286.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACOSAMIDE 10 MG/ML SOLN,637,1 ,$168.55 ,$111.24 ,$82.59 ,$168.55 , N/A ,$151.05 ,$151.05 , N/A ,$134.84 ,$143.27 ,$105.34 ,$151.70 , N/A , N/A ,$160.12 ,$151.70 ,$143.27 ,$143.27 , N/A ,$143.27 ,$143.27 ,$151.70 ,$102.65 , N/A , N/A , N/A ,$151.70 , N/A ,$155.07 ,$151.70 ,$111.26 ,$111.26 ,$102.65 ,$111.26 ,$109.56 ,$115.15 ,$166.84 ,$133.15 , N/A ,$82.59 ,$82.59 , N/A ,$82.59 ,$168.55 ,$160.12 ,$138.21 ,$138.21 ,$134.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACOSAMIDE 100 MG TABS,637,1 ,$74.70 ,$49.30 ,$36.60 ,$74.70 , N/A ,$66.95 ,$66.95 , N/A ,$59.76 ,$63.50 ,$46.69 ,$67.23 , N/A , N/A ,$70.97 ,$67.23 ,$63.50 ,$63.50 , N/A ,$63.50 ,$63.50 ,$67.23 ,$45.49 , N/A , N/A , N/A ,$67.23 , N/A ,$68.72 ,$67.23 ,$49.31 ,$49.31 ,$45.49 ,$49.31 ,$48.56 ,$51.04 ,$73.94 ,$59.01 , N/A ,$36.60 ,$36.60 , N/A ,$36.60 ,$74.70 ,$70.97 ,$61.25 ,$61.25 ,$59.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACOSAMIDE 50 MG TABS,637,1 ,$47.78 ,$31.53 ,$23.41 ,$47.78 , N/A ,$42.82 ,$42.82 , N/A ,$38.22 ,$40.61 ,$29.86 ,$43.00 , N/A , N/A ,$45.39 ,$43.00 ,$40.61 ,$40.61 , N/A ,$40.61 ,$40.61 ,$43.00 ,$29.10 , N/A , N/A , N/A ,$43.00 , N/A ,$43.96 ,$43.00 ,$31.54 ,$31.54 ,$29.10 ,$31.54 ,$31.06 ,$32.64 ,$47.29 ,$37.75 , N/A ,$23.41 ,$23.41 , N/A ,$23.41 ,$47.78 ,$45.39 ,$39.18 ,$39.18 ,$38.22 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTULOSE 20 G PACK,637,1 ,$36.90 ,$24.35 ,$18.08 ,$36.90 , N/A ,$33.07 ,$33.07 , N/A ,$29.52 ,$31.37 ,$23.06 ,$33.21 , N/A , N/A ,$35.06 ,$33.21 ,$31.37 ,$31.37 , N/A ,$31.37 ,$31.37 ,$33.21 ,$22.47 , N/A , N/A , N/A ,$33.21 , N/A ,$33.95 ,$33.21 ,$24.36 ,$24.36 ,$22.47 ,$24.36 ,$23.99 ,$25.21 ,$36.52 ,$29.15 , N/A ,$18.08 ,$18.08 , N/A ,$18.08 ,$36.90 ,$35.06 ,$30.26 ,$30.26 ,$29.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LAMOTRIGINE 100 MG TABS,637,1 ,$17.70 ,$11.68 ,$8.67 ,$17.70 , N/A ,$15.86 ,$15.86 , N/A ,$14.16 ,$15.05 ,$11.06 ,$15.93 , N/A , N/A ,$16.82 ,$15.93 ,$15.05 ,$15.05 , N/A ,$15.05 ,$15.05 ,$15.93 ,$10.78 , N/A , N/A , N/A ,$15.93 , N/A ,$16.28 ,$15.93 ,$11.68 ,$11.68 ,$10.78 ,$11.68 ,$11.51 ,$12.09 ,$17.52 ,$13.98 , N/A ,$8.67 ,$8.67 , N/A ,$8.67 ,$17.70 ,$16.82 ,$14.51 ,$14.51 ,$14.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CIPROFLOXACIN 500 MG TABS,637,1 ,$17.70 ,$11.68 ,$8.67 ,$17.70 , N/A ,$15.86 ,$15.86 , N/A ,$14.16 ,$15.05 ,$11.06 ,$15.93 , N/A , N/A ,$16.82 ,$15.93 ,$15.05 ,$15.05 , N/A ,$15.05 ,$15.05 ,$15.93 ,$10.78 , N/A , N/A , N/A ,$15.93 , N/A ,$16.28 ,$15.93 ,$11.68 ,$11.68 ,$10.78 ,$11.68 ,$11.51 ,$12.09 ,$17.52 ,$13.98 , N/A ,$8.67 ,$8.67 , N/A ,$8.67 ,$17.70 ,$16.82 ,$14.51 ,$14.51 ,$14.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LAMOTRIGINE 25 MG TABS,637,1 ,$14.40 ,$9.50 ,$7.06 ,$14.40 , N/A ,$12.91 ,$12.91 , N/A ,$11.52 ,$12.24 ,$9.00 ,$12.96 , N/A , N/A ,$13.68 ,$12.96 ,$12.24 ,$12.24 , N/A ,$12.24 ,$12.24 ,$12.96 ,$8.77 , N/A , N/A , N/A ,$12.96 , N/A ,$13.25 ,$12.96 ,$9.51 ,$9.51 ,$8.77 ,$9.51 ,$9.36 ,$9.84 ,$14.25 ,$11.38 , N/A ,$7.06 ,$7.06 , N/A ,$7.06 ,$14.40 ,$13.68 ,$11.81 ,$11.81 ,$11.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LAMOTRIGINE ER 100 MG TB24,637,1 ,$47.70 ,$31.48 ,$23.37 ,$47.70 , N/A ,$42.75 ,$42.75 , N/A ,$38.16 ,$40.55 ,$29.81 ,$42.93 , N/A , N/A ,$45.32 ,$42.93 ,$40.55 ,$40.55 , N/A ,$40.55 ,$40.55 ,$42.93 ,$29.05 , N/A , N/A , N/A ,$42.93 , N/A ,$43.88 ,$42.93 ,$31.49 ,$31.49 ,$29.05 ,$31.49 ,$31.01 ,$32.59 ,$47.22 ,$37.68 , N/A ,$23.37 ,$23.37 , N/A ,$23.37 ,$47.70 ,$45.32 ,$39.11 ,$39.11 ,$38.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LANSOPRAZOLE 30 MG CPDR,637,1 ,$19.30 ,$12.74 ,$9.46 ,$19.30 , N/A ,$17.30 ,$17.30 , N/A ,$15.44 ,$16.41 ,$12.06 ,$17.37 , N/A , N/A ,$18.34 ,$17.37 ,$16.41 ,$16.41 , N/A ,$16.41 ,$16.41 ,$17.37 ,$11.75 , N/A , N/A , N/A ,$17.37 , N/A ,$17.76 ,$17.37 ,$12.74 ,$12.74 ,$11.75 ,$12.74 ,$12.55 ,$13.19 ,$19.10 ,$15.25 , N/A ,$9.46 ,$9.46 , N/A ,$9.46 ,$19.30 ,$18.34 ,$15.83 ,$15.83 ,$15.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LATANOPROST 0.005 % SOLN 2.5 ML BOTTLE,637,1 ,$323.95 ,$213.81 ,$158.74 ,$323.95 , N/A ,$290.32 ,$290.32 , N/A ,$259.16 ,$275.36 ,$202.47 ,$291.56 , N/A , N/A ,$307.75 ,$291.56 ,$275.36 ,$275.36 , N/A ,$275.36 ,$275.36 ,$291.56 ,$197.29 , N/A , N/A , N/A ,$291.56 , N/A ,$298.03 ,$291.56 ,$213.84 ,$213.84 ,$197.29 ,$213.84 ,$210.57 ,$221.32 ,$320.65 ,$255.92 , N/A ,$158.74 ,$158.74 , N/A ,$158.74 ,$323.95 ,$307.75 ,$265.64 ,$265.64 ,$259.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEFLUNOMIDE 20 MG TABS,637,1 ,$55.80 ,$36.83 ,$27.34 ,$55.80 , N/A ,$50.01 ,$50.01 , N/A ,$44.64 ,$47.43 ,$34.88 ,$50.22 , N/A , N/A ,$53.01 ,$50.22 ,$47.43 ,$47.43 , N/A ,$47.43 ,$47.43 ,$50.22 ,$33.98 , N/A , N/A , N/A ,$50.22 , N/A ,$51.34 ,$50.22 ,$36.83 ,$36.83 ,$33.98 ,$36.83 ,$36.27 ,$38.12 ,$55.23 ,$44.08 , N/A ,$27.34 ,$27.34 , N/A ,$27.34 ,$55.80 ,$53.01 ,$45.76 ,$45.76 ,$44.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LETROZOLE 2.5 MG TABS,637,1 ,$61.40 ,$40.52 ,$30.09 ,$61.40 , N/A ,$55.03 ,$55.03 , N/A ,$49.12 ,$52.19 ,$38.38 ,$55.26 , N/A , N/A ,$58.33 ,$55.26 ,$52.19 ,$52.19 , N/A ,$52.19 ,$52.19 ,$55.26 ,$37.39 , N/A , N/A , N/A ,$55.26 , N/A ,$56.49 ,$55.26 ,$40.53 ,$40.53 ,$37.39 ,$40.53 ,$39.91 ,$41.95 ,$60.77 ,$48.51 , N/A ,$30.09 ,$30.09 , N/A ,$30.09 ,$61.40 ,$58.33 ,$50.35 ,$50.35 ,$49.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVETIRACETAM 100 MG/ML SOLN,637,1 ,$10.35 ,$6.83 ,$5.07 ,$10.35 , N/A ,$9.28 ,$9.28 , N/A ,$8.28 ,$8.80 ,$6.47 ,$9.32 , N/A , N/A ,$9.83 ,$9.32 ,$8.80 ,$8.80 , N/A ,$8.80 ,$8.80 ,$9.32 ,$6.30 , N/A , N/A , N/A ,$9.32 , N/A ,$9.52 ,$9.32 ,$6.83 ,$6.83 ,$6.30 ,$6.83 ,$6.73 ,$7.07 ,$10.24 ,$8.18 , N/A ,$5.07 ,$5.07 , N/A ,$5.07 ,$10.35 ,$9.83 ,$8.49 ,$8.49 ,$8.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVETIRACETAM ER 500 MG TB24,637,1 ,$15.15 ,$10.00 ,$7.42 ,$15.15 , N/A ,$13.58 ,$13.58 , N/A ,$12.12 ,$12.88 ,$9.47 ,$13.64 , N/A , N/A ,$14.39 ,$13.64 ,$12.88 ,$12.88 , N/A ,$12.88 ,$12.88 ,$13.64 ,$9.23 , N/A , N/A , N/A ,$13.64 , N/A ,$13.94 ,$13.64 ,$10.00 ,$10.00 ,$9.23 ,$10.00 ,$9.85 ,$10.35 ,$14.99 ,$11.97 , N/A ,$7.42 ,$7.42 , N/A ,$7.42 ,$15.15 ,$14.39 ,$12.42 ,$12.42 ,$12.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOFLOXACIN 0.5 % SOLN 5 ML BOTTLE,637,1 ,$468.80 ,$309.41 ,$229.71 ,$468.80 , N/A ,$420.14 ,$420.14 , N/A ,$375.04 ,$398.48 ,$293.00 ,$421.92 , N/A , N/A ,$445.36 ,$421.92 ,$398.48 ,$398.48 , N/A ,$398.48 ,$398.48 ,$421.92 ,$285.50 , N/A , N/A , N/A ,$421.92 , N/A ,$431.30 ,$421.92 ,$309.45 ,$309.45 ,$285.50 ,$309.45 ,$304.72 ,$320.28 ,$464.02 ,$370.35 , N/A ,$229.71 ,$229.71 , N/A ,$229.71 ,$468.80 ,$445.36 ,$384.42 ,$384.42 ,$375.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOFLOXACIN 250 MG TABS,637,1 ,$50.10 ,$33.07 ,$24.55 ,$50.10 , N/A ,$44.90 ,$44.90 , N/A ,$40.08 ,$42.59 ,$31.31 ,$45.09 , N/A , N/A ,$47.60 ,$45.09 ,$42.59 ,$42.59 , N/A ,$42.59 ,$42.59 ,$45.09 ,$30.51 , N/A , N/A , N/A ,$45.09 , N/A ,$46.09 ,$45.09 ,$33.07 ,$33.07 ,$30.51 ,$33.07 ,$32.57 ,$34.23 ,$49.59 ,$39.58 , N/A ,$24.55 ,$24.55 , N/A ,$24.55 ,$50.10 ,$47.60 ,$41.08 ,$41.08 ,$40.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOFLOXACIN 500 MG TABS,637,1 ,$65.60 ,$43.30 ,$32.14 ,$65.60 , N/A ,$58.79 ,$58.79 , N/A ,$52.48 ,$55.76 ,$41.00 ,$59.04 , N/A , N/A ,$62.32 ,$59.04 ,$55.76 ,$55.76 , N/A ,$55.76 ,$55.76 ,$59.04 ,$39.95 , N/A , N/A , N/A ,$59.04 , N/A ,$60.35 ,$59.04 ,$43.30 ,$43.30 ,$39.95 ,$43.30 ,$42.64 ,$44.82 ,$64.93 ,$51.82 , N/A ,$32.14 ,$32.14 , N/A ,$32.14 ,$65.60 ,$62.32 ,$53.79 ,$53.79 ,$52.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOFLOXACIN 750 MG TABS,637,1 ,$83.70 ,$55.24 ,$41.01 ,$83.70 , N/A ,$75.01 ,$75.01 , N/A ,$66.96 ,$71.15 ,$52.31 ,$75.33 , N/A , N/A ,$79.52 ,$75.33 ,$71.15 ,$71.15 , N/A ,$71.15 ,$71.15 ,$75.33 ,$50.97 , N/A , N/A , N/A ,$75.33 , N/A ,$77.00 ,$75.33 ,$55.25 ,$55.25 ,$50.97 ,$55.25 ,$54.41 ,$57.18 ,$82.85 ,$66.12 , N/A ,$41.01 ,$41.01 , N/A ,$41.01 ,$83.70 ,$79.52 ,$68.63 ,$68.63 ,$66.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LINACLOTIDE 145 MCG CAPS,637,1 ,$66.73 ,$44.04 ,$32.70 ,$66.73 , N/A ,$59.80 ,$59.80 , N/A ,$53.38 ,$56.72 ,$41.71 ,$60.06 , N/A , N/A ,$63.39 ,$60.06 ,$56.72 ,$56.72 , N/A ,$56.72 ,$56.72 ,$60.06 ,$40.64 , N/A , N/A , N/A ,$60.06 , N/A ,$61.39 ,$60.06 ,$44.05 ,$44.05 ,$40.64 ,$44.05 ,$43.37 ,$45.59 ,$66.05 ,$52.72 , N/A ,$32.70 ,$32.70 , N/A ,$32.70 ,$66.73 ,$63.39 ,$54.72 ,$54.72 ,$53.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LINEZOLID 600 MG TABS,637,1 ,$587.75 ,$387.92 ,$288.00 ,$587.75 , N/A ,$526.74 ,$526.74 , N/A ,$470.20 ,$499.59 ,$367.34 ,$528.98 , N/A , N/A ,$558.36 ,$528.98 ,$499.59 ,$499.59 , N/A ,$499.59 ,$499.59 ,$528.98 ,$357.94 , N/A , N/A , N/A ,$528.98 , N/A ,$540.73 ,$528.98 ,$387.97 ,$387.97 ,$357.94 ,$387.97 ,$382.04 ,$401.55 ,$581.76 ,$464.32 , N/A ,$288.00 ,$288.00 , N/A ,$288.00 ,$587.75 ,$558.36 ,$481.96 ,$481.96 ,$470.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LIRAGLUTIDE 18 MG/3ML SOPN 3 ML PEN,637,1 ,"$1,767.30 ","$1,166.42 ",$865.98 ,"$1,767.30 ", N/A ,"$1,583.85 ","$1,583.85 ", N/A ,"$1,413.84 ","$1,502.21 ","$1,104.56 ","$1,590.57 ", N/A , N/A ,"$1,678.94 ","$1,590.57 ","$1,502.21 ","$1,502.21 ", N/A ,"$1,502.21 ","$1,502.21 ","$1,590.57 ","$1,076.29 ", N/A , N/A , N/A ,"$1,590.57 ", N/A ,"$1,625.92 ","$1,590.57 ","$1,166.59 ","$1,166.59 ","$1,076.29 ","$1,166.59 ","$1,148.75 ","$1,207.42 ","$1,749.27 ","$1,396.17 ", N/A ,$865.98 ,$865.98 , N/A ,$865.98 ,"$1,767.30 ","$1,678.94 ","$1,449.19 ","$1,449.19 ","$1,413.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISDEXAMFETAMINE 30 MG CAPS,637,1 ,$47.85 ,$31.58 ,$23.45 ,$47.85 , N/A ,$42.88 ,$42.88 , N/A ,$38.28 ,$40.67 ,$29.91 ,$43.07 , N/A , N/A ,$45.46 ,$43.07 ,$40.67 ,$40.67 , N/A ,$40.67 ,$40.67 ,$43.07 ,$29.14 , N/A , N/A , N/A ,$43.07 , N/A ,$44.02 ,$43.07 ,$31.59 ,$31.59 ,$29.14 ,$31.59 ,$31.10 ,$32.69 ,$47.36 ,$37.80 , N/A ,$23.45 ,$23.45 , N/A ,$23.45 ,$47.85 ,$45.46 ,$39.24 ,$39.24 ,$38.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISDEXAMFETAMINE 20 MG CAPS,637,1 ,$47.85 ,$31.58 ,$23.45 ,$47.85 , N/A ,$42.88 ,$42.88 , N/A ,$38.28 ,$40.67 ,$29.91 ,$43.07 , N/A , N/A ,$45.46 ,$43.07 ,$40.67 ,$40.67 , N/A ,$40.67 ,$40.67 ,$43.07 ,$29.14 , N/A , N/A , N/A ,$43.07 , N/A ,$44.02 ,$43.07 ,$31.59 ,$31.59 ,$29.14 ,$31.59 ,$31.10 ,$32.69 ,$47.36 ,$37.80 , N/A ,$23.45 ,$23.45 , N/A ,$23.45 ,$47.85 ,$45.46 ,$39.24 ,$39.24 ,$38.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LUBIPROSTONE 24 MCG CAPS,637,1 ,$25.25 ,$16.67 ,$12.37 ,$25.25 , N/A ,$22.63 ,$22.63 , N/A ,$20.20 ,$21.46 ,$15.78 ,$22.73 , N/A , N/A ,$23.99 ,$22.73 ,$21.46 ,$21.46 , N/A ,$21.46 ,$21.46 ,$22.73 ,$15.38 , N/A , N/A , N/A ,$22.73 , N/A ,$23.23 ,$22.73 ,$16.67 ,$16.67 ,$15.38 ,$16.67 ,$16.41 ,$17.25 ,$24.99 ,$19.95 , N/A ,$12.37 ,$12.37 , N/A ,$12.37 ,$25.25 ,$23.99 ,$20.71 ,$20.71 ,$20.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LURASIDONE 40 MG TABS,637,1 ,$192.95 ,$127.35 ,$94.55 ,$192.95 , N/A ,$172.92 ,$172.92 , N/A ,$154.36 ,$164.01 ,$120.59 ,$173.66 , N/A , N/A ,$183.30 ,$173.66 ,$164.01 ,$164.01 , N/A ,$164.01 ,$164.01 ,$173.66 ,$117.51 , N/A , N/A , N/A ,$173.66 , N/A ,$177.51 ,$173.66 ,$127.37 ,$127.37 ,$117.51 ,$127.37 ,$125.42 ,$131.82 ,$190.98 ,$152.43 , N/A ,$94.55 ,$94.55 , N/A ,$94.55 ,$192.95 ,$183.30 ,$158.22 ,$158.22 ,$154.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MELOXICAM 7.5 MG TABS,637,1 ,$10.55 ,$6.96 ,$5.17 ,$10.55 , N/A ,$9.45 ,$9.45 , N/A ,$8.44 ,$8.97 ,$6.59 ,$9.50 , N/A , N/A ,$10.02 ,$9.50 ,$8.97 ,$8.97 , N/A ,$8.97 ,$8.97 ,$9.50 ,$6.43 , N/A , N/A , N/A ,$9.50 , N/A ,$9.71 ,$9.50 ,$6.96 ,$6.96 ,$6.43 ,$6.96 ,$6.86 ,$7.21 ,$10.45 ,$8.33 , N/A ,$5.17 ,$5.17 , N/A ,$5.17 ,$10.55 ,$10.02 ,$8.65 ,$8.65 ,$8.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MENTHOL 16 % 16 % GEL 42.5 G TUBE,637,1 ,$11.60 ,$7.66 ,$5.68 ,$11.60 , N/A ,$10.40 ,$10.40 , N/A ,$9.28 ,$9.86 ,$7.25 ,$10.44 , N/A , N/A ,$11.02 ,$10.44 ,$9.86 ,$9.86 , N/A ,$9.86 ,$9.86 ,$10.44 ,$7.06 , N/A , N/A , N/A ,$10.44 , N/A ,$10.67 ,$10.44 ,$7.66 ,$7.66 ,$7.06 ,$7.66 ,$7.54 ,$7.93 ,$11.49 ,$9.16 , N/A ,$5.68 ,$5.68 , N/A ,$5.68 ,$11.60 ,$11.02 ,$9.51 ,$9.51 ,$9.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MENTHOL 16 % 16 % GEL 85 G TUBE,637,1 ,$17.35 ,$11.45 ,$8.50 ,$17.35 , N/A ,$15.55 ,$15.55 , N/A ,$13.88 ,$14.75 ,$10.84 ,$15.62 , N/A , N/A ,$16.48 ,$15.62 ,$14.75 ,$14.75 , N/A ,$14.75 ,$14.75 ,$15.62 ,$10.57 , N/A , N/A , N/A ,$15.62 , N/A ,$15.96 ,$15.62 ,$11.45 ,$11.45 ,$10.57 ,$11.45 ,$11.28 ,$11.85 ,$17.17 ,$13.71 , N/A ,$8.50 ,$8.50 , N/A ,$8.50 ,$17.35 ,$16.48 ,$14.23 ,$14.23 ,$13.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MENTHOL 16 % 16 % LIQD 73 ML BOTTLE,637,1 ,$29.05 ,$19.17 ,$14.23 ,$29.05 , N/A ,$26.03 ,$26.03 , N/A ,$23.24 ,$24.69 ,$18.16 ,$26.15 , N/A , N/A ,$27.60 ,$26.15 ,$24.69 ,$24.69 , N/A ,$24.69 ,$24.69 ,$26.15 ,$17.69 , N/A , N/A , N/A ,$26.15 , N/A ,$26.73 ,$26.15 ,$19.18 ,$19.18 ,$17.69 ,$19.18 ,$18.88 ,$19.85 ,$28.75 ,$22.95 , N/A ,$14.23 ,$14.23 , N/A ,$14.23 ,$29.05 ,$27.60 ,$23.82 ,$23.82 ,$23.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MENTHOL-METHYL SALICYLATE 10-15% CREA 85 G TUBE,637,1 ,$11.85 ,$7.82 ,$5.81 ,$11.85 , N/A ,$10.62 ,$10.62 , N/A ,$9.48 ,$10.07 ,$7.41 ,$10.67 , N/A , N/A ,$11.26 ,$10.67 ,$10.07 ,$10.07 , N/A ,$10.07 ,$10.07 ,$10.67 ,$7.22 , N/A , N/A , N/A ,$10.67 , N/A ,$10.90 ,$10.67 ,$7.82 ,$7.82 ,$7.22 ,$7.82 ,$7.70 ,$8.10 ,$11.73 ,$9.36 , N/A ,$5.81 ,$5.81 , N/A ,$5.81 ,$11.85 ,$11.26 ,$9.72 ,$9.72 ,$9.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MENTHOL-METHYL SALICYLATE 10-15 % CREA 85 G TUBE,637,1 ,$11.85 ,$7.82 ,$5.81 ,$11.85 , N/A ,$10.62 ,$10.62 , N/A ,$9.48 ,$10.07 ,$7.41 ,$10.67 , N/A , N/A ,$11.26 ,$10.67 ,$10.07 ,$10.07 , N/A ,$10.07 ,$10.07 ,$10.67 ,$7.22 , N/A , N/A , N/A ,$10.67 , N/A ,$10.90 ,$10.67 ,$7.82 ,$7.82 ,$7.22 ,$7.82 ,$7.70 ,$8.10 ,$11.73 ,$9.36 , N/A ,$5.81 ,$5.81 , N/A ,$5.81 ,$11.85 ,$11.26 ,$9.72 ,$9.72 ,$9.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MESALAMINE 250 MG CPCR,637,1 ,$12.39 ,$8.18 ,$6.07 ,$12.39 , N/A ,$11.10 ,$11.10 , N/A ,$9.91 ,$10.53 ,$7.74 ,$11.15 , N/A , N/A ,$11.77 ,$11.15 ,$10.53 ,$10.53 , N/A ,$10.53 ,$10.53 ,$11.15 ,$7.55 , N/A , N/A , N/A ,$11.15 , N/A ,$11.40 ,$11.15 ,$8.18 ,$8.18 ,$7.55 ,$8.18 ,$8.05 ,$8.46 ,$12.26 ,$9.79 , N/A ,$6.07 ,$6.07 , N/A ,$6.07 ,$12.39 ,$11.77 ,$10.16 ,$10.16 ,$9.91 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MESALAMINE EC 1.2 G TBEC,637,1 ,$42.45 ,$28.02 ,$20.80 ,$42.45 , N/A ,$38.04 ,$38.04 , N/A ,$33.96 ,$36.08 ,$26.53 ,$38.21 , N/A , N/A ,$40.33 ,$38.21 ,$36.08 ,$36.08 , N/A ,$36.08 ,$36.08 ,$38.21 ,$25.85 , N/A , N/A , N/A ,$38.21 , N/A ,$39.05 ,$38.21 ,$28.02 ,$28.02 ,$25.85 ,$28.02 ,$27.59 ,$29.00 ,$42.01 ,$33.54 , N/A ,$20.80 ,$20.80 , N/A ,$20.80 ,$42.45 ,$40.33 ,$34.81 ,$34.81 ,$33.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METAXALONE 800 MG TABS,637,1 ,$20.05 ,$13.23 ,$9.82 ,$20.05 , N/A ,$17.97 ,$17.97 , N/A ,$16.04 ,$17.04 ,$12.53 ,$18.05 , N/A , N/A ,$19.05 ,$18.05 ,$17.04 ,$17.04 , N/A ,$17.04 ,$17.04 ,$18.05 ,$12.21 , N/A , N/A , N/A ,$18.05 , N/A ,$18.45 ,$18.05 ,$13.24 ,$13.24 ,$12.21 ,$13.24 ,$13.03 ,$13.70 ,$19.84 ,$15.84 , N/A ,$9.82 ,$9.82 , N/A ,$9.82 ,$20.05 ,$19.05 ,$16.44 ,$16.44 ,$16.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHYLERGONOVINE 0.2 MG TABS,637,1 ,$224.40 ,$148.10 ,$109.96 ,$224.40 , N/A ,$201.11 ,$201.11 , N/A ,$179.52 ,$190.74 ,$140.25 ,$201.96 , N/A , N/A ,$213.18 ,$201.96 ,$190.74 ,$190.74 , N/A ,$190.74 ,$190.74 ,$201.96 ,$136.66 , N/A , N/A , N/A ,$201.96 , N/A ,$206.45 ,$201.96 ,$148.13 ,$148.13 ,$136.66 ,$148.13 ,$145.86 ,$153.31 ,$222.11 ,$177.28 , N/A ,$109.96 ,$109.96 , N/A ,$109.96 ,$224.40 ,$213.18 ,$184.01 ,$184.01 ,$179.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOLAZONE 2.5 MG TABS,637,1 ,$11.25 ,$7.43 ,$5.51 ,$11.25 , N/A ,$10.08 ,$10.08 , N/A ,$9.00 ,$9.56 ,$7.03 ,$10.13 , N/A , N/A ,$10.69 ,$10.13 ,$9.56 ,$9.56 , N/A ,$9.56 ,$9.56 ,$10.13 ,$6.85 , N/A , N/A , N/A ,$10.13 , N/A ,$10.35 ,$10.13 ,$7.43 ,$7.43 ,$6.85 ,$7.43 ,$7.31 ,$7.69 ,$11.13 ,$8.89 , N/A ,$5.51 ,$5.51 , N/A ,$5.51 ,$11.25 ,$10.69 ,$9.23 ,$9.23 ,$9.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METRONIDAZOLE 0.75 % CREA 45 G TUBE,637,1 ,"$1,869.55 ","$1,233.90 ",$916.08 ,"$1,869.55 ", N/A ,"$1,675.49 ","$1,675.49 ", N/A ,"$1,495.64 ","$1,589.12 ","$1,168.47 ","$1,682.60 ", N/A , N/A ,"$1,776.07 ","$1,682.60 ","$1,589.12 ","$1,589.12 ", N/A ,"$1,589.12 ","$1,589.12 ","$1,682.60 ","$1,138.56 ", N/A , N/A , N/A ,"$1,682.60 ", N/A ,"$1,719.99 ","$1,682.60 ","$1,234.09 ","$1,234.09 ","$1,138.56 ","$1,234.09 ","$1,215.21 ","$1,277.28 ","$1,850.48 ","$1,476.94 ", N/A ,$916.08 ,$916.08 , N/A ,$916.08 ,"$1,869.55 ","$1,776.07 ","$1,533.03 ","$1,533.03 ","$1,495.64 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METRONIDAZOLE 50 MG/ML 50 MG/ML SUSR,637,1 ,$86.80 ,$57.29 ,$42.53 ,$86.80 , N/A ,$77.79 ,$77.79 , N/A ,$69.44 ,$73.78 ,$54.25 ,$78.12 , N/A , N/A ,$82.46 ,$78.12 ,$73.78 ,$73.78 , N/A ,$73.78 ,$73.78 ,$78.12 ,$52.86 , N/A , N/A , N/A ,$78.12 , N/A ,$79.86 ,$78.12 ,$57.30 ,$57.30 ,$52.86 ,$57.30 ,$56.42 ,$59.30 ,$85.92 ,$68.57 , N/A ,$42.53 ,$42.53 , N/A ,$42.53 ,$86.80 ,$82.46 ,$71.18 ,$71.18 ,$69.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METYROSINE 250 MG CAPS,637,1 ,"$1,334.60 ",$880.84 ,$653.95 ,"$1,334.60 ", N/A ,"$1,196.07 ","$1,196.07 ", N/A ,"$1,067.68 ","$1,134.41 ",$834.13 ,"$1,201.14 ", N/A , N/A ,"$1,267.87 ","$1,201.14 ","$1,134.41 ","$1,134.41 ", N/A ,"$1,134.41 ","$1,134.41 ","$1,201.14 ",$812.77 , N/A , N/A , N/A ,"$1,201.14 ", N/A ,"$1,227.83 ","$1,201.14 ",$880.97 ,$880.97 ,$812.77 ,$880.97 ,$867.49 ,$911.80 ,"$1,320.99 ","$1,054.33 ", N/A ,$653.95 ,$653.95 , N/A ,$653.95 ,"$1,334.60 ","$1,267.87 ","$1,094.37 ","$1,094.37 ","$1,067.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MEXILETINE 150 MG CAPS,637,1 ,$8.65 ,$5.71 ,$4.24 ,$8.65 , N/A ,$7.75 ,$7.75 , N/A ,$6.92 ,$7.35 ,$5.41 ,$7.79 , N/A , N/A ,$8.22 ,$7.79 ,$7.35 ,$7.35 , N/A ,$7.35 ,$7.35 ,$7.79 ,$5.27 , N/A , N/A , N/A ,$7.79 , N/A ,$7.96 ,$7.79 ,$5.71 ,$5.71 ,$5.27 ,$5.71 ,$5.62 ,$5.91 ,$8.57 ,$6.83 , N/A ,$4.24 ,$4.24 , N/A ,$4.24 ,$8.65 ,$8.22 ,$7.09 ,$7.09 ,$6.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MEXILETINE 200 MG CAPS,637,1 ,$10.30 ,$6.80 ,$5.05 ,$10.30 , N/A ,$9.23 ,$9.23 , N/A ,$8.24 ,$8.76 ,$6.44 ,$9.27 , N/A , N/A ,$9.79 ,$9.27 ,$8.76 ,$8.76 , N/A ,$8.76 ,$8.76 ,$9.27 ,$6.27 , N/A , N/A , N/A ,$9.27 , N/A ,$9.48 ,$9.27 ,$6.80 ,$6.80 ,$6.27 ,$6.80 ,$6.70 ,$7.04 ,$10.19 ,$8.14 , N/A ,$5.05 ,$5.05 , N/A ,$5.05 ,$10.30 ,$9.79 ,$8.45 ,$8.45 ,$8.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DAPSONE 100 MG TABS,637,1 ,$10.30 ,$6.80 ,$5.05 ,$10.30 , N/A ,$9.23 ,$9.23 , N/A ,$8.24 ,$8.76 ,$6.44 ,$9.27 , N/A , N/A ,$9.79 ,$9.27 ,$8.76 ,$8.76 , N/A ,$8.76 ,$8.76 ,$9.27 ,$6.27 , N/A , N/A , N/A ,$9.27 , N/A ,$9.48 ,$9.27 ,$6.80 ,$6.80 ,$6.27 ,$6.80 ,$6.70 ,$7.04 ,$10.19 ,$8.14 , N/A ,$5.05 ,$5.05 , N/A ,$5.05 ,$10.30 ,$9.79 ,$8.45 ,$8.45 ,$8.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % CREA 15 G TUBE,637,1 ,$17.85 ,$11.78 ,$8.75 ,$17.85 , N/A ,$16.00 ,$16.00 , N/A ,$14.28 ,$15.17 ,$11.16 ,$16.07 , N/A , N/A ,$16.96 ,$16.07 ,$15.17 ,$15.17 , N/A ,$15.17 ,$15.17 ,$16.07 ,$10.87 , N/A , N/A , N/A ,$16.07 , N/A ,$16.42 ,$16.07 ,$11.78 ,$11.78 ,$10.87 ,$11.78 ,$11.60 ,$12.20 ,$17.67 ,$14.10 , N/A ,$8.75 ,$8.75 , N/A ,$8.75 ,$17.85 ,$16.96 ,$14.64 ,$14.64 ,$14.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % CREA 30 G TUBE,637,1 ,$24.50 ,$16.17 ,$12.01 ,$24.50 , N/A ,$21.96 ,$21.96 , N/A ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 , N/A ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A , N/A , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$24.25 ,$19.36 , N/A ,$12.01 ,$12.01 , N/A ,$12.01 ,$24.50 ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GENTEAL TEARS 0.1-0.2-0.3 % SOLN 15 ML BOTTLE,637,1 ,$24.50 ,$16.17 ,$12.01 ,$24.50 , N/A ,$21.96 ,$21.96 , N/A ,$19.60 ,$20.83 ,$15.31 ,$22.05 , N/A , N/A ,$23.28 ,$22.05 ,$20.83 ,$20.83 , N/A ,$20.83 ,$20.83 ,$22.05 ,$14.92 , N/A , N/A , N/A ,$22.05 , N/A ,$22.54 ,$22.05 ,$16.17 ,$16.17 ,$14.92 ,$16.17 ,$15.93 ,$16.74 ,$24.25 ,$19.36 , N/A ,$12.01 ,$12.01 , N/A ,$12.01 ,$24.50 ,$23.28 ,$20.09 ,$20.09 ,$19.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % CREA 45 G TUBE,637,1 ,$40.10 ,$26.47 ,$19.65 ,$40.10 , N/A ,$35.94 ,$35.94 , N/A ,$32.08 ,$34.09 ,$25.06 ,$36.09 , N/A , N/A ,$38.10 ,$36.09 ,$34.09 ,$34.09 , N/A ,$34.09 ,$34.09 ,$36.09 ,$24.42 , N/A , N/A , N/A ,$36.09 , N/A ,$36.89 ,$36.09 ,$26.47 ,$26.47 ,$24.42 ,$26.47 ,$26.07 ,$27.40 ,$39.69 ,$31.68 , N/A ,$19.65 ,$19.65 , N/A ,$19.65 ,$40.10 ,$38.10 ,$32.88 ,$32.88 ,$32.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % POWD,637,1 ,$21.25 ,$14.03 ,$10.41 ,$21.25 , N/A ,$19.04 ,$19.04 , N/A ,$17.00 ,$18.06 ,$13.28 ,$19.13 , N/A , N/A ,$20.19 ,$19.13 ,$18.06 ,$18.06 , N/A ,$18.06 ,$18.06 ,$19.13 ,$12.94 , N/A , N/A , N/A ,$19.13 , N/A ,$19.55 ,$19.13 ,$14.03 ,$14.03 ,$12.94 ,$14.03 ,$13.81 ,$14.52 ,$21.03 ,$16.79 , N/A ,$10.41 ,$10.41 , N/A ,$10.41 ,$21.25 ,$20.19 ,$17.43 ,$17.43 ,$17.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % POWD 71 G BOTTLE,637,1 ,$20.30 ,$13.40 ,$9.95 ,$20.30 , N/A ,$18.19 ,$18.19 , N/A ,$16.24 ,$17.26 ,$12.69 ,$18.27 , N/A , N/A ,$19.29 ,$18.27 ,$17.26 ,$17.26 , N/A ,$17.26 ,$17.26 ,$18.27 ,$12.36 , N/A , N/A , N/A ,$18.27 , N/A ,$18.68 ,$18.27 ,$13.40 ,$13.40 ,$12.36 ,$13.40 ,$13.20 ,$13.87 ,$20.09 ,$16.04 , N/A ,$9.95 ,$9.95 , N/A ,$9.95 ,$20.30 ,$19.29 ,$16.65 ,$16.65 ,$16.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % POWD 71 G CAN,637,1 ,$19.35 ,$12.77 ,$9.48 ,$19.35 , N/A ,$17.34 ,$17.34 , N/A ,$15.48 ,$16.45 ,$12.09 ,$17.42 , N/A , N/A ,$18.38 ,$17.42 ,$16.45 ,$16.45 , N/A ,$16.45 ,$16.45 ,$17.42 ,$11.78 , N/A , N/A , N/A ,$17.42 , N/A ,$17.80 ,$17.42 ,$12.77 ,$12.77 ,$11.78 ,$12.77 ,$12.58 ,$13.22 ,$19.15 ,$15.29 , N/A ,$9.48 ,$9.48 , N/A ,$9.48 ,$19.35 ,$18.38 ,$15.87 ,$15.87 ,$15.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MIDAZOLAM 2 MG/ML SYRP,637,1 ,$24.95 ,$16.47 ,$12.23 ,$24.95 , N/A ,$22.36 ,$22.36 , N/A ,$19.96 ,$21.21 ,$15.59 ,$22.46 , N/A , N/A ,$23.70 ,$22.46 ,$21.21 ,$21.21 , N/A ,$21.21 ,$21.21 ,$22.46 ,$15.19 , N/A , N/A , N/A ,$22.46 , N/A ,$22.95 ,$22.46 ,$16.47 ,$16.47 ,$15.19 ,$16.47 ,$16.22 ,$17.05 ,$24.70 ,$19.71 , N/A ,$12.23 ,$12.23 , N/A ,$12.23 ,$24.95 ,$23.70 ,$20.46 ,$20.46 ,$19.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MIDODRINE 5 MG TABS,637,1 ,$15.30 ,$10.10 ,$7.50 ,$15.30 , N/A ,$13.71 ,$13.71 , N/A ,$12.24 ,$13.01 ,$9.56 ,$13.77 , N/A , N/A ,$14.54 ,$13.77 ,$13.01 ,$13.01 , N/A ,$13.01 ,$13.01 ,$13.77 ,$9.32 , N/A , N/A , N/A ,$13.77 , N/A ,$14.08 ,$13.77 ,$10.10 ,$10.10 ,$9.32 ,$10.10 ,$9.95 ,$10.45 ,$15.14 ,$12.09 , N/A ,$7.50 ,$7.50 , N/A ,$7.50 ,$15.30 ,$14.54 ,$12.55 ,$12.55 ,$12.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MINERAL OIL OIL 10 ML VIAL,637,1 ,$62.20 ,$41.05 ,$30.48 ,$62.20 , N/A ,$55.74 ,$55.74 , N/A ,$49.76 ,$52.87 ,$38.88 ,$55.98 , N/A , N/A ,$59.09 ,$55.98 ,$52.87 ,$52.87 , N/A ,$52.87 ,$52.87 ,$55.98 ,$37.88 , N/A , N/A , N/A ,$55.98 , N/A ,$57.22 ,$55.98 ,$41.06 ,$41.06 ,$37.88 ,$41.06 ,$40.43 ,$42.50 ,$61.56 ,$49.14 , N/A ,$30.48 ,$30.48 , N/A ,$30.48 ,$62.20 ,$59.09 ,$51.00 ,$51.00 ,$49.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MIRABEGRON ER 25 MG TB24,637,1 ,$58.45 ,$38.58 ,$28.64 ,$58.45 , N/A ,$52.38 ,$52.38 , N/A ,$46.76 ,$49.68 ,$36.53 ,$52.61 , N/A , N/A ,$55.53 ,$52.61 ,$49.68 ,$49.68 , N/A ,$49.68 ,$49.68 ,$52.61 ,$35.60 , N/A , N/A , N/A ,$52.61 , N/A ,$53.77 ,$52.61 ,$38.58 ,$38.58 ,$35.60 ,$38.58 ,$37.99 ,$39.93 ,$57.85 ,$46.18 , N/A ,$28.64 ,$28.64 , N/A ,$28.64 ,$58.45 ,$55.53 ,$47.93 ,$47.93 ,$46.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MIRTAZAPINE 15 MG TABS,637,1 ,$9.75 ,$6.44 ,$4.78 ,$9.75 , N/A ,$8.74 ,$8.74 , N/A ,$7.80 ,$8.29 ,$6.09 ,$8.78 , N/A , N/A ,$9.26 ,$8.78 ,$8.29 ,$8.29 , N/A ,$8.29 ,$8.29 ,$8.78 ,$5.94 , N/A , N/A , N/A ,$8.78 , N/A ,$8.97 ,$8.78 ,$6.44 ,$6.44 ,$5.94 ,$6.44 ,$6.34 ,$6.66 ,$9.65 ,$7.70 , N/A ,$4.78 ,$4.78 , N/A ,$4.78 ,$9.75 ,$9.26 ,$8.00 ,$8.00 ,$7.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % CREA 28 G TUBE,637,1 ,$9.75 ,$6.44 ,$4.78 ,$9.75 , N/A ,$8.74 ,$8.74 , N/A ,$7.80 ,$8.29 ,$6.09 ,$8.78 , N/A , N/A ,$9.26 ,$8.78 ,$8.29 ,$8.29 , N/A ,$8.29 ,$8.29 ,$8.78 ,$5.94 , N/A , N/A , N/A ,$8.78 , N/A ,$8.97 ,$8.78 ,$6.44 ,$6.44 ,$5.94 ,$6.44 ,$6.34 ,$6.66 ,$9.65 ,$7.70 , N/A ,$4.78 ,$4.78 , N/A ,$4.78 ,$9.75 ,$9.26 ,$8.00 ,$8.00 ,$7.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MIRTAZAPINE 7.5 MG TABS,637,1 ,$9.00 ,$5.94 ,$4.41 ,$9.00 , N/A ,$8.07 ,$8.07 , N/A ,$7.20 ,$7.65 ,$5.63 ,$8.10 , N/A , N/A ,$8.55 ,$8.10 ,$7.65 ,$7.65 , N/A ,$7.65 ,$7.65 ,$8.10 ,$5.48 , N/A , N/A , N/A ,$8.10 , N/A ,$8.28 ,$8.10 ,$5.94 ,$5.94 ,$5.48 ,$5.94 ,$5.85 ,$6.15 ,$8.91 ,$7.11 , N/A ,$4.41 ,$4.41 , N/A ,$4.41 ,$9.00 ,$8.55 ,$7.38 ,$7.38 ,$7.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BALSALAZIDE 750 MG CAPS,637,1 ,$9.00 ,$5.94 ,$4.41 ,$9.00 , N/A ,$8.07 ,$8.07 , N/A ,$7.20 ,$7.65 ,$5.63 ,$8.10 , N/A , N/A ,$8.55 ,$8.10 ,$7.65 ,$7.65 , N/A ,$7.65 ,$7.65 ,$8.10 ,$5.48 , N/A , N/A , N/A ,$8.10 , N/A ,$8.28 ,$8.10 ,$5.94 ,$5.94 ,$5.48 ,$5.94 ,$5.85 ,$6.15 ,$8.91 ,$7.11 , N/A ,$4.41 ,$4.41 , N/A ,$4.41 ,$9.00 ,$8.55 ,$7.38 ,$7.38 ,$7.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MODAFINIL 100 MG TABS,637,1 ,$89.70 ,$59.20 ,$43.95 ,$89.70 , N/A ,$80.39 ,$80.39 , N/A ,$71.76 ,$76.25 ,$56.06 ,$80.73 , N/A , N/A ,$85.22 ,$80.73 ,$76.25 ,$76.25 , N/A ,$76.25 ,$76.25 ,$80.73 ,$54.63 , N/A , N/A , N/A ,$80.73 , N/A ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$88.79 ,$70.86 , N/A ,$43.95 ,$43.95 , N/A ,$43.95 ,$89.70 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MORPHINE CR 30 MG TBCR,637,1 ,$11.33 ,$7.48 ,$5.55 ,$11.33 , N/A ,$10.15 ,$10.15 , N/A ,$9.06 ,$9.63 ,$7.08 ,$10.20 , N/A , N/A ,$10.76 ,$10.20 ,$9.63 ,$9.63 , N/A ,$9.63 ,$9.63 ,$10.20 ,$6.90 , N/A , N/A , N/A ,$10.20 , N/A ,$10.42 ,$10.20 ,$7.48 ,$7.48 ,$6.90 ,$7.48 ,$7.36 ,$7.74 ,$11.21 ,$8.95 , N/A ,$5.55 ,$5.55 , N/A ,$5.55 ,$11.33 ,$10.76 ,$9.29 ,$9.29 ,$9.06 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MULTIVITAMINS ADULT INJ 10 ML VIAL,637,1 ,$81.40 ,$53.72 ,$39.89 ,$81.40 , N/A ,$72.95 ,$72.95 , N/A ,$65.12 ,$69.19 ,$50.88 ,$73.26 , N/A , N/A ,$77.33 ,$73.26 ,$69.19 ,$69.19 , N/A ,$69.19 ,$69.19 ,$73.26 ,$49.57 , N/A , N/A , N/A ,$73.26 , N/A ,$74.89 ,$73.26 ,$53.73 ,$53.73 ,$49.57 ,$53.73 ,$52.91 ,$55.61 ,$80.57 ,$64.31 , N/A ,$39.89 ,$39.89 , N/A ,$39.89 ,$81.40 ,$77.33 ,$66.75 ,$66.75 ,$65.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MUPIROCIN 2 % OINT 22 G TUBE,637,1 ,$145.35 ,$95.93 ,$71.22 ,$145.35 , N/A ,$130.26 ,$130.26 , N/A ,$116.28 ,$123.55 ,$90.84 ,$130.82 , N/A , N/A ,$138.08 ,$130.82 ,$123.55 ,$123.55 , N/A ,$123.55 ,$123.55 ,$130.82 ,$88.52 , N/A , N/A , N/A ,$130.82 , N/A ,$133.72 ,$130.82 ,$95.95 ,$95.95 ,$88.52 ,$95.95 ,$94.48 ,$99.30 ,$143.86 ,$114.83 , N/A ,$71.22 ,$71.22 , N/A ,$71.22 ,$145.35 ,$138.08 ,$119.19 ,$119.19 ,$116.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MUPIROCIN CALCIUM 2 % OINT 1 G TUBE,637,1 ,$69.70 ,$46.00 ,$34.15 ,$69.70 , N/A ,$62.47 ,$62.47 , N/A ,$55.76 ,$59.25 ,$43.56 ,$62.73 , N/A , N/A ,$66.22 ,$62.73 ,$59.25 ,$59.25 , N/A ,$59.25 ,$59.25 ,$62.73 ,$42.45 , N/A , N/A , N/A ,$62.73 , N/A ,$64.12 ,$62.73 ,$46.01 ,$46.01 ,$42.45 ,$46.01 ,$45.31 ,$47.62 ,$68.99 ,$55.06 , N/A ,$34.15 ,$34.15 , N/A ,$34.15 ,$69.70 ,$66.22 ,$57.15 ,$57.15 ,$55.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NA SULFATE-K SULFATE-MG SULFATE 17.5-3.13-1.6 GM/177ML SOLN 177 ML PACKAGE,637,1 ,$222.70 ,$146.98 ,$109.12 ,$222.70 , N/A ,$199.58 ,$199.58 , N/A ,$178.16 ,$189.30 ,$139.19 ,$200.43 , N/A , N/A ,$211.57 ,$200.43 ,$189.30 ,$189.30 , N/A ,$189.30 ,$189.30 ,$200.43 ,$135.62 , N/A , N/A , N/A ,$200.43 , N/A ,$204.88 ,$200.43 ,$147.00 ,$147.00 ,$135.62 ,$147.00 ,$144.76 ,$152.15 ,$220.43 ,$175.93 , N/A ,$109.12 ,$109.12 , N/A ,$109.12 ,$222.70 ,$211.57 ,$182.61 ,$182.61 ,$178.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NA SULFATE-K SULFATE-MG SULFATE 17.5-3.13-1.6 GM/177ML SOLN 354 ML PACKAGE,637,1 ,$445.35 ,$293.93 ,$218.22 ,$445.35 , N/A ,$399.12 ,$399.12 , N/A ,$356.28 ,$378.55 ,$278.34 ,$400.82 , N/A , N/A ,$423.08 ,$400.82 ,$378.55 ,$378.55 , N/A ,$378.55 ,$378.55 ,$400.82 ,$271.22 , N/A , N/A , N/A ,$400.82 , N/A ,$409.72 ,$400.82 ,$293.98 ,$293.98 ,$271.22 ,$293.98 ,$289.48 ,$304.26 ,$440.80 ,$351.83 , N/A ,$218.22 ,$218.22 , N/A ,$218.22 ,$445.35 ,$423.08 ,$365.19 ,$365.19 ,$356.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NALTREXONE 50 MG TABS,637,1 ,$14.70 ,$9.70 ,$7.20 ,$14.70 , N/A ,$13.17 ,$13.17 , N/A ,$11.76 ,$12.50 ,$9.19 ,$13.23 , N/A , N/A ,$13.97 ,$13.23 ,$12.50 ,$12.50 , N/A ,$12.50 ,$12.50 ,$13.23 ,$8.95 , N/A , N/A , N/A ,$13.23 , N/A ,$13.52 ,$13.23 ,$9.70 ,$9.70 ,$8.95 ,$9.70 ,$9.56 ,$10.04 ,$14.55 ,$11.61 , N/A ,$7.20 ,$7.20 , N/A ,$7.20 ,$14.70 ,$13.97 ,$12.05 ,$12.05 ,$11.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEBIVOLOL 5 MG TABS,637,1 ,$23.00 ,$15.18 ,$11.27 ,$23.00 , N/A ,$20.61 ,$20.61 , N/A ,$18.40 ,$19.55 ,$14.38 ,$20.70 , N/A , N/A ,$21.85 ,$20.70 ,$19.55 ,$19.55 , N/A ,$19.55 ,$19.55 ,$20.70 ,$14.01 , N/A , N/A , N/A ,$20.70 , N/A ,$21.16 ,$20.70 ,$15.18 ,$15.18 ,$14.01 ,$15.18 ,$14.95 ,$15.71 ,$22.77 ,$18.17 , N/A ,$11.27 ,$11.27 , N/A ,$11.27 ,$23.00 ,$21.85 ,$18.86 ,$18.86 ,$18.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-5000 OINT 14 G TUBE,637,1 ,$18.30 ,$12.08 ,$8.97 ,$18.30 , N/A ,$16.40 ,$16.40 , N/A ,$14.64 ,$15.56 ,$11.44 ,$16.47 , N/A , N/A ,$17.39 ,$16.47 ,$15.56 ,$15.56 , N/A ,$15.56 ,$15.56 ,$16.47 ,$11.14 , N/A , N/A , N/A ,$16.47 , N/A ,$16.84 ,$16.47 ,$12.08 ,$12.08 ,$11.14 ,$12.08 ,$11.90 ,$12.50 ,$18.11 ,$14.46 , N/A ,$8.97 ,$8.97 , N/A ,$8.97 ,$18.30 ,$17.39 ,$15.01 ,$15.01 ,$14.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 5-400-5000 OINT 14.2 G TUBE,637,1 ,$18.35 ,$12.11 ,$8.99 ,$18.35 , N/A ,$16.45 ,$16.45 , N/A ,$14.68 ,$15.60 ,$11.47 ,$16.52 , N/A , N/A ,$17.43 ,$16.52 ,$15.60 ,$15.60 , N/A ,$15.60 ,$15.60 ,$16.52 ,$11.18 , N/A , N/A , N/A ,$16.52 , N/A ,$16.88 ,$16.52 ,$12.11 ,$12.11 ,$11.18 ,$12.11 ,$11.93 ,$12.54 ,$18.16 ,$14.50 , N/A ,$8.99 ,$8.99 , N/A ,$8.99 ,$18.35 ,$17.43 ,$15.05 ,$15.05 ,$14.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEOMYCIN-POLYMYXIN-HYDROCORTISONE 3.5-10000-1 SUSP 10 ML BOTTLE,637,1 ,$356.60 ,$235.36 ,$174.73 ,$356.60 , N/A ,$319.58 ,$319.58 , N/A ,$285.28 ,$303.11 ,$222.88 ,$320.94 , N/A , N/A ,$338.77 ,$320.94 ,$303.11 ,$303.11 , N/A ,$303.11 ,$303.11 ,$320.94 ,$217.17 , N/A , N/A , N/A ,$320.94 , N/A ,$328.07 ,$320.94 ,$235.39 ,$235.39 ,$217.17 ,$235.39 ,$231.79 ,$243.63 ,$352.97 ,$281.71 , N/A ,$174.73 ,$174.73 , N/A ,$174.73 ,$356.60 ,$338.77 ,$292.41 ,$292.41 ,$285.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEOMYCIN-POLYMYXIN-HYDROCORTISONE 3.5-10000-1 SOLN 10 ML BOTTLE,637,1 ,$356.60 ,$235.36 ,$174.73 ,$356.60 , N/A ,$319.58 ,$319.58 , N/A ,$285.28 ,$303.11 ,$222.88 ,$320.94 , N/A , N/A ,$338.77 ,$320.94 ,$303.11 ,$303.11 , N/A ,$303.11 ,$303.11 ,$320.94 ,$217.17 , N/A , N/A , N/A ,$320.94 , N/A ,$328.07 ,$320.94 ,$235.39 ,$235.39 ,$217.17 ,$235.39 ,$231.79 ,$243.63 ,$352.97 ,$281.71 , N/A ,$174.73 ,$174.73 , N/A ,$174.73 ,$356.60 ,$338.77 ,$292.41 ,$292.41 ,$285.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NICOTINE 21 MG/24HR PT24,637,1 ,$8.75 ,$5.78 ,$4.29 ,$8.75 , N/A ,$7.84 ,$7.84 , N/A ,$7.00 ,$7.44 ,$5.47 ,$7.88 , N/A , N/A ,$8.31 ,$7.88 ,$7.44 ,$7.44 , N/A ,$7.44 ,$7.44 ,$7.88 ,$5.33 , N/A , N/A , N/A ,$7.88 , N/A ,$8.05 ,$7.88 ,$5.78 ,$5.78 ,$5.33 ,$5.78 ,$5.69 ,$5.98 ,$8.66 ,$6.91 , N/A ,$4.29 ,$4.29 , N/A ,$4.29 ,$8.75 ,$8.31 ,$7.18 ,$7.18 ,$7.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUVOXAMINE 50 MG TABS,637,1 ,$8.75 ,$5.78 ,$4.29 ,$8.75 , N/A ,$7.84 ,$7.84 , N/A ,$7.00 ,$7.44 ,$5.47 ,$7.88 , N/A , N/A ,$8.31 ,$7.88 ,$7.44 ,$7.44 , N/A ,$7.44 ,$7.44 ,$7.88 ,$5.33 , N/A , N/A , N/A ,$7.88 , N/A ,$8.05 ,$7.88 ,$5.78 ,$5.78 ,$5.33 ,$5.78 ,$5.69 ,$5.98 ,$8.66 ,$6.91 , N/A ,$4.29 ,$4.29 , N/A ,$4.29 ,$8.75 ,$8.31 ,$7.18 ,$7.18 ,$7.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITAZOXANIDE 500 MG TABS,637,1 ,$528.70 ,$348.94 ,$259.06 ,$528.70 , N/A ,$473.82 ,$473.82 , N/A ,$422.96 ,$449.40 ,$330.44 ,$475.83 , N/A , N/A ,$502.27 ,$475.83 ,$449.40 ,$449.40 , N/A ,$449.40 ,$449.40 ,$475.83 ,$321.98 , N/A , N/A , N/A ,$475.83 , N/A ,$486.40 ,$475.83 ,$348.99 ,$348.99 ,$321.98 ,$348.99 ,$343.66 ,$361.21 ,$523.31 ,$417.67 , N/A ,$259.06 ,$259.06 , N/A ,$259.06 ,$528.70 ,$502.27 ,$433.53 ,$433.53 ,$422.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NYSTATIN 100000 UNIT/GM OINT 15 G TUBE,637,1 ,$59.55 ,$39.30 ,$29.18 ,$59.55 , N/A ,$53.37 ,$53.37 , N/A ,$47.64 ,$50.62 ,$37.22 ,$53.60 , N/A , N/A ,$56.57 ,$53.60 ,$50.62 ,$50.62 , N/A ,$50.62 ,$50.62 ,$53.60 ,$36.27 , N/A , N/A , N/A ,$53.60 , N/A ,$54.79 ,$53.60 ,$39.31 ,$39.31 ,$36.27 ,$39.31 ,$38.71 ,$40.68 ,$58.95 ,$47.04 , N/A ,$29.18 ,$29.18 , N/A ,$29.18 ,$59.55 ,$56.57 ,$48.83 ,$48.83 ,$47.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NYSTATIN 100000 UNIT/GM CREA 15 G TUBE,637,1 ,$59.55 ,$39.30 ,$29.18 ,$59.55 , N/A ,$53.37 ,$53.37 , N/A ,$47.64 ,$50.62 ,$37.22 ,$53.60 , N/A , N/A ,$56.57 ,$53.60 ,$50.62 ,$50.62 , N/A ,$50.62 ,$50.62 ,$53.60 ,$36.27 , N/A , N/A , N/A ,$53.60 , N/A ,$54.79 ,$53.60 ,$39.31 ,$39.31 ,$36.27 ,$39.31 ,$38.71 ,$40.68 ,$58.95 ,$47.04 , N/A ,$29.18 ,$29.18 , N/A ,$29.18 ,$59.55 ,$56.57 ,$48.83 ,$48.83 ,$47.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NYSTATIN 100000 UNIT/GM POWD 15 G BOTTLE,637,1 ,$127.35 ,$84.05 ,$62.40 ,$127.35 , N/A ,$114.13 ,$114.13 , N/A ,$101.88 ,$108.25 ,$79.59 ,$114.62 , N/A , N/A ,$120.98 ,$114.62 ,$108.25 ,$108.25 , N/A ,$108.25 ,$108.25 ,$114.62 ,$77.56 , N/A , N/A , N/A ,$114.62 , N/A ,$117.16 ,$114.62 ,$84.06 ,$84.06 ,$77.56 ,$84.06 ,$82.78 ,$87.01 ,$126.05 ,$100.61 , N/A ,$62.40 ,$62.40 , N/A ,$62.40 ,$127.35 ,$120.98 ,$104.43 ,$104.43 ,$101.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NYSTATIN 100000 UNIT/ML SUSP,637,1 ,$17.20 ,$11.35 ,$8.43 ,$17.20 , N/A ,$15.41 ,$15.41 , N/A ,$13.76 ,$14.62 ,$10.75 ,$15.48 , N/A , N/A ,$16.34 ,$15.48 ,$14.62 ,$14.62 , N/A ,$14.62 ,$14.62 ,$15.48 ,$10.47 , N/A , N/A , N/A ,$15.48 , N/A ,$15.82 ,$15.48 ,$11.35 ,$11.35 ,$10.47 ,$11.35 ,$11.18 ,$11.75 ,$17.02 ,$13.59 , N/A ,$8.43 ,$8.43 , N/A ,$8.43 ,$17.20 ,$16.34 ,$14.10 ,$14.10 ,$13.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OLANZAPINE 2.5 MG TABS,637,1 ,$38.10 ,$25.15 ,$18.67 ,$38.10 , N/A ,$34.15 ,$34.15 , N/A ,$30.48 ,$32.39 ,$23.81 ,$34.29 , N/A , N/A ,$36.20 ,$34.29 ,$32.39 ,$32.39 , N/A ,$32.39 ,$32.39 ,$34.29 ,$23.20 , N/A , N/A , N/A ,$34.29 , N/A ,$35.05 ,$34.29 ,$25.15 ,$25.15 ,$23.20 ,$25.15 ,$24.77 ,$26.03 ,$37.71 ,$30.10 , N/A ,$18.67 ,$18.67 , N/A ,$18.67 ,$38.10 ,$36.20 ,$31.24 ,$31.24 ,$30.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OLANZAPINE 5 MG TABS,637,1 ,$44.95 ,$29.67 ,$22.03 ,$44.95 , N/A ,$40.28 ,$40.28 , N/A ,$35.96 ,$38.21 ,$28.09 ,$40.46 , N/A , N/A ,$42.70 ,$40.46 ,$38.21 ,$38.21 , N/A ,$38.21 ,$38.21 ,$40.46 ,$27.37 , N/A , N/A , N/A ,$40.46 , N/A ,$41.35 ,$40.46 ,$29.67 ,$29.67 ,$27.37 ,$29.67 ,$29.22 ,$30.71 ,$44.49 ,$35.51 , N/A ,$22.03 ,$22.03 , N/A ,$22.03 ,$44.95 ,$42.70 ,$36.86 ,$36.86 ,$35.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OLOPATADINE 0.1 % SOLN 5 ML BOTTLE,637,1 ,$106.25 ,$70.13 ,$52.06 ,$106.25 , N/A ,$95.22 ,$95.22 , N/A ,$85.00 ,$90.31 ,$66.41 ,$95.63 , N/A , N/A ,$100.94 ,$95.63 ,$90.31 ,$90.31 , N/A ,$90.31 ,$90.31 ,$95.63 ,$64.71 , N/A , N/A , N/A ,$95.63 , N/A ,$97.75 ,$95.63 ,$70.14 ,$70.14 ,$64.71 ,$70.14 ,$69.06 ,$72.59 ,$105.16 ,$83.94 , N/A ,$52.06 ,$52.06 , N/A ,$52.06 ,$106.25 ,$100.94 ,$87.13 ,$87.13 ,$85.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OMEGA-3 ACID 1 GM CAPS,637,1 ,$14.95 ,$9.87 ,$7.33 ,$14.95 , N/A ,$13.40 ,$13.40 , N/A ,$11.96 ,$12.71 ,$9.34 ,$13.46 , N/A , N/A ,$14.20 ,$13.46 ,$12.71 ,$12.71 , N/A ,$12.71 ,$12.71 ,$13.46 ,$9.10 , N/A , N/A , N/A ,$13.46 , N/A ,$13.75 ,$13.46 ,$9.87 ,$9.87 ,$9.10 ,$9.87 ,$9.72 ,$10.21 ,$14.80 ,$11.81 , N/A ,$7.33 ,$7.33 , N/A ,$7.33 ,$14.95 ,$14.20 ,$12.26 ,$12.26 ,$11.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROXYCHLOROQUINE 200 MG TABS,637,1 ,$14.95 ,$9.87 ,$7.33 ,$14.95 , N/A ,$13.40 ,$13.40 , N/A ,$11.96 ,$12.71 ,$9.34 ,$13.46 , N/A , N/A ,$14.20 ,$13.46 ,$12.71 ,$12.71 , N/A ,$12.71 ,$12.71 ,$13.46 ,$9.10 , N/A , N/A , N/A ,$13.46 , N/A ,$13.75 ,$13.46 ,$9.87 ,$9.87 ,$9.10 ,$9.87 ,$9.72 ,$10.21 ,$14.80 ,$11.81 , N/A ,$7.33 ,$7.33 , N/A ,$7.33 ,$14.95 ,$14.20 ,$12.26 ,$12.26 ,$11.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHADONE 10 MG/ML CONC,637,1 ,$14.95 ,$9.87 ,$7.33 ,$14.95 , N/A ,$13.40 ,$13.40 , N/A ,$11.96 ,$12.71 ,$9.34 ,$13.46 , N/A , N/A ,$14.20 ,$13.46 ,$12.71 ,$12.71 , N/A ,$12.71 ,$12.71 ,$13.46 ,$9.10 , N/A , N/A , N/A ,$13.46 , N/A ,$13.75 ,$13.46 ,$9.87 ,$9.87 ,$9.10 ,$9.87 ,$9.72 ,$10.21 ,$14.80 ,$11.81 , N/A ,$7.33 ,$7.33 , N/A ,$7.33 ,$14.95 ,$14.20 ,$12.26 ,$12.26 ,$11.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MICONAZOLE 2 % POWD 43 G BOTTLE,637,1 ,$14.95 ,$9.87 ,$7.33 ,$14.95 , N/A ,$13.40 ,$13.40 , N/A ,$11.96 ,$12.71 ,$9.34 ,$13.46 , N/A , N/A ,$14.20 ,$13.46 ,$12.71 ,$12.71 , N/A ,$12.71 ,$12.71 ,$13.46 ,$9.10 , N/A , N/A , N/A ,$13.46 , N/A ,$13.75 ,$13.46 ,$9.87 ,$9.87 ,$9.10 ,$9.87 ,$9.72 ,$10.21 ,$14.80 ,$11.81 , N/A ,$7.33 ,$7.33 , N/A ,$7.33 ,$14.95 ,$14.20 ,$12.26 ,$12.26 ,$11.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OMEPRAZOLE 2 MG/ML SUSP,637,1 ,$56.25 ,$37.13 ,$27.56 ,$56.25 , N/A ,$50.41 ,$50.41 , N/A ,$45.00 ,$47.81 ,$35.16 ,$50.63 , N/A , N/A ,$53.44 ,$50.63 ,$47.81 ,$47.81 , N/A ,$47.81 ,$47.81 ,$50.63 ,$34.26 , N/A , N/A , N/A ,$50.63 , N/A ,$51.75 ,$50.63 ,$37.13 ,$37.13 ,$34.26 ,$37.13 ,$36.56 ,$38.43 ,$55.67 ,$44.44 , N/A ,$27.56 ,$27.56 , N/A ,$27.56 ,$56.25 ,$53.44 ,$46.13 ,$46.13 ,$45.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ONDANSETRON 4 MG TBDP,637,1 ,$78.60 ,$51.88 ,$38.51 ,$78.60 , N/A ,$70.44 ,$70.44 , N/A ,$62.88 ,$66.81 ,$49.13 ,$70.74 , N/A , N/A ,$74.67 ,$70.74 ,$66.81 ,$66.81 , N/A ,$66.81 ,$66.81 ,$70.74 ,$47.87 , N/A , N/A , N/A ,$70.74 , N/A ,$72.31 ,$70.74 ,$51.88 ,$51.88 ,$47.87 ,$51.88 ,$51.09 ,$53.70 ,$77.80 ,$62.09 , N/A ,$38.51 ,$38.51 , N/A ,$38.51 ,$78.60 ,$74.67 ,$64.45 ,$64.45 ,$62.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ONDANSETRON 4 MG/5ML SOLN,637,1 ,$38.70 ,$25.54 ,$18.96 ,$38.70 , N/A ,$34.68 ,$34.68 , N/A ,$30.96 ,$32.90 ,$24.19 ,$34.83 , N/A , N/A ,$36.77 ,$34.83 ,$32.90 ,$32.90 , N/A ,$32.90 ,$32.90 ,$34.83 ,$23.57 , N/A , N/A , N/A ,$34.83 , N/A ,$35.60 ,$34.83 ,$25.55 ,$25.55 ,$23.57 ,$25.55 ,$25.16 ,$26.44 ,$38.31 ,$30.57 , N/A ,$18.96 ,$18.96 , N/A ,$18.96 ,$38.70 ,$36.77 ,$31.73 ,$31.73 ,$30.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OPIUM-BELLADONA 16.2-30 MG SUPP,637,1 ,$93.60 ,$61.78 ,$45.86 ,$93.60 , N/A ,$83.88 ,$83.88 , N/A ,$74.88 ,$79.56 ,$58.50 ,$84.24 , N/A , N/A ,$88.92 ,$84.24 ,$79.56 ,$79.56 , N/A ,$79.56 ,$79.56 ,$84.24 ,$57.00 , N/A , N/A , N/A ,$84.24 , N/A ,$86.11 ,$84.24 ,$61.79 ,$61.79 ,$57.00 ,$61.79 ,$60.84 ,$63.95 ,$92.65 ,$73.94 , N/A ,$45.86 ,$45.86 , N/A ,$45.86 ,$93.60 ,$88.92 ,$76.75 ,$76.75 ,$74.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OPIUM-BELLADONNA 16.2-60 MG SUPP,637,1 ,$113.75 ,$75.08 ,$55.74 ,$113.75 , N/A ,$101.94 ,$101.94 , N/A ,$91.00 ,$96.69 ,$71.09 ,$102.38 , N/A , N/A ,$108.06 ,$102.38 ,$96.69 ,$96.69 , N/A ,$96.69 ,$96.69 ,$102.38 ,$69.27 , N/A , N/A , N/A ,$102.38 , N/A ,$104.65 ,$102.38 ,$75.09 ,$75.09 ,$69.27 ,$75.09 ,$73.94 ,$77.71 ,$112.59 ,$89.86 , N/A ,$55.74 ,$55.74 , N/A ,$55.74 ,$113.75 ,$108.06 ,$93.28 ,$93.28 ,$91.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OSELTAMIVIR 30 MG CAPS,637,1 ,$48.25 ,$31.85 ,$23.64 ,$48.25 , N/A ,$43.24 ,$43.24 , N/A ,$38.60 ,$41.01 ,$30.16 ,$43.43 , N/A , N/A ,$45.84 ,$43.43 ,$41.01 ,$41.01 , N/A ,$41.01 ,$41.01 ,$43.43 ,$29.38 , N/A , N/A , N/A ,$43.43 , N/A ,$44.39 ,$43.43 ,$31.85 ,$31.85 ,$29.38 ,$31.85 ,$31.36 ,$32.96 ,$47.76 ,$38.12 , N/A ,$23.64 ,$23.64 , N/A ,$23.64 ,$48.25 ,$45.84 ,$39.57 ,$39.57 ,$38.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OSELTAMIVIR 6 MG/ML SUSR,637,1 ,$9.93 ,$6.55 ,$4.87 ,$9.93 , N/A ,$8.90 ,$8.90 , N/A ,$7.94 ,$8.44 ,$6.21 ,$8.94 , N/A , N/A ,$9.43 ,$8.94 ,$8.44 ,$8.44 , N/A ,$8.44 ,$8.44 ,$8.94 ,$6.05 , N/A , N/A , N/A ,$8.94 , N/A ,$9.14 ,$8.94 ,$6.55 ,$6.55 ,$6.05 ,$6.55 ,$6.45 ,$6.78 ,$9.83 ,$7.84 , N/A ,$4.87 ,$4.87 , N/A ,$4.87 ,$9.93 ,$9.43 ,$8.14 ,$8.14 ,$7.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OSELTAMIVIR 75 MG CAPS,637,1 ,$52.60 ,$34.72 ,$25.77 ,$52.60 , N/A ,$47.14 ,$47.14 , N/A ,$42.08 ,$44.71 ,$32.88 ,$47.34 , N/A , N/A ,$49.97 ,$47.34 ,$44.71 ,$44.71 , N/A ,$44.71 ,$44.71 ,$47.34 ,$32.03 , N/A , N/A , N/A ,$47.34 , N/A ,$48.39 ,$47.34 ,$34.72 ,$34.72 ,$32.03 ,$34.72 ,$34.19 ,$35.94 ,$52.07 ,$41.55 , N/A ,$25.77 ,$25.77 , N/A ,$25.77 ,$52.60 ,$49.97 ,$43.13 ,$43.13 ,$42.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYBUTYNIN XL 10 MG TB24,637,1 ,$10.50 ,$6.93 ,$5.15 ,$10.50 , N/A ,$9.41 ,$9.41 , N/A ,$8.40 ,$8.93 ,$6.56 ,$9.45 , N/A , N/A ,$9.98 ,$9.45 ,$8.93 ,$8.93 , N/A ,$8.93 ,$8.93 ,$9.45 ,$6.39 , N/A , N/A , N/A ,$9.45 , N/A ,$9.66 ,$9.45 ,$6.93 ,$6.93 ,$6.39 ,$6.93 ,$6.83 ,$7.17 ,$10.40 ,$8.30 , N/A ,$5.15 ,$5.15 , N/A ,$5.15 ,$10.50 ,$9.98 ,$8.61 ,$8.61 ,$8.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOSARTAN 100 MG TABS,637,1 ,$10.50 ,$6.93 ,$5.15 ,$10.50 , N/A ,$9.41 ,$9.41 , N/A ,$8.40 ,$8.93 ,$6.56 ,$9.45 , N/A , N/A ,$9.98 ,$9.45 ,$8.93 ,$8.93 , N/A ,$8.93 ,$8.93 ,$9.45 ,$6.39 , N/A , N/A , N/A ,$9.45 , N/A ,$9.66 ,$9.45 ,$6.93 ,$6.93 ,$6.39 ,$6.93 ,$6.83 ,$7.17 ,$10.40 ,$8.30 , N/A ,$5.15 ,$5.15 , N/A ,$5.15 ,$10.50 ,$9.98 ,$8.61 ,$8.61 ,$8.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYBUTYNIN XL 15 MG TB24,637,1 ,$10.75 ,$7.10 ,$5.27 ,$10.75 , N/A ,$9.63 ,$9.63 , N/A ,$8.60 ,$9.14 ,$6.72 ,$9.68 , N/A , N/A ,$10.21 ,$9.68 ,$9.14 ,$9.14 , N/A ,$9.14 ,$9.14 ,$9.68 ,$6.55 , N/A , N/A , N/A ,$9.68 , N/A ,$9.89 ,$9.68 ,$7.10 ,$7.10 ,$6.55 ,$7.10 ,$6.99 ,$7.34 ,$10.64 ,$8.49 , N/A ,$5.27 ,$5.27 , N/A ,$5.27 ,$10.75 ,$10.21 ,$8.82 ,$8.82 ,$8.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE 5 MG/5ML SOLN,637,1 ,$28.58 ,$18.86 ,$14.00 ,$28.58 , N/A ,$25.61 ,$25.61 , N/A ,$22.86 ,$24.29 ,$17.86 ,$25.72 , N/A , N/A ,$27.15 ,$25.72 ,$24.29 ,$24.29 , N/A ,$24.29 ,$24.29 ,$25.72 ,$17.41 , N/A , N/A , N/A ,$25.72 , N/A ,$26.29 ,$25.72 ,$18.87 ,$18.87 ,$17.41 ,$18.87 ,$18.58 ,$19.53 ,$28.29 ,$22.58 , N/A ,$14.00 ,$14.00 , N/A ,$14.00 ,$28.58 ,$27.15 ,$23.44 ,$23.44 ,$22.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE ER 10 MG T12A,637,1 ,$19.55 ,$12.90 ,$9.58 ,$19.55 , N/A ,$17.52 ,$17.52 , N/A ,$15.64 ,$16.62 ,$12.22 ,$17.60 , N/A , N/A ,$18.57 ,$17.60 ,$16.62 ,$16.62 , N/A ,$16.62 ,$16.62 ,$17.60 ,$11.91 , N/A , N/A , N/A ,$17.60 , N/A ,$17.99 ,$17.60 ,$12.91 ,$12.91 ,$11.91 ,$12.91 ,$12.71 ,$13.36 ,$19.35 ,$15.44 , N/A ,$9.58 ,$9.58 , N/A ,$9.58 ,$19.55 ,$18.57 ,$16.03 ,$16.03 ,$15.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE ER 20 MG T12A,637,1 ,$36.38 ,$24.01 ,$17.83 ,$36.38 , N/A ,$32.60 ,$32.60 , N/A ,$29.10 ,$30.92 ,$22.74 ,$32.74 , N/A , N/A ,$34.56 ,$32.74 ,$30.92 ,$30.92 , N/A ,$30.92 ,$30.92 ,$32.74 ,$22.16 , N/A , N/A , N/A ,$32.74 , N/A ,$33.47 ,$32.74 ,$24.01 ,$24.01 ,$22.16 ,$24.01 ,$23.65 ,$24.85 ,$36.01 ,$28.74 , N/A ,$17.83 ,$17.83 , N/A ,$17.83 ,$36.38 ,$34.56 ,$29.83 ,$29.83 ,$29.10 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE-ACETAMINOPHEN 10-325 MG TABS,637,1 ,$12.15 ,$8.02 ,$5.95 ,$12.15 , N/A ,$10.89 ,$10.89 , N/A ,$9.72 ,$10.33 ,$7.59 ,$10.94 , N/A , N/A ,$11.54 ,$10.94 ,$10.33 ,$10.33 , N/A ,$10.33 ,$10.33 ,$10.94 ,$7.40 , N/A , N/A , N/A ,$10.94 , N/A ,$11.18 ,$10.94 ,$8.02 ,$8.02 ,$7.40 ,$8.02 ,$7.90 ,$8.30 ,$12.02 ,$9.60 , N/A ,$5.95 ,$5.95 , N/A ,$5.95 ,$12.15 ,$11.54 ,$9.96 ,$9.96 ,$9.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE-ACETAMINOPHEN 7.5-325 MG TABS,637,1 ,$9.35 ,$6.17 ,$4.58 ,$9.35 , N/A ,$8.38 ,$8.38 , N/A ,$7.48 ,$7.95 ,$5.84 ,$8.42 , N/A , N/A ,$8.88 ,$8.42 ,$7.95 ,$7.95 , N/A ,$7.95 ,$7.95 ,$8.42 ,$5.69 , N/A , N/A , N/A ,$8.42 , N/A ,$8.60 ,$8.42 ,$6.17 ,$6.17 ,$5.69 ,$6.17 ,$6.08 ,$6.39 ,$9.25 ,$7.39 , N/A ,$4.58 ,$4.58 , N/A ,$4.58 ,$9.35 ,$8.88 ,$7.67 ,$7.67 ,$7.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXCARBAZEPINE 300 MG TABS,637,1 ,$9.35 ,$6.17 ,$4.58 ,$9.35 , N/A ,$8.38 ,$8.38 , N/A ,$7.48 ,$7.95 ,$5.84 ,$8.42 , N/A , N/A ,$8.88 ,$8.42 ,$7.95 ,$7.95 , N/A ,$7.95 ,$7.95 ,$8.42 ,$5.69 , N/A , N/A , N/A ,$8.42 , N/A ,$8.60 ,$8.42 ,$6.17 ,$6.17 ,$5.69 ,$6.17 ,$6.08 ,$6.39 ,$9.25 ,$7.39 , N/A ,$4.58 ,$4.58 , N/A ,$4.58 ,$9.35 ,$8.88 ,$7.67 ,$7.67 ,$7.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYMETAZOLINE 0.05 % SOLN 30 ML BOTTLE,637,1 ,$21.75 ,$14.36 ,$10.66 ,$21.75 , N/A ,$19.49 ,$19.49 , N/A ,$17.40 ,$18.49 ,$13.59 ,$19.58 , N/A , N/A ,$20.66 ,$19.58 ,$18.49 ,$18.49 , N/A ,$18.49 ,$18.49 ,$19.58 ,$13.25 , N/A , N/A , N/A ,$19.58 , N/A ,$20.01 ,$19.58 ,$14.36 ,$14.36 ,$13.25 ,$14.36 ,$14.14 ,$14.86 ,$21.53 ,$17.18 , N/A ,$10.66 ,$10.66 , N/A ,$10.66 ,$21.75 ,$20.66 ,$17.84 ,$17.84 ,$17.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYMETAZOLINE 0.05 % SOLN 30 ML SPRAY BOTTLE,637,1 ,$8.40 ,$5.54 ,$4.12 ,$8.40 , N/A ,$7.53 ,$7.53 , N/A ,$6.72 ,$7.14 ,$5.25 ,$7.56 , N/A , N/A ,$7.98 ,$7.56 ,$7.14 ,$7.14 , N/A ,$7.14 ,$7.14 ,$7.56 ,$5.12 , N/A , N/A , N/A ,$7.56 , N/A ,$7.73 ,$7.56 ,$5.54 ,$5.54 ,$5.12 ,$5.54 ,$5.46 ,$5.74 ,$8.31 ,$6.64 , N/A ,$4.12 ,$4.12 , N/A ,$4.12 ,$8.40 ,$7.98 ,$6.89 ,$6.89 ,$6.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DAPSONE 25 MG TABS,637,1 ,$8.40 ,$5.54 ,$4.12 ,$8.40 , N/A ,$7.53 ,$7.53 , N/A ,$6.72 ,$7.14 ,$5.25 ,$7.56 , N/A , N/A ,$7.98 ,$7.56 ,$7.14 ,$7.14 , N/A ,$7.14 ,$7.14 ,$7.56 ,$5.12 , N/A , N/A , N/A ,$7.56 , N/A ,$7.73 ,$7.56 ,$5.54 ,$5.54 ,$5.12 ,$5.54 ,$5.46 ,$5.74 ,$8.31 ,$6.64 , N/A ,$4.12 ,$4.12 , N/A ,$4.12 ,$8.40 ,$7.98 ,$6.89 ,$6.89 ,$6.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PALIPERIDONE ER 3 MG TB24,637,1 ,$103.95 ,$68.61 ,$50.94 ,$103.95 , N/A ,$93.16 ,$93.16 , N/A ,$83.16 ,$88.36 ,$64.97 ,$93.56 , N/A , N/A ,$98.75 ,$93.56 ,$88.36 ,$88.36 , N/A ,$88.36 ,$88.36 ,$93.56 ,$63.31 , N/A , N/A , N/A ,$93.56 , N/A ,$95.63 ,$93.56 ,$68.62 ,$68.62 ,$63.31 ,$68.62 ,$67.57 ,$71.02 ,$102.89 ,$82.12 , N/A ,$50.94 ,$50.94 , N/A ,$50.94 ,$103.95 ,$98.75 ,$85.24 ,$85.24 ,$83.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 10000-32000 UNITS CPEP,637,1 ,$15.60 ,$10.30 ,$7.64 ,$15.60 , N/A ,$13.98 ,$13.98 , N/A ,$12.48 ,$13.26 ,$9.75 ,$14.04 , N/A , N/A ,$14.82 ,$14.04 ,$13.26 ,$13.26 , N/A ,$13.26 ,$13.26 ,$14.04 ,$9.50 , N/A , N/A , N/A ,$14.04 , N/A ,$14.35 ,$14.04 ,$10.30 ,$10.30 ,$9.50 ,$10.30 ,$10.14 ,$10.66 ,$15.44 ,$12.32 , N/A ,$7.64 ,$7.64 , N/A ,$7.64 ,$15.60 ,$14.82 ,$12.79 ,$12.79 ,$12.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MESALAMINE ER 0.375 G CP24,637,1 ,$15.60 ,$10.30 ,$7.64 ,$15.60 , N/A ,$13.98 ,$13.98 , N/A ,$12.48 ,$13.26 ,$9.75 ,$14.04 , N/A , N/A ,$14.82 ,$14.04 ,$13.26 ,$13.26 , N/A ,$13.26 ,$13.26 ,$14.04 ,$9.50 , N/A , N/A , N/A ,$14.04 , N/A ,$14.35 ,$14.04 ,$10.30 ,$10.30 ,$9.50 ,$10.30 ,$10.14 ,$10.66 ,$15.44 ,$12.32 , N/A ,$7.64 ,$7.64 , N/A ,$7.64 ,$15.60 ,$14.82 ,$12.79 ,$12.79 ,$12.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 12000 UNIT CPEP,637,1 ,$15.40 ,$10.16 ,$7.55 ,$15.40 , N/A ,$13.80 ,$13.80 , N/A ,$12.32 ,$13.09 ,$9.63 ,$13.86 , N/A , N/A ,$14.63 ,$13.86 ,$13.09 ,$13.09 , N/A ,$13.09 ,$13.09 ,$13.86 ,$9.38 , N/A , N/A , N/A ,$13.86 , N/A ,$14.17 ,$13.86 ,$10.17 ,$10.17 ,$9.38 ,$10.17 ,$10.01 ,$10.52 ,$15.24 ,$12.17 , N/A ,$7.55 ,$7.55 , N/A ,$7.55 ,$15.40 ,$14.63 ,$12.63 ,$12.63 ,$12.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 24000 UNIT CPEP,637,1 ,$30.50 ,$20.13 ,$14.95 ,$30.50 , N/A ,$27.33 ,$27.33 , N/A ,$24.40 ,$25.93 ,$19.06 ,$27.45 , N/A , N/A ,$28.98 ,$27.45 ,$25.93 ,$25.93 , N/A ,$25.93 ,$25.93 ,$27.45 ,$18.57 , N/A , N/A , N/A ,$27.45 , N/A ,$28.06 ,$27.45 ,$20.13 ,$20.13 ,$18.57 ,$20.13 ,$19.83 ,$20.84 ,$30.19 ,$24.10 , N/A ,$14.95 ,$14.95 , N/A ,$14.95 ,$30.50 ,$28.98 ,$25.01 ,$25.01 ,$24.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANTOPRAZOLE EC 40 MG TBEC,637,1 ,$17.95 ,$11.85 ,$8.80 ,$17.95 , N/A ,$16.09 ,$16.09 , N/A ,$14.36 ,$15.26 ,$11.22 ,$16.16 , N/A , N/A ,$17.05 ,$16.16 ,$15.26 ,$15.26 , N/A ,$15.26 ,$15.26 ,$16.16 ,$10.93 , N/A , N/A , N/A ,$16.16 , N/A ,$16.51 ,$16.16 ,$11.85 ,$11.85 ,$10.93 ,$11.85 ,$11.67 ,$12.26 ,$17.77 ,$14.18 , N/A ,$8.80 ,$8.80 , N/A ,$8.80 ,$17.95 ,$17.05 ,$14.72 ,$14.72 ,$14.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANTOPRAZOLE EC 20 MG TBEC,637,1 ,$17.95 ,$11.85 ,$8.80 ,$17.95 , N/A ,$16.09 ,$16.09 , N/A ,$14.36 ,$15.26 ,$11.22 ,$16.16 , N/A , N/A ,$17.05 ,$16.16 ,$15.26 ,$15.26 , N/A ,$15.26 ,$15.26 ,$16.16 ,$10.93 , N/A , N/A , N/A ,$16.16 , N/A ,$16.51 ,$16.16 ,$11.85 ,$11.85 ,$10.93 ,$11.85 ,$11.67 ,$12.26 ,$17.77 ,$14.18 , N/A ,$8.80 ,$8.80 , N/A ,$8.80 ,$17.95 ,$17.05 ,$14.72 ,$14.72 ,$14.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENAZOPYRIDINE 100 MG TABS,637,1 ,$9.20 ,$6.07 ,$4.51 ,$9.20 , N/A ,$8.25 ,$8.25 , N/A ,$7.36 ,$7.82 ,$5.75 ,$8.28 , N/A , N/A ,$8.74 ,$8.28 ,$7.82 ,$7.82 , N/A ,$7.82 ,$7.82 ,$8.28 ,$5.60 , N/A , N/A , N/A ,$8.28 , N/A ,$8.46 ,$8.28 ,$6.07 ,$6.07 ,$5.60 ,$6.07 ,$5.98 ,$6.29 ,$9.10 ,$7.27 , N/A ,$4.51 ,$4.51 , N/A ,$4.51 ,$9.20 ,$8.74 ,$7.54 ,$7.54 ,$7.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHLORTHALIDONE 25 MG TABS,637,1 ,$9.20 ,$6.07 ,$4.51 ,$9.20 , N/A ,$8.25 ,$8.25 , N/A ,$7.36 ,$7.82 ,$5.75 ,$8.28 , N/A , N/A ,$8.74 ,$8.28 ,$7.82 ,$7.82 , N/A ,$7.82 ,$7.82 ,$8.28 ,$5.60 , N/A , N/A , N/A ,$8.28 , N/A ,$8.46 ,$8.28 ,$6.07 ,$6.07 ,$5.60 ,$6.07 ,$5.98 ,$6.29 ,$9.10 ,$7.27 , N/A ,$4.51 ,$4.51 , N/A ,$4.51 ,$9.20 ,$8.74 ,$7.54 ,$7.54 ,$7.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CITALOPRAM 20 MG TABS,637,1 ,$9.20 ,$6.07 ,$4.51 ,$9.20 , N/A ,$8.25 ,$8.25 , N/A ,$7.36 ,$7.82 ,$5.75 ,$8.28 , N/A , N/A ,$8.74 ,$8.28 ,$7.82 ,$7.82 , N/A ,$7.82 ,$7.82 ,$8.28 ,$5.60 , N/A , N/A , N/A ,$8.28 , N/A ,$8.46 ,$8.28 ,$6.07 ,$6.07 ,$5.60 ,$6.07 ,$5.98 ,$6.29 ,$9.10 ,$7.27 , N/A ,$4.51 ,$4.51 , N/A ,$4.51 ,$9.20 ,$8.74 ,$7.54 ,$7.54 ,$7.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENOL 1.4 % LIQD 177 ML BOTTLE,637,1 ,$8.45 ,$5.58 ,$4.14 ,$8.45 , N/A ,$7.57 ,$7.57 , N/A ,$6.76 ,$7.18 ,$5.28 ,$7.61 , N/A , N/A ,$8.03 ,$7.61 ,$7.18 ,$7.18 , N/A ,$7.18 ,$7.18 ,$7.61 ,$5.15 , N/A , N/A , N/A ,$7.61 , N/A ,$7.77 ,$7.61 ,$5.58 ,$5.58 ,$5.15 ,$5.58 ,$5.49 ,$5.77 ,$8.36 ,$6.68 , N/A ,$4.14 ,$4.14 , N/A ,$4.14 ,$8.45 ,$8.03 ,$6.93 ,$6.93 ,$6.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BACLOFEN 10 MG TABS,637,1 ,$8.45 ,$5.58 ,$4.14 ,$8.45 , N/A ,$7.57 ,$7.57 , N/A ,$6.76 ,$7.18 ,$5.28 ,$7.61 , N/A , N/A ,$8.03 ,$7.61 ,$7.18 ,$7.18 , N/A ,$7.18 ,$7.18 ,$7.61 ,$5.15 , N/A , N/A , N/A ,$7.61 , N/A ,$7.77 ,$7.61 ,$5.58 ,$5.58 ,$5.15 ,$5.58 ,$5.49 ,$5.77 ,$8.36 ,$6.68 , N/A ,$4.14 ,$4.14 , N/A ,$4.14 ,$8.45 ,$8.03 ,$6.93 ,$6.93 ,$6.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENOL 1.4 % LIQD 177 ML SPRAY BOTTLE,637,1 ,$10.25 ,$6.77 ,$5.02 ,$10.25 , N/A ,$9.19 ,$9.19 , N/A ,$8.20 ,$8.71 ,$6.41 ,$9.23 , N/A , N/A ,$9.74 ,$9.23 ,$8.71 ,$8.71 , N/A ,$8.71 ,$8.71 ,$9.23 ,$6.24 , N/A , N/A , N/A ,$9.23 , N/A ,$9.43 ,$9.23 ,$6.77 ,$6.77 ,$6.24 ,$6.77 ,$6.66 ,$7.00 ,$10.14 ,$8.10 , N/A ,$5.02 ,$5.02 , N/A ,$5.02 ,$10.25 ,$9.74 ,$8.41 ,$8.41 ,$8.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENYLEPHRINE 0.5 % SOLN 15 ML BOTTLE,637,1 ,$13.35 ,$8.81 ,$6.54 ,$13.35 , N/A ,$11.96 ,$11.96 , N/A ,$10.68 ,$11.35 ,$8.34 ,$12.02 , N/A , N/A ,$12.68 ,$12.02 ,$11.35 ,$11.35 , N/A ,$11.35 ,$11.35 ,$12.02 ,$8.13 , N/A , N/A , N/A ,$12.02 , N/A ,$12.28 ,$12.02 ,$8.81 ,$8.81 ,$8.13 ,$8.81 ,$8.68 ,$9.12 ,$13.21 ,$10.55 , N/A ,$6.54 ,$6.54 , N/A ,$6.54 ,$13.35 ,$12.68 ,$10.95 ,$10.95 ,$10.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENYTOIN 50 MG CHEW,637,1 ,$8.13 ,$5.37 ,$3.98 ,$8.13 , N/A ,$7.29 ,$7.29 , N/A ,$6.50 ,$6.91 ,$5.08 ,$7.32 , N/A , N/A ,$7.72 ,$7.32 ,$6.91 ,$6.91 , N/A ,$6.91 ,$6.91 ,$7.32 ,$4.95 , N/A , N/A , N/A ,$7.32 , N/A ,$7.48 ,$7.32 ,$5.37 ,$5.37 ,$4.95 ,$5.37 ,$5.28 ,$5.55 ,$8.05 ,$6.42 , N/A ,$3.98 ,$3.98 , N/A ,$3.98 ,$8.13 ,$7.72 ,$6.67 ,$6.67 ,$6.50 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PIMECROLIMUS 1 % CREA 30 G TUBE,637,1 ,"$1,034.80 ",$682.97 ,$507.05 ,"$1,034.80 ", N/A ,$927.39 ,$927.39 , N/A ,$827.84 ,$879.58 ,$646.75 ,$931.32 , N/A , N/A ,$983.06 ,$931.32 ,$879.58 ,$879.58 , N/A ,$879.58 ,$879.58 ,$931.32 ,$630.19 , N/A , N/A , N/A ,$931.32 , N/A ,$952.02 ,$931.32 ,$683.07 ,$683.07 ,$630.19 ,$683.07 ,$672.62 ,$706.98 ,"$1,024.25 ",$817.49 , N/A ,$507.05 ,$507.05 , N/A ,$507.05 ,"$1,034.80 ",$983.06 ,$848.54 ,$848.54 ,$827.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PIOGLITAZONE 15 MG TABS,637,1 ,$23.85 ,$15.74 ,$11.69 ,$23.85 , N/A ,$21.37 ,$21.37 , N/A ,$19.08 ,$20.27 ,$14.91 ,$21.47 , N/A , N/A ,$22.66 ,$21.47 ,$20.27 ,$20.27 , N/A ,$20.27 ,$20.27 ,$21.47 ,$14.52 , N/A , N/A , N/A ,$21.47 , N/A ,$21.94 ,$21.47 ,$15.74 ,$15.74 ,$14.52 ,$15.74 ,$15.50 ,$16.29 ,$23.61 ,$18.84 , N/A ,$11.69 ,$11.69 , N/A ,$11.69 ,$23.85 ,$22.66 ,$19.56 ,$19.56 ,$19.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POLYVINYL ALCOHOL 1.4 % SOLN 15 ML BOTTLE,637,1 ,$25.20 ,$16.63 ,$12.35 ,$25.20 , N/A ,$22.58 ,$22.58 , N/A ,$20.16 ,$21.42 ,$15.75 ,$22.68 , N/A , N/A ,$23.94 ,$22.68 ,$21.42 ,$21.42 , N/A ,$21.42 ,$21.42 ,$22.68 ,$15.35 , N/A , N/A , N/A ,$22.68 , N/A ,$23.18 ,$22.68 ,$16.63 ,$16.63 ,$15.35 ,$16.63 ,$16.38 ,$17.22 ,$24.94 ,$19.91 , N/A ,$12.35 ,$12.35 , N/A ,$12.35 ,$25.20 ,$23.94 ,$20.66 ,$20.66 ,$20.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POSACONAZOLE 100 MG TBEC,637,1 ,$192.45 ,$127.02 ,$94.30 ,$192.45 , N/A ,$172.47 ,$172.47 , N/A ,$153.96 ,$163.58 ,$120.28 ,$173.21 , N/A , N/A ,$182.83 ,$173.21 ,$163.58 ,$163.58 , N/A ,$163.58 ,$163.58 ,$173.21 ,$117.20 , N/A , N/A , N/A ,$173.21 , N/A ,$177.05 ,$173.21 ,$127.04 ,$127.04 ,$117.20 ,$127.04 ,$125.09 ,$131.48 ,$190.48 ,$152.04 , N/A ,$94.30 ,$94.30 , N/A ,$94.30 ,$192.45 ,$182.83 ,$157.81 ,$157.81 ,$153.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POTASSIUM CHLORIDE 20 MEQ/15ML (10%) SOLN,637,1 ,$82.85 ,$54.68 ,$40.60 ,$82.85 , N/A ,$74.25 ,$74.25 , N/A ,$66.28 ,$70.42 ,$51.78 ,$74.57 , N/A , N/A ,$78.71 ,$74.57 ,$70.42 ,$70.42 , N/A ,$70.42 ,$70.42 ,$74.57 ,$50.46 , N/A , N/A , N/A ,$74.57 , N/A ,$76.22 ,$74.57 ,$54.69 ,$54.69 ,$50.46 ,$54.69 ,$53.85 ,$56.60 ,$82.01 ,$65.45 , N/A ,$40.60 ,$40.60 , N/A ,$40.60 ,$82.85 ,$78.71 ,$67.94 ,$67.94 ,$66.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POTASSIUM CITRATE CR 10 MEQ (1080 MG) TBCR,637,1 ,$9.85 ,$6.50 ,$4.83 ,$9.85 , N/A ,$8.83 ,$8.83 , N/A ,$7.88 ,$8.37 ,$6.16 ,$8.87 , N/A , N/A ,$9.36 ,$8.87 ,$8.37 ,$8.37 , N/A ,$8.37 ,$8.37 ,$8.87 ,$6.00 , N/A , N/A , N/A ,$8.87 , N/A ,$9.06 ,$8.87 ,$6.50 ,$6.50 ,$6.00 ,$6.50 ,$6.40 ,$6.73 ,$9.75 ,$7.78 , N/A ,$4.83 ,$4.83 , N/A ,$4.83 ,$9.85 ,$9.36 ,$8.08 ,$8.08 ,$7.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAMIPEXOLE 0.25 MG TABS,637,1 ,$10.00 ,$6.60 ,$4.90 ,$10.00 , N/A ,$8.96 ,$8.96 , N/A ,$8.00 ,$8.50 ,$6.25 ,$9.00 , N/A , N/A ,$9.50 ,$9.00 ,$8.50 ,$8.50 , N/A ,$8.50 ,$8.50 ,$9.00 ,$6.09 , N/A , N/A , N/A ,$9.00 , N/A ,$9.20 ,$9.00 ,$6.60 ,$6.60 ,$6.09 ,$6.60 ,$6.50 ,$6.83 ,$9.90 ,$7.90 , N/A ,$4.90 ,$4.90 , N/A ,$4.90 ,$10.00 ,$9.50 ,$8.20 ,$8.20 ,$8.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAMIPEXOLE 0.5 MG TABS,637,1 ,$10.05 ,$6.63 ,$4.92 ,$10.05 , N/A ,$9.01 ,$9.01 , N/A ,$8.04 ,$8.54 ,$6.28 ,$9.05 , N/A , N/A ,$9.55 ,$9.05 ,$8.54 ,$8.54 , N/A ,$8.54 ,$8.54 ,$9.05 ,$6.12 , N/A , N/A , N/A ,$9.05 , N/A ,$9.25 ,$9.05 ,$6.63 ,$6.63 ,$6.12 ,$6.63 ,$6.53 ,$6.87 ,$9.95 ,$7.94 , N/A ,$4.92 ,$4.92 , N/A ,$4.92 ,$10.05 ,$9.55 ,$8.24 ,$8.24 ,$8.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHENAMINE 1 G TABS,637,1 ,$10.05 ,$6.63 ,$4.92 ,$10.05 , N/A ,$9.01 ,$9.01 , N/A ,$8.04 ,$8.54 ,$6.28 ,$9.05 , N/A , N/A ,$9.55 ,$9.05 ,$8.54 ,$8.54 , N/A ,$8.54 ,$8.54 ,$9.05 ,$6.12 , N/A , N/A , N/A ,$9.05 , N/A ,$9.25 ,$9.05 ,$6.63 ,$6.63 ,$6.12 ,$6.63 ,$6.53 ,$6.87 ,$9.95 ,$7.94 , N/A ,$4.92 ,$4.92 , N/A ,$4.92 ,$10.05 ,$9.55 ,$8.24 ,$8.24 ,$8.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAMIPEXOLE 0.125 MG TABS,637,1 ,$10.05 ,$6.63 ,$4.92 ,$10.05 , N/A ,$9.01 ,$9.01 , N/A ,$8.04 ,$8.54 ,$6.28 ,$9.05 , N/A , N/A ,$9.55 ,$9.05 ,$8.54 ,$8.54 , N/A ,$8.54 ,$8.54 ,$9.05 ,$6.12 , N/A , N/A , N/A ,$9.05 , N/A ,$9.25 ,$9.05 ,$6.63 ,$6.63 ,$6.12 ,$6.63 ,$6.53 ,$6.87 ,$9.95 ,$7.94 , N/A ,$4.92 ,$4.92 , N/A ,$4.92 ,$10.05 ,$9.55 ,$8.24 ,$8.24 ,$8.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRASUGREL 10 MG TABS,637,1 ,$56.15 ,$37.06 ,$27.51 ,$56.15 , N/A ,$50.32 ,$50.32 , N/A ,$44.92 ,$47.73 ,$35.09 ,$50.54 , N/A , N/A ,$53.34 ,$50.54 ,$47.73 ,$47.73 , N/A ,$47.73 ,$47.73 ,$50.54 ,$34.20 , N/A , N/A , N/A ,$50.54 , N/A ,$51.66 ,$50.54 ,$37.06 ,$37.06 ,$34.20 ,$37.06 ,$36.50 ,$38.36 ,$55.58 ,$44.36 , N/A ,$27.51 ,$27.51 , N/A ,$27.51 ,$56.15 ,$53.34 ,$46.04 ,$46.04 ,$44.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAVASTATIN 10 MG TABS,637,1 ,$10.90 ,$7.19 ,$5.34 ,$10.90 , N/A ,$9.77 ,$9.77 , N/A ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 , N/A ,$9.27 ,$9.27 ,$9.81 ,$6.64 , N/A , N/A , N/A ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$10.79 ,$8.61 , N/A ,$5.34 ,$5.34 , N/A ,$5.34 ,$10.90 ,$10.36 ,$8.94 ,$8.94 ,$8.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAVASTATIN 20 MG TABS,637,1 ,$11.08 ,$7.31 ,$5.43 ,$11.08 , N/A ,$9.93 ,$9.93 , N/A ,$8.86 ,$9.42 ,$6.93 ,$9.97 , N/A , N/A ,$10.53 ,$9.97 ,$9.42 ,$9.42 , N/A ,$9.42 ,$9.42 ,$9.97 ,$6.75 , N/A , N/A , N/A ,$9.97 , N/A ,$10.19 ,$9.97 ,$7.31 ,$7.31 ,$6.75 ,$7.31 ,$7.20 ,$7.57 ,$10.97 ,$8.75 , N/A ,$5.43 ,$5.43 , N/A ,$5.43 ,$11.08 ,$10.53 ,$9.09 ,$9.09 ,$8.86 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PREDNISOLONE 15 MG/5ML SYRP,637,1 ,$14.05 ,$9.27 ,$6.88 ,$14.05 , N/A ,$12.59 ,$12.59 , N/A ,$11.24 ,$11.94 ,$8.78 ,$12.65 , N/A , N/A ,$13.35 ,$12.65 ,$11.94 ,$11.94 , N/A ,$11.94 ,$11.94 ,$12.65 ,$8.56 , N/A , N/A , N/A ,$12.65 , N/A ,$12.93 ,$12.65 ,$9.27 ,$9.27 ,$8.56 ,$9.27 ,$9.13 ,$9.60 ,$13.91 ,$11.10 , N/A ,$6.88 ,$6.88 , N/A ,$6.88 ,$14.05 ,$13.35 ,$11.52 ,$11.52 ,$11.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPHENHYDRAMINE-ZINC ACETATE 1-0.1 % CREA 28.3 G TUBE,637,1 ,$14.05 ,$9.27 ,$6.88 ,$14.05 , N/A ,$12.59 ,$12.59 , N/A ,$11.24 ,$11.94 ,$8.78 ,$12.65 , N/A , N/A ,$13.35 ,$12.65 ,$11.94 ,$11.94 , N/A ,$11.94 ,$11.94 ,$12.65 ,$8.56 , N/A , N/A , N/A ,$12.65 , N/A ,$12.93 ,$12.65 ,$9.27 ,$9.27 ,$8.56 ,$9.27 ,$9.13 ,$9.60 ,$13.91 ,$11.10 , N/A ,$6.88 ,$6.88 , N/A ,$6.88 ,$14.05 ,$13.35 ,$11.52 ,$11.52 ,$11.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PREGABALIN 25 MG CAPS,637,1 ,$36.80 ,$24.29 ,$18.03 ,$36.80 , N/A ,$32.98 ,$32.98 , N/A ,$29.44 ,$31.28 ,$23.00 ,$33.12 , N/A , N/A ,$34.96 ,$33.12 ,$31.28 ,$31.28 , N/A ,$31.28 ,$31.28 ,$33.12 ,$22.41 , N/A , N/A , N/A ,$33.12 , N/A ,$33.86 ,$33.12 ,$24.29 ,$24.29 ,$22.41 ,$24.29 ,$23.92 ,$25.14 ,$36.43 ,$29.07 , N/A ,$18.03 ,$18.03 , N/A ,$18.03 ,$36.80 ,$34.96 ,$30.18 ,$30.18 ,$29.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUTICASONE-SALMETEROL 115-21 MCG/ACT AERO,637,1 ,$36.80 ,$24.29 ,$18.03 ,$36.80 , N/A ,$32.98 ,$32.98 , N/A ,$29.44 ,$31.28 ,$23.00 ,$33.12 , N/A , N/A ,$34.96 ,$33.12 ,$31.28 ,$31.28 , N/A ,$31.28 ,$31.28 ,$33.12 ,$22.41 , N/A , N/A , N/A ,$33.12 , N/A ,$33.86 ,$33.12 ,$24.29 ,$24.29 ,$22.41 ,$24.29 ,$23.92 ,$25.14 ,$36.43 ,$29.07 , N/A ,$18.03 ,$18.03 , N/A ,$18.03 ,$36.80 ,$34.96 ,$30.18 ,$30.18 ,$29.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PREGABALIN 50 MG CAPS,637,1 ,$40.43 ,$26.68 ,$19.81 ,$40.43 , N/A ,$36.23 ,$36.23 , N/A ,$32.34 ,$34.37 ,$25.27 ,$36.39 , N/A , N/A ,$38.41 ,$36.39 ,$34.37 ,$34.37 , N/A ,$34.37 ,$34.37 ,$36.39 ,$24.62 , N/A , N/A , N/A ,$36.39 , N/A ,$37.20 ,$36.39 ,$26.69 ,$26.69 ,$24.62 ,$26.69 ,$26.28 ,$27.62 ,$40.01 ,$31.94 , N/A ,$19.81 ,$19.81 , N/A ,$19.81 ,$40.43 ,$38.41 ,$33.15 ,$33.15 ,$32.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PREGABALIN 100 MG CAPS,637,1 ,$40.43 ,$26.68 ,$19.81 ,$40.43 , N/A ,$36.23 ,$36.23 , N/A ,$32.34 ,$34.37 ,$25.27 ,$36.39 , N/A , N/A ,$38.41 ,$36.39 ,$34.37 ,$34.37 , N/A ,$34.37 ,$34.37 ,$36.39 ,$24.62 , N/A , N/A , N/A ,$36.39 , N/A ,$37.20 ,$36.39 ,$26.69 ,$26.69 ,$24.62 ,$26.69 ,$26.28 ,$27.62 ,$40.01 ,$31.94 , N/A ,$19.81 ,$19.81 , N/A ,$19.81 ,$40.43 ,$38.41 ,$33.15 ,$33.15 ,$32.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PREGABALIN 75 MG CAPS,637,1 ,$28.68 ,$18.93 ,$14.05 ,$28.68 , N/A ,$25.70 ,$25.70 , N/A ,$22.94 ,$24.38 ,$17.93 ,$25.81 , N/A , N/A ,$27.25 ,$25.81 ,$24.38 ,$24.38 , N/A ,$24.38 ,$24.38 ,$25.81 ,$17.47 , N/A , N/A , N/A ,$25.81 , N/A ,$26.39 ,$25.81 ,$18.93 ,$18.93 ,$17.47 ,$18.93 ,$18.64 ,$19.59 ,$28.39 ,$22.66 , N/A ,$14.05 ,$14.05 , N/A ,$14.05 ,$28.68 ,$27.25 ,$23.52 ,$23.52 ,$22.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROMETHAZINE 25 MG SUPP,637,1 ,$60.25 ,$39.77 ,$29.52 ,$60.25 , N/A ,$54.00 ,$54.00 , N/A ,$48.20 ,$51.21 ,$37.66 ,$54.23 , N/A , N/A ,$57.24 ,$54.23 ,$51.21 ,$51.21 , N/A ,$51.21 ,$51.21 ,$54.23 ,$36.69 , N/A , N/A , N/A ,$54.23 , N/A ,$55.43 ,$54.23 ,$39.77 ,$39.77 ,$36.69 ,$39.77 ,$39.16 ,$41.16 ,$59.63 ,$47.60 , N/A ,$29.52 ,$29.52 , N/A ,$29.52 ,$60.25 ,$57.24 ,$49.41 ,$49.41 ,$48.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROPAFENONE SR 225 MG CP12,637,1 ,$33.05 ,$21.81 ,$16.19 ,$33.05 , N/A ,$29.62 ,$29.62 , N/A ,$26.44 ,$28.09 ,$20.66 ,$29.75 , N/A , N/A ,$31.40 ,$29.75 ,$28.09 ,$28.09 , N/A ,$28.09 ,$28.09 ,$29.75 ,$20.13 , N/A , N/A , N/A ,$29.75 , N/A ,$30.41 ,$29.75 ,$21.82 ,$21.82 ,$20.13 ,$21.82 ,$21.48 ,$22.58 ,$32.71 ,$26.11 , N/A ,$16.19 ,$16.19 , N/A ,$16.19 ,$33.05 ,$31.40 ,$27.10 ,$27.10 ,$26.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ARTIFICIAL TEARS 83-15 % OINT 3.5 G TUBE,637,1 ,$33.05 ,$21.81 ,$16.19 ,$33.05 , N/A ,$29.62 ,$29.62 , N/A ,$26.44 ,$28.09 ,$20.66 ,$29.75 , N/A , N/A ,$31.40 ,$29.75 ,$28.09 ,$28.09 , N/A ,$28.09 ,$28.09 ,$29.75 ,$20.13 , N/A , N/A , N/A ,$29.75 , N/A ,$30.41 ,$29.75 ,$21.82 ,$21.82 ,$20.13 ,$21.82 ,$21.48 ,$22.58 ,$32.71 ,$26.11 , N/A ,$16.19 ,$16.19 , N/A ,$16.19 ,$33.05 ,$31.40 ,$27.10 ,$27.10 ,$26.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROPRANOLOL LA 80 MG CP24,637,1 ,$8.35 ,$5.51 ,$4.09 ,$8.35 , N/A ,$7.48 ,$7.48 , N/A ,$6.68 ,$7.10 ,$5.22 ,$7.52 , N/A , N/A ,$7.93 ,$7.52 ,$7.10 ,$7.10 , N/A ,$7.10 ,$7.10 ,$7.52 ,$5.09 , N/A , N/A , N/A ,$7.52 , N/A ,$7.68 ,$7.52 ,$5.51 ,$5.51 ,$5.09 ,$5.51 ,$5.43 ,$5.70 ,$8.26 ,$6.60 , N/A ,$4.09 ,$4.09 , N/A ,$4.09 ,$8.35 ,$7.93 ,$6.85 ,$6.85 ,$6.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIVALPROEX ER 250 MG TB24,637,1 ,$8.35 ,$5.51 ,$4.09 ,$8.35 , N/A ,$7.48 ,$7.48 , N/A ,$6.68 ,$7.10 ,$5.22 ,$7.52 , N/A , N/A ,$7.93 ,$7.52 ,$7.10 ,$7.10 , N/A ,$7.10 ,$7.10 ,$7.52 ,$5.09 , N/A , N/A , N/A ,$7.52 , N/A ,$7.68 ,$7.52 ,$5.51 ,$5.51 ,$5.09 ,$5.51 ,$5.43 ,$5.70 ,$8.26 ,$6.60 , N/A ,$4.09 ,$4.09 , N/A ,$4.09 ,$8.35 ,$7.93 ,$6.85 ,$6.85 ,$6.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROPYLTHIOURACIL 50 MG TABS,637,1 ,$11.45 ,$7.56 ,$5.61 ,$11.45 , N/A ,$10.26 ,$10.26 , N/A ,$9.16 ,$9.73 ,$7.16 ,$10.31 , N/A , N/A ,$10.88 ,$10.31 ,$9.73 ,$9.73 , N/A ,$9.73 ,$9.73 ,$10.31 ,$6.97 , N/A , N/A , N/A ,$10.31 , N/A ,$10.53 ,$10.31 ,$7.56 ,$7.56 ,$6.97 ,$7.56 ,$7.44 ,$7.82 ,$11.33 ,$9.05 , N/A ,$5.61 ,$5.61 , N/A ,$5.61 ,$11.45 ,$10.88 ,$9.39 ,$9.39 ,$9.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PYRAZINAMIDE 500 MG TABS,637,1 ,$26.20 ,$17.29 ,$12.84 ,$26.20 , N/A ,$23.48 ,$23.48 , N/A ,$20.96 ,$22.27 ,$16.38 ,$23.58 , N/A , N/A ,$24.89 ,$23.58 ,$22.27 ,$22.27 , N/A ,$22.27 ,$22.27 ,$23.58 ,$15.96 , N/A , N/A , N/A ,$23.58 , N/A ,$24.10 ,$23.58 ,$17.29 ,$17.29 ,$15.96 ,$17.29 ,$17.03 ,$17.90 ,$25.93 ,$20.70 , N/A ,$12.84 ,$12.84 , N/A ,$12.84 ,$26.20 ,$24.89 ,$21.48 ,$21.48 ,$20.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,QUETIAPINE 100 MG TABS,637,1 ,$23.35 ,$15.41 ,$11.44 ,$23.35 , N/A ,$20.93 ,$20.93 , N/A ,$18.68 ,$19.85 ,$14.59 ,$21.02 , N/A , N/A ,$22.18 ,$21.02 ,$19.85 ,$19.85 , N/A ,$19.85 ,$19.85 ,$21.02 ,$14.22 , N/A , N/A , N/A ,$21.02 , N/A ,$21.48 ,$21.02 ,$15.41 ,$15.41 ,$14.22 ,$15.41 ,$15.18 ,$15.95 ,$23.11 ,$18.45 , N/A ,$11.44 ,$11.44 , N/A ,$11.44 ,$23.35 ,$22.18 ,$19.15 ,$19.15 ,$18.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,QUETIAPINE 25 MG TABS,637,1 ,$12.85 ,$8.48 ,$6.30 ,$12.85 , N/A ,$11.52 ,$11.52 , N/A ,$10.28 ,$10.92 ,$8.03 ,$11.57 , N/A , N/A ,$12.21 ,$11.57 ,$10.92 ,$10.92 , N/A ,$10.92 ,$10.92 ,$11.57 ,$7.83 , N/A , N/A , N/A ,$11.57 , N/A ,$11.82 ,$11.57 ,$8.48 ,$8.48 ,$7.83 ,$8.48 ,$8.35 ,$8.78 ,$12.72 ,$10.15 , N/A ,$6.30 ,$6.30 , N/A ,$6.30 ,$12.85 ,$12.21 ,$10.54 ,$10.54 ,$10.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITROFURANTOIN (MACROCRYSTAL-MONOHYDRATE) 100 MG CAPS,637,1 ,$12.85 ,$8.48 ,$6.30 ,$12.85 , N/A ,$11.52 ,$11.52 , N/A ,$10.28 ,$10.92 ,$8.03 ,$11.57 , N/A , N/A ,$12.21 ,$11.57 ,$10.92 ,$10.92 , N/A ,$10.92 ,$10.92 ,$11.57 ,$7.83 , N/A , N/A , N/A ,$11.57 , N/A ,$11.82 ,$11.57 ,$8.48 ,$8.48 ,$7.83 ,$8.48 ,$8.35 ,$8.78 ,$12.72 ,$10.15 , N/A ,$6.30 ,$6.30 , N/A ,$6.30 ,$12.85 ,$12.21 ,$10.54 ,$10.54 ,$10.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,QUETIAPINE 300 MG TABS,637,1 ,$57.70 ,$38.08 ,$28.27 ,$57.70 , N/A ,$51.71 ,$51.71 , N/A ,$46.16 ,$49.05 ,$36.06 ,$51.93 , N/A , N/A ,$54.82 ,$51.93 ,$49.05 ,$49.05 , N/A ,$49.05 ,$49.05 ,$51.93 ,$35.14 , N/A , N/A , N/A ,$51.93 , N/A ,$53.08 ,$51.93 ,$38.09 ,$38.09 ,$35.14 ,$38.09 ,$37.51 ,$39.42 ,$57.11 ,$45.58 , N/A ,$28.27 ,$28.27 , N/A ,$28.27 ,$57.70 ,$54.82 ,$47.31 ,$47.31 ,$46.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,QUETIAPINE XR 50 MG TB24,637,1 ,$30.20 ,$19.93 ,$14.80 ,$30.20 , N/A ,$27.07 ,$27.07 , N/A ,$24.16 ,$25.67 ,$18.88 ,$27.18 , N/A , N/A ,$28.69 ,$27.18 ,$25.67 ,$25.67 , N/A ,$25.67 ,$25.67 ,$27.18 ,$18.39 , N/A , N/A , N/A ,$27.18 , N/A ,$27.78 ,$27.18 ,$19.94 ,$19.94 ,$18.39 ,$19.94 ,$19.63 ,$20.63 ,$29.89 ,$23.86 , N/A ,$14.80 ,$14.80 , N/A ,$14.80 ,$30.20 ,$28.69 ,$24.76 ,$24.76 ,$24.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RALOXIFENE 60 MG TABS,637,1 ,$24.25 ,$16.01 ,$11.88 ,$24.25 , N/A ,$21.73 ,$21.73 , N/A ,$19.40 ,$20.61 ,$15.16 ,$21.83 , N/A , N/A ,$23.04 ,$21.83 ,$20.61 ,$20.61 , N/A ,$20.61 ,$20.61 ,$21.83 ,$14.77 , N/A , N/A , N/A ,$21.83 , N/A ,$22.31 ,$21.83 ,$16.01 ,$16.01 ,$14.77 ,$16.01 ,$15.76 ,$16.57 ,$24.00 ,$19.16 , N/A ,$11.88 ,$11.88 , N/A ,$11.88 ,$24.25 ,$23.04 ,$19.89 ,$19.89 ,$19.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIFAXIMIN 200 MG TABS,637,1 ,$39.35 ,$25.97 ,$19.28 ,$39.35 , N/A ,$35.27 ,$35.27 , N/A ,$31.48 ,$33.45 ,$24.59 ,$35.42 , N/A , N/A ,$37.38 ,$35.42 ,$33.45 ,$33.45 , N/A ,$33.45 ,$33.45 ,$35.42 ,$23.96 , N/A , N/A , N/A ,$35.42 , N/A ,$36.20 ,$35.42 ,$25.97 ,$25.97 ,$23.96 ,$25.97 ,$25.58 ,$26.88 ,$38.95 ,$31.09 , N/A ,$19.28 ,$19.28 , N/A ,$19.28 ,$39.35 ,$37.38 ,$32.27 ,$32.27 ,$31.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIFAXIMIN 550 MG TABS,637,1 ,$202.35 ,$133.55 ,$99.15 ,$202.35 , N/A ,$181.35 ,$181.35 , N/A ,$161.88 ,$172.00 ,$126.47 ,$182.12 , N/A , N/A ,$192.23 ,$182.12 ,$172.00 ,$172.00 , N/A ,$172.00 ,$172.00 ,$182.12 ,$123.23 , N/A , N/A , N/A ,$182.12 , N/A ,$186.16 ,$182.12 ,$133.57 ,$133.57 ,$123.23 ,$133.57 ,$131.53 ,$138.25 ,$200.28 ,$159.86 , N/A ,$99.15 ,$99.15 , N/A ,$99.15 ,$202.35 ,$192.23 ,$165.93 ,$165.93 ,$161.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RILUZOLE 50 MG TABS,637,1 ,$125.60 ,$82.90 ,$61.54 ,$125.60 , N/A ,$112.56 ,$112.56 , N/A ,$100.48 ,$106.76 ,$78.50 ,$113.04 , N/A , N/A ,$119.32 ,$113.04 ,$106.76 ,$106.76 , N/A ,$106.76 ,$106.76 ,$113.04 ,$76.49 , N/A , N/A , N/A ,$113.04 , N/A ,$115.55 ,$113.04 ,$82.91 ,$82.91 ,$76.49 ,$82.91 ,$81.64 ,$85.81 ,$124.32 ,$99.22 , N/A ,$61.54 ,$61.54 , N/A ,$61.54 ,$125.60 ,$119.32 ,$102.99 ,$102.99 ,$100.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RISPERIDONE 0.25 MG TABS,637,1 ,$13.25 ,$8.75 ,$6.49 ,$13.25 , N/A ,$11.87 ,$11.87 , N/A ,$10.60 ,$11.26 ,$8.28 ,$11.93 , N/A , N/A ,$12.59 ,$11.93 ,$11.26 ,$11.26 , N/A ,$11.26 ,$11.26 ,$11.93 ,$8.07 , N/A , N/A , N/A ,$11.93 , N/A ,$12.19 ,$11.93 ,$8.75 ,$8.75 ,$8.07 ,$8.75 ,$8.61 ,$9.05 ,$13.11 ,$10.47 , N/A ,$6.49 ,$6.49 , N/A ,$6.49 ,$13.25 ,$12.59 ,$10.87 ,$10.87 ,$10.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RISPERIDONE 1 MG TABS,637,1 ,$15.55 ,$10.26 ,$7.62 ,$15.55 , N/A ,$13.94 ,$13.94 , N/A ,$12.44 ,$13.22 ,$9.72 ,$14.00 , N/A , N/A ,$14.77 ,$14.00 ,$13.22 ,$13.22 , N/A ,$13.22 ,$13.22 ,$14.00 ,$9.47 , N/A , N/A , N/A ,$14.00 , N/A ,$14.31 ,$14.00 ,$10.26 ,$10.26 ,$9.47 ,$10.26 ,$10.11 ,$10.62 ,$15.40 ,$12.28 , N/A ,$7.62 ,$7.62 , N/A ,$7.62 ,$15.55 ,$14.77 ,$12.75 ,$12.75 ,$12.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ESCITALOPRAM 20 MG TABS,637,1 ,$15.55 ,$10.26 ,$7.62 ,$15.55 , N/A ,$13.94 ,$13.94 , N/A ,$12.44 ,$13.22 ,$9.72 ,$14.00 , N/A , N/A ,$14.77 ,$14.00 ,$13.22 ,$13.22 , N/A ,$13.22 ,$13.22 ,$14.00 ,$9.47 , N/A , N/A , N/A ,$14.00 , N/A ,$14.31 ,$14.00 ,$10.26 ,$10.26 ,$9.47 ,$10.26 ,$10.11 ,$10.62 ,$15.40 ,$12.28 , N/A ,$7.62 ,$7.62 , N/A ,$7.62 ,$15.55 ,$14.77 ,$12.75 ,$12.75 ,$12.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIVAROXABAN 15 MG TABS,637,1 ,$70.30 ,$46.40 ,$34.45 ,$70.30 , N/A ,$63.00 ,$63.00 , N/A ,$56.24 ,$59.76 ,$43.94 ,$63.27 , N/A , N/A ,$66.79 ,$63.27 ,$59.76 ,$59.76 , N/A ,$59.76 ,$59.76 ,$63.27 ,$42.81 , N/A , N/A , N/A ,$63.27 , N/A ,$64.68 ,$63.27 ,$46.41 ,$46.41 ,$42.81 ,$46.41 ,$45.70 ,$48.03 ,$69.58 ,$55.54 , N/A ,$34.45 ,$34.45 , N/A ,$34.45 ,$70.30 ,$66.79 ,$57.65 ,$57.65 ,$56.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIVAROXABAN 10 MG TABS,637,1 ,$70.30 ,$46.40 ,$34.45 ,$70.30 , N/A ,$63.00 ,$63.00 , N/A ,$56.24 ,$59.76 ,$43.94 ,$63.27 , N/A , N/A ,$66.79 ,$63.27 ,$59.76 ,$59.76 , N/A ,$59.76 ,$59.76 ,$63.27 ,$42.81 , N/A , N/A , N/A ,$63.27 , N/A ,$64.68 ,$63.27 ,$46.41 ,$46.41 ,$42.81 ,$46.41 ,$45.70 ,$48.03 ,$69.58 ,$55.54 , N/A ,$34.45 ,$34.45 , N/A ,$34.45 ,$70.30 ,$66.79 ,$57.65 ,$57.65 ,$56.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIVASTIGMINE 1.5 MG CAPS,637,1 ,$15.90 ,$10.49 ,$7.79 ,$15.90 , N/A ,$14.25 ,$14.25 , N/A ,$12.72 ,$13.52 ,$9.94 ,$14.31 , N/A , N/A ,$15.11 ,$14.31 ,$13.52 ,$13.52 , N/A ,$13.52 ,$13.52 ,$14.31 ,$9.68 , N/A , N/A , N/A ,$14.31 , N/A ,$14.63 ,$14.31 ,$10.50 ,$10.50 ,$9.68 ,$10.50 ,$10.34 ,$10.86 ,$15.74 ,$12.56 , N/A ,$7.79 ,$7.79 , N/A ,$7.79 ,$15.90 ,$15.11 ,$13.04 ,$13.04 ,$12.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIVASTIGMINE 4.6 MG/24HR PT24,637,1 ,$93.30 ,$61.58 ,$45.72 ,$93.30 , N/A ,$83.62 ,$83.62 , N/A ,$74.64 ,$79.31 ,$58.31 ,$83.97 , N/A , N/A ,$88.64 ,$83.97 ,$79.31 ,$79.31 , N/A ,$79.31 ,$79.31 ,$83.97 ,$56.82 , N/A , N/A , N/A ,$83.97 , N/A ,$85.84 ,$83.97 ,$61.59 ,$61.59 ,$56.82 ,$61.59 ,$60.65 ,$63.74 ,$92.35 ,$73.71 , N/A ,$45.72 ,$45.72 , N/A ,$45.72 ,$93.30 ,$88.64 ,$76.51 ,$76.51 ,$74.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIVASTIGMINE 13.3 MG/24HR PT24,637,1 ,$93.30 ,$61.58 ,$45.72 ,$93.30 , N/A ,$83.62 ,$83.62 , N/A ,$74.64 ,$79.31 ,$58.31 ,$83.97 , N/A , N/A ,$88.64 ,$83.97 ,$79.31 ,$79.31 , N/A ,$79.31 ,$79.31 ,$83.97 ,$56.82 , N/A , N/A , N/A ,$83.97 , N/A ,$85.84 ,$83.97 ,$61.59 ,$61.59 ,$56.82 ,$61.59 ,$60.65 ,$63.74 ,$92.35 ,$73.71 , N/A ,$45.72 ,$45.72 , N/A ,$45.72 ,$93.30 ,$88.64 ,$76.51 ,$76.51 ,$74.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIVASTIGMINE 9.5 MG/24HR PT24,637,1 ,$57.45 ,$37.92 ,$28.15 ,$57.45 , N/A ,$51.49 ,$51.49 , N/A ,$45.96 ,$48.83 ,$35.91 ,$51.71 , N/A , N/A ,$54.58 ,$51.71 ,$48.83 ,$48.83 , N/A ,$48.83 ,$48.83 ,$51.71 ,$34.99 , N/A , N/A , N/A ,$51.71 , N/A ,$52.85 ,$51.71 ,$37.92 ,$37.92 ,$34.99 ,$37.92 ,$37.34 ,$39.25 ,$56.86 ,$45.39 , N/A ,$28.15 ,$28.15 , N/A ,$28.15 ,$57.45 ,$54.58 ,$47.11 ,$47.11 ,$45.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIZATRIPTAN 5 MG TBDP,637,1 ,$113.10 ,$74.65 ,$55.42 ,$113.10 , N/A ,$101.36 ,$101.36 , N/A ,$90.48 ,$96.14 ,$70.69 ,$101.79 , N/A , N/A ,$107.45 ,$101.79 ,$96.14 ,$96.14 , N/A ,$96.14 ,$96.14 ,$101.79 ,$68.88 , N/A , N/A , N/A ,$101.79 , N/A ,$104.05 ,$101.79 ,$74.66 ,$74.66 ,$68.88 ,$74.66 ,$73.52 ,$77.27 ,$111.95 ,$89.35 , N/A ,$55.42 ,$55.42 , N/A ,$55.42 ,$113.10 ,$107.45 ,$92.74 ,$92.74 ,$90.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ROFLUMILAST 500 MCG TABS,637,1 ,$56.90 ,$37.55 ,$27.88 ,$56.90 , N/A ,$50.99 ,$50.99 , N/A ,$45.52 ,$48.37 ,$35.56 ,$51.21 , N/A , N/A ,$54.06 ,$51.21 ,$48.37 ,$48.37 , N/A ,$48.37 ,$48.37 ,$51.21 ,$34.65 , N/A , N/A , N/A ,$51.21 , N/A ,$52.35 ,$51.21 ,$37.56 ,$37.56 ,$34.65 ,$37.56 ,$36.99 ,$38.87 ,$56.32 ,$44.95 , N/A ,$27.88 ,$27.88 , N/A ,$27.88 ,$56.90 ,$54.06 ,$46.66 ,$46.66 ,$45.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ROPINIROLE 0.5 MG TABS,637,1 ,$8.50 ,$5.61 ,$4.17 ,$8.50 , N/A ,$7.62 ,$7.62 , N/A ,$6.80 ,$7.23 ,$5.31 ,$7.65 , N/A , N/A ,$8.08 ,$7.65 ,$7.23 ,$7.23 , N/A ,$7.23 ,$7.23 ,$7.65 ,$5.18 , N/A , N/A , N/A ,$7.65 , N/A ,$7.82 ,$7.65 ,$5.61 ,$5.61 ,$5.18 ,$5.61 ,$5.53 ,$5.81 ,$8.42 ,$6.72 , N/A ,$4.17 ,$4.17 , N/A ,$4.17 ,$8.50 ,$8.08 ,$6.97 ,$6.97 ,$6.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GUAIFENESIN-DEXTROMETHORPHAN 100-10 MG/5ML SYRP,637,1 ,$8.50 ,$5.61 ,$4.17 ,$8.50 , N/A ,$7.62 ,$7.62 , N/A ,$6.80 ,$7.23 ,$5.31 ,$7.65 , N/A , N/A ,$8.08 ,$7.65 ,$7.23 ,$7.23 , N/A ,$7.23 ,$7.23 ,$7.65 ,$5.18 , N/A , N/A , N/A ,$7.65 , N/A ,$7.82 ,$7.65 ,$5.61 ,$5.61 ,$5.18 ,$5.61 ,$5.53 ,$5.81 ,$8.42 ,$6.72 , N/A ,$4.17 ,$4.17 , N/A ,$4.17 ,$8.50 ,$8.08 ,$6.97 ,$6.97 ,$6.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CETIRIZINE 10 MG TABS,637,1 ,$8.50 ,$5.61 ,$4.17 ,$8.50 , N/A ,$7.62 ,$7.62 , N/A ,$6.80 ,$7.23 ,$5.31 ,$7.65 , N/A , N/A ,$8.08 ,$7.65 ,$7.23 ,$7.23 , N/A ,$7.23 ,$7.23 ,$7.65 ,$5.18 , N/A , N/A , N/A ,$7.65 , N/A ,$7.82 ,$7.65 ,$5.61 ,$5.61 ,$5.18 ,$5.61 ,$5.53 ,$5.81 ,$8.42 ,$6.72 , N/A ,$4.17 ,$4.17 , N/A ,$4.17 ,$8.50 ,$8.08 ,$6.97 ,$6.97 ,$6.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5ML SYRP,637,1 ,$8.50 ,$5.61 ,$4.17 ,$8.50 , N/A ,$7.62 ,$7.62 , N/A ,$6.80 ,$7.23 ,$5.31 ,$7.65 , N/A , N/A ,$8.08 ,$7.65 ,$7.23 ,$7.23 , N/A ,$7.23 ,$7.23 ,$7.65 ,$5.18 , N/A , N/A , N/A ,$7.65 , N/A ,$7.82 ,$7.65 ,$5.61 ,$5.61 ,$5.18 ,$5.61 ,$5.53 ,$5.81 ,$8.42 ,$6.72 , N/A ,$4.17 ,$4.17 , N/A ,$4.17 ,$8.50 ,$8.08 ,$6.97 ,$6.97 ,$6.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ROPINIROLE XL 2 MG TB24,637,1 ,$9.30 ,$6.14 ,$4.56 ,$9.30 , N/A ,$8.33 ,$8.33 , N/A ,$7.44 ,$7.91 ,$5.81 ,$8.37 , N/A , N/A ,$8.84 ,$8.37 ,$7.91 ,$7.91 , N/A ,$7.91 ,$7.91 ,$8.37 ,$5.66 , N/A , N/A , N/A ,$8.37 , N/A ,$8.56 ,$8.37 ,$6.14 ,$6.14 ,$5.66 ,$6.14 ,$6.05 ,$6.35 ,$9.20 ,$7.35 , N/A ,$4.56 ,$4.56 , N/A ,$4.56 ,$9.30 ,$8.84 ,$7.63 ,$7.63 ,$7.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ROSUVASTATIN 10 MG TABS,637,1 ,$24.30 ,$16.04 ,$11.91 ,$24.30 , N/A ,$21.78 ,$21.78 , N/A ,$19.44 ,$20.66 ,$15.19 ,$21.87 , N/A , N/A ,$23.09 ,$21.87 ,$20.66 ,$20.66 , N/A ,$20.66 ,$20.66 ,$21.87 ,$14.80 , N/A , N/A , N/A ,$21.87 , N/A ,$22.36 ,$21.87 ,$16.04 ,$16.04 ,$14.80 ,$16.04 ,$15.80 ,$16.60 ,$24.05 ,$19.20 , N/A ,$11.91 ,$11.91 , N/A ,$11.91 ,$24.30 ,$23.09 ,$19.93 ,$19.93 ,$19.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SACUBITRIL-VALSARTAN 24-26 MG TABS,637,1 ,$43.26 ,$28.55 ,$21.20 ,$43.26 , N/A ,$38.77 ,$38.77 , N/A ,$34.61 ,$36.77 ,$27.04 ,$38.93 , N/A , N/A ,$41.10 ,$38.93 ,$36.77 ,$36.77 , N/A ,$36.77 ,$36.77 ,$38.93 ,$26.35 , N/A , N/A , N/A ,$38.93 , N/A ,$39.80 ,$38.93 ,$28.56 ,$28.56 ,$26.35 ,$28.56 ,$28.12 ,$29.56 ,$42.82 ,$34.18 , N/A ,$21.20 ,$21.20 , N/A ,$21.20 ,$43.26 ,$41.10 ,$35.47 ,$35.47 ,$34.61 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SALIVA SUBSTITUTE SOLN 120 ML BOTTLE,637,1 ,$34.70 ,$22.90 ,$17.00 ,$34.70 , N/A ,$31.10 ,$31.10 , N/A ,$27.76 ,$29.50 ,$21.69 ,$31.23 , N/A , N/A ,$32.97 ,$31.23 ,$29.50 ,$29.50 , N/A ,$29.50 ,$29.50 ,$31.23 ,$21.13 , N/A , N/A , N/A ,$31.23 , N/A ,$31.92 ,$31.23 ,$22.91 ,$22.91 ,$21.13 ,$22.91 ,$22.56 ,$23.71 ,$34.35 ,$27.41 , N/A ,$17.00 ,$17.00 , N/A ,$17.00 ,$34.70 ,$32.97 ,$28.45 ,$28.45 ,$27.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SELEGILINE 5 MG TABS,637,1 ,$10.10 ,$6.67 ,$4.95 ,$10.10 , N/A ,$9.05 ,$9.05 , N/A ,$8.08 ,$8.59 ,$6.31 ,$9.09 , N/A , N/A ,$9.60 ,$9.09 ,$8.59 ,$8.59 , N/A ,$8.59 ,$8.59 ,$9.09 ,$6.15 , N/A , N/A , N/A ,$9.09 , N/A ,$9.29 ,$9.09 ,$6.67 ,$6.67 ,$6.15 ,$6.67 ,$6.57 ,$6.90 ,$10.00 ,$7.98 , N/A ,$4.95 ,$4.95 , N/A ,$4.95 ,$10.10 ,$9.60 ,$8.28 ,$8.28 ,$8.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENYLEPHRINE-MINERAL OIL-PETROLATUM 0.25-14-74.9 % OINT 57 G TUBE,637,1 ,$10.10 ,$6.67 ,$4.95 ,$10.10 , N/A ,$9.05 ,$9.05 , N/A ,$8.08 ,$8.59 ,$6.31 ,$9.09 , N/A , N/A ,$9.60 ,$9.09 ,$8.59 ,$8.59 , N/A ,$8.59 ,$8.59 ,$9.09 ,$6.15 , N/A , N/A , N/A ,$9.09 , N/A ,$9.29 ,$9.09 ,$6.67 ,$6.67 ,$6.15 ,$6.67 ,$6.57 ,$6.90 ,$10.00 ,$7.98 , N/A ,$4.95 ,$4.95 , N/A ,$4.95 ,$10.10 ,$9.60 ,$8.28 ,$8.28 ,$8.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SERTRALINE 100 MG TABS,637,1 ,$9.70 ,$6.40 ,$4.75 ,$9.70 , N/A ,$8.69 ,$8.69 , N/A ,$7.76 ,$8.25 ,$6.06 ,$8.73 , N/A , N/A ,$9.22 ,$8.73 ,$8.25 ,$8.25 , N/A ,$8.25 ,$8.25 ,$8.73 ,$5.91 , N/A , N/A , N/A ,$8.73 , N/A ,$8.92 ,$8.73 ,$6.40 ,$6.40 ,$5.91 ,$6.40 ,$6.31 ,$6.63 ,$9.60 ,$7.66 , N/A ,$4.75 ,$4.75 , N/A ,$4.75 ,$9.70 ,$9.22 ,$7.95 ,$7.95 ,$7.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SERTRALINE 50 MG TABS,637,1 ,$9.69 ,$6.40 ,$4.75 ,$9.69 , N/A ,$8.68 ,$8.68 , N/A ,$7.75 ,$8.24 ,$6.06 ,$8.72 , N/A , N/A ,$9.21 ,$8.72 ,$8.24 ,$8.24 , N/A ,$8.24 ,$8.24 ,$8.72 ,$5.90 , N/A , N/A , N/A ,$8.72 , N/A ,$8.91 ,$8.72 ,$6.40 ,$6.40 ,$5.90 ,$6.40 ,$6.30 ,$6.62 ,$9.59 ,$7.66 , N/A ,$4.75 ,$4.75 , N/A ,$4.75 ,$9.69 ,$9.21 ,$7.95 ,$7.95 ,$7.75 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SEVELAMER CARBONATE 800 MG TABS,637,1 ,$22.25 ,$14.69 ,$10.90 ,$22.25 , N/A ,$19.94 ,$19.94 , N/A ,$17.80 ,$18.91 ,$13.91 ,$20.03 , N/A , N/A ,$21.14 ,$20.03 ,$18.91 ,$18.91 , N/A ,$18.91 ,$18.91 ,$20.03 ,$13.55 , N/A , N/A , N/A ,$20.03 , N/A ,$20.47 ,$20.03 ,$14.69 ,$14.69 ,$13.55 ,$14.69 ,$14.46 ,$15.20 ,$22.02 ,$17.58 , N/A ,$10.90 ,$10.90 , N/A ,$10.90 ,$22.25 ,$21.14 ,$18.25 ,$18.25 ,$17.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SILDENAFIL 20 MG TABS,637,1 ,$68.80 ,$45.41 ,$33.71 ,$68.80 , N/A ,$61.66 ,$61.66 , N/A ,$55.04 ,$58.48 ,$43.00 ,$61.92 , N/A , N/A ,$65.36 ,$61.92 ,$58.48 ,$58.48 , N/A ,$58.48 ,$58.48 ,$61.92 ,$41.90 , N/A , N/A , N/A ,$61.92 , N/A ,$63.30 ,$61.92 ,$45.41 ,$45.41 ,$41.90 ,$45.41 ,$44.72 ,$47.00 ,$68.10 ,$54.35 , N/A ,$33.71 ,$33.71 , N/A ,$33.71 ,$68.80 ,$65.36 ,$56.42 ,$56.42 ,$55.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SILODOSIN 4 MG CAPS,637,1 ,$31.80 ,$20.99 ,$15.58 ,$31.80 , N/A ,$28.50 ,$28.50 , N/A ,$25.44 ,$27.03 ,$19.88 ,$28.62 , N/A , N/A ,$30.21 ,$28.62 ,$27.03 ,$27.03 , N/A ,$27.03 ,$27.03 ,$28.62 ,$19.37 , N/A , N/A , N/A ,$28.62 , N/A ,$29.26 ,$28.62 ,$20.99 ,$20.99 ,$19.37 ,$20.99 ,$20.67 ,$21.73 ,$31.48 ,$25.12 , N/A ,$15.58 ,$15.58 , N/A ,$15.58 ,$31.80 ,$30.21 ,$26.08 ,$26.08 ,$25.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SILVER SULFADIAZINE 1 % CREA 25 G TUBE,637,1 ,$30.60 ,$20.20 ,$14.99 ,$30.60 , N/A ,$27.42 ,$27.42 , N/A ,$24.48 ,$26.01 ,$19.13 ,$27.54 , N/A , N/A ,$29.07 ,$27.54 ,$26.01 ,$26.01 , N/A ,$26.01 ,$26.01 ,$27.54 ,$18.64 , N/A , N/A , N/A ,$27.54 , N/A ,$28.15 ,$27.54 ,$20.20 ,$20.20 ,$18.64 ,$20.20 ,$19.89 ,$20.91 ,$30.29 ,$24.17 , N/A ,$14.99 ,$14.99 , N/A ,$14.99 ,$30.60 ,$29.07 ,$25.09 ,$25.09 ,$24.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SILVER SULFADIAZINE 1 % CREA 50 G JAR,637,1 ,$51.35 ,$33.89 ,$25.16 ,$51.35 , N/A ,$46.02 ,$46.02 , N/A ,$41.08 ,$43.65 ,$32.09 ,$46.22 , N/A , N/A ,$48.78 ,$46.22 ,$43.65 ,$43.65 , N/A ,$43.65 ,$43.65 ,$46.22 ,$31.27 , N/A , N/A , N/A ,$46.22 , N/A ,$47.24 ,$46.22 ,$33.90 ,$33.90 ,$31.27 ,$33.90 ,$33.38 ,$35.08 ,$50.82 ,$40.57 , N/A ,$25.16 ,$25.16 , N/A ,$25.16 ,$51.35 ,$48.78 ,$42.11 ,$42.11 ,$41.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SILVER SULFADIAZINE 1 % CREA 50 G TUBE,637,1 ,$50.70 ,$33.46 ,$24.84 ,$50.70 , N/A ,$45.44 ,$45.44 , N/A ,$40.56 ,$43.10 ,$31.69 ,$45.63 , N/A , N/A ,$48.17 ,$45.63 ,$43.10 ,$43.10 , N/A ,$43.10 ,$43.10 ,$45.63 ,$30.88 , N/A , N/A , N/A ,$45.63 , N/A ,$46.64 ,$45.63 ,$33.47 ,$33.47 ,$30.88 ,$33.47 ,$32.96 ,$34.64 ,$50.19 ,$40.05 , N/A ,$24.84 ,$24.84 , N/A ,$24.84 ,$50.70 ,$48.17 ,$41.57 ,$41.57 ,$40.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SIMVASTATIN 10 MG TABS,637,1 ,$9.50 ,$6.27 ,$4.66 ,$9.50 , N/A ,$8.51 ,$8.51 , N/A ,$7.60 ,$8.08 ,$5.94 ,$8.55 , N/A , N/A ,$9.03 ,$8.55 ,$8.08 ,$8.08 , N/A ,$8.08 ,$8.08 ,$8.55 ,$5.79 , N/A , N/A , N/A ,$8.55 , N/A ,$8.74 ,$8.55 ,$6.27 ,$6.27 ,$5.79 ,$6.27 ,$6.18 ,$6.49 ,$9.41 ,$7.51 , N/A ,$4.66 ,$4.66 , N/A ,$4.66 ,$9.50 ,$9.03 ,$7.79 ,$7.79 ,$7.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PAROXETINE 20 MG TABS,637,1 ,$9.50 ,$6.27 ,$4.66 ,$9.50 , N/A ,$8.51 ,$8.51 , N/A ,$7.60 ,$8.08 ,$5.94 ,$8.55 , N/A , N/A ,$9.03 ,$8.55 ,$8.08 ,$8.08 , N/A ,$8.08 ,$8.08 ,$8.55 ,$5.79 , N/A , N/A , N/A ,$8.55 , N/A ,$8.74 ,$8.55 ,$6.27 ,$6.27 ,$5.79 ,$6.27 ,$6.18 ,$6.49 ,$9.41 ,$7.51 , N/A ,$4.66 ,$4.66 , N/A ,$4.66 ,$9.50 ,$9.03 ,$7.79 ,$7.79 ,$7.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PAROXETINE 20 MG TABS 1 EACH BLISTER,637,1 ,$9.50 ,$6.27 ,$4.66 ,$9.50 , N/A ,$8.51 ,$8.51 , N/A ,$7.60 ,$8.08 ,$5.94 ,$8.55 , N/A , N/A ,$9.03 ,$8.55 ,$8.08 ,$8.08 , N/A ,$8.08 ,$8.08 ,$8.55 ,$5.79 , N/A , N/A , N/A ,$8.55 , N/A ,$8.74 ,$8.55 ,$6.27 ,$6.27 ,$5.79 ,$6.27 ,$6.18 ,$6.49 ,$9.41 ,$7.51 , N/A ,$4.66 ,$4.66 , N/A ,$4.66 ,$9.50 ,$9.03 ,$7.79 ,$7.79 ,$7.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POLYETHYLENE GLYCOL PACK,637,1 ,$9.50 ,$6.27 ,$4.66 ,$9.50 , N/A ,$8.51 ,$8.51 , N/A ,$7.60 ,$8.08 ,$5.94 ,$8.55 , N/A , N/A ,$9.03 ,$8.55 ,$8.08 ,$8.08 , N/A ,$8.08 ,$8.08 ,$8.55 ,$5.79 , N/A , N/A , N/A ,$8.55 , N/A ,$8.74 ,$8.55 ,$6.27 ,$6.27 ,$5.79 ,$6.27 ,$6.18 ,$6.49 ,$9.41 ,$7.51 , N/A ,$4.66 ,$4.66 , N/A ,$4.66 ,$9.50 ,$9.03 ,$7.79 ,$7.79 ,$7.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SITAGLIPTIN 50 MG TABS,637,1 ,$70.95 ,$46.83 ,$34.77 ,$70.95 , N/A ,$63.59 ,$63.59 , N/A ,$56.76 ,$60.31 ,$44.34 ,$63.86 , N/A , N/A ,$67.40 ,$63.86 ,$60.31 ,$60.31 , N/A ,$60.31 ,$60.31 ,$63.86 ,$43.21 , N/A , N/A , N/A ,$63.86 , N/A ,$65.27 ,$63.86 ,$46.83 ,$46.83 ,$43.21 ,$46.83 ,$46.12 ,$48.47 ,$70.23 ,$56.05 , N/A ,$34.77 ,$34.77 , N/A ,$34.77 ,$70.95 ,$67.40 ,$58.18 ,$58.18 ,$56.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SODIUM CHLORIDE 0.65 % SOLN 44 ML BOTTLE,637,1 ,$8.10 ,$5.35 ,$3.97 ,$8.10 , N/A ,$7.26 ,$7.26 , N/A ,$6.48 ,$6.89 ,$5.06 ,$7.29 , N/A , N/A ,$7.70 ,$7.29 ,$6.89 ,$6.89 , N/A ,$6.89 ,$6.89 ,$7.29 ,$4.93 , N/A , N/A , N/A ,$7.29 , N/A ,$7.45 ,$7.29 ,$5.35 ,$5.35 ,$4.93 ,$5.35 ,$5.27 ,$5.53 ,$8.02 ,$6.40 , N/A ,$3.97 ,$3.97 , N/A ,$3.97 ,$8.10 ,$7.70 ,$6.64 ,$6.64 ,$6.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MAGNESIUM CITRATE 1.745 GM/30ML SOLN,637,1 ,$8.10 ,$5.35 ,$3.97 ,$8.10 , N/A ,$7.26 ,$7.26 , N/A ,$6.48 ,$6.89 ,$5.06 ,$7.29 , N/A , N/A ,$7.70 ,$7.29 ,$6.89 ,$6.89 , N/A ,$6.89 ,$6.89 ,$7.29 ,$4.93 , N/A , N/A , N/A ,$7.29 , N/A ,$7.45 ,$7.29 ,$5.35 ,$5.35 ,$4.93 ,$5.35 ,$5.27 ,$5.53 ,$8.02 ,$6.40 , N/A ,$3.97 ,$3.97 , N/A ,$3.97 ,$8.10 ,$7.70 ,$6.64 ,$6.64 ,$6.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHENAMINE MANDELATE 1 G TABS,637,1 ,$8.10 ,$5.35 ,$3.97 ,$8.10 , N/A ,$7.26 ,$7.26 , N/A ,$6.48 ,$6.89 ,$5.06 ,$7.29 , N/A , N/A ,$7.70 ,$7.29 ,$6.89 ,$6.89 , N/A ,$6.89 ,$6.89 ,$7.29 ,$4.93 , N/A , N/A , N/A ,$7.29 , N/A ,$7.45 ,$7.29 ,$5.35 ,$5.35 ,$4.93 ,$5.35 ,$5.27 ,$5.53 ,$8.02 ,$6.40 , N/A ,$3.97 ,$3.97 , N/A ,$3.97 ,$8.10 ,$7.70 ,$6.64 ,$6.64 ,$6.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MORPHINE SULFATE 100 MG/5ML SOLN,637,1 ,$8.10 ,$5.35 ,$3.97 ,$8.10 , N/A ,$7.26 ,$7.26 , N/A ,$6.48 ,$6.89 ,$5.06 ,$7.29 , N/A , N/A ,$7.70 ,$7.29 ,$6.89 ,$6.89 , N/A ,$6.89 ,$6.89 ,$7.29 ,$4.93 , N/A , N/A , N/A ,$7.29 , N/A ,$7.45 ,$7.29 ,$5.35 ,$5.35 ,$4.93 ,$5.35 ,$5.27 ,$5.53 ,$8.02 ,$6.40 , N/A ,$3.97 ,$3.97 , N/A ,$3.97 ,$8.10 ,$7.70 ,$6.64 ,$6.64 ,$6.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SODIUM ZIRCONIUM CYCLOSILICATE 10 G PACK,637,1 ,$99.25 ,$65.51 ,$48.63 ,$99.25 , N/A ,$88.95 ,$88.95 , N/A ,$79.40 ,$84.36 ,$62.03 ,$89.33 , N/A , N/A ,$94.29 ,$89.33 ,$84.36 ,$84.36 , N/A ,$84.36 ,$84.36 ,$89.33 ,$60.44 , N/A , N/A , N/A ,$89.33 , N/A ,$91.31 ,$89.33 ,$65.51 ,$65.51 ,$60.44 ,$65.51 ,$64.51 ,$67.81 ,$98.24 ,$78.41 , N/A ,$48.63 ,$48.63 , N/A ,$48.63 ,$99.25 ,$94.29 ,$81.39 ,$81.39 ,$79.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SOLIFENACIN 5 MG TABS,637,1 ,$47.20 ,$31.15 ,$23.13 ,$47.20 , N/A ,$42.30 ,$42.30 , N/A ,$37.76 ,$40.12 ,$29.50 ,$42.48 , N/A , N/A ,$44.84 ,$42.48 ,$40.12 ,$40.12 , N/A ,$40.12 ,$40.12 ,$42.48 ,$28.74 , N/A , N/A , N/A ,$42.48 , N/A ,$43.42 ,$42.48 ,$31.16 ,$31.16 ,$28.74 ,$31.16 ,$30.68 ,$32.25 ,$46.72 ,$37.29 , N/A ,$23.13 ,$23.13 , N/A ,$23.13 ,$47.20 ,$44.84 ,$38.70 ,$38.70 ,$37.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SUCRALFATE 1 GM/10ML SUSP,637,1 ,$41.45 ,$27.36 ,$20.31 ,$41.45 , N/A ,$37.15 ,$37.15 , N/A ,$33.16 ,$35.23 ,$25.91 ,$37.31 , N/A , N/A ,$39.38 ,$37.31 ,$35.23 ,$35.23 , N/A ,$35.23 ,$35.23 ,$37.31 ,$25.24 , N/A , N/A , N/A ,$37.31 , N/A ,$38.13 ,$37.31 ,$27.36 ,$27.36 ,$25.24 ,$27.36 ,$26.94 ,$28.32 ,$41.02 ,$32.75 , N/A ,$20.31 ,$20.31 , N/A ,$20.31 ,$41.45 ,$39.38 ,$33.99 ,$33.99 ,$33.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,KETOTIFEN 0.025 % SOLN 5 ML BOTTLE,637,1 ,$41.45 ,$27.36 ,$20.31 ,$41.45 , N/A ,$37.15 ,$37.15 , N/A ,$33.16 ,$35.23 ,$25.91 ,$37.31 , N/A , N/A ,$39.38 ,$37.31 ,$35.23 ,$35.23 , N/A ,$35.23 ,$35.23 ,$37.31 ,$25.24 , N/A , N/A , N/A ,$37.31 , N/A ,$38.13 ,$37.31 ,$27.36 ,$27.36 ,$25.24 ,$27.36 ,$26.94 ,$28.32 ,$41.02 ,$32.75 , N/A ,$20.31 ,$20.31 , N/A ,$20.31 ,$41.45 ,$39.38 ,$33.99 ,$33.99 ,$33.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SULFACETAMIDE 10 % SOLN 15 ML BOTTLE,637,1 ,$207.45 ,$136.92 ,$101.65 ,$207.45 , N/A ,$185.92 ,$185.92 , N/A ,$165.96 ,$176.33 ,$129.66 ,$186.71 , N/A , N/A ,$197.08 ,$186.71 ,$176.33 ,$176.33 , N/A ,$176.33 ,$176.33 ,$186.71 ,$126.34 , N/A , N/A , N/A ,$186.71 , N/A ,$190.85 ,$186.71 ,$136.94 ,$136.94 ,$126.34 ,$136.94 ,$134.84 ,$141.73 ,$205.33 ,$163.89 , N/A ,$101.65 ,$101.65 , N/A ,$101.65 ,$207.45 ,$197.08 ,$170.11 ,$170.11 ,$165.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SUMATRIPTAN 50 MG TABS,637,1 ,$85.50 ,$56.43 ,$41.90 ,$85.50 , N/A ,$76.63 ,$76.63 , N/A ,$68.40 ,$72.68 ,$53.44 ,$76.95 , N/A , N/A ,$81.23 ,$76.95 ,$72.68 ,$72.68 , N/A ,$72.68 ,$72.68 ,$76.95 ,$52.07 , N/A , N/A , N/A ,$76.95 , N/A ,$78.66 ,$76.95 ,$56.44 ,$56.44 ,$52.07 ,$56.44 ,$55.58 ,$58.41 ,$84.63 ,$67.55 , N/A ,$41.90 ,$41.90 , N/A ,$41.90 ,$85.50 ,$81.23 ,$70.11 ,$70.11 ,$68.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SODIUM POLYSTYRENE 15 GM/60ML SUSP,637,1 ,$85.50 ,$56.43 ,$41.90 ,$85.50 , N/A ,$76.63 ,$76.63 , N/A ,$68.40 ,$72.68 ,$53.44 ,$76.95 , N/A , N/A ,$81.23 ,$76.95 ,$72.68 ,$72.68 , N/A ,$72.68 ,$72.68 ,$76.95 ,$52.07 , N/A , N/A , N/A ,$76.95 , N/A ,$78.66 ,$76.95 ,$56.44 ,$56.44 ,$52.07 ,$56.44 ,$55.58 ,$58.41 ,$84.63 ,$67.55 , N/A ,$41.90 ,$41.90 , N/A ,$41.90 ,$85.50 ,$81.23 ,$70.11 ,$70.11 ,$68.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SUMATRIPTAN 100 MG TABS,637,1 ,$85.50 ,$56.43 ,$41.90 ,$85.50 , N/A ,$76.63 ,$76.63 , N/A ,$68.40 ,$72.68 ,$53.44 ,$76.95 , N/A , N/A ,$81.23 ,$76.95 ,$72.68 ,$72.68 , N/A ,$72.68 ,$72.68 ,$76.95 ,$52.07 , N/A , N/A , N/A ,$76.95 , N/A ,$78.66 ,$76.95 ,$56.44 ,$56.44 ,$52.07 ,$56.44 ,$55.58 ,$58.41 ,$84.63 ,$67.55 , N/A ,$41.90 ,$41.90 , N/A ,$41.90 ,$85.50 ,$81.23 ,$70.11 ,$70.11 ,$68.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TAMSULOSIN 0.4 MG CAPS,637,1 ,$14.35 ,$9.47 ,$7.03 ,$14.35 , N/A ,$12.86 ,$12.86 , N/A ,$11.48 ,$12.20 ,$8.97 ,$12.92 , N/A , N/A ,$13.63 ,$12.92 ,$12.20 ,$12.20 , N/A ,$12.20 ,$12.20 ,$12.92 ,$8.74 , N/A , N/A , N/A ,$12.92 , N/A ,$13.20 ,$12.92 ,$9.47 ,$9.47 ,$8.74 ,$9.47 ,$9.33 ,$9.80 ,$14.20 ,$11.34 , N/A ,$7.03 ,$7.03 , N/A ,$7.03 ,$14.35 ,$13.63 ,$11.77 ,$11.77 ,$11.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AZITHROMYCIN 250 MG TABS,637,1 ,$14.35 ,$9.47 ,$7.03 ,$14.35 , N/A ,$12.86 ,$12.86 , N/A ,$11.48 ,$12.20 ,$8.97 ,$12.92 , N/A , N/A ,$13.63 ,$12.92 ,$12.20 ,$12.20 , N/A ,$12.20 ,$12.20 ,$12.92 ,$8.74 , N/A , N/A , N/A ,$12.92 , N/A ,$13.20 ,$12.92 ,$9.47 ,$9.47 ,$8.74 ,$9.47 ,$9.33 ,$9.80 ,$14.20 ,$11.34 , N/A ,$7.03 ,$7.03 , N/A ,$7.03 ,$14.35 ,$13.63 ,$11.77 ,$11.77 ,$11.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALFUZOSIN ER 10 MG TB24,637,1 ,$14.35 ,$9.47 ,$7.03 ,$14.35 , N/A ,$12.86 ,$12.86 , N/A ,$11.48 ,$12.20 ,$8.97 ,$12.92 , N/A , N/A ,$13.63 ,$12.92 ,$12.20 ,$12.20 , N/A ,$12.20 ,$12.20 ,$12.92 ,$8.74 , N/A , N/A , N/A ,$12.92 , N/A ,$13.20 ,$12.92 ,$9.47 ,$9.47 ,$8.74 ,$9.47 ,$9.33 ,$9.80 ,$14.20 ,$11.34 , N/A ,$7.03 ,$7.03 , N/A ,$7.03 ,$14.35 ,$13.63 ,$11.77 ,$11.77 ,$11.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TELMISARTAN 40 MG TABS,637,1 ,$19.00 ,$12.54 ,$9.31 ,$19.00 , N/A ,$17.03 ,$17.03 , N/A ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 , N/A ,$16.15 ,$16.15 ,$17.10 ,$11.57 , N/A , N/A , N/A ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.54 ,$12.54 ,$11.57 ,$12.54 ,$12.35 ,$12.98 ,$18.81 ,$15.01 , N/A ,$9.31 ,$9.31 , N/A ,$9.31 ,$19.00 ,$18.05 ,$15.58 ,$15.58 ,$15.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TEMAZEPAM 7.5 MG CAPS,637,1 ,$33.80 ,$22.31 ,$16.56 ,$33.80 , N/A ,$30.29 ,$30.29 , N/A ,$27.04 ,$28.73 ,$21.13 ,$30.42 , N/A , N/A ,$32.11 ,$30.42 ,$28.73 ,$28.73 , N/A ,$28.73 ,$28.73 ,$30.42 ,$20.58 , N/A , N/A , N/A ,$30.42 , N/A ,$31.10 ,$30.42 ,$22.31 ,$22.31 ,$20.58 ,$22.31 ,$21.97 ,$23.09 ,$33.46 ,$26.70 , N/A ,$16.56 ,$16.56 , N/A ,$16.56 ,$33.80 ,$32.11 ,$27.72 ,$27.72 ,$27.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TERBINAFINE 250 MG TABS,637,1 ,$43.50 ,$28.71 ,$21.32 ,$43.50 , N/A ,$38.98 ,$38.98 , N/A ,$34.80 ,$36.98 ,$27.19 ,$39.15 , N/A , N/A ,$41.33 ,$39.15 ,$36.98 ,$36.98 , N/A ,$36.98 ,$36.98 ,$39.15 ,$26.49 , N/A , N/A , N/A ,$39.15 , N/A ,$40.02 ,$39.15 ,$28.71 ,$28.71 ,$26.49 ,$28.71 ,$28.28 ,$29.72 ,$43.06 ,$34.37 , N/A ,$21.32 ,$21.32 , N/A ,$21.32 ,$43.50 ,$41.33 ,$35.67 ,$35.67 ,$34.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,THEOPHYLLINE ER 100 MG CP24,637,1 ,$11.90 ,$7.85 ,$5.83 ,$11.90 , N/A ,$10.66 ,$10.66 , N/A ,$9.52 ,$10.12 ,$7.44 ,$10.71 , N/A , N/A ,$11.31 ,$10.71 ,$10.12 ,$10.12 , N/A ,$10.12 ,$10.12 ,$10.71 ,$7.25 , N/A , N/A , N/A ,$10.71 , N/A ,$10.95 ,$10.71 ,$7.86 ,$7.86 ,$7.25 ,$7.86 ,$7.74 ,$8.13 ,$11.78 ,$9.40 , N/A ,$5.83 ,$5.83 , N/A ,$5.83 ,$11.90 ,$11.31 ,$9.76 ,$9.76 ,$9.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TICAGRELOR 90 MG TABS,637,1 ,$28.95 ,$19.11 ,$14.19 ,$28.95 , N/A ,$25.95 ,$25.95 , N/A ,$23.16 ,$24.61 ,$18.09 ,$26.06 , N/A , N/A ,$27.50 ,$26.06 ,$24.61 ,$24.61 , N/A ,$24.61 ,$24.61 ,$26.06 ,$17.63 , N/A , N/A , N/A ,$26.06 , N/A ,$26.63 ,$26.06 ,$19.11 ,$19.11 ,$17.63 ,$19.11 ,$18.82 ,$19.78 ,$28.66 ,$22.87 , N/A ,$14.19 ,$14.19 , N/A ,$14.19 ,$28.95 ,$27.50 ,$23.74 ,$23.74 ,$23.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TICAGRELOR 60 MG TABS,637,1 ,$28.95 ,$19.11 ,$14.19 ,$28.95 , N/A ,$25.95 ,$25.95 , N/A ,$23.16 ,$24.61 ,$18.09 ,$26.06 , N/A , N/A ,$27.50 ,$26.06 ,$24.61 ,$24.61 , N/A ,$24.61 ,$24.61 ,$26.06 ,$17.63 , N/A , N/A , N/A ,$26.06 , N/A ,$26.63 ,$26.06 ,$19.11 ,$19.11 ,$17.63 ,$19.11 ,$18.82 ,$19.78 ,$28.66 ,$22.87 , N/A ,$14.19 ,$14.19 , N/A ,$14.19 ,$28.95 ,$27.50 ,$23.74 ,$23.74 ,$23.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIMOLOL 0.25 % SOLN 5 ML BOTTLE,637,1 ,$51.00 ,$33.66 ,$24.99 ,$51.00 , N/A ,$45.71 ,$45.71 , N/A ,$40.80 ,$43.35 ,$31.88 ,$45.90 , N/A , N/A ,$48.45 ,$45.90 ,$43.35 ,$43.35 , N/A ,$43.35 ,$43.35 ,$45.90 ,$31.06 , N/A , N/A , N/A ,$45.90 , N/A ,$46.92 ,$45.90 ,$33.67 ,$33.67 ,$31.06 ,$33.67 ,$33.15 ,$34.84 ,$50.48 ,$40.29 , N/A ,$24.99 ,$24.99 , N/A ,$24.99 ,$51.00 ,$48.45 ,$41.82 ,$41.82 ,$40.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIMOLOL 0.5 % SOLN 10 ML BOTTLE,637,1 ,$110.00 ,$72.60 ,$53.90 ,$110.00 , N/A ,$98.58 ,$98.58 , N/A ,$88.00 ,$93.50 ,$68.75 ,$99.00 , N/A , N/A ,$104.50 ,$99.00 ,$93.50 ,$93.50 , N/A ,$93.50 ,$93.50 ,$99.00 ,$66.99 , N/A , N/A , N/A ,$99.00 , N/A ,$101.20 ,$99.00 ,$72.61 ,$72.61 ,$66.99 ,$72.61 ,$71.50 ,$75.15 ,$108.88 ,$86.90 , N/A ,$53.90 ,$53.90 , N/A ,$53.90 ,$110.00 ,$104.50 ,$90.20 ,$90.20 ,$88.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIMOLOL 0.5 % SOLN 15 ML BOTTLE,637,1 ,$165.75 ,$109.40 ,$81.22 ,$165.75 , N/A ,$148.55 ,$148.55 , N/A ,$132.60 ,$140.89 ,$103.59 ,$149.18 , N/A , N/A ,$157.46 ,$149.18 ,$140.89 ,$140.89 , N/A ,$140.89 ,$140.89 ,$149.18 ,$100.94 , N/A , N/A , N/A ,$149.18 , N/A ,$152.49 ,$149.18 ,$109.41 ,$109.41 ,$100.94 ,$109.41 ,$107.74 ,$113.24 ,$164.06 ,$130.94 , N/A ,$81.22 ,$81.22 , N/A ,$81.22 ,$165.75 ,$157.46 ,$135.92 ,$135.92 ,$132.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIMOLOL 0.5 % SOLN 5 ML BOTTLE,637,1 ,$57.80 ,$38.15 ,$28.32 ,$57.80 , N/A ,$51.80 ,$51.80 , N/A ,$46.24 ,$49.13 ,$36.13 ,$52.02 , N/A , N/A ,$54.91 ,$52.02 ,$49.13 ,$49.13 , N/A ,$49.13 ,$49.13 ,$52.02 ,$35.20 , N/A , N/A , N/A ,$52.02 , N/A ,$53.18 ,$52.02 ,$38.15 ,$38.15 ,$35.20 ,$38.15 ,$37.57 ,$39.49 ,$57.21 ,$45.66 , N/A ,$28.32 ,$28.32 , N/A ,$28.32 ,$57.80 ,$54.91 ,$47.40 ,$47.40 ,$46.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIOTROPIUM 1.25 MCG/ACT AERS 4 G INHALER,637,1 ,"$1,908.95 ","$1,259.91 ",$935.39 ,"$1,908.95 ", N/A ,"$1,710.80 ","$1,710.80 ", N/A ,"$1,527.16 ","$1,622.61 ","$1,193.09 ","$1,718.06 ", N/A , N/A ,"$1,813.50 ","$1,718.06 ","$1,622.61 ","$1,622.61 ", N/A ,"$1,622.61 ","$1,622.61 ","$1,718.06 ","$1,162.55 ", N/A , N/A , N/A ,"$1,718.06 ", N/A ,"$1,756.23 ","$1,718.06 ","$1,260.10 ","$1,260.10 ","$1,162.55 ","$1,260.10 ","$1,240.82 ","$1,304.19 ","$1,889.48 ","$1,508.07 ", N/A ,$935.39 ,$935.39 , N/A ,$935.39 ,"$1,908.95 ","$1,813.50 ","$1,565.34 ","$1,565.34 ","$1,527.16 "
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIOTROPIUM 2.5 MCG/ACT AERS,637,1 ,$190.90 ,$125.99 ,$93.54 ,$190.90 , N/A ,$171.08 ,$171.08 , N/A ,$152.72 ,$162.27 ,$119.31 ,$171.81 , N/A , N/A ,$181.36 ,$171.81 ,$162.27 ,$162.27 , N/A ,$162.27 ,$162.27 ,$171.81 ,$116.26 , N/A , N/A , N/A ,$171.81 , N/A ,$175.63 ,$171.81 ,$126.01 ,$126.01 ,$116.26 ,$126.01 ,$124.09 ,$130.42 ,$188.95 ,$150.81 , N/A ,$93.54 ,$93.54 , N/A ,$93.54 ,$190.90 ,$181.36 ,$156.54 ,$156.54 ,$152.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIOTROPIUM 2.5 MCG/ACT AERS 4 G INHALER,637,1 ,$61.20 ,$40.39 ,$29.99 ,$61.20 , N/A ,$54.85 ,$54.85 , N/A ,$48.96 ,$52.02 ,$38.25 ,$55.08 , N/A , N/A ,$58.14 ,$55.08 ,$52.02 ,$52.02 , N/A ,$52.02 ,$52.02 ,$55.08 ,$37.27 , N/A , N/A , N/A ,$55.08 , N/A ,$56.30 ,$55.08 ,$40.40 ,$40.40 ,$37.27 ,$40.40 ,$39.78 ,$41.81 ,$60.57 ,$48.35 , N/A ,$29.99 ,$29.99 , N/A ,$29.99 ,$61.20 ,$58.14 ,$50.18 ,$50.18 ,$48.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIZANIDINE 4 MG TABS,637,1 ,$8.70 ,$5.74 ,$4.26 ,$8.70 , N/A ,$7.80 ,$7.80 , N/A ,$6.96 ,$7.40 ,$5.44 ,$7.83 , N/A , N/A ,$8.27 ,$7.83 ,$7.40 ,$7.40 , N/A ,$7.40 ,$7.40 ,$7.83 ,$5.30 , N/A , N/A , N/A ,$7.83 , N/A ,$8.00 ,$7.83 ,$5.74 ,$5.74 ,$5.30 ,$5.74 ,$5.66 ,$5.94 ,$8.61 ,$6.87 , N/A ,$4.26 ,$4.26 , N/A ,$4.26 ,$8.70 ,$8.27 ,$7.13 ,$7.13 ,$6.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TOBRAMYCIN 0.3 % SOLN 5 ML BOTTLE,637,1 ,$49.55 ,$32.70 ,$24.28 ,$49.55 , N/A ,$44.41 ,$44.41 , N/A ,$39.64 ,$42.12 ,$30.97 ,$44.60 , N/A , N/A ,$47.07 ,$44.60 ,$42.12 ,$42.12 , N/A ,$42.12 ,$42.12 ,$44.60 ,$30.18 , N/A , N/A , N/A ,$44.60 , N/A ,$45.59 ,$44.60 ,$32.71 ,$32.71 ,$30.18 ,$32.71 ,$32.21 ,$33.85 ,$49.05 ,$39.14 , N/A ,$24.28 ,$24.28 , N/A ,$24.28 ,$49.55 ,$47.07 ,$40.63 ,$40.63 ,$39.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TOFACITINIB 5 MG TABS,637,1 ,$332.95 ,$219.75 ,$163.15 ,$332.95 , N/A ,$298.39 ,$298.39 , N/A ,$266.36 ,$283.01 ,$208.09 ,$299.66 , N/A , N/A ,$316.30 ,$299.66 ,$283.01 ,$283.01 , N/A ,$283.01 ,$283.01 ,$299.66 ,$202.77 , N/A , N/A , N/A ,$299.66 , N/A ,$306.31 ,$299.66 ,$219.78 ,$219.78 ,$202.77 ,$219.78 ,$216.42 ,$227.47 ,$329.55 ,$263.03 , N/A ,$163.15 ,$163.15 , N/A ,$163.15 ,$332.95 ,$316.30 ,$273.02 ,$273.02 ,$266.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TOLNAFTATE 1 % CREA 30 G TUBE,637,1 ,$29.60 ,$19.54 ,$14.50 ,$29.60 , N/A ,$26.53 ,$26.53 , N/A ,$23.68 ,$25.16 ,$18.50 ,$26.64 , N/A , N/A ,$28.12 ,$26.64 ,$25.16 ,$25.16 , N/A ,$25.16 ,$25.16 ,$26.64 ,$18.03 , N/A , N/A , N/A ,$26.64 , N/A ,$27.23 ,$26.64 ,$19.54 ,$19.54 ,$18.03 ,$19.54 ,$19.24 ,$20.22 ,$29.30 ,$23.38 , N/A ,$14.50 ,$14.50 , N/A ,$14.50 ,$29.60 ,$28.12 ,$24.27 ,$24.27 ,$23.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ERYTHROMYCIN 5 MG/GM OINT 1 G TUBE,637,1 ,$29.60 ,$19.54 ,$14.50 ,$29.60 , N/A ,$26.53 ,$26.53 , N/A ,$23.68 ,$25.16 ,$18.50 ,$26.64 , N/A , N/A ,$28.12 ,$26.64 ,$25.16 ,$25.16 , N/A ,$25.16 ,$25.16 ,$26.64 ,$18.03 , N/A , N/A , N/A ,$26.64 , N/A ,$27.23 ,$26.64 ,$19.54 ,$19.54 ,$18.03 ,$19.54 ,$19.24 ,$20.22 ,$29.30 ,$23.38 , N/A ,$14.50 ,$14.50 , N/A ,$14.50 ,$29.60 ,$28.12 ,$24.27 ,$24.27 ,$23.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TOPIRAMATE 100 MG TABS,637,1 ,$23.65 ,$15.61 ,$11.59 ,$23.65 , N/A ,$21.20 ,$21.20 , N/A ,$18.92 ,$20.10 ,$14.78 ,$21.29 , N/A , N/A ,$22.47 ,$21.29 ,$20.10 ,$20.10 , N/A ,$20.10 ,$20.10 ,$21.29 ,$14.40 , N/A , N/A , N/A ,$21.29 , N/A ,$21.76 ,$21.29 ,$15.61 ,$15.61 ,$14.40 ,$15.61 ,$15.37 ,$16.16 ,$23.41 ,$18.68 , N/A ,$11.59 ,$11.59 , N/A ,$11.59 ,$23.65 ,$22.47 ,$19.39 ,$19.39 ,$18.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMPHETAMINE-DEXTROAMPHETAMINE XR 10 MG CP24,637,1 ,$23.65 ,$15.61 ,$11.59 ,$23.65 , N/A ,$21.20 ,$21.20 , N/A ,$18.92 ,$20.10 ,$14.78 ,$21.29 , N/A , N/A ,$22.47 ,$21.29 ,$20.10 ,$20.10 , N/A ,$20.10 ,$20.10 ,$21.29 ,$14.40 , N/A , N/A , N/A ,$21.29 , N/A ,$21.76 ,$21.29 ,$15.61 ,$15.61 ,$14.40 ,$15.61 ,$15.37 ,$16.16 ,$23.41 ,$18.68 , N/A ,$11.59 ,$11.59 , N/A ,$11.59 ,$23.65 ,$22.47 ,$19.39 ,$19.39 ,$18.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRANEXAMIC ACID 100 MG/ML SOLN,637,1 ,$204.00 ,$134.64 ,$99.96 ,$204.00 , N/A ,$182.82 ,$182.82 , N/A ,$163.20 ,$173.40 ,$127.50 ,$183.60 , N/A , N/A ,$193.80 ,$183.60 ,$173.40 ,$173.40 , N/A ,$173.40 ,$173.40 ,$183.60 ,$124.24 , N/A , N/A , N/A ,$183.60 , N/A ,$187.68 ,$183.60 ,$134.66 ,$134.66 ,$124.24 ,$134.66 ,$132.60 ,$139.37 ,$201.92 ,$161.16 , N/A ,$99.96 ,$99.96 , N/A ,$99.96 ,$204.00 ,$193.80 ,$167.28 ,$167.28 ,$163.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIAMCINOLONE 0.1 % CREA 15 G TUBE,637,1 ,$18.75 ,$12.38 ,$9.19 ,$18.75 , N/A ,$16.80 ,$16.80 , N/A ,$15.00 ,$15.94 ,$11.72 ,$16.88 , N/A , N/A ,$17.81 ,$16.88 ,$15.94 ,$15.94 , N/A ,$15.94 ,$15.94 ,$16.88 ,$11.42 , N/A , N/A , N/A ,$16.88 , N/A ,$17.25 ,$16.88 ,$12.38 ,$12.38 ,$11.42 ,$12.38 ,$12.19 ,$12.81 ,$18.56 ,$14.81 , N/A ,$9.19 ,$9.19 , N/A ,$9.19 ,$18.75 ,$17.81 ,$15.38 ,$15.38 ,$15.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MONTELUKAST 10 MG TABS,637,1 ,$18.75 ,$12.38 ,$9.19 ,$18.75 , N/A ,$16.80 ,$16.80 , N/A ,$15.00 ,$15.94 ,$11.72 ,$16.88 , N/A , N/A ,$17.81 ,$16.88 ,$15.94 ,$15.94 , N/A ,$15.94 ,$15.94 ,$16.88 ,$11.42 , N/A , N/A , N/A ,$16.88 , N/A ,$17.25 ,$16.88 ,$12.38 ,$12.38 ,$11.42 ,$12.38 ,$12.19 ,$12.81 ,$18.56 ,$14.81 , N/A ,$9.19 ,$9.19 , N/A ,$9.19 ,$18.75 ,$17.81 ,$15.38 ,$15.38 ,$15.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIAMCINOLONE 0.1 % CREA 80 G TUBE,637,1 ,$42.75 ,$28.22 ,$20.95 ,$42.75 , N/A ,$38.31 ,$38.31 , N/A ,$34.20 ,$36.34 ,$26.72 ,$38.48 , N/A , N/A ,$40.61 ,$38.48 ,$36.34 ,$36.34 , N/A ,$36.34 ,$36.34 ,$38.48 ,$26.03 , N/A , N/A , N/A ,$38.48 , N/A ,$39.33 ,$38.48 ,$28.22 ,$28.22 ,$26.03 ,$28.22 ,$27.79 ,$29.21 ,$42.32 ,$33.77 , N/A ,$20.95 ,$20.95 , N/A ,$20.95 ,$42.75 ,$40.61 ,$35.06 ,$35.06 ,$34.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIAMCINOLONE 0.1 % OINT 15 G TUBE,637,1 ,$18.95 ,$12.51 ,$9.29 ,$18.95 , N/A ,$16.98 ,$16.98 , N/A ,$15.16 ,$16.11 ,$11.84 ,$17.06 , N/A , N/A ,$18.00 ,$17.06 ,$16.11 ,$16.11 , N/A ,$16.11 ,$16.11 ,$17.06 ,$11.54 , N/A , N/A , N/A ,$17.06 , N/A ,$17.43 ,$17.06 ,$12.51 ,$12.51 ,$11.54 ,$12.51 ,$12.32 ,$12.95 ,$18.76 ,$14.97 , N/A ,$9.29 ,$9.29 , N/A ,$9.29 ,$18.95 ,$18.00 ,$15.54 ,$15.54 ,$15.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIAMCINOLONE 0.1 % PSTE 5 G TUBE,637,1 ,$274.05 ,$180.87 ,$134.28 ,$274.05 , N/A ,$245.60 ,$245.60 , N/A ,$219.24 ,$232.94 ,$171.28 ,$246.65 , N/A , N/A ,$260.35 ,$246.65 ,$232.94 ,$232.94 , N/A ,$232.94 ,$232.94 ,$246.65 ,$166.90 , N/A , N/A , N/A ,$246.65 , N/A ,$252.13 ,$246.65 ,$180.90 ,$180.90 ,$166.90 ,$180.90 ,$178.13 ,$187.23 ,$271.25 ,$216.50 , N/A ,$134.28 ,$134.28 , N/A ,$134.28 ,$274.05 ,$260.35 ,$224.72 ,$224.72 ,$219.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIAMCINOLONE 0.5 % CREA 15 G TUBE,637,1 ,$37.75 ,$24.92 ,$18.50 ,$37.75 , N/A ,$33.83 ,$33.83 , N/A ,$30.20 ,$32.09 ,$23.59 ,$33.98 , N/A , N/A ,$35.86 ,$33.98 ,$32.09 ,$32.09 , N/A ,$32.09 ,$32.09 ,$33.98 ,$22.99 , N/A , N/A , N/A ,$33.98 , N/A ,$34.73 ,$33.98 ,$24.92 ,$24.92 ,$22.99 ,$24.92 ,$24.54 ,$25.79 ,$37.37 ,$29.82 , N/A ,$18.50 ,$18.50 , N/A ,$18.50 ,$37.75 ,$35.86 ,$30.96 ,$30.96 ,$30.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIMETHOPRIM-POLYMYXIN B 10000-0.1 UNIT/ML-% SOLN 10 ML BOTTLE,637,1 ,$59.25 ,$39.11 ,$29.03 ,$59.25 , N/A ,$53.10 ,$53.10 , N/A ,$47.40 ,$50.36 ,$37.03 ,$53.33 , N/A , N/A ,$56.29 ,$53.33 ,$50.36 ,$50.36 , N/A ,$50.36 ,$50.36 ,$53.33 ,$36.08 , N/A , N/A , N/A ,$53.33 , N/A ,$54.51 ,$53.33 ,$39.11 ,$39.11 ,$36.08 ,$39.11 ,$38.51 ,$40.48 ,$58.64 ,$46.81 , N/A ,$29.03 ,$29.03 , N/A ,$29.03 ,$59.25 ,$56.29 ,$48.59 ,$48.59 ,$47.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,UREA 10% 10 % CREA,637,1 ,$37.60 ,$24.82 ,$18.42 ,$37.60 , N/A ,$33.70 ,$33.70 , N/A ,$30.08 ,$31.96 ,$23.50 ,$33.84 , N/A , N/A ,$35.72 ,$33.84 ,$31.96 ,$31.96 , N/A ,$31.96 ,$31.96 ,$33.84 ,$22.90 , N/A , N/A , N/A ,$33.84 , N/A ,$34.59 ,$33.84 ,$24.82 ,$24.82 ,$22.90 ,$24.82 ,$24.44 ,$25.69 ,$37.22 ,$29.70 , N/A ,$18.42 ,$18.42 , N/A ,$18.42 ,$37.60 ,$35.72 ,$30.83 ,$30.83 ,$30.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,UREA 20 % CREA 85 G TUBE,637,1 ,$49.45 ,$32.64 ,$24.23 ,$49.45 , N/A ,$44.32 ,$44.32 , N/A ,$39.56 ,$42.03 ,$30.91 ,$44.51 , N/A , N/A ,$46.98 ,$44.51 ,$42.03 ,$42.03 , N/A ,$42.03 ,$42.03 ,$44.51 ,$30.12 , N/A , N/A , N/A ,$44.51 , N/A ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 ,$48.94 ,$39.07 , N/A ,$24.23 ,$24.23 , N/A ,$24.23 ,$49.45 ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,URSODIOL 300 MG CAPS,637,1 ,$25.00 ,$16.50 ,$12.25 ,$25.00 , N/A ,$22.41 ,$22.41 , N/A ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 , N/A ,$21.25 ,$21.25 ,$22.50 ,$15.23 , N/A , N/A , N/A ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.50 ,$16.50 ,$15.23 ,$16.50 ,$16.25 ,$17.08 ,$24.74 ,$19.75 , N/A ,$12.25 ,$12.25 , N/A ,$12.25 ,$25.00 ,$23.75 ,$20.50 ,$20.50 ,$20.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VALACYCLOVIR 500 MG TABS,637,1 ,$13.51 ,$8.92 ,$6.62 ,$13.51 , N/A ,$12.11 ,$12.11 , N/A ,$10.81 ,$11.48 ,$8.44 ,$12.16 , N/A , N/A ,$12.83 ,$12.16 ,$11.48 ,$11.48 , N/A ,$11.48 ,$11.48 ,$12.16 ,$8.23 , N/A , N/A , N/A ,$12.16 , N/A ,$12.43 ,$12.16 ,$8.92 ,$8.92 ,$8.23 ,$8.92 ,$8.78 ,$9.23 ,$13.38 ,$10.67 , N/A ,$6.62 ,$6.62 , N/A ,$6.62 ,$13.51 ,$12.83 ,$11.08 ,$11.08 ,$10.81 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VALSARTAN 160 MG TABS,637,1 ,$17.00 ,$11.22 ,$8.33 ,$17.00 , N/A ,$15.24 ,$15.24 , N/A ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 , N/A ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A , N/A , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$16.83 ,$13.43 , N/A ,$8.33 ,$8.33 , N/A ,$8.33 ,$17.00 ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,EPLERENONE 25 MG TABS,637,1 ,$17.00 ,$11.22 ,$8.33 ,$17.00 , N/A ,$15.24 ,$15.24 , N/A ,$13.60 ,$14.45 ,$10.63 ,$15.30 , N/A , N/A ,$16.15 ,$15.30 ,$14.45 ,$14.45 , N/A ,$14.45 ,$14.45 ,$15.30 ,$10.35 , N/A , N/A , N/A ,$15.30 , N/A ,$15.64 ,$15.30 ,$11.22 ,$11.22 ,$10.35 ,$11.22 ,$11.05 ,$11.61 ,$16.83 ,$13.43 , N/A ,$8.33 ,$8.33 , N/A ,$8.33 ,$17.00 ,$16.15 ,$13.94 ,$13.94 ,$13.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VALSARTAN 80 MG TABS,637,1 ,$15.65 ,$10.33 ,$7.67 ,$15.65 , N/A ,$14.03 ,$14.03 , N/A ,$12.52 ,$13.30 ,$9.78 ,$14.09 , N/A , N/A ,$14.87 ,$14.09 ,$13.30 ,$13.30 , N/A ,$13.30 ,$13.30 ,$14.09 ,$9.53 , N/A , N/A , N/A ,$14.09 , N/A ,$14.40 ,$14.09 ,$10.33 ,$10.33 ,$9.53 ,$10.33 ,$10.17 ,$10.69 ,$15.49 ,$12.36 , N/A ,$7.67 ,$7.67 , N/A ,$7.67 ,$15.65 ,$14.87 ,$12.83 ,$12.83 ,$12.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VANCOMYCIN 125 MG CAPS,637,1 ,$106.45 ,$70.26 ,$52.16 ,$106.45 , N/A ,$95.40 ,$95.40 , N/A ,$85.16 ,$90.48 ,$66.53 ,$95.81 , N/A , N/A ,$101.13 ,$95.81 ,$90.48 ,$90.48 , N/A ,$90.48 ,$90.48 ,$95.81 ,$64.83 , N/A , N/A , N/A ,$95.81 , N/A ,$97.93 ,$95.81 ,$70.27 ,$70.27 ,$64.83 ,$70.27 ,$69.19 ,$72.73 ,$105.36 ,$84.10 , N/A ,$52.16 ,$52.16 , N/A ,$52.16 ,$106.45 ,$101.13 ,$87.29 ,$87.29 ,$85.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VARENICLINE 1 MG TABS,637,1 ,$31.55 ,$20.82 ,$15.46 ,$31.55 , N/A ,$28.28 ,$28.28 , N/A ,$25.24 ,$26.82 ,$19.72 ,$28.40 , N/A , N/A ,$29.97 ,$28.40 ,$26.82 ,$26.82 , N/A ,$26.82 ,$26.82 ,$28.40 ,$19.21 , N/A , N/A , N/A ,$28.40 , N/A ,$29.03 ,$28.40 ,$20.83 ,$20.83 ,$19.21 ,$20.83 ,$20.51 ,$21.56 ,$31.23 ,$24.92 , N/A ,$15.46 ,$15.46 , N/A ,$15.46 ,$31.55 ,$29.97 ,$25.87 ,$25.87 ,$25.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VENLAFAXINE XR 37.5 MG CP24,637,1 ,$14.20 ,$9.37 ,$6.96 ,$14.20 , N/A ,$12.73 ,$12.73 , N/A ,$11.36 ,$12.07 ,$8.88 ,$12.78 , N/A , N/A ,$13.49 ,$12.78 ,$12.07 ,$12.07 , N/A ,$12.07 ,$12.07 ,$12.78 ,$8.65 , N/A , N/A , N/A ,$12.78 , N/A ,$13.06 ,$12.78 ,$9.37 ,$9.37 ,$8.65 ,$9.37 ,$9.23 ,$9.70 ,$14.05 ,$11.22 , N/A ,$6.96 ,$6.96 , N/A ,$6.96 ,$14.20 ,$13.49 ,$11.64 ,$11.64 ,$11.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VENLAFAXINE XR 75 MG CP24,637,1 ,$14.30 ,$9.44 ,$7.01 ,$14.30 , N/A ,$12.82 ,$12.82 , N/A ,$11.44 ,$12.16 ,$8.94 ,$12.87 , N/A , N/A ,$13.59 ,$12.87 ,$12.16 ,$12.16 , N/A ,$12.16 ,$12.16 ,$12.87 ,$8.71 , N/A , N/A , N/A ,$12.87 , N/A ,$13.16 ,$12.87 ,$9.44 ,$9.44 ,$8.71 ,$9.44 ,$9.30 ,$9.77 ,$14.15 ,$11.30 , N/A ,$7.01 ,$7.01 , N/A ,$7.01 ,$14.30 ,$13.59 ,$11.73 ,$11.73 ,$11.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MINERAL OIL OIL,637,1 ,$14.30 ,$9.44 ,$7.01 ,$14.30 , N/A ,$12.82 ,$12.82 , N/A ,$11.44 ,$12.16 ,$8.94 ,$12.87 , N/A , N/A ,$13.59 ,$12.87 ,$12.16 ,$12.16 , N/A ,$12.16 ,$12.16 ,$12.87 ,$8.71 , N/A , N/A , N/A ,$12.87 , N/A ,$13.16 ,$12.87 ,$9.44 ,$9.44 ,$8.71 ,$9.44 ,$9.30 ,$9.77 ,$14.15 ,$11.30 , N/A ,$7.01 ,$7.01 , N/A ,$7.01 ,$14.30 ,$13.59 ,$11.73 ,$11.73 ,$11.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TETRAHYDROZOLINE 0.05 % SOLN 15 ML BOTTLE,637,1 ,$14.30 ,$9.44 ,$7.01 ,$14.30 , N/A ,$12.82 ,$12.82 , N/A ,$11.44 ,$12.16 ,$8.94 ,$12.87 , N/A , N/A ,$13.59 ,$12.87 ,$12.16 ,$12.16 , N/A ,$12.16 ,$12.16 ,$12.87 ,$8.71 , N/A , N/A , N/A ,$12.87 , N/A ,$13.16 ,$12.87 ,$9.44 ,$9.44 ,$8.71 ,$9.44 ,$9.30 ,$9.77 ,$14.15 ,$11.30 , N/A ,$7.01 ,$7.01 , N/A ,$7.01 ,$14.30 ,$13.59 ,$11.73 ,$11.73 ,$11.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,URSODIOL 250 MG TABS,637,1 ,$14.30 ,$9.44 ,$7.01 ,$14.30 , N/A ,$12.82 ,$12.82 , N/A ,$11.44 ,$12.16 ,$8.94 ,$12.87 , N/A , N/A ,$13.59 ,$12.87 ,$12.16 ,$12.16 , N/A ,$12.16 ,$12.16 ,$12.87 ,$8.71 , N/A , N/A , N/A ,$12.87 , N/A ,$13.16 ,$12.87 ,$9.44 ,$9.44 ,$8.71 ,$9.44 ,$9.30 ,$9.77 ,$14.15 ,$11.30 , N/A ,$7.01 ,$7.01 , N/A ,$7.01 ,$14.30 ,$13.59 ,$11.73 ,$11.73 ,$11.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VORICONAZOLE 200 MG TABS,637,1 ,$270.40 ,$178.46 ,$132.50 ,$270.40 , N/A ,$242.33 ,$242.33 , N/A ,$216.32 ,$229.84 ,$169.00 ,$243.36 , N/A , N/A ,$256.88 ,$243.36 ,$229.84 ,$229.84 , N/A ,$229.84 ,$229.84 ,$243.36 ,$164.67 , N/A , N/A , N/A ,$243.36 , N/A ,$248.77 ,$243.36 ,$178.49 ,$178.49 ,$164.67 ,$178.49 ,$175.76 ,$184.74 ,$267.64 ,$213.62 , N/A ,$132.50 ,$132.50 , N/A ,$132.50 ,$270.40 ,$256.88 ,$221.73 ,$221.73 ,$216.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZINC OXIDE 20 % OINT 28.4 G TUBE,637,1 ,$13.10 ,$8.65 ,$6.42 ,$13.10 , N/A ,$11.74 ,$11.74 , N/A ,$10.48 ,$11.14 ,$8.19 ,$11.79 , N/A , N/A ,$12.45 ,$11.79 ,$11.14 ,$11.14 , N/A ,$11.14 ,$11.14 ,$11.79 ,$7.98 , N/A , N/A , N/A ,$11.79 , N/A ,$12.05 ,$11.79 ,$8.65 ,$8.65 ,$7.98 ,$8.65 ,$8.52 ,$8.95 ,$12.97 ,$10.35 , N/A ,$6.42 ,$6.42 , N/A ,$6.42 ,$13.10 ,$12.45 ,$10.74 ,$10.74 ,$10.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMANTADINE 50 MG/5ML SOLN,637,1 ,$13.10 ,$8.65 ,$6.42 ,$13.10 , N/A ,$11.74 ,$11.74 , N/A ,$10.48 ,$11.14 ,$8.19 ,$11.79 , N/A , N/A ,$12.45 ,$11.79 ,$11.14 ,$11.14 , N/A ,$11.14 ,$11.14 ,$11.79 ,$7.98 , N/A , N/A , N/A ,$11.79 , N/A ,$12.05 ,$11.79 ,$8.65 ,$8.65 ,$7.98 ,$8.65 ,$8.52 ,$8.95 ,$12.97 ,$10.35 , N/A ,$6.42 ,$6.42 , N/A ,$6.42 ,$13.10 ,$12.45 ,$10.74 ,$10.74 ,$10.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZINC OXIDE 20 % OINT 57 G TUBE,637,1 ,$12.80 ,$8.45 ,$6.27 ,$12.80 , N/A ,$11.47 ,$11.47 , N/A ,$10.24 ,$10.88 ,$8.00 ,$11.52 , N/A , N/A ,$12.16 ,$11.52 ,$10.88 ,$10.88 , N/A ,$10.88 ,$10.88 ,$11.52 ,$7.80 , N/A , N/A , N/A ,$11.52 , N/A ,$11.78 ,$11.52 ,$8.45 ,$8.45 ,$7.80 ,$8.45 ,$8.32 ,$8.75 ,$12.67 ,$10.11 , N/A ,$6.27 ,$6.27 , N/A ,$6.27 ,$12.80 ,$12.16 ,$10.50 ,$10.50 ,$10.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZIPRASIDONE 20 MG CAPS,637,1 ,$28.80 ,$19.01 ,$14.11 ,$28.80 , N/A ,$25.81 ,$25.81 , N/A ,$23.04 ,$24.48 ,$18.00 ,$25.92 , N/A , N/A ,$27.36 ,$25.92 ,$24.48 ,$24.48 , N/A ,$24.48 ,$24.48 ,$25.92 ,$17.54 , N/A , N/A , N/A ,$25.92 , N/A ,$26.50 ,$25.92 ,$19.01 ,$19.01 ,$17.54 ,$19.01 ,$18.72 ,$19.68 ,$28.51 ,$22.75 , N/A ,$14.11 ,$14.11 , N/A ,$14.11 ,$28.80 ,$27.36 ,$23.62 ,$23.62 ,$23.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZIPRASIDONE 80 MG CAPS,637,1 ,$104.80 ,$69.17 ,$51.35 ,$104.80 , N/A ,$93.92 ,$93.92 , N/A ,$83.84 ,$89.08 ,$65.50 ,$94.32 , N/A , N/A ,$99.56 ,$94.32 ,$89.08 ,$89.08 , N/A ,$89.08 ,$89.08 ,$94.32 ,$63.82 , N/A , N/A , N/A ,$94.32 , N/A ,$96.42 ,$94.32 ,$69.18 ,$69.18 ,$63.82 ,$69.18 ,$68.12 ,$71.60 ,$103.73 ,$82.79 , N/A ,$51.35 ,$51.35 , N/A ,$51.35 ,$104.80 ,$99.56 ,$85.94 ,$85.94 ,$83.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZONISAMIDE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IRON POLYSACCHARIDES 150 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ISONIAZID 300 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ISOSORBIDE DINITRATE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ISOSORBIDE MONONITRATE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ISOSORBIDE MONONITRATE ER 30 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,KETOROLAC 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LABETALOL 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTASE 3000 UNITS TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTASE 9000 UNITS TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTOBACILLUS CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTOBACILLUS PACK,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTULOSE 10 GM/15ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTULOSE 10 GM/15ML SOLN 473 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LACTULOSE 20 GM/30ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DRY MOUTH LIQD 237 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DRY MOUTH LIQD 473 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ENALAPRIL 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ESTRADIOL 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ESTRADIOL 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ETHAMBUTOL 400 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FAMOTIDINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FENOFIBRATE 48 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FERROUS GLUCONATE 324 (38 FE) MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FERROUS SULFATE (65 MG ELEMENTAL) 325 (65 FE) MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FERROUS SULFATE 220 (44 FE) MG/5ML ELIX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FERROUS SULFATE EC 325 (65 FE) MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FISH OIL 1000 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FISH OIL 1000 MG CPDR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLECAINIDE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FLUDROCORTISONE 0.1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FOLIC ACID 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FUROSEMIDE 10 MG/ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FUROSEMIDE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,FUROSEMIDE 40 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 100 MG CAPS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 250 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 300 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 300 MG CAPS 100 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GABAPENTIN 400 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GEMFIBROZIL 600 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLIMEPIRIDE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLIMEPIRIDE 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLIPIZIDE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLIPIZIDE XL 2.5 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYBURIDE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYBURIDE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYCERIN (ADULT) 2 G SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYCERIN (ADULT) 2.1 G SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYCERIN (PEDS/INFANT) 1 G SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYCERIN (PEDS/INFANT) 1.2 G SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYCERIN ADULT 5.4 GM/DOSE ENEM,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % SOLN 15 ML BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GUAIFENESIN 100 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GUAIFENESIN ER 600 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,GUAIFENESIN-CODEINE 100-10 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HALOPERIDOL 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HALOPERIDOL 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HALOPERIDOL 2 MG/ML CONC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HALOPERIDOL 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDRALAZINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDRALAZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCHLOROTHIAZIDE 12.5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCHLOROTHIAZIDE 12.5 MG CAPS 100 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCHLOROTHIAZIDE 12.5 MG CAPS 500 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCHLOROTHIAZIDE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCHLOROTHIAZIDE 25 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCODONE-ACETAMINOPHEN 10-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCODONE-ACETAMINOPHEN 5-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCODONE-ACETAMINOPHEN 7.5-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROCORTISONE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROMORPHONE 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROXYUREA 500 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROXYZINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROXYZINE 10 MG/5ML SYRP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYDROXYZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYOSCYAMINE 0.125 MG SUBL,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYOSCYAMINE 0.125 MG TBDP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,HYOSCYAMINE ER 0.375 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IBUPROFEN 100 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IBUPROFEN 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IBUPROFEN 600 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IBUPROFEN 800 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,IMIPRAMINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,INDAPAMIDE 1.25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,INDAPAMIDE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,INDOMETHACIN 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVETIRACETAM 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVETIRACETAM 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 100 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 100 MCG TABS 90 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 112 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 25 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 25 MCG TABS 100 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 50 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LEVOTHYROXINE 88 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LIOTHYRONINE 5 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 10 MG TABS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 20 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 20 MG TABS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LISINOPRIL 5 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LITHIUM 150 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LITHIUM 300 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LITHIUM CR 300 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LITHIUM CR 450 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOPERAMIDE 1 MG/7.5ML LIQD,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOPERAMIDE 2 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LORAZEPAM 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LORAZEPAM 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOSARTAN 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOSARTAN 25 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOSARTAN 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,LOSARTAN 50 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MAGNESIUM CHLORIDE EC 64 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MAGNESIUM HYDROXIDE 400 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MAGNESIUM OXIDE 400 (241.3 MG) MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MAGNESIUM OXIDE 400 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MAGNESIUM-ALUMINUM-SIMETHICONE 400-400-40 MG/5ML SUSP 30 ML CUP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MECLIZINE 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MECLIZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MEDROXYPROGESTERONE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MELATONIN 3 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MELATONIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MEMANTINE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METFORMIN 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METFORMIN 850 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHADONE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHADONE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHIMAZOLE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHOCARBAMOL 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METHYLPHENIDATE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOCLOPRAMIDE 1 MG/ML 10 MG/10ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOCLOPRAMIDE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOCLOPRAMIDE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOPROLOL SUCCINATE ER 100 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOPROLOL SUCCINATE ER 25 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOPROLOL SUCCINATE ER 50 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOPROLOL TARTRATE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOPROLOL TARTRATE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METOPROLOL TARTRATE 50 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METRONIDAZOLE 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,METRONIDAZOLE 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MIDODRINE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MINOCYCLINE 50 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MISOPROSTOL 200 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MORPHINE 15 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MORPHINE CR 15 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MULTI VITAMIN/MINERALS TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MULTIPLE VITAMINS-MINERALS CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MULTIVITAMIN LIQD,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,MULTIVITAMIN WITH MINERALS LIQD,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NAPROXEN 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NATEGLINIDE 60 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-5000 OINT 1 EACH BOX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-5000 OINT 1 EACH PACKET,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NIACIN 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NIACIN CR 500 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NICOTINE 14 MG/24HR PT24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NICOTINE 7 MG/24HR PT24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NICOTINE POLACRILEX 2 MG GUM,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NIFEDIPINE 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NIFEDIPINE ER 30 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NIFEDIPINE XL 30 MG TB24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITROGLYCERIN 0.1 MG/HR PT24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITROGLYCERIN 0.2 MG/HR PT24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITROGLYCERIN 0.4 MG SUBL,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITROGLYCERIN 0.4 MG/HR PT24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NITROGLYCERIN 2 % OINT,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NORTRIPTYLINE 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,NORTRIPTYLINE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXCARBAZEPINE 150 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXCARBAZEPINE 300 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYBUTYNIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE IMMEDIATE RELEASE 15 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE IMMEDIATE RELEASE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OXYCODONE-ACETAMINOPHEN 5-325 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,OYSTER SHELL CALCIUM 500 MG (ELEMENTAL) 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 5000-24000 UNITS CPEP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PANCRELIPASE (LIP-PROT-AMYL) 6000 UNIT CPEP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PAROXETINE 10 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PENICILLIN VK 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PENTOXIFYLLINE CR 400 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENOBARBITAL 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENOBARBITAL 32.4 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENYTOIN 125 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PHENYTOIN ER 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POLYCARBOPHIL 625 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POLYVINYL ALCOHOL 1% - POVIDONE 0.6% 1.4-0.6 % SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POTASSIUM  AND  SODIUM PHOSPHATES 280-160-250 MG PACK,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ TBEF,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POTASSIUM CHLORIDE CR 10 MEQ TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,POTASSIUM CHLORIDE CR 20 MEQ TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAZOSIN 1 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRAZOSIN 5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRENATAL VITAMIN (LOW IRON) 27-0.8 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRENATAL VITAMIN 27-1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRIMIDONE 250 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PRIMIDONE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROBENECID 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROCHLORPERAZINE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROMETHAZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROPAFENONE 150 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROPRANOLOL 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PROPRANOLOL 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PSEUDOEPHEDRINE 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PSEUDOEPHEDRINE ER 120 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PSYLLIUM 100 % PACK,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PSYLLIUM 28 % PACK,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PSYLLIUM 58.12 % PACK,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PSYLLIUM SUGAR FREE 58.6 % PACK,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,PYRIDOSTIGMINE 60 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RANOLAZINE ER 500 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,RIFAMPIN 300 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ROPINIROLE 0.25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ROPINIROLE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SACCHAROMYCES BOULARDII 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SALINE (FLEET) PEDIATRIC 3.5-9.5 GM/59ML ENEM,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SALINE ENEMA ADULT 7-19 GM/118ML ENEM,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SELEGILINE 5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SENNA 176 MG/5 ML SYRP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SENNA 8.6 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SENNA-DOCUSATE 8.6-50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SERTRALINE 20 MG/ML CONC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SERTRALINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SIMETHICONE 80 MG CHEW,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SODIUM BICARBONATE 650 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SODIUM CHLORIDE 1 GM TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SORBITOL 70 % SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SOTALOL 80 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SPIRONOLACTONE 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SPIRONOLACTONE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SUCRALFATE 1 G TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,SULFASALAZINE 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TAMOXIFEN 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TERAZOSIN 1 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TERAZOSIN 5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TETRACAINE HCL POWD,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,THIORIDAZINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,THYROID 120 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,THYROID 60 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TIZANIDINE 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TOPIRAMATE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TORSEMIDE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TORSEMIDE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRAMADOL 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRAZODONE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5-25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,TRIMETHOPRIM 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VALPROIC ACID 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VALPROIC ACID 250 MG/5ML SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VENLAFAXINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VENLAFAXINE 37.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VENLAFAXINE 75 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VERAPAMIL 120 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VERAPAMIL 120 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VERAPAMIL 180 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VERAPAMIL 40 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VERAPAMIL 80 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN A 3 MG (10000 UT) CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN B-1 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN B-12 100 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN B-12 1000 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN B-12 500 MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN B-2 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN B-6 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN C 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN D2 (ERGOCALCIFEROL) 50000 UNITS CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN D3 (CHOLECALCIFEROL) 1.25 MG (50000 UT) CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN D3 (CHOLECALCIFEROL) 10 MCG (400 UNIT) TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN D3 (CHOLECALCIFEROL) 1000 UNIT TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN D3 (CHOLECALCIFEROL) 5000 UNITS CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN E 100 UNIT CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN E 180 MG (400 UNIT) CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN E 400 UNIT CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,VITAMIN E 45 MG (100 UNIT) CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,WARFARIN 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,WARFARIN 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,WARFARIN 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,WARFARIN 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,WHITE PETROLEUM GEL 28.25 G TUBE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZINC SULFATE 220 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ZOLPIDEM 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALPRAZOLAM 0.25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALPRAZOLAM 0.25 MG TBDP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALPRAZOLAM 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALPRAZOLAM 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMANTADINE 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMIODARONE 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMITRIPTYLINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMITRIPTYLINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMITRIPTYLINE 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMLODIPINE 2.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMLODIPINE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMLODIPINE 5 MG TABS 1 EACH BLISTER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN 250 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN 400 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN 500 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMOXICILLIN 875 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AMPHETAMINE-DEXTROAMPHETAMINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ASPIRIN 300 MG SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ASPIRIN 325 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ASPIRIN 81 MG CHEW,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ASPIRIN EC 325 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ASPIRIN EC 81 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ASPIRIN-ACETAMINOPHEN-CAFFEINE 250-250-65 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATENOLOL 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATENOLOL 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATENOLOL 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ATORVASTATIN 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,AZITHROMYCIN 200 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,B COMPLEX-C TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,B COMPLEX-C-FOLIC ACID 0.8 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BACITRACIN 500 UNIT/GM OINT 1 EACH PACKET,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,"BENADRYL,MAALOX,LIDOCAINE 0.68%,SIMETHICONE SUSP",637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BENZOCAINE-MENTHOL 15-3.6 MG LOZG,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BENZOCAINE-MENTHOL 6-10 MG LOZG,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BENZTROPINE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BETAMETHASONE VALERATE OINTMENT 0.1 % OINT 15 G TUBE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BISACODYL 10 MG SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BISACODYL EC 5 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BISMUTH SUBSALICYLATE 262 MG/15ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUMETANIDE 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPROPION 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPROPION 75 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPROPION SR 100 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUPROPION SR 150 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUSPIRONE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUSPIRONE 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50-325-40 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCITRIOL 0.25 MCG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCIUM ACETATE (PHOS BINDER) 667 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCIUM ACETATE 667 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCIUM CARBONATE 500 MG CHEW,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCIUM CARBONATE-VITAMIN D 500-5 MG-MCG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CALCIUM CITRATE-VITAMIN D 315 MG-250 UNIT 315-250 MG-UNIT TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CAPTOPRIL 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBAMAZEPINE 100 MG CHEW,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBAMAZEPINE 100 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBAMAZEPINE 200 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBAMAZEPINE XR 100 MG TB12,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA-LEVODOPA 10-100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA-LEVODOPA 25-100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA-LEVODOPA 25-100 MG TBDP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA-LEVODOPA 25-250 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA-LEVODOPA CR 25-100 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBIDOPA-LEVODOPA CR 50-200 MG TBCR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBOXYMETHYLCELLULOSE 0.5 % SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBOXYMETHYLCELLULOSE PF 0.5 % SOLN,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARBOXYMETHYLCELLULOSE PF 1 % GEL,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARISOPRODOL 350 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARVEDILOL 12.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARVEDILOL 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARVEDILOL 3.125 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CARVEDILOL 6.25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CEPHALEXIN 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CEPHALEXIN 250 MG/5ML SUSR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHERRY SYRUP SYRP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHILDREN'S MULTIVITAMIN CHEW,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHLORDIAZEPOXIDE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHLORDIAZEPOXIDE 5 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CHOLECALCIFEROL 125 MCG (5000 UT) TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CILOSTAZOL 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CILOSTAZOL 50 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLINDAMYCIN 150 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLONAZEPAM 0.5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLONAZEPAM 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CLONIDINE 0.1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,COLESTIPOL 1 G TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,CYCLOBENZAPRINE 10 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DESIPRAMINE 25 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DEXTROMETHORPHAN ER 30 MG/5ML SUER,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIAZEPAM 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIAZEPAM 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DICLOFENAC EC 50 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DICLOFENAC EC 75 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DICLOXACILLIN 250 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DICYCLOMINE 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DICYCLOMINE 20 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIGOXIN 0.125 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DILTIAZEM 30 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DILTIAZEM CD 120 MG CP24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DILTIAZEM CD 180 MG CP24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DILTIAZEM XR 180 MG CP24,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPHENHYDRAMINE 12.5 MG/5ML LIQD,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPHENHYDRAMINE 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPHENHYDRAMINE 25 MG CAPS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIPHENOXYLATE-ATROPINE 2.5-0.025 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIVALPROEX DR SPRINKLE 125 MG CSDR,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIVALPROEX EC 125 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DIVALPROEX EC 250 MG TBEC,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOCUSATE 50 MG/5ML LIQD,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOCUSATE CALCIUM 240 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOCUSATE SODIUM 100 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DONEPEZIL 5 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXAZOSIN 1 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXAZOSIN 2 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXAZOSIN 4 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXEPIN 10 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXEPIN 25 MG CAPS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,DOXYCYCLINE 50 MG/5ML SYRP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 120 MG SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 160 MG/5ML SUSP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 325 MG SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 325 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 500 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,"ACETAMINOPHEN 500 MG TABS 1,000 EACH BOTTLE",637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 500 MG TABS 100 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 500 MG TABS 100 EACH BOX,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 500 MG TABS 700 EACH BOTTLE,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN 650 MG SUPP,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACETAMINOPHEN-CODEINE 300-30 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ACYCLOVIR 400 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALLOPURINOL 100 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),63700001,N/A,ALLOPURINOL 300 MG TABS,637,1 ,$8.00 ,$5.28 ,$3.92 ,$8.00 , N/A ,$7.17 ,$7.17 , N/A ,$6.40 ,$6.80 ,$5.00 ,$7.20 , N/A , N/A ,$7.60 ,$7.20 ,$6.80 ,$6.80 , N/A ,$6.80 ,$6.80 ,$7.20 ,$4.87 , N/A , N/A , N/A ,$7.20 , N/A ,$7.36 ,$7.20 ,$5.28 ,$5.28 ,$4.87 ,$5.28 ,$5.20 ,$5.47 ,$7.92 ,$6.32 , N/A ,$3.92 ,$3.92 , N/A ,$3.92 ,$8.00 ,$7.60 ,$6.56 ,$6.56 ,$6.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),68200002,N/A,HC LEVEL 2 TRAUMA ACTIVATION <30 MINS,682,1 ,"$3,348.80 ","$2,210.21 ",$762.36 ,"$3,348.80 ", N/A ,"$3,001.19 ","$3,001.19 ",$886.10 ,"$2,679.04 ","$2,846.48 ","$2,093.00 ","$3,013.92 ", N/A , N/A ,"$3,181.36 ","$3,013.92 ","$2,846.48 ","$2,846.48 ",$886.10 ,"$2,846.48 ","$2,846.48 ","$3,013.92 ","$2,039.42 ", N/A ,"$2,076.26 ", N/A ,"$3,013.92 ", N/A ,"$3,080.90 ","$3,013.92 ","$2,210.54 ","$2,210.54 ","$2,039.42 ","$2,210.54 ","$2,176.72 ","$2,287.90 ",$762.36 ,"$2,645.55 ", N/A ,"$1,640.91 ","$1,640.91 ",$886.10 ,"$1,640.91 ", N/A ,"$3,181.36 ","$2,746.02 ","$2,746.02 ","$2,679.04 "
ST. CLARE MEMORIAL HOSPITAL (ACU),68400002,G0390,HC LEVEL 2 TRAUMA  ACTIVATION,684,1 ,"$3,348.80 ","$2,210.21 ",$237.38 ,"$3,348.80 ",$237.38 ,"$3,001.19 ","$3,001.19 ",$886.10 ,"$2,679.04 ","$2,846.48 ","$2,093.00 ","$3,013.92 ",$237.38 ,$237.38 ,"$3,181.36 ","$3,013.92 ","$2,846.48 ","$2,846.48 ",$886.10 ,"$2,846.48 ","$2,846.48 ","$3,013.92 ","$2,039.42 ",$237.38 ,"$2,076.26 ",$251.62 ,"$3,013.92 ", N/A ,"$3,080.90 ","$3,013.92 ","$2,210.54 ","$2,210.54 ","$2,039.42 ","$2,210.54 ","$2,176.72 ","$2,287.90 ",$762.36 ,"$2,645.55 ",$251.62 ,"$1,640.91 ","$1,640.91 ",$886.10 ,"$1,640.91 ", N/A ,"$3,181.36 ","$2,746.02 ","$2,746.02 ","$2,679.04 "
ST. CLARE MEMORIAL HOSPITAL (ACU),71000006,N/A,HC SHORT STAY EXTENDED,710,1 ,$701.72 ,$463.14 ,$159.75 ,$701.72 , N/A ,$628.88 ,$628.88 ,$185.67 ,$561.38 ,$596.46 ,$438.58 ,$631.55 , N/A , N/A ,$666.63 ,$631.55 ,$596.46 ,$596.46 ,$185.67 ,$596.46 ,$596.46 ,$631.55 ,$427.35 , N/A ,$435.06 , N/A ,$631.55 , N/A ,$645.58 ,$631.55 ,$463.21 ,$463.21 ,$427.35 ,$463.21 ,$456.12 ,$479.42 ,$159.75 ,$554.36 , N/A ,$343.84 ,$343.84 ,$185.67 ,$343.84 , N/A ,$666.63 ,$575.41 ,$575.41 ,$561.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000055,N/A,HC RECOVERY PHASE I,710,1 ,$101.68 ,$67.11 ,$23.15 ,$101.68 , N/A ,$91.13 ,$91.13 ,$26.90 ,$81.34 ,$86.43 ,$63.55 ,$91.51 , N/A , N/A ,$96.60 ,$91.51 ,$86.43 ,$86.43 ,$26.90 ,$86.43 ,$86.43 ,$91.51 ,$61.92 , N/A ,$63.04 , N/A ,$91.51 , N/A ,$93.55 ,$91.51 ,$67.12 ,$67.12 ,$61.92 ,$67.12 ,$66.09 ,$69.47 ,$23.15 ,$80.33 , N/A ,$49.82 ,$49.82 ,$26.90 ,$49.82 , N/A ,$96.60 ,$83.38 ,$83.38 ,$81.34 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000056,N/A,HC RECOVERY PHASE II,710,1 ,$75.89 ,$50.09 ,$17.27 ,$75.89 , N/A ,$68.01 ,$68.01 ,$20.08 ,$60.71 ,$64.51 ,$47.43 ,$68.30 , N/A , N/A ,$72.10 ,$68.30 ,$64.51 ,$64.51 ,$20.08 ,$64.51 ,$64.51 ,$68.30 ,$46.22 , N/A ,$47.06 , N/A ,$68.30 , N/A ,$69.82 ,$68.30 ,$50.10 ,$50.10 ,$46.22 ,$50.10 ,$49.33 ,$51.85 ,$17.27 ,$59.95 , N/A ,$37.19 ,$37.19 ,$20.08 ,$37.19 , N/A ,$72.10 ,$62.23 ,$62.23 ,$60.71 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000100,N/A,HC SHORT STAY 1 HR SURGERY,710,1 ,"$1,224.30 ",$808.04 ,$278.72 ,"$1,224.30 ", N/A ,"$1,097.22 ","$1,097.22 ",$323.95 ,$979.44 ,"$1,040.66 ",$765.19 ,"$1,101.87 ", N/A , N/A ,"$1,163.09 ","$1,101.87 ","$1,040.66 ","$1,040.66 ",$323.95 ,"$1,040.66 ","$1,040.66 ","$1,101.87 ",$745.60 , N/A ,$759.06 , N/A ,"$1,101.87 ", N/A ,"$1,126.36 ","$1,101.87 ",$808.16 ,$808.16 ,$745.60 ,$808.16 ,$795.80 ,$836.44 ,$278.72 ,$967.20 , N/A ,$599.91 ,$599.91 ,$323.95 ,$599.91 , N/A ,"$1,163.09 ","$1,003.93 ","$1,003.93 ",$979.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000101,N/A,HC SHORT STAY ADDN HR SURGERY,710,1 ,$467.46 ,$308.52 ,$106.43 ,$467.46 , N/A ,$418.94 ,$418.94 ,$123.69 ,$373.97 ,$397.34 ,$292.16 ,$420.71 , N/A , N/A ,$444.09 ,$420.71 ,$397.34 ,$397.34 ,$123.69 ,$397.34 ,$397.34 ,$420.71 ,$284.68 , N/A ,$289.82 , N/A ,$420.71 , N/A ,$430.06 ,$420.71 ,$308.57 ,$308.57 ,$284.68 ,$308.57 ,$303.85 ,$319.37 ,$106.43 ,$369.29 , N/A ,$229.06 ,$229.06 ,$123.69 ,$229.06 , N/A ,$444.09 ,$383.32 ,$383.32 ,$373.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000102,N/A,HC SHORT STAY 5 > HR SURGERY,710,1 ,$467.46 ,$308.52 ,$106.43 ,$467.46 , N/A ,$418.94 ,$418.94 ,$123.69 ,$373.97 ,$397.34 ,$292.16 ,$420.71 , N/A , N/A ,$444.09 ,$420.71 ,$397.34 ,$397.34 ,$123.69 ,$397.34 ,$397.34 ,$420.71 ,$284.68 , N/A ,$289.82 , N/A ,$420.71 , N/A ,$430.06 ,$420.71 ,$308.57 ,$308.57 ,$284.68 ,$308.57 ,$303.85 ,$319.37 ,$106.43 ,$369.29 , N/A ,$229.06 ,$229.06 ,$123.69 ,$229.06 , N/A ,$444.09 ,$383.32 ,$383.32 ,$373.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000200,N/A,HC RECOVERY CLASS 2 INIT,710,1 ,$701.72 ,$463.14 ,$159.75 ,$701.72 , N/A ,$628.88 ,$628.88 ,$185.67 ,$561.38 ,$596.46 ,$438.58 ,$631.55 , N/A , N/A ,$666.63 ,$631.55 ,$596.46 ,$596.46 ,$185.67 ,$596.46 ,$596.46 ,$631.55 ,$427.35 , N/A ,$435.06 , N/A ,$631.55 , N/A ,$645.58 ,$631.55 ,$463.21 ,$463.21 ,$427.35 ,$463.21 ,$456.12 ,$479.42 ,$159.75 ,$554.36 , N/A ,$343.84 ,$343.84 ,$185.67 ,$343.84 , N/A ,$666.63 ,$575.41 ,$575.41 ,$561.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000201,N/A,HC RECOVERY CLASS 2 ADDL,710,1 ,$467.46 ,$308.52 ,$106.43 ,$467.46 , N/A ,$418.94 ,$418.94 ,$123.69 ,$373.97 ,$397.34 ,$292.16 ,$420.71 , N/A , N/A ,$444.09 ,$420.71 ,$397.34 ,$397.34 ,$123.69 ,$397.34 ,$397.34 ,$420.71 ,$284.68 , N/A ,$289.82 , N/A ,$420.71 , N/A ,$430.06 ,$420.71 ,$308.57 ,$308.57 ,$284.68 ,$308.57 ,$303.85 ,$319.37 ,$106.43 ,$369.29 , N/A ,$229.06 ,$229.06 ,$123.69 ,$229.06 , N/A ,$444.09 ,$383.32 ,$383.32 ,$373.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000202,N/A,HC RECOVERY CLASS 3 INIT,710,1 ,$934.92 ,$617.05 ,$212.84 ,$934.92 , N/A ,$837.88 ,$837.88 ,$247.38 ,$747.94 ,$794.68 ,$584.33 ,$841.43 , N/A , N/A ,$888.17 ,$841.43 ,$794.68 ,$794.68 ,$247.38 ,$794.68 ,$794.68 ,$841.43 ,$569.37 , N/A ,$579.66 , N/A ,$841.43 , N/A ,$860.13 ,$841.43 ,$617.14 ,$617.14 ,$569.37 ,$617.14 ,$607.70 ,$638.74 ,$212.84 ,$738.59 , N/A ,$458.11 ,$458.11 ,$247.38 ,$458.11 , N/A ,$888.17 ,$766.63 ,$766.63 ,$747.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000203,N/A,HC RECOVERY CLASS 3 ADDL,710,1 ,$467.46 ,$308.52 ,$106.43 ,$467.46 , N/A ,$418.94 ,$418.94 ,$123.69 ,$373.97 ,$397.34 ,$292.16 ,$420.71 , N/A , N/A ,$444.09 ,$420.71 ,$397.34 ,$397.34 ,$123.69 ,$397.34 ,$397.34 ,$420.71 ,$284.68 , N/A ,$289.82 , N/A ,$420.71 , N/A ,$430.06 ,$420.71 ,$308.57 ,$308.57 ,$284.68 ,$308.57 ,$303.85 ,$319.37 ,$106.43 ,$369.29 , N/A ,$229.06 ,$229.06 ,$123.69 ,$229.06 , N/A ,$444.09 ,$383.32 ,$383.32 ,$373.97 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000204,N/A,HC RECOVERY CLASS 4 INIT,710,1 ,"$1,224.30 ",$808.04 ,$278.72 ,"$1,224.30 ", N/A ,"$1,097.22 ","$1,097.22 ",$323.95 ,$979.44 ,"$1,040.66 ",$765.19 ,"$1,101.87 ", N/A , N/A ,"$1,163.09 ","$1,101.87 ","$1,040.66 ","$1,040.66 ",$323.95 ,"$1,040.66 ","$1,040.66 ","$1,101.87 ",$745.60 , N/A ,$759.06 , N/A ,"$1,101.87 ", N/A ,"$1,126.36 ","$1,101.87 ",$808.16 ,$808.16 ,$745.60 ,$808.16 ,$795.80 ,$836.44 ,$278.72 ,$967.20 , N/A ,$599.91 ,$599.91 ,$323.95 ,$599.91 , N/A ,"$1,163.09 ","$1,003.93 ","$1,003.93 ",$979.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),71000205,N/A,HC RECOVERY CLASS 4 ADDL,710,1 ,$701.72 ,$463.14 ,$159.75 ,$701.72 , N/A ,$628.88 ,$628.88 ,$185.67 ,$561.38 ,$596.46 ,$438.58 ,$631.55 , N/A , N/A ,$666.63 ,$631.55 ,$596.46 ,$596.46 ,$185.67 ,$596.46 ,$596.46 ,$631.55 ,$427.35 , N/A ,$435.06 , N/A ,$631.55 , N/A ,$645.58 ,$631.55 ,$463.21 ,$463.21 ,$427.35 ,$463.21 ,$456.12 ,$479.42 ,$159.75 ,$554.36 , N/A ,$343.84 ,$343.84 ,$185.67 ,$343.84 , N/A ,$666.63 ,$575.41 ,$575.41 ,$561.38 
ST. CLARE MEMORIAL HOSPITAL (ACU),73000002,93005,HC EKG,730,1 ,$232.30 ,$153.32 ,$49.68 ,$232.30 ,$49.68 ,$208.19 ,$208.19 ,$61.47 ,$185.84 ,$197.46 ,$145.19 ,$209.07 ,$49.68 ,$49.68 ,$220.69 ,$209.07 ,$197.46 ,$197.46 ,$61.47 ,$197.46 ,$197.46 ,$209.07 ,$141.47 ,$49.68 ,$144.02 ,$52.66 ,$209.07 ,$129.33 ,$213.72 ,$209.07 ,$153.34 ,$153.34 ,$141.47 ,$153.34 ,$151.00 ,$158.71 ,$52.88 ,$183.52 ,$52.66 ,$108.00 ,$108.00 ,$61.47 ,$114.00 ,$57.48 ,$220.69 ,$190.49 ,$190.49 ,$185.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$566.95 ,$374.19 ,$116.11 ,$566.95 ,$124.66 ,$508.10 ,$508.10 ,$150.02 ,$453.56 ,$481.91 ,$354.34 ,$510.26 ,$124.66 ,$124.66 ,$538.60 ,$510.26 ,$481.91 ,$481.91 ,$150.02 ,$481.91 ,$481.91 ,$510.26 ,$345.27 ,$124.66 ,$351.50 ,$132.14 ,$510.26 ,$261.25 ,$521.59 ,$510.26 ,$374.24 ,$374.24 ,$345.27 ,$374.24 ,$368.52 ,$387.34 ,$129.07 ,$447.89 ,$132.14 ,$462.00 ,$462.00 ,$150.02 ,$499.00 ,$116.11 ,$538.60 ,$464.90 ,$464.90 ,$453.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100001,93226,HC HOLTER SCAN  AND  REPORT 24 HR,731,1 ,$721.05 ,$475.89 ,$116.11 ,$721.05 ,$124.66 ,$646.21 ,$646.21 ,$190.79 ,$576.84 ,$612.89 ,$450.66 ,$648.95 ,$124.66 ,$124.66 ,$685.00 ,$648.95 ,$612.89 ,$612.89 ,$190.79 ,$612.89 ,$612.89 ,$648.95 ,$439.12 ,$124.66 ,$447.06 ,$132.14 ,$648.95 ,$261.25 ,$663.37 ,$648.95 ,$475.97 ,$475.97 ,$439.12 ,$475.97 ,$468.68 ,$492.62 ,$164.15 ,$569.63 ,$132.14 ,$462.00 ,$462.00 ,$190.79 ,$499.00 ,$116.11 ,$685.00 ,$591.26 ,$591.26 ,$576.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100002,93226,HC HOLTER SCAN  AND  REPORT 48 HR,731,1 ,$824.55 ,$544.20 ,$116.11 ,$824.55 ,$124.66 ,$738.96 ,$738.96 ,$218.18 ,$659.64 ,$700.87 ,$515.34 ,$742.10 ,$124.66 ,$124.66 ,$783.32 ,$742.10 ,$700.87 ,$700.87 ,$218.18 ,$700.87 ,$700.87 ,$742.10 ,$502.15 ,$124.66 ,$511.22 ,$132.14 ,$742.10 ,$261.25 ,$758.59 ,$742.10 ,$544.29 ,$544.29 ,$502.15 ,$544.29 ,$535.96 ,$563.33 ,$187.72 ,$651.39 ,$132.14 ,$462.00 ,$462.00 ,$218.18 ,$499.00 ,$116.11 ,$783.32 ,$676.13 ,$676.13 ,$659.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,$322.00 ,$212.52 ,$35.00 ,$322.00 ,$124.66 ,$288.58 ,$288.58 ,$85.20 ,$257.60 ,$273.70 ,$201.25 ,$289.80 ,$124.66 ,$124.66 ,$305.90 ,$289.80 ,$273.70 ,$273.70 ,$85.20 ,$273.70 ,$273.70 ,$289.80 ,$196.10 ,$124.66 ,$199.64 ,$132.14 ,$289.80 ,$78.75 ,$296.24 ,$289.80 ,$212.55 ,$212.55 ,$196.10 ,$212.55 ,$209.30 ,$219.99 ,$73.30 ,$254.38 ,$132.14 ,$322.00 ,$322.00 ,$85.20 ,$322.00 ,$35.00 ,$305.90 ,$264.04 ,$264.04 ,$257.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),73100005,93271,HC CARDIAC EVENT MONITOR,731,1 ,$966.00 ,$637.56 ,$99.81 ,$966.00 ,$124.66 ,$865.73 ,$865.73 ,$255.60 ,$772.80 ,$821.10 ,$603.75 ,$869.40 ,$124.66 ,$124.66 ,$917.70 ,$869.40 ,$821.10 ,$821.10 ,$255.60 ,$821.10 ,$821.10 ,$869.40 ,$588.29 ,$124.66 ,$598.92 ,$132.14 ,$869.40 ,$224.57 ,$888.72 ,$869.40 ,$637.66 ,$637.66 ,$588.29 ,$637.66 ,$627.90 ,$659.97 ,$219.91 ,$763.14 ,$132.14 ,$462.00 ,$462.00 ,$255.60 ,$499.00 ,$99.81 ,$917.70 ,$792.12 ,$792.12 ,$772.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),73130072,73130,HC HAND 3 VIEW-PRV 72 HR,320,1 ,$368.10 ,$242.95 ,$83.80 ,$368.10 ,$105.66 ,$115.43 ,$94.31 ,$97.40 ,$294.48 ,$312.89 ,$230.06 ,$331.29 ,$105.66 ,$105.66 ,$349.70 ,$331.29 ,$312.89 ,$312.89 ,$97.40 ,$312.89 ,$312.89 ,$331.29 ,$224.17 ,$105.66 ,$228.22 ,$112.00 ,$331.29 ,$195.48 ,$338.65 ,$331.29 ,$242.98 ,$242.98 ,$224.17 ,$242.98 ,$239.27 ,$251.49 ,$83.80 ,$290.80 ,$112.00 ,$368.10 ,$368.10 ,$97.40 ,$368.10 ,$86.88 ,$349.70 ,$301.84 ,$301.84 ,$294.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),74000006,95810,HC SLEEP STUDY,740,1 ,"$4,779.33 ","$3,154.36 ",$934.38 ,"$4,779.33 ","$1,442.99 ","$3,337.00 ","$2,892.00 ","$1,264.61 ","$3,823.46 ","$4,062.43 ","$2,987.08 ","$4,301.40 ","$1,442.99 ","$1,442.99 ","$4,540.36 ","$4,301.40 ","$4,062.43 ","$4,062.43 ","$1,264.61 ","$4,062.43 ","$4,062.43 ","$4,301.40 ","$2,910.61 ","$1,442.99 ","$2,963.18 ","$1,529.57 ","$4,301.40 ","$2,102.36 ","$4,396.98 ","$4,301.40 ","$3,154.84 ","$3,154.84 ","$2,910.61 ","$3,154.84 ","$3,106.56 ","$3,265.24 ","$1,088.04 ","$3,775.67 ","$1,529.57 ","$1,257.00 ","$1,257.00 ","$1,264.61 ","$1,382.00 ",$934.38 ,"$4,540.36 ","$3,919.05 ","$3,919.05 ","$3,823.46 "
ST. CLARE MEMORIAL HOSPITAL (ACU),74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$5,091.02 ","$3,360.07 ",$934.38 ,"$5,091.02 ","$1,442.99 ","$3,337.00 ","$2,892.00 ","$1,347.09 ","$4,072.82 ","$4,327.37 ","$3,181.89 ","$4,581.92 ","$1,442.99 ","$1,442.99 ","$4,836.47 ","$4,581.92 ","$4,327.37 ","$4,327.37 ","$1,347.09 ","$4,327.37 ","$4,327.37 ","$4,581.92 ","$3,100.43 ","$1,442.99 ","$3,156.44 ","$1,529.57 ","$4,581.92 ","$2,102.36 ","$4,683.74 ","$4,581.92 ","$3,360.58 ","$3,360.58 ","$3,100.43 ","$3,360.58 ","$3,309.16 ","$3,478.18 ","$1,158.99 ","$4,021.91 ","$1,529.57 ","$1,257.00 ","$1,257.00 ","$1,347.09 ","$1,382.00 ",$934.38 ,"$4,836.47 ","$4,174.64 ","$4,174.64 ","$4,072.82 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000015,N/A,HC EGD/BIOPSY,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000025,N/A,HC EGD/SCLEROTHERAPY,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000032,N/A,HC HEMORRHOID BAND WITH SCOPE,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000073,N/A,HC SIGMOIDOSCOPY,750,1 ,"$2,114.70 ","$1,395.70 ",$481.42 ,"$2,114.70 ", N/A ,"$1,895.19 ","$1,895.19 ",$559.55 ,"$1,691.76 ","$1,797.50 ","$1,321.69 ","$1,903.23 ", N/A , N/A ,"$2,008.97 ","$1,903.23 ","$1,797.50 ","$1,797.50 ",$559.55 ,"$1,797.50 ","$1,797.50 ","$1,903.23 ","$1,287.85 ", N/A ,"$1,311.12 ", N/A ,"$1,903.23 ", N/A ,"$1,945.52 ","$1,903.23 ","$1,395.91 ","$1,395.91 ","$1,287.85 ","$1,395.91 ","$1,374.56 ","$1,444.76 ",$481.42 ,"$1,670.61 ", N/A , N/A , N/A ,$559.55 , N/A , N/A ,"$2,008.97 ","$1,734.05 ","$1,734.05 ","$1,691.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$2,070.00 ","$1,366.20 ",$471.24 ,"$2,070.00 ","$1,387.23 ","$1,855.13 ","$1,855.13 ",$547.72 ,"$1,656.00 ","$1,759.50 ","$1,293.75 ","$1,863.00 ","$1,387.23 ","$1,387.23 ","$1,966.50 ","$1,863.00 ","$1,759.50 ","$1,759.50 ",$547.72 ,"$1,759.50 ","$1,759.50 ","$1,863.00 ","$1,260.63 ","$1,387.23 ","$1,283.40 ","$1,470.46 ","$1,863.00 ","$1,857.40 ","$1,904.40 ","$1,863.00 ","$1,366.41 ","$1,366.41 ","$1,260.63 ","$1,366.41 ","$1,345.50 ","$1,414.22 ",$471.24 ,"$1,635.30 ","$1,470.46 ","$2,070.00 ","$2,070.00 ",$547.72 ,"$2,070.00 ",$825.51 ,"$1,966.50 ","$1,697.40 ","$1,697.40 ","$1,656.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000102,N/A,HC SECONDARY GI PROC COLONOSCOPY,750,1 ,"$2,337.30 ","$1,542.62 ",$532.10 ,"$2,337.30 ", N/A ,"$2,094.69 ","$2,094.69 ",$618.45 ,"$1,869.84 ","$1,986.71 ","$1,460.81 ","$2,103.57 ", N/A , N/A ,"$2,220.44 ","$2,103.57 ","$1,986.71 ","$1,986.71 ",$618.45 ,"$1,986.71 ","$1,986.71 ","$2,103.57 ","$1,423.42 ", N/A ,"$1,449.12 ", N/A ,"$2,103.57 ", N/A ,"$2,150.32 ","$2,103.57 ","$1,542.85 ","$1,542.85 ","$1,423.42 ","$1,542.85 ","$1,519.25 ","$1,596.84 ",$532.10 ,"$1,846.47 ", N/A , N/A , N/A ,$618.45 , N/A , N/A ,"$2,220.44 ","$1,916.59 ","$1,916.59 ","$1,869.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000103,N/A,HC SECONDARY GI PROC EGD,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000104,N/A,HC SECONDARY GI PROC ERCP,750,1 ,"$3,005.10 ","$1,983.37 ",$684.12 ,"$3,005.10 ", N/A ,"$2,693.17 ","$2,693.17 ",$795.15 ,"$2,404.08 ","$2,554.34 ","$1,878.19 ","$2,704.59 ", N/A , N/A ,"$2,854.85 ","$2,704.59 ","$2,554.34 ","$2,554.34 ",$795.15 ,"$2,554.34 ","$2,554.34 ","$2,704.59 ","$1,830.11 ", N/A ,"$1,863.16 ", N/A ,"$2,704.59 ", N/A ,"$2,764.69 ","$2,704.59 ","$1,983.67 ","$1,983.67 ","$1,830.11 ","$1,983.67 ","$1,953.32 ","$2,053.08 ",$684.12 ,"$2,374.03 ", N/A , N/A , N/A ,$795.15 , N/A , N/A ,"$2,854.85 ","$2,464.18 ","$2,464.18 ","$2,404.08 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000105,N/A,HC SECONDARY GI PROC EUS,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000106,N/A,HC SECONDARY GI PROC ENTEROSCOPY,750,1 ,"$2,337.30 ","$1,542.62 ",$532.10 ,"$2,337.30 ", N/A ,"$2,094.69 ","$2,094.69 ",$618.45 ,"$1,869.84 ","$1,986.71 ","$1,460.81 ","$2,103.57 ", N/A , N/A ,"$2,220.44 ","$2,103.57 ","$1,986.71 ","$1,986.71 ",$618.45 ,"$1,986.71 ","$1,986.71 ","$2,103.57 ","$1,423.42 ", N/A ,"$1,449.12 ", N/A ,"$2,103.57 ", N/A ,"$2,150.32 ","$2,103.57 ","$1,542.85 ","$1,542.85 ","$1,423.42 ","$1,542.85 ","$1,519.25 ","$1,596.84 ",$532.10 ,"$1,846.47 ", N/A , N/A , N/A ,$618.45 , N/A , N/A ,"$2,220.44 ","$1,916.59 ","$1,916.59 ","$1,869.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000107,N/A,HC SECONDARY PROCEDURE SIGMOIDOSCOPY,750,1 ,"$23,307.30 ","$15,382.82 ","$5,306.00 ","$23,307.30 ", N/A ,"$20,888.00 ","$20,888.00 ","$6,167.11 ","$18,645.84 ","$19,811.21 ","$14,567.06 ","$20,976.57 ", N/A , N/A ,"$22,141.94 ","$20,976.57 ","$19,811.21 ","$19,811.21 ","$6,167.11 ","$19,811.21 ","$19,811.21 ","$20,976.57 ","$14,194.15 ", N/A ,"$14,450.52 ", N/A ,"$20,976.57 ", N/A ,"$21,442.72 ","$20,976.57 ","$15,385.15 ","$15,385.15 ","$14,194.15 ","$15,385.15 ","$15,149.75 ","$15,923.55 ","$5,306.00 ","$18,412.77 ", N/A , N/A , N/A ,"$6,167.11 ", N/A , N/A ,"$22,141.94 ","$19,111.99 ","$19,111.99 ","$18,645.84 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75000510,49082,HC PARACENTESIS W/O IMAGING,750,1 ,"$2,793.35 ","$1,843.61 ",$635.91 ,"$2,793.35 ","$1,387.23 ","$2,503.40 ","$2,503.40 ",$739.12 ,"$2,234.68 ","$2,374.35 ","$1,745.84 ","$2,514.02 ","$1,387.23 ","$1,387.23 ","$2,653.68 ","$2,514.02 ","$2,374.35 ","$2,374.35 ",$739.12 ,"$2,374.35 ","$2,374.35 ","$2,514.02 ","$1,701.15 ","$1,387.23 ","$1,731.88 ","$1,470.46 ","$2,514.02 ","$1,857.40 ","$2,569.88 ","$2,514.02 ","$1,843.89 ","$1,843.89 ","$1,701.15 ","$1,843.89 ","$1,815.68 ","$1,908.42 ",$635.91 ,"$2,206.75 ","$1,470.46 ","$2,415.00 ","$2,415.00 ",$739.12 ,"$2,656.00 ",$825.51 ,"$2,653.68 ","$2,290.55 ","$2,290.55 ","$2,234.68 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001071,N/A,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001072,N/A,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$3,450.30 ","$2,277.20 ",$785.48 ,"$3,450.30 ", N/A ,"$3,092.16 ","$3,092.16 ",$912.95 ,"$2,760.24 ","$2,932.76 ","$2,156.44 ","$3,105.27 ", N/A , N/A ,"$3,277.79 ","$3,105.27 ","$2,932.76 ","$2,932.76 ",$912.95 ,"$2,932.76 ","$2,932.76 ","$3,105.27 ","$2,101.23 ", N/A ,"$2,139.18 ", N/A ,"$3,105.27 ", N/A ,"$3,174.28 ","$3,105.27 ","$2,277.54 ","$2,277.54 ","$2,101.23 ","$2,277.54 ","$2,242.70 ","$2,357.25 ",$785.48 ,"$2,725.74 ", N/A , N/A , N/A ,$912.95 , N/A , N/A ,"$3,277.79 ","$2,829.25 ","$2,829.25 ","$2,760.24 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001073,N/A,HC EGD W/SUBMUCOSAL INJ - 43236,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001075,N/A,HC EGD W/US FINE NEEDLE ASPIRATION LIMITED - 43238,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001076,N/A,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$2,574.53 ","$1,699.19 ",$586.10 ,"$2,574.53 ", N/A ,"$2,307.29 ","$2,307.29 ",$681.22 ,"$2,059.62 ","$2,188.35 ","$1,609.08 ","$2,317.08 ", N/A , N/A ,"$2,445.80 ","$2,317.08 ","$2,188.35 ","$2,188.35 ",$681.22 ,"$2,188.35 ","$2,188.35 ","$2,317.08 ","$1,567.89 ", N/A ,"$1,596.20 ", N/A ,"$2,317.08 ", N/A ,"$2,368.57 ","$2,317.08 ","$1,699.45 ","$1,699.45 ","$1,567.89 ","$1,699.45 ","$1,673.44 ","$1,758.92 ",$586.10 ,"$2,033.88 ", N/A , N/A , N/A ,$681.22 , N/A , N/A ,"$2,445.80 ","$2,111.11 ","$2,111.11 ","$2,059.62 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001079,N/A,HC EGD W/SCLEROTHERAPY - 43243,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001080,N/A,HC EGD W/BAND LIGATION - 43244,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001082,N/A,HC EGD W/PLACEMENT G-TUBE - 43246,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001083,N/A,HC EGD W/FB REMOVAL - 43247,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001084,N/A,HC EGD W/INSERT GUIDEWIRE - 43248,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001085,N/A,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001086,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001087,N/A,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001089,N/A,HC EGD W/ENDO MUCOSAL RESECTION - 43254,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001090,N/A,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$3,895.50 ","$2,571.03 ",$886.83 ,"$3,895.50 ", N/A ,"$3,491.15 ","$3,491.15 ","$1,030.75 ","$3,116.40 ","$3,311.18 ","$2,434.69 ","$3,505.95 ", N/A , N/A ,"$3,700.73 ","$3,505.95 ","$3,311.18 ","$3,311.18 ","$1,030.75 ","$3,311.18 ","$3,311.18 ","$3,505.95 ","$2,372.36 ", N/A ,"$2,415.22 ", N/A ,"$3,505.95 ", N/A ,"$3,583.86 ","$3,505.95 ","$2,571.42 ","$2,571.42 ","$2,372.36 ","$2,571.42 ","$2,532.08 ","$2,661.41 ",$886.83 ,"$3,077.45 ", N/A , N/A , N/A ,"$1,030.75 ", N/A , N/A ,"$3,700.73 ","$3,194.31 ","$3,194.31 ","$3,116.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001093,N/A,HC EGD W/TUMOR ABLATION - 43270,750,1 ,"$5,231.10 ","$3,452.53 ","$1,190.88 ","$5,231.10 ", N/A ,"$4,688.11 ","$4,688.11 ","$1,384.15 ","$4,184.88 ","$4,446.44 ","$3,269.44 ","$4,707.99 ", N/A , N/A ,"$4,969.55 ","$4,707.99 ","$4,446.44 ","$4,446.44 ","$1,384.15 ","$4,446.44 ","$4,446.44 ","$4,707.99 ","$3,185.74 ", N/A ,"$3,243.28 ", N/A ,"$4,707.99 ", N/A ,"$4,812.61 ","$4,707.99 ","$3,453.05 ","$3,453.05 ","$3,185.74 ","$3,453.05 ","$3,400.22 ","$3,573.89 ","$1,190.88 ","$4,132.57 ", N/A , N/A , N/A ,"$1,384.15 ", N/A , N/A ,"$4,969.55 ","$4,289.50 ","$4,289.50 ","$4,184.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001096,N/A,HC ERCP W/SPHINCTEROTOMY - 43262,750,1 ,"$9,488.33 ","$6,262.30 ","$2,160.06 ","$9,488.33 ", N/A ,"$8,503.44 ","$8,503.44 ","$2,510.61 ","$7,590.66 ","$8,065.08 ","$5,930.21 ","$8,539.50 ", N/A , N/A ,"$9,013.91 ","$8,539.50 ","$8,065.08 ","$8,065.08 ","$2,510.61 ","$8,065.08 ","$8,065.08 ","$8,539.50 ","$5,778.39 ", N/A ,"$5,882.76 ", N/A ,"$8,539.50 ", N/A ,"$8,729.26 ","$8,539.50 ","$6,263.25 ","$6,263.25 ","$5,778.39 ","$6,263.25 ","$6,167.41 ","$6,482.43 ","$2,160.06 ","$7,495.78 ", N/A , N/A , N/A ,"$2,510.61 ", N/A , N/A ,"$9,013.91 ","$7,780.43 ","$7,780.43 ","$7,590.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001111,N/A,HC ENTEROSCOPY UPPER SMALL BOWEL - 44360,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001112,N/A,HC ENTEROSCOPY UPR SM BOWEL W/BIOPSY - 44361,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001113,N/A,HC ENTEROSCOPY W/REM TUMOR SNARE TECH - 44364,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001114,N/A,HC ENTEROSCOPY W/REM TUMOR HOT BIOPSY - 44365,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001115,N/A,HC ENTEROSCOPY W/CONTROL BLEEDING - 44366,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001125,N/A,HC COLONOSCOPY STOMA DX W/BRUSH/WASH - 44388,750,1 ,"$3,672.90 ","$2,424.11 ",$836.16 ,"$3,672.90 ", N/A ,"$3,291.65 ","$3,291.65 ",$971.85 ,"$2,938.32 ","$3,121.97 ","$2,295.56 ","$3,305.61 ", N/A , N/A ,"$3,489.26 ","$3,305.61 ","$3,121.97 ","$3,121.97 ",$971.85 ,"$3,121.97 ","$3,121.97 ","$3,305.61 ","$2,236.80 ", N/A ,"$2,277.20 ", N/A ,"$3,305.61 ", N/A ,"$3,379.07 ","$3,305.61 ","$2,424.48 ","$2,424.48 ","$2,236.80 ","$2,424.48 ","$2,387.39 ","$2,509.33 ",$836.16 ,"$2,901.59 ", N/A , N/A , N/A ,$971.85 , N/A , N/A ,"$3,489.26 ","$3,011.78 ","$3,011.78 ","$2,938.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001126,N/A,HC COLONOSCOPY STOMA W/BX SGL/MULT - 44389,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001128,N/A,HC COLONOSCOPY STOMA W/CONTROL BLEEDING - 44391,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001130,N/A,HC COLONOSCOPY STOMA W/REM TUMOR SNARE TECH - 44394,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001131,N/A,HC COLONOSCOPY STOMA W/ABLATION  - 44401,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001142,N/A,HC SIGMOIDOSCOPY DX W/BRUSH/WASH - 45330,750,1 ,"$2,114.70 ","$1,395.70 ",$481.42 ,"$2,114.70 ", N/A ,"$1,895.19 ","$1,895.19 ",$559.55 ,"$1,691.76 ","$1,797.50 ","$1,321.69 ","$1,903.23 ", N/A , N/A ,"$2,008.97 ","$1,903.23 ","$1,797.50 ","$1,797.50 ",$559.55 ,"$1,797.50 ","$1,797.50 ","$1,903.23 ","$1,287.85 ", N/A ,"$1,311.12 ", N/A ,"$1,903.23 ", N/A ,"$1,945.52 ","$1,903.23 ","$1,395.91 ","$1,395.91 ","$1,287.85 ","$1,395.91 ","$1,374.56 ","$1,444.76 ",$481.42 ,"$1,670.61 ", N/A , N/A , N/A ,$559.55 , N/A , N/A ,"$2,008.97 ","$1,734.05 ","$1,734.05 ","$1,691.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001143,N/A,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001144,N/A,HC SIGMOIDOSCOPY W/FB REMOVAL -45332,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001145,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN  HOT BIOPSY -45333,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001146,N/A,HC SIGMOIDOSCOPY W/CONTROL BLEEDING - 45334,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001147,N/A,HC SIGMOIDOSCOPY W/SUBMUCOSAL INJ - 45335,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001149,N/A,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$2,448.60 ","$1,616.08 ",$557.43 ,"$2,448.60 ", N/A ,"$2,194.44 ","$2,194.44 ",$647.90 ,"$1,958.88 ","$2,081.31 ","$1,530.38 ","$2,203.74 ", N/A , N/A ,"$2,326.17 ","$2,203.74 ","$2,081.31 ","$2,081.31 ",$647.90 ,"$2,081.31 ","$2,081.31 ","$2,203.74 ","$1,491.20 ", N/A ,"$1,518.14 ", N/A ,"$2,203.74 ", N/A ,"$2,252.71 ","$2,203.74 ","$1,616.32 ","$1,616.32 ","$1,491.20 ","$1,616.32 ","$1,591.59 ","$1,672.88 ",$557.43 ,"$1,934.39 ", N/A , N/A , N/A ,$647.90 , N/A , N/A ,"$2,326.17 ","$2,007.85 ","$2,007.85 ","$1,958.88 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001150,N/A,HC SIGMOIDOSCOPY W/DILATION - 45340,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001152,N/A,HC SIGMOIDOSCOPY W/US GUIDED BIOPSY -45342,750,1 ,"$4,118.80 ","$2,718.41 ",$937.65 ,"$4,118.80 ", N/A ,"$3,691.27 ","$3,691.27 ","$1,089.84 ","$3,295.04 ","$3,500.98 ","$2,574.25 ","$3,706.92 ", N/A , N/A ,"$3,912.86 ","$3,706.92 ","$3,500.98 ","$3,500.98 ","$1,089.84 ","$3,500.98 ","$3,500.98 ","$3,706.92 ","$2,508.35 ", N/A ,"$2,553.66 ", N/A ,"$3,706.92 ", N/A ,"$3,789.30 ","$3,706.92 ","$2,718.82 ","$2,718.82 ","$2,508.35 ","$2,718.82 ","$2,677.22 ","$2,813.96 ",$937.65 ,"$3,253.85 ", N/A , N/A , N/A ,"$1,089.84 ", N/A , N/A ,"$3,912.86 ","$3,377.42 ","$3,377.42 ","$3,295.04 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001153,N/A,HC SIGMOIDOSCOPY W/ABLATION TUMOR - 45346,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001155,N/A,HC SIGMOIDOSCOPY W/ENDO MUCOSAL RESECTION - 45349,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001156,N/A,HC SIGMOIDOSCOPY W/BAND LIGATION - 45350,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001157,N/A,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$3,672.90 ","$2,424.11 ",$836.16 ,"$3,672.90 ", N/A ,"$3,291.65 ","$3,291.65 ",$971.85 ,"$2,938.32 ","$3,121.97 ","$2,295.56 ","$3,305.61 ", N/A , N/A ,"$3,489.26 ","$3,305.61 ","$3,121.97 ","$3,121.97 ",$971.85 ,"$3,121.97 ","$3,121.97 ","$3,305.61 ","$2,236.80 ", N/A ,"$2,277.20 ", N/A ,"$3,305.61 ", N/A ,"$3,379.07 ","$3,305.61 ","$2,424.48 ","$2,424.48 ","$2,236.80 ","$2,424.48 ","$2,387.39 ","$2,509.33 ",$836.16 ,"$2,901.59 ", N/A , N/A , N/A ,$971.85 , N/A , N/A ,"$3,489.26 ","$3,011.78 ","$3,011.78 ","$2,938.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001158,N/A,HC COLONOSCOPY W/FB REMOVAL - 45379,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001159,N/A,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001160,N/A,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001161,N/A,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001162,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001163,N/A,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001165,N/A,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$4,118.10 ","$2,717.95 ",$937.50 ,"$4,118.10 ", N/A ,"$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ", N/A , N/A ,"$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ", N/A ,"$2,553.22 ", N/A ,"$3,706.29 ", N/A ,"$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ", N/A , N/A , N/A ,"$1,089.65 ", N/A , N/A ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001167,N/A,HC COLONOSCOPY W/MUCOSAL RESECTION - 45390,750,1 ,"$7,347.00 ","$4,849.02 ","$1,672.58 ","$7,347.00 ", N/A ,"$6,584.38 ","$6,584.38 ","$1,944.02 ","$5,877.60 ","$6,244.95 ","$4,591.88 ","$6,612.30 ", N/A , N/A ,"$6,979.65 ","$6,612.30 ","$6,244.95 ","$6,244.95 ","$1,944.02 ","$6,244.95 ","$6,244.95 ","$6,612.30 ","$4,474.32 ", N/A ,"$4,555.14 ", N/A ,"$6,612.30 ", N/A ,"$6,759.24 ","$6,612.30 ","$4,849.75 ","$4,849.75 ","$4,474.32 ","$4,849.75 ","$4,775.55 ","$5,019.47 ","$1,672.58 ","$5,804.13 ", N/A , N/A , N/A ,"$1,944.02 ", N/A , N/A ,"$6,979.65 ","$6,024.54 ","$6,024.54 ","$5,877.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001171,N/A,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$6,455.40 ","$4,260.56 ","$1,469.60 ","$6,455.40 ", N/A ,"$5,785.33 ","$5,785.33 ","$1,708.10 ","$5,164.32 ","$5,487.09 ","$4,034.63 ","$5,809.86 ", N/A , N/A ,"$6,132.63 ","$5,809.86 ","$5,487.09 ","$5,487.09 ","$1,708.10 ","$5,487.09 ","$5,487.09 ","$5,809.86 ","$3,931.34 ", N/A ,"$4,002.34 ", N/A ,"$5,809.86 ", N/A ,"$5,938.97 ","$5,809.86 ","$4,261.21 ","$4,261.21 ","$3,931.34 ","$4,261.21 ","$4,196.01 ","$4,410.33 ","$1,469.60 ","$5,099.77 ", N/A , N/A , N/A ,"$1,708.10 ", N/A , N/A ,"$6,132.63 ","$5,293.43 ","$5,293.43 ","$5,164.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001173,N/A,HC HERMORRHOIDECTOMY INTERNAL W/LIGATION - 46221,750,1 ,"$2,431.80 ","$1,604.99 ",$553.60 ,"$2,431.80 ", N/A ,"$2,179.38 ","$2,179.38 ",$643.46 ,"$1,945.44 ","$2,067.03 ","$1,519.88 ","$2,188.62 ", N/A , N/A ,"$2,310.21 ","$2,188.62 ","$2,067.03 ","$2,067.03 ",$643.46 ,"$2,067.03 ","$2,067.03 ","$2,188.62 ","$1,480.97 ", N/A ,"$1,507.72 ", N/A ,"$2,188.62 ", N/A ,"$2,237.26 ","$2,188.62 ","$1,605.23 ","$1,605.23 ","$1,480.97 ","$1,605.23 ","$1,580.67 ","$1,661.41 ",$553.60 ,"$1,921.12 ", N/A , N/A , N/A ,$643.46 , N/A , N/A ,"$2,310.21 ","$1,994.08 ","$1,994.08 ","$1,945.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001174,N/A,HC ANOSCOPY DX W/SPECIMEN -46600,750,1 ,"$3,203.32 ","$2,114.19 ",$729.25 ,"$3,203.32 ", N/A ,"$2,870.82 ","$2,870.82 ",$847.60 ,"$2,562.66 ","$2,722.82 ","$2,002.08 ","$2,882.99 ", N/A , N/A ,"$3,043.15 ","$2,882.99 ","$2,722.82 ","$2,722.82 ",$847.60 ,"$2,722.82 ","$2,722.82 ","$2,882.99 ","$1,950.82 ", N/A ,"$1,986.06 ", N/A ,"$2,882.99 ", N/A ,"$2,947.05 ","$2,882.99 ","$2,114.51 ","$2,114.51 ","$1,950.82 ","$2,114.51 ","$2,082.16 ","$2,188.51 ",$729.25 ,"$2,530.62 ", N/A , N/A , N/A ,$847.60 , N/A , N/A ,"$3,043.15 ","$2,626.72 ","$2,626.72 ","$2,562.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001176,N/A,HC ANOSCOPY W/BIOPSY SGL/MULT - 46606,750,1 ,"$3,203.32 ","$2,114.19 ",$729.25 ,"$3,203.32 ", N/A ,"$2,870.82 ","$2,870.82 ",$847.60 ,"$2,562.66 ","$2,722.82 ","$2,002.08 ","$2,882.99 ", N/A , N/A ,"$3,043.15 ","$2,882.99 ","$2,722.82 ","$2,722.82 ",$847.60 ,"$2,722.82 ","$2,722.82 ","$2,882.99 ","$1,950.82 ", N/A ,"$1,986.06 ", N/A ,"$2,882.99 ", N/A ,"$2,947.05 ","$2,882.99 ","$2,114.51 ","$2,114.51 ","$1,950.82 ","$2,114.51 ","$2,082.16 ","$2,188.51 ",$729.25 ,"$2,530.62 ", N/A , N/A , N/A ,$847.60 , N/A , N/A ,"$3,043.15 ","$2,626.72 ","$2,626.72 ","$2,562.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001177,N/A,HC ANOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 46610,750,1 ,"$3,203.32 ","$2,114.19 ",$729.25 ,"$3,203.32 ", N/A ,"$2,870.82 ","$2,870.82 ",$847.60 ,"$2,562.66 ","$2,722.82 ","$2,002.08 ","$2,882.99 ", N/A , N/A ,"$3,043.15 ","$2,882.99 ","$2,722.82 ","$2,722.82 ",$847.60 ,"$2,722.82 ","$2,722.82 ","$2,882.99 ","$1,950.82 ", N/A ,"$1,986.06 ", N/A ,"$2,882.99 ", N/A ,"$2,947.05 ","$2,882.99 ","$2,114.51 ","$2,114.51 ","$1,950.82 ","$2,114.51 ","$2,082.16 ","$2,188.51 ",$729.25 ,"$2,530.62 ", N/A , N/A , N/A ,$847.60 , N/A , N/A ,"$3,043.15 ","$2,626.72 ","$2,626.72 ","$2,562.66 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001178,N/A,HC EXCISION ANAL LESIONS SIMPLE - 46922,750,1 ,"$2,431.80 ","$1,604.99 ",$553.60 ,"$2,431.80 ", N/A ,"$2,179.38 ","$2,179.38 ",$643.46 ,"$1,945.44 ","$2,067.03 ","$1,519.88 ","$2,188.62 ", N/A , N/A ,"$2,310.21 ","$2,188.62 ","$2,067.03 ","$2,067.03 ",$643.46 ,"$2,067.03 ","$2,067.03 ","$2,188.62 ","$1,480.97 ", N/A ,"$1,507.72 ", N/A ,"$2,188.62 ", N/A ,"$2,237.26 ","$2,188.62 ","$1,605.23 ","$1,605.23 ","$1,480.97 ","$1,605.23 ","$1,580.67 ","$1,661.41 ",$553.60 ,"$1,921.12 ", N/A , N/A , N/A ,$643.46 , N/A , N/A ,"$2,310.21 ","$1,994.08 ","$1,994.08 ","$1,945.44 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001200,G0104,HC COLONOSCOPY SCREEN W/FLEX SIGMOID - G0104,750,1 ,"$2,114.70 ","$1,395.70 ",$481.42 ,"$2,114.70 ","$1,892.02 ","$1,895.19 ","$1,895.19 ",$559.55 ,"$1,691.76 ","$1,797.50 ","$1,321.69 ","$1,903.23 ","$1,892.02 ","$1,892.02 ","$2,008.97 ","$1,903.23 ","$1,797.50 ","$1,797.50 ",$559.55 ,"$1,797.50 ","$1,797.50 ","$1,903.23 ","$1,287.85 ","$1,892.02 ","$1,311.12 ","$2,005.54 ","$1,903.23 ","$1,869.84 ","$1,945.52 ","$1,903.23 ","$1,395.91 ","$1,395.91 ","$1,287.85 ","$1,395.91 ","$1,374.56 ","$1,444.76 ",$481.42 ,"$1,670.61 ","$2,005.54 ","$1,974.00 ","$1,974.00 ",$559.55 ,"$2,047.00 ",$831.04 ,"$2,008.97 ","$1,734.05 ","$1,734.05 ","$1,691.76 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001214,G0105,HC COLON SCREENING HIGH RISK- G0105,750,1 ,"$4,118.10 ","$2,717.95 ",$831.04 ,"$4,118.10 ","$1,892.02 ","$3,690.64 ","$3,690.64 ","$1,089.65 ","$3,294.48 ","$3,500.39 ","$2,573.81 ","$3,706.29 ","$1,892.02 ","$1,892.02 ","$3,912.20 ","$3,706.29 ","$3,500.39 ","$3,500.39 ","$1,089.65 ","$3,500.39 ","$3,500.39 ","$3,706.29 ","$2,507.92 ","$1,892.02 ","$2,553.22 ","$2,005.54 ","$3,706.29 ","$1,869.84 ","$3,788.65 ","$3,706.29 ","$2,718.36 ","$2,718.36 ","$2,507.92 ","$2,718.36 ","$2,676.77 ","$2,813.49 ",$937.50 ,"$3,253.30 ","$2,005.54 ","$1,974.00 ","$1,974.00 ","$1,089.65 ","$2,047.00 ",$831.04 ,"$3,912.20 ","$3,376.84 ","$3,376.84 ","$3,294.48 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001215,G0121,HC COLONOSCOPY SCREENING LOW RISK- G0121,750,1 ,"$3,672.90 ","$2,424.11 ",$831.04 ,"$3,672.90 ","$1,892.02 ","$3,291.65 ","$3,291.65 ",$971.85 ,"$2,938.32 ","$3,121.97 ","$2,295.56 ","$3,305.61 ","$1,892.02 ","$1,892.02 ","$3,489.26 ","$3,305.61 ","$3,121.97 ","$3,121.97 ",$971.85 ,"$3,121.97 ","$3,121.97 ","$3,305.61 ","$2,236.80 ","$1,892.02 ","$2,277.20 ","$2,005.54 ","$3,305.61 ","$1,869.84 ","$3,379.07 ","$3,305.61 ","$2,424.48 ","$2,424.48 ","$2,236.80 ","$2,424.48 ","$2,387.39 ","$2,509.33 ",$836.16 ,"$2,901.59 ","$2,005.54 ","$1,974.00 ","$1,974.00 ",$971.85 ,"$2,047.00 ",$831.04 ,"$3,489.26 ","$3,011.78 ","$3,011.78 ","$2,938.32 "
ST. CLARE MEMORIAL HOSPITAL (ACU),75001223,N/A,HC SMALL BOWEL ENDOSCOPY- 44378,750,1 ,"$2,126.36 ","$1,403.40 ",$484.07 ,"$2,126.36 ", N/A ,"$1,905.64 ","$1,905.64 ",$562.64 ,"$1,701.09 ","$1,807.41 ","$1,328.98 ","$1,913.72 ", N/A , N/A ,"$2,020.04 ","$1,913.72 ","$1,807.41 ","$1,807.41 ",$562.64 ,"$1,807.41 ","$1,807.41 ","$1,913.72 ","$1,294.95 ", N/A ,"$1,318.34 ", N/A ,"$1,913.72 ", N/A ,"$1,956.25 ","$1,913.72 ","$1,403.61 ","$1,403.61 ","$1,294.95 ","$1,403.61 ","$1,382.13 ","$1,452.73 ",$484.07 ,"$1,679.82 ", N/A , N/A , N/A ,$562.64 , N/A , N/A ,"$2,020.04 ","$1,743.62 ","$1,743.62 ","$1,701.09 "
ST. CLARE MEMORIAL HOSPITAL (ACU),76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$1,362.75 ",$899.42 ,$310.23 ,"$1,744.74 ","$1,645.98 ","$1,221.30 ","$1,221.30 ",$360.58 ,"$1,090.20 ","$1,158.34 ",$851.72 ,"$1,226.48 ","$1,645.98 ","$1,362.75 ","$1,294.61 ","$1,226.48 ","$1,158.34 ","$1,158.34 ",$360.58 ,"$1,158.34 ","$1,158.34 ","$1,226.48 ",$829.91 ,"$1,645.98 ",$844.90 ,"$1,444.52 ","$1,226.48 ","$1,449.77 ","$1,253.73 ","$1,226.48 ",$899.55 ,$899.55 ,$829.91 ,$899.55 ,$885.79 ,$931.03 ,$310.23 ,"$1,076.57 ","$1,744.74 ",$667.75 ,$667.75 ,$360.58 ,$667.75 ,$644.34 ,"$1,294.61 ","$1,117.46 ","$1,117.46 ","$1,090.20 "
ST. CLARE MEMORIAL HOSPITAL (ACU),76200004,G0378,HC CDTU LV I PER HOUR,762,1 ,$190.90 ,$125.99 ,$43.46 ,$190.90 , N/A ,$171.08 ,$171.08 ,$50.51 ,$152.72 ,$162.27 ,$119.31 ,$171.81 , N/A , N/A ,$181.36 ,$171.81 ,$162.27 ,$162.27 ,$50.51 ,$162.27 ,$162.27 ,$171.81 ,$116.26 , N/A ,$118.36 , N/A ,$171.81 , N/A ,$175.63 ,$171.81 ,$126.01 ,$126.01 ,$116.26 ,$126.01 ,$124.09 ,$130.42 ,$43.46 ,$150.81 , N/A ,$190.90 ,$190.90 ,$50.51 ,$190.90 , N/A ,$181.36 ,$156.54 ,$156.54 ,$152.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),76200005,G0378,HC CDTU LV II PER HOUR,762,1 ,$238.05 ,$157.11 ,$54.19 ,$238.05 , N/A ,$213.34 ,$213.34 ,$62.98 ,$190.44 ,$202.34 ,$148.78 ,$214.25 , N/A , N/A ,$226.15 ,$214.25 ,$202.34 ,$202.34 ,$62.98 ,$202.34 ,$202.34 ,$214.25 ,$144.97 , N/A ,$147.60 , N/A ,$214.25 , N/A ,$219.01 ,$214.25 ,$157.14 ,$157.14 ,$144.97 ,$157.14 ,$154.73 ,$162.64 ,$54.19 ,$188.06 , N/A ,$238.05 ,$238.05 ,$62.98 ,$238.05 , N/A ,$226.15 ,$195.20 ,$195.20 ,$190.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,$440.45 ,$290.70 ,$100.26 ,$440.45 ,$237.38 ,$394.73 ,$394.73 ,$116.54 ,$352.36 ,$374.38 ,$275.28 ,$396.41 ,$237.38 ,$237.38 ,$418.43 ,$396.41 ,$374.38 ,$374.38 ,$116.54 ,$374.38 ,$374.38 ,$396.41 ,$268.23 ,$237.38 ,$273.08 ,$251.62 ,$396.41 , N/A ,$405.21 ,$396.41 ,$290.74 ,$290.74 ,$268.23 ,$290.74 ,$286.29 ,$300.92 ,$100.26 ,$347.96 ,$251.62 ,$440.45 ,$440.45 ,$116.54 ,$440.45 , N/A ,$418.43 ,$361.17 ,$361.17 ,$352.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$80.78 ,$53.31 ,$18.39 ,$80.78 , N/A ,$72.40 ,$72.40 ,$21.37 ,$64.62 ,$68.66 ,$50.49 ,$72.70 , N/A , N/A ,$76.74 ,$72.70 ,$68.66 ,$68.66 ,$21.37 ,$68.66 ,$68.66 ,$72.70 ,$49.20 , N/A ,$50.08 , N/A ,$72.70 , N/A ,$74.32 ,$72.70 ,$53.32 ,$53.32 ,$49.20 ,$53.32 ,$52.51 ,$55.19 ,$18.39 ,$63.82 , N/A ,$80.78 ,$80.78 ,$21.37 ,$80.78 , N/A ,$76.74 ,$66.24 ,$66.24 ,$64.62 
ST. CLARE MEMORIAL HOSPITAL (ACU),76831072,76831,HC SONOHYSTEROGRAM,972,1 ,$285.00 ,$188.10 ,$64.89 ,$525.42 ,$315.37 ,$255.42 ,$255.42 ,$127.64 ,$228.00 ,$242.25 ,$178.13 ,$256.50 ,$315.37 ,$285.00 ,$270.75 ,$256.50 ,$242.25 ,$242.25 ,$127.64 ,$242.25 ,$242.25 ,$256.50 ,$173.57 ,$315.37 ,$260.48 ,$302.10 ,$256.50 ,$525.42 ,$262.20 ,$256.50 ,$188.13 ,$188.13 ,$173.57 ,$188.13 ,$185.25 ,$194.71 ,$64.89 ,$225.15 ,$334.29 , N/A , N/A ,$127.64 , N/A ,$233.52 ,$270.75 ,$233.70 ,$233.70 ,$228.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$64.40 ,$42.50 ,$14.66 ,$151.81 ,$75.20 ,$57.72 ,$57.72 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$75.20 ,$64.40 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$75.20 ,$39.92 ,$68.26 ,$57.96 ,$151.81 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$79.71 ,$43.00 ,$43.00 ,$17.04 ,$43.00 ,$67.47 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100001,90471,HC RABIES VACC ADMIN IM,771,1 ,$178.25 ,$117.65 ,$40.58 ,$178.25 ,$75.20 ,$159.75 ,$159.75 ,$47.17 ,$142.60 ,$151.51 ,$111.41 ,$160.43 ,$75.20 ,$75.20 ,$169.34 ,$160.43 ,$151.51 ,$151.51 ,$47.17 ,$151.51 ,$151.51 ,$160.43 ,$108.55 ,$75.20 ,$110.52 ,$79.71 ,$160.43 ,$151.81 ,$163.99 ,$160.43 ,$117.66 ,$117.66 ,$108.55 ,$117.66 ,$115.86 ,$121.78 ,$40.58 ,$140.82 ,$79.71 ,$43.00 ,$43.00 ,$47.17 ,$43.00 ,$67.47 ,$169.34 ,$146.17 ,$146.17 ,$142.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$64.40 ,$42.50 ,$14.66 ,$79.71 ,$75.20 ,$57.72 ,$57.72 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$75.20 ,$64.40 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$75.20 ,$39.92 ,$68.26 ,$57.96 , N/A ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 ,$14.66 ,$50.88 ,$79.71 ,$43.00 ,$43.00 ,$17.04 ,$43.00 , N/A ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$64.40 ,$42.50 ,$17.04 ,$95.33 ,$75.20 ,$57.72 ,$57.72 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$75.20 ,$64.40 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$75.20 ,$39.92 ,$68.26 ,$57.96 ,$95.33 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 , N/A ,$50.88 ,$79.71 ,$43.00 ,$43.00 ,$17.04 ,$43.00 ,$42.37 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$64.40 ,$42.50 ,$17.04 ,$95.33 ,$75.20 ,$57.72 ,$57.72 ,$17.04 ,$51.52 ,$54.74 ,$40.25 ,$57.96 ,$75.20 ,$64.40 ,$61.18 ,$57.96 ,$54.74 ,$54.74 ,$17.04 ,$54.74 ,$54.74 ,$57.96 ,$39.22 ,$75.20 ,$39.92 ,$68.26 ,$57.96 ,$95.33 ,$59.25 ,$57.96 ,$42.51 ,$42.51 ,$39.22 ,$42.51 ,$41.86 ,$44.00 , N/A ,$50.88 ,$79.71 ,$43.00 ,$43.00 ,$17.04 ,$43.00 ,$42.37 ,$61.18 ,$52.81 ,$52.81 ,$51.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100009,0001A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML FIRST DOSE,771,1 ,$115.00 ,$75.90 ,$26.18 ,$115.00 , N/A ,$103.06 ,$103.06 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 , N/A , N/A ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 , N/A ,$71.30 , N/A ,$103.50 ,$93.42 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 , N/A ,$43.00 ,$43.00 ,$30.43 ,$43.00 ,$41.52 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100010,0002A,HC ADMINISTRATION SARS-COV-2 VACCINE 30 MCG/0.3ML SECOND DOSE,771,1 ,$115.00 ,$75.90 ,$26.18 ,$115.00 , N/A ,$103.06 ,$103.06 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 , N/A , N/A ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 , N/A ,$71.30 , N/A ,$103.50 ,$93.42 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 , N/A ,$43.00 ,$43.00 ,$30.43 ,$43.00 ,$41.52 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100011,0011A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5ML FIRST DOSE,771,1 ,$115.00 ,$75.90 ,$2.23 ,$115.00 , N/A ,$103.06 ,$103.06 ,$2.23 ,$92.00 ,$97.75 ,$71.88 ,$103.50 , N/A , N/A ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$2.23 ,$97.75 ,$97.75 ,$103.50 ,$70.04 , N/A ,$4.47 , N/A ,$103.50 ,$93.42 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$2.46 ,$90.85 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100012,0012A,HC ADMINISTRATION SARS-COV-2 VACCINE 100 MCG/0.5M SECOND DOSE,771,1 ,$115.00 ,$75.90 ,$2.23 ,$115.00 , N/A ,$103.06 ,$103.06 ,$2.23 ,$92.00 ,$97.75 ,$71.88 ,$103.50 , N/A , N/A ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$2.23 ,$97.75 ,$97.75 ,$103.50 ,$70.04 , N/A ,$4.47 , N/A ,$103.50 ,$93.42 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$2.46 ,$90.85 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100013,0021A,HC ADMINISTRATION SARS-COV-2 VACCINE 5X10 VIRAL PARTICLES/0.5ML FIRST DOSE,771,1 ,$100.00 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 , 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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 , N/A ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 , 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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 ,$75.20 ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$75.20 ,$75.20 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$75.20 ,$4.47 ,$79.71 ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 ,$75.20 ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$75.20 ,$75.20 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$75.20 ,$4.47 ,$79.71 ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$22.77 ,$100.00 ,$75.20 ,$89.62 ,$89.62 ,$26.46 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$75.20 ,$75.20 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$26.46 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$75.20 ,$62.00 ,$79.71 ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$22.77 ,$79.00 ,$79.71 ,$43.00 ,$43.00 ,$26.46 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 ,$75.20 ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$75.20 ,$75.20 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$75.20 ,$4.47 ,$79.71 ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 ,$75.20 ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 ,$75.20 ,$75.20 ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 ,$75.20 ,$4.47 ,$79.71 ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$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 ,$66.00 ,$2.23 ,$100.00 , N/A ,$89.62 ,$89.62 ,$2.23 ,$80.00 ,$85.00 ,$62.50 ,$90.00 , N/A , N/A ,$95.00 ,$90.00 ,$85.00 ,$85.00 ,$2.23 ,$85.00 ,$85.00 ,$90.00 ,$60.90 , N/A ,$4.47 , N/A ,$90.00 ,$93.42 ,$92.00 ,$90.00 ,$66.01 ,$66.01 ,$60.90 ,$66.01 ,$65.00 ,$68.32 ,$2.46 ,$79.00 , N/A ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$95.00 ,$82.00 ,$82.00 ,$80.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100031,M0222,HC INTRAVENOUS INJECTION BEBTELOVIMAB ADMINISTRATION,260,1 ,$105.00 ,$69.30 ,$23.90 ,$788.63 ,$105.00 ,$94.10 ,$94.10 ,$27.78 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$105.00 ,$105.00 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$27.78 ,$89.25 ,$89.25 ,$94.50 ,$63.95 ,$105.00 ,$65.10 ,$111.30 ,$94.50 ,$788.63 ,$96.60 ,$94.50 ,$69.31 ,$69.31 ,$63.95 ,$69.31 ,$68.25 ,$71.74 ,$23.90 ,$82.95 ,$111.30 ,$105.00 ,$105.00 ,$27.78 ,$105.00 ,$350.50 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100036,0134A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT 50MCG/0.5ML,771,1 ,$105.00 ,$69.30 ,$2.23 ,$105.00 ,$75.20 ,$94.10 ,$94.10 ,$2.23 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$75.20 ,$75.20 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$2.23 ,$89.25 ,$89.25 ,$94.50 ,$63.95 ,$75.20 ,$4.47 ,$79.71 ,$94.50 ,$93.42 ,$96.60 ,$94.50 ,$69.31 ,$69.31 ,$63.95 ,$69.31 ,$68.25 ,$71.74 ,$2.46 ,$82.95 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100037,0144A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT 25MCG/0.25ML,771,1 ,$105.00 ,$69.30 ,$2.23 ,$105.00 ,$75.20 ,$94.10 ,$94.10 ,$2.23 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$75.20 ,$75.20 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$2.23 ,$89.25 ,$89.25 ,$94.50 ,$63.95 ,$75.20 ,$4.47 ,$79.71 ,$94.50 ,$93.42 ,$96.60 ,$94.50 ,$69.31 ,$69.31 ,$63.95 ,$69.31 ,$68.25 ,$71.74 ,$2.46 ,$82.95 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100038,0124A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT TRI-SUCROSE 30MCG/0.3ML,771,1 ,$105.00 ,$69.30 ,$2.23 ,$105.00 ,$75.20 ,$94.10 ,$94.10 ,$2.23 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$75.20 ,$75.20 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$2.23 ,$89.25 ,$89.25 ,$94.50 ,$63.95 ,$75.20 ,$4.47 ,$79.71 ,$94.50 ,$93.42 ,$96.60 ,$94.50 ,$69.31 ,$69.31 ,$63.95 ,$69.31 ,$68.25 ,$71.74 ,$2.46 ,$82.95 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),77100039,0154A,HC ADMIN SARS-COV-2 VACCINE SPIKE PROTEIN BIVALENT TRI-SUCROSE 10MCG/0.2ML,771,1 ,$105.00 ,$69.30 ,$2.23 ,$105.00 ,$75.20 ,$94.10 ,$94.10 ,$2.23 ,$84.00 ,$89.25 ,$65.63 ,$94.50 ,$75.20 ,$75.20 ,$99.75 ,$94.50 ,$89.25 ,$89.25 ,$2.23 ,$89.25 ,$89.25 ,$94.50 ,$63.95 ,$75.20 ,$4.47 ,$79.71 ,$94.50 ,$93.42 ,$96.60 ,$94.50 ,$69.31 ,$69.31 ,$63.95 ,$69.31 ,$68.25 ,$71.74 ,$2.46 ,$82.95 ,$79.71 ,$43.00 ,$43.00 ,$2.23 ,$43.00 ,$41.52 ,$99.75 ,$86.10 ,$86.10 ,$84.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$250.00 ,$165.00 ,$27.00 ,$250.00 ,$37.63 ,$224.05 ,$224.05 ,$66.15 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$37.63 ,$37.63 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$66.15 ,$212.50 ,$212.50 ,$225.00 ,$152.25 ,$37.63 ,$155.00 ,$39.89 ,$225.00 ,$64.44 ,$230.00 ,$225.00 ,$165.03 ,$165.03 ,$152.25 ,$165.03 ,$162.50 ,$170.80 ,$56.92 ,$197.50 ,$39.89 ,$27.00 ,$27.00 ,$66.15 ,$27.00 ,$28.64 ,$237.50 ,$205.00 ,$205.00 ,$200.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000098,99221,PC TELEHEALTH INITIAL HOSP INP/OBS CARE LVL 1 LOW 40MIN - 95,960,1 ,$249.90 ,$164.93 ,$56.89 ,$251.62 ,$237.38 ,$223.96 ,$223.96 ,$87.99 ,$199.92 ,$212.42 ,$156.19 ,$224.91 ,$237.38 ,$237.38 ,$237.41 ,$224.91 ,$212.42 ,$212.42 ,$87.99 ,$212.42 ,$212.42 ,$224.91 ,$152.19 ,$237.38 ,$179.58 ,$251.62 ,$224.91 , N/A ,$229.91 ,$224.91 ,$164.96 ,$164.96 ,$152.19 ,$164.96 ,$162.44 ,$170.73 ,$56.89 ,$197.42 ,$251.62 , N/A , N/A ,$87.99 , N/A , N/A ,$237.41 ,$204.92 ,$204.92 ,$199.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000099,99222,PC TELEHEALTH INITIAL HOSP INP/OBS CARE LVL 2 MODERATE 55 MIN -95,960,1 ,$337.05 ,$222.45 ,$76.73 ,$337.05 ,$237.38 ,$302.06 ,$302.06 ,$139.31 ,$269.64 ,$286.49 ,$210.66 ,$303.35 ,$237.38 ,$237.38 ,$320.20 ,$303.35 ,$286.49 ,$286.49 ,$139.31 ,$286.49 ,$286.49 ,$303.35 ,$205.26 ,$237.38 ,$284.30 ,$251.62 ,$303.35 , N/A ,$310.09 ,$303.35 ,$222.49 ,$222.49 ,$205.26 ,$222.49 ,$219.08 ,$230.27 ,$76.73 ,$266.27 ,$251.62 , N/A , N/A ,$139.31 , N/A , N/A ,$320.20 ,$276.38 ,$276.38 ,$269.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000100,99223,PC TELEHEALTH INITIAL HOSP INP/OBS CARE LVL 3 HIGH 75 MIN -95,960,1 ,$489.30 ,$322.94 ,$111.40 ,$489.30 ,$237.38 ,$438.51 ,$438.51 ,$186.49 ,$391.44 ,$415.91 ,$305.81 ,$440.37 ,$237.38 ,$237.38 ,$464.84 ,$440.37 ,$415.91 ,$415.91 ,$186.49 ,$415.91 ,$415.91 ,$440.37 ,$297.98 ,$237.38 ,$380.60 ,$251.62 ,$440.37 , N/A ,$450.16 ,$440.37 ,$322.99 ,$322.99 ,$297.98 ,$322.99 ,$318.05 ,$334.29 ,$111.40 ,$386.55 ,$251.62 , N/A , N/A ,$186.49 , N/A , N/A ,$464.84 ,$401.23 ,$401.23 ,$391.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000104,99231,PC TELEHEALTH SUBSQ HOSP INP/OBS CARE  LVL 1 LOW 25 MIN - 95,960,1 ,$119.70 ,$79.00 ,$27.25 ,$251.62 ,$237.38 ,$107.28 ,$107.28 ,$52.81 ,$95.76 ,$101.75 ,$74.81 ,$107.73 ,$237.38 ,$119.70 ,$113.72 ,$107.73 ,$101.75 ,$101.75 ,$52.81 ,$101.75 ,$101.75 ,$107.73 ,$72.90 ,$237.38 ,$107.78 ,$126.88 ,$107.73 , N/A ,$110.12 ,$107.73 ,$79.01 ,$79.01 ,$72.90 ,$79.01 ,$77.81 ,$81.78 ,$27.25 ,$94.56 ,$251.62 , N/A , N/A ,$52.81 , N/A , N/A ,$113.72 ,$98.15 ,$98.15 ,$95.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000105,99232,PC TELEHEALTH SUBSQ HOSP INP/OBS CARE  LVL 2 MODERATE 35 MIN - 95,960,1 ,$184.80 ,$121.97 ,$42.07 ,$251.62 ,$237.38 ,$165.62 ,$165.62 ,$85.02 ,$147.84 ,$157.08 ,$115.50 ,$166.32 ,$237.38 ,$184.80 ,$175.56 ,$166.32 ,$157.08 ,$157.08 ,$85.02 ,$157.08 ,$157.08 ,$166.32 ,$112.54 ,$237.38 ,$173.52 ,$195.89 ,$166.32 , N/A ,$170.02 ,$166.32 ,$121.99 ,$121.99 ,$112.54 ,$121.99 ,$120.12 ,$126.26 ,$42.07 ,$145.99 ,$251.62 , N/A , N/A ,$85.02 , N/A , N/A ,$175.56 ,$151.54 ,$151.54 ,$147.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000106,99233,PC TELEHEALTH SUBSQ HOSP INP/OBS CARE  LVL 3 HIGH 50 MIN - 95,960,1 ,$255.15 ,$168.40 ,$58.08 ,$261.08 ,$237.38 ,$228.67 ,$228.67 ,$127.93 ,$204.12 ,$216.88 ,$159.47 ,$229.64 ,$237.38 ,$237.38 ,$242.39 ,$229.64 ,$216.88 ,$216.88 ,$127.93 ,$216.88 ,$216.88 ,$229.64 ,$155.39 ,$237.38 ,$261.08 ,$251.62 ,$229.64 , N/A ,$234.74 ,$229.64 ,$168.42 ,$168.42 ,$155.39 ,$168.42 ,$165.85 ,$174.32 ,$58.08 ,$201.57 ,$251.62 , N/A , N/A ,$127.93 , N/A , N/A ,$242.39 ,$209.22 ,$209.22 ,$204.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000107,99234,PC TELEHEALTH HOSP INP/OBS CARE SAME DATE LOW 45 MIN- 95,960,1 ,$516.60 ,$340.96 ,$105.39 ,$516.60 ,$237.38 ,$462.98 ,$462.98 ,$105.39 ,$413.28 ,$439.11 ,$322.88 ,$464.94 ,$237.38 ,$237.38 ,$490.77 ,$464.94 ,$439.11 ,$439.11 ,$105.39 ,$439.11 ,$439.11 ,$464.94 ,$314.61 ,$237.38 ,$215.08 ,$251.62 ,$464.94 , N/A ,$475.27 ,$464.94 ,$341.01 ,$341.01 ,$314.61 ,$341.01 ,$335.79 ,$352.94 ,$117.61 ,$408.11 ,$251.62 , N/A , N/A ,$105.39 , N/A , N/A ,$490.77 ,$423.61 ,$423.61 ,$413.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000108,99235,PC TELEHEALTH HOSP INP/OBS CARE SAME DATE MODERATE 70 MIN-95,960,1 ,$652.05 ,$430.35 ,$148.44 ,$652.05 ,$237.38 ,$584.37 ,$584.37 ,$171.48 ,$521.64 ,$554.24 ,$407.53 ,$586.85 ,$237.38 ,$237.38 ,$619.45 ,$586.85 ,$554.24 ,$554.24 ,$171.48 ,$554.24 ,$554.24 ,$586.85 ,$397.10 ,$237.38 ,$349.96 ,$251.62 ,$586.85 , N/A ,$599.89 ,$586.85 ,$430.42 ,$430.42 ,$397.10 ,$430.42 ,$423.83 ,$445.48 ,$148.44 ,$515.12 ,$251.62 , N/A , N/A ,$171.48 , N/A , N/A ,$619.45 ,$534.68 ,$534.68 ,$521.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000109,99236,PC TELEHEALTH HOSP INP/OBS CARE SAME DATE HIGH 85 MIN-95,960,1 ,$836.85 ,$552.32 ,$190.51 ,$836.85 ,$237.38 ,$749.99 ,$749.99 ,$224.78 ,$669.48 ,$711.32 ,$523.03 ,$753.17 ,$237.38 ,$237.38 ,$795.01 ,$753.17 ,$711.32 ,$711.32 ,$224.78 ,$711.32 ,$711.32 ,$753.17 ,$509.64 ,$237.38 ,$458.74 ,$251.62 ,$753.17 , N/A ,$769.90 ,$753.17 ,$552.40 ,$552.40 ,$509.64 ,$552.40 ,$543.95 ,$571.74 ,$190.51 ,$661.11 ,$251.62 , N/A , N/A ,$224.78 , N/A , N/A ,$795.01 ,$686.22 ,$686.22 ,$669.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000110,99238,PC TELEHEALTH HOSP INP/OBS DISCHARGE DAY <31MIN- 95,960,1 ,$282.45 ,$186.42 ,$64.30 ,$282.45 ,$168.32 ,$253.13 ,$253.13 ,$86.91 ,$225.96 ,$240.08 ,$176.53 ,$254.21 ,$168.32 ,$168.32 ,$268.33 ,$254.21 ,$240.08 ,$240.08 ,$86.91 ,$240.08 ,$240.08 ,$254.21 ,$172.01 ,$168.32 ,$177.36 ,$178.42 ,$254.21 , N/A ,$259.85 ,$254.21 ,$186.45 ,$186.45 ,$172.01 ,$186.45 ,$183.59 ,$192.97 ,$64.30 ,$223.14 ,$178.42 , N/A , N/A ,$86.91 , N/A , N/A ,$268.33 ,$231.61 ,$231.61 ,$225.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000111,99239,PC TELEHEALTH HOSP INP/OBS DISCHARGE DAY >30MIN- 95,960,1 ,$412.65 ,$272.35 ,$93.94 ,$412.65 ,$168.32 ,$369.82 ,$369.82 ,$122.97 ,$330.12 ,$350.75 ,$257.91 ,$371.39 ,$168.32 ,$168.32 ,$392.02 ,$371.39 ,$350.75 ,$350.75 ,$122.97 ,$350.75 ,$350.75 ,$371.39 ,$251.30 ,$168.32 ,$250.96 ,$178.42 ,$371.39 , N/A ,$379.64 ,$371.39 ,$272.39 ,$272.39 ,$251.30 ,$272.39 ,$268.22 ,$281.92 ,$93.94 ,$325.99 ,$178.42 , N/A , N/A ,$122.97 , N/A , N/A ,$392.02 ,$338.37 ,$338.37 ,$330.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000176,G0425,PC TELEHEALTH ED/IP CONSULT 30 MIN - 95,960,1 ,$350.00 ,$231.00 ,$79.68 ,$350.00 ,$237.38 ,$313.67 ,$313.67 ,$99.07 ,$280.00 ,$297.50 ,$218.75 ,$315.00 ,$237.38 ,$237.38 ,$332.50 ,$315.00 ,$297.50 ,$297.50 ,$99.07 ,$297.50 ,$297.50 ,$315.00 ,$213.15 ,$237.38 ,$202.18 ,$251.62 ,$315.00 , N/A ,$322.00 ,$315.00 ,$231.04 ,$231.04 ,$213.15 ,$231.04 ,$227.50 ,$239.12 ,$79.68 ,$276.50 ,$251.62 , N/A , N/A ,$99.07 , N/A , N/A ,$332.50 ,$287.00 ,$287.00 ,$280.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000177,G0426,PC TELEHEALTH ED/IP CONSULT 50 MIN - 95,960,1 ,$450.00 ,$297.00 ,$102.45 ,$450.00 ,$237.38 ,$403.29 ,$403.29 ,$139.69 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,$237.38 ,$237.38 ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$139.69 ,$382.50 ,$382.50 ,$405.00 ,$274.05 ,$237.38 ,$285.08 ,$251.62 ,$405.00 , N/A ,$414.00 ,$405.00 ,$297.05 ,$297.05 ,$274.05 ,$297.05 ,$292.50 ,$307.44 ,$102.45 ,$355.50 ,$251.62 , N/A , N/A ,$139.69 , N/A , N/A ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000178,G0427,PC TELEHEALTH ED/IP CONSULT 70 MIN - 95,960,1 ,$550.00 ,$363.00 ,$125.21 ,$550.00 ,$237.38 ,$492.91 ,$492.91 ,$200.24 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$237.38 ,$237.38 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$200.24 ,$467.50 ,$467.50 ,$495.00 ,$334.95 ,$237.38 ,$408.66 ,$251.62 ,$495.00 , N/A ,$506.00 ,$495.00 ,$363.06 ,$363.06 ,$334.95 ,$363.06 ,$357.50 ,$375.76 ,$125.21 ,$434.50 ,$251.62 , N/A , N/A ,$200.24 , N/A , N/A ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000191,G0508,PC TELEHEALTH CRITICAL CARE CONSULT 60 MIN - 95,960,1 ,$650.00 ,$429.00 ,$147.98 ,$650.00 ,$237.38 ,$582.53 ,$582.53 ,$220.33 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$237.38 ,$237.38 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$220.33 ,$552.50 ,$552.50 ,$585.00 ,$395.85 ,$237.38 ,$449.66 ,$251.62 ,$585.00 , N/A ,$598.00 ,$585.00 ,$429.07 ,$429.07 ,$395.85 ,$429.07 ,$422.50 ,$444.08 ,$147.98 ,$513.50 ,$251.62 , N/A , N/A ,$220.33 , N/A , N/A ,$617.50 ,$533.00 ,$533.00 ,$520.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000192,G0509,PC TELEHEALTH CRITICAL CARE CONSULT 50 MIN - 95,960,1 ,$650.00 ,$429.00 ,$147.98 ,$650.00 ,$237.38 ,$582.53 ,$582.53 ,$202.89 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$237.38 ,$237.38 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$202.89 ,$552.50 ,$552.50 ,$585.00 ,$395.85 ,$237.38 ,$414.06 ,$251.62 ,$585.00 , N/A ,$598.00 ,$585.00 ,$429.07 ,$429.07 ,$395.85 ,$429.07 ,$422.50 ,$444.08 ,$147.98 ,$513.50 ,$251.62 , N/A , N/A ,$202.89 , N/A , N/A ,$617.50 ,$533.00 ,$533.00 ,$520.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000224,G0425,PC TELEHEALTH STROKE ED/IP CONSULT 30 MIN - G0,960,1 ,$350.00 ,$231.00 ,$79.68 ,$350.00 ,$237.38 ,$313.67 ,$313.67 ,$99.07 ,$280.00 ,$297.50 ,$218.75 ,$315.00 ,$237.38 ,$237.38 ,$332.50 ,$315.00 ,$297.50 ,$297.50 ,$99.07 ,$297.50 ,$297.50 ,$315.00 ,$213.15 ,$237.38 ,$202.18 ,$251.62 ,$315.00 , N/A ,$322.00 ,$315.00 ,$231.04 ,$231.04 ,$213.15 ,$231.04 ,$227.50 ,$239.12 ,$79.68 ,$276.50 ,$251.62 , N/A , N/A ,$99.07 , N/A , N/A ,$332.50 ,$287.00 ,$287.00 ,$280.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000225,G0426,PC TELEHEALTH STROKE ED/IP CONSULT 50 MIN - G0,960,1 ,$450.00 ,$297.00 ,$102.45 ,$450.00 ,$237.38 ,$403.29 ,$403.29 ,$139.69 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,$237.38 ,$237.38 ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$139.69 ,$382.50 ,$382.50 ,$405.00 ,$274.05 ,$237.38 ,$285.08 ,$251.62 ,$405.00 , N/A ,$414.00 ,$405.00 ,$297.05 ,$297.05 ,$274.05 ,$297.05 ,$292.50 ,$307.44 ,$102.45 ,$355.50 ,$251.62 , N/A , N/A ,$139.69 , N/A , N/A ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000226,G0427,PC TELEHEALTH STROKE ED/IP CONSULT 70 MIN - G0,960,1 ,$550.00 ,$363.00 ,$125.21 ,$550.00 ,$237.38 ,$492.91 ,$492.91 ,$200.24 ,$440.00 ,$467.50 ,$343.75 ,$495.00 ,$237.38 ,$237.38 ,$522.50 ,$495.00 ,$467.50 ,$467.50 ,$200.24 ,$467.50 ,$467.50 ,$495.00 ,$334.95 ,$237.38 ,$408.66 ,$251.62 ,$495.00 , N/A ,$506.00 ,$495.00 ,$363.06 ,$363.06 ,$334.95 ,$363.06 ,$357.50 ,$375.76 ,$125.21 ,$434.50 ,$251.62 , N/A , N/A ,$200.24 , N/A , N/A ,$522.50 ,$451.00 ,$451.00 ,$440.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000227,G0508,PC TELEHEALTH STROKE CRITICAL CARE CONSULT 60 MIN - G0,960,1 ,$650.00 ,$429.00 ,$147.98 ,$650.00 ,$237.38 ,$582.53 ,$582.53 ,$220.33 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$237.38 ,$237.38 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$220.33 ,$552.50 ,$552.50 ,$585.00 ,$395.85 ,$237.38 ,$449.66 ,$251.62 ,$585.00 , N/A ,$598.00 ,$585.00 ,$429.07 ,$429.07 ,$395.85 ,$429.07 ,$422.50 ,$444.08 ,$147.98 ,$513.50 ,$251.62 , N/A , N/A ,$220.33 , N/A , N/A ,$617.50 ,$533.00 ,$533.00 ,$520.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),78000228,G0509,PC TELEHEALTH STROKE CRITICAL CARE CONSULT 50 MIN -G0,960,1 ,$650.00 ,$429.00 ,$147.98 ,$650.00 ,$237.38 ,$582.53 ,$582.53 ,$202.89 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$237.38 ,$237.38 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$202.89 ,$552.50 ,$552.50 ,$585.00 ,$395.85 ,$237.38 ,$414.06 ,$251.62 ,$585.00 , N/A ,$598.00 ,$585.00 ,$429.07 ,$429.07 ,$395.85 ,$429.07 ,$422.50 ,$444.08 ,$147.98 ,$513.50 ,$251.62 , N/A , N/A ,$202.89 , N/A , N/A ,$617.50 ,$533.00 ,$533.00 ,$520.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),80048072,80048,HC BASIC METABOLIC PANEL-PRV 72 HR,301,1 ,$163.30 ,$107.78 ,$8.46 ,$163.30 ,$8.74 ,$29.61 ,$29.61 ,$43.21 ,$130.64 ,$138.81 ,$102.06 ,$146.97 ,$8.74 ,$8.74 ,$155.14 ,$146.97 ,$138.81 ,$138.81 ,$43.21 ,$138.81 ,$138.81 ,$146.97 ,$99.45 ,$8.74 ,$101.24 ,$9.26 ,$146.97 ,$19.04 ,$150.24 ,$146.97 ,$107.79 ,$107.79 ,$99.45 ,$107.79 ,$106.15 ,$111.57 ,$37.18 ,$129.01 ,$9.26 ,$10.15 ,$10.15 ,$43.21 ,$10.15 ,$8.46 ,$155.14 ,$133.91 ,$133.91 ,$130.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),80050072,80050,HC GENERAL HEALTH PANEL-72HR,301,1 ,$384.10 ,$253.51 ,$15.23 ,$384.10 ,$15.23 ,$135.78 ,$135.78 ,$101.64 ,$307.28 ,$326.49 ,$240.06 ,$345.69 ,$15.23 ,$15.23 ,$364.90 ,$345.69 ,$326.49 ,$326.49 ,$101.64 ,$326.49 ,$326.49 ,$345.69 ,$233.92 ,$15.23 ,$238.14 ,$16.14 ,$345.69 , N/A ,$353.37 ,$345.69 ,$253.54 ,$253.54 ,$233.92 ,$253.54 ,$249.67 ,$262.42 ,$87.44 ,$303.44 ,$16.14 ,$56.74 ,$56.74 ,$101.64 ,$56.74 , N/A ,$364.90 ,$314.96 ,$314.96 ,$307.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),80053072,80053,HC COMPREHENSIVE METABOL PANEL-PRV 72 HR,301,1 ,$136.85 ,$90.32 ,$10.56 ,$136.85 ,$10.91 ,$36.96 ,$36.96 ,$36.21 ,$109.48 ,$116.32 ,$85.53 ,$123.17 ,$10.91 ,$10.91 ,$130.01 ,$123.17 ,$116.32 ,$116.32 ,$36.21 ,$116.32 ,$116.32 ,$123.17 ,$83.34 ,$10.91 ,$84.84 ,$11.56 ,$123.17 ,$23.76 ,$125.90 ,$123.17 ,$90.33 ,$90.33 ,$83.34 ,$90.33 ,$88.95 ,$93.50 ,$31.15 ,$108.11 ,$11.56 ,$12.67 ,$12.67 ,$36.21 ,$12.67 ,$10.56 ,$130.01 ,$112.22 ,$112.22 ,$109.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),80061072,80061,HC LIPID PANEL-PRV 72 HR,301,1 ,$194.35 ,$128.27 ,$13.39 ,$194.35 ,$13.84 ,$46.87 ,$46.87 ,$51.42 ,$155.48 ,$165.20 ,$121.47 ,$174.92 ,$13.84 ,$13.84 ,$184.63 ,$174.92 ,$165.20 ,$165.20 ,$51.42 ,$165.20 ,$165.20 ,$174.92 ,$118.36 ,$13.84 ,$120.50 ,$14.67 ,$174.92 ,$30.13 ,$178.80 ,$174.92 ,$128.29 ,$128.29 ,$118.36 ,$128.29 ,$126.33 ,$132.78 ,$44.25 ,$153.54 ,$14.67 ,$16.07 ,$16.07 ,$51.42 ,$16.07 ,$13.39 ,$184.63 ,$159.37 ,$159.37 ,$155.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),80076072,80076,HC HEPATIC FUNCTION PANEL-PRV 72 HR,301,1 ,$171.35 ,$113.09 ,$8.17 ,$171.35 ,$8.44 ,$28.60 ,$28.60 ,$45.33 ,$137.08 ,$145.65 ,$107.09 ,$154.22 ,$8.44 ,$8.44 ,$162.78 ,$154.22 ,$145.65 ,$145.65 ,$45.33 ,$145.65 ,$145.65 ,$154.22 ,$104.35 ,$8.44 ,$106.24 ,$8.95 ,$154.22 ,$18.38 ,$157.64 ,$154.22 ,$113.11 ,$113.11 ,$104.35 ,$113.11 ,$111.38 ,$117.07 ,$39.00 ,$135.37 ,$8.95 ,$9.80 ,$9.80 ,$45.33 ,$9.80 ,$8.17 ,$162.78 ,$140.51 ,$140.51 ,$137.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),80156072,80156,HC CARABAMIZIPINE,301,1 ,$218.50 ,$144.21 ,$14.57 ,$218.50 ,$15.06 ,$51.00 ,$51.00 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$15.06 ,$15.06 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$15.06 ,$135.48 ,$15.96 ,$196.65 ,$32.78 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$15.96 ,$17.48 ,$17.48 ,$57.82 ,$17.48 ,$14.57 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),80162072,80162,HC DIGOXIN LEVELS-PRV 72 HR,301,1 ,$201.25 ,$132.83 ,$13.28 ,$201.25 ,$13.72 ,$46.48 ,$46.48 ,$53.25 ,$161.00 ,$171.06 ,$125.78 ,$181.13 ,$13.72 ,$13.72 ,$191.19 ,$181.13 ,$171.06 ,$171.06 ,$53.25 ,$171.06 ,$171.06 ,$181.13 ,$122.56 ,$13.72 ,$124.78 ,$14.54 ,$181.13 ,$29.88 ,$185.15 ,$181.13 ,$132.85 ,$132.85 ,$122.56 ,$132.85 ,$130.81 ,$137.49 ,$45.81 ,$158.99 ,$14.54 ,$15.94 ,$15.94 ,$53.25 ,$15.94 ,$13.28 ,$191.19 ,$165.03 ,$165.03 ,$161.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),80188072,80188,HC PRIMADONE,301,1 ,$249.55 ,$164.70 ,$16.59 ,$249.55 ,$17.14 ,$58.07 ,$58.07 ,$66.03 ,$199.64 ,$212.12 ,$155.97 ,$224.60 ,$17.14 ,$17.14 ,$237.07 ,$224.60 ,$212.12 ,$212.12 ,$66.03 ,$212.12 ,$212.12 ,$224.60 ,$151.98 ,$17.14 ,$154.72 ,$18.17 ,$224.60 ,$37.33 ,$229.59 ,$224.60 ,$164.73 ,$164.73 ,$151.98 ,$164.73 ,$162.21 ,$170.49 ,$56.81 ,$197.14 ,$18.17 ,$19.91 ,$19.91 ,$66.03 ,$19.91 ,$16.59 ,$237.07 ,$204.63 ,$204.63 ,$199.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),80198072,80198,HC THEOPHYLINE,301,1 ,$138.00 ,$91.08 ,$14.14 ,$138.00 ,$14.61 ,$49.49 ,$49.49 ,$36.51 ,$110.40 ,$117.30 ,$86.25 ,$124.20 ,$14.61 ,$14.61 ,$131.10 ,$124.20 ,$117.30 ,$117.30 ,$36.51 ,$117.30 ,$117.30 ,$124.20 ,$84.04 ,$14.61 ,$85.56 ,$15.49 ,$124.20 ,$31.82 ,$126.96 ,$124.20 ,$91.09 ,$91.09 ,$84.04 ,$91.09 ,$89.70 ,$94.28 ,$31.42 ,$109.02 ,$15.49 ,$16.97 ,$16.97 ,$36.51 ,$16.97 ,$14.14 ,$131.10 ,$113.16 ,$113.16 ,$110.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),80299072,80299,HC QT OF DRUG ASSAY-PRV 72 HR,301,1 ,$147.20 ,$97.15 ,$18.64 ,$147.20 ,$19.26 ,$65.24 ,$65.24 ,$38.95 ,$117.76 ,$125.12 ,$92.00 ,$132.48 ,$19.26 ,$19.26 ,$139.84 ,$132.48 ,$125.12 ,$125.12 ,$38.95 ,$125.12 ,$125.12 ,$132.48 ,$89.64 ,$19.26 ,$91.26 ,$20.42 ,$132.48 ,$41.94 ,$135.42 ,$132.48 ,$97.17 ,$97.17 ,$89.64 ,$97.17 ,$95.68 ,$100.57 ,$33.52 ,$116.29 ,$20.42 ,$22.37 ,$22.37 ,$38.95 ,$22.37 ,$18.64 ,$139.84 ,$120.70 ,$120.70 ,$117.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),81001072,81001,HC URINALYSIS AUTO W/MICRO-PRV 72 HR,307,1 ,$109.25 ,$72.11 ,$3.17 ,$109.25 ,$3.28 ,$11.10 ,$11.10 ,$28.91 ,$87.40 ,$92.86 ,$68.28 ,$98.33 ,$3.28 ,$3.28 ,$103.79 ,$98.33 ,$92.86 ,$92.86 ,$28.91 ,$92.86 ,$92.86 ,$98.33 ,$66.53 ,$3.28 ,$67.74 ,$3.48 ,$98.33 ,$7.13 ,$100.51 ,$98.33 ,$72.12 ,$72.12 ,$66.53 ,$72.12 ,$71.01 ,$74.64 ,$24.87 ,$86.31 ,$3.48 ,$3.80 ,$3.80 ,$28.91 ,$3.80 ,$3.17 ,$103.79 ,$89.59 ,$89.59 ,$87.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),81003072,81003,HC URINALYSIS SPECIFIC GRAVITY-PRV 72 HR,307,1 ,$42.55 ,$28.08 ,$2.25 ,$42.55 ,$2.32 ,$7.88 ,$7.88 ,$11.26 ,$34.04 ,$36.17 ,$26.59 ,$38.30 ,$2.32 ,$2.32 ,$40.42 ,$38.30 ,$36.17 ,$36.17 ,$11.26 ,$36.17 ,$36.17 ,$38.30 ,$25.91 ,$2.32 ,$26.38 ,$2.46 ,$38.30 ,$5.06 ,$39.15 ,$38.30 ,$28.09 ,$28.09 ,$25.91 ,$28.09 ,$27.66 ,$29.07 ,$9.69 ,$33.61 ,$2.46 ,$2.70 ,$2.70 ,$11.26 ,$2.70 ,$2.25 ,$40.42 ,$34.89 ,$34.89 ,$34.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),81025072,81025,HC URINE PREGNANCY TEST-PRV 72 HR,300,1 ,$95.45 ,$63.00 ,$8.61 ,$95.45 ,$8.90 ,$30.14 ,$30.14 ,$25.25 ,$76.36 ,$81.13 ,$59.66 ,$85.91 ,$8.90 ,$8.90 ,$90.68 ,$85.91 ,$81.13 ,$81.13 ,$25.25 ,$81.13 ,$81.13 ,$85.91 ,$58.13 ,$8.90 ,$59.18 ,$9.43 ,$85.91 ,$19.37 ,$87.81 ,$85.91 ,$63.01 ,$63.01 ,$58.13 ,$63.01 ,$62.04 ,$65.21 ,$21.73 ,$75.41 ,$9.43 ,$10.33 ,$10.33 ,$25.25 ,$10.33 ,$8.61 ,$90.68 ,$78.27 ,$78.27 ,$76.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),82009072,82009,HC ACETONE KETO,301,1 ,$66.70 ,$44.02 ,$4.52 ,$66.70 ,$4.67 ,$15.82 ,$15.82 ,$17.65 ,$53.36 ,$56.70 ,$41.69 ,$60.03 ,$4.67 ,$4.67 ,$63.37 ,$60.03 ,$56.70 ,$56.70 ,$17.65 ,$56.70 ,$56.70 ,$60.03 ,$40.62 ,$4.67 ,$41.36 ,$4.95 ,$60.03 ,$10.17 ,$61.36 ,$60.03 ,$44.03 ,$44.03 ,$40.62 ,$44.03 ,$43.36 ,$45.57 ,$15.18 ,$52.69 ,$4.95 ,$5.42 ,$5.42 ,$17.65 ,$5.42 ,$4.52 ,$63.37 ,$54.69 ,$54.69 ,$53.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),82043072,82043,HC MICROALBUMIN URINE,301,1 ,$207.00 ,$136.62 ,$5.78 ,$207.00 ,$5.97 ,$20.23 ,$20.23 ,$54.77 ,$165.60 ,$175.95 ,$129.38 ,$186.30 ,$5.97 ,$5.97 ,$196.65 ,$186.30 ,$175.95 ,$175.95 ,$54.77 ,$175.95 ,$175.95 ,$186.30 ,$126.06 ,$5.97 ,$128.34 ,$6.33 ,$186.30 ,$13.01 ,$190.44 ,$186.30 ,$136.64 ,$136.64 ,$126.06 ,$136.64 ,$134.55 ,$141.42 ,$47.13 ,$163.53 ,$6.33 ,$6.94 ,$6.94 ,$54.77 ,$6.94 ,$5.78 ,$196.65 ,$169.74 ,$169.74 ,$165.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),82150072,82150,HC ASSAY OF AMYLASE-PRV 72HR,301,1 ,$101.20 ,$66.79 ,$6.48 ,$101.20 ,$6.70 ,$22.68 ,$22.68 ,$26.77 ,$80.96 ,$86.02 ,$63.25 ,$91.08 ,$6.70 ,$6.70 ,$96.14 ,$91.08 ,$86.02 ,$86.02 ,$26.77 ,$86.02 ,$86.02 ,$91.08 ,$61.63 ,$6.70 ,$62.74 ,$7.10 ,$91.08 ,$14.58 ,$93.10 ,$91.08 ,$66.80 ,$66.80 ,$61.63 ,$66.80 ,$65.78 ,$69.14 ,$23.04 ,$79.95 ,$7.10 ,$7.78 ,$7.78 ,$26.77 ,$7.78 ,$6.48 ,$96.14 ,$82.98 ,$82.98 ,$80.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),82164072,82164,HC ANGIOTENSIN,301,1 ,$225.40 ,$148.76 ,$14.60 ,$225.40 ,$15.09 ,$51.10 ,$51.10 ,$59.64 ,$180.32 ,$191.59 ,$140.88 ,$202.86 ,$15.09 ,$15.09 ,$214.13 ,$202.86 ,$191.59 ,$191.59 ,$59.64 ,$191.59 ,$191.59 ,$202.86 ,$137.27 ,$15.09 ,$139.74 ,$16.00 ,$202.86 ,$32.85 ,$207.37 ,$202.86 ,$148.79 ,$148.79 ,$137.27 ,$148.79 ,$146.51 ,$153.99 ,$51.31 ,$178.07 ,$16.00 ,$17.52 ,$17.52 ,$59.64 ,$17.52 ,$14.60 ,$214.13 ,$184.83 ,$184.83 ,$180.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),82248072,82248,HC BILIRUBIN DIRECT-PRV 72 HR,300,1 ,$77.05 ,$50.85 ,$4.70 ,$77.05 ,$4.70 ,$17.57 ,$17.57 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$4.70 ,$4.70 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$4.70 ,$47.78 ,$4.98 ,$69.35 ,$11.30 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$4.98 ,$6.02 ,$6.02 ,$20.38 ,$6.02 ,$5.02 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),82270072,82270,HC BLOOD OCCULT-PRV 72 HR,300,1 ,$74.75 ,$49.34 ,$3.66 ,$74.75 ,$3.66 ,$15.33 ,$15.33 ,$19.78 ,$59.80 ,$63.54 ,$46.72 ,$67.28 ,$3.66 ,$3.66 ,$71.01 ,$67.28 ,$63.54 ,$63.54 ,$19.78 ,$63.54 ,$63.54 ,$67.28 ,$45.52 ,$3.66 ,$46.34 ,$3.88 ,$67.28 ,$9.86 ,$68.77 ,$67.28 ,$49.34 ,$49.34 ,$45.52 ,$49.34 ,$48.59 ,$51.07 ,$17.01 ,$59.05 ,$3.88 ,$5.26 ,$5.26 ,$19.78 ,$5.26 ,$4.38 ,$71.01 ,$61.30 ,$61.30 ,$59.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),82272072,82272,HC BLOOD OCCULT FECES-PRV 72 HR,300,1 ,$43.70 ,$28.84 ,$4.23 ,$43.70 ,$4.26 ,$14.81 ,$14.81 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$4.26 ,$4.26 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$4.26 ,$27.10 ,$4.52 ,$39.33 ,$9.52 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$4.52 ,$5.08 ,$5.08 ,$11.56 ,$5.08 ,$4.23 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),82306072,82306,HC VITAMIN D 25 HYDROX-PRV 72 HR,305,1 ,$334.65 ,$220.87 ,$29.60 ,$334.65 ,$30.59 ,$103.60 ,$103.60 ,$88.55 ,$267.72 ,$284.45 ,$209.16 ,$301.19 ,$30.59 ,$30.59 ,$317.92 ,$301.19 ,$284.45 ,$284.45 ,$88.55 ,$284.45 ,$284.45 ,$301.19 ,$203.80 ,$30.59 ,$207.48 ,$32.43 ,$301.19 ,$66.60 ,$307.88 ,$301.19 ,$220.90 ,$220.90 ,$203.80 ,$220.90 ,$217.52 ,$228.63 ,$76.19 ,$264.37 ,$32.43 ,$35.52 ,$35.52 ,$88.55 ,$35.52 ,$29.60 ,$317.92 ,$274.41 ,$274.41 ,$267.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),82365072,82365,HC CALCULUS INFRARED SPEC,300,1 ,$159.85 ,$105.50 ,$12.90 ,$159.85 ,$13.33 ,$45.15 ,$45.15 ,$42.30 ,$127.88 ,$135.87 ,$99.91 ,$143.87 ,$13.33 ,$13.33 ,$151.86 ,$143.87 ,$135.87 ,$135.87 ,$42.30 ,$135.87 ,$135.87 ,$143.87 ,$97.35 ,$13.33 ,$99.10 ,$14.13 ,$143.87 ,$29.03 ,$147.06 ,$143.87 ,$105.52 ,$105.52 ,$97.35 ,$105.52 ,$103.90 ,$109.21 ,$36.40 ,$126.28 ,$14.13 ,$15.48 ,$15.48 ,$42.30 ,$15.48 ,$12.90 ,$151.86 ,$131.08 ,$131.08 ,$127.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),82565072,82565,HC CREATININE-PRV 72HR,301,1 ,$88.55 ,$58.44 ,$5.12 ,$88.55 ,$5.29 ,$17.92 ,$17.92 ,$23.43 ,$70.84 ,$75.27 ,$55.34 ,$79.70 ,$5.29 ,$5.29 ,$84.12 ,$79.70 ,$75.27 ,$75.27 ,$23.43 ,$75.27 ,$75.27 ,$79.70 ,$53.93 ,$5.29 ,$54.90 ,$5.61 ,$79.70 ,$11.52 ,$81.47 ,$79.70 ,$58.45 ,$58.45 ,$53.93 ,$58.45 ,$57.56 ,$60.50 ,$20.16 ,$69.95 ,$5.61 ,$6.14 ,$6.14 ,$23.43 ,$6.14 ,$5.12 ,$84.12 ,$72.61 ,$72.61 ,$70.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),82570072,82570,HC CREATININE OTHER SOURCE-PRV 72 HR,300,1 ,$89.70 ,$59.20 ,$5.18 ,$89.70 ,$5.35 ,$18.13 ,$18.13 ,$23.74 ,$71.76 ,$76.25 ,$56.06 ,$80.73 ,$5.35 ,$5.35 ,$85.22 ,$80.73 ,$76.25 ,$76.25 ,$23.74 ,$76.25 ,$76.25 ,$80.73 ,$54.63 ,$5.35 ,$55.62 ,$5.67 ,$80.73 ,$11.66 ,$82.52 ,$80.73 ,$59.21 ,$59.21 ,$54.63 ,$59.21 ,$58.31 ,$61.28 ,$20.42 ,$70.86 ,$5.67 ,$6.22 ,$6.22 ,$23.74 ,$6.22 ,$5.18 ,$85.22 ,$73.55 ,$73.55 ,$71.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),82607072,82607,HC VITAMIN B12-PRV 72 HR,301,1 ,$269.10 ,$177.61 ,$15.08 ,$269.10 ,$15.58 ,$52.78 ,$52.78 ,$71.21 ,$215.28 ,$228.74 ,$168.19 ,$242.19 ,$15.58 ,$15.58 ,$255.65 ,$242.19 ,$228.74 ,$228.74 ,$71.21 ,$228.74 ,$228.74 ,$242.19 ,$163.88 ,$15.58 ,$166.84 ,$16.51 ,$242.19 ,$33.93 ,$247.57 ,$242.19 ,$177.63 ,$177.63 ,$163.88 ,$177.63 ,$174.92 ,$183.85 ,$61.26 ,$212.59 ,$16.51 ,$18.10 ,$18.10 ,$71.21 ,$18.10 ,$15.08 ,$255.65 ,$220.66 ,$220.66 ,$215.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),82728072,82728,HC FERRITIN-PRV 72 HR,301,1 ,$163.30 ,$107.78 ,$13.63 ,$163.30 ,$14.08 ,$47.71 ,$47.71 ,$43.21 ,$130.64 ,$138.81 ,$102.06 ,$146.97 ,$14.08 ,$14.08 ,$155.14 ,$146.97 ,$138.81 ,$138.81 ,$43.21 ,$138.81 ,$138.81 ,$146.97 ,$99.45 ,$14.08 ,$101.24 ,$14.92 ,$146.97 ,$30.67 ,$150.24 ,$146.97 ,$107.79 ,$107.79 ,$99.45 ,$107.79 ,$106.15 ,$111.57 ,$37.18 ,$129.01 ,$14.92 ,$16.36 ,$16.36 ,$43.21 ,$16.36 ,$13.63 ,$155.14 ,$133.91 ,$133.91 ,$130.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),82784072,82784,HC IG A D G M,301,1 ,$115.00 ,$75.90 ,$9.30 ,$115.00 ,$9.61 ,$32.55 ,$32.55 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$9.61 ,$9.61 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 ,$9.61 ,$71.30 ,$10.19 ,$103.50 ,$20.93 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 ,$10.19 ,$11.16 ,$11.16 ,$30.43 ,$11.16 ,$9.30 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),82948072,82948,HC GLUCOSE REAGENT STRIP-PRV 72 HR,300,1 ,$39.10 ,$25.81 ,$4.45 ,$39.10 ,$4.45 ,$17.64 ,$17.64 ,$10.35 ,$31.28 ,$33.24 ,$24.44 ,$35.19 ,$4.45 ,$4.45 ,$37.15 ,$35.19 ,$33.24 ,$33.24 ,$10.35 ,$33.24 ,$33.24 ,$35.19 ,$23.81 ,$4.45 ,$24.24 ,$4.72 ,$35.19 ,$11.34 ,$35.97 ,$35.19 ,$25.81 ,$25.81 ,$23.81 ,$25.81 ,$25.42 ,$26.71 ,$8.90 ,$30.89 ,$4.72 ,$6.05 ,$6.05 ,$10.35 ,$6.05 ,$5.04 ,$37.15 ,$32.06 ,$32.06 ,$31.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),83036072,83036,HC GLYCOSYLATED HGB-PRV 72 HR,301,1 ,$148.35 ,$97.91 ,$9.71 ,$148.35 ,$10.03 ,$33.99 ,$33.99 ,$39.25 ,$118.68 ,$126.10 ,$92.72 ,$133.52 ,$10.03 ,$10.03 ,$140.93 ,$133.52 ,$126.10 ,$126.10 ,$39.25 ,$126.10 ,$126.10 ,$133.52 ,$90.35 ,$10.03 ,$91.98 ,$10.63 ,$133.52 ,$21.85 ,$136.48 ,$133.52 ,$97.93 ,$97.93 ,$90.35 ,$97.93 ,$96.43 ,$101.35 ,$33.77 ,$117.20 ,$10.63 ,$11.65 ,$11.65 ,$39.25 ,$11.65 ,$9.71 ,$140.93 ,$121.65 ,$121.65 ,$118.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),83090072,83090,HC HOMOCYSTINE-PREVEA 72HR,301,1 ,$169.05 ,$111.57 ,$17.92 ,$169.05 ,$18.52 ,$62.72 ,$62.72 ,$44.73 ,$135.24 ,$143.69 ,$105.66 ,$152.15 ,$18.52 ,$18.52 ,$160.60 ,$152.15 ,$143.69 ,$143.69 ,$44.73 ,$143.69 ,$143.69 ,$152.15 ,$102.95 ,$18.52 ,$104.82 ,$19.63 ,$152.15 ,$40.32 ,$155.53 ,$152.15 ,$111.59 ,$111.59 ,$102.95 ,$111.59 ,$109.88 ,$115.50 ,$38.48 ,$133.55 ,$19.63 ,$21.50 ,$21.50 ,$44.73 ,$21.50 ,$17.92 ,$160.60 ,$138.62 ,$138.62 ,$135.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),83540072,83540,HC IRON TOTAL-PRV 72 HR,301,1 ,$96.60 ,$63.76 ,$6.47 ,$96.60 ,$6.69 ,$22.65 ,$22.65 ,$25.56 ,$77.28 ,$82.11 ,$60.38 ,$86.94 ,$6.69 ,$6.69 ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 ,$6.69 ,$59.90 ,$7.09 ,$86.94 ,$14.56 ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 ,$7.09 ,$7.76 ,$7.76 ,$25.56 ,$7.76 ,$6.47 ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),83550072,83550,HC IRON BINDING CAPACITY-PRV 72 HR,301,1 ,$127.65 ,$84.25 ,$8.74 ,$127.65 ,$9.03 ,$30.59 ,$30.59 ,$33.78 ,$102.12 ,$108.50 ,$79.78 ,$114.89 ,$9.03 ,$9.03 ,$121.27 ,$114.89 ,$108.50 ,$108.50 ,$33.78 ,$108.50 ,$108.50 ,$114.89 ,$77.74 ,$9.03 ,$79.14 ,$9.57 ,$114.89 ,$19.67 ,$117.44 ,$114.89 ,$84.26 ,$84.26 ,$77.74 ,$84.26 ,$82.97 ,$87.21 ,$29.06 ,$100.84 ,$9.57 ,$10.49 ,$10.49 ,$33.78 ,$10.49 ,$8.74 ,$121.27 ,$104.67 ,$104.67 ,$102.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),83615072,83615,HC LACTATE DEHYDRO (LDH)-PRV 72 HR,301,1 ,$85.10 ,$56.17 ,$6.04 ,$85.10 ,$6.24 ,$21.14 ,$21.14 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$6.24 ,$6.24 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$6.24 ,$52.76 ,$6.61 ,$76.59 ,$13.59 ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$6.61 ,$7.25 ,$7.25 ,$22.52 ,$7.25 ,$6.04 ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),83690072,83690,HC LIPASE-PRV 72 HR,300,1 ,$146.05 ,$96.39 ,$6.89 ,$146.05 ,$7.12 ,$24.12 ,$24.12 ,$38.64 ,$116.84 ,$124.14 ,$91.28 ,$131.45 ,$7.12 ,$7.12 ,$138.75 ,$131.45 ,$124.14 ,$124.14 ,$38.64 ,$124.14 ,$124.14 ,$131.45 ,$88.94 ,$7.12 ,$90.56 ,$7.55 ,$131.45 ,$15.50 ,$134.37 ,$131.45 ,$96.41 ,$96.41 ,$88.94 ,$96.41 ,$94.93 ,$99.78 ,$33.25 ,$115.38 ,$7.55 ,$8.27 ,$8.27 ,$38.64 ,$8.27 ,$6.89 ,$138.75 ,$119.76 ,$119.76 ,$116.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),83721072,83721,HC CHOLESTEROL LDL,301,1 ,$100.05 ,$66.03 ,$10.50 ,$100.05 ,$10.85 ,$36.75 ,$36.75 ,$26.47 ,$80.04 ,$85.04 ,$62.53 ,$90.05 ,$10.85 ,$10.85 ,$95.05 ,$90.05 ,$85.04 ,$85.04 ,$26.47 ,$85.04 ,$85.04 ,$90.05 ,$60.93 ,$10.85 ,$62.04 ,$11.50 ,$90.05 ,$23.63 ,$92.05 ,$90.05 ,$66.04 ,$66.04 ,$60.93 ,$66.04 ,$65.03 ,$68.35 ,$22.78 ,$79.04 ,$11.50 ,$12.60 ,$12.60 ,$26.47 ,$12.60 ,$10.50 ,$95.05 ,$82.04 ,$82.04 ,$80.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),83735072,83735,HC MAGNESIUM-PRV 72 HR,301,1 ,$88.55 ,$58.44 ,$6.70 ,$88.55 ,$6.92 ,$23.45 ,$23.45 ,$23.43 ,$70.84 ,$75.27 ,$55.34 ,$79.70 ,$6.92 ,$6.92 ,$84.12 ,$79.70 ,$75.27 ,$75.27 ,$23.43 ,$75.27 ,$75.27 ,$79.70 ,$53.93 ,$6.92 ,$54.90 ,$7.34 ,$79.70 ,$15.08 ,$81.47 ,$79.70 ,$58.45 ,$58.45 ,$53.93 ,$58.45 ,$57.56 ,$60.50 ,$20.16 ,$69.95 ,$7.34 ,$8.04 ,$8.04 ,$23.43 ,$8.04 ,$6.70 ,$84.12 ,$72.61 ,$72.61 ,$70.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),83789072,83789,HC MASS SPEC QT-PRV 72 HR,301,1 ,$195.50 ,$129.03 ,$24.11 ,$195.50 ,$24.91 ,$84.39 ,$84.39 ,$51.73 ,$156.40 ,$166.18 ,$122.19 ,$175.95 ,$24.91 ,$24.91 ,$185.73 ,$175.95 ,$166.18 ,$166.18 ,$51.73 ,$166.18 ,$166.18 ,$175.95 ,$119.06 ,$24.91 ,$121.22 ,$26.40 ,$175.95 ,$54.25 ,$179.86 ,$175.95 ,$129.05 ,$129.05 ,$119.06 ,$129.05 ,$127.08 ,$133.57 ,$44.51 ,$154.45 ,$26.40 ,$28.93 ,$28.93 ,$51.73 ,$28.93 ,$24.11 ,$185.73 ,$160.31 ,$160.31 ,$156.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),83880072,83880,HC BNP NATRIURETIC PEPTIDE-PRV 72 HR,301,1 ,$249.55 ,$164.70 ,$39.26 ,$249.55 ,$40.57 ,$137.41 ,$137.41 ,$66.03 ,$199.64 ,$212.12 ,$155.97 ,$224.60 ,$40.57 ,$40.57 ,$237.07 ,$224.60 ,$212.12 ,$212.12 ,$66.03 ,$212.12 ,$212.12 ,$224.60 ,$151.98 ,$40.57 ,$154.72 ,$43.00 ,$224.60 ,$88.34 ,$229.59 ,$224.60 ,$164.73 ,$164.73 ,$151.98 ,$164.73 ,$162.21 ,$170.49 ,$56.81 ,$197.14 ,$43.00 ,$47.11 ,$47.11 ,$66.03 ,$47.11 ,$39.26 ,$237.07 ,$204.63 ,$204.63 ,$199.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),83883072,83883,HC NEPHELOMETRY,301,1 ,$161.00 ,$106.26 ,$13.60 ,$161.00 ,$14.05 ,$47.60 ,$47.60 ,$42.60 ,$128.80 ,$136.85 ,$100.63 ,$144.90 ,$14.05 ,$14.05 ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$42.60 ,$136.85 ,$136.85 ,$144.90 ,$98.05 ,$14.05 ,$99.82 ,$14.89 ,$144.90 ,$30.60 ,$148.12 ,$144.90 ,$106.28 ,$106.28 ,$98.05 ,$106.28 ,$104.65 ,$110.00 ,$36.65 ,$127.19 ,$14.89 ,$16.32 ,$16.32 ,$42.60 ,$16.32 ,$13.60 ,$152.95 ,$132.02 ,$132.02 ,$128.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),83921072,83921,HC ORGANIC ACID,301,1 ,$218.50 ,$144.21 ,$21.21 ,$218.50 ,$21.92 ,$74.24 ,$74.24 ,$57.82 ,$174.80 ,$185.73 ,$136.56 ,$196.65 ,$21.92 ,$21.92 ,$207.58 ,$196.65 ,$185.73 ,$185.73 ,$57.82 ,$185.73 ,$185.73 ,$196.65 ,$133.07 ,$21.92 ,$135.48 ,$23.24 ,$196.65 ,$47.72 ,$201.02 ,$196.65 ,$144.23 ,$144.23 ,$133.07 ,$144.23 ,$142.03 ,$149.28 ,$49.74 ,$172.62 ,$23.24 ,$25.45 ,$25.45 ,$57.82 ,$25.45 ,$21.21 ,$207.58 ,$179.17 ,$179.17 ,$174.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),83970072,83970,HC PARATHORMONE PTH-PREV 72HR,301,1 ,$355.35 ,$234.53 ,$41.28 ,$355.35 ,$42.65 ,$144.48 ,$144.48 ,$94.02 ,$284.28 ,$302.05 ,$222.09 ,$319.82 ,$42.65 ,$42.65 ,$337.58 ,$319.82 ,$302.05 ,$302.05 ,$94.02 ,$302.05 ,$302.05 ,$319.82 ,$216.41 ,$42.65 ,$220.32 ,$45.21 ,$319.82 ,$92.88 ,$326.92 ,$319.82 ,$234.57 ,$234.57 ,$216.41 ,$234.57 ,$230.98 ,$242.78 ,$80.90 ,$280.73 ,$45.21 ,$49.54 ,$49.54 ,$94.02 ,$49.54 ,$41.28 ,$337.58 ,$291.39 ,$291.39 ,$284.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),84132072,84132,HC POTASSIUM SERUM-PRV 72 HR,300,1 ,$85.10 ,$56.17 ,$4.76 ,$85.10 ,$4.92 ,$16.66 ,$16.66 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$4.92 ,$4.92 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$4.92 ,$52.76 ,$5.22 ,$76.59 ,$10.71 ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$5.22 ,$5.71 ,$5.71 ,$22.52 ,$5.71 ,$4.76 ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),84156072,84156,HC URINE PROTEIN-PRV 72 HR,301,1 ,$116.15 ,$76.66 ,$3.67 ,$116.15 ,$3.79 ,$12.85 ,$12.85 ,$30.73 ,$92.92 ,$98.73 ,$72.59 ,$104.54 ,$3.79 ,$3.79 ,$110.34 ,$104.54 ,$98.73 ,$98.73 ,$30.73 ,$98.73 ,$98.73 ,$104.54 ,$70.74 ,$3.79 ,$72.02 ,$4.02 ,$104.54 ,$8.26 ,$106.86 ,$104.54 ,$76.67 ,$76.67 ,$70.74 ,$76.67 ,$75.50 ,$79.35 ,$26.44 ,$91.76 ,$4.02 ,$4.40 ,$4.40 ,$30.73 ,$4.40 ,$3.67 ,$110.34 ,$95.24 ,$95.24 ,$92.92 
ST. CLARE MEMORIAL HOSPITAL (ACU),84165072,84165,HC PROTEIN ELECTOPHORESUS,300,1 ,$149.50 ,$98.67 ,$10.74 ,$149.50 ,$11.10 ,$37.59 ,$37.59 ,$39.56 ,$119.60 ,$127.08 ,$93.44 ,$134.55 ,$11.10 ,$11.10 ,$142.03 ,$134.55 ,$127.08 ,$127.08 ,$39.56 ,$127.08 ,$127.08 ,$134.55 ,$91.05 ,$11.10 ,$92.70 ,$11.77 ,$134.55 ,$24.17 ,$137.54 ,$134.55 ,$98.69 ,$98.69 ,$91.05 ,$98.69 ,$97.18 ,$102.14 ,$34.04 ,$118.11 ,$11.77 ,$12.89 ,$12.89 ,$39.56 ,$12.89 ,$10.74 ,$142.03 ,$122.59 ,$122.59 ,$119.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),84403072,84403,HC TESTERONE TOTAL-PRV 72HR,301,1 ,$244.95 ,$161.67 ,$25.81 ,$244.95 ,$26.67 ,$90.34 ,$90.34 ,$64.82 ,$195.96 ,$208.21 ,$153.09 ,$220.46 ,$26.67 ,$26.67 ,$232.70 ,$220.46 ,$208.21 ,$208.21 ,$64.82 ,$208.21 ,$208.21 ,$220.46 ,$149.17 ,$26.67 ,$151.86 ,$28.27 ,$220.46 ,$58.07 ,$225.35 ,$220.46 ,$161.69 ,$161.69 ,$149.17 ,$161.69 ,$159.22 ,$167.35 ,$55.76 ,$193.51 ,$28.27 ,$30.97 ,$30.97 ,$64.82 ,$30.97 ,$25.81 ,$232.70 ,$200.86 ,$200.86 ,$195.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),84439072,84439,HC T4 FREE-PRV 72 HR,301,1 ,$186.30 ,$122.96 ,$9.02 ,$186.30 ,$9.32 ,$31.57 ,$31.57 ,$49.29 ,$149.04 ,$158.36 ,$116.44 ,$167.67 ,$9.32 ,$9.32 ,$176.99 ,$167.67 ,$158.36 ,$158.36 ,$49.29 ,$158.36 ,$158.36 ,$167.67 ,$113.46 ,$9.32 ,$115.50 ,$9.88 ,$167.67 ,$20.30 ,$171.40 ,$167.67 ,$122.98 ,$122.98 ,$113.46 ,$122.98 ,$121.10 ,$127.28 ,$42.41 ,$147.18 ,$9.88 ,$10.82 ,$10.82 ,$49.29 ,$10.82 ,$9.02 ,$176.99 ,$152.77 ,$152.77 ,$149.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),84443072,84443,HC THYROID STIMULATING HORM-PRV 72 HR,301,1 ,$164.45 ,$108.54 ,$16.80 ,$164.45 ,$17.36 ,$58.80 ,$58.80 ,$43.51 ,$131.56 ,$139.78 ,$102.78 ,$148.01 ,$17.36 ,$17.36 ,$156.23 ,$148.01 ,$139.78 ,$139.78 ,$43.51 ,$139.78 ,$139.78 ,$148.01 ,$100.15 ,$17.36 ,$101.96 ,$18.40 ,$148.01 ,$37.80 ,$151.29 ,$148.01 ,$108.55 ,$108.55 ,$100.15 ,$108.55 ,$106.89 ,$112.35 ,$37.44 ,$129.92 ,$18.40 ,$20.16 ,$20.16 ,$43.51 ,$20.16 ,$16.80 ,$156.23 ,$134.85 ,$134.85 ,$131.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),84450072,84450,HC AST/SGOT-PRV 72 HR,301,1 ,$86.25 ,$56.93 ,$5.18 ,$86.25 ,$5.35 ,$18.13 ,$18.13 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$5.35 ,$5.35 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$5.35 ,$53.48 ,$5.67 ,$77.63 ,$11.66 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$5.67 ,$6.22 ,$6.22 ,$22.82 ,$6.22 ,$5.18 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),84460072,84460,HC ALT/SGPT-PRV 72 HR,301,1 ,$86.25 ,$56.93 ,$5.30 ,$86.25 ,$5.48 ,$18.55 ,$18.55 ,$22.82 ,$69.00 ,$73.31 ,$53.91 ,$77.63 ,$5.48 ,$5.48 ,$81.94 ,$77.63 ,$73.31 ,$73.31 ,$22.82 ,$73.31 ,$73.31 ,$77.63 ,$52.53 ,$5.48 ,$53.48 ,$5.81 ,$77.63 ,$11.93 ,$79.35 ,$77.63 ,$56.93 ,$56.93 ,$52.53 ,$56.93 ,$56.06 ,$58.93 ,$19.64 ,$68.14 ,$5.81 ,$6.36 ,$6.36 ,$22.82 ,$6.36 ,$5.30 ,$81.94 ,$70.73 ,$70.73 ,$69.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),84550072,84550,HC URIC ACID-PRV 72 HR,301,1 ,$96.60 ,$63.76 ,$4.52 ,$96.60 ,$4.67 ,$15.82 ,$15.82 ,$25.56 ,$77.28 ,$82.11 ,$60.38 ,$86.94 ,$4.67 ,$4.67 ,$91.77 ,$86.94 ,$82.11 ,$82.11 ,$25.56 ,$82.11 ,$82.11 ,$86.94 ,$58.83 ,$4.67 ,$59.90 ,$4.95 ,$86.94 ,$10.17 ,$88.87 ,$86.94 ,$63.77 ,$63.77 ,$58.83 ,$63.77 ,$62.79 ,$66.00 ,$21.99 ,$76.31 ,$4.95 ,$5.42 ,$5.42 ,$25.56 ,$5.42 ,$4.52 ,$91.77 ,$79.21 ,$79.21 ,$77.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),85014072,85014,HC HEMATOCRIT-PRV 72 HR,305,1 ,$71.30 ,$47.06 ,$2.37 ,$71.30 ,$2.45 ,$8.30 ,$8.30 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$2.45 ,$2.45 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$2.45 ,$44.20 ,$2.60 ,$64.17 ,$5.33 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 ,$16.23 ,$56.33 ,$2.60 ,$2.84 ,$2.84 ,$18.86 ,$2.84 ,$2.37 ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),85018072,85018,HC HEMOGLOBIN-PRV 72 HR,305,1 ,$71.30 ,$47.06 ,$2.37 ,$71.30 ,$2.45 ,$8.30 ,$8.30 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$2.45 ,$2.45 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$2.45 ,$44.20 ,$2.60 ,$64.17 ,$5.33 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 ,$16.23 ,$56.33 ,$2.60 ,$2.84 ,$2.84 ,$18.86 ,$2.84 ,$2.37 ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),85025072,85025,HC CBC AUTO W/AUTO DIFF-PRV 72 HR,305,1 ,$82.80 ,$54.65 ,$7.77 ,$82.80 ,$8.03 ,$27.20 ,$27.20 ,$21.91 ,$66.24 ,$70.38 ,$51.75 ,$74.52 ,$8.03 ,$8.03 ,$78.66 ,$74.52 ,$70.38 ,$70.38 ,$21.91 ,$70.38 ,$70.38 ,$74.52 ,$50.43 ,$8.03 ,$51.34 ,$8.51 ,$74.52 ,$17.48 ,$76.18 ,$74.52 ,$54.66 ,$54.66 ,$50.43 ,$54.66 ,$53.82 ,$56.57 ,$18.85 ,$65.41 ,$8.51 ,$9.32 ,$9.32 ,$21.91 ,$9.32 ,$7.77 ,$78.66 ,$67.90 ,$67.90 ,$66.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),85027072,85027,HC CBC W/O DIFF-PRV 72 HR,305,1 ,$140.30 ,$92.60 ,$6.47 ,$140.30 ,$6.69 ,$22.65 ,$22.65 ,$37.12 ,$112.24 ,$119.26 ,$87.69 ,$126.27 ,$6.69 ,$6.69 ,$133.29 ,$126.27 ,$119.26 ,$119.26 ,$37.12 ,$119.26 ,$119.26 ,$126.27 ,$85.44 ,$6.69 ,$86.98 ,$7.09 ,$126.27 ,$14.56 ,$129.08 ,$126.27 ,$92.61 ,$92.61 ,$85.44 ,$92.61 ,$91.20 ,$95.85 ,$31.94 ,$110.84 ,$7.09 ,$7.76 ,$7.76 ,$37.12 ,$7.76 ,$6.47 ,$133.29 ,$115.05 ,$115.05 ,$112.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),85379072,85379,HC D-DIMMER QUAN-PRV 72 HR,305,1 ,$170.20 ,$112.33 ,$10.18 ,$170.20 ,$10.52 ,$35.63 ,$35.63 ,$45.03 ,$136.16 ,$144.67 ,$106.38 ,$153.18 ,$10.52 ,$10.52 ,$161.69 ,$153.18 ,$144.67 ,$144.67 ,$45.03 ,$144.67 ,$144.67 ,$153.18 ,$103.65 ,$10.52 ,$105.52 ,$11.15 ,$153.18 ,$22.91 ,$156.58 ,$153.18 ,$112.35 ,$112.35 ,$103.65 ,$112.35 ,$110.63 ,$116.28 ,$38.75 ,$134.46 ,$11.15 ,$12.22 ,$12.22 ,$45.03 ,$12.22 ,$10.18 ,$161.69 ,$139.56 ,$139.56 ,$136.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),85610072,85610,HC PROTHROMBIN TIME (PT)-PRV 72 HR,305,1 ,$85.10 ,$56.17 ,$4.29 ,$85.10 ,$4.43 ,$15.02 ,$15.02 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$4.43 ,$4.43 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$4.43 ,$52.76 ,$4.70 ,$76.59 ,$9.65 ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$4.70 ,$5.15 ,$5.15 ,$22.52 ,$5.15 ,$4.29 ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),85652072,85652,HC ESR AUTO- PRV 72 HR,305,1 ,$77.05 ,$50.85 ,$2.70 ,$77.05 ,$2.79 ,$9.45 ,$9.45 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$2.79 ,$2.79 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$2.79 ,$47.78 ,$2.96 ,$69.35 ,$6.08 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$2.96 ,$3.24 ,$3.24 ,$20.38 ,$3.24 ,$2.70 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),85730072,85730,HC PTT-PRV 72 HR,305,1 ,$72.45 ,$47.82 ,$6.01 ,$72.45 ,$6.21 ,$21.04 ,$21.04 ,$19.17 ,$57.96 ,$61.58 ,$45.28 ,$65.21 ,$6.21 ,$6.21 ,$68.83 ,$65.21 ,$61.58 ,$61.58 ,$19.17 ,$61.58 ,$61.58 ,$65.21 ,$44.12 ,$6.21 ,$44.92 ,$6.58 ,$65.21 ,$13.52 ,$66.65 ,$65.21 ,$47.82 ,$47.82 ,$44.12 ,$47.82 ,$47.09 ,$49.50 ,$16.49 ,$57.24 ,$6.58 ,$7.21 ,$7.21 ,$19.17 ,$7.21 ,$6.01 ,$68.83 ,$59.41 ,$59.41 ,$57.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),86038072,86038,HC ANA SCREEN-PRV 72 HR,302,1 ,$151.80 ,$100.19 ,$12.09 ,$151.80 ,$12.49 ,$42.32 ,$42.32 ,$40.17 ,$121.44 ,$129.03 ,$94.88 ,$136.62 ,$12.49 ,$12.49 ,$144.21 ,$136.62 ,$129.03 ,$129.03 ,$40.17 ,$129.03 ,$129.03 ,$136.62 ,$92.45 ,$12.49 ,$94.12 ,$13.24 ,$136.62 ,$27.20 ,$139.66 ,$136.62 ,$100.20 ,$100.20 ,$92.45 ,$100.20 ,$98.67 ,$103.71 ,$34.55 ,$119.92 ,$13.24 ,$14.51 ,$14.51 ,$40.17 ,$14.51 ,$12.09 ,$144.21 ,$124.48 ,$124.48 ,$121.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),86140072,86140,HC C-REACTIVE PROTEIN-PRV 72 HR,302,1 ,$163.30 ,$107.78 ,$5.18 ,$163.30 ,$5.35 ,$18.13 ,$18.13 ,$43.21 ,$130.64 ,$138.81 ,$102.06 ,$146.97 ,$5.35 ,$5.35 ,$155.14 ,$146.97 ,$138.81 ,$138.81 ,$43.21 ,$138.81 ,$138.81 ,$146.97 ,$99.45 ,$5.35 ,$101.24 ,$5.67 ,$146.97 ,$11.66 ,$150.24 ,$146.97 ,$107.79 ,$107.79 ,$99.45 ,$107.79 ,$106.15 ,$111.57 ,$37.18 ,$129.01 ,$5.67 ,$6.22 ,$6.22 ,$43.21 ,$6.22 ,$5.18 ,$155.14 ,$133.91 ,$133.91 ,$130.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),86255072,86255,HC FLUOR AB SC,302,1 ,$181.70 ,$119.92 ,$12.05 ,$181.70 ,$12.45 ,$42.18 ,$42.18 ,$48.08 ,$145.36 ,$154.45 ,$113.56 ,$163.53 ,$12.45 ,$12.45 ,$172.62 ,$163.53 ,$154.45 ,$154.45 ,$48.08 ,$154.45 ,$154.45 ,$163.53 ,$110.66 ,$12.45 ,$112.66 ,$13.20 ,$163.53 ,$27.11 ,$167.16 ,$163.53 ,$119.94 ,$119.94 ,$110.66 ,$119.94 ,$118.11 ,$124.14 ,$41.37 ,$143.54 ,$13.20 ,$14.46 ,$14.46 ,$48.08 ,$14.46 ,$12.05 ,$172.62 ,$148.99 ,$148.99 ,$145.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),86304072,86304,HC TUMOR AG CA 125-PRV 72 HR,302,1 ,$197.80 ,$130.55 ,$20.81 ,$197.80 ,$21.50 ,$72.84 ,$72.84 ,$52.34 ,$158.24 ,$168.13 ,$123.63 ,$178.02 ,$21.50 ,$21.50 ,$187.91 ,$178.02 ,$168.13 ,$168.13 ,$52.34 ,$168.13 ,$168.13 ,$178.02 ,$120.46 ,$21.50 ,$122.64 ,$22.79 ,$178.02 ,$46.82 ,$181.98 ,$178.02 ,$130.57 ,$130.57 ,$120.46 ,$130.57 ,$128.57 ,$135.14 ,$45.02 ,$156.26 ,$22.79 ,$24.97 ,$24.97 ,$52.34 ,$24.97 ,$20.81 ,$187.91 ,$162.20 ,$162.20 ,$158.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),86308072,86308,HC HETEROPHILE SCRN-PRV 72 HR,300,1 ,$104.65 ,$69.07 ,$5.18 ,$104.65 ,$5.35 ,$18.13 ,$18.13 ,$27.69 ,$83.72 ,$88.95 ,$65.41 ,$94.19 ,$5.35 ,$5.35 ,$99.42 ,$94.19 ,$88.95 ,$88.95 ,$27.69 ,$88.95 ,$88.95 ,$94.19 ,$63.73 ,$5.35 ,$64.88 ,$5.67 ,$94.19 ,$11.66 ,$96.28 ,$94.19 ,$69.08 ,$69.08 ,$63.73 ,$69.08 ,$68.02 ,$71.50 ,$23.82 ,$82.67 ,$5.67 ,$6.22 ,$6.22 ,$27.69 ,$6.22 ,$5.18 ,$99.42 ,$85.81 ,$85.81 ,$83.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),86331072,86331,HC IMMUNODIFF EL EA AB-PRV 72 HR,302,1 ,$151.80 ,$100.19 ,$11.98 ,$151.80 ,$12.38 ,$41.93 ,$41.93 ,$40.17 ,$121.44 ,$129.03 ,$94.88 ,$136.62 ,$12.38 ,$12.38 ,$144.21 ,$136.62 ,$129.03 ,$129.03 ,$40.17 ,$129.03 ,$129.03 ,$136.62 ,$92.45 ,$12.38 ,$94.12 ,$13.12 ,$136.62 ,$26.96 ,$139.66 ,$136.62 ,$100.20 ,$100.20 ,$92.45 ,$100.20 ,$98.67 ,$103.71 ,$34.55 ,$119.92 ,$13.12 ,$14.38 ,$14.38 ,$40.17 ,$14.38 ,$11.98 ,$144.21 ,$124.48 ,$124.48 ,$121.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),86332072,86332,HC IMMUNE COMPLEX ASSAY-PRV 72 HR,300,1 ,$203.55 ,$134.34 ,$24.37 ,$203.55 ,$25.18 ,$85.30 ,$85.30 ,$53.86 ,$162.84 ,$173.02 ,$127.22 ,$183.20 ,$25.18 ,$25.18 ,$193.37 ,$183.20 ,$173.02 ,$173.02 ,$53.86 ,$173.02 ,$173.02 ,$183.20 ,$123.96 ,$25.18 ,$126.20 ,$26.69 ,$183.20 ,$54.83 ,$187.27 ,$183.20 ,$134.36 ,$134.36 ,$123.96 ,$134.36 ,$132.31 ,$139.07 ,$46.34 ,$160.80 ,$26.69 ,$29.24 ,$29.24 ,$53.86 ,$29.24 ,$24.37 ,$193.37 ,$166.91 ,$166.91 ,$162.84 
ST. CLARE MEMORIAL HOSPITAL (ACU),86334072,86334,HC IMMUNOFIXATION SERUM,300,1 ,$207.00 ,$136.62 ,$22.34 ,$207.00 ,$23.08 ,$78.19 ,$78.19 ,$54.77 ,$165.60 ,$175.95 ,$129.38 ,$186.30 ,$23.08 ,$23.08 ,$196.65 ,$186.30 ,$175.95 ,$175.95 ,$54.77 ,$175.95 ,$175.95 ,$186.30 ,$126.06 ,$23.08 ,$128.34 ,$24.46 ,$186.30 ,$50.27 ,$190.44 ,$186.30 ,$136.64 ,$136.64 ,$126.06 ,$136.64 ,$134.55 ,$141.42 ,$47.13 ,$163.53 ,$24.46 ,$26.81 ,$26.81 ,$54.77 ,$26.81 ,$22.34 ,$196.65 ,$169.74 ,$169.74 ,$165.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),86430072,86430,HC RHEUMATOID FACTOR-PRV 72 HR,302,1 ,$81.65 ,$53.89 ,$6.14 ,$81.65 ,$6.34 ,$21.49 ,$21.49 ,$21.61 ,$65.32 ,$69.40 ,$51.03 ,$73.49 ,$6.34 ,$6.34 ,$77.57 ,$73.49 ,$69.40 ,$69.40 ,$21.61 ,$69.40 ,$69.40 ,$73.49 ,$49.72 ,$6.34 ,$50.62 ,$6.72 ,$73.49 ,$13.82 ,$75.12 ,$73.49 ,$53.90 ,$53.90 ,$49.72 ,$53.90 ,$53.07 ,$55.78 ,$18.59 ,$64.50 ,$6.72 ,$7.37 ,$7.37 ,$21.61 ,$7.37 ,$6.14 ,$77.57 ,$66.95 ,$66.95 ,$65.32 
ST. CLARE MEMORIAL HOSPITAL (ACU),86580072,86580,HC TB SCREEN-PRV 72 HR,300,1 ,$119.60 ,$78.94 ,$18.68 ,$119.60 ,$18.68 ,$34.59 ,$34.59 ,$31.64 ,$95.68 ,$101.66 ,$74.75 ,$107.64 ,$18.68 ,$18.68 ,$113.62 ,$107.64 ,$101.66 ,$101.66 ,$31.64 ,$101.66 ,$101.66 ,$107.64 ,$72.84 ,$18.68 ,$74.16 ,$19.80 ,$107.64 ,$56.16 ,$110.03 ,$107.64 ,$78.95 ,$78.95 ,$72.84 ,$78.95 ,$77.74 ,$81.71 ,$27.23 ,$94.48 ,$19.80 ,$27.59 ,$27.59 ,$31.64 ,$27.59 ,$24.96 ,$113.62 ,$98.07 ,$98.07 ,$95.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),86618072,86618,HC LYMES DISEASE-PRV 72 HR,302,1 ,$180.55 ,$119.16 ,$17.03 ,$180.55 ,$17.60 ,$59.61 ,$59.61 ,$47.77 ,$144.44 ,$153.47 ,$112.84 ,$162.50 ,$17.60 ,$17.60 ,$171.52 ,$162.50 ,$153.47 ,$153.47 ,$47.77 ,$153.47 ,$153.47 ,$162.50 ,$109.96 ,$17.60 ,$111.94 ,$18.66 ,$162.50 ,$38.32 ,$166.11 ,$162.50 ,$119.18 ,$119.18 ,$109.96 ,$119.18 ,$117.36 ,$123.35 ,$41.11 ,$142.63 ,$18.66 ,$20.44 ,$20.44 ,$47.77 ,$20.44 ,$17.03 ,$171.52 ,$148.05 ,$148.05 ,$144.44 
ST. CLARE MEMORIAL HOSPITAL (ACU),86695072,86695,HC HERPES SIMPLEX AB-PRV 72 HR,302,1 ,$159.85 ,$105.50 ,$13.19 ,$159.85 ,$13.63 ,$46.17 ,$46.17 ,$42.30 ,$127.88 ,$135.87 ,$99.91 ,$143.87 ,$13.63 ,$13.63 ,$151.86 ,$143.87 ,$135.87 ,$135.87 ,$42.30 ,$135.87 ,$135.87 ,$143.87 ,$97.35 ,$13.63 ,$99.10 ,$14.45 ,$143.87 ,$29.68 ,$147.06 ,$143.87 ,$105.52 ,$105.52 ,$97.35 ,$105.52 ,$103.90 ,$109.21 ,$36.40 ,$126.28 ,$14.45 ,$15.83 ,$15.83 ,$42.30 ,$15.83 ,$13.19 ,$151.86 ,$131.08 ,$131.08 ,$127.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),86696072,86696,HC HERPES SIMPLEX AB II-PRV 72 HR,302,1 ,$159.85 ,$105.50 ,$19.35 ,$159.85 ,$19.99 ,$67.73 ,$67.73 ,$42.30 ,$127.88 ,$135.87 ,$99.91 ,$143.87 ,$19.99 ,$19.99 ,$151.86 ,$143.87 ,$135.87 ,$135.87 ,$42.30 ,$135.87 ,$135.87 ,$143.87 ,$97.35 ,$19.99 ,$99.10 ,$21.19 ,$143.87 ,$43.54 ,$147.06 ,$143.87 ,$105.52 ,$105.52 ,$97.35 ,$105.52 ,$103.90 ,$109.21 ,$36.40 ,$126.28 ,$21.19 ,$23.22 ,$23.22 ,$42.30 ,$23.22 ,$19.35 ,$151.86 ,$131.08 ,$131.08 ,$127.88 
ST. CLARE MEMORIAL HOSPITAL (ACU),86705072,86705,HC HEP B CORE IGM AB PRV 72 HR,300,1 ,$125.35 ,$82.73 ,$11.77 ,$125.35 ,$12.16 ,$41.20 ,$41.20 ,$33.16 ,$100.28 ,$106.55 ,$78.34 ,$112.82 ,$12.16 ,$12.16 ,$119.08 ,$112.82 ,$106.55 ,$106.55 ,$33.16 ,$106.55 ,$106.55 ,$112.82 ,$76.34 ,$12.16 ,$77.72 ,$12.89 ,$112.82 ,$26.48 ,$115.32 ,$112.82 ,$82.74 ,$82.74 ,$76.34 ,$82.74 ,$81.48 ,$85.64 ,$28.54 ,$99.03 ,$12.89 ,$14.12 ,$14.12 ,$33.16 ,$14.12 ,$11.77 ,$119.08 ,$102.79 ,$102.79 ,$100.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),87040072,87040,HC BLOOD CULTURE-72HR PRV,306,1 ,$162.15 ,$107.02 ,$10.32 ,$162.15 ,$10.66 ,$36.12 ,$36.12 ,$42.90 ,$129.72 ,$137.83 ,$101.34 ,$145.94 ,$10.66 ,$10.66 ,$154.04 ,$145.94 ,$137.83 ,$137.83 ,$42.90 ,$137.83 ,$137.83 ,$145.94 ,$98.75 ,$10.66 ,$100.54 ,$11.30 ,$145.94 ,$23.22 ,$149.18 ,$145.94 ,$107.04 ,$107.04 ,$98.75 ,$107.04 ,$105.40 ,$110.78 ,$36.91 ,$128.10 ,$11.30 ,$12.38 ,$12.38 ,$42.90 ,$12.38 ,$10.32 ,$154.04 ,$132.96 ,$132.96 ,$129.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),87045072,87045,HC CULTURE FECES-PRV 72HR,300,1 ,$138.00 ,$91.08 ,$9.44 ,$138.00 ,$9.75 ,$33.04 ,$33.04 ,$36.51 ,$110.40 ,$117.30 ,$86.25 ,$124.20 ,$9.75 ,$9.75 ,$131.10 ,$124.20 ,$117.30 ,$117.30 ,$36.51 ,$117.30 ,$117.30 ,$124.20 ,$84.04 ,$9.75 ,$85.56 ,$10.34 ,$124.20 ,$21.24 ,$126.96 ,$124.20 ,$91.09 ,$91.09 ,$84.04 ,$91.09 ,$89.70 ,$94.28 ,$31.42 ,$109.02 ,$10.34 ,$11.33 ,$11.33 ,$36.51 ,$11.33 ,$9.44 ,$131.10 ,$113.16 ,$113.16 ,$110.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87046072,87046,HC CX FECES ADDNL-PRV 72 HR,306,1 ,$265.65 ,$175.33 ,$3.40 ,$265.65 ,$3.40 ,$33.04 ,$33.04 ,$70.30 ,$212.52 ,$225.80 ,$166.03 ,$239.09 ,$3.40 ,$3.40 ,$252.37 ,$239.09 ,$225.80 ,$225.80 ,$70.30 ,$225.80 ,$225.80 ,$239.09 ,$161.78 ,$3.40 ,$164.70 ,$3.60 ,$239.09 ,$21.24 ,$244.40 ,$239.09 ,$175.36 ,$175.36 ,$161.78 ,$175.36 ,$172.67 ,$181.49 ,$60.48 ,$209.86 ,$3.60 ,$11.33 ,$11.33 ,$70.30 ,$11.33 ,$9.44 ,$252.37 ,$217.83 ,$217.83 ,$212.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),87077072,87077,HC CULTURE AEROBIC ID ADDL-PRV 72 HR,306,1 ,$141.45 ,$93.36 ,$8.08 ,$141.45 ,$8.35 ,$28.28 ,$28.28 ,$37.43 ,$113.16 ,$120.23 ,$88.41 ,$127.31 ,$8.35 ,$8.35 ,$134.38 ,$127.31 ,$120.23 ,$120.23 ,$37.43 ,$120.23 ,$120.23 ,$127.31 ,$86.14 ,$8.35 ,$87.70 ,$8.85 ,$127.31 ,$18.18 ,$130.13 ,$127.31 ,$93.37 ,$93.37 ,$86.14 ,$93.37 ,$91.94 ,$96.64 ,$32.20 ,$111.75 ,$8.85 ,$9.70 ,$9.70 ,$37.43 ,$9.70 ,$8.08 ,$134.38 ,$115.99 ,$115.99 ,$113.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),87081072,87081,HC CULTURE SCREEN ONLY-PRV 72 HR,306,1 ,$71.30 ,$47.06 ,$6.63 ,$71.30 ,$6.85 ,$23.21 ,$23.21 ,$18.86 ,$57.04 ,$60.61 ,$44.56 ,$64.17 ,$6.85 ,$6.85 ,$67.74 ,$64.17 ,$60.61 ,$60.61 ,$18.86 ,$60.61 ,$60.61 ,$64.17 ,$43.42 ,$6.85 ,$44.20 ,$7.26 ,$64.17 ,$14.92 ,$65.60 ,$64.17 ,$47.07 ,$47.07 ,$43.42 ,$47.07 ,$46.35 ,$48.71 ,$16.23 ,$56.33 ,$7.26 ,$7.96 ,$7.96 ,$18.86 ,$7.96 ,$6.63 ,$67.74 ,$58.47 ,$58.47 ,$57.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),87086072,87086,HC CULTURE URINE W/COLONY CT-PRV 72 HR,306,1 ,$118.45 ,$78.18 ,$8.07 ,$118.45 ,$8.34 ,$28.25 ,$28.25 ,$31.34 ,$94.76 ,$100.68 ,$74.03 ,$106.61 ,$8.34 ,$8.34 ,$112.53 ,$106.61 ,$100.68 ,$100.68 ,$31.34 ,$100.68 ,$100.68 ,$106.61 ,$72.14 ,$8.34 ,$73.44 ,$8.84 ,$106.61 ,$18.16 ,$108.97 ,$106.61 ,$78.19 ,$78.19 ,$72.14 ,$78.19 ,$76.99 ,$80.93 ,$26.96 ,$93.58 ,$8.84 ,$9.68 ,$9.68 ,$31.34 ,$9.68 ,$8.07 ,$112.53 ,$97.13 ,$97.13 ,$94.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),87088072,87088,HC CULTURE URINE ID EA ISOL-PRV 72 HR,306,1 ,$111.55 ,$73.62 ,$8.09 ,$111.55 ,$8.36 ,$28.32 ,$28.32 ,$29.52 ,$89.24 ,$94.82 ,$69.72 ,$100.40 ,$8.36 ,$8.36 ,$105.97 ,$100.40 ,$94.82 ,$94.82 ,$29.52 ,$94.82 ,$94.82 ,$100.40 ,$67.93 ,$8.36 ,$69.16 ,$8.86 ,$100.40 ,$18.20 ,$102.63 ,$100.40 ,$73.63 ,$73.63 ,$67.93 ,$73.63 ,$72.51 ,$76.21 ,$25.40 ,$88.12 ,$8.86 ,$9.71 ,$9.71 ,$29.52 ,$9.71 ,$8.09 ,$105.97 ,$91.47 ,$91.47 ,$89.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),87186072,87186,HC SENSITIVITY MIC-PRV 72 HR,306,1 ,$124.20 ,$81.97 ,$8.65 ,$124.20 ,$8.94 ,$30.28 ,$30.28 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$8.94 ,$8.94 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$8.94 ,$77.00 ,$9.48 ,$111.78 ,$19.46 ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$9.48 ,$10.38 ,$10.38 ,$32.86 ,$10.38 ,$8.65 ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),87220072,87220,HC FUNGAL SMEAR-PRV 72 HR,300,1 ,$79.35 ,$52.37 ,$4.27 ,$79.35 ,$4.41 ,$14.95 ,$14.95 ,$20.99 ,$63.48 ,$67.45 ,$49.59 ,$71.42 ,$4.41 ,$4.41 ,$75.38 ,$71.42 ,$67.45 ,$67.45 ,$20.99 ,$67.45 ,$67.45 ,$71.42 ,$48.32 ,$4.41 ,$49.20 ,$4.67 ,$71.42 ,$9.61 ,$73.00 ,$71.42 ,$52.38 ,$52.38 ,$48.32 ,$52.38 ,$51.58 ,$54.21 ,$18.06 ,$62.69 ,$4.67 ,$5.12 ,$5.12 ,$20.99 ,$5.12 ,$4.27 ,$75.38 ,$65.07 ,$65.07 ,$63.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),87324072,87324,HC C DIFF TOXIN,300,1 ,$109.25 ,$72.11 ,$11.98 ,$109.25 ,$12.38 ,$41.93 ,$41.93 ,$28.91 ,$87.40 ,$92.86 ,$68.28 ,$98.33 ,$12.38 ,$12.38 ,$103.79 ,$98.33 ,$92.86 ,$92.86 ,$28.91 ,$92.86 ,$92.86 ,$98.33 ,$66.53 ,$12.38 ,$67.74 ,$13.12 ,$98.33 ,$26.96 ,$100.51 ,$98.33 ,$72.12 ,$72.12 ,$66.53 ,$72.12 ,$71.01 ,$74.64 ,$24.87 ,$86.31 ,$13.12 ,$14.38 ,$14.38 ,$28.91 ,$14.38 ,$11.98 ,$103.79 ,$89.59 ,$89.59 ,$87.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),87328072,87328,HC CRYPTO GIAR-PRV 72 HR,306,1 ,$95.45 ,$63.00 ,$13.82 ,$95.45 ,$14.28 ,$48.37 ,$48.37 ,$25.25 ,$76.36 ,$81.13 ,$59.66 ,$85.91 ,$14.28 ,$14.28 ,$90.68 ,$85.91 ,$81.13 ,$81.13 ,$25.25 ,$81.13 ,$81.13 ,$85.91 ,$58.13 ,$14.28 ,$59.18 ,$15.14 ,$85.91 ,$31.10 ,$87.81 ,$85.91 ,$63.01 ,$63.01 ,$58.13 ,$63.01 ,$62.04 ,$65.21 ,$21.73 ,$75.41 ,$15.14 ,$16.58 ,$16.58 ,$25.25 ,$16.58 ,$13.82 ,$90.68 ,$78.27 ,$78.27 ,$76.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),87329072,87329,HC ENZYME IMMUN-PRV 72 HR,306,1 ,$95.45 ,$63.00 ,$11.98 ,$95.45 ,$12.38 ,$41.93 ,$41.93 ,$25.25 ,$76.36 ,$81.13 ,$59.66 ,$85.91 ,$12.38 ,$12.38 ,$90.68 ,$85.91 ,$81.13 ,$81.13 ,$25.25 ,$81.13 ,$81.13 ,$85.91 ,$58.13 ,$12.38 ,$59.18 ,$13.12 ,$85.91 ,$26.96 ,$87.81 ,$85.91 ,$63.01 ,$63.01 ,$58.13 ,$63.01 ,$62.04 ,$65.21 ,$21.73 ,$75.41 ,$13.12 ,$14.38 ,$14.38 ,$25.25 ,$14.38 ,$11.98 ,$90.68 ,$78.27 ,$78.27 ,$76.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),87338072,87338,HC H PYLORI AG STOOL,306,1 ,$135.70 ,$89.56 ,$14.38 ,$135.70 ,$14.86 ,$50.33 ,$50.33 ,$35.91 ,$108.56 ,$115.35 ,$84.81 ,$122.13 ,$14.86 ,$14.86 ,$128.92 ,$122.13 ,$115.35 ,$115.35 ,$35.91 ,$115.35 ,$115.35 ,$122.13 ,$82.64 ,$14.86 ,$84.14 ,$15.75 ,$122.13 ,$32.36 ,$124.84 ,$122.13 ,$89.58 ,$89.58 ,$82.64 ,$89.58 ,$88.21 ,$92.71 ,$30.89 ,$107.20 ,$15.75 ,$17.26 ,$17.26 ,$35.91 ,$17.26 ,$14.38 ,$128.92 ,$111.27 ,$111.27 ,$108.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),87804072,87804,HC FLU-PRV 72 HR,300,1 ,$115.00 ,$75.90 ,$16.55 ,$115.00 ,$16.86 ,$57.93 ,$57.93 ,$30.43 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$16.86 ,$16.86 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$30.43 ,$97.75 ,$97.75 ,$103.50 ,$70.04 ,$16.86 ,$71.30 ,$17.87 ,$103.50 ,$37.24 ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 ,$17.87 ,$19.86 ,$19.86 ,$30.43 ,$19.86 ,$16.55 ,$109.25 ,$94.30 ,$94.30 ,$92.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),87880072,87880,HC STREP-PRV 72 HR,300,1 ,$104.65 ,$69.07 ,$16.53 ,$104.65 ,$16.86 ,$57.86 ,$57.86 ,$27.69 ,$83.72 ,$88.95 ,$65.41 ,$94.19 ,$16.86 ,$16.86 ,$99.42 ,$94.19 ,$88.95 ,$88.95 ,$27.69 ,$88.95 ,$88.95 ,$94.19 ,$63.73 ,$16.86 ,$64.88 ,$17.87 ,$94.19 ,$37.19 ,$96.28 ,$94.19 ,$69.08 ,$69.08 ,$63.73 ,$69.08 ,$68.02 ,$71.50 ,$23.82 ,$82.67 ,$17.87 ,$19.84 ,$19.84 ,$27.69 ,$19.84 ,$16.53 ,$99.42 ,$85.81 ,$85.81 ,$83.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),88142072,88142,HC CYTOPATH CERVICAL,311,1 ,$165.60 ,$109.30 ,$20.26 ,$165.60 ,$20.93 ,$70.91 ,$70.91 ,$43.82 ,$132.48 ,$140.76 ,$103.50 ,$149.04 ,$20.93 ,$20.93 ,$157.32 ,$149.04 ,$140.76 ,$140.76 ,$43.82 ,$140.76 ,$140.76 ,$149.04 ,$100.85 ,$20.93 ,$102.68 ,$22.19 ,$149.04 ,$45.59 ,$152.35 ,$149.04 ,$109.31 ,$109.31 ,$100.85 ,$109.31 ,$107.64 ,$113.14 ,$37.70 ,$130.82 ,$22.19 ,$24.31 ,$24.31 ,$43.82 ,$24.31 ,$20.26 ,$157.32 ,$135.79 ,$135.79 ,$132.48 
ST. CLARE MEMORIAL HOSPITAL (ACU),89055072,89055,HC LUEKO ACCESS STOLL QN/SEMI,300,1 ,$78.20 ,$51.61 ,$4.27 ,$78.20 ,$4.41 ,$14.95 ,$14.95 ,$20.69 ,$62.56 ,$66.47 ,$48.88 ,$70.38 ,$4.41 ,$4.41 ,$74.29 ,$70.38 ,$66.47 ,$66.47 ,$20.69 ,$66.47 ,$66.47 ,$70.38 ,$47.62 ,$4.41 ,$48.48 ,$4.67 ,$70.38 ,$9.61 ,$71.94 ,$70.38 ,$51.62 ,$51.62 ,$47.62 ,$51.62 ,$50.83 ,$53.43 ,$17.81 ,$61.78 ,$4.67 ,$5.12 ,$5.12 ,$20.69 ,$5.12 ,$4.27 ,$74.29 ,$64.12 ,$64.12 ,$62.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),90471072,90471,HC IMMUN ADMIN ONE VACCINE-PRV 72 HR,771,1 ,$43.70 ,$28.84 ,$9.95 ,$151.81 ,$75.20 ,$39.16 ,$39.16 ,$11.56 ,$34.96 ,$37.15 ,$27.31 ,$39.33 ,$75.20 ,$43.70 ,$41.52 ,$39.33 ,$37.15 ,$37.15 ,$11.56 ,$37.15 ,$37.15 ,$39.33 ,$26.61 ,$75.20 ,$27.10 ,$46.32 ,$39.33 ,$151.81 ,$40.20 ,$39.33 ,$28.85 ,$28.85 ,$26.61 ,$28.85 ,$28.41 ,$29.86 ,$9.95 ,$34.52 ,$79.71 ,$43.00 ,$43.00 ,$11.56 ,$43.00 ,$67.47 ,$41.52 ,$35.83 ,$35.83 ,$34.96 
ST. CLARE MEMORIAL HOSPITAL (ACU),90632072,90632,HC HEPA VACCINE ADULT IM,983,1 ,$172.00 ,$113.52 ,$39.16 ,$172.00 ,$52.21 ,$154.15 ,$154.15 , N/A ,$137.60 ,$146.20 ,$107.50 ,$154.80 ,$52.21 ,$52.21 ,$163.40 ,$154.80 ,$146.20 ,$146.20 , N/A ,$146.20 ,$146.20 ,$154.80 ,$104.75 ,$52.21 , N/A ,$55.34 ,$154.80 , N/A ,$158.24 ,$154.80 ,$113.54 ,$113.54 ,$104.75 ,$113.54 ,$111.80 ,$117.51 ,$39.16 ,$135.88 ,$55.34 , 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 ,$25.74 ,$8.88 ,$55.34 ,$52.21 ,$34.95 ,$34.95 ,$10.32 ,$31.20 ,$33.15 ,$24.38 ,$35.10 ,$52.21 ,$39.00 ,$37.05 ,$35.10 ,$33.15 ,$33.15 ,$10.32 ,$33.15 ,$33.15 ,$35.10 ,$23.75 ,$52.21 ,$24.18 ,$41.34 ,$35.10 ,$27.20 ,$35.88 ,$35.10 ,$25.74 ,$25.74 ,$23.75 ,$25.74 ,$25.35 ,$26.64 ,$8.88 ,$30.81 ,$55.34 ,$19.11 ,$19.11 ,$10.32 ,$19.11 ,$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 ,$23.10 ,$9.26 ,$95.33 ,$75.20 ,$31.37 ,$31.37 ,$9.26 ,$28.00 ,$29.75 ,$21.88 ,$31.50 ,$75.20 ,$35.00 ,$33.25 ,$31.50 ,$29.75 ,$29.75 ,$9.26 ,$29.75 ,$29.75 ,$31.50 ,$21.32 ,$75.20 ,$21.70 ,$37.10 ,$31.50 ,$95.33 ,$32.20 ,$31.50 ,$23.10 ,$23.10 ,$21.32 ,$23.10 ,$22.75 ,$23.91 , N/A ,$27.65 ,$79.71 ,$17.15 ,$17.15 ,$9.26 ,$17.15 ,$42.37 ,$33.25 ,$28.70 ,$28.70 ,$28.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),90715072,90715,HC DTAP VACCINE >7 YEARS,636,1 ,$59.00 ,$38.94 ,$13.44 ,$59.00 ,$52.21 ,$59.00 ,$56.45 ,$15.61 ,$47.20 ,$50.15 ,$36.88 ,$53.10 ,$52.21 ,$52.21 ,$56.05 ,$53.10 ,$50.15 ,$50.15 ,$15.61 ,$50.15 ,$50.15 ,$53.10 ,$35.93 ,$52.21 ,$36.58 ,$55.34 ,$53.10 , N/A ,$54.28 ,$53.10 ,$38.95 ,$38.95 ,$35.93 ,$38.95 ,$38.35 ,$40.31 ,$13.44 ,$46.61 ,$55.34 ,$28.91 ,$28.91 ,$15.61 ,$28.91 , 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 ,$56.10 ,$19.35 ,$85.00 ,$52.21 ,$85.00 ,$85.00 ,$22.49 ,$68.00 ,$72.25 ,$53.13 ,$76.50 ,$52.21 ,$52.21 ,$80.75 ,$76.50 ,$72.25 ,$72.25 ,$22.49 ,$72.25 ,$72.25 ,$76.50 ,$51.77 ,$52.21 ,$52.70 ,$55.34 ,$76.50 ,$59.29 ,$78.20 ,$76.50 ,$56.11 ,$56.11 ,$51.77 ,$56.11 ,$55.25 ,$58.07 ,$19.35 ,$67.15 ,$55.34 ,$41.65 ,$41.65 ,$22.49 ,$41.65 ,$26.35 ,$80.75 ,$69.70 ,$69.70 ,$68.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$2,509.25 ","$1,656.11 ",$233.52 ,"$2,509.25 ",$315.37 ,"$2,248.79 ","$2,248.79 ",$663.95 ,"$2,007.40 ","$2,132.86 ","$1,568.28 ","$2,258.33 ",$315.37 ,$315.37 ,"$2,383.79 ","$2,258.33 ","$2,132.86 ","$2,132.86 ",$663.95 ,"$2,132.86 ","$2,132.86 ","$2,258.33 ","$1,528.13 ",$315.37 ,"$1,555.74 ",$334.29 ,"$2,258.33 ",$525.42 ,"$2,308.51 ","$2,258.33 ","$1,656.36 ","$1,656.36 ","$1,528.13 ","$1,656.36 ","$1,631.01 ","$1,714.32 ",$571.24 ,"$1,982.31 ",$334.29 ,$389.00 ,$389.00 ,$663.95 ,$417.00 ,$233.52 ,"$2,383.79 ","$2,057.59 ","$2,057.59 ","$2,007.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,"$1,571.11 ","$1,036.93 ",$106.88 ,"$1,571.11 ",$203.25 ,"$1,408.03 ","$1,408.03 ",$415.72 ,"$1,256.89 ","$1,335.44 ",$981.94 ,"$1,414.00 ",$203.25 ,$203.25 ,"$1,492.55 ","$1,414.00 ","$1,335.44 ","$1,335.44 ",$415.72 ,"$1,335.44 ","$1,335.44 ","$1,414.00 ",$956.81 ,$203.25 ,$974.08 ,$215.45 ,"$1,414.00 ",$240.48 ,"$1,445.42 ","$1,414.00 ","$1,037.09 ","$1,037.09 ",$956.81 ,"$1,037.09 ","$1,021.22 ","$1,073.38 ",$357.67 ,"$1,241.18 ",$215.45 ,$389.00 ,$389.00 ,$415.72 ,$417.00 ,$106.88 ,"$1,492.55 ","$1,288.31 ","$1,288.31 ","$1,256.89 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,"$1,387.88 ",$916.00 ,$116.11 ,"$1,387.88 ",$203.25 ,"$1,243.82 ","$1,243.82 ",$367.24 ,"$1,110.30 ","$1,179.70 ",$867.43 ,"$1,249.09 ",$203.25 ,$203.25 ,"$1,318.49 ","$1,249.09 ","$1,179.70 ","$1,179.70 ",$367.24 ,"$1,179.70 ","$1,179.70 ","$1,249.09 ",$845.22 ,$203.25 ,$860.48 ,$215.45 ,"$1,249.09 ",$261.25 ,"$1,276.85 ","$1,249.09 ",$916.14 ,$916.14 ,$845.22 ,$916.14 ,$902.12 ,$948.20 ,$315.95 ,"$1,096.43 ",$215.45 ,$389.00 ,$389.00 ,$367.24 ,$417.00 ,$116.11 ,"$1,318.49 ","$1,138.06 ","$1,138.06 ","$1,110.30 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,993.89 ","$1,315.97 ",$145.43 ,"$1,993.89 ",$317.09 ,"$1,786.92 ","$1,786.92 ",$527.58 ,"$1,595.11 ","$1,694.81 ","$1,246.18 ","$1,794.50 ",$317.09 ,$317.09 ,"$1,894.20 ","$1,794.50 ","$1,694.81 ","$1,694.81 ",$527.58 ,"$1,694.81 ","$1,694.81 ","$1,794.50 ","$1,214.28 ",$317.09 ,"$1,236.22 ",$336.12 ,"$1,794.50 ",$327.22 ,"$1,834.38 ","$1,794.50 ","$1,316.17 ","$1,316.17 ","$1,214.28 ","$1,316.17 ","$1,296.03 ","$1,362.23 ",$453.92 ,"$1,575.17 ",$336.12 ,$389.00 ,$389.00 ,$527.58 ,$417.00 ,$145.43 ,"$1,894.20 ","$1,634.99 ","$1,634.99 ","$1,595.11 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,"$1,993.89 ","$1,315.97 ",$145.43 ,"$1,993.89 ",$317.09 ,"$1,786.92 ","$1,786.92 ",$527.58 ,"$1,595.11 ","$1,694.81 ","$1,246.18 ","$1,794.50 ",$317.09 ,$317.09 ,"$1,894.20 ","$1,794.50 ","$1,694.81 ","$1,694.81 ",$527.58 ,"$1,694.81 ","$1,694.81 ","$1,794.50 ","$1,214.28 ",$317.09 ,"$1,236.22 ",$336.12 ,"$1,794.50 ",$327.22 ,"$1,834.38 ","$1,794.50 ","$1,316.17 ","$1,316.17 ","$1,214.28 ","$1,316.17 ","$1,296.03 ","$1,362.23 ",$453.92 ,"$1,575.17 ",$336.12 ,$389.00 ,$389.00 ,$527.58 ,$417.00 ,$145.43 ,"$1,894.20 ","$1,634.99 ","$1,634.99 ","$1,595.11 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$2,343.51 ","$1,546.72 ",$203.25 ,"$2,343.51 ",$203.25 ,"$2,100.25 ","$2,100.25 ",$620.09 ,"$1,874.81 ","$1,991.98 ","$1,464.69 ","$2,109.16 ",$203.25 ,$203.25 ,"$2,226.33 ","$2,109.16 ","$1,991.98 ","$1,991.98 ",$620.09 ,"$1,991.98 ","$1,991.98 ","$2,109.16 ","$1,427.20 ",$203.25 ,"$1,452.98 ",$215.45 ,"$2,109.16 ",$630.14 ,"$2,156.03 ","$2,109.16 ","$1,546.95 ","$1,546.95 ","$1,427.20 ","$1,546.95 ","$1,523.28 ","$1,601.09 ",$533.51 ,"$1,851.37 ",$215.45 ,$389.00 ,$389.00 ,$620.09 ,$417.00 ,$280.06 ,"$2,226.33 ","$1,921.68 ","$1,921.68 ","$1,874.81 "
ST. CLARE MEMORIAL HOSPITAL (ACU),92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$2,790.00 ","$1,841.40 ",$233.52 ,"$2,790.00 ",$315.37 ,"$2,500.40 ","$2,500.40 ",$738.23 ,"$2,232.00 ","$2,371.50 ","$1,743.75 ","$2,511.00 ",$315.37 ,$315.37 ,"$2,650.50 ","$2,511.00 ","$2,371.50 ","$2,371.50 ",$738.23 ,"$2,371.50 ","$2,371.50 ","$2,511.00 ","$1,699.11 ",$315.37 ,"$1,729.80 ",$334.29 ,"$2,511.00 ",$525.42 ,"$2,566.80 ","$2,511.00 ","$1,841.68 ","$1,841.68 ","$1,699.11 ","$1,841.68 ","$1,813.50 ","$1,906.13 ",$635.16 ,"$2,204.10 ",$334.29 ,$389.00 ,$389.00 ,$738.23 ,$417.00 ,$233.52 ,"$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 ","$1,052.70 ",$106.88 ,"$1,595.00 ",$203.25 ,"$1,429.44 ","$1,429.44 ",$422.04 ,"$1,276.00 ","$1,355.75 ",$996.88 ,"$1,435.50 ",$203.25 ,$203.25 ,"$1,515.25 ","$1,435.50 ","$1,355.75 ","$1,355.75 ",$422.04 ,"$1,355.75 ","$1,355.75 ","$1,435.50 ",$971.36 ,$203.25 ,$988.90 ,$215.45 ,"$1,435.50 ",$240.48 ,"$1,467.40 ","$1,435.50 ","$1,052.86 ","$1,052.86 ",$971.36 ,"$1,052.86 ","$1,036.75 ","$1,089.70 ",$363.11 ,"$1,260.05 ",$215.45 ,$389.00 ,$389.00 ,$422.04 ,$417.00 ,$106.88 ,"$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 ,$501.60 ,$106.88 ,$760.00 ,$203.25 ,$681.11 ,$681.11 ,$201.10 ,$608.00 ,$646.00 ,$475.00 ,$684.00 ,$203.25 ,$203.25 ,$722.00 ,$684.00 ,$646.00 ,$646.00 ,$201.10 ,$646.00 ,$646.00 ,$684.00 ,$462.84 ,$203.25 ,$471.20 ,$215.45 ,$684.00 ,$240.48 ,$699.20 ,$684.00 ,$501.68 ,$501.68 ,$462.84 ,$501.68 ,$494.00 ,$519.23 ,$173.02 ,$600.40 ,$215.45 ,$389.00 ,$389.00 ,$201.10 ,$417.00 ,$106.88 ,$722.00 ,$623.20 ,$623.20 ,$608.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),92100039,93931,HC DUPLEX ARTRL UPR EXT PSEUD ONLY,921,1 ,$760.00 ,$501.60 ,$106.88 ,$760.00 ,$203.25 ,$681.11 ,$681.11 ,$201.10 ,$608.00 ,$646.00 ,$475.00 ,$684.00 ,$203.25 ,$203.25 ,$722.00 ,$684.00 ,$646.00 ,$646.00 ,$201.10 ,$646.00 ,$646.00 ,$684.00 ,$462.84 ,$203.25 ,$471.20 ,$215.45 ,$684.00 ,$240.48 ,$699.20 ,$684.00 ,$501.68 ,$501.68 ,$462.84 ,$501.68 ,$494.00 ,$519.23 ,$173.02 ,$600.40 ,$215.45 ,$389.00 ,$389.00 ,$201.10 ,$417.00 ,$106.88 ,$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 ","$1,211.10 ",$233.52 ,"$1,835.00 ",$315.37 ,"$1,644.53 ","$1,644.53 ",$485.54 ,"$1,468.00 ","$1,559.75 ","$1,146.88 ","$1,651.50 ",$315.37 ,$315.37 ,"$1,743.25 ","$1,651.50 ","$1,559.75 ","$1,559.75 ",$485.54 ,"$1,559.75 ","$1,559.75 ","$1,651.50 ","$1,117.52 ",$315.37 ,"$1,137.70 ",$334.29 ,"$1,651.50 ",$525.42 ,"$1,688.20 ","$1,651.50 ","$1,211.28 ","$1,211.28 ","$1,117.52 ","$1,211.28 ","$1,192.75 ","$1,253.67 ",$417.74 ,"$1,449.65 ",$334.29 ,$389.00 ,$389.00 ,$485.54 ,$417.00 ,$233.52 ,"$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 ","$1,211.10 ",$233.52 ,"$1,835.00 ",$315.37 ,"$1,644.53 ","$1,644.53 ",$485.54 ,"$1,468.00 ","$1,559.75 ","$1,146.88 ","$1,651.50 ",$315.37 ,$315.37 ,"$1,743.25 ","$1,651.50 ","$1,559.75 ","$1,559.75 ",$485.54 ,"$1,559.75 ","$1,559.75 ","$1,651.50 ","$1,117.52 ",$315.37 ,"$1,137.70 ",$334.29 ,"$1,651.50 ",$525.42 ,"$1,688.20 ","$1,651.50 ","$1,211.28 ","$1,211.28 ","$1,117.52 ","$1,211.28 ","$1,192.75 ","$1,253.67 ",$417.74 ,"$1,449.65 ",$334.29 ,$389.00 ,$389.00 ,$485.54 ,$417.00 ,$233.52 ,"$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 ",$831.60 ,$106.88 ,"$1,260.00 ",$203.25 ,"$1,129.21 ","$1,129.21 ",$333.40 ,"$1,008.00 ","$1,071.00 ",$787.50 ,"$1,134.00 ",$203.25 ,$203.25 ,"$1,197.00 ","$1,134.00 ","$1,071.00 ","$1,071.00 ",$333.40 ,"$1,071.00 ","$1,071.00 ","$1,134.00 ",$767.34 ,$203.25 ,$781.20 ,$215.45 ,"$1,134.00 ",$240.48 ,"$1,159.20 ","$1,134.00 ",$831.73 ,$831.73 ,$767.34 ,$831.73 ,$819.00 ,$860.83 ,$286.85 ,$995.40 ,$215.45 ,$389.00 ,$389.00 ,$333.40 ,$417.00 ,$106.88 ,"$1,197.00 ","$1,033.20 ","$1,033.20 ","$1,008.00 "
ST. CLARE MEMORIAL HOSPITAL (ACU),93000072,93000,HC EKG COMPLETE,730,1 ,$277.15 ,$182.92 ,$49.68 ,$277.15 ,$49.68 ,$248.38 ,$248.38 ,$73.33 ,$221.72 ,$235.58 ,$173.22 ,$249.44 ,$49.68 ,$49.68 ,$263.29 ,$249.44 ,$235.58 ,$235.58 ,$73.33 ,$235.58 ,$235.58 ,$249.44 ,$168.78 ,$49.68 ,$171.84 ,$52.66 ,$249.44 , N/A ,$254.98 ,$249.44 ,$182.95 ,$182.95 ,$168.78 ,$182.95 ,$180.15 ,$189.35 ,$63.09 ,$218.95 ,$52.66 ,$108.00 ,$108.00 ,$73.33 ,$114.00 , N/A ,$263.29 ,$227.26 ,$227.26 ,$221.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),93005072,93005,HC EKG-PRV 72 HR,730,1 ,$193.20 ,$127.51 ,$43.98 ,$193.20 ,$49.68 ,$173.15 ,$173.15 ,$51.12 ,$154.56 ,$164.22 ,$120.75 ,$173.88 ,$49.68 ,$49.68 ,$183.54 ,$173.88 ,$164.22 ,$164.22 ,$51.12 ,$164.22 ,$164.22 ,$173.88 ,$117.66 ,$49.68 ,$119.78 ,$52.66 ,$173.88 ,$129.33 ,$177.74 ,$173.88 ,$127.53 ,$127.53 ,$117.66 ,$127.53 ,$125.58 ,$131.99 ,$43.98 ,$152.63 ,$52.66 ,$108.00 ,$108.00 ,$51.12 ,$114.00 ,$57.48 ,$183.54 ,$158.42 ,$158.42 ,$154.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),93010072,93010,HC EKG INTER AND REPORT PRO,985,1 ,$90.00 ,$59.40 ,$8.79 ,$90.00 ,$49.68 ,$80.66 ,$80.66 ,$8.79 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$49.68 ,$49.68 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$8.79 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$49.68 ,$17.94 ,$52.66 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$52.66 , N/A , N/A ,$8.79 , 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 ,$141.24 ,$23.12 ,$336.12 ,$317.09 ,$191.79 ,$191.79 ,$23.12 ,$171.20 ,$181.90 ,$133.75 ,$192.60 ,$317.09 ,$214.00 ,$203.30 ,$192.60 ,$181.90 ,$181.90 ,$23.12 ,$181.90 ,$181.90 ,$192.60 ,$130.33 ,$317.09 ,$47.18 ,$226.84 ,$192.60 , N/A ,$196.88 ,$192.60 ,$141.26 ,$141.26 ,$130.33 ,$141.26 ,$139.10 ,$146.20 ,$48.72 ,$169.06 ,$336.12 , N/A , N/A ,$23.12 , 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 ,$148.50 ,$15.20 ,$336.12 ,$317.09 ,$201.65 ,$201.65 ,$15.20 ,$180.00 ,$191.25 ,$140.63 ,$202.50 ,$317.09 ,$225.00 ,$213.75 ,$202.50 ,$191.25 ,$191.25 ,$15.20 ,$191.25 ,$191.25 ,$202.50 ,$137.03 ,$317.09 ,$31.02 ,$238.50 ,$202.50 , N/A ,$207.00 ,$202.50 ,$148.52 ,$148.52 ,$137.03 ,$148.52 ,$146.25 ,$153.72 ,$51.22 ,$177.75 ,$336.12 , N/A , N/A ,$15.20 , 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 ,$133.40 ,$88.04 ,$30.37 ,$133.40 ,$69.81 ,$119.55 ,$119.55 ,$35.30 ,$106.72 ,$113.39 ,$83.38 ,$120.06 ,$69.81 ,$69.81 ,$126.73 ,$120.06 ,$113.39 ,$113.39 ,$35.30 ,$113.39 ,$113.39 ,$120.06 ,$81.24 ,$69.81 ,$82.70 ,$74.00 ,$120.06 ,$78.75 ,$122.73 ,$120.06 ,$88.06 ,$88.06 ,$81.24 ,$88.06 ,$86.71 ,$91.14 ,$30.37 ,$105.39 ,$74.00 ,$133.40 ,$133.40 ,$35.30 ,$133.40 ,$35.00 ,$126.73 ,$109.39 ,$109.39 ,$106.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$285.20 ,$188.23 ,$64.93 ,$285.20 ,$127.41 ,$255.60 ,$255.60 ,$75.46 ,$228.16 ,$242.42 ,$178.25 ,$256.68 ,$127.41 ,$127.41 ,$270.94 ,$256.68 ,$242.42 ,$242.42 ,$75.46 ,$242.42 ,$242.42 ,$256.68 ,$173.69 ,$127.41 ,$176.82 ,$135.05 ,$256.68 ,$261.25 ,$262.38 ,$256.68 ,$188.26 ,$188.26 ,$173.69 ,$188.26 ,$185.38 ,$194.85 ,$64.93 ,$225.31 ,$135.05 ,$124.00 ,$124.00 ,$75.46 ,$131.00 ,$116.11 ,$270.94 ,$233.86 ,$233.86 ,$228.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),94010072,94010,HC BREATHING CAPACITY TEST-PRV 72 HR,983,1 ,$78.00 ,$51.48 ,$17.76 ,$327.22 ,$103.51 ,$69.90 ,$69.90 ,$28.86 ,$62.40 ,$66.30 ,$48.75 ,$70.20 ,$103.51 ,$78.00 ,$74.10 ,$70.20 ,$66.30 ,$66.30 ,$28.86 ,$66.30 ,$66.30 ,$70.20 ,$47.50 ,$103.51 ,$58.90 ,$82.68 ,$70.20 ,$327.22 ,$71.76 ,$70.20 ,$51.49 ,$51.49 ,$47.50 ,$51.49 ,$50.70 ,$53.29 ,$17.76 ,$61.62 ,$109.72 , N/A , N/A ,$28.86 , N/A ,$145.43 ,$74.10 ,$63.96 ,$63.96 ,$62.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),94060072,94060,HC EVAL OF BRONCHOSPASM-PRV 72 HR,410,1 ,$168.45 ,$111.18 ,$38.35 ,$630.14 ,$191.30 ,$150.96 ,$150.96 ,$44.57 ,$134.76 ,$143.18 ,$105.28 ,$151.61 ,$191.30 ,$168.45 ,$160.03 ,$151.61 ,$143.18 ,$143.18 ,$44.57 ,$143.18 ,$143.18 ,$151.61 ,$102.59 ,$191.30 ,$104.44 ,$178.56 ,$151.61 ,$630.14 ,$154.97 ,$151.61 ,$111.19 ,$111.19 ,$102.59 ,$111.19 ,$109.49 ,$115.09 ,$38.35 ,$133.08 ,$202.78 ,$166.00 ,$166.00 ,$44.57 ,$168.45 ,$280.06 ,$160.03 ,$138.13 ,$138.13 ,$134.76 
ST. CLARE MEMORIAL HOSPITAL (ACU),94200008,99406,HC SMOKING CESSATION PULM 3-10MIN,942,1 ,$90.49 ,$59.72 ,$20.60 ,$90.49 ,$46.18 ,$81.10 ,$81.10 ,$23.94 ,$72.39 ,$76.92 ,$56.56 ,$81.44 ,$46.18 ,$46.18 ,$85.97 ,$81.44 ,$76.92 ,$76.92 ,$23.94 ,$76.92 ,$76.92 ,$81.44 ,$55.11 ,$46.18 ,$56.10 ,$48.95 ,$81.44 ,$66.78 ,$83.25 ,$81.44 ,$59.73 ,$59.73 ,$55.11 ,$59.73 ,$58.82 ,$61.82 ,$20.60 ,$71.49 ,$48.95 ,$90.49 ,$90.49 ,$23.94 ,$90.49 ,$29.68 ,$85.97 ,$74.20 ,$74.20 ,$72.39 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$82.80 ,$54.65 ,$18.85 ,$298.63 ,$281.73 ,$82.80 ,$82.80 ,$21.91 ,$66.24 ,$70.38 ,$51.75 ,$74.52 ,$281.73 ,$82.80 ,$78.66 ,$74.52 ,$70.38 ,$70.38 ,$21.91 ,$70.38 ,$70.38 ,$74.52 ,$50.43 ,$281.73 ,$51.34 ,$87.77 ,$74.52 ,$270.16 ,$76.18 ,$74.52 ,$54.66 ,$54.66 ,$50.43 ,$54.66 ,$53.82 ,$56.57 ,$18.85 ,$65.41 ,$298.63 ,$82.80 ,$82.80 ,$21.91 ,$82.80 ,$120.07 ,$78.66 ,$67.90 ,$67.90 ,$66.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300005,93798,HC CARDIAC REHAB W/EKG SESSION (PH2),943,1 ,$556.60 ,$367.36 ,$120.07 ,$556.60 ,$281.73 ,$528.00 ,$473.00 ,$147.27 ,$445.28 ,$473.11 ,$347.88 ,$500.94 ,$281.73 ,$281.73 ,$528.77 ,$500.94 ,$473.11 ,$473.11 ,$147.27 ,$473.11 ,$473.11 ,$500.94 ,$338.97 ,$281.73 ,$345.10 ,$298.63 ,$500.94 ,$270.16 ,$512.07 ,$500.94 ,$367.41 ,$367.41 ,$338.97 ,$367.41 ,$361.79 ,$380.27 ,$126.71 ,$439.71 ,$298.63 ,$456.00 ,$456.00 ,$147.27 ,$506.00 ,$120.07 ,$528.77 ,$456.41 ,$456.41 ,$445.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300009,93798,HC CARDIAC REHAB W/EKG SESSION (ASSESSMENT),943,1 ,$556.60 ,$367.36 ,$120.07 ,$556.60 ,$281.73 ,$528.00 ,$473.00 ,$147.27 ,$445.28 ,$473.11 ,$347.88 ,$500.94 ,$281.73 ,$281.73 ,$528.77 ,$500.94 ,$473.11 ,$473.11 ,$147.27 ,$473.11 ,$473.11 ,$500.94 ,$338.97 ,$281.73 ,$345.10 ,$298.63 ,$500.94 ,$270.16 ,$512.07 ,$500.94 ,$367.41 ,$367.41 ,$338.97 ,$367.41 ,$361.79 ,$380.27 ,$126.71 ,$439.71 ,$298.63 ,$456.00 ,$456.00 ,$147.27 ,$506.00 ,$120.07 ,$528.77 ,$456.41 ,$456.41 ,$445.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$556.60 ,$367.36 ,$120.07 ,$556.60 ,$281.73 ,$528.00 ,$473.00 ,$147.27 ,$445.28 ,$473.11 ,$347.88 ,$500.94 ,$281.73 ,$281.73 ,$528.77 ,$500.94 ,$473.11 ,$473.11 ,$147.27 ,$473.11 ,$473.11 ,$500.94 ,$338.97 ,$281.73 ,$345.10 ,$298.63 ,$500.94 ,$270.16 ,$512.07 ,$500.94 ,$367.41 ,$367.41 ,$338.97 ,$367.41 ,$361.79 ,$380.27 ,$126.71 ,$439.71 ,$298.63 ,$456.00 ,$456.00 ,$147.27 ,$506.00 ,$120.07 ,$528.77 ,$456.41 ,$456.41 ,$445.28 
ST. CLARE MEMORIAL HOSPITAL (ACU),94640072,94640,HC AIRWAY INHALATION TREATMENT-PRV 72 HR,410,1 ,$305.90 ,$201.89 ,$69.64 ,$430.88 ,$103.51 ,$274.15 ,$274.15 ,$80.94 ,$244.72 ,$260.02 ,$191.19 ,$275.31 ,$103.51 ,$103.51 ,$290.61 ,$275.31 ,$260.02 ,$260.02 ,$80.94 ,$260.02 ,$260.02 ,$275.31 ,$186.29 ,$103.51 ,$189.66 ,$109.72 ,$275.31 ,$430.88 ,$281.43 ,$275.31 ,$201.92 ,$201.92 ,$186.29 ,$201.92 ,$198.84 ,$208.99 ,$69.64 ,$241.66 ,$109.72 ,$166.00 ,$166.00 ,$80.94 ,$187.00 ,$191.50 ,$290.61 ,$250.84 ,$250.84 ,$244.72 
ST. CLARE MEMORIAL HOSPITAL (ACU),94726072,94726,HC SPIROMETRY W/BRONCHOD-PREV 72HR,976,1 ,$116.00 ,$76.56 ,$26.41 ,$630.14 ,$191.30 ,$103.96 ,$103.96 ,$58.55 ,$92.80 ,$98.60 ,$72.50 ,$104.40 ,$191.30 ,$116.00 ,$110.20 ,$104.40 ,$98.60 ,$98.60 ,$58.55 ,$98.60 ,$98.60 ,$104.40 ,$70.64 ,$191.30 ,$119.48 ,$122.96 ,$104.40 ,$630.14 ,$106.72 ,$104.40 ,$76.57 ,$76.57 ,$70.64 ,$76.57 ,$75.40 ,$79.25 ,$26.41 ,$91.64 ,$202.78 , N/A , N/A ,$58.55 , N/A ,$280.06 ,$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 ,$181.17 ,$119.57 ,$41.25 ,$181.17 ,$65.29 ,$162.36 ,$162.36 ,$47.94 ,$144.94 ,$153.99 ,$113.23 ,$163.05 ,$65.29 ,$65.29 ,$172.11 ,$163.05 ,$153.99 ,$153.99 ,$47.94 ,$153.99 ,$153.99 ,$163.05 ,$110.33 ,$65.29 ,$112.32 ,$69.21 ,$163.05 ,$129.33 ,$166.68 ,$163.05 ,$119.59 ,$119.59 ,$110.33 ,$119.59 ,$117.76 ,$123.78 ,$41.25 ,$143.12 ,$69.21 ,$161.00 ,$161.00 ,$47.94 ,$181.17 ,$57.48 ,$172.11 ,$148.56 ,$148.56 ,$144.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),94800002,94626,HC PHY/QHP OP PULM RHB W/MNTR,948,1 ,$181.17 ,$119.57 ,$41.25 ,$181.17 ,$65.29 ,$162.36 ,$162.36 ,$47.94 ,$144.94 ,$153.99 ,$113.23 ,$163.05 ,$65.29 ,$65.29 ,$172.11 ,$163.05 ,$153.99 ,$153.99 ,$47.94 ,$153.99 ,$153.99 ,$163.05 ,$110.33 ,$65.29 ,$112.32 ,$69.21 ,$163.05 ,$129.33 ,$166.68 ,$163.05 ,$119.59 ,$119.59 ,$110.33 ,$119.59 ,$117.76 ,$123.78 ,$41.25 ,$143.12 ,$69.21 ,$161.00 ,$161.00 ,$47.94 ,$181.17 ,$57.48 ,$172.11 ,$148.56 ,$148.56 ,$144.94 
ST. CLARE MEMORIAL HOSPITAL (ACU),96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$25.00 ,$16.50 ,$5.69 ,$25.00 , N/A ,$22.41 ,$22.41 , N/A ,$20.00 ,$21.25 ,$15.63 ,$22.50 , N/A , N/A ,$23.75 ,$22.50 ,$21.25 ,$21.25 , N/A ,$21.25 ,$21.25 ,$22.50 ,$15.23 , N/A , N/A , N/A ,$22.50 , N/A ,$23.00 ,$22.50 ,$16.50 ,$16.50 ,$15.23 ,$16.50 ,$16.25 ,$17.08 ,$5.69 ,$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 ,$33.00 ,$11.39 ,$50.00 , N/A ,$44.81 ,$44.81 , N/A ,$40.00 ,$42.50 ,$31.25 ,$45.00 , N/A , N/A ,$47.50 ,$45.00 ,$42.50 ,$42.50 , N/A ,$42.50 ,$42.50 ,$45.00 ,$30.45 , N/A , N/A , N/A ,$45.00 , N/A ,$46.00 ,$45.00 ,$33.01 ,$33.01 ,$30.45 ,$33.01 ,$32.50 ,$34.16 ,$11.39 ,$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 ,$49.50 ,$17.07 ,$75.00 , N/A ,$67.22 ,$67.22 , N/A ,$60.00 ,$63.75 ,$46.88 ,$67.50 , N/A , N/A ,$71.25 ,$67.50 ,$63.75 ,$63.75 , N/A ,$63.75 ,$63.75 ,$67.50 ,$45.68 , N/A , N/A , N/A ,$67.50 , N/A ,$69.00 ,$67.50 ,$49.51 ,$49.51 ,$45.68 ,$49.51 ,$48.75 ,$51.24 ,$17.07 ,$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 ,$460.02 ,$158.67 ,$697.00 ,$309.60 ,$624.65 ,$624.65 , N/A ,$557.60 ,$592.45 ,$435.63 ,$627.30 ,$309.60 ,$309.60 ,$662.15 ,$627.30 ,$592.45 ,$592.45 , N/A ,$592.45 ,$592.45 ,$627.30 ,$424.47 ,$309.60 , N/A ,$328.18 ,$627.30 , N/A ,$641.24 ,$627.30 ,$460.09 ,$460.09 ,$424.47 ,$460.09 ,$453.05 ,$476.19 ,$158.67 ,$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 ,$99.00 ,$34.15 ,$565.78 ,$533.75 ,$134.43 ,$134.43 ,$147.00 ,$120.00 ,$127.50 ,$93.75 ,$135.00 ,$533.75 ,$150.00 ,$142.50 ,$135.00 ,$127.50 ,$127.50 ,$147.00 ,$127.50 ,$127.50 ,$135.00 ,$91.35 ,$533.75 ,$300.00 ,$159.00 ,$135.00 ,$327.83 ,$138.00 ,$135.00 ,$99.02 ,$99.02 ,$91.35 ,$99.02 ,$97.50 ,$102.48 ,$34.15 ,$118.50 ,$565.78 , N/A , N/A ,$147.00 , N/A ,$145.70 ,$142.50 ,$123.00 ,$123.00 ,$120.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400001,100,PC ANESTH SALIVARY GLAND,964,1 ,$10.90 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$2.23 ,$10.90 , N/A ,$9.77 ,$9.77 ,$2.23 ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$2.23 ,$9.27 ,$9.27 ,$9.81 ,$6.64 , N/A ,$4.47 , N/A ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$2.46 ,$8.61 , N/A , N/A , N/A ,$2.23 , 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 ,$7.19 ,$2.23 ,$10.90 , N/A ,$9.77 ,$9.77 ,$2.23 ,$8.72 ,$9.27 ,$6.81 ,$9.81 , N/A , N/A ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$2.23 ,$9.27 ,$9.27 ,$9.81 ,$6.64 , N/A ,$4.47 , N/A ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$2.46 ,$8.61 , N/A , N/A , N/A ,$2.23 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$105.60 ,$36.43 ,$160.00 ,$41.88 ,$143.39 ,$143.39 , N/A ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$41.88 ,$41.88 ,$152.00 ,$144.00 ,$136.00 ,$136.00 , N/A ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$41.88 , N/A ,$44.39 ,$144.00 , N/A ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$44.39 , 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 ,$105.60 ,$36.43 ,$160.00 ,$41.88 ,$143.39 ,$143.39 , N/A ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$41.88 ,$41.88 ,$152.00 ,$144.00 ,$136.00 ,$136.00 , N/A ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$41.88 , N/A ,$44.39 ,$144.00 , N/A ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$36.43 ,$126.40 ,$44.39 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$39.60 ,$4.31 ,$60.00 ,$4.31 ,$53.77 ,$53.77 ,$16.07 ,$48.00 ,$51.00 , N/A ,$54.00 ,$4.31 ,$4.31 ,$57.00 ,$54.00 ,$51.00 ,$51.00 ,$16.07 ,$51.00 ,$51.00 ,$54.00 ,$36.54 ,$4.31 ,$32.80 ,$4.57 ,$54.00 , N/A ,$55.20 ,$54.00 ,$39.61 ,$39.61 ,$36.54 ,$39.61 ,$39.00 ,$40.99 ,$13.66 ,$47.40 ,$4.57 , N/A , N/A ,$16.07 , 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 ,$105.60 ,$41.88 ,$160.00 ,$41.88 ,$143.39 ,$143.39 ,$69.41 ,$128.00 ,$136.00 ,$100.00 ,$144.00 ,$41.88 ,$41.88 ,$152.00 ,$144.00 ,$136.00 ,$136.00 ,$69.41 ,$136.00 ,$136.00 ,$144.00 ,$97.44 ,$41.88 ,$138.83 ,$44.39 ,$144.00 , N/A ,$147.20 ,$144.00 ,$105.62 ,$105.62 ,$97.44 ,$105.62 ,$104.00 ,$109.31 ,$76.50 ,$126.40 ,$44.39 , N/A , N/A ,$69.41 , 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 ,$422.40 ,$58.90 ,$812.49 ,$766.50 ,$573.57 ,$573.57 ,$58.90 ,$512.00 ,$544.00 ,$400.00 ,$576.00 ,$766.50 ,$640.00 ,$608.00 ,$576.00 ,$544.00 ,$544.00 ,$58.90 ,$544.00 ,$544.00 ,$576.00 ,$389.76 ,$766.50 ,$120.20 ,$678.40 ,$576.00 , N/A ,$588.80 ,$576.00 ,$422.46 ,$422.46 ,$389.76 ,$422.46 ,$416.00 ,$437.25 ,$145.70 ,$505.60 ,$812.49 , N/A , N/A ,$58.90 , 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 ,$435.60 ,$74.32 ,"$2,177.69 ","$2,054.42 ",$591.49 ,$591.49 ,$74.32 ,$528.00 ,$561.00 ,$412.50 ,$594.00 ,"$2,054.42 ",$660.00 ,$627.00 ,$594.00 ,$561.00 ,$561.00 ,$74.32 ,$561.00 ,$561.00 ,$594.00 ,$401.94 ,"$2,054.42 ",$151.68 ,$699.60 ,$594.00 ,"$1,917.41 ",$607.20 ,$594.00 ,$435.67 ,$435.67 ,$401.94 ,$435.67 ,$429.00 ,$450.91 ,$150.25 ,$521.40 ,"$2,177.69 ", N/A , N/A ,$74.32 , N/A ,$852.18 ,$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 ,$168.30 ,$58.06 ,"$1,744.74 ","$1,645.98 ",$228.53 ,$228.53 ,$105.24 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,645.98 ",$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$105.24 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,"$1,645.98 ",$214.78 ,$270.30 ,$229.50 ,"$1,449.77 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,"$1,744.74 ", N/A , N/A ,$105.24 , N/A ,$644.34 ,$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 ,$168.30 ,$58.06 ,"$1,744.74 ","$1,645.98 ",$228.53 ,$228.53 ,$113.40 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,645.98 ",$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$113.40 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,"$1,645.98 ",$231.42 ,$270.30 ,$229.50 ,"$1,449.77 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,"$1,744.74 ", N/A , N/A ,$113.40 , N/A ,$644.34 ,$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 ,$168.30 ,$58.06 ,"$1,917.41 ","$1,645.98 ",$228.53 ,$228.53 ,$84.95 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,645.98 ",$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$84.95 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,"$1,645.98 ",$173.36 ,$270.30 ,$229.50 ,"$1,917.41 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,"$1,744.74 ", N/A , N/A ,$84.95 , N/A ,$852.18 ,$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 ,$168.30 ,$58.06 ,"$1,744.74 ","$1,645.98 ",$228.53 ,$228.53 ,$105.01 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,645.98 ",$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$105.01 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,"$1,645.98 ",$214.30 ,$270.30 ,$229.50 ,"$1,449.77 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,"$1,744.74 ", N/A , N/A ,$105.01 , N/A ,$644.34 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400398,64425,PC INJ ANESTH ILIOINGUINAL NERVE,964,1 ,$410.00 ,$270.60 ,$58.25 ,"$1,449.77 ",$766.50 ,$367.44 ,$367.44 ,$58.25 ,$328.00 ,$348.50 ,$256.25 ,$369.00 ,$766.50 ,$410.00 ,$389.50 ,$369.00 ,$348.50 ,$348.50 ,$58.25 ,$348.50 ,$348.50 ,$369.00 ,$249.69 ,$766.50 ,$118.88 ,$434.60 ,$369.00 ,"$1,449.77 ",$377.20 ,$369.00 ,$270.64 ,$270.64 ,$249.69 ,$270.64 ,$266.50 ,$280.11 ,$93.34 ,$323.90 ,$812.49 , N/A , N/A ,$58.25 , N/A ,$644.34 ,$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 ,$168.30 ,$44.48 ,"$1,449.77 ",$766.50 ,$228.53 ,$228.53 ,$44.48 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$766.50 ,$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$44.48 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,$766.50 ,$90.78 ,$270.30 ,$229.50 ,"$1,449.77 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,$812.49 , N/A , N/A ,$44.48 , N/A ,$644.34 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400400,64418,PC NERVE BLOCK SUPRACAPULAR,964,1 ,$255.00 ,$168.30 ,$58.06 ,"$1,449.77 ",$766.50 ,$228.53 ,$228.53 ,$59.05 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$766.50 ,$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$59.05 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,$766.50 ,$120.52 ,$270.30 ,$229.50 ,"$1,449.77 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,$812.49 , N/A , N/A ,$59.05 , N/A ,$644.34 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400401,64417,PC NERVE BLOCK AXILLARY NERVE,964,1 ,$410.00 ,$270.60 ,$67.42 ,"$2,177.69 ","$2,054.42 ",$367.44 ,$367.44 ,$67.42 ,$328.00 ,$348.50 ,$256.25 ,$369.00 ,"$2,054.42 ",$410.00 ,$389.50 ,$369.00 ,$348.50 ,$348.50 ,$67.42 ,$348.50 ,$348.50 ,$369.00 ,$249.69 ,"$2,054.42 ",$137.60 ,$434.60 ,$369.00 ,"$1,917.41 ",$377.20 ,$369.00 ,$270.64 ,$270.64 ,$249.69 ,$270.64 ,$266.50 ,$280.11 ,$93.34 ,$323.90 ,"$2,177.69 ", N/A , N/A ,$67.42 , N/A ,$852.18 ,$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 ,$141.90 ,$48.94 ,$812.49 ,$766.50 ,$192.68 ,$192.68 ,$73.42 ,$172.00 ,$182.75 ,$134.38 ,$193.50 ,$766.50 ,$215.00 ,$204.25 ,$193.50 ,$182.75 ,$182.75 ,$73.42 ,$182.75 ,$182.75 ,$193.50 ,$130.94 ,$766.50 ,$149.84 ,$227.90 ,$193.50 , N/A ,$197.80 ,$193.50 ,$141.92 ,$141.92 ,$130.94 ,$141.92 ,$139.75 ,$146.89 ,$48.94 ,$169.85 ,$812.49 , N/A , N/A ,$73.42 , 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 ,$168.30 ,$58.06 ,"$1,917.41 ","$1,645.98 ",$228.53 ,$228.53 ,$91.42 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,645.98 ",$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$91.42 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,"$1,645.98 ",$186.58 ,$270.30 ,$229.50 ,"$1,917.41 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,"$1,744.74 ", N/A , N/A ,$91.42 , N/A ,$852.18 ,$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 ,$168.30 ,$58.06 ,"$1,917.41 ","$1,645.98 ",$228.53 ,$228.53 ,$95.27 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,"$1,645.98 ",$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$95.27 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,"$1,645.98 ",$194.42 ,$270.30 ,$229.50 ,"$1,917.41 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$58.06 ,$201.45 ,"$1,744.74 ", N/A , N/A ,$95.27 , N/A ,$852.18 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400407,64445,PC NERVE BLOCK SCIATIC SINGLE,964,1 ,$555.00 ,$366.30 ,$77.25 ,"$1,449.77 ",$766.50 ,$497.39 ,$497.39 ,$77.25 ,$444.00 ,$471.75 ,$346.88 ,$499.50 ,$766.50 ,$555.00 ,$527.25 ,$499.50 ,$471.75 ,$471.75 ,$77.25 ,$471.75 ,$471.75 ,$499.50 ,$338.00 ,$766.50 ,$157.66 ,$588.30 ,$499.50 ,"$1,449.77 ",$510.60 ,$499.50 ,$366.36 ,$366.36 ,$338.00 ,$366.36 ,$360.75 ,$379.18 ,$126.35 ,$438.45 ,$812.49 , N/A , N/A ,$77.25 , N/A ,$644.34 ,$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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$7.19 ,$6.64 ,$44.39 ,$41.88 ,$9.77 ,$9.77 ,$11.97 ,$8.72 ,$9.27 ,$6.81 ,$9.81 ,$41.88 ,$10.90 ,$10.36 ,$9.81 ,$9.27 ,$9.27 ,$11.97 ,$9.27 ,$9.27 ,$9.81 ,$6.64 ,$41.88 ,$21.36 ,$11.55 ,$9.81 , N/A ,$10.03 ,$9.81 ,$7.20 ,$7.20 ,$6.64 ,$7.20 ,$7.09 ,$7.45 ,$12.08 ,$8.61 ,$44.39 , N/A , N/A ,$11.97 , 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 ,$435.60 ,$83.11 ,"$2,177.69 ","$2,054.42 ",$591.49 ,$591.49 ,$83.11 ,$528.00 ,$561.00 ,$412.50 ,$594.00 ,"$2,054.42 ",$660.00 ,$627.00 ,$594.00 ,$561.00 ,$561.00 ,$83.11 ,$561.00 ,$561.00 ,$594.00 ,$401.94 ,"$2,054.42 ",$169.62 ,$699.60 ,$594.00 ,"$1,917.41 ",$607.20 ,$594.00 ,$435.67 ,$435.67 ,$401.94 ,$435.67 ,$429.00 ,$450.91 ,$150.25 ,$521.40 ,"$2,177.69 ", N/A , N/A ,$83.11 , N/A ,$852.18 ,$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 ,$297.00 ,$83.03 ,"$1,744.74 ","$1,645.98 ",$403.29 ,$403.29 ,$83.03 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,"$1,645.98 ",$450.00 ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$83.03 ,$382.50 ,$382.50 ,$405.00 ,$274.05 ,"$1,645.98 ",$169.44 ,$477.00 ,$405.00 ,"$1,449.77 ",$414.00 ,$405.00 ,$297.05 ,$297.05 ,$274.05 ,$297.05 ,$292.50 ,$307.44 ,$102.45 ,$355.50 ,"$1,744.74 ", N/A , N/A ,$83.03 , N/A ,$644.34 ,$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 ,$198.00 ,$51.92 ,"$1,744.74 ","$1,645.98 ",$268.86 ,$268.86 ,$51.92 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,"$1,645.98 ",$300.00 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$51.92 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,"$1,645.98 ",$105.96 ,$318.00 ,$270.00 , N/A ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$68.30 ,$237.00 ,"$1,744.74 ", N/A , N/A ,$51.92 , 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 ,$297.00 ,$87.30 ,"$1,744.74 ","$1,645.98 ",$403.29 ,$403.29 ,$87.30 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,"$1,645.98 ",$450.00 ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$87.30 ,$382.50 ,$382.50 ,$405.00 ,$274.05 ,"$1,645.98 ",$178.16 ,$477.00 ,$405.00 ,"$1,449.77 ",$414.00 ,$405.00 ,$297.05 ,$297.05 ,$274.05 ,$297.05 ,$292.50 ,$307.44 ,$102.45 ,$355.50 ,"$1,744.74 ", N/A , N/A ,$87.30 , N/A ,$644.34 ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),96400638,64448,PC FEMORAL NERVE BLOCK CONTINUOUS,964,1 ,$210.00 ,$138.60 ,$47.80 ,"$2,177.69 ","$2,054.42 ",$188.20 ,$188.20 ,$77.09 ,$168.00 ,$178.50 ,$131.25 ,$189.00 ,"$2,054.42 ",$210.00 ,$199.50 ,$189.00 ,$178.50 ,$178.50 ,$77.09 ,$178.50 ,$178.50 ,$189.00 ,$127.89 ,"$2,054.42 ",$157.32 ,$222.60 ,$189.00 ,"$1,917.41 ",$193.20 ,$189.00 ,$138.62 ,$138.62 ,$127.89 ,$138.62 ,$136.50 ,$143.47 ,$47.80 ,$165.90 ,"$2,177.69 ", N/A , N/A ,$77.09 , N/A ,$852.18 ,$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 ,$161.70 ,$55.77 ,"$2,177.69 ","$2,054.42 ",$219.57 ,$219.57 ,$65.90 ,$196.00 ,$208.25 ,$153.13 ,$220.50 ,"$2,054.42 ",$245.00 ,$232.75 ,$220.50 ,$208.25 ,$208.25 ,$65.90 ,$208.25 ,$208.25 ,$220.50 ,$149.21 ,"$2,054.42 ",$134.50 ,$259.70 ,$220.50 ,"$1,917.41 ",$225.40 ,$220.50 ,$161.72 ,$161.72 ,$149.21 ,$161.72 ,$159.25 ,$167.38 ,$55.77 ,$193.55 ,"$2,177.69 ", N/A , N/A ,$65.90 , N/A ,$852.18 ,$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 ,$156.78 ,$54.08 ,$812.49 ,$766.50 ,$212.88 ,$212.88 ,$83.11 ,$190.03 ,$201.91 ,$148.46 ,$213.79 ,$766.50 ,$237.54 ,$225.66 ,$213.79 ,$201.91 ,$201.91 ,$83.11 ,$201.91 ,$201.91 ,$213.79 ,$144.66 ,$766.50 ,$169.62 ,$251.79 ,$213.79 , N/A ,$218.54 ,$213.79 ,$156.80 ,$156.80 ,$144.66 ,$156.80 ,$154.40 ,$162.29 ,$54.08 ,$187.66 ,$812.49 , N/A , N/A ,$83.11 , 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 ,$112.20 ,$38.70 ,"$2,177.69 ","$2,054.42 ",$152.35 ,$152.35 ,$81.21 ,$136.00 ,$144.50 ,$106.25 ,$153.00 ,"$2,054.42 ",$170.00 ,$161.50 ,$153.00 ,$144.50 ,$144.50 ,$81.21 ,$144.50 ,$144.50 ,$153.00 ,$103.53 ,"$2,054.42 ",$165.74 ,$180.20 ,$153.00 ,"$1,917.41 ",$156.40 ,$153.00 ,$112.22 ,$112.22 ,$103.53 ,$112.22 ,$110.50 ,$116.14 ,$38.70 ,$134.30 ,"$2,177.69 ", N/A , N/A ,$81.21 , N/A ,$852.18 ,$161.50 ,$139.40 ,$139.40 ,$136.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),97500072,49321,HC LAPAROSCOPY BIOPSY,975,1 ,"$2,297.00 ","$1,516.02 ",$355.30 ,"$11,727.34 ","$6,972.48 ","$2,058.57 ","$2,058.57 ",$355.30 ,"$1,837.60 ","$1,952.45 ","$1,435.63 ","$2,067.30 ","$6,972.48 ","$2,297.00 ","$2,182.15 ","$2,067.30 ","$1,952.45 ","$1,952.45 ",$355.30 ,"$1,952.45 ","$1,952.45 ","$2,067.30 ","$1,398.87 ","$6,972.48 ",$725.10 ,"$2,434.82 ","$2,067.30 ","$11,727.34 ","$2,113.24 ","$2,067.30 ","$1,516.25 ","$1,516.25 ","$1,398.87 ","$1,516.25 ","$1,493.05 ","$1,569.31 ",$522.92 ,"$1,814.63 ","$7,390.83 ", N/A , N/A ,$355.30 , N/A ,"$5,212.15 ","$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 ,$489.06 ,$60.78 ,"$3,373.99 ","$1,290.13 ",$664.08 ,$664.08 ,$60.78 ,$592.80 ,$629.85 ,$463.13 ,$666.90 ,"$1,290.13 ",$741.00 ,$703.95 ,$666.90 ,$629.85 ,$629.85 ,$60.78 ,$629.85 ,$629.85 ,$666.90 ,$451.27 ,"$1,290.13 ",$124.04 ,$785.46 ,$666.90 ,"$3,373.99 ",$681.72 ,$666.90 ,$489.13 ,$489.13 ,$451.27 ,$489.13 ,$481.65 ,$506.25 ,$168.69 ,$585.39 ,"$1,367.54 ", N/A , N/A ,$60.78 , N/A ,"$1,499.55 ",$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 ,$404.58 ,$57.70 ,"$1,367.54 ","$1,290.13 ",$549.37 ,$549.37 ,$57.70 ,$490.40 ,$521.05 ,$383.13 ,$551.70 ,"$1,290.13 ",$613.00 ,$582.35 ,$551.70 ,$521.05 ,$521.05 ,$57.70 ,$521.05 ,$521.05 ,$551.70 ,$373.32 ,"$1,290.13 ",$117.76 ,$649.78 ,$551.70 ,$839.41 ,$563.96 ,$551.70 ,$404.64 ,$404.64 ,$373.32 ,$404.64 ,$398.45 ,$418.80 ,$139.55 ,$484.27 ,"$1,367.54 ", N/A , N/A ,$57.70 , N/A ,$373.07 ,$582.35 ,$502.66 ,$502.66 ,$490.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180002,10060,PC DRAIN SKIN ABSCESS SIMPLE,981,1 ,$354.00 ,$233.64 ,$111.49 ,$406.31 ,$318.12 ,$317.25 ,$317.25 ,$113.35 ,$283.20 ,$300.90 ,$221.25 ,$318.60 ,$318.12 ,$318.12 ,$336.30 ,$318.60 ,$300.90 ,$300.90 ,$113.35 ,$300.90 ,$300.90 ,$318.60 ,$215.59 ,$318.12 ,$231.32 ,$337.21 ,$318.60 ,$406.31 ,$325.68 ,$318.60 ,$233.68 ,$233.68 ,$215.59 ,$233.68 ,$230.10 ,$241.85 ,$111.49 ,$279.66 ,$337.21 , N/A , N/A ,$113.35 , N/A ,$180.58 ,$336.30 ,$290.28 ,$290.28 ,$283.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180003,10061,PC DRAIN SKIN ABSCESS COMPLIC,981,1 ,$546.00 ,$360.36 ,$192.65 ,$839.41 ,$318.12 ,$489.33 ,$489.33 ,$195.85 ,$436.80 ,$464.10 ,$341.25 ,$491.40 ,$318.12 ,$318.12 ,$518.70 ,$491.40 ,$464.10 ,$464.10 ,$195.85 ,$464.10 ,$464.10 ,$491.40 ,$332.51 ,$318.12 ,$399.70 ,$337.21 ,$491.40 ,$839.41 ,$502.32 ,$491.40 ,$360.41 ,$360.41 ,$332.51 ,$360.41 ,$354.90 ,$373.03 ,$192.65 ,$431.34 ,$337.21 , N/A , N/A ,$195.85 , N/A ,$373.07 ,$518.70 ,$447.72 ,$447.72 ,$436.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180004,10080,PC DRAIN PILONIDAL CYST SIMPL,981,1 ,$503.00 ,$331.98 ,$109.09 ,"$1,460.18 ",$318.12 ,$450.79 ,$450.79 ,$110.91 ,$402.40 ,$427.55 ,$314.38 ,$452.70 ,$318.12 ,$318.12 ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$110.91 ,$427.55 ,$427.55 ,$452.70 ,$306.33 ,$318.12 ,$226.34 ,$337.21 ,$452.70 ,"$1,460.18 ",$462.76 ,$452.70 ,$332.03 ,$332.03 ,$306.33 ,$332.03 ,$326.95 ,$343.65 ,$109.09 ,$397.37 ,$337.21 , N/A , N/A ,$110.91 , N/A ,$648.97 ,$477.85 ,$412.46 ,$412.46 ,$402.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180005,10081,PC DRAIN PILONIDAL CYST COMPLIC,981,1 ,$503.00 ,$331.98 ,$176.19 ,"$2,227.09 ","$2,101.03 ",$450.79 ,$450.79 ,$179.12 ,$402.40 ,$427.55 ,$314.38 ,$452.70 ,"$2,101.03 ",$503.00 ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$179.12 ,$427.55 ,$427.55 ,$452.70 ,$306.33 ,"$2,101.03 ",$365.56 ,$533.18 ,$452.70 ,"$1,460.18 ",$462.76 ,$452.70 ,$332.03 ,$332.03 ,$306.33 ,$332.03 ,$326.95 ,$343.65 ,$176.19 ,$397.37 ,"$2,227.09 ", N/A , N/A ,$179.12 , N/A ,$648.97 ,$477.85 ,$412.46 ,$412.46 ,$402.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180006,10120,PC REMOVE FOREIGN BODY SIMPLE,981,1 ,$423.00 ,$279.18 ,$110.29 ,$839.41 ,$318.12 ,$379.09 ,$379.09 ,$112.12 ,$338.40 ,$359.55 ,$264.38 ,$380.70 ,$318.12 ,$318.12 ,$401.85 ,$380.70 ,$359.55 ,$359.55 ,$112.12 ,$359.55 ,$359.55 ,$380.70 ,$257.61 ,$318.12 ,$228.82 ,$337.21 ,$380.70 ,$839.41 ,$389.16 ,$380.70 ,$279.22 ,$279.22 ,$257.61 ,$279.22 ,$274.95 ,$288.99 ,$110.29 ,$334.17 ,$337.21 , N/A , N/A ,$112.12 , N/A ,$373.07 ,$401.85 ,$346.86 ,$346.86 ,$338.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180007,10121,PC REMOVE FOREIGN BODY COMPLIC,981,1 ,$768.00 ,$506.88 ,$191.29 ,"$3,373.99 ","$2,299.87 ",$688.28 ,$688.28 ,$194.46 ,$614.40 ,$652.80 ,$480.00 ,$691.20 ,"$2,299.87 ",$768.00 ,$729.60 ,$691.20 ,$652.80 ,$652.80 ,$194.46 ,$652.80 ,$652.80 ,$691.20 ,$467.71 ,"$2,299.87 ",$396.86 ,$814.08 ,$691.20 ,"$3,373.99 ",$706.56 ,$691.20 ,$506.96 ,$506.96 ,$467.71 ,$506.96 ,$499.20 ,$524.70 ,$191.29 ,$606.72 ,"$2,437.86 ", N/A , N/A ,$194.46 , N/A ,"$1,499.55 ",$729.60 ,$629.76 ,$629.76 ,$614.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180008,10140,PC DRAINAGE OF HEMATOMA/FLUID,981,1 ,$530.00 ,$349.80 ,$123.45 ,"$3,373.99 ","$2,101.03 ",$474.99 ,$474.99 ,$125.50 ,$424.00 ,$450.50 ,$331.25 ,$477.00 ,"$2,101.03 ",$530.00 ,$503.50 ,$477.00 ,$450.50 ,$450.50 ,$125.50 ,$450.50 ,$450.50 ,$477.00 ,$322.77 ,"$2,101.03 ",$256.12 ,$561.80 ,$477.00 ,"$3,373.99 ",$487.60 ,$477.00 ,$349.85 ,$349.85 ,$322.77 ,$349.85 ,$344.50 ,$362.10 ,$123.45 ,$418.70 ,"$2,227.09 ", N/A , N/A ,$125.50 , N/A ,"$1,499.55 ",$503.50 ,$434.60 ,$434.60 ,$424.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180009,10160,PC PUNCTURE DRAINAGE OF LESION,981,1 ,$371.00 ,$244.86 ,$101.07 ,$839.41 ,$318.12 ,$332.49 ,$332.49 ,$102.75 ,$296.80 ,$315.35 ,$231.88 ,$333.90 ,$318.12 ,$318.12 ,$352.45 ,$333.90 ,$315.35 ,$315.35 ,$102.75 ,$315.35 ,$315.35 ,$333.90 ,$225.94 ,$318.12 ,$209.70 ,$337.21 ,$333.90 ,$839.41 ,$341.32 ,$333.90 ,$244.90 ,$244.90 ,$225.94 ,$244.90 ,$241.15 ,$253.47 ,$101.07 ,$293.09 ,$337.21 , N/A , N/A ,$102.75 , N/A ,$373.07 ,$352.45 ,$304.22 ,$304.22 ,$296.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180021,11042,PC CLEANSING OF SKIN/TISSUE,981,1 ,$435.00 ,$287.10 ,$62.20 ,$839.41 ,$717.24 ,$389.85 ,$389.85 ,$63.24 ,$348.00 ,$369.75 ,$271.88 ,$391.50 ,$717.24 ,$435.00 ,$413.25 ,$391.50 ,$369.75 ,$369.75 ,$63.24 ,$369.75 ,$369.75 ,$391.50 ,$264.92 ,$717.24 ,$129.06 ,$461.10 ,$391.50 ,$839.41 ,$400.20 ,$391.50 ,$287.14 ,$287.14 ,$264.92 ,$287.14 ,$282.75 ,$297.19 ,$62.20 ,$343.65 ,$760.27 , N/A , N/A ,$63.24 , N/A ,$373.07 ,$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 ,$126.72 ,$33.64 ,$261.25 ,$123.43 ,$172.07 ,$172.07 ,$34.20 ,$153.60 ,$163.20 ,$120.00 ,$172.80 ,$123.43 ,$123.43 ,$182.40 ,$172.80 ,$163.20 ,$163.20 ,$34.20 ,$163.20 ,$163.20 ,$172.80 ,$116.93 ,$123.43 ,$69.80 ,$130.84 ,$172.80 ,$261.25 ,$176.64 ,$172.80 ,$126.74 ,$126.74 ,$116.93 ,$126.74 ,$124.80 ,$131.17 ,$33.64 ,$151.68 ,$130.84 , N/A , N/A ,$34.20 , N/A ,$116.11 ,$182.40 ,$157.44 ,$157.44 ,$153.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180029,11750,PC REMOVAL OF NAIL BED,981,1 ,$953.00 ,$628.98 ,$106.81 ,$953.00 ,$832.76 ,$854.08 ,$854.08 ,$108.58 ,$762.40 ,$810.05 ,$595.63 ,$857.70 ,$832.76 ,$832.76 ,$905.35 ,$857.70 ,$810.05 ,$810.05 ,$108.58 ,$810.05 ,$810.05 ,$857.70 ,$580.38 ,$832.76 ,$221.60 ,$882.73 ,$857.70 ,$839.41 ,$876.76 ,$857.70 ,$629.08 ,$629.08 ,$580.38 ,$629.08 ,$619.45 ,$651.09 ,$106.81 ,$752.87 ,$882.73 , N/A , N/A ,$108.58 , N/A ,$373.07 ,$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 ,$184.80 ,$97.69 ,$839.41 ,$123.43 ,$250.94 ,$250.94 ,$99.31 ,$224.00 ,$238.00 ,$175.00 ,$252.00 ,$123.43 ,$123.43 ,$266.00 ,$252.00 ,$238.00 ,$238.00 ,$99.31 ,$238.00 ,$238.00 ,$252.00 ,$170.52 ,$123.43 ,$202.68 ,$130.84 ,$252.00 ,$839.41 ,$257.60 ,$252.00 ,$184.83 ,$184.83 ,$170.52 ,$184.83 ,$182.00 ,$191.30 ,$97.69 ,$221.20 ,$130.84 , N/A , N/A ,$99.31 , N/A ,$373.07 ,$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 ,$314.16 ,$45.34 ,$476.00 ,$351.11 ,$426.59 ,$426.59 ,$46.10 ,$380.80 ,$404.60 ,$297.50 ,$428.40 ,$351.11 ,$351.11 ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$46.10 ,$404.60 ,$404.60 ,$428.40 ,$289.88 ,$351.11 ,$94.08 ,$372.18 ,$428.40 ,$406.31 ,$437.92 ,$428.40 ,$314.21 ,$314.21 ,$289.88 ,$314.21 ,$309.40 ,$325.20 ,$45.34 ,$376.04 ,$372.18 , N/A , N/A ,$46.10 , N/A ,$180.58 ,$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 ,$322.08 ,$59.34 ,$488.00 ,$351.11 ,$437.35 ,$437.35 ,$60.33 ,$390.40 ,$414.80 ,$305.00 ,$439.20 ,$351.11 ,$351.11 ,$463.60 ,$439.20 ,$414.80 ,$414.80 ,$60.33 ,$414.80 ,$414.80 ,$439.20 ,$297.19 ,$351.11 ,$123.12 ,$372.18 ,$439.20 ,$406.31 ,$448.96 ,$439.20 ,$322.13 ,$322.13 ,$297.19 ,$322.13 ,$317.20 ,$333.40 ,$59.34 ,$385.52 ,$372.18 , N/A , N/A ,$60.33 , N/A ,$180.58 ,$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 ,$335.28 ,$73.70 ,$508.00 ,$351.11 ,$455.27 ,$455.27 ,$74.92 ,$406.40 ,$431.80 ,$317.50 ,$457.20 ,$351.11 ,$351.11 ,$482.60 ,$457.20 ,$431.80 ,$431.80 ,$74.92 ,$431.80 ,$431.80 ,$457.20 ,$309.37 ,$351.11 ,$152.90 ,$372.18 ,$457.20 ,$406.31 ,$467.36 ,$457.20 ,$335.33 ,$335.33 ,$309.37 ,$335.33 ,$330.20 ,$347.07 ,$73.70 ,$401.32 ,$372.18 , N/A , N/A ,$74.92 , N/A ,$180.58 ,$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 ,$570.90 ,$95.15 ,$865.00 ,$351.11 ,$775.21 ,$775.21 ,$96.73 ,$692.00 ,$735.25 ,$540.63 ,$778.50 ,$351.11 ,$351.11 ,$821.75 ,$778.50 ,$735.25 ,$735.25 ,$96.73 ,$735.25 ,$735.25 ,$778.50 ,$526.79 ,$351.11 ,$197.40 ,$372.18 ,$778.50 ,$839.41 ,$795.80 ,$778.50 ,$570.99 ,$570.99 ,$526.79 ,$570.99 ,$562.25 ,$590.97 ,$95.15 ,$683.35 ,$372.18 , N/A , N/A ,$96.73 , N/A ,$373.07 ,$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 ",$781.44 ,$116.97 ,"$1,184.00 ",$351.11 ,"$1,061.10 ","$1,061.10 ",$118.92 ,$947.20 ,"$1,006.40 ",$740.00 ,"$1,065.60 ",$351.11 ,$351.11 ,"$1,124.80 ","$1,065.60 ","$1,006.40 ","$1,006.40 ",$118.92 ,"$1,006.40 ","$1,006.40 ","$1,065.60 ",$721.06 ,$351.11 ,$242.70 ,$372.18 ,"$1,065.60 ",$839.41 ,"$1,089.28 ","$1,065.60 ",$781.56 ,$781.56 ,$721.06 ,$781.56 ,$769.60 ,$808.91 ,$116.97 ,$935.36 ,$372.18 , N/A , N/A ,$118.92 , N/A ,$373.07 ,"$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 ",$882.42 ,$145.52 ,"$1,337.00 ",$351.11 ,"$1,198.22 ","$1,198.22 ",$147.94 ,"$1,069.60 ","$1,136.45 ",$835.63 ,"$1,203.30 ",$351.11 ,$351.11 ,"$1,270.15 ","$1,203.30 ","$1,136.45 ","$1,136.45 ",$147.94 ,"$1,136.45 ","$1,136.45 ","$1,203.30 ",$814.23 ,$351.11 ,$301.92 ,$372.18 ,"$1,203.30 ",$406.31 ,"$1,230.04 ","$1,203.30 ",$882.55 ,$882.55 ,$814.23 ,$882.55 ,$869.05 ,$913.44 ,$145.52 ,"$1,056.23 ",$372.18 , N/A , N/A ,$147.94 , N/A ,$180.58 ,"$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 ,$331.98 ,$55.76 ,$503.00 ,$351.11 ,$450.79 ,$450.79 ,$56.69 ,$402.40 ,$427.55 ,$314.38 ,$452.70 ,$351.11 ,$351.11 ,$477.85 ,$452.70 ,$427.55 ,$427.55 ,$56.69 ,$427.55 ,$427.55 ,$452.70 ,$306.33 ,$351.11 ,$115.70 ,$372.18 ,$452.70 ,$406.31 ,$462.76 ,$452.70 ,$332.03 ,$332.03 ,$306.33 ,$332.03 ,$326.95 ,$343.65 ,$55.76 ,$397.37 ,$372.18 , N/A , N/A ,$56.69 , N/A ,$180.58 ,$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 ,$349.14 ,$58.41 ,$529.00 ,$351.11 ,$474.09 ,$474.09 ,$59.38 ,$423.20 ,$449.65 ,$330.63 ,$476.10 ,$351.11 ,$351.11 ,$502.55 ,$476.10 ,$449.65 ,$449.65 ,$59.38 ,$449.65 ,$449.65 ,$476.10 ,$322.16 ,$351.11 ,$121.18 ,$372.18 ,$476.10 ,$406.31 ,$486.68 ,$476.10 ,$349.19 ,$349.19 ,$322.16 ,$349.19 ,$343.85 ,$361.41 ,$58.41 ,$417.91 ,$372.18 , N/A , N/A ,$59.38 , N/A ,$180.58 ,$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 ,$386.76 ,$75.01 ,$586.00 ,$351.11 ,$525.17 ,$525.17 ,$76.25 ,$468.80 ,$498.10 ,$366.25 ,$527.40 ,$351.11 ,$351.11 ,$556.70 ,$527.40 ,$498.10 ,$498.10 ,$76.25 ,$498.10 ,$498.10 ,$527.40 ,$356.87 ,$351.11 ,$155.62 ,$372.18 ,$527.40 ,$406.31 ,$539.12 ,$527.40 ,$386.82 ,$386.82 ,$356.87 ,$386.82 ,$380.90 ,$400.36 ,$75.01 ,$462.94 ,$372.18 , N/A , N/A ,$76.25 , N/A ,$180.58 ,$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 ,$510.18 ,$94.57 ,$773.00 ,$351.11 ,$692.76 ,$692.76 ,$96.14 ,$618.40 ,$657.05 ,$483.13 ,$695.70 ,$351.11 ,$351.11 ,$734.35 ,$695.70 ,$657.05 ,$657.05 ,$96.14 ,$657.05 ,$657.05 ,$695.70 ,$470.76 ,$351.11 ,$196.20 ,$372.18 ,$695.70 ,$406.31 ,$711.16 ,$695.70 ,$510.26 ,$510.26 ,$470.76 ,$510.26 ,$502.45 ,$528.11 ,$94.57 ,$610.67 ,$372.18 , N/A , N/A ,$96.14 , N/A ,$180.58 ,$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 ,$628.98 ,$128.47 ,$953.00 ,$351.11 ,$854.08 ,$854.08 ,$130.59 ,$762.40 ,$810.05 ,$595.63 ,$857.70 ,$351.11 ,$351.11 ,$905.35 ,$857.70 ,$810.05 ,$810.05 ,$130.59 ,$810.05 ,$810.05 ,$857.70 ,$580.38 ,$351.11 ,$266.52 ,$372.18 ,$857.70 ,$839.41 ,$876.76 ,$857.70 ,$629.08 ,$629.08 ,$580.38 ,$629.08 ,$619.45 ,$651.09 ,$128.47 ,$752.87 ,$372.18 , N/A , N/A ,$130.59 , N/A ,$373.07 ,$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 ,$436.92 ,$195.30 ,"$1,307.14 ",$717.24 ,$593.28 ,$593.28 ,$198.56 ,$529.60 ,$562.70 ,$413.75 ,$595.80 ,$717.24 ,$662.00 ,$628.90 ,$595.80 ,$562.70 ,$562.70 ,$198.56 ,$562.70 ,$562.70 ,$595.80 ,$403.16 ,$717.24 ,$405.22 ,$701.72 ,$595.80 ,"$1,307.14 ",$609.04 ,$595.80 ,$436.99 ,$436.99 ,$403.16 ,$436.99 ,$430.30 ,$452.28 ,$195.30 ,$522.98 ,$760.27 , N/A , N/A ,$198.56 , N/A ,$580.95 ,$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 ,$471.90 ,$158.73 ,$839.41 ,$717.24 ,$640.78 ,$640.78 ,$161.38 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,$717.24 ,$715.00 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$161.38 ,$607.75 ,$607.75 ,$643.50 ,$435.44 ,$717.24 ,$329.34 ,$757.90 ,$643.50 ,$839.41 ,$657.80 ,$643.50 ,$471.97 ,$471.97 ,$435.44 ,$471.97 ,$464.75 ,$488.49 ,$158.73 ,$564.85 ,$760.27 , N/A , N/A ,$161.38 , N/A ,$373.07 ,$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 ,$584.10 ,$199.09 ,$885.00 ,$717.24 ,$793.14 ,$793.14 ,$202.40 ,$708.00 ,$752.25 ,$553.13 ,$796.50 ,$717.24 ,$717.24 ,$840.75 ,$796.50 ,$752.25 ,$752.25 ,$202.40 ,$752.25 ,$752.25 ,$796.50 ,$538.97 ,$717.24 ,$413.06 ,$760.27 ,$796.50 ,$839.41 ,$814.20 ,$796.50 ,$584.19 ,$584.19 ,$538.97 ,$584.19 ,$575.25 ,$604.63 ,$199.09 ,$699.15 ,$760.27 , N/A , N/A ,$202.40 , N/A ,$373.07 ,$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 ,$448.80 ,$213.72 ,$839.41 ,$717.24 ,$609.42 ,$609.42 ,$217.28 ,$544.00 ,$578.00 ,$425.00 ,$612.00 ,$717.24 ,$680.00 ,$646.00 ,$612.00 ,$578.00 ,$578.00 ,$217.28 ,$578.00 ,$578.00 ,$612.00 ,$414.12 ,$717.24 ,$443.42 ,$720.80 ,$612.00 ,$839.41 ,$625.60 ,$612.00 ,$448.87 ,$448.87 ,$414.12 ,$448.87 ,$442.00 ,$464.58 ,$213.72 ,$537.20 ,$760.27 , N/A , N/A ,$217.28 , N/A ,$373.07 ,$646.00 ,$557.60 ,$557.60 ,$544.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180050,12035,"PC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20",981,1 ,"$1,085.10 ",$716.17 ,$247.52 ,"$1,085.10 ",$717.24 ,$972.47 ,$972.47 ,$251.63 ,$868.08 ,$922.34 ,$678.19 ,$976.59 ,$717.24 ,$717.24 ,"$1,030.85 ",$976.59 ,$922.34 ,$922.34 ,$251.63 ,$922.34 ,$922.34 ,$976.59 ,$660.83 ,$717.24 ,$513.54 ,$760.27 ,$976.59 ,$839.41 ,$998.29 ,$976.59 ,$716.27 ,$716.27 ,$660.83 ,$716.27 ,$705.32 ,$741.34 ,$247.52 ,$857.23 ,$760.27 , N/A , N/A ,$251.63 , N/A ,$373.07 ,"$1,030.85 ",$889.78 ,$889.78 ,$868.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180053,12041,PC LAYR CLOS WND REST BODY <2.5CM,981,1 ,$731.00 ,$482.46 ,$151.56 ,$839.41 ,$717.24 ,$655.12 ,$655.12 ,$154.08 ,$584.80 ,$621.35 ,$456.88 ,$657.90 ,$717.24 ,$717.24 ,$694.45 ,$657.90 ,$621.35 ,$621.35 ,$154.08 ,$621.35 ,$621.35 ,$657.90 ,$445.18 ,$717.24 ,$314.44 ,$760.27 ,$657.90 ,$839.41 ,$672.52 ,$657.90 ,$482.53 ,$482.53 ,$445.18 ,$482.53 ,$475.15 ,$499.42 ,$151.56 ,$577.49 ,$760.27 , N/A , N/A ,$154.08 , N/A ,$373.07 ,$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 ,$506.88 ,$204.82 ,$839.41 ,$717.24 ,$688.28 ,$688.28 ,$208.22 ,$614.40 ,$652.80 ,$480.00 ,$691.20 ,$717.24 ,$717.24 ,$729.60 ,$691.20 ,$652.80 ,$652.80 ,$208.22 ,$652.80 ,$652.80 ,$691.20 ,$467.71 ,$717.24 ,$424.94 ,$760.27 ,$691.20 ,$839.41 ,$706.56 ,$691.20 ,$506.96 ,$506.96 ,$467.71 ,$506.96 ,$499.20 ,$524.70 ,$204.82 ,$606.72 ,$760.27 , N/A , N/A ,$208.22 , N/A ,$373.07 ,$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 ,$504.24 ,$222.10 ,"$1,307.14 ",$717.24 ,$684.70 ,$684.70 ,$225.79 ,$611.20 ,$649.40 ,$477.50 ,$687.60 ,$717.24 ,$717.24 ,$725.80 ,$687.60 ,$649.40 ,$649.40 ,$225.79 ,$649.40 ,$649.40 ,$687.60 ,$465.28 ,$717.24 ,$460.80 ,$760.27 ,$687.60 ,"$1,307.14 ",$702.88 ,$687.60 ,$504.32 ,$504.32 ,$465.28 ,$504.32 ,$496.60 ,$521.96 ,$222.10 ,$603.56 ,$760.27 , N/A , N/A ,$225.79 , N/A ,$580.95 ,$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 ",$817.74 ,$283.32 ,"$1,307.14 ",$717.24 ,"$1,110.39 ","$1,110.39 ",$288.03 ,$991.20 ,"$1,053.15 ",$774.38 ,"$1,115.10 ",$717.24 ,$717.24 ,"$1,177.05 ","$1,115.10 ","$1,053.15 ","$1,053.15 ",$288.03 ,"$1,053.15 ","$1,053.15 ","$1,115.10 ",$754.55 ,$717.24 ,$587.82 ,$760.27 ,"$1,115.10 ","$1,307.14 ","$1,139.88 ","$1,115.10 ",$817.86 ,$817.86 ,$754.55 ,$817.86 ,$805.35 ,$846.48 ,$283.32 ,$978.81 ,$760.27 , N/A , N/A ,$288.03 , N/A ,$580.95 ,"$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 ,$524.04 ,$177.08 ,$839.41 ,$717.24 ,$711.58 ,$711.58 ,$180.02 ,$635.20 ,$674.90 ,$496.25 ,$714.60 ,$717.24 ,$717.24 ,$754.30 ,$714.60 ,$674.90 ,$674.90 ,$180.02 ,$674.90 ,$674.90 ,$714.60 ,$483.55 ,$717.24 ,$367.38 ,$760.27 ,$714.60 ,$839.41 ,$730.48 ,$714.60 ,$524.12 ,$524.12 ,$483.55 ,$524.12 ,$516.10 ,$542.46 ,$177.08 ,$627.26 ,$760.27 , N/A , N/A ,$180.02 , N/A ,$373.07 ,$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 ,$594.00 ,$208.66 ,$900.00 ,$717.24 ,$806.58 ,$806.58 ,$212.12 ,$720.00 ,$765.00 ,$562.50 ,$810.00 ,$717.24 ,$717.24 ,$855.00 ,$810.00 ,$765.00 ,$765.00 ,$212.12 ,$765.00 ,$765.00 ,$810.00 ,$548.10 ,$717.24 ,$432.90 ,$760.27 ,$810.00 ,$839.41 ,$828.00 ,$810.00 ,$594.09 ,$594.09 ,$548.10 ,$594.09 ,$585.00 ,$614.88 ,$208.66 ,$711.00 ,$760.27 , N/A , N/A ,$212.12 , N/A ,$373.07 ,$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 ,$559.02 ,$224.57 ,$847.00 ,$717.24 ,$759.08 ,$759.08 ,$228.30 ,$677.60 ,$719.95 ,$529.38 ,$762.30 ,$717.24 ,$717.24 ,$804.65 ,$762.30 ,$719.95 ,$719.95 ,$228.30 ,$719.95 ,$719.95 ,$762.30 ,$515.82 ,$717.24 ,$465.92 ,$760.27 ,$762.30 ,$839.41 ,$779.24 ,$762.30 ,$559.10 ,$559.10 ,$515.82 ,$559.10 ,$550.55 ,$578.67 ,$224.57 ,$669.13 ,$760.27 , N/A , N/A ,$228.30 , N/A ,$373.07 ,$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 ",$817.74 ,$227.07 ,"$1,239.00 ",$717.24 ,"$1,110.39 ","$1,110.39 ",$230.84 ,$991.20 ,"$1,053.15 ",$774.38 ,"$1,115.10 ",$717.24 ,$717.24 ,"$1,177.05 ","$1,115.10 ","$1,053.15 ","$1,053.15 ",$230.84 ,"$1,053.15 ","$1,053.15 ","$1,115.10 ",$754.55 ,$717.24 ,$471.10 ,$760.27 ,"$1,115.10 ",$839.41 ,"$1,139.88 ","$1,115.10 ",$817.86 ,$817.86 ,$754.55 ,$817.86 ,$805.35 ,$846.48 ,$227.07 ,$978.81 ,$760.27 , N/A , N/A ,$230.84 , N/A ,$373.07 ,"$1,177.05 ","$1,015.98 ","$1,015.98 ",$991.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180063,12055,"PC LAYR CLOS WND FACE,FACIAL 12.6-20",981,1 ,"$1,401.51 ",$925.00 ,$307.92 ,"$1,401.51 ",$717.24 ,"$1,256.03 ","$1,256.03 ",$313.03 ,"$1,121.21 ","$1,191.28 ",$875.94 ,"$1,261.36 ",$717.24 ,$717.24 ,"$1,331.43 ","$1,261.36 ","$1,191.28 ","$1,191.28 ",$313.03 ,"$1,191.28 ","$1,191.28 ","$1,261.36 ",$853.52 ,$717.24 ,$638.84 ,$760.27 ,"$1,261.36 ",$839.41 ,"$1,289.39 ","$1,261.36 ",$925.14 ,$925.14 ,$853.52 ,$925.14 ,$910.98 ,$957.51 ,$307.92 ,"$1,107.19 ",$760.27 , N/A , N/A ,$313.03 , N/A ,$373.07 ,"$1,331.43 ","$1,149.24 ","$1,149.24 ","$1,121.21 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180069,13121,"PC REPR CMPL WND SCALP,EXTR 2.6-7.5",981,1 ,"$1,297.00 ",$856.02 ,$268.94 ,"$1,307.14 ",$832.76 ,"$1,162.37 ","$1,162.37 ",$273.41 ,"$1,037.60 ","$1,102.45 ",$810.63 ,"$1,167.30 ",$832.76 ,$832.76 ,"$1,232.15 ","$1,167.30 ","$1,102.45 ","$1,102.45 ",$273.41 ,"$1,102.45 ","$1,102.45 ","$1,167.30 ",$789.87 ,$832.76 ,$557.98 ,$882.73 ,"$1,167.30 ","$1,307.14 ","$1,193.24 ","$1,167.30 ",$856.15 ,$856.15 ,$789.87 ,$856.15 ,$843.05 ,$886.11 ,$268.94 ,"$1,024.63 ",$882.73 , N/A , N/A ,$273.41 , N/A ,$580.95 ,"$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 ,$359.70 ,$84.89 ,$882.73 ,$832.76 ,$488.43 ,$488.43 ,$86.30 ,$436.00 ,$463.25 ,$340.63 ,$490.50 ,$832.76 ,$545.00 ,$517.75 ,$490.50 ,$463.25 ,$463.25 ,$86.30 ,$463.25 ,$463.25 ,$490.50 ,$331.91 ,$832.76 ,$176.12 ,$577.70 ,$490.50 , N/A ,$501.40 ,$490.50 ,$359.75 ,$359.75 ,$331.91 ,$359.75 ,$354.25 ,$372.34 ,$84.89 ,$430.55 ,$882.73 , N/A , N/A ,$86.30 , 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 ",$698.94 ,$252.03 ,"$1,059.00 ",$832.76 ,$949.08 ,$949.08 ,$256.21 ,$847.20 ,$900.15 ,$661.88 ,$953.10 ,$832.76 ,$832.76 ,"$1,006.05 ",$953.10 ,$900.15 ,$900.15 ,$256.21 ,$900.15 ,$900.15 ,$953.10 ,$644.93 ,$832.76 ,$522.88 ,$882.73 ,$953.10 ,$839.41 ,$974.28 ,$953.10 ,$699.05 ,$699.05 ,$644.93 ,$699.05 ,$688.35 ,$723.51 ,$252.03 ,$836.61 ,$882.73 , N/A , N/A ,$256.21 , N/A ,$373.07 ,"$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 ","$1,071.84 ",$315.96 ,"$1,624.00 ",$832.76 ,"$1,455.43 ","$1,455.43 ",$321.21 ,"$1,299.20 ","$1,380.40 ","$1,015.00 ","$1,461.60 ",$832.76 ,$832.76 ,"$1,542.80 ","$1,461.60 ","$1,380.40 ","$1,380.40 ",$321.21 ,"$1,380.40 ","$1,380.40 ","$1,461.60 ",$989.02 ,$832.76 ,$655.54 ,$882.73 ,"$1,461.60 ","$1,307.14 ","$1,494.08 ","$1,461.60 ","$1,072.00 ","$1,072.00 ",$989.02 ,"$1,072.00 ","$1,055.60 ","$1,109.52 ",$315.96 ,"$1,282.96 ",$882.73 , N/A , N/A ,$321.21 , N/A ,$580.95 ,"$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 ,$328.02 ,$140.40 ,"$2,437.86 ","$2,299.87 ",$445.41 ,$445.41 ,$142.74 ,$397.60 ,$422.45 ,$310.63 ,$447.30 ,"$2,299.87 ",$497.00 ,$472.15 ,$447.30 ,$422.45 ,$422.45 ,$142.74 ,$422.45 ,$422.45 ,$447.30 ,$302.67 ,"$2,299.87 ",$291.30 ,$526.82 ,$447.30 , N/A ,$457.24 ,$447.30 ,$328.07 ,$328.07 ,$302.67 ,$328.07 ,$323.05 ,$339.55 ,$140.40 ,$392.63 ,"$2,437.86 ", N/A , N/A ,$142.74 , 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 ,$165.00 ,$46.45 ,"$1,307.14 ",$351.11 ,$224.05 ,$224.05 ,$47.23 ,$200.00 ,$212.50 ,$156.25 ,$225.00 ,$351.11 ,$250.00 ,$237.50 ,$225.00 ,$212.50 ,$212.50 ,$47.23 ,$212.50 ,$212.50 ,$225.00 ,$152.25 ,$351.11 ,$96.38 ,$265.00 ,$225.00 ,"$1,307.14 ",$230.00 ,$225.00 ,$165.03 ,$165.03 ,$152.25 ,$165.03 ,$162.50 ,$170.80 ,$46.45 ,$197.50 ,$372.18 , N/A , N/A ,$47.23 , N/A ,$580.95 ,$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 ,$174.90 ,$57.35 ,$406.31 ,$351.11 ,$237.49 ,$237.49 ,$58.30 ,$212.00 ,$225.25 ,$165.63 ,$238.50 ,$351.11 ,$265.00 ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$58.30 ,$225.25 ,$225.25 ,$238.50 ,$161.39 ,$351.11 ,$118.98 ,$280.90 ,$238.50 ,$406.31 ,$243.80 ,$238.50 ,$174.93 ,$174.93 ,$161.39 ,$174.93 ,$172.25 ,$181.05 ,$57.35 ,$209.35 ,$372.18 , N/A , N/A ,$58.30 , N/A ,$180.58 ,$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 ,$297.00 ,$113.88 ,$450.00 ,$351.11 ,$403.29 ,$403.29 ,$115.77 ,$360.00 ,$382.50 ,$281.25 ,$405.00 ,$351.11 ,$351.11 ,$427.50 ,$405.00 ,$382.50 ,$382.50 ,$115.77 ,$382.50 ,$382.50 ,$405.00 ,$274.05 ,$351.11 ,$236.26 ,$372.18 ,$405.00 ,$406.31 ,$414.00 ,$405.00 ,$297.05 ,$297.05 ,$274.05 ,$297.05 ,$292.50 ,$307.44 ,$113.88 ,$355.50 ,$372.18 , N/A , N/A ,$115.77 , N/A ,$180.58 ,$427.50 ,$369.00 ,$369.00 ,$360.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180089,20103,"PC EXPLORE WOUND,EXTREMITY",981,1 ,"$1,807.00 ","$1,192.62 ",$354.20 ,"$3,373.99 ",$717.24 ,"$1,619.43 ","$1,619.43 ",$360.09 ,"$1,445.60 ","$1,535.95 ","$1,129.38 ","$1,626.30 ",$717.24 ,$717.24 ,"$1,716.65 ","$1,626.30 ","$1,535.95 ","$1,535.95 ",$360.09 ,"$1,535.95 ","$1,535.95 ","$1,626.30 ","$1,100.46 ",$717.24 ,$734.88 ,$760.27 ,"$1,626.30 ","$3,373.99 ","$1,662.44 ","$1,626.30 ","$1,192.80 ","$1,192.80 ","$1,100.46 ","$1,192.80 ","$1,174.55 ","$1,234.54 ",$354.20 ,"$1,427.53 ",$760.27 , N/A , N/A ,$360.09 , N/A ,"$1,499.55 ","$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 ,$314.16 ,$154.15 ,"$3,654.53 ","$3,447.67 ",$426.59 ,$426.59 ,$156.71 ,$380.80 ,$404.60 ,$297.50 ,$428.40 ,"$3,447.67 ",$476.00 ,$452.20 ,$428.40 ,$404.60 ,$404.60 ,$156.71 ,$404.60 ,$404.60 ,$428.40 ,$289.88 ,"$3,447.67 ",$319.82 ,$504.56 ,$428.40 ,"$3,373.99 ",$437.92 ,$428.40 ,$314.21 ,$314.21 ,$289.88 ,$314.21 ,$309.40 ,$325.20 ,$154.15 ,$376.04 ,"$3,654.53 ", N/A , N/A ,$156.71 , N/A ,"$1,499.55 ",$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 ",$872.52 ,$254.85 ,"$5,812.31 ","$3,447.67 ","$1,184.78 ","$1,184.78 ",$259.08 ,"$1,057.60 ","$1,123.70 ",$826.25 ,"$1,189.80 ","$3,447.67 ","$1,322.00 ","$1,255.90 ","$1,189.80 ","$1,123.70 ","$1,123.70 ",$259.08 ,"$1,123.70 ","$1,123.70 ","$1,189.80 ",$805.10 ,"$3,447.67 ",$528.74 ,"$1,401.32 ","$1,189.80 ","$5,812.31 ","$1,216.24 ","$1,189.80 ",$872.65 ,$872.65 ,$805.10 ,$872.65 ,$859.30 ,$903.19 ,$254.85 ,"$1,044.38 ","$3,654.53 ", N/A , N/A ,$259.08 , N/A ,"$2,583.25 ","$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 ,$195.36 ,$36.80 ,$611.75 ,$463.61 ,$265.28 ,$265.28 ,$37.42 ,$236.80 ,$251.60 ,$185.00 ,$266.40 ,$463.61 ,$296.00 ,$281.20 ,$266.40 ,$251.60 ,$251.60 ,$37.42 ,$251.60 ,$251.60 ,$266.40 ,$180.26 ,$463.61 ,$76.36 ,$313.76 ,$266.40 ,$611.75 ,$272.32 ,$266.40 ,$195.39 ,$195.39 ,$180.26 ,$195.39 ,$192.40 ,$202.23 ,$36.80 ,$233.84 ,$491.43 , N/A , N/A ,$37.42 , N/A ,$271.89 ,$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 ,$209.88 ,$38.15 ,$611.75 ,$463.61 ,$284.99 ,$284.99 ,$38.78 ,$254.40 ,$270.30 ,$198.75 ,$286.20 ,$463.61 ,$318.00 ,$302.10 ,$286.20 ,$270.30 ,$270.30 ,$38.78 ,$270.30 ,$270.30 ,$286.20 ,$193.66 ,$463.61 ,$79.14 ,$337.08 ,$286.20 ,$611.75 ,$292.56 ,$286.20 ,$209.91 ,$209.91 ,$193.66 ,$209.91 ,$206.70 ,$217.26 ,$38.15 ,$251.22 ,$491.43 , N/A , N/A ,$38.78 , N/A ,$271.89 ,$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 ,$275.88 ,$46.44 ,$611.75 ,$463.61 ,$374.61 ,$374.61 ,$47.21 ,$334.40 ,$355.30 ,$261.25 ,$376.20 ,$463.61 ,$418.00 ,$397.10 ,$376.20 ,$355.30 ,$355.30 ,$47.21 ,$355.30 ,$355.30 ,$376.20 ,$254.56 ,$463.61 ,$96.34 ,$443.08 ,$376.20 ,$611.75 ,$384.56 ,$376.20 ,$275.92 ,$275.92 ,$254.56 ,$275.92 ,$271.70 ,$285.58 ,$46.44 ,$330.22 ,$491.43 , N/A , N/A ,$47.21 , N/A ,$271.89 ,$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 ,$175.56 ,$161.99 ,$266.00 , N/A ,$238.39 ,$238.39 , N/A ,$212.80 ,$226.10 ,$166.25 ,$239.40 , N/A , N/A ,$252.70 ,$239.40 ,$226.10 ,$226.10 , N/A ,$226.10 ,$226.10 ,$239.40 ,$161.99 , N/A , N/A , N/A ,$239.40 , N/A ,$244.72 ,$239.40 ,$175.59 ,$175.59 ,$161.99 ,$175.59 ,$172.90 ,$181.73 , 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 ",$661.98 ,$61.98 ,"$3,123.32 ",$859.29 ,$898.89 ,$898.89 ,$63.01 ,$802.40 ,$852.55 ,$626.88 ,$902.70 ,$859.29 ,$859.29 ,$952.85 ,$902.70 ,$852.55 ,$852.55 ,$63.01 ,$852.55 ,$852.55 ,$902.70 ,$610.83 ,$859.29 ,$128.60 ,$910.85 ,$902.70 ,"$3,123.32 ",$922.76 ,$902.70 ,$662.08 ,$662.08 ,$610.83 ,$662.08 ,$651.95 ,$685.25 ,$61.98 ,$792.37 ,$910.85 , N/A , N/A ,$63.01 , N/A ,"$1,388.14 ",$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 ",$969.54 ,$98.49 ,"$6,401.32 ",$859.29 ,"$1,316.52 ","$1,316.52 ",$100.13 ,"$1,175.20 ","$1,248.65 ",$918.13 ,"$1,322.10 ",$859.29 ,$859.29 ,"$1,395.55 ","$1,322.10 ","$1,248.65 ","$1,248.65 ",$100.13 ,"$1,248.65 ","$1,248.65 ","$1,322.10 ",$894.62 ,$859.29 ,$204.34 ,$910.85 ,"$1,322.10 ","$6,401.32 ","$1,351.48 ","$1,322.10 ",$969.69 ,$969.69 ,$894.62 ,$969.69 ,$954.85 ,"$1,003.62 ",$98.49 ,"$1,160.51 ",$910.85 , N/A , N/A ,$100.13 , N/A ,"$2,845.03 ","$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 ,$345.18 ,$317.16 ,"$6,401.32 ",$859.29 ,$468.71 ,$468.71 ,$322.44 ,$418.40 ,$444.55 ,$326.88 ,$470.70 ,$859.29 ,$523.00 ,$496.85 ,$470.70 ,$444.55 ,$444.55 ,$322.44 ,$444.55 ,$444.55 ,$470.70 ,$318.51 ,$859.29 ,$658.04 ,$554.38 ,$470.70 ,"$6,401.32 ",$481.16 ,$470.70 ,$345.23 ,$345.23 ,$318.51 ,$345.23 ,$339.95 ,$357.31 ,$317.16 ,$413.17 ,$910.85 , N/A , N/A ,$322.44 , N/A ,"$2,845.03 ",$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 ","$1,611.06 ",$346.50 ,"$6,401.32 ","$5,095.86 ","$2,187.62 ","$2,187.62 ",$352.25 ,"$1,952.80 ","$2,074.85 ","$1,525.63 ","$2,196.90 ","$5,095.86 ","$2,441.00 ","$2,318.95 ","$2,196.90 ","$2,074.85 ","$2,074.85 ",$352.25 ,"$2,074.85 ","$2,074.85 ","$2,196.90 ","$1,486.57 ","$5,095.86 ",$718.88 ,"$2,587.46 ","$2,196.90 ","$6,401.32 ","$2,245.72 ","$2,196.90 ","$1,611.30 ","$1,611.30 ","$1,486.57 ","$1,611.30 ","$1,586.65 ","$1,667.69 ",$346.50 ,"$1,928.39 ","$5,401.61 ", N/A , N/A ,$352.25 , N/A ,"$2,845.03 ","$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 ","$1,418.34 ",$456.82 ,"$2,149.00 ",$859.29 ,"$1,925.93 ","$1,925.93 ",$523.21 ,"$1,719.20 ","$1,826.65 ","$1,343.13 ","$1,934.10 ",$859.29 ,$859.29 ,"$2,041.55 ","$1,934.10 ","$1,826.65 ","$1,826.65 ",$523.21 ,"$1,826.65 ","$1,826.65 ","$1,934.10 ","$1,308.74 ",$859.29 ,"$1,067.78 ",$910.85 ,"$1,934.10 ","$1,027.85 ","$1,977.08 ","$1,934.10 ","$1,418.55 ","$1,418.55 ","$1,308.74 ","$1,418.55 ","$1,396.85 ","$1,468.20 ",$514.66 ,"$1,697.71 ",$910.85 , N/A , N/A ,$523.21 , N/A ,$456.82 ,"$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 ,$373.56 ,$31.48 ,$566.00 ,$307.08 ,$507.25 ,$507.25 ,$32.00 ,$452.80 ,$481.10 ,$353.75 ,$509.40 ,$307.08 ,$307.08 ,$537.70 ,$509.40 ,$481.10 ,$481.10 ,$32.00 ,$481.10 ,$481.10 ,$509.40 ,$344.69 ,$307.08 ,$65.30 ,$325.50 ,$509.40 ,$465.77 ,$520.72 ,$509.40 ,$373.62 ,$373.62 ,$344.69 ,$373.62 ,$367.90 ,$386.69 ,$31.48 ,$447.14 ,$325.50 , N/A , N/A ,$32.00 , N/A ,$207.01 ,$537.70 ,$464.12 ,$464.12 ,$452.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180116,23605,"PC CLOSED RX PROX HUMERUS FX,MANIP",981,1 ,"$1,278.90 ",$844.07 ,$451.82 ,"$3,227.67 ",$859.29 ,"$1,146.15 ","$1,146.15 ",$459.34 ,"$1,023.12 ","$1,087.07 ",$799.31 ,"$1,151.01 ",$859.29 ,$859.29 ,"$1,214.96 ","$1,151.01 ","$1,087.07 ","$1,087.07 ",$459.34 ,"$1,087.07 ","$1,087.07 ","$1,151.01 ",$778.85 ,$859.29 ,$937.42 ,$910.85 ,"$1,151.01 ","$3,227.67 ","$1,176.59 ","$1,151.01 ",$844.20 ,$844.20 ,$778.85 ,$844.20 ,$831.29 ,$873.74 ,$451.82 ,"$1,010.33 ",$910.85 , N/A , N/A ,$459.34 , N/A ,"$1,434.52 ","$1,214.96 ","$1,048.70 ","$1,048.70 ","$1,023.12 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180119,23650,PC CLOSED RX SHLDR DISLOCATION,981,1 ,"$1,124.00 ",$741.84 ,$207.01 ,"$1,124.00 ",$859.29 ,"$1,007.33 ","$1,007.33 ",$323.40 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ",$859.29 ,$859.29 ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$323.40 ,$955.40 ,$955.40 ,"$1,011.60 ",$684.52 ,$859.29 ,$660.00 ,$910.85 ,"$1,011.60 ",$465.77 ,"$1,034.08 ","$1,011.60 ",$741.95 ,$741.95 ,$684.52 ,$741.95 ,$730.60 ,$767.92 ,$318.12 ,$887.96 ,$910.85 , N/A , N/A ,$323.40 , N/A ,$207.01 ,"$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 ",$943.14 ,$430.56 ,"$3,227.67 ","$1,915.43 ","$1,280.67 ","$1,280.67 ",$437.72 ,"$1,143.20 ","$1,214.65 ",$893.13 ,"$1,286.10 ","$1,915.43 ","$1,429.00 ","$1,357.55 ","$1,286.10 ","$1,214.65 ","$1,214.65 ",$437.72 ,"$1,214.65 ","$1,214.65 ","$1,286.10 ",$870.26 ,"$1,915.43 ",$893.30 ,"$1,514.74 ","$1,286.10 ","$3,227.67 ","$1,314.68 ","$1,286.10 ",$943.28 ,$943.28 ,$870.26 ,$943.28 ,$928.85 ,$976.29 ,$430.56 ,"$1,128.91 ","$2,030.36 ", N/A , N/A ,$437.72 , N/A ,"$1,434.52 ","$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 ",$788.04 ,$423.11 ,"$3,227.67 ",$859.29 ,"$1,070.06 ","$1,070.06 ",$430.15 ,$955.20 ,"$1,014.90 ",$746.25 ,"$1,074.60 ",$859.29 ,$859.29 ,"$1,134.30 ","$1,074.60 ","$1,014.90 ","$1,014.90 ",$430.15 ,"$1,014.90 ","$1,014.90 ","$1,074.60 ",$727.15 ,$859.29 ,$877.86 ,$910.85 ,"$1,074.60 ","$3,227.67 ","$1,098.48 ","$1,074.60 ",$788.16 ,$788.16 ,$727.15 ,$788.16 ,$776.10 ,$815.74 ,$423.11 ,$943.26 ,$910.85 , N/A , N/A ,$430.15 , N/A ,"$1,434.52 ","$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 ",$766.92 ,$221.59 ,"$5,812.31 ","$3,447.67 ","$1,041.38 ","$1,041.38 ",$225.26 ,$929.60 ,$987.70 ,$726.25 ,"$1,045.80 ","$3,447.67 ","$1,162.00 ","$1,103.90 ","$1,045.80 ",$987.70 ,$987.70 ,$225.26 ,$987.70 ,$987.70 ,"$1,045.80 ",$707.66 ,"$3,447.67 ",$459.72 ,"$1,231.72 ","$1,045.80 ","$5,812.31 ","$1,069.04 ","$1,045.80 ",$767.04 ,$767.04 ,$707.66 ,$767.04 ,$755.30 ,$793.88 ,$221.59 ,$917.98 ,"$3,654.53 ", N/A , N/A ,$225.26 , N/A ,"$2,583.25 ","$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 ,$571.56 ,$168.53 ,"$3,654.53 ","$3,447.67 ",$776.11 ,$776.11 ,$171.33 ,$692.80 ,$736.10 ,$541.25 ,$779.40 ,"$3,447.67 ",$866.00 ,$822.70 ,$779.40 ,$736.10 ,$736.10 ,$171.33 ,$736.10 ,$736.10 ,$779.40 ,$527.39 ,"$3,447.67 ",$349.66 ,$917.96 ,$779.40 ,"$3,373.99 ",$796.72 ,$779.40 ,$571.65 ,$571.65 ,$527.39 ,$571.65 ,$562.90 ,$591.65 ,$168.53 ,$684.14 ,"$3,654.53 ", N/A , N/A ,$171.33 , N/A ,"$1,499.55 ",$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 ","$1,216.38 ",$538.03 ,"$11,650.85 ","$10,991.37 ","$1,651.70 ","$1,651.70 ",$546.97 ,"$1,474.40 ","$1,566.55 ","$1,151.88 ","$1,658.70 ","$10,991.37 ","$1,843.00 ","$1,750.85 ","$1,658.70 ","$1,566.55 ","$1,566.55 ",$546.97 ,"$1,566.55 ","$1,566.55 ","$1,658.70 ","$1,122.39 ","$10,991.37 ","$1,116.26 ","$1,953.58 ","$1,658.70 ","$6,697.49 ","$1,695.56 ","$1,658.70 ","$1,216.56 ","$1,216.56 ","$1,122.39 ","$1,216.56 ","$1,197.95 ","$1,259.14 ",$538.03 ,"$1,455.97 ","$11,650.85 ", N/A , N/A ,$546.97 , N/A ,"$2,976.66 ","$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 ",$969.54 ,$207.01 ,"$1,469.00 ",$859.29 ,"$1,316.52 ","$1,316.52 ",$368.05 ,"$1,175.20 ","$1,248.65 ",$918.13 ,"$1,322.10 ",$859.29 ,$859.29 ,"$1,395.55 ","$1,322.10 ","$1,248.65 ","$1,248.65 ",$368.05 ,"$1,248.65 ","$1,248.65 ","$1,322.10 ",$894.62 ,$859.29 ,$751.12 ,$910.85 ,"$1,322.10 ",$465.77 ,"$1,351.48 ","$1,322.10 ",$969.69 ,$969.69 ,$894.62 ,$969.69 ,$954.85 ,"$1,003.62 ",$362.03 ,"$1,160.51 ",$910.85 , N/A , N/A ,$368.05 , N/A ,$207.01 ,"$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 ,$326.70 ,$85.25 ,$910.85 ,$859.29 ,$443.62 ,$443.62 ,$86.67 ,$396.00 ,$420.75 ,$309.38 ,$445.50 ,$859.29 ,$495.00 ,$470.25 ,$445.50 ,$420.75 ,$420.75 ,$86.67 ,$420.75 ,$420.75 ,$445.50 ,$301.46 ,$859.29 ,$176.88 ,$524.70 ,$445.50 ,$465.77 ,$455.40 ,$445.50 ,$326.75 ,$326.75 ,$301.46 ,$326.75 ,$321.75 ,$338.18 ,$85.25 ,$391.05 ,$910.85 , N/A , N/A ,$86.67 , N/A ,$207.01 ,$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 ",$699.60 ,$207.01 ,"$1,060.00 ",$859.29 ,$949.97 ,$949.97 ,$268.74 ,$848.00 ,$901.00 ,$662.50 ,$954.00 ,$859.29 ,$859.29 ,"$1,007.00 ",$954.00 ,$901.00 ,$901.00 ,$268.74 ,$901.00 ,$901.00 ,$954.00 ,$645.54 ,$859.29 ,$548.44 ,$910.85 ,$954.00 ,$465.77 ,$975.20 ,$954.00 ,$699.71 ,$699.71 ,$645.54 ,$699.71 ,$689.00 ,$724.19 ,$264.34 ,$837.40 ,$910.85 , N/A , N/A ,$268.74 , N/A ,$207.01 ,"$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 ,$408.54 ,$207.01 ,$910.85 ,$859.29 ,$554.75 ,$554.75 ,$282.68 ,$495.20 ,$526.15 ,$386.88 ,$557.10 ,$859.29 ,$619.00 ,$588.05 ,$557.10 ,$526.15 ,$526.15 ,$282.68 ,$526.15 ,$526.15 ,$557.10 ,$376.97 ,$859.29 ,$576.90 ,$656.14 ,$557.10 ,$465.77 ,$569.48 ,$557.10 ,$408.60 ,$408.60 ,$376.97 ,$408.60 ,$402.35 ,$422.90 ,$278.07 ,$489.01 ,$910.85 , N/A , N/A ,$282.68 , N/A ,$207.01 ,$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 ","$2,321.22 ",$539.68 ,"$3,517.00 ",$859.29 ,"$3,151.94 ","$3,151.94 ",$548.64 ,"$2,813.60 ","$2,989.45 ","$2,198.13 ","$3,165.30 ",$859.29 ,$859.29 ,"$3,341.15 ","$3,165.30 ","$2,989.45 ","$2,989.45 ",$548.64 ,"$2,989.45 ","$2,989.45 ","$3,165.30 ","$2,141.85 ",$859.29 ,"$1,119.68 ",$910.85 ,"$3,165.30 ","$3,227.67 ","$3,235.64 ","$3,165.30 ","$2,321.57 ","$2,321.57 ","$2,141.85 ","$2,321.57 ","$2,286.05 ","$2,402.81 ",$539.68 ,"$2,778.43 ",$910.85 , N/A , N/A ,$548.64 , N/A ,"$1,434.52 ","$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 ","$1,021.68 ",$207.01 ,"$1,548.00 ",$859.29 ,"$1,387.32 ","$1,387.32 ",$483.00 ,"$1,238.40 ","$1,315.80 ",$967.50 ,"$1,393.20 ",$859.29 ,$859.29 ,"$1,470.60 ","$1,393.20 ","$1,315.80 ","$1,315.80 ",$483.00 ,"$1,315.80 ","$1,315.80 ","$1,393.20 ",$942.73 ,$859.29 ,$985.72 ,$910.85 ,"$1,393.20 ",$465.77 ,"$1,424.16 ","$1,393.20 ","$1,021.83 ","$1,021.83 ",$942.73 ,"$1,021.83 ","$1,006.20 ","$1,057.59 ",$475.10 ,"$1,222.92 ",$910.85 , N/A , N/A ,$483.00 , N/A ,$207.01 ,"$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 ,$471.90 ,$148.21 ,$715.00 ,$318.12 ,$640.78 ,$640.78 ,$150.67 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,$318.12 ,$318.12 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$150.67 ,$607.75 ,$607.75 ,$643.50 ,$435.44 ,$318.12 ,$307.48 ,$337.21 ,$643.50 ,$406.31 ,$657.80 ,$643.50 ,$471.97 ,$471.97 ,$435.44 ,$471.97 ,$464.75 ,$488.49 ,$148.21 ,$564.85 ,$337.21 , N/A , N/A ,$150.67 , N/A ,$180.58 ,$679.25 ,$586.30 ,$586.30 ,$572.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180180,26641,"PC TREAT THUMB DISLOC,MANIPULATN",981,1 ,$615.00 ,$405.90 ,$207.01 ,$910.85 ,$859.29 ,$551.16 ,$551.16 ,$412.82 ,$492.00 ,$522.75 ,$384.38 ,$553.50 ,$859.29 ,$615.00 ,$584.25 ,$553.50 ,$522.75 ,$522.75 ,$412.82 ,$522.75 ,$522.75 ,$553.50 ,$374.54 ,$859.29 ,$842.50 ,$651.90 ,$553.50 ,$465.77 ,$565.80 ,$553.50 ,$405.96 ,$405.96 ,$374.54 ,$405.96 ,$399.75 ,$420.17 ,$406.07 ,$485.85 ,$910.85 , N/A , N/A ,$412.82 , N/A ,$207.01 ,$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 ",$747.78 ,$418.69 ,"$3,227.67 ",$859.29 ,"$1,015.39 ","$1,015.39 ",$425.64 ,$906.40 ,$963.05 ,$708.13 ,"$1,019.70 ",$859.29 ,$859.29 ,"$1,076.35 ","$1,019.70 ",$963.05 ,$963.05 ,$425.64 ,$963.05 ,$963.05 ,"$1,019.70 ",$690.00 ,$859.29 ,$868.66 ,$910.85 ,"$1,019.70 ","$3,227.67 ","$1,042.36 ","$1,019.70 ",$747.89 ,$747.89 ,$690.00 ,$747.89 ,$736.45 ,$774.07 ,$418.69 ,$895.07 ,$910.85 , N/A , N/A ,$425.64 , N/A ,"$1,434.52 ","$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 ","$1,519.98 ",$510.53 ,"$10,793.46 ","$10,182.51 ","$2,063.95 ","$2,063.95 ",$519.02 ,"$1,842.40 ","$1,957.55 ","$1,439.38 ","$2,072.70 ","$10,182.51 ","$2,303.00 ","$2,187.85 ","$2,072.70 ","$1,957.55 ","$1,957.55 ",$519.02 ,"$1,957.55 ","$1,957.55 ","$2,072.70 ","$1,402.53 ","$10,182.51 ","$1,059.22 ","$2,441.18 ","$2,072.70 ","$6,697.49 ","$2,118.76 ","$2,072.70 ","$1,520.21 ","$1,520.21 ","$1,402.53 ","$1,520.21 ","$1,496.95 ","$1,573.41 ",$510.53 ,"$1,819.37 ","$10,793.46 ", N/A , N/A ,$519.02 , N/A ,"$2,976.66 ","$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 ,$485.76 ,$207.01 ,$910.85 ,$859.29 ,$659.60 ,$659.60 ,$336.67 ,$588.80 ,$625.60 ,$460.00 ,$662.40 ,$859.29 ,$736.00 ,$699.20 ,$662.40 ,$625.60 ,$625.60 ,$336.67 ,$625.60 ,$625.60 ,$662.40 ,$448.22 ,$859.29 ,$687.08 ,$780.16 ,$662.40 ,$465.77 ,$677.12 ,$662.40 ,$485.83 ,$485.83 ,$448.22 ,$485.83 ,$478.40 ,$502.84 ,$331.17 ,$581.44 ,$910.85 , N/A , N/A ,$336.67 , N/A ,$207.01 ,$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 ","$1,708.08 ",$604.02 ,"$10,793.46 ","$10,182.51 ","$2,319.37 ","$2,319.37 ",$614.07 ,"$2,070.40 ","$2,199.80 ","$1,617.50 ","$2,329.20 ","$10,182.51 ","$2,588.00 ","$2,458.60 ","$2,329.20 ","$2,199.80 ","$2,199.80 ",$614.07 ,"$2,199.80 ","$2,199.80 ","$2,329.20 ","$1,576.09 ","$10,182.51 ","$1,253.20 ","$2,743.28 ","$2,329.20 ","$6,697.49 ","$2,380.96 ","$2,329.20 ","$1,708.34 ","$1,708.34 ","$1,576.09 ","$1,708.34 ","$1,682.20 ","$1,768.12 ",$604.02 ,"$2,044.52 ","$10,793.46 ", N/A , N/A ,$614.07 , N/A ,"$2,976.66 ","$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 ,$249.48 ,$204.15 ,$910.85 ,$859.29 ,$338.76 ,$338.76 ,$207.54 ,$302.40 ,$321.30 ,$236.25 ,$340.20 ,$859.29 ,$378.00 ,$359.10 ,$340.20 ,$321.30 ,$321.30 ,$207.54 ,$321.30 ,$321.30 ,$340.20 ,$230.20 ,$859.29 ,$423.56 ,$400.68 ,$340.20 ,$465.77 ,$347.76 ,$340.20 ,$249.52 ,$249.52 ,$230.20 ,$249.52 ,$245.70 ,$258.25 ,$204.15 ,$298.62 ,$910.85 , N/A , N/A ,$207.54 , N/A ,$207.01 ,$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 ,$485.76 ,$207.01 ,$910.85 ,$859.29 ,$659.60 ,$659.60 ,$297.92 ,$588.80 ,$625.60 ,$460.00 ,$662.40 ,$859.29 ,$736.00 ,$699.20 ,$662.40 ,$625.60 ,$625.60 ,$297.92 ,$625.60 ,$625.60 ,$662.40 ,$448.22 ,$859.29 ,$608.00 ,$780.16 ,$662.40 ,$465.77 ,$677.12 ,$662.40 ,$485.83 ,$485.83 ,$448.22 ,$485.83 ,$478.40 ,$502.84 ,$293.05 ,$581.44 ,$910.85 , N/A , N/A ,$297.92 , N/A ,$207.01 ,$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 ","$1,030.92 ",$450.81 ,"$10,793.46 ","$10,182.51 ","$1,399.86 ","$1,399.86 ",$458.31 ,"$1,249.60 ","$1,327.70 ",$976.25 ,"$1,405.80 ","$10,182.51 ","$1,562.00 ","$1,483.90 ","$1,405.80 ","$1,327.70 ","$1,327.70 ",$458.31 ,"$1,327.70 ","$1,327.70 ","$1,405.80 ",$951.26 ,"$10,182.51 ",$935.32 ,"$1,655.72 ","$1,405.80 ","$6,697.49 ","$1,437.04 ","$1,405.80 ","$1,031.08 ","$1,031.08 ",$951.26 ,"$1,031.08 ","$1,015.30 ","$1,067.16 ",$450.81 ,"$1,233.98 ","$10,793.46 ", N/A , N/A ,$458.31 , N/A ,"$2,976.66 ","$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 ,$253.44 ,$207.01 ,$910.85 ,$859.29 ,$344.14 ,$344.14 ,$284.23 ,$307.20 ,$326.40 ,$240.00 ,$345.60 ,$859.29 ,$384.00 ,$364.80 ,$345.60 ,$326.40 ,$326.40 ,$284.23 ,$326.40 ,$326.40 ,$345.60 ,$233.86 ,$859.29 ,$580.06 ,$407.04 ,$345.60 ,$465.77 ,$353.28 ,$345.60 ,$253.48 ,$253.48 ,$233.86 ,$253.48 ,$249.60 ,$262.35 ,$279.57 ,$303.36 ,$910.85 , N/A , N/A ,$284.23 , N/A ,$207.01 ,$364.80 ,$314.88 ,$314.88 ,$307.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180209,27250,PC CLOSED RX TRAUMATIC HIP DISLOCATN,981,1 ,$313.95 ,$207.21 ,$180.18 ,$910.85 ,$859.29 ,$281.36 ,$281.36 ,$183.18 ,$251.16 ,$266.86 ,$196.22 ,$282.56 ,$859.29 ,$313.95 ,$298.25 ,$282.56 ,$266.86 ,$266.86 ,$183.18 ,$266.86 ,$266.86 ,$282.56 ,$191.20 ,$859.29 ,$373.84 ,$332.79 ,$282.56 ,$465.77 ,$288.83 ,$282.56 ,$207.24 ,$207.24 ,$191.20 ,$207.24 ,$204.07 ,$214.49 ,$180.18 ,$248.02 ,$910.85 , N/A , N/A ,$183.18 , N/A ,$207.01 ,$298.25 ,$257.44 ,$257.44 ,$251.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180213,27265,PC CLOSED RX POST HIP ARTHRPLAS DISLOC,981,1 ,"$1,117.00 ",$737.22 ,$207.01 ,"$1,117.00 ",$859.29 ,"$1,001.06 ","$1,001.06 ",$443.95 ,$893.60 ,$949.45 ,$698.13 ,"$1,005.30 ",$859.29 ,$859.29 ,"$1,061.15 ","$1,005.30 ",$949.45 ,$949.45 ,$443.95 ,$949.45 ,$949.45 ,"$1,005.30 ",$680.25 ,$859.29 ,$906.02 ,$910.85 ,"$1,005.30 ",$465.77 ,"$1,027.64 ","$1,005.30 ",$737.33 ,$737.33 ,$680.25 ,$737.33 ,$726.05 ,$763.13 ,$436.69 ,$882.43 ,$910.85 , N/A , N/A ,$443.95 , N/A ,$207.01 ,"$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 ",$978.78 ,$207.01 ,"$1,483.00 ",$859.29 ,"$1,329.06 ","$1,329.06 ",$505.70 ,"$1,186.40 ","$1,260.55 ",$926.88 ,"$1,334.70 ",$859.29 ,$859.29 ,"$1,408.85 ","$1,334.70 ","$1,260.55 ","$1,260.55 ",$505.70 ,"$1,260.55 ","$1,260.55 ","$1,334.70 ",$903.15 ,$859.29 ,"$1,032.04 ",$910.85 ,"$1,334.70 ",$465.77 ,"$1,364.36 ","$1,334.70 ",$978.93 ,$978.93 ,$903.15 ,$978.93 ,$963.95 ,"$1,013.19 ",$497.44 ,"$1,171.57 ",$910.85 , N/A , N/A ,$505.70 , N/A ,$207.01 ,"$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 ",$809.82 ,$207.01 ,"$1,227.00 ",$859.29 ,"$1,099.64 ","$1,099.64 ",$369.74 ,$981.60 ,"$1,042.95 ",$766.88 ,"$1,104.30 ",$859.29 ,$859.29 ,"$1,165.65 ","$1,104.30 ","$1,042.95 ","$1,042.95 ",$369.74 ,"$1,042.95 ","$1,042.95 ","$1,104.30 ",$747.24 ,$859.29 ,$754.58 ,$910.85 ,"$1,104.30 ",$465.77 ,"$1,128.84 ","$1,104.30 ",$809.94 ,$809.94 ,$747.24 ,$809.94 ,$797.55 ,$838.29 ,$363.70 ,$969.33 ,$910.85 , N/A , N/A ,$369.74 , N/A ,$207.01 ,"$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 ",$861.96 ,$207.01 ,"$1,306.00 ",$859.29 ,"$1,170.44 ","$1,170.44 ",$334.18 ,"$1,044.80 ","$1,110.10 ",$816.25 ,"$1,175.40 ",$859.29 ,$859.29 ,"$1,240.70 ","$1,175.40 ","$1,110.10 ","$1,110.10 ",$334.18 ,"$1,110.10 ","$1,110.10 ","$1,175.40 ",$795.35 ,$859.29 ,$682.00 ,$910.85 ,"$1,175.40 ",$465.77 ,"$1,201.52 ","$1,175.40 ",$862.09 ,$862.09 ,$795.35 ,$862.09 ,$848.90 ,$892.26 ,$328.71 ,"$1,031.74 ",$910.85 , N/A , N/A ,$334.18 , N/A ,$207.01 ,"$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 ","$1,310.10 ",$461.38 ,"$3,227.67 ",$859.29 ,"$1,778.96 ","$1,778.96 ",$469.06 ,"$1,588.00 ","$1,687.25 ","$1,240.63 ","$1,786.50 ",$859.29 ,$859.29 ,"$1,885.75 ","$1,786.50 ","$1,687.25 ","$1,687.25 ",$469.06 ,"$1,687.25 ","$1,687.25 ","$1,786.50 ","$1,208.87 ",$859.29 ,$957.26 ,$910.85 ,"$1,786.50 ","$3,227.67 ","$1,826.20 ","$1,786.50 ","$1,310.30 ","$1,310.30 ","$1,208.87 ","$1,310.30 ","$1,290.25 ","$1,356.15 ",$461.38 ,"$1,568.15 ",$910.85 , N/A , N/A ,$469.06 , N/A ,"$1,434.52 ","$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 ","$2,669.70 ",$451.11 ,"$4,045.00 ",$859.29 ,"$3,625.13 ","$3,625.13 ",$458.61 ,"$3,236.00 ","$3,438.25 ","$2,528.13 ","$3,640.50 ",$859.29 ,$859.29 ,"$3,842.75 ","$3,640.50 ","$3,438.25 ","$3,438.25 ",$458.61 ,"$3,438.25 ","$3,438.25 ","$3,640.50 ","$2,463.41 ",$859.29 ,$935.94 ,$910.85 ,"$3,640.50 ","$3,227.67 ","$3,721.40 ","$3,640.50 ","$2,670.10 ","$2,670.10 ","$2,463.41 ","$2,670.10 ","$2,629.25 ","$2,763.54 ",$451.11 ,"$3,195.55 ",$910.85 , N/A , N/A ,$458.61 , N/A ,"$1,434.52 ","$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 ","$2,100.12 ",$462.99 ,"$3,227.67 ",$859.29 ,"$2,851.71 ","$2,851.71 ",$470.68 ,"$2,545.60 ","$2,704.70 ","$1,988.75 ","$2,863.80 ",$859.29 ,$859.29 ,"$3,022.90 ","$2,863.80 ","$2,704.70 ","$2,704.70 ",$470.68 ,"$2,704.70 ","$2,704.70 ","$2,863.80 ","$1,937.84 ",$859.29 ,$960.58 ,$910.85 ,"$2,863.80 ","$3,227.67 ","$2,927.44 ","$2,863.80 ","$2,100.44 ","$2,100.44 ","$1,937.84 ","$2,100.44 ","$2,068.30 ","$2,173.94 ",$462.99 ,"$2,513.78 ",$910.85 , N/A , N/A ,$470.68 , N/A ,"$1,434.52 ","$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 ",$741.84 ,$207.01 ,"$1,124.00 ",$859.29 ,"$1,007.33 ","$1,007.33 ",$414.88 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ",$859.29 ,$859.29 ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$414.88 ,$955.40 ,$955.40 ,"$1,011.60 ",$684.52 ,$859.29 ,$846.70 ,$910.85 ,"$1,011.60 ",$465.77 ,"$1,034.08 ","$1,011.60 ",$741.95 ,$741.95 ,$684.52 ,$741.95 ,$730.60 ,$767.92 ,$408.10 ,$887.96 ,$910.85 , N/A , N/A ,$414.88 , N/A ,$207.01 ,"$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 ",$741.84 ,$207.01 ,"$1,124.00 ",$859.29 ,"$1,007.33 ","$1,007.33 ",$250.00 ,$899.20 ,$955.40 ,$702.50 ,"$1,011.60 ",$859.29 ,$859.29 ,"$1,067.80 ","$1,011.60 ",$955.40 ,$955.40 ,$250.00 ,$955.40 ,$955.40 ,"$1,011.60 ",$684.52 ,$859.29 ,$510.20 ,$910.85 ,"$1,011.60 ",$465.77 ,"$1,034.08 ","$1,011.60 ",$741.95 ,$741.95 ,$684.52 ,$741.95 ,$730.60 ,$767.92 ,$245.91 ,$887.96 ,$910.85 , N/A , N/A ,$250.00 , N/A ,$207.01 ,"$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 ","$1,335.18 ",$207.01 ,"$2,023.00 ",$859.29 ,"$1,813.01 ","$1,813.01 ",$434.78 ,"$1,618.40 ","$1,719.55 ","$1,264.38 ","$1,820.70 ",$859.29 ,$859.29 ,"$1,921.85 ","$1,820.70 ","$1,719.55 ","$1,719.55 ",$434.78 ,"$1,719.55 ","$1,719.55 ","$1,820.70 ","$1,232.01 ",$859.29 ,$887.30 ,$910.85 ,"$1,820.70 ",$465.77 ,"$1,861.16 ","$1,820.70 ","$1,335.38 ","$1,335.38 ","$1,232.01 ","$1,335.38 ","$1,314.95 ","$1,382.11 ",$427.66 ,"$1,598.17 ",$910.85 , N/A , N/A ,$434.78 , N/A ,$207.01 ,"$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 ","$1,952.28 ",$592.73 ,"$14,882.92 ","$10,182.51 ","$2,650.96 ","$2,650.96 ",$602.58 ,"$2,366.40 ","$2,514.30 ","$1,848.75 ","$2,662.20 ","$10,182.51 ","$2,958.00 ","$2,810.10 ","$2,662.20 ","$2,514.30 ","$2,514.30 ",$602.58 ,"$2,514.30 ","$2,514.30 ","$2,662.20 ","$1,801.42 ","$10,182.51 ","$1,229.76 ","$3,135.48 ","$2,662.20 ","$14,882.92 ","$2,721.36 ","$2,662.20 ","$1,952.58 ","$1,952.58 ","$1,801.42 ","$1,952.58 ","$1,922.70 ","$2,020.91 ",$592.73 ,"$2,336.82 ","$10,793.46 ", N/A , N/A ,$602.58 , N/A ,"$6,614.63 ","$2,810.10 ","$2,425.56 ","$2,425.56 ","$2,366.40 "
ST. CLARE MEMORIAL HOSPITAL (ACU),98180257,28435,"PC CLOSED RX TALUS FX,MANIPULATN",981,1 ,"$1,109.00 ",$731.94 ,$347.39 ,"$3,227.67 ",$859.29 ,$993.89 ,$993.89 ,$353.17 ,$887.20 ,$942.65 ,$693.13 ,$998.10 ,$859.29 ,$859.29 ,"$1,053.55 ",$998.10 ,$942.65 ,$942.65 ,$353.17 ,$942.65 ,$942.65 ,$998.10 ,$675.38 ,$859.29 ,$720.76 ,$910.85 ,$998.10 ,"$3,227.67 ","$1,020.28 ",$998.10 ,$732.05 ,$732.05 ,$675.38 ,$732.05 ,$720.85 ,$757.67 ,$347.39 ,$876.11 ,$910.85 , N/A , N/A ,$353.17 , N/A ,"$1,434.52 ","$1,053.55 ",$909.38 ,$909.38 ,$887.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180264,28490,PC CLOSED RX BIG TOE FRACTURE,981,1 ,$467.00 ,$308.22 ,$133.75 ,$910.85 ,$859.29 ,$418.53 ,$418.53 ,$135.97 ,$373.60 ,$396.95 ,$291.88 ,$420.30 ,$859.29 ,$467.00 ,$443.65 ,$420.30 ,$396.95 ,$396.95 ,$135.97 ,$396.95 ,$396.95 ,$420.30 ,$284.40 ,$859.29 ,$277.50 ,$495.02 ,$420.30 ,$465.77 ,$429.64 ,$420.30 ,$308.27 ,$308.27 ,$284.40 ,$308.27 ,$303.55 ,$319.05 ,$133.75 ,$368.93 ,$910.85 , N/A , N/A ,$135.97 , N/A ,$207.01 ,$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 ,$246.18 ,$159.21 ,$910.85 ,$859.29 ,$334.28 ,$334.28 ,$161.86 ,$298.40 ,$317.05 ,$233.13 ,$335.70 ,$859.29 ,$373.00 ,$354.35 ,$335.70 ,$317.05 ,$317.05 ,$161.86 ,$317.05 ,$317.05 ,$335.70 ,$227.16 ,$859.29 ,$330.32 ,$395.38 ,$335.70 ,$465.77 ,$343.16 ,$335.70 ,$246.22 ,$246.22 ,$227.16 ,$246.22 ,$242.45 ,$254.83 ,$159.21 ,$294.67 ,$910.85 , N/A , N/A ,$161.86 , N/A ,$207.01 ,$354.35 ,$305.86 ,$305.86 ,$298.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180266,28496,PC PERCUT BIG TOE FX,981,1 ,$847.00 ,$559.02 ,$262.41 ,"$10,793.46 ","$10,182.51 ",$759.08 ,$759.08 ,$266.78 ,$677.60 ,$719.95 ,$529.38 ,$762.30 ,"$10,182.51 ",$847.00 ,$804.65 ,$762.30 ,$719.95 ,$719.95 ,$266.78 ,$719.95 ,$719.95 ,$762.30 ,$515.82 ,"$10,182.51 ",$544.44 ,$897.82 ,$762.30 ,"$6,697.49 ",$779.24 ,$762.30 ,$559.10 ,$559.10 ,$515.82 ,$559.10 ,$550.55 ,$578.67 ,$262.41 ,$669.13 ,"$10,793.46 ", N/A , N/A ,$266.78 , N/A ,"$2,976.66 ",$804.65 ,$694.54 ,$694.54 ,$677.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180267,28510,PC CLOSED RX TOE FX,981,1 ,$216.00 ,$142.56 ,$129.11 ,$910.85 ,$859.29 ,$193.58 ,$193.58 ,$131.26 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$859.29 ,$216.00 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$131.26 ,$183.60 ,$183.60 ,$194.40 ,$131.54 ,$859.29 ,$267.88 ,$228.96 ,$194.40 ,$465.77 ,$198.72 ,$194.40 ,$142.58 ,$142.58 ,$131.54 ,$142.58 ,$140.40 ,$147.57 ,$129.11 ,$170.64 ,$910.85 , N/A , N/A ,$131.26 , N/A ,$207.01 ,$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 ,$410.52 ,$153.52 ,$910.85 ,$859.29 ,$557.44 ,$557.44 ,$156.06 ,$497.60 ,$528.70 ,$388.75 ,$559.80 ,$859.29 ,$622.00 ,$590.90 ,$559.80 ,$528.70 ,$528.70 ,$156.06 ,$528.70 ,$528.70 ,$559.80 ,$378.80 ,$859.29 ,$318.50 ,$659.32 ,$559.80 ,$465.77 ,$572.24 ,$559.80 ,$410.58 ,$410.58 ,$378.80 ,$410.58 ,$404.30 ,$424.95 ,$153.52 ,$491.38 ,$910.85 , N/A , N/A ,$156.06 , N/A ,$207.01 ,$590.90 ,$510.04 ,$510.04 ,$497.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180276,28630,PC CLOSED RX MT-PHAL TOE DISLOCATION,981,1 ,$555.98 ,$366.95 ,$115.56 ,$910.85 ,$859.29 ,$498.27 ,$498.27 ,$117.48 ,$444.78 ,$472.58 ,$347.49 ,$500.38 ,$859.29 ,$555.98 ,$528.18 ,$500.38 ,$472.58 ,$472.58 ,$117.48 ,$472.58 ,$472.58 ,$500.38 ,$338.59 ,$859.29 ,$239.76 ,$589.34 ,$500.38 ,$465.77 ,$511.50 ,$500.38 ,$367.00 ,$367.00 ,$338.59 ,$367.00 ,$361.39 ,$379.85 ,$115.56 ,$439.22 ,$910.85 , N/A , N/A ,$117.48 , N/A ,$207.01 ,$528.18 ,$455.90 ,$455.90 ,$444.78 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180279,28660,"PC CLOSED RX I-P JT,TOE DISLOCATION",981,1 ,$508.00 ,$335.28 ,$97.08 ,$910.85 ,$859.29 ,$455.27 ,$455.27 ,$98.70 ,$406.40 ,$431.80 ,$317.50 ,$457.20 ,$859.29 ,$508.00 ,$482.60 ,$457.20 ,$431.80 ,$431.80 ,$98.70 ,$431.80 ,$431.80 ,$457.20 ,$309.37 ,$859.29 ,$201.42 ,$538.48 ,$457.20 ,$465.77 ,$467.36 ,$457.20 ,$335.33 ,$335.33 ,$309.37 ,$335.33 ,$330.20 ,$347.07 ,$97.08 ,$401.32 ,$910.85 , N/A , N/A ,$98.70 , N/A ,$207.01 ,$482.60 ,$416.56 ,$416.56 ,$406.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180286,29105,PC APPLY LONG ARM SPLINT,981,1 ,$344.00 ,$227.04 ,$42.40 ,$344.00 ,$132.85 ,$308.29 ,$308.29 ,$43.11 ,$275.20 ,$292.40 ,$215.00 ,$309.60 ,$132.85 ,$132.85 ,$326.80 ,$309.60 ,$292.40 ,$292.40 ,$43.11 ,$292.40 ,$292.40 ,$309.60 ,$209.50 ,$132.85 ,$87.98 ,$140.82 ,$309.60 ,$327.96 ,$316.48 ,$309.60 ,$227.07 ,$227.07 ,$209.50 ,$227.07 ,$223.60 ,$235.02 ,$42.40 ,$271.76 ,$140.82 , N/A , N/A ,$43.11 , N/A ,$145.76 ,$326.80 ,$282.08 ,$282.08 ,$275.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180287,29125,"PC APPLY FOREARM SPLINT,STATIC",981,1 ,$265.00 ,$174.90 ,$41.74 ,$265.00 ,$132.85 ,$237.49 ,$237.49 ,$42.43 ,$212.00 ,$225.25 ,$165.63 ,$238.50 ,$132.85 ,$132.85 ,$251.75 ,$238.50 ,$225.25 ,$225.25 ,$42.43 ,$225.25 ,$225.25 ,$238.50 ,$161.39 ,$132.85 ,$86.60 ,$140.82 ,$238.50 ,$261.25 ,$243.80 ,$238.50 ,$174.93 ,$174.93 ,$161.39 ,$174.93 ,$172.25 ,$181.05 ,$41.74 ,$209.35 ,$140.82 , N/A , N/A ,$42.43 , N/A ,$116.11 ,$251.75 ,$217.30 ,$217.30 ,$212.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180288,29126,"PC APPLY FOREARM SPLINT,DYNAMIC",981,1 ,$352.00 ,$232.32 ,$51.35 ,$352.00 ,$132.85 ,$315.46 ,$315.46 ,$52.20 ,$281.60 ,$299.20 ,$220.00 ,$316.80 ,$132.85 ,$132.85 ,$334.40 ,$316.80 ,$299.20 ,$299.20 ,$52.20 ,$299.20 ,$299.20 ,$316.80 ,$214.37 ,$132.85 ,$106.54 ,$140.82 ,$316.80 ,$261.25 ,$323.84 ,$316.80 ,$232.36 ,$232.36 ,$214.37 ,$232.36 ,$228.80 ,$240.49 ,$51.35 ,$278.08 ,$140.82 , N/A , N/A ,$52.20 , N/A ,$116.11 ,$334.40 ,$288.64 ,$288.64 ,$281.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180289,29130,"PC APPLY FINGER SPLINT,STATIC",981,1 ,$156.00 ,$102.96 ,$29.95 ,$261.25 ,$132.85 ,$139.81 ,$139.81 ,$30.45 ,$124.80 ,$132.60 ,$97.50 ,$140.40 ,$132.85 ,$132.85 ,$148.20 ,$140.40 ,$132.60 ,$132.60 ,$30.45 ,$132.60 ,$132.60 ,$140.40 ,$95.00 ,$132.85 ,$62.14 ,$140.82 ,$140.40 ,$261.25 ,$143.52 ,$140.40 ,$102.98 ,$102.98 ,$95.00 ,$102.98 ,$101.40 ,$106.58 ,$29.95 ,$123.24 ,$140.82 , N/A , N/A ,$30.45 , N/A ,$116.11 ,$148.20 ,$127.92 ,$127.92 ,$124.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180290,29131,"PC APPLY FINGER SPLINT,DYNAMIC",981,1 ,$182.00 ,$120.12 ,$35.76 ,$182.00 ,$132.85 ,$163.11 ,$163.11 ,$36.36 ,$145.60 ,$154.70 ,$113.75 ,$163.80 ,$132.85 ,$132.85 ,$172.90 ,$163.80 ,$154.70 ,$154.70 ,$36.36 ,$154.70 ,$154.70 ,$163.80 ,$110.84 ,$132.85 ,$74.20 ,$140.82 ,$163.80 ,$129.33 ,$167.44 ,$163.80 ,$120.14 ,$120.14 ,$110.84 ,$120.14 ,$118.30 ,$124.34 ,$35.76 ,$143.78 ,$140.82 , N/A , N/A ,$36.36 , N/A ,$57.48 ,$172.90 ,$149.24 ,$149.24 ,$145.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180291,29240,PC STRAPPING OF SHOULDER,981,1 ,$189.00 ,$124.74 ,$19.52 ,$261.25 ,$132.85 ,$169.38 ,$169.38 ,$19.84 ,$151.20 ,$160.65 ,$118.13 ,$170.10 ,$132.85 ,$132.85 ,$179.55 ,$170.10 ,$160.65 ,$160.65 ,$19.84 ,$160.65 ,$160.65 ,$170.10 ,$115.10 ,$132.85 ,$40.50 ,$140.82 ,$170.10 ,$261.25 ,$173.88 ,$170.10 ,$124.76 ,$124.76 ,$115.10 ,$124.76 ,$122.85 ,$129.12 ,$19.52 ,$149.31 ,$140.82 , N/A , N/A ,$19.84 , N/A ,$116.11 ,$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 ,$56.76 ,$20.12 ,$140.82 ,$132.85 ,$77.07 ,$77.07 ,$20.45 ,$68.80 ,$73.10 ,$53.75 ,$77.40 ,$132.85 ,$86.00 ,$81.70 ,$77.40 ,$73.10 ,$73.10 ,$20.45 ,$73.10 ,$73.10 ,$77.40 ,$52.37 ,$132.85 ,$41.74 ,$91.16 ,$77.40 ,$129.33 ,$79.12 ,$77.40 ,$56.77 ,$56.77 ,$52.37 ,$56.77 ,$55.90 ,$58.76 ,$20.12 ,$67.94 ,$140.82 , N/A , N/A ,$20.45 , N/A ,$57.48 ,$81.70 ,$70.52 ,$70.52 ,$68.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180304,29505,PC APPLY LONG LEG SPLINT,981,1 ,$216.00 ,$142.56 ,$53.74 ,$327.96 ,$132.85 ,$193.58 ,$193.58 ,$54.63 ,$172.80 ,$183.60 ,$135.00 ,$194.40 ,$132.85 ,$132.85 ,$205.20 ,$194.40 ,$183.60 ,$183.60 ,$54.63 ,$183.60 ,$183.60 ,$194.40 ,$131.54 ,$132.85 ,$111.50 ,$140.82 ,$194.40 ,$327.96 ,$198.72 ,$194.40 ,$142.58 ,$142.58 ,$131.54 ,$142.58 ,$140.40 ,$147.57 ,$53.74 ,$170.64 ,$140.82 , N/A , N/A ,$54.63 , N/A ,$145.76 ,$205.20 ,$177.12 ,$177.12 ,$172.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180305,29515,PC APPLY LOWER LEG SPLINT,981,1 ,$255.00 ,$168.30 ,$51.20 ,$327.96 ,$132.85 ,$228.53 ,$228.53 ,$52.06 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$132.85 ,$132.85 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$52.06 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,$132.85 ,$106.24 ,$140.82 ,$229.50 ,$327.96 ,$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$51.20 ,$201.45 ,$140.82 , N/A , N/A ,$52.06 , N/A ,$145.76 ,$242.25 ,$209.10 ,$209.10 ,$204.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180321,30300,PC REMOVE NASAL FOREIGN BODY,981,1 ,$715.00 ,$471.90 ,$116.11 ,$715.00 ,$307.08 ,$640.78 ,$640.78 ,$134.01 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,$307.08 ,$307.08 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$134.01 ,$607.75 ,$607.75 ,$643.50 ,$435.44 ,$307.08 ,$273.50 ,$325.50 ,$643.50 ,$261.25 ,$657.80 ,$643.50 ,$471.97 ,$471.97 ,$435.44 ,$471.97 ,$464.75 ,$488.49 ,$131.82 ,$564.85 ,$325.50 , N/A , N/A ,$134.01 , N/A ,$116.11 ,$679.25 ,$586.30 ,$586.30 ,$572.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180323,30801,"PC CAUTERIZATION, INNER NOSE",981,1 ,$715.00 ,$471.90 ,$162.96 ,"$3,123.32 ","$2,798.95 ",$640.78 ,$640.78 ,$165.67 ,$572.00 ,$607.75 ,$446.88 ,$643.50 ,"$2,798.95 ",$715.00 ,$679.25 ,$643.50 ,$607.75 ,$607.75 ,$165.67 ,$607.75 ,$607.75 ,$643.50 ,$435.44 ,"$2,798.95 ",$338.10 ,$757.90 ,$643.50 ,"$3,123.32 ",$657.80 ,$643.50 ,$471.97 ,$471.97 ,$435.44 ,$471.97 ,$464.75 ,$488.49 ,$162.96 ,$564.85 ,"$2,966.89 ", N/A , N/A ,$165.67 , N/A ,"$1,388.14 ",$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 ",$687.06 ,$216.10 ,"$5,401.61 ","$5,095.86 ",$932.94 ,$932.94 ,$219.70 ,$832.80 ,$884.85 ,$650.63 ,$936.90 ,"$5,095.86 ","$1,041.00 ",$988.95 ,$936.90 ,$884.85 ,$884.85 ,$219.70 ,$884.85 ,$884.85 ,$936.90 ,$633.97 ,"$5,095.86 ",$448.36 ,"$1,103.46 ",$936.90 ,"$3,123.32 ",$957.72 ,$936.90 ,$687.16 ,$687.16 ,$633.97 ,$687.16 ,$676.65 ,$711.21 ,$216.10 ,$822.39 ,"$5,401.61 ", N/A , N/A ,$219.70 , N/A ,"$1,388.14 ",$988.95 ,$853.62 ,$853.62 ,$832.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180325,30901,"PC CTRL NOSEBLEED,ANTER,SIMPLE",981,1 ,$384.00 ,$253.44 ,$57.83 ,$384.00 ,$307.08 ,$344.14 ,$344.14 ,$58.80 ,$307.20 ,$326.40 ,$240.00 ,$345.60 ,$307.08 ,$307.08 ,$364.80 ,$345.60 ,$326.40 ,$326.40 ,$58.80 ,$326.40 ,$326.40 ,$345.60 ,$233.86 ,$307.08 ,$120.00 ,$325.50 ,$345.60 ,$261.25 ,$353.28 ,$345.60 ,$253.48 ,$253.48 ,$233.86 ,$253.48 ,$249.60 ,$262.35 ,$57.83 ,$303.36 ,$325.50 , N/A , N/A ,$58.80 , N/A ,$116.11 ,$364.80 ,$314.88 ,$314.88 ,$307.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180326,30903,"PC CTRL NOSEBLEED,ANTER,COMPLEX",981,1 ,$635.00 ,$419.10 ,$79.12 ,$635.00 ,$307.08 ,$569.09 ,$569.09 ,$80.44 ,$508.00 ,$539.75 ,$396.88 ,$571.50 ,$307.08 ,$307.08 ,$603.25 ,$571.50 ,$539.75 ,$539.75 ,$80.44 ,$539.75 ,$539.75 ,$571.50 ,$386.72 ,$307.08 ,$164.16 ,$325.50 ,$571.50 ,$261.25 ,$584.20 ,$571.50 ,$419.16 ,$419.16 ,$386.72 ,$419.16 ,$412.75 ,$433.83 ,$79.12 ,$501.65 ,$325.50 , N/A , N/A ,$80.44 , N/A ,$116.11 ,$603.25 ,$520.70 ,$520.70 ,$508.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180327,30905,PC CONTROL OF NOSEBLEED,981,1 ,"$1,105.00 ",$729.30 ,$108.10 ,"$1,105.00 ",$307.08 ,$990.30 ,$990.30 ,$109.91 ,$884.00 ,$939.25 ,$690.63 ,$994.50 ,$307.08 ,$307.08 ,"$1,049.75 ",$994.50 ,$939.25 ,$939.25 ,$109.91 ,$939.25 ,$939.25 ,$994.50 ,$672.95 ,$307.08 ,$224.30 ,$325.50 ,$994.50 ,$261.25 ,"$1,016.60 ",$994.50 ,$729.41 ,$729.41 ,$672.95 ,$729.41 ,$718.25 ,$754.94 ,$108.10 ,$872.95 ,$325.50 , N/A , N/A ,$109.91 , N/A ,$116.11 ,"$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 ,$514.80 ,$137.21 ,$780.00 ,$307.08 ,$699.04 ,$699.04 ,$139.49 ,$624.00 ,$663.00 ,$487.50 ,$702.00 ,$307.08 ,$307.08 ,$741.00 ,$702.00 ,$663.00 ,$663.00 ,$139.49 ,$663.00 ,$663.00 ,$702.00 ,$475.02 ,$307.08 ,$284.68 ,$325.50 ,$702.00 ,$467.62 ,$717.60 ,$702.00 ,$514.88 ,$514.88 ,$475.02 ,$514.88 ,$507.00 ,$532.90 ,$137.21 ,$616.20 ,$325.50 , N/A , N/A ,$139.49 , N/A ,$207.83 ,$741.00 ,$639.60 ,$639.60 ,$624.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180329,31500,PC INSERT EMERGENCY ENDOTRACH AIRWAY,981,1 ,$624.00 ,$411.84 ,$144.19 ,"$1,456.37 ","$1,373.93 ",$559.23 ,$559.23 ,$146.58 ,$499.20 ,$530.40 ,$390.00 ,$561.60 ,"$1,373.93 ",$624.00 ,$592.80 ,$561.60 ,$530.40 ,$530.40 ,$146.58 ,$530.40 ,$530.40 ,$561.60 ,$380.02 ,"$1,373.93 ",$299.14 ,$661.44 ,$561.60 ,$467.62 ,$574.08 ,$561.60 ,$411.90 ,$411.90 ,$380.02 ,$411.90 ,$405.60 ,$426.32 ,$144.19 ,$492.96 ,"$1,456.37 ", N/A , N/A ,$146.58 , N/A ,$207.83 ,$592.80 ,$511.68 ,$511.68 ,$499.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180330,31502,PC TRACH TUBE CHANGE,981,1 ,$342.00 ,$225.72 ,$35.95 ,$467.62 ,$307.08 ,$306.50 ,$306.50 ,$36.54 ,$273.60 ,$290.70 ,$213.75 ,$307.80 ,$307.08 ,$307.08 ,$324.90 ,$307.80 ,$290.70 ,$290.70 ,$36.54 ,$290.70 ,$290.70 ,$307.80 ,$208.28 ,$307.08 ,$74.58 ,$325.50 ,$307.80 ,$467.62 ,$314.64 ,$307.80 ,$225.75 ,$225.75 ,$208.28 ,$225.75 ,$222.30 ,$233.65 ,$35.95 ,$270.18 ,$325.50 , N/A , N/A ,$36.54 , N/A ,$207.83 ,$324.90 ,$280.44 ,$280.44 ,$273.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180345,32551,PC CHEST TUBE INSERTION,981,1 ,$660.00 ,$435.60 ,$156.50 ,"$3,347.66 ","$1,845.03 ",$591.49 ,$591.49 ,$159.10 ,$528.00 ,$561.00 ,$412.50 ,$594.00 ,"$1,845.03 ",$660.00 ,$627.00 ,$594.00 ,$561.00 ,$561.00 ,$159.10 ,$561.00 ,$561.00 ,$594.00 ,$401.94 ,"$1,845.03 ",$324.70 ,$699.60 ,$594.00 ,"$3,347.66 ",$607.20 ,$594.00 ,$435.67 ,$435.67 ,$401.94 ,$435.67 ,$429.00 ,$450.91 ,$156.50 ,$521.40 ,"$1,955.73 ", N/A , N/A ,$159.10 , N/A ,"$1,487.85 ",$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 ,$161.04 ,$41.60 ,$973.39 ,$918.29 ,$218.67 ,$218.67 ,$42.30 ,$195.20 ,$207.40 ,$152.50 ,$219.60 ,$918.29 ,$244.00 ,$231.80 ,$219.60 ,$207.40 ,$207.40 ,$42.30 ,$207.40 ,$207.40 ,$219.60 ,$148.60 ,$918.29 ,$86.32 ,$258.64 ,$219.60 ,$849.53 ,$224.48 ,$219.60 ,$161.06 ,$161.06 ,$148.60 ,$161.06 ,$158.60 ,$166.70 ,$41.60 ,$192.76 ,$973.39 , N/A , N/A ,$42.30 , N/A ,$377.57 ,$231.80 ,$200.08 ,$200.08 ,$195.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180351,43761,PC REPOSITION GASTROSTOMY TUBE,981,1 ,$607.00 ,$400.62 ,$105.69 ,$973.39 ,$918.29 ,$543.99 ,$543.99 ,$107.45 ,$485.60 ,$515.95 ,$379.38 ,$546.30 ,$918.29 ,$607.00 ,$576.65 ,$546.30 ,$515.95 ,$515.95 ,$107.45 ,$515.95 ,$515.95 ,$546.30 ,$369.66 ,$918.29 ,$219.28 ,$643.42 ,$546.30 ,$483.46 ,$558.44 ,$546.30 ,$400.68 ,$400.68 ,$369.66 ,$400.68 ,$394.55 ,$414.70 ,$105.69 ,$479.53 ,$973.39 , N/A , N/A ,$107.45 , N/A ,$214.87 ,$576.65 ,$497.74 ,$497.74 ,$485.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180354,59430,PC CARE AFTER DELIVERY ONLY,981,1 ,$590.00 ,$389.40 ,$176.79 ,$590.00 ,$469.05 ,$528.76 ,$528.76 ,$179.72 ,$472.00 ,$501.50 ,$368.75 ,$531.00 ,$469.05 ,$469.05 ,$560.50 ,$531.00 ,$501.50 ,$501.50 ,$179.72 ,$501.50 ,$501.50 ,$531.00 ,$359.31 ,$469.05 ,$366.78 ,$497.19 ,$531.00 , N/A ,$542.80 ,$531.00 ,$389.46 ,$389.46 ,$359.31 ,$389.46 ,$383.50 ,$403.09 ,$176.79 ,$466.10 ,$497.19 , N/A , N/A ,$179.72 , 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 ,$458.04 ,$63.18 ,"$1,744.74 ","$1,645.98 ",$621.96 ,$621.96 ,$64.23 ,$555.20 ,$589.90 ,$433.75 ,$624.60 ,"$1,645.98 ",$694.00 ,$659.30 ,$624.60 ,$589.90 ,$589.90 ,$64.23 ,$589.90 ,$589.90 ,$624.60 ,$422.65 ,"$1,645.98 ",$131.08 ,$735.64 ,$624.60 ,"$1,449.77 ",$638.48 ,$624.60 ,$458.11 ,$458.11 ,$422.65 ,$458.11 ,$451.10 ,$474.14 ,$63.18 ,$548.26 ,"$1,744.74 ", N/A , N/A ,$64.23 , N/A ,$644.34 ,$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 ",$884.40 ,$247.02 ,"$4,757.00 ","$2,607.86 ","$1,200.91 ","$1,200.91 ",$251.12 ,"$1,072.00 ","$1,139.00 ",$837.50 ,"$1,206.00 ","$2,607.86 ","$1,340.00 ","$1,273.00 ","$1,206.00 ","$1,139.00 ","$1,139.00 ",$251.12 ,"$1,139.00 ","$1,139.00 ","$1,206.00 ",$816.06 ,"$2,607.86 ",$512.48 ,"$1,420.40 ","$1,206.00 ","$4,757.00 ","$1,232.80 ","$1,206.00 ",$884.53 ,$884.53 ,$816.06 ,$884.53 ,$871.00 ,$915.49 ,$247.02 ,"$1,058.60 ","$2,764.33 ", N/A , N/A ,$251.12 , N/A ,"$2,114.22 ","$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 ",$693.00 ,$124.75 ,"$1,050.00 ",$520.24 ,$941.01 ,$941.01 ,$126.83 ,$840.00 ,$892.50 ,$656.25 ,$945.00 ,$520.24 ,$520.24 ,$997.50 ,$945.00 ,$892.50 ,$892.50 ,$126.83 ,$892.50 ,$892.50 ,$945.00 ,$639.45 ,$520.24 ,$258.84 ,$551.45 ,$945.00 ,$595.60 ,$966.00 ,$945.00 ,$693.11 ,$693.11 ,$639.45 ,$693.11 ,$682.50 ,$717.36 ,$124.75 ,$829.50 ,$551.45 , N/A , N/A ,$126.83 , N/A ,$264.71 ,$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 ,$21.12 ,$12.54 ,$79.71 ,$75.20 ,$28.68 ,$28.68 ,$12.75 ,$25.60 ,$27.20 ,$20.00 ,$28.80 ,$75.20 ,$32.00 ,$30.40 ,$28.80 ,$27.20 ,$27.20 ,$12.75 ,$27.20 ,$27.20 ,$28.80 ,$19.49 ,$75.20 ,$26.02 ,$33.92 ,$28.80 , N/A ,$29.44 ,$28.80 ,$21.12 ,$21.12 ,$19.49 ,$21.12 ,$20.80 ,$21.86 ,$12.54 ,$25.28 ,$79.71 , N/A , N/A ,$12.75 , 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 ,$613.80 ,$190.43 ,"$1,456.37 ","$1,373.93 ",$833.47 ,$833.47 ,$193.61 ,$744.00 ,$790.50 ,$581.25 ,$837.00 ,"$1,373.93 ",$930.00 ,$883.50 ,$837.00 ,$790.50 ,$790.50 ,$193.61 ,$790.50 ,$790.50 ,$837.00 ,$566.37 ,"$1,373.93 ",$395.12 ,$985.80 ,$837.00 ,$630.14 ,$855.60 ,$837.00 ,$613.89 ,$613.89 ,$566.37 ,$613.89 ,$604.50 ,$635.38 ,$190.43 ,$734.70 ,"$1,456.37 ", N/A , N/A ,$193.61 , N/A ,$280.06 ,$883.50 ,$762.60 ,$762.60 ,$744.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180438,92960,"PC CARDIOVERSION, ELECTIVE;EXTERN",981,1 ,$979.00 ,$646.14 ,$113.54 ,"$1,323.32 ","$1,197.97 ",$877.38 ,$877.38 ,$115.42 ,$783.20 ,$832.15 ,$611.88 ,$881.10 ,"$1,197.97 ",$979.00 ,$930.05 ,$881.10 ,$832.15 ,$832.15 ,$115.42 ,$832.15 ,$832.15 ,$881.10 ,$596.21 ,"$1,197.97 ",$235.56 ,"$1,037.74 ",$881.10 ,"$1,323.32 ",$900.68 ,$881.10 ,$646.24 ,$646.24 ,$596.21 ,$646.24 ,$636.35 ,$668.85 ,$113.54 ,$773.41 ,"$1,269.85 ", N/A , N/A ,$115.42 , N/A ,$588.14 ,$930.05 ,$802.78 ,$802.78 ,$783.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180454,96361,PC INTRAVENOUS INFUSION,981,1 ,$53.00 ,$34.98 ,$13.49 ,"$1,019.60 ",$961.89 ,$47.50 ,$47.50 ,$13.72 ,$42.40 ,$45.05 , N/A ,$47.70 ,$961.89 ,$53.00 ,$50.35 ,$47.70 ,$45.05 ,$45.05 ,$13.72 ,$45.05 ,$45.05 ,$47.70 ,$32.28 ,$961.89 ,$28.00 ,$56.18 ,$47.70 ,$95.33 ,$48.76 ,$47.70 ,$34.99 ,$34.99 ,$32.28 ,$34.99 ,$34.45 ,$36.21 ,$13.49 ,$41.87 ,"$1,019.60 ", N/A , N/A ,$13.72 , N/A ,$42.37 ,$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 ,$111.54 ,$39.47 ,$464.78 ,$86.98 ,$151.46 ,$151.46 ,$40.13 ,$135.20 ,$143.65 , N/A ,$152.10 ,$86.98 ,$86.98 ,$160.55 ,$152.10 ,$143.65 ,$143.65 ,$40.13 ,$143.65 ,$143.65 ,$152.10 ,$102.92 ,$86.98 ,$81.90 ,$92.20 ,$152.10 ,$464.78 ,$155.48 ,$152.10 ,$111.56 ,$111.56 ,$102.92 ,$111.56 ,$109.85 ,$115.46 ,$39.47 ,$133.51 ,$92.20 , N/A , N/A ,$40.13 , N/A ,$206.57 ,$160.55 ,$138.58 ,$138.58 ,$135.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180462,99175,PC INDUCTION OF VOMITING,981,1 ,$120.00 ,$79.20 ,$31.88 ,$120.00 , N/A ,$107.54 ,$107.54 ,$32.41 ,$96.00 ,$102.00 ,$75.00 ,$108.00 , N/A , N/A ,$114.00 ,$108.00 ,$102.00 ,$102.00 ,$32.41 ,$102.00 ,$102.00 ,$108.00 ,$73.08 , N/A ,$66.14 , N/A ,$108.00 , N/A ,$110.40 ,$108.00 ,$79.21 ,$79.21 ,$73.08 ,$79.21 ,$78.00 ,$81.98 ,$31.88 ,$94.80 , N/A , N/A , N/A ,$32.41 , 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 ,$153.78 ,$102.07 ,$261.25 ,$127.41 ,$208.81 ,$208.81 ,$103.76 ,$186.40 ,$198.05 ,$145.63 ,$209.70 ,$127.41 ,$127.41 ,$221.35 ,$209.70 ,$198.05 ,$198.05 ,$103.76 ,$198.05 ,$198.05 ,$209.70 ,$141.90 ,$127.41 ,$211.76 ,$135.05 ,$209.70 ,$261.25 ,$214.36 ,$209.70 ,$153.80 ,$153.80 ,$141.90 ,$153.80 ,$151.45 ,$159.19 ,$102.07 ,$184.07 ,$135.05 , N/A , N/A ,$103.76 , N/A ,$116.11 ,$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 ,$90.42 ,$12.00 ,$251.62 ,$237.38 ,$122.78 ,$122.78 ,$12.20 ,$109.60 ,$116.45 ,$85.63 ,$123.30 ,$237.38 ,$137.00 ,$130.15 ,$123.30 ,$116.45 ,$116.45 ,$12.20 ,$116.45 ,$116.45 ,$123.30 ,$83.43 ,$237.38 ,$24.90 ,$145.22 ,$123.30 ,$168.95 ,$126.04 ,$123.30 ,$90.43 ,$90.43 ,$83.43 ,$90.43 ,$89.05 ,$93.60 ,$12.00 ,$108.23 ,$251.62 , N/A , N/A ,$12.20 , N/A ,$75.09 ,$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 ,$125.40 ,$43.61 ,$314.30 ,$237.38 ,$170.28 ,$170.28 ,$44.34 ,$152.00 ,$161.50 ,$118.75 ,$171.00 ,$237.38 ,$190.00 ,$180.50 ,$171.00 ,$161.50 ,$161.50 ,$44.34 ,$161.50 ,$161.50 ,$171.00 ,$115.71 ,$237.38 ,$90.48 ,$201.40 ,$171.00 ,$314.30 ,$174.80 ,$171.00 ,$125.42 ,$125.42 ,$115.71 ,$125.42 ,$123.50 ,$129.81 ,$43.61 ,$150.10 ,$251.62 , N/A , N/A ,$44.34 , N/A ,$139.69 ,$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 ,$191.40 ,$74.72 ,$551.32 ,$237.38 ,$259.90 ,$259.90 ,$75.96 ,$232.00 ,$246.50 ,$181.25 ,$261.00 ,$237.38 ,$237.38 ,$275.50 ,$261.00 ,$246.50 ,$246.50 ,$75.96 ,$246.50 ,$246.50 ,$261.00 ,$176.61 ,$237.38 ,$155.02 ,$251.62 ,$261.00 ,$551.32 ,$266.80 ,$261.00 ,$191.43 ,$191.43 ,$176.61 ,$191.43 ,$188.50 ,$198.13 ,$74.72 ,$229.10 ,$251.62 , N/A , N/A ,$75.96 , N/A ,$245.03 ,$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 ,$264.00 ,$126.46 ,$858.62 ,$237.38 ,$358.48 ,$358.48 ,$128.56 ,$320.00 ,$340.00 ,$250.00 ,$360.00 ,$237.38 ,$237.38 ,$380.00 ,$360.00 ,$340.00 ,$340.00 ,$128.56 ,$340.00 ,$340.00 ,$360.00 ,$243.60 ,$237.38 ,$262.36 ,$251.62 ,$360.00 ,$858.62 ,$368.00 ,$360.00 ,$264.04 ,$264.04 ,$243.60 ,$264.04 ,$260.00 ,$273.28 ,$126.46 ,$316.00 ,$251.62 , N/A , N/A ,$128.56 , N/A ,$381.61 ,$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 ,$396.00 ,$183.41 ,"$1,233.25 ",$237.38 ,$537.72 ,$537.72 ,$186.46 ,$480.00 ,$510.00 ,$375.00 ,$540.00 ,$237.38 ,$237.38 ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$186.46 ,$510.00 ,$510.00 ,$540.00 ,$365.40 ,$237.38 ,$380.54 ,$251.62 ,$540.00 ,"$1,233.25 ",$552.00 ,$540.00 ,$396.06 ,$396.06 ,$365.40 ,$396.06 ,$390.00 ,$409.92 ,$183.41 ,$474.00 ,$251.62 , N/A , N/A ,$186.46 , N/A ,$548.11 ,$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 ,$580.14 ,$223.62 ,"$1,727.37 ",$237.38 ,$787.76 ,$787.76 ,$227.33 ,$703.20 ,$747.15 ,$549.38 ,$791.10 ,$237.38 ,$237.38 ,$835.05 ,$791.10 ,$747.15 ,$747.15 ,$227.33 ,$747.15 ,$747.15 ,$791.10 ,$535.31 ,$237.38 ,$463.94 ,$251.62 ,$791.10 ,"$1,727.37 ",$808.68 ,$791.10 ,$580.23 ,$580.23 ,$535.31 ,$580.23 ,$571.35 ,$600.53 ,$223.62 ,$694.41 ,$251.62 , N/A , N/A ,$227.33 , N/A ,$767.72 ,$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 ,$274.56 ,$112.09 ,$416.00 ,$237.38 ,$372.82 ,$372.82 ,$113.96 ,$332.80 ,$353.60 ,$260.00 ,$374.40 ,$237.38 ,$237.38 ,$395.20 ,$374.40 ,$353.60 ,$353.60 ,$113.96 ,$353.60 ,$353.60 ,$374.40 ,$253.34 ,$237.38 ,$232.58 ,$251.62 ,$374.40 , N/A ,$382.72 ,$374.40 ,$274.60 ,$274.60 ,$253.34 ,$274.60 ,$270.40 ,$284.21 ,$112.09 ,$328.64 ,$251.62 , N/A , N/A ,$113.96 , 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 ","$1,795.20 ",$237.38 ,"$2,720.00 ",$237.38 ,"$2,437.66 ","$2,437.66 ",$833.80 ,"$2,176.00 ","$2,312.00 ","$1,700.00 ","$2,448.00 ",$237.38 ,$237.38 ,"$2,584.00 ","$2,448.00 ","$2,312.00 ","$2,312.00 ",$833.80 ,"$2,312.00 ","$2,312.00 ","$2,448.00 ","$1,656.48 ",$237.38 ,"$1,701.64 ",$251.62 ,"$2,448.00 ", N/A ,"$2,502.40 ","$2,448.00 ","$1,795.47 ","$1,795.47 ","$1,656.48 ","$1,795.47 ","$1,768.00 ","$1,858.30 ",$820.17 ,"$2,148.80 ",$251.62 , N/A , N/A ,$833.80 , 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 ,$576.18 ,$139.49 ,"$1,460.18 ",$832.76 ,$782.38 ,$782.38 ,$141.81 ,$698.40 ,$742.05 ,$545.63 ,$785.70 ,$832.76 ,$832.76 ,$829.35 ,$785.70 ,$742.05 ,$742.05 ,$141.81 ,$742.05 ,$742.05 ,$785.70 ,$531.66 ,$832.76 ,$289.40 ,$882.73 ,$785.70 ,"$1,460.18 ",$803.16 ,$785.70 ,$576.27 ,$576.27 ,$531.66 ,$576.27 ,$567.45 ,$596.43 ,$139.49 ,$689.67 ,$882.73 , N/A , N/A ,$141.81 , N/A ,$648.97 ,$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 ,$227.70 ,$53.09 ,$345.00 ,$139.30 ,$309.19 ,$309.19 ,$53.96 ,$276.00 ,$293.25 ,$215.63 ,$310.50 ,$139.30 ,$139.30 ,$327.75 ,$310.50 ,$293.25 ,$293.25 ,$53.96 ,$293.25 ,$293.25 ,$310.50 ,$210.11 ,$139.30 ,$110.12 ,$147.66 ,$310.50 ,$261.25 ,$317.40 ,$310.50 ,$227.73 ,$227.73 ,$210.11 ,$227.73 ,$224.25 ,$235.70 ,$53.09 ,$272.55 ,$147.66 , N/A , N/A ,$53.96 , N/A ,$116.11 ,$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 ,$28.38 ,$16.17 ,$129.33 , N/A ,$38.54 ,$38.54 ,$16.44 ,$34.40 ,$36.55 ,$26.88 ,$38.70 , N/A , N/A ,$40.85 ,$38.70 ,$36.55 ,$36.55 ,$16.44 ,$36.55 ,$36.55 ,$38.70 ,$26.19 , N/A ,$33.56 , N/A ,$38.70 ,$129.33 ,$39.56 ,$38.70 ,$28.38 ,$28.38 ,$26.19 ,$28.38 ,$27.95 ,$29.38 ,$16.17 ,$33.97 , N/A , N/A , N/A ,$16.44 , N/A ,$57.48 ,$40.85 ,$35.26 ,$35.26 ,$34.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180498,11760,PC REPAIR NAIL BED,981,1 ,$353.07 ,$233.03 ,$115.93 ,"$1,307.14 ",$123.43 ,$316.42 ,$316.42 ,$117.86 ,$282.46 ,$300.11 ,$220.67 ,$317.76 ,$123.43 ,$123.43 ,$335.42 ,$317.76 ,$300.11 ,$300.11 ,$117.86 ,$300.11 ,$300.11 ,$317.76 ,$215.02 ,$123.43 ,$240.54 ,$130.84 ,$317.76 ,"$1,307.14 ",$324.82 ,$317.76 ,$233.06 ,$233.06 ,$215.02 ,$233.06 ,$229.50 ,$241.22 ,$115.93 ,$278.93 ,$130.84 , N/A , N/A ,$117.86 , N/A ,$580.95 ,$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 ,$70.86 ,$38.59 ,$611.75 ,$463.61 ,$96.23 ,$96.23 ,$39.23 ,$85.90 ,$91.26 ,$67.11 ,$96.63 ,$463.61 ,$107.37 ,$102.00 ,$96.63 ,$91.26 ,$91.26 ,$39.23 ,$91.26 ,$91.26 ,$96.63 ,$65.39 ,$463.61 ,$80.06 ,$113.81 ,$96.63 ,$611.75 ,$98.78 ,$96.63 ,$70.87 ,$70.87 ,$65.39 ,$70.87 ,$69.79 ,$73.36 ,$38.59 ,$84.82 ,$491.43 , N/A , N/A ,$39.23 , N/A ,$271.89 ,$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 ","$1,219.02 ",$668.66 ,"$3,227.67 ","$2,532.02 ","$1,655.28 ","$1,655.28 ",$679.78 ,"$1,477.60 ","$1,569.95 ","$1,154.38 ","$1,662.30 ","$2,532.02 ","$1,847.00 ","$1,754.65 ","$1,662.30 ","$1,569.95 ","$1,569.95 ",$679.78 ,"$1,569.95 ","$1,569.95 ","$1,662.30 ","$1,124.82 ","$2,532.02 ","$1,387.30 ","$1,957.82 ","$1,662.30 ","$3,227.67 ","$1,699.24 ","$1,662.30 ","$1,219.20 ","$1,219.20 ","$1,124.82 ","$1,219.20 ","$1,200.55 ","$1,261.87 ",$668.66 ,"$1,459.13 ","$2,683.94 ", N/A , N/A ,$679.78 , N/A ,"$1,434.52 ","$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 ,$180.84 ,$4.31 ,$274.00 ,$4.31 ,$245.56 ,$245.56 ,$20.07 ,$219.20 ,$232.90 , N/A ,$246.60 ,$4.31 ,$4.31 ,$260.30 ,$246.60 ,$232.90 ,$232.90 ,$20.07 ,$232.90 ,$232.90 ,$246.60 ,$166.87 ,$4.31 ,$40.96 ,$4.57 ,$246.60 , N/A ,$252.08 ,$246.60 ,$180.87 ,$180.87 ,$166.87 ,$180.87 ,$178.10 ,$187.20 ,$19.75 ,$216.46 ,$4.57 , N/A , N/A ,$20.07 , 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 ,$70.62 ,$9.51 ,$135.05 ,$127.41 ,$95.89 ,$95.89 ,$9.66 ,$85.60 ,$90.95 , N/A ,$96.30 ,$127.41 ,$107.00 ,$101.65 ,$96.30 ,$90.95 ,$90.95 ,$9.66 ,$90.95 ,$90.95 ,$96.30 ,$65.16 ,$127.41 ,$19.72 ,$113.42 ,$96.30 , N/A ,$98.44 ,$96.30 ,$70.63 ,$70.63 ,$65.16 ,$70.63 ,$69.55 ,$73.10 ,$9.51 ,$84.53 ,$135.05 , N/A , N/A ,$9.66 , N/A , N/A ,$101.65 ,$87.74 ,$87.74 ,$85.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180529,36556,PC INS CATH CV NON-TUNL >5 YRS,981,1 ,"$1,212.00 ",$799.92 ,$86.53 ,"$6,702.68 ","$2,105.50 ","$1,086.19 ","$1,086.19 ",$87.97 ,$969.60 ,"$1,030.20 ",$757.50 ,"$1,090.80 ","$2,105.50 ","$1,212.00 ","$1,151.40 ","$1,090.80 ","$1,030.20 ","$1,030.20 ",$87.97 ,"$1,030.20 ","$1,030.20 ","$1,090.80 ",$738.11 ,"$2,105.50 ",$179.54 ,"$1,284.72 ","$1,090.80 ","$6,702.68 ","$1,115.04 ","$1,090.80 ",$800.04 ,$800.04 ,$738.11 ,$800.04 ,$787.80 ,$828.04 ,$86.53 ,$957.48 ,"$2,231.83 ", N/A , N/A ,$87.97 , N/A ,"$2,978.97 ","$1,151.40 ",$993.84 ,$993.84 ,$969.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180532,36680,PC PLACE NDL INFS INTRAOSSEOUS,981,1 ,$541.00 ,$357.06 ,$59.80 ,$849.53 ,$463.61 ,$484.84 ,$484.84 ,$60.80 ,$432.80 ,$459.85 ,$338.13 ,$486.90 ,$463.61 ,$463.61 ,$513.95 ,$486.90 ,$459.85 ,$459.85 ,$60.80 ,$459.85 ,$459.85 ,$486.90 ,$329.47 ,$463.61 ,$124.08 ,$491.43 ,$486.90 ,$849.53 ,$497.72 ,$486.90 ,$357.11 ,$357.11 ,$329.47 ,$357.11 ,$351.65 ,$369.61 ,$59.80 ,$427.39 ,$491.43 , N/A , N/A ,$60.80 , N/A ,$377.57 ,$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 ",$739.53 ,$159.37 ,"$1,120.50 ",$307.08 ,"$1,004.19 ","$1,004.19 ",$162.01 ,$896.40 ,$952.43 ,$700.31 ,"$1,008.45 ",$307.08 ,$307.08 ,"$1,064.48 ","$1,008.45 ",$952.43 ,$952.43 ,$162.01 ,$952.43 ,$952.43 ,"$1,008.45 ",$682.38 ,$307.08 ,$330.64 ,$325.50 ,"$1,008.45 ",$849.53 ,"$1,030.86 ","$1,008.45 ",$739.64 ,$739.64 ,$682.38 ,$739.64 ,$728.33 ,$765.53 ,$159.37 ,$885.20 ,$325.50 , N/A , N/A ,$162.01 , N/A ,$377.57 ,"$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 ,$529.98 ,$116.11 ,$803.00 ,$307.08 ,$719.65 ,$719.65 ,$164.70 ,$642.40 ,$682.55 ,$501.88 ,$722.70 ,$307.08 ,$307.08 ,$762.85 ,$722.70 ,$682.55 ,$682.55 ,$164.70 ,$682.55 ,$682.55 ,$722.70 ,$489.03 ,$307.08 ,$336.12 ,$325.50 ,$722.70 ,$261.25 ,$738.76 ,$722.70 ,$530.06 ,$530.06 ,$489.03 ,$530.06 ,$521.95 ,$548.61 ,$162.01 ,$634.37 ,$325.50 , N/A , N/A ,$164.70 , N/A ,$116.11 ,$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 ","$1,571.46 ",$104.85 ,"$2,983.89 ","$2,814.99 ","$2,133.85 ","$2,133.85 ",$106.59 ,"$1,904.80 ","$2,023.85 ","$1,488.13 ","$2,142.90 ","$2,814.99 ","$2,381.00 ","$2,261.95 ","$2,142.90 ","$2,023.85 ","$2,023.85 ",$106.59 ,"$2,023.85 ","$2,023.85 ","$2,142.90 ","$1,450.03 ","$2,814.99 ",$217.54 ,"$2,523.86 ","$2,142.90 ","$1,869.84 ","$2,190.52 ","$2,142.90 ","$1,571.70 ","$1,571.70 ","$1,450.03 ","$1,571.70 ","$1,547.65 ","$1,626.70 ",$104.85 ,"$1,880.99 ","$2,983.89 ", N/A , N/A ,$106.59 , N/A ,$831.04 ,"$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 ,$429.00 ,$133.52 ,$656.91 ,$360.32 ,$582.53 ,$582.53 ,$135.74 ,$520.00 ,$552.50 ,$406.25 ,$585.00 ,$360.32 ,$360.32 ,$617.50 ,$585.00 ,$552.50 ,$552.50 ,$135.74 ,$552.50 ,$552.50 ,$585.00 ,$395.85 ,$360.32 ,$277.02 ,$381.94 ,$585.00 ,$656.91 ,$598.00 ,$585.00 ,$429.07 ,$429.07 ,$395.85 ,$429.07 ,$422.50 ,$444.08 ,$133.52 ,$513.50 ,$381.94 , N/A , N/A ,$135.74 , N/A ,$291.96 ,$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 ,$327.36 ,$116.29 ,$496.00 ,$360.32 ,$444.52 ,$444.52 ,$118.23 ,$396.80 ,$421.60 ,$310.00 ,$446.40 ,$360.32 ,$360.32 ,$471.20 ,$446.40 ,$421.60 ,$421.60 ,$118.23 ,$421.60 ,$421.60 ,$446.40 ,$302.06 ,$360.32 ,$241.28 ,$381.94 ,$446.40 ,$400.79 ,$456.32 ,$446.40 ,$327.41 ,$327.41 ,$302.06 ,$327.41 ,$322.40 ,$338.87 ,$116.29 ,$391.84 ,$381.94 , N/A , N/A ,$118.23 , N/A ,$178.13 ,$471.20 ,$406.72 ,$406.72 ,$396.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180590,64400,PC INJ ANES NERVE TRIGEMINAL,981,1 ,$363.00 ,$239.58 ,$50.41 ,$812.49 ,$766.50 ,$325.32 ,$325.32 ,$51.24 ,$290.40 ,$308.55 ,$226.88 ,$326.70 ,$766.50 ,$363.00 ,$344.85 ,$326.70 ,$308.55 ,$308.55 ,$51.24 ,$308.55 ,$308.55 ,$326.70 ,$221.07 ,$766.50 ,$104.58 ,$384.78 ,$326.70 ,$611.75 ,$333.96 ,$326.70 ,$239.62 ,$239.62 ,$221.07 ,$239.62 ,$235.95 ,$248.00 ,$50.41 ,$286.77 ,$812.49 , N/A , N/A ,$51.24 , N/A ,$271.89 ,$344.85 ,$297.66 ,$297.66 ,$290.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180592,64405,PC INJ ANES NERVE OCCIPITAL,981,1 ,$286.00 ,$188.76 ,$52.54 ,$812.49 ,$766.50 ,$256.31 ,$256.31 ,$53.41 ,$228.80 ,$243.10 ,$178.75 ,$257.40 ,$766.50 ,$286.00 ,$271.70 ,$257.40 ,$243.10 ,$243.10 ,$53.41 ,$243.10 ,$243.10 ,$257.40 ,$174.17 ,$766.50 ,$109.00 ,$303.16 ,$257.40 ,$611.75 ,$263.12 ,$257.40 ,$188.79 ,$188.79 ,$174.17 ,$188.79 ,$185.90 ,$195.40 ,$52.54 ,$225.94 ,$812.49 , N/A , N/A ,$53.41 , N/A ,$271.89 ,$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 ,$277.20 ,$61.38 ,"$1,449.77 ",$766.50 ,$376.40 ,$376.40 ,$62.41 ,$336.00 ,$357.00 ,$262.50 ,$378.00 ,$766.50 ,$420.00 ,$399.00 ,$378.00 ,$357.00 ,$357.00 ,$62.41 ,$357.00 ,$357.00 ,$378.00 ,$255.78 ,$766.50 ,$127.36 ,$445.20 ,$378.00 ,"$1,449.77 ",$386.40 ,$378.00 ,$277.24 ,$277.24 ,$255.78 ,$277.24 ,$273.00 ,$286.94 ,$61.38 ,$331.80 ,$812.49 , N/A , N/A ,$62.41 , N/A ,$644.34 ,$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 ,$351.78 ,$25.68 ,"$2,177.69 ","$2,054.42 ",$477.67 ,$477.67 ,$26.10 ,$426.40 ,$453.05 ,$333.13 ,$479.70 ,"$2,054.42 ",$533.00 ,$506.35 ,$479.70 ,$453.05 ,$453.05 ,$26.10 ,$453.05 ,$453.05 ,$479.70 ,$324.60 ,"$2,054.42 ",$53.26 ,$564.98 ,$479.70 ,"$1,917.41 ",$490.36 ,$479.70 ,$351.83 ,$351.83 ,$324.60 ,$351.83 ,$346.45 ,$364.15 ,$25.68 ,$421.07 ,"$2,177.69 ", N/A , N/A ,$26.10 , N/A ,$852.18 ,$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 ,$168.30 ,$66.27 ,"$1,449.77 ",$766.50 ,$228.53 ,$228.53 ,$67.37 ,$204.00 ,$216.75 ,$159.38 ,$229.50 ,$766.50 ,$255.00 ,$242.25 ,$229.50 ,$216.75 ,$216.75 ,$67.37 ,$216.75 ,$216.75 ,$229.50 ,$155.30 ,$766.50 ,$137.50 ,$270.30 ,$229.50 ,"$1,449.77 ",$234.60 ,$229.50 ,$168.33 ,$168.33 ,$155.30 ,$168.33 ,$165.75 ,$174.22 ,$66.27 ,$201.45 ,$812.49 , N/A , N/A ,$67.37 , N/A ,$644.34 ,$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 ",$752.40 ,$131.39 ,"$1,460.18 ",$307.08 ,"$1,021.67 ","$1,021.67 ",$133.57 ,$912.00 ,$969.00 ,$712.50 ,"$1,026.00 ",$307.08 ,$307.08 ,"$1,083.00 ","$1,026.00 ",$969.00 ,$969.00 ,$133.57 ,$969.00 ,$969.00 ,"$1,026.00 ",$694.26 ,$307.08 ,$272.60 ,$325.50 ,"$1,026.00 ","$1,460.18 ","$1,048.80 ","$1,026.00 ",$752.51 ,$752.51 ,$694.26 ,$752.51 ,$741.00 ,$778.85 ,$131.39 ,$900.60 ,$325.50 , N/A , N/A ,$133.57 , N/A ,$648.97 ,"$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 ,$275.22 ,$49.15 ,$417.00 , N/A ,$373.72 ,$373.72 ,$49.96 ,$333.60 ,$354.45 ,$260.63 ,$375.30 , N/A , N/A ,$396.15 ,$375.30 ,$354.45 ,$354.45 ,$49.96 ,$354.45 ,$354.45 ,$375.30 ,$253.95 , N/A ,$101.96 , N/A ,$375.30 ,$261.25 ,$383.64 ,$375.30 ,$275.26 ,$275.26 ,$253.95 ,$275.26 ,$271.05 ,$284.89 ,$49.15 ,$329.43 , N/A , N/A , N/A ,$49.96 , N/A ,$116.11 ,$396.15 ,$341.94 ,$341.94 ,$333.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180603,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT,981,1 ,$159.00 ,$104.94 ,$33.85 ,$159.00 , N/A ,$142.50 ,$142.50 ,$34.42 ,$127.20 ,$135.15 ,$99.38 ,$143.10 , N/A , N/A ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$34.42 ,$135.15 ,$135.15 ,$143.10 ,$96.83 , N/A ,$70.24 , N/A ,$143.10 ,$129.33 ,$146.28 ,$143.10 ,$104.96 ,$104.96 ,$96.83 ,$104.96 ,$103.35 ,$108.63 ,$33.85 ,$125.61 , N/A , N/A , N/A ,$34.42 , N/A ,$57.48 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180607,99151,PC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,981,1 ,$262.00 ,$172.92 ,$25.68 ,$262.00 ,$41.88 ,$234.80 ,$234.80 ,$26.10 ,$209.60 ,$222.70 ,$163.75 ,$235.80 ,$41.88 ,$41.88 ,$248.90 ,$235.80 ,$222.70 ,$222.70 ,$26.10 ,$222.70 ,$222.70 ,$235.80 ,$159.56 ,$41.88 ,$53.26 ,$44.39 ,$235.80 , N/A ,$241.04 ,$235.80 ,$172.95 ,$172.95 ,$159.56 ,$172.95 ,$170.30 ,$179.00 ,$25.68 ,$206.98 ,$44.39 , N/A , N/A ,$26.10 , 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 ,$108.90 ,$12.72 ,$165.00 ,$41.88 ,$147.87 ,$147.87 ,$12.93 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$41.88 ,$41.88 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$12.93 ,$140.25 ,$140.25 ,$148.50 ,$100.49 ,$41.88 ,$26.38 ,$44.39 ,$148.50 , N/A ,$151.80 ,$148.50 ,$108.92 ,$108.92 ,$100.49 ,$108.92 ,$107.25 ,$112.73 ,$12.72 ,$130.35 ,$44.39 , N/A , N/A ,$12.93 , 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 ,$37.62 ,$11.29 ,$57.00 ,$41.88 ,$51.08 ,$51.08 ,$11.49 ,$45.60 ,$48.45 ,$35.63 ,$51.30 ,$41.88 ,$41.88 ,$54.15 ,$51.30 ,$48.45 ,$48.45 ,$11.49 ,$48.45 ,$48.45 ,$51.30 ,$34.71 ,$41.88 ,$23.44 ,$44.39 ,$51.30 , N/A ,$52.44 ,$51.30 ,$37.63 ,$37.63 ,$34.71 ,$37.63 ,$37.05 ,$38.94 ,$11.29 ,$45.03 ,$44.39 , N/A , N/A ,$11.49 , 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 ,$108.90 ,$56.33 ,$406.31 ,$123.43 ,$147.87 ,$147.87 ,$57.26 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$123.43 ,$123.43 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$57.26 ,$140.25 ,$140.25 ,$148.50 ,$100.49 ,$123.43 ,$116.86 ,$130.84 ,$148.50 ,$406.31 ,$151.80 ,$148.50 ,$108.92 ,$108.92 ,$100.49 ,$108.92 ,$107.25 ,$112.73 ,$56.33 ,$130.35 ,$130.84 , N/A , N/A ,$57.26 , N/A ,$180.58 ,$156.75 ,$135.30 ,$135.30 ,$132.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180864,51702,PC INSERT CATH BLADDER SIMPLE,981,1 ,$367.70 ,$242.68 ,$25.92 ,$367.70 ,$150.61 ,$329.53 ,$329.53 ,$26.35 ,$294.16 ,$312.55 ,$229.81 ,$330.93 ,$150.61 ,$150.61 ,$349.32 ,$330.93 ,$312.55 ,$312.55 ,$26.35 ,$312.55 ,$312.55 ,$330.93 ,$223.93 ,$150.61 ,$53.78 ,$159.65 ,$330.93 ,$261.25 ,$338.28 ,$330.93 ,$242.72 ,$242.72 ,$223.93 ,$242.72 ,$239.01 ,$251.21 ,$25.92 ,$290.48 ,$159.65 , N/A , N/A ,$26.35 , N/A ,$116.11 ,$349.32 ,$301.51 ,$301.51 ,$294.16 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180944,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT-LT,981,1 ,$159.00 ,$104.94 ,$33.85 ,$159.00 , N/A ,$142.50 ,$142.50 ,$34.42 ,$127.20 ,$135.15 ,$99.38 ,$143.10 , N/A , N/A ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$34.42 ,$135.15 ,$135.15 ,$143.10 ,$96.83 , N/A ,$70.24 , N/A ,$143.10 ,$129.33 ,$146.28 ,$143.10 ,$104.96 ,$104.96 ,$96.83 ,$104.96 ,$103.35 ,$108.63 ,$33.85 ,$125.61 , N/A , N/A , N/A ,$34.42 , N/A ,$57.48 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180945,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT-RT,981,1 ,$159.00 ,$104.94 ,$33.85 ,$159.00 , N/A ,$142.50 ,$142.50 ,$34.42 ,$127.20 ,$135.15 ,$99.38 ,$143.10 , N/A , N/A ,$151.05 ,$143.10 ,$135.15 ,$135.15 ,$34.42 ,$135.15 ,$135.15 ,$143.10 ,$96.83 , N/A ,$70.24 , N/A ,$143.10 ,$129.33 ,$146.28 ,$143.10 ,$104.96 ,$104.96 ,$96.83 ,$104.96 ,$103.35 ,$108.63 ,$33.85 ,$125.61 , N/A , N/A , N/A ,$34.42 , N/A ,$57.48 ,$151.05 ,$130.38 ,$130.38 ,$127.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180947,G0425,PC TELEHEALTH CONSULT 30 MIN,981,1 ,$300.00 ,$198.00 ,$97.44 ,$300.00 ,$237.38 ,$268.86 ,$268.86 ,$99.07 ,$240.00 ,$255.00 ,$187.50 ,$270.00 ,$237.38 ,$237.38 ,$285.00 ,$270.00 ,$255.00 ,$255.00 ,$99.07 ,$255.00 ,$255.00 ,$270.00 ,$182.70 ,$237.38 ,$202.18 ,$251.62 ,$270.00 , N/A ,$276.00 ,$270.00 ,$198.03 ,$198.03 ,$182.70 ,$198.03 ,$195.00 ,$204.96 ,$97.44 ,$237.00 ,$251.62 , N/A , N/A ,$99.07 , 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 ,$264.00 ,$137.41 ,$400.00 ,$237.38 ,$358.48 ,$358.48 ,$139.69 ,$320.00 ,$340.00 ,$250.00 ,$360.00 ,$237.38 ,$237.38 ,$380.00 ,$360.00 ,$340.00 ,$340.00 ,$139.69 ,$340.00 ,$340.00 ,$360.00 ,$243.60 ,$237.38 ,$285.08 ,$251.62 ,$360.00 , N/A ,$368.00 ,$360.00 ,$264.04 ,$264.04 ,$243.60 ,$264.04 ,$260.00 ,$273.28 ,$137.41 ,$316.00 ,$251.62 , N/A , N/A ,$139.69 , 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 ,$330.00 ,$196.97 ,$500.00 ,$237.38 ,$448.10 ,$448.10 ,$200.24 ,$400.00 ,$425.00 ,$312.50 ,$450.00 ,$237.38 ,$237.38 ,$475.00 ,$450.00 ,$425.00 ,$425.00 ,$200.24 ,$425.00 ,$425.00 ,$450.00 ,$304.50 ,$237.38 ,$408.66 ,$251.62 ,$450.00 , N/A ,$460.00 ,$450.00 ,$330.05 ,$330.05 ,$304.50 ,$330.05 ,$325.00 ,$341.60 ,$196.97 ,$395.00 ,$251.62 , N/A , N/A ,$200.24 , 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 ,$420.42 ,$43.76 ,"$1,449.77 ",$766.50 ,$570.88 ,$570.88 ,$44.48 ,$509.60 ,$541.45 ,$398.13 ,$573.30 ,$766.50 ,$637.00 ,$605.15 ,$573.30 ,$541.45 ,$541.45 ,$44.48 ,$541.45 ,$541.45 ,$573.30 ,$387.93 ,$766.50 ,$90.78 ,$675.22 ,$573.30 ,"$1,449.77 ",$586.04 ,$573.30 ,$420.48 ,$420.48 ,$387.93 ,$420.48 ,$414.05 ,$435.20 ,$43.76 ,$503.23 ,$812.49 , N/A , N/A ,$44.48 , N/A ,$644.34 ,$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 ,$150.48 ,$30.65 ,$261.25 ,$139.30 ,$204.33 ,$204.33 ,$31.16 ,$182.40 ,$193.80 ,$142.50 ,$205.20 ,$139.30 ,$139.30 ,$216.60 ,$205.20 ,$193.80 ,$193.80 ,$31.16 ,$193.80 ,$193.80 ,$205.20 ,$138.85 ,$139.30 ,$63.60 ,$147.66 ,$205.20 ,$261.25 ,$209.76 ,$205.20 ,$150.50 ,$150.50 ,$138.85 ,$150.50 ,$148.20 ,$155.77 ,$30.65 ,$180.12 ,$147.66 , N/A , N/A ,$31.16 , N/A ,$116.11 ,$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 ,$535.26 ,$42.84 ,$849.53 ,$139.30 ,$726.82 ,$726.82 ,$43.55 ,$648.80 ,$689.35 ,$506.88 ,$729.90 ,$139.30 ,$139.30 ,$770.45 ,$729.90 ,$689.35 ,$689.35 ,$43.55 ,$689.35 ,$689.35 ,$729.90 ,$493.90 ,$139.30 ,$88.88 ,$147.66 ,$729.90 ,$849.53 ,$746.12 ,$729.90 ,$535.34 ,$535.34 ,$493.90 ,$535.34 ,$527.15 ,$554.08 ,$42.84 ,$640.69 ,$147.66 , N/A , N/A ,$43.55 , N/A ,$377.57 ,$770.45 ,$665.02 ,$665.02 ,$648.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180957,43762,PC REPLACE GASTRO TUBE PERC,981,1 ,$416.00 ,$274.56 ,$37.44 ,$973.39 ,$918.29 ,$372.82 ,$372.82 ,$38.06 ,$332.80 ,$353.60 ,$260.00 ,$374.40 ,$918.29 ,$416.00 ,$395.20 ,$374.40 ,$353.60 ,$353.60 ,$38.06 ,$353.60 ,$353.60 ,$374.40 ,$253.34 ,$918.29 ,$77.68 ,$440.96 ,$374.40 ,$483.46 ,$382.72 ,$374.40 ,$274.60 ,$274.60 ,$253.34 ,$274.60 ,$270.40 ,$284.21 ,$37.44 ,$328.64 ,$973.39 , N/A , N/A ,$38.06 , N/A ,$214.87 ,$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 ,$289.08 ,$88.63 ,$973.39 ,$918.29 ,$392.54 ,$392.54 ,$90.10 ,$350.40 ,$372.30 ,$273.75 ,$394.20 ,$918.29 ,$438.00 ,$416.10 ,$394.20 ,$372.30 ,$372.30 ,$90.10 ,$372.30 ,$372.30 ,$394.20 ,$266.74 ,$918.29 ,$183.88 ,$464.28 ,$394.20 ,$483.46 ,$402.96 ,$394.20 ,$289.12 ,$289.12 ,$266.74 ,$289.12 ,$284.70 ,$299.24 ,$88.63 ,$346.02 ,$973.39 , N/A , N/A ,$90.10 , N/A ,$214.87 ,$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 ,$106.92 ,$22.61 ,$882.73 ,$832.76 ,$145.18 ,$145.18 ,$22.98 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$832.76 ,$162.00 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$22.98 ,$137.70 ,$137.70 ,$145.80 ,$98.66 ,$832.76 ,$46.90 ,$171.72 ,$145.80 , N/A ,$149.04 ,$145.80 ,$106.94 ,$106.94 ,$98.66 ,$106.94 ,$105.30 ,$110.68 ,$22.61 ,$127.98 ,$882.73 , N/A , N/A ,$22.98 , 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 ,$106.92 ,$26.54 ,$882.73 ,$832.76 ,$145.18 ,$145.18 ,$26.98 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$832.76 ,$162.00 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$26.98 ,$137.70 ,$137.70 ,$145.80 ,$98.66 ,$832.76 ,$55.06 ,$171.72 ,$145.80 , N/A ,$149.04 ,$145.80 ,$106.94 ,$106.94 ,$98.66 ,$106.94 ,$105.30 ,$110.68 ,$26.54 ,$127.98 ,$882.73 , N/A , N/A ,$26.98 , 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 ,$106.92 ,$31.81 ,$882.73 ,$832.76 ,$145.18 ,$145.18 ,$32.35 ,$129.60 ,$137.70 ,$101.25 ,$145.80 ,$832.76 ,$162.00 ,$153.90 ,$145.80 ,$137.70 ,$137.70 ,$32.35 ,$137.70 ,$137.70 ,$145.80 ,$98.66 ,$832.76 ,$66.02 ,$171.72 ,$145.80 , N/A ,$149.04 ,$145.80 ,$106.94 ,$106.94 ,$98.66 ,$106.94 ,$105.30 ,$110.68 ,$31.81 ,$127.98 ,$882.73 , N/A , N/A ,$32.35 , 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 ,$213.84 ,$48.77 ,$882.73 ,$832.76 ,$290.37 ,$290.37 ,$49.59 ,$259.20 ,$275.40 ,$202.50 ,$291.60 ,$832.76 ,$324.00 ,$307.80 ,$291.60 ,$275.40 ,$275.40 ,$49.59 ,$275.40 ,$275.40 ,$291.60 ,$197.32 ,$832.76 ,$101.20 ,$343.44 ,$291.60 ,$839.41 ,$298.08 ,$291.60 ,$213.87 ,$213.87 ,$197.32 ,$213.87 ,$210.60 ,$221.36 ,$48.77 ,$255.96 ,$882.73 , N/A , N/A ,$49.59 , N/A ,$373.07 ,$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 ,$213.84 ,$58.63 ,"$1,307.14 ",$832.76 ,$290.37 ,$290.37 ,$59.60 ,$259.20 ,$275.40 ,$202.50 ,$291.60 ,$832.76 ,$324.00 ,$307.80 ,$291.60 ,$275.40 ,$275.40 ,$59.60 ,$275.40 ,$275.40 ,$291.60 ,$197.32 ,$832.76 ,$121.64 ,$343.44 ,$291.60 ,"$1,307.14 ",$298.08 ,$291.60 ,$213.87 ,$213.87 ,$197.32 ,$213.87 ,$210.60 ,$221.36 ,$58.63 ,$255.96 ,$882.73 , N/A , N/A ,$59.60 , N/A ,$580.95 ,$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 ,$396.00 ,$216.73 ,$600.00 ,$237.38 ,$537.72 ,$537.72 ,$220.33 ,$480.00 ,$510.00 ,$375.00 ,$540.00 ,$237.38 ,$237.38 ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$220.33 ,$510.00 ,$510.00 ,$540.00 ,$365.40 ,$237.38 ,$449.66 ,$251.62 ,$540.00 , N/A ,$552.00 ,$540.00 ,$396.06 ,$396.06 ,$365.40 ,$396.06 ,$390.00 ,$409.92 ,$216.73 ,$474.00 ,$251.62 , N/A , N/A ,$220.33 , 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 ",$874.50 ,$307.08 ,"$1,325.00 ",$307.08 ,"$1,187.47 ","$1,187.47 ",$383.89 ,"$1,060.00 ","$1,126.25 ",$828.13 ,"$1,192.50 ",$307.08 ,$307.08 ,"$1,258.75 ","$1,192.50 ","$1,126.25 ","$1,126.25 ",$383.89 ,"$1,126.25 ","$1,126.25 ","$1,192.50 ",$806.93 ,$307.08 ,$783.44 ,$325.50 ,"$1,192.50 ","$1,027.85 ","$1,219.00 ","$1,192.50 ",$874.63 ,$874.63 ,$806.93 ,$874.63 ,$861.25 ,$905.24 ,$377.62 ,"$1,046.75 ",$325.50 , N/A , N/A ,$383.89 , N/A ,$456.82 ,"$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 ,$61.44 ,$45.07 ,$240.48 ,$203.25 ,$83.43 ,$83.43 ,$45.81 ,$74.47 ,$79.13 ,$58.18 ,$83.78 ,$203.25 ,$93.09 ,$88.44 ,$83.78 ,$79.13 ,$79.13 ,$45.81 ,$79.13 ,$79.13 ,$83.78 ,$56.69 ,$203.25 ,$93.50 ,$98.68 ,$83.78 ,$240.48 ,$85.64 ,$83.78 ,$61.45 ,$61.45 ,$56.69 ,$61.45 ,$60.51 ,$63.60 ,$45.07 ,$73.54 ,$215.45 , N/A , N/A ,$45.81 , N/A ,$106.88 ,$88.44 ,$76.33 ,$76.33 ,$74.47 
ST. CLARE MEMORIAL HOSPITAL (ACU),98180984,98925,PC OSTEOPATHIC MAN 1-2 REGIONS,981,1 ,$66.40 ,$43.82 ,$24.54 ,$66.40 ,$61.52 ,$59.51 ,$59.51 ,$24.94 ,$53.12 ,$56.44 ,$41.50 ,$59.76 ,$61.52 ,$61.52 ,$63.08 ,$59.76 ,$56.44 ,$56.44 ,$24.94 ,$56.44 ,$56.44 ,$59.76 ,$40.44 ,$61.52 ,$50.90 ,$65.21 ,$59.76 ,$56.21 ,$61.09 ,$59.76 ,$43.83 ,$43.83 ,$40.44 ,$43.83 ,$43.16 ,$45.36 ,$24.54 ,$52.46 ,$65.21 , N/A , N/A ,$24.94 , N/A ,$24.98 ,$63.08 ,$54.45 ,$54.45 ,$53.12 
ST. CLARE MEMORIAL HOSPITAL (ACU),98300005,11042,PC DEBR SKIN/SUBQ TISS/PROC INIT 20CM PRO,983,1 ,$460.00 ,$303.60 ,$63.24 ,$839.41 ,$717.24 ,$412.25 ,$412.25 ,$63.24 ,$368.00 ,$391.00 ,$287.50 ,$414.00 ,$717.24 ,$460.00 ,$437.00 ,$414.00 ,$391.00 ,$391.00 ,$63.24 ,$391.00 ,$391.00 ,$414.00 ,$280.14 ,$717.24 ,$129.06 ,$487.60 ,$414.00 ,$839.41 ,$423.20 ,$414.00 ,$303.65 ,$303.65 ,$280.14 ,$303.65 ,$299.00 ,$314.27 ,$104.72 ,$363.40 ,$760.27 , N/A , N/A ,$63.24 , N/A ,$373.07 ,$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 ,$396.00 ,$29.56 ,$600.00 ,$507.21 ,$537.72 ,$537.72 ,$29.56 ,$480.00 ,$510.00 ,$375.00 ,$540.00 ,$507.21 ,$507.21 ,$570.00 ,$540.00 ,$510.00 ,$510.00 ,$29.56 ,$510.00 ,$510.00 ,$540.00 ,$365.40 ,$507.21 ,$60.32 ,$537.64 ,$540.00 ,$491.94 ,$552.00 ,$540.00 ,$396.06 ,$396.06 ,$365.40 ,$396.06 ,$390.00 ,$409.92 ,$136.59 ,$474.00 ,$537.64 , N/A , N/A ,$29.56 , N/A ,$218.64 ,$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 ,$369.60 ,$125.50 ,"$3,373.99 ","$2,101.03 ",$501.87 ,$501.87 ,$125.50 ,$448.00 ,$476.00 ,$350.00 ,$504.00 ,"$2,101.03 ",$560.00 ,$532.00 ,$504.00 ,$476.00 ,$476.00 ,$125.50 ,$476.00 ,$476.00 ,$504.00 ,$341.04 ,"$2,101.03 ",$256.12 ,$593.60 ,$504.00 ,"$3,373.99 ",$515.20 ,$504.00 ,$369.66 ,$369.66 ,$341.04 ,$369.66 ,$364.00 ,$382.59 ,$127.49 ,$442.40 ,"$2,227.09 ", N/A , N/A ,$125.50 , N/A ,"$1,499.55 ",$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 ,$75.90 ,$26.18 ,$251.62 ,$237.38 ,$103.06 ,$103.06 ,$51.36 ,$92.00 ,$97.75 ,$71.88 ,$103.50 ,$237.38 ,$115.00 ,$109.25 ,$103.50 ,$97.75 ,$97.75 ,$51.36 ,$97.75 ,$97.75 ,$103.50 ,$70.04 ,$237.38 ,$104.82 ,$121.90 ,$103.50 , N/A ,$105.80 ,$103.50 ,$75.91 ,$75.91 ,$70.04 ,$75.91 ,$74.75 ,$78.57 ,$26.18 ,$90.85 ,$251.62 , N/A , N/A ,$51.36 , 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 ,$103.62 ,$35.74 ,$251.62 ,$237.38 ,$140.70 ,$140.70 ,$87.82 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$237.38 ,$157.00 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$87.82 ,$133.45 ,$133.45 ,$141.30 ,$95.61 ,$237.38 ,$179.22 ,$166.42 ,$141.30 , N/A ,$144.44 ,$141.30 ,$103.64 ,$103.64 ,$95.61 ,$103.64 ,$102.05 ,$107.26 ,$35.74 ,$124.03 ,$251.62 , N/A , N/A ,$87.82 , 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 ,$176.88 ,$61.01 ,$290.46 ,$237.38 ,$240.18 ,$240.18 ,$142.33 ,$214.40 ,$227.80 ,$167.50 ,$241.20 ,$237.38 ,$237.38 ,$254.60 ,$241.20 ,$227.80 ,$227.80 ,$142.33 ,$227.80 ,$227.80 ,$241.20 ,$163.21 ,$237.38 ,$290.46 ,$251.62 ,$241.20 , N/A ,$246.56 ,$241.20 ,$176.91 ,$176.91 ,$163.21 ,$176.91 ,$174.20 ,$183.10 ,$61.01 ,$211.72 ,$251.62 , N/A , N/A ,$142.33 , 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 ,$231.00 ,$79.68 ,$394.40 ,$237.38 ,$313.67 ,$313.67 ,$193.26 ,$280.00 ,$297.50 ,$218.75 ,$315.00 ,$237.38 ,$237.38 ,$332.50 ,$315.00 ,$297.50 ,$297.50 ,$193.26 ,$297.50 ,$297.50 ,$315.00 ,$213.15 ,$237.38 ,$394.40 ,$251.62 ,$315.00 , N/A ,$322.00 ,$315.00 ,$231.04 ,$231.04 ,$213.15 ,$231.04 ,$227.50 ,$239.12 ,$79.68 ,$276.50 ,$251.62 , N/A , N/A ,$193.26 , 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 ,$36.96 ,$9.54 ,$251.62 ,$237.38 ,$50.19 ,$50.19 ,$9.54 ,$44.80 ,$47.60 ,$35.00 ,$50.40 ,$237.38 ,$56.00 ,$53.20 ,$50.40 ,$47.60 ,$47.60 ,$9.54 ,$47.60 ,$47.60 ,$50.40 ,$34.10 ,$237.38 ,$19.46 ,$59.36 ,$50.40 , N/A ,$51.52 ,$50.40 ,$36.97 ,$36.97 ,$34.10 ,$36.97 ,$36.40 ,$38.26 ,$12.75 ,$44.24 ,$251.62 , N/A , N/A ,$9.54 , 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 ,$42.90 ,$14.80 ,$251.62 ,$237.38 ,$58.25 ,$58.25 ,$37.98 ,$52.00 ,$55.25 ,$40.63 ,$58.50 ,$237.38 ,$65.00 ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$37.98 ,$55.25 ,$55.25 ,$58.50 ,$39.59 ,$237.38 ,$77.52 ,$68.90 ,$58.50 , N/A ,$59.80 ,$58.50 ,$42.91 ,$42.91 ,$39.59 ,$42.91 ,$42.25 ,$44.41 ,$14.80 ,$51.35 ,$251.62 , N/A , N/A ,$37.98 , 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 ,$71.28 ,$24.59 ,$251.62 ,$237.38 ,$96.79 ,$96.79 ,$70.80 ,$86.40 ,$91.80 ,$67.50 ,$97.20 ,$237.38 ,$108.00 ,$102.60 ,$97.20 ,$91.80 ,$91.80 ,$70.80 ,$91.80 ,$91.80 ,$97.20 ,$65.77 ,$237.38 ,$144.48 ,$114.48 ,$97.20 , N/A ,$99.36 ,$97.20 ,$71.29 ,$71.29 ,$65.77 ,$71.29 ,$70.20 ,$73.79 ,$24.59 ,$85.32 ,$251.62 , N/A , N/A ,$70.80 , 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 ,$108.90 ,$37.56 ,$251.62 ,$237.38 ,$147.87 ,$147.87 ,$104.75 ,$132.00 ,$140.25 ,$103.13 ,$148.50 ,$237.38 ,$165.00 ,$156.75 ,$148.50 ,$140.25 ,$140.25 ,$104.75 ,$140.25 ,$140.25 ,$148.50 ,$100.49 ,$237.38 ,$213.78 ,$174.90 ,$148.50 , N/A ,$151.80 ,$148.50 ,$108.92 ,$108.92 ,$100.49 ,$108.92 ,$107.25 ,$112.73 ,$37.56 ,$130.35 ,$251.62 , N/A , N/A ,$104.75 , 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 ,$154.44 ,$53.27 ,$314.20 ,$237.38 ,$209.71 ,$209.71 ,$153.96 ,$187.20 ,$198.90 ,$146.25 ,$210.60 ,$237.38 ,$234.00 ,$222.30 ,$210.60 ,$198.90 ,$198.90 ,$153.96 ,$198.90 ,$198.90 ,$210.60 ,$142.51 ,$237.38 ,$314.20 ,$248.04 ,$210.60 , N/A ,$215.28 ,$210.60 ,$154.46 ,$154.46 ,$142.51 ,$154.46 ,$152.10 ,$159.87 ,$53.27 ,$184.86 ,$251.62 , N/A , N/A ,$153.96 , 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 ,$46.20 ,$15.93 ,$336.12 ,$317.09 ,$62.73 ,$62.73 ,$23.12 ,$56.00 ,$59.50 ,$43.75 ,$63.00 ,$317.09 ,$70.00 ,$66.50 ,$63.00 ,$59.50 ,$59.50 ,$23.12 ,$59.50 ,$59.50 ,$63.00 ,$42.63 ,$317.09 ,$47.18 ,$74.20 ,$63.00 , N/A ,$64.40 ,$63.00 ,$46.21 ,$46.21 ,$42.63 ,$46.21 ,$45.50 ,$47.82 ,$15.93 ,$55.30 ,$336.12 , N/A , N/A ,$23.12 , 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 ,$80.50 ,$53.13 ,$18.34 ,$251.62 ,$237.38 ,$80.50 ,$80.50 ,$21.31 ,$64.40 ,$68.43 ,$50.31 ,$72.45 ,$237.38 ,$80.50 ,$76.48 ,$72.45 ,$68.43 ,$68.43 ,$21.31 ,$68.43 ,$68.43 ,$72.45 ,$49.02 ,$237.38 ,$49.92 ,$85.33 ,$72.45 , N/A ,$74.06 ,$72.45 ,$53.14 ,$53.14 ,$49.02 ,$53.14 ,$52.33 ,$55.00 ,$18.34 ,$63.60 ,$251.62 ,$39.45 ,$39.45 ,$21.31 ,$39.45 , N/A ,$76.48 ,$66.01 ,$66.01 ,$64.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),99203072,99203,HC CLINIC VISIT INTERM NEW-PRV 72 HR,510,1 ,$128.80 ,$85.01 ,$29.32 ,$251.62 ,$237.38 ,$128.80 ,$111.00 ,$34.08 ,$103.04 ,$109.48 ,$80.50 ,$115.92 ,$237.38 ,$128.80 ,$122.36 ,$115.92 ,$109.48 ,$109.48 ,$34.08 ,$109.48 ,$109.48 ,$115.92 ,$78.44 ,$237.38 ,$79.86 ,$136.53 ,$115.92 , N/A ,$118.50 ,$115.92 ,$85.02 ,$85.02 ,$78.44 ,$85.02 ,$83.72 ,$88.00 ,$29.32 ,$101.75 ,$251.62 ,$63.11 ,$63.11 ,$34.08 ,$63.11 , N/A ,$122.36 ,$105.62 ,$105.62 ,$103.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),99204072,99204,HC CLINIC VISIT COMPLEX NEW-PRV 72 HR,510,1 ,$179.40 ,$118.40 ,$40.84 ,$251.62 ,$237.38 ,$139.00 ,$111.00 ,$47.47 ,$143.52 ,$152.49 ,$112.13 ,$161.46 ,$237.38 ,$179.40 ,$170.43 ,$161.46 ,$152.49 ,$152.49 ,$47.47 ,$152.49 ,$152.49 ,$161.46 ,$109.25 ,$237.38 ,$111.22 ,$190.16 ,$161.46 , N/A ,$165.05 ,$161.46 ,$118.42 ,$118.42 ,$109.25 ,$118.42 ,$116.61 ,$122.57 ,$40.84 ,$141.73 ,$251.62 ,$87.91 ,$87.91 ,$47.47 ,$87.91 , N/A ,$170.43 ,$147.11 ,$147.11 ,$143.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),99205072,99205,HC CLINIC VISIT COMPREH NEW-PRV 72 HR,510,1 ,$212.75 ,$140.42 ,$48.43 ,$251.62 ,$237.38 ,$139.00 ,$111.00 ,$56.29 ,$170.20 ,$180.84 ,$132.97 ,$191.48 ,$237.38 ,$212.75 ,$202.11 ,$191.48 ,$180.84 ,$180.84 ,$56.29 ,$180.84 ,$180.84 ,$191.48 ,$129.56 ,$237.38 ,$131.90 ,$225.52 ,$191.48 , N/A ,$195.73 ,$191.48 ,$140.44 ,$140.44 ,$129.56 ,$140.44 ,$138.29 ,$145.35 ,$48.43 ,$168.07 ,$251.62 ,$104.25 ,$104.25 ,$56.29 ,$104.25 , N/A ,$202.11 ,$174.46 ,$174.46 ,$170.20 
ST. CLARE MEMORIAL HOSPITAL (ACU),99211072,99211,HC CLINIC VISIT BRIEF EST-PRV 72 HR,510,1 ,$35.65 ,$23.53 ,$8.11 ,$251.62 ,$237.38 ,$35.65 ,$35.65 ,$9.44 ,$28.52 ,$30.30 ,$22.28 ,$32.09 ,$237.38 ,$35.65 ,$33.87 ,$32.09 ,$30.30 ,$30.30 ,$9.44 ,$30.30 ,$30.30 ,$32.09 ,$21.71 ,$237.38 ,$22.10 ,$37.79 ,$32.09 , N/A ,$32.80 ,$32.09 ,$23.53 ,$23.53 ,$21.71 ,$23.53 ,$23.17 ,$24.36 ,$8.11 ,$28.16 ,$251.62 ,$17.47 ,$17.47 ,$9.44 ,$17.47 , N/A ,$33.87 ,$29.23 ,$29.23 ,$28.52 
ST. CLARE MEMORIAL HOSPITAL (ACU),99212072,99212,HC CLINIC VISIT LIMIT EST-PRV 72 HR,510,1 ,$62.10 ,$40.99 ,$14.13 ,$251.62 ,$237.38 ,$62.10 ,$62.10 ,$16.43 ,$49.68 ,$52.79 ,$38.81 ,$55.89 ,$237.38 ,$62.10 ,$59.00 ,$55.89 ,$52.79 ,$52.79 ,$16.43 ,$52.79 ,$52.79 ,$55.89 ,$37.82 ,$237.38 ,$38.50 ,$65.83 ,$55.89 , N/A ,$57.13 ,$55.89 ,$40.99 ,$40.99 ,$37.82 ,$40.99 ,$40.37 ,$42.43 ,$14.13 ,$49.06 ,$251.62 ,$30.43 ,$30.43 ,$16.43 ,$30.43 , N/A ,$59.00 ,$50.92 ,$50.92 ,$49.68 
ST. CLARE MEMORIAL HOSPITAL (ACU),99213072,99213,HC CLINIC VISIT INTERM EST-PRV 72 HR,510,1 ,$85.10 ,$56.17 ,$19.37 ,$251.62 ,$237.38 ,$85.10 ,$85.10 ,$22.52 ,$68.08 ,$72.34 ,$53.19 ,$76.59 ,$237.38 ,$85.10 ,$80.85 ,$76.59 ,$72.34 ,$72.34 ,$22.52 ,$72.34 ,$72.34 ,$76.59 ,$51.83 ,$237.38 ,$52.76 ,$90.21 ,$76.59 , N/A ,$78.29 ,$76.59 ,$56.17 ,$56.17 ,$51.83 ,$56.17 ,$55.32 ,$58.14 ,$19.37 ,$67.23 ,$251.62 ,$41.70 ,$41.70 ,$22.52 ,$41.70 , N/A ,$80.85 ,$69.78 ,$69.78 ,$68.08 
ST. CLARE MEMORIAL HOSPITAL (ACU),99214072,99214,HC CLINIC VISIT COMPLX EST-PRV 72 HR,510,1 ,$124.20 ,$81.97 ,$28.28 ,$251.62 ,$237.38 ,$124.20 ,$111.00 ,$32.86 ,$99.36 ,$105.57 ,$77.63 ,$111.78 ,$237.38 ,$124.20 ,$117.99 ,$111.78 ,$105.57 ,$105.57 ,$32.86 ,$105.57 ,$105.57 ,$111.78 ,$75.64 ,$237.38 ,$77.00 ,$131.65 ,$111.78 , N/A ,$114.26 ,$111.78 ,$81.98 ,$81.98 ,$75.64 ,$81.98 ,$80.73 ,$84.85 ,$28.28 ,$98.12 ,$251.62 ,$60.86 ,$60.86 ,$32.86 ,$60.86 , N/A ,$117.99 ,$101.84 ,$101.84 ,$99.36 
ST. CLARE MEMORIAL HOSPITAL (ACU),99215072,99215,HC CLINIC VISIT COMPRH EST-PRV 72 HR,510,1 ,$157.55 ,$103.98 ,$35.87 ,$251.62 ,$237.38 ,$139.00 ,$111.00 ,$41.69 ,$126.04 ,$133.92 ,$98.47 ,$141.80 ,$237.38 ,$157.55 ,$149.67 ,$141.80 ,$133.92 ,$133.92 ,$41.69 ,$133.92 ,$133.92 ,$141.80 ,$95.95 ,$237.38 ,$97.68 ,$167.00 ,$141.80 , N/A ,$144.95 ,$141.80 ,$104.00 ,$104.00 ,$95.95 ,$104.00 ,$102.41 ,$107.64 ,$35.87 ,$124.46 ,$251.62 ,$77.20 ,$77.20 ,$41.69 ,$77.20 , N/A ,$149.67 ,$129.19 ,$129.19 ,$126.04 
ST. CLARE MEMORIAL HOSPITAL (ACU),99217072,99217,HC OBSERVATION;INITAL HIGH COMP,982,1 ,$233.00 ,$153.78 ,$53.05 ,$233.00 , N/A ,$208.81 ,$208.81 , N/A ,$186.40 ,$198.05 ,$145.63 ,$209.70 , N/A , N/A ,$221.35 ,$209.70 ,$198.05 ,$198.05 , N/A ,$198.05 ,$198.05 ,$209.70 ,$141.90 , N/A , N/A , N/A ,$209.70 , N/A ,$214.36 ,$209.70 ,$153.80 ,$153.80 ,$141.90 ,$153.80 ,$151.45 ,$159.19 ,$53.05 ,$184.07 , N/A , N/A , N/A , N/A , 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 ,$185.46 ,$63.97 ,$281.00 , N/A ,$251.83 ,$251.83 , N/A ,$224.80 ,$238.85 ,$175.63 ,$252.90 , N/A , N/A ,$266.95 ,$252.90 ,$238.85 ,$238.85 , N/A ,$238.85 ,$238.85 ,$252.90 ,$171.13 , N/A , N/A , N/A ,$252.90 , N/A ,$258.52 ,$252.90 ,$185.49 ,$185.49 ,$171.13 ,$185.49 ,$182.65 ,$191.98 ,$63.97 ,$221.99 , N/A , N/A , N/A , N/A , 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 ,$260.70 ,$89.92 ,$395.00 , N/A ,$354.00 ,$354.00 , N/A ,$316.00 ,$335.75 ,$246.88 ,$355.50 , N/A , N/A ,$375.25 ,$355.50 ,$335.75 ,$335.75 , N/A ,$335.75 ,$335.75 ,$355.50 ,$240.56 , N/A , N/A , N/A ,$355.50 , N/A ,$363.40 ,$355.50 ,$260.74 ,$260.74 ,$240.56 ,$260.74 ,$256.75 ,$269.86 ,$89.92 ,$312.05 , N/A , N/A , N/A , N/A , 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 ,$326.70 ,$112.69 ,$495.00 , N/A ,$443.62 ,$443.62 , N/A ,$396.00 ,$420.75 ,$309.38 ,$445.50 , N/A , N/A ,$470.25 ,$445.50 ,$420.75 ,$420.75 , N/A ,$420.75 ,$420.75 ,$445.50 ,$301.46 , N/A , N/A , N/A ,$445.50 , N/A ,$455.40 ,$445.50 ,$326.75 ,$326.75 ,$301.46 ,$326.75 ,$321.75 ,$338.18 ,$112.69 ,$391.05 , N/A , N/A , N/A , N/A , 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 ,$126.72 ,$43.71 ,$192.00 , N/A ,$172.07 ,$172.07 , N/A ,$153.60 ,$163.20 ,$120.00 ,$172.80 , N/A , N/A ,$182.40 ,$172.80 ,$163.20 ,$163.20 , N/A ,$163.20 ,$163.20 ,$172.80 ,$116.93 , N/A , N/A , N/A ,$172.80 , N/A ,$176.64 ,$172.80 ,$126.74 ,$126.74 ,$116.93 ,$126.74 ,$124.80 ,$131.17 ,$43.71 ,$151.68 , N/A , N/A , N/A , N/A , 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 ,$182.16 ,$62.83 ,$276.00 , N/A ,$247.35 ,$247.35 , N/A ,$220.80 ,$234.60 ,$172.50 ,$248.40 , N/A , N/A ,$262.20 ,$248.40 ,$234.60 ,$234.60 , N/A ,$234.60 ,$234.60 ,$248.40 ,$168.08 , N/A , N/A , N/A ,$248.40 , N/A ,$253.92 ,$248.40 ,$182.19 ,$182.19 ,$168.08 ,$182.19 ,$179.40 ,$188.56 ,$62.83 ,$218.04 , N/A , N/A , N/A , N/A , 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 ,$238.92 ,$82.41 ,$362.00 , N/A ,$324.42 ,$324.42 , N/A ,$289.60 ,$307.70 ,$226.25 ,$325.80 , N/A , N/A ,$343.90 ,$325.80 ,$307.70 ,$307.70 , N/A ,$307.70 ,$307.70 ,$325.80 ,$220.46 , N/A , N/A , N/A ,$325.80 , N/A ,$333.04 ,$325.80 ,$238.96 ,$238.96 ,$220.46 ,$238.96 ,$235.30 ,$247.32 ,$82.41 ,$285.98 , N/A , N/A , N/A , N/A , 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 ,$103.62 ,$35.74 ,$251.62 ,$237.38 ,$140.70 ,$140.70 ,$52.81 ,$125.60 ,$133.45 ,$98.13 ,$141.30 ,$237.38 ,$157.00 ,$149.15 ,$141.30 ,$133.45 ,$133.45 ,$52.81 ,$133.45 ,$133.45 ,$141.30 ,$95.61 ,$237.38 ,$107.78 ,$166.42 ,$141.30 , N/A ,$144.44 ,$141.30 ,$103.64 ,$103.64 ,$95.61 ,$103.64 ,$102.05 ,$107.26 ,$35.74 ,$124.03 ,$251.62 , N/A , N/A ,$52.81 , 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 ,$151.80 ,$52.36 ,$251.62 ,$237.38 ,$206.13 ,$206.13 ,$85.02 ,$184.00 ,$195.50 ,$143.75 ,$207.00 ,$237.38 ,$230.00 ,$218.50 ,$207.00 ,$195.50 ,$195.50 ,$85.02 ,$195.50 ,$195.50 ,$207.00 ,$140.07 ,$237.38 ,$173.52 ,$243.80 ,$207.00 , N/A ,$211.60 ,$207.00 ,$151.82 ,$151.82 ,$140.07 ,$151.82 ,$149.50 ,$157.14 ,$52.36 ,$181.70 ,$251.62 , N/A , N/A ,$85.02 , 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 ,$397.98 ,$137.28 ,$603.00 ,$237.38 ,$540.41 ,$540.41 ,$171.48 ,$482.40 ,$512.55 ,$376.88 ,$542.70 ,$237.38 ,$237.38 ,$572.85 ,$542.70 ,$512.55 ,$512.55 ,$171.48 ,$512.55 ,$512.55 ,$542.70 ,$367.23 ,$237.38 ,$349.96 ,$251.62 ,$542.70 , N/A ,$554.76 ,$542.70 ,$398.04 ,$398.04 ,$367.23 ,$398.04 ,$391.95 ,$411.97 ,$137.28 ,$476.37 ,$251.62 , N/A , N/A ,$171.48 , 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 ,$49.45 ,$32.64 ,$13.08 ,$95.33 ,$75.20 ,$44.32 ,$44.32 ,$13.08 ,$39.56 ,$42.03 ,$30.91 ,$44.51 ,$75.20 ,$49.45 ,$46.98 ,$44.51 ,$42.03 ,$42.03 ,$13.08 ,$42.03 ,$42.03 ,$44.51 ,$30.12 ,$75.20 ,$30.66 ,$52.42 ,$44.51 ,$95.33 ,$45.49 ,$44.51 ,$32.64 ,$32.64 ,$30.12 ,$32.64 ,$32.14 ,$33.78 , N/A ,$39.07 ,$79.71 ,$43.00 ,$43.00 ,$13.08 ,$43.00 ,$42.37 ,$46.98 ,$40.55 ,$40.55 ,$39.56 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0101072,G0101,HC PELVIC/BREAST EXAM,983,1 ,$92.00 ,$60.72 ,$20.94 ,$251.62 ,$237.38 ,$82.45 ,$82.45 ,$28.91 ,$73.60 ,$78.20 ,$57.50 ,$82.80 ,$237.38 ,$92.00 ,$87.40 ,$82.80 ,$78.20 ,$78.20 ,$28.91 ,$78.20 ,$78.20 ,$82.80 ,$56.03 ,$237.38 ,$59.00 ,$97.52 ,$82.80 ,$170.66 ,$84.64 ,$82.80 ,$60.73 ,$60.73 ,$56.03 ,$60.73 ,$59.80 ,$62.85 ,$20.94 ,$72.68 ,$251.62 , N/A , N/A ,$28.91 , N/A ,$75.85 ,$87.40 ,$75.44 ,$75.44 ,$73.60 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0103072,G0103,HC PSA ANNUAL SCREENING,301,1 ,$220.80 ,$145.73 ,$19.31 ,$220.80 ,$19.95 ,$67.59 ,$67.59 ,$58.43 ,$176.64 ,$187.68 ,$138.00 ,$198.72 ,$19.95 ,$19.95 ,$209.76 ,$198.72 ,$187.68 ,$187.68 ,$58.43 ,$187.68 ,$187.68 ,$198.72 ,$134.47 ,$19.95 ,$136.90 ,$21.15 ,$198.72 ,$43.45 ,$203.14 ,$198.72 ,$145.75 ,$145.75 ,$134.47 ,$145.75 ,$143.52 ,$150.85 ,$50.26 ,$174.43 ,$21.15 ,$23.17 ,$23.17 ,$58.43 ,$23.17 ,$19.31 ,$209.76 ,$181.06 ,$181.06 ,$176.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0105072,G0105,HC COLORECTAL CANCER SCREEN-PRV 72 HR,975,1 ,"$1,216.00 ",$802.56 ,$192.67 ,"$2,005.54 ","$1,892.02 ","$1,089.78 ","$1,089.78 ",$192.67 ,$972.80 ,"$1,033.60 ",$760.00 ,"$1,094.40 ","$1,892.02 ","$1,216.00 ","$1,155.20 ","$1,094.40 ","$1,033.60 ","$1,033.60 ",$192.67 ,"$1,033.60 ","$1,033.60 ","$1,094.40 ",$740.54 ,"$1,892.02 ",$393.20 ,"$1,288.96 ","$1,094.40 ","$1,869.84 ","$1,118.72 ","$1,094.40 ",$802.68 ,$802.68 ,$740.54 ,$802.68 ,$790.40 ,$830.77 ,$276.83 ,$960.64 ,"$2,005.54 ", N/A , N/A ,$192.67 , N/A ,$831.04 ,"$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 ,$85.14 ,$29.37 ,$141.90 ,$133.87 ,$115.61 ,$115.61 ,$34.13 ,$103.20 ,$109.65 ,$80.63 ,$116.10 ,$133.87 ,$129.00 ,$122.55 ,$116.10 ,$109.65 ,$109.65 ,$34.13 ,$109.65 ,$109.65 ,$116.10 ,$78.56 ,$133.87 ,$79.98 ,$136.74 ,$116.10 ,$118.85 ,$118.68 ,$116.10 ,$85.15 ,$85.15 ,$78.56 ,$85.15 ,$83.85 ,$88.13 ,$29.37 ,$101.91 ,$141.90 ,$103.00 ,$103.00 ,$34.13 ,$114.00 ,$52.82 ,$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 ",$908.82 ,$192.79 ,"$2,005.54 ","$1,892.02 ","$1,234.07 ","$1,234.07 ",$192.79 ,"$1,101.60 ","$1,170.45 ",$860.63 ,"$1,239.30 ","$1,892.02 ","$1,377.00 ","$1,308.15 ","$1,239.30 ","$1,170.45 ","$1,170.45 ",$192.79 ,"$1,170.45 ","$1,170.45 ","$1,239.30 ",$838.59 ,"$1,892.02 ",$393.44 ,"$1,459.62 ","$1,239.30 ","$1,869.84 ","$1,266.84 ","$1,239.30 ",$908.96 ,$908.96 ,$838.59 ,$908.96 ,$895.05 ,$940.77 ,$313.48 ,"$1,087.83 ","$2,005.54 ", N/A , N/A ,$192.79 , N/A ,$831.04 ,"$1,308.15 ","$1,129.14 ","$1,129.14 ","$1,101.60 "
ST. CLARE MEMORIAL HOSPITAL (ACU),G0402072,G0402,HC MEDICARE PHYSICAL,510,1 ,$77.05 ,$50.85 ,$17.54 ,$271.94 ,$237.38 ,$77.05 ,$77.05 ,$20.38 ,$61.64 ,$65.49 ,$48.16 ,$69.35 ,$237.38 ,$77.05 ,$73.20 ,$69.35 ,$65.49 ,$65.49 ,$20.38 ,$65.49 ,$65.49 ,$69.35 ,$46.92 ,$237.38 ,$47.78 ,$81.67 ,$69.35 ,$271.94 ,$70.89 ,$69.35 ,$50.86 ,$50.86 ,$46.92 ,$50.86 ,$50.08 ,$52.64 ,$17.54 ,$60.87 ,$251.62 ,$37.75 ,$37.75 ,$20.38 ,$37.75 ,$120.86 ,$73.20 ,$63.18 ,$63.18 ,$61.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0404072,G0404,HC EKG TRACING INITIAL PHYSICAL-PRV 72HR,730,1 ,$161.00 ,$106.26 ,$24.96 ,$161.00 ,$49.68 ,$144.29 ,$144.29 ,$42.60 ,$128.80 ,$136.85 ,$100.63 ,$144.90 ,$49.68 ,$49.68 ,$152.95 ,$144.90 ,$136.85 ,$136.85 ,$42.60 ,$136.85 ,$136.85 ,$144.90 ,$98.05 ,$49.68 ,$99.82 ,$52.66 ,$144.90 ,$56.16 ,$148.12 ,$144.90 ,$106.28 ,$106.28 ,$98.05 ,$106.28 ,$104.65 ,$110.00 ,$36.65 ,$127.19 ,$52.66 ,$108.00 ,$108.00 ,$42.60 ,$114.00 ,$24.96 ,$152.95 ,$132.02 ,$132.02 ,$128.80 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0405072,G0405,HC IPPE EKG INTERPRETATION,985,1 ,$90.00 ,$59.40 ,$8.79 ,$90.00 ,$49.68 ,$80.66 ,$80.66 ,$8.79 ,$72.00 ,$76.50 ,$56.25 ,$81.00 ,$49.68 ,$49.68 ,$85.50 ,$81.00 ,$76.50 ,$76.50 ,$8.79 ,$76.50 ,$76.50 ,$81.00 ,$54.81 ,$49.68 ,$17.94 ,$52.66 ,$81.00 , N/A ,$82.80 ,$81.00 ,$59.41 ,$59.41 ,$54.81 ,$59.41 ,$58.50 ,$61.49 ,$20.49 ,$71.10 ,$52.66 , N/A , N/A ,$8.79 , N/A , N/A ,$85.50 ,$73.80 ,$73.80 ,$72.00 
ST. CLARE MEMORIAL HOSPITAL (ACU),G0438072,G0438,HC ANNUAL WELLNESS,510,1 ,$220.80 ,$145.73 ,$50.26 ,$356.83 ,$237.38 ,$139.00 ,$111.00 ,$58.43 ,$176.64 ,$187.68 ,$138.00 ,$198.72 ,$237.38 ,$220.80 ,$209.76 ,$198.72 ,$187.68 ,$187.68 ,$58.43 ,$187.68 ,$187.68 ,$198.72 ,$134.47 ,$237.38 ,$136.90 ,$234.05 ,$198.72 ,$356.83 ,$203.14 ,$198.72 ,$145.75 ,$145.75 ,$134.47 ,$145.75 ,$143.52 ,$150.85 ,$50.26 ,$174.43 ,$251.62 ,$108.19 ,$108.19 ,$58.43 ,$108.19 ,$158.59 ,$209.76 ,$181.06 ,$181.06 ,$176.64 
ST. CLARE MEMORIAL HOSPITAL (ACU),J1030072,J1030,HC DEPO-MEDROL 40MG,636,1 ,$33.00 ,$21.78 ,$7.52 ,$33.00 , N/A ,$18.18 ,$12.12 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , 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 ,$42.90 ,$14.80 ,$65.00 , N/A ,$28.69 ,$19.13 ,$17.20 ,$52.00 ,$55.25 ,$40.63 ,$58.50 , N/A , N/A ,$61.75 ,$58.50 ,$55.25 ,$55.25 ,$17.20 ,$55.25 ,$55.25 ,$58.50 ,$39.59 , N/A ,$40.30 , N/A ,$58.50 , N/A ,$59.80 ,$58.50 ,$42.91 ,$42.91 ,$39.59 ,$42.91 ,$42.25 ,$44.41 ,$14.80 ,$51.35 , N/A ,$31.85 ,$31.85 ,$17.20 ,$31.85 , 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 ,$4.09 ,$0.20 ,$6.20 , N/A ,$0.29 ,$0.20 ,$1.64 ,$4.96 ,$5.27 ,$3.88 ,$5.58 , N/A , N/A ,$5.89 ,$5.58 ,$5.27 ,$5.27 ,$1.64 ,$5.27 ,$5.27 ,$5.58 ,$3.78 , N/A ,$3.84 , N/A ,$5.58 , N/A ,$5.70 ,$5.58 ,$4.09 ,$4.09 ,$3.78 ,$4.09 ,$4.03 ,$4.24 ,$1.41 ,$4.90 , N/A ,$3.04 ,$3.04 ,$1.64 ,$3.04 , 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 ,$17.82 ,$5.78 ,$27.00 , N/A ,$8.66 ,$5.78 ,$7.14 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$7.14 ,$22.95 ,$22.95 ,$24.30 ,$16.44 , N/A ,$16.74 , N/A ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.82 ,$17.82 ,$16.44 ,$17.82 ,$17.55 ,$18.45 ,$6.14 ,$21.33 , N/A ,$13.23 ,$13.23 ,$7.14 ,$13.23 , 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 ,$14.52 ,$1.14 ,$22.00 , N/A ,$1.71 ,$1.14 ,$5.82 ,$17.60 ,$18.70 ,$13.75 ,$19.80 , N/A , N/A ,$20.90 ,$19.80 ,$18.70 ,$18.70 ,$5.82 ,$18.70 ,$18.70 ,$19.80 ,$13.40 , N/A ,$13.64 , N/A ,$19.80 , N/A ,$20.24 ,$19.80 ,$14.52 ,$14.52 ,$13.40 ,$14.52 ,$14.30 ,$15.03 ,$5.01 ,$17.38 , N/A ,$10.78 ,$10.78 ,$5.82 ,$10.78 , 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 ,$34.32 ,$0.74 ,$52.00 , N/A ,$1.10 ,$0.74 ,$13.76 ,$41.60 ,$44.20 ,$32.50 ,$46.80 , N/A , N/A ,$49.40 ,$46.80 ,$44.20 ,$44.20 ,$13.76 ,$44.20 ,$44.20 ,$46.80 ,$31.67 , N/A ,$32.24 , N/A ,$46.80 , N/A ,$47.84 ,$46.80 ,$34.33 ,$34.33 ,$31.67 ,$34.33 ,$33.80 ,$35.53 ,$11.84 ,$41.08 , N/A ,$25.48 ,$25.48 ,$13.76 ,$25.48 , 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 ,$21.78 ,$7.52 ,$33.00 , N/A ,$15.80 ,$10.53 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , 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 ,$40.26 ,$8.07 ,$61.00 , N/A ,$12.11 ,$8.07 ,$16.14 ,$48.80 ,$51.85 ,$38.13 ,$54.90 , N/A , N/A ,$57.95 ,$54.90 ,$51.85 ,$51.85 ,$16.14 ,$51.85 ,$51.85 ,$54.90 ,$37.15 , N/A ,$37.82 , N/A ,$54.90 , N/A ,$56.12 ,$54.90 ,$40.27 ,$40.27 ,$37.15 ,$40.27 ,$39.65 ,$41.68 ,$13.89 ,$48.19 , N/A ,$29.89 ,$29.89 ,$16.14 ,$29.89 , 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 ,$17.82 ,$0.14 ,$27.00 , N/A ,$0.20 ,$0.14 ,$7.14 ,$21.60 ,$22.95 ,$16.88 ,$24.30 , N/A , N/A ,$25.65 ,$24.30 ,$22.95 ,$22.95 ,$7.14 ,$22.95 ,$22.95 ,$24.30 ,$16.44 , N/A ,$16.74 , N/A ,$24.30 , N/A ,$24.84 ,$24.30 ,$17.82 ,$17.82 ,$16.44 ,$17.82 ,$17.55 ,$18.45 ,$6.14 ,$21.33 , N/A ,$13.23 ,$13.23 ,$7.14 ,$13.23 , 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 ","$5,588.88 ","$1,927.78 ","$8,468.00 ", N/A ,"$4,998.67 ","$3,332.45 ","$2,240.63 ","$6,774.40 ","$7,197.80 ","$5,292.50 ","$7,621.20 ", N/A , N/A ,"$8,044.60 ","$7,621.20 ","$7,197.80 ","$7,197.80 ","$2,240.63 ","$7,197.80 ","$7,197.80 ","$7,621.20 ","$5,157.01 ", N/A ,"$5,250.16 ", N/A ,"$7,621.20 ", N/A ,"$7,790.56 ","$7,621.20 ","$5,589.73 ","$5,589.73 ","$5,157.01 ","$5,589.73 ","$5,504.20 ","$5,785.34 ","$1,927.78 ","$6,689.72 ", N/A ,"$4,149.32 ","$4,149.32 ","$2,240.63 ","$4,149.32 ", 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 ,$13.20 ,$4.56 ,$20.00 , N/A ,$7.00 ,$4.67 ,$5.29 ,$16.00 ,$17.00 ,$12.50 ,$18.00 , N/A , N/A ,$19.00 ,$18.00 ,$17.00 ,$17.00 ,$5.29 ,$17.00 ,$17.00 ,$18.00 ,$12.18 , N/A ,$12.40 , N/A ,$18.00 , N/A ,$18.40 ,$18.00 ,$13.20 ,$13.20 ,$12.18 ,$13.20 ,$13.00 ,$13.66 ,$4.56 ,$15.80 , N/A ,$9.80 ,$9.80 ,$5.29 ,$9.80 , 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 ,$21.78 ,$7.52 ,$33.00 , N/A ,$12.31 ,$8.21 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 , N/A , N/A ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 , N/A ,$20.46 , N/A ,$29.70 , N/A ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 , N/A ,$16.17 ,$16.17 ,$8.73 ,$16.17 , 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 ,$84.48 ,$29.14 ,$128.00 , N/A ,$114.71 ,$114.71 ,$33.87 ,$102.40 ,$108.80 ,$80.00 ,$115.20 , N/A , N/A ,$121.60 ,$115.20 ,$108.80 ,$108.80 ,$33.87 ,$108.80 ,$108.80 ,$115.20 ,$77.95 , N/A ,$79.36 , N/A ,$115.20 , N/A ,$117.76 ,$115.20 ,$84.49 ,$84.49 ,$77.95 ,$84.49 ,$83.20 ,$87.45 ,$29.14 ,$101.12 , N/A ,$62.72 ,$62.72 ,$33.87 ,$62.72 , 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 ,$47.52 ,$3.74 ,$72.00 , N/A ,$5.60 ,$3.74 ,$19.05 ,$57.60 ,$61.20 ,$45.00 ,$64.80 , N/A , N/A ,$68.40 ,$64.80 ,$61.20 ,$61.20 ,$19.05 ,$61.20 ,$61.20 ,$64.80 ,$43.85 , N/A ,$44.64 , N/A ,$64.80 , N/A ,$66.24 ,$64.80 ,$47.53 ,$47.53 ,$43.85 ,$47.53 ,$46.80 ,$49.19 ,$16.40 ,$56.88 , N/A ,$35.28 ,$35.28 ,$19.05 ,$35.28 , 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 ,$12.54 ,$2.42 ,$19.00 , N/A ,$3.62 ,$2.42 ,$5.03 ,$15.20 ,$16.15 ,$11.88 ,$17.10 , N/A , N/A ,$18.05 ,$17.10 ,$16.15 ,$16.15 ,$5.03 ,$16.15 ,$16.15 ,$17.10 ,$11.57 , N/A ,$11.78 , N/A ,$17.10 , N/A ,$17.48 ,$17.10 ,$12.54 ,$12.54 ,$11.57 ,$12.54 ,$12.35 ,$12.98 ,$4.32 ,$15.01 , N/A ,$9.31 ,$9.31 ,$5.03 ,$9.31 , 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 ,$17.16 ,$4.50 ,$26.00 , N/A ,$6.75 ,$4.50 ,$6.88 ,$20.80 ,$22.10 ,$16.25 ,$23.40 , N/A , N/A ,$24.70 ,$23.40 ,$22.10 ,$22.10 ,$6.88 ,$22.10 ,$22.10 ,$23.40 ,$15.83 , N/A ,$16.12 , N/A ,$23.40 , N/A ,$23.92 ,$23.40 ,$17.16 ,$17.16 ,$15.83 ,$17.16 ,$16.90 ,$17.76 ,$5.92 ,$20.54 , N/A ,$12.74 ,$12.74 ,$6.88 ,$12.74 , 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 ",$808.50 ,$278.88 ,"$1,225.00 ",$952.52 ,"$1,097.85 ","$1,097.85 ",$324.13 ,$980.00 ,"$1,041.25 ",$765.63 ,"$1,102.50 ",$952.52 ,$952.52 ,"$1,163.75 ","$1,102.50 ","$1,041.25 ","$1,041.25 ",$324.13 ,"$1,041.25 ","$1,041.25 ","$1,102.50 ",$746.03 ,$952.52 ,$759.50 ,"$1,009.67 ","$1,102.50 ", N/A ,"$1,127.00 ","$1,102.50 ",$808.62 ,$808.62 ,$746.03 ,$808.62 ,$796.25 ,$836.92 ,$278.88 ,$967.75 ,"$1,009.67 ",$600.25 ,$600.25 ,$324.13 ,$600.25 , 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 ,$32.11 ,$42.30 , N/A , N/A , N/A , N/A , N/A , N/A , N/A ,$42.30 , N/A , N/A , N/A ,$42.30 , N/A , N/A , N/A , N/A , N/A ,$42.30 , 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 ,$32.11 , 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 ,$169.05 ,$111.57 ,$14.86 ,$169.05 ,$14.86 ,$55.72 ,$55.72 ,$44.73 ,$135.24 ,$143.69 ,$105.66 ,$152.15 ,$14.86 ,$14.86 ,$160.60 ,$152.15 ,$143.69 ,$143.69 ,$44.73 ,$143.69 ,$143.69 ,$152.15 ,$102.95 ,$14.86 ,$104.82 ,$15.75 ,$152.15 ,$38.95 ,$155.53 ,$152.15 ,$111.59 ,$111.59 ,$102.95 ,$111.59 ,$109.88 ,$115.50 ,$38.48 ,$133.55 ,$15.75 ,$18.14 ,$18.14 ,$44.73 ,$18.14 ,$17.31 ,$160.60 ,$138.62 ,$138.62 ,$135.24 
ST. CLARE MEMORIAL HOSPITAL (ACU),Q0091072,Q0091,HC PAP SMEAR COLLECTION-PRV 72 HR,983,1 ,$73.00 ,$48.18 ,$16.62 ,$73.00 ,$34.34 ,$65.42 ,$65.42 ,$19.82 ,$58.40 ,$62.05 ,$45.63 ,$65.70 ,$34.34 ,$34.34 ,$69.35 ,$65.70 ,$62.05 ,$62.05 ,$19.82 ,$62.05 ,$62.05 ,$65.70 ,$44.46 ,$34.34 ,$40.44 ,$36.40 ,$65.70 ,$56.16 ,$67.16 ,$65.70 ,$48.19 ,$48.19 ,$44.46 ,$48.19 ,$47.45 ,$49.87 ,$16.62 ,$57.67 ,$36.40 , N/A , N/A ,$19.82 , N/A ,$24.96 ,$69.35 ,$59.86 ,$59.86 ,$58.40 
ST. CLARE MEMORIAL HOSPITAL (ACU),Q2038072,Q2038,HC FLU VAX>3YRS FLUZONE,636,1 ,$33.00 ,$21.78 ,$7.52 ,$55.34 ,$52.21 ,$29.57 ,$29.57 ,$8.73 ,$26.40 ,$28.05 ,$20.63 ,$29.70 ,$52.21 ,$33.00 ,$31.35 ,$29.70 ,$28.05 ,$28.05 ,$8.73 ,$28.05 ,$28.05 ,$29.70 ,$20.10 ,$52.21 ,$20.46 ,$34.98 ,$29.70 ,$23.02 ,$30.36 ,$29.70 ,$21.78 ,$21.78 ,$20.10 ,$21.78 ,$21.45 ,$22.55 ,$7.52 ,$26.07 ,$55.34 ,$16.17 ,$16.17 ,$8.73 ,$16.17 ,$10.23 ,$31.35 ,$27.06 ,$27.06 ,$26.40